MyMedR

Anatomical challenges, electronic working length determination and current developments in root canal preparation of primary molar teeth

Ahmed HM

Int Endod J, 2013 Nov;46(11):1011-22.

PMID: 23711096 DOI: 10.1111/iej.12134

Paediatric endodontics is an integral part of dental practice that aims to preserve fully functional primary teeth in the dental arch. Pulpectomy of primary molars presents a unique challenge for dental practitioners. Negotiation and thorough instrumentation of bizarre and tortuous canals encased in roots programmed for physiological resorption are the main challenges for this treatment approach. Consequently, numerous in vitro and in vivo studies have been conducted to validate the application of some contemporary endodontic armamentarium for effective treatment in primary molars whilst maintaining favourable clinical outcomes. Electronic apex locators, rotary nickel-titanium files and irrigation techniques are at the forefront of endodontic armamentarium in paediatric dentistry. Hence, this review aims to map out the root and root canal morphology of primary molars, to discuss the application of electronic apex locators in primary molars and to provide an update on the preparation of their root canal systems.

Fulltext Nano-computed tomography: current and future perspectives

Ahmed HM

Restor Dent Endod, 2016 Aug;41(3):236-8.

PMID: 27508168 DOI: 10.5395/rde.2016.41.3.236

Discolouration potential of endodontic procedures and materials: a review

Ahmed HM, Abbott PV

Int Endod J, 2012 Oct;45(10):883-97.

PMID: 22621247 DOI: 10.1111/j.1365-2591.2012.02071.x

Advances in endodontic materials and techniques are at the forefront of endodontic research. Despite continuous improvements, tooth discolouration, especially in anterior teeth, is considered an undesirable consequence following endodontic treatment as it creates a range of aesthetic problems. This article aims to discuss the intrinsic and internalized tooth discolouration caused by endodontic procedures, and to address the discolouration potential of materials used during root canal treatment, including root canal irrigants, intra-canal medicaments, endodontic and post-endodontic filling materials. In addition, the discolouration patterns caused by combined endodontic and nonendodontic aetiological factors are discussed. The recommended guidelines that should be followed by dental practitioners to prevent and manage tooth discolouration are also outlined.

Fulltext Accessory roots in maxillary molar teeth: a review and endodontic considerations

Ahmed HM, Abbott PV

Aust Dent J, 2012 Jun;57(2):123-31; quiz 248.

PMID: 22624750 DOI: 10.1111/j.1834-7819.2012.01678.x

Maxillary molar teeth may have accessory roots. The aim of this paper is to review and discuss the endodontic implications of this anatomical variation. A review of the literature was undertaken to identify studies and reported cases where accessory roots have been recorded in maxillary molar teeth. The results show that although the prevalence of accessory roots in maxillary molar teeth is low, they can exist in all three types of maxillary molar teeth, and they may be located palatally, buccally, mesially or distally. Hence, it is essential that dentists undertaking root canal treatment thoroughly assess all teeth to determine how many roots are present in order to provide the best possible outcome of treatment for the patient.

Fulltext The antibacterial activity of sodium hypochlorite and chlorhexidine against Enterococcus faecalis: A review on agar diffusion and direct contact methods

Luddin N, Ahmed HM

J Conserv Dent, 2013 Jan;16(1):9-16.

PMID: 23349569 DOI: 10.4103/0972-0707.105291

Complete debridement and disinfection of the root canal system are fundamental requirements for successful endodontic treatment. Despite the morphological challenges of the internal root anatomy, root canal irrigants play an important role in the optimization of the root canal preparation, which is essentially a chemo-mechanical procedure. Enterococcus faecalis is one of the most resistant microorganisms that dominants the microbial ecosystem of persistent periradicular lesions in retreatment cases. For that reason, many in vitro and in vivo studies evaluated and compared the antibacterial activity of sodium hypochlorite and chlorhexidine at varying concentrations using different experimental models against this microorganism. However, many controversies with regard to the ideal irrigant and concentration do in fact exist. Hence, this review aims to discuss the antibacterial activity of these two main root canal irrigants against Enterococcus faecalis using the agar diffusion and direct contact methods and the possible modulating factors responsible for inconsistent findings among different studies. In addition, the disinfection potential of both chemical agents on gutta percha and Resilon cones are also discussed. The source of this review was conducted through an electronic literature search using PubMed database from December 1997 until December 2011, which analyze the related laboratory investigations of both irrigants, published in major endodontic journals.

Accessory roots and root canals in human anterior teeth: a review and clinical considerations

Ahmed HM, Hashem AA

Int Endod J, 2016 Aug;49(8):724-36.

PMID: 26174943 DOI: 10.1111/iej.12508

Anterior teeth may have aberrant anatomical variations in the number of roots and root canals. A review of the literature was conducted using appropriate key words in major endodontic journals to identify the available reported cases as well as experimental and clinical investigations on accessory roots and root canals in anterior teeth. After retrieving the full text of related articles, cross-citations were identified, and the pooled data were then discussed. Results revealed a higher prevalence in accessory root/root canal variations in mandibular anterior teeth than in maxillary counterparts. However, maxillary incisor teeth revealed the highest tendency for accessory root/root canal aberrations caused by anomalies such as dens invaginatus and palato-gingival groove. Primary anterior teeth may also exhibit external and internal anatomical variations in the root, especially maxillary canines. Therefore, dental practitioners should thoroughly assess all teeth scheduled for root canal treatment to prevent the undesirable consequences caused by inadequate debridement of accessory configurations of the root canal system.

Rubber dam application in endodontic practice: an update on critical educational and ethical dilemmas

Ahmed HM, Cohen S, Lévy G, Steier L, Bukiet F

Aust Dent J, 2014 Dec;59(4):457-63.

PMID: 25091028 DOI: 10.1111/adj.12210

Proper isolation is an essential prerequisite for successful endodontic treatment. This article aims to provide an update on the prevalence of rubber dam (RD) use, and the role of education along with attitudes of general dental practitioners (GDPs) and patients towards the application of RD in endodontics. Critical ethical issues are also highlighted. Using certain keywords, an electronic search was conducted spanning the period from January 1983 to April 2013 to identify the available related investigations, and the pooled data were then analysed. The results show that although RD is the Standard of Care in endodontic practice, there is a clear discrepancy in what GDPs are taught in dental school and what they practice after graduation. There is little scientific evidence to support the application of RD; however, patient safety and clinical practice guidelines indicate that it is unnecessary and unethical to consider a cohort study to prove what is already universally agreed upon. A few clinical situations may require special management which should be highlighted in the current guidelines. This would pave the way for clear and straightforward universal guidelines.

Teaching future health care professionals about the concept of essential medicines

Ahmed HM, Ibrahim MI

Med Teach, 2010;32(4):346-7.

PMID: 20369399

Assessment of Root Canal Filling Removal Effectiveness Using Micro-computed Tomography: A Systematic Review

Rossi-Fedele G, Ahmed HM

J Endod, 2017 Apr;43(4):520-526.

PMID: 28214018 DOI: 10.1016/j.joen.2016.12.008

INTRODUCTION: The removal of obturation materials from the root canal system is a primary objective in root canal retreatment procedures. This systematic review aims to discuss the effectiveness of different instrumentation procedures in removing root-canal filling materials assessed by micro-computed tomography.

METHODS: An electronic search in PubMed and major endodontic journals was conducted using appropriate key words to identify investigations that examined the effectiveness of obturation material removal assessed by micro-computed tomography.

RESULTS: Among 345 studies, 22 satisfied the inclusion criteria. Seven studies compared hand instrumentation with Nickel-Titanium rotary or reciprocating systems. Three studies investigated rotary systems, and another three studies explored reciprocation. Eight studies compared rotary systems and reciprocation in removing filling materials from the root canal system. Other factors, such as the role of solvents and irrigant agitation, were discussed.

CONCLUSIONS: The application of different instrumentation protocols can effectively, but not completely, remove the filling materials from the root canal system. Only hand instrumentation was not associated with iatrogenic errors. Reciprocating and rotary systems exhibited similar abilities in removing root filling material. Retreatment files performed similarly to conventional ones. Solvents enhanced penetration of files but hindered cleaning of the root canal. The role of irrigant agitation was determined as controversial.

Fulltext Editorial: A New Achievement to the European Endodontic Journal and Appreciation to Editors and Reviewers

Davut Capar I, Aly Ahmed HM

Eur Endod J, 2020;5(1):1.

PMID: 32342029 DOI: 10.14744/eej.2020.1

Sealing ability of various restorative materials as coronal barriers between endodontic appointments

Tapsir Z, Aly Ahmed HM, Luddin N, Husein A

J Contemp Dent Pract, 2013 Jan 1;14(1):47-50.

PMID: 23579892

To evaluate and compare the microleakage of various restorative materials used as coronal barriers between endodontic appointments.

Fulltext Cytotoxicity of accelerated white MTA and Malaysian white Portland cement on stem cells from human exfoliated deciduous teeth (SHED): An in vitro study

Ong RM, Luddin N, Ahmed HM, Omar NS

Singapore Dent J, 2012 Dec;33(1):19-23.

PMID: 23739319 DOI: 10.1016/j.sdj.2012.11.001

The aim of this study was to compare the cytotoxicity of accelerated-set white MTA (AWMTA) and accelerated-set Malaysian white PC (AMWPC) on stem cells from human exfoliated deciduous teeth (SHED). The test materials were introduced into paraffin wax moulds after mixing with calcium chloride dihydrate and sterile distilled water. Subsequently, the set cement specimens were sterilized, incubated in a prepared Dulbecco's modified Eagle medium (DMEM) for seven days. The biomarker CD166 was used for characterization of SHED using flow cytometry. The material extracts were diluted at five different concentrations and incubated for 72h with SHED. The cell viability was evaluated using Dimethylthiazol diphenyltetrazolium bromide (MTT) assay, and the data was analysed using Mann-Whitney test (P<0.05). The results showed that AWMTA revealed significantly greater cell viability at 25 and 12.5mg/ml concentrations (P<0.05). Concomitantly, AMWPC exhibited greater cell viability at concentrations <12.5mg/ml and the results were significant at 1.563mg/ml (P<0.05). Both materials demonstrated moderate cytotoxicity at 25mg/ml and slight cytotoxicity at 6.25 and 3.125mg/ml. At 1.563mg/ml, no cytotoxic activity was merely observed with AMWPC. In conclusion, AMWPC exhibited favourable and comparable cell viability to that of AWMTA, and has the potential to be used as an alternative and less costly material in dental applications.

Fulltext Management and prognosis of teeth with trauma induced crown fractures and large periapical cyst like lesions following apical surgery with and without retrograde filling

Ahmed HM, Al Rayes MH, Saini D

J Conserv Dent, 2012 Jan;15(1):77-9.

PMID: 22368341 DOI: 10.4103/0972-0707.92612

Crown fractures are common detrimental consequences of dental traumatic injuries. Early management of such cases is mandatory in order to prevent subsequent pathological changes that could further complicate the treatment. Pulp necrosis, chronic and cystic apical periodontitis can be the fate if these teeth are left untreated. Despite these serious complications, root canal treatment followed by apical surgery is considered a valid treatment option when such cases become complicated with large periapical lesions. However, whether a retrograde filling is essential to be placed or not is still a matter of debate. This case report discusses the orthograde endodontic management, the surgical approach and the clinical outcomes of longstanding crown fractured teeth with large cyst-like periapical lesions with and without retrograde filling.

Fulltext Cytotoxicity evaluation of a new fast set highly viscous conventional glass ionomer cement with L929 fibroblast cell line

Ahmed HM, Omar NS, Luddin N, Saini R, Saini D

J Conserv Dent, 2011 Oct;14(4):406-8.

PMID: 22144813 DOI: 10.4103/0972-0707.87212

This study aims to evaluate the cytotoxicity of a new fast set highly viscous conventional glass ionomer cement (GIC) with L929 fibroblasts.

Seven root canals in a deciduous maxillary molar detected by the dental operating microscope and micro-computed tomography

Ahmed HM, Khamis MF, Gutmann JL

Scanning, 2016 Nov;38(6):554-557.

PMID: 26751249 DOI: 10.1002/sca.21299

The root and root canal morphology of deciduous molars shows considerable variations. Consequently, a comprehensive understanding of the normal and unusual root and root canal configuration types in deciduous teeth is of prime importance. The purpose of this report is to describe a rare anatomical variation in a double-rooted maxillary deciduous molar examined by the dental operating microscope and micro-computed tomography. SCANNING 38:554-557, 2016. © 2016 Wiley Periodicals, Inc.

Cell attachment properties of Portland cement-based endodontic materials: biological and methodological considerations

Ahmed HM, Luddin N, Kannan TP, Mokhtar KI, Ahmad A

J Endod, 2014 Oct;40(10):1517-23.

PMID: 25127931 DOI: 10.1016/j.joen.2014.06.013

The attachment and spreading of mammalian cells on endodontic biomaterials are an area of active research. The purpose of this review is to discuss the cell attachment properties of Portland cement (PC)-based materials by using scanning electron microscope (SEM). In addition, methodological aspects and technical challenges are discussed.

Current Assessment of Reciprocation in Endodontic Preparation: A Comprehensive Review-Part I: Historic Perspectives and Current Applications

Grande NM, Ahmed HM, Cohen S, Bukiet F, Plotino G

J Endod, 2015 Nov;41(11):1778-83.

PMID: 26514866 DOI: 10.1016/j.joen.2015.06.014

During the evolution of mechanical instrumentation in endodontics, an important role has been played by reciprocating stainless steel files using horizontal rotational, vertical translational, or combined movements. These kinds of systems are still in use mainly as an accessory to help in the first phases of the treatment.

Current Assessment of Reciprocation in Endodontic Preparation: A Comprehensive Review--Part II: Properties and Effectiveness

Plotino G, Ahmed HM, Grande NM, Cohen S, Bukiet F

J Endod, 2015 Dec;41(12):1939-50.

PMID: 26480824 DOI: 10.1016/j.joen.2015.08.018

Many reciprocating file systems (RFs) have recently been introduced. This article reviews the properties, effectiveness, and clinical outcomes of the RFs.

Anesthetic Efficacy of Gow-Gates, Vazirani-Akinosi, and Mental Incisive Nerve Blocks for Treatment of Symptomatic Irreversible Pulpitis: A Systematic Review and Meta-analysis with Trial Sequential Analysis

Nagendrababu V, Aly Ahmed HM, Pulikkotil SJ, Veettil SK, Dharmarajan L, Setzer FC

J Endod, 2019 Oct;45(10):1175-1183.e3.

PMID: 31551112 DOI: 10.1016/j.joen.2019.06.008

INTRODUCTION: This systematic review compared the anesthetic efficacy between Gow-Gates (GG), Vazirani-Akinosi (VA), and mental incisive (MI) nerve blocks (NBs) with inferior alveolar nerve blocks (IANBs) in mandibular teeth with irreversible pulpitis using meta-analysis and trial sequential analysis (TSA).

METHODS: Studies were identified from 4 electronic databases up to June 2019. Randomized clinical trials (RCTs) comparing the anesthetic success rate of GG, VA, and MI NBs with IANBs in mandibular premolars and molars with irreversible pulpitis were included. The quality of selected RCTs was appraised using the revised Cochrane risk of bias tool. Random-effects meta-analyses of risk ratio (RR) and 95% confidence intervals (CIs) were calculated, and random errors were evaluated by TSA. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach.

RESULTS: Five RCTs were included; 2 of them were classified as low risk of bias. No significant difference was observed in the anesthesia success rate compared between GG and IA NBs (RR = 1.10; 95% CI, 0.82-1.48; I2 = 0%). Similarly, no difference was evident between MINB and IANB (RR = 1.15; 95% CI, 0.97-1.36; I2 = 0%). Overall, the cumulative success rates for the 3 anesthetic techniques were low. TSA showed a lack of firm evidence for the results of the meta-analysis between GG NB and IANB. The Grading of Recommendations, Assessment, Development and Evaluation approach evaluation showed that the evidence was of moderate quality for GG NB and IANB compared with low quality for MI and IA NBs. Because only 1 study was available comparing VA NB and IANB, a meta-analysis was not performed. The adverse effect associated with MI NB was swelling, whereas it was prolonged numbness for IANB.

CONCLUSIONS: GG NB and IANB showed similar anesthetic efficacy compared with IANB in mandibular teeth with irreversible pulpitis. However, the success rates for each technique indicate the need for supplemental anesthesia. Further well-designed RCTs evaluating different anesthetic techniques with and without supplemental injection are required to provide stronger evidence.

Fulltext Unusual Deviation of the Main Foramen from the Root Apex

Versiani MA, Ahmed HM, Sousa-Neto MD, De-Deus G, Dummer PM

Braz Dent J, 2016 Sep-Oct;27(5):589-591.

PMID: 27982239 DOI: 10.1590/0103-6440201601106

The relationship of the main foramen to the anatomic root apex has been the subject of several studies. Although they are anatomically close, they rarely coincide, and their distance can vary according to age or tooth type, ranging from 0.2 to 3.0 mm. The aim of this short communication was to evaluate the distance between the main foramen of independent middle mesial canals (MMCs) and the anatomical mesial root apex of mandibular first molars using the micro-computed tomography. Twenty-five mandibular first molars with MMCs were scanned (resolution of 9.9 µm), and the distance from its main foramen to the anatomical apex was evaluated. Overall, the distance ranged from 0.2 to 2.4 mm; however, in 3 specimens the distance was greater than 3 mm. This report demonstrates that the exit of the main foramen of the MMC varies considerably and could approach a substantial distance from the anatomical apex greater than previously reported in the literature.

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