Research Articles (Odontology)

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Awareness of possible complications associated with direct composite restorations : a multinational survey among dentists from 13 countries with meta-analysis
(Elsevier, 2024-06) Lehmann, Anna; Nijakowski, Kacper; Jankowski, Jakub; Donnermeyer, David; Palma, Paulo J.; Drobac, Milan; Martins, Joao Filipe Brochado; Hatipoglu, Fatma Pertek; Tulegenova, Indira; Javed, Muhammad Qasim; Alharkan, Hamad Mohammad; Bekjanova, Olga; Wyzga, Sylvia; Mohamed Alkhawas, Moataz-Bellah Ahmed; Kudenga, Rutendo; Hatipoglu, Omer; Surdacka, Anna
OBJECTIVES : Resin-based composites (RBCs) evolved into favoured materials for teeth restorations, marking a significant change in dental practice. Despite many advantages, RBCs exhibit various limitations in their physical and chemical properties. Therefore, we assessed the dentists’ awareness of possible complications after direct composite restorations and their opinions about this material. METHODS : The online questionnaire was created in English in May 2023. A 16-item survey was dedicated to general dentists and specialists. The first section included four questions related to demographic characteristics. The second section comprised twelve questions and focused on awareness of potential side effects of composite restorations, the most crucial advantages and disadvantages of composite resins, and the frequency of experienced clinical complications after the application of composite materials. RESULTS : A total of 1830 dentists from 13 countries took part in the survey. Dentists most often declared awareness of low adhesion to the dentine (77.5 %) and, most rarely, solubility in oral fluids (42.6 %). Aesthetics was identified as the main advantage of composite fillings (79 %), followed by the possibility of repair (59 %) and adhesion to enamel (57 %). Polymerisation shrinkage was a major disadvantage for most countries (70 % overall). Analysing the declared potential clinical complications for all countries, statistically significant findings were obtained for marginal discolouration (OR=2.982, 95 % CI: 1.321–6.730, p-value=0.009) and borderline significance for secondary caries (OR=1.814, 95 % CI: 0.964–3.415, p-value=0.065). CONCLUSIONS : Dentists value aesthetics and repairability but are aware of shrinkage and experience discolouration. The issue of toxicity and solubility seems to be the least known to dentists.
A micro-computed tomographic evaluation of maxillary first molar accessory root canal morphology in a Black South African subpopulation
(Nihon University School of Dentistry, 2024-09) Jonker, Casper Hendrik; Van der Vyver, Peet J.; Lambourn, Guy; Oettle, Anna Catherina
PURPOSE : The aim of this study was to investigate the accessory root canal morphology of maxillary first molars in a Black South African subpopulation. METHODS : Micro-computed tomography was used to investigate 101 maxillary first molars (from 50 male and 51 female teeth, right 53 teeth, left 48 teeth). The prevalence of chamber canals, and the number, type and location (root third) of accessory canals were recorded. The relationships between arch side, sex and age were examined using chi-squared tests of association. Intra- and inter-observer reliability were assessed using Cohen's kappa test. RESULTS : Intra- and inter-rater agreement was 96.9% and 98.1%, respectively. Variations in accessory root canal anatomy according to side, sex and age were evident. Chamber canals were identified in 10.9% of teeth. Accessory canals were found mainly in the apical third of most teeth in the sample, and distributed predominantly in the mesio-buccal root. Apical deltas were most prevalent in the mesio-buccal root, and their frequency decreased in the palatal and then finally the disto-buccal root. CONCLUSION : Accessory root canals were common in this population, and showed a diverse range of anatomy. The present findings will be of assistance to clinicians during endodontic treatment and will also be valuable for educational purposes.
A comparison of preparation times between manual, rotary, and reciprocating files in primary molar pulpectomy
(Wolters Kluwer Medknow, 2024-01) Middleton, Ilana; Vorster, Martin; Van der Vyver, Peet J.; ilana.middleton@up.ac.za
AIM : To compare preparation times using manual, rotary, and reciprocating files during pulpectomy treatment of primary molars. SETTINGS AND DESIGN : This study was an in vitro, randomised, cross-sectional study. METHODS : The study was performed on 60 extracted human primary mandibular second molars. Only mesiobuccal canals were prepared using one of three preparation techniques; each preparation technique group comprised 20 canals. Canal preparations were performed by a single, skilled operator using stainless-steel (ss) K-files (ISO size 20–35), a ProTaper Gold SX file, and a WaveOne Gold Medium file following glide path preparation. Preparation times were recorded in second (s) with a digital stopwatch. STATISTICAL ANALYSIS : Preparation times were compared using analysis of variance and the Kruskal–Wallis analysis of variance, where appropriate. The level of significance was set at P ≤ 0.05. RESULTS : The mean preparation time using the ss K-files was significantly longer (186.4 s) than when using the ProTaper Gold SX (29.6 s) or WaveOne Gold Medium files (30.5 s) (P < 0.001). Similar preparation times were recorded when using the ProTaper Gold SX and WaveOne Gold Medium files (P = 0.939). CONCLUSION : Preparation times with the ProTaper Gold SX and WaveOne Gold Medium files were significantly faster than when using the ss K-files to prepare primary tooth root canals for pulpectomy. Similar preparation times were noted when using the rotary and reciprocation instrumentation groups (P > 0.05).
Resolution of apical periodontitis-induced mental nerve paresthesia through nonsurgical endodontic retreatment : a case report
(Elsevier, 2023-07) Buchanan, Glynn Dale; Smit, Chane; Gamieldien, Mohamed Yasin; ElSheshtawy, Ahmed S.; glynn.buchanan@up.ac. za
Paresthesia is a potential consequence of unsuccessful root canal treatment. Persistent infection resulting in apical periodontitis may enlarge sufficiently to involve the mental neurovascular bundle. The case presented in this report was referred for endodontic evaluation with a chief complaint of discomfort on mastication and persistent numbness of the lower left lip. Clinical and radiographic evaluation revealed incomplete primary endodontic treatment of the left mandibular second premolar with complex internal anatomy. The untreated root canal system resulted in the progression of apical periodontitis involving the left mental neurovascular bundle as confirmed by cone-beam computed tomography imaging. Nonsurgical root canal retreatment was performed over 2 visits. At the 3-year follow-up visit, the paresthesia had resolved with return of normal sensation. Nonsurgical endodontic retreatment may be sufficient to allow healing of large periapical lesions and resolve complications including paresthesia without the need for surgical intervention.
Assessment of the prevalence of radix entomolaris and distolingual canal in mandibular first molars in 15 countries : a multinational cross-sectional study with meta-analysis
(Elsevier, 2023-10) Hatipoglu, Fatma Pertek; Magat, Guldane; Hatipoglu, Omer; Al-khatib, Hanan; Elatrash, Anas S.; Abidin, Imran Zainal; Kulczyk, Tomasz; Alkhawas, Bellah Ahmed Mohamed; Buchanan, Glynn Dale; Kopbayeva, Maira; Surendar, Sugumaran; Javed, Muhammad Qasim; Madfa, Ahmed A.; Burklein, Sebastian; Mimica, Sarah; Bhatti, Usman Anwer; Maratovna, Tulegenova Indira; Palma, Paulo J.; Martins, Joao Filipe Brochado
AIM : The aim of this study was two-folded: i) to assess the prevalence of Distolingual Canal (DLC) and Radix Entomolaris (RE) in Mandibular First Molars (M1Ms), using Cone Beam Computed Tomography (CBCT) images and ii) to assess the impact of sociodemographic factors on the prevalence of these conditions worldwide. METHODS : CBCT images were scanned retrospectively and the ones including bilateral M1Ms were included in the study. The evaluation was performed by 1 researcher in each country, trained with CBCT technology. A written and video instruction program explaining the protocol to be followed step-by-step was provided to all observers to calibrate them. The CBCT imaging screening procedure consisted of evaluating axial sections from coronal to apical. The presence of DLC and RE in M1Ms (yes/ no) was identified and recorded. RESULTS : Six thousand three hundred four CBCTs, representing 12,608 M1Ms, were evaluated. A significant difference was found between countries regarding the prevalence of both RE and DLC (P , .05). The prevalence of DLC ranged from 3% to 50%, and the overall prevalence was 22% (95% CI: 15%–29%). RE prevalence ranged from 0% to 12%, and the overall prevalence was 3% (95% CI: 2%–5%). There were no significant differences between left and right M1Ms or between genders for either DLC or RE (P ..05). CONCLUSION : The overall prevalence of RE and DLC in M1Ms was 3% and 22%. Additionally, both RE and DLC showed substantial bilaterally. These variations should be considered by endodontic clinicians during endodontic procedures in order to avoid potential complications.
A micro-computed tomographic evaluation of maxillary first molar root canal morphology in Black South Africans
(Nihon University School of Dentistry, 2024-07) Jonker, Casper H.; L'Abbe, Ericka Noelle; Van der Vyver, Petrus Jacobus; Zahra, Daniel; Oettlé, Anna C.
PURPOSE : This study was conducted to investigate the root canal anatomy of maxillary first molars in Black South Africans. METHODS : Micro-computed tomography was used to investigate 101 maxillary first molars (53 teeth from the right, 48 from the left; 50 male and 51 female teeth). The number of root canals in each tooth was determined, and the relationship between side, sex and age was analyzed using chi-squared test. To determine intra- and inter-observer reliability, Cohen’s kappa coefficients were calculated. RESULTS : Intra- and inter-rater agreements of 96.92% and 98.08% were achieved, respectively. Most teeth contained either three or four canals, but a second, third and fourth mesio-buccal canal was found in 60.39%, 5.94% and 0.99% of teeth, respectively. The disto-buccal and palatal roots contained predominantly single canals, but additional canals were noted in 2.97% and 1.98% of teeth. Four canals were common in females and teeth on the right side often contained a second mesio-buccal canal. However, the prevalence of a third mesio-buccal canal was higher in males than in females. CONCLUSION : The teeth studied showed diversity and variations between sexes and arch sides. These findings will aid clinicians in endodontic treatment and will be applicable for educational purposes.
In vitro comparison of the physical and mechanical properties of an ormocer with an ormocer-based composite and a nanocomposite restorative material
(Wiley, 2023-10) Jansen van Rensburg, Karien; Kritzinger, Dorette; Arnold, Samantha; Buchanan, Glynn Dale; karien.jansenvanrensburg@up.ac.za
OBJECTIVES : To compare an ormocer with a first generation ormocer‐based composite and a nanocomposite in terms of surface roughness, surface hardness, and microleakage. MATERIALS AND METHODS : An ormocer (Admira Fusion), a first generation ormocerbased composite (Admira) and a nanocomposite (Filtek Z350 XT) were prepared strictly in accordance with the manufacturer's instruction and recommendation to provide optimal material properties. Twelve disk samples of each material were evaluated to assess both surface roughness and surface hardness. For surface roughness, all samples were finished, polished, and Ra values measured with a profilometer. For surface hardness, samples were stored in an incubator, polished and a Vickers diamond indenter was used to record values. For microleakage, 36 standardized, Class V cavities were prepared and randomly divided into three groups. Restored teeth were thermally fatigued, immersed in 2% methylene blue solution for 48 h, sectioned, and scored for occlusal and gingival microleakage. RESULTS : Statistical significance was set at p < .05. The one‐way analysis of variance identified no significant difference in terms of surface roughness between the three material groups (p > .05). A significantly higher surface hardness was identified for the nanocomposite compared to both the ormocer (p < .001) and ormocer‐based composite (p < .001). Fisher's exact test identified no significant difference in terms of occlusal microleakage (p = .534) and gingival microleakage (p = .093) between the three material groups. CONCLUSIONS : No significant differences in terms of surface roughness or microleakage were noted. The nanocomposite was significantly harder than the ormocer materials.
Apexification of dens evaginatus in a mandibular premolar : a case report
(Wiley, 2023-05) Van der Vyver, Petrus Jacobus; Vorster, Martin; Buchanan, Glynn Dale; glynn.buchanan@up.ac.za
Dens evaginatus (DE) is an uncommon anomaly affecting mandibular premolars, frequently requiring endodontic intervention. This report documents the treatment of an immature mandibular premolar presenting with DE. Early diagnosis and preventive strategies remain the preferred management for these anomalies, however endodontic approaches may be successfully applied to retain these teeth.
Management of a permanent lateral incisor with a talon cusp and immature apex : a case report
(Wiley, 2024-01) Van der Vyver, Petrus Jacobus; Potgieter, Nicoline; Vorster, Martin; martin.vorster@up.ac.za
This case report focuses on the diagnosis and treatment of a maxillary lateral incisor affected by a talon cusp, a rare developmental dental anomaly. The case presented with irreversible pulpitis and an immature apex. The article discusses the prevalence, etiology, classification, and treatment options for talon cusps, highlighting their clinical significance and potential complications. Clinical and radiographic findings obtained from a periapical radiograph and a cone-beam computed tomography (CBCT) scan are outlined. The treatment approach involved the removal of the talon cusp, endodontic therapy including apexification with mineral trioxide aggregate, and aesthetic restoration of the tooth. The report underscores the value of precise diagnosis, careful treatment planning, and the utility of CBCT scans in effectively managing talon cusps.
Investigation of mandibular second molar root and canal morphology in a Black South African population using cone-beam computed tomography and two classification systems
(Nihon University School of Dentistry, 2023) Buchanan, Glynn Dale; Gamieldien, Mohamed Yasin; Fabris-Rotelli, Inger Nicolette; Van Schoor, Albert-Neels; Uys, Andre
PURPOSE : To investigate the root and canal morphology of mandibular second molars, including anatomical variations, in a Black South African population using two classification systems. METHODS : Cone-beam computed tomography images of 386 teeth were evaluated. The number of roots and canal configurations were categorized using the classifications of Vertucci (with modifications by Sert and Bayirli) and Ahmed et al. (including the modified Melton classification). Relationships between variables were assessed using Fisher’s exact test (P < 0.05). RESULTS : Mandibular second molars were predominantly two-rooted (91.7%). The majority of teeth had three canals including Type IV mesial (41.2%) and Type I (75.1%) distal (Ahmed et al. configuration: 2MDM M2 D1). Three or more canals were present in almost one-fifth of mesial (n = 72/386, 18.6%) and a small number of distal (n = 21/386, 5.4%) roots. Males displayed additional canals more frequently in the distal root (P = 0.02). C-shaped anatomy was found in 5.7%. Among the C-shapes, the most common was Melton’s Type III in the coronal (50%), middle (81%) and apical (72%) thirds. CONCLUSION : In this population, mandibular second molar teeth exhibited diverse morphology, which would have clinical significance for endodontic practitioners. The Ahmed et al. classification provided a better description than the Vertucci classification.
Errors in clinical diagnosis : a narrative review
(Sage, 2023-08) Vally, Zunaid Ismail; Khammissa, Razia Abdool Gafaar; Feller, Gal; Ballyram, Raoul; Beetge, Mia-Michaela; Feller, Liviu; razia.khammissa@up.ac.za
Diagnostic errors are often caused by cognitive biases and sometimes by other cognitive errors, which are driven by factors specific to clinicians, patients, diseases, and health care systems. An experienced clinician diagnoses routine cases intuitively, effortlessly, and automatically through non-analytic reasoning and uses deliberate, cognitively effortful analytic reasoning to diagnose atypical or complicated clinical cases. However, diagnostic errors can never be completely avoided. To minimize the frequency of diagnostic errors, it is advisable to rely on multiple sources of information including the clinician’s personal experience, expert opinion, principals of statistics, evidence-based data, and well-designed algorithms and guidelines, if available. It is also important to frequently engage in thoughtful, reflective, and metacognitive practices that can serve to strengthen the clinician’s diagnostic skills, with a consequent reduction in the risk of diagnostic error. The purpose of this narrative review was to highlight certain factors that influence the genesis of diagnostic errors. Understanding the dynamic, adaptive, and complex interactions among these factors may assist clinicians, managers of health care systems, and public health policy makers in formulating strategies and guidelines aimed at reducing the incidence and prevalence of the phenomenon of clinical diagnostic error, which poses a public health hazard.
The effect of different access cavity designs in combination with WaveOne Gold and TruNatomy instrumentation on remaining dentin thickness and volume
(Elsevier, 2023-01) Vorster, Martin; Van der Vyver, Petrus Jacobus; Markou, George; martin.vorster@up.ac.za
INTRODUCTION : The purpose of this study was to evaluate and compare 2 different access cavity designs in combination with 2 popular single-file preparation systems to see which combination preserves dentin, more specifically pericervical dentin, best. The minimum remaining dentin thickness and dentin volumes were evaluated pre- and postinstrumentation. METHODS : Sixty extracted human mandibular molars were selected and randomly divided into 2 different access cavity design preparation groups: traditional access cavities (n = 30) and conservative access cavities (n = 30). Within each cavity preparation design group, the 30 teeth were divided into 2 instrumentation groups (WaveOne Gold Primary; Dentsply Sirona, Ballaigues, Switzerland [n = 15] and TruNatomy Prime, Dentsply Sirona [n = 15]). Samples were scanned using micro–computed tomographic imaging before and after access cavity preparation as well as after final endodontic instrumentation. The pericervical remaining dentin thickness and dentin volume changes were evaluated and compared. RESULTS : Conservative access cavity designs resulted in more favorable remaining dentin thickness. The least amount of mean dentin volume loss was also recorded in the conservative access cavity preparation groups regardless of the preparation instrumentation. CONCLUSIONS : In terms of the remaining pericervical dentin thickness and dentin volume reductions, the authors conclude that conservative access cavity designs preserve dentin best.
A cone-beam computed tomography study of canalis sinuosus and its accessory canals in a South African population
(Springer, 2024-07) Beckenstrater, Michael A.; Gamieldien, Mohamed Yasin; Smit, Chane; Buchanan, Glynn Dale
OBJECTIVES : Canalis sinuosus (CS) is a clinically relevant structure in the anterior maxilla. The present study aimed to determine the prevalence and distribution of CS and its accessory canals (ACs) in the South African population and describe its anatomical variations. METHODS : In total, 500 cone-beam computed tomography (CBCT) scans of the anterior maxilla were assessed for prevalence, sidedness, diameter, and distribution of CS. The frequency, number, diameter, configuration, and point of termination of ACs were also recorded. Statistical analysis was performed using analysis of variance, Kruskal–Wallis, chi-squared, and Fisher Exact tests with P < 0.05. RESULTS : CS was present in most cases (99.6%), and commonly occurred bilaterally (98.8%). The mean diameter of CS was 1.08 mm (range: 0.50 mm–2.39 mm). Sex, population group, and age had no significant effect on the prevalence or sidedness of CS. Additionally, 535 ACs were observed in 58.8% of the sample, with 42.9% of ACs found bilaterally and 57.1% unilaterally. The mean diameter of the ACs was 0.86 mm on the left and 0.87 mm on the right (range; 0.50 mm–1.52 mm). The majority of ACs maintained a straight vertical configuration (72.3%). ACs most commonly terminated in the anterior palatal region of the maxilla (57.2%). No significant differences were found in any groups mentioned (P > 0.05). CONCLUSIONS : A high prevalence of CS as well as ACs were observed in the sample population. Due to their clinical significance, surgical planning with the aid of high quality CBCT scans of the anterior maxilla is advisable.
Race in health research : considerations for researchers and research ethics committees
(South African Medical Association, 2023-04) Van Staden, Werdie; Nienaber, A.; Rossouw, T.; Turner, Astrid Chrisilda; Filmalter, Cecilia Jacoba; Nel, Jan Gert; Bapela, S.; Beetge, Mia-Michaela; Blumenthal, Ryan; Castelyn, Camille De Villebois; De Witt-Jordaan, T.W. (Wilma); Dlagnekova, Antonia; Kotze, Carla; Mangwane, S.; Napoles, Lizeka; Somers, R.; Sykes, Leanne M.; Van Zyl, W.B.; Venter, Marietjie; Uys, Andre; Warren, Nichola
This article provides ethical guidance on using race in health research as a variable or in defining the study population. To this end, a plain, non-exhaustive checklist is provided for researchers and research ethics committees, preceded by a brief introduction on the need for justification when using race as a variable or in defining a study population, the problem of exoticism, that distinctions pertain between race, ethnicity and ancestry, the problematic naming of races, and that race does not serve well as a presumed biological construct in genetic research.
A study of mandibular premolar root and canal morphology in a Black South African population using cone-beam computed tomography and two classification systems
(Nihon University School of Dentistry, 2022) Buchanan, Glynn Dale; Gamieldien, Mohamed Yasin; Fabris-Rotelli, Inger Nicolette; Van Schoor, Albert-Neels; Uys, Andre; glynn.buchanan@up.ac.za
PURPOSE : An investigation of the configurations of mandibular premolar roots and canals in a population of Black South Africans. METHODS : Cone-beam computed tomography analysis of 772 mandibular premolars was performed, and the premolars were classified according to the systems proposed by Vertucci and Ahmed et al. Root number, canal morphology, age, and sex were recorded. Fisher’s exact test was used to determine relationships based on age and sex (P < 0.05). RESULTS : Single roots were seen in the majority of mandibular premolars (97.1%). Single canal configurations (i.e., Vertucci Type 1/Ahmed et al. 1MP1) were observed in 48.5% of first and 81.3% of second mandibular premolars. Mandibular first premolars demonstrated multiple canals in more than half of the sample (51.5%), and C-shaped morphology in more than one-tenth (11.1%). A relationship between sex and the presence of radicular grooves was demonstrated (P = 0.049), males being more likely to demonstrate this feature (P = 0.051). Multiple canals in mandibular first premolars also showed a relationship with sex (P = 0.005), a male predilection being evident (P = 0.007). The Ahmed et al. system proved superior to the Vertucci classification for reporting complex configurations and anatomical variations, although a greater number of unique categories were created. CONCLUSION : Diverse mandibular premolar root and canal morphology was observed in the studied population. Clinicians must be aware of common morphological features as well as possible anatomical variations in mandibular premolars, as failure to treat complete root canal systems may negatively impact endodontic treatment outcomes.
Root and canal morphology of the permanent anterior dentition in a Black South African population using cone-beam computed tomography and two classification systems
(Nihon University School of Dentistry, 2022-10) Buchanan, Glynn Dale; Gamieldien, Mohamed Yasin; Fabris-Rotelli, Inger Nicolette; Van Schoor, Albert-Neels; Uys, Andre; glynn.buchanan@up.ac.za
PURPOSE : This study investigated the root and canal morphology of the permanent anterior dentition in a Black South African population. METHODS : In total 2,343 permanent anterior teeth were evaluated using cone-beam computed tomography images and described according to the Vertucci and Ahmed et al. classifications. Demographic information, root number and internal canal morphology were recorded. Age and sex associations were made using Fisher’s exact test (P < 0.05). RESULTS : All anterior teeth were single-rooted (100%). The most frequent configuration in maxillary anteriors was a single canal (Vertucci Type I/1MXA1). In mandibular anteriors, single canal configurations (Type I/1MDA1) predominated, however 36.6% of mandibular central and 33.9% of lateral incisors displayed two canals. Older subjects (>40 years) demonstrated single canals more than younger subjects (P = 0.0004). Females displayed variations more compared to males (P = 0.002). The two classifications were found to be comparable for evaluation of permanent anterior teeth. Complex configurations were better described using the newer system. CONCLUSION : The permanent anterior teeth of this population exhibited exclusively single roots and diverse internal characteristics. Clinicians should be aware of anatomical variations, particularly in mandibular incisors, as these may result in adverse endodontic outcomes if not taken into consideration by the treating practitioner.
The effect of different molar access cavity designs on root canal shaping times using rotation and reciprocation instruments in mandibular first molars
(Elsevier, 2022-07) Vorster, Martin; Van der Vyver, Petrus Jacobus; Markou, George; martin.vorster@up.ac.za
INTRODUCTION : The aim was to compare the glide path and final preparation times of WaveOne Gold and TruNatomy in conjunction with two different endodontic access cavity designs in extracted human molar teeth. METHODS : 60 extracted human mandibular molars with mesiobuccal canals were selected and randomly divided into two different access cavity design preparation groups (n = 30). Traditional access cavities (TAC) and conservative access cavities (CAC). Within each cavity design group, the 30 teeth were divided in to two instrumentation groups (WaveOne Gold Primary (n = 15) and TruNatomy Prime (n = 15)). Group 1: TAC, #10 stainless steel manual K-file followed by WaveOne Gold Glider and WaveOne Gold Primary. Group 2: CAC, #10 stainless steel manual K-file followed by WaveOne Gold Glider and WaveOne Gold Primary. Group 3: TAC, #10 stainless steel manual K-file followed by TruNatomy Orifice Modifier and Glider and TruNatomy Prime. Group 4: CAC, #10 stainless steel manual K-file followed by TruNatomy Glider and TruNatomy Prime. Glide path and final preparation times were recorded. RESULTS : Shaping time with TruNatomy Glider in combination with TruNatomy Prime instruments were faster compared to the WaveOne Gold Glider/ WaveOne Gold Primary instruments regardless of the type of access cavity preparation. TAC design yielded faster preparation time (38.2 ± 4.57 seconds) compared to the CAC (55.6 ± 6.91 seconds) in the WaveOne Gold Glider/ WaveOne Gold Primary instrumentation group. No difference was found between the different access cavity design groups in combination with TruNatomy Glider/TruNatomy Prime preparation. CONCLUSION : Preparation time with TruNatomy Glider and Prime instruments was significantly faster than WaveOne Gold Glider/WaveOne Gold Primary, regardless of the access cavity design. TAC design in combination with WaveOne Gold Glider/ WaveOne Gold Primary instrumentation resulted in faster preparation time compared to WaveOne Gold Glider/WaveOne Gold in combination with the CAC design.
Effect of different endodontic access cavity designs in combination with WaveOne Gold and TruNatomy on the fracture resistance of mandibular first molars : a nonlinear finite element analysis
(Elsevier, 2023-05) Vorster, Martin; Gravett, Dewald Zane; Van der Vyver, Petrus Jacobus; Markou, George; martin.vorster@up.ac.za
INTRODUCTION : This study evaluated the effect of traditional and conservative endodontic access cavity designs in combination with WaveOne Gold and TruNatomy instrumentation systems on the fracture resistance of mandibular first molars by means of nonlinear finite element analysis (FEA). METHODS : Micro-CT images of 4 human mandibular first molars were used to generate representative FEA models. The mandibular first molars samples were scanned before and after endodontic access cavity preparation and instrumentation of all 3 canals. Five nonlinear static loads were applied vertically and horizontally to specific contact points on the occlusal surface of the teeth. Maximum von Mises stress before failure and distribution of von Mises strains were recorded and compared between groups. RESULTS : Molars with conservative endodontic access cavities required similar levels of loads to reach failure compared with their control samples, whereas molars with traditional endodontic access cavities required significantly reduced loads in order to fail. According to the numerical investigation, the type of instrumentation system was found to have an insignificant effect on the fracture resistance of the teeth under study. Von Mises stress was concentrated around the cervical region and in the larger distal roots for all numerical models. CONCLUSIONS : The fracture resistance of mandibular first molars is influenced significantly by a reduction in dental hard tissue, which was found to control the level of the ultimate failure load for each tooth.
Root and canal morphology of maxillary second molars in a Black South African subpopulation using cone-beam computed tomography and two classifications
(Wiley, 2023-09) Buchanan, Glynn Dale; Gamieldien, Mohamed Yasin; Fabris-Rotelli, Inger Nicolette; Van Schoor, Albert-Neels; Uys, Andre; glynn.buchanan@up.ac.za
This study investigated the root and canal morphology of maxillary second molars in a Black South African population using high-resolution cone-beam computed tomography. In total, 386 maxillary second molar teeth were evaluated and described according to the classifications of Vertucci (with the additions of Sert and Bayirli), as well as Ahmed et al. Root number, fusions and canal morphology were recorded. Relationships between morphology, sex and age were assessed using Fisher's exact test (p < 0.05). Maxillary second molars were predominantly three-rooted (96.1%), with root fusion observed in 14%. No relationships between sex, age and canal morphology were found. Additional canals were observed in 67.4% of mesiobuccal roots. The Ahmed et al. classification provided a better overall description of the morphology. In this population, maxillary second molar teeth exhibited a diversity of root and canal morphology. Complex variations may render endodontic management more difficult and increase the possibility of missed anatomy.
The search for healthy sugar substitute in aid to lower the incidence of early childhood caries : a comparison of sucrose, xylitol, erythritol and stevia
(South African Dental Association, 2022-09) Moelich, Nadine; Potgieter, Nicoline; Botha, Francien Susanna; Wesley-Smith, James; Van Wyk, Candice; candice.vanwyk@up.ac.za
AIM : A pursuit to And a healthy alternative to sucrose with less cariogenic potential, which can potentially lower the incidence of Early Childhood Caries (ECC), by means of comparison. METHODS : Primary tooth enamel blocks (n=32) were randomly divided into four groups and exposed to 5% concentrations of the respective test groups (sucrose, xylitol, erythritol and stevia). All samples were inoculated with S. mutans standard strain (ATCC 25175) at room temperature. Analysis of Colony Forming Units (CFUs), acidity measurements (pH) and Scanning Electron Microscopy (SEM) observations were done after 6, 12, 18 and 24 h and compared. RESULTS : After 6 h, the marginal mean CFU count indicated equal S. mutans growth in all groups. Stevia showed lower CFU counts compared to other groups at 12, 18 and 24 h. The pH levels for all non-fermentable sugar substitutes (NSS) initially decreased but never below the critical pH=5.5 and stabilized from 12 to 18 h. The pH levels of sucrose dropped and remained below pH=5.5 at all time intervals. The SEM analysis of S. mutans supported the CFU results indicating growth in the presence of sucrose and reduction in the presence of the NSS. CONCLUSIONS : Compared to sucrose, xylitol, erythritol and stevia have less cariogenic potential with reduced growth of S. mutans and subsequent acidity levels. Stevia had the least cariogenic potential of all the NSS tested, followed by erythritol and then xylitol.

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