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Journal of the American Dental... Nov 2019An expert panel convened by the American Dental Association Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and...
Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: A report from the American Dental Association.
BACKGROUND
An expert panel convened by the American Dental Association Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated clinical recommendations for the urgent management of symptomatic irreversible pulpitis with or without symptomatic apical periodontitis, pulp necrosis and symptomatic apical periodontitis, or pulp necrosis and localized acute apical abscess using antibiotics, either alone or as adjuncts to definitive, conservative dental treatment (DCDT) in immunocompetent adults.
TYPES OF STUDIES REVIEWED
The authors conducted a search of the literature in MEDLINE, Embase, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature to retrieve evidence on benefits and harms associated with antibiotic use. The authors used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in the evidence and the Evidence-to-Decision framework.
RESULTS
The panel formulated 5 clinical recommendations and 2 good practice statements, each specific to the target conditions, for settings in which DCDT is and is not immediately available. With likely negligible benefits and potentially large harms, the panel recommended against using antibiotics in most clinical scenarios, irrespective of DCDT availability. They recommended antibiotics in patients with systemic involvement (for example, malaise or fever) due to the dental conditions or when the risk of experiencing progression to systemic involvement is high.
CONCLUSION AND PRACTICAL IMPLICATIONS
Evidence suggests that antibiotics for the target conditions may provide negligible benefits and probably contribute to large harms. The expert panel suggests that antibiotics for target conditions be used only when systemic involvement is present and that immediate DCDT should be prioritized in all cases.
Topics: Adult; American Dental Association; Anti-Bacterial Agents; Evidence-Based Dentistry; Humans; Periapical Abscess; Toothache
PubMed: 31668170
DOI: 10.1016/j.adaj.2019.08.020 -
Reviews in Cardiovascular Medicine Mar 2022A potential relationship between oral health and cardiovascular diseases has been proposed. However, uncertainty remains as to whether there is sufficient data to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
A potential relationship between oral health and cardiovascular diseases has been proposed. However, uncertainty remains as to whether there is sufficient data to support this association. This review aims to appraise the relationship between apical periodontitis and cardiovascular disease based on data from observational studies.
METHODS
The databases Medline (via PubMed) and EMBASE (via Scopus) were searched up to August 2020 for observational studies (case-control, cross-sectional, and cohort) assessing the association of apical periodontitis with cardiovascular disease among adults. Pooled relative risk/odds ratio and 95% confidence interval (CI) were estimated using a random-effects model. Sensitivity analyses and random-effects meta-regressions were performed.
RESULTS
The initial search yielded 2537 documents, of which 15 were eligible for inclusion, including 8 cross-sectional studies, 5 case-control studies, and 2 cohort studies. The majority of studies enrolled both men and women, with mean age ranging from 41 to 66 years. In cross-sectional studies, the presence of apical periodontitis was significantly associated with cardiovascular disease with a combined odds ratio of 1.53 (95% CI: 1.02-2.29, = 0.039; I2 = 75.0%; < 0.001). In the case-control studies, the combined odds ratio did not show a significant association of apical periodontitis with cardiovascular disease (OR = 1.24; 95% CI: 0.67-2.29, = 0.494; I2 = 82.1%; < 0.001). The pooled risk ratio from the 2 cohort studies showed (RR = 1.27; 95% CI: 0.71-2.27, = 0.413; I2 = 69.1%; = 0.072) also showed no significant association between apical periodontitis and cardiovascular disease. These results should be interpreted with caution due to the high heterogeneity.
CONCLUSIONS
Data derived from cross-sectional studies suggest a weak association between apical periodontitis and cardiovascular disease. As the results were not consistent across study designs, further research is recommended, namely longitudinal studies with long-term follow-up.
REGISTRATION
PROSPERO database (CRD42020204379).
Topics: Adult; Aged; Cardiovascular Diseases; Case-Control Studies; Cross-Sectional Studies; Databases, Factual; Female; Humans; Male; Middle Aged; Periapical Periodontitis
PubMed: 35345267
DOI: 10.31083/j.rcm2303100 -
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 -
Journal of Clinical Medicine Feb 2020Investigate if there is an association between apical periodontitis and diabetes mellitus.
OBJECTIVE
Investigate if there is an association between apical periodontitis and diabetes mellitus.
MATERIAL AND METHODS
A bibliographic search was performed on Medline/PubMed, Scopus and Cochrane databases using the keywords apical periodontitis and diabetes mellitus. Published papers written in English and performed on animals or humans were included. Meta-analysis was performed using the OpenMeta (analyst) tool for the statistical analysis. The variables analyzed were the prevalence of Apical Periodontitis (AP) among teeth and patients with Diabetes Mellitus (DM).
RESULTS
Of the total studies found, only 21 met the inclusion criteria. Ten clinical studies on animals, ten studies on humans and a systematic review were included. Meta-analysis shows that the prevalence of teeth with apical periodontitis among patients with diabetes mellitus has an odds ratio of 1.166 corresponding to 507 teeth with AP + DM and 534 teeth with AP without DM. The prevalence of patients with AP and DM shows an odds ratio of 1.552 where 91 patients had AP + DM and 582 patients AP without DM.
CONCLUSION
Scientific evidence suggests that there could be a common physiopathological factor between apical periodontitis and diabetes mellitus but more prospective studies are needed to investigate the association between these two diseases.
PubMed: 32079175
DOI: 10.3390/jcm9020540 -
Journal of Clinical Medicine Oct 2020This systematic review and meta-analysis aimed to investigate the association between smoking habits and the prevalence of radiolucent periapical lesions (RPLs) in... (Review)
Review
AIM
This systematic review and meta-analysis aimed to investigate the association between smoking habits and the prevalence of radiolucent periapical lesions (RPLs) in root-filled teeth (RFT).
METHODS
The Population, Intervention, Comparison, and Outcome (PICO) question was: in adult patients who have RFT, does the absence or presence of a smoking habit affect the prevalence of RPLs associated with RFT? Systematic MEDLINE/PubMed, Wiley Online Database, Web of Science, Scopus, and PRISMA protocol were used to evaluate and present the results. Studies comparing smokers with control non-smoker subjects, including RFT, and providing data on the prevalence of RFT with RPLs, were included. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used for certainty in the evidence. The risk of bias was assessed according to Cochrane Collaboration common scheme for bias and ROBINS-I tool. Cumulative meta-analysis was performed with a random effects model. PROSPERO registration code: CRD42020165279.
RESULTS
Four studies reported data on inclusion criteria, representing data from 9257 root-filled teeth-4465 from non-smokers and 4792 from smoker patients. The meta-analysis provided an odds ratio indicating a significant association between smoking and higher prevalence of root filled teeth with radiolucent periapical lesions (OR = 1.16; 95% CI = 1.07-1.26; = 0.0004). The certainty of the literature assessment was moderate per GRADE. The ROBINS-I tool classified three studies as low risk of bias, and the fourth as moderate risk of bias.
CONCLUSIONS
Moderate, quality scientific evidence indicates a weak but significant relationship between smoking and the prevalence of RPLs in RFT. Smoking can be considered a negative prognostic factor for the outcome of root canal treatment. Endodontic providers should be aware of the relationship between smoking and persistent apical periodontitis, assessed as RPLs, in RFT.
PubMed: 33138302
DOI: 10.3390/jcm9113506 -
BMC Oral Health Oct 2023Statins are a category of medications widely used to reduce plasma LDL-cholesterol levels, that also possess antibacterial, anti-inflammatory, and immunomodulatory...
OBJECTIVES
Statins are a category of medications widely used to reduce plasma LDL-cholesterol levels, that also possess antibacterial, anti-inflammatory, and immunomodulatory action. The aim of this systematic review was to explore the effects of systemic statins therapy on the development and treatment of apical periodontitis (AP) on humans and animals.
MATERIAL AND METHODS
Three electronic databases (PubMed, Web of Science, and Scopus) and grey literature were searched from their inception until February, 20 2023 (PROSPERO CRD42021246231). For the quality assessment and risk of bias, different guidelines were used according to the typology of the studies considered (Animal Research Reporting of In Vivo Experiments, Newcastle-Ottawa Quality Assessment Form for Cohort Studies, Systematic Review Centre for Laboratory animal Experimentation Risk of Bias tool and Tool to assess risk of bias in cohort studies of CLARITY Group).
RESULTS
Seven hundred eleven records were screened, and six articles were included for this qualitative review. The eligible studies showed a moderate overall quality and risk of bias. Human patients in treatment with statins exhibited a higher healing rate of AP following root canal treatment. In experimental animal models, statins had a beneficial effect on the development of AP.
CONCLUSIONS
Despite the limited number of studies and considering that most of them are on animals, our findings suggest that systemically administered statins make a positive contribution to prevent the development and help healing of AP.
CLINICAL RELEVANCE
There is an increased evidence that a pharmacologic adjunct to endodontic treatment may be considered to enhance healing of AP. Among other medications, statins seem to have a positive impact on the disease.
Topics: Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Periapical Periodontitis; Root Canal Therapy; Anti-Bacterial Agents; Wound Healing
PubMed: 37805447
DOI: 10.1186/s12903-023-03472-3 -
Journal of Clinical and Experimental... Mar 2023This systematic review investigated the effectiveness, efficiency and apical extrusion of the debris of two rotary and two reciprocating single-file systems used for the... (Review)
Review
BACKGROUND
This systematic review investigated the effectiveness, efficiency and apical extrusion of the debris of two rotary and two reciprocating single-file systems used for the removal of filling material from straight root canals.
MATERIAL AND METHODS
A literature search was performed in the Medline, ISI Web of Science, and Scopus databases for relevant articles matching the keyword search strategy. Effectiveness was determined with studies dealing with the ability of the instruments to remove filling material from root canals. Efficiency was assessed with studies dealing with the time needed to completely remove the root canal filling, and apical extrusion was determined with studies that measured the amount of filling material extruded through the apex.
RESULTS
From the 424 articles initially found, 406 were excluded for being non-relevant or not fulfilling the selection criteria. Another 9 articles were excluded after methodology evaluation. Finally, 9 studies were included in the systematic review.
CONCLUSIONS
None of the reviewed systems is effective to completely remove the filling materials from straight root canals, and all systems appear to be equally time-efficient, although this variable shows different results. In terms of apical extrusion, the analyzed reciprocating systems extrude more material toward the periapical tissues than the continuous rotation systems. Systematic review, rotary files, reciprocating files, apical extrusion, endodontic retreatment.
PubMed: 37008238
DOI: 10.4317/jced.59953 -
International Journal of Molecular... Sep 2022The regenerative endodontic procedure (REP) represents a treatment option for immature necrotic teeth with a periapical lesion. Currently, this therapy has a wide field... (Review)
Review
The regenerative endodontic procedure (REP) represents a treatment option for immature necrotic teeth with a periapical lesion. Currently, this therapy has a wide field of pre-clinical and clinical applications, but no standardization exists regarding successful criteria. Thus, by analysis of animal and human studies, the aim of this systematic review was to highlight the main characteristics of the tissue generated by REP. A customized search of PubMed, EMBASE, Scopus, and Web of Science databases from January 2000 to January 2022 was conducted. Seventy-five human and forty-nine animal studies were selected. In humans, the evaluation criteria were clinical 2D and 3D radiographic examinations. Most of the studies identified a successful REP with an asymptomatic tooth, apical lesion healing, and increased root thickness and length. In animals, histological and radiological criteria were considered. Newly formed tissues in the canals were fibrous, cementum, or bone-like tissues along the dentine walls depending on the area of the root. REP assured tooth development and viability. However, further studies are needed to identify procedures to successfully reproduce the physiological structure and function of the dentin-pulp complex.
Topics: Animals; Dental Pulp Necrosis; Humans; Periapical Tissue; Regenerative Endodontics
PubMed: 36142446
DOI: 10.3390/ijms231810534 -
International Journal of Environmental... Feb 2023This systematic review aimed to investigate the scientific literature on volumetric studies concerning the diagnosis and treatment of apical periodontitis using CBCT. A... (Review)
Review
This systematic review aimed to investigate the scientific literature on volumetric studies concerning the diagnosis and treatment of apical periodontitis using CBCT. A systematic review protocol was written following the preferred reporting items for the systematic reviews and meta-analyses (PRISMA) checklist. Four electronic databases were searched for relevant publications in English, which were published up to 21 January 2023. The inclusion criteria and corresponding search keys were applied. The risk of bias was assessed using the Joanna Briggs Institute Meta-Analysis of Statistic Assessment and Review Instrument. The search strategy identified 202 studies, with 123 studies excluded during the title and abstract screening and 47 studies left for full text screening. A total of 17 studies met the inclusion criteria. The lesion volume was measured and classified according to different indices which compared the effectiveness of their diagnostics. Moreover, the volume of AP lesions increased with the thickness of the maxillary sinus mucosa in primary and secondary infections and decreased due to endodontic treatment. Volumetric measurements using CBCT are useful in the correct definition of periapical tissue pathosis using a CBCT periapical volume index and assessment of the dynamics of the treatment of apical lesions.
Topics: Humans; Cone-Beam Computed Tomography; Maxillary Sinus; Periapical Periodontitis
PubMed: 36833634
DOI: 10.3390/ijerph20042940 -
International Urogynecology Journal Jan 2022Sacrocolpopexy and sacrospinous ligament fixation (SSLF) have been used for the restoration of apical support. Studies comparing sacrocolpopexy and SSLF have reported... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION AND HYPOTHESIS
Sacrocolpopexy and sacrospinous ligament fixation (SSLF) have been used for the restoration of apical support. Studies comparing sacrocolpopexy and SSLF have reported conflicting results. We aim to assess the current evidence regarding efficiency and the complications of sacrocolpopexy compared with SSLF.
METHODS
We searched PubMed, Embase, and Cochrane Library and performed a systematic review meta-analysis to assess the two surgical approaches.
RESULTS
5Five randomized controlled trials, 8 retrospective studies, and 2 prospective studies including 4,120 cases were identified. Compared with abdominal sacrocolpopexy (ASC), SSLF was associated with a lower success rate (88.32% and 91.45%; OR 0.52; 95% CI 0.29-0.95; p = 0.03), higher recurrence (11.58% and 8.32%; OR 1.97; 95% CI 1.04-3.46; p = 0.04), and dyspareunia rate (14.36% and 4.67%; OR 3.10; 95% CI 1.28-7.50; p = 0.01). Patients in this group may benefit from shorter operative time (weighted mean difference -25.08 min; 95% CI -42.29 to -7.88; p = 0.004), lower hemorrhage rate (0.85% and 2.58%; OR 0.45; 95% CI 0.25-0.85; p = 0.009), wound infection rate (3.30% and 5.76%; OR 0.55; 95% CI 0.39-0.77; p = 0.0005), and fewer gastrointestinal complications (1.33% and 6.19%; OR 0.33; 95% CI 0.15-0.76; p = 0.009).
CONCLUSION
Both sacrocolpopexy and SSLF offer an efficient alternative to the restoration of apical support. When anatomical durability and sexual function is a priority, ASC may be the preferred option. When considering factors of mesh erosion, operative time, gastrointestinal complications, hemorrhage, and wound infections, SSLF may be the better option.
Topics: Female; Gynecologic Surgical Procedures; Humans; Ligaments; Pelvic Organ Prolapse; Prospective Studies; Retrospective Studies; Treatment Outcome
PubMed: 34081163
DOI: 10.1007/s00192-021-04823-w