Apical Periodontitis and Cardiovascular Disease in Adults: A Systematic Review with Meta-Analysis.

BACKGROUND: A potential relationship between oral health and cardiovascular diseases has been proposed. However, uncertainty remains as to whether there is sufficient data to support this association. This review aims to appraise the relationship between apical periodontitis and cardiovascular disease based on data from observational studies. METHODS: The databases Medline (via PubMed) and EMBASE (via Scopus) were searched up to August 2020 for observational studies (case-control, cross-sectional, and cohort) assessing the association of apical periodontitis with cardiovascular disease among adults. Pooled relative risk/odds ratio and 95% confidence interval (CI) were estimated using a random-effects model. Sensitivity analyses and random-effects meta-regressions were performed. RESULTS: The initial search yielded 2537 documents, of which 15 were eligible for inclusion, including 8 cross-sectional studies, 5 case-control studies, and 2 cohort studies. The majority of studies enrolled both men and women, with mean age ranging from 41 to 66 years. In cross-sectional studies, the presence of apical periodontitis was significantly associated with cardiovascular disease with a combined odds ratio of 1.53 (95% CI: 1.02-2.29, p = 0.039; I2 = 75.0%; p < 0.001). In the case-control studies, the combined odds ratio did not show a significant association of apical periodontitis with cardiovascular disease (OR = 1.24; 95% CI: 0.67-2.29, p = 0.494; I2 = 82.1%; p < 0.001). The pooled risk ratio from the 2 cohort studies showed (RR = 1.27; 95% CI: 0.71-2.27, p = 0.413; I2 = 69.1%; p = 0.072) also showed no significant association between apical periodontitis and cardiovascular disease. These results should be interpreted with caution due to the high heterogeneity. CONCLUSIONS: Data derived from cross-sectional studies suggest a weak association between apical periodontitis and cardiovascular disease. As the results were not consistent across study designs, further research is recommended, namely longitudinal studies with long-term follow-up. REGISTRATION: PROSPERO database (CRD42020204379).

Dental Dam Application for Endodontics in Dogs-A Novel Clamp Kit.

Although rubber dams are widely used in endodontic treatment in humans with well-known advantages, their use in veterinary medicine is uncommon. The use of a dental rubber dam provides better control of cross-infection, prevents soft tissue contact of chemicals, and improves treatment efficiency. The purpose of this article is to describe a new line of clamps specifically designed for dogs and to review the procedure and materials used for isolating the operative field in endodontic patients. This new design of clamps, better adapted to canine tooth anatomy with different sizes and conformations, has been successfully used in dogs by the authors with good clinical results. The clamps allow for better adaptation to the tooth without injuring the gingiva or the furcation and provide increased retention of the dam for more effective isolation. Given the proven benefits in humans, the authors expect that the widespread use of a rubber dam with clamps specifically designed for canine dental anatomy will improve clinical outcomes in endodontics.

New and Efficient Bioactive Glass Compositions for Controlling Endodontic Pathogens.

Endodontic treatment aims to conserve teeth through removing infected tissue, disinfecting, and filling/sealing the root canal. One of the most important treatment steps is the removal of microorganisms to avoid reinfection and consequent tooth loss. Due to increased resistance to intracanal medications, new alternative procedures are needed. Thus, an intracanal medication is suggested using three bioactive glass (BG) compositions (BG1, BG2, and BG3) produced by the sol-gel method, with different molar contents of bactericidal oxides. The BGs were morphologically and physically characterized. Their ability to inhibit the growth of two oral pathogens responsible for the failure of endodontic treatments (E. faecalis and C. albicans) was also studied. The results suggest that BG2 and BG3 can inhibit the growth of E. faecalis after 48 h of incubation, and all BG samples have a significant effect on C. albicans survival.

Animal models used in furcation perforation studies: A systematic review and comprehensive synthesis of model characteristics.

In order to systematise furcation perforation (FP) experimental animal models described in the literature and to determine whether there is evidence that a model is superior to others, MEDLINE/PubMed, SciELO and Cochrane Library were searched to find studies which used animal models of FP. Data were gathered concerning model characteristics, chosen groups, sample numbers, type of outcomes, journal and main area studied. Twenty-five articles were included in this systematic review, four conducted in rodent models, three in non-human primates and 18 in dogs. Medians were six animals and 34 teeth per study; 10 teeth per test group and, when performed, six teeth per control group. Twenty-four studies investigated the use of materials for FP repair; eight also tested adjuvant materials/substances. Although there is no model which can be described as ideal and superior than others for FP studies, dogs appear to possess the most suitable model characteristics.

Nonsurgical endodontic retreatment of fused teeth with transposition: a case report.

Tooth transposition is a disorder in which a permanent tooth develops and erupts in the normal position of another permanent tooth. Fusion and gemination are developmental disturbances presenting as the union of teeth. This article reports the nonsurgical retreatment of a very rare case of fused teeth with transposition. A patient was referred for endodontic treatment of her maxillary left first molar in the position of the first premolar, which was adjacent to it on the distobuccal side. Orthopantomography and periapical radiography showed two crowns sharing the same root, with a root canal treatment and an associated periapical lesion. Tooth fusion with transposition of a maxillary molar and a premolar was diagnosed. Nonsurgical endodontic retreatment was performed. At four yr follow-up, the tooth was asymptomatic and the radiolucency around the apical region had decreased, showing the success of our intervention. The diagnosis and treatment of fused teeth require special attention. The canal system should be carefully explored to obtain a full understanding of the anatomy, allowing it to be fully cleaned and obturated. Thermoplastic techniques were useful in obtaining hermetic obturation. A correct anatomical evaluation improves the set of treatment options under consideration, leading to a higher likelihood of esthetically and functionally successful treatment.

Synergistic antimicrobial action of chlorhexidine and ozone in endodontic treatment.

OBJECTIVES: The aim of this study was to determine whether irrigation with sodium hypochlorite, chlorhexidine, and ozone gas, alone or in combination, were effective against Enterococcus faecalis and Candida albicans; these are microorganisms frequently isolated from teeth with periapical lesions resistant to endodontic treatment. MATERIAL AND METHODS: 220 single root teeth, recently extracted, were inoculated with Candida albicans and Enterococcus faecalis. The formulations tested were sodium hypochlorite at 1, 3, and 5% chlorhexidine at 0.2% and 2% and ozone gas applied for different periods of time. The combination of sodium hypochlorite at 5% and chlorhexidine at 2%, with gaseous ozone, were also assessed. For the most active treatments the mechanism of action was assessed through flow cytometry. RESULTS: Sodium hypochlorite, chlorhexidine, and gaseous ozone alone were ineffective in completely eliminating the microorganisms. The association of chlorhexidine at 2% followed by ozone gas for 24 seconds promoted the complete elimination of Candida albicans and Enterococcus faecalis. Flow cytometry shows that ozone and chlorhexidine act differently, which could explain its synergic activity. CONCLUSIONS: This new disinfection protocol, combining irrigation with chlorhexidine at 2% and ozone gas for 24 seconds, may be advantageous when treating infected root canals.

Efeito do hidróxido de cálcio e do hipoclorito de sódio na resistência da dentina: estudo in vitro / Effect of calcium hydroxide and sodium hypochlorite in dentin resistance: in vitro study

Introdução: várias substâncias utilizadas como medicação intracanal têm sido associadas ao enfraquecimento da estrutura dentária, particularmente se usadas por períodos prolongados. Objetivo: avaliar o efeito da solução de hipoclorito de sódio a 5% e da pasta de hidróxido de cálcio na composição inorgânica da dentina. Métodos: doze canais instrumentados de dentes monorradiculares, divididos em quatro grupos de 3 dentes cada, foram seccionados longitudinalmente em duas partes iguais, após a remoção da coroa. Em seguida, o grupo A foi irrigado com hipoclorito de sódio e armazenado no hidróxido de cálcio; o grupo B foi irrigado com hipoclorito de sódio e armazenado em soro fisiológico; o grupo C foi irrigado com solução salina e armazenado em soro fisiológico; o grupo D foi irrigado com soro fisiológico e armazenado em hidróxido de cálcio. Os dentes foram armazenados por 1 e 3 meses e, subsequentemente, analisados por microssonda eletrônica. Resultados: após a análise da composição química, a relação cálcio-fósforo (Ca/P) foi relativamente constante. Conclusão: os resultados sugerem que nem o hidróxido de cálcio nem o hipoclorito de sódio afetaram o componente inorgânico dos dentes, sustentando a ideia de que o principal efeito dessas substâncias está na parte orgânica.

Tratamento em incisivos centrais superiores após traumatismo dental / Treatment of upper central incisors after trauma

Os traumatismos dentários constituem, na atualidade, uma das principais causas da procura pelo cirurgião-dentista. O objetivo deste artigo é apresentar um caso clínico de traumatismo dental, abordando as diferentes reações pulpares dos dentes afetados e uma proposta de tratamento. Foram identificados dois tipos distintos de respostas pulpares ocorridas em dentes que foram sujeitos a um mesmo traumatismo (dente 21 e 11). Após o exame clínico e radiográfico, foi feito o diagnóstico diferencial entre lesão periapical no dente 21 e a imagem radiolúcida do orifício do nervo nasopalatino. Foi diagnosticado necrose pulpar no dente 21, sem lesão periapical e polpa viva no dente 11, apresentando este reabsorção interna e externa da raiz. Foi realizado o planejamento com indicação de tratamento de canal dos dentes 21 e 11, bem como a restauração estética dos mesmos com recurso de técnicas de clareamento interno e externo. O tratamento seleccionado mostrou um ótimo resultado estético com um custo relativamente baixo. O follow-up de dois anos permitiu confirmar o êxito e a longevidade do tratamento proposto.

Presently, dental trauma is one of the main causes for seeking a dental surgeon. The present paper presents a case report of dental trauma, addressing the different pulp reactions of the affected teeth and a treatment plan. The authors identified two distinct types of pulp reactions in teeth (tooth 21 and 11) subject to the same trauma. After clinical and radiographic examination, the differential diagnosis between periapical lesion on tooth 21 and radiolucency of the nasopalatine foramen was performed. Pulpal necrosis, without periapical lesion, was diagnosed in tooth 21, and live pulp in tooth 11, with internal and external root resorption. A treatment plan was designed, which included root canal treatment of teeth 21 and 11, as well as aesthetical restoration of both using internal and external bleaching techniques. This treatment resulted in optimal aesthetic outcome with relatively low cost. The 2-year follow-up confirmed the success and longevity of the treatment.

In vitro evaluation of the antimicrobial activity of different antiseptics on contaminated gutta-percha cones / Estudo in vitro da atividade antimicrobiana de direferentes soluções antissépticas em cones de guta-percha contaminados

OBJECTIVES: The purpose of this in vitro study was to evaluate the effectiveness of different antisepticsfor decontamination of gutta-percha cones. MATERIALS AND METHODS: Thirty-six cones werecontaminated with standardized pure cultures of six different microorganisms: Staphylococcus aureus,Enterococcus faecalis, Escherichia coli, Klebsiella pneumoniae and Candida albicans. The cones were treated forfive minutes with different antiseptic solutions: 2% iodine alcohol, 3% sodium hypochlorite, 0.2%chlorohexidine and 5% citric acid. RESULTS: Iodine alcohol was the most effective for all themicroorganisms, except for Candida albicans. For this microorganism, the best results were obtainedwith 3% sodium hypochlorite and 5% citric acid; these two solutions showed moderate activity onother microorganisms. Chlorohexidine was not effective on any of the microorganisms.

OBJETIVOS: Neste trabalho avaliou-se a atividade antimicrobiana in vitro de diferentessoluções antissépticas na desinfecção de cones de guta-percha. MATERIAIS E MÉTODOS:Trinta e seis cones de guta-percha foram contaminados com culturas puras de diferentesmicrorganismos: Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, Klebsiellapneumoniae e Candida albicans. Os cones foram imersos em diferentes soluções antissépticas:álcool iodado a 2%, hipoclorito de sódio a 3%, clorhexidina a 0,2% e ácido cítrico a 5%,durante 5 minutos. RESULTADOS: Os resultados indicam que o álcool iodado é o maiseficaz sobre todos os microrganismos, exceto sobre a C. albicans. Sobre esta, o mais eficazfoi o hipoclorito de sódio a 3 %, mostrando moderada eficácia sobre os restantesmicrorganismos, tal como o ácido cítrico. A clorhexidina não mostrou eficácia sobre qualquerdos microrganismos, nestas condições experimentais.