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  1. Maqbool M, Noorani TY, Samsudin NA, Awang Nawi MA, Rossi-Fedele G, Karobari MI, et al.
    PMID: 34360261 DOI: 10.3390/ijerph18157970
    There is a paucity of information concerning vital pulp treatment outcomes in the undergraduate teaching setting. This study aimed to determine which type of deciduous molar, arch location, type of vital pulp therapy, and the number of carious surfaces involved had a better prognosis when carried out by undergraduate dental students. The method used was the review of clinical records of 590 patients with 600 deciduous molars, that visited the outpatient undergraduate dental clinics for vital pulp therapy. Statistical analysis used to determine the associations of tooth type, arch location, treatment type, and the number of carious surfaces involved in successful outcomes was logistic regression analysis with significance set at p < 0.05. According to the regression analysis model results, there was a significant association based on tooth type (p < 0.05) and arch location (p = 0.003). In addition, there was a significant association based on the type of treatment performed (p = 0.036). However, there was no significant association in success rates based on the number of carious surfaces involved (p = 0.873). In conclusion, second deciduous molars and maxillary deciduous molars had a better overall prognosis, and indirect pulp therapy was revealed to be more highly associated with successful treatment outcomes in comparison to ferric sulfate pulpotomy in our setting.
  2. Karobari MI, Maqbool M, Ahmad P, Abdul MSM, Marya A, Venugopal A, et al.
    Biomed Res Int, 2021;2021:6657167.
    PMID: 34746305 DOI: 10.1155/2021/6657167
    Background: Citation analysis has emerged to play a significant role in recognition of the most useful areas of research. Endodontic microbiology has been a topic of interest for endodontists as well as periodontists and oral surgeons. This bibliometric analysis is aimed at identifying and reporting the characteristics of the top 50 cited articles on endodontic microbiology.

    Methods: The articles were identified through a search on Web of Science (WoS), property of Clarivate Analytics database published on endodontic microbiology. The citation information of the selected articles was recorded. The Journal of Endodontics, International Endodontic Journal, Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology, Dental Traumatology, and Australian Endodontic Journal were searched in the search title. Descriptive and bivariate analyses were performed using a statistical software package SPSS. Statistical analysis was performed using Shapiro-Wilk, Kruskal-Wallis, Post hoc, Mann-Kendall trend, and Spearman-rank tests.

    Results: The 50 most cited articles were published from 1965 to 2012 with citation count varying from 1065 to 103 times. The total citation counts of articles recorded were 11,525 (WoS), 12,602 (Elseviers' Scopus), and 28,871 (Google Scholar). The most prolific years in terms of publications were 2001, 2002, and 2003, with five publications each, followed by 2005 with four. The year with most citations was 1998, with 1,330 citations, followed by 1965 and 2001, with 1,065 and 1,015 citations, respectively. A total of 136 authors contributed to the top 50 most cited articles with 27 corresponding institutions from 12 different countries. The most common methodological design was in vitro study, followed by clinic-laboratory study, literature review, systematic review and meta-analysis, and animal study.

    Conclusions: The present study provided a detailed list of the top 50 most cited and classic articles on microbiology in endodontics. This will help researchers, students, and clinicians in the field of endodontics as an impressive source of information.

  3. Maqbool M, Tirmazi SSM, Shakoor A, Akram Z, Nazir R, Chohan AN, et al.
    Biomed Res Int, 2023;2023:1044541.
    PMID: 36845639 DOI: 10.1155/2023/1044541
    BACKGROUND: Despite of having improved endodontic file designs as well as the reinforced metal alloy file structure, intracanal endodontic file separation (EFS) is still a very problematic and worrisome dental incident, which usually occurs without any visible signs of permanent deformation. Further, there have been conflicting reports regarding the clinical significance of leaving separated files within root canals.

    AIMS: The aim of this study was to look into the current perceptions and awareness about file separation during endodontic treatment among the dental house officers (DHOs).

    MATERIALS AND METHODS: A novel validated questionnaire comprising of 15 close-ended questions was distributed anonymously via Google Forms through email to 1100 DHOs across Pakistan. The questionnaire consisted of two parts: the first component (Section I) collected demographic data and the second component (Section II) investigated the causes of EFS during root canal treatment. Following the completion of socioeconomic information, including age and gender, the DHOs were asked to answer a few questions about the various reasons for endodontic instrument fracture.

    RESULTS: A total of 800 responses were recorded, with an effective rate of 72.8%. The majority of the DHOs (p value < 0.001) perceived that endodontic instrument fracture occurred in the posterior (61.5%) and apical third of the canal (50.5%) and in older permanent dentition (67.3%), possibly due to patient anxiety (62%). Better choice of instrument (61.15%), operators' experience (95.3%), knowledge (87.5%), and proper root canal cleaning (91.1%) are believed to be the vital steps in reducing endodontic file separation/fracture. Furthermore, majority of them (p value < 0.001) perceived that stainless steel was a superior alloy for filing instruments. Manual files tend to be more prone to fractures due to repeated use than rotary files.

    CONCLUSION: This study demonstrated that young DHOs had adequate knowledge and awareness regarding the potential predisposing factors and handling techniques for EFS. This study thereby provides an evaluating tool to access the insights of the current perceptions and awareness of DHOs concerning EFS.

  4. Karobari MI, Batul R, Khan M, Patil SR, Basheer SN, Rezallah NNF, et al.
    BMC Oral Health, 2024 Jan 02;24(1):1.
    PMID: 38167114 DOI: 10.1186/s12903-023-03624-5
    INTRODUCTION: Mandibular first premolars are familiar with their varied root canal morphology, causing difficulties and challenges for successful endodontic procedures. This systematic review and meta-analysis aim to study the characterization of root and canal morphology of the first mandibular premolar using micro-computed tomography.

    METHODOLOGY: The literature search was conducted using electronic web databases like PubMed, Scopus, ScienceDirect and Cochrane with the chosen MeSH key words and data was retrieved until May 2023. Further to perform the statistical analysis, R v 4.3.1 software with "meta", 'metafor" "metaviz" " ggplot2" package was used, and results were represented by odds ratios (OR) and the percentage of forest plots along a 95 per cent confidence interval (CI).

    RESULTS: The total number of studies meeting the inclusion criteria was 13; these studies were conducted on mandibular first premolar using Micro-CT; the total sample size was 1817. To scan the sample, an X-ray micro-focus CT system (Siemens Inveon CT, Erlangen, Germany) was used in four studies and seven different machines were used in the respective studies. Mimics 10.01 software (Materialize, Leuven, Belgium) and NRecon v.1.6.9 software (Bruker, Kontich, Belgium) were commonly operated. The minimum and maximum voxel size ranges between 11.94 and 50 μm. Vertucci's classification was frequently used (9), while one study applied Ahmed et al. and Vertucci's classification.

    CONCLUSION: This systematic review provides essential information about the root and canal configurations, radicular grooves, accessory canals, and apical foramina through Micro-CT, aiming to improve the accuracy of endodontic treatment and help practitioners.

  5. Lin GSS, Ghani NRNA, Noorani TY, Ismail NH, Mamat N
    Odontology, 2021 Jan;109(1):149-156.
    PMID: 32623538 DOI: 10.1007/s10266-020-00535-7
    To compare the dislodgement resistance and the adhesive pattern of four different endodontic sealers to root dentine walls. Ninety lower premolars were assigned to five groups (n = 18), Group 1: no sealer (control); Group 2: EndoRez (ERZ); Group 3: Sealapex (SPX); Group 4: EndoSeal MTA (ESA) and Group 5: BioRoot RCS (BRS). They were instrumented up to size 30 taper 0.06 and obturated using single cone technique with matched-taper gutta-percha cones and one of the mentioned sealers. Six teeth from each group were then randomly subjected to 100, 1000 and 10,000 thermocycles, respectively. 1 mm slice of mid root region, measuring 6 mm from the apical foramen was prepared and subjected to push-out test under a Universal Testing Machine. Adhesive patterns of sealers were assessed using a stereomicroscope at 20 × magnification and classified using a new system. Statistical analyses were performed using two-way ANOVA, complemented by Tukey HSD and Chi-square tests. ESA and BRS showed significantly higher (p  0.05) at 100, 1000 and 10,000 thermocycles, respectively. Both ESA and BRS exhibited a significant higher rate (p 
  6. Karobari MI, Parveen A, Mirza MB, Makandar SD, Nik Abdul Ghani NR, Noorani TY, et al.
    Int J Dent, 2021;2021:6682189.
    PMID: 33679981 DOI: 10.1155/2021/6682189
    Introduction: While there are many root morphology classification systems with their own distinct advantages, there are many shortcomings that come along with each system.

    Objectives: The aim of this review was to compare the various root and root canal morphology classifications, their advantages, limitations, and clinical and research implications. Data Sources and Selection. An extensive literature search was conducted on PubMed and Scopus to identify the published data on root and root canal classification systems published until 1 May 2020 using keywords, root canal classification system, classification systems for root canals, and root morphology. The related literature was reviewed and then summarized. Data Synthesis. Several studies have analysed and detailed root and root canal classifications and further added new subsystems, works of Weine et al. (1969) and Vertucci et al. (1974). Besides, Sert and Bayirli (2004) added supplementary types to Vertucci's classification system. A new classification was most recently introduced by Ahmed et al. (2017) involving the use of codes for tooth numbering, number of roots, and canal configuration.

    Conclusions: Weine et al. classified only single-rooted teeth, without considering multirooted teeth and complex configurations. Vertucci's classification included complex configurations, with Sert and Bayirli adding further complex supplemental types. Ahmed et al.'s classification simplifies classifying root and canal morphology while overcoming the limitations of several previous classification systems making it beneficial for implementation in dental schools.

  7. Lin GSS, Ghani NRNA, Ismail NH, Singbal K, Noorani TY, Mamat N
    Contemp Clin Dent, 2021 03 20;12(1):21-27.
    PMID: 33967533 DOI: 10.4103/ccd.ccd_298_20
    Background: An ideal composite resin should demonstrate smooth surface after polishing and high hardness value to provide long-term success. Thus, this study aimed to compare the surface roughness and microhardness of new experimental zirconia-reinforced rice husk nanohybrid composite (Zr-Hybrid) with commercialized nanofilled (Filtek-Z350-XT) and microhybrid composite (Zmack-Comp) resins before and after artificial ageing.

    Methods: One hundred and eighty standardized disc samples were prepared, of which ninety samples each were used for surface roughness and microhardness test, respectively. They were divided equally into: Group 1 (Filtek-Z350-XT), Group 2 (Zmack-Comp), and Group 3 (Zr-Hybrid). For surface roughness test, all samples were polished with aluminium oxide discs and further subdivided into aged and unaged subgroups, in which composite samples in aged subgroups were subjected to 2500 thermal cycles. Next, all the samples were subjected to surface roughness test using a contact stylus profilometer. As for microhardness test, all the aged and unaged samples were tested using a Vickers hardness machine with a load of 300 kgf for 10 s and viewed under a digital microscope to obtain microhardness value. Data were analyzed using two-way ANOVA followed by post hoc Tukey's honestly significant difference and paired sample t-test with significance level set at P = 0.05.

    Results: In both the aged and unaged groups, Zr-Hybrid showed statistically significantly lower surface roughness (P < 0.05) than Filtek-Z350-XT and Zmack-Comp, but no statistically significant difference was noted between Filtek-Z350-XT and Zmack-Comp (P > 0.05). A similar pattern was noted in microhardness test, whereby Zr-Hybrid showed the highest value (P < 0.05) followed by Filtek-Z350-XT and lastly Zmack-Comp. Besides, significant differences in surface roughness and microhardness were noted between the aged and unaged groups.

    Conclusion: Zr-Hybrid seems to demonstrate better surface roughness and microhardness value before and after artificial ageing.

  8. Karobari MI, Noorani TY, Halim MS, Dummer PMH, Ahmed HMA
    Int Endod J, 2019 Jun;52(6):917-919.
    PMID: 31074504 DOI: 10.1111/iej.13106
  9. Lin GSS, Cher CY, Cheah KK, Noorani TY, Ismail NH, Ghani NRNA
    J Esthet Restor Dent, 2021 Oct 30.
    PMID: 34716755 DOI: 10.1111/jerd.12831
    OBJECTIVES: This review aimed to summarize contemporary evidence related to dental composite resin derived from rice husk biowaste and its potential future advancement. This review paper included the techniques for synthesis, characterization, and preparation of rice husk composite resin. Focus was also given to the flexural strength and modulus, compressive strength, wear rate, hardness, surface roughness, color stability, polymerization shrinkage, degree of conversion, and their application onto root canal treated teeth.

    MATERIAL AND METHODS: A search of English peer-reviewed literature (January 1960-February 2021) was conducted from electronic databases (PubMed Central, Cochrane, LILACS, Science Direct, Web of Science, SIGLE, EMBASE, EBSCO, Medline, and Google Scholar).

    RESULTS: 11 articles and a book section were finally selected for qualitative analysis. Studies concluded that the physicomechanical properties and the color stability of rice husk dental composites showed comparable results to conventional dental composites. Incorporation of zirconia nanopowder into rice husk dental composite increased the compressive strength and hardness values, associated with lower shrinkage, a high degree of conversion, and improved fracture strength when applied on root canal treated teeth.

    CONCLUSIONS: Due to its low cost, eco-friendliness, and acceptable clinical performances, rice husk dental composite resin can be considered as an alternative to conventional composites.

    CLINICAL SIGNIFICANCE: Dental composite resin derived from rice husk silica demonstrated excellent performance, which could potentially substitute currently available composite resins. This review will give new insight to clinicians and researchers on the usage of natural biowaste mass in the field of dental restorative materials.

  10. Lin GSS, Sim DHH, Luddin N, Lai JCH, Ghani HA, Noorani TY
    J Dent Sci, 2023 Apr;18(2):604-612.
    PMID: 37021270 DOI: 10.1016/j.jds.2022.08.012
    BACKGROUND/PURPOSE: The usage of bioceramic-based root canal sealers has escalated over the years due to their excellent properties. The present study aimed to fabricate a novel algin incorporated bioactive glass 58S calcium-silicate (Bio-G) sealer and characterise its surface microstructure and chemical compositions in comparison to commercially available bioceramic sealers (BioRoot RCS and iRoot SP).

    MATERIALS AND METHODS: The powder form of experimental Bio-G sealer consisted of synthesised BG 58S particle, calcium silicate, zirconia dioxide, calcium carbonate and alginic acid powder as binder. The liquid composed of 5% calcium chloride solution. Five standardised disc specimens were prepared for each sealer group according to the manufacturer's instructions. Subsequently, sealer disc-specimens were placed in an incubator at 37 °C, 95% relative humidity for 72 h to allow setting prior to testing under scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS), Fourier transformed infrared spectroscopy (FTIR) and X-ray diffraction (XRD).

    RESULTS: Experimental Bio-G sealer revealed irregular micro-sized particles ranging from 0.5 μm to 105 μm aggregated in clusters comparable to those of BioRoot RCS and iRoot SP. EDS microanalysis showed that Bio-G had high content of oxygen, silicon, and calcium, with the presence of aluminium and chloride similar to BioRoot RCS. Meanwhile, the FTIR and XRD findings suggested that all sealers predominantly contained calcium silicate hydrate, calcium carbonate, and zirconium dioxide, while calcium aluminium silicate oxide was detected in Bio-G.

    CONCLUSION: The present novel Bio-G sealer demonstrated desirable particle size distribution and acceptable degree of purity. Future studies are warranted to explore its properties and clinical application.

  11. Maqbool M, Syed NH, Rossi-Fedele G, Shatriah I, Noorani TY
    Odontology, 2023 Jul;111(3):531-540.
    PMID: 36309897 DOI: 10.1007/s10266-022-00762-0
    MicroRNAs (miRNAs) are short, 19-23 nucleotide non-coding RNA molecules that regulate gene expression by silencing or degrading the target mRNA gene. Since their discovery in the nineties of the last century, they have emerged as key inflammatory regulators. Inflammation induces the synthesis of various miRNAs that modulate the expression of multiple molecules involved in orchestrating the inflammatory response. This review aims to provide an insight into the role of miRNAs as potential biomarkers, mediators, and potential therapeutic targets of dental pulp inflammation. A literature search was conducted using the keywords; biogenesis of microRNA, human dental pulp cells, pulpitis, and inflammation in PubMed and Scopus index databases for all the published articles dealing with the role of miRNAs in pulp inflammation in the last 10 years. According to the literature, there is a clear correlation between miRNAs and several physiological events, as well as their role as mediators of innate immune response and inflammation in dental pulp cells. Our narrative review stipulates that numerous miRNAs play a key role in modulating inflammation, delaying or enhancing cell repair, cell differentiation, and survival in dental pulp diseases. However, further studies are required for the validation of miRNAs as reliable biomarkers in dental pulp pathology and their targeted therapy.
  12. Karobari MI, Ahmed HMA, Khamis MFB, Ibrahim N, Noorani TY
    J Dent Educ, 2023 Aug;87(8):1089-1098.
    PMID: 37164913 DOI: 10.1002/jdd.13236
    PURPOSE: To assess the application and accuracy of two systems (Vertucci et al. 1974 and Ahmed et al. 2017) in classifying the root and canal morphology of human dentition among final-year undergraduates, interns, and postgraduate dental students in India.

    METHODS: The survey was conducted using physical and online presentation modes in two phases. Phase 1; PowerPoint presentation (PPT), describing the most used classification system (Vertucci et al. 1974) and its supplementary types and Ahmed et al. (2017) classification. A single presenter delivered the PPT to participants, using either a projector in an auditorium/seminar hall (face-to-face) or an online platform (zoom meeting software). Phase 2 involved determining the students' responses. A questionnaire was distributed amongst the participants after the lecture and collected for analysis. Fisher's exact test was used to analyze the data statistically, and the significance level was set at 0.05 (p 

  13. Karobari MI, Batul R, Snigdha NTS, Al-Rawas M, Noorani TY
    PLoS One, 2023;18(11):e0294076.
    PMID: 37956149 DOI: 10.1371/journal.pone.0294076
    INTRODUCTION: Root canal sealing materials play a crucial role in an endodontic procedure by forming a bond between the dentinal walls and the gutta-percha. The current study aims to analyse the dentinal tubule penetration and adhesive pattern, including the push-out bond strength of six commercially available root canal sealers.

    METHODOLOGY: Eighty-four mandibular first premolars were split into seven groups (and n = 12), Group 1: Dia-Root, Group 2: One-Fil, Group 3: BioRoot RCS, Group 4: AH Plus, Group 5: CeraSeal, Group 6: iRoot SP, Group 7: GP without sealer (control). Two groups were made, one for dentinal tubule penetration and the other for push-out bond strength; the total sample size was one hundred sixty-eight. Root canal treatment was performed using a method called the crown down technique, and for obturation, the single cone technique was used. A confocal laser scanning microscope (Leica, Microsystem Heidel GmbH, Version 2.00 build 0585, Germany) was used to evaluate dentinal tubule penetration, and Universal Testing Machine was utilised to measure the push-out bond strength (Shimadzu, Japan) using a plunger size of 0.4 mm and speed of 1mm/min. Finally, the adhesive pattern of the sealers was analysed by HIROX digital microscope (KH-7700). Statistical analysis was carried out by a one-way Anova test, Dunnet's T3 test, and Chi-square test.

    RESULTS: Highest dentinal tubule penetration was noticed with One-Fil (p<0.05), followed by iRoot SP, CeraSeal, AH Plus, Dia-Root also, the most negligible value was recorded for BioRoot RCS. Meanwhile, BioRoot RCS (p<0.05) demonstrated the greater value of mean push-out bond strength, followed by One-fil, iRoot SP, CeraSeal, AH Plus and Dia-Root. Regarding adhesive pattern, most of the samples were classified as type 3 and type 4 which implies greater sealing ability and better adherence to the dentinal wall. However, BioRoot RCS revealed the most type 4 (p<0.05), followed by AH Plus, One-Fil, CeraSeal and Dia-Root.

    CONCLUSION: The highest dentinal tubule penetration was shown by One-Fil compared to other groups. Meanwhile, BioRoot RCS had greater push-out bond strength and more adhesive pattern than other tested materials.

  14. Karobari MI, Alam BF, Bashir R, Fahim MF, Mirza MB, Noorani TY
    Clin Exp Dent Res, 2023 Dec;9(6):1156-1168.
    PMID: 37877522 DOI: 10.1002/cre2.801
    OBJECTIVES: This bibliometric analysis aimed to evaluate the leading nations, authors, journals, institutes, highly cited publications, and most commonly used keywords concerning scientific publications based on root and root canal morphology using the CBCT.

    MATERIAL AND METHODS: For this bibliometric analysis, an extensive search was carried out on September 25, 2023 using the Scopus database. Pertinent articles in the field were scrutinized after applying inclusion and exclusion criteria. Data were evaluated using Vosviewer and Microsoft Excel.

    RESULTS: A literature search revealed the initiation of scientific publication in 2008. Significant contributions made by Saudi Arabia, India, and China concerning the number of publications were seen. Similarly, Jazan University from SA was recognized as the leading institute. The Journal of Endodontics was the leading journal, while authors JNR Martins and G Gambarini produced the highest number of papers.

    CONCLUSIONS: This bibliometric analysis demonstrated that scientific publications have increased tremendously since 2008. Significant contributions have been made by developing and developed nations. The Journal of Endodontics and Jazan University have been identified as the leading journal and institute.

  15. Ahmad P, Dummer PMH, Noorani TY, Asif JA
    Int Endod J, 2019 Jun;52(6):803-818.
    PMID: 30667524 DOI: 10.1111/iej.13083
    AIM: To analyse the main characteristics of the top 50 most-cited articles published in the International Endodontic Journal from 1967 to 2018.

    METHODOLOGY: The Clarivate Analytics' Web of Science 'All Databases', Elsevier's Scopus, Google Scholar and PubMed Central were searched to retrieve the 50 most-cited articles in the IEJ published from April 1967 to December 2018. The articles were analysed and information including number of citations, year of publication, contributing authors, institutions and countries, study design, study topic, impact factor and keywords was extracted.

    RESULTS: The number of citations of the 50 selected papers varied from 575 to 130 (Web of Science), 656 to164 (Elsevier's Scopus), 1354 to 199 (Google Scholar) and 123 to 3 (PubMed). The majority of papers were published in the year 2001 (n = 7). Amongst 102 authors, the greatest contribution was made by four contributors that included Gulabivala K (n = 4), Ng YL (n = 4), Pitt Ford TR (n = 4) and Wesselink PR (n = 4). The majority of papers originated from the United Kingdom (n = 8) with most contributions from King's College London Dental Institute (UK) and Eastman Dental Hospital, London. Reviews were the most common study design (n = 19) followed by Clinical Research (n = 16) and Basic Research (n = 15). The majority of topics covered by the most-cited articles were Outcome Studies (n = 9), Intracanal medicaments (n = 8), Endodontic microbiology (n = 7) and Canal instrumentation (n = 7). Amongst 76 unique keywords, Endodontics (n = 7), Mineral Trioxide Aggregate (MTA) (n = 7) and Root Canal Treatment (n = 7) were the most frequently used.

    CONCLUSION: This is the first study to identify and analyse the top 50 most-cited articles in a specific professional journal within Dentistry. The analysis has revealed information regarding the development of the IEJ over time as well as scientific progress in the field of Endodontology.

  16. Karobari MI, Khijmatgar S, Noorani TY, Assiry A, Alharbi T
    J Conserv Dent, 2021 02 10;23(5):518-521.
    PMID: 33911363 DOI: 10.4103/JCD.JCD_220_19
    Objective: The aim of this study is to determine the role of clinical audit in improving endodontic treatment outcomes.

    Materials and Methods: An audit at the department of endodontics at dental specialty centre kingdom of Saudi Arabia was carried out. The audit was conducted by developing endodontics treatment and success predictors based on evidence, that can be measured for endodontic care. A total of 12 months' data was examined from the previous dental records. Ten clinical cards were which included root canal treatment were selected. The audit was carried out for a minimum of 50 teeth and a maximum of 200 teeth. The radiographs of record cards were studied and a single dentist completed the audit tool.

    Results: The vitality test was performed in 1.98% cases, intra-canal medicament was used and named in 3.96% cases, 3.96% the teeth were extracted due to endodontic failure. Further, in 6.93% of the cases that were identified had certain spaces but overall root canal filling was evaluated as satisfactory.

    Conclusion: The vitality test, type of intracanal medicament, and assessment of root canal filling were not done, but there was an overall performance of predictors for endodontic treatment.

  17. Karobari MI, Noorani TY, Halim MS, Ahmed HMA
    Aust Endod J, 2021 Aug;47(2):202-216.
    PMID: 33159714 DOI: 10.1111/aej.12454
    This cone beam computed tomography (CBCT) study aimed to evaluate the root canal morphology of permanent anteriors in Malaysian population using two classification systems (Vertucci 1984 and Ahmed et al 2017). CBCT images of 856 patients with 10,080 anterior teeth were analysed. Results showed that, except for six mandibular canines, all anterior teeth were single-rooted. According to Ahmed et al's system and Vertucci's classification, code 1 MaxA1 and type I were the most common types except in mandibular laterals where 1 ManA1-2-1 and type III were the most common, respectively. The prevalence of canal variations in mandibular incisors was higher in males and the 20-30 age group than in females and other age groups (P 
  18. Lin GSS, Ghani NRNA, Noorani TY
    Odontology, 2021 Jul;109(3):672-678.
    PMID: 33458795 DOI: 10.1007/s10266-021-00589-1
    To compare the microhardness and crack formation in root dentine presented with butterfly effect in lower premolars. Sixty mature lower premolars were selected and divided into the control and experimental groups. Teeth in the experimental group were instrumented up to size 30/.04. The roots were cut horizontally into twelve parts of 1-mm-thick cross-section and were numbered accordingly. They were divided into coronal, middle, and apical root sections. Sections were then viewed under a microscope to determine the presence of butterfly effect and subsequently scored. 8 teeth from both control and experimental groups with the highest and lowest score were selected. Crack formation was inspected and classified into four different types of cracks. Microhardness test was performed using a Vickers hardness test. Higher frequency of butterfly effect was found in the apical root section and root dentine with butterfly effect were harder mesiodistally. The middle and apical root sections with butterfly effect were harder than the coronal section. No significant difference of dentine hardness between the control and experimental groups. Cracks only occurred in the experimental group and presented in buccolingual direction with a higher rate of Type 1 and Type 2 cracks. Prevalence of butterfly effect in lower premolars increased from coronal to apical with increased hardness mesiodistally. More buccolingual cracks were found in radicular dentine with butterfly effect and most of them exhibited Type 1 and Type 2 cracks. Roots of lower premolar with butterfly effect may be susceptible to a higher rate of vertical root fracture in buccolingual direction, especially after root canal treatment. Thus, special attention should be given not to overload instruments during root canal preparation.
  19. Noorani TY, Luddin N, Rahman IA, Masudi SM
    J Clin Diagn Res, 2017 Apr;11(4):ZC105-ZC109.
    PMID: 28571275 DOI: 10.7860/JCDR/2017/24753.9739
    INTRODUCTION: Glass Ionomer Cements (GIC) are among the most popular restorative materials, but their use in dentistry is limited due to their physical properties. The hardness of GIC was improved by incorporation of nano-hydroxyapatite-silica into GIC, to expand its applicability.

    AIM: To evaluate the cytotoxic effects of nano-hydroxyapatite-silica incorporated glass ionomer cement (HA-SiO2-GIC) on human Dental Pulp Stem Cells (DPSC) and compare it with conventional GIC and resin modified GIC.

    MATERIALS AND METHODS: Material extracts of Fuji IX, Fuji II LC and HA-SiO2-GIC were prepared into seven serial concentrations and applied to 96-well-plates seeded with DPSC. The 96-well-plates were incubated for 24 and 72 hours. The morphology of DPSC was observed under the inverted phase contrast microscope, and the cell viability was determined using MTT assay at both time intervals. Kruskal-Wallis test was performed for statistical analysis.

    RESULTS: At maximum concentration, DPSC appeared fewer in number, but the normal spindle morphology was maintained in all groups except for Fuji II LC. At lower concentrations, DPSC appeared normal and more confluent in all groups. The cytotoxic effects of all groups were dose dependent. Fuji IX demonstrated the lowest cytotoxicity, followed by HA-SiO2-GIC. Fuji II LC demonstrated the highest cytotoxicity. The difference was significant between all groups at 200 mg/ml concentration (p<0.05). At concentration <100 mg/ml, cytotoxicity of HA-SiO2-GIC was comparable to that of Fuji IX and lower than that of Fuji II LC.

    CONCLUSION: HA-SiO2-GIC showed a favourable cytotoxicity response and thus holds promise as a future potential restorative material in clinical dentistry.

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