Oral surgery, oral medicine, oral pathology, oral radiology and endodontics

Avulsion of permanent teeth is one of the most serious dental injuries, and a prompt and correct emergency management is very important for the prognosis. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the task group. The guidelines represent the current best evidence and practice based on literature research and professionals' opinion. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of avulsed permanent teeth.

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International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth

In vitro tests continue to be an indispensable method for the initial screening of dental materials. Thermal cycling is one of the most widely used procedures to simulate the physiological aging experienced by biomaterials in clinical practice. Consequently it is routinely employed in experimental studies to evaluate materials' performance. A literature review aimed to elucidate test parameters for in vitro aging of adhesive restorations was performed. This study aims to assess whether or not a standardized protocol of thermal cycling has been acknowledged from a review of the literature. An exhaustive literature search, examining the effect of thermal cycling on restorative dental materials, was performed with electronic database and by hand. The search was restricted to studies published from 1998 to August 2013. No language restrictions were applied. The search identified 193 relevant experimental studies. Only twenty-three studies had faithfully applied ISO standard. The majority of studies used their own procedures, showing only a certain consistency within the temperature parameter (5-55°C) and a great variability in the number of cycles and dwell time chosen. A wide variation in thermal cycling parameters applied in experimental studies has been identified. The parameters selected amongst these studies seem to be done on the basis of convenience for the authors in most cases. A comparison of results between studies would appear to be impossible. The available data suggest that further investigations will be required to ultimately develop a standardized thermal cycling protocol.

Thermal cycling for restorative materials: does a standardized protocol exist in laboratory testing? A literature review.

For restoring cavitated dental lesions, whether carious or not, a large number of material combinations are available. We aimed to systematically review and synthesize data of comparative dental restorative trials. A systematic review was performed. Randomized controlled trials published between 2005 and 2015 were included that compared the survival of ≥2 restorative and/or adhesive materials (i.e., no need for restorative reintervention). Pairwise and Bayesian network meta-analyses were performed, with separate evaluations for cervical cavitated lesions and load-bearing posterior cavitated lesions in permanent and primary teeth. A total of 11,070 restorations (5,330 cervical, 5,740 load bearing) had been placed in 3,633 patients in the included trials. Thirty-six trials investigated restoration of cervical lesions (all in permanent teeth) and 36 of load-bearing lesions (8 in primary and 28 in permanent teeth). Resin-modified glass ionomer cements had the highest chance of survival in cervical cavitated lesions; composites or compomers placed via 2-step self-etch and 3-step etch-and-rinse adhesives were ranked next. Restorations placed with 2-step etch-and-rinse or 1-step self-etch adhesives performed worst. For load-bearing restorations, conventional composites had the highest probability of survival, while siloranes were found least suitable. Ambiguity remains regarding which adhesive strategy to use in load-bearing cavitated lesions. Most studies showed high risk of bias, and several comparisons were prone for publication bias. If prioritized for survival, resin-modified glass ionomer cements might be recommended to restore cervical lesions. For load-bearing ones, conventional or bulk fill composites seem most suitable. The available evidence is quantitatively and qualitatively insufficient for further recommendations, especially with regard to adhesive strategies in posterior load-bearing situations. Moreover, different material classifications might yield different findings on the same materials. Future trials should aim for sufficient power, longer follow-up times, and high internal validity to prove or refute differences between certain material combinations. An agreed material classification for future syntheses is desirable.

Directly Placed Restorative Materials Review and Network Meta-analysis

Essentials of complete denture prosthodontics

Inappropriate mechanical debridement, persistence of bacteria in the canals and apex, poor obturation quality, over and under extension of the root canal filling, and coronal leakage are some of the commonly attributable causes of failure. Despite the high success rate of endodontic treatment, failures do occur in a large number of cases and most of the times can be attributed to the already stated causes. With an ever increasing number of endodontic treatments being done each day, it has become imperative to avoid or minimize the most fundamental of reasons leading to endodontic failure. This paper reviews the most common causes of endodontic failure along with radiographic examples.

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Failure of endodontic treatment: The usual suspects

BACKGROUND/AIMS A wide variety of materials has been researched for their use as potential storage media for avulsed teeth, but it is essential to recognize the medium most recommended for improvement of the prognosis of avulsed teeth. The aim of this systematic review was to identify the most recommended medium to store and transport avulsed teeth based on the survival of periodontal ligament (PDL) cells as determined by in vitro studies. METHODS Only laboratory-based experimental studies on PDL cells found on adult permanent teeth were included. Data were collected using PubMed, CINAHL plus (EBSCO host), and the Cochrane Library, along with Google Scholar and a hand search. The key terms employed were permutations of [avulsed permanent teeth* OR dental avulsion* OR knocked out teeth*] AND [storage media* OR transport media* OR biological transport* OR PDL cell viability* OR PDL cell survival*]. A customized data extraction pro forma was used to extract the data and to evaluate the quality and risk of bias. RESULTS The initial search yielded 978 articles, but only 67 were selected. Milk was the most recommended individual medium followed by Hank's balanced salt solution. Among natural products other than milk, propolis and coconut water were most frequently recommended. Recommendations were based on maintenance of PDL cell viability followed by ease of availability, low cost, and long shelf life. CONCLUSIONS Natural products are more effective in maintaining the PDL cell viability compared to synthetic products. Some storage media recommendations were also based upon practical aspects. Although natural products other than milk have more recommendations as a group, milk is the most recommended storage medium individually, based not only on PDL cell viability, but also practical considerations.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/edt.12382

Which is the most recommended medium for the storage and transport of avulsed teeth? A systematic review.

Aim : To compare the difference in microleakage values using conventional and new low-shrink Silorane composites using the dye penetration method. Background : With improvement in adhesive technology, problems associated with composites have been largely overcome. However, microleakage due to polymerization shrinkage still remains a challenge. New Silorane-based composites are alleged to have less than 1% polymerization shrinkage, which would potentially decrease the microleakage, and hence, resolve this longstanding issue. Materials and Methods : The teeth were randomly divided into three groups (A,B, and C). Group A was restored with conventional composite (Valux TM Plus), with a total-etch protocol, Group B was restored with conventional composite, with a self-etch protocol, and group C were restored with a silorane-based composite (Filtek TMP90). Thermocycling at 200 cycles between 5 and 55°C ± 2°C with a dwell time of 60 seconds was conducted. The teeth were stained with methylene blue dye and then sectioned and viewed under a dissection microscope, afer which the microleakage was evaluated. Results : The interexaminer reliability was evaluated using the kappa score, which was acceptable (61 - 78%). The total-etch group performed statistically and significantly better (P Conclusions : The Silorane composite did not perform better than the conventional composites, however, it may have its uses and requires further research.

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An in vitro evaluation of microleakage in class V preparations restored with Hybrid versus Silorane composites.

Purpose
The aim of this systematic review was to assess the gingival retraction methods in terms of the amount of gingival retraction achieved and changes observed in various clinical parameters: gingival index (GI), plaque index (PI), probing depth (PD), and attachment loss (AL).

Methods
Data sources included three major databases, PubMed, CINAHL plus (Ebsco), and Cochrane, along with hand search. Search was made using the key terms in different permutations of gingival retraction* AND displacement method* OR technique* OR agents OR material* OR medicament*.

Results
The initial search results yielded 145 articles which were narrowed down to 10 articles using a strict eligibility criteria of including clinical trials or experimental studies on gingival retraction methods with the amount of tooth structure gained and assessment of clinical parameters as the outcomes conducted on human permanent teeth only. Gingival retraction was measured in 6/10 studies whereas the clinical parameters were assessed in 5/10 studies.

Conclusions
The total number of teeth assessed in the 10 included studies was 400. The most common method used for gingival retraction was chemomechanical. The results were heterogeneous with regards to the outcome variables. No method seemed to be significantly superior to the other in terms of gingival retraction achieved. Clinical parameters were not significantly affected by the gingival retraction method.

Gingival Retraction Methods: A Systematic Review

Purpose The aim of this systematic review was to determine the most effective alveolar augmentation technique for vertical bone gain. Materials and methods A systematic search to select clinical trials and retrospective studies done on patients with reduced vertical bone height was conducted. The intervention of interest was autogenous block graft done compared to procedures such as distraction osteogenesis (DO), particulate grafting, block plus particulate grafting with titanium mesh, and tent pole technique in systematically healthy adult patients age 18 and older. The following electronic databases were explored: PubMed, CINAHL, and Dental and Oral Science. A supplementary manual search of published full-text articles from January 2005 to December 2017 was done using Google Scholar. Grey literature was also sought using greylit.org. The review protocol was registered at the Prospero registry (CRD # 42017072432). The risk of bias of the included studies was assessed using EPOC criteria. Meta-analysis was performed using Review Manager for studies with quantitative data on mean values of vertical bone gain and bone resorption achieved with various bone augmentation techniques. Random effect model was used. Heterogeneity among studies was evaluated using the I2 statistic. Results A total of 2322 articles were found. After excluding the irrelevant papers, only 8 papers were finally selected for the detailed evaluation. Of these 8, 5 were clinical trials, and 3 were retrospective studies. Four studies were on DO, 2 on particulate grafting, 1 on autogenous block grafting plus particulate grafting, and 1 on tent pole grafting. The control group in all studies were autogenous block graft. Meta-analysis revealed no significant difference between DO and autogenous block grafting for vertical bone gain (mean difference 0.82 [-1.28, 2.91]). Similarly, no significant difference was observed in the 2 techniques for bone resorption (mean difference 0.38 [-0.23, 0.99]). Conclusions DO was not superior to autogenous block grafting for vertical bone augmentation. Both techniques were associated with a number of complications. There was no difference in the bone resorption observed in the 2 techniques. No conclusive results can be drawn on other techniques on account of limited data.

Farhan Raza Khan

Papers

Failure of endodontic treatment: The usual suspects

Which is the most recommended medium for the storage and transport of avulsed teeth? A systematic review.

An in vitro evaluation of microleakage in class V preparations restored with Hybrid versus Silorane composites.

Gingival Retraction Methods: A Systematic Review

Vertical Ridge Gain with Various Bone Augmentation Techniques: A Systematic Review and Meta-Analysis.