Search

Aim: To reach a consensus on a consistent strategy to adopt when screening patients for dental/periodontal infections and on the feasibility of providing dental treatment before cardiothoracic surgery, cardiovascular surgery or other cardiovascular invasive procedures. Methodology: A panel of experts from six Italian scientific societies was created. The deliberations of the panel were based on the RAND method. From an initial systematic literature review, it became clear that a consensually validated protocol for the reproducible dental screening of patients awaiting cardiac interventions was considered mandatory by professionals with expertise in the dental, cardiologic and cardiac surgery areas. However, a systematic review also concluded that the treatment options to be provided, their prognosis and timing in relation to the physical condition of patients, had never been defined. Following the systematic review, several fundamental questions were generated. The panel was divided into two working groups each of which produced documents that addressed the topic and which were subsequently used to generate a questionnaire. Each member of the panel completed the questionnaire independently, and then, a panel discussion was held to reach a consensus on how best to manage patients with dental/periodontal infections who were awaiting invasive cardiac procedures. Results: A high level of agreement was reached regarding all the items on the questionnaire, and each of the clinical questions formulated were answered. Three tables were created which can be used to generate a useful tool to provide standardized dental/periodontal screening of patients undergoing elective cardiovascular interventions and to summarize both the possible oral and cardiovascular conditions of the patient and the timing available for the procedures considered. Conclusions: Upon publication of this consensus document, the dissemination of the information to a wide dental and cardiac audience should commence. The authors hope that this consensus will become a model for the development of a dedicated protocol, ideally usable by heart and dental teams in the pre‐interventional preparation phase. [ABSTRACT FROM AUTHOR]

The Italian scientific societies of cardiology (SIC and ANMCO), cardiothoracic surgery, endodontics, and periodontology realized that a specific protocol addressing preoperative dental/peri-dental screening in patients undergoing elective cardiothoracic surgery was lacking in the literature. As a consequence, they projected and then realized in 2019 a consensus document to establish the modalities for such a diagnostic and therapeutic screening, whose related options and timing depend on the patient's physical conditions as well as the time available before surgery. A high level of agreement was reached by the experts involved in the release of the consensus document and each clinical issue was addressed adequately. Three tables were released, with the aim of sharing a standardized protocol for the perioperative dental/peri-dental screening of patients who are waiting for elective cardiothoracic procedures. The authors of the consensus document, which has been widely diffused by all the involved scientific societies, hope that it can be largely accepted and applied, during the multidisciplinary phase preceding cardiovascular surgery the most.

Apexification is an endodontic technique used in immature necrotic teeth, the primary goal of which is to induce a calcified barrier in roots with open apices and to promote the continuation of apical root development. A 7-year-old patient with a coronal fracture in a maxillary central incisor was treated with an apexification technique using calcium hydroxide. The apical closure was obtained after one year, then a permanent root canal filling was performed. The tooth was monitored for a period of 20 years, up to when a trauma caused its extraction. The newly formed root was analyzed macroscopically, histologically and through scanning electron microscopy. A morphologically normal root was observed, with a large apex and accessory foramina, showing a combination of tissue structures similar to secondary and tertiary dentine, close to amorphous mineralized areas. Despite the final evolution of the case, calcium hydroxide apexification is a good therapy in order to treat pulp necrosis in an immature tooth, leading to complete development of the root and allowing the tooth to be kept in the mouth., (Copyright © 2017 Elsevier GmbH. All rights reserved.)

Purpose: To evaluate whether it is more effective to complete endodontic treatment in a single visit or in two visits with 1-week intracanal calcium hydroxide medication in symptomatic teeth and teeth with periapical lesions., Materials and Methods: One hundred and ninety-nine patients, with one symptomatic tooth or a tooth with a periapical lesion, were randomised, according to a parallel group design, to receive a complete endodontic treatment in a single visit (99 patients) or in two visits with 1-week intracanal calcium hydroxide medication (100 patients), at two centres. Patients were followed for up to 1 year post-treatment and the outcome measures were tooth loss, radiographic healing, any complication, post-treatment pain and amount of painkillers used., Results: Seven patients dropped out from the single-visit and ten patients from the two-visit group (all patients from one centre only). One patient lost his tooth from the single-visit and two patients from the two-visit group (difference in proportion = -0.01; 95% CI: -0.05 to 0.03; P = 0.619). Five single-visit patients and nine two-visit patients experienced one complication each (difference in proportion = -0.05; 95% CI: -0.12 to 0.03; P = 0.278). There were no statistically significant differences in tooth loss and complications. One year after treatment, complete radiographic healing was observed in 22 patients of the single-visit group and in 19 patients of the two-visit group; improvement in 43 patients of the single-visit group and in 54 patients of the two-visit group; and no changes/worsening in 24 patients of the single-visit group and in 15 patients of the two-visit group. There were no statistically significant differences in radiographic healing between the two groups (P = 0.509). Pre-treatment pain was reported by 68 single-visit patients and by 68 two-visit patients; 1-week post-treatment pain was reported by 27 single-visit patients and by 46 two-visit patients, and 2-week post-treatment pain was reported by 2 single-visit patients and 11 two-visit patients. For the first week, an average of 0.53 ± 1.23 tablets was taken by single-visit patients and 1.44 ± 3.32 tablets by two-visit patients. For the second week, no single-visit patients needed tablets and in the two-visit group the average was 0.37 ± 1.72 tablets. Patients of the two-visits group had statistically significant more post-treatment pain at 1 (P = 0.002) and 2 weeks (P = 0.011), and took more ibuprofen tablets at 1 (difference = -0.92; 95% CI: -1.62 to -0.21; P = 0.011) and 2 weeks after treatment (difference = -0.37; 95% CI: -0.72 to -0.03; P = 0.033), than in patients treated in a single visit., Conclusions: One year after treatment, both groups achieved similar clinical results; however, patients endodontically treated in a single visit suffered less postoperative pain and took less analgesics than patients treated in two visits, therefore a single-visit treatment should be recommended. Conflict-of-interest statement: This trial was self-funded and the authors have no conflict of interests to declare, however, rotary instruments were kindly provided by Sweden & Martina, Due Carrare PD, Italy.

Purpose: To evaluate the 10-year prognosis of consecutively endodontically treated or retreated teeth and to investigate some of the prognostic factors which could predict the long-term outcome of endodontic therapy., Materials and Methods: This retrospective cohort study included any patient who had endodontically treated or retreated teeth from 1986 to 1998 by a single operator in a private practice. Outcome measures were clinical and radiographic success assessed by the operator, radiographic success assessed by an independent outcome assessor and complications evaluated 10 years after treatment. Descriptive statistics, life table, Kaplan-Meier and Cox regression analyses for success were fitted., Results: A total of 411 patients with 1175 endodontically treated teeth were identified. Ten years after treatment 102 patients (24.8%) with 223 (19.0%) teeth were lost at the follow-up. The number of teeth that were originally treated and retreated were 704 and 471, respectively. Thirty-two teeth (2.7%) had one complication, which was successfully treated. A total of 988 (84.1%) teeth were considered a complete success, 46 (3.9%) a partial success, 52 (4.4%) a partial failure and 68 (5.8%) had to be extracted according to the treating clinician. For 21 teeth (1.8%) there was no follow-up information. The radiographic healing of 1086 teeth was evaluated by an independent assessor: 980 (90.2%) showed complete healing, 52 (4.8%) improvement, and 54 (5.0%) no change or worsening. The life-table analysis showed 93% of teeth surviving at 10 years after endodontic treatment. There were no differences for survival rates between teeth treated for the first time and those that were retreated (Kaplan-Meier). Teeth retreated because of symptoms or for a periapical/lateral radiolucency were more likely to fail., Conclusions: Approximately 7% of endodontically treated teeth were extracted 10 years after treatment. Symptoms and radiolucency of teeth needing retreatment may be important predictors for failure.