Displaying publications 1 - 20 of 45 in total

  1. Ahmed HMA
    Int Endod J, 2022 Feb 06.
    PMID: 35124829 DOI: 10.1111/iej.13702
    The technical execution of root canal treatment procedures demands a thorough understanding and knowledge of root and canal anatomy. Over the decades, and with the aid of various research methods such as staining and clearing, 2D radiographic imaging, sectioning procedures, cone beam computed tomography and micro-computed tomography, many laboratory and clinical studies have been undertaken to understand the root and canal anatomy of the human dentition. This has resulted in a tremendous increase in the body of knowledge with a wide range of qualitative and quantitative presentations of the root and canal anatomy. This review aims to provide a critical analysis for the laboratory and clinical research methods in root and canal anatomy studies. In addition, it aims to identify existing gaps and present insights for directions of future research and ways for translation to clinical endodontics.
  2. Hashem AAR, Ahmed HMA
    Eur Endod J, 2017;2(1):1-4.
    PMID: 33403327 DOI: 10.5152/eej.2017.17042
    A comprehensive knowledge and understanding of root canal anatomical variations are essential for successful root canal treatment. Mandibular molar teeth show considerable variations in their external and internal radicular morphology that require special attention from dental practitioners to provide the best clinical outcomes to the patients. This report aims to present root canal treatment of a mandibular first molar that has six separate root canals (three root canals in the mesial roots and three in the distal roots [236 M3 D3]). This report points out the importance of proper exploration for identifying additional canals in mandibular molars.
  3. Ahmed HMA, Neelakantan P, Dummer PMH
    Int Endod J, 2018 Feb;51(2):164-176.
    PMID: 28635100 DOI: 10.1111/iej.12800
    Thorough knowledge of anatomical complexities of the root canal system has a direct impact on the effectiveness of canal preparation and filling, and is an essential prerequisite for successful root canal treatment. A wide range of complex variations in root canal anatomy exists, including root canal configuration type, developmental anomalies and minor canal morphology such as accessory canals and apical deltas. Accessory canals and apical deltas have been associated with pulp disease, primary canal infection, canal reinfection and post-treatment disease. The current definitions of accessory canal anatomy are not standardized and potentially confusing. Given their role in endodontic disease and their impact on treatment outcomes, there is a need to have a simple classification of their anatomy to provide an accurate description of their position and path from the canal to the external surface of the root. The purpose of this article is to introduce a new system for classifying accessory canal morphology for use in research, clinical practice and training.
  4. Ahmed HMA, Dummer PMH
    Eur Endod J, 2018;3(1):9-17.
    PMID: 32161850 DOI: 10.5152/eej.2017.17064
    Objective: A new coding system for classifying the roots, main and accessory canals as well as developmental anomalies has been introduced recently. This paper discusses the advantages and potential application of the new system in research and clinical practice.

    Methods: A comprehensive analysis was undertaken on the most common, existing classification for root canal morphology. The advantages and potential applications of a new system for classifying roots and canal systems in research and clinical practice are discussed.

    Results: The analysis demonstrates deficiencies of the existing classification including lack of information on the number of roots, pulp chamber outline, lack of clarity in multi-rooted teeth, inability to define complex root canal configurations. The new coding system addresses the root and canal morphology in an accurate and systematic manner to provide detailed information of the tooth, root and canal anatomical features.

    Conclusion: With current advances in endodontic research and practice and the increasing body of knowledge on root and canal morphology, the deficiencies of the existing system used for classifying root canal morphology have become more apparent. The new system for classifying root, main and accessory canal morphology as well as teeth with anomalies has the potential to be used in research, clinical practice and education to accurately reflect the real anatomy of a tooth.

  5. Ahmed HMA, Rossi-Fedele G
    Eur Endod J, 2020 12;5(3):159-176.
    PMID: 33353923 DOI: 10.14744/eej.2020.88942
    OBJECTIVE: Consistent reporting of publications in a given topic is essential. This systematic review aimed to identify and evaluate the reporting items in previous publications related to root canal anatomy in major Endodontic journals.

    METHODS: A systematic review was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed by 2 independent reviewers using a customized search strategy in major Endodontic journals through Scopus until November 2019. Studies investigating root and canal anatomy were included. The selected publications were divided into 7 categories according to the study design: micro-computed tomography (microCT) and cone-beam computed tomography (CBCT) experimental studies (extracted teeth), CBCT and 2D clinical studies, CBCT and 2D case reports in addition to others (i.e. staining and clearing method and root sectioning). The selected studies were evaluated according to three domains: 1) Criteria for study sample selection; 2) Criteria for methodological procedures and 3) Criteria for detection and evaluation.

    RESULTS: After the removal of duplicated and irrelevant papers, 137 articles were included. Results showed that microCT studies reported accurately the tooth type, number of teeth, classifications used, qualitative and/or quantitative analysis (if required) and the evaluation process. However, sample size calculation, calibration, and reproducibility were not reported in the majority of microCT studies. CBCT clinical studies presented information for the type of study, inclusion/exclusion criteria, number of patients, tooth type, and number of teeth. However, the majority did not report sample size calculation and calibration of examiners. Radiographic exposure descriptions and classifications used were not reported adequately in CBCT and 2D case reports. Sample size calculation, calibration and reproducibility were not reported in staining and clearing method.

    CONCLUSION: Despite accurate presentation of certain items, there is considerable inconsistent reporting of root and canal morphology regardless of the type of study and experimental procedure used. The PROUD checklist protocol presented in this systematic review aims to provide an accurate description of root canal anatomy in experimental, clinical, and case report publications.

  6. 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.
  7. 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 
  8. Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH
    Int Endod J, 2017 Aug;50(8):761-770.
    PMID: 27578418 DOI: 10.1111/iej.12685
    Knowledge of root and root canal morphology is a prerequisite for effective nonsurgical and surgical endodontic treatments. The external and internal morphological features of roots are variable and complex, and several classifications have been proposed to define the various types of canal configurations that occur commonly. More recently, improvements in nondestructive digital image systems, such as cone-beam and micro-computed tomography, as well as the use of magnification in clinical practice, have increased the number of reports on complex root canal anatomy. Importantly, using these newer techniques, it has become apparent that it is not possible to classify many root canal configurations using the existing systems. The purpose of this article is to introduce a new classification system that can be adapted to categorize root and root canal configurations in an accurate, simple and reliable manner that can be used in research, clinical practice and training.
  9. Ahmed HMA, Versiani MA, De-Deus G, Dummer PMH
    Int Endod J, 2018 Oct;51(10):1182-1183.
    PMID: 30191599 DOI: 10.1111/iej.12928
  10. Saber SEDM, Ahmed MHM, Obeid M, Ahmed HMA
    Int Endod J, 2019 Mar;52(3):267-278.
    PMID: 30225932 DOI: 10.1111/iej.13016
    AIM: To investigate the number of roots and root canal configurations using two coding systems and the root canal diverging and merging levels in extracted maxillary premolars in an Egyptian subpopulation using cone beam computed tomography (CBCT).

    METHODOLOGY: A total of 700 maxillary premolars were examined using CBCT in an Egyptian subpopulation. The number of roots was identified, and root canal configurations were classified according to Vertucci's classification and a new system for classifying root and canal morphology. In addition, the position where roots bifurcated and the levels where canals merged or diverged were identified. Fisher's exact test and independent t-test were used for statistical analysis, and the level of significance was set at 0.05 (P = 0.05).

    RESULTS: More than half of maxillary first premolars were double-rooted, and the majority of maxillary second premolars were single-rooted (P 

  11. Arslan H, Doğanay E, Karataş E, Ünlü MA, Ahmed HMA
    J Endod, 2017 Nov;43(11):1765-1769.
    PMID: 28967495 DOI: 10.1016/j.joen.2017.06.028
    INTRODUCTION: Low-level laser therapy (LLLT) is a practical, nonpharmacologic technique for reducing pain. This study evaluated the effect of LLLT on postoperative pain after root canal retreatment (RCR).

    METHODS: This study enrolled patients (N = 36) who required root canal retreatment (RCR) on mandibular molar teeth, presented with periapical lesions with periapical index scores of 2 or 3, and had a pain visual analog scale (VAS) <50 and a percussion pain VAS <50. The participants were divided into 2 groups: (1) patients scheduled for RCR followed by LLLT (n = 18) and (2) patients scheduled for RCR followed by a mock LLLT (placebo) (n = 18). Postoperative pain was assessed using the VAS. Data were collected and statistically analyzed with the chi-square test, the independent sample t test, and the Mann-Whitney U test (P = .05).

    RESULTS: On the first 4 days, postoperative pain significantly reduced in the LLLT group compared with the placebo group (P  .05). The number of patients who needed analgesics was lower in the LLLT group than in the placebo group (P 

  12. Sharma G, Ahmed HMA, Zilm PS, Rossi-Fedele G
    Aust Endod J, 2018 Apr;44(1):60-65.
    PMID: 29168274 DOI: 10.1111/aej.12216
    This review aims to evaluate the antimicrobial efficacy of calcium hydroxide against endodontic pathogens when used for 7 days or longer. A systematic electronic literature search was performed in the PubMed, Embase and EBSCO Dentistry & Oral Sciences Source databases using appropriate key words to identify investigations written in the English language that examined the association between the contact time of intracanal calcium hydroxide dressing and its antimicrobial properties. There were no exclusions based on study design. The search yielded 6993 publications. After duplicate removal, 5913 publications were identified and 11 studies met the inclusion criteria. Results showed that the antimicrobial effect of calcium hydroxide for contact times ranging between seven and 45 days is comparable. Two studies demonstrated contradictory findings when exposure was extended to more than 45 days. Future studies are warranted to investigate and optimise calcium hydroxide application for longer periods and identify the potential benefits of its use in clinical settings.
  13. Ahmed HMA, Rossi-Fedele G, Dummer PMH
    Aust Endod J, 2023 Sep 08.
    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.
  14. Daood U, Parolia A, Matinlinna J, Yiu C, Ahmed HMA, Fawzy A
    Dent Mater, 2020 12;36(12):e386-e402.
    PMID: 33010944 DOI: 10.1016/j.dental.2020.09.008
    OBJECTIVES: Evaluate a new modified quaternary ammonium silane irrigant solution for its antimicrobial, cytotoxic and mechanical properties of dentine substrate.

    METHODS: Root canal preparation was performed using stainless steel K-files™ and F4 size protaper with irrigation protocols of 6% NaOCl + 2% CHX; 3.5% QIS; 2% QIS and sterile saline. Biofilms were prepared using E. faecalis adjusted and allowed to grow for 3 days, treated with irrigants, and allowed to grow for 7 days. AFM was performed and surface free energy calculated. MC3T3 cells were infected with endo irrigant treated E. faecalis biofilms. Raman spectroscopy of biofilms were performed after bacterial re-growth on root dentine and exposed to different irrigation protocols and collagen fibers analysed collagen fibers using TEM. Antimicrobial potency against E. faecalis biofilms and cytoxicity against 3T3 NIH cells were also. Resin penetration and MitoTracker green were also evaluated for sealer penetration and mitochondrial viability. Data were analysed using One-way ANOVA, principal component analysis and post-hoc Fisher's least-significant difference.

    RESULTS: Elastic moduli were maintained amongst control (5.5 ± 0.9) and 3.5% QIS (4.4 ± 1.1) specimens with surface free energy higher in QIS specimens. MC3T3 cells showed reduced viability in 6%NaOCl+2%CHX specimens compared to QIS specimens. DNA/purine were expressed in increased intensities in control and 6% NaOCl + 2% CHX specimens with bands around 480-490 cm-1 reduced in QIS specimens. 3.5% QIS specimens showed intact collagen fibrillar network and predominantly dead bacterial cells in confocal microscopy. 3.5% QIS irrigant formed a thin crust-type surface layer with cytoplasmic extensions of 3T3NIH spread over root dentine. Experiments confirmed MitoTracker accumulation in 3.5% treated cells.

    SIGNIFICANCE: Novel QIS root canal irrigant achieved optimum antimicrobial protection inside the root canals facilitating a toxic effect against the Enterococcus faecalis biofilm. Root dentine substrates exhibited optimum mechanical properties and there was viability of fibroblastic mitochondria.

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