Factors Affecting the Decision-making of Direct Pulp Capping Procedures among Dental Practitioners: A Multinational Survey from 16 Countries with Meta-analysis.

INTRODUCTION: Direct pulp capping (DPC) procedures require the placement of a bioactive material over an exposure site without selective pulp tissue removal. This web-based multicentered survey had 3 purposes: (1) to investigate the factors that affect clinicians' decisions in DPC cases, (2) to determine which method of caries removal is preferred, and (3) to evaluate the preferred capping material for DPC. METHODS: The questionnaire comprised 3 sections. The first part comprised questions regarding demographic features. The second part comprised questions on how treatment plans change according to factors such as nature, location, number and size of the pulp exposure, and patients' age. The third part composed of questions on the common materials and techniques used in DPC. To estimate the effect size, the risk ratio (RR) and 95% confidence interval (CI) were calculated using a meta-analysis software. RESULTS: A tendency toward more invasive treatment was observed for the clinical scenario with carious-exposed pulp (RR = 2.86, 95% CI: 2.46, 2.32; P < .001) as opposed to the clinical scenario with 2 pulp exposures (RR = 1.38, 95% CI: 1.24, 1.53; P < .001). Complete caries removal was significantly preferred to selective caries removal (RR = 4.59, 95% CI: 3.70, 5.69; P < .001). Among the capping materials, calcium silicate-based materials were preferred over calcium hydroxide-based materials (RR = 0.58, 95% CI: 0.44, 0.76; P < .05). CONCLUSIONS: While carious-exposed pulp is the most important factor in clinical decisions regarding DPC, the number of exposures has the least impact. Overall, complete caries removal was preferred over selective caries removal. In addition, the use of calcium silicate-based materials appears to have replaced calcium hydroxide-based materials.

Assessment of the Prevalence of Middle Mesial Canal in Mandibular First Molar: A Multinational Cross-sectional Study with Meta-analysis.

BACKGROUND: An additional canal found in the mandibular first molar (M1M) is the middle mesial canal (MMC), which is often missed during root canal treatment. In this study, the prevalence of MMC in M1M on cone-beam computed tomography (CBCT) images was evaluated in 15 countries, along with the effect of some demographic factors on its prevalence. METHODS: Deidentified CBCT images were scanned retrospectively, and the ones including bilateral M1Ms were included in the study. A written and video instruction program explaining the protocol to be followed step-by-step was provided to all observers to calibrate them. The CBCT imaging screening procedure consisted of evaluating three planes (coronal, sagittal, and axial) after a 3-dimensional alignment of the long axis of the root(s). The presence of an MMC in M1Ms (yes/no) was identified and recorded. RESULTS: In total, 6304 CBCTs, representing 12,608 M1Ms, were evaluated. A significant difference was found between countries (P < .05). MMC prevalence ranged from 1% to 23%, and the overall prevalence was 7% (95% confidence interval [CI]: 5%-9%). No significant differences were found between the left and right M1M (odds ratio = 1.09, 95% CI: 0.93, 1.27; P > .05) or between genders (odds ratio= 1.07, 95% CI: 0.91, 1.27; P > .05). As for the age groups, no significant differences were found (P > .05). CONCLUSIONS: The prevalence of MMC varies by ethnicity, but it is generally estimated at 7% worldwide. Physicians must pay close attention to the presence of MMC in M1M, especially for opposite M1Ms, due to the prevalence of MMC being significantly bilateral.

The effect of obturation techniques on the push-out bond strength of a premixed bioceramic root canal sealer.

OBJECTIVES: The aim of the study was to evaluate the effect of obturation techniques on the push-out bond strength of a premixed bioceramic (TotalFill BC) root canal sealer to root canal dentin surface. METHODS: The palatal root canal of sixty extracted human maxillary first premolar were prepared with Mtwo rotary system, teeth were divided into two groups; according to the sealer to be obturated with; TotalFill BC sealer and AH Plus sealer. Each group was then divided into three subgroups (n = 10) according to the obturation technique; cold lateral compaction, single cone, and warm vertical compaction. After obturation teeth were stored in an incubator for two weeks. Three slices of 1.5 mm thickness were then obtained from each root. Bond strength of obturation materials to root dentine was measured using push-out test by universal testing machine. Data were analyzed using ANOVA followed by Tukey's test. Mode of failure was determined by optical microscope examination. RESULTS: Overall, the push-out bond strength of TotalFill BC sealer was significantly higher than that of AH Plus sealer (P < 0.001). The obturation technique had no significant effect on the bond strength of TotalFill. While the bond strength of AH Plus was significantly affected, warm vertical compaction and single cone groups displayed lower bond strength than cold lateral compaction group (P < 0.05). Mixed mode of failure was most predominant in all groups. CONCLUSIONS: TotalFill BC sealer showed a higher push-out bond strength than AH Plus sealer, and the obturation technique significantly affected AH Plus sealer but not the TotalFill. CLINICAL SIGNIFICANCE: Warm vertical compaction significantly reduced the bond strength of the resin based AH Plus sealer compared to cold lateral compaction, but this was not significant with the bioceramic TotalFill BC sealer. Single cone technique could be used with bioceramic sealer which make the obturation faster and easier.