Assistant Professor, College of Dentistry, Endodontics BDSc, GradDipClinDent (Endo), MDSc (Endo), MRACDS (Endo), FRACDS (Endo), JMC (Endo), MIADT, MIADR.
We present two cases where the identities of mixed radiopaque radiolucent lesions in the lower incisor region were unclear, although the position of the lesions and positive pulp sensitivity tests were suggestive of periapical osseous dysplasia. In the first case, the lesion presented as a solitary round mixed radiopaque radiolucent periapical lesion, suggestive in some images as periapical osseous dysplasia. Cone beam CT (CBCT) provided clear images, which confirmed the diagnosis and, additionally, the images showed evidence of initial lesions associated with other anterior teeth and some destruction of the labial plate, not evident on the conventional radiographs. In the second case, radiopacities were identified within the lesion on conventional radiographs, but CBCT imaging also showed extensive and unexpected perforation of the lingual plate. Such destruction of cortical plates may be a feature of periapical osseous dysplasia, which is not visible in conventional radiography.
AIM To develop an experimental in vivo model to study dentoalveolar ankylosis and osseous replacement resorption after delayed replantation. MATERIALS AND METHODS The maxillary right incisors of eight rabbits were extracted and replanted, while the maxillary left incisors served as controls. A special technique for extraction was used, luxating the incisor laterally prior to extraction. Extra-oral root canal treatment was performed. In four of the eight replanted teeth, periodontal ligament was removed using gauze. All teeth were replanted after one-hour dry storage. A horizontal line was drilled on the labial enamel surface of the incisors to enable registration of possible subsequent infraposition. The rabbits were sacrificed after 1 week or 4 weeks, respectively. Percussion test of the teeth was carried out and infraposition was registered. Histological processing and evaluation were performed. RESULTS Percussion sound was normal after 1 week and high in the 4 week group; infraposition was noted in all replanted teeth in the 4-week group. Fusion between the bone and dentin was seen in some areas on the root already after 1 week, but there was little or no osseous replacement. Larger areas of ankylosis were seen in the 4-week group although not significant, but deeper progressive osseous replacement was noted in this group. There was no significant difference in ankylosis with regard to periodontal ligament removal or not. Pulp and periodontal tissues were normal in all control teeth. CONCLUSION The rabbit tooth model may be useful for experimental in-vivo studies on delayed replantation, subsequent ankylosis, osseous replacement and infraposition.
The aim of this study was to assess the effect of the quality of the coronal restoration and the root filling on the success of endodontic treatment. Patients treated at Kuwait University Dental Clinics (KUDC) from 2003 to 2014 were contacted by telephone calls. Demographic data and clinical records of patients, including age, gender, the tooth number, and medical history were recorded. Each patient received clinical examination for all teeth, including assessment of the coronal filling (type, quality), root- and/or coronal fracture, and the periodontal condition around the tooth (e.g., probing depth, gingival recession); percussion and mobility tests. A periapical radiograph of the endodontic treated tooth was taken to determine the health of the periapical tissues using the periapical index. The quality of the root filling was assessed by length and density of the root filling. The mean follow-up period was 4.8 years. The overall success rate of endodontic treatment was 86%; teeth without any initial periapical lesion had a success of 93%, whereas those with such lesion had a success rate of 80%. Periapical healing was not significantly associated with either the length of root filling (p = 0.40) or the density of root filling (p = 0.099), but was statistically significantly associated with the presence of coronal filling defects (p = 0.001). This study demonstrated that inadequate coronal filling but not the quality of root filling was associated with a higher prevalence of periapical lesions.
Objective: Percussion of teeth with a handle of a mouth mirror is a common method of diagnosis in dentistry. Pain or discomfort in response to the percussive force can indicate a variety of problems including diseased periodontium or pulp via eliciting pain. The main objective was to instrument a mouth mirror to assess the forces that dentists routinely use in such percussion, as compared to maximum bite forces.Methods: The instrumented handle of a mouth mirror was used by one clinician to tap healthy teeth in 15 subjects. These percussive forces were compared to maximum voluntary forces produced by the subjects. A pilot study of 15 dentists was then run, who percussed the teeth of two healthy subjects.Results: In the preliminary study, biting forces were variably two orders of magnitude higher than for tapping, being higher on posterior teeth (p
Background: The growing success of dental implants has made this treatment mode increasingly more popular for the replacement of missing teeth. The aim of this study was to assess public awareness and determine patient’s expectations concerning dental implants through requisite information on treatment mode, prior to presenting for professional consultation on dental implant, as a treatment option. Materials and methods: In a cross-sectional survey, 527 adult participants were interviewed, through random selection from attendance at public places. A structured questionnaire, with multiple-choice questions, was used to obtain the participants' level of knowledge on dental implants, including the source of information on which they based this knowledge, their reasons to accept or reject dental implant treatment, as well as their understanding of the procedures involved. Results: In all, (96.4%) of participants had heard of dental implants, and (79.2%) were willing to learn more about dental implants. Almost, two-third (64.9%) of the respondents thought dental implant to be the healthiest treatment mode for missing teeth. Maximum (33.9%) participants gathered dental implants information through media, followed by friends or social gatherings (24%), dental clinics (23.3%), and family (18.8%). Significantly more females than males, and more Kuwaitis than non-Kuwaitis expressed, ‘Good looking’, the reason for acceptance for dental implants (p
Objective: The objective of this study was to determine the association between periapical health status with the quality of the root filling and was the coronal restoration and identify the predictors of periapical lesion. Subjects and Methods: It was conducted among 197 adult patients who visited Kuwait University. Periapical status was measured by periapical index. The presence or absence of periapical lesions was evaluated using panoramic radiographs. Statistical Analysis: Data were analyzed using the Statistical Package for Social Sciences. Chi-square tests were performed to assess associations between categorical variables. Results: Of the 4,841 teeth examined, 2.7% were root-filled (n = 130). Thirty-four percent of the root-filled teeth (n = 44), and 3% of the nonroot-filled teeth (n = 141 of 4711) exhibited periapical radiolucency. Of the root filled teeth, 49% were judged to be inadequate (n = 64) and 91% of the inadequate ones had short root filling (n = 58). The presence of periapical lesion was significantly predicted by inadequate coronal restoration, dental caries, periodontal bone loss, and the presence of post crown. Conclusion: This study demonstrated a large number of untreated teeth with periapical pathology. The quality of root fillings in this population appeared to be poor and was significantly associated with a high prevalence of apical periodontitis.
Objective The aim of this study was to determine prescription patterns of antibiotics and analgesics among dentists in the management of dental pain and infection for medically healthy patients undergoing endodontic management. Materials and Methods This descriptive cross-sectional survey was based on a structured questionnaire. The questionnaire collected data on age, gender, years of experience, and the qualifications of dentists. Feedback on prescription patterns for antibiotics and analgesics was collected for a number of clinical scenarios. Participants' choices regarding the type, dose, and duration of antibiotics/analgesics were recorded. Completed questionnaires were analyzed using the Statistical Package for Social Sciences (SPSS; version 24) to determine relationships between prescription patterns, age, gender, and educational qualification. Results Of the 227 participants surveyed, 190 (83.7%) did not prescribe antibiotics for patients complaining of severe pain. There were significant associations between age and years of experience and antibiotic prescription for pain management (p = 0.035 and 0.04, respectively). Of the participants, 199 (87.7%) never prescribed antibiotics for reversible pulpitis with normal periapical area; there was a statistical significance in relation to gender (p = 0.044). Amoxicillin 500 mg was prescribed most of the time (51.5%). Diclofenac K (50 mg) was prescribed by 41% of the participants, while 39.2% of the participants very often prescribed ibuprofen (600 mg). Conclusion Most dentists prescribed analgesics and antibiotics as recommended, but more education on the proper use of these medicines is needed for dentists and patients.
Background/aim: Delayed (dry storage > 60 minutes) replantation results in ankylosis and replacement resorption. It has been suggested to remove the non-viable periodontal ligament before replantation to possibly reduce the rate of replacement resorption. However there has been no study on the rate of replacement resorption after such measures. The aim of this study was to investigate if there was any difference in the rate of replacement resorption by either removing the periodontal ligament (PDL) with gauze or not removing PDL in teeth subjected to delayed replantation followed by healing for 2 or 6 weeks. Materials and methods: Maxillary central incisors were extracted in 8 rabbits. In the right central incisors, the necrotic PDL was removed by dry gauze over the root surface. In the left eight extracted teeth PDL was left on the root surface. All extracted teeth were left to dry for 60 minutes. Extra-oral root canal treatment was performed before replantation. The rabbits were sacrificed after 2 weeks and 6 weeks respectively. Histologic processing and evaluation was done. Results: In the 2 weeks group, all teeth showed ankylosis. The cementum was intact, and fusion of the bone and root was generally seen without resorption of the root, whereas in the 6 weeks group regardless of whether PDL had been kept or not, ankylosis and osseous replacement of the dentin was seen. There was no evidence of inflammatory infiltrate in the sections examined. Conclusion: Removal of PDL prior to delayed replantation may result in some initial protection of the cementum during the first few weeks. However, over longer times there seems to be neither protection of the dentin from ankylosis and osseous replacement, nor any influence on the rate of replacement resorption.
Background: The use of rubber dam (RD) has been recommended in dental procedures including root canal treatment. The aim of the study was to identify factors that were associated with patients' satisfaction and acceptance of RD. Setting and design:: This was a cross-sectional study, conducted from January 2015 to December 2016 at Kuwait University School of Dentistry. Materials and methods: A pretested questionnaire was used by a face-to-face interview of patients after taking informed consent. The study was approved by the Institutional Ethics Review Board. The providers/operators who applied RD were grouped into three categories: undergraduate final year (7th year) dental students; general dentists and postgraduate students; and specialists. Results: Mean age of the patients (n = 175) was 31.6 ± 13.0 years. About 55% had past experience, and 52% expressed a better experience during the current procedure compared with the previous one. A positive experience during the current procedure correlated significantly with the future intention of RD use (r = 0.244, P = 0.001). Time needed for RD application was short (4 min), irrespective of the operators. The duration of RD use during the procedure was significantly shorter among dental specialists compared with the other groups. Time for RD application was the only significant predictor for patient satisfaction, after controlling for other independent variables. Conclusion: Based on the positive influence of current RD use on the future intention, dentists should spend time needed to explain the importance, safety and effectiveness of RD use with their patients.
Background: Knowledge of the risk indicators of aggressive periodontitis (AgP) will help clinicians to better diagnose the disease, put a treatment plan that involves modification of modifiable risk indicators, understand non-modifiable risk indicators, and may potentially serve as an aid in developing preventive programs. The objective of the present study was to assess risk indicators of aggressive periodontitis (AgP) in Jordan including socio-demographic factors, oral hygiene habits, smoking, family history and parents' consanguinity. Methods: A total of 162 patients (81 AgP and 81 controls), attending the Periodontology clinic at Jordan University of Science and Technology, Dental Teaching Centre, were interviewed and examined. All AgP subjects had full periodontal and radiographic examination. The data recorded included socio-demographic and economic variables, oral hygiene and smoking habits, family history and parents' consanguinity. Results: Most AgP patients were young females, had ≤12 years of education, lived in urban areas and brushed their teeth ≥ once daily. Risk indicators of AgP included: age > 35 years, female gender and positive family history. Conclusions: Risk indicators associated with AgP in this study population were: age > 35 years, female gender and positive family history of periodontal disease.
Background The etiology, presentation and management of traumatic dental injuries (TDIs) vary significantly between the adult and the younger population. Most epidemiological studies on TDIs have focused on the pediatric age group. This study aims to report and compare the distributions of TDIs among adults in a sub-population in India. Methods This prospective observational study was performed on 1562 consecutively selected patients (1218 males and 344 females) from a university dental hospital in India, between July 2014 and June 2018. The clinical examinations were performed by a single trained and calibrated endodontist. Only TDIs to anterior teeth were recorded (canine to canine in the maxilla and mandible) and classified using a modified version of the World Health Organization's (WHO’s) classification. Periapical and panoramic radiographs were taken for all the subjects. Results A total of 1562 patients aged between 20 and 73 years, with a mean age of 36 years, were examined during the study period. The total number of teeth with TDIs was 3044. Males (78%) clearly outnumbered the females (22%) in all the age groups. The most common type of injury occurring in both the genders is uncomplicated crown fractures (male=31.0% and female=36.6%). Avulsion injuries are more likely to be seen by a dentist within 1 hour post-trauma. About two-third of the TDIs were caused by road traffic accidents (RTAs) followed by falls in about 20% of the patients. Conclusion Uncomplicated crown fracture was the most commonly observed type of TDI, and RTAs were the primary cause of TDI.