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Gonçalves PS, Candemil AP, Petean IBF, Silva-Sousa AC, Pires CRF, Mazzi-Chaves JF, Sousa-Neto MD, Gaêta-Araujo H. Identification and classification of pulp calcifications in posterior teeth according to dental condition using digital panoramic radiography and cone beam CT. Dentomaxillofac Radiol 2024; 53:308-315. [PMID: 38608191 PMCID: PMC11211681 DOI: 10.1093/dmfr/twae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/28/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVE To compare digital panoramic radiography (DPR) and cone beam CT (CBCT) in the detection and classification of pulp calcifications in posterior teeth in relation to tooth condition and its location. METHODS Two hundred and fifty patients with simultaneous DPR and CBCT scans were selected from a dental image bank. For each posterior tooth, its condition was registered (healthy, restored, or decayed). The presence of calcifications was assessed and classified according to location (coronal or radicular) and type (total obliteration, partial obliteration, narrowing, and no calcification). Chi-square and McNemar tests were used to compare DPR and CBCT results, with a significance level of 5%. DPR diagnostic values were calculated using CBCT as reference. RESULTS Decayed and restored teeth showed a significantly (P < .001) higher prevalence of pulp calcifications than healthy teeth in both imaging exams. There was a significant discrepancy between the imaging modalities in the identification of calcifications (P < .001), especially for radicular calcifications of maxillary teeth (DPR = 55.2%; CBCT = 30.9%). In the case of coronal calcifications, there was a greater discrepancy between CBCT and DPR in the mandibular teeth (10.7%) than in the maxillary teeth (7.7%). Overall, DPR presents higher sensitivity (0.855) than specificity (0.483) for pulp calcifications detection. CONCLUSION DPR considerably overestimates pulp calcifications in posterior teeth, as compared to CBCT. A higher prevalence of pulp calcifications is related to decayed and restored teeth.
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Affiliation(s)
- Poliana Santos Gonçalves
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto 14040-904, Brazil
| | - Amanda Pelegrin Candemil
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto 14040-904, Brazil
| | - Igor Bassi Ferreira Petean
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto 14040-904, Brazil
| | - Alice Correa Silva-Sousa
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto 14040-904, Brazil
| | - Cassiano Ricardo Ferreira Pires
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto 14040-904, Brazil
| | - Jardel Francisco Mazzi-Chaves
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto 14040-904, Brazil
| | - Manoel Damião Sousa-Neto
- Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto 14040-904, Brazil
| | - Hugo Gaêta-Araujo
- Department of Stomatology, Public Health, and Forensic Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto 14040-904, Brazil
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Alamoudi RA, Alzayer FM, Alotaibi RA, Alghamdi F, Zahran S. Assessment of the Correlation Between Systemic Conditions and Pulp Canal Calcification: A Case-Control Study. Cureus 2023; 15:e45484. [PMID: 37859878 PMCID: PMC10583123 DOI: 10.7759/cureus.45484] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVE Pulp canal calcification is a dental condition that is characterized by the deposition of mineralized tissue within the dental pulp space. While it is primarily a local phenomenon, recent studies have suggested a potential link between pulp calcification and systemic diseases. This study aimed to determine the correlation between certain systemic diseases, medications, and the presence of pulp canal calcification. Second, it aimed to estimate the prevalence of pulp calcification in the smoker population. METHODS A pair-matched case-control observational study was conducted from June 2022 to June 2023 at the Faculty of Dentistry, King Abdulaziz University. Digital periapical and bitewing radiographs were used for case-based sampling. Patients were categorized into two study groups: the cases group (n=100), consisting of patients with pulp canal calcification including either pulp stone, pulp canal obliteration, or both. Whereas the control group (n=100), consisted of patients without pulp canal calcification. Detailed medical histories were obtained to identify the presence of systemic diseases. Additionally, systemic medications and smoking status were documented. RESULT The participants were divided into two groups; cases (n=100), diagnosed with teeth calcifications and confirmed by radiographic examination, and controls (n=100), showing no evidence of teeth calcifications. Among the patients in the calcification group, 26% had a history of systemic disease compared to 17% in the control non-calcification group with no significant difference between both groups. No correlation between certain medications and pulp canal calcification. Smoking did not demonstrate a statistically significant association with teeth calcifications (p > 0.05). CONCLUSION Pulp calcification on routine radiographic examination could indicate an underlying unnoticed systemic disorder that demands accurate referral and subsequent therapy.
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Affiliation(s)
- Ruaa A Alamoudi
- Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
| | - Fatimah M Alzayer
- General Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
| | - Rawabi A Alotaibi
- General Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
| | - Faisal Alghamdi
- Oral Biology, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
| | - Shatha Zahran
- Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
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Zhu Z. Transient apical breakdown of a discoloured maxillary central incisor during orthodontic treatment: A case report. AUST ENDOD J 2023; 49 Suppl 1:476-480. [PMID: 36807463 DOI: 10.1111/aej.12740] [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: 11/14/2022] [Accepted: 02/05/2023] [Indexed: 02/20/2023]
Abstract
Transient apical breakdown (TAB) appears to be a repair process taking place in the pulp and periapical area of traumatised teeth which may display crown discoloration and have no responses to pulp sensitivity tests. Few TAB cases induced by orthodontic forces have been reported so far. Presented is a case report in which TAB occurred on the maxillary right central incisor during orthodontic treatment. The affected tooth suddenly displayed crown discoloration and had no response to pulp testing at 6 weeks after the placement Invisalign Clear Aligner appliances. Condition of the discoloured tooth was monitored by periodic recall examinations without any active treatment. Six months after the occurrence of discoloration, the affected tooth recovered to its original shade and responded normally to pulp sensitivity tests.
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Affiliation(s)
- Zufeng Zhu
- Department of Stomatology, Xiaoshan Traditional Chinese Medical Hospital, Hangzhou, China
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Ramirez I, Kirschneck C, Corrêa Silva-Sousa A, Proff P, S. Antunes L, Gabbardo MCL, Silva Barroso de Oliveira D, Sousa-Neto MD, Baratto-Filho F, Küchler EC. The investigation of WNT6 and WNT10A single nucleotide polymorphisms as potential biomarkers for dental pulp calcification in orthodontic patients. PLoS One 2023; 18:e0288782. [PMID: 37566620 PMCID: PMC10420345 DOI: 10.1371/journal.pone.0288782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/04/2023] [Indexed: 08/13/2023] Open
Abstract
The aim of this study is to evaluate if single nucleotide polymorphisms (SNPs) in WNT6 and WNT10A are associated with the risk of dental pulp calcification in orthodontic patients. This cross-sectional study followed the "Strengthening the Reporting of Genetic Association Studies" (STREGA) guidelines. Panoramic radiographs (pre- and post-orthodontic treatment) and genomic DNA from 132 orthodontic patients were studied. Dental pulp calcification (pulp stones and/or pulp space narrowing) was recorded in upper and lower first molars. The SNPs in WNT6 and WNT10A (rs7349332, rs3806557, rs10177996, and rs6754599) were assessed through genotyping analysis using DNA extracted from buccal epithelial cells. The association between pulp calcification and SNPs were analyzed using allelic and genotypic distributions and haplotype frequencies (p<0.05). Prevalence of dental pulp calcification was 42.4% in the 490 studied molars. In the genotypic analysis, the SNPs in WNT10A showed a statistically significant value for molar calcification (p = 0.027 for rs1017799), upper molar calcification (p = 0.040 for rs1017799) (recessive model), and molar calcification (p = 0.046 for rs3806557) (recessive model). In the allelic distribution, the allele C of the SNP rs10177996 in WNT10A was associated with molar calcifications (p = 0.042) and with upper first molar calcification (p = 0.035). Nine combinations of haplotypes showed statistically significant value (p<0.05). The findings of this study indicates that SNPs in WNT10A and WNT6 are associated with dental pulp calcification in molars after orthodontic treatment and may be considered as biomarkers for dental pulp calcification.
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Affiliation(s)
- Iago Ramirez
- School of Dentistry, University of São Paulo (FORP-USP), Ribeirão Preto, Brazil
| | | | | | - Peter Proff
- Department of Orthodontics, University of Regensburg, Regensburg, Germany
| | - Leonardo S. Antunes
- School of Dentistry, Tuiuti University from Paraná, Curitiba, Paraná, Brazil
| | | | | | | | - Flares Baratto-Filho
- School of Dentistry, Federal University of Alfenas (UNIFAL-MG), Alfenas, Brazil
- Department of Dentistry, University of Joinville Region (Univille), Joinville, SC, Brazil
| | - Erika C. Küchler
- Department of Orthodontics, University of Regensburg, Regensburg, Germany
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MacDonald D, Alebrahim S, Yen E, Aleksejuniene J. Cone-beam computed tomographic reconstructions in the evaluation of maxillary impacted canines. Imaging Sci Dent 2023; 53:145-151. [PMID: 37405198 PMCID: PMC10315227 DOI: 10.5624/isd.20220211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/30/2023] [Accepted: 04/05/2023] [Indexed: 07/06/2023] Open
Abstract
Purpose Prior to cone-beam computed tomography (CBCT), orthodontic competence included radiological interpretation. Nevertheless, maxillary impacted canines (MICs), because of their position and adjacent complex anatomy, have been challenging to interpret, particularly with regard to root resorption. Although CBCT cross-sectional reconstructions of MICs yielded clearer insights into its diagnosis and treatment planning, the value of simultaneously using 2 different cross-sectional or multiplanar reconstructions of the CBCT datasets - orthogonal and curved/panoramic multiplanar reconstructions - has hitherto not been considered. Materials and Methods Both orthogonal and curved/panoramic multiplanar reconstruction series of 5 screenshots were each reconstructed from the 5 cm × 5 cm CBCT datasets of 15 separate MICs. Fifteen credentialled and experienced orthodontist volunteers reviewed 2 separate PowerPoints of 15 randomized series each, 1 week apart. Their review considered 6 factors that could affect treatment: the position and level of the MIC, the presence or absence of root resorption, ankylosis, cysts, and dilaceration. Results All 15 orthodontists were statistically similar regarding overall years of experience and of CBCT use. Although either reconstruction alone allowed the orthodontists to determine whether ankylosis and, to a lesser extent, most of the other features were present or absent in the MIC, reviewing both reconstructions together was necessary to determine whether root resorption was present or absent in the adjacent tooth. Conclusion Reviewing both orthogonal and curved/panoramic multiplanar reconstructions was necessary to evaluate the presence or absence of root resorption in the teeth adjacent to MICs and that of many other features.
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Affiliation(s)
- David MacDonald
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sharifa Alebrahim
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edwin Yen
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jolanta Aleksejuniene
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
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Parashos P. Endodontic-orthodontic interactions: a review and treatment recommendations. Aust Dent J 2023; 68 Suppl 1:S66-S81. [PMID: 37961018 DOI: 10.1111/adj.12996] [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] [Accepted: 10/19/2023] [Indexed: 11/15/2023]
Abstract
The literature is replete with articles describing the many and varied interactions between endodontic treatment and orthodontic tooth movement (OTM), often reporting conflicting views and findings, which creates confusion for clinicians. Original research and review articles have described aspects such as apical root resorption and potential pulpal complications of teeth related to OTM. Some interactions are of relatively minor clinical significance, whilst others may have adverse consequences. A history of dental trauma before or during OTM further complicates the interactions. This review re-assesses the historical literature on endodontic-orthodontic interactions in light of more recent research and presents guidelines for managing clinical situations involving both disciplines. © 2023 Australian Dental Association.
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Affiliation(s)
- P Parashos
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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Golež A, Ovsenik M, Cankar K. The effect of orthodontic tooth movement on the sensitivity of dental pulp: A systematic review and meta-analysis. Heliyon 2023; 9:e14621. [PMID: 37025792 PMCID: PMC10070381 DOI: 10.1016/j.heliyon.2023.e14621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/02/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
Objectives Orthodontic tooth movement (OTM) is a process that's initiated by orthodontic forces. As a consequence, the forces could restrict pulpal blood supply, possibly affecting dental pulp. The study aimed to review the available evidence on the short and long-term effects of orthodontic tooth movement on dental pulp sensitivity and to identify clinically relevant risk factors. Sources PubMed, Embase, Scopus, and Web of Science were searched for papers from 1990 to the end of December 2021. Study selection The studies that evaluated dental pulp sensitivity of teeth undergoing OTM were included in the systematic review. Randomized, nonrandomized and case-controlled studies were included in the analysis. Risk of bias in each study was assessed using the ROBINS-I tool. Data The systematic search yielded an initial sample of 1110 studies, 17 were included in qualitative analysis. Most studies were classified as moderate risk of bias, however only limited long-term evidence with a higher risk of bias exists. Electric pulp test (EPT) sensitivity threshold during active OTM was increased by 4.25 SD (P < 0.001) and the relative risk (RR) of pulpal non-sensitivity was 13.27 (P < 0.001) higher compared to pre-orthodontic baseline status. Significant differences were between subgroups associated with the type of OTM. A positive relationship between pulpal non-sensitivity and mean patient age was discovered (P = 0.041). After OTM the risk of pulpal non-sensitivity remained 5.76 times higher (P < 0.001) in the long term. Conclusions Evidence showed that OTM could affect dental pulp sensitivity. The type of OTM and patients' age were identified as clinically relevant risk factors. Clinical significance Orthodontic tooth movement negatively impacts the sensitivity of dental pulp during active treatment and to a lesser degree in the long term. Pulpal sensitivity tests during active OTM should therefore be interpreted with caution. Data indicates younger patients have a lower risk of negative pulpal sensitivity during orthodontic treatment.
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Affiliation(s)
- A. Golež
- University of Ljubljana, Faculty of Medicine, Institute of Physiology, Zaloska Cesta 4, Ljubljana, Slovenia
- Orthos Institute, Vilharjev podhod 18, Ljubljana, Slovenia
- Corresponding author. University of Ljubljana, Faculty of Medicine, Institute of Physiology, Zaloska Cesta 4, Ljubljana, Slovenia.
| | - M. Ovsenik
- Orthos Institute, Vilharjev podhod 18, Ljubljana, Slovenia
- University of Ljubljana, Faculty of Medicine, Department of Orthodontics and Dentofacial Orthopaedics, Hrvatski trg 6, Ljubljana, Slovenia
| | - K. Cankar
- University of Ljubljana, Faculty of Medicine, Institute of Physiology, Zaloska Cesta 4, Ljubljana, Slovenia
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Huokuna J, Loimaranta V, Laine MA, Svedström-Oristo AL. Adverse effects of orthodontic forces on dental pulp. Appearance and character. A systematic review. Acta Odontol Scand 2022; 81:267-277. [PMID: 36436210 DOI: 10.1080/00016357.2022.2137232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To comprehensively assess recent data on the effects of orthodontic forces on the dental pulp and to critically evaluate, whether any of the changes are permanent. MATERIALS AND METHODS Articles published between 2/2009 and 2/2022 were searched electronically on the PubMed, EMBASE and SCOPUS databases. The initial search retrieved 780 publications and, applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 33 relevant articles were identified. Twenty articles fulfilled the requirements for high (n = 1) or moderate (n = 19) methodological quality and were included. All assessments were made independently by three researchers. RESULTS Orthodontic forces appeared to cause a reduction in pulpal blood flow and a reduction in tooth sensibility, as indicated by increased response thresholds and increased amounts of negative responses to tooth sensibility tests. In addition, there were increases in the expression or activity levels of enzymes and neuropeptides associated with hypoxia and inflammation. Fibrotic tissue formation in the pulp was also reported. CONCLUSIONS Except for some histological and morphological alterations, the observed pulpal changes were in most cases only temporary, appearing within days of initiating the treatment and usually lasting for weeks. There were no clear signs of permanent damage.
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Affiliation(s)
- Jukka Huokuna
- Institute of Dentistry, University of Turku, Turku, Finland
| | | | - Merja A. Laine
- Institute of Dentistry, University of Turku, Turku, Finland
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Guo R, Yu Q, Lin Y, Li J, Huang Y, Li W. Pulp blood flow changes in maxillary and mandibular anterior teeth after orthodontic retraction: a prospective study. BMC Oral Health 2022; 22:508. [PMCID: PMC9670555 DOI: 10.1186/s12903-022-02559-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Background
Previous studies of pulpal blood flow (PBF) changes in anterior teeth have been limited in the early phase of orthodontic treatment; less is known about the blood supply of anterior teeth in bimaxillary protrusion patients after orthodontic retraction.
Methods
Fifty bimaxillary protrusion patients (25 orthodontic patients ready for debonding and 25 non-orthodontic patients) were selected as study participants. The PBF of maxillary and mandibular anterior teeth were measured using laser Doppler flowmetry. For orthodontic patients, the PBF was measured at 1 day (T1), 1 month (T2), and 3 months (T3) after fixed appliance removal. Non-orthodontic patient PBF was measured as a control. Cone-beam computed tomography (CBCT) examinations before and after orthodontic treatment were performed for orthodontic patients to measure the root resorption. The anterior teeth in orthodontic group were further divided into subgroups according to root resorption and patient age.
Results
At T1 and T3, PBF changes did not differ significantly between the orthodontic and non-orthodontic groups. Maxillary lateral incisor, maxillary central incisor, and mandibular lateral incisor PBFs at T2 were significantly higher in the orthodontic group (P = 0.048, P = 0.04, and P = 0.021). No significant difference in PBF was found between the root resorption and non-resorption subgroups at any time point. Adolescent patients showed a higher PBF in the maxillary lateral incisor at T2 (12.23 ± 3.48) relative to that at T1 (9.10 ± 3.76) and T3 (9.81 ± 2.80) with statistically significant difference (P = 0.020).
Conclusion
For bimaxillary protrusion patients with four premolars extraction, PBF in the maxillary anterior teeth increased transiently after orthodontic appliance removal and then returned to non-orthodontic levels 3 months later. This effect was more pronounced in adolescents. The PBF of anterior teeth after orthodontic retraction may not be influenced by root resorption.
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Insights into the March 2022 Issue of the JOE. J Endod 2022; 48:295-297. [DOI: 10.1016/j.joen.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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