Cone-beam computed tomography-based descriptive classification for transverse root fracture.

Transverse root fracture (TRF) is classified as a cervical, middle or apical third root fracture on a periapical radiograph. The International Association of Dental Traumatology (IADT) suggests that cone-beam computed tomography (CBCT) should be considered, when conventional radiographs provide 'insufficient' information for diagnosis and treatment planning. Considering that CBCT can divulge additional information, it would be beneficial to have a clinically pertinent three-dimensional classification for TRF. The proposed alphanumeric classification includes the traumatised tooth number, describes the number of TRF, the facial and lingual location of each fracture line on the anatomic root, and its position relative to the crest of the alveolar bone. Further, diastasis, displacement of the coronal fragment and status of the alveolar bone at the site of TRF are also documented. This comprehensive classification system would provide a standard format for reporting, aid in referral communication and can be applied for future outcome studies on TRF.

Analytical Methods for Triamcinolone Acetonide: An Exploratory Literature Review.

An artificial glucocorticoid with anti-inflammatory and immunosuppressive properties is triamcinolone acetonide. It is abundantly used to treat redness, itching, and many other skin conditions like itching and psoriasis. As a result, there are several different triamcinolone acetonide formulations available. Each of these formulations must go through the correct phases of development and validation in order to identify the medications and other additives for safer use. This review article is just a representation of all the methods reported for the development and validation of triamcinolone acetonide in pure form to break down contaminants, in addition to other medications, and even in biological samples. The International Council for Harmonization (ICH) technical requirements for human use suggestions, which include a number of analytical parameters, have been followed in the validation of all the procedures. The present study also clarified the most significant drug combination.

Outcome and associated predictors for nonsurgical management of large cyst-like periapical lesions: A CBCT-based prospective cohort study.

AIM: The aim of this cone-beam computed tomography (CBCT)-based study was to evaluate the outcome of nonsurgical root canal treatment (RCT) performed for the management of large cyst-like periapical lesions (LCPL) and to identify the predictive factors affecting healing. METHODOLOGY: Fifty-four subjects (77 permanent maxillary anterior teeth) with LCPL (>10 mm) of endodontic origin were included. A single operator performed standardized multi-visit RCT. Patients were clinically and radiographically examined at 6, 12 months, and a CBCT scan was taken at 24 months. Two independent blinded evaluators measured the pre- and postoperative volume of periapical lesions on CBCT scans using ITK snap software (version 3.8.0-beta-20181028-win64). The outcome was assessed as a percentage change in lesion volume and dichotomized as success (resolved/reduced) or failure (unchanged/enlarged). Ten preoperative (gender; age; intraoral draining sinus, soft tissue swelling, tooth discoloration, pulp canal obliteration, open apex, root resorption, cortical bone defect and lesion volume) and four intraoperative (apical extent and density of root filling; number of treatment visits and type of root filling) predictive factors were observed. Bivariate and stepwise multivariable linear regression analysis was performed to identify independent predictors affecting treatment outcomes. The significance level was set at 5%. RESULTS: A recall rate of 88% was achieved. The success rate of RCT was 82.2% (8.9% resolved, 73.3% reduced). Median lesion volume reduction was 75% (IQR 61%-93%). No pre- or intra-operative factors were related to treatment failure. However, presence of preoperative cortical bone defect (palatal versus no cortical defect, ß = -51.5; 95% CI: -86.9 to -16, p = .006) and apical extent of obturation (long versus flush, ß = -27.2; 95% CI: -53.8 to -0.6, p = .04) were negatively associated with reduction in lesion volume (%). CONCLUSION: Large cyst-like periapical lesions may be successfully managed with RCT. Preoperative cortical bone defect and apical extent of obturation may negatively influence osseous healing.

Quality and accuracy of patient-oriented Web-based information regarding tooth avulsion.

BACKGROUND/AIM: Tooth avulsion (TA) is a severe form of traumatic dental injury. The tooth's prognosis depends on the immediate measures taken. First responders are often laypeople, and the Internet is a favored platform to access health-related information. The aim of this descriptive study was to evaluate the accuracy, quality, readability, and popularity of patient-oriented web information regarding the emergency management of TA. METHODS: Three search engines (Google, Bing, and Yahoo.com) were browsed with six VPNs using "knocked out tooth," "fallen out tooth," and "tooth avulsion" as keywords. The top 20 results for each were evaluated. Webpages were included if they had information oriented to caregivers. They were analyzed for accuracy (cutoff ≥95%). Quality of web pages was assessed using DISCERN and the Journal of the American Medical Association (JAMA) benchmark. Readability was evaluated using Flesch-Kincaid Grade Level (FKGL), Gunning Fog (FOG), Coleman-Liau Index (CLI), and Simple Measure of Gobbledygook (SMOG). Popularity was assessed by Alexa Popularity Rank (APR). Accurate and inaccurate webpages were compared using chi-square analysis and the Mann-Whitney U test. Spearman's correlation between the studied metrics was established. A p < .05 was considered significant. RESULTS: Seventy-two webpages were included, of which 23 (32%) were accurate. The median DISCERN ratings for accurate and inaccurate webpages were 3.0 [2.5-3.0] and 3.0 [2.0-3.0], respectively (p = .331). Ten (44%) accurate and 12 (24.5%) inaccurate webpages had high-quality JAMA (p = .089). The median readability scores for accurate webpages were FKGL (8 [6.75-9.2]), FOG (10.6 [9.55-12.3]), CLI (7 [6-7]), SMOG (6.7 [6.15-7.5]), while scores for the inaccurate webpages were FKGL (7.85 [6.275-8.525]), FOG (10.55 [8.875-11.425]), CLI (7 [7-8.25]), and SMOG (7 [6.2-7.925]), with a higher CLI score for inaccurate webpages (p = .0035). The median APRs for accurate and inaccurate webpages were 1,02,538 [26,852-14,43,755] and 7,63,190 [2,19,799-29,92,067], respectively (p = .163). Accuracy had a positive correlation with quality (DISCERN: rho = .293, p = .013; JAMA: rho = .249, p = .036), while popularity (APR) was negatively correlated with quality (DISCERN: rho = -.330, p = .013; JAMA: rho = -.287, p = .032). CONCLUSION: Relevant webpages were limited and had low accuracy. This can impact the emergency management by laypeople and adversely affect the prognosis following avulsion.

Treatment outcome of regenerative endodontic procedures in mature permanent teeth compared to nonsurgical endodontic treatment: A systematic review and meta-analysis.

Background: Regenerative endodontic procedures (REP) have the advantage of restoring root canal's native defense ability by re-establishing vital pulp-like tissue. This review aims to determine the overall clinical and/or radiographic success rate (O) of REP (I) in mature permanent teeth (P) and to compare it (C) with nonsurgical endodontic treatment (NSET). Materials and Methods: Sources: PubMed, Web of Science, Embase, EBSCO, Cochrane Central Register of Controlled trials, ClinicalTrials.gov, Clinical Trials Registry-India and OpenGrey. Inclusion: Randomized clinical trials and single-arm prospective studies evaluating the treatment outcomes of REP in mature permanent teeth. Exclusion: Incomplete trials/studies, in vitro studies, animal studies, case reports/series, conference proceedings. Cochrane ROB2.0 and ROBINS-I tools were used to assess the risk of bias. Risk difference (R.D.) between NSET and REP was determined by meta-analysis of the randomized clinical trials. The overall success rate of REP was calculated using data from both randomized clinical trials and single-arm prospective studies. Sensitivity analysis and subgroup analysis were performed. Results: Ten studies (n = 552) were included. R.D between REP and NSET was 0.032 (95% C.I: 0.023-0.087; P = 0.258). Overall success rate of REP was 96.0% (95% confidence interval: 94%-98%). No significant difference was found in sensitivity analysis (P = 0.551), or any of the subgroup analysis (P > 0.05). Discussion: A limited number of randomized clinical trials were available, and only two of them had a low risk of bias. Consistent results were obtained in both types of included studies. Conclusion: Based on a limited number of comparative studies, REP has a similar success rate to NSET in mature permanent teeth. Other: Funding: Nil. Registration: PROSPERO (CRD42020204882).

India's contribution to regenerative endodontics: A bibliometric analysis.

Regenerative endodontics (RE) is a dynamic field with widespread global impact. The aim of this bibliometric analysis is to highlight India's contribution in the field. Electronic search was performed in PubMed and Web of Science database till December 2019 using the search terms "Dental pulp regeneration," "Pulp revascularisation," "Revitalisation," "Regenerative endodontic," and their permutation. Articles of Indian authors with affiliation to Indian institutes were included. The following data were extracted: first author, institute and state of affiliation, year and journal of publication, study design, level of evidence (LOE), and number of citations. A total of 76 articles (case reports [n = 29, 38.15%], review [n = 25, 32.8%]) were published between 2008 and 2019. Majority (42.6%) were categorized as LOE 4. 7.4% articles were in LOE1 category. Eight percent articles had citations above 100 (highest cited-354 citations). The average yearly growth rate between 2011 and 2019 was 33.28% and highest number of publications was in the year 2015. The south zone had the maximum publications. At an institutional level, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, had the maximum publications. Journal of Conservative Dentistry published the highest number of articles. India contributed 7.6% of the global PubMed indexed publications and reported 22% of clinical trials. This analysis reveals increasing trend of research in RE in India. However, it highlights the need to generate articles with higher LOE by conducting quality multicenter trials and promote national and international collaborations.

Comparative evaluation of the accuracy of two electronic apex locators in determining the working length in teeth with simulated apical root resorption: An in vitro study.

INTRODUCTION: Accurate determination of working length (WL) is a critical factor for endodontic success. This is commonly achieved using an apex locator which is influenced by the presence or absence of the apical constriction. Hence, this study was done to compare the accuracy of two generations of apex locators in teeth with simulated apical root resorption. MATERIALS AND METHODS: Forty maxillary central incisors were selected and after access preparation, were embedded in an alginate mold. On achieving partial set, teeth were removed, and a 45° oblique cut was made at the apex. The teeth were replanted and stabilized in the mold, and WL was determined using two generations of apex locators (Raypex 5 and Apex NRG XFR). Actual length of teeth (control) was determined by visual method. STATISTICAL ANALYSIS: Results were subjected to statistical analysis using the paired t-test. RESULTS: Raypex 5 and Apex NRG was accurate for only 33.75% and 23.75% of samples, respectively. However, with ±0.5 mm acceptance limit, they showed an average accuracy of 56.2% and 57.5%, respectively. There was no significant difference in the accuracy between the two apex locators. CONCLUSION: Neither of the two apex locators were 100% accurate in determining the WL.