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Oral Diseases May 2024This scoping review aims to provide an overview of the research and potential applications of carbon dots (CDs) for oral health purposes. (Review)
Review
OBJECTIVES
This scoping review aims to provide an overview of the research and potential applications of carbon dots (CDs) for oral health purposes.
DESIGN
Systematic literature searches were performed on PubMed and Web of Science databases (up to February 2023). Two co-authors selected the published works independently and extracted the data in accordance with the PRISMA statement. Studies with the application of CDs for oral health purposes were included.
RESULTS
Among 152 articles, 19 articles were finally selected. Eight studies investigated the anti-microbial effects of CDs against, for example, oral pathogens, eight studies explored the applicability of CDs in relation to oral cancer, and three studies investigated CDs in relation to cell differentiation and tissue regeneration in oral health. The studies showed the promising potential of CDs in oral health, particularly for inducing bacterial killing by increasing reactive oxygen species, killing oral cancer cells via photodynamic therapeutic effects, and inducing dental pulp and periodontal bone regeneration.
CONCLUSION
The findings show that CDs have the potential to be utilized in the future for various oral health purposes. Besides, these results underline the broad-spectrum applicability of CDs, crossing the borders of oral health.
Topics: Humans; Carbon; Oral Health; Mouth Neoplasms; Quantum Dots; Dental Pulp; Photochemotherapy; Bone Regeneration
PubMed: 37530494
DOI: 10.1111/odi.14702 -
Journal of Endodontics Apr 2024The development of dedicated coils and new magnetic resonance imaging (MRI) sequences has led to an increase in image resolution and a reduction in artifacts.... (Review)
Review
INTRODUCTION
The development of dedicated coils and new magnetic resonance imaging (MRI) sequences has led to an increase in image resolution and a reduction in artifacts. Consequently, numerous studies have demonstrated the utility of MRI as a nonionizing alternative to cone-beam computed tomographic imaging. The aim of this systematic review was to evaluate the accuracy of MRI in clinical applications in endodontics.
METHODS
A literature search was conducted using PubMed, Embase, Scopus, and Web of Science. The inclusion criteria encompassed studies evaluating MRI applications in endodontics, covering tooth and root canal anatomy, root canal working length, pulp vitality and regeneration, the effect of caries on dental pulp, guided endodontics, periapical lesions, and root cracks/fractures. The selected studies examined both ex vivo and in vivo human teeth using clinical MRI units. Two researchers independently screened the studies, applied the eligibility criteria, and assessed the potential risk of bias using the revised QUADAS-2 tool (Bristol Medical School, University of Bristol, UK).
RESULTS
A total of 18 studies were included in this systematic review, demonstrating that the use of MRI has a high diagnostic value in endodontics. In the evaluation of tooth and root canal anatomy, pulp vitality and regeneration, the effect of caries on dental pulp, periapical lesions, and root cracks/fractures, MRI's accuracy is comparable to or even higher than reference standards such as cone-beam computed tomographic imaging, micro-computed tomographic imaging, and histology.
CONCLUSIONS
MRI has high potential accuracy for diagnosing various clinical endodontic tasks, except for root canal length, size of caries, and periapical lesion dimensions, which are overestimated in MRI.
Topics: Humans; Dental Pulp Cavity; Root Canal Therapy; Endodontics; Dental Caries; Magnetic Resonance Imaging; Cone-Beam Computed Tomography
PubMed: 38290691
DOI: 10.1016/j.joen.2024.01.014 -
Journal of Endodontics Nov 2023The controversial issue of whether the Archaea domain plays a role in endodontic infections is the focus of this systematic review with meta-analysis. The aim is to... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The controversial issue of whether the Archaea domain plays a role in endodontic infections is the focus of this systematic review with meta-analysis. The aim is to emphasize the significance of minority microbial domains in oral dysbiosis by evaluating the prevalence of archaea in root canals and its association with clinical parameters such as symptomatology and type of endodontic infection.
METHODS
The search strategy involved researching 6 databases and the gray literature. Publications were accepted in any year or language that identified archaea in samples from endodontic canals. A 2-step selection process narrowed the final choice to 16 articles. The methodological quality of the studies was evaluated using tools from the Joanna Briggs Institute, and the certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.
RESULTS
The results showed that archaea were present in 20% (95% [confidence interval] CI = 8%-32%) of individuals with endodontic samples analyzed. The samples were about twice as likely to be archaeal-positive if collected from individuals with primary vs. persistent/secondary infection (odds ratio = 2.33; 95% CI = 1.31-4.14; I = 0%), or individuals with self-reported vs. symptom-free infections (odds ratio = 2.67; 95% CI = 1.47-4.85; I = 0%). Methanogenic archaea were reported in 66% of the included studies. Representative members of phyla Thaumarchaeota and Crenarchaeota were also identified.
CONCLUSIONS
Archaea are present in about one-fifth of the infected root canals. Recognized biases in experimental approaches for researching archaea must be addressed to understand the prevalence and roles of archaea in endodontic infections, and to determine whether the decontamination process should include the elimination or neutralization of archaea from root canals (International Prospective Register of Systematic Reviews protocol = CRD42021264308).
Topics: Humans; Archaea; Dental Pulp Cavity; Dental Pulp Diseases; Dysbiosis
PubMed: 37544428
DOI: 10.1016/j.joen.2023.07.025 -
European Journal of Dentistry Nov 2023Recent evidence suggests the immense potential of human mesenchymal stem cell (hMSC) secretome conditioned medium-mediated augmentation of angiogenesis. However,...
Recent evidence suggests the immense potential of human mesenchymal stem cell (hMSC) secretome conditioned medium-mediated augmentation of angiogenesis. However, angiogenesis potential varies from source and origin. The hMSCs derived from the oral cavity share an exceptional quality due to their origin from a hypoxic environment. Our systematic review aimed to compare the mesenchymal stem cells (MSCs) derived from various oral cavity sources and cell-derived secretomes, and evaluate their angiogenic potential. A literature search was conducted using PubMed and Scopus from January 2000 to September 2020. Source-wise outcomes were systematically analyzed using , , and studies, emphasizing endothelial cell migration, tube formation, and blood vessel formation. Ninety-four studies were included in the systematic review, out of which 4 studies were subsequently included in the meta-analysis. Prominent growth factors and other bioactive components implicated in improving angiogenesis were included in the respective studies. The findings suggest that oral tissues are a rich source of hMSCs. The meta-analysis revealed a positive correlation between dental pulp-derived MSCs (DPMSCs) and stem cells derived from apical papilla (SCAP) compared to human umbilical cord-derived endothelial cell lines as a control. It shows a statistically significant positive correlation between the co-culture of human umbilical vein endothelial cells (HUVECs) and DPMSCs with tubule length formation and total branching points. Our meta-analysis revealed that oral-derived MSCs (dental pulp stem cells and SCAP) carry a better angiogenic potential than endothelial cell lines alone. The reviewed literature illustrates that oral cavity-derived MSCs (OC-MSCs) increased angiogenesis. The present literature reveals a dearth of investigations involving sources other than dental pulp. Even though OC-MSCs have revealed more significant potential than other MSCs, more comprehensive, target-oriented interinstitutional prospective studies are warranted to determine whether oral cavity-derived stem cells are the most excellent sources of significant angiogenic potential.
PubMed: 37995732
DOI: 10.1055/s-0043-1776315 -
Odontology Oct 2023The aim of this systematic review and meta-analysis (SRM) was to assess postoperative pain (PP) after endodontic treatment with bioceramic root canal sealer compared to... (Meta-Analysis)
Meta-Analysis Review
The aim of this systematic review and meta-analysis (SRM) was to assess postoperative pain (PP) after endodontic treatment with bioceramic root canal sealer compared to AH Plus® sealer. This SRM was carried out in accordance with the items on the PRISMA 2020 checklist and Cochrane guidelines and registered in PROSPERO (CRD42021259283). Only randomized clinical trials (RCTs) were included. Meta-analysis was conducted using R software, the standardized means difference (SMD) measure of effect was calculated for quantitative variables, and the odds ratio (OR) for binary variables. The Cochrane tool (RoB 2.0) was used to assess the risk of bias, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence. Qualitative and quantitative analysis included 18 and 17 studies, respectively. For quantitative variables, the bioceramic root canal sealer presented less occurrence of postoperative pain than the AH Plus® sealer in 24 h (SMD - 0.17 [- 0.34; - 0.01], p = 0.0340). For binary variables, there was no difference observed between the sealers evaluated, except for sealer extrusion where the bioceramic group had lower post-filling material extrusion (OR 0.52 [0.32; 0.84], p = 0.007). Regarding the risk of bias analysis, low risk was observed for most domains, except allocation that was considered unclear, while the certainty of evidence ranged from moderate to low. The results showed that bioceramics sealers reduced postoperative endodontic pain only after 24 h and showed less sealer extrusion compared to the AH Plus® sealer. However, more robust and standardized clinical trials are needed to confirm the results with less heterogeneity and higher quality of evidence.
Topics: Humans; Root Canal Filling Materials; Epoxy Resins; Dental Pulp Cavity; Randomized Controlled Trials as Topic; Root Canal Obturation; Pain, Postoperative
PubMed: 37378833
DOI: 10.1007/s10266-023-00830-z -
International Endodontic Journal Oct 2023Regenerative endodontics has evolved in recent years with tissue engineering concepts in particular appearing promising. Endodontic tissue engineering (ETE) describes... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Regenerative endodontics has evolved in recent years with tissue engineering concepts in particular appearing promising. Endodontic tissue engineering (ETE) describes the various approaches based on the orthograde introduction of scaffolds or biomaterials (with or without cells) into the root canal to achieve pulp tissue regeneration. There are currently no systematic reviews investigating whether ETE is a suitable method for the treatment of endodontic disease in both mature and immature permanent teeth.
OBJECTIVES
The purpose of this systematic review was to determine the effectiveness of ETE in permanent teeth with pulp necrosis in comparison with conventional endodontic treatment.
METHODS
We searched MEDLINE, Embase and the Cochrane Library for published reports as well as Google Scholar for grey literature up to November 2021. Included were studies of patients with permanent immature or mature teeth and pulp necrosis with or without signs of apical periodontitis (P) comparing ETE (I) with calcium hydroxide apexification, apical plug and root canal treatment (C) in terms of tooth survival, pain, tenderness, swelling, need for medication (analgesics and antibiotics), radiographic evidence of reduction in apical lesion size, radiographic evidence of normal periodontal ligament space, function (fracture and restoration longevity), the need for further intervention, adverse effects (including exacerbation, restoration integrity, allergy and discolouration), oral health-related quality of life (OHRQoL), presence of sinus tract and response to sensibility testing (O). An observation period of at least 12 months was mandatory (T) and the number of patients in human experimental studies or longitudinal observational studies had to be at least 20 (10 in each arm) at the end (S). Risk of bias was appraised using the Cochrane risk-of-bias (RoB 2) tool. Two authors independently screened the records, assessed full texts for eligibility and evaluated risk of bias. Heterogeneity of outcomes and limited body of evidence did not allow for meta-analysis.
RESULTS
Two randomized clinical trials investigating cell transplantation approaches with a total of 76 participants (40 treated immature teeth and 36 treated mature teeth) were included for qualitative analysis. Both studies had moderate concerns in terms of risk of bias. Due to the lack of homogeneity a meta-analysis was not possible. Tooth survival for ETE, root canal treatment and apexification was 100% after 12 months. Teeth treated with ETE showed a higher number of cases with positive pulpal responses to sensitivity tests and with blood perfusion compared with root canal treatment or apexification.
DISCUSSION
This systematic review highlights that there is limited evidence for ETE approaches. Even though the results of this review suggest a high survival with ETE in mature and immature teeth, there is a moderate risk of bias due to methodological limitations in the included studies, so the overall results should be interpreted with caution. Lack of a robust control group was a common problem during literature screening, and outcomes besides dental survival were reported inconsistently. Future clinical trials need to address methodical as well as assessment concerns and report long-term results.
CONCLUSION
The benefits and high survival rates reported for ETE techniques suggest that this procedure might be an alternative to conventional procedures for permanent teeth with pulpal necrosis. However, more appropriate studies are needed to derive clinical recommendations.
REGISTRATION
PROSPERO (CRD42021266350).
Topics: Humans; Tissue Engineering; Dental Pulp Necrosis; Quality of Life; Periapical Periodontitis; Anti-Bacterial Agents; Root Canal Therapy
PubMed: 35699668
DOI: 10.1111/iej.13784 -
Dental Traumatology : Official... Jul 2023Variability in the outcome measures used to assess the success of tooth autotransplantation presents challenges for combining data to examine the success of the...
BACKGROUND/AIM
Variability in the outcome measures used to assess the success of tooth autotransplantation presents challenges for combining data to examine the success of the technique. Reaching agreement on the most important outcomes will enable routine procedural and follow-up data to be collected in a standardised way. In turn this will promote greater data synthesis to evaluate outcomes and examine which procedural techniques influence outcome. The aim of this study was to identify which prognostic factors and outcomes are most important to clinicians with experience in autotransplantation of developing teeth.
METHODS
The Delphi method was used to build consensus on the most important prognostic factors and outcomes. Item identification involved a systematic literature review and review of current clinical datasets in use. A two-round Delphi questionnaire was undertaken with clinicians providing tooth autotransplantation, followed by a consensus meeting to finalise the most important items.
RESULTS
Outcomes and prognostic factors were identified from the systematic review (82 studies and eight reviews), one guideline and three existing clinical datasets. Patient interviews and a clinician survey added a number of items that would not have been identified from the literature only. A total of 56 outcomes and 93 prognostic factors were included for rating in the Delphi questionnaire. The Delphi questionnaire was completed by 15 respondents in round one and 13 respondents in round two. The consensus meeting was attended by nine participants. The final items that were judged to be most important included 29 outcomes (25 clinical, three patient-reported and one service delivery) and 49 prognostic factors (18 patient characteristics, four presurgical, 17 surgical and 10 postsurgical). Clinical outcomes were consistently rated higher than patient-reported outcomes.
CONCLUSIONS
The clinical outcomes rated as the most important were transplant survival and reason for failure, outcomes relating to pulp health, different types of resorption and evidence of infection (suppuration). Important patient-reported outcomes were satisfaction with overall treatment experience, and outcome and quality of life related to function of the transplanted tooth. Procedural information rated as being the most important related to the donor tooth: stage of root development, method for surgical removal and storage and condition of the donor tooth root surface following removal.
Topics: Humans; Prognosis; Transplantation, Autologous; Quality of Life; Tooth; Tooth Root
PubMed: 36965034
DOI: 10.1111/edt.12843 -
International Endodontic Journal Oct 2023The exposed pulp has been the topic of numerous studies, but well-designed and well-executed comparative trials on the outcome and treatment of these teeth have been... (Review)
Review
BACKGROUND
The exposed pulp has been the topic of numerous studies, but well-designed and well-executed comparative trials on the outcome and treatment of these teeth have been limited.
OBJECTIVES
This study was conducted to answer the following questions: in patients with nontraumatic pulpitis associated with no or nonspontaneous pain in permanent teeth, (i) is direct pulp capping or pulpotomy (partial/full) as effective as selective or stepwise caries removal [Population/participants, Intervention(s), Comparator(s)/control, Outcome(s) (PICO) 1], (ii) is pulpotomy (partial/full) as effective as direct pulp capping (PICO 2) and (iii) is pulpotomy (partial/full) as effective as a pulpectomy (PICO 3), in terms of a combination of patient and clinical reported outcomes, with 'tooth survival' as the most critical outcome?
METHODS
A literature search was conducted using Clarivate Analytics' Web of Science, Scopus, PubMed and Cochrane Central Register of Controlled Trials from inception to November 3rd 2021. Grey literature and contents of the major subject journals were examined. Eligibility criteria followed the PICO questions. Two independent reviewers performed study selection, data extraction and appraisal; disagreements were resolved by a third reviewer. The risk of bias was assessed by the revised Cochrane risk-of-bias tool for randomized trials.
RESULTS
Three randomized clinical trials (RCTs) were included in the review. No study fulfilled the criteria to answer PICO 1. There were no significant differences in the reported outcomes between investigated treatments in all included RCTs. None of the included studies reported the most critical outcome 'tooth survival'. A high loss of patients during the follow-up period was observed.
DISCUSSION
Although a few studies fulfilled strict eligible criteria, the results of this systematic review clearly highlight a paucity of available evidence. At the present time, clinical decisions cannot be substantiated by direct comparative trials.
CONCLUSIONS
Based on limited evidence, this systematic review discovered no significant differences in effectiveness between compared vital pulp treatments in managing nontraumatic pulpitis associated with no or nonspontaneous pain. Further high-quality RCTs are necessary to investigate the effectiveness of direct pulp capping or pulpotomy (partial/full) compared to selective or stepwise caries removal.
REGISTRATION
PROSPERO database (CRD42021259742).
Topics: Humans; Pulpitis; Dental Caries; Dental Pulp; Pulpotomy; Root Canal Therapy; Dental Pulp Capping; Treatment Outcome
PubMed: 35579062
DOI: 10.1111/iej.13776 -
Dental Traumatology : Official... Apr 2024This systematic review aimed to evaluate the evidence related to the occurrence of pulp necrosis and related complications in permanent anterior teeth with lateral... (Review)
Review
This systematic review aimed to evaluate the evidence related to the occurrence of pulp necrosis and related complications in permanent anterior teeth with lateral luxation. It was envisaged to address the ambiguity related to the recommendation for pulp extirpation in teeth with mature root apex. An a priori protocol was formulated as per the best practices of evidence-based medicine and registered in PROSPERO. A comprehensive search was performed electronically in PubMed, LILACS, Web of Science, EMBASE, Scopus, and Cochrane on July 10,2023 without any restriction of language or year of publication. The screening of titles and abstracts and later the full-text articles were performed. Later, the data extraction was performed by using a self-designed sheet, risk of bias (ROB) assessment was done, meta-analysis was performed, and the GRADE approach was used to assess the quality of evidence. The qualitative synthesis was performed on 13 studies done from 1985 to 2020 in hospital settings. There was variability in the minimum and total observation periods, sample sizes, and characteristics of the sample population. The overall pooled prevalence of pulp necrosis was found to be 57% (95% CI: 42, 72%). It was 12% (95% CI: 8%, 18%, I = 0%) in immature teeth, and 58% (95% CI: 42, 73%, I = 86%) in mature teeth. The pooled prevalence of EIRR was found to be 11% (95% CI: 4, 27%, I = 95%) with greater risk in teeth with mature root apex (RR: 1.26, 95% CI: 1.12, 1.42, I = 0%). The ROB was moderate or high in nine studies and the GRADE of evidence was very low in 14 of 15 outcomes. There are greater chances of pulp necrosis in teeth with lateral luxation, especially with mature apex. However, it can still be less than 60% in most cases with the prevalence of EIRR less than 20%. Hence, an absolute recommendation for endodontic intervention in mature teeth with lateral luxation must be interpreted with slight caution.
PubMed: 38576393
DOI: 10.1111/edt.12956 -
International Endodontic Journal Oct 2023Pulpitis characterized by spontaneous pain can result in debilitating pain. Dogma has existed to offer only have two treatment options, namely root canal treatment (RCT)... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pulpitis characterized by spontaneous pain can result in debilitating pain. Dogma has existed to offer only have two treatment options, namely root canal treatment (RCT) or extraction, although pulpotomy has always remained a potential treatment modality.
OBJECTIVE
This review aimed to answer the following research question: 'Does pulpotomy (partial or full) (I) result in better patient and clinical reported outcomes (O), compared with RCT (C) in permanent teeth with pulpitis characterized by spontaneous pain (P) evaluated at various time intervals?' (T).
METHODS
Two authors independently performed study selection, data extraction and risk of bias assessment. The literature search was conducted in the following electronic databases: Clarivate Analytics' Web of Science, Scopus, PubMed and Cochrane Central Register of Controlled Trials. English language clinical trials comparing the patient and clinical reported outcomes between RCT and pulpotomy were included. The meta-analysis was performed on a fixed-effect model and the quality of evidence assessed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.
RESULTS
Two randomized clinical trials were included. Amongst two trials, one has published four reports at different time points involving the same cohorts. The meta-analysis revealed no difference in postoperative pain (Day 7) between RCT and pulpotomy (OR = 0.99, 95% CI 0.63-1.55, I = 0%) and quality of evidence was graded as 'High'. Clinical success was high at year 1, 98% for both interventions, however, decreased over time to 78.1% (pulpotomy) and 75.3% (RCT) at 5 years.
DISCUSSION
Pulpotomy is a definitive treatment modality that is as effective as RCT. This could have a significant impact on treatment of such patients affording the advantages of retaining a vital pulp and preventing the need for RCT.
CONCLUSION
This review could only include two trials, hence there is insufficient evidence to draw robust conclusions. The clinical data accumulated so far suggests no difference in pain between RCT and pulpotomy at Day 7 postoperatively and a single randomized control trial suggests that the clinical success rate for both treatment modalities is similar long term. There is a need for more well-designed trials by different research groups to develop a stronger evidence base in this area.
REGISTRATION
PROSPERO database (CRD42021259744).
Topics: Humans; Pulpotomy; Pulpitis; Dental Pulp Cavity; Root Canal Therapy; Pain, Postoperative; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 36209498
DOI: 10.1111/iej.13844