Periradicular repair after single- and two-visit root canal treatments using ultrasonic irrigant activation and calcium hydroxide dressing of teeth with apical periodontitis: study protocol for randomized controlled trials.

BACKGROUND: In certain clinical situations, root canal treatment in teeth with apical periodontitis is performed in multiple visits, with the use of intracanal dressing between visits, aiming to reduce microorganisms and their by-products of the root canal system prior to filling. However, in recent years, discussions have been growing about the real need for the use of intracanal dressing in these cases. The use of ultrasonic activation of the auxiliary chemical substance has increased the potential for decontamination promoted during the chemomechanical preparation of the root canal. Thus, this study is designed to explore whether the use of intracanal dressing between visits during endodontic treatment favors periradicular repair in teeth with apical periodontitis. METHODS: This is a randomized, prospective, double-blinded, controlled clinical trial designed to evaluate 3 distinct clinical approaches used during endodontic therapy: group 1-root canal treatment in a single visit (RCT-SV); group 2-root canal treatment in two visits with intracanal dressing (RCT-TVWD); and group 3-root canal treatment in two visits without intracanal dressing (RCT-TVWOD). A total of 150 adult patients aged 18 to 60, with at least one tooth diagnosed with asymptomatic apical periodontitis and periradicular lesion (confirmed with a cone beam computed tomography (CBCT)), will be randomized and will undergo one of the types of clinical approaches during endodontic therapy. Patients' postoperative pain levels will also be recorded in periods of 24, 48, and 72 h and 7 days. Subsequently, clinical findings and long-term follow-up evaluations, with periradicular repair, will be performed at 6 and 12 months by intraoral periapical radiograph (IOPAR) and CBCT at the 24-month follow-up. DISCUSSION: This study will evaluate the periradicular repair of mandibular molar teeth with apical periodontitis, providing information about the efficacy, benefits, and safety of performing the endodontic treatment in a single and two visits, with and without the use of calcium hydroxide dressing. All endodontic therapy procedures will be performed under a dental operating microscope and using ultrasonic activation of auxiliary chemical substances. These results may contribute to changes in the clinical approaches adopted during endodontic therapy of teeth with apical periodontitis and reveal the potential of complementary approaches that aim to enhance the decontamination of the root canal system during the preparation stage. TRIAL REGISTRATION: ClinicalTrials.gov NCT05256667. Registered on 24 February 2022.

Trabecular and cortical mandibular bone investigation in familial adenomatous polyposis patients.

Mandibular cortical and trabecular bone abnormalities in patients with familial adenomatous polyposis (FAP) were evaluated using dental panoramic radiographs (DPR) radiomorphometric indices and fractal dimension (FD). Sixty DPRs from 15 FAP patients and 45 healthy controls were evaluated. FAP group was composed of 33.3% females and 66.6% males, agemean = 37.2 years (SD 15.79). The non-FAP group was paired by gender and sex. The parameters analyzed were: FD of the trabecular bone in four regions of interest (ROI), mandibular cortical index (MCI) and width (MCW). FD values were lower for the FAP group. Statistically significance differences were shown by ROI 2 and 3 anteriorly to the mental foramen bilaterally, p = 0.001, and p = 0.006. The ROI 1 and 4, at the mandibular angle trabeculae, indicated statistical significances on the right side (p = 0.036) and no differences on the left side (p = 0.091). There was no significant difference in MCI and MCW when the groups were compared, MCW (L) p = 0.247, and MCW (R) p = 0.070. Fractal values of FAP patients' mandibular trabecular bone were lower than healthy controls. The radiomorphometric indices MCI and MCW were not useful for analyzing the cortical bone pattern. Therefore, FD is a promising tool for detection of abnormal bone structure in DPRs and for supporting the appropriate referral of FAP patients.

The scope of dental education during COVID-19 pandemic: A systematic review.

INTRODUCTION: COVID-19 forced e-learning processes to develop abruptly and posed challenges to the educational infrastructure. Emergency Remote Teaching was designated to distinguish the new educational scheme. This concept involves production of online activities that may return to face-to-face format as soon as the isolation period ends. OBJECTIVE: From March through September of 2020, this systematic review attempted to elucidate experiences, benefits, and challenges enforced in dental education due to the pandemic, the learning technologies, and methods used to maintain education. METHODS: A literature search was conducted on Cochrane, Embase, Lilacs, Livivo, PubMed, Scopus, and Web of Science databases. Gray literature was also contemplated. Studies in which online teaching methods were described and dental learners were the subjects during pandemic were included. RESULTS: Learning technology, pedagogical model, knowledge gain, and dental learners' satisfaction and attitudes toward remote learning were assessed. The Joanna Briggs Institute JBI Critical Appraisal Checklist for Case Reports was applied as the methodological quality assessment to the 16 included studies. Assessments were related to demographic and historical characteristics of the participants, the intervention procedure, pre- and post-intervention descriptions, and identification of unanticipated events. All studies described the use of learning technology to ensure education continuity, and 15 studies highlighted the pedagogical model applied. Eight studies investigated knowledge gain while 12 searched the learners' satisfaction with online technologies. CONCLUSION: The evidence suggests that learning technologies can support continuity in dental education. Reported problems include poor knowledge of faculty members on how to deal with technology, Internet connection, and content transition to online education.

Capability of CBCT to identify patients with low bone mineral density: a systematic review.

The aim of this study was to systematically review the literature about the capability of CBCT images to identify individuals with low bone mineral density (BMD). As the literature is scarce regarding this topic, the purpose of this systematic review is also to guide future research in this area. A detailed search was performed in five databases without restrictions of time or languages. Additionally, a grey literature search was conducted. The Quality Assessment Tool for Diagnostic Accuracy Studies-2 was applied to evaluate the methodological design of selected studies. With the inclusion of only six studies, the evidence is limited to endorse the use of CBCT assertively as a diagnostic tool for low BMD. All of the three studies that analyzed radiomorphometric indices found that the linear measurements of the mandibular inferior cortex were lower in osteoporotic individuals. CBCT-derived radiographic density vertebral and mandibular measurements were also capable for differentiating individuals with osteoporosis from individuals with normal BMD. The analysis of the cervical vertebrae showed high accuracy measurements. This systematic review indicates a scarcity of studies regarding the potential of CBCT for screening individuals with low BMD. However, the studies indicate that radiomorphometric indices and CBCT-derived radiographic density should be promising tools for differentiating individuals with osteoporosis from individuals with normal BMD.

Effectiveness of E-Learning in Oral Radiology Education: A Systematic Review.

E-learning has been used recently in dental curricula to support traditional learning methods. However, the published literature concerning e-learning in oral radiology has shown mixed conclusions. The aim of this systematic review was to provide a synthesis of the effectiveness of e-learning in oral radiology education when compared with traditional classroom learning methods. A search of the literature was conducted on the LILACS, PubMed, Science Direct, Scopus, and Web of Science databases. Trials registries were also consulted for ongoing trials, and a partial grey literature search was conducted. Controlled trials about oral radiology education that compared any e-learning method with a control group using any traditional classroom instruction method were included. E-learning effectiveness was measured using three outcomes from Kirkpatrick's model of evaluation: attitudes about e-learning, knowledge gain, and performance on clinical procedures. Data were analyzed descriptively. Qualitative appraisal was performed according to the Cochrane risk of bias tool for randomized trials and MINORS tool for non-randomized trials. Eleven studies met the inclusion criteria. Risk of bias was identified related to the selection procedures, blinding, lack of sample size calculation, and incomplete analyses. Ten studies reported that students had positive attitude when using e-learning. Results from the knowledge gain outcome were mixed. Only two studies examined performance on clinical procedures, showing contrasting results. The evidence reviewed in this study suggests that e-learning in oral radiology is at least as effective as traditional learning methods and that students have positive attitudes about e-learning.

Dental panoramic indices and fractal dimension measurements in osteogenesis imperfecta children under pamidronate treatment.

OBJECTIVES: To verify radiomorphometric indices and fractal dimension (FD) in dental panoramic radiographs (DPRs) of children with different types of osteogenesis imperfecta (OI) and also to verify the effect of pamidronate (PAM) treatment in such panoramic analyses. METHODS: In this retrospective study, 197 DPRs of 62 children with OI Types I, III and IV who were in treatment with a comparable dosage of intravenous PAM were selected. The mandibular cortical width (MCW), mandibular cortical index, visual estimation of the cortical width and FD of three standardized trabecular and cortical mandibular regions of interest were obtained from the radiographs. Factorial analysis of variance and Fisher test were used to compare FD and MCW measurements in children with different types of OI for different PAM cycles. RESULTS: Children with all types of OI have thinner and more porous mandibular cortices at the beginning of treatment. There were significant differences between MCW and FD of the cortical bone, regarding different types of OI and number of PAM cycles (p = 0.037 and p = 0.044, respectively). FD measurements of the trabecular bone were not statistically different among OI types nor were PAM cycles (p > 0.05). CONCLUSIONS: Children with OI presented cortical bone alterations after PAM treatment. Both MCW and the FD of the cortical bone were higher in children with OI after PAM treatment. It is argued that cortical bone should be considered for analyzing patients with OI, as well as to monitor the progress of PAM treatment.

Taurodontism in Brazilian patients with tooth agenesis and first and second-degree relatives: a case-control study.

AIM: An association between tooth agenesis and taurodontism has been suggested. To verify if tooth agenesis and taurodontism are associated within families and specific patterns of tooth agenesis, this study aims to compare the frequency of taurodontism in patients with nonsyndromic familial tooth agenesis, their first and second-degree relatives with complete permanent dentition and a control group of unrelated healthy individuals with complete permanent dentition. MATERIALS AND METHODS: Panoramic radiographs of patients with nonsyndromic familial tooth agenesis, their first and second-degree relatives and a control group of individuals with complete permanent dentition were examined. Taurodontism was assessed on permanent mandibular first molars. The difference in the frequency of taurodontism among the studied groups was tested with Fisher's Exact Test. RESULTS: Seventeen families with nonsyndromic familial tooth agenesis were studied. The frequency of taurodontism was 29% in patients with tooth agenesis, 10.3% in their first and second degree relatives, and 6.6% in the control group. A significant statistical difference among the studied groups was observed (p=0.002). Taurodontism was proportionally more frequent in patients with a higher number of absent teeth. It was mainly observed in patients from families in which the proband was diagnosed with oligodontia. CONCLUSIONS: Taurodontism is more frequent in nonsyndromic familial tooth agenesis. Individuals in families with second premolar and molar oligodontia are more likely to have taurodontism, even the individuals with complete dentition. This association could define a subphenotype for future genetic studies of dental development.

Pycnodysostosis with craniosynostosis: case report of the craniofacial and oral features.

Pycnodysostosis (OMIM 265800) is an uncommon hereditary disorder characterized by osteosclerosis of the skeleton, short stature, and bone fragility. The syndrome was first described by Maroteaux and Lamy (1962). Facial dysmorphology, hypoplasia of the mandible,dysplasia of the skull, bones with delayed closure of the cranial sutures, clavicular dysplasia, acroosteolysis or partial aplasia of the terminal phalanges, and abnormal tooth eruption have also been reported (Gelb et al., 1995). An autosomal recessive mode of inheritance has been also suggested and the locus of the disease was initially mapped to human chromosome 1q21 by genetic linkage (Bernard et al., 1980). Since then, several mutations on unrelated patients and consanguineous families have been identified in the cathepsin K gene (CTSK), affecting osteoclast function.Only two previous reports have demonstrated the presence of craniosynostosis in patients with pycnodysostosis(Fleming et al., 2007; Osimani et al., 2010). The purpose of this case report is to describe the craniofacial and dental features of a 12-year-old boy with pycnodysostosisand an uncommon association with craniosynosotosis.