Displaying publications 1 - 20 of 31 in total

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  1. Martins JNR, Worldwide Anatomy Research Group, Versiani MA
    J Endod, 2024 Jan 25.
    PMID: 38280512 DOI: 10.1016/j.joen.2024.01.016
    INTRODUCTION: This study aimed to examine the global prevalence of root and root canal morphologies in mandibular canines and analyze potential influences of region, ethnicity, sex, and age on the proportion of a second root and root canal configuration.

    METHODS: Observers from 44 countries screened 13,200 canines using cone-beam computed tomographic exams and gather data on the percentages of 2 root canal morphologies and 2-rooted configurations (primary outcomes), as well as the root canal configurations (secondary outcome). Demographic factors (ethnicity, sex, and age) were collected for each participant. Primary outcomes were represented as odds ratios and untransformed proportions accompanied by 95% confidence interval (CI) forest plots. Meta-analysis compared sub-groups and identified sources of heterogeneity. Intra- and inter-rater tests were conducted. Statistical significance was set at 5%.

    RESULTS: The worldwide prevalence of a second canal was 7.5% (95% CI, 6.3%-8.7%), ranging from 0.7% in Nigeria to 17.7% in Uruguay. The meta-analysis also revealed significant variations when comparing ethnicity, gender and age (P.05).

    CONCLUSIONS: The prevalence of two root canals and two-rooted configurations in the mandibular canine exhibited variations based on geographic location, ethnicity, sex, and age. The global prevalence of two root canals and two-root configuration was 7.5% and 1.9%, respectively.

  2. Martins JNR, “Worldwide Anatomy Research Group”, Versiani MA
    J Endod, 2023 Oct 26.
    PMID: 37898333 DOI: 10.1016/j.joen.2023.10.009
    INTRODUCTION: This worldwide study examined the root and root canal characteristics of maxillary premolars and explored how demographic factors impact the outcomes.

    METHODS: Observers from 44 countries assessed 26,400 maxillary premolars using cone-beam computed tomography and employed a standardized screening method to gather data on multiple canal morphology and 3-rooted configuration (primary outcomes), as well as secondary outcomes related to root and root canal anatomies. Demographic factors such as ethnicity, sex, and age were collected for each participant. The intra- and inter-observer tests ensured observer reliability. Primary outcomes were represented as odds ratios and untransformed proportions accompanied by 95% confidence interval (CI) forest plots. Meta-analysis compared sub-groups and identified sources of heterogeneity (α=5%).

    RESULTS: The overall prevalence of multiple canal morphology in the first premolar was 93.5% (95% CI, 93.3%-94.7%), while in the second premolar, it was 49.7% (95% CI, 44.9%-54.6%). The proportion of 3-rooted configuration was 1.8% (95% CI, 1.4%-2.1%) in the first premolar and 0.4% (95% CI, 0.3%-0.5%) in the second. Asian countries generally displayed fewer roots and root canals, while European nations showed higher counts (P<0.05). Males exhibited higher percentages and odds ratios for both outcomes in both premolars. Younger patients demonstrated lower percentages of multiple root canal morphologies (P<0.05). Factors such as tooth side, voxel size and field-of-view did not influence the outcomes (P>0.05).

    CONCLUSIONS: The worldwide assessment of root and root canal characteristics of maxillary premolars has revealed a discernible influence of various factors such as tooth type, geographical region, ethnicity, sex, and age.

  3. Hatipoğlu FP, Mağat G, Hatipoğlu Ö, Al-Khatib H, Elatrash AS, Abidin IZ, et al.
    J Endod, 2023 Oct;49(10):1308-1318.
    PMID: 37393948 DOI: 10.1016/j.joen.2023.06.011
    AIM: The aim of this study was two-folded: i) to assess the prevalence of Distolingual Canal (DLC) and Radix Entomolaris (RE) in Mandibular First Molars (M1Ms), using Cone Beam Computed Tomography (CBCT) images and ii) to assess the impact of sociodemographic factors on the prevalence of these conditions worldwide.

    METHODS: CBCT images were scanned retrospectively and the ones including bilateral M1Ms were included in the study. The evaluation was performed by 1 researcher in each country, trained with CBCT technology. A written and video instruction program explaining the protocol to be followed step-by-step was provided to all observers to calibrate them. The CBCT imaging screening procedure consisted of evaluating axial sections from coronal to apical. The presence of DLC and RE in M1Ms (yes/no) was identified and recorded.

    RESULTS: Six thousand three hundred four CBCTs, representing 12,608 M1Ms, were evaluated. A significant difference was found between countries regarding the prevalence of both RE and DLC (P  .05).

    CONCLUSION: The overall prevalence of RE and DLC in M1Ms was 3% and 22%. Additionally, both RE and DLC showed substantial bilaterally. These variations should be considered by endodontic clinicians during endodontic procedures in order to avoid potential complications.

  4. Hatipoğlu Ö, Hatipoğlu FP, Javed MQ, Nijakowski K, Taha N, El-Saaidi C, et al.
    J Endod, 2023 Jun;49(6):675-685.
    PMID: 37094712 DOI: 10.1016/j.joen.2023.04.005
    INTRODUCTION: Direct pulp capping (DPC) procedures require the placement of a bioactive material over an exposure site without selective pulp tissue removal. This web-based multicentered survey had 3 purposes: (1) to investigate the factors that affect clinicians' decisions in DPC cases, (2) to determine which method of caries removal is preferred, and (3) to evaluate the preferred capping material for DPC.

    METHODS: The questionnaire comprised 3 sections. The first part comprised questions regarding demographic features. The second part comprised questions on how treatment plans change according to factors such as nature, location, number and size of the pulp exposure, and patients' age. The third part composed of questions on the common materials and techniques used in DPC. To estimate the effect size, the risk ratio (RR) and 95% confidence interval (CI) were calculated using a meta-analysis software.

    RESULTS: A tendency toward more invasive treatment was observed for the clinical scenario with carious-exposed pulp (RR = 2.86, 95% CI: 2.46, 2.32; P 

  5. Martins JNR, Worldwide Anatomy Research Group, Versiani MA
    J Endod, 2023 May 22.
    PMID: 37225039 DOI: 10.1016/j.joen.2023.05.012
    INTRODUCTION: This cross-sectional study assessed the influence of patient demographics on the worldwide prevalence of a lingual canal in mandibular incisors.

    METHODS: 26,400 mandibular incisors were evaluated using cone-beam computed tomography imaging by pre-calibrated observers from 44 countries. A standardized screening method was employed to collect data on the presence of a lingual canal, the anatomic configuration of the root canal, and number of roots. Patient demographic information (age, sex, and ethnicity) was also recorded. Multiple intra- and inter-rater tests assessed the reliability of the observers and groups, and a meta-analysis was used to examine differences and heterogeneities (α=5%).

    RESULTS: The prevalence of the lingual canal in mandibular central and lateral incisors varied from 2.3% (0.06%-4.0%; Nigeria) to 45.3% (39.7%-51.0%; Syria) and from 2.3% (0.06%-4.0%; Nigeria) to 55.0% (49.4%-60.6%; India), respectively. Ethnicity had a significant impact on the prevalence of the lingual canal, with African, Asian, and Hispanic groups having the lowest proportions (P

  6. Pertek Hatipoğlu F, Mağat G, Hatipoğlu Ö, Taha N, Alfirjani S, Abidin IZ, et al.
    J Endod, 2023 Mar 01.
    PMID: 36863567 DOI: 10.1016/j.joen.2023.02.012
    BACKGROUND: An additional canal found in the mandibular first molar (M1M) is the middle mesial canal (MMC), which is often missed during root canal treatment. In this study, the prevalence of MMC in M1M on cone-beam computed tomography (CBCT) images was evaluated in 15 countries, along with the effect of some demographic factors on its prevalence.

    METHODS: Deidentified CBCT images were scanned retrospectively, and the ones including bilateral M1Ms were included in the study. A written and video instruction program explaining the protocol to be followed step-by-step was provided to all observers to calibrate them. The CBCT imaging screening procedure consisted of evaluating three planes (coronal, sagittal, and axial) after a 3-dimensional alignment of the long axis of the root(s). The presence of an MMC in M1Ms (yes/no) was identified and recorded.

    RESULTS: In total, 6304 CBCTs, representing 12,608 M1Ms, were evaluated. A significant difference was found between countries (P  .05) or between genders (odds ratio= 1.07, 95% CI: 0.91, 1.27; P > .05). As for the age groups, no significant differences were found (P > .05).

    CONCLUSIONS: The prevalence of MMC varies by ethnicity, but it is generally estimated at 7% worldwide. Physicians must pay close attention to the presence of MMC in M1M, especially for opposite M1Ms, due to the prevalence of MMC being significantly bilateral.

  7. Ong TK, Lim GS, Singh M, Fial AV
    J Endod, 2020 Dec;46(12):1856-1866.e2.
    PMID: 32827507 DOI: 10.1016/j.joen.2020.08.016
    INTRODUCTION: The purposes of this review were to appraise the level of evidence of the existing regenerative endodontic therapy (RET) publications, perform a meta-analysis on the survival and healing rates of necrotic immature permanent teeth treated with RET, and run a meta-analysis on the quantitative assessment of the root development of those teeth.

    METHODS: Electronic searches were performed in Web of Science, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane Library databases. Two authors independently screened the titles and abstracts for eligibility. The analyses were performed on the clinical outcomes (ie, survival, healing, and root development) of the procedure.

    RESULTS: Eleven articles were included in the qualitative and quantitative syntheses. Three studies were randomized controlled trials, 6 were prospective cohort studies, and 2 were retrospective cohort studies. The pooled survival and healing rates were 97.3% and 93.0%, respectively. The pooled rates of root lengthening, root thickening, and apical closure were 77.3%, 90.6%, and 79.1%, respectively. However, if 20% radiographic changes were used as a cutoff point, there were only 16.1% root lengthening and 39.8% root thickening.

    CONCLUSIONS: Within the limitations of the present study, it can be concluded that RET yielded high survival and healing rates with a good root development rate. However, clinical meaningful root development after RET was unpredictable.

  8. Ahmad P, Elgamal HAM
    J Endod, 2020 Aug;46(8):1042-1051.
    PMID: 32417289 DOI: 10.1016/j.joen.2020.04.014
    INTRODUCTION: Bibliometric analysis is the quantitative measure of the impact of a scientific article in its respective field of research. The aim of this study was to identify and analyze the main features of the top 50 most cited articles published in the Journal of Endodontics since its inception as well as the top 50 most downloaded articles in 2017 and 2018 in order to evaluate the changing trends and other bibliometric parameters of the contemporary literature compared with the classic literature.

    METHODS: An electronic search was conducted on the Clarivate Analytics Web of Science "All Databases" to identify and analyze the top 50 most frequently cited scientific articles. After ranking the articles in a descending order based on their citation counts, each article was then crossmatched with the citation counts in Scopus, Google Scholar, and PubMed.

    RESULTS: The citation counts of the 50 selected most cited articles ranged between 218 and 731 (Clarivate Analytics Web of Science). The years in which most top 50 articles were published were 2004 and 2008 (n = 5). Among 131 authors, the greatest contribution was made by M. Torabinejad (n = 14). Most of the articles originated from the United States (n = 38) with the greatest contributions from the School of Dentistry, Loma Linda University, Loma Linda, CA (n = 15). Basic research-technology was the most frequent study design (n = 18). A negative, significant correlation occurred between citation density and publication age (correlation coefficient = -0.708, P < .01).

    CONCLUSIONS: Several interesting differences were found between the main characteristics of the most cited articles and the most downloaded articles.

  9. Teh LA, Abdullah D, Liew AKC, Soo E
    J Endod, 2020 Jun;46(6):748-755.
    PMID: 32279884 DOI: 10.1016/j.joen.2020.02.007
    INTRODUCTION: The pulpal involvement, ulceration, fistula, and abscess (PUFA) index was developed to screen for the clinical consequences of untreated dental caries. The aim of this study was to compare the diagnostic accuracy of the PUFA index and the periapical index (PAI) in identifying pulpal and periapical diseases.

    METHODS: A cross-sectional study was conducted using consecutive sampling. Each participant went through screening using the PUFA index, orthopantomography assessment using PAI, and comprehensive clinical examination to derive pulpal and apical diagnoses. The outcomes were dichotomized. Reliability was estimated using the Cohen kappa coefficient. Sensitivity, specificity, and predictive values were calculated. The area under the receiver operating characteristic curve was compared using the chi-square test.

    RESULTS: A total of 165 participants were examined, 98.2% of whom had a decayed, missing, or filled tooth index >0. Of 4115 teeth assessed, 16.2% (n = 666) were diagnosed with pulpal disease and 7.9% (n = 325) with periapical disease. Interexaminer reliability for the PUFA index and PAI was 0.87 and 0.80, respectively. Intraexaminer reliability was 0.83 and 0.76 for the PUFA index and 0.75 and 0.72 for PAI. For pulpal diagnosis, the sensitivity of the PUFA index and PAI was 67.6% and 41.7%, respectively; the specificity of the PUFA index and PAI was 99.8% and 99.2%, respectively. For apical diagnosis, the sensitivity of the PUFA index and PAI was 87.7% and 75.4%, respectively; the specificity of the PUFA index and PAI was 95.4% and 98.4%, respectively. The PUFA index is statistically more accurate than PAI for pulpal diagnosis and apical diagnosis (P < .05).

    CONCLUSIONS: The PUFA index can be used in screening for pulpal and periapical diseases with some limitations.

  10. Plotino G, Nagendrababu V, Bukiet F, Grande NM, Veettil SK, De-Deus G, et al.
    J Endod, 2020 Jun;46(6):707-729.
    PMID: 32334856 DOI: 10.1016/j.joen.2020.01.023
    INTRODUCTION: Negotiation, glide path, and preflaring are essential steps in root canal shaping procedures. This report aimed to discuss the terminology, basic concepts, and clinical considerations of negotiation, glide path, and preflaring procedures and the influence of these steps on root canal shaping.

    METHODS: This systematic review was undertaken following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol has been registered with the International Prospective Register of Systematic Reviews (number CRD42019127021). A comprehensive literature search was performed by 2 independent reviewers using a selected search strategy in 2 electronic databases (PubMed and Scopus) until January 28, 2019. A further search was performed manually in endodontic journals. Studies investigating or comparing at least 1 shaping property resulting from root canal instrumentation with a glide path or preflaring in human extracted teeth or clinical studies were included.

    RESULTS: The literature shows that the definition of glide path and preflaring procedures remains controversial, which requires an elaboration in the American Association of Endodontists' Glossary of Endodontic Terms. After the removal of irrelevant and duplicated articles, 98 articles were included. The impact of glide path preparation and preflaring on working length determination, apical file size determination, canal transportation, separation of endodontic files, shaping time, dentinal microcrack formation, and extrusion of debris was discussed. Because of heterogeneity among the included studies, quantitative synthesis was not performed for most of the parameters.

    CONCLUSIONS: An evidence-based guideline is needed to define and correlate the basic concepts and current applications of each step of contemporary advancements in root canal instruments. Glide path preparation reduces the risk of debris extrusion, has no influence on the incidence of dentinal crack formation, and improves the preservation of the original canal anatomy. The creation of a glide path may have no impact on Reciproc files (VDW, Munich, Germany) in reaching the full working length. Preflaring increases the accuracy of working length determination. Further randomized clinical trials are required to evaluate the effect of a glide path and preflaring on root canal treatment outcomes.

  11. Nagendrababu V, Aly Ahmed HM, Pulikkotil SJ, Veettil SK, Dharmarajan L, Setzer FC
    J Endod, 2019 Oct;45(10):1175-1183.e3.
    PMID: 31551112 DOI: 10.1016/j.joen.2019.06.008
    INTRODUCTION: This systematic review compared the anesthetic efficacy between Gow-Gates (GG), Vazirani-Akinosi (VA), and mental incisive (MI) nerve blocks (NBs) with inferior alveolar nerve blocks (IANBs) in mandibular teeth with irreversible pulpitis using meta-analysis and trial sequential analysis (TSA).

    METHODS: Studies were identified from 4 electronic databases up to June 2019. Randomized clinical trials (RCTs) comparing the anesthetic success rate of GG, VA, and MI NBs with IANBs in mandibular premolars and molars with irreversible pulpitis were included. The quality of selected RCTs was appraised using the revised Cochrane risk of bias tool. Random-effects meta-analyses of risk ratio (RR) and 95% confidence intervals (CIs) were calculated, and random errors were evaluated by TSA. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach.

    RESULTS: Five RCTs were included; 2 of them were classified as low risk of bias. No significant difference was observed in the anesthesia success rate compared between GG and IA NBs (RR = 1.10; 95% CI, 0.82-1.48; I2 = 0%). Similarly, no difference was evident between MINB and IANB (RR = 1.15; 95% CI, 0.97-1.36; I2 = 0%). Overall, the cumulative success rates for the 3 anesthetic techniques were low. TSA showed a lack of firm evidence for the results of the meta-analysis between GG NB and IANB. The Grading of Recommendations, Assessment, Development and Evaluation approach evaluation showed that the evidence was of moderate quality for GG NB and IANB compared with low quality for MI and IA NBs. Because only 1 study was available comparing VA NB and IANB, a meta-analysis was not performed. The adverse effect associated with MI NB was swelling, whereas it was prolonged numbness for IANB.

    CONCLUSIONS: GG NB and IANB showed similar anesthetic efficacy compared with IANB in mandibular teeth with irreversible pulpitis. However, the success rates for each technique indicate the need for supplemental anesthesia. Further well-designed RCTs evaluating different anesthetic techniques with and without supplemental injection are required to provide stronger evidence.

  12. Arslan H, Ahmed HMA, Şahin Y, Doğanay Yıldız E, Gündoğdu EC, Güven Y, et al.
    J Endod, 2019 Jul;45(7):863-872.
    PMID: 31155298 DOI: 10.1016/j.joen.2019.04.005
    INTRODUCTION: This preliminary study compared clinical and radiographic outcomes of regenerative endodontic procedures (REPs) with that of conventional root canal treatment (CRCT) in necrotic mature teeth with periapical radiolucencies.

    METHODS: Fifty-six mature necrotic teeth with large periapical radiolucencies were distributed into 2 groups: group 1, REPs and group 2, CRCT (n = 28/group). Clinical and radiographic follow-up assessments were undertaken up to 12 months. Statistical analysis was performed using the independent samples t test and the chi-square test, and the level of significance was set at P = .05.

    RESULTS: With a follow-up rate of about 73.4% of the total patients for 12 months, favorable clinical and radiographic outcomes were found in 92.3% and 80% in REPs and CRCT groups, respectively, and the difference was not statistically significant (P > .05). Half of the teeth treated with REPs responded to the electric pulp test.

    CONCLUSIONS: Regenerative endodontic procedures have the potential to be used as a treatment option for mature teeth with large periapical radiolucencies.

  13. Nagendrababu V, Pulikkotil SJ, Jinatongthai P, Veettil SK, Teerawattanapong N, Gutmann JL
    J Endod, 2019 Apr;45(4):364-371.
    PMID: 30737050 DOI: 10.1016/j.joen.2018.10.016
    INTRODUCTION: This review aimed to find the most effective oral premedication in reducing pain in adults after nonsurgical root canal therapy (NSRCT) using network meta-analysis.

    METHODS: The review protocol was registered in the PROSPERO database (CRD42017071899). A literature search was performed in the MEDLINE and EBSCOhost databases until June 2017 with no language restriction. Randomized controlled trials evaluating the efficacy of oral premedications, whether given alone or in combination, compared with other agents, placebo, or no treatment in adult patients before NSRCT for postoperative pain were included. Nonintervention studies, nonendodontic studies, animal studies, and reviews were excluded. The quality of the studies was assessed using the revised Cochrane risk of bias tool. Pair-wise meta-analysis, network meta-analysis, and quality of evidence assessment using the Grading of Recommendations Assessment, Development and Evaluation criteria was performed.

    RESULTS: Eleven studies comparing pharmacologic groups of medications were included in the primary analysis. Compared with placebo, corticosteroids (prednisolone 30-40 mg) was ranked best for reducing postoperative pain (median difference [MD] = -18.14 [95% confidence interval (CI), -32.90 to -3.37] for the pain score at 6 hours; MD = -22.17 [95% CI, -36.03 to -8.32] for the pain score at 12 hours; and MD = -21.50 [95% CI, -37.95 to -5.06] for the pain score at 24 hours). However, the evidence was very low (6 and 24 hours) to moderate quality (12 hours). Nonsteroidal anti-inflammatory drugs were ranked least among the medications, and the quality of this evidence was very low. Additional analysis based on the chemical name showed that sulindac, ketorolac, and ibuprofen significantly reduced pain at 6 hours, whereas piroxicam and prednisolone significantly reduced the pain at 12 and 24 hours. Etodolac was found to be least effective in reducing pain. Overall, the evidence was of moderate to very low quality.

    CONCLUSIONS: Based on the limited and low-quality evidence, oral premedication with piroxicam or prednisolone could be recommended for controlling postoperative pain after NSRCT. However, more trials are warranted to confirm the results with a higher quality of evidence.

  14. Decurcio DA, Rossi-Fedele G, Estrela C, Pulikkotil SJ, Nagendrababu V
    J Endod, 2019 Apr;45(4):387-393.e2.
    PMID: 30833095 DOI: 10.1016/j.joen.2019.01.013
    INTRODUCTION: This systematic review and meta-analysis aimed to assess whether machine-assisted agitation resulted in less postoperative pain (PP) compared with syringe irrigation with needle alone in adult patients undergoing root canal treatment.

    METHODS: A literature search was performed in 3 electronic databases for articles published before August 2018. Randomized clinical trials published in English that compared PP between machine-assisted agitation and syringe irrigation with needles as part of nonsurgical root canal treatment were included. Two authors were independently involved in the article selection process, data extraction, and assessment of the quality of included studies using the revised Cochrane risk of bias tool. The pooled effect estimates of the standardized mean difference (SMD) between machine-assisted agitation and syringe irrigation with needle was calculated by a random effects-modeled meta-analysis. A subgroup meta-analysis was performed. The quality of evidence was evaluated by the Grading of Recommendations, Assessment, Development and Evaluations approach.

    RESULTS: Six studies were included for systematic review. Meta-analysis was performed using 3 studies and showed that machine-assisted agitation resulted in less PP compared with syringe irrigation with needle at 24 hours (SMD = -0.73; 95% confidence interval, -1.04 to -0.42; I2 = 30.6%) and 48 hours (SMD = -0.60; 95% CI, -0.85 to -0.35; I2 = 0%). The quality of evidence by Grading of Recommendations, Assessment, Development and Evaluations for the PP outcomes (24 hours and 48 hours) was graded as "moderate" quality.

    CONCLUSIONS: Machine-assisted agitation reduced PP compared with syringe irrigation with needles in nonsurgical root canal treatment. Future clinical trials are needed to support the result of this review.

  15. Nagendrababu V, Pulikkotil SJ, Sultan OS, Jayaraman J, Peters OA
    J Endod, 2018 Jun;44(6):903-913.
    PMID: 29602531 DOI: 10.1016/j.joen.2018.02.013
    INTRODUCTION: The aim of this systematic review (SR) was to evaluate the quality of SRs and meta-analyses (MAs) in endodontics.

    METHODS: A comprehensive literature search was conducted to identify relevant articles in the electronic databases from January 2000 to June 2017. Two reviewers independently assessed the articles for eligibility and data extraction. SRs and MAs on interventional studies with a minimum of 2 therapeutic strategies in endodontics were included in this SR. Methodologic and reporting quality were assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA), respectively. The interobserver reliability was calculated using the Cohen kappa statistic. Statistical analysis with the level of significance at P 

  16. Nagendrababu V, Pulikkotil SJ, Veettil SK, Teerawattanapong N, Setzer FC
    J Endod, 2018 Jun;44(6):914-922.e2.
    PMID: 29709297 DOI: 10.1016/j.joen.2018.02.017
    INTRODUCTION: Successful anesthesia with an inferior alveolar nerve block (IANB) is imperative for treating patients with irreversible pulpitis in mandibular teeth. This systematic review assessed the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) as oral premedications on the success of IANBs in irreversible pulpitis.

    METHODS: Three databases were searched to identify randomized clinical trials (RCTs) published up until September 2017. Retrieved RCTs were evaluated using the revised Cochrane Risk of Bias Tool. The primary efficacy outcome of interest was the success rate of IANB anesthesia. Meta-analytic estimates (risk ratio [RR] with 95% confidence intervals [CIs]) performed using a random effects model and publication bias determined using funnel plot analysis were assessed. Random errors were evaluated with trial sequential analyses, and the quality of evidence was appraised using a Grading of Recommendations, Assessment, Development and Evaluation approach.

    RESULTS: Thirteen RCTs (N = 1034) were included. Eight studies had low risk of bias. Statistical analysis of good-quality RCTs showed a significant beneficial effect of any NSAID in increasing the anesthetic success of IANBs compared with placebo (RR = 1.92; 95% CI, 1.55-2.38). Subgroup analyses showed a similar beneficial effect for ibuprofen, diclofenac, and ketorolac (RR = 1.83 [95% CI, 1.43-2.35], RR = 2.56 [95% CI, 1.46-4.50], and RR = 2.07 [95% CI, 1.47-2.90], respectively). Dose-dependent ibuprofen >400 mg/d (RR = 1.85; 95% CI, 1.39-2.45) was shown to be effective; however, ibuprofen ≤400 mg/d showed no association (RR = 1.78; 95% CI, 0.90-3.55). TSA confirmed conclusive evidence for a beneficial effect of NSAIDs for IANB premedication. The Grading of Recommendations, Assessment, Development and Evaluation approach did not reveal any concerns regarding the quality of the results.

    CONCLUSIONS: Oral premedication with NSAIDs and ibuprofen (>400 mg/d) increased the anesthetic success of IANBs in patients with irreversible pulpitis.

  17. Arslan H, Doğanay E, Karataş E, Ünlü MA, Ahmed HMA
    J Endod, 2017 Nov;43(11):1765-1769.
    PMID: 28967495 DOI: 10.1016/j.joen.2017.06.028
    INTRODUCTION: Low-level laser therapy (LLLT) is a practical, nonpharmacologic technique for reducing pain. This study evaluated the effect of LLLT on postoperative pain after root canal retreatment (RCR).

    METHODS: This study enrolled patients (N = 36) who required root canal retreatment (RCR) on mandibular molar teeth, presented with periapical lesions with periapical index scores of 2 or 3, and had a pain visual analog scale (VAS) <50 and a percussion pain VAS <50. The participants were divided into 2 groups: (1) patients scheduled for RCR followed by LLLT (n = 18) and (2) patients scheduled for RCR followed by a mock LLLT (placebo) (n = 18). Postoperative pain was assessed using the VAS. Data were collected and statistically analyzed with the chi-square test, the independent sample t test, and the Mann-Whitney U test (P = .05).

    RESULTS: On the first 4 days, postoperative pain significantly reduced in the LLLT group compared with the placebo group (P  .05). The number of patients who needed analgesics was lower in the LLLT group than in the placebo group (P 

  18. Nocca G, Ahmed HMA, Martorana GE, Callà C, Gambarini G, Rengo S, et al.
    J Endod, 2017 Sep;43(9):1545-1552.
    PMID: 28734651 DOI: 10.1016/j.joen.2017.04.025
    INTRODUCTION: The literature reveals controversies regarding the formation of para-chloroaniline (PCA) when chlorhexidine (CHX) is mixed with sodium hypochlorite (NaOCl). This study aimed to investigate the stability of PCA in the presence of NaOCl and to examine the in vitro cytotoxic effects of CHX/NaOCl reaction mixtures.

    METHODS: Different volumes of NaOCl were added to CHX (mix 1) or PCA (mix 2). Upon centrifugation, the supernatant and precipitate fractions collected from samples were analyzed using high-performance liquid chromatography. The cytotoxic effects of both fractions were examined on human periodontal ligament and 3T3 fibroblast cell lines.

    RESULTS: High-performance liquid chromatographic analysis showed no PCA signal when NaOCl was mixed with CHX (mix 1). In mix 2, the intensity of PCA was decreased when NaOCl was added to PCA, and chromatographic signals, similar to that of CHX/NaOCl, were also observed. The mortality of precipitates exerted on both cell lines was lower compared with that of supernatants.

    CONCLUSIONS: The discrepancy in the data from the literature could be caused by the instability of the PCA in the presence of NaOCl. The CHX/NaOCl reaction mixture exhibits a wide range of cytotoxic effects.

  19. Rossi-Fedele G, Ahmed HM
    J Endod, 2017 Apr;43(4):520-526.
    PMID: 28214018 DOI: 10.1016/j.joen.2016.12.008
    INTRODUCTION: The removal of obturation materials from the root canal system is a primary objective in root canal retreatment procedures. This systematic review aims to discuss the effectiveness of different instrumentation procedures in removing root-canal filling materials assessed by micro-computed tomography.

    METHODS: An electronic search in PubMed and major endodontic journals was conducted using appropriate key words to identify investigations that examined the effectiveness of obturation material removal assessed by micro-computed tomography.

    RESULTS: Among 345 studies, 22 satisfied the inclusion criteria. Seven studies compared hand instrumentation with Nickel-Titanium rotary or reciprocating systems. Three studies investigated rotary systems, and another three studies explored reciprocation. Eight studies compared rotary systems and reciprocation in removing filling materials from the root canal system. Other factors, such as the role of solvents and irrigant agitation, were discussed.

    CONCLUSIONS: The application of different instrumentation protocols can effectively, but not completely, remove the filling materials from the root canal system. Only hand instrumentation was not associated with iatrogenic errors. Reciprocating and rotary systems exhibited similar abilities in removing root filling material. Retreatment files performed similarly to conventional ones. Solvents enhanced penetration of files but hindered cleaning of the root canal. The role of irrigant agitation was determined as controversial.

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