Knowledge, Attitude, and Practice of Hepatitis B Vaccination among Dentists in Lebanon.

BACKGROUND: The hepatitis B virus (HBV) is a serious occupational hazard for healthcare workers, including dentists. The purpose of this study is to assess dentists' knowledge, attitude, and practice (KAP) with respect to hepatitis B vaccination. MATERIALS AND METHODS: A cross-sectional survey of a representative sample of dentists (n = 349) from Lebanon was carried out. Participants' knowledge of hepatitis B, attitudes toward vaccination, and immunization habits were assessed using a standardized questionnaire. To examine the data, descriptive statistics were used, and associations between variables were investigated using appropriate statistical tests. RESULTS: The study found that most participating dentists are HBV-vaccinated. These dentists boast a basic to a significantly substantial understanding of HBV infection prevention strategies, such as immunization, routine preventive measures, and handling equipment. Notwithstanding the generally positive attitudes towards vaccination, a proportion of dentists lacked some HBV prevention practices, specifically with respect to conducting regular follow-ups of anti-HBs titer levels and getting booster vaccination doses when warranted. CONCLUSION: This study sheds light on the KAP of hepatitis B immunization among Lebanese dentists. The findings emphasize the significance of focused educational efforts in view of improving awareness and encouraging a more thorough understanding of the benefits of vaccination. The study provides useful data that can be used to influence public health policies as well as activities aimed at increasing hepatitis B vaccination rates among dental professionals in Lebanon. How to cite this article: Yared G, Sokhn ES, Al-Khatib A, et al. Knowledge, Attitude, and Practice of Hepatitis B Vaccination among Dentists in Lebanon. J Contemp Dent Pract 2024;25(2):134-140.

Response of dental pulp capped with calcium-silicate based material, calcium hydroxide and adhesive resin in rabbit teeth

Direct pulp capping induces a local inflammatory process. Several biomaterials have been used for this procedure. The aim of this study was to compare the dentinal bridge thickness using three different pulp capping biomaterials with the conventional technique (high speed diamond bur) or Er-Yag laser, 1 month after pulp effraction. Materials and Methods: Forty two Class V cavities were prepared on the buccal surface of 4 maxillary incisors and 2 mandibular incisors of New Zealand rabbits. Specimens were divided into 6 treatment groups. Teeth were treated with: In Group 1: Er-Yag laser and Biodentine® (Septodont), in Group 2: Er: Yag laser and calcium hydroxide (Dycal® Dentsply), in Group 3: Er: Yag laser and adhesive system (Prime& Bond® NT Dentsply), in Group 4: high speed diamond bur and Biodentine® (Septodont), in Group 5: high speed diamond bur and calcium hydroxide (Dycal® Dentsply), and in Group 6: high speed diamond bur and adhesive system (Prime& Bond® NT Dentsply). The preparation was done with copious irrigation. The animals were sacrificed at 30 days and the teeth were extracted and prepared for histological analysis. Results: In the group of « laser Er-Yag ¼, iatrogenic pulpal wounds treated with Biodentine® were covered with a thick hard tissue barrier after 1 month. The difference was not significant with the groups of Dycal® used with Er: Yag laser and high speed diamond bur. Prime& Bond® NT Dentsply specimens showed a thin dentinal bridge layer. Conclusion: At 1 month, Er-Yag laser proved to be useful with Biodentine® for direct pulp capping procedures

Poor Biointegration of Porcine Acellular Dermal Matrix Associated with Unfavorable Gingival Healing: A Report of Three Cases.

AIM: The aim of the present work was to explain the poor biointegration of acellular dermal xenogeneic matrix, leading to an unfavorable gingival healing following a grafting procedure for the treatment of soft tissue deficiencies. BACKGROUND: Numerous works have demonstrated the successful use of acellular dermal matrix (ADM) in soft tissue augmentation procedures. However, spare human investigations reported adverse healing outcomes at microscopic level. CASE DESCRIPTION: Three patients showing various soft tissue deficiencies (recession, gingival thickening) requiring a gingival augmentation were grafted using an ADM porcine acellular dermal matrices (pADM) as a soft tissue substitute. For this purpose, appropriate soft tissue augmentation surgeries were performed and the grafted pADM was left for proper healing. Biopsies were harvested from two out of the three patients, respectively, at 11 and 27 weeks in order to conduct a histological evaluation of the pADM's doubtful biointegration. Moreover, the ultrastructural analysis of pADM was performed using scanning electron microscopy, and additional histological procedures were used to assess its ability to support human gingival fibroblast cultures. Signs of gingival inflammation persisted several months postoperatively. Histologically, numerous inflammatory cells characterized the grafted site. Indeed, the high number of foreign body giant cell granulomas and the very densified newly formed collagen fibers highlighted a fibrotic process within gingival connective tissue. The ultrastructural and histological analysis showed that pADM was characterized by very thick and dense collagen bundles demonstrating a nonphysiological collagen network organization. Cell culture experiments showed fibroblasts proliferating on the matrix surface, sparing its deeper part, even though the collagen matrix degradation seemed to occur following a gradient from the pADM surface inward. CONCLUSION: The unfavorable clinical results may be caused by the poor colonization of matrix cells and poor angiogenesis leading to the inadequate biointegration of pADM. Hence, the pADM structure in terms of porosity and degradability should be further investigated. CLINICAL SIGNIFICANCE: The present cases highlighted a poor integration of pADM following soft tissue grafting procedures, which was caused by the inadequate ultrastructure of the used pADM. Therefore, despite the utility of such tissue substitutes, their manufacturing improvement could be required to obtain a better biointegration.

Ex vivo ability of a noninstrumentation technique to disinfect oval-shaped canals.

CONTEXT: Oval-shaped canals represent a challenge in endodontics. Infected tissue may remain in their recesses. This concern may be more critical with minimally instrumentation techniques. AIMS: The present study evaluated the disinfection ability in oval-shaped canals of a noninstrumentation technique using ultrasonic agitation and intracanal heating of sodium hypochlorite (NaOCl) compared to rotary canal preparation and ultrasonic agitation with and without heating of NaOCl. SETTINGS AND DESIGNS: Sixty extracted mandibular incisors were included. The teeth had pulp necrosis and apical periodontitis and oval-shaped canals. They were divided into three groups depending on the treatment protocol: (1) IHAN: intracanal heating and ultrasonic agitation of NaOCl only, (2) R-IHAN: Rotary preparation followed by IHAN, and (3) R-passive ultrasonic agitation (PUA): Rotary preparation and ultrasonic agitation of NaOCl. METHODS: Root canal samples were taken before (S1) and after (S2) the endodontic procedures were completed and cultured anaerobically. STATISTICAL ANALYSIS USED: Wilcoxon tests were performed to compare colony-forming units (CFUs) before and after the endodontic procedures for the three groups. The percentage of variation of CFUs was compared among the three groups using Kruskal-Wallis tests, followed by Mann-Whitney U-tests. RESULTS: All S1 samples were positive. All S2 samples showed bacterial growth in R-PUA compared to 17 in R-IHAN. None of the S2 samples in IHAN were positive. Bacteria reduction was significant in each group (P < 0.001). The percentage of bacteria reduction was highest for IHAN and lowest for R-PUA (P < 0.001). CONCLUSIONS: Intracanal heating and ultrasonic agitation of NaOCl without instrumentation completely eliminated bacteria from infected oval-shaped canals.

Antibacterial Ability of Sodium Hypochlorite Heated in the Canals of Infected Teeth: An Ex Vivo Study.

Background Apical periodontitis is caused by bacteria present in the root canal space. The removal of the infection is crucial to obtain healing. Canal irrigation is among one of the most important steps in eliminating bacteria. Sodium hypochlorite (NaOCl) is still the preferred irrigant due to its disinfecting and pulpal dissolution abilities. Heating NaOCl improves those abilities. However, the ability of intracanal heated NaOCl to kill bacteria has not yet been evaluated. Objectives This study compared the disinfecting ability of different irrigation regimens using NaOCl with and without sonic and ultrasonic agitation, and with and without intracanal heating of NaOCl. Methods The canals of extracted mandibular premolars were prepared, sterilized and infected with E. faecalis for 28 days. The canals were then assigned to eight groups of 10 teeth depending on the NaOCl irrigation protocol. Group CONV: conventional irrigation with syringe and needle; Group END: NaOCl sonic agitation with EndoActivator; Group EDD: NaOCl sonic agitation with EDDY; Group PUI: NaOCl passive ultrasonic agitation; Group H: intracanal heating of NaOCl; Groups END-H, EDD-H and PUI-H: NaOCl agitation with EndoActivator, EDDY and passive ultrasound, respectively, followed by intracanal heating of NaOCl. The canals were sampled before (S1) and after (S2) the different irrigation protocols were performed, the colony-forming units were counted and the percentage of bacteria reduction was calculated for each group. Results The number of bacteria decreased significantly for the different protocols (p < 0.001). The groups with NaOCl intracanal heating reduced bacteria significantly more than the other groups (p < 0.001). Five S2 samples in group H were free of bacteria. All of the S2 samples in the groups with NaOCl sonic and ultrasonic agitation followed by NaOCl heating were free of bacteria. Intracanal heating of NaOCl was more effective in killing bacteria than conventional irrigation, and sonic or passive ultrasonic agitation of NaOCl. Conclusions Intracanal heating of NaOCl has the potential to be used as an adjunct to root canal irrigation in order to increase bacterial reduction in comparison to the conventional irrigation techniques involving sonic or ultrasonic agitation. Agitation of NaOCl followed by intracanal warming of the solution seems to be very promising in eliminating bacteria from infected root canals.

Canal preparation with nickel-titanium or stainless steel instruments without the risk of instrument fracture: preliminary observations.

This report introduces a novel technique that allows a safe and predictable canal negotiation, creation of a glide path and canal preparation with reciprocating nickel-titanium or stainless steel engine-driven instruments in canals where the use of rotary and the newly developed reciprocating instruments is contraindicated. In this novel technique, the instruments are used in reciprocating motion with very small angles. Hand files are not used regardless of the complexity of the canal anatomy. It also allows achieving predictable results in canal negotiation and glide path creation in challenging canals without the risk of instrument fracture.

Accuracy of the TCM Endo III torque-control motor for nickel-titanium rotary instruments.

The purpose of this study was to determine the torque output and examine the accuracy of five TCM Endo III torque control motors. A handpiece was attached to the motor and gripped with a vise. A 0.07 taper Orifice Shaper, size 50, was inserted in the handpiece. The instrument tip was clamped in a chuck connected to a torque sensor. Four torque settings were evaluated at 350 rpm. Ten tests were performed at each torque setting. A new instrument was used for each test. The means of the torque values generated by the motors at the different torque levels were analyzed using analysis of variance and post-hoc pairwise comparisons with the Bonferroni test. The actual torque values were significantly higher than the torque preset on the motor (p < 0.0001) and did not differ significantly among the motors (p > 0.05). The actual torque deviated from the preset torque. The usefulness of these motors is questionable.

In vitro study of the torsional properties of new and used ProFile nickel titanium rotary files.

The purpose of this study was to investigate torque and angle of rotation at fracture of new and used.06 ProFile instruments. ProFile sizes 15 to 40 were tested according to American National Standards Institute/American Dental Association Specification #28. Thirty new and used instruments were tested for each size. An analysis of variance was used to compare the torque and angle of rotation at fracture between new and used instruments. The relationship between torque at fracture and size of instrument was determined with a regression analysis. The used instruments had significantly lower torque and angle of rotation at fracture values compared with the new instruments (p < 0.0001). A stronger relationship was found between the size of the instrument and the torque at fracture for the new instruments (p < 0.0001) than for the used ones (p < 0.0001). In conclusion, the repeated use of.06 ProFile instruments significantly reduced the torque and angle of rotation at fracture.

Accuracy of the Nouvag torque control motor for nickel-titanium rotary instruments.

OBJECTIVES: To determine the torque output and examine the accuracy of 5 Nouvag torque control motors. STUDY DESIGN: A handpiece was attached to the motor and gripped with a vise. A size 50 Orifice Shaper, with a 0.07 mm/mm taper was inserted in the handpiece. The instrument tip was clamped in a chuck connected to a torque sensor. Four torque settings were evaluated at 350 rpm. Ten tests were done at each torque setting. A new instrument was used for each test. The means of the torque values generated by the motors at the different torque levels were analyzed using analysis of variance and the Student t test. RESULTS: The actual torque values were significantly higher than the torque preset on the motor (P<.0001) and did not differ significantly among the motors (P>.05). CONCLUSIONS: The actual torque deviated from the preset torque. The usefulness of these motors is questionable.

Torsional properties of new and used rotary K3 NiTi files.

The purpose of this study was to compare torque (gcm) and angle of rotation (degrees) at fracture of new and used NiTi K3 .04 rotary instruments. The relation between size of instrument and torque at fracture was also investigated. The torque and angle of rotation at fracture of new and used NiTi K3 .04 rotary instruments sizes 15 to 40 were determined according to ANSI/ADA Specification No. 28. Analysis of variance was used to compare the torque and angle of rotation at fracture among the different sizes of the new instruments and between new and used instruments of the same size (alpha = 0.05). The relationship between torque at fracture and size of instrument was determined with a regression analysis. Torque at fracture of the new instruments increased significantly with the diameter (p < 0.05). The used instruments, sizes 25 to 40, had significantly lower torque at fracture values compared to the new ones (p < 0.05). The used instruments, sizes 20 and 35 had significantly lower angle of rotation at fracture compared to the new ones (p < 0.05). A stronger relationship was found between the size of the file and the torque at fracture for the new instruments (p < 0.0001) compared to the used ones (p < 0.0001). The results of the present study suggested that the torque at fracture values of new instruments increased significantly with the diameter. The results also suggested that repeated use of .04 K3 instruments affected mainly the torque at fracture.

An in vitro study of the torsional properties of new and used rotary nickel-titanium files in plastic blocks.

OBJECTIVE: The purpose of this study was to compare torque (in grams per centimeter) and angle of rotation (in degrees) at the time of fracture of new and used nickel-titanium .04 ProFile rotary files. The relationship between the size of the instrument and the torque at fracture was also investigated. STUDY DESIGN: The torque and angle of rotation at fracture of new and used nickel-titanium .04 ProFile rotary files Nos. 15 to 40 were determined according to American National Standards Institute/American Dental Association Specification No. 28. Analysis of variance was used to compare the torque and angle of rotation at fracture of the different sizes of the new instruments and of new and used instruments of the same size (alpha =.05). The relationship between torque at fracture and the size of the instrument was determined by means of regression analysis. RESULTS: The torque at fracture of the new instruments increased significantly with the diameter. The used instruments, Nos. 25 to 40, had significantly lower values of torque at fracture than did the new ones. There were no statistically significant differences between the angle of rotation at fracture of the new and the used instruments (P >.05). A stronger relationship was found between the size of the file and the torque at fracture for the new instruments (P <.0001) than for the used ones (P <.0001). CONCLUSION: The results of the present study suggest that the values of the torque at fracture of new instruments increased significantly with the diameter. The results also suggest that repeated use of ProFile .04 instruments mainly affected the torque at fracture.

Influence of torque control motors and the operator's proficiency on ProTaper failures.

OBJECTIVE: The purpose of this study was to evaluate the influence of 2 electric torque control motors and operator experience with a specific nickel-titanium rotary instrumentation technique on the incidence of deformation and separation of instruments. STUDY DESIGN: ProTaper (PT) nickel-titanium rotary instruments were used at 300 rpm. In the first part of the study, electric high torque control (group 1) and low torque control (group 2) motors were compared. In the second part of the study, 3 operators with varying experience (groups 3, 4, and 5) were also compared. Twenty sets of PT instruments and 100 canals of extracted human molars were used in each group. Each set of PT instruments was used in up to 5 canals and sterilized before each case. For irrigation, 2.5% NaOCl was used. The number of deformed and separated instruments among the groups (within each part of the study) was statistically analyzed for significance with pair-wise comparisons by using the Fisher exact test (alpha =.05). RESULTS: In part 1, instrument deformation and separation did not occur in groups 1 and 2. In part 2, 25 and 12 instruments were deformed and separated, respectively, with the least experienced operator. Instrument deformation and separation did not occur with the most experienced operator. The Fisher exact test revealed a significant difference between groups 3 and 4 with respect to instrument deformation (P =.0296). In addition, the Fisher exact test revealed that the incidence of instrument deformation was statistically different between groups 3 and 5 (P <.0001) and groups 4 and 5 (P =.0018). The incidence of instrument separation was significantly higher in group 5 than in groups 3 and 4 (P =.001). CONCLUSIONS: Preclinical training in the use of the PT technique at 300 rpm is crucial to prevent instrument separation and reduce the incidence of instrument deformation. The use of an electric high torque control motor is safe with the experienced operator.

Periapical inflammation affecting coronally-inoculated dog teeth with root fillings augmented by white MTA orifice plugs.

Placement of orifice plugs has been suggested to augment the seal of conventional root canal fillings. This study assessed in vivo the efficacy of white mineral trioxide aggregate (MTA) plugs in preventing periapical inflammation subsequent to coronal inoculation of root-filled teeth. The two-rooted mandibular premolars of six beagle dogs were conventionally prepared and filled with gutta-percha and sealer. A white MTA orifice plug was placed into one canal in each tooth. Pulp chambers were inoculated with plaque except for 12 teeth (negative control), and restored. Radiographs were taken at regular intervals. At 10 months, dogs were killed and jaw blocks processed for histology. None of the roots revealed radiographic or histologic evidence of severe inflammation. Mild inflammation was observed in 17% and 39% of the roots with and without an orifice plug, respectively (McNemar, p > 0.05). Without development of severe inflammation, the seal augmentation efficacy of MTA orifice plugs could not be determined.

Failure of ProFile instruments used with air, high torque control, and low torque control motors.

OBJECTIVE: The purpose of this study was to evaluate the influence of 350-rpm rotational speed on the failure incidence of ProFile nickel-titanium rotary instruments (PRI) when used by an experienced operator in conjunction with different motors. STUDY DESIGN: Extracted human mandibular and maxillary first and second molars demonstrating curvatures greater than 25 degrees were used. PRI sizes 40 to 15 and with 0.06 taper were used in crown-down fashion at 350 rpm. In groups 1 through 4, air, high torque control, low torque control, and very low torque control motors were used, respectively. Each group included 30 canals. One set of PRI was used for each canal. Before each use the PRI set was sterilized by steam autoclave. The canals were enlarged until a size 25 PRI reached the working length. A 2.5 x magnification was used to check for instrument deformation after each passage. The number of deformed and separated instruments was recorded for the various experimental groups. RESULTS: Instrument deformation and separation did not occur in any of the 4 groups. CONCLUSIONS: The results suggested that the use of PRI in conjunction with the different motors by an experienced operator in a crown-down manner at 350 rpm is safe.