Naseem Shah

Efficacy of Revascularization to Induce Apexification/Apexogensis in Infected, Nonvital, Immature Teeth: A Pilot Clinical Study

Endodontic treatment options for immature, nonvital teeth conventionally include surgical endodontics, apexification with calcium hydroxide, or single visit mineral trioxide aggregate plug. A new treatment option of revascularization has recently been introduced. It involves disinfecting the root canal system, providing a matrix of blood clot into which cells could grow, and sealing of the coronal access. The present pilot clinical study was undertaken to evaluate the efficacy of revascularization in 14 cases of infected, immature teeth. Endodontic treatment was initiated, and after infection control, revascularization was performed. The access cavity was sealed with glass ionomer cement. The cases were followed up at regular intervals of 3 months; the range in follow-up was 0.5-3.5 years. The outcomes were as follows. Radiographic resolution of periradicular radiolucencies was judged to be good to excellent in 93% (13 of 14) of the cases. In the majority of cases, a narrowing of the wide apical opening was evident. In 3 cases, thickening of apical dentinal walls and increased root length were observed. The striking finding was complete resolution of clinical signs and symptoms and appreciable healing of periapical lesions in 78% (11 of 14) of cases. Thickening of lateral dentinal walls was evident in 57% (8/14) of cases, and increased root length was observed in 71% (10/14) of cases. None of the cases presented with pain, reinfection, or radiographic enlargement of preexisting apical pathology. This pilot study documented a favorable outcome of revascularization procedures conducted in immature nonvital, infected permanent teeth.

Revascularization with and without Platelet-rich Plasma in Nonvital, Immature, Anterior Teeth: A Pilot Clinical Study

INTRODUCTION This study was conducted to evaluate and compare maturogenesis induced by revascularization with and without platelet-rich plasma (PRP). METHODS Twenty patients with nonvital, immature anterior teeth were randomly categorized into 2 groups. Subsequent to chemomechanical preparation, revascularization with and without PRP carried on a collagen sponge was induced in groups 1 and 2, respectively. The cases were followed up clinically and radiographically at 6- and 12-month intervals. RESULTS Clinically, all cases were asymptomatic with complete resolution of signs and symptoms. Radiographically, there was a marked difference in periapical healing, apical closure, and dentinal wall thickening in group 2 in comparison with group 1. However, root lengthening was comparable for both of the procedures. CONCLUSIONS Revascularization is a conservative and an effective method for inducing maturogenesis in nonvital, immature teeth. Supplementations with PRP can potentially improve the desired biological outcome of this regenerative technique.

RETRACTED: The Evaluation of Computed Tomography Scans and Ultrasounds in the Differential Diagnosis of Periapical Lesions

Traditionally, the definitive diagnosis of periapical lesion depends on histopathological examination of the tissues, which is impractical in cases planned for nonsurgical treatment. Recently, some authors have used ultrasound with power Doppler and computed tomography in differential diagnosis between a cyst and a granuloma. The aim of this study was to evaluate and compare the use of computed tomography (CT) scan and ultrasound with power Doppler flowmetry in differential diagnosis of periapical lesions. Twelve periapical lesions were imaged with the help of CT scans and ultrasound with color-power Doppler flowmetry. A provisional preoperative diagnosis was made based on history, clinical presentation, and radiographic features. The cases were treated by surgical endodontics. In all 12 cases, the diagnosis with CT scan and ultrasound coincided with the histopathological diagnosis of the lesions. It is proposed that CT scans and ultrasound with power Doppler flowmetry can provide an additional dignostic tool without invasive surgery, where treatment option is nonsurgical.

Endodontic Management of a Maxillary First Molar with Two Palatal Canals with the Aid of Spiral Computed Tomography: A Case Report

This case report presents the endodontic management of a maxillary first molar with 2 palatal canals with separate orifices and apical foramen. The diagnosis was confirmed with the help of spiral computed tomography. This article discusses the variations in the canal morphology and the use of latest adjuncts in successfully diagnosing and negotiating them.

High-end physician migration from India

OBJECTIVE To examine the relation between the quality of physicians and migration among alumni of All India Institute of Medical Sciences (AIIMS), New Delhi, India over the period 1989-2000. METHODS In a retrospective cohort study, data on graduates of AIIMS were collected from entrance exam qualifier lists, the AIIMS alumni directory, convocation records, the American Medical Association and informal alumni networks. The data were analysed by use of 2x2 contingency tables and logistic regression models. FINDINGS Nearly 54% of AIIMS graduates during 1989-2000 now reside outside India. Students admitted under the general category are twice as likely to reside abroad (95% confidence interval: 1.53-2.99) as students admitted under the affirmative-action category. Recipients of multiple academic awards were 35% more likely to emigrate than non-recipients of awards (95% confidence interval: 1.04-1.76). Multivariate analyses do not change these basic conclusions. CONCLUSION Graduates from higher quality institutions account for a disproportionately large share of emigrating physicians. Even within high-end institutions, such as AIIMS, better physicians are more likely to emigrate. Interventions should focus on the highly trained individuals in the top institutions that contribute disproportionately to the loss of human resources for health. Our findings suggest that affirmative-action programmes may have an unintended benefit in that they may help retain a subset of such personnel.

Comparative evaluation of rotary ProTaper, Profile, and conventional stepback technique on reduction in Enterococcus faecalis colony-forming units and vertical root fracture resistance of root canals.

OBJECTIVE The purpose of this in vitro study was to evaluate the effect of various root canal instrumentation techniques with different instrument tapers on cleaning efficacy and resultant vertical root fracture (VRF) strength of the roots. STUDY DESIGN Fifty human mandibular first premolar roots were enlarged to ISO size 20, inoculated with Enterococcus faecalis [ATCC2912] for 72 hours and divided into 5 groups: group I: prepared with .02 taper hand instruments ISO size 40; group II: Profile .04 taper size 40; group III: Profile .06 taper size 40; group IV: ProTaper size F4; and group V (control group) further divided into: Va: with bacterial inoculation and no mechanical instrumentation; and Group Vb: neither bacterial inoculation nor mechanical instrumentation. Cleaning efficacy was evaluated in terms of reduction of colony forming units (CFUs). The VRF strength was evaluated using D11 spreader as wedge in an Instron testing machine. RESULTS Root canals instrumented with ProTaper and 6% Profile instruments showed maximum reduction in CFUs, with statistically insignificant difference between them. The VRF resistance decreased in all instrumented groups. The difference of VRF between 2% and 4% taper Profile groups was statistically insignificant (P = .195). One-way analysis of variance showed that canals instrumented with ProTaper F4 showed maximum reduction in VRF resistance compared with control uninstrumented group. CONCLUSIONS Profile 6% taper instruments offer the advantage of maximum debridement without significant reduction in root fracture resistance.

Recent advances in imaging technologies in dentistry

Dentistry has witnessed tremendous advances in all its branches over the past three decades. With these advances, the need for more precise diagnostic tools, specially imaging methods, have become mandatory. From the simple intra-oral periapical X-rays, advanced imaging techniques like computed tomography, cone beam computed tomography, magnetic resonance imaging and ultrasound have also found place in modern dentistry. Changing from analogue to digital radiography has not only made the process simpler and faster but also made image storage, manipulation (brightness/contrast, image cropping, etc.) and retrieval easier. The three-dimensional imaging has made the complex cranio-facial structures more accessible for examination and early and accurate diagnosis of deep seated lesions. This paper is to review current advances in imaging technology and their uses in different disciplines of dentistry.

Effect of Cyclic Loading on Marginal Adaptation and Bond Strength in Direct vs Indirect Class II MO Composite Restorations

This study evaluated the effect of cyclic loading on the marginal adaptation and microtensile bond strength of direct vs indirect Class II composite restorations in an in-vitro model. Forty Class II cavities were prepared on the mesial surface of extracted human maxillary first premolars and divided into two groups: Group I--direct composite restorations and Group II--indirect composite restorations. Groups I and II were further divided into subgroups: A (without cyclic loading) and B (with cyclic loading of 150,000 cycles at 60N). The gingival margin of the proximal box was evaluated at 200x magnification for marginal adaptation in a low vacuum scanning electron microscope. The restorations were sectioned perpendicular to the bonded surface into 1 mm thickslabs. The slabswere further trimmed at the interface to produce a cross-sectional surface area of approximately 1 mm2. All specimens were subjected to microtensile bond strength testing. The marginal adaptation was analyzed using descriptive studies and bond strength data were analyzed by one-way ANOVA test. The indirect composite restorations performed better under cyclic loading.

Comparative outcome of revascularization in bilateral, non-vital, immature maxillary anterior teeth supplemented with or without platelet rich plasma: A case series

Loss of pulp vitality in an immature permanent tooth arrests root development. This leads to tooth with open apex and weak lateral dentinal walls. Management of such necrotic teeth with immature roots poses several treatment challenges. The documented study was performed to evaluate and compare apexogenesis induced by revascularization, with and without platelet rich plasma (PRP) in non-vital, immature anterior teeth. Three patients having bilateral, non-vital, immature maxillary central incisors with apical periodontitis were recruited after institutional ethical clearance. Subsequent to chemo-mechanical preparation, revascularization with and without PRP was randomly induced in either of the tooth. The cases were followed-up clinically and radiographically at 6 and 12 months. There was a marked difference in periapical healing, apical closure and dentinal wall thickening of teeth treated by revascularization with PRP.

A spectrophotometric evaluation of color changes of various tooth colored veneering materials after exposure to commonly consumed beverages

Purpose of study : Proper color match of a dental restoration with the adjacent teeth is important not only at the initial stage of giving the restoration but also over a longer period of time. Out of different materials Porcelain has established itself as being color stable and durable but composites are known to be susceptible to discoloration because of internal mechanisms, external contamination and staining. The newer universal composite systems are optimized in terms of composition to minimize internal discoloration but still not much attention is given to resistance to external staining. Procedure : Visual shade matching and color determination being a psychophysical phenomenon suffer from subjective variations in interpretation, therefore the present study was undertaken to evaluate and compare the color stability of a porcelain (Vitadur alpha) and two universal composites (Filtek Z 250 and Tetric Ceram) after exposure to commonly consumed beverages i.e. tea, coffee, coca-cola and distilled water (as control) by using a reflectance spectrophotometer and CIELAB system. Conclusion : T0 he color match of esthetic restorations in the oral cavity is affected by dietary habits