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.

Evaluation of the Diagnostic and Prognostic Accuracy of Artificial Intelligence in Endodontic Dentistry: A Comprehensive Review of Literature.

Aim: This comprehensive review is aimed at evaluating the diagnostic and prognostic accuracy of artificial intelligence in endodontic dentistry. Introduction: Artificial intelligence (AI) is a relatively new technology that has widespread use in dentistry. The AI technologies have primarily been used in dentistry to diagnose dental diseases, plan treatment, make clinical decisions, and predict the prognosis. AI models like convolutional neural networks (CNN) and artificial neural networks (ANN) have been used in endodontics to study root canal system anatomy, determine working length measurements, detect periapical lesions and root fractures, predict the success of retreatment procedures, and predict the viability of dental pulp stem cells. Methodology. The literature was searched in electronic databases such as Google Scholar, Medline, PubMed, Embase, Web of Science, and Scopus, published over the last four decades (January 1980 to September 15, 2021) by using keywords such as artificial intelligence, machine learning, deep learning, application, endodontics, and dentistry. Results: The preliminary search yielded 2560 articles relevant enough to the paper's purpose. A total of 88 articles met the eligibility criteria. The majority of research on AI application in endodontics has concentrated on tracing apical foramen, verifying the working length, projection of periapical pathologies, root morphologies, and retreatment predictions and discovering the vertical root fractures. Conclusion: In endodontics, AI displayed accuracy in terms of diagnostic and prognostic evaluations. The use of AI can help enhance the treatment plan, which in turn can lead to an increase in the success rate of endodontic treatment outcomes. The AI is used extensively in endodontics and could help in clinical applications, such as detecting root fractures, periapical pathologies, determining working length, tracing apical foramen, the morphology of root, and disease prediction.

Adjunctive use of Er, Cr: YSGG laser, Potassium titanyl Phosphate laser, and photosensitizer on extrusion bond strength of radicular dentin to bioceramic sealers.

AIM: To assess the impact of adjunctive final root canal disinfection regime curcumin photosensitizer (CP) activated by Photodynamic therapy (PDT), Er, Cr: YSGG laser (ECL), and Potassium titanyl Phosphate (KTP) laser on the bond integrity of two endodontic Bioceramic (BC) sealers. MATERIALS AND METHOD: Decoration of eighty human single-rooted teeth was performed up to a cementoenamel junction. After instrumentation, all samples were irrigated with 2.25% NaOCl solution followed by 17% EDTA. The specimens were divided arbitrarily into 8 groups (n = 10) based on the adjunctive final irrigation method used. Group 1 and 5 (Control): No adjunctive regime, cleaned using 2.25% NaOCl + 17% EDTA, group 2 and group 6: CP activated by PDT, Group 3 and Group 7 using ECL, Group 4 and Group 8: KTP laser. Following disinfection samples in groups 1, 2, 3, and 4 were obturated using Sankin apatite root canal sealer (SARS). Specimens in groups 5, 6, 7, and 8 were obturated using Pro-root endo sealer (PRES). Sectioning of samples was performed. The sectioned specimens were subjected to a compressive loading exerted via a steel plunger moving at a 0.5 mm/min crosshead speed till debonding. Means and standard deviations (SD) of EBS of BC sealer with the root canal dentin were assessed using one-way analysis of variance (ANOVA) and Post Hoc Tukey multiple comparison tests. The level of significance was measured at p = 0.05. RESULTS: The coronal section of samples in group 5 (Na-E-PRES) exhibited the highest bond value. The lowest PBS was displayed by the middle third of specimens in group 6. Group 1 (Na-E-SARS), group 3 (Na-E-ECL-SARS), group 5 (Na-E-PRES), and group 7 (Na-E-ECL-PRES) exhibited comparable bond values (p>0.05). Whereas, group 2 (Na-E-PDT-SARS) and group 4 (Na-E-PTPL-SARS), group 6 (Na-E-PDT-PRES), and group 8 (Na-E-PTPL-PRES) were found to be comparable (p>0.05). CONCLUSION: Adjunctive use of Er, Cr: YSGG laser displayed better extrusion bond strength with BC root canal sealer compared to CP activated by PDT and KTP laser. Bond strength is influenced by the type of irrigation.

The effect of 400 nm femtosecond laser and Zn(II)chlorin e6 methyl ester (Zn(II)e6Me) photosensitizer on disinfection of radicular dentin bonded to glass fiber post.

AIM: To assess and compare push-out bond strength (PBS) when canal disinfected with 5.25% NaOCl, 400 nm femtosecond laser, and natural PS activated by PDT (CP and Zn (II) Ce6 methyl ester) on bond efficacy of radicular dentin bonded to glass fiber post. MATERIAL AND METHODS: A sum of 40 non-traumatic, cautiously extracted with closed apex human mandibular premolars were collected and decoronated up to the cement-o-enamel junction. Canals of all specimens were cleaned and shaped using a Protaper universal NiTi system via a crown-down approach, then finally dried out and obturated with gutta-percha. Post alignment space was formed with peso reamers and sanitized. Then samples were randomly allocated into four groups as per the radicular dentin designated disinfection protocols. Group 1 disinfected with curcumin photosensitizer + EDTA, group 2: 5.25% NaOCl and EDTA, group 3: Zn (II) Ce6 methyl ester and EDTA and group 4 sanitized with 400 nm fs-laser + EDTA. GFP was cemented into the radicular canal space and specimens were placed in a thermocycler. Segmentation of the root was done at three levels (coronal, middle, and apical) and positioned in a universal testing machine for PBS analysis. Failure mode analysis was performed using a stereomicroscope and statistical analysis was executed by one-way ANOVA and Tukey multiple comparison tests at a statistically significant level of p < 0.05. RESULTS: The highest PBS was revealed by group 2 canal disinfected with 5.25% NaOCl +17% EDTA (control) at coronal (9.49 ± 1.42 MPa) and middle (7.545 ± 0.15 MPa) root levels. Whereas, the lowest PBS was displayed by group 3: Zn (II) Ce6 methyl ester +17% EDTA at coronal (6.31 ± 0.54 MPa) middle (4.85 ± 0.11 MPa) root levels respectively. Intergroup comparison presented that radicular dentin disinfected with 400 nm femtosecond laser + 17% EDTA substantiated comparable PBS result to group 2 (control) at all three root levels (p > 0.05). Likewise, root surface disinfection with Curcumin activated by PDT+17% EDTA unveiled no statistically significant result for specimens disinfected with Zn(II) Ce6 methyl ester +17% EDTA(p > 0.05). Furthermore, apical root segments in all groups showed a substantial decrease in PBS value and were comparable (p > 0.05). CONCLUSION: The bond efficacy of glass fiber post to radicular dentin disinfected with 400 nm femtosecond laser has the potential to be used as an alternative to conventional sodium hypochlorite.

Association between the baseline gene expression profile in periapical granuloma and periapical wound healing after surgical endodontic treatment.

In this study, we have investigated the association between the baseline gene expression profile in periapical granuloma and periapical wound healing after surgical endodontic treatment. Twenty-seven patients aged between 15 and 57 years underwent periapical surgery. The retrieved periapical tissue sample was used for mRNA expression analysis of COL1A1, VTN, ITGA5, IL-4, TNF, ANGPT, VEGFA, and CTGF. All patients were recalled after 6 and 12 months for periapical healing evaluation. Healing was then correlated with baseline gene expression. Healing was observed in 15 patients at the end of 6 months, which increased to 21 patients after 12 months. Six patients showed no healing even after 12 months. Analysis of baseline expression levels of the tested genes with healing status showed the mean relative expression of VTN, VEGFA, ANGPT, TNF, and CTGF to be significantly different (p < 0.05) between the healing group (6 and 12 months) (72.99%) and the non-healing (94.42%) group. Periapical Index scores 3-5 exhibited a positive correlation with ITGA-5 expression. Overexpression of ANGPT and a strong positive correlation between ITGA5 and PAI scores in the non-healing group of patients may suggest these genes to be a potential prognostic biomarker for periapical wound non-healing after surgical endodontic treatment.

Correlation of Blood and Salivary pH Levels in Healthy, Gingivitis, and Periodontitis Patients before and after Non-Surgical Periodontal Therapy.

Periodontitis is an infectious illness which leads to the inflammation of protective tissues around the teeth and the continuous loss of alveolar bone and conjunctive tissue. Biomarker analysis in serum and saliva helps in the evaluation of disease progression and activity. It is also established that every inflammatory change along with resultant damage of tissues ends up in altered pH values in the fluids and tissues. AIM: To correlate the connection of pH levels in both blood as well as saliva in healthy, periodontitis, and gingivitis patients. MATERIALS AND METHODS: The current research involved 145 subjects amidst the age of 20 and 55 years. The subjects were split into three different groups: healthy (Group A), gingivitis (Group B), and finally chronic periodontitis (Group C). The recording of clinical parameters was done by gingival index (GI), probing depth (PD), and plaque index (PI). pH of saliva and blood was analyzed with the help of digital single electrode pH meter. Subjects have gone through scaling and root planning (SRP) coupled with the instructions of oral hygiene. They were recalled post 4 weeks, and saliva and blood samples were gathered for analyzing pH. RESULTS: Clinical parameters GI and PI were statistically important in both group C as well as group B post SRP. A crucial change has been observed in attachment levels (AL) and PD in the case of periodontitis group post SRP. The difference in the salivary pH values were significant between group B vs. C and A vs. C before the treatment because the values for group C were acidic, whereas in groups B and A the pH was alkaline. After the treatment, the values were still significant because the pH has become more alkaline compared to preoperative value in both group B and C. Saliva's pH levels have demonstrated a statistically significant reduction in group C post SRP. CONCLUSION: Salivary pH levels and blood evidently became alkaline in the group C patients post SRP and there is a positive correlation between them and the clinical parameters.

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.