Prevalence of Fusobacterium Species in Endodontic Infections Detected With Molecular Methods: Systematic Review and Meta-Analysis.

INTRODUCTION: Endodontic infections are polymicrobial; however, investigating the role of bacterial species is critical because they may influence pathogenesis, the development of symptoms, or the persistence of disease. This systematic review aimed to determine the prevalence of Fusobacterium species and its association with different types of endodontic infections. METHODS: MEDLINE (Ovid), PubMed, Scopus, Web of Science, and Cochrane Library databases were used as electronic databases to retrieve relevant studies. The studies were evaluated for eligibility criteria, and the certainty in evidence and risk of bias were evaluated using critical appraisal tools for prevalence studies from the Joanna Briggs Institute. Forty studies were selected for meta-analysis and statistically analyzed for the relationship between the prevalence of Fusobacterium species and both the presence of symptoms and the type of infections (primary vs secondary/persistent) using meta-regression analysis. RESULTS: The prevalence of Fusobacterium spp. in endodontic infections ranged from 3%-100% (mean = 42.51%) in the 40 included studies. Calculated confidence intervals indicated that the presence of Fusobacterium spp. was not statistically associated with the presence of symptoms or with the type of infections (the set of 2 predictors was not significant; P < .05). CONCLUSIONS: The prevalence of Fusobacterium infection, which was identified with molecular methods, was not significant for overall regression using both predictors (ie, symptoms [symptomatic vs asymptomatic] and types of infections [primary vs secondary/persistent]).

The influence of horizontal glass fiber posts on fracture strength and fracture pattern of endodontically treated teeth: A systematic review and meta-analysis of in vitro studies.

PURPOSE: This systematic review and meta-analysis aimed to summarize available evidence regarding the effect of horizontal glass fiber posts (HGFPs) on fracture strength and fracture pattern of endodontically treated teeth (ETT) compared to controls without HGFP. The review protocol was registered on the OSF registries. METHODS: Literature searches were conducted in MEDLINE/PubMed, Scopus, Web of Science, Embase, Google Scholar, and ProQuest for all relevant studies published up to February 2022. All in vitro studies that assessed the influence of HGFPs on fracture strength and fracture pattern of ETT whether mesio-occluso-distal or mesio-occlusal or DO cavities were considered eligible. Review Manager (RevMan) was used for the meta-analysis. Subgroup and funnel plot analyses were also performed. Quality assessment was conducted by two independent reviewers. RESULTS: A total of 12 articles met the inclusion criteria, and 10 studies underwent quantitative evaluation. The pooled effect showed that fracture resistance of molar teeth restored with HGFP was significantly higher than teeth without HGFP (standardized mean difference [SMD]: 1.61, 95% confidence interval [CI]: 0.14, 3.09, p = 0.03), whereas marginally significant for premolars (SMD: 1.36, 95% CI: -0.00, 2.73, p = 0.05). Regarding fracture patterns, the presence of an HGFP significantly increased the occurrence of restorable fracture patterns for premolars (odds ratios [OR]: 4.15, 95% CI: 1.60, 10.82, p = 0.004) compared to controls, whereas the difference was not significant for molars (OR: 1.09, 95% CI: 0.43, 2.77, p = 0.85). Moderate risk of bias was identified in 9/12 studies; one study showed a high risk of bias and two studies showed a low risk of bias. CONCLUSIONS: Within the limitations of this study, there is evidence from in vitro studies that the use of HGFP increases the fracture resistance of the ETT when compared to teeth without HGFP and also reduces the occurrence of non-restorable fractures for premolars. However, well-conducted in vitro and prospective clinical studies are warranted to validate this finding.

Antibacterial and anti-inflammatory efficacy of N-acetyl cysteine in endodontic treatment: a scoping review.

BACKGROUND: This scoping review systematically summarized the available evidence about the efficacy of N-acetyl cysteine (NAC) as an intracanal antibacterial and/or anti-inflammatory. METHODS: PubMed, Scopus, Web of Science, and Google scholar search engines/databases were searched up to February 2022 to retrieve relevant studies. The studies were evaluated for eligibility criteria, and identifying relevant studies. RESULTS: Out of 193 studies, 15 fulfilled the inclusion criteria and were processed for data extraction. Thirteen in vitro studies assessed antibacterial/antibiofilm efficacy of NAC, and reported good and promising efficacy: NAC was found as efficacious as the comparators (chlorhexidine, sodium hypochlorite, calcium hydroxide), or even showed higher efficacy. Regarding the anti-inflammatory efficacy of NAC, one in vitro study found it equivalent to, while one clinical trial revealed it more efficacious than calcium hydroxide. CONCLUSIONS: There is accumulating evidence on the anti-microbial and anti-inflammatory efficacy of NAC in context of endodontics. However, further clinical trials with robust methodology and objective and reliable clinical, biological and microbial outcomes are warranted to translate its use for clinical practice on humans.

Association between dental diseases and history of stroke in the United States.

OBJECTIVE: This study aimed to determine the potential association between the dental diseases and self-reported history of stroke in the United States based on data from the Third National Health and Nutrition Examination Survey (NHANES III). METHODS: Data were extracted from NHANES III. Dental variables were carious tooth surfaces, number of missing teeth, gingival bleeding, and periodontal pockets. Multiple logistic regression modeling was used to estimate the effect of these dental diseases on the self-reported history of stroke with intent to adjust for the other potential determinants: age, sex, race, marital status, health insurance, education, exercise, body mass index, smoking, alcohol, hypertension, high serum cholesterol, and diabetes. RESULTS: Number of missing teeth was found to be significantly associated with the self-reported history of stroke. Associations between the self-reported history of stroke and caries, gingival bleeding, or periodontal pockets were not statistically significant. CONCLUSIONS: Number of missing teeth was an independent determinant of the self-reported history of stroke.

Root and Canal Morphology of Mandibular Second Molars in a Yemeni Population: A Cone-beam Computed Tomography.

OBJECTIVE: This study aimed to identify and characterize root and canal morphology and the prevalence of C-shaped canals of mandibular second molars (MSMs) in a Yemeni population using cone-beam computed tomography (CBCT). METHODS: Three-dimensional digital images of 500 MSMs with mature roots were taken from 250 Yemeni individuals and analyzed for the following features: number of roots, shape and type of roots, type of canal configuration in each root, prevalence of C-shaped canal, and primary variations in the morphology of root and canal systems. Chi square and Fisher's exact tests were employed for statistical analysis. RESULTS: 89.6% of MSMs had two separate roots, 9% had two fused roots, 0.6% had three separate roots and 0.8% had one root. Mesial root was mostly ribbon-shaped (60.5%) and distal root was mostly kidney-shaped (50.7%). Type II and Type I canal configurations were the most frequent in mesial (56.9%) and distal (91.3%) roots, respectively. C-shaped canals were found in 9%. Six variants were found with variant 3 being the most common (71%). CONCLUSION: Yemeni MSMs are mainly two-rooted. The prevalence of three- and one-rooted MSMs was relatively low. Various canals configurations were found in MSMs among this sample of Yemeni population. The clinicians should consider C-shaped roots and canals when treating Yemeni MSMs and should be aware of their morphological variations to ensure successful root canal treatment. Although bilateral similarity of many anatomical features of MSMs was found, individual evaluation of each MSM is necessary while performing endodontic treatment on both sides.

Management of cracked tooth using simvastatin as intracanal medicament.

Cracked tooth syndrome is presented as pain associated with biting and sensitivity. Intracanal medication with simvastatin stimulates hard tissue formation at crack line, and the tooth was functioning on the follow-ups.

Histologic Evaluation of Artificial Floors Under MTA and Nano-Filled Resin-Modified Glass Ionomer Used to Repair Furcation Perforations in Dogs.

Objective: This study aimed to compare the tissue reaction of two repair materials for furcation perforations, nano-filled resin modified glass ionomer (Nano-FRMGI) and mineral trioxide aggregate (MTA), used with or without an artificial floor. Methods: A total of 96 teeth in 6 dogs were used for this study. After access cavities, root canals were prepared and obturated with gutta percha using cold lateral condensation technique. Perforations were then created on the floors of the pulp chambers. The perforations divided into four groups n=24/group that were sealed with MTA alone, MTA with calcium sulphate artificial floor (CSAF), FRMGI alone and Nano-FRMGI with CSAF. All access cavities were filled with composite resin. Two dogs were sacrificed at 1, 3, and 6 month. The experimental tooth along with the surrounding alveolar bone were cut in block sections and histologically evaluated for tissue response. Data were analyzed by Chi-square (P≤0.05). Results: MTA and MTA with CSAF showed more bone and cementum apposition when compared to Nano-FRMGI at 6-month interval. MTA and MTA with CSAF showed less bone resorption, epithelium proliferation and inflammation compared to Nano-FRMGI at 6-month interval. Conclusion: MTA with CSAF or MTA-alone show better outcomes in the repair of pulp chamber floor perforation.

Root and Canal Configuration of Mandibular First Molars in a Yemeni Population: A Cone-beam Computed Tomography.

Objective: To describe root and canal morphology of mandibular first molars (MFMs) in a Yemeni population using cone-beam computed tomography (CBCT). Methods: CBCT images of 500 right and left untreated MFMs with fully developed roots from 250 Yemenis (125 male and 125 female) comprised the sample size of this study. The following characteristics were recorded: (1) number of roots and their type and morphology, (2) number of canals orifices per root, (3) type of canal configuration and (4) primary variations in the morphology of the root and canal systems. Results: 96.8% of MFMs are double-rooted. A third root was found in 3.2%, more in females than males. Mesial root was mainly ribbon-shaped (92.2%) and distal root was kidney-shaped in 56.2%. Two canals orifices were found in mesial root of 95.8% and one canal orifice was found in distal root of 96.4%. Vertucci type II canal configuration was the most frequent (57%), followed by type IV (35.6%) in mesial root. Type III canal configuration was the most prevalent (48.8%), followed by type I (41%) in distal root. Variant 3 represented the most common root and canal morphology (89.8%). Conclusion: MFMs in Yemeni population are mainly two-rooted with 3.2% having a supernumerary distolingual root. Cross section of mesial root was mainly ribbon-shaped and distal root was kidney-shaped. Vertucci type II and III configurations were the higher incidence in mesial and distal roots, respectively. The presence of two canals in mesial root and one canal in distal root of MFMs with two separate roots (variant 3) was the most common morphology.

Low intensity pulsed ultrasound increases mandibular height and Col-II and VEGF expression in arthritic mice.

OBJECTIVE: Rheumatoid arthritis (RA) is a chronic inflammatory disease involving persistent inflammation resulting in cartilage and bone damage. RA can affect the temporomandibular joint (TMJ), and damage to the TMJ condyle can lead to craniofacial developmental disturbances, causing micrognathia, malocclusion, retrognathia, and increased overjet. Current treatments of TMJ arthritis are unsatisfactory. This pilot study aimed to investigate the effect of low intensity pulsed ultrasound (LIPUS) on the mandible and TMJ condyles in an RA mouse model using micro-computed tomography (Micro-CT), histologic, and immunohistochemical analyses. METHODS: MRL-lpr/lpr mice received LIPUS application to their TMJs for 20 min/day for 2 and 4 weeks. Micro-CT analysis measured condylar length and width, posterior mandibular height (P.M.H), mandibular ramus length (M.R.L), effective mandibular length (Ef.M.L), angular process length (A.P.L), mandibular plane (M.P), mandibular axis (M.Ax), and lower incisor height (L.I.H). Condylar cartilage thickness was histologically measured, and type II collagen (Col-II), vascular endothelial growth factor (VEGF), nuclear factor kappa-B ligand (RANKL), and osteoprotegerin (OPG) expression was analyzed using immunohistochemistry. RESULTS: Comparing the LIPUS-treated group with the control, P.M.H, M.R.L, and M.P were significantly greater in the LIPUS-treated group. Immunostaining for Col-II and VEGF was stronger in the LIPUS-treated group after 4 weeks. OPG showed slightly more expression in the LIPUS group. CONCLUSIONS: LIPUS may enhance mandibular and TMJ condylar bone formation in this RA mouse model by preventing any growth disturbances involved in inflammation. Further studies are recommended to analyze the effect of LIPUS on TMJ of RA in other animal models.

Orthodontic-induced External Root Resorption of Endodontically Treated Teeth: A Meta-analysis.

INTRODUCTION: The difference in the amount of orthodontic-induced external root resorption (OIERR) of endodontically treated teeth (ETT) compared with vital pulp teeth (VPT) treatment is controversial. This systematic review and meta-analysis assessed the available evidence regarding OIERR of ETT compared with VPT. METHODS: PubMed, Scopus, MEDLINE, Web of Science, and Cochrane databases were searched up to May 2018 to retrieve relevant studies. The studies were evaluated for eligibility criteria, and the risk of bias was assessed using the Risk of Bias In Non-randomised Studies of Interventions tool (Cochrane Bias Methods Group, Odense, Denmark). Weighted means of OIERR in ETT and VPT were calculated using a fixed effects model, and a random effects model was used to assess the significance of treatment effects. RESULTS: Eight studies were identified, from which 7 were included in the meta-analyses. The funnel plot of the random effects model exhibited a symmetrical distribution, which indicates no publication bias of the included studies. Because of the significant heterogeneity between studies, a random effects model was used. Significantly less OIERR for ETT was identified compared with their contralateral VPT. CONCLUSIONS: Endodontic treatment does not seem to increase OIERR.

Management of a failed endodontic treatment for a maxillary second molar with two separate palatal roots.

Complexity of root canal system and variations in internal anatomy of teeth require careful analysis of preoperative cone beam computed tomography or multiangle radiographs to locate and identify possible extra roots or canals. A fourth canal in upper molars is expected, and much effort should be made when planning the endodontic treatment to avoid missing a canal.

Effect of Apical Patency on Postoperative Pain: A Meta-analysis.

INTRODUCTION: This systematic review and meta-analysis assessed the available evidence regarding the effect of apical patency versus nonpatency on postendodontic pain in adult patients. METHODS: The study adhered strictly to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. PubMed, Scopus, MEDLINE via Ovid, Google Scholar, and the Web of Science databases were searched up to April 2018 to retrieve the most relevant studies. Two authors evaluated the studies for eligibility criteria and assessed the risk of bias using the Cochrane tool. The weighted means were calculated using a fixed effects model. When statistically significant (P < .1) heterogeneity was detected, a random effects model was used to assess the significance of treatment effects. RESULTS: Five studies were identified for this systematic review; 4 were included in the meta-analyses. Two studies revealed a low risk of bias, whereas 3 studies revealed a high risk of bias. Because of the significant heterogeneity between studies, a random effects model was used. The meta-analysis showed that the apical patency resulted in less postoperative pain compared with nonpatency, but the difference was not statistically significant. Moreover, no statistically significant difference was found with regard to analgesic consumption. CONCLUSIONS: Considering the limitations of this study, it was concluded that maintaining apical patency during routine endodontic treatment was not associated with an increased incidence of postoperative pain in adult patients.

Root form and canal morphology of maxillary first premolars of a Yemeni population.

BACKGROUND: The purpose of this study was to investigate variations in the root canal systems of permanent maxillary first premolars in a Yemeni population using a clearing technique. METHODS: Two hundred fifty permanent maxillary first premolar teeth extracted from Yemeni individuals were collected. A small hole in the center of the occlusal surface of each tooth was prepared and pulp tissue was removed by immersion in 5.25% sodium hypochlorite. Teeth were stored in 5-10% nitric acid solution for 5-6 days. Next, teeth were rinsed, dried, and dehydrated using ascending concentrations of ethanol (70, 95, and 100%) successively for 12 h each. Waterproof black ink was injected into the dried dehydrated teeth. Stained teeth were then rendered clear by immersion in methyl salicylate solution (98%) until evaluation. Root canal morphology of each tooth was then examined. RESULTS: 54.8% of teeth were single-rooted, while 44.4% were double-rooted and only 0.8% had three separated roots. The most common canal system configuration was Vertucci type IV (55.6%). Eight specimens of the single-rooted premolars (3.2%) had new canal configurations that have not been recognized in previous published studies. Accessory canals and inter-canal communications were detected in a total of 52.8 and 34.4% of the specimens, respectively. The apical foramen was located centrally to the apex in 84.9% and apical deltas were found in 13.2% of the studied sample. CONCLUSIONS: Yemeni permanent maxillary first premolars are mainly single-rooted and predominantly present Vertucci type IV canal morphology. The finding of additional canal configurations in this study is low but should be kept in mind when performing endodontic therapy for these teeth.

Coronal Microleakage of the Resilon and Gutta-Percha Obturation Materials with Epiphany SE Sealer: An in-vitro Study.

INTRODUCTION: The coronal leakage of bacteria and other irritants to the root canal system is one of the main factors that may result in clinical failure and affect the long term success of endodontic treatment. The Resilon/Epiphany obturation system has been developed as an alternative to gutta-percha and traditional sealers. AIM: This study aimed to evaluate and compare the coronal leakage between Resilon obturation material and gutta-percha using the same sealer. MATERIALS AND METHODS: In this in-vitro study, 72 freshly extracted single-rooted human teeth were used, and were sectioned at CEJ with 13mm length. The roots were randomly divided into four groups. In Group I, 30 roots were obturated using Resilon and Epiphany SE sealer, Group II, 30 roots were obturated using gutta-percha and Epiphany SE. Group III and Group IV, 12 roots were used as control groups (positive and negative). The coronal leakage was measured using the dye penetration technique. Data were statistically analysed by a One-Way ANOVA test. RESULTS: There was a significant difference between the two experimental groups where Resilon revealed less microleakage than gutta-percha group (p <0.05). CONCLUSION: Resilon is a suitable replacement for gutta-percha on the basis of its increased resistance to microleakage, but it failed to provide complete hermetic coronal sealing.

Canal configuration of mandibular first premolars in an Egyptian population.

The purpose of this study was to investigate canal configuration of mandibular first premolars in an Egyptian population. Two hundred fifty human extracted mandibular first premolars were collected from Egyptian patients and a small hole in the center of the occlusal surface of each tooth was made perforating the roof of the pulp chamber. Teeth were decalcified by immersing in nitric acid and dehydrated in ascending concentrations of ethyl alcohol. A waterproof black ink was passively injected from the occlusal hole into pulp system and stained teeth were immersed in methyl salicylate solution for clearing. Standardized pictures of the cleared teeth were obtained and anatomical features of the root canal were observed. The average length of the mandibular first premolar teeth was 22.48 ± 1.74 mm, one-rooted teeth were 96.8% and the two-rooted were 3.2%. Vertucci Type I canal configuration represented the highest percentage (61.2%) followed by Type V (16.4%), Type IV (13.2%), Type II (5.6%) and Type III (2.8%). Vertucci Type VI canal configuration represented the lowest percentage (0.4%) and a complex configuration was found in one tooth. Accessory canals were detected in 22.8% and inter-canal connections were observed in 24.8% while 54% showed apical delta. Such knowledge is clinically useful for localization and negotiation of canals of mandibular first premolar, as well as their subsequent management in Egyptian population.