The applications of ultrasound, and ultrasonography in dentistry: a scoping review of the literature.

OBJECTIVES: This scoping review aims to summarize the available literature on the clinical applications of ultrasonography and ultrasound in diagnostic, therapeutic, and interventional dental applications. MATERIALS AND METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Extension for Scoping Reviews checklist and conducted a protocol-driven scoping review of randomized controlled trials, cohort studies, cross-sectional studies, case-control studies, and case series that assessed ultrasonography or ultrasound use as a stand-alone diagnostic, therapeutic, and interventional tool in dentistry. We included studies published after 1980, study samples ≥ 10, with diagnostic, concordance, or therapeutic outcomes. We searched Ovid MEDLINE, Embase, and others (up to April 2021) and extracted information regarding study level, patient level, test or treatment level, and outcome level data. RESULTS: Five interventional studies (related to oral medicine, temporomandibular disorders, and dental anesthesia), eight therapeutic studies (related to surgery and orthodontics), and seventy-five diagnostic studies (related to orthodontics, surgery, endodontics, oral medicine, temporomandibular disorders, restorative dentistry, and periodontology) were identified and presented in this review. CONCLUSION: Ultrasonography has a well-established niche in diagnostic dentistry, while therapeutic and interventional ultrasounds have a smaller, yet present, niche in dentistry. However, further research is needed to report the precise estimates of the diagnostic, therapeutic, and interventional effects. CLINICAL SIGNIFICANCE: Dentists are mostly unfamiliar with ultrasonography and ultrasound and their potential uses. This review maps the diagnostic and therapeutic applications of ultrasonography and ultrasound technology in dentistry and highlights the current challenges, gaps of knowledge, and research status of ultrasound technology in this regard.

A Scoping Review of Four Decades of Outcomes in Nonsurgical Root Canal Treatment, Nonsurgical Retreatment, and Apexification Studies: Part 3-A Proposed Framework for Standardized Data Collection and Reporting of Endodontic Outcome Studies.

INTRODUCTION: Despite initiatives to standardize and improve reporting of rapidly growing endodontic outcome research studies, issues related to missing and ambiguous information are still of great concern. In this article, we propose a framework for standardized data collection and a compiled checklist for reporting of various study designs on endodontic outcome. METHODS: A comprehensive search was carried out to locate randomized controlled trials, cohorts, case-control studies, or case series of >100 patients that reported on endodontic outcomes. We reviewed these articles to develop a Data Collection Template and compiled a checklist for reporting of future endodontic outcome research. RESULTS: Out of 354 eligible articles previously reported in our scoping review on endodontic outcome studies, 109 articles were selected and screened for study variables or levels of categorization. Our complied Data Collection Template was developed in 19 domains to highlight important demographic, preoperative, intraoperative, and postoperative variables. Because of the specific needs for endodontic outcome literature, we also proposed a compiled checklist (consisting of 4 main domains) to facilitate the reporting of various study designs on endodontic outcome studies. This checklist included simple descriptions of the required items and examples on reporting from published endodontic studies. CONCLUSIONS: By facilitating the collection and reporting of relevant research data by investigators in private practice and academia, we hope that the proposed Data Collection Template and reporting guideline can highlight the importance of standardization among clinicians and researchers while producing valid scientific information that will support evidence-based treatment decisions.

A Scoping Review of 4 Decades of Outcomes in Nonsurgical Root Canal Treatment, Nonsurgical Retreatment, and Apexification Studies-Part 2: Outcome Measures.

INTRODUCTION: Inconsistencies in the definitions of endodontic outcome terminology jeopardize evaluations of proposed interventions and patient care quality. This scoping review aimed to provide groundwork to develop a set of basic outcomes in endodontics. METHODS: We performed a comprehensive literature search for randomized controlled trials, cohort studies, case-control studies, and case series (≥10 patients) published after 1980 with patients ≥10 years of age with any preoperative pulpal and periapical diagnosis in permanent teeth requiring nonsurgical root canal treatment, retreatment, or apexification. Abstracted data on outcome assessment methods, assessors, and domains were reported after univariate and bivariate analyses. RESULTS: Treatment outcomes were evaluated radiographically (88%) or clinically (73%). Although 2-dimensional radiography exceeded 3-dimensional radiography, the use of the latter has increased since 2010, mostly for nonsurgical retreatments. Of 19 identified outcomes, 5 were most frequent: success (168 studies, 40%), radiographic healing (128 studies, 30%), survival (of an asymptomatic tooth [48 studies, 12%] or of a procedure code in administrative databases [31 studies, 7%]), pain assessment (14 studies, 3%), and quality of life (11 studies, 3%). Clinician-centered outcomes have been most frequently studied since the 1980s (71%), in academic settings (76%), and using a prospective design (45%). Patient-centered outcomes were reported in 19% of studies before 2010 and 30% since 2010. They were more common among retrospective studies (49%). CONCLUSIONS: Patient-centered outcome measures are lacking in endodontic studies. The state of available research can provide a baseline for the development of a core outcome set in endodontics, which should represent the important patient-centered outcomes in conjunction with well-validated clinician-centered outcomes.

A Scoping Review of 4 Decades of Outcomes in Nonsurgical Root Canal Treatment, Nonsurgical Retreatment, and Apexification Studies-Part 1: Process and General Results.

INTRODUCTION: Despite initiatives to standardize reports, variances in study design, outcomes assessed, and tools used are persistent in the literature. This review scoped the existing literature on endodontic outcome studies for future development of core outcome sets. METHODS: A comprehensive literature search of randomized controlled trials, cohort studies, case-control studies, and case series (≥10 patients) published after 1980 including patients ≥10 years of age with any preoperative pulpal and periapical diagnosis in permanent teeth requiring nonsurgical root canal treatment (NS-RCT), retreatment (NS-ReTx), or apexification was performed. Abstracted data were reported through descriptive statistics. RESULTS: Of the 9957 studies screened, 354 were included. An increase in the quantity of endodontic outcome publications and levels of evidence in their study design was noted over the past 4 decades. Although 41% of the studies included participants 26-50 years of age, literature including participants >50 years old has increased since 2000. Apexification and NS-ReTx were mostly provided by specialists and postgraduate students. The most common follow-up period was 2-5 years (35%), and most randomized controlled trials (58%) reported follow-up times <1 year. Multiple-visit treatment was most common in apexification studies (85%). Deficiency, inconsistency, and ambiguity were observed across many reports. CONCLUSIONS: NS-ReTx and NS-RCT/NS-ReTx studies have increased over the past 2 decades, particularly those focusing on molars and patients >50 years old. Despite the progress in endodontic research, heterogeneity in reporting styles yields considerable limitations, particularly data standardization challenges and inconsistencies in methods and results reporting. This scoping review highlighted the state of available research and supported the development of standardized guidelines for future investigations.

Efficacy and Safety of Postoperative Medications in Reducing Pain after Nonsurgical Endodontic Treatment: A Systematic Review and Network Meta-analysis.

INTRODUCTION: The purpose of this study was to evaluate the efficacy and safety of postoperative medications in decreasing pain after nonsurgical endodontic treatment using a network meta-analytic approach. METHODS: MEDLINE, Embase, CENTRAL, CINAHL, and Scopus were searched (until July 31, 2019). Two reviewers selected eligible randomized controlled trials and extracted and meta-analyzed data to estimate the treatment effects of pain assessed on a 0-100 scale (mean difference [MD]); 95% credible interval [CrI], and surface under the cumulative ranking curve [SUCRA]) at 6-8, 12, 24, and 48 hours postoperatively after the administration of various interventions. The Cochrane risk of bias tool was applied to eligible trials. The overall quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach obtained from the CINeMA Web application (University of Bern, Bern, Switzerland). RESULTS: Eight interventions among 11 studies were identified: nonsteroidal anti-inflammatory drugs (NSAIDs), NSAIDs + acetaminophen, NSAIDs + benzodiazepines, NSAIDs + opioids, corticosteroids, opioids, acetaminophen, and placebo. Compared with placebo, nonsurgical endodontic treatment pain 6-8 hours postoperatively improved with NSAIDs + acetaminophen (MD = -22; 95% CrI, -38 to -7.2; SUCRA = 73%; moderate confidence) and NSAIDs (MD = -21; 95% CrI, -34 to -7.6; SUCRA = 68%; very low confidence). At 12 and 24 hours, only NSAIDs were effective in decreasing postoperative pain. At 48 hours, no treatment resulted in significant pain reduction. Corticosteroids and opioids did not significantly decrease pain. No major safety concerns were reported. CONCLUSIONS: Very low- to moderate-quality evidence suggests that NSAIDs or NSAIDs + acetaminophen administered after nonsurgical endodontic treatment lead to a clinically relevant decrease in postoperative pain for patients with irreversible pulpitis or pulpal necrosis and are the most effective treatments available. Postoperative corticosteroids or opioids did not significantly decrease postoperative pain.

Effectiveness of treatments for medication-related osteonecrosis of the jaw: A systematic review and meta-analysis.

BACKGROUND: The effectiveness of management strategies used for the treatment of medication-related osteonecrosis of the jaw (MRONJ) remains poorly understood. The authors evaluated systematically the effectiveness of the various treatment modalities used for MRONJ. TYPES OF STUDIES REVIEWED: The authors conducted a comprehensive search of MEDLINE, Embase, the Cochrane Library, and Scopus to identify randomized controlled trials, nonrandomized controlled trials, and prospective cohort studies to evaluate comparatively the effectiveness of management strategies for the treatment of MRONJ. The authors conducted the identification of eligible studies in duplicate and synthesized the extracted data by means of a meta-analysis, when feasible. RESULTS: The authors found 13 studies with a medium-to-high risk of bias that met the inclusion criteria of this review. The authors found that, compared with medical treatment of local antimicrobials with or without systemic antimicrobials, the study investigators associated surgical treatment with higher odds of complete resolution of the condition (2 studies; 76 participants; unadjusted odds ratio, 3.55; 95% confidence interval, 1.12 to 11.19). The effectiveness of other therapies, such as bisphosphonate drug holidays, teriparatide, and hyperbaric oxygen, was uncertain. CONCLUSIONS AND PRACTICAL IMPLICATIONS: On the basis of the results of an unadjusted analysis, the results of the studies that were deemed to be medium to low quality and to have medium-to-low statistical power suggested that there are higher odds of resolving MRONJ with surgical treatment compared with medical treatment. High-quality research is required for conclusive statements to be made regarding treatment strategies for management of MRONJ.

ORAL HEALTH STATUS OF IMMIGRANT AND REFUGEE CHILDREN IN NORTH AMERICA: A SCOPING REVIEW.

OBJECTIVES: The aim of this scoping review was to assess the oral health status of the children of refugees and immigrants ("newcomers"); the barriers to appropriate oral health care and use of dental services; and clinical and behavioural interventions for this population in North America. METHODS: Explicit inclusion and exclusion criteria were used in searching electronic databases to identify North American studies between 2007 and 2014 that reported oral health status, behaviours and environment of children of newcomers. Additional studies from 1995-2008 were found in a recently published review. Pertinent data from all selected studies were summarized. RESULTS: Overall, 32 relevant North American studies were identified. In general, children of newcomers exhibit poorer oral health compared with their non-newcomer counterparts. This population faces language, cultural and financial barriers that, consequently, limit their access to and use of dental services. Intervention programs, such as educational courses and counseling, targeting newcomer parents or their children are helpful in improving the oral health status of this population. CONCLUSIONS: Children of newcomers are suffering from poor oral health and face several barriers to use of dental care services. The disparity in dental caries between children of newcomers and their counterparts can be reduced by improving their parents' literacy in the official language(s) and educating parents regarding good oral health practices. An appropriate oral health policy remains crucial for marginalized populations in general and newcomer children in particular.