Pulpotomy of Symptomatic Permanent Teeth with Carious Exposure Using Mineral Trioxide Aggregate

Introduction: To evaluate the clinical and radiographic outcomes of pulpotomy treatment with mineral trioxide aggregate (MTA) in symptomatic mature permanent teeth with carious exposure. Materials and Methods: Ten patients aged 27-54 years presented with 11 symptomatic permanent teeth (n=11). Each offending carious tooth was clinically and radiographically determined. We removed caries as conservatively as possible; however pulp exposure was inevitable. ProRoot MTA pulpotomy was performed on these teeth. The patients were followed-up clinically and radiographically for 24-42 months. Results: Immediate relief of patients` symptoms occurred. Moreover, teeth responses to the electric pulp tester were within normal range on follow-up appointment and the radiographs did not reveal any abnormality/lesion in the periapical areas. Conclusion: Pulpotomy using MTA could be a good alternative for root canal therapy (RCT) for managing symptomatic mature permanent teeth with carious exposure, however further large-scale multicenter clinical trials are highly encouraged to confirm this hypothesis

Oral squamous cell carcinoma among Yemenis: onset in young age and presentation at advanced stage

Objectives: Oral cancer represents a health burden worldwide. Up to 90% of oral cancer cases are squamous cell carcinomas (SCC). The data on oral SCC in Yemen are lacking. The objective of this study therefore was to describe and analyze the demographic, clinical and histological characteristics of Yemeni patients with oral SCC. Study design: In this cross-sectional study, two sets of retrospective data for Yemeni cancer patients were obtained officially by two different registries. Patients with oral SCC were included. Their ages were dichotomized using 40 and 45 years alternately as individual cut-points for young and old patients. The patients` demographic, clinical and histological characteristics were statistically analyzed. Results: There were 457 Yemenis with oral SCC; 253 patients (55.4%) were men. The overall mean age was 58.15'}14.11 years. The tongue was the most affected oral sub-site accounting for 53% of the reported cases. The well and moderately differentiated oral SCC accounted for 55.5% and 25.6% of the total cases respectively. Noteworthy, 62 patients (14%) were affected by the age of .40; this increased to 105 patients (23%) aged .45 years. Additionally, a high proportion of oral SCC patients (62%, 283) were diagnosed at advanced tumor stages (regional extension or metastasized). The distributions of histological grades and tumor stages in young and old patients were significantly different (P=0.006 and 0.026 respectively). Conclusion: The relative frequency of oral SCC among Yemeni young people is high. Unfortunately, most of oral SCC patients in Yemen were diagnosed at advanced stage

Antibacterial and anti-inflammatory efficacy of N-acetyl cysteine in endodontic treatment: a scoping review

BACKGROUND: This scoping review systematically summarized the available evidence about the efficacy of N-acetyl cysteine (NAC) as an intracanal antibacterial and/or anti-inflammatory. METHODS: PubMed, Scopus, Web of Science, and Google scholar search engines/databases were searched up to February 2022 to retrieve relevant studies. The studies were evaluated for eligibility criteria, and identifying relevant studies. RESULTS: Out of 193 studies, 15 fulfilled the inclusion criteria and were processed for data extraction. Thirteen in vitro studies assessed antibacterial/antibiofilm efficacy of NAC, and reported good and promising efficacy: NAC was found as efficacious as the comparators (chlorhexidine, sodium hypochlorite, calcium hydroxide), or even showed higher efficacy. Regarding the anti-inflammatory efficacy of NAC, one in vitro study found it equivalent to, while one clinical trial revealed it more efficacious than calcium hydroxide. CONCLUSIONS: There is accumulating evidence on the anti-microbial and anti-inflammatory efficacy of NAC in context of endodontics. However, further clinical trials with robust methodology and objective and reliable clinical, biological and microbial outcomes are warranted to translate its use for clinical practice on humans

Perceived Stress among Undergraduate Dental Students in Relation to Gender, Clinical Training and Academic Performance

Cilj: Ovo istraživanje usmjereno je na procjenu uočenog stresa i njegovih izvora među studentima dodiplomskog studija dentalne medicine Sveučilišta Jazan u Saudijskoj Arabiji. Materijali i metode: U ovoj presječnoj studiji podatci su prikupljeni DES upitnikom. Ukupan rezultat stresa i rezultati po pojedinim područjima opisani su i analizirani različitim čimbenicima grupiranja – prema spolu, godini studija, bračnom stanju i prosjeku ocjena (GPA). Rezultati: Ukupno 366 studenata dentalne medicine pristalo je sudjelovati u ovom istraživanju. Među njima je bilo 57 posto žena. Ukupan DES iznosio je 1,67 ± 0,45. Studentice i oženjeni studenti pokazali su veći stres od svojih kolega. Stres se znatno povećavao na višim godinama studija. Suprotno tomu, pokazatelji stresa bili su niži kod sudionika s visokim GPA-om. Višestruke linearne regresijske analize pokazale su stupanj studija i spol kao važne neovisne determinante ukupnoga DES-a i većine područja stresa. Obje ove odrednice objasnile su 41 posto varijabilnosti u DES bodovima. Zaključak: DES među studentima dentalne medicine Sveučilišta Jazan umjeren je i neznatno povećan. Veći je među ženama i znatno se povećava na višim godinama studija. No studenti s višim GPA-om pokazali su nižu razinu stresa. Kliničko značenje: Smanjenje i/ili ublažavanje stresa među studentima dentalne medicine pozitivno će utjecati na njihov uspjeh u učenju, što će rezultirati boljim upravljanjem i brigom o pacijentu.Aim: This study aimed at evaluating the perceived stress and its sources among undergraduate dental students at Jazan University, Saudi Arabia. Materials and Methods: In this cross-sectional study, the data were collected using the DES questionnaire. The overall score of stress and scores by individual domains were described and analyzed by different grouping factors: gender, study level, marital status and GPA. Results: A total of 366 dental students agreed to take a part in this study. Up to 57% of the participants were females. The overall DES score was 1.67 ± 0.45. Female students and married students scored higher stress levels than their counterparts. Stress increased significantly among students as their educational level increased. Inversely, the stress levels were lower in participants with high GPA. Multiple linear regression analyses revealed that “Study level” and “Gender” were significant independent determinants of overall DES and, also, most of the stress domains. Forty one percent of the variability in DES score can be explained by these determinants. Conclusion: DES among dental students in Jazan University is moderate and slightly higher. It is higher among females and increases significantly with study progression. However, students who had higher GPA showed lower levels of stress. Clinical significance: Reduction and/or relief of stress among dental students will reflect positively on persistence and academic achievement, which will lead to better management and care of patients

The Potential Association Between Inflammatory Bowel Diseases and Apical Periodontitis: A Systematic Review and Meta-Analysis.

Recent literature has suggested a potential association between inflammatory bowel diseases (IBD) and apical periodontitis (AP). The present systematic review and meta-analysis sought to analyse and appraise the available evidence regarding the reported association. Following 2020 PRISMA guidelines, a comprehensive search of multiple online databases (PubMed, Scopus, Web of Science, and Google Scholar) was conducted for all relevant studies published from the date of inception until 27 April 2023 using various relevant keywords. All observational studies that assessed the association between IBD and AP in humans were eligible for inclusion. The quality of the selected studies was carried out independently by two reviewers, and meta-analysis was performed using Comprehensive Meta-Analysis Version 2.2.064. Six studies (five case-control studies and one cohort study) were included. A total of 657 patients (277 with IBD) were included in 5 case-control studies, and 48,223 subjects (35,740 with AP) were included in the cohort study, where 188 developed IBD on follow-up. The pooled data from the five case-control studies revealed that IBD was significantly associated with a higher risk of AP (OR=1.71, 95% CI: 1.21-2.42; I2=10.337%, fixed-effect, p=0.002). The qualitative analysis also showed that most of the included studies found a higher mean number of teeth with AP in IBD groups than the healthy controls. Newcastle-Ottawa Scale (NOS)-based quality appraisal results demonstrated that five studies were of high quality, and one was of moderate quality. The results suggest a potential association between IBD and AP. Large-scale and prospective studies are required to further confirm and elucidate the nature of such an association

Orthodontic camouflage versus orthodontic-orthognathic surgical treatment in borderline class III malocclusion: a systematic review.

This systematic review evaluated the available evidence regarding the skeletal, dentoalveolar, and soft tissue effects of orthodontic camouflage (OC) versus orthodontic-orthognathic surgical (OOS) treatment in borderline class III malocclusion patients. Eligibility criteria. The included studies were clinical trials and/or follow-up observational studies (retrospective and prospective). Information sources. PubMed, Scopus, Science Direct, Web of Science, Cochrane, and LILACS were searched up to October 2021. Risk of bias. Downs and Black quality assessment checklist was used. Synthesis of results. The outcomes were the skeletal, dentoalveolar, and soft tissue changes obtained from pre- and post-cephalometric measurements. Included studies. Out of 2089 retrieved articles, 6 were eligible and thus included in the subsequent analyses. Their overall risk of bias was moderate. Outcome results. The results are presented as pre- and post-treatment values or mean changes in both groups. Two studies reported significant retrusion of the maxillary and mandibular bases in OC, in contrast to significant maxillary protrusion and mandibular retrusion with increased ANB angle in OOS. Regarding the vertical jaw relation, one study reported a significant decrease in mandibular plane inclination in OC and a significant increase in OOS. Most of the included studies reported a significant proclination in the maxillary incisors in both groups. Three studies reported a significant proclination of the mandibular incisors in OOS, while four studies reported retroclination in OC. Interpretation. The OSS has a protrusive effect on the maxillary base, retrusive effect on the mandibular base, and thus improvement in the sagittal relationship accompanied with a clockwise rotational effect on the mandibular plane. The OC has more proclination effect on the maxillary incisors and retroclination effect on the mandibular incisors compared to OOS. Limitation. Meta-analysis was not possible due to considerable variations among the included studies. Owing to the fact that some important data in the included studies were missing, conducting further studies with more standardized methodologies is highly urgent. Registration. The protocol for this systematic review was registered at the International Prospective Register of Systematic Reviews (PROSPERO, No.: CRD42020199591). The common features including skeletal, dental, and soft tissue characteristics of borderline class III malocclusion cases make it more difficult to select the most appropriate treatment modality that can be either OC or OOS. The availability of high-level evidence-systematic reviews-makes the clinical decision much more clear and based on scientific basis rather than personal preference.Open Access funding provided by the Qatar National Library

Skeletal and dentoalveolar effects of class II malocclusion treatment using bi-maxillary skeletal anchorage: a systematic review

Background: The goal of this systematic review was to assess the available evidence regarding the skeletal and dentoalveolar effects of bi-maxillary skeletal anchorage devices (BMSADs) used in treating growing class II malocclusion patients. Methods: A comprehensive search was conducted on PubMed, Scopus, Science Direct, Web of Science, Cochrane, and LILACS up to November 2021, which was augmented by a manual search. The studies included were clinical trials (RCTs) and/or follow-up observational studies (retrospective and prospective). The outcomes of interest were the skeletal, dentoalveolar, and occlusal treatment-induced changes obtained from pre- and post-cephalometric measurements. The risks of bias of the included studies were assessed using an assessment tool from previous publications. Results: Out of 742 screened articles, only 4 were eligible and thus included in the qualitative synthesis. They showed a moderate overall risk of bias. The results are presented as mean changes in both the study and control groups. All studies reported retrusion of the maxillary base and advancement of the mandible (meaning reduced ANB angle). Three of the included studies reported an increase in the vertical jaw relation, which was contrary to what the fourth study reported. Three studies reported an increase in the maxillary incisors’ inclination or position, while one study reported their retroclination. Proclination of the mandibular incisors happened in two studies, whereas the other two studies reported retroclination. The overjet was reduced in all included studies. Conclusion: Apart from the protrusive effects on the mandible, retrusive effects on the maxilla, and the consequent reduction of the overjet, BMSADs results in inconsistent skeletal and dentoalveolar effects. However, the current evidence is limited due to the variability in the biomechanics of the intermaxillary components, type of anchorage, and comparable groups in the included studies. Further RCTs with more standardized methodologies are highly encouraged. Clinical relevance: BMSADs (using miniscrews or miniplates on both jaws) induces more skeletal than dentoalveolar effects. However, this must be practiced with caution, based on the benefit to risk (surgical insertion) ratio, and the limited evidence available in hand so far. Registration The protocol for this systematic review was registered at the International Prospective Register of Systematic Reviews (PROSPERO, No.: CRD42020199601)

Recommendations for standard criteria for the positional and morphological evaluation of temporomandibular joint osseous structures using cone-beam CT: a systematic review

Objective: This systematic review aimed to appraise the reliability and comprehensiveness of imaging methods in studies that used three-dimensional assessment of the temporomandibular joint (TMJ) in order to propose a standardized imaging method. Methods: Six databases/search engines were searched up until September 2022. The outcomes of interest included measurements of the mandibular condyle, glenoid fossa, joint spaces, or the entire TMJ. Two checklists were utilized: one to assess the risk of bias, with a maximum score of 37, and the other, a pre-designed checklist consisting of 22 items to evaluate the comprehensiveness of the methods used, with a maximum score of 33. Results: Out of the 2567 records retrieved, only 14 studies, which used cone bean computed tomography (CBCT), were deemed eligible and thus included in the qualitative analysis. Three studies were deemed of low risk of bias, while the remaining studies were rated as moderate to high risk of bias, primarily due to improper reporting of inter-observer agreement, varying reliability values, and a limited number of cases included in the reliability analysis. Regarding the comprehensiveness of the methods used, only four studies achieved relatively high scores. The deficiencies observed were related to the reporting of variables such as slice thickness and voxel size, absence of or improper reporting of intra- and inter-examiner reliability analyses, and failure to assess all osseous components of the TMJ. Conclusion: CBCT-based methods used to assess the positions and morphology of TMJ bony structures appear to be imperfect and lacking in comprehensiveness. Hence, criteria for a standardized assessment method of these TMJ structures are proposed. Clinical relevance statement: Accurately, comprehensively, and reliably assessing the osseous structures of the temporomandibular joint will provide valid and valuable diagnostic features of the normal temporomandibular joint, and help establish potential associations between these osseous features and temporomandibular disorders. Registration: The protocol for this systematic review was registered at the International Prospective Register of Systematic Reviews (PROSPERO, No.: CRD42020199792). Key Points: •Although many methods have been introduced to assess the osseous structure of the temporomandibular joint, they yielded inconsistent findings. •None of the published studies comprehensively assessed the temporomandibular joint. •Recommendations for a comprehensive temporomandibular joint osseous assessment method were suggested for better validity and reliability of future research

Knowledge, beliefs, attitude, and practices of E-cigarette use among dental students: A multinational survey

E-cigarette use is a trend worldwide nowadays with mounting evidence on associated morbidities and mortality. Dentists can modify the smoking behaviors of their patients. This study aimed to explore the knowledge, beliefs, attitude, and practice of E-cigarette use among dental students. This multinational, cross-sectional, questionnaire-based study recruited undergraduate dental students from 20 dental schools in 11 countries. The outcome variable was current smoking status (non-smoker, E-cigarette user only, tobacco cigarette smoker only, dual user). The explanatory variables were country of residence, sex, age, marital status, and educational level. Multiple linear regression analysis was performed to explore the explanatory variables associated with E-cigarette smoking. Of the 5697 study participants, 5156 (90.8%) had heard about E-cigarette, and social media was the most reported source of information for 33.2% of the participants. For the 5676 current users of E-cigarette and/or tobacco smoking, 4.5% use E-cigarette, and 4.6% were dual users. There were significant associations between knowledge and country (P< 0.05), educational level (B = 0.12; 95% CI: 0.02, 0.21; P = 0.016) and smoking status (P< 0.05). The country of residence (P< 0.05) and smoking status (P< 0.05) were the only statistically significant factors associated with current smoking status. Similarly, there were statistically significant associations between attitude and country (P< 0.05 for one country only compared to the reference) and history of previous E-cigarette exposure (B = -0.52; 95% CI: -0.91, -0.13; P = 0.009). Also, the practice of E-cigarettes was significantly associated with country (P< 0.05 for two countries only compared to the reference) and gender (B = -0.33; 95% CI: -0.52, -0.13; P = 0.001). The knowledge of dental students about E-cigarette was unsatisfactory, yet their beliefs and attitudes were acceptable. Topics about E-cigarette should be implemented in the dental curriculum.Deanship of Scientific Research, King Saud University, for funding through the Vice Deanship of Scientific Research for Research Chairs. Qatar National Library for the open access funding