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Introduction The smear layer in radicular dentin reduces effective disinfection by occluding dentinal tubules and decreasing dentin permeability, contributing to persistent microbial infection and root canal treatment failures. Objective To compare the effect of 980 nm Diode laser irradiation and conventional irrigation with Sodium hypochlorite and ethylenediaminetetraacetic acid (NaOCl +EDTA) on smear layer removal in radicular dentin through dye penetration test. Material and methods Sixty-six extracted single-rooted permanent teeth were randomly allocated into two groups. Group I underwent 980 nm diode laser irradiation using a 200 µm fiber in helicoidal motion (2 W power, 200 Hz frequency, 1–4 ms pulse duration). Group II received conventional irrigation with 3% NaOCl followed by 17% EDTA. All specimens were immersed in 2% methylene blue dye for 48 h, after which cross-sections were obtained at 3, 5, and 8 mm from the anatomical apex. Dye penetration diameter (mm) and area (mm²) between the inner and outer circumferences were measured using ImageJ software under a stereomicroscope. Statistical analysis was performed using one-way ANOVA with Bonferroni post-hoc tests. Results The diode laser irradiation demonstrated overall significantly greater dentinal tubule penetration (16.2 ± 1.91 mm) compared to the conventional irrigation (5.32 ± 0.70 mm; p  = 0.001). The overall mean area of the laser group (12.61 ± 2.02 mm²) was greater as compared to the conventional group (1.67 ± 0.73 mm²; p  = 0.001). Conclusion Diode laser irradiation may serve as an effective adjunct for smear layer removal and improved root canal disinfection.

Background Artificial Intelligence (AI) has become increasingly integrated into dental diagnostics, particularly for detecting carious lesions. While AI offers benefits such as improved accuracy and efficiency, its use raises important ethical concerns, including transparency, patient privacy, autonomy, diversity and accountability. This scoping review aims to identify these ethical concerns using a structured ethical framework. Methodology Three databases were searched for papers regarding caries detection using AI. An established ethical framework was used to screen each paper for potential areas of concern. Results A total of 351 abstracts were screened, of which 7 articles were included in this review. Each article was screened for established ethical principles including transparency, diversity, wellness, autonomy, privacy, accountability, equity, prudence, sustainable development, solidarity and governance. Diversity was the main ethical concern. Concerns related to accountability, equity and transparency were identified in 2 of the articles whereas ethical issue of privacy was identified in 4 of the articles. Only one study mentioned that no ethical approval was taken prior to commencement of study. Conclusion AI in caries detection faces ethical issues like data bias, privacy risks, and equity concerns, potentially leading to flawed AI models. These issues can be addressed by creating a more specialized ethical framework that is specific to AI in dentistry. Clinical relevance Understanding ethical challenges in AI-driven caries detection is critical to ensure accurate diagnostics, maintain patient trust, protect privacy, and support informed decision-making. Clinicians must be equipped to navigate these challenges as AI tools become more prevalent in dental practice.

IntroductionVarious intracanal medicaments have been used in cases of chronic apical periodontitis for appropriate disinfection of the root canal system to eliminate microbes especially from the inaccessible areas. Calcium hydroxide is the most common intracanal medicament available in various forms, but its effectiveness with or without iodoform using microbial culture is unknown. Therefore, our aim is to compare the antimicrobial efficacy of Calcipex and Metapex in endodontic treatment of teeth presenting with chronic apical periodontitis by assessing the bacterial load reduction.Method and analysis60 single rooted teeth of patients with diagnosis of chronic apical periodontitis will be selected and the canals debrided chemomechanically. The patients will be randomised into two groups: Calcipex and Metapex. The first sample (S1) for bacterial culture will be taken before placement of intracanal medicament and the second sample (S2) will be taken after 7 days, before final obturation from the canal and sent to lab for culture. Colony-forming unit will be evaluated. Paired t-test will be used to assess difference between antimicrobial efficacies within the group of medicaments. Independent sample t-test will be used to assess antimicrobial efficacies between groups. Level of significance will be kept at 0.05.Ethics and disseminationApproval from Aga Khan University Hospital Ethical review committee is taken. Findings will be reported according to the Standard Protocol Items for Randomised Trials guidelines. Research findings will be disseminated through annual reports, peer-reviewed journals and conferences.Trial registration numberNCT04336709.

BackgroundMajority of patients with Dento-Facial Traumatic Injuries (DFTI) seek initial care at an Emergency Department (ED). The timely management of DFTI is of utmost importance in determining long-term prognosis of the tooth and the patient’s overall quality of life. Thus, knowledge and awareness of ED residents & physicians regarding the management of DFTI is crucial for better patient outcomes. Numerous studies have investigated the knowledge of ED specialists regarding initial management of dental trauma, however, scientific evidence in this domain is scarce in our region.ObjectiveThe aim of this study was to evaluate the knowledge and awareness of ED residents and physicians regarding diagnosis and management of DFTI using a web-based survey on REDCap.MethodsAn observational cross-sectional study was conducted among the ED residents and physicians of private and public hospitals in Karachi, Pakistan. Data was collected through a web-based questionnaire, sent via email to the participants. The survey comprised of questions assessing their knowledge regarding the diagnosis and management of various dental and maxillofacial injuries. Responses from the participants were graded as low, moderate or high knowledge levels according to a pre-determined criteria. Pearson’s chi-square test was applied to determine the association between knowledge scores.ResultsThe total response rate was 47.6%. Out of 116 participants, 49 (42%) responses were received from physicians and 67 (58%) from residents. The overall knowledge level of participants was low (46.6%) and there was no significant difference in the knowledge level between residents and physicians (p = 0.157). Participants who had received formal training in dental trauma (p = 0.038) and those with more years of clinical experience (p = 0.004) had higher knowledge scores, that were statistically significant.ConclusionsThe knowledge and awareness of ED residents and physicians in dental trauma management was generally low. Specialized training courses are required to provide timely and adequate management of traumatic dental injuries in order to improve patient-related outcomes.

Three-dimensional (3D) printing is the process of building 3D objects by additive manufacturing approach. It is being used in endodontics, periodontology, maxillofacial surgery, prosthodontics, orthodontics, and restorative dentistry, but our review article is focused on periodontal application. A detailed literature search was done on PubMed/Medline and Google Scholar using various key terms. A total of 45 articles were included in this study. Most of the studies were in vitro, preclinical, case reports, retrospective, and prospective studies. Few clinical trials have also been done. Periodontal applications included education models, scaffolds, socket preservation, and sinus and bone augmentation and guided implant placement. It showed better alveolar ridge preservation, better regenerative capabilities, greater reduction in pocket depth and bony fill, ease of implant placement in complex cases with greater precision and reduced time with improved outcome and an important tool for education and training using simulated models.

Background and Aim: Gingival hyperpigmentation is an esthetic problem. The aim of the present study was to identify most effective treatment modality for managing generalized physiological gingival pigmentation. Materials and Methods: A systematic review and meta-analysis were done (1919 to October 2018) using PubMed, CINHAL, Dental and Oral Science, and manual searches. Twenty-five articles were finally reviewed. Only human clinical trials were considered with physiological gingival pigmentation treated with different depigmentation methods and compared with surgical stripping. The outcome was the achievement of gingival depigmentation and its recurrence. RevMan software was used for data analysis. Results: Of 26,132 articles, 25 met the inclusion criteria. Seventeen were randomized control trials and 8 were nonrandomized control trials. Most of the studies were on laser. The control group was scalpel surgery. Majority of studies showed no difference in compared treatment modality. A meta-analysis compared laser ablation with surgical stripping revealed a nonsignificance difference regarding recurrence (P = 0.75) and depigmentation (P = 0.23) and a statistically significant difference regarding postoperative pain favoring laser ablation (P ≤ 0.05). Conclusions: Surgical stripping has been the conventional treatment of choice, but our review showed that new techniques are equally effective or even better. Laser especially diode laser was the most frequently used technique and showed better esthetic outcomes, less pain, faster healing, and patients' preference and satisfaction after treatment. However, laser showed more regimentation at 6-month evaluation. More good quality randomized controlled trials with different depigmentation methods are needed to draw strong conclusions.

Background: Access to apical root canal system is gained after flap elevation using various incision techniques. Soft-tissue healing after periradicular surgery may include gingival recession, papilla recession, changes in probing depth, and clinical attachment loss. Objective: The objective of this study was to compare the effect of full sulcular flap design versus papilla-sparing flap design on the periodontal parameters in periradicular surgeries. Materials and Methods: It was a systematic review and meta-analysis. Electronic and manual searches were conducted in multiple databases including PubMed, Dental and Oral Sciences, Cochrane, and CINAHL Plus until May 2019. Initial search yielded 2575 studies with 5 articles meeting the inclusion criteria. The primary outcomes assessed were gingival recession and change in the papilla height. The secondary outcomes evaluated were probing depth, clinical attachment loss, postoperative pain, bleeding, and discomfort. Random-effects model was employed for computation of effect size, and forest plots were made. Results: Out of the five articles that satisfied the inclusion criteria, three were randomized control trials and two were nonrandom trials. No significant differences were found in the gingival recession (P = 0.79), papilla height (P = 0.55), gingival bleeding, and plaque indices. Statistically significant differences in probing depth (P = 0.006) and clinical attachment loss (P = 0.0004) were observed for the two flap designs in probing depth (P = 0.006) and clinical attachment loss (P = 0.0004). Conclusions: The present systematic review and meta-analysis showed that probing depth and attachment loss are affected by the choice of flap design. On the other hand, gingival recession and papilla height are not influenced by the type of incision. However, finding of the present review may change if more studies on this topic will be included in the future. Therefore, more clinical trials with long-term follow-ups are needed.

Resorption is both a physiological and pathological process which results in loss of hard tissues of the tooth, i.e , cementum and dentine and the surrounding bone. External resorption is much more common than internal resorption and can occur when tooth is luxated or avulsed. If remained unchecked, resorption can eventually lead to loss of the tooth. Timely management of the affected tooth can slow down the resorptive lesion and increase the prognosis of the survival of the tooth. This case report describes the surgical management of extensive external root resorption leading to perforation of apical one-third of the root area which was managed through root canal along with periapical surgery and bone grafting. A 6-month follow-up showed arrest of the resorptive defect and progressive healing as evident on the cone-beam computed tomography.

Introduction: Iatrogenic damage to the adjacent tooth during crown preparation is a frequent disastrous effect. The aim of the study was, therefore, to determine the frequency of different types, degree and location of iatrogenic damage to the adjacent tooth during crown and bridge preparations in a tertiary care setting that lead towards the morbidity of tooth. Materials and Methods: A prospective study was conducted in Aga Khan University dental laboratory in two months period in which a total of 150 dental casts fulfilling the inclusion criteria were analyzed using non-probability convenient sampling technique. The casts were examined using 3.5x magnifying loupes for the location, degree and type of damage to the proximal surface adjacent to the prepared tooth using Moonpar and Faulkner criteria. Data were analyzed by using SPSS version 22. Chi square test was used to assess the association between the experience of practitioner and degree of damage to adjacent tooth. It was also used to determine the association between location of tooth and degree of damage to adjacent tooth. Inter-examiner reliability was assessed by using kappa statistics. Results: A high prevalence of damage to the proximal surface of adjacent teeth (78% on mesial tooth and 60.6% on distal tooth) was observed, with the majority (32.6%) belonging to the mild categories. There were statistically significant associations between the experience of practitioner and the damage to the surface mesial to the preparation. However, more severe damages occurred in mandibular teeth preparations as compared to maxillary teeth preparations. Conclusions: A high frequency of iatrogenic damage to the adjacent teeth had been found during crown and bridge work with the middle of the tooth as the most susceptible site. However, the majority of damages were of milder type including only abrasions.