Survival, complications, and patient-reported outcomes of endodontically treated teeth versus dental implant-supported prostheses: A systematic review.

STATEMENT OF PROBLEM: Decision making for compromised teeth involving the choice between endodontic treatment and tooth extraction followed by an implant-supported prosthesis is challenging. However, systematic reviews examining studies using the same patients or clinical settings to provide conclusive evidence regarding the best approach are lacking. PURPOSE: The purpose of this systematic review was to compare the survival rate, complications, failure, and patient-reported outcomes of endodontically treated teeth and implant-supported prostheses. MATERIAL AND METHODS: After the protocol had been registered at the International Prospective Register of Systematic Reviews (PROSPERO), PubMed, Scopus, and the Cochrane Database of Systematic Reviews were searched from database inception to July 2023 with no language restriction. A manual literature search was performed. The review protocol was based on the population, intervention, comparator, outcome, and study design (PICOS) criteria and included all observational and experimental human studies that directly compared the survival, complications, and patient-reported outcomes of teeth with pulpal and periapical disease after all types of endodontic treatment and subsequent restoration and tooth extraction followed by an implant-supported prosthesis. The risk of bias of the included studies was assessed by using the modified Newcastle-Ottawa scale. RESULTS: Eight observational studies were included in this systematic review: 3 retrospective cohort and 5 case-control studies. Three included studies revealed no difference in survival rate between endodontically treated teeth and implant-supported prostheses during the first 3 years, but the survival of endodontically treated teeth declined over time with a higher failure rate than implant-supported prostheses. In contrast, the other 3 included studies reported lower survival rate for implant-supported prostheses and more complications. In terms of patient-reported outcomes, patients were generally satisfied with both treatment modalities, with notable improvements in oral health-related quality of life in those receiving endodontic treatment. CONCLUSIONS: Whether implant-supported prostheses or endodontically treated teeth are better in terms of survival outcome is unclear. Improved oral health-related quality of life was found after endodontic treatment.

Toll-like receptor and C-type lectin receptor agonists attenuate osteogenic differentiation in human dental pulp stem cells.

BACKGROUND: This study aimed to investigate the effects of various toll-like receptor (TLR) and C-type lectin receptor (CLR) ligands on osteogenic differentiation in human dental pulp stem cells (hDPSCs). METHODS: hDPSCs were cultured and treated with various concentrations (0.01, 0.1, 1.0, and 10 µg/mL) of TLR or CLR agonists (PG-LPS, E.coli LPS, poly(I:C), Pam3CSK4, Furfurman, and Zymosan). Cell viability was determined by MTT assay. The effects of TLR and CLR agonists on osteogenic differentiation of hDPSCs were measured by alkaline phosphatase (ALP) activity, Alizarin Red S staining, and Von Kossa staining. In addition, the mRNA expression of osteogenesis-related genes (ALP, COL1A1, RUNX2, OSX, OCN and DMP1) was examined by RT-qPCR. A non-parametric analysis was employed for the statistical analyses. The statistically significant difference was considered when p < 0.05. RESULTS: Treatment with TLR and CLR agonists was associated with an increase in hDPSCs' colony-forming unit ability. Compared with the control group, TLR and CLR agonists significantly inhibited the osteogenic differentiation of hDPSCs by decreasing the ALP activity, mineralised nodule formation, and mRNA expression levels of osteogenesis-related genes (ALP, COL1A1, RUNX2, OSX, OCN and DMP1). The inhibition of TRIF but not Akt signalling rescued the effects of TLR and CLR agonist attenuating hDPSCs' mineralisation. CONCLUSIONS: The activation of TLRs or CLRs exhibited an inhibitory effect on osteogenic differentiation of hDPSCs via the TRIF-dependent signalling pathway.

Comparison of the efficacy of three different supplementary cleaning protocols in root-filled teeth with a bioceramic sealer after retreatment-a micro-computed tomographic study.

OBJECTIVE: The present study evaluated the efficacy of three different supplementary cleaning protocols on the removal of bioceramic-based root canal filling materials from oval-shaped canals. MATERIALS AND METHODS: A total of 36 human mandibular premolars were instrumented and obturated with gutta-percha and iRoot SP using the single-cone technique. Retreatment was performed with ProTaper Universal retreatment files. The samples were randomly divided into the following supplementary cleaning protocols: conventional syringe irrigation (CSI), passive ultrasonic irrigation (PUI), and XP-endo Finisher R (XPR). The samples underwent micro-CT scanning to quantify the amount of residual filling materials after retreatment and after performing the cleaning protocols. The volume of filling material removal was analyzed by one-way analysis of variance and post hoc Bonferroni and Games-Howell tests (P < 0.05). RESULTS: There were significant differences in the amount of root canal filling material removal in every comparison group (P < 0.05). The XPR removed significantly more residual filling materials (P < 0.01) followed by PUI and CSI (P < 0.05). Similar efficacy was found in the total root canal and all root thirds. CONCLUSIONS: The additional use of XP-endo Finisher R and passive ultrasonic irrigation effectively removed the bioceramic-obturated root filling materials from the oval-shaped canals. However, none of the techniques completely removed the filling materials. CLINICAL RELEVANCE: The XP-endo Finisher R and passive ultrasonic irrigation exhibited greater efficacy compared with syringe irrigation in the reduction of residual filling materials after retreatment in root-filled teeth with a bioceramic sealer.