Aims Preservation of peri-cervical dentin during the preparation of endodontic access is important to prevent fractures and improve the long-term prognosis. The purpose of this study was to evaluate the impact of rotary file instrumentation (TruNatomy and XP-Endo Shaper) on peri-cervical dentin removal, depending on access size. Materials and Methods Forty 3D printed mandibular first molars, with either a small or large access design, were instrumented using TruNatomy or XP-endo Shaper file systems. Canal volumes were calculated based on micro-computed tomography data obtained pre- and post-operatively. Digital sectioning of each reconstructed volume was performed 90-degrees to the long axis at the floor of the pulp chamber at 5 levels, at the pulp chamber floor (Level 0) as well as 1 and 2mm coronally and apically of Level 0. Linear measurements were taken from the inner wall of the access cavity or canal to the outer surface of the tooth for both instrumentation techniques and compared to the unprepared control dataset. These measurements served as an approximation of remaining peri-cervical dentin after root canal instrumentation. Results Some of the coronal measurements were not reportable for the control group due to incomplete capture of the crown during the microCT scan. The remaining peri-cervical dentin thickness at the level of the pulpal floor and coronally were significantly (p<0.01) affected by the access cavity size, with the smaller access preserving more dentin in all samples. Apical to the pulpal floor, there was no significant difference between instrumentation groups at the data points evaluated. Remaining dentin thickness was largest at coronal section 1 and smallest at apical section 6 with 3.81mm (p = 0.05) and 1.84mm (p = 0.06), respectively. Conclusion Access cavity size had a significant impact on remaining dentin thickness at the level of the pulpal floor and coronally, with more remaining dentin in the conservative access group, irrespective of instrumentation technique. Future studies will evaluate dentin thickness in the furcation and mid root level, as well as apical canal transportation, and procedural errors.

Aim: The aim of this study was to evaluate the accuracy of the Wirele-X (Forum Tec, Ashkelon, Israel), a new Bluetooth-enabled electronic apex locator (EAL). The accuracy of the Wirele-X and the Root ZX II (J. Morita, Tokyo, Japan) was compared in vitro using an alginate model. Materials/Methods: Thirty-one extracted single-rooted human teeth with mature apices were decoronated at the CEJ. Under 10X magnification, actual canal lengths (ACL) were determined. The teeth were embedded in alginate and electronic canal length measurements were obtained using the Root ZX II and Wirele-X EALs. Each tooth was measured three times with both EALs. A blinded examiner measured each file with a digital micrometer to the nearest 0.01 mm. Differences between ACLs and the average measurements from the EALs were compared with Student's t test for related samples. Results: The average distance from the file tip to the apical foramen (AF) was -0.11 mm (±0.16) and -0.07 mm (±0.21) for the Root ZX II and Wirele-X systems, respectively. There were no statistically significant differences between the two apex locators in their ability to locate the AF (p > 0.05). Conclusions: Both the Wirele-X and the Root ZX II provided a high level of accuracy and reliability in locating the AF.

Introduction: When skeletal transverse discrepancies exist between the maxilla and mandible, they commonly manifest in dental malocclusion. If left uncorrected, the malocclusion can lead to periodontal issues, tooth fractures, tooth loss, or other significant dental problems. Utilization of microimplants in palatal expansion aims to correct transverse discrepancies between the maxilla and mandible by separating the palatal suture in a parallel manner aimed at maximizing skeletal changes and minimizing dental side effects. Overlying soft tissue changes can be affected by the induced skeletal changes. The purpose of this study is to evaluate skeletal expansion and the overlying soft tissue change that occurs using MARPEs (microimplant assisted rapid palatal expanders) at the end of orthodontic treatment in skeletally mature (Cervical Vertebral Maturation (CMV) ≥ 5) patients using cone-beam computed tomography (CBCT) imaging and to evaluate soft tissue changes that occur at the time of orthodontic treatment completion using CBCT imaging. Materials and Methods: CBCT scans from 19 patients who were treated using microimplant assisted rapid palatal expanders were traced and evaluated at three time points: Before orthodontic treatment (T1), post MARPE expansion with MARPE in place (T2), and after orthodontic treatment with MARPE removed. Fourteen hard tissue landmarks and six soft tissue landmarks in the midface and nasal cavity regions were traced by three judges at each time point. The traced landmark points were averaged among all three judges and comparisons were made between the three time points to see the amount of expansion that occurred at various anatomical 2 regions. Intraclass correlation coefficient (ICC) was used to evaluate inter-judge reliability for all measurements. A repeated measures ANOVA test was used for statistical comparison across all three time points and a Tukey post hoc test was used for comparison between time points. Significance was set to .05 and ICC was set to >.70. Results: Expansion with microimplant assisted rapid palatal expanders can affect the hard tissue of the midface region as well as the overlying soft tissue. Increases in skeletal width from the ANS down to the maxillary alveolar bone were statistically significant in both the short term (T1-T2) and long term (T1-T3). The nasal cavity width at inferior turbinate area increased significantly after expansion (T2) and remained increased at treatment completion (T3) and the increased soft tissue width of the alar base that presented after expansion therapy remained increased at treatment completion. Conclusion: Maxillary expansion with microimplant assisted expanders resulted in skeletal changes throughout the maxilla and led to a significant long-term increase in nasal cavity width. The soft tissue changes associated with MARPE treatment show that a widening of the base of the nose may be expected after expansion and can remain at treatment completion.

Introduction: Orthodontic and orthopedic expansion is necessary to create space to resolve crowding due to arch deficiency or tooth size discrepancy. The Invisalign First clear aligner appliance as a modality for early interceptive orthodontic treatment has become incorporated into orthodontic practices in very recent years. The present study aims to investigate the magnitude of expansion of the Invisalign First clear aligner appliance compared to a Schwartz removable expander in patients with mixed dentition. Additionally, the study aims to compare the efficacy and predictability of Invisalign First clear aligners in this population. Materials & Methods: In this retrospective study, a sample was collected from a single orthodontist practitioner. The sample consisted of 34 patients, 16 patients treated with Invisalign First clear aligners only (Group1) and 19 patients treated with a Schwartz removable appliance and Invisalign First clear aligners (Group 2). Intraoral scans of four timepoints, initial (T1), post-expansion for Group 2 only (T1Exp), first refinement (T2), and final (T3), and planned Clincheck goal (P) model from Clincheck software were imported to Align Technology’s digital measure program (Quantify©). Arch widths and molar inclinations were measured at each timepoint and the changes between timepoints were calculated. Predictability of arch expansion was calculated as T13 (change between initial and final) divided by the Planned dimension multiplied by one hundred. A two sample t-test was used to assess differences in the changes in arch widths and predictability of expansion between two groups. Results: There were statistically significant differences found in the magnitude of expansion and predictability of arch expansion between two groups. Group 2 showed a greater amount of expansion and predictability. Group 1 showed about 50-60% of the planned expansion at the end of treatment. In regards to magnitude of expansion when comparing the two groups, the efficacy predictability of transverse dimensional changes were significantly greater in the Group 2 compared to Group 1, 83% vs 56% (p = 0.001), respectively. The changes in inclination were similar in both groups, with no statistically significant differences.Conclusions: There is a significantly greater amount of expansion and greater predictability with the Schwartz removable appliance compared to the Invisalign First clear aligner appliance in the mixed dentition. The predictability of Invisalign First was 56% and indicates a significant overcorrection of arch expansion is required at the virtual treatment planning stage in Clincheck in order to obtain the arch expansion that was planned

Aim: The aim of this study is to determine the varying levels of salivary statherin production in patients with varying levels of risk for diabetes. The goal is to identify a causal relationship and thus, statherin could be used as a preliminary biomarker for identifying patients with diabetes. Materials and Methods: Saliva from 47 participants were collected in order to quantify the levels of statherin production via western blot analysis. Participants were also asked to fill out self-reported questionnaires regarding risk factors for type 2 diabetes. The questionnaire consisted of 7 questions regarding age, sex, history of diabetes, hypertension, level of physical activity, and weight class. Each individual factor as well as total risk for type two diabetes was compared to levels of salivary statherin levels via the unpaired t-test and one way ANOVA testing. Results: Risk factors for type two diabetes such as; age, sex, history of diabetes, hypertension, level of physical activity, and weight class showed no correlation to levels of salivary statherin secretion. All risk factors combined as a total risk level for type two diabetes also did not show a correlation to levels of salivary statherin secretion. Conclusions: It can be concluded in this study that salivary statherin protein does not show a correlation for risk or status of type two diabetes. Salivary statherin does not act as a useful biomarker for detection of type two diabetes.

Introduction: The aim of this study was to determine the types and prevalence of complications following MARPE protocol at University of the Pacific and to investigate the complication of asymmetry using CBCT analysis. Methods: In the first portion of this study, 97 patients who started treatment prior to July 2020 and who had MARPE expander treatment at the University of the Pacific were included. Chart review and evaluation of progress clinical photographs were used to report the following complications: inflammation, pain, appliance malfunction, broken microscrew, and pulpitis. In the second portion of this study, 77 patients from a private practice orthodontist who started treatment prior to January 2021 were included in this study. The complication of asymmetry was measured using CBCT measurements from T1 (prior to treatment start) and T2 (immediately following MARPE expansion). The change in U6 molar angulation changes was also assessed. Results: It was determined in the first portion of this study that the most common complication was inflammation around the MARPE site, with 82% of the study population exhibiting any severity of inflammation. 3 patients exhibited severe inflammation requiring removal of MARPE. 18% reported pain in the MARPE area. 9 patients exhibited appliance malfunction, 1 patient exhibited broken microscrew, and 1 patient exhibited pulpitis. It was determined in the second portion of this study that 47% of patients exhibited asymmetry greater than 1 mm and the average asymmetry at ANS was 1.47 mm. No correlation was exhibited between amount of asymmetric expansion and the following measures: age, molar inclination, palatal thickness, posterior screw expansion and palatal vault height. 3 Conclusions: Inflammation of the MARPE is the most common complication that can result in early removal of the expander. Other complications such as asymmetry and pain are common as well.

In December 2019, the coronavirus disease 2019 (COVID-19) was first identified as an acute infectious disease in Wuhan, China and subsequently led to an ongoing pandemic. At the onset of the pandemic, dental professionals were understood to face the greatest exposure risk to SARS-Cov-2 due to aerosolization of fluids from the oral cavity and respiratory airways . As a result, dental professionals, including academic institutions and their students and residents halted much of their operations to minimize exposure risks and potentially slow the spread of infection to peers and patients alike. Currently, there is little in the literature that describes the changes that academic institutions have implemented in the face of pandemics. This study will discuss the chronology, modifications, and possible resultant outcomes of COVID-19 related events in respect to Graduate Endodontic programs in the United States.

The aims of this study were to determine the efficacy of the KontrolFlexTM AccufileTM compared to the READY•STEEL™ Flexofile® using an electronic apex locator and to evaluate the instrument’s design via scanning electron microscopy. Actual canal lengths of thirty extracted teeth were determined under magnification. An alginate model was used to determine experimental canal lengths with the Root ZX II apex locator and size #10 Accufiles and Flexofiles. Differences between actual lengths and experimental lengths were compared with Student’s t test. The average experimental lengths were short of the actual length by -0.10 mm (±0.34) and -0.12 mm (±0.16) for the Accufile and Flexofile, respectively with no statistical difference (p > 0.05). SEM images revealed similar non-cutting “batt” tips and a square cross-section for the Accufile and triangular for the Flexofile. Both files provided similarly high levels of reliability when used with the Root ZX II electronic apex locator.

The purpose of this study was to examine the effect of partial and total immersion in sodium hypochlorite on nickel-titanium rotary files and to determine whether resistance to fracture was influenced by the immersion time. One hundred K3™ and 100 ProFile® rotary files were either partially or totally immersed in 5.25% sodium hypochlorite for zero, one, five, thirty, or sixty minutes. After immersion, files were subjected to cyclic fatigue testing. Time to fracture was recorded and analyzed by a two-way ANOVA. Tukey's honest significant difference was used to identify any differences in immersion times. Within all ProFile groups and partial immersion K3 groups, there was no significant decrease in time to fracture with increased immersion time in sodium hypochlorite. Only the K3 total immersion groups revealed a significant decrease in time to fracture with increased immersion time in sodium hypochlorite.

The purpose of this study was to compare three direct digital sensors (Kodak 6100, Schick CDR, and Dexis PerfectSize), a phosphor plate system (OpTime), and F-speed film to standard D-speed film in the detection of artificial bone lesions prepared in mandible bone sections. Multiple artificial bone lesions were prepared at varying depths in the cortical bone. Specimens were imaged with six different radiographic systems. Radiographs were randomly presented to nine different observers. A logistic regression analysis indicated that the ability of the different radiographic systems to detect the bone lesions was significantly different at the mean percentage of cortical bone remaining. The Kodak filtered, Schick filtered, OpTime unfiltered, Schick unfiltered, and Dexis filtered images were significantly better at lesion detection compared to D-speed film. Also, all filtered digital images were significantly better at lesion detection than D-speed film.