Factors associated with the outcome of root canal treatment-A cohort study conducted in a private practice.

AIM: To investigate the association of various pre-, intra- and post-operative factors on root canal treatment outcome. METHODOLOGY: In this cohort study, primary or secondary root canal treatment of mature permanent teeth was performed by a single endodontist in a private practice over 13 years, and followed 1-4 years after treatment. Treatment details and clinical and radiographic data were collected. The proportion of successfully treated teeth and roots based on strict radiographic (periapical index (PAI) ≤2) and clinical criteria (absence of pain, swelling or sinus tract) was estimated. To evaluate joint associations of prognostic factors and treatment success probability, 44 pre, intra- and post-operative factors were investigated using bivariate associations, and a multiple logistic regression model was fitted using Generalized Estimating Equations. RESULTS: 1259 teeth (2445 roots, 3149 canals) were assessed with a recall rate of 91%. The proportion of successfully treated teeth was 79.9% [95% confidence interval 77.7-82.1]. Eleven prognostic factors were identified that significantly reduced the odds ratio (OR) for treatment success at tooth level. Six were preoperative: injury history (OR = 0.05[0.01-0.24]), root PAI (OR = 0.29[0.20-0.42], 0.21[0.13-0.34] and 0.22[0.12-0.42] for PAI = 3, 4 and 5, respectively, against PAI = 1), lesion diameter (OR = 0.30[0.21-0.43] and 0.24[0.16-0.37] for diameters of 1-5 mm and ≥6 mm, respectively, against no lesion), tooth type (OR = 0.51[0.27-0.97] and OR = 0.45[0.24-0.83] for premolars and molars, respectively, against incisors or canines), tenderness to periapical palpation (OR = 0.64[0.43-0.94]) and two canals per root (OR = 0.67[0.54-0.83]). Four factors were intraoperative: root filling of unsatisfactory quality (OR = 0.18[0.08-0.40]) or extending beyond or shorter than 2 mm from the apex (OR = 0.44[0.26-0.75] and 0.62[0.40-0.97] respectively), resin sealer (OR = 0.58[0.39-0.87] against bioceramic sealer) and single visit treatment (OR = 0.40[0.21-0.75] against multiple visits). One factor was post-operative: defective coronal restoration (OR = 0.35[0.21-0.56]). CONCLUSION: The following factors were associated with unsuccessful root canal treatment: (i) history of injury, apical periodontitis with increased severity (larger lesion, higher PAI, tenderness to periapical palpation), or complicated anatomic conditions (premolar or molar, two canals in a single root); (ii) technically suboptimal root filling (of unsatisfactory quality or not ending within 2 mm of radiographic apex) performed in a single-visit, or use of resin sealer instead of novel bioceramic sealer; (iii) suboptimal quality coronal restoration.

Influence of childhood asthma on dental caries: A longitudinal study.

OBJECTIVES: The study investigated the influence of childhood asthma on dental caries development and caries risk factors among children with asthma in Slovenia. MATERIAL AND METHODS: The study population consisted of 2-17 years old children (n = 138), who had used anti-asthmatic medicines for at least 1 year. Controls were their non-asthmatic siblings (n = 140). International Caries Detection and Assessment System-II was used to assess caries status. After 3 years, 106 baseline participants (53 asthmatic and 53 siblings) were reexamined. Questionnaires completed by parents and data from the patients' medical records provided information on demographics, child's medical history, medication usage, and oral health behaviors. Additional 308 asthmatic children were examined to assess caries risk factors among children with asthma. RESULTS: Asthmatic children had significantly higher mean d12 fs and D12 MFS (p ≤ 0.05), and fewer caries-free individuals (p ≤ 0.01). In asthmatic children, 3 years mean increment in D12 MFS was significantly higher (p ≤ 0.05). Furthermore, progression over 3 years from sound tooth surfaces to decayed cavitated and filled lesions in primary and permanent teeth were present in significantly higher (p ≤ 0.05) percentage, and likewise transition from decayed cavitated lesions to missing tooth surfaces because of caries in primary teeth, and from filled to filled non-cavitated and cavitated lesions in permanent teeth. Lower caries experience in asthmatic children was associated with lower doses of inhaled glucocorticoid use, leucotriene antagonist use, and daily milk and cheese consumption. CONCLUSIONS: Asthmatic children who had used anti-asthmatic medicines had higher caries experience and higher caries progression over 3 years in both primary and permanent dentitions. Besides anti-asthmatic medicines, other factors were associated with higher caries experience in asthmatic children.

Bone tissue morphology of rat offspring lactationally exposed to polychlorinated biphenyl 169 and 155.

Polychlorinated biphenyls (PCBs) are ubiquitous, persistent, organic pollutants also considered endocrine-disrupting chemicals. Our study examined the effects of lactational exposure to nondioxin-like PCB-155 and/or dioxin-like PCB-169 on longitudinal femur growth at the distal epiphyseal growth plate (EGP) in young rats at three different ages [postnatal days (PNDs) 9, 22, and 42]. After delivery, lactating rats were divided into four groups (PCB-169, PCB-155, PCB-155 + 169, and control) and administered PCBs intraperitoneally. The femurs of offspring were used to estimate growth rate (µm/day), and histomorphometric analysis on the distal femur included the thickness of the EGP and zones of proliferation and hypertrophy with calcification. Stereometry was used to determine trabecular bone volume density. In the PCB-169 and PCB-155 + 169 groups, PCB-169 affected longitudinal bone growth in the early postnatal period by interfering with chondrocytes in the EGP zone of proliferation and, to a lesser extent, the zone of hypertrophy. Morphometric alterations in EGP structure diminished until puberty. A slow growth rate persisted in the PCB-169 group until PND 42, while in the PCB-155 group, a fast growth rate between PNDs 9 to 22 was significantly reduced between PNDs 22 to 42. Sterometric assessment showed decreased trabecular bone volume in the PCB-155 + 169 group compared with that in the control on PND 9 and increased in the PCB-169 group compared with that in the PCB-155 group on PND 42. To summarize, studied PCB congeners exerted congener- and age-dependent effects on femur growth rate and its histomorphometric characteristics.

Lactational exposure to dioxin-like polychlorinated biphenyl 169 and nondioxin-like polychlorinated biphenyl 155: Effects on rat femur growth, biomechanics and mineral composition.

Exposure to polychlorinated biphenyls (PCBs), which are persistent lipophilic environmental pollutants, has a variety of adverse effects on wildlife and human health, including bone mineralization, growth and mechanical strength. The present study evaluated the effects of lactational exposure to nondioxin-like PCB-155 and dioxin-like PCB-169, individually and in combination, on pubertal rat femur development and its biomechanics. After offspring delivery, Wistar rat mothers were divided into four groups, i.e., PCB-169, PCB-155, PCB-155+169 and control, and were administered PCBs intraperitoneally. Data on bone geometry, biomechanics and mineral composition were obtained by analysis of femurs from 42-day-old offspring by microCT scanning, three-point bending test and inductively coupled plasma mass spectrometry. Decreased somatic mass and femur size, i.e., mass, periosteal circumference and cross sectional area, were observed in the PCB-169 and PCB-155 groups. Additionally, lactational exposure to planar PCB-169 resulted in harder and more brittle bones containing higher amounts of minerals. Combined exposure to structurally and functionally different PCBs demonstrated only mild alterations in bone width and mineralization. To conclude, our results demonstrated that alterations, observed on postnatal day 42, were primarily induced by PCB-169, while toxicity from both of the individual congeners may have been reduced in the combined group.

Case report of a molar-root incisor malformation in a patient with an autoimmune lymphoproliferative syndrome.

BACKGROUND: Molar-root incisor malformation (MRIM) is a novel dental phenotype likely related to a patient's past medical history. This case aimed to confirm MRIM by histological and scanning electron microscopy (SEM) examination for the first time in a patient diagnosed with autoimmune lymphoproliferative syndrome (ALPS) and to propose a possible link between ALPS and MRIM that could be attributable to abnormally proliferated bone marrow. CASE PRESENTATION: A 12.5-year-old boy with an extensive medical history, including diagnosis of ALPS, was examined clinically and radiologically to elucidate the reason for pain primarily originating from the area of the lower left permanent first molar tooth (PFM; tooth 36). Dental examination and radiographic survey revealed abnormal pulp cavity morphology of all four PFMs, and these were extracted, resolving the dental pain in the patient. The extracted PFMs were subjected to light microscopy, SEM evaluation and mineral density and elemental composition analyses. Histology of two PFMs revealed the presence of dentin-, bone- and cartilage-like tissues with abundant blood vessels occupying the majority of the pulp chamber. The root canals were obliterated with mineralized structures resembling pulp stones. Two different, highly mineralized abnormal tissues filling the majority of the pulp chamber revealed by SEM and confirming the diagnosis of MRIM displayed a mineral density and elemental composition similar to those of enamel and dentin, respectively. CONCLUSIONS: It appears likely that in addition to the complex medical history during early childhood in the present case, extensive lymphoid infiltrates that are possible in ALPS patients can be regarded as a cofactor in the development of MRIM by exerting considerable pressure on the developing tooth bud and providing cells capable of differentiating into diverse cell types.

Alterations in geometry, biomechanics, and mineral composition of juvenile rat femur induced by nonplanar PCB-155 and/or planar PCB-169.

Exposure to widespread lipophilic and bioaccumulative polychlorinated biphenyls (PCBs) induces diverse biochemical and toxicological responses in various organs, including the bone. The aim of this study was to evaluate the changes in growth rate, geometry, serum, and bone biochemical parameters and biomechanics of juvenile rat femur induced by lactational exposure to nonplanar PCB-155 and planar PCB-169 individually and in combination. Fifteen lactating Wistar rats were divided into four groups (PCB-169, PCB-155, PCB-155+169, and control), and PCBs were administered intraperitoneally at different time points after delivery. Femurs from 22-day-old offspring were analyzed by microCT, three-point bending test and inductively coupled plasma-mass spectrometry (ICP-MS) to obtain data on bone geometry, biomechanics and mineral composition. The serum levels of calcium, phosphate and alkaline phosphatase were also determined. Lactational exposure to planar PCB-169 resulted in shorter and thinner femurs, reduced endosteal and periosteal perimeters, smaller total cross-sectional and medullary areas, and lowered serum bone marker levels and calcium levels in the bone, while femur mechanical properties were not significantly altered. The changes observed in the combination exposure (PCB-155+169) group were similar to those observed in the PCB-169 group but were less pronounced. In summary, our results demonstrate that alterations in lactationally exposed offspring were primarily induced by planar PCB-169. The milder outcome in the combined group suggested that the PCB-169-mediated toxic effects on the bone might be reduced by a nonplanar PCB-155 congener. © 2016 Wiley Periodicals, Inc. Environ Toxicol 32: 1135-1146, 2017.

Proximal caries lesion detection using the Canary Caries Detection System: an in vitro study.

OBJECTIVE: This study investigated the accuracy of the Canary System (CS) to detect proximal caries lesions in vitro, and compared it with conventional methods: International Caries Detection and Assessment System (ICDAS) II and bitewing radiography (BW). METHODS: Visible proximal surfaces of extracted human teeth were assessed by ICDAS-II before setting them in five manikin mouth models. Then contacting proximal surfaces in mouth models were assessed by BW and CS. Histological validation with polarized-light microscopy served as a gold standard. Pairwise comparisons were performed on area under the curve (AUC), sensitivity, and specificity of the three methods, and corrected using Bonferroni's method. Sensitivities and specificities were compared using a test of proportions and AUC values were compared using DeLong's method. RESULTS: The CS presented significantly higher sensitivity (0.933) than ICDAS-II (0.733, P = 0.01) and BW (0.267, P < 0.001), and ICDAS-II higher sensitivity than BW (P < 0.001). There were no significant differences between their specificity values: 0.825 (CS), 0.65 (ICDAS-II), and 0.875 (BW). The AUC of CS (0.862) was significantly higher than of ICDAS-II (0.681, P < 0.001) and BW (0.577, P < 0.001). CONCLUSION: The CS demonstrated greater accuracy in detecting proximal lesions than ICDAS-II and BW, although without significantly higher specificity.

Levels and distribution of organochlorine pollutants in primary dental tissues and bone of lamb.

This study examined the bioconcentration of selected organochlorine pollutants, tetra- and hexa-chlorobiphenyls with planar (PCB-80, PCB-169) and non-planar (PCB-54, PCB-155) structure, and persistent organochlorine pesticides with planar [hexachlorobenzene (HCB)] and non-planar [1,1-bis (4-chlorophenyl)-2,2-dichloroethene (4,4'-DDE)] structure in primary dental tissues (pulp, dentine, and enamel) and mandibular bone of lactationally exposed lambs, and compared it with the organochlorines distribution pattern in permanent dental tissues and bone. Also, the role of pollutants physicochemical properties and tissue specific characteristics in the bioconcentration was assessed. Residual levels of individual pollutants were analyzed by high-resolution gas chromatography with electron-capture detection. Our results showed that transfer of organochlorines to primary hard dental tissues was higher than to permanent hard dental tissues. Metabolically more stable, planar, and toxic organochlorines (e.g. PCB-169 and HCB) predominated in primary hard dental tissues, where they may represent a potential risk for developmental dental defects.

Influence of anti-asthmatic medications on dental caries in children in Slovenia.

OBJECTIVE. The study investigated the influence of exposure to anti-asthmatic medications and of various factors on the caries prevalence in children in Slovenia. METHODS. The study population consisted of children aged 2 to 17 years (n = 220) under treatment for asthma, who had used anti-asthmatic medications for at least 1 year; 220 controls were matched for age. Caries status was determined by the number of decayed, missing, and filled surfaces through clinical examination by two calibrated dentists using the International Caries Detection and Assessment System-II scoring criteria. Questionnaires completed by parents and data from the patients' medical records provided information on various confounding factors. RESULTS. Asthmatic children had significantly higher (P ≤ 0.01) prevalence of caries on primary and permanent teeth in all age groups, and the proportion of caries-free children was significantly smaller (P ≤ 0.05). In multivariate regression analysis, asthma diagnosis, child's age, daily use of inhaled glucocorticoids, length and frequency of medicine application, spacer use, mouth rinsing with water after medicine application, parents' education, frequent food and drink consumption, and frequency of toothbrushing were associated with caries experience of asthmatic children. CONCLUSION. Children with asthma who had used anti-asthmatic medications had higher caries experience in primary and permanent teeth.

Size, ultrastructure, and microhardness of natal teeth with agenesis of permanent successors.

OBJECTIVE: Natal and neonatal teeth may occur in conjunction with other oral anomalies, including anomalous development of succedaneous teeth. Our purpose was to examine the size, ultrastructure, and microhardness of two natal teeth without permanent successor germs, and compare them with the characteristics of normal primary teeth. DESIGN: The dimensions of two natal mandibular incisors extracted from a healthy 7-year-old child were measured with a digital sliding caliper. The crown dimensions of normal primary mandibular central incisors were established from dental casts of 102 children. Since the natal teeth were nearly completely devoid of enamel, the average enamel thickness determined on a sample of 19 normal primary mandibular incisors was added to the values measured. External surfaces and transverse sections of the natal teeth were examined under a scanning electron microscope. Vickers microhardness of radicular dentine was assessed for the natal teeth and for 11 normal primary mandibular incisors. RESULTS: Only remnants of enamel were present. All crown dimensions corrected for enamel loss were within the normal range. The ultrastructure of hard dental tissues was normal. The radicular dentine hardness of the natal teeth was similar to that of the normal primary mandibular incisors. CONCLUSIONS: The results indicate that the natal teeth were prematurely erupted regular primary mandibular central incisors. In our case, the occurrence of natal teeth associated with agenesis of their primary successors appears to be related to an accelerated or premature pattern of dental development, rather than to superficial positioning of the tooth germs.

Dental caries in Faroese children exposed to polychlorinated biphenyls.

The effects of exposure to polychlorinated biphenyls (PCBs) on dental caries of first permanent molars in children in the Faroe Islands, where the population is exposed to PCBs in their traditional diet, were evaluated. This study was part of a cohort study aimed at determining developmental risks resulting from the consumption of contaminated seafood. One hundred and fourteen children from a birth cohort of 182 mother-child pairs, aged 9-10 years, were examined. Caries scoring was performed according to WHO criteria; cavitated and noncavitated lesions were included. Exposure assessment was based on the PCB concentrations in maternal milk samples. Data from the project data set provided information on various confounding factors. Mean maternal milk PCB concentration was 2205 (range 70-11,150)ng/g lipids. The number of carious surfaces of first permanent molars correlated with milk PCB concentration (r=0.26, p=0.01). In multivariate linear regression analysis, PCB exposure was significantly related to caries susceptibility. The findings support an association between children's PCB exposure and caries prevalence.

Developmental dental defects in children exposed to PCBs in eastern Slovakia.

The effects of long-term exposure to polychlorinated biphenyls (PCBs) on developmental dental defects of deciduous and permanent teeth in children in eastern Slovakia, where PCBs from a chemical plant manufacturing Delors contaminated the surrounding district were evaluated. Four hundred and thirtytwo children, lifelong residents, aged 8-9 years were examined. Children's caries susceptibility and gingival health was assessed by standard dental indices, and developmental enamel defects by the FDI index. Data from the PCBRISK project data set and questionnaires completed by the parents provided information on exposure and various confounding factors. The proportion of teeth with different types and extensions of developmental enamel defects correlated with serum PCB concentration. The proportion of deciduous teeth affected with enamel defects was significantly higher in higher exposed children (chi(2)=8.35; p=0.03) according to their serum PCB concentration (group 0: <200; group 1: 200-600; group 2: >600 ng PCBs g(-1) serum lipids). The proportion of permanent teeth affected with any enamel defect was significantly higher in higher exposed children (chi2=7.237; p=0.027). Furthermore, the extent of the enamel defects was also greater (chi2=10.714; p=0.005). In multivariate linear regression analysis PCB exposure was significantly related to developmental enamel defects of permanent teeth only. No associations between PCB exposure and caries susceptibility, gingival health or number of teeth were observed. This study demonstrated a dose-response relationship between PCB exposure and developmental enamel defects of permanent teeth in children, the evidence for deciduous teeth was not conclusive.

Distribution of organochlorine pollutants in ovine dental tissues and bone.

The distribution of selected lipophilic organochlorine pollutants, including two pairs of tetra- and hexa-chlorobiphenyl isomers (PCB-54, -80, -155, -169) and organochlorine pesticides [hexachlorobenzene (HCB) and 1,1-bis(4-chlorophenyl)-2,2-dichloroethene (4,4'-DDE)], in ovine dental pulp, dentine, enamel and mandibular bone was examined. Sheeps were given a single dose of individual organochlorine (1-4µmol/kg) in olive oil by intramuscular injection and sacrificed 2 months later. Organochlorine residues were determined by gas chromatography. The highest levels of organochlorines were found in bone. The lipid adjusted levels varied significantly between tissues. Lower chlorinated, metabolically unstable, non-planar PCB-54 was enriched in enamel, while higher chlorinated, metabolically resistant, planar PCB-169 was preferentially retained in pulp. The ratio of planar to non-planar PCB homologues and pesticides (PCB-169/-155, PCB-80/-54, HCB/4,4'-DDE) decreased in the order pulp>dentine>enamel, suggesting that besides compound's lipophilicity and the tissue's lipid content, other physicochemical properties of organochlorines and tissue specific characteristics affect their distribution.

Excretion pattern of co-planar and non-planar tetra- and hexa-chlorobiphenyls in ovine milk and faeces.

This study employed the gas chromatography with electron capture detection to determine residual levels and excretion patterns of two pairs of structurally diverse polychlorinated biphenyl (PCB) congeners (IUPAC Nos. 54, 80, 155, and 169) administered to lactating sheep by intramuscular injection. PCB levels and excretion patterns in blood, milk, and faeces were time-dependent and differed from the composition of PCB congeners administered. Lactational transfer substantially exceeded the faecal transfer. Between days 3 and 7, the amount of PCB congeners 54 and 169 excreted in milk was around 50- and 800-fold higher than the amount of these two congeners excreted via faeces. During the same period, the relative contribution of co-planar PCB congeners (80 and 169) in PCB pattern decreased in blood and increased in milk and faeces compared with non-planar PCBs (54 and 155). On day 3, the ratio PCB 169 to 54 was 7-fold higher in milk than in faeces. PCB congeners with log Kow values under 6.5 reached peaks of their excretion in milk within the first three days after administration, while the super-lipophilic PCB 169 congener with log Kow value of over 7 has not reached the plateau until day 10, but afterwards, its level remained relatively high throughout the observation period. During the 57-day follow-up period, the excretion of PCB 80, 155, and 169 in milk was 4.5-, 14-, and 46-fold greater compared with PCB 54. Differences in levels and patterns were explained with some physico-chemical properties of individual PCB congeners, such as lipophilicity, planarity, metabolic stability, sorption/diffusion properties.

Modeling AC current conduction through a human tooth.

Impedance between the electrode inserted in a root canal of a human tooth and the outer electrode placed on the oral mucosa serves as a measure of the root canal length, a vital parameter necessary for efficient endodontic procedure in dentistry. For better understanding of current conduction through the tooth, the impedance has been measured on extracted teeth (in vitro) and further used to develop corresponding electrical lumped element models. For modeling the metal/solution interface and complex structure of the tooth, Fricke's constant phase elements are employed. More detailed insight into current conduction is given by numerical simulation. Numerical simulation demonstrates the influence on the impedance of several important parameters, such as dentin conductance, canal preparation, and solution conductance.

Numerical computation of impedances of a human tooth for estimation of the root canal length.

Alternative current (ac) current conduction through a human tooth has been investigated through numerical simulation. Numerical calculation of impedance between the file (electrode) inserted in the root canal of the tooth and the outer electrode enables investigation of the impedance method used in dentistry for evaluation of the root canal length. Simulations confirm the improved sensitivity of the impedance method using the results of multiple frequency measurements.