Endodontics

What opinions do Saudi endodontic residents hold about regenerative endodontics? Saeed S Al Qahtani, Salman Aziz, Hmoud Al Garni, Mohammed Sulmain Alaenazi Saudi Endodontic Journal 2019 9(1):1-7 Aim: The aim of this study is to investigate the opinions, current knowledge, and expectations of Saudi endodontic residents regarding the use of regenerative endodontics as part of future dental treatment and establishing a baseline for further research and development. Materials and Methods: Saudi endodontic residents all over Kingdom of Saudi Arabia (KSA) were contacted, for participation. A survey form consisting of 28 questions was personally distributed to all endodontic residents who were actively enrolled in a residency training program either Saudi board program or Master Degree and provided informed consent for inclusion into the study. Data were collected and statistical analysis was carried out using SPSS version 22. Results: Out of one hundred and fifteen endodontic residents 97 participated in this questionnaire-based survey. Two forms were excluded due to incomplete and unclear information. Out of the remaining 95 majority of the residents were male (67.4%) and belonged to Saudi board program. The greater part of residents agreed for the inclusion of regenerative endodontics in the dental curricula. Most of the candidates wanted to improve their skills in regenerative endodontics by participating in continuing dental education programs. The most popular belief (n = 81) was that regenerative therapy to save teeth is better than implants. Use of regenerative procedures in clinics was carried out by only 44 participants. Conclusion: The emerging importance of regenerative endodontics in KSA is evident through this study. This study highlights many core issues which need attention and forms a baseline for further research in regenerative endodontics.

Removal ability of MTA-, bioceramic-, and resin-based sealers from obturated root canals, following XP-endo® Finisher R file: An ex vivo study Taxiarchis G Kontogiannis, Nikolaos P Kerezoudis, Konstantinos Kozyrakis, Elefterios Terry. R. Farmakis Saudi Endodontic Journal 2019 9(1):8-13 Aim: Removability assessment of mineral trioxide aggregate (MTA)-, bioceramic-, and epoxy resin-based sealers, with or without XP-endo® Finisher R file, was achieved. Materials and Methods: One hundred and twenty extracted single-rooted premolars were randomly organized into three equal groups, instrumented up to #40.04 and obturated with single-cone technique by gutta-percha and one of the following sealers: MTA Fillapex, TotalFill BC Sealer, or AH Plus. Following setting of the sealer, D-RaCe instruments were used in retreating all specimens. In half of the specimens, XP-endo® Finisher R file was additionally applied following D-RaCe, as a final step in retreatment. Working length (WL) following the procedure and patency were recorded. All specimens were split and observed for residuals under optical microscopy. Images were acquired, placed adjacent to each other forming continuous strips, and focus stacked with Helicon Focus software. A blinded observer evaluated all photographs. Analysis included Chi-square tests and one-way ANOVA. Results: WL was fully regained in all cases. Patency regaining (in terms of canal cleanness) was easier in AH Plus groups. Residuals were significantly more in TotalFill groups (P < 0.0001). XP-endo® Finisher R file improved removal only in the AH Plus subgroup. Conclusions: TotalFill residuals were harder to remove than those from MTA Fillapex or AH Plus groups. Patency is also harder to regain. XP-endo® Finisher R file had a positive removal influence only in the AH Plus subgroup.

Restorative methods to rehabilitate endodontically treated posterior teeth by students and new graduates of King Saud University: A survey study Sahar A AlZain Saudi Endodontic Journal 2019 9(1):14-20 Aim: The aim of the study was to evaluate the efficiency of dental students and new graduates of College of Dentistry, King Saud University, in Riyadh, Saudi Arabia, to select the appropriate methods of restoring endodontically treated posterior teeth (ETPT) at different conditions of remaining sound tooth structure. Materials and Methods: A questionnaire was distributed among the 4th- and 5th-year dental students and new graduates. Respondents were requested to indicate their gender and level of education and to select the preferred restoration of ETPT at different conditions. Results were analyzed using one-way frequency and two-way cross-tabulations. Results: At >50% tooth remaining (condition A), 39.9% of the respondents preferred to use an amalgam restoration, while 30.9% preferred to use a restoration followed by a crown at 50% of remaining tooth (condition B). At <50% tooth remaining (condition C), 74.6% preferred to use a cast post-and-core and a crown. Respondents changed their choices of restoration to more advanced ones when teeth served as abutments for fixed or removable prostheses. Chi-square analysis demonstrated a statistically significant relationship between the selected restorative method at condition A and both gender (P = 0.045) and level of education (P = 0.001), between the method of restoration at condition B and both the gender (P = 0.000) and the level of education (P = 0.003), and between the selected restorative method at condition C and the level of education (P = 0.000). Conclusions: Respondents demonstrated a high knowledge when selecting the appropriate method of restoring ETPT at different clinical conditions.

Comparative evaluation of shaping ability of rotary and reciprocating nickel-titanium single file instruments on simulated root canals Arvind Kumar, A Sheerin Sarthaj Saudi Endodontic Journal 2019 9(1):21-26 Introduction: Effective cleaning of the root canal system is the primary objective of rotary instrumentation. For three-dimensional obturation of the root canal system, ideal preparation should have a continuously tapering funnel shape from the orifice to the apex. The study aimed to evaluate the shaping ability of two rotary and two reciprocating nickel-titanium (NiTi) single-file instruments on simulated root canals using image analysis software. Materials and Methods: Forty resin blocks with simulated canals of 30° curvature were divided into four experimental groups containing ten samples in each group. The canals were prepared using Reciproc (VDW, Munich, Germany), WaveOne (Dentsply, Maillefer, Ballaigues, Switzerland), OneShape (Micro-Mega, Besancon, France), and F360 (Komet, Brasseler, Lemgo, Germany) size 25 NiTi systems using X Smart Plus (Dentsply). Pre- and post-preparation canals were photographed in a standardized manner and were superimposed. The inner and outer walls of canal curvature were evaluated to determine the most significant change using the image analysis software. Results: The amount of resin removed from the inner walls was less with rotary single-file NiTi systems when compared with reciprocating. Preparation time was less with rotary instruments. No instrument separation was noted. All instrument systems maintained the original canal curvature. Conclusion: Rotary single-file systems maintained the canal curvature better than reciprocating single-file systems.

Sodium hypochlorite use, storage, and delivery methods: A Survey Sumaya O Basudan Saudi Endodontic Journal 2019 9(1):27-33 Aim: The aim of this study is to investigate sodium hypochlorite (NaOCl) delivery and storage methods by general dental practitioners (GDPs) and specialists. Materials and Methods: A self-reporting questionnaire was distributed to academic, governmental, and private dental centers in Riyadh, Saudi Arabia. The survey consisted of questions related to the concentration, duration, volume, delivery methods of NaOCl irrigation, storage materials, and conditions. Results: Of the 261 dentists that responded, 63.2% were GDPs, 21.8% were endodontists, and 14.9% were advanced restorative specialists. A NaOCl concentration of 2.5%–5% was the most commonly selected (52.7%), 37.2% used 5–10 ml for irrigation of each canal and 44.8% performed irrigation for <1 min. Dentists who used higher concentrations reported longer irrigation durations. Irrigant delivery by needles and a syringe was reported by 83.9% of respondents, but only 5.7% applied irrigation activation methods. Regarding storage conditions, 40% used clear containers, and 75.5% stored it at room temperature. Endodontists used significantly higher concentrations, longer durations, and activated the irrigant more than GDPs. Conclusion: The most commonly used NaOCl concentration is 2.5%–5%. The storage conditions of NaOCl and use of activation methods need to be improved. In addition, practices of specialists differed from those of GDPs with regard to concentrations, duration of irrigation, storage of NaOCl, and use of irrigation adjuncts.

Triple antibiotic paste versus propolis: A clinical quest for the reliable treatment of periapical lesions in primary molars DV Divya, Madu Ghanashyam Prasad, Ambati Naga Radhakrishna, Rayala Venkata Sandeep, Suravarapu Pavani Reddy, K V. K. Santosh Kumar Saudi Endodontic Journal 2019 9(1):34-39 Background: Teeth with infected root canals, particularly those in which the infection has reached the periradicular tissues, require effective treatment interventions to save the tooth. Lesion sterilization concept (lesion sterilization and tissue repair [LSTR]) was successful in treating periapical polymicrobial infection, but this poses a risk of development of antimicrobial resistance. Aim: The present study evaluated and compared both clinically and radiographically the healing abilities of Propolis liquid (natural therapeutic agent)-mixed Endoflas powder with LSTR (allopathic combination) for the management of periapical lesions in primary molars. Materials and Methods: A total of 30 selected primary molars were randomly divided into two groups of 15 each: Group 1 – Propolis liquid-mixed Endoflas powder and Group 2 – LSTR (3Mix). Follow-up after 3, 6, and 12 months was done to evaluate progress in clinical and radiographic parameters. The obtained data were subjected to statistical analysis. McNemar's test was applied between the time points in each group. Comparison of Group 1 with Group 2 was done using Chi-square test. Results: At the end of 12th-month follow-up, the overall clinical and radiographic success rate for Group 1 was 100%, whereas for Group 2, it was 93% and 60%, respectively. The difference in the radiographic success rate between the two groups was statistically significant (P < 0.05). Conclusion: In the present study, Propolis liquid-mixed Endoflas powder combination has shown better results than LSTR. This novel combination of Propolis liquid-mixed Endoflas powder can, therefore, be considered as the material of choice for pulpectomy in deciduous molars with extensive involvement of pulp and periradicular tissues.

The knowledge and attitude of general dental practitioners toward the proper standards of care while managing endodontic patients in Saudi Arabia Dania F Bogari, Nouran A Alzebiani, Rowaina M Mansouri, Faris G Aljiaid, Mohunned A Alghamdi, Majed Almalki, Khalid Merdad, Turki Y Alhazzazi Saudi Endodontic Journal 2019 9(1):40-50 Aim: The aim of this study was to assess the knowledge and attitude of general dental practitioners (GDPs) toward performing the proper standards of care while managing patients undergoing endodontic treatment in Saudi Arabia. Materials and Methods: An e-questionnaire was distributed among GDPs in Saudi Arabia (n = 650). The e-questionnaire questions covered the assessment of knowledge, attitude, and performance of GDPs toward practicing the proper standards of endodontic treatment in their clinic. Data were analyzed using SPSS version 22, and the relationships between categorical variables were established using Chi-square test. Results: Most of the participants reported obtaining full medical history before root canal treatment (RCT, 82.3%; P < 0.05). However, only 12.2% of the participants regularly measure the blood pressure for their patients before starting RCT. Only 56.3% of the participated dentists are applying rubber dam isolation during RCT, while 24.2% believe that partial isolation is sufficient for such a procedure (P < 0.05). Furthermore, 42.8% of the surveyed GDPs use cold test to confirm the endodontic diagnosis, while 55.5% think that percussion is a reliable method for diagnosis (P < 0.05). Surprisingly, 37.3% of the dentists still prefer leaving the tooth open for pain relief and drainage in abscess cases. Finally, only 28.7% of the participants mentioned performing regular follow-up after RCT. Conclusions: Our data show a clear deficiency in the standards of care provided by GDPs when performing RCT in Saudi Arabia. We hope that this publication will help highlight key areas where lack of knowledge and poor attitude exist while performing RCT by the GDPs in Saudi, thereby helping to raise treatment standards and improve treatment outcomes.

Effect of applying metal artifact reduction algorithm in cone beam computed tomography in detection of vertical root fractures of teeth with metallic post versus digital intraoral radiography Islam Shawky Shaker, Nashwa Salah Mohamed, Ahmed Mohamed Abdelsamad Saudi Endodontic Journal 2019 9(1):51-55 Background: Conventional radiographs are not an efficient diagnostic imaging modality to detect vertical root fracture. Cone-beam computed tomography (CBCT) is a three-dimensional imaging modality that overcomes the limitations of conventional radiography in the detection of vertical root fractures (VRFS), although metallic structures produce artifacts in the produced images and since most of the teeth with VRF are endodontically treated and have metallic posts in root canal so fracture detection may be difficult. Aim: This study aimed to determine the diagnostic accuracy of CBCT using metal artifact reduction algorithm in detection of VRF of teeth with metallic posts compared to digital intraoral radiography. Materials and Methods: One hundred and twenty single-rooted extracted human teeth were endodontically treated then placed in an acrylic block and metallic posts were inserted. The teeth roots were divided into two groups; one with induced VRF and the other having intact roots. Then, each tooth was coded and imaged three times using CBCT with and without metal artifact reduction algorithm and digital periapical radiography. Data were collected and statistically analyzed. Results: Digital periapical radiography showed statistically significantly lower diagnostic accuracy than CBCT modalities (P ≤ 0.05). The use of metal artifact reduction algorithm improved the diagnostic accuracy from CBCT1 to CBCT2 but with no statistically significant difference (P ≥ 0.05). Conclusion: From the study, we can conclude that in case of presence of metallic posts, CBCT with metal artifact reduction algorithm can improve detection of VRF.

Multidisciplinary approach to the treatment of a complicated crown-root fracture Badi B Alotaibi Saudi Endodontic Journal 2019 9(1):56-60 Complicated crown-root fractures are uncommon type of dental trauma but usually result in significant esthetic and functional problems to those affected. This case report demonstrates sequential endodontic, restorative, orthodontic, periodontal, and prosthodontic modalities for the conservative management of a complicated crown-root fracture of the maxillary left central incisor in a young patient. After root canal treatment and core buildup, the tooth was extruded using forced orthodontic eruption for 8 weeks and retention for 7 weeks. Zinc phosphate cement acrylic crown was used to preserve esthetics and function during the forced eruption and retention period.

A combined management of a rare case of a maxillary lateral incisor with accessory root and deep mesio-radicular groove Safura Anita Baharin, Masfueh Razali Saudi Endodontic Journal 2019 9(1):61-65 This case report describes the combined nonsurgical endodontic retreatment and surgical intervention of a failed root canal treatment associated with a maxillary lateral incisor with an accessory root and deep mesio-radicular groove. A 42-year-old female Malay patient presented with persistent infection associated with deep mesial pocket from her maxillary left lateral incisor (#22). The medical history was noncontributory and the tooth was previously root treated. Following comprehensive clinical and radiographic examination, a combined nonsurgical endodontic retreatment and surgical management of tooth #22 were carried out. The inability to debride the periodontal defect necessitates the amputation of the accessory root, and surgical debridement of the deep radicular groove was carried out. The clinical and radiographic examination 1 year after completion of treatment revealed evidence of healing. The early recognition of root and canal variation, correct diagnosis, and appropriate management of tooth with accessory root and deep radicular groove is essential to ensure favorable treatment outcome.