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Fulltext General dental practitioners' confidence in performing molar root canal treatment

Abdullah, M., Che Ab Aziz, Z.A., Roslan Saub, Murat, N., Sulaiman, E., Hashim, N., et al.

Ann Dent, 2009;16(1):9-14.
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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.

Matched MeSH terms: Root Canal Therapy
Some observations on the breakage of ultrasonic files driven piezoelectrically

Ahmad M, Roy RA

Endod Dent Traumatol, 1994 Apr;10(2):71-6.
PMID: 8062810

The incidence of breakage of Piezon-Master ultrasonic K files were evaluated. Three groups of unused files were subjected to three treatments, namely; free vibration in air without irrigation, free vibration in root canal while minimizing contact with the wall of canal in the presence of irrigation and light filing in root canal with free flow of irrigation. Cavitation produced by files in contact and free of contact with a glass surface was examined in order to observe the relationship between cavitation defects and breakage. In addition, the fractured and unfractured files were examined under a scanning electron microscope for the presence of cavitation pits. The results indicated that more files broke in air. In water, a higher incidence of breakage occurred when files were allowed to freely vibrate while no breakage occurred when the files were used in filing. All files generated cavitation which resulted in pitting of their surfaces. However, it was considered unlikely that the pits contributed to fracture. Fatigue cracks which could be the result of the manufacturing process were observed at some of the corners of the cross sections of the fractured files and could be the main contributory factor to fracture.

Matched MeSH terms: Root Canal Therapy/instrumentation*
Variations in power output of the Piezon-Master 400 ultrasonic endodontic unit

Ahmad M, Roy RA, Kamarudin AG

Int Endod J, 1994 Jan;27(1):26-31.
PMID: 7806408

The present study was undertaken to see if there was any variability in the power output of Piezon-Master 400 ultrasonic files when driven using different generators, tranducers and file holders. The displacement amplitude of the oscillating tip of the file in air was used as a measure of the power output. The results showed that there was considerable variability in the power output of Piezon-Master 400 ultrasonic files of similar size and length when driven using different generators, transducers and file holders. In consideration of this, it is recommended that a calibration device be incorporated in the ultrasonic unit so that the operator will have some knowledge of when the unit is working at its maximum efficiency.

Matched MeSH terms: Root Canal Therapy/instrumentation*
The vibratory pattern of ultrasonic files driven piezoelectrically

Ahmad M, Roy RA, Kamarudin AG, Safar M

Int Endod J, 1993 Mar;26(2):120-4.
PMID: 8330934

The pattern of oscillation of a Piezon-Master 400 ultrasonic file driven by a piezoelectric transducer was studied in air and on water. In addition, the displacement amplitudes of the files were measured. The findings were compared with those observed with the Cavi-Endo unit reported in another study (Ahmad 1969). It was observed that the file vibrated such that a standing wave was formed on the file and it exhibited points of maximum deflection (antinode) and points of minimum deflection (node) with the largest deflection occurring at the apical end. This pattern of oscillation was similar to that exhibited by the Cavi-Endo file which employed a magnetostrictive transducer. However, the displacement amplitudes were very much higher than those exhibited by the Cavi-Endo. It is considered that the 120 degrees angle of the file holder inherent in the Piezon-Master 400 unit and the more effective power transmission with the piezoelectric transducer may have contributed to the large amplitudes.

Matched MeSH terms: Root Canal Therapy/instrumentation*
Observations of acoustic streaming fields around an oscillating ultrasonic file

Ahmad M, Roy RA, Kamarudin AG

Endod Dent Traumatol, 1992 Oct;8(5):189-94.
PMID: 1302678

The steady acoustic streaming generated around straight and precurved oscillating ultrasonic files driven by the Piezon-Master 400 unit was examined in the free field and in small channels using a stereomicroscope. In addition, the effect of file-wall contact on streaming production was also investigated. The results indicated that the ultrasonic files can generate acoustic streaming both in the free field and in the small channel. Higher velocity streaming was observed when smaller size files were employed and when the file was precurved. Light file-wall contact did not totally inhibit streaming while severe file-wall contact inhibited movement of the file and, as a result, no streaming was observed. The positions and length scales of the streaming vortices appeared to be influenced by the presence of boundaries. In the free field, two rows of vortices were situated along the sides of the file while in the small channel, the vortices were positioned above the surface of the file. These results indicated that it is possible for acoustic streaming to occur in a confined space as in a root canal provided that severe file-wall contact is avoided. It is therefore recommended that light filing or allowing the file to freely vibrate during some stage of treatment should be carried out in order to generate streaming in the root canal.

Matched MeSH terms: Root Canal Therapy/instrumentation*; Root Canal Therapy/methods
Comparison between two ultrasonic units in shaping curved canals in teeth using macroradiography

Ahmad M

Endod Dent Traumatol, 1991 Apr;7(2):55-8.
PMID: 1782894

The efficacy of two ultrasonic units in shaping curved canals in teeth were compared. Twenty teeth were instrumented using the Cavi-Endo unit at a power setting 1 using the technique recommended by the manufacturer. Another group of 20 teeth received similar treatment but were instrumented with the Enac unit. The time taken to instrument each canal was recorded. The pre- and post-instrumented radiographs of the teeth of x 10 magnification were taken using a microfocal technique. The radiographs were subjected to a subtraction technique to result in composite images of the pre- and post-instrumented shapes. The canal shape and the incidence of elbows were evaluated using various measurements taken from the radiographs. The manner the dentine was removed was similar in both groups. All canals exhibited unequal removal along the canal with more dentine being removed at the coronal end. The Enac group exhibited a higher incidence of elbows which occurred further apically than those in the Cavi-Endo group. There was no significant difference between groups in the following: time of instrumentation, amount of apical and coronal canal enlargement, apical deviation and change in width at the elbow. These findings were no different from those of another study using simulated canals.

Matched MeSH terms: Root Canal Therapy/instrumentation*
Some observations on the mechanics of oscillation of ultrasonic files

Ahmad M

Endod Dent Traumatol, 1990 Feb;6(1):12-5.
PMID: 2202589

The resonant characteristics of ultrasonic files driven by the Cavi-Endo unit were examined. The investigation was carried out by evaluating the pattern of oscillation and the power emitted by the ultrasonic files. It was observed that the files oscillated in a sinusoidal fashion, exhibiting a standing wave pattern along the file. The power emitted was found to be directly proportional to the flexibility of the file. Such behaviour is typical of a system that exhibits resonance.

Matched MeSH terms: Root Canal Therapy/instrumentation*
Effectiveness of ultrasonic files in the disruption of root canal bacteria

Ahmad M, Pitt Ford TR, Crum LA, Wilson RF

Oral Surg. Oral Med. Oral Pathol., 1990 Sep;70(3):328-32.
PMID: 2216361

The physical mechanisms of ultrasound, namely cavitation and acoustic streaming, generated by the Enac-Osada ultrasonic unit were investigated for effectiveness in disrupting Streptococcus mitis. In addition, the bactericidal effect of ultrasound in the presence of 2.5% sodium hypochlorite was examined. Bacterial suspensions were irradiated directly with ultrasound in simulated root canals, and the viability of bacteria was examined after growth on a blood agar medium under anaerobic conditions at 37 degrees C for 5 days. The results indicated that ultrasound per se failed to disrupt bacteria but resulted in increases in the viable counts; the former was considered to be because of the lack of cavitation and the latter because of the dispersal effects of acoustic streaming. The 2.5% sodium hypochlorite solution demonstrated powerful bactericidal activity.

Matched MeSH terms: Root Canal Therapy/instrumentation*
Shape of the root canal after ultrasonic instrumentation with K-Flex files

Ahmad M

Endod Dent Traumatol, 1990 Jun;6(3):104-8.
PMID: 2079012
Matched MeSH terms: Root Canal Therapy/instrumentation*
Measurements of temperature generated by ultrasonic file in vitro

Ahmad M

Endod Dent Traumatol, 1990 Oct;6(5):230-1.
PMID: 2133315

The temperature rise of the irrigant in the root canal during free vibration of the ultrasonic file was studied in vitro in 10 human teeth. The mean temperature rise was found to be 0.6 degrees C. The minimal temperature increase may not significantly contribute to the effectiveness of ultrasonic root canal instrumentation.

Matched MeSH terms: Root Canal Therapy/instrumentation*
Fulltext Management and prognosis of teeth with trauma induced crown fractures and large periapical cyst like lesions following apical surgery with and without retrograde filling

Ahmed HM, Al Rayes MH, Saini D

J Conserv Dent, 2012 Jan;15(1):77-9.
PMID: 22368341 DOI: 10.4103/0972-0707.92612

Crown fractures are common detrimental consequences of dental traumatic injuries. Early management of such cases is mandatory in order to prevent subsequent pathological changes that could further complicate the treatment. Pulp necrosis, chronic and cystic apical periodontitis can be the fate if these teeth are left untreated. Despite these serious complications, root canal treatment followed by apical surgery is considered a valid treatment option when such cases become complicated with large periapical lesions. However, whether a retrograde filling is essential to be placed or not is still a matter of debate. This case report discusses the orthograde endodontic management, the surgical approach and the clinical outcomes of longstanding crown fractured teeth with large cyst-like periapical lesions with and without retrograde filling.

Matched MeSH terms: Root Canal Therapy
Discolouration potential of endodontic procedures and materials: a review

Ahmed HM, Abbott PV

Int Endod J, 2012 Oct;45(10):883-97.
PMID: 22621247 DOI: 10.1111/j.1365-2591.2012.02071.x

Advances in endodontic materials and techniques are at the forefront of endodontic research. Despite continuous improvements, tooth discolouration, especially in anterior teeth, is considered an undesirable consequence following endodontic treatment as it creates a range of aesthetic problems. This article aims to discuss the intrinsic and internalized tooth discolouration caused by endodontic procedures, and to address the discolouration potential of materials used during root canal treatment, including root canal irrigants, intra-canal medicaments, endodontic and post-endodontic filling materials. In addition, the discolouration patterns caused by combined endodontic and nonendodontic aetiological factors are discussed. The recommended guidelines that should be followed by dental practitioners to prevent and manage tooth discolouration are also outlined.

Matched MeSH terms: Root Canal Therapy/adverse effects*
Application of a new system for classifying tooth, root and canal morphology in the primary dentition

Ahmed HMA, Musale PK, El Shahawy OI, Dummer PMH

Int Endod J, 2020 Jan;53(1):27-35.
PMID: 31390075 DOI: 10.1111/iej.13199

Knowledge of root and canal morphology is essential for the effective practice of root canal treatment. Paediatric endodontics aims to preserve fully functional primary teeth in the dental arch; however, pulpectomy procedures in bizarre and tortuous canals encased in roots programmed for physiologic resorption are unique challenges. A new coding system for classifying the roots and main canals (https://doi.org/10.1111/iej.12685), accessory canals (https://doi.org/10.1111/iej.12800) and developmental anomalies (https://doi.org/10.1111/iej.12867) has been introduced recently. This paper discusses challenges for describing root and canal morphology in primary teeth and describes the potential application of the new classification system for root canals in the primary dentition.

Matched MeSH terms: Root Canal Therapy
Application of a new system for classifying root and canal anatomy in studies involving micro-computed tomography and cone beam computed tomography: Explanation and elaboration

Ahmed HMA, Ibrahim N, Mohamad NS, Nambiar P, Muhammad RF, Yusoff M, et al.

Int Endod J, 2021 Jul;54(7):1056-1082.
PMID: 33527452 DOI: 10.1111/iej.13486

Adequate knowledge and accurate characterization of root and canal anatomy is an essential prerequisite for successful root canal treatment and endodontic surgery. Over the years, an ever-increasing body of knowledge related to root and canal anatomy of the human dentition has accumulated. To correct deficiencies in existing systems, a new coding system for classifying root and canal morphology, accessory canals and anomalies has been introduced. In recent years, micro-computed tomography (micro-CT) and cone beam computed tomography (CBCT) have been used extensively to study the details of root and canal anatomy in extracted teeth and within clinical settings. This review aims to discuss the application of the new coding system in studies using micro-CT and CBCT, provide a detailed guide for appropriate characterization of root and canal anatomy and to discuss several controversial issues that may appear as potential limitations for proper characterization of roots and canals.

Matched MeSH terms: Root Canal Therapy
A new system for classifying tooth, root and canal anomalies

Ahmed HMA, Dummer PMH

Int Endod J, 2018 Apr;51(4):389-404.
PMID: 29023779 DOI: 10.1111/iej.12867

Understanding the normal anatomical features as well as the more unusual developmental anomalies of teeth, roots and root canals is essential for successful root canal treatment. In addition to various types of root canal configuration and accessory canal morphology, a wide range of developmental tooth, root and canal anomalies exists, including C-shaped canals, dens invaginatus, taurodontism, root fusion, dilacerations and palato-gingival grooves. There is a direct association between developmental anomalies and pulp and periradicular diseases that usually require a multidisciplinary treatment approach to achieve a successful outcome. A number of classifications have categorized tooth, root and canal anomalies; however, several important details are often missed making the classifications less than ideal and potentially confusing. Recently, a new coding system for classifying root, root canal and accessory canal morphology has been introduced. The purpose of this article is to introduce a new system for classifying tooth, root and canal anomalies for use in research, clinical practice and training, which can serve as complementary codes to the recently described system for classifying root, as well as main and accessory canal morphology.

Matched MeSH terms: Root Canal Therapy
Developing a consensus-based glossary of controversial terms in Endodontology

Ahmed HMA, Nagendrababu V, Duncan HF, Peters OA, Dummer PMH

Int Endod J, 2023 Jul;56(7):788-791.
PMID: 37300405 DOI: 10.1111/iej.13918
Matched MeSH terms: Root Canal Therapy
Implications of root, pulp chamber, and canal anatomy on pulpotomy and revitalization procedures

Ahmed HMA, El-Karim I, Duncan HF, Krastl G, Galler K

Clin Oral Investig, 2023 Nov;27(11):6357-6369.
PMID: 37870593 DOI: 10.1007/s00784-023-05284-9

OBJECTIVES: This review aims to discuss the implications of anatomy of the root, pulp chamber, and canals on pulpotomy and revitalization procedures (RPs) as treatment alternatives to root canal treatment procedures.
METHODS: This narrative review was undertaken to address two main questions - why remove vital pulp tissue in teeth with complex canal anatomy when it can be preserved? And why replace the necrotic pulp in teeth with mature roots with a synthetic material when we can revitalize? This review also aims to discuss anatomical challenges with pulpotomy and revitalization procedures.
RESULTS: Maintaining the vitality of the pulp via partial or full pulpotomy procedures avoids the multiple potential challenges faced by clinicians during root canal treatment. However, carrying out pulpotomy procedures requires a meticulous understanding of the pulp chamber anatomy, which varies from tooth to tooth. Literature shows an increased interest in the application of RPs in teeth with mature roots; however, to date, the relation between the complexity of the root canal system and outcomes of RPs in necrotic multi-rooted teeth with mature roots is unclear and requires further robust comparative research and long-term follow-up.
CONCLUSIONS: Whenever indicated, pulpotomy procedures are viable treatment options for vital teeth with mature roots; however, comparative, adequately powered studies with long-term follow-up are needed as a priority in this area. RPs show promising outcomes for necrotic teeth with mature roots that warrant more evidence in different tooth types with long-term follow-ups. CLINICAL RELEVANCE: Clinicians should be aware of the pulp chamber anatomy, which is subject to morphological changes by age or as a defensive mechanism against microbial irritation, before practicing partial and full pulpotomy procedures. RP is a promising treatment option for teeth with immature roots, but more evidence is needed for its applications in teeth with mature roots. A universal consensus and considerably more robust evidence are needed for the standardization of RPs in teeth with mature roots.

Matched MeSH terms: Root Canal Therapy/methods
Critical analysis of a new system to classify root and canal morphology - A systematic review

Ahmed HMA, Rossi-Fedele G, Dummer PMH

Aust Endod J, 2023 Dec;49(3):750-768.
PMID: 37688283 DOI: 10.1111/aej.12780

A novel system to classify root and canal morphology was recently introduced (Ahmed et al. 2017). This systematic review aimed to answer the following research question: Does the Ahmed et al. system provide a more accurate and practical classification of root and canal anatomy compared to other classifications? A literature search was conducted in Google Scholar, Scopus and Wiley Online Library to identify the citation counts for the article entitled 'A new system for classifying root and root canal morphology; doi.org/10.1111/iej.12685'. After removal of duplicates and unrelated articles, 15 studies were included and analysed. All studies compared the Ahmed et al. system with the Vertucci classification. Results revealed that both systems were able to classify simple canal configurations in single-rooted anterior and premolar teeth, disto-buccal and palatal roots of maxillary molars. However, the Ahmed et al. system provided more accurate and comprehensive categorisations of single-rooted teeth with complex canal anatomy, multi-rooted maxillary and mandibular premolars and the mesio-buccal root of maxillary molars. Further evidence on the utility of the Ahmed et al. system is required using other diagnostic devices especially in molars.

Matched MeSH terms: Root Canal Therapy*
Fulltext The Study and Relevance of Pulp Chamber Anatomy in Endodontics - A Comprehensive Review

Ahmed HMA, Wolf TG, Rossi-Fedele G, Dummer PMH

Eur Endod J, 2024 Jan 01;9(1):18-34.
PMID: 37990569 DOI: 10.14744/eej.2023.76598

With the ever-increasing understanding of tooth anatomy, there is a renewed focus on the pulp chamber as an important component of the root canal system. For example, the pulp chamber is of critical relevance during diagnostic procedures such as pulp sensibility tests, deep caries removal, vital pulp treatments, access cavity preparation, tooth whitening, tooth restoration as well as methods for examining the floor of the pulp chamber to aid the detection of root canal orifices or the presence of perforations and cracks. The more recent concept of minimal invasive endodontics has also created a need to understand better the anatomy of the pulp chamber. The purpose of this article is to discuss the research methods used to study pulp chamber anatomy and the significance of the pulp chamber in endodontic research and clinical practice. In addition, directions for future research are emphasised.

Matched MeSH terms: Root Canal Therapy/methods
Effect of aging on coronal microleakage in access cavities through metal ceramic crowns restored with resin composites

Al-Maqtari AA, Lui JL

J Prosthodont, 2010 Jul;19(5):347-56.
PMID: 20456026 DOI: 10.1111/j.1532-849X.2010.00593.x

The purpose of this in vitro study was to determine if packable resin composite with/without flowable resin composite has the ability to prevent coronal leakage in restored endodontic access openings following aging.

Matched MeSH terms: Root Canal Therapy/methods*

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