A Systematic Review and Meta-analysis of Clinical,Immunological, and Microbiological Shift in Periodontitis After Nonsurgical Periodontal Therapy With Adjunctive Use of Probiotics

ObjectivesThere is a lack of evidence regarding long-term effects of probiotics as adjuncts to nonsurgical periodontal therapy (NSPT) in the management of periodontitis. Therefore, this systematic review aimed to evaluate the clinical, microbiological, and immunological outcomes of probiotics applied as an adjunct to NSPT with at least 3 months of follow-up.MethodsElectronic searches of 5 databases were performed. Clinical trials that compared the adjunctive use of probiotics in NSPT with NSPT alone, reporting clinical or immunological or microbiological outcomes, were selected. The primary clinical outcome variables were clinical attachment level (CAL) and probing pocket depth (PPD). Meta-analyses were conducted to evaluate the efficacy of probiotics over different longitudinal intervals.ResultsTen randomized controlled trials were included, and high heterogeneity in methods was noted. Meta-analysis revealed CAL gain, and PPD reduction in the probiotics group was significant at 3 months and 12 months, but no significant difference was noted at 6 months and 9 months. There was no significant difference in periodontal pathogen levels between groups at 3 months. Immunological data were not sufficient for quantitative analysis. Ancillary sensitivity analysis indicated a subset of studies with severe mean baseline PPD (≥5 mm) at baseline showed significant and more CAL gain and PPD reduction at 3 months, with probiotics administration of 2-4 weeks.ConclusionHeterogenous evidence implied a long-term clinical benefit of probiotics as an adjunct to NSPT. Outcomes may be impacted by baseline disease severity. Limited microbiological and immunological data precluded any conclusive findings. Current evidence is insufficient to formulate clinical recommendations.     

Association between Pulp Stones and Kidney Stones: A Systematic Review and Meta-analysis

IntroductionA systematic review and meta-analysis were performed to evaluate the association between pulp stones and kidney stones.MethodsA search for observational studies was performed in PubMed, Scopus, Web of Science, Biblioteca Virtual em Saúde, and the gray literature. The Newcastle-Ottawa Scale for Risk of Bias criteria were used to evaluate the internal quality of the included studies. A fixed-effects meta-analysis was performed to evaluate the association between the conditions.ResultsA total of 213 studies were identified after the removal of duplicates. Of these, 9 studies were selected after screening the titles and abstracts. Finally, after full-text reading for qualitative analysis, 7 studies were selected, and of these, 2 were used in the meta-analysis. A significant association was found between pulp stones and kidney stones (1.97 [95% confidence interval, 1.21–3.18]; P < .05).ConclusionsThis study revealed an association between pulp stones and kidney stones. Further well-designed studies should be conducted in order to confirm whether pulp stones are predictive indicators of undiagnosed kidney stones.     

Effectiveness and Safety of Ozone Therapy in Dental Caries Treatment: Systematic Review and Meta-analysis

ObjectiveThis systematic review and meta-analysis aimed to investigate the effectiveness and safety of ozone therapy for treating dental caries.MethodsWe searched for randomized controlled trials (RCTs) in 8 databases, from inception to April 4, 2020 (MEDLINE, EMBASE, CENTRAL, LILACS, Bibliografia Brasileira de Odontologia, ClinicalTrials.gov, WHO, and OpenGrey). Primary outcome measures were antimicrobial effect and adverse events. We used the Cochrane risk of bias tool to evaluate methodological quality of included RCTs and GRADE approach to evaluate the certainty of the evidence. We used the Review Manager software to conduct meta-analyses.ResultsWe included 12 RCTs comparing ozone therapy with no ozone, chlorhexidine digluconate, fissure sealants (alone and added to ozone), and fluoride. Considering primary outcomes, ozone therapy showed (a) lower reduction in the bacterial number than chlorhexidine digluconate in children (mean difference [MD]: −5.65 [−9.79 to −1.51]), but no difference was observed in adults (MD: −0.10 [−1.07 to 0.88]); (b) higher reduction in the bacterial number than sealant (MD: 12.60 [3.86-21.34]), but no difference was observed after final excavation (MD: −0.00 [−0.01 to 0.01]). Regarding safety of ozone therapy, results from individual studies presented no adverse events during or after treatment. Most of these results are imprecise and should be interpreted with caution because of clinical and methodological concerns, small sample size, and wide confidence interval, precluding to determine the real effect direction.ConclusionBased on a very low certainty of evidence, there is not enough support from published RCTs to recommend the use of ozone for the treatment of dental caries. Well-conducted studies should be encouraged, measuring mainly the antimicrobial effects of ozone therapy at long term and following the recommendations of the CONSORT statement for the reporting of RCTs.     

Effect of Ultrasonic Activation of Endodontic Sealers on Intratubular Penetration and Bond Strength to Root Dentin

IntroductionThis study aimed to evaluate the effect of ultrasonic activation (UA) of endodontic sealers on dentin tubule penetration and the bond strength to root dentin.MethodOne hundred single-rooted teeth were prepared with 40.06 nickel-titanium instruments and divided into 2 groups: with or without UA. Three resin-based sealers (MTA Fillapex [Angelus Dental Solutions, Londrina, PR, Brazil], Sealer Plus [MK Life Medical and Dental Products, Porto Alegre, RS, Brazil], and AH Plus [Dentsply, DeTrey GmbH, Konstanz, Germany]; n = 20) and 2 calcium silicate–based sealers (Sealer Plus BC [MK Life Medical and Dental Products] and EndoSequence BC [Brasseler, Savannah, GA], n = 20) were used and subdivided (n = 10) according to the protocols. Fluo-3 (Thermo Fisher Scientific, Waltham, MA) and rhodamine B dyes were added to the calcium silicate- and resin-based sealers, respectively. In the UA groups, the activation was performed for 40 seconds followed by lateral compaction. Samples were transversely sectioned to evaluate the dentin tubule penetration and the bond strength to root dentin. The penetration data were analyzed with the Student t test, 1-factor analysis of variance, and Bonferroni tests. Bond strength was evaluated using the Student t test, Kruskal-Wallis, and Dunn post hoc test.ResultsResin-based sealers showed the highest tubule penetration without UA (P < .05). UA significantly enhanced MTA Fillapex and Endosequence BC dentin tubule penetration (P < .05). AH Plus and Sealer Plus BC improved their bond strength to root dentin after UA (P < .05). AH Plus/UA, Sealer Plus/UA, and Sealer Plus BC/UA presented the highest bond strength values (P < .05). Adhesive failures were predominant in all groups regardless of the use of ultrasound.ConclusionsUA interferes with tubule penetration and the bond strength to root dentin of resin- and calcium silicate–based sealers.     

Torque Expression in Stainless Steel Orthodontic Brackets: A Systematic Review

Objective:To evaluate the quantitative effects on torque expression of varying the slot size of stainless steel orthodontic brackets and the dimension of stainless steel wire, and to analyze the limitations of the experimental methods used.Materials and Methods:In vitro studies measuring torque expression in conventional and self-ligating stainless steel brackets with a torque-measuring device, with the use of straight stainless steel orthodontic wire without second-order mechanics and without loops, coils, or auxiliary wires, were sought through a systematic review process.Results:Eleven articles were selected. Direct comparison of different studies was limited by differences in the measuring devices used and in the parameters measured. On the basis of the selected studies, in a 0.018 inch stainless steel bracket slot, the engagement angle ranges from 31 degrees with a 0.016 × 0.016 inch stainless steel archwire to 4.6 degrees with a 0.018 × 0.025 inch stainless steel archwire. In a 0.022 inch stainless steel bracket slot, the engagement angle ranges from 18 degrees with a 0.018 × 0.025 inch stainless steel archwire to 6 degrees with a 0.021 × 0.025 inch stainless steel archwire. Active stainless steel self-ligating brackets demonstrate an engagement angle of approximately 7.5 degrees, whereas passive stainless steel self-ligating brackets show an engagement angle of approximately 14 degrees with 0.019 × 0.025 inch stainless steel wire in a 0.022 inch slot.Conclusions:The engagement angle depends on archwire dimension and edge shape, as well as on bracket slot dimension, and is variable and larger than published theoretical values. Clinically effective torque can be achieved in a 0.022 inch bracket slot with archwire torsion of 15 to 31 degrees for active self-ligating brackets and of 23 to 35 degrees for passive self-ligating brackets with a 0.019 × 0.025 inch stainless steel wire.     

Machine-assisted Agitation Reduces Postoperative Pain during Root Canal Treatment: A Systematic Review and Meta-analysis from Randomized Clinical Trials

Introduction

This systematic review and meta-analysis aimed to assess whether machine-assisted agitation resulted in less postoperative pain (PP) compared with syringe irrigation with needle alone in adult patients undergoing root canal treatment.

Comparison of different root canal sealers: cytotoxicity and the type of induced cell death

Summary  The aim of this study was to compare in vitro cytotoxicity and determine the type of cell death induced by Hermetic, Diaket, GuttaFlow, Epiphany, SuperEBA and IRM using human laryngeal carcinoma HEp2 cells as the model system. The cytotoxicity was determined by counting the total number of cells by electronic counter, while the number of viable cells was estimated under a light microscope. The number of apoptotic or necrotic cells was estimated under a fluorescent microscope according to their characteristic morphology and staining with specific fluorescent dyes. The results show that GuttaFlow was biocompatible, hardly reducing the number of living human laryngeal carcinoma HEp2 cells through all research periods (except after one month period). On the contrary, Diaket, Epiphany, IRM, Hermetic, and Super EBA exhibited strong toxicity. Diaket and IRM mostly induced apoptosis while for Epiphany, Hermetic and Super EBA, necrosis was the predominant or only type of cell death.      

Mechanical Self-performed Oral Hygiene of Implant Supported Restorations: A Systematic Review

A systematic review of self-performed oral hygiene practices for optimal maintenance of dental implant-supported restorations reveals a lack of evidence to support best practices.BackgroundThe standard of the patients' home care is a key factor for long term stability of dental implants and the prevention of biological complications. The objective of this systematic review is to evaluate and summarize the literature with respect to various mechanical oral hygiene modalities around implant-supported restorations.MethodsMEDLINE, Cochrane-CENTRAL and EMBASE databases were searched up to October 2013 to identify eligible studies. Five studies that met the inclusion criteria were included. Two cohort studies about powered toothbrushes and three (randomized) controlled trials comparing powered to manual toothbrushes were reviewed. All studies showed an improvement in the clinical parameters over time. Powered toothbrushes were found to perform better than manual toothbrushes but no firm conclusions can be made between treatment modalities.ConclusionsThere is a lack of evidence with respect to effective and optimal self-performed oral hygiene around dental implants. At present, home care recommendations are based on the knowledge that is available with respect to cleaning of natural teeth. It becomes evident that there is an urgent need for academic institutions and industry to initiate and support high quality randomized controlled clinical trials on this topic in the near future.     

Effect of Resin-based and Bioceramic Root Canal Sealers on Postoperative Pain: A Split-mouth Randomized Controlled Trial

Introduction

The aim of this study was to compare the effect of resin-based and bioceramic root canal sealers on the occurrence and intensity of postoperative pain in patients with asymptomatic apical periodontitis (AAP).

Physicochemical Properties and Biocompatibility of Various Bioceramic Root Canal Sealers: In Vitro Study

IntroductionThe aim of this study was to compare the physicochemical properties and biocompatibility of various calcium silicate–based bioceramic sealers (CSBSs).MethodsFour recently developed CSBSs, including AH Plus Bioceramic Sealer (AHB), EndoSequence BC Sealer (ESB), TotalFill BC Sealer (TTB), and Bio-C Sealer (BIC), were compared with the epoxy resin–based sealer AH Plus (AHP). Their physical properties, including flow, setting time, radiopacity, dimensional stability, and pH, were evaluated according to the International Organization for Standardization (ISO) 6876. Their cytotoxicity in human periodontal ligament fibroblast (hPDLF) was assessed through the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and compared. Additionally, cell attachment to the sealer surface was analyzed using green fluorescent protein and confocal laser scanning microscopy to evaluate cell viability. Data were analyzed using a one-way analysis of variance to determine the difference between groups for categorical variables, followed by Tukey's post hoc test at the significance level of 95%.ResultsThe flow, setting time, and radiopacity of all tested CSBSs satisfied the ISO 6876/2012 standards. Further, these CSBSs showed shrinkage after immersion in distilled water for 30 days and complied with the ISO 6876/2001 requirements. The pH values of AHB, ESB, TTB, and BIC were greater than 11, whereas AHP had a pH of 6.69 after 4 weeks. CSBS showed excellent biocompatibility compared with that of AHP (P < .05). Confocal laser scanning microscopy showed that alive hPDLFs were attached well to all the tested CSBSs but not to AHP.ConclusionsCSBSs have similar physical characteristics within the ISO standards and higher biocompatibility than epoxy resin–based sealers.     

Bond strength to root dentin and fluid filtration test of AH Plus/gutta-percha,EndoREZ and RealSeal systems

Objectives

To investigate the bond strength and seal ability produced by AH Plus/gutta-percha, EndoREZ and RealSeal systems to root canal dentin.

Material and Methods

Sixty extracted single-root human teeth, instrumented manually to size 40, were divided into three groups (n=20) according to the sealer used; G1: AH Plus, G2: EndoREZ, and G3: RealSeal sealers. After filling using the lateral condensation technique, each sealer group was randomly divided into two subgroups according to the tests applied (n=10 for µPush-out test and n=10 for fluid filtration test). A fluid filtration method was used for quantitative evaluation of apical leakage. Four 1-mm-thick slices (cervical and medium level) were obtained from each root sample and a µPush-out test was performed. Failure modes were examined under microscopy at 40x, and a one-way ANOVA was applied to analyze the permeability. Non-parametrical statistics for related (Friedman''s and Wilcoxon''s rank tests) or unrelated samples (Kruskal-Wallis'' and Mann-Whitney''s tests) allowed for comparisons of µPush-out strength values among materials at the different levels. Statistical significance was accepted for p values <.05.

Results

There are no significant differences among fluid filtration of the three sealers. The sealer/core material does not significantly influence the µPush-out bond strength values (F=2.49; p=0.10), although statistically significant differences were detected with regard to root level (Chi²=23.93; p<0.001). AH Plus and RealSeal obtained higher bond strength to intraradicular dentin in the medium root slices.

Conclusions

There are no significant differences between the permeability and global µPush-out bond strength to root canal dentin achieved by AH Plus/gutta-percha, EndoREZ and RealSeal systems.     

Vitality Tests for Pulp Diagnosis of Traumatized Teeth: A Systematic Review

Introduction

The objective of this systematic review was to evaluate the efficacy of vitality tests (pulse oximetry and flowmetry) in the pulpal diagnosis of traumatized teeth in comparison with sensibility tests.

认知行为疗法治疗颞下颌关节紊乱病的系统评价

目的:评价认知行为疗法治疗颞下颌关节紊乱病的疗效。方法:计算机检索PubMed(1990～2009)、OV-ID(1960～2009)、EMbase(1974～2009)、Cochrane图书馆临床对照试验资料库(2009年第3期)、中国生物医学文献数据库(CBM,1978～2009),和中国期刊全文数据库(CNKI,1994～2009),收集认知行为疗法治疗颞下颌关节紊乱病的随机对照试验和半随机对照试验。由两名评价者独立评价研究质量和提取数据,对同质研究采用RevMan5.0软件进行Meta分析,对异质性研究不能进行Meta分析者,则进行描述性的定性分析。结果:共检索到相关文献323篇,评价后纳入5个研究,其中3个随机对照试验和2个半随机对照试验。质量评价结果为2个研究被评为B级,3个研究被评为为C级,纳入研究的方法学质量普遍不高。由于纳入研究存在疗程不一,随访期不一,以及对照组干预措施等临床异质性,无法用Meta分析方法合并效应量,只做了描述性的定性分析。分析结果显示CBT对TMD的治疗效果较其对照组并无明显优势,各研究随访结果也有差异,其疗效还无法确定。结论:基于目前的证据无法得出CBT治疗TMD的确切疗效。因此尚需要开展设计严谨,方法学质量更高的临床试验以获得更可靠的证据。     

Effect of orthodontic force on dental pulp histomorphology and tissue factor expression:: A systematic review

ObjectivesTo evaluate the effects of orthodontic force on histomorphology and tissue factor expression in the dental pulp.Materials and MethodsTwo reviewers comprehensively and systematically searched the literature in the following databases: Latin American and Caribbean Health Sciences, Embase, Cochrane, PubMed, Scopus, Web of Science, and Grey literature (Google Scholar, OpenGrey, and ProQuest) up to September 2020. According to the Population, Intervention, Comparison, Outcomes, Studies criteria, randomized clinical trials (RCTs) and observational studies that evaluated the effects of orthodontic force on dental pulp were included. Case series/reports, laboratory-based or animal studies, reviews, and studies that did not investigate the association between orthodontic force and pulpal changes were excluded. Newcastle-Ottawa Scale and Cochrane risk-of-bias tool were used to assess the risk of bias. The overall certainty level was evaluated with the Grading of Recommendations Assessment, Development and Evaluation tool.Results26 observational studies and five RCTs were included. A detailed qualitative analysis of articles showed a wide range of samples and applied methodologies concerning impact of orthodontic force on the dental pulp. The application of orthodontic force seems to promote several pulpal histomorphological changes, including tissue architecture, cell pattern, angiogenesis, hard tissue deposition, inflammation, and alteration of the expression levels of 14 tissue factors.ConclusionsAlthough the included articles suggest that orthodontic forces may promote histomorphological changes in the dental pulp, due to the very low-level of evidence obtained, there could be no well-supported conclusion that these effects are actually due to orthodontic movement. Further studies with larger samples and improved methods are needed to support more robust conclusions.     

Prevalence of Candida Species in Endodontic Infections: Systematic Review and Meta-analysis

Introduction

Candida in endodontic infections has been investigated in a large number of studies, but its role as an endodontic pathogen is still debatable. The aim of this study was to systematically review the literature on the prevalence of Candida species in root canal infections.

A microleakage study of gutta-percha/AH Plus and Resilon/Real self-etch systems after different irrigation protocols

The development and maintenance of the sealing of the root canal system is the key to the success of root canal treatment. The resin-based adhesive material has the potential to reduce the microleakage of the root canal because of its adhesive properties and penetration into dentinal walls. Moreover, the irrigation protocols may have an influence on the adhesiveness of resin-based sealers to root dentin.

Objective

The objective of the present study was to evaluate the effect of different irrigant protocols on coronal bacterial microleakage of gutta-percha/AH Plus and Resilon/Real Seal Self-etch systems.

Material and Methods

One hundred ninety pre-molars were used. The teeth were divided into 18 experimental groups according to the irrigation protocols and filling materials used. The protocols used were: distilled water; sodium hypochlorite (NaOCl)+eDTA; NaOCl+H₃PO₄; NaOCl+eDTA+chlorhexidine (CHX); NaOCl+H₃PO₄+CHX; CHX+eDTA; CHX+ H₃PO₄; CHX+eDTA+CHX and CHX+H₃PO₄+CHX. Gutta-percha/AH Plus or Resilon/Real Seal Se were used as root-filling materials. The coronal microleakage was evaluated for 90 days against Enterococcus faecalis. Data were statistically analyzed using Kaplan-Meier survival test, Kruskal-Wallis and Mann-Whitney tests.

Results

No significant difference was verified in the groups using chlorhexidine or sodium hypochlorite during the chemo-mechanical preparation followed by eDTA or phosphoric acid for smear layer removal. The same results were found for filling materials. However, the statistical analyses revealed that a final flush with 2% chlorhexidine reduced significantly the coronal microleakage.

Conclusion

A final flush with 2% chlorhexidine after smear layer removal reduces coronal microleakage of teeth filled with gutta-percha/AH Plus or Resilon/Real Seal SE.     

Efficacy of Corticosteroids on Postoperative Endodontic Pain: A Systematic Review and Meta-analysis

Introduction

The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of corticosteroids on postoperative endodontic pain and to determine/adjust between-trial heterogeneity using meta-regression analysis.