Effectiveness of diagnosing pulpitis: A systematic review

BACKGROUND

The diagnosis of the status of the inflamed pulp is essential in clinical diagnosis and treatment provision. There are a limited number of well-designed and well-executed clinical trials on the diagnosis of the true status of the pulp.

OBJECTIVES

Three PICO questions were formulated and agreed a priori by the European Society of Endodontology to evaluate the clinical tests for sensibility testing, determination of biomarkers and pulp bleeding with regard to their suitability to correctly diagnose the condition of the pulp tissue for the development of S3-Level guidelines.

METHODS

A literature search was conducted using PubMed, Clarivate Analytics' Web of Science, Scopus, Google Scholar and Cochrane Central Register of Controlled Trials from inception to 21 January 2022. Additionally, a hand search was performed, and the contents of the major subject journals were also examined. Eligibility criteria followed the proposed PICO questions. Two independent reviewers were involved in study selection, data extraction and appraising the included studies; disagreements were resolved by a third reviewer. The risk of bias was assessed by the QUADAS-2 tool for diagnostic accuracy studies, the Newcastle-Ottawa scale for noncomparative, nonrandomized studies and the Newcastle-Ottawa Quality Assessment scale adapted for cross-sectional studies.

RESULTS

In total, 28 studies out of 29 publications were considered eligible and were included in the review. Twelve studies were identified to investigate the diagnostic accuracy of the pulp vitality. Ten studies fulfilled the criteria to evaluate the diagnostic accuracy of the pulpal conditions, while 6 studies investigating the expression of biomarkers were eligible. Three studies addressing the prognostic factors and therapeutic interventions relating to pulpal status were included.

DISCUSSION

The core problem in pulp diagnostics is that a reliable reference standard is lacking under clinical conditions. Based on limited evidence, the most promising current approach seems to define a combination of different clinical tests and symptoms, probably in future including molecular diagnosis ("diagnostic package") will be required to ascertain the best possible strategy to clinically diagnose true pulpal conditions.

CONCLUSIONS

The effectiveness of diagnosing pulpitis is low due to limited scientific evidence regarding the accuracy and reproducibility of diagnostic tests. There is a lack of evidence to determine the true status of the pulp or to identify prognostic indicators allowing for a reliable pre-operative estimation of the outcome of vital pulp treatment.

REGISTRATION

PROSPERO database (CRD42021265366).

Evaluation of Gingival Phenotype in the Early Transitional Dentition Phase in Children-Comparison of Three Non-Invasive Methods

Gingival phenotype (GP) is determined based on the thickness and width of the gingival tissue. An evaluation of GP is essential for adequate treatment planning and outcome monitoring, including orthodontic treatments in a paediatric population. The present study aimed to compare the reliability of the visual and TRAN methods with that of the ultrasound biometer measurements in the early transitional dentition phase. One hundred ninety three generally healthy, 7-year-old children were examined. An assessment of GP was performed by a paedodontist and a periodontist. The average thickness of the gingiva was 0.76 ± 0.36 mm, which was classified as a thin GP. The agreement between a visual assessment and the biometric ultrasound measurements reached the highest (94%) level when assessing a very thin GP (Spearman's rank correlation coefficient r = 0.37, p < 0.01). Similarly, 99% agreement in the diagnosis of a thin GP was recorded for the TRAN and ultrasound methods (Spearman's rank correlation coefficient r = 0.49, p < 0.001). In total, 86% of cases diagnosed as having a thick GP using the TRAN method turned out to be thin according to the ultrasound measurements. The dentist's specialization and professional experience in the assessment of GP were irrelevant (Spearman's rank correlation coefficient r = 0.49, p < 0.001). All methods tested in the present study were proven to be easy to perform and well accepted by the children. The visual assessment and TRAN methods, despite the fact that they enabled the diagnosis of a thin GP (crucial for treatment planning), cannot be recommended during the teeth replacement period. A misdiagnosis of thick GP may deprive a young at-risk patient of special supervision, which may develop into mucogingival deformities. A biometric ultrasound, although expensive, allows for reliable assessment of the gingiva thickness when needed.

The Washout Resistance of Bioactive Root-End Filling Materials

Fast-setting bioactive cements were developed for the convenience of retrograde fillings during endodontic microsurgery. This in vitro study aimed to investigate the effect of irrigation on the washout of relatively fast-setting materials (Biodentine, EndoCem Zr, and MTA HP) in comparison with MTA Angelus White and IRM in an apicectomy model. Washout resistance was assessed using artificial root ends. A total of 150 samples (30 for each material) were tested. All samples were photographed using a microscope, and half of them were also scanned. The samples were irrigated and immersed in saline for 15 min. Then the models were evaluated. Rinsing and immersing the samples immediately after root-end filling and after 3 min did not disintegrate the fillings made of all tested materials except Biodentine. Root-end fillings made of Biodentine suffered significant damage both when rinsing was performed immediately and 3 min after the filling. Quantitative assessment of washed material resulted in a slight loss of IRM, EndoCem MTA Zr, and MTA HP. MTA Angelus White showed a slightly greater washout. Rinsing and immersion of Biodentine restorations resulted in their significant destruction. Under the conditions of the current study, the evaluated materials, excluding Biodentine, showed good or relatively good washout resistance.

Prevalence of the Onodi cell in the Polish adult population: an anatomical computed tomography study

BACKGROUND

Onodi cell is a posterior ethmoid air cell with the optic canal bulging into it; the common position of the bulge is into the sphenoid sinus, usually immediately posterior to the posterior ethmoid air cells. Variable pneumatisation patterns lead to various structures of lamellae and sinuses occasionally exposing important nerves and vessels, such as the optic and vidian nerves, internal carotid artery and cavernous sinus. In clinical practice, special imaging techniques are used to navigate through the paranasal sinuses and hence avoid injury to these structures. This study is aimed to determine the prevalence of the Onodi cell in the Polish population and compare it with other reported occurrences.

MATERIALS AND METHODS

A retrospective analysis of 296 computed tomography (CT) scans of patients treated in Krakow, Poland, using a Siemens Somatom Sensation 16 spiral CT scanner. No contrast medium was administered.

RESULTS

The Onodi cell was found in 31 out of the 296 patients, or approximately 10.5%, consistent with the majority of research reporting on Onodi variants. Additionally, there was one presentation of a bilateral Onodi cell in a male patient. No statistically significant difference was found between the male and female populations with a positive identification of the variant (p = 0.095, Chi2 test).

CONCLUSIONS

This study helped approximate the Onodi variant prevalence of 10.47%, falling within a commonly reported range 8-14%. This gives clinicians and surgeons a better understanding of this variant's structure and significance, and therefore an opportunity to improve treatment outcomes and research.

Effectiveness of Teeth Whitening after Regenerative Endodontics Procedures: An In Vitro Study

Discolouration resulting from regenerative endodontic procedures may have a negative impact on the quality of life of treated patients; therefore, it is recommended to minimize this risk by selecting appropriate scaffolds and barrier materials, and if discolouration occurs, the use of a simple, cost-effective and minimally invasive technique, such as whitening, should be considered. This in vitro study aimed to evaluate tooth discolouration after two- and single-visit regenerative endodontic procedures and the effectiveness of subsequent whitening procedures with carbamide peroxide. Two hundred bovine incisors were included in this study and divided into twenty groups based on the tested material combinations. Two groups were control groups, one with saline and the other group with blood. In the 12 groups, the experiment was designed to be consistent with the two-visit regenerative endodontic procedures. Triple antibiotic paste or calcium hydroxide were placed in the root canal, and then scaffolds (e.g., blood or platelet-rich fibrin) and barrier materials (Biodentine, OrthoMTA or MTA Repair HP) were applied after rinsing the disinfectant pastes. In the six groups that corresponded to the single-visit regenerative endodontic procedure, the use of a disinfectant paste was omitted. Subsequently, the specimens were bleached twice with carbamide peroxide at a 7-day interval. Colour change measurements were performed using a spectrophotometer (VITA Easyshade Compact 5.0, VITA Zahnfabrik, Bad Säckingen, Germany). Statistical analysis was performed with the Kruskal−Wallis H test, the independent t-test and t-test for related samples. Tooth discolouration was noticed after two- and single-visit regenerative endodontic procedures, except for the platelet-rich fibrin+MTA Repair HP group. After the first and second whitening procedures, all of the tested two- and single-visit regenerative endodontic procedures groups showed a change in the colour of the crown, which was noticeable to the naked eye (∆E > 3.3). When analysing the ∆E value between the first and second bleaching procedures, no changes in the colour of teeth were visually noticed in the calcium hydroxide and platelet-rich fibrin +MTA Repair HP groups (∆E < 3.3). Single-visit regenerative endodontic procedures are suggested if possible; however, if two-visit regenerative endodontic procedures are performed, it is recommended to use calcium hydroxide as the disinfectant paste because of the lower staining potential. In the context of discolouration, platelet-rich fibrin is advisable for use as a scaffold. The whitening procedure is worth considering, but does not guarantee a return to the original tooth colour, especially when triple antibiotic paste is used.

European student wellness, stress, coping, support and perceptions about remote dental training during COVID-19

OBJECTIVES

The aim of this study was to compare wellness, stress, ability to cope, social support and perceptions about remote training amongst European dental students during COVID-19.

METHODS

1795 undergraduate dental students from six countries and eight dental schools participated. The anonymous survey collected data about different aspects in each of the following domains: wellness, stress, ability to cope, social support and perceptions about remote training. Complex multi-item scales were used for all domains.

RESULTS

There were differences amongst countries in all the domains. Overall, student stress scores were lower than either their coping or support scores. The highest wellness score (mean ±sd) was observed in Romania: 62.5% ± 11.2% whilst the highest mean stress scores were observed in Albania: 46.3% ± 11.7% and Lithuania: 42.2% ± 13.8%. Overall, student stress and coping ability scores were lower and their support scores higher. About 10% of students did not have any support. In the linear multivariable regression analysis, significant predictors of wellness were being female (β = 0.073), not being in a graduating year (β = 0.059), having less stress (β = 0.222), ability to cope (β = 0.223) and having support (β = 0.179). The student positive perceptions about remote training were predicted by less stress (β = 0.080), coping (β = 0.182) and support (β = 0.057).

CONCLUSIONS

Students varied in wellness, stress, coping, social support and perceptions of remote training. Also, there were significant differences amongst students from different countries. Coping was the best predictor of both student wellness and their positive perceptions about remote training.

Alkalizing Properties of Six Calcium-Silicate Endodontic Biomaterials

INTRODUCTION

Calcium silicate-based cements (CSC), are self-setting hydraulic biomaterials widely used for reparative procedures in dentistry and endodontics. These materials possess physical properties, such as ion release, porosity, solubility, and radiopacity. Their biological properties are connected to their alkalizing activity and calcium release capacity.

MATERIALS AND METHODS

Six calcium silicate-based materials were selected for this study: TheraCal LC (Bisco Inc., Schaumburg, IL, USA), MTA Plus (PrevestDenpro, Jammu, India Avalon Biomed Inc., Bradenton, FL, USA), Biodentine (Septodont, Saint-Maur-des-Fossés, France), RetroMTA (BioMTA, Seoul, Korea), MTA Flow (Ultradent Products, Inc., South Jordan, UT, USA), and OrthoMTA (BioMTA, Seoul, Korea). The pH was analyzed immediately after immersion (baseline) and after 1 h, 3 h, 1 day, 2 days, 3 days, 1 week, 2 weeks, 3 weeks, and 1 year with a pH meter, previously calibrated with solutions of known pH. All testing materials had alkaline pH.

RESULTS

Analysis of the tested materials showed statistically significant differences in terms of pH changes as a function of the time showed a gradual rise in the pH of all materials.

CONCLUSIONS

All tested materials exhibited continuous hydroxyl ion release resulting in a rise in pH until the end of time of experience.

Gingival Phenotype Changes and the Prevalence of Mucogingival Deformities during the Early Transitional Dentition Phase-A Two-Year Longitudinal Study

Thin gingival phenotype (GPh) may contribute to periodontal tissue breakdown and recession development. Thus, the early identification of thin GPh in children can allow proper preventive care and the identification of children at risk during orthodontic treatment. The present long-term study aimed to monitor GPh changes, i.e., thickness (GT) and width of attached gingiva (AGW) during the early transitional dentition phase, as well as its potential associations with the mucogingival deformities. Materials and Methods: 83 systematically healthy children were examined twice with an interval of 2 years. Probing depth, GT and AGW at mandibular incisors, vestibular depth, type of lower lip frenum attachment and mucogingival defects were recorded. Results: 95.2% of participants at baseline and 93.9% at 2-year examination expressed thin GPh. During the transition from the deciduous to permanent dentition, GT and AGW declined, but the GT of permanent incisors already erupted at the baseline examination increased in the observation period. Conclusions: Gingival phenotype undergoes changes in the early transitional dentition phase. In spite of the thin gingival phenotype, only single pseudo-recessions and primary shallow vestibule were noticed.

Agenesis of the sphenoid sinus and a single sphenoid sinus: a computed tomography anatomical evaluation

BACKGROUND

Sphenoid sinuses are pneumatic spaces within the body of the sphenoid bone. Their development begins in the prenatal life and continues until the adulthood. Agenesis of the sphenoid sinuses is a situation in which they are undeveloped. On the other hand, asingle sphenoid sinus lacks the presence of the main septum, leading to the formation of a single antrum. Contemporary use of transnasal transsphenoidal approaches for the pituitary surgery, as well as functional endoscopic sinus surgery urges medical professionals to be well acquainted with the aforementioned variant.

MATERIALS AND METHODS

Paranasal sinuses of 300 patients (150 females, 150 males) were evaluated using computed tomography, without the use of contrast medium. Inclusion criteria involved absence of any identifiable pathology within the sphenoid sinuses and age over 18 years. Subgroup analysis involved probing for potential sources of heterogeneity, namely gender.

RESULTS

In the whole research material of 300 patients, agenesis of the sphenoid sinuses was noted in 1% of the patients. No statistically significant differences were noted between the absence of the sphenoid sinuses and gender (p = 0.999). A single sphenoid sinus was found in 0.33% of the patients. There were no statistically significant differences found between the presence of fully developed sphenoid sinuses and gender (p = 0.498).

CONCLUSIONS

Both agenesis of the sphenoid sinuses, as well as a single sphenoid sinus are rare anatomical variants. Adequate planning for transsphenoidal surgeries with preoperative medical imaging is of essence in order to perform a safe and quality procedure.

A computed tomography comprehensive evaluation of the ostium of the sphenoid sinus and its clinical significance

BACKGROUND

The purpose of this research was to evaluate the size of the sphenoid sinuses' ostia, the distance between them and the distance between the medial margin of the ostia and the median line in the Polish adult population.

MATERIALS AND METHODS

The analysis was undertaken as a retrospective study of 296 computed tomography (CT) scans of patients (147 females, 149 males) with no comorbidities in their sphenoid sinuses. The paranasal sinuses were investigated by using Spiral CT Scanner (Siemens Somatom Sensation 16), in the option Siemens CARE Dose 4D, without administering any contrast medium. Having obtained transverse planes, multiplans reconstruction tool was used in order to glean sagittal and frontal planes.

RESULTS

The average size of both sphenoid sinuses ostia was 0.31 cm for both genders (for females ranging from 0.1 to 0.5 cm and from 0.1 to 0.6 cm for males). The mean distance between both sphenoid sinuses ostia was 0.6 cm for both genders (the range for females was 0.1-1.4 cm, whereas 0.1-1.8 cm for males). The average distance between the medial margin of the ostium and the median line was 0.32 cm for both genders (0.31 cm for females in the range of 0-0.9 cm and 0.32 cm for males in the range of 0-1 cm).

CONCLUSIONS

Intraoperative identification of the sphenoid sinus ostia might prove difficult and their inadequate excision could lead to potential iatrogenic complications, hence detailed anatomical descriptions are still warranted in specific populations in order to perform safe and effective procedures.

Superior Orbicularis Oris Muscle Activity in Children Surgically Treated for Bilateral Complete Cleft Lip and Palate

The aim of this cross-sectional study was to evaluate the electromyographic activity of the superior orbicularis oris muscle both in children surgically treated for bilateral complete cleft lip and palate (BCCLP) as well as in subjects without BCCLP. The study comprised 77 children aged 6.6 to 12.5 years. All the patients with clefts had previously undergone lip and palate surgery. The upper lip electromyographic (EMG) assessments were made with a DAB-Bluetooth device (Zebris Medical GmbH, Germany) at rest, while swallowing saliva, protruding lips and compressing lips. EMG measurements were also made when the subjects produced phonemes /p/, /b/, and /m/ with the vowel /a/. The Mann-Whitney U test was applied to statistically analyze the EMG values. Significantly higher median upper lip EMG activity under working conditions such as swallowing saliva, lip compression, and production of the phoneme /p/ with the vowel /a/ was observed in patients with BCCLP compared to those without a cleft. The results of the study showed that the upper lip muscle activity increases in children with BCCLP when swallowing saliva, compressing lips and during some speech movement tasks. This may be important in the aspect of the effect of surgical lip repair on the craniofacial growth.

Efficiency of Teeth Bleaching after Regenerative Endodontic Treatment: A Systematic Review

The aim of this review is to evaluate of effectiveness of bleaching procedures used to treat discolored teeth subsequent to regenerative endodontic procedures (REPs) based on the review of in vitro and in vivo studies. This literature review was carried out according to the PRISMA guidelines. Four databases (PubMed, Scopus, the Cochrane Library, and Web of Science databases) were searched electronically, until 30 January 2020 without a year limit. The quality of studies was assessed using a modified methodological index for non-randomized studies. After analyzing 1405 studies, 6 in vitro and 9 in vivo studies were eligible for this review. In in vitro studies, effectiveness of bleaching was assessed in teeth discolored by antibiotic pastes, blood, and barrier materials in various combinations. In all analyzed studies, bleaching was effective in teeth discolored by antibiotic pastes as well as by blood and barrier materials. Of 26 treated teeth in the in vivo studies, 17 teeth were bleached successfully. In six cases, there was improvement of the shade. In three cases, bleaching was not sufficient. Bleaching material, techniques, and times differed between studies. Whitening of discolored teeth after REPs is achievable. However, to establish precise guidelines, further long-term clinical studies should be performed.

The attached gingiva thickness in the mandibular anterior region during the early transitional dentition phase

Objectives: Adequate gingival thickness provides a stable base for appropriate oral hygiene maintenance and mucogingival lesion prevention. The study aim was to assess attached gingiva thickness in relation to its width, probing depth, crowding, and tooth position in the arch during the early transitional dentition phase. Method and materials: A cross-sectional study in 193 children aged 7 years with healthy mucogingival complex was conducted, and PIROP ultrasonic biometer measurement of gingival thickness of mandibular incisors was applied. To compare qualitative variables across different dentition groups, chi-square test or Fisher exact test were used, and for quantitative variables Kruskal-Wallis test plus post-hoc analysis (Dunn test). Spearman correlation coefficient was used to correlate gingival thickness with width of attached gingiva, as well as Kruskal-Wallis test and post-hoc analysis to assess the relationship between gingival thickness and tooth position in the arch, type of incisor, and eruption phase. Results: The mean gingival thickness value was less than 1 mm in all incisor type groups. The thinnest gingiva was noticed at permanent newly erupted incisors (0.72 ± 0.36; P < .001). Thickness of attached gingiva positively correlated with its width and with probing depth (r = 0.164, P < .001). Gingival thickness was significantly thinner at incisors positioned labially. No correlation of attached gingiva thickness with transitional crowding in mandibular incisor segment was observed. Conclusions: The results revealed thin gingiva at mandibular incisors in white children during the early transitional dentition phase. Objective, ultrasound measurements were used for the first time in a pediatric population, and the device was simple and well tolerated.

Knowledge of Oral and Physical Manifestations of Anorexia Nervosa Among Polish Dentists: A Cross-Sectional Study

Background: Anorexia nervosa is a psychosomatic disorder and is commonly associated with impaired oral health. Dentists can play a relevant role in the early diagnosis of anorexia nervosa. With the help of intra- and extraoral examinations and anamnesis, the dentist can detect characteristic signs and symptoms of this eating disorder. The purpose of this study was to determine the knowledge regarding the oral and physical manifestations of anorexia nervosa among general dental practitioners and specialist dentists of Poland. Material and Methods: A pretested online questionnaire consisting of a first part asking for the characteristics of the participant and a second part with 22 specific questions on their general knowledge of anorexia nervosa and knowledge of physical and oral manifestations of this eating disorder was used. Results: A total of 369 dentists completed the questionnaire. The Polish dentists in this study reported sufficient knowledge regarding anorexia nervosa. However, younger dentists and general dental practitioners had relatively lower knowledge scores than other groups. The dentists mainly had difficulties with the oral symptoms of anorexia nervosa. Conclusion: Despite Polish dentists having sufficient knowledge about anorexia nervosa in relation to the general symptoms of anorexia, there are deficits with regard to oral manifestations. Therefore, there is a need to increase continuing education in this field, which can improve early diagnosis of this disease by dental practitioners and referral to specialists for treatment.

Protrusion of the carotid canal into the sphenoid sinuses: evaluation before endonasal endoscopic sinus surgery

BACKGROUND

Many reports have previously indicated the vast number of anatomical variations of the sphenoid sinuses, e.g. presence of the recesses. Notwithstanding, there are a few crucial neurovascular structures directly neighbouring with the sinuses. The following research aimed to evaluate frequency prevalence of the carotid canal's protrusion into the sphenoid sinuses in adult population.

MATERIALS AND METHODS

Computed tomography (CT) scans of the paranasal sinuses of 296 patients (147 females, 149 males) were analysed in this retrospective study. The patients did not present any pathology in the sinuses. Spiral CT scanner Siemens Somatom Sensation 16 was used in the standard procedure in the option Siemens CARE Dose 4D.

RESULTS

Protrusion of the carotid canal was found in the majority of the patients - 55.74%, more frequently in males (65.1% of the patients) than in females (46.26% of the patients). The said variant - regardless of gender - was noted more often bilaterally (41.55% of the cases: 29.93% females, 53.02% males) than unilaterally (14.19% of the cases: 16.33% females, 12.08% males). In the unilateral type (regardless of gender), the protrusion was more common for the left sphenoid sinus - 10.81% of the patients (12.24% females, 9.4% males) than for the right - 3.38% of the patients (4.08% females, 2.68% males).

CONCLUSIONS

Complicated structure of the paranasal sinuses, derived from the high prevalence of their anatomical variations, may perplex routine surgical interventions. Henceforth, referral for a CT scan is imperative in order to abate the risks associated with an invasive procedure in the said region.

Pulp and dentine responses to selective caries excavation: A histological and histobacteriological human study

OBJECTIVE

The present study investigated the histobacteriological condition of human carious dentine, and the histological response of dental pulps after selective caries excavation to firm dentine and cavity restoration with adhesive procedures.

METHODS

Twelve vital teeth with medium/deep occlusal caries from 12 patients were scheduled for extraction. The patients gave consent to have caries removed selectively and the cavity restored with adhesive procedures prior to extraction. Caries excavation was achieved using burs and sharp hand excavators until "leathery" or "firm" dentine was encountered. After extraction, the teeth were completely-demineralised, processed for light microscopy, serial-sectioned and stained with haematoxylin and eosin staining for histological examination of dentine characteristics and pulpal responses. Additional sections were stained with Taylor-modified Brown and Brenn technique for histobacteriological examination of bacteria infiltration of the dentinal tubules and dental pulp.

RESULTS

The 12 teeth showed varying degrees of tertiary dentine formation. Chronic inflammatory cell infiltrates were identified in the pulp of all specimens and appeared as scattered inflammatory cells or exiguous localised accumulations. Capillaries were heavily congested with erythrocytes and polymorphonuclear leukocytes. A large amount of stainable bacteria was observed in the dentine subjacent to the cavity floor in all specimens.

CONCLUSIONS

The present study demonstrated that "leathery" or "firm" carious dentine is infected. The remnant bacteria in the dentine provoked subclinical pulpal inflammation over the entire evaluation period. The presence of potentially-arrested caries does not necessarily mean that bacterial infection is absent or under control.

CLINICAL SIGNIFICANCE

Knowledge on the pulpal response to active caries and the inflammatory responses associated with bacteria ingress into dentine is paramount in helping clinicians make an informed, rational choice based on biologically-robust principles.

The influence of two forms of chlorhexidine on the accuracy of contemporary electronic apex locators

Background

Accurate determination of working length (WL) is crucial for the success of endodontic therapy. The aim of this study was to determine the influence of 2% chlorhexidine digluconate solution, 2% chlorhexidine digluconate gel and 2% hypochlorite solution on the accuracy of two devices: the Raypex 5 and the ApexDal.

Methods

Twenty-nine single-rooted human teeth were used in this study. The crowns were cut horizontally and embedded in an alginate mass. In each tooth, six endodontic measurements were made using two electronic apex locators (EALs): a Raypex 5 and an ApexDal. For each EAL, measurements were taken with the following products: 2% chlorhexidine solution (CHX-S group), 2% chlorhexidine gel (CHX-G group) and 2% NaOCl (NaOCl group). After performing an endodontic measurement, the endodontic instruments were stabilized with flow resin composite. Afterwards, the roots were removed from the alginate mass, and the apical one-third of each root was cut lengthways to recover the canal system. Last, the distance between the file tip and the apical foramen was measured under a microscope at 60 x magnification.

Results

Statistically significant differences were found between CHX-S and NaOCl and CHX-G and NaOCl, but no significant differences were detected between CHX-S and CHX-G during the testing of both devices. No statistically significant differences were observed between the Raypex 5 and ApexDal for all intracanal media tested.

Conclusion

The EALs Raypex 5 and ApexDal had higher accuracy in the anatomical foramen of the root containing chlorhexidine in the gel or in the solution form than in the canal containing sodium hypochlorite.

SEM and EDS study of TotalFill BC Sealer and GuttaFlow Bioseal root canal sealers

BACKGROUND

Recently, a new generation of calcium silicate-based root canal sealers has been developed. These new types of sealers have the ability to set in wet environment, have high alkalinity and present potential antimicrobial activity.

OBJECTIVES

The aim of this study was to determine the chemical composition and microstructure of 2 novel calcium silicate-containing root canal sealers - TotalFill® BC Sealer and GuttaFlow® Bioseal.

MATERIAL AND METHODS

The tested sealers were prepared according to the manufacturers' instructions. Sixteen cylindrical dishes (inner diameter: 4 mm; height: 3 mm) were placed on a glass Petri dish and packed with the materials. The Petri dish was transferred to an incubator. After the sealers set, excess material was removed with diamond discs and polishing paste. The materials were assessed using scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS) X‑ray microanalysis.

RESULTS

Both TotalFill BC Sealer and GuttaFlow Bioseal contained calcium, zirconium, oxygen, carbon, silicon, and a trace of sodium. In the case of TotalFill BC Sealer, trace amounts of copper and technetium were also present, and for GuttaFlow Bioseal, iron, zinc, and a trace of magnesium and hafnium were noted. No bismuth was found. Both of the assessed sealers contained fine particles embedded in the matrix; however, GuttaFlow Bioseal also had larger particles with a diameter of 2-10 μm.

CONCLUSIONS

TotalFill BC Sealer represents a higher degree of purity in comparison with GuttaFlow Bioseal. The clinical implications of heavy metals present in GuttaFlow Bioseal need to be investigated. Both materials have a fine particle structure, which is desirable for root canal sealers.

A study of the symmetry of roots and root canal morphology in mandibular anterior teeth using cone-beam computed tomographic imaging in a Polish population

BACKGROUND

The purpose of the study was to analyse mandibular anterior teeth in a Polish population and determine the symmetry of root and root canal morphology between the right and left side using cone-beam computed tomography (CBCT) scanning.

MATERIALS AND METHODS

From 111 CBCT examinations, 303 pairs of equivalent mandibular anterior teeth were analysed on the right and left sides to evaluate symmetry. Axial, sagittal, and cross-sectional slices with a thickness of 0.2-0.25 mm were used. The number of root canals and their internal patterns were classified following Vertucci's criteria.

RESULTS

All incisors in this study had 1 root. Canines usually had a single root and much less often had 2 roots. Type I and III root canal configurations were found most often, while type V and II configurations were less frequent. Significant compatibility between the left and right side was observed in all evaluated variables. Incisors had the highest symmetry with regard to the number of roots (100%). Second canals were observed more often in males than females, but only the results in lateral incisors were significant.

CONCLUSIONS

This study provides supplemental information for dentists and should help them to better predict the morphology of mandibular anterior teeth in complicated cases in the Polish population. Symmetry was observed in roots and root canal morphology in all examined parameters.

Materials used in regenerative endodontic procedures and their impact on tooth discoloration

There is some evidence of tooth discoloration after regenerative endodontic procedures. The aim of this review is to determine which materials used in regenerative procedures induce tooth discoloration. The authors searched six digital databases in February 2018: PubMed, Google Scholar, the Cochrane Library, Scopus, Web of Science, and Lilacs. As a result, 353 studies were found. Eleven studies that met the established criteria were selected. Analysis of the selected studies showed that most materials used in regenerative endodontic procedures have the potential to stain tooth tissues. To decrease tooth discoloration, sealing dentin with a dentin-bonding agent before the placement of a disinfectant paste and barrier materials should be considered. Only a small number of in vitro studies have been performed; therefore, further studies on this topic are warranted.

The Diagnostic Value of Electromyography in Identifying Patients With Pain-Related Temporomandibular Disorders

Introduction: Orofacial pain disorders can be divided into several subgroups. One of them is temporomandibular disorders (TMD) with recognizable signs such as joint noises, limitations in the range of motion, or mandibular deviation during function and symptoms-pain in the muscles or joint. Surface electromyography (sEMG) is a diagnostic tool that ensures reliable and valid evaluation of muscle activity. sEMG detects electrical potentials and on this account may conceivably be employed in the TMD recognition. The aim of this study was to assess the sensitivity, specificity, and accuracy of electromyography in diagnosing subjects with temporomandibular disorders, including pain-free TMD and pain-related TMD. Methods: The sample comprised 88 patients with cleft lip and palate and mixed dentition. TMD has been recognized on the grounds of Axis I of the Research Diagnostic Criteria for TMD (RDC/TMD). To evaluate the electrical activity of the temporal and masseter muscles in the rest position and during maximum voluntary contraction, a DAB-Bluetooth Instrument (Zebris Medical GmbH, Germany) was used. The analysis of the receiver operating characteristic (ROC) curve gave information about accuracy, cut-off point value, sensitivity and specificity of the normalized sEMG data. Results: The highest diagnostic efficiency of sEMG in terms of identifying subjects with TMD and pain-related TMD was observed for the mean values of temporal and masseter muscle activity as well as the Asymmetry Index of the masseter muscles in a rest position. A moderate degree of EMG accuracy in differentiating between pain-related TMD and non-TMD children was observed for the mean values of masseter muscle activity and the Asymmetry Index of the masseter muscles at rest. Conclusion: An evaluation of electromyography exhibits its diagnostic usability in recognition of patients with pain-related TMD and it could be used as an adjunctive tool in the identification of this disorder. Clinical Trial Registration: This clinical research was registered in the ClinicalTrials.gov database under the number NCT03308266.

Panoramic radiographs and quantitative ultrasound of the radius and phalanx III to assess bone mineral status in postmenopausal women

Background

Various mandibular indices have been developed to detect osteoporosis on panoramic radiographs. Quantitative ultrasound (QUS) is a low-cost, radiation-free method to assess bone status. The aim of this study was to compare mandibular morphometric analysis and QUS at the radius and proximal phalanx III finger.

Methods

The study involved 97 postmenopausal women, aged 48.5–71.5y (mean: 55.4). Mandibular morphometric analysis comprised: distance between upper and lower mandibular borders just behind the mental foramen (H), distance: mental foramen - inferior mandibular cortex (IM) and mandibular cortical width at the mental region (MCW). Then, ratios were calculated: MCW/IM = PMI (panoramic mandibular index), H/IM = MR (mandibular ratio). Mandibular cortical index (MCI) was used to classify the morphology of the mandibular cortex.

Bone mineral status assessed using QUS at the radius and proximal phalanx III finger was compared to population mean apical bone mass (T-score).

Linear regression analysis was used for correlations between continuous variables, Pearson’s correlation coefficient r - for variables of normal distribution. Student’s t-test was used to compare variables of normal distribution and for the latter - Mann-Whitney U-test. The level of significance was p < 0.05.

Results

Mandibular height was 13.42–34.42 mm. The mean mandibular cortical width was 3.31 mm. Mean values of PMI and MR were 0.33 and 2.57, respectively. Higher mean value of Ad-SoS was found in the radius than in the III finger. Phalanx T-score values ​​were lower than those of the radius. T-score of the radius was < − 1.0 in 22 patients, indicating osteopenia. Basing on phalanx T-score, osteopenia was found in 39 patients. Category C1 of Mandibular Cortical Index was found in 48 women, C2 - in 37 women and C3 - in 12 women. Higher scores of Mandibular Cortical Index were recorded in older women. MCI significantly correlated with the skeletal status (p = 0.01) as well as with H, MCW and MR. Phalanx T-score was not correlated to PMI, MR or MCW.

Conclusions

1. Mandibular Cortical Index can be used as a screening tool for detecting osteoporosis.

2. Quantitative ultrasound at the phalanx III constitutes a reliable way of assessing bone status.

Electronic supplementary material

The online version of this article (10.1186/s12903-018-0593-4) contains supplementary material, which is available to authorized users.

Factors affecting the outcomes of direct pulp capping using Biodentine

Introduction

This study aimed to evaluate the prognostic value of factors with regard to the treatment outcome of direct pulp capping using Biodentine (Septodont, Saint-Maur-des-Fossés, France), in permanent teeth in which the pulps were exposed during caries removal.

Methods

Between 2010 and 2014, 112 teeth with deep carious lesions underwent direct pulp capping. The patients were followed up at 2–3 months and 1–1.5 years with a routine examination on both recall visits. Periapical radiographs were taken at 1–1.5 years. Lack of patient complaints, positive reactions to cold and electric testing, no sensitivity to percussion, and no widening of the periapical ligament indicated success. The Fisher exact test was used for statistical analysis. The significance level was P = .05.

Results

Eighty-six teeth were available for 1–1.5 years follow-up. The overall success rate was 82.6%. Only age had a significant effect on the pulpal survival rate: the success rate was 90.9% in patients younger than 40 years and 73.8% in patients 40 years or older (P = .0480). Sex, initial or secondary caries treatment, occlusal or cervical/proximal caries, delayed placement of permanent filling, tooth position, and arch type did not influence the outcome.

Conclusions

A patient’s age influenced the outcome of direct pulp capping using this new calcium silicate cement.

Clinical relevance

Asymptomatic vital permanent teeth with cariously exposed pulp can be treated successfully by direct pulp capping using Biodentine.

The role of aryl hydrocarbon receptor (AhR) in the pathology of pleomorphic adenoma in parotid gland

OBJECTIVES

Pleomorphic adenoma (benign mixed tumor) is one of the most common salivary gland tumors. However, molecular mechanisms implicated in its development are not entirely defined. Therefore, the study aimed at definition of aryl hydrocarbon receptor (AhR) involvement in pleomorphic adenoma pathology, as the AhR controlled gene system was documented to play a role in development of various human tumors.

DESIGN

The study was carried out in pleomorphic adenoma and control parotid gland tissues where gene expression of AHR, AhR nuclear translocator (ARNT), AhR repressor (AHRR), as well as AhR controlled genes: CYP1A1 and CYP1B1, at mRNA and protein (immunohistochemistry) levels were studied. Functional evaluation of AhR system was evaluated in HSY cells (human parotid gland adenocarcinoma cells) using 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) as AhR specific inducer.

RESULTS

Pleomorphic adenoma specimens showed cytoplasmic and nuclear AhR expression in epithelial cells as well as in mesenchymal cells. In parotid gland AhR was expressed in cytoplasm of duct cells. Quantitative expression at mRNA level showed significantly higher expression of AHR, ARNT and CYP1B1, and comparable levels of CYP1A1 in pleomorphic adenoma tissue in comparison to healthy parotid gland. The HSY cell study revealed significantly higher expression level of AHRR in HSY as compared with MCF-7 cells (human breast adenocarcinoma cell line used as reference). Upon TCDD stimulation a drop in AHRR level in HSY cells and an increase in MCF-7 cells were observed. The HSY and MCF-7 cell proliferation rate (measured by WST-1 test) was not affected by TCDD.

CONCLUSIONS

Summarizing both in vitro and in vivo observations it can be stated that AhR system may play a role in the pathology of pleomorphic adenoma.

Evaluation of alginate as a substitute for root-surrounding tissues in electronic root canal measurements

Alginate as a substitute for root-surrounding tissue was investigated. The electronic working lengths of root canals under clinical conditions were compared with an in vitro simulation of the same teeth extracted and embedded in alginate. The working lengths in 26 teeth were determined on two occasions using an electronic apex locator, before extraction and after extraction with the same teeth embedded in an alginate mass. The apical 4 mm of the root canals were exposed following the measurements, and the distances between the apical constrictions and the tips of files repositioned in the canals were measured and recorded. The mean distance between the file tip and the constriction was +0.33 mm (±0.38) in vivo and +0.32 mm (±0.30) in vitro. The Wilcoxon signed-rank test indicated that these means were not significantly different. The apical constriction was assessed to be within the limits of 0.5 mm in 80.7% of in vivo cases and in 76.9% of extracted teeth. Statistical analysis demonstrated that there was no significant difference between the results recorded in vivo and in vitro regarding apical constriction localisation. Based on the results of this study, the alginate mass is a useful tool in evaluating the performance of electronic apex locators.

Loss of sight caused by calcium hydroxide paste accidentally splashed into the eye during endodontic treatment: case report

Calcium hydroxide, widely used in endodontic treatment, is a strong base that may cause irreversible injury to vital tissue that comes into contact with this substance. We present the first case of a dentist who accidentally splashed endodontic calcium hydroxide into her own eye. After washing with copious amounts of water for several minutes, she was treated in the hospital within 30 minutes of the accident. Because of the burning caused by the base solution, the dentist lost vision in the affected eye. She returned to the hospital several times for treatment of a corneal abscess and corneal fungal infection. She had the keloid that formed between the eyeball and eyelid removed 3 times. Calcium hydroxide can cause blindness when it comes into contact with the eye. Clinicians should take adequate precautions to prevent this serious complication. In case of an accident, it is important to wash the eye efficiently.

Surface electromyography in orthodontics - a literature review

Electromyography is the most objective and reliable technique for evaluating muscle function and efficiency by detecting their electrical potentials. It makes it possible to assess the extent and duration of muscle activity. The main aim of surface electromyography is to detect signals from many muscle fibers in the area of the detecting surface electrodes. These signals consist of a weighted summation of the spatial and temporal activity of many motor units. Hence, the analysis of the recordings is restricted to an assessment of general muscle activity, the cooperation of different muscles, and the variability of their activity over time.

This study presents the main assumptions in the assessment of electrical muscle activity through the use of surface electromyography, along with its limitations and possibilities for further use in many areas of orthodontics. The main clinical uses of sEMG include the diagnostics and therapy of temporomandibular joint disorders, an assessment of the extent of stomatognathic system dysfunctions in subjects with malocclusion, and the monitoring of orthodontic therapies.

[Cleanliness of the walls of root canals in teeth with incomplete development of root, rinsed with 2% chlorexidine. A SEM study]

INTRODUCTION

The aim of the study was to evaluate the cleanliness of the walls of root canals with incomplete development of root, whose lumen was rinsed with 2% chlorhexidine solution during mechanical preparation.

MATERIAL AND METHODS

Use was made of 8 maxillary premolar teeth with a single root canal and with incomplete development of the root apex (the teeth were removed during the growing stage for orthodontic reasons). The coronal and middle parts of the canals were instrumented using Gates-Glidden no. 3 and 4 drills, and the apical section with the help of Hedstroem size 50-80 files. During instrumentation of the canals irrigation was carried out using 2% chlorhexidine solution. Irrigating solution, volume 2 mL, was introduced into the canal with the use of a syringe and an endodontic needle after using each instrument, and 5 mL volume after complete instrumentation of the canal.

RESULTS

Observations using a scanning electron microscope with x200 and x1000 magnification showed relatively effective removal of pulp remains and dentine chips, and the presence of a thick smear layer covering the canal walls throughout their length. Statistical analysis did not show significant differences in the degree of cleaning of particular sections of the canals.

CONCLUSION

The presence of the smear layer in canals irrigated with chlorhexidine is evidence that it does not have properties for it to be dissolved, and this dictates the necessity of using chelating agents.

[Evaluation of adaptation of FibreFill/Resilon post and Epiphany to the walls of the root canal. Scanning electron microscope study]

BACKGROUND

The aim of the study was to evaluate the adaptation of sealer to the dentine and to the components of the post, i.e. the part made of composite reinforced with glass fibre and the part made of resilon.

MATERIALS AND METHODS

The study was carried out on 7 extracted one-canal human teeth that were treated using Mtwo nickel-titanium instruments and an Endo IT Professional endodontic micromotor. The canals were rinsed with NaOCl, EDTA and chlorhexidine, and then filled with the Epiphany sealer and FibreFill posts. Next, tooth roots were cut along the frontal plane, to expose the entire lumen length of the filled canal, and inspected under the scanning electron microscope.

RESULTS

SEM study demonstrated good adaptation of sealers to the walls of the root canals on their entire length, despite occasional gaps between the sealer and dentine.

CONCLUSIONS

The results of preliminary studies suggest that FibreFill posts and Epiphany sealer are useful for canal filling. However, several-years' clinical follow-up is necessary for the complete evaluation of the system.

The influence of natural head position on the assessment of facial morphology

BACKGROUND

Skeletal relationships play a major part in determining occlusal relationships, and that is why they also affect orthodontic treatment. Facial morphology can be assessed by clinical or radiological methods. Soft tissue analysis of the face is accepted as an integral part of orthodontic diagnosis and treatment planning.

OBJECTIVES

The aim of the study was to determine the impact of the inclination between the Frankfort horizontal(FH) and the extracranial horizontal (HOR) lines with the head in the natural position (NHP) on the assessment of facial morphology.

MATERIAL AND METHODS

Lateral facial photographs of 200 young adult males and females were taken with the head in the natural head position and then analyzed. Each image was rotated in order to position the Frankfort line parallel to the extracranial horizontal line. Twelve landmarks on each of the 400 profile photographs (200 originals,200 processed) were identified, and nine linear measurements and three angular measurements were assessed.

RESULTS

The inclination angle between the extracranial horizontal line and the Frankfort horizontal line in the NHP varied from -7.1° to 5.6° (mean -1.20°). Significant correlations were found between the inclination angle FH/HOR and both sagittal and vertical morphology predictors such as the sections N-Sn (r = 0.3737, p = 0.0001), Sn-Gn(r = 0.3231, p = 0.0000), and both facial angles (r = 0.9774, p = 0.0000) and proflle angles (r = 0.9654, p = 0.0000).

CONCLUSIONS

A comparison of soft tissue measurements determined with reference to the Frankfort horizontal and extracranial horizontal lines with the head in the natural position reveals significant differences

An assessment of relationships between the five-factor personality model and the morphology and function of the stomathognatic system

BACKGROUND

The personality as a system of genetically predetermined features is responsible for modifying relations between an individual's genotype and phenotype. The key element linking personality with facial morphology is the muscular system.

OBJECTIVES

The aim of this study was to investigate the association between facets of the five-factor personality model (FFM) domains and both the morphology and function of the stomathognatic system.

MATERIAL AND METHODS

Two hundred volunteers (100 female and 100 male) aged 20 to 25 (mean age: 23.4) underwent anthropometric measurements to calculate the anterior face height ratio N-Sn/Sn-Gn. For cephalometric analysis, standard right-profile images of the face were used. Calibration was performed with a 100-mm metal ruler placed next to each photographed individual. The Revised NEO Personality Inventory (NEO-PI-R), which includes 240 statements, was used for personality assessment in order to investigate the five main personality domains: neuroticism, extraversion, openness to experience, agreeableness, conscientiousness and six facets within each domain.

RESULTS

The results show significant correlations between factors of the personality such as neuroticism (r = 0.3488; p = 0.0000) and extraversion (r = -0.3405; p = 0.0000) and the inclination angle (FH/HOR) as the predictor of the function of the stomathognatic system. Additionally, the correlation analysis revealed a significant positive association between the anterior face height ratio and anxiety (r = 0.3952; p = 0.0000).

CONCLUSIONS

The results of this study indicate a selective association between personality and both the morphology and function of the stomathognatic system

Loss of sight caused by calcium hydroxide paste accidentally splashed into the eye during endodontic treatment: case report

Calcium hydroxide, widely used in endodontic treatment, is a strong base that may cause irreversible injury to vital tissue that comes into contact with this substance. We present the first case of a dentist who accidentally splashed endodontic calcium hydroxide into her own eye. After washing with copious amounts of water for several minutes, she was treated in the hospital within 30 minutes of the accident. Because of the burning caused by the base solution, the dentist lost vision in the affected eye. She returned to the hospital several times for treatment of a corneal abscess and corneal fungal infection. She had the keloid that formed between the eyeball and eyelid removed 3 times. Calcium hydroxide can cause blindness when it comes into contact with the eye. Clinicians should take adequate precautions to prevent this serious complication. In case of an accident, it is important to wash the eye efficiently.

TGF-β1 gene polymorphism in renal transplant patients with and without gingival overgrowth

BACKGROUND

The incidence of gingival overgrowth among renal transplant patients treated with cyclosporine A ranges from 13% to 84.6%, and the overgrowth is not only esthetic but also a medical problem. We studied the determination of association between TGF-β1 (TGFB1) gene polymorphism and gingival overgrowth in kidney transplant patients medicated with cyclosporin A.

METHODS

Eighty-four kidney transplant patients with gingival overgrowth and 140 control transplant patients without overgrowth were enrolled into the case control study. TGFB1 polymorphism was determined using the PCR-RFLP assay for +869T > C in codon 10 and +915G > C in codon 25 as well as TaqMan real-time PCR assays for promoter -800G>A and -509C > T SNPs.

RESULTS

In kidney transplant patients suffering from gingival overgrowth, mean score of gingival overgrowth was 1.38 ± 0.60, whereas in control subjects it was 0.0. The patients with gingival overgrowth were characterized by similar distribution of TGFB1 genotypes and allele in comparison to subjects without gingival overgrowth. Among 16 potentially possible haplotypes of TGFB1 gene, only four were observed in the studied sample of kidney transplant patients: G_C_T_G, G_T_C_G, G_C_C_C, and A_C_T_G, with similar frequency in patients with and without gingival overgrowth.

CONCLUSION

No association between the TGFB1 gene polymorphism and gingival overgrowth was revealed in kidney transplant patients administered cyclosporine A.

Effect of different water flows on root surface temperature during ultrasonic removal of posts

OBJECTIVE

This in vitro study evaluated rises in temperature on the outer root surface of human incisors during ultrasonic post removal with different water flows.

STUDY DESIGN

Thirty-six extracted teeth (12 maxillary central incisors, 12 maxillary lateral incisors, and 12 mandibular incisors) were used. After root canal preparation, the teeth were obturated, and prefabricated posts were cemented into the prepared spaces. Posts were ultrasonically instrumented dry and with irrigation at 20 mL/min and 40 mL/min. Temperature changes on the entire mesial outer surfaces of the roots were measured at 10-second intervals using an infrared thermal imaging camera.

RESULTS

Increases in root surface temperature were significantly lower when posts were instrumented with 40 mL/min water irrigation compared with dry vibration and 20 mL/min irrigation, which also significantly differed from each other. Statistical analysis among tooth groups showed differences in the mean temperature rise of maxillary central incisors and maxillary lateral incisors compared with mandibular incisors when posts were instrumented dry or with 20 mL/min irrigation. There were no significant differences in mean temperature rises between the studied groups when 40 mL/min irrigation was used.

CONCLUSIONS

Water cooling during ultrasonic post instrumentation significantly reduced temperature increases on the outer root surface; however, the intensity of the cooling was also important. Our results suggest that copious water irrigation during post removal is an effective method to protect the root's surrounding tissue.

Influence of water cooling on root surface temperature generated during post space preparation

INTRODUCTION

This in vitro study evaluated the temperature increases on the root surface of teeth during preparation of post space with and without water cooling.

METHODS

Thirty premolar teeth with a single canal were used. After root canal obturation, the teeth were divided into 2 groups, and post spaces were prepared by using a drill without cooling (dry group) and with water irrigation of 25 mL/min(-1) (wet group). Temperatures were measured on the entire root surface by using a thermal imaging camera.

RESULTS

Root surface temperature increases were significantly lower when post spaces were created with water cooling compared with dry post preparation (P < .0001 for root canal filling removal and P < .0001 for post space preparation). In both groups, significantly higher temperatures were recorded during the post space preparation than during the filling removal (P < .001 for nonirrigated teeth and P < .001 for irrigated teeth).

CONCLUSIONS

Irrigation during post space preparation significantly influenced the outer root surface temperature. The risk of irreversible injury to the root surrounding tissues is potentially minimized when post space is prepared by using water cooling.

[Comprehensive treatment of the endo-perio syndrome. Case reports]

INTRODUCTION

The endo-perio syndrome presenting with periodontitis is very difficult to manage due to its pathomechanism which until today has evaded clarification. Substantial loss of tooth-bearing tissues within the alveolar processes of the maxilla and the alveolar part of the mandible compounds the situation and complicates efforts to control the inflammatory process and restore the missing periodontal tissues, to minimize the costs for the patient, and to achieve a good cosmetic effect. The aim of this work was to assess therapeutic efforts undertaken in some cases of the endo-perio syndrome.

MATERIAL AND METHODS

The results of periodontic and implantologic treatment in three patients with the endo-perio syndrome caused by periodontitis are presented.

CONCLUSIONS

Conservative treatment of the endo-perio syndrome leads to restoration of periodontal tissues, provides a good esthetic effect, and greatly minimizes the psychosocial costs due to temporary loss of a tooth in the visible part of dental arches.

[Dentinal hypersensivity after vertical stripping of enamel]

INTRODUCTION

Vertical stripping of enamel in patients with minor or moderate crowding of teeth and Angle's class I is an effective method which supplements orthodontic treatment. Stripping is an alternative to tooth extraction or to extension of alveolar arches which carries the risk of recurrence of crowding and further periodontal difficulties. Stripping also shortens considerably the duration of treatment. Apart from unquestionable advantages, enamel reduction may lead to complications such as caries or hypersensitivity of interproximal surfaces of stripped teeth. The aim of this study was to determine the prevalence of hypersensitivity and to measure the intensity of pain.

MATERIALS AND METHODS

We performed a verbal and visual assessment of pain in a group of 32 patients who underwent stripping during the recent few years as part of orthodontic treatment.

RESULTS

According to verbal assessment, the highest percentage (46.9%) of patients rated their pain as 1 (gentle pain) which corresponded to 1-3 cm on the 10 cm Visual Analog Scale. 37.5% of patients reported no pain.

CONCLUSION

None of the patients described their pain as very strong and discouraging from further treatment. All symptoms subsided without recurrence. The patients found this method to be more effective than alternative ones.

[The effect of age on the process of healing of chronic periapical inflammation]

INTRODUCTION

The aim of this study was to determine the effect of age on the process of healing of chronic periapical inflammation.

MATERIAL AND METHODS

The study was carried out in 59 patients with accidentally disclosed chronic periapical inflammation and no other pathology. The patients were allocated to two age groups: group I--from 17 to 44 years of age; group II--from 45 to 78 years of age. All teeth with periapical inflammation were endodontically treated. Control radiographs were taken 6 and 12 months later.

RESULTS

Radiographs taken after 6 months disclosed partial or complete restoration of periapical tissues in 79.5% of patients in group I and 65.0% of patients in group II. Radiographs after 12 months showed partial or complete healing in 94.8% of patients in group I and 90.0% of patients in group II.

CONCLUSIONS

The process of healing of chronic periapical inflammation lasted longer in patients aged 45-78 years than in patients aged 17-44 years. The outcome of treatment was similar in both groups.

[Response of dental pulp to self-etching adhesive systems used in indirect capping. A literature review]

OBJECTIVE

To review the literature on dental pulp responses to self-etching adhesive systems used in indirect capping.

MATERIAL AND METHODS

Many studies in vitro and in vivo focused on biocompatibility of the self-etching adhesive system used in deep defects. Clinical and radiographic findings from animal and human studies are compared and discussed.

RESULTS

Self-etching adhesive systems may be useful when applied to dentin. The results in animal studies cannot be extrapolated directly to humans. Many studies in vitro have shown that components of self-etching adhesive systems exhibit cytotoxic effects in contact with cell cultures.

CONCLUSIONS

The reaction of dental pulp to self-etching bonding agents depends on the depth of defect, type of agent, and method of application.

Endodontic and prosthetic treatment of teeth with C-shaped root canals

INTRODUCTION

The aim of this study was to describe and discuss the unusual anatomy that can be detected during routine endodontic and prosthetic treatment of mandibular second molars.

MATERIAL AND METHODS

We studied 2 mandibular second molars with C-shaped canals in two patients who underwent endodontic and prosthetic treatment. In one patient, the preoperative radiograph of mandibular right second molar indicated radicular fusion with single apex and two canals. However, four separate canals were disclosed during endodontic treatment. There were no complications during cleaning, shaping, and obturation of the canals. In the second patient, prosthetic restoration of the mandibular left second molar after root canal treatment was necessary. The radiograph showed radicular fusion with one wide central canal correctly obturated. The tooth was prepared without difficulty or complications for the cast post and crown.

RESULTS

Endodontic treatment in the first patient was successful as confirmed with the postoperative radiograph showing precisely obturated canals. The cast post performed in the second patient enabled effective tooth reconstruction with a prosthetic crown.

CONCLUSIONS

C-shaped canals may be precisely debrided and obturated on condition that they have been disclosed on preoperative radiographs. Prosthetic reconstruction of these teeth with a post-crown is possible but only with the use of the distal canal.

[Frequency and etiology of noncarious cervical lesions with pulp exposure]

PURPOSE

Noncarious cervical lesions have a multifactorial etiology encompassing occlusal trauma, toothbrush abrasion, and exposure of enamel to erosive factors. The purpose of this study was to determine the frequency of cervical lesions with exposure of pulp and to analyze their etiology.

MATERIAL AND METHODS

The study was done in 124 patients (59 women and 65 men) with a mean age of 44 years (15-72 years). Clinical assessment of cervical lesions was based on criteria of the universal tooth wear index for the cervical surface. Additionally, the following findings were recorded: frequency of cervical lesions depending on tooth type, pulp exposure, oral hygiene status, and type of occlusal guidance. The questionnaire consisted of detailed questions concerning toothbrushing, frequency of consumption of some foods, and parafunctional habits. The risk of cervical lesion was estimated with the logistic regression model.

RESULTS

The frequency, localization, and depth of noncarious cervical lesions were related to age of the patient. Very deep defects with pulp exposure were found in 44 teeth. The effect of consumption of acid foods and drinks and of oral hygiene habits on the depth of wedge-shaped defects was corroborated. Correlations between lateral excursive tooth contact, bruxism, and formation of cervical lesions were disclosed, confirming the relationship between occlusal pathology and cervical lesions.

CONCLUSIONS

Elucidation of the multifactorial etiology of cervical lesions is important for proper treatment and prevention of pulp exposure.