Regenerative endodontic procedures: are they more successful in mature permanent teeth with necrotic pulp than in immature teeth?

DATA SOURCES: Five scientific databases were electronically searched: PubMed, EMBASE, OpenGrey, Web of Science and Cochrane Library.  The search was conducted until 17 February 2022 without any restriction on date of publication but was restricted to English language. Relevant studies were also screened for related publications. The aim of this systematic review and meta-analysis was to evaluate the effectiveness of regenerative endodontic procedures (REPs) in mature and immature permanent teeth with necrotic pulp and to evaluate if the success rate was affected by the stage of root development. STUDY SELECTION: Types of studies: all of the included studies were randomised controlled trials (RCTs). TYPES OF PARTICIPANTS: people with necrotic permanent teeth (immature or mature) treated with regenerative endodontic procedures. Types of interventions: regenerative endodontic procedures. Language: RCTs published in English. EXCLUSION CRITERIA: Types of studies: (1) case reports, (2) retrospective cohort trials, (3) prospective cohort trials, (4) animal trials, (5) in-vitro trials, (6) non-randomised trials. POPULATION: primary teeth. Types of interventions: no details about the clinical procedures. Follow-up period: <6 months. DATA EXTRACTION AND SYNTHESIS: The titles and abstracts of the RCTs identified by the search strategies were independently screened by two reviewers. After the initial screening, the full text of the relevant trials were reassessed against the inclusion and exclusion criteria. Discrepancies and disagreements were resolved by consensus after including a third reviewer. RESULTS: Following the initial electronic and manual searches, a total of 3766 articles were initially identified. This was reduced to 2739 articles after duplicates were removed. However, after the initial screening phase, 35 articles were considered potentially relevant and qualified for full-text scrutiny. Out of the 35 articles, only 27 were considered eligible for inclusion. The differences in the success rate and the asymptomatic rate between the mature and immature permanent teeth with necrotic pulp were not statistically significant. However, the differences between the two groups were statistically significant in the rate of positive response to electrical pulp testing. CONCLUSIONS: Based on the results of this systematic review and meta-analysis, the authors concluded that REPs are an effective therapy and can achieve high success rates for both mature and immature necrotic permanent teeth. It was also concluded that the REPs were more successful in regaining vitality responses for mature compared with immature permanent teeth with necrotic pulps.

Artificial intelligence: is it more accurate than endodontists in root canal therapy?

DATA SOURCES: The following databases were electronically searched (up to 20 March 2022): PubMed, Scopus, Google Scholar, and Cochrane Library. This was followed by hand-searching the reference lists of the included articles. The search was restricted to articles published in English. The aim of this study was to evaluate the effectiveness of artificial intelligence in identifying, analyzing, and interpreting radiographic features related to endodontic therapy. STUDY SELECTION: The selection criteria were limited to trials evaluating the effectiveness of artificial intelligence in identifying, analyzing, and interpreting radiographic features related to endodontic therapy. TYPES OF STUDIES: Clinical, ex-vivo, and in-vitro trials. TYPES OF RADIOGRAPHIC IMAGES: Two-dimensional intra-oral imaging (bitewings and/or periapicals), panoramic radiographs (PRs), and cone beam computed tomography (CBCT). EXCLUSION CRITERIA: 1) Case reports, letters, and commentaries; 2) Reviews, conferences, and books; 3) Inaccessible reports. DATA EXTRACTION AND SYNTHESIS: The titles and abstracts of the results of the searches were screened by two authors against the inclusion criteria. The full text of any potentially relevant abstract and title were retrieved for more comprehensive assessment. The risk of bias was assessed initially by two examiners and then by two authors. Any discrepancies were resolved through discussion and consensus. RESULTS: Out of the 1131 articles which were identified in the initial search, 30 were considered relevant, and only 24 articles were eventually included. The exclusion of the six articles was related to the absence of appropriate clinical or radiological data. Meta-analysis was not performed due to high heterogeneity. Various degrees of bias were detected in more than 58% of the included studies. CONCLUSIONS: Although most of the included studies were biased, the authors concluded that the use of artificial intelligence can be an effective alternative in identifying, analyzing and interpreting radiographic features related to root canal therapy.

INTRA-CANAL ANTIBIOTIC PASTES MAY PROMOTE THICKER DENTIN WALLS AND CALCIUM HYDROXIDE MAY PROMOTE MORE APICAL CLOSURE.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Báez, Viviana; Corcos, Lorena; Morgillo, Florencia; Imperatrice, Lorena; Gualtieri, Ariel Félix (2022). Meta-analysis of regenerative endodontics outcomes with antibiotics pastes and calcium hydroxide. The apex of the iceberg. J Oral Biol Craniofac Res 12(1): 90-98. SOURCE OF FUNDING: Non-funded study TYPE OF STUDY/DESIGN: Systematic review and meta-analysis.

Latrine Utilization and Its Associated Factors Among Community Led Total Sanitation Implemented and Non-Implemented Kebeles of Tullo District, West Hararge, Eastern Ethiopia.

Background: Improper human waste management is a major health problem in most developing countries, including Ethiopia. In Ethiopia, the majority of the population used unimproved sanitation facilities and practiced open defecation. This problem is significantly higher in the rural parts of the country. Objective: The aim of this study was to assess latrine utilization and associated factors among Community Led Total Sanitation (CLTS) implemented and non-implemented kebeles in Tullo District, West Hararghe, and Eastern Ethiopia. Methods: A community-based comparative cross-sectional study design was conducted in 740 households in 3 kebeles Community Led Total Sanitation implemented and 3 kebeles non-Community Lead Total Sanitation implemented for comparison. Study units were selected using a multi-stage sampling technique. The data was cleaned and coded before being entered into Epi-data version 3.1 and analyzed with the Statistical Package for the Social Sciences version 20. Logistic regression analysis was used to assess the association between dependent and independent variables. Result: In this study, the overall prevalence of latrine utilization in the study area was 415 (56.1%) (95% CI = 52.6%, 59.9%). Of them, 243 (65.7%) (95% CI = 60.4%, 70.3%) and 172 (46.5%) (95% CI = 41.3%, 51.7%) of participants in the CLTS and non CLTS kebeles were utilized latrine, respectively. In CLTS implemented kebeles, literate (AOR = 3.66; 95% CI: 1.53, 8.73), households being visited by health extension worker (AOR = 11.72; 95% CI: 4.01, 34.31), households being graduated as model family(AOR = 7.56, 95% CI: 2.79, 20.44), ⩾2 years by years of latrine owning (AOR = 12.10, 95% CI: 3.21, 45.64), >6 meters distance of toilet to home (AOR = 27.43, 95%CI: 8.43, 89.29),Latrine with hand washing (AOR = 2.93, 95%CI: 1.19, 7.17), latrine with superstructure (AOR = 6.54, 95% CI: 2.04, 20.98) were significantly associated with latrine utilization, while in non CLTS implemented kebeles, literate (AOR = 25.78, 95% CI: 13.35, 49.78), medium wealth status(AOR = 4.87, 95% CI: 2.10, 11.29), poor wealth status(AOR = 2.51, 95% CI: 1.26, 5.01) were significantly associated with latrine utilization. Conclusion: The findings of this study revealed that more of the rural households had utilized latrines in CLTS implemented kebeles than non-CLTS implemented' kebeles. So, it is recommended that the district health office increase the latrine utilization rate through the effective and sustainable implementation of the CLTS approach.

Carotid plaque vulnerability on magnetic resonance imaging and risk of future ischemic events: a systematic review and meta-analysis.

INTRODUCTION: Magnetic resonance imaging (MRI) can characterize carotid plaque features, including intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), and thin/ruptured fibrous cap (TRFC), that have increased tendency to cause future cerebrovascular ischemic events. We performed a systematic review and meta-analysis of studies evaluating association of MRI-identified high-risk plaque features, including IPH, LRNC, and TRFC, with risks of subsequent ischemic events of stroke, transient ischemic attack (TIA), or amaurosis fugax (AF) over follow-up duration of ≥3 months. EVIDENCE ACQUISITION: Multiple databases were searched for relevant publications between January 2000 and March 2020. Studies reporting outcomes of future ischemic events of stroke, TIA, or AF for individual MRI-identified high-risk carotid plaque features over follow-up duration of ≥3 months were included. Random effects meta-analysis was performed to estimate odds ratios (OR) and 95% confidence intervals (CI) comparing outcomes between MRI-positive and MRI-negative groups. EVIDENCE SYNTHESIS: Fifteen studies including 2350 patients were included. The annual rate of future ischemic events was 11.9% for MRI-positive IPH, 5.4% for LRNC, and 5.7% for TRFC. IPH, LRNC, and TRFC were associated with increased risk of future ischemic events (OR 6.37; 95% CI, 3.96 to 10.24), (OR 4.34; 95% CI, 1.65 to 11.42), and (OR 10.60, 95% CI 3.56 to 31.58), respectively. CONCLUSIONS: The current study findings strengthen the assertion that MRI-positive "high-risk" or "vulnerable" plaque features, including IPH, LRNC, and/or TRFC can predict risks of future ischemic events of stroke, TIA, or AF.

Guideline developers in the United States were inconsistent in applying criteria for appropriate Grading of Recommendations, Assessment, Development and Evaluation use.

OBJECTIVES: We assessed whether guidelines published by organizations based in the United States comply with published criteria for the use of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. STUDY DESIGN AND SETTING: We performed a cross-sectional study of all clinical practice guidelines that indicated the use of the GRADE approach, were published between 2011 and 2018, and listed in the National Guidelines Clearinghouse. RESULTS: We included 67 guideline documents from 44 of 135 (32.6%) US-based organizations that indicated the use of the GRADE approach. The majority (60/67, 89.6%) of guidelines defined the certainty of evidence consistent with GRADE, but only approximately 1 in 10 (7/67, 10.4%) explicitly reported consideration of all eight criteria to assess the certainty in the evidence for rating down and up. A majority of guidelines (36/67, 53.7%) provided a summary of the evidence, described explicit consideration of all four central domains (36/67, 53.7%), and rated the strength of recommendation consistent with GRADE (36/67, 53.7%). CONCLUSION: Approximately one in three US-based organizations developing evidence-based guidelines report the use of GRADE, but adherence to published criteria is inconsistent. As uptake of the GRADE approach increases in the United States, continued efforts to train guideline methodologists and panel members are important.

Prevalence of sleep disorders among medical students of Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.

Background: Sleep disorders are a common medical problem and can affect health and quality of life. There are multiple types of sleep disorders such as obstructive sleep apnea, insomnia, narcolepsy, restless legs/periodic limb movement disorder, circadian rhythm disorders, sleepwalking and nightmares. Medical students appear to be more liable to develop sleep disorders due to their high academic load. Design and Methods: This study seeks to estimate the prevalence of sleep disorders among Umm Al-Qura University medical students and associated risk factors. This cross-sectional study was conducted at the Faculty of Medicine of Umm Al-Qura University in Makkah, Saudi Arabia. A self administrated questionnaire was used to collect the data including socio-demographic data and sleep-50 questionnaire. Four hundred and thirty-eight (438) medical students from the second year to the sixth year were recruited to the study Results: Three hundred and twenty-three participants (73.8%) complained of at least one sleep disorder. The most prevalent sleep disorder among students was narcolepsy at 226 (51.6%). Female students, second year students and students spending significant time watching television or on smartphones were more affected than others with p values of 0.001, 0.005, and 0.004 respectively. Conclusions: Sleep disorders are common among medical students. It is essential to detect and address them before their condition deteriorates.

Endovascular treatment of carotid blowout syndrome.

BACKGROUND: Carotid blowout syndrome (CBS) is a life-threatening complication of head and neck cancer and radiation therapy. Endovascular techniques have emerged as preferable alternatives to surgical ligation for treatment of CBS. We performed a systematic review and meta-analysis to study periprocedural complications and outcomes of CBS patients treated with coil embolization and covered stents. METHODS: A comprehensive literature search identified studies that reported outcomes of endovascular treatment of CBS published from 2000 to April 2016. Outcomes included technical success, postoperative rebleeding, survival time, and perioperative complications. Meta-analyses were performed using a random-effects model. RESULTS: Twenty-five noncomparative studies with 559 patients were included in the meta-analysis. Technical success rate was 100% in both coiling and covered stenting groups. Median survival time was 3 months (range, 0-96 months) for all CBS patients. Overall perioperative mortality was 11% (95% confidence interval [CI], 5%-17%). Postoperative rebleeding rate was 27% (95% CI, 19%-367%). Perioperative stroke and infection rates were 3% (95% CI, 1%-6%) and 1% (95% CI, 0%-5%), respectively. At last follow-up, 39% of patients were alive (95% CI, 29%-48%). CONCLUSIONS: Coil embolization and stent grafts may both be safe treatment options for CBS with few perioperative complications and high rates of technical success, but prognosis after treatment remains poor. In general, noncomparative studies do not demonstrate differences between the two techniques with respect to periprocedural complications and patient outcomes.

Improved Construction of Auricular Prosthesis by Digital Technologies.

Implant-retained auricular prostheses are a successful prosthetic treatment option for patients who are missing their ear(s) due to trauma, oncology, or birth defects. The prosthetic ear is aesthetically pleasing, composed of natural looking anatomical contours, shape, and texture along with good color that blends with surrounding existing skin. These outcomes can be optimized by the integration of digital technologies in the construction process. This report describes a sequential process of reconstructing a missing left ear by digital technologies. Two implants were planned for placement in the left mastoid region utilizing specialist biomedical software (Materialise, Belgium). The implant positions were determined underneath the thickest portion (of anti-helix area) left ear that is virtually simulated by means of mirror imaging of the right ear. A surgical stent recording the implant positions was constructed and used in implant fixtures placement. Implants were left for eight weeks, after which they were loaded with abutments and an irreversible silicone impression was taken to record their positions. The right existing ear was virtually segmented using the patient CT scan and then mirror imaged to produce a left ear, which was then printed using 3D printer (Z Corp, USA). The left ear was then duplicated in wax which was fitted over the defect side. Then, it was conventionally flasked. Skin color was digitalized using spectromatch skin color system (London, UK). The resultant silicone color was mixed as prescribed and then packed into the mold. The silicone was cured conventionally. Ear was trimmed and fitted and there was no need for any extrinsic coloring. The prosthetic ear was an exact match to the existing right ear in shape, skin color, and orientation due to the great advantages of technologies employed. Additionally, these technologies saved time and provided a base for reproducible results regardless of operator.

The Endocrine Society guidelines: when the confidence cart goes before the evidence horse.

CONTEXT: In 2005, the Endocrine Society (TES) adopted the GRADE system of developing clinical practice guidelines. Grading of Recommendations, Assessment, Development, and Evaluation working group guidance suggests that strong recommendations based on low or very low (L/VL) confidence may often be inappropriate, and has offered a taxonomy of paradigmatic situations in which strong recommendations based on L/VL confidence estimates may be appropriate. OBJECTIVE: We sought to characterize strong recommendations of TES based on L/VL confidence evidence. DATA SOURCES AND EXTRACTION: We identified all strong recommendations based on L/VL confidence evidence published in TES guidelines between 2005 and 2011. We identified those consistent with one of the paradigmatic situations in the taxonomy. DATA SYNTHESIS: Two hundred six of 357 (58%) of the recommendations of TES were strong; of these, 121 (59%) were based on L/VL confidence evidence. Of these 121, 35 (29%) were consistent with one of the paradigmatic situations. The most common situation (13, 11%) was of a strong recommendation against the intervention because of low confidence evidence for benefit and high confidence evidence for harm. The remaining 86 (71%) comprised 43 (36%) "best practice" statements for which sensible alternatives do not exist; 5 (4%) in which recommendations were for "additional research"; 5 (4%) in which greater confidence in the estimates was warranted; and 33 (27%) for which we could not find a compelling explanation for the incongruence. CONCLUSIONS: Guideline panels should beware of formulating strong recommendations when confidence in estimates is low. Our taxonomy when such recommendations are appropriate may be helpful.

Inflammatory bowel disease in the geriatric population.

Inflammatory bowel disease (IBD) is a chronic disease that affects not only the young adults, but also the elderly. The elderly are more vulnerable and at higher risk from complications related to IBD. In this review we focus on IBD important features in the elderly and discuss the disease (1) epidemiology, (2) pathophysiology, (3) clinical manifestations and diagnosis, (4) prognosis, (6) therapy and (7) potential future research directions.

Accuracy and quality of clinical decision rules for syncope in the emergency department: a systematic review and meta-analysis.

STUDY OBJECTIVE: We assess the methodological quality and prognostic accuracy of clinical decision rules in emergency department (ED) syncope patients. METHODS: We searched 6 electronic databases, reviewed reference lists of included studies, and contacted content experts to identify articles for review. Studies that derived or validated clinical decision rules in ED syncope patients were included. Two reviewers independently screened records for relevance, selected studies for inclusion, assessed study quality, and abstracted data. Random-effects meta-analysis was used to pool diagnostic performance estimates across studies that derived or validated the same clinical decision rule. Between-study heterogeneity was assessed with the I(2) statistic, and subgroup hypotheses were tested with a test of interaction. RESULTS: We identified 18 eligible studies. Deficiencies in outcome (blinding) and interrater reliability assessment were the most common methodological weaknesses. Meta-analysis of the San Francisco Syncope Rule (sensitivity 86% [95% confidence interval {CI} 83% to 89%]; specificity 49% [95% CI 48% to 51%]) and the Osservatorio Epidemiologico sulla Sincope nel Lazio risk score (sensitivity 95% [95% CI 88% to 98%]; specificity 31% [95% CI 29% to 34%]). Subgroup analysis identified study design (prospective, diagnostic odds ratio 8.82 [95% CI 3.5 to 22] versus retrospective, diagnostic odds ratio 2.45 [95% CI 0.96 to 6.21]) and ECG determination (by evaluating physician, diagnostic odds ratio 25.5 [95% CI 4.41 to 148] versus researcher or cardiologist, diagnostic odds ratio 4 [95% CI 2.15 to 7.55]) as potential explanations for the variability in San Francisco Syncope Rule performance. CONCLUSION: The methodological quality and prognostic accuracy of clinical decision rules for syncope are limited. Differences in study design and ECG interpretation may account for the variable prognostic performance of the San Francisco Syncope Rule when validated in different practice settings.

Diagnostic accuracy of the TIMI risk score in patients with chest pain in the emergency department: a meta-analysis.

BACKGROUND: The Thrombolysis in Myocardial Infarction (TIMI) risk score uses clinical data to predict the short-term risk of acute myocardial infarction, coronary revascularization or death from any cause. It was originally developed for use in patients with unstable angina or non-ST-elevation myocardial infarction. We sought to expand the clinical application of the TIMI risk score by assessing its prognostic accuracy in patients in the emergency department with potential acute coronary syndromes. METHODS: We searched five electronic databases, hand-searched reference lists of included studies and contacted content experts to identify articles for review. We included prospective cohort studies that validated the TIMI risk score in emergency department patients. We performed a meta-regression to determine whether a linear relation exists between TIMI risk score and the cumulative incidence of cardiac events. RESULTS: We included 10 prospective cohort studies (with a total of 17 265 patients) in our systematic review. Data were available for meta-analysis in 8 of the 10 studies. Of patients with a score of zero, 1.8% had a cardiac event within 30 days (sensitivity 97.2%, 95% CI 96.4-97.8; specificity 25.0%, 95% CI 24.3-25.7; positive likelihood ratio 1.30, 95% CI 1.28-1.31; negative likelihood ratio 0.11, 95% CI 0.09-0.15). Meta-regression analysis revealed a strong linear relation between TIMI risk score (p < 0.001) and the cumulative incidence of cardiac events. INTERPRETATION: Although the TIMI risk score is an effective risk stratification tool for patients in the emergency department with potential acute coronary syndromes, it should not be used as the sole means of determining patient disposition.

No available evidence to assess the effectiveness of bonded amalgams.

DATA SOURCES: Sources of data were the Cochrane Oral Health Group's Trials Register, Cochrane CENTRAL (Cochrane Library), Medline and Embase. Reference lists of relevant articles were also searched and the investigators of the included studies were contacted for details of additional published and unpublished trials. STUDY SELECTION: Randomised controlled trials (RCT) were chosen that compared adhesively bonded versus traditional nonbonded amalgam restorations in conventional preparations utilising deliberate retention, in adults with permanent molar and premolar teeth suitable for Class I and II amalgam restorations only. DATA EXTRACTION AND SYNTHESIS: Two review authors independently screened papers, extracted trial details and assessed the risk of bias in the included study. RESULTS: One trial was included, comprising 31 patients who received 113 restorations. At 2 years, only three out of 53 restorations in the nonbonded group were lost, which was attributed to a lack of retention, and 55 out of 60 bonded restorations survived, with five unaccounted for at followup. Postinsertion sensitivity was not significantly different (P >0.05) at baseline or 2-year followup. No fractures of tooth tissue were reported and there was no significant difference between the groups or matched pairs of restorations in their marginal adaptation (P >0.05). CONCLUSIONS: There is no evidence to either claim or refute a difference in survival between bonded and nonbonded amalgam restorations. This review only found one methodologically sound but somewhat under-reported trial. This trial did not find any significant difference in the in-service performance of moderately sized adhesively bonded amalgam restorations, in terms of their survival rate and marginal integrity, in comparison with nonbonded amalgam restorations over a 2-year period. In view of the lack of evidence on the additional benefit of adhesively bonding amalgam compared with with nonbonded amalgam, it is important that clinicians are mindful of the additional costs that may be incurred.