Impact of systemic diseases and tooth-based factors on outcome of root canal treatment.

Aim To investigate the impact of systemic health and tooth-based factors on the outcome of root canal treatment (RCT). Methodology The target population consisted of all patients receiving RCT at the Helsinki University Clinic in 2008-2011. The inclusion criteria were diagnosable pre- and postoperative (minimum 6 months after root filling) radiographs and adequate patient records of RCT available. Teeth extracted for nonendodontic reasons were excluded. Patient documents including digital radiographs of 640 permanent teeth in 504 patients were scrutinized. The radiographs were assessed by two examiners under standardized conditions. The Periapical Index was used to define radiographically 'healthy' and 'healing' cases as successful. Data included systemic health, technical quality of root fillings, type of restoration and level of alveolar bone loss. Statistical evaluation of differences between groups included chi-squared tests and Fisher's exact tests. Logistic regression modelling utilizing robust standard errors to allow for clustering within patients was applied to analyse factors related to the outcome of RCT. Results The mean age of patients was 51.5 years (standard deviation (SD) 15.0; range 10-83), and 49% were female. In 41 cases (6%), the patient had diabetes mellitus (DM), in 132 (21%) cardiovascular disease and in 284 (44%) no systemic disease. The follow-up period was 6-71 months (mean 22.7). In the primary analyses, the success rate of RCT was 73.2% in DM patients and 85.6% in patients with no systemic disease (P = 0.043); other systemic diseases had no impact on success. In the multifactorial analysis, the impact of DM became nonsignificant and RCTs were more likely to succeed in the absence of apical periodontitis (AP; odds ratio (OR) = 4.4; P <0.001), in teeth with optimal root filling quality (OR = 2.5; P <0.001), in teeth restored with indirect restorations (OR = 3.7; P = 0.002) and in teeth with none/mild alveolar bone loss (OR = 2.4; P = 0.003). Conclusions DM diminished the success of RCT, especially in teeth with apical periodontitis. However, tooth-based factors had a more profound impact on the outcome of RCT. This should be considered in clinical decision-making and in assessment of RCT prognosis.Peer reviewe

Radiographic outcome of root canal treatment in general dental practice: tooth type and quality of root filling as prognostic factors

Objective:This study evaluated the radiographic outcome of root canal treatments (RCTs) performed by general dental practitioners (GDPs) with focus on tooth type and quality of root filling. Materials and methods:The target population included all patients receiving root filling by GDPs in City of Helsinki in 2010-2011. Equal numbers of each tooth type (anteriors, premolars, molars) by jaw were included, resulting in 426 teeth. Pre- and post-operative periapical radiographs were assessed to evaluate periapical status and quality of root filling. Statistical evaluation utilized Chi-squared tests, Cohen's kappa and logistic regression modelling. Results:The overall success rate of RCT was 67.4%, being 76.8%, 69.7% and 55.6% (p <.001) for anteriors, premolars and molars, respectively. The quality of root fillings varied by tooth type (p <.001); optimal fillings were least frequent (43%) in molars. In multifactorial analysis, RCTs were more likely to succeed in non-molars (OR = 1.8), in teeth with optimal root fillings (OR = 3.6) and in teeth without apical periodontitis (OR = 3.2). Conclusion:The quality of root fillings and radiographic outcome of RCTs varied considerably according to tooth type; success was least likely in molars. Improvement is needed in quality of RCTs by GDPs.Peer reviewe

Hammastyypin vaikutus juurihoidon onnistumiseen

Objectives We assessed the impact of type of tooth on the outcome of root canal treatment (RCT) according to factors potentially weakening the prognosis such as preoperative apical periodontitis (AP) and treatment modality (primary or secondary RCT). Materials and methods We scrutinized patient documents including pre- and postoperative radiographs of 640 permanent teeth receiving non-surgical RCT at Helsinki University Clinic in 2008–2011. Of teeth, 44% were molars, 32% premolars, and 24% anterior teeth. Patients’ mean age was 51.5 years; 51% were male. AP was present in 60.5% of teeth preoperatively. We used the periapical index (PAI) to assess the radiographs and defined radiographically “healthy” and “healing” cases as successful. Statistical evaluation included chi-squared tests, Fisher’s exact tests, t tests, and logistic regression modeling. Results The overall success rate (SR) was 84.1%; 88.3% for primary and 75.5% for secondary RCT (p < 0.001). The SRs for anterior teeth, premolars and molars were 85.6%, 88.8%, and 79.7%, respectively. Teeth with and without AP had SRs of 77.3% and 94.5%, respectively (p < 0.001). The RCTs were more likely to succeed in anterior teeth and premolars than in molars (OR 1.7; 95% CI 1.1–2.7) and in females than in males (OR 1.9; 95% CI 1.2–3.1). Conclusions Apart from existing AP and retreatment scenario, also, the type of tooth and gender had a significant influence on the outcome of RCT in this study. Clinical relevance The prognosis of RCT varies by type of tooth; special attention should be given to RCT of molar teeth.Peer reviewe

Outcome of root canal treatment according to tooth-, patient-, and operator-related factors

Root canal treatment (RCT) is a common procedure in dentistry that aims to heal and prevent a root canal infection. The evidence on the outcome of RCT is primarily based on studies from controlled settings, such as teaching clinics, but little is known about the outcome in general dental practice. The aim of this study was to investigate and compare the radiographic outcome of non-surgical RCT in two distinct treatment settings and operators: RCTs by dental students in the University Dental Clinic of the City of Helsinki in 2008–2011 and by general dental practitioners (GDPs) in Health Centres of the City of Helsinki in 2010–2011. Furthermore, the study aimed to assess the impact of various factors, such as tooth type, quality of root filling, and systemic diseases on the outcome of RCT. This study is based on patient records, including digital radiographs. The first dataset consisted of 640 permanent teeth, root-canal-treated by dental students, in 504 patients. These treatments followed a strict protocol and were supervised by specialised endodontists. The second dataset was scrutinised using stratified random sampling by tooth type amongst RCTs by GDPs; the sample included equal numbers of teeth per tooth type (n = 71), resulting in 426 teeth in 426 patients. The clinical protocol for these treatments was not standardised. The periapical index (PAI) was utilised for the evaluation of success of RCT. Only the latest follow-up radiograph was included for each case. The follow-up periods were 6–71 months and 6–105 months for RCTs by dental students and GDPs, respectively. Both healthy and healing cases were considered successful. The quality of root fillings varied by type of tooth; adequate root fillings were least frequent in molars. Root fillings by dental students were more often optimal than root fillings by GDPs. The success rate of RCTs was favourable and comparable to previous studies for RCTs by dental students; 84% of cases were successful. For RCTs by GDPs, success was achieved in 67% of cases, thus less often than when performed by dental students. Success was more likely for teeth without preoperative apical periodontitis. Type of tooth influenced the outcome of RCT; success was more likely in non-molars than molars. Diabetic patients experienced poorer RCT outcomes than healthy patients, especially in teeth with apical periodontitis prior to treatment. Other systemic diseases seemed to have no impact on the outcome. In conclusion, the outcome of RCT achieved by dental students was up to par, whereas the outcome by GDPs was unsatisfactory, especially in molars. The outcome of RCT varies according to tooth-based and patient-related factors, thus the prognosis should be estimated separately for each tooth and patient. RCTs are successful when performed following guideline standards, consequently reinforcing the necessity of the continuous education of dentists, and the option of referral of more complex cases, such as molars, to endodontic specialists.Juurihoidon tulos vaihtelee Juurihoitoon päädytään tavallisimmin pitkälle edenneen hammaskarieksen takia. Juurihoidon tavoitteena on tulehdusvapaa, toimiva ja oireeton hammas. Juurihoitojen onnistumista on kansainvälisesti tutkittu eniten valvotuissa olosuhteissa tehtyinä, kuten opetusklinikoilla. Perushammaslääkäreiden tekemien juurihoitojen onnistumisesta tietoa on niukasti. Tässä tutkimuksessa perehdyttiin hammaslääketieteen opiskelijoiden ja terveyskeskushammas-lääkäreiden tekemien juurihoitojen onnistumiseen. Onnistuminen määritettiin röntgenkuvista. Tutkimuksen tavoitteena oli arvioida ja verrata hammaslääketieteen opiskelijoiden vuosina 2008-2011 Helsingin kaupungin yliopistohammasklinikalla ja terveyskeskushammaslääkäreiden vuosina 2010-2011 Helsingin terveyskeskuksissa tekemien juurihoitojen onnistumista. Lisäksi tavoitteena oli tutkia useiden tekijöiden, kuten hammastyypin, juurentäytteen laadun ja yleisterveyden vaikutusta juurihoidon onnistumiseen. Tutkimus perustui potilasasiakirjoihin. Aineistot käsittivät 640 opiskelijoiden ja 426 terveyskeskushammaslääkäreiden juurihoitamaa hammasta. Opiskelijoiden tekemät juurihoidot noudattivat tarkasti hoitosuosituksia, ja hoitoja ohjasivat erikoishammaslääkärit. Terveyskeskushammaslääkäreiden tekemät juurihoidot olivat osa normaalia vastaanottotoimintaa. Seuranta-aika opiskelijoiden tekemille juurihoidoille oli 6-71 kuukautta ja hammaslääkäreiden 6-105 kuukautta. Juurentäytteiden laatu vaihteli hammastyypeittäin. Hyvälaatuisia juurentäytteitä oli vähiten poskihampaissa. Opiskelijoiden tekemät juurentäytteet olivat useammin hyvälaatuisia kuin hammaslääkäreiden tekemät. Opiskelijoiden tekemät juurihoidot onnistuivat hyvin (84%) ja vastaavasti kuin aiemmissa tutkimuksissa. Hammaslääkäreiden juurihoidoista onnistui 67%. Hammastyyppi vaikutti hoidon onnistumiseen; onnistuminen oli todennäköisempää muissa hampaissa kuin poskihampaissa. Diabeetikoiden juurihoidot onnistuivat harvemmin kuin muiden, erityisesti jos hampaassa oli juurenpään tulehdus ennen hoitoa. Muilla yleissairauksilla ei ollut merkitystä juurihoidon onnistumiselle. Juurihoidon tulos on hyvä, kun hoito tehdään suositusten mukaisesti. Terveyskeskushammaslääkäreiden tekemät juurihoidot, erityisesti poskihampaissa, menestyivät heikosti. Juurihoidon tulos vaihteli hammas- ja potilaskohtaisesti, joka tulisi huomioida hoitopäätöksiä tehdessä. Hammaslääkäreiden jatkuva täydennyskoulutus ja mahdollisuus lähettää vaikeampia hoitoja, kuten poskihampaiden juurihoitoja, erikoishammaslääkärin hoitoon on suositeltavaa

Therapeutic efficacy of SYM004, a mixture of two anti-EGFR antibodies in human colorectal cancer with acquired resistance to cetuximab and MET activation

Cetuximab and panitumumab have an effective therapeutic response in a subset ofRASWild-Type (WT) metastatic colorectal cancers (mCRCs). Despite molecular-driven selection, all patients do not respond to epidermal growth factor receptor (EGFR) inhibitors and the onset of secondary resistance limits their clinical benefit

New insights into the genetic etiology of Alzheimer’s disease and related dementias

Characterization of the genetic landscape of Alzheimer’s disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/‘proxy’ AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele

New insights into the genetic etiology of Alzheimer’s disease and related dementias

Characterization of the genetic landscape of Alzheimer’s disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/‘proxy’ AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele