E-ISSN 2548-0839
: 3 (3)

Volume: 3  Issue: 3 - 2018

REVIEW ARTICLES
1.Effects of Ibuprofen Compared to Other Premedication Drugs on the Risk and Intensity of Postendodontic Pain: A Systematic Review
Juliana L. De Geus, Letícia M. Wambier, Thaynara F. Boing, Alessandro D. Loguercio, Alessandra Reis
doi: 10.14744/eej.2018.83803  Pages 123 - 133
Objective: This systematic review aims to evaluate the effects of ibuprofen compared to other drugs on the risk and intensity of postoperative pain resulting from endodontic treatment in adult patients.
Methods: A systematic search was carried out through Medline databases (Pubmed, Scopus, Web of Science, Cochrane, Lilacs, and BBO). There was no restriction on the publication year or idiom. The gray literature was explored. The Periodicos Capes Theses Databases and ProQuest Dissertations were also searched, as well as the unpublished and ongoing trials registry and the IADR abstracts (1990–2016). Solely randomized clinical trials that compared the risk or intensity of pain resulting from endodontic treatment in adult patients were included in this systematic review. The risk of bias of the articles was evaluated using the Cochrane Collaboration’s tool. A random-effect meta-analysis was conducted for ibuprofen versus placebo and ibuprofen versus other drugs at 6, 8, and 24 hours. The GRADE approach was used to assess the quality of the evidence.
Results: A total of 1132 studies were identified, and only seven meet the eligibility criteria. No difference between the groups was detected in any of the meta-analysis. An exception was observed when one study was removed from the meta-analysis of pain intensity at 24 hours for ibuprofen versus placebo, favoring ibuprofen (SMD −0.67; 95% CI −1.05 to −0.17). The quality of evidence in all meta-analyses was graded as low or very low.
Conclusion: Results of the present systematic review indicate that there is no clear evidence supporting that preoperative ibuprofen is better than other drugs in reducing the risk and intensity of postendodontic pain.

2.Root Resorption Classifications: A Narrative Review and a Clinical Aid Proposal for Routine Assessment
Henrique Aidos, Patrícia Diogo, João Miguel Santos
doi: 10.14744/eej.2018.33043  Pages 134 - 145
Root resorption (RR) refers to noninfectious damage related to the loss of hard and soft dental tissue that results from clastic cell activity. It is observed as a pathologic process that is predominantly asymptomatic in the permanent dentition and physiological during the shedding of primary teeth. Roots are protected by unmineralized organic cementoid and predentine. RR occurs because of the inability of the clastic cells to adhere to unmineralized surfaces. Since the first RR classification was described by Andreasen in the 1970s, several classifications have been proposed with diverse terminology. A narrative literature review was undertaken on the current classification, diagnosis, pathophysiology, and treatment of RR. A bibliographic search resulted in 434 titles and abstracts, and from those, 17 articles were obtained that alluded to 15 RR classifications. A total of 28 articles that met the inclusion criteria were included. Results showed that Andreasen’s classification is the most widely used for classifying RR. In terms of epidemiologic data, studies are scarce, although RR pathophysiology is well described in the literature. Overall clinical guidelines are summarized in a new RR classification diagram. The choice of RR treatment application should be in line with the RR type and the dentist’s experience. However, an earlier and correct diagnosis will significantly improve final outcomes and long-term prognosis, especially with the current evolution of advanced imaging techniques, such as cone-beam computed tomography and bioceramic-based endodontic sealers.

ORIGINAL ARTICLES
3.The use of Enamel Matrix Derivative (Emd) for Treatment of Combined Apicomarginal Lesions in Apical Surgery: A Retrospective Analysis
Thomas Von Arx, Dieter Bosshardt
doi: 10.14744/eej.2018.97269  Pages 146 - 152
Objective: The outcome of apical surgery using modern techniques is favourable. However, the presence of a combined apicomarginal defect may negatively affect the postsurgical healing. The objective of this retrospective analysis was to assess the healing of teeth with apicomarginal defects treated with apical surgery and enamel matrix derivative (EMD).
Methods: This retrospective study evaluated the application of EMD in apical surgery of 17 teeth with apicomarginal defects. Cases were followed for at least 1 year, and healing was classified based on established clinical and radiographic criteria.
Results: The patient sample included nine females and eight males with a mean age of 50±18.2 years. Maxillary incisors (six lateral and four central) were the most frequently treated teeth. The majority of apicomarginal defects was located on the facial aspect of the root (70.6%) and belonged to defect class I (76.5%). Follow-up periods ranged from 1 to 5 years. Healing was successful in 14 teeth (82.4%).
Conclusion: The application of EMD resulted in a similar outcome as in previously published clinical studies related to regenerative techniques for the treatment of apicomarginal defects in conjunction with apical surgery.

4.Vascularity and VEGF/VEGFR2 Signaling in the Dentine–Pulp Complex of Immature and Mature Permanent Teeth
Lara T Friedlander, Dawn Coates, Gregory Seymour, Mary Cullinan, Alison M Rich
doi: 10.14744/eej.2018.07269  Pages 153 - 159
Objective: To examine the microvessel density (MVD) and spatial distribution of endothelial cells and angiogenic activity in immature and mature permanent teeth using immunohistochemistry.
Methods: Healthy third molars with immature and mature root development were formalin-fixed, decalcified in 10% ethylenediaminetetraacetic acid, and processed for routine immunohistochemistry with endothelial cell markers anti-CD34 and anti-CD146 and angiogenic markers anti-vascular endothelial growth factor (VEGF) and anti-VEGF receptor-2 (VEGFR2). Staining was visualized with diaminobenzidine and examined using light microscopy. The distribution of markers was analyzed qualitatively and quantitatively in the coronal, middle, and apical regions of the dentine–pulp complex.
Results: There were spatial differences in protein expression for immature and mature teeth. The pulps of immature teeth were more vascular, had a greater number of CD34+ and CD146+ cells, and a significantly higher MVD in the coronal region than those of mature teeth (P=0.03). The apical papilla contained few blood vessels. VEGF/VEGFR2 activity was significantly greater for immature teeth (P=0.001). VEGF was expressed throughout the pulp–dentine complex, but there was significantly more growth factor coronally (immature P=0.04 and mature P=0.02). VEGFR2 was expressed less than VEGF but was seen on the endothelial cells and single cells unrelated to a vessel lumen.
Conclusion: The spatial distribution of vascular and angiogenic (VEGF/VEGFR2) markers indicates the potential for altered healing responses in the pulps of immature and mature teeth. Immature teeth have a greater MVD and VEGF/VEGFR2 expression than mature teeth, and the increased expression of these markers in the coronal region of both tooth types is important for pulp healing.

5.Root Denitne Thickness and Concavity Depth in Mandibular Molars: A Cone Beam Computed Tomography Population Study
Juan Gonzalo Olivieri, Fernando Duran- Sindreu
doi: 10.14744/eej.2018.96158  Pages 160 - 166
Objective: The purposes of the present study were to evaluate dentine thickness and concavity depth below the furcation level of the mesial canals of the mandibular first and second molars, to examine differences between gender, age, and quadrant, and to prove if there is a relationship between root length and dentine thickness.
Methods: Two hundred eleven mandibular first and second molars were included in this study. Samples were divided according to age, gender, quadrant, and root length. Measurements of dentine thickness from the external border of the root canal to the external root surface and concavity depth were recorded 1, 2, and 4 mm below the furcation level. Kruskal–Wallis and Wilcoxon rank sum tests were performed to estimate the influence of different variables, and a multiple regression analysis was performed to evaluate the influence of dentine thickness below the furcation level.
Results: First molars had a deeper concavity depth with significant differences in both 1 mm and 2 mm levels than second molars (P<0.05). According to concavity depth, there was no relationship with teeth length (P>0.05). The distal concavity was significantly deeper in the 1 and 2 mm levels (P<0.05). According to gender, the female group had a reduced dentine thickness in both mesiolingual and mesiobuccal canals in both 1 mm and 2 mm levels (P<0.05).
Conclusion: Female patients have a reduced dentine thickness below the furcation level. In order to select the most appropriate instrumentation procedure in every specific case, clinicians must be aware of the dentine reduced thickness measurements to avoid procedural iatrogenic damage.

6.Factors Affecting the Decision-Making of Direct Pulp Capping Procedures Amongst Turkish Dental Practitioners
Ömer Hatipoðlu
doi: 10.14744/eej.2018.09609  Pages 167 - 173
Objective: To examine the factors affecting the decision-making of direct pulp capping procedures amongst Turkish dental practitioners.
Methods: A total of 378 Turkish dentists participated in the survey. The questionnaire comprised three sections. The first part comprised questions regarding demographic features. The second part comprised; questions on how treatment plans change according to factors such as pulp perforation position, number, size, how it occurred, and patient age. The third part composed of questions on the common materials and techniques used in pulp capping treatment. Descriptive statistics was calculated using Pearson’s χ2 test, and the risk assessments of factors affecting the choice of pulp capping decision were computed using logistic regression analysis.
Results: 85.18% of participants preferred the pulp capping treatment. When the perforation size was >1 mm, males and university dentists decided more pulp capping treatments than females and private dentists respectively did (p<0.05). While the perforation size factor changed the dentists’ decision most (OR=6.85), the patient’s age factor least altered the choice (OR=1.38). Gender did not affect the decision of technique and material (p>0.05), but workplace and experience affected the choice of material (p<0.05). Technique did not affect the decision (p>0.05).
Conclusion: Turkish dentists prefer invasive treatments when risk factors in pulp capping treatment increase. The possible cause may be to reduce the rate of unsuccessful treatment; thus, ensure the continuity of patient confidence.

7.Fracture Resistance of Endodontically Treated Anterior Teeth Restored with Different Post Systems: An in Vitro Study
Abdulrahman Fadag, Maged Negm, Abdulaziz Samran, Ahlam Samran, Giraldine Ahmed, Ali Alqerban, Mutlu Özcan
doi: 10.14744/eej.2018.70299  Pages 174 - 178
Objective: This in vitro study aimed to evaluate the fracture resistance of endodontically treated maxillary central incisors with different post systems.
Methods: Fifty-six extracted intact maxillary permanent central incisors were used, treated endodontically (except for the control group), and distributed into the following seven test groups (n=8) depending on the post type: UHT (control group: root-filled teeth without endodontic post), ZRP (prefabricated zirconia post), GFP (prefabricated glass fiber post), CFP (prefabricated carbon fiber post), CPC (custom-made cast post and core), TIP (prefabricated titanium post), and MIP (prefabricated mixed post). The specimens were loaded in a universal testing machine until fracture occurrence. Failure loads were then analyzed with one-way analysis of variance (ANOVA), followed by multiple comparisons by using Tukey’s honest significant difference test (α=0.05).
Results: Mean (SD) failure loads for groups ranged from 524±73.2 N for CPC to 764.1±156 N for GFP. One-way ANOVA showed significant differences in terms of fracture resistances among groups (P<0.001). Tukey’s honest significant difference test showed significant differences in fracture resistance within groups (P≤0.05), whereas no difference was observed between the UHT (control group) and CFP and CPC groups (P≥0.05).
Conclusion: Endodontically treated teeth restored with zirconia post, glass fiber post, titanium post, or mixed post were more resistant to fracture loads compared with those that were not restored (control group) or restored with either carbon fiber post or cast post and core.

8.Quality of Root Canal Fillings Performed by Undergraduate Students and the Related Factors on the Treatment Outcome: A 2- to 5-Year Follow-Up
Nikolaos K. Polyzos, Kyriakos G. Sarris, Afroditi I. Pita, Georgios V. Mikrogeorgis, Kleoniki M. Lyroudia
doi: 10.14744/eej.2018.69077  Pages 179 - 185
Objective: To evaluate radiographically the quality of root canal fillings performed by undergraduate students between 2012 and 2015, and to investigate the impact of their quality in correlation with root type, preoperative periapical status, and type of restorative treatment on the treatment outcome.
Methods: Six hundred seventy-seven non-surgical root canal treatments were performed by undergraduate students from the Aristotle University of Thessaloniki at the endodontic department clinics between 2012 and 2015. Two hundred forty-four teeth (349 roots) fulfilled the criteria and were clinically and radiographically re-examined between 2016 and 2017, and the outcome was classified as “success” or “failure.” Root canal fillings were radiographically evaluated in terms of apical extension and density. The root filling was classified as acceptable when both parameters were rated as acceptable. Statistical analysis was performed using generalized estimating equations. Pairwise comparisons were performed by the sequential Bonferroni method. Intra-examiner and inter-examiner agreements were checked by the intraclass correlation coefficient and Cohen’s kappa. The statistical significance level was set at p<0.05.
Results: The percentage of the roots with acceptable root canal fillings was 40.4%. The molar roots demonstrated the lowest rate (30.7%) compared with the anterior (53%, p<0.05) and premolar teeth (43%, p>0.05). The results of the correlation of the quality of the root canal fillings with the root type, preoperative periapical status, type of coronal restoration, and the treatment outcome showed that the unacceptable quality of root canal filling in relation to root or presence of periapical lesion or crown revealed the lowest success rates (47.2%, 40.3%, and 52.3%, respectively). In contrast, results showed that roots with canal fillings of acceptable quality demonstrated success rates close to 90%, regardless of the other variables.
Conclusion: Within the limitations of the present study, the percentage of radiographically acceptable root canal fillings performed in the undergraduate clinic of the Department of Endodontology at Aristotle University of Thessaloniki was low (40.4%). Results showed that there was a strong association of higher success rates with root fillings of acceptable quality.

9.Endodontic Procedural Errors by Students in Two Saudi Dental Schools
Saleem Abdulrab, Wafa Alaajam, Fuad Al- Sabri, Mazen Doumani, Khadija Maleh, Fawzia Alshehri, Hassan Alamer, Esam Halboub Halboub
doi: 10.14744/eej.2018.29491  Pages 186 - 191
Objective: To explore endodontic procedural errors committed by undergraduate dental students in King Khalid University (KKU), Abha and AlFarabi dental college, Riyadh.
Methods: In this cross sectional study, a questionnaire was distributed to 500 dental students from both schools and of both genders in the 5th and 6th levels in the academic year 2016–2017. Participants were asked to record their endodontic procedural error(s) that had occurred during training.
Results: Returned and eligible questionnaires were 469 (93.8% response rate) and were almost equally distributed by university (KKU and Alfarabi). The participants’ age ranged from 22 to 24 years, and approximately 47% of them were female students and 65% were 6th level students. Almost 56% of the sample reported at least one endodontic procedural error during their training. Female students reported errors (65%) more frequently than the male students (49%; P=0.002). Up to 54% of these errors were in the posterior teeth and 65% were in teeth with curved roots. Most common error during access cavity preparation was gouging (68%) and due to instrumentation was ledge formation (47%), during obturation was voids (41%). There were no differences in the reported endodontic errors between the two universities.
Conclusion: The frequency of reported endodontic procedural errors by senior dental students in both schools, more specifically those in the 6th year, is high. Ledge formation and voids in the root canal filling are the most frequently reported endodontic errors.

CASE REPORT
10.Endodontic Management of a Chronic Periapical Abscess in a Maxillary Central Incisor with an Immature Root Apex Using Platelet-Rich Fibrin: A Case Report
Weerapan Aunmeungtong, Tadkamol Krongbaramee, Pathawee Khongkhunthian
doi: 10.14744/eej.2018.19483  Pages 192 - 196
Platelet-rich fibrin (PRF) has been used for several treatments in dentistry. The present study reports the clinical and radiographic outcomes of a root canal treatment of a necrotic immature maxillary central incisor using PRF. A 15-year-old female patient presented with a diagnosis of maxillary left central incisor pulp necrosis with open apex and periapical radiolucency and extraoral sinus tract. Two months after a two-visit root canal treatment using calcium hydroxide as a root canal dressing, no clinical symptoms were observed, and the previous sinus tract at the patient’s nostril had completely disappeared. In the subsequent visit, the PRF was prepared and delivered into the root canal. The PRF layer was covered with collagen membrane and then sealed with white mineral trioxide aggregate. One year later, the patient remained asymptomatic. Radiological examination using cone beam computed tomography (CBCT) showed that the destructive buccal alveolar bone was completely repaired.

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