Endodontically treated posterior teeth restored with or without crown restorations: A 5‐year retrospective study of survival rates from fracture

 
First published: 12 June 2019

 

Aim

The aim of the present study was to investigate survival rates from fracture of endodontically treated posterior teeth (ETT) restored with or without crowns with recall periods of up to 5 years.

Methods

ETT with single‐unit crown or resin composite restorations were studied based on the inclusion criteria. Restoration, tooth structure loss, adjacent teeth, fracture, and restorability were recorded. Survival rates from fracture were calculated, and risk factors were identified.

Results

Overall, survival rate of ETT with crowns (92.2%) was significantly higher than resin composites (77.4%) (< 0.05). ETT with one or two surface loss/es and two adjacent teeth had a high survival rate of 86.9%, which was not significantly different to ETT with crowns (≥ 0.05). Restoration and adjacent teeth were identified as significant factors. The majority of fractured ETT with resin composites were restorable, whereas those with crowns were unrestorable. Survival rates from unrestorable fracture were not significantly different between the crown (93.1%) and resin composite (96%) (≥ 0.05).

Conclusions

The survival rate from the fracture of ETT restored with crowns was significantly higher than ETT restored with resin composites, but was not significantly different to ETT with one or two ETT with one or two surface loss/es and two adjacent teeth. ETT restored with resin composites had mostly restorable fracture, whereas ETT with unrestorable fracture were similar between the two restorations.

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CLINICAL ORAL PATHOLOGY CONSULTS IN A US DENTAL SCHOOL: A RETROSPECTIVE ANALYSIS OF UTILIZATION AND EFFICACY

Volume 128, Issue 1, July 2019, Page e87
Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Introduction

Chairside clinical oral pathology consultations are frequently provided in most dental schools; however, the outcome and efficacy of those consults remains largely unanalyzed. We designed a retrospective study to assess the utilization of consults by Oral and Maxillofacial Pathology (OMP) providers at the UF College of Dentistry (UFCOD).

Materials and Methods

With IRB approval, the clinical record system (AxiUm) at the UFCOD was searched from January 1, 2011 until July 1, 2017 for oral pathology consultations. The following information was collected for these consults: year of consult, requesting clinic, reason/clinical impression, presumptive diagnosis, recommended plan of action, and outcome (follow up).

Results

A total of 418 consults were included in this study, of which 11 were repeat consults on the same lesion on different occasions. The most frequent clinics requesting consults were in decreasing order: undergraduate DMD clinics, followed by faculty practice, graduate prosthodontics, graduate periodontics clinic, with other clinics requesting consults infrequently. The most common reasons consults were requested in descending order were: white lesions, ulcerations, nodules, pigmented lesions, swellings/enlargements, and erythematous lesions. Radiographic consults were uncommon in our study as at UFCOD, these are usually assigned or re-assigned to oral radiology. The disposition of the consults resulted in the following recommendations: 35% for observation/re-evaluation (ORE) in original clinic, 24% referred for biopsy, 19% treatment in original clinic followed by ORE, 12% referral to specialty clinic for treatment, and 10% multiple recommendations/lesions. In terms of outcome, biopsy and referral compliance was relatively reasonable, however ORE remained problematic.

Conclusions

This study illustrates the scope and difficulties associated with clinical consults in dental school and identifies areas of potential improvement.
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Deep Learning for the Radiographic Detection of Apical Lesions

 Published online: May 31, 2019

Abstract

Introduction

We applied deep convolutional neural networks (CNNs) to detect apical lesions (ALs) on panoramic dental radiographs.

Methods

Based on a synthesized data set of 2001 tooth segments from panoramic radiographs, a custom-made 7-layer deep neural network, parameterized by a total number of 4,299,651 weights, was trained and validated via 10 times repeated group shuffling. Hyperparameters were tuned using a grid search. Our reference test was the majority vote of 6 independent examiners who detected ALs on an ordinal scale (0, no AL; 1, widened periodontal ligament, uncertain AL; 2, clearly detectable lesion, certain AL). Metrics were the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and positive/negative predictive values. Subgroup analysis for tooth types was performed, and different margins of agreement of the reference test were applied (base case: 2; sensitivity analysis: 6).

Results

The mean (standard deviation) tooth level prevalence of both uncertain and certain ALs was 0.16 (0.03) in the base case. The AUC of the CNN was 0.85 (0.04). Sensitivity and specificity were 0.65 (0.12) and 0.87 (0.04,) respectively. The resulting positive predictive value was 0.49 (0.10), and the negative predictive value was 0.93 (0.03). In molars, sensitivity was significantly higher than in other tooth types, whereas specificity was lower. When only certain ALs were assessed, the AUC was 0.89 (0.04). Increasing the margin of agreement to 6 significantly increased the AUC to 0.95 (0.02), mainly because the sensitivity increased to 0.74 (0.19).

Conclusions

A moderately deep CNN trained on a limited amount of image data showed satisfying discriminatory ability to detect ALs on panoramic radiographs.
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Does selective carious tissue removal of soft dentin increase the restorative failure risk in primary teeth?: Systematic review and meta-analysis.

J Am Dent Assoc. 2019 May 27. pii: S0002-8177(19)30134-5. doi: 10.1016/j.adaj.2019.02.018. [Epub ahead of print]

xAbstract

BACKGROUND:

The authors conducted a systematic review of randomized controlled trials comparing the risk of experiencing restoration failure in primary teeth after complete and selective carious tissue removal of soft dentin.

METHODS:

The authors searched electronic databases (PubMed [MEDLINE], Scopus, Cochrane Central Register of Controlled Trials) and the ClinicalTrials.gov Web site with manual searching and cross-referencing for trials reporting restoration failure after follow-up of 6 months or longer. Two reviewers independently selected studies, extracted data, and assessed the risk of bias and quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. The authors performed intention-to-treat and per-protocol meta-analyses and calculated odds ratios (OR) as effect estimates in the random-effects model.

RESULTS:

From 327 potentially eligible studies, the authors selected 23 for full-text screening and included 4. Results showed increased risk of experiencing restoration failure (intention-to-treat analysis, OR [95% confidence interval] 1.74 [1.01 to 3.00], and per-protocol analysis, OR [95% confidence interval] 1.79 [1.04 to 3.09]) after selective carious tissue removal of soft dentin. The risk of bias was high, and the quality of evidence was low.

CONCLUSIONS:

Selective carious tissue removal of soft dentin may increase the risk of experiencing restoration failure in primary teeth. However, the evidence level is insufficient for definitive conclusions.

PRACTICAL IMPLICATIONS:

Patients with restorations performed after selective carious tissue removal of soft dentin should have shorter recall visit intervals to evaluate the restorations’ quality and control caries disease, allowing for more conservative approaches, such as repair, in cases of defective restorations.

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Association between periodontitis and cognitive impairment: analysis of national health and nutrition examination survey (NHANES) -III.

J Clin Periodontol. 2019 Jun 1. doi: 10.1111/jcpe.13155. [Epub ahead of print]

Abstract

OBJECTIVES:

Periodontitis has been hypothesized as being one of the most common potential risk factors for the development of dementia and cognitive impairment. In order to investigate the relationship between periodontitis and cognition impairment, the National Health and Nutrition Examination Survey (NHANES) database was analyzed after adjusting for potential confounding factors, including age and other systemic co-morbidities.

MATERIALS AND METHODS:

In total, 4663 participants aged 20 to 59 years who had received full mouth periodontal examination and undergone the cognitive functional test were enrolled. The grade of periodontal disease was categorized into severe, moderate, and mild. Cognitive function examinations, including the Simple Reaction Time test (SRTT), Symbol Digit Substitution Test (SDST), and Serial Digit Learning Test (SDLT), were adopted for the evaluation of cognitive impairment.

RESULTS:

The subjects with mild and moderate to severe periodontitis had higher SDLT and SDST scores, which indicated decreased cognitive function, compared to the healthy group. After adjusting for demographic factors, education, smoking, cardiovascular diseases, and laboratory data, periodontitis was significantly correlated with elevated SDST and SDLT scores (P values for trend = 0.014 and 0.038, respectively) by generalized linear regression models.

CONCLUSION:

Our study highlighted that periodontal status was associated with cognitive impairment in a nationally representative sample of US adults.

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Smartphones and tooth brushing: content analysis of the current available mobile health apps for motivation and training

Abstract

Introduction

Smartphone mobile app is an innovative concept for health behaviour‐based interventions.

Aim

The present study aimed to analyse apps developed for smartphones that promote tooth brushing amongst children using the Coventry, Aberdeen, and London-Refined (CALO-RE) taxonomy for behaviour change.

Materials and methods

Tooth brushing apps available in English and free to download that purported to assist with brushing were searched on the Apple app store using search terms based on Boolean logic and included AND combinations for keywords tooth brushing, children, toothbrush and motivation in the health and fitness category; six apps met the inclusion criteria and were downloaded. The behaviour change taxonomies were assessed individually for each app and scored as per coding and analysed for presence or absence.

Results

Only three of the behaviour change taxonomies were present in all apps, i.e. information provision (general), goal setting (behaviour) and prompt practice. Setting graded tasks, self-monitoring of behavioural outcome, demonstration of behaviour, prompt use of imagery and time management were included in four out of six apps.

Conclusion

The present study explores a new arena for oral healthcare motivation and prevention in children through the use of mobile phone apps.
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