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International Endodontic Journal Oct 2023To manage apical periodontitis in root filled maxillary and mandibular molars, root resection techniques may be employed to avoid the loss of the tooth. (Review)
Review
Effectiveness of root resection techniques compared with root canal retreatment or apical surgery for the treatment of apical periodontitis and tooth survival: A systematic review.
BACKGROUND
To manage apical periodontitis in root filled maxillary and mandibular molars, root resection techniques may be employed to avoid the loss of the tooth.
OBJECTIVES
The objectives of the study were to systematically analyse the effectiveness of root resection techniques (root resection/crown resection/root amputation) for the management of apical periodontitis with non-surgical root canal retreatment or apical surgery by the evaluation of clinical and patient-related outcomes (PROMS), in human experimental studies and longitudinal studies.
METHODS
An electronic literature search in PubMed, MEDLINE via OVID interface, EMBASE and Cochrane Central, supplemented by a manual hand search of the grey literature, was performed up to 25th September 2021. Randomized controlled trials, comparative clinical trials and observational studies reporting on the outcome (tooth survival and patient-reported outcome measures with a minimum follow-up of 1 year) of root resection techniques for treating apical periodontitis were identified. The risk of bias was evaluated using the Newcastle-Ottawa scale.
RESULTS
From a total of 2098 reports, 36 were considered for further screening. Three retrospective studies, published between 2018 and 2020, were included in this systematic review. A high heterogeneity in terms of protocols, study design and the reported outcomes were observed. The risk of bias was scored as low to moderate. These three studies consisted of data from 305 resected teeth, from 254 patients, with a follow-up period of 1-16.8 years. Overall, 151 teeth were extracted during the follow-up period. In these studies, root resection treatment was carried out on 42 teeth exclusively for endodontic reasons. One of these studies reported 12 out of 23 teeth lost at follow-up. None of the studies reported on PROMS.
DISCUSSION
Although root resection techniques may be used for treating teeth with apical periodontitis, the data are limited. Furthermore, the studies are very heterogeneous and associated with high risk of bias.
CONCLUSIONS
Given the current level of available evidence, it is not possible to recommend, or dismiss, root resection techniques for managing apical periodontitis.
REGISTRATION
PROSPERO database (CRD42021260306).
Topics: Humans; Dental Pulp Cavity; Retrospective Studies; Root Canal Therapy; Periapical Periodontitis; Retreatment
PubMed: 35920073
DOI: 10.1111/iej.13808 -
European Urology Oncology Dec 2023It is unclear whether a magnetic resonance imaging (MRI)-targeted transperineal (TP) biopsy can improve the detection of clinically significant prostate cancer (csPCa). (Meta-Analysis)
Meta-Analysis Review
Is There an Impact of Transperineal Versus Transrectal Magnetic Resonance Imaging-targeted Biopsy in Clinically Significant Prostate Cancer Detection Rate? A Systematic Review and Meta-analysis.
CONTEXT
It is unclear whether a magnetic resonance imaging (MRI)-targeted transperineal (TP) biopsy can improve the detection of clinically significant prostate cancer (csPCa).
OBJECTIVE
To compare the MRI-targeted TP and transrectal (TR) approaches for csPCa detection.
EVIDENCE ACQUISITION
A literature search was conducted using the PubMed/Medline, Embase, and Web of Science databases to identify reports published until February 2023. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to identify eligible studies. The primary outcome was the detection of csPCa (Gleason grade group ≥2). Sensitivity analyses were performed to investigate csPCa detection rates according to tumor location, Prostate Imaging Reporting and Data System (PI-RADS) score, and type of fusion (cognitive or software based).
EVIDENCE SYNTHESIS
Eleven studies met our inclusion criteria, and data from 3522 and 5140 patients who underwent, respectively, TR and TP MRI-targeted biopsies were reviewed. No statistically significant difference in the detection of csPCa was observed between the TR and TP approaches (odds ratio [OR] 1.11, 95% confidence interval [CI] 0.98-1.25; p = 0.1). When stratifying patients according to lesion location, the TP approach was associated with higher csPCa detection in case of anterior (OR 2.17, 95% CI 1.46-3.22; p < 0.001) and apical (OR 1.86, 95% CI 1.14-3.03; p = 0.01) lesions. In the subgroup analysis based on PI-RADS score, the TP approach was associated with higher csPCa detection (OR 1.57, 95% CI 1.07-2.29; p = 0.02) in PI-RADS 4 lesions. Conversely, no difference was found in PI-RADS 3 and 5 lesions (p > 0.05). The main limitation was the retrospective design of most included studies.
CONCLUSIONS
No significant association was found between the prostate biopsy approach and csPCa detection rate when we considered all biopsy indications. The TP approach provides a detection advantage in anterior and apical tumors, arguing for a preferred use of the TP approach in these lesion locations.
PATIENT SUMMARY
The transperineal magnetic resonance imaging-targeted prostate biopsy approach appears to be more effective only for selected lesions. No clear benefit was seen for the transperineal approach in the overall population.
Topics: Male; Humans; Prostatic Neoplasms; Prostate; Magnetic Resonance Imaging; Retrospective Studies; Biopsy
PubMed: 37634971
DOI: 10.1016/j.euo.2023.08.001 -
Journal of Clinical Medicine Sep 2023(1) Background: A Dynamic Navigation System (DNS) is an innovative tool that facilitates the management of complex endodontic cases. Despite the number of advantages and... (Review)
Review
(1) Background: A Dynamic Navigation System (DNS) is an innovative tool that facilitates the management of complex endodontic cases. Despite the number of advantages and limitations of this approach, there is no evidence-based information about its efficiency in comparison with that of the traditional method in endodontics. (2) Objectives: We aimed to explore any beneficial effects of the DNS and compare the outcomes of DNS vs. free-hand (FH) approaches for non-surgical and microsurgical endodontics. (3) Methods: A literature search was conducted in August 2023 to identify randomized, experimental, non-surgical, and microsurgical endodontic studies that compared the DNS with FH approaches. The procedural time (ΔT, s), substance loss (ΔV, mm), angular deviation (ΔAD, °), coronal/platform linear deviation (ΔLD_C, mm), and apical linear deviation (ΔLD_A, mm) were recorded and analyzed. Quality and risk of bias assessments were conducted according to the Quality Assessment Tool For In Vitro Studies. A meta-analysis was performed using mean difference and standard deviation for each outcome, and heterogeneity () was estimated. < 0.05 was considered significant. (4) Results: One-hundred and forty-six studies were identified following duplicate removal, and nine were included in the systematic review and meta-analysis. The overall risk of bias was classified as low. The DNS was found to be more accurate and efficient than the FH approach was, resulting in a significantly shorter operation time ( < 0.00001) and less angular ( ≤ 0.0001) and linear deviation ( ≤ 0.01). For substance loss, the advantage of the DNS was significant only for microsurgery ( = 0.65, and < 0.005, for non-surgical and microsurgical procedures, respectively). A reduced risk of iatrogenic failure using the DNS was observed for both expert and novice operators. (5) Conclusions: The DNS appears beneficial for non-surgical and microsurgical endodontics, regardless of the operator's experience. However, appropriate training and experience are necessary to access the full advantages offered by the DNS.
PubMed: 37762786
DOI: 10.3390/jcm12185845 -
International Endodontic Journal Oct 2023Apical periodontitis (AP) is a chronic inflammatory response of microbial aetiology. Pathological changes associated with AP may not be visible on radiographic images... (Review)
Review
BACKGROUND
Apical periodontitis (AP) is a chronic inflammatory response of microbial aetiology. Pathological changes associated with AP may not be visible on radiographic images and may linger without causing any symptoms. Clinicians rely mostly on clinical examination and imaging techniques to establish a diagnosis.
OBJECTIVES
The aim of this review was to answer the following question using the PICO format: In the adult human permanent dentition (P), what is the efficacy of diagnostic imaging of the periapical tissues (I) using histopathology as a reference standard (C) in the diagnosis of apical periodontitis, in terms of diagnostic accuracy (O).
METHODS
MEDLINE, EMBASE, Scopus and Cochrane Library were searched for English articles published through October 2021. At least two independent reviewers evaluated the study design, imaging modality used, histopathological assessment, outcome measures, results and conclusions for each article. The risk of bias was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies-2.
RESULTS
The initial search strategy identified 544 articles. Seven articles were included for analysis in the final review, all of which involved tissue samples obtained from cadavers. No clinical studies were identified that met the eligibility criteria. A consistently low sensitivity score and negative predictive value were reported for periapical radiography, especially in comparison to CBCT, which scored highly. Both modalities achieved high scores for specificity and positive predictive value. Diagnostic accuracy of CBCT was lower for root-filled teeth in comparison to non-root-filled teeth.
DISCUSSION
Assessment of the periapical tissues using periapical radiographs was shown to have a low to moderate agreement with the histopathological assessment. CBCT was reported to be more accurate than PR and demonstrated a good agreement with histopathology, especially for non-root-filled teeth.
CONCLUSIONS
This review identified a need for greater standardization in methodology and reporting, and as the findings are based on cadaver studies, their clinical relevance must be interpreted with caution.
REGISTRATION
PROSPERO (CRD42021272147).
Topics: Adult; Humans; Cone-Beam Computed Tomography; Periapical Periodontitis; Periapical Tissue; Cadaver; Reference Standards; Root Canal Therapy
PubMed: 37067066
DOI: 10.1111/iej.13921 -
Korean Journal of Orthodontics Jan 2024: This systematic review aimed to evaluate the correlation between vitamin D levels and the rate of tooth movement, external apical root resorption, bone biomarker...
OBJECTIVE
: This systematic review aimed to evaluate the correlation between vitamin D levels and the rate of tooth movement, external apical root resorption, bone biomarker expression, and bone remodeling.
METHODS
: Three databases (PubMed, Scopus, and Web of Science) were systematically searched from inception until 14th March 2023 to identify studies investigating the correlation between orthodontic tooth movement and vitamin D in animals and humans. The quality assessment was made in accordance with the Joanna Briggs Institute Critical Appraisal Checklist.
RESULTS
: Overall, 519 records were identified, and 19 were selected for the qualitative synthesis. Eleven studies investigated the effect of local administration (injections in the periodontal ligament, to the gingiva distal to the teeth, or submucosae palatal area) and systemic administration (oral supplementation) of vitamin D on tooth movement, external apical root movement, pro-inflammatory cytokines, and bone remodeling factors. The remaining eight studies investigated the correlation between serum vitamin D levels and salivary vitamin D levels on bone turnover markers and tooth movement.
CONCLUSIONS
: The findings of this systematic review support that vitamin D3 local injections might increase the rate of tooth movement via the receptor activator of the nuclear factor-kB/osteoprotegerin axis. However, the non-uniform study designs and the different protocols and outcome methods make it challenging to draw reliable conclusions.
PubMed: 38268460
DOI: 10.4041/kjod23.064 -
Polish Journal of Radiology 2023We aimed to conduct a systematic review and meta-analysis of studies examining the performance of cone-beam computed tomography (CBCT) imaging in apical periodontitis... (Review)
Review
PURPOSE
We aimed to conduct a systematic review and meta-analysis of studies examining the performance of cone-beam computed tomography (CBCT) imaging in apical periodontitis (AP) prediction. This was done to address the contradictory results reported in the existing literature on this topic.
MATERIAL AND METHODS
We searched the Embase, PubMed, Cochrane library, and Scopus databases for literature published from inception to 30 June 2023 without language restriction using appropriate keywords. We included studies that reported the diagnostic accuracy values of CBCT in AP detection among humans by comparing AP diagnosis with a control group without lesions. We pooled the diagnostic accuracy values using a random effects model and presented the estimates as percentage and 95% confidence interval (CI). The heterogeneity between the surveys was explored by statistic.
RESULTS
Out of 301 citations initially identified, a total of 8 eligible studies were finally included. According to the analyses, the overall pooled sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) estimated for CBCT were 94.6% (95% CI: 90.2-97.1; = 55.9%, = 0.026), 91.2% (95% CI: 81.7-96.0; = 81.6%, < 0.001), 93.0% (95% CI: 87.4-96.2; = 56.5%, = 0.024), and 92.3% (95% CI: 82.3-96.8; = 86.4%, < 0.001), respectively. The overall pooled sensitivity, specificity, PPV, and NPV of digital radiography were 61.0% (95% CI: 38.3-79.8; = 94.4%, < 0.001), 97.3% (95% CI: 85.6-99.5; = 86.7%, < 0.001), 98.3% (95% CI: 92.0-99.6; = 74.4%, = 0.002), and 41.6% (95% CI: 28.0-56.6; = 89.5%, < 0.001), respectively.
CONCLUSIONS
CBCT imaging has excellent diagnostic accuracy in AP prediction. Also, CBCT has better discriminant test performance for AP than digital radiography.
PubMed: 38362018
DOI: 10.5114/pjr.2023.134035 -
ESC Heart Failure Jun 2024Takotsubo syndrome (TTS) is a rare complication of vaccination. In this study, we sought to provide insight into the characteristics of reported TTS induced by...
AIMS
Takotsubo syndrome (TTS) is a rare complication of vaccination. In this study, we sought to provide insight into the characteristics of reported TTS induced by vaccination.
METHODS AND RESULTS
We did a systematic review, searching PubMed, Embase, Web of Science, Ovid MEDLINE, Journals@Ovid, and Scopus databases up to 26 April 2023 to identify case reports or case series of vaccine-induced TTS. We then extracted and summarized the data from these reports. Eighteen reports were identified, with a total of 19 patients with TTS associated with vaccinations. Of the 19 included patients, the majority were female (n = 13, 68.4%) with a mean age of 56.6 ± 21.9 years. Seventeen patients developed TTS after coronavirus disease 2019 vaccination, 14 of whom received an mRNA vaccination. Two cases of TTS occurred after influenza vaccination. Among the 19 patients, 17 (89.5%) completed transthoracic echocardiography and 16 (84.2%) underwent angiography procedures. Seven patients (36.8%) completed cardiac magnetic resonance imaging. The median time to symptom onset was 2 (inter-quartile range, 1-4) days. The most common symptoms were chest pain (68.4%), dyspnoea (57.9%), and digestive symptoms (31.6%). A total of 57.9% of patients developed nonspecific symptoms such as fatigue, myalgia, diaphoresis, and fever. Among the 16 reported cases of TTS, 15 patients (93.8%) exhibited elevated cardiac troponin levels, while among the nine reported cases, eight patients (88.9%) had elevated natriuretic peptide levels. All patients had electrocardiographic changes: ST-segment change (47.1%), T-wave inversion (58.8%), and prolonged corrected QT interval (35.3%). The most common TTS type was apical ballooning (88.2%). Treatment during hospitalization typically included beta-blockers (44.4%), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (33.3%), and diuretics (22.2%). After treatment, 81.3% of patients were discharged with improved symptoms. Among this group, nine patients (56.3%) were reported to have recovered ventricular wall motion during follow-up. Two patients (12.5%) died following vaccination without resuscitation attempts.
CONCLUSIONS
TTS is a rare but potentially life-threatening complication of vaccination. Typical TTS symptoms such as chest pain and dyspnoea should be considered alarming symptoms, though nonspecific symptoms are common. The risks of such rare adverse events should be balanced against the risks of infection.
Topics: Humans; Takotsubo Cardiomyopathy; COVID-19 Vaccines; COVID-19; Vaccination; SARS-CoV-2; Echocardiography
PubMed: 38344896
DOI: 10.1002/ehf2.14719 -
BMC Oral Health Mar 2024This systematic review explores the accuracy of computerized guided implant placement including computer-aided static, dynamic, and robot-assisted surgery. An electronic... (Meta-Analysis)
Meta-Analysis
This systematic review explores the accuracy of computerized guided implant placement including computer-aided static, dynamic, and robot-assisted surgery. An electronic search up to February 28, 2023, was conducted using the PubMed, Embase, and Scopus databases using the search terms "surgery", "computer-assisted", "dynamic computer-assisted", "robotic surgical procedures", and "dental implants". The outcome variables were discrepancies including the implant's 3D-coronal, -apical and -angular deviations. Articles were selectively retrieved according to the inclusion and exclusion criteria, and the data were quantitatively meta-analysed to verify the study outcomes. Sixty-seven articles were finally identified and included for analysis. The accuracy comparison revealed an overall mean deviation at the entry point of 1.11 mm (95% CI: 1.02-1.19), and 1.40 mm (95% CI: 1.31-1.49) at the apex, and the angulation was 3.51˚ (95% CI: 3.27-3.75). Amongst computerized guided implant placements, the robotic system tended to show the lowest deviation (0.81 mm in coronal deviation, 0.77 mm in apical deviation, and 1.71˚ in angular deviation). No significant differences were found between the arch type and flap operation in cases of dynamic navigation. The fully-guided protocol demonstrated a significantly higher level of accuracy compared to the pilot-guided protocol, but did not show any significant difference when compared to the partially guided protocol. The use of computerized technology clinically affirms that operators can accurately place implants in three directions. Several studies agree that a fully guided protocol is the gold standard in clinical practice.
Topics: Humans; Robotic Surgical Procedures; Surgery, Computer-Assisted; Dental Implantation, Endosseous; Dental Implants; Computers; Computer-Aided Design; Cone-Beam Computed Tomography; Imaging, Three-Dimensional
PubMed: 38509530
DOI: 10.1186/s12903-024-04033-y -
Australian Endodontic Journal : the... Aug 2023The aim of this systematic scoping review is to explore the literature on root fenestration prevalence and its possible etiologic, aggravating and predisposing clinical... (Review)
Review
The aim of this systematic scoping review is to explore the literature on root fenestration prevalence and its possible etiologic, aggravating and predisposing clinical factors. A systematic search was conducted in 5 electronic databases, by two independent reviewers, without any language and date restrictions. Forty-six full-text records were included in the study, out of which 27 were used for prevalence analysis and 42 for clinical factor analysis. The results suggest that the literature is heterogenous, with major differences in the study protocols and results' presentation, providing limited information regarding root fenestration prevalence and possible racial distribution patterns. Further documentation is also required regarding clinical parameters that may affect root fenestration's presence and severity. Despite their few limitations, retrospective cone beam computed tomography studies with high-resolution protocols, as well as open flap studies for direct observation of possible root fenestration sites, seem the most reliable methods to better comprehend its presence and possible distribution patterns.
Topics: Alveolar Process; Prevalence; Retrospective Studies; Cone-Beam Computed Tomography; Otologic Surgical Procedures
PubMed: 35852910
DOI: 10.1111/aej.12647 -
International Endodontic Journal Mar 2024Several studies have suggested a relationship between AP, as well as the loss of root-filled teeth (RFT), and hypertension (HTN). (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Several studies have suggested a relationship between AP, as well as the loss of root-filled teeth (RFT), and hypertension (HTN).
OBJECTIVES
The aims of this systematic review and meta-analysis were to investigate the prevalence of AP, and non-retention of RFT, in hypertensive patients.
METHODS
A search was performed in PubMed/MEDLINE, Web of Science, Scopus and EMBASE. The inclusion criteria established were studies published until February 2023, comparing hypertensive subjects with controls, assessing the prevalence of AP and/or providing data on the prevalence of non-retained RFT. Meta-analysis was performed using the RevMan (analyst) tool to determine the pooled prevalence of AP and loss of RFT. Risk of bias was assessed using the Cochrane Risk-of-Bias tool. The quality of evidence was assessed by GRADE.
RESULTS
The search strategy identified 454 articles, and only eight met the inclusion criteria. Six studies had analysed the association between AP and HTN and two studies had analysed the association between non-retention of RFT and HTN. Meta-analysis showed and overall OR = 1.71 (95% CI = 0.92-3.16; p = .09) for the prevalence of AP among patients with HTN. The prevalence of non-retention of RFT among patients with HTN has an overall OR = 1.78 (95% CI = 1.60-1.98; p = .000001). The risk of bias in the individual studies was low or moderate, and the quality of the overall evidence has shown a level of certainty very low.
DISCUSSION
There is no association between the prevalence of AP and HTN. In addition, hypertensive patients have significantly increased odds of losing RFT. Given the high prevalence of hypertension, it is very common to perform root canal treatments on hypertensive patients. It is imperative to communicate this heightened risk to patients and recommend periodic monitoring of oral health and hypertension, paying special attention to this subset of patients.
REGISTRATION
PROSPERO CRD42022302385.
Topics: Humans; Prevalence; Periapical Periodontitis; Root Canal Therapy; Dental Care; Hypertension
PubMed: 38051279
DOI: 10.1111/iej.14007