Pub Date : 2024-08-20DOI: 10.1038/s41432-024-01054-y
Mohammed Bux, Mohammed Adam
Determining the health the status of the pulp is crucial in treatment planning. Both sensibility and vitality testing techniques may be employed. Sensibility testing may be inaccurate in teeth with incomplete root apices. This study intends to compare the accuracy of cold testing (CT), electric pulp testing (EPT) and pulse oximetry (PO) in determining pulpal status of mature and immature anterior teeth. 20 mature and 20 immature maxillary permanent incisors of healthy 6–12-year-olds were included. Teeth were categorised as mature permanent central incisors, immature permanent central incisors, and a negative control group with endodontically treated incisors. Vitality and sensitivity tests were performed using EPT, CT, and PO, with measurements taken thrice per tooth. PO was measured with infant pulse oximetry probe sensors placed on the tooth surfaces and fingers. Descriptive statistics were computed, and data distribution was assessed using the Shapiro-Wilk test. The Spearman correlation coefficient analysed correlations between dental and finger SpO2 measurements, while the Kruskal-Wallis test with Dunn post-hoc analysis compared SpO2 and EPT measurements across tooth development stages, with a significance threshold set at p < 0.05. SpO2 values were significantly higher in immature teeth compared to mature teeth (p < 0.05), and both were significantly higher than in the negative control group. There was no significant correlation between SpO2 values measured from fingers and teeth. EPT values were significantly higher in immature teeth compared to mature teeth (p < 0.001). The accuracy rate of PO, EPT, and cold tests was 100% in this study, with no false positive or negative responses in the control group. The SpO2 values in mature and immature vital teeth ranged between 80–92%. PO is a reliable and non-invasive method for determining pulp vitality in both mature and immature teeth, comparable to traditional sensitivity tests like EPT and CT. PO can be considered an alternative vitality test, especially useful in paediatric dental patients due to its atraumatic and objective nature. Further studies with larger sample sizes and additional vitality tests like doppler flowmetry are recommended to enhance the clinical diagnosis of pulp vitality in anterior and posterior teeth.
简介确定牙髓的健康状况对于制定治疗计划至关重要。感度和活力测试技术均可使用。对于根尖不完整的牙齿，感度测试可能不准确。本研究旨在比较冷测试（CT）、电动牙髓测试（EPT）和脉搏血氧仪（PO）在确定成熟和不成熟前牙牙髓状态方面的准确性。牙齿分为成熟恒中切牙、未成熟恒中切牙和阴性对照组，阴性对照组的切牙经过牙髓治疗。使用 EPT、CT 和 PO 进行活力和敏感性测试，每颗牙齿测量三次。PO是通过放置在牙齿表面和手指上的婴儿脉搏氧饱和度探头传感器进行测量的。计算描述性统计，并使用 Shapiro-Wilk 检验法评估数据分布。Spearman 相关系数分析了牙齿和手指 SpO2 测量值之间的相关性，而 Kruskal-Wallis 检验和 Dunn 事后分析则比较了不同牙齿发育阶段的 SpO2 和 EPT 测量值，显著性阈值设定为 p 结果：未成熟牙齿的 SpO2 值明显高于成熟牙齿（p 2）。与成熟牙齿相比，未成熟牙齿的 EPT 值明显更高（成熟和未成熟重要牙齿的 p 2 值介于 80-92% 之间）：牙髓活力测试是一种可靠、非侵入性的方法，可用于确定成熟牙和未成熟牙的牙髓活力，与传统的灵敏度测试（如 EPT 和 CT）不相上下。牙髓活力测试由于其无创伤和客观性，可被视为牙髓活力测试的替代方法，尤其适用于儿童牙科患者。建议进一步研究更大的样本量和更多的活力测试，如多普勒血流测量法，以加强对前、后牙牙髓活力的临床诊断。
{"title":"Accuracy of vitality and sensibility testing in mature and immature anterior teeth: a clinical trial","authors":"Mohammed Bux, Mohammed Adam","doi":"10.1038/s41432-024-01054-y","DOIUrl":"10.1038/s41432-024-01054-y","url":null,"abstract":"Determining the health the status of the pulp is crucial in treatment planning. Both sensibility and vitality testing techniques may be employed. Sensibility testing may be inaccurate in teeth with incomplete root apices. This study intends to compare the accuracy of cold testing (CT), electric pulp testing (EPT) and pulse oximetry (PO) in determining pulpal status of mature and immature anterior teeth. 20 mature and 20 immature maxillary permanent incisors of healthy 6–12-year-olds were included. Teeth were categorised as mature permanent central incisors, immature permanent central incisors, and a negative control group with endodontically treated incisors. Vitality and sensitivity tests were performed using EPT, CT, and PO, with measurements taken thrice per tooth. PO was measured with infant pulse oximetry probe sensors placed on the tooth surfaces and fingers. Descriptive statistics were computed, and data distribution was assessed using the Shapiro-Wilk test. The Spearman correlation coefficient analysed correlations between dental and finger SpO2 measurements, while the Kruskal-Wallis test with Dunn post-hoc analysis compared SpO2 and EPT measurements across tooth development stages, with a significance threshold set at p < 0.05. SpO2 values were significantly higher in immature teeth compared to mature teeth (p < 0.05), and both were significantly higher than in the negative control group. There was no significant correlation between SpO2 values measured from fingers and teeth. EPT values were significantly higher in immature teeth compared to mature teeth (p < 0.001). The accuracy rate of PO, EPT, and cold tests was 100% in this study, with no false positive or negative responses in the control group. The SpO2 values in mature and immature vital teeth ranged between 80–92%. PO is a reliable and non-invasive method for determining pulp vitality in both mature and immature teeth, comparable to traditional sensitivity tests like EPT and CT. PO can be considered an alternative vitality test, especially useful in paediatric dental patients due to its atraumatic and objective nature. Further studies with larger sample sizes and additional vitality tests like doppler flowmetry are recommended to enhance the clinical diagnosis of pulp vitality in anterior and posterior teeth.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 3","pages":"158-159"},"PeriodicalIF":0.0,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-19DOI: 10.1038/s41432-024-01050-2
Kelvin I. Afrashtehfar, Nasser M. Assery, Khaled A. K. Alblooshi, Patrick R. Schmidlin
A systematic appraisal without statistical aggregation. The researchers utilized Ovid (Medline), Embase, Web of Science, and CINAHL databases. They performed a comprehensive literature search, which concluded in July 2023. References of selected studies and systematic reviews were examined for additional relevant articles. The review included studies (randomized controlled trials [RCTs], systematic reviews [SRs], narrative reviews, retrospective studies, cross-sectional studies, case series, case reports) discussing the cost-effectiveness of preserving teeth versus replacing them with implants in patients with severe periodontal disease. Non-English publications, letters, conference abstracts, and brief reports were excluded. Two reviewers independently screened titles and abstracts using a systematic review screening tool, resolving conflicts with a third reviewer. The extracted data included study design, patient demographics, treatment details, economic models, costs, and clinical implications. Quality was assessed using Joanna Briggs Institute (JBI) critical appraisal tools, with scores converted to percentages. A total of 633 studies were identified for periodontal treatment, with 9 included after screening, while 114 studies were identified for dental implants, of which 3 were included after screening. The included studies were published between 2008 and 2018, predominantly from Germany, and mainly comprised retrospective designs, along with some prospective and model-based analyses. Follow-up periods ranged from 36 months to 33 years. Treatment costs were found to increase with disease severity, with surgical treatments being more expensive than nonsurgical ones, and supportive periodontal treatment (SPT) representing the highest cost share in periodontal treatment. Maintaining implants proved more costly than maintaining teeth, especially in cases of peri-implantitis. For chronic periodontitis, total treatment costs per tooth were €222 ± €98 over 18.7 years, and for aggressive periodontitis, €267 ± €148 over 16.9 years. Regular SPT cost €806 per tooth per year over 28.7 years, with significant cost variations across studies. A 2013 study found that maintaining implants was five times costlier than maintaining teeth, particularly if peri-implantitis developed. A 2018 study indicated that implant-supported crowns (ISCs) were the most expensive therapy. Only one study directly compared costs within the same patient, finding periodontal treatment to be more cost-effective than implants. Costs also increased with irregular SPT, aggressive periodontitis, and specialist treatments compared to regular SPT, chronic periodontitis, and treatments by general dental practitioners. The quality of included studies scored between 45% and 84.6%, indicating moderate to high quality, with methodological issues including unclear strategies for handling confounding factors and incomplete follow-up. Implants are effective for repl
{"title":"Maintaining periodontally compromised teeth seems more cost-effective than replacing them with dental implants","authors":"Kelvin I. Afrashtehfar, Nasser M. Assery, Khaled A. K. Alblooshi, Patrick R. Schmidlin","doi":"10.1038/s41432-024-01050-2","DOIUrl":"10.1038/s41432-024-01050-2","url":null,"abstract":"A systematic appraisal without statistical aggregation. The researchers utilized Ovid (Medline), Embase, Web of Science, and CINAHL databases. They performed a comprehensive literature search, which concluded in July 2023. References of selected studies and systematic reviews were examined for additional relevant articles. The review included studies (randomized controlled trials [RCTs], systematic reviews [SRs], narrative reviews, retrospective studies, cross-sectional studies, case series, case reports) discussing the cost-effectiveness of preserving teeth versus replacing them with implants in patients with severe periodontal disease. Non-English publications, letters, conference abstracts, and brief reports were excluded. Two reviewers independently screened titles and abstracts using a systematic review screening tool, resolving conflicts with a third reviewer. The extracted data included study design, patient demographics, treatment details, economic models, costs, and clinical implications. Quality was assessed using Joanna Briggs Institute (JBI) critical appraisal tools, with scores converted to percentages. A total of 633 studies were identified for periodontal treatment, with 9 included after screening, while 114 studies were identified for dental implants, of which 3 were included after screening. The included studies were published between 2008 and 2018, predominantly from Germany, and mainly comprised retrospective designs, along with some prospective and model-based analyses. Follow-up periods ranged from 36 months to 33 years. Treatment costs were found to increase with disease severity, with surgical treatments being more expensive than nonsurgical ones, and supportive periodontal treatment (SPT) representing the highest cost share in periodontal treatment. Maintaining implants proved more costly than maintaining teeth, especially in cases of peri-implantitis. For chronic periodontitis, total treatment costs per tooth were €222 ± €98 over 18.7 years, and for aggressive periodontitis, €267 ± €148 over 16.9 years. Regular SPT cost €806 per tooth per year over 28.7 years, with significant cost variations across studies. A 2013 study found that maintaining implants was five times costlier than maintaining teeth, particularly if peri-implantitis developed. A 2018 study indicated that implant-supported crowns (ISCs) were the most expensive therapy. Only one study directly compared costs within the same patient, finding periodontal treatment to be more cost-effective than implants. Costs also increased with irregular SPT, aggressive periodontitis, and specialist treatments compared to regular SPT, chronic periodontitis, and treatments by general dental practitioners. The quality of included studies scored between 45% and 84.6%, indicating moderate to high quality, with methodological issues including unclear strategies for handling confounding factors and incomplete follow-up. Implants are effective for repl","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 3","pages":"129-130"},"PeriodicalIF":0.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41432-024-01050-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-17DOI: 10.1038/s41432-024-01052-0
Kelvin I. Afrashtehfar, Jad Moriss Kazma, Islam Yahia, Aesa A. Jaber
This retrospective cohort study aimed to investigate the risk and variables of tooth loss for teeth adjacent to dental implants compared to teeth nonadjacent to implants. The study followed the STROBE guidelines and was approved by the Institutional Review Board. The study included patients treated with dental implants at UCSF School of Dentistry between 2000 and 2020. The inclusion criteria for teeth adjacent to implants required the implant to support a fixed prosthesis and a follow-up period of at least 12 months. Nonadjacent teeth also required a follow-up period of at least 12 months. Teeth were excluded if they had a hopeless prognosis or were planned for extraction before the completion of restorative treatment. Data were extracted from electronic health records, including patient demographics, dental histories, and outcomes for teeth adjacent and nonadjacent to implants. Statistical analyses, including Kaplan-Meier survival plots, log-rank tests, and multivariate logistic regression, were used to compare tooth survival and identify aetiologies of tooth loss. The study included 787 patients, with 2048 teeth adjacent and 15,637 teeth nonadjacent to implants. The 10-year cumulative survival rate was 89.2% for teeth adjacent to implants and 99.3% for nonadjacent teeth. Teeth adjacent to implants had a significantly higher risk of tooth loss (Odds Ratio [OR] 13.15). The primary etiology of tooth loss adjacent to implants was root fracture (45.2%), followed by caries (28.9%), periodontitis (24.1%), and endodontic failure (1.8%). For nonadjacent teeth, periodontitis was the leading cause of tooth loss (51.9%). The study found that teeth adjacent to dental implants had a significantly higher risk of tooth loss, primarily due to root fractures. The findings suggest that dental implants may act as an iatrogenic factor, increasing the risk of complications for adjacent teeth. Conservative management of natural dentition should be prioritized, with emphasis on stringent periodontal surveillance and effective home care. Future research should focus on prospective studies to further explore these associations and improve clinical outcomes.
{"title":"Dental implants significantly increase adjacent tooth loss risk due to root fracture","authors":"Kelvin I. Afrashtehfar, Jad Moriss Kazma, Islam Yahia, Aesa A. Jaber","doi":"10.1038/s41432-024-01052-0","DOIUrl":"10.1038/s41432-024-01052-0","url":null,"abstract":"This retrospective cohort study aimed to investigate the risk and variables of tooth loss for teeth adjacent to dental implants compared to teeth nonadjacent to implants. The study followed the STROBE guidelines and was approved by the Institutional Review Board. The study included patients treated with dental implants at UCSF School of Dentistry between 2000 and 2020. The inclusion criteria for teeth adjacent to implants required the implant to support a fixed prosthesis and a follow-up period of at least 12 months. Nonadjacent teeth also required a follow-up period of at least 12 months. Teeth were excluded if they had a hopeless prognosis or were planned for extraction before the completion of restorative treatment. Data were extracted from electronic health records, including patient demographics, dental histories, and outcomes for teeth adjacent and nonadjacent to implants. Statistical analyses, including Kaplan-Meier survival plots, log-rank tests, and multivariate logistic regression, were used to compare tooth survival and identify aetiologies of tooth loss. The study included 787 patients, with 2048 teeth adjacent and 15,637 teeth nonadjacent to implants. The 10-year cumulative survival rate was 89.2% for teeth adjacent to implants and 99.3% for nonadjacent teeth. Teeth adjacent to implants had a significantly higher risk of tooth loss (Odds Ratio [OR] 13.15). The primary etiology of tooth loss adjacent to implants was root fracture (45.2%), followed by caries (28.9%), periodontitis (24.1%), and endodontic failure (1.8%). For nonadjacent teeth, periodontitis was the leading cause of tooth loss (51.9%). The study found that teeth adjacent to dental implants had a significantly higher risk of tooth loss, primarily due to root fractures. The findings suggest that dental implants may act as an iatrogenic factor, increasing the risk of complications for adjacent teeth. Conservative management of natural dentition should be prioritized, with emphasis on stringent periodontal surveillance and effective home care. Future research should focus on prospective studies to further explore these associations and improve clinical outcomes.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 3","pages":"123-124"},"PeriodicalIF":0.0,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41432-024-01052-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-17DOI: 10.1038/s41432-024-01048-w
Amy Carroll
This community-based trial aimed to explore a change in levels of parental understanding of factors that could contribute to early childhood caries (ECC) following educational visits with community health workers (CHWs). This intervention was aided through the utilisation of a behavioural education programme; the named example within this study is MySmileBuddy. Children met with their parents and CHWs over the period of a year, to discuss goals that would aim to increase parent education about caries, to establish good habits and behaviours that could contribute to a reduction in the child’s future caries risk. They met at least 3 times during the year in person, and subsequent follow up was completed via a multitude of communication methods e.g. telephone call. At each visit, an electronic survey was completed evaluating agreement or disagreement with statements about factors that could contribute to caries development. This study was carried out in New York City over a period of twelve months for each child. 1207 children from 977 families, with clinically diagnosed ECC, were recruited. Inclusion criteria included children that had at least one filled or decayed primary tooth surface and were aged between 2 years to 6 years. Exclusion criteria included children that may have conditions that would have prevented the provision of oral hygiene habits or moderation of diet, for example children with severe autism. Families were recruited from local specialist residency programmes within the city or by direct referral from local CHWs. Evaluation of the parental education was established through use of electronic surveys at baseline level and follow up following CHWs’ intervention. The data was collected between 2015 and 2017 and required follow up appointments that were completed via telephone and other remote methods. Data collection separated caries risk factors into six domains with 26 factions across the pre- and post-intervention period. These addressed both parental knowledge of the aetiology of caries and factors that can contribute to this. Domains included titles such as saliva factors, hygiene, diet, severity/susceptibility, and outcome expectations. Parents were asked to note their agreement with the statements using a four-point scale (Strongly Agree, Agree, Disagree and Strongly Disagree). The survey was made up of statements including themes of caries risk factors, and behavioural science that can contribute to caries development. Examples include ‘drinking juice can cause tooth decay’ and ‘all kids get tooth decay’. Correct answers would be given as part of the targeted advice and education given by the CHWs at subsequent visits. Data was collected from a total of 669 parents of 977 taking part in the study. Analysis focussed on the trend of changing knowledge of parents from baseline to follow up. The analysis also assessed features of the participants including the parents’ first language, education level, country of birth, average
{"title":"Changing smiles and minds—a community-based trial on parental knowledge impact on early childhood caries","authors":"Amy Carroll","doi":"10.1038/s41432-024-01048-w","DOIUrl":"10.1038/s41432-024-01048-w","url":null,"abstract":"This community-based trial aimed to explore a change in levels of parental understanding of factors that could contribute to early childhood caries (ECC) following educational visits with community health workers (CHWs). This intervention was aided through the utilisation of a behavioural education programme; the named example within this study is MySmileBuddy. Children met with their parents and CHWs over the period of a year, to discuss goals that would aim to increase parent education about caries, to establish good habits and behaviours that could contribute to a reduction in the child’s future caries risk. They met at least 3 times during the year in person, and subsequent follow up was completed via a multitude of communication methods e.g. telephone call. At each visit, an electronic survey was completed evaluating agreement or disagreement with statements about factors that could contribute to caries development. This study was carried out in New York City over a period of twelve months for each child. 1207 children from 977 families, with clinically diagnosed ECC, were recruited. Inclusion criteria included children that had at least one filled or decayed primary tooth surface and were aged between 2 years to 6 years. Exclusion criteria included children that may have conditions that would have prevented the provision of oral hygiene habits or moderation of diet, for example children with severe autism. Families were recruited from local specialist residency programmes within the city or by direct referral from local CHWs. Evaluation of the parental education was established through use of electronic surveys at baseline level and follow up following CHWs’ intervention. The data was collected between 2015 and 2017 and required follow up appointments that were completed via telephone and other remote methods. Data collection separated caries risk factors into six domains with 26 factions across the pre- and post-intervention period. These addressed both parental knowledge of the aetiology of caries and factors that can contribute to this. Domains included titles such as saliva factors, hygiene, diet, severity/susceptibility, and outcome expectations. Parents were asked to note their agreement with the statements using a four-point scale (Strongly Agree, Agree, Disagree and Strongly Disagree). The survey was made up of statements including themes of caries risk factors, and behavioural science that can contribute to caries development. Examples include ‘drinking juice can cause tooth decay’ and ‘all kids get tooth decay’. Correct answers would be given as part of the targeted advice and education given by the CHWs at subsequent visits. Data was collected from a total of 669 parents of 977 taking part in the study. Analysis focussed on the trend of changing knowledge of parents from baseline to follow up. The analysis also assessed features of the participants including the parents’ first language, education level, country of birth, average ","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 3","pages":"141-142"},"PeriodicalIF":0.0,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: The overall pooled success rate of the Hall Technique (HT) in various types of studies has not been investigated. The present study aims to evaluate the success rate of HT to restore carious primary molars.
Methods: A systematic search was carried out in the MEDLINE/PubMed, Excerpta Medica Database (EMBASE), Scopus, Web of Science, and LIVIVO electronic databases, as well as the ProQuest database for grey literature review. A search was carried out up to September 2023 for studies meeting the eligibility criteria: Randomised Clinical Trials (RCTs) and Non-Randomised Studies of Interventions (NRSIs); children with primary molars treated using HT; and reporting success for at least 1-month post-treatment. Single-arm meta-analysis assessed the pooled proportion (95% CI) of HT success rates. Risk of bias and certainty of evidence using the GRADE approach were assessed.
Results: Searching identified 665 studies, with 25 (15 RCTs and 10 NRSIs) meeting the eligibility criteria. In meta-analyses of RCTs, the pooled proportion success rate was 98% (95% CI: 97-99%) at 12-month follow-up. For NRSIs, the pooled proportion success rate was 95% (95% CI: 91-100%) up to 89 months.
Conclusions: HT presents a high success rate, even though the primary studies had "low" to "high" risk of bias and demonstrated "moderate" to "low" certainty of evidence. One of the main reasons for downgrading was related to blinding, which was generally unfeasible due to visibly different restorative materials. The systematic review protocol was registered in PROSPERO (ID: CRD42021204415).
{"title":"Success rate of Hall Technique for restoring carious primary molars - systematic review and meta-analysis.","authors":"Tamara Kerber Tedesco, Nicola Patricia Innes, Claudia Lopez Gallegos, Gabriela Seabra Silva, Thais Gimenez, Mariana Minatel Braga, Mariana Pinheiro Araujo, Jayakumar Jayaraman, Waraf Al-Yaseen, Daniela Prócida Raggio","doi":"10.1038/s41432-024-01044-0","DOIUrl":"https://doi.org/10.1038/s41432-024-01044-0","url":null,"abstract":"<p><strong>Objectives: </strong>The overall pooled success rate of the Hall Technique (HT) in various types of studies has not been investigated. The present study aims to evaluate the success rate of HT to restore carious primary molars.</p><p><strong>Methods: </strong>A systematic search was carried out in the MEDLINE/PubMed, Excerpta Medica Database (EMBASE), Scopus, Web of Science, and LIVIVO electronic databases, as well as the ProQuest database for grey literature review. A search was carried out up to September 2023 for studies meeting the eligibility criteria: Randomised Clinical Trials (RCTs) and Non-Randomised Studies of Interventions (NRSIs); children with primary molars treated using HT; and reporting success for at least 1-month post-treatment. Single-arm meta-analysis assessed the pooled proportion (95% CI) of HT success rates. Risk of bias and certainty of evidence using the GRADE approach were assessed.</p><p><strong>Results: </strong>Searching identified 665 studies, with 25 (15 RCTs and 10 NRSIs) meeting the eligibility criteria. In meta-analyses of RCTs, the pooled proportion success rate was 98% (95% CI: 97-99%) at 12-month follow-up. For NRSIs, the pooled proportion success rate was 95% (95% CI: 91-100%) up to 89 months.</p><p><strong>Conclusions: </strong>HT presents a high success rate, even though the primary studies had \"low\" to \"high\" risk of bias and demonstrated \"moderate\" to \"low\" certainty of evidence. One of the main reasons for downgrading was related to blinding, which was generally unfeasible due to visibly different restorative materials. The systematic review protocol was registered in PROSPERO (ID: CRD42021204415).</p>","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-13DOI: 10.1038/s41432-024-01047-x
Asim Al-Ansari
Cochrane Oral Health’s Trials Register, Cochrane Pregnancy and Childbirth’s Trials Register, CENTRAL, MEDLINE, Embase, CINAHL EBSCO, the US National Institutes of Health Ongoing Trials Register, and WHO International Clinical Trials Registry Platform. Randomized controlled trials (RCTs) and cluster-RCTs assessing the effects of interventions targeted at pregnant women, new mothers or other primary caregivers for preventing early childhood caries (ECC) in infants during the first year of life. Selection of studies, data extraction and management, and assessment of risk of bias in the included studies were independently performed by two authors. Twenty-three trials met the inclusion criteria. Child diet and feeding practices advice could reduce the risk of developing dental caries in primary teeth by 15% with the evidence being of moderate certainty. All other measures showed little to no difference compared to standard care, with evidence of low to very low certainty. Generally, the evidence assessing the effects of interventions targeted at pregnant women and new mother for preventing early childhood caries (ECC) in infants during the first year of life is of low to very low certainty. More robust RCTs are needed to inform practice and policy making.
{"title":"Which interventions could prevent early childhood caries in pregnant women, new mothers, and other primary caregivers?","authors":"Asim Al-Ansari","doi":"10.1038/s41432-024-01047-x","DOIUrl":"10.1038/s41432-024-01047-x","url":null,"abstract":"Cochrane Oral Health’s Trials Register, Cochrane Pregnancy and Childbirth’s Trials Register, CENTRAL, MEDLINE, Embase, CINAHL EBSCO, the US National Institutes of Health Ongoing Trials Register, and WHO International Clinical Trials Registry Platform. Randomized controlled trials (RCTs) and cluster-RCTs assessing the effects of interventions targeted at pregnant women, new mothers or other primary caregivers for preventing early childhood caries (ECC) in infants during the first year of life. Selection of studies, data extraction and management, and assessment of risk of bias in the included studies were independently performed by two authors. Twenty-three trials met the inclusion criteria. Child diet and feeding practices advice could reduce the risk of developing dental caries in primary teeth by 15% with the evidence being of moderate certainty. All other measures showed little to no difference compared to standard care, with evidence of low to very low certainty. Generally, the evidence assessing the effects of interventions targeted at pregnant women and new mother for preventing early childhood caries (ECC) in infants during the first year of life is of low to very low certainty. More robust RCTs are needed to inform practice and policy making.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 3","pages":"138-140"},"PeriodicalIF":0.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Importance of oral health during pregnancy has been well reported. To prevent the occurrence of oral diseases and maintenance of oral health, a number of guidelines have been developed by different organizations. However, despite numerous efforts in development of these guidelines, a critical evaluation of the quality of guidelines has not been carried out. Thus, we aimed to perform a systematic review to assess the quality of guidelines on oral health care during pregnancy. PubMed, Embase, Scopus and Cochrane Databases were electronically searched in March 2024. Study Eligibility Criteria: We included guidelines that were carried out within last 10 years and focused on oral health during pregnancy were included in this review. Guidelines focused for both oral health professionals and non-oral health professionals were included in this review. The assessment of the guidelines in this review was carried out using the AGREE II instrument. The four appraisers who carried out the assessment comprised of a gynecologists, a dental practioners, a public health expert and a dental public health professional. The instrument comprises of 23 key items within six domains and two additional global rating items. We included eight guidelines in this review. The AGREE II showed two domains with mean score of more than 70% scores across the guidelines. A comparative evaluation of all the guidelines revealed consistently higher scores in scope and purpose (81.71 + 6.3) and clarity of presentation (71.61 + 11.7). Lowest mean scores were reported for editorial independence (47.87 + 7.21) followed by rigour of development (56.19 + 16.97), applicability (57.50 + 13.7) and stakeholder involvement domain (63.17 + 14.31). Although many guidelines have demonstrated adherence to systematic methodologies, there still exists a scope of improvement in domains such as editorial independence, rigour of development, applicability and stakeholder involvement. Addressing these shortcomings is essential for promoting evidence-based oral health care practices and improving maternal and neonatal health outcomes.
{"title":"Assessment of the quality of guidelines on oral health care during pregnancy: a systematic review","authors":"Upendra Singh Bhadauria, Sarveshwari Singh, Pooja Paswan, Pooja Bhattacharya, Bharathi Purohit, Harsh Priya","doi":"10.1038/s41432-024-01046-y","DOIUrl":"10.1038/s41432-024-01046-y","url":null,"abstract":"Importance of oral health during pregnancy has been well reported. To prevent the occurrence of oral diseases and maintenance of oral health, a number of guidelines have been developed by different organizations. However, despite numerous efforts in development of these guidelines, a critical evaluation of the quality of guidelines has not been carried out. Thus, we aimed to perform a systematic review to assess the quality of guidelines on oral health care during pregnancy. PubMed, Embase, Scopus and Cochrane Databases were electronically searched in March 2024. Study Eligibility Criteria: We included guidelines that were carried out within last 10 years and focused on oral health during pregnancy were included in this review. Guidelines focused for both oral health professionals and non-oral health professionals were included in this review. The assessment of the guidelines in this review was carried out using the AGREE II instrument. The four appraisers who carried out the assessment comprised of a gynecologists, a dental practioners, a public health expert and a dental public health professional. The instrument comprises of 23 key items within six domains and two additional global rating items. We included eight guidelines in this review. The AGREE II showed two domains with mean score of more than 70% scores across the guidelines. A comparative evaluation of all the guidelines revealed consistently higher scores in scope and purpose (81.71 + 6.3) and clarity of presentation (71.61 + 11.7). Lowest mean scores were reported for editorial independence (47.87 + 7.21) followed by rigour of development (56.19 + 16.97), applicability (57.50 + 13.7) and stakeholder involvement domain (63.17 + 14.31). Although many guidelines have demonstrated adherence to systematic methodologies, there still exists a scope of improvement in domains such as editorial independence, rigour of development, applicability and stakeholder involvement. Addressing these shortcomings is essential for promoting evidence-based oral health care practices and improving maternal and neonatal health outcomes.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 4","pages":"214-215"},"PeriodicalIF":0.0,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141970934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-12DOI: 10.1038/s41432-024-01045-z
Nitchakul Joensahakij, Pravej Serichetaphongse, Wareeratn Chengprapakorn
This systematic review aimed to compare the accuracy of conventional impression techniques with digital methods, including intraoral scanners or photogrammetry, in full-arch implant-supported prostheses. An electronic search of the MEDLINE (PubMed, Scopus, and Cochrane) databases was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. The review included in vitro studies published between January 2000 to January 2024 that compared the accuracy of digital and conventional implant impression techniques. Descriptive analyses were performed using the data extracted from each study. Twenty-three in vitro studies met the inclusion criteria. Of these, eighteen utilized intraoral scanners and five employed photogrammetry. Twelve studies concluded that digital techniques were more accurate than conventional methods, six found conventional techniques to be more accurate, and five reported comparable accuracy between the two methods. Within limitation of the included studies, digital implant impression technique were generally more accurate than conventional methods for full-arch implant-supported prostheses. This review suggests that future research should use perform standardized methodologies and report consistent accuracy outcomes to enable the inclusion of more studies in a meta-analysis. The study was registered in PROSPERO (ID: CRD42023397916).
{"title":"The accuracy of conventional versus digital (intraoral scanner or photogrammetry) impression techniques in full-arch implant-supported prostheses: a systematic review","authors":"Nitchakul Joensahakij, Pravej Serichetaphongse, Wareeratn Chengprapakorn","doi":"10.1038/s41432-024-01045-z","DOIUrl":"10.1038/s41432-024-01045-z","url":null,"abstract":"This systematic review aimed to compare the accuracy of conventional impression techniques with digital methods, including intraoral scanners or photogrammetry, in full-arch implant-supported prostheses. An electronic search of the MEDLINE (PubMed, Scopus, and Cochrane) databases was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. The review included in vitro studies published between January 2000 to January 2024 that compared the accuracy of digital and conventional implant impression techniques. Descriptive analyses were performed using the data extracted from each study. Twenty-three in vitro studies met the inclusion criteria. Of these, eighteen utilized intraoral scanners and five employed photogrammetry. Twelve studies concluded that digital techniques were more accurate than conventional methods, six found conventional techniques to be more accurate, and five reported comparable accuracy between the two methods. Within limitation of the included studies, digital implant impression technique were generally more accurate than conventional methods for full-arch implant-supported prostheses. This review suggests that future research should use perform standardized methodologies and report consistent accuracy outcomes to enable the inclusion of more studies in a meta-analysis. The study was registered in PROSPERO (ID: CRD42023397916).","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 4","pages":"216-217"},"PeriodicalIF":0.0,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141970965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-10DOI: 10.1038/s41432-024-01049-9
Ana Luisa Amaral, Michael R. Hamblin, Sérgio Araújo Andrade
A review of the principal clinical applications of antimicrobial photodynamic therapy (aPDT) in dentistry. To provide an overview of clinical applications and future perspectives of aPDT in dentistry. A comprehensive search was conducted on PubMed, Web of Science, Scopus, and Embase up to September 2022, where only data from randomized clinical trials were included. In vitro studies, animal studies, literature reviews, and duplicate articles were excluded from the review. Out of a total of 1042 references initially identified, only 89 studies were included in the review. Six main oral conditions for which aPDT has been used were identified: periodontal and peri-implant diseases, endodontics, bacterial plaque, caries, and fungal and viral infections. The review suggests that aPDT can be used as an effective complementary treatment for reducing pathogenic microorganisms in bacterial plaque; carious lesions; and periodontal, peri-implant, endodontic, fungal, and viral infections. Despite the efficacy of aPDT against different types of microorganisms, there are no specific irradiation parameters for its respective photosensitizers due to the significant heterogeneity of clinical trials. Therefore, more studies are needed to determine irradiation protocols and development of new photosensitizers to improve the safety and efficacy of aPDT.
{"title":"What is the potential of antibacterial, antiviral and antifungal photodynamic therapy in dentistry?","authors":"Ana Luisa Amaral, Michael R. Hamblin, Sérgio Araújo Andrade","doi":"10.1038/s41432-024-01049-9","DOIUrl":"10.1038/s41432-024-01049-9","url":null,"abstract":"A review of the principal clinical applications of antimicrobial photodynamic therapy (aPDT) in dentistry. To provide an overview of clinical applications and future perspectives of aPDT in dentistry. A comprehensive search was conducted on PubMed, Web of Science, Scopus, and Embase up to September 2022, where only data from randomized clinical trials were included. In vitro studies, animal studies, literature reviews, and duplicate articles were excluded from the review. Out of a total of 1042 references initially identified, only 89 studies were included in the review. Six main oral conditions for which aPDT has been used were identified: periodontal and peri-implant diseases, endodontics, bacterial plaque, caries, and fungal and viral infections. The review suggests that aPDT can be used as an effective complementary treatment for reducing pathogenic microorganisms in bacterial plaque; carious lesions; and periodontal, peri-implant, endodontic, fungal, and viral infections. Despite the efficacy of aPDT against different types of microorganisms, there are no specific irradiation parameters for its respective photosensitizers due to the significant heterogeneity of clinical trials. Therefore, more studies are needed to determine irradiation protocols and development of new photosensitizers to improve the safety and efficacy of aPDT.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 4","pages":"186-187"},"PeriodicalIF":0.0,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41432-024-01049-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-10DOI: 10.1038/s41432-024-01051-1
Sundas Jamil
The study conducted by Olmedo-Gaya et al. aimed to investigate the effects of various surgical techniques on the initial stability of implants placed in the posterior maxilla through a randomized controlled clinical trial. The study compared insertion torque (IT) and implant stability quotients (ISQ) among implants placed using under preparation, expanders, and standard surgical instrumentation. The study enrolled 108 patients, each receiving one implant in the posterior maxilla region. Patients were distributed into three groups: group 1 (n = 36) with the under preparation technique, group 2 (n = 36) using the expander technique, and group 3 (n = 36) with conventional drilling. IT was measured using a torque indicator, while ISQ was recorded through resonance frequency analysis immediately post-surgery. The ISQ values were analyzed in relation to the patient’s bone quality, categorized into types II, III, and IV. ISQ values varied significantly with bone quality, being highest in type II (76.65) and type III (73.60), and lowest in type IV (67.34) bone, with a significant difference (p < 0.0001). The conventional drilling technique yielded lower ISQ values (69.31) compared to under preparation (74.29) and expander techniques (73.99), with statistical significance (p = 0.008 and p = 0.005, respectively). Surgical technique significantly influences primary stability in low-quality bone. Conventional drilling results in lower ISQ values, suggesting that alternative techniques such as under preparation or expanders should be used in low-quality bone to achieve better primary stability. For implants in low-quality bone, replacing the conventional drilling technique with under preparation or expander techniques can enhance primary stability.
{"title":"Unlocking implant success: the impact of surgical techniques on primary stability in the posterior maxilla","authors":"Sundas Jamil","doi":"10.1038/s41432-024-01051-1","DOIUrl":"10.1038/s41432-024-01051-1","url":null,"abstract":"The study conducted by Olmedo-Gaya et al. aimed to investigate the effects of various surgical techniques on the initial stability of implants placed in the posterior maxilla through a randomized controlled clinical trial. The study compared insertion torque (IT) and implant stability quotients (ISQ) among implants placed using under preparation, expanders, and standard surgical instrumentation. The study enrolled 108 patients, each receiving one implant in the posterior maxilla region. Patients were distributed into three groups: group 1 (n = 36) with the under preparation technique, group 2 (n = 36) using the expander technique, and group 3 (n = 36) with conventional drilling. IT was measured using a torque indicator, while ISQ was recorded through resonance frequency analysis immediately post-surgery. The ISQ values were analyzed in relation to the patient’s bone quality, categorized into types II, III, and IV. ISQ values varied significantly with bone quality, being highest in type II (76.65) and type III (73.60), and lowest in type IV (67.34) bone, with a significant difference (p < 0.0001). The conventional drilling technique yielded lower ISQ values (69.31) compared to under preparation (74.29) and expander techniques (73.99), with statistical significance (p = 0.008 and p = 0.005, respectively). Surgical technique significantly influences primary stability in low-quality bone. Conventional drilling results in lower ISQ values, suggesting that alternative techniques such as under preparation or expanders should be used in low-quality bone to achieve better primary stability. For implants in low-quality bone, replacing the conventional drilling technique with under preparation or expander techniques can enhance primary stability.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 3","pages":"125-126"},"PeriodicalIF":0.0,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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