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Sinha N, Asthana G, Parmar G, Langaliya A, Shah J, Singh B. Evaluation of postoperative pain in endodontic retreatment with apical periodontitis using ozonated 2% chlorhexidine and 0.1% octenidine application: A randomized clinical trial. JOURNAL OF CONSERVATIVE DENTISTRY AND ENDODONTICS 2024; 27:654-661. [PMID: 38989488 PMCID: PMC11232761 DOI: 10.4103/jcde.jcde_146_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 07/12/2024]
Abstract
Introduction This study aimed to evaluate and compare postoperative pain (PP) in single-visit nonsurgical endodontic retreatment (SV NSER) with 2% chlorhexidine (CHX), 0.1% octenidine (OCT) with or without ozone, and 5.25% sodium hypochlorite (NaOCl). Materials and Methods In this randomized, parallel, prospective, double-blind, clinical trial, 132 single-rooted, root-filled teeth with symptomatic apical periodontitis (AP) requiring NSER were allocated into six groups randomly (n = 22/group): 2% CHX with NaOCl (CHXH), 2% Ozonated CHX without NaOCl (OCHX), 2% Ozonated CHX with NaOCl (OCHXH), 0.1% OCT with NaOCl (OCTH), 0.1% Ozonated OCT without NaOCl (OOCT), and 0.1% Ozonated OCT with NaOCl (OOCTH). Standard NSER protocol was followed groups were irrigated with 15 ml of ozonated or nonozonated irrigant (CHX/OCT) for 3-5 min with ultrasonic agitation. PP at baseline, after 6, 12, 24, 48 h, and 7 days was recorded using the Visual Analog Scale (VAS). Logistic regression of predictor variables was compared using the Chi-square test. For group-wise and time-wise comparisons, a two-way analysis of variance followed by the post hoc Bonferroni test was carried out. Results None of the patient-related variables in logistic regression obtained a statistically significant (P > 0.05) role in PP. The VAS score after 6 h was OCHX (4.72) > OOCT (4.42) > CHXH (4.23) > OCTH (3.95) > OCHXH (3.42) > OOCTH (3.21). OOCTH and OCHXH groups demonstrated statistically significant reductions in VAS scores at various time intervals (P < 0.05). Conclusion SV NSER with ozonated OCT, CHX irrigation, and NaOCl resulted in lesser PP at all time intervals, i.e., 6, 12, 24, 48 h, and 7 days in patients with symptomatic AP.
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Affiliation(s)
- Nidhi Sinha
- Department of Conservative Dentistry and Endodontics, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
- Department of Conservative Dentistry and Endodontics, Government Dental College, Gujarat University, Ahmedabad, Gujarat, India
| | - Geeta Asthana
- Department of Conservative Dentistry and Endodontics, Government Dental College, Gujarat University, Ahmedabad, Gujarat, India
| | - Girish Parmar
- Department of Conservative Dentistry and Endodontics, Government Dental College, Gujarat University, Ahmedabad, Gujarat, India
| | - Akshayraj Langaliya
- Department of Conservative Dentistry and Endodontics, AMC Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Jinali Shah
- Consultant Endodontist, Vikram Dental Care, Ahmedabad, Gujarat, India
| | - Bijay Singh
- Department of Prosthodontics, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
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Şehirli AÖ, Aksoy U, Sibai A, Orhan K, Sayıner S. Effects of N-acetyl-L-cysteine against apical periodontitis in rats with adriamycin-induced cardiomyopathy and nephropathy. Int Endod J 2024; 57:195-207. [PMID: 38071432 DOI: 10.1111/iej.14010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/22/2023] [Accepted: 11/28/2023] [Indexed: 01/11/2024]
Abstract
AIM This study aimed to investigate the potential protective effects of N-acetyl-L-cysteine (NAC) against apical periodontitis (AP) in rats with adriamycin (ADR)-induced kidney and heart diseases. METHODOLOGY Fourty-eight Wistar albino rats were divided into six groups: (1) Control group, (2) ADR group (1 mg/kg/day ip for 10 days), (3) AP Group (1st mandibular molar tooth), (4) AP + ADR Group, (5) AP + NAC group (150 mg/kg/day ip), and (6) AP + ADR + NAC group. After 3 weeks, the rats were decapitated and blood and tissue samples (heart, kidney, and jaw) were collected. Tissue samples were evaluated by biochemical (inflammatory cytokines and hemodynamic parameters) and radiological analyses. One-way anova with Tukey post hoc tests was used to compare data, considering p < .05 as statistically significant. RESULTS The serum levels of TNF-α, IL-1β, BUN, Creatinine, CK, and LDH were elevated in the test groups compared with the control group, and treatment with NAC reduced these levels (p < .05). Heart and kidney tissue analysis showed a higher heart-to-body weight ratio (HW/BW) and kidney-to-body weight ratio (KW/BW) in the test groups compared with the control group (p < .05). No significant differences in HW/BW and KW/BW were found between the control and AP + NAC groups. Volumetric apical bone resorption analysis showed an increase in periapical radiolucencies in AP-induced groups indicating apical periodontitis. NAC treatment reduced the total area and volume of resorption cavities (p < .05). CONCLUSIONS The results suggest that NAC's antioxidant and anti-inflammatory effects can reduce adriamycin-mediated heart and kidney damage and may have a positive effect on apical periodontitis in individuals with nephropathy and cardiomyopathy.
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Affiliation(s)
- Ahmet Özer Şehirli
- Department of Pharmacology, Faculty of Dentistry, Near East University, North Cyprus, Turkey
| | - Umut Aksoy
- Department of Endodontics, Faculty of Dentistry, Near East University, North Cyprus, Turkey
| | - Abdullah Sibai
- Department of Endodontics, Faculty of Dentistry, Near East University, North Cyprus, Turkey
| | - Kaan Orhan
- Department of DentoMaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Serkan Sayıner
- Department of Biochemistry, Faculty of Veterinary Medicine, Near East University, North Cyprus, Turkey
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Brochado Martins JF, Hagay S, Herbst SR, Falk S. Cost-effectiveness analysis of full versus selective root canal retreatment. Int Endod J 2023; 56:1319-1327. [PMID: 37732616 DOI: 10.1111/iej.13972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/22/2023]
Abstract
AIM Selective root-canal retreatment has been proposed as an alternative to full retreatment in multirooted, root-canal-filled teeth with evidence of apical pathology, where only the affected root(s) is retreated. Whilst this option may save costs initially, failures and retreatments may compensate for these initial savings. We assessed the cost-effectiveness of full versus selective root-canal retreatment using data from a recent clinical pilot study, employing a modelling approach. METHODOLOGY A Markov model was constructed to follow up a previously root-canal treated maxillary molar with apical pathology on a single root (mesio-buccal), receiving either selective or full root-canal retreatment. A private-payer perspective in Dutch health care was adopted. Permanent molar teeth with apical lesions on the mesial root were simulated over the lifetime of initially 50-year-old patients. Teeth could have endodontic complications and require interventions such as retreatment or tooth extraction and replacement. Costs were calculated based on the Dutch dental fee catalogues. Monte-Carlo microsimulations were performed to assess lifetime costs and effectiveness (measured as tooth retention time), and the resulting cost-effectiveness. Probabilistic joint uncertainty and sensitivity analyses were performed, and cost-effectiveness at different willingness-to-pay-thresholds was evaluated. RESULTS In the base-case scenario, selective retreatment was less costly (2137; 2.5%-97.5% percentiles: 1944-2340 Euro) and more effective (19.6; 18.3-20.8 Years) than full retreatment (2495; 2305-2671 Euro; 16.5; 15.2-17.9 Years) in 100% of the simulations and regardless of the willingness-to-pay threshold. Only in a worst case scenario was selective retreatment more costly, but remained more effective. CONCLUSIONS Selective retreatment, when clinically applicable, is likely to be more cost-effective than full retreatment in endodontically treated molars with persistent apical periodontitis. Our results should be interpreted with caution because the quality of the underlying data is limited.
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Affiliation(s)
- João Filipe Brochado Martins
- Department of Endodontology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Shemesh Hagay
- Department of Endodontology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Sascha Rudolf Herbst
- Department of Oral Diagnostic, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Schwendicke Falk
- Department of Oral Diagnostic, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Brochado Martins JF, Guerreiro Viegas O, Cristescu R, Diogo P, Shemesh H. Outcome of selective root canal retreatment-A retrospective study. Int Endod J 2023; 56:345-355. [PMID: 36403111 PMCID: PMC10100215 DOI: 10.1111/iej.13871] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022]
Abstract
AIM Selective root canal retreatment is when the treatment is limited to root(s) with radiographic evidence of periapical pathosis. The goals of this retrospective study were as follows: (i) evaluate the clinical and radiographic (periapical radiographs [PR] or cone-beam computerized tomographs [CBCT]) outcome of selective root canal retreatment after ≥12 months follow-up; (ii) evaluate the periapical status of the unretreated roots; and (iii) assess tooth survival. METHODOLOGY A retrospective study (January 2018 to April 2021) was conducted to identify permanent multirooted teeth that underwent selective root canal retreatment. Clinical records, PR and CBCT were examined to ascertain variables of interest. Outcomes (per root and per tooth) were classified into 'favourable' or 'unfavourable' using well-established clinical and radiographic healing criteria. Treatment outcomes for the whole tooth and per root were compared as well as bivariate associations between the treatment outcome of the retreated roots and the treatment-related parameters (quality of root filling, sealer extrusion, iatrogenic mishaps and type of restoration) were analysed using Fisher's exact test (α = .05). Survival was recorded in months. RESULTS A total of 75 teeth (195 roots) in 75 subjects were available for outcome analysis. The favourable outcome per tooth was 86.7%. At follow-up, 92.6% of the retreated roots had a favourable outcome. From the unretreated roots, 3.5% showed radiographic signs of an emerging periapical lesion. No statistical difference was shown between the outcomes per root and per tooth between both groups. None of the treatment-related parameters had a direct influence on the outcome of the retreated roots. The survival rate at 12-48 months after retreatment was 91.5%. CONCLUSIONS Selective root canal retreatment is associated with a favourable outcome in a majority of cases. Unretreated roots rarely developed radiographic signs of a new periapical lesion at follow-up. Future high-quality clinical trials with larger sample sizes and longer follow-up periods are required to confirm these findings.
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Affiliation(s)
- João Filipe Brochado Martins
- Department of Endodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Patrícia Diogo
- Faculty of Medicine, Institute of Endodontics, University of Coimbra, Coimbra, Portugal
| | - Hagay Shemesh
- Department of Endodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Mackiewicz E, Bonsmann T, Kaczor-Wiankowska K, Nowicka A. Volumetric Assessment of Apical Periodontitis Using Cone-Beam Computed Tomography-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2940. [PMID: 36833634 PMCID: PMC9966796 DOI: 10.3390/ijerph20042940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/28/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
This systematic review aimed to investigate the scientific literature on volumetric studies concerning the diagnosis and treatment of apical periodontitis using CBCT. A systematic review protocol was written following the preferred reporting items for the systematic reviews and meta-analyses (PRISMA) checklist. Four electronic databases were searched for relevant publications in English, which were published up to 21 January 2023. The inclusion criteria and corresponding search keys were applied. The risk of bias was assessed using the Joanna Briggs Institute Meta-Analysis of Statistic Assessment and Review Instrument. The search strategy identified 202 studies, with 123 studies excluded during the title and abstract screening and 47 studies left for full text screening. A total of 17 studies met the inclusion criteria. The lesion volume was measured and classified according to different indices which compared the effectiveness of their diagnostics. Moreover, the volume of AP lesions increased with the thickness of the maxillary sinus mucosa in primary and secondary infections and decreased due to endodontic treatment. Volumetric measurements using CBCT are useful in the correct definition of periapical tissue pathosis using a CBCT periapical volume index and assessment of the dynamics of the treatment of apical lesions.
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Affiliation(s)
- Ewa Mackiewicz
- Student Scientific Circle at the Department of Conservative Dentistry and Endodontics, Pomeranian Medical University in Szczecin, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Tobias Bonsmann
- Student Scientific Circle at the Department of Conservative Dentistry and Endodontics, Pomeranian Medical University in Szczecin, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Kinga Kaczor-Wiankowska
- Department of Conservative Dentistry and Endodontics, Pomeranian Medical University in Szczecin, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Alicja Nowicka
- Department of Conservative Dentistry and Endodontics, Pomeranian Medical University in Szczecin, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland
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de Oliveira LD, de Oliveira FE, Hatje BA, Valera MC, Carvalho CAT, Hasna AA. Detoxification of LTA by intracanal medication: analysis by macrophages proinflammatory cytokines production. Braz Dent J 2022; 33:36-43. [PMID: 36477963 PMCID: PMC9733371 DOI: 10.1590/0103-6440202205195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/17/2022] [Indexed: 12/12/2022] Open
Abstract
The aim of this study was to evaluate in vitro the effect of calcium hydroxide [Ca(OH)2], 2% chlorhexidine gel (CHX) on macrophages (RAW 264.7) to produce pro-inflammatory cytokines and nitric oxide after pretreatment with lipoteichoic acid (LTA) of Enterococcus faecalis. Forty-eight human single-rooted teeth were instrumented with R25.08 (RECIPROC) and sterilized by gamma irradiation. LTA was inoculated in the root canal of each specimen for 96 hours. Specimens were instrumented with 40.06 and 50.05 (RECIPROC) and medicated with: I) Pyrogen-free saline solution (SS); II) 2% CHX gel; III) Ca(OH)2 + SS; or IV) Ca(OH)2 + CHX for 14 days. Three samples (S) were performed of the root canal of each specimen at: S1) immediately after instrumentation; S2) after Ethylenediaminetetraacetic acid (EDTA); S3) after intracanal medication removal. Subsequent quantification of cytokines (IL-1β, TNF-α, MIP-1α, IP-10, G-CSF and IL-6) by immunosorbent assay (ELISA) and nitric oxide by the Griess method was carried-out. Data were submitted to a normality test and then analyzed with one-way ANOVA and Tukey test with a significance level of 5% using GraphPad Prism 6. Ca(OH)2 + SS and Ca(OH)2 + CHX presented lower levels of TNF-α, TNF-α, IL-6, G-CSF and nitric oxide. Ca(OH)2 + SS was the most effective in reducing MIP-1α. CHX was effective in reducing IL-6 and G-CSF. Therefore, the combined intracanal medication of calcium hydroxide and chlorhexidine is effective in reducing the cytokines TNF-α, IL-1β, IL-6, G-CSF and nitric oxide.
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Affiliation(s)
- Luciane Dias de Oliveira
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University - UNESP, São José dos Campos, São Paulo, Brazil
| | - Felipe Eduardo de Oliveira
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University - UNESP, São José dos Campos, São Paulo, Brazil
| | - Bárbara Araujo Hatje
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University - UNESP, São José dos Campos, São Paulo, Brazil
| | - Marcia Carneiro Valera
- Department of Restorative Dentistry, Endodontics division, Institute of Science and Technology, São Paulo State University - UNESP, São José dos Campos, São Paulo, Brazil.
| | - Cláudio Antonio Talge Carvalho
- Department of Restorative Dentistry, Endodontics division, Institute of Science and Technology, São Paulo State University - UNESP, São José dos Campos, São Paulo, Brazil.
| | - Amjad Abu Hasna
- Department of Restorative Dentistry, Endodontics division, Institute of Science and Technology, São Paulo State University - UNESP, São José dos Campos, São Paulo, Brazil.
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Aminoshariae A, Azarpazhooh A, Diogenes AR, Fouad AF, Glickman GN, He J, Kishen A, Letra AM, Levin L, Setzer FC, Tay FR, Hargreaves KM. Insights into the January 2022 Issue of the JOE. J Endod 2021; 48:1-3. [PMID: 34915996 DOI: 10.1016/j.joen.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | | | - Anibal R Diogenes
- University of Texas Health San Antonio School of Dentistry, San Antonio, Texas
| | - Ashraf F Fouad
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Jianing He
- Texas A&M College of Dentistry, Dallas, Texas
| | - Anil Kishen
- Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Ariadne M Letra
- University of Texas Health Science Center at Houston School of Dentistry, Houston, Texas
| | | | - Frank C Setzer
- University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
| | - Franklin R Tay
- The Dental College of Georgia, Augusta University, Augusta, Georgia
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