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Journal of the Indian Society of... 2022Direct pulp treatment is carried out when a healthy pulp gets mechanically/accidentally exposed during the operative procedures or trauma. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Direct pulp treatment is carried out when a healthy pulp gets mechanically/accidentally exposed during the operative procedures or trauma.
AIM
To determine the effects of various direct pulp capping materials as measured by the clinical and radiographic analysis.
DESIGN
Two reviewers performed a database search of the studies published between January 2005 and November 2020. The inclusion criteria were papers published in the English language; children aged 3-12 years having deep carious lesions in primary teeth. All potential studies were acknowledged by their title and abstract. The full-text analysis of potentially relevant studies, the selected studies were included in the systematic review. A meta-analysis calculation was performed for the overall data and the subgroup data.
RESULTS
The database searching led to 57 articles, which were of direct pulp treatment in primary teeth, after the removal of duplicates, 55 records remained but did not meet all inclusion criteria. A high variability was observed among the papers. Further filtering with criteria led to nine articles, which met all inclusion criteria. Meta-analysis demonstrated the success rates of DPT in primary teeth (95% confidence interval -0.799-0.898); P < 0.001. Clinical assessments of various direct pulp capping materials suggested 84.9% of success irrespective of the material used. The nine studies were heterogeneous according to the random effect model (P < 0.001, I = 84.08%).
CONCLUSIONS
Direct pulp treatment has the advantage of being a conservative vital pulp therapy reducing the need for a more invasive treatment.
Topics: Child; Dental Caries; Dental Pulp; Dental Pulp Capping; Humans; Root Canal Therapy; Tooth, Deciduous
PubMed: 35859400
DOI: 10.4103/jisppd.jisppd_210_22 -
BioMed Research International 2022The healing of the periapical tissues is crucial to the success of root canal treatment. The review studies effectively examine various endodontic root canal sealants in... (Review)
Review
The healing of the periapical tissues is crucial to the success of root canal treatment. The review studies effectively examine various endodontic root canal sealants in terms of periapical healing. This systematic review was formulated following the PRISMA 2020 guidelines and registered in the international prospective register of systematic reviews (PROSPERO) number-CRD42021239192. To find relevant articles, PubMed Central and Medline databases (until February 2022) were searched. Studies that evaluated healing following the application of different endodontic sealers were analysed. A primary outcome measure was the resolution of periapical lesions following the endodontic treatment. In vivo studies comparing radiographic treatment outcomes and articles with a minimum of 6-month follow-up were included. A total of 9 clinical trial studies that met all the inclusion criteria were included in the analysis. The overall risk of bias was high in four studies out of nine studies. Periapical lesions showed significant healing after endodontic treatment regardless of sealer type, although bioceramic and bioactive sealers had shown better results.
Topics: Dental Pulp Cavity; Root Canal Filling Materials; Root Canal Therapy; Treatment Outcome; Wound Healing
PubMed: 35845966
DOI: 10.1155/2022/3569281 -
European Archives of Paediatric... Oct 2022To systematically search the available evidence and evaluate the clinical effectiveness of restorative materials for restoration of carious primary teeth. The findings...
PURPOSE
To systematically search the available evidence and evaluate the clinical effectiveness of restorative materials for restoration of carious primary teeth. The findings aimed to support the European Academy of Paediatric Dentistry (EAPD) guidelines development.
METHODS
Literature search was performed by searching 4 electronic databases for eligible randomised controlled clinical trials (RCTs) comparing restorative materials for the restoration of carious primary teeth up to December 28th, 2020. Quality assessment was performed with the revised Cochrane risk-of-bias tool for randomized trials (RoB 2).
RESULTS
Of 1685 identified articles 29 RCTs were finally deemed as eligible for inclusion. Annual failure rates were: Amalgam 1-28%; atraumatic restorative treatment 1.2-37.1%; glass-ionomer cement (GIC) 7.6-16.6%, metal-reinforced GIC 29.9%, resin-modified GIC 1.9-16.9%, high-viscosity GIC 2.9-25.6%; glass carbomer ≤ 46.2%; compomer 0-14.7%; composite resin (CR) 0-19.5%, bulk-fill CR 0-16.9%; zirconia crowns 3.3%, composite strip crowns 15%, and preformed metal crowns (Hall-Technique) 3.1%. Secondary caries, poor marginal adaptation, loss of retention, and fracture of restoration were reported as reasons for failure. Four studies were evaluated at unclear and 25 at high risk of bias. Clinical and methodological heterogeneity, and the diversity of tested materials across included studies did not allow for meta-analyses.
CONCLUSIONS
Within the limitations of this systematic review, namely, the heterogeneity and the overall high risk of bias among included studies, clear recommendations based on solid evidence for the best restorative approach in primary teeth cannot be drawn. There is a need for future thoroughly implemented RCTs evaluating restorations in primary teeth to close this knowledge gap.
Topics: Child; Humans; Composite Resins; Dental Atraumatic Restorative Treatment; Dental Caries; Dental Materials; Dental Restoration Failure; Dental Restoration, Permanent; Glass Ionomer Cements; Tooth, Deciduous; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 35819627
DOI: 10.1007/s40368-022-00725-7 -
Journal of Clinical Medicine Jul 2022This systematic review aimed to evaluate interventions individually and compare the clinical outcome of young, immature teeth treated with regenerative endodontic... (Review)
Review
This systematic review aimed to evaluate interventions individually and compare the clinical outcome of young, immature teeth treated with regenerative endodontic therapy (RET) and apexification procedure. The protocol was registered with PROSPERO (International Prospective Register of Systematic Reviews), bearing the registration number CRD42021230284. A bibliographic search in the biomedical databases was conducted in four databases-PubMed, CENTRAL, EMBASE and ProQuest-using searching keywords and was limited to studies published between January 2000 and April 2022 in English. The search was supplemented by manual searching, citation screening and scanning of all reference lists of selected paper. The study selection criteria were randomized clinical trial, prospective clinical studies and observational studies. The search found 32 eligible articles, which were included in the study. The quality assessment of the studies was performed using the Cochrane risk of bias tool for randomized control trials and non-randomized clinical studies. The meta-analysis was performed using Review Manager software (REVMAN, version 5). The results indicated that a clinicians' MTA apexification procedure was more successful compared to calcium hydroxide. In RET, apical closure and overall success rate is statistically same for both apical platelet concentrates (APCs) and blood clots (BC). Both interventions have similar survival rates; however, RET should be preferred in cases where the root development is severely deficient, there is insufficient dentine and the tooth's prognosis is hopeless even with an apexification procedure.
PubMed: 35807193
DOI: 10.3390/jcm11133909 -
Evidence-based Complementary and... 2022To evaluate the application of hydrogel scaffold materials and triple antibiotic paste in endodontic regeneration through literature review. (Review)
Review
OBJECTIVE
To evaluate the application of hydrogel scaffold materials and triple antibiotic paste in endodontic regeneration through literature review.
METHODS
An electronic search of the literature published on PubMed, Wangfang database, and CNKI database using the search terms "endodontic regeneration," "pulp blood flow reconstruction," "recanalization," "triple antibiotic paste," and "scaffold material" was conducted. The searched literature was used for analysis. Hydrogels regulate stem cell fates, modulate growth factor release, and encapsulate antibacterial and anti-inflammatory drugs. The triple antibiotic paste is composed of metronidazole, ciprofloxacin, and minocycline, which exhibits promising antibacterial effects and duration at appropriate concentrations, with low cytotoxicity, and effectively promotes the preservation and regeneration of pulp tissues and the formation of dental hard tissues. However, issues such as tooth discoloration and bacterial drug resistance also exist. The present article reviews the progress of research on the application of hydrogel scaffold materials and triple antibiotic paste in endodontic revascularization.
PubMed: 35795267
DOI: 10.1155/2022/3610461 -
Journal of Dentistry Sep 2022Preservation of pulpal vitality in immature permanent teeth with deep carious lesions is essential to enable further root development and apical closure. This systematic... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Preservation of pulpal vitality in immature permanent teeth with deep carious lesions is essential to enable further root development and apical closure. This systematic review aimed to evaluate the evidence regarding the efficacy, presented clinical and radiographic success, and bacteriological outcomes of techniques and materials used for deep caries management in vital immature permanent teeth.
DATA
Randomised controlled trials evaluating Vital Pulp Therapy (VPT) for deep caries in immature permanent posterior teeth without history of irreversible pulpitis, and a follow up period of ≥12 months were included. Study characteristics and outcomes of all included studies were summarized. Cochrane's Risk-of-bias tool 2.0 was used to assess the quality of eligible studies. Meta-analyses using a random effects model was performed.
SOURCES
Electronic databases PubMed, Medline, Embase, LILACS, CENTRAL and Cochrane Library were searched, followed by a manual search.
STUDY SELECTION
Twelve papers were included into the review. Overall success rates were 98%, 93.5%, 93.6% for direct pulp cap (DPC), indirect pulp cap (IPC) and pulpotomy (PP) respectively. Regardless of VPT technique, there were no significant differences between clinical and radiographic success rates. Completion of root development was achieved in more than 83% of the cases in all VPT techniques.
CONCLUSIONS
All treatment modalities for PP were equally efficient with high overall success rates. Biodentine showed high success rates regardless of technique. No significant differences were found in the clinical and radiographic success rates between various follow-up intervals. There are no clear conclusions regarding superiority of either VPT technique on apical closure.
CLINICAL SIGNIFICANCE
This manuscript systematically evaluates the evidence and summarises all available data on each vital pulp therapy technique and materials used in treatment of deep caries in immature permanent teeth with vital pulps. The limitations in the current scientific literature and recommendations for future research are also highlighted.
Topics: Dental Caries; Dental Caries Susceptibility; Dental Pulp Capping; Dentin; Dentition, Permanent; Humans; Pulpotomy
PubMed: 35793760
DOI: 10.1016/j.jdent.2022.104214 -
European Endodontic Journal Jun 2022The objective of this systematic review was to comprehensively assess the literature regarding the applications, accuracy, advantages and limitations of dynamic...
OBJECTIVE
The objective of this systematic review was to comprehensively assess the literature regarding the applications, accuracy, advantages and limitations of dynamic navigation in endodontics.
METHODS
Case reports and laboratory studies in the English language, which used the Dynamic Navigation System (DNS) for endodontic application and assessed the accuracy of treatment, the time required for treatment and iatrogenic errors were included. PubMed, Scopus, Embase and Web of Science were searched for eligible articles (up to July 2021). Additional hand searching of four peer-reviewed endodontic journals and a grey literature search were also carried out. A risk of bias assessment was done using the Joanna Briggs Institute (JBI) critical appraisal checklists. Data were extracted based on endodontic application of DNS, tooth type, DNS brand, accuracy, iatrogenic errors, and time taken, followed by qualitative analysis.
RESULTS
Fourteen articles (three case reports and eleven in-vitro studies) met the eligibility criteria and were included. The quality assessment revealed a low risk of bias, with mean scores of 83.34% for case reports and 84.09% for in-vitro studies. DNS was used for various clinical applications such as access cavity preparation, pulp canal obliteration, endodontic retreatment and microsurgery. The DNS brands used were Navident, X-guide, ImplaNav, and DENACAM. Due to the nature of the component studies, meta-analysis was not possible.
CONCLUSION
Challenging clinical situations like pulp canal obliteration, conservative access preparation, endodontic retreatment and microsurgery can be managed efficiently with fewer iatrogenic errors in a shorter time using DNS. However, this systematic review's evidence is low since the included articles are either case reports or in-vitro studies. Clinical studies are needed to test DNS efficacy among operators, including those who are less proficient and compare the accuracy of currently available systems.
Topics: Dental Care; Dental Pulp Diseases; Endodontics; Humans; Iatrogenic Disease; Research Design
PubMed: 35786584
DOI: 10.14744/eej.2022.96168 -
Journal of Clinical Medicine Apr 2022This systematic review's objective was to conduct a complete analysis of the literature on the root canal morphology using advanced micro-computed tomography. The...
This systematic review's objective was to conduct a complete analysis of the literature on the root canal morphology using advanced micro-computed tomography. The electronic web databases PubMed, Scopus, and Cochrane were examined for research papers concerning the chosen keywords, evaluating the root canal morphology using Micro-CT, published up to 2021. The articles were searched using MeSH keywords and searched digitally on four specialty journal websites. DARE2 extended (Database of Attributes of Reviews of Effects) was used to assess bias risk. The information was gathered from 18 published studies that strictly met the criteria for inclusion. In the included studies, a total of 6696 samples were studied. The studies were conducted on either maxillary (-2222) or mandibular teeth (-3760), permanent anteriors (-625), and Third molars (-89). To scan samples, a Scanco Medical machine in was used in 10 studies, Bruker Micro-CT in 34, and seven other machines were utilized in the rest. Bruker Micro-CT software from Kontich, Belgium, VG-Studio Max 2.2 software from Volume Graphics, Heidelberg, Germany, was the most commonly used software. The minimum Voxel size (resolution) adopted in the included studies was 11.6 µm. However, 60 µm was the maximum. Most studies classified the root canal morphology using Vertucci's classification system (-16) and the four-digit system (-6).
PubMed: 35566414
DOI: 10.3390/jcm11092287 -
Journal of Conservative Dentistry : JCD 2021Regenerative endodontic procedures (REP) have the advantage of restoring root canal's native defense ability by re-establishing vital pulp-like tissue. This review aims... (Review)
Review
BACKGROUND
Regenerative endodontic procedures (REP) have the advantage of restoring root canal's native defense ability by re-establishing vital pulp-like tissue. This review aims to determine the overall clinical and/or radiographic success rate (O) of REP (I) in mature permanent teeth (P) and to compare it (C) with nonsurgical endodontic treatment (NSET).
MATERIALS AND METHODS
Sources: PubMed, Web of Science, Embase, EBSCO, Cochrane Central Register of Controlled trials, ClinicalTrials.gov, Clinical Trials Registry-India and OpenGrey. Inclusion: Randomized clinical trials and single-arm prospective studies evaluating the treatment outcomes of REP in mature permanent teeth. Exclusion: Incomplete trials/studies, studies, animal studies, case reports/series, conference proceedings. Cochrane ROB2.0 and ROBINS-I tools were used to assess the risk of bias. Risk difference (R.D.) between NSET and REP was determined by meta-analysis of the randomized clinical trials. The overall success rate of REP was calculated using data from both randomized clinical trials and single-arm prospective studies. Sensitivity analysis and subgroup analysis were performed.
RESULTS
Ten studies ( = 552) were included. R.D between REP and NSET was 0.032 (95% C.I: 0.023-0.087; = 0.258). Overall success rate of REP was 96.0% (95% confidence interval: 94%-98%). No significant difference was found in sensitivity analysis ( = 0.551), or any of the subgroup analysis ( > 0.05).
DISCUSSION
A limited number of randomized clinical trials were available, and only two of them had a low risk of bias. Consistent results were obtained in both types of included studies.
CONCLUSION
Based on a limited number of comparative studies, REP has a similar success rate to NSET in mature permanent teeth.
OTHER
Funding: Nil. Registration: PROSPERO (CRD42020204882).
PubMed: 35558674
DOI: 10.4103/jcd.jcd_535_21 -
Cureus Apr 2022Bleaching agents can cause certain surface alterations on the enamel, such as depressions, surface porosity, and surface irregularities; this makes the dentin more... (Review)
Review
Bleaching agents can cause certain surface alterations on the enamel, such as depressions, surface porosity, and surface irregularities; this makes the dentin more susceptible to post-operative tooth sensitivity (PoS). In addition, the presence of flawed or leaky restorations, gingival recession, or defects in the cementoenamel junction can also cause severe tooth sensitivity post tooth bleaching.Hence, the current study aimed to perform a systematic review to determine the efficacy of various desensitizing agents (DA) in managing post-operative tooth sensitivity and color alteration when applied before in-office bleaching procedures. Randomized clinical trials were searched to conduct an SR where the post-operative tooth sensitivity was evaluated after in-office bleaching with various desensitizing agents used before the procedure. Post-operative pain assessment was measured using the Visual Analogue Scale (VAS). Outcomes were evaluated up to an hour and 24 hours post the procedure. Out of 163 articles, only 13 titles were selected that met the eligibility criteria. Eight hundred and forty-one adult patients with vital pulp status were included. The participants receiving prior desensitizing agent applications reported significantly lower pain scores in the VAS reports. The most significant reduction of post-operative sensitivity was observed in the immediate (up to an hour) and 24 hours after the in-office bleaching. The popular desensitizing agent that could manage post-operative tooth sensitivity (TS) is 5% potassium nitrate and 2% sodium fluoride used before the in-office bleaching procedure.
PubMed: 35547454
DOI: 10.7759/cureus.24028