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Introduction The purpose of this study was to investigate the accuracy and efficiency of the 3-dimensional dynamic navigation system (DNS) compared with the freehand technique (FH) when removing fiber posts from root canal–treated teeth. Methods Twenty-six maxillary teeth were included. Teeth were root canal treated and restored with Parapost Taper Lux (Coltene/Whaledent, Altstatten, Switzerland) luted with RelyX Unicem (3M ESPE, St Paul, MN). A core buildup was then performed using Paracore (Coltene/Whaledent). Teeth were mounted in tissue-denuded cadaver maxillae. Teeth were divided into 2 groups: the DNS group (n = 13) and the FH group (n = 13). Cone-beam computed tomographic scans were taken pre- and postoperatively. The drilling path and depth were planned virtually using X-guide software (X-Nav Technologies, Lansdale, PA) in both groups. For the DNS group, drilling was guided with X-Nav software and the FH group under a dental operating microscope. Global coronal and apical deviations, angular deflection, operation time, and the number of mishaps were compared between the groups to determine the accuracy and efficiency. The 3-dimensional volume (mm3) of all teeth was calculated before and after post removal using the Mimics Innovation Suite (Materialise NV, Leuven, Belgium). The Shapiro-Wilk, 1-way analysis of variance, and Fisher exact tests were used (P Results The DNS group showed significantly less global coronal and apical deviations and angular deflection than the FH group (P Conclusions The DNS was more accurate and efficient in removing fiber posts from root canal–treated teeth than the FH technique.

To determine and compare the accuracy and efficiency of a dynamic navigation system (DNS) with a freehand (FH) technique when conducting root-end resection in a human cadaver model.Forty roots in cadaver heads were included and divided into two groups: DNS (n = 20) and FH (n = 20). Cone beam computed tomography (CBCT) scans of all teeth were taken. The drilling path and depth were planned virtually to using the X-guide software (X-Nav Technologies, Lansdale, PA, USA). Osteotomy and root-end resection were done under navigation in the DNS group, and freehand under the dental operating microscope in the FH group. Post-operative CBCTs were taken. Linear deviations, angular deflection, time of operation and number of mishaps were compared with determine the accuracy and efficiency. Shapiro-Wilk, one-way ANOVA and Fisher exact tests were used (P 0.05).Linear deviations, angular deflection and operation time were significantly less in the DNS group (P 0.05). The number of mishaps was not different between the two groups (P 0.05). Subgroup analyses revealed that the distance of5 mm from buccal cortical plate was significantly associated with lower accuracy, increased operation time and greater incidence of mishaps in the FH group (P 0.05), but not in the DNS group.The dynamic navigation system was more accurate and more efficient in root-end resection in a cadaver model than the freehand technique. The distance of the roots from the buccal cortical plate had a significant negative impact on the accuracy and efficacy of the root-end resection procedure when using the freehand technique. The dynamic navigation system has the potential to be a safe and reliable technological addition to endodontic microsurgery.

Objectives: The aim of this study was to evaluate the validity of international normalized ratio (INR) in patients with liver diseases or abnormal liver function tests as related to bleeding risk in dental procedures. Materials and Methods: From July 2008 to January 2019, the INR of 187 patients with liver diseases who underwent oral surgical procedures at the Department of Oral and Maxillofacial Surgery Clinic, University of Maryland School of Dentistry was collected and compared with normal value. Patients who were taking anticoagulants were excluded from the data pool. Results: The compiled INR for the 187 patients (M/F = 122/65) with mean age of 47 years (range: 22–77) was 1.126, with a median and mode of 1.1. The standard deviation was 0.17. The range for the INR values was 0.7 (n = 1) to 1.7 (n = 1). Conclusion: In the present study, there was no significant difference between the INR of patients with liver diseases or abnormal liver function tests and normal INR value. This supports the belief that pre-operative INR testing is not a dependable marker to assess bleeding risk in patients with chronic liver diseases who are not taking Vitamin K antagonist anticoagulants.

The aim of this article was to provide evidence-based information for the oral health-care providers to better understand the COVID-19 disease and be prepared to treat their patients. The impact of the severe acute respiratory syndrome coronavirus 2 pandemic has been unprecedented, especially in health care. Overwhelming amount of information flooded the literature to the point that dentists and specialists alike might feel more confused than knowledgeable, which can make decision-making a challenge. Dental community is no stranger to infection control and to treat patients with highly infectious diseases. With careful planning, modifications, and sound clinical judgment, it is certainly feasible to provide routine care to the patients during the pandemic and serve the community. Negative pressure ventilation operatories and/or air purifiers are good addition to contain the droplet transmitted diseases including COVID-19. It is of particular importance for health-care providers to take appropriate measures to minimize the risk of infection to their patients, themselves, and other members of the dental team.

The aim of the study is to investigate whether the 3-dimensional dynamic navigation system (3D-DNS) can improve experienced endodontists' (EEs') and novice endodontists' (NEs') accuracy and efficiency in osteotomy and root-end resection (RER) and to verify that the 3D-DNS enables NEs to perform osteotomy and RER as accurately and efficiently as EEs.Seventy-six roots in cadaver heads were randomly divided into 4 groups: 3D-DNS-NE, 3D-DNS-EE, freehanded (FH)-NE, and FH-EE (all, n = 19). Cone-beam computed tomography scans were taken preoperatively and postoperatively. Osteotomy and RER were planned virtually in the X-guided software (X-Nav Technologies, Lansdale). Accuracy was calculated by measuring the 2-dimensional and 3D virtual deviations and angular deflection using superimposing software (X-Nav technologies). Efficiency was determined by the time of operation and the number of mishaps.Accuracy deviations were significantly fewer in the 3D-DNS-EE group than those in the FH-EE group (P .05). We found less 2-dimensional and 3D accuracy deviations comparing the 3D-DNS-NE group to the FH-NE group (P .05). The time required for osteotomy and RER with the 3D-DNS was ∼ ½ of that required for the FH method for both EEs and NEs (P .05). We found no difference in the number of mishaps between the 3D-DNS and FH groups for EEs and NEs (P .05).The 3D-DNS improved EEs' and NEs' accuracy and efficiency in osteotomy and RER. The NEs were as efficient as the EEs using the 3D-DNS. Notably, the 3D-DNS improved the NEs' accuracy compared to the FH method, but the 3D-DNS did not enable the NEs to perform osteotomy and RER as accurately as the EEs.

Electronic cigarette (EC) use is on a steady rise, leading to increased concerns about its efficacy with regard to tobacco cessation goals and safety with regard to systemic and oral health. Recent studies have shown that EC flavoring agents can have adverse effects similar to those of combustible tobacco products. Evidence is mounting that EC use should not be considered a healthier alternative to tobacco smoking. The aerosols produced by ECs have been associated with respiratory, cardiac, and central nervous system disease as well as oral mucosal alterations. In addition, ECs can affect kidney and liver function. Their use has also resulted in EC explosions and burn injuries, some of which have been fatal. The aim of this article is to review the systemic and oral health concerns associated with EC use.

The treatment of calcified root canals is challenging in endodontic practice. A 63-year-old man was referred to the postgraduate endodontic clinic at the University of Maryland School of Dentistry, Baltimore, MD, for the treatment of tooth #3. Because of the patient's history of head and neck radiation and the high risk of developing osteoradionecrosis, a nonsurgical endodontic approach was found to be the most reasonable treatment option despite the questionable prognosis of the tooth. During the endodontic treatment, the distobuccal canal appeared to be partially calcified and was not possible to be located freehand even with use of the dental operating microscope and cone-beam computed tomographic approximated approach. Therefore, the dynamic navigation system using the X-Guide system (X-Nav technologies, LLC, Lansdale, PA) was used, which allowed for the successful location of the canal. Conventional endodontic treatment was completed following standardized instrumentation, irrigation, and obturation. Details on how to use the dynamic navigation system are described including its advantages, disadvantages, and limitations.

Introduction Calcified canals present a challenge during endodontic treatments. The purpose of this study was to compare the accuracy and efficiency of a dynamic navigation system (DNS) to the freehand (FH) method for locating calcified canals in human teeth. Methods Sixty human single-rooted teeth with canal obliteration were selected and mounted in dry cadaver jaws. Based on cone-beam computed tomographic scans of the jaws, the drilling path and depth were virtually planned to use X-Guide software (X-Nav Technologies, LLC, Lansdale, PA). Access preparation was made with navigation in the DNS group and without guidance in the FH group by 2 operators with different levels of experience. Postoperative cone-beam computed tomographic scans were taken of all teeth. Linear and angular deviations and reduced dentin thickness at 2 levels were measured. The time for locating the canal, the number of mishaps, and the unsuccessful attempts were determined and analyzed. Results The mean linear and angular deviations, reduced dentin thickness (at both levels), the time for access cavity preparation, and the number of mishaps in the DNS group were significantly less than the FH group (P ≤ .05). The unsuccessful attempts were not different between the 2 groups (P > .05). The time for access preparation was significantly shorter for the board-certified endodontist in the FH group (P ≤ .05). Conclusions The DNS was more accurate and more efficient than the FH technique in locating calcified canals in human teeth. This novel DNS can help clinicians avoid catastrophic mishaps during access preparation in calcified teeth.

Mycosis fungoides (MF) accounts for approximately 50% of all primary cutaneous lymphomas. MF occurrence in the oral cavity is extremely rare with approximately 45 cases reported to date. We present a case of a 68 year-old man with a raised nodular lesion of the ventral tongue with clinical impression of irritational fibroma. Histopathologic and immunohistochemical (IHC) examination revealed a phenotype consistent with MF with large cell transformation in the context of Sezary syndrome. The histological diagnosis of oral MF requires a high index of suspicion and IHC panel to rule out large cell transformation. To our knowledge, only four cases of large cell transformation of oral MF have been reported in the English literature. The clinical and histopathologic features of a rare case of intra-oral MF with large cell transformation are exemplified in this article.