Effect of Apical Patency on Postoperative Pain: A Meta-analysis

Introduction

This systematic review and meta-analysis assessed the available evidence regarding the effect of apical patency versus nonpatency on postendodontic pain in adult patients.

Maintaining Apical Patency Does Not Increase Postoperative Pain in Molars with Necrotic Pulp and Apical Periodontitis: A Randomized Controlled Trial

Introduction

This prospective, single-center, single-blind, randomized controlled trial aimed to evaluate whether maintaining apical patency (AP) during endodontic treatment increases postoperative pain in molar teeth with necrotic pulp and apical periodontitis.

Regaining Apical Patency after Obturation with Gutta-percha and a Sealer Containing Mineral Trioxide Aggregate

Introduction

MTA Fillapex (Angelus Solucoes Odontologicas, Londrina PR, Brazil) was introduced as a mineral trioxide aggregate (MTA)-based sealer used for endodontic obturation. There is a lack of research that evaluates the ability of different solvents to soften MTA-based sealers during retreatment. This study tested the ability of 4 commonly used endodontic solvents to soften gutta-percha and MTA Fillapex to allow for the re-establishment of apical patency.

Methods

Eighty-six extracted maxillary anterior teeth were instrumented to the working length to a size 45 (.04 taper size). Teeth were divided into 2 groups (n = 43 for each group). MTA Fillapex was placed into all canals. Group 1 was obturated with gutta-percha to the working length, and group 2 was obturated 2 mm short of the working length to ensure the apical 2 mm was filled with sealer only. Both groups were divided into 4 subgroups (n = 10). The remaining teeth served as the control group. Each subgroup was exposed to 1 of the following solvents: chloroform, Endosolv R (Septodont, Saint-Maur, France), Endosolv E (Septodont), or eucalyptol.

Results

Patency was re-established in 100% of the teeth in groups 1 and 2 when tested with chloroform or Endosolv E, 80% of the teeth in group 1 and 90% in group 2 when tested with eucalyptol, and 10% of the teeth in group 1 and 50% in group 2 tested when with Endosolv R. The chi-square test indicated there was a statistical difference between Endosolv R and the other tested solvents for both groups.

Conclusions

Chloroform, Endosolv E, and Eucalyptol soften GP and MTA Fillapex sufficiently to aid in re-establishing apical patency during endodontic retreatment.     

下颌第三磨牙拔出方法与颞下颌关节紊乱病的相关性研究

目的:分析不同拔牙方式对下颌第三磨牙拔出后患者出现TMD的症状,探讨两种拔牙方式拔出下颌第三磨牙后与TMD的相关性。方法:随机选择符合纳入标准的需要拔出下颌第三磨牙的患者160例,采用微创拔牙法与传统拔牙法拔出异位萌出的下颌第三磨牙,在拔牙术前、术后1周、4周、6月分别进行TMD的双轴诊断,确定TMD的不同程度。结果:通过对160例拔牙患者6个月的回访发现,微创拔牙方式拔除下颌第三磨牙后弹响消失、减轻的患者占15%,选择传统拔牙方式拔除下颌第三磨牙后弹响消失、减轻的患者占7.5%;双轴诊断评价结果显示运用微创技术拔出下颌第三磨牙后出现颞下颌关节结构紊乱疾病、咀嚼肌紊乱疾病的患者数量较传统拔牙法有下降的趋势,差异具有统计学意义。结论:微创拔牙技术能够显著降低下颌第三磨牙拔出术中、术后颞下颌关节紊乱并发症出现的几率。     

颞下颌关节内紊乱与关节疼痛关系的研究

目的 :探讨TMJ疼痛与TMJID的关系。方法 :对 4 4例单侧关节疼痛TMD患者 88侧关节完成开闭口斜矢状位PDW成像 ,以非疼痛侧盘突关系做自身对照 ,评价关节疼痛与TMJID的关系。结果 :4 4个疼痛关节中 ,30个关节 (6 8.2 % )表现为TMJID ,其中ADDR为 11个关节 (2 5 % ) ,ADDWR为 19个关节 (4 3.2 % ) ;而 4 4个非疼痛关节中 6个关节 (13.6 % )表现为ADDR。经统计学分析 ,TMJ疼痛与TMJID及TMJID的类型有显著相关性 (P <0 .0 0 5 )。结论 :TMJID是颞下颌关节疼痛的原因之一     

慢性根尖周炎中Wnt5a与骨吸收的关系

目的:检测Wnt5a在慢性根尖周炎病损中的表达以及Wnt5a与病变范围的关系。方法:18例慢性根尖周炎患者,根据病变大小分为A组(d≥6 mm)、B组(6 mm＞d≥3 mm),21例因正畸需要而拔除的健康牙作对照组,采用RT-PCR(Real-Time PCR)法,从mRNA水平检测Wnt5a的表达,分析Wnt5a mRNA表达与临床病变范围的关系。A组、B组及对照组各随机抽取5例进行免疫组化。采用SPSS13.0软件包对数据进行统计学分析。结果:RT-PCR结果中病例组Wnt5a mRNA表达水平显著高于对照组(P＜0.05);A组中Wnt5a mRNA表达水平显著高于对照组(P＜0.01);A组中Wnt5a mRNA表达水平与B组相比(P＜0.01);B组中Wnt5a mRNA表达水平与正常对照组相比差异无统计学意义(P＞0.05)。免疫组化结果中病例组Wnt5a表达水平显著高于正常对照组(P＜0.01),A组Wnt5a的表达水平显著高于正常对照组(P＜0.01);B组Wnt5a的表达水平高于正常对照组(P＜0.05);A组中Wnt5a表达水平高于B组(P＜0.05)。结论:Wnt5a与慢性根尖周炎的骨组织吸收相关,可能促进了骨吸收的发展。     

牙齿发育与手腕骨钙化间的相关性研究

目的　探索牙齿钙化发育与手腕骨成熟度间是否存在恒定的内在联系。方法　选择本院正畸科 36 7名 7～ 16岁初诊患者 ,运用Demirjian法评估上下颌尖牙、下颌前磨牙、下颌第二磨牙的钙化发育阶段及测量下颌尖牙根冠比 ,运用SPSS10 0软件统计其与年龄、CHN骨龄及青春发育阶段间的内在联系。结果　除个别牙齿发育的个别阶段外 ,牙齿发育各阶段年龄的离散程度均小于骨龄的离散程度 ;牙齿钙化发育各阶段与骨骼成熟各阶段间的Gamma一致性系数 0 6 6 0～ 0 913(P <0 0 0 0 ) ;男性下颌尖牙根冠比与年龄、骨龄的Pearson相关系数分别为 0 772 (P <0 0 0 0 )、0 6 84 (P <0 0 0 0 )。女性根冠比与年龄、骨龄的Pearson相关系数分别为 0 732 (P <0 0 0 0 )、0 6 84 (P <0 0 0 0 )。结论　牙齿发育、手腕骨钙化间无内在必然联系。     

牙齿功能面磨耗与偏侧咀嚼及侧方咬合的相关性研究

目的:调查研究牙齿功能面磨耗与偏侧咀嚼及侧方咬合的关系。方法:通过问卷调查和临床检查收集数据,t检验分析牙齿功能面磨耗与偏侧咀嚼习惯、侧方咬合之间的关系。结果:在257名受试者中,有133名(52%)受试者有偏侧咀嚼习惯,其中77名(30%)为右侧咀嚼习惯,56名(22%)为左侧咀嚼习惯。偏侧咀嚼习惯与牙齿功能面磨耗相关(P<0.05),进一步分区研究显示主要是习惯侧的磨合面磨耗严重(P=0.038<0.05)。所有的受试者中,在左侧,23名(8.9%)受试者为尖牙保护牙合,213名(82.9%)受试者为组牙功能牙合,21名(8.2%)受试者无法测量;在右侧,22名(8.6%)受试者为尖牙保护牙合,217名(84.4%)受试者为组牙功能牙合,18名(7.0%)受试者无法测量。组牙功能牙合磨牙区牙齿牙合面磨耗要比尖牙保护牙合磨牙区牙齿牙合面磨耗严重(P<0.05)。结论:在偏侧咀嚼侧的牙齿功能面磨耗更严重;组牙功能合磨牙区牙齿牙合面磨耗要比尖牙保护牙合磨牙区牙齿牙合面磨耗严重。     

正畸加力后牙周疼痛与龈沟液中生物活性物质变化的相关研究

目的 观察正畸患者正畸加力后疼痛的时间变化规律，了解正畸加力前后龈沟液中生物活性物质的变化特点，以及两者之间的相关性。方法 采用放射免疫测定法，测定正畸患者50例样本上颌侧切牙受唇向倾斜力前和后12h、24h、48h、72h龈沟液中前列腺素E2(PGE2)、P物质(SP)、白细胞介素-6(IL-6)和巨噬细胞集落刺激因子(GM—CSF)的浓度变化，记录并描述正畸加力后疼痛的时间规律。对正畸加力后疼痛与生物活性物质的变化进行相关分析。结果 正畸加力后12h左右开始出现疼痛，24h左右疼痛程度最高，72h左右明显减轻。正畸加力后12h左右PGE2、SP、IL-6和GM—CSF的浓度升高，24h后SP、PGE2达到高峰，而IL-6和GM—CSF的浓度无明显变化；72h，IL-6和GM—CSF保持较高水平，而PGEa、SP的浓度明显下降。结论 正畸牙加力后疼痛呈规律性变化，而这种变化与牙周某些局部生物活性物质如SP和PGE2的浓度变化相关。     

成都市学龄前儿童龋病与出生状况的调查分析

目的:了解学龄前儿童龋病与其出生状况的关系,筛选患龋的高危人群。方法:对四川省成都市五城区3~6 岁儿童2500名进行患龋情况调查,随机选取龋敏感儿童和无龋对照儿童各260名,按年龄、性别配对,对出生状况、喂养方式、饮食习惯等29个可能引起儿童乳牙龋的指标变量进行问卷调查,获得200对有效样本。对样本进行Lo- gistic回归及V2检验分析。结果:新生儿出生状况对学龄前儿童的乳牙龋有影响(P<0105),出生时为早产儿的学龄前儿童患龋状况较出生时为足月产的学龄前儿童患龋严重(P<0105),足月难产与足月顺产的新生儿到学龄前其患龋无明显差异(P>0105)。结论:为更好地预防儿童龋病,应将胎龄不足的早产儿作为龋病预防的重点人群。     

牙列中度与重度拥挤人群牙量和骨量的相关性研究

目的 分析牙齿和基骨的各项指标对牙列拥挤度的影响。方法 选取中度、重度拥挤患者101例,运用牙(牙合)模型系统测量两组的牙齿和基骨的各项指标,将测量结果进行比较。结果 两组患者牙量差异有显著性;基骨宽度和基骨长度的差异无显著性;牙量和骨量的比值,即Howes值的差异有显著性。结论 牙列拥挤度与牙量、Howes值有关,骨量对拥挤度的影响不明显。提示临床对于拥挤度较大的患者应采用拔牙矫治。     

Expressions and Functions of Neurotrophic Factors in Tooth Development

Neurotrophic factors are soluble growth factors predominantly expressed in vertebrate nervous systems and have been well-characterized for their critical roles in neural tissues. Recent studies have revealed that neurotrophin factors and their receptors are also expressed in multiple non-neural tissues, and play a role in a wide range of biological functions, such as regulation of cellular proliferation, survival, migration, and differentiation. The neurotrophic factor family is defined by its structural and functional similarities to 4 ligands; nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3), and neurotrophin-4 (NT-4, also known as NT-5). They activate 2 different receptors, trk tyrosine kinase and p75, the latter of which is a member of the tumor necrosis factor receptor superfamily. During tooth development, observations of dynamic changes of specific expression patterns of neurotrophic factors and their receptors imply their important functions in odontogenic processes. In addition, our recent study demonstrated that NT-4 regulates proliferation and differentiation of dental epithelium, and promotes the production of enamel matrixes. In this review, we describe the expression patterns and functions of neurotrophic factors in the tooth germ, and discuss the relationships with tooth development.     

Differences in Inflammation and Bone Resorption between Apical Granulomas,Radicular Cysts,and Dentigerous Cysts

IntroductionDental cysts can be of inflammatory (radicular cysts) or noninflammatory (dentigerous cysts) origin. Apical periodontitis is a necrosis of the pulp and infection of the root canal causing the development of apical granulomas or radicular cysts. The immunology of granuloma and cyst formation is important because modern root filling materials are immunologically active and can contribute to the resolution of apical granulomas. In contrast, radicular cysts often require apicectomy. A better understanding of the pathophysiology of inflammation and bone resorption in apical periodontitis could be the basis for developing new root filling materials with superior immunomodulatory properties.MethodsForty-one apical granulomas, 23 radicular cysts, and 23 dentigerous cysts were analyzed in this study. A tissue microarray of the 87 consecutive specimens was created, and human leukocyte antigen–DR isotype (HLA-DR)-, CD83-, receptor activator of nuclear factor kappa B ligand–, macrophage colony-stimulating factor (MCSF)-, galectin-3 (Gal3)-, CD4-, and CD8-positive cells were detected by immunohistochemistry. Tissue microarrays were digitized, and the expression of markers was quantitatively assessed.ResultsHLA-DR, CD83, MCSF, and Gal3 expression was significantly (P < .05) higher in radicular cysts compared with apical granulomas. HLA-DR, CD83, MCSF, receptor activator of nuclear factor kappa B ligand, and Gal3 expression in dentigerous cysts was significantly (P < .05) lower than in both periapical lesions (apical granulomas and radicular cysts). CD4 and CD8 infiltration was not statistically different between apical granulomas and radicular cysts. Dentigerous cysts showed a significantly (P < .05) lower T-cell infiltration than apical periodontitis. The CD4/CD8 ratio was not significantly different between the analyzed groups.ConclusionsThe development of radicular cysts in apical periodontitis is associated with an increased expression of myeloid inflammatory markers and bone resorption parameters. Antigen-presenting cells and myeloid cells might be more relevant for the pathogenesis of apical periodontitis than T cells. Increased inflammation might promote the formation of radicular cysts and more pronounced bone resorption.     

不同磨牙关系的安氏Ⅱ类错[牙][合]上下颌牙量关系的对比研究

目的：通过比较不同磨牙关系的安氏II类错殆Bolton指数及Bolton不调量,探讨不同磨牙关系的安氏Ⅱ类错胎患者在上下颌牙量关系方面的差异。方法：以安氏Ⅱ错骀162例为研究对象,按照磨牙关系不同分为磨牙关系远中尖对尖组（简称尖对尖组）114例,磨牙关系完全远中组（简称完全远中组）48例,分别对其模型进行牙冠宽度测量,计算Bolton指数,再根据Bolton指数正常值获取上颌Bolton不调量。两组之间进行统计学分析。结果：完全远中组全牙、前牙Bolton指数比值均大于尖对尖组,有统计学差异（P〈O．05）。两组错胎间全牙Bolton不调的分布比率表现出统计学差异（P〈O．05）。而前牙Bolton不调的分布比率未表现出统计学差异。两组错黯间Bolton不调量总和与Bolton不调程度的分布比率的比较未表现出统计学差异。结论：不同磨牙关系的安氏II类错胎畸形在上下颌牙量关系方面存在差异,在治疗时应该加以重视。