Volume 24 – Issue 1 (Jan – Mar 2015)

The aims of Part-2 updated review are to present biological properties, clinical applications and comparisons of Mineral Trioxide Aggregate (MTA) with other alternate materials. MTA is a bioactive material that does not possess any cytotoxicity, neurotoxicity and mutagenicity. Clinically MTA performs better compared to other endodontic materials therefore, advocated as material of choice for various endodontic applications such as, pulp capping, pulpotomy, apexification, perforation repair, repair of root resorption and root end filling. MTA holds excellent sealing ability, biocompatibility, alkalinity and good interaction with mineral tissue forming cells to induce mineralization.The ability of MTA to induce mineral tissue formation is similar to calcium hydroxide however is more fast, thick and with uniform structural integrity. Difficult handling characteristics extended setting time, discoloration and higher cost are main shortcomings of MTA therefore, number of modified MTA products have been introduced (MTA Angelus, MTA Bio, Biodentine, DiaRoot Bioaggregate and MTA Plus). These alternate materials do possess some improvements over MTA however; considerable evaluation in laboratory and in clinical trials is required to improve clinical practices.

Keywords:

Mineral trioxide aggregate, biological properties, clinical applications, calcium silicate cements.

Background

With establishment of number of dental teaching institutions in Karachi, a substantial amount of dental care is presently provided in these dental institutions as opposed to private clinics. Since, there is a difference in the two settings; it was imperative to compare the pattern of endodontic services provided by the clinicians employed in these settings.

Objective

To compare the knowledge regarding endodontic materials and techniques among dentists employed at dental institutions and private practices in Karachi.

Methodology

A cross sectional study was planned and data was collected from the academic institutions and the selected dental practices. The teaching group comprised of 71 dentists while non-teaching group had 97 subjects. A structured, self-administered questionnaire comprising 11 questions was used. Chi square test was applied to asses, if their knowledge and decision making is different between the groups. The level of significance was kept at 0.05.

Results

The response rate among academic group was 94.67% while in the non-academic group it was 44.1%. Nearly 28% teaching dentists reported performing retrograde endodontics for failed anterior root canals compared to only 4% non-teaching dentists. There were statistically significant differences between the two groups of dentists for selection of endodontic sealer, method of gaining retention on root treated teeth and crown lengthening decisions (p<0.001).

Conclusion

The material and technique selection in endodontics was significantly different between the two groups of dentists.

Keywords

Endodontics, dental materials, endodontic techniques, teaching dentist, dental institutions, private practice.

Objective

The criteria for repair of composite restorations are controversial. This study investigates the knowledge and the current practices of dental graduates about the repair of resin-based composites.

Methodology

A questionnaire based survey was developed, seeking information about management (repair or replacement) of defective composite restorations and distributed among 200 dental graduates of four teaching dental hospitals in Lahore.

Result

The decision to choose composite repair as a treatment option in clinical practice was influenced by whether it was taught at undergraduate level. Sixty one percent of graduates reported that they were not taught composite repair at dental undergraduate level, as a result only 18% of these respondents chose repair in their clinical practice as a treatment option. The preferred indication for composite repair was secondary caries (37%) (p=0.010) followed by partial loss of composite restoration (29.5%), fracture of composite (21%) and composite discoloration (12.5%). Large number of respondents (73%) agreed that repair increased longevity of a defective composite restoration. The results highlighted that knowledge and application of composite repair is significantly higher in experienced clinicians (p=0.003). Half of the participants considered that repair was less time consuming and 73% responder agreed that repair increased longevity of a previously restored defective composite restoration.

Conclusion

This study demonstrated that knowledge about composite repair rather than replacement requires serious consideration at undergraduate level as majority of dental graduates are not familiar with the concept and implication of composite repair. Didactic and clinical training component regarding composite repair should be added in dental curriculum to inculcate the knowledge of repair of composite restorations.

To compare the level of post-operative sensitivity (POS) in teeth restored with posterior dental composite restorations using self-etch and total-etch adhesive systems.

Keywords

Post-operative sensitivity, self-etch adhesives, total-etch adhesives, composites.

Objective

The current concept of restoring endodontically treated teeth is based on the use of materials having elastic modulus similar to that of dentine (18.6 GPa). In this regard combination of fiber-reinforced posts and composite resin cements has shown promising results. The objective of the study was to evaluate the bond strength of the luting material with the dentine and the glass fiber post systems through push out test. The integration between these three materials was also observed through scanning electron microscopy.

Methodology

The crowns of 40 extracted, non carious, single rooted human teeth were removed transversely at the cemento-enamel junction. After the standardized post space preparation two types of glass fiber posts (Everstick® POST and RelyX™ Fiber Posts) were placed using two adhesive systems (RelyX™ Unicem and AquaCem®), in four equal groups. Each root was cut horizontally into slices. Push-out bond strength test was conducted and the results were analyzed using kruskul wallis and tukey’s post hoc analysis with a p≤ 0.05 for statistical significance.

Results

The mean bond strengths of RelyX™ Fiber Posts cemented with AquaCem® and RelyX™ Unicem were not statistically significant (p=0.696). Whereas the mean bond strength of Everstick glass fiber posts cemented with AquaCem or RelyX™ Unicem was lower than RelyX™ Fiber Posts cemented with either cement. This difference was statistically significant (p≤l0.05).

Conclusion

The type of luting cements and posts significantly affected the bond strength. RelyX™ Unicem was more effective and demonstrated the highest bond strength values with both type of fiber post systems used in the study compared to AquaCem®. AquaCem® presented similar bond strength values as the RelyX™ Unicem with RelyX™ Fiber Post (p =0.696).

Keywords

Endodontic treatment, elastic modulus, dentine, composite resins, fiber posts, bond strength, cementoenamel junction, adhesives, push-out test.

Background

Proshthodontic intervention has become a necessity, since loss of teeth leads to degeneracy of oral function, phonetics and esthetics. A trend in increase of the life expectancy of the elderly also demands an increase in the prosthodontic restorations. The aim of the current study was to assess complications rates among complete denture wearers in a teaching hospital of Karachi.

Study Design

A cross sectional analytical study was conducted at the Department of Prosthodontics, Dr. Ishrat ul Ebad Khan Institute of Oral Health Sciences (DIKIOHS), Karachi, Pakistan from March 2014 to May 2014.

Methodology

A total of 65 patients were selected who had worn heat cured acrylic complete dentures fabricated by post graduates and undergraduates. Variables such as age gender and satisfaction were recorded on a Visual Analog Scale (VAS). Various parameters that have potential effects on patient satisfaction and denture complication were assessed using SPSS version 18. Descriptive statistics like percentage, mean and median were used. Quantitative data were tested with student t-test to find the relation between different variables.

Results

The results obtained were as follows; Males were greater in number i.e. 52.3% as compared to females who were 47.6% out of total number of patients. The complications seen were: Ulcer development: 44.6%, Fractures in the denture base: 27.6%, Loss of retention: 84.6%, Loss of teeth: 30.7%, Denture-related stomatitis: 7.6%. Patient satisfaction according to the Visual Analog Scale (VAS) was found to be Esthetics: 72.5, Chewing Ability: 50 and Phonetics: 90.

Conclusion

Within the limitations of the current study, Loss of retention in complete dentures was found to be the most prevalent complication amongst all.

Objectives

To assess dental caries status of school-children of 6-years and 12-years in public and private schools of Karachi city.

Methodology

An analytical cross sectional study of 1600 school-children, from of 6 years and 12 years of age, were conducted among nine different towns of Karachi city. At the first stage, nine towns out of eighteen towns were selected randomly through cluster sampling. In the next stage, from each selected town one private and one public school were identified randomly. Selected sample of school-children were examined for assessment of dental caries by using WHO criteria of diagnosing dental caries. The data were entered and managed by using Statistical Package for Social Sciences (SPSS) Version 17.Descriptive analysis of the data including frequencies, percentages and means of school-children’s decayed, missing and filled components was performed. Comparisons among dental caries status of private and public school-children were performed by using independent sample t test. Level of significance was kept at p=0.05.

Results

The overall prevalence of dental caries among the sample was more than half (n=1114, 69.6%) with a mean DMFT score of (2.98, ±3.47) amongst which major contributor was decayed component which was found to be (2.56, ±3.99).. Whereas, caries prevalence among deciduous dentition was three forth (n=664, 74.9%) with mean dmft score was (2.01, ±3.30) and among permanent dentition prevalence was found to be more than half (n=450, 63%) with mean DMFT score of (0.97, ±1.97). Moreover, gender wise mean DMFT among permanent and deciduous dentition was found to be statistically non significant (p>0.109), (p>0.461) respectively. Furthermore, statistically significant difference was found in dental caries among permanent dentition of private and public schoolchildren (p<0.001).

Conclusion

This study suggests that considerable proportion of children (both among younger and older age categories) had dental caries with significantly more involvement among public school children belonging to eight different towns of Karachi city.

Keywords

Dental Caries, Private and Public school children, Oral Health Education, Oral Health Promotion.

Objectives

To assess and compare the frequency of dental anxiety among patients visiting the public and private dental hospitals of Karachi, Pakistan.

Methadology

This cross sectional study was conducted in 2014 among patients at public and private dental hospitals of Karachi. Sample size of 400 patients was selected from the Outpatient Department (OPD) of hospitals through non probability convenience sampling technique. Data was collected by interviewing the study participant via structured questionnaire using Modified Dental Anxiety Scale (MDAS). Data was entered and analyzed using SPSS version 20.

Results

Total 400 patients were studied of which 184 (46%) were males and 216 (54%) were females. Tooth extraction and filling were identified as the most common reason to visit dental OPD as answered by 111 (27.8%) and 100 (25%) patients respectively. Among them 276 (69.5%) had positive experience and were satisfied while treated in dental OPD. Using MDAS, dental anxiety was found in 12 (3%) patients at private as compared to none in public dental hospital (p=0.001).

Conclusion

On the basis of MDAS score dental anxiety was found more among patients from private dental hospital as compare to patients from public dental hospitals.

Keywords

Dental Anxiety, Public, and Private Dental Hospitals.

Abstract

Structurally compromised endodontically treated teeth can be rehabilitated using a multi disciplinary approach. The treatment plan may involve all areas of dentistry. The treating clinician may find himself in unknown territory if the required plan involves procedures outside his set of skills. This might lead to presentation of more invasive plan to treat such teeth. Present report is about such a case where a canine with a history of repeated failures of post retained crowns was restored again with a custom cast post and core and an improved ferrule.