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Journal of Conservative Dentistry and... 2023This systematic review investigates the crucial need for solvent use in root canal retreatment, as it effectively removes filling materials, reduces apical debris... (Review)
Review
INTRODUCTION
This systematic review investigates the crucial need for solvent use in root canal retreatment, as it effectively removes filling materials, reduces apical debris extrusion, and alleviates postoperative pain, ultimately enhancing treatment success. The review aims to assess the success rates, compare outcomes, explore benefits and drawbacks, and identify subgroups where solvent use may be more effective during root canal retreatment.
MATERIALS AND METHODS
The search was performed in PubMed Central, Scopus, Cochrane, LILAC, ScienceDirect, Google Search, Web of Science, and manually using the search items alone and in combination by means of PUBMED search builder. The studies were assessed for eligibility according to the eligibility criteria by two independent reviewers. Groups containing solvent with nonsolvent groups and randomized control trials were included and in vitro studies, retrospective studies, and animal studies were excluded from the study. Quality assessment was performed using the risk of bias (RoB) 2.0 tool.
RESULTS
Out of the 596 articles obtained, 14 were shortlisted for full-text reading and finally two articles were included in the study. The studies were assessed for quality, and data were extracted in a tabulated form. Overall RoB is low, but due to the lack of homogeneity, meta-analysis could not be conducted.
CONCLUSION
The use of solvent does not cause any significant difference in the postoperative pain levels or analgesic intake for retrieval of gutta-percha in cases of root canal retreatment. Due to the limited number of studies available and the lack of clinician-related outcomes such as time taken to retrieve the gutta-percha, these results should be taken into consideration with caution.
PubMed: 38292751
DOI: 10.4103/JCDE.JCDE_86_23 -
International Endodontic Journal Apr 2024Microorganisms colonizing the apical root canal system are conceivably the ones directly involved with the causation and maintenance of apical periodontitis. (Review)
Review
BACKGROUND
Microorganisms colonizing the apical root canal system are conceivably the ones directly involved with the causation and maintenance of apical periodontitis.
OBJECTIVES
This article systematically reviews the reports on the microbiome occurring exclusively at the apical root canal of teeth with primary and posttreatment apical periodontitis.
METHODS
The electronic databases PubMed, Embase, Web of Science, Science Direct, and Proquest were searched up to August 2023. Clinical studies using culture and molecular microbiology methods to identify the microbial taxa present exclusively in the apical root canal segment of infected teeth with apical periodontitis were included. Studies were critically assessed using the Joanna Briggs Institute Critical Prevalence Assessment Checklist.
RESULTS
From 2277 articles initially detected, 52 were selected for full reading and 21 were eventually included in this review. Of these, molecular methods were used in 19 and culture in 2 studies. Ten studies evaluated primary infections, 8 evaluated posttreatment infections, and 3 included both. Cryopulverization of the apical root specimens was conducted in 11 studies. All studies evaluated the prevalence and diversity of bacteria, and only one also reported on fungi. Overall, the most frequent/abundant bacterial taxa found in the apical canal of primary infections were Pseudoramibacter alactolyticus, Olsenella uli, Fusobacterium species, Streptococcus species, Porphyromonas endodontalis, Prevotella species, Actinomyces species, Parvimonas micra, Treponema denticola, Synergistetes species, and an as-yet uncharacterized taxon. In posttreatment infections, the most prevalent/abundant bacterial taxa included species of Streptococcus, Enterococcus, Fusobacterium, Actinomyces, Pseudoramibacter, Pseudomonas, and Propionibacterium. At the phylum level, Firmicutes was the most represented. The average apical bacterial load ranged from 10 to 10 in primary infections and from 10 to 10 in posttreatment infections.
DISCUSSION
Microbial diversity in the apical part of the root canal system was examined encompassing data from both primary and posttreatment infections. Heterogeneity amongst the studies, especially in sample collection and microbial identification methods, is an important limitation that prevented a meta-analysis.
CONCLUSIONS
There is a pronounced bacterial diversity in the infected apical canal, with a high interindividual variability. Different microbiome compositions at the species/genus level are observed according to the infection type.
REGISTRATION
PROSPERO CRD42021275886.
PubMed: 38634795
DOI: 10.1111/iej.14071 -
Medicine Aug 2023Small incision lenticule extraction (SMILE) and femtosecond laser in situ keratomileusis (FS-LASIK) have been extensively studied as the main surgical methods for... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Small incision lenticule extraction (SMILE) and femtosecond laser in situ keratomileusis (FS-LASIK) have been extensively studied as the main surgical methods for corneal refractive surgery. However, there is no consensus on whether SMILE is superior to FS-LASIK in corneal biomechanics. Therefore, this systematic review and meta-analysis used the results of ocular response analyzer and corvis ST to explore whether SMILE is superior to FS-LASIK in corneal biomechanics.
METHODS
The literature was searched in PubMed, EMBASE, and Controlled Trials Register databases. The Cochrane Collaboration's "risk of bias" tool was used to evaluate the quality of the included randomized clinical trials, and the Newcastle-Ottawa Scale was used to evaluate the included non-randomized controlled trials. The results were analyzed using Revman 5.3.
RESULTS
Sixteen studies (3 randomized clinical trials and 13 non-randomized controlled trials) were included in this meta-analysis. There was no statistical difference in corneal biomechanics between SMILE and FS-LASIK in corneal hysteresis [mean difference (MD), 0.20; 95% confidence interval (CI): -0.09, 0.49; P = .18] and corneal resistant factor (MD, 0.31; 95% CI: -0.09, 0.71; P = .13), A1 time (MD, -0.02; 95% CI: -0.11, 0.07; P = .66), A1 length (MD, 0.01; 95% CI: -0.01, 0.03; P = .42), A1 velocity (MD, 0.00; 95% CI: -0.01, 0.01; P = .85), A2 velocity (MD, -0.01; 95% CI: -0.11, 0.09; P = .86), HC time (MD, 0.12; 95% CI: -0.13, 0.38; P = .35), The stiffness parameter at first applanation (MD, -7.91; 95% CI: -17.96, 2.14; P = .12), The ratio between the deformation amplitude 2 mm away from apex and the apical deformation (MD, 0.01; 95% CI: -0.26, 0.27; P = .96).
CONCLUSION
A comprehensive assessment of the parameters of ocular response analyzer and corvis ST showed that SMILE is not superior to LASIK in corneal biomechanics 3 months post-surgery.
Topics: Humans; Keratomileusis, Laser In Situ; Biomechanical Phenomena; Myopia; Cornea; Prospective Studies; Surgical Wound; Corneal Stroma
PubMed: 37565903
DOI: 10.1097/MD.0000000000034580 -
International Endodontic Journal Oct 2023Sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) and/or calcium hydroxide (Ca(OH) ) are commonly used during root canal treatment. Evaluation of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) and/or calcium hydroxide (Ca(OH) ) are commonly used during root canal treatment. Evaluation of their effectiveness regarding clinical and patient-related outcomes requires further understanding.
OBJECTIVES
To assess the effectiveness of root canal irrigation and dressing for the treatment of teeth with apical periodontitis (AP).
METHODS
A search was conducted in the PubMed-MEDLINE, Scopus, EMBASE, Google scholar databases and available repositories, followed by hand searches, until July 2021. Eligibility criteria followed the a priori formulated Population, Intervention, Comparator, Outcomes, Timing, and Study design (PICOTS) framework. Clinical studies restricted to English language were included. The revised Cochrane risk-of-bias tool for randomised trials (RoB 2) was used to assess the quality of included studies. Meta-analyses were performed using the fixed-effect model to obtain Risk Ratio (RR) and 95% Confidence Interval (CI), with sensitivity analysis. Overall quality of evidence of meta-analyses was assessed through the Grading of Recommendations Assessment, Development, and Evaluation tool.
RESULTS
The search identified 1357 records of which six fulfilled the inclusion criteria, providing data for 'irrigation' from 212 teeth and for 'dressings' from 438 teeth. Two studies reported no significant difference regarding the outcome 'pain at 7 days' using 2% chlorhexidine vs. 5.25% NaOCl and EDTA or after using different concentrations of NaOCl (1% vs. 5%). No significant difference was detected between different NaOCl concentrations regarding the reduction of AP. A meta-analysis was possible for the comparison of single-visit (SV) versus multiple-visits including the use of Ca(OH) demonstrating a significant effect in favour of SV (RR: 1.10; 95% CI: 1.03-1.19; p = .007; I = 0). RoB of included studies was moderate to low.
DISCUSSION
The use of Ca(OH) for the treatment of AP may not be beneficial. There is scarce or no evidence fulfilling the proposed PICOTS regarding irrigants and dressings.
CONCLUSIONS
There is moderate certainty that SV treatment is associated with better radiographic evidence of normal periodontal ligament space (strict criteria) compared with the use of Ca(OH) Reduction of AP is comparable after irrigation with 1% and 5% NaOCl, whereas postoperative pain at 7 days for the irrigants assessed is similar.
REGISTRATION
PROSPERO database CRD42021260271.
Topics: Humans; Dental Pulp Cavity; Edetic Acid; Root Canal Therapy; Periapical Periodontitis; Bandages; Root Canal Irrigants
PubMed: 35579074
DOI: 10.1111/iej.13777 -
The Journal of Prosthetic Dentistry May 2024The gingival zenith (GZ) influences the line angle position in the emergence profile and the axial inclination of the crown. Irregularities in GZ symmetry and contour... (Review)
Review
STATEMENT OF PROBLEM
The gingival zenith (GZ) influences the line angle position in the emergence profile and the axial inclination of the crown. Irregularities in GZ symmetry and contour have a negative impact on dental esthetics. GZ location is not consistently distal to the crown's long axis; instead, it tends to be more distal in anterior teeth. The GZ levelling of the lateral incisor is often described as either level with or slightly above the zenith line connecting the central incisor and canine teeth, but there are also reports of GZ being aligned apically to the zenith line. Controversial reports persist regarding GZ positioning, magnitude, and location, potentially leading to inadequate positioning and levelling of the GZ in esthetic restorative therapy.
PURPOSE
The purpose of this systematic review and meta-analysis was to assess the scientific evidence related to GZ level, position, and symmetry in maxillary incisors and canines.
MATERIAL AND METHODS
This study adhered to the population, variable, outcome (PVO) criteria and the preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist. Cross-sectional studies involving healthy adults with complete dentition of the maxillary anterior sextant were subjected to prevalence analysis and quantitative measurement to assess the gingival zenith level and position. Data were extracted, and methodological quality was appraised using the Joanna Briggs Institute critical appraisal checklist for analytical cross-sectional studies. Certainty of evidence was evaluated through the grading of recommendations, assessment, development, and evaluation (GRADE) system.
RESULTS
The GZs were distally positioned, coinciding with the tooth axis or mesially positioned in, respectively, 96%, 3%, and 1% on central incisors; 84%, 14%, and 1% on lateral incisors; and 43%, 44%, and 5% on canines. GZ distal positioning was greater in central incisors, followed by lateral incisors and canines. In lateral incisors, the GZ was levelled coronally in 82% of the population. Contralateral symmetry was observed for GZ levelling and positioning. The certainty of the evidence was very low for all comparisons.
CONCLUSIONS
The frequency and magnitude of the distal position of the GZ increased the more anterior the tooth. Axially, the GZ was frequently levelled coronally to the zenith line. The contralateral positioning and levelling of the GZ was symmetrical.
PubMed: 38704322
DOI: 10.1016/j.prosdent.2024.03.031 -
The Journal of Prosthetic Dentistry Nov 2023Digital technology can improve the success of zygomatic implant (ZI) surgery. However, the reliability and efficacy of computer-assisted zygomatic implant surgery... (Review)
Review
STATEMENT OF PROBLEM
Digital technology can improve the success of zygomatic implant (ZI) surgery. However, the reliability and efficacy of computer-assisted zygomatic implant surgery (CAZIS) need further analysis.
PURPOSE
The purpose of this scoping review was to provide an overview of the placement accuracy, implant survival, and complications of CAZIS.
MATERIAL AND METHODS
A systematic search of English and Mandarin Chinese publications up to May 2023 was conducted in PubMed, Web of Science, Embase, and Wanfang database. The nonpeer-reviewed literature was searched in the trial register (clinicaltrials.gov). Clinical studies and cadaver studies on CAZIS were included. After data extraction and collection, the findings were critically reviewed, analyzed, interpreted, and discussed.
RESULTS
Forty-one studies met the inclusion criteria. After excluding publications with duplicate data, retaining the most recent, 28 articles were included in this scoping review. Of these, 18 were on static computer-assisted zygomatic implant surgery (sCAZIS), 8 on dynamic computer-assisted zygomatic implant surgery (dCAZIS), and 2 on robot-assisted zygomatic implant surgery (rAZIS). Excluding the outliers, the mean deviations of ZIs in the sCAZIS group (with 8 articles reporting implant placement accuracy, 183 ZIs involved) were: 1.15 ±1.37 mm (coronal deviation), 2.29 ±1.95 mm (apical deviation), and 3.32 ±3.36 degrees (angular deviation). The mean deviations of dCAZIS (3 articles, 251 ZIs) were: 1.60 ±0.74 mm (coronal), 2.27 ±1.05 mm (apical), and 2.89 ±1.69 degrees (angular). The mean deviations of rAZIS (2 articles, 5 ZIs) were: 0.82 ±0.21 mm (coronal), 1.25 ±0.52 mm (apical), and 1.46 ±0.35 degrees (angular). Among the CAZIS reported in the literature, the implant survival rate was high (96.3% for sCAZIS, 98.2% for dCAZIS, and 100% for rAZIS, specified in 14 of 21 clinical studies). The incidence of complications was low, but, because of the few relevant studies (4/21 specified), valid conclusions regarding complications could not be drawn.
CONCLUSIONS
CAZIS has demonstrated clinical efficacy with high implant survival rates and placement accuracy. Of the 3 guided approaches, rAZIS showed the smallest 3-dimensional deviation.
PubMed: 38007293
DOI: 10.1016/j.prosdent.2023.10.032 -
Journal of Endodontics Mar 2024The aim of this systematic review was to assess the existing literature and examine whether or not the size of apical enlargement during mechanical preparation... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The aim of this systematic review was to assess the existing literature and examine whether or not the size of apical enlargement during mechanical preparation affects the outcome of treatment in patients undergoing nonsurgical root canal therapy (NSRCT).
METHODS
MEDLINE (PubMed), Embase, Cochrane Library, and gray literature were searched (January 2000-May 2023). Study selection and data extraction were performed in duplicate. Eligible studies were critically appraised for risk of bias and quality of evidence and were meta-analyzed to estimate the treatment effects.
RESULTS
Two studies were included in the meta-analysis. The overall pooled success rate was 75.8%. The success rates of treatment with an apical size ≥ 30 and < 30 were 80.9% and 52.9%, respectively. Cases with an apical size ≥ 30 demonstrated significantly more favorable results (RR = 0.63, 95% Confidence Interval 0.46-0.79, P < .05). The overall quality of evidence was low.
CONCLUSIONS
With a low certainty of evidence, master apical preparation size ≥ 30 may result in an increased healing outcome in terms of clinical and radiographic evaluations.
Topics: Humans; Root Canal Therapy
PubMed: 38135112
DOI: 10.1016/j.joen.2023.11.007 -
Cureus Dec 2023Frequently, adolescents exhibit instances of immature necrotic teeth, which are identifiable by their slender root walls and unclosed root tips. The lack of a natural... (Review)
Review
Frequently, adolescents exhibit instances of immature necrotic teeth, which are identifiable by their slender root walls and unclosed root tips. The lack of a natural narrowing near the root's end creates difficulty when using standard endodontic procedures, making the effective sealing of the immature root canal difficult or impractical. Revascularization therapy surfaces as a prospective strategy for addressing the management of undeveloped, non-vital, immature, necrotic teeth. Notwithstanding this, apexification continues to hold prominence in the preferences of clinicians owing to its perceived predictability in treatment outcomes. A systematic investigation was conducted involving various search engines and databases, covering the period from 2001 to 2023. The main aim of this investigation was to find randomized clinical trials that compared the efficacy of revascularization therapy to apexification for treating immature necrotic teeth. The evaluation included a thorough examination of both clinical and radiographic outcomes assessing the success rates and complications. Out of the 850 identified articles, 15 studies were chosen for comprehensive analysis. Notable dissimilarities were not identified between the revascularization therapy and apexification groups concerning parameters such as rates of periapical healing, overall effectiveness/invalidation, and apical closure. However, concentrating on measurable factors, it became clear that the revascularization treatment group displayed a notable rise in root length compared to the apexification group. Both revascularization endodontic therapy and apexification demonstrated effectiveness in addressing periapical periodontitis healing and open apex closure. Pulp revascularization stood out for its notable efficacy in enhancing root elongation and thickening, all while having a reduced likelihood of treatment being deemed ineffective overall.
PubMed: 38292962
DOI: 10.7759/cureus.51364 -
Medicina (Kaunas, Lithuania) Dec 2023: The present systematic review and meta-analysis undertake a comparison of studies that examine the accuracy of robot-assisted dental implant placement in relation to... (Meta-Analysis)
Meta-Analysis Review
Accuracy Comparison between Robot-Assisted Dental Implant Placement and Static/Dynamic Computer-Assisted Implant Surgery: A Systematic Review and Meta-Analysis of In Vitro Studies.
: The present systematic review and meta-analysis undertake a comparison of studies that examine the accuracy of robot-assisted dental implant placement in relation to static computer-assisted implant surgery (SCAIS), dynamic computer-assisted implant surgery (DCAIS), and freehand procedures. This study aims to provide a comprehensive understanding of the precision of robot-assisted dental implant placement and its comparative efficacy in relation to other placement techniques. : The guidelines recommended by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used to organize and compose this review. Four electronic databases (PubMed, Web of Science, Scopus, and Cochrane) were systematically searched for pertinent articles. Articles were selected following the inclusion and exclusion criteria. Qualitative and quantitative analyses of the selected articles were performed. : The initial electronic search resulted in 1087 hits. Based on the inclusion and exclusion criteria, five articles were selected for qualitative analysis, out of which three were considered for quantitative analysis. Three parameters were considered for accuracy evaluation (angular, coronal, and apical deviation). The mean angular deviation was -1.22 degrees (95% CI, -1.06--1.39), the mean coronal deviation was -0.15 mm (95% CI, -0.24--0.07), and the mean apical deviation was -0.19 mm (95% CI, -0.27--0.10). : The robotic implant system was found to have significantly lower angular deviations and insignificantly lower coronal and apical deviations compared to DCAIS. Within the limitations of this review, it can be concluded that robot-assisted implant placement in resin models permits higher accuracy compared to DCAIS and SCAIS systems. However, due to the limited number of comparative studies with high heterogeneity, the findings of this review should be interpreted with caution. Further research is necessary to confirm the clinical application of robotics in implant surgery.
Topics: Humans; Dental Implants; Robotics; Surgery, Computer-Assisted; Research Design; Computers; Imaging, Three-Dimensional
PubMed: 38276045
DOI: 10.3390/medicina60010011 -
Journal of Endodontics Jun 2024This systematic review and meta-analysis aimed to evaluate the clinical and radiographic failure of nonsurgical endodontic treatment and retreatment for mature permanent... (Meta-Analysis)
Meta-Analysis Review
Clinical and Radiographic Failure of Nonsurgical Endodontic Treatment and Retreatment Using Single-cone Technique With Calcium Silicate-based Sealers: A Systematic Review and Meta-analysis.
INTRODUCTION
This systematic review and meta-analysis aimed to evaluate the clinical and radiographic failure of nonsurgical endodontic treatment and retreatment for mature permanent teeth with or without apical periodontitis using the single-cone (SC) obturation technique with calcium silicate-based bio-ceramic (CSBC) sealers and to compare these failure rates to other sealer materials and obturation techniques.
METHODS
A comprehensive search was conducted using MEDLINE (PubMed), Embase, Cochrane Library, Scopus, Web of Science, and gray literature up to March 2023. Two reviewers assessed the eligibility of the included studies. Eligible studies were critically appraised for risk of bias and quality of evidence. Subsequently, a meta-analysis of pooled data was conducted utilizing the RevMan software (P < .05) to evaluate the failure rate of non-surgical root canal therapy using CSBC sealers and SC obturation procedures. Separately, another analysis was conducted to compare those results with the outcome of nonsurgical root canal therapy using alternative obturation materials and methods.
RESULTS
Five studies were included. The pooled failure rate for nonsurgical endodontic treatment and retreatment combined using CSBC sealers and SC obturation technique was 6.8% [95% confidence interval (CI) = (3%-12%), I = 46%]. A second analysis was conducted on the 3 included clinical trials to compare the outcomes of the intervention (CSBC sealers and SC obturation technique) and control groups (other sealers and other obturation techniques). This analysis found no significant difference between the 2 groups regarding clinical and radiographic failure of endodontic treatment and retreatment [Risk ratio = 0.71, 95% CI = (0.33, 1.51), I = 0]. This difference was also not statistically significant when the failure rate of primary root canal treatment and retreatment were separately analyzed [Combined Risk ratio of primary root canal treatment = 0.94, 95% CI = (0.46, 1.93), I = 0%; Combined Risk ratio of retreatment = 0.21, 95% CI = (0.001, 75.46), I = 0%].
CONCLUSIONS
The overall results of this systematic review and meta-analysis demonstrate that the SC obturation technique with CSBC sealer provides similar results compared to other obturation materials and techniques in facilitating the healing of apical periodontitis.
Topics: Humans; Calcium Compounds; Dental Restoration Failure; Periapical Periodontitis; Retreatment; Root Canal Filling Materials; Root Canal Obturation; Root Canal Therapy; Silicates; Treatment Failure
PubMed: 38548045
DOI: 10.1016/j.joen.2024.03.007