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Journal of Endodontics Sep 2018This study addressed the following population, intervention, comparator, outcome, timing, study design and setting question: in patients with preoperative pain who... (Meta-Analysis)
Meta-Analysis
Effect of Preoperative Corticosteroids in Patients with Symptomatic Pulpitis on Postoperative Pain after Single-visit Root Canal Treatment: A Systematic Review and Meta-analysis.
INTRODUCTION
This study addressed the following population, intervention, comparator, outcome, timing, study design and setting question: in patients with preoperative pain who undergo single-visit nonsurgical endodontic treatment, what is the comparative efficacy of corticosteroids compared with other analgesics or placebo in reducing postoperative pain and the incidence of adverse events.
METHODS
Database/electronic searches were conducted using the PubMed/MEDLINE, Scopus, and Cochrane databases to identify published articles using included key words in various combinations. Manual searching of articles was performed, and the Clinicaltrials.gov site was also searched. Two independent reviewers assessed eligibility for inclusion, extracted data, and assessed quality using the risk of bias tool. Where applicable, meta-analysis was conducted on the pooled effect size.
RESULTS
The database search identified 481 citations and 37 citations through the manual search. After removing duplicates and going through abstracts, 28 full-text articles were perused. Five articles met the inclusion criteria; qualitative analysis revealed 4 studies had unclear risk of bias, and 1 study had low risk of bias. Only 1 study had a sizable sample size; the others had lesser sample sizes. Meta-analysis showed that prednisolone administered preoperatively was able to reduce the incidence of postoperative pain at 6, 12, and 24 hours. The patients in the studies reported no adverse effects.
CONCLUSIONS
Corticosteroids may be more effective than placebo for the relief of postoperative endodontic pain in patients with symptomatic pulpitis undergoing single-visit root canal treatment. However, more studies need to be conducted with greater sample sizes to validate the conclusions.
Topics: Adrenal Cortex Hormones; Ambulatory Care; Databases, Bibliographic; Humans; Pain, Postoperative; Postoperative Complications; Preoperative Care; Pulpitis; Root Canal Therapy; Time Factors; Treatment Outcome
PubMed: 30054100
DOI: 10.1016/j.joen.2018.05.015 -
Journal of Endodontics Feb 2011The choice of single- versus multiple-visit root canal treatment for infected teeth is in dispute. The purpose of this systematic review was to compare the healing rate... (Comparative Study)
Comparative Study Review
INTRODUCTION
The choice of single- versus multiple-visit root canal treatment for infected teeth is in dispute. The purpose of this systematic review was to compare the healing rate and post-obturation pain of single- versus multiple-visit root canal treatment for teeth with infected root canals.
METHODS
An exhaustive literature search combined with specified inclusion criteria was performed to identify randomized or quasi-randomized controlled trials (RCTs or quasi-RCTs), comparing root canal treatment in single and multiple appointments (2 or more visits) in patients with infected root canals.
RESULTS
Ten RCTs were identified and included in this review. Of these, 6 compared the healing rate and 5 compared the prevalence of post-obturation pain in single- and multiple-visit root canal treatment on teeth with infected root canals. No significant difference was observed in the healing rate between single- versus multiple-visit root canal treatment, as well as the incidence of medium-term post-obturation pain. As to the short-term follow up, the prevalence of post-obturation pain was significantly lower in single-visit than in multiple-visit group.
CONCLUSIONS
On the basis of current studies, the healing rate of single- and multiple-visit root canal treatment is similar for infected teeth. Patients experience less frequency of short-term post-obturation pain after single-visit than those having multiple-visit root canal treatment.
Topics: Episode of Care; Humans; Office Visits; Pain, Postoperative; Pulpitis; Root Canal Therapy; Treatment Outcome
PubMed: 21238790
DOI: 10.1016/j.joen.2010.09.005 -
The Journal of Evidence-based Dental... Sep 2020Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: A report... (Meta-Analysis)
Meta-Analysis
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION
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. Lockhart PB, Tampi MP, Abt E, et al. J Am Dent Assoc 2019;150(11):906-921.e12.
SOURCE OF FUNDING
The American Dental Association.
TYPE OF STUDY/DESIGN
Systematic review with meta-analysis of data.
Topics: Anti-Bacterial Agents; Humans; Pain; Pulpitis; United States
PubMed: 32921385
DOI: 10.1016/j.jebdp.2020.101465 -
Pediatric Dentistry Jan 2024The purpose of this study was to present an evidence-based guideline for primary teeth with deep caries or trauma requiring vital pulp therapies (VPT). A systematic... (Meta-Analysis)
Meta-Analysis
The purpose of this study was to present an evidence-based guideline for primary teeth with deep caries or trauma requiring vital pulp therapies (VPT). A systematic review/meta-analysis on vital primary teeth resulting from trauma or caries was conducted using GRADE to assess the certainty of evidence for clinical recommendations. A decision tree was provided for choosing VPTs. No articles on trauma VPT were found. For VPT in primary teeth with deep caries, indirect pulp treatment (IPT) or pulpotomy using the calcium silicate cement (mineral trioxide aggregate [MTA] or Biodentine) show increased success over using direct pulp capping (DPC) and other pulpotomies. Different liners do not affect IPT success (high certainty) or DPC capping agents' success (very low certainty) after 24 months. It is strongly recommended, with high certainty from 24-month data, that calcium silicate cement pulpotomy is preferred over formocresol, ferric sulfate, zinc oxide eugenol pulpotomy, and other pulpotomies. Using selective caries removal and IPT for deep caries is strongly recommended with moderate certainty over complete and stepwise removal. Statistically, this results in significantly fewer pulp exposures. No caries removal and Hall technique crown may be used when indicated (moderate certainty at 24 months). For vital primary incisors with deep caries, pulpotomy was significantly better statistically than pulpectomy. Teeth diagnosed with/without reversible pulpitis pain showed comparable success after 12 months of treatment by IPT or calcium silicate cement pulpotomy. The following had little or no significant effect on MTA pulpotomy success: coronal pulp removal methods; irrigation solution; method to control hemorrhage; base over MTA; treatment in one or two visits; anterior or posterior teeth. Indirect pulp treatment or calcium silicate cement pulpotomy is likely to increase vital pulp therapy success over other VPTs such as direct pulp capping and other pulpotomies after 24 months (moderate certainty).
Topics: Humans; Dental Care; Pulpotomy; Dental Pulp; Calcium; Dental Cements; Glass Ionomer Cements; Tooth, Deciduous; Calcium Compounds; Silicates
PubMed: 38449041
DOI: No ID Found -
The Cochrane Database of Systematic... Oct 2007Root canal treatment (RoCT), or endodontic treatment, is a common procedure in dentistry. The main indications for RoCT are irreversible pulpitis and necrosis of the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Root canal treatment (RoCT), or endodontic treatment, is a common procedure in dentistry. The main indications for RoCT are irreversible pulpitis and necrosis of the dental pulp caused by carious processes, tooth cracks or chips, or dental trauma. Successful RoCT is characterised by an absence of symptoms and clinical signs in teeth without radiographic evidence of periodontal involvement. The success of RoCT depends on a series of variables related to the preoperative condition of the tooth, as well as the endodontic procedures.
OBJECTIVES
To compare the effectiveness of single- and multiple-visit RoCT, measured as tooth extraction due to endodontic problems and radiological success.To assess the difference in short- and long-term complications between single- and multiple-visit RoCT.
SEARCH STRATEGY
The following databases were searched for relevant trials: Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE, and EMBASE. Handsearching was performed for the major oral medicine journals. References of included studies and reviews were checked. Endodontics experts were contacted through e-mail. No language limitations were imposed. Date of last search was 6th March 2007.
SELECTION CRITERIA
Randomised and quasi-randomised controlled trials of patients needing RoCT were included. Surgical endodontic treatment was excluded. The outcomes considered were the number of teeth extracted for endodontic problems; radiological success after at least 1 year, that is, absence of any periapical radiolucency; postoperative pain; painkiller use; swelling; or sinus track formation.
DATA COLLECTION AND ANALYSIS
Data were collected using a specific extraction form. The validity of included studies was assessed on the basis of allocation concealment, blindness of the study, and loss of participants. Data were analysed by calculating risk ratios. When valid and relevant data were collected, a meta-analysis of the data was undertaken.
MAIN RESULTS
Twelve randomised controlled trials were included in the review. Four studies had a low risk of bias, four a moderate risk, and another four had a high risk of bias. The frequency of radiological success and immediate postoperative pain were not significantly different between single- and multiple-visit RoCT. Patients undergoing single-visit RoCT reported a higher frequency of painkiller use and swelling, but the results for swelling were not significantly different between the two groups. We found no study that included tooth loss and sinus track formation among its primary outcomes.
AUTHORS' CONCLUSIONS
No difference exists in the effectiveness of RoCT, in terms of radiological success, between single- and multiple-visit RoCT. Most short- and long-term complications are also similar in terms of frequency, although patients undergoing a single visit may experience a slightly higher frequency of swelling and are significatively more likely to take painkillers.
Topics: Analgesics; Anti-Bacterial Agents; Appointments and Schedules; Dental Pulp Necrosis; Dentition, Permanent; Humans; Office Visits; Pulpitis; Radiography; Randomized Controlled Trials as Topic; Root Canal Therapy; Tooth Extraction; Treatment Outcome
PubMed: 17943848
DOI: 10.1002/14651858.CD005296.pub2 -
BioMed Research International 2019Failure in the provision of inferior alveolar nerve block anesthesia (IANB) is a significant problem during endodontic treatment of irreversible pulpitis. Various...
BACKGROUND
Failure in the provision of inferior alveolar nerve block anesthesia (IANB) is a significant problem during endodontic treatment of irreversible pulpitis. Various methodologies have been advocated one of which is administration of premedication prior to anesthesia. Despite the considerable number of reports, the topic yet deserves more clarification. This systematic review was conducted to provide an oversight on the effectiveness of premedication prior to IANB in mandibular teeth.
METHODS
A PubMed and Cochrane Database search was conducted by using MeSH terms inferior alveolar nerve block + pulpitis and mandibular anesthesia+pulpitis. Two reviewers independently performed the screening, selection of papers, and data extraction. Papers in English language that included randomized clinical studies on the impact of different medications on the success of inferior alveolar block anesthesia in irreversible pulpitis were included. Additionally, relevant supporting literature was also used where necessary.
RESULTS
Initially, 118 papers were selected from PubMed and 68 were selected from Cochrane. Five additional articles were retrieved from Google Search. Following the elimination of duplicates and irrelevant articles, 35 studies were selected meeting the criteria. It was observed that there was moderate evidence to suggest that some premedications were partially effective for the enhancement of mandibular anesthetic effect in irreversible pulpitis.
CONCLUSION
Though some medications appear to be promising, further supporting research will help highlight this significant topic which requires further clarification.
Topics: Anesthesia, Conduction; Anesthetics, Local; Humans; Mandibular Nerve; Premedication; Pulpitis
PubMed: 30881994
DOI: 10.1155/2019/6587429 -
Journal of Dentistry May 2019The most commonly-accepted strategy for managing irreversible pulpitis, an irreversible condition of dental pulp inflammation, is root canal treatment, which is limited... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The most commonly-accepted strategy for managing irreversible pulpitis, an irreversible condition of dental pulp inflammation, is root canal treatment, which is limited by high costs and complex techniques. High success rates have been reported for the use of pulpotomy in managing pulp exposure resulting from extensive caries. The objective of the present work was to evaluate the effectiveness and cost-effectiveness of pulpotomy and associated medicaments in saving permanent teeth with pulp exposure resulting from extensive caries.
SOURCES
Multiple databases were searched on January 12, 2019, without limitations on the language or year of publication.
STUDY SELECTION
Randomized controlled trials comparing pulpotomy with alternative treatments, or comparing two or more medicaments in pulpotomy for permanent teeth with carious pulp exposure were included.
DATA
Seventeen studies reported in 21 articles were included. Intention-to-treat analyses on studies comparing pulpotomy and other treatment modalities tended to favor pulpotomy. Meta-analysis was not performed on comparisons of pulpotomy and other treatments because of the limited number of studies. Most evidence on comparisons among different pulpotomy medicaments was found in trials comparing mineral trioxide aggregate (MTA) and calcium hydroxide, with the results of meta-analyses favoring MTA. Data were insufficient to determine the cost-effectiveness of successful modality.
CONCLUSIONS
Pulpotomy is a prospective substitute for root canal treatment in managing permanent teeth with carious pulp exposures, even in permanent teeth with irreversible pulpitis. Large, well-designed trials comparing pulpotomy with other treatments in terms of cost-effectiveness should be informative.
CLINICAL SIGNIFICANCE
The success of pulpotomy in managing irreversible pulpitis challenges the rhetoric that irreversible pulpitis can only be managed by root canal treatment. Cost-effectiveness analysis rather than analysis on effectiveness of treatment outcome alone should be considered in all health care domains to evaluate the benefits of alternative treatment options.
Topics: Aluminum Compounds; Calcium Compounds; Calcium Hydroxide; Dental Caries; Dentition, Permanent; Drug Combinations; Humans; Oxides; Prospective Studies; Pulpitis; Pulpotomy; Silicates; Treatment Outcome
PubMed: 30981748
DOI: 10.1016/j.jdent.2019.03.010 -
Journal of Endodontics Dec 2009Consensus Conference Subcommittee 2 was charged with the identification and definition of all diagnostic terms for pulpal health and disease states by using a systematic...
INTRODUCTION
Consensus Conference Subcommittee 2 was charged with the identification and definition of all diagnostic terms for pulpal health and disease states by using a systematic review of the literature.
METHODS
Eight databases were searched, and numerous widely recognized endodontic texts were consulted. For each reference the level of evidence was determined, and the findings were summarized by members of the subcommittee. Highest levels of evidence were always included when available. Areas of inquiry included quantification of pulpal pain, the designation of conditions that can be identified in the dental pulp, diagnostic terms that can best represent pulpal health and disease, and metrics used to arrive at such designations.
RESULTS AND CONCLUSIONS
On the basis of the findings of this inquiry, specific diagnostic terms for pulpal health and disease are suggested. In addition, numerous areas for further study were identified.
Topics: Dental Pulp; Dental Pulp Calcification; Dental Pulp Diseases; Dental Pulp Necrosis; Humans; Pain Measurement; Pulpitis; Root Canal Therapy; Root Resorption; Terminology as Topic
PubMed: 19932339
DOI: 10.1016/j.joen.2009.09.032 -
Journal of Endodontics Feb 2006The Cochrane Systematic Review promotes evidence-based outcomes studies. The review summarized here was conducted in an attempt to achieve reliable evidence concerning... (Review)
Review
The Cochrane Systematic Review promotes evidence-based outcomes studies. The review summarized here was conducted in an attempt to achieve reliable evidence concerning the effectiveness, or otherwise, of prescribing antibiotics for patients having irreversible pulpitis. A competent search strategy was developed and used across several databases including MEDLINE to identify randomized controlled trials for inclusion. Assessment of methodological quality was based on criteria defined by The Cochrane Collaboration. Clinical outcome, expressed in terms of pain relief, was examined. There was a relative dearth of research providing a high level of evidence. Only one methodologically sound trial was found that compared pain relief with systemic antibiotic/analgesic treatment against a placebo/analgesic combination during the acute preoperative phase of irreversible pulpitis. Although the selected study used a relatively small, low-powered sample, it did provide some evidence that there is no significant difference in pain relief for patients with untreated irreversible pulpitis who received antibiotics versus those who did not. These findings increase the rationale to investigate the teaching of safe and effective antibiotic prescribing in endodontics and to advance the development of appropriate evidence-based clinical guidelines.
Topics: Adult; Anti-Bacterial Agents; Humans; Pain Measurement; Penicillins; Pulpitis; Randomized Controlled Trials as Topic; Statistics, Nonparametric; Toothache
PubMed: 16427452
DOI: 10.1016/j.joen.2005.10.029 -
Acta Odontologica Scandinavica Oct 2019Coronal pulpotomies were recently re-investigated as an alternative to root canal treatment in vital permanent teeth. General dentists may be interested in knowing how...
Coronal pulpotomies were recently re-investigated as an alternative to root canal treatment in vital permanent teeth. General dentists may be interested in knowing how to perform full pulpotomy, in particular in face of difficult endodontic cases of vital teeth. A systematic review was undertaken on the PubMed and Cochrane databases in order to determine which procedure should be applied for pulp capping and coronal restoration in routine dental practice. Fifty-three publications were included and allocated to one of two methodological categories: histological and clinical studies. There is no evidence to recommend one single procedure for full pulpotomy in vital permanent teeth that can be indicated for different pulpal diagnoses which differ greatly in terms of the inflammation process from healthy teeth to irreversible pulpitis. For each clinical case, all actions aiming to prevent pre-operative contamination, to control per-operative infection and to achieve a complete seal above the radicular pulp sections are unavoidable steps that should be complied with. Reproducing procedures adopted in high quality trials could insure high success rates.
Topics: Dental Pulp Capping; Dental Pulp Exposure; Dentition, Permanent; Humans; Outcome Assessment, Health Care; Pulpitis; Pulpotomy; Silicates
PubMed: 31146622
DOI: 10.1080/00016357.2019.1614217