Management of radix entomolaris on permanent mandibular first molar complicated with ledge: a case report

Radix entomolaris is a supernumerary root located distolingually on permanent mandibular molars. It is considered as an anatomical variant and usually curved buccolingually. The presence of radix entomolaris can be endodontically challenging to treat and susceptible to endodontic mishaps such as ledge. This report describes the management of ledge in a radix entomolaris with type-3 curvature on tooth 46. Ledge was bypassed using pre-curved K-files #10, #15, and #20 sequentially and preparation was continued using step-back technique. Then, the root canal was obturated using gutta percha and root canal sealer. Diagnostic and clinical challenges in managing radix entomolaris, and prevention and management of ledge were also discussed

Endodontic-orthodontic interrelationship: a review.

The endodontic-orthodontic interface is not well understood due to the limited scientific literature on the topic. This article aims to provide an overview of the orthodontic treatment and the risk of root resorption, the effects of orthodontic tooth movement on dental pulp and endodontically treated teeth, the role of orthodontics in endodontic-restorative treatment planning, and interdisciplinary patient management. Articles published in English from 1982 to 2021 were searched manually from google scholar using keywords ‘endodontic-orthodontic interface’ and ‘endodontic-orthodontic interrelationship’. Another search engine was MEDLINE/PubMed database using keywords ‘endodontics AND orthodontics’, ‘orthodontic tooth movement AND dental pulp’, 'orthodontic tooth movement AND endodontic treatment' and 'orthodontics AND dental trauma'. Other relevant articles were obtained from the references of the selected papers. Alterations to the dental pulp following orthodontic tooth movement can be histologic and/or cell biological reactions as well as the increased response threshold to pulp sensibility tests. However, the occurrence of root resorption is complex and multifactorial, and can be linked to individual variation, genetic predisposition and orthodontic treatment-related factors. Endodontically treated teeth can move as readily and respond similarly to orthodontic forces as vital teeth, however with inadequate endodontic treatment, the risk of apical inflammation and bone destruction following orthodontic tooth movement is increased. Dental treatment that involves endodontic and orthodontic specialities should be carefully planned according to the individual case, taking into consideration the skills and experience of the clinicians while applying interdisciplinary patient management and available scientific data

A pilot study on expectation and satisfaction of denture patients in IIUM dental clinic

A patient’s expectations can profoundly affect the satisfaction with a new denture construction. Previous studies have stated that prosthetic treatment failures occur not because of the clinical and technical problems but due to unrealistic expectations of the patient who expects the denture to be comparable to the natural dentition functionally and aesthetically. It is vital to determine the level of patient expectations and educate them so that their expectation could be kept at a reasonable level. In addition, this could ensure high satisfaction with the dental treatment. The objective of the study was to determine the patient expectation and satisfaction before and after denture construction. This research involves 40 patients who received one or a pair of complete dentures at the Kuliyyah of Dentistry, IIUM. The subjects were divided into two groups, a tested and a control group. The tested group received an informational pamphlet and none for the control group. Patients with partial dentition on both arches and patients with severe gag reflex were excluded from this study. The level of expectation and satisfaction of the patient toward the prosthesis was measured by using a self-administered questionnaire. There was no significance differences of expectation and satisfaction shown between the tested and control groups before treatment. However, after a session of denture education by using an informational pamphlet, the level of expectation reduced, and the level of satisfaction increased slightly in the tested group. The use of informational pamphlets during denture education does give a positive impact on the outcome of prosthodontics treatment

In vitro cytotoxicity analysis of bioceramic root canal sealers on human gingival fibroblast cells

Cytotoxicity of various bioceramic root canal sealers are not well understood due to the limited scientific data. Previous research focused on comparing the conventional and bioceramic root canal sealers but there was no comparison between the latter. The aim of this study is to evaluate the cytotoxicity of bioceramic root canal sealers and to propose the material that is less cytotoxic for clinical purposes. Bioceramic root canal sealers, such as GuttaFlow Bioseal, MTA Fillapex, CeraSeal Bioceramic root canal sealer and iRoot SP root canal sealer were mixed according to the manufacturers’ instructions and placed into a sterilised cylindrical silicone mold with 5 mm diameter and 3 mm thickness. Fourier transform infrared spectroscopy was used to analyse changes in the quality and consistency of all the bioceramic root canal sealers. Human gingival fibroblast cells were cultivated and exposed to material extracts for 24 h, 48 h and 72 h in a 5% CO2 humidified incubator at 37 °C. The MTT (3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide) assay was conducted to determine cell viability at each incubation period and compared between all the bioceramic root canal sealers. The cell viability was qualitatively graded as severe ( 90%). The data were analysed using Statistical Package for Social Sciences, version 25.0. GuttaFlow Bioseal showed less cytotoxicity followed by CeraSeal Bioceramic root canal sealer, iRoot SP root canal sealer, and MTA Fillapex. Clinicians should select bioceramic root canal sealers that have low cytotoxic effects during root canal treatment procedure

In vitro cytotoxicity analysis of bioceramic root canal sealers on human gingival fibroblast cells

Cytotoxicity of various bioceramic root canal sealers are not well understood due to the limited scientific data. Previous research focused on comparing the conventional and bioceramic root canal sealers but there was no comparison between the latter. The aim of this study is to evaluate the cytotoxicity of bioceramic root canal sealers and to propose the material that is less cytotoxic for clinical purposes. Bioceramic root canal sealers, such as GuttaFlow Bioseal, MTA Fillapex, CeraSeal Bioceramic root canal sealer and iRoot SP root canal sealer were mixed according to the manufacturers’ instructions and placed into a sterilised cylindrical silicone mold with 5 mm diameter and 3 mm thickness. Fourier transform infrared spectroscopy was used to analyse changes in the quality and consistency of all the bioceramic root canal sealers. Human gingival fibroblast cells were cultivated and exposed to material extracts for 24 h, 48 h and 72 h in a 5% CO2 humidified incubator at 37 °C. The MTT (3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide) assay was conducted to determine cell viability at each incubation period and compared between all the bioceramic root canal sealers. The cell viability was qualitatively graded as severe ( 90%). The data were analysed using Statistical Package for Social Sciences, version 25.0. GuttaFlow Bioseal showed less cytotoxicity followed by CeraSeal Bioceramic root canal sealer, iRoot SP root canal sealer, and MTA Fillapex. Clinicians should select bioceramic root canal sealers that have low cytotoxic effects during root canal treatment procedure

Guttaflow bioseal as monocone obturation technique in curved root canals. A scanning electron microscopy study.

The obturation with GuttaFlow Bioseal (GFB) in curved root canals is not clearly investigated due to the new generation of root filling material. This study compared the obturated surface area, extrusion of root filling material beyond the apical foramen and duration of obturation procedure in curved root canals using monocone obturation technique. Access cavity was prepared on twenty human mandibular molars. The root canal curvature of more than 10 determined according to Schneider’s method was included. Samples were prepared using Hyflex CM rotary files and divided into two groups (n=10). Group 1 [gutta-percha (GP) cone and GFB] and Group 2 [GP cone and RoekoSeal Automix root canal sealer]. The duration of obturation procedure was recorded and the obturation radiograph was taken. Samples were bisected and the mesial roots were sectioned horizontally to obtain 3 root segments; apical, middle and coronal. All resected roots were mounted on brass stubs, sputter-coated with thin platinum coating and observed under scanning electron microscope (SEM) at 70x magnification. The SEM images were transferred to the SketchAndCalc Area Calculator software. There were no statistically significant differences on the obturated surface area and extrusion of root filling material between Group 1 and 2 irrespective of the status of root canal curvature. The duration of obturation procedure in severe root canal curvature between Group 1 and 2 exhibited statistically significant difference. The obturated surface area and extrusion of root filling material were not affected by the status of root canal curvature. The duration of obturation procedure with GFB in severe root canal curvature was slightly longer. Neither root filling material was able to seal the curved root canal of mandibular molars completely. Both root filing materials in the present study can be opted depending on the clinical cases, material availability and clinician preference

GuttaFlow Bioseal versus Monocone Obturation Technique. A Scanning Electron Microscopy Study.

Introduction: The adaptation of GuttaFlow Bioseal in root canal system is poorly understood due to the limited evidence and further investigation may provide better insights. This study compared sealing ability, extrusion of root filling materials beyond apical foramen and duration of time required for obturation between GuttaFlow Bioseal and monocone obturation techniques. Materials and methods: The root canals of twenty single-rooted mandibular premolars were prepared using Hyflex CM rotary files (Coltène/Whaledent). Then, the samples were equally divided into two groups; GuttaFlow Bioseal and monocone. The roots were sectioned at perpendicular direction to obtain 3 root segments; coronal 1/3, middle 1/3 and apical 1/3. All resected roots were mounted on brass stubs, sputter-coated with thin gold coating and observed under scanning electron microscope (Zeiss EVO50, Germany) at 20x magnification. All images were transferred to the SketchAndCalc Area Calculator software and the root canals sealed with root filling materials were evaluated. The data was analysed with SPSS version 23.0. Results: The mean score of root canals sealed with root filling materials ranged from 81.90 to 89.31 with no statistically significant difference at any level of evaluation. The mean proportion of extrusion of root filling materials between GuttaFlow Bioseal and monocone were 0.4 and 0.5 respectively, with no statistically significant difference. Meanwhile, the mean proportion of duration of obturation between GuttaFlow Bioseal and monocone were 134.3 and 143.9 respectively with no statistically significant difference. Conclusion: The sealing ability, the extrusion and the duration of obturation between Guttaflow Bioseal and monocone were comparable