Fracture resistance and failure pattern of endodontically treated maxillary premolars restored with transfixed glass fiber post: an in vitro and finite element analysis.

The aims of the study were to determine the effect of different types of endodontic sealers and the presence of a horizontal glass fiber post (HGFP) on the fracture resistance and fracture pattern of mesio-occluso-distal (MOD) restored upper premolars and to analyze the stress distribution. Sixty extracted upper premolars received root canal treatment (RCT) and a MOD cavity preparation. All MOD cavities were restored with the same composite resin (CR). The 60 teeth were divided randomly into 6 groups (n = 10); Group1= AH Plus sealer; Group 2= TotalFill BC sealer; Group 3= BioRoot RCS sealer; Group 4= AH plus sealer + HGFP; Group 5= TotalFill BC sealer + HGFP; and, Group 6= Bio Root RCS sealer + HGFP. All specimens were thermocycled and subjected to cyclic loading. Next, the specimens were subjected to a static load using a universal testing machine. Data were analyzed using two-way ANOVA. Two micro-CTs of the same upper premolar, one without the HGFP and later one with HGFP inserted were made and used to create two finite element (FE) models. For the fracture resistance, two-way ANOVA revealed significant differences for the effect of HGFP (p = 0.029), but no differences for the effect of root canal sealer type (p = 0.561). The HGFP groups showed higher restorable fracture compared to groups without HGFP (p = 0.013). Finite element analysis showed that the inclusion of HGFP reduces stress concentration at the occlusal interface and cervical region. Therefore, it can be concluded that HGFP significantly increased the fracture resistance of endodontically treated upper premolars with MOD cavities and reduced the risk for non-restorable fractures. The FE analysis supports the mechanical test results.

The Potential Association Between Inflammatory Bowel Diseases and Apical Periodontitis: A Systematic Review and Meta-Analysis.

Recent literature has suggested a potential association between inflammatory bowel diseases (IBD) and apical periodontitis (AP). The present systematic review and meta-analysis sought to analyse and appraise the available evidence regarding the reported association. Following 2020 PRISMA guidelines, a comprehensive search of multiple online databases (PubMed, Scopus, Web of Science, and Google Scholar) was conducted for all relevant studies published from the date of inception until 27 April 2023 using various relevant keywords. All observational studies that assessed the association between IBD and AP in humans were eligible for inclusion. The quality of the selected studies was carried out independently by two reviewers, and meta-analysis was performed using Comprehensive Meta-Analysis Version 2.2.064. Six studies (five case-control studies and one cohort study) were included. A total of 657 patients (277 with IBD) were included in 5 case-control studies, and 48,223 subjects (35,740 with AP) were included in the cohort study, where 188 developed IBD on follow-up. The pooled data from the five case-control studies revealed that IBD was significantly associated with a higher risk of AP (OR=1.71, 95% CI: 1.21-2.42; I2=10.337%, fixed-effect, p=0.002). The qualitative analysis also showed that most of the included studies found a higher mean number of teeth with AP in IBD groups than the healthy controls. Newcastle-Ottawa Scale (NOS)-based quality appraisal results demonstrated that five studies were of high quality, and one was of moderate quality. The results suggest a potential association between IBD and AP. Large-scale and prospective studies are required to further confirm and elucidate the nature of such an association.

The impact of periodontal disease on the clinical outcomes of COVID-19: A systematic review and meta-analysis.

BACKGROUND: A possible relationship between periodontitis (PD) and COVID-19 and its adverse outcomes has been suggested. Hence, the present systematic review and meta-analysis aimed to investigate the available evidence regarding the potential association between periodontitis (PD) and COVID-19 and its adverse outcomes. MATERIALS AND METHODS: PubMed, Scopus, Web of Science, and Google Scholar were searched for relevant studies published up to April 15th, 2023. Studies that evaluated the association between PD and COVID-19 were included. Risk of bias was evaluated by two reviewers, and meta-analyses were performed using RevMan 5.3 software. RESULTS: A total of 22 studies involving 92,535 patients from USA, Europe, Asia, the Middle East and South America were included; of these, 12 were pooled into the meta-analysis. Most of the studies (19 studies) reported a significant association between PD and COVID-19. The pooled data found a significant association between PD and COVID-19 outcomes: more severe symptoms (OR = 6.95, P = 0.0008), ICU admissions (OR = 3.15, P = 0.0001), and mortality (OR = 1.92, P = 0.21). Additionally, compared to mild PD, severe PD was significantly associated with higher risks of severe COVID-19 outcomes: severe symptoms (P = 0.02); ICU admission (P = 0.0001); and higher mortality rates (P = 0.0001). The results also revealed 58% higher risk for COVID-19 infection in patients with PD (P = 0.00001). CONCLUSIONS: The present findings suggest a possible association between poor periodontal health and the risk of poor COVID-19 outcomes. However, owing to the observed methodological heterogeneity across the included studies, further prospective cohort studies with standardized methodologies are warranted to further unravel the potential association between periodontal disease and COVID-19 and its adverse outcomes.

The influence of horizontal glass fiber posts on fracture strength and fracture pattern of endodontically treated teeth: A systematic review and meta-analysis of in vitro studies.

PURPOSE: This systematic review and meta-analysis aimed to summarize available evidence regarding the effect of horizontal glass fiber posts (HGFPs) on fracture strength and fracture pattern of endodontically treated teeth (ETT) compared to controls without HGFP. The review protocol was registered on the OSF registries. METHODS: Literature searches were conducted in MEDLINE/PubMed, Scopus, Web of Science, Embase, Google Scholar, and ProQuest for all relevant studies published up to February 2022. All in vitro studies that assessed the influence of HGFPs on fracture strength and fracture pattern of ETT whether mesio-occluso-distal or mesio-occlusal or DO cavities were considered eligible. Review Manager (RevMan) was used for the meta-analysis. Subgroup and funnel plot analyses were also performed. Quality assessment was conducted by two independent reviewers. RESULTS: A total of 12 articles met the inclusion criteria, and 10 studies underwent quantitative evaluation. The pooled effect showed that fracture resistance of molar teeth restored with HGFP was significantly higher than teeth without HGFP (standardized mean difference [SMD]: 1.61, 95% confidence interval [CI]: 0.14, 3.09, p = 0.03), whereas marginally significant for premolars (SMD: 1.36, 95% CI: -0.00, 2.73, p = 0.05). Regarding fracture patterns, the presence of an HGFP significantly increased the occurrence of restorable fracture patterns for premolars (odds ratios [OR]: 4.15, 95% CI: 1.60, 10.82, p = 0.004) compared to controls, whereas the difference was not significant for molars (OR: 1.09, 95% CI: 0.43, 2.77, p = 0.85). Moderate risk of bias was identified in 9/12 studies; one study showed a high risk of bias and two studies showed a low risk of bias. CONCLUSIONS: Within the limitations of this study, there is evidence from in vitro studies that the use of HGFP increases the fracture resistance of the ETT when compared to teeth without HGFP and also reduces the occurrence of non-restorable fractures for premolars. However, well-conducted in vitro and prospective clinical studies are warranted to validate this finding.

Antibacterial and anti-inflammatory efficacy of N-acetyl cysteine in endodontic treatment: a scoping review.

BACKGROUND: This scoping review systematically summarized the available evidence about the efficacy of N-acetyl cysteine (NAC) as an intracanal antibacterial and/or anti-inflammatory. METHODS: PubMed, Scopus, Web of Science, and Google scholar search engines/databases were searched up to February 2022 to retrieve relevant studies. The studies were evaluated for eligibility criteria, and identifying relevant studies. RESULTS: Out of 193 studies, 15 fulfilled the inclusion criteria and were processed for data extraction. Thirteen in vitro studies assessed antibacterial/antibiofilm efficacy of NAC, and reported good and promising efficacy: NAC was found as efficacious as the comparators (chlorhexidine, sodium hypochlorite, calcium hydroxide), or even showed higher efficacy. Regarding the anti-inflammatory efficacy of NAC, one in vitro study found it equivalent to, while one clinical trial revealed it more efficacious than calcium hydroxide. CONCLUSIONS: There is accumulating evidence on the anti-microbial and anti-inflammatory efficacy of NAC in context of endodontics. However, further clinical trials with robust methodology and objective and reliable clinical, biological and microbial outcomes are warranted to translate its use for clinical practice on humans.

Association between dental diseases and history of stroke in the United States.

OBJECTIVE: This study aimed to determine the potential association between the dental diseases and self-reported history of stroke in the United States based on data from the Third National Health and Nutrition Examination Survey (NHANES III). METHODS: Data were extracted from NHANES III. Dental variables were carious tooth surfaces, number of missing teeth, gingival bleeding, and periodontal pockets. Multiple logistic regression modeling was used to estimate the effect of these dental diseases on the self-reported history of stroke with intent to adjust for the other potential determinants: age, sex, race, marital status, health insurance, education, exercise, body mass index, smoking, alcohol, hypertension, high serum cholesterol, and diabetes. RESULTS: Number of missing teeth was found to be significantly associated with the self-reported history of stroke. Associations between the self-reported history of stroke and caries, gingival bleeding, or periodontal pockets were not statistically significant. CONCLUSIONS: Number of missing teeth was an independent determinant of the self-reported history of stroke.

Association between serum zinc levels and recurrent aphthous stomatitis: a meta-analysis with trial sequential analysis.

OBJECTIVES: The present meta-analysis sought to investigate the potential association between zinc levels and recurrent aphthous stomatitis (RAS). METHODS: A comprehensive search of online databases (PubMed, Scopus, Web of Science, and China National Knowledge Infrastructure (CNKI)) was conducted to identify all English and Chinese studies published up to August 2020. All case-control studies that assessed plasma/serum zinc levels were eligible for inclusion. Data were analyzed using Comprehensive Meta-Analysis software version 2.2.046 (Biostat, Englewood, NJ, USA). Trial sequential analysis (TSA) was conducted with the trial sequential analysis program. RESULTS: Nineteen case-control studies, involving 1079 RAS cases and 965 controls, were included in the meta-analysis. The pooled results of 19 studies showed that zinc level was significantly lower in RAS patients than in healthy controls (weighted difference in means = - 21.092, 95% CI - 26.695 to - 15.490, I2 = 95.375%, P < 0.001). Upon subgroup analysis by geographic distribution of the sample (Chinese vs. others), the association remained significant in each individual subgroup, although the association was more pronounced among Chinese populations. TSA indicated that the current studies surpassed the required information size, confirming that the differences were reliable. CONCLUSION: The results suggest a significant association between low serum zinc levels and the occurrence of RAS. Although TSA confirmed a solid conclusion, conducting large-scale studies with the highest standards of quality is encouraged. CLINICAL RELEVANCE: Determining zinc levels should be considered in diagnosis, management, and prevention of RAS.

N-acetylcysteine versus chlorhexidine in treatment of aphthous ulcers: a preliminary clinical trial.

INTRODUCTION: This study sought to assess the efficacy of N-acetyl cysteine (NAC) in the treatment of recurrent aphthous stomatitis (RAS). METHODS: Fifty-eight patients, aged 28 ± 9.7 years, presented with clinically diagnosed RAS to two oral medicine centers. They were assigned randomly to a single application of either NAC (200 mg dissolved in water, n = 38) or 0.12% chlorhexidine digluconate (CHX, n = 20) mouthwashes for 30 seconds. Pain was measured using a Visual Analog Scale (VAS). The size of the ulcer was measured through its greatest dimension using a periodontal probe. These two measurements were taken pre-application (day 1) and 2nd, 4th, and 6th day post-application. Average time (in days) until complete healing was assessed. RESULTS: Of all participants, 33 (57%) were females; 34 (59%) married; 29 (50%) reported a family history of aphthae; and 51 (88%) were affected with minor RAS. There were greater improvement in pain from day 1 with NAC on the second day (-3.0 ± 2.0 versus -1.8 ± 1.9; p = .028) and on the fourth day (-5.0 ± 2.6 versus -3.4 ± 2.7; p = .041). The differences with regard to the change in ulcer size and average healing time were not significant between NAC and CHX. CONCLUSION: Single application of NAC results in a clinically significant reduction of RAS-associated pain within one day of application and is more effective than CHX.

Management of cracked tooth using simvastatin as intracanal medicament.

Cracked tooth syndrome is presented as pain associated with biting and sensitivity. Intracanal medication with simvastatin stimulates hard tissue formation at crack line, and the tooth was functioning on the follow-ups.

Orofacial manifestations of COVID-19: a brief review of the published literature.

Coronavirus disease 2019 (COVID-19) has spread exponentially across the world. The typical manifestations of COVID-19 include fever, dry cough, headache and fatigue. However, atypical presentations of COVID-19 are being increasingly reported. Recently, a number of studies have recognized various mucocutaneous manifestations associated with COVID-19. This study sought to summarize the available literature and provide an overview of the potential orofacial manifestations of COVID-19. An online literature search in the PubMed and Scopus databases was conducted to retrieve the relevant studies published up to July 2020. Original studies published in English that reported orofacial manifestations in patients with laboratory-confirmed COVID-19 were included; this yielded 16 articles involving 25 COVID-19-positive patients. The results showed a marked heterogeneity in COVID-19-associated orofacial manifestations. The most common orofacial manifestations were ulcerative lesions, vesiculobullous/macular lesions, and acute sialadentitis of the parotid gland (parotitis). In four cases, oral manifestations were the first signs of COVID-19. In summary, COVID-19 may cause orofacial manifestations that might be the initial features in several cases. However, the occurrence of orofacial manifestations in COVID-19 seems to be underreported, mainly due to the lack of oral examination of patients with suspected and/or confirmed COVID-19. Oral examination of all suspected and confirmed COVID-19 cases is crucial for better understanding and documenting COVID-19-associated orofacial manifestations.

Histologic Evaluation of Artificial Floors Under MTA and Nano-Filled Resin-Modified Glass Ionomer Used to Repair Furcation Perforations in Dogs.

Objective: This study aimed to compare the tissue reaction of two repair materials for furcation perforations, nano-filled resin modified glass ionomer (Nano-FRMGI) and mineral trioxide aggregate (MTA), used with or without an artificial floor. Methods: A total of 96 teeth in 6 dogs were used for this study. After access cavities, root canals were prepared and obturated with gutta percha using cold lateral condensation technique. Perforations were then created on the floors of the pulp chambers. The perforations divided into four groups n=24/group that were sealed with MTA alone, MTA with calcium sulphate artificial floor (CSAF), FRMGI alone and Nano-FRMGI with CSAF. All access cavities were filled with composite resin. Two dogs were sacrificed at 1, 3, and 6 month. The experimental tooth along with the surrounding alveolar bone were cut in block sections and histologically evaluated for tissue response. Data were analyzed by Chi-square (P≤0.05). Results: MTA and MTA with CSAF showed more bone and cementum apposition when compared to Nano-FRMGI at 6-month interval. MTA and MTA with CSAF showed less bone resorption, epithelium proliferation and inflammation compared to Nano-FRMGI at 6-month interval. Conclusion: MTA with CSAF or MTA-alone show better outcomes in the repair of pulp chamber floor perforation.

Orofacial manifestations of COVID-19: a brief review of the published literature

Abstract: Coronavirus disease 2019 (COVID-19) has spread exponentially across the world. The typical manifestations of COVID-19 include fever, dry cough, headache and fatigue. However, atypical presentations of COVID-19 are being increasingly reported. Recently, a number of studies have recognized various mucocutaneous manifestations associated with COVID-19. This study sought to summarize the available literature and provide an overview of the potential orofacial manifestations of COVID-19. An online literature search in the PubMed and Scopus databases was conducted to retrieve the relevant studies published up to July 2020. Original studies published in English that reported orofacial manifestations in patients with laboratory-confirmed COVID-19 were included; this yielded 16 articles involving 25 COVID-19-positive patients. The results showed a marked heterogeneity in COVID-19-associated orofacial manifestations. The most common orofacial manifestations were ulcerative lesions, vesiculobullous/macular lesions, and acute sialadentitis of the parotid gland (parotitis). In four cases, oral manifestations were the first signs of COVID-19. In summary, COVID-19 may cause orofacial manifestations that might be the initial features in several cases. However, the occurrence of orofacial manifestations in COVID-19 seems to be underreported, mainly due to the lack of oral examination of patients with suspected and/or confirmed COVID-19. Oral examination of all suspected and confirmed COVID-19 cases is crucial for better understanding and documenting COVID-19-associated orofacial manifestations.

Tooth Decay Prevention: Knowledge and Practices Survey of Dental Students.

OBJECTIVES: This study aimed to assess the level of knowledge, attitudes, and practices fissure sealants among undergraduate Saudi dental students. METHODS: A modified questionnaire consisted of 24-items was distributed among 226 undergraduate dental students, males and females of different years at Al-Farabi Colleges, Riyadh, Saudi Arabia. Chi-square/Fisher's exact tests were used for descriptive statistical analyses. RESULTS: The response rate was 100%. Most of the respondents were male (60.2) and (39.8%) were female. With regard to the level of study, 20.8% were in the fourth year, 43.8% in the fifth year, and 16.8% were in the sixth year. The respondents showed a sensible level of learning about sealants, with the majority (88%) believed that there is strong scientific evidence about fissure sealants effectiveness and around 90% showed a good understanding of sealant placement instructions. Furthermore, respondents demonstrated inadequate learning about sealants clinical practice. CONCLUSION: Despite a high proportion of undergraduate dental students' showed sufficient knowledge about dental sealant, following guidelines and standardized procedures in clinical practice is lacking. The findings suggest an urgent need of dental colleges to additionally and/or update their curriculum regarding fissure sealants to reflect advance dental education that concentrates on evidence-based practice (EBP) in Pediatric Dentistry and Dental Public Health need for regular continuing education courses for the dental professional. HOW TO CITE THIS ARTICLE: Al-Sabri FA, Ba-Salamah M, et al. Tooth Decay Prevention: Knowledge and Practices Survey of Dental Students. Int J Clin Pediatr Dent 2019;12(2):92-95.

Subgingival microbiome of experimental gingivitis: shifts associated with the use of chlorhexidine and N-acetyl cysteine mouthwashes.

This study aimed to demonstrate subgingival microbial changes associated with development, prevention, and treatment of experimental gingivitis using chlorhexidine (CHX) and N-acetylcysteine (NAC) mouthwashes. This randomized clinical trial comprised two parts: a 3-week prevention sub-study in which 30 study subjects were equally assigned to either mouthwash or placebo while developing experimental gingivitis; followed by a 2-week treatment sub-study in which 20 subjects with experimental gingivitis were assigned to either mouthwash. Subgingival samples were collected at the beginning and end of each sub-study for microbial profiling with 16S rRNA gene sequencing. As expected, CHX was effective in both preventing and reversing experimental gingivitis; NAC had a modest effect. Gingivitis was associated with enrichment of TM7 HOT-346/349, Tannerella HOT-286, Cardiobacterium valvarum, Campylobacter gracilis, Porphyromonas catoniae, Leptotrichia HOT-219, and Selen o monas spp. At the phylum/genus level, TM7 showed the strongest association. Gingival health was associated with increased abundance of Haemophilus parainfluenzae, Lautropia mirabilis, Rothia spp., Streptococcus spp., and Kingella oralis. CHX demonstrated largely indiscriminate antimicrobial action, resulting in significant drop in biomass and diversity. Our results substantiate the role of specific oral bacterial species in the development of gingivitis. They also indicate that NAC is not a promising mouthwash at the concentration tested.

N-acetyl cysteine versus chlorhexidine mouthwashes in prevention and treatment of experimental gingivitis: a randomized, triple-blind, placebo-controlled clinical trial.

OBJECTIVES: To compare the efficacy of N-acetyl cysteine (NAC) mouthwash with chlorhexidine (CHX) in prevention and treatment of experimental gingivitis MATERIALS AND METHODS: Sixty subjects were assigned randomly and blindly into one of three equal groups: NAC, CHX, or placebo group. The study was conducted in two stages: preventive and treatment substudies. Professional prophylaxis was performed ahead of starting the preventive substudy. Then, the subjects were instructed to stop oral hygiene practices and begin rinsing twice/day with 15 ml of the assigned mouthwash (1.25% NAC, 0.2% CHX, or inert base). Plaque index (PI), gingival index (GI), and papillary bleeding index (PBI) were measured at baseline, 7, 14, and 21 days. The treatment substudy started on day 21 in which the subjects in the placebo group (now with established experimental gingivitis) were assigned to NAC (n = 10) or CHX (n = 10); the abovementioned indices were measured at 28 and 35 days. Efficacy of these interventions was compared. RESULTS: All groups accumulated plaque and developed some degree of gingivitis: full-blown in the placebo group and remarkably mild in the CHX group. NAC had slight preventive properties at days 14 and 21. In the treatment substudy, CHX was associated with remarkable reduction in plaque and gingivitis while NAC resulted in insignificant reductions. CONCLUSIONS: 1.25% NAC is marginally effective in prevention and treatment of experimental gingivitis. CLINICAL RELEVANCE: When compared with the placebo, NAC showed promising preventive and treatment effects of gingivitis that deserve further development and studies. TRIAL REGISTRATION: ISRCTN31352091.

Aloe vera in treatment of oral submucous fibrosis: A systematic review and meta-analysis.

The management of oral submucous fibrosis (OSF) is quite challenging, and as yet, no effective therapy is available for its management. The present systematic review and meta-analysis sought to assess the effectiveness of aloe vera in alleviating pain and clinical signs of OSF. A comprehensive search in PubMed/Medline, Scopus, and Web of Science databases was conducted to identify the relevant randomized clinical trials. RevMan 5.3 software was used for data analysis. Six randomized controlled trials fulfilled the inclusion criteria. The results of meta-analysis showed statistically significant differences between aloe vera and control groups in alleviating pain/burning sensation at the end of the first and second month, in favor of aloe vera, but no significant differences were found at the end of the third month. With regard to objective clinical outcomes, no statistically significant differences were found between the groups. Aloe vera has a promising effect in reducing pain/burning sensation and clinical improvement in patients with OSF. However, owing to the marked heterogeneity of the included studies, conducting well-designed trials with long follow-up periods, standardized outcome measures and adequate sample sizes are warranted.

Management of a failed endodontic treatment for a maxillary second molar with two separate palatal roots.

Complexity of root canal system and variations in internal anatomy of teeth require careful analysis of preoperative cone beam computed tomography or multiangle radiographs to locate and identify possible extra roots or canals. A fourth canal in upper molars is expected, and much effort should be made when planning the endodontic treatment to avoid missing a canal.

Effect of Apical Patency on Postoperative Pain: A Meta-analysis.

INTRODUCTION: This systematic review and meta-analysis assessed the available evidence regarding the effect of apical patency versus nonpatency on postendodontic pain in adult patients. METHODS: The study adhered strictly to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. PubMed, Scopus, MEDLINE via Ovid, Google Scholar, and the Web of Science databases were searched up to April 2018 to retrieve the most relevant studies. Two authors evaluated the studies for eligibility criteria and assessed the risk of bias using the Cochrane tool. The weighted means were calculated using a fixed effects model. When statistically significant (P < .1) heterogeneity was detected, a random effects model was used to assess the significance of treatment effects. RESULTS: Five studies were identified for this systematic review; 4 were included in the meta-analyses. Two studies revealed a low risk of bias, whereas 3 studies revealed a high risk of bias. Because of the significant heterogeneity between studies, a random effects model was used. The meta-analysis showed that the apical patency resulted in less postoperative pain compared with nonpatency, but the difference was not statistically significant. Moreover, no statistically significant difference was found with regard to analgesic consumption. CONCLUSIONS: Considering the limitations of this study, it was concluded that maintaining apical patency during routine endodontic treatment was not associated with an increased incidence of postoperative pain in adult patients.