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Journal of Functional Biomaterials Jan 2023(1) Background: Different compositions of biodegradable materials are being investigated to successfully replace non-resorbable ones in bone tissue regeneration in... (Review)
Review
(1) Background: Different compositions of biodegradable materials are being investigated to successfully replace non-resorbable ones in bone tissue regeneration in dental surgery. The systematic review tried to address the question, "Can biodegradable polymers act as a replacement for conventional materials in dental surgery procedures?" (2) Methods: An electronic search of the PubMed and Scopus databases was conducted in October 2022. The following keywords were used: (lactide polymers) and (hydroxyapatite or fluorapatite) and (dentistry) and (regeneration). Initially, 59 studies were found. Forty-one studies met the inclusion criteria and were included in the review. (3) Results: These usually improved the properties and induced osteogenesis, tissue mineralisation and bone regeneration by inducing osteoblast proliferation. Five studies showed higher induction of osteogenesis in the case of biomaterials, UV-HAp/PLLA, ALBO-OS, bioresorbable raw particulate hydroxyapatite/poly-L-lactide and PLGA/Hap, compared to conventional materials such as titanium. Four studies confirmed improvement in tissue mineralisation with the usage of biomaterials: hydroxyapatite/polylactic acid (HA/PLA) loaded with dog's dental pulp stem cells (DPSCs), Coll/HAp/PLCL, PDLLA/VACNT-O:nHAp, incorporation of hydroxyapatite and simvastatin. Three studies showed an acceleration in proliferation of osteoblasts for the use of biomaterials with additional factors such as collagen and UV light. (4) Conclusions: Lactide polymers present higher osteointegration and cell proliferation rate than the materials compared. They are superior to non-biodegradable materials in terms of the biocompability, bone remodelling and healing time tests. Moreover, because there is no need of reoperation, as the material automatically degrades, the chance of scars and skin sclerosis is lower. However, more studies involving greater numbers of biomaterial types and mixes need to be performed in order to find a perfect biodegradable material.
PubMed: 36826882
DOI: 10.3390/jfb14020083 -
JPMA. the Journal of the Pakistan... Feb 2023The aim of the review is to present the currently applied tissue regeneration through stem cells technology in regenerative endodontics. This review also summarises the...
OBJECTIVES
The aim of the review is to present the currently applied tissue regeneration through stem cells technology in regenerative endodontics. This review also summarises the various preclinical models used for the evaluation of stem cell-based therapies, their limitations, recent advances and challenges related to clinical applications of human stem cells.
METHODOLOGY
A literature survey from 2010 to August 2022 was carried out in various electronic databases to identify the articles required for review on Pulp Regeneration through Stem Cells Technology. MeSH terms/keywords such as "Pulp regeneration," "Pulp Revascularization," "Pulp revitalization," "Regenerative Endodontics" were used to search in the electronic databases comprised of PubMed database, SCOPUS, COCHRANRE library, EMBASE, CINAHL, ICTRP, Science Direct and a manual search was also done using the cross references and textbooks.
RESULTS
The searches revealed 299 articles. After reading the full text articles and applying the inclusion and exclusion criteria 15 articles were selected for the review fulfilling the criteria of the study.
CONCLUSIONS
Currently in regenerative endodontics, there is a broad consent that the final tissue acquired is more likely to bone-like tissue mixed with connective tissue rather than the pulp-dentin complex. Moreover, re-innervation from sensory axons in regenerated tissue, is still to date, difficult to achieve.
Topics: Humans; Dental Pulp; Regeneration; Regenerative Endodontics; Stem Cell Transplantation
PubMed: 36788390
DOI: 10.47391/JPMA.AKUS-07 -
Diagnostics (Basel, Switzerland) Jan 2023Technological advancements in health sciences have led to enormous developments in artificial intelligence (AI) models designed for application in health sectors. This... (Review)
Review
Technological advancements in health sciences have led to enormous developments in artificial intelligence (AI) models designed for application in health sectors. This article aimed at reporting on the application and performances of AI models that have been designed for application in endodontics. Renowned online databases, primarily PubMed, Scopus, Web of Science, Embase, and Cochrane and secondarily Google Scholar and the Saudi Digital Library, were accessed for articles relevant to the research question that were published from 1 January 2000 to 30 November 2022. In the last 5 years, there has been a significant increase in the number of articles reporting on AI models applied for endodontics. AI models have been developed for determining working length, vertical root fractures, root canal failures, root morphology, and thrust force and torque in canal preparation; detecting pulpal diseases; detecting and diagnosing periapical lesions; predicting postoperative pain, curative effect after treatment, and case difficulty; and segmenting pulp cavities. Most of the included studies ( = 21) were developed using convolutional neural networks. Among the included studies. datasets that were used were mostly cone-beam computed tomography images, followed by periapical radiographs and panoramic radiographs. Thirty-seven original research articles that fulfilled the eligibility criteria were critically assessed in accordance with QUADAS-2 guidelines, which revealed a low risk of bias in the patient selection domain in most of the studies (risk of bias: 90%; applicability: 70%). The certainty of the evidence was assessed using the GRADE approach. These models can be used as supplementary tools in clinical practice in order to expedite the clinical decision-making process and enhance the treatment modality and clinical operation.
PubMed: 36766519
DOI: 10.3390/diagnostics13030414 -
European Endodontic Journal Jan 2023This systematic review aims to establish whether various irrigant activation techniques (IATs) result in greater penetration of irrigant up to the working length. The... (Meta-Analysis)
Meta-Analysis
Comparative Efficacy of Different Irrigant Activation Techniques for Irrigant Delivery Up to the Working Length of Mature Permanent Teeth: A Systematic Review and Meta-Analysis.
This systematic review aims to establish whether various irrigant activation techniques (IATs) result in greater penetration of irrigant up to the working length. The MEDLINE, Scopus and Cochrane Library electronic databases were searched to determine the difference in irrigant penetration depth in the main canal following the use of manual dynamic activation (MDA), sonic irrigation (SI), passive ultrasonic irrigation (PUI), and apical negative pressure irrigation technique (ANP) in comparison with conventional needle irrigation technique (CNI) in mature permanent teeth. Meta-analysis was performed for straight canals as well as curved canals in addition to subgroup analyses for a) Individual IATs in comparison with CNI, b) Comparison of PUI v ANP and SI v ANP in the straight canals, c) comparison of different IATs performed in straight and curved canals. The outcome was presented as effect size: standardized mean difference (SMD) and percentage difference (% diff) of irrigant penetration up to the working length (WL) alongside 95% confidence intervals using chi-square analysis. Of the 840 records screened, 20 studies were included in the systematic review and 17 studies were included in the meta-analysis. It revealed IATs had significant improvement in irrigant delivery up to the WL in straight (% diff: 51.94%, 95% CI: 39.20-64.67%) and curved canals (SMD: 1.08, 95% CI: 0.64-1.52) over CNI. The subgroup analysis revealed ANP was the most effective and significant technique followed by PUI, SI and MDA techniques in straight canals (% diff: 91.70%, 95% CI: 75.63-107.77%) and curved canals (SMD: 1.45, 95% CI: 0.77-2.13). IATs improve irrigant penetration when compared to CNI technique. In both straight and curved canals, ANP is the most effective in delivering the irrigant up to the WL followed by PUI, SI and MDA techniques. Hence adaptation of recent IATs in routine endodontic practice is recommended. (EEJ-2022-03-036).
Topics: Dental Pulp Cavity; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Therapeutic Irrigation; Humans
PubMed: 36748449
DOI: 10.14744/eej.2022.87587 -
BioMed Research International 2022. has been implicated in infections of treated root canals. Current irrigants and intracanal medicaments cannot eliminate completely from the root canal. Silver... (Review)
Review
. has been implicated in infections of treated root canals. Current irrigants and intracanal medicaments cannot eliminate completely from the root canal. Silver diamine fluoride (SDF) prevents caries by promoting remineralization and exerting an antibacterial effect. Studies suggest that SDF may possess antibacterial properties against . The purpose of this review is to systematically and critically analyze the literature, focusing on the use of SDF as an intracanal medicament or irrigant, when compared to other antibacterial agents. . The focused question was "Is the antibacterial effect of SDF against better than other intracanal medicaments and irrigants?" Using the keywords ((silver diamine fluoride) AND ()) AND ((sodium hypochlorite) OR (NaOCl) OR (chlorhexidine) OR (calcium hydroxide) OR (Ca(OH))), an electronic search was conducted on the following databases: PubMed/MEDLINE, ISI Web of Science, Scopus, EMBASE, and Google Scholar. The clinical trial registers ClinicalTrials.gov and CONTROL were also searched using the same keywords. General characteristics and outcomes were extracted, and quality of the studies was assessed using the Preferred Reporting Items for Laboratory studies in Endodontology (PRILE) guidelines. . Six articles (five studies and one study) were included in this systematic review. In the majority of the studies, SDF had equal or better antibacterial efficacy against compared to calcium hydroxide, sodium hypochlorite, and chlorhexidine. However, the majority of the studies did not fulfill several items in the PRILE criteria and had numerous sources of bias. . Within the limitations of the systematic review and the studies reviewed, SDF may be effective against and therefore could be used as an intracanal medicament and/or irrigant to prevent reinfections of the root canals and improve the outcomes of endodontic treatment. However, animal and clinical studies should be carried out to determine the efficacy of SDF in endodontics. . The protocol for this review was registered on PROSPERO. Registration number: CRD42021224741.
Topics: Animals; Chlorhexidine; Enterococcus faecalis; Sodium Hypochlorite; Calcium Hydroxide; Anti-Infective Agents; Anti-Bacterial Agents; Dental Pulp Cavity
PubMed: 36567909
DOI: 10.1155/2022/6544292 -
Biomimetics (Basel, Switzerland) Nov 2022Recently, biomimetic bioactive biomaterials have been introduced to the market for dental pulp capping. This systematic review and meta-analysis aimed to determine any... (Review)
Review
Recently, biomimetic bioactive biomaterials have been introduced to the market for dental pulp capping. This systematic review and meta-analysis aimed to determine any variation between the effect of using TheraCal LC and other bioactive biomaterials for pulp capping is different, as measured by dentin increment and clinical success. The risk of bias was assessed using the Risk of Bias 2 and Newcastle−Ottawa tools for randomized clinical trials and observational studies. A search for relevant articles was performed on five databases. Additionally, the quality of the included studies was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. A summary of individual studies and a meta-analysis were performed. The odds ratio of data from clinical success was combined using a random-effects meta-analysis. The meta-analysis results showed homogeneity between the studies (I2 = 0%). They revealed that the clinical success showed no differences between the patients who received TheraCal LC, light-cured calcium silicate-based biomimetic biomaterial, for dental pulp capping or the comparator biomaterials (p > 0.5). However, the certainty of the evidence was low to moderate due to the risk of bias in the included studies.
PubMed: 36546911
DOI: 10.3390/biomimetics7040211 -
The Cochrane Database of Systematic... Dec 2022Root canal treatment (RoCT), or endodontic treatment, is a common procedure in dentistry. The main indications for RoCT are irreversible pulpitis and necrosis of the... (Review)
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, coronal crack or fracture, or dental trauma. Successful RoCT is characterised by an absence of symptoms (i.e. pain) and clinical signs (i.e. swelling and sinus tract) in teeth without radiographic evidence of periodontal involvement (i.e. normal periodontal ligament). The success of RoCT depends on a number of variables related to the preoperative condition of the tooth, as well as the endodontic procedures. RoCT can be carried out with a single-visit approach, which involves root canal system obturation (filling and sealing) directly after instrumentation and irrigation, or with a multiple-visits approach, in which the treatment is completed in two or more sessions and obturation is performed in the last session. This review updates the previous versions published in 2007 and 2016.
OBJECTIVES
To evaluate the benefits and harms of completion of root canal treatment (RoCT) in a single visit compared to RoCT over two or more visits, with or without medication, in people aged over 10 years.
SEARCH METHODS
We used standard, extensive Cochrane search methods. The latest search date was 25 April 2022.
SELECTION CRITERIA
We included randomised controlled trials and quasi-randomised controlled trials in people needing RoCT comparing completion of RoCT in a single visit compared to RoCT over two or more visits. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were 1. tooth extraction and 2. radiological failure after at least one year (i.e. periapical radiolucency). Our secondary outcomes were 3. postoperative and postobturation pain; 4. swelling or flare-up; 5. analgesic use and 6. presence of sinus track or fistula after at least one month. We used GRADE to assess certainty of evidence for each outcome. We excluded five studies that were included in the previous version of the review because they did not meet the current standard of care (i.e. rubber dam isolation and irrigation with sodium hypochlorite).
MAIN RESULTS
We included 47 studies with 5805 participants and 5693 teeth analysed. We judged 10 studies at low risk of bias, 17 at high risk of bias and 20 at unclear risk of bias. Only two studies reported data on tooth extraction. We found no evidence of a difference between treatment in one visit or treatment over multiple visits, but we had very low certainty about the findings (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.09 to 2.50; I = 0%; 2 studies, 402 teeth). We found no evidence of a difference between single-visit and multiple-visit treatment in terms of radiological failure (RR 0.93, 95% CI 0.81 to 1.07; I = 0%; 13 studies, 1505 teeth; moderate-certainty evidence). We found evidence of a higher proportion of participants reporting pain within one week in single-visit groups compared to multiple visit groups (RR 1.55, 95% CI 1.14 to 2.09; I = 18%; 5 studies, 638 teeth; moderate-certainty evidence). We found no evidence of a difference in the proportion of participants reporting pain until 72 hours postobturation (RR 0.97, 95% CI 0.81 to 1.16; I = 70%; 12 studies, 1329 teeth; low-certainty evidence), pain intensity until 72 hours postobturation (mean difference (MD) 0.26, 95% CI -4.76 to 5.29; I = 98%; 12 studies, 1258 teeth; low-certainty evidence) or pain at one week postobturation (RR 1.05, 95% CI 0.67 to 1.67; I = 61%; 9 studies, 1139 teeth; very low-certainty evidence). We found no evidence of a difference in swelling or flare-up incidence (RR 0.56 95% CI 0.16 to 1.92; I = 0%; 6 studies; 605 teeth; very low-certainty evidence), analgesic use (RR 1.25 95% CI 0.75 to 2.09; I = 36%; 6 studies, 540 teeth; very low-certainty evidence) or sinus tract or fistula presence (RR 1.00, 95% CI 0.24 to 4.28; I = 0%; 5 studies, 650 teeth; very low-certainty evidence). Subgroup analysis found no differences between single-visit and multiple-visit RoCT for considered outcomes other than proportion of participants reporting post-treatment pain within one week, which was higher in the single-visit groups for vital teeth (RR 2.16, 95% CI 1.39 to 3.36; I = 0%; 2 studies, 316 teeth), and when instrumentation was mechanical (RR 1.80, 95% CI 1.10 to 2.92; I = 56%; 2 studies, 278 teeth).
AUTHORS' CONCLUSIONS
As in the previous two versions of the review, there is currently no evidence to suggest that one treatment regimen (single-visit or multiple-visit RoCT) is more effective than the other. Neither regimen can prevent pain and other complications in the 12-month postoperative period. There was moderate-certainty evidence of higher proportion of participants reporting pain within one week in single-visit groups compared to multiple-visit groups. In contrast to the results of the last version of the review, there was no difference in analgesic use.
Topics: Humans; Aged; Dentition, Permanent; Root Canal Therapy; Tooth Extraction; Analgesics; Pain
PubMed: 36512807
DOI: 10.1002/14651858.CD005296.pub4 -
Journal of Clinical and Experimental... Nov 2022Dens invaginatus is a developmental dental anomaly resulting from an invagination of dental tissues folding from the outer surface towards dental pulp. The aim of this... (Review)
Review
BACKGROUND
Dens invaginatus is a developmental dental anomaly resulting from an invagination of dental tissues folding from the outer surface towards dental pulp. The aim of this systematic review and meta-analysis was to determine the prevalence of dens invaginatus using cone beam computed tomography (CBCT).
MATERIAL AND METHODS
A systematic review was conducted following PRISMA statements. The research question was: What is the prevalence of dens invaginatus in the adult population assessed by CBCT? The MeSH terms were used to search articles published in the electronic database PubMed. Studies were selected considering predetermined eligibility criteria. The Robins-I tool developed by Cochrane was used to assess methodological quality and risk of bias.
RESULTS
Four studies were included in this systematic review, including 2009 CBCT images. The overall prevalence of dens invaginatus was 9.0% (95% CI = 7.2 - 10.8%; < 0.001). Three studies were considered of low risk of bias.
CONCLUSIONS
The results of this systematic review and meta-analysis show that prevalence of dens invaginatus using CBCT was higher than previous estimations carried out with conventional radiographs. Therefore, an early identification and a correct management of invaginated teeth is essential for improving the prognosis of these teeth. It can be concluded that teeth with dens invaginatus should always be studied using CBCT. Dens invaginatus, Dens in dente, Dental anomalies, CBCT, Cone beam computed tomography.
PubMed: 36458027
DOI: 10.4317/jced.59849 -
Scientific Reports Nov 2022Treatment planning is key to clinical success. Permanent teeth diagnosed with "irreversible pulpitis" have long been implied to have an irreversibly damaged dental pulp... (Meta-Analysis)
Meta-Analysis
Treatment planning is key to clinical success. Permanent teeth diagnosed with "irreversible pulpitis" have long been implied to have an irreversibly damaged dental pulp that is beyond repair and warranting root canal treatment. However, newer clinical approaches such as pulpotomy, a minimally invasive and biologically based procedure have re-emerged to manage teeth with pulpitis. The primary aim of the study was to conduct a meta-analysis to comprehensively estimate the overall success rate of pulpotomy in permanent teeth with irreversible pulpitis as a result of carious pulp exposure. The secondary aim of the study was to investigate the effect of predictors such as symptoms, root apex development (closed versus open), and type of pulp capping material on the success rate of pulpotomy. Articles were searched using PubMed, Scopus, CENTRAL, and Web of Science databases, until January 2021. Outcomes were calculated by pooling the success rates with a random effect model. Comparison between the different subgroups was conducted using the z statistic test for proportion with significance set at alpha = 0.05. A total of 1,116 records were retrieved and 11 studies were included in the quantitative analysis. The pooled success rate for pulpotomy in teeth with irreversible pulpitis was 86% [95% CI: 0.76-0.92; I = 81.9%]. Additionally, prognostic indicators of success were evaluated. Stratification of teeth based on (1) symptoms demonstrated that teeth with symptomatic and asymptomatic irreversible pulpitis demonstrated success rate of 84% and 91% respectively, with no significant difference (p = 0.18) using z-score analysis; (2) open apex teeth demonstrated a significantly greater success rate (96%) compared to teeth with closed apex (83%) (p = 0.02), and (3) pulp capping materials demonstrated that Biodentine yielded significantly better success rates compared to Mineral Trioxide Aggregate (MTA), calcium hydroxide, and Calcium Enriched Mixture (CEM.) Collectively, this is the first meta-analytical study to determine the clinical outcome of pulpotomy for carious teeth with irreversible pulpitis and it's predictors for success. Moreover, we identify the stage of root development and type of biomaterial as predictors for success of pulpotomy.
Topics: Humans; Pulpotomy; Pulpitis; Dentition, Permanent; Calcium Hydroxide; Root Canal Therapy
PubMed: 36385132
DOI: 10.1038/s41598-022-20918-w -
Oral Health & Preventive Dentistry Nov 2022To identify and assess any changes in the pulp tissue complex following orthodontic force application. (Meta-Analysis)
Meta-Analysis
Changes in the Pulp Tissue Complex Induced by Orthodontic Forces: Is There a Need for Concern? A Systematic Review and Meta-Analysis of RCTs and Prospective Clinical Trials.
PURPOSE
To identify and assess any changes in the pulp tissue complex following orthodontic force application.
MATERIALS AND METHODS
Published and unpublished literature was searched in seven databases until 9 August 2022 for randomised controlled trials (RCTs) and prospective trials (nR-PCT). Representative key words included 'pulp response', 'pulp tissue', 'orthodontic force', and 'tooth movement'. Study selection, data extraction, risk of bias and certainty of evidence assessment were conducted independently by two reviewers. Random effects meta-analyses with respective confidence intervals (95%CIs) were conducted where applicable.
RESULTS
A total of 363 records were screened, a final number of 24 articles were eligible for qualitative synthesis, while 8 of those contributed to meta-analyses. There was evidence that pulpal blood flow (PBF) decreased after 3 weeks of tooth movement compared to no force application (4 studies, mean difference: -1.68; 95% CI: -3.21, -0.15; p = 0.03). However, this was not the case after 6 months of treatment (p = 0.68). A rise in the activity of aspartate aminotransferase (AST) was detected after 7 days of treatment, but combining 2 studies, this was not statistically significant (p = 0.25). Other outcomes were assessed through single studies. Risk of bias was within the range of 'some concerns/moderate to high/critical overall', while certainty of evidence was low to very low according to GRADE.
CONCLUSIONS
As a short-term effect, PBF decreased upon initiation of orthodontic force application, while enzymatic and peptide activity within the pulp was transiently affected. Further long-term evidence of improved quality and certainty is needed.
Topics: Humans; Dental Pulp; Tooth Movement Techniques
PubMed: 36346338
DOI: 10.3290/j.ohpd.b3556039