Root Canal Configurations and Morphological Variations in Maxillary and Mandibular Second Molars in a Pakistani Population

OBJECTIVE

To determine the dental morphology and root canal anatomy of maxillary and mandibular second molars in Pakistani population living in Hyderabad.

STUDY DESIGN

Retrospective, cross-sectional study. Place and Duration of the Study: Department of Operative Dentistry and Endodontics, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro, from April to May 2023.

METHODOLOGY

This study analysed the number of roots, root canal configurations, and frequency of C-shaped root canals and their configuration assessment. The data was obtained from Cone Beam Computerised Tomography (CBCT) records sourced from the Department of Radiology at Advanced Dental Care Centre of LUMHS.

RESULTS

Two-rooted maxillary second molar was present in 10.6% of teeth, while 5.3% were single-rooted. Among mandibular second molars, 6.8% had one root, while 2.3% had three. The maxillary second molar mesiobuccal roots were Type I in 47.7% cases. The maxillary second molars had C1-shaped canals in 3.8% of cases. The study revealed that 10.6% of mandibular second molars had C-shaped canals, 3.0% were C1, 6.8% C3a, and 0.8% C4. A minority of patients had palatal morphology with two roots (MP and DP) and Type 1 canal structure, while a subset had both MP and DP canals.

CONCLUSION

The prevalence of radix in mandibular second molars was found to be relatively infrequent. The prevalent root canal configurations were Type I in the mesiobuccal and palatal roots and Type IV in the mesial root of mandibular second molars. A noteworthy correlation was detected between the molar type characterised by a single root and the existence of a C-shaped canal in the female population.

KEY WORDS

CBCT, Dental anatomy, Gender, Root canal, Morphology, Pakistani population.

Root Canal Morphology of Mandibular First Premolars using Radiography: An in vitro study

Objective: The goal of this study was to document the Root Canal morphology of the first mandibular premolars using radiography. Materials and Methods: The trial took place at the LUMHS Operative Dentistry Department. Two hundred removed permanent mandibular first premolars that met all of the study's inclusion criteria were gathered from LUMHS Jamshoro/Hyderabad and nearby private dental clinics in Hyderabad. All debris, soft tissues, and calculus were removed from the teeth, which were then preserved in a 10% formalin solution. Each tooth's length was measured from the crown's tip to the root's apex. An removed tooth, on the other hand, was examined from all angles, including buccal, lingual, and proximal. Root concavities and grooves, as well as bifurcation and apical curvature, were found. Results: Comparison between both views showed 189 teeth have 1 root in and 186 have 1 canal in buccolingual view, while 182 teeth have 1 root and 179 have 1 canal in mesiodistal view. 11 teeth on buccolingual and 18 teeth on mesiodistal view showed 2 roots and 14 teeth on buccolingual and 21 teeth on mesiodistal view showed 2 canals. 110 teetj showed type I canal pattern. Conclusion: It is concluded that mandibular first premolar teeth have a wide range of radicular traits, with the majority of them having one root and one canal.

Association of Dental Caries with Body Mass Index in Patients Attending Dental OPD of Tertiary Care Hospital, Pakistan: A Cross-Sectional Study

Background: Dental caries area public health problem. Its prevalence is about 60%  in the Pakistani population. Purpose: The purpose of this study was to correlate the association between decayed, missing, and filled teeth (DMFT) score and its body mass index in patients visiting the Dental Department of Liaquat University of Medical and Health Sciences, Jamshoro. Materials and Methods: This cross-sectional study was conducted from January 2021 to May 2021 at the Department of Operative Dentistry Liaquat University of Medical and Health Sciences. Patients with age 16 to 70 years with presence of atleast 15 to 18 permanent teeth were included in te study. Patients having primary teeth were set in exclusion criteria. For Dental caries status, decayed, missing, and filled teeth (DMFT) index was used. Height and weight were measured using digital scales. BMI was calculated according to the formula weight in kilograms/height in centimeters. Data were analyzed for descriptive statistics. One Way ANOVA test was used for association. The statistical significance level was evaluated at p<0.05 Results: We were able to obtain the data of a total of 203 patients of which 57% were female.The mean age was 36.7±13.8. ). The mean DMTF score was 5.7±3.7. In association of BMI with DMTF score, females BMI was statistically significant with DMTF score with p=0.039 and in overall was also significant p =0.002 Conclusion: DMFT score was higher in overweight and obese individuals and it was significant statistically. However, large community based studies are required to confirm the association.

Effect of Triclosan and Sodium Monofluorophosphate on Plaque Reduction

Objective:  The aim of the study is to compare the clinical efficacy between two ingredient Triclosan and sodium monofluorophosphate on plaque accumulation. Material and Methodology: This cross section study was carried out in school (Govt Girls High School Kotri). Total 100 school children were selected, between age ranges 13–16 years, which were divided in to two groups (group A & B) according to dentifrice given. Group A: Toothpaste containing the active ingredient 0.3% Triclosan. Group B: Toothpaste containing 0.8% sodium monofluorophosphate.                      All patients were examined clinically for assessment using the Plaque index (PI) at follow up periods every week. Plaque was evaluated by using the silness-loe index.  Oral examination for dental plaque assessment was carried out at the start of the study and the children were follow up to 10 weeks. Data were analyzed by SPSS 16 version and one-way ANOVA test. Result: Triclosan toothpaste users experienced significant reduction in plaque accumulation as compared to the sodium monofluorophosphate toothpaste users. Conclusion:  At 3-weeks, Triclosan provided statistically significantly greater reductions than sodium monofluorophosphate in plaque reduction.

Clinical Assessment: Short Term Retention of Giomer and Compomer Restorations in Class V Non-Carious Cervical Lesions

Objective: To compare the retention rate of giomer and compomer in Class V restorations in non-carious cervical lesions (NCCL). Materials and methods: In this experimental study patients with non-carious cervical lesions were divided in to two groups (Group A and B). In group A (n=60), restoration was done with Giomer type of material and in group B (n=60) Compomer type of material was used for filling by the same operator. Cvar & Ryge Criteria were used to evaluate the retention of both materials as: Alpha (restoration fully retained), Bravo (restoration partially retained) and Charlie (restoration completely missing) at follow-ups 1st, 2nd, 3rd, 4th, 5th and 6th months. The data was analyzed using SPSS version 17. Results: Males were 72% and females were 28%. The Mean age was 30.62 ±3.89 ranges from 13–85 years. Charlie score was observed at 5th and 6th months. The comparison between Giomer and Compomer at follow-up of 1st, 2nd, 4rd, 4th, 5th and 6th showed no statistical difference. Conclusion: Giomer and compomer both have same retention rate in clinical trials.

Comparison between Conventional 2.0 mm Miniplates versus 3-D Plates In Management of Mandibular Fractures

Objective: To compare the outcomes stability, malunion and intra operative time by using 2.0mm conventional miniplates and 3-D plates in management of the anterior mandibular fracture. Materials and Methods: Total 94 patients were included and equally divided in two groups. Fixation of fracture was done by 2.0mm conventional miniplates in Group-A and a single 3D plate in Group-B. Stability, healing and malunion were assessed on follow-up at 1st week, 6th week, and 12th week using Chi Square Test. Results: Stability was 91.5% in group-A and 93.6% in group-B. Clinically malunion was 12.8% at 1st week, 14.8% at 2nd week, 14.8% at 8th week in group-A while in group-B, malunion was 8.5% at 1st week, 2nd week and at 8th week. Radiographically, malunion was 12.8% at 1st week, 14.8% at 2nd week, 14.8% at 8th week in group-A while in group-B, malunion was 8.5% at 1stweek, 2nd week and at 8th week. Conclusion: The results of the study concluded that 3-D plating system has advantages over conventional 2 mm miniplates.

Arthroscopic management of suprascapular neuropathy of the shoulder improves pain and functional outcomes with minimal complication rates

PURPOSE

The purpose of this study was to systematically assess the arthroscopic management of suprascapular neuropathy, including the aetiology, surgical decision-making, clinical outcomes, and complications associated with the procedure.

METHODS

Three databases [PubMed, Ovid (Medline), and Embase] were searched. Systematic literature screening and data abstraction was performed in duplicate to present a review of studies reporting on arthroscopic management of suprascapular neuropathy. The quality of the included studies was assessed using level of evidence and the MINORS (Methodological Index for Nonrandomized Studies) checklist.

RESULTS

In total, 40 studies (17 case reports, 20 case series, 2 retrospective comparative studies, and 1 prospective comparative study) were identified, including 259 patients (261 shoulders) treated arthroscopically for suprascapular neuropathy. The most common aetiology of suprascapular neuropathy was suprascapular nerve compression by a cyst at the spinoglenoid notch (42%), and the decision to pursue arthroscopic surgery was most commonly based on the results of clinical findings and investigations (47%). Overall, 97% of patients reported significant improvement in or complete resolution of their pre-operative symptoms (including pain, strength, and subjective function of the shoulder) over a mean follow-up period of 23.7 months. Further, there was a low overall complication rate (4%) associated with the arthroscopic procedures.

CONCLUSION

While most studies evaluating arthroscopic management of suprascapular neuropathy are uncontrolled studies with lower levels of evidence, results indicate that such management provides patients with significant improvements in pain, strength, and subjective function of the shoulder, and has a low incidence of complications. Patients managed arthroscopically for suprascapular neuropathy may expect significant improvements in pain, strength, and subjective function of the shoulder.

LEVEL OF EVIDENCE

Level IV, systematic review of level II to IV studies.

Health Issues in Ethnic Minorities: Awareness and Action

A key issue in health provision is the approach to health inequalities. In the UK, black and ethnic minority populations are disadvantaged in this respect. We obtained annual/public health reports from 13 health authorities (HAs) and 22 primary care trusts/groups (PCT/Gs) serving conurbations with large black and ethnic minority populations, and examined them for mention of special health issues for these groups and the action being taken. 22 of the 35 reports referred to such issues but only 17 referred to special initiatives; the most frequently mentioned were diabetes and coronary heart disease. We recommend that HAs and PCT/Gs serving large black and ethnic minority populations state specifically in their annual reports their awareness of health-equality issues and the action being taken to address them.

Five-year publication rate of clinical presentations at the open and closed American shoulder and elbow surgeons annual meeting from 2005-2010

BACKGROUND

The purpose of this study was to evaluate the five-year publication rate of papers presented at both the open and closed American Shoulder and Elbow Surgeons' (ASES) annual meetings from 2005 to 2010.

METHODS

Online abstracts of the presentations at the open and closed ASES annual meetings were independently screened for clinical studies and graded for quality using level of evidence. The databases PubMed (MEDLINE), Ovid (MEDLINE), and EMBASE were comprehensively searched for full-text publications corresponding to these presentations and any paper published within five years of the presentation date was counted.

RESULTS

Overall, 131/266 papers corresponding to the meeting presentations were identified for a five-year publication rate of 49.2 %. Sixty two (48 %) of the papers were published in The Journal of Shoulder and Elbow Surgeons, 23 (18 %) were published in The American Journal of Sports Medicine, and 20 (16 %) were published in The Journal of Bone and Joint Surgery. The mean patient sample size included in presentations with a subsequent full-text publication was higher (154; standard error =27) than the presentations not published (93; standard error = 13) (p = 0.039). There was no correlation (p = 0.248) between the publication rate and the level of evidence of the presentations.

CONCLUSIONS

The publication rate of presentations at ASES meetings from 2005 to 2010 is similar to that reported from other orthopaedic meetings. Studies with large sample sizes should continue to be encouraged, and high quality presentations must consistently be followed up with full-text manuscript preparation in order to maximize the future clinical impact.

Extraskeletal Ewing's sarcoma family of tumours in adults: analysis of 57 patients from a single institution

AIMS

Extraskeletal Ewing's sarcoma (EES) is a rare form of soft tissue sarcoma. The aim of the present study was to assess the outcome and the prognosis of adult patients presenting with EES treated with multi-modality therapy.

MATERIALS AND METHODS

All EES patients older than 15 years referred to our institution between January 1995 and December 2004 were reviewed. In total, 57 patients were identified. Their median age at diagnosis was 20 years (range 15-57).

RESULTS

The median size of the primary tumour was 11 cm (range 4-30 cm). Eighteen patients (31%) had metastatic disease at initial presentation. Wide surgical resection with negative margins was achieved in 23 cases (40%). Chemotherapy consisting of vincristine, adriamycin, ifosfamide, actinomycin D was given in 50 patients (88%). Radiotherapy was delivered in 37 patients (65%). Forty-one patients (72%) achieved complete remission and 16 (28%) progressed on therapy. Twenty-one patients (51%) relapsed. Local recurrence was encountered in 15 patients (36%). At a median follow-up of 46 months (range 6-143 months), the 5-year event-free survival and overall survival rates were 35 and 47%, respectively. Metastases at presentation, tumour size and surgical resection margin associated significantly with overall survival and event-free survival.

CONCLUSION

EES is an aggressive type of tumour with a high incidence of local recurrence and distant metastasis. This series showed that the outcome of adult EES is not unlike that of skeletal Ewing's sarcoma in terms of response to multi-modality treatment and the prognostic factors influencing treatment outcome. Adequate surgical resection, aggressive chemotherapy and adjuvant local radiation therapy, when indicated, constitute the optimal treatment to achieve the best results in this rare type of disease.

Treatment of aggressive fibromatosis: the experience of a single institution

AIMS

Aggressive fibromatosis is a locally aggressive infiltrative low-grade tumour, although pathologically benign, and it does not metastasise, yet it can cause serious local distressing symptoms by virtue of local destruction and impairment of local function. The aim of this study was to emphasise the role of radiotherapy and adequate surgery in the treatment of fibromatosis in patients presenting with newly diagnosed or recurrent disease and to analyse our treatment results over 15 years for this rare tumour type.

MATERIALS AND METHODS

Fifty-four patients with confirmed diagnosis of aggressive fibromatosis treated at King Faisal Specialist Hospital between 1990 and 2006 were identified from our local cancer registry. Forty-seven patients had surgery: complete resection (R0) in 20 patients, incomplete surgery (R1/2) in 27 patients, and seven patients had biopsy only. Forty-five patients were treated with radiotherapy: 38 patients were treated with postoperative radiotherapy, three patients were treated with preoperative radiotherapy and four patients had radiotherapy as the only treatment. The radiotherapy dose ranged between 45 and 60Gy (median 50.4Gy). Three patients did not receive any form of treatment apart from biopsy, but were still included in the final analysis.

RESULTS

Fifty-two per cent (28/54 patients) of our patient population had tumour recurrence when first presented to King Faisal Specialist Hospital. The median age was 29.5 years (range 2-63 years). The most common site of involvement was the extremities (28 patients). Among the 54 patients (with primary and recurrent presentation) there were 10 local recurrences, all of which were within the original primary site. The 5-year progression-free survival and overall survival rates for the whole group were 75 and 95%, respectively. Univariate and multivariate Cox regression analysis showed that the depth of invasion significantly affected progression-free survival.

CONCLUSION

Aggressive fibromatosis is effectively treated with surgery and postoperative radiotherapy. Patients first presenting with tumour recurrence may still have local tumour control comparable with newly diagnosed patients.

Health issues in ethnic minorities: awareness and action

A key issue in health provision is the approach to health inequalities. In the UK, black and ethnic minority populations are disadvantaged in this respect. We obtained annual/public health reports from 13 health authorities (HAs) and 22 primary care trusts/groups (PCT/Gs) serving conurbations with large black and ethnic minority populations, and examined them for mention of special health issues for these groups and the action being taken. 22 of the 35 reports referred to such issues but only 17 referred to special initiatives; the most frequently mentioned were diabetes and coronary heart disease. We recommend that HAs and PCT/Gs serving large black and ethnic minority populations state specifically in their annual reports their awareness of health-equality issues and the action being taken to address them.

Pulmonary metastatectomy for soft tissue sarcomas: is it valuable?

BACKGROUND

A retrospective study and analysis was performed to determine the value and benefit of pulmonary metastatectomy for soft tissue sarcomas, and which factors predict prognosis following resection.

METHODS

Twenty-three patients underwent resections for pulmonary metastases from a soft tissue sarcoma (STS) at King Faisal Specialist Hospital and Research Center (KFSH&RC), between January 1985 and December 1998. There were 11 male and 12 female patients. Thirteen of 23 patients (57%) had one to three metastases, and 10 (43%) had four or more metastases. A total of 41 thoracic explorations was performed for the 23 evaluable patients. Median sternotomy was used only for three patients and lateral thoracotomy was used for 20 patients as an initial surgical approach. Pulmonary resections performed included one or more wedge resections (n=16), segmentectomy (n=5), and lobectomy (n=2). No one in this series underwent pneumonectomy. The number of resected metastatic nodules ranged from one-six with average three. Eight patients (35%) received various kinds of postoperative adjuvant chemotherapy.

RESULTS

The overall and disease-free survival rate post-metastatectomy at five years was 24% and 21%, respectively. Various prognostic indicators were examined to evaluate their association with improved survival. Age, sex localization of the primary site and histologic type, tumor grade, size of the resected nodules, laterality (unilateral or bilateral), types of resection, adjuvant chemotherapy, and local recurrence did not significantly affect survival. However, patient with disease free interval >6 months, and those with three or fewer metastases showed a trend toward a higher five-year overall survival (p=0.06, 0.07, respectively).

CONCLUSIONS

Surgical excision of lung metastases from soft tissue sarcomas is well accepted and should be considered as a first line of treatment if preoperative evaluation indicated that complete resection of the metastases is possible. Further investigation is needed before chemotherapy can be recommended as additional therapy.

Metastatic Ewing sarcoma/PNET of bone at diagnosis: prognostic factors--a report from Saudi Arabia

BACKGROUND

To evaluate outcome and prognostic factors in Saudi Arabian patients with metastatic Ewing sarcoma and PNET of bone (PMES) at diagnosis.

PROCEDURE

Ninety-nine of 304 (33%) consecutive patients with Ewing sarcoma and PNET of bone registered at our centre from 1975 to 1998, had metastatic disease at registration and 93 were available for analysis. The maximum x-axis diameter of the primary tumor was used as the measure of primary tumor size. Usually a trial of systemic treatment was undertaken before a decision was made on local treatment. Standard chemotherapy regimens were used in all treated patients. Forty-one (44%) patients did not receive radical local treatment due to an inadequate response to chemotherapy, or a decision not to undertake more than palliative treatment. Radical treatment of the primary site was radiation alone 41 (79%), resection alone 7 (13%), and resection and radiation 4 (8%).

RESULTS

The 5-year survival rates were 9% for all 93 evaluable patients, 16% for 52 patients who received chemotherapy and radical local treatment, 0% for 41 patients who received lesser treatment, 19% for 43 patients with lung metastases alone, and 0% (P = 0.002) for 50 patients with other sites involved. For 60 patients with imaging data, 5-year survivals were 34 and 0% when the maximum transverse diameter of the primary tumor was < 10 cm (N = 20) and > or = 10 cm (N = 40), respectively.

CONCLUSIONS

Small primary tumor size and the presence of lung metastases alone were the only significant favorable prognostic factors. Earlier diagnosis will be the basis for better results.

Ethnic minority health. Restricted access

A survey of health authorities and primary care groups with high ethnic minority populations in England showed HAs were further advanced in addressing the special needs of ethnic minorities than PCGs. More than three-quarters of HAs cited initiatives for ethnic minorities compared with only 36 per cent of PCGs. Only a minority of organisations reported schemes to address health inequalities. Commissioning organisations covering large communities of people from ethnic minorities should do more to address their special health needs.

Malignant ovarian germ cell tumours -- a survival and prognostic analysis

The medical records and histopathology of all ovarian germ cell tumours (OGCT) in a tertiary centre between 1980 and 1996 were reviewed. Response, overall survival (OS), relapse-free survival (RFS) and prognostic factors were analysed. Sixty-seven patients with OGCT were identified and treated, including 33 dysgerminomas, 18 immature teratomas, 10 endodermal sinus tumours, and 6 mixed tumours. Fifty-three patients (79%) received conservative surgery, 24 (36%) had residual disease post-primary surgery, and 43 (64%) had chemotherapy. Complete response was achieved in 62 patients (93%), 4 out of 5 patients who relapsed were successfully salvaged; OS and RFS at 5 years were 89% and 76%, respectively. Advancing stage of disease was the only significant adverse prognostic factor (p = 0.0001 for OS, and 0.0003 for RFS at 5 years). Out of 44 women with the potential to conceive following treatment, there were 16 successful pregnancies. None of the children born subsequent to the chemotherapy were reported to have any congenital abnormalities. The review indicates a high cure rate in OGCT with combined surgery and chemotherapy and that conservative surgery and preservation of fertility are feasible.

Joint working. One for the boys

An increase in the number of complications following male circumcisions performed by non-professionals led to the establishment of a special clinic for religious circumcisions. The clinic is jointly funded by health organisations, the local authority and the Muslim community. Parents pay 45 pounds for the service, which is acceptable to the local Muslim community.

Reversible cyclosporine-induced cortical blindness in allogeneic bone marrow transplant recipients

We report the occurrence of reversible cyclosporine-induced cortical blindness in three allogeneic bone marrow transplant recipients. Possible mechanisms involved in this rare complication, as well as the associated radiographic and pathologic findings, are discussed.

A putative CEA moiety is shared by the cotton-top tamarin (Saguinus oedipus) and humans

CEA-like molecules immunologically distinct from those in humans have been described in non-human primates. These primates do not share the human predilection for colitis and subsequent development of colorectal cancer. CEA expression has not been fully evaluated in a lower-order primate, the cotton-top tamarin (Saguinus oedipus), an animal model for colitis and colorectal cancer. We found increased levels of CEA in both colonic washings and tissues of these animals using a commercially available kit, CEA AIA-PACK (Tosoh Medics, Foster City, CA). In contrast, we observed that other CEA kits failed to detect CEA in tamarins. To elucidate the nature of the CEA-like protein detected, we used the two component monoclonal antibodies used in the CEA AIA-PACK kit, and identified the reactive molecules by Western blotting. A band of approximately M(r) 50,000 was found to be common to samples from both humans and the tamarins. Minimal binding was observed with NCA antibody. We conclude that a CEA-like molecule shared by humans and tamarins may play a role in the pathogenesis of colitis and cancer in both species.

The morphology of abdominal and inguinal cryptorchid testes in stallions: a light and electron microscopic study

Eleven unilateral cryptorchid stallions, two to three years old, were castrated at Louisiana State University Veterinary Teaching Hospital. Five of these cryptorchid cases were abdominal and the rest were inguinal. This study was initiated to document the differences between the abdominal and inguinal equine cryptorchid testes. Specimens were obtained from the abepididymal side of each cryptorchid testes and processed for light and electron microscopic study. The cryptorchid testes were smaller than the scrotal testes, with the abdominal testes being one-fourth the size of the scrotal testes. Two of the abdominal testes had cysts filled with a straw-colored fluid. The seminiferous tubules of the abdominal testes were larger than those in the inguinal testes. The epithelial linings of the seminiferous tubules of the abdominal testes were vacuolated and did not contain more than two layers of undifferentiated cells. The interstitial collagen fibers of the abdominal testes were coarse and more abundant than those of the inguinal testes. The seminiferous tubules of the inguinal testes were smaller and contained many layers of epithelial cells at different stages of embryological differentiation, with scattered primordial germ cells. The necrotic, degenerative changes of the epithelial cells of the abdominal testes were distinct, while the inguinal testes had healthy cells at embryological arrest.