Métodos de diagnóstico molecular en la práctica odontológica / Molecular diagnostic methods in dental practice

El diagnóstico molecular, mediante la aplicación de técnicas molecu- lares, ha permitido estudiar microorganismos presentes en el inicio y progresión de la caries dental, enfermedad periodontal, y en los fracasos endodónticos. Las técnicas moleculares permiten la detección y cuan- tificación del material genético del ácido desoxirribonucleico (DNA), ácido ribonucleico (RNA) o proteínas, lo que posibilita el estudio del genoma completo o secuencias de DNA específicas. Estas técnicas surgen como una necesidad de detectar microorganismos de difícil o lento crecimiento en cultivos; la técnica más utilizada es la reacción en cadena de la polimerasa (PCR) que permite la amplificación de peque- ños segmentos de material genético al utilizar cebadores, por lo que es un método económico, preciso, sensible y rápido para la detección de microorganismos. El presente artículo de revisión bibliográfica servirá para informar sobre los avances de las técnicas moleculares utilizadas para el diagnóstico en la práctica odontológica (AU)

Molecular diagnosis, through the application of molecular techniques, has made it possible to study microorganisms present in the onset and progression of dental caries, periodontal disease, and endodontic failures. Molecular techniques allow the detection and quantification of the genetic material of deoxyribonucleic acid (DNA), ribonucleic acid (RNA) or proteins, allowing the study of the complete genome or specific DNA sequences, they arise as a need to detect difficult or slow growing microorganisms in cultures. The most widely used technique is the polymerase chain reaction (PCR) that allows the amplification of small segments of genetic material using primers, it is an economical, precise, sensitive and fast method for the detection of microorganisms. This bibliographic review article will serve to report on the advances in molecular techniques used for diagnosis in dental practice (AU)

Diagnosis consensus among endodontic specialists and general practitioners: An international survey and a proposed modification to the current diagnostic terminology.

INTRODUCTION: This survey aimed to determine the consensus amongst endodontic specialists in North America and practitioners worldwide to diagnose the pulp and periapical conditions of selected case scenarios encountered in daily practice using the American Association of Endodontists (AAE) pulpal and periapical diagnostic terms. Secondly, an attempt was made to suggest modifications in terms accordingly. METHODOLOGY: A survey designed by two endodontic educators was sent to endodontists in North America and clinicians worldwide through an electronic database. The survey included socio-demographic questions followed by the clinical and radiographic presentations of four clinical scenarios. The participants were then requested to provide the pulpal and the periapical diagnosis of 11 teeth presented in these cases (22 answers in total/participant) using the AAE diagnostic terminology. Cases were designed to include 12 pulpal/periapical conditions as control (non-controversial conditions) and ten so-called controversial conditions. A proportion threshold of 10% was required for any diagnostic term to be reported in this survey. The participants were divided into two groups based on the region of endodontic training and/or practice to 'Specialised North American' or 'International Practitioners,' and their results were statistically compared using chi-squared tests (p < .05). RESULTS: The survey included 421 participants. 74% were endodontists, and 46.1% were amongst the 'Specialised North American' group and 53.9% amongst the 'International Practitioners'. Eleven of 12 control conditions had an almost complete agreement amongst the participants regarding the diagnostic terms selected, ranging between 82% and 96%, with no other diagnostic term exceeding the 10% threshold. All the controversial conditions yielded more than one diagnostic term selected/condition that exceeded the 10% threshold for groups ('Specialised North American' and 'International practitioners'). There were no differences in the diagnostic terms selected between the two groups; however, the weight for each term varied between the groups in some cases. CONCLUSION: There is a lack of consensus amongst clinicians, regardless of their training and region of practice, on the appropriate diagnostic terms to be used in particular clinical conditions. More diagnostic terms and modifications in the current terms may be required to establish a more reliable diagnostic terminology.

Making sense of sensibility: part 2.

To reach an accurate endodontic diagnosis, it is important for clinicians to understand how to undertake pulpal sensibility tests correctly, how to interpret their results and how to understand their limitations. Part one of this series defined different terms relevant to pulp testing and detailed the diagnostic uses and diagnostic accuracy of pulp testing methods. This section describes clinical techniques for commonly used pulp tests and highlights their limitations and correct interpretation of their results. Applying these principles and techniques will enable accurate endodontic diagnosis in different clinical scenarios.

Making sense of sensibility: part 1.

Thermal and electric pulp sensibility tests are commonly used by the majority of clinicians when diagnosing endodontic disease. These tests indirectly determine the state of pulpal health by assessing the response of the Aδ nerve fibres within the pulp-dentine complex. A positive response to sensibility testing indicates that the nerve fibres are functioning but does not give any quantitative information on nerve function, pulpal blood flow or histological status of the dental pulp. These tests have inherent limitations, including a reliance on a patient's subjective response to the test and the dentist's interpretation of the patient's response. This two-part series aims to help clinicians to reach an accurate endodontic diagnosis by providing an overview of how to undertake common pulpal sensibility tests correctly, how to interpret their results and understand their limitations. This section provides an overview of pulp testing, definitions of terminology relevant to pulp testing, the diagnostic uses of pulp testing and a summary of the diagnostic accuracy of different pulp tests.

[Progress in the diagnosis and treatment strategies of caries-derived dental pulp diseases].

Caries-derived dental pulp diseases are characterized with high incidence and serious endangerment. Considering the complexity of the pulpal infection and the limitation of the pulp self-repairing capability, it is still an urgent problem that how to eradicate infection and to promote tissue regeneration subsequently for dental clinicians. This review discusses and prospects on the pathogenesis, diagnosis and treatment strategies of caries-derived dental pulp diseases, so as to provid a reference on diagnosis and treatment of such diseases for the clinicians.

Magnificación en la terapia endodóncica mediante el microscopio operatorio / Magnification in endodontic therapy through the operatory microscope

La microendodoncia involucra la visualización a través de un microscopio operatorio de todas las fases del tratamiento de conductos y procedimientos de cirugía apical y correctiva por parte del endodoncista. Existe sobrada evidencia acerca de las mejoras que puede aportar la magnificación al tratamiento; la literatura demuestra que la capacidad del operador mejora si su visión del campo gana claridad y precisión, ambos recursos pueden ser proporcionados por el microscopio operatorio, aunado a que posibilita diagnósticos más certeros junto con mejoras en el pronóstico, lo que permite evitar posibles complicaciones. La calidad de los tratamientos endodóncicos involucra infinidad de factores, cada uno relevante en sí mismo pero, en determinados casos, el microscopio puede significar la diferencia entre un tratamiento exitoso o un fracaso clínico. En la actualidad, se ha convertido en un tema de lo más relevante, por lo que el objetivo del presente trabajo es revisar la literatura con el fin de ayudar al entendimiento basado en evidencia científica de los criterios que determinan la relevancia del uso del microscopio en el ámbito endodóncico (AU)

Microendodontics involves the visualization through an operating microscope of all phases of root canal treatment and apical and corrective surgery procedures by the endodontist. There is plenty of evidence about the improvements that magnification can provide, the literature shows that the operator's ability improves if his vision of the field gains clarity and precision, both resources can be provided by the operating microscope, added to the fact that it enables more accurate diagnoses together with improvements in the prognosis allowing to avoid possible complications. The quality of endodontic treatments involves countless factors, each relevant in itself, but in certain cases the microscope can mean the difference between a successful treatment or a clinical failure. At present, it has become a very relevant topic, so the objective of this work is to review the literature in order to help understand the criteria that determine the relevance of the use of the microscope in the endodontic field based on scientific evidence (AU)

Endosoft: herramienta para el aprendizaje de las patologías pulpares y periapicales / Endosoft: a tool for learning from pulp and periapical diseases

Introducción: el empleo de software educativo es una alternativa motivadora en los diferentes escenarios docentes. Objetivo: mostrar la validación del software educativo sobre diagnóstico y tratamiento de enfermedades pulpares y periapicales para su generalización en estudiantes de Estomatología. Material y Métodos: se realizó un estudio de innovación tecnológica o producto terminado digital en la etapa comprendida desde marzo de 2018 a marzo de 2019. Se utilizó la herramienta Mediator v9.0. Se utilizaron métodos teóricos: histórico-lógico, analítico-sintético y el sistémico-estructural; y empíricos: la revisión documental y una encuesta a estudiantes y expertos en función de evaluadores externos del producto. Para evaluar la factibilidad del software se utilizó el método de Criterio de Experto y el Criterio de usuario. Las principales variables evaluadas fueron el diseño de las secciones del software, su funcionalidad, cientificidad del contenido, relación de las imágenes con el objetivo del software, así como su uso en la docencia. Resultados: el producto obtenido consta de un texto básico con hipervínculos para acceder a los demás componentes, así como galerías de imágenes y ejercicios de autoevaluación. Según Criterio de Experto la calidad técnica del producto y la calidad del contenido quedaron evaluadas en la categoría Muy Adecuado. Según Criterio de Usuario, la funcionalidad, la motivación individual y los aspectos de diseño fueron evaluados de Bien. Conclusiones: se desarrolló un software educativo que cuenta con recursos variados para el aprendizaje sobre el tema abordado(AU)

Introduction: The use of the educational software is a motivating alternative in different teaching scenarios. Objective: To validate the educational software related to the diagnosis and treatment of pulp and periapical diseases for its generalization in dental students. Material and Methods: A study linked with technological innovation or digital finished product was conducted during the period between March 2018 and March 2019. The tool used was Mediator v9.0. Theoretical methods such as historical-logical, analytical-synthetic, inductive-deductive, and systemic-structural were used; empirical methods, which included the documentary review and a survey, were applied to students and experts as external evaluators of the product. The methods of Expert Judgment and Customer Judgment were used to evaluate the feasibility of the software. The main variables evaluated were the design of software sections, its functionality, scientific content, relationship between the images and the objective of the software and its use in the teaching-learning process. Results: The product obtained is a basic text with hyperlinks to access the rest of the components, image galleries and self-evaluation exercises. According to Expert Judgment, the technical quality of the software and the quality of its content were evaluated as good. According to Customer Judgment, the functionality, self-motivation and design aspects were evaluated as optimal. Conclusions: An educational software with various resources for learning about the topic approached was developed(AU)

Investigation of Filifactor alocis in primary and in secondary endodontic infections: A molecular study.

OBJECTIVE: Identification of specific bacteria in root canals (RCs) in distinct clinical conditions can support the comprehension of pathological processes. Thus, the objective of this clinical study was to investigate the presence of F. alocis in RCs of teeth with primary endodontic infection (PEI) and with persistent/secondary endodontic infection (SEI) by using molecular techniques. It was also aimed to associate its presence with the clinical features. In addition, the levels of F. alocis as well as the total bacterial cells in the samples were also quantitated. DESIGN: One hundred teeth (50 PEI and 50 SEI) were included. Microbial samples were performed using sterile paper points and assessed by using nested PCR and quantitative Real Time PCR (qPCR). The prevalence of F.alocis in RCs from PEI and SEI were compared by chi-square analysis. Fisher´s exact test or Pearson Chi-square, when appropriate, was used to test associations between clinical and radiographic features and the presence of F. alocis. Significance level was set at 5%. RESULTS: F. alocis was detected in 23 and 28 (PEI) and 12 and 11 (SEI) RCs using Nested PCR and qPCR, respectively. Statistically significant associations were found between the presence of F. alocis and PEI, pain, wet canals, swelling, abscess and purulent exudate (P < 0.05). Total bacterial count was similar in both conditions (P > 0.05). CONCLUSIONS: PEI harbour a significantly higher number of F. alocis than those with SEI. Filifactor alocis was significantly associated with clinical features in primary endodontic infections. Total bacterial count was similar in both clinical conditions.

The Importance of Obtaining a Pulpal and Periradicular Diagnosis Prior to Restorative Treatment.

Maintaining dental pulp vitality should be among the clinical goals of any restorative treatment. By obtaining a pretreatment pulpal and periradicular diagnosis before performing restorative treatment, the clinician will be better able to proceed with treatment of the pulp, especially if it is exposed during caries excavation. A pretreatment pulpal and periapical diagnosis may be effectively attained by performing five objective clinical tests: pulp sensibility, percussion (which may include bite testing), palpation, periodontal probing/ tooth mobility, and updated radiography. This article provides a description of these five clinical tests and gives an overview of current terminologies used when obtaining a pulpal and periradicular diagnosis.

Pulp therapy for primary and immature permanent teeth: an overview.

Pulp therapy for pediatric patients aims to alleviate pulpal infection, relieve associated symptoms, and, ultimately, preserve the tooth. Primary teeth adequately retain space for their successors and have been described as "the best space maintainers." Therefore, the decision to extract a primary tooth should take into consideration occlusal growth and development as well as the potential outcome of pulp therapy. Maintaining pulpal vitality in young permanent teeth is essential for continued root formation; if vitality is lost, the root will cease growth and remain at an unfavorable length. A systematic approach to diagnosis and treatment planning is imperative, and a good history of signs and symptoms and a detailed evaluation of radiographs are prerequisites to accurate diagnosis. The purpose of this review is to aid dental professionals in correctly establishing a pulpal diagnosis and selecting the appropriate method of pulp therapy to achieve a successful outcome. The article discusses contemporary views on indications and pulp medicaments and presents step-by-step descriptions of pulp treatments for both primary and immature permanent teeth.

Frecuencia de alteraciones pulpares y periapicales en los pacientes atendidos en un hospital de la provincia de Loja ­ Ecuador / Pulp and periapical alterations frequency in the patients attended to al Loja hospital­Ecuador

Las alteraciones pulpares y periapicales, son un conjunto de patologías que afectan a los tejidos pulpar y periapical del diente; constituyen una de las causas por las cuales el paciente acude a consulta. Objetivos: Determinar la frecuencia de enfermedades pulpares y periapicales, de acuerdo al sexo, así como el órgano dentario más afectado; en los pacientes atendidos en el Consultorio Odontológico del Hospital Básico de Catacocha, durante el periodo enero - diciembre 2013. Material y Métodos: Estudio documental, comparativo. La población estuvo constituida por los pacientes que acudieron al servicio de Especialidad de Endodoncia del Hospital. La muestra fue de 330 pacientes, que presentaron enfermedad pulpar, se consideró el primer y segundo diagnósticos. Se procedió a revisión de las historias clínicas del Hospital, partes diarios y sistema CARDEX del Ministerio de Salud Pública del Ecuador para corroborar los datos; previo el respectivo permiso de las autoridades del hospital. Se utilizó la prueba estadística chi cuadrado. Resultados: Se revisaron 330 historias clínicas. Los valores más altos, fueron: Pulpitis 40% (n=90) sexo femenino, pulpitis 40% (n=41) sexo masculino, como primer diagnóstico, y como segundo diagnóstico; Periodontitis apical crónica 34% (n=12) sexo femenino, periodontitis apical crónica 44% (n=7) sexo masculino. El órgano dentario más afectado resultó el primer molar inferior izquierdo 3.6, en el primer diagnóstico; y el diente No. 2.1 en el segundo diagnóstico. Conclusiones: Los tipos de diagnósticos no tienen diferencias significativas, entre varones y mujeres. (AU)

Pulp and periapical alterations are a set of pathologies which affect the pulp and periapical tissues of the tooth. This is one of the causes why patients go to the dentist's office. Objectives: To determine the frequency of pulp and periapical diseases in relation with sex as well as the most affected dental organ in the patients of the Dentist's Office at Basic Hospital in Catacocha during the period JanuaryDecember 2013.Material and Methods: Comparative documentary study. The population was the patients who attended the Hospital Endodontics Specialty service. The sample was 330 patients, who presented the pulp disease. The first and second diagnoses were taken under consideration. In order to confirm the data collected, the clinical histories of the Hospital, the daily reports and the CARDEX system from the Ministry of Public Health of Ecuador, with the previous permission of the Hospital, were compared. The statistic test used was square chi. Results: 330 were taken under consideration. The highest values were: Pulpitis 40% (n=90) feminine sex, Pulpitis 40% (n=41) masculine sex, both at first and second diagnosis; chronic apical Periodontitis 34% (n=12) feminine sex, chronic apical periodontitis 44% (n=7) masculine sex. The most affected dental organ was the first lower left molar 3.6, in the first diagnosis; and tooth number 2.1 in the second diagnosis. Conclusions: The types of diagnosis do not present meaningful differences between men and women. (AU)

Lesão endo-perio: classificação e diagnóstico / Endo-perio lesions: classifi cation and diagnosis

Lesões endo-perio são lesões inflamatórias que acometem, em diversos graus, tanto os tecidos periodontais como a polpa dental. O objetivo deste artigo é mostrar, através de uma revisão da literatura, a importância da classificação das lesões endo-perio, assim como o diagnóstico dessas lesões. A partir dos trabalhos revisados, conclui-se que as lesões endo-perio apresentam uma etiologia variada, sendo de fundamental importância o conhecimento do profissional quanto às causas e seu correto diagnóstico. Assim, para o sucesso e a resolução das lesões endo-perio, uma avaliação clínica e radiográfica eficaz determinará a correta classificação e, consequentemente, a melhor forma de tratamento.

Endo-periodontal lesions are inflammatory conditions that affect the periodontal tissues and the dental pulp. The aim of this article is to show the importance of the classification and the diagnosis of the endo-perio lesions. From the studies reviewed, it is concluded that endo-perio lesions present a varied etiology, being of fundamental importance the knowledge of the professional as to its causative factors and its correct diagnosis. Thus, for the success and resolution of endo-perio lesions an effective clinical and radiographic evaluation will determine the correct classification and consequently the best form of treatment.

[Endodontic treatment efficacy enhancement by means of instrumental physiotherapy]. / Povyshenie éffektivnosti éndodonticheskogo lecheniia s pomoshch'iu apparaturnykh metodov.

The article describes in detail and examines the prospects of such methods as electroodontodiagnosis, diathermocoagulation and apex-phoresis. It proves the necessity of development and standardization of devices for the mentioned treatment modalities that will improve the effectiveness an quality of caries complications treatment.

Diagnostic procedures employed by dental practitioners in Australia with a focus on endodontic diagnostic procedures.

BACKGROUND: An accurate diagnosis is the foundation for determining prognosis and appropriate management. This study adds to pre-existing (albeit limited) evidence by exploring the use of diagnostic techniques amongst dental practitioners. The main aim of the study was to identify the availability, usage and clinician preference for specific diagnostic tests. A secondary aim was to investigate the use of diagnostic tests for common clinical scenarios. METHODS: A cross-sectional survey was distributed online to dental practitioners registered with the Australian Dental Association. Quantitative data on clinician demography, and the availability and preference of diagnostic tests was summarized with Stata 13 software. Pearson's chi-squared test was used to determine associations. RESULTS: General dental practitioners (GDP) and specialists comprised 86% and 14% of the 433 respondents, respectively. Unlike light transillumination, most GDP had radiography, biting tests and pulp sensibility tests available. The electric pulp test and ethyl chloride were first choices of most practitioners despite markedly lower availability relative to cold spray. Symptoms and endodontic assessments generally attracted wider usage of pulp testing. CONCLUSIONS: More dental practitioners should utilize diagnostic testing in order to arrive at accurate diagnoses. The availability of diagnostic tests did not completely translate to usage and none of the scenarios presented warranted pulp sensibility testing from all respondents.

Influence of Cone-Beam Computed Tomography filters on diagnosis of simulated endodontic complications.

AIM: To evaluate the influence of cone-beam computed tomography (CBCT) filters on diagnosis of simulated endodontic complications. METHODOLOGY: Sixteen human teeth, in three mandibles, were submitted to the following simulated endodontic complications: (G1) fractured file, (G2) perforations in the canal walls, (G3) deviated cast post, and (G4) external root resorption. The mandibles were submitted to CBCT examination (I-Cat® Next Generation). Five oral radiologists evaluated the images independently with and without XoranCat® software filters. Accuracy, sensitivity and specificity were determined. ROC curves were calculated for each group with the filters, and the areas under the curves were compared using anova (one-way) test. McNemar test was applied for pair-wise agreement between all images versus the gold standard and original images versus images with filters (P < 0.05). RESULTS: G1 was the most difficult endodontic complication to diagnosis, followed by G2, G4 and G3. There were no differences between areas under the ROC curves for the filters in all groups; however, Sharpen Super Mild filter had the best results for G1 (0.47), Angio Sharpen Low 3 × 3 for G2 (0.93), Angio Sharpen Low 3 × 3, S9, Shadow and Sharpen for G3 (1.00) and Sharpen 3 × 3 for G4 (1.00). The McNemar test revealed significant differences between all filters with the gold standard (P = 0.00 for all filters) and the originals images (P = 0.00 for all filters) only in G1 group. There were no differences in the other groups. CONCLUSIONS: The filters did not improve the diagnosis of the simulated endodontic complications evaluated. Their diagnosis remains a major challenge in clinical practice.

Prevalence of endodontic diseases: an epidemiological evaluation in a Brazilian subpopulation

Aim: To determine the prevalence of pulp and periradicular diseases in a Brazilian subpopulation, correlating the prevalence with sex, age and most affected teeth. Methods: Data collected from medical records of patients treated at the Clinic of Specialization in Endodontics of the Federal University of Pernambuco between 2003 and 2010. The following variables were recorded for each patient: sex, age, affected teeth and diagnosed endodontic disease. Using Pearson's chi-square and Fisher's exact tests, the collected data analysis was set at a 5% significance level. Results: From all the treated teeth, 57% were diagnosed with pulp diseases, with the symptomatic irreversible pulpitis being the most prevalent (46.3%), while among the diagnosed periradicular diseases (43%), chronic apical periodontitis was the most prevalent (81%). Pulp diseases were detected in men and women in an unequal mode (p=0.008). Subjects under 40 years old had higher prevalence of pulp disease (p=0.286), and patients over 50 years were most affected by periradicular diseases (p=0.439). Maxillary incisors and mandibular first molars were the most affected teeth by endodontic diseases. Conclusions: In the evaluated subpopulation, the endodontic diseases were more prevalente in the maxillary incisive, affected indiscriminately individuals of different age groups and chronic apical periodontitis was the most prevalent diagnosed disease (Au)

Modern Endodontic Planning Part 1: Assessing Complexity and Predicting Success.

Following a diagnosis of irreversible pulpal disease, periapical disease or failed endodontic therapy, the options for the tooth are extraction or root canal treatment. There is increasing evidence that certain factors may allow the clinician to predict the likely outcome of root canal therapy (RCT) and thus better inform the patient of the possible success rates. Should the patient choose root canal treatment, the clinician must also be able to gauge the potential difficulties that may be encountered and consequently determine whether it is within their competency. CPD/CLINICAL RELEVANCE: Assessing outcomes and complexity of care is an essential part of informed consent. Knowing when to refer is an essential component of best clinical practice.

Pain Part 4: Odontogenic Pain.

UNLABELLED: Pain is one of the major reasons that lead patients to seek dental care. For the majority of patients, the pain is of odontogenic origin, as a consequence of dental disease. The timely diagnosis and management of dental pain is an essential component of dental care, and this article reminds readers of the common presenting symptoms of simple dental pain, diagnoses and pragmatic management. CLINICAL RELEVANCE: Pain of odontogenic origin is common, and distressing. However, the pathology is consistent, as are the symptoms, and an understanding of this underpins the careful history-taking that will lead the clinician to the diagnosis.