Prevention of hemorrhagic complications after dental extractions into open heart surgery patients under anticoagulant therapy: the use of leukocyte- and platelet-rich fibrin

Leukocyte- and platelet-rich fibrin (L-PRF) is a biomaterial commonly used in periodontology and implant dentistry to improve healing and tissue regeneration, particularly as filling material in alveolar sockets to regenerate bone for optimal dental implant placement. The objective of this work was to evaluate the use of L-PRF as a safe filling and hemostatic material after dental extractions (or avulsions) for the prevention of hemorrhagic complications in heart surgery patients without modification of the anticoagulant oral therapy. Fifty heart surgery patients under oral anticoagulant therapy who needed dental extractions were selected for the study. Patients were treated with L-PRF clots placed into 168 postextraction sockets without modification of anticoagulant therapy (mean international normalized ratio = 3.16 ± 0.39). Only 2 patients reported hemorrhagic complications (4%), all of which resolved a few hours after the surgery by compression and hemostatic topical agents. Ten patients (20%) showed mild bleeding, which spontaneously resolved or was resolved by minimal compression less than 2 hours after surgery. No case of delayed bleeding was reported. The remaining 38 patients (76%) showed an adequate hemostasis after the dental extractions. In all cases, no alveolitis or painful events were reported, soft tissue healing was quick, and wound closure was always complete at the time of suture removal one week after surgery. The proposed protocol is a reliable therapeutic option to avoid significant bleeding after dental extractions without the suspension of the continuous oral anticoagulant therapy in heart surgery patients. Other applications of the hemostatic and healing properties of L-PRF should be investigated in oral implantology.     

Advanced platelet-rich fibrin (A-PRF) has an impact on the initial healing of gingival regeneration after tooth extraction

ObjectivesPlatelet-rich fibrin (PRF) is widely used in wound healing because it contains several growth factors, including vascular endothelial growth factor (VEGF). In this study, we investigated the effects of advanced PRF (A-PRF) in early-stage gingival regeneration after tooth extraction.MethodsBlood sample was collected from females beagle dogs (age: 12 months) before tooth extraction for A-PRF preparation. All animals were sacrificed by perfusion-fixation on postoperative days 1, 3, and 7. The upper jaws were prepared for hematoxylin and eosin staining and immunostaining (for CD34 and VEGF). The lower jaw samples were prepared for scanning electron microscope observations. Blood flow in the gingiva before and after surgery was measured using laser Doppler flowmetry.ResultsIn the A-PRF group, a large number of microvessels were observed in the gingival tissue on postoperative day 1. The microvessels in the control group were fewer and sparse. Regarding the vascular resin cast, a large number of new blood vessels were observed on postoperative day 1 in the A-PRF group. A stronger CD34-positive signal was obtained around the blood vessels in the A-PRF group than in the control group. Further, a strong VEGF-positive signal was observed in the perivascular tissue in the A-PRF group. Gingival blood flow was significantly higher in the A-PRF group after surgery.ConclusionA-PRF had a positive impact on angiogenesis in the gingiva through the induction of VEGF expression. Thus, A-PRF may be beneficial for gingival tissue regeneration.     

Efficacy of the application of leukocyte and platelet-rich fibrin (L-PRF) on alveolar ridge preservation. A randomized controlled clinical trial

Introduction

Alveolar ridge preservation (ARP) is a well-defined treatment performed to reduce bone dimensional changes occurring during the healing of post-extraction sockets to allow for adequate implant placement. Leukocyte and platelet-rich fibrin (L-PRF) has been showing to potentially promote bone and tissue regeneration during wound healing. Therefore, the aim of this study is to evaluate its efficacy for ARP when applied to fresh extraction sockets, in comparison with spontaneous healing.

Materials and Methods

Twenty-seven patients with hopeless non-molar teeth were treated. After randomization, fresh extraction sockets were either filled with L-PRF or allowed to heal spontaneously. CBCTs and intraoral scans were obtained immediately after extraction and at 4 months. Through superimposition of the obtained images, changes in the horizontal ridge width, height, buccal volume, and ridge contour changes were measured, as well as patient-reported outcome measures (PROM's).

Results

The ridge dimensions changed similarly in both groups. Although less reduction occurred in the test group at 1 mm from the bone crest, differences were not statistically significant (p > 0.05). Application of L-PRF did not prevent reductions of ridge contours, neither in the linear vertical aspect nor in volumetric changes. There were no differences between groups in the need for bone regeneration when placing implants. Patients in both groups reported similar outcomes in terms of bleeding, pain, inflammation, and function at 1 and 4 weeks postoperatively.

Conclusion

Alveolar preservation with L-PRF neither minimized bone resorption occurring after tooth extraction in non-molar sites nor reduced the need for bone regeneration when placing implants. Furthermore, its use did not improve PROM's.     

Randomized double-blind clinical trial evaluation of bone healing after third molar surgery with the use of leukocyte- and platelet-rich fibrin

The objective of this study was to evaluate the use of leukocyte- and platelet-rich fibrin (L-PRF) in bone healing after mandibular third molar extraction. In this prospective, double-blind, split-mouth study, 34 extractions were performed. On one side, the socket was sutured primarily (control side); on the other side, L-PRF was inserted before suturing. The patients were assessed for postoperative bone regeneration, pain and soft tissue healing. The primary outcome was bone regeneration, which was performed through tomographic evaluation in the immediate postoperative period and 3 months after the procedure. The ITK-SNAP software was used for image evaluation by the intensity of grey of each voxel. Pain was analysed using a visual analogue scale (VAS), and soft tissue healing was analysed both based on the modified healing index of Landry et al., and by comparing pre- and postoperative periodontal probing at the distal of the lower second molar. The application of L-PRF improved bone density, which was higher in test group (p = 0.007). There was no statistical difference related to pain or soft tissue between the groups (p > 0.05). There was evidence for improved bone healing in response to L-PRF. However, to better understand the effect of L-PRF more clinical trials with larger samples are necessary.     

Multi-walled carbon nanotube/hydroxyapatite nanocomposite with leukocyte- and platelet-rich fibrin for bone regeneration in sheep model

Background

The aim of this study was to evaluate the effects of multi-walled carbon nanotubes/hydroxyapatite (MWCNT/HA) granules with or without leukocyte- and platelet-rich fibrin (L-PRF) on bone regeneration in cancellous bone of sheep model.

Methods

Totally, 32 cylindrical holes were drilled in female sheep (n?=?4) in the distal epiphysis and proximal metaphysis of right and left humerus and femur. The defects were randomly filled with (1) MWCNT/HA, (2) MWCNT/HA mixed with L-PRF, (3) L-PRF, and (4) left empty as control. After 8 weeks, defects were evaluated and compared radiographically using multi-slice computed tomographic (CT) scan and cone beam CT scans, histologically and histomorphometrically.

Results

The results showed that there was no significant inflammation (>?10%) or foreign body reaction around the granules. The new lamellar bone was regenerated around the MWCNT/HA nanocomposite granules. Addition of L-PRF to MWCNT/HA demonstrated significantly improvement of new bone formation, about 27.40?±?1.08%, in comparison with the L-PRF alone, about (12.16?±?1.46%) (P?<?0.01). Also, the rate of new bone formation was significantly greater with the use of MWCNT/HA granules (24.59?±?1.54%) compared to the control (10.36?±?1.17%) (P?<?0.01).

Conclusion

Consequently, both biocompatibility and osteoconductivity of MWCNT/HA nanocomposite were demonstrated in the preclinical sheep model, and the use of L-PRF in combination with MWCNT/HA nanocomposite can improve bone regeneration.

     

‘Plain lignocaine’ vs ‘Lignocaine with vasoconstrictor’—Comparative evaluation of pain during administration and post-extraction wound healing by a double blinded randomized controlled clinical trial

Objectives: The aim of this double blinded randomized controlled clinical trial was to evaluate the efficacy of two local anaesthetic solutions, ‘Plain lignocaine’ and ‘Lignocaine with vasoconstrictor’, on pain during administration and post-extraction wound healing in patients undergoing therapeutic extractions.

Materials and methods: Fifty patients indicated for therapeutic extraction of upper and lower premolars for orthodontic purpose were recruited for the study. Using a split-mouth study design, anaesthesia was achieved using lignocaine with adrenaline on the control side and plain lignocaine on the study side. Pain perception was measured by modified visual analogue scale and wound healing was assessed by Landry’s Wound Healing Index. Sample allocation was done by simple randomization. The outcome parameters compared were (1) pain during administration of LA and (2) post-operative healing after extraction. Data analysis involved Chi-square test to compare proportions between treatment groups and independent sample t-test to compare mean values between treatment groups. SPSS version 22.0 was used to analyse the data.

Results: The study group demonstrated a statistically significant wound healing on day1 and day 3 between the study and control group with p p?Conclusion: The patients who received Plain Lignocaine perceived less pain during injection of local anaesthetic solution when compared to patients who received lignocaine with vasoconstrictor. The early post-operative wound healing was better in patients anaesthetized by Plain Lignocaine.     

Correlation between perceived experience of caries disease and recorded caries activity among adult patients at a Swedish Public Dental Clinic: A longitudinal study

Abstract

Objective. To compare patients' perceived experiences of caries activity with recorded longitudinal caries prevalence, consequences of caries and length of recall intervals. Materials and methods. A questionnaire was mailed to 134 caries active (CA) and 40 caries inactive (CI) adult patients at a Swedish Public Dental Clinic. The overall response rate was 69%. The questionnaire included items regarding perceived caries activity, general health, dietary and oral hygiene habits, level of education and socioeconomic status. Questionnaire responses were studied for their association to clinical data extracted from patient dental records. Results. There was a correlation between patient-perceived and documented caries activity for all respondents (rho = 0.65; p < 0.001). CA patients had significantly more perceived caries activity (p < 0.001), decayed teeth (p < 0.001), root fillings (p = 0.001) and extractions (p < 0.001) than CI patients. The mean recall interval was 1.5 years for CA and 2.1 years for CI (p < 0.001). In multiple logistic regression analysis, CA patients were at increased risk for xerostomia (OR = 22.66, p = 0.003), sleep disturbances (OR = 4.36, p = 0.04) and more frequent use of daily extra fluoride (OR = 3.58, p = 0.03). Conclusions. Patient-perceived experience of caries correlated well with recorded caries activity in this group of middle-aged Swedish adults. Individuals with active caries were aware of their disease and made more frequent attempts to reduce caries activity by use of daily extra fluoride. Individual risk-based recall intervals did not seem to eliminate consequences of disease activity such as root fillings and extractions during the follow-up period.     

Effects of leukocyte- and platelet-rich fibrin alone and combined with hyaluronic acid on early soft tissue healing after surgical extraction of impacted mandibular third molars: A prospective clinical study

Purpose

In this prospective, randomized, double-blind, controlled study, we evaluated the effects of leukocyte- and platelet-rich fibrin (L-PRF) alone and combined with hyaluronic acid (HA) sponge on early healing of soft tissue after mandibular third molar (M3) surgery.

Quantitative evaluation of myofibroblast apoptosis during wound healing in rat palate after post-operative administration of basic fibroblast growth factor (bFGF)

Abstract

Objective. Excessive wound contraction apparently inhibits maxillary growth; thus, myofibroblast apoptosis needs to be accelerated in mucoperiosteal denudation after palatoplasty. The aim of this study was to evaluate myofibroblast apoptosis during wound healing in mucoperiosteal denudation of rat palates immediately after post-operative administration of basic fibroblast growth factor (bFGF). Materials and methods. A total of 100 male Wistar rats aged 20 days were divided into control, scar, sham and bFGF groups (n = 25 each). In the scar, sham and bFGF groups, mucoperiosteum was removed from the palate and fibrin glue was applied to the exposed bone surface immediately after surgery. In the bFGF group, 10 μL of 2 μg/μL bFGF solution was injected into the operated area beneath the fibrin glue. At 2, 5, 7, 14 and 28 days post-operatively, myofibroblast apoptosis during the wound healing process was investigated by double immunofluorescence staining. The apoptotic area of myofibroblasts was measured using image software. Results. In the bFGF group, at 2 days, apoptosis of myofibroblasts in the lamina propria and submucosa was marked, as compared with the other three groups and apoptosis of myofibroblasts was scarcely seen at 5 days. At 5 and 7 days, the apoptotic area of myofibroblasts in the bFGF group was statistically significantly smaller when compared to the scar and sham groups. Conclusion. The results confirmed that bFGF injection immediately after surgery accelerated apoptosis of myofibroblasts in mucoperiosteal denudation of rats. This may reduce maxillary growth retardation due to excessive wound contraction.     

Comparison of two surgical techniques in the treatment of multiple gingival recessions sandwiched with a combination of A-PRF and L-PRF

Aim

The aim of this study is to compare semilunar vestibular incision technique with pouch and tunnel technique in combination with A-PRF and L-PRF for treatment of Miller’s class I and II multiple gingival recessions.

Evaluation of risk factors for oral infection with potential for spread in a 1-year cohort study

Objectives

To determine the frequency of oral infection with potential for spread (OIPS) and behavioural risk factors in patients referred to a regional tertiary care-centre for OIPS assessment and clearance.

Materials and methods

A database search of all referrals to the Oral and Maxillofacial Diseases unit of HUH in 2009 was performed. Of the 2807 referrals, 408 were due to a known or suspected OIPS. The electronic patient records of these patients were analysed for patient demographics, lifestyle factors, radiological findings and clinical oral findings. Risk factors for OIPS were analysed using logistic regression and using the significant factors in univariate analyses in the multivariate models.

Results

The mean age of the patients was 58 years. Most patients (n = 270, 66%) were referred due to upcoming cancer or other immunosuppressive therapy. The majority (n = 314, 77%) were diagnosed with one or more OIPS. In univariate analyses, smoking (OR 3.2, 95% CI 1.6–6.4; p = 0.0006), male gender (OR 1.7, 95% CI 1.1–2.8; p = 0.02), excessive alcohol use (OR 3.0, 95% 1.1–7.9; p = 0.03) and irregular dental care (OR 4.8, 95% CI 2.6–8.8; p < 0.0001) were risk factors for OIPS. However, in multivariate analyses, smoking was the only independent risk factor for OIPS (OR 3.6, 95% CI 1.2–11.8; p = 0.02).

Conclusions

OIPS are common in patients referred for OIPS clearance, and smoking was identified as an independent behavioural risk factor for them. These findings highlight the burden of disease in this patient group and the importance of smoking cessation encouragement.

Clinical relevance

To identify patients at increased risk of OIPS.

     

The use of leukocyte- and platelet-rich fibrin in the management of soft tissue healing and pain in post-extraction sockets: A randomized clinical trial

This study aimed to evaluate the clinical effect of leukocyte- and platelet-rich fibrin (L-PRF) to improve epithelialization and decrease postoperative pain in post-extraction sockets. Thirty two participants requiring extractions of posterior teeth were randomized into two groups: 1) extractions and socket filling with L-PRF membrane (test group) and 2) extraction with spontaneous healing (control group). One week after extraction, an assessment of soft tissue healing around the sockets was performed using the healing index. Also, postoperative pain by visual analog scale (VAS) and number of consumed analgesic tablets were recorded. In the first week, the sockets of the test group presented a significantly (mean of 3.81 ± 0.54; p = 0.0138) higher level of healing when compared to the sockets of the control group (mean of 3.18 ± 0.65). The participants of control group reported a significantly (mean of 5.12 ± 1.08; p = 0.0128) higher level of postoperative pain when compared to the test group (mean of 4 ± 1.15). Also, the control group consumed a greater number of analgesics (mean of 1.75 ± 0.85; p = 0.0136) when compared to the test group (mean of 1 ± 1.15). The results of the present study demonstrate that whenever improved healing of the extraction socket is needed, the use of L-PRF should be considered. In addition, the use of L-PRF decreases postoperative pain and discomfort.     

Saliva viscosity as a potential risk factor for oral malodor

Objectives. The objective of this study was to assess whether saliva viscosity, measured by a viscometer, was a predictor of oral malodor. Materials and methods. The subjects were 617 patients who visited an oral malodor clinic. The organoleptic test (OT) was used for diagnosis of oral malodor. An oral examination assessed the numbers of teeth present and decayed teeth as well as the presence or absence of dentures. Further, periodontal pocket depths (PD), gingival bleeding, dental plaque and tongue coating were investigated. Unstimulated saliva were collected for 5 min. Saliva viscosity was measured with a viscometer. Logistic regression analysis with oral malodor status by OT as a dependent variable was performed. Possible confounders including age, gender, number of teeth present, number of decayed teeth, number of teeth with PD ≥ 4 mm, number of teeth with bleeding on probing, presence or absence of dentures, plaque index, area of tongue coating, saliva flow rate, saliva pH and saliva viscosity were used as independent variables. Results. Saliva viscosity (p = 0.047) along with the number of teeth with PD ≥4 mm (p = 0.001), plaque index (p = 0.037) and area of tongue coating (p < 0.001) were significant variables for oral malodor. Subjects with a higher number of teeth with PD ≥ 4 mm (OR = 1.32), plaque index (OR = 2.13), area of tongue coating (OR = 3.17) and saliva viscosity (OR = 1.10) were more likely to have oral malodor compared to those with lower values. Conclusions. The results suggested that high saliva viscosity could be a potential risk factor for oral malodor.     

Dentin caries risk indicators in 1-year-olds. A two year follow-up study

Background: Early childhood caries (ECC) risk factors are suspected to vary between regions with different caries prevalence.

Aim: Identify ECC risk factors for 1-year-olds predicting dentin caries at 3 years of age in a region with low caries prevalence.

Design: Caries risk was assessed by dental hygienist or dental assistant in 779 one-year-olds. The oral mutans streptococci (MS) score was performed from a tooth surface or (in pre-dentate children) from oral mucosa. A parental questionnaire with questions regarding family factors (siblings with or without caries), general health, food habits (night meals, breastfeeding, other beverage than water), oral hygiene habits and emerged teeth were answered by parents of the 1-year-olds. Dentin caries was assessed when the children were 3-year-olds. Simple and multiple logistic regression analyses were used for identification of caries-associated factors.

Results: An increased caries risk was assessed in 4.4% of the 1-year-olds. Dentin caries was found in 2.6% of the 3-year-olds. Caries risk at 1 year was associated with caries at 3 years (OR?=?6.5, p?=?.002). Multiple regression analysis found the variables Beverages other than water (OR?=?7.1, p?Caries in sibling (OR?=?4.8, p?=?.002), High level of MS (score 2–3) (OR?=?3.4, p?=?.03) and Night meal (OR?=?3.0, p?=?.03) to be associated with caries. The single variables Beverage other than water between meals and Caries in sibling were more reliable than Caries risk assessed performed by dental personnel.

Conclusions: Behavioural, family and microbial factors are important when assessing caries risk among 1-year-olds in a region with low caries experience.     

The impact of cardiovascular disease and endodontic outcome: a systematic review of longitudinal studies

Objectives

To date, the relationship between cardiovascular disease (CVD) and endodontic treatment outcomes remains elusive with mixed reports. Thus, the purpose of this systematic review of longitudinal cohort studies was to evaluate whether CVD was a risk factor for endodontic outcome.

Materials and methods

Two reviewers independently conducted a comprehensive electronic database search to July 2020. The bibliographies of all relevant articles, textbooks, and gray literature were manually searched. The methodological quality of evidence was appraised by the Newcastle-Ottawa Scale and GRADE. The authors considered any publication on CVD and endodontic outcome. Endodontic outcome referred to either healing or survival of endodontically treated tooth. Risk ratio (RR) with 95% confidence interval (CI) was used.

Results

Three articles met the inclusion criteria with a low risk of bias. Patients with CVD demonstrated a 67% higher risk for negative endodontic outcomes compared with patients who were healthy (RR = 1.67, P = 0.001, 95% confidence interval 1.53–1.81).

Conclusion

With the limitations of this systematic review, the overall confidence by GRADE was moderate suggesting that CVD might be a risk factor for endodontic outcomes.

Clinical relevance

The results support an association between CVD and endodontic outcomes.

     

The Frequency of Bleeding Complications After Invasive Dental Treatment in Patients Receiving Single and Dual Antiplatelet Therapy

BackgroundThe dental literature suggests that a patient&apos;s antiplatelet medication schedule should not be altered before invasive dental procedures. The authors conducted a study to examine the frequency of bleeding complications after invasive dental procedures in patients taking antiplatelet medications.

MethodsIn a retrospective study of 43 dental patients who were receiving single or dual antiplatelet therapy, the authors conducted a chart review of patient records and examining documentation of the medical history. They collected demographic data; medical history; medication history; social history; presence of preoperative infection at any dental visit as evidenced by swelling, purulence or periapical radiolucency; number and type of invasive dental visits; emergency department visits; types of dental procedures performed; use of adjunctive perioperative local hemostatic measures (for example, topical thrombin, absorbable gelatin compressed sponge, sutures); blood products used preoperatively and postoperatively; and postoperative complications.ResultsTwenty-nine patients (67 percent) were receiving dual antiplatelet therapy. There were 88 invasive-procedure visits consisting of extractions, periodontal surgery, and subgingival scaling and root planing. The authors found no differences between patients receiving single or dual antiplatelet therapy for all variables, most notably the number of invasive-procedure visits, total extractions and adjunctive hemostatic measures. There were no documented episodes of prolonged postoperative bleeding.ConclusionsThe frequency of oral bleeding complications after invasive dental procedures was low to negligible for patients who were receiving single or dual antiplatelet therapy.Clinical ImplicationsThe risks of altering or discontinuing use of antiplatelet medications far outweigh the low risk of postoperative oral bleeding complications resulting from dental procedures.     

Application of propolis extract,nanovitamin C and nanovitamin E to prevent alveolar osteitis after impacted lower third molar surgery. A randomized,double-blind,split-mouth,pilot study

Background Propolis has anti-inflammatory, analgesic and healing properties. The purpose of this study was to determine whether a gel containing 2% of propolis extract, 0.2% of ascorbic acid and 0.2% of tocopherol acetate is effective in preventing surgical complications related to impacted lower third molar extractions. Material and Methods A randomized, double-blind, split-mouth study was performed. Fifteen patients were recruited who needed bilateral impacted lower third molar extractions with a similar surgical difficulty. A test or placebo gel was administered randomly inside post-extraction sockets. Each patient was instructed to apply the gel 3 times/day in the surgical wound for a week. After a month, the contralateral third molar was extracted, and the opposite gel applied. The following parameters were diagnosed/evaluated and then recorded: alveolar osteitis following Blum’s criteria, swelling and trismus at day one, two, three and seven post-intervention, wound healing at day 7 post-intervention, and postoperative pain using a visual analog scale, as well as, the number of analgesic pill intake. Results A total of twenty-six surgical procedures were performed in 13 patients (mean age 20.67±2 years). Alveolar osteitis was reported in 3 patients from the placebo group (23.1%) and none in the test group (0%) (p=0.25). No statistically significant differences were reported in swelling, trismus, wound healing or analgesic pill consumption between two groups. But statistically lower postoperative pain during the 7 days after surgical extractions was found according to visual analog scale in test group compared to the placebo group (p=0.007). No side effects were reported. Conclusions The application of this gel may be effective in preventing alveolitis and thus reducing postoperative pain after impacted third molar extractions. More randomized clinical trials with larger sample are needed to confirm these results. Key words:Propolis, nanovitamin, third molar surgery, oral surgery, alveolar osteitis.     

Should we fear direct oral anticoagulants more than vitamin K antagonists in simple single tooth extraction? A prospective comparative study

Objectives

The aim of this prospective comparative clinical study was to evaluate the effect of oral anticoagulants on peri- and post-operative bleeding during simple single tooth extractions, comparing patients in treatment with vitamin K antagonists (VKAs) and patients assuming direct oral anticoagulants (DOACs).

Materials and methods

Patients under oral anticoagulant therapy needing dental extraction were eligible for entering the study; patients were enrolled following inclusion and exclusion criteria and divided into VKAs and DOAC group according to the anticoagulation therapy. Included patients underwent a simple single dental extraction with elevators and forceps with a maximum surgical time of 15 minutes, without anticoagulation therapy discontinuation. All participants were assessed pre-operatively, during surgery, 30 min minutes and 7 days after surgery. Biological complications were registered and post-extraction bleeding was clinically defined according to Iwabuchi classification. Parametric and non-parametric tests were used to evaluate the variables between the groups.

Results

Sixty-five patients per group were enrolled and 130 teeth were extracted. The two groups were comparable for pre-, peri-, and post-operative variables. Only 1 patient of DOAC group and 2 patients for VKA group needed medical evaluation for post-extractive bleeding. No statistically significant difference resulted in post-operative bleeding events between the groups (p = 0.425).

Conclusions

DOAC and VKA patients showed the same incidence of bleeding complications after simple single tooth extraction. Bleeding events were not statistically significant and not clinically relevant.

Clinical relevance

Patients assuming DOACs can be treated similarly to patients in VKAs therapy with INR index between 2 and 3. Non-ceasing of DOAC therapy seems to be appropriate for simple single dental extractions.

     

Antimicrobial effectiveness of ultrasonic irrigation in root canal treatment: a systematic review of randomized clinical trials and meta-analysis

Objective

The objective of this systematic review and meta-analysis (SRM) was to answer the question as to whether the use of ultrasonic irrigation (UI) results in better antimicrobial activity in root canal disinfection compared to conventional irrigation (CI).

Methods

A literature search was performed in the main scientific databases, carried out until October 2021. The eligibility criteria were randomized clinical trials (RCTs). Two meta-analyses were conducted using R software with the “META” package. The mean difference (MD) and odds ratio (OR) measure of effect were calculated. The fixed effect model was applied with a 95% confidence interval. The Cochrane collaboration scale was used to assess risk of bias and the GRADE tool to assess the quality of evidence.

Results

A total of 1782 records were screened, and 12 studies meeting the criteria were included in this review. A low risk of bias was observed for most domains, except allocation concealment that was considered unclear. The certainty of evidence was classified as moderate in the OR meta-analyses and low in the MD meta-analyses. Ultrasonic irrigation resulted in a better antimicrobial effect in both meta-analyses, MD 1.42 [1.60; 1.23] p < 0.0001, I² = 80%; and OR 3.86 [1.98; 7.53] p< 0.0001, I² = 28.7%.

Conclusion

Within the limitations of this SRM, UI presented better antimicrobial efficacy than CI.

Clinical Relevance

UI should be used by clinicians as it promotes better antimicrobial efficacy in patients undergoing endodontic treatment.