WP Front Range Dental

Is it proper to alter amount in dental patients’ accounts after billing? Find out what #DentalCodeology advises. #dentistry https://www.dentistryiq.com/front-office/collections/article/14168273/thursday-troubleshooter-is-it-proper-to-alter-amount-in-dent

Tue, 25 Feb 2020 16:00:00 -0700

Is it proper to alter amount in dental patients’ accounts after billing? Find out what #DentalCodeology advises. #dentistry https://www.dentistryiq.com/front-office/collections/article/14168273/thursday-troubleshooter-is-it-proper-to-alter-amount-in-dental-patients-accounts-after-billing … pic.twitter.com/0WFLZ3jjTO

Hire slowly & fire quickly. Don't hang on to your #dental employees longer than necessary. If someone doesn't improve after proper warnings, Dr. Chris Salierno says it's better for the business to cut ties sooner rather than later. #dentistry #dentists h

Tue, 25 Feb 2020 13:00:00 -0700

Hire slowly & fire quickly. Don't hang on to your #dental employees longer than necessary. If someone doesn't improve after proper warnings, Dr. Chris Salierno says it's better for the business to cut ties sooner rather than later. #dentistry #dentists https://www.dentistryiq.com/practice-management/staffing/article/14168280/hire-slowly-and-fire-quickly … pic.twitter.com/Iwh5olvkxW

The #pain game: Do you have a clear plan for managing & treating patients who are in pain? Dr. Stacey Gividen offers insight into making the comprehensive management of patients’ pain less painful for you & your practice. #dental #dentistry https://www.d

Tue, 25 Feb 2020 09:00:01 -0700

The #pain game: Do you have a clear plan for managing & treating patients who are in pain? Dr. Stacey Gividen offers insight into making the comprehensive management of patients’ pain less painful for you & your practice. #dental #dentistry https://www.dentistryiq.com/clinical/pharmacology/article/14168497/playing-the-pain-game-in-dentistry … pic.twitter.com/sK1X923yLP

PRICE 2020 Guidelines for reporting case reports in Endodontics: A consensus‐based development

Tue, 25 Feb 2020 05:25:17 -0700

Abstract

Case reports can provide early information about new, unusual or rare disease(s), newer treatment strategies, improved therapeutic benefits and adverse effects of interventions or medications. This paper describes the process that led to the development of the Preferred Reporting Items for Case reports in Endodontics (PRICE) 2020 guidelines through a consensus‐based methodology. A steering committee was formed with eight members (PD, VN, BC, PM, PS, EP, JJ, SP), including the project leaders (PD, VN). The steering committee developed an initial checklist by combining and modifying the items from the Case Report (CARE) guidelines and Clinical and Laboratory Images in Publications (CLIP) principles. A PRICE Delphi Group (PDG) and PRICE Face‐to‐Face Meeting Group (PFMG) were then formed. The members of the PDG were invited to participate in an online Delphi process to achieve consensus on the wording and utility of the checklist items and the accompanying flowchart that was created to complement the PRICE 2020 guidelines. The revised PRICE checklist and flowchart developed by the online Delphi process was discussed by the PFMG at a meeting held during the 19^th European Society of Endodontology (ESE) Biennial Congress in Vienna, Austria, in September 2019. Following the meeting, the steering committee created a final version of the guidelines, which were piloted by several authors during the writing of a case report. In order to help improve the clarity, completeness and quality of case reports in Endodontics, we encourage authors to use the PRICE 2020 guidelines.

An in-depth study shows 80% of #dental patients were prescribed “unnecessary” antibiotics according to evidence-based guidelines for antibiotic prophylaxis. #Pharmacist Thomas Viola takes a closer look. #dentistry https://www.dentistryiq.com/clinical/pha

Fri, 21 Feb 2020 12:00:01 -0700

An in-depth study shows 80% of #dental patients were prescribed “unnecessary” antibiotics according to evidence-based guidelines for antibiotic prophylaxis. #Pharmacist Thomas Viola takes a closer look. #dentistry https://www.dentistryiq.com/clinical/pharmacology/article/14038510/are-dentists-prescribing-too-many-unnecessary-antibiotics … pic.twitter.com/hizjjPJ7hJ

This #dental team member has been instructed to change the amount billed in patients' ledgers. She's concerned there might be a problem with this. Find out what @DentalCodeology has to say. #dentistry #dentists https://www.dentistryiq.com/front-office/co

Fri, 21 Feb 2020 08:41:34 -0700

This #dental team member has been instructed to change the amount billed in patients' ledgers. She's concerned there might be a problem with this. Find out what @DentalCodeology has to say. #dentistry #dentists https://www.dentistryiq.com/front-office/collections/article/14168273/thursday-troubleshooter-is-it-proper-to-alter-amount-in-dental-patients-accounts-after-billing … pic.twitter.com/UQIM6mF3S0

Is #dental charting important? You bet it is! In her latest #myth buster, Dental Assistant Tija Hunter explains why good charting matters. #dentistry https://www.dentistryiq.com/dental-assisting/clinical/article/14168096/myth-busters-for-dental-assistant

Thu, 20 Feb 2020 15:30:00 -0700

Is #dental charting important? You bet it is! In her latest #myth buster, Dental Assistant Tija Hunter explains why good charting matters. #dentistry https://www.dentistryiq.com/dental-assisting/clinical/article/14168096/myth-busters-for-dental-assistants-chart-notes-arent-that-important … pic.twitter.com/EiFQMtiDBG

No #dental patient likes fighting dry mouth. There's relief for that! Here are 5 products for dry mouth recommended by a #dentalhygienist. Tell your patients! #dentistry https://www.dentistryiq.com/products/salivary/article/14068946/dry-mouth-relief-5-p

Thu, 20 Feb 2020 12:30:00 -0700

No #dental patient likes fighting dry mouth. There's relief for that! Here are 5 products for dry mouth recommended by a #dentalhygienist. Tell your patients! #dentistry https://www.dentistryiq.com/products/salivary/article/14068946/dry-mouth-relief-5-products-for-xerostomia-patients … pic.twitter.com/A9dkLg7Ux8

#Dentists, remember—your most important asset is YOU, and it’s important to do what's necessary to protect and invest in yourself. #dental #dentistry https://www.dentistryiq.com/practice-management/financial/article/14167986/dentists-your-best-asset-is-y

Thu, 20 Feb 2020 08:30:00 -0700

#Dentists, remember—your most important asset is YOU, and it’s important to do what's necessary to protect and invest in yourself. #dental #dentistry https://www.dentistryiq.com/practice-management/financial/article/14167986/dentists-your-best-asset-is-you … pic.twitter.com/pJRY8DXQxs

If #directmail intrigues you, but your #dental practice doesn't have the budget for it, don't despair. You can #DIY! Jessica Thiefels explains how to create a direct mail campaign. It's easier than you think! #dentistry https://www.dentistryiq.com/practi

Wed, 19 Feb 2020 16:30:00 -0700

If #directmail intrigues you, but your #dental practice doesn't have the budget for it, don't despair. You can #DIY! Jessica Thiefels explains how to create a direct mail campaign. It's easier than you think! #dentistry https://www.dentistryiq.com/practice-management/marketing/article/14075158/how-to-diy-your-first-direct-mail-campaign … pic.twitter.com/oNRI7vqnsd

Efficacy of bioactive nanoparticles on tissue‐endotoxin induced suppression of stem cell viability, migration and differentiation

Wed, 19 Feb 2020 12:46:22 -0700

Abstract

Aim

To characterize a lipopolysaccharide (LPS)‐treated dentine tissue model (LPS‐dentine) to analyse the efficacy of polycationic chitosan nanoparticles (CSnp) and/or dexamethasone conjugate chitosan nanoparticles (Dex‐CSnp) on the viability /differentiation potential of stem cells from apical papilla (SCAP) when exposed to LPS‐dentine. A further aim was to understand the effect of macrophage‐dependent inflammation on SCAP migration in presence of LPS‐dentine.

Methodology

A total of 88 dentine slabs were used. TOF‐SIMS analysis was performed among the LPS‐treated and untreated dentine groups (n=2/group). The study was conducted using four dentine groups: no treatment (control); LPS‐treatment only; LPS‐treatment followed by CSnp conditioning; and LPS‐treatment followed by Dex‐CSnp conditioning groups. SCAP adherence, viability, differentiation and biomineralization potential on dentine from different groups was studied using fluorescent and scanning electron microscopy. Inflammation by macrophages in response to LPS‐dentine was quantified and effect on SCAP migration was analysed. Statistical analysis was performed using the student's t‐test with a significance level of p < 0.05.

Result

TOF‐SIMS analysis confirmed LPS contamination. LPS‐dentine affected SCAP viability but not adherence to dentine (p < 0.001). Conditioning of LPS‐dentine with either nanoparticles improved SCAP viability (p < 0.01), and rescued other LPS related adverse effects on SCAPs, such as F‐actin disruption, decrease in differentiation/biomineralization potential. IL‐6 produced by macrophages in response to LPS‐ treated dentine impeded SCAP migration (p < 0.001), diminished on CSnp and Dex‐CSnp conditioning groups (p < 0.01).

Conclusion

This study developed an LPS‐dentine model and highlighted the ability of CSnp and Dex‐CSnp to promote stem cell viability, migration, differentiation potential and reduce inflammation, providing an environment conducive for tissue regeneration/repair.

Age‐specific findings on endodontic treatments performed by private dentists in Finland in 2012 and 2017: a nationwide register‐based observation

Wed, 19 Feb 2020 12:46:22 -0700

Abstract

Aim

To evaluate age‐specific aspects and changes in volume and content of endodontic treatment for adults visiting private dentists in Finland in 2012 and 2017.

Methodology

This study utilized register‐based data of private dental care. The observation unit of the aggregated macro‐level data was age group, with 5‐year age groups from 20–24 years onwards and the oldest group combining all patients aged 90 years and over. Data from years 2012 and 2017 included all the oral health care of 2.04 million patients receiving reimbursement for treatment by private dentists; a total of 183 932 patients received at least one endodontic treatment and were analysed. The number of teeth receiving endodontic treatment were counted separately as pulp cappings, pulpotomies and root canal fillings according to number of canals filled per tooth. Statistical associations were assessed as correlation coefficients.

Results

The mean age of endodontic patients was 53.6 years in 2012 and 55.9 years in 2017. In both years, 38% were aged from 50 to 64 years. In 2012, 9.9%, and in 2017, 8.0% of patients received at least one endodontic treatment; the older the patients, the fewer received endodontic treatment (r = ‐0.9). From 2012 to 2017, numbers of all patients and treatments decreased, endodontic patients and treatments even more notably, and in all age groups. Per thousand patients in 2017, 62.1 teeth received root canal treatment and 14.9 pulp capping. Pulp capping comprised 19.2%, pulpotomies 0.8% and root canal fillings 80.0% of teeth receiving endodontic treatment. Of root‐filled teeth, 45.1% received filling in one canal, 17.0% in two and 37.9% in three or more canals, multi‐canal options being less frequent in older patients (r = ‐0.94).

Conclusions

Endodontic treatment, received by 9% of adult patients visiting private dentists in Finland, was strongly age‐dependent, showing a decreasing trend with age and time.

#Dental assistants. Do you think charting is not important? That's a #myth that persists among DAs, & this assistant explains why correct charting is actually very #important & should be done well. #dentistry https://www.dentistryiq.com/dental-assisting/

Wed, 19 Feb 2020 12:30:00 -0700

#Dental assistants. Do you think charting is not important? That's a #myth that persists among DAs, & this assistant explains why correct charting is actually very #important & should be done well. #dentistry https://www.dentistryiq.com/dental-assisting/clinical/article/14168096/myth-busters-for-dental-assistants-chart-notes-arent-that-important … pic.twitter.com/WTgqpxSTRD

Chicago Midwinter #Dental Meeting starts tomorrow! @RDHmag wants to help you with your search for new #products. Check out some recommendations here. #dentistry #dentalhygienists https://www.rdhmag.com/career-profession/article/14167861/products-to-see-a

Wed, 19 Feb 2020 09:00:00 -0700

Chicago Midwinter #Dental Meeting starts tomorrow! @RDHmag wants to help you with your search for new #products. Check out some recommendations here. #dentistry #dentalhygienists https://www.rdhmag.com/career-profession/article/14167861/products-to-see-at-the-2020-chicago-midwinter-meeting … pic.twitter.com/1nh0jNVzyK

What can this #dental hygienist do when the #dentist insists that she provide anesthesia illegally? Find out here. #dentistry https://www.dentistryiq.com/practice-management/hygiene-department/article/14068437/thursday-troubleshooter-dentist-insists-hygi

Tue, 18 Feb 2020 16:00:00 -0700

What can this #dental hygienist do when the #dentist insists that she provide anesthesia illegally? Find out here. #dentistry https://www.dentistryiq.com/practice-management/hygiene-department/article/14068437/thursday-troubleshooter-dentist-insists-hygienist-administer-anesthetic-illegally … pic.twitter.com/M8tWhEIXlr

Who has time to look for oral #cancer? To patients with undiagnosed oral cancer, this is the most important part of the appointment—but most #dental hygienists don't do it. Why is that? #dentistry https://www.dentistryiq.com/dental-hygiene/clinical-hygie

Tue, 18 Feb 2020 12:30:00 -0700

Who has time to look for oral #cancer? To patients with undiagnosed oral cancer, this is the most important part of the appointment—but most #dental hygienists don't do it. Why is that? #dentistry https://www.dentistryiq.com/dental-hygiene/clinical-hygiene/article/14073034/who-has-time-to-look-for-oral-cancer-the-basics-of-a-screening-most-hygienists-never-do … pic.twitter.com/0LREQeoCYJ

#HumanResources questions? These #dentists ask the HR #experts about how to pay for working interviews, & what they're required to provide for references when asked. #dental #dentistry https://www.dentistryiq.com/practice-management/human-resources/artic

Tue, 18 Feb 2020 08:11:28 -0700

#HumanResources questions? These #dentists ask the HR #experts about how to pay for working interviews, & what they're required to provide for references when asked. #dental #dentistry https://www.dentistryiq.com/practice-management/human-resources/article/14167207/human-resources-questions-for-dentists-pay-for-working-interviews-reference-requirements … pic.twitter.com/zfm4EFm7pB

Dr. Scott Froum presents the pathology case of a #dental patient who came to the office for treatment of an implant affected by peri-implantitis. When a leukoplakic lesion was discovered during the exam, the patient had a ready answer. #dentistry https:/

Mon, 17 Feb 2020 17:30:00 -0700

Dr. Scott Froum presents the pathology case of a #dental patient who came to the office for treatment of an implant affected by peri-implantitis. When a leukoplakic lesion was discovered during the exam, the patient had a ready answer. #dentistry https://www.dentistryiq.com/clinical/pathology/article/14074794/bc-oral-pathology-case-no-45-nothing-extra-im-only-here-to-get-the-implant-treated … pic.twitter.com/pxYYTa9zvJ

It's almost 2 months into #2020. Is your #dental practice aware of the new & updated #dental codes for the year? Are you implementing them properly? #dentistry #doitright https://www.dentistryiq.com/front-office/insurance-coding-and-tips/article/14074813

Mon, 17 Feb 2020 12:00:00 -0700

It's almost 2 months into #2020. Is your #dental practice aware of the new & updated #dental codes for the year? Are you implementing them properly? #dentistry #doitright https://www.dentistryiq.com/front-office/insurance-coding-and-tips/article/14074813/are-you-aware-of-the-new-ada-dental-coding-changes-for-2020 … pic.twitter.com/K3vuwnFJim

Let's start off the #newweek with some #infection control tips for #dental assistants, who are often in charge of this important task in their offices. #dentistry #keepitclean https://www.dentistryiq.com/dental-assisting/infection-control/article/1407162

Mon, 17 Feb 2020 08:30:00 -0700

Let's start off the #newweek with some #infection control tips for #dental assistants, who are often in charge of this important task in their offices. #dentistry #keepitclean https://www.dentistryiq.com/dental-assisting/infection-control/article/14071621/beyond-the-operatory-implementing-officewide-infection-prevention … pic.twitter.com/2pahiO7GWV

Using Meglumine Diatrizoate to improve the accuracy of diagnosis of cracked teeth on Cone‐beam CT images

Mon, 17 Feb 2020 04:43:32 -0700

Abstract

Aim

To explore in a laboratory setting the feasibility of using Meglumine Diatrizoate (MD) to improve the accuracy of diagnosis of cracked teeth on cone‐beam CT (CBCT) images.

Methodology

Twenty‐four teeth were cracked artificially by soaking them cyclically in liquid nitrogen and hot water. The number and position of crack lines were evaluated with a dental operating microscope and used as the gold standard. The artificially cracked teeth were then examined using routine scanning (RS) and enhanced scanning (ES) modes, respectively. For the ES mode, MD was painted on the surface of the crack lines, and then, CBCT scanning with the same parameters was performed after 10 min. A radiological graduate student and an experienced radiologist evaluated the presence or absence of crack lines, respectively. The differences between the RS and ES modes were determined and assessed using McNemar’s test. Inter‐examiner agreement and intra‐examiner agreement were assessed using kappa analysis.

Results

Fifty‐seven crack lines were found in the 24 cracked teeth. In the RS mode, the accuracy of detection of crack lines was 23% (radiological graduate student) and 32% (experienced radiologist), whereas in the ES mode, the accuracy was 61% (radiological graduate student) and 65% (experienced radiologist). The inter‐examiner agreement was 0.693 in RS mode and 0.849 in ES mode. The intra‐examiner agreement was 0.872 and 0.949 for the radiological graduate student in RS and ES mode respectively; and one for the experienced radiologist both in RS and ES mode.

Conclusions

Compared with routine scanning mode, more crack lines could be detected in enhanced scanning mode using Meglumine Diatrizoate as a contrast medium. MD could be a potential contrast medium to improve the accuracy of detection of crack lines on CBCT images.

Porphyromonas gingivalis lipopolysaccharide rapidly activates trigeminal sensory neurons and may contribute to pulpal pain

Sun, 16 Feb 2020 02:22:29 -0700

Abstract

Aim

To determine whether Porphyromonas gingivalis lipopolysaccharide (LPS) can directly activate trigeminal neurons, to identify which receptors are involved, and to establish whether activation leads to secretion of the neuropeptide calcitonin‐gene related peptide (CGRP) and/or the translocation of NF‐κB.

Methodology

Mouse trigeminal ganglion (TG) cells were cultured in vitro for 2 days. The effect of P. gingivalis LPS (20 μg/mL) on calcium signalling was assessed (by calcium imaging using Cal‐520 AM) in comparison to the transient receptor potential channel A1 (TRPA1) agonist cinnamaldehyde (CA; 100 μM), the TRP channel V1 (TRPV1) agonist capsaicin (CAP; 1 μM), and high potassium (60 mM KCl). TG cultures were pre‐treated with either 1 μM CLI‐095 to block Toll‐like receptor 4 (TLR4) signalling or with 3 μM HC‐030031 to block TRPA1 signalling. CGRP release was determined using ELISA, and nuclear translocation of NF‐κB was investigated using immunocytochemistry. Data were analysed by one‐way analysis of variance, followed by Bonferroni’s post‐hoc test as appropriate.

Results

P. gingivalis LPS directly exerted a rapid excitatory response on sensory neurons and non‐neuronal cells (p<0.001 to p<0.05). The effects on neurons appear to be mediated via TLR4‐ and TRPA1‐dependent pathways. The responses were accompanied by an increased release of CGRP (p<0.001) and by NF‐κB nuclear translocation (p<0.01).

Conclusions

P. gingivalis LPS directly activates trigeminal sensory neurons (via TLR4 and TRPA1 receptors) and non‐neuronal cells, resulting in CGRP release and NF‐κB nuclear translocation. This indicates that P. gingivalis can directly influence activity in trigeminal sensory neurons and this may contribute to acute and chronic inflammatory pain.

How Did Family Day Get Its Start?

Sat, 15 Feb 2020 11:02:45 -0700

Family Day is celebrated on the third Monday of every February. Though not an official national holiday, the event is celebrated far and wide across the country, with dozens of family festivals and things to do organized each year in the provinces where it’s observed: New Brunswick, Alberta, Ontario, Saskatchewan, and British Columbia. (NOTE: Interestingly, […]

The post How Did Family Day Get Its Start? appeared first on 123Dentist.

There are two new saliva (#dental) codes: one for analyzing a saliva sample, & one for the assessment of salivary flow by measurement. Learn how to incorporate them into your practice here. #dentistry https://www.dentistryiq.com/front-office/insurance-co

Fri, 14 Feb 2020 15:30:00 -0700

There are two new saliva ( #dental) codes: one for analyzing a saliva sample, & one for the assessment of salivary flow by measurement. Learn how to incorporate them into your practice here. #dentistry https://www.dentistryiq.com/front-office/insurance-coding-and-tips/article/14167524/coding-with-kyle-saliva-testing-with-new-ada-code-d0418 … pic.twitter.com/UbJVHNtGRt

If chairside manner in your #dental practice doesn't come easily, @DianneWatterson has some ideas to help you out. #dentistry https://www.dentaleconomics.com/practice/patient-communication-and-patient-financing/article/14167627/the-5-essentials-of-a-supe

Fri, 14 Feb 2020 12:00:01 -0700

If chairside manner in your #dental practice doesn't come easily, @DianneWatterson has some ideas to help you out. #dentistry https://www.dentaleconomics.com/practice/patient-communication-and-patient-financing/article/14167627/the-5-essentials-of-a-superb-chairside-manner … pic.twitter.com/Z1GaIwExb9

#HappyValentinesDay2020 to everyone in #dental world! #dentistrypic.twitter.com/dDIREeQkrD

Fri, 14 Feb 2020 08:30:58 -0700

#HappyValentinesDay2020 to everyone in #dental world! #dentistry pic.twitter.com/dDIREeQkrD

The anti‐biofilm and collagen‐stabilizing effects of proanthocyanidin as an auxiliary endodontic irrigant

Fri, 14 Feb 2020 05:42:49 -0700

Abstract

Aim

To evaluate the anti‐biofilm effect of Proanthocyanidin (PA) solution as an irrigant against Enterococcus faecalis (E. faecalis) and its influence on the mechanical properties and biodegradation resistance of demineralized root dentine.

Methodology

E. faecalis were introduced into human root dentine tubules by a serial centrifugation method and grown for 1 week. Dentine blocks infected with 1‐week‐old E. faecalis biofilms were treated with the following irrigants: sterile water (control), 2% chlorhexidine (CHX), 2% PA, 5% PA and 10% PA. After treatment, the live and dead bacteria proportions within E. faecalis biofilms were analysed using confocal laser scanning microscopy. To evaluate the biostability of fully demineralized dentine treated by the aforementioned irrigants, the elastic modulus and hydroxyproline release of human dentine incubated in collagenase solution were tested at baseline, after irrigant treatment and after biodegradation, respectively. Furthermore, the surface chemical bond of demineralized dentine collagen treated by different irrigants was characterized by X‐ray photoelectron spectroscopy (XPS). Statistical analysis was performed using one‐way ANOVA and Tukey's post hoc multiple comparisons with the significance level at 5%.

Results

The proportion of dead E. faecalis volume was significantly higher in the PA and CHX groups than that in the control group (p < 0.05). PA irrigation significantly increased the mechanical properties of demineralized dentine (p < 0.05) and the effect was enhanced with increasing PA concentration. CHX and PA groups had significantly less elasticity loss and hydroxyproline release (p < 0.05). The biomodification of dentine collagen by PA was verified by increased C‐O/C‐N peak percentage under C1s and C‐O peak percentage under O1s narrow‐scan XPS spectra.

Conclusions

PA killed E. faecalis within biofilms and enhanced the biostability of the collagen matrix of demineralized root dentine. It might be used as an auxiliary endodontic irrigant with anti‐biofilm and collagen‐stabilizing effects.

Characterization of a mouse model to study the relationship between apical periodontitis and atherosclerosis

Fri, 14 Feb 2020 05:42:49 -0700

Abstract

Aim

First, to determine the feasibility of using the low density lipoprotein receptor knockout (LDLR KO) mouse model to study apical periodontitis (AP). Second, to investigate the causal relationship between AP and atherosclerosis. It was hypothesized that it would be feasible to induce AP and atherosclerosis in LDLR KO mice and find a difference in atherosclerosis between AP and Sham groups.

Methodology

Using a published methodology, AP was induced in LDLR KO mice by exposing the dental pulp of the four first molars (Tx). Shams received only anaesthesia. Mice were fed a high fat, Western type diet (WTD), to induce atherosclerosis. At 16 weeks, mice were euthanized and aortas collected to measure atherosclerosis lesion burden (oil red O staining). Periapical lesions were validated using microCT and histology. Systemic inflammation was measured using a cytokine array.

Results

Both groups developed a similar degree of atherosclerosis (mean lesion area 7.46±0.44% in the Tx group compared with 7.65±0.46%, in the Sham group, p=0.77), and a similar degree of inflammation. Periapical lesions (PALs) in all four molars were only identified in a small subset of Tx mice.

Conclusions

A novel mouse model, which combines AP and CVD, was created. This model allows investigation of the relationship between the two diseases, while avoiding other potential common confounders. Although no difference in the degree of atherosclerosis was found between the groups, more studies in which the number of periapical lesions, changes in systemic inflammation, and the degree of atherosclerosis are correlated are necessary to ultimately determine the impact of AP on CVD.

A connectivity mapping approach predicted acetylsalicylic acid (aspirin) to induce osteo/odontogenic differentiation of dental pulp cells

Thu, 13 Feb 2020 18:35:11 -0700

Abstract

Aim

To use the connectivity map, a bioinformatics approach, to identify compounds that could induce odontogenic differentiation of dental pulp cells (DPCs) and to experimentally validate this effect. A subsidiary aim was to investigate the anti‐inflammatory effect of any identified compound.

Methodology

The Gene Expression Omnibus (GEO) database was searched for microarray datasets assessing odontogenic differentiation of human DPCs. An odontogenic gene expression signature was generated by differential expression analysis. The statistical significant connectivity map (ssCMap) method was used to identify compounds with a highly correlating gene expression pattern. DPCs were treated with the compound identified and osteo/odontogenic differentiation was assessed by alizarin red staining, alkaline phosphatase activity and expression of osteo/odontogenic genes ALPL, RUNX2, COL1A1, DSPP, DMP1 and SPP1 by RT‐PCR. The anti‐inflammatory effect of the compound was assessed using an ex vivo pulpitis model and cytokine levels were measured with multiplex assay. Means were compared using the t‐ test or ANOVA followed by a Bonferroni post hoc ‐test with the level of significance set at p ≤ 0.05.

Results

The GEO database search identified a specific gene expression signature for osteo/odontogenic differentiation. Analysis using the ssCMap found that acetylsalicylic acid (ASA)/aspirin was the drug with the strongest correlation to that gene signature. The treatment of DPCs with 0.05 mM ASA showed increased alkaline phosphatase activity (p < 0.001), mineralisation (p < 0.05), and increased the expression of the osteo/odontogenic genes, DMP1 and DSPP (p < 0.05). Low concentration (0.05mM) ASA reduced inflammatory cytokines IL‐6 (p < 0.001), CCL21 (P < 0.05) and MMP‐9 (p < 0.05) in an ex vivo pulpitis model.

Conclusions

Connectivity mapping, a web based informatics method, was successfully used to identify aspirin as a candidate drug that could modulate the differentiation of DPCs. Aspirin was shown to induce odontogenic differentiation in DPCs in vitro and this, together with its anti‐inflammatory effects, makes it a potential candidate for vital pulp therapies.

Effectiveness of five instruments when removing calcium hydroxide paste from simulated internal root resorption cavities in extracted maxillary central incisors

Thu, 13 Feb 2020 18:35:11 -0700

Abstract

Aim

To evaluate the effectiveness of five instruments used for irrigant agitation during the removal of calcium hydroxide [Ca(OH)₂] paste in simulated internal root resorption (IRR) cavities created in extracted maxillary central incisors.

Methodology

Seventy maxillary central incisors with a single canal were selected. The canals were accessed and instrumented with Reciproc R50, then the roots were split in the bucco‐lingual direction and the halves separated. Simulated IRR cavities were created, in both halves of the roots, 5 mm from the apex with a spherical bur. The specimens were reconstructed with cyanoacrylate glue and allocated into seven groups: negative control – no treatment; positive control – filled with Ca(OH)₂ without performing any irrigation protocol; the other groups were divided according to the instrument used for irrigant agitation, namely: Ultrasonic, EndoActivator^®, EDDY^®, XP‐endo^® Finisher and XP‐endo^® Shaper. The specimens were cleaved and analysed using optical microscopy and scanning electron microscopy, to compare the Ca(OH)₂ remnants between them. Then, the IRR cavities created by the burs were cleaned and subjected to a protocol of demineralization with 20% nitric acid, the roots reconstructed, and the irrigant agitation methods, as well as the microscopic analysis was repeated. Analysis of the images of Ca(OH)₂ remaining in the simulated IRR cavities after irrigation was performed by two calibrated examiners based on a previously established scoring system. The data were statistically compared by Kruskal–Wallis test, Mann–Whitney U‐test and Wilcoxon tests, with the significance level set at 5%.

Results

There was a significant difference in the effectiveness of the instruments in relation to the cavity creation method (bur vs. bur/acid) and evaluation method (optical microscopy and scanning electron microscopy) (P < 0.05). The XP‐endo^® Finisher and EDDY^® groups were associated with significantly more effective removal of Ca(OH)₂ when the IRR cavities were created using the acid protocol and analysed by scanning electron microscopy.

Conclusion

None of the instruments tested were able to completely remove the Ca(OH)₂ paste from the simulated IRR cavities; however, the EDDY^® and XP‐endo^® Finisher removed more Ca(OH)₂ in the bur/acid cavity creation method analysed by scanning electron microscopy.

Cutting efficiency of conventional and heat‐treated nickel–titanium rotary or reciprocating glide path instruments

Thu, 13 Feb 2020 18:35:11 -0700

Abstract

Aim

To compare the cutting efficiency of several glide path files: HyFlex EDM Glidepath File (HEGF), One G (OG), R‐Pilot (RP) and WaveOne Gold Glider (WOGG) at different cutting inclinations.

Methodology

Cutting efficiency of 120 new HEGF, OG, RP and WOGG was tested at 90°, 70° and 45° inclination in relation to the sample. Depending on manufacturer instructions, instruments were tested in continuous rotation or reciprocating motion against standardized gypsum samples for 120 s using a customized apparatus. Cutting efficiency was determined by measuring the weight loss and the length of the sample cut. Data were analysed using two‐way analysis of variance and Tukey t‐test (P < 0.05).

Results

RP and WOGG had greater cutting ability than HEGF and OG in all tested angles. RP tested at 45° had significantly greater cutting efficiency than when tested at 90° and 70° (P < 0.05). OG was not significantly different in terms of cutting ability at 90°, 70° and 45° (P > 0.05). HEGF and WOGG had significantly greater cutting efficiency at 45° and 70° compared to 90° (P < 0.05), with no significant difference between 45° and 70° (P > 0.05). RP had the greatest cutting ability at all tested angles.

Conclusions

Reciprocating glide path instruments had greater cutting efficiency compared to those in continuous rotation. An inclined insertion (45° or 70°) increased the cutting ability of glide path files except for One G conventional NiTi files.

Effect of immersion in distilled water or phosphate‐buffered saline on the solubility, volumetric change and presence of voids within new calcium silicate‐based root canal sealers

Thu, 13 Feb 2020 18:35:11 -0700

Abstract

Aim

To assess the effect of immersion in distilled water or phosphate‐buffered saline (PBS) on the solubility, volumetric change and presence of voids of calcium silicate‐based root canal sealers (TotalFill BC, Sealer Plus BC and Bio‐C), in comparison with the gold standard epoxy resin‐based sealer (AH Plus).

Methodology

All properties were evaluated after immersion in distilled water or PBS. Solubility was determined by the percentage of mass loss, whereas volumetric change and presence of voids were evaluated by micro‐computed tomography, after 7 days of immersion. The volumetric change and percentage of voids between the baseline (after setting) and the experimental period were calculated. Statistical analysis was performed using one‐way anova and Tukey's or Student's t‐tests (α = 0.05).

Results

The calcium silicate‐based sealers had significantly greater solubility and volumetric loss than AH Plus, after immersion in distilled water or PBS (P < 0.05). Bio‐C had the greatest solubility (P < 0.05), followed by TotalFill BC and Sealer Plus BC, which were similar (P > 0.05). Regarding the volumetric change, AH Plus had a volume increase, with similar values in distilled water and PBS (P > 0.05). TotalFill BC, Sealer Plus BC and Bio‐C had a similar volumetric change (P > 0.05). The calcium silicate‐based materials had the greatest solubility and volume loss after immersion in distilled water (P < 0.05). There was no difference in the percentage of voids amongst the sealers, before and after immersion in distilled water or PBS (P > 0.05).

Conclusions

TotalFill BC, Sealer Plus BC and Bio‐C had significantly greater solubility and volumetric loss than AH Plus. Although storage in PBS significantly reduced the solubility and volumetric change of calcium silicate‐based sealers, their solubility remained above that recommend by ISO 6876. All the sealers evaluated had low and similar voids, even after immersion in distilled water or PBS.

Effect of intercellular adhesion molecule 1 deficiency on the development of apical periodontitis

Thu, 13 Feb 2020 18:35:11 -0700

Abstract

Aim

To evaluate the specific role of ICAM‐1 in host responses against endodontic infection.

Methods

Apical periodontitis was experimentally induced in the mandibular first molars of ICAM‐1 knockout and wild‐type (WT) mice by pulp exposure to the oral environment. At 7, 21 and 42 days following pulp infection, the animals were euthanized and the jaws were prepared for analysis under conventional and fluorescence microscopy (histopathologic and morphometric analysis), immunohistochemistry (polymorphonuclear leucocytes), enzyme histochemistry (osteoclasts and cementoclasts) and RT‐PCR (IL‐1 α, TNF‐α, INF‐γ, IL‐10, RANK, RANKL and OPG). A generalized linear model with GLIMMIX procedure with Satterthwaite approximation method of degrees of freedom, Tukey–Kramer, pseudo‐ranking nonparametric, Bonferroni–Holm multiple testing adjustment, analysis of variance (ANOVA) and the Tukey's multiple comparisons tests were used to evaluate the statistical differences between the groups using SAS 9.4 and the GraphPad Prism 5.0 software (α = 0.05).

Results

Compared to WT mice, ICAM‐1 knockout mice had significantly greater bone resorption (P < 0.05), reduced recruitment of neutrophils to periapical inflammatory tissues (P < 0.05) and an increased number of fibroblasts (P < 0.05) at all experimental periods. The osteoclast number was significantly higher in ICAM‐1 KO than that of WT animals at all times (P < 0.05), while there was no significant difference between the groups regarding cementoclasts. At day 21, the level of IL‐1α, RANK, RANKL and IL‐10 had increased significantly in tissues from ICAM‐1 KO versus WT mice (P < 0.05), while no significant difference was observed in TNF‐α and OPG levels (P > 0.05). Tissue levels of INF‐γ were significantly lower in ICAM‐1 KO than those in WT mice (P < 0.05).

Conclusion

ICAM‐1 deficiency impaired the host response against endodontic infection, resulting in increased tissue destruction.

The effect of an intraorifice barrier and base under coronal restorations on the healing of apical periodontitis: a randomized controlled trial

Thu, 13 Feb 2020 18:35:11 -0700

Abstract

Aim

To evaluate the effect of intraorifice barriers and bases on the healing of apical periodontitis following root canal treatment in mandibular molars.

Methodology

A total of 120 permanent mandibular molars with necrotic pulps and periapical radiolucencies (PAI score ≥ 3) were recruited. Root canal treatment was performed in all teeth using a standard protocol, following which they were randomly allocated to one of the three treatment groups: intraorifice barrier group: coronal 3‐mm gutta‐percha was removed and replaced with glass–ionomer cement (GIC) barrier. The floor of the pulp chamber was then sealed with 2‐mm‐thick GIC base followed by final composite resin restoration; base group: received 2‐mm‐thick GIC base before placement of composite resin restoration; and control group: had pulp chamber entirely filled with composite resin only. Follow‐up was done at 3, 6, 9 and 12 months. Combination of clinical and radiographic parameters were used to assess treatment outcome. The data were analysed using Kruskal–Wallis, chi‐square and Wilcoxon signed‐rank tests and logistic regression analysis.

Results

At the end of 12 months, the base group had the most favourable healing (97.1%), whilst the control group had the least favourable healing (83.8%). The intraorifice barrier group had healing of 92.1%. However, there was no significant difference in healing between groups at the end of the follow‐up period (P > 0.05). Additional subgroup analysis revealed a nonsignificant effect of periodontal status and root filling level on periapical healing.

Conclusion

The use of an additional barrier under permanent restorations did not significantly improve the outcome of primary root canal treatment in posterior teeth after 12 months. However, its influence in the long term requires further evaluation.

Evaluation of apically extruded debris during the removal of canal filling material using three different Ni‐Ti systems and hand files in teeth with simulated apical root resorption

Thu, 13 Feb 2020 18:35:11 -0700

Abstract

Aim

To compare the weight of apically extruded debris produced during the removal of root canal filling material using various files in extracted teeth with simulated apical root resorption.

Methodology

The root canals of one hundred and twenty extracted mandibular premolar teeth were prepared with Revo‐S files and filled using a cold lateral compaction technique with gutta‐percha and a resin‐based sealer (AdSeal; Meta‐Biomed, Cheongwon, Korea). Sixty teeth were randomly assigned to four control groups (hand file, ProTaper Universal retreatment file, D‐RaCe retreatment file, and Reciproc file) for the removal of root canal filling material. The apical portion of the remaining 60 teeth was modified to simulate apical root resoption, and the teeth were then randomly divided into 4 experimental groups (using the same techniques as in the control groups) for the removal of root canal filling material. Apically extruded debris was collected into pre‐weighed Eppendorf tubes and then dried. The mean weight of the apically extruded debris was assessed with an analytical balance to an accuracy of 10⁻⁴ g. Data were analysed using two‐way analysis of variance and a Tukey’s post hoc test.

Results

In the simulated apical root resorption groups, all file systems were associated with significantly more debris extrusion compared to the groups without simulated resorption (P < 0.05). The amount of apically extruded debris was greatest in the hand file groups compared with the other groups (P < 0.05). In the groups with simulated apical root resorption, the Reciproc system was associated with the least weight of apically extruded debris (P < 0.05), whereas there was no significant difference between the ProTaper Universal retreatment and D‐RaCe files (P > 0.05). In the groups without simulated apical root resorption, there was no significant difference between Reciproc, ProTaper Universal retreatment and D‐RaCe retreatment files (P> 0.05). The time required to remove the root canal filling material was as follows: hand file > ProTaper Universal retreatment = D‐RaCe retreatment > Reciproc (P < 0.05).

Conclusions

The weight of apically extruded debris was significantly greater in teeth with simulated apical root resorption than in those teeth without simulated apical root resorption. Hand files were associated with significantly more apically extruded debris in all groups during removal of root canal filling material.

Arrowhead design ultrasonic tip as a supplementary tool for canal debridement

Thu, 13 Feb 2020 18:35:11 -0700

Abstract

Aim

To investigate the shaping and cleaning performance of the Clearsonic ultrasonic tip as a supplementary tool during the preparation of long oval‐shaped root canals through micro‐computed tomographic (micro‐CT) imaging technology. The Reciproc M‐Wire R40 instrument was used as a reference instrumentation technique for comparison.

Methodology

Twenty mandibular incisors with single, straight and long oval‐shaped canals were selected and pair‐matched by micro‐CT scanning. The root canals were prepared with Reciproc R25 and R40 instruments, scanned again in a micro‐CT device and randomly allocated into one of the two experimental groups (n = 10), according to the supplementary debridement protocol used: Clearsonic or Reciproc R40 used in a brushing motion against buccal and lingual walls. Noninstrumented canal areas, accumulation of hard‐tissue debris (AHTD) and volume of removed dentine were assessed using micro‐CT imaging following the supplementary debridement protocols. Data were analysed statistically in two phases using a t‐test with a significance level of 5%.

Results

In phase‐1, there was a significant similarity between the samples regarding the evaluated micro‐CT baseline parameters (P > 0.05), validating the anatomical similarity between the tooth pairs. In phase‐2, there was a significant difference between the groups for canal volume, surface area, noninstrumented root canal walls and the amount of removed dentine for both absolute and percentage values (P < 0.05), but not for AHTD (P = 0.759).

Conclusions

The Clearsonic tip outperformed the Reciproc R40 instrument as a supplementary debridement protocol as it was associated with significantly greater reduction of noninstrumented root canals walls and consequently a larger amount of removed dentine. Both groups performed similarly regarding the AHTD.

Gaps at the interface between dentine and self‐adhesive resin cement in post‐endodontic restorations quantified in 3D by phase contrast‐enhanced micro‐CT

Thu, 13 Feb 2020 18:35:11 -0700

Abstract

Aim

To assess the extent of gaps between root dentine and titanium or fibreglass post restorations following cementation with a self‐adhesive resin cement.

Methodology

Fourteen root filled maxillary central incisors restored with prefabricated posts made of Fibreglass (n = 7) or Titanium (n = 7) and cemented with RelyX Unicem 2 were imaged by rapid, high‐resolution phase contrast‐enhanced micro‐CT (PCE‐CT) in a synchrotron X‐ray imaging facility (ID19, ESRF, 34 KeV, 0.65 µm pixel resolution). Reconstructions were used to measure canal, cement and post perimeters and cross‐sectional areas and interfacial gaps at 0.1 mm increments in the root canal space, along the cervical region of the tooth. Remnants of endodontic sealer (AH Plus), when present, were also quantified. Mann–Whitney and 2‐way ANOVA tests were used to compare findings within slices and between the two post groups. Pearson correlation coefficients (r) were determined between the interfacial gaps and the other measured parameters.

Results

Clearly detectable gaps were found in 45% (±14%) of the interfaces between dentine and cement, along the canal in the cervical area of the tooth beneath the core. The length of interfacial gaps was moderately correlated to the canal cross‐sectional area, to the canal perimeter and to the canal area filled by cement (R = 0.52 ~ 0.55, P < 0.001). There was no significant difference between samples with fibreglass or titanium (P > 0.01). Both post types had defect‐free interfaces with cement. Endodontic sealer remnants were found on ~10% of the canal walls and were moderately correlated to the presence of gaps. Approximately 30% of the sealer‐affected interfaces exhibited no detachment between dentine, sealer and cement.

Conclusions

Self‐adhesive cements had interfacial gaps along substantial regions of the root canal surface, which was not correlated with the amount of cement in the canal. PCE‐CT proved to be an excellent non‐destructive method to study root canal restorations of hydrated samples in 3D.

Successful pulp revascularization of an autotransplantated mature premolar with fragile fracture apicoectomy and plasma rich in growth factors: a 3‐year follow‐up

Thu, 13 Feb 2020 18:35:11 -0700

Abstract

Aim

This case report demonstrates a positive outcome of the adjuvant use of fragile fracture (FF), which is a technique used to harvest dental pulp stem cells (DPSCs), and platelet‐rich plasma (PRP) in a mandibular premolar (tooth 44) with a completely formed root that was transplanted into a surgically created socket and which maintained pulp vitality and function.

Summary

After virtual surgical planning, a 3D tooth replica of tooth 44 was fabricated. A surgical socket was created in the position of tooth 14; then, tooth 44 was extracted and the root dentine was abraded using a turbine diamond bur 3 mm from the apex until a circular groove was prepared around the outer circumference of the root; and then, an FF was performed without damaging the pulp tissue. PRP was placed in the socket, after which the donor tooth was inserted in the recipient area. At 2 weeks post‐treatment, orthodontic traction was applied. At 3‐year follow‐up, the tooth had adequate alignment and was asymptomatic. Response to pulp testing was positive, and the presence of pulp canal obliteration was observed as a sign of pulpal healing.

Key learning points

Autotransplantation is a good alternative for replacing missing teeth, with repair of tissues and pulp revascularization. Revascularization of an autotransplanted mature tooth using the fragile fracture technique and PRP scaffold is a feasible option and might have positive effects on the long‐term outcome of the procedure. Including completely formed teeth as donors in autotransplantation, maintaining vitality and their functions is an option that warrants further study.

Microsurgical Endodontics by Aranaldo Castellucci

Thu, 13 Feb 2020 18:35:11 -0700

International Endodontic Journal, Volume 53, Issue 3, Page 434-434, March 2020.

Outcome of endodontic treatment – the elephant in the room

Thu, 13 Feb 2020 18:35:11 -0700

International Endodontic Journal, Volume 53, Issue 3, Page 291-297, March 2020.

Issue Information

Thu, 13 Feb 2020 18:35:11 -0700

International Endodontic Journal, Volume 53, Issue 3, Page 289-289, March 2020.

Altmetric analysis of the contemporary scientific literature in Endodontology

Thu, 13 Feb 2020 18:35:11 -0700

Abstract

Aim

To analyse and visualize the knowledge structure of scientific articles in the field of Endodontology with high altmetric attention scores to discover hot topics, active researchers and the journals involved.

Methodology

On 5 June 2019, the altmetric database (Altmetric LLP, London, UK) was searched using the titles of 11 endodontic journals. Bibliometric data from endodontic articles and journals with an altmetric score >5 (top 5%) were retrieved from PubMed and analysed using the VOSviewer. Science mapping of articles with an altmetric score >5 at two levels was created: author keywords co‐occurrence and co‐authorship network analysis.

Results

Of the 2197 articles in the field of Endodontology identified with altmetrics, 192 had altmetric scores >5 (top 5%). Considering the total mentions amongst all altmetric resources, the Journal of Endodontics had the highest rank followed by the International Endodontic Journal and Australian Endodontic Journal. Twitter was the most popular altmetric data resource followed by patents and Facebook. Meta‐analysis, systematic review and pulpitis were the hot topics. At the author level, Dummer P.M.H had the greatest influence on the network. There was no significant correlation between altmetric score and citations count (P > 0.05). Mendeley mentions correlated with citations (P < 0.05).

Conclusions

Overall, the altmetric scores of topics within Endodontology were low, possibly due to the specific and specialized nature of the specialty, as well as the difficulty members of the public probably have in understanding endodontic research. Journals and researchers with a focus on Endodontology would have more influence if they were to set‐up their own social media profiles and thus enhance their visibility and social impact by immediately sharing research findings and communicating with their network and audience.

The effect of ozone therapy in root canal disinfection: a systematic review

Thu, 13 Feb 2020 18:35:11 -0700

Abstract

Aim

To answer the following focused question: ‘As regards microorganism load reduction for patients undergoing root canal treatment, is the use of ozone therapy comparable to conventional chemomechanical techniques using sodium hypochlorite (NaOCl)?’

Data sources

A systematic review was conducted using controlled vocabulary and free‐text key words in the following databases: PubMed, Science Direct, Scopus, Web of Science and Open Grey until 2 November 2018. Additional studies were sought through hand searching of endodontic journals.

Study eligibility criteria, participants and interventions

The inclusion criteria comprised studies that compared microbial reduction in root canals after treatments with ozone and NaOCl in extracted mature human teeth or randomized clinical trials.

Study appraisal and synthesis methods

The quality assessment of included laboratory studies was performed with the following parameters: (i) sample size calculation, (ii) samples with similar dimensions, (iii) control group, (iv) standardization of procedures, (v) statistical analysis and (vi) other risk of bias. For randomized clinical trials, the qualitative analysis of the studies was performed from the bias risk assessment using the tool ‘Bias Risk Assessment of Randomized Controlled Studies’ Cochrane Handbook 5.0.2.

Results

The search resulted in 180 published studies. After removal of duplicate studies and full‐text analysis, eight studies were selected and seven were considered low risk of bias (seven ex vivo studies and one random clinical trial). Overall, the results demonstrated that ozone therapy provides significantly less microbial load reduction than NaOCl. As an adjunct in chemomechanical preparation, ozone was ineffective in increasing the antimicrobial effect of NaOCl. Ozone performance was strongly associated with the application protocol used: it is dose, time and bacterial strain dependent, besides the correlation with the use of complementary disinfection sources.

Limitations

A restricted number of randomized clinical trial was found, and the difference amongst the methodology of the studies did not allow a meta‐analysis to be performed.

Conclusions and implications of key findings

Although the selected studies had limitations, this review reached a satisfactory methodological and moderate evidence quality contributing to important preliminary information regarding ozone therapy. As regards load reduction of microorganisms for patients undergoing root canal treatment, ozone is not indicated neither to replace nor to complement the antimicrobial action of NaOCl.

A systematic review and meta‐analysis of randomized clinical trials comparing rotary canal instrumentation techniques with manual instrumentation techniques in primary teeth

Thu, 13 Feb 2020 18:35:11 -0700

Abstract

Background

Use of rotary instruments in the root canals of permanent teeth is well known; however, there are no evidence‐based recommendations on the effectiveness of rotary canal instrumentation techniques over manual instrumentation techniques during root canal treatment in primary teeth.

Aim

To appraise the current literature on the effectiveness of rotary canal preparation techniques compared to manual techniques during root canal treatment in primary teeth.

Data sources

MEDLINE, Embase, Cochrane Library, Scopus, PubMed and Web of Science (1 January 1991 to 3 January 2019).

Study eligibility criteria, participants and interventions

Population: Children with primary teeth; Intervention: Rotary canal instrumentation; Control: Manual canal instrumentation; Outcomes: Success rates (clinical and/or radiographic), quality of root filling, instrumentation and root filling time, postoperative pain, cleaning effectiveness.

Study appraisal and synthesis methods

Cochrane risk of bias tool 2.0 was used to ascertain the validity across five domains. Risk ratio (RR) for dichotomous variables and weighted mean difference for continuous variables were used as summary measures. The GRADE approach was used to assess the certainty of evidence using GRADE‐pro software.

Results

A total of 13 trials were selected of 2471 records after screening of the databases. The RR of clinical success in rotary versus manual canal preparation technique was 1.01 (95% CI: 0.91–1.12; P = 0.913) at 6 months. The RR of radiographic success in rotary versus manual techniques was 0.97 (95% CI: 0.74–1.27; P = 0.805) at 6 months. The quality of root filling was not significantly different between the two groups (P = 0.062). The weighted mean difference of instrumentation time and canal filling time was significantly less with rotary techniques (P < 0.001); however, postoperative pain was non‐significant across both techniques at 12, 24 and 72 h but significantly less with rotary techniques at 6 h (P < 0.001) and 48 h (P = 0.023).

Limitations

Inclusion of only English literature.

Conclusions and implications of key findings

Rotary canal instrumentation had a similar clinical and radiographic success rate, less postoperative pain (at 6 and 48 h), and took less instrumentation time compared to manual instrumentation techniques (moderate level of evidence).

Nutrition and Your Oral Health

Wed, 12 Feb 2020 16:35:49 -0700

Nutrition affects your entire body from the inside out. If you’re not eating and drinking the right things on a regular basis, then you’ll be more susceptible to disease and dental problems. Changing your daily diet and oral hygiene habits will improve your overall health and well-being. Here are a few simple steps you can take […]

The post Nutrition and Your Oral Health appeared first on 123Dentist.

Physico‐chemical investigation of endodontic sealers exposed to simulated intracanal heat application: epoxy resins and zinc oxide–eugenols

Wed, 12 Feb 2020 16:33:09 -0700

Abstract

Aim

To gain information in a laboratory setting about the effect of thermal treatment of epoxy resin‐based and zinc oxide–eugenol‐based sealers.

Methodology

AH Plus and Pulp Canal Sealer (PCS) were exposed to thermal treatment at 37, 47, 57, 67, 77, 87 and 97 °C for 30 s. According to clinically relevant considerations, intracanal sealer temperature is likely not to exceed 60 °C during warm vertical root canal filling. Heat application is recommended for less than 30 s during continuous wave technique, but might exceed this threshold in complex cases. Furthermore, heat treatment at 97 °C was performed for 60 and 180 s to simulate inappropriate implementation of warm vertical filling techniques. Specimens were heated inside 2‐mL plastic tubes in a thermo‐controlled water bath until the temperatures were reached and kept at this temperature for the determined period of time. Afterwards, specimens were cooled to body temperature and physical properties (setting time, flow, film thickness according to ISO 6876) were assessed. Chemical properties (Fourier transformed infrared spectroscopy) were assessed after complete setting of the specimens in an incubator at 37 °C and 100% humidity. Statistical analysis of physical properties was performed using Kruskal–Wallis test (P = 0.05).

Results

The setting time of AH Plus and PCS decreased when temperature and duration of heat application increased. Whilst the setting time of AH Plus decreased from 622 min at 20 °C (for 30 s) to 381 min at 97 °C (for 180 s; P < 0.05), heat treatment of PCS at 97 °C for 180 s led to an immediate setting of the material. From 20 °C (for 30 s) to 97 °C (for 30 s), the setting time of PCS decreased from 80.1 to 41.0 h (P < 0.05). Film thickness and flow were not relevantly influenced by thermal treatment except for PCS at 97 °C for 180 s. FT‐IR spectroscopy did not reveal any chemical changes of either sealer after thermal treatment.

Conclusions

Thermal treatment simulating clinically relevant temperature levels and heating times did not lead to any substantial physical or chemical changes at all temperature levels when heating did not exceed 60 s. AH Plus and Pulp Canal Sealer can be considered suitable for warm root filling techniques.

Don’t Have a Sitter This Valentine’s Day? No Problem

Mon, 10 Feb 2020 09:14:02 -0700

Valentine’s Day can be a wonderfully romantic time that couples spend months planning, looking forward to, and desperately needing. This year, this lovely holiday falls on a Friday — and if you have kids, that means planning around work and school while booking a baby sitter if you want to get out in the evening. […]

The post Don’t Have a Sitter This Valentine’s Day? No Problem appeared first on 123Dentist.

Antibacterial effectiveness of calcium hydroxide alone or in combination with ibuprofen and ciprofloxacin in teeth with asymptomatic apical periodontitis: a randomized controlled clinical study

Sat, 08 Feb 2020 10:44:52 -0700

Abstract

Aim

To evaluate the antimicrobial effectiveness of Ca(OH)₂ paste combined with ibuprofen or ciprofloxacin in infected root canals of teeth with asymptomatic apical periodontitis.

Methodology

Forty‐five patients were randomly divided into three groups using a web program according to the medication selected: Ca(OH)₂: 1 g Ca(OH)₂ powder with 1 mL propylene glycol, Ca(OH)₂ + Ibuprofen: 50 mg of ibuprofen was added into 950 mg Ca(OH)₂ powder and mixed with 1 mL propylene glycol, Ca(OH)₂ + Ciprofloxacin: 50 mg of Ciprofloxacin was added into 950 mg Ca(OH)₂ powder and mixed with 1 mL propylene glycol. Root canal bacteriological samples were collected before root canal treatment (S1) and after chemo‐mechanical procedures (S2). After root canal preparation, the intracanal medicaments were placed into the root canals to a level approximately 1 mm short of the working length using K‐files and access cavities were filled temporarily. The participants were scheduled for a second visit 7 days later when the medication was removed mechanically and after irrigation of the root canals, the final samples (S3) were collected. Samples were subjected to quantitative real‐time polymerase chain reaction to evaluate the numbers of total bacteria, Enterococcus faecalis and Streptococcus species. For intragroup analysis, a Friedman test was used to compare reduction of counts of total bacteria, Streptococci and E. faecalis among the three samples (S1, S2 and S3). The chi‐square test was used to compare the number of root canals positive for bacteria in S1, S2 and S3 among the groups.

Results

Intragroup analysis revealed a significant reduction in the number of intracanal bacterial cells from S1 to S2 and from S2 to S3 in all medication groups (P < 0.01). Although there was no significant difference among the groups when comparing quantitative S1 or S2 data, there were significantly lower bacterial counts in the Ca(OH)₂ + Ciprofloxacin group (0.49 × 10²) than the pure Ca(OH)₂ (1.25 × 10²) and Ca(OH)₂ + Ibuprofen groups (0.76 × 10²) at S3. The percentage of reduction from S1 to S3 and from S2 to S3 was significantly greater in the Ca(OH)2 + Ciprofloxacin than the pure Ca(OH)2 and Ca(OH)2 + Ibuprofen groups. (P < 0.05). In the Ca(OH)₂ + Ciprofloxacin group there were significantly fewer positive cases (8/15) than the pure Ca(OH)₂ (13/15) and Ca(OH)₂ + Ibuprofen (13/15) groups (P < 0.05).

Conclusion

The addition of ciprofloxacin to Ca(OH)₂ provided further antibacterial effectiveness when used as an intracanal medicament in vivo during root canal treatment.

Effects of transforming growth factor‐β1 on plasminogen activation in stem cells from the apical papilla: role of activating receptor‐like kinase 5/Smad2 and mitogen‐activated protein kinase kinase (MEK)/extracellular signal‐regulated kinase (ERK) signall

Sat, 08 Feb 2020 10:44:52 -0700

Abstract

Aim

To study the effects of TGF‐β1 on the plasminogen activation (PA) system of stem cells from the apical papilla (SCAP) and its signalling.

Methodology

SCAP cells were isolated from the apical papilla of immature permanent teeth extracted for orthodontic reasons. They were exposed to various concentration of TGF‐β1 with/without pretreatment and coincubation by SB431542 (ALK/Smad2/3 inhibitor), or U0126 (MEK/ERK inhibitor). MTT assay, Western blotting and enzyme‐linked immunosorbent assay (ELISA) were used to detect their effects on cell viability, and the protein expression of plasminogen activator inhibitor‐1 (PAI‐1), urokinase‐type plasminogen activator (uPA), uPA receptor (uPAR) and their secretion. The paired Student’s t‐test was used for statistical analysis.

Results

TGF‐β1 significantly stimulated PAI‐1 and soluble uPAR (suPAR) secretion of SCAP cells (P < 0.05), whereas uPA secretion was inhibited. Accordingly, TGF‐β1 induced both PAI‐1 and uPAR protein expression of SCAP cells. SB431542 (an ALK5/Smad2/3 inhibitor) pretreatment and coincubation prevented the TGF‐β1‐induced PAI‐1 and uPAR of SCAP. U0126 attenuated the TGF‐β1‐induced expression/secretion of uPAR, but not PAI‐1 in SCAP. SB431542 reversed the TGF‐β1‐induced decline of uPA.

Conclusions

TGF‐β1 may affect the repair/regeneration activities of SCAP via differential increase or decrease of PAI‐1, uPA and uPAR. These effects induced by TGF‐β1 are associated with ALK5/Smad2/3 and MEK/ERK activation. Elucidation the signalling pathways and effects of TGF‐β1 is useful for treatment of immature teeth with open apex by revascularization/revitalization procedures and tissue repair/regeneration.

Real‐time chemical analysis of root filling materials with heating: guidelines for safe temperature levels

Sat, 08 Feb 2020 10:44:52 -0700

Abstract

Aim

To investigate the chemical changes affecting different types of gutta‐percha and endodontic sealers during heating, and correlate changes with the heating capacity of different heat carriers.

Methodology

The heating capacity of three endodontic heat carriers was evaluated using thermocouples to produce heat profiles. The devices were activated at different temperature set‐ups, in continuous or cut‐out modes. Chemical changes of six brands of gutta‐percha and four types of sealers were assessed in real time during heating using micro‐Raman spectroscopy equipped with a heating stage. Raman spectra of each tested material were averaged and compared at different temperature levels. The sealers were further assessed by Fourier transform infrared (FT‐IR) spectroscopy.

Results

None of the tested heat carriers achieved the temperature levels that were set by the devices and recommended by the manufacturer. The use of continuous heating mode resulted in higher rises in temperature than the 4 s cut‐out mode that reached 110 °C. The various brands of gutta‐percha exhibited different chemical changes in response to heat. Some changes even occurred below temperature levels generated by the heating devices. All sealers revealed changes in their chemical composition upon heating. Changes in epoxy resin‐ and zinc oxide–eugenol‐based sealers were detectable at 100 °C, with structural alterations beyond that temperature and irreversible changes after cooling. Water loss was irreversible in BioRoot, but its chemical structure was stable as well as for the TotalFill.

Conclusions

The heating capacity of endodontic heat carriers needs to be standardized, so that the temperatures delivered by the tips are the same as that set on the dial. Practitioners should be aware of the actual temperatures generated by these devices, and the suitability of sealers to be used at the temperature levels achieved.