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  1. Mamat R, Nik Abdul Ghani NR
    Cureus, 2023 Nov;15(11):e49024.
    PMID: 38111413 DOI: 10.7759/cureus.49024
    The main goal of root canal treatment is to eliminate the infection in the complex root canal system for the long-term preservation of a functional tooth. Proper debridement of the root canal system, especially in the apical portion, is essential for successful root canal treatment. The complexity of the canal anatomy in the apical region plays a crucial role in reducing the microbial load. Therefore, clinicians must have a thorough knowledge of the anatomy of the root canal system and its variations, especially in the apical portion. Root canal configurations in cross-section have been classified as round, oval, long oval, flattened, or irregularly shaped. Treating oval, long oval, flattened, or irregularly shaped canals is challenging and should be approached differently than a circular canal. Recognizing the root canal shape and apical anatomy determines the different strategies to be used in cleaning, shaping, and obturation to achieve the best result of root canal treatment. The recent development of the instrumentation system improves the treatment outcome for clinicians and patients. This review aimed to discuss the definition, prevalence, and instrumentation for cleaning and shaping in the apical area with the complexity of root canal systems. Therefore, with the aid of this review, we can better understand the variations in the anatomy of the root canal, especially at the apical portion.
  2. Nik Abdul Ghani NR, Abdul Hamid NF, Karobari MI
    Clin Case Rep, 2020 Aug;8(8):1387-1391.
    PMID: 32884760 DOI: 10.1002/ccr3.2942
    An untreated root canal infection usually stimulates the development of a radicular cyst. Nonsurgical root canal procedures and periapical surgery followed by placement of bone substitute will promote the healing process of the bony defect.
  3. Siew Ching H, Thirumulu Ponnuraj K, Luddin N, Ab Rahman I, Nik Abdul Ghani NR
    Polymers (Basel), 2020 Sep 17;12(9).
    PMID: 32957636 DOI: 10.3390/polym12092125
    This study aimed to investigate the effects of nanohydroxyapatite-silica-glass ionomer cement (nanoHA-silica-GIC) on the differentiation of dental pulp stem cells (DPSCs) into odontogenic lineage. DPSCs were cultured in complete Minimum Essential Medium Eagle-Alpha Modification (α-MEM) with or without nanoHA-silica-GIC extract and conventional glass ionomer cement (cGIC) extract. Odontogenic differentiation of DPSCs was evaluated by real-time reverse transcription polymerase chain reaction (rRT-PCR) for odontogenic markers: dentin sialophosphoprotein (DSPP), dentin matrix protein 1 (DMP1), osteocalcin (OCN), osteopontin (OPN), alkaline phosphatase (ALP), collagen type I (COL1A1), and runt-related transcription factor 2 (RUNX2) on day 1, 7, 10, 14, and 21, which were normalized to the house keeping gene glyceraldehyde-3-phosphate dehydrogenase (GAPDH). Untreated DPSCs were used as a control throughout the study. The expressions of DSPP and DMP1 were higher on days 7 and 10, that of OCN on day 10, those of OPN and ALP on day 14, and that of RUNX2 on day 1; COL1A1 exhibited a time-dependent increase from day 7 to day 14. Despite the above time-dependent variations, the expressions were comparable at a concentration of 6.25 mg/mL between the nanoHA-silica-GIC and cGIC groups. This offers empirical support that nanoHA-silica-GIC plays a role in the odontogenic differentiation of DPSCs.
  4. Karobari MI, Parveen A, Mirza MB, Makandar SD, Nik Abdul Ghani NR, Noorani TY, et al.
    Int J Dent, 2021;2021:6682189.
    PMID: 33679981 DOI: 10.1155/2021/6682189
    Introduction: While there are many root morphology classification systems with their own distinct advantages, there are many shortcomings that come along with each system.

    Objectives: The aim of this review was to compare the various root and root canal morphology classifications, their advantages, limitations, and clinical and research implications. Data Sources and Selection. An extensive literature search was conducted on PubMed and Scopus to identify the published data on root and root canal classification systems published until 1 May 2020 using keywords, root canal classification system, classification systems for root canals, and root morphology. The related literature was reviewed and then summarized. Data Synthesis. Several studies have analysed and detailed root and root canal classifications and further added new subsystems, works of Weine et al. (1969) and Vertucci et al. (1974). Besides, Sert and Bayirli (2004) added supplementary types to Vertucci's classification system. A new classification was most recently introduced by Ahmed et al. (2017) involving the use of codes for tooth numbering, number of roots, and canal configuration.

    Conclusions: Weine et al. classified only single-rooted teeth, without considering multirooted teeth and complex configurations. Vertucci's classification included complex configurations, with Sert and Bayirli adding further complex supplemental types. Ahmed et al.'s classification simplifies classifying root and canal morphology while overcoming the limitations of several previous classification systems making it beneficial for implementation in dental schools.

  5. Moheet IA, Luddin N, Rahman IA, Kannan TP, Nik Abd Ghani NR, Masudi SM
    Eur J Dent, 2019 Jul;13(3):470-477.
    PMID: 31280484 DOI: 10.1055/s-0039-1693524
    The aim of this article is to provide a brief insight regarding the recent studies and their recommendations related to the modifications to glass ionomer cement (GIC) powder in order to improve their properties. An electronic search of publications was made from the year 2000 to 2018. The databases included in the current study were EBSCOhost, PubMed, and ScienceDirect. The inclusion criteria for the current study include publication with abstract or full-text articles, original research, reviews or systematic reviews, in vitro, and in vivo studies that were written in English language. Among these only articles published in peer-reviewed journals were included. Articles published in other languages, with no available abstract and related to other nondentistry fields, were excluded. A detailed review of the recent materials used as a filler phase in GIC powder has revealed that not all modifications produce beneficial results. Recent work has demonstrated that modification of GIC powder with nano-particles has many beneficial effects on the properties of the material. This is due to the increase in surface area and surface energy, along with better particle distribution of the nano-particle. Therefore, more focus should be given on nano-particle having greater chemical affinity for GIC matrix as well as the tooth structure that will enhance the physicochemical properties of GIC.
  6. Moheet IA, Luddin N, Ab Rahman I, Masudi SM, Kannan TP, Nik Abd Ghani NR
    Polymers (Basel), 2021 Oct 12;13(20).
    PMID: 34685263 DOI: 10.3390/polym13203504
    One of the foremost missions in restorative dentistry is to discover a suitable material that can substitute lost and damaged tooth structure. To this date, most of the restorative materials utilized in dentistry are bio-inert. It is predicted that the addition of nano-HA-SiO2 to GIC matrix could produce a material with better ion-exchange between the restorative material and natural teeth. Therefore, the aim of the current study was to synthesize and investigate the transfer of specific elements (calcium, phosphorus, fluoride, silica, strontium, and alumina) between nano-hydroxyapatite-silica added GIC (nano-HA-SiO2-GIC) and human enamel and dentine. The novel nano-hydroxyapatite-silica (nano-HA-SiO2) was synthesized using one-pot sol-gel method and added to cGIC. Semi-quantitative energy dispersive X-ray (EDX) analysis was carried out to determine the elemental distribution of fluorine, silicon, phosphorus, calcium, strontium, and aluminum. Semi-quantitative energy dispersive X-ray (EDX) analysis was performed by collecting line-scans and dot-scans. The results of the current study seem to confirm the ionic exchange between nano-HA-SiO2-GIC and natural teeth, leading to the conclusion that increased remineralization may be possible with nano-HA-SiO2-GIC as compared to cGIC (Fuji IX).
  7. Subhi H, Husein A, Mohamad D, Nik Abdul Ghani NR, Nurul AA
    Polymers (Basel), 2021 Sep 30;13(19).
    PMID: 34641172 DOI: 10.3390/polym13193358
    Calcium silicate-based cements (CSCs) are widely used in various endodontic treatments to promote wound healing and hard tissue formation. Chitosan-based accelerated Portland cement (APC-CT) is a promising and affordable material for endodontic use. This study investigated the effect of APC-CT on apoptosis, cell attachment, dentinogenic/osteogenic differentiation and mineralization activity of stem cells from human exfoliated deciduous teeth (SHED). APC-CT was prepared with various concentrations of chitosan (CT) solution (0%, 0.625%, 1.25% and 2.5% (w/v)). Cell attachment was determined by direct contact analysis using field emission scanning electron microscopy (FESEM); while the material extracts were used for the analyses of apoptosis by flow cytometry, dentinogenic/osteogenic marker expression by real-time PCR and mineralization activity by Alizarin Red and Von Kossa staining. The cells effectively attached to the surfaces of APC and APC-CT, acquiring flattened elongated and rounded-shape morphology. Treatment of SHED with APC and APC-CT extracts showed no apoptotic effect. APC-CT induced upregulation of DSPP, MEPE, DMP-1, OPN, OCN, OPG and RANKL expression levels in SHED after 14 days, whereas RUNX2, ALP and COL1A1 expression levels were downregulated. Mineralization assays showed a progressive increase in the formation of calcium deposits in cells with material containing higher CT concentration and with incubation time. In conclusion, APC-CT is nontoxic and promotes dentinogenic/osteogenic differentiation and mineralization activity of SHED, indicating its regenerative potential as a promising substitute for the commercially available CSCs to induce dentin/bone regeneration.
  8. Bapna P, Ali A, Makandar SD, Nik Abdul Ghani NR, Metgud S
    Cureus, 2023 Jan;15(1):e34247.
    PMID: 36843773 DOI: 10.7759/cureus.34247
    AIM: To compare the effect of different tapers of the K3XF file system on the fracture resistance of endodontically treated mandibular premolars obturated with a three-dimensional (3-D) obturation system.

    METHODOLOGY: For the study, 80 freshly extracted human mandibular premolars with single well-developed roots without any curvatures were taken and the tooth roots were wrapped in a single layer of aluminum foil, and they were placed vertically in a plastic mold filled with self-curing acrylic resin. The access was opened, and working lengths were determined. The canals were instrumented keeping an apical size of #30 by different taper rotary files: Group 1: un-instrumented (control group), Group 2: 30/.04, Group 3: 30/.06, Group 4: 30/.08 K3XF file system, and teeth were obturated using a 3-D obturation system, and access cavities were filled using composite. Both experimental and control groups were subjected to fracture load using a conical steel tip (0.5mm) attached to a universal testing machine to record force applied in newton until root fracture.

    RESULTS: Root canal instrumented groups showed lower fracture resistance than the uninstrumented group.

    CONCLUSION: Hence it could be concluded that endodontic instrumentation with increased taper rotary instruments caused a decrease in fracture resistance of the teeth, and biomechanical preparation of root canal system with rotary or reciprocating instruments caused a significant decrease in fracture resistance of endodontically treated teeth (ETT), thereby decreasing their prognosis and long-term survival.

  9. Lin GS, Ghani NR, Ismail NH, Singbal K, Murugeshappa DG, Mamat N
    J Clin Exp Dent, 2020 Aug;12(8):e762-e770.
    PMID: 32913574 DOI: 10.4317/jced.56864
    Background: This study aimed to compare the fracture strength, fracture pattern and type of fracture of endodontically treated maxillary lateral incisors restored with new zirconia reinforced rice husk nanohybrid composite.

    Material and Methods: Eighty mature permanent maxillary lateral incisors from patients age range of 30-60 years with single canal were selected and randomly divided into: Group 1 - RCT + nanofilled composite (Filtek), Group 2 - RCT + microhybrid composite (Zmack), Group 3 - RCT + new nanohybrid composite (Zr-Hybrid) and Group 4 - Intact teeth (control). Standardized mesio-palatal-distal cavity was prepared, and endodontic treatment was carried out using crown-down technique until size 30, tapered 0.04. Obturation was completed using single cone technique with gutta-percha and AH plus sealer. Cavity access was restored with respective composite resins. Next, teeth were stored in incubator for 24 hours and subdivided into aged and unaged subgroups. Teeth in aged subgroups were subjected to 2500 thermal cycles for 5ºC, 37ºC and 55ºC with 30 seconds dwell time and 5 seconds transfer time. After that, root surfaces of teeth were covered with silicone-based material and placed in boxes filled with acrylic until the cemento-enamel-junction (CEJ) level. They were then tested under Universal Testing Machine until fracture occurred. Samples were then viewed under Leica microscope to determine the fracture pattern and type of fracture. Data analyzed using One-way ANOVA complimented by post hoc Tukey HSD and paired sample T test for fracture strength. Fracture pattern and type of fracture were analyzed using Chi-square test. Level of significance was set at p<0.05.

    Results: Significant differences were observed (p<0.05) with Group 3 demonstrating the highest fracture strength followed by Group 4, Group 1 and lastly Group 2 in both aged and unaged subgroups respectively. A significant decreased in fracture strength was noted in Group 1 and Group 2 (p<0.05) as number of thermocycle increased but no significant differences were noted in Group 3 and Group 4 (p>0.05). Besides, Group 3 and Group 4 showed higher rate of favorable fracture pattern, followed by Group 1 and lastly Group 2. Most favorable fracture pattern was noted to exhibit horizontal fracture type (86.36%), whereas most unfavorable fracture pattern exhibited vertical fracture type (77.78%).

    Conclusions: Endodontically treated teeth restored with new zirconia reinforced rice husk nanohybrid composite (Zr-Hybrid) demonstrated higher fracture strength than commercialized composite resins especially after artificial ageing. Zr-Hybrid showed similar fracture pattern to those of intact teeth with higher rate of horizontal fracture type. Key words:Fracture strength, fracture pattern, composite resin, rice husk, Zirconia.

  10. Hii SC, Luddin N, Kannan TP, Ab Rahman I, Nik Abdul Ghani NR
    Contemp Clin Dent, 2019;10(2):324-332.
    PMID: 32308298 DOI: 10.4103/ccd.ccd_581_18
    BACKGROUND: Despite their lower strength, glass ionomer cements (GICs) are widely used as restorative materials because of their anti-cariogenic properties, direct adhesion to tooth structure and good biocompatibility. Recently, the addition of nano-hydroxyapatite (nano-HA)-silica to conventional GIC (cGIC) has been shown to improve the strength of cGIC. However, the biocompatibility and cell attachment properties of this material are unknown.

    AIMS: This study aims to evaluate and compare the cytotoxicity and cell attachment properties of cGIC and nano-HA-silica-GIC on dental pulp stem cells (DPSCs).

    METHODS AND MATERIALS: Material extracts of nano-HA-silica-GIC and cGIC were prepared into seven serial dilutions and applied to 96 well plates seeded with DPSCs. After 72 h, the cell viability was determined using MTT assay. The DPSCs cell attachment properties were examined under scanning electron microscope (SEM) after 24 and 72 h. Kruskal-Wallis test was used to analyse the data for MTT assay (P < 0.05). SEM images of cell attachment properties were also described.

    RESULTS: Nano-HA-silica-GIC and cGIC was shown to be slight to non-cytotoxic at all concentrations, except 200 mg/ml. Moderate cytotoxicity has been observed at 200 mg/ml concentration where nano-HA-silica-GIC and cGIC revealed cell viability values of 44.38 and 42.15%, respectively. Nano-HA-silica-GIC demonstrated better cell viability values than cGIC at all concentrations except for 6.25 and 12.5 mg/ml. Nevertheless, the results were not statistically significant (P > 0.05). SEM examination revealed the increasing numbers of DPSCs attached to both groups with prominent filopodia, especially after 72 h.

    CONCLUSIONS: Nano-HA-silica-GIC exhibited good biocompatibility which is comparable to cGIC and favoured the attachment of DPSCs.

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