Micro computed tomography (Micro-CT) characterization of root and root canal morphology of mandibular first premolars: a systematic review and meta-analysis.

INTRODUCTION: Mandibular first premolars are familiar with their varied root canal morphology, causing difficulties and challenges for successful endodontic procedures. This systematic review and meta-analysis aim to study the characterization of root and canal morphology of the first mandibular premolar using micro-computed tomography. METHODOLOGY: The literature search was conducted using electronic web databases like PubMed, Scopus, ScienceDirect and Cochrane with the chosen MeSH key words and data was retrieved until May 2023. Further to perform the statistical analysis, R v 4.3.1 software with "meta", 'metafor" "metaviz" " ggplot2" package was used, and results were represented by odds ratios (OR) and the percentage of forest plots along a 95 per cent confidence interval (CI). RESULTS: The total number of studies meeting the inclusion criteria was 13; these studies were conducted on mandibular first premolar using Micro-CT; the total sample size was 1817. To scan the sample, an X-ray micro-focus CT system (Siemens Inveon CT, Erlangen, Germany) was used in four studies and seven different machines were used in the respective studies. Mimics 10.01 software (Materialize, Leuven, Belgium) and NRecon v.1.6.9 software (Bruker, Kontich, Belgium) were commonly operated. The minimum and maximum voxel size ranges between 11.94 and 50 µm. Vertucci's classification was frequently used (9), while one study applied Ahmed et al. and Vertucci's classification. CONCLUSION: This systematic review provides essential information about the root and canal configurations, radicular grooves, accessory canals, and apical foramina through Micro-CT, aiming to improve the accuracy of endodontic treatment and help practitioners.

Exploring age and gender variations in root canal morphology of maxillary premolars in Saudi sub population: a cross-sectional CBCT study.

BACKGROUND: In complex teeth like maxillary premolars, endodontic treatment success depends on a complete comprehension of root canal anatomy. The research on mandibular premolars' root canal anatomy has been extensive and well-documented in existing literature. However, there appears to be a notable gap in available data concerning the root canal anatomy of maxillary premolars. This study aimed to explore the root canal morphology of maxillary premolars using cone-beam computed tomography (CBCT) imaging, considering age and gender variations. METHODS: From 500 patient CBCT scans, 787 maxillary premolar teeth were evaluated. The sample was divided by gender and age (10-20, 21-30, 31-40, 41-50, 51-60, and 61 years and older). Ahmed et al. classification system was used to record root canal morphology. RESULTS: The most frequent classifications for right maxillary 1st premolars were 2MPM1 B1 L1 (39.03%) and 1MPM1 (2.81%), while the most frequent classifications for right maxillary 2nd premolars were 2MPM1 B1 L1 (39.08%) and 1MPM1 (17.85%). Most of the premolars typically had two roots (left maxillary first premolars: 81.5%, left maxillary second premolars: 82.7%, right maxillary first premolars: 74.4%, right maxillary second premolars: 75.7%). Left and right maxillary 1st premolars for classes 1MPM1 and 1MPM1-2-1 showed significant gender differences. For classifications 1MPM1 and 1MPM1-2-1, age-related changes were seen in the left and right maxillary first premolars. CONCLUSION: This study provides novel insights into the root canal anatomy of maxillary premolars within the Saudi population, addressing a notable gap in the literature specific to this demographic. Through CBCT imaging and analysis of large sample sizes, the complex and diverse nature of root canal morphology in these teeth among Saudi individuals is elucidated. The findings underscore the importance of CBCT imaging in precise treatment planning and decision-making tailored to the Saudi population. Consideration of age and gender-related variations further enhances understanding and aids in personalized endodontic interventions within this demographic.

MicroRNA and their implications in dental pulp inflammation: current trends and future perspectives.

MicroRNAs (miRNAs) are short, 19-23 nucleotide non-coding RNA molecules that regulate gene expression by silencing or degrading the target mRNA gene. Since their discovery in the nineties of the last century, they have emerged as key inflammatory regulators. Inflammation induces the synthesis of various miRNAs that modulate the expression of multiple molecules involved in orchestrating the inflammatory response. This review aims to provide an insight into the role of miRNAs as potential biomarkers, mediators, and potential therapeutic targets of dental pulp inflammation. A literature search was conducted using the keywords; biogenesis of microRNA, human dental pulp cells, pulpitis, and inflammation in PubMed and Scopus index databases for all the published articles dealing with the role of miRNAs in pulp inflammation in the last 10 years. According to the literature, there is a clear correlation between miRNAs and several physiological events, as well as their role as mediators of innate immune response and inflammation in dental pulp cells. Our narrative review stipulates that numerous miRNAs play a key role in modulating inflammation, delaying or enhancing cell repair, cell differentiation, and survival in dental pulp diseases. However, further studies are required for the validation of miRNAs as reliable biomarkers in dental pulp pathology and their targeted therapy.

Identifying relevant topics and their competency levels for dental materials science: a fuzzy Delphi study.

BACKGROUND: Dental materials science is an important core course in undergraduate dental programs which integrates foundational concepts of chemical engineering and materials science into clinical dentistry. The present study aimed to identify relevant dental materials science topics for Malaysian undergraduate dental curricula and to determine their appropriate competency levels in terms of cognitive and psychomotor taxonomies. METHODS: Potential dental materials science topics were drafted in alignment with the revised national competency statement. The list of topics was further amended after comparing it with those recommended topics in the literature. Fuzzy Delphi method was applied. Experts were selected based on the different inclusion criteria. They ranked the topics using a five-point Likert scale and recommended the appropriate cognitive and psychomotor levels. Next, fuzzy evaluation was performed. Consensus was deemed for a topic to be included if (a) the average expert agreement was ≥ 75%, (b) the d-construct threshold value for each topic was ≤ 0.2 and (c) the average fuzzy number was ≥ 0.5. RESULTS: Sixty-two experts participated in the study. They accepted 33 out of 36 potential dental materials science topics. The average Likert score and fuzzy number ranged from 3.63 to 4.92 and 0.526 to 0.784, respectively. Furthermore, "Endodontic materials" was ranked as the most significant topic. Meanwhile, many topics required dental students to demonstrate a cognitive level of "Apply" and a psychomotor level of "Guided response". Based on mean scores, "Impression materials" was rated as the most cognitively demanding topic, whilst "Temporary restorative materials" was the most demanding topic for psychomotor taxonomy. CONCLUSION: The present study has identified relevant dental materials science topics and their appropriate cognitive and psychomotor levels using the Fuzzy Delphi approach. The findings of the present study form the basis for future studies to develop measurable learning outcomes, design corresponding innovative pedagogy and propose assessment criteria for each topic.

Evaluation of root and canal morphology of mandibular premolar amongst Saudi subpopulation using the new system of classification: a CBCT study.

BACKGROUND: The clinician should have complete knowledge of the normal anatomy of the root as well as complexities in the root canal configuration for a better outcome, as missed or improper handling of the canal system can lead to the failure of an entire endodontic procedure. The present study aims to assess the morphology of roots and canals in permanent mandibular premolars in the Saudi subpopulation with a new classification system. METHODS: The present study includes 1230 mandibular premolars (645 first premolars and 585-second premolars) from 500 CBCT images of the patients, including retrospective data. iCAT scanner system (Imaging Sciences International, Hatfield, PA, USA) was used to obtain the images; scanning of 8 × 8 cm images was performed at 120 KVp and 5-7 mA with a voxel size of 0.2 mm. The new method of classification presented by Ahmed et al. 2017 was used to record and classify the root canal morphology, followed by recording the differences regarding the age and gender of the patients. Comparison of canal morphology in lower permanent premolars and its association with gender and age of the patients was done by Chi-square test/ Fisher exact test; the significance level was set at 5% (p ≤ 0.05). RESULTS: The left mandibular 1st and 2nd premolars with one root were 47.31%, with two roots were 2.19%. However, three roots (0.24%) and C-shaped canals (0.24%) were reported only in the left mandibular 2nd premolar. The right mandibular 1st and 2nd premolars with one root were 47.56%, with two roots were 2.03%. The overall percentage of the number of roots and canals in the first and second premolars 1 PM 1 (88.38%), 2 PM 1 B 1 L 1 (3.5%), 2 PM B 1 L 1 (0.65%), 1 PM 1-2-1 (3.08%), 1 PM 1-2 (3.17%), 1 PM 1-2-1-2 (0.24%), 3 PMMB 1 DB 1 L1 (0.48%). However, the C-shaped canals (0.40%) were reported in right and left mandibular second premolars. No statistically significant difference was reported between mandibular premolars and gender. A statistically significant difference was reported between mandibular premolars and the age of the study subjects. CONCLUSION: Type I (1 TN 1) was the major root canal configuration in permanent mandibular premolars, which was higher among males. The CBCT imaging provides thorough details about the root canal morphology of lower premolars. These findings could support diagnosis, decision-making, and root canal treatment, for dental professionals.

An Insight into the Role of Marine Biopolymer Alginate in Endodontics: A Review.

Alginate is a natural marine biopolymer that has been widely used in biomedical applications, but research on its use as an endodontic material is still sparse in the literature. This pioneer review aims to summarize the emerging roles of alginate and to outline its prospective applications as a core biomaterial in endodontics. Ten electronic databases and five textbooks were used to perform a search of English-language literature on the use of alginate in endodontics published between January 1980 and June 2022. The risk of bias (RoB) of each included study was assessed using the Office of Health Assessment and Translation (OHAT) tool. Subsequently, studies were categorized into three tiers to represent the overall risk. Qualitative analysis was performed, and the articles were sorted into different thematic categories. An initial search yielded a total of 1491 articles, but only 13 articles were chosen. For most domains, all the studies were rated with 'probably low' or 'definitely low' RoB, except for domains 2 and 6. All included studies fall in the Tier 1 category and were either in vitro, in vivo, or ex vivo. Four thematic categories were identified: endodontic regeneration, intracanal medicament, filing material, and chelating agent. Based on the available evidence, alginate has emerged as a cell carrier and scaffold in regenerative endodontics, a microcapsule delivery system for intracanal medicaments, a chelating agent reinforcing material, and a root canal sealer. More well-designed experiments and clinical trials are needed to warrant the promising advent of this hydrogel-based biomaterial.

Vertical root fracture resistance and dentinal crack formation of root canal-treated teeth instrumented with different nickel-titanium rotary systems: an in-vitro study.

To compare the vertical root fracture (VRF) resistance of root canal-treated teeth instrumented with four different nickel-titanium (NiTi) rotary file systems and examine the dentinal crack pattern and direction using a new classification. Eighty mature mandibular premolars were selected and decoronated, leaving 13 mm of the root. The root samples were mounted in acrylic resin and divided randomly into five groups of different NiTi file systems: Group 1-control, Group 2-T-Pro, Group 3-HyFlex CM, Group 4-TG6 and lastly Group 5-ZenFlex. Samples in Group 2 and Group 3 were instrumented up to size 25/0.04, whereas Group 4 and Group 5 were instrumented up to size 25/0.06. Obturation was performed with AH Plus sealer and gutta-percha using single cone technique. Subsequently, all samples were subjected to occlusal compressive force until they were fractured. The force (N) needed to cause root fracture was recorded. The crack patterns and directions were also inspected under magnification and classified using a new and simple classification. The highest (VRF) resistance was noted in the control group (453.15 ± 92.23 N), followed by T-Pro (387.43 ± 76.81 N), HyFlex CM (381.88 ± 52.73 N), ZenFlex (369.15 ± 89.41 N) and finally TG6 (346.05 ± 72.08 N), but there was no significant difference between T-Pro and HyFlex (P = 0.438). A significantly higher prevalence (P = 0.001) of Type 1 crack pattern was observed, especially in samples instrumented with TG6. Majority of the cracks ran buccolingually except in some samples instrumented with ZenFlex (P = 0.898). Smaller file taper increased the VRF resistance of root canal-treated teeth. Majority of the dentinal crack exhibited Type 1 pattern and ran buccolingually.

Novel dental composite resin derived from rice husk natural biowaste: A systematic review and recommendation for future advancement.

OBJECTIVES: This review aimed to summarize contemporary evidence related to dental composite resin derived from rice husk biowaste and its potential future advancement. This review paper included the techniques for synthesis, characterization, and preparation of rice husk composite resin. Focus was also given to the flexural strength and modulus, compressive strength, wear rate, hardness, surface roughness, color stability, polymerization shrinkage, degree of conversion, and their application onto root canal treated teeth. MATERIAL AND METHODS: A search of English peer-reviewed literature (January 1960-February 2021) was conducted from electronic databases (PubMed Central, Cochrane, LILACS, Science Direct, Web of Science, SIGLE, EMBASE, EBSCO, Medline, and Google Scholar). RESULTS: 11 articles and a book section were finally selected for qualitative analysis. Studies concluded that the physicomechanical properties and the color stability of rice husk dental composites showed comparable results to conventional dental composites. Incorporation of zirconia nanopowder into rice husk dental composite increased the compressive strength and hardness values, associated with lower shrinkage, a high degree of conversion, and improved fracture strength when applied on root canal treated teeth. CONCLUSIONS: Due to its low cost, eco-friendliness, and acceptable clinical performances, rice husk dental composite resin can be considered as an alternative to conventional composites. CLINICAL SIGNIFICANCE: Dental composite resin derived from rice husk silica demonstrated excellent performance, which could potentially substitute currently available composite resins. This review will give new insight to clinicians and researchers on the usage of natural biowaste mass in the field of dental restorative materials.

Evaluation of root canal morphology in permanent maxillary and mandibular anterior teeth in Saudi subpopulation using two classification systems: a CBCT study.

BACKGROUND: Adequate knowledge of root canal morphology and possible variations is essential to achieve perfect root canal treatment and overcome treatment failure. Appropriate knowledge on root and canal morphology, communication, and documentation amongst dentists will be challenging from a diagnostic and successful treatment point of view. METHODS: A total of 3420 samples were included in this study from 285 cone-beam computed tomography images of the Saudi residents, including 171 males and 114 females aged 15 to 68 years from retrospective data dated from January 2018 to April 2021. The images were examined in sagittal, axial and coronal views using a 3D version software 1.0.10.6388. The number of canal and canal morphology was recorded using Vertucci and the new classification system. The SPSS 26 was used to conduct the statistical analysis as descriptive statistics such as mean; standard deviation and frequency were calculated. The Chi-square test analysed the data with the significance level set at 0.05. RESULTS: A total of 285 subjects participated in the study. Majority of the participants were Saudi nationals (80.7%), followed by Indian (7.4%), Pakistani (4.2%) and other nationalities. According to Vertucci and the new classification system, Type I and 1TN1 were the most common types, followed by Type III and Type IV, and then 1TN1-2-1 and 1TN1-2 in mandibular anteriors. The prevalence of canal variations in mandibular canine was higher in females than in males (P = 0.002). Maxillary laterals and mandibular anteriors showed the significant difference in the prevalence of root canal variation in relation to the ethnicity (P = 0.001) and age of the patients. Younger patients showed more variations than the older patients (P = 0.012, P = 0.023, P = 0.001, P = 0.001) in terms of maxillary laterals, mandibular central, laterals and canines, respectively. CONCLUSION: Mandibular permanent anteriors showed a wide range of canal variations and canal complexity. Males and females did not demonstrate a wide range of variation in the root canal morphology except for the canines in relation to the gender of the patients.

The existence of butterfly effect and its impact on the dentinal microhardness and crack formation after root canal instrumentation.

To compare the microhardness and crack formation in root dentine presented with butterfly effect in lower premolars. Sixty mature lower premolars were selected and divided into the control and experimental groups. Teeth in the experimental group were instrumented up to size 30/.04. The roots were cut horizontally into twelve parts of 1-mm-thick cross-section and were numbered accordingly. They were divided into coronal, middle, and apical root sections. Sections were then viewed under a microscope to determine the presence of butterfly effect and subsequently scored. 8 teeth from both control and experimental groups with the highest and lowest score were selected. Crack formation was inspected and classified into four different types of cracks. Microhardness test was performed using a Vickers hardness test. Higher frequency of butterfly effect was found in the apical root section and root dentine with butterfly effect were harder mesiodistally. The middle and apical root sections with butterfly effect were harder than the coronal section. No significant difference of dentine hardness between the control and experimental groups. Cracks only occurred in the experimental group and presented in buccolingual direction with a higher rate of Type 1 and Type 2 cracks. Prevalence of butterfly effect in lower premolars increased from coronal to apical with increased hardness mesiodistally. More buccolingual cracks were found in radicular dentine with butterfly effect and most of them exhibited Type 1 and Type 2 cracks. Roots of lower premolar with butterfly effect may be susceptible to a higher rate of vertical root fracture in buccolingual direction, especially after root canal treatment. Thus, special attention should be given not to overload instruments during root canal preparation.

Dislodgement resistance and adhesive pattern of different endodontic sealers to dentine wall after artificial ageing: an in-vitro study.

To compare the dislodgement resistance and the adhesive pattern of four different endodontic sealers to root dentine walls. Ninety lower premolars were assigned to five groups (n = 18), Group 1: no sealer (control); Group 2: EndoRez (ERZ); Group 3: Sealapex (SPX); Group 4: EndoSeal MTA (ESA) and Group 5: BioRoot RCS (BRS). They were instrumented up to size 30 taper 0.06 and obturated using single cone technique with matched-taper gutta-percha cones and one of the mentioned sealers. Six teeth from each group were then randomly subjected to 100, 1000 and 10,000 thermocycles, respectively. 1 mm slice of mid root region, measuring 6 mm from the apical foramen was prepared and subjected to push-out test under a Universal Testing Machine. Adhesive patterns of sealers were assessed using a stereomicroscope at 20 × magnification and classified using a new system. Statistical analyses were performed using two-way ANOVA, complemented by Tukey HSD and Chi-square tests. ESA and BRS showed significantly higher (p < 0.05) push-out bond strength, followed by SPX, ERZ and lastly the control, but no significant difference was noted between ESA and BRS (p > 0.05) at 100, 1000 and 10,000 thermocycles, respectively. Both ESA and BRS exhibited a significant higher rate (p < 0.05) of Type 3 and Type 4 adhesive patterns as the thermocycles increased. ESA and BRS demonstrated higher bond strength and better adhesive pattern to root dentine wall than SPX and ERZ, especially after artificial ageing.

Can perception of fractured endodontic files benefit 1st degree dental students and dental educators: A questionnaire-based survey.

PURPOSE: This study aimed (i) to assess the perception of dental undergraduate (1st degree dental students) learners about endodontic file separation (EFS) and knowledge of its avoidance, as well as (ii) to aid dental educators in conceptualizing and designing student-directed courses for better understanding. The rationale of this study was to provide both learners and educators with a tool to help self-assess/impart knowledge and devise simple yet innovative modern ways of teaching in the field of endodontics. The study utilized a self-reporting dataset from one institution to disclose this limitation. MATERIALS: A validated self-administered questionnaire from a previous study was converted into an online Google form link consisting of 15 multiple-choice questions. This was distributed to 100 Year 4 and Year 5 1st degree dental students. Pearson chi-square test was used for statistical analysis (p < 0.05). RESULTS: The response rate was 81%. The majority of the learners expressed that performing endodontic treatment in permanent (100%) posterior teeth of old-aged people causes EFS (95.1%). Ninety-nine percent answered that EFS was a gender-independent factor, 72.8% perceived that patient anxiety leads to EFS, and 88.9% said that the apical third was more prone to instrument fracture and had the poorest prognosis (95.1%). Hundred percent, 93.8%, 100%, 92.6%, 100%, and 97.5% of respondents, respectively, perceived that the role of operator, coronal flare, ethylenediaminetetraacetic acid (EDTA) gel, cleaning endodontic instrument, reusing instrument, and choice of instrument affects the occurrence of EFS. A total of 71.6% said hand files fractured, while 86.4% perceived that stainless steel alloy files separated easily, and 69.1% of learners perceived that EFS occurred often during the cleaning and shaping stage. CONCLUSIONS: The perception of 1st degree dental students regarding EFS and knowledge of its avoidance was good. Results from this study confirmed that the 1st degree dental students' clinical training courses and study modules adopted and designed by their dental educators were well-suited and appropriate.

Knowledge and attitude regarding obstructive sleep apnoea among medical and dental practitioners working in North-Eastern Peninsular Malaysia: A comparative cross-sectional study.

BACKGROUND: Obstructive Sleep Apnea (OSA) is a temporary airflow obstruction during periods of sleep. Patients with OSA often suffer from poor work performance, compromised sleep quality, and low quality of life which may lead to a life-threatening event. Adequate knowledge and a positive attitude toward OSA among medical and dental practitioners are crucial to the initial diagnosis and treatment. OBJECTIVE: This study aimed to identify the differences in knowledge and attitude toward OSA between medical and dental practitioners working in North-Eastern Peninsular Malaysia. METHODS: A comparative cross-sectional study was performed from February 2020 to February 2021. A total of fifty-two medical practitioners and fifty-two dental practitioners working at university-based outpatient clinics, government health clinics, and oral health clinics located in Kelantan State of Malaysia participated in the study, and data were collected by the structured questionnaire including sociodemographic inquiry and OSAKA questionnaire by non-probability stratified random sampling. The Mann-Whitney U test was used to compare knowledge and attitude scores between the two groups. RESULTS: The mean age of the respondents was 34.6 years. The current study shows that 92.3% of medical doctors and 96.1% of dental doctors were able to correctly answer the question "Most of the patients with OSA snore" a significant finding in our study. Only 1% of medical professionals could answer seventeen questions correctly with a median score of 11, and only 1% of dental professionals could answer sixteen questions correctly with a median score of 9. None of them could provide an accurate answer to all the knowledge questions. Medical and dental practitioners exhibited different knowledge levels on OSA (z- statistics=-4.39, U = 827.00 with p <  0.05, and effect size, r = 0.61). However, no significant differences were found in total knowledge score by gender (p-value>0.05), ethnicity (p-value>0.05), total service years (p-value>0.05), and training attended. In addition, significant differences in attitude levels between medical and dental practitioners have been observed (z-statistics=-3.42, U = 725.00 with p <  0.05, and effect size, r = 0.47). Nevertheless, no significant differences have been seen in total attitude score by ethnicity (p-value >  0.05), total service years (p-value >  0.05), attending training on OSA (p-value >  0.05), and professional status (p-value >  0.05) except gender (p-value <  0.05). CONCLUSION: A Significant difference is evident concerning knowledge and attitude toward OSA diagnosis and management between medical and dental practitioners working in North-Eastern Peninsular Malaysia. Medical practitioners in this study recorded a higher knowledge and attitude score compared to dental practitioners.

Application of two systems to classify the root and canal morphology in the human dentition: A national survey in India.

PURPOSE: To assess the application and accuracy of two systems (Vertucci et al. 1974 and Ahmed et al. 2017) in classifying the root and canal morphology of human dentition among final-year undergraduates, interns, and postgraduate dental students in India. METHODS: The survey was conducted using physical and online presentation modes in two phases. Phase 1; PowerPoint presentation (PPT), describing the most used classification system (Vertucci et al. 1974) and its supplementary types and Ahmed et al. (2017) classification. A single presenter delivered the PPT to participants, using either a projector in an auditorium/seminar hall (face-to-face) or an online platform (zoom meeting software). Phase 2 involved determining the students' responses. A questionnaire was distributed amongst the participants after the lecture and collected for analysis. Fisher's exact test was used to analyze the data statistically, and the significance level was set at 0.05 (p < 0.05). RESULTS: A total of 1082 participants were involved in this survey. Overall, 93% of study participants found that Ahmed et al. classification system was more practical and accurate than Vertucci et al. system and its supplemental configurations (p < 0.001). About 97% agreed that Ahmed et al. classification system aided in understanding root and canal morphology better than Vertucci's and its additional configurations, and they recommended to include in their curriculum (p < 0.001). CONCLUSIONS: In comparison to Vertucci's classification system and supplementary types, the undergraduate and postgraduate dental students, and interns in India agreed that Ahmed et al. classification system is more practical and accurate for classifying the root and canal morphology.

Dislodgment Resistance, Adhesive Pattern, and Dentinal Tubule Penetration of a Novel Experimental Algin Biopolymer-Incorporated Bioceramic-Based Root Canal Sealer.

The currently available bioceramic-based sealers still demonstrate low bond strength with a poor seal in root canal despite desirable biological properties. Hence, the present study aimed to determine the dislodgment resistance, adhesive pattern, and dentinal tubule penetration of a novel experimental algin-incorporated bioactive glass 58S calcium silicate-based (Bio-G) sealer and compared it with commercialised bioceramic-based sealers. A total of 112 lower premolars were instrumented to size 30. Four groups (n = 16) were assigned for the dislodgment resistance test: control, gutta-percha + Bio-G, gutta-percha + BioRoot RCS, and gutta-percha + iRoot SP, with exclusion of the control group in adhesive pattern and dentinal tubule penetration tests. Obturation was done, and teeth were placed in an incubator to allow sealer setting. For the dentinal tubule penetration test, sealers were mixed with 0.1% of rhodamine B dye. Subsequently, teeth were cut into a 1 mm-thick cross section at 5 mm and 10 mm levels from the root apex, respectively. Push-out bond strength, adhesive pattern, and dentinal tubule penetration tests were performed. Bio-G showed the highest mean push-out bond strength (p < 0.05), while iRoot SP showed the greatest sealer penetration (p < 0.05). Bio-G demonstrated more favourable adhesive patterns. No significant association was noted between dislodgment resistance and dentinal tubule penetration (p > 0.05).

Evaluation of push-out bond strength, dentinal tubule penetration and adhesive pattern of bio-ceramic and epoxy resin-based root canal sealers.

INTRODUCTION: Root canal sealing materials play a crucial role in an endodontic procedure by forming a bond between the dentinal walls and the gutta-percha. The current study aims to analyse the dentinal tubule penetration and adhesive pattern, including the push-out bond strength of six commercially available root canal sealers. METHODOLOGY: Eighty-four mandibular first premolars were split into seven groups (and n = 12), Group 1: Dia-Root, Group 2: One-Fil, Group 3: BioRoot RCS, Group 4: AH Plus, Group 5: CeraSeal, Group 6: iRoot SP, Group 7: GP without sealer (control). Two groups were made, one for dentinal tubule penetration and the other for push-out bond strength; the total sample size was one hundred sixty-eight. Root canal treatment was performed using a method called the crown down technique, and for obturation, the single cone technique was used. A confocal laser scanning microscope (Leica, Microsystem Heidel GmbH, Version 2.00 build 0585, Germany) was used to evaluate dentinal tubule penetration, and Universal Testing Machine was utilised to measure the push-out bond strength (Shimadzu, Japan) using a plunger size of 0.4 mm and speed of 1mm/min. Finally, the adhesive pattern of the sealers was analysed by HIROX digital microscope (KH-7700). Statistical analysis was carried out by a one-way Anova test, Dunnet's T3 test, and Chi-square test. RESULTS: Highest dentinal tubule penetration was noticed with One-Fil (p<0.05), followed by iRoot SP, CeraSeal, AH Plus, Dia-Root also, the most negligible value was recorded for BioRoot RCS. Meanwhile, BioRoot RCS (p<0.05) demonstrated the greater value of mean push-out bond strength, followed by One-fil, iRoot SP, CeraSeal, AH Plus and Dia-Root. Regarding adhesive pattern, most of the samples were classified as type 3 and type 4 which implies greater sealing ability and better adherence to the dentinal wall. However, BioRoot RCS revealed the most type 4 (p<0.05), followed by AH Plus, One-Fil, CeraSeal and Dia-Root. CONCLUSION: The highest dentinal tubule penetration was shown by One-Fil compared to other groups. Meanwhile, BioRoot RCS had greater push-out bond strength and more adhesive pattern than other tested materials.

Correction: Evaluation of push-out bond strength, dentinal tubule penetration and adhesive pattern of bio-ceramic and epoxy resin-based root canal sealers.

[This corrects the article DOI: 10.1371/journal.pone.0294076.].

Perception of Dental House Officers regarding Endodontic File Separation during Endodontic Treatment.

Background: Despite of having improved endodontic file designs as well as the reinforced metal alloy file structure, intracanal endodontic file separation (EFS) is still a very problematic and worrisome dental incident, which usually occurs without any visible signs of permanent deformation. Further, there have been conflicting reports regarding the clinical significance of leaving separated files within root canals. Aims: The aim of this study was to look into the current perceptions and awareness about file separation during endodontic treatment among the dental house officers (DHOs). Materials and Methods: A novel validated questionnaire comprising of 15 close-ended questions was distributed anonymously via Google Forms through email to 1100 DHOs across Pakistan. The questionnaire consisted of two parts: the first component (Section I) collected demographic data and the second component (Section II) investigated the causes of EFS during root canal treatment. Following the completion of socioeconomic information, including age and gender, the DHOs were asked to answer a few questions about the various reasons for endodontic instrument fracture. Results: A total of 800 responses were recorded, with an effective rate of 72.8%. The majority of the DHOs (p value < 0.001) perceived that endodontic instrument fracture occurred in the posterior (61.5%) and apical third of the canal (50.5%) and in older permanent dentition (67.3%), possibly due to patient anxiety (62%). Better choice of instrument (61.15%), operators' experience (95.3%), knowledge (87.5%), and proper root canal cleaning (91.1%) are believed to be the vital steps in reducing endodontic file separation/fracture. Furthermore, majority of them (p value < 0.001) perceived that stainless steel was a superior alloy for filing instruments. Manual files tend to be more prone to fractures due to repeated use than rotary files. Conclusion: This study demonstrated that young DHOs had adequate knowledge and awareness regarding the potential predisposing factors and handling techniques for EFS. This study thereby provides an evaluating tool to access the insights of the current perceptions and awareness of DHOs concerning EFS.

Bibliometric analysis: Root and root canal morphology using cone-beam computed tomography.

OBJECTIVES: This bibliometric analysis aimed to evaluate the leading nations, authors, journals, institutes, highly cited publications, and most commonly used keywords concerning scientific publications based on root and root canal morphology using the CBCT. MATERIAL AND METHODS: For this bibliometric analysis, an extensive search was carried out on September 25, 2023 using the Scopus database. Pertinent articles in the field were scrutinized after applying inclusion and exclusion criteria. Data were evaluated using Vosviewer and Microsoft Excel. RESULTS: A literature search revealed the initiation of scientific publication in 2008. Significant contributions made by Saudi Arabia, India, and China concerning the number of publications were seen. Similarly, Jazan University from SA was recognized as the leading institute. The Journal of Endodontics was the leading journal, while authors JNR Martins and G Gambarini produced the highest number of papers. CONCLUSIONS: This bibliometric analysis demonstrated that scientific publications have increased tremendously since 2008. Significant contributions have been made by developing and developed nations. The Journal of Endodontics and Jazan University have been identified as the leading journal and institute.

Fabrication and characterisation of novel algin incorporated bioactive-glass 58S calcium-silicate-based root canal sealer.

Background/purpose: The usage of bioceramic-based root canal sealers has escalated over the years due to their excellent properties. The present study aimed to fabricate a novel algin incorporated bioactive glass 58S calcium-silicate (Bio-G) sealer and characterise its surface microstructure and chemical compositions in comparison to commercially available bioceramic sealers (BioRoot RCS and iRoot SP). Materials and methods: The powder form of experimental Bio-G sealer consisted of synthesised BG 58S particle, calcium silicate, zirconia dioxide, calcium carbonate and alginic acid powder as binder. The liquid composed of 5% calcium chloride solution. Five standardised disc specimens were prepared for each sealer group according to the manufacturer's instructions. Subsequently, sealer disc-specimens were placed in an incubator at 37 °C, 95% relative humidity for 72 h to allow setting prior to testing under scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS), Fourier transformed infrared spectroscopy (FTIR) and X-ray diffraction (XRD). Results: Experimental Bio-G sealer revealed irregular micro-sized particles ranging from 0.5 µm to 105 µm aggregated in clusters comparable to those of BioRoot RCS and iRoot SP. EDS microanalysis showed that Bio-G had high content of oxygen, silicon, and calcium, with the presence of aluminium and chloride similar to BioRoot RCS. Meanwhile, the FTIR and XRD findings suggested that all sealers predominantly contained calcium silicate hydrate, calcium carbonate, and zirconium dioxide, while calcium aluminium silicate oxide was detected in Bio-G. Conclusion: The present novel Bio-G sealer demonstrated desirable particle size distribution and acceptable degree of purity. Future studies are warranted to explore its properties and clinical application.