Assessment of Knowledge and Awareness Regarding Oro-systemic Link among General Population: A Cross-sectional Survey.

Aim: Various surveys aimed at gathering the knowledge and awareness of health practitioners as well as students, both medical and dental, regarding the link between oral health and systemic diseases have been published. However, relatively few studies have attempted to examine the awareness of such knowledge among the general population. Therefore, the current study aimed to explore the public perception regarding the oro-systemic link. Materials and methods: The present study was designed as a cross-sectional survey to be carried out in the Department of Periodontology and Oral Implantology, PGIDS, Rohtak. All survey participants were provided with a written questionnaire which was required to be completed by each participant independently. The study questionnaire was designed to collect demographic data followed by specific questions targeting the awareness and knowledge of the participants regarding the relationship between oral and systemic health. Results: A total of 240 completed questionnaires were available for analysis. Only about a quarter of the total participants (27.5 %) believed that oral health status has any effect on the rest of the body. A positive response (YES) of 25% was observed for effect of diabetes and physician prescribed medicines on systemic health. Regarding the effect of pregnancy, smoking, stress, and obesity on systemic health, less than 20% positive response was recorded. Conclusion: The findings indicate a very poor awareness regarding the impact of systemic conditions on oral status and vice versa, among the studied population. Clinical significance: Pedodontists should lay emphasis on imparting knowledge about oro-systemic connections to their patients as well accompanying guardians. This would go a long way in spreading much needed awareness among the general population as well as ensuring that children adopt healthy lifestyle habits right from childhood. How to cite this article: Sangwan A, Sangwan P, Kaur M, et al. Assessment of Knowledge and Awareness Regarding Oro-systemic Link among General Population: A Cross-sectional Survey. Int J Clin Pediatr Dent 2023;16(S-2):S202-S205.

Association of Apical Periodontitis with Different Stages of Chronic Kidney Disease Measured by Glomerular Filtration Rate and Systemic Markers: An Observational Study.

INTRODUCTION: The aim of this study was to assess the prevalence and severity of apical periodontitis (AP) in subjects with different stages of chronic kidney disease (CKD) and its association with systemic markers. METHODS: In this cross-sectional study, 105 patients with CKD (n = 35 each in the early, predialysis, and hemodialysis groups) and 105 healthy controls were included. The prevalence, number of teeth with AP (endodontic burden [EB]), and the severity of AP were recorded. High- sensitivity C-reactive protein, blood urea, and serum creatinine levels were also recorded. Logistic regression was applied to determine the possible association between CKD and AP in the study population, and linear regression was performed to predict the effect of AP on systemic markers in CKD patients. RESULTS: AP in at least 1 tooth was found in 75.2% of CKD patients and 40.9% of the controls (P < .05). CKD patients were 4 times more likely to have AP than controls (P < .05; odds ratio = 3.954; 95% confidence interval, 2.09-7.45). EB and the severity of AP were also significantly higher in CKD patients than the healthy controls (P < .05). Although higher values of EB and severe AP were observed with the progression of disease, the difference was not significant. The severity of AP was significantly associated with an increase in serum creatinine, blood urea, and a decrease in estimated glomerular filtration rate (P < .05) in CKD patients. CONCLUSIONS: AP was significantly more prevalent in the CKD group. The association between the severity of AP and CKD markers suggests that AP could possibly alter the progression of CKD. However, these findings do not establish a cause-and-effect relationship.

Comparative histological evaluation of two PRF formulations (PRF High and PRF Medium) on quality of life and healing outcome of apicomarginal defects: A randomized clinical trial.

The objective of this randomized clinical trial was to investigate the effects of two PRF formulations (PRF High and PRF Medium) on quality of life and healing outcome (2D and 3D) of apicomarginal defects. Patients presenting with endodontic lesions and concomitant periodontal communication were randomly allocated to PRF High and PRF Medium groups. The treatment protocol in each group included a periapical surgical procedure with placement of PRF clot and membrane in the bony defect and on the denuded root surface, respectively. Quality of life was assessed for 1 week after surgery following a modified version of the patient's perception questionnaire. Postoperative pain was assessed using a visual analog scale. Clinical and radiographic evaluations were performed using Rud and Molven 2D criteria and Modified PENN 3D criteria. Buccal bone formation was assessed using sagittal and corresponding axial sections in CBCT. Histological analysis was performed using hematoxylin and eosin (H and E) staining and attaching primary antibodies to tissue sections. In total, 40 patients were enrolled in the trial (N = 20 per group). PRF Medium group patients reported significantly less swelling on the 1st (p = 0.036), 2nd (p = 0.034), and 3rd (p = 0.023) days, and average pain on the 2nd (p = 0.031), 3rd (p = 0.03), and 4th (p = 0.04) days postoperatively. The difference in success rate for periapical healing was non-significant between the PRF Medium group (89.5%) and PRF High group (90%), in both 2D and 3D imaging (p = 0.957). The formation of buccal bone was observed in five cases (26.3%) and four cases (20%) in the PRF Medium and PRF High groups, respectively, with a non-significant difference (p = 0.575). PRF Medium clots had a loose fibrin structure with a significantly higher number of neutrophils (473.79 ± 82.89 per mm2) than PRF High clots, which had a dense structure and fewer neutrophils (253.15 ± 63.86 per mm2) (p = 0.001). Autologous platelet concentrates (APCs) promoted satisfactory periapical healing, with no significant difference between the groups. Within the limitations of the study, it seems that PRF Medium should be preferred over PRF High when the patients' quality of life is the priority.

Patient-centric outcome assessment of endodontic microsurgery using periapical radiography versus cone beam computed tomography: A randomized clinical trial.

AIM: This study aimed to evaluate whether utilizing additional cone beam computed tomography (CBCT) imaging has any effect on quality of life and healing outcome following periapical surgery compared with periapical radiographs (PR). METHODOLOGY: The study was registered in ClinicalTrials.gov (NCT04333940). In this parallel group randomized controlled trial, 52 patients (88 teeth) with persistent apical periodontitis and periapical radiographic evidence of periapical lesion were randomly assigned to either PR or CBCT group. The primary predictor was the type of the imaging method (PR only or with additional CBCT). The primary outcome was patient's quality of life during the first week after periapical surgery and the secondary outcomes were duration of surgery and healing outcome at 12-month follow-up. Participants of both groups received periapical surgery based on the pre-surgical plan provided by the radiographic imaging methods. Quality of life (QoL) was assessed using Modified Shugars questionnaire. Radiographic analysis for healing was conducted using Molven's criteria and modified PENN 3D criteria. The categorical data between groups were analysed using the Chi-square test, whilst intragroup comparisons were analysed using the McNemar test. The average scores for each component of QoL (oral functions, general functions, pain, swelling and other symptoms), combined QoL scores (overall average of values of 13 variables) and analgesic usage on each day were calculated and analysed. RESULTS: At 12 months of follow-up, fifty patients were evaluated. Participants in PR group reported significantly more swelling on first three days compared with CBCT group. The analgesic use was higher in the PR group on 2nd and 3rd day (Mann-Whitney U test with Bonferroni correction; p < .007). A significant difference in the limitation of general functions was observed at the second day (p < .07) with the higher values in the PR group. The combined QoL score between the two groups was found to be non-significant. However, none of the patients experienced intraoperative complications or neurovascular exposure. The mean surgical time was lesser in the CBCT group (p < .05). Radiographic healing revealed a success rate of 96.2% for the PR group and 95.8% for the CBCT group with no significant difference between the groups. CONCLUSION: Participants in the CBCT group experienced substantially less early postoperative swelling and limitation in general functions, in comparison with the PR group. However, preoperative CBCT had no effect on other QoL parameters and intraoperative complications in medium-risk patients. Furthermore, CBCT did not exhibit any added advantage over periapical radiography in terms of assessing healing outcome following endodontic microsurgery. CBCT offered surgically relevant anatomic information for pre-surgical planning and ensured the treatment rendition with a significantly reduced operative time.

Evaluation of amniotic membrane in the healing of apicomarginal defects using 2D and 3D imaging modalities: a randomized controlled trial.

OBJECTIVE: The study aimed to evaluate healing in apicomarginal defects with amniotic membrane (AM) using 2D periapical radiography and 3D cone beam computed tomography imaging. METHOD AND MATERIALS: Thirty-four patients with symptomatic apical periodontitis and apicomarginal communication were allocated to either the AM or control group. Clinical and radiographic assessment was performed at baseline and at 12 months using Molven criteria, modified Penn 3D criteria, and RAC and B indices at resected plane, apical area, cortical plate, and combined apicocortical area, respectively. RESULTS: There was no significant difference in the healing outcome in 2D imaging (93.3% control and 86.7% AM) and 3D imaging (80.0% control and 53.3% AM) between the groups. With RAC scoring, a greater percentage of unhealed cases was observed in cortical plate. Radiographic buccal bone formation in the 3D imaging was evident only in six cases. However, both the groups depicted significantly greater percentage reduction in the size of the lesion in 2D than the 3D analysis (AM group 91.69 ± 15.99 2D, 76.06 ± 47.62 3D, P = .020) and (control group 92.06 ± 14.36 2D, 85.12 ± 18.55 3D, P = .005). CONCLUSION: No significant difference in healing was observed between the AM and the control groups with the use of both periapical radiography and CBCT imaging. Despite good clinical healing and radiographic apical bone fill, buccal bone formation was not evident in 3D imaging in most of the cases.

Comparative evaluation of complete and partial pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis: A randomized clinical trial.

AIM: The study aimed to compare the outcome of complete pulpotomy (CP) and partial pulpotomy (PP) techniques when utilised for the management of mature permanent teeth with carious pulpal exposure and symptomatic irreversible pulpitis (SIP). METHODOLOGY: The study protocol was registered with ClinicalTrials.gov (NCT04397315). One hundred and six permanent mandibular molars with carious pulpal exposure and clinical diagnosis of SIP with periapical index ≤2, from patients aged between 18 and 40 years were randomly allocated in equal proportion to either CP or PP group. Allocated procedures were performed using standardised protocols. The allocated procedure was abandoned in cases where pulpal bleeding could not be controlled within 6 min using cotton pellets soaked in 3% sodium hypochlorite. MTA was used as a pulpotomy agent and teeth were restored using a base of glass ionomer followed by composite restoration. The pain was recorded by the patient preoperatively before administration of local anaesthesia and postoperatively every 24 h for 1 week using visual analogue scale. Success was analysed at 12 months based on clinical and radiographic examination. Mann-Whitney U test was used to compare age, pain scores and mean analgesic consumption between the groups. Categorical data were analysed using chi-square test. Fisher's exact test was used to assess the clinical and radiographic success and incidence of pain. Kaplan-Meier analysis was used to assess the survival of teeth. A p-value <.05 was considered as statistically significant. RESULTS: One hundred and one patients were analysed at follow up. Higher success was observed in CP (89.8%) in comparison to PP group (80.8%), but the difference was non-significant statistically (p = .202). Although no significant difference was observed in pain incidence between the groups at 24 h (p = .496), a significant difference in pain intensities was observed between groups at all the tested time intervals, with lower values reported in CP group (p < .05). CONCLUSIONS: Both CP and PP resulted in favourable outcomes in the management of cariously exposed permanent teeth with signs indicative of SIP. Given the more conservative nature of PP, it may be attempted first before proceeding to CP in such cases.

Nonsurgical management of cutaneous sinus tract of odontogenic origin: A report of two cases.

Discharging facial lesions of dental etiology are almost always difficult to diagnose. Due to the lack of dental signs in most patients, these lesions are often misunderstood and overlooked. Such patients often seek cosmetic therapy and end up undergoing unnecessary treatments, if an odontogenic source is not established. To make an accurate diagnosis, a comprehensive medical and dental history, as well as knowledge of the various presentations of facial lesions, is of pivotal importance. The cases identified here were misdiagnosed at first, and they were treated with antibiotics and surgical procedures as a result. Root canal operations were performed after referral to a dental unit, and the sinus tract eventually healed. This emphasizes the significance of taking odontogenic sources into account when treating head and neck lesions.

Effect of premedication on postoperative pain after root canal therapy in patients with irreversible pulpitis: a systematic review and meta-analysis.

This systematic review aimed to assess the effect of premedication on postoperative pain after root canal treatment in vital teeth. Five electronic databases were searched for randomized clinical trials, and two independent reviewers selected eligible studies, extracted data, and assessed the quality of studies using the Cochrane Risk of Bias tool. Meta-analysis was conducted using the random-effects model, and the pooled effect estimate of the standardized mean difference (SMD) between premedication and placebo was calculated. Subgroup analysis was conducted based on the class and route of the drug. Studies with a high risk of bias were excluded from the sensitivity analysis. Ten trials satisfied the inclusion criteria, of which eight were included in the meta-analysis. Premedication was more effective in reducing postoperative pain than placebo at 6 hours (SMD = -1.00; 95% confidence interval [CI] = -1.33 to -0.66), 12 hours (SMD = -0.80; 95% CI = -1.05 to -0.56), and 24 hours (SMD = -0.72; 95% CI = -1.02 to -0.43). The results of the sensitivity analysis confirmed the findings of the primary analysis. Based on these results, it can be concluded that premedication is effective in reducing postoperative pain in teeth with irreversible pulpitis. However, additional quality studies are required for further validation.

Comparative analysis of the accuracy of periapical radiography and cone-beam computed tomography for diagnosing complex endodontic pathoses using a gold standard reference - A prospective clinical study.

AIM: To compare the diagnostic accuracy of periapical radiography (PR) and cone-beam computed tomography (CBCT) for detecting pathoses of endodontic origin using the gold standard of direct surgical visualization. METHODOLOGY: Seventy-four patients (112 teeth) underwent radiographic examination by periapical radiography and CBCT. The presence of periapical lesions, root perforations and their locations, root fractures, different types of external root resorptive defects, apicomarginal bone defects, through and through bone defects, buccal bone status and proximity of root apices and lesions to vital anatomical structures were assessed. These same parameters were assessed intraoperatively by direct surgical visualization which served as the gold standard reference for the radiographic assessments. Sensitivity, specificity, positive predictive values, negative predictive values were determined for comparison of diagnostic accuracy between two modalities. RESULTS: There were no significant differences between the two imaging modalities for root resorptive defects and root fractures. However, CBCT accurately detected periapical lesions, root perforations, apicomarginal bone defects and through and through bone defects. The overall accuracy of CBCT varied from 91% to 96% in detecting dehiscence and fenestration of buccal cortical plates. CONCLUSION: Overall, CBCT had a higher diagnostic accuracy in complex endodontic pathoses compared to PR. Nevertheless, CBCT failed to diagnose apicomarginal bone defects in 33% teeth. In evaluating the status of buccal cortical plate from CBCT images, observers could detect absence of bone better than its presence. Thus, limited FOV CBCT should be considered for selective cases where periapical radiography has diagnostic ambiguity.

Effect of the Piezoelectric Device on Intraoperative Hemorrhage Control and Quality of Life after Endodontic Microsurgery: A Randomized Clinical Study.

INTRODUCTION: The purpose of this study was to evaluate the effect of the piezoelectric device on intraoperative hemorrhage control during surgery and the quality of life of patients after endodontic microsurgery. METHODS: A total of 40 patients were randomly divided into the piezo group (n = 20) and the control group (n = 20). In the piezo group, after flap reflection, bone cutting, granulation tissue removal, and root-end resection were performed using the piezoelectric surgical device and surgical carbide burs, and curettes were used in the control group. The quality of life of patients was evaluated daily for 1 week postsurgery for limitations of oral and general functions, pain, and other symptoms. Limitation of functions and other symptoms were recorded by a modified version of the patient's perception questionnaire using a 5-point Likert scale for mouth opening, chewing, speaking, sleeping, daily routine, missed work, swelling, nausea, and bad taste/breath, and the visual analog scale was adopted for pain. Hemorrhage control during surgery was independently assessed by the surgeon and 2 blinded observers and recorded as 0 (no hemorrhage control), 1 (intermittent control), and 2 (complete control). The chi-square test was used to assess hemorrhage control. For variables related to function and symptoms other than pain and analgesics taken, the Fisher exact test was used. For the assessment of pain between the 2 groups, the Mann-Whitney U test was used. RESULTS: For parameters of quality of life, the piezo group showed significantly less swelling on the first, second, and third days and pain on the first and second days compared with the control group (P < .05). Analgesics taken were also significantly less in the piezo group (P < .05). In the piezo group, complete hemorrhage control was achieved in 10 patients, and in the control group, it was achieved only in 1 patient (P < .05). CONCLUSIONS: Piezoelectric surgery resulted in improved quality of life of patients in the first week postsurgery with lower levels of pain and swelling as well as the number of analgesics taken and better hemorrhage control during surgery.

Importance of preoperative diagnostic imaging in treatment of maxillary central incisors with Vertucci's type V root canal configuration - A report of 2 cases.

Root canal system typically has a diverse canal configuration. One of the most difficult aspects of ensuring successful endodontic treatment is accurately identifying all canals found in a tooth. Diverse root canal configurations are not uncommon, even if the majority of maxillary incisors have a single root canal. One canal bifurcating into two at the apical third is exceptionally rare, with only two case reports previously reported. For the precise diagnosis of certain anatomical peculiarities, a thorough evaluation of preoperative diagnostic radiographs is highly required. As of periapical radiography, which is the most important diagnostic imaging for determining root canal anatomy, is limited by its two-dimensional nature, technological innovations such as cone beam computed tomography can be extremely beneficial. This paper emphasizes the significance of preoperative diagnostic imaging in the treatment planning of maxillary central incisors with unusual root canal morphology.

Impact of Platelet-rich Plasma in the Healing of Through-and-through Periapical Lesions Using 2-dimensional and 3-dimensional Evaluation: A Randomized Controlled Trial.

INTRODUCTION: The purpose of this randomized controlled trial was to evaluate the role of platelet-rich plasma (PRP) in the healing of through-and-through periapical lesions using both 2-dimensional periapical radiographs and 3-dimensional (3D) cone-beam computed tomographic imaging. METHODS: Thirty-four patients after confirmation of a through-and-through periapical lesion were enrolled and randomly assigned to either the control or PRP group. Periapical surgery was performed, and grafting of the bone defect with PRP was done in the PRP group before suturing. Follow-up was scheduled at 12 months for clinical and radiographic analysis based on Molven's criteria; modified Penn 3D criteria; and resected plane, apical area, and cortical plate indexes. The absolute area and volume of the lesions were measured preoperatively and at follow-up using CorelDRAW X7 (64-bit) (Corel Corporation, Ottawa, Canada) and ITK Snap software (free software under the GNU General Public License developed by the National Institutes of Health, the US National Institute of Biomedical Imaging and BioEngineering, the US National Library of Medicine, the Universities of Pennsylvania and North Carolina, and an independent developer group), respectively. RESULTS: Thirty-two patients were available at follow-up. A success rate of 93.7% was observed for both the control and PRP groups on 2-dimensional evaluation, whereas the PRP group exhibited a significantly higher success rate (87.5%) than the control (50%) on 3D assessment. A significantly higher percentage reduction in the lesion volume was documented in the PRP group (92.30 ± 4.72) than the control group (83.04 ± 12.82). Resected plane, apical area, and cortical plate indexes revealed a significantly higher scoring at the resected plane and cortical plate parameter in the PRP group. Overall analysis documented the faster re-establishment of the palatal cortical plate than the buccal cortical plate in through-and-through lesions. CONCLUSIONS: These results suggest that PRP improves the healing outcome in through-and-through lesions. CBCT imaging provides better healing assessment after periapical surgery over periapical radiographs in such lesions.

Success of Direct Pulp Capping Using Mineral Trioxide Aggregate and Calcium Hydroxide in Mature Permanent Molars with Pulps Exposed during Carious Tissue Removal: 1-year Follow-up.

INTRODUCTION: This randomized clinical trial aimed to compare the success rate and postoperative pain of direct pulp capping (DPC) using calcium hydroxide (CH) and mineral trioxide aggregate (MTA) in teeth with carious pulp exposures and reversible pulpitis. METHODS: Sixty-four permanent teeth were randomly divided after caries excavation into 2 groups: CH and MTA (n = 32 in each group). Exposed pulps were capped using standardized protocols. The treated teeth were restored with glass ionomer cement and composite restoration. The primary outcome was success rate at the 12-month follow-up, and the secondary outcome was postoperative pain after 7 days. Clinical and radiographic evaluations were performed at 3, 6, and 12 months. Pain was recorded using the visual analog scale every 24 hours for 7 days after intervention. RESULTS: Fifty-six patients were analyzed at the 12-month follow-up, 29 treated with CH and 27 with ProRoot MTA (Dentsply Tulsa Dental, Tulsa, OK). The success rate was 69% for CH and 93% for ProRoot MTA (P < .05). The kappa value of interrater agreement was 0.773.No significant difference in pain incidence was found between the 2 groups (P > .05) although a significant pain reduction was found 6 hours after the procedure in both the groups. Significantly lower pain scores were reported in the MTA group (6.3 ± 9.5) compared with the CH group (18.5 ± 20.8) after 18 hours. CONCLUSIONS: Teeth with carious pulp exposures and reversible pulpitis can be treated successfully with DPC. MTA proved better than CH in terms of both success rate and pain intensity.

Effect of Different Concentrations of Sodium Hypochlorite on Outcome of Primary Root Canal Treatment: A Randomized Controlled Trial.

INTRODUCTION: The aim of this study was to evaluate the effect of 2 different concentrations of sodium hypochlorite on healing and postoperative pain after primary endodontic treatment. METHODS: One hundred mandibular molars with pulp necrosis and chronic apical periodontitis were randomly assigned to 2 treatment groups: high-concentration (HC) 5% sodium hypochlorite and low-concentration (LC) 1% sodium hypochlorite. Root canal treatment was performed using a standardized protocol. Canals were prepared using equal volumes of respective irrigants after each instrument change. After chemomechanical preparation, the final flush was performed with 5 mL 17% EDTA solution followed by 5 mL 5% or 1% sodium hypochlorite depending on the group. All patients were asked to record the degree of pain on a visual analog scale every 24 hours for 1 week. At the second visit, canals were obturated, and the teeth were restored permanently. Clinical and radiographic evaluations were performed every 3 months for 12 months. The data collected were statistically analyzed. RESULTS: Eighty-six teeth were available for evaluation at the 1-year follow-up. The overall healing rate observed was 76.7%. Greater healing was observed in the HC (81.4%) group compared with the LC group (72.1%), but the difference was not statistically significant (P > .05). No significant differences in pain incidence and pain scores were found between the 2 groups (P >.05), with lower values reported in the LC group. CONCLUSIONS: The use of LC or HC sodium hypochlorite did not result in a significant difference in the clinical outcome.

The effect of endodontic treatment using different intracanal medicaments on periodontal attachment level in concurrent endodontic-periodontal lesions: A randomized controlled trial.

AIM: The aim of this study is to evaluate the effect of different intracanal medicaments used during endodontic treatment on periodontal attachment level in concurrent endodontic-periodontal lesions without communication. MATERIALS AND METHODS: Seventy-five teeth with combined endodontic-periodontal lesions were randomly assigned to 3 groups: Test Group I (calcium hydroxide [Ca(OH)2]), Test Group II (2% chlorhexidine + Ca(OH)2), and control group (no intracanal medicament). Root canal treatment (RCT) was performed using standard methodology. Teeth of test groups were medicated with respective medicaments for 10 days before obturation. Scaling and root planning was done 1 month after completion of RCT in all the groups. Clinical measurements, including probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were recorded at baseline, 1, 3, and 6 months. Radiographic parameters, including periapical index (PAI) score and alveolar bone level, were measured at baseline and 6 months. STATISTICAL ANALYSIS: Data were analyzed using Friedman test, Kruskal-Wallis, and Wilcoxon signed-rank test. RESULTS: Significant improvement in PD, CAL, %BOP, and PAI score (P < 0.05) was found in all the three groups from baseline to 6 months. However, there was no significant intergroup difference. No significant difference was observed from baseline to 6 months in marginal bone level within the three groups. CONCLUSION: Endodontic treatment before periodontal therapy results in attachment gain. Intracanal medicaments may not affect the healing of concurrent endodontic-periodontal lesions without communication.

Retrieval of Extruded Mineral Trioxide Aggregate Using a Novel Suction Device.

Treatment of necrotic immature permanent teeth is an exigently demanding situation for an endodontist. Regenerative endodontic procedures are being employed for such teeth in a hope to restore a functional pulp tissue and continue root development. However, currently advocated techniques may not be effective in retaining mineral trioxide aggregate (MTA) in its coronal position. The present paper describes two immature teeth with pulpal necrosis and apical periodontitis that were treated through revascularization. In both the cases, apical extrusion of the coronal MTA plug occurred. A suction tip was customized to completely retrieve the extruded material. Both cases proved out to be a clinical and radiographic success over extended follow-up periods.

Comparative Evaluation of Postoperative Pain and Success Rate after Pulpotomy and Root Canal Treatment in Cariously Exposed Mature Permanent Molars: A Randomized Controlled Trial.

INTRODUCTION: The aim of this study was to compare postoperative pain and success rate following pulpotomy and root canal treatment. METHODOLOGY: Fifty-four permanent teeth with carious exposures were randomly divided equally into 2 groups. Mineral trioxide aggregate pulpotomy was performed in the experimental group and root canal treatment was performed in the control group, using standardized protocols. The treated teeth were restored with base of glass-ionomer cement followed by composite restoration. Pain was recorded every 24 hours for 7 days after intervention. Clinical and radiographic evaluations were done every 3 months for 18 months. The data collected were statistically analyzed. RESULTS: At the end of follow-up, overall success rate was 85% in the pulpotomy group and 87.5% in the root canal treatment group (P > .05). Significant difference in pain incidence and pain reduction was found between the 2 groups (P < .05), with lower scores reported in the pulpotomy group. CONCLUSION: Pulpotomy can be an alternative treatment for management of symptomatic permanent teeth with deep caries lesions.

Healing of Apical Periodontitis after Nonsurgical Treatment in Patients with Type 2 Diabetes.

INTRODUCTION: The purpose of this prospective study was to compare the success of primary root canal treatment between type 2 diabetic and nondiabetic patients and to investigate the effect of periapical healing on glycated hemoglobin (HbA1c) in type 2 diabetic patients with apical periodontitis. METHODS: Sixty mandibular molars with necrotic pulps and apical radiolucency (size ≥ 2 mm × 2 mm) were included in the study. Based on the HbA1c levels, patients were divided into 2 groups: type 2 diabetic (HbA1c ≥6.5%) and nondiabetic (HbA1c <6.5%). Forty-six teeth were evaluated at the 12-month follow-up time period. The primary outcome measure was the change in apical bone density as determined by the periapical index. RESULTS: Both the diabetic and nondiabetic group depicted a significant reduction in the periapical score after endodontic treatment at the 12-month follow-up (P < .05). Significantly less periapical healing was observed in the diabetic group (43%) compared with the nondiabetic group (80%) at the 12-month follow-up (P < .05). HbA1c levels in the diabetic group increased at each follow-up after endodontic treatment. CONCLUSIONS: Diabetes mellitus may have a negative impact on the outcome of endodontic treatment in terms of periapical healing. Nonsurgical endodontic treatment did not improve HbA1c levels in patients with type 2 diabetes.

Comparative evaluation of platelet-rich fibrin, mineral trioxide aggregate, and calcium hydroxide as pulpotomy agents in permanent molars with irreversible pulpitis: A randomized controlled trial.

BACKGROUND: Pulpotomy has been proposed as an alternative for the management of irreversible pulpitis in permanent molars with closed apices. AIM: To compare the performances of calcium hydroxide (CH), mineral trioxide aggregate (MTA), and platelet-rich fibrin (PRF) as pulpotomy agents in mature permanent molars with irreversible pulpitis. MATERIALS AND METHODS: Fifty-four permanent mandibular molars with carious exposure and symptoms of irreversible pulpitis were randomly allocated to three groups, and full pulpotomy was performed using CH, MTA, or PRF as pulpotomy agents. Pain intensity was recorded using numeric rating scale score at baseline, 24 h, 7 days, 6 months, and 1 year. Clinical and radiographic assessments were done at 6 months and 1 year. STATISTICAL ANALYSIS: Kruskal-Wallis test and Friedman test were used for intergroup and intragroup comparison of pain scores, respectively. The radiographic outcomes between the three study arms were compared using Chi-square test. RESULTS: Clinical success rate was 94.4% at 7 days, which dropped to 85.4% at 12 months. All three agents were equally effective in providing pain relief at all the intervals tested, with no significant difference between them (P > 0.05 at all intervals). However, at 6 months and 12 months, 26.2% and 52.4% teeth depicted slight widening of periodontal ligament space. No significant difference was observed between the radiographic success rates observed with the three groups (P = 0.135 at 6 months, 0.717 at 12 months). CONCLUSION: Pulpotomy exhibited a high clinical success rate in mature molars with irreversible pulpitis and selection of biomaterial did not affect its outcome.