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Background: Understanding the root canal morphology is essential for the success of root canal treatment. Therefore, this study aimed to evaluate and analyze the root canal configuration of maxillary premolars using Cone Beam Computed Tomography in the Pakistani subpopulation. Method: This cross-sectional study utilized CBCT scans from two distinct centres: Aga Khan University in Karachi and Jinnah MRI and Body Scans in Lahore. The CBCT images were visualized using GALAXIS version 1.9 (SICAT GmbH and Co. KG, Bonn, Germany), integrated within the Sirona Dental System (D-64625 Bensheim, Germany). The scanning parameters were standardized at 85 kV, 7 mA, with a 15-s exposure time and a voxel size of 0.16 mm. A total of 707 CBCT scans were collected, encompassing 2180 maxillary premolars. Root canal configurations were classified based on (Ahmed et al. Int Endod J. 2017;50(8):761–70). Statistical analyses were performed using SPSS version 26, employing the Chi-square test with a significance level set at p < 0.05. Results: The distribution of root canal morphologies varied significantly with age and gender. Among maxillary premolars, 50% exhibited the typical configuration of 2MPMB1 L1 (two roots, single canal in each buccal and lingual root), while 26% of maxillary right second premolars displayed 1MPM1 (one root, one canal). Overall, 1MPM1 accounted for 27.4% of the total cases in the second premolars. There was no statistically significant relationship between age and root canal distribution in either first premolars (p = 0.338) or second premolars (p = 0.833). Regarding gender, a significant difference was observed in the distribution of right maxillary 1st premolars (p = 0.022*), with a higher prevalence among females. Conclusion: This study offers significant insights into the anatomical variations of root canals in maxillary premolars across diverse regional subpopulations in Pakistan. While specific root canal configurations were prevalent, the findings indicate no statistically significant correlation between age and root canal morphology in maxillary premolars. However, a notable gender disparity was observed in the distribution of the right maxillary first premolars. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of two canals in mandibular central incisors using a radiographic technique in a sample representing Karachi Pakistan. Study Design: Cross-sectional in Vitro study. Setting: Hamdard University Dental Hospital. Period: January, 2022 to July, 2022. Material & Methods: According to inclusion criteria 187 extracted mandibular central incisors were collected, flushed under running tap water. 10% formalin was used as storage media afterwards. The attached periodontal tissues and calculus remaining after extraction were removed using a 1/2 Gracey Curette. Number 2 round bur was used in a high speed hand piece to initiate access chamber opening of the pulp chamber. Irrigation was done with 2.5% sodium hypochlorite to make the pulp chamber clearly visible. Detection and negotiation of second canal were performed by using Dental Operating Microscope. No. 15 K-files were introduced into the main canals. Two peri-apical radiographs were exposed at different angulations using DIGORA OPTIME for confirmation. Data was analyzed by using SPSS version 23. Results: Mean age of the patients included in the study were 37.12±12.81 years. According to gender distribution there were 101 (54%) males and 86 (46%) females. Outcome concludes that in mandibular central incisors frequency of two canals was 28.3 %. Conclusion: Presence of two canals in mandibular central incisors among Pakistani population in our study was 28.3%. When endodontic therapy is commenced on these teeth, dentist must consider the possibility of existence of second canal and exercise caution. [ABSTRACT FROM AUTHOR]

Objective: To identify the pattern of tooth extraction and its relative risk factors in our local population, in terms of gender distribution and age groups. Study Design: Cross-sectional study. Setting: Department of Oral & Maxillofacial Surgery, Sir Syed College of Medical Sciences for Girls, Karachi-Pakistan. Period: May 2018 to April 2019. Material & Methods: Following the selection criteria, a number of 242 patients were selected with the age ranging from 15 years to 65 years. After history and examination, following information was recorded in a proforma; age, gender, type of tooth extracted, reason for extraction of tooth (caries, periodontal disease, trauma, pericoronitis, impactions, prosthesis, supernumerary teeth and failed root canal treatment), relative risk factors (uncontrolled diabetes mellitus, smokers) were also noted, data was analyzed using SPSS version 21. Results: 242 patients underwent a total of 1149 dental extractions in a period of 1 year. Mean age was 36 years with a male predilection. Most commonly extracted tooth was mandibular molar. Most common reason of tooth extraction were dental caries, followed by periodontal diseases. Relative risk factors like diabetes and smoking had a statistically strong association with tooth extraction. Conclusion: Dental extractions were more common in males. Most common reason of tooth extraction was dental caries. Diabetes and smoking are significant relative risk factor for extractions. [ABSTRACT FROM AUTHOR]

Objective: To categorize root canal configuration according to Vertucci's classification and determine the frequency of second canal in mandibular lateral incisors of Pakistani subpopulation (Karachi based) by using Cone Beam Computed Tomography. Study Design: Cross sectional study. Place and Duration of Study: Out-patient department of Oral and Maxillofacial Surgery and the department of Radiology at Dow University of Health Sciences, Karachi Pakistan, from Jan to Jul 2019. Methodology: Study was conducted on 160 extracted permanent mandibular lateral incisors. After extraction, teeth were randomly arranged in wax models and imaged via CBCT. Each tooth sample was analyzed in axial and sagittal sections. The images were investigated by two blinded examiners and data on canal morphology was recorded. Results: The frequency of single canal mandibular incisors was recorded as 107 (66.9%) whereas 53 (33.1%) of teeth showed two canals. Females presented with a higher frequency of two canalled incisors, although the results were statistically insignificant. The most prevalent canal anatomy detected was Type I (105, 65.6%) followed by Type III (33, 20.6%), Type II (12, 7.5%) and Type V (10, 6.3%). Mandibular lateral incisors presenting with two canals anatomy, Type III (32, 97%) morphology was most commonly detected followed by Type II (12, 100%) and Type V (9, 90%). Conclusion: CBCT scans are an effective tool for identification of root canal morphology. Mandibular lateral incisors most frequently presented with Type I canal anatomy whereas incisors with two canals most frequently presented with Type III configuration. [ABSTRACT FROM AUTHOR]

Objective: To compare manual H-File with ProTaper Retreatment files for the abolition of Gutta Percha filling material from the root canals with or without solvent use (Eugenate). Study Design: Quasi-experimental study. Place and Duration of Study: Operative Dentistry Department, Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from Sep 2019 to Feb 2020. Methodology: Forty mandibular premolars with previously failed root canal treatment were chosen. They were randomly divided into four groups, each with ten teeth. Gutta-percha filling material elimination was done with manual H-Files and rotary ProTaper with and without Eugenate and evaluated radiographically. The time duration for complete removal was also noted and evaluated by stopwatch. Results: Out of the total 40 patients 22(55%) were female and 18(45%) were males. Comparison of mean operating time duration of elimination of Gutta Percha filling material from the canals was less with ProTaper with Eugenate compared with the other three groups; however, it showed statistically significant differences among groups (p<0.05). Conclusion: Every group showed some residual lling material in the canals. ProTaper D retreatment files with Eugenate performed faster than ProTaper alone, followed by manual H-files without Eugenate and Eugenate. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To find out number of roots, root-canals and canal configuration in permanent mandibular third molars through tooth clearing technique. METHODS: In this cross-sectional study, 193 extracted human mandibular permanent third molars with completely formed apical foramen and intact roots were collected from both genders treated at dental hospitals in Peshawar, st st Pakistan from 1st July to 31th December 2019. After collection teeth were visually inspected to count number of roots, followed by access cavity preparation, pulp extirpation and canal staining with black Indian ink. Decalcification was done by placing teeth in nitric acid for 5 days followed by dehydration in ascending concentrations of alcohol. Complete transparency was achieved by immersing teeth in methyl-salicylate for 72 hours. Transparent teeth were inspected again for number of roots and root-canals. RESULTS: Among 193 extracted mandibular third molars, (n=161; 83.4%) had two-roots and (n=24; 12.4%) were single-rooted. Two-canals were present in vast majority (n=142; 73.6%) whereas three and one-canal were seen in (n=37; 19.2%) and (n=13; 6.7%) teeth respectively. Most common type of root canal pattern was Vertucci's Type-I in mesial-roots (n=79; 63.7%) and distal-roots (n=120; 96.8%). Vertucci's Type-II and Type-IV were (n=15; 12.1%) and (n=12; 9.7%) in the mesial-roots respectively. Mandibular third molars didn't present with any configurations that didn't fullfill Vertucci's criteria. Correlation between number of roots and root-canals of mandibular third molars was non-significant. CONCLUSION: Two-roots and two-canals were common patterns for mandibular third molars. Mesial and distal roots were predominant in Type-I followed by Type-II and Type-IV Vertucci's classification. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of the study is to assess the variations in the root canal configuration of maxillary second permanent molars in the Pakistani subpopulation by using different clinical aids in vivo. METHODOLOGY: The Cross-sectional analytical study was conducted from April to October 2018 at the College of Dentistry, Riphah International University, Pakistan. The root canal configurations of Maxillary second molars were evaluated in 95 adult patients that presented to the Operative Department, after obtaining consent. After access cavity preparation the orifices were identified and cross checked using 2.5x magnification and different clinical tests. Data analysis was done by utilizing SPSS version 23. RESULTS: Out of the 95 teeth 6(6.3%) teeth had a single canal, 7(7.4%) teeth had two canals, 58(61.1%) teeth had three canals and 24(25.3%) teeth had four canals. Age-wise analysis of the frequency of different canals showed that prevalence of molars with three canals was significantly higher in the subjects with age between 41 and 50 years. CONCLUSION: Overall, the study noted four morphological variations in the root canal configuration of Maxillary second molar teeth in Pakistani subpopulation. Hence, while executing the endodontic treatment in the maxillary second molars a thorough assessment of the root canal system should be carried out. The results of the study can guide Pakistani dentists. [ABSTRACT FROM AUTHOR]

Objective: To investigate the opinions and attitudes of dental practitioners towards intracanal separation of endodontic instruments and to create awareness regarding the management of separated instruments Study Design: Cross-sectional survey Place and Duration of Study: Department of Operative Dentistry Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from Mar to Apr 2021. Methodology: An online questionnaire was circulated among 374 dentists of private and public hospitals in Rawalpindi and Islamabad. The questionnaire consisted of close-ended questions related to demographic details, dentists' awareness of instrument separation, the frequency of separated instruments, the causes of separation, the management of separated instruments, and the retrieval strategies if used. Results: Out of 374 study participants, 307(82.1%) of the participants thought that operator-related factors such as improper or overuse of the instrument were considered the most common factors for instrument separation during root canal procedures. 205(54.8%) thought unwinding, defective flutes and shiny areas were the most common factors affecting instrument separation. 241(64.4%) of the instruments are separated during cleaning and shaping. 135(36.1%) K files and 119(31.8%) H files were separated in this survey. Conclusion: Most dentists of Rawalpindi and Islamabad face the problem of endodontic instrument separation during root canal preparation. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To identify and compare the variations in the root and canal morphology of maxillary first and second premolars in the local population. METHODS: Maxillary premolars (n=210) were collected from local population from six hospitals and clinics of two cities i.e. Peshawar and Kohat, Pakistan. The demographics collected from the patients included linguistic ethnicity and gender. External morphological parameters; length, root form, mesial surface depression, were observed by the naked eye. These were then observed under stereomicroscope to identify the internal root morphology including canal form, lateral canals, and canal isthmi. RESULTS: Common root form of first premolars was two rooted (70%) while second premolars were single rooted (81%). Mesial surface depression was more common in first premolars (76%) than second premolars (36%) p<0.001. In first premolars common canal configuration was Type IV (62%) and type II (9.5%) while in second premolars type I (20%), II (35%), IV (11.4%) and type VI (24.8%) configuration were commonly found. Lateral canals and canal isthmi were a lesser common finding in both types of teeth. CONCLUSION: Canal configuration of first premolars was most commonly type IV while that of second premolar was type I, II, VI and IV in our population. This indicates that second premolar has more diversity in canal configuration. [ABSTRACT FROM AUTHOR]

Objective: To analyse the C-shaped canal configuration in the mandibular second molar in a Pakistani subpopulation using cone beam computed tomography (CBCT). Study Design: Cross-sectional study. Place and Duration of Study: Department of Radiology, Dow University of Health Sciences, Karachi Pakistan, from Feb to Jul 2020. Methodology: Cone-beam computed tomography (CBCT) scans of the mandibular second molar that were taken for some other purpose were included in the study. One hundred fifty mandibular second molar teeth were assessed for C-shaped canal morphology. The c-shaped canal was then further examined at three different levels classifying according to Fan criteria, a modification of Melton's classification. Differences between gender left and right sides, unilateral and bilateral, were determined. Results: Out of 150 mandibular second molars, a C-shaped canal was found in 13(8.7%) of the teeth examined, in which 9(69.2%) were in females, and 4(30.8%) were in males. Bilateral distribution was found to be 11(92.3%). Conclusion: A high frequency of C-shaped canal in the mandibular second molars was observed in the present study. Therefore the variations in the morphology of the root canal system of the mandibular second molars should be considered when performing root canal treatment. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine the number and configuration of canals in permanent maxillary premolars using Cone Beam Computed Tomography (CBCT) and the relationship between canals count and patient gender in northwest region of Pakistan. METHODS: This cross-sectional observational study was conducted at Khyber st College of Dentistry (KCD) Peshawar, Pakistan. Data was collected from July 1 th to 30 December 2020, using 133 patient's CBCT scans with 266 maxillary premolar teeth. Roots and canals frequency as well as configurations were analyzed using Vertucci canal classification. CBCT images were obtained from Radiology department of KCD. Data were analyzed using SPSS-23 software, RESULTS: Type-I Vertucci's canal composition was most common in first premolars (45.4%), followed by Type-IV (25.9%). Type-I was the most frequent find in second premolars (64.2%), followed by Type-III (15.4%). In Maxillary first premolars, 247 (92.8%) were single-rooted and 19 (7.14%) were two-rooted. In maxillary second premolars, 155 (57.9%) were single-rooted, 110 (41.3%) were two-rooted, and one (0.37%) was three-rooted. In first and second premolar, single-root was the commonest root among males (92.7% and 58.4%) and females (30.8% and 19%) respectively. Gender-based difference in canal count in all premolars was not-significant. Mean tooth length of first and second premolar was 19.40±2.035 mm and 20.08±2.395 mm respectively. Mean crown length of first and second premolar was 6.05±0.752 mm and 5.69±0.505 mm respectively. CONCLUSION: Most of the maxillary first and second premolars had Vertucci classification Type-I configuration. Gender-based diversity for number of canals was not-significant. All Vertucci canal configuration types were observed in maxillary premolars. [ABSTRACT FROM AUTHOR]

BACKGROUND: Various methods are described in literature for determining accurate age, one of which is coronal pulp index by using dental radiograph. OBJECTIVES: The purpose of present study is to check the validity of coronal pulp index in estimation of age in Pakistani population. METHODS: Cross-sectional study was conducted in AKUH dental clinics in two months period in which a total of 397 teeth (210 females and 187 males) of Pakistani individuals were analyzed on panoramic radiographs using non-probability convenient sampling technique. Coronal pulp chamber heights and crown height were measured in unrestored mandibular right and left first and second premolars, and first and second molars. These measurements were then used to calculate the tooth coronal index (TCI). Data was analyzed by using SPSS version 19. Paired sample t-test was used to assess bilateral symmetry of TCI for premolars and molars. Pearson correlation was used to assess association between chronological age and tooth coronal index. RESULTS: The correlation coefficient between chronological age and tooth coronal index was found to be 0.05. The correlation coefficient in males ranges from -0.049 (for tooth# 34) to 0.03 (for tooth # 46) whereas in females the correlation coefficient ranges from -0.19(for teeth # 36 and 47) to 0.25(for tooth # 35). However, tooth # 47 in males showed some degree of negative correlation(r= -0.43) but is not statistically significant. CONCLUSION: This study shows that there is no association between age and TCI of any tooth in Pakistani population so coronal pulp index cannot be used for age estimation of Pakistani population. Other methods should be used for accurate age estimation. [ABSTRACT FROM AUTHOR]