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Journal of Clinical Medicine Oct 2021Several studies have linked apical periodontitis and systemic diseases. The aim of this study is to present a systematic review of the available literature investigating... (Review)
Review
Several studies have linked apical periodontitis and systemic diseases. The aim of this study is to present a systematic review of the available literature investigating whether there is an association between pulpal-periapical pathology and autoimmune disease. The review was conducted following the PRISMA statement. A literature search was performed in five databases. Studies involving patients with pulpal-periapical pathology and autoimmune diseases were included in the review. Based on the PICO model, the research question aimed to assess whether there is an increased risk of developing pulpal-periapical pathology in patients with autoimmune disease. Article selection, data extraction, and quality assessment were performed using an adapted version of the STROBE guidelines. A total of seven studies were included in our review. The types of articles were five case-control and two cross-sectional studies. Periapical pathologies were associated to three autoimmune diseases (diabetes mellitus I, rheumatoid arthritis, and inflammatory bowel disease). Among the included studies, four show a low risk of bias, while three present a moderate risk. There could be an association between apical periodontitis and autoimmune diseases, although most studies report statistically non-significant associations.
PubMed: 34768405
DOI: 10.3390/jcm10214886 -
Journal of Dental Anesthesia and Pain... Oct 2021This systematic review aimed to assess the effect of premedication on postoperative pain after root canal treatment in vital teeth. Five electronic databases were... (Review)
Review
This systematic review aimed to assess the effect of premedication on postoperative pain after root canal treatment in vital teeth. Five electronic databases were searched for randomized clinical trials, and two independent reviewers selected eligible studies, extracted data, and assessed the quality of studies using the Cochrane Risk of Bias tool. Meta-analysis was conducted using the random-effects model, and the pooled effect estimate of the standardized mean difference (SMD) between premedication and placebo was calculated. Subgroup analysis was conducted based on the class and route of the drug. Studies with a high risk of bias were excluded from the sensitivity analysis. Ten trials satisfied the inclusion criteria, of which eight were included in the meta-analysis. Premedication was more effective in reducing postoperative pain than placebo at 6 hours (SMD = -1.00; 95% confidence interval [CI] = -1.33 to -0.66), 12 hours (SMD = -0.80; 95% CI = -1.05 to -0.56), and 24 hours (SMD = -0.72; 95% CI = -1.02 to -0.43). The results of the sensitivity analysis confirmed the findings of the primary analysis. Based on these results, it can be concluded that premedication is effective in reducing postoperative pain in teeth with irreversible pulpitis. However, additional quality studies are required for further validation.
PubMed: 34703890
DOI: 10.17245/jdapm.2021.21.5.397 -
PeerJ 2021The goal of this systematic review and meta-analysis is to determine the performance of 4% Articaine 2% Lidocaine for mandibular and maxillary block and infiltration...
Efficacy of 4% articaine 2% lidocaine in mandibular and maxillary block and infiltration anaesthesia in patients with irreversible pulpitis: a systematic review and meta-analysis.
OBJECTIVE
The goal of this systematic review and meta-analysis is to determine the performance of 4% Articaine 2% Lidocaine for mandibular and maxillary block and infiltration anaesthesia in patients with irreversible pulpitis (IP).
METHODS
PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, Google Scholar, and Open Gray were used to conduct a thorough literature search. A manual search of the reference lists of the publications found was also carried out. Two reviewers critically evaluated the papers for inclusion and exclusion criteria, and data extraction was done on the selected publications. The Cochrane Collaboration Tool and the Minors checklist were used to assess the quality of the selected studies for randomised controlled trials (RCTs) and non-randomised studies, respectively. The RevMan software was used to perform a meta-analysis of the pooled data and subgroups according to the technique of anaesthetic solution delivery, as well as a sensitivity analysis ( < 0.05).
RESULTS
A total of twenty-six papers were included in the qualitative synthesis, with twenty-two of them being included in the meta-analysis. There were fifteen studies with a low potential for bias, three with a moderate potential for bias, and seven with a high potential for bias. The combined results of the 19 trials in the tooth level unit revealed that 4% articaine had a success rate 1.37 times greater than 2% lidocaine for mandibular teeth (RR, 1.37; 95% CI [1.17-1.62]; = 0.0002). For the maxillary buccal infiltration method, the combined results from the three trials revealed that 4% articaine resulted in a success rate 1.06 times greater than 2% lidocaine (RR, 1.06; 95% CI [0.95-1.2]; = 0.3). Excluding subgroups with a single study in sensitivity analysis for mandibular teeth revealed a substantial improvement in the success rate of the articaine group in treating IP when compared to the lidocaine group.
CONCLUSION
The findings of this meta-analysis back up the claim that articaine is more effective than lidocaine in providing anaesthesia in patients with IP. PROSPERO Registration No.: CRD42020204606 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020204606).
PubMed: 34631321
DOI: 10.7717/peerj.12214 -
Medicina Oral, Patologia Oral Y Cirugia... Nov 2021It is unclear if buccal articaine infiltration can be used as an alternative to standard inferior alveolar nerve block (IANB) for treating mandibular molars in pediatric... (Meta-Analysis)
Meta-Analysis
Can buccal infiltration of articaine replace traditional inferior alveolar nerve block for the treatment of mandibular molars in pediatric patients?: A systematic review and meta-analysis.
BACKGROUND
It is unclear if buccal articaine infiltration can be used as an alternative to standard inferior alveolar nerve block (IANB) for treating mandibular molars in pediatric patients. Therefore, this study aimed to pool evidence to compare the efficacy of buccal infiltration of articaine vs IANB with lignocaine for pediatric dental procedures.
MATERIAL AND METHODS
We searched the PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar databases for randomized controlled trials (RCTs) comparing the two techniques in pediatric patients and reporting the success of anesthesia and/or pain during treatment. PRISMA guidelines were followed.
RESULTS
Seven RCTs were included. Pooled analysis of five studies indicated no statistically significant difference in the success rates of the two anesthetic techniques (OR: 1.02; 95% CI: 0.13, 7.96; I2=69%, p=0.98). Meta-analysis of data from the four studies demonstrated no statistically significant difference in pain during the procedure with buccal infiltration of articaine or IANB with lignocaine (SMD: 0.62; 95% CI: -1.37, 0.12; I2=88%, p=0.10).
CONCLUSIONS
Evidence suggests that buccal infiltration of articaine is a viable alternative to IANB with lignocaine in pediatric patients for treating mandibular molars. Based on the confidence intervals, there may be a tendency of higher success rates with buccal infiltration of articaine.
Topics: Anesthesia, Dental; Anesthetics, Local; Carticaine; Child; Double-Blind Method; Humans; Lidocaine; Mandibular Nerve; Molar; Nerve Block; Pulpitis
PubMed: 34564678
DOI: 10.4317/medoral.24726 -
Journal of Dental Anesthesia and Pain... Aug 2021Achieving profound anesthesia in mandibular molars with irreversible pulpitis is a tedious task. This review aimed at evaluating the success of buccal/lingual... (Review)
Review
Anesthetic efficacy of primary and supplemental buccal/lingual infiltration in patients with irreversible pulpitis in human mandibular molars: a systematic review and meta-analysis.
Achieving profound anesthesia in mandibular molars with irreversible pulpitis is a tedious task. This review aimed at evaluating the success of buccal/lingual infiltrations administered with a primary inferior alveolar nerve block (IANB) injection or as a supplemental injection after the failure of the primary injection in symptomatic and asymptomatic patients with irreversible pulpitis in human mandibular molars. The review question was "What will be the success of primary and supplemental infiltration injection in the endodontic treatment of patients with irreversible pulpitis in human mandibular molars?" We searched electronic databases, including Pubmed, Scopus, and Ebsco host and we did a comprehensive manual search. The review protocol was framed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. We included clinical studies that evaluated and compared the anesthetic outcomes of primary IANB with primary and/or supplementary infiltration injections. Standard evaluation of the included studies was performed and suitable data and inferences were assessed. Twenty-six studies were included, of which 13 were selected for the meta-analysis. In the forest plot representation of the studies evaluating infiltrations, the combined risk ratio (RR) was 1.88 (95% CI: 1.49, 2.37), in favor of the secondary infiltrations with a statistical heterogeneity of 77%. The forest plot analysis for studies comparing primary IANB + infiltration versus primary IANB alone showed a low heterogeneity (0%). The included studies had similar RRs and the combined RR was 1.84 (95% CI: 1.44, 2.34). These findings suggest that supplemental infiltrations given along with a primary IANB provide a better success rate. L'Abbe plots were generated to measure the statistical heterogeneity among the studies. Trial sequential analysis suggested that the number of patients included in the analysis was adequate. Based on the qualitative and quantitative analyses, we concluded that the infiltration technique, either as a primary injection or as a supplementary injection, given after the failure of primary IANB, increases the overall anesthetic efficacy.
PubMed: 34395897
DOI: 10.17245/jdapm.2021.21.4.283 -
Journal of Dental Anesthesia and Pain... Aug 2021This review aimed to assess and compare the outcomes of the anesthetic efficacy of inferior alveolar nerve block (IANB) and Gow-Gates mandibular nerve block (GGMNB) in... (Review)
Review
This review aimed to assess and compare the outcomes of the anesthetic efficacy of inferior alveolar nerve block (IANB) and Gow-Gates mandibular nerve block (GGMNB) in patients with symptomatic irreversible pulpitis. A descriptive systematic review of quantitative research was conducted wherein the "Preferred Reporting Items for Systematic Reviews (PRISMA)" was adopted, and the Problem/Patient/Population, Intervention/Indicator, Comparison, Outcome (PICO) criteria were used to structure the research question. A literature search was performed using PubMed/Medline, Cochrane Library, Google Scholar, and Ovid. Selection criteria were applied for populations over nine years of age, of either sex, with irreversible pulpitis, and articles published in English regarding conventional IANB or IANB and Gow-Gates techniques between 2009 and 2019. Prospective randomized clinical trials or randomized controlled trials were included in the review, in which anesthetic efficacy or success was measured. After screening, four articles were included. Three studies were randomized clinical trials, and two were randomized controlled trials. The validity and reliability of the individual studies were examined. There was evidence of the higher efficacy of the GGMNB technique than that of the IANB technique. However, both techniques can be mastered through training.
PubMed: 34395896
DOI: 10.17245/jdapm.2021.21.4.269 -
Molecules (Basel, Switzerland) Jul 2021A wide range of mediators are released from the pulp tissue because of bacterial invasion which causes inflammation. Interleukins (ILs) and matrix metalloproteinases...
A wide range of mediators are released from the pulp tissue because of bacterial invasion which causes inflammation. Interleukins (ILs) and matrix metalloproteinases (MMPs) have a leading role in initiating and spreading of inflammation because of their synergic action. Biomarkers such as ILs and MMPs can be identified via several methods, establishing the inflammatory response of the dental pulp. The aim of this systematic review is to evaluate the levels of ILs and/or MMPs in human dental pulp. PubMed, OVID, Cochrane, Scopus, Web of Science and Wiley online library databases were searched for original clinical studies. After applying inclusion and exclusion criteria, a quality assessment of studies was performed based on a modified Newcastle-Ottawa scale. In the review were included articles that evaluated the presence of ILs and/or MMPs in pulp tissue using enzyme-linked immunosorbent assay (ELISA) or western blot or multiplex assay. Six articles were included in the present synthesis. Although various diagnostic methods were used, statistically significant higher levels of ILs and/or MMPs were mostly found in the experimental groups compared to healthy pulp samples. The biomarkers studied can be a promising tool to evaluate pulp tissue health or even in pulpitis treatment.
Topics: Dental Pulp; Humans; Inflammation; Interleukins; Matrix Metalloproteinases
PubMed: 34299403
DOI: 10.3390/molecules26144129 -
The Cochrane Database of Systematic... Jul 2021Traditionally, cavitated carious lesions and those extending into dentine have been treated by 'complete' removal of carious tissue, i.e. non-selective removal and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Traditionally, cavitated carious lesions and those extending into dentine have been treated by 'complete' removal of carious tissue, i.e. non-selective removal and conventional restoration (CR). Alternative strategies for managing cavitated or dentine carious lesions remove less or none of the carious tissue and include selective carious tissue removal (or selective excavation (SE)), stepwise carious tissue removal (SW), sealing carious lesions using sealant materials, sealing using preformed metal crowns (Hall Technique, HT), and non-restorative cavity control (NRCC).
OBJECTIVES
To determine the comparative effectiveness of interventions (CR, SE, SW, sealing of carious lesions using sealant materials or preformed metal crowns (HT), or NRCC) to treat carious lesions conventionally considered to require restorations (cavitated or micro-cavitated lesions, or occlusal lesions that are clinically non-cavitated but clinically/radiographically extend into dentine) in primary or permanent teeth with vital (sensitive) pulps.
SEARCH METHODS
An information specialist searched four bibliographic databases to 21 July 2020 and used additional search methods to identify published, unpublished and ongoing studies. SELECTION CRITERIA: We included randomised clinical trials comparing different levels of carious tissue removal, as listed above, against each other, placebo, or no treatment. Participants had permanent or primary teeth (or both), and vital pulps (i.e. no irreversible pulpitis/pulp necrosis), and carious lesions conventionally considered to need a restoration (i.e. cavitated lesions, or non- or micro-cavitated lesions radiographically extending into dentine). The primary outcome was failure, a composite measure of pulp exposure, endodontic therapy, tooth extraction, and restorative complications (including resealing of sealed lesions).
DATA COLLECTION AND ANALYSIS
Pairs of review authors independently screened search results, extracted data, and assessed the risk of bias in the studies and the overall certainty of the evidence using GRADE criteria. We measured treatment effects through analysing dichotomous outcomes (presence/absence of complications) and expressing them as odds ratios (OR) with 95% confidence intervals (CI). For failure in the subgroup of deep lesions, we used network meta-analysis to assess and rank the relative effectiveness of different interventions.
MAIN RESULTS
We included 27 studies with 3350 participants and 4195 teeth/lesions, which were conducted in 11 countries and published between 1977 and 2020. Twenty-four studies used a parallel-group design and three were split-mouth. Two studies included adults only, 20 included children/adolescents only and five included both. Ten studies evaluated permanent teeth, 16 evaluated primary teeth and one evaluated both. Three studies treated non-cavitated lesions; 12 treated cavitated, deep lesions, and 12 treated cavitated but not deep lesions or lesions of varying depth. Seventeen studies compared conventional treatment (CR) with a less invasive treatment: SE (8), SW (4), two HT (2), sealing with sealant materials (4) and NRCC (1). Other comparisons were: SE versus HT (2); SE versus SW (4); SE versus sealing with sealant materials (2); sealant materials versus no sealing (2). Follow-up times varied from no follow-up (pulp exposure during treatment) to 120 months, the most common being 12 to 24 months. All studies were at overall high risk of bias. Effect of interventions Sealing using sealants versus other interventions for non-cavitated or cavitated but not deep lesions There was insufficient evidence of a difference between sealing with sealants and CR (OR 5.00, 95% CI 0.51 to 49.27; 1 study, 41 teeth, permanent teeth, cavitated), sealing versus SE (OR 3.11, 95% CI 0.11 to 85.52; 2 studies, 82 primary teeth, cavitated) or sealing versus no treatment (OR 0.05, 95% CI 0.00 to 2.71; 2 studies, 103 permanent teeth, non-cavitated), but we assessed all as very low-certainty evidence. HT, CR, SE, NRCC for cavitated, but not deep lesions in primary teeth The odds of failure may be higher for CR than HT (OR 8.35, 95% CI 3.73 to 18.68; 2 studies, 249 teeth; low-certainty evidence) and lower for HT than NRCC (OR 0.19, 95% CI 0.05 to 0.74; 1 study, 84 teeth, very low-certainty evidence). There was insufficient evidence of a difference between SE versus HT (OR 8.94, 95% CI 0.57 to 139.67; 2 studies, 586 teeth) or CR versus NRCC (OR 1.16, 95% CI 0.50 to 2.71; 1 study, 102 teeth), both very low-certainty evidence. CR, SE, SW for deep lesions The odds of failure were higher for CR than SW in permanent teeth (OR 2.06, 95% CI 1.34 to 3.17; 3 studies, 398 teeth; moderate-certainty evidence), but not primary teeth (OR 2.43, 95% CI 0.65 to 9.12; 1 study, 63 teeth; very low-certainty evidence). The odds of failure may be higher for CR than SE in permanent teeth (OR 11.32, 95% CI 1.97 to 65.02; 2 studies, 179 teeth) and primary teeth (OR 4.43, 95% CI 1.04 to 18.77; 4 studies, 265 teeth), both very low-certainty evidence. Notably, two studies compared CR versus SE in cavitated, but not deep lesions, with insufficient evidence of a difference in outcome (OR 0.62, 95% CI 0.21 to 1.88; 204 teeth; very low-certainty evidence). The odds of failure were higher for SW than SE in permanent teeth (OR 2.25, 95% CI 1.33 to 3.82; 3 studies, 371 teeth; moderate-certainty evidence), but not primary teeth (OR 2.05, 95% CI 0.49 to 8.62; 2 studies, 126 teeth; very low-certainty evidence). For deep lesions, a network meta-analysis showed the probability of failure to be greatest for CR compared with SE, SW and HT.
AUTHORS' CONCLUSIONS
Compared with CR, there were lower numbers of failures with HT and SE in the primary dentition, and with SE and SW in the permanent dentition. Most studies showed high risk of bias and limited precision of estimates due to small sample size and typically limited numbers of failures, resulting in assessments of low or very low certainty of evidence for most comparisons.
Topics: Adolescent; Adult; Bias; Child; Child, Preschool; Crowns; Dental Atraumatic Restorative Treatment; Dental Caries; Dental Restoration Failure; Dentin; Dentition, Permanent; Humans; Middle Aged; Network Meta-Analysis; Pit and Fissure Sealants; Randomized Controlled Trials as Topic; Tooth, Deciduous
PubMed: 34280957
DOI: 10.1002/14651858.CD013039.pub2 -
Medicina (Kaunas, Lithuania) Jun 2021: Symptomatic irreversible pulpitis in permanent mature teeth is a common indication for nonsurgical root canal treatment (NSRCT), but contemporary studies have reported... (Review)
Review
: Symptomatic irreversible pulpitis in permanent mature teeth is a common indication for nonsurgical root canal treatment (NSRCT), but contemporary studies have reported on vital pulp therapy (VPT) applied in such teeth as a less invasive treatment. This systematic review assessed the outcomes of VPT, including partial and full pulpotomy performed with hydraulic calcium silicate cements (HCSCs) in permanent mature posterior teeth diagnosed with symptomatic irreversible pulpitis. : The PRISMA guidelines were followed. The search strategy included PubMed, EMBASE, Cochrane library and grey literature electronic databases. The quality assessment of the identified studies followed the Cochrane Collaboration Risk of Bias, ROBINS-I and Newcastle-Ottawa Scale tools. : The search of primary databases identified 142 articles, of which 9 randomized controlled trials and 3 prospective cohort studies were selected for review. The risk-of-bias was assessed as 'high' or 'serious', 'fair', and 'low' for three, seven and two articles, respectively. One to five years after VPT using HCSCs, the success rates mostly ranged from 78 to 90%. Based on two articles, the outcomes of the VPT and NSRCT were comparable at one and five years. Despite the necessity for the intra-operative pulp assessment in VPT procedures, the majority of the studies did not fully report on this step or on the time needed to achieve hemostasis. Small sample sizes, of under 23 teeth, were reported in three studies. : The reviewed 12 articles reported favorable outcomes of the VPT performed with HCSCs in permanent mature posterior teeth with symptomatic irreversible pulpitis, with radiographic success in the range of 81 to 90%. Two articles suggested comparable outcomes of the VPT and root canal treatment. Universal case selection and outcome criteria needs to be established for VPT when considered as an alternative to NSRCT. This evidence supports the need for further research comparing longer-term outcomes of both of the treatment modalities.
Topics: Dentition, Permanent; Humans; Prospective Studies; Pulpitis; Pulpotomy; Treatment Outcome
PubMed: 34205149
DOI: 10.3390/medicina57060573 -
Journal of Conservative Dentistry : JCD 2020The objective of the present systematic review is to evaluate the success of pulpotomy in mature permanent teeth presented with irreversible pulpitis. The following... (Review)
Review
The objective of the present systematic review is to evaluate the success of pulpotomy in mature permanent teeth presented with irreversible pulpitis. The following databases were searched: PubMed, Oral and Dentistry Database, Cochrane, and CINAHL plus. We included studies published in the English language only. However, narrative reviews and case reports/series were excluded. The first electronic and hand search yielded a total of 2851 articles. After going through extensive screening and eligibility process, only six articles were finally selected for the review. The follow-up period ranged from 1 to 10 years. Randomized controlled trial compared pulpotomy with the root canal treatment and reported comparable and even better success of the pulpotomy (78% success). All the other studies have also shown better clinical and radiographic success of pulpotomy (68%-100%). Pulpotomy can be considered an alternative option for mature permanent teeth with irreversible pulpitis.
PubMed: 33384481
DOI: 10.4103/JCD.JCD_179_19