Impact of Nonsurgical Treatment of Asymptomatic Apical Periodontitis on the Oral Health-related Quality of Life: A Prospective Study

Introduction: The aim of this study was to evaluate the impact of nonsurgical root canal treatment (nRCT) and the healing of asymptomatic apical periodontitis (AAP) on the oral health-related quality of life (OHRQoL) in a Brazilian population. Materials and Methods: This prospective longitudinal observational study included 56 adults, in which 84 teeth with asymptomatic apical periodontitis underwent nonsurgical root canal treatment. Socio-demographic and medical data were collected; the primary outcome oral health-related quality of life was measured by the short form of the Oral Health Impact Profile (OHIP-14). Statistical analysis was carried out by Mann-Whitney U-test, and changes in the oral health-related quality of life scores post-treatment were estimated by Student t-test. Results: The mean age was 51.0±15.2 years, with 53.5% of females. Overall, nRCT significantly improved the OHRQoL (P<0.001, effect size=0.76). Gender (female) was associated with a higher OHRQoL after nRCT (P<0.05). OHIP-14 showed a significant reduction six months after root canal treatment compared to baseline scores. Conclusion: Present findings revealed that nonsurgical root canal treatment improved the oral health-related quality of life in patients with asymptomatic apical periodontitis

Pharmacological management of postoperative pain in dentistry : a review

Introdução: A dor ocorre por um processo inflamatório e apresenta diferentes intensidades em função de fatores como o tipo e a duração do procedimento odontológico. O controle da dor pós-operatória dá-se por meio do uso de medicamentos, escolhidos por causa dos seus sítios de ação, do tipo de efeito esperado, da duração do efeito e de características individuais do paciente. Outro método é a realizaçãode analgesia preventiva, utilizando medicamentos previamente aos procedimentos para prevenir ou diminuir a sensibilização nervosa no pós-operatório. Objetivos: Revisar e discutir as diferentes classes de medicamentos disponíveis e suas associações para controle da dor pós-operatória. Revisão da literatura: Os medicamentos analisados foram os corticosteroides e anti-inflamatórios não esteroides (Aines), os analgésicos opioides e não opioides, a associação desses medicamentos e aqueles utilizados para analgesia preemptiva. Resultados: Para dor leve e moderada, recomenda-se o uso de um Aine, associado ou não, a um analgésico não opioide. Para dor intensa, pode ser indicada a associação de um Aine a um analgésico opioide. Para analgesia preemptiva, sugere-se o uso de corticosteroide cerca de 1 hora antes do procedimento. Conclusão: A combinação de dois medicamentos parece alcançar melhores resultados em comparação ao uso de um individualmente, mesmo que seja uma associação ou um opioide. A analgesia preemptiva, pelo uso de corticosteroide em dose única previamente aos procedimentos, contribui para o controle efetivo da dor, bem como o uso de anestésico local a longo prazo.Introduction: Pain occurs through an inflammatory process with different intensities due to factors such as the type and duration of the dental procedure. The control of postoperative pain occurs through the use of drugs, chosen due to their sites of action, type of effect expected, effect duration, and the individual characteristics of the patient. Another method is to perform preemptive analgesia, using drugs before the procedures to prevent or decrease postoperative nerve sensitization. Objectives: To report and discuss the different classes of medication available and which associations are the most recommended for use in the dental office. Literature review: The drugs analyzed were the corticosteroids and non-steroidal anti-inflammatory drugs (NSAID), opioid and non-opioid analgesics, the association of these drugs, and those used for preemptive analgesia. Results: For mild and moderate pain, the use of an NSAID associated or not with a non-opioid analgesic is recommended, and, when facing severe pain, the association of an NSAID with an opioid analgesic may be recommended. For preemptive analgesia, it is recommended the use of a corticosteroid about 1 hour before the procedure. Conclusion: The combination of two drugs seems to achieve better results compared to the use of one individually, even if this is an association or an opioid. Preemptive analgesia, through the use of a corticosteroid in a single dose, previously to the procedures contributes in the effective control of pain, as well as the use of a long-term local anesthetic

Effect of A Clinical-Replicable Cooling Protocol on the Cyclic Fatigue Resistance of Heat-Treated Nickel-Titanium Instruments

Introduction: The aim of this study was to evaluate the bending and cyclic fatigue resistance of Wave One Gold (WOG) and X1 Blue (X1B) instruments when tested at body temperature (36° ± 1°C) subjected or not to an alloy cooling protocol. Methods and Materials: Twenty instruments of each system (n=40) were selected and divided into two groups: body temperature (BT); body temperature with cooling protocol (CP). Cyclic fatigue test was performed until fracture in a custom stainless-steel device with water bath equipment to simulate body temperature. CP group instruments were subjected to 5 seconds of spray cooling at every 30 seconds. Time to fracture was recorded. Resistance to bending at 45o was evaluated using ten instruments of each system. Fractured surfaces were examined under scanning electron microscopy (SEM). Statistical analysis was performed using Student t test at 5% significance level. Results: WOG instruments had significantly less cyclic fatigue resistance compared to X1B instruments in BT (P=0.00001) and CP (P=0.0001) groups. Significantly increased resistance was observed in X1B instruments (P=0.0003) and in WOG (P=0.0003) when cooling protocol was applied. There were no significant differences between the values of resistance increase presented by the instruments after cooling (P>0.05). Bending test presented no statistically significant differences between the tested instruments (P>0.05). Both instruments in both groups showed typical features of cyclic fatigue behavior under SEM. Conclusions: Cooling protocol extended the cyclic fatigue resistance of both instruments

Evaluation of the mechanical properties of different nickel–titanium retreatment instruments

O objetivo desse estudo foi o de investigar a resistência à fadiga cíclica, flexural, torsional e deflexão angular de instrumentos de níquel-titânio (NiTi) usados para desobturação do canal radicular. Um total de 80 instrumentos de NiTi foram selecionados para esse estudo. As amostras foram divididas em quatro grupos (n = 20), da seguinte forma: Pro-R #25.08; ProDesign Logic RT #25.08; Retratamento MK #25.08; e ProTaper Retratamento D2 #25.08. O teste de fadiga cíclica foi realizado até a fratura em um dispositivo de aço inoxidável personalizado em um equipamento de banho-maria para simular a temperatura corporal. O tempo para fratura foi registrado. O número de ciclos foi calculado. A resistência flexural até 45o, a resistência torsional, e a deflexão angular foram avaliadas. As superfícies das fraturas foram examinadas por microscopia eletrônica de varredura. A análise estatística foi realizada com os testes ANOVA unidirecional e Tukey e Kruskal-Wallis e de Dunn. Pro-R e Logic RT apresentaram a maior fadiga cíclica (P 0.05). A performance dos instrumentos dependeu das suas características geométricas e tratamentos térmicos.The aim of this study was to investigate the cyclic fatigue, bending, torsional resistance, and angular deflection of nickel-titanium (NiTi) instruments used for root canal desobturation. A total of 80 NiTi instruments were selected for this study. The samples were divided in four groups (n = 20), as follows: Pro-R #25.08; ProDesign Logic RT #25.08; MK Retreatment #25,08; and ProTaper Retreatment D2 #25.08. Cyclic fatigue test was performed until fracture in a custom stainless-steel device with water bath equipment to simulate body temperature. Time to fracture was recorded. Number of cycles was calculated. Resistance to bending at 45o, torsional resistance, and angular deflection were evaluated. The fracture surfaces were examined by scanning electron microscopy. Statistical analysis was performed with one-way ANOVA and Tukey and Kruskal-Wallis and Dunn tests. Pro-R and Logic RT presented the highest cyclic fatigue (P 0.05). Instruments performances were dependent on their geometrical features and heat treatments

Benzodiazepines for conscious sedation in the dental office: literature review

Conventional behavioral conditioning techniques are usually sufficient for management of patients with fear and anxiety during dental treatment. When such techniques do not produce the expected results, dental anxiety can be managed using drug-based treatments known as conscious sedation. Anxiety can complicate dental procedures because of effects such as increased blood pressure, hyperventilation, and fainting. Medications such as benzodiazepines can be used to avoid these complications. When used properly, dental procedures are safer and there are fewer difficulties for both patient and clinician. These drugs’ mechanisms of action are exerted on the central nervous system and ultimately result in depression of excitatory cells. Effects vary, depending on the dose administered and the drug used, and can include sedation, hypnosis, muscle relaxation, anticonvulsant effects, coronary dilation, and neuromuscular blockade. With wide safety margins and few contraindications, the benzodiazepines most commonly used by dentists are diazepam, as a mild sedation-inducing anxiolytic, midazolam, to induce sleep and amnesia, and alprazolam, lorazepam, and triazolam, each with their appropriate properties and preferred dosages. This literature review allows us to conclude that benzodiazepines are an effective therapeutic option for management of patients with anxiety during dental treatment and are available for use in both inpatient and outpatient settings

DOES ORTHODONTIC MOVEMENTS OF TRAUMATIZED TEETH INDUCE PULP NECROSIS? – A SYSTEMATIC REVIEW

The aim of this systematic review was to evaluate whether orthodontic movements of traumatized teeth induce pulp necrosis. Searches were performed until July 21st, 2022, without restriction of language or year of publication, in the following databases: MEDLINE/PubMed, Cochrane Library, Scopus, LILACS, Web of Science, EMBASE, SciELO, and Gray Literature Report. Eligibility criteria were based on the PICOS strategy, as follows: (P) patients with a history of dental trauma; (I) patients undergoing orthodontic movement; (C) patients without orthodontic movement; (O) pulp necrosis; (S) longitudinal studies. The Cochrane Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool was used to assess the risk of bias. The overall quality of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. In total, six studies were included. The teeth evaluated were central and lateral maxillary incisors. Trauma involved enamel and enamel/dentin fractures, concussions, subluxations, lateral, extrusive and intrusive luxations. Orthodontic appliances evaluated were appliances for intrusion, extrusion, removable and fixed. Time between trauma and orthodontic movement ranged from three months to one year. Assessment of pulp status was performed by clinical and radiographic examinations in all studies, cold thermal testing in four studies, and electrical testing in two studies. Moments of the evaluations were in the initial and final visit, and when there was evidence of pulp necrosis. In general, studies demonstrated that traumatized teeth are more susceptible to pulp necrosis during orthodontic movements. Teeth with total pulp cavity obliteration appear to be more susceptible to necrosis. All studies had a serious risk of bias. The overall quality of evidence was low. Based on the available evidence, it can be concluded that orthodontic movements of traumatized teeth can lead to pulp necrosis, but this information should be interpreted with caution

DOES THE PRE-ANAESTHETIC MEDICATION IMPROVE THE ANALGESIA OF MANDIBULAR MOLARS WITH IRREVERSIBLE PULPITIS? AN UMBRELLA REVIEW

Determine whether the use of premedication increase the anaesthetic efficacy of the inferior alveolar nerve in teeth with symptomatic irreversible pulpitis, through the review question: Does the use of premedication increase the efficacy of the anaesthetic technique of inferior alveolar nerve block on teeth with symptomatic irreversible pulpitis?. Systematic reviews with and without meta-analyses that evaluated the influence of premedication on anaesthetic efficacy of the inferior alveolar nerve in symptomatic irreversible pulpitis of mandibular molars were systematically searched in six electronic databases (MEDLINE/PubMed, Scoupus, Web of Science, Cochrane Library, EMBASE and Open Grey), without restriction of language or year of publication. A Measurement Tool to Assess systematic Reviews (AMSTAR 2) was used to evaluate the quality of the included studies. Twelve systematic reviews were included. Only one did not performed meta-analysis. The AMSTAR 2 overall confidence ranged from very low to high quality. The main findings of the systematic reviews were that non-steroidal anti-inflammatory drugs (e.g., ibuprofen, oxicam, diclofenac, association of ibuprofen with paracetamol, and ketorolac) increased the success of the inferior alveolar nerve block. From the ‘very low’ to ‘high’ quality evidence available, this umbrella review concluded that NSAIDs as premedication acts through cyclooxygenases pathways and block the synthesis of specific prostaglandins that difficult the mechanism of action of the anaesthesia, increasing the success rate of the anaesthetic technique of inferior alveolar nerve block efficacy in cases of mandibular molars with symptomatic irreversible pulpitis

EFFECTS OF ESTROGEN DEFICIENCY ON THE PROGRESSION OF APICAL PERIODONTITIS. SYSTEMATIC REVIEW OF PRECLINICAL STUDIES.

The aim of this systematic review was to verify whether estrogen deficiency can influence in the progression of apical periodontitis. Searches were performed in MEDLINE/PubMed, Cochrane Library, Scopus, Web of Science, EMBASE and Gray Literature Report databases, without restriction of language or year of publication. Eligibility criteria were based on the PICOS strategy, as follows: (P) estrogen-deficient animals; (I) induction of apical periodontitis; (C) animals without estrogen deficiency (control group or sham surgery); (O) two-dimensional and/or three-dimensional measurements of apical periodontitis progression; (S) studies in animal models. The risk of bias was assessed using the SYRCLE Risk of Bias tool. The overall quality of evidence was assessed using the GRADE tool. In total, 12 studies were included. All studies (100%) demonstrated that estrogen deficiency influenced the progression of apical periodontitis. Most studies performed a histomorphometric analysis evaluating bone loss area (58.3%), radiographic bone loss area (41.7%), bone volume assessment with microcomputed tomography (25%), fluorescence microscopy lesion area in mm2 (16.7%), and radiographic density assessment in one study (8.3%). The most frequent period of analysis was 21 days after lesion induction (75%). GRADE assessment showed a moderate certainty of evidence. The included studies demonstrated several limitations regarding randomization, blinding, and description of baseline characteristics. All studies have shown that a hypoestrogenic condition can favor an increased progression of apical periodontitis, generating larger lesions compared to healthy animals. Clinical studies are needed to confirm this correlation