Perspectives of Indian dental residents on novel online practical examination during COVID-19: A cross-sectional study

PURPOSE

This cross-sectional study aimed to assess the graduating dental residents' perspectives on the online clinical examination format.

METHODS

The questionnaire used to assess the perspectives was developed via a focus group discussion and was validated for face and content validity, readability testing, and pilot testing for the online version. This self-administered, online questionnaire integrated 15 Likert-scale-based multiple choice questions and one open-ended question. It was distributed to the residents across 16 dental schools after the clinical examination was completed. The perspectives regarding examination preparation, the ability to transition to online mode, and the performance in the examination were assessed. Descriptive statistical analysis (counts and percentages) was performed.

RESULTS

A total of 256 subjects participated in the study by returning the online survey. In the preparation phase, 70.7% (n = 181) residents reported anxiety and 56.1% (n = 144) reported stress. During the examinations, only 13.6% (n = 35) of the participants reported difficulty with internet speed. The majority, 64.6% (n = 165) of the participants reported that the absence of an external examiner face-to-face reduced anxiety. The compiled answers to the open-ended question revealed that residents expressed inconvenience in digitizing the academic logbooks and clinical work. The poor quality of sound and images affected the display of skills.

CONCLUSIONS

The study revealed a moderate level of acceptance for the novel online practical examination method. The residents reported stress before and during the examination due to the sudden transition to an online examination. The online practical examination with modifications might be a viable alternative to the in-person clinical examination.

Real-time guided endodontics: A case report of maxillary central incisor with calcific metamorphosis

Dental trauma results in various complications and poses an enigma to the practitioner. Calcific metamorphosis is one of the sequelae of trauma. A female patient of 35 years visited the specialty clinic of endodontics for the management of a discolored tooth. Clinically, discolored 21 was observed with no pain on palpation and percussion. The pulp sensibility test revealed a negative response. Radiographic examination revealed pulp canal obliteration with an apical radiolucency of Peri Apical Index (PAI 4). The tooth was diagnosed as necrotic pulp with asymptomatic apical periodontitis. Attempt to negotiate the canal under a Dental Operating Microscope (LABOMED, Los Angeles, CA, USA) and ultrasonics (Satelec, Acteon, France) was futile. Cone-beam computed tomography image revealed a patent canal in the apical third. Using real-time guided endodontics with a dynamic navigation system (Navident, ClaroNav, Toronto, ON, Canada), the protocol of plan, trace, and place was followed, and successful canal negotiation was achieved. After radiographic confirmation, root canal treatment was completed.

Comparative evaluation of efficacy of three single file retreatment systems for removal of gutta percha and assessment of root canal transportation - An In Vitro study

Background

In comparison to multiple file systems, recent advancements in single file retreatment systems had reduced the working time and ease of operation for clinicians.

Aim

To compare the efficacy of retreatment systems compared with hand instrumentation, by evaluating their removal efficacy, time required for retreatment and assessment of canal transportation.

Methods and Material

Forty premolars were instrumented using ProTaper Gold gold files. Post instrumentation, scan was taken, obturated using warm vertical compaction technique, and stored in artificial saliva for three months and randomly divided into four groups for retreatment. Hand instrumentation (Hi), Neoniti (Nn), Mtwo R (Mt), WaveOne Gold (Wg). Post retreatment, scan was taken. Teeth were sectioned longitudinally and photographed under the stereomicroscope. Retreatment time was recorded, and canal transportation was calculated.

Statistical Analysis

The results were analyzed using one-way analysis of variance (ANOVA) followed by Tukey's post hoc test at 95% confidence level.

Results

The retreatment time was significantly longer in the Hi group. Within the test groups, a significantly longer time has been taken by Wg (p < 0.05) compared to Mt and Nn. There was no difference in the canal transportation between the single file systems at 3 mm, 6 mm and 9 mm from the apex, there was statistically significant higher transportation for the Hi group at 9 mm from the apex (p < 0.05).

Conclusions

All techniques were effective in removal of filling material with minimal canal transportation. Wg system was shown to increased time compared to Nn and Mt systems. Hi group was slowest with maximum canal transportation at 9 mm from the apex.

Evaluation of Bond Durability, Surface Morphology, and Remineralization at the Adhesive Interface with Dentin Bonding Agents Modified with Silica-doped Nanohydroxyapatite

Objectives

To compare and evaluate the bond durability, surface morphology, and remineralization of the adhesive layer with newer adhesive systems modified with novel bioactive nanoparticles.

Methodology

Bonding agents evaluated in this study include (a) Conventional dentin bonding agent (CN-DBA) (b) Nanohydroxyapatite (nanoHAP) incorporated dentin bonding agent (NH DBA); (c) Silica doped nanohydroxyapatite (Si nanoHAP) incorporated dentin bonding agent (Si NH DBA). A total of 104 human dentin discs (5 mm × 5 mm × 2 mm) were sectioned. Elemental analysis (Ca/P ratio) and surface morphology of the adhesive layer with different dentin adhesives were evaluated under scanning electron microscopy with energy-dispersive X-ray analysis after speculated storage time of 1 day and 6 months. Microshear bond strength of adhesive restorations with different dentin adhesives was evaluated under universal testing machine and fractographic analysis under scanning electron microscope after speculated storage time of 1 day and 6 months. The results were analyzed using analysis of variance and post hoc analysis.

Results

Si-NH-DBA showed highest mean microshear bond strength for both 1 day and 6 months, which was significantly higher compared to conventional nanofilled dentin bonding agent (CN-DBA) and NH-DBA. Si-NH-DBA group showed only 10% reduction in bond strength after 6 months, which was less compared to that of other groups. Similarly, Si-NH-DBA showed higher remineralization with stellate-shaped crystals at the adhesive layer after 6 months with hydrolytic resistant hybrid layer, compared to CN-DBA and NH-DBA.

Conclusion

Silica-doped nanohydroxyapatite proved its efficiency on bond stability, remineralization, and hydrolytic resistance when incorporated into dentin bonding agents because of its bioactivity and carbonate-containing apatite-forming ability.

Mineral Trioxide Aggregate for Management of Three Resorptive Areas in a Single Rooted Tooth

The maxillary anterior tooth is the key tooth for the esthetics of an individual. Unfortunate trauma to the maxillary anterior tooth results in compromised esthetics and self-esteem of a young patient. Multiple resorptive defects in a tooth may compromise its prognosis and may be indicated for extraction following replacement by the implant. However, “a naturally retained tooth is the ultimate implant”. A 25-year-old patient visited the Department of Conservative Dentistry and Endodontics with the complaint of purulent pus discharge and unacceptable color in the front tooth region for two months. The yellowish-brown discolouration was observed in 11. Radiographic imaging revealed two internal resorption areas. Apical resorption was evident on the distal aspect of the root. The Cone-beam Computed Tomography (CBCT) imaging revealed two internal resorptive areas with external resorption. This case report describes the successful surgical therapy of communicating internal, external and apical resorption with complicated pulp space that was managed effectively with the help of CBCT, magnification and bioceramic materials. This case report highlights the importance of Mineral Trioxide Aggregate (MTA), Dental operating microscope and CBCT for the diagnosis and effective management of a structurally compromised tooth.

Comparison of Tentative Radiographic Working Length with and without grid Versus Electronic Apex Locator

The apical termination of obturation is the most important factor influencing the success of root canal treatment (RCT). Working length (WL) is the key element in achieving this.

AIM

The aim of this study is to compare and evaluate the preoperative estimated WL with conventional radiograph and with grid radiograph, with reference to electronic apex locator (EAL) in single-rooted teeth.

SETTINGS AND DESIGN

Thirty permanent anterior teeth with complete root formation indicated for RCT were included in this study.

MATERIALS AND METHODS

Conventional radiograph (Group 1) and conventional radiograph with external grid (Group 2) were made before access opening. WL with EAL (Group 3) was determined after access opening.

STATISTICAL ANALYSIS

The statistical package for the social sciences (SPSS) version 16.0 (SPSS Inc., Chicago, IL, USA) was used to compare the WLs of three groups, and the statistical significance was considered to be P ≤ 0.05. ANOVA, post hoc test were made to measure the intergroup comparison, and Pearson correlation values were obtained.

RESULTS AND CONCLUSION

The results of the study showed a higher correlation between grid WL and apex locator WL than conventional WL and apex locator WL. Preoperative metrics with radiographic grid along with the apex locator is a better measuring tool compared to the conventional radiographic WL in a single-rooted tooth.

Comparative evaluation of chlorhexidine, grape seed extract, riboflavin/chitosan modification on microtensile bond strength of composite resin to dentin after polymerase chain reaction thermocycling: An in vitro study

Aim:

The purpose of this study was to evaluate the influence of chlorhexidine (CHX), grape seed extract (GSE), riboflavin/chitosan modification on microtensile bond strength (μTBS) of composite resin to dentin after polymerase chain reaction (PCR) thermocycling.

Materials and Methods:

Forty extracted human molars were used and a flat surface was then prepared by removing the occlusal one-third. The teeth were randomly assigned into four groups - Group I in which self-etch adhesive (Adper Easy One) was applied and Groups II, III, IV were pretreated with 2% CHX, 6.5% GSE, and 1% riboflavin/chitosan, respectively, before the application of self-etch adhesive. Composite build-ups were constructed, and PCR thermocycling (5000 cycles) was performed. The μTBS was evaluated using the universal testing machine. Data were analyzed using one-way analysis of variance and Tukey's test.

Results:

The mean μTBS values for Group I (control), Group II (CHX), Group III (GSE), and Group IV (riboflavin/chitosan modification) were 30.81, 43.15, 38.79, and 35.07 MPa, respectively.

Conclusion:

Pretreatment with CHX and GSE leads to a significant increase in μTBS of composite resin to dentin.

Surgical management of lateral incisor with type II dens invaginatus and a periapical pathosis: A case report with 1-year follow-up

Dens invaginatus is a relatively common dental malformation resulting from an infolding of enamel organ into the dental papilla varying in depth into the tooth tissues. Complex morphological anatomy associated with the pulpal pathology presents inaccessibility to completely remove the necrotic pulp tissues and hence poses challenges in rendering endodontic treatment. A combination of nonsurgical and surgical management in treating such cases is advisable depending on the presented variations. The present case reports the surgical endodontic treatment of an immature maxillary lateral incisor with type II dens invaginatus and periapical pathology.

Spectrophotometric Evaluation of Colour Stability of Nano Hybrid Composite Resin in Commonly Used Food Colourants in Asian Countries

INTRODUCTION

There is growing interest in colour stability of aesthetic restorations. So far few studies have been reported.

AIM

This study was designed to investigate the effects of different common food colourants i.e., Turmeric and Carmoisine (orange red dye) consumed by patients in Asian countries on a recent nano hybrid composite resin.

MATERIALS AND METHODS

A total of sixty disk shaped specimens measuring 10 mm in diameter and 2 mm in thickness were prepared. The samples were divided into two groups {Z 100 (Dental restorative composite) Filtek Z 250 XT (Nano hybrid universal restorative)}. Baseline colour measurement of all specimens were made using reflectance spectrophotometer with CIE L*a*b* system. Specimens were immersed in artificial saliva and different experimental solutions containing food colourants (carmoisine solution and turmeric solution) for three hours per day at 37°C. Colour measurements were made after 15 days. Colour difference (ΔE*) was calculated. Mean values were compared by one-way analysis of variance (ANOVA). Multiple range test by Tukey Post-hoc test procedure was employed to identify the significant groups at 5% level.

RESULTS

Z 100 showed minimum staining capacity when compared to Z 250 XT in both the colourant solutions.

CONCLUSION

The nanohybrid composite resin containing TEGDMA showed significant colour change when compared to that of microhybrid composite resin as a result of staining in turmeric and carmoisine solution.

Shaping ability of reciprocating motion of WaveOne and HyFlex in moderate to severe curved canals: A comparative study with cone beam computed tomography

Introduction:

M-Wire and reciprocating motion of WaveOne and controlled memory (CM) wire) of HyFlex were the recent innovations using thermal treatment. Therefore, a study was planned to evaluate the shaping ability of reciprocating motion of WaveOne and HyFlex using cone beam computed tomography (CBCT).

Methodology:

Forty-five freshly extracted mandibular teeth were selected and stored in saline until use. All teeth were scanned pre- and post-operatively using CBCT (Kodak 9000). All teeth were accessed and divided into three groups. (1) Group 1 (control n = 15): Instrumented with ProTaper. (2) Group 2 (n = 15): Instrumented with primary file (8%/25) WaveOne. (3) Group 3 (n = 15): Instrumented with (4%/25) HyFlex CM. Sections at 1, 3, and 5 mm were obtained from the pre- and post-operative scans. Measurement was done using CS3D software and Adobe Photoshop software. Apical transportation and degree of straightening were measured and statistically analyzed.

Results:

HyFlex showed lesser apical transportation when compared to other groups at 1 and 3 mm. WaveOne showed lesser degree of straightening when compared to other groups.

Conclusion:

This present study concluded that all systems could be employed in routine endodontics whereas HyFlex and WaveOne could be employed in severely curved canals.

A comparative evaluation of the increase in root canal surface area and canal transportation in curved root canals by three rotary systems: A cone-beam computed tomographic study

Aim:

The aim of this study was to measure the increase in root canal surface area and canal transportation after biomechanical preparation at 1, 3, and 5 mm short of the apex with three different rotary systems in both continuous rotary and reciprocating rotary motions.

Materials and Methods:

Sixty freshly extracted human mandibular molars with mesial root canal curvatures between 20° and 30° were included in the study. Teeth were randomly distributed into three groups (n = 20). Biomechanical preparations were done in all the mesial canals. In Group 1, instrumentation was done with ProTaper universal rotary files, Group 2, with K3XF rotary files, and Group 3, with LSX rotary files. Each group was further subdivided into subgroups A and B (n = 10) where instrumentation was done by continuous rotary and reciprocating rotary techniques, respectively. Increase in root canal surface area and canal transportation was measured using the preoperative and postoperative cone-beam computed tomography scans.

Statistical Analysis:

The data were analyzed by one-way ANOVA followed by Tukey pairwise multiple comparison tests.

Results:

Increase in root canal surface area was significantly more (P < 0.05) in ProTaper and K3XF groups when compared to LSX group. Canal transportation was significantly more (P < 0.05) in ProTaper group when compared to K3XF and LSX groups. There was no significant difference (P > 0.05) in increase of root canal surface area and canal transportation between continuous rotary and reciprocating rotary techniques for ProTaper Universal, K3XF and LSX groups.

Conclusion:

LSX rotary system showed minimal increase of root canal surface area and minimal canal transportation when compared to ProTaper and K3XF rotary systems.

Evaluation of the Quality of Obturation with Obtura at Different Sizes of Apical Preparation Through Microleakage Testing

INTRODUCTION

Obturation of the root canal system is required to prevent recontamination of the root canal after cleaning and shaping procedures and to seal the root canal completely, both the apical and coronal avenues of potential leakage and to maintain the disinfected status.

AIM

The aim of this study was to determine the microleakage by dye leakage method at 1mm, 3mm and 5mm short of the apex with different sizes of apical preparation, obturated by Obtura.

MATERIALS AND METHODS

Sixty freshly extracted human single rooted teeth were randomly distributed into six equal groups. Group I (control group) was obturated by lateral compaction technique. Group II to VI were experimental groups (apical preparations done upto ISO sizes 20, 30, 40, 50 and 60 respectively), obturated by Obtura technique. After storing the samples at 100% humidity for seven days and one day in 2% methylene blue, the roots of the teeth were sectioned at 3mm short of the apex. They were observed under stereomicroscope at 20X magnification and the images were analysed for microleakage using the scoring criteria. The data obtained were analysed by One-way ANOVA followed by Tukey pair-wise multiple comparison test and p ≤ 0.05 was considered as the level of significance.

RESULTS

The lowest mean microleakage score was seen in Group VI (0) and the highest mean leakage score was seen in Group II (1.5). There was statistically significant difference between Group II and Group V (p = 0.044), Group II and Group VI (p = 0.013). There was no significant difference between all the other groups (p> 0.05).

CONCLUSION

Comparison of microleakage between different groups from ISO sizes 20-60 recommends a minimum apical preparation of ISO size 30.

Comparative evaluation of microshear bond strength of the caries-affected dentinal surface treated with conventional method and chemomechanical method (papain)

Background:

There is a growing interest in chemomechanical excavation (papain) in permanent molar teeth. There are several studies dealing with primary molar teeth.

Aim:

The aim of this study was to evaluate the influence of conventional method and Carie-care (chemomechanical method) on the microshear bond strength (μSBS) and the type of failure of an adhesive system to caries-affected dentin of permanent molar teeth.

Materials and Methods:

Twenty permanent molar teeth with carious lesions extending into the dentin were selected. Through the center of the carious lesion, teeth were sectioned mesiodistally and divided into two groups based on the method of caries excavation (conventional and chemomechanical method). The time required for the completion of excavation procedure was noted. Samples were again divided into two subgroups in each according to the method of restoration (Ketac N100 and Filtek Z350 composite). The bonded interface was subjected to μSBS testing in a universal testing machine. Fractured surfaces were examined under a stereomicroscope, and representative specimens were examined under scanning electron microscope for the type of failure.

Statistical Analysis:

It was achieved with unpaired t-test and Kruskal-Wallis H-test at 5% level of significance.

Results:

The μSBS values of Carie-care groups were similar to that of the conventional method. The μSBSs of resin composite were significantly (P < 0.001) more than that of resin glass ionomer bonded irrespective of the method of caries excavation.

Conclusion:

A papain-based chemomechanical agent can be used safely as a method for caries removal when employing conventional adhesive systems.

A Comparitive Evaluation of Sealing Ability, pH and Rheological Properties of Zinc Oxide Eugenol Sealer Combined with Different Antibiotics: An In Vitro Study

AIM

The objective of this study was to evaluate and compare the sealing ability, pH & viscosity of Zinc oxide eugenol sealer mixed with different antibiotics (Amoxicillin, Ciprofloxacin, Clindamycin and Doxycycline).

MATERIALS AND METHODS

Ninety single rooted anterior teeth were randomly divided into four experimental groups of 15 teeth each and 3 control groups of 10 each. Sealer-antibiotic combination was used as a sealer in experimental group. Teeth were sectioned longitudinally to assess linear dye penetration. pH and viscosity of the experimental groups were evaluated with Elico pH Meter and Brook Field Viscometer respectively.

RESULTS

(Amoxicillin+ ZOE) Group II and (Clindamycin + ZOE) Group IV have shown minimum linear dye leakage of 1.07mm & 1.22 mm respectively & (Ciprofloxacin + ZOE) Group III and (Doxycycline + ZOE) Group V 2.69 mm & 2.59 mm respectively. There was decrease in the viscosity of the experimental group. pH was found to be 8.55 for Group II sealer which was greater than control group.

CONCLUSION

Amoxicillin and sealer combination can improve the success rate of endodontic therapy by enhancing the antimicrobial activity, alkaline environment and reducing apical microleakage.

A novel approach for restoration of hemisectioned mandibular second molar with modified tunnel restoration: a case report

Hemisection refers to sectioning of a mandibular molar into two halves followed by removal of the diseased root and its coronal portion. Hemisection of a mandibular molar may be a suitable treatment option when the decay is restricted to one root and the other root is healthy. The retained root is endodontically treated and the furcation area is made self-cleansable. Retained tooth structure is restored as premolar which helps to reduce the masticatory load. Hemisection of mandibular molar was often referred to as premolarization. Studies showed that the remaining coronal structure influenced the fracture resistance of endodontically treated maxillary first premolars. Clinical experience showed the viability of tunnel restoration as an alternative to class II conventional cavity preparation in initial proximal lesion. This article discusses a case that presents the novel technique involved in restoration of the remaining hemisected tooth using modified tunnel restoration.

Biological dentin post for intra radicular rehabilitation of a fractured anterior tooth

Ideal coronal reconstruction of endodontically treated tooth is still a challenge for restorative dentistry. Despite having varied types of commercially available posts, none of them meet all the ideal biological and mechanical properties. In this context a "Biological Post" serves as a homologous recipe for intraradicular rehabilitation of a fractured endodontically treated tooth by virtue of its biomimetic property.This case report addresses the esthetic and functional restoration of a fractured, endodontically treated maxillary lateral incisor in a young patient, through the preparation and adhesive cementation of a "Biological Post" made from a freshly extracted, intact human canine. The use of biological post can be considered as a novel alternative technique for the rehabilitation of an extensively damaged tooth.

An in vitro stereomicroscopic comparative evaluation of a combination of apex locator and endodontic motor with an integrated endodontic motor

Objective:

To compare the efficacy of an integrated apex locator and an apex locator and endodontic motor assembly in maintaining the working length when operated under autoreverse mode.

Study Design:

Thirty distobuccal roots of intact maxillary first molars were taken and access cavities were prepared. The teeth were divided into Group I: Prepared with TCM Endo V and Group II: Prepared with ProPex and NSK assembly. The instrumentation was ended in ProTaper F3 file, which was cemented in the canal. The roots were sectioned, observed under a stereomicroscope and the distance from instrument tip to the apical foramen was measured.

Results:

Mean difference in the deviation of two groups was 0.075 mm, P = 0.34 (>0.05) which was statistically insignificant when assessed with unpaired t-test.

Conclusion:

The assembly of ProPex-NSK Endo-mate DT and the apex locating endomotor TCM Endo V Nouvag are clinically acceptable.

A comparative evaluation of efficacy of protaper universal rotary retreatment system for gutta-percha removal with or without a solvent

Aim:

The aim was to evaluate and compare the efficacy of ProTaper Universal rotary retreatment system with or without solvent and stainless steel hand files for endodontic filling removal from root canals and also to compare retreatment time for each system.

Materials and Methods:

Thirty extracted mandibular premolars with single straight canals were endodontically treated. Teeth were divided into three major groups, having 10 specimens each. Removal of obturating material in group 1 by stainless steel hand files with RC Solve, group 2 by ProTaper Universal retreatment instruments and group 3 by ProTaper Universal retreatment instruments along with RC solve was done. Retreatment was considered complete for all groups when no filling material was observed on the instruments. The retreatment time was recorded for each tooth. All specimens were grooved longitudinally in a buccolingual direction. The split halves were examined under a stereomicroscope and images were captured and analyzed. The remaining filling debris area ratios were considered for statistical analysis.

Results:

With ANOVA test, statistical analysis showed that there was statistically no significant difference regarding the amount of filling remnants between the groups (P < 0.05). Differences between the means of groups are statistically significant regarding the retreatment time.

Conclusion:

Irrespective of the technique used, all the specimens had some remnants on the root canal wall. ProTaper Universal retreatment system files alone proved to be faster than the other experimental groups.

Effect of different placement techniques on marginal microleakage of deep class-II cavities restored with two composite resin formulations

Aim:

The study aims to evaluate and compare marginal microleakage in deep class II cavities restored with various techniques using different composites.

Materials and Methods:

Sixty freshly extracted teeth were divided into six groups of 10 teeth each. Standardized class II cavities were made and were restored using composites of different consistencies with different placement techniques. Group 1 with Microhybrid composite, Group 2 with Packable composite, Group 3 Microhybrid composite with a flowable composite liner, Group 4 Packable composite with a flowable composite liner, Group 5 Microhybrid composite with precured composite insert in second increment and Group 6 Packable composite with precured insert in second increment. Specimens then were stored in distilled water, thermocycled and immersed in 50% silver nitrate solution. These specimens were sectioned and evaluated for microleakage at the occlusal and cervical walls separately using stereomicroscope.

Results:

The results demonstrated that in the occlusal wall, packable composite, showed significantly more marginal microleakage than the other groups. In the cervical wall, teeth restored with a flowable composite liner showed less marginal microleakage when compared to all other groups.

Conclusion:

Based on the results of this study, the use of flowable composite as the first increment is recommended in deep class II cavities.