Morphometric Analysis of the Mandibular Canal, Anterior Loop, and Mental Foramen: A Cone-Beam Computed Tomography Evaluation

This study investigated the cone-beam computed tomography (CBCT)-based features of the mandibular canal, mental foramen, anterior loop, and accessory mental foramina with respect to age and sex. A total of 306 CBCT mandibular images were included in this retrospective study to measure the mandibular canal location and extension, the mental foramen position, the presence of the anterior loop, and the accessory mental foramina. The measurements were obtained in sagittal, coronal, and axial views. Descriptive statistics are presented. Sex-related differences, correlations, and comparisons were calculated using SPSS at 5% significance level. The mandibular canal was located more coronal and medial in male patients. The majority of cases had the mental foramen located just apical to the mandibular second premolar with a mean height of 2.94 mm and a mean length of 3.28 mm. Age affected the size of the mental foramen. The mental canal in all cases tended to show a coronal direction. Mesial extension of the anterior loop was found in 66.01% of the images while accessory mental foramina were detected in 2.6%. The complexity of the mandibular canal, mental foramen, anterior loop, and accessory mental foramina among Sudanese patients with respect to age and sex was confirmed

The Antifungal Effect of Propolis Endodontic Irrigant with Three Other Irrigation Solutions in Presence and Absence of Smear Layer: An In Vitro Study

Introduction: the aim of this in vitro study was to compare the antifungal effect of propolis as an endodontic irrigant agent with a mixture of doxycycline, citric acid, and a detergent (MTAD), 2% chlorhexidine (CHX) and 3% sodium hypochlorite (NaOCl) against Candida albicans in presence and absence of smear layer. Methods and Materials: Extracted teeth with single canals (n=104) were prepared and randomly distributed into four experimental groups; 30% propolis, MTAD, 2% CHX and 3% NaOCl. Each group had two subgroups; with and without smear layer. The antifungal effectiveness was evaluated. The Kruskal-Wallis and Mann-Whitney tests were used to compare the overall effectiveness of different treatments at significance level of 0.05. Results: Propolis, CHX and NaOCl had similar levels of effectiveness to each other against C. albicans, and these levels were not affected by the presence or absence of the smear layer. Each irrigant was significantly more effective than MTAD or saline solution. MTAD was less effective in the presence of the smear layer than in its absence. Conclusions: Propolis irrigation can produce root canals that are free of C. albicans, even in the presence of the smear layer. Keywords: Candida albicans; Chlorhexidine; Irrigating Solution; Propolis; Smear Layer; Sodium Hypochlorit

The effect of reduced glutathione on the toxicity of silver diamine fluoride in rat pulpal cells

Introduction: Due to its ability to arrest untreated dental caries, silver diamine fluoride (SDF) has been advocated for indirect pulp capping procedures. However, the high concentrations of silver and fluoride in SDF raise concerns about its biocompatibility to pulpal tissues. Objectives: This study aimed to investigate the effect of SDF on the viability, alkaline phosphatase (ALP) activity, and morphology of pulpal-like cells (RPC-C2A) and to evaluate the influence of reduced glutathione (GSH) on SDF-induced cytotoxicity and deposit formation on dentin. Methodology: The cytotoxicity of diluted 38% SDF solutions (10-4 and 10-5), with or without the addition of 5 mM or 50 mM GSH, was evaluated at 6 and 24 hours. Cell viability was detected using WST-8 and the effect on ALP activity was performed using an ALP assay kit. Cell morphology was observed using a phase-contrast microscope. Scanning electron microscopy analysis was conducted to evaluate the effect of GSH incorporation or conditioning on SDF-induced deposit formation on dentin discs. Cytotoxicity data were analyzed by two-way analysis of variance (ANOVA) and Tukey post hoc tests (p<0.05). Results: There were significant differences between the groups. The results demonstrated that all tested SDF dilutions caused a remarkable cytotoxic effect, while the addition of GSH prevented SDF-induced damage at 6-hour exposure time in the higher dilution of SDF. Dentin treated with plain SDF or GSH-incorporated SDF solution showed deposit formation with occluded dentinal tubules, unlike the other groups. Conclusion: SDF severely disturbed the viability, mineralization-ability, and morphology of pulpal-like cells, while controlled concentrations of GSH had a short-term protective effect against SDF-induced damage. GSH showed an inhibitory effect on SDF-induced dentinal deposit formation. Further research is warranted to evaluate the effect of GSH on caries-arresting, anti-hypersensitivity, and antibacterial functions of SDF

Detecting the Second Mesiobuccal Canal in Maxillary Molars in a Saudi Arabian Population: A Micro-CT Study

The aim of this study was to determine MB2 canal detectability in maxillary first and second molars obtained from a Saudi population using micro-CT. Maxillary first (n=35) and second (n=30) molars were scanned with micro-CT technology. The number of canals was recorded, and in case of having more than one canal, the level of extracanal detection was analyzed. The presence of extracanal was categorized based on the level they were first detected. Among the maxillary first molars, 28 (80%) and six (17%) teeth had two and three MB canals, respectively. Among the maxillary second molars, 24 (80%) and four (13%) teeth had two and three MB canals, respectively. The MB2 canal was detected at the chamber floor in 70% and 61% of the maxillary first and second molars, respectively. At 1 mm depth, the MB2 canal was found in 15% and 18% of the maxillary first and second molars, respectively. At 2 mm depth, the MB2 canal was found in 3% and 18% of the maxillary first and second molars, respectively. The remaining teeth had the MB2 canal at levels deeper than 2 mm. The MB2 canal was detected in 97% and 93%% of maxillary first and second molars, respectively. Among them, the MB2 canal could be immediately detected in 70% and 61% of the maxillary first and second molars, respectively, once the pulp chamber is exposed. However, the rest of the MB2 were observed at deeper levels in the root and this requires troughing preparation in the chamber floor

Apical Gutta-percha cone adaptation and degree of tug-back sensation after canal preparation

Aims: The aim of this study was to investigate the degree of tug-back after canal preparation with respect to the Gutta-percha-occupied area (GPOA). Materials and Methods: Roots of twenty premolar teeth were prepared till size 35/0.04, then GP cones of same size and taper were adapted to root canals and the degree of tug-back sensation was scored as loose, slight, adequate, and strong. Root canals were filled with GP and AH26 sealer, and then sectioned horizontally 1 mm from the apical end at three levels. GPOA and its sum from the three levels sum of GPOA (sGPOA%) were calculated using digital stereomicroscope. Statistical Analysis: At each sectioned level, GPOA% was compared with the score of tug-back sensation using one-way ANOVA at a 5% significance level. Multiple pairwise comparisons were performed using Tukey test. Results: Tug-back sensation was present in all canals, described as slight, adequate, and strong in 4, 8, and 8 canals, respectively. Among the tug-back scores, quantitative analyses of GPOA% showed significant differences at 2- and 3-mm levels. The strong tug-back with sGPOA of 76.5 ± 11.1% was significantly higher than that of slight tug-back. Conclusions: Under the conditions of this study, the tug-back scoring system can be applied to determine the amount of GP adaptation inside the root canal. Strong tug-back sensation showed the highest GP adaptation although at least one-fifth of the apical canal region was left unfilled

Regenerative Endodontic Management of an Immature Molar Using Calcium Hydroxide and Triple Antibiotic Paste: a Two-Year Follow-Up

The regenerative endodontic procedure (REP) is considered a viable treatment option for immature teeth with necrotic pulp and periapical radiolucency which can facilitate continued root formation. In this report, an immature necrotic mandibular molar received REP in three appointments wherein chemomechanical debridement was performed with a sequential application of nonsetting calcium hydroxide (in the whole canal) and triple antibiotics paste (in the root’s middle third) dressings in the first and second appointments, respectively. In the third appointment, blood clots were created in the root canals. MTA was placed over the blood clots and the tooth was restored with a composite filling and stainless-steel crown. Recall appointments were performed for two years where the tooth was deemed asymptomatic clinically and a complete root formation with significant periapical healing was evident radiographically. More cases are required to warrant the feasibility of this disinfection protocol

Developments and Performance of Artificial Intelligence Models Designed for Application in Endodontics: A Systematic Review

Technological advancements in health sciences have led to enormous developments in artificial intelligence (AI) models designed for application in health sectors. This article aimed at reporting on the application and performances of AI models that have been designed for application in endodontics. Renowned online databases, primarily PubMed, Scopus, Web of Science, Embase, and Cochrane and secondarily Google Scholar and the Saudi Digital Library, were accessed for articles relevant to the research question that were published from 1 January 2000 to 30 November 2022. In the last 5 years, there has been a significant increase in the number of articles reporting on AI models applied for endodontics. AI models have been developed for determining working length, vertical root fractures, root canal failures, root morphology, and thrust force and torque in canal preparation; detecting pulpal diseases; detecting and diagnosing periapical lesions; predicting postoperative pain, curative effect after treatment, and case difficulty; and segmenting pulp cavities. Most of the included studies (n = 21) were developed using convolutional neural networks. Among the included studies. datasets that were used were mostly cone-beam computed tomography images, followed by periapical radiographs and panoramic radiographs. Thirty-seven original research articles that fulfilled the eligibility criteria were critically assessed in accordance with QUADAS-2 guidelines, which revealed a low risk of bias in the patient selection domain in most of the studies (risk of bias: 90%; applicability: 70%). The certainty of the evidence was assessed using the GRADE approach. These models can be used as supplementary tools in clinical practice in order to expedite the clinical decision-making process and enhance the treatment modality and clinical operation

Developments and Performance of Artificial Intelligence Models Designed for Application in Endodontics: A Systematic Review

Technological advancements in health sciences have led to enormous developments in artificial intelligence (AI) models designed for application in health sectors. This article aimed at reporting on the application and performances of AI models that have been designed for application in endodontics. Renowned online databases, primarily PubMed, Scopus, Web of Science, Embase, and Cochrane and secondarily Google Scholar and the Saudi Digital Library, were accessed for articles relevant to the research question that were published from 1 January 2000 to 30 November 2022. In the last 5 years, there has been a significant increase in the number of articles reporting on AI models applied for endodontics. AI models have been developed for determining working length, vertical root fractures, root canal failures, root morphology, and thrust force and torque in canal preparation; detecting pulpal diseases; detecting and diagnosing periapical lesions; predicting postoperative pain, curative effect after treatment, and case difficulty; and segmenting pulp cavities. Most of the included studies (n = 21) were developed using convolutional neural networks. Among the included studies. datasets that were used were mostly cone-beam computed tomography images, followed by periapical radiographs and panoramic radiographs. Thirty-seven original research articles that fulfilled the eligibility criteria were critically assessed in accordance with QUADAS-2 guidelines, which revealed a low risk of bias in the patient selection domain in most of the studies (risk of bias: 90%; applicability: 70%). The certainty of the evidence was assessed using the GRADE approach. These models can be used as supplementary tools in clinical practice in order to expedite the clinical decision-making process and enhance the treatment modality and clinical operation