DENTAL PATIENT-REPORTED OUTCOMES IN ENDODONTICS - A NARRATIVE REVIEW.

Recently in oral health care settings, the focus of assessing treatment outcomes has shifted from the perspective of the clinician towards that of the patient. Endodontology is a specialty of dentistry concerned with the prevention and treatment of pulp and periapical diseases. Research in endodontology and its associated treatment outcomes have focused mainly on clinician-reported outcomes (CROs) and not dental patient-reported outcomes (dPROs). As a result, there is a need to emphasize the importance and relevance of dPROs to researchers and clinicians. The aim of this review is to present an overview of dPROs and dPROMs within endodontics in an attempt to create a better understanding of the patient experience, highlight the need to place the patient at the center of treatment, enhance patient care and encourage more research into dPROs. The key dPROs following endodontic treatment include pain, tenderness, tooth function, need for further intervention, adverse effects (exacerbation of symptoms, tooth discoloration) and Oral Health-Related Quality of Life. dPROs are important following endodontic treatment because they assist clinicians and patients when they discuss and select the most appropriate management options, help clinicians make decisions on pre-operative assessment, prevention and treatment, and improve the methodology and design of future clinical studies. Clinicians and researchers in endodontology should prioritize patient welfare and undertake routine analyses of dPROs using appropriate and robust measures. Due to the lack of agreement over the reporting and definition of endodontic treatment outcomes, a comprehensive project to define a ``Core Outcome Set for Endodontic Treatment Methods (COSET)'' is currently ongoing. In the future, a new and exclusive assessment tool should be developed to reflect the viewpoints of patients receiving endodontic treatment more accurately.

Dental patient-reported outcomes following traumatic dental injuries and treatment: A narrative review.

Dental patient-reported outcomes (dPROs) are self-reported descriptions of a patient's oral health status that are not modified or interpreted by a healthcare professional. Dental patient-reported outcome measures (dPROMs) are objective or subjective measurements used to assess dPROs. In oral healthcare settings, the emphasis on assessing treatment outcomes from the patient's perspective has increased and this is particularly important after traumatic dental injuries (TDIs), as this group of injuries represent the fifth most prevalent disease or condition worldwide. The purpose of this review is to summarize the current use of dPROs and dPROMs in the field of dental traumatology. Oral Health-Related Quality of Life, pain, swelling, aesthetics, function, adverse effects, patient satisfaction, number of clinical visits and trauma-related dental anxiety are the key dPROs following TDIs. Clinicians and researchers should consider the well-being of patients as their top priority and conduct routine evaluations of dPROs using measures that are appropriate, accurate and reflect what is important to the patient. After a TDI, dPROs can assist clinicians and patients to choose the best management option(s) for each individual patient and potentially improve the methodology, design and relevance of clinical studies.

Cone-beam computed tomography-Predictors and characteristics of usage in Australia and New Zealand, a multifactorial analysis.

Cone-beam computed tomography (CBCT) is an increasingly used imaging modality. This study aimed to identify the factors that predict its usage amongst endodontists in Australia and New Zealand and describe usage characteristics. Data were collected via an online questionnaire, with analysis including descriptive statistics, cross-tabulation and multifactorial modelling. Ninety-four endodontists completed the questionnaire who were using CBCT for 7 years (median), over half had a CBCT unit in practice, with most prescribing up to 10 scans/month and 55 using a small field of view. Sixty-eight participated in >5 h of CBCT education/year and a third received a specialist-prepared report. The number of prescriptions/month was significantly associated with on-site CBCT units (Exp B: 8.53; 95% CI: 1.46-49.86, p < 0.05) and the number of years of CBCT usage by participants (Exp B: 1.46; 95% CI: 1.17-1.84, p = 0.001). CBCT imaging in endodontics is a useful diagnostic aid to decision making and treatment planning, with widespread acceptance and usage.

Patient-related outcomes and Oral Health-Related Quality of Life in endodontics.

There is increased interest in outcome measures that complement the classic goal of endodontics, being the prevention and healing of apical periodontitis. Possible outcome measures can be subdivided into patient-centred outcomes (PCOs), encompassing data collected by nonpatients aiming to assess the effectiveness of an intervention and patient-reported outcomes (PROs), which are reported directly by the patient. PROs can be subsequently classed into PRO measures that ascertain patients' view of their symptoms, their functional status, and their health-related quality of life, and patient-reported experience measures that focus on aspects including the humanity of care, patient satisfaction, patient preference and adherence, personal costs, expectation fulfilment, and decision regrets. The present review aims to define various patient-related outcomes and discuss the literature available regarding PCOs and PROs in endodontics. This includes those proposed to assess the effectiveness of endodontic treatment for pulpitis and apical periodontitis for use in the development of European Society of Endodontology S3-level clinical practice guidelines that have been included by all working groups, except for the radiographic assessment of apical periodontitis. Based on limited evidence in the field, it can be summarized that after recall periods of various lengths, endodontic treatment is associated with a high likelihood of tooth survival and limited need for further intervention, including extraction and further restorative procedures. Oral Health-Related Quality of Life (OHRQoL) is likely to improve following the completion of treatment. Nonetheless, the literature assessing the association between OHRQoL and endodontics is hampered by the use of instruments that have not been previously validated. Amongst the remaining outcome measures discussed in the present review, it is worth highlighting that there is only one study assessing exacerbations in teeth with the presence of endodontic pathosis, which suggests a very low incidence of this adverse effect following endodontic treatment. Patients' expectation fulfilment, adherence, and satisfaction are closely inter-related and depend also on various nonclinical factors. Further studies assessing PCOs and PROs, in association with healing and prevention of apical periodontitis, are required to better understand endodontic treatment from the perspective of patients.

Predictors of societal and professional impact of Endodontology research articles: A multivariate scientometric analysis.

AIM: To identify factors that are predictive of short-term professional and societal impact of research within the specialty of Endodontology and to identify the top-10 articles that achieved the greatest societal impact and describe their characteristics. METHODOLOGY: Research articles in the field of Endodontology published in 2019 were eligible for inclusion, with the sample identified using Medline. Following screening of titles and abstracts, bibliometric data of the identified articles were exported into a spreadsheet, where further data related to continental origin, type of article, type of journal (endodontic or non-endodontic) and grant-funding were collated, with additional data concerning presence of journal impact factor, citations, news mentions and Altmetric-tracked-mentions and scores compiled using Clarivate, Scopus, ProQuest and Altmetric Explorer, respectively. Data analysis comprised descriptive statistics, frequency distributions, cross-tabulations and un/adjusted negative binomial regression models (p < .05). RESULTS: The search retrieved 30 443 articles; 951 were included for analysis. Most articles originated from Asia (43.2%) with over 51.5% of articles published in endodontic journals and 80% published in a journal with an impact factor. Over three-quarters of articles were primary research, 141 were grant-funded, 165 had a news mention, 338 achieved an Altmetric Attention Score (AAS) and 808 were cited. The five-highest ranked articles were mentioned in general news bulletins, five of the top-10 articles were primary research and six of the top-10 were published in endodontic journals. The highest AAS and citation count were 100 and 87, respectively. Adjusted models demonstrated that the type of article, publication in a journal with an impact factor, absence of grant-funding and coverage within general news bulletins predicted the AAS 's (p < .001). Article type, publication in an impact-factor journal and presence of an AAS were predictive of citations (p < .001). CONCLUSIONS: Article type and publication in a journal with an impact factor were significant predictors of both societal and professional impact of research articles within Endodontology in the short-term. Non grant-funded research and coverage in general news bulletins achieved greater societal impact, whereas an article achieving an AAS was also strongly related to professional impact.

Removable orthodontic retainers: practical considerations.

This article provides an overview of removable orthodontic retainers, discussing their history and the different types available, and compares the two most popular removable retainers. Practical information on consent and the clinical steps involved in the provision of removable retainers, as well as suggested wear and care instructions, are also presented.

Accuracy of periapical and panoramic radiography for detection of root morphologies: a comparative study.

Maxillary and mandibular incisors have increased risk for severe orthodontically induced inflammatory root resorption. A patient-related risk factor is aberrant root morphology. This study aimed to assess the frequency of detection of different root morphologies in anterior teeth using dental panoramic tomography (DPT) and long cone periapical radiographs (LCPAs). A retrospective cross-sectional design was used to assess a sample of 50 consecutive pre-treatment radiographic records of patients from a specialist orthodontic practice in Adelaide, Australia. A reference guide was developed that included three previously unreported morphologies: pipette and bent, bent and pointed, bent and blunt. Two trained and calibrated assessors examined each record against the inclusion criteria, then independently assessed each anterior tooth from DPTs and LCPAs to detect the type of root morphology present. Data were analysed using the chi-square statistical test. Radiographic records for 48 patients (48 DPTs and 161 LCPAs) were eligible, with 355 and 426 teeth on DPTs and LCPAs, respectively, included for assessment. Normal root morphology (119 teeth) was commonly observed in DPTs, while bent (154 teeth) was frequently observed using LCPAs. Mandibular incisors often had normal morphology in DPTs but bent in LCPAs. Bent was the most common morphology in maxillary lateral incisors using DPT and LCPAs, although maxillary centrals were mostly normal in DPTs but pointed in LCPAs. Differences using the two image acquisition methods were highly significant (p < 0.01). Aberrant root morphologies are more easily detected in anterior teeth using LCPAs compared to DPTs.

Accuracy of periapical and panoramic radiography for detection of root morphologies: a comparative study

Abstract: Maxillary and mandibular incisors have increased risk for severe orthodontically induced inflammatory root resorption. A patient-related risk factor is aberrant root morphology. This study aimed to assess the frequency of detection of different root morphologies in anterior teeth using dental panoramic tomography (DPT) and long cone periapical radiographs (LCPAs). A retrospective cross-sectional design was used to assess a sample of 50 consecutive pre-treatment radiographic records of patients from a specialist orthodontic practice in Adelaide, Australia. A reference guide was developed that included three previously unreported morphologies: pipette and bent, bent and pointed, bent and blunt. Two trained and calibrated assessors examined each record against the inclusion criteria, then independently assessed each anterior tooth from DPTs and LCPAs to detect the type of root morphology present. Data were analysed using the chi-square statistical test. Radiographic records for 48 patients (48 DPTs and 161 LCPAs) were eligible, with 355 and 426 teeth on DPTs and LCPAs, respectively, included for assessment. Normal root morphology (119 teeth) was commonly observed in DPTs, while bent (154 teeth) was frequently observed using LCPAs. Mandibular incisors often had normal morphology in DPTs but bent in LCPAs. Bent was the most common morphology in maxillary lateral incisors using DPT and LCPAs, although maxillary centrals were mostly normal in DPTs but pointed in LCPAs. Differences using the two image acquisition methods were highly significant (p < 0.01). Aberrant root morphologies are more easily detected in anterior teeth using LCPAs compared to DPTs.

Post-operative instructions following minor oral surgery - the quality and level of evidence: a cross-sectional study.

Aims To assess the quality of information targeting lay people regarding post-operative instructions after minor oral surgery (MOS), and to determine the level of evidence of any scientific articles cited in the instructions.Design and setting A dynamic Internet-based cross-sectional study.Materials and methods An Internet search for professional organisations/specialist dental societies in ten English-speaking countries with a search of their websites was conducted to locate post-operative instructions. Where not readily available, these were requested from each respective organisation/society. Reliability and quality of the instructions were assessed using the DISCERN instrument. Evidence level of cited articles was analysed using the Joanna Briggs Institute Levels of Evidence.Results Of the 59 identified organisations/societies, 26 sets of instructions were assessed. Overall quality of information was low, represented by median scores of 45%, 42.9% and 42.7% for reliability, quality of information and total DISCERN score, respectively. Only two instructions cited articles to support their content; these were of moderate-low level evidence.Conclusion Post-operative instructions following MOS that target the lay public have low quality and cite articles of moderate-low level evidence to support their content. Peak organisations should ensure such content is easily locatable, of high quality and is supported by high-level evidence.

Comparative Histopathologic Analysis of Granulomatous Tissue of Endodontic and Periodontal Origin.

PURPOSE: The aim of this study was to compare the percentage of tissue types and assess the presence/absence of odontoblasts or preodontoblasts in granulation tissue harvested from lesions associated with teeth extracted due to endodontic and periodontal reasons. MATERIALS AND METHODS: Histologic reports of cases with a confirmed diagnosis (ie, endodontic or periodontal diseases) were included. These should include a semiquantitative analysis of the percentage of tissue types per sample (ie, epithelium, subepithelial connective tissue, bone or chronic inflammation/deep connective tissue). The overall percentage of tissue type per diagnosis was calculated. Quantitative variables were summarized with means and standard deviations. Normal distribution was tested by the D'Agostino-Pearson omnibus normality test. The level of P < .05 was adopted for statistical significance. Finally, an analysis of the salient findings was summarized. RESULTS: The reports from 19 patients were included, 9 of endodontic and 10 of periodontal origins. The granulomatous tissue of endodontic and periodontal disease origin was similar, and consisted mainly of chronic inflammation (endodontic 40%, periodontal 41.7%), followed by epithelium (endodontic 25.7%, periodontal 29.2%), subepithelial connective tissue (endodontic 18.6%, periodontal 20.8%), and bone (endodontic 15.7%, periodontal 8.3%). No significant differences were found when comparing the groups regarding the percentage of tissue types (P ≥ .05). No osteoblasts or preosteoblasts were reported. CONCLUSION: Within the limitations of the study, the granulomatous tissues associated with chronic infection of endodontic or periodontal origin are comparable and consist primarily of chronic inflammatory cells.

The long-term influence of orthodontic treatment on dental knowledge and behaviour: An Australian cohort study.

OBJECTIVES: Fixed orthodontic treatment (FOT) typically lasts 14-33 months, with regular appointments at short intervals to monitor changes, adjust appliances, and remotivate patients to maintain excellent oral hygiene standards to prevent dental disease. Past experiences are important influencers of dental attitudes and self-care dental behaviours in adulthood. Since FOT comprises a high frequency of appointments compared to other dental visiting, we hypothesised that previous FOT enhances dental knowledge and behaviour in later life. METHODS: This cohort study followed-up 30-year-old participants who originally took part in an oral epidemiological study when aged 13-years. Participants completed a questionnaire regarding sociodemographics, dental health behaviours, dental knowledge (prevention of caries and periodontal disease, including questions about popular myths) and FOT. Data analysis comprised un/adjusted binomial logistic regression and multivariate generalised linear regression. RESULTS: Data for 448 participants (56 % female, 35 % received FOT) were analysed; adjusted models controlled for sociodemographics and baseline malocclusion severity. There was no association between FOT and regular toothbrushing (Exp B: 1.35, 95% CI: 0.87-2.10), flossing (Exp B: 1.18, 95 % CI: 0.48-2.90), dental attendance within last 2 years (Exp B: 0.96, 95 % CI: 0.62-1.49) or a non-emergency dental visit (Exp B: 1.01, 95 % CI: 0.51-1.99). Non-FOT participants placed importance on a calcium-rich diet preventing caries (Exp B: 1.99, 95 % CI: 1.14-3.50, P < 0.05), while those with a baseline definite malocclusion had higher levels of knowledge about dental visiting compared to those with minimal or more severe malocclusions (P < 0.05). CONCLUSION: Previous FOT appears to have limited impact on dental knowledge and may not affect long-term dental behaviours. CLINICAL SIGNIFICANCE: This 17-year follow-up study examined the influence of previous fixed orthodontic treatment on dental knowledge and behaviour later in life. Although patients have numerous and regular appointments during the course of orthodontic treatment, this does not seem to impact on either dental knowledge or behaviour in adulthood.

Endodontic complications associated with orthodontic temporary anchorage devices: A systematic review of human studies.

This review, registered in PROSPERO (CRD42018102582), assessed the effect of temporary anchorage device placement on endodontic complications. A search strategy was followed to identify studies where any temporary anchorage devices contacted or were in proximity to tooth roots in humans. Studies with low possibility of bias and published in English or Latin-character languages were considered for inclusion. Ten studies were identified; five case reports, one clinical study and four studies with intentional injury, totalling 736 temporary anchorage devices in 327 patients. Complications may ensue following temporary anchorage device placement, whether or not root contact occurs. Chronic apical periodontitis developed when there was root injury involving the pulp; necrosis can also occur. When damage was limited to the periodontal ligament, cementum or dentine, repair occurred, normally within 12 weeks. Clinicians should be aware of the potential for endodontic complications during temporary anchorage device placement, as well as during orthodontic treatment.

The association of overjet size and traumatic dental injuries-A systematic review and meta-analysis.

BACKGROUND/AIMS: Traumatic dental injuries are one of the most prevalent diseases globally, impacting people of different ages and socio-economic statuses. As disease prevention is preferable to management, understanding when an individual's overjet is prone to dental trauma helps identify at-risk patients, so to institute preventive strategies. The aim of this study was to identify the different overjet sizes that present an increased risk for developing dental trauma across different ages and dentition stages. METHODS: The title and protocol were registered and published a priori with the Joanna Briggs Institute (JBI) and PROSPERO (CRD42017060907) and followed the JBI methodology of systematic reviews of association (etiology). A three-step search strategy was performed, including electronic searches of gray literature and four databases. Studies of healthy human participants of any age and in any dental dentition stage were considered for inclusion. Only high methodological quality studies with low risk of bias were included. Where possible, meta-analyses were performed using the random-effects model, supplemented with the fixed-effects model in situations where statistical heterogeneity was ≤50%, assessed using the I2 statistic. RESULTS: The study identified 3718 articles, 41 were included. An increased overjet was significantly associated with higher odds of developing trauma in all dentition stages and age groups. Children 0-6 years with an overjet ≥3mm have an odds of 3.37 (95%CI, 1.36-8.38, P = 0.009) for trauma. Children in the mixed and secondary dentition with an overjet >5mm have an odds of 2.43 (95%CI, 1.34-4.42, P = 0.004). Twelve-year-old children with an overjet >5mm have an odds of 1.81 (95%CI, 1.44-2.27, P < 0.0001). CONCLUSIONS: The results confirm the association between increased overjet and dental trauma. A child in the primary dentition could be considered as having an overjet at risk for trauma when it is ≥3mm. In the early secondary dentition, the threshold for trauma is an overjet ≥5mm.

The long-term influence of orthodontic treatment on adults' psychosocial outcomes: An Australian cohort study.

OBJECTIVES: To assess the influence of orthodontic treatment on psychosocial outcomes in 30-year-olds. The research hypothesis tested was that participants previously treated orthodontically would have better psychosocial outcomes. SETTING AND SAMPLE POPULATION: A prospective longitudinal cohort design was used to follow-up a sample of 1859 30-year-olds from Adelaide, South Australia, who had previously participated in an oral epidemiology study. MATERIALS AND METHODS: Clinical examination in 1988-1989 recorded participants' malocclusion severity. In 2005-2006, participants were invited to complete a questionnaire collecting data on socio-demographic characteristics, dental health behaviours, receipt of orthodontic treatment and psychosocial factors. Data were analysed descriptively and by linear regression models. RESULTS: Data for 448 participants were available; 56% of participants were female. Over a third of participants had received orthodontic treatment. Higher income earners had the best psychosocial outcomes while participants with a basic level of secondary education had the lowest. Regardless of initial malocclusion severity, orthodontic treatment was not associated with better psychosocial outcomes. Instead, a pattern of better psychosocial outcome was observed amongst untreated participants, regardless of malocclusion severity, this being significant for optimism. Adjusted models controlling for socio-demographic, dental health behaviour and malocclusion severity showed no association between orthodontic treatment and self-efficacy, health competence or social support. There was, however, a strong association with optimism. CONCLUSION: There was no difference in long-term psychosocial outcomes based on orthodontic treatment. Our study does not support the contention that orthodontic treatment produces better psychosocial functioning later in life.

The influence of orthodontic treatment on dental caries: An Australian cohort study.

OBJECTIVE: To assess the influence of orthodontic treatment on long-term caries experience in 30-year-old South Australians. The research hypothesis that was tested was that those with previous orthodontic treatment would have lower caries experience. METHODS: In 2005-2006, a sample of 1859 30-year-olds from Adelaide, South Australia, who comprised 47% of participants who had previously taken part in an oral epidemiology study in 1988-1989, were traced from the Australian electoral roll and invited to participate in a cross-sectional study investigating long-term dental health outcomes. Participants completed a questionnaire that collected information on socio-demographic characteristics, dental health behaviours and receipt of orthodontic treatment. This was followed by clinical examination. The outcome variables were the summed decayed, missing and filled teeth (DMFT) score, and its individual components. Data were analysed using negative binomial regression. RESULTS: The response rate for the questionnaire was 34% (n = 632). There were no systematic differences between those who were followed up and those who were not followed up. Clinical data for 448 participants were available for analyses, representing 24% of the originally contacted individuals. By the age of 30, over a third of participants had received orthodontic treatment. Regardless of initial malocclusion classification, orthodontically treated participants had a lower DMFT score at age 30 but this did not reach statistical significance. Adjusted models controlling for socio-demographic, dental health behaviour and malocclusion status showed no associations between orthodontic treatment and decayed (Exp B: 1.00, 95% CI: 0.72-1.40), missing (Exp B: 1.00, 95% CI: 0.59-1.69), or filled teeth (Exp B: 1.18, 95% CI: 0.93-1.51) or overall DMFT (Exp B: 1.12, 95% CI: 0.88-1.41). CONCLUSION: There was no difference in the long-term caries experience of South Australians aged 30 years based on past orthodontic treatment. Our study does not support the contention that those treated orthodontically have better dental health later in life.

The association of overjet with traumatic dental injuries: a systematic review protocol.

REVIEW QUESTION: The objective of this review of association (etiology) is to identify the relationship between different overjet measurements and developing a traumatic dental injury (TDI) across different dentition stages. Specifically, the review will elucidate the critical level, in millimetres, at which an overjet will place an individual at an increased risk of developing a TDI within each specific dentition stage. The specific review questions are.