Regenerative Endodontic Procedures for the Treatment of Necrotic Mature Teeth with Apical Periodontitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

IntroductionRegenerative endodontic procedures (REPs) are intended to repair and regenerate part of the pulp-dentin complex. The aim of this study was to systematically appraise the existing evidence on the effectiveness of REPs on mature teeth with pulp necrosis and apical periodontitis.MethodsElectronic database and hand searches were performed on 8 databases of published and unpublished literature from inception to January 3, 2021, for the identification of randomized controlled trials (RCTs) or prospective clinical trials. The related key words included “regenerative,” “pulp revascularization,” “revitalization procedure,” and “necrotic mature teeth.” A random effects meta-analysis was conducted assessing success as the main outcome treatment. Risk of bias was assessed through the Cochrane Risk of Bias 2.0 tool, and the quality of the evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation approach.ResultsOf the 337 initial hits, 4 RCTs were eligible for inclusion, whereas 3 were included in the quantitative synthesis. Overall, there was no difference in the relative risk for a successful/unsuccessful treatment outcome between REPs or conventional treatment (3 studies, relative risk = 1.03; 95% confidence interval, 0.92–1.15; P = .61; heterogeneity I² = 0.0%, P = .53; prediction interval = 0.51–2.09). Risk of bias ranged from low to raising some concerns, whereas the quality of the evidence was graded as moderate.ConclusionsBased on moderate-quality evidence, REPs appear as a viable treatment alternative for mature necrotic teeth with periapical lesions at present. Furthermore, well-designed RCTs might also provide confirmatory evidence in this respect while also framing a backbone for standardization of the therapeutic protocol of REPs.     

The Expanding Spectrum of Human coronin 1A deficiency

The skin is the largest organ of our body; it consists of the epidermis, dermis, hair follicles, sweat glands, blood vessels, and connective tissue matrix. Its main function is to act as a barrier to the outside world and protect us from infections. Any component of the skin is subject to insults from the environment and/or from within the body. Primary immune deficiency patients present with recurrent or prolonged infections not frequently seen in healthy individuals. Oftentimes, these infections involve the skin. Primary immune deficiency may also present with noninfectious cutaneous signs, such as eczema; erythroderma; granulomas; dysplasia of the skin, hair, nails, or teeth; pigmentary changes; angioedema; urticaria; vasculitis; or autoimmune skin disease due to immune dysregulation. Prompt recognition of the underlying diagnosis and initiation of treatment decrease morbidity. This review provides the reader with an up-to-date summary of the common dermatologic manifestations of primary immune deficiency diseases.     

Kikuchi‐fujimoto disease in fine‐needle aspiration smears: A clinico‐cytologic study of 76 cases of KFD and 684 cases of reactive hyperplasia of the lymph node

Kikuchi‐Fujimoto disease (KFD) is cytologically characterized by a polymorphous lymphoid cell population, abundant karyorrhectic debris and histiocytes, many of which are crescentic (Kikuchi histiocytes). As per reviewed literature, KFD may be confused with tuberculosis, lymphoma, and reactive hyperplasia of lymph nodes (RHLN). Since RHLN was found to be a major challenging factor during routine cytodiagnosis of KFD in our material, we tried to find out the differentiating clinico‐cytologic features between 76 KFD and 684 RHLN cases seen in Kuwait. 63.2% of KFD were in 3rd and 4th decades of life as compared to 40.2% of RHLN (P = 0.0002). Male to female ratio was 1: 2.45 for KFD and 1:1.09 for RHLN (P = 0.0022). Kuwaiti:non‐Kuwaiti ratio was 1:2.04 for KFD and 1.31:1 for RHLN (P < 0.0001). Capillary networks was present in 71.1% of KFD smears and 52.6% of RHLN (P = 0.0023). Tingible body macrophages and dendritic reticulum cells were detected in 17.1% and 22.4%, respectively, in KFD as opposed to 50.1% and 58.8%, respectively, in RHLN (P < 0.0001). Kikuchi histiocyte count ranged from 2 to 36% in KFD and was ≥10% in 31 (40.8%). Rare Kikuchi histiocytes were detected in 16 (2.3%) of RHLN cases but in none of them the count exceeded 1%, whereas their count was >1% in all KFD cases (P < 0.0001). Thus, KFD cases differed significantly from RHLN in respect of age and sex distribution, Kuwaiti:non‐Kuwaiti ratio, and cytomorphologic features such as capillary networks, Kikuchi histiocyte count, dendritic reticulum cells, and tingible body macrophages. Diagn. Cytopathol. 2013;41:288–295. © 2011 Wiley Periodicals, Inc.     

Enamel gloss changes induced by orthodontic bonding

ABSTRACT

Objective: The purpose of this study was to assess enamel gloss changes induced by orthodontic bracket bonding with a light-cured composite or a light-cured resin-reinforced glass ionomer cement.

Setting: The Department of Biomaterials, School of Dentistry, National and Kapodistrian University of Athens, Greece.

Design: Laboratory study.

Methods: A total of twenty extracted upper human first premolars were included in this study and each tooth served as a control for itself. Their buccal surfaces were subjected to 60^o-angle gloss measurement (G%60) with a standardized and secure repeated analysis of the same site. After baseline evaluation, a bracket was bonded on the buccal surface of each tooth. Half of the specimens were bonded with acid-etching and a light-cured composite whereas the other half with a light-cured resin-reinforced glass ionomer cement without prior enamel conditioning. Gloss measurements were repeated after bracket debonding and removal of the composite/glass ionomer cement with an 18-fluted carbide bur. Gloss differences between the two measurement conditions (baseline and post-debonding) were analyzed through linear regression with standard errors derived using the bootstrap method. Level of significance was set at a?<?0.05.

Results: A statistically significant difference was detected between the tested groups for the outcome of interest. Teeth bonded with light-cured composite exhibited larger enamel gloss changes as compared to resin-reinforced glass ionomer cement (β?=?0.74; 95% CIs: 0.10, 1.38; p?=?0.02).

Conclusions: Bracket bonding with two common bonding protocols (acid-etching with a light-cured composite vs. no etching with resin reinforced glass-ionomer cement) and subsequently debonding and adhesive removal with an 18-fluted carbide bur induced enamel gloss changes.     

Factors associated with the development of superficial vein thrombosis in patients with varicose veins

Introduction

Superficial vein thrombosis (SVT) is a common and controversial clinical entity. Recent studies have demonstrated that SVT should be seen as a venous thromboembolism (VTE). The objective of this study was to investigate the prevalence of thrombophilia defects and to estimate the role of age, sex and body mass index (BMI) in patients with varicose veins (VVs) and SVT.

Materials and Methods

A total of 230 patients with VVs, 128 with, and 102 without SVT underwent thrombophilia testing included factor V Leiden, prothrombin G20210A, methylenetetrahydrofolate reductase and plasminogen activator inhibitor- 1 mutations, protein C, protein S (PS), anti-thrombin III and plasminogen deficiencies and levels of A₂ antiplasmin, activate protein C resistance and lupus anticoagulant. According to Clinical- Etiology- Anatomy- Pathophysiology (CEAP) classification patients were categorized in two subgroups: moderate disease (C_2,3) and severe disease (C_4,5,6). Age and body mass index were also assessed.

Results

The prevalence of thrombophilia defects was significantly higher in patients with moderate disease and SVT (p = 0.002). In the C_2,3 group, SVT was associated with PS deficiency (p = 0.018), obesity (p < 0.001), male gender (p = 0.047) and age (p < 0.001). There were no significant differences in patients with severe disease.

Conclusions

Age, male sex, obesity and PS deficiency are factors associated with SVT development among patients with VVs having moderate disease (C_2,3).     

Influence of general anaesthesia on slow waves of intracranial pressure

Objective: Slow vasogenic intracranial pressure (ICP) waves are spontaneous ICP oscillations with a low frequency bandwidth of 0.3–4 cycles/min (B-waves). B-waves reflect dynamic oscillations in cerebral blood volume associated with autoregulatory cerebral vasodilation and vasoconstriction. This study quantifies the effects of general anaesthesia (GA) on the magnitude of B-waves compared to natural sleep and conscious state.

Materials and methods: The magnitude of B-waves was assessed in 4 groups of 30 patients each with clinical indications for ICP monitoring. Normal pressure hydrocephalus patients undergoing Cerebrospinal Fluid (CSF) infusion studies in the conscious state (GROUP A) and under GA (GROUP B), and hydrocephalus patients undergoing overnight ICP monitoring during physiological sleep (GROUP C) were compared to deeply sedated traumatic brain injury (TBI) patients with well-controlled ICP during the first night of Intensive Care Unit (ICU) stay (GROUP D).

Results: A total of 120 patients were included. During CSF infusion studies, the magnitude of slow waves was higher in conscious patients (GROUP A: 0.23+/?0.10 mm Hg) when compared to anaesthetised patients (GROUP B: 0.15+/?0.10 mm Hg; p = 0.011). Overnight magnitude of slow waves was higher in patients during natural sleep (GROUP C: 0.20+/?0.13 mm Hg) when compared to TBI patients under deep sedation (GROUP D: 0.11+/? 0.09 mm Hg; p = 0.002).

Conclusion: GA and deep sedation are associated with a reduced magnitude of B-waves. ICP monitoring carried out under GA is affected by iatrogenic suppression of slow vasogenic waves of ICP. Accounting for the effects of anaesthesia on vasogenic waves may prevent the misidentification of potential shunt-responders as non-responders.     

A phase I study of temozolomide and lapatinib combination in patients with recurrent high-grade gliomas

We undertook this phase I study to investigate the feasibility of the combination of temozolomide (TMZ) and lapatinib (LP) and to define the maximum tolerated dose (MTD) of LP in patients with relapsed high-grade gliomas. Eligible patients were enrolled in this dose escalation study of LP. TMZ was administered at a fixed dose of 200 mg/m² d1–d5 every 28 days. Starting dose of LP was set at 1,000 mg daily continuously, escalated by 250 mg in cohorts of minimum three patients. Translational research investigations were also undertaken in available biopsy material. Between January 2009 and December 2010, 16 patients were entered into the study at three LP levels: 1,000 mg sid (11 patients), 1,250 mg sid (4 patients) and 1,500 mg sid (1 patient). A total of 55 cycles had been delivered. Fourteen patients had stopped treatment because of disease progression, and two because of toxicity. Three patients received 10, 11 and 17 cycles of treatment. Dose-limiting hematological toxicity was observed in 2 patients at the second LP dose level of 1,250 mg sid. MTD was defined at LP 1,000 mg sid. Median progression-free survival (PFS) and survival were 2.4 and 5.9 months, respectively. EGFR amplification and EGFRvIII expression were not related to PFS. Combination of TMZ and LP is feasible with manageable toxicity. The activity of this combination in patients with recurrent glioblastoma multiforme is further investigated in a recently initiated phase II trial.