Hisham Abada

Objectives: Postoperative pain remains a significant concern in endodontics. The main aim of this clinical trial was to assess the impact of various obturation technique and sealer types on post-obturation pain and sealer extrusion in single-visit nonsurgical root canal treatments. Materials and methods: Study participants were recruited through consecutive sampling from patients referred to the Endodontic Department, Faculty of Dentistry, Institution University, diagnosed as asymptomatic irreversible pulpitis. The study was conducted on 150 cases that were equally and randomly allocated to each of the studied groups (30 for each group) as following; Group 1 - cold lateral compaction with CeraSeal (CLC-CS); Group 2 - continuous wave compaction with CeraSeal (CWC-CS); Group 3 - single cone technique with CeraSeal (SC-CS); Group 4 - Cold lateral compaction with AH Plus (CLC-AH); and Group 5 - continuous wave compaction with AH Plus (CWC-AH). All endodontic procedures were performed by a single experienced endodontist to standardize treatment protocols. The main outcomes were the post-obturation pain which was assessed using a visual analog scale (VAS) scale (0–10), and the incidence of sealer extrusion among the studied groups. Results: At 6, 24, and 72 h the postobturation pain score did not differ significantly between all studied groups. After 12 and 48 h CWC-CS and CLC-CS showed the lowest significant postobturation pain score respectively, and CWC-AH had the most significant postobturation pain score. During the study, none of the patients needed an emergency visit, the pain score was ranged from (0:1.4). Within the same group, the pain intensity began to significantly decrease for gp1 (CLC-CS) after 24 h, for gp3, gp4, and gp5 (SC-CS, CLC-AH, and CWC-AH, respectively) after 12 h, and for gp2 (CWC-CS) after 6 h. After 72 h, the level of pain in each group was around 0. Regardless of the type of sealer used, no significant difference was found between the type of obturation technique and the postoperative pain intensity (p = 0.124), while regardless of the type of obturation technique used, there was a significant difference in postoperative pain intensity and sealer type (p < 0.001). The incidence of sealer extrusion did not differ significantly between the tested groups (p = 0.499), the results showed that the presence of sealer extrusion was associated with higher significant pain score (p < 0.001). Conclusion: The postoperative pain score after Single-Visit RCT for patient diagnosed as asymptomatic irreversible pulpitis was low to moderate pain score, presence of sealer extrusion increased the postoperative pain intensity. Regardless the type of sealer, different obturation techniques did not associated with postoperative pain intensity, while regardless the obturation technique, AH Plus sealer was associated with higher postoperative pain intensity than CeraSeal sealer. Postoperative pain was related to presence of sealer extrusion.

Aim: The aim of this work was to evaluate the prevalence of dental diseases in patients ‎undergoing cataract surgery.‎ Materials and methods: This cross-sectional study was carried out on 1000 patients ‎undergoing cataract surgery. All patients were subjected to eye examination through several ‎tests [vision, eye structure, retinal and fluid pressure test], information on smoking habits, ‎alcohol consumption, regular physical exercise and demographic data were taken, the dental ‎examination include periodontal examination to detect presence of calculus, diagnosis of ‎caries, teeth required RCT or root canal retreatment, detection of any septic focus, ‎remaining root structure, and /or presence of periapical lesion.‎ Results: Dental caries were present in 65.1% of patients, patients with calculus were 76.8% ‎with variable degree of severity. 88.2% of patients had dental events. The events of the ‎highest frequencies were combined caries and calculus (30.9%), and combined caries, ‎periapical lesions, and calculus (22.1%).‎ Conclusion: The incidence of oral infections particularly periodontitis is relatively high ‎among adults, as their presence can significantly increase the likelihood of postoperative ‎complications after cataract surgery, addressing oral health issues prior to surgery is crucial ‎for improving surgical outcomes and minimizing risks of complications following cataract ‎surgery.‎

Aim: Evaluate Effect of blood contamination on marginal adaptation, surface hardness, and bond strength of two retrograde materials.Materials and methods: 144 single-rooted mandibular premolars were collected, disinfected, crowns were removed, roots were endodontically treated, and root-end resection was made by cutting 3 mm from apex. Root-end cavities were prepared, then classified into two groups (n=72) according to root-end filling materials, Group I, restored with ProRoot MTA (PMTA), Group 2 restored by Well-Root PT (WRPT). Each group was classified into two subgroups (n=36) according to the setting environment; subgroup A; the materials allowed to set in deionized water (PMTA/W and WRPT/W), while subgroup B; the materials allowed to set in human blood (PMTA/B and WRPT/B). Twelve samples from each subgroup were used to study the marginal adaptation, surface hardness, and bond strength.Results: In contact to deionized water and human blood, WRPT showed less significant marginal gap distance and non-significant less hardness value than PMTA, the push-out bond strength for WRPT was highly significant than PMTA in contact to deionized water, and highly non-significant than PMTA in contact to human blood. The blood contamination had negative significant effect on marginal adaptation of PMTA, hardness number of WRPT, and push-out bond strength of both root-end filling materials.Conclusion: The marginal adaptation and bond strength for WRPT are superior to those for PMTA. Blood contamination negatively effect on the studied properties of both materials.

Background: Detection of strip root canal perforation in obturated teeth depend mainly on radiographic methods. The Periapical radiographs (PR) provide valuable two-dimensional images, while the Cone-Beam Computed Tomography (CBCT) imaging offers a three-dimensional visualization of the tooth and its surrounding structures. The voxel size used for CBCT acquisition has impact on the diagnostic accuracy of those images. This study aimed to compare the diagnostic accuracy of the digital PR and CBCT with 0.2 and 0.3 mm3 voxel sizes for the strip perforation detection in mandibular root.Methods: For this investigation, 48 sound lower first molars were selected and divided into the following groups: (i) without obturation and without strip perforation, (ii) obturation and without strip perforation, (iii) without obturation and strip perforation, (iv) obturation and strip perforation. To obtain the requested radiographic images each tooth was placed in dehydrated human mandible. All images were evaluated by four observers, data was collected, and SPSS software program was used to analyse the data.Results: In our study the area under the curves (AUC) values for the CBCT images were highly significance than the value for PR images, there was no significance difference between the two CBCT voxel sizes images for perforation detection in obturated teeth.Conclusions: Compared to PR, A significantly higher accuracy for detection of strip root canal perforation was associated to the CBCT images. For non-obturated teeth the 0.2 mm3 CBCT voxel sizes has a higher significant difference than 0.3 mm3 CBCT voxel sizes.

Objectives:The aim of this study is to quantitatively compare the diagnostic accuracy of CBCT with 0.2 and 0.4 mm³voxel sizes and a digital PR for the detection of strip perforation for mesial root of the mandibular first molar with and without root canal obturation when evaluated by different observer specialty.Materials and Methods:48 intact mandibular first molars were selected for this study, the teeth were divided to the following groups: (i)no strip perforation and no obturation, (ii) no strip perforation and obturation, (iii) strip perforation and no obturation, (iv) strip perforation and obturation. Each tooth was inserted in a dry mandible to obtain intraoral digital, CBCT images were obtained using two voxel sizes 0.2 and 0.4 mm³. Two general practitioners, two endodontists, and two dentomaxillofacial radiologists were asked to evaluate all images for detection of strip root perforation individually and together. The sensitivity and specificity of all images modalities to diagnose perforations were calculated.Results:There was no statistically significant difference between the accuracy of the PR images observed by the two general practitioners and two radiologists, while they showed a statistically low significant difference compared to the images observed by the two endodontists. CBCT images accuracy showed a higher significant difference than PR images observed by general practitioners and radiologists.Conclusions: CBCT was associated with significantly greater accuracy for detection of strip root perforation than PR. When two endodontist specialists observed the PR together, they showed a higher significance difference in the detection of root perforation compared to general practitioners and radiologists, and they showed no significant difference compared CBCT images. There was no significant difference between 0.2 and 0.4 mm³voxel sizes of CBCT images.Clinical Relevance: The accuracy of PR in the detection of root perforation is equal to that of CBCT when observed by two endodontists, and it is higher than the accuracy of PR images observed by general practitioners and radiologists.

Background: This scoping review systematically summarized the available evidence about the efficacy of N-acetyl cysteine (NAC) as an intracanal antibacterial and/or anti-inflammatory.Methods: PubMed, Scopus, Web of Science, and Google scholar search engines/databases were searched up to February 2022 to retrieve relevant studies. The studies were evaluated for eligibility criteria, and identifying relevant studies.Results: Out of 193 studies, 15 fulfilled the inclusion criteria and were processed for data extraction. Thirteen in vitro studies assessed antibacterial/antibiofilm efficacy of NAC, and reported good and promising efficacy: NAC was found as efficacious as the comparators (chlorhexidine, sodium hypochlorite, calcium hydroxide), or even showed higher efficacy. Regarding the anti-inflammatory efficacy of NAC, one in vitro study found it equivalent to, while one clinical trial revealed it more efficacious than calcium hydroxide.Conclusions: There is accumulating evidence on the anti-microbial and anti-inflammatory efficacy of NAC in context of endodontics. However, further clinical trials with robust methodology and objective and reliable clinical, biological and microbial outcomes are warranted to translate its use for clinical practice on humans.

Aim of the study was to investigate the effect of taper and sealer materials on the fracture resistance (FR) of roots. Material and method: Total number of 120 single-canalled human mandibular central and lateral teeth with equal size were chosen and kept in distilled water until needed, all teeth were decoronated and divided into one positive control group (n=12) and three experimental groups (n=36) according to the degree of taper used for root canal instrumentation using K3XF files system (#25/4%, #25/6% and #25/8%), each experimental group was further subdivided into one negative control subgroup (n=12) in which the root canal instrumented but not obturated and two experimental subgroups (n=12) according to type of root canal sealer used for obturation (AH Plus and MTA Fillapex ). Each specimen was embedded in acrylic mould and subjected to FR test using a universal testing machine. The force required to fracture each specimen was recorded and the data obtained were statistically analysed. Results: Group 1 showed highest FR among all experimental groups followed by group 2 with non-significance difference between both groups while group 3 (#25/8%) showed the least FR. MTA Fillapex subgroup showed less non-significantly difference from AH Plus subgroup regardless the degree of taper used for preparation. Conclusion: Using 4% and 6% taper preparation have non-significant difference from each other when using AH plus or MTA Fillapex sealer. MTA Fillapex did not significantly improve the FR of the root regardless the preparation taper used.

Objective The aim of the present study was to evaluate the regenerative potential of permanent necrotic mature teeth with different apical foramen diameters in comparison to conventional endodontic treatment. Methods Pulp necrosis and periapical pathosis were induced in premolars (144 roots) in six mongrel dogs. The infected teeth were divided into six groups; conventional root canal treatment (RCT) group prepared up to apical preparation sizes #F3 ProTaper file, regenerative endodontic therapy (RET) groups; groups RET-F3, RET-F4, and RET-F5 where regenerative endodontic procedures were applied after apical preparation up to sizes #F3, F4, and F5 ProTaper file, respectively, control groups; and positive (P) and negative (N) groups included infected and healthy teeth respectively. Each group (12 teeth with 24 roots each) was further subdivided into two subgroups (6 teeth with 12 roots each) according to the evaluation periods 1 and 3 months; each group was equally randomized in the upper and lower jaws during each evaluation period. Results The inflammatory cell counts for the RCT group were statistically significantly higher than that of all RET groups at the first period and only significantly higher than RET-F5 at the second period. The enlargement of the apical foramen to #F5 showed no statistically significant difference with #F4 regarding the inflammatory cell count, tissue in-growth inside the root canal, and percentage of bone resorption. The tissue formed after RET was not true pulp tissue and is considered tissue repair with connective tissue, dilated blood vessels, and cementum-like structures.  Conclusion Increasing the apical size diameter was associated with less inflammatory cell count, less percentage of bone resorption, more tissue ingrowth, and more percentage of new hard tissue formation inside root canal. The minimum apical diameter that should be enlarged for RET is 0.4 mm. Clinical relevance RET could be used as an alternative procedure to RCT for the treatment of mature teeth with necrotic pulp and apical periodontitis.