Monday – Friday 8:45 AM. The dental pulp helps complete formation of the secondary teeth (adult teeth) one to two years after eruption into the mouth. In a root canal, the pulp is removed from the tooth. Biocompatibility is defined as the ability. com. Root Canals Explained. 9% of male and 22. Once treated, most cracked teeth continue to function as they should, for many years of pain-free biting and chewing. Thorough eradication of microorganisms from the root canal system is necessary to ensure treatment success;. Overall, the time required to remove the filling materials using the rotary systems. Root canal treatment is one of the most common dental procedures performed, well over 14 million every year. Previous Next 2 of 7 Why you may need a root canal. Many people have found that debilitating symptoms such as problems with digestion, fatigue. As a result, the purpose of this study was to use CBCT to characterize the exact root and canal morphology of mandibular premolars in a Saudi subpopulation. Study of the apices of human permanent teeth with the use of a scanning electron microscope. For the principle palatal canal, it is the one whose orifice is located most palatally. A root canal is a somewhat invasive dental procedure and can cause tooth discomfort following the procedure. Wisdom Teeth. Enterococcus faecalis (E. 5% of female. The aim of this article was to present a case of a mandibular canine with two roots and two root canals and to. Endodontists are specialists in saving teeth. As per what has already been mentioned, know where to look for the MB2 canal. This flat fee applies regardless of how many visits you need or how many teeth are treated (provided it all relates to the same course of treatment). A root canal infection spread can become an emergency. Learn more about root canals. Top 10 Best Root Canal Affordable Cost in Moorpark, CA 93021 - October 2023 - Yelp - Kosta's Dental Office, Konstantinos Proussaefs, DDS, Paul Jang Dentistry, Daniel Elbert, DDS, Zachary Potts, DDS, Arroyo Dental, Western Dental & Orthodontics, Comfy Dental Group and Orthodontics, First Street Dental Group. MOHP - PPBR6CXT - 170323. The sooner your tooth is treated, the better the outcome. However, it was also a procedure that was designed to prevent pain. Root canal specialist near me. Common causes of pulpal infection or damage are tooth decay, trauma to the tooth due to an accident or sports-related injury, or a crack in the tooth, which is a dental problem more commonly seen in adults and in teeth. Contact us today for a free quote or call 04475 217 658!Pain after a root canal is typically mild and only lasts a few days; it is a normal and manageable after-effect. The body’s immune system can better get on top of any existing infection. Teeth have numerous canals present inside them, which are interconnected. Hence, a profound and correct experience about the regular and variable root canal system anatomy is crucial for successful endodontic therapy []. A comprehensive understanding of the complexity of root canal systems is imperative for successful root canal treatment. Therefore, the knowledge of root canal anatomy and variations. Intra-observer. Biocompatibility is an essential requirement of any root canal sealer as the root filling material constitutes a true implant coming into direct contact with the vital tissue at the apical and lateral foramina of the root or indirectly via surface restoration []. [] have suggested the use of. Uses ozone gas to help sterilize the canals of the tooth. By contrast, the microbial composition, even in the apical third of the root canal of periapically affected teeth, with pulp canals exposed to the oral cavity, not only differs from the root canal flora of teeth with intact crowns but is also less dominated (<70%) by strict anaerobes . A root canal might be required if there is swelling around the tooth. Decades ago, root canal treatments often were painful. 4 and 4. 24. Root Canal Cost. They help dentists and endodontists to save millions of teeth from being extracted, every year. Endodontic retreatment: Removes and replaces materials from a previous root canal that didn’t heal properly. whenever the paper point was unable to reach the full length of the root. The duration for scanning a single sample ranged between 30 and 40 min and a three. 04. Surgery may also be needed to remove calcium. The root canal system configuration (RCC) of mandibular second premolars (Mn2P) is typically described as a single-rooted tooth with a 1–1–1/1 RCC according to the classification described by Briseño Marroquín et al. Objectives To assess occurrence and its variation over time of serious accidental perforations during endodontic treatment and the fate of perforated teeth by tooth type and characteristics of patients and dentists. Eat Healthy. 4% a single canal, 21. NaOCl functions by eliminating bacterial biofilms and dissolving organic tissue, which may vary according to several factors such as the microbiology of root canal infection and the concentration of the. By limiting their practice to endodontics, endodontists focus exclusively on treatments of the dental pulp. Based on a radiograph, the restorability of a tooth and the complexity of the root canal morphology, and necessary treatment protocols can be evaluated []. Literature Search and Data Extraction. If your kidney, liver or any other organ in your body dies, it. Endodontists specialize in saving cracked teeth and will cater treatment to the type, location, and extent of the crack. Each tooth has a canal system which goes from the crown (top surface) to the root. Introduction. Introduction. Anterior root canal treatment cost ranges from $400 to $1,200. 13. The most common procedures and typical amounts charged by dentists are: Root Canal – Front Tooth (approximately $620 - $1,100 Out-of-Network) 1. Aim To evaluate the efficacy of 4 different. Root canal infections are caused by microorganisms that have penetrated the dental pulp and colonized the root canal system. " Human teeth may have one to four root canals, depending on the anatomy of the tooth. Because the tooth typically has a large filling or is weakened from extensive decay, it needs to be protected from future damage and returned to normal function. In this. [10,11,12,13] The morphological variations in root canals such as long, narrow, or curved canals are most prone to endodontic mishaps, which can cause serious problems during root canal therapy. poor oral or dental hygiene. Root canals are typically successful, but sometimes they fail. Your dentist’s goal will be one of treating the entire length of each of your tooth’s root canals but not beyond. Root canal sealers are needed to adequately seal the root canal space to prevent microleakage. Failed root canal – Discoloration. This helps determine the. The root canals were dried with paper. FAIR Health says the average cost of a filling is $395, or, more specifically: $132 for an amalgam (silver) filling. Dentists use sophisticated anesthetics to numb the area and you practically don’t even feel a thing. The present study reported a rare anatomical configuration with six root canals in the mandibular right first molar diagnosed during endodontic treatment using a dental operating microscope and confirmed with the help of. Pre operative condition of the first mandibular molar. Sometimes, the initial treatment fails to completely remove the infection. Dr. Most root canals can be done in one to two appointments. 1. A root canal is a dental procedure used to save a tooth that has become deeply decayed or infected. (i) The principle mesiobuccal or distobuccal canal is that canal whose orifice is located most mesially and buccally or distally and buccally, respectively. Read on to learn why you might need endodontic surgery and view a step-by-step explanation of the most common surgical procedure, an apicoectomy. Failure to recognise and treat these variations may lead to unpredictable outcomes. 3% NaOCl and normal saline. Sensitivity To Heat Or Cold. All members of the dental team need to be fully informed of exactly what this involves in order. Teeth that receive a. Root canal treatment is needed when dental X-rays show that the pulp has been damaged by a bacterial infection. Root Canal Treatment. Decaying nerves in your tooth hurt a lot. 5mm-8. A 35-year-old Chinese female had repeated swelling in the upper right posterior maxilla for 3 months. The purpose of. The root canal wall is a surface where bacteria can adhere and biofilm can develop when the root canal system is infected (Chávez de Paz 2007, Ricucci et al. However, a sizeable variation in the number of roots and root canals of the Mn2P was described in which the. Chlorhexidine (CHX) is a strong antiseptic that is often used to chemically control plaque in the mouth. The dentist makes an opening in the tooth to reach the root canal system and the damaged pulp. The most prevalent root canal morphology was the presence of two canals in the mesial root and one canal in the distal root of teeth with two distinct roots (variant 3). These rates show the full cost of dental care without insurance coverage. Let’s quickly define some terms before we move on any further. dentalstudiomooroolbark@gmail. The cross-section of the pulp chamber in the mandibular. The patient should be cautious when it comes to brushing, flossing, and chewing certain foods after their root canal. 92mm. An endodontist will typically treat your abscess with a root canal procedure or endodontic surgery. For Dental Professionals. Additional canal forms do occur. A crown (cap) is usually recommended to restore the tooth properly. In case of a wet canal (or those that have been previously irrigated with saline) numerous paper points were used to absorb all the fluid inside the canal. Myth 3: It’s better to pull a tooth than have root canal treatment. International Endodontic Journal,33, 1–18, 2000. According to an article in the European Journal of Dentistry (EJD), this treatment is very predictable, with success rates ranging from 86% to 98%. Opening Hours Monday 9:00AM - 7:00PM Tuesday 9:00AM - 5:00PM Wednesday 8:00AM - 5:00PM Thursday 9:00AM - 5:00PMThe Dental Studio Mooroolbark Team P: (03) 8560 6060 E: info. 4% of maxillary first molars which were conducted by Acosta Vigorans and Gray. Reduce the amount of sugary foods and drinks you consume. 3% as shown in. 1 min, respectively) were significantly lower than those required by the RB and WOG rotary systems (5. 7 – 20. Bacterial infection is the main cause of pulp and periapical tissue disease, therefore the main goal of root canal treatment is to disinfect and prevent reinfection []. Inadequate knowledge in this regard will lead to incomplete debridement and filling of the root canals, which is the main cause of failure. Endodontists don't place fillings or clean teeth — they dedicate their time to diagnosing and. Bicuspids: The cost of bicuspid root canals is generally more than front teeth and less than molars. Apical periodontitis is an inflammatory condition of dental peri-radicular tissues caused by bacteria invading the dental pulp and the root canal system. The present study reported a rare anatomical configuration with six root canals in the mandibular right first molar diagnosed during endodontic treatment using a dental operating microscope and confirmed with the help of cone‑beam computed tomography (CBCT) images. Endodontic surgery can be used to locate small fractures or hidden canals previously undetected on X-rays during the initial treatment. Check-up: Your dentist or dental hygienist will check for cavities and to see if there’s any plaque – that’s the clear, sticky layer of bacteria – or tartar on your teeth. We can also provide oral surgery and correct orthodontic issues for all ages, including early treatment for children aged 6-10 years. The current study included. Tooth discoloration, swelling, and pimples on gum are all indications of a failed root-canal. Root canal infections are treatable with endodontic retreatment, surgery, or extraction. . Root canals are typically successful, but sometimes they fail. Teeth Grinding Splints. A crown after root canal ranges from $600-$2,500, depending on the material. 9 min, respectively) [P < 0. Monday –. This in vitro study aimed to evaluate the impact of three power modes of a sonic activation device (EDDY) on its antimicrobial effectiveness in infected root canals. A front tooth costs $762. 6% of female. The overall price of the root canal and filling will vary, based on the materials used. Find over 4200 relaxing and challenging games across a variety of genres, including hidden object games, puzzle games, match-3 games, time management and tycoon games, solitaire games and mahjong games. Root canal treatment, also known as root canal therapy (RCT) or endodontic treatment, is a dental procedure that involves drilling into a decayed tooth, with the aim of removing the soft centre, 'dental pulp'. Dr Emily Pow has a special interest for restorative dental treatments like fillings and crowns. Divine Dental Care is a modern and accredited Dentist serving the community of Croydon Victoria. Unit 4/91-111 Brice Avenue Mooroolbark, VIC 3138. The endodontic intervention in all root canals is essential to promote cleaning, removal of necrotic content and reduction of the microbial contingent and their by-products (2, 3). Most bifurcations were located in the coronal part. 1. General, Cosmetic and Emergency Dentist Shop 4/91-111 Brice Avenue Mooroolbark, VIC 3138 Opening Hours Monday 9:00AM - 7:00PM Tuesday 9:00AM - 5:00PM Wednesday 8:00AM - 5:00PM Thursday 9:00AM - 5:00PM On average, a root canal takes about 30 to 60 minutes to complete. In short, when you need a root canal, it may feel like throbbing pain due to infection inside of the root of your tooth. Aware that root canal treatment consists of a cumulative series of interdependent steps, several researchers including Strindberg (Strindberg, 1956) and Ng's group (Ng et al. The premixed or fifth-type HCSB materials can be used with all root canal obturation techniques, such as cold lateral and warm vertical compaction or a. After a tooth has had a root canal, it can become dry and brittle and easy to break. Retreatment is the most common option and has the highest rate of success. Our Team; Payments &. Bicuspid (mid-mouth): $705 to $1,250. Some root canals are done correctly, but many times they aren't. So, even if you don’t feel any pain now, and your dentist recommends a root. The treatment plan (root canal therapy) was explained to the patient and an informed consent was obtained from her. These include: Retreatment. Root canals are typically successful, but sometimes they fail. Cone-beam computed tomographic. Sixty (N = 60) human extracted MSPs were collected and prepared for micro-CT scanning. It’s possible that a nonsurgical root canal procedure won’t be enough to save your tooth and that your endodontist will recommend surgery. Dentists in big cities tend to charge higher fees than those in rural areas. Eat softer foots that are high in vitamin A and C. Tooth discoloration, swelling, and pimples on gum are all indications of a failed root-canal. The percentage of mandibular molars, with two canals in. Root canal treatment is a common dental procedure that treats infected, badly decayed, or damaged teeth. 3636 or 312. red, warm, swollen tissue near the tooth, especially the gums under or around the tooth — in some cases, swelling can affect your face and neck, too. The dentist then fills and seals the tooth's pulp chamber and root canals. Invisalign; About. $199 Scale & Clean and Check-up Offer* *Limited time New patient offerThey use the most specialized and advanced technology to treat tooth pain and perform root canal treatment. With dental insurance, root canal treatment costs can be covered at 50% to 80%. The presence of split roots in. This involves removing the bacteria from the. Teeth Whitening; Dental Veneers; Dental Crowns; Dental Implants. Type III: one canal leaves the pulp chamber and divides into two smaller canals which later merge again to exit through one canal. [ edit on Wikidata] A root canal is the naturally occurring anatomic space within the root of a tooth. After a root canal, a tooth lasts a little over 11 years, according to a large study. It is $850 for the root canal on a molar, $195 for the Core buildup, and $800 for a crown to. Discussion. 20 illustrate maxillary molar teeth in various aspects. Two main foramina were observed in 43. Root canal treatment is usually carried out under local anaesthetic, a painkilling medicine that numbs your infected tooth and the gum around it. The inability to locate, disinfect, and fill the root canal completely can cause endodontic failure []. The pulp is made up of nerves, connective tissue, and blood vessels that help the tooth grow. However, this can vary depending on your insurance plan. She is registered with the Australian Health and Practice Regulatory Authority and certified by the Australian Dental Council. However, several factors can impact that, including follow-up treatments. Molar: $870 to. An electronic search was performed on Web of. 9–100%). Invisalign; About. Maxillary premolars have highly variable root canal morphology. An Expert Guide - Our skilled Root canal specialist Edmonton at Midtown Family Dental is a dentist with advanced training in endodontics,. In the most severe cases, the infection may. 3). It's actually a relatively painless procedure since local anesthesia will be used. In two-directional radiography used by Pineda F et al. Dr Swati is a qualified dental professional with over 15 years of experience. Maxillary first molar has predominantly three roots with the presence of one canal per root except mesiobuccal root where the second canal can be found in the range of 57. Other reasons included non-negotiable canal (18), difficult root morphology (10), peri-radicular surgery (16), canal curvature greater than 40° (2) and other modifying factors (6). The root canal configuration of maxillary second molars is quite heterogeneous; the mesiobuccal root has predominantly two root canal entrances (58. The findings of a study by Sadaf give an idea of what might be expected. 3%) followed by two canals (19. The purpose of treatment (prevention or cure of apical periodontitis) is served by the functions of the obturation (sealing, killing microbes, and filling the space), which depend on some properties of the materials. Introduction. Root canals are typically successful, but sometimes they fail. Several microorganisms can cause endodontic treatment failure. 4% unbearable pain. [2,3] The clinician should have a. Either enter your address or location, or click on the location finder icon in the search bar. Different views of the internal anatomy of a representative maxillary second molar. The anatomy of root canal morphology plays a decisive role in determining the conditions under which endodontic treatment can be performed effectively. Facts to Consider About Root Canals. A possible explanation for this finding is that root resorption may alter the shape and position of the apical foramen and apical constriction, increasing the chance of over instrumentation and subsequent overfilling of the root canal. Swelling. The infection can recur, with symptoms that can last for months. Herein, we report the presence of two separate root canals in a. During root canal treatment, your dentist or endodontist will remove the damaged pulp from inside of the decaying tooth and follow by cleaning and sealing the canal (s) to protect against future infection Your dentist can then place a crown or. With dental advances and local anesthetics, most people have little if any. Contact us today for a free quote or call 04475 217 658! The most common endodontic surgical procedure is an apicoectomy or root-end resection. Pain after a root canal is typically mild and only lasts a few days; it is a normal and manageable after-effect. This study monitored 140 patients during the day (24 hours post-op) following the completion of their (two-visit) root canal [email protected] et al. Successful root canal treatment depends on adequate debridement and filling of the entire root canal system [1–5]. A crown (cap) is usually recommended to. It is generally accepted that most maxillary first molars have 3 roots and 4 canals; various studies have reported prevalence of second mesiobuccal. Then, after some time to be certain the treatment was successful, you’ll visit your dentist. Introduction. For Dental Professionals. Root canals, however, are dead teeth, and these dead teeth typically become one of, if not the worst, sources of chronic bacterial toxicity in your body. Expect to pay an additional 18% to 20% on top of the basic root canal price, depending on tooth location. Root canal morphology of human permanent teeth in a Turkish population. What happens during the root canal process? Before beginning your root canal, your healthcare provider will take dental X-rays of the affected tooth. A root canal treatment is done to repair and save a badly damaged or infected tooth instead of removing the tooth from the mouth. Once this matter is removed the cavity is filled with a permanent filling, and finally fitted with a crown. InternetsWasYes • 14 yr. [] reported five canals; showing three canals in the MB root. Root canal treatment can save your tooth from further decay and infection. Root canals usually require 2 or 3 visits to the dentist, but that will depend on your particular situation. There is a documentary on Netflix called Root Cause that is about an apparent link between root canal treatments and heart attacks and cancer, among other things. CBCT is widely and, in recent years, most frequently used for research on the root canal morphology of. Download games for free today at iWin. Tooth discoloration, swelling, and pimples on gum are all indications of a failed root-canal. Patients typically need a root canal when there is inflammation or infection in the roots of a tooth. 1%) with one main foramen (54. Root canal treatment is an often straightforward procedure to relieve dental pain and save your teeth. Over time, materials have. Root Canal Treatment. Wisdom Teeth. Dental treatment alternatives to a root canal include direct pulp capping, pulpotomy, pulpectomy, endodontic retreatment, endodontic surgery, tooth extraction, dental implants, bridges, or dentures. 80 (England) or £203. Find practices offering Root Canal Treatment services within Mooroolbark, VIC 3138. Nowadays, there is a whole variety of irrigating. The mesiobuccal root has the highest anatomical variability and has two or more canals in 56. Root canals are typically successful, but sometimes they fail. The root showed 46% with one foramen, 46% two foramina, and 8% three foramina. Root canal anchoring will remain as an important tool in restorative and/or prosthetic treatment. This is around $200 to $400 more than the average cost of a root canal in a smaller town or city. Methods . Dr. The infection can recur, with symptoms that can last for months. There are a number of options available for dental patients affected by a failing root canal. 03 5821 6997 [email protected] 79 Knight St Shepparton VIC 3630. The infection can recur, with symptoms that can last for months. From the holistic dental perspective, if faced with an infected, dead, or dying tooth and a compromised pulp chamber the only long-term and safest alternative is a biological extraction of the tooth. Molar — $890 to $1,500. Option #2: Creating access cavity through the crown. Type I: a single main canal is present starting from the pulp chamber to the root apex. The average root canal cost varies by region and individual dental offices. This usually happens when a cavity is left untreated for a long time. Mouthwash is made up of 0. 2. Take the time to learn more about root canal treatment and some of the common misconceptions about it and then take the first step to a pain-free, healthy mouth by visiting an endodontist near you. Facts to Consider About Root Canals. If the root canal is infected, biofilm will also be present in lateral morphological features such as lateral canals, fins, isthmuses and the dentinal tubules (Peters et al. 18, 7. However, anatomical complexities pose a challenge during endodontic treatment. Root canal treatment is designed to eliminate bacteria from the infected root canal, prevent reinfection of the tooth and save the natural tooth. To protect your tooth from bacteria in your saliva during the treatment, the dentist places a rubber dam around the tooth being treated. American Association of Endodontists (AAE) 180 N. tenderness or discomfort in swollen tissue. Background Sonic irrigant activation has gained widespread popularity among general dentists and endodontists alike in recent years. 9 ). These studies have origins in different countries and use. The cost of a root canal on a molar (back tooth) generally costs between $1,000 and $1,300, but can run higher. FMA. It is the most heavily restored teeth and also common to undergo root canal treatment in adult dentition. 1 Comment. The prerequisite for using ultrasonics is the removal of the adjacent restorative material and the exposure of the post for visualising the cement at the root canal orifice ( Figures 20. Review The focal infection theory was prominent in the medical literature during the early 1900s and curtailed the progress of endodontics. However, the pain they feel is caused by an infection in the tooth, not by root canal treatment. Open in a separate window. interest in Root Canal Treatments in and around Mooroolbark, VIC 3138, including real positive customer. Chawla et al. When people are told that they need a root canal treatment, they usually think about pain. 55674. Root canal variations frequently occur in maxillary first molars, which greatly affects the success of its treatment. Adequate knowledge of root canal morphology and possible variations is essential to achieve perfect root canal treatment and overcome treatment failure. Root canals are extremely common, with more than 15 million taking place in the United States every year. She had repeated episodes of swelling in the upper right posterior maxilla for the past three months. Introduction. Journal of Endodontics. Root canal treatment (also known as endodontic therapy, endodontic. More than 95% of the maxillary first molars have three roots—mesiobuccal, distobuccal, and palatal. Procedures for root canal. 2008;34(1):87–89 should be made to find and treat all the root canals for successful clinical results. Before having root canal treatment, your dentist may take a series of X-rays of the affected tooth. HOME; ABOUT US. How to Recognize the Symptoms Of A Failed Root Canal. Her outstanding work resulted in her being nominated the President of the Bendigo Oral Health. Before dental insurance, a root canal procedure in the United States costs anywhere from $500-$2,250. 1 years. Though root canal treatment is safe and effective most of the time, re-infection can occur. Stage 2: Instrumentation - A Deep cleaning and Thorough Medication. It is located within the root which is the part of the tooth that extends below the gum. Root canals performed in the Northeast preserved teeth for much longer than root canals in other regions of the country. When a dentist told Corrine Rivera that her 7-year-old daughter needed a baby root canal at her routine checkup, Rivera didn’t understand that “baby” was describing the tooth, not the size of the procedure. The mandibular first molar is the first permanent tooth to develop at the age of 6 years. The cost varies depending on the severity of disease and the type of dental professional who treats the problem. The final stage of the root canal is restoring your tooth. Successful root canal therapy is achieved by thorough shaping and cleaning of the root canal space followed by three-dimensional obturation of the root canal []. Materials and methods Data, based on patient documents on healthcare malpractice claims, comprised all endodontic injuries (n. Stetson Ave, Ste 1500 Chicago, IL 60601Introduction. In the second session, the patient’s symptoms had subsided completely. This procedure relieves the inflammation or infection in the bony area around the end of your tooth. [] and Ozcan et al. This. It consists of the pulp chamber (within the coronal part of the tooth), the main canal (s), and more intricate anatomical branches that may connect the root canals to each other or to the surface of the root. Root canal therapy is done in three steps, and it takes between one and three sessions to complete. Learn more about root canals. Root Canals (Endodontics) Wisdom Teeth Removal; Cosmetic Dentistry. Root canal therapy is necessary when oral bacteria invade the pulp inside of your tooth. For instance, a root canal in Los Angeles costs between $700 and $900. First, the dentist removes everything that is inside the root canal. The mandibular first molars normally have three or four root canals and rarely have five or more root canals. Lack of Sanitation. The simple truth is that the only alternative to a conventional root canal is an extraction of the tooth. At our 145+ Members First Ultimate providers, Bupa members with eligible extras cover that includes General Dental can get: 100% back on check-up and cleans on up to two 6-monthly dental check-up and cleans (select dental items only) per person. Background To investigate the efficacy of a nickel-titanium (NiTi) file with an automated computerized numerical control (CNC) system for root canal shaping. Yea (03) 5715 6442 Mooroolbark (03) 9727 1914Introduction. Root Canals Explained. 1995;21(4):200. Regarding the maxillary second molar, some studies have reported three canals in the mesiobuccal root [ 6 ], while other studies have reported two canals in the palatal root [ 7 – 10 ]. A tooth has up to 4 canals containing dental pulp. If you are having treatment on a larger tooth with multiple roots, it can take up to an hour and a half. Extruded root canal filling causing an immune response. Treatments. com. Nieves will carefully examine your tooth and take x-rays to determine if the root canal is indeed failing. Successful root canal treatment requires knowledge of the root canal morphology because it varies with age, population, ethnicity, sex, number of teeth, and study methodology (Joshi et al.