General Dental Practitioners’ Knowledge about the Emergency Management of Dental Trauma

Introduction: The aim of this descriptive cross-sectional study was to assess the general dental practitioners (GDPs)’s knowledge regarding the emergency management of traumatic dental injuries (TDI) in Isfahan, Iran. Methods and Materials: In this study a two-part questionnaire consisting of 14 questions was distributed among 241 GDPs. Part 1 included seven questions focusing on personal and professional information and part 2 asked questions about seven given cases of dental traumas. One score was dedicated to each correct answer; the total score of 0 to 4 was considered as poor knowledge, while scores 5-8, 9-11 and 12-14 were assigned as moderate, good and excellent knowledge, respectively. The data were analyzed using the Student’s t-test and one-way ANOVA. Spearman’s and Pearson’s correlation coefficient were used to determine the associations between the emergency treatment knowledge and dentists’ professional information. Results: With regards to the level of GDP’s knowledge, the mean score was 7.61±2.68 suggesting a moderate score; a total of 177 (73.2%) of the dentists showed a moderate level of knowledge. A significant association was found between the frequency of dental trauma cases that were encountered and treated by GDPs in their daily practice (P=0.004, r=0.2). Conclusion: The overall knowledge of GDPs about the emergency management of TDI in the selected community was moderate

Scanning Electron Microscopic Evaluation of Residual Smear Layer Following Preparation of Curved Root Canals Using Hand Instrumentation or Two Engine-Driven Systems

Introduction: In this experimental study, the amount of smear layer (SL) remnants in curved root canals after chemomechanical instrumentation with two engine-driven systems or hand instrumentation was evaluated. Methods and Materials: Forty-eight mesiobuccal roots of mandibular first molars with curvatures ranging between 25 and 35 degrees (according to Schneider’s method) were divided into three groups (n=16) which were prepared by either the ProTaper Universal file series, Reciproc single file system or hand instrumentation. The canals were intermittently irrigated with 5.25% NaOCl and 17% (ethylenediaminetetraacetic acid) EDTA, followed by distilled water as the final rinse. The roots were split longitudinally and the apical third of the specimens were evaluated under 2500× magnification with a scanning electron microscope (SEM). The mean scores of the SL were calculated and analyzed using the non-parametric Kruskal-Wallis and Mann-Whitney U tests. Results: The mean scores of the SL were 2.00±0.73, 1.94±0.68 and 1.44±0.63 µm for the ProTaper Universal, Reciproc and hand instrumentation, respectively. Mean score of SL was significantly less in the hand instrumentation group than the ProTaper (P=0.027) and Reciproc (P=0.035) groups. The difference between the two engine-driven systems, however, was not significant (P=0.803). Conclusion: The amount of smear layer in the apical third of curved root canals prepared with both engine-driven systems was similar and greater than the hand instrumentation technique. Complete cleanliness was not attained.Keywords: Canal Preparation; Endodontics; Irrigants; Scanning Electron Microscopy; Smear layer

A Survey on the Knowledge and Attitude of Iranian Endodontists toward Evidence Based Dentistry in 2017

Objectives Dentists make clinical decisions about dental cares on a daily basis. Thus, the best scientific evidence should be used to maximize the probability of successful patient care outcomes. The aim of this study was to evaluate the knowledge and attitude of endodontists towards evidence-based dentistry in Iran in 2017. Methods First a questionnaire was designed by the researchers. To evaluate the quality of the questionnaire, it was sent to six experts and they were asked to comment on each question. After collecting the questionnaires via e-mail, for each question, the statistics were determined by the expert and the reliability of the questionnaire was determined using the Cronbach's alpha coefficient. The target population of this cross-sectional study was the Iranian endodontists. Data were analyzed by SPSS software, and the frequency and descriptive indexes were used to evaluate the study variables (α=0.05). Results The mean score of knowledge of endodontists about evidence-based dentistry was 63.43±13.7 (out of 100) and the mean score of their attitude towards evidence-based dentistry was 62.22±18.5. Conclusion The results of this study revealed low level of knowledge and attitude of endodontists towards evidence-based dentistry, which is consistent with the results of studies conducted in other countries

Anesthetic Efficacy of Articaine and Ketamine for Inferior Alveolar Nerve Block in Symptomatic Irreversible Pulpitis: A Prospective Randomized Double-Blind Study

Introduction: The aim of this prospective, randomized, double-blind study was to investigate the effect of articaine combined with ketamine on the success rate of inferior alveolar nerve block (IANB) in posterior mandible teeth with symptomatic irreversible pulpitis. Methods and Materials: Forty two adult patients with diagnosis of symptomatic irreversible pulpitis of a mandibular posterior tooth were selected. The patients received two cartridges of either containing 3.2 mL 4% articaine with epinephrine 1:200000 and 0.4 mL 50 mg/mL ketamine hydrochloride (A-ketamine group) or 3.2 mL 4% articaine with epinephrine 1:200000 and 0.4 mL normal saline (A-saline group) using conventional IANB injections. Access cavity preparation started 15 min after injection. Lip numbness was required for all the patients. Success was considered as no or mild pain on the basis of Heft-Parker visual analog scale recordings upon access cavity preparation or initial instrumentation. Data were analyzed by independent student t, Mann-Whitney and Chi-square tests. Results: The success rates were 55% and 42.9% for A-ketamine and A-saline group, respectively, with no significant differences between the two groups (P=0.437). Conclusion: Adding 0.4 mL 50 mg/mL ketamine hydrochloride to the articaine local anesthetic did not increase the efficacy of IANB for posterior mandibular teeth with symptomatic irreversible pulpitis.Keywords: Articaine; Inferior Alveolar Nerve Block; Irreversible Pulpitis; Ketamin

Root Morphology and Canal Configuration of First and Second Maxillary Molars in a Selected Iranian Population: A Cone-Beam Computed Tomography Evaluation

Introduction: The aim of this investigation was to evaluate root canal morphology of maxillary first and second molars and also to assess the prevalence and morphology of the second mesiobuccal canal (MB2) in these teeth, using cone-beam computed tomography (CBCT). Methods and Materials: In this cross-sectional study, the total of 470 CBCT images from the archive of Radiology Department of Isfahan University of Medical Sciences (IUMS), Iran, was evaluated and 295 images were selected. The number of roots, and canal configuration were determined based on Vertucci’s classification system. The data was analyzed using SPSS 20, and P-values less than 0.05 were considered significant. Results: A total of 295 images from 295 patients (165 females and 130 males), including 389 maxillary first (197 right and 192 left) and 460 maxillary second (235 right and 225 left) molars were evaluated. The prevalence of MB2 canals were 70.2% and 43.4% in the maxillary first and second molars, respectively. The most common type of Vertucci’s classification was type II (53.1%), followed by type I. Conclusion: The second mesiobuccal canal was present in almost two thirds of first and less than half of second molars. The morphology and canal configuration of a maxillary molar can almost predict the morphology of contralateral molar. However, it does not relate to the ipsilateral molar.Keywords: Cone-Beam Computed Tomography; Maxillary Molar; Mesiobuccal Canal; Root Canal Configuratio

Artificial intelligence in detecting mandibular fractures: A review of literature

Background: Mandibular fractures are a common trauma in oral and maxillofacial surgery. The accurate diagnosis of these fractures is crucial for successful treatment. However, the interpretation of radiographic scans can be time-consuming and prone to human error. The advent of artificial intelligence (AI), specifically Convolutional Neural Networks (CNNs), has opened up new possibilities for improving the accuracy and efficiency of fracture detection.Objectives: This review aims to explore the role of AI in detecting mandibular fractures.Methods: A comprehensive literature search was performed using PubMed, Embase, Web of Science, and Google Scholar databases. Studies were included if they used AI techniques, specifically CNNs or transformers, for the detection of mandibular fractures.Results: The systematic search yielded 53 studies, with eight studies meeting the inclusion criteria. The AI models across these studies demonstrated a generally high degree of effectiveness in detecting mandibular fractures, with F1 scores ranging from 45% to 100%. Some studies also compared the diagnostic prowess of human clinicians and AI models, with AI models often matching or surpassing human performance.Conclusion: The application of AI in detecting mandibular fractures represents a promising avenue of research. AI models have the potential to reduce the workload of radiologists, improve the efficiency of fracture detection, and lead to faster diagnosis and treatment. However, further research is needed to validate these findings in larger and more diverse datasets and to address challenges such as the interpretability of AI algorithms and the availability of large, well-annotated datasets

Prevalence of Apical Periodontitis in Different Communities: A Meta-Analysis

Introduction: The aim of this study was to perform a meta-analysis on the prevalence of apical periodontitis (AP) in different communities to obtain accurate data on its prevalence. Methods and Materials: The prevalence of AP in different communities based on the number of individuals, teeth and root-filled teeth was searched using electronic databases of ISI Web of Knowledge, PubMed, Scopus and also ProQuest and Springer. The Metaprop meta-analysis was done using the software R version 3.3.0 with Meta package. The Logit transformation method and random-effects model were used to calculate the pooled prevalence. Heterogeneity was tested by the Q-test (P<0.1 represented statistical significance), I2 statistics (25%, 50% and 75% represented low, medium and high heterogeneity, respectively) and 2τ (2τ was calculated by DerSimonian-Laird estimator method). Results: A total of 77 studies were identified to qualify for inclusion into this meta-analysis. The prevalence of AP based on the number of individuals, teeth and root-filled teeth with the pooled prevalence was 0.519, 0.0498 and 0.3828, respectively. Conclusions: The results of the present study can be helpful for policy makers to monitor the dental public health demographically and compare it to other communities; they may be able find the strengths and drawbacks of their oral and dental health program.Keywords: Meta-Analysis; Periapical Periodontitis; Root Canal Therap

Isolation and differentiation of adipose-derived stem cells into odontoblast-like cells: a preliminary in vitro study

Objective The aim of present study was to isolate and differentiate human adipose-derived stem cells (ASCs) into odontoblast-like cells. Materials and Methods In this experimental study, human adipose tissues were taken from the buccal fat pad of three individuals (mean age: 24.6 ± 2.1 years). The tissues were transferred to a laboratory in a sterile culture medium, divided into small pieces and digested by collagenase I (2 mg/mL, 60-90 minutes). ASCs were isolated by passing the cell suspension through cell strainers (70 and 40 µm), followed by incubation at 37ºC and 5% CO2in Dulbecco’s modified eagle medium (DMEM) supplemented with fetal bovine serum (FBS 5%) and penicillin/streptomycin (P/S). After three passages, the ASCs were harvested. Subsequently, flow cytometry and reverse transcriptase polymerase chain reaction (RT-PCR) were used to detect expression levels of NANOG and OCT4 to evaluate stemness. Then, a differentiation medium that included high-glucose DMEM supplemented with 10% FBS, dexamethasone (10 nM), sodium β-glycerophosphate (5 mM) and ascorbic acid (100 µM) was added. The cells were cultivated for four weeks, and the odontogenic medium was changed every two days. Cell differentiation was evaluated with Alizarin red staining and expressions of collagen I (COL1A1), dentin sialophosphoprotein (DSPP) and dentin matrix protein-1 (DMP1). Results The ASCs were effectively and easily isolated. They were negative for CD45 and positive for the CD105 and CD73 markers. The ASCs expressed OCT4 and NANOG. Differentiated cells highly expressed DSPP, COL1A1 and DMP1. Alizarin red staining revealed a positive reaction for calcium deposition. Conclusion ASCs were isolated successfully in high numbers from the buccal fat pad of human volunteers and were differentiated into odontoblast-like cells. These ASCs could be considered a new source of cells for use in regenerative endodontic treatments

Science map of Cochrane systematic reviews receiving the most altmetric attention score: a network analysis

The present study aimed to analyze and visualize the science map of Cochrane systematic reviews (CSRs) with high Altmetric attention score (AAS). On 2020-07-29, the altmetric data of the Cochrane Database of Systematic Reviews were obtained from the Altmetric database (Altmetric LLP, London, UK). Bibliometric data of the top 5% AAS of CSRs were extracted from the Web of Science. Keyword co-occurrence, co-authorship and co-citation network analyses were then employed using VOSviewer software. The random forest model was used to rank the importance of the altmetric resource. A total of 11222 CSRs with AAS were found (Total mentions: 305265), with Twitter being the most popular Altmetric resource. Consequently, the top 5% AAS (649 articles, mean AAS: 204.95, 95% confidence level: 18.95, mean citations: 123.68, 95% confidence level: 13.9) were included. Density mapping revealed female, adult and child as the most popular author keywords. According to network visualization, Helen V. Worthington (University of Manchester, Manchester, UK), the University of Oxford and UK had the greatest impact on the network at the author, organization and country levels respectively. AAS were weekly correlated with citations (rs=0.21) although citations were moderately correlated with policy document and blog mentions (rs=0.46 and rs=0.43). Cochrane systematic reviews received high levels of online attention, particularly in the Twittersphere and mostly from the UK. However, CSRs were rarely publicized and discussed using recently developed academic tools, such as F1000 prime, Publons and PubPeer

MicroRNAs-mediated regulation of the differentiation of dental pulp-derived mesenchymal stem cells: a systematic review and bioinformatic analysis

Background: Human dental pulp-derived mesenchymal stem cells (hDP-MSCs), which include human dental pulp stem cells (hDPSCs) and stem cells from human exfoliated deciduous teeth (SHEDs), are promising cell sources for regenerative therapies. Nevertheless, a lack of knowledge relating to the mechanisms regulating their differentiation has limited their clinical application. microRNAs (miRNAs) are important regulatory molecules in cellular processes including cell differentiation. This systematic review aims to provide a panel of miRNAs that regulate the differentiation of hDP-MSCs including hDPSCs and SHEDs. Additionally, bioinformatic analyses were conducted to discover target genes, signaling pathways and gene ontologies associated with the identified miRNAs. Methods: A literature search was performed in MEDLINE (via PubMed), Web of Science, Scopus, Embase and Cochrane Library. Experimental studies assessing the promotive/suppressive effect of miRNAs on the differentiation of hDP-MSCs and studies evaluating changes to the expression of miRNAs during the differentiation of hDP-MSCs were included. miRNAs involved in odontogenic/osteogenic differentiation were then included in a bioinformatic analysis. A miRNA-mRNA network was constructed, and Gene Ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were performed. A protein–protein interaction (PPI) network was also constructed. Results: Of 766 initially identified records through database searching, 42 and 36 studies were included in qualitative synthesis and bioinformatic analyses, respectively. Thirteen miRNAs promoted and 17 suppressed odontogenic/osteogenic differentiation of hDP-MSCs. hsa-miR-140-5p, hsa-miR-218 and hsa-miR-143 were more frequently reported suppressing the odontogenic/osteogenic differentiation of hDP-MSCs. hsa-miR-221 and hsa-miR-124 promoted and hsa-miR-140-5p inhibited neuronal differentiation, hsa-miR-26a-5p promoted and hsa-miR-424 suppressed angiogenic differentiation, and hsa-miR-135 and hsa-miR-143 inhibited differentiation within myogenic lineages. A miRNA-mRNA network including 1890 nodes and 2171 edges was constructed. KEGG pathway analysis revealed MAPK, PI3K-Akt and FoxO as key signaling pathways involved in the odontogenic/osteogenic differentiation of hDP-MSCs. Conclusions: The findings of this systematic review support the potential application of the specific miRNAs to regulate the directed differentiation of hDP-MSCs in the field of regenerative therapies