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The Journal of Prosthetic Dentistry May 2024The gingival zenith (GZ) influences the line angle position in the emergence profile and the axial inclination of the crown. Irregularities in GZ symmetry and contour... (Review)
Review
STATEMENT OF PROBLEM
The gingival zenith (GZ) influences the line angle position in the emergence profile and the axial inclination of the crown. Irregularities in GZ symmetry and contour have a negative impact on dental esthetics. GZ location is not consistently distal to the crown's long axis; instead, it tends to be more distal in anterior teeth. The GZ levelling of the lateral incisor is often described as either level with or slightly above the zenith line connecting the central incisor and canine teeth, but there are also reports of GZ being aligned apically to the zenith line. Controversial reports persist regarding GZ positioning, magnitude, and location, potentially leading to inadequate positioning and levelling of the GZ in esthetic restorative therapy.
PURPOSE
The purpose of this systematic review and meta-analysis was to assess the scientific evidence related to GZ level, position, and symmetry in maxillary incisors and canines.
MATERIAL AND METHODS
This study adhered to the population, variable, outcome (PVO) criteria and the preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist. Cross-sectional studies involving healthy adults with complete dentition of the maxillary anterior sextant were subjected to prevalence analysis and quantitative measurement to assess the gingival zenith level and position. Data were extracted, and methodological quality was appraised using the Joanna Briggs Institute critical appraisal checklist for analytical cross-sectional studies. Certainty of evidence was evaluated through the grading of recommendations, assessment, development, and evaluation (GRADE) system.
RESULTS
The GZs were distally positioned, coinciding with the tooth axis or mesially positioned in, respectively, 96%, 3%, and 1% on central incisors; 84%, 14%, and 1% on lateral incisors; and 43%, 44%, and 5% on canines. GZ distal positioning was greater in central incisors, followed by lateral incisors and canines. In lateral incisors, the GZ was levelled coronally in 82% of the population. Contralateral symmetry was observed for GZ levelling and positioning. The certainty of the evidence was very low for all comparisons.
CONCLUSIONS
The frequency and magnitude of the distal position of the GZ increased the more anterior the tooth. Axially, the GZ was frequently levelled coronally to the zenith line. The contralateral positioning and levelling of the GZ was symmetrical.
PubMed: 38704322
DOI: 10.1016/j.prosdent.2024.03.031 -
European Archives of... May 2024Most of Superior Semicircular Canal Dehiscence (SSCD) are located in the apical region of the SSC. However, in a small number of cases, it may be situated in the medial...
PURPOSE
Most of Superior Semicircular Canal Dehiscence (SSCD) are located in the apical region of the SSC. However, in a small number of cases, it may be situated in the medial wall, causing the SSC to contact with the superior petrosal sinus (SPS). The aim of this study is to describe four patients with SSCD involving the superior petrosal sinus (SSCD-SPS) and to perform a review of the literature.
METHODS
Observational retrospective study of patients diagnosed of SSCD-SPS in a tertiary referral center. A systematic review was made, identifying 7 articles in the literature. Clinical presentation, complementary test (pure-tone audiometry, PTA; vestibular evoked myogenic potential, VEMP; computed tomography, CT), therapeutic management and outcomes were reported.
RESULTS
Four new cases of SSCD-SPS are reported, in three of them a transmastoid plugging was performed. 54 patients with SSCD-SPS (57 dehiscences) were reported in the literature. The most frequent symptoms were aural pressure (57.41%) and vertigo provoked by pressure/Valsalva (55.55%). Conductive hearing loss was the most common finding in PTA (47.37%). Abnormally low thresholds were observed in 59.46% of reported VEMP. Transmastoid approach was used in ten cases, middle fossa approach in four, round window reinforcement in one, and occlusion of the SPS using coils in two.
CONCLUSIONS
Within SSCD, we have encountered a rare subtype characterized by its medial wall location in close proximity to the SPS. This subgroup needs special consideration as it has shown its own distinct characteristics. Regarding therapeutic management, we advocate a transmastoid approach.
PubMed: 38698161
DOI: 10.1007/s00405-024-08682-1 -
International Dental Journal Apr 2024The aim of this study was to evaluate the amount of external apical root resorption in patients who had undergone orthodontic treatment with clear aligners evaluated...
OBJECTIVE
The aim of this study was to evaluate the amount of external apical root resorption in patients who had undergone orthodontic treatment with clear aligners evaluated using cone beam computed tomography.
METHODS
Studies that evaluated external apical root resorption before and after comprehensive orthodontic treatment with clear aligners were assessed by performing an electronic search from 5 databases comprising PubMed, SCOPUS, EBSCO, Cochrane Library, and LILACS and manual searches in the relevant journals and the reference lists of the included studies. Database search, elimination of duplicate studies, and data extraction were performed independently by 2 authors. The quality of the included studies was assessed using the Risk of Bias in Non-randomised Studies-of Interventions and the Cochrane Collaboration's Risk of Bias Tool. Studies that reported the tooth length or volume were used for quantitative analyses.
RESULTS
Nine studies were included in the meta-analysis. The overall root length after clear aligner treatment was significantly decreased compared with the pre-treatment length using cone beam computed tomography (mean differences = -0.56 mm, 95% confidence interval [-0.73, -0.38], P < .00001). However, only the maxillary central incisors, maxillary lateral incisors, and mandibular central incisors had significant reduction in root length. The meta-analysis from 3 studies also indicated that the root volume of the upper incisors also significantly decreased (mean differences = -13.34 mm, 95% confidence interval [-16.57, -10.10], P < .00001).
CONCLUSIONS
Current evidence suggests that clear aligners can cause minimal root resorption. The highest amount of root resorption was observed in the maxillary central incisors.
PubMed: 38692962
DOI: 10.1016/j.identj.2024.04.008 -
Antibiotics (Basel, Switzerland) Mar 2024After pulp infection and necrosis, the passage of microbial antigens into the periapical space causes apical periodontitis (AP). Most of the clinical forms of AP can be... (Review)
Review
UNLABELLED
After pulp infection and necrosis, the passage of microbial antigens into the periapical space causes apical periodontitis (AP). Most of the clinical forms of AP can be managed without prescribing antibiotics, only with root canal treatment and abscess drainage or, where appropriate, tooth extraction. However, the scientific literature provides evidence of inappropriate antibiotic prescriptions by dentists in the management of apical disease.
OBJECTIVES
The aim of this systematic review and meta-analysis was to analyze the global pattern of antibiotic prescription in the treatment of apical disease.
METHODS
PRISMA Guidelines were followed to carry out this systematic review. The research question was as follows: What is the pattern of antibiotic prescription by dentists in the treatment of the different clinical forms of apical periodontitis? A systematic search was conducted on MEDLINE/PubMed, Wiley Online Database, Web of Science and Scopus. All studies reporting data about the pattern of antibiotic prescription by dentists in the treatment of apical disease were included. The meta-analyses were calculated using the Open Meta Analyst version 10.10 software. Random-effects meta-analyses were performed. The risk of bias was assessed using the Newcastle-Ottawa Scale. The certainty of evidence was assessed using GRADE.
RESULTS
The search strategy identified 96 articles and thirty-nine cross-sectional studies fulfilled the inclusion criteria. The overall percentage of antibiotic prescriptions by dentists in cases of symptomatic AP was 25.8%, and 31.5% in cases of asymptomatic AP with sinus tract present. The percentage of dentists prescribing antibiotics in cases of acute apical abscess with no/mild symptoms was 47.7%, whereas, in cases of acute apical abscess with moderate/severe symptoms, 88.8% of dentists would prescribe antibiotics. Endodontists prescribe antibiotics at a lower rate than general practitioners. The total risk of bias was considered moderate, and the final rating for the certainty of the evidence was low.
CONCLUSIONS
Dentists worldwide are over-prescribing antibiotics in the management of apical disease. It is necessary to improve antibiotic prescribing habits in the treatment of endodontic infections, as well as educational initiatives to encourage the rational and appropriate prescription of antibiotics in periapical diseases.
PubMed: 38666965
DOI: 10.3390/antibiotics13040289 -
International Endodontic Journal Aug 2024Microorganisms colonizing the apical root canal system are conceivably the ones directly involved with the causation and maintenance of apical periodontitis. (Review)
Review
BACKGROUND
Microorganisms colonizing the apical root canal system are conceivably the ones directly involved with the causation and maintenance of apical periodontitis.
OBJECTIVES
This article systematically reviews the reports on the microbiome occurring exclusively at the apical root canal of teeth with primary and posttreatment apical periodontitis.
METHODS
The electronic databases PubMed, Embase, Web of Science, Science Direct, and Proquest were searched up to August 2023. Clinical studies using culture and molecular microbiology methods to identify the microbial taxa present exclusively in the apical root canal segment of infected teeth with apical periodontitis were included. Studies were critically assessed using the Joanna Briggs Institute Critical Prevalence Assessment Checklist.
RESULTS
From 2277 articles initially detected, 52 were selected for full reading and 21 were eventually included in this review. Of these, molecular methods were used in 19 and culture in 2 studies. Ten studies evaluated primary infections, 8 evaluated posttreatment infections, and 3 included both. Cryopulverization of the apical root specimens was conducted in 11 studies. All studies evaluated the prevalence and diversity of bacteria, and only one also reported on fungi. Overall, the most frequent/abundant bacterial taxa found in the apical canal of primary infections were Pseudoramibacter alactolyticus, Olsenella uli, Fusobacterium species, Streptococcus species, Porphyromonas endodontalis, Prevotella species, Actinomyces species, Parvimonas micra, Treponema denticola, Synergistetes species, and an as-yet uncharacterized taxon. In posttreatment infections, the most prevalent/abundant bacterial taxa included species of Streptococcus, Enterococcus, Fusobacterium, Actinomyces, Pseudoramibacter, Pseudomonas, and Propionibacterium. At the phylum level, Firmicutes was the most represented. The average apical bacterial load ranged from 10 to 10 in primary infections and from 10 to 10 in posttreatment infections.
DISCUSSION
Microbial diversity in the apical part of the root canal system was examined encompassing data from both primary and posttreatment infections. Heterogeneity amongst the studies, especially in sample collection and microbial identification methods, is an important limitation that prevented a meta-analysis.
CONCLUSIONS
There is a pronounced bacterial diversity in the infected apical canal, with a high interindividual variability. Different microbiome compositions at the species/genus level are observed according to the infection type.
REGISTRATION
PROSPERO CRD42021275886.
Topics: Periapical Periodontitis; Humans; Microbiota; Dental Pulp Cavity; Bacteria
PubMed: 38634795
DOI: 10.1111/iej.14071 -
European Journal of Oral Sciences Jun 2024This systematic review and meta-analysis aimed to determine whether apical patency increases postoperative pain after endodontic therapy. This study explored the degree... (Meta-Analysis)
Meta-Analysis
This systematic review and meta-analysis aimed to determine whether apical patency increases postoperative pain after endodontic therapy. This study explored the degree and incidence of postoperative pain during root canal therapy, as well as the number of required analgesic doses. We searched PubMed, Scopus, Embase, Web of Science, Cochrane Library, and gray literature from the date of database inception until May 2023. RevMan 5.4 software was used for data analysis. Twelve studies were considered eligible for meta-analysis. The mean pain scores on days 1 (mean difference [MD] = -1.69) and 2 (MD = -0.85) differed significantly between the apical patency and non-patency groups. The odds for pain after 24 h were significantly lower (OR 0.59) in the apical patency group than in the non-patency group. Furthermore, the mean number of required analgesic doses was not significantly different between the two groups. In conclusion, apical patency significantly alleviated postoperative pain (low-quality evidence) and reduced the incidence of pain (moderate evidence). However, high-quality randomized controlled trials are required to validate these findings.
Topics: Humans; Pain Measurement; Pain, Postoperative; Root Canal Therapy; Tooth Apex
PubMed: 38632110
DOI: 10.1111/eos.12986 -
The International Journal of Oral &... Apr 2024The purpose of this systematic review was to assess histological and imaging outcomes related to new bone formation around implants, inserted simultaneously with sinus...
PURPOSE
The purpose of this systematic review was to assess histological and imaging outcomes related to new bone formation around implants, inserted simultaneously with sinus augmentation, comparing different types of grafts.
MATERIALS AND METHODS
Systematic Review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta- Analysis (PRISMA), and the Cochrane Handbook for Systematic Reviews of Interventions. LILACS/BVS, Medline/PubMed, Cochrane Library and Embase databases, including gray literature and manual investigation, were searched to identify clinical trials reporting human histological and imaging data of bone formation around implants, inserted into the maxillary sinus at the same moment of the elevation and augmentation procedure, using several materials. Study selection, risk of bias (Rob 2.0 or ROBINS I), quality of evidence (GRADE), and data collection were performed by two independent reviewers.
RESULTS
Of the 1101 potentially eligible articles, 44 were retrieved, 12 were assessed for eligibility and 5 were included in this systematic review (4 randomized and one controlled clinical trials). As a result, 130 grafted sinuses with 179 installed implants in 103 patients, aged between 24 and 79 years and followed up from 6 to 15 months, were analyzed. The heterogeneity between studies did not allow the data to be combined for meta-analyses. All graft materials proved to be viable options for the intervention. The use of BCP was related to higher bone-to-implant contact.
CONCLUSION
All the assessed grafts are viable options for the intervention addressed. The use of some material is justified to maintain the sinus volume and allow bone formation in the apical site of implants under the sinus membrane. Longer chair time and the morbidity of the donor site should be considered when choosing autogenous bone. Synthetic biphasic materials can be selected for this intervention due to superior values of %BIC when compared to DBB.
PubMed: 38607362
DOI: 10.11607/jomi.10600 -
Iranian Endodontic Journal 2024Foraminal Enlargement (FE) is a cleaning performed in the apical-most region of the tooth, in order to optimize root disinfection. This systematic review evaluated the... (Review)
Review
INTRODUCTION
Foraminal Enlargement (FE) is a cleaning performed in the apical-most region of the tooth, in order to optimize root disinfection. This systematic review evaluated the influence of FE during root canal treatment on bacterial reduction and repair of the periapical lesion.
MATERIALS AND METHODS
Searches in PubMed/MEDLINE, Scopus, Cochrane Library, Web of Science, Embase, Scielo, Lilacs and OpenGrey were performed until January-2024. and studies evaluating the effects of FE in the bacterial reduction and repair of the periapical lesion were included, respectively, followed by risk of bias assessment (modified version of Joanna Briggs Institute's for studies and Systematic Review Centre for Laboratory animal Experimentation's risk of bias tools for studies). The meta-analysis was not feasible and a qualitative summary for each outcome was provided.
RESULTS
Of 950 studies, 2 studies were eligible, using animal models with infected teeth. Of these two, periapical repair was evaluated with hematoxylin-eosin stain, and FE improved periapical healing. Regarding studies, 3 were eligible, using extracted human teeth. The inoculations in models were performed with and FE reduced in the models.
CONCLUSIONS
Foraminal enlargement seems to increase bacterial reduction within the root canal, and provide major periapical tissue repair on the histological analysis in animal studies. However, caution is necessary when translating these results to the clinical environment.
PubMed: 38577004
DOI: 10.22037/iej.v19i2.44037 -
Journal of Endodontics Jun 2024This systematic review and meta-analysis aimed to evaluate the clinical and radiographic failure of nonsurgical endodontic treatment and retreatment for mature permanent... (Meta-Analysis)
Meta-Analysis Review
Clinical and Radiographic Failure of Nonsurgical Endodontic Treatment and Retreatment Using Single-cone Technique With Calcium Silicate-based Sealers: A Systematic Review and Meta-analysis.
INTRODUCTION
This systematic review and meta-analysis aimed to evaluate the clinical and radiographic failure of nonsurgical endodontic treatment and retreatment for mature permanent teeth with or without apical periodontitis using the single-cone (SC) obturation technique with calcium silicate-based bio-ceramic (CSBC) sealers and to compare these failure rates to other sealer materials and obturation techniques.
METHODS
A comprehensive search was conducted using MEDLINE (PubMed), Embase, Cochrane Library, Scopus, Web of Science, and gray literature up to March 2023. Two reviewers assessed the eligibility of the included studies. Eligible studies were critically appraised for risk of bias and quality of evidence. Subsequently, a meta-analysis of pooled data was conducted utilizing the RevMan software (P < .05) to evaluate the failure rate of non-surgical root canal therapy using CSBC sealers and SC obturation procedures. Separately, another analysis was conducted to compare those results with the outcome of nonsurgical root canal therapy using alternative obturation materials and methods.
RESULTS
Five studies were included. The pooled failure rate for nonsurgical endodontic treatment and retreatment combined using CSBC sealers and SC obturation technique was 6.8% [95% confidence interval (CI) = (3%-12%), I = 46%]. A second analysis was conducted on the 3 included clinical trials to compare the outcomes of the intervention (CSBC sealers and SC obturation technique) and control groups (other sealers and other obturation techniques). This analysis found no significant difference between the 2 groups regarding clinical and radiographic failure of endodontic treatment and retreatment [Risk ratio = 0.71, 95% CI = (0.33, 1.51), I = 0]. This difference was also not statistically significant when the failure rate of primary root canal treatment and retreatment were separately analyzed [Combined Risk ratio of primary root canal treatment = 0.94, 95% CI = (0.46, 1.93), I = 0%; Combined Risk ratio of retreatment = 0.21, 95% CI = (0.001, 75.46), I = 0%].
CONCLUSIONS
The overall results of this systematic review and meta-analysis demonstrate that the SC obturation technique with CSBC sealer provides similar results compared to other obturation materials and techniques in facilitating the healing of apical periodontitis.
Topics: Humans; Calcium Compounds; Dental Restoration Failure; Periapical Periodontitis; Retreatment; Root Canal Filling Materials; Root Canal Obturation; Root Canal Therapy; Silicates; Treatment Failure
PubMed: 38548045
DOI: 10.1016/j.joen.2024.03.007 -
Journal of Endodontics Jul 2024This systematic review aimed to compare reciprocating with continuous rotary instrumentation kinematics, by means of microcomputed tomography evaluations, in extracted...
Shaping Efficiency of Rotary and Reciprocating Kinematics of Engine-driven Nickel-Titanium Instruments in Moderate and Severely curved Root Canals Using Microcomputed Tomography: A Systematic Review of Ex Vivo Studies.
INTRODUCTION
This systematic review aimed to compare reciprocating with continuous rotary instrumentation kinematics, by means of microcomputed tomography evaluations, in extracted human permanent teeth with moderate and severe canal curvatures.
METHODS
The research protocol was registered in the International Prospective Register of Systematic Reviews and given the reference number CRD42023404035. An electronic search was undertaken in MEDLINE (PubMed), EBSCO, Scopus, Web of Science databases until December 2021. Manual screening of issues in endodontic journals and references of relevant articles were assessed individually. The risk of bias (RoB) of the included articles was evaluated with the QUIN tool (Quality Assessment Tool for In Vitro Studies).
RESULTS
Among 1640 retrieved articles, 49 were included in the qualitative synthesis. Fifteen articles had low RoB, 33 articles had medium RoB, and only 1 study was at high RoB. Continuous rotary systems had better centering ability in both moderate and severe canal curvatures and resulted in less apical transportation in severely curved root canals. None of the kinematic systems was capable of instrumenting the entire canal surface area. Reciprocating kinematics systems tended to provide higher increase in surface area of severely curved canals and produced fewer dentinal microcracks in moderately curved canals.
CONCLUSIONS
The evidence presented in this review suggests that continuous rotary system seems to be better than reciprocating system in solving the major issues encountered during root canal instrumentation of extracted teeth with moderate and severe curvatures.
Topics: Humans; Biomechanical Phenomena; Dental Instruments; Dental Pulp Cavity; Equipment Design; Nickel; Root Canal Preparation; Titanium; X-Ray Microtomography
PubMed: 38537784
DOI: 10.1016/j.joen.2024.03.009