Incidence of Altered Sensation after Mandibular Premolar and Molar Periapical Surgery.

INTRODUCTION: Altered sensation is a rare but disturbing adverse event after mandibular premolar and molar periapical surgery procedures, and its incidence is not known. The aim of this study was to determine the incidence of altered sensation after periapical surgery procedures in mandibular premolars and molars. METHODS: This retrospective study includes patients who received periapical surgery in endodontic clinics of a university hospital in the United States. Data were obtained by review of the records for patients who met the inclusion criteria, and statistical analysis of possible predictive factors was performed using the 2-tailed Fisher exact test (α = 0.05). RESULTS: Sixty-two patients (63 teeth, 13 premolars and 50 molars) met the inclusion and exclusion criteria and were analyzed in the study. The first follow-up visit occurred 3 to 37 days after surgery. Altered sensation was observed in 9 patients. Observation of altered sensation was significantly higher (odds ratio = 7.19) after premolar surgeries (5/13) compared with molar surgeries (4/50). CONCLUSIONS: Despite the limited size and retrospective nature of this study, it was concluded that the incidence of altered sensation after periapical surgery appears to be relatively high (14%), with a higher incidence found in premolars compared with molars.

Diagnostic Accuracy of 5 Dental Pulp Tests: A Systematic Review and Meta-analysis.

INTRODUCTION: The aim of this systematic review was to investigate and compare the diagnostic accuracy including sensitivity, specificity, adjusted accuracy, adjusted positive predictive value (PPV), and adjusted negative predictive value (NPV) of cold pulp testing (CPT), heat pulp testing (HPT), electric pulp testing (EPT), laser Doppler flowmetry (LDF), and pulse oximetry (PO). METHODS: Three electronic databases were searched from January 1964 to December 2016. True-positive, false-positive, true-negative, and false-negative values were extracted from data in each study. Sensitivity, specificity, adjusted accuracy, adjusted PPV, and adjusted NPV were calculated from those values, if not presented. A random effects model was used to calculate pooled estimates of sensitivity, specificity, adjusted accuracy, adjusted PPV, and adjusted NPV. RESULTS: A total of 125 articles were identified, and 28 studies were included for the final review. The pooled estimates of sensitivity for CPT, EPT, HPT, LDF, and PO were 0.87, 0.72, 0.78, 0.98, and 0.97, respectively. Those of specificity were 0.84, 0.93, 0.67, 0.95, and 0.95, respectively. Those of adjusted accuracy were 0.84, 0.82, 0.72, 0.97, and 0.97, respectively. For adjusted PPV, they were 0.81, 0.89, 0.62, 0.94, and 0.94, respectively, and for adjusted NPV, they were 0.87, 0.80, 0.79, 1.00, and 0.99, respectively. CONCLUSIONS: LDF and PO were the most accurate diagnostic methods, and HPT was the least accurate diagnostic method. EPT showed high accuracy when testing vital teeth (specificity = 0.93) but low accuracy when assessing nonvital teeth (sensitivity = 0.72). CPT had moderate accuracy when evaluating vital (specificity = 0.84) and nonvital (sensitivity = 0.87) teeth.

A Systematic Review of the Survival of Teeth Intentionally Replanted with a Modern Technique and Cost-effectiveness Compared with Single-tooth Implants.

INTRODUCTION: The aim of this study was to investigate the survival rate of teeth intentionally replanted with a modern technique and to compare their cost-effectiveness with that of single-tooth implants. MATERIALS AND METHODS: Four databases were systematically searched for articles that met inclusion criteria published between January 1966 and February 2017. Overall survival rate of intentional replantation was determined through a meta-analysis using a random-effects model. Cost of different procedures was determined from the 2016 American Dental Association Dental Fees Survey. Cost-effectiveness analysis was performed for different treatment modalities. RESULTS: Six studies met the inclusion criteria. Meta-analysis resulted in a survival rate of 89.1% (95% confidence interval, 83.8%-94.4%). Compared with a single-tooth implant, intentional replantation was more cost-effective even when custom post/core and crown are also needed. CONCLUSION: The meta-analysis revealed a high survival rate for intentional replantation. Although the survival rate of implants is higher, intentional replantation is a more cost-effective treatment modality. Intentional replantation should be a treatment option discussed with patients, especially because an implant can still be placed if intentional replantation is unsuccessful.

Synthesis of (±)-acetylnorloline via stereoselective tethered aminohydroxylation.

Loline alkaloids exhibit a strained ether-bridged pyrrolizidine skeleton and possess insecticidal and insect antifeedant properties. The synthesis of acetylnorloline, a prototypical member of the alkaloid family, is described. Central to the route is a stereoselective tethered aminohydroxylation (TA) of a homoallylic carbamate. Allylic (A1,3) strain is exploited to enforce diastereofacial selectivity during the aminohydroxylation.