Topography of root-end surface after freehand and three-dimensional-guided apicoectomy procedure: A scanning electron microscope study.

Background: Dentinal microcracks formed during apical resection may lead to increased susceptibility to root fracture and improper sealing of apical preparation that may negatively influence the outcome of endodontic microsurgery. Aims: This study was performed to analyze the root-end surface for dentinal microcracks using a scanning electron microscope (SEM) after resection with high-speed bur and trephine drill. Materials and Methods: Thirty extracted single-rooted maxillary premolar teeth were selected and randomly distributed into two groups (n = 15). Working length was established using a #15 K-type file. Canals were prepared with a rotary Ni-Ti system to size 30/0.06 using endomotor, irrigated with 3% sodium hypochlorite, dried with paper points, and obturated with gutta-percha cones using a single-cone technique. All samples were mounted on preformed molds and poured using a mixture of sawdust and gypsum. In Group A; tungsten carbide bur was used to perform a freehand apicoectomy. In Group B; a trephine drill was used with a three-dimensional guide to perform 3 mm of root resection. Apicoectomy was performed in both groups under a dental operating microscope. Resected root ends were inspected for microcracks using SEM. The Shapiro-Wilk and Mann-Whitney U-test were used for statistical analysis. Results: Microcracks were observed in all samples in both study groups. Trephine drill produced more microcracks on the resected root surface compared to the use of high-speed tungsten carbide bur with a statistically significant difference (P < 0.05). Conclusions: The trephine drill used during targeted endodontic microsurgery produced more microcracks on the resected root dentine surface compared to the high-speed tungsten carbide bur used during freehand apicoectomy.

Novel cryotherapy technique for pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis- a randomized controlled trial.

OBJECTIVES: To assess the effect of cryotherapy on haemostasis, post-operative pain, and the outcome of full pulpotomy performed in mature permanent teeth with symptomatic irreversible pulpitis. MATERIALS AND METHODS: The study included sixty mature permanent mandibular molar teeth with symptomatic irreversible pulpitis and no periapical rarefaction. After coronal pulp tissue amputation, teeth were randomly allocated to one of two groups (n = 30 each). In group I (conventional pulpotomy), a sterile cotton pellet moistened with 2.5% NaOCl was used for haemostasis. In group II (cryotherapy), the pulp chamber was continuously lavaged with 2.50C normal saline solution for haemostasis using an indigenous portable cryotherapy irrigation unit. Following haemostasis, the pulp was capped with mineral trioxide aggregate and the tooth was restored with resin composite. The time taken to achieve haemostasis was recorded. Preoperative and 24, 48 and 72 h postoperative pain was measured using the Numerical Rating Scale. The pulpotomy outcome was assessed at the 12-month follow-up. Data were analyzed using Fischer's exact test, two-sample t-test, two-sample Wilcoxon rank-sum test, Friedman Test, and Wilcoxon Signed Rank Test. RESULTS: The cryotherapy group achieved haemostasis in less time (p < 0.05). There was a significant pain reduction at 24 and 48 h in the cryotherapy group when compared with the conventional pulpotomy group (P < 0.005). The overall success rate of pulpotomy after 12 months was 88% (n = 22) in both study groups(p < 0.05). CONCLUSIONS: Cryotherapy application reduces postoperative pain and has no adverse effect on the outcome of pulpotomy in permanent teeth with symptomatic irreversible pulpitis. CLINICAL RELEVANCE: The cryotherapy can be incorporated in pulpotomy protocol as an adjunct to minimize post-operative pain.

Comparative evaluation of full and partial pulpotomy in permanent teeth with irreversible pulpitis: A systematic review and meta-analysis.

The purpose of this systematic review and meta-analysis is to conduct a comparative evaluation of partial and full pulpotomy techniques in cariously exposed teeth with symptoms indicative of symptomatic irreversible pulpitis. Databases such as PubMed, EMBASE, Cochrane, and Web of Science were searched. Studies evaluating and/or comparing clinical and/or radiographic success of partial and full pulpotomy in teeth diagnosed with irreversible pulpitis with a minimum of 12 months follow-up were included. The risk of bias (ROB) tool was used for the assessment of ROB. A meta-analysis was conducted to compare the healing outcome of partial and full pulpotomy. Three studies fulfilled the inclusion criteria, there was a low risk of bias in each of the five domains. Full pulpotomy had a higher success rate than partial pulpotomy, according to meta-analysis, but the difference was not statistically significant.

Influence of the severity of periodontal disease on the outcome of non-surgical endodontic therapy: A prospective cohort study.

OBJECTIVE: To investigate the influence of severity of periodontal disease on periapical healing after non-surgical endodontic therapy (NSET). MATERIAL AND METHODS: In this prospective study, subjects (n = 45) requiring NSET in a mandibular molar tooth with the diagnosis of pulp necrosis and asymptomatic apical periodontitis exhibiting radiographic periapical index (PAI) score ≥ 3 and concomitant endodontic periodontal lesion (CEPL) without communication were enrolled. After dividing as per the classification of Periodontal and Peri-Implant Diseases and Conditions, subjects were equally allocated into three groups. Group I- only endodontic lesion {control: healthy periodontium (n = 15)}, Group II- CEPL having stage I and II periodontitis (n = 15) and Group III- CEPL having stage III periodontitis (n = 15). Standardized two-visit NSET was performed with 2% chlorhexidine gel as an intracanal medicament. Periodontal therapy was instituted wherever required. Subjects were recalled at 6-and 12-months for clinical and radiographic assessment. Chi-square test was performed to evaluate the difference between the groups. RESULTS: At 12-month follow-up, all teeth in the three study groups were asymptomatic. On radiographic evaluation of the periapical region, healing was observed in 80%, 47% and 50% of teeth in Groups I, Group II and Group III, respectively. However, the difference was not statistically significant between the groups (p = 0.150). CONCLUSION: The severity of periodontal disease had no influence on periapical healing after NSET in teeth with concomitant endodontic periodontal lesions without communication. CLINICAL RELEVANCE: Periodontal disease has significant impact on apical periodontitis however severity of the periodontitis does not negatively impact the apical periodontitis.

Influence of intracanal medicaments on the periodontal and periapical healing in concurrent endodontic-periodontal lesions with/without communication: a systematic review and meta-analysis.

OBJECTIVES: The purpose of this review is to determine the effectiveness of intracanal medicament (ICM) on periodontal and periapical healing (PH) of concurrent endodontic-periodontal lesions with/without communication in permanent teeth. MATERIALS AND METHODS: The pre-defined protocol was registered in PROSPERO, and a literature search using keywords was conducted on PubMed, Scopus, Cochrane, Embase electronic databases, and Gray literature and was hand-searched until August 2023. Two reviewers independently screened the title and abstracts using the inclusion criteria. Randomized or non-randomized clinical trials, cohort studies, and case-control studies were included in the review. The same reviewers extracted the study-level data and assessed the risk of bias using the Cochrane Risk of Bias 2.0 and the Newcastle-Ottawa Scale (NOS) independently. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to assess the certainty of evidence. Random effects meta-analysis was performed on eligible studies using Revman software. RESULTS: A total of 598 records were identified from the database search; seven studies met the inclusion criteria and were included in the review. Four randomized clinical trials, two prospective cohorts, and one retrospective case-control study with 362 patients were included. Calcium hydroxide (CH) was the most commonly used ICM, followed by using chlorhexidine gel in four studies. Periodontal therapy was performed as initial scaling and root planning (SRP) in all studies, along with open flap debridement (OFD) in three randomized clinical trials. The time lapse between two treatment protocols was variable (ranging from 1 week to 3 months). All studies exhibited a decrease in probing depth (PD) and an increase in clinical attachment level (CAL) after the treatment. Meta-analysis showed insignificant differences between different ICM materials, and the certainty of evidence was low. CONCLUSION: In patients with/without concurrent endodontic-periodontal lesions, intracanal medication improved clinical periodontal parameters following endodontic therapy. In terms of influence on periapical healing, the results were inconclusive. CLINICAL RELEVANCE: Two-visit RCT may be considered since it allows for the placement of an ICM in endodontic-periodontal lesions with/without communication. Sufficient time should be allowed after endodontic therapy for any potential periodontal regeneration to occur.

Selective Removal to Soft Dentine versus Full Pulpotomy for Management of Proximal Deep Carious Lesions: A Randomized Controlled Non-Inferiority Trial.

The management of the deep carious lesion with reversible pulpitis is a dilemma for the dentist. The current study compared selective removal to soft dentine (SRSD) and full pulpotomy (FP) for treating proximal deep carious lesions in teeth with reversible pulpitis. Visual-tactile examination and bitewing radiographs were used to determine the depth of carious lesion, and American Association of Endodontists recommendations were used to formulate pulp diagnosis. Sixty mandibular molar teeth from healthy patients between the ages of 16-35 years and a diagnosis of proximal deep carious lesion with reversible pulpitis were included. Teeth were randomly allocated to two study groups. SRSD group (n = 30): soft dentine was preserved over the pulpal aspect. A hard-setting calcium hydroxide cement liner and resin-modified glass ionomer cement base were applied over the remaining soft carious dentine. FP group (n = 30): complete caries removal followed by mineral trioxide aggregate FP was performed. The teeth in both groups were restored with composite resin restoration. The established criteria for outcome assessment of SRSD and pulpotomy were used. Accordingly, only asymptomatic teeth with no radiological evidence of periapical rarefaction were considered successful at the 12-month follow-up. Two-sample t test, Pearson χ2 test/Fisher's exact test, and percentage agreement were used for statistical evaluation. According to the per-protocol analysis, the success rate of both SRSD and FP treatment was 95.45% and 95.65%, respectively, and the actual difference between the two treatments was 1% (95% CI: [-10, 9]). The data suggests that both treatments (SRSD and FP) appear to have a good success rate (>95%) when used to manage permanent mandibular molar teeth with proximal deep carious lesion and reversible pulpitis. As SRSD is a noninvasive procedure, it should be favored over FP in these instances.

Influence of the restoration after pulpotomy on the strength of electrical stimulus reaching the pulp space: An in vitro investigation.

Introduction: The study evaluated the influence of coronal restoration after pulpotomy on the strength of electrical stimulus reaching the radicular pulp using an electric pulp test (EPT). Materials and Methods: The pulp tissue from ten freshly extracted mandibular premolar teeth was removed and replaced with an electroconductive gel. The cathode probe of Powerlab was inserted into the pulp space and the anode probe was attached to the EPT handpiece. The EPT probe coated with electro-conducting material was positioned in the middle third of the buccal crown surface. The EPT stimulus reaching the pulp space of an intact tooth at 40 numerical readings was recorded. The tooth was removed from model and endodontic access was made. The 2-mm thick mineral trioxide aggregate was placed at the cementoenamel junction followed by composite resin restoration. The experimental setup was re-established and postpulpotomy EPT stimulus data were recorded. The data collected were compared using the Wilcoxon signed-rank test. Results: There was a statistically significant difference (P = 0.038) between observed between the strength of EPT stimulus reaching the pulp space in prepulpotomy (mean 91.18 ± 101.02 V and median 25.79 V) and postpulpotomy (mean 58.49 ± 77.13 V and median 13.75 V) tooth samples. Conclusion: The placement of the restoration and pulp capping agent after pulpotomy dampens the strength of EPT stimulus reaching the pulp canal space.

Effect of Intracanal Scaffolds on the Success Outcomes of Regenerative Endodontic Therapy - A Systematic Review and Network Meta-analysis.

INTRODUCTION: The scaffolds used in regenerative endodontic therapy (RET) provide structural support for cells so that they can adhere to the scaffolds and also are crucial for cellular proliferation and differentiation. The objective of this network meta-analysis was to compare effects of different intracanal scaffolds on success outcomes of RET. METHODS: PubMed/Medline, EMBASE, Cochrane, CINAHL, Scopus, and Web of Science databases were searched. Studies evaluating and/or comparing clinical and/or radiographic success of RET using different scaffolds with a minimum of 12 months follow-up were included. The Cochrane Collaboration risk of bias (ROB) tool and appropriate tools from Joanna Briggs Institute were used for the assessment of ROB. A network meta-analysis was performed to compare the primary outcome (clinical success) and other success outcomes (root maturation, and pulpal sensibility) using different scaffolds. RESULTS: Twenty-seven studies fulfilled the desired inclusion criteria of which 25 had a low ROB whereas 2 had a moderate ROB. Clinical success of RET using platelet-rich plasma (PRP), blood clot (BC), and platelet-rich fibrin (PRF) scaffolds ranged between 91.66%-100%, 84.61%-100%, and 77%-100% respectively. The different scaffolds did not show any statistically significant difference in clinical success (PRF vs BC [P = 1.000], PRP vs BC [P = 1.000], and PRF vs PRP [P = .999]), apical root closure (PRF vs BC [P = 1.000], PRP vs BC [P = .835], PRF vs PRP [P = .956]), and pulp sensibility (PRF vs BC [P = .980], PRP versus BC [P = .520], and PRF vs PRP [P = .990]). CONCLUSION: The intracanal scaffolds used during RET did not result in significant differences in regard to clinical success, root maturation, and pulpal sensibility.

Outcome and associated predictors for nonsurgical management of large cyst-like periapical lesions: A CBCT-based prospective cohort study.

AIM: The aim of this cone-beam computed tomography (CBCT)-based study was to evaluate the outcome of nonsurgical root canal treatment (RCT) performed for the management of large cyst-like periapical lesions (LCPL) and to identify the predictive factors affecting healing. METHODOLOGY: Fifty-four subjects (77 permanent maxillary anterior teeth) with LCPL (>10 mm) of endodontic origin were included. A single operator performed standardized multi-visit RCT. Patients were clinically and radiographically examined at 6, 12 months, and a CBCT scan was taken at 24 months. Two independent blinded evaluators measured the pre- and postoperative volume of periapical lesions on CBCT scans using ITK snap software (version 3.8.0-beta-20181028-win64). The outcome was assessed as a percentage change in lesion volume and dichotomized as success (resolved/reduced) or failure (unchanged/enlarged). Ten preoperative (gender; age; intraoral draining sinus, soft tissue swelling, tooth discoloration, pulp canal obliteration, open apex, root resorption, cortical bone defect and lesion volume) and four intraoperative (apical extent and density of root filling; number of treatment visits and type of root filling) predictive factors were observed. Bivariate and stepwise multivariable linear regression analysis was performed to identify independent predictors affecting treatment outcomes. The significance level was set at 5%. RESULTS: A recall rate of 88% was achieved. The success rate of RCT was 82.2% (8.9% resolved, 73.3% reduced). Median lesion volume reduction was 75% (IQR 61%-93%). No pre- or intra-operative factors were related to treatment failure. However, presence of preoperative cortical bone defect (palatal versus no cortical defect, ß = -51.5; 95% CI: -86.9 to -16, p = .006) and apical extent of obturation (long versus flush, ß = -27.2; 95% CI: -53.8 to -0.6, p = .04) were negatively associated with reduction in lesion volume (%). CONCLUSION: Large cyst-like periapical lesions may be successfully managed with RCT. Preoperative cortical bone defect and apical extent of obturation may negatively influence osseous healing.

3D geometric analysis of second mesiobuccal canal in permanent maxillary first molar tooth.

Cone-beam computed tomography scans exhibiting a second mesiobuccal (MB2) canal were examined. The vertical distance of the MB2 orifice from the pulp floor (depth), inter-orifice distance (IOD) of MB2 from mesiobuccal (MB) and palatal (P) orifices, the horizontal distance of the MB2 orifice from the line joining MB-P orifices [mesial deviation (MD)] and root canal configuration (RCC) were evaluated on 330 scans. The Student's t-test, ANOVA, Spearman's correlation and linear regression analysis were applied. The MB2 depth was 1.69 ± 0.86 mm. IOD (MB-MB2, MB2-P) was 2.18 ± 0.58 mm and 4.63 ± 1.06 mm, respectively. MD was 1.02 ± 0.37 mm. The predominant RCC was Vertucci's type II (75.5%). No correlation of depth with IOD of MB-MB2 (rho = 0.0367, p = 0.506) was observed. Significant correlation of depth with IOD of MB2-P (rho = 0.696, p < 0.001) and MD (rho = 0.174, p = 0.001) was established. No association of depth with age and IOD (MB-MB2) was observed on linear regression analysis. However, a significant positive association was established with IOD (MB2-P) (p < 0.001) and MD (p = 0.001).

Flow characteristics of positive and negative pressure irrigation in an immature tooth - A computational fluid dynamics study.

Aim: This study aims to investigate the irrigation dynamics in an immature tooth during positive and negative pressure irrigation using a computational fluid dynamics (CFDs) model. Materials and Methods: Cone-beam computed tomography scan of the maxillary central incisor with Cvek's stage III root development was used for the reconstruction of the root canal geometry. The computer-aided design models of open (front vent and notched) and closed (side vent [SV]) needles were positioned inside the root canal at two penetration depths, i.e., 3 mm and 1 mm short of apex. The negative pressure microcannula (MiC) was positioned at the level of the root apex. A prevalidated CFD model was used to simulate endodontic irrigation. Results: The irrigant velocity in the apical root canal beyond the needle tip exceeded 0.1 m/s. As the needles were positioned closer to the apex, the wall shear stress (WSS) increased for the open-ended needles and decreased for the SV needle. MiC produced the lowest WSS. The mean apical pressure produced by the SV needle and MiC were below the critical threshold for periapical extrusion. Conclusions: The SV needle inserted within 1-3 mm of root apex during endodontic irrigation in an immature tooth allows adequate irrigant exchange with minimal risk of periapical extrusion.

Indices for the assessment of radiation-related caries.

Radiation therapy, either used alone or in combination with surgery and or chemotherapy, is the most commonly utilized modality for treating head and neck cancers. Patients undergoing radiation therapy usually experience significant early and late-onset toxicities/adverse effects. Radiation-related caries (RRC) is a common complication that detrimentally affects patients' quality of life (QoL). A clearer understanding and more uniform approach to scoring systems help provide a more accurate diagnosis, form treatment protocols, plan, and evaluate outcomes of preventive initiatives and create scientific databases. Many indices have been used to assess and quantify the dental caries experience after radiotherapy. Considering the need for uniform standards for measuring radiation caries, indices specific to radiation caries have been proposed in the literature to capture postradiation damage to the dentition accurately. This narrative review aims to consolidate the evolution of different indices used for scoring RRC to improve the understanding of radiation caries assessment.

Effect of body temperature on the cyclic fatigue resistance of the nickel-titanium endodontic instruments: A systematic review and meta-analysis of in vitro studies.

Aim: The aim of this systematic review was to compare the effect of body temperature (I) on the cyclic fatigue resistance (O) of nickel-titanium (NiTi) endodontic instruments (P) to that of room temperature (C). Methods: The study was registered in the PROSPERO database (CRD42020204286). A systematic search in PubMed, Scopus, Web of Science, Google Scholar, and OpenGrey was conducted in English until December 31, 2021. In vitro studies comparing the cyclic fatigue resistance of NiTi instruments at the body (35°C ± 2°C) and room temperature (20°C-25°C) were included. Eligible studies were evaluated for risk of bias and meta-analyzed to estimate the effects. Results: Twenty-one studies out of 347 met the criteria for inclusion. The meta-analysis included six studies (n = 215) with comparative study parameters. The overall effect sizes (5.49; 95% confidence interval [CI]: 4.04-6.93) were significantly different (P < 0.001), indicating that the mean values at room temperature were significantly (P < 0.001) higher. The effect sizes for full rotary motion (standardized mean difference [SMD]: 4.80; 95% CI: 3.04-6.56) and reciprocating motion (SMD: 6.37; 95% CI: 3.63-9.11) were not significantly different (P = 0.346). Heterogeneity was high (I 2 = 94%). Sensitivity analysis revealed that the SMD values were not significantly different (P > 0.05) from the overall effect size, indicating that none of the studies had an effect on the overall effect size. Conclusions: Within the limitation of the study, the cyclic fatigue resistance of heat-treated NiTi endodontic files is significantly reduced at body temperature when compared to room temperature. Cyclic fatigue testing should be conducted at simulated body temperature.

Cone Beam Computed Tomographic Cone beam computed tomographic characterization of short root anomaly in chloroquine-induced Stevens-Johnson Syndrome - a case report.

Stevens-Johnson syndrome (SJS) is a rare medical condition with severe mucocutaneous reaction due to infection or adverse drug reaction. The present case reports the impact of chloroquine-induced SJS on the tooth root development. A 20-year-old Indian male reported to conservative dentistry and endodontics speciality clinic with the chief complaint of food lodgement and sensitivity in maxillary and mandibular posterior teeth. He had a past medical history of severe cutaneous reaction after taking Tab. Lariago (chloroquine) for treatment of malarial fever at the age of 8 years. The acute inflammatory immune response was managed by hospitalization and administration of steroids and anti-inflammatory drugs. Clinical examination revealed dry mucosa, carious teeth with adequate oral hygiene. Panoramic X-ray showed multiple teeth with short roots. A detailed cone beam computed tomographic scan (CBCT) demonstrated a healthy bone trabecular pattern with the absence of any periapical radiolucency. Short, blunt roots with immature apex were seen in many teeth. Based upon the measurement of root to the crown ratio on the CBCT scan and correlating the development status of teeth with the medical history, a diagnosis of short root anomaly (SRA) after chloroquine-induced SJS was made. This is the first report to describe the three-dimensional features of teeth with SRA in a patient with SJS. Diagnostic, restorative, and endodontic implications of SJS are highlighted.

Effects of type 2 diabetes on the viscoelastic behavior of human trabecular bone.

Type 2 diabetes (T2D) is a well-known disease that impaired bone mechanical properties and increases the risk of fragility fracture. The bone tissue is a viscoelastic material that means the loading rate determines its mechanical properties. This study investigates the impact of T2D on the viscoelastic properties of human bone and its association with microstructure and biochemical properties. INTRODUCTION: Viscoelasticity is an important mechanical property of bone and for this the interaction of individual constituents of bone plays an important role. The viscoelastic nature of bone can be affected by aging and diseases, which can further influence its deformation and damage behavior. METHODS: The present study investigated the effects of T2D on the viscoelastic behavior of trabecular bone. The femoral heads of T2D (n = 26) and non-T2D (n = 40) individuals with hip fragility fractures were collected for this investigation. Following the micro-CT scanning of all bone samples, the stress relaxation and dynamic mechanical analysis (DMA) tests were performed to quantify the viscoelasticity of bone. Further, a correlation analysis was performed to investigate the effects of alteration in bone microstructural and biochemical parameters on viscoelasticity. RESULTS: The stress relaxation and frequency sweep responses of T2D and non-T2D trabecular bone specimens were not found significantly different. However, the storage modulus, initial stiffness, and initial stress were found lower in T2D bone. The significant correlation of percentage stress relaxed is obtained between the mineral content (r= - 0.52, p-value = 0.003), organic content (r = 0.40, p-value = 0.02), and mineral-to-matrix ratio (r = - 0.43, p-value = 0.009). Further, storage and loss modulus were correlated with bone volume fraction (BV/TV) for both groups. The stress relaxation and frequency sweep characteristics were not found significantly connected with the other chemical, structural, or clinical parameters. CONCLUSION: This study suggests that T2D does not affect the time-dependent response of human femoral trabecular bone. The viscoelastic properties are positively correlated with organic content and negatively correlated with mineral content.

A Novel Approach to Repositioning and Stabilization of a Luxated Tooth With Displacement Using a 3D Printed Guide.

The management of traumatic dental injury aims at functional and esthetic rehabilitation. After luxation injury, a displaced tooth must be replaced into its normal position as soon as possible. Incorrect tooth repositioning can cause discomfort to the patient and compromise the outcome. This report documents a novel digital technology-based approach for the management of teeth following luxation injury with displacement. A 25-year-old female reported 2 days after traumatic dental injury to her maxillary right central incisor tooth #8. After clinical and radiographic examination, a diagnosis of lateral luxation of tooth #8 was made. The preoperative high-resolution cone-beam computed tomography (CBCT) image data set confirmed palatal luxation of tooth #8 with fractured and displaced labial cortical plate. The CBCT data were imported into a medical image processing software program, and a segmentation tool was used to segment the fractured cortical plate, luxated tooth, and alveolar process. The socket is reconstructed by realigning fractured cortical bone over the alveolar process and repositioning the tooth in the virtual planning software. A three-dimensional (3D) guiding template was designed over the repositioned tooth and adjacent teeth and printed. This 3D printed guide was used for the repositioning of luxated tooth #8 and stabilizing it during the splinting procedure. This technique of using CBCT and 3D guide for repositioning is an objective, precise, and predictable approach. The 3D printed model of the dental arch after virtual tooth alignment can be used by the dentist to determine the exact splint length and contour before splinting.

Quality and accuracy of patient-oriented Web-based information regarding tooth avulsion.

BACKGROUND/AIM: Tooth avulsion (TA) is a severe form of traumatic dental injury. The tooth's prognosis depends on the immediate measures taken. First responders are often laypeople, and the Internet is a favored platform to access health-related information. The aim of this descriptive study was to evaluate the accuracy, quality, readability, and popularity of patient-oriented web information regarding the emergency management of TA. METHODS: Three search engines (Google, Bing, and Yahoo.com) were browsed with six VPNs using "knocked out tooth," "fallen out tooth," and "tooth avulsion" as keywords. The top 20 results for each were evaluated. Webpages were included if they had information oriented to caregivers. They were analyzed for accuracy (cutoff ≥95%). Quality of web pages was assessed using DISCERN and the Journal of the American Medical Association (JAMA) benchmark. Readability was evaluated using Flesch-Kincaid Grade Level (FKGL), Gunning Fog (FOG), Coleman-Liau Index (CLI), and Simple Measure of Gobbledygook (SMOG). Popularity was assessed by Alexa Popularity Rank (APR). Accurate and inaccurate webpages were compared using chi-square analysis and the Mann-Whitney U test. Spearman's correlation between the studied metrics was established. A p < .05 was considered significant. RESULTS: Seventy-two webpages were included, of which 23 (32%) were accurate. The median DISCERN ratings for accurate and inaccurate webpages were 3.0 [2.5-3.0] and 3.0 [2.0-3.0], respectively (p = .331). Ten (44%) accurate and 12 (24.5%) inaccurate webpages had high-quality JAMA (p = .089). The median readability scores for accurate webpages were FKGL (8 [6.75-9.2]), FOG (10.6 [9.55-12.3]), CLI (7 [6-7]), SMOG (6.7 [6.15-7.5]), while scores for the inaccurate webpages were FKGL (7.85 [6.275-8.525]), FOG (10.55 [8.875-11.425]), CLI (7 [7-8.25]), and SMOG (7 [6.2-7.925]), with a higher CLI score for inaccurate webpages (p = .0035). The median APRs for accurate and inaccurate webpages were 1,02,538 [26,852-14,43,755] and 7,63,190 [2,19,799-29,92,067], respectively (p = .163). Accuracy had a positive correlation with quality (DISCERN: rho = .293, p = .013; JAMA: rho = .249, p = .036), while popularity (APR) was negatively correlated with quality (DISCERN: rho = -.330, p = .013; JAMA: rho = -.287, p = .032). CONCLUSION: Relevant webpages were limited and had low accuracy. This can impact the emergency management by laypeople and adversely affect the prognosis following avulsion.

Deep learning for categorization of endodontic lesion based on radiographic periapical index scoring system.

OBJECTIVE: The study aimed to apply convolutional neural network (CNN) to score periapical lesion on an intraoral periapical radiograph (IOPAR) based on the periapical index (PAI) scoring system. MATERIALS AND METHODS: A total of 3000 periapical root areas (PRA) on 1950 digital IOPAR were pre-scored by three endodontists. This data was used to train the CNN model-"YOLO version 3." A total of 450 PRA was used for validation of the model. Data augmentation techniques and model optimization were applied. A total of 540 PRA on 250 digital IOPAR was used to test the performance of the CNN model. RESULTS: A total of 303 PRA (56.11%) exhibited true prediction. PAI score 1 showed the highest true prediction (90.9%). PAI scores 2 and 5 exhibited the least true prediction (30% each). PAI scores 3 and 4 had a true prediction of 60% and 71%, respectively. When the scores were dichotomized as healthy (PAI scores 1 and 2) and diseased (PAI score 3, 4, and 5), the model achieved a true prediction of 76.6% and 92%, respectively. The model exhibited a 92.1% sensitivity/recall, 76% specificity, 86.4% positive predictive value/precision, and 86.1% negative predictive value. The accuracy, F1 score, and Matthews correlation coefficient were 86.3%, 0.89, and 0.71, respectively. CONCLUSION: The CNN model trained on a limited amount of IOPAR data showed potential for PAI scoring of the periapical lesion on digital IOPAR. CLINICAL RELEVANCE: An automated system for PAI scoring is developed that would potentially benefit clinician and researchers.

Response to Pulp Sensibility Tests after Full Pulpotomy in Permanent Mandibular Teeth with Symptomatic Irreversible Pulpitis: A Retrospective Data Analysis.

INTRODUCTION: This retrospective study analyzed the 12-month pulp sensibility (cold and electric) test response after mineral trioxide aggregate (MTA) full pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis. METHODS: The records of 120 subjects from 3 completed and 1 ongoing clinical study on MTA full pulpotomy were retrieved. Ninety-six first and second mandibular molar teeth with a diagnosis of symptomatic irreversible pulpitis that underwent a single-visit MTA full pulpotomy and had completed a 12-month clinical, radiographic, and pulp sensibility (cold and electric) test follow-up were included. The data were analyzed using the Fisher exact test, the Pearson chi-square test, and the McNemar test. The significance level was predetermined at P < .05. RESULTS: A higher percentage of teeth (94.7%) responded to the electric pulp test in comparison with the cold test (13.5%) (P < .05). Sex-based responses to the electric pulp test (P > .05) and the cold test were similar (P > .05). The age-based response was similar for the electric pulp test (P > .05) but was significant for the cold test (P < .05). The tooth quadrant (left and right), the tooth (mandibular first and second molar), and the location of restoration (proximal or occlusal) did not influence the response of either the electric pulp test (P > .05) or the cold test (P > .05). At the 1-year follow-up, all the teeth that were classified as clinically and radiographically successful responded to the electric pulp test; however, only 13 teeth responded to the cold test (P = .00). CONCLUSIONS: The majority (94.7%) of the teeth that underwent MTA full pulpotomy responded to the electric pulp test at a 1-year time interval.

Parental awareness of on-site management of traumatic dental injuries: An online survey.

Background: Despite the high prevalence of traumatic dental injuries (TDIs), parents generally lack awareness about dental trauma emergency management. This preliminary study's goal was to assess parents'/guardians' awareness of the treatment of tooth fractures/avulsion. Materials and Methods: A preformed questionnaire in e-format was sent to parents of school-going children. Kolmogorov-Smirnov test and Shapiro-Wilks's test were employed to test the normality of data. In addition, a Chi-square test was performed for quantitative variables. P ≤ 0.05 was considered statistically significant. Results: A response rate of 82.1% was achieved. Approximately 19.6% of parents reported dental injuries, with the majority (51.9%) occurring at home. In avulsion, 54.8% of parents believed that reinserting the tooth back into the socket was possible. For tooth fractures, 36.2% of parents believed that the fractured tooth could be glued. Tap water was preferred as a storage medium (43.3%). An insignificant association was observed with regard to storage media (P > 0.05). Conclusion: Inadequate understanding of the treatment of TDI by the primary caregiver leads to ineffective interventions at the scene of the accident and a poor prognosis for otherwise treatable cases.