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   Table of Contents - Current issue
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September-December 2021
Volume 11 | Issue 3
Page Nos. 277-432

Online since Friday, September 3, 2021

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REVIEW ARTICLES  

Most effective local anesthetic technique for mandibular posterior teeth with irreversible pulpitis: A systematic review and meta-analysis Highly accessed article p. 277
Muhammad Rizwan Nazeer, Kamil Zafar, Farhan Raza Khan, Robia Ghafoor, Rashna Hoshang Sukhia
DOI:10.4103/sej.sej_259_20  
Introduction: Achieving profound pulpal anesthesia is considered as a keystone in endodontic practice as it benefits both the patient and the dentist for smooth delivery of care. A tooth that has irreversible pulpitis causes severe pain and poses an additional challenge. The aim of the present systematic review is to compare the standard inferior alveolar nerve block with other local anesthesia techniques for effectively anesthetizing the mandibular posterior teeth that present with irreversible pulpitis. Materials and Methods: A systematic review protocol was registered at Prospero. The following databases were searched: PubMed, CINAHL, Cochrane, EBSCO Oral and Dentistry Database, and Trip Database using strict inclusion and exclusion criteria. All randomized control trials on the topic published in the English language only were included. Results: The first search yielded 1213 articles, and after going through extensive screening and eligibility process, only 8 articles were finally selected for the review. There were six articaine infiltration technique groups; two were based on intraosseous technique and one each on Gow-Gates and Vazirani–Akinosi methods. The standard inferior alveolar nerve block was compared with other mandibular anesthesia techniques pooled together. A meta-analysis was carried out to compare inferior alveolar nerve block with the articaine infiltration. The difference among two sets of techniques was found to be nonsignificant (P = 0.07). However, the overall results of the meta-analysis favor articaine infiltration. The study is first of its kind comparing multiple anesthetic techniques in mandibular posterior teeth with irreversible pulpitis. Studies with the highest level of evidence, i.e., randomized controlled trials, were included only. No conclusive inference regarding Gow-Gates block and Vazirani–Akinosi techniques could be drawn on account of limited data. Conclusions: Infiltration and intraosseous appeared to be viable alternative to standard inferior alveolar nerve block in the posterior teeth with irreversible pulpitis.
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Failure of molar anesthesia in endodontics : A systematic review Highly accessed article p. 283
Vidhi Kiran Bhalla, Sonali Taneja, Sherin Jose Chockattu
DOI:10.4103/sej.sej_152_20  
Introduction: Failure of molar anesthesia is commonly encountered in our clinical practice ranging around 15% in normal pulps and 44%–81% in inflamed pulps. Effective pain management is challenging in such situations. The aim of the present systematic review was to enlist the reasons for local anesthesia failure in mandibular molars during root canal treatment and to assess the effectiveness of supplementary methods along with the conventional inferior alveolar nerve block (IANB) in achieving profound anesthesia. Materials and Methods: A literature search on Pubmed and Google scholar database from the year 1990–2020 was conducted using the keywords: “Molar anesthesia,” “Local anesthesia failure,” “Hot tooth,” “irreversible pulpitis.” The articles pertaining to the failure of IANB during endodontic treatment of mandibular molars and the techniques for the improved success of molar anesthesia were reviewed. The data were analyzed in terms of author, year, type of study design, study population and type of intervention, method of assessment of outcome, outcome assessed, result and clinical recommendations. Results: The search yielded 9090 articles, from which the specific articles relevant to the topic were reviewed. The articles were reviewed independently by two authors. Finally, a total of 7 randomized controlled trials fulfilling the eligibility criteria were analyzed and subjected to qualitative assessment. Conclusion: The failure of IANB could be attributed to several reasons such as anatomical variations, Operator Technique, Presence of inflammation, and Psychological reasons. In addition, there is a positive association in using adjuncts for achieving effective anesthesia in mandibular molars.
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Reporting of sample size parameters for randomized controlled trials published in high impact factor endodontic journals in the last decade: A bibliometric analysis p. 292
Fahad Umer, Zainab Haji, Shizrah Jamal
DOI:10.4103/sej.sej_216_20  
Introduction: Analysis of journals helps in identifying areas of improvement in the respective field as an author/reviewer. The aim of the present study was to report the parameters used in sample size calculations for randomized controlled trials (RCTs) published in Journal of Endodontics (JOE) and International Endodontic Journal (IEJ) in the last decade. Materials and Methods: A Medline search retrieved all published RCTs in JOE and IEJ from the last decade. The searche was limited to RCTs studies published in english language from January 01, 2010 to April 31, 2020 having enrolled human participants. Articles were reviewed for description of method used to calculate sample size and reporting of parameters i.e. (level of significance, power, effect size, and variance) used for sample size calculation. The data were statistically analyzed. Results: Sample size was mentioned in 94.5% of all articles. Alpha was reported in 81.6% followed by power, effect size, and variance as 67.3%, 57.1%, and 11.5%, respectively. Only 8.7% articles explicitly reported all four parameters of sample size. Conclusion: The reporting of sample size calculation parameters for RCTs was inconsistent. Authors, editors, and reviewers need to increase the reporting of adequate sample size parameters to make the results of RCTs more robust for clinical applications.
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ORIGINAL ARTICLES Top

Effect of combining platelet-rich fibrin with synthetic bone graft on the healing of intrabony defects after apicectomy in dogs with periapical pathosis p. 300
Doaa G Basta, Ashraf M Abu-Seida, Kariem M El-Batouty, Hossam M Tawfik
DOI:10.4103/sej.sej_191_20  
Introduction: An apicectomy is traditionally a surgical endodontic procedure that deals with the local excision of the root tip and periapical pathosis of failed conventional root canal treatment. The proper healing of the intrabony defects plays a crucial role in the success of endodontic surgery. This study evaluates the role of platelet rich fibrin (PRF) in conjunction with synthetic bone graft on the healing of intrabony defects after apicectomy in dogs with induced periapical lesion. Materials and Methods: Induced periapical pathosis and root canal obturation were carried out in 36 mandibular premolar dogs, teeth, then treated with either apicectomy (Group I) or apicectomy followed by application of PRF and synthetic bone graft (Group II). The periapical healing of both groups was evaluated by radiography and histopathology after 1 month (subgroup A) and 3 months (subgroup B). The periapical bone density, percentage of difference in radiodensity, inflammatory cell count, and percentage of new bone formation were measured. The quantitative data of both groups were statistically analyzed. The P < 0.05 was considered statistically significant. Results: There were significant differences between both groups in periapical radiodensity, percentage of difference in radiodensity, mean inflammatory cell count, and percentage of new bone formation in both subgroups (P < 0.05). In contrast to Group I, Group II exhibited high significant differences between both subgroups in the mean radiodensity, percentage of difference in radiodensity, and new bone formation (P < 0.001). Conclusions: Using of PRF in conjuction with the synthetic bone graft enhances the healing of periapical intrabony defects after apicectomy in dogs' teeth.
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Evaluating effect of ferrule height, configuration, and post and core approaches on stress distribution of flared root canal: A three-dimensional finite element analysis p. 308
Nitin Gupta, Sonali Taneja, Vidhi Kiran Bhalla
DOI:10.4103/sej.sej_292_20  
Introduction: Radicular rehabilitation in cases of flared canals presents a challenge and is influenced by the type of post and the ferrule design. Use of anatomic posts has been advocated in such cases to allow for homogenous stress distribution. Hence, the aim of the present study was to evaluate and compare the effect of ferrule height, configuration, and post and core approaches on stress distribution of endodontically treated teeth with flared root canal by three-dimensional (3D) finite element analysis. Materials and Methods: Thirteen 3D models of single rooted maxillary second premolar were made using the solid works 2014 software. These were divided into four Groups I, II, III, and IV restored with no post, glass fiber, anatomic, and cast post and core, respectively. Group II, III, and IV were further subdivided into four subgroups a – no ferrule, b – 3 mm circumferential, c – incomplete ferrule of 2.5 mm on buccal and 1.5 mm on palatal side, and d – incomplete ferrule of 1.5 mm on buccal and 2.5 mm on palatal side. Load of 200 N at an angle of 45° was applied to buccal and palatal cusps. ANSYS/ABACUS standard solver with Microsoft Windows 10 Professional was used to analyze model data and perform stress analysis around various elements when subjected to occlusal loading in three dimensions. The maximum von Mises stresses were calculated within post, core, cervical, and radicular dentin and distribution at dentin and cement interface and cement and post interface. Results: The minimum stresses were seen in model restored with 3 mm circumferential ferrule with anatomic post and minimal stress was observed with no ferrule and rehabilitation with cast post. The presence of ferrule reduces the stress distribution in all the models. Incomplete ferrule design is associated with high stresses than partial ferrule. Conclusion: Ferrule allows for a uniform stress distribution and also reduces the stresses at the cervical region of the tooth. Palatal ferrule is more important to provide a fracture resistance to tooth as compared to buccal ferrule.
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Root and root canal morphology of permanent mandibular incisors in a Kuwaiti subpopulation: A cone-beam computed tomography study p. 315
Mohammad Ahmad Alenezi, Faisal A Albutaihani, Ibrahim Ali Ahmad, Mazen A Aldosimani, Mohammad Al-Omari
DOI:10.4103/sej.sej_3_21  
Introduction: Sound knowledge of the external and internal anatomy of different teeth is an important prerequisite for successful endodontic treatment. The purpose of this in vivo study was to evaluate the root and root canal morphology of permanent mandibular incisors among a Kuwaiti subpopulation using cone-beam computed tomography (CBCT). Materials and Methods: A total of 600 Kuwaiti patients' CBCT images were screened and evaluated. A total of 1200 mandibular central incisors and 1200 lateral mandibular incisors were studied. The root canal morphology was recorded using Vertucci's classification and the association between the total number of root canals and patient's gender, tooth type (central vs. lateral incisor), and tooth location (right vs. left) were analyzed using Pearson's Chi-square test. Results: The prevalence of two canals in mandibular central incisors and lateral incisors was 24% and 27%, respectively. In both incisors, Type I root canal configuration was the most common (74.5%) followed by Types III and II. The total number of root canals per tooth was significantly higher in the central (P < 0.00001) and lateral (P = 0.00002) incisors in males compared to females, while tooth type and location had no effect on the number of root canals. Conclusion: Within the limitations of this clinical study, Type I root canal configuration was the most common root canal configuration of the mandibular incisors. The prevalence of two canals was significantly higher in males compared to females.
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Academic performance and dental student satisfaction with emergency remote teaching of endodontics during COVID-19 pandemic: A retrospective cohort study p. 321
Fahda Nabeel Alkahtani, Rahaf A Almohareb, Reem M Barakat
DOI:10.4103/sej.sej_30_21  
Introduction: The study aimed to evaluate the consequences of introducing online modalities for emergency remote teaching during the coronavirus disease 2019 pandemic, on students' learning satisfaction in the endodontic preclinical course and their performance in the summative examination. Materials and Methods: On completion of the preclinical endodontic course, 39 students were E-mailed an online questionnaire investigating their overall satisfaction with online modalities used for emergency remote teaching. They were requested to evaluate their satisfaction with three methods of lecture delivery: conventional face to face, online synchronized and online asynchronized, in terms of comprehension and retention of knowledge, communication with the lecturer, time convenience, Internet or technical support, transportation for face-to-face lectures, and stress-free learning. Students' scores were compared to scores of students who took the course before the pandemic and received only conventional face-to-face teaching. Data were statistically analyzed. Results: A response rate of 100% showed that 87% of the students were satisfied with the online modalities used for emergency remote teaching. Students were significantly less satisfied with online-asynchronized lectures in terms of communication with the lecturer (P < 0.001) and with online-synchronized lectures in terms of time convenience (P < 0.001). The students' examination performance was not affected by shifting to emergency remote teaching (P = 0.076). Conclusion: Dental students were satisfied with online modalities used for emergency remote teaching in the preclinical endodontic course and their academic performance was not adversely affected.
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A bibliometric analysis of articles published in the Saudi Endodontic Journal p. 327
Abdulmohsen Alfadley, Ikram Ul Haq, Ahmed Jamleh, Khalid Alfouzan, Saad Al-Nazhan
DOI:10.4103/sej.sej_43_21  
Introduction: Bibliometric evaluation of the scientific literature quantifies the growth of individual articles and assesses their impact on subsequent publications within that field. This study investigated the bibliometric attributes of articles published in Saudi Endodontic Journal (SEJ) from 2011 to 2020. Materials and Methods: A retrospective study was carried out on the datasets which were retrieved manually from the SEJ website in September 2020. The chronological growth of the journal was assessed based on the annual growth rate. Type and field of study for each article were categorized. The most prolific author, institution, and country were identified as well as citation and authorship patterns. Descriptive analysis of the data was performed. Results: A total of 280 articles met the selection criteria for inclusion in the study. The total number of citations received was 1061 with 3.8 cites/document, with an average annual growth rate of 36.7%. The most frequent types of study were laboratorial (37.9%), case report (33.2%), and survey (11.1%). The most commonly occurring fields of study were root canal anatomy (25.7%), irrigation (14.6%), and canal instrumentation (12.9%). Literature reviews (9.6%) and articles on endodontic microbiology (8.3%) were associated with more citations compared to other study types and field of study, respectively. Saad Al-Nazhan has emerged as the most prolific author (n = 16; 5.7%), King Saud University as the most contributing institution (n = 40; 14.3%), and Saudi Arabia as the most contributing country (n = 112; 40%). Conclusion: SEJ has contributed significantly to the growth of endodontic literature as evident by the diversity of subjects covered in the past 10 years. The increased growth in international audience reflects the sturdy confidence of the scientific community on SEJ.
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The effect of root canal treatment on oral health-related quality of life: Clinical trial p. 334
Abdulsamad Turki Ezzat, Abdulwahab F Nagro, Ahmed T Fawzy, Omair M Bukhari
DOI:10.4103/sej.sej_148_20  
Introduction: The awareness of patient-centered outcomes regarding the sequel of endodontic therapy in everyday life is limited. This study aimed to quantify the impact of root canal treatment in one visit compared to root canal treatment in multiple visits on oral health-related quality of life (OHRQoL). Material and Methods: This is a controlled clinical trial, in which 32 patients were included; the age range was 16–60 years. At the patient's convenience, participants were divided into two groups: the first group received a single-visit treatment and the other group received a multiple-visit treatment. Conventional endodontic treatment was performed for indicated teeth by undergraduate dental students in a single visit or multiple visits. OHRQoL was recorded using an Arabic Oral Health Impact Profile (OHIP) questionnaire. Results: A total of 32 patients, with a mean age of 30.5 (SD = 8.2), received root canal treatments and filled OHIP questionnaire. Male patients composed 50% of the sample. The majority of the patients had a high school education (75%). Single-visit root canal treatment significantly improved OHRQoL by 7.6 points (P = 0.001) and multiple visits by 8 points (P = 0.001). Conclusion: Both single and multiple visits endodontic treatments equally improved OHRQoL.
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The demand for emergency care after pulpotomy with Biodentine® on permanent molars with irreversible acute pulpitis: Clinical trial study p. 339
Anta Seck, Fatou Lèye-Benoist, Babacar Touré, Haikel Youssef
DOI:10.4103/sej.sej_186_20  
Introduction: In Endodontology, intra- and postoperative pain control is a key aspect of clinical practice. Such pain can be immediate, deferred, transitional, prolonged, or permanent. This clinical trial was performed to assess the demand for emergency care after pulpotomy on mature permanent molars with clinical signs of irreversible pulpitis. Materials and Methods: Fifty patients aged 15–46 years who had undergone pulpotomy and were prescribed ibuprofen were given cards on which to record the occurrence and intensity of pain on a visual analog scale ranging from 0 (no symptom) to 10 (unbearable pain), and the use of any medication. After 1 week, the patients returned the cards and underwent clinical examination. The patients had clinical and radiographic checkups at months 3 (M3) and 6 (M6), and contacted their practitioners if they required additional appointments for pain relief. Data were statistically analyzed. Results: Examinations were performed on 49 patients on day 7 (D7), 44 patients at M3, and 41 patients at M6. On D7, 42 (85.7%) patients had pain, with an average duration of 2.1 ± 1.3 days and the average intensity of 1.1 ± 0.8. The intensity of pain was significantly greater in patients males (P = 0.013). No patient had pain, discomfort, or irritation between D7 and M3, at M3, or between M3 and M6. At M6, one (2.4%) patient had a broken tooth with pain on chewing and 97.6% of patients were pain-free. Conclusion: Pulpotomy with Biodentine® appears to be appropriate for mature permanent teeth with acute irreversible pulpitis.
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Radiographic variations of maxillary and mandibular premolars with type V canal configuration – A cone-beam computed tomographic study p. 345
Faisal Alnassar, Waleed Almutairi, Yousef Al-Dahman
DOI:10.4103/sej.sej_204_20  
Introduction: Cone-beam computed tomography (CBCT) image properly provides enhanced and accurate information of root morphology, canal configuration, and its possible variations. The aim of this study was to calculate the average distance from the cementoenamel junction (CEJ) up to the canal terminus and the width of the canal at the area of the division of type V configuration (Vertucci's classification) in premolar teeth using CBCT. Materials and Methods: Sevend hundered and seven CBCT images of the mandibular and maxillary premolars were screened for having type V configuration. The distance from CEJ to canal terminus and the width of the canal in the area of the division were measured. Age and gender were also recorded. Data were statistically analyzed. The statistical significance level was set at P < 0.05. Results: Maxillary second premolar teeth exhibited the shortest median distance from CEJ to the point of separation of the canal (3.86 mm) and the smallest width at the area of division (mean 1.86 ± 0.33 mm). No significant differences were observed in the distance nor width between genders in all teeth (P = 0.662 and 0.465, respectively). Moreover, no correlation was found between age and distance nor age and width of the canal (P = 0.89 and 0.95, respectively). Conclusion: The measurements give a general guideline for a more quantitative approach to endodontic access preparation for premolar teeth with type V configuration.
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Effect of Q-Mix® and apple vinegar on penetration of alizarin red dye through dentinal tubules: A comparative confocal microscopic study p. 350
Samar Mahmoud Mohamed Saied, Sybel Mokhtar Moussa, Nihal Adel Leheta, Ghada Mohamed Mourad
DOI:10.4103/sej.sej_205_20  
Introduction: Effective treatment of an endodontic therapy aims for removal of microorganisms from the root canal. Therefore, intraradicular removal of the smear layer is essential for successful treatment. The aim of the study was to analyze area and percentage of alizarin dye penetration into dentinal tubules to investigate the elimination of smear layer among Q-Mix®, apple cider vinegar (ACV), and ethylenediaminetetraacetic acid (EDTA) using confocal laser scanning microscopy (CLSM). Materials and Methods: Thirty mandibular premolars were subjected to decoronation to 15-mm standardized length. Root canals were prepared and randomly allocated to three groups according to the final irrigation used: Group I: 10 mL of Q-Mix for 1 min, Group II: 10 mL of ACV for 1 min, and Group III: 10 mL 17% EDTA for 1 min. The samples were irrigated with 2.5% sodium hypochlorite labeled with 0.2% alizarin red dye and then horizontally sectioned to be examined under CLSM. Data were statistically analyzed. The level of statistical significance was set at P < 0.05. Results: No statistically significant difference (P < 0.05) was present in the area and percentage of penetration of alizarin dye into the dentinal tubules among Q-Mix, ACV, and EDTA groups at the distinct levels of the canal walls. Conclusions: Q-Mix, ACV, and EDTA revealed effective cleaning ability in the coronal and middle thirds when compared to the apical canal section.
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Detection of dentinal cracks after use of piezoelectric device and surgical bur during root-end resection: An ex vivo comparative study p. 358
Yaser Dalaan Abdulraheem, Raif Rashad Marqoshi, Mohsen Hasan Daghestani, Hussain Nasser Almashhadi, Mohamed AhmedRefky Ibrahim, Majed Abdullah Almalki
DOI:10.4103/sej.sej_208_20  
Introduction: The piezoelectric device was implemented successfully in many oral and maxillofacial surgeries. However, in endodontic surgery, it is not widely used due to lack of scientific support. Thus, the aim of the conducted study was to compare the formation of the cracks of roots resected with piezoelectric surgery versus high-speed surgical bur using scanning electron microscopy. Materials and Methods: Sixty single-rooted human teeth were accessed followed by canal preparation with rotary files and filled with gutta-percha. The teeth were mounted on plastic cylindrical test tubes and emerged within the impression material to simulate periodontal ligament. Consequently, the teeth were divided into three groups: the control group (n = 10), piezoelectric group (n = 25), and the surgical bur group (n = 25). The surface of the resected root was examined under scanning electron microscopy for cracks detection. The one-way analysis of variance test was used to investigate the number and types of cracks at a significance level of 95%. Results: Dentinal cracks were detected in all groups. However, there was no statistically significant difference in the number of cracks between the three groups, but they differed in terms of crack type. Conclusions: All tested groups produce cracks on resected root surface, whereas the piezoelectric presented with satisfactory result.
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An in-vitro evaluation of cytotoxicity of fungal derived nanosilver particle endodontic irrigant on human periodontal ligament fibroblast cells. p. 364
Rahul S Halkai, Kiran R Halkai, Shishir Ram Shetty, Raghavendra M Shetty, Sunaina Shetty, Prathibha Prasad
DOI:10.4103/sej.sej_223_20  
Introduction: Recently, silver nanoparticles were indicated for root canal irrigation. The cytotoxicity evaluation of these agents helps to ascertain confident clinical use. This article aims at evaluating the cytotoxic effect of fungal-derived nanosilver particle irrigant on human periodontal ligament fibroblast (hPDLF) cells using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Materials and Methods: The test “nanoparticle” irrigant was produced using the fungi “Fusarium semitectum.” The cells were cultured in Dulbecco's Modified Eagle's Medium solution and adjusted to 5 × 103 cells/ml. About 100 μl of cells were seeded into a 96 well microplate and 100 μl test irrigant ranging from 5 to 640 μg/ml concentrations was added to a microplate and incubated at 37°C, 5% CO2 humidified conditions for 24 h. Untreated cells were used as a control group. About 5 mg/ml MTT was added to the plates and incubated at 37°C in 5% CO2 conditions for 4 h. The viability of cells and the percentage inhibition of cell were determined. Results: The 50% inhibition of cells was found to be around 320 μg/ml concentration. Cytotoxicity was found to be dose dependent and increased with higher concentrations of the nanosolution. Conclusion: Fungal-derived nanosilver irrigant is safe to hPDLF cells “in vitro” at a concentration of <320 μg/ml.
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Should South Africa train specialist endodontists? A cross-sectional online survey p. 369
Glynn Dale Buchanan, Mohamed Yasin Gamieldien, Sheree Tredoux, Martin Vorster, Nichola Warren, Peet J Van der Vyfer
DOI:10.4103/sej.sej_238_20  
Introduction: Endodontics as an independent dental specialty exists in many regions worldwide, with training programs established in both developed and developing countries. Endodontic specialty training is, however, currently not available in South Africa. This study aimed to determine whether private dental practitioners, who perform clinical endodontic treatment, believed that South Africa should train specialist endodontists. Materials and Methods: A cross-sectional, observational study was conducted. An online program was used to generate a survey which was electronically mailed to 3252 South African private dental practitioners. Quantitative and qualitative questions with open-ended responses were used. Topics included the following: demographic information, management/referral strategies regarding difficult endodontic cases, and need for endodontics as an independent dental specialty in South Africa. Data were analyzed using simple descriptive methods. Results: A total of 215 (n = 215/3252) responses were received by the closing date. The overall response rate was 7%. The valid responses of 193 participants were included (n = 193/215). The majority (83%, n = 160/193) of the respondents indicated the opinion that South Africa should train specialist endodontists. The reasons for this opinion were varied. Strategies in place for the management of difficult endodontic cases and existing endodontic referral pathways were additionally identified. Conclusion: There is a need to train specialist endodontists in South Africa.
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Assessment of knowledge of traumatic tooth fracture management among endodontists and general practitioners in two different countries: A cross-sectional survey p. 375
Rahaf A Almohareb, Reem MZ Barakat, Alanoud M Alrabiah, Aryaf H Alyabis, Asma H Bin Humeed, Hadeel N AlJurayyan, Manar A Alhefdhi, Salwa A Kheir
DOI:10.4103/sej.sej_246_20  
Introduction: Knowledgeable and timely management of traumatic dental injuries (TDIs) plays a decisive role in their long-term prognosis. The aim of this study was to assess knowledge of managing traumatic tooth fracture of permanent teeth among endodontists and general practitioners (GPs) set in two different countries. Materials and Methods: A two-part self-administered questionnaire assessing knowledge of traumatic tooth fracture management was distributed among 400 professionals in Saudi Arabia and the United Kingdom. The first part contained seven questions related to the participants' demographic data, and the second part included ten questions related to the management of trauma case scenarios focused on crown and root fracture. Data were statistically analyzed. Results: One hundred and eighty-two individuals participated in this survey. Endodontists managed TDIs more frequently, and the mean number of their correct answers was significantly higher when compared with GPs (P = 0.004). Specialty was the constant predictor of level of knowledge (P = 0.001) excluding geographic location and frequency of treating TDIs. Conclusion: The level of knowledge of the participants in both countries in managing traumatic tooth fracture was moderate. Correct answer score was influenced by having a specialty in endodontics. Dental professionals' perception of their knowledge did not reflect their objectively measured level.
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Mandibular second molars' C-shaped canal frequency in the Pakistani subpopulation: A retrospective cone-beam computed tomography clinical study p. 383
Hamza Ulfat, Alia Ahmed, Muhammad Qasim Javed, Faisal Hanif
DOI:10.4103/sej.sej_288_20  
Introduction: The adequate knowledge of the canal configuration can improve the quality and prognosis of endodontic treatment. The aim of the study was to determine the frequency of C-shaped root canal in the mandibular permanent second molars among a Pakistani subpopulation sample by utilizing cone-beam computed tomography images. Materials and Methods: Cone-beam computed tomographic images of 360 patients with 720 mandibular second molars were analyzed for the presence of C-shaped canal configuration. The root canal system was classified according to Fan's classification at three distinct levels. Unilateral or bilateral presence of C-shaped root canals and the location of the longitudinal groove were assessed. Moreover, the correlation of frequency of C-shaped canal with the gender was measured using the Chi-square test. The data were analyzed using SPSS version 23. Results: Of 720 mandibular second molars of 360 patients, 10% of teeth were found to have C-shaped canals in 48 patients. The most commonly noted C-shaped canal configurations in the coronal and middle third were C1 (41.7%) and C3 (37.5%), respectively, whereas C2 (33.3%) and C4 (33.3%) configurations were commonly found in the apical third. Twenty-four of 48 patients had bilateral C-shaped root canals. Overall, 37.5% of the teeth were right-sided teeth and 62.5% were left-sided teeth. The frequency of C-shaped canals was significantly higher in females as compared to males, 15.6% and 4.2%, respectively (P = 0.03). The longitudinal groove was most commonly located on the lingual surface (66.7%). Conclusions: The frequency of C-shaped canal configuration in the Pakistani subpopulation was 10% in the mandibular second molar teeth.
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Oral health-related quality of life and satisfaction after root canal treatment according to operator expertise: A longitudinal prospective study p. 388
Ibrahim Eid Alroudhan, Jothish Ravi, Shilpa Shaliputra Magar, Mohammad Khursheed Alam, Khalid Nafea Alsharari, Fadhel Musaad Alsharari
DOI:10.4103/sej.sej_291_20  
Introduction: Although the success rate of conventional root canal treatment is 70%–95%, patient satisfaction varies depending on various factors. Patient satisfaction and quality of life (QOL) are suspected to differ depending on the level of operator expertise. We investigated factors affecting the QOL and satisfaction of patients after root canal treatment performed by students, postgraduates, and specialists. Materials and Methods: The Oral Health Impact Profile survey (OHIP-17), seven semantic differential scales, and a radiographic assessment sheet were used in this study. The validity of the Arabic version of OHIP-17 was demonstrated by calculating the kappa statistic (0.95). The sample size was 250 patients; 63, 91, and 96 of whom were treated by specialists, graduates, and undergraduate students, respectively. Using the OHIP-17, an independent examiner interviewed each patient before and 2 weeks after treatment; patient satisfaction was assessed using a differential scale at the same time points. Radiographic assessments were conducted preoperatively and 2 weeks postoperatively by two independent radiographers. Results: The responses to most OHIP-17 questions showed no significant differences pre- and post-treatment. However, three, four, and two items were significantly different pre- and post-treatment in the undergraduate, graduate, and specialist groups, respectively. A P < 0.05 was considered to be significant. Conclusion: Root canal treatment improved the QOL of the patients. The findings will help dentists to understand patient perception and thus improve the holistic value of endodontic care.
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Effect of conventional and experimental silanes on the adhesion of fiberglass posts to root canals: In vitro study p. 393
Marcos Cezar Pomini, Carmem Silvia Pfeifer, Ana Paula Piovezan Fugolin, Vitoria Massoneto Piccolli, Roberta Araujo de Paula Ramos, Rafael Leonardo Xediek Consani
DOI:10.4103/sej.sej_297_20  
Introduction: Thiourethane addition to methacrylate of resin cements improves properties of flexural strength, toughness modulus, and fracture toughness. The aim of this study was to evaluate the effect of experimental silanes based on thiourethane in the adhesion of fiberglass posts to the root canal submitted to thermal and mechanical cycling. Materials and Methods: Two oligomers were synthesized with catalytic amounts of triethylamine. Multifunctional thiol–pentaerythritol tetra-3-mercaptopropionate was combined with difunctional isocyanates – 1,6-hexanedioldiissocyante (aliphatic) or 1,3-bis (1-isocyanato-1-methylethyl) benzene (aromatic). Human dental root canals were treated with conventional and experimental silanes, establishing six experimental groups (n = 10) endodontically rehabilitated with fiberglass posts. The specimens were submitted to 1.2 x 106 mechanical cycles and 500 thermal cycles (5°C and 55°C). One slice from each root region (cervical, middle, and apical) was submitted to the push-out bond test, and the fracture pattern evaluated. Scanning electron microscopy micrographs were obtained from the marginal gaps occurred in the adhesive interfaces. Data were analyzed with two-way ANOVA followed by Tukey's test at α = 0.05 confidence level. Results: Conventional and experimental silanes improved bond strength (P < 0.001) with similar values among the root regions (P = 0.199), decreased the occurrence of adhesive failures in dentin-cement bond, and increased the cohesive failures in dentin and the mixed failures. The marginal gaps showed in scanning electron microscopy micrographs were similar, except for the Angelus conventional silane, showing greater slit. Conclusions: Conventional and experimental silanes provided greater adhesive strength, reduced dentin-cement failures, and the marginal gaps were similar, except for the control group Angelus, showing greater slit.
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CASE REPORTS Top

Endodontic management of a mandibular premolar with a concurrent occurrence of dental anomalies p. 400
Sundus Mohammed Taher Bukhary
DOI:10.4103/sej.sej_164_20  
Developmentally abnormal teeth presenting a complex root canal morphology requires special endodontic management. The present case report demonstrates successful endodontic management of a mandibular first premolar with an unusual concurrent occurrence of a double tooth and dens evaginatus with a C-shaped canal configuration in a 21-year-old patient that was diagnosed with pulpal necrosis with symptomatic apical periodontitis. In this case, the use of cone-beam computed tomography and the dental operating microscope contributed remarkably to the diagnosis and treatment of the complex root canal morphology of the anomalous tooth. Therefore, the use of recent advances in endodontics is strongly recommended in such cases to ensure predictable and successful results.
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Management of external root resorption with Biodentine and platelet-rich fibrin matrix: A case report with 3 year follow up p. 405
Kavalipurapu Venkata Teja, Immadi Laxmi Sujith Kumar, Sindhu Ramesh, Kaligotla Apoorva Vasundhara
DOI:10.4103/sej.sej_143_20  
A male patient aged 28 years presented with a chief complaint of discolored left central incisor and missing tooth, due to road traffic accident 15 years ago with no associated symptoms. Clinical and radiographic examination revealed no pulp to response to vitality test, large periapical radiolucency, and root resorption of the middle third of the root. A definite diagnosis of pulpal necrosis with asymptomatic apical periodontitis and external resorption was made. Root canal treatment was done, and the extent of the lesion was analyzed and planned for surgical management. The periapical lesion was curetted, and the external resorption site was sealed with a matrix of Biodentine and platelet-rich fibrin. The case has shown successful healing after 3-year follow-up.
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Inadvertent pulmonary aspiration of endodontic hand instrument -procedural negligence and litigation: Case report p. 412
Monika Khangwal, Hena Rahman, Ravinder Solanki, Rajat Goyal
DOI:10.4103/sej.sej_156_20  
Aspiration/ingestion in dentistry is rare but serious complication. Dentist should be tremendously conscientious during any intercession, especially in supine position and the management of small instrument. A 21-year-old male patient reported in apprehension with a complaint of aspiration/ingestion of endodontic hand file instrument while undergoing root canal treatment. A prompt Non-Contrast Computed Tomography of the thorax was done, which discovered an endodontic file in the right bronchus. The patient was well-versed about the existence of the instrument and was instantly admitted to the Pulmonary Medicine Department. High-risk consent was duly signed by the patient before treatment. Flexible fiberoptic Bronchoscopy was considered for retrieval of the instrument under local anesthesia. A successful bronchoscopy was performed, and the endodontic instrument was retrieved. The patient was kept under observation for any symptoms. Follow-up chest-X ray done immediately and after 6 months. Consequently, focused Ethical standard practice guidelines, including rubber dam isolation, should be followed in dentistry/endodontic procedure to lessen unreasonable, difficult perilous situations, and negligence litigations.
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Endodontic treatment of a hypertaurodont mandibular second molar with C-shaped canal: A case report p. 418
Shaikh Shahbaz, Sharique Alam, Surendra Kumar Mishra, Syed Mukhtar-Un-Nisar Andrabi
DOI:10.4103/sej.sej_168_20  
Taurodontism is a variation in tooth anatomy characterized by an enlarged pulp chamber with hypertaurodont being its most severe presentation. The complexity of endodontic treatment of hypertaurodont tooth may be compounded by coexistent C-shaped canal anatomy. A 26-year-old patient reported with spontaneous and lingering pain due to a deep carious lesion in the right mandibular second molar. Clinical and radiographic examinations were done. A diagnosis of symptomatic irreversible pulpitis with symptomatic apical periodontitis in a hypertaurodont with an associated C-shaped canal configuration was made. The cone-beam computed tomography image guide together with microscopic magnification was utilized to negotiate, clean, and shape the root canal system. The isthmus of the C-shaped canal was prepared with ultrasonic tips, while Endoactivator sonic irrigant activation was employed for effectively disinfecting of the uninstrumentable intercommunications, apical splits, and ramifications. The apical root canals were obturated by lateral condensation technique, while warm vertical compaction of gutta-percha was utilized to fill the remaining pulp chamber. A 1 year follow-up of the case reveals a functional tooth with no signs of periapical infection, indicating a successful treatment outcome.
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Dystrophic pulpal calcification and crown darkening as sequelae of dental trauma: Report of two cases p. 423
Tiago Martins Feijó Miguelis, Josué Martos, Melissa Feres Damian, Giovane Hisse Gomes, Cristina Braga Xavier, Juan Pablo Aitken Saavedra
DOI:10.4103/sej.sej_215_20  
Dystrophic calcification of pulp tissue is a phenomenon that occurs more frequently in teeth with a history of concussion and luxation or even in avulsed and replanted teeth. The objective of this report is to describe the posttraumatic dystrophic calcification of the pulp, approaching a conservative treatment illustrated with clinical cases. The patients had intense yellowing of the dental crown of anterior teeth, and in the pulp sensitivity tests, a negative response was obtained on traumatized teeth. In both the cases, the periapical radiographic examination showed canal calcification. The clinical and radiographic findings revealed a diagnosis of pulp canal obliteration of traumatized teeth resulting from a sequel of dental trauma. The in-office dental bleaching by using hydrogen peroxide at 35% in two patients was the treatment option performed. The clinical responses of in-office dental bleaching in the presented cases of dystrophic calcification of the pulp were effective. It was possible to conclude that dental bleaching with hydrogen peroxide in two clinical sessions presented satisfactory and harmonic results.
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NEWS Top

10th Saudi endodontic society international conference 2021 p. 428
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DOI:10.4103/1658-5984.325568  
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