Over all Best Scientific presentation - Delegate category

Over all Best Scientific presentation – Delegate category FIRST PLACE: External root resorption: Hypoxia related changes expression of dec1 and dec2 genes of human cementoblast cells can give us a clue NITESH TEWARI, UJJAL BHAWAL, VIJAY MATHUR, LI XIAOYAN Centre for Dental Education and Research, All India Institute of Medical Sciences, Delhi, India Aim: To evaluate the effect of hypoxia on expression of DEC1 and DEC2 genes along-with proliferation and migration of humancementoblasts. Materials and Methods: An in-vitro experimental study was conducted using immortalised human-cementoblast cell-lines (HCEM-2). Hypoxia was created by using Mitsubishi AnaeroPackanaero in airtight container, incubated at 37-degree centigrade with 5%CO2 in a humidified atmosphere. Effect of hypoxia was studied at periods of 24 hours, 48 hours and 72 hours using MTS assay for cell proliferation, wound healing assay (Ibidi, Germany) for cell motility and RT-PCR for gene expression of DEC1 and DEC2. HCEM2 under normoxia were taken as control. The experiments were performed in triplicate and statistical analysis was done using STATA-16. Results: Cell proliferation was significantly reduced due to hypoxia at all times. It was less than half of that of normoxia after 72 hours. Wound healing assay revealed cementoblast motility to be reduced by hypoxia with a uniform trend from 24 to 72 hours. Expression of DEC1 and DEC2 was negligible in normoxia at 24 hours which further reduced at 48 hours and was absent at 72 hours while their expression was significantly high at all times in hypoxia. Discussion: Cementoblasts comprise of lesser studied cell line which forms the basis of attachment of periodontal ligament fibres to the tooth, maintaining the homeostasis of periodontium. Compression and mechanical tear after luxation injuries, peri-radicular lesions and cysts secondary to trauma cause hypoxia. The present study observed its detrimental effects on cementoblasts causing up-regulation of circadian-clock genes linked with autophagy and energy metabolism. These pathways need to be understood to develop tissue engineering based solutions for managing external root resorptions. Conclusions: Cementoblasts showed decrease in proliferation, reduced motility and up regulation of DEC1 and DEC2 genes. SECOND PLACE: Immediate autotransplantation of horizontally impacted third molar: Case report HYEWON JEON, MIRI KIM, HYUNJUNG KO Asan Medical Center, Songpa Gu, Republic of Korea A horizontally impacted third molar can increase the risk of caries and resorption of the adjacent second molar. These problems can make the tooth unrestorable and lead to tooth extraction. Usually, both teeth are removed together and implant is considered for prosthetic rehabilitation. However, autotransplantation of the third molar which caused such problems can be an alternative treatment. These two cases present the autotransplanatation of the horizontally impacted third molar for replacing the unrestorable second molar with distal area defects. The mandibular second molar was removed and the recipient site was prepared. The donor tooth, the horizontally impacted third molar, was also carefully extracted and replanted at the recipient site. Extra-oral time was less than 5 minutes, and the tooth was splinted for additional stability. Root canal treatment was performed within 2 weeks after surgery. Patients were recalled for post-operative evaluation, and clinical/radiological examinations were performed. During the follow up, favorable results were obtained in both cases, and no pathological signs were observed. In autotransplantation, it is necessary to reduce the extra-oral time and minimize the damage of the donor tooth for periodontal ligament cell preservation. The pre-position of the horizontally impacted tooth should be considered as it is related to distal bone healing. With proper case selection and surgical procedures, autotransplantation of the horizontally impacted third molar can be successful and prolong the function of the natural tooth. THIRD PLACE: Platelet-rich fibrin mediated regenerative treatment of an immature apex in mandibular premolar with dens evaginatus and chronic periapical lesion: Clinical case report with histological analysis ABHISHEK MYSORE ANIL, PREETESH SHETTY1, RAKSHA BHAT1, ADITYA SHETTY1, MITHRA N HEGDE1, NAMRATA KHANNA2 Clinician, Bengaluru, 1A B Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, 2Clinician, Pune, Maharashtra, India A 26 year old male patient with history of incomplete root canal treatment (1 year since initial treatment) of mandibular left second premolar, reported for completion. Radiographic examination revealed thin-walled immature root with huge periapical radiolucency and dense intracanal radiopaque material. Clinically, the tooth was buccally tilted with severe lingual gingival recession, loss of lingual cortical plate, but no signs of mobility. Diagnosis of dens evaginatus with chronic periapical granuloma was made. Treatment options were discussed. Patient decided to save the tooth as it served as an abutment for removable prosthesis, until a permanent replacement was planned. The existing restoration was removed, and canal flushed with low concentration sodium hypochlorite and saline, to effectively remove old intracanal medicament. No instrumentation was done to preserve remaining dentin thickness. Instead, passive ultrasonic irrigation was performed for debridement. Calcium hydroxide-iodoform paste was placed, and access cavity sealed with PTFE and temporary restorative material. After a month, the canal was flushed with saline and 17% EDTA, and activated as earlier. Radiograph revealed marked reduction in lesion size. Modified triple antibiotic paste (cefaclor instead of minocycline) was placed in canal using lentulospirals. The patient was recalled after 3 weeks. Whole blood was collected and centrifuged to obtain platelet-rich fibrin clot. Canal was irrigated with 17% EDTA. A thin, sharp spreader was inserted beyond apex to induce bleeding. PRF clot was placed inside the canal, and ProRoot MTA (Dentsply, Tulsa Dental, OK, USA) was placed directly over PRF clot. The tooth was restored permanently with glass ionomer and fibre reinforced composite. The 14 and 20-month follow-up radiographs revealed thickening of dentinal walls, partial closure of apex and reduction in periapical bone defect, with positive response to pulp tests. The tooth was extracted for placement of implant, and specimen sent for histological analysis. 1 year follow-up of implant placement (44 months since root canal treatment was initiated) revealed rebuilt bone architecture and stable implants. Regenerative endodontics has paved a biological way to repair and replace lost tissues and additionally, in this case, create a favourable environment for the placement of implants without the need for bone graft. Over all Best Scientific presentation – Student category FIRST PLACE: Impairment of the angiogenic process may contribute to lower success rate of endodontic treatments in diabetes mellitus JOSÉ MARTINHO, ANA COELHO, SALOMÉ PIRES, MARGARIDA ABRANTES, SIRI PAULO, CATARINA CARVALHO, EUNICE CARRILHO, CARLOS MIGUEL MARTO, PAULO MATAFOME, MANUEL MARQUES FERREIRA Faculty of Medicine, University of Coimbra, Coimbra, Portugal Objective: To investigate the association between root canal treatment outcome, diabetes mellitus, and alterations of the angiogenic process. Methodology: A retrospective observational study was conducted in healthy (control group, CG) and diabetic (type II diabetes mellitus group, DG) patients after root canal treatment. The follow-up appointments were performed to clinically and radiographically observe symptoms, the healing of periapical lesions, and the quality of root filling. In the animal model study, diabetic Goto Kakizaki (GK) rats and control Wistar rats were used. After 21 days of pulp exposure and the development of apical periodontitis (AP), the mandibles were removed for scintigraphic, radiographic, histopathological and molecular analyses. Chi-square tests were performed to examine the variables related to endodontic outcome and differences between animal groups were assessed using the Student's t-test. Results: The group of patients with diabetes had a significantly lower rate of success following root canal treatment than the CG (P<0.001). Logistic regression suggested that diabetes is a risk factor for success of root canal treatment. In the animal study, GK rats had significantly higher fasting glycemia at t0 and t21 (P<0.001) and triglycerides levels (P<0.05) and area under the curve (AUC) during the insulin tolerance test at t21 (P<0.001). AP area was significantly greater in GK rats (P<0.05). Histologically, diabetic rats had increased signs of periodontal ligament inflammation 21 days after the induction of apical periodontitis, with fibro-hyaline matrix filling and vessel with undefined walls. Wistar rats had significantly increased vascular endothelial growth factor (VEGF) levels and VEGF/Ang-2 ratio 21 days after AP induction (P<0.08; p<0.07). GK rats had intrinsically lower levels of VEGF than control rats (P<0.05), which did not change after AP. Conclusion: Diabetes mellitus should be considered as an important factor in the prognosis of root canal treatment and its outcomes over time. Future strategies to improve angiogenesis and tissue repair should be pursued to achieve better root canal treatment outcomes in diabetic patients. SECOND PLACE: Potential association of serum vitamin d levels with nonsurgical periapical healing: a cross-sectional study AMAL RANA, HEENA RAMNANI, AMRITA CHAWLA, VIJAY KUMAR, AJAY LOGANI, SIDHARTHA SHARMA All India Institute of Medical Sciences, Delhi, India Introduction: Vitamin D is required for normal bone metabolism. Its deficiency is a global public health issue that has a negative impact on osseous healing. The study aimed to assess the serum vitamin D level in patients undergoing nonsurgical endodontic therapy (NSET) and observe its potential association with periapical healing. Methods: Records of subjects who underwent a standard two visit NSET between January to December 2019 in mature permanent anterior teeth and completed one-year follow-up were identified A total of 189 subjects were enrolled. The radiographic healing was evaluated using pre and post-PAI scores. Biochemical estimation was performed for serum vitamin D, intact parathyroid hormone (iPTH), calcium, inorganic phosphate, and alkaline phosphatase levels. The scores and the corresponding biochemical data were statistically analyzed. Results: The serum vitamin D level was deficient in 77.25% of the total subjects. (n=146). Among vitamin D deficient subjects, 10.96% (n=16) had severe, 33.5 % (n=49) had moderate, and 55.48 % (n=81) had mild deficiency. The percentage of healed teeth were 58.9 % (n=86), 38 % (n=13), and 44 % (n=4) in Vitamin D deficient, insufficient, and sufficient subjects, respectively (P=0.07). Vitamin D deficient subjects had significantly higher serum iPTH levels (P=0.01). No significant difference was established in the levels of serum calcium (P=0.22), inorganic phosphate (P=0.5) and alkaline phosphatase (P=0.84). Conclusions: Vitamin D deficiency has a high prevalence rate in subjects who underwent NSET. No association was established between serum Vitamin D level and periapical healing at one-year follow-up. THIRD PLACE: Outcome of intentional replantation of endodontically treated teeth with periapical pathosis: A systematic review and meta-analysis FAIZAN JAVED, KAMIL ZAFAR, FARHAN RAZA KHAN The Aga Khan University, Karachi, Pakistan Objective: The purpose of the present review was to evaluate success, survival and failure following intentional replantation of endodontically treated teeth and to determine the factors that might affect the outcome of replantation in these teeth. Methods: PubMed NLM, CINAHL Plus, and Wiley Cochrane Library databases were systematically searched for articles that were published between January 1966 and February 2021. Clinical trials, longitudinal studies, case series with >10 cases, atleast one year follow-up, and published in the English language were included. Data were extracted to analyze success, survival and failure. Meta-analysis was performed using random-effects computation model employing MedCalc software. Risk of bias was assessed using Newcastle-Ottawa Scale. Results: A total of 189 articles were obtained in the electronic and hand search. Thirteen articles were included in the final systematic review. Most studies carried low risk of bias.. The average rate of success following intentional replantation was 77.3%. Inflammatory root resorption was the most frequent complication found in 8.1% of total cases. Meta-analysis revealed the mean weighted survival to be 85.9%. Conclusions: Intentional replantation has acceptable success and survival. Common complications include inflammatory root resorption and ankylosis. The long term success and survival rate of intentionally replanted teeth are found to be dependent upon short extra oral time, reduced pocket depth, type of tooth, type of root-end filling material, and the prevention of iatrogenic tooth root damage during replantation.

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