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   Table of Contents - Current issue
Coverpage
May-August 2022
Volume 12 | Issue 2
Page Nos. 149-226

Online since Wednesday, April 20, 2022

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REVIEW ARTICLES  

Evaluation of the impact of two irrigating solutions on postendodontic treatment pain in teeth with pulpal necrosis: A systematic review of randomized clinical trials and updates p. 149
Faisal Alghamdi, Leena Sabri, Abeer Lamfon, Abeer Abduljawad, Samar Alzubaidi
DOI:10.4103/sej.sej_161_21  
Introduction: Some irrigating solutions have the potential to induce postendodontic treatment pain (PETP). Unfortunately, there is no clear guidance of suitable irrigating solution to contribute in reducing the PETP in the current literature. This study aimed to collect and evaluate all available updated studies that investigated the impact of sodium hypochlorite (NaOCl) against chlorhexidine (CHX) on PETP following root canal therapy in permanent teeth with pulpal necrosis. Materials and Methods: The reviewers searched PubMed, Scopus, Web of Science databases, and Google Scholar as an engine to retrieve relevant randomized clinical trials (RCTs). RCTs were done on comparing the effect of NaOCl and CHX on PETP in teeth of adult patients with pulpal necrosis. Reviews, animal studies, and other irrelevant studies were excluded. This systematic review was carried out in accordance with the preferred reporting items for systematic review and meta-analysis guidelines. The reviewers selected the articles based on specified eligibility criteria, performed data extraction, and evaluated the risk of bias. Results: Four articles met the inclusion criteria for the systematic review. Two studies were deemed to have a low risk of bias. The outcomes illustrated no statistically significant difference regarding PETP between the two irrigating solutions. Conclusions: Based on current studies, this review found that neither NaOCl nor CHX irrigating solutions could ensure the absence of PETP.
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Evaluation of genotoxicity induced by endodontic materials: A systematic review p. 158
Sadaf Tamanna, Huma Iftekhar, Asmat Fatima, Aaliya Rehman
DOI:10.4103/sej.sej_163_21  
The ability of a substance to cause harm to the DNA molecule is known as genotoxicity. Because there is significant evidence of link between genetic damage and carcinogenesis, determining the real health hazards to patients and dental workers requires a thorough examination of genotoxicity caused by various dental materials. The aim of this paper is to provide a thorough overview of the genotoxicity induced by various endodontic materials. A systematic electronic search and screening of reference list were undertaken until November 2019. A meticulous search confined to English language articles was carried out in PubMed, Web of Science, and Scopus databases from their inception. The electronic search method retrieved 338 papers after the removal of duplicates, only 25 papers met the inclusion requirements following a thorough review of the findings. All evidence of genotoxicity has been found in the literature notably in relation to bleaching agents, restorative materials, and resin-based sealers. Such data will definitely be included to that already established for regulatory purposes as a secure way to enhance oral healthcare and avoid oral carcinogenesis. Reported information of genotoxicity induced by various endodontic materials is crucial for validating their safety in clinical practice as well as for identifying potential gaps in knowledge that must be studied further in future studies.
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ORIGINAL ARTICLES Top

Applications and advantages of the use of cone-beam computed tomography in endodontics: An updated literature review p. 168
Ana Boquete-Castro, Alejandro Pena Lopez, Aline Savariz Martins, Alberto Sierra Lorenzo, Patricia Rodriguez Perez
DOI:10.4103/sej.sej_167_21  
Introduction: To assess the potential uses and benefits of cone-beam computed tomography (CBCT) in the field of endodontics, where the anatomy evaluated is complex, and to summarize the possible advantages over two-dimensional (2D) radiography. Methods: For this study, a review of the literature of the last 13 years was carried out in the PubMed and Google Scholar databases by using the following keywords: CBCT, dental radiography, endodontic diagnosis, management of endodontic problems; 3D imaging. Moreover, inclusion and exclusion criteria were applied. Results: A total of 29 articles were selected because they fulfilled the inclusion criteria. Articles were analyzed to investigate the advantages, limitations, radiological aspects, and uses of CBCT in endodontics from a critical point of view. Conclusions: Conventional radiography continues to be the main diagnostic method in endodontics, but taking into account the as low as reasonably achievable principle, in cases in which there are inconclusive signs and symptoms with 2D radiography, CBCT is a useful complement in endodontic diagnosis and allows a more accurate and predictable treatment plan design.
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Effect of SmearOFF and ethylenediaminetetraacetic acid on the surface roughness and microhardness of human root canal dentin – An ex vivo study p. 175
Raj Kumar Narkedamalli, Sandya Kini, Shubha Chhaparwal, Nidambur Vasudev Ballal
DOI:10.4103/sej.sej_162_21  
Introduction: The removal of smear layer using chelating agents often involves decalcification of the dentin that affects its physical properties. Hence, the objective of this study was to assess the outcome of SmearOFF and 17% ethylenediaminetetraacetic (EDTA) solutions on the surface roughness and microhardness of human root canal dentin. Materials and Methods: Twenty-three extracted human mandibular single-rooted premolars were split into 46 sections and placed into an autopolymerizing acrylic resin and were grated flat using silicon carbide abrasive papers. Forty-five samples were arbitrarily categorized into three groups as per experimental solutions used: control group (n = 15), 5 ml of 0.9% saline for 1 min + 5 ml of distilled water for 1 min, EDTA group (n = 15), 5 ml of 17% EDTA for 1 min + 5 ml of distilled water for 1 min, and the SmearOFF group (n = 15), 5 ml of SmearOFF for 1 min + 5 ml of distilled water for 1 min. The samples were then assessed for surface roughness using an atomic force microscope. The same samples were then assessed for microhardness using Vickers microhardness tester. The data were statistically analyzed using one-way analysis of variance, and the mean values were juxtaposed using Tukey's honest significant difference test. Results: The lowest surface roughness value was seen in the control group, followed by 17% EDTA and SmearOFF in an increasing order. The highest decrease in microhardness was seen in the SmearOFF group samples, followed by 17% EDTA group samples and least in the control group (P < 0.001). Conclusion: SmearOFF produced more surface roughness and caused a greater reduction in microhardness of root canal dentin in contrast to 17% EDTA.
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Root and canal configurations of maxillary molars in a Saudi subpopulation (Southern region): In vivo cone-beam computed tomography study p. 180
Mohammed Mashyakhy, Ahmad Jabali, Nassreen Albar, Abdulaziz AbuMelha, Mazen Alkahtany, Hashim Bajawi, Riyadh Alroomy, Fahad Alamri, Shilpa Bhandi
DOI:10.4103/sej.sej_171_21  
Introduction: Knowledge regarding the root canal morphology is a key for successful root canal therapy. Maxillary molars comprise a complex root canal system. Thus, this study aimed to evaluate the root morphology and root canal configurations of maxillary molars using cone-beam computed tomography (CBCT) radiographic analysis in a Saudi subpopulation. Materials and Methods: The CBCT images of 624 maxillary molar teeth from 208 patient records (age: 28.74 ± 9.56 years) were analyzed using i-Dixel three-dimensional imaging software. Sagittal, axial, and coronal serial sections were used to examine the number of roots, root canal configuration, the number of canals, and differences between the right and left sides. Frequencies and percentages were used to represent the results. Differences between both sides were determined by the Chi-square test, and the significance level was set at P < 0.05 for all statistical tests. Results: In the first molars, 85.8% of teeth had four canals, 14.2% had three canals, 48.2% mesiobuccal (MB) roots had Vertucci Type IV configuration, and both distobuccal and palatal roots had Vertucci Type I roots. In the second molars, three and four canals were present in 33.6% and 66.4% of the teeth, respectively. All the second molars had Vertucci Type I distobuccal and palatal roots, whereas the MB roots were present in 32.9% of the teeth. No significant difference was found between both sides (P > 0.05) for all parameters. Conclusions: Wide variations were found among the same population, and the presence of four canals in maxillary molars was commonly observed. Clinicians should be aware of such differences and use available diagnostic tools, such as CBCT and dental operative microscopy.
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Cone-beam computed tomographic study of root morphology, canal configuration, and bilateral symmetry of mandibular first and second molars in a Qatari population p. 186
Fatima A Al-Sheeb, Hanan I Diab, Maryam M Al Obaid, Amal I Diab, Mashael G Lari, Nadya M Mahmoud
DOI:10.4103/sej.sej_176_21  
Introduction: Identifying root and canal morphology are essential for successful endodontic treatment. The study aimed to identify the anatomical variation and the bilateral symmetry of mandibular first and second molars among the Qatari population using cone-beam computed tomography (CBCT). Materials and Methods: Two endodontists reviewed 544 CBCT images of Qatari patients. Age, gender, root morphology, and canal configuration according to Vertucci classification, were recorded. A descriptive analysis was implemented to provide a detailed characterization of the root morphology, root canal configuration, and symmetry between right and left teeth. Kappa agreement analysis was performed to assess the intra- and inter-examiner agreement. Results: A total of 195 mandibular first molar (MFM) and 255 mandibular second molar (MSM) were included in this study. The most commonly observed number of roots in both molars was two in 96.4% of MFMs and 92.9% of MSMs. The majority of MFMs and MSMs had three canals, 79% and 74.2%, respectively. The most common root canal configuration of the mesial root was type IV, found in 66.5% of MFM and 57.8% of MSM. Type I was the most common root canal configuration of the distal roots in 56.9% of MFM and 87.3% of MSM. The symmetrical analysis revealed a high symmetry in the number of the roots. However, the symmetry of the number of canals per root drops to around 75%. Conclusions: Mandibular first and second molars had predominantly two roots with three canals. Variations such as single, three, or four roots and C-shaped canal morphology were also detected and were associated mainly with mandibular second molars.
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Diagnostic and therapeutic approaches to endodontic-periodontal lesions: A survey among dental surgeons in Ouagadougou, Burkina Faso p. 195
Wendpoulomdé Aimé Désiré Kabore, Jocelyne Valérie Wendkouni Garé, Célestin Koama
DOI:10.4103/sej.sej_174_21  
Introduction: Endodontic-periodontal lesions (EPLs) continue to be a challenge for clinicians in terms of diagnosis, therapy, and prognosis. The objective of this study was to evaluate the diagnostic, therapeutic, and prognostic approaches to EPLs by dental surgeons in Burkina Faso. Materials and Methods: This was a cross-sectional study with a descriptive purpose. The study population consisted of dental surgeons practicing in the city of Ouagadougou. The data were collected using a self-administered questionnaire and analyzed with R Commander version 3.6.0 software. Results: Fifty practitioners participated in the survey. The level of knowledge of the diagnosis was above average for 70% of the practitioners surveyed, while 98% of the practitioners had an above-average level of knowledge regarding therapeutic and prognostic approaches to EPLs. The overall level of awareness of EPL management was average to good for 85.5% of the practitioners. Having a postgraduate degree was significantly associated with the overall level of knowledge (P = 0.01). Conclusion: The overall theoretical knowledge of dental surgeons regarding EPLs appears to be good. Nevertheless, there are deficiencies in the knowledge of diagnostic parameters. This could result in failures in terms of how this pathology is managed.
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Analysis of endodontic radiographic imaging repeat rate: A cross-sectional study in an undergraduate clinical setting p. 204
Maysoon Haji Albahiti, Tariq S Abuhaimed, Bashaer Al-Noman, Razan Hashim
DOI:10.4103/sej.sej_241_21  
Introduction: Inexperienced undergraduate dental students tend to take unnecessary radiographs during endodontic treatment, which has an adverse effect on clinical workflow. The aim of this study was to quantify the repeat rate of endodontic periapical radiographs taken by senior dental students during endodontic treatment stages and to analyze the prevalence of radiographic errors that led to repeated radiographs. In addition, the average number of visits required to complete the treatment was determined. Materials and Methods: A total of 583 cases that included 5689 periapical radiographs were collected from the records of a completed academic year. The periapical images were divided according to tooth type and the stages of the treatment procedure. The prevalence of error types, number of visits, and repeated images exceeding the number of radiographs allowed for completion of the treatment were evaluated. The collected data were statistically analyzed. Results: The overall repeat rates of anterior, premolars, and molars were 36%, 36%, and 39%, respectively (P = 0.66). The highest repeat rates were recorded during instrumentation (44%-55%), followed by obturation (36%–46%). The most common error types were working length adjustment (27%–33%), missing apex (24%–28%), and obturation adjustment (19%–24%). The mean number of visits was higher than recommended for all tooth types. Conclusions: The repeated rates of radiographs and number of visits were higher than recommended. A set of recommendations were formulated to optimize quality assurance and deliver a better-quality health service to the patients.
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Outcome of vital pulp therapy, revascularization, and apexification procedures: A retrospective study p. 210
Mey A Al-Habib
DOI:10.4103/sej.sej_239_21  
Introduction: Vital pulp therapy (VPT), revascularization, and apexification are different endodontic treatment modalities that aim to preserve tooth structure and decrease bacterial leakage increasing the long-term success of the treatment. The study aims to report the outcome of VPT, revascularization, and apexification procedures treated teeth in the endodontic department at King Abdulaziz University Dental Hospital performed by faculty and postgraduate residents. Materials and Methods: Thirty-three cases of VPT, revascularization, and apexification cases were evaluated. The outcome was assessed depending on the patient's signs and symptoms, healing of the apical periodontitis, and the signs of continued root development. Results: The overall results have shown that 60% of the cases were healed completely, 30% presented with incomplete healing, and 10% failed during the follow-up period and required further intervention. Conclusion: It has been concluded that the outcomes of VPT, revascularization, and apexification were fairly high as they favored healing of periapical periodontitis and root maturation with presentation of no signs and symptoms.
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CASE REPORTS Top

Nonsurgical management of maxillary sinusitis caused by root perforation p. 217
Hee-Jin Kim, Kyung-San Min
DOI:10.4103/sej.sej_222_21  
The present case report describes the nonsurgical management of maxillary sinusitis of endodontic origin (MSEO) caused by iatrogenic root perforation. A 32-year-old woman had facial pain on her upper posterior teeth. The pain increased when she ran on a treadmill or bent over. Root perforation of the left maxillary second premolar (#25) and its anatomical proximity to the maxillary sinus has been shown on cone-beam computed tomography (CBCT) and clinically detected by the dental operating microscope. Based on these findings, a diagnosis of MSEO with root perforation on #25 was made. The maxillary sinusitis was successfully treated with nonsurgical management of the root perforation using a premixed bioceramic repair material. Many clinicians have a tendency to opt for surgical repair or extraction when they encounter a complex situation involving failing perforated root canals with maxillary sinusitis. To avoid a surgical approach on the posterior maxilla, dentists should consider CBCT taking and nonsurgical repair of root perforation and not attempt to make a final decision of extraction.
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Localized contact urticaria due to epoxy resin-based endodontic sealer p. 222
Afzal Ali, Meltem Sümbüllü, Aasima İshaq, Hakan Arslan
DOI:10.4103/sej.sej_251_21  
This case report aimed to report the localized contact Urticaria with epoxy resin-based root canal sealer (AH Plus). Dental materials usually contain chemical that may cause potential allergic reactions to the clinicians as well as patients. Occupational disease in form of contact dermatitis may occur to the dentists. An adolescent postgraduate student in the department of conservative dentistry and endodontics, with an ASA physical status I encountered itching, erythema, and swelling of her left-hand skin with the first-time use of AH Plus sealer in her career. A diagnosis of Contact Urticaria was established by the dermatologist upon examination. Topical steroids and antihistamine drugs were advised to the endodontic postgraduate and within a week the symptoms were resolved. The case report focuses attention on handling of epoxy resin-based root canal sealer. The dentists should exercise care and follow manufacturer's instructions while handling the dental materials.
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