Effect of preemptive use of a nonsteroidal anti-inflammatory drug and a corticosteroid on the efficacy of inferior alveolar nerve blockade and postoperative pain control in endodontic treatment of molars with symptomatic pulpitis: A randomized double-blind placebo-controlled clinical trial

AIM

The anaesthetic success rate of an inferior alveolar nerve block (IANB) in mandibular molars with irreversible symptomatic pulpitis can be low, and postoperative pain control in teeth with this diagnosis can be challenging. This study aimed to evaluate the influence of preemptive use of dexamethasone and oral potassium diclofenac on the success of IANB. The influence of these drugs on the intensity of postoperative pain was assessed as a secondary outcome.

METHODOLOGY

Eighty-four patients with mandibular molars diagnosed with irreversible symptomatic pulpitis recorded preoperative pain intensity using a cold thermal test and a modified Numerical Rating Scale (mNRS). Sixty minutes before the anaesthetic procedure, patients were randomly assigned to one of three groups based on the medication they received: dexamethasone (4 mg), diclofenac potassium (50 mg), or placebo. All patients received IANB with 4% articaine (1:200 000 epinephrine), and 15 min later, they were evaluated for pain intensity using the cold thermal test. Anaesthetic success was analysed. The pain intensity was then recorded, and endodontic treatment and provisional restoration of the tooth were executed in a single session. Patients were monitored for 6, 12, 24, 48 and 72 h using the mNRS to assess the intensity of postoperative pain.

RESULTS

There was a statistically significant increase in anaesthetic success when 4 mg dexamethasone (39.3%) or 50 mg diclofenac potassium (21.4%) was used compared to the placebo group (3.6%) (p < .001), with no significant difference between the two drugs. Regarding postoperative pain, dexamethasone was superior to placebo at 6 h (p < .001), with diclofenac having an intermediate behaviour, not differing between dexamethasone and placebo (p > .05). There was no significant difference amongst the groups at 12 h (p > .05). At 24, 48 and 72 h, the effectiveness of dexamethasone and diclofenac were comparable, and both were superior to placebo (p < .001).

CONCLUSION

The use of dexamethasone or diclofenac potassium was favourable in terms of increasing the success rate of inferior alveolar nerve block in cases of mandibular molars with irreversible symptomatic pulpitis and decreased the occurrence of postoperative pain when compared to the use of a placebo.

Analysis of Cutting Capacity, Surface Finishing, and Mechanical Properties of NiTi Instruments 25/.04: ROTATE and LOGIC 2

INTRODUCTION

In an effort to enhance the quality of mechanized endodontic instruments, various thermal treatment methods, and design modifications have been suggested. However, upon evaluation, these endodontic instruments may exhibit microscopic irregularities. The objective of this in vitro study was to analyze the cutting capacity, surface finish, and mechanical properties of Nickel-Titanium 25/.04 Rotate (VDW GmbH, Munich, Germany) and LOGIC 2 (Easy Equipamentos Odontológicos, Belo Horizonte, MG, Brazil) rotary instruments.

METHODOLOGY

Twenty rotary instruments were divided into 2 groups: GR, the group with ROTATE instruments (n = 10); and GL2, the group with LOGIC 2 instruments (n = 10). They were evaluated for roughness, using a profilometer, for bending resistance, buckling resistance, and cutting capacity using a universal testing machine, as well as for torsional strength (torque and angular deflection) using a torquemeter. The instruments were visualized before and after the mechanical tests through scanning electron microscopy.

RESULTS

GR showed better surface finish in terms of roughness, greater cutting capacity, and greater angular deflection than GL2 (P < .05). However, GL2 showed better flexibility than GR (P < .05). GL2 and GR did not show statistically significant differences in terms of buckling and torque (P > .05).

CONCLUSION

The ROTATE and LOGIC 2 rotary instruments differed in their surface finish, cutting capacity, and mechanical properties, except for their buckling resistance and required fracture torque.

Effect of supplementary sodium hypochlorite agitation techniques on an ex vivo oral multispecies biofilm during passive disinfection of simulated immature roots

AIM

To compare the effect of different sodium hypochlorite (NaOCl) agitation techniques on an ex vivo oral multispecies biofilm during passive disinfection of simulated immature roots.

METHODOLOGY

Extracted human teeth were prepared to simulate immature roots. They were infected with a dental plaque-derived multispecies biofilm and cultured for 14 days. The roots were randomly designated into four groups: (1) negative control (PBS), (2) 1.5% NaOCl (CNI), (3) CNI + Ultrasonic activation (UA), (4) CNI + EasyClean agitation (ECA), (5) CNI + XP-endo finisher agitation (XPF), and (6) positive control (6% NaOCl). Biofilm samples were collected from the root canals and used to determine the number of viable cells (colony-forming units), scanning electron microscopy, and 16S rRNA gene sequencing. The mean colony-forming units per mL (CFU/mL) were analysed using One-way anova. 16S rRNA sequencing data were analysed for alpha (observed OTUs, Shannon index, and Chao1) and beta diversity (Bray-Curtis dissimilarities). The LEfSe analysis was used to determine the effect of treatment procedures on the abundance of root canal microbiota. The significance was set at .05.

RESULTS

PBS and CNI samples had significantly higher CFU/mL counts than UA, ECA, XPF, and 6% NaOCl samples (p < .05). The pre-treatment, PBS, and CNI groups had significantly greater alpha diversity than the UA, ECA, XPF, and 6% NaOCl groups (p < .05). NaOCl agitation groups and the 6% NaOCl group achieved a more pronounced reduction in bacteria from the genera Fusobacterium, Actinomyces, Porphyromonas, and Capnocytophaga.

CONCLUSIONS

The effectiveness of passive disinfection protocols was enhanced by NaOCl agitation techniques, suggesting that this supplementary method can improve the outcome of revitalization procedures.

In Vitro Evaluation of the Dynamic Cyclic Fatigue Resistance of a New TruNatomy Glider File after Different Cycles of Use

INTRODUCTION

Determination of the glide path is recommended before using rotary instruments. This study aimed to evaluate the dynamic cyclic fatigue resistance of new and used glider rotary instruments in up to 6 root canals.

METHODS

Seventy-two TruNatomy Glider files were used for the preparation of root canals of extracted lower molars, which were then submitted to the dynamic cyclic fatigue test carried out in a curved metallic artificial canal. The instruments were divided into 4 groups (n = 18): Control group, new instruments without any use in the root canal; Group 2U, instruments used in 2 mesial canals; Group 4U, instruments used in 4 mesial canals; Group 6U, instruments used in 6 mesial canals. The time to failure (TF) of the instrument was recorded, and the number of cycles to failure (NCF) was calculated. The data were submitted to 1-way analysis of variance and to the Games-Howell test for multiple comparisons, adopting a significance level of 5%.

RESULTS

TF and NCF were significantly affected by the number of file uses. The Games-Howell test revealed that TF and NCF were significantly greater in the control group than in Group 4U. In Group 2U, TF and NCF were intermediate and not significantly different from the control group. Group 6U had significantly lower TF and NCF than all other groups.

CONCLUSION

The TruNatomy Glider can be used as a glide path for up to 2 mesial canals of mandibular molars, whereas its use on 4 or 6 root canals is not suggested.

Effect of EDTA Activation on Blood Clot Structure in Regenerative Endodontics: A Scanning Electron Microscopy Study

INTRODUCTION

EDTA plays a crucial role in regenerative endodontic therapy (RET) because of its significant biological effects. However, EDTA is also recognized as the preferred anticoagulant for hematologic tests. Thus, this study aimed to assess the influence of different EDTA activation techniques on the morphology of blood clots after conditioning the root canal dentin.

METHODS

Forty extracted human teeth were prepared to simulate immature teeth and divided into the following 5 groups: (1) saline solution (negative control), (2) EDTA 17% + saline solution (CNI), (3) CNI + ultrasonic activation, (4) CNI + Easy clean activation, and (5) CNI + XP-endo Finisher activation. After irrigation, the roots were cleaved, and the root canals were filled with human blood to clot formation. The morphology and density of erythrocytes, platelets, and the fibrin network were observed using a scanning electron microscope. The fibrin network density was classified using a 4-point scale. Data were analyzed using the Friedman test and the Kruskal-Wallis test with Bonferroni adjustment (α = 5%).

RESULTS

All groups exhibited consistent blood clot morphology characterized by a high density of erythrocytes, platelets, and white blood cells throughout the entire length of the root canal. The negative control group showed statistically significant high scores of fibrin density compared with the CNI group in all root thirds (P < .05). However, there was no statistical difference in the scores for the fibrin network density between the groups irrigated with EDTA with and without activation (P > .05).

CONCLUSIONS

EDTA may impair the fibrin network formation compared with the saline group. However, EDTA activation did not significantly change the effects on the blood clot in contact with the conditioned intraradicular dentin.

Development of nanobiosilicate, tricalcium phosphate and chlorhexidine materials for biomineralization with crystallographic similarity to hydroxyapatite and biomodified collagen

OBJECTIVES

The aim of this work is to test experimental cements, doped with a silicate based bioactive nanoparticle (NanoBiosilicate). Methods, we synthesized a glass nanoparticle by Sol-Gel Stöber method, used to be incorporated in a dental material for endodontic uses.

MATERIALS AND METHODS

We assess the mineralizing properties and biocompatibility. Besides the crystallography characterization of the resultant new crystals. Results, After analysis, and comparison with commercial materials, the material tested was similar in mechanical properties required by ISO, The ion release was effective after 2 hr. of setting and the novel material was cell compatible accepted by ISO.

RESULTS

We found new formed Calcium Phosphate peaks in the spectroscopic analysis (FTIR), remarkably the crystals formed were comparable to hydroxyapatite when analyzed with a Selected Area Electron Diffractometer, with rings of 2.84 Å for 002, and the 2.77 Å is also visible for 210. The 6.83 Å and 6.88 Å, for respective 222 and 004. The incorporation of Chlorhexidine was not detrimental for this property, Significance, the features mentioned represented a progress in biomineralization field that was associated to an improved mineral structure formation with increased crystallographic similarity to natural hydroxyapatite. When chlorhexidine was added a favorable biomodification of the remaining collagen in dentinal walls and antimicrobial activity potential were also observed.

Knowledge and attitudes of rural healthcare providers regarding domestic violence against women: a systematic review

BACKGROUND

Specific types of violence such as intimate partner sexual violence and intimate partner homicide occur more frequently in rural areas.

OBJECTIVE

This study aimed to systematically review the literature on the knowledge and attitudes of rural healthcare providers regarding cases of domestic violence against women.

DESIGN AND SETTING

Systematic review developed at Universidade Federal de Uberlândia.

METHODS

We conducted an electronic search of six databases, which only included observational studies, regardless of the year, language, or country of publication, except for studies that used secondary data and were exclusively qualitative. Two reviewers performed the selection, data extraction, and risk of bias assessment using a specific Joanna Briggs Institute tool.

RESULTS

Six studies met the inclusion criteria. All the studies had a low risk of bias. Approximately 38% of these professionals identified injuries caused by violence in patients. When asked about knowing the correct attitude to take in cases of confirmed violence, between 12% and 64% of rural healthcare providers answered positively; most of them would refer to specialized institutions and promote victim empowerment and counseling. The number of professionals with an educational background in the field ranged from 16% to 98%.

CONCLUSIONS

The evident disparity across studies shows that some professionals have suboptimal knowledge and require training to adopt the correct attitude when identifying female victims of domestic violence in clinical practice.

SYSTEMATIC REVIEW REGISTRATION

This systematic review was registered in the Open Science Framework Database under the registration http://doi.org/10.17605/OSF.IO/B7Q6S.

Clinical evaluation of culturable bacteria, endotoxins and lipoteichoic acid in teeth with vital normal pulp tissues

The objective of this study was to investigate the presence of culturable bacteria, endotoxins (LPS) and lipoteichoic acid (LTA) levels in teeth with normal vital pulp (NVP) with intact crowns (IC) and those with coronal restoration (CR) limited to the enamel level. A total of 20 teeth indicated for endodontic treatment due to prosthetic reasons were selected. Samples were collected from the root canals. The levels of cultivable bacteria, LPS and LTA were assessed. Statistical analyses were performed at significance level set at 5%. None of the teeth presented microbial growth. In the IC group, the LPS levels were limited to the lowest concentration of LPS. On the contrary, higher LPS and LTA levels were detected in teeth with CR. It was concluded that teeth with NVP and IC were negative for bacteria, LPS and LTA; while teeth with CR were positive for bacterial virulence factors.

Assessment of the root surface temperature during the use of intracanal agitation systems: In vitro study

This study aimed to evaluate the temperature changes that the different methods of agitation of irrigants promote on the external dental root surface. Nine extracted human lower premolars were standardized by cone-beam computed tomography and used. The root canal was instrumented with a Reciproc 40.06 file. Temperature measurement was performed using K-type thermocouple sensors attached to the middle, cervical, and apical thirds of the teeth. The teeth had their roots immersed in distilled water at 37ºC, which were distributed into 3 experimental groups according to the mechanical agitation methods to be studied. US Group (n=3), Irrisonic Ultrasonic Tip activated through ultrasound; EC Group (n=3), Easyclean Tip coupled to a contra-angle low-speed handpiece; XP Group (n=3), XP-endo Finisher file coupled to an endodontic electrical motor. Temperature measurements were performed simultaneously with agitation and irrigation of intracanal irrigants. Statistical analysis was performed using SPSS software with a significance level of 5%. For multiple comparisons, the Tukey test was used. The association between mechanical agitation methods and root third was statistically significant. Regarding the temperatures recorded on the external surface of the roots, the ultrasonic tip was significantly higher than the XP-endo Finisher file and the Easyclean tip, which did not differ from each other. Regarding the ultrasonic tip, the external temperature in the middle third (39.46ºC) of the root was significantly lower than in the cervical (40.41ºC) and apical third (40.53ºC). None of the agitation methods of irrigants studied presented heating above 47ºC, and their use is safe for periodontal tissues.

Epidemiology and severity of traumatic dental injuries in permanent teeth: A 20-year retrospective study

This study aimed to assess the traumatic dental injuries (TDIs) in permanent dentition among patients who attended at the outpatient clinic of a Brazilian dental school, during the last 20 years, and to investigate factors associated with the severity of these injuries. Clinical records of patients who attended a specialized center for dental trauma care in Brazil presenting at least one TDI in a permanent tooth, between the years 2000 and 2019, were reviewed. The data recorded were sex, age, affected arch, etiology, number, and type of the teeth affected, and classification and severity of the TDIs. The diagnosis and classification of the TDIs were based on the guidelines of the International Association of Dental Traumatology (IADT). The severity of each patient's injuries was defined as mild, moderate, or severe. Descriptive statistics, chi-square and multinomial regression analyses were used to evaluate the results. The significance level was set at 5%. A total of 837 clinical records were included, totaling 2357 teeth. Males were more prevalent than females. The patients' age ranged from 5 to 71 years. The most common traumas were avulsion (n=512) and uncomplicated enamel-dentin fracture (n=488). Univariate analyses showed that there was a statistically significant association between age group (p=0.004), etiology (p=0.000) and number of teeth affected (p=0.000) with severity of dental trauma. In conclusion, TDIs that occurred in Piracicaba and region are epidemiologically similar to those found worldwide, and that more severe injuries are related to age range, etiology and number of teeth affected.

In vitro Dental Discoloration Provoked by Intracanal Calcium Silicate-based Dressing Used for Regenerative Endodontic Procedures: One-Year Spectrometric Analysis

INTRODUCTION

Regenerative endodontic procedures (REP) provide conditions for the continuity of apical formation and increase of the dentin walls thickness, being a useful technique to resume root development of necrotic teeth with incomplete apex. This study aimed to evaluate the coronal discoloration promoted by a new intracanal calcium silicate-based dressing and compare it with other intracanal dressings used in REP.

METHODS

Sixty bovine incisors were prepared to simulate teeth with incomplete apexes, and divided according to the intracanal dressing used: triple antibiotic paste - TAP, double antibiotic paste - DAP, calcium hydroxide associated with 2% chlorhexidine gel, calcium hydroxide associated with saline solution, and Bio-C Temp. As control, no dressing was performed. The intracanal dressings remained in the simulated root canal for 21 days. Luminosity (ΔL) and color difference (ΔE_ab and ΔE₀₀) were evaluated using long-term (1 year) spectrophotometric analysis. The results were analyzed using the ANOVA test with Tukey's post hoc with a significance of 5%.

RESULTS

TAP showed the highest values of ΔE_ab and ΔE₀₀ and lowest values of ΔL (p < .05). Bio-C Temp showed higher ΔE_ab than the other groups from 6 months (p < .05), higher ΔE₀₀ and lower ΔL after one year (p < .05).

CONCLUSIONS

Bio-C Temp induced noticeable coronary discoloration after the one-year analysis.

Quantitative analysis of culturable bacteria, levels of endotoxins, inflammatory mediators, and substance P in teeth with symptomatic irreversible pulpitis and in teeth with vital normal pulp tissues

AIM

To comparatively analyse the levels of culturable bacteria, endotoxins (LPS), tumour necrosis factor-alpha (TNF-α), interleukin-1 beta IL-1β and substance P in teeth with symptomatic irreversible pulpitis (SIP) and vital normal pulp (VNP) tissues.

METHODOLOGY

Thirty-two patients were included (20 teeth with SIP and 12 teeth with VNP tissues) in this cross-sectional study. Samples were collected from the full length of the root canals (microbial analysis) and periapical tissues (2 mm beyond the apex for immunological analysis), using sterile absorbent paper points. The levels of culturable bacteria (culture method), endotoxins (LAL Pyrogent 5000), TNF-α, IL-1β and substance P (ELISA) were assessed. The Mann-Whitney test was used for comparisons between the levels of CFU/mL, LPS, TNF-α, IL-1β and substance P in the SIP and VNP groups. The statistical analysis was performed with the significance level set at 5%.

RESULTS

Culturable bacteria were recovered from all teeth with SIP. On the other hand, no positive cultures were observed in the VNP tissues group (P > 0.05). The levels of LPS were approximately 4 times higher in teeth with SIP than in teeth with VNP tissues (P < 0.05). Higher levels of TNF-α and substance P were detected in teeth with SIP (P < 0.05). On the other hand, no difference in the levels of IL-1β was detected between the two groups (P > 0.05).

CONCLUSION

Teeth with symptomatic irreversible pulpitis present higher levels of culturable bacteria, endotoxins, TNF-α and substance P than those with vital normal pulp tissues. On the other hand, the levels of IL-1β were similar in teeth from both groups suggesting reduced implications of this inflammatory mediator in the early stages of infection.

Association between the prevalence of pulp stones and calcified atherosclerotic plaques: a systematic review and meta-analysis

OBJECTIVE

To evaluate the association between the prevalence of pulp stones (PS) in permanent teeth and calcified atherosclerotic plaques (CAP).

METHODS

An electronic search was performed in 10 databases to locate observational studies that investigated the association between PS in permanent teeth and CAP, published until March 2022. Two reviewers performed the search, selection and extraction of data from eligible studies. The individual risk of bias of eligible studies was assessed using the JBI Critical Appraisal Tools. The meta-analysis was conducted using fixed and random effects and odds ratio (OR) as an effect measure with a 95% confidence interval (CI). The heterogeneity between the studies was quantified using the I² test. The certainty of evidence was evaluated using the GRADE approach.

RESULTS

The electronic search resulted in 2968 records, of which only 7 studies were considered eligible. The total sample consisted of 3770 participants from 5 countries. All studies showed biases of confounding factors and exposure assessment. Based on six studies and with very low certainty of evidence, the meta-analysis showed that patients with PS were more likely to also have CAP in carotid or coronary arteries (OR: 1.70; 95% CI: 1.21; 2.38, I² = 0%).

CONCLUSIONS

Limited evidence suggests that there is a positive association between the prevalence of PS in permanent teeth detected using panoramic radiography and CAP in the coronary or carotid arteries.

Microbiological profile of root canals indicated for endodontic retreatment due to secondary endodontic infections or for prosthetic reasons

OBJECTIVE

The objective of this study was to evaluate the microbiological profile of root canals indicated for endodontic retreatment due to secondary endodontic infections evidenced by the presence of chronic apical periodontitis (G1) or for prosthetic reasons, without clinical and radiographic signs of endodontic reinfection (G2).

METHODS

Microbiological samples were collected from thirty teeth (N=30) out of which 15 were indicated for retreatment due to the presence of chronic apical periodontitis (G1) and 15 were indicated exclusively for prosthetic reasons (G2). Samples were collected from root canals before (S1), after chemomechanical preparation (S2), and after 30 days of intracanal medication composed of calcium hydroxide and 2% chlorhexidine gel (S3). The molecular analysis was performed using Nested-PCR for the detection of 17 bacterial species. The efficacy of each stage of the retreatment in reducing the microbial load was verified by counting colony-forming units (CFU). The statistical analysis considered a significance level of 5%.

RESULTS

The results showed that bacteria were detected in 100% of the cases in S1, in both groups, by Nested PCR. The most frequently found species in S1 in both groups were Enterococcus faecalis, Fusobacterium nucleatum, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, and Parvimonas micra. The microbial load of G1 was higher than G2 in the initial samples (S1). Endodontic retreatment was effective in reducing the microbial load in G1 and G2. Statistically significant associations were found between specific bacteria and clinical signs and symptoms.

CONCLUSION

It was concluded that the microbial community present in the root canal of teeth indicated for endodontic retreatment is mixed and heterogeneous. G1 and G2 differ in the number of species per case and microbial load.

CLINICAL RELEVANCE

Endodontic retreatment was effective in reducing the microbial load. Statistically significant associations were found between specific bacteria and clinical signs and symptoms.

Critical appraisal of confounding factors of observational studies on the association between dentofacial features and dental trauma in a Brazilian population

AIMS/OBJECTIVES

Dental trauma is a highly prevalent dental emergency. Children and adolescents without inadequate lip coverage, increased overjet, and anterior open bite are associated with the occurrence of traumatic dental injuries. Observational studies do not allow the inference of causality, one of the reasons being: the potential confounding factors. Therefore, this review aimed to critically appraise the confounding factors considered in epidemiological studies that associate dentofacial features with the occurrence of dental trauma in Brazilian children and adolescents.

METHODS

Studies included in the qualitative synthesis of a recently published comprehensive systematic review and meta-analysis on the topic were screened. Studies that only mentioned the performance of bivariate analyzes or that did not mention the performance of multivariate analyzes were excluded. Evaluation of control statements for possible confounders and bias consideration was performed for each selected study. Confounding factors in these studies were also identified and categorized according to their domains.

RESULTS

Fifty-five observational studies were screened, of which 11 were excluded due to the mention of only bivariate analyzes or the lack of multivariate analyses. The remaining 44 studies were critically appraised. Of these, 9 studies specifically mentioned the term confounding, and 12 studies mentioned the term bias. However, only 14 studies mentioned limitations on confounding factors in their findings. Among the 99 different variables identified, the most used were type of trauma, followed by sex and age.

CONCLUSION

Most studies did not acknowledge the control for possible confounding factors and rarely stressed the need for caution in interpreting their results. Cross-sectional studies do not allow inferring a cause-and-effect relationship between dentofacial features and dental trauma.

The effect of photodynamic therapy on postoperative pain in teeth with primary endodontic infection

INTRODUCTION

The objective of this study was to investigate the action of photodynamic therapy on pain control after endodontic treatment in asymptomatic teeth with a primary infection, within a single visit.

METHODS

Sixty (60) single-rooted teeth with pulp necrosis and periapical lesions were selected and randomly divided into two (2) groups (n=30), according to the protocol; a control group (CG) and a group using photodynamic therapy (aPDT). The canals were instrumented with Reciproc files # 25 up to 40 along the entire length of the canal, using 2% chlorhexidine gel as the auxiliary chemical substance, followed by irrigation with sterile saline. The canals were filled with Endomethasone N cement, 0.005% methylene blue, using AsGaAl diode laser, 660 nm wavelength, 100 mW of power and 9 J of energy, using optical fibers with 365 µm in diameter.

RESULTS

Pain intensity was assessed at 8, 12, 24, 48, 72 hours and 1 week after endodontic treatment using a visual analogue scale. The level of pain was classified as none (0), mild (1-3), moderate (4-7) or severe (8-10). The data were at a significance level of 5%. There was a statistically significant difference (p<0.05) in the periods of 8, 12, 24, 48 and 72 hours between the control group and the aPDT group. After 1 week, there was no statistically significant difference.

CONCLUSIONS

It is concluded that photodynamic therapy had a significant effect on decreasing post-endodontic treatment pain in teeth with necrotic pulp and asymptomatic periapical lesions.

Prevalence of dental trauma in Brazilian children and adolescents: a systematic review and meta-analysis

This study aimed to investigate the prevalence of dental trauma in Brazilian children and adolescents. A systematic review was conducted considering eight databases: MEDLINE (via PubMed), LILACS, BBO, Scopus, Embase, Web of Science, Open Access Theses and Dissertations, and OpenThesis. Only prevalence studies that used a probabilistic sampling method were included, without restriction on year or language of publication. The JBI critical appraisal tools for prevalence studies were used to assess the individual risk of bias. The individual studies were combined in the meta-analysis using the random-effects model. The heterogeneity between the studies was analyzed by Cochran's Q and the I-square statistics. A meta-regression analysis was performed to evaluate the sources of heterogeneity. The GRADE approach assessed the certainty of evidence across included studies. The search resulted in 2,069 records, of which 36 were included in the study. The eligible studies were published from 2000 to 2021, with a total sample of 40,194 children and adolescents. Most studies (75%) had a low risk of bias. In permanent teeth, the prevalence of dental trauma was 21% (95%CI: 16.0; 26.0) and in deciduous teeth; 35% (95%CI: 26.0; 44.0). The prevalence of dental trauma among boys was higher than among girls for both dentitions. Based on a low certainty, the prevalence of traumatic dental injuries in Brazilian children and adolescents is higher than that found worldwide both in deciduous and permanent teeth. Also, the prevalence of dental trauma among boys is higher than among girls.

Efficacy of 6% Sodium Hypochlorite on Infectious Content of Teeth with Symptomatic Irreversible Pulpitis

INTRODUCTION

The objective of this study was to monitor the effects of chemomechanical preparation (CMP) performed with 6% sodium hypochlorite and calcium hydroxide-based intracanal medication (ICM) on the levels and diversity of bacteria, endotoxins (LPS) and lipoteichoic acid (LTA) in root canals of teeth with symptomatic irreversible pulpitis.

METHODS

Samples were collected from ten teeth with symptomatic irreversible pulpitis before CMP (S1), after CMP (S2) and after ICM (S3). The levels of bacteria, LPS and LTA were assessed by using checkerboard DNA-DNA hybridisation, LAL Pyrogent 5000 and enzyme linked immunosorbent assay (ELISA), respectively. Wilcoxon's test, repeated measures ANOVA and Tukey's post-hoc test were used for statistical analysis at a significance level of 5%.

RESULTS

Forty species were detected at S1. Two species were eliminated after CMP and five after ICM. Resistant and pain-related species were detected in the root canals. Higher levels of culturable bacteria were detected at S1. However, CMP and ICM effectively reduced the microbial load in the root canals. Higher levels of LPS and LTA were detected at S1. CMP was effective in reducing both LPS and LTA (P < 0.05). ICM produced additional reduction in the levels of LPS (P > 0.05) and LTA (P < 0.05).

CONCLUSION

Chemomechanical preparation using 6% sodium hypochlorite and calcium hydroxide-based intracanal medication were effective in reducing the levels of bacteria, endotoxins and lipoteichoic acid in teeth with vital pulp and irreversibly inflamed pulp.

SARS-CoV-2: A Professional and social gamechanger - Medical and dental aspects

This study reports the SARS-CoV-2 outbreak and its impact on dental practice and education in Brazil. A literature review involving medical and dental interests was performed based on recent general findings about the infection (research and relevant guidelines). COVID-19 is a high transmissible, unpredictable systemic disease, involving a viral replication phase, followed by an inflammatory phase that can evolve into hyperinflammation that leads to a cytokine storm and other serious issues including sepsis, shock and multiple organ failure. The dentists are directly impacted by the new coronavirus as they work with the oral cavity that is irrigated by the saliva and receive the respiratory aerosols and droplets from the patient. In conclusion, the world is facing a completely new situation that deserves the comprehension of the population and close attention of the authorities. Following protocols to attend patients can prevent the dissemination of the virus, cross-infection, and the contamination of health care professionals. New strategies need to be developed to enhance the existing teaching and learning protocols in Universities and to allow research to continue.

CONSORT Compliance in Randomized Clinical Trials of Regenerative Endodontic treatments of Necrotic Immature Teeth. A Scoping Review

INTRODUCTION

This study aimed to investigate methodological quality of clinical trials in regenerative endodontics and its compliance with the CONSORT statement.

METHODS

An electronic search was performed in eight electronic databases. Only clinical trials whose participants underwent regenerative endodontic treatment on necrotic permanent immature teeth were included. Quality assessment was performed using the Cochrane Collaboration's Risk of Bias Tool (RoB, version 2.0). Compliance of articles with the CONSORT guidelines was assessed by a tool with scales: 0 = no description, 1 = deficient, and 2 = adequate description, totaling a maximum score of 32 points. The Mann-Whitney and Kruskal-Wallis tests were used to compare the scores between journals, studies, country, income levels, and publication periods. Spearman correlation analyses were performed between CONSORT compliance scores and 2019 journal CiteScore values, publication year, and quality assessment.

RESULTS

Twenty studies were included. The average CONSORT compliance score was 20.95 (±6.19). The better reported items were the description of the interventions performed in the trials (100%), followed by the description of the number of patients analyzed, losses and exclusions (90%) and the hypothesis tested (85%). Within the 20 studies, 3 articles were classified as "low risk of bias," 8 studies were classified as "some concerns" and 9 studies were considered "high risk of bias". Studies carried out in countries with higher income levels presented higher CONSORT scores. Significant moderate correlations were found between the CONSORT score and the percentage of risk of bias in low-risk domains (r_s = 0.63, 95%CI = 0.31 to 0.94, p = 0.003) and the overall risk of bias categories (r_s = 0.76, 95%CI = 0.54 to 0.98, p = 0.001).

CONCLUSIONS

The adequacy of reporting based on the CONSORT checklist items of regenerative endodontic trials was low with a moderate to high risk of bias.

Clinical and Radiographic Outcomes of Regenerative Endodontic Procedures in Traumatized Immature Permanent Teeth: Interappointment Dressing or Single-Visit?

INTRODUCTION

More data are needed before affirming that single-visit approaches are effective and safe for regenerative endodontic procedures (REPs). This study compared clinical and radiographic outcomes of REPs between interappointment dressing or single-visit protocols.

METHODS

Twenty young patients presenting traumatized immature teeth with pulp necrosis were divided into 2 groups. Teeth were submitted to 6% sodium hypochlorite and 2% chlorhexidine irrigation and to 17% EDTA use before blood clot induction. In the interappointment dressing group (n = 11), calcium hydroxide was used with 2% chlorhexidine gel for 21 days before scaffold induction. In the single-visit group (n = 9), the scaffold was induced during the only appointment. Patients were followed up for 24 months. Primary, secondary, and tertiary outcomes were assessed by 3 independent evaluators. Preoperative and follow-up radiographs were assessed for quantitative measurements of the apical diameter, root width, root length, and cervical barrier placement and compared between groups using the t test or Mann-Whitney U test. Categoric variables were assessed with the G test and the Fisher exact test and continuous variables with the Mann-Whitney U test. Statistical significance was set at 5%.

RESULTS

One tooth showed persistence of infection. No difference was observed in cervical barrier placement (P > .05); between groups regarding primary, secondary, and tertiary outcomes (P > .05); and in parameters of quantitative radiographic outcomes (P > .05).

CONCLUSIONS

Completing REPs with an interappointment dressing or a single-visit protocol presented similar clinical and radiographic outcomes. A single-visit protocol of REPs using 6% sodium hypochlorite, 2% chlorhexidine, and 17% EDTA permitted satisfactory outcomes in necrotic immature permanent teeth.

The association of inadequate lip coverage and malocclusion with dental trauma in Brazilian children and adolescents - A systematic review and meta-analysis

BACKGROUND/AIM

Dental trauma (DT) occurs frequently in children and adolescents. Therefore, understanding the factors associated with its occurrence in these age groups is important to establish specific preventive measures. The aim of this study was to investigate the relationships of lip coverage, overjet, and open bite to dental trauma in Brazilian children and adolescents.

MATERIAL AND METHODS

The review protocol was registered in the PROSPERO database (CRD42020156290) and the bibliographic search was performed in nine electronic databases until July 2020. The studies included were observational, performed in Brazil, with healthy children and adolescents (0-19 years old), and without the restriction of date or language. Two reviewers assessed the individual risk of bias of the eligible studies with a standardized checklist. The meta-analyses were stratified by dentition stage and age range using fixed or random effects, odds ratio (OR) as the effect measure, and 95% confidence interval. The heterogeneity across studies was assessed with the I² test and the GRADE approach assessed the certainty of evidence.

RESULTS

The search presented 2493 initial results, from which 55 met the eligibility criteria and were included. Most studies (67%) presented a low risk of bias and were published between 2000 and 2019. Children and adolescents with inadequate lip coverage are 1.86-2.36 times more likely to suffer from DT, while those with increased overjet are 1.94-3.11 times more likely. Children with primary dentitions and anterior open bites are 1.76 (95% CI: 1.20-2.59) times more likely to suffer from DT. The certainty of evidence varied from very low to moderate.

CONCLUSIONS

Inadequate lip coverage, increased overjet, and anterior open bite are associated with the occurrence of dental trauma in Brazilian children and adolescents.

Comparative analysis of bacterial content, levels of lipopolysaccharides and lipoteichoic acid in symptomatic and asymptomatic endodontic infections at different stages of endodontic treatment

OBJECTIVES

This study aimed to detect the presence of specific bacteria and to evaluate the levels of lipopolysaccharides (LPS) and lipoteichoic acid (LTA) in symptomatic necrotic root canals associated with acute apical abscess (symptomatic group - GI). It also aimed to compare the findings with those presented by asymptomatic necrotic root canals (asymptomatic group - GII) in the different stages of the endodontic treatment.

MATERIALS AND METHODS

Microbiological samples were collected from 20 root canals, including purulent collection from acute apical abscesses, before and after chemo-mechanical preparation (CMP) preparation (CMP) with chlorhexidine gel 2% and after 30 days of intracanal medication (ICM) with (Ca[OH]₂) + chlorhexidine. The culture method was used to evaluate the efficacy of CMP and ICM. Nested PCR was used to detect the presence of 17 specific bacteria. Levels of LPS were measured by using limulus amebocyte lysate, whereas enzyme-linked immunosorbent assay was used for the quantification of LTA.

RESULTS

CMP was effective in reducing the microbial load in both groups (P < 0.05). LPS levels were higher in GI than in GII (P < 0.05). There was a significant reduction in the LPS levels after CMP and ICM (P < 0.05) in GI and GII. LTA levels were significantly reduced in GI after ICM and in GII after CMP and ICM (both P < 0.05). Fusobacterium nucleatum and Enterococcus faecalis were frequently identified in both groups, alone or in combination with each other.

CONCLUSION

Different species were detected in all stages of the endodontic treatment. CMP was able to reduce bacterial content and the levels of LPS, but not of LTA in the symptomatic group. High levels of LPS were correlated with spontaneous pain and pain to percussion in the symptomatic group.

CLINICAL RELEVANCE

This clinical study showed that chemo-mechanical preparation was able to reduce bacterial load and levels of LPS, but not of LTA in the symptomatic group. Elevated levels of LPS were correlated with the presence of symptomatology.

Calcium Silicate-Based Sealers Do Not Reduce the Risk and Intensity of Postoperative Pain after Root Canal Treatment when Compared with Epoxy Resin-Based Sealers: A Systematic Review and Meta-Analysis

This review aims to evaluate whether root canal obturation with calcium silicate-based (CSB) sealers reduces the risk and intensity of endodontic postoperative pain when compared to epoxy resin-based (ERB) sealers. The review was registered at PROSPERO (CRD42020169255). Two independent reviewers conducted an electronic search in PubMed, Scopus, EMBASE, Web of Science, Cochrane Library and LILACS until November 2020 and included only randomized clinical trials with adult health participants undergoing root canal treatment. After selection, the JBI Critical Appraisal tool was used to assess the risk of bias. A fixed-effect meta-analysis was performed to summarize the results of pain risk and pain intensity at time intervals of 24 and 48 hours. Finally, the certainty of evidence was assessed using the GRADE approach. The search resulted in 1,206 records, of which five studies (n = 421 patients) met the eligibility criteria and presented moderate to low risk of bias. There was no significant difference between groups in the risk of pain in the first 24 hours (relative risk or RR = 0.83, 95% confidence interval or CI: 0.60, 1.16, I 2 =) or 48 hours (RR = 0.56, 95% CI: 0.26, 1.21, I 2 =). Silicate-based sealers led to lower pain intensity only at 48 hours (mean and standard deviation = 0.37, 95% CI: 0.69, 0.05). All analyses revealed low heterogeneity (I 2 < 25%). The evidence presented moderate level of certainty. Currently available evidence has shown that there is no difference between CSB and ERB sealers in the risk or intensity of postoperative pain.

Heating stability, physical and chemical analysis of calcium silicate-based endodontic sealers

AIM

To evaluate possible modifications in root canal sealers subjected to a variety of heating conditions using vibrational spectroscopy and analysis of physical and chemical properties.

METHODOLOGY

EndoSequence BC Sealer HiFlow, Bio-C Sealer, BioRoot RCS and AH Plus were analysed chemically using Raman spectroscopy (25-220 °C) and Fourier-transform infrared spectroscopy (FT-IR) (37-100 °C ). For FT-IR, the materials were tested individually and mixed with root dentine powder. Scanning electron microscopy (SEM) and coupled energy dispersive spectroscopy (EDS) were used to evaluate surface and chemical elements. ISO 6876-2012 and ASTM-C266-07 specifications were followed to evaluate flow, setting time (moist and dry), solubility and radiopacity. Also, pH analysis at 37 and 100 °C was performed. Shapiro-Wilk and Mixed ANOVA (within and between the effects of the subjects), Levene, and a post hoc analyses with Bonferroni correction were performed (P < 0.05).

RESULTS

Vibrational spectroscopy revealed peaks of tricalcium silicate, dicalcium silicate and zirconium dioxide. Chemical changes in the Raman spectra during heating were discrete, as the inorganic content predominated the signalling for all root canal sealers. FT-IR analysis exhibited spectral changes in water absorption for EndoSequence BC Sealer HiFlow and Bio-C Sealer, probably related to dehydration. For BioRoot RCS and AH Plus, no significant chemical changes were observed. Bio-C Sealer exhibited a band of polyethylene glycol only after heating to 100 °C, probably related to its thermal decomposition. SEM/EDS analysis corroborated the composition results observed in vibrational spectroscopy for all materials. Heating to 100 °C significantly changed the flowability of all calcium silicate-based sealers with a wide variation in setting times at both temperatures, along with solubility levels above ISO standards. For all tested sealers, radiopacity fulfilled the requirements, and pH exhibited alkaline values.

CONCLUSIONS

The tested calcium silicate-based sealers were affected by heating. Calcium silicate-based root canal sealers had high solubility which is a concern for their clinical use. AH Plus was the only root canal sealer that was stable after heating.

Do intracanal medications used in regenerative endodontics affect the bond strength of powder-to-liquid and ready-to-use cervical sealing materials?

Aim:

This study evaluated the effect of four intracanal medications commonly used in regenerative endodontic procedures on the bond strength of four calcium silicate-based materials, in which two are powder-to-liquid products (MTA and MTA-HP) and the other are ready-to-use materials (EndoSequence Root Repair Material Fast Set Putty [ERRM] and Bioceramic Repair [BIO-C Repair]).

Methods:

Ten bovine central incisors were selected and 4 slices (1.0 ± 0.1 mm) were prepared from each root. Next, four 0.8-mm wide holes were drilled in each slice and specimens were filled with one of the following intracanal medications: triple antibiotic paste, double antibiotic paste, calcium hydroxide with distilled water, and calcium hydroxide with 2% chlorhexidine gel. After 21 days, holes were filled with one of the materials: MTA, MTA-HP, ERRM, or BIO-C Repair. After storage, push-out test and failure analysis were performed. Data were submitted to analysis of variance in a 4 × 4 factorial scheme. Tukey's test was used for multiple comparisons.

Results:

The use of different interappointment dressings did not influence the results (P > 0.05). ERRM and BIO-C Repair presented significantly higher values than MTA and MTA-HP (P < 0.0001). Specimens showed a 100% occurrence of adhesive failures.

Conclusion:

The use of different intracanal medications presented similar impact on bond strength of calcium silicate-based materials. Ready-to-use ERRM and BIO-C Repair materials presented the best push-out values to dentine, whereas powder-to-liquid MTA and MTA-HP cements showed the lowest results.

Bacteria and virulence factors in periapical lesions associated with teeth following primary and secondary root canal treatment

AIM

This cross-sectional study aimed to investigate the microbial profile and to quantify the levels of endotoxins (LPS) and lipoteichoic acid (LTA) present in periapical lesions associated with root filled teeth and those that had received root canal retreatment. It also aimed to investigate the association between microorganisms and their virulence factors with clinical and radiographic features.

METHODOLOGY

Patients with periapical lesions in teeth with post-treatment endodontic disease following primary root canal treatment (n = 19) and unsuccessful root canal retreatment (n = 13) were treatment planned for endodontic microsurgery, where the periapical lesions were collected. Clinical and radiographic data were also collected. For microbiological analysis, nested polymerase chain reaction was used to detect 17 bacterial species. Levels of LPS and LTA were determined using limulus amebocyte lysate and enzyme-linked immunosorbent assays, respectively. The Student t-test or Wilcoxon-Mann-Whitney tests were applied to compare the data on LPS and LTA with clinical and radiographic features. The associations between the clinical and radiographic features and the bacterial species were analysed using the Fisher's exact test. A significance level of 5% was adopted.

RESULTS

Bacterial DNA, LPS and LTA were detected in all samples. Parvimonas micra was the most commonly detected species in all groups, followed by Enterococcus faecalis, Fusobacterium nucleatum and Porphyromonas endodontalis. The type of endodontic treatment, whether a primary root canal treatment or retreatment, was not associated with the presence of any bacterial species in periapical lesions. The levels of LPS and LTA in periapical lesions of root filled teeth were not significantly different from those that had been retreated. Associations between the levels of LPS and LTA with clinical signs and symptoms were found. No association was found between specific bacteria and clinical features.

CONCLUSION

Periapical lesions associated with teeth after primary root canal treatment and retreatment had similar polymicrobial composition. The levels of LPS and LTA in periapical lesions associated with teeth after primary root canal treatment and retreatment were similar, and both were associated with the same symptomatology.

Success, Survival Rate, and Soft Tissue Esthetic of Tooth Autotransplantation

INTRODUCTION

The aim of this retrospective study was to assess the success, survival rate, and soft tissue esthetic of autotransplanted teeth.

METHODS

This study included patients with at least 1 tooth autotransplanted to the maxilla during childhood or adolescence. The autotransplantation technique included the removal of an immature tooth from a donor site and its placement in the maxilla as a replacement for a missing or extremely compromised tooth. The cases were properly restored to ensure function and esthetic. To be considered successful, the tooth should be asymptomatic at the time of assessment, no pain to palpation and percussion, have no signs of apical periodontitis or a sinus tract, have a periodontal probe ≤3, and have an absence of root resorption and development of at least 70% of the normal root. The esthetic evaluation of the soft tissue was based on the pink esthetic score and graded as very unsatisfactory, unsatisfactory, poor, fair, good, or excellent. Data were statistically analyzed at a significance level of 5%.

RESULTS

Thirty-five patients (23 males and 12 females) had 43 anterior teeth replaced, including 42 central incisors and 1 lateral incisor. The follow-up period ranged from 1-25 years. In regard to success and the survival rate, 43 teeth were assessed; 34 cases (79.07%) were considered successful and 9 (20.93%) unsuccessful. Only 1 tooth was lost, and 42 teeth remained functional (survival rate = 97.67%). In regard to the esthetic, 40 teeth could be assessed and were considered as excellent (30%), good (35%), fair (27.5%), and poor (7.5%); there were no reports of unsatisfactory or very unsatisfactory cases.

CONCLUSIONS

Tooth autotransplantation can be considered a valid procedure to replace lost teeth in the maxilla, presenting high survival and success rates. The overall esthetic of the patients was considered as satisfactory.

Outcomes of traumatised immature teeth treated with apexification or regenerative endodontic procedure: a retrospective study

This study compares the clinical success rate and continued radiographic root development of apexification and regenerative endodontic procedure in traumatised immature permanent teeth, and proposes a method to evaluate apical convergence, namely apical angle. Clinical and radiological data were collected from 44 treated teeth (22 with apexification and 22 with regenerative endodontic procedure). The preoperative and follow-up periapical radiographs were analysed to calculate the percentage changes in root length, root width, apical diameter and apical angle. The success rates for complete healing with apexification and regenerative endodontic procedure were 86.36% and 95.45%, respectively. Radiographically, regenerative endodontic procedure showed significantly greater percentage changes in root width only (P < 0.05). Apexification and regenerative endodontic procedure provide satisfactory outcomes concerning clinical success rates. Continued root development in regenerative endodontic procedure was similar to apexification, except for root width. Apical angle allowed us to assess the convergence of the root canal walls.

Clinical efficacy of EDTA ultrasonic activation in the reduction of endotoxins and cultivable bacteria

AIM

This clinical study was conducted to investigate the influence of 17% ethylenediaminetetraacetic acid (EDTA) ultrasonic activation after chemomechanical preparation (CMP) on eliminating/reducing oral bacterial lipopolysaccharides (known as endotoxins) and cultivable bacteria in teeth with pulp necrosis and apical periodontitis.

METHODOLOGY

Samples were taken from 24 root canals at several clinical periods: S1 - before CMP; S2 - after CMP; S3 - after EDTA: G1 - with ultrasonic activation (n = 12) and G2 - without ultrasonic activation (n = 12). Root canals were instrumented using Mtwo rotary files. Culture techniques were used to determine the number of colony-forming units (CFU). Limulus amebocyte lysate (LAL) was used to measure endotoxin levels. Friedman's and Wilcoxon signed-rank tests were used to compare the amount of bacteria and endotoxin levels in each period (P < 0.05).

RESULTS

Endotoxins and cultivable bacteria were recovered in 100% of the initial samples (S1). CMP was effective in reducing endotoxins and bacterial load (all with P < 0.05). Higher values of endotoxin reduction were achieved with EDTA ultrasonic activation [G1, 0.02 EU mL^-1 (range 0.01-0.75)] compared with the no activation group [G2, 1.13 EU mL^-1 (range 0.01-8.34)] (P < 0.05). Regarding bacterial reduction, no statistically significant difference was found in S3, regardless of the group (G1, G2, P > 0.05).

CONCLUSIONS

Chemomechanical preparation was effective in reducing bacteria and endotoxins, but could not completely eliminate them. The ultrasonic activation of EDTA was effective in further reducing endotoxin levels in the root canals of teeth with pulp necrosis and apical periodontitis.