Awareness of possible complications associated with direct composite restorations: A multinational survey among dentists from 13 countries with meta-analysis

OBJECTIVES

Resin-based composites (RBCs) evolved into favoured materials for teeth restorations, marking a significant change in dental practice. Despite many advantages, RBCs exhibit various limitations in their physical and chemical properties. Therefore, we assessed the dentists' awareness of possible complications after direct composite restorations and their opinions about this material.

METHODS

The online questionnaire was created in English in May 2023. A 16-item survey was dedicated to general dentists and specialists. The first section included four questions related to demographic characteristics. The second section comprised twelve questions and focused on awareness of potential side effects of composite restorations, the most crucial advantages and disadvantages of composite resins, and the frequency of experienced clinical complications after the application of composite materials.

RESULTS

A total of 1830 dentists from 13 countries took part in the survey. Dentists most often declared awareness of low adhesion to the dentine (77.5 %) and, most rarely, solubility in oral fluids (42.6 %). Aesthetics was identified as the main advantage of composite fillings (79 %), followed by the possibility of repair (59 %) and adhesion to enamel (57 %). Polymerisation shrinkage was a major disadvantage for most countries (70 % overall). Analysing the declared potential clinical complications for all countries, statistically significant findings were obtained for marginal discolouration (OR=2.982, 95 % CI: 1.321-6.730, p-value=0.009) and borderline significance for secondary caries (OR=1.814, 95 % CI: 0.964-3.415, p-value=0.065).

CONCLUSIONS

Dentists value aesthetics and repairability but are aware of shrinkage and experience discolouration. The issue of toxicity and solubility seems to be the least known to dentists.

CLINICAL SIGNIFICANCE

Dentists should use RBCs with critical caution due to possible side effects. Despite the undoubted aesthetics of direct composite restorations, it is necessary to remember potential clinical complications such as marginal discolouration or secondary caries.

Self-reported preparedness of final year undergraduate dental students and interns in Saudi Arabia: a multi-institutional study

BACKGROUND

Contemporary undergraduate dental education aims to equip the dental students with clinical competence, empathy, and professionalism to enable them to deliver safe and effective dental care to the communities. The purpose of this study was to assess the self-reported preparedness of final year dental students and interns at three Saudi dental institutions, using the pre-validated Dental Undergraduates Preparedness Assessment Scale (DU-PAS).

METHODS

A cross-sectional study design was employed to assess the self-reported preparedness of the participants using the DU-PAS. Following ethics approval, a probability sampling technique was used to recruit undergraduate dental students and interns from three dental institutions in Saudi Arabia. The data was collected online on Google Forms and all participants provided their consent to participate in the study prior to providing their responses to DU-PAS.

RESULTS

Responses were received from 397 participants including 171 males and 226 females yielding a response rate of 60.3%. The total mean score of the participants was 81.85 ± 13.11. Although higher scores were reported in males, the interaction between gender and DU-PAS scores were not significant. Interaction between DU-PAS scores and stage of education showed significant effect of the stage of education with interns reporting higher overall scores. The participants reported that they were able to perform most clinical procedures independently. However, low confidence was reported in performing multi-rooted endodontics, fabrication of removable dentures and orthodontic assessment. The participants also expressed their confidence in a wide range of behavioural attributes related to communication, teamworking and professionalism. However, lack of experience was noted in referral for oral cancer, interpreting research, and evaluation of new dental products using an evidence-based approach.

CONCLUSION

The study provides useful insights into the self-reported preparedness of undergraduate dental students and interns in three dental institutions. While the overall preparedness of the participants was comparable to their international peers, the findings underscore the need for further enhancements to the teaching and training of undergraduate students particularly in multirooted endodontics, removable prosthodontics and orthodontics.

Relationship between Desiccation Tolerance and Biofilm Formation in Shiga Toxin-Producing Escherichia coli

Shiga toxin-producing Escherichia coli (STEC) is a major concern in the food industry and requires effective control measures to prevent foodborne illnesses. Previous studies have demonstrated increased difficulty in the control of biofilm-forming STEC. Desiccation, achieved through osmotic stress and water removal, has emerged as a potential antimicrobial hurdle. This study focused on 254 genetically diverse E. coli strains collected from cattle, carcass hides, hide-off carcasses, and processing equipment. Of these, 141 (55.51%) were STEC and 113 (44.48%) were generic E. coli. The biofilm-forming capabilities of these isolates were assessed, and their desiccation tolerance was investigated to understand the relationships between growth temperature, relative humidity (RH), and bacterial survival. Only 28% of the STEC isolates had the ability to form biofilms, compared to 60% of the generic E. coli. Stainless steel surfaces were exposed to different combinations of temperature (0 °C or 35 °C) and relative humidity (75% or 100%), and the bacterial attachment and survival rates were measured over 72 h and compared to controls. The results revealed that all the strains exposed to 75% relative humidity (RH) at any temperature had reduced growth (p < 0.001). In contrast, 35 °C and 100% RH supported bacterial proliferation, except for isolates forming the strongest biofilms. The ability of E. coli to form a biofilm did not impact growth reduction at 75% RH. Therefore, desiccation treatment at 75% RH at temperatures of 0 °C or 35 °C holds promise as a novel antimicrobial hurdle for the removal of biofilm-forming E. coli from challenging-to-clean surfaces and equipment within food processing facilities.

Morphometric relationships in mesio-buccal roots of maxillary first molars in Saudi subpopulation: A CBCT study

This CBCT-based study analysed morphometric relationships in Mesio-Buccal (MB) roots of maxillary first molars (MFM). 133 MFM with two MB canals were assessed and classified using Vertucci's classification. MB roots' length and MB1-MB2 canals inter-orifice distances (IOD) were noted. The data were analysed using SPSS software. The most frequently present canal was type IV (59.4%) followed by type II (40.6%). Mean MB roots' length for canals exhibiting type IV was 9.26 ± 0.21 mm and of those exhibiting type II was 12.8 ± 0.42 mm. Statistically significant relationship was found between MB root length and canal type. Mean IOD for type II and type IV canals was 2.4 ± 0.47 and 3.8 ± 0.21 mm, respectively. Statistically significant relationship was found between IOD and canal type. Length of MB root and IOD had a significant association with canal type present in MFM. This knowledge can enhance clinicians' understanding of canal morphology which can increase predictability and success rate of endodontic treatment.

A Cone Beam Computed Tomography-Based Investigation of the Frequency and Pattern of Radix Entomolaris in the Saudi Arabian Population

Background and Objectives: An understanding of the anatomical complexity of teeth is a significant factor for a successful endodontic treatment outcome. The aim of this study was to explore the frequency and pattern of distribution of radix entomolaris (RE) in mandibular first molars (MFMs) of a Saudi Arabian subpopulation using CBCT scans. Materials and Methods: This study was conducted at dental clinics of Qassim University from February to May 2023 by evaluating CBCT scans that were previously obtained for diagnostic purposes. Scans of Saudi national patients with bilaterally present MFMs and fully formed root apices were included. Conversely, scans with one/or two missing MFMs, MFMs with incomplete root apices, full- or partial-coverage prosthesis, endodontic treatment, and associated radicular resorption were excluded from study. A total of 303 CBCT scans with 606 bilateral MFMs were analyzed by two calibrated evaluators for the presence of, and type according to Song's typolgy of RE. The data were analyzed using SPPS-24. The descriptive variables were documented as frequencies and percentages. The chi-square test was used to determine the association between the prevalence of RE with the gender, jaw side and age group. Both inter-rater and intra-rater agreements were estimated for detecting and classifying RE using Cohen's kappa test. Results: The sample had 63.7% males and 36.3% females. The prevalence of RE was 6.6%, with Song's type III (57.5%) as the most common variant. Absolute agreement was noted between the raters about the presence of RE and very strong agreement was noted for the classification of the RE. Conclusions: RE is an uncommon finding among the mandibular first molars of the Saudi population without any gender and quadrant predilection. The clinicians' knowledge of the presence and Song's type of RE may contribute towards the enhancement of endodontic treatment outcomes.

Comparison of Efficacy of Lidocaine and Articaine as Inferior Alveolar Nerve Blocking Agents in Patients with Symptomatic Irreversible Pulpitis: Randomized Controlled Trial

Background and Objectives: Lidocaine Hydrochloride has been the standard choice for local anesthesia in dentistry and Articaine's unique structure and growing popularity make it a viable alternative. Due to contradictory results in prior research and a scarcity of trials conducted in the Pakistani population, this study aims to compare the anesthetic efficacy of Lidocaine with Articaine for inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis. Materials and Methods: This double-blinded, randomized controlled trial included 152 patients who were selected by consecutive non-probability sampling. The participants included patients who presented with symptomatic irreversible pulpitis in mandibular posterior teeth (molars and premolars) and depicted normal apical tissue radiographically. The patients were equally and randomly divided into two groups. The control group received 2% Lidocaine Hydrochloride injections, and the experiment group received 4% Articaine Hydrochloride injections. Participants scored their pain on the HP-VAS both before and after the administration of anesthesia. A value of 54 mm or less on the scale indicated effective anesthesia. The data obtained were analyzed using SPSS. Chi-square test was applied to analyze data for statistical significance. Results: There was no statistically significant difference in the efficacy of the two anesthetic agents. During access cavity preparation, Lidocaine demonstrated a success rate of 93%, whereas Articaine exhibited a slightly higher success rate of 97%. During initial instrumentation, the success rates for Lidocaine and Articaine were 72% and 71%, respectively. This suggests that both Lidocaine and Articaine were effective in achieving anesthesia during the dental procedure in patients with symptomatic irreversible pulpitis, with Articaine showing a slightly better success rate, although the difference was not statistically significant. Conclusions: The anesthetic efficacy of Articaine is similar to that of lidocaine in subjects with symptomatic irreversible pulpitis. Hence, Articaine can serve as an alternative to Lidocaine for local anesthesia administration in dentistry.

Assessment of the Prevalence of Radix Entomolaris and Distolingual Canal in Mandibular First Molars in 15 Countries: A Multinational Cross-sectional Study with Meta-analysis

AIM

The aim of this study was two-folded: i) to assess the prevalence of Distolingual Canal (DLC) and Radix Entomolaris (RE) in Mandibular First Molars (M1Ms), using Cone Beam Computed Tomography (CBCT) images and ii) to assess the impact of sociodemographic factors on the prevalence of these conditions worldwide.

METHODS

CBCT images were scanned retrospectively and the ones including bilateral M1Ms were included in the study. The evaluation was performed by 1 researcher in each country, trained with CBCT technology. A written and video instruction program explaining the protocol to be followed step-by-step was provided to all observers to calibrate them. The CBCT imaging screening procedure consisted of evaluating axial sections from coronal to apical. The presence of DLC and RE in M1Ms (yes/no) was identified and recorded.

RESULTS

Six thousand three hundred four CBCTs, representing 12,608 M1Ms, were evaluated. A significant difference was found between countries regarding the prevalence of both RE and DLC (P < .05). The prevalence of DLC ranged from 3% to 50%, and the overall prevalence was 22% (95% CI: 15%-29%). RE prevalence ranged from 0% to 12%, and the overall prevalence was 3% (95% CI: 2%-5%). There were no significant differences between left and right M1Ms or between genders for either DLC or RE (P > .05).

CONCLUSION

The overall prevalence of RE and DLC in M1Ms was 3% and 22%. Additionally, both RE and DLC showed substantial bilaterally. These variations should be considered by endodontic clinicians during endodontic procedures in order to avoid potential complications.

Attitude and practice of regenerative endodontic procedures among endodontists and paediatric dentists: A multinational survey from 13 countries

BACKGROUND

Regenerative endodontics (RET) refers to biologically based procedures that aim to restore damaged tooth structures and reinstate the pulp-dentine complex to its normal physiological state.

AIM

The purpose of this study was to examine the attitudes and practices of endodontists and paediatric dentists regarding RET.

DESIGN

A survey was conducted among endodontists and paediatric dentists from 13 countries. A number of factors were evaluated, including frequency of RET application, followed guidelines, disinfection techniques, intracanal medication type, scaffold type, preferred coronal seal material, and follow-up period.

RESULTS

Among the 1394 respondents, 853 (61.2%) and 541 (38.8%) were endodontists and paediatric dentists, respectively. Almost half (43%) of participants have not performed RET yet. The American Association of Endodontics guideline (47.3%) was selected as the primary source for the clinical protocol. The most frequently selected irrigant solution was 1.5%-3% NaOCl at the first (26.1%) and second (13.6%) sessions. A blood clot (68.7%) and MTA (61.9%) were the most frequently selected scaffold type and coronal barrier. Most participants preferred a 6-month follow-up period.

CONCLUSION

According to this survey, deviations exist from current RET guidelines regarding all aspects evaluated. Standardizing clinical protocols and adhering to available guidelines would help to ensure more predictable outcomes.

Influence of Root Canal Treatment on Oral-Health-Related Quality of Life (OHRQoL) in Saudi Patients: A Cross-Sectional Study

Objective This cross-sectional study aimed to assess the influence of root canal treatment on the oral-health-related quality of life (OHRQoL) of patients in the Kingdom of Saudi Arabia (KSA). The data on KSA's population are significantly limited, highlighting the significance of additional research to be carried out in this particular field. Methods The study was conducted at the dental clinics of the College of Dentistry, Qassim University, from January to June 2022. A total of 112 patients who had undergone endodontic therapy (ET) for teeth with irreversible pulpitis were included. Demographic data and treatment procedures were recorded. The patients' responses to the OHIP-14 questionnaire were analyzed to assess their OHRQoL. The scores were converted into qualitative categories (good, moderate, poor) for classification. Results The majority of patients (59.8%) reported a good OHRQoL after ET. Physical pain was the only variable where more than 50% of patients reported experiencing pain. Older age and smoking status were significantly associated with a poorer OHRQoL. However, no significant gender differences in OHRQoL were observed. Conclusion ET had a positive impact on the OHRQoL of patients in Saudi Arabia. The study highlights the importance of considering patient-centered outcomes, such as OHRQoL, in assessing the success of root canal treatment. Further research with longitudinal designs and randomized controlled trials is needed to better understand the long-term effects of root canal treatment on patients' OHRQoL and to compare them with other dental treatments.

Self-efficacy and Online Learning Readiness of Undergraduate Dental Students in Pakistan During COVID-19 Pandemic

OBJECTIVE

To investigate the correlation between general self-efficacy and online learning readiness among Pakistani undergraduate dental students.

STUDY DESIGN

Cross-sectional study. Place and Duration of the Study: Riphah International University, Islamabad, between September 2020 and March 2021.

METHODOLOGY

Using cluster sampling, three dental colleges of Islamabad and Rawalpindi were selected. Electronic questionnaires were sent to 750 students. The questionnaire was comprised of two instruments, General Self-Efficacy Scale (GSES), and Online Learning Readiness Scale (OLRS). GSES had 10-items with response measurement on four-point Likert scale, while the OLRS had 18 items in five different domains measured by five-point Likert scale. Data were analysed using SPSS-23. Correlation between dependent variables was calculated using linear regression analysis.

RESULTS

The response rate was 59.3% with a predominant response from female students (82.2%) compared with male students (17.8%). The majority of responses were recorded from third year students (27.9%). The year four students' scores for GSE, computer and internet self-efficacy, and self-directed learning differed significantly from other students. The overall mean GSE score was 29.37+4.57. Regression indicated a low degree of correlation between GSE and the five domains of OLRS with r2 values ranging from 0.12 to 0.32.

CONCLUSION

A weak to moderate correlation was found between self-efficacy and the five dimensions of online learning readiness among Pakistani undergraduate dental students as depicted by the r-values.

KEY WORDS

Cross-sectional studies, Dental education, Dental students, Dentistry, Efficacy, Online learning, Questionnaire.

Undergraduate Students' and Interns' Perception towards Learning Environment at Dental Clinics, Qassim University, Saudi Arabia

Background

Dental clinical educational environment plays a critical part in the inculcation of skills and enhancement of knowledge for the dental students. The objective was to assess undergraduate dental students' and interns' perceptions towards the clinical learning environment.

Methods

Current cross-sectional study was conducted from December 2020 to February 2021, using the 24-item dental clinical learning environment inventory (DECLEI) on a six point Likert scale. The possible range of cumulative score for DECLEI was from 0 to 100 (interpretation poor to excellent). The inventory was emailed to 111 students and interns at College of Dentistry, Qassim University. The relationship between the independent variables and DECLEI scores was determined by using Pearson correlation test. SPSS version-23 was used for statistical analysis.

Results

Overall response rate was 78.37%. The mean DECLEI score was noted as 67.5 ± 17.98. Among the factors, the highest mean score was documented for the systematic self-evaluation and the lowest mean score was observed for the item related to patients' punctuality for appointments. A factor-wise analysis of three subscales of DECLEI demonstrated the respondents had good perception towards all subscales with the highest mean score (72.3 ± 18.06) for Factor III and lowest mean score (61.3 ± 19.81) for Factor II. Overall, the DECELI was found to be reliable with the Cronbach's Alpha value of 0.94. The Pearson's correlation test showed the weak positive insignificant correlation of mean DECLEI score with gender and categories.

Conclusions

Present study indicated more positive than negative perceptions of the dental students related to their clinical learning environment. The DECLEI helped in recognizing both strengths and shortcomings of the dental clinical learning environment.

Recurrence of Invasive Cervical Resorption after six years of Nonsurgical and Surgical management by Bioceramic-Material

Invasive cervical resorption (ICR) is a phenomenon of unknown etiology that results in the loss of hard dental tissue. To have a successful outcome for a tooth affected by ICR, correct diagnosis and management are needed. With the introduction of new biocompatible materials and the advancement of CBCT imaging, these pathologies can be identified and treated with precision, resulting in promising outcomes. This case report aims to present the management of maxillary central incisors diagnosed with external ICR, treated with bioceramic root repair material, and followed-up to six years.

Factors Affecting the Decision-Making of Direct Pulp Capping Procedures Amongst Dental Practitioners: A Multinational Survey from 16 Countries with Meta-Analysis

BACKGROUND

Direct pulp capping (DPC) procedures require the placement of a bioactive material over an exposure site without selective pulp tissue removal. This web-based multicentered survey had three purposes: i) to investigate the factors that affect clinicians' decisions in DPC cases, ii) to determine which method of caries removal is preferred, and iii) to evaluate the preferred capping material for DPC.

METHODS

The questionnaire comprised three sections. The first part comprised questions regarding demographic features. The second part comprised questions on how treatment plans change according to factors such as nature, location, number and size of the pulp exposure and patients' age. The third part composed of questions on the common materials and techniques used in DPC. To estimate the effect size, the risk ratio (RR) and 95% confidence interval (CI) were calculated using a meta-analysis software.

RESULTS

A tendency towards more invasive treatment was observed for the clinical scenario with carious-exposed pulp (RR=2.86, 95% CI:2.46,2.32; p<0.001) as opposed to the clinical scenario with two pulp exposures (RR=1.38, 95% CI:1.24,1.53; p<0.001). Complete caries removal was significantly preferred to selective caries removal (RR=4.59, 95% CI: 3.70, 5.69; p<0.001). Among the capping materials, calcium silicate-based materials (CS) were preferred over calcium hydroxide-based materials (CH) (RR=0.58, 95% CI: 0.44,0.76; p<0.05).

CONCLUSION

While carious-exposed pulp is the most important factor in clinical decisions regarding DPC, the number of exposures has the least impact. Overall, complete caries removal was preferred over selective caries removal. In addition, the use of CS appears to have replaced CH.

Assessment of the Prevalence of Middle Mesial Canal in Mandibular First Molar: A Multinational Cross-sectional Study with Meta-analysis

BACKGROUND

An additional canal found in the mandibular first molar (M1M) is the middle mesial canal (MMC), which is often missed during root canal treatment. In this study, the prevalence of MMC in M1M on cone-beam computed tomography (CBCT) images was evaluated in 15 countries, along with the effect of some demographic factors on its prevalence.

METHODS

Deidentified CBCT images were scanned retrospectively, and the ones including bilateral M1Ms were included in the study. A written and video instruction program explaining the protocol to be followed step-by-step was provided to all observers to calibrate them. The CBCT imaging screening procedure consisted of evaluating three planes (coronal, sagittal, and axial) after a 3-dimensional alignment of the long axis of the root(s). The presence of an MMC in M1Ms (yes/no) was identified and recorded.

RESULTS

In total, 6304 CBCTs, representing 12,608 M1Ms, were evaluated. A significant difference was found between countries (P < .05). MMC prevalence ranged from 1% to 23%, and the overall prevalence was 7% (95% confidence interval [CI]: 5%-9%). No significant differences were found between the left and right M1M (odds ratio = 1.09, 95% CI: 0.93, 1.27; P > .05) or between genders (odds ratio= 1.07, 95% CI: 0.91, 1.27; P > .05). As for the age groups, no significant differences were found (P > .05).

CONCLUSIONS

The prevalence of MMC varies by ethnicity, but it is generally estimated at 7% worldwide. Physicians must pay close attention to the presence of MMC in M1M, especially for opposite M1Ms, due to the prevalence of MMC being significantly bilateral.

The Effect of Calcium Hydroxide, Triple Antibiotic Paste and Chlorhexidine on Pain in Teeth with Symptomatic Apical Periodontitis: A Randomised Controlled Trial

BACKGROUND

One of the main reasons for post endodontic pain is the polymicrobial intracanal flora that may survive the initial disinfection. A single antimicrobial agent might not provide adequate disinfection, and an antimicrobial combination such as triple antibiotic paste was tested to achieve this goal.

AIM

The study aimed to assess the efficacy of three intra-canal medicaments on post root canal preparation pain.

MATERIALS AND METHODS

Eighty patients with single-rooted necrotic teeth and symptomatic apical periodontitis were randomly assigned to four treatment groups (n = 20). Their preoperative pain was recorded on Wong-Baker's FACES pain rating scale. After chemo-mechanical canal preparation, intracanal medications were applied to the groups (Group 1 (20% calcium hydroxide), Group 2 (2% chlorhexidine), Group 3 (tri-antibiotic paste), Group 4 (no medication (Control group)). Patients were instructed to record pain on the Wong-Baker FACES pain rating scale at 4, 48, 72 and 96 hrs, postoperatively. Pain scores were analyzed using a one-way ANOVA test and Tukey's post hoc test and, if significant, Dunn's test was used for pair-wise comparisons. The significance level was set at a p-value ≤ 0.05.

RESULTS

Tukey's post hoc test revealed significantly lower pain scores in Group 3 compared with other groups at all follow up intervals. Dunnett's test showed significantly lower pain in Group 3 compared with the Control group at 48, 72 and 96 hrs, postoperatively.

CONCLUSIONS

Triple-antibiotic paste showed effective pain control as an intracanal medication on necrotic teeth with symptomatic apical periodontitis.

How Well Prepared Are Dental Students and New Graduates in Pakistan-A Cross-Sectional National Study

The transition of an undergraduate dental student to an actual practicing dentist is a crucial phase and ensuring the preparedness of graduates for the complexity and demands of contemporary dental practice is a challenging task. This study aimed to evaluate the self-perceived preparedness of undergraduate dental students and house officers in the dental colleges of Pakistan. A cross-sectional national study was planned to collect information from dental students and new graduates in Pakistan. The pre-validated Dental Undergraduates Preparedness Assessment Scale (DU-PAS) was used. A purposive sampling technique was utilized to recruit house officers and undergraduate dental students from 27 dental schools in Pakistan. The data analysis was carried out using the R statistical environment for Windows (R Core Team, 2015). A total of 862 responses with 642 females and 219 males were analyzed in the study. Overall, the clinical skills score was 30.56 ± 9.08 and the score for soft skills was 30.54 ± 10.6. The mean age of the participants was 23.42 ± 1.28. Deficiencies were reported in various soft skills and clinical skills attributes. The results highlighted the strengths and weaknesses of dental students and new graduates in Pakistani dental institutions. The findings may be used to further develop and strengthen the teaching and training of dental students in Pakistan.

Root Canal Configuration and Its Relationship with Endodontic Technical Errors and Periapical Status in Premolar Teeth of a Saudi Sub-Population: A Cross-Sectional Observational CBCT Study

Endodontic technical errors are the foremost cause of treatment failure. A thorough understanding of root canal configuration (RCC) is essential to prevent these iatrogenic errors. This study used CBCT images to determine the association between root canal configuration, endodontic technical errors, and periapical status. CBCT images of 101 patients, including total of 212 obturated premolars (256 canals) were assessed. RCCs were classified according to the Vertucci system. The presence of endodontic errors and periapical lesions associated with each RCC was noted. Presence or absence of coronal restoration and its association with periapical radiolucency was recorded. The most frequent RCC was Type I (199 cases; 77.73%), followed by Type II (26 cases; 10.15%), Type IV (22 cases; 8.59%), Type V (4 cases; 1.56%), Type III (4 cases; 1.56%), and Type VI (1 case; 0.39%). Under-filling and non-homogeneous filling were the most common technical errors. Prevalence of periapical radiolucency was 81% in the presence of technical errors. The absence of coronal restoration caused apical lesions in 93% of cases. The frequency of endodontic technical errors increased as the root canal configurations became more complex. Periapical lesions occurred more often in teeth with endodontic errors and/or absent coronal restoration.

Students' performance in clinics and self-perceived Confidence in performing Endodontic procedures: A correlation study

Objective

The study aimed to evaluate undergraduate dental students' self-perceived confidence in carrying out Endodontic procedures and correlating it with their performance in Endodontic clinics.

Methods

The correlational study was conducted on fifth year dental students at Qassim University, Saudi Arabia. The self-perceived confidence of students was assessed by using Endodontic Self-Perceived Confidence Scale (ESCS). The students' endodontic clinical performance scores were obtained from the department head. Data were analyzed by IBM SPSS-23.0. Descriptive statistics were recorded as percentages, frequencies, and mean. Chi-square test was used for gender-wise comparison of all items of ESCS, Student t-test was used for comparing means and Pearson correlation coefficient was utilized for exploring correlation.

Results

Over all response rate was 91.8%. Students exhibited the highest confidence level for achieving rubber dam isolation (4.57±0.66) while the lowest confidence level was documented for the treatment of teeth with immature apices (2.82±0.95). The mean self-confidence score of male students on ESCS was higher than the female students (P-value=0.18). However, mean endodontic clinic score of female students was significantly higher than the male students (P-value=0.02). The insignificant correlation was noted between the students' mean confidence scores and endodontic clinical performance scores (P-value=0.82).

Conclusions

The insignificant correlation between self-perceived confidence and clinic scores raises significant caveats for utilizing the self-assessment in the aforementioned group. Hence, the students should be adequately trained in self-assessment to prepare them for lifetime learning. Additionally, clinical instructors by creating a supportive learning environment should help students to deal with their shortcomings.

Frequency of middle mesial canal in mandibular first molars and its association with various anatomic variables

This study aimed to determine the frequency of the middle mesial canal in the mandibular first molars and its association with various anatomical features. Two experienced endodontists evaluated 149 CBCT images, containing n = 298 mandibular first molars and n = 298 mandibular second molars. Binary logistic regression was used to explore the relationship between the presence of middle mesial canal and other independent variables. The middle mesial canal was found in 7.7% (n = 23) of mandibular first molars and 11.4% of which exhibited adjacent C-shaped mandibular second molars. The presence of an adjacent C-shaped mandibular second molar was associated with a 3 times increased likelihood of finding a middle mesial canal (P = 0.048, OR: 3.108) in mandibular first molars. The middle mesial canal is an uncommon finding with a rare occurrence of bilateral presence in mandibular molars; however, an adjacent C-molar is an important predictor of middle mesial canal presence.

Management of concomitant strip and apical perforation in mandibular first molar

Iatrogenic perforation is a complication that can occur during endodontic treatment. If left untreated, it adversely affects the prognosis of the tooth. The use of optimal magnification and appropriate repair material help in achieving favourable outcome. The current case report illustrates the management of concomitant strip and apical perforation in the mesial canals of lower first molar of 13 years old paediatric patient. The management of perforations was done with MTA under 25x magnification of a dental operating microscope. The periapical radiograph and clinical investigations revealed complete bone formation at the furcal area adjacent to the repaired strip perforation and ossification of the apical lesion indicating a favourable healing outcome at 18 months of follow up. doi: https://doi.org/10.12669/pjms.38.7.6009 How to cite this:Al-Attas MH, Aldhelai TA, Javed MQ. Management of concomitant strip and apical perforation in mandibular first molar. Pak J Med Sci. 2022;38(7):---------. doi: https://doi.org/10.12669/pjms.38.7.6009 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Non-Surgical Management of Lingual Hemangioma by Combined Sclerotherapy and Cryotherapy

Hemangioma is frequently seen benign tumour of vascular origin, typed into capillary and cavernous hemangiomas based on the nature of vessels in the lesions. Capillary hemangioma is a collection of small capillary-size vessels and shows lobule formation. Cavernous hemangioma is formed by the large dilated vessels and it can reach a large size. The hemangioma can cause aesthetic and functional problems when it is located on the tongue. Several treatment modalities including sclerotherapy, embolisation, laser surgery, and cryosurgery have been described. Here, we are reporting a case of a 12-year boy diagnosed with a hemangioma on the left lateral border of the tongue using ultrasonography with color Doppler application and treated non-surgically with sclerotherapy and cryotherapy. Key Words: Color Doppler ultrasonography, Cryotherapy, Hemangioma, Sclerotherapy, tongue.

Cone-beam computed tomographic analysis of root canal morphology of permanent mandibular incisors - Prevalence and related factors

Objectives:

To investigate the prevalence of additional canals and the occurrence of oval canals in apical third area of mandibular permanent incisors of Saudi sub-population.

Methods:

This study was conducted from November 2020 to May 2021 at College of Dentistry, Qassim University. For the investigation purpose of this study, 314 scans were analyzed within the age limits of 13 to 70 years. The root canal morphology, presence of oval canals, number of roots, and prevalence of various canal configurations based on age, gender and bilateral symmetry were recorded. The obtained data was statistically analyzed using SPSS software.

Results:

The mandibular central incisors (CI) exhibited, significant difference between Type-I, II, III and IV canal configurations and Type-I, II, III and V canal configurations (p < 0.05). For the mandibular lateral incisor (LI), significant difference was found between Type-I, II, III, IV and VII canal configurations (p < 0.05). The cumulative prevalence of oval canals in mandibular incisors was found to be 46.6%. For both mandibular CI and LI, the prevalence of Type-I canals was significantly higher in males as compared to females (p < 0.05). Conversely, significantly higher prevalence of Type-III canals was noted for females as compared to males (p < 0.05). No significant difference was found in the prevalence of different canal configurations on the left and the right side of the mouth.

Conclusion:

In this study, multiple canals were prominently recognized with Type-III mandibular incisors dominating this feature. Oval canals were predominantly found in single canal especially Type-III. This research suggests variability in canal morphology among different populations. Knowledge of these aberrant canal anatomies is useful for the clinician to achieve a favorable endodontic outcome.

Intentional Replantation Of Mandibular First Molar With Two Years Follow Up- Case Report

Intentional replantation (IR) is a reliable and predictable treatment option for cases with failed non-surgical root canal treatment. The success of IR is found to be 52-95%. The current case is of 35years old female who presented with severe pain and swelling in lower right first mandibular molar with previously initiated non-surgical root canal treatment that resulted in instrument separation in mesio-buccal canal. Periapical radiograph showed rarefactions at furcation area, mesial and distal root apices. It was decided to complete the non-surgical root canal treatment followed by intentional replantation and retrograde filling with MTA. The tooth was found to be asymptomatic after two years follow up and periapical radiographs depicted complete healing. Intentional replantation with careful case selection is a successful, easy and reliable treatment option for hopeless cases. Atraumatic extraction, minimum extra-alveolar time and aseptic techniques during the procedure are the key factors for success of the procedure.

Work-Related Musculoskeletal Disorders and Their Associated Risk Factors among Pakistani Dental Practitioners: A Cross-Sectional Study

Background

Work-related musculoskeletal disorders (WMSDs) have a negative impact on quality of life, and dentists are at risk of WMSDs due to the nature of work being static, repetitious, and for a long duration. The study was aimed at measuring the prevalence and distribution of work-related musculoskeletal disorders and determining the risk factors associated with affliction among Pakistani dentists.

Methods

An online cross-sectional survey was conducted using a validated questionnaire consisting of four sections. The first section had questions related to sociodemographic information, the second section had questions that assessed the intensity and frequency of musculoskeletal pain (MSP), third section questions were concerned with the effect of MSP on the respondents' daily life, while the last section contained questions on whether they perceived their work in the dental clinic as a cause of their pain. Chi-square and one-way ANOVA tests were used for the analysis of the data in SPSS-23.

Results

A total of 600 completely filled questionnaires were received with a response rate of 76.4%, and about 87% of the dental practitioners had some sort of MSD. The intensity and frequency of WMSDs were statistically significant (p < 0.05) in association with all the sociodemographic characteristics. The lower back area was the most reported site of WMSD pain (51.3%) followed by the neck/upper back (21.3%) and shoulder (17.6%). The site of pain was statistically significant (p < 0.05) in association with all the sociodemographic characteristics except gender (p = 0.11). A majority of participants (95.4%) had sought medical treatment and taken sick leaves (70%) due to WMSDs pain during their life. Participants attributed a number of working years and working posture as the two main reasons behind WMSDs.

Conclusion

Considering the high prevalence of WMSDs among dentists, preventive strategies that minimize the occurrence of WMSDs should be adopted by dental professionals. The impact of WMSDs can be reduced by maintaining good posture, taking breaks and rest in between work, doing regular exercise, and improving the work environment.

Teledentistry awareness, its usefulness, and challenges among dental professionals in Pakistan and Saudi Arabia

Objectives

This study aims to describe the perception of dental professionals in Pakistan and Saudi Arabia (SA) towards the practice of teledentistry, its usefulness and challenges.

Methods

A cross-sectional study was carried out among 190 dentists from January 2021 to April 2021. The participants were included in the study using snowball sampling method. A 26-item adopted questionnaire was distributed using different social media channels. Chi-square test was used for analysis.

Results

Out of 190 participants, 46.3% were from Pakistan and 53.7% were from SA. The majority of participants in both countries agreed that teledentistry would enhance guidelines and advice (74.2%), improve peer-to-peer interaction (79.5%) and make patient's referrals more efficient (75.8%). For the usefulness, most participants agree that it is economical for the patients (61.1%), improves communication (74.7%), helps in educating the patients (86.3%), avoid unnecessary travel (76.8%), helps monitoring (71.6%), and benefits patients in remote areas (74.7%); however, more Pakistani participants perceived that time spent with the patient would increase compared to SA participants (p < 0.001) and a higher proportion of SA participants believe that it helps in communication and monitoring of patients (p < 0.001) than Pakistani participants. Regarding the challenges in the use of teledentistry, few participants think that it violates the patient's privacy (22.6%) or is difficult to use (14.7%) or have distrust towards the teledentistry equipment (24.2%).

Conclusion

The results indicated a high awareness and a positive attitude towards teledentistry, and its adaptation in their dental practice in both countries. However, limited infrastructure, set-up cost, and information technology (IT) literacy are the main challenges in integrating teledentistry which can be overcome by strategic government initiatives, policies, and programs.

Retrospective audit for quality assessment of root fillings performed by undergraduate dental students in clinics

Objectives

To evaluate the technical quality of root canal obturations performed by undergraduate students.

Methods

The records of 347 patients who underwent endodontic treatment by undergraduate students of Qassim University between 2018 and 2020 were assessed using standardised criteria based on obturation length, density and taper. All teeth that received primary endodontic treatment and had post-obturation periapical radiographs depicting the entire radicular length and the 2–3-mm periradicular area were included in the study.

Results

A total of 653 canals of 397 teeth were evaluated. The maxillary central incisor was the most commonly assessed tooth (15.1%). Overall, 80.2% of the evaluated canals were deemed acceptable based on all three assessment criteria. Maxillary teeth had significantly better obturation quality than the mandibular teeth. The mesio-lingual canal had the lowest quality in all three criteria.

Conclusions

The technical quality of root canal obturations performed by undergraduate students in Qassim University was acceptable in the majority of the evaluated cases. Among the evaluated parameters of obturation quality, length control was the most frequently observed deficiency. Additional measures are therefore required to improve the quality of the obturation length.

Dundee Ready Education Environment Measure of Dentistry: Analysis of Dental Students' Perception about Educational Environment in College of Dentistry, Mustaqbal University

INTRODUCTION

Evaluation of the educational environment is an important element which can be used to improve our curriculum. The aims and objectives of this cross-sectional study were to identify the student's perception about educational environment in College of Dentistry, Mustaqbal University. As the educational environment has a significant impact on the learning and academic performance of the students, the present study will help us identify areas of improvement and refining the dental curriculum.

MATERIALS AND METHODS

A total of 120 students of year 4, 5, 6, and interns, both male and female, responded to the Dundee Ready Education Environment Measure (DREEM) in the 1^st month of the second semester, 2021. This scale measures the student's perceptions of the educational environment overall and for five domains: learning, teaching, academic self-perception, atmosphere, and social self-perception.

RESULTS

A total of 92 students responded and were generally positive about their learning environment, with a total DREEM score of 130.87 ± 32.73/200. The lowest score for Domain 5 (social self-perception) and the highest score for Domain 1 (student's perception of learning.) were noted.

CONCLUSION

Students' perception of educational environment of College of Dentistry, Mustaqbal University, was more positive than negative. This study provided a valuable insight of how students perceive their course and identified several weak areas that need to be worked upon, hence helping in improvement of the curriculum.

Predictors of periodontal and caries related perinatal oral healthcare, investigation of dentists' practices: a cross-sectional study

Background

The objectives of the study were to assess the knowledge, attitude, and practice of dentists towards providing oral health care to pregnant women and to identify barriers and predictors of periodontal and caries related perinatal oral healthcare practices.

Methods

A cross-sectional analytical survey was conducted on dentists by using a random sampling technique, and a pre-validated questionnaire was delivered to 350 dentists from May 2018 to October 2018. Data were analyzed by utilizing SPSS software. Frequencies and percentages were recorded for descriptive variables. Binary logistic regression was used to analyze the probability of predicting group membership to the dependent variable using different independent variables determined from contingency tables.

Results

Overall response rate was 41%. The mean knowledge score of respondents was 15.86 ± 3.34. The lowest correct responses were noted in the questions related to periodontal health. It was found that the advice to delay dental visits until after pregnancy was eight times more likely to be observed among dentists who lacked the knowledge of importance of oral health during pregnancy (P = 0.04, OR = 8.75). Dentists were more likely to consult obstetricians regarding dental procedures when they fear a risk of labor in the dental practice (P < 0.05, OR = 3.72). Dentists who had the knowledge of periodontal disease association with preterm delivery were about four times more likely to treat periodontal disease during pregnancy (P = 0.01, OR = 3.95). Dentists knowing the association between maternal oral health and childhood decay were more likely to counsel pregnant patients regarding caries prevention (P > 0.05, OR = 3.75).

Conclusions

Collectively the results indicated few gaps in knowledge among some dentists and a need to improve existing attitudes towards perinatal oral health. Dentists failing to recognize the importance of perinatal oral health are more likely to be hesitant in treating pregnant patients. Failing to recognize the link between periodontal disease and obstetric complications increases the possibility of hesitance to counsel pregnant patients regarding the same. The appreciation of the evidence for poor perinatal oral health and risk of early childhood caries increases the likelihood of counseling by dentists on caries prevention.

Dental health care providers' concerns, perceived impact, and preparedness during the COVID-19 pandemic in Saudi Arabia

Background

Dental health care providers (DHCPs)are at high risk of cross-infection during clinical practice therefore, the aim of the study was to evaluate the DHCPs Covid-19 related concerns, its perceived impact, and their preparedness in Saudi Arabia.

Methods

This cross-sectional study on DHCPs was carried out at five dental teaching hospitals/colleges in four provinces of Saudi Arabia from October to December 2020. A 35-item valid and reliable questionnaire was used to assess the concerns, perceived impact, and preparedness of DHCPs in the COVID-19 pandemic. Chi-square tests and logistic regression were used to compare parameters between the clinical and non-clinical staff.

Results

A total of 320 DHCPs participated in this study with proportion of clinical staff (57.5%) surpassing the non-clinical staff (42.5%). The clinical DHCPs felt greater odds of falling ill with COVID-19 than non-clinical workers (OR, 2.61) and willing to look for another job (OR, 3.50). The higher proportion in both groups was worried that people close to them would be at higher exposure risk (96.3%) however, slightly more clinical DHCPs were concerned for their children than a non-clinical worker (OR, 3.57). The clinical DHCPs have greater odds of worrying that people would avoid them and their family members because of their job (OR, 2.75). A higher proportion in both groups (75.0%, 63.2%) felt that they would feel stress at work. More non-clinical DHCPs (94.1%) had received training for infection control than clinical (94.1% vs 63.0%: OR 0.10). Similarly, more DHCPs in the nonclinical group received adequate personal protective equipment training (88.2%; OR, 0.48). Most participants practiced self-preparation such as buying masks and disinfection (94.4%, 96.9%).

Conclusion

The majority of DHCPs felt concerned about their risk of exposure and falling ill from infection and infecting friends/family. These concerns could potentially affect the working of DHCPs during this pandemic. Measures to improve protection for DHCPs, minimize psychological implications, and potential social stigmatization should be identified at the planning phase before any pandemic.

Problem-based Learning and Team-based Learning as a Novel Package Approach

OBJECTIVE

To identify the insights of dentistry students towards a new 3/1 problem-based learning (PBL) and team-based learning (TBL) blended package approach.

STUDY DESIGN

Mixed method triangulation design, using validating quantitative data model.

PLACE AND DURATION OF STUDY

College of Dentistry, Qassim University, KSA, from March to July 2020.

METHODOLOGY

Modified TBL within an existing PBL hybrid curriculum, by strategically designing three modified PBL sessions followed by one modified TBL session was evaluated. There were 241 students enrolled over five academic years of session 2019-2020, and all were included in the study. Feedback of the students regarding novel approach was collected at the culmination of the academic year through an e-questionnaire, utilising closed- and open-ended questions. Descriptive statistics and thematic analysis were used to analyse data.

RESULTS

In total, 124 (51.5%) students filled a questionnaire regarding use of PBL and TBL in the new blended approach. The median perception score of TBL was 3.9 (3.2-4.3) and PBL was 3.9 (3.3-4.3). Thematic analysis of the qualitative data supported the quantitative results. Students reported positive aspects of TBL experience as more engaging format, collaborative learning, teamwork, and group competition. They stated that PBL has improved their research, presentation, and clinical reasoning skills.

CONCLUSION

Students valued the novel PBL-TBL package as an optimum learning approach. They predominantly voted in favour of TBL. Students further identified the sequence and format of the current approach conducive to learning, feedback and assessment. Key Words: Hybrid curriculum, Team-based learning, Problem-based learning, Blended learning, Innovative instructional strategy.

Team-based learning versus Traditional lecture-based learning: An investigation of students' perceptions and academic achievements

Objectives:

Evaluation of TBL from students’ perspective has been done extensively, but limited studies have analyzed the effect of TBL on students’ academic performance. Objectives of the present study were to assess students’ perceptions about team-based learning versus traditional lectures and then to compare with students’ grades in both TBL and lecture-based assessments.

Methods:

Cross-sectional descriptive study which included 147 dentistry students was conducted between March and June, 2020 at Qassim University, Saudi Arabia. A self-composed 10 item closed ended instrument was administered through electronic mail. One block from each academic year was selected randomly and organizers were requested to provide grades of students in both TBL and lecture-based exams. Grades from A to F were determined as achievement indicator and were compared statistically using Kruskal Wallis, Tuckey Posthoc and Chi-square tests.

Results:

A total of 120 students (81.6%) responded to the survey, and mean perception score was (3.29±0.94). Perceptions of students, regarding TBL as a learning strategy were comparatively superior as compared to the lectures. Students scored significantly higher grades in TBL exams (p<0.05) as compared to lecture-based assessments. Gender-wise analysis indicated that female students secured significantly higher grades in the TBL.

Conclusion:

We conclude that dentistry students perceived TBL as superior teaching and learning strategy compared to traditional lectures. Their perception was verified by their significant higher academic achievements in the assessments for the coursework taught by utilizing team-based learning strategy.

Delayed Replantation Of Avulsed Tooth With 22 Hours Dry Time: Four Years Follow-Up Of A Viable Treatment Modality

Avulsion is the complete displacement of tooth out of its socket. It is the gravest form of dental traumatic injury which accounts for 0.5-3% of the total dental traumatic injuries of the permanent teeth and most commonly involves the maxillary central incisors. The treatment is immediate tooth replantation or if that is not possible then storing tooth in an appropriate storage medium and attending dental clinic at the earliest. The present case report describes the replantation of maxillary left central incisor tooth that was avulsed. The tooth was out of the socket for 22 hours without any storage medium. Tooth was replanted after the removal of non-viable periodontal tissues; splinting was done for 4 weeks and endodontic treatment was initiated after 7 days. The tooth was stable and functional with mild discoloration and ankyloses at four years follow up, which is considered a desirable treatment outcome after delayed replantation.

Fiber reinforced composite supported restoration of congenitally missing tooth by minimally invasive approach: Two years follow-up

Maxillary lateral incisor is the most frequent congenitally missing anterior tooth of the permanent dentition. The absence of the anterior tooth can adversely affect the production/transmission of speech sounds, mental health, and facial aesthetics of an individual. Considering this, prosthetic rehabilitation of missing front tooth is important. The treatment alternatives include implant supported single crown, conventional fixed partial dentures (FPDs), and resin bonded FPDs that are unilaterally or bilaterally supported by metallic wings. However, with the development in adhesive dentistry fiber reinforced composite (FRC) supported FPDs have provided a workable substitute for traditional techniques because of their improved esthetics, minimal invasiveness, less cost, enhanced bond strength, and revocable nature. The current case, reports the two years follow up of twenty-four years old female patient, for whom the congenitally absent maxillary right lateral incisor was restored with FRC supported FPD.

Quality Assurance Audit of Digital Intraoral Periapical Radiographs at the Undergraduate Dental Clinics

OBJECTIVE

To assess the quality of digital intraoral periapical radiographs by investigating the percentage of radiographic images that satisfied the good quality standards.

STUDY DESIGN

An audit.

PLACE AND DURATION OF STUDY

Undergraduate Dental Clinics, Qassim University College of Dentistry, Saudi Arabia, from April to September 2018.

METHODOLOGY

This standard-based audit was conducted at the clinics of undergraduate dental school. A total of 506 intraoral periapical radiographs taken by dental students were graded, according to the standards set by Health Protection Agency, by two evaluators after the necessary calibration to reduce the inter-evaluator differences. In addition to the grading of radiographs, the documentation of errors like coning off, foreshortening/elongation, contact overlap, poor contrast, and image blurring was done. The data analysis was carried out with Microsoft excel software by utilising simple descriptive statistics.

RESULTS

Out of the 506 digital periapical radiographs, 231 (45.7%) radiographs were categorised as Grade 1, 190 (37.6%) radiographs were categorised as Grade 2, and 85 (16.7%) radiographs were categorised as Grade 3, requiring a repeat radiograph; and were diagnostically unacceptable. Considering the aforementioned results, the findings of the first cycle fell short of the required standards.

CONCLUSION

According to the results of the quality assurance audit, the radiographs were below the standards set by the Health Protection Agency. Recommendations were made for improvement measures in the radiology department, and re-audit was planned after one year. Key Words: Quality assurance, ALARA, Radiation protection, Audit, Digital dental radiography.

Intra-radicular reinforcement using a modified fiber post customization technique: a case report

Trauma sustained by developing anterior teeth can lead to an arrested root development and loss of structure which can complicate the endodontic and restorative management. The preservation of the anterior tooth has a definite esthetic and biologic advantage especially during the developmental years of adolescence. However, restorative treatment of such cases is met with serious biomechanical and adhesive challenges in the form of thin dentinal walls, a high configuration factor etc. This case report describes a fiber post customization technique for the intraradicular reinforcement of a maxillary central incisor in a 14-year-old patient.

Undergraduate Dental Students' And Instructors' Perceptions About The Quality Of Clinical Feedback

BACKGROUND

Feedback is an essential component of the clinical skills development of dental students. The clinical training is a complex integration of knowledge, psychomotor skills, behaviour and clinical communication skills under stress for both instructor and student. This study aimed to investigate the perceptions of undergraduate dental students and their instructors on the quality of clinical feedback.

METHODS

The current cross-sectional observational study was conducted at the Department of Operative Dentistry and Endodontics, Riphah International University, Islamabad from August to December 2019. A self-administered questionnaire was used to collect responses from final year undergraduate dental students and faculty. The questionnaire comprised of 13 items, subdivided into six categories, targeting the various aspects of clinical feedback. SPSS 23 was utilized to analyse the data. Descriptive statistics were tabulated and data was analysed using the Mann-Whitney test (p<0.05) for differences between the two cohorts.

RESULTS

The mean age of the 64 students who responded was 24±0.8 years. Students' male to female ratio was 1:1.56, while for the 18 instructors the ratio was 1:1. Good agreement between the students and instructors was shown for items related to personal dignity and empathy. Moderate agreement was found for items covering the domains of time, understanding, comfort level, professionalism, and self-assessment. The disagreement was observed for the items associated with conflicting feedback, conflict satisfaction, and effective communication.

CONCLUSIONS

Incongruousness existed between the dental students and instructors, about the quality of clinical feedback provided to the dental students. Communication between the instructors and learners must be promoted to increase the level of understanding of the feedback given by the clinical instructors.

Supraorbital Rim Fracture Involving Frontal Sinus by Sports Injury

Supraorbital rim fracture is a rare sports-related injury encountered by craniofacial specialty and great challenge to the surgeons because of their anatomical location and relation with vital structures in close relation. Currently, in the literature, no classification system or treatment protocol exists for the supraorbital rim fracture. Supraorbital rim fracture forms a small proportion of sports-related injuries. Here we present a case with supraorbital rim fracture by sports injury diagnosed by computed tomography and treated surgically by open reduction methods using mini plates.

Retrospective quality assurance audit of Lateral Cephalometric Radiographs at postgraduate teaching hospital

Objective:

The objective of our audit was to assess the quality of lateral cephalometric radiographs by investigating the percentage of lateral cephalometric radiographic images that satisfied the good quality standards.

Methods:

The standard-based retrospective audit was conducted at Riphah International University, Pakistan, from April to September 2018. The sample size was 50 radiographs that were randomly selected from the radiographs taken over one year. The radiographs were graded according to the standards set by the National Radiation Protection Board by two evaluators after the necessary calibration. Moreover, the percentages of images that met the criteria set by the Royal College of Surgeons of England were identified. The data analysis was carried out by the SPSS software version 23.

Results:

Out of the 50 radiographs, thirty-one were Grade-I, sixteen were Grade-II and three radiographs were Grade-III. Furthermore, out of the criteria set by Royal College, one criterion met the 100% standard that was correct head positioning. Less frequent errors were comprised of poor visibility of soft tissue structures (16%), teeth not properly occluded (14%), Incorrect positioning of labels (12%), Sella and Nasion not visible (8%). According to the results of the quality assurance audit, the radiographs fell short of the required standards.

Conclusion:

Quality assurance by periodic auditing is important to yield radiographs with maximum diagnostic value, minimal errors, and avoid unnecessary radiation exposure by repeat radiographs. Recommendations were made for the formulation and implementation of comprehensive radiation protection regulations, at all the Dental institutes of Pakistan.

Conservative esthetic management of post orthodontic treatment discolored tooth with calcified canal: a case report

A case of pulp canal obliteration (PCO) two years after the completion of orthodontic treatment is presented. Post orthodontic treatment PCO is a rare finding. A 23 years old female presented with the discoloration of clinical crown of maxillary right central incisor. Radiographic examination revealed the calcified canal and diffused periapical radiolucency. Vitality tests were negative. A decision was made to do root canal treatment followed by the walking bleaching. After the successful completion of the root canal treatment the internal bleaching was performed. The discolored tooth showed significant improvement in color. Internal bleaching is a viable conservative treatment for improving esthetics in single non vital discolored tooth.

Faculty's Perception of Their Role as a Medical Teacher at Qassim University, Saudi Arabia

Purpose

Medical teaching is a highly demanding and complex task. The advanced integrated curriculum and modern educational practices demand the roles of the medical teacher be redefined. This study was designed to understand the perceptions of the faculty of the Dental College, Qassim University, about their key roles as a teacher. These perceptions can be used to design faculty development workshops to enhance the awareness of the faculty about their educational responsibilities and achieve their potential.

Methods

It was a cross-sectional descriptive survey conducted on the faculty of the College of Dentistry, Qassim University, KSA. The study used a validated 12-item e-questionnaire to measure the perceptions of faculty about their teaching roles.

Results

A total of 44 faculty members submitted the e-questionnaire. Most faculty members perceived the most important role of the medical teacher as an information provider (90%) in clinical settings, followed by an on-job role model (89%). The least important role perceived was curriculum evaluator (82%) followed by curriculum planner (79%).

Conclusion

The role of a medical teacher has extended beyond the boundaries of information providers. The faculty of Qassim University exhibited their awareness about modern-day medical education and recognized the most important role of a medical teacher to be not only an information provider but also an on-job role model and academic advisor to students.

Quality Assurance Audit Of Intra-Oral Periapical Radiographs At The Undergraduate Dental School

BACKGROUND

The three fundamental principles of radiation protection are justification, dose optimization or limitation and subsequently following the As Low as Reasonably Practicable- (ALARP) principle. Quality assurance (QA) program for dental radiography is important in order to yield results with maximum diagnostic value, minimize errors, aid in interpretation, avoid unnecessary repetition of radiographs and therefore, additional radiation exposure.

METHODS

This standard based audit was conducted at an undergraduate and postgraduate teaching hospital. One thousand and sixty four intra oral periapical radiographs were graded according to the set standards by NRPB by 3 examiners. Data were analyzed with SPSS-24.

RESULTS

Out of the 532 conventional periapical radiographs, 313 radiographs were Grade 1, 177 radiographs were Grade 2 and 42 radiographs were Grade 3, requiring a repeat radiograph. For 532 digitally taken periapical radiographs, 255 radiographs were Grade 1, 192 radiographs were Grade 2 and 85 radiographs were Grade 3 and diagnostically unacceptable. Considering the aforementioned results, the findings of the first cycle did not meet the standards.

CONCLUSIONS

According to the results of the quality assurance audit, the radiographs were below the standards set by NRPB. Recommendations were made for improvement measures in the radiology department and plan to re-audit after six months.

Evaluation of Film Thickness of Crown Disclosing Agents and Their Comparison with Cement Film Thickness after Final Cementation

Objective  Verification of the accuracy of crown fit before final cementation is imperative. The aim of this in vitro study was to evaluate the film thickness of commonly used dental crown disclosing materials and their comparison with final cement thickness.

Materialsand Methods One hundred fifty provisional crowns (Protemp) were fabricated on standardized resin dies and divided into five groups ( N = 150; n = 30) based on five disclosing agents: A = Fit-Checker auto-mix; B = Okklu-top; C = Express; D = Fit-Checker hand-mix; E = Coltene PSI, and Final cement = Relyx U200. Crowns were loaded with test materials, tried over dies under load (50N), and later cemented under same load. Film thickness (µm) was recorded between crown margin and the finish line of die after loading with test material and final cementation using a digital microscope.

Statistical Analysis  Descriptive statistics, analysis of variance, Tukey’s and paired t -test were used for statistical analysis ( p < 0.05).

Results  Significant variations were found between the film thicknesses of the five disclosing agents ( p = 0.019). Group-A showed the lowest (131.67 ± 101.10 μm), while group-B (295.00 ± 263.88 μm) showed the highest film thickness ( p = 0.011). Film thicknesses after cementation were similar for groups ( p = 0.957). Significant difference was observed for group-B disclosing agent versus final cement ( p = 0.010). The lowest mean difference between the film thicknesses of the disclosing agent and final cementation of 13.1 μm was revealed for group-A.

Conclusions  Variations in the film thicknesses of the tested disclosing agents were found. Fit-Checker auto-mix was found with minimal film thickness and satisfied the requirements as the disclosing agent, while Okklu-top aerosol spray did not.

The Evaluation Of Empathy Level Of Undergraduate Dental Students In Pakistan: A Cross-Sectional Study

BACKGROUND

Empathy is of significant importance in the dentist-patient relationship. The objective of the current study was to assess the empathy level of students at the culmination of their respective academic year, studying in first to fourth year across the undergraduate dental school of Pakistan.

METHODS

The cross-sectional study of undergraduate dental students was carried out at the dental school of Riphah International University in Islamabad, Pakistan in 2017. The survey was conducted with each class as they approached near the completion of their academic year. The Jefferson Scale of Physician Empathy- Health Professions Student Version (JSE-HPS version), was used in the study for measuring empathy. JSE-HPS is a valid and reliable self-reporting instrument comprising of 20 items. The total score on this instrument ranges between 20 and 140. ANOVA test and Independent sample t-test were used to analyze the data on SPSS 24.

RESULTS

Two hundred and twenty-two students participated in this study. The mean empathy score of students was 101.15±13.73. The mean empathy score of the first-year dental students was the highest (104.70±15.53) followed by the scores of second year students (102.70±13.48); the third-year class had the lowest mean empathy score (98.63±11.53) that corresponded to the first year of clinical training and final year students had a score of 99.48±13.96. Dichotomization of data showed statistically significant difference between the mean empathy scores of students studying in the preclinical and clinical years. The difference in the mean empathy scores of male and female students was found to be statistically significant. The JSE-HPS was found to be reliable with Cronbach's alpha=0.77.

CONCLUSIONS

The present study revealed a statistically significant decline in empathy levels of undergraduate dental students when the empathy levels of the students studying in the preclinical years and clinical years were compared. The JSE-HPS was found to be a reliable instrument for assessing the empathy levels of dental students.