Aim: To determine the prevalence of the number of root canals in permanent maxillary first and second premolars of a Saudi Arabian sub-population. Results will be compared to previous Asian studies. Materials and Methods: A total of 894 periapical radiographs of endodontically treated maxillary first and second premolars of 628 Saudi patients (268 males and 360 females) were viewed. The teeth were segregated into maxillary first premolars (463) and maxillary second premolars (431). The diagnostic, working length, master cone and final films with different angles were mounted, projected and, with the utilization of written clinical records, evaluated. Teeth with multiple canal systems were categorized according to whether the canals exited the root by common or separate apical foramen. Data was analyzed statistically using Chi-square test and professional t-test, by comparing pairs of groups with the significant level established at 5% (P < 0.05). Results: More than 90% of first maxillary premolar and more than 50% of the second maxillary premolar was found to have two canals. There was no significant difference between male (92%) and female (95%) in the distribution of the two root canals of the first maxillary premolar (t-test = 1.21, P value = 0.228), however, there was significant difference between the distributions of male (69.4%) and female (52.2%) of the two root canals within the second maxillary premolar (t-test = 3.75, P value = 0.000). Few teeth showed three canals. Conclusion: The number of root canals of the maxillary first premolar in Saudi population shows a higher incidence of two canals (93.6%) than previously reported. In addition, the figure is higher than most of the Asian countries.

Aim: The aim of our study is to elaborate a new cement based on Portland cement (PC), Modified Portland Cement (MPC) with modified chemical and physical properties that allow easier clinical manipulation and faster setting time than MTA^® and then to evaluate its cytotoxicity in vitro and its biocompatibility in vivo in comparison with MTA^® . Materials and Methods: Elaboration of MPC: Portland cement powder slenderly grinded to homogenize the particles, mixed with a radiopaque element and a setting time accelerator. A comparative in vitro study (MTS test) of the toxic effect of MTA^® and MPC with culture isolated from the calvaria of 18-day-old fetal Swiss OF1 mice are done. A comparative in vivo study of the biocompatibility of MTA^® and MPC: Under general anaesthesia, three holes (2.5 mm) were made in both the left and right femurs of six White New Zealand rabbits. In the first hole MPC is placed, in the second MTA^® and the third one is left empty (negative control group). Three weeks after implantation, two rabbits are sacrificed, then two other rabbits over six weeks and the last two after twelve weeks. The neck of the femur is trimmed and prepared for undecalcified histological studies. Mann-Whitney test was used to analyze the results. Results: The cell viability test according to the morphological observations suggested the biocompatibility of the two biomaterials tested. The in vivo test showed similar biocompatibility between MTA^® and MPC. Bone healing and minimal inflammatory response adjacent to MTA^® and MPC implants were observed at all experimental periods (3, 6 and 12 weeks), suggesting that both materials are well tolerated. Conclusion: This pilot comparative study of MTA^® and MPC showed no or very limited toxic effects of both cements in vitro and similar biocompatibility in vivo. However, additional in vivo and clinical studies should be done on MPC before it can be introduced in our clinical practice.

Aim: The purpose of this in vitro study was to assess the apical sealing ability of Epiphany/Resilon, AH Plus/gutta-percha and their cross combinations-AH Plus + Resilon and Epiphany+gutta-percha. Materials and Methods: Fifty eight extracted human single-rooted mandibular premolars were used and obturated with different combinations of core material and sealer using lateral compaction technique. The groups were as follows: Group-1: Epiphany + Resilon; Group-2: AH Plus + Gutta-percha; Group-3: AH Plus + Resilon; Group-4: Epiphany + Gutta-percha; Group-5: Negative control group. Apical microleakage was assessed with dye penetration method using stereomicroscope. Statistical analysis was performed using one-way ANOVA followed by post hoc test (Bonferroni test), with significance level set at P < 0.05. Results: Results indicated that AH Plus + Resilon had the least microleakage than all the other groups, followed by Epiphany + Gutta-percha group while Epiphany + Resilon group demonstrated the greatest amount of microleakage. Statistical analysis showed significant results (P < 0.05) except for comparison between Group 1-2 and Group 3-4 (P > 0.05). Conclusions: Resilon + AH Plus showed significantly least amount of microleakage and better apical sealing ability as compared to other groups.

Aim: To present the current situation of dental operating microscopy (DOM) training in the available Advance Specialty Education Programs in Endodontics in Arab Middle-Eastern countries. Materials and Methods: A web-based survey was sent to the electronic mail address of Advance Specialty Education programs of 15 Arab and middle east countries. The questions were limited to those who have an advanced specialty education program in Endodontics at their University if they are using an operating microscope? Results: Out of 15 countries, only 4 countries have microscopic technology in their Advance Education Programs in Endodontics. Conclusion: Few Arab Middle-Eastern countries have DOM in their advance education programs in endodontics. The highest authority in advancing endodontic education in the Arab Middle-East should consider in the near future the importance of this technology as standard care in teaching advance endodontics. An advance workshops should be organized regularly to provide enough knowledge about this standard educational technology.

Introduction: Vertical root fractures (VRFs) of endodontically treated teeth are serious complications that are associated with a poor survival prognosis. The diagnosis of VRFs is difficult, because the clinical signs and symptoms are often obscure and periapical radiographs (PAs) provide limited diagnostic information. Recently, Cone Beam Computed Tomography (CBCT) has been used to address complicated cases of VRFs with an inconclusive diagnosis. Aim: To determine the clinical diagnostic accuracy of CBCT in detecting VRFs in complex failing cases of endodontically treated teeth, as an adjunct to PAs. Materials and Methods: Evaluating the diagnostic accuracy of CBCT in a series of clinical cases of suspected VRFs, presented via clinical photographs, PAs, and CBCT images. Results: CBCT imaging significantly aided the differential diagnosis in most cases. Conclusions: CBCT imaging provides a 3D image and information in many cases of VRF that 2-dimensional PAs fail to generate. The slice thickness and interslice interval of the CBCT image influence the perception of the normal anatomy and pathoses.

Aim: To assess the effects of three root canal preparation techniques on canal volume and surface area using three-dimensionally reconstructed root canals in extracted human maxillary molars. Materials and Methods: Thirty extracted Human Maxillary Molars having three separate roots and similar root shape were randomly selected from a pool of extracted teeth for this study and stored in normal saline solution until used. A computed tomography scanner (Philips Brilliance CT 64-slice) was used to analyze root canals in extracted maxillary molars. Specimens were scanned before and after canals were prepared using stainless steel K-Files, Ni-Ti rotary ProTaper and rotary SafeSiders instruments. Differences in dentin volume removed, the surface area, the proportion of unchanged area and canal transportation were calculated using specially developed software. Results: Instrumentation of canals increased volume and surface area. Statistical analysis found a statistically significant difference among the 3 groups in total change in volume (P = 0.001) and total change in surface area (P = 0.13). Significant differences were found when testing both groups with group III (SafeSiders). Significant differences in change of volume were noted when grouping was made with respect to canal type (in MB and DB) (P < 0.05). Conclusion: The current study used computed tomography, an innovative and non destructive technique, to illustrate changes in canal geometry. Overall, there were few statistically significant differences between the three instrumentation techniques used. SafeSiders stainless steel 40/0.02 instruments exhibit a greater cutting efficiency on dentin than K-Files and ProTaper. CT is a new and valuable tool to study root canal geometry and changes after preparation in great details. Further studies with 3D-techniques are required to fully understand the biomechanical aspects of root canal preparation.

Crown root fractures in the maxillary anterior region represent an intriguing challenge for clinicians. An interdisciplinary approach based on exposing fractured margins and the definitive prosthetic rehabilitation represent the standard modality of treatment for these conditions to restore the appropriate biologic dimension and esthetics. However, if the margins of the fragment and the tooth show perfect juxtaposition with no interfragmentary space and immediate esthetic replacement is needed, reattachment of the fractured segment using adhesives may be indicated. The aim of this case report is to describe the treatment of a crown root fracture at CEJ of an endodontically treated tooth having porcelain fused to metal crown by means of metal post placement and reattactment of the fragment using Glass ionomer cement with follow up of one year. Conclusion: Reattachment of a tooth fragment is a viable technique that restores function and aesthetics with a very conservative approach in a single visit and can be considered when treating patients with crown/root fractures of the anterior teeth.

Biomechanical preparation of the entire root canal system is one of the most important procedures in endodontic treatment. Separation of instruments while preparing root canals presents a compromised situation in which a biologically inert segment is left behind with potential contamination that has the ability to affect the healing process. Management of this procedural error is tedious and requires creativity as well as clinical knowledge and skills. In this report, we demonstrated two cases with separated instrument in which a combined technique of ultrasonic method with microtube tube method was used to retrieve the separated tips using a modified Vista dental tip.

Whenever unrestorable teeth need to be extracted or tooth agenesis is evident, other treatment alternatives, such as tooth transplantation, should be considered, instead of immediately replacing teeth with fixed, removable, or implant-supported prostheses. Supernumerary and impacted teeth should be considered as a reservoir for transplants. Transplanted tooth should be managed carefully during transplantation and endodontic treatment. This present case report discusses an autotransplantation of an impacted third molar into an unrestorable second molar.