The objective of this study was to determine whether dental calcification can be used as a first-level diagnostic tool for assessment of skeletal maturity.
This cross sectional study investigated the clinical and radiographic status of crowned teeth with and without root canal treatment. The study used secondary data from records of patients who received crown treatment at the Faculty of Dentistry, University of Malaya before 2015 and walk-in patients attending the primary care clinic between July - December 2016. The inclusion criterion was crown fitted for more than 12 months. Once identified, the patients were assessed for clinical and radiographic status. Data were entered into and analysed using SPSS Version 20 software. A total of 66 crowns [35 root canal treated (RCT) and 31 non-root canal treated (n-RCT)] were identified. Chi-square test was carried out to determine the health of crowned teeth and for its longevity in the oral cavity. There were 43 crowns (46.5% RCT; 53.5% n-RCT) with plaque accumulation, 15 (66.7% RCT; 33.3% n-RCT) with gingival swelling/recession, 17 (46.5% RCT; 53.5% n-RCT) with widening of the periodontal ligament, 13 (53.8% RCT; 46.2% n-RCT) with bone loss and 5 (60% RCT; 40% n-RCT) crowns with periapical lesion. There was no statistically significant difference except for poorer alveolar bone condition for crowns that have been in the mouth for >10 years. Based on the study, no significant adverse pulpal involvement between crown with RCT and crown without RCT was observed.
The root canal walls of twenty -five deciduous molar teeth with exposed and necrotic pulps were examined using thescanning electronmicroscope. Immediately after extraction, all teeth were fixed in Kamosky's solution. The coronal portion of the tooth was sectioned at about 2mm above the enamel cemental junction.The mesial and distal roots were separat~d and either split in the mesio-distal or bucco-lingual direction. All specimens were prepared for SEM. Obsevations showed that all roots were infected with organisms consisting of cocciand short rods. Some of the coccihad penetrated the dentine layer. However, the distribution of organisms is. not uniform throughout thecanals. Bacterialinvasion ismostinthecoronal region and reduces towards the apical region: Accompanying bacterial invasion is root canal walls deterioration. The odontoblastic processes are the first to deteriorate followed by the predentine layer.
During post crown restoration, the preparation of the post canal can be fraught with difficulties resulting in widening, gouging and transportation of the post canal; sometimes with near root perforation. A technique is described to repair such iatrogenically damaged internal root canal walls using reinforcing resin composite and optic glass fibre posts. The root dentine, resin composite and glass fibres, having similar moduli of elasticity, will result in a repaired root with a ‘monolithic’ structure and possessing numerous desirable characteristics. This repair technique can easily be carried out in one sitting at the chairside thereby allowing the continued serviceability of the iatrogenically compromised root-filled tooth.
Aim: To manufacture a clinical simulation apparatus for the undergraduates' endodontic radiography teaching Objectives: • To provide a model for teaching of parallax method using Kelly's forcep • To provide a model for undergraduates to practice radiographic localization employing parallax method. • To allow students to practice taking radiographs in a way that simulates the clinical situations with a good diagnostic quality Methods: Impressions of a dentate arch (maxillary and mandibullary) were used to form a stone cast. A section of the cast, in the area where the natural teeth were to be placed, is sectioned and removed. Three maxillary extracted teeth (canine, first and second premolar) were selected and mounted with acrylic resin at the sectioned area. The resin was cured in a light box. The arches were mounted in a phantom head with a placement of rubber cheek. The first premolar was isolated with rubber dam. The intraoral holder (Kelly's forcep) was attached to a robotic arm. The students were taught the correct angulations of the x-ray cone for the paralleling technique and parallax method using Kelly's forcep during root canal treatment. Results: All students managed to complete the exercise and were considered competent when they produced acceptable quality of radiographs. Conclusion: The model described was improvised from a model that has been used during the past 2 years for undergraduates' endodontic courses. It has been well accepted as it simulates the clinical situation more closely than was possible previously.
This study aimed to detect the presence of enterococci in the root canals of untreated and treated teeth with periapical disease and to compare this to their presence in the saliva and in the immediate surgical environment during root canal treatment. Using an aseptic technique, 33 samples were obtained from 27 untreated and 6 previously treated teeth associated with apical periodontitis. Reduced Transport Fluid (RTF) was used as transport medium. Saliva samples and areas in the surgical environment were also sampled. These were performed prior to chemo-mechanical debrjdement and obturation for every case. The saliva was diluted to 10- J and was plated on Bile Aesculin Azide (BEA) agar whereas the rest of the samples were plated on Bile Aesculin (BE) agar. These plates were then incubated aerobically at 37°C for 48 hours. All the colony types that blackened the agar were sub-cultured to obtain pure isolates and tested on 6.5% sodium chloride (NaCI). Growth on this medium was Gram stained for further confirmation of cell morphology. Gram positive cocci isolated from previous positive test were identified as enterococci. Enterococci were recovered from untreated cases only; from 2 teeth (in 2 patients) prior to chemo-mechanical debridement, from 3 teeth (in 3 patients) prior to obturation and I from saliva sample. A 'total of 5 samples from 5 different patients were positive for enteroco•cci. Sampling in the immediate surgical environment revealed a low occurence in the range of3.0% (1/33) to 15_2% (5/33). In conclusion, the occurence of enterococci in patients and the immediate surgical environment was low number.
The objectives of this study were to assess the practice of molar root canal treatment (RCT) among general dental practitioners (GDPs), confidence level of GDPs in performing molar RCT and to identify factors that influence their confidence in managing molar RCI. One hundred questionnaires were distributed to GDPs in Kuala Lumpur and Selangor. Fifty questionnaires were delivered by mail and the remaining fifty were hand-delivered. All data was coded and verified. Fiftysix OOPs rcsponded to the questionnaires. Only fortyfive questionnaires were accepted (n=45) as eleven OOPs had never performed molar RCI. Most of the OOPs followed the standard quality guidelines while performing molar RCT except for vitality testing (36.4%) and rubber dam usage (27.3%). In this study, 100% of the GDPs were confident in making diagnosis of perinidicular diseases and 95.4% were confident in performing molar RCT from history taking until obturation. Patients' tolerance and availability of instruments and materials (97.7%) were two factors that most influence the GDPs' confidence level. The. least influcncing factor was undergraduate training (78.1 %). Attending seminars and lectures on endodontic, large number of molar teeth treated for ReT, patLents' affordability to pay for RCT and postgraduate training also influencc GDPs' confidence to a certain degree. From this study, it can be concluded that majority of OOPs complied standard quality guidelines except for vitality testing and rubber dam usage. Most of them were confident in performing molar RCT and were greatly influenced by the availability or"instruments and materials in their clinic and patients' tolerance in receiving molar RCI.
Background: Majority of root canal treatment in Malaysia was provided by general dental practitioner. The purpose of this study was to evaluate the knowledge and practice (canal’s preparation, use of materials) by them. Methods: A questionnaire was structured and distributed to 120 registered general dental practitioners in selected areas in Perak, Johor and Klang Valley regarding the provision of root canal therapy in their practices. The questionnaires were hand delivered and collected after 1 to 2 weeks. Results: Reply rate was 95% (n=114). The result demonstrated that 62% respondents indicated that they performed the root canal therapy (RCT) themselves. Out of these only 26% included molars in the treatment. Three quarters of them (77%) used step-back technique and 54% used stainless steel instruments to prepare the canals. The majority of the respondents (69%) used calcium hydroxide as intracanal medicaments. Only 30% used rubber dam for isolation whereas the rest used cotton rolls. The numbers of routine radiographs taken were two for anterior teeth and three for molar. Half of the respondents indicated that they usually completed the RCT for the anterior tooth within two visits whereas three visits were needed for the molar tooth. The results were analyzed descriptively. Conclusions: This study indicates that most of the general dental practitioners’ do not comply with quality standards guidelines such as use of rubber dam as isolation. Cotton roll was the most popular isolation method. In spite of this, most of the respondents tend to update their knowledge and practices with current techniques and materials.
Simulated canals in clear resin blocks have been widely used in pre-clinical endodontic teaching. The artificial canal provides direct visualisation of procedures in root canal treatment. Stanuardised simulated root canals have been produced in the Faculty of Dentistry, University of Malaya for dental education and research. The canals are easy and inexpensive to construct. An outline of the method of construction of resin simulated canals is presented in this paper.
The objective of this study was to investigate the effect of various luting cement systems on bond strength of fibre-reinforced posts to root canal dentine. 40 extracted single rooted sound premolar teeth were root filled, decoronated and randomly divided into four groups. Fibre posts, Aestheti- Plus™ (Bisco,Inc. Schaumburg, IL, USA) were cemented using four luting cements: Group A (control): Elite 100® Zinc phosphate (GC Corp, Japan), Group B: Calibra ™ Esthetic Resin Cement (Dentsply Caulk, USA), Group C: RelyX ARC Adhesive Resin (3M ESPE), Group D: RelyX Unicem Aplicap (3M ESPE). Each root was sliced into 2 discs representing the coronal and middle portions of the root canal giving rise to 20 specimens per group. Bond strength was determined using push-out tests and data was analyzed using SPSS version 14.0. The mean bond strength of Group A to Aestheti-Plus™ post was 7.71 MPa (±2.51) and Group B was 5.69 MPa (±3.23). Group C exhibited the lowest mean bond strength, 4.29 MPa (±3.53) while the highest bond strength was obtained from Group D, 7.98 MPa (±2.61). One way ANOVA showed significant interaction between all groups (p=.OOI). Post-hoc Bonferroni test reve;iled that bond strength of Group C was significantly lower compared to Group A (p=.008) and D (p=.004). In conclusion, the mean bond strength of Aestheti- Plus™ post to root canal dentine was highest when cemented with RelyX Unicem resin cement followed by Elite 100® zinc phosphate cement, Calibra and RelyX ARC resin cements. However, the bond strengths of Cali bra and RelyX Unicem resin cements were not significantly different from Elite 100® zinc phosphate cement.
The skin of a fast swimming shark reveals riblet structures that help reduce the shark's skin friction drag, enhancing its efficiency and speed while moving in the water. Inspired by the structure of the shark skin denticles, our team has carried out a study as an effort in improving the hydrodynamic design of marine vessels through hull design modification which was inspired by this riblet structure of shark skin denticle. Our study covers on macroscaled design modification. This is an attempt to propose an alternative for a better economical and practical modification to obtain a more optimum cruising characteristics for marine vessels. The models used for this study are constructed using computer-aided design (CAD) software, and computational fluid dynamic (CFD) simulations are then carried out to predict the effectiveness of the hydrodynamic effects of the biomimetic shark skins on those models. Interestingly, the numerical calculated results obtained show that the presence of biomimetic shark skin implemented on the vessels give about 3.75% reduction of drag coefficient as well as reducing up to 3.89% in drag force experienced by the vessels. Theoretically, as force drag can be reduced, it can lead to a more efficient vessel with a better cruising speed. This will give better impact to shipping or marine industries around the world. However, it can be suggested that an experimental procedure is best to be conducted to verify the numerical result that has been obtained for further improvement on this research.
The purpose of this study was to evaluate hardness (indicator for polymerization) and thickness of two types of resin cement at coronal, middle and apical level of tooth root canal. Ten extracted maxillary incisors were instrumented and post space was prepared for cementation of titanium post. Samples were divided into two groups and each group was cemented either of the two types of resin cements; Panavia F [dual-cured (PF)] and Rely X Luting 2 [self-cured (RL)]. The teeth were longitudinally sectioned; hardness and thickness was measured using Vickers hardness tester and a microscope (Leica DMLM). SEM observations along the cement line at the 3 different root levels were performed. Statistical analysis was performed to test significance of differences in hardness and thickness of the two types of cement (t-test; p= 0.05) and at different levels of the same type (one-way ANOVA followed by multiple comparison; p= 0.05). Significant difference of hardness was found at the apical level between the two groups and between the coronal and apical level of PF (p0.05). Moreover, voids were more obvious within the dual-cured group of cement. Dual-cured resin cement was found to be less polymerized than self-cured type at apical level. Increased thicknesses of resin cements in comparison to post space size were observed in both groups. Use of metallic post with resin cements needs further evaluation.
Sufficient knowledge on the root and root canal anatomy is essential for practicing root canal treatment. The mesiobuccal roots of maxillary molar teeth present an endodontic challenge due to their wide variability and complexity of their internal morphological landmarks. A review on the literature indicates that the prevalence of a third mesiobuccal root canal in the mesiobuccal root of maxillary molar teeth may reach 9%, and the root canal configuration usually is type XV (3-2). These reported data reveal the importance of absolute awareness for this anatomical aberration that requires special attention from dental practitioners while commencing root canal treatment in maxillary molar teeth. Hence, this article aims to report and describe the management of a maxillary first molar tooth with three mesiobuccal root canals, but with an unusual configuration.
Root canal treatment (RCT) requires high level of technical skills of the dentist. Its outcome is an important part of evidence-based practice and become the basis of treatment planning and prognostic considerations. Adequate removal of micro-organisms and prevention of recolonization of residual micro-organisms through the placement of root filling with satisfactory coronal seal ensures success. This retrospective record review study aimed to investigate the practices of RCT in Hospital Universiti Sains Malaysia (HUSM) Dental Clinic, Kota Bharu, Kelantan. It involved 333 randomly selected patient records at the HUSM Record Unit. Data was obtained by careful analyses of daily treatment progress sheets and analyzed using SPSS version 12.0. A total of 2996 RCT cases were seen and 59.8% of patients were females. The age range of patients varied from 14 to 64 years. The maxillary anterior teeth were most commonly treated (52.6%). Most operators (99.1%) used step-back technique and 97.6% used files to prepare root canals. The most commonly used material for obturation and sealing was gutta-percha and epoxy resin-based sealer (AH26). About 82.9% used calcium hydroxide as intra-canal medication. About 25.5% of cases had no periapical pathology, 65.8% with pre-existing periapical radiolucencies healed in 1-3 months whereas 2.1% of cases with periapical pathology eventually healed after a year. About 6.9% cases failed after retreatment. The number of radiographs taken was two to four pieces. RCT is a useful intervention to maintain longevity of teeth. Decision making and current updates of methods and materials are essential among practitioners as well as administrators to ensure success.
Dental caries is an important community dental health problem with limited studies in the mixed dentition stage. The aim of this study was to determine the caries prevalence and treatment needs among 7- 9 year old school children in Kelantan which is situated in North East Malaysia. A retrospective dental record review of fully documented dental records belonging to primary school children attending a paediatric dental clinic was conducted. Dental caries was recorded using dmft index and DMFT index for deciduous teeth and permanent teeth respectively. Three hundred and nineteen dental records of 175 (54.9%) boys’ and 144 (45.1%) girls’ were selected and subjected to a ‘dental record study’. The prevalence of dental caries was 93% (95% CI : 89,97) in primary dentition and 50.5% (95% CI : 42.2, 58.8) in permanent teeth. Mean dmft and DMFT was 6.2(SD 3.39) and 1.04(SD 1.34) respectively. Regarding treatment needs in the primary dentition, 35.4% of teeth needed one surface filling, 34.7% needed extraction, 24.5% needed two or more surfaces filling and 5.6% needed pulp care. In the permanent dentition, 54.7% required sealants and 21.9% required one surface restoration. The caries prevalence and treatment needs were high among this study population in the mixed dentition stage, particularly showing the early involvement of newly erupted permanent teeth. It appears that high caries prevalence in the primary dentition is a risk factor for caries in newly erupted permanent teeth. Oral health promotions programmes are required in the mixed dentition stage and may reduce the risk of caries in permanent dentition.
Mitochondrial DNA (mtDNA) is a hereditary material located in mitochondria and is normally maternally inherited. Mutational analysis performed on mtDNA proved that the mutations are closely related with a number of genetic illnesses, besides being exploitable for forensic identification. Those findings imply the importance of mtDNA in the scientific field. MtDNA can be found in abundance in tooth dentin where it is kept protected by the enamel, the hardest outer part of the tooth. In this study, two techniques of mtDNA extraction were compared to determine the efficacy between the two techniques. Teeth used for the study was collected from Dental Clinic, Hospital Universiti Sains Malaysia. After the removal of tooth from the tooth socket of the patient, the tooth was kept at -20C until use. Later, pulp tissue and enamel was excised using dental bur and only the root dentin was utilized for the isolation of mtDNA by crushing it mechanically into powdered form. MtDNA was extracted using the two published methods, Pfeifer and Budowle and then subjected to spectrophotometry DNA quantification and purity, Polymerase chain reaction (PCR) amplification of hypervariable-two region of mtDNA, followed by DNA sequencing to analyze the reliability of the extraction techniques. In conclusion, both techniques proved to be efficient and capable for the extraction of mtDNA from tooth dentin.
The main objective of a root end filling material is to provide an apical seal that prevents the movement of bacteria and the diffusion of bacterial products from the root canal system into periapical tissues. The aim of this study was to compare the microleakage of three root end filling materials Mineral trioxide aggregate (MTA), Glass ionomer cement (GIC) and Silver GIC (Miracle Mix) using dye penetration technique under stereomicroscope. Forty-five extracted human maxillary central incisors were instrumented and obturated with gutta percha using lateral compaction technique. Following this, the teeth were stored in saline. After one week, teeth were apically resected at an angle of 90ï° to the long axis of the root and root end cavities were prepared. The teeth were divided into three groups of fifteen specimens each and were filled with Group I -MTA, Group II - GIC and Group III - Miracle Mix. The samples were coated with varnish and after drying, they were immersed in 1% methylene blue dye for 72 hours. The teeth were then rinsed, sectioned longitudinally and observed under stereomicroscope. The depth of dye penetration was measured in millimeters. Microleakage was found to be significantly less in MTA (0.83 mm) when compared to GIC (1.32 mm) (p < 0.001) and with Miracle Mix (1.39 mm) (p < 0.001) No significant difference was found when microleakage in Miracle Mix was compared to that of GIC (p = 0.752). Thus we concluded that MTA is a better material as root end filling material to prevent microleakage, in comparison to GIC and Miracle Mix.
The aim of this study was to isolate stem cells from dental pulp of primary molars and incisors to be used as possible source for tissue engineering. Human primary molars and incisors were collected from subjects aged 4-7 year-old under standardized procedures. Within 24 hours, the tooth was cut at the cemento-enamel junction using hard tissue material cutter. The dental pulp tissue was extracted, digested and then cultured in Alpha Modified Eagles's Medium (α-MEM) supplemented with 20% FCS, 100 mM L-ascorbic acid 2-phosphate, 200 mM L-glutamine and 5000 units/ml Penicillin/Streptomycin. The cells were observed daily under the microscope until confluence. Children's tooth pulp- derived progenitor cells were found positive for stem cell markers CD105 and CD166, which are consistent with the finding for mesenchymal stem cells (MSCs) from bone marrow.
Perivitelline fluid (PVF) of the horseshoe crab embryo has been reported to possess an important role
during embryogenesis by promoting cell proliferation. This study aims to evaluate the effect of PVF on the
expression of cell cycle regulatory genes from human dental pulp stem cells (DPSCs) between different cell
passages viz. 4, 5, 6. The cells were treated with a single dose of PVF (26.89 mg/ml) PVF. Gene expression was
quantified for CDKNA2A, PTEN, MDM2 and TP53 genes using reverse transcriptase PCR. CDKN2A and MDM2
expression for treated and untreated DPSCs, expressed a similar pattern of expression. The higher expression of
CDKN2A showed that the treatment increased cell proliferation and prevented cell senescence. DPSCs with PVF
treatment showed increased expression of MDM2 at passage 4 and drastically declined expression at passage 5
and slightly increased at passage 6. TP53 expression of DPSCs treated group showed a higher expression
compared to untreated group. On the other hand, the expression of PTEN in DPSCs treated group started to
increase from passage 5 to 6. However, on the whole, the PTEN expression was higher than the untreated group
in all the passages studied here. The results showed that PVF could enhance cell cycle regulatory gene
expression in DPSCs as indicated by the higher expression of all the genes considered in this study at different
cell passages in the treated group compared to the untreated group. Mann Whitney test was utilized to determine
the significance of cell cycle regulatory genes expression between treated and untreated group. Significant
difference in expression of genes between the treated and untreated groups were found at all passages except
for CDKN2A gene whereby, its expression was not significantly different at passage 5 though it did express
slightly higher in PVF treated DPSCs.