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Volume 49 (1); February 2024
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Editorial
Restorative Dentistry and Endodontics is indexed in Web of Science and Scopus, marking the start of a new era
Kyung-San Min
Restor Dent Endod 2024;49(1):e11.   Published online February 20, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e11
PDFPubReaderePub
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Review Article
Cone-beam computed tomography in endodontics: from the specific technical considerations of acquisition parameters and interpretation to advanced clinical applications
Néstor Ríos-Osorio, Sara Quijano-Guauque, Sandra Briñez-Rodríguez, Gustavo Velasco-Flechas, Antonieta Muñoz-Solís, Carlos Chávez, Rafael Fernandez-Grisales
Restor Dent Endod 2024;49(1):e1.   Published online December 11, 2023
DOI: https://doi.org/10.5395/rde.2024.49.e1
AbstractAbstract PDFPubReaderePub

The implementation of imaging methods that enable sensitive and specific observation of anatomical structures has been a constant in the evolution of endodontic therapy. Cone-beam computed tomography (CBCT) enables 3-dimensional (3D) spatial anatomical navigation in the 3 volumetric planes (sagittal, coronal and axial) which translates into great accuracy for the identification of endodontic pathologies/conditions. CBCT interpretation consists of 2 main components: (i) the generation of specific tasks of the image and (ii) the subsequent interpretation report. A systematic and reproducible method to review CBCT scans can improve the accuracy of the interpretation process, translating into greater precision in terms of diagnosis and planning of endodontic clinical procedures. MEDLINE (PubMed), Web of Science, Google Scholar, Embase and Scopus were searched from inception to March 2023. This narrative review addresses the theoretical concepts, elements of interpretation and applications of the CBCT scan in endodontics. In addition, the contents and rationale for reporting 3D endodontic imaging are discussed.

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Research Articles
Predictor factors of 1-rooted mandibular second molars on complicated root and canal anatomies of other mandibular teeth
Hakan Aydın, Hatice Harorlı
Restor Dent Endod 2024;49(1):e2.   Published online January 3, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e2
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to determine the effects of 1-rooted mandibular second molar (MnSM) teeth on root canal anatomy complexities of the mandibular central incisor (MnCI), mandibular lateral incisor (MnLI), mandibular canine (MnCn), mandibular first premolar (MnFP), mandibular second premolar (MnSP), and mandibular first molar (MnFM) teeth.

Materials and Methods

Cone-beam computed tomography images of 600 patients with full lower dentition were examined. Individuals with 1-rooted MnSMs were determined, and the complexity of root canal anatomy of other teeth was compared with individuals without 1-rooted MnSMs (Group-1; subjects with at least one 1-rooted MnSM, Group-2; subjects with more than a single root in both MnSMs). A second canal in MnCIs, MnLIs, MnCns, MnFPs, and MnSPs indicated a complicated root canal. The presence of a third root in MnFMs was recorded as complicated.

Results

The prevalence of 1-rooted MnSMs was 12.2%, with the C-shaped root type being the most prevalent (9%). There were fewer complicated root canals in MnCIs (p = 0.02), MnLIs (p < 0.001), and MnFPs (p < 0.001) in Group 1. The other teeth showed no difference between the groups (p > 0.05). According to logistic regression analysis, 1-rooted right MnSMs had a negative effect on having complex canal systems of MnLIs and MnFPs. Left MnSMs were explanatory variables on left MnLIs and both MnFPs.

Conclusions

In individuals with single-rooted MnSMs, a less complicated root canal system was observed in all teeth except the MnFMs.

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Prevalence of salivary microbial load and lactic acid presence in diabetic and non-diabetic individuals with different dental caries stages
Monika Mohanty, Shashirekha Govind, Shakti Rath
Restor Dent Endod 2024;49(1):e4.   Published online January 12, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e4
AbstractAbstract PDFPubReaderePub
Objectives

This study aims to correlate caries-causing microorganism load, lactic acid estimation, and blood groups to high caries risk in diabetic and non-diabetic individuals and low caries risk in healthy individuals.

Materials and Methods

This study includes 30 participants divided into 3 groups: Group A, High-risk caries diabetic individuals; Group B, High-risk caries non-diabetic individuals; and Group C, Low-risk caries individuals. The medical condition, oral hygiene, and caries risk assessment (American Dental Association classification and International Caries Detection and Assessment System scoring) were documented. Each individual’s 3 mL of saliva was analyzed for microbial load and lactic acid as follows: Part I: 2 mL for microbial quantity estimation using nutrient agar and blood agar medium, biochemical investigation, and carbohydrate fermentation tests; Part II: 0.5 mL for lactic acid estimation using spectrophotometric analysis. Among the selected individuals, blood group correlation was assessed. The χ2 test, Kruskal-Wallis test, and post hoc analysis were done using Dunn’s test (p < 0.05).

Results

Group A had the highest microbial load and lactic acid concentration, followed by Groups B and C. The predominant bacteria were Lactobacilli (63.00 ± 15.49) and Streptococcus mutans (76.00 ± 13.90) in saliva. Blood Group B is prevalent in diabetic and non-diabetic high-risk caries patients but statistically insignificant.

Conclusions

Diabetic individuals are more susceptible to dental caries due to high microbial loads and increased lactic acid production. These factors also lower the executing tendency of neutrophils, which accelerates microbial accumulation and increases the risk of caries in diabetic individuals.

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The status of clinical trials regarding root canal sealers
Ahmad AL Malak, Yasmina EL Masri, Mira Al Ziab, Nancy Zrara, Tarek Baroud, Pascale Salameh
Restor Dent Endod 2024;49(1):e5.   Published online January 15, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e5
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to present the results and analyses of clinical trials, including updates on the different functions of root canal sealers.

Materials and Methods

In June 2023, we performed a comprehensive search of ClinicalTrials.gov to identify interventional clinical trials pertaining to root canal sealers. In total, 23 clinical trials conducted up to June 2023 were included in this study.

Results

Approximately half of the trials (11 out of 23) were completed, while none were terminated or withdrawn. Each included trial had a minimum of 10 participants, with 11 trials having more than 100 participants. None of the assessed trials provided outcomes, and the majority (17 out of 23) lacked associated publications. In terms of geographic distribution, the USA and Canada did not contribute to any root canal sealer trials.

Conclusions

This study highlights the lack of diversity in trial locations, the absence of reported results, and a scarcity of clinical trials examining the physicochemical properties of different sealers. Most published trials primarily focused on assessing the post-operative pain effect of these sealers, but no significant difference was found regarding post-operative pain control.

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Effect of different storage media on elemental analysis and microhardness of cervical cavity margins restored with a bioactive material
Hoda Saleh Ismail, Brian Ray Morrow, Ashraf Ibrahim Ali, Rabab Elsayed Elaraby Mehesen, Salah Hasab Mahmoud, Franklin Garcia-Godoy
Restor Dent Endod 2024;49(1):e6.   Published online January 17, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e6
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to investigate the elemental analysis and microhardness of a bioactive material (Activa) and marginal tooth structure after storage in different media.

Materials and Methods

Fifteen teeth received cervical restorations with occlusal enamel and gingival dentin margins using the tested material bonded with a universal adhesive, 5 of them on the 4 axial surfaces and the other 10 on only the 2 proximal surfaces. The first 5 teeth were sectioned into 4 restorations each, then stored in 4 different media; deionized water, Dulbecco's phosphate buffered saline (DPBS), Tris buffer, and saliva. The storage period for deionized water was 24 hours while it was 3 months for the other media. Each part was analyzed by scanning electron microscopy-energy dispersive spectroscopy (SEM-EDS) analysis for different substrates/distances and the wt% of calcium, phosphorus, silica, and fluoride were calculated. The other 10 teeth were sectioned across the restoration, stored in either Tris buffer or saliva for 24 hours or 3 months, and were evaluated for microhardness of different substrates/areas. Data were analyzed using analysis of variance and Tukey’s post hoc test.

Results

Enamel and dentin interfaces in the DPBS group exhibited a significant increase in calcium and phosphorus wt%. Both silica and fluoride significantly increased in tooth structure up to a distance of 75 μm in the 3-month-media groups than the immediate group. Storage media did not affect the microhardness values.

Conclusions

SEM-EDS analysis suggests an ion movement between Activa and tooth structure through a universal adhesive while stored in DPBS.

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Color discrepancy of single-shade composites at different distances from the interface measured using cell phone images
Márcia Luciana Carregosa Santana, Gabriella de Jesus Santos Livi, André Luis Faria-e-Silva
Restor Dent Endod 2024;49(1):e7.   Published online January 24, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e7
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to evaluate the impact of substrate color and interface distance on the color adjustment of 2 single-shade composites, Vittra APS Unique and Charisma Diamond One.

Materials and Methods

Dual disc-shaped specimens were created using Vittra APS Unique or Charisma Diamond One as the center composite, surrounded by shaded composites (A1 or A3). Color measurements were taken with a spectrophotometer against a gray background, recording the color coordinates in the CIELAB color space. Illumination with a light-correcting device and image acquisition using a polarizing filter-equipped cell phone were performed on specimens over the same background. Image processing software was used to measure the color coordinates in the center and periphery of the inner composite and in the outer composite. The color data were then converted to CIELAB coordinates and adjusted using data from the spectrophotometer. Color differences (ΔE00) between the center/periphery of single-shade and outer composites were calculated, along with color changes in single-shade composites caused by different outer composites. Color differences for the inner composites surrounded by A1 and A3 were also calculated. Data were analyzed using repeated-measures analysis of variance (α = 0.05).

Results

The results showed that color discrepancies were lowest near the interface and when the outer composite was whiter (A1). Additionally, Charisma Diamond One exhibited better color adjustment ability than Vittra APS Unique.

Conclusions

Color discrepancies between the investigated single-shade composites diminished towards the interface with the surrounding composite, particularly when the latter exhibited a lighter shade.

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Effect of Dental Practicality Index training using an online video on decision-making and confidence level in treatment planning by dental undergraduates
Zhai Wei See, Ming Sern Lee, Abhishek Parolia, Shalini Kanagasingam, Shilpa Gunjal, Shanon Patel
Restor Dent Endod 2024;49(1):e8.   Published online January 24, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e8
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of this study was to evaluate the effect of Dental Practicality Index (DPI) training using an online video on the treatment planning decisions and confidence level of dental undergraduates (DUs).

Materials and Methods

Ninety-four DUs were shown 15 clinical case scenarios and asked to decide on treatment plans based on 4 treatment options. The most appropriate treatment plan had been decided by a consensus panel of experienced dentists. DUs then underwent DPI training using an online video. In a post-DPI-training test, DUs were shown the same clinical case scenarios and asked to assign the best treatment option. After 6 weeks, DUs were retested to assess their knowledge retention. In all 3 tests, DUs completed the confidence level scale questionnaire. Data were analyzed using the related-samples Wilcoxon signed rank test and the independent-samples Mann-Whitney U test with the level of significance set at p < 0.05.

Results

DPI training significantly improved the mean scores of the DUs from 7.53 in the pre-DPI-training test to 9.01 in the post-DPI-training test (p < 0.001). After 6 weeks, the mean scores decreased marginally to 8.87 in the retention test (p = 0.563). DPI training increased their confidence level from 5.68 pre-DPI training to 7.09 post-DPI training.

Conclusions

Training DUs using DPI with an online video improved their decision-making and confidence level in treatment planning.

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Pomegranate extract on eroded dentin: antioxidant action, bond strength and morphology of the adhesive interface after aging
Thiago Vinícius Cortez, Nathália Mancioppi Cerqueira, Julia Adornes Gallas, Wanderley Pereira Oliveira, Silmara Aparecida Milori Corona, Aline Evangelista Souza-Gabriel
Restor Dent Endod 2024;49(1):e9.   Published online January 26, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e9
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to evaluate the effect of pomegranate solution (Punica granatum) on eroded dentin through antioxidant action, shear bond strength (SBS) and interface morphology.

Materials and Methods

The 10% pomegranate peel extract was prepared by the lyophilization method. Punicalagin polyphenol was confirmed by high-performance liquid chromatography. Antioxidant activity was evaluated by capturing the 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical. For the SBS, 48 dentin fragments were divided into sound or eroded, and subdivided according to the pretreatment (n = 12): water or P. granatum. The surfaces were restored with self-etch adhesive and a bulk-fill resin (Ecosite; DMG). The SBS was done immediately (24 hours) and after thermal cycling + water storage (12 months). For scanning electron microscopy, 48 dentin fragments (24 sound and 24 eroded) received the same treatments as for SBS (n = 6), and they were analyzed after 24 hours and 12 months.

Results

The P. granatum had antioxidant action similar (p = 0.246) to the phenolic standard antioxidants. After 24 hours, eroded dentin had lower SBS than sound dentin (p < 0.001), regardless of the pretreatment. After 12 months, P. granatum maintained the SBS of sound dentin (13.46 ± 3.42 MPa) and eroded dentin (10.96 ± 1.90 MPa) statistically similar. The lowest values were found on eroded dentin treated with water (5.75 ± 1.65 MPa) (p < 0.001). P. granatum on eroded dentin caused peritubular demineralization and hybrid layer with resin tags.

Conclusions

The pomegranate extract had antioxidant action and preserved the adhesive interface of the eroded dentin.

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YouTube as a source of information about rubber dam: quality and content analysis
Gülsen Kiraz, Arzu Kaya Mumcu, Safa Kurnaz
Restor Dent Endod 2024;49(1):e10.   Published online February 5, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e10
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to evaluate the content, quality and demographics of YouTube videos about rubber dam as an information source for clinicians and dental students.

Materials and Methods

“Rubber dam,” “rubber dam application,” “dental isolation,” “rubber dam isolation,” and “dental dam” were determined as keywords for the detection of YouTube videos related to rubber dam. Seventy 3 videos were evaluated and a total of 34 videos met the inclusion criteria. All selected videos were evaluated according to 8 parameters. The videos were scored 1 if the videos contained information about the selected parameter, but if the videos did not contain enough information, they were scored 0. The data were statistically analyzed with the analysis of variance and post hoc Tukey test (p < 0.05).

Results

We found that 41% of the videos have poor, 47% have moderate, and 12% have good information. There is a statistically significant difference in time between poor and good information content (p < 0.05). There is a statistically significant difference between the poor and good information in the video information and quality index 1.

Conclusions

Rubber dam-related videos available on YouTube are generally moderately informed and insufficient. YouTube is currently not sufficient as a source of information for patients and clinicians at the moment. The YouTube platform should be developed and enriched with quality information on current and dental issues.

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Statistical Review Article
Sample size determination for conducting a pilot study to assess reliability of a questionnaire
Mohamad Adam Bujang, Evi Diana Omar, Diana Hui Ping Foo, Yoon Khee Hon
Restor Dent Endod 2024;49(1):e3.   Published online January 10, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e3
AbstractAbstract PDFPubReaderePub

This article is a narrative review that discusses the recommended sample size requirements to design a pilot study to assess the reliability of a questionnaire. A list of various sample size tables that are based on the kappa agreement test, intra-class correlation test and Cronbach’s alpha test has been compiled together. For all calculations, type I error (alpha) was set at a maximum value of 0.05, and power was set at a minimum value of 80.0%. For the kappa agreement test, intra-class correlation test, and Cronbach’s alpha test, the recommended minimum sample size requirement based on the ideal effect sizes shall be at least 15, 22, and 24 subjects respectively. By making allowances for a non-response rate of 20.0%, a minimum sample size of 30 respondents will be sufficient to assess the reliability of the questionnaire. The clear guideline of minimum sample size requirement for the pilot study to assess the reliability of a questionnaire is discussed and this will ease researchers in preparation for the pilot study. This study provides justification for a minimum requirement of a sample size of 30 respondents specifically to test the reliability of a questionnaire.

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