Assessment of the root and canal morphology in the permanent dentition of Saudi Arabian population using cone beam computed and micro-computed tomography - a systematic review.

INTRODUCTION: Root canal treatment procedures require a thorough understanding of root and canal anatomy. The purpose of this systematic review was to examine the morphological differences of teeth root and their canals assessed using cone-beam computed and micro-computed tomography in Saudi Arabian population. METHODOLOGY: An electronic search was conducted in PubMed / Medline, Scopus, Google Scholar, and Web of Science databases until January 2023 to retrieve related studies. "Root canal morphology," "Saudi Arabia," "Micro-CT," and "cone-beam computed tomography" were used as keywords. A modified version of previously published risk of bias assessment tool was used to determine the quality assessment of included studies. RESULTS: The literature search revealed 47 studies that matched the criteria for inclusion, out of which 44 studies used cone beam computed tomography (CBCT) and three were micro-computed tomography (micro-CT) studies. According to the modified version of risk of bias assessment tool, the studies were categorized as low, moderate, and high risk of bias. A total of 47,612 samples were included which comprised of either maxillary teeth (5,412), or mandibular teeth (20,572), and mixed teeth (21,327). 265 samples were used in micro-CT studies while 47,347 teeth samples were used in CBCT studies. Among the CBCT studies, except for three, all the studies were retrospective studies. Frequently used imaging machine and software were 3D Accuitomo 170 and Morita's i-Dixel 3D imaging software respectively. Minimum and maximum voxel sizes were 75 and 300 µm, Vertucci's classification was mostly used to classify the root canal morphology of the teeth. The included micro-CT studies were in-vitro studies where SkyScan 1172 X-ray scanner was the imaging machine with pixel size ranging between 13.4 and 27.4 µm. Vertucci, Ahmed et al. and Pomeranz et al. classifications were applied to classify the root canal morphology. CONCLUSION: This systematic review revealed wide variations in root and canal morphology of Saudi population using high resolution imaging techniques. Clinicians should be aware of the common and unusual root and canal anatomy before commencing root canal treatment. Future micro-CT studies are needed to provide additional qualitative and quantitative data presentations.

Detecting Vertical Root Fractures Using Modified Methylene Blue Dye: A Preliminary In Vitro Study.

Diagnostically, vertical root fractures (VRFs) can be a frustrating experience for the dentist. Misdiagnosis could result in significant time and effort losses involved in erroneously intervening endodontically and/or periodontally. Certainly, diagnosing VRFs is often very difficult, and diagnoses based on speculations have led to the extraction of many salvageable teeth. This study was conducted in the radiology unit of College of Dentistry, Prince Sattam bin Abdulaziz University, between December 2021 and June 2022 to evaluate the ability to detect VRFs following the use of a novel radio-opaque dye using periapical radiographs (PARs) and cone-beam computed tomography (CBCT). After carefully inducing VRFs on extracted, single-rooted, virgin premolars (n = 26), they were assigned to control (n = 2) and experimental groups (n = 24). The fracture site of the tooth in the control group received methylene blue dye, whereas the experimental group received a novel dye. Two differently angled PARs were obtained for all the teeth, followed by a CBCT image. Three blinded investigators participated in scoring a Likert scale form with a set of questions. Inter-/intra-examiner reliability showed excellent consistency using Cronbach's alpha test. The Z-test revealed CBCT and PAR to be equally adept at detecting VRFs, with the mean values showing no statistically significant differences. The extent of the VRFs and dye penetration were significantly better when angled radiographs and axial view CBCT were evaluated. Within the limitations of this study, the dye tested showed promising initial results as an aid in radiographically detecting VRFs. The use of such minimally invasive methods is critically needed for diagnosing and managing VRFs. However, further testing should be performed prior to its clinical use.

Anatomical Evaluation of Posterior Maxillary Roots in Relation to the Maxillary Sinus Floor in a Saudi Sub-Population: A Cross-Sectional Cone-Beam Computed Tomography Study.

To evaluate the mean distance and differences between posterior maxillary teeth and maxillary sinus floor (MSF) concerning the age and gender of the patients, a total of 124 maxillary sinuses and 496 posterior maxillary teeth were randomly selected in 62 cone-beam computed tomography (CBCT) images. Mean distances between posterior maxillary roots (PMRs) from different teeth and the MSF were measured using a calibrated tool in the software. Other relations regarding the gender and age of the patients were determined. The mean root-MSF distances in the right and left first premolars were more significant compared to the second premolars. No significant relation was found between the apices of the right and left first and second molar roots and the floor of the maxillary sinus concerning gender. A statistically significant relation was found between the apices of the buccal root of the right first premolar, right and left first and second molars and floor of the maxillary sinus concerning the age group 21-40 years (p-value = 0.009). This study showed that the second molar mesiobuccal root apex is frequently related to the sinus floor. Differences were reported concerning age, concerning the distance between posterior maxillary teeth and the maxillary sinus floor. CBCT technology helped provide the clinical proximity between the MSF and the posterior teeth root apices during the treatment planning.

Effectiveness of antimicrobial photodynamic therapy as an adjunct to mechanical instrumentation in reducing counts of Enterococcus faecalis and Candida albicans from C-shaped root canals.

BACKGROUND/PURPOSE: The aim was to assess the effectiveness of antimicrobial photodynamic therapy (aPDT) as an adjunct to mechanical instrumentation (MI) in reducing Enterococcus faecalis (E faecalis) and Candida albicans (C albicans) counts from C-shaped root-canals. METHODS: Teeth with C-shaped canals as identified on cone beam computed tomographic images were included. Following incubation with E faecalis and C albicans, samples were divided into 4 groups a four follows: Group-1: MI with adjunct aPDT; Group-2: aPDT alone; Group-3: MI alone; and Group-4: no treatment. The pulp chambers of these teeth were exposed and coronal pulp was mechanically derided using sterile endodontic excavators. Using flexible files, all canals were debrided up to size #30 K-files with intermittent irrigation with 2.5% sodium hypochlorite irrigation. In Groups 1 and 3, methylene-blue was injected in all canals and aPDT was performed using a 600 nm diode laser. Sample-size estimation was done on data from a pilot investigation and group-comparisons were done using one way analysis of variance and Bonferroni post-hoc adjustment tests. P < .05 was considered statistically significant. RESULTS: Sixty periodontally hopeless mandibular second molars with C-shaped canals were included. There was a statistically significant reduction CFU/mL of E faecalis (P < .001) and C albicans (P < .001). At post-operative microbial assessments in Group-1. There was no difference CFU/mL of E faecalis and C albicans at post-operative microbial assessments in Groups 2-4. CONCLUSION: MI with adjunct aPDT is more effective in reducing count of E faecalis and C albicans from C-shaped root canals.

Efficacy of root canal treatment in c-shaped canals with adjunctive photodynamic therapy using micro-CT.

AIM: To investigate the efficacy of conventional root canal treatment (cRCT) with adjunctive photodynamic therapy (aPDT) against microbial biofilms within infected c-shaped root canals. METHODS: In this in vitro report, the inoculation of 20 freshly extracted human mandibular molar teeth having c-shaped root canal configuration was performed with E. faecalis and P. aeruginosa to produce three-day biofilms in prepared canal system. PDT used a combination of chlorin (ce6) and polyethylenimine (PEI) as the photosensitizer (PS). A 200 µ-fiber was employed to deliver a 660 nm diode laser light into the root canal, and this was compared and conjugated with conventional endodontic treatment utilizing antiseptic irrigation and mechanical debridement. RESULTS: The utilization of aPDT (group-2) resulted in a considerable decrease in the count of E. faecalis and P. aeruginosa from 12.84 ±â€¯2.18 CFU/mL to 5.13 ±â€¯0.67 CFU/mL, and from 14.06 ±â€¯3.98 CFU/mL to 4.82 ±â€¯1.05 CFU/mL pre-and post-treatment, respectively. A statistically significant reduction in the bacterial counts of both microbes was observed after treatment among the samples of the both study groups (p < 0.05). Specimens in group-2 (8.42 ±â€¯1.14 MPa) demonstrated the highest mean push-out bond strength, whereas the lowest was shown by samples in group-1 (7.08 ±â€¯1.09 MPa). ANOVA showed no statistical difference between the research groups (p = 0.676). The independent t-test revealed that the mean push-out bond strength scores of the cervical segments were higher than the apical and middle segments of roots in research groups (p < 0.05). CONCLUSION: In c-shaped root canals, the application of photodynamic therapy as an adjuvant to conventional root canal treatment contributes to a statistically significant decrease in the microbial count of E. faecalis and P. aeruginosa along with an improved push-out bond strength of the root canal filling material with root.

Applications of CBCT in dental practice: a review of the literature.

This article reviews the various clinical applications of cone-beam computed tomography (CBCT). A literature search was conducted via PubMed for publications related to dental applications of CBCT published between January 1998 and June 15, 2010. The search revealed a total of 540 articles, 129 of which were clinically relevant and analyzed in detail. A literature review demonstrated that CBCT has been utilized for oral and maxillofacial surgery, endodontics, implantology, orthodontics, temporomandibular joint dysfunction, periodontics, and restorative and forensic dentistry. This literature review showed that the different indications for CBCT are governed by the needs of the specific dental discipline and the type of procedure performed.