-
International Journal of Clinical... 2021Knowledge of the cytotoxicity and bioactivity of endodontic materials may assist in understanding their ability to promote dental pulp stem cell activity and pulp... (Review)
Review
BACKGROUND
Knowledge of the cytotoxicity and bioactivity of endodontic materials may assist in understanding their ability to promote dental pulp stem cell activity and pulp healing in primary teeth.
MATERIALS AND METHODS
This systematic review was carried out by searching the electronic databases such as PubMed, Google Scholar, and Cochrane reviews for the articles published between January 2000 and December 2018 using the appropriate MeSH keywords. An independent investigator evaluated the abstracts and titles for possible inclusion, as per the stipulated inclusion and exclusion criteria. The topics considered for extracting data from each study were: cell lineage, cytotoxicity assay used, and type of material tested.
RESULTS
Seven eligible studies were selected for assessing the quality of evidence on the bioactivity of bioactive endodontic cements (BECs) (1 human cell line, 2 animal cell lines, and 4 , animal, and human studies) and 13 studies were selected for reviewing the quality of evidence on cytotoxicity (7 human cell lines, 4 animal cell lines, and 2 animal model studies). Very limited studies had been conducted on the bioactivity of materials other than mineral trioxide aggregate (MTA). With regards to cytotoxicity, the studies were diverse and most of the studies were based on MTT assay. Mineral trioxide aggregate is the most frequently used as well as studied root-end filling cement, and the literature evidence corroborated its reduced cytotoxicity and enhanced bioavailability.
CONCLUSION
There was a lack of sufficient evidence to arrive at a consensus on the ideal material with minimal cytotoxicity and optimal bioactivity. More focused human/cell line-based studies are needed on the available root filling materials.
CLINICAL SIGNIFICANCE
The present systematic review provides an update on the available literature evidence on the cytotoxicity and bioactivity of various BECs including MTAs and their influence on the different cells with respect to their composition and strength.
HOW TO CITE THIS ARTICLE
Maru V, Dixit U, Patil RSB, Cytotoxicity and Bioactivity of Mineral Trioxide Aggregate and Bioactive Endodontic Type Cements: A Systematic Review. Int J Clin Pediatr Dent 2021;14(1):30-39.
PubMed: 34326580
DOI: 10.5005/jp-journals-10005-1880 -
International Journal of Molecular... Sep 2022The regenerative endodontic procedure (REP) represents a treatment option for immature necrotic teeth with a periapical lesion. Currently, this therapy has a wide field... (Review)
Review
The regenerative endodontic procedure (REP) represents a treatment option for immature necrotic teeth with a periapical lesion. Currently, this therapy has a wide field of pre-clinical and clinical applications, but no standardization exists regarding successful criteria. Thus, by analysis of animal and human studies, the aim of this systematic review was to highlight the main characteristics of the tissue generated by REP. A customized search of PubMed, EMBASE, Scopus, and Web of Science databases from January 2000 to January 2022 was conducted. Seventy-five human and forty-nine animal studies were selected. In humans, the evaluation criteria were clinical 2D and 3D radiographic examinations. Most of the studies identified a successful REP with an asymptomatic tooth, apical lesion healing, and increased root thickness and length. In animals, histological and radiological criteria were considered. Newly formed tissues in the canals were fibrous, cementum, or bone-like tissues along the dentine walls depending on the area of the root. REP assured tooth development and viability. However, further studies are needed to identify procedures to successfully reproduce the physiological structure and function of the dentin-pulp complex.
Topics: Animals; Dental Pulp Necrosis; Humans; Periapical Tissue; Regenerative Endodontics
PubMed: 36142446
DOI: 10.3390/ijms231810534 -
BMC Oral Health Apr 2023The purpose of this systematic review was to research the difference between root-filled teeth (RFT) and vital pulp teeth (VPT) in orthodontically induced external... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The purpose of this systematic review was to research the difference between root-filled teeth (RFT) and vital pulp teeth (VPT) in orthodontically induced external apical root resorption (EARR) and to offer suggestions for clinicians on therapeutic sequence and timing when considering combined treatment of endodontic and orthodontic.
MATERIALS AND METHODS
An electronic search of published studies was conducted before November 2022 in PubMed, Web of Science and other databases. Eligibility criteria were based on the Population, Intervention, Comparison, Outcome, and Study design (PICOS) framework. RevMan 5.3 software was used for statistical analysis. Single-factor meta-regression analysis was used to explore the sources of literature heterogeneity, and a random effects model was used for analysis.
RESULTS
This meta-analysis comprised 8 studies with 10 sets of data. As there was significant heterogeneity among the studies, we employed a random effects model. The funnel plot of the random effects model exhibited a symmetrical distribution, indicating no publication bias among the included studies. The EARR rate of RFT was significantly lower than that of VPT.
CONCLUSIONS
In the context of concurrent endodontic and orthodontic treatment, priority should be given to endodontic therapy, as it serves as the foundation for subsequent orthodontic procedures. The optimal timing for orthodontic tooth movement post-root canal therapy is contingent upon factors such as the extent of periapical lesion resolution and the degree of dental trauma sustained. A comprehensive clinical assessment is essential in guiding the selection of the most suitable approach for achieving optimal treatment outcomes.
Topics: Humans; Root Resorption; Tooth, Nonvital; Tooth Root; Dental Pulp; Root Canal Obturation
PubMed: 37098519
DOI: 10.1186/s12903-023-02982-4 -
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 -
Role of Lipopolysaccharide, Derived from Various Bacterial Species, in Pulpitis-A Systematic Review.Biomolecules Jan 2022Lipopolysaccharide (LPS) is widely used for induction of inflammation in various human tissues, including dental pulp. The purpose of this study was to summarize current... (Review)
Review
Lipopolysaccharide (LPS) is widely used for induction of inflammation in various human tissues, including dental pulp. The purpose of this study was to summarize current medical literature focusing on (1) cell types used by researchers to simulate dental pulp inflammation, (2) LPS variants utilized in experimental settings and how these choices affect the findings. Our study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched for studies reporting outcomes of lipopolysaccharide application on dental pulp cells in vitro using electronic databases: MEDLINE, Web of Science and Scopus. Having gathered data from 115 papers, we aimed to present all known effects LPS has on different cell types present in dental pulp. We focused on specific receptors and particles that are involved in molecular pathways. Our review provides an essential foundation for further research using in vitro models of pulpitis.
Topics: Humans; Inflammation; Lipopolysaccharides; Pulpitis
PubMed: 35053286
DOI: 10.3390/biom12010138 -
Journal of Endodontics Apr 2022Crown fracture with pulp involvement and concomitant complications is a traumatic injury that may have several clinical considerations for dentists and patients. The aim... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Crown fracture with pulp involvement and concomitant complications is a traumatic injury that may have several clinical considerations for dentists and patients. The aim of the present study was to appraise existing scientific evidence on factors related to pulp survival after complicated crown fracture following vital pulp therapy.
METHODS
An electronic search was performed on 8 sources of published and unpublished literature, as of August 18, 2021. Randomized controlled trials and nonrandomized studies were included, involving patients undergoing treatment in teeth (mature or immature), with vital pulp, after complicated crown fracture. Risk of bias of included studies was examined and assessed through RoB 2.0 or the Risk of Bias in Nonrandomized Studies of Interventions tool, conditional on study design. Random effects meta-analyses were conducted, where applicable, and the certainty of evidence was evaluated through the Grading of Recommendations Assessment, Development, and Evaluation approach.
RESULTS
Of the 506 initial articles, 24 were eligible for inclusion in the qualitative synthesis, and 7 ultimately contributed to meta-analyses. Based on synthesized evidence, in teeth treated with pulpotomy, there was no difference in successful clinical/radiographic outcome denoting pulp survival, when either bioceramic material versus CaOH (2 studies, Risk Ratio [RR] = 1.07; 95% confidence interval [CI], 0.99-1.16; P = .09; I = 0.0%), or mineral trioxide aggregate versus CaOH (2 studies, RR = 0.94; 95% CI, 0.76-1.16; P = .56; I = 0.0%). For different pulp management procedures, in pooled immature and mature teeth samples, there was no evidence that pulpotomy performed better than pulp capping with either CaOH or mineral trioxide aggregate (5 studies/6 comparisons, RR = 1.06; 95% CI, 0.71-1.58; P = .77; I = 74.8%). Risk of bias for randomized controlled trials ranged from raising some concerns to low, whereas nonrandomized studies were recorded as serious to critical risk of bias.
CONCLUSIONS
The quality of the evidence was very low to moderate. The need for more carefully designed clinical trials in the field is profound, to inform high-quality clinical decision making.
Topics: Crowns; Dental Pulp Capping; Dental Pulp Exposure; Humans; Pulpotomy; Tooth Fractures
PubMed: 35090933
DOI: 10.1016/j.joen.2022.01.013 -
Journal of the Indian Society of... 2022This study aimed to determine the mean oxygen saturation values (SpO) in primary teeth using pulse oximetry. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
This study aimed to determine the mean oxygen saturation values (SpO) in primary teeth using pulse oximetry.
MATERIALS AND METHODS
This comprehensive literature search on pulse oximeter used for primary teeth in determining pulp vitality using MeSH terms in four electronic databases, including PubMed, Scopus, Cochrane Library, and Ovid, from January 1990 to January 2022. Studies reported the sample size and the mean SpO values (with standard deviations) for each tooth group were included. The quality assessment of all the included studies was done using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the Newcastle-Ottawa Scale. The meta-analysis included studies reporting means and standard deviations of SpO values. The I statistics were used to determine the degree of heterogeneity among the studies.
RESULTS
A total of 90 studies were identified, of which five met the eligibility criteria that were qualified for the systematic review, and among them, three were included in the meta-analysis. All five included studies were of low quality due to the high risk of bias related to the patient selection, index test, and uncertainties about outcome valuation. In the meta-analysis, the mean fixed-effect measure of oxygen saturation in the pulp of primary teeth was 88.45% (confidence interval: 83.97%-92.93%).
CONCLUSION
Though most of the available studies were of poor quality, the SpO in the healthy pulp can be established (minimum saturation, 83.48%) in primary teeth. Reference values established might help clinicians to assess changes in pulp status.
Topics: Humans; Oxygen Saturation; Dental Pulp; Oximetry; Health Status; Tooth, Deciduous
PubMed: 36861550
DOI: 10.4103/jisppd.jisppd_359_22 -
BMC Oral Health Apr 2023Restoring vital teeth with indirect restorations may threaten dental pulp integrity. However, the incidence of and influential factors on pulp necrosis and periapical... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Restoring vital teeth with indirect restorations may threaten dental pulp integrity. However, the incidence of and influential factors on pulp necrosis and periapical pathosis in such teeth are still unknown. Therefore, this systematic review and meta-analysis aimed to investigate the incidence of and influential factors on pulp necrosis and periapical pathosis of vital teeth following indirect restorations.
METHODS
The search was conducted in five databases, using MEDLINE via PubMed, Web of Science, EMBASE, CINAHL, and Cochrane Library. Eligible clinical trials and cohort studies were included. The risk of bias was assessed using Joanna Briggs Institute's critical appraisal tool and Newcastle-Ottawa Scale. The overall incidences of pulp necrosis and periapical pathosis following indirect restorations were calculated using a random effects model. Subgroup meta-analyses were also performed to determine the potential influencing factors for pulp necrosis and periapical pathosis. The certainty of the evidence was assessed using the GRADE tool.
RESULTS
A total of 5,814 studies were identified, of which 37 were included in the meta-analysis. The overall incidences of pulp necrosis and periapical pathosis following indirect restorations were determined to be 5.02% and 3.63%, respectively. All studies were assessed as having a moderate-low risk of bias. The incidence of pulp necrosis following indirect restorations increased when the pulp status was objectively assessed (thermal/electrical testing). The presence of pre-operative caries or restorations, treatment of anterior teeth, temporization for more than two weeks, and cementation with eugenol-free temporary cement, all increased this incidence. Final impression with polyether and permanent cementation with glass ionomer cement both increased the incidence of pulp necrosis. Longer follow-up periods (> 10 years) and treatment provided by undergraduate students or general practitioners were also factors that increased this incidence. On the other hand, the incidence of periapical pathosis increased when teeth were restored with fixed partial dentures, the bone level was < 35%, and the follow-up was > 10 years. The certainty of the evidence overall was assessed as low.
CONCLUSIONS
Although the incidences of pulp necrosis and periapical pathosis following indirect restorations remain low, many factors affect these incidences that should thus be considered when planning indirect restorations on vital teeth.
DATABASE REGISTRATION
PROSPERO (CRD42020218378).
Topics: Humans; Dental Pulp Necrosis; Incidence; Dental Caries; Dental Cements; Glass Ionomer Cements
PubMed: 37009911
DOI: 10.1186/s12903-023-02826-1 -
The Cochrane Database of Systematic... Nov 2016There is a range of treatment options for the management of the pulp in extensively decayed teeth. These include direct and indirect pulp capping, pulpotomy or... (Review)
Review
BACKGROUND
There is a range of treatment options for the management of the pulp in extensively decayed teeth. These include direct and indirect pulp capping, pulpotomy or pulpectomy. If the tooth is symptomatic or if there are periapical bone changes, then endodontic treatment is required. However, if the tooth is asymptomatic but the caries is extensive, there is no consensus as to the best method of management. In addition, there has been a recent move towards using alternative materials and methods such as the direct or indirect placement of bonding agents and mineral trioxide aggregate.Most studies have investigated the management of asymptomatic carious teeth with or without an exposed dental pulp using various capping materials (e.g. calcium hydroxide, Ledermix, Triodent, Biorex, etc.). However, there is no long term data regarding the outcome of management of asymptomatic, carious teeth according to different regimens.
OBJECTIVES
This study aims to assess the effectiveness of techniques used to treat asymptomatic carious teeth and maintain pulp vitality.
SEARCH METHODS
Electronic searches of the following databases were undertaken: The Cochrane Oral Health Group's Trials Register (March 2006), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 1), MEDLINE (1966 to week 4, February 2006), EMBASE (1974 to 13 March 2006), National Research Register (March 2006), Science Citation Index - SCISEARCH (1981 to March 2006). Detailed search strategies were developed for each database. Handsearching and screening of reference lists were undertaken. There was no restriction with regard to language of publication.
SELECTION CRITERIA
Studies included were randomised controlled trials (RCTs). Asymptomatic vital permanent teeth with extensive caries were included. Studies were those which compared techniques to maintain pulp vitality. Outcome measures included clinical success and adverse events.
DATA COLLECTION AND ANALYSIS
Data were independently extracted by three review authors. Authors were contacted for details of randomisation and withdrawals and a quality assessment was carried out. The Cochrane Collaboration's statistical guidelines were followed.
MAIN RESULTS
Only four RCTs were identified. Interventions examined included: Ledermix, glycerrhetinic acid/antibiotic mix, zinc oxide eugenol, calcium hydroxide, Cavitec, Life, Dycal, potassium nitrate, dimethyl isosorbide, and polycarboxylate cement. Only one study showed a statistically significant finding; potassium nitrate/dimethyl isosorbide/polycarboxylate cement resulted in fewer clinical symptoms than potassium nitrate/polycarboxylate cement or polycarboxylate cement alone when used as a capping material for carious pulps.
AUTHORS' CONCLUSIONS
It was disappointing that there were so few studies which could be considered as being suitable for inclusion in this review. The findings from this review do not suggest that there should be any significant change from accepted conventional practice procedures when the pulp of the carious tooth is considered. Further well designed RCTs are needed to investigate the potential of contemporary materials which may be suitable when used in the management of carious teeth. It is recognised that it is difficult to establish the 'ideal' clinical study when ethical approval for new materials must be sought and strict attention to case selection, study protocol and interpretation of data is considered. It is also not easy to recruit sufficient numbers of patients meeting the necessary criteria.
Topics: Adult; Dental Caries; Dental Pulp; Dental Pulp Diseases; Humans; Randomized Controlled Trials as Topic
PubMed: 27892627
DOI: 10.1002/14651858.CD004484.pub3