A Cone Beam Computed Tomography-Based Investigation of the Frequency and Pattern of Radix Entomolaris in the Saudi Arabian Population.

Background and Objectives: An understanding of the anatomical complexity of teeth is a significant factor for a successful endodontic treatment outcome. The aim of this study was to explore the frequency and pattern of distribution of radix entomolaris (RE) in mandibular first molars (MFMs) of a Saudi Arabian subpopulation using CBCT scans. Materials and Methods: This study was conducted at dental clinics of Qassim University from February to May 2023 by evaluating CBCT scans that were previously obtained for diagnostic purposes. Scans of Saudi national patients with bilaterally present MFMs and fully formed root apices were included. Conversely, scans with one/or two missing MFMs, MFMs with incomplete root apices, full- or partial-coverage prosthesis, endodontic treatment, and associated radicular resorption were excluded from study. A total of 303 CBCT scans with 606 bilateral MFMs were analyzed by two calibrated evaluators for the presence of, and type according to Song's typolgy of RE. The data were analyzed using SPPS-24. The descriptive variables were documented as frequencies and percentages. The chi-square test was used to determine the association between the prevalence of RE with the gender, jaw side and age group. Both inter-rater and intra-rater agreements were estimated for detecting and classifying RE using Cohen's kappa test. Results: The sample had 63.7% males and 36.3% females. The prevalence of RE was 6.6%, with Song's type III (57.5%) as the most common variant. Absolute agreement was noted between the raters about the presence of RE and very strong agreement was noted for the classification of the RE. Conclusions: RE is an uncommon finding among the mandibular first molars of the Saudi population without any gender and quadrant predilection. The clinicians' knowledge of the presence and Song's type of RE may contribute towards the enhancement of endodontic treatment outcomes.

Self-efficacy and Online Learning Readiness of Undergraduate Dental Students in Pakistan During COVID-19 Pandemic.

OBJECTIVE: To investigate the correlation between general self-efficacy and online learning readiness among Pakistani undergraduate dental students. STUDY DESIGN: Cross-sectional study. Place and Duration of the Study: Riphah International University, Islamabad, between September 2020 and March 2021. METHODOLOGY: Using cluster sampling, three dental colleges of Islamabad and Rawalpindi were selected. Electronic questionnaires were sent to 750 students. The questionnaire was comprised of two instruments, General Self-Efficacy Scale (GSES), and Online Learning Readiness Scale (OLRS). GSES had 10-items with response measurement on four-point Likert scale, while the OLRS had 18 items in five different domains measured by five-point Likert scale. Data were analysed using SPSS-23. Correlation between dependent variables was calculated using linear regression analysis. RESULTS: The response rate was 59.3% with a predominant response from female students (82.2%) compared with male students (17.8%). The majority of responses were recorded from third year students (27.9%). The year four students' scores for GSE, computer and internet self-efficacy, and self-directed learning differed significantly from other students. The overall mean GSE score was 29.37+4.57. Regression indicated a low degree of correlation between GSE and the five domains of OLRS with r2 values ranging from 0.12 to 0.32. CONCLUSION: A weak to moderate correlation was found between self-efficacy and the five dimensions of online learning readiness among Pakistani undergraduate dental students as depicted by the r-values. KEY WORDS: Cross-sectional studies, Dental education, Dental students, Dentistry, Efficacy, Online learning, Questionnaire.

Assessment of the Prevalence of Radix Entomolaris and Distolingual Canal in Mandibular First Molars in 15 Countries: A Multinational Cross-sectional Study with Meta-analysis.

AIM: The aim of this study was two-folded: i) to assess the prevalence of Distolingual Canal (DLC) and Radix Entomolaris (RE) in Mandibular First Molars (M1Ms), using Cone Beam Computed Tomography (CBCT) images and ii) to assess the impact of sociodemographic factors on the prevalence of these conditions worldwide. METHODS: CBCT images were scanned retrospectively and the ones including bilateral M1Ms were included in the study. The evaluation was performed by 1 researcher in each country, trained with CBCT technology. 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 axial sections from coronal to apical. The presence of DLC and RE in M1Ms (yes/no) was identified and recorded. RESULTS: Six thousand three hundred four CBCTs, representing 12,608 M1Ms, were evaluated. A significant difference was found between countries regarding the prevalence of both RE and DLC (P < .05). The prevalence of DLC ranged from 3% to 50%, and the overall prevalence was 22% (95% CI: 15%-29%). RE prevalence ranged from 0% to 12%, and the overall prevalence was 3% (95% CI: 2%-5%). There were no significant differences between left and right M1Ms or between genders for either DLC or RE (P > .05). CONCLUSION: The overall prevalence of RE and DLC in M1Ms was 3% and 22%. Additionally, both RE and DLC showed substantial bilaterally. These variations should be considered by endodontic clinicians during endodontic procedures in order to avoid potential complications.

Attitude and practice of regenerative endodontic procedures among endodontists and paediatric dentists: A multinational survey from 13 countries.

BACKGROUND: Regenerative endodontics (RET) refers to biologically based procedures that aim to restore damaged tooth structures and reinstate the pulp-dentine complex to its normal physiological state. AIM: The purpose of this study was to examine the attitudes and practices of endodontists and paediatric dentists regarding RET. DESIGN: A survey was conducted among endodontists and paediatric dentists from 13 countries. A number of factors were evaluated, including frequency of RET application, followed guidelines, disinfection techniques, intracanal medication type, scaffold type, preferred coronal seal material, and follow-up period. RESULTS: Among the 1394 respondents, 853 (61.2%) and 541 (38.8%) were endodontists and paediatric dentists, respectively. Almost half (43%) of participants have not performed RET yet. The American Association of Endodontics guideline (47.3%) was selected as the primary source for the clinical protocol. The most frequently selected irrigant solution was 1.5%-3% NaOCl at the first (26.1%) and second (13.6%) sessions. A blood clot (68.7%) and MTA (61.9%) were the most frequently selected scaffold type and coronal barrier. Most participants preferred a 6-month follow-up period. CONCLUSION: According to this survey, deviations exist from current RET guidelines regarding all aspects evaluated. Standardizing clinical protocols and adhering to available guidelines would help to ensure more predictable outcomes.

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.

Students' performance in clinics and self-perceived Confidence in performing Endodontic procedures: A correlation study.

Objective: The study aimed to evaluate undergraduate dental students' self-perceived confidence in carrying out Endodontic procedures and correlating it with their performance in Endodontic clinics. Methods: The correlational study was conducted on fifth year dental students at Qassim University, Saudi Arabia. The self-perceived confidence of students was assessed by using Endodontic Self-Perceived Confidence Scale (ESCS). The students' endodontic clinical performance scores were obtained from the department head. Data were analyzed by IBM SPSS-23.0. Descriptive statistics were recorded as percentages, frequencies, and mean. Chi-square test was used for gender-wise comparison of all items of ESCS, Student t-test was used for comparing means and Pearson correlation coefficient was utilized for exploring correlation. Results: Over all response rate was 91.8%. Students exhibited the highest confidence level for achieving rubber dam isolation (4.57±0.66) while the lowest confidence level was documented for the treatment of teeth with immature apices (2.82±0.95). The mean self-confidence score of male students on ESCS was higher than the female students (P-value=0.18). However, mean endodontic clinic score of female students was significantly higher than the male students (P-value=0.02). The insignificant correlation was noted between the students' mean confidence scores and endodontic clinical performance scores (P-value=0.82). Conclusions: The insignificant correlation between self-perceived confidence and clinic scores raises significant caveats for utilizing the self-assessment in the aforementioned group. Hence, the students should be adequately trained in self-assessment to prepare them for lifetime learning. Additionally, clinical instructors by creating a supportive learning environment should help students to deal with their shortcomings.

How Well Prepared Are Dental Students and New Graduates in Pakistan-A Cross-Sectional National Study.

The transition of an undergraduate dental student to an actual practicing dentist is a crucial phase and ensuring the preparedness of graduates for the complexity and demands of contemporary dental practice is a challenging task. This study aimed to evaluate the self-perceived preparedness of undergraduate dental students and house officers in the dental colleges of Pakistan. A cross-sectional national study was planned to collect information from dental students and new graduates in Pakistan. The pre-validated Dental Undergraduates Preparedness Assessment Scale (DU-PAS) was used. A purposive sampling technique was utilized to recruit house officers and undergraduate dental students from 27 dental schools in Pakistan. The data analysis was carried out using the R statistical environment for Windows (R Core Team, 2015). A total of 862 responses with 642 females and 219 males were analyzed in the study. Overall, the clinical skills score was 30.56 ± 9.08 and the score for soft skills was 30.54 ± 10.6. The mean age of the participants was 23.42 ± 1.28. Deficiencies were reported in various soft skills and clinical skills attributes. The results highlighted the strengths and weaknesses of dental students and new graduates in Pakistani dental institutions. The findings may be used to further develop and strengthen the teaching and training of dental students in Pakistan.

Retrospective audit for quality assessment of root fillings performed by undergraduate dental students in clinics.

Objectives: To evaluate the technical quality of root canal obturations performed by undergraduate students. Methods: The records of 347 patients who underwent endodontic treatment by undergraduate students of Qassim University between 2018 and 2020 were assessed using standardised criteria based on obturation length, density and taper. All teeth that received primary endodontic treatment and had post-obturation periapical radiographs depicting the entire radicular length and the 2-3-mm periradicular area were included in the study. Results: A total of 653 canals of 397 teeth were evaluated. The maxillary central incisor was the most commonly assessed tooth (15.1%). Overall, 80.2% of the evaluated canals were deemed acceptable based on all three assessment criteria. Maxillary teeth had significantly better obturation quality than the mandibular teeth. The mesio-lingual canal had the lowest quality in all three criteria. Conclusions: The technical quality of root canal obturations performed by undergraduate students in Qassim University was acceptable in the majority of the evaluated cases. Among the evaluated parameters of obturation quality, length control was the most frequently observed deficiency. Additional measures are therefore required to improve the quality of the obturation length.

Frequency of middle mesial canal in mandibular first molars and its association with various anatomic variables.

This study aimed to determine the frequency of the middle mesial canal in the mandibular first molars and its association with various anatomical features. Two experienced endodontists evaluated 149 CBCT images, containing n = 298 mandibular first molars and n = 298 mandibular second molars. Binary logistic regression was used to explore the relationship between the presence of middle mesial canal and other independent variables. The middle mesial canal was found in 7.7% (n = 23) of mandibular first molars and 11.4% of which exhibited adjacent C-shaped mandibular second molars. The presence of an adjacent C-shaped mandibular second molar was associated with a 3 times increased likelihood of finding a middle mesial canal (P = 0.048, OR: 3.108) in mandibular first molars. The middle mesial canal is an uncommon finding with a rare occurrence of bilateral presence in mandibular molars; however, an adjacent C-molar is an important predictor of middle mesial canal presence.

Predictors of periodontal and caries related perinatal oral healthcare, investigation of dentists' practices: a cross-sectional study.

BACKGROUND: The objectives of the study were to assess the knowledge, attitude, and practice of dentists towards providing oral health care to pregnant women and to identify barriers and predictors of periodontal and caries related perinatal oral healthcare practices. METHODS: A cross-sectional analytical survey was conducted on dentists by using a random sampling technique, and a pre-validated questionnaire was delivered to 350 dentists from May 2018 to October 2018. Data were analyzed by utilizing SPSS software. Frequencies and percentages were recorded for descriptive variables. Binary logistic regression was used to analyze the probability of predicting group membership to the dependent variable using different independent variables determined from contingency tables. RESULTS: Overall response rate was 41%. The mean knowledge score of respondents was 15.86 ± 3.34. The lowest correct responses were noted in the questions related to periodontal health. It was found that the advice to delay dental visits until after pregnancy was eight times more likely to be observed among dentists who lacked the knowledge of importance of oral health during pregnancy (P = 0.04, OR = 8.75). Dentists were more likely to consult obstetricians regarding dental procedures when they fear a risk of labor in the dental practice (P < 0.05, OR = 3.72). Dentists who had the knowledge of periodontal disease association with preterm delivery were about four times more likely to treat periodontal disease during pregnancy (P = 0.01, OR = 3.95). Dentists knowing the association between maternal oral health and childhood decay were more likely to counsel pregnant patients regarding caries prevention (P > 0.05, OR = 3.75). CONCLUSIONS: Collectively the results indicated few gaps in knowledge among some dentists and a need to improve existing attitudes towards perinatal oral health. Dentists failing to recognize the importance of perinatal oral health are more likely to be hesitant in treating pregnant patients. Failing to recognize the link between periodontal disease and obstetric complications increases the possibility of hesitance to counsel pregnant patients regarding the same. The appreciation of the evidence for poor perinatal oral health and risk of early childhood caries increases the likelihood of counseling by dentists on caries prevention.

Patient's perspective and awareness of materials used in dentistry.

OBJECTIVE: To assess patients' knowledge and attitude towards different dental materials used in private and public dental facilities in an urban setting. METHODS: The cross-sectional study was conducted at the Islamabad Dental and Medical College, Islamabad, Pakistan, from February to July 2019, and comprised individuals at private dental clinics and teaching hospitals. Data was collected using a pre-validated structured questionnaire that recorded socio-demographic information as well as patients' perception on evidence-based dentistry using visual analogue, trust on the dentist, quality of materials and the source of information. Data was analysed using SPSS 21. RESULTS: Of the 269 participants, 151(56.1%) were females with a mean age of 33.87±12.63 years, and 118(43.9%) were males with a mean age of 33.28±13.71 years. Overall, 208(77.3%) respondents were in favour of using materials with long-term scientific data; 201(74.7%) recognised a difference in quality of materials used at private clinics and teaching hospitals; 128(63.7%) believed that poor quality materials were used in teaching hospitals; 229(85%) trusted their dentists for using high-quality materials; and 108(40%) identified dentists as the source of information. There was a significant relationship between patient's education level and realising the importance of using dental materials supported by scientific evidence (p≤0.01). CONCLUSIONS: Majority of subjects believed that poor quality materials were used in teaching hospitals compared to private dental facilities.

Light Curing Units And Their Intensity Output In Dental Setups Of Islamabad And Rawalpindi.

BACKGROUND: Dental composites are commonly used to restore teeth. However, to ensure adequate physical properties and biocompatibility, they require sufficient light intensity with the help of light curing units (LCU). This study aimed to evaluate the type and intensity of LCU being used in the dental setups of Rawalpindi and Islamabad. METHODS: Dental clinics were visited and the type of the LCU was noted. Three consecutive intensity measurements were taken using a radiometer. For Quartz tungsten halogen (QTH) LCU, a light intensity below 300mW/cm2 was considered unsatisfactory, while for light-emitting diode (LED) LCU, a reading below 600mW/cm2 was considered unsatisfactory. To analyse the difference between the output intensities of the two LCU, Mann-Whitney U test was used (p<0.05), while Fisher's Exact test was used for the association between the type of LCU and clinical acceptability of output intensity. RESULTS: A total of 96 LCU were evaluated, out of which, eight were QTH and 88 were LED. A total of 16.7% LCU were considered unsatisfactory. Amongst them, 62.5% QTH had intensity less than 300mW/cm2, while for LED, 12.5% had intensity below 600mW/cm2. The mean intensity for LED was statistically significant compared to QTH LCU (p<0.05). A statistically significant association existed between the type of LCU and their intensity (p<0.05). CONCLUSION: A trend towards the use of LED LCU in the dental setups of Islamabad and Rawalpindi was observed. LED LCU showed greater mean light intensity than QTH LCU. Periodic evaluation of LCU using radiometers is suggested to ensure optimal intensity output.

Intra-radicular reinforcement using a modified fiber post customization technique: a case report.

Trauma sustained by developing anterior teeth can lead to an arrested root development and loss of structure which can complicate the endodontic and restorative management. The preservation of the anterior tooth has a definite esthetic and biologic advantage especially during the developmental years of adolescence. However, restorative treatment of such cases is met with serious biomechanical and adhesive challenges in the form of thin dentinal walls, a high configuration factor etc. This case report describes a fiber post customization technique for the intraradicular reinforcement of a maxillary central incisor in a 14-year-old patient.