Sectional matrix band system has been found superior to circumferential matrix band system.

Introduction: Preservation of endodontically treated teeth (ETT) depends upon several patient-related and operator-related factors. The objectives of this study were to assess the effects of different types of coronal restoration and delayed placement on ETT survival. Methods: Data on dates of root canal treatment (RCT), restoration type, and extraction time of tooth, when applicable, were analyzed for all patients who underwent RCT from 2010 to 2018 at our institution. Inclusion Criteria: Root canal-treated teeth with complete preoperative and postoperative radiographs; ETT that were restorable and received final permanent coronal restorations; no periodontal disease or crack detected during RCT; and ETT with acceptable RCT quality. Exclusion Criteria: Patients who did not attend for follow-up, those had incomplete information available about the coronal restoration, and those with periodontally compromised teeth were excluded. ETT that involved any procedural error were also excluded. The teeth were categorized according to whether they underwent definitive coronal restoration 0-14 days, 15-59 days, or 60+ days after RCT. The statistical analysis was performed using SPSS version 25 (IBM Corp., Armonk, NY). The rate of survival of ETT of 8 years was estimated, and the differences between groups were determined after applying Kaplan-Meier statistics and log-rank tests. A multivariate Cox regression test and Wilcoxon (Gehan) statistics were computed to analyze the influence of different variables. A P-value <0.05 was considered as statistically significant. Results: The type of restoration, opposing dentition, presence of a post, and dentistry training (year 4 or 5 students) showed significant effects on the survival of ETT (P ≤ 0.000). ETT which received crowns was 2.05 times more likely to need extraction than those in which a composite buildup was performed (hazard ratio [HR] 2.05; confidence interval [CI] 1.84-2.29; P ≤ 0.000). All composite buildups were performed within 14 days of completion of RCT. There was a significant correlation between the time of placement of the final coronal restoration and ETT survival (P ≤ 0.000). Extraction of ETT was 25% more likely (HR 0.25; CI 0.231-0.277) when the final coronal restoration was placed 15-59 days after completion of RCT and 73% more likely (HR 0.73; CI 0.655-0.814) when placed after 60 days than when placed at 0-14 days. Conclusion: Timely placement of the final coronal restoration is found to be the most critical factor affecting the long-term survival of teeth after RCT.

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Vital pulp therapies have been used in primary teeth and immature permanent teeth. However, with the advent of new bioactive material, the paradigm is shifting toward permanent teeth with mature apices of roots. There are many prospective and retrospective studies, randomized controlled trials, and systematic reviews that report coronal pulpotomy with bioactive material in permanent teeth with pulpal pathosis proved to be as successful as root canal therapy (RCT). Coronal pulpotomy is cost-effective, not very technical demanding like root canal therapy and less time consuming for both the dentists and patients. This treatment can be offered to the patient as an alternative to endodontic therapy. The objective of this study is to review the literature related to the clinical outcome of coronal pulpotomy in permanent teeth with mature apex and having pulpal pathosis. This evidencebased review will facilitate clinical decision making in situations to choose coronal pulpotomy over root canal therapy in mature permanent teeth with irreversible pulpitis.

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IntroductionRoot canal treatment is one of the oldest dental procedures for the treatment of endodontic infection. Extrusion of debris beyond the root apex during root canal instrumentation and subsequent persistence of pain are common complications. A systematic review of the evidence on reciprocating single-file instrumentation systems and their comparison with rotary single-file systems, with apical extrusion of debris as primary outcome, will be done through this study.Methods and analysisPublished ex vivo and in vitro studies with no language restriction will be included. We will search MEDLINE (Ovid), EMBASE (Ovid), Web of Science, Cochrane and Google Scholar. Strategies will be incorporated to search grey literature also. Thorough evaluation of search results, completion of data abstraction and assessment of quality will be done by two reviewers independent from each other. Assessment of included studies will be done by utilising an evidence model developed on the basis of standards of quality reported in guidelines to document ex vivo and in vitro studies regarding dental materials and pertained for extrusion of debris apically and has been already used in quality assessment of studies involving quantification of debris extrusion apically. We will calculate the standardised mean differences for apically extruded debris, with congruent 95% CIs. We will measure the statistical heterogeneity by applying the Cochrane Q test and quantify using the I2 statistic. Existence of covariates and any potential heterogeneity will be explored through prespecified subgroup and sensitivity analyses.Ethics and disseminationApproval from an ethical research committee is not required because it will be done using data that have been already published and have no concerns related to the privacy of patients. Extensive dissemination of results from this review will be done through submission to a peer-reviewed journal for publication and conferences.PROSPERO registration numberCRD42019151804.

The primary objective of evidence-based practice is to improve the quality of health care. It helps in making a clinical decision based on recent and advanced research and the best available evidence. Evidence-based dentistry is an integration of best available evidence with clinical expertise and patient’s needs and preferences. However, there are many barriers to apply evidence-based knowledge into practice. Information overflow, inability to select appropriate evidence, and critically appraising the evidence are the main challenges a practitioner may face. The focus of this review is defining a well-structured clinical question, key principles of literature search, type of search studies, and how to appraise an evidence. Furthermore, despite the availability of good evidence, patient’s needs and preferences are crucial factors in making clinical decision. Finally, the clinician’s experience and lack of motivation to change practice is another big challenge to evidence-based practice. This article discusses the six structured steps to apply evidence-based practice in dentistry with examples. Finally, this article will help practitioners to integrate their experience and skill with modern research evidence as well as to educate their patients to reach a final clinical decision.

This study aimed to compare the sensitivity and specificity of DIAGNOdent versus bitewing radiographs in detecting non-cavitated proximal caries. Patients and Methods: This observational prospective study included 120 proximal surfaces, without obvious cavitation, on permanent mandibular and maxillary posterior teeth in patients over 16 years old. The DIAGNOdent test was performed, and digital bitewing radiographs were obtained; these were compared with a standard reference method, which comprised a clinical assessment of the proximal surfaces following the application of an orthodontic separator between the teeth for 7 days. Each test was performed by a different investigator blinded to the assessment results of the other examiners. Results: The DIAGNOdent device exhibited a higher sensitivity in detecting enamel proximal caries (95%) than digital bitewing radiographs (64%), and the specificity of DIAGNOdent (89%) was greater than that of bitewing radiographs (77%). Regarding the detection of dentin caries, the sensitivities of DIAGNOdent and bitewing radiographs were similar (both 62%); however, the specificity of DIAGNOdent was higher (98% versus 88%). The results of the Kruskal-Wallis test revealed a significant difference in DIAGNOdent scores across the three diagnoses (sound tooth surfaces, enamel caries, dentin caries) (p-value <0.001). Conclusion: The diagnostic accuracy of DIAGNOdent in detecting enamel caries is significantly higher than that of digital bitewing radiography. The routine use of DIAGNOdent can facilitate an accurate diagnosis of early carious lesions and inform the implementation of preventive treatment.