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Stera G, Giusti M, Magnini A, Calistri L, Izzetti R, Nardi C. Diagnostic accuracy of periapical radiography and panoramic radiography in the detection of apical periodontitis: a systematic review and meta-analysis. LA RADIOLOGIA MEDICA 2024:10.1007/s11547-024-01882-z. [PMID: 39225920 DOI: 10.1007/s11547-024-01882-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE Apical periodontitis (AP) is one of the most common pathologies of the oral cavity. An early and accurate diagnosis of AP lesions is crucial for proper management and planning of endodontic treatments. This study investigated the diagnostic accuracy of periapical radiography (PR) and panoramic radiography (PAN) in the detection of clinically/surgically/histopathologically confirmed AP lesions. METHOD A systematic literature review was conducted in accordance with the PRISMA guidelines. The search strategy was limited to English language articles via PubMed, Embase and Web of Science databases up to June 30, 2023. Such articles provided diagnostic accuracy values of PR and/or PAN in the detection of AP lesions or alternatively data needed to calculate them. RESULTS Twelve studies met inclusion criteria and were considered for the analysis. The average value of diagnostic accuracy in assessing AP lesions was 71% for PR and 66% for PAN. According to different accuracy for specific anatomical areas, it is recommended to use PR in the analysis of AP lesions located in the upper arch and lower incisor area, whereas lower premolar and molar areas may be investigated with the same accuracy with PR or PAN. CONCLUSIONS Two-dimensional imaging must be considered the first-level examination for the diagnosis of AP lesions. PR had an overall slightly higher diagnostic accuracy than PAN. Evidence from this review provided a useful tool to support radiologists and dentists in their decision-making when inflammatory periapical bone lesions are suspected to achieve the best clinical outcome for patients, improving the quality of clinical practice.
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Affiliation(s)
| | - Martina Giusti
- Department of Experimental and Clinical Medicine, University of Florence, 50134, Florence, Italy
| | - Andrea Magnini
- Radiodiagnostic Unit n. 2, Department of Experimental and Clinical Biomedical Sciences, University of Florence-Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Linda Calistri
- Radiodiagnostic Unit n. 2, Department of Experimental and Clinical Biomedical Sciences, University of Florence-Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Rossana Izzetti
- Unit of Dentistry and Oral Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126, Pisa, Italy
| | - Cosimo Nardi
- Radiodiagnostic Unit n. 2, Department of Experimental and Clinical Biomedical Sciences, University of Florence-Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy.
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Peters OA, Rossi-Fedele G, George R, Kumar K, Timmerman A, Wright PP. Guidelines for non-surgical root canal treatment. AUST ENDOD J 2024; 50:202-214. [PMID: 38864671 DOI: 10.1111/aej.12848] [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: 03/25/2024] [Accepted: 04/04/2024] [Indexed: 06/13/2024]
Abstract
Guidelines were developed by the Australian Society of Endodontology Inc. with the intent to describe relevant aspects of contemporary evidence-based root canal treatment. The document aims to support clinicians by describing a Standard of Practice in the Australian context. The presented guidelines refer to Competence criteria and Quality standards for the main steps in root canal treatment. While the intent is not to replace individual clinical decision-making, it is envisaged that these periodically reviewable guidelines may help to improve clinical outcomes.
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Affiliation(s)
- Ove A Peters
- The University of Queensland, Brisbane, Queensland, Australia
| | | | - Roy George
- Griffith University, Gold Coast, Queensland, Australia
| | - Kiran Kumar
- The University of Queensland, Brisbane, Queensland, Australia
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Pedergnana A, Seiler R, Huber R, Eppenberger P, Rühli F. Insights into medieval rural lives: A paleo-odontological investigation of two central European communities. Arch Oral Biol 2024; 164:105985. [PMID: 38703544 DOI: 10.1016/j.archoralbio.2024.105985] [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: 03/05/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE Oral status is an important indicator of past lifestyles. Determining the presence and extent of oral pathologies helps reconstruct average oral health, paramasticatory activities and diet of ancient and historical populations. DESIGN In this study, the dental remains from the early medieval cemetery of Früebergstrasse in Baar (Canton of Zug, Switzerland) and the high medieval Dalheim cemetery (North Rhine-Westphalia, Germany) were analyzed. Caries, periodontal condition, periapical lesions, antemortem tooth loss, and enamel hypoplasia were assessed in 654 teeth (993 observable loci) from 68 individuals (Baar: n = 36; Dalheim: n = 32). RESULTS The oral status of both populations was affected by age with higher values of tooth wear in advanced age individuals. High tooth wear values in both populations point towards the consumption of abrasive foods. Pronounced anterior tooth wear in Baar may also be due to non-masticatory tooth usage. Finally, possible nutritional deficiencies were hypothesized for the Baar population. A higher caries prevalence was observed in the Baar group, probably due to differences in carbohydrate intake. The oral conditions observed in the two studied populations exhibited several analogies, suggesting comparable lifestyles despite their separation in space and time. The only differences observed are related to the use of teeth as "tools" and are thus determined by behavioral choices rather than diverse socioeconomic factors. CONCLUSIONS Using multiple dental parameters to examine the oral health of premodern individuals can provide useful insights into the interactions between humans and their environment, from dietary patterns to paramasticatory activities.
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Affiliation(s)
- Antonella Pedergnana
- Institute of Evolutionary Medicine - University of Zurich, Winterthurerstrasse, 190, 8057 Zurich, Switzerland; South Tyrol Archeological Museum, Bozen, Italy; Institute for Mummy Studies, Eurac Research, Bozen, Italy.
| | - Roger Seiler
- Institute of Evolutionary Medicine - University of Zurich, Winterthurerstrasse, 190, 8057 Zurich, Switzerland
| | - Renata Huber
- Amt für Denkmalpflege und Archäologie, Canton Zug, Switzerland
| | - Patrick Eppenberger
- Institute of Evolutionary Medicine - University of Zurich, Winterthurerstrasse, 190, 8057 Zurich, Switzerland
| | - Frank Rühli
- Institute of Evolutionary Medicine - University of Zurich, Winterthurerstrasse, 190, 8057 Zurich, Switzerland
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Hakeem FF, Hakeem MM, Abdulaziz Baik A, Omar Aldadjan R, Ali Alsahli R, Jafar Almarwani A, Abu Zaid BM. Prevalence of Apical Periodontitis in Saudi Arabia: A Systematic Review and Meta-analysis. Saudi Dent J 2024; 36:1078-1085. [PMID: 39176162 PMCID: PMC11337961 DOI: 10.1016/j.sdentj.2024.06.009] [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: 03/04/2024] [Revised: 05/19/2024] [Accepted: 06/02/2024] [Indexed: 08/24/2024] Open
Abstract
Objective This systematic review was aimed to assess the prevalence of apical periodontitis (AP) in Saudi Arabia, focusing on individual-level prevalence and the frequency of AP in endodontically versus untreated teeth. Methods This review followed the PRISMA guidelines and involved searches in several databases, including PubMed-MEDLINE, Cochrane-CENTRAL, and EMBASE, without date restrictions until August 19th, 2023. Eligibility criteria encompassed studies using CBCT, panoramic, and periapical radiographs to diagnose AP in the Saudi population. The meta-analysis employed a random-effects model due to high heterogeneity among studies. Results From 359 records, 13 studies were included, indicating a 40% prevalence of AP in individuals and a 6% prevalence across all teeth within the Saudi population. Root canal-treated teeth demonstrated a higher prevalence at 47%. The data revealed a substantial prevalence of AP compared to global averages, with first molars being the most affected. Studies showed moderate risk of bias and significant heterogeneity. Conclusion The high occurrence of AP in Saudi Arabia, particularly in root-treated teeth, emphasizes the need for enhanced endodontic care and more accurate diagnostics. Urgent improvements in dental health policies and further research are essential to understand AP's impact and improve oral health outcomes.
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Affiliation(s)
- Faisal F. Hakeem
- Department of Preventive Dental Sciences, College of Dentistry, Taibah University, Madinah, Saudi Arabia
| | - Muhannad M. Hakeem
- Department of Substitutive Dental Sciences, College of Dentistry, Taibah University, Madinah, Saudi Arabia
| | | | - Rasha Omar Aldadjan
- College of Dentistry, Taibah University Dental College & Hospital, Madinah, Saudi Arabia
| | - Razan Ali Alsahli
- College of Dentistry, Taibah University Dental College & Hospital, Madinah, Saudi Arabia
| | - Arina Jafar Almarwani
- College of Dentistry, Taibah University Dental College & Hospital, Madinah, Saudi Arabia
| | - Basim M. Abu Zaid
- College of Dentistry, Taibah University Dental College & Hospital, Madinah, Saudi Arabia
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Stiklaru I, Lalum E, Levin A, Shemesh A, Azizi H, Yavnai N, Ben Itzhak J, Solomonov M. Endodontic radiography - what's displaying the radiograph? The yield of commercial computer screens vs. DICOM calibrated medical screens in endodontic radiography. BDJ Open 2024; 10:61. [PMID: 39068173 PMCID: PMC11283460 DOI: 10.1038/s41405-024-00247-y] [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: 03/19/2024] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
OBJECTIVE A comparison between commercial computer screens and DICOM-calibrated medical screens for characterizing anatomy and diagnosing dental pathologies was performed. The aim of this study was to evaluate and compare the ability of each of those screens to identify root apices and widening of the periodontal ligament (PDL) in the posterior maxillary area. MATERIALS AND METHODS Digital X-ray images of 53 maxillary molar teeth were examined by means of a commercial computer screen and again two months later with a DICOM screen to compare their ability to help identify and diagnose PDL widening and to locate the root apices of those teeth. RESULTS The DICOM screen had a significantly better ability to identify widened PDLs (from 31.4% to 34.8% of the cases compared to 19% to 26.1% for the commercial screens, P < .001), depending upon the observer. The DICOM screen was also significantly superior in depicting the root apices compared to the commercial screens (from 77.4% to 83.6% of the cases compared to 56% to 66.7% for the commercial screens, P < 0.001), depending upon the observer. CONCLUSION DICOM-calibrated medical screens were significantly superior to commercial computer screens for identifying widened PDLs and locating the root apex in the posterior maxillary area.
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Affiliation(s)
- Idan Stiklaru
- Department of Endodontics, Israel Defense Forces (IDF), Medical Corps, Tel Hashomer, Israel.
- "Bina" Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Ella Lalum
- Department of Endodontics, Israel Defense Forces (IDF), Medical Corps, Tel Hashomer, Israel
- "Bina" Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Avi Levin
- Department of Endodontics, Israel Defense Forces (IDF), Medical Corps, Tel Hashomer, Israel
- "Bina" Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Avi Shemesh
- Department of Endodontics, Israel Defense Forces (IDF), Medical Corps, Tel Hashomer, Israel
- "Bina" Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hadas Azizi
- Department of Endodontics, Israel Defense Forces (IDF), Medical Corps, Tel Hashomer, Israel
- "Bina" Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nirit Yavnai
- Department of Community Dentistry, Faculty of Dental Medicine, Hebrew University, Hadassah Ein Kerem Campus, Jerusalem, Israel
| | - Joe Ben Itzhak
- Department of Endodontics, Israel Defense Forces (IDF), Medical Corps, Tel Hashomer, Israel
- "Bina" Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael Solomonov
- Department of Endodontics, Israel Defense Forces (IDF), Medical Corps, Tel Hashomer, Israel
- "Bina" Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Gandhe P, Aravelli S, Penigalapati S, Kasam S, Ramachandruni N, Alam S. Effect of apical foraminal enlargement on postoperative pain and inflammatory markers in asymtomatic single-rooted mandibular teeth with apical periodontitis - An in vivo randomized controlled trial. JOURNAL OF CONSERVATIVE DENTISTRY AND ENDODONTICS 2024; 27:584-590. [PMID: 38989502 PMCID: PMC11232762 DOI: 10.4103/jcde.jcde_138_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: 03/16/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 07/12/2024]
Abstract
Aim of the Study This study aims to assess the effect of apical foraminal enlargement on inflammatory markers and pain in patients with asymptomatic single-rooted mandibular teeth with apical periodontitis. Materials and Methods The study included 60 patients based on inclusion and exclusion criteria. Before beginning root canal treatment (RCT), a blood sample was obtained from the antecubital fossa to evaluate the inflammatory markers, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Access opening was done and initial irrigation was done. Working length (WL) was determined with an electronic apex locator and verified with a radiograph. In the control group, the determined WL was maintained, while in the experimental group, the WL was set till the apical foramen. Biomechanical preparation was done in both groups till F2 or F3 based on the initial apical file, followed by final irrigation and obturation based on the master apical file size. Patients were given a Visual Analog Scale to record pain sensations at 24, 48, and 72 h postoperative. After 72 h, patients were recalled for follow-up appointments, and blood was taken from the antecubital fossa again to evaluate inflammatory markers. Statistical Analysis The resultant findings for the reduction in inflammatory markers before and after RCT with or without foraminal enlargement were statistically analyzed using the Student's t-test. The pain was statistically examined with one-way "analysis of variance" and Tukey's post hoc test for inter-group comparison of pain. The level of significance was set at P < 0.05. The statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) Version 23 for Windows (SPSS Inc., Chicago, IL, USA). As pain in the control groups is zero before and after RCT, statistical analysis is not required as the overall pain score is zero. Results The P values of the CRP and ESR of the control group were 0.02 and 0.03, respectively, which indicates it is significant whereas the P values of the ESR and CRP of the experimental group were 0.0002 and 0.0008 which indicates it is highly significant. Results indicate that the experimental group is more effective compared to the control group in reducing inflammatory markers. Pain in the control group after RCT was zero at the end of 24, 48, and 72 h. In the experimental group, where RCT was done with apical foraminal enlargement, mild pain was present at the end of 24 h which gradually decreased at the end of 48 h and no pain was reported at the end of 72 h. Conclusion Reduction in inflammatory markers was more effective in RCT with apical enlargement than without apical enlargement. RCT with apical enlargement caused mild pain in the patients immediately after treatment which gradually decreased over time.
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Affiliation(s)
- Pooja Gandhe
- Department of Conservative Dentistry and Endodontics, Malla Reddy Dental College for Women, Hyderabad, Telangana, India
| | - Swathi Aravelli
- Department of Conservative Dentistry and Endodontics, Malla Reddy Dental College for Women, Hyderabad, Telangana, India
| | - Sivaram Penigalapati
- Department of Conservative Dentistry and Endodontics, Malla Reddy Dental College for Women, Hyderabad, Telangana, India
| | - Swetha Kasam
- Department of Conservative Dentistry and Endodontics, Malla Reddy Dental College for Women, Hyderabad, Telangana, India
| | - Nimeshika Ramachandruni
- Department of Conservative Dentistry and Endodontics, Malla Reddy Dental College for Women, Hyderabad, Telangana, India
| | - Sindhura Alam
- Department of Conservative Dentistry and Endodontics, Malla Reddy Dental College for Women, Hyderabad, Telangana, India
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Cope AL, Francis N, Wood F, Thompson W, Chestnutt IG. Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults. Cochrane Database Syst Rev 2024; 5:CD010136. [PMID: 38712714 PMCID: PMC11075121 DOI: 10.1002/14651858.cd010136.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
BACKGROUND Dental pain can have a detrimental effect on quality of life. Symptomatic apical periodontitis and acute apical abscess are common causes of dental pain and arise from an inflamed or necrotic dental pulp, or infection of the pulpless root canal system. Clinical guidelines recommend that the first-line treatment for these conditions should be removal of the source of inflammation or infection by local operative measures, and that systemic antibiotics are currently only recommended for situations where there is evidence of spreading infection (cellulitis, lymph node involvement, diffuse swelling) or systemic involvement (fever, malaise). Despite this, there is evidence that dentists frequently prescribe antibiotics in the absence of these signs. There is concern that this could contribute to the development of antibiotic-resistant bacteria. This review is the second update of the original version first published in 2014. OBJECTIVES To evaluate the effects of systemic antibiotics provided with or without surgical intervention (such as extraction, incision and drainage of a swelling, or endodontic treatment), with or without analgesics, for symptomatic apical periodontitis and acute apical abscess in adults. SEARCH METHODS We searched Cochrane Oral Health's Trials Register (26 February 2018 (discontinued)), CENTRAL (2022, Issue 10), MEDLINE Ovid (23 November 2022), Embase Ovid (23 November 2022), CINAHL EBSCO (25 November 2022) and two trials registries, and performed a grey literature search. There were no restrictions on language or date of publication. SELECTION CRITERIA Randomised controlled trials of systemic antibiotics in adults with a clinical diagnosis of symptomatic apical periodontitis or acute apical abscess, with or without surgical intervention (considered in this situation to be extraction, incision and drainage, or endodontic treatment) and with or without analgesics. DATA COLLECTION AND ANALYSIS Two review authors independently screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias. We used a fixed-effect model in the meta-analysis as there were fewer than four studies. We contacted study authors to request missing information. We used GRADE criteria to assess the certainty of the evidence. MAIN RESULTS There was one new completed trial on this topic since the last update in 2018. In total, we included three trials with 134 participants. Systemic antibiotics versus placebo with surgical intervention and analgesics for symptomatic apical periodontitis or acute apical abscess One trial (72 participants) compared the effects of a single preoperative dose of clindamycin versus a matched placebo when provided with a surgical intervention (endodontic chemo-mechanical debridement and filling) and analgesics to adults with symptomatic apical periodontitis. We assessed this study at low risk of bias. There were no differences in participant-reported pain or swelling across trial arms at any time point assessed. The median values for pain (numerical rating scale 0 to 10) were 3.0 in both groups at 24 hours (P = 0.219); 1.0 in the antibiotic group versus 2.0 in the control group at 48 hours (P = 0.242); and 0 in both groups at 72 hours and seven days (P = 0.116 and 0.673, respectively). The risk ratio of swelling when comparing preoperative antibiotic to placebo was 0.50 (95% confidence interval (CI) 0.10 to 2.56; P = 0.41). The certainty of evidence for all outcomes in this comparison was low. Two trials (62 participants) compared the effects of a seven-day course of oral phenoxymethylpenicillin (penicillin VK) versus a matched placebo when provided with a surgical intervention (total or partial endodontic chemo-mechanical debridement) and analgesics to adults with acute apical abscess or symptomatic necrotic tooth. Participants in both trials also received oral analgesics. We assessed one study at high risk of bias and the other at unclear risk of bias. There were no differences in participant-reported pain or swelling at any time point assessed. The mean difference for pain (short ordinal numerical scale 0 to 3, where 0 was no pain) was -0.03 (95% CI -0.53 to 0.47) at 24 hours; 0.32 (95% CI -0.22 to 0.86) at 48 hours; and 0.08 (95% CI -0.38 to 0.54) at 72 hours. The standardised mean difference for swelling was 0.27 (95% CI -0.23 to 0.78) at 24 hours; 0.04 (95% CI -0.47 to 0.55) at 48 hours; and 0.02 (95% CI -0.49 to 0.52) at 72 hours. The certainty of evidence for all the outcomes in this comparison was very low. Adverse effects, as reported in two studies, were diarrhoea (one participant in the placebo group), fatigue and reduced energy postoperatively (one participant in the antibiotic group) and dizziness preoperatively (one participant in the antibiotic group). Systemic antibiotics without surgical intervention for adults with symptomatic apical periodontitis or acute apical abscess We found no studies that compared the effects of systemic antibiotics with a matched placebo delivered without a surgical intervention for symptomatic apical periodontitis or acute apical abscess in adults. AUTHORS' CONCLUSIONS The evidence suggests that preoperative clindamycin for adults with symptomatic apical periodontitis results in little to no difference in participant-reported pain or swelling at any of the time points included in this review when provided with chemo-mechanical endodontic debridement and filling under local anaesthesia. The evidence is very uncertain about the effect of postoperative phenoxymethylpenicillin for adults with localised apical abscess or a symptomatic necrotic tooth when provided with chemo-mechanical debridement and oral analgesics. We found no studies which compared the effects of systemic antibiotics with a matched placebo delivered without a surgical intervention for symptomatic apical periodontitis or acute apical abscess in adults.
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Affiliation(s)
- Anwen L Cope
- Dental Public Health, School of Dentistry, Cardiff University, Cardiff, UK
| | - Nick Francis
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Fiona Wood
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Wendy Thompson
- Division of Dentistry, University of Manchester, Manchester, UK
| | - Ivor G Chestnutt
- Dental Public Health, School of Dentistry, Cardiff University, Cardiff, UK
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Kazimierczak W, Wajer R, Wajer A, Kiian V, Kloska A, Kazimierczak N, Janiszewska-Olszowska J, Serafin Z. Periapical Lesions in Panoramic Radiography and CBCT Imaging-Assessment of AI's Diagnostic Accuracy. J Clin Med 2024; 13:2709. [PMID: 38731237 PMCID: PMC11084607 DOI: 10.3390/jcm13092709] [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: 04/23/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024] Open
Abstract
Background/Objectives: Periapical lesions (PLs) are frequently detected in dental radiology. Accurate diagnosis of these lesions is essential for proper treatment planning. Imaging techniques such as orthopantomogram (OPG) and cone-beam CT (CBCT) imaging are used to identify PLs. The aim of this study was to assess the diagnostic accuracy of artificial intelligence (AI) software Diagnocat for PL detection in OPG and CBCT images. Methods: The study included 49 patients, totaling 1223 teeth. Both OPG and CBCT images were analyzed by AI software and by three experienced clinicians. All the images were obtained in one patient cohort, and findings were compared to the consensus of human readers using CBCT. The AI's diagnostic accuracy was compared to a reference method, calculating sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and F1 score. Results: The AI's sensitivity for OPG images was 33.33% with an F1 score of 32.73%. For CBCT images, the AI's sensitivity was 77.78% with an F1 score of 84.00%. The AI's specificity was over 98% for both OPG and CBCT images. Conclusions: The AI demonstrated high sensitivity and high specificity in detecting PLs in CBCT images but lower sensitivity in OPG images.
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Affiliation(s)
- Wojciech Kazimierczak
- Department of Radiology and Diagnostic Imaging, Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, 85-067 Bydgoszcz, Poland
- Department of Radiology and Diagnostic Imaging, University Hospital no 1 in Bydgoszcz, Marii Skłodowskiej Curie 9, 85-094 Bydgoszcz, Poland
- Kazimierczak Private Medical Practice, Dworcowa 13/u6a, 85-009 Bydgoszcz, Poland
| | - Róża Wajer
- Department of Radiology and Diagnostic Imaging, University Hospital no 1 in Bydgoszcz, Marii Skłodowskiej Curie 9, 85-094 Bydgoszcz, Poland
| | - Adrian Wajer
- Dental Primus, Poznańska 18, 88-100 Inowrocław, Poland
| | - Veronica Kiian
- Kazimierczak Private Medical Practice, Dworcowa 13/u6a, 85-009 Bydgoszcz, Poland
| | - Anna Kloska
- The Faculty of Medicine, Bydgoszcz University of Science and Technology, Kaliskiego 7, 85-796 Bydgoszcz, Poland
| | - Natalia Kazimierczak
- Kazimierczak Private Medical Practice, Dworcowa 13/u6a, 85-009 Bydgoszcz, Poland
| | - Joanna Janiszewska-Olszowska
- Department of Interdisciplinary Dentistry, Pomeranian Medical University in Szczecin, Al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland
| | - Zbigniew Serafin
- Department of Radiology and Diagnostic Imaging, Collegium Medicum, Nicolaus Copernicus University in Torun, Jagiellońska 13-15, 85-067 Bydgoszcz, Poland
- Department of Radiology and Diagnostic Imaging, University Hospital no 1 in Bydgoszcz, Marii Skłodowskiej Curie 9, 85-094 Bydgoszcz, Poland
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Alhailaa AA, Al-Nazhan SA, Aldosimani MA. Prevalence of apical periodontitis and quality of root canal treatment in an adult Kuwaiti sub-population: a cross-sectional study. Restor Dent Endod 2024; 49:e16. [PMID: 38841383 PMCID: PMC11148409 DOI: 10.5395/rde.2024.49.e16] [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: 01/13/2024] [Revised: 01/26/2024] [Accepted: 02/13/2024] [Indexed: 06/07/2024] Open
Abstract
Objectives This cross-sectional study evaluated the prevalence of apical periodontitis (AP) and the technical quality of root canal fillings in an adult Kuwaiti subpopulation using cone-beam computed tomography (CBCT) images. Materials and Methods Two experienced examiners analyzed 250 CBCT images obtained from Kuwaiti patients aged 15-65 years who attended government dental specialist clinics between January 2019 and September 2020. The assessment followed the radiographic scoring criteria proposed by De Moor for periapical status and the technical quality of root canal filling. Chi-square and Fisher's exact tests were used for statistical analysis, with significance level set at p < 0.05. Results Among the 2,762 examined teeth, 191 (6.91%) exhibited radiographic signs of AP, and 176 (6.37%) had undergone root canal filling. AP prevalence in root canal-treated teeth was 32.38%, with a significant difference between males and females. Most of the endodontically treated teeth exhibited adequate root canal filling (71.5%). Conclusions The study demonstrated a comparable prevalence of AP and satisfactory execution of root canal treatment compared to similar studies in different countries.
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Affiliation(s)
- Abdulrahman A. Alhailaa
- Department of Restorative Dentistry, College of Medicine and Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
- Farwania Dental Department, Ministry of Health, Kuwait City, Kuwait
| | - Saad A Al-Nazhan
- Department of Restorative Dentistry – Endodontics, College of Medicine and Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Mazen A Aldosimani
- Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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Abdel-Baset ST, Fahmy SH, Obeid MF. Can instrumentation kinematics affect postoperative pain and substance P levels? A randomized controlled trial. BMC Oral Health 2024; 24:102. [PMID: 38233887 PMCID: PMC10792914 DOI: 10.1186/s12903-024-03882-x] [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: 11/15/2023] [Accepted: 01/10/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND This study aimed to assess the influence of continuous rotation and reciprocation kinematics on postoperative pain (POP) levels and substance P (SP) levels in patients diagnosed with irreversible pulpitis and symptomatic apical periodontitis (SAP). MATERIALS AND SUBJECTS A total of twenty patients were randomly assigned into two groups: Continuous Rotation Group (CRG) (n = 10), subjected to mechanical preparation with the EdgeEndox7 rotary system (Albuquerque, NM, USA), and Reciprocation Group (RG) (n = 10), treated with the EdgeOne Fire reciprocating system (Albuquerque, NM, USA). Apical fluid (AF) samples were collected, and SP levels were quantified through radioimmunoassay. POP was assessed using the Numerical Rating Scale (NRS) at various time intervals (preoperatively, 6 h, 12 h, 24 h, 48 h, and 72 h). Data were statistically analyzed utilizing the independent t-test, Mann-Whitney U test, Friedman's test, and Nemenyi post hoc test. RESULTS There was a significant increase in SP levels in the reciprocating group compared to the continuous rotation group (P ≤ 0.05). Additionally, patients in the reciprocating group reported significantly higher POP levels (P ≤ 0.05) at all measured intervals (6 h, 12 h, 24 h, and 48 h), with both groups exhibiting similar pain level reductions at the 72-hour mark. CONCLUSION Our findings suggest that continuous rotation kinematics in root canal preparation leads to a considerable reduction in SP expression and POP. TRIAL REGISTRATION The study protocol was retrospectively registered on the www. CLINICALTRIALS gov database (NCT06081335) at (13/10/2023) after the approval of the Ethics Committee, Faculty of Dentistry, Ain Shams University (FDASU-RecIM012135).
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Affiliation(s)
| | - Sarah Hossam Fahmy
- Department of Endodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Maram Farouk Obeid
- Department of Endodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt.
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11
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Zargar N, Khosravi K, Zadsirjan S, Safi Y, Vatankhah M, Akbarzadeh Baghban A, Aghajani Varzaneh F. The association of endodontic prognostic factors with the presence of periapical lesion, its volume, and bone characteristics in endodontically treated molars: a cross-sectional study. BMC Oral Health 2024; 24:28. [PMID: 38183066 PMCID: PMC10771002 DOI: 10.1186/s12903-023-03818-x] [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: 11/16/2023] [Accepted: 12/21/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND This study intended to evaluate the association between several endodontic prognostic factors with the presence of periapical lesions (PLs), their volume, and bone characteristics including cortical bone destruction (CBD) and buccal plate bone height (BPBH) in root-filled molar teeth using cone-beam computed tomography. METHODS A collection of 143 scans of endodontically treated maxillary/mandibular first or second molars recorded over 8 years, were obtained from a specialized radiology center. Data on prognostic factors including tooth number, gender, jaw type, the status and number of missed canals, obturation length, restoration type, presence of a separated instrument, presence of a post or screw in the canals, and presence of perforation were collected. The assessed outcomes included PL presence, PL volume, CBD, and BPBH. The association between prognostic factors and outcomes was evaluated using multiple logistic regression models with adjusted covariates and multifactorial ANOVA at a significance level of 0.05. RESULTS A total of 282 molars from 82 women and 50 men with a mean age of 40.6 ± 12.27 were included. Among those, 139 teeth presented PL with a mean volume of 18.68 mm3. CBD was prevalent in 137 teeth and the mean BPBH appeared to be 9.45 mm. The presence of a missed canal (OR = 10.022, P < .05), underfilled canal (OR = 3.725, P < .05), overfilled canal (OR = 15.859, P = .018), and perforation (OR = 15.261, P = .013) was significantly associated with PLs. None of the prognostic factors could considerably contribute to the CBD (P > .05). The presence of a missed canal was positively associated with the PL volume (P < .05). Similarly, missed canals (P < .05), perforation (P < .05), and separated instruments (P = .004) were associated with a significantly reduced BPBH. CONCLUSIONS Overfillings, perforations, missed canals, and underfillings were identified as remarkable predictors of PL, arranged in descending order of their respective impact. The only factor capable of significantly increasing the PL volume was the missed canal. In brief, obturation length errors, perforations, missed canals, and separated instruments were robustly correlated with endodontic failure, which highlights the importance of mitigating the potential for errors by following the fundamentals of endodontics.
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Affiliation(s)
- Nazanin Zargar
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kamyar Khosravi
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeede Zadsirjan
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yaser Safi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Vatankhah
- School of Dentistry, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Akbarzadeh Baghban
- Proteomics Research Center, Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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12
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Seeballuck C, Dolan S, K Kilgariff J. Getting it right at every stage: Top tips for traumatic dental injury review: Part 1. Br Dent J 2024; 236:82-86. [PMID: 38278886 DOI: 10.1038/s41415-024-6780-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Affiliation(s)
- Clement Seeballuck
- Clinical Lecturer in Paediatric Dentistry, Dundee Dental Hospital and Research School, Dundee, DD1 4HR, UK.
| | - Sean Dolan
- Specialty Training Registrar in Restorative Dentistry, Glasgow Dental Hospital and School, Glasgow, G2 3JZ, UK.
| | - Julie K Kilgariff
- Consultant in Endodontics, Dundee Dental Hospital and Research School, Dundee, DD1 4HR, UK.
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13
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Nursin R, Harun MH, Mohamad D, Mohd Bakhori SK, Mahmud S. Subcutaneous tissue reaction to a novel nano zinc oxide eugenol dental cement. Biomed Mater Eng 2024; 35:139-151. [PMID: 38007638 DOI: 10.3233/bme-230118] [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] [Indexed: 11/27/2023]
Abstract
BACKGROUND Zinc oxide eugenol (ZOE) cement is a popular dental material due mainly to its analgesic, antibacterial and anti-inflammatory effects. The formulation of ZOE cement from nano particle-sized zinc oxide (ZnO) has the potential to increase these properties as well as reduce its adverse effects to the surrounding tissues. OBJECTIVE This study evaluated the subcutaneous tissue response towards nano ZOE cements (ZOE-A and ZOE-B) in comparison to conventional ZOE (ZOE-K). METHODS Test materials were implanted into 15 New Zealand white rabbits. Tissue samples were obtained after 7, 14, and 30 days (n = 5 per period) for histopathological evaluation of inflammatory cell infiltrate, fibrous tissue condensation, and abscess formation. RESULTS ZOE-A showed the lowest score for the variable macrophage and lymphocyte at day 7. Both ZOE-A and ZOE-B presented lower fibrous tissue condensation and abscess formation compared to conventional ZOE-K. By day 30, ZOE-A exhibited less lymphocytic and neutrophilic infiltrate compared to the other materials, while ZOE-B had the lowest score for macrophages. ZOE-K exerted higher inflammatory cell response at almost all of the experimental periods. All of the materials resulted in thin fiber condensation after 30 days. CONCLUSIONS Rabbit tissue implanted with ZOE-A and ZOE-B showed better response compared to ZOE-K.
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Affiliation(s)
- Rohmat Nursin
- Faculty of Dentistry, SEGi University, No. 9, Jalan Teknologi, Petaling Jaya, Malaysia
| | - Masitah Hayati Harun
- School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kota Bharu, Malaysia
| | - Dasmawati Mohamad
- School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kota Bharu, Malaysia
| | | | - Shahrom Mahmud
- School of Physics, Universiti Sains Malaysia, Pulau Pinang, Malaysia
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14
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Karataş E, Kul A, Camilleri J, Yonel Z. Association between rheumatoid arthritis and pulpal-periapical pathology: a systematic review. Clin Oral Investig 2023; 27:7019-7028. [PMID: 37828236 PMCID: PMC10713683 DOI: 10.1007/s00784-023-05305-7] [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: 08/18/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES Rheumatoid arthritis (RA) is a debilitating disease where numerous pro-inflammatory cytokines have a proven role in its pathology. These cytokines are also involved in the pathogenesis of apical periodontitis (AP) where they have a pro-inflammatory role and induce bone resorption. Patients with RA may therefore be more prone to develop pulpal-periapical pathology (PPP). This study systematically reviewed the existing literature evaluating the association between RA and PPP. MATERIALS AND METHODS Studies including human participants with both RA and PPP were included. The search was performed in PubMed, Web of Science, and The Cochrane Library databases using keywords and Medical Subject Headings (MeSH) search terms. The risk of bias was assessed using Newcastle-Ottawa Quality Assessment Scale. The following parameters were extracted and analyzed by the reviewers; author, journal, year, design of the study, diagnostic criteria for periapical pathology, the association between rheumatoid arthritis and periapical pathology, and the evidence level. RESULTS The search identified 142 records. Inclusion criteria were as follows; studies in the English language, including human participants only, including patients with RA and PPP, cohort studies, cross-sectional studies, clinical trials, and case-control studies. According to the inclusion criteria, 5 studies were included in this systematic review. Three of the five studies reported significant association between RA and PPP. CONCLUSIONS Existing evidence suggests there may be an association between RA and PPP. CLINICAL RELEVANCE Clinicians should be aware that RA patients can be more prone to develop PPP which may result in a reduced quality of life.
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Affiliation(s)
- Ertugrul Karataş
- Department of Endodontics, Faculty of Dentistry, Atatürk University, Erzurum, Turkey
- School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ayhan Kul
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Josette Camilleri
- School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
| | - Zehra Yonel
- Periodontology Research Group, School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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15
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Hilmi A, Patel S, Mirza K, Galicia JC. Efficacy of imaging techniques for the diagnosis of apical periodontitis: A systematic review. Int Endod J 2023; 56 Suppl 3:326-339. [PMID: 37067066 DOI: 10.1111/iej.13921] [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: 06/01/2022] [Revised: 03/31/2023] [Accepted: 04/13/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Apical periodontitis (AP) is a chronic inflammatory response of microbial aetiology. Pathological changes associated with AP may not be visible on radiographic images and may linger without causing any symptoms. Clinicians rely mostly on clinical examination and imaging techniques to establish a diagnosis. OBJECTIVES The aim of this review was to answer the following question using the PICO format: In the adult human permanent dentition (P), what is the efficacy of diagnostic imaging of the periapical tissues (I) using histopathology as a reference standard (C) in the diagnosis of apical periodontitis, in terms of diagnostic accuracy (O). METHODS MEDLINE, EMBASE, Scopus and Cochrane Library were searched for English articles published through October 2021. At least two independent reviewers evaluated the study design, imaging modality used, histopathological assessment, outcome measures, results and conclusions for each article. The risk of bias was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies-2. RESULTS The initial search strategy identified 544 articles. Seven articles were included for analysis in the final review, all of which involved tissue samples obtained from cadavers. No clinical studies were identified that met the eligibility criteria. A consistently low sensitivity score and negative predictive value were reported for periapical radiography, especially in comparison to CBCT, which scored highly. Both modalities achieved high scores for specificity and positive predictive value. Diagnostic accuracy of CBCT was lower for root-filled teeth in comparison to non-root-filled teeth. DISCUSSION Assessment of the periapical tissues using periapical radiographs was shown to have a low to moderate agreement with the histopathological assessment. CBCT was reported to be more accurate than PR and demonstrated a good agreement with histopathology, especially for non-root-filled teeth. CONCLUSIONS This review identified a need for greater standardization in methodology and reporting, and as the findings are based on cadaver studies, their clinical relevance must be interpreted with caution. REGISTRATION PROSPERO (CRD42021272147).
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Affiliation(s)
- Ali Hilmi
- Department of Endodontology, King's College London Dental Institute, London, UK
| | - Shanon Patel
- Department of Endodontology, King's College London Dental Institute, London, UK
- Specialist Practice, London, UK
| | - Kazim Mirza
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, USA
| | - Johnah C Galicia
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, USA
- Department of Endodontics, Eastman Dental Institute, University College of London, London, UK
- College of Dentistry, Manila Central University, Caloocan City, Philippines
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16
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Sathyanarayanan K, Ranjana NI, Bhavana M, R M, Sankar A, Mirnalini S. Asymptomatic Apical Periodontitis Lesions and Their Association With Systemic Inflammatory Burden: A Preliminary Prospective Clinical Study. Cureus 2023; 15:e46357. [PMID: 37920638 PMCID: PMC10619333 DOI: 10.7759/cureus.46357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 11/04/2023] Open
Abstract
Background: Apical periodontitis (AP) is an inflammatory disorder of the periapical tissues caused by the persistence of a microbial infection within the root canal system of the affected tooth. Clinically, it is symptomatic or asymptomatic depending on several factors such as the type of microorganisms, bacterial load, immunological reaction, and local tissue mediators. Chronic or asymptomatic infections may initiate and modulate intravascular accumulation of inflammatory cells resulting in endothelial dysfunction which subsequently represents a possible systemic inflammatory burden. Aim: The present study aimed to evaluate the relationship between asymptomatic AP and systemic inflammatory burden by assessing the levels of chronic inflammatory cells. Methodology: A total of 25 patients diagnosed with asymptomatic AP who showed a negative response to the pulp sensitivity test with no history of any systemic diseases were included in this preliminary prospective observational study. Blood samples were collected at each phase of the study, and a complete hemogram was carried out. All hematological parameters were recorded before and after root canal therapy and they were analyzed for statistical significance at p <.05 using IBM SPSS Statistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, New York, United States). Results: Evaluation of the mean total leukocyte count (TLC), lymphocyte, and eosinophil cell count showed a significant reduction in the number of cells before and after root canal therapy treatment respectively (p<.05). One-way analysis of variance also revealed statistical significance at p < .05 with a weak positive correlation between the TLC, lymphocyte, and eosinophil count before and after treatment. Conclusion: The present study showed that systemically healthy individuals with asymptomatic AP had increased inflammatory burden in the circulation, and thus, it is essential to identify and quantify the risk associated. It was evident that complete healing of the asymptomatic AP lesions results in an overall reduction of systemic inflammatory cells ultimately reducing the burden and risk of associated systemic inflammatory diseases.
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Affiliation(s)
| | - N I Ranjana
- Conservative Dentistry and Endodontics, Sathyabama Dental College and Hospital, Chennai, IND
| | - Mohan Bhavana
- Conservative Dentistry and Endodontics, Sathyabama Dental College and Hospital, Chennai, IND
| | - Megavarnan R
- Conservative Dentistry and Endodontics, Sathyabama Dental College and Hospital, Chennai, IND
| | - Aravinthan Sankar
- Conservative Dentistry and Endodontics, Sathyabama Dental College and Hospital, Chennai, IND
| | - Selvakumar Mirnalini
- Conservative Dentistry and Endodontics, Sathyabama Dental College and Hospital, Chennai, IND
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17
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Thanissorn C, Ye J, Girgis D, van Dort N, Abbott PV. A comparison of endodontic referrals and treatment in the public and private sectors in Western Australia. AUST ENDOD J 2023; 49 Suppl 1:390-398. [PMID: 37002703 DOI: 10.1111/aej.12755] [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: 12/07/2022] [Accepted: 03/20/2023] [Indexed: 04/04/2023]
Abstract
The aim was to compare referral patterns and treatment provided by specialist Endodontists and Endodontic Registrars. A retrospective review was conducted of the clinical records of the first 25 patients seen by seven private endodontic clinicians and the equivalent number (175) of patients seen by five public sector endodontic clinicians from 1 January 2017. The average age and range of medical co-morbidities of patients in the public sector were statistically greater. Referred patients and referrers mainly worked in metropolitan Perth. The most frequent reasons for referral in both public and private sectors were to assess and manage non-painful endodontic pathosis, to manage pain, and to manage calcified canals. There was a wide range of cases referred to both sectors but with similar patterns suggesting that the training of specialists adequately prepares them for private practice. The results also indicate that Endodontists must be proficient in all aspects of the speciality.
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Affiliation(s)
- Charn Thanissorn
- UWA Dental School, University of Western Australia, 17 Monash Ave, Nedlands, Western Australia, 6009, Australia
| | - Johnson Ye
- UWA Dental School, University of Western Australia, 17 Monash Ave, Nedlands, Western Australia, 6009, Australia
| | - Daniel Girgis
- UWA Dental School, University of Western Australia, 17 Monash Ave, Nedlands, Western Australia, 6009, Australia
| | - Nathan van Dort
- UWA Dental School, University of Western Australia, 17 Monash Ave, Nedlands, Western Australia, 6009, Australia
| | - Paul V Abbott
- UWA Dental School, University of Western Australia, 17 Monash Ave, Nedlands, Western Australia, 6009, Australia
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18
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Gliga A, Imre M, Grandini S, Marruganti C, Gaeta C, Bodnar D, Dimitriu BA, Foschi F. The Limitations of Periapical X-ray Assessment in Endodontic Diagnosis-A Systematic Review. J Clin Med 2023; 12:4647. [PMID: 37510762 PMCID: PMC10380197 DOI: 10.3390/jcm12144647] [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: 06/07/2023] [Revised: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Diagnosis is a key aspect in endodontic treatment, in a decade where invasive interventions are misapprehended as social tendency instead of medical necessity. All diagnostic facets should be considered before intending the operative phase. Intraoral endodontic radiology-based diagnosis has been shown to be limited. Periapical X-ray is the most used endodontic imaging, yet it does not provide high accuracy. Traditionally, dentists have been trained to diagnose a cyst by certain aspects (size, shape and appearance); hence, an assumption that teeth are affected by "periapical cyst" were subjected to unnecessary extraction or apicoectomy. The aim of this systematic review is to critically appraise the publications that relate the histological diagnosis of a periapical lesion (considered the gold standard) to intraoral X-ray investigation. Ovid Medline, PubMed, ScienceDirect, Mendeley and Scopus were searched for English-language studies comparing periapical diagnosis obtained by using two techniques (histopathology and X-ray). Sixteen articles were included for the final analysis (qualitative and quantitative evaluation) out of which only two supported the statement that periapical diagnosis can be coherently assessed through periapical imaging. Although there is not enough evidence to deliver a definitive conclusion, there are many publications that refute the diagnosis of a cyst via periapical X-ray.
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Affiliation(s)
- Alexandru Gliga
- Department of Operative Dentistry, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Unit of Endodontics, Department of Medical Biotechnologies, Periodontology, Restorative and Paediatric Dentistry, University of Siena, 53100 Siena, Italy
| | - Marina Imre
- Department of Complete Denture, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Simone Grandini
- Unit of Endodontics, Department of Medical Biotechnologies, Periodontology, Restorative and Paediatric Dentistry, University of Siena, 53100 Siena, Italy
| | - Crystal Marruganti
- Unit of Endodontics, Department of Medical Biotechnologies, Periodontology, Restorative and Paediatric Dentistry, University of Siena, 53100 Siena, Italy
| | - Carlo Gaeta
- Unit of Endodontics, Department of Medical Biotechnologies, Periodontology, Restorative and Paediatric Dentistry, University of Siena, 53100 Siena, Italy
| | - Dana Bodnar
- Department of Operative Dentistry, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Bogdan Alexandru Dimitriu
- Department of Endodontology, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Federico Foschi
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London SE19RT, UK
- Peninsula Dental School, University of Plymouth, Plymouth PL6 8BT, UK
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Sobieszczański J, Mertowski S, Sarna-Boś K, Stachurski P, Grywalska E, Chałas R. Root Canal Infection and Its Impact on the Oral Cavity Microenvironment in the Context of Immune System Disorders in Selected Diseases: A Narrative Review. J Clin Med 2023; 12:4102. [PMID: 37373794 DOI: 10.3390/jcm12124102] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/09/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
The oral cavity has a specific microenvironment, and structures such as teeth are constantly exposed to chemical and biological factors. Although the structure of the teeth is permanent, due to exposure of the pulp and root canal system, trauma can have severe consequences and cause the development of local inflammation caused by external and opportunistic pathogens. Long-term inflammation can affect not only the local pulp and periodontal tissues but also the functioning of the immune system, which can trigger a systemic reaction. This literature review presents the current knowledge on root canal infections and their impact on the oral microenvironment in the context of immune system disorders in selected diseases. The result of the analysis of the literature is the statement that periodontal-disease-caused inflammation in the oral cavity may affect the development and progression of autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, or Sjogren's syndrome, as well as affecting the faster progression of conditions in which inflammation occurs such as, among others, chronic kidney disease or inflammatory bowel disease.
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Affiliation(s)
- Jarosław Sobieszczański
- Preclinical Dentistry Lab, Medical University of Lublin, Chodźki 6 Street, 20-093 Lublin, Poland
| | - Sebastian Mertowski
- Department of Experimental Immunology, Medical University of Lublin, 4a Chodźki Street, 20-093 Lublin, Poland
| | - Katarzyna Sarna-Boś
- Department of Dental Prosthetics, Medical University of Lublin, Chodźki 6 Street, 20-093 Lublin, Poland
| | - Piotr Stachurski
- Department of Pediatric Dentistry, Medical University of Lublin, 20-093 Lublin, Poland
| | - Ewelina Grywalska
- Department of Experimental Immunology, Medical University of Lublin, 4a Chodźki Street, 20-093 Lublin, Poland
| | - Renata Chałas
- Department of Oral Medicine, Medical University of Lublin, Chodźki 6 Street, 20-093 Lublin, Poland
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20
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Olivieri JG, Feijoo Pato N, Labraca P, Tomàs J, Miró Q, Duran-Sindreu F. Outcome of non-surgical root canal retreatment procedures obturated with warm gutta-percha techniques: A longitudinal clinical study. J Endod 2023:S0099-2399(23)00322-9. [PMID: 37315780 DOI: 10.1016/j.joen.2023.06.002] [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: 01/31/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To evaluate the success rate of non-surgical root canal retreatment at the 2- to 3-year follow-up and identify the possible prognostic factors. METHODS Patients who underwent root canal retreatment at a university dental clinic were contacted for clinical and radiographic follow-up. The retreatment outcomes in these cases were based on clinical signs, symptoms, and radiographic criteria. Inter- and intra-examiner concordance were calculated using Cohen's kappa coefficient. The retreatment outcome was dichotomized into success or failure according to strict and loose criteria. The radiographic success criteria consisted of complete resolution or absence of a periapical lesion (strict criteria) or a reduction in the size of an existing periapical lesion at recall (loose criteria). χ2 tests were used to evaluate possible variables associated with retreatment outcomes (age, sex, tooth type, location, contact points, periapical status, quality of previous and final root canal filling, previous and final restoration, number of visits, and complications). RESULTS Overall, 129 teeth (113 patients) were included in the final evaluation. The success rate was 80.6% under strict criteria and 93% under loose criteria. Molars, teeth with an initially higher periapical index (PAI) score, and teeth with > 5 mm periapical radiolucency had a lower success rate according to the strict criteria model (p < 0.05). When the loose success criteria were used, teeth with larger (> 5 mm) periapical lesions and those that had been perforated during retreatment showed a lower success rate (p < 0.05). CONCLUSIONS The present study demonstrated that non-surgical root canal retreatment is a highly successful procedure after an observation period of 2-3 years. Treatment success is primarily affected by the presence of periapical lesions.
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Affiliation(s)
- Juan Gonzalo Olivieri
- Department of Endodontics, Universitat Internacional de Catalunya, Barcelona, Spain.
| | - Nancy Feijoo Pato
- School of Medicine and Dentistry, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Patricia Labraca
- Department of Endodontics, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Jordi Tomàs
- Department of Endodontics, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Queralt Miró
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
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21
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Abbott PV. Indications for root canal treatment following traumatic dental injuries to permanent teeth. Aust Dent J 2023; 68 Suppl 1:S123-S140. [PMID: 37908151 DOI: 10.1111/adj.12989] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/02/2023]
Abstract
The dental pulp may respond favourably or unfavourably to traumatic dental injuries. The most serious unfavourable responses are pulp necrosis and infection of the root canal system. These cause apical periodontitis and/or external inflammatory resorption of the tooth. The following injuries require root canal treatment as part of their emergency management-(A) complicated crown fractures (but some may be suitable for conservative pulp treatments, such as pulp capping, partial pulpotomy or pulpotomy), (B) complicated crown-root fractures, (C) supra-crestal coronal third root fractures and (D) injuries where pulp necrosis is predictable or highly likely to occur AND where there has been damage to the root surface and/or periodontal ligament with the aim of preventing external inflammatory resorption. This latter group of injuries are avulsion, intrusion, lateral luxation with a crown fracture, extrusion with a crown fracture (all in fully developed teeth) plus avulsion with a crown fracture and intrusion with a crown fracture (both in incompletely developed teeth). All other injuries should not have root canal treatment commenced as part of the emergency management, but they must be reviewed regularly to monitor the pulp for any adverse changes to its status, particularly pulp necrosis and infection of the root canal system.
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Affiliation(s)
- P V Abbott
- UWA Dental School, The University of Western Australia, Perth, Western Australia, Australia
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22
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Cruz A, Gascón LG, Palafox-Sánchez CA, Flores-García C, Espinoza-García N, Sagrero-Fabela N, Cintra LTA, Mejía-Flores R, Salazar-Camarena DC. TNFSF13B rs9514828 gene polymorphism and soluble B cell activating factor levels: Association with apical periodontitis. Int Endod J 2023; 56:419-431. [PMID: 36508294 DOI: 10.1111/iej.13879] [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: 04/06/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
AIM The aim of this case-control study was to evaluate the association between the TNFSF13B rs9514828 (-871 C > T) polymorphism and soluble BAFF (sBAFF) in apical periodontitis (AP) patients. METHODOLOGY Two hundred and sixty one healthy subjects (HS) and 158 patients with AP classified as: 46 acute apical abscess (AAA), 81 primary AP (pAP) and 31 secondary AP (sAP) patients were included. Genomic DNA (gDNA) was extracted from peripheral blood cells according to the salting out method. The TNFSF13B rs9514828 (NC_000013.11:g.108269025C > T) were identified using polymerase chain reaction (PCR) followed by restriction fragment length polymorphisms (RFLP). Serum sBAFF levels were measured by ELISA test. The chi-squared or Fisher's exact test was performed. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated to evaluate the risk of AP associated with the rs9514828. The Mann-Whitney U test and Kruskal-Wallis analysis were used for non-normally distributed data. Differences were considered significant with a p-value <.05. RESULTS No differences in the genotype/allele frequencies were shown between HS and patients with AAA. However, the TT genotype (OR = 2.68, 95% CI: 1.10-6.53; p = .025) and T allele (OR = 1.46, 95% CI: 1.00-2.12; p = .045) were associated with increased risk of pAP. In contrast, the minor allele T significantly decreased the risk of sAP (OR = 0.49, 95% CI: 0.024-0.99; p = .043). sBAFF serum levels were increased in AAA and pAP compared with HS (p < .01 and p = .021, respectively). The AAA patients had higher sBAFF serum levels than pAP (p = .034) and sAP (p < .01). CONCLUSIONS These results suggest that the TNFSF13B rs9514828 (-871 C > T) polymorphism is associated with pAP susceptibility and that BAFF is a cytokine that might be involved in acute and chronic AP. The future exploration of the rs9514828 polymorphism in other AP cohorts is recommended.
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Affiliation(s)
- Alvaro Cruz
- Posgrado en Endodoncia, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara (UDG), Guadalajara, Mexico.,Instituto de Investigación en Ciencias Biomédicas (IICB), Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara (UDG), Guadalajara, Mexico.,Laboratorio de Investigación en Biomateriales Odontológicos, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara (UDG), Guadalajara, Mexico
| | - Luis Gerardo Gascón
- Posgrado en Endodoncia, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara (UDG), Guadalajara, Mexico
| | - Claudia Azucena Palafox-Sánchez
- Instituto de Investigación en Ciencias Biomédicas (IICB), Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara (UDG), Guadalajara, Mexico.,Grupo de Inmunología Molecular, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara (UDG), Guadalajara, Mexico
| | - Christian Flores-García
- Laboratorio de Investigación en Biomateriales Odontológicos, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara (UDG), Guadalajara, Mexico
| | - Noemí Espinoza-García
- Instituto de Investigación en Ciencias Biomédicas (IICB), Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara (UDG), Guadalajara, Mexico
| | - Nefertari Sagrero-Fabela
- Instituto de Investigación en Ciencias Biomédicas (IICB), Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara (UDG), Guadalajara, Mexico
| | - Luciano Tavares Angelo Cintra
- Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), Araçatuba, Brazil.,School of Dentistry, Dental Assistance Center for Disabled Persons (CAOE) of the São Paulo State University (UNESP), Araçatuba, Brazil
| | - Rocío Mejía-Flores
- Posgrado en Endodoncia, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara (UDG), Guadalajara, Mexico
| | - Diana Celeste Salazar-Camarena
- Posgrado en Endodoncia, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara (UDG), Guadalajara, Mexico.,Laboratorio de Investigación en Biomateriales Odontológicos, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara (UDG), Guadalajara, Mexico.,Grupo de Inmunología Molecular, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara (UDG), Guadalajara, Mexico
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23
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Chan WS, Gulati K, Peters OA. Advancing Nitinol: From heat treatment to surface functionalization for nickel–titanium (NiTi) instruments in endodontics. Bioact Mater 2023; 22:91-111. [PMID: 36203965 PMCID: PMC9520078 DOI: 10.1016/j.bioactmat.2022.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/04/2022] [Accepted: 09/09/2022] [Indexed: 11/27/2022] Open
Abstract
Nickel-titanium (NiTi) alloy has been extensively researched in endodontics, particularly in cleaning and shaping the root canal system. Research advances have primarily focused on the design, shape, and geometry of the NiTi files as well as metallurgy and mechanical properties. So far, extensive investigations have been made surrounding surface and thermomechanical treatments, however, limited work has been done in the realm of surface functionalization to augment its performance in endodontics. This review summarizes the unique characteristics, current use, and latest developments in thermomechanically treated NiTi endodontic files. It discusses recent improvements in nano-engineering and the possibility of customizing the NiTi file surface for added functionalization. Whilst clinical translation of this technology has yet to be fully realized, future research direction will lie in the use of nanotechnology. Nitinol (Nickel Titanium alloy) is widely used to clean/shape root canal system in endodontics. To enhance its performance, various thermo-mechanical and nano-engineering modifications have been performed. This comprehensive review summarizes the latest advances and future trends relating to functionalized NiTi endodontic files.
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24
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Segura-Egea JJ, Cabanillas-Balsera D, Martín-González J, Cintra LTA. Impact of systemic health on treatment outcomes in endodontics. Int Endod J 2023; 56 Suppl 2:219-235. [PMID: 35752972 DOI: 10.1111/iej.13789] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The healing of periapical lesions after root canal treatment (RCT) is not the result of the curative action of the treatment. The process of healing begins with inflammation, and is resolved by the clearance of the immunogen that induces the immune response. Then, the periapical tissue itself carries out the healing of the periapical lesion, by repair or by a combination of repair and regeneration, depending on the host's reparative response working properly. The ultimate objective of RCT is to achieve wound healing by removing the source of bacterial antigens and toxins, allowing chronic inflammatory tissue to become reparative tissue. Some systemic conditions increase the susceptibility of the host to infection or impair the tissue reparative response, maintaining the inflammatory process and periapical bone resorption after RCT. This can cause the failure of RCT and even the need for extraction of the affected tooth. OBJECTIVE To analyse the scientific literature on the possible influence of systemic conditions on the treatment outcomes in endodontics, as well as to discuss the biological mechanisms that may be involved. METHODS The search was carried out in PubMed, SCOPUS and EMBASE. The inclusion criteria established were original scientific articles reporting data about some systemic condition in relation to treatment outcomes in endodontics, including clinical studies and studies carried out in animal models. RESULTS Systemic factors (age, nutrition, stress, hormones, smoking habits), and systemic diseases, such as diabetes, cardiovascular diseases, osteoporosis, HIV infection, inflammatory bowel disease, and others, can influence or interfere in the repair of periapical tissues after RCT. DISCUSSION Some of these systemic diseases can alter bone turnover and fibroblast function, preventing or delaying periapical wound healing. Others can alter the microvasculature, reducing nutrients and oxygen supply to periapical tissues. As a result, these systemic conditions can decrease the success rate of RCT and provoke incomplete wound healing (typically granulomatous tissue formation) in the periapical region. CONCLUSIONS The results of this narrative review show worse success rate of RCT, with higher percentage of postoperative radiolucent periapical lesions and higher proportion of non-retained teeth (RFT), associated with several systemic conditions, such as smoking habits and diabetes.
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Affiliation(s)
- Juan J Segura-Egea
- Endodontic Section, Department of Stomatology, School of Dentistry, University of Sevilla, Sevilla, Spain
| | - Daniel Cabanillas-Balsera
- Endodontic Section, Department of Stomatology, School of Dentistry, University of Sevilla, Sevilla, Spain
| | - Jenifer Martín-González
- Endodontic Section, Department of Stomatology, School of Dentistry, University of Sevilla, Sevilla, Spain
| | - Luciano T A Cintra
- Endodontic Section, Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (Unesp), São Paulo, Brazil
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25
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Plasma Rich in Growth Factors in the Treatment of Endodontic Periapical Lesions in Adult Patients: 3-Dimensional Analysis Using Cone-Beam Computed Tomography on the Outcomes of Non-Surgical Endodontic Treatment Using A-PRF+ and Calcium Hydroxide: A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11206092. [PMID: 36294413 PMCID: PMC9605098 DOI: 10.3390/jcm11206092] [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: 09/07/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 01/24/2023] Open
Abstract
The study presents results of periapical lesion healing after one-visit root canal treatment (RCT) with Advanced Platelet Rich Fibrin plus (A-PRF+) application compared to a two-visit RCT with an inter-appointment calcium hydroxide filling. The comparison was made based on CBCT-Periapical Index (PAI) lesion volume changes and the occurrence of post endodontic pain. The results of 3D radiographic healing assessments based on volume reduction criteria were different from the CBCT-PAI. Based on volume changes, the healing assessment criteria-9 cases from the Study Group and six cases in the Control Group were defined as healed. Based on the CBCT-PAI healing assessment criteria, 8 cases from the Study Group and 9 cases from the Control Group were categorized as healed. The volumes of apical radiolucency were, on average, reduced by 85.93% in the Study Group and by 72.31% in the Control Group. Post-endodontic pain occurred more frequently in the Control than in the Study Group. The highest score of pain in the Study Group was five (moderate pain, n = 1), while in the Control Group, the highest score was eight (severe pain, n = 2). In the 6-month follow-up, CBCT scans showed a better healing tendency for patients in the Study Group.
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26
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Cotti E, Schirru E. Present status and future directions: Imaging techniques for the detection of periapical lesions. Int Endod J 2022; 55 Suppl 4:1085-1099. [PMID: 36059089 DOI: 10.1111/iej.13828] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/29/2022]
Abstract
Diagnosing and treating apical periodontitis (AP) in an attempt to preserve the natural dentition, and to prevent the direct and indirect systemic effects of this condition, is the major goal in endodontics. Considering that AP is frequently asymptomatic, and is most often associated with a lesion in the periapex of the affected tooth, within the maxillary bones, imaging becomes of paramount importance for the diagnosis of the disease. The aim of this narrative review was to investigate the most relevant classic and current literature to describe which are, to date, the diagnostic imaging systems most reliable and advanced to achieve the early and predictable detection of AP, the best measures of the lesions and the disclosure of the different features of the disease. Dental panoramic tomography (DPT) is a classic exam, considered still useful to provide the basic diagnosis of AP in certain districts of the maxillary bones. Periapical radiographs (PRs) represent a valid routine examination, with few, known limitations. Cone-beam computed tomography (CBCT) is the only system that ensures the early and predictable detection of all periapical lesions in the jaws, with the minor risk of false positives. These techniques can be successfully implemented, with ultrasounds (USI) or magnetic resonance (MRI) imaging, exams that do not use ionising radiations. MRI and USI provide information on specific features of the lesions, like the presence and amount of vascular supply, their content and their relationship with the surrounding soft tissues, leading to differential diagnoses. Further, all the three-dimensional systems (CBCT, USI and MRI) allow the volumetric assessment of AP. Pioneering research on artificial intelligence is slowly progressing in the detection of periapical radiolucencies on DPTs, PRs and CBCTs, however, with promising results. Finally, it is established that all imaging techniques have to be associated with a thorough clinical examination and a good degree of calibration of the operator.
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Affiliation(s)
- Elisabetta Cotti
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
| | - Elia Schirru
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
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27
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Ferreira ML, Buligon MP, Sfreddo CS, Liedke GS, Morgental RD. Factors related to apical periodontitis in a southern Brazilian population: a multilevel analysis. Braz Oral Res 2022; 36:e112. [PMID: 35946740 DOI: 10.1590/1807-3107bor-2022.vol36.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 09/11/2021] [Indexed: 11/22/2022] Open
Abstract
The aim of this cross-sectional study was to evaluate the effects of individual-level and tooth-level factors on apical periodontitis (AP) in an urban population in southern Brazil. A random sample of digital panoramic radiographs (n = 545) from a dental school database was evaluated. The diagnosis of AP was determined by using a dichotomous scale (yes/no). AP was assessed according to gender, age, presence and quality of endodontic treatment (ET), presence of an intracanal post, coronal condition, and dental group. Data were analyzed descriptively and through multilevel Poisson regression analysis, considering teeth characteristics (level 1) nested in individuals (level 2). In this sample of 545 participants, the prevalence of AP was 49.5% (n =2 70) and ET was 43.5% (n = 237). Considering 13,595 teeth, AP was identified in 596 (4.4%) and ET in 617 (4.5%). Of the teeth with ET, 153 (24.8%) presented AP. Among individual-level factors, the disease was not significantly associated with gender or age. For tooth-level factors, AP was significantly associated with ET quality: teeth with short fillings (< 3 mm) and teeth with over-fillings had 2.77 (CI: 1.95-3.94, p < 0.001) and 1.08 (CI: 0.39-2.98, p < 0.001) higher prevalence of AP, respectively. There was no association between AP and age, gender, dental group, coronal condition, or the presence of an intracanal post. AP was highly prevalent in this population, and multilevel analysis indicated a significant association with ET quality.
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Affiliation(s)
- Monika Lamas Ferreira
- Universidade Federal de Pelotas - UFPel, Graduate Program in Dentistry , Pelotas , RS , Brazil
| | - Mônica Pagliarini Buligon
- Universidade Federal de Santa Maria - UFSM, Graduate Program in Dental Sciences , Santa Maria , RS , Brazil
| | - Camila Silveira Sfreddo
- Universidade Federal de Pelotas - UFPel, School of Dentistry , Department of Semiology and Clinics , Pelotas , RS , Brazil
| | - Gabriela Salatino Liedke
- Universidade Federal de Santa Maria - UFSM, School of Dentistry , Department of Stomatology , Santa Maria , RS , Brazil
| | - Renata Dornelles Morgental
- Universidade Federal de Santa Maria - UFSM, School of Dentistry , Department of Stomatology , Santa Maria , RS , Brazil
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28
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Abbott PV, Lin S. Tooth resorption-Part 2: A clinical classification. Dent Traumatol 2022; 38:267-285. [PMID: 35605161 PMCID: PMC9543863 DOI: 10.1111/edt.12762] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/25/2022] [Accepted: 04/25/2022] [Indexed: 11/28/2022]
Abstract
Tooth resorption is either a physiological or a pathological process resulting in loss of dentin and/or cementum. It may also be associated with bone loss. Currently there is no universal classification for the different types of tooth resorption. This lack of a universal classification leads to both confusion amongst practitioners and poor understanding of the resorptive processes occurring in teeth which can result in incorrect/inappropriate diagnoses and mis‐management. When developing a classification of diseases and/or conditions that occur within the body, several criteria should be followed to ensure a useful classification. The classification should not only include pathological conditions but also physiological conditions. Since tooth resorption can be either pathological or physiological, a classification of tooth resorption should include both of these categories. Any classification of diseases should be possible to use clinically, meaningful, useful, clear and universal. It should enable easy storage, retrieval and analysis of health information for evidenced‐based decision‐making. It should also be possible to share and compare data and information between different institutions, settings and countries. A classification of tooth resorption should be developed by combining anatomical, physiological and pathological approaches. For some types of resorption, the aetiological approach should also be incorporated. A classification of tooth resorption that uses simple, relevant and appropriate terminology based on the nature and location of the resorptive process occurring in teeth is proposed. There are two broad categories of internal and external tooth resorption which are sub‐divided into three types of internal tooth resorption (surface, inflammatory, replacement) and eight types of external tooth resorption (surface, inflammatory, replacement, invasive, pressure, orthodontic, physiological, idiopathic). The clinician's understanding, diagnosis and management of tooth resorption can be facilitated by using this simple classification which should ideally be used universally by the entire dental profession to ensure clarity and to avoid confusion.
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Affiliation(s)
- Paul V Abbott
- UWA Dental School, The University of Western Australia, Crawley, Western Australia, Australia
| | - Shaul Lin
- Department of Endodontic and Dental Trauma, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,The Israeli National Center for Trauma & Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Canter, Tel Hashomer, Israel
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29
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Lin S, Moreinos D, Kaufman AY, Abbott PV. Tooth Resorption - Part 1: The evolvement, rationales and controversies of tooth resorption. Dent Traumatol 2022; 38:253-266. [PMID: 35559593 PMCID: PMC9546147 DOI: 10.1111/edt.12757] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 12/27/2022]
Abstract
In 1966, Andreasen and Hjørting‐Hansen were the first to describe a relationship between tooth resorption and dental trauma. However, Andreasen's original classification did not include other resorptive processes which have since been identified. Numerous articles have been published suggesting new terminology and definitions for tooth resorption. A uniform language with universally accepted terminology is crucial to eliminate the multiplicity of terms and definitions which only cause confusion within the profession. An electronic literature search was carried out in the PubMed database using the following keywords for articles published in English: “root resorption,” “inflammatory root resorption,” “replacement resorption,” “cervical resorption,” “trauma,” “ankylosis,” “surface resorption,” and “internal resorption.” The search also included textbooks and glossaries that may not have surfaced in the online search. This was done to identify articles related to tooth resorption and its etiology in dentistry. The aim of this review was to present the history that has led to the variety of terms and definitions for resorption. This review emphasizes the need for a clearer, simpler, and more comprehensive nomenclature for the various types of tooth resorption which are presented in Part 2 of this series.
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Affiliation(s)
- Shaul Lin
- Department of Endodontic and Dental Trauma, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,The Gertner Institute Emergency Management and Disaster Medicine, Sheba Medical Center, Tel Hashomer, Israel
| | - Daniel Moreinos
- Endodontics Department, Galilee Medical Center, Nahariya, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Arieh Y Kaufman
- Department of Endodontic and Dental Trauma, Rambam Health Care Campus, Haifa, Israel
| | - Paul V Abbott
- UWA Dental School, The University of Western Australia, Perth, Western Australia, Australia
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30
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Gund MP, Wrbas KT, Hannig M, Rupf S. Apical periodontitis after intense bruxism. BMC Oral Health 2022; 22:91. [PMID: 35331220 PMCID: PMC8951715 DOI: 10.1186/s12903-022-02123-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/16/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Bruxism is known to cause masticatory muscle pain, temporomandibular joint pain, headaches, mechanical tooth wear, prosthodontic complications and cracked teeth. Less known to the practitioner, and described only experimentally in literature, is that bruxism can also damage the pulp. To our knowledge, this is the first known clinical case of a patient developing apical periodontitis due to bruxism. CASE PRESENTATION This article presents the case and successful treatment of a 28-year-old healthy male patient with apical periodontitis on teeth 36 and 46 requiring root canal treatment after an intense phase of bruxism. Due to an unclear diagnosis, treatment had been delayed. CONCLUSIONS Incomprehensible tooth pain can be the result of bruxism. Practitioners need to be informed that intense bruxism can possibly lead to apical periodontitis. It is important, therefore, that a thorough anamnesis is collected and taken into account during diagnostics.
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Affiliation(s)
- Madline P Gund
- Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University Hospital, Saarland University, Kirrberger Str. 100, Building 73, 66421, Homburg, Saar, Germany.
| | - Karl-Thomas Wrbas
- Department of Operative Dentistry and Periodontology, Centre for Dental Medicine, Oral and Maxillofacial Surgery, Medical Centre, University of Freiburg, Freiburg i.Br., Germany.,Division of Endodontics, Department of Dentistry, Faculty of Medicine and Dentistry, Danube Private University, 3500, Krems, Austria
| | - Matthias Hannig
- Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University Hospital, Saarland University, Kirrberger Str. 100, Building 73, 66421, Homburg, Saar, Germany
| | - Stefan Rupf
- Chair of Synoptic Dentistry, Saarland University, Kirrbergerstr. 100, Building 73, 66421, Homburg, Germany
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31
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Li S, Liu J, Zhou Z, Zhou Z, Wu X, Li Y, Wang S, Liao W, Ying S, Zhao Z. Artificial intelligence for caries and periapical periodontitis detection. J Dent 2022; 122:104107. [PMID: 35341892 DOI: 10.1016/j.jdent.2022.104107] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Periapical periodontitis and caries are common chronic oral diseases affecting most teenagers and adults worldwide. The purpose of this study was to develop an evaluation tool to automatically detect dental caries and periapical periodontitis on periapical radiographs using deep learning. METHODS A modified deep learning model was developed using a large dataset (4,129 images) with high-quality annotations to support the automatic detection of both dental caries and periapical periodontitis. The performance of the model was compared to the classification performance of dentists. RESULTS The deep learning model automatically distinguished dental caries with an F1-score of 0.829 and periapical periodontitis with an F1-score of 0.828. The comparison of model-only and expert-only detection performance showed that the accuracy of the fully automatic method was significantly higher than that of the junior dentists. With deep learning assistance, the experts not only reached a higher diagnostic accuracy with an average F1-score of 0.7844 for dental caries and 0.8208 for periapical periodontitis compared to expert-only scenarios but also increased interobserver agreement from 0.585/0.590 to 0.726/0.713 for dental caries and from 0.623/0.563 to 0.752/0.740 for periapical periodontitis. CONCLUSIONS Based on the experimental results, deep learning can improve the accuracy and consistency of evaluating dental caries and periapical periodontitis on periapical radiographs. CLINICAL SIGNIFICANCE Deep learning models can improve accuracy and consistency and reduce the workload of dentists, making AI a powerful tool for clinical practice.
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Affiliation(s)
- Shihao Li
- National Key Laboratory of Fundamental Science on Synthetic Vision, College of Computer Science, Sichuan University, No. 24 South Section 1, Yihuan Road, Chengdu Sichuan, China, 610065.
| | - Jialing Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Diseases, West China Hospital of Stomatology, Sichuan University, No. 17 People's South Road, 610041, Chengdu, Sichuan, China.
| | - Zirui Zhou
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Diseases, West China Hospital of Stomatology, Sichuan University, No. 17 People's South Road, 610041, Chengdu, Sichuan, China.
| | - Zilin Zhou
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Diseases, West China Hospital of Stomatology, Sichuan University, No. 17 People's South Road, 610041, Chengdu, Sichuan, China.
| | - Xiaoyue Wu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Diseases, West China Hospital of Stomatology, Sichuan University, No. 17 People's South Road, 610041, Chengdu, Sichuan, China.
| | - Yazhen Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Diseases, West China Hospital of Stomatology, Sichuan University, No. 17 People's South Road, 610041, Chengdu, Sichuan, China.
| | - Shida Wang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Diseases, West China Hospital of Stomatology, Sichuan University, No. 17 People's South Road, 610041, Chengdu, Sichuan, China.
| | - Wen Liao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Diseases, West China Hospital of Stomatology, Sichuan University, No. 17 People's South Road, 610041, Chengdu, Sichuan, China.
| | - Sancong Ying
- College of Computer Science, Sichuan University, Chengdu, Sichuan 610041, China.
| | - Zhihe Zhao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Diseases, West China Hospital of Stomatology, Sichuan University, No. 17 People's South Road, 610041, Chengdu, Sichuan, China.
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Abbott PV. Present status and future directions - managing endodontic emergencies. Int Endod J 2021; 55 Suppl 3:778-803. [PMID: 34958512 DOI: 10.1111/iej.13678] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/20/2021] [Accepted: 12/26/2021] [Indexed: 11/28/2022]
Abstract
Endodontic emergencies are common in both general dental practices and specialist Endodontic practices. The aim of this review is to provide an overview of endodontic emergencies. Endodontic emergencies can be a result of many different conditions of the pulp, root canal and periradicular tissues. They may occur before endodontic treatment has been started, between appointments when treatment is being performed over multiple visits, or after endodontic treatment has been completed. In the latter situation, the emergency may be very soon after the treatment or it may occur many years later, in which case it is usually a new disease process as a result of the root canal system becoming infected. An emergency can be a stressful situation for both the patient and the dentist (or endodontist) as it is usually an unexpected event. It is incumbent on dental professionals to provide timely assistance to patients who have an emergency, and it is also important to allow sufficient time to manage the situation comprehensively. Management of endodontic emergencies should follow the principles of the 3D's - Diagnosis, Definitive dental treatment and Drugs - and in that sequence. An accurate diagnosis, the first "D", is essential so the appropriate treatment can be provided. Diagnosis requires a thorough understanding of the various conditions that can cause the emergency and this can be helped by having a comprehensive classification of the various conditions. The diagnosis should also direct the clinician to the appropriate definitive dental treatment, the second "D". Root canal treatment will not always be required as some cases can be managed conservatively. Other cases may require root canal re-treatment. The specific details of how the treatment is done can also vary, according to the diagnosis. The final "D" is Drugs - the use of drugs should also be dependent on the diagnosis and the dental treatment. Drugs should only be an adjunct following the treatment. The clinician must also differentiate between inflammation and infection in order to provide the appropriate treatment and to prescribe the appropriate medication for effective pain relief and resolution of other symptoms or signs such as swelling.
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Affiliation(s)
- Paul V Abbott
- UWA Dental School, The University of Western Australia, Western Australia, Australia
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Weitz D, Ordinola-Zapata R, McClanahan SB, Shyne M, Law AS, Nixdorf DR. Preoperative Factors Associated with Anesthesia Failure for Patients Undergoing Nonsurgical Root Canal Therapy: A National Dental Practice-Based Research Network Study. J Endod 2021; 47:1875-1882. [PMID: 34560117 DOI: 10.1016/j.joen.2021.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The aim of this study was to identify preoperative factors associated with local anesthesia failure. METHODS The National Dental Practice-Based Research Network (www.NationalDentalPBRN.org) data from 534 patients who received a nonsurgical root canal treatment completed in a single appointment were included in this analysis. Three methods for defining anesthesia failure were used: definition 1, patient-reported level of numbness; definition 2, provider-reported quality of anesthesia; and definition 3, provider-reported use of supplemental anesthesia. Fifty-one preoperative factors were investigated and analyzed individually against the overall failure rate for each method, and multivariate generalized estimating equation logistic models were fit with predictors chosen using stepwise model selection to evaluate factors that may interact with each other. RESULTS The overall anesthesia failure rates were 5%, 15%, and 30% for definitions 1, 2, and 3, respectively. Provider experience, diabetes, absence of sharp or aching pain, absence of smoking, and a fair expected outcome were associated with anesthesia failure (definition 1). Provider level of training, absence of a sinus tract, bite sensitivity, and stress making the pain worse were associated with anesthesia failure (definition 2). Provider level of training, pain provoked by stimulus, mandibular teeth, teeth with vital pulps, and pain interfering with daily activities were associated with the use of supplemental anesthesia (definition 3). CONCLUSIONS With the range of 5%-30% of anesthesia failures, a few common factors across the models assessed were elucidated. Providers with higher levels of training had significantly fewer anesthesia failures. Patient self-reported history of diabetes and preoperative pain-related interference with daily activities were associated with more anesthesia failures. Greater severity of various tooth-related pain characteristics, as a group but not individually, accounted for more anesthesia failures.
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Affiliation(s)
- Dustin Weitz
- Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, Minnesota
| | - Ronald Ordinola-Zapata
- Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, Minnesota.
| | - Scott B McClanahan
- Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, Minnesota
| | - Michael Shyne
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota
| | - Alan S Law
- Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, Minnesota; Private Practice, The Dental Specialists, Lake Elmo, Minnesota
| | - Donald R Nixdorf
- Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, Minnesota
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- School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama
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Altaie AM, Venkatachalam T, Samaranayake LP, Soliman SSM, Hamoudi R. Comparative Metabolomics Reveals the Microenvironment of Common T-Helper Cells and Differential Immune Cells Linked to Unique Periapical Lesions. Front Immunol 2021; 12:707267. [PMID: 34539639 PMCID: PMC8446658 DOI: 10.3389/fimmu.2021.707267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 08/12/2021] [Indexed: 12/12/2022] Open
Abstract
Periapical abscesses, radicular cysts, and periapical granulomas are the most frequently identified pathological lesions in the alveolar bone. While little is known about the initiation and progression of these conditions, the metabolic environment and the related immunological behaviors were examined for the first time to model the development of each pathological condition. Metabolites were extracted from each lesion and profiled using gas chromatography-mass spectrometry in comparison with healthy pulp tissue. The metabolites were clustered and linked to their related immune cell fractions. Clusters I and J in the periapical abscess upregulated the expression of MMP-9, IL-8, CYP4F3, and VEGF, while clusters L and M were related to lipophagy and apoptosis in radicular cyst, and cluster P in periapical granuloma, which contains L-(+)-lactic acid and ethylene glycol, was related to granuloma formation. Oleic acid, 17-octadecynoic acid, 1-nonadecene, and L-(+)-lactic acid were significantly the highest unique metabolites in healthy pulp tissue, periapical abscess, radicular cyst, and periapical granuloma, respectively. The correlated enriched metabolic pathways were identified, and the related active genes were predicted. Glutamatergic synapse (16–20),-hydroxyeicosatetraenoic acids, lipophagy, and retinoid X receptor coupled with vitamin D receptor were the most significantly enriched pathways in healthy control, abscess, cyst, and granuloma, respectively. Compared with the healthy control, significant upregulation in the gene expression of CYP4F3, VEGF, IL-8, TLR2 (P < 0.0001), and MMP-9 (P < 0.001) was found in the abscesses. While IL-12A was significantly upregulated in cysts (P < 0.01), IL-17A represents the highest significantly upregulated gene in granulomas (P < 0.0001). From the predicted active genes, CIBERSORT suggested the presence of natural killer cells, dendritic cells, pro-inflammatory M1 macrophages, and anti-inflammatory M2 macrophages in different proportions. In addition, the single nucleotide polymorphisms related to IL-10, IL-12A, and IL-17D genes were shown to be associated with periapical lesions and other oral lesions. Collectively, the unique metabolism and related immune response shape up an environment that initiates and maintains the existence and progression of these oral lesions, suggesting an important role in diagnosis and effective targeted therapy.
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Affiliation(s)
- Alaa Muayad Altaie
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Thenmozhi Venkatachalam
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Lakshman P Samaranayake
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Department of Oral Biosciences, Faculty of Dentistry, University of Hong Kong, Hong Kong, Hong Kong, SAR China
| | - Sameh S M Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Rifat Hamoudi
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Division of Surgery and Interventional Science, University College London, London, United Kingdom
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Yong D, Cathro P. Conservative pulp therapy in the management of reversible and irreversible pulpitis. Aust Dent J 2021; 66 Suppl 1:S4-S14. [PMID: 33818812 DOI: 10.1111/adj.12841] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/05/2021] [Accepted: 03/30/2021] [Indexed: 11/26/2022]
Abstract
Conservative pulp therapy is an alternative treatment option to tooth removal and root canal treatment in the management of deep caries, traumatic pulp exposures and developmental anomalies. Pulp tissue preservation can extend the long-term survival of teeth through relatively simple restorative procedures. This article aims to update clinicians on the current state of research in materials, techniques and outcomes of vital pulp therapies and provide practical guidelines for their implementation into daily practice.
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Affiliation(s)
- D Yong
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago Dental School, Dunedin, New Zealand
| | - P Cathro
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago Dental School, Dunedin, New Zealand
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36
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Kazemipoor M, Valizadeh F, Jambarsang S. Three-dimensional pattern of inflammatory periapical lesion extension in the premolar's region: an application of K-means clustering. Curr Med Imaging 2021; 17:1151-1158. [PMID: 33632108 DOI: 10.2174/1573405617666210225090213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/01/2021] [Accepted: 01/06/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cone-beam computed tomography (CBCT) provides better diagnosis of endodontic lesions. INTRODUCTION The present study would assess the pattern of periapical lesion extension in premolar teeth using CBCT. METHOD In this descriptive study' 330 roots in the regions of maxillary and mandibular premolars have been evaluated. Maximum periapical lesion extensions in the three orthogonal planes (axial, coronal and sagittal) were measured and recorded in millimeters. Measurements were compared based on gender' dental arch, tooth type and root. Statistical analysis was performed using repeated measure ANOVA, Bonferroni, Chi-square tests and clustering data analysis (K-means method). The significant level was set at 0.05. RESULT There were significant differences between the lesion expansions in the three dimensional planes (p-value<0.001). The highest average of lesion extension in the premolar regions of the examined population was reported in the vertical dimension (4.1± 1.3), followed by horizontal buccolingual dimension (3.4±1.1) and horizontal mesiodistal dimension (3.1±1.0) respectively. According to independent variables, in the premolar region only tooth roots showed significant differences in the lesion extension (p-value=0.002). Clustering data analysis showed that the majority of the participants categorized in a cluster with lower lesion extension. Based on clustering data analysis, the small lesions were significantly observed in the first premolar and buccal roots. CONCLUSION Since the periapical lesion extension in the buccolingual dimension, which could not be detected in the 2-D imaging techniques, was rather high in the region of premolar teeth, CBCT -as a 3-D imaging technique- is a suitable option for the precise evaluation of periapical lesion extension. Also, the majority of the lesions in this tooth area are small and located in the buccal roots.
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Affiliation(s)
- Maryam Kazemipoor
- Department of Endodontics, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd. Iran
| | - Fatemeh Valizadeh
- Department of Endodontics, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd. Iran
| | - Sara Jambarsang
- Department of Biostatistics and Epidemiology, School of Public health, Shahid Sadoughi University of Medical Sciences, Yazd. Iran
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Kumar G, Tewari S, Tagg J, Chikindas ML, Popov IV, Tiwari SK. Can Probiotics Emerge as Effective Therapeutic Agents in Apical Periodontitis? A Review. Probiotics Antimicrob Proteins 2021; 13:299-314. [PMID: 33580864 DOI: 10.1007/s12602-021-09750-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2021] [Indexed: 01/09/2023]
Abstract
Apical periodontitis (AP) is a biofilm-associated disease initiated by the invasion of dental pulp by microorganisms from the oral cavity. Eradication of intracanal microbial infection is an important goal of endodontic treatment, and this is typically accomplished by mechanical instrumentation and application of sodium hypochlorite and chlorhexidine. However, these agents are tissue-irritating at higher concentrations and cytotoxic. Certain probiotics have been found effective in controlling marginal periodontitis, as evidenced by reduction of pathogenic bacterial loads, gains in clinical attachment levels, and reduced bleeding on probing. In vitro studies have shown inhibitory activity of some probiotics against endodontic pathogens. Similarly, in vivo studies in rats have demonstrated a positive immuno-modulatory role of probiotics in AP, as manifested by decreased levels of proinflammatory markers and increased levels of anti-inflammatory markers. A role for probiotics in effecting a reduction of bone resorption has also been reported. This review provides an outline of current research into the probiotic management of AP, with a focus on understanding the mechanisms of their direct antagonistic activity against target pathogens and of their beneficial modulation of the immune system.
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Affiliation(s)
- Gaurav Kumar
- Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences, Rohtak, India
| | - Sanjay Tewari
- Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences, Rohtak, India
| | - John Tagg
- BLIS Technologies Ltd, Dunedin, New Zealand
| | - Michael Leonidas Chikindas
- Health Promoting Naturals Laboratory, School of Environmental and Biological Sciences, Rutgers State University, 65 Dudley Road, New Brunswick, NJ, 08901, USA.,Center for Agrobiotechnology, Don State Technical University, Gagarin Square 1, Rostov-on-Don, 344002, Russia.,I.M. Sechenov First Moscow State Medical University, Bol'shaya Pirogovskaya Str., 19c1, Moscow, 119146, Russia
| | - Igor V Popov
- Center for Agrobiotechnology, Don State Technical University, Gagarin Square 1, Rostov-on-Don, 344002, Russia
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Tibúrcio-Machado CS, Michelon C, Zanatta FB, Gomes MS, Marin JA, Bier CA. The global prevalence of apical periodontitis: a systematic review and meta-analysis. Int Endod J 2021; 54:712-735. [PMID: 33378579 DOI: 10.1111/iej.13467] [Citation(s) in RCA: 180] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 12/24/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Apical periodontitis (AP) frequently presents as a chronic asymptomatic disease. To arrive at a true diagnosis, in addition to the clinical examination, it is mandatory to undertake radiographic examinations such as periapical or panoramic radiographs, or cone-beam computed tomography (CBCT). Thus, the worldwide burden of AP is probably underestimated or unknown. Previous systematic reviews attempted to estimate the prevalence of AP, but none have investigated which factors may influence its prevalence worldwide. OBJECTIVES To assess: (i) the prevalence of AP in the population worldwide, as well as the frequency of AP in all teeth, nontreated teeth and root filled teeth; (ii) which factors can modify the prevalence of AP. METHODS A search was conducted in the PubMed-MEDLINE, EMBASE, Cochrane-CENTRAL, LILACS, Google scholar and OpenGrey databases, followed by hand searches, until September 2019. Cross-sectional, case-control and cohort studies reporting the prevalence of AP in humans, using panoramic or periapical radiograph or CBCT as image methods were included. No language restriction was applied. An adaptation of the Newcastle-Ottawa Scale was used to evaluate the quality of the studies. A meta-analysis was performed to determine the pooled prevalence of AP at the individual level. Secondary outcomes were the frequency of AP in all teeth, nontreated teeth and rootfilled teeth. Subgroup analyses using random-effect models were carried out to analyse the influence of explanatory covariables on the outcome. RESULTS The search strategy identified 6670 articles, and 114 studies were included in the meta-analysis, providing data from 34 668 individuals and 639 357 teeth. The prevalence of AP was 52% at the individual level (95% CI 42%-56%, I2 = 97.8%) and 5% at the tooth level (95% CI 4%-6%; I2 = 99.5%). The frequency of AP in root-filled teeth and nontreated teeth was 39% (95% CI 36%-43%; I2 = 98.5%) and 3% (95% CI 2%-3%; I2 = 99.3%), respectively. The prevalence of AP was greater in samples from dental care services (DCS; 57%; 95% CI 52%-62%; I2 = 97.8%) and hospitals (51%; 95% CI 40%-63%; I2 = 95.9%) than in those from the general population (GP; 40%; 95% CI 33%-46%; I2 = 96.5%); it was also greater in people with a systemic condition (63%; 95% CI 56%-69%, I2 = 89.7%) compared to healthy individuals (48%; 95% CI 43%-53%; I2 = 98.3%). DISCUSSION The subgroup analyses identified explanatory factors related to the variability in the prevalence of AP. However, the high clinical heterogeneity and high risk of bias across the primary studies indicate that the findings must be interpreted with caution. CONCLUSIONS Half of the adult population worldwide have at least one tooth with apical periodontitis. The prevalence of AP is greater in samples from the dental care services, but it is also high amongst community representative samples from the general population. The present findings should bring the attention of health policymakers, medical and dental communities to the hidden burden of endodontic disease in the population worldwide.
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Affiliation(s)
- C S Tibúrcio-Machado
- Graduate Program in Dental Science, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - C Michelon
- Medical and Dental Center of the Brazilian Army, Santa Maria, Brazil
| | - F B Zanatta
- Graduate Program in Dental Science, Federal University of Santa Maria (UFSM), Santa Maria, Brazil.,Department of Stomatology, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - M S Gomes
- Graduate Program in Dentistry, School of Health and Life Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.,Medical and Dental Center of the Military Police, Porto Alegre, Brazil
| | - J A Marin
- Universidade Franciscana (UFN), Santa Maria, Brazil
| | - C A Bier
- Graduate Program in Dental Science, Federal University of Santa Maria (UFSM), Santa Maria, Brazil.,Department of Stomatology, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
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Ioannidis K, Batty C, Turner C, Smith D, Mannocci F, Deb S. A laboratory study to assess the formation of effluent volatile compounds and disinfection by-products during chemomechanical preparation of infected root canals and application of activated carbon for their removal. Int Endod J 2020; 54:601-615. [PMID: 33237607 DOI: 10.1111/iej.13454] [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: 07/08/2020] [Accepted: 11/20/2020] [Indexed: 12/01/2022]
Abstract
AIM To assess in a laboratory setting using extracted teeth the formation of volatile compounds (VOCs) and disinfection by-products (DBPs) in effluent aliquots, during chemomechanical preparation of artificially infected root canal specimens, and determine the role of silver-impregnated activated carbon (Ag-AC) in their removal. METHODOLOGY Single-rooted human teeth were decoronated to obtain 15 mm-long root specimens and a nutrient-stressed multispecies biofilm was grown in the root canals. Specimens were randomly assigned into three groups [Group 1; instrumentation with rotary files and irrigation with sterile saline, Groups 2 and 3; instrumentation with rotary files and irrigation with 2.5% NaOCl and 17% EDTA]. A portable medical suction device was used to collect the effluent aliquots during root canal irrigation. In Groups 1 and 2, the reaction products of the collected effluents were analysed by selected ion flow tube mass spectrometry (SIFT-MS). The effluents from Group 3 were treated with Ag-AC prior to SIFT-MS analysis, to assess the removal capacity of Ag-AC against the reaction products. The synthesis of Ag-AC was characterized with scanning electron microscopy/energy-dispersive X-ray spectroscopy (SEM/EDS). Two-way analysis of variance (anova) with post hoc Tukey tests was used for data analysis and determination of a significant difference (P < 0.05). RESULTS In Group 1, effluent VOCs and DBPs were detectable at very low levels. In Group 2, the collected effluent aliquots released high concentrations of methanol, propanol, ammonia, chloroform and formaldehyde, which were significantly greater compared to Group 1 (P < 0.001). SEM/EDS analysis confirmed impregnation of Ag within the AC matrix. The treatment of effluent aliquots with Ag-AC (Group 3) resulted in a significant reduction in concentrations of acetone, acetic acid, propanol, acetaldehyde, acetonitrile and chloroform, compared to Group 2 (P < 0.001). The concentration levels of ethanol, methanol, ammonia and formaldehyde remained unaffected (P > 0.05). CONCLUSIONS In this laboratory setting using extracted human teeth, the chemomechanical preparation of artificially infected root canals resulted in the formation of toxic VOCs and DBPs as effluent suspensions. Their release during aspiration with dental suction indicates that potential environmental hazards should be investigated. The use of silver-impregnated activated carbon had potential for the point-of-use treatment of post-irrigation effluent aliquots.
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Affiliation(s)
- K Ioannidis
- Faculty of Dentistry, Oral and Craniofacial Sciences, Centre for Oral Clinical and Translational Science, Guy's Hospital, King's College London, London, UK
| | - C Batty
- School of Life, Health and Chemical Sciences, The Open University, Milton Keynes, UK
| | - C Turner
- College of Health and Life Sciences, Brunel University, Uxbridge, London, UK
| | - D Smith
- Transspectra Limited, Newcastle Under Lyme, UK
| | - F Mannocci
- Department of Endodontology, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - S Deb
- Faculty of Dentistry, Oral and Craniofacial Sciences, Centre for Oral Clinical and Translational Science, Guy's Hospital, King's College London, London, UK
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Girgis D, van Dort N, Ye J, Abbott PV. The scope of practice of the modern Endodontist in Western Australia. AUST ENDOD J 2020; 46:330-337. [PMID: 33280193 DOI: 10.1111/aej.12450] [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: 06/30/2020] [Accepted: 09/16/2020] [Indexed: 11/28/2022]
Abstract
There are limited data regarding the scope of practice of Endodontists in Australia. The aim of this study was to investigate the scope of practice of Endodontists and Endodontic Registrars in Western Australia. The study comprised a three-part survey relating to demographics, clinical factors and materials and equipment. The response rate was 70.6%. Compared to the public sector, clinicians in the private sector treated on average twice as many patients per day, twice as many trauma cases per year and, as a proportion of all cases, four and a half times as many apical surgical procedures. These aspects were all statistically significantly different. Other aspects were similar to previous studies within Australia and from other countries.
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Affiliation(s)
- Daniel Girgis
- UWA Dental School, University of Western Australia, Nedlands, WA, Australia
| | - Nathan van Dort
- UWA Dental School, University of Western Australia, Nedlands, WA, Australia
| | - Johnson Ye
- UWA Dental School, University of Western Australia, Nedlands, WA, Australia
| | - Paul V Abbott
- UWA Dental School, University of Western Australia, Nedlands, WA, Australia
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Virtej A, Tenstad O, Wiig H, Berggreen E. Interstitial fluid drainage from rat apical area takes place via vessels in the mandibular canal. Eur J Oral Sci 2020; 128:190-195. [PMID: 32306433 DOI: 10.1111/eos.12690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2020] [Indexed: 12/21/2022]
Abstract
We sought to investigate the transport route for protein-rich fluid from the apical area towards the draining lymph nodes. The first mandibular molar root canals in 24 female Wistar rats were instrumented and filled with radioactive-labelled human serum albumin. The rats were sacrificed at different intervals beginning after 10 min (time 0) and continuing up to 72 h. Three jaw segments, gingiva around the first molar, blood samples, submandibular and cervical lymph nodes were collected and analyzed for radioactivity. The starting volume of tracer (control) for all experiments was calculated from measurements at time 0. At time 0, radioactivity was only detected in the jaw segments. Within lymph nodes and serum, the tracer was found after 4 h, with the highest amount recorded in serum up to 24 h. Lymphatics were found within the mandibular canal along blood vessels and nerves and exiting via foramen mandibularis, after immunohistochemical staining in four untreated rats. Our results show tracer distribution from the apical area towards the mandibular canal in a posterior direction. The tracer washout rate was low, and the fluid was mainly absorbed into blood vessels. The lymphatics in the mandibular canal may be more important for immune cell transport than for fluid drainage.
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Affiliation(s)
- Anca Virtej
- Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Olav Tenstad
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Helge Wiig
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Ellen Berggreen
- Department of Biomedicine, University of Bergen, Bergen, Norway
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Assessment of Australian Dentists' Treatment Planning Decisions Based on Diagnosis. J Endod 2020; 46:483-489. [DOI: 10.1016/j.joen.2020.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/30/2019] [Accepted: 01/05/2020] [Indexed: 12/21/2022]
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Meirinhos J, Martins JNR, Pereira B, Baruwa A, Gouveia J, Quaresma SA, Monroe A, Ginjeira A. Prevalence of apical periodontitis and its association with previous root canal treatment, root canal filling length and type of coronal restoration - a cross-sectional study. Int Endod J 2019; 53:573-584. [PMID: 31749154 DOI: 10.1111/iej.13256] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/17/2019] [Accepted: 11/19/2019] [Indexed: 12/13/2022]
Abstract
AIM To analyse the prevalence of periapical lesions and their association with previous root canal treatment, root canal filling length and type of coronal restoration using in vivo cone-beam computed tomographic (CBCT) assessment. METHODOLOGY A global sample of 20 836 teeth, with a combined total of 27 046 roots, from 1160 patients, was analysed via CBCT assessment in eight health centres. Each tooth was evaluated by one out of five examiners after having performed a defined calibration procedure on the basis of 319 teeth. Intra- and inter-rater reliability tests were performed. Each tooth was classified according the tooth number, presence/absence of periapical lesions, presence/absence of previous root canal treatment, length of root canal filling (short, good or overfilling) and type of coronal restoration. The z-test for proportions was used to analyse differences between tooth subgroups, and an odds ratio was determined in order to analyse the association between treatment status and periapical lesions. A P < 0.05 was considered significant. RESULTS At a tooth level, the overall prevalence of periapical lesions in the sample was 10.4%. Maxillary teeth were associated with a significantly larger percentage of lesions (13.1%), whilst maxillary first molars had the greater proportion of lesions (21.2%). The prevalence of periapical lesions was significantly larger in root filled teeth (55.5%), short root canal fillings (72.7%) and in teeth restored with crowns (46.1%). At a root level, the mesiobuccal roots of both maxillary first molars had a tendency for a larger percentage of periapical lesions. CONCLUSION History of root canal treatment, root canal filling length and type of coronal restoration influenced the presence of periapical lesions. Molars were more commonly associated with periapical lesions on root filled teeth, particularly those with short root fillings and those with crowns.
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Affiliation(s)
- J Meirinhos
- Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal
| | - J N R Martins
- Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal
| | - B Pereira
- Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal
| | - A Baruwa
- Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal
| | - J Gouveia
- Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal
| | - S A Quaresma
- Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal
| | - A Monroe
- Private Practice, San Diego, CA, USA
| | - A Ginjeira
- Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal
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Salivary Metabolomics Fingerprint of Chronic Apical Abscess with Sinus Tract: A Pilot Study. ScientificWorldJournal 2019; 2019:3162063. [PMID: 31827413 PMCID: PMC6881753 DOI: 10.1155/2019/3162063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 10/26/2019] [Indexed: 11/30/2022] Open
Abstract
Chronic apical abscess (CAA) is a lesion of apical periodontitis mostly characterized by areas of liquefactive necrosis with disintegrating polymorphonuclear neutrophils surrounded by macrophages. Its presence leads to local bacterial infection, systemic inflammatory response, pain, and swelling. The use of a novel approach for the study of CAA, such as metabolomics, seems to be important since it has proved to be a powerful tool for biomarkers discovery which could give novel molecular insight on CAA. So, the aim of this study was to verify the possibility to identify the metabolic fingerprint of CAA through the analysis of saliva samples. Nineteen patients were selected for this study: eleven patients affected by CAA with a sinus tract constituted the study group whereas eight patients without clinical and radiographic signs of CAA formed the healthy control group. Saliva samples were collected from each subject and immediately frozen at −80°C. Metabolomic profiles were obtained using a gas chromatography/mass spectrometry instrument. Subsequently, in order to compare the two groups, a multivariate statistical model was built that resulted to be statistically significant. The class of metabolites characterizing the CAA patients was closely related to the bacterial catabolism, tissue necrosis, and presence of a sinus tract. These preliminary results, for the first time, indicate that saliva samples analyzed by means of GC/MS metabolomics may be useful for identifying the presence of CAA, leading to new insights into this disease.
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Cotti E, Musu D, Goddi A, Dettori C, Campisi G, Shemesh H. Ultrasound Examination to Visualize and Trace Sinus Tracts of Endodontic Origin. J Endod 2019; 45:1184-1191. [DOI: 10.1016/j.joen.2019.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 06/22/2019] [Accepted: 07/14/2019] [Indexed: 12/29/2022]
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Cope AL, Francis N, Wood F, Chestnutt IG. Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults. Cochrane Database Syst Rev 2018; 9:CD010136. [PMID: 30259968 PMCID: PMC6513530 DOI: 10.1002/14651858.cd010136.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Dental pain can have a detrimental effect on quality of life. Symptomatic apical periodontitis and acute apical abscess are common causes of dental pain and arise from an inflamed or necrotic dental pulp, or infection of the pulpless root canal system. Clinical guidelines recommend that the first-line treatment for teeth with these conditions should be removal of the source of inflammation or infection by local, operative measures, and that systemic antibiotics are currently only recommended for situations where there is evidence of spreading infection (cellulitis, lymph node involvement, diffuse swelling) or systemic involvement (fever, malaise). Despite this, there is evidence that dentists frequently prescribe antibiotics in the absence of these signs. There is concern that this could contribute to the development of antibiotic-resistant bacterial colonies within both the individual and the community. This review is an update of the original version that was published in 2014. OBJECTIVES To evaluate the effects of systemic antibiotics provided with or without surgical intervention (such as extraction, incision and drainage of a swelling, or endodontic treatment), with or without analgesics, for symptomatic apical periodontitis and acute apical abscess in adults. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 26 February 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 1) in the Cochrane Library (searched 26 February 2018), MEDLINE Ovid (1946 to 26 February 2018), Embase Ovid (1980 to 26 February 2018), and CINAHL EBSCO (1937 to 26 February 2018). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. A grey literature search was conducted using OpenGrey (to 26 February 2018) and ZETOC Conference Proceedings (1993 to 26 February 2018). No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA Randomised controlled trials of systemic antibiotics in adults with a clinical diagnosis of symptomatic apical periodontitis or acute apical abscess, with or without surgical intervention (considered in this situation to be extraction, incision and drainage or endodontic treatment) and with or without analgesics. DATA COLLECTION AND ANALYSIS Two authors screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias independently and in duplicate. We calculated mean differences (MD) (standardised mean difference (SMD) when different scales were reported) and 95% confidence intervals (CI) for continuous data. A fixed-effect model was used in the meta-analysis as there were fewer than four studies. We contacted study authors to obtain missing information. MAIN RESULTS We included two trials in this review, with 62 participants included in the analyses. Both trials were conducted in university dental schools in the USA and compared the effects of oral penicillin V potassium (penicillin VK) versus a matched placebo when provided in conjunction with a surgical intervention (total or partial pulpectomy) and analgesics to adults with acute apical abscess or symptomatic necrotic tooth. The patients included in these trials had no signs of spreading infection or systemic involvement (fever, malaise). We assessed one study as having a high risk of bias and the other study as having unclear risk of bias.The primary outcome variables reported in both studies were participant-reported pain and swelling (one trial also reported participant-reported percussion pain). One study reported the type and number of analgesics taken by participants. One study recorded the incidence of postoperative endodontic flare-ups (people who returned with symptoms that necessitated further treatment). Adverse effects, as reported in one study, were diarrhoea (one participant, placebo group) and fatigue and reduced energy postoperatively (one participant, antibiotic group). Neither study reported quality of life measurements.Objective 1: systemic antibiotics versus placebo with surgical intervention and analgesics for symptomatic apical periodontitis or acute apical abscessTwo studies provided data for the comparison between systemic antibiotics (penicillin VK) and a matched placebo for adults with acute apical abscess or a symptomatic necrotic tooth when provided in conjunction with a surgical intervention. Participants in one study all underwent a total pulpectomy of the affected tooth, while participants in the other study had their tooth treated by either partial or total pulpectomy. Participants in both trials received oral analgesics. There were no statistically significant differences in participant-reported measures of pain or swelling at any of the time points assessed within the review. The MD for pain (short ordinal numerical scale 0 to 3) was -0.03 (95% CI -0.53 to 0.47) at 24 hours; 0.32 (95% CI -0.22 to 0.86) at 48 hours; and 0.08 (95% CI -0.38 to 0.54) at 72 hours. The SMD for swelling was 0.27 (95% CI -0.23 to 0.78) at 24 hours; 0.04 (95% CI -0.47 to 0.55) at 48 hours; and 0.02 (95% CI -0.49 to 0.52) at 72 hours. The body of evidence was assessed as at very low quality.Objective 2: systemic antibiotics without surgical intervention for adults with symptomatic apical periodontitis or acute apical abscessWe found no studies that compared the effects of systemic antibiotics with a matched placebo delivered without a surgical intervention for symptomatic apical periodontitis or acute apical abscess in adults. AUTHORS' CONCLUSIONS There is very low-quality evidence that is insufficient to determine the effects of systemic antibiotics on adults with symptomatic apical periodontitis or acute apical abscess.
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Affiliation(s)
- Anwen L Cope
- Cardiff and Vale University Health BoardHeath ParkCardiffUKCF14 4YS
- School of Dentistry, Cardiff UniversityApplied Clinical Research and Public HealthCardiffUK
| | - Nick Francis
- School of Medicine, Cardiff UniversityDivision of Population MedicineHeath ParkCardiffUKCF14 4YS
| | - Fiona Wood
- School of Medicine, Cardiff UniversityDivision of Population MedicineHeath ParkCardiffUKCF14 4YS
| | - Ivor G Chestnutt
- School of Dentistry, Cardiff UniversityApplied Clinical Research and Public HealthCardiffUK
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Yu CY, Abbott PV. Pulp microenvironment and mechanisms of pain arising from the dental pulp: From an endodontic perspective. AUST ENDOD J 2018. [DOI: 10.1111/aej.12257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Christine Y. Yu
- Discipline of Endodontics; UWA Dental School; Oral Health Centre of Western Australia; The University of Western Australia (M512); Crawley Western Australia Australia
| | - Paul V. Abbott
- Discipline of Endodontics; UWA Dental School; Oral Health Centre of Western Australia; The University of Western Australia (M512); Crawley Western Australia Australia
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Jun MK, Ku HM, Kim E, Kim HE, Kwon HK, Kim BI. Detection and Analysis of Enamel Cracks by Quantitative Light-induced Fluorescence Technology. J Endod 2016; 42:500-4. [PMID: 26794344 DOI: 10.1016/j.joen.2015.12.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 11/24/2015] [Accepted: 12/06/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The ability to accurately detect tooth cracks and quantify their depth would allow the prediction of crack progression and treatment success. The aim of this in vitro study was to determine the capabilities of quantitative light-induced fluorescence (QLF) technology in the detection of enamel cracks. METHODS Ninety-six extracted human teeth were selected for examining naturally existing or suspected cracked teeth surfaces using a photocuring unit. QLF performed with a digital camera (QLF-D) images were used to assess the ability to detect enamel cracks based on the maximum fluorescence loss value (ΔFmax, %), which was then analyzed using the QLF-D software. A histologic evaluation was then performed in which the samples were sectioned and observed with the aid of a polarized light microscope. The relationship between ΔFmax and the histology findings was assessed based on the Spearman rank correlation. The sensitivity and specificity were calculated to evaluate the validity of using QLF-D to analyze enamel inner-half cracks and cracks extending to the dentin-enamel junction. RESULTS There was a strong correlation between the results of histologic evaluations of enamel cracks and the ΔFmax value, with a correlation coefficient of 0.84. The diagnostic accuracy of QLF-D had a sensitivity of 0.87 and a specificity of 0.98 for enamel inner-half cracks and a sensitivity of 0.90 and a specificity of 1.0 for cracks extending to the dentin-enamel junction. CONCLUSIONS These results indicate that QLF technology would be a useful clinical tool for diagnosing enamel cracks, especially given that this is a nondestructive method.
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Affiliation(s)
- Mi-Kyoung Jun
- Department of Preventive Dentistry and Public Oral Health, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Hye-Min Ku
- Department of Preventive Dentistry and Public Oral Health, College of Dentistry, Yonsei University, Seoul, South Korea; BK 21 PLUS Project, Yonsei University, College of Dentistry, Seoul, South Korea
| | - Euiseong Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Hee-Eun Kim
- Department of Dental Hygiene, Gachon University College of Health Science, Incheon, South Korea
| | - Ho-Keun Kwon
- Department of Preventive Dentistry and Public Oral Health, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Baek-Il Kim
- Department of Preventive Dentistry and Public Oral Health, College of Dentistry, Yonsei University, Seoul, South Korea; BK 21 PLUS Project, Yonsei University, College of Dentistry, Seoul, South Korea; Oral Science Research Institute, Yonsei University, College of Dentistry, Seoul, South Korea.
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Cotti E, Zedda A, Deidda M, Piras A, Flore G, Ideo F, Madeddu C, Pau VM, Mercuro G. Endodontic Infection and Endothelial Dysfunction Are Associated with Different Mechanisms in Men and Women. J Endod 2015; 41:594-600. [DOI: 10.1016/j.joen.2015.01.037] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 01/27/2015] [Accepted: 01/30/2015] [Indexed: 10/23/2022]
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Murray CM, Chandler NP. Undergraduate endodontic teaching in New Zealand: Students’ experience, perceptions and self-confidence levels. AUST ENDOD J 2014; 40:116-22. [DOI: 10.1111/aej.12084] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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