Comparing clinical outcomes of immediate implant placement with early implant placement in healthy adult patients requiring single-tooth replacement in the aesthetic zone: a systematic review and meta-analysis of randomised controlled trials.

BACKGROUND: The aim of this systematic review and meta-analysis was to assess the clinical efficacy of the immediate implant placement (IIP) protocol in the aesthetic zone with early dental implant placement (EIP) protocol. METHODS: Electronic databases MEDLINE (via OVID), EMBASE (via OVID), ISI Web of Science core collection, Cochrane, SCOPUS, and Google Scholar were searched for the studies comparing the two clinical protocols. Randomised controlled trials were included. Cochrane Risk of Bias tool (ROB-2) was used to assess the quality of included students. RESULTS: A total of six studies were selected. Implant failure was observed at 3.84%, 9.3%, and 4.45% in three studies while in the other studies, no implant failure was reported. Meta-analysis of four studies showed no statistically significant difference in the vertical bone levels between IIP and EIP (148 patients), mean difference (MD)0.10 [95% CI: -0.29 to 0.091.32] P > 0.05. Meta-analysis of two studies showed the probing depth between IIP versus EIP was not significantly different (100 patients), mean difference(MD)-0.00 [95% CI; -0.23 to 0.23]; P > 0.05. The pink aesthetic score (PES) was improved in EIP as compared to IIP with a statistically significant difference (P < 0.05). CONCLUSION: The available evidence supports the clinical efficacy of the IIP protocol. Present findings indicate aesthetics and clinical results of immediate implant placement protocol are comparable to early and delayed placement protocols. Therefore, future research with long-term follow-up is warranted.

An overview of systematic reviews on endotoxins in endodontic infections and the effectiveness of root canal therapy in its removal.

Background The objective of this overview was to synthesise the current evidence on the role of endotoxins in endodontics infections and to evaluate the effectiveness of endodontic procedures in its removal using information from published systematic reviews.Methods Electronic databases Medline, Scopus, Embase, Cochrane Library and Google Scholar were searched for reviews published up to July 2021. Systematic reviews on endotoxins based on clinical and/or observational studies were included. The quality of systematic reviews was assessed with the AMSTAR2 tool.Results A total of five systematic reviews were selected, of which two reviews were of high quality. A significantly higher level of endotoxins were found in teeth with exudation, teeth with a previous episode of pain and pain on percussion. Chemomechanical preparation of root canals significantly reduce endotoxin levels. Calcium hydroxide intracanal medication in symptomatic teeth was significantly effective in endotoxin reduction (standardised mean difference -1.051 [95% confidence interval -2.039 to -0.063]; p <0.05; I2 = 83.3%; certainty of evidence = very low). Multiple session root canal treatment in teeth with symptomatic apical periodontitis was significantly more effective in endotoxins/lipopolysaccharides removal than single-session treatment.Conclusion Limited quality of evidence showed a significant association of endotoxins in infected teeth with clinical symptoms. Conventional chemomechanical preparation of root canals and intracanal medication were unable to eliminate endotoxins from the root canal system. Future evolution of effective disinfection therapies is warranted.

Effect of mode of rotation on apical extrusion of debris with four different single-file endodontic instrumentation systems: Systematic review and meta-analysis.

This systematic review and meta-analysis evaluated whether single-file endodontic instrumentation systems with the reciprocating type of motion are responsible for more debris extrusion than single-file endodontic instrumentation systems with the full rotational type of motion. Electronic and manual searches were performed following the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analysis - PRISMA. We included studies comparing rotary (Neoniti and/ OneShape) versus reciprocating (WaveOne and/ Reciproc) systems. We evaluated the quality of studies and performed statistical analysis using R-Project software. Eight studies of high quality were included to perform the meta-analysis. Subgroup analysis was also done. The overall risk of bias was too low. In conclusion, single-file reciprocating systems tend to generate more extrusion of debris than single-file rotary systems.

Calcium hydroxide as an intracanal medication for postoperative pain during primary root canal therapy: A systematic review and meta-analysis with trial sequential analysis of randomised controlled trials.

OBJECTIVE: To evaluate the effectiveness of CH as an intracanal medicament compared to no dressing and / or other intracanal medicaments to control postoperative pain in patients with apical periodontitis requiring primary root canal therapy. MATERIALS AND METHODS: We conducted electronic searches in PubMed, EMBASE, Scopus and Cochrane Library, Open Gray, and Google Scholar. A structured Population-Intervention-Comparison-Outcome of the review was as follows: Population: adults who presented with apical periodontitis requiring primary root canal therapy; Intervention: CH intracanal medicament; Comparison: no dressing/other intracanal medicaments; Main Outcome: Postoperative pain. We assessed the risk of bias using Cochrane criteria. Our outcome measures were intensity of pain on a validated scale reported as mean and standard deviation. We performed meta-analysis using the random-effects model. We rated the quality of evidence using GRADE. RESULTS: We included 18 studies with 1192 participants. The overall risk of bias was moderate. We found a significant improvement in postoperative pain at 24 hours in favor of CH over no intracanal medication (4 trials, n = 226: standardised mean difference: -0.71; [95% confidence interval: -1.38, -0.03]; P = .04; I2= 78%; moderate certainty evidence). Ledermix (Lederle Germany) (steroid-antibiotic) and chlorhexidine were significantly more effective than CH for controlling pain at 72 hours postprocedure (low certainty evidence). Silver nanoparticles were more effective than CH at 6 and 24 hours and combinations of CH with dexamethasone or lidocaine HCl were significantly more effective than CH alone at improving postoperative pain. Substantial heterogeneity limits the robustness of findings. CONCLUSION: Limited evidence suggests that CH may be an effective intracanal medicament for controlling interappointment pain. Combination therapies appear to be more effective than using CH alone. Further research assessing the comparative effectiveness of interventions for managing postoperative pain following root canal therapy is warranted.

CALCIUM HYDROXIDE (CA[OH]2) AS AN INTRACANAL MEDICATION MAY SIGNIFICANTLY REDUCE ENDOTOXINS LEVEL FROM INFECTED TEETH.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Bedran NR, Nadelman P, Magno MB, de Almeida Neves A, Ferreira DM, Braga Pintor AV, Maia LC, Primo LG. Does Calcium Hydroxide Reduce Endotoxins in Infected Root Canals? Systematic Review and Meta-analysis. J Endod. 2020 Aug 11:S0099-2399(20)30582-3. doi:10.1016/j.joen.2020.08.002. Epub ahead of print. PMID: 32795549. SOURCE OF FUNDING: This systematic review was supported in part by the Coordenaçao de Aperfeiçoamento de Pessoal de Nível Superior (finance code 001, 88882.424816/2019-01) and Fundaçao Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio de Janeiro (grant nos. E-26/202.334/2019, E-26/202.399/ 2017, and E-26/210.352/2019). TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

Effectiveness of Intracanal Cryotherapy in Root Canal Therapy: A Systematic Review and Meta-analysis of Randomized Clinical Trials.

INTRODUCTION: The effectiveness of intracanal cryotherapy for reducing postoperative pain is unclear. The objective of this systematic review was to evaluate the effect of intracanal cryotherapy on postoperative pain after root canal therapy in patients with pulpal or periradicular pathosis. METHODS: We searched PubMed, Embase, Scopus, and the Cochrane Library as well as the top 3 endodontic journals for relevant articles. We included randomized controlled trials that included adults. Our main outcome was postoperative pain intensity measured with a validated scale. We assessed the risk of bias using the Cochrane criteria and the quality of the included studies using Grading of Recommendation Assessment, Development, and Evaluation. We used a random-effects model for meta-analysis. RESULTS: Eight studies involving 810 patients were included. The overall risk of bias was moderate. Seven of 8 studies used a visual analog scale to measure pain intensity. Compared with controls, intracanal cryotherapy significantly reduced postoperative pain at 6 (mean difference = -1.37; 95% confidence interval [CI], -0.61 to -2.14; P < .05; I2 = 76%; moderate-quality evidence) and 24 hours after the procedure (mean difference = -1.43; 95% confidence interval, -0.70 to -2.15; P < .05; I2 = 89%; moderate-quality evidence). There was no significant effect on pain at 48 and 72 hours and 7 days after the procedure. CONCLUSIONS: Moderate-quality evidence suggests that intracanal cryotherapy (ie, using cold saline irrigation as a final irrigant) significantly reduces the intensity of pain at 6 and 24 hours after root canal therapy. Future clinical trials assessing the effectiveness of intracanal cryotherapy are advocated.

Accurate Detection of Non-Cavitated Proximal Caries in Posterior Permanent Teeth: An in vivo Study.

PURPOSE: This study aimed to compare the sensitivity and specificity of DIAGNOdent versus bitewing radiographs in detecting non-cavitated proximal caries. PATIENTS AND METHODS: This observational prospective study included 120 proximal surfaces, without obvious cavitation, on permanent mandibular and maxillary posterior teeth in patients over 16 years old. The DIAGNOdent test was performed, and digital bitewing radiographs were obtained; these were compared with a standard reference method, which comprised a clinical assessment of the proximal surfaces following the application of an orthodontic separator between the teeth for 7 days. Each test was performed by a different investigator blinded to the assessment results of the other examiners. RESULTS: The DIAGNOdent device exhibited a higher sensitivity in detecting enamel proximal caries (95%) than digital bitewing radiographs (64%), and the specificity of DIAGNOdent (89%) was greater than that of bitewing radiographs (77%). Regarding the detection of dentin caries, the sensitivities of DIAGNOdent and bitewing radiographs were similar (both 62%); however, the specificity of DIAGNOdent was higher (98% versus 88%). The results of the Kruskal-Wallis test revealed a significant difference in DIAGNOdent scores across the three diagnoses (sound tooth surfaces, enamel caries, dentin caries) (p-value <0.001). CONCLUSION: The diagnostic accuracy of DIAGNOdent in detecting enamel caries is significantly higher than that of digital bitewing radiography. The routine use of DIAGNOdent can facilitate an accurate diagnosis of early carious lesions and inform the implementation of preventive treatment.

Apical extrusion of debris with different rotary and reciprocating single-file endodontic instrumentation systems: a systematic review and meta-analysis protocol.

INTRODUCTION: Root canal treatment is one of the oldest dental procedures for the treatment of endodontic infection. Extrusion of debris beyond the root apex during root canal instrumentation and subsequent persistence of pain are common complications. A systematic review of the evidence on reciprocating single-file instrumentation systems and their comparison with rotary single-file systems, with apical extrusion of debris as primary outcome, will be done through this study. METHODS AND ANALYSIS: Published ex vivo and in vitro studies with no language restriction will be included. We will search MEDLINE (Ovid), EMBASE (Ovid), Web of Science, Cochrane and Google Scholar. Strategies will be incorporated to search grey literature also. Thorough evaluation of search results, completion of data abstraction and assessment of quality will be done by two reviewers independent from each other. Assessment of included studies will be done by utilising an evidence model developed on the basis of standards of quality reported in guidelines to document ex vivo and in vitro studies regarding dental materials and pertained for extrusion of debris apically and has been already used in quality assessment of studies involving quantification of debris extrusion apically. We will calculate the standardised mean differences for apically extruded debris, with congruent 95% CIs. We will measure the statistical heterogeneity by applying the Cochrane Q test and quantify using the I2 statistic. Existence of covariates and any potential heterogeneity will be explored through prespecified subgroup and sensitivity analyses. ETHICS AND DISSEMINATION: Approval from an ethical research committee is not required because it will be done using data that have been already published and have no concerns related to the privacy of patients. Extensive dissemination of results from this review will be done through submission to a peer-reviewed journal for publication and conferences. PROSPERO REGISTRATION NUMBER: CRD42019151804.

Success of Coronal Pulpotomy in Permanent Teeth with Irreversible Pulpitis: An Evidence-based Review.

Vital pulp therapies have been used in primary teeth and immature permanent teeth. However, with the advent of new bioactive material, the paradigm is shifting toward permanent teeth with mature apices of roots. There are many prospective and retrospective studies, randomized controlled trials, and systematic reviews that report coronal pulpotomy with bioactive material in permanent teeth with pulpal pathosis proved to be as successful as root canal therapy (RCT). Coronal pulpotomy is cost-effective, not very technical demanding like root canal therapy and less time consuming for both the dentists and patients. This treatment can be offered to the patient as an alternative to endodontic therapy. The objective of this study is to review the literature related to the clinical outcome of coronal pulpotomy in permanent teeth with mature apex and having pulpal pathosis. This evidence-based review will facilitate clinical decision making in situations to choose coronal pulpotomy over root canal therapy in mature permanent teeth with irreversible pulpitis.

Survival Rates of Endodontically Treated Teeth After Placement of Definitive Coronal Restoration: 8-Year Retrospective Study.

INTRODUCTION: Preservation of endodontically treated teeth (ETT) depends upon several patient-related and operator-related factors. The objectives of this study were to assess the effects of different types of coronal restoration and delayed placement on ETT survival. METHODS: Data on dates of root canal treatment (RCT), restoration type, and extraction time of tooth, when applicable, were analyzed for all patients who underwent RCT from 2010 to 2018 at our institution. INCLUSION CRITERIA: Root canal-treated teeth with complete preoperative and postoperative radiographs; ETT that were restorable and received final permanent coronal restorations; no periodontal disease or crack detected during RCT; and ETT with acceptable RCT quality. EXCLUSION CRITERIA: Patients who did not attend for follow-up, those had incomplete information available about the coronal restoration, and those with periodontally compromised teeth were excluded. ETT that involved any procedural error were also excluded. The teeth were categorized according to whether they underwent definitive coronal restoration 0-14 days, 15-59 days, or 60+ days after RCT. The statistical analysis was performed using SPSS version 25 (IBM Corp., Armonk, NY). The rate of survival of ETT of 8 years was estimated, and the differences between groups were determined after applying Kaplan-Meier statistics and log-rank tests. A multivariate Cox regression test and Wilcoxon (Gehan) statistics were computed to analyze the influence of different variables. A P-value <0.05 was considered as statistically significant. RESULTS: The type of restoration, opposing dentition, presence of a post, and dentistry training (year 4 or 5 students) showed significant effects on the survival of ETT (P ≤ 0.000). ETT which received crowns was 2.05 times more likely to need extraction than those in which a composite buildup was performed (hazard ratio [HR] 2.05; confidence interval [CI] 1.84-2.29; P ≤ 0.000). All composite buildups were performed within 14 days of completion of RCT. There was a significant correlation between the time of placement of the final coronal restoration and ETT survival (P ≤ 0.000). Extraction of ETT was 25% more likely (HR 0.25; CI 0.231-0.277) when the final coronal restoration was placed 15-59 days after completion of RCT and 73% more likely (HR 0.73; CI 0.655-0.814) when placed after 60 days than when placed at 0-14 days. CONCLUSION: Timely placement of the final coronal restoration is found to be the most critical factor affecting the long-term survival of teeth after RCT.

Management of Acute Periodontal Abscess Mimicking Acute Apical Abscess in the Anterior Lingual Region: A Case Report.

Purulent infections of periodontal tissues are known as periodontal abscesses localized to the region of the involved tooth. Due to the high prevalence rate and aggressive symptoms, it is considered a dental emergency; urgent care is mandatory to maintain the overall health and well being of the patient. This case report describes the management of a patient who presented with an acute periodontal abscess secondary to poor oral hygiene. Clinically and radiographically, the lesion was mimicking an acute apical abscess secondary to pulpal necrosis. Periodontal treatment was started after completion of antibiotic therapy. The clinical presentation of the condition and results of the recovery, along with a brief review of relevant literature are discussed.

Limited Quality Evidence Suggests that Application of Cryotherapy May Be Helpful in Reducing Postoperative Pain in Root Canal Therapy in Patients With Symptomatic Apical Periodontitis.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Effects of Various Cryotherapy Applications on Postoperative Pain in Molar Teeth with Symptomatic Apical Periodontitis: A Preliminary Randomized Prospective Clinical Trial. Gundogdu EC, Arslan H. J Endod 2018:44(3):349-54. SOURCE OF FUNDING: Not mentioned. TYPE OF STUDY/DESIGN: Randomized controlled trial with parallel design.

Factors associated with postoperative pain in endodontic therapy.

OBJECTIVE: To assess postoperative pain in endodontic therapy and its association with clinical factors such as gender, age, tooth type, pulpal diagnosis, and preoperative pain, length of obturation and sealer extrusion. STUDY DESIGN: Cross-Sectional study. PLACE AND DURATION OF STUDY: Dental section of the Aga khan university hospital, Karachi, Pakistan from January to December 2009. METHODOLOGY: One hundred and forty patients (140) requiring endodontic therapy for molar and premolar teeth were included in this study. Local Anesthesia (2% Lidocain with 1:80,000 Epinephrine) was administered. The tooth was isolated with rubber dam. Access cavity was prepared with the help of round carbide No. 2 bur. Canal preparation was completed using crown-down technique. Access was sealed with sterile dry cotton pallet and restored temporarily with double layer of Glass ionomer cement and Cavit. After one week patients were recalled and access was re-opened, obturation was done using cold lateral condensation technique. Ca(OH)(2) based sealer was used. Postoperative radiographs were taken. Patients were recalled after 24 hours and postobturation pain was recorded using Visual analogue scale (VAS).Data was obtained on a structured Performa. χ(2) test was used for statistical analysis. RESULTS: Pain was present in 42.9% of patients. Females more frequently experienced pain (65%) than males (35%). Preoperative pain was found to be significantly associated with postoperative pain (p value < 0.001). Obturation length was not found to be significantly associated with postoperative pain (p value 1.0). Sealer extrusion was not found to be significantly associated with postoperative (P value 0.547).

Role of Brushing and Occlusal Forces in Non-Carious Cervical Lesions (NCCL).

OBJECTIVE: To assess the association of occlusal forces and brushing with non-carious cervical lesions (NCCL). METHODOLOGY: It was a Cross-sectional study. The study was conducted in Dental clinics, Department of Surgery, The Aga Khan University Hospital Karachi. The study duration was from 1(st) January 2009 to 28(th) Feb 2009. Ninety patients visiting dental clinic were examined clinically. Presence of Non- carious cervical lesions, broken restorations, fractured cusps, presence of occlusal facets, brushing habits, Para functional habits were assessed. All the relevant information and clinical examination were collected on a structured Performa and was analyzed using SPSS version 14.0. . Chi square χ(2) test was applied to assess association among different categorical variables. RESULT: Twenty three (26%) females and 67 (74%) males were included in the study. Thirty five of them (38.9%) were found to have Non-carious cervical lesions. Presence of NCCL has no association with gender (P value 0.458). A significant association was found between NCCL and teeth sensitivity (P value 0.002).The association between use of hard tooth brush and Non-carious cervical lesions was found significant (P value <0.001). However the association among Non-carious cervical lesions and fractured cups, broken restoration, teeth grinding, jaw clenching, pan chalia chewing and frequency of teeth brushing were insignificant. CONCLUSION: Hard tooth brushing and teeth sensitivity have significant association with Non-carious cervical lesions. The role of occlusal wear in the formation of NCCL is not significant.