Aim: To evaluate and compare the regenerative potential of natural autologous scaffolds (blood clot and platelet rich fibrin [PRF]) with artificial scaffolds (commercially available collagen and poly-lactic-co-glycolic acid [PLGA] polymer) in inducing apexogenesis in necrotic immature permanent teeth. Materials and Methods: Necrotic immature permanent maxillary incisors with or without radiographic evidence of periapical lesion were included. Access opening was done under rubber dam isolation. Canal disinfection was done using minimal instrumentation, copious irrigation, and triple antibiotic paste as interappointment medicament for 4 weeks. After 4 weeks, asymptomatic teeth were divided into four groups on the basis of scaffolds used for revascularization procedure: Group I (blood clot); Group II (PRF); Group III (collagen); Group IV (PLGA). The clinical and radiographic evaluations of teeth were done at 6 and 12 months after the procedure and compared with baseline records. Result: Clinically, patients were completely asymptomatic throughout the study period. Radiographically, all cases showed improvement in terms of periapical healing, apical closure, root lengthening, and dentinal wall thickening. PRF and collagen gave better results than blood clot and PLGA in terms of periapical healing, apical closure, and dentinal wall thickening. Conclusion: Revascularization procedure is more effective and conservative over apexification in the management of necrotic immature permanent teeth. This study has shown that PRF and collagen are better scaffolds than blood clot and PLGA for inducing apexogenesis in immature necrotic permanent teeth.

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Aim and Objectives: The aim of this study was to test the dentinal tubule penetration of mineral trioxide aggregate (MTA) Fillapex (Angelus, Londria, PR, Brazil), GuttaFlow^® 2 sealer (Coltene/Whaledent) with standard sealer AH Plus (Dentsply Detrey, Konstanz, Germany) in instrumented root canals obturated by using cold lateral compaction techniques in either the presence or absence of the smear layer. Materials and Methods: Sixty extracted human mandibular premolars with a single root canal were used for this study. All teeth were prepared using F2 Pro Taper nickel–titanium rotary system. Teeth were randomly divided into three groups of 20 teeth each. GuttaFlow 2, MTA Fillapex and AH Plus were used as sealers in Group I, Group II, and Group III, respectively. Groups were divided into two subgroups in which either the smear layer was removed or retained. Removal of smear layer was achieved by continuous irrigation with 5.25% sodium hypochlorite and 2 ml of 17% ethylenediaminetetraacetic acid. The canals were dried and obturated using respective sealers by cold lateral compaction techniques. After storage at 37°C and 100% humidity for 14 days, the roots were then split into two halves using chisel and mallet. On each section, sealer penetration in the dentinal tubules at cervical, middle, and apical levels was examined by using scanning electron microscope. Results: Sealer penetration into the dentinal tubules was noticed in all groups. AH plus showed deeper penetration, followed by MTA Fillapex and GuttaFlow® 2. The penetration depth of the sealers at the cervical and middle third of root was significantly more than those at apical third. Conclusions: Within the parameters of the present study it was concluded, with the removal of smear layer AH plus sealer showed deeper penetration into the dentinal tubules at cervical and middle third of root compared with apical third.

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An excellent knowledge of root canal anatomy of teeth is a golden standard for the successful clinical outcome of root canal therapy. Several anatomic variations may occur in a permanent mandibular first molar. Usually, three to four root canals are found, but six to eight canals have been reported. A 22-year-old Bangladeshi woman was referred for endodontic treatment of mandibular right first molar. Rigorous clinical examination revealed the presence of three canals in mesial root and three canals in distal root as well. The dentists should expect any variation in root canal system and use the diagnostic tools to manage the cases.

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Aim: This study is aimed to evaluate the confidence level of undergraduate final year dental students in performing root canal treatment (RCT) and how it may affect their performance and perception regarding endodontics. Materials and Methods: A self-administered questionnaire was distributed to the final year dental students, at the University of Medical Sciences and Technology, Khartoum, Sudan (2013–2014). A total of 21 students were requested to participate voluntary and were asked to score their level of confidence using a 5-point Likert's scale. Results: Response rate was 100%, all the students (100%) stated that the requirements set were enough, and 66.7% rated endodontic as average in terms of difficulty. When rating the mean of self-confidence for performing RCT in the dentition, maxillary teeth (2.43 ± 0.51) followed by mandibular teeth (2.71 ± 0.64) were higher, whereas the molars were the least. Higher scores of self-confidence were in administrating local anesthesia (4.24 ± 0.70), followed by root canal shaping by hand instrument (3.76 ± 0.54). No association was found between overall confidence level and the number of performed RCT (P = 0.721). No association was found between overall confidence level of students who were subjected to instrument fracture and their frequency of fracture (P = 0.507), supervisor' reaction (P = 0.587), and willingness to specialize in endodontics (P = 0.530). Conclusion: Students displayed high confidence in performing basic endodontic and treating single-rooted teeth. More exposure is recommended to enhance the students' self-confidence.

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Aim: The aim of this investigation was to compare the efficacy of passive ultrasonic irrigation (PUI) with either 2.5% sodium hypochlorite (NaOCl) or saline, with that of conventional syringe irrigation on intraradicular Enterococcus faecalis biofilm. Materials and Methods: Biofilms of E. faecalis were established over 21 days in 80 single roots that had undergone biomechanical preparation followed by gamma radiation. Biofilms were treated for 1 min with 2.5% NaOCl/PUI (Group 1), 2.5% NaOCl (Group 2), sterile saline/PUI (Group 3), and sterile saline (Group 4). The positive control (n = 4) was used to confirm the presence of biofilm before various treatments. Additional four samples that served as a negative control were used to confirm the sterility of the samples. Biofilm eradication was evaluated by Colony Forming Unit (CFU) quantification and scanning electron microscopy (SEM). Results: The median of CFUs of S1 was significantly higher than that of S2 in all experimental groups. SEM examination showed a significant difference between the positive control and the experimental groups (P < 0.001), with the highest score of biofilm in the positive control group followed by Group 4 and both groups were not statistically significant from each other (P = 0.067). Following various treatments, the highest scores of biofilm were observed in the coronal third and the least were in the apical third. Conclusions: PUI did not increase the effectiveness of NaOCl irrigation on biofilm removal, however, PUI enhanced biofilm disturbance when used with saline. The least mean score of remaining biofilm was in the apical third of all treatment groups compared to other thirds.

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Objective: This study evaluated the quality of root canal treatment (RCT) and determined the prevalence of apical periodontitis (AP) in Al-Madinah Al-Munawwarah, Saudi Arabia. Materials and Methods: Panoramic radiographs of 630 patients (316 males and 314 females) who attended clinics at the Dental College of Taibah University seeking dental care for the first time between 2010and 2013 were assessed for the adequacy of RCT and presence of AP. Results: RCT of at least one tooth was found in 52.8% of the patients, with a significantly higher prevalence in females (28.4 vs. 24.4%; P = 0.012), and AP was found in 53.5% of the patients, with a significantly higher prevalence in females (31.9 vs 21.6%; P = 0.000). Conclusions: There was a significant correlation between AP and inadequate endodontic treatment. This study reveals the importance of improving RCT in Al-Madinah Al-Munawwarah.

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Thorough debridement is the key to the success of nonsurgical endodontic treatment in teeth with periapical lesions. Missed canals harbor bacteria which lead to treatment failure. This case report presents an unusual case of two rooted maxillary lateral incisors with the periapical lesion and emphasizes the importance of knowledge of the variability of root canal morphology. The tooth was treated with nonsurgical endodontic therapy. The patient was asymptomatic and bony healing was evident on radiograph at 12 and 18 months follow-up.

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Introduction: Root canal treatment (RCT) is a meticulous procedure that requires focus and precision while working in a confined space such as the root canal system of the tooth. Hence, it is a challenging practice for dental students a questionnaire-based study was conducted to evaluate senior dental students' perception toward single- and multiple-visit RCT while considering tooth type and patient cooperation, and to identify the most common reasons for multiple-visit RCT. Materials and Methods: This cross-sectional study included 267 senior year dental students from three universities and one private college in Saudi Arabia. A self-administered questionnaire was distributed between May and October 2014. The questionnaire was divided into four main sections, which evaluated student perception regarding single- and multiple-visit treatment, patient cooperation, and the nontherapeutic reasons for multiple-visits treatment. The collected data were analyzed using SAS 9.3. Results: Two hundred and seventeen questionnaires were returned (response rate, 81%). Dental students perceive multiple-visit RCT for anterior and premolar teeth as a significantly more stressful event than multiple-visit RCT for molars (P < 0.0001; Bowker's test). Tooth type and patient medical status were the highest ranked reasons for multiple-visit RCT. The majority of the responders (90%) considered single-visit RCT for single-rooted teeth a positive practice. Conclusions: Multiple-visit RCT is a stressful event for dental students, especially if the treated tooth was a single-rooted tooth. Dental students are aware of the negative effect of multiple-visit treatment on patient compliance. Clinical training should consider single-visit treatment for single rooted teeth.

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