Antibiotic use for irreversible pulpitis.

BACKGROUND: Irreversible pulpitis, which is characterised by acute and intense pain, is one of the most frequent reasons that patients attend for emergency dental care. Apart from removal of the tooth, the customary way of relieving the pain of irreversible pulpitis is by drilling into the tooth, removing the inflamed pulp (nerve) and cleaning the root canal. However, a significant number of dentists continue to prescribe antibiotics to stop the pain of irreversible pulpitis.This review updates the previous version published in 2013. OBJECTIVES: To assess the effects of systemic antibiotics for irreversible pulpitis. SEARCH METHODS: We searched the Cochrane Oral Health Group's Trials Register (to 27 January 2016); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 12); MEDLINE via Ovid (1946 to 27 January 2016); EMBASE via Ovid (1980 to 27 January 2016), ClinicalTrials.gov (to 27 January 2016) and the WHO International Clinical Trials Registry Platform (to 27 January 2016). There were no language restrictions in the searches of the electronic databases. SELECTION CRITERIA: Randomised controlled trials which compared pain relief with systemic antibiotics and analgesics, against placebo and analgesics in the acute preoperative phase of irreversible pulpitis. DATA COLLECTION AND ANALYSIS: Two review authors screened studies and extracted data independently. We assessed the quality of the evidence of included studies using GRADEpro software. Pooling of data was not possible and a descriptive summary is presented. MAIN RESULTS: One trial assessed at low risk of bias, involving 40 participants was included in this update of the review. The quality of the body of evidence was rated low for the different outcomes. There was a close parallel distribution of the pain ratings in both the intervention and placebo groups over the seven-day study period. There was insufficient evidence to claim or refute a benefit for penicillin for pain intensity. There was no significant difference in the mean total number of ibuprofen tablets over the study period: 9.2 (standard deviation (SD) 6.02) in the penicillin group versus 9.6 (SD 6.34) in the placebo group; mean difference -0.40 (95% confidence interval (CI) -4.23 to 3.43; P value = 0.84). This applied equally for the mean total number of Tylenol tablets: 6.9 (SD 6.87) used in the penicillin group versus 4.45 (SD 4.82) in the placebo group; mean difference 2.45 (95% CI -1.23 to 6.13; P value = 0.19). Our secondary outcome on reporting of adverse events was not addressed in this study. AUTHORS' CONCLUSIONS: This systematic review which was based on one low powered small sample trial assessed as at low risk of bias, illustrates that there is insufficient evidence to determine whether antibiotics reduce pain or not compared to not having antibiotics. The results of this review confirm the necessity for further larger sample and methodologically sound trials that can provide additional evidence as to whether antibiotics, prescribed in the preoperative phase, can affect treatment outcomes for irreversible pulpitis.

Comparison of Virtual Dental Implant Planning Using the Full Cross-Sectional and Transaxial Capabilities of Cone Beam Computed Tomography vs Reformatted Panoramic Imaging and 3D Modeling.

PURPOSE: To compare the choice and placement of virtual dental implants in the posterior edentulous bounded regions using the full cross-sectional and transaxial capabilities of cone beam computed tomography (CBCT) vs reformatted panoramic images and three-dimensional (3D) virtual models. MATERIALS AND METHODS: Fifty-two cases with posterior bounded edentulous regions (61 dental implant sites) were identified from a retrospective audit of 4,014 radiographic volumes. Two image sets were created from selected CBCT data: (1) a combination of reformatted panoramic imaging and a 3D model (PIref/3D), and (2) the full 3D power in CBCT image volume analyses (XS). One virtual implant was placed by consensus of three prosthodontists in each image set: PIref/3D and XS. The choice of implant length and the perceived need for ridge augmentation were recorded for implant placement in both test situations. All the virtual implant placements from both PIref/3D and XS image sets were inspected retrospectively using virtual 3D models, and the number of exposed threads on both the buccal and lingual/palatal aspects of the virtual dental implant was evaluated. The chi-square and paired t tests were used with the level of significance set at α = .05. RESULTS: Shorter implants were chosen more often using XS than PIref/3D (P = .001). Fewer threads were exposed when placed with XS than with PIref/3D (P = .001). The use of XS reduced the perceived need for ridge augmentation compared with PIref/3D (P = .001). CONCLUSION: The use of the full 3D power of CBCT (including cross-sectional images in all three orthagonal planes and transaxially) provides supplemental information that significantly changes the choice of virtual implant length and vertical position of the implant, and reduces the frequency of perceived need for ridge augmentation before implant placement.

Antibiotic use for irreversible pulpitis.

BACKGROUND: Irreversible pulpitis, which is characterised by acute and intense pain, is one of the most frequent reasons that patients attend for emergency dental care. Apart from removal of the tooth, the customary way of relieving the pain of irreversible pulpitis is by drilling into the tooth, removing the inflamed pulp (nerve) and cleaning the root canal. However, a significant number of dentists continue to prescribe antibiotics to stop the pain of irreversible pulpitis. OBJECTIVES: To assess the effects of systemic antibiotics for irreversible pulpitis. SEARCH METHODS: We searched the Cochrane Oral Health Group's Trials Register (to 5 September 2013); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 9); MEDLINE via OVID (1946 to 5 September 2013); EMBASE via OVID (1980 to 5 September 2013) and the US National Institutes of Health Trials Register (http://clinicaltrials.gov). There were no language restrictions in the searches of the electronic databases. SELECTION CRITERIA: Randomised controlled trials which compared pain relief with systemic antibiotics and analgesics, against placebo and analgesics in the acute preoperative phase of irreversible pulpitis. DATA COLLECTION AND ANALYSIS: Two review authors screened studies and extracted data independently. We assessed the quality of the evidence of included studies using GRADEPro software. Pooling of data was not possible and a descriptive summary is presented. MAIN RESULTS: One trial assessed at low risk of bias, involving 40 participants was included in this update of the review. The quality of the body of evidence was rated low for the different outcomes. There was a close parallel distribution of the pain ratings in both the intervention and placebo groups over the seven-day study period. There was insufficient evidence to claim or refute a benefit for penicillin for pain intensity. There was no significant difference in the mean total number of ibuprofen tablets over the study period: 9.2 (standard deviation (SD) 6.02) in the penicillin group versus 9.6 (SD 6.34) in the placebo group; mean difference -0.40 (95% confidence interval (CI) -4.23 to 3.43; P value = 0.84). This applied equally for the mean total number of Tylenol tablets: 6.9 (SD 6.87) used in the penicillin group versus 4.45 (SD 4.82) in the placebo group; mean difference 2.45 (95% CI -1.23 to 6.13; P value = 0.19). Our secondary outcome on reporting of adverse events was not addressed in this study. AUTHORS' CONCLUSIONS: This systematic review which was based on one low powered small sample trial assessed as a low risk of bias, illustrates that there is insufficient evidence to determine whether antibiotics reduce pain or not compared to not having antibiotics. The results of this review confirm the necessity for further larger sample and methodologically sound trials that can provide additional evidence as to whether antibiotics, prescribed in the preoperative phase, can affect treatment outcomes for irreversible pulpitis.

Diagnosis and management of calcified carotid artery atheroma: dental perspectives.

The calcification of cervical carotid artery atheroma (CCAA) represents maturation of a lumenal atherosclerotic plaque that has been associated with a high risk of cerebral stroke. The demonstration of CCAA on rotational panoramic images has received increasing attention in dentistry since it was first described in 1981. The purposes of this article are to provide a background to the mechanism of arterial calcification, to review the clinical diagnostic and management algorithms for dental practitioners when CCAA are identified radiologically, and to describe and illustrate current appropriate radiographic modalities and medical management strategies used to confirm and assess stenosis associated with CCAA.

Comparison of restoratively projected and surgically acceptable virtual implant position for mandibular overdentures.

PURPOSE: To compare differences between restoratively projected and surgically acceptable virtual implant positions at sites identified by cylindric radiopaque markers on diagnostic templates for implant-retained mandibular overdentures using cone beam computed tomography (CBCT). MATERIALS AND METHODS: A retrospective chart audit of a CBCT database identified 77 subjects who had been imaged to assess the residual alveolar ridge in the completely edentulous mandible prior to implant placement for mandibular overdentures. Individuals had been scanned with a diagnostic template using cylindric markers to identify the restoratively derived locations and trajectories for implants. Qualitative and quantitative differences between restoratively projected and surgically acceptable positions on transaxial CBCT images were recorded using implant planning software based on a standard implant. RESULTS: Only 6.4% of restoratively projected positions were within the criteria for surgically acceptable implant placement. However, most implant placement plans (77.9%) could be modified to fulfill surgically acceptable criteria. Of the projected implant positions, 15.7% were deemed inadvisable because of potential anatomical complications. Restoratively projected implant position was more likely to deviate buccally than lingually to the available residual alveolar ridge, as determined by CBCT. The mean angular deviation of the clinical prediction from ideal was 14.0 ± 5.5 degrees, the mean platform translation was 2.1 ± 1.3 mm, and the mean apex translation was 2.3 ± 1.5 mm. The average residual alveolar ridge reduction required in the posterior segment was 3.9 ± 2.5 mm. CONCLUSION: The restoratively projected trajectory for implant placement determined by visual inspection, diagnostic casts, and panoramic radiography deviated from the surgically acceptable location determined using CBCT data sets.

Utility and effectiveness of computer-aided diagnosis of dental caries.

Digital radiography has created a growing opportunity for computer-aided diagnostic (CAD) tools. The Logicon Caries Detector (LCD), with upgraded CAD software based on user feedback, was re-evaluated for its effectiveness via a retrospective clinical study. Using the upgraded LCD software, 12 dentists (evaluators) blindly assessed 17 radiographs taken by another (attending) dentist, who restored 28 proximal surfaces. The attending dentist confirmed the presence of early dentinal caries, as well as identifying 48 surfaces as caries-free or with enamel caries only subject to noninvasive treatment. The radiographs, imported into the software using a digital imaging and communications in medicine (DICOM) reader, were visually assessed under typical operatory lighting conditions, then with the aid of the software's density analysis tool. The effectiveness of the evaluators was gauged by calculating two measures of performance, sensitivity and specificity, for the detection and classification of dentinal caries. Sensitivity among all evaluator dentists was 30% with the initial image; 34% with the brightness and contrast adjusted image; 39% when the image was sharpened; and 69% when the density analysis tool was utilized. Specificity was found to be 97% with the initial image; 95% with the brightness and contrast adjusted image; 93% with the sharpened image; and 94% when the density analysis tool was used. Compared to the unaided eye, the LCD can significantly improve dentists' ability to detect and classify caries. Dentists may be able to find twice as much early dentinal caries requiring restoration (or at least aggressive noninvasive treatment) than previously, while not unnecessarily restoring additional healthy teeth. The LCD enables dentists to obtain more information from dental digital radiography than is possible with the unaided eye, leading to improved patient care.

Qualitative near-infrared vascular imaging system with tuned aperture computed tomography.

We developed a novel system for imaging and qualitatively analyzing the surface vessels using near-infrared (NIR) radiation using tuned aperture computed tomography (TACT(®)). The system consisted of a NIR-sensitive CCD camera surrounded by sixty light emitting diodes (with wavelengths alternating between 700 or 810 nm). This system produced thin NIR tomograms, under 0.5 mm in slice thickness. The venous oxygenation index reflecting oxygen saturation levels calculated from NIR tomograms was more sensitive than that from the NIR images. This novel system makes it possible to noninvasively obtain NIR tomograms and accurately analyze changes in oxygen saturation.

Massive craniofacial intraosseous vascular malformation resembling cystic angiomatosis: report of 2 cases and review of the literature.

Cystic angiomatosis of bone is a rare condition of multifocal angiomas of the skeleton. The condition is believed to be congenital, grows slowly and starts in first decades of life. Two cases of progressive bimaxillary enlargement, presented here with a history of slowly enlargement of facial bones when they were 9 and 6 year old, respectively. Radiographic evaluation of the craniofacial bones revealed aggressive hypertrophy with severe displacement of the teeth. The histopathological evaluation of the gross specimen showed vital bone containing capillary and cavernous spaces with endothelial lining. Aggressive cystic angiomatosis of the facial bones was described here as the most probable diagnosis.