Patient-related outcomes and Oral Health-Related Quality of Life in endodontics.

There is increased interest in outcome measures that complement the classic goal of endodontics, being the prevention and healing of apical periodontitis. Possible outcome measures can be subdivided into patient-centred outcomes (PCOs), encompassing data collected by nonpatients aiming to assess the effectiveness of an intervention and patient-reported outcomes (PROs), which are reported directly by the patient. PROs can be subsequently classed into PRO measures that ascertain patients' view of their symptoms, their functional status, and their health-related quality of life, and patient-reported experience measures that focus on aspects including the humanity of care, patient satisfaction, patient preference and adherence, personal costs, expectation fulfilment, and decision regrets. The present review aims to define various patient-related outcomes and discuss the literature available regarding PCOs and PROs in endodontics. This includes those proposed to assess the effectiveness of endodontic treatment for pulpitis and apical periodontitis for use in the development of European Society of Endodontology S3-level clinical practice guidelines that have been included by all working groups, except for the radiographic assessment of apical periodontitis. Based on limited evidence in the field, it can be summarized that after recall periods of various lengths, endodontic treatment is associated with a high likelihood of tooth survival and limited need for further intervention, including extraction and further restorative procedures. Oral Health-Related Quality of Life (OHRQoL) is likely to improve following the completion of treatment. Nonetheless, the literature assessing the association between OHRQoL and endodontics is hampered by the use of instruments that have not been previously validated. Amongst the remaining outcome measures discussed in the present review, it is worth highlighting that there is only one study assessing exacerbations in teeth with the presence of endodontic pathosis, which suggests a very low incidence of this adverse effect following endodontic treatment. Patients' expectation fulfilment, adherence, and satisfaction are closely inter-related and depend also on various nonclinical factors. Further studies assessing PCOs and PROs, in association with healing and prevention of apical periodontitis, are required to better understand endodontic treatment from the perspective of patients.

Dental patient-reported outcomes following traumatic dental injuries and treatment: A narrative review.

Dental patient-reported outcomes (dPROs) are self-reported descriptions of a patient's oral health status that are not modified or interpreted by a healthcare professional. Dental patient-reported outcome measures (dPROMs) are objective or subjective measurements used to assess dPROs. In oral healthcare settings, the emphasis on assessing treatment outcomes from the patient's perspective has increased and this is particularly important after traumatic dental injuries (TDIs), as this group of injuries represent the fifth most prevalent disease or condition worldwide. The purpose of this review is to summarize the current use of dPROs and dPROMs in the field of dental traumatology. Oral Health-Related Quality of Life, pain, swelling, aesthetics, function, adverse effects, patient satisfaction, number of clinical visits and trauma-related dental anxiety are the key dPROs following TDIs. Clinicians and researchers should consider the well-being of patients as their top priority and conduct routine evaluations of dPROs using measures that are appropriate, accurate and reflect what is important to the patient. After a TDI, dPROs can assist clinicians and patients to choose the best management option(s) for each individual patient and potentially improve the methodology, design and relevance of clinical studies.

DENTAL PATIENT-REPORTED OUTCOMES IN ENDODONTICS - A NARRATIVE REVIEW.

Recently in oral health care settings, the focus of assessing treatment outcomes has shifted from the perspective of the clinician towards that of the patient. Endodontology is a specialty of dentistry concerned with the prevention and treatment of pulp and periapical diseases. Research in endodontology and its associated treatment outcomes have focused mainly on clinician-reported outcomes (CROs) and not dental patient-reported outcomes (dPROs). As a result, there is a need to emphasize the importance and relevance of dPROs to researchers and clinicians. The aim of this review is to present an overview of dPROs and dPROMs within endodontics in an attempt to create a better understanding of the patient experience, highlight the need to place the patient at the center of treatment, enhance patient care and encourage more research into dPROs. The key dPROs following endodontic treatment include pain, tenderness, tooth function, need for further intervention, adverse effects (exacerbation of symptoms, tooth discoloration) and Oral Health-Related Quality of Life. dPROs are important following endodontic treatment because they assist clinicians and patients when they discuss and select the most appropriate management options, help clinicians make decisions on pre-operative assessment, prevention and treatment, and improve the methodology and design of future clinical studies. Clinicians and researchers in endodontology should prioritize patient welfare and undertake routine analyses of dPROs using appropriate and robust measures. Due to the lack of agreement over the reporting and definition of endodontic treatment outcomes, a comprehensive project to define a ``Core Outcome Set for Endodontic Treatment Methods (COSET)'' is currently ongoing. In the future, a new and exclusive assessment tool should be developed to reflect the viewpoints of patients receiving endodontic treatment more accurately.

Predictors of societal and professional impact of Endodontology research articles: A multivariate scientometric analysis.

AIM: To identify factors that are predictive of short-term professional and societal impact of research within the specialty of Endodontology and to identify the top-10 articles that achieved the greatest societal impact and describe their characteristics. METHODOLOGY: Research articles in the field of Endodontology published in 2019 were eligible for inclusion, with the sample identified using Medline. Following screening of titles and abstracts, bibliometric data of the identified articles were exported into a spreadsheet, where further data related to continental origin, type of article, type of journal (endodontic or non-endodontic) and grant-funding were collated, with additional data concerning presence of journal impact factor, citations, news mentions and Altmetric-tracked-mentions and scores compiled using Clarivate, Scopus, ProQuest and Altmetric Explorer, respectively. Data analysis comprised descriptive statistics, frequency distributions, cross-tabulations and un/adjusted negative binomial regression models (p < .05). RESULTS: The search retrieved 30 443 articles; 951 were included for analysis. Most articles originated from Asia (43.2%) with over 51.5% of articles published in endodontic journals and 80% published in a journal with an impact factor. Over three-quarters of articles were primary research, 141 were grant-funded, 165 had a news mention, 338 achieved an Altmetric Attention Score (AAS) and 808 were cited. The five-highest ranked articles were mentioned in general news bulletins, five of the top-10 articles were primary research and six of the top-10 were published in endodontic journals. The highest AAS and citation count were 100 and 87, respectively. Adjusted models demonstrated that the type of article, publication in a journal with an impact factor, absence of grant-funding and coverage within general news bulletins predicted the AAS 's (p < .001). Article type, publication in an impact-factor journal and presence of an AAS were predictive of citations (p < .001). CONCLUSIONS: Article type and publication in a journal with an impact factor were significant predictors of both societal and professional impact of research articles within Endodontology in the short-term. Non grant-funded research and coverage in general news bulletins achieved greater societal impact, whereas an article achieving an AAS was also strongly related to professional impact.

The long-term influence of orthodontic treatment on adults' psychosocial outcomes: An Australian cohort study.

OBJECTIVES: To assess the influence of orthodontic treatment on psychosocial outcomes in 30-year-olds. The research hypothesis tested was that participants previously treated orthodontically would have better psychosocial outcomes. SETTING AND SAMPLE POPULATION: A prospective longitudinal cohort design was used to follow-up a sample of 1859 30-year-olds from Adelaide, South Australia, who had previously participated in an oral epidemiology study. MATERIALS AND METHODS: Clinical examination in 1988-1989 recorded participants' malocclusion severity. In 2005-2006, participants were invited to complete a questionnaire collecting data on socio-demographic characteristics, dental health behaviours, receipt of orthodontic treatment and psychosocial factors. Data were analysed descriptively and by linear regression models. RESULTS: Data for 448 participants were available; 56% of participants were female. Over a third of participants had received orthodontic treatment. Higher income earners had the best psychosocial outcomes while participants with a basic level of secondary education had the lowest. Regardless of initial malocclusion severity, orthodontic treatment was not associated with better psychosocial outcomes. Instead, a pattern of better psychosocial outcome was observed amongst untreated participants, regardless of malocclusion severity, this being significant for optimism. Adjusted models controlling for socio-demographic, dental health behaviour and malocclusion severity showed no association between orthodontic treatment and self-efficacy, health competence or social support. There was, however, a strong association with optimism. CONCLUSION: There was no difference in long-term psychosocial outcomes based on orthodontic treatment. Our study does not support the contention that orthodontic treatment produces better psychosocial functioning later in life.

The association of overjet size and traumatic dental injuries-A systematic review and meta-analysis.

BACKGROUND/AIMS: Traumatic dental injuries are one of the most prevalent diseases globally, impacting people of different ages and socio-economic statuses. As disease prevention is preferable to management, understanding when an individual's overjet is prone to dental trauma helps identify at-risk patients, so to institute preventive strategies. The aim of this study was to identify the different overjet sizes that present an increased risk for developing dental trauma across different ages and dentition stages. METHODS: The title and protocol were registered and published a priori with the Joanna Briggs Institute (JBI) and PROSPERO (CRD42017060907) and followed the JBI methodology of systematic reviews of association (etiology). A three-step search strategy was performed, including electronic searches of gray literature and four databases. Studies of healthy human participants of any age and in any dental dentition stage were considered for inclusion. Only high methodological quality studies with low risk of bias were included. Where possible, meta-analyses were performed using the random-effects model, supplemented with the fixed-effects model in situations where statistical heterogeneity was ≤50%, assessed using the I2 statistic. RESULTS: The study identified 3718 articles, 41 were included. An increased overjet was significantly associated with higher odds of developing trauma in all dentition stages and age groups. Children 0-6 years with an overjet ≥3mm have an odds of 3.37 (95%CI, 1.36-8.38, P = 0.009) for trauma. Children in the mixed and secondary dentition with an overjet >5mm have an odds of 2.43 (95%CI, 1.34-4.42, P = 0.004). Twelve-year-old children with an overjet >5mm have an odds of 1.81 (95%CI, 1.44-2.27, P < 0.0001). CONCLUSIONS: The results confirm the association between increased overjet and dental trauma. A child in the primary dentition could be considered as having an overjet at risk for trauma when it is ≥3mm. In the early secondary dentition, the threshold for trauma is an overjet ≥5mm.

The quality of information on the Internet on orthodontic retainer wear: a cross-sectional study.

OBJECTIVES: The objectives of this study were to assess the accessibility, usability, reliability and quality of information on the Internet written for the lay public about orthodontic retainers, and to elucidate the different retention protocols encouraged. DESIGN: A cross-sectional, observational study. SETTING: Online, using a computer connected to the Internet in Australia. METHODS: Two search terms; 'orthodontic retainer' and 'how long should someone wear a retainer after their braces are removed?' were entered alternatively into five search engines. Twenty results for each search term per search engine that fulfilled the inclusion criteria were evaluated in terms of accessibility, usability, reliability and quality of information using the LIDA and DISCERN instruments, ensuring there were no internal or cross-search engine duplicates. Any information about frequency and duration of retainer wear was also collected. RESULTS: Two hundred different websites were identified and assessed. The median overall LIDA score was 72%, corresponding to a moderate quality level. The median total DISCERN score was 47%. Twenty-two websites recommended patients adhere to the specific protocol prescribed to them by their practitioner. There were 45 (22.5%) and 28 (14%) websites advising indefinite use of removable and bonded retainers respectively. CONCLUSIONS: Information about retainers on the Internet is easily accessible and usable, though the quality of the content is generally of a moderate level. However, the information is not always accurate and reliable. Both full-time and part-time wear of removable retainers was suggested over greatly varying time periods. Indefinite wear of removable and bonded retainers was also advocated.

The Hawlix: a simple and aesthetic prosthetic- orthodontic retainer.

This report introduces the Hawlix, a hybrid thermoformed and cold-cured retainer. It was developed to overcome the limitations that modified Hawley retainers possess when used in patients with bounded saddles, attributable to dental trauma or hypodontia. The Hawlix can be used as an intermediate retainer while a patient is waiting to receive restorative treatment. Some of the advantages of the Hawlix over the modified Hawley retainer include: superior aesthetics, cost-effectiveness, ease of manufacture, adequate resistance to fracture, preservation of a residual ridge, and precise space maintenance.

Multi-disciplinary management of a patient with a post-traumatised incisor presenting concurrent replacement and inflammatory resorption: a case report.

This case report describes the multidisciplinary management of a young male who presented with a Class I incisor relationship and bi-maxillary dento-alveolar protrusion on a Class I skeletal base. The occlusion was complicated by an ankylosed and moderately infra-positioned upper left permanent central incisor, an anterior crossbite, crowding, a reduced overbite and centreline discrepancy. The incisor was traumatised and avulsed when the root was immature and the tooth was reimplanted with delay. On referral for orthodontic treatment at age 11 .5 years, the upper left central incisor was experiencing ankylosis-related (osseous replacement) resorption and external root resorption simultaneously. Aside from the orthodontic aims, it was important to address the disrupted alveolar development to facilitate later prosthodontic replacement of the upper left permanent central incisor by idealising the inter-coronal and inter-radicular spaces. Treatment consisted of fixed orthodontic appliances in conjunction with the extraction of all second premolars and the upper left permanent central incisor with episodic surgical curettage. An upper Hawlix retainer was provided immediately at debond and a cantilevered resin-retained bridge was placed four months later.

Location and severity of root resorption related to impacted maxillary canines: a cone beam computed tomography (CBCT) evaluation.

BACKGROUND: The present investigation was designed to determine the location and severity of root resorption associated with impacted maxillary canine teeth using cone beam computed tomography (CBCT). A secondary aim was to identify possible influencing factors. METHODS: The radiological reports of 183 patients, radiographed with a small-volume CBCT focussed on the impacted maxillary canine teeth, were assessed. Eighty-five patients had resorption associated with the impaction. The CBCT image datasets were viewed to determine the location and severity of the lesions. RESULTS: A total of 110 impacted maxillary canine teeth resorbed 120 adjacent teeth, including 14 premolars and one permanen molar. The apical third and palatal surface were commonly involved. Fifty per cent of the resorptive lesions were mild, 20% moderate and 30% severe. There was no significant relation between age or gender on the number, location or severity of resorption. There was a statistically significant correlation between the number of impacted canine teeth an'd the number of teeth resorbed, as well as the tooth type and the surface involved in the resorption. CONCLUSIONS: All root levels and surfaces of teeth associated with impacted maxillary canine teeth can be resorbed to different levels of severity. Neither age nor gender influences the number, location or severity of the resorption.

Dental Abrasion of Incisor caused by a Babies' Dummy Clip: A Case Report.

Tooth surface loss (TSL), the non-carious loss of tooth tissue, is considered pathological if the teeth involved experience sensitivity and pain, are functionally compromised or they detract from the patient's appearance. TSL is a common clinical finding in many patient groups, although differences between the primary and permanent dentition contribute to TSL occurring at a faster rate and with worse outcomes in the primary dentition. This case report presents localized abrasion and associated apical periodontitis affecting a single primary tooth in a 2-year-old infant following the misuse of a babies' dummy clip whilst teething. Abrasion is rare in the primary dentition. CPD/CLINICAL RELEVANCE: This article highlights an unusual presentation of dental abrasion affecting the primary dentition caused by a previously unreported foreign object; abrasion in this case was a side-effect of soothing the discomfort of teething.

Oral health-related quality of life and perceptions of patients following primary root canal treatment or non-surgical retreatment.

This retrospective cohort study compared the effect of primary root canal treatment (RCT) with root canal retreatment (Re-RCT) on patient-reported outcomes in Kuala Lumpur, Malaysia. Forty randomly selected adults participated (RCT n = 20; Re-RCT n = 20). The impact their dentition had on the Oral Health Impact Profile-14 (OHIP-14) was assessed by calculating the prevalence of oral health impact, and the severity score. Focus group discussions using a semi-structured guide were arranged through an online meeting platform. Qualitative content analysis identified common themes, and relevant quotes gathered. The impact on OHIP-14 was limited for both RCT and Re-RCT groups with no significant differences in the prevalence of oral health impact. Significant differences were found for functional limitation (RCT higher) and psychological discomfort (Re-RCT higher). Common themes from the discussions include the importance of retaining teeth, the significance of effective communication between clinicians and patients and that the respondents were satisfied with the treatment.

Cone-beam computed tomography-Predictors and characteristics of usage in Australia and New Zealand, a multifactorial analysis.

Cone-beam computed tomography (CBCT) is an increasingly used imaging modality. This study aimed to identify the factors that predict its usage amongst endodontists in Australia and New Zealand and describe usage characteristics. Data were collected via an online questionnaire, with analysis including descriptive statistics, cross-tabulation and multifactorial modelling. Ninety-four endodontists completed the questionnaire who were using CBCT for 7 years (median), over half had a CBCT unit in practice, with most prescribing up to 10 scans/month and 55 using a small field of view. Sixty-eight participated in >5 h of CBCT education/year and a third received a specialist-prepared report. The number of prescriptions/month was significantly associated with on-site CBCT units (Exp B: 8.53; 95% CI: 1.46-49.86, p < 0.05) and the number of years of CBCT usage by participants (Exp B: 1.46; 95% CI: 1.17-1.84, p = 0.001). CBCT imaging in endodontics is a useful diagnostic aid to decision making and treatment planning, with widespread acceptance and usage.

Removable orthodontic retainers: practical considerations.

This article provides an overview of removable orthodontic retainers, discussing their history and the different types available, and compares the two most popular removable retainers. Practical information on consent and the clinical steps involved in the provision of removable retainers, as well as suggested wear and care instructions, are also presented.

Accuracy of periapical and panoramic radiography for detection of root morphologies: a comparative study.

Maxillary and mandibular incisors have increased risk for severe orthodontically induced inflammatory root resorption. A patient-related risk factor is aberrant root morphology. This study aimed to assess the frequency of detection of different root morphologies in anterior teeth using dental panoramic tomography (DPT) and long cone periapical radiographs (LCPAs). A retrospective cross-sectional design was used to assess a sample of 50 consecutive pre-treatment radiographic records of patients from a specialist orthodontic practice in Adelaide, Australia. A reference guide was developed that included three previously unreported morphologies: pipette and bent, bent and pointed, bent and blunt. Two trained and calibrated assessors examined each record against the inclusion criteria, then independently assessed each anterior tooth from DPTs and LCPAs to detect the type of root morphology present. Data were analysed using the chi-square statistical test. Radiographic records for 48 patients (48 DPTs and 161 LCPAs) were eligible, with 355 and 426 teeth on DPTs and LCPAs, respectively, included for assessment. Normal root morphology (119 teeth) was commonly observed in DPTs, while bent (154 teeth) was frequently observed using LCPAs. Mandibular incisors often had normal morphology in DPTs but bent in LCPAs. Bent was the most common morphology in maxillary lateral incisors using DPT and LCPAs, although maxillary centrals were mostly normal in DPTs but pointed in LCPAs. Differences using the two image acquisition methods were highly significant (p < 0.01). Aberrant root morphologies are more easily detected in anterior teeth using LCPAs compared to DPTs.