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BACKGROUND: Regenerative techniques are increasingly being advocated in endodontic apical surgery (AS) to enhance the healing of periapical lesions. Various grafting and membrane materials are employed as adjuncts to modern AS. OBJECTIVES: This systematic review aimed to answer the following PICO question: In patients with apical periodontitis (P) what is the impact of bone grafting with/without barrier membrane materials (I) compared with surgery without grafting materials (C) on the outcome of AS evaluated clinically and radiographically (O). METHODS: A systematic search was conducted in four databases (Embase, Web of Science, PubMed and Cochrane Central Register of Controlled Trials) until 1 August 2023. Google Scholar was also manually searched. Studies with a prospective randomized design were included. Cochrane risk-of-bias (RoB) tool 2.0 assessed bias. Two independent reviewers performed the study selection, data extraction and appraisal of studies. Meta-analysis was performed using R3.5.1 software. RESULTS: From the identified 2582 studies, eight randomized clinical trials were included for meta-analysis. Two studies had low RoB, while six had some concerns. Analysis revealed significantly better outcomes when surgery involved bone regeneration techniques than conventional surgery (OR = 2.18, 95% CI: 1.32-4.31, p = .004). Subgroup analyses on individual grafts (OR = 0.22, 95% CI: -0.99 to 1.44, p = .720) (OR = -0.09, 95% CI: -1.42 to 1.23, p = .885) and membranes (OR = -1.09, 95% CI: -2.94 to 0.76, p = .247) and their combinations (OR = 0.03, 95% CI: -1.50 to 1.55, p = .970) did not yield any significant results. The type of membrane used did not significantly impact the outcome (OR = -1.09, 95% CI: -2.94 to 0.76, p = .247) nor did altering the combination of graft/membrane. DISCUSSION: This systematic review examined the effects of bone grafting with/without membrane placement on the outcome of AS. It highlights the potential advantages of regenerative techniques and the need for further research in this area. CONCLUSIONS: Based on current evidence, bone grafting with/without barrier membrane placement significantly improves healing after AS. Subgroup analysis of resorbable membranes or grafting did not significantly influence the outcome. The combination of membrane and graft was also not significant. Future well-designed, randomized controlled trials in this area are essential before these materials can be recommended for routine use to enhance healing outcomes in AS. REGISTRATION: PROSPERO (CRD42021255171).
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Transplante Ósseo , Periodontite Periapical , Humanos , Periodontite Periapical/cirurgia , Transplante Ósseo/métodos , Resultado do Tratamento , Membranas Artificiais , Regeneração Óssea , Ensaios Clínicos Controlados Aleatórios como Assunto , Apicectomia/métodosRESUMO
BACKGROUND: Consensus on the treatment of choice for complicated crown fractures of teeth is limited. Recent guidance recommends vital-pulp-therapy; however, the preferred type is not specified. Higher success rates for pulpotomy compared to pulp-capping have been documented, which suggests pulpotomy may be a preferable option for complicated crown-fractures. OBJECTIVES: The purpose of this systematic review was to determine the success rate of pulpotomy (partial and complete) on teeth that suffered complicated crown fractures. PARTICIPANTS: patients who have suffered a complicated crown fracture to an anterior permanent tooth. INTERVENTION: pulpotomy (partial or complete). Comparator: pulp-capping or root canal treatment. OUTCOME: combined clinical and radiographic success at or after 12 months. METHODS: A systematic literature using key search terms was conducted using PubMed, Web of Science and Cochrane-Central-Register-of-Controlled-Trials (CENTRAL) as well as a grey literature search from inception to May 2021 and without language restricted to English. Strict inclusion criteria were applied. A standardized tool with defined criteria to assess the risk of bias in each study was used. For non-randomized comparative trials, the Robins-I tool was used while the Newcastle-Ottawa scale was used for non-comparative non-randomized studies. RESULTS: Seven retrospective clinical studies were included. The studies reported high success rates for pulpotomy with overall success ranges for partial or complete pulpotomy ranging from 75% to 96%. One study compared the success rates of pulpotomy to an alternative treatment option pulp capping (90.9% vs. 67%, respectively). Due to the lack of homogeneity in the included studies, a meta-analysis was not possible. DISCUSSION: This review highlights the limited evidence based for the current guidance on treatment of complicated crown fractures. The findings of the review indicate high success rates for pulpotomy; however, there is a moderate risk of bias and small sample sizes in the included studies with the result that the overall results should be interpreted with caution. CONCLUSION: Within the limitations of this review, the benefits and high success rates reported for partial pulpotomy suggest this procedure, rather than pulp-capping, should be considered as the treatment of choice for both immature and mature teeth that have suffered complicated crown-fractures.
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Dentição Permanente , Pulpotomia , Coroas , Capeamento da Polpa Dentária/métodos , Humanos , Pulpotomia/métodos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: To assess the change of the Schneider membrane thickness measured by CBCT before and after root canal treatment, retreatment and pulp capping procedures. METHODS: This retrospective study was conducted on CBCT scans of a patient population of Guy's Hospital NHS Foundation Trust, London. Three groups of patients were studied: Group 1 consisted of patients referred for primary endodontic treatment; Group 2 for endodontic retreatment; Group 3 for indirect pulp capping procedures (serving as a control group). Follow up scans were carried out 1 year after treatment. Measurements were carried out on CBCT scans and data were analysed statistically by Wilcoxon Signed Rank Test. Linear regression was used to assess predictive parameters for membrane thickness. RESULTS: A statistically significant reduction of the Schneider membrane thickness was observed one year after endodontic treatment and retreatment (P < 0.05) but no significant reduction was observed after pulp capping procedures. Linear regression showed that age and gender were significant predictors influencing the Schneider membrane thickness. CONCLUSIONS: Within the limitations of this retrospective study, following root canal treatment and re-treatment a Schneiderian membrane thickness reduction occurred at 1-year follow-up. The removal of odontogenic infection following endodontic treatment may help reducing the thickness of the Schneider membrane.
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Tomografia Computadorizada de Feixe Cônico/métodos , Capeamento da Polpa Dentária , Cavidade Pulpar/diagnóstico por imagem , Mucosa Nasal/diagnóstico por imagem , Tratamento do Canal Radicular , Feminino , Humanos , Londres , Masculino , Mucosa Nasal/anatomia & histologia , Retratamento , Estudos RetrospectivosRESUMO
PURPOSE: To report two cases of primary vitreoretinal lymphoma (PVRL), which presented as intermediate and posterior uveitis. METHODS: Combined clinical assessment, multimodal imaging with spectral-domain optical coherence tomography, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, brain magnetic resonance imaging and vitreous and retinal biopsy. Case 1 was a 48-year-old woman who complained of visual loss in her right eye secondary to a diffuse vitreous opacification and multiple chorioretinal lesions. Case 2, a 74-year-old man, presented with low vision in his right eye due to a wide chorioretinal lesion at the posterior pole, vitreous opacification and posterior uveitis in both eyes. RESULTS: Diffuse large B cell lymphoma was histologically diagnosed in the cerebellum in the first case and in chorioretinal tissue in the second patient. Atypical lymphoid cells were detected and allowed to make a diagnosis of primary central nervous system lymphoma in case 1 and PVRL in case 2. CONCLUSION: PVRL often masquerades ad intermediate or posterior uveitis. The management of the patients needed a team of pathologists, haematologists and ophthalmologists to achieve the correct diagnosis and choose the more appropriate therapy. Some peculiar characteristics on multimodal imaging, even in atypical cases of PVRL, should raise suspicious for PVRL and lead to a diagnostic vitrectomy and/or retinal biopsy.
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Angiofluoresceinografia/métodos , Linfoma Difuso de Grandes Células B/diagnóstico , Imagem Multimodal/métodos , Retina/patologia , Neoplasias da Retina/diagnóstico , Uveíte Posterior/etiologia , Corpo Vítreo/patologia , Idoso , Biópsia , Diagnóstico Diferencial , Feminino , Seguimentos , Fundo de Olho , Humanos , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/cirurgia , Masculino , Pessoa de Meia-Idade , Neoplasias da Retina/complicações , Neoplasias da Retina/cirurgia , Tomografia de Coerência Óptica , Uveíte Posterior/diagnóstico , Uveíte Posterior/cirurgia , Acuidade Visual , VitrectomiaRESUMO
OBJECTIVES: To evaluate the in vitro accuracy of digital impressions for three-dimensional (3D) volumetric measurement of residual coronal tooth structure postendodontic cavity preparation, with reference to micro-computed tomography (µCT). METHODS: Quantification of the accuracy and precision of the intraoral digital scanner (3M True Definition Scanner - IOS) was performed using a metrology gauge block and a profilometric calibration model. Thirty-four human extracted molars with endodontic access cavities were scanned using both intraoral scanning (test scanner) in high-resolution mode, and µCT (reference scanner: GE Locus SP µCT scanner) in high- (HiResCT) and low- (LoResCT) resolution modes. Comparisons of volumetric accuracy and 3D profilometric deviations were performed using surface metrology software. One-way repeated measures analysis of variance (ANOVA), in combination with the Bonferroni post hoc test, was implemented to compare the differences in volume measurements between scanning methods. RESULTS: Digital scanning revealed smaller volume measurements by 1.36% and 0.68% compared to HiResCT and LoResCT, respectively. There was a statistically significant difference in the volumetric measurements obtained from the IOS scanner and both HiResCT and LoResCT scans (P < 0.001). Analysis of the mean 3D profilometric deviations revealed that the IOS displayed greater surface deviation (± 27/33 µm) vs HiResCT and LoResCT (± 16/32 µm). CONCLUSIONS: Although volumetric measurements of endodontically accessed teeth were up to 1.36% smaller in comparison to µCT, the digital scanner was able to reliably measure the extra- and intracoronal aspect of the endodontically accessed tooth.
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Técnica de Moldagem Odontológica , Processamento de Imagem Assistida por Computador , Dente não Vital , Microtomografia por Raio-X , Humanos , Imageamento Tridimensional , Modelos DentáriosRESUMO
OBJECTIVES: Determinants of inappropriate antibiotic prescription in the community are not clearly defined. The objective of this study was to perform a systematic review and meta-analysis evaluating gender differences in antibiotic prescribing in primary care. METHODS: All studies analysing antibiotic prescription in primary care were eligible. PubMed and MEDLINE entries with publication dates from 1976 until December 2013 were searched. The primary outcomes were the incidence rate ratio (IRR) (measured as DDD/1000 inhabitants/day) and the prevalence rate ratio (PRR) (measured as prevalence rate/1000 inhabitants) of antimicrobial prescription, stratified by gender, age and antibiotic class. Random-effects estimates of the IRR and PRR and standard deviations were calculated. RESULTS: Overall, 576 articles were reviewed. Eleven studies, comprising a total of 44â333â839 individuals, were included. The studies used data from prospective national (five studies) or regional (six studies) surveillance of community pharmacy, insurance or national healthcare systems. Women were 27% (PRR 1.27â±â0.12) more likely than men to receive an antibiotic prescription in their lifetimes. The amount of antibiotics prescribed to women was 36% (IRR 1.36â±â0.11) higher than that prescribed for men in the 16 to 34 years age group and 40% (IRR 1.40â±â0.03) greater in the 35 to 54 years age group. In particular, the amounts of cephalosporins and macrolides prescribed to women were 44% (IRR 1.44â±â0.30) and 32% (IRR 1.32â±â0.15) higher, respectively, than those prescribed for men. CONCLUSIONS: This meta-analysis shows that women in the 16 to 54 years age group receive a significantly higher number of prescriptions of cephalosporins and macrolides in primary care than men do. Prospective studies are needed to address reasons for gender inequality in prescription and to determine whether a difference in adverse events, including resistance development, also occurs.
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Antibacterianos/uso terapêutico , Prescrições de Medicamentos , Prescrição Inadequada , Padrões de Prática Médica , Atenção Primária à Saúde , Caracteres Sexuais , Adolescente , Adulto , Antibacterianos/efeitos adversos , Uso de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Estudos Prospectivos , Adulto JovemRESUMO
OBJECTIVES: The presence of opportunistic pathogens such as Propionibacterium acnes (P. acnes) may contribute to the endodontic pathology. The presence of P. acnes may be influenced by different endodontic conditions. The aims of the study were firstly, to identify P. acnes within the whole cultivable microbiota of primary endodontic infections, to investigate which P. acnes phylotypes predominate in such infections and secondly to determine if the presence of an "open" communication (e.g. a sinus) can be associated with the isolation of P. acnes from the root canal. MATERIAL AND METHODS: The predominant cultivable microbiota of 15 primary endodontic lesions (7 without communication with the oral environment and 8 with an open communication) were identified using partial 16S ribosomal RNA (rRNA) gene sequence analysis. The identification of the organism was determined by interrogating the Human Oral Microbiome Database. The P. acnes isolates were typed on the basis of the recA gene sequence comparison. A neighbor-joining tree was constructed using MEGA 4.1 with the inclusion of known recA sequences. RESULTS: There was no difference in the number of species identified from lesions without communication (5.86 ± 3.7) and those with communication (5.37 ± 3.6) (P > 0.05). PCR-based 16S rRNA gene sequencing revealed P. acnes as the most prevalent isolate recovered from lesions with communication. recA gene sequencing revealed two phylogenetic lineages present in lesion with communication, with mainly type I (further split into type IA and type IB) and type II. CONCLUSIONS: The presence of P. acnes as opportunistic pathogens has been confirmed and may sustain the traits observed in specific clinical presentations. CLINICAL RELEVANCE: Clinical management of open lesions may require further disinfection to eliminate opportunistic bacteria.
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Infecções por Bactérias Gram-Positivas/microbiologia , Infecções Oportunistas/microbiologia , Fístula Bucal/microbiologia , Propionibacterium acnes/isolamento & purificação , Pulpite/microbiologia , Abscesso/microbiologia , Adolescente , Adulto , Técnicas de Tipagem Bacteriana , Feminino , Humanos , Masculino , Microbiota , Propionibacterium acnes/classificaçãoRESUMO
OBJECTIVES: The purpose of this study was to determine in vitro using a synchrotron radiation-based µCT (SRCT) whether rotary and reciprocating nickel titanium (NiTi) instrumentations lead to the formation of dentine microcracks. MATERIAL AND METHODS: Fourteen extracted human molars were obtained with ethical approval. Seven distobuccal roots of the maxillary molars and seven mesial roots of the mandibular molars were assigned to two experimental groups: (A) prepared with rotary Pro Taper instrumentation (n = 6) and (B) reciprocating WaveOne (n = 6). Irrigation with 1 % NaOCl and 17 % EDTA solutions was carried out. The remaining roots served as positive control with induced fractures (group C). SRCT was used to scan all samples pre and post-operatively. An imaging software was used to determine the number and length of microcracks. Statistical analyses weighed differences between pre and post-instrumentation and between shaping methods. RESULTS: A significant increase in the number and length of microcracks was detected post-shaping. No significant difference between rotary and reciprocating instrumentation was observed. CONCLUSIONS: Within the limitations of this in vitro study, an increased number and length of microcracks was induced by mechanical instrumentation. Reciprocating and rotary instrumentation are similar in terms of effect. CLINICAL SIGNIFICANCE: Dentinal damage may occur following rotary and reciprocating instrumentation.
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Dentina/diagnóstico por imagem , Dentina/lesões , Dente Molar/diagnóstico por imagem , Dente Molar/cirurgia , Preparo de Canal Radicular/instrumentação , Microtomografia por Raio-X/métodos , Adulto , Desenho de Equipamento , Humanos , Técnicas In Vitro , Pessoa de Meia-Idade , Níquel , Síncrotrons , TitânioRESUMO
The aim of this study was to evaluate the effect of chlorine dioxide and various other more common irrigation solutions on the microhardness and surface roughness of root canal dentin. Fifty human maxillary central incisors were sectioned longitudinally and treated for 1 minute with 5 ml of the following aqueous solutions (v/v%): Group 1:13.8% chlorine dioxide, Group 2:17% ethylene diamine tetraacetic acid (EDTA). Group 3: 7% maleic acid, Group 4: 2.5% sodium hypochlorite (5ml/min), Group 5: Saline (control). Specimens were subjected to microhardness and surface roughness testing. Chlorine dioxide and sodium hypochlorite reduced the microhardness more than other test agents. The highest surface roughness was produced with maleic acid. Chlorine dioxide should be used cautiously during chemomechanical preparation of the root canal system in order to prevent untoward damage to the teeth.
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Compostos Clorados/farmacologia , Cavidade Pulpar/efeitos dos fármacos , Dentina/efeitos dos fármacos , Óxidos/farmacologia , Irrigantes do Canal Radicular/farmacologia , Cavidade Pulpar/ultraestrutura , Dentina/ultraestrutura , Ácido Edético/farmacologia , Dureza , Humanos , Incisivo , Maleatos/farmacologia , Teste de Materiais , Microscopia de Força Atômica , Cloreto de Sódio , Hipoclorito de Sódio/farmacologia , Fatores de TempoRESUMO
The aim of this study was to evaluate the effect of chlorine dioxide and various other more common irrigation solutions on the microhardness and surface roughness of root canal dentin. Fifty human maxillary central incisors were sectioned longitudinally and treated for 1 minute with 5 ml of the following aqueous solutions (v/v%): Group 1: 13.8% chlorine dioxide, Group 2: 17% ethylene diamine tetraacetic acid (EDTA). Group 3: 7% maleic acid, Group 4: 2.5% sodium hypochlorite (5 ml/min), Group 5: Saline (control). Specimens were subjected to microhardness and surface roughness testing. Chlorine dioxide and sodium hypochlorite reduced the microhardness more than other test agents. The highest surface roughness was produced with maleic acid. Chlorine dioxide should be used cautiously during chemomechanical preparation of the root canal system in order to prevent untoward damage to the teeth.
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Compostos Clorados/farmacologia , Cavidade Pulpar/efeitos dos fármacos , Dentina/efeitos dos fármacos , Óxidos/farmacologia , Irrigantes do Canal Radicular/farmacologia , Cavidade Pulpar/ultraestrutura , Dentina/ultraestrutura , Ácido Edético/farmacologia , Dureza , Humanos , Maleatos/farmacologia , Teste de Materiais , Microscopia de Força Atômica , Cloreto de Sódio , Hipoclorito de Sódio/farmacologia , Ápice Dentário/efeitos dos fármacos , Ápice Dentário/ultraestruturaRESUMO
Introduction The success of root canal treatment (RCTx) relies on the technical quality of the root canal filling, often assessed through radiographic evaluation.Aims This audit aims to evaluate the technical proficiency of Peninsula Dental School (PDS) undergraduate dental students in RCTx, comparing it with established European standards.Design Conducted as a retrospective study, this evaluation focuses on assessing the technical quality of RCTx performed by undergraduate dental students at PDS across various academic years.Setting PDS, a primary care-based dental school in the UK, serves as the focal point for this evaluation.Materials and methods Reviewed 2021-2022 endodontic cases by supervised undergraduates. Analysed radiographs for obturation, voids and errors based on established benchmarks. Randomly selected unbiased cases, assessing voids, filling proximity, missed canals and canal anatomy preservation.Interventions Comparative analysis of RCTx quality between PDS students and counterparts from other dental schools, exemplified by Dublin Dental University Hospital (DDUH).Results Findings revealed that 62.07% of single-rooted and 60% of multi-rooted teeth treated by PDS students met European standards.Discussion The implications highlight the proficiency of PDS students in RCTx, comparing favourably to DDUH.Conclusion Recommendations emphasise conducting regular educational audits in dental schools to continually enhance RCTx techniques and ensure high-quality clinical teaching.
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OBJECTIVE: This study aimed to assess the treatment quality factors associated with the risk of radiographic detection of apical periodontitis (AP) in root-filled teeth (RFT) on CBCT images. METHODS: Two hundred eighty-five CBCT scans of patients (range 18-60, mean 35.1) years old were selected from a pool of CBCT scans which were taken from 2016-2022. Gender and age were recorded. The presence/absence of AP, unfilled canal, perforation, zipping and ledge and homogenous/nonhomogeneous root canal filling (RCF), adequate/inadequate coronal restoration and under/over filled RCF and those within 0-2 mm from the radiographic apex were recorded for RFTs. Kappa was used to assess intra-consensus reliability. Chi-square and Binary logistic regression were used to assess and predict risk factors related to the detection of AP. A significant difference was set at p<0.05. RESULTS: AP was present in 81.5% of RFTs. No significant difference was present in the AP prevalence in RFT between males and females, maxilla and mandible, right and left sides, RFT with adequate and inadequate coronal restoration and RFT with/without zipping and ledge and between RFT with overfilled and those with RCF end within 0-2 mm from the radiographic apex (p>0.05), respectively. Significantly higher AP prevalence was present in RFT with unfilled canal, perforations, non-homogenous and underfilled RCF (p<0.05), respectively. The odds of AP detection were 2.02, 5.5, 2 and 1.98 times higher in RFT with unfilled canal, perforations, non-homogenous and underfilled RCF, respectively. Intra-consensus reliability was (0.98, 0.95, 0.85, 0.81, 0.88, 0.85 and 0.92) for AP, unfilled canal, perforation, zipping and ledge, homogeneity of RCF, coronal restoration and length of RCF, respectively. CONCLUSION: The vast majority of teeth with previous root fillings presented with AP. AP detection risk was significantly higher in root-filled teeth with perforation, non-homogeneous, and underfilled root canal filling. Other factors do not influence the radiographic detection of AP in CBCT images. (EEJ-2024-02-042).
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INTRODUCTION: Previous studies on the prevalence of vertical root fractures (VRFs) were based on extracted teeth, or teeth referred for apical surgery. This study examined teeth with an isolated periodontal probing depth (PD) as an indicator of VRF. The primary aim of this study was to investigate the prevalence of vertical root fracture (VRF) and non-VRF among teeth with an isolated probing depth (PD) ≥ 5 mm. The secondary aim was to assess factors associated with VRF by comparing the teeth with and without VRF in the Japanese population. METHODS: A total of 288 teeth with an isolated PD ≥ 5 mm were grouped pathologically into 8 groups comprising VRF and non-VRF conditions. A descriptive analysis for age, sex, tooth type, endodontically treated teeth (ETT) versus non-ETT, proximal contacts, PD (depth), PD (broadness and location), restoration type, and presence of a post was performed. Moreover, the associations between these factors and VRFs were investigated using the Chi-square test. RESULTS: The prevalence of VRF was 32%. Lower first molars were the most common tooth type in both VRF (31.5%) and non-VRF groups (29.7%), while premolars were exclusively frequent in VRF (30.2%) and not frequent in non-VRF (7.8%). Narrow buccolingual PD was common in VRF (78.1%) whereas wide PD was frequent in non-VRF (67.1%). ETT, narrow buccolingual PD, tooth type (premolars), restoration type (crown), and the presence of a post showed significant associations with VRF (P ≤ .001). CONCLUSIONS: VRFs may be more prevalent in ETT among the Japanese. Careful assessment is necessary to differentiate VRFs from other conditions when the lower first molars show an isolated PD ≥ 5 mm. When an endodontically treated premolar with a post shows a narrow buccolingual PD, the probability of a VRF may be greater than in other tooth types.
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Fraturas dos Dentes , Dente não Vital , Humanos , Raiz Dentária , Fraturas dos Dentes/epidemiologia , Fraturas dos Dentes/cirurgia , Prevalência , População do Leste Asiático , Dente Pré-Molar , Dente não Vital/epidemiologia , Tomografia Computadorizada de Feixe CônicoRESUMO
BACKGROUND: The distinction between where the pulp chamber ends and the root canal system begins is poorly defined within the existing literature. METHODS: This paper aimed to describe a range of accurate methods to define the transition from pulp chamber to root canal in different first molar root morphologies using micro-focus computed tomography (micro-CT). METHODS: The sample consisted of 86 mandibular and 101 maxillary first molars from the skeletal collections housed in the Department of Anatomy and Histology of the Sefako Makgatho Health Sciences University and the Pretoria Bone Collection. A stepwise approach using the cemento-enamel junction (CEJ) and dedicated landmarks was followed to create an automated cross-sectional slice. RESULTS: Transition from pulp chamber to root canal could be accurately determined on maxillary and mandibular teeth. The occurrence of two separate roots in mandibular molars was 97.7%, with the remaining 2.3% having an additional disto-lingual root, with no mandibular molars displaying fused roots. In the maxillary molars, 92.1% had three separate roots and 7.9% displayed root fusion. Within this group, one tooth displayed a C-shaped root canal configuration and one a mesotaurodont-type morphology. CONCLUSION: The suggested methodology to determine orifice location was found to be appropriate in all morphological types.
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Diagnosis is a key aspect in endodontic treatment, in a decade where invasive interventions are misapprehended as social tendency instead of medical necessity. All diagnostic facets should be considered before intending the operative phase. Intraoral endodontic radiology-based diagnosis has been shown to be limited. Periapical X-ray is the most used endodontic imaging, yet it does not provide high accuracy. Traditionally, dentists have been trained to diagnose a cyst by certain aspects (size, shape and appearance); hence, an assumption that teeth are affected by "periapical cyst" were subjected to unnecessary extraction or apicoectomy. The aim of this systematic review is to critically appraise the publications that relate the histological diagnosis of a periapical lesion (considered the gold standard) to intraoral X-ray investigation. Ovid Medline, PubMed, ScienceDirect, Mendeley and Scopus were searched for English-language studies comparing periapical diagnosis obtained by using two techniques (histopathology and X-ray). Sixteen articles were included for the final analysis (qualitative and quantitative evaluation) out of which only two supported the statement that periapical diagnosis can be coherently assessed through periapical imaging. Although there is not enough evidence to deliver a definitive conclusion, there are many publications that refute the diagnosis of a cyst via periapical X-ray.
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PURPOSE: To evaluate the bond strength of resin dentin interfaces created with adhesives applied on root dentin using the water wet or ethanol wet bonding technique. The morphology of resin dentin interfaces was evaluated using confocal microscopy. METHODS: Four experimental resin adhesives (R#A to R#D) and one commercial three-step/etch and rinse adhesive were applied to the root canal dentin of endodontically treated single canal incisors using the water (control) or ethanol wet bonding technique. The ethanol wet bonding substrate was achieved by keeping the root canal immersed in absolute ethanol (100%) for 3 minutes. The root dentin bonded specimens were sectioned into beams, stored in distilled water (24 hours) and finally tested for microtensile bond strengths (tTBS). Additional dentin surfaces were conditioned and bonded as previously described. They were prepared for the microscopy study and finally observed using confocal microscopy. RESULTS: The ethanol wet bonding technique gave higher bond strength values for all the adhesives tested: in Group 1 (water wet bonding technique) no significant difference was found between the resins tested; the only exception being the most hydrophilic Resin #4 showing the highest bond strength values (P < 0.05). In Group 2 (ethanol wet bonding technique) no statistical differences were present between Resin #A and Resin #D. Resin #C showed the highest bond strength values. Confocal microscopy showed better resin diffusion and hybrid layer formation when the ethanol wet bonding was used.
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Resinas Compostas , Colagem Dentária/métodos , Cavidade Pulpar , Dentina , Cimentos de Resina/química , Análise de Variância , Análise do Estresse Dentário , Permeabilidade da Dentina , Etanol , Humanos , Interações Hidrofóbicas e Hidrofílicas , Incisivo , Teste de Materiais , Microscopia Confocal , Resistência à Tração , ÁguaRESUMO
INTRODUCTION: Regenerative endodontic procedures (REPs) are intended to repair and regenerate part of the pulp-dentin complex. The aim of this study was to systematically appraise the existing evidence on the effectiveness of REPs on mature teeth with pulp necrosis and apical periodontitis. METHODS: Electronic database and hand searches were performed on 8 databases of published and unpublished literature from inception to January 3, 2021, for the identification of randomized controlled trials (RCTs) or prospective clinical trials. The related key words included "regenerative," "pulp revascularization," "revitalization procedure," and "necrotic mature teeth." A random effects meta-analysis was conducted assessing success as the main outcome treatment. Risk of bias was assessed through the Cochrane Risk of Bias 2.0 tool, and the quality of the evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Of the 337 initial hits, 4 RCTs were eligible for inclusion, whereas 3 were included in the quantitative synthesis. Overall, there was no difference in the relative risk for a successful/unsuccessful treatment outcome between REPs or conventional treatment (3 studies, relative risk = 1.03; 95% confidence interval, 0.92-1.15; P = .61; heterogeneity I2 = 0.0%, P = .53; prediction interval = 0.51-2.09). Risk of bias ranged from low to raising some concerns, whereas the quality of the evidence was graded as moderate. CONCLUSIONS: Based on moderate-quality evidence, REPs appear as a viable treatment alternative for mature necrotic teeth with periapical lesions at present. Furthermore, well-designed RCTs might also provide confirmatory evidence in this respect while also framing a backbone for standardization of the therapeutic protocol of REPs.
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Periodontite Periapical , Endodontia Regenerativa , Necrose da Polpa Dentária/terapia , Humanos , Periodontite Periapical/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Tratamento do Canal RadicularRESUMO
BACKGROUND: The number of voids within the root canal obturation is a relevant parameter to describe the quality of the technique, as well as to predict long-term prognosis. The aim of this study was to evaluate the quality of root canal obturation in curved root canals filled with Thermafil, GuttaCore, GuttaFusion and lateral compaction with AH Plus and EndoSequence BC sealer, by means of percentage of gutta-percha and sealer filled area. METHODS: 200 curved canals of mandibular molars were divided in five groups (n = 40). Each specimen was evaluated at 3, 6 and 9 mm from the apex. A total of 600 samples were analyzed. Obturation was performed with either Thermafil (TH), GuttaCore (GC), GuttaFusion (GF) or lateral compaction (LC), using AH Plus as sealer. In another group EndoSequence BC sealer (BC) was used. Subgroups (n = 20) were made depending on the use of sonic activation during the placement of the sealer. The percentage of total obturation material was analyzed as an indirect measurement of percentage of voids. RESULTS: GF showed a better performance at the apical level, while GC showed the higher percentage of total obturation at the coronal area. No differences were observed for the activation of sealers in any of the groups. Statistical analysis was performed by using two-way ANOVA. Statistical significance was set at CI: 95% (p < 0.05). CONCLUSIONS: Sonic activation of sealers did not show any benefit to avoid the presence of voids within obturation of curved canals. Following the manufacturer recommendations, we found that TH did not show benefits when applied to curved canals.
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This study investigated the antibacterial activity, bond strength to dentin (SBS), and ultra-morphology of the polymer-dentin interface of experimental adhesive systems doped with pyrogallol (PY), which is a ubiquitous phenolic moiety that is present in flavonoids and polyphenols. A universal adhesive containing 4-META and 10-MDP was used in this study. PY behaves as an antioxidant and anti-cancerogenic agent and it was incorporated into the adhesive at different concentrations (0.5 and 1 wt.%). The antibacterial activity and SBS were analyzed and the results were statistically analyzed. The ultra-morphology of the polymer-dentin interface was assessed using scanning electron microscopy (SEM). At 24 h, a lower antibacterial activity was observed for the control adhesive compared to those with 0.5% and 1% PY. No difference was seen in SBS between the three groups at 24 h. After 6 months, the SBS of the 0.5% PY adhesive was significantly lower than the other tested adhesives. The specimens created with 1% PY adhesive presented a higher bond strength at six months compared with that found at 24 h. No morphological differences were found at the polymer-dentin interfaces of the tested adhesives. Pyrogallol may be incorporated into modern universal adhesive systems to preserve the polymer-dentin bonding interface and confer a certain degree of antibacterial activity.
RESUMO
BACKGROUND: The aim of this study was to compare the success rate of root canal treatments undertaken using a calcium silicate root canal sealer in combination with a single cone with non-calcium silicate cement and warm vertical condensation. METHODS: 150 necrotic or pulpitic teeth were treated. (REC: 08/H0804/79). Following standardized root canal chemo-debridement. The canals were obturated using warm vertical condensation of gutta-percha and epoxy-based sealer (AH plus) or a calcium silicate sealer (BioRootTM RCS) with a single cone technique. Follow-up assessment was conducted at 12 months using Cone Beam Computed Tomography (CBCT). RESULTS: At 1-year recall, 104 teeth were assessed (51 AH plus, 53 BioRootTM RCS). The success rate using loose criteria for the CBCT images and PA radiographs was respectively 80% and 89% in the AH plus/warm vertical condensation group, 84% and 90% in the BioRootTM RCS/single cone group. There was no statistically significant difference between the two groups (Fisher exact test p value 0.6099 for the CBCT images). CONCLUSION: Within the limitations of this non-randomized trial, a calcium silicate cement in combination with single cone resulted in a similar proportion of successful cases compared to warm vertical condensation and epoxy-based sealer.