Assessment of dental students' knowledge and performance of master gutta-percha cone selection and fitting during root canal treatment: a pilot study.

BACKGROUND: Misconceptions should be detected early in dental students' training to improve their clinical performance. Accordingly, this study aimed to assess undergraduate dental students' knowledge and performance of master gutta-percha (GP) cone selection and fitting during clinical endodontic courses at the College of Dentistry, King Saud University. METHODS: Ninety-nine undergraduate dental students completed an online survey about their knowledge of master GP cone selection. Forty-five of these students were observed by faculty members in clinical endodontic courses while they fitted master GP cones during root canal treatments. The observers recorded the details of each student's cone-fitting techniques. The data were analysed using t-tests, one-way analysis of variance, and chi-square tests (p < 0.05). Inter- and intra-observer reliability were tested using Fliess' Kappa. RESULTS SURVEY: All participants had good knowledge of over-extended cone management, while 80.8% knew how to properly manage a short cone. The proper flaring assessment method was selected by 86.9% of the female and 34.2% of the male students, and this difference was statistically significant (p = 0.0001). OBSERVATION: The students labelled the working length on the master GP cone with an indentation in 64.4% of the cases and by bending the cone 35.6% of the time. Of all students, 84.4% encountered an apical stop, and this rate correlated significantly with the length of the cone on the master apical cone radiograph (p = 0.001). Improper shaping of the canal was the most common cause of ill-fitting cones (83.3%), while 16.7% of the students chose the wrong cone size. The final obturation length was adequate in 80% of the cases; 57.8% of the students were helped by instructors. CONCLUSIONS: Most students had the basic knowledge required to solve problems related to the selection of master GP cones. However, in the clinical setting, more than half of the students required the assistance of an instructor to adjust their cone's fit. The presence of an apical stop had the most significant effect on the length of the fitted master GP cone on radiography. The most common cause of ill-fitting master cones was improper shaping of the canal.

Significance of Endodontic Case Difficulty Assessment: A Retrospective Study.

OBJECTIVES: The present study aimed to evaluate the significance of the American Association of Endodontics (AAE) Case Difficulty Assessment on the occurrence of endodontic mishaps in an undergraduate student clinic at the Dental College at King Saud University. METHODS: All teeth endodontically treated by undergraduate dental students in their fourth year at the College of Dentistry, Girls University Campus at King Saud University over 2 years (2018-2019) were selected. Four investigators (3 dental interns and 1 endodontist) recorded the AAE case difficulty level, mishap occurrence, number of treatment visits, type of teeth, and type of instrumentation technique. The associations amongst these variables were analysed. STATISTICAL ANALYSIS: A point-biserial correlation was used to determine the relationship between the number of visits and the AAE case difficulty and the instrumentation technique. Spearman's rank-order correlation was used to assess the relationship between the number of visits and mishaps. A Mann-Whitney U test was applied to determine any differences in mishaps amongst cases with different difficulty levels. RESULTS: A total of 586 teeth were included (54.1% moderate- to high-difficulty cases), and 34.98% of cases experienced mishaps. Molars were significantly more often found in the moderate- to high-difficulty category. The moderate- to high-difficulty cases experienced more mishaps (64.8%; P = .000) and a greater number of treatment visits (3.49 ± 1.27; P = .000) compared to minimal-difficulty cases (35.12%, 2.38 ± 1.24, respectively). The type of instrumentation technique was not associated with mishap occurrence. CONCLUSIONS: Undergraduate students should use the AAE case classification assessment tool to reduce the number of endodontic treatment mishaps and the number of visits.

Comparison between students' self-evaluation and faculty members' evaluation in a clinical endodontic course at King Saud University.

INTRODUCTION: The objective of this study was to compare faculty member evaluations with student self-evaluations in a clinical endodontic course in the dental school at King Saud University and to evaluate the reliability of the students' self-assessment scores after using a rubric with well-defined criteria. MATERIALS AND METHODS: Evaluated and self-evaluated endodontic cases that were clinically treated by the fourth-year undergraduate dental students at the College of Dentistry, Girls University Campus, at King Saud University over 2 years (2017-2018) were included. Cases included anterior teeth, premolars and molars. The evaluation form was divided into six sections with well-defined criteria to cover all aspects of nonsurgical root canal treatment with a maximum grade of 10 points can be scored for each student per case. The students evaluated themselves for each section and then were evaluated by two faculty members. Student and faculty assessment agreement and the reliability of the students' self-assessment scores were measured. A p ≤ .05 was considered significant. RESULTS: A total of 363 cases were included: 26.7% anterior teeth, 38.84% premolars and 34.43% molars. The students evaluated themselves with higher grades compared to the evaluators' grading in all steps and in the overall grading in all teeth types. The students' self-assessment scores showed good and moderate reliability in all steps and in the overall grading. CONCLUSION: The students tend to overrate their performance, and their assessments have moderate to good reliability, which reflects the reliability of the rubric used as an accurate measurement tool that helps the evaluator and the student objectively assess their performance.

Interpretation of Root Canal Anatomy of Maxillary and Mandibular Permanent Canines in Saudi Subpopulation: A Cone-Beam Computed Tomography (CBCT) Study.

The objective of this investigation was to evaluate the root canal anatomy of permanent canines in a Saudi subpopulation utilizing CBCT. A total of 1328 CBCT images of maxillary (634) and mandibular (694) permanent canines were collected from Saudi patients who visited the College of Dentistry at King Saud University in Riyadh. The images were analyzed for root and canal numbers, canal configuration types, and symmetry between the bilateral canine teeth in each arch. Gender, age, and tooth position were recorded. The Kappa test was used for both inter- and intraexaminer reliabilities. Data were analyzed with the chi-square test at a P value ≤ 0.05. There were no two-rooted teeth in maxillary canines, and 1.89% had two canals. Double roots and double canals in mandibular canines were found in 2.88% and 9.94% of the teeth, respectively. Type I canal configuration was more common in maxillary canines (97.94%) compared to mandibular canines (92.07%). Maxillary canines showed higher bilateral symmetries of root and canal numbers and canal configuration types (100%, 98.1%, and 97.9%, resp.) compared to mandibular canines (97.1%, 90.1%, and 92.1%, respectively). The majority of maxillary and mandibular canines had a single root with a single canal and type I canal configuration. Mandibular canines are characterized by having more than one root and canal and alterations in root canal configurations compared to maxillary canines.

Knowledge, Attitude, and Practice (KAP) of Radiographic Protection by Dental Undergraduate and Endodontic Postgraduate Students, General Practitioners, and Endodontists.

The aim of this study is to evaluate the knowledge, attitude, and perception of radiation hazard and preventive measures among dental undergraduate students, general practitioners, endodontic postgraduate students, and endodontists in Saudi Arabia. Multiple choice questions questionnaires were distributed among undergraduate and endodontic postgraduate dental students, general practitioners, and endodontists in the colleges of dentistry in Saudi Arabia, government hospitals, and private clinics. The questionnaire included sociodemographic data, assessment of the knowledge of radiation physics and biology, assessment of the practice of dental radiography, and assessment of knowledge of radiation protection. Chi-square test was used for individual and multiresponse analysis. Level of statistical significance was set at P ≤ 0.05. Three hundred and twenty-nine responded to the questionnaire. More than half of the respondents agreed that dental X-ray is hazardous to health (60.79%), and 68.1% were familiar with ALARA (as low as reasonably achievable) principle. However, only 34% are familiar with the recommendations of the National Council on Radiation Protection (NCRP) and International Commission on Radiological Protection (ICRP). The use of lead apron and thyroid collar for patients' protection from X-ray radiation was practiced among endodontic postgraduate students more frequently as well as those who are proactive in the academic field. Undergraduate students, endodontic postgraduate students, and endodontists in the academic field were the most aware towards radiation reduction measures. The use of the preventive measures needs to be emphasized more among general practitioners, endodontic postgraduate students, and endodontists especially in governmental hospitals and private sectors.

Antibacterial efficacy of silver diamine fluoride as a root canal irrigant.

Objectives: Conventional disinfectants and medicaments have not been able to achieve and maintain sterilization of root canals. The purpose of the study was to evaluate the antibacterial efficacy of 3.8% silver diamine fluoride (SDF) in comparison with 2% chlorhexidine (CHX) against Enterococcus faecalis biofilm. Materials and methods: Extracted human teeth were used to make 70 dentin discs that were then inoculated with E. faecalis to generate a 3-week-old biofilm model. The discs were subjected to treatment with 3.8% SDF, 2% CHX, sodium hypochlorite (NaOCl), or saline for 10 min. After exposure, the dentin discs were examined with a confocal laser scanning microscope to verify the percentage of live versus dead cells within the biofilm. Univariate one-way analysis of variance and Tukey-honestly significant difference post hoc analysis (p < .05) were performed to detect significant differences. Results and conclusion: The NaOCl group showed the greatest percentage of dead cells (62.26%) among all groups (p < .05). The SDF group showed a significantly higher percentage of dead cells (57.39%) than the 2% CHX and saline groups (p < .05). SDF possessed higher antimicrobial activity than 2% CHX against E. faecalis biofilms.

Comparison of the Antibacterial Efficacy of Commiphora molmol and Sodium Hypochlorite as Root Canal Irrigants against Enterococcus faecalis and Fusobacterium nucleatum.

OBJECTIVE: The investigation aims to compare antimicrobial efficacy of the extract of Commiphora molmol, against Enterococcus faecalis and Fusobacterium nucleatum, with sodium hypochlorite (NaOCl). DESIGN: T he dehydrated oleo-gum resin of Commiphora molmol was extracted by using 70% ethanol and was suspended in 99.8% dimethyl sulfoxide (DMSO) as a dissolving agent in a 1:2 volume to produce an aqueous solution at room temperature. Agar-well diffusion and broth microdilution methods assay were utilized to determine both the antimicrobial activity and minimum inhibitory concentration, of alcoholic extract of Commiphora molmol against E. faecalis and F. nucleatum. The values of the inhibition zones were determined based on the concentration of the investigated material. One hundred and forty extracted human premolar teeth were instrumented and immersed in bacterial suspension of E. faecalis or F. nucleatum (70 teeth in each species suspension). Prepared teeth were then immersed in the myrrh extract solution, 2.5% NaOCl, DMSO, or Cefotaxime and incubated for 30 and 60 minutes. RESULTS: The largest inhibition zone diameter for both bacterial species was obtained by the 100mg/100µL concentration. The minimum inhibitory concentration (MIC) was 0.03mg/300µL for both E. faecalis and F. nucleatum. The minimum bactericidal concentration (MBC) results showed that 0.03mg/µL myrrh extract and 2.5% sodium hypochlorite significantly reduced bacterial growth at both 30 and 60 minutes of different treatments of root canals, compared to DMSO group (negative control) and the antibiotic group (positive group). CONCLUSION: Myrrh extract was proven to have considerable antibacterial activity against both F. nucleatum and E. faecalis.

Natural products in endodontics.

Herbal remedies are used throughout the world, either in earlier or in recent times. The number of studies on this alternative therapeutic system increased in the last decades. In this paper, the relevant literature on the use of natural products in root canal therapy is revised from a MEDLINE database search. The uses of medicinal plants in endodontics include cleaning and disinfection of root canals, intracanal medicaments between appointments, sealer cements, and for removal of obturation material. Other studies showed the effect of natural products in pulpal and dentin repair. Their use is anecdotal, and their effectiveness showed to be variable and is always compared to the chemical standards currently being used. Alkaloids, coumarins, saponins, and flavonoids are aromatic substances that are produced by plants and evaluated for their therapeutic potential. Further investigation into benefits of natural products is warranted.