Biometric analysis of furcation area of molar teeth and its relationship with instrumentation

The anatomy of furcation favours the bacterial retention and makes periodontal debridement as well as oral hygiene procedures difficult. Teeth that have lost attachment to a level of the furcation are said to have a furcal invasion or furcation involved.Involvement of furcation in a multi-rooted tooth poses a very different type of clinical situation in terms of establishment of diagnosis, determination of prognosis and of course planning the treatment modality.The present study was carried out on 200 selected extracted human first and second permanent molar teeth based on a predefined criteria. Teeth with prosthetic crowns, fused or fractured roots, those not fully developed, grossly carious or heavily restored at the cementoenamel junction (CEJ) were excluded from the study. The morphology of the root trunk was recorded by measuring various dimensions of the root trunk,including furcal angle and root trunk volume was calculated by using a custom made special apparatus. The furcation areas were debrided with different types of curettes in the market in order to see how best the instrument could be maneuvered in the furcation area. The data so obtained was statistically analysed using SPSS version 22. The highest root trunk volume and the longest root trunk length were found to be in the maxillary second molar. 48.60% furcations didn't allow instrument engagementof furcation area with standard area specific curettes. The proposal of inclusion of root trunk length (mm) is suggested in addition to classification of FI to have assess prognosis and appropriate treatment for of the involved tooth.

Prevalence of obstructive sleep apnoea syndrome in oncological patients: A systematic review and meta-analysis

BACKGROUND

Obstructive sleep apnoea syndrome (OSAS) has garnered increasing attention in recent years due to its potential association with cancer. This systematic review and meta-analysis aimed to assess the prevalence of OSAS in cancer patients through a comprehensive analysis of existing literature.

METHODS

This systematic review and meta-analysis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, aimed to evaluate the prevalence of OSAS in cancer patients. A comprehensive search of electronic databases was performed to identify relevant studies published up to September 2021. Eligible studies reporting on the prevalence of OSAS in cancer patients, encompassing various study designs, were included in the analysis. Pooled estimates of the odds ratios (OR) with 95% confidence intervals (CIs) were calculated using a random effects model. Heterogeneity among the studies was assessed using the I2 statistic.

RESULTS

Seventeen studies fulfilled the inclusion criteria and were subsequently included in the review. The prevalence of OSAS in cancer patients was estimated to have an overall OR of 0.80 (95% CI: 0.75-0.85). In comparison with non-cancer patients, cancer patients had a statistically significant greater risk of OSAS, as indicated by the total estimated RR for the prevalence of OSAS in cancer patients, which was 0.89 (95% CI: 0.86-0.92). Nonetheless, there was a significant amount of heterogeneity (I2 = 96%) among the studies.

CONCLUSION

The overall data analysed in this review indicates that patients with cancer had far reduced likelihood of developing OSAS than individuals without cancer. However, the significant variation across the included studies highlights the need for additional investigation to fully clarify the complex association between OSAS and cancer incidence. These results emphasise how critical it is to identify OSAS as a possible comorbidity in cancer patients, one that should be taken into account for clinical management and ongoing research.

Identification of prevalence of musculoskeletal disorders and various risk factors in dentists

Purpose

The awkward and repetitive movements lead to tissue straining, potentially leading to painful musculoskeletal disorders (MSDs). MSDs in dentists result in work inefficiency and a reduction in work hours. A survey was conducted to assess the prevalence of MSDs amongst the dental population of interest.

Methods

Customized individual detail questionnaires, Standard Nordic Musculoskeletal questionnaires, and Level of Pain estimation using the Likert Scale were used to deduce the various responsible risk factors for the occurrence of MSDs in dentists. Inferential statistical analysis was done to identify the prevalence and severity of the MSDs. The Chi-Square test (95 % confidence interval) was used to identify and compare the association of risk factors involved in MSDs with the occurrence of the Effect of MSDs, the presence of MSDs, and the severity of the MSDs.

Results

The results of the study deduced that the dentists followed the sedentary work practices. The dentists experienced maximum discomfort in the neck region, which was accompanied by the discomfort experienced in the lower back, hands and wrists, making the upper extremity being more susceptible to the MSDs. Gender risk factors the, the prevalence of MSDs in the dentist's upper back, and the severity of pain in the upper back region showed a significant association level.

Conclusion

The wrist posture, the prevalence of MSDs and the severity of pain in the dentists' neck, shoulder and upper back showed a significant association level.

Depleting levels of endogenous anti-oxidant superoxide dismutase in oral sub-mucous fibrosis: A systematic review and meta-analysis

Objective

The systematic review is aimed to assess the antioxidant status by superoxide dismutase level in oral sub-mucous fibrosis using available literature.

Materials and methods

A literature search was accomplished electronically in Pubmed (MeSH), Science Direct, Scopus, Web of Science core collection, Cochrane, and Cross-reference, using the keywords such as 'oral submucous fibrosis,' 'antioxidant status' and 'superoxide dismutase.'

Results

Of the 352 articles identified, only 16 satisfied the selection criteria and were included in the systematic review. Among the selected, six studies were included for serum level analysis of superoxide dismutase. The assessment showed a significant reduction of serum superoxide dismutase in oral submucous fibrosis patients than in control (p < 0.004). The mean difference in serum superoxide dismutase concentration between oral submucous fibrosis and healthy subjects was -86.23 U/ml (95% CI -145.30, -27.17). The serum SOD level was significantly reduced as the disease progressed to stage I or stage II (p < 0.001) compared to the control group.

Conclusion

The studies showed significantly lower levels of superoxide dismutase in various human samples of patients with OSMF. Therefore, further studies are required to estimate antioxidant status using different biomarkers of oral submucous fibrosis concerning different stages of the disease in order to augment future therapy.

Clinical relevance

Assessment of antioxidant activity helps to identify the patients at risk of malignant transformation. It serves as a reliable guide to validate therapy. It serves as a marker of prognosis in patients suffering from oral submucous fibrosis.

COVID 19 Scoping: A Systemic Review and Meta-Analysis

Introduction:

The world has faced the pandemic of COVID-19 in the march of 2020 and still it continues to effect in 2021. Hence, in the present study we aim to evaluate the gulps in the research so that certain recommendations can be made for the future research. We conducted a scoping review of the COVID meta-analysis.

Materials and Methods:

Online data was collected from the search engines of EBSCO, PubMed, Google Scholar, and Scopus. The searched terms were COVID-19, CORONA, SARS-CoV-2, clinical features, Wuhan, etc. The study articles were collected that from January 2020 to February 2021. Based on the PRISMA guidelines, the meta-analysis was performed.

Results:

In the present study, we finalized 316 articles. On February 2020, the first article was published. We observed a spike in the meta-analysis later on. Most of the meta-analysis were issued in the virology and infection magazines. As expected, the majority studies were from Wuhan. The other countries that published the meta-analysis were the USA, the UK, and Italy. The studies included in each meta-analysis were nearly 25 and the subjects were approximately 16 thousand. However, we noticed a poor quality in majority of these meta-analysis and <10% of all the meta-analysis showed higher confidence.

Conclusion:

A poor quality of the meta-analysis has predominated the data and very few are of high quality. All the journal editors and the reviewing team should verify and thoroughly organize the protocol so that only high quality meta-analysis are encouraged.

Examining the Effect of Gravity on Different Irrigation Systems: An In vitro Study

Background

Periapical extrusion is frequently observed during endodontic therapy. It can lead to acute injury of periapical tissues, resulting in interappointment pain or swelling. The effect is pronounced in teeth with immature apex, which are more susceptible to the extrusion of irrigant. The aim of this study was to evaluate the effect of gravity on the apical extrusion of irrigating solution with different irrigation protocols in single-rooted premolars.

Methodology

A total number of 80 permanent single-rooted teeth (premolars) with same working length (WL) were divided into two main groups: Group A: Penetration depth of irrigation syringe to 2 mm from the WL and Group B: Penetration depth of irrigation syringe to 4 mm from the WL. Each group was subdivided into four subgroups. (n = 10). The extruded debris and irrigants were weighed, and the data were statistically analyzed by the analysis of variance and the Tukey test.

Results

Irrespective of the irrigation technique used, the amount of irrigant extruded from the apex showed a statistically significant difference related to the effect of gravity (P < 0.05). There was no statistically significant difference observed between irrigation methods (P > 0.05).

Conclusion

The degree of apical extrusion of irrigant was dependent on the type of irrigation technique and gravity. Greater caution should be taken during irrigation to prevent postoperative pain.

Can Herbal Extracts Serve as Antibacterial Root Canal Irrigating Solutions? Antimicrobial Efficacy of Tylophora indica, Curcumin longa, Phyllanthus amarus, and Sodium Hypochlorite on Enterococcus faecalis Biofilms Formed on Tooth Substrate: In Vitro Study

Aim:

The purpose of this study was to evaluate the antimicrobial efficacy of Tylophora indica, Curcumin longa, and Phyllanthus amarus on Enterococcus faecalis biofilms formed on the tooth substrate. Sodium hypochlorite was used as a positive control. DMSO (dimethyl sulfoxide), the vehicle for the herbal extracts, was used as the negative control.

Materials and Methods:

Extracted human teeth were biomechanically prepared, vertically sectioned, placed in the tissue culture wells exposing the root canal surface to E. faecalis to form a biofilm. At the end of the third week, all groups were treated for 15 min with the test solutions and the control. The results were analyzed both quantitatively and qualitatively.

Results:

Statistical analysis was performed by using one-way analysis of variance and compared by the Mann–Whitney test using the Statistical Package for the Social Sciences (SPSS) software, version 20.0. The qualitative assay with the 3-week biofilm on the canal portion showed complete inhibition of bacterial growth for NaOCl, whereas samples treated with herbal solutions showed significant reduction of bacterial growth compared to control group, which showed 139.9 × 10⁹ CFU/mL among the experimental herbal solutions groups. P. amarus has shown maximum bacterial count followed by C. longa and T. indica.

Conclusion:

NaOCl 5% showed maximum antibacterial activity against 3-week biofilm on tooth substrate. T. indica, P. amarus, and C. longa showed statistically significant antibacterial activity against 3-week biofilm. The use of herbal alternatives might prove to be advantageous considering the several undesirable characteristics of NaOCl.

Prosthodontic Management of a Pediatric Patient with Christ-Siemens-Touraine Syndrome: A Case Report

Ectodermal dysplasias (ED) are a group of rare genetic disorders characterized by congenital defects involving two or more ectodermal structures. Christ-Siemens-Touraine syndrome or hypohidrotic ectodermal dysplasia is the commonest form of ED. Hypohidrotic ectodermal dysplasia (HED) is an X-linked disorder characterized by excessively dry skin due to the absence of sweat glands (anhidrosis), sparse body hair especially on the scalp and eyebrows (hypotrichosis), brittle nails, absence of sebaceous glands (asteatosis) and malformed or absent teeth. Oral manifestations include oligodontia or complete anodontia, conical teeth, underdeveloped alveolar ridges, generalized spacing and delayed eruption of permanent teeth. This case report discusses a classical case of HED and the options for rehabilitation in a growing patient. A thorough knowledge about the clinical manifestations of ED will lead to proper diagnosis and appropriate treatment plan thereby leading to significant improvements in esthetics, phonetics and masticatory function in ED patients, which in turn leads to improved quality of life in these individuals.

An in vitro Comparative Evaluation of Volume of Removed Dentin, Canal Transportation, and Centering Ratio of 2Shape, WaveOne Gold, and ProTaper Gold Files Using Cone-Beam Computed Tomography

Objectives

The aim of this study was to compare the shaping ability of three file systems - 2Shape (2S), WaveOne Gold (WOG), and ProTaper Gold - using cone-beam computed tomography (CBCT).

Materials and  Methods

Forty-five freshly extracted mandibular teeth were chosen and instrumented using the following brands of NiTi files: 2S, WOG, and ProTaper Gold. Pre- and post-instrumentation CBCT imaging was performed to measure mesial and distal distance of the dentin walls and calculate the volume of removed dentin, apical transportation, and centering ratio. A statistical analysis of the data was performed using independent t-test. Statistical significance was set at 5%.

Results

There were no significant differences between the 2S and WOG in terms of the total volume of removed dentin, apical transportation, and centering ratio, whereas ProTaper showed a greater significant difference when compared to 2S and WOG.

Conclusion

Both 2S and WOG maintained the original canal anatomy better and did not remove excess dentin while chemomechanical preparation as compared to ProTaper Gold. Instruments that use rotary movement achieved an effect similar to that of the reciprocating instruments in relation to change in angle. 2S which is a two-file system and WOG which is a single-file system might perform better clinically and might show enhanced shaping ability with less canal transportation and more centered preparation when compared to ProTaper Gold that is a multiple file-system.

Levels of Mercury in Fish-Eating Children, With and Without Amalgam Restoration

Background:

Mercury is a naturally occurring metal that exists in three forms: elemental (metallic), inorganic, and organic mercury. Amalgam, which is an alloy of inorganic mercury, is used as a restorative material in dentistry. Organic mercury gets ingested in the body mainly by the consumption of seafood. Mercury is also stated to cause various adverse health effects such as gastrointestinal disturbances, dermatitis, muscle weakness, and neurological disorders. In recent years, the use of amalgam has become a controversy stating the various adverse effects of mercury. Hence, the study was conducted to determine and compare the variation in levels of organic and inorganic mercury in fish-eating children before and after placement of amalgam restoration.

Materials and Methods:

Seventy-five subjects, 42 males (56%) and 35 females (44%) of age group ranging 7–13 years, living in South Canara district of Karnataka, India, were selected as a part of the study. Hair and urine samples were collected for estimation of organic and inorganic levels of mercury, respectively. Informed consent was collected from all the participating subjects.

Results:

On comparison between organic and inorganic mercury levels during the study period, the concentration of organic mercury in hair samples was greater irrespective of amalgam restorations present (1.172 and 0.085, respectively; P < 0.001).

Conclusion:

Thus inorganic levels of mercury do not seem to pose a threat as much as the organic levels observed in hair, which remain fairly constant for a longer period of time. Hence in a coastal region where this study was undertaken and fish being a staple food, the risk could probably be attributed to more of an organic toxicity than an inorganic one. Thus amalgam is relatively safe to be practiced and the controversy against it should be reevaluated.

Shaping Ability of 2Shape and WaveOne Gold Files Using Cone-Beam Computed Tomography

Aim and Objective:

The aim of this study is to evaluate the apical transportation, centering ability, and volume of removed dentin of WaveOne Gold (WOG) and 2Shape with the use of cone-beam computed tomography.

Materials and Methods:

Freshly extracted mandibular teeth with sample size of thirty were carefully chosen and instrumented using the 2Shape and WOG rotary files. Preoperative and postinstrumentation cone-beam computed tomographic scans were done to accomplish mesial and distal dentin walls’ measurements and volume of removed dentin calculations, apical transportation, and centering ratio. Statistical analysis was performed and confirmed by independent t-test. Statistical significance was set at 5%.

Results:

When shaping ability of 2Shape and WOG was evaluated, it was reported that there was no statistically significant differences noted among the groups in relation to the total volume of removed dentin, apical transportation, and centering ratio.

Conclusion:

It can be concluded that 2Shape and WOG preserved the original canal anatomy well and did not eliminate excess dentin during shaping and cleaning. Rotary nickel–titanium files which work on the principle of rotary movement attained an outcome analogous to that of the rotary files working on reciprocating motion in relation to alteration in angle.

Resistance to torsional failure and cyclic fatigue resistance of ProTaper Next, WaveOne, and Mtwo files in continuous and reciprocating motion: An in vitro study

Aims:

The purpose of this study was to evaluate the resistance to torsional failure and cyclic fatigue resistance of ProTaper Next (PTN), WaveOne, and Mtwo files in continuous and reciprocating motion.

Settings and Design:

Randomized control trial in a tertiary care setting.

Subjects and Methods:

A total of 10 new size 25.06 taper PTN X2, 25.06 taper Mtwo files, and 25.08 taper WaveOne primary files each was selected. A custom fabricated cyclic fatigue testing device with a 70° angle of curvature and 3 mm width; curvature starting at 6 mm from the tip was used. All instruments were rotated and reciprocated till fracture occurred and time till fracture of each instrument was recorded in seconds. For torsional failure testing 5 mm tip of each file was embedded in composite resin block and uniform torsional stresses (300 rpm, 2.0 Ncm) were applied repetitively by an endodontic motor with auto stop mode until file succumbed to torsional failure. Number of load applications leading to failure was recorded.

Statistical Analysis Used:

Data were analyzed using t-test for equality of means, Pearson correlation, and ANOVA test.

Results:

All the files showed superior resistance to cyclic fatigue in reciprocating motion when compared with continuous rotation mode. WaveOne primary files displayed maximum resistance to cyclic fatigue both in continuous and reciprocating motion. WaveOne primary files also demonstrated maximum resistance to torsional failure followed by PTN with Mtwo files exhibiting least resistance.

Conclusions:

Operating files in reciprocating motion enhances their cyclic fatigue resistance. WaveOne files showed maximum resistance to cyclic fatigue and torsional failure due to their cross-sectional diameter coupled M-Wire technology.

Three-dimensional evaluation of surface roughness of resin composites after finishing and polishing

Aim:

This study aims to investigate the effects of finishing and polishing procedures on four novel resin composites using three-dimensional optical profilometer.

Materials and Methods:

Four composites classified according to their filler size, were selected: Filtek™ Z350 XT/Nanofill (3M™ ESPE™), Esthet-X HD/Hybrid (Dentsply Caulk), Te Econom/Microfill (Ivoclar Vivadent^®), Tetric EvoCeram^® /Nanohybrid (Ivoclar Vivadent^®). Composite specimens were made in Plexiglass mold and polished with Soflex (3M ESPE), Enhance + Pogo (Dentsply Caulk). Both the systems were used according to the manufacturers’ instructions, and the polished surfaces were assessed with an optical profilometer.

Statistical Analysis Used:

Kruskal-Wallis test and further pairwise comparison were performed by Mann-Whitney test.

Results:

The smoothest surfaces for all the resin composites tested were obtained from the Mylar strip; statistically significant differences were observed among them (P = 0.001). The order of composites was ranked from the lowest to highest surface roughness; Filtek Z350 XT < Te Econom < Tetric EvoCeram < Esthet XHD. Pairwise multiple comparison with Mann-Whitney test showed Filtek Z350 to have the smoothest surface and the least with Teric EvoCeram. Among the polishing systems, Soflex showed the smoothest surface and was significantly different from Pogo (P = 0.046).

Conclusions:

The effectiveness of the polishing systems seems to be dependent on the material used, treatment modality and also on the filler particle size.

Internet remote control of pump settings for postoperative continuous peripheral nerve blocks: a feasibility study in 59 patients

INTRODUCTION

During continuous peripheral nerve blocks, infusion adjustments are essential for postoperative analgesia without side effects. Beside, physicians and nurse visits related to pump's settings and monitoring are time consuming and costly. We hypothesized that a remote control of pump's settings, by telemedicine transmission, adjusted to patients' feedbacks, is feasible and interesting in optimizing patient's postoperative pain management.

METHODS

Fifty-nine ASA physical status I and II patients were included. Ropivacaine 0.2% was infused during 72 h in CPNB catheters. After returning to the surgical ward, the patient was allowed to answer a 10 indicators questionnaire 3 times a day (8.00 AM, 2.00 PM, 8.00 PM), or unlimited on patient's demand. This information was transmitted from the pump to a server through the Internet. If one indicator was out of the predefined thresholds, the anesthesiologist in charge was immediately informed by texto on his cell phone. The anesthesiologist connected to the website, checked the data from the patient and modified the settings of the pump by remote control according to a written protocol. The changes need a secure access with a password and a confirmation. The number of settings changes, the time to realize the procedure and the adverse events related to the technique were noted. When the catheter was removed, the pump was unassigned to the patient and the data archived.

RESULTS

Thirty sciatic, 24 femoral and 5 interscalene catheters were inserted in 59 patients. Five catheters were accidentally removed before the end of the 72-h period. The median VAS pain values at rest and during movement were respectively at 2 and 3. Sixteen patients complained about numbness promoting 2 (0-3) changes in pump settings; 9 about motor blockade with 1 (0-2) change; 5 about difficulties for physiotherapy with 1 (0-3) change. The mean time of pump settings modification after response to questionnaire or voluntarily patient's alert was 15 ± 2.2 minutes. Early physiotherapy in the surgical ward was totally uneventful in 54 patients. The mean value of satisfaction scale of the patients was 8.4 ± 1.6. No adverse event necessitated a postoperative analgesia technique change.

CONCLUSION

Remote control pump's feedbacks and e-settings for postoperative analgesia using CPNB permitted a real adaptation to patients' needs, complaints and pain VAS values without nurse and physician physical intervention.