The Impact of the Preferred Reporting Items for Case Reports in Endodontics (PRICE) 2020 Guidelines on the Reporting of Endodontic Case Reports

Aim The aim of this study is to evaluate the impact of the Preferred Reporting Items for Case reports in Endodontics (PRICE) 2020 guideline on the reporting of published endodontic case reports (CRs). Methodology All case reports published in the International Endodontic Journal, European Endodontic Journal, Journal of Endodontics and Restorative Dentistry and Endodontics, in the year before and after the release of PRICE 2020, were included for analysis. Two panels comprising dentists scored case reports against a scoring system adapted from the guideline. Individual items were scored up to a maximum of 1; scores were then summated to provide an overall maximum of 47 for each CR. Each report provided an overall percentage adherence, and panel agreement was calculated using the intraclass correlation coefficient (ICC). Disagreement on scoring was discussed until a consensus was reached. Scores before and after PRICE guideline publication were compared using an unpaired two-tailed t test. Results A total 19 CRs were identified in both the pre- and post-PRICE guideline publication. Mean adherence to PRICE 2020 increased by 7.9% (p=0.003) from 70.0%±8.89 to 77.9%±6.23 following its publication. Agreement between panels was moderate (ICC pre-PRICE: 0.673 {p=0.011}; ICC post-PRICE: 0.742 {p=0.003}). Items 1a, 6c, 6e, 6f, 6g, 6j, 6q, 6s, 7a, 9a, 11a, 12c and 12d experienced a fall in compliance. Conclusion The PRICE 2020 guideline has resulted in a modest improvement in the reporting of endodontic case reports. Greater awareness and a wider acceptance and implementation of the guideline in endodontic journals are needed to improve adherence to the novel guideline.

Exploiting dentine matrix proteins in cell-free approaches for periradicular tissue engineering

The recent discovery of mesenchymal stem cells within periapical lesions (PL-MSC) has presented novel opportunities for managing periradicular diseases in adult teeth by way of enhancing tissue regeneration. This discovery coincides with the current paradigm shift toward biologically driven treatment strategies in endodontics, which have typically been reserved for non-vital immature permanent teeth. One such approach that shows promise is utilizing local endogenous non-collagenous dentine extracellular matrix components (dECM) to recruit and upregulate the intrinsic regenerative capacity of PL-MSCs in situ. At picogram levels, these morphogens have demonstrated tremendous ability to enhance the cellular activities in in vitro and in vivo animal studies that would otherwise be necessary for periradicular regeneration. Briefly, these include proliferation, viability, migration, differentiation, and mineralization. Therefore, topical application of dECMs during ortho- or retrograde root canal treatment could potentially enhance and sustain the regenerative mechanisms within diseased periapical tissues that are responsible for attaining favorable clinical and radiographic outcomes. This would provide many advantages when compared with conventional antimicrobial-only therapies for apical periodontitis (AP), which do not directly stimulate healing and have had stagnant success rates over the past five decades despite significant advances in operative techniques. The aim of this narrative review was to present the novel concept of exploiting endogenous dECMs as clinical tools for treating AP in mature permanent teeth. A large scope of literature was summarized to discuss the issues associated with conventional treatment modalities; current knowledge surrounding PL-MSCs; composition of the dECM; inductive potentials of dECM morphogens in other odontogenic stem cell niches; how treatment protocols can be adapted to take advantage of dECMs and PL-MSCs; and finally, the challenges currently impeding successful clinical translation alongside directions for future research.

A matched irrigation and obturation strategy for root canal therapy

In root canal therapy, irrigating solutions are employed to eliminate the bacterial load and also prepare dentin for sealer interaction. The aim of this research was to assess how irrigating solutions employed on their own or in sequence affected the tooth structure. The best way to prepare the tooth for obturation using hydraulic calcium silicate cement (HCSC) sealers and gutta-percha, thus guiding clinicians on a matched irrigation-obturation strategy for optimized root canal treatment was investigated. The effect of irrigating solutions on dentine was investigated by assessing changes in dentin microhardness, ultrastructure and mineral content, organic/inorganic matter, surface roughness and Young’s modulus. The interaction of four root canal sealers with the dentin was analysed by assessing the changes in microhardness of the dentin after sealer placement and also the sealer to dentin interface by scanning electron and confocal laser microscopy. The irrigating solutions damaged the dentin irreversibly both when used on their own and in combination. The best sequence involved sodium hypochlorite followed by chelator and a final rinse with sodium hypochlorite and obturation using HCSC sealers that enabled the restoration of dentin properties. The HCSC sealers did not rely on chelator irrigating solutions for a good material adaptation to dentin.

Preserving pulp vitality: part one - strategies for managing deep caries in permanent teeth

This is the first article in a series reviewing the current literature surrounding the management of deep caries in permanent teeth. Approaches to caries management are continuing to evolve, with more conservative management increasingly favoured. This philosophy has never been more important than in managing the deep carious lesion. Evidence is emerging that the use of selective caries removal to reduce the risk of pulp exposure, in conjunction with calcium silicate cements, can be successful in maintaining pulp vitality, delaying the restorative cycle and prolonging the lifespan of the tooth.

Current trends in endodontic irrigation amongst general dental practitioners and dental schools within the United Kingdom and Ireland: a cross-sectional survey

Aims To investigate current trends in endodontic irrigation amongst general dental practitioners (GDPs) and dental schools within UK and Ireland. Secondly, to evaluate if significant differences exist between the irrigant practices of National Health Service (NHS) and private GDPs.Methodology In 2019, an online questionnaire was distributed to the 18 dental schools within the UK and Ireland and 8,568 GDPs. These surveys explored current trends in teaching and usage of endodontic irrigants. Chi-squared tests were performed to make comparisons between NHS and private GDPs (α <0.01).Results All 18 dental schools (100%) and 495 GDPs (6%) returned valid questionnaires. Three hundred and thirty (66.7%) practitioners were NHS and 165 (33.3%) were private. There was strong consensus on irrigation teaching amongst dental schools. These results aligned with GDP responses in terms of irrigant selection (sodium hypochlorite [NaOCl]); NaOCl concentration (≤3%); ethylenediaminetetraacetic acid (EDTA) contact time (>0-5 minutes); final rinse protocols (penultimate EDTA rinse); irrigant temperature (room); and agitation techniques (manual dynamic activation; >0-60 seconds). There was, however, considerable variation in NaOCl contact time and GDPs infrequently used chelating agents or agitation techniques. Compared with private practitioners, NHS GDPs used significantly lower NaOCl contact times and concentrations, less EDTA and activation techniques, and more chlorhexidine (P <0.01).Conclusions Overall, irrigation teaching within the UK and Ireland is consistent and evidence-based. Furthermore, trends in irrigant usage amongst UK GDPs are now more aligned with these teaching practices. Significant differences were, however, observed between NHS and private practitioners.

Root canal retreatment

Root canal therapy is not always successful and an increasing number of patients are requesting retreatment to address intra-radicular infection. The armamentarium available to assist the dentist, some of which is described in this article, has never been greater.

CLINICAL RELEVANCE

This paper discusses the causes of failure and reviews many of the techniques available to the practitioner to tackle the problem.

Root Canal Retreatment

Root canal therapy is not always successful and an increasing number of patients are requesting retreatment to address intraradicular infection. The armamentarium available to assist the dentist, some of which is described in this article, has never been greater.

Trends in Indirect Dentistry: 2. Post and Core Restorations

Modern post preparation techniques reflect a change from what was once considered a prosthodontic procedure to one which marries endodontic principles with sound understanding of mechanical objectives. This article presents a rationale for techniques in materials selection and post-space preparation. A review of literature is presented and practical clinical guidelines are suggested when post placement is considered the treatment of choice.

Trends in indirect dentistry: 1. Case selection

Indirect restorations can provide a conservative, functional and aesthetic method for managing a patient's dentition. These restorations, however, are only as good as the environment in which they are placed. Many restorations, though technically satisfactory, may fail because assessment and subsequent treatment planning has been unsatisfactory. This article presents a philosophy of case selection mindful of factors related to the patient, operator and oral environment. The wrong treatment, however skilfully executed, may invite failure.

Feasibility and usefulness of family record cards in general practice

In order to determine the feasibility of family record cards in general practice a research secretary created cards for 1825 households from a practice of 10 600 patients. The capital cost was pound108 and the time taken by the secretary was 1638 hours, which is equivalent to a wage of pound1330 for a maximum grade secretary, assuming a 70% rebate paid by the family practitioner committee. Approximately six and a half hours of receptionist/secretarial time are needed each week to maintain the system. The doctors spent a mean of three minutes checking and completing the initial update of each card.Before the cards were introduced, most information about families was held in the doctors' heads, and little was written in the records even though the doctors considered family information relevant in 33% of consultations. After the introduction of family record cards the doctors had access to reasonably complete information about the family at 98% of consultations and the cards were used at 95% of consultations. The doctors believed the information was useful for establishing rapport, identifying patients' concerns, obtaining relevant history, forming diagnostic hypotheses and managing the present complaint. Trainees and locums found the cards more useful than principals.

Sharing problem cards with patients

The problem cards of 100 patients in a group practice were shared and discussed with the patients concerned. The patients then completed a questionnaire recording their reactions to the experience. Although the sharing of problem cards can cause patients to become anxious and raises the questions of confidentiality, patients' rights and autonomy, the replies to the questionnaire demonstrate that patients valued seeing their problem lists. Sharing problem cards gave patients an opportunity to review their health needs and in some cases to correct inaccurate information although the lists of problems were found to be reasonably accurate.The results of this experiment show that sharing problem cards with patients has a beneficial effect on the accuracy of the records and could increase the trust between doctor and patient.