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INTRODUCTION: Due to COVID-19, innovative, virtual educational methods are being developed to provide students with learning experiences comparable to established clinical practices. Our objective was to produce the Periodontal Senior Case Clinical Challenge (PSCCC) that would provide fourth-year students an alternative for senior case presentations and would be a formative assessment for which student opinions would be provided and analysed. The PSCCC would utilise an online, case-based, written, clinical assessment and follow-up, structured discussion to challenge students to demonstrate ability to apply didactic periodontal knowledge to patient-based experiences. We hypothesised the PSCCC would provide effective learning and a formative assessment. MATERIAL AND METHODS: Relevant didactic resources were distributed to 48 students for independent review. The PSCCC was delivered in two sections, (1) a case-based assessment via a virtual classroom with written student responses, and (2) oral discussions conducted via virtual meetings that were moderated and assessed by ten periodontists, with the collaboration of nine residents. A voluntary six-statement survey was used to evaluate the students' opinions of the PSCCC. The scores for 75% (36/48) of students who participated were evaluated for statistical and clinical importance. RESULTS: The value of our PSCCC was supported by 91.7% (33/36) of the analyses (p

In recent years, the application of Guided Endodontics has gained interest for non-surgical endodontic treatment and retreatment. The newest research focuses on the accuracy of Dynamic Navigation (DN). This article systematically reviewed existing data on the accuracy of non-surgical endodontic treatment procedures that were completed using DN. Following the PRISMA criteria, an electronic database search was conducted in PubMed, Web of Science, Scopus, and Cochrane Library. Studies comparing the accuracy of non-surgical endodontic treatment using DN and the conventional freehand technique were eligible. The literature search resulted in 176 preliminary records. After the selection process six studies were included. The risk of bias was evaluated using the modified Cochrane Collaboration Risk of Bias 2.0 tool. Five studies examined the aid of DN for planning and executing endodontic access cavities, and one for fiber post removal. In two studies, endodontic access cavities were performed in teeth with pulp canal obliteration. The main outcomes that were measured in the included studies were preparation time, global coronal entry point and apical endpoint deviations, angular deviation, tooth substance loss, qualitative precision, number of unsuccessful attempts or procedural mishaps. The risk of bias was rated from low to raising some concerns. Overall, DN showed increased accuracy compared to the freehanded technique and could be especially helpful in treating highly difficult endodontic cases. Clinical studies are needed to confirm the published in vitro data.

The present study evaluated the effect of ultrasonic agitation on the porosity distribution of BioRoot RCS/single gutta-percha cone (BR/SC) and MTA Flow (MF) root canals fillings used as apical plugs in moderately curved and apically perforated roots. Eighty mesial root canals of mandibular first molars were enlarged up to ProTaper NEXT X5 rotary instrument 2 mm beyond the apical foramen, simulating apical perforations. Specimens were randomly divided into four experimental groups (20 canals per group) according to the material and technique used for root canal obturation: BR/SC, BR/SC with ultrasonic agitation (BR/SC-UA), MF and MF with ultrasonic agitation (MF-UA). The ultrasonic tip was passively inserted into the root canal after the injection of flowable cement and activated for 10 s. The specimens were scanned before and after obturation with a high-resolution micro-computed tomography scanner, and the porosity of the apical plugs was assessed. The differences between groups were analyzed using the Kruskal-Wallis and Mann-Whitney tests, with the significance level set at 5%. None of the obturation materials and techniques used in this study was able to provide a pore-free root canal filling in the apical 5 mm. Considerably higher percentages of open and closed pores were observed in the MF and MF-UA groups, with the highest porosity being in the MF-UA group (p &lt, 0.05). No significant differences were observed between the BR/SC and BR/SC-UA groups, where the quantity of open and closed pores remained similar (p &gt, 0.05).

The objective of this study was to assess the porosity distribution of BioRoot RCS/single gutta-percha point root-canal fillings performed by a general dental practitioner and endodontist. Fourteen plastic models of maxillary premolars with two roots were selected and shaped with HyFlex EDM instruments to a size 40/0.04 taper and randomly divided into two experimental groups. A total of 14 canals in each group were obturated by two different operators with one HyFlex EDM size 40 gutta-percha point and BioRoot RCS sealer. The specimens were scanned with a high-resolution micro-computed tomography scanner, and the porosity of the fillings at the coronal, middle, and apical thirds of the root canals was qualified and quantified. The differences between groups and root-canal thirds were compared using Mann–Whitney, Friedman, and Wilcoxon tests with the significance level set at p &lt, 0.05. The highest number of pores was observed in the apical third of root-canal fillings in both groups, however, the porosity distribution between the two groups was not significantly different in the apical and middle thirds (p &gt, 0.05). Statistically significant differences were determined only in the coronal third (p &lt, 0.05). The predominance of open pores was detected in all root-canal thirds and groups, with no significant differences in the number of open pores between the coronal and middle thirds (p &gt, 0.05).

The present study evaluated the obturation quality of root canals filled with BioRoot RCS sealer and single gutta-percha point by undergraduate student (US), postgraduate student (PS) and endodontist (ED). Twenty-one plastic models of upper premolars were enlarged with HyFlex EDM instruments to a size 40/0.04 taper and randomly divided into three groups (7 teeth/14 canals per group): US, PS and ED. After the obturation of root canals with BioRoot RCS and one HyFlex EDM size 40 gutta-percha point, plastic models were scanned using micro-computed tomography scanner (µCT) SkyScan 1272 at isotropic resolution of 10 µm. The porosity distribution was evaluated separately for the apical, middle and coronal thirds. The Kruskal–Wallis, Mann–Whitney, Friedman and Wilcoxon tests with the significance level set at 5% were used for data analysis. The µCT evaluation revealed open pores being the dominant type of porosity in all experimental groups and root canal thirds, with the highest percentage of pores in the apical third of root canal fillings. The quality and homogeneity of single cone root canals fillings remained similar between the groups in the apical and middle thirds (p &gt, 0.05). Significant differences were observed only in the coronal third (p &lt, 0.05).

Pulpectomy in deciduous teeth involves endodontic access opening, root canal debridement and obturation with an appropriate filling material. EndoREZ (ER) is the urethane dimethacrylate-based filler, which can be used for root canal obturation in permanent and primary teeth. This observation aimed to evaluate the behavior of the ER as a filler in root canals of two primary molars after the physiological resorption process using the scanning electron microscopy (SEM) and micro-computed tomography (µCT) in second lower molars after their natural exfoliation. The SEM analysis revealed a non-uniform, porous and lacunary structure of ER, visually similar to the resorbed surface of the dentine. The µCT observations demonstrated the differences in the resorption level of the root and material surfaces. The preliminary observations suggest that ER is resorbed faster than root tissues and can therefore be a suitable material for the root canal filling in primary teeth. However, more investigations are needed to support these preliminary findings.

The better understanding of the clinically important behavioral features of new instrument systems has an important significance for the clinical endodontics. This study aimed to investigate the shaping and centering ability as well as cyclic fatigue resistance of HyFlex CM (CM), HyFlex EDM (EDM) and EdgeFile (EF) thermally treated nickel&ndash, titanium (NiTi) endodontic instrument systems. Sixty curved root canals of the mesial roots of mandibular molars were randomly assigned into three groups (n = 20) and shaped using CM, EDM and EF files up to the size 40 and taper 04 of the instruments. &micro, CT scanning of the specimens before and after preparation was performed and the morphometric 2D and 3D parameters were evaluated in the apical, middle and coronal thirds of root canals. In each group, 40.04 instruments (n = 20) were subjected to the cyclic fatigue resistance test in artificial root canals at 37 &deg, C temperature until fractures occurred, and the number of cycles to failure (NCF) was calculated. The fractographic analysis was performed using a scanning electron microscope, evaluating topographic features and surface profiles of the separated instruments. The one-way analysis of variance with post hoc Tuckey&rsquo, s test was used for statistical analysis of the data, the significance level was set at 5%. All systems prepared the comparable percentage of root canal surface with the similar magnitude of canal transportation in all root thirds (p &gt, 0.05), but demonstrated significantly different resistance to cyclic fatigue (p &lt, 0.05). The most resistant to fracture was EF, followed by EDM and CM. The length of the fractured fragments was not significantly different between the groups, and fractographic analysis by SEM detected the typical topographic features of separated thermally treated NiTi instrument surfaces.

Objective: The aim of this study was to compare the impact of treatment procedures on roots previously treated with resorcinol–formaldehyde resin and analyze the effectiveness of dye and magnification for the detection of dentin cracks. Materials and methods: Distal roots of 80 permanent first mandibular molars with a single canal were sectioned at 3 mm and 9 mm from the anatomical apex. Two groups were formed according to the method used for root canal penetration: group 1 (K-file and Pro Taper instruments) and group 2 (Ultrasound with Pro Ultra and Pro Taper files). Before and after the completion of procedures, photographs of the roots were taken for examination for cracks or/and infraction lines with two levels of magnification and with or without a dye. Results: In groups 1 and 2, either with dye or without it, there were statistically significant differences (P &lt, 0.001) with more fractures observed in the coronal than in the apical part of specimens. Statistically significant proportional differences regarding the location of fractures were observed at both magnifications. When the dye was used, there were no statistically significant differences between the two magnifications in the detection of cracks. In the specimens where the dye was not used, differences between the groups were statistically significant at both magnifications with more complete and intra-dental fractures observed in group 2. Conclusions: Retreatment methods had a damaging effect on the root dentin of teeth previously treated with resorcinol–formaldehyde resin. At magnification ×16, the efficacy of using the dye for the detection of cracks was higher than detection without the dye.

To identify the prevalence and determinants of dental trauma in permanent anterior teeth among 11- to 13-year-old schoolchildren, to compare self-reported dental trauma rates with clinical examination trauma rates, and to examine mouthguard use among children engaged in contact sports.A probability sampling scheme was used to recruit schools, with all 6th grade children in the selected schools invited to participate. A total of 2621 caregiver consent forms were sent, of which 807 were returned (31%). Caregivers were asked four trauma-related questions. Clinical examinations included assessment of dental trauma experience (trauma index with five severity codes), lip competence and incisal overjet. Child- and tooth-level analyses were performed.Clinical evidence of dental trauma was found in 52% of participants, 13% self-reported dental trauma, and 7% of children did not remember the occurrence of any trauma. The two most frequently self-reported reasons of dental injury were falls or collisions with objects (63%) and sport/leisure activities (32%). Nearly half of the more severe dental injuries did not receive the necessary treatments. One-third of schoolchildren participated in contact sport activities, but only 3% always used mouthguards. There was a substantial difference between the clinical and self-reported findings. Logistic regression analyses revealed no statistically significant associations between dental trauma experience and the potential determinants studied: gender, lip coverage and overjet.In this study, traumatic dental injuries were observed with 52% prevalence. A substantial discrepancy between self-reported and clinical findings was observed.

The present study evaluated the porosity distribution of BioRoot RCS/single gutta-percha point (BR/SC) and MTA flow (MF) fillings, which were used as plugs for the apical perforation repair in curved canals of extracted mandibular molars using micro-computed tomography (&mu, CT). Forty mesial root canals of mandibular first molars were shaped with ProTaper NEXT X1&ndash, X5 files 2 mm beyond the apex to simulate apical perforations that were randomly divided into two groups (n = 20) according to the material and technique used for the apical plug: BR/SC or MF. The specimens were scanned before and after canal filling at an isotropic resolution of 9.9 &mu, m. The volumetric analysis of voids in the apical 5 mm of the fillings was performed. Data were analyzed using one-way ANOVA with Bonferroni correction (p &lt, 0.05). Micro-computed tomography (&micro, CT) evaluation revealed significant differences between the groups in terms of porosity: the total volume and percentage volume of voids was lower in the BR/SC group in comparison with the MF group (p &lt, 0.05), with the predominance of open pores in both groups. Neither of the materials and/or application techniques were able to produce void-free root fillings in the apical region of artificially perforated curved roots of mandibular molars.

Dental implant abutment and prosthetic materials, their surface treatment, and cleaning modalities are important factors for the formation of a peri-implant soft tissue seal and long-term stability of bone around the implant. This study aimed to investigate the influence of a polymeric material surface cleaning method on the surface roughness, water contact angle, and human gingival fibroblasts (HGF) proliferation. Polymeric materials tested: two types of milled polymethylmethacrylate (PMMA-Ker and PMMA-Bre), three-dimensionally (3D) printed polymethylmethacrylate (PMMA-3D), polyetheretherketone (PEEK), and polyetherketoneketone (PEKK). Titanium (Ti) and zirconia oxide ceramics (ZrO-HT) were used as positive controls. A conventional surface cleaning protocol (CCP) was compared to a multi-step research cleaning method (RCP). Application of the RCP method allowed to reduce Sa values in all groups from 0.14&ndash, 0.28 &micro, m to 0.08&ndash, 0.17 &micro, m (p &lt, 0.05 in PMMA-Ker and PEEK groups). Moreover, the water contact angle increased in all groups from 74&ndash, 91&deg, to 83&ndash, 101&deg, (p &lt, 0.05 in the PEKK group), except ZrO-HT&mdash, it was reduced from 98.7 &plusmn, 4.5&deg, to 69.9 &plusmn, 6.4&deg, 0.05). CCP resulted in higher variability of HGF viability after 48 and 72 h. RCP application led to higher HGF viability in PMMA-3D and PEKK groups after 48 h, but lower for the PMMA-Ker group (p &lt, 0.05). After 72 h, no significant differences in HGF viability between both cleaning methods were observed. It can be concluded that the cleaning method of the polymeric materials affected surface roughness, contact angle, and HGF viability at 48 h.

To analyze the need for referral to a specialist and to identify the reasons of referrals among Lithuanian general dental practitioners.Questionnaires were sent to all 2879 Lithuanian dental practitioners registered on the Lithuanian Dental Chamber license registry. The questionnaire was made with multiple-choice answers. Respondents were asked to choose only one category of answer that best fitted their clinical attitude. Questions included in the questionnaire concerned general and specific information regarding the need and main reasons for endodontic referral.Of the 2879 questionnaires mailed, 1532 questionnaires containing useful information were returned. The response rate was 53.2%. Of the 1532 respondents, 1431 were general dental practitioners. Majority (72.1%) of the respondents performed complicated root canal treatment by themselves. Almost half (49.6%) of them would like to refer patients to an endodontist. Two of the reasons, which restricted their decision, were the shortage of endodontists and high cost of the procedures in the specialized clinics. Approximately 19% of the respondents referred patients to an endodontist. The main reasons for referral were fractured instruments (86.6%), dental trauma (83.6%), difficulties in diagnostics (79%) followed by persistent symptoms (78.1%).The findings of the present study suggest that the need for referral of patients to an endodontist among Lithuanian dental practitioners exists. The main reasons for referrals were complications of endodontic treatment, traumatic injuries, difficulties in diagnostic procedures, and persistent symptoms.

Purpose: Plasma-sprayed hydroxyapatite (HA)-coated implants show failures along the coating–substrate interface due to poor bond strength. We analyzed HA coatings obtained by pulsed laser deposition (PLD) and compared them to commercially used plasma-sprayed coatings with respect to their bond strength to titanium alloy (Ti-6Al-4V), as well as surface roughness alterations produced by each of the two deposition methods. Materials and Methods: Twelve titanium alloy disks were plasma-sprayed under commercial implant coating conditions, and 24 titanium alloy disks were coated using PLD. All coatings were characterized by the presence of the different calcium phosphate (CaP) phases. The plasma-sprayed coatings (n = 12) were predominantly HA, and the pulsed laser-deposited coatings were hydroxydyapatite (n = 12) and HA coating with a tetra calcium phosphate (TTCP) phase (n = 12). The surface roughness was analyzed before and after the coating processes to assess roughness changes to the surface by the coatings. The adhesive bond strengths of these coatings to the substrate titanium alloy was tested and compared. Scheffe's test was used to analyze the statistical significance of the data. Results: The surface roughness alteration following PLD was a decrease of 0.2 μm, whereas following plasma spraying the decrease was 1.0 μm. Bond strengths were as follows [mean (SD) in MPa]: pulsed laser-deposited HA coatings: 68.3 (17.8); pulsed laser-deposited HA with tetra-CaP: 55.2 (21.1); plasma-sprayed HA 17.0 (2.8). The multivariate Scheffe's test revealed that HA coatings obtained by PLD had significantly increased bond strengths compared with the plasma sprayed ones (p≤ 0.05). Conclusions: HA coatings obtained by PLD showed greater adherence to titanium alloy. PLD offers an alternative method to produce thinner coatings with better adherence properties, along with precise control over the deposition process.