Molar root canal treatment performed by undergraduate dental students; an observational study of procedural errors and student perception.

BACKGROUND: Molar root canal treatment (RCT) is challenging and requires training and specific skills. Rotary instrumentation (RI) reduces the time needed for instrumentation but may increase the risk of certain procedural errors. The aims of this study were to evaluate the quality of molar RCTs provided by undergraduate students, to compare the prevalence of procedural errors following manual and RI, and to assess the students' self-perceived confidence to perform molar RCT without supervision and their preference for either manual or RI. METHODS: Molar RCTs performed by the final year students were evaluated radiographically according to predefined criteria (Appendix 1). The procedural errors, treatment details, and the students' self-perceived confidence to perform molar RCT and their preference for either manual or RI were recorded. Descriptive statistics were performed, and the Chi-squared test was used to detect any statistically significant differences. RESULTS: 60.4% of RCTs were insufficient. RI resulted in more sufficient treatments compared with MI (49% vs. 30.3% respectively. X2: 7.39, p = 0.007), required fewer visits to complete (2.9 vs. 4.6 respectively. X2: 67.23, p < 0.001) and was the preferred technique by 93.1% of students. The most common procedural errors were underextension of the root canal obturation (48.4%), insufficient obturation (45.5%), and improper coronal seal (35.2%) without a significant difference between the two techniques. 26.4% of the participating students reported that they did not feel confident to perform molar RCT without supervision. CONCLUSION: The quality of molar RCT provided by UG students was generally insufficient. RI partially improved the technical quality of RCT compared with MI. UG students need further endodontic training and experience before they can safely and confidently practise molar RCT.

Deep Margin Elevation - A Retrospective Clinical Study.

PURPOSE: The aim of this retrospective study was to assess the short- to mid-term restorative and periodontal outcome of deep margin elevation (DME) performed using resin composite. MATERIALS AND METHODS: Twenty-eight teeth treated with DME and indirect adhesive restorations were followed-up for a mean of 25.4 months (minimum: 12 months). Clinical and radiographic examination assessed the adaptation of the DME material and indirect restorations, presence of recurrent caries or discoloration, periodontal health at DME and non-DME sites, and periapical health. RESULTS: The overall success rate was 96.6%. One tooth showed signs and symptoms of apical pathology after 34 months following DME. No caries, discoloration, or periodontal pockets were detected in any of the treated teeth. DME had no detrimental effect on the gingival/periodontal health or plaque accumulation. There was no correlation between the distance from the DME material to the marginal bone level and pocket depth, gingival inflammation, and plaque accumulation (p > 0.05). CONCLUSION: Deep margin elevation might be considered a safe procedure for teeth with deep subgingival proximal caries in the short- and mid-term.

Mechanical properties and bonding of maxillofacial silicone elastomer mixed with nano-sized anti-microbials.

OBJECTIVES: The antibacterial efficacy of silicone is improved by impregnating it with antimicrobials such as chlorohexidine and zinc oxide. The purpose of this study was to examine mechanical properties and bonding of maxillofacial silicone elastomer mixed with Zinc Oxide nanoparticles (ZnO-NP), and Chlorohexidine Diacetate Salt (CHX) at three different concentrations (1 %, 3 %, and 5 %). METHODS: Specimens of a silicone elastomer (M511) were prepared and divided into 7 groups. Group 1 was control of no additive. Groups 2-4 included silicone elastomer mixed with ZnO-NP (surface area = 67 m2/g) at 3 different concentrations (by weight %); 1 %, 3 % and 5 %. Groups 5-7 included silicone elastomer mixed with CHX at the same concentrations. Tear and tensile strengths, elongation percentage, modulus of elasticity, and shear bond strength to primed acrylic resin surfaces were evaluated. Data was analyzed with 1-way ANOVA, Bonferroni, and Dunnett's T3 post-hoc tests (P < 0.05). RESULTS: There was significant effect of the additives on the tensile strength, elongation percentage, tear strength, and shear bond strength (P < 0.05). Shear bond strengths ranged from 0.55 to 0.96 MPa. Silicone elastomer mixed with CHX (5 %) resulted in the highest shear bond strength (P < 0.05). Non-linear regressions between tensile strength and ZnO and CHX additives were 0.95 and 0.96 respectively. SIGNIFICANCE: All additives reduced the tensile strength of the silicone. However, CHX at 5 % optimized shear bond strength and thus is proposed in order to fabricate maxillofacial prostheses of sufficient mechanical properties, bonding and antimicrobial activity.

Effect of freshly placed core buildup composites on setting of silicon impression materials.

Aim: The aim is to study the effect of freshly placed composite build-ups on setting of additional silicone impression materials. Settings and Design: In vitro - experimental study. Materials and Methods: Three composite materials; Build-It™ F. R™, Filtek™ Bulk Fill flow and Filtek™ Z350 and three light-bodied additional silicone impression materials; Elite HD+, Aquasil LV Ultra and Express™ were used. Cylindrical-shaped specimens were made of each material (diameter 15 mm and height 10 mm). The silicone specimens were brought into contact with the composite specimens, which were either freshly cured (9 groups, n = 90) or cured and then stored in normal saline for 1 week (9 groups, n = 90). Shore A hardness (SAH) scores of silicone surfaces were recorded following the ASTM D2240-5 standards for shore A Durometer testing. Six measurements were made per each silicone surface and medians were calculated. Kruskal-Wallis and Mann-Whitney tests (SPSS v20) were used to check statistical significant differences between all groups and paired comparisons, respectively (P < 0.05). Statistical Analysis Used: Kruskal-Wallis and Mann-Whitney tests. Results: The SAH scores of additional silicones in direct contact with freshly placed composites were significantly less than SAH scores of additional silicones in direct contact with composites specimens aged for 1 week in 7 out of 9 combinations (P < 0.05). Only when Express™ and Elite HD+ were applied over freshly placed Filtek™ Bulk Fill flow, the SAH scores difference was not statistically significant to SAH scores of matching combinations applied after 1 week of composite storage. Conclusions: Freshly placed composite might affect setting of additional silicone impression materials. Dentists should carefully assess final impression on areas of prepared teeth that have received composite fillings recently.

Methodological Quality of Systematic Reviews Relating to Performance of All-Ceramic Implant Abutments, Frameworks, and Restorations.

PURPOSE: To assess the methodological quality of published systematic reviews relating to all ceramic implant frameworks, abutments and restorations. MATERIALS AND METHODS: Published systematic reviews relating to all ceramic implant restorations for single tooth and multiple teeth replacements were retrieved to assess their methodological qualities. Sixteen systematic reviews were included for methodological quality assessment by two independent assessors using AMSTAR-2 critical appraisal tool. Inter-rater agreement was assessed using the weighted Cohen's Kappa statistic. RESULTS: Most systematic reviews included randomized clinical trials and nonrandomized studies of intervention. The majority of included systematic reviews (15 out of 16) scored critically low on quality with more than one critical flaw when assessed using the AMSTAR-2 tool. Most systematic reviews assessed lacked analysis of the effects of the risk of bias and heterogeneity of the included studies. The inter-rater agreement of the independent assessors was substantial (0.63). CONCLUSIONS: Confidence in the evidence presented in these systematic reviews was undermined by their tendency to overlook the effect of risk of bias and heterogeneity in evidence synthesis.

Phase down of amalgam. Awareness of Minamata convention among Jordanian dentists.

OBJECTIVES: To assess the knowledge of Jordanian dentists toward phase down of dental amalgam as recommended by the Minamata Convention, and their training and competency in placing posterior composites.  Methods: This study was conducted through structured questionnaire interviews with randomly selected cohort of dentists in Jordan between March 2015 and June 2015. Out of 230 dentists who were invited, 196 (85.2%) agreed to participate. Dentists were asked if they know about the Minamata Convention. They were also asked about their training in placement of posterior composite.  Results: Out of the 196 interviewed, only 13.8% know about Minamata Convention and 17% had an undergraduate training in favor of placing composites in posterior teeth. Approximately 50% of those dentists were not trained in using rubber dam when placing posterior composites, while only 38.3% had training in sectional matrix placement. Undergraduate training did not influence (p=0.00) the dentists' decision to remove old amalgam based on patient's demands. Only 28.1% were of the opinion of discontinuing the use of amalgam due to its alleged health and environmental hazards. There was no general agreement on the type of composite, liner, and bonding strategy when placing posterior composites. Conclusion: Dentists are not well informed on the Minamata Convention and the phase down of amalgam. Training in posterior composite placement should be given more room in undergraduate curriculum and continuous dental education.

Technical quality of root canal treatment of posterior teeth after rotary or hand preparation by fifth year undergraduate students, The University of Jordan.

The aim of this study was to investigate the technical quality of root canal treatment provided by the undergraduate students as their first experience in molar endodontics using nickel-titanium (NiTi) files in a crown-down approach compared with stainless steel standard technique. This study was carried out by the fifth year undergraduate students attending peer review sessions as a part of their training programme, using two different questionnaires to assess the overall technical quality and potential problems regarding endodontic complications after root canal preparation with these two techniques. The overall results indicated a statistically significant difference in the performance of the two instrument techniques in difficult cases showing better performance of the NiTi system and mean rotary preparation time (P < 0.001). Under the conditions of this study, novice dental students, using NiTi ProTaper rotary files, were able to prepare root canals faster with more preparation accuracy compared with canals of same teeth prepared with hand instruments.

Multiple lingual cusps trait on mandibular premolars and hypoconulid reduction trait on mandibular first molar in living Jordanian population. Intra- and inter-trait interactions.

The objective was to determine the expression and fluctuating asymmetry of two dental morphological traits in the living Jordanians: The lingual cusp number on the lower premolars (LP1 and LP2) and the hypoconulid (distal cusp) reduction on the lower first molar (LM1). In addition, both intra- trait and inter- trait interactions were analyzed. Three hundred school children (15.5 +/- 0.4 years) were involved. Impressions for the mandibular dental arches were taken, and dental casts were reproduced. The above-mentioned traits were observed. Paired sample t test and nonparametric correlation analysis were used for data analysis. Three-cusped LP1 was found in 11.40 % of the examined students, while the two-cusped LP1 was found in 88.60%. In comparison, the Three-cusped LP2 was found in 61.40% while the two-cusped LP2 was found in 38.60% of the observed subjects. The frequencies of the 4-cusped and 5-cusped LM1 were found to be 8.65% and 91.35%, respectively. Nonparametric correlation analysis revealed positive and statistically significant association between the expression of two lingual cusps on LP1 and on LP2 in both genders (p < 0.01), while there was no significant correlation between expression of two lingual cusps on either LP1 or LP2 and the hypoconulid loss on LM1 in both genders (p > 0.05). Bilateralism was highly significant in the tested traits in both genders (p < 0.001). This finding might be a sign of relatively low environmental stresses experienced by the living Jordanians and/or great ability of its individuals to buffer the adverse effects of such stresses on dental development. This study is a useful addition to the existing literature in that it examines a previously poorly characterized population and assists in placing the contemporary Jordanian population within the current framework of human population groups globally.

Hypocone reduction and Carabelli's traits in contemporary Jordanians and the association between Carabelli's trait and the dimensions of the maxillary first permanent molar.

The objective of this study is to determine the prevalence of expression and bilateralism of two dental morphological traits in contemporary Jordanians: The hypocone reduction trait on the maxillary second permanent molar and Carabelli's trait on maxillary permanent first and second molars. Furthermore, inter-trait correlation and the relationship of Carabelli's traits with upper first molar dimensions were investigated. Three hundred subjects of school children at their 10th grade and of an average age of 15.5 +/- 0.4 years were involved. Alginate impressions for the maxillary arch were taken, dental casts were reproduced. The selected accurate casts were of 132 male- and 155 female-students. The frequencies of hypocone reduction trait on the maxillary second molar and Carabelli's trait on the maxillary molars were examined. Buccolingual and mesiodistal diameters of the maxillary first molar were measured and recorded. Paired Sample t test and Nonparametric Correlation analysis were used for data analysis. Hypocone reduction trait on the maxillary second molar was found in 29.8% of the examined students. Positive forms of Carabelli's trait on first and second molars were observed in 65.0% and 3.8%, respectively. Nonparametric correlation analysis revealed positive association between Carabelli's trait on first molar and hypocone reduction trait on the maxillary second molar. The presence of Carabelli's trait on first molar was strongly associated with the increase of buccolingual, but not the mesiodistal, diameter. Bilateralism was found highly significant in the tested traits and both genders (p < 0.001). This finding might be a sign of relatively low environmental stresses in the living Jordanian population and/or great ability of its individuals to buffer the adverse effects of such stresses.

An ancient bottleneck in the Lost Pines of central Texas.

The retreating edge hypothesis for species responding to climate change predicts severe bottlenecks and eventual extinction. The disjunct Lost Pines population at the westernmost edge of the widespread Pinus taeda range is well suited for testing this prediction. The occurrence of one or more genetic bottlenecks in the Lost Pines population was tested using 34 nuclear microsatellite markers and a control sample from the larger, more continuous east Texas P. taeda forests. The Lost Pines population has undergone drastic contractions in effective population size between 3000 and 30 000 years bp. These results were supported by: (i) detection of transient heterozygosity excess, (ii) a mode-shift indicator of allele frequencies, and (iii) a ratio of allele number to allele size range. No bottleneck was detected for the east Texas control using any of the three methods. The distribution of allele frequencies was skewed for the Lost Pines population compared to the control, indicating a loss of rare alleles. However, allelic diversity was similar between the Lost Pines population and its east Texas control; the mean allele number per locus was 5.29 and 5.38, respectively. It is proposed that the Lost Pines population was the western refugium for P. taeda during Pleistocene glaciation and that East Texas P. taeda forests descended from the bottlenecked Lost Pines population.