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Cureus Aug 2023Objective To explore perceptions of undergraduate dental students regarding difficulties faced during endodontic procedures. Methods An e-questionnaire was sent to 57...
Objective To explore perceptions of undergraduate dental students regarding difficulties faced during endodontic procedures. Methods An e-questionnaire was sent to 57 fourth-year and 45 fifth-year dental students. It comprised questions regarding demographic data and difficulties faced during different steps of the endodontic treatment. The responses were recorded on a 5-point Likert scale. During dichotomization, responses where one and two were chosen were considered yes whereas responses where three, four, and five were chosen were considered no. The sample size (SS) calculated using the Qualtrics SS calculator was 89. Data were analyzed using SPSS version 20. Frequencies and percentages were calculated. A p-value of less than 0.05 was considered significant. The chi-square test was applied for comparison based on the students' academic year and genders. Results Ninety students responded with an 88.2% response rate. Most students reported not facing any difficulty in differentiating healthy pulp and periapex from conditions of pulp pathosis (78.9%) and periapical pathosis (75.6%). Most males found access opening and de-roofing of the pulp chamber (35.6%) and working length determination (31.1%) difficult. Females reported having difficulty mostly in mesial and distal shift radiograph techniques (55.6%) and access openings (51.1%). No statistical difference was found based on an academic year or gender except in the use of mesial and distal shift techniques for radiograph acquisition Conclusion Assessing difficulties encountered by students during endodontic therapy can aid in the development of teaching strategies for preclinical and clinical instruction. Mesial and distal shift techniques, access cavity preparation, and working length determination are areas requiring more focus in the training process.
PubMed: 37692626
DOI: 10.7759/cureus.43215 -
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 -
Dental Materials : Official Publication... Dec 2023The aims of this study were to systematically review the literature and compare the relative effects of various luting agents on bonding between glass-fiber posts and... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The aims of this study were to systematically review the literature and compare the relative effects of various luting agents on bonding between glass-fiber posts and root canal dentin in short- and long-term aging conditions.
DATA/SOURCES
The literature was electronically searched in PubMed, Embase, and Scopus. A manual search was performed by scanning the reference lists of the included studies.
STUDY SELECTION
Two reviewers independently conducted the selection of studies, data extraction, and risk of bias assessment. Pairwise meta-analyses were based on random effect models. Network meta-analyses were conducted within a frequentist framework with a multivariable random effects approach. The standardized mean difference and 95% confidence interval was calculated.
RESULTS
One hundred and eighteen studies were included and assessed the effects of five luting agents. For pairwise meta-analyses, in short-term aging conditions, a significantly higher bond strength of self-adhesive resin cement (SARC) compared to etch-and-rinse adhesive composite resin core material (ERCM) in the total, coronal, and middle regions. In long-term aging conditions, a significantly higher bond strength of ERCM compared to etch-and-rinse adhesive resin cement (ERRC) in all regions. Furthermore, SARC showed a significantly higher bond strength compared to self-etch adhesive composite resin core material (SECM) in the total, middle, and apical regions. For network meta-analyses, in the apical region, a significantly higher bond strength of SARC compared to ERRC in both aging conditions.
CONCLUSIONS
The SARC tended to be the most effective luting agent in bonding between glass-fiber posts and root canal dentin in short- and long-term aging conditions.
Topics: Dental Cements; Resin Cements; Dental Bonding; Network Meta-Analysis; Dental Pulp Cavity; Composite Resins; Post and Core Technique; Dentin; Materials Testing; Dentin-Bonding Agents; Glass
PubMed: 37845166
DOI: 10.1016/j.dental.2023.10.015 -
Journal of Endodontics Jan 2024Nonsurgical endodontic teeth treatment with severe pulp canal obliteration poses challenges, primarily locating canals. By combining 3-dimensional reconstruction and...
Nonsurgical endodontic teeth treatment with severe pulp canal obliteration poses challenges, primarily locating canals. By combining 3-dimensional reconstruction and spatial location registration, the dynamic navigation technique uses an optical tracking system to guide the clinician to drill in real time according to the predesigned path until access to the canal is established. Several in vitro studies and case reports have shown that calcified canal location with dynamic navigation system (DNS) is more accurate and efficient, yet the technique has limitations. In 4 cases with 7 teeth, this work presents manipulation process and clinical outcomes of DNS helping in calcified canal location. We performed handpiece adaptation and elucidated the failure to locate the canals with DNS in 2 teeth, resulting in canal geometry alteration and canal path deviation. Subsequently, the more experienced endodontist located the canals by combining cone-beam computed tomographic imaging and dental operating microscopy. All patients were completely asymptomatic after treatment. At the 1-year follow-up visit, the bone healing of periapical lesions progressed well according to the periapical radiography or cone-beam computed tomographic imaging. These findings indicate that DNS is a promising technique for locating calcified canals; however, it needs to be refined before clinical use.
Topics: Humans; Dental Pulp Cavity; Cone-Beam Computed Tomography; Molar; Dental Care; Root Canal Therapy
PubMed: 37890613
DOI: 10.1016/j.joen.2023.10.010 -
Journal of the American Dental... Feb 2024This systematic review aimed to investigate whether vital pulp therapy and root canal treatment (RCT) promote different postoperative pain. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This systematic review aimed to investigate whether vital pulp therapy and root canal treatment (RCT) promote different postoperative pain.
STUDIES REVIEWED
The authors searched PubMed, Cochrane Library, Embase, and Latin American and Caribbean Health Sciences Literature databases for studies published through June 30, 2022. The authors included randomized clinical trials if they reported on the assessment of postoperative pain after direct pulp capping, partial pulpotomy, pulpotomy, or single-visit RCT. The authors assessed the frequency of no, mild, moderate, and severe postoperative pain. They conducted meta-analyses to compare postoperative pain after full pulpotomy (PULP) and RCT.
RESULTS
The qualitative synthesis included 57 studies, and the authors conducted meta-analysis of 3. PULP leads to more asymptomatic cases (relative risk [RR], 1.06; 95% CI, 1.01 to 1.11; P < .01; I = 67%) and to a lower occurrence of mild (RR, 0.89; 95% CI, 0.79 to 0.99; P < .04; I = 37%) and moderate (RR, 0.70; 95% CI, 0.51 to 0.95; P < .02; I = 57%) postoperative pain than RCT. The frequency of severe pain was very low for both vital pulp therapy and RCT. Moderate to severe postoperative pain was more common at 48 hours through 72 hours after RCT and up to 36 hours after PULP. Pain intensity after PULP was higher using calcium-enriched material compared with using mineral trioxide aggregate at 12, 18, and 36 hours (P < .001).
PRACTICAL IMPLICATIONS
PULP showed a significantly higher incidence of no pain and a lower incidence of mild and moderate pain than single-visit RCT. Clinical decisions for RCT or PULP should not be based on differences in postoperative pain. When analgesia is indicated, it probably should be limited to a short time after PULP.
Topics: Humans; Dental Pulp Cavity; Root Canal Therapy; Dental Care; Pulpotomy; Pain, Postoperative
PubMed: 38325970
DOI: 10.1016/j.adaj.2023.11.008 -
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 -
Clinical and Experimental Dental... Dec 2023This bibliometric analysis aimed to evaluate the leading nations, authors, journals, institutes, highly cited publications, and most commonly used keywords concerning... (Review)
Review
OBJECTIVES
This bibliometric analysis aimed to evaluate the leading nations, authors, journals, institutes, highly cited publications, and most commonly used keywords concerning scientific publications based on root and root canal morphology using the CBCT.
MATERIAL AND METHODS
For this bibliometric analysis, an extensive search was carried out on September 25, 2023 using the Scopus database. Pertinent articles in the field were scrutinized after applying inclusion and exclusion criteria. Data were evaluated using Vosviewer and Microsoft Excel.
RESULTS
A literature search revealed the initiation of scientific publication in 2008. Significant contributions made by Saudi Arabia, India, and China concerning the number of publications were seen. Similarly, Jazan University from SA was recognized as the leading institute. The Journal of Endodontics was the leading journal, while authors JNR Martins and G Gambarini produced the highest number of papers.
CONCLUSIONS
This bibliometric analysis demonstrated that scientific publications have increased tremendously since 2008. Significant contributions have been made by developing and developed nations. The Journal of Endodontics and Jazan University have been identified as the leading journal and institute.
Topics: Humans; Dental Pulp Cavity; Endodontics; Bibliometrics; Cone-Beam Computed Tomography; Databases, Factual
PubMed: 37877522
DOI: 10.1002/cre2.801 -
Pharmaceutics Aug 2023Adult mesenchymal stem cells are those obtained from the conformation of dental structures (DMSC), such as deciduous and permanent teeth and other surrounding tissues.... (Review)
Review
Adult mesenchymal stem cells are those obtained from the conformation of dental structures (DMSC), such as deciduous and permanent teeth and other surrounding tissues. Background: The self-renewal and differentiation capacities of these adult stem cells allow for great clinical potential. Because DMSC are cells of ectomesenchymal origin, they reveal a high capacity for complete regeneration of dental pulp, periodontal tissue, and other biomedical applications; their differentiation into other types of cells promotes repair in muscle tissue, cardiac, pancreatic, nervous, bone, cartilage, skin, and corneal tissues, among others, with a high predictability of success. Therefore, stem and progenitor cells, with their exosomes of dental origin and surrounding areas in the oral cavity due to their plasticity, are considered a fundamental pillar in medicine and regenerative dentistry. Tissue engineering (MSCs, scaffolds, and bioactive molecules) sustains and induces its multipotent and immunomodulatory effects. It is of vital importance to guarantee the safety and efficacy of the procedures designed for patients, and for this purpose, more clinical trials are needed to increase the efficacy of several pathologies. Conclusion: From a bioethical and transcendental anthropological point of view, the human person as a unique being facilitates better clinical and personalized therapy, given the higher prevalence of dental and chronic systemic diseases.
PubMed: 37631323
DOI: 10.3390/pharmaceutics15082109 -
Zhonghua Kou Qiang Yi Xue Za Zhi =... Jan 2024Deep caries occurs when caries progresses to the deep dentin layer, and further progression has the risk of pulp exposure, which may affect pulp vitality and tooth...
Deep caries occurs when caries progresses to the deep dentin layer, and further progression has the risk of pulp exposure, which may affect pulp vitality and tooth longevity. Currently, there are no objective standards for the diagnosis of deep caries. In addition, traditional therapy for deep caries emphasizes complete debridement of the decayed tissue, resulting in an incremental high risk of pulp exposure. There are different views on how to deal with the remaining dentin after caries removal, and root canal treatment is often adopted directly after pulp exposure. In recent years, due to advances in dental pulp biology, bioactive pulp-capping materials, and clinical evidence-based medicine, the principle of deep caries treatment has shifted to pulp protection. Based on the latest international research progress, evidence-based medicine and expert consensus, we present a series of advancements in this article, including the terminology of deep caries, pathological changes and defense mechanisms of the pulp close to the deep caries, treatment principles of deep caries, technical strategies for carious tissues removal, and the decision-making of treatment protocols after pulp exposure, with the aim of enhancing the understanding of deep caries among dentists, as well as providing a reference for the clinical diagnosis and treatment of deep caries.
Topics: Humans; Dental Pulp Exposure; Dental Caries Susceptibility; Dental Pulp Capping; Root Canal Therapy; Dental Caries; Dental Pulp
PubMed: 38172058
DOI: 10.3760/cma.j.cn112144-20231018-00203 -
Australian Endodontic Journal : the... Sep 2023This study evaluated the accuracy of the Wirele-X (Forum Tec, Ashkelon, Israel), a novel Bluetooth-enabled wireless electronic apex locator. Thirty-one extracted teeth...
This study evaluated the accuracy of the Wirele-X (Forum Tec, Ashkelon, Israel), a novel Bluetooth-enabled wireless electronic apex locator. Thirty-one extracted teeth with mature apices were used. Under 10X magnification, the actual canal lengths were determined. The teeth were embedded in alginate and electronic canal lengths were obtained using the Root ZX II and Wirele-X electronic apex locators. The actual canal lengths and electronic canal lengths were compared with Student's t-test. The average distance from the file tip to the actual canal length was -0.11 mm (±0.16) for the Root ZX II, and - 0.07 mm (±0.21) for the Wirele-X. There were no statistically significant differences between the two electronic apex locators in their ability to determine the actual canal length (p > 0.05). The wireless apex locator (Wirele-X) and the wired apex locator (Root ZX II) were found to be equally accurate.
Topics: Humans; Tooth Apex; Dental Pulp Cavity; Odontometry; Tooth Root; Electronics; Root Canal Preparation
PubMed: 36106697
DOI: 10.1111/aej.12688