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Chakithandy S, Nazzal H, Matoug-Elwerfelli M, Narasimhan S, Uddin S, Prabhu KS, Zarif L, Mumtaz N, Sharma A, Al-Khelaifi M. Plasma neurological biomarkers as a measure of neurotoxicity in pediatric dental general anesthesia: a prospective observational feasibility study. Eur Arch Paediatr Dent 2024; 25:267-275. [PMID: 38649631 PMCID: PMC11058848 DOI: 10.1007/s40368-024-00884-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/04/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Neurotoxicity concerns have been raised over general anesthesia and sedation medication use in children. Such concerns are largely based on animal studies, historical anesthetic agents, and assessment tools, thus warranting further investigations. Blood biomarkers in detecting neuronal inflammation and apoptosis are novel methods for detecting neuronal damage. Therefore, the aim of this feasibility study was to assess the usefulness of the levels of four plasma biomarkers in dental general anesthesia (DGA) as surrogate markers of neurotoxicity in children. The secondary aim was to compare changes in motor manipulative skills pre- and post-anesthetic exposure. METHODS This single-center prospective observational study included 22 healthy children aged between 3 and 6 years old who underwent DGA. Subclinical neurotoxicity was measured with a panel of four plasma biomarkers: Caspase-3, neuron-specific enolase (NSE), neurofilament light chain, and S100B at three time points (1; at start, 2; end and 3; on recovery from DGA). The Skillings-Mack test was used to identify the difference in the biomarker levels at three time points. Motor manipulative score assessment, prior and two weeks after DGA was also performed. RESULTS A total of 22 study participants (mean age = 5 ± 1 years) were included with a median DGA duration of 106 ± 28 min. A reduction in Caspase-3 levels was recorded, with pairwise comparison over three time points, reporting a statistical significance between time point 2 vs. 1 and time point 3 vs. 1. Although fluctuations in NSE levels were recorded, no significant changes were found following pairwise comparison analysis. Among other biomarkers, no significant changes over the three periods were recorded. Furthermore, no significant changes in manipulative motor scores were reported. CONCLUSION Caspase-3 reduced significantly in the short time frames during day-care DGA; this might be due to the relatively short anesthesia duration associated with dental treatment as compared with more extensive medical-related treatments. Therefore, further studies on Caspase-3 as a potential biomarker in pediatric DGA neurotoxicity are required to further ascertain results of this study.
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Affiliation(s)
- S Chakithandy
- Pediatric Anaesthesiology Department, Sidra Medicine, Doha, Qatar
| | - H Nazzal
- Hamad Dental Centre, Hamad Medical Corporation (HMC), Doha, Qatar.
- College of Dental Medicine, QU Health, Qatar University, Doha, Qatar.
| | | | - S Narasimhan
- Hamad Dental Centre, Hamad Medical Corporation (HMC), Doha, Qatar
| | - S Uddin
- Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - K S Prabhu
- Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - L Zarif
- Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - N Mumtaz
- Pediatric Anaesthesiology Department, Hamad Medical Corporation, Doha, Qatar
| | - A Sharma
- Anaesthesiology Department, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, USA
| | - M Al-Khelaifi
- Pediatric Anaesthesiology Department, Hamad Medical Corporation, Doha, Qatar
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2
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Nazzal H, Baccar M, Ziad T, Al-Musfir T, Al Emadi B, Matoug-Elwerfelli M, Narasimhan S, Khan Y, Reagu S. Prevalence of anxiety, sleep bruxism and temporomandibular disorders during COVID-19 in Qatari children and adolescents: a cross-sectional study. Eur Arch Paediatr Dent 2023; 24:787-795. [PMID: 37848680 PMCID: PMC10657298 DOI: 10.1007/s40368-023-00847-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/15/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Understanding the impact of coronavirus disease-2019 (COVID-19) pandemic social restrictions on the lives of children and adolescents is of utmost importance to enable timely diagnosis and treatment. Therefore, the aim of this study was to explore the prevalence of anxiety, sleep bruxism, temporomandibular disorders (TMD) and change in dietary and brushing habits and their association with COVID-19 social restrictions. METHODS Parents of fit and healthy Qatari children and adolescents were recruited and interviewed by the research team, whereby validated questioners were used to assess the prevalence of children's/adolescents' anxiety, sleep bruxism and TMD. Furthermore, changes in dietary and brushing habits were also evaluated. RESULTS A total of 199 parents of children and adolescents (mean age = 9.3 ± 3.2 years old) were included. Overall anxiety symptoms, sleep bruxism and TMD were evident in 29.6%, 5.7% and 23.1%, respectively. An increased consumption of food, sweets and worsening of brushing habits were evident in 51.8%, 62.8% and 31.2%, respectively. CONCLUSION Within the limitations of this study, pandemic-related social restrictions could result in elevated levels of anxiety, specifically, social phobia, amongst children and adolescents, which could inevitably lead to unwanted dental consequences.
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Affiliation(s)
- H Nazzal
- Hamad Dental Centre, Hamad Medical Corporation, Doha, Qatar
- College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
| | - M Baccar
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - T Ziad
- Hamad Dental Centre, Hamad Medical Corporation, Doha, Qatar
- NYU Langone Dental Medicine, Advanced Education in Pediatric Dentistry, Brooklyn, NY, USA
- Pediatric Dental Services, Sun Life Health, Casa Grande, Arizona, USA
| | - T Al-Musfir
- Hamad Dental Centre, Hamad Medical Corporation, Doha, Qatar
| | - B Al Emadi
- Hamad Dental Centre, Hamad Medical Corporation, Doha, Qatar
| | | | - S Narasimhan
- Hamad Dental Centre, Hamad Medical Corporation, Doha, Qatar
| | - Y Khan
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - S Reagu
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine, Doha, Qatar
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Al Sheeb M, Al Jawad FA, Nazzal H. Parents' knowledge of emergency management of avulsed permanent teeth in children and adolescents in the State of Qatar: a questionnaire cross-sectional study. Eur Arch Paediatr Dent 2023; 24:643-650. [PMID: 37651072 PMCID: PMC10600271 DOI: 10.1007/s40368-023-00829-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/01/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE To elucidate the level of parental knowledge in Qatar regarding the management of avulsed teeth. METHODS A self-administered questionnaire was completed by 400 parents attending their children's routine dental appointments. The questionnaire comprised of items on sociodemographics, parents' prior knowledge on management of avulsion, parents' willingness to replant avulsed teeth at the site of injury, and parents' opinion as to the best format for future parental education on the management of dental trauma. Univariate and multivariate logistic regressions were employed to assess the association between sociodemographic status and knowledge in the management of avulsion. RESULTS The overall mean score of parents' knowledge was (23%). Only 23.3% (n = 93) of parents thought that it was possible to reinsert an avulsed permanent tooth. Out of those, only 12.9% (n = 12) indicated willingness to reinsert the tooth back into its socket, while 48.4% (n = 49) indicated that an avulsed tooth should be stored using physiological media. Less than one third (27.8%) indicated that they would seek professional help within 30 min. Males were less likely to give favourable answers when compared to females (OR = 0.43, 95% CI = 0.22-0.84). Age groups "31-40" years and "41-50" years were more likely to give favourable answers when compared to 20-30 years age group (OR = 2.8, 95% CI = 1.05-8.0and OR = 3.8, 95% CI = 1.3-11.48; respectively). CONCLUSION This study highlights critical deficiencies in parental knowledge on the management of tooth avulsion and the need to improve parents' knowledge by developing easily accessible onsite emergency management tools.
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Affiliation(s)
- M Al Sheeb
- Hamad Dental Centre, Hamad Medical Corporation, Doha, Qatar
| | - F A Al Jawad
- Hamad Dental Centre, Hamad Medical Corporation, Doha, Qatar
| | - H Nazzal
- Hamad Dental Centre, Hamad Medical Corporation, Doha, Qatar.
- College of Dental Medicine, Qatar University, Doha, Qatar.
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Nazzal H, El Shahawy OI, Al-Jundi S, Hussein I, Tahmassebi JF. Correction to: The use of behaviour management techniques amongst paediatric dentists working in the Arabian region: a cross-sectional survey study. Eur Arch Paediatr Dent 2022; 23:497. [PMID: 35604572 PMCID: PMC9167170 DOI: 10.1007/s40368-022-00713-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- H Nazzal
- Paediatric Dentistry Section, Hamad Dental Centre, Hamad Medical Corporation, Doha, Qatar.
| | - O I El Shahawy
- Department of Paediatric Dentistry, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - S Al-Jundi
- Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| | - I Hussein
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - J F Tahmassebi
- Leeds School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9LU, UK
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Matoug‐Elwerfelli M, ElSheshtawy A, Duggal M, Tong H, Nazzal H. Vital pulp treatment for traumatised permanent teeth: a systematic review. Int Endod J 2022; 55:613-629. [DOI: 10.1111/iej.13741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | - A.S. ElSheshtawy
- Department of Endodontics Faculty of Dentistry Cairo University Egypt
| | - M. Duggal
- College of Dental Medicine QU Health Qatar University Doha Qatar
| | - H.J. Tong
- Discipline of Orthodontics and Paediatric Dentistry Faculty of Dentistry National University of Singapore Singapore
| | - H. Nazzal
- Dentistry Department Hamad Dental Centre Hamad Medical Corporation Doha Qatar
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Al-Jundi SH, Ei Shahawy OI, Nazzal H. Paediatric dentistry undergraduate education across dental schools in the Arabian region: a cross-sectional study. Eur Arch Paediatr Dent 2021; 22:969-977. [PMID: 34351613 PMCID: PMC8526457 DOI: 10.1007/s40368-021-00656-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/25/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess and compare teaching of paediatric dentistry in the undergraduate curriculum among dental schools in the Arabian region. METHODS A 28-item online cross-sectional questionnaire survey was conducted of undergraduate dental programme directors in the Arab region. The survey included questions related to the programme's content, method of instruction on specific paediatric dentistry topics as well as the director's opinion on the level of training obtained by the undergraduate students at the end of the programme. RESULTS The final sample included 31 dental schools representing undergraduate programmes in ten Arabian countries (60.8% response rate). All programmes provided theoretical and practical education on communicative behaviour management techniques and caries prevention. Pulpectomy and formocresol pulpotomy were taught in the form of theoretical and practical education in 87.1% and 80.6% of the programmes, respectively. The method of education on common orthodontic topics was mainly theoretical with the exception of space maintainers. Instructions on managing trauma to permanent dentition was theoretical and practical in most programmes (61.3%). Most respondents rated the level of training of students in behaviour management and caries prevention as good to reasonable, while only 22.6% thought that the level of training was excellent in pulp therapy. CONCLUSION Variations were observed in paediatric dentistry education among undergraduate dental programmes in the Arabian region in terms of topics, instruction methods, year of introduction of paediatric dentistry education, and number of clinical sessions offered. This study establishes a framework for future paediatric dentistry curriculum development and/or improvement in the Arabian region.
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Affiliation(s)
- S H Al-Jundi
- Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| | - O I Ei Shahawy
- Department of Preventive Dentistry, Faculty of Dentistry, Future University, Cairo, Egypt
| | - H Nazzal
- Pediatric Dentistry, Hamad Dental Center, Hamad Medical Corporation, Doha, Qatar.
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Matoug-Elwerfelli M, Nazzal H, Duggal M, El-Gendy R. What the future holds for regenerative endodontics: novel antimicrobials and regenerative strategies. Eur Cell Mater 2021; 41:811-833. [PMID: 34169502 DOI: 10.22203/ecm.v041a51] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Regenerative/revitalisation endodontic techniques are increasingly used as a treatment approach for the management of immature permanent teeth with necrotic pulps. Different chemical irrigants and medicaments are routinely used clinically for intra-canal disinfection. However, despite remarkable progress in this field, coronal discolouration, cell cytotoxicity, difficulty of removal of organic biofilm from the root canal, development of sensitisation and antimicrobial resistance are still challenges to this line of treatment. This review critically discusses and challenges the current status quo of antimicrobials used in regenerative endodontics and sheds the light on future alternative antimicrobial materials with regenerative potential.
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Affiliation(s)
- M Matoug-Elwerfelli
- Department of Clinical Dental Science, Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi
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Alghutaimel H, Yang X, Drummond B, Nazzal H, Duggal M, Raïf E. Investigating the vascularization capacity of a decellularized dental pulp matrix seeded with human dental pulp stem cells: in vitro and preliminary in vivo evaluations. Int Endod J 2021; 54:1300-1316. [PMID: 33709438 DOI: 10.1111/iej.13510] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 12/17/2022]
Abstract
AIM To investigate the vascularization capacity of a decellularized dental pulp matrix (DDP) of bovine origin seeded with human dental pulp stem cells (hDPSCs) in vitro and to present preliminary in vivo findings. METHODOLOGY Bovine dental pulps were decellularized and then analysed using histological staining and DNA quantification. The resultant DDPs were characterized using immunohistochemical staining for the retention of vascular endothelial growth factor A (VEGF-A) and fibroblast growth factor 2 (FGF-2). Furthermore, DDPs were recellularized with hDPSCs and analysed histologically. The expression of markers involved in angiogenesis by hDPSCs colonizing the DDPs was assessed in vitro. A preliminary in vivo study was then conducted in which hDPSCs-seeded and unseeded DDPs were inserted in debrided human premolars root slices and implanted subcutaneously in immunodeficient mice. Samples were retrieved after 30 days and analysed using histological and immunohistochemical staining. The independent samples t-test, analysis of variance and a Kruskal-Wallis test were used to analyse the quantitative data statistically depending on the group numbers and normality of data distribution. The difference between the groups was considered significant when the P-value was less than 0.05. RESULTS Acellular dental pulp matrices were generated following bovine dental pulp decellularization. Evaluation of the developed DDPs revealed a significant DNA reduction (P < 0.0001) with preservation of the native histoarchitecture and vasculature and retention of VEGF-A and FGF-2. Upon recellularization of the DDPs with hDPSCs, the in vitro analyses revealed cell engraftment with progressive repopulation of DDPs' matrices and vasculature and with enhanced expression of markers involved in angiogenesis. In vivo implantation of root slices with hDPSCs-seeded DDPs revealed apparent vascularization enhancement as compared to the unseeded DDP group (P < 0.0001). CONCLUSIONS The developed decellularized dental pulp matrix had pro-angiogenic properties characterized by the retention of native vasculature and angiogenic growth factors. Seeding of hDPSCs into the DDP led to progressive repopulation of the vasculature, enhanced expression of markers involved in angiogenesis in hDPSCs and improved in vivo vascularization capacity. The se suggest that a combination of DDP and hDPSCs have the potential to provide a promising vascularization promoting strategy for dental pulp regeneration.
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Affiliation(s)
- H Alghutaimel
- Department of Paediatric Dentistry, School of Dentistry, University of Leeds, Leeds, UK.,Department of Paediatric Dentistry, School of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - X Yang
- Department of Oral Biology, School of Dentistry, University of Leeds, Leeds, UK
| | - B Drummond
- Department of Paediatric Dentistry, School of Dentistry, University of Leeds, Leeds, UK
| | - H Nazzal
- Paediatric Dentistry Section, Hamad Dental Centre, Hamad Medical Corporation, Doha, Qatar
| | - M Duggal
- College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
| | - E Raïf
- Department of Oral Biology, School of Dentistry, University of Leeds, Leeds, UK
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Nazzal H, El Shahawy OI, Al-Jundi S, Hussein I, Tahmassebi JF. The use of behaviour management techniques amongst paediatric dentists working in the Arabian region: a cross-sectional survey study. Eur Arch Paediatr Dent 2020; 22:375-385. [PMID: 32902832 PMCID: PMC8213577 DOI: 10.1007/s40368-020-00560-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/24/2020] [Indexed: 11/19/2022]
Abstract
Purpose The purposes of this study were to investigate paediatric dental practitioners’ training and confidence in using dental behaviour management techniques in the Arabian region and to assess the factors influencing the application of advanced behaviour management techniques. Methods: An online questionnaire was distributed to paediatric dental practitioners in the Arabian region. Data were analysed using descriptive statistics and Pearson Chi Square. Results A total of 113 responses were obtained. Of these, the majority were from Egypt (45%, n = 51). Just over half of the respondents were registered as specialists at the country where they were practicing paediatric dentistry (53%, n = 60). The use of behaviour management techniques varied amongst participants with tell-show-do (95%, n = 107) and positive reinforcement (89%, n = 101) being the most routinely used techniques. The majority of participants reported using voice control (83%) and parental separation (68%) techniques. Hand over mouth exercise (HOME) was only used by 24% (n = 27) of participants, whilst just over half of the participants, 53%, reported using protective stabilisation. A significant association was shown between country of practice, country of obtaining paediatric dental training, speciality status and the use of advanced behaviour management techniques, whilst confidence in using HOME and sedation were associated with work setting and country of practice, respectively. Conclusion The use of advanced behaviour management techniques was found to be high amongst respondents in the Arabian region. The lack of training in using these techniques, however, is of concern. Further assessment of the factors affecting the use of and confidence in applying advanced behaviour management techniques in the Arabian region is needed.
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Affiliation(s)
- H Nazzal
- Paediatric Dentistry Section, Hamad Dental Centre, Hamad Medical Corporation, Doha, Qatar.
| | - O I El Shahawy
- Department of Paediatric Dentistry, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - S Al-Jundi
- Faculty of Dentistry, University of Science and Technology, Irbid, Jordan
| | - I Hussein
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - J F Tahmassebi
- Leeds School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9LU, UK
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Tong HJ, Sim YF, Berdouses E, Al-Jundi S, El Shahawy O, Nazzal H. Regenerative endodontic therapy (RET) for managing immature non-vital teeth: experiences and opinions of paediatric dental practitioners in the European and Arabian regions. Eur Arch Paediatr Dent 2020; 22:145-155. [PMID: 32535749 DOI: 10.1007/s40368-020-00542-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 05/29/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE MTA apical plug approach is considered the gold standard in managing immature teeth with necrotic pulp tissues but does not increase root dimensions. Regenerative Endodontic Therapy (RET) has been advocated as an alternative technique for management of these teeth. This study aimed to assess the knowledge, experience and the opinions of dentists treating paediatric patients in the European and Arabian regions on RET. METHODS A cross-sectional, pre-piloted 23-item self-administered questionnaire survey was distributed electronically using the Bristol Online Survey tool through the mailing list of the European Academy of Paediatric Dentistry, the Arabian Academy of Paediatric Dentistry's and the Egyptian Society of Paediatric Dentistry. RESULTS 308 respondents completed the survey. Approximately half practised RET (N = 158; 51.3%), which was most frequently used to manage non-vital traumatized teeth. Majority of RET practitioners worked in university or dental institute practices. Protocol differences with deviation from the current published RET guidelines were observed. Half of the respondents reported discolouration as an undesirable outcome. Lack of training, materials, evidence and suitable cases were reasons for not using RET. CONCLUSIONS Although RET is being practised by European and Arabian paediatric dentists, different protocols are being used with clear deviations from the current evidence-based guidelines.
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Affiliation(s)
- H J Tong
- Faculty of Dentistry, National University of Singapore, National University Centre for Oral Health, 9 Lower Kent Ridge Road, #10-01, Singapore, 119085, Singapore.
| | - Y F Sim
- Faculty of Dentistry, National University of Singapore, National University Centre for Oral Health, 9 Lower Kent Ridge Road, #10-01, Singapore, 119085, Singapore
| | - E Berdouses
- , 22 Kodrou str, Halandri, 151 27, Athens, Greece
| | - S Al-Jundi
- Faculty of Dentistry, Jordan University of Science and Technology, Ar Ramtha 3030،, Ramtha, Jordan
| | - O El Shahawy
- Department of Pediatric Dentistry, Future University Egypt, 90th St, First New Cairo, Cairo Governorate, 11835, Egypt
| | - H Nazzal
- Hamad Medical Corporation, Doha, Qatar
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ElSheshtawy AS, Nazzal H, El Shahawy OI, El Baz AA, Ismail SM, Kang J, Ezzat KM. The effect of platelet-rich plasma as a scaffold in regeneration/revitalization endodontics of immature permanent teeth assessed using 2-dimensional radiographs and cone beam computed tomography: a randomized controlled trial. Int Endod J 2020; 53:905-921. [PMID: 32249441 DOI: 10.1111/iej.13303] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/26/2020] [Indexed: 12/20/2022]
Abstract
AIM To assess the outcomes of platelet-rich plasma as a scaffold in regenerative/revitalization endodontics (RET) using cone beam computed tomography (CBCT) and 2-dimensional radiographs. METHODOLOGY Twenty-six healthy patients with mean age of 12.66 ± 4.47, and immature permanent anterior teeth with necrotic pulps, were randomly allocated to two groups, whereby RET was performed using platelet-rich plasma (PRP, test group) and blood clot (BLC, control group). Changes in root length (RL), root dentinal thickness (RDT), apical foramen width (AFW) and radiographic root area (RRA), were assessed using both radiographic methods, whilst changes in periapical area diameter (PAD) were assessed using CBCT, over a period of 12 months. T-test and chi-square/Fisher's exact tests were used to compare continuous and categorical data between BLC and PRP groups, respectively. Changes in RL, RDT, AFW, RRA and PAD were examined by comparing the two groups (PRP versus BLC) using multilevel modelling, considering the clustering effect of repeated measures of several teeth originating from the same participant. RESULTS Changes in RL, RDT, AFW, RRA and PAD, over time, were found to be significant for both groups. There was, however, no difference between the RET techniques (PRP versus BLC), using both radiographic and CBCT methods. The results of both assessment techniques (CBCT and 2-dimensional radiographic methods) were highly consistent (overall ICC ranged between 0.80 and 0.94). In addition, a significant effect of baseline PAD was found on RL, RRA and AD at 12 months (RL effect = -0.68, P < 0.001; RRA effect = -1.91, P = 0.025; AD effect = 0.08, P = 0.024). CONCLUSION The current study highlights successful and comparable clinical and radiographic outcomes of RET techniques using PRP and BLC. Standardized and calibrated 2-dimensional radiographic assessment was as effective as CBCT in assessing RET outcomes; therefore, the routine use of CBCT in RET is not recommended. Although an effect of baseline periapical lesion diameter on root development outcomes, at 12 months, were observed, more studies are recommended in order to assess such an effect.
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Affiliation(s)
- A S ElSheshtawy
- Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - H Nazzal
- Paediatric Dentistry Section, Hamad Dental Center, Hamad Medical Corporation, Doha, Qatar
| | - O I El Shahawy
- Department of Pediatric Dentistry, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - A A El Baz
- Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - S M Ismail
- Department of Endodontics, The National Research Center, Cairo, Egypt
| | - J Kang
- Department of Oral Biology, School of Dentistry, University of Leeds, Leeds, UK
| | - K M Ezzat
- Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
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12
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Antov H, Duggal MS, Nazzal H. Management of discolouration following revitalization endodontic procedures: A case series. Int Endod J 2019; 52:1660-1670. [PMID: 31127956 DOI: 10.1111/iej.13160] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 05/22/2019] [Indexed: 01/09/2023]
Abstract
AIM To discuss the causes and management of tooth crown discolouration following regenerative/revitalization endodontic therapy (RET) and to present the decision-making process affecting three RET-related cases of crown discolouration. SUMMARY This case series outlines several approaches used in the management of post-RET discolouration. The cases highlight the influence of the material used in creating a coronal seal on the choice and success of the management techniques provided. The first two cases highlight successful management of post-RET discolouration through the use of internal-external bleaching. The use of internal bleaching in the third case was not recommended; therefore, external bleaching followed by a direct composite veneer was carried out.
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Affiliation(s)
- H Antov
- Oral & Maxillofacial Surgery, Pinderfields Hospital, Wakefield, UK
| | - M S Duggal
- Department of Paediatric Dentistry, National University of Singapore, Singapore.,Department of Paediatric Dentistry, Leeds Dental Institute, University of Leeds, Leeds, UK
| | - H Nazzal
- Department of Paediatric Dentistry, Leeds Dental Institute, University of Leeds, Leeds, UK.,Department of Paediatric Dentistry, Hamad Medical Corporation, Doha, Qatar
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Ghouth N, Duggal MS, Nazzal H. The use of dental pulp tests in children with dental trauma: a national survey of the British Society of Paediatric Dentistry's members. Br Dent J 2019; 226:sj.bdj.2019.99. [PMID: 30705441 DOI: 10.1038/sj.bdj.2019.99] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2018] [Indexed: 12/28/2022]
Affiliation(s)
- N Ghouth
- School of Dentistry, University of Leeds, Leeds, UK
- College of Dentistry, Taibah University, Al-Madinah Al-Munawarah, Saudi Arabia
| | - M S Duggal
- Discipline of Orthodontics and Paediatric Dentistry, National University Health System, Singapore
| | - H Nazzal
- Hamad Medical Corporation, Doha, Qatar
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Nazzal H, Tong H, Nixon P, Duggal M. Regenerative endodontic therapy for managing immature non-vital teeth: a national survey of UK paediatric dental specialists and trainees. Br Dent J 2018; 224:247-254. [DOI: 10.1038/sj.bdj.2018.122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2017] [Indexed: 12/18/2022]
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Matoug-Elwerfelli M, Duggal MS, Nazzal H, Esteves F, Raïf E. A biocompatible decellularized pulp scaffold for regenerative endodontics. Int Endod J 2017; 51:663-673. [PMID: 29197101 DOI: 10.1111/iej.12882] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/27/2017] [Indexed: 01/29/2023]
Abstract
AIM To investigate the feasibility of decellularizing the entire dental pulp using a mild treatment protocol to develop a decellularized biological extracellular matrix scaffold for use in regenerative endodontic procedures. METHODOLOGY Decellularized human dental pulps were assessed using histological and immunohistochemical methods, scanning electron microscope and DNA quantification assay. Cytotoxicity assays to determine decellularized scaffold biocompatibility were also performed. Decellularized scaffolds were seeded with human dental pulp stem cells and cell viability assessed using Live/Dead® stain. Quantitative data were analysed statistically using Student's t-test and one-way analysis of variance to compare mean values between groups depending on group numbers. RESULTS Assessment of decellularized tissues revealed an acellular matrix with preservation of native tissue histoarchitecture and composition. Decellularized tissues showed no evidence of cytotoxicity, with cell growth in direct contact with the scaffold and no reduction in cellular activity following extract incubation. Furthermore, the scaffold was able to support human dental pulp stem cell viability and attachment following recellularization. CONCLUSIONS Promising results were observed in developing a decellularized biological scaffold derived from the dental pulp with the perseveration of extracellular structural components which are required for tissue-specific regeneration.
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Affiliation(s)
- M Matoug-Elwerfelli
- Division of Oral Biology, School of Dentistry, University of Leeds, Leeds, UK
| | - M S Duggal
- Discipline of Orthodontics and Paediatric Dentistry, National University Health System, Singapore
| | - H Nazzal
- Department of Paediatric Dentistry, School of Dentistry, University of Leeds, Leeds, UK
| | - F Esteves
- Leeds Institute of Cancer and Pathology, St James University Hospital, Leeds, UK
| | - E Raïf
- Division of Oral Biology, School of Dentistry, University of Leeds, Leeds, UK
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Nazzal H, Kenny K, Altimimi A, Kang J, Duggal MS. A prospective clinical study of regenerative endodontic treatment of traumatized immature teeth with necrotic pulps using bi-antibiotic paste. Int Endod J 2017; 51 Suppl 3:e204-e215. [PMID: 28653761 DOI: 10.1111/iej.12808] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/23/2017] [Indexed: 01/15/2023]
Abstract
AIM To evaluate the treatment outcomes of a revitalization endodontic technique (RET) for the management of traumatized immature teeth with necrotic pulps in children. METHODOLOGY Fifteen healthy children (age range = 7-10 years) with traumatized immature maxillary incisors with necrotic pulps treated with bi-antibiotic revitalization endodontic technique were prospectively assessed over approximately two years (mean = 22 months). One operator undertook all treatments, clinical reviews and standardized radiographic exposures with radiographic analysis being carried out by two calibrated experienced clinicians. Crown colour change was assessed using an objective published methodology. Wilcoxon signed-rank test was used to compare root lengths, root dentinal widths and apical foramen widths over time. RESULTS Interoperator measurement reliability was consistently strong for all measurements. There was no significant difference in root lengths or root dentinal wall widths following RET. A significant difference in apical foramen widths was observed after 2 years (P = 0.013) with resolution of clinical signs of infection in all cases. Despite omitting minocycline and using Portland cement (nonbismuth containing cement), a noticeable crown colour change (yellower, redder and lighter), as measured by an objective colour measurement system with ΔE = 7.39, was recorded. Most patients, however, were satisfied with the aesthetic outcome. CONCLUSION Traumatized immature teeth with necrotic pulps treated with revitalization endodontic technique did not demonstrate continuation of root development or dentine formation when assessed by periapical radiographs. However, apical closure and periodontal healing were observed. A measurable change in crown colour (yellower, redder and lighter), with mostly no aesthetic concern to the patients/parents, was also observed.
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Affiliation(s)
- H Nazzal
- Department of Paediatric Dentistry, School of Dentistry, University of Leeds, Leeds, UK
| | - K Kenny
- Department of Paediatric Dentistry, School of Dentistry, University of Leeds, Leeds, UK
| | - A Altimimi
- Department of Paediatric Dentistry, School of Dentistry, University of Leeds, Leeds, UK
| | - J Kang
- Department of Oral Biology, School of Dentistry, University of Leeds, Leeds, UK
| | - M S Duggal
- Department of Paediatric Dentistry, School of Dentistry, University of Leeds, Leeds, UK
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Duggal M, Tong HJ, Al-Ansary M, Twati W, Day PF, Nazzal H. Erratum to: Interventions for the endodontic management of non-vital traumatised immature permanent anterior teeth in children and adolescents: a systematic review of the evidence and guidelines of the European Academy of Paediatric Dentistry. Eur Arch Paediatr Dent 2017; 18:153. [PMID: 28593580 DOI: 10.1007/s40368-017-0292-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- M Duggal
- Department of Paediatric Dentistry, Leeds Dental Institute, University of Leeds, The Worsley Building, Clarendon Way, Leeds, LS2 9LU, UK. .,Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, National University of Singapore, 11 Lower Kent Ridge Road, Singapore, 119083, Singapore.
| | - H Jinn Tong
- Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, National University of Singapore, 11 Lower Kent Ridge Road, Singapore, 119083, Singapore
| | - M Al-Ansary
- Department of Paediatric Dentistry, Leeds Dental Institute, University of Leeds, The Worsley Building, Clarendon Way, Leeds, LS2 9LU, UK
| | - W Twati
- Department of Paediatric Dentistry, Leeds Dental Institute, University of Leeds, The Worsley Building, Clarendon Way, Leeds, LS2 9LU, UK
| | - P F Day
- Department of Paediatric Dentistry, Leeds Dental Institute, University of Leeds, The Worsley Building, Clarendon Way, Leeds, LS2 9LU, UK
| | - H Nazzal
- Department of Paediatric Dentistry, Leeds Dental Institute, University of Leeds, The Worsley Building, Clarendon Way, Leeds, LS2 9LU, UK
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Duggal M, Tong HJ, Al-Ansary M, Twati W, Day PF, Nazzal H. Interventions for the endodontic management of non-vital traumatised immature permanent anterior teeth in children and adolescents: a systematic review of the evidence and guidelines of the European Academy of Paediatric Dentistry. Eur Arch Paediatr Dent 2017; 18:139-151. [PMID: 28508244 PMCID: PMC5488080 DOI: 10.1007/s40368-017-0289-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 04/10/2017] [Indexed: 01/09/2023]
Abstract
Aim This systematic review was undertaken in order to develop guidelines for the European Academy of Paediatric Dentistry for the management of non-vital permanent anterior teeth with incomplete root development. Methods Three techniques were considered; apexification by single or multiple applications of calcium hydroxide, use of Mineral Trioxide Aggregate (MTA) for the creation of an apical plug followed by obturation of the root canal, and finally a Regenerative Endodontic Technique (RET). Scottish Intercollegiate Guideline Network (SIGN) Guidelines (2008) were used for the synthesis of evidence and grade of recommendation. Results Variable levels of evidence were found and generally evidence related to these areas was found to be weak and of low quality. It was not possible to produce evidence-based guidelines based on the strength of evidence that is currently available for the management of non-vital immature permanent incisors. Conclusions Based on the available evidence the European Academy of Paediatric Dentistry proposes Good Clinical Practice Points as a guideline for the management of such teeth. It is proposed that the long term use of calcium hydroxide in the root canals of immature teeth should be avoided and apexification with calcium hydroxide is no longer advocated. The evidence related to the use of a Regenerative Endodontic Technique is currently extremely weak and therefore this technique should only be used in very limited situations where the prognosis with other techniques is deemed to be extremely poor. The current review supports the use of MTA followed by root canal obturation as the treatment of choice.
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Affiliation(s)
- M Duggal
- Department of Paediatric Dentistry, Leeds Dental Institute, University of Leeds, The Worsley Building, Clarendon Way, Leeds, LS2 9LU, UK. .,Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, National University of Singapore, 11 Lower Kent Ridge Road, Singapore, 119083, Singapore.
| | - H J Tong
- Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, National University of Singapore, 11 Lower Kent Ridge Road, Singapore, 119083, Singapore
| | - M Al-Ansary
- Department of Paediatric Dentistry, Leeds Dental Institute, University of Leeds, The Worsley Building, Clarendon Way, Leeds, LS2 9LU, UK
| | - W Twati
- Department of Paediatric Dentistry, Leeds Dental Institute, University of Leeds, The Worsley Building, Clarendon Way, Leeds, LS2 9LU, UK
| | - P F Day
- Department of Paediatric Dentistry, Leeds Dental Institute, University of Leeds, The Worsley Building, Clarendon Way, Leeds, LS2 9LU, UK
| | - H Nazzal
- Department of Paediatric Dentistry, Leeds Dental Institute, University of Leeds, The Worsley Building, Clarendon Way, Leeds, LS2 9LU, UK
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Abstract
Aims Regenerative endodontic techniques (RETs) have been hailed as a paradigm shift for the management of traumatised non-vital immature permanent anterior teeth. In this article the aim was to critically appraise the literature with regards to the outcome of regenerative endodontics on root development. Methods Critical review of the literature where regenerative endodontic techniques have been used in the management of immature non-vital teeth with continuation of root development as the main outcome reported. Results Most studies published were in the form of case reports and series with very few randomised controlled trials with a high risk of bias. Continuation of root development following the use of RET has been shown to be unpredictable at best with lower success in those teeth losing vitality as a result of dental trauma. Conclusions Despite the high success of regenerative endodontics in terms of periodontal healing including resolution of clinical and radiographic signs and symptoms of infection, continuation of root development remains an unpredictable outcome. The use of a blood clot as a scaffold in regenerative endodontics should be reviewed carefully as that might offer an environment for repair rather than regeneration. In addition, preservation of structures, such as Hertwig’s epithelial root sheath, may have an important bearing on the success of this approach and should be further investigated.
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Affiliation(s)
- H Nazzal
- Department of Paediatric Dentistry, Leeds School of Dentistry, University of Leeds, Clarendon Way, Leeds, LS2 9LU, UK.
| | - M S Duggal
- Department of Paediatric Dentistry, Leeds School of Dentistry, University of Leeds, Clarendon Way, Leeds, LS2 9LU, UK
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BaniHani A, Nazzal H, Webb L, Toumba KJ, Fabbroni G. An unusual presentation of erythema multiforme in a paediatric patient. Eur Arch Paediatr Dent 2015; 16:297-302. [DOI: 10.1007/s40368-015-0181-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 03/05/2015] [Indexed: 11/29/2022]
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