Undergraduates' comparative assessment, utilizing a structured rubric, of hands-on versus video-supported presentation in class II cavity preparation.

BACKGROUND: Dental education is considered as a complex, challenging and often stressful educational procedure. Acquisition of psychomotor skills by undergraduate students is an important step in many health professions to become a successful professional. During under graduation, class II cavity preparation exercise is of utmost important in dentistry. OBJECTIVE: To compare class II cavities prepared by students after hands-on live demonstration and pre-recorded video demonstration using well-organised evaluation rubrics. METHOD: Preclinical dental students (n= 50) were divided into two groups. The students in group I (n= 25) attended a hands-on live demonstration performed by one faculty while students in group II (n= 25) watched a 15-minute pre-recorded procedural video on the projector. Both groups were appealed to prepare class II cavity for amalgam involving disto-occlusal surface of mandibular second molar articulated on jaw model (TRU LON study model, Jayna industries, Ghaziabad U.P., India). Following completion of the preparations, all teeth were collected, and labelled grades of prepared cavities were given according to prespecified rubrics. The data of scores were presented as means and standard deviation. Statistical analysis of data was executed using SPSS software. A paired t-test was used to compare scores between groups. RESULTS: The study shows that the video-supported demonstration of a cavity preparation was better than the live hands-on demonstration. A higher mean response for the procedural video group was found compared to the live demonstration group (p= 0.000133). CONCLUSION: Pre-recorded video-supported demonstration along with guidance by a tutor may be a viable alternative to hands-on live demonstration in cavity preparation procedures during undergraduate dental training. Moreover, rubric methods can be implemented in the teaching of various preclinical exercises for conservative dentistry and endodontics.

Accuracy of Different Apex Locators in Teeth with Simulated Apical Root Resorption: an In Vitro Study.

BACKGROUND: Accurate working length (WL) determination is necessary in achieving optimal healing by non-surgical root canal therapy in teeth with inflammatory apical root resorption. Electronic apex locators (EALs) are one of the mainstays in determination of WL of teeth. AIM: This study evaluated the accuracy of three EALs [RootZX (third generation), iPex (fourth generation) and Raypex 6 (modification of a fifth generation)] in determining the WL of teeth with simulated apical root resorption in permanent teeth. MATERIALS AND METHODS: Forty freshly extracted maxillary anterior teeth were collected and a 45° oblique cut was made at the root apex with a disc to simulate apical root resorption. Actual working length (AWL) was determined by direct visual method and was used as a control. Electronic working length (EWL) values were measured by three different apex locators that are RootZX (Group I), iPex (Group II) and Raypex 6 (Group III) at apex, 0.5 mm and 1 mm from apex. All values obtained were tabulated and statistical evaluation was carried out. RESULTS: At apex, EWL obtained using iPex (p=0.05) showed a statistically significant difference from AWL. At 0.5 mm and 1.0 mm tolerance, iPex showed non-acceptability for WL measurement in 67.5% and 17.5% of samples compared to Root ZX (12.5% and 2.5%) and Raypex (7.5% and none) respectively. CONCLUSION: Within the limitation of this study, it can be concluded that Raypex 6 and RootZX show statistically significant accuracy in WL measurement compared with iPex in teeth with apical root resorption.

Bioceramics in endodontics - a review.

Bioceramics are materials which include Alumina, Zirconia, Bioactive glass, Glass ceramics, Hydroxyapatite, resorbable Calcium phosphates, among others. They have been used in dentistry for filling up bony defects, root repair materials, apical fill materials, perforation sealing, as endodontic sealers and as aids in regeneration. They have certain advantages like biocompatibility, non toxicity, dimensional stability and most importantly in endodontic applications, being bio-inert. They have a similarity to Hydroxyapatite, an intrinsic osteo conductive activity and have an ability to induce regenerative responses in the human body. In Endodontics, they can be broadly classified into Calcium Phosphate/ Tricalcium/ Hydroxyapatite based, Calcium Silicate based or mixtures of Calcium Silicate and Phosphates. This review focuses on an overview of Bioceramics, classification and their advantages. It also gives a detailed insight into individual bioceramic materials currently used in the fields of Endodontics along with their properties and applications.

Canal transportation and centering ability of protaper and self-adjusting file system in long oval canals: An ex-vivo cone-beam computed tomography analysis.

CONTEXT AND AIMS: The purpose of this study was to compare and evaluate the shaping ability of ProTaper (PT) and Self-Adjusting File (SAF) system using cone-beam computed tomography (CBCT) to assess their performance in oval-shaped root canals. MATERIALS AND METHODS: Sixty-two mandibular premolars with single oval canals were divided into two experimental groups (n = 31) according to the systems used: Group I - PT and Group II - SAF. Canals were evaluated before and after instrumentation using CBCT to assess centering ratio and canal transportation at three levels. Data were statistically analyzed using one-way analysis of variance, post hoc Tukey's test, and t-test. RESULTS: The SAF showed better centering ability and lesser canal transportation than the PT only in the buccolingual plane at 6 and 9 mm levels. The shaping ability of the PT was best in the apical third in both the planes. The SAF had statistically significant better centering and lesser canal transportation in the buccolingual as compared to the mesiodistal plane at the middle and coronal levels. CONCLUSIONS: The SAF produced significantly less transportation and remained centered than the PT at the middle and coronal levels in the buccolingual plane of oval canals. In the mesiodistal plane, the performance of both the systems was parallel.

Novel Matricing Technique for Management of Fractured Cusp Conundrum - A Clinician's Corner.

Longitudinal tooth fracture can be classified as craze lines, fractured cusp, cracked tooth, split tooth and vertical root fracture based on extent and severity of the fracture line. The most common type of longitudinal tooth fracture is fractured cusp that poses the treatment dilemma. Retention of the fractured cusp segment temporarily with matrix band followed by permanent bonded restoration and finally removal of tooth fragment during crown preparation is a novel technique. This paper throws light on a matricing and holding technique for the management of supra-crestally fractured palatal cusp of maxillary first premolar in a 29-year-old Asian male.

Anaesthesia Techniques for Maxillary Molars - A Questionnaire-Based Retrospective Field Survey of Dentist in Western India.

INTRODUCTION: Clinicians use various anaesthesia techniques like Posterior Superior Alveolar (PSA) nerve block, buccal infiltration with or without supplemental anaesthesia like palatal and intraligamentary infiltrations for root canal treatment in maxillary molars. However there is no general consensus regarding which technique is enough for performing endodontic treatment in maxillary molars. AIM: The aim of this questionnaire-based survey is to compare and evaluate the various techniques used to anaesthetize the maxillary molars and its effect on postoperative pain. MATERIALS AND METHODS: The data were obtained from 290 dental practitioners using a specially prepared questionnaire survey conducted anonymously. The questionnaire contained questions covering data such as years in dentistry, acquired specialty, techniques used for anaesthetizing maxillary molars, success of anaesthesia, and postoperative pain, etc. RESULTS: Buccal infilteration with supplemental anaesthesia in the form of palatal (82%) and intra-ligamentary infilteration (88%) show higher success rate compared to only buccal infilteration (69%). However, intra-ligamentary infilteration group showed highest rate (75%) of postoperative pain. General practitioners (62% of clinicians) prefer to give both buccal and palatal infilterations and specialists opt for only buccal infilteration (66-74% of specialists). CONCLUSION: Only buccal infilteration is sufficient during root canal treatment of maxillary molars. Routine use of supplemental anaesthesia in the form of palatal and intra-ligamentary infilteration is not necessary unless patient experiences discomfort during endodontic treatment. However, intra-ligamentary infilteration may lead to postoperative discomfort in the form of pain.

Mineral trioxide aggregate pulpotomy in autotransplanted immature mandibular third molar with a 4-year follow-up.

Autotransplantation is the surgical transposition of a tooth from its original site to another, replacing a lost or a compromised tooth by another tooth, usually the third molar in the same individual. This technique is considered a viable method due to its high success rate, well-grounded treatment option, provided the case selection and the procedure followed is within the acceptable limits. Autotransplantation is considered as an alternative approach of oral rehabilitations in a conservative manner mainly in young patients with compromised financial conditions to perform a high cost treatment. It is a fast way to recover function and aesthetic properties without interfering with the orofacial growth. This report describes a successful 4-year follow-up of a case of immediately performed mineral trioxide aggregate (MTA) pulpotomy in autotransplantated mandibular left immature third molar to replace the mandibular left first molar that was extracted due to extensive carious lesion.

Comparative evaluation of effect of preoperative alprazolam and diclofenac potassium on the success of inferior alveolar, Vazirani-Akinosi, and Gow-Gates techniques for teeth with irreversible pulpitis: Randomized controlled trial.

INTRODUCTION: In teeth with irreversible pulpitis, successful local anesthesia is hard to achieve irrespective of the amount of local anesthesia and technique used. Such cases can be managed by concoction of pre-medications like anxiolytics, analgesics and effective local anesthesia. This double-blind, placebo-controlled study was planned to evaluate the effect of oral administration of alprazolam and diclofenac potassium on the success rate of inferior alveolar nerve block (IANB), Gow-Gates (GG) and Vazirani-Akinosi (VA) techniques for the root canal treatment of mandibular molars with irreversible pulpitis. METHOD: 198 emergency patients with symptomatic irreversible pulpitis were randomly divided into three groups as - A, B and C receiving IANB, GG or V-A respectively using 2% lidocaine with 1: 100,000 epinephrine. These groups were sub-divided into sub-groups I and II as control and pre-medication groups. Patients who did not react to the stimulus made by an explorer between the canine and first premolar and showing subjective lip and tongue numbness were included in the study. RESULT: All sub-groups showed statistically significant reduction in VAS score. However sub-groups V and VI (that is GG with and without pre-medication respectively) showed best improvement in initial severe pain in mandibular molars with irreversible pulpitis. Moreover, all pre-medication sub-groups showed better pain control compared to respective control groups. CONCLUSION: It was concluded that use of pre-medications in the form of combination of anxiolytics and analgesics improves the success rate of local anesthesia in teeth with irreversible pulpitis. Use of anxiolytics eases the patient in endodontic emergencies. Also use of GG along with pre-medication is the best method for effective pain management of acute pain in irreversible pulpitis.

Comparative evaluation of canal cleaning ability of various rotary endodontic filesin apical third: A scanning electron microscopic study.

BACKGROUND: The purpose of this study was to evaluate the canal cleaning ability of three novel endodontic rotary instruments and compare with ProTaper files as a control in apical third of root canals under scanning electron microscopy (SEM). MATERIALS AND METHODS: Eighty freshly extracted mandibular premolars were selected according to inclusion criteria. Buccal cusp tips were ground to ensure having a flat coronal reference point with a total tooth length of 16 mm for all samples. Teeth were divided equally into four groups: Group I (ProTaper group), Group II (ProTaper next group), Group III (variable taper group), and Group IV (self-adjusting file [SAF] group). Using SEM, the dentinal surfaces were observed and rated at apical thirds with a magnification of ×1000 for the presence/absence of smear layer and debris. Descriptive analysis was performed, and analysis of variance with Bonferroni post hoc test was carried out for comparison between the groups, at a significance level of 0.05. RESULTS: There was statistically significant difference between Group II and Group IV for debris (P = 0.047) and smear layer (P = 0.037). CONCLUSION: In apical third of root canal, SAF showed statistically significant canal cleaning ability due to combined effect of continuous streaming irrigation with effectively replacing the irrigant from the apical portion of the root canal, irrigants activation through the creation of turbulence, and its self-adapting design to root canal anatomy with a scrubbing motion on the canal walls.

Autologus Platelet Rich Fibrin aided Revascularization of an immature, non-vital permanent tooth with apical periodontitis: A case report.

Caries or trauma induced non-vital immature permanent tooth with blunderbuss, thin root which are very common among childrens are corrected using regenerative endodontic (revascularization) procedures. In the presented case, a 16-year-old boy reported with chief complaint of pain in maxillary left central incisor (Tooth #21). Tooth #21 showed grade III mobility, draining labial sinus, and short blunderbuss root with diffuse periapical radiolucency. Patient was explained the treatment plan and written informed consent was taken. Platelet rich fibrin (PRF) was prepared according to standard protocol. Autologous PRF was carried to the apical portion of the root canal after inducing revascularization. Access opening was double sealed with MTA and resin modified glass ionomer cement (RMGI). Baseline, 12 month and 18 month follow-up intraoral radiographs were taken. Clinically case was asymptomatic with complete resolution of intraoral sinus. Periapical healing, apical closure, root lengthening and dentinal wall thickening were uneventful. Thus PRF supplementation hastens the predictability and rate of revascularization in non-vital immature permanent teeth.

Conservative management of dens evaginatus and attached supernumerary tooth/odontome in mandibular premolar with dual radiolucencies.

Recently, an innovative, nonsurgical regenerative endodontic treatment protocol "SealBio" was introduced to manage mature nonvital permanent teeth with periapical lesions. This paper explains the management of an unusual case of dens evaginatus and an attached supernumerary tooth/an odontome associated with two distinct radiolucencies in a mandibular premolar with "SealBio" technique and discusses the various hypotheses on the pathogenesis of unusual malformation and associated pericervical cyst-like radiolucency in the involved tooth.

Endodontic management of maxillary first molar with type I canal configuration- a rare case report.

Thorough knowledge about the root canal variations is essential for the predictable endodontic treatment outcome. The root and root canal anatomy of maxillary first molar varies greatly. A Pub-med literature search about single rooted single canalled maxillary first molar was done to know its details such as incidence, diagnostic method used, age, sex and ethnic background of patient. This article presented report of a single rooted single canalled maxillary first molar in a 27-year-old healthy Asian female.

Karyotype, Pedigree and cone-beam computerized tomography analysis of a case of nonsyndromic pandental anomalies.

This case report presented a karyotype and pedigree analysis of a case with unusual combination of dental anomalies: Generalized short roots, talon cusps, dens invagination, low alveolar bone heights, very prominent cusp of carabelli and protostylid on first permanent molars, taurodontism of second permanent molars, rotated, missing and impacted teeth. None of the anomalies alone are rare. However, until date, nonsyndromic pandental anomalies that are affecting entire dentition with detailed karyotype, pedigree and cone-beam computerized tomography analysis have not been reported. The occurrence of these anomalies is probably incidental as the conditions are etiologically unrelated.

Endodontic management of a two rooted, three canaled mandibular canine with a fractured instrument.

It is important to assess the root canal morphology and its variations before initiating the endodontic procedure. This is because the inability to clean the complete root canal system forms the seat for the persistent infection which ultimately leads to endodontic treatment failure. This case reports the use of dental operating microscope for the successful endodontic management of a two rooted and three canaled mandibular canine with the fractured instrument in the middle canal of a 38-year-old healthy Asian woman. This case report highlights the need to use the dental operating microscope and ultrasonics in locating the elusive canal orifices. It is important to note the internal and external root canal morphological variations before starting the endodontic treatment without any pre-operative assumptions about the usual anatomy of the toot.

Platelet-rich plasma supplemented revascularization of an immature tooth associated with a periapical lesion in a 40-year-old man.

The present case report is the first of its kind that documents the successful outcome of "revascularization," a regeneration-based treatment protocol in a mature adult patient. It belies the myth that "revascularization" should only be done in children and young, adolescent patients. The misconception that stem cells number as well as viability in older age group patients will not allow revascularization to be successful is also contradicted by this case. The paper highlights all the mechanisms that come into play and the enhancing of regenerative response by supplementation with platelet-rich plasma (PRP).

Management of a rare combination of avulsion and intrusive luxation: A case report.

In traumatic dental injury, concomitant occurrence of avulsion and intrusive luxation is exceptional. This is because the vectors of forces responsible for both avulsive and intrusive injuries are in different directions. The present case report reviews the management of a rare combination of avulsion in right maxillary lateral incisor (tooth #12) and intrusive luxation in right maxillary central incisor (tooth #11) in a 22-year-old Asian male. Clinical and radiographic evaluation was done at 12-month follow-up. Various treatment modalities and complications associated with both avulsion and intrusion are also discussed in the paper.

Comparative outcome of revascularization in bilateral, non-vital, immature maxillary anterior teeth supplemented with or without platelet rich plasma: A case series.

Loss of pulp vitality in an immature permanent tooth arrests root development. This leads to tooth with open apex and weak lateral dentinal walls. Management of such necrotic teeth with immature roots poses several treatment challenges. The documented study was performed to evaluate and compare apexogenesis induced by revascularization, with and without platelet rich plasma (PRP) in non-vital, immature anterior teeth. Three patients having bilateral, non-vital, immature maxillary central incisors with apical periodontitis were recruited after institutional ethical clearance. Subsequent to chemo-mechanical preparation, revascularization with and without PRP was randomly induced in either of the tooth. The cases were followed-up clinically and radiographically at 6 and 12 months. There was a marked difference in periapical healing, apical closure and dentinal wall thickening of teeth treated by revascularization with PRP.