Patient-centric outcome assessment of endodontic microsurgery using periapical radiography versus cone beam computed tomography: A randomized clinical trial.

AIM: This study aimed to evaluate whether utilizing additional cone beam computed tomography (CBCT) imaging has any effect on quality of life and healing outcome following periapical surgery compared with periapical radiographs (PR). METHODOLOGY: The study was registered in ClinicalTrials.gov (NCT04333940). In this parallel group randomized controlled trial, 52 patients (88 teeth) with persistent apical periodontitis and periapical radiographic evidence of periapical lesion were randomly assigned to either PR or CBCT group. The primary predictor was the type of the imaging method (PR only or with additional CBCT). The primary outcome was patient's quality of life during the first week after periapical surgery and the secondary outcomes were duration of surgery and healing outcome at 12-month follow-up. Participants of both groups received periapical surgery based on the pre-surgical plan provided by the radiographic imaging methods. Quality of life (QoL) was assessed using Modified Shugars questionnaire. Radiographic analysis for healing was conducted using Molven's criteria and modified PENN 3D criteria. The categorical data between groups were analysed using the Chi-square test, whilst intragroup comparisons were analysed using the McNemar test. The average scores for each component of QoL (oral functions, general functions, pain, swelling and other symptoms), combined QoL scores (overall average of values of 13 variables) and analgesic usage on each day were calculated and analysed. RESULTS: At 12 months of follow-up, fifty patients were evaluated. Participants in PR group reported significantly more swelling on first three days compared with CBCT group. The analgesic use was higher in the PR group on 2nd and 3rd day (Mann-Whitney U test with Bonferroni correction; p < .007). A significant difference in the limitation of general functions was observed at the second day (p < .07) with the higher values in the PR group. The combined QoL score between the two groups was found to be non-significant. However, none of the patients experienced intraoperative complications or neurovascular exposure. The mean surgical time was lesser in the CBCT group (p < .05). Radiographic healing revealed a success rate of 96.2% for the PR group and 95.8% for the CBCT group with no significant difference between the groups. CONCLUSION: Participants in the CBCT group experienced substantially less early postoperative swelling and limitation in general functions, in comparison with the PR group. However, preoperative CBCT had no effect on other QoL parameters and intraoperative complications in medium-risk patients. Furthermore, CBCT did not exhibit any added advantage over periapical radiography in terms of assessing healing outcome following endodontic microsurgery. CBCT offered surgically relevant anatomic information for pre-surgical planning and ensured the treatment rendition with a significantly reduced operative time.

Prevalence of dens invaginatus and palatogingival groove in North India: A cone-beam computed tomography-based study.

Aim: The aim of this study was to study the prevalence of dens invaginatus (DI) and palatogingival groove (PGG) in maxillary lateral incisors, and the occurrence of apical periodontitis in association with these anomalies in North Indian population. Methodology: Maxillary lateral incisors in 163 cone-beam computed tomography scans were assessed to determine the presence of DI and PGG. Anomalies identified were then classified as per Oehler's and Gu's classification, respectively. Their side and gender predilection and association with apical and lateral radiolucency was also studied. Statistical Analysis: Descriptive data were reported as percentages. Chi-square analysis was used to determine the association with gender and side predilection. Results: DI was present in 13.5% of the scans, while PGG was present in 7.3% of the scans. No significant gender and side predilection was observed. 6.67% of lateral incisors with DI and 25% of lateral incisors with PGG had an associated apical radiolucency. 33.33% of lateral incisors with PGG had an associated lateral radiolucency. Conclusions: There is a high prevalence of DI and PGG in maxillary lateral incisors.

Factors causing stress in postgraduate dental students during COVID-19 pandemic: A cross-sectional survey.

BACKGROUND: COVID-19 pandemic has impacted the academic and clinical training of postgraduate dental students. This study aimed to assess various factors causing psychological stress in them, and the extent of stress perception during pandemic. MATERIALS AND METHODS: In this cross-sectional study, 250 postgraduate students from nine dental colleges of Haryana and National Capital Region, India, responded to an online questionnaire sent electronically to them in September 2020, which included modified dental environment stress (DES) score, Perceived Stress Scale (PSS), and questions regarding COVID-associated stress (CAS). Students already diagnosed with any psychiatric disorder or having a history of any major adverse event during the last 6 months likely to affect their psychological health were excluded from this study. The data obtained were analyzed using Chi-square test, Independent t-test, univariate ANOVA with post hoc tests, Pearson moment correlation, and multiple hierarchical regression tests. P < 0.05 was considered statistically significant. RESULTS: DES score was moderate for 48.8% and high for 34.4% of the participants. PSS was moderate for 69.2% and high for 18.8% of the participants. The most stressful factor in dental environment was the pattern of university examination, while the most stressful factor specific to COVID-19 was the fear of family members contracting the infection. PSS score was significantly higher in female participants. DES and CAS scores were significantly higher in students staying in hostels. Multiple hierarchical regression model depicted gender, mean health, and DES score as significant predictors of PSS. CONCLUSION: Postgraduate dental students reported the adverse impact of COVID-19 pandemic upon their training and prospects as a reason for the increase in stress.

Reconstruction of trileaflet pulmonary valve using autologous pericardium.

Tetralogy of Fallot with atretic or absent pulmonary valve may require pulmonary valve replacement or reconstruction. We propose a technique of reconstruction of a trileaflet valve at the level of the pulmonary annulus using untreated autologous pericardium. Six cases operated upon, using this technique, had trivial pulmonary regurgitation with a median gradient of 24 mmHg (18-38) across the newly created valve. This approach can be considered in cases with limited availability of more suitable alternatives.

Does rheumatic valvular heart disease affect right ventricular performance?

AIM: Right ventricular (RV) function often determines clinical outcome in patients with valvular heart disease. Though difficult to assess by echocardiography, Tei index is useful in its assessment. The aims of the study were to evaluate global RV function using the Tei index in patients with rheumatic heart disease and to observe if such abnormalities in RV function were reversible post-operatively. METHOD: The study included patients with atrial septal defect (ASD, Group I, n = 15) and rheumatic valvular heart disease (RVHD, Group II, n = 18). Patients with atrial fibrillation were excluded from the study. Conventional 2-D echocardiography was performed preoperatively, immediate postoperative and in last follow-up. RESULT: ASD group had lower left LVES and LVED dimensions as compared to RHVD (p = 0.001) and better ejection fraction (EF) than RVHD group (p = 0.02). LV Tei in the ASD group was above the normal limit (> 0.5), while RV Tei was increased in the RHVD group. The median RVSP was similar in two groups (p = 0.9). The impaired LVMPI in the ASD group improved as early as 2 weeks following surgery (p = 0.09) while in patients with RHVD it deteriorated which mirrored the reduction in median LVEF (p = 0.04). Group II that had an abnormal RV Tei pre-operatively demonstrated improvement following surgery (p = 0.03). CONCLUSION: RVHD is associated with impairment of RV function. Volume overload of RV in patients of ASD is associated with normal MPI. The abnormalities in RVMPI improved as early as 2 weeks after valve surgery with sustained improvement noted at follow up.