Diagnosis of Vertical Root Fractures by Cone-beam Computed Tomography in Root-filled Teeth with Confirmation by Direct Visualization: A Systematic Review and Meta-Analysis.

INTRODUCTION: The purpose of this review was to determine the diagnostic accuracy of cone-beam computed tomographic (CBCT) imaging in detecting vertical root fractures (VRFs) in root-filled teeth compared with a reference standard (direct visualization). METHODS: Electronic searches were performed in Medline, Scopus, Cochrane, and gray literature for English language articles until June 2020. Prospective and retrospective clinical studies using CBCT imaging to diagnose VRFs in root-filled teeth were included. Case reports and in vitro studies were excluded. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess the risk of bias and applicability concerns. Meta-analysis was performed using Stata 16.1 software (StataCorp, College Station, TX) via the MIDAS v.3.0 package and METANDI module. Publication bias was evaluated using Deeks' funnel plot analysis. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was performed to evaluate the certainty of evidence. This systematic review was registered in the Open Science Framework (10.17605/OSF.IO/7JKE2). RESULTS: Eight articles were included in this systematic review and meta-analysis. Risk of bias assessment showed that 5 articles in the patient selection domain had low risk of bias with low applicability concern. In the index test and reference standard domains, 7 articles had moderate risk of bias with moderate applicability concern. Three articles had high RB in the flow and timing domain. There was no publication bias. CBCT imaging had a pooled sensitivity and specificity of 0.78 (95% confidence interval [CI], 0.64-0.88) and 0.80 (95% CI, 0.63-0.91), respectively, and an accuracy of 0.86 (95% CI, 0.83-0.89). CBCT imaging also had pooled positive and negative likelihood ratios of 4 and 0.2, respectively. In GRADE analysis, the quality of evidence was low for sensitivity and moderate for specificity when CBCT imaging was used for the diagnosis of VRF. CONCLUSIONS: The overall quality assessment of the included articles showed that in the patient selection domain, the risk of bias was low, and it was moderate in the index test and reference standard domains. Evidence from this systematic review and meta-analysis indicates that CBCT imaging is still not a good tool for diagnosing VRFs in root-filled teeth compared with direct visualization.

Comparison of antibacterial effectiveness of three rotary file system with different geometry in infected root canals before and after instrumentation-a double-blinded randomized controlled clinical trial.

INTRODUCTION: To compare the antibacterial effectiveness of three rotary file systems i.e., ProTaper Next, ProTaper Gold and XP-endo Shaper in root canals of teeth with asymptomatic apical periodontitis by using the real-time polymerase chain reaction. MATERIALS AND METHODS: Root canals from single or multi-rooted teeth (straight canals) with necrotic pulps and asymptomatic apical periodontitis were instrumented using either ProTaper Next (n = 20), ProTaper Gold (n = 20) and XP-endo Shaper (n = 20) under irrigation with 3% sodium hypochlorite. Samples obtained before and after instrumentation were subjected to DNA extraction, amplification and quantitation of total amount of bacteria by using the real-time polymerase chain reaction. RESULTS: Samples were taken before preparation (S1) were positive for presence of bacteria, with mean numbers of 9.94 × 107, 20.4 × 107 and 9.20 × 107 bacterial cells for the ProTaper Next, ProTaper Gold and XP-endo Shaper groups, respectively. After preparation (S2) with ProTaper Next, ProTaper Gold, and XP-endo Shaper, root canals still had bacteria with mean counts of 11.8 × 105, 87.2 × 105 and 4.52 × 105 bacterial cells, respectively. Both XP-endo Shaper (99.50%) and ProTaper Next (98.81%) were effective in reducing total bacterial count, and there was no statistically significant difference between them (P > 0.05). XP-endo Shaper succeeded in reducing total bacterial count than ProTaper Gold (95.72%) and there exists statistically significant difference between them (P < 0.05). CONCLUSIONS: XP-endo Shaper was highly effective in reducing total bacterial count from root canals of teeth with asymptomatic apical periodontitis than ProTaper Gold. ProTaper Next also showed improved microbial reduction percentage as compared with ProTaper Gold.

Expression profile of salivary micro RNA-21 and 31 in oral potentially malignant disorders.

Oral potentially malignant disorders (OPMD) possess significant chances of malignancy conversion. In order to develop an early diagnostic tool, the present study evaluated the expression of miRNA-21 and 31 as salivary markers. The case-control study was carried out in 36 healthy participants as controls and in 36 patients who were newly diagnosed as OPMD having four different lesions including leucoplakia, oral sub mucous fibrosis (OSMF)궱, oral lichen planus, and (OSMF)궱 with leucoplakia. The samples were also classified as non-dysplastic, or with mild, moderate, and severe dysplasia according to their histopathological reports. The salivary miRNA-21 and 31 expressions were studied using real-time PCR. The statistical analysis was carried out using SPSS version 22. Salivary miRNA-21 (p-value = 0.02) and 31 (p-value = 0.01) were significantly upregulated in severe dysplasia compared with control. Among the different lesions, leucoplakia had significant upregulation of miRNA-21 and 31. miRNA-21 can be used as a diagnostic marker with specificity of 66% and sensitivity of 69%. The area under the ROC curve was 0.820 for miRNA-21 and 0.5 for miRNA-31, which proved that miRNA-21 is a better diagnostic marker than miRNA-31 for OPMD.

Expression profile of salivary micro RNA-21 and 31 in oral potentially malignant disorders

Abstract Oral potentially malignant disorders (OPMD) possess significant chances of malignancy conversion. In order to develop an early diagnostic tool, the present study evaluated the expression of miRNA-21 and 31 as salivary markers. The case-control study was carried out in 36 healthy participants as controls and in 36 patients who were newly diagnosed as OPMD having four different lesions including leucoplakia, oral sub mucous fibrosis (OSMF)궱, oral lichen planus, and (OSMF)궱 with leucoplakia. The samples were also classified as non-dysplastic, or with mild, moderate, and severe dysplasia according to their histopathological reports. The salivary miRNA-21 and 31 expressions were studied using real-time PCR. The statistical analysis was carried out using SPSS version 22. Salivary miRNA-21 (p-value = 0.02) and 31 (p-value = 0.01) were significantly upregulated in severe dysplasia compared with control. Among the different lesions, leucoplakia had significant upregulation of miRNA-21 and 31. miRNA-21 can be used as a diagnostic marker with specificity of 66% and sensitivity of 69%. The area under the ROC curve was 0.820 for miRNA-21 and 0.5 for miRNA-31, which proved that miRNA-21 is a better diagnostic marker than miRNA-31 for OPMD.

Quantitative analysis for detection of toxic elements in various irrigants, their combination (precipitate), and para-chloroaniline: An inductively coupled plasma mass spectrometry study.

INTRODUCTION: Chlorhexidine (CHX) interacts with sodium hypochlorite (NaOCl) and herbal irrigants such as neem and tulsi to form precipitate which contains para-chloroaniline (PCA). No studies till date have reported about metal elements present in this combination as well as in irrigants. AIM: The aim of this study was to evaluate the precipitate formed on combination of different irrigants, weigh the amount of precipitate formed, and to analyze 35 different metal elements in each irrigant, precipitate formed as well as in PCA. MATERIALS AND METHODS: Seven irrigants, namely 2% CHX gluconate, 3% NaOCl, 17% ethylenediaminetetraacetic acid (EDTA), 5% neem, 5% tulsi, 5% Aloe vera, and 5% garlic were taken in different test tubes. Group (1-6): 1 ml of CHX is mixed with 1 ml of 3% NaOCl/17% EDTA/5% neem/5% tulsi/5% A. vera/5% garlic. Group (7-11): 1 ml of 3% NaOCl is mixed with 1 ml of 17% EDTA/5% neem/5% tulsi/5% A. vera/5% garlic. Group (12-15): 1 ml of 17% EDTA is mixed with 1 ml of 5% neem/5% tulsi/5% A. vera/5% garlic. Group (16-18): 1 ml of 5% neem is mixed with 1 ml of 5% tulsi/5% A. vera/5% garlic. Group (19 and 20): 1 ml of 5% tulsi is mixed with 5% A. vera/5% garlic. Group 21 includes 1 ml of 5% A. vera and 5% garlic. Each group is observed for any precipitate formation, and precipitate formed was weighed. Samples such as 2% CHX gluconate, 3% NaOCl, 17% EDTA, 5% neem, 5% tulsi, 5% A. vera, PCA, and precipitate formed in each group were analyzed for 35 different metal elements using inductively coupled plasma mass spectrometry (ICP-MS). STATISTICAL ANALYSIS: One-way ANOVA and Post hoc Tukey's test for the precipitate formed. RESULTS: Precipitate formation was seen in CHX + NaOCl (reddish-brown), CHX + EDTA (white), CHX + neem (light green), CHX + A. vera (green), CHX + tulsi (dark green), CHX + garlic (beige). ICP-MS analysis showed the presence of International Agency for Research on Cancer Group 1 carcinogens in NaOCl, CHX, EDTA, and PCA. CONCLUSION: Carcinogenic metals are undetected in herbal irrigants which is found to be risk free alternatives in near future.

Effectiveness of rotary and reciprocating systems on microbial reduction: A systematic review.

INTRODUCTION: The role of microorganism and their products in the initiation, propagation, and persistence of periradicular periodontitis has been established. One of the major goals of the treatment of infected root canals of teeth with apical periodontitis is to promote maximal reduction in the intracanal bacterial populations. Engine-driven nickel-titanium instruments possess the latest generation of root canal instruments. The possible benefit of rotary instrumentation over other instrumentation techniques regarding cleaning and disinfecting effects would be irrigant warming and/or turbulence caused by the mechanical rotation of instruments. Furthermore, reciprocating instrument has been introduced for root canal preparation. It has been shown that instruments subjected to reciprocation have increased resistance to fatigue and longer usual life when combined with instruments used in continuous rotation motion. The reciprocating system uses single-file instrumentation technique which can shape and clean the canal in a shorter period and together with the lesser amount of antimicrobial agent. OBJECTIVE: The objective of this study is to compare and evaluate the microbial reduction of rotary and reciprocating systems on microbial reduction. SEARCH STRATEGY: A search was performed in Electronic databases (i.e., PubMed, Cochrane library, Science direct, Lilac, Sigle) using following search terms alone and in combination by means of PubMed search builder from January 1985 to December 2017. SELECTION CRITERIA: Studies were selected if they met the following criteria: In vivo studies comparing rotary and reciprocating system in asymptomatic apical periodontitis patients. MAIN RESULTS: The results showed that the reciprocating system exerted an almost similar antibacterial effect when compared with the rotary system. CONCLUSION: The present systematic review does not provide concrete evidence to show increased antibacterial efficacy of reciprocating system as compared to the rotary system. Furthermore, clinical trials are required to evaluate the efficacy of various instrumentation systems in reducing bacteria from the root canal system.

Probiotic Streptococcus strains in caries prevention: A systematic review.

OBJECTIVE: The aim of this article is to review the published literature with the purpose of knowing the importance of using various probiotic Streptococcus strains as a preventive and therapeutic method for dental caries management. MATERIALS AND METHODS: Research question was formulated based on the PICO strategy. A comprehensive electronic literature search was conducted across PubMed/Medline, Scopus, and EBSCOhost databases independently by two reviewers. All papers published from 1989 to December 2017 that focused on the use of probiotic Streptococcus strains for caries prevention were included in this review. Inclusion and exclusion criteria were applied to the selected articles, and a customized data extraction sheet was formulated. The selected articles were subjected to quality assessment, and the risk of bias in selected studies was evaluated. RESULTS: A total of five articles were included. The overall risk of bias of the selected clinical trials was found to be high risk, and the overall level of evidence of the selected in vitro studies was moderate. CONCLUSION: The two included clinical studies on the use of probiotic Streptococcus strains for caries prevention had high risk of bias. Although in-vitro studies showed promising results, clinical studies have not demonstrated clear clinical outcomes. Thus, there is a vast scope for future research in this field. CLINICAL RELEVANCE: Application of oral probiotics will help reinstate a balanced microbiota and thereby improving oral health. This systematic review focused on evaluating the role played by probiotic Streptococcus strains in the carious lesion incidence.

Comparative evaluation of postoperative pain after using endodontic needle and EndoActivator during root canal irrigation: A randomised controlled trial.

The purpose of this study was to evaluate and compare the postoperative level of pain after activation of irrigants using EndoActivator with conventional needle irrigation during root canal therapy. In this prospective randomised clinical trial, 72 symptomatic irreversible pulpitis patients were selected. Based on block randomisation after routine root canal preparation, patients were assigned to two groups. In group EN, procedures were performed with endodontic irrigating needle (n = 36) while group EA received activation using EndoActivator (n = 36) in the final irrigation protocol. All the participants were called through phone at 8, 24 and 48 h to analyse pain score using visual analogue scale. Those patients who developed pain were prescribed ibuprofen 200 mg. Pain score and frequency of tablet intake were recorded and statistically analysed. Results showed that group EA resulted in significantly less postoperative pain and analgesics intake than group EN. In conclusion, within the limitations of this study, the activation of irrigants using EndoActivator can be considered an effective method for reducing postoperative pain.

Influence of calcium hydroxide on the post-treatment pain in Endodontics: A systematic review.

INTRODUCTION: Pain of endodontic origin has been a major concern to the patients and the clinicians for many years. Post-operative pain is associated with inflammation in the periradicular tissues caused by irritants egressing from root canal during treatment. It has been suggested that calcium hydroxide intra-canal medicament has pain-preventive properties because of its anti-microbial or tissue altering effects. Some dispute this and reasoned that calcium hydroxide may initiate or increase pain by inducing or increasing inflammation. OBJECTIVE: To evaluate the effectiveness of calcium hydroxide in reducing the post-treatment pain when used as an intra-canal medicament. MATERIALS AND METHODS: THE FOLLOWING DATABASES WERE SEARCHED: PubMed CENTRAL (until July 2013), MEDLINE, and Cochrane Database of Systematic Reviews. Bibliographies of clinical studies and reviews identified in the electronic search were analyzed for studies published outside the electronically searched journals. The primary outcome measure was to evaluate the post-treatment pain reduction when calcium hydroxide is used as an intra-canal medicament in patients undergoing root canal therapy. RESULTS: The reviews found some clinical evidence that calcium hydroxide is not very effective in reducing post-treatment pain when it is used alone, but its effectiveness can be increased when used in combination with other medicaments like chlorhexidine and camphorated monochlorophenol (CMCP). CONCLUSION: Even though calcium hydroxide is one of the most widely used intra-canal medicament due to its anti-microbial properties, there is no clear evidence of its effect on the post-treatment pain after the chemo-mechanical root canal preparation.

Effect of two different chemomechanical caries removal agents on dentin microhardness: An in vitro study.

AIM: The aim of this in vitro study was to evaluate the effect of two different chemomechanical caries removal (CMCR) agents on dentin microhardness. MATERIALS AND METHODS: In this study, the crown portion of ten carious-free and ten caries-affected teeth were selected. In carious-free samples, the teeth were decoronated at the level of cemento - enamel junction. Only the crown portion of the teeth was selected. Occlusal one-third of the crowns were cross-sectioned and discarded to expose the dentin, and it was divided into two groups, five teeth in each group. Then, they were further sectioned longitudinally through the centre. In one group, no agent was applied on one half and Carisolv was applied on other half. In another group, no agent was applied on one-half and Carie-Care was applied on the other half for 1 min. In carious samples, the crowns were sectioned through the centre of carious lesion. Carisolv was applied on one-half and Carie-Care was applied on the other half. After using CMCR agents, surface hardness of dentin was examined using Vickers hardness number (VHN). STATISTICAL ANALYSIS AND RESULTS: The data were analyzed using t-test and one-way analysis of variance (ANOVA). There were no significant difference among normal dentin (62.91 ± 2.76), Carisolv-treated normal dentin (61.72 ± 2.89), and Carie-Care-treated normal dentin (61.90 ± 3.19). In carious samples, the results of Carisolv-treated dentin (58.57 ± 2.62) was not statistically significantly different from those of the Carie-Care-treated dentin (56.77 ± 4.41). CONCLUSION: In conclusion, neither of the CMCR methods caused a significant change in the microhardness of normal dentin and the treated carious dentin.