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.
Arrested root development of permanent te~th can occur due to local factors such as infection and trauma or general factors such as radiation and odontodysplasia. This case report presents a 11 tooth with arrested root development requiring endodontic treatment. Following obturation with MTA, a minor surgical procedure was performed to remove periapical pathologic tissue. The tooth had remained asymptomatic at the 6-month review and the case will be followed-up for at least 2 years to ensure complete healing.
This study was designed to determine the optimum vertical height of the retraction force on the power arm that is required for efficient anterior tooth retraction during space closure with sliding mechanics.
Progressive replacement resorption following delayed replantation of avulsed teeth has proved to be an intractable clinical problem. A wide variety of therapeutic approaches have failed to result in the predictable arrest of resorption, with a good long-term prognosis for tooth survival. Bisphosphonates are used in the medical management of a range of bone disorders and topically applied bisphosphonate has been reported to inhibit root resorption in dogs. This study evaluated the effectiveness of a bisphosphonate (etidronate disodium) as an intracanal medicament in the root canals of avulsed monkey teeth, placed before replantation after 1 h of extraoral dry storage. Incisors of six Macaca fascicularis monkeys were extracted and stored dry for 1 h. Teeth were then replanted after canal contamination with dental plaque (negative control) or after root canal debridement and placement of etidronate sealed in the canal space. A positive control of calcium hydroxide placed 8-9 days after replantation was also included. All monkeys were sacrificed 8 weeks later and block sections were prepared for histomorphometric assessment of root resorption and periodontal ligament status. Untreated teeth showed the greatest extent of root resorption (46% of the root surface), which was predominantly inflammatory in nature. Calcium hydroxide treated teeth showed the lowest overall level of resorption (<30% of the root surface), while the bisphosphonate-treated group was intermediate (39%). Ankylosis, defined as the extent of the root surface demonstrating direct bony union to both intact and resorbed root surface, was the lowest in the untreated control group (15% of the root surface), intermediate in the calcium hydroxide group (27%) and the highest in the bisphosphonate group (41%). Bony attachment to the tooth root was divided approximately equally between attachment to intact cementum and to previously resorbed dentin. Overall, bisphosphonate resulted in a worse outcome than calcium hydroxide in terms of both root resorption and ankylosis.
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.
Complicated crown-root fractures are rare and often need complex treatment planning. This paper describes a simplified treatment option for a complicated crown root fracture that minimally encroached into the biologic region in a growing child without the need for surgery or orthodontic treatment.
This research investigated the unit-root tests using nonparametric sequences-reversals (S-R), Phillip-Perron (PP) tests and parametric Augmented Dickey-Fuller (ADF) test for the Malaysian equity indices. Under the considerations of drift and structural break, it was found that during the restructuring period after the Asian financial crisis, most of the indices provided evidences against the unit-root tests. These results are somewhat contrasted with the conventional unit-root tests that ignored the impact of structural changes. In addition, the S-R tests were found to have little power to identify the deviations from the unit-root even after the inclusion of structural break.
Endodontically treated teeth are generally weaker than sound teeth. The study objective was to compare the fracture resistance of endodontically treated teeth restored with different restorative techniques. Fifty extracted human maxillary central incisors of similar size were divided into five groups of 10 teeth. Group 1 was left intact as the control group. Other groups (Groups 2, 3, 4 and 5) were all endodontically treated followed by restorations using different restorative techniques; light cured composite resin (CR), CR and crown, post and CR, and post-CR core and crown respectively. The specimens were loaded in a universal testing machine with a static force at a crosshead speed of 0.5mm/min at 135 ° to the long axis of the root until failure. The means and the standard deviations of the maximum load at failure for groups 1, 2, 3, 4 and 5 were 1259.11N (379.12N), 578.63N (196.70N), 667.13N (298.72N), 1247.65N (294.48N) and 623.60N (193.75N) respectively. The results of one-way ANOVA showed statistically significant differences existed among the groups tested (p
We report the first case of Osteo-odonto-keratoprosthesis (OOKP) who successfully underwent surgery in Malaysia following a grade 4 (severe) chemical injury in both eyes in 2006. The patient's left eye was eviscerated and his right eye underwent penetrating keratoplasty. However, the corneal graft failed and became opaque. His right eye could only perceive light. The OOKP was offered to him hoping to recover some functional vision. He underwent a 2-stage surgery to implant the OOKP into his right eye. However, 2 months post-operation, he developed vitreous haemorrhage. A successful pars plana vitrectomy (PPV) was performed via the limited view through the lens. He attained a final visual acuity of 6/60 (N36). He was able to mobilize more independently, feed, dress himself and read large print.
Radiographic examination is essential in diagnosis and treatment planning in endodontics. Conventional radiographs depict structures in two dimensions only. The ability to assess the area of interest in three dimensions is advantageous. Computed tomography is an imaging technique which produces three-dimensional images of an object by taking a series of two-dimensional sectional X-ray images. DentaScan is a computed tomography software program that allows the mandible and maxilla to be imaged in three planes: axial, panoramic, and cross-sectional. As computed tomography is used in endodontics, DentaScan can play a wider role in endodontic diagnosis. It provides valuable information in the assessment of the morphology of the root canal, diagnosis of root fractures, internal and external resorptions, pre-operative assessment of anatomic structures etc. The aim of this article is to explore the clinical usefulness of computed tomography and DentaScan in endodontic diagnosis, through a series of four cases of different endodontic problems.
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.
The objectives of this study were to determine the normal mean value of the root-crown (R/C ratios) in Malay patients and their variations by gender and dental arch from orthopantomogram radiographs (OPGs). Two thousand nine hundred and twenty teeth with fully developed roots were measured from 112 OPGs. Subjects with history of maxillofacial trauma or orthodontic therapy were excluded. The mean age of the subjects was 19.1 (SD 2.08) years old for males while females 18.9 (SD 2.19) years old in the range from 15 to 22 years old. The intra-examiner reproducibility of the assessment method was good (Intraclass correlation coefficient 0.81). Results of this study showed that there was no significant difference between R/C ratios of males and females groups. However, the ratios of the antagonist teeth for both males and females were significantly greater in the mandible than in the maxilla (p
Study site: Dental clinic, Hospital Universiti Sains Malaysia
Background: The importance of tooth sectioning is realized in disasters such as earthquake, airplane crash investigation, terror, micro leakage studies, age estimation etc. The objective of this study was to develop a simple method to make thin sections (approximately 100 mm) from freshly extracted teeth.
Methods: One hundred and twenty human premolars recently extracted for orthodontic purpose were used for this study. The teeth were stored in 0.5% chorlaramine for 2 weeks and were not allowed to dry at any stage of the experiment. The teeth were thoroughly washed in distilled water teeth and then were sectioned buccolingually from crown to the root portion.
Results: A detailed embedding-cutting-mounting procedure is described. The prepared thin ground sections were then examined under a Polarised light microscope for the enamel and the dentine, as well as the caries lesions can clearly be distinguished.
Conclusion: This is an effective and efficient method for preparation of ground sections in which the hard tissue details are preserved.
Maxillary molar teeth may have accessory roots. The aim of this paper is to review and discuss the endodontic implications of this anatomical variation. A review of the literature was undertaken to identify studies and reported cases where accessory roots have been recorded in maxillary molar teeth. The results show that although the prevalence of accessory roots in maxillary molar teeth is low, they can exist in all three types of maxillary molar teeth, and they may be located palatally, buccally, mesially or distally. Hence, it is essential that dentists undertaking root canal treatment thoroughly assess all teeth to determine how many roots are present in order to provide the best possible outcome of treatment for the patient.
Tujuan kertas kerja ini adalah untuk mengetahui hubungan, kesan ekonomi semasa dan faktor pencemaran terhadap modal, perbelanjaan terhadap pertumbuhan ekonomi terutamanya kepada Malaysia dan dibandingkan dengan negara seperti Jepun, Singapura dan Zimbabwe. Persoalan utama adalah sama ada modal dan perbelanjaan dapat berterusan menyumbangkan kepada pertumbuhan ekonomi ataupun tidak. Untuk mengkaji perhubungan, kami gunakan Test Unit Root (TUR); Augmented Dickey-Fuller Method (ADF), Phillip-Perron Test (PP) dan Kwiatkowski-Phillip-Schmidt-Shin (KPSS), Test Johansen Cointegration (TJC), diikuti Vector Error Correction Model (VECM) dan akhir sekali Test Granger Causality (TGC). Tujuan pengujian ini adalah untuk mengukur perhubungan, kestabilan dan kesahihan model. Kedua, untuk mengkaji kesan impak ekonomi kami gunakan Impulse Respond dan ujian Variance Decomposition yang menyelidik kesan berapa banyak dan berapa panjang model bertindakbalas kepada kesan Kegawatan Ekonomi Asia pada 1997 dan Kesan Serangan Pengganas di Amerika Syarikat pada September 2011. Ketiga kami juga megukur kesan perbelanjaan isi rumah dan kerajaan terhadap alam persekitaran. Kertas kerja ini mendapati, ia menyokong idea modal penjana pertumbuhan tetapi natijah perbelanjaan penjana pertumbuhan adalah berbeda mengikut tahap pertumbuhan. Di mana Malaysia dan Singapura menyokong sepenuhnya tetapi Jepun dan Zimbabwe hanya menyokong separa sahaja. Apabila kami mengukur impak kesan ekonomi pula, di dapati pada negara Zimbabwe tiada kesan antara krisis pada tahun 1997 ataupun pada 2001. Tetapi impak pada negara seperti Jepun, Malaysia dan Singapura pula berhadapan dalam posisi tidak baik pada krisis tahun 1997 tetapi keadaan yang baik pula pada krisis tahun 2001. Akhir sekali kami juga bangunkan theori pencemaran dimana untuk negara Zimbabwe ke semua pembolehubah seperti Perbelanjaan isi rumah (HC), Perbelanjaan Kerajaan (GC) dan Modal Tetap Kasar (GFC) tidak mempengaruhi pencemaran iaitu Karbon Dioksida (CO2). Tetapi natijah untuk negara Malaysia dan Singapura pula hanya HC mencipta CO2, tidak untuk GC dan GFC. Dan pengakhiran sekali Negara Jepun pula semua pembolehubah seperti GC,HC dan GFC mencipta pencemaran. Kesimpulannya krisis yang berlaku pada negara Amerika Syarikat pada tahun 2001 memberi kesan terus pada Negara Amerika tetapi tidak pada negara seperti Malaysia, Jepun dan Singapura, walhal negara-negara ini menadapat lambakan di dalam pasaran modal akibat perubahan ketidaktentuan dalam ekonomi Amerika seterusnya meningkatkan secara langsung Keluaran Dalam Negara Kasar (GDP). Walaubagaimanapun negara Zimbabwe tidak mempunyai kesan langsung sama ada sebelum atupun selepas masalah krisis ekonomi ini. Apabila kertas kerja ini mengkaji daripada sudut pembangunan lestari didapati Negara Zimbabwe seperti HC dan GC tidaklah mencemar seperti negara Malaysia dan Singapura yang menunjukkan HC punca pencemaran dan bukannya GC yang mungkin disebabkan skala ekonominya yang lebih kecil. Untuk negara Jepun pula disebabkan negara ini mempunyai skala ekonomi yang lebih besar HC dan GC adalah agen kepada pencemaran. Implikasinya model ini sepatutnya diambil kira dalam pembuat keputusan terutamanya untuk meninkatkan pertumbuhan ekonomi.
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.
Complete debridement and disinfection of the root canal system are fundamental requirements for successful endodontic treatment. Despite the morphological challenges of the internal root anatomy, root canal irrigants play an important role in the optimization of the root canal preparation, which is essentially a chemo-mechanical procedure. Enterococcus faecalis is one of the most resistant microorganisms that dominants the microbial ecosystem of persistent periradicular lesions in retreatment cases. For that reason, many in vitro and in vivo studies evaluated and compared the antibacterial activity of sodium hypochlorite and chlorhexidine at varying concentrations using different experimental models against this microorganism. However, many controversies with regard to the ideal irrigant and concentration do in fact exist. Hence, this review aims to discuss the antibacterial activity of these two main root canal irrigants against Enterococcus faecalis using the agar diffusion and direct contact methods and the possible modulating factors responsible for inconsistent findings among different studies. In addition, the disinfection potential of both chemical agents on gutta percha and Resilon cones are also discussed. The source of this review was conducted through an electronic literature search using PubMed database from December 1997 until December 2011, which analyze the related laboratory investigations of both irrigants, published in major endodontic journals.
Hertwig's epithelial root sheath (HERS) cells play a pivotal role during root formation of the tooth and are able to form cementum-like tissue. The aim of the present study was to establish a HERS cell line for molecular and biochemical studies using a selective digestion method. Selective digestion was performed by the application of trypsin-EDTA for 2 min, which led to the detachment of fibroblast-like-cells, with the rounded cells attached to the culture plate. The HERS cells displayed a typical cuboidal/squamous-shaped appearance. Characterization of the HERS cells using immunofluorescence staining and flow cytometry analysis showed that these cells expressed pan-cytokeratin, E-cadherin, and p63 as epithelial markers. Moreover, RT-PCR confirmed that these cells expressed epithelial-related genes, such as cytokeratin 14, E-cadherin, and ΔNp63. Additionally, HERS cells showed low expression of CD44 and CD105 with absence of CD34 and amelogenin expressions. In conclusion, HERS cells have been successfully isolated using a selective digestion method, thus enabling future studies on the roles of these cells in the formation of cementum-like tissue in vitro.
Osteo-odontokeratoprosthesis (OOKP) surgery is a technique used to replace damaged cornea in blind patients for whom cadaveric transplantation is not feasible. OOKP surgery is a complex procedure requiring lifetime follow-up. The preservation of the osteo-odontolamina is the vital feature in maintaining the stability of the OOKP. Early detection of lamina resorption enables early prophylactic measures to be taken and prevent resorption-related complications. This case illustrates the radiological findings of the first OOKP surgery in Malaysia and the role of multidetector computed tomography (MDCT) in postoperative management of OOKP surgery.