Comparison of two composite resin materials for splinting of dental luxation injuries: A double blind randomized controlled trial.

BACKGROUND/AIM: Luxation is a common traumatic dental injury treated with a wire composite (WC) splint. However, bulk-fill flowable composite and conventional packable composite have not been compared for retaining these splints. Therefore, the objectives of this randomized controlled trial were (1) to compare retention of WC splints, and (2) to compare adhesive point dimension, application and removal time, and effect on tooth mobility between the two WC splints. MATERIALS AND METHODS: In this parallel group, non-inferiority double blind randomized controlled trial, a total of 90 patients, aged 16-50 years participated. They were randomly allocated into two groups, the packable composite group (PC) n = 45 and the bulk-fill flowable composite group (BF-FC) n = 45 by lottery method. Following measurements were taken at the splint application appointment. Horizontal tooth mobility measured via Periotest, splint application time, and frontal images of splinted teeth to measure the percentage composite adhesive point area. After 2 weeks, splints were visually inspected for retention, whereas mobility and removal times were also recorded. Statistically, comparisons were made using independent samples sample T-test, Fisher's exact test, and Mann-Whitney U at p ≤ .05. RESULTS: A total of 88 patients with 156 luxated teeth completed the trial, as two patients were lost to follow-up. Two patients in the PC group reported with completely de-bonded splints while none de-bonded in the BF-FC group. Both groups were similar in terms of splint retention (p = .352), reduction of mobility (p = .426), and splint removal times (p = .372). The BF-FC group performed significantly better in adhesive point dimension percentages (p < .001) and splint application time (p < .001). CONCLUSION: Both groups were comparable in most parameters of the study. However, for BF-FC group application time and adhesive point dimension were significantly less.

Identification of eczema clusters and their association with filaggrin and atopic comorbidities: analysis of five birth cohorts.

BACKGROUND: Longitudinal modelling of the presence/absence of current eczema through childhood has identified similar phenotypes, but their characteristics often differ between studies. OBJECTIVES: To demonstrate that a more comprehensive description of longitudinal pattern of symptoms may better describe trajectories than binary information on eczema presence. METHODS: We derived six multidimensional variables of eczema spells from birth to 18 years of age (including duration, temporal sequencing and the extent of persistence/recurrence). Spells were defined as consecutive observations of eczema separated by no eczema across 5 epochs in five birth cohorts: infancy (first year); early childhood (age 2-3 years); preschool/early school age (4-5 years); middle childhood (8-10 years); adolescence (14-18 years). We applied Partitioning Around Medoids clustering on these variables to derive clusters of the temporal patterns of eczema. We then investigated the stability of the clusters, within-cluster homogeneity and associated risk factors, including FLG mutations. RESULTS: Analysis of 7464 participants with complete data identified five clusters: (i) no eczema (51.0%); (ii) early transient eczema (21.6%); (iii) late-onset eczema (LOE; 8.1%); (iv) intermittent eczema (INT; 7.5%); and (v) persistent eczema (PE; 11.8%). There was very-high agreement between the assignment of individual children into clusters when using complete or imputed (n = 15 848) data (adjusted Rand index = 0.99; i.e. the clusters were very stable). Within-individual symptom patterns across clusters confirmed within-cluster homogeneity, with consistent patterns of symptoms among participants within each cluster and no overlap between the clusters. Clusters were characterized by differences in associations with risk factors (e.g. parental eczema was associated with all clusters apart from LOE; sensitization to inhalant allergens was associated with all clusters, with the highest risk in the PE cluster). All clusters apart from LOE were associated with FLG mutations. Of note, the strongest association was for PE [relative risk ratio (RRR) 2.70, 95% confidence interval (CI) 2.24-3.26; P < 0.001] followed by INT (RRR 2.29, 95% CI 1.82-2.88; P < 0.001). CONCLUSIONS: Clustering of multidimensional variables identified stable clusters with different genetic architectures. Using multidimensional variables may capture eczema development and derive stable and internally homogeneous clusters. However, deriving homogeneous symptom clusters does not necessarily mean that these are underpinned by completely unique mechanisms.

Viewing of clinical cases on social media by dentists: A cause of motivation or dissatisfaction?

Objective: To evaluate the thoughts and feelings of dentists viewing posted clinical cases (PCCs) on various social media (SM) platforms. Methods: A questionnaire was developed, validated and its reliability was established. It was distributed (in 2022) to 355 dentists who had graduated at least 2 years prior. It had three sections consisting of 20 items pertaining to general information, SM usage, and feelings. Descriptive data were reported using percentages. The chi-squared test was used for inferential analysis. P ≤ 0.05 was considered statistically significant. Results: The response rate was 92%. The majority of respondents were non-post-graduates (63%), and aged ≤40 years (90%) with clinical experience <5 years (41%). Dentists with the most clinical experience (>15 years) shared their clinical work significantly more than their counterparts (p < 0.05). Most of the dentists did not feel motivated after viewing the PCCs (41%), especially those aged >40 years (p = 0.037), and thought that viewing the PCCs was the reason for personal dissatisfaction (50%). They had a belief that they possess skills (36%) and knowledge (42%), but not the necessary equipment to replicate the PCCs (39%). Conclusions: The majority of dentists felt that viewing the PCCs on SM can cause personal dissatisfaction and lack of motivation. They had a belief that they possess the skills and knowledge to replicate the PCCs, but lack equipment. Investing resources in clinical workshops, mentorship, and the procurement of modern equipment early in the career of dentists may improve their mental well-being, satisfaction, and quality of treatment delivered to patients.

Investigating In Situ Expression of Neurotrophic Factors and Partner Proteins in Irreversible Pulpitis.

INTRODUCTION: In situ assessments of neurotrophic factors and their associated molecular partners have not been explored to date, particularly in humans. The present investigation aimed to explore the expressional dysregulation of neurotrophic factors (nerve growth factor [NGF], brain derived neurotrophic factor [BDNF], and NT4/5), their receptors (TrkA and TrkB), and their modulators (USP36 and Nedd4-2) directly in irreversibly inflamed human pulp tissues. METHODS: Forty samples each of healthy and irreversibly inflamed pulp were extirpated for the study. Immunohistochemical examinations were carried out for the anatomic changes and expression of neurotrophic factors and partner proteins. Expression was digitally quantified using the IHC profiler module of ImageJ and deduced as optical density. Statistical analyses were carried out by GraphPad Prism. RESULTS: Decrease in nuclear and vessel diameters was observed in irreversibly inflamed pulp tissues. NGF and BDNF were found to be significantly upregulated in symptomatic irreversible pulpitis (SIP), whereas no significant difference was observed in the expression of TrkA and TrkB. Expression of Nedd4-2, USP36, and TrkA was found positively correlated with the NGF in healthy pulp tissues. However, in SIP, positive correlation was only observed between the expression of USP36 and NGF. Among the ligands, BDNF expression was found positively correlated with NGF in healthy pulp but not with NT4/5. In the case of SIP, no correlation was observed between any neurotrophic factors. CONCLUSIONS: Upregulation of NGF, BDNF, USP36 and Nedd4-2 in SIP indicates dysregulation in the molecular events underlying the disease biology and could be exploited as potential markers for the disease diagnosis.

A novel experimental model to investigate fungal involvement shows expression of Dectin-1 in periapical lesion pathogenesis.

BACKGROUND: Candida albicans is linked to persistent endodontic lesions. However, the recognition receptor that identifies it is not explored previously. OBJECTIVES: The aim of this study was to (1) establish a zymosan-induced model of apical periodontitis in mouse, (2) observe the expression of Dectin-1 and its possible relationship with toll-like receptor (TLR) 2 and (3) observe relationship between Osteopontin (OPN) and inflammatory cytokines. METHODS: A total of 138 Naval Medical Research Institute (NMRI) mice were randomly divided into; Experimental Group n = 69 and Zymosan Group n = 69. Periapical periodontitis was developed in right maxillary molar. The animals were sacrificed at 7, 21 and 42 days. Bone blocks containing the mesial root (n = 15 for qRT-PCR, n = 45 for enzyme-linked immune sorbent assay (ELISA)) were collected for mRNA expression and ELISA. While whole maxilla (n = 3 from each time interval) were used for histology and immunohistochemical analysis. One way analysis of variance (ANOVA) and Tuckey's posthoc was used for statistical analysis at p ≤ .05. RESULTS: TLR-2, Dectin-1 and TLR4-positive cells was detected at all time intervals in both groups. A strong positive correlation was observed between TLR-2 and Dectin-1 in both lesions (regular r = .680, p = .015, zymosan (r = .861, p < .001)). A significant correlation was found between OPN and tumour necrosis factor-alpha (TNF-α) in zymosan lesion (r = .827, p = .001). CONCLUSIONS: Immune cells of inflamed periapical tissue expressed Dectin-1 receptor in response to the microbial challenge from infected root canals and showed positive correlation with TLR-2 and OPN suggesting a possible receptor collaboration mediated by OPN. The expression of OPN and TNF-α showed positive correlation in response to fungal antigen, indicating a possible relationship.

Exploring the Most Effective Apical Seal for Contemporary Bioceramic and Conventional Endodontic Sealers Using Three Obturation Techniques.

Background and Objective: Despite a plethora of studies conducted to date, researchers continue to investigate the best sealer and obturation technique combinations. The aim of this study is to compare the apical seal provided by two bioceramic sealers (Endoseal and Endosequence) with that provided by a calcium hydroxide sealer (Sealapex), and to evaluate the effect of different obturation techniques (cold lateral condensation, continuous wave compaction and single cone) on the apical seal under a stereomicroscope. Materials and Methods: A total of 110 single-rooted mandibular premolar teeth were decoronated, cleaned and shaped using the Endosequence filing system to tip size 30/0.04 taper. Canals were irrigated with 5.25% NaOCl and 17% EDTA. The samples were randomly divided into 11 groups (9 experimental and 2 control groups) according to the designated sealer and technique. Samples were stored in an incubator for 7 days at 37 °C under 100% humidity. Samples were coated with nail varnish except for apical 2 mm and vertically placed in 0.2% rhodamine B dye solution for 48 h. Samples were split longitudinally and viewed under a stereomicroscope at 40× magnification. Results: Insignificant results were obtained between obturation techniques (p = 0.499) whereas statistically significant results were attained based on the type of endodontic sealer (p < 0.001). The overall lowest mean apical microleakage and best sealing ability was demonstrated by Sealapex (2.59 ± 1.20 mm) and amongst techniques by continuous wave compaction (3.90 ± 2.51 mm). Conclusions: Endosequence produced the best apical seal with the continuous wave compaction technique, whereas Endoseal did so with the bioceramic-coated single-cone technique. For the Sealapex sealer, the most effective apical seal was observed using cold lateral condensation. The quality and effectiveness of apical seal differed with the type of endodontic sealer and obturation technique used, and vice versa.

Expression of Toll-like receptor 2, Dectin-1, and Osteopontin in murine model of pulpitis.

OBJECTIVES: This in vivo animal study aimed to develop a murine model of pulpitis induced by pulp exposure with or without application of zymosan in Naval Medical Research Institute (NMRI) mice and observe expressions of Toll-like receptor (TLR)-2, TLR-4, Dectin-1, Osteopontin (OPN), tumor necrosis factor alpha (TNF-α), interleukin (IL)-6, and IL-1ß. MATERIAL AND METHODS: A total of 168 NMRI mice were divided into two groups, i.e., group A (n = 84) (pulpitis induced by pulp exposure only) and group B (n = 84) (pulpitis induced by pulp exposure and zymosan application). Right maxillary molar pulps were exposed with » round bur, and animals were sacrificed at 0, 6, 9, 12, 24, 48, and 72 h. The exposed teeth were obtained for real-time polymerase chain reaction (qRT-PCR) analysis and histological and immunohistochemistry (IHC) analysis. RESULTS: Histological evaluation revealed a time-dependent steady increase in inflammation. Similar time-dependent increase in the expression of inflammatory cytokines was noted. Group A exhibited an increase in TLR-4, Dectin-1, and OPN at 6 h, while TLR-2 was expressed at 24 h. Group B expressed TLR-2, Dectin-1, and OPN at 9, 48, and 72 h, respectively (p ≤ 0.05). Expression of OPN and TNF-α exhibited a similar pattern in both groups. IHC also detected expression of TLR-2, Dectin-1, TLR4, and CD68 in some cells at 6 and 9 h. CONCLUSIONS: NMRI mice provided for a stable pulp inflammation model. Zymosan may be used to develop pulp inflammation model and study inflammatory response towards fungal antigens. Dental pulp expressed Dectin-1 receptor. OPN and TNF-α exhibited a similar expression pattern. CLINICAL RELEVANCE: Innate immunity of dental pulp is capable of detecting fungal pathogens.

Gene expression analysis of toll like receptor 2 and 4, Dectin-1, Osteopontin and inflammatory cytokines in human dental pulp ex-vivo.

BACKGROUND: Toll like receptors (TLR) 2 and 4 present on innate immune cells of the dental pulp detect cariogenic bacteria. Along with bacteria, C. albicans may also be present in dental caries. The presence of C. albicans can be detected by Dectin-1 a C type Lectin receptor. Expression of Dectin-1 in human pulpits has not been reported. Similarly, cytokines are released as a consequence of dental pulp inflammation caused by cariogenic bacteria. The T helper (Th) 1 inflammatory response leads to exacerbation of inflammation and its relationship with Osteopontin (OPN) is not known in pulp inflammation. OBJECTIVE: The aim of this study was to observe the expression of Dectin-1, TLR-2, OPN and pro-inflammatory cytokines in irreversibly inflamed human dental pulp and to observe relationship between Dectin-1/TLR-2 and OPN/Pro-inflammatory cytokines in the presence of appropriate controls. METHODS: A total of 28 subjects diagnosed with irreversible pulpitis were included in this ex-vivo study. Fifteen samples were subjected to standard hematoxylin and Eosin (H&E) and immunohistochemistry staining. Whereas, gene expression analysis was performed on 13 samples to observe mRNA expression of pro-inflammatory cytokines; tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1 beta (ß), IL-6 Dectin-1, OPN, TLR-2 and TLR-4. SPSS version 21 was used for statistical analysis. One way analysis of variance (ANOVA), Pearson correlation and Chi-square test were used at p ≤ 0.05. RESULTS: Gene expressions of Dectin-1, TLR-2 and TLR-4 were observed in all samples. Dectin-1 and TLR-2 expressions were significantly correlated (r = 0.5587, p = 0.0002). Similarly, OPN and TNF-α expression showed a significant correlation (r = 0.5860, p = 0001). The agreement between histologic and clinical diagnosis was 69.2% in the cases of irreversible pulpitis. CONCLUSION: Dectin-1 was expressed by inflamed human dental pulp. Dectin-1 and TLR-2 expression pattern was suggestive of a collaborative receptor response in inflamed pulp environment. OPN and TNF-α expressions showed a positive correlation indicating a possible relationship.

Bonded amalgam as a fissure sealant in low-income setting: A randomised controlled trial.

OBJECTIVES: To compare one year retention rate of bonded amalgam sealants (BAS) with that of conventional resin-based sealant (RBS). METHODS: It was a parallel group, equivalence, randomised controlled trial done during March 2018 to December 2019 at the dental clinics of Dow University of Health Sciences, and the Jinnah Sind Medical University, Karachi, Pakistan on children aged 12-16 years, who were randomly assigned to one of the two treatment groups (BAS vs. RBS). Complete retention of the sealant at one year follow-up was labeled as success. Multi-level mixed effect logistic regression model was employed. Study was registered at www.clinicaltrials.gov # NCT NCT03130725. RESULTS: There were 137 teeth (23 subjects) in the BAS and 128 teeth (15 subjects) in the RBS group that were evaluated for sealant retention at 12 months follow-up. Among the BAS group, 100/137 (73%) sealants were completely retained whereas 110/128 (86%) were fully retained in the RBS group. Nearly, 22/137 (16%) BAS and 10/128 (7.8%) RBS were completely dislodged. In multivariable analysis, subject age >15 years and male gender were found to be significantly associated with the dislodgement of sealants. CONCLUSIONS: At 12 months follow-up, the retention of bonded amalgam sealant (BAS) was significantly lower than that of the resin-based sealant (RBS). RCT REGISTRATION: www.clinicaltrials.gov with # NCT NCT03130725.

Effect of glucose mediated oxidative stress on apoptotic gene expression in gingival mesenchymal stem cells.

BACKGROUND: Diabetes is a common disease that causes gingival and periodontal problems. Stem cells isolated from dental sources are an emerging area of research with a potential to facilitate regenerative medicine. The stem cells retain the property of self-renewal and the ones isolated from dental sources are mainly multipotent mesenchymal stem cells that have the ability to self-renew as well as differentiation towards multiple lineages. OBJECTIVES: We aimed to isolate and characterize gingival mesenchymal stem cells by pluripotency markers and investigated the effect of oxidative stress on growth kinetics and apoptotic gene expression of gingival cells exposed to glucose mediated oxidative stress. METHODS: In this study, we isolated gingival mesenchymal stem cells from gingiva. This was followed by morphologic analysis using inverted phase contrast microscopy and molecular profiling of these cells for the mRNA expression of specific genes. The isolated cells were cultured till passage 3 and then exposed to oxidative stress (high glucose concentration). We measured the apoptotic gene expression and compared their growth kinetics. RESULTS: The results showed that oxidative stress produced by glucose reduced growth kinetics and increased apoptotic gene expression in gingival mesenchymal stem cells. According to the genetic results, glucose activated TNF family to initiate apoptosis. CONCLUSION: In conclusion, the present study demonstrated that high glucose obliterated cellular proliferation testified by evaluating growth kinetics and induced apoptotic gene expression in gingival mesenchymal stem cells. This initiated extrinsic apoptotic pathway mediated by TNF family. Therefore, in diabetes oral health condition is compromised and periodontal disease is common.

Associations of early childhood caries with salivary beta defensin-3 and childhood anemia: a case-control study.

BACKGROUND: Human beta defensin-3 (HßD-3) is an antimicrobial peptide present in saliva that protects tooth surfaces from microbial attack. These peptides are part of innate immunity so levels may be affected by different systemic diseases like anemia. Therefore, anemia may predispose an affected child to an increased risk of dental caries. The objectives of this study were to determine the association of early childhood caries (ECC) with HßD-3 levels and observe the association of HßD-3 levels with childhood anemia. METHODS: A total of 80 children admitted in a pediatric medical ward, age 48-71 months, of either sex were included in the study. The included children were categorized as cases (children with ECC n = 40) and controls (children without ECC n = 40). Children were further segregated into the anemic and non-anemic sub-groups based on the hospital record of hemoglobin level. The salivary concentration of HßD-3 was measured by Enzyme-Linked Immuno-sorbent assay (ELISA). IBM SPSS version 20 software was used for statistical analysis. Two sample t-test and one-way ANOVA were used to compare mean values while spearman was used for correlations at p < 0.05. RESULTS: The mean Salivary HßD-3 level in cases (8.87 ± 4.30) was significantly higher (p = 0.042) as compared to controls (7.23 ± 2.57). Salivary HßD-3 level in patients with caries and without anemia was highest (10.80 ± 4.50) whereas salivary HßD-3 level in the presence of caries and anemia was lowest (6.94 ± 3.13) amongst all groups. This difference was statistically significant (p = 0.001). Salivary HßD-3 level was found to be moderately correlated with cases (p = 0.002). An inverse correlation was found between salivary HßD-3 level and anemia (r = -0.479, p = 0.002). CONCLUSION: Anemia may affect the innate immunity of children, and may result in a decreased level of salivary HßD3, thus increasing vulnerability to decay.

Access Cavity Preparations: Classification and Literature Review of Traditional and Minimally Invasive Endodontic Access Cavity Designs.

INTRODUCTION: Several endodontic access cavity designs have been proposed in the past decade to access the root canal space in a minimally invasive manner. The rationale for this approach was derived from the assumption that preserving more tooth structure during access preparation will improve the tooth's resistance to fracture and its long-term survivability. However, is this assumption valid? Also, can this approach compromise other treatment-related aspects? METHODS: We conducted a literature review using 4 online databases and classified the access cavity designs presented in each article according to our proposed classification. RESULTS: Through the literature search, we identified 49 articles that evaluated the effect of the access cavity design on 11 different treatment parameters. The majority of the studies failed to demonstrate clear benefits of the minimally invasive access designs, whereas others raised concerns regarding the ability to adequately disinfect, fill, and restore teeth with a minimally invasive access cavity design. CONCLUSION: Minimally invasive access cavity designs present more risk than benefit on the outcome of endodontic treatment. Clinicians should reconsider the application of a minimally invasive access cavity for routine endodontics and cautiously apply it in selected cases when the proper armamentarium is available.

Single-dose instillation of povidone iodine for chyluria: A safe and effective therapy.

INTRODUCTION: Management of chyluria with initial conservative approach and then using endoscopic sclerotherapy is a mainstay approach. However, a wide range of sclerosants are available with differential success rates and complication rates. This study evaluated the safety and efficacy of a single-dose instillation of 1% povidone iodine for the treatment of chyluria. MATERIALS AND METHODS: This was a prospective, observational study conducted on patients with chyluria who did not respond to conservative management with dietary restriction and diethylcarbamazine. The site of chyle efflux was identified by cystoscopy. A 6 Fr ureteral stent was inserted into effluxing side, diluted contrast was injected to delineate the pelvicalyceal system and the pyelolymphatic connection (arborization of the pelvicalyceal system), and a single-dose of 1% povidone iodine was instilled. Patients were observed for loin pain, fever, and disappearance of milky urine postinstillation and followed up at intervals of 3 months for a total duration of 1 year. RESULTS: Of a total 50 patients included, 35 were men and 15 were women, with a mean age of 37 years. Pyelolymphatic connections were noted in 48% of the patients. All patients showed an immediate disappearance of milky urine. During 1-year follow-up, 92% of the patients were symptom-free till the last follow-up while only 8% of the patients experienced recurrence of chyluria which were treated with other treatment modalities. The mean duration of recurrence was 8 weeks. CONCLUSION: Single dose of 1% povidone iodine was effective in immediate clearance of milky urine and well tolerated in patients with chyluria during 1-year follow-up.

Effect of Natural and Artificial Dentin Conditioners on the Release of Vascular Endothelial Growth Factor.

INTRODUCTION: The purpose of this study was to observe the release of vascular endothelial growth factor (VEGF) after conditioning with etidronic acid (also known as 1-hydroxyethylidene-1 and 1-bisphosphonate [HEDP]) and phytic acid (inositol hexakisphosphate [IP6]) in comparison with EDTA on human dentin disks and cylinders. METHODS: Human dentin disks were disinfected and prepared by the standardized method. Seventeen percent EDTA, 9% HEDP, 1% IP6, and distilled water (5 minutes) were used to immerse dentin disks. The dentin cylinders were prepared by following disinfection and the standardized preparation method to achieve a truncated cone-shaped canal with a 1-mm open apex. The dentin cylinder samples were irrigated with sodium hypochlorite (5 mL/5 minutes) and then rinsed with 17% EDTA, 9% HEDP, 1% IP6 and distilled water (5 mL/5 min). Enzyme-linked immunosorbent essay was performed to measure VEGF release. One-way analysis of variance was used to compare the mean release of VEGF between study groups and controls at a significance level of .05. A post hoc Tukey test was used for multiple comparisons between study groups. RESULTS: Among conditioners, HEDP released more VEGF from both disks and cylinders. In cylinders, VEGF release by HEDP was significantly greater than the other conditioners, whereas in disks the release of VEGF was similar with all conditioners. CONCLUSIONS: The release of VEGF by 9% HEDP and 1% IP6 was comparable with 17% EDTA from dentin disks; however, HEDP demonstrated more release from dentin cylinders than EDTA and IP6.

Outcome Of Endodontic Procedures Performed By Dental Interns Using Stainless Steel And Niti Files: A 10- Year Retrospective Study.

BACKGROUND: Preparation of root canal according to its desired anatomy and complete disinfection is a laborious task. Several factors influence the endodontic treatment including operator's skill and knowledge, anatomy of the tooth, the instruments and equipment used. In the past stainless-steel instruments were used to prepare the root canal but it causes many iatrogenic errors. Nickel titanium instruments evolved to overcome the iatrogenic damages caused by stainless steel instruments. Keeping this in mind a comparative study was conducted on the clinical work of dental intern using stainless steel files and progressively taper nickel titanium instruments. The objective of this study was to compare the performance of interns using either stainless Steel or progressively tapered hand operated NiTi instruments. METHODS: This retrospective study included post-treatment radiographs of root canal treatments performed by interns by using either stainless steel files or NiTi Protaper files, in the endodontic department of Hamdard University Dental Hospital, Karachi, Pakistan. It was a 10-year audit, from 2008 to 2018, of endodontic performance. A total of 1219 post treatment radiographs of good quality and showing at least 2mm periapical area beyond the root apex were included. In SS group, preparation were performed by step back method, while in NiTi group the Protaper instruments for hand were used. Scoring criteria was used to evaluate technical quality. The data was analysed using SPSS for windows version 17.0. Chi-square test was used to determine difference in proportions between the outcomes in SS and NiTi groups at p0.05. RESULTS: A total of 1219 radiographs were included out of which 584 (47.9%) belonged to SS and 635 (52.1%) to NiTi group. Overall satisfactory performance was in 553 (45.4%) teeth. Treatment done with NiTi was only marginally better than that achieved with SS files (NiTi n=298 (46.9%), SS n=255 (43.7%)). In the SS group, there were more overfills and internal and external transportation (p<0.001). NiTi reported more cases of inadequate lateral seal and separated instruments (p<0.05). CONCLUSIONS: Endodontic performance of interns was not improved with progressive taper NiTi manual instruments.

Self-Reported Effectiveness of e-Learning Classes during COVID-19 Pandemic: A Nation-Wide Survey of Pakistani Undergraduate Dentistry Students.

OBJECTIVES: The main aim of this study was to determine the undergraduate dental students' self-reported effectiveness of online classes offered by various dental institutes of Pakistan. MATERIALS AND METHODS: A cross-sectional study was conducted using an online survey. A pretested and validated questionnaire comprising of 31 questions was circulated among dental students. The study participants were inquired about the perceived level of accessibility of resources and the effectiveness of online teaching. The data was analyzed using SPSS version 24. Mann-Whitney U test and Kruskal-Wallis test were used for statistical analysis at p ≤0.05. RESULTS: A total of 1,207 students from all over Pakistan responded. The majority of students was dissatisfied with the institutional learning management system and quality of learning resources available. Students were also dissatisfied with the level of training of teachers for online lectures. The worst rating was reported for questions related to the effectiveness of online classes (average rating: 3.83 and 3.781/5). First-year students reported poor interaction with teachers (p < 0.001) and strongly disagreed with the effectiveness of online classes (mean rating: 4.14 ± 0.935). CONCLUSIONS: The results from the present survey showed that dental students of Pakistan unanimously voiced dissatisfaction toward various elements of online teaching sessions. Findings from this survey will aid the academic institutes to establish proficient learning platforms focused on improving students` learning experience.

Erosive Potential of 1% Phytic Acid on Radicular Dentine at Different Time Intervals.

Objective: The objective of this in-vitro study was to compare the erosive potential and smear layer removal ability of 1% Phytic acid (IP6) and 17% Ethylenediaminetetaacetic acid (EDTA). Methods: Canal preparation of 225 single rooted extracted human teeth was performed with Protaper NiTi rotary instruments. Teeth were divided into three groups according to the final irrigation protocol. Group 1: Saline irrigation (n=75), Group 2: 17% EDTA (n=75), Group 3: 1% Phytic Acid (n=75). Roots were splitted and observed under Scanning Electron Microscope (SEM) for erosion and smear layer removal. Mean differences between the groups for smear layer removal and erosion were assessed using the Kruskal Wallis and Mann Whitney U test. (P≤0.05) Friedman and Willcoxon Signed Rank tests were used to make comparisons within the groups. Results: Group 3 was significantly less erosive than Group 2 at all root portions (P<0.001). With regards to smear layer removal, group 2 (EDTA) removed more smear layer compared to group 3 (Phytic acid) at all root portions (P<0.001). Both 17% EDTA and 1% IP6 removed significantly less smear layer in the apical root portion. Intra group comparisons revealed no significant differences at any root level. There was a time dependent increase in erosion and smear layer removal in Group 2, with severe erosion at 5 minutes time interval. In Group 3, however, there was moderate erosion and smear removal at 3 and 5 minutes interval. Conclusion: IP6 at the concentration of 1% and pH 3 was less erosive than 17% EDTA. It exhibited moderate smear layer removal ability.

Predictors for Proximal Caries in Permanent First Molars: A Multiple Regression Analysis.

AIM: The aim of this study was to determine the predictors of proximal decay in the permanent first molar. MATERIALS AND METHODS: A cross-sectional study was conducted at the Department of Oral Medicine, Dow Dental College, Dow University of Health Sciences. A total of 171 patients presenting with 227 first molars were included. Calibrated examiners performed a detailed history and examination using a specialized form. The form recorded caries predictors and assigned a caries risk category based on the presence of these predictors. The statistical analysis was performed using the SPSS for windows version 17. A descriptive analysis was used to calculate the mean and proportions. Backward regression was carried out to evaluate the predictor for caries on mesial and distal surfaces at p ≤ 0.05. RESULTS: The included 171 patients presented with a total of 227 decayed first molars and 412 decayed proximal surfaces. The mesial surface was found to be more affected by decay (0.92 ± 0.85). The caries risk profile explains 60%, and caries on the adjacent surface explains 90% of caries occurrence on the mesial surface. In the case of distal surfaces, the predictor which can cause caries significantly was caries risk only. The caries risk profile explains the 3% of caries occurrence on distal surfaces. CONCLUSION: Our study identified caries on the adjacent tooth surface and the caries risk profile as significant predictors of future caries risk for the mesial surface of permanent molars. CLINICAL SIGNIFICANCE: Predictors for mesial and distal surfaces of the permanent first molar may differ. Overall caries risk and status of adjacent teeth must be taken into account to predict future caries occurrence.

Combined Endodontic and Surgical Management of Twin Rooted Maxillary Lateral Incisor with a Palatogingival Groove.

A case of unusual anatomy in a maxillary lateral incisor is presented. A 20-year old female presented with failing endodontics. Clinical examination and radiographs revealed poorly obturated maxillary left lateral incisor with an untreated patent second root and a palatogingival groove. A decision was made to treat the tooth non-surgically. After removing gutta-percha from main canal, the orifice of second root could not be located from inside the chamber. After determining the position of this root to be mesial and palatal to main canal, gingival tissue was removed from mesio-palatal side and access was extended to include the cingulum and orifice was located mesio-palatally. This canal was mechanically prepared and both canals were filled with calcium hydroxide. Three weeks later when symptoms subsided, the canals were obturated using the warm vertical technique. However, patient returned after a month complaining of pain and pus discharge. The tooth was surgically retreated; the enucleation was performed without root end resection. Patient returned after two years and reported complete healing but with mild discoloration of crown which was treated with walking bleach technique.

Inflammatory myofibroblastic tumor involving liver, gallbladder, pylorus & duodenum: A rare case presentation.

Inflammatory myofibroblastic tumors are rare benign tumors that can mimic malignancy of unknown aetiology. It has spectrum of myofibroblastic proliferation along with varying amount of inflammatory infiltrate. Recently, the concept of this lesion being reactive has been challenged based on the clinical demonstration of recurrences and metastasis and cytogenetic evidence of acquired clonal chromosomal abnormalities. We hereby report a case of inflammatory myofibroblastic tumor involving liver, gallbladder pylorus and 1st part of duodenum.