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  1. Al-Haddad A, Che Ab Aziz ZA
    Int J Biomater, 2016;2016:9753210.
    PMID: 27242904 DOI: 10.1155/2016/9753210
    Bioceramic-based root canal sealers are considered to be an advantageous technology in endodontics. The aim of this review was to consider laboratory experiments and clinical studies of these sealers. An extensive search of the endodontic literature was made to identify publications related to bioceramic-based root canal sealers. The outcome of laboratory and clinical studies on the biological and physical properties of bioceramic-based sealers along with comparative studies with other sealers was assessed. Several studies were evaluated covering different properties of bioceramic-based sealers including physical properties, biocompatibility, sealing ability, adhesion, solubility, and antibacterial efficacy. Bioceramic-based sealers were found to be biocompatible and comparable to other commercial sealers. The clinical outcomes associated with the use of bioceramic-based root canal sealers are not established in the literature.
  2. Al-Haddad A, Abu Kasim NH, Che Ab Aziz ZA
    Dent Mater J, 2015;34(4):516-21.
    PMID: 26235718 DOI: 10.4012/dmj.2015-049
    This study evaluated and compared the sealer thickness and interfacial adaptation of bioceramic sealers (Sankin Apatite III, MTA Fillapex(®), EndoSequence(®) BC) to root dentin against AH Plus(®) sealer. Sixty extracted single-root premolars were prepared and equally divided into four groups. Sealers were labeled with 0.1% Rhodamine B fluorescent dye. Roots were dissected along the transverse plane at 1 mm (apical), 3 mm (middle), and 6 mm (coronal) levels. Sealer-to-whole canal area ratio was evaluated. Percentage of gap-containing region to canal circumference was calculated using a confocal laser microscope. Sealer thickness was significantly higher at apical and middle levels than at coronal level. EndoSequence BC had the significantly highest thickness compared with MTA Fillapex and AH Plus. The coronal level had significantly less interfacial gaps compared with apical and middle levels. Bioceramic sealers showed more gaps compared with AH Plus, with no significant differences among them.
  3. Al-Haddad AY, Kutty MG, Che Ab Aziz ZA
    Int J Biomater, 2018;2018:1731857.
    PMID: 30154852 DOI: 10.1155/2018/1731857
    Objectives: To evaluate the push-out bond strength of experimental apatite calcium phosphate coated gutta-percha (HAGP) compared to different commercially available coated gutta-percha root obturation points.

    Methods: Extracted teeth were selected and instrumented using ProTaper rotary files. The canals were assigned into five equal groups and obturated using matching single cone technique as follows: EndoREZ cones and EndoREZ sealer, Bioceramic Endosequence gutta-percha (BCGP) with Endosequence BC sealer, Active GP with Endosequence BC sealer (ActiV GP), conventional GP with Endosequence BC sealer, and HAGP with Endosequence BC sealer. Each root was sectioned transversally at the thickness of 1±0.1 mm to obtain 5 sections (n=25 per group). The specimens were subjected to push-out test using a Universal Test Machine at a loading speed of 0.5 mm/ min. Failure modes after push-out test was examined under stereomicroscope and the push-out data were analyzed using ANOVA and the post hoc Dunnett T3 test (p = 0.05).

    Results: The highest mean bond strength was yielded by HAGP followed by BCGP, ActiV GP, conventional GP, and EndoREZ. There were significant differences between EndoREZ and all other groups (p<0.001). The prominent failure mode of HAGP was mixed mode, whereas EndoREZ exhibited adhesive failure mode. Conventional GP, ActiV GP, and BCGP showed cohesive failure mode.

    Conclusion: HAGP showed promising results to be used as root canal filling material in combination with bioceramic sealer.

  4. Al-Haddad AY, Kutty MG, Abu Kasim NH, Che Ab Aziz ZA
    J Dent Sci, 2017 Dec;12(4):340-346.
    PMID: 30895073 DOI: 10.1016/j.jds.2017.03.008
    Background/purpose: Intraradicular moisture is not standardized and alters the sealing properties and adhesion of root sealers. The aim of this work was to evaluate the effect of different moisture on the constitution of bioceramic sealers.

    Materials and methods: The sealers were evaluated before mixing, and after setting using X-ray diffraction (XRD), Energy Dispersive Analysis (EDX) and Scanning Electron Microscope (SEM) techniques. Twenty four extracted teeth were prepared and assigned to four groups according to the moisture conditions: (1) dry: using ethanol as final irrigation, (2) normal: using paper points until the last one appeared dry, (3) moist: using a Luer adapter for 5 s followed by 1 paper point, and (4) wet: the canals remained totally flooded. The roots were filled with MTA Fillapex® and Endosequence® BC and kept in phosphate buffer solution at 37 °C for 10 days. Each root was sectioned transversally and longitudinally. The sealers harvested from longitudinal sections were analysed using XRD. Whilst the transverse sections were analysed using SEM/EDX.

    Results: The XRD analysis showed MTA Fillapex composed of Bismuth trioxide, calcium silicate and tricalcium aluminate. The intensity of peaks in the wet condition was reduced. Endosequence BC contained mainly calcium silicate, calcium silicate hydrate, zirconia and calcium hydroxide. The wet condition showed a small increase in hydrated calcium silicate. The EDX analysis showed changes in the elemental concentrations with different moisture conditions. The surface morphology differed with different moisture conditions.

    Conclusion: Tested sealers have different constitution that not affected by the degree of moisture. However, it changed their relative quantity.

  5. Yap WY, Che Ab Aziz ZA, Azami NH, Al-Haddad AY, Khan AA
    Med Princ Pract, 2017;26(5):464-469.
    PMID: 28934753 DOI: 10.1159/000481623
    OBJECTIVE: To evaluate the push-out bond strength and failure modes of different sealers/obturation systems to intraradicular dentin at 2 weeks and 3 months after obturation compared to AH Plus®/gutta-percha.

    MATERIALS AND METHODS: A total of 180 root slices from 60 single-canal anterior teeth were prepared and assigned to 5 experimental groups (n = 36 in each group), designated as G1 (AH Plus®/gutta-percha), G2 (TotalFill BC™ sealer/BC-coated gutta-percha), G3 (TotalFill BC™ sealer/gutta-percha), G4 (EndoREZ® sealer/EndoREZ®-coated gutta-percha), and G5 (EndoREZ® sealer/gutta-percha). Push-out bond strengths of 18 root slices in each group were assessed at 2 weeks and the other 18 at 3 months after obturation using a universal testing machine. Data were analyzed using repeated measures ANOVA. An independent t test was used to compare the mean push-out bond strength for each group at 2 weeks and 3 months after obturation.

    RESULTS: The mean push-out bond strengths of G4 and G5 were significantly lower than those of G1, G2, and G3 (p < 0.05) at both 2 weeks (G1: 1.46 ± 0.29 MPa, G2: 1.74 ± 0.43 MPa, G3: 1.74 ± 0.43 MPa, G4: 0.66 ± 0.31 MPa, G5: 0.74 ± 0.47 MPa) and 3 months after obturation (G1: 1.70 ± 1.05 MPa, G2: 3.69 ± 1.20 MPa, G3: 2.84 ± 0.83 MPa, G4: 0.14 ± 0.05 MPa, G5: 0.24 ± 0.10 MPa). The mean push-out bond strengths of G2 (3.69 ± 1.20 MPa) and G3 (2.84 ± 0.83 MPa) were higher at 3 months compared to 2 weeks after obturation (G2: 1.74 ± 0.43 MPa, G3: 1.33 ± 0.29 MPa).

    CONCLUSION: The TotalFill BC™ obturation system (G2) and the TotalFill BC™ sealer/gutta-percha (G3) showed comparable bond strength to AH Plus®. Their bond strength increased over time, whereas the EndoREZ® obturation system (G4) and EndoREZ sealer (G5) had low push-out bond strength which decreased over time.

  6. Ahmad NA, Naimie Z, Lui JL, Aziz AA, Abdullah M, Abu Kasim NH, et al.
    J Dent Educ, 2012 Oct;76(10):1377-83.
    PMID: 23066138
    This study is part of ongoing educational research conducted by the Department of Conservative Dentistry, University of Malaya, Malaysia, to evaluate the perception of clinical pairing. A thirteen-question survey was distributed to 148 dental students after they had experienced four-handed dentistry. The objectives were to identify the advantages, disadvantages, and the acceptance of the implementation of clinical pairing from the students' point of view. The responses from the open-ended questions were categorized into six main themes (areas of interest): quality-related (Q), patient-related (PT), partner-related (P), lecturer-related (T), infection control (IC), and learning environment (L). Data analysis was done using SPSS version 18. Results indicated that the students perceived they possessed enough knowledge regarding clinical pairing. However, it was found that they still preferred to work independently as compared to working in pairs. The benefits of clinical pairing may not be viewed in the same vein by both dental students and teachers. The quality-related theme was perceived by students as the main advantage of clinical pairing, whilst the partner-related theme was perceived otherwise. The study also revealed that students may have some preconceived notions about pairing that may have impaired their acceptance. As a consequence, some reluctance was seen in their responses.
  7. Mat Yudin Z, Ali K, Wan Ahmad WMA, Ahmad A, Khamis MF, Brian Graville Monteiro N', et al.
    Eur J Dent Educ, 2020 Feb;24(1):163-168.
    PMID: 31698535 DOI: 10.1111/eje.12480
    AIMS: To evaluate the self-perceived preparedness of final-year dental undergraduate students in dental public universities in Malaysia.

    METHODS: Final-year dental undergraduate students from six dental public universities in Malaysia were invited to participate in an online study using a validated Dental Undergraduates Preparedness Assessment Scale DU-PAS.

    RESULTS: In total, about 245 students responded to the online questionnaire yielding a response rate of 83.05%. The age range of the respondents was 23-29 years with a mean age of 24.36 (SD 0.797). The total score obtained by the respondents was ranged from 48 to 100 with a mean score of 79.56 (SD 13.495). Weaknesses were reported in several clinical skills, cognitive and behavioural attributes.

    CONCLUSIONS: The preparedness of undergraduate students at six dental institutions in Malaysia was comparable to students from developed countries. The dental undergraduate preparedness assessment scale is a useful tool, and dental institutions may be used for self-assessment as well as to obtain feedback from the supervisors.

  8. Ahmed HMA, Che Ab Aziz ZA, Azami NH, Farook MS, Khan AA, Mohd Noor NS, et al.
    Int Endod J, 2020 Jun;53(6):871-879.
    PMID: 32003029 DOI: 10.1111/iej.13271
    AIM: To evaluate and compare the feedback of final year undergraduate dental students in eight Malaysian dental schools on the application of a new system for classifying root canal morphology in teaching and clinical practice.

    METHODS: One PowerPoint presentation describing two classification systems for root canal morphology (Oral Surgery Oral Medicine Oral Pathology, 1974 38, 456 and its supplemental configurations, International Endodontic Journal 2017, 50, 761) was delivered to final year undergraduate dental students in eight dental schools in Malaysia by two presenters (each presented to four schools). To examine students' feedback on the utility of each system, printed questionnaires consisting of six questions (five multiple choice questions and one open-ended question) were distributed and collected after the lecture. The questionnaire was designed to compare the classification systems in terms of accuracy, practicability, understanding of root canal morphology and recommendation for use in pre-clinical and clinical courses. The exact test was used for statistical analysis, with the level of significance set at 0.05 (P = 0.05).

    RESULTS: A total of 382 (out of 447) students participated giving a response rate of 86%. More than 90% of students reported that the new system was more accurate and more practical compared with the Vertucci system (P  0.05). The students' responses for all questions were almost similar for both presenters (P > 0.05).

    CONCLUSIONS: The new system of International Endodontic Journal 2017, 50, 761 for classifying root and canal morphology was favoured by final year undergraduate dental students in Malaysia. The new system has the potential to be included in the undergraduate endodontic curriculum for teaching courses related to root and canal morphology.

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