Oral potentially malignant disorders (OPMD) are chronic conditions, which have a higher risk of transformation to oral squamous cell carcinoma. The aim of this systematic review and meta‐analysis was ...to answer the question: “What is the prevalence of oral potentially malignant disorders among adults?” Studies reporting the prevalence of these conditions (leukoplakia, erythroplakia, oral submucous fibrosis OSMF, and actinic cheilitis) were selected, only studies in which a clinical assessment and histopathological confirmation were performed were included. Of the 5513 studies, 22 met the inclusion criteria for qualitative and quantitative analyses. The risk of bias (RoB) of the selected studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. Seven studies were classified as high risk, 12 as moderate risk, and 3 as low RoB. The meta‐analysis showed that the prevalence of OPMD was 4.47% (95% CI = 2.43‐7.08). The most prevalent OPMDs were OSMF (4.96%; 95% CI = 2.28‐8.62) and leukoplakia (4.11%; 95% CI = 1.98‐6.97). OPMDs were identified more commonly in males (59.99%; 95% CI = 41.27‐77.30). Asian and South American/Caribbean populations had the highest prevalence rates of 10.54% (95% CI = 4.60‐18.55) and 3.93% (95% CI = 2.43‐5.77), respectively. The overall prevalence of OPMD worldwide was 4.47%, and males were more frequently affected by these disorders. The prevalence of OPMD differs between populations; therefore, further population‐based studies may contribute to the better understanding of these differences.
Abstract Introduction Endodontic diagnosis depends on accurate radiographic examination. Assessment of the location and extent of apical periodontitis (AP) can influence treatment planning and ...subsequent treatment outcomes. Therefore, this systematic review and meta-analysis assessed the diagnostic accuracy of conventional radiography and cone-beam computed tomographic (CBCT) imaging on the discrimination of AP from no lesion. Methods Eight electronic databases with no language or time limitations were searched. Articles in which the primary objective was to evaluate the accuracy (sensitivity and specificity) of any type of radiographic technique to assess AP in humans were selected. The gold standard was the histologic examination for actual AP ( in vivo ) or in situ visualization of bone defects for induced artificial AP ( in vitro ). Accuracy measurements described in the studies were transformed to construct receiver operating characteristic curves and forest plots with the aid of Review Manager v.5.2 (The Nordic Cochrane Centre, Copenhagen, Denmark) and MetaDisc v.1.4. software (Unit of Clinical Biostatistics Team of the Ramón y Cajal Hospital, Madrid, Spain). The methodology of the selected studies was evaluated using the Quality Assessment Tool for Diagnostic Accuracy Studies-2. Results Only 9 studies met the inclusion criteria and were subjected to a qualitative analysis. A meta-analysis was conducted on 6 of these articles. All of these articles studied artificial AP with induced bone defects. The accuracy values (area under the curve) were 0.96 for CBCT imaging, 0.73 for conventional periapical radiography, and 0.72 for digital periapical radiography. No evidence was found for panoramic radiography. Conclusions Periapical radiographs (digital and conventional) reported good diagnostic accuracy on the discrimination of artificial AP from no lesions, whereas CBCT imaging showed excellent accuracy values.
An avulsion injury is a serious trauma to pulp and periodontal tissues. After avulsion and replantation, teeth are at risk of infection and root resorption, which may affect treatment outcome and ...survival rate. Thus, the purpose of this systematic review was to evaluate the incidence of root resorption after the replantation of avulsed teeth.
Two reviewers searched 7 electronic databases for observational studies involving human subjects that evaluated the incidence of root resorption after tooth avulsion. Risk of bias (RoB) was evaluated using the Meta-Analysis of Statistics Assessment and Review Instrument, and the quality of available evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool.
Of the 1507 articles, 23 met the inclusion criteria. A meta-analysis was conducted and showed that the incidence of internal root resorption was 1.2% (95% confidence interval CI, 0.02–5.50). Regarding external root resorption, the incidence of surface root resorption was 13.3% (95% CI, 6.21–22.62), that of inflammatory root resorption was 23.2% (95% CI, 13.94–34.19), and that of replacement root resorption was 51.0% (95% CI, 40.10–62.00). Two studies presented a high RoB, 16 had a moderate RoB, and 11 had a low RoB. The overall level of evidence identified was very low.
The incidence of root resorption after avulsion and replantation in descending order was replacement root resorption > inflammatory root resorption > surface root resorption > internal root resorption.
1.This meta-analysis investigated the available evidence regarding root resorption (RR) after replantation of avulsed teeth.2.In general, the incidence of RR related to replantation of avulsed teeth is high.3.Specifically, the most common incident type of resorption was replacement RR followed by inflammatory RR, surface RR, and internal RR.
Reactive hyperplastic lesions develop in response to a chronic injury simulating an exuberant tissue repair response. They represent some of the most common oral lesions including inflammatory ...fibrous hyperplasia, oral pyogenic granuloma, giant cell fibroma, peripheral ossifying fibroma, and peripheral giant cell lesions.
The incidence of those lesions was investigated in an oral pathology service, and the clinical characteristics, associated etiological factors, concordance between the clinical and histopathological diagnostic was determined.
A total of 2400 patient records were screened from 2006 to 2016. Clinical features were recorded from biopsy reports and patients’ files.
A total of 534 cases of reactive hyperplastic lesions were retrieved and retrospectively studied, representing 22.25% of all diagnoses. The most frequent lesion was inflammatory fibrous hyperplasia (72.09%), followed by oral pyogenic granuloma (11.79%), giant cell fibroma (7.30%), peripheral ossifying fibroma (5.24%), and peripheral giant cell lesions (3.55%). Females were predominantly affected (74.19%), the gingiva and alveolar ridge were the predominant anatomical site (32.89%), and chronic traumatism was presented as the main etiological factor. The age widely ranges from the 1st decade of life to the 7th. Clinically, the reactive hyperplastic lesions consisted of small lesions (0.5–2cm) and shared a strong likeness in color to the oral mucosa. The concordance between the clinical and histopathological diagnostic was high (82.5%).
Reactive hyperplastic lesions had a high incidence among oral pathologies. The understanding of their clinical features helps to achieve a clearer clinical and etiological diagnosis, and the knowledge of factors related to their development. This may contribute to adequate treatment and positive prognosis.
As lesões hiperplásicas reativas se desenvolvem em resposta a uma lesão crônica que estimula uma resposta acentuada de reparo tecidual. Elas representam uma das lesões orais mais comuns, inclusive a hiperplasia fibrosa inflamatória, granuloma piogênico oral, fibroma de células gigantes, fibroma periférico ossificante e lesão periférica de células gigantes.
A incidência dessas lesões foi investigada em um serviço de patologia bucal e as características clínicas, os fatores etiológicos associados e a concordância entre os diagnósticos clínico e histopatológico foram determinados.
Foram selecionados 2.400 registros de pacientes entre 2006 e 2016. As características clínicas foram registradas a partir de laudos de biópsia e dos prontuários dos pacientes.
Um total de 534 casos de lesões hiperplásicas reativas foram recuperados e retrospectivamente estudados, representando 22,25% de todos os diagnósticos. A lesão mais frequente foi hiperplasia fibrosa inflamatória (72,09%), seguida por granuloma piogênico oral (11,79%), fibroma de células gigantes, (7,30%), fibroma periférico ossificante (5,24%) e lesão periférica de células gigantes (3,55%). O sexo feminino foi predominante (74,19%), a gengiva e a crista alveolar foram o local anatômico predominante (32,89%) e o traumatismo crônico foi demonstrado como o principal fator etiológico. A idade variou desde a 1ª década de vida até a 7ª. Clinicamente, as LHR consistiram em pequenas lesões (0,5 a 2cm) que apresentaram uma forte semelhança de cor com a mucosa oral. A concordância entre o diagnóstico clínico e histopatológico foi alta (82,5%).
As lesões hiperplásicas reativas apresentaram alta incidência entre as patologias bucais. A compreensão das características clínicas ajuda na realização de um diagnóstico clínico e etiológico mais claro, bem como determinar os fatores relacionados ao seu desenvolvimento. Dessa forma contribui para um tratamento adequado e um prognóstico positivo.
To answer the focused question, “What are the prevalence of percutaneous injuries (PIs) on dentists, the location with the highest prevalence, and the dental instrument most responsible for these ...injuries?" As secondary outcomes, the prevalence by geographic location, type of PI, sex distribution, and dentist’s specialty were also considered.
Observational descriptive studies investigating the prevalence of percutaneous injuries on dentists were included.
Five electronic databases and three partial grey literature searches were performed.
The MAStARI tool assessed the potential risk of bias (RoB) among the studies, while the GRADE approach determined the level of evidence.
Among 2284 identified studies, 55 were included. Three studies were classified as low RoB, 17 as moderate RoB, and 35 as high RoB. The sample size ranged from 9 to 4107 dentists.
The PI prevalence in dentists ranged from 7.72% (95% confidence interval CI: 0.93–37.59) to 66.74% (95%CI: 29.83–94.51). North America was the most affected region, while South America was the least affected. Differences between sexes were not significant. The dental bur was the most commonly reported dental instrument causing PIs.
Owing to the very low GRADE level of evidence, caution should be applied when considering these findings and further research is required.
A high PI prevalence among dentists was noticed, and most were caused by dental burs. These findings imply that PIs should be considered by every dentist and proper measures instituted to reduce their prevalence.
Objectives
This systematic review (SR) aimed to investigate the influence of obturation extent on the final outcome of root canal treatment (RCT), by answering the question “among patients requiring ...RCT on fully formed permanent teeth, is there an association between obturation extent and the final treatment outcome?”
Materials and methods
Five electronic databases and three gray literature searches were performed. Observational studies investigating the association between obturation extent and RCT outcome in fully formed permanent teeth with a minimum follow-up of 12 months were included. We evaluated the risk of bias (RoB) in with MAStARI for cohort studies. The overall quality of the evidence was assessed with the GRADE-tool.
Results
Twenty-two studies were included, 2 had high RoB, 7 moderate RoB, and 13 low RoB. Underextended obturation demonstrated increased odds of an unfavorable outcome in seven studies, in which the odds varied between 6.94 (95%CI 2.20–21.87) and 1.73 (95%CI 1.02–2.95). Overextended obturation also demonstrated this association in four studies, with odds varying from 1.90 (95%CI 1.23–2.94) to 23.00 (95%CI 5.58–94.75). Due to heterogeneity and the very low level of evidence found in the GRADE analysis, the results from this SR should be interpreted with caution.
Conclusions
Obturation extent seems to influence RCT outcome; overextended and underextended obturations showed higher chance of association with less favorable outcomes than adequate obturation; however, this association was not categorically supported.
Clinical relevance
This SR provides information about obturation extent influence on RCT outcome and guides clinicians to make evidence-based decisions during endodontic practice.
Abstract Introduction Investigating the vertical root fracture (VRF) pathway under different clinical scenarios may help to diagnose this condition properly. We aimed to determine the capability and ...intrareliability of VRF pathway detection through cone-beam computed tomographic (CBCT) imaging as well as analyze the influence of different intracanal and crown materials. Methods VRFs were mechanically induced in 30 teeth, and 4 clinical situations were reproduced in vitro : no filling, gutta-percha, post, and metal crown. A Prexion (San Mateo, CA) 3-dimensional tomographic device was used to generate 104 CBCT scans. The VRF pathway was determined by using landmarks in the Avizo software (Version 8.1; FEI Visualization Sciences Group, Burlington, MA) by 1 observer repeated 3 times. Analysis of variance and post hoc tests were applied to compare groups. Results Intrareliability demonstrated an excellent agreement (intraclass correlation coefficient mean = 0.93). Descriptive analysis showed that the fracture line measurement was smaller in the post and metal crown groups than in the no-filling and gutta-percha groups. The 1-way analysis of variance test found statistically significant differences among the groups measurements. The Bonferroni correction showed statistically significant differences related to the no-filling and gutta-percha groups versus the post and metal crown groups. Conclusions The VRF pathway can be accurately detected in a nonfilled tooth using limited field of view CBCT imaging. The presence of gutta-percha generated a low beam hardening artifact that did not hinder the VRF extent. The presence of an intracanal gold post made the fracture line appear smaller than it really was in the sagittal images; in the axial images, a VRF was only detected when the apical third was involved. The presence of a metal crown did not generate additional artifacts on the root surface compared to the intracanal gold post by itself.
The aim of this study was to perform a systematic review to assess the sensitivity, specificity, and accuracy of magnetic resonance imaging (MRI), computed tomography (CT), and intraoral ultrasound ...(US) to determine the depth of invasion (DOI) and/or tumor thickness (TT) in oral cavity cancers, with histopathological evaluation as the gold standard.
Articles whose primary objective was to evaluate the accuracy (sensitivity and specificity) of MRI, CT, and US imaging to assess DOI and/or TT were searched in six major electronic databases, in addition to three grey literature databases. The methodological quality of the selected studies was evaluated by using the Quality Assessment Tool for Diagnostic Accuracy Studies-2.
Twelve studies met the inclusion criteria and underwent qualitative analysis: six studies on MRI, three on US, and one on CT. The accuracy values for MRI ranged from 67 to 83%, with sensitivity values above 80% and specificity above 75%. For US, mean values of sensitivity ranged from 91 to 93%. For CT, accuracy was 75%.
For the application of US, CT, MRI, good accuracy was reported in DOI and/or TT, as evaluated in the preoperative period. US offered advantages for detection of small lesions.
Objective
Traumatic dental injuries often affect the dental hard tissues, periodontal tissues, and dental pulp. Root resorption (RR) is a significantly concerning phenomenon that could lead to loss ...of the traumatized tooth. The purpose of this systematic review was to analyze the incidences of different types of RR after concussion, subluxation, lateral luxation, intrusive luxation, and extrusive luxation.
Material and methods
Seven databases were electronically and manually searched for the identification of observational studies that evaluated the incidence of RR after luxation injuries. Following study selection, data extraction, and risk of bias assessment through MAStARI checklist, the GRADE quality of available evidence was assessed.
Results
In total, 14 studies were included in the present systematic review. Ten and four studies presented a moderate and low RoB, respectively, and the overall GRADE quality of evidence was “very low” for all outcomes. The highest incidence rates of RR were observed for teeth with intrusive luxation, followed by those with extrusive luxation, lateral luxation, subluxation, and concussion. In general, the most common type of RR documented for all injuries was inflammatory RR, followed by replacement RR, surface RR, and internal RR.
Conclusions
Our findings suggest that RR most commonly occurs in association with intrusive luxation and by inflammatory RR. Awareness regarding the incidence of RR after injuries is useful for clinicians to minimize the risk and severity of its occurrence, because a late diagnosis of RR may limit treatment alternatives and result in tooth loss.
Clinical relevance
Knowledge about the incidence of RR in teeth with concussion and different types of luxation injuries can ensure appropriate follow-up protocols and favorable outcomes.
Orthodontic force triggers a sequence of biological responses that can affect dental pulp. The aim of this study was to systematically evaluate the clinical and radiographic findings of orthodontic ...force application on dental pulp.
Two reviewers comprehensively and systematically searched 6 electronic databases (Latin American and Caribbean Health Sciences LILACS, Embase, Cochrane Library, MEDLINE/PubMed, Scopus, and Web of Science) and the gray literature (Google Scholar, OpenGrey, and ProQuest) until April 2021. According to the PICOS criteria, randomized clinical trials and observational studies that evaluated clinical or radiographic findings compatible with dental pulp changes due to orthodontic force were included. Studies in open apex or traumatized teeth, case series or reports, and laboratory-based or animal studies were excluded. The Newcastle-Ottawa Scale and Cochrane Risk of Bias 2.0 tool were used to determine the risk of bias assessment. The overall certainty level was evaluated with the Grading of Recommendations, Assessment, Development and Evaluations tool.
Twenty-six studies were included. Among the clinical findings, orthodontic force promoted an increased pulp sensibility response and decreased pulp blood flow. Changes in pulp cavity volume and increased incidence of pulp stones were the radiographic findings observed. The studies presented a moderate risk of bias for most of the domains. The certainty of the evidence was considered very low.
Orthodontic force promoted changes in the dental pulp, generating clinical and radiographic findings. It is crucial to know these changes so that orthodontic mechanics can be safely performed. The clinician has effective noninvasive methods to assess the health and possible pulp changes during orthodontic treatment.
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