Publications by authors named "Juan José Segura-Egea"

42 Publications

Relationship between Apical Periodontitis and Metabolic Syndrome and Cardiovascular Events: A Cross-Sectional Study.

J Clin Med 2020 Oct 4;9(10). Epub 2020 Oct 4.

Department of Odontostomatolgy, School of Medicine and Health Sciences (Dentistry)-Dental Hospital, University of Barcelona, 08970 L'Hospitalet de Llobregat, Barcelona, Spain.

Aim: Both apical periodontitis (AP) and metabolic syndrome (MetS) are associated with atherosclerotic cardiovascular disease (ACVD), the main cause of cardiovascular events. The aim of this study was to investigate the prevalence of AP and the oral inflammatory burden in control subjects and patients suffering cardiovascular events, analyzing the possible association between AP and the oral inflammatory burden with MetS.

Materials And Methods: Using a cross-sectional design, 83 patients suffering a cardiovascular event were recruited in the study group (SG), and 48 patients without cardiovascular events were included in the control group (CG). Periapical index (PAI) was used to diagnose AP, and total dental index (TDI) was used to assess the total oral inflammatory burden. Diagnosis of MetS was made by meeting three or more American Heart Association Scientific Statement components.

Results: In the multivariate logistic regression analysis, the number of teeth with AP (OR = 2.3; 95% C.I. = 1.3-4.3; = 0.006) and TDI scores (OR = 1.5; 95% C.I. = 1.2-1.9; = 0.001), significantly correlated with cardiovascular events. MetS was strongly associated (OR = 18.0; 95% C.I. = 6.5-49.7; = 0000) with cardiovascular events. Higher TDI scores were significantly associated with MetS (OR = 1.3; 95% C.I. = 1.1-1.6; = 0.003. Neither the number of root-filled teeth (RFT) (OR = 0.9; 95% C.I. = 0.6-1.3; = 0.61) nor the number of teeth with apical periodontitis (OR = 1.1; 95% C.I. = 0.8-1.7; = 0.49) were associated with MetS.

Conclusions: Apical periodontitis is significantly associated with cardiovascular events. Total oral inflammatory burden assessed by TDI, but not AP alone, is associated with MetS.
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http://dx.doi.org/10.3390/jcm9103205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600401PMC
October 2020

A Microstructure Insight of MTA Repair HP of Rapid Setting Capacity and Bioactive Response.

Materials (Basel) 2020 Apr 2;13(7). Epub 2020 Apr 2.

Materials Science Institute of Seville (ICMS), Joint CSIC-University of Seville Center, 41092 Seville, Spain.

Mineral trioxide aggregate (MTA) is considered a bioactive endodontic material, which promotes natural mineralization at the material-tooth tissue interface. MTA Repair HP stands out because of the short setting time and the quick and effective bioactive response in vitro. The bioactivity, depens on material composition and microstructure. This work is devoted to analyze MTA Repair HP microstructural features, of both the powder precursor and set material, to get insights into the material physicochemical parameters-functionality performance relationships. Transmission electron microscopy (TEM), and field emission gun scanning electron microscopy (FEG-SEM) coupled with energy-dispersive X-ray (EDX) analyses were performed. X-ray diffraction (XRD) measurements were carried out at different times to investigate setting process. Bioactivity evaluation in vitro was carried out by soaking the processed cement disk in simulated body fluid (SBF). The presented results point out those MTA Repair HP precursor material characteristics of tricalcium silicate particles of nanometric size and high aspect ratio, which provide an elevated surface area and maximized components dispersion of calcium silicate and very reactive calcium aluminate. The MTA Repair HP precursor powder nanostructure and formulation, allows a hydration process comprising silicate hydrate structures, which are very effective to achieve both fast setting and efficient bioactive response.
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http://dx.doi.org/10.3390/ma13071641DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7178307PMC
April 2020

Apical Periodontitis and Diabetes Mellitus Type 2: A Systematic Review and Meta-Analysis.

J Clin Med 2020 Feb 17;9(2). Epub 2020 Feb 17.

Department of Stomatology, School of Dentistry, University of Sevilla, 41009 Sevilla, Spain.

Objective: Investigate if there is an association between apical periodontitis and diabetes mellitus.

Material And Methods: A bibliographic search was performed on Medline/PubMed, Scopus and Cochrane databases using the keywords apical periodontitis and diabetes mellitus. Published papers written in English and performed on animals or humans were included. Meta-analysis was performed using the OpenMeta (analyst) tool for the statistical analysis. The variables analyzed were the prevalence of Apical Periodontitis (AP) among teeth and patients with Diabetes Mellitus (DM).

Results: Of the total studies found, only 21 met the inclusion criteria. Ten clinical studies on animals, ten studies on humans and a systematic review were included. Meta-analysis shows that the prevalence of teeth with apical periodontitis among patients with diabetes mellitus has an odds ratio of 1.166 corresponding to 507 teeth with AP + DM and 534 teeth with AP without DM. The prevalence of patients with AP and DM shows an odds ratio of 1.552 where 91 patients had AP + DM and 582 patients AP without DM.

Conclusion: Scientific evidence suggests that there could be a common physiopathological factor between apical periodontitis and diabetes mellitus but more prospective studies are needed to investigate the association between these two diseases.
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http://dx.doi.org/10.3390/jcm9020540DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074097PMC
February 2020

Influence of the Pecking Motion Frequency on the Cyclic Fatigue Resistance of Endodontic Rotary Files.

J Clin Med 2019 Dec 24;9(1). Epub 2019 Dec 24.

Department of Endodontics, School of Health Sciences, University of Zaragoza, 22006 Aragorn, Spain.

Purpose: To analyze the influence of the pecking motion frequency on the cyclic fatigue resistance of endodontic rotary files.

Material And Methods: Sixty PlexV 25.06 endodontic rotary files were selected and distributed into three groups: 30 movements/min ( = 20), 60 movements/min ( = 20), and 120 movements/min ( = 20). A dynamic cyclic fatigue device was designed using Computer Aided Design/ Computer Aided Engineering (CAD/CAE) technology and manufactured by 3D impressions to simulate the pecking motion performed by an operator. Failures of the endodontic rotary files were detected by a Light-Emitting Diode (LED)/Light-Dependent Resistor (LDR) system controlled by an Arduino-Driver complex and management software. Endodontic rotary files were tested on an artificial root canal manufactured by wire electrical discharge machining (EDM), with similar dimensions to those of the instrument under examination. Endodontic rotary files were used following the manufacturer's recommendations. The results were analyzed by ANOVA and Weibull statistics.

Results: All pairwise comparisons revealed statistically significant differences in all three variables, except for the difference in the number of cycles between the groups with 60 and 120 movements/min ( = 0.298). The scale distribution parameter of Weibull statistics showed statistically significant differences in all three variables, except for the differences in the number of cycles between groups with 30 and 60 movements/min ( = 0.0722). No statistically significant differences in the three variables were observed for the shape distribution parameter.

Conclusion: A low frequency of pecking motion is recommended to reduce the risk of failure of endodontic rotary files associated with cyclic fatigue.
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http://dx.doi.org/10.3390/jcm9010045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7020062PMC
December 2019

Physicochemical parameters - hydration performance relationship of the new endodontic cement MTA Repair HP.

J Clin Exp Dent 2019 Aug 1;11(8):e739-e744. Epub 2019 Aug 1.

Materials Science Institute of Sevilla (ICMS), Joint CSIC-University of Sevilla Center, Sevilla, Spain.

Background: To characterize the chemical composition and textural parameters of the MTA Repair HP precursor powder and their influence to hydration performance.

Material And Methods: Un-hydrated precursor material was characterized by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), X-ray fluorescence (XRF), laser diffraction (LD), N2 physisorption and field emission gun scanning electron microscopy (FEG-SEM). Setting time was assessed according to ASTM specification C 266. Hydrated material was analysed by XRD, FT-IR, energy dispersive X-ray (EDX) analysis and FEG-SEM.

Results: Ca3SiO5 and Ca2SiO4, in addition to CaWO4 as radiopacifier are the main compositional phases. Other measured parameter indicates high specific surface area of 4.8 m2 g-1, high aluminium content of 1.7 wt.% and low initial and final setting times of 12 and 199 min, respectively. Singular microstructural features consisting of high aspect ratio nanoparticles are main constituents of un-hydrated precursor. Besides, FEM-SEM observation shows notably growth of hexagonal shaped plate-like morphologies homogeneously distributed along the sample during hydration process.

Conclusions: The short setting time measured for HP Repair, is correlated with high surface area of precursor powder, high Al content and the absence of compositional sulphate phases. Bioactive endodontic cements, hydration performance, MTA HP Repair, physicochemical parameters.
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http://dx.doi.org/10.4317/jced.56013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6776399PMC
August 2019

Low-level laser therapy in patients with Burning Mouth Syndrome: A double-blind, randomized, controlled clinical trial.

J Clin Exp Dent 2019 Feb 1;11(2):e162-e169. Epub 2019 Feb 1.

Facultative Director and Clinical Head of the Surgical Medical Area of the Odontological Hospital University of Barcelona.

Background: Evaluate the effect of LLLT in the treatment of burning mouth syndrome (BMS).

Material And Methods: Twenty-one BMS patients were randomly assigned to two groups: 12 in the laser group (LG) and 9 in the control group (CG). Patients in the LG underwent 2-week sessions of LLLT for 4 weeks. The spot tip area of this tool is 0.088cm2, semi-conductor GaAlAs, with a wavelength of 808nm ±5nm (infrared), 200 mW output power, 1.97W/cm2 of power density, 3 J energy per point and application time 15 seconds per point. LLLT was applied punctually, in continuous emissions, on each of the sites where there was a symptom. Symptoms were evaluated with a visual analogue scale (VAS) and patient psychological profiles were assessed using the Hospital Anxiety-Depression Scale. No side effects were recorded. Statistical analysis was carried out via ANOVA and logistic regression analysis.

Results: The initial VAS score mean was 8.9 for the LG and 8.3 for the CG ( >0.05). After the eighth session the VAS score was 5.5 and 5.8 respectively, and at two months it was 4.7 and 5.1 respectively. Improvement variables were established by dichotomizing the pain scales. We obtained levels of significance for the improvement variable for the LG at the two-month follow-up (=0.0038) and for the univariate analysis of the treatment. The improvement was marginally significant in the multivariant analysis of: dry mouth, dysgeusia, pain and the treatment (=0.0538).

Conclusions: LLLT may be an alternative treatment for the relief of oral burning in patients with BMS. Burning mouth syndrome, oral pain, laser dentistry, laser therapy, low intensity laser therapy.
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http://dx.doi.org/10.4317/jced.55517DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6383904PMC
February 2019

Higher hydration performance and bioactive response of the new endodontic bioactive cement MTA HP repair compared with ProRoot MTA white and NeoMTA plus.

J Biomed Mater Res B Appl Biomater 2019 08 14;107(6):2109-2120. Epub 2019 Jan 14.

Materials Science Institute of Seville (ICMS), Joint CSIC-University of Seville Center, Sevilla, Spain.

The aim of this study was to characterize the hydration performance and the bioactive response of the new bioactive endodontic cement MTA HP repair (HP), comparing its physicochemical parameters with those of ProRoot MTA White (Pro) and NeoMTA Plus (Neo). Un-hydrated precursor materials were characterized by X-ray fluorescence, laser diffraction, N physisorption and field emission gun scanning electron microscopy (FEG-SEM). Setting time was assessed according to ASTM specification C 266. Hydrated materials were analyzed by X-ray diffraction, Fourier transform infrared spectroscopy (FT-IR) and (FEG-SEM). Bioactivity evaluation in vitro was carried out, by soaking processed cement disk in simulated body fluid (SBF) during 168 h. The cements surface was studied by FT-IR, FEG-SEM, and energy dispersive X-ray. Release to the SBF media of ionic degradation products was monitored using inductively coupled plasma atomic emission spectroscopy. HP showed shorter initial setting time compared to Pro and Neo and produce a quick and effective bioactive response in vitro in terms of phosphate phase surface coating formation. This higher bioactive response for HP is correlated with increasing calcium aluminate content, increasing surface area of un-hydrated powder precursor and the increasing release capacity of Si ionic products of the final hydrated product. The higher bioactive response of MTA HP repair highlights this material, as very interesting to further investigate its performance to improve the outcome of vital pulp therapy procedures. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 2109-2120, 2019.
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http://dx.doi.org/10.1002/jbm.b.34304DOI Listing
August 2019

Leptin stimulates DMP-1 and DSPP expression in human dental pulp via MAPK 1/3 and PI3K signaling pathways.

Arch Oral Biol 2019 Feb 20;98:126-131. Epub 2018 Nov 20.

Department of Stomatology (Endodontics section), School of Dentistry, University of Sevilla, C/ Avicena s/n, 41009, Sevilla, Spain. Electronic address:

Introduction: To investigate the physiological function of leptin in human dental pulp, and to determine the specific pathways implicated in its effect.

Methods: Twenty-seven dental pulp samples were obtained from human third molars. Pulp samples were treated with or without human recombinant leptin. Leptin functional effect was analyzed in terms of regulation of the synthesis levels of DSPP and DMP-1, determined by immunoblot.

Results: Leptin stimulated DMP-1 and DSPP synthesis in all human dental pulp specimens. The stimulatory effect of leptin on DMP-1 and DSPP synthesis was partially prevented by blocking mitogen-activated protein kinase (MAPK 1/3) and phosphatidylinositol 3 kinase (PI3K) pathways, respectively.

Conclusions: The present study demonstrates the functional effect of leptin in human dental pulp stimulating the expression of DMP-1 and DSPP, both proteins implicated in dentinogenesis. Leptin stimulates DSPP expression via PI3K pathway and DMP-1 synthesis via MAPK 1/3 pathway. These results support the role of leptin in pulpal reparative response, opening a new research line that could have translational application to the clinic in vital pulp therapy procedures.
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http://dx.doi.org/10.1016/j.archoralbio.2018.11.019DOI Listing
February 2019

Comparative study of debris and smear layer removal with EDTA and Er,Cr:YSGG laser.

J Clin Exp Dent 2018 Jun 1;10(6):e598-e602. Epub 2018 Jun 1.

Department of Stomatology, School of Dentistry, University of Seville.

Background: To evaluate , the ability in removing debris and Smear Layer of 17% EDTA and Er,Cr:YSGG laser.

Material And Methods: 58 unirradicular teeth were instrumented with MTwo® and divided into 3 groups according to irrigation protocol: 17%EDTA, laser and a combination of 17%EDTA and laser. All samples were analyzed in the apical and middle third with Scanning Electron Microscope. The Chi-cuadrado and McNemar tests were used to determine the statistical analysis and data processing and analysis was performed with the statistical package StatGraphics Centurion XVI.

Results: Debris analysis showed statistical significant differences when compared EDTA vs laser and EDTA vs EDTA+laser in the middle third. The Smear Layer removal showed statistical significant differences in the middle third when compared EDTA vs laser and EDTA vs EDTA+laser.

Conclusions: Laser showed a greater cleaning capacity than EDTA in the middle third; the cleanliness was even better when combined laser with EDTA, so the effect is accumulative. Root canal treatment, Smear Layer, Er,Cr:YSGG laser, debridement.
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http://dx.doi.org/10.4317/jced.54936DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005092PMC
June 2018

Use of Platelet-rich Plasma in Endodontic Procedures in Adults: Regeneration or Repair? A Report of 3 Cases with 5 Years of Follow-up.

J Endod 2017 Aug 27;43(8):1294-1301. Epub 2017 Jun 27.

School of Dentistry, Barcelona University/Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute), IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.

Introduction: Regenerative endodontic procedures (REP) are a promising alternative for necrotic immature teeth in adolescents and children, but very little evidence is available on this alternative in long-lasting necrotic teeth with open apices in adults. REPs are designed to replace damaged structures of the pulp-dentin complex, but no regeneration has been obtained in any of the cases described in necrotic immature permanent teeth with apical periodontitis with histologic results. The results are limited to periapical tissue repair with increasing root length, thickening of the root walls, and apical closure in young patients. In this series of cases, we report on the outcomes of the adjuvant use of autologous platelet-rich plasma (PRP) in endodontic therapy in adults by monitoring periapical tissue healing with periodic periapical radiographs and cone-beam computed tomographic scanning.

Methods: Three teeth with apical periodontitis and open apices in 3 different patients from 21 to 35 years-old were evaluated. An REP was performed with the adjuvant use of PRP.

Results: At controls, complete disappearance of the radiolucent lesions and the presence of calcified structures forming bridges occupying the pulp lumen were observed but not an ostensible thickening of root walls with a regeneration of pulp-dentin complex.

Conclusions: The repair of periapical tissues with REPs of open apex teeth with apical periodontitis and in nonsurgical endodontic retreatment appears to be feasible in adults, but no regeneration was obtained in any of the present cases. The use of PRP may be a good choice as an autologous matrix because of its stability and induction; it contains growth factors and bioactive molecules like transforming growth factor beta, bone morphogenic proteins, insulinlike growth factors, and angiogenetic growth factors, which stimulate collagen production, angiogenesis, and cell differentiation. Anti-inflammatory and antibacterial properties have also been reported for this preparation, which are involved in all processes of repair.
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http://dx.doi.org/10.1016/j.joen.2017.04.010DOI Listing
August 2017

Worldwide pattern of antibiotic prescription in endodontic infections.

Int Dent J 2017 Aug 17;67(4):197-205. Epub 2017 Apr 17.

Department of Stomatology (Comprehensive Dentistry), School of Dentistry, University of Sevilla, Sevilla, Spain.

Background: Odontogenic infections, and especially endodontic infections, are polymicrobial, involving a combination of Gram-positive and Gram-negative facultative anaerobes and strictly anaerobic bacteria. Therefore, antibiotics can be used as an adjunct to endodontic treatment. However, most chronic and even acute endodontic infections can be successfully managed by disinfection of the root-canal system, which eliminates the source of infection, followed by abscess drainage or tooth extraction, without the need for antibiotics. The literature provides evidence of inadequate prescribing practices by dentists. The aim of this concise review was to analyse the worldwide pattern of antibiotic prescription in endodontic infections.

Methods: Comprehensive searches were conducted in MEDLINE/PubMed, Wiley Online Database, Web of Science and Scopus. The databases were searched up to 13 March 2016 for studies in which dentists used systemic antibiotics to treat endodontic lesions and which reported data on the type of antibiotic prescribed and on the diagnosis of the endodontic disease treated.

Results: The electronic and hand searches identified 69 titles, of which 25 were included in the final analysis. Amoxicillin was reported as the drug of choice for endodontic infections in most countries, and clindamycin and erythromycin were the choice for patients allergic to penicillin. Dentists worldwide prescribe antibiotics for non-indicated conditions, such as pulpitis.

Conclusion: Antibiotics are overprescribed for the management of endodontic infections. It is necessary to improve antibiotic-prescribing habits in the treatment of endodontic infections, as well as to introduce educational initiatives to encourage the coherent and proper use of antibiotics in such conditions.
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http://dx.doi.org/10.1111/idj.12287DOI Listing
August 2017

Role of leptin as a link between metabolism and the immune system.

Cytokine Growth Factor Rev 2017 Jun 4;35:71-84. Epub 2017 Mar 4.

Department of Medical Biochemistry and Molecular Biology and Immunology, Medical School and Department of Clinical Biochemistry, Virgen Macarena University Hospital, University of Seville, Spain. Electronic address:

Leptin is an adipocyte-derived hormone not only with an important role in the central control of energy metabolism, but also with many pleiotropic effects in different physiological systems. One of these peripheral functions of leptin is a regulatory role in the interplay between energy metabolism and the immune system, being a cornerstone of the new field of immunometabolism. Leptin receptor is expressed throughout the immune system and the regulatory effects of leptin include cells from both the innate and adaptive immune system. Leptin is one of the adipokines responsible for the inflammatory state found in obesity that predisposes not only to type 2 diabetes, metabolic syndrome and cardiovascular disease, but also to autoimmune and allergic diseases. Leptin is an important mediator of the immunosuppressive state in undernutrition status. Placenta is the second source of leptin and it may play a role in the immunomodulation during pregnancy. Finally, recent work has pointed to the participation of leptin and leptin receptor in the pathophysiology of inflammation in oral biology. Therefore, leptin and leptin receptor should be considered for investigation as a marker of inflammation and immune activation in the frontier of innate-adaptive system, and as possible targets for intervention in the immunometabolic mediated pathophysiology.
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http://dx.doi.org/10.1016/j.cytogfr.2017.03.001DOI Listing
June 2017

Regenerative Endodontic Procedures: A Perspective from Stem Cell Niche Biology.

J Endod 2017 Jan;43(1):52-62

Materials Science Institute of Seville (ICMS), Joint CSIC-University of Seville Center, Seville, Spain; Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), University of Málaga, Málaga, Spain. Electronic address:

Introduction: Endodontics uses cell therapy strategies to treat pulpal and periapical diseases. During these therapies, surgeons aim to reconstruct the natural microenvironments that regulate the activity of dental stem cells.

Methods: We searched for more than 400 articles in PubMed using key words from regenerative endodontics and dental stem cell biology. In 268 articles, we reviewed what factors may influence histologic results after preclinical dental treatments that use regenerative endodontic procedures after pulpectomy.

Results: Several factors, such as the origin of stem cells, the biomimicry of scaffolds used, and the size of lesions, are considered to influence the histologic appearance of the regenerated pulp-dentin complex after treatments. Information is accumulating on transcription factors that generate the pulp-dentin complex and survival/trophic factors that would benefit niche recovery and histologic results.

Conclusions: In this article, we discuss the noninterchangeability of stem cells, the influence of dentin-entrapped molecule release on pulp regeneration and survival of stem cells, and the need of positional markers to assess treatments histologically. The ex vivo amplification of appropriate dental stem cells, the search for scaffolds storing the molecular diversity entrapped in the dentin, and the use of positional transcription factors as histologic markers are necessary to improve future preclinical experiments.
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http://dx.doi.org/10.1016/j.joen.2016.09.011DOI Listing
January 2017

Histologic characterization of regenerated tissues after pulp revascularization of immature dog teeth with apical periodontitis using tri-antibiotic paste and platelet-rich plasma.

Arch Oral Biol 2016 Nov 26;71:122-128. Epub 2016 Jul 26.

Department of Stomatology, School of Dentistry, University of Sevilla, C/Avicena s/n, 41009 Sevilla, Spain. Electronic address:

Introduction: This study evaluates histologically the efficacy of 4 revascularization protocols in necrotic-infected immature dog teeth with apical periodontitis (AP).

Methods: Forty double-rooted immature premolar teeth from 4 female Beagle dogs aged 5 months were used. Four teeth were left untouched as negative controls; the other 36 teeth were infected to develop pulp necrosis and AP. Four teeth were left untreated and assigned to the positive control group. The last 28 teeth were randomly assigned into four experimental groups of 8 teeth, each one treated with a different treatment protocol: A1, sodium hypochlorite (SH)+blood clot (BC); A2, SH+platelet-rich plasma (PRP); B1, SH+modified tri-antibiotic paste (mTAP)+BC; B2, SH+mTAP+PRP. The animals were sacrificed, histologic sections were prepared and three parameters were assessed: (1) presence or absence of new hard tissue on the internal root dentinal walls, (2) presence or absence of continued apical closure, and (3) presence or absence of vital tissue within the canal space.

Results: Significant differences (p<0.05) between the four experimental groups were evident in the percentage of teeth showing histological apical closure (34.5%) and vital tissue within the canal space (68.8%). Group B2 showed the maximal improvement in the three variables assessed (p<0.05). Group A1 showed the minimum percentages in the three parameters assessed (p<0.05).

Conclusions: These results suggest that an intracanal dressing of mTAP, and the use of PRP as scaffold, improves the success rate of the revascularization procedure.
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http://dx.doi.org/10.1016/j.archoralbio.2016.07.007DOI Listing
November 2016

Pulp Revascularization of Immature Dog Teeth with Apical Periodontitis Using Triantibiotic Paste and Platelet-rich Plasma: A Radiographic Study.

J Endod 2015 Aug 14;41(8):1299-304. Epub 2015 Jun 14.

Department of Stomatology, School of Dentistry, University of Sevilla, Sevilla, Spain. Electronic address:

Introduction: This study evaluates radiographically the efficacy of 4 revascularization protocols in necrotic-infected immature dog teeth with apical periodontitis (AP).

Methods: Forty double-rooted immature premolar teeth from 4 female beagle dogs aged 5 months were used. Four teeth were left untouched as negative controls; the other 36 teeth were infected to develop pulp necrosis and AP following different treatment protocols. Four teeth were left untreated and assigned to the positive control group, and the last 28 teeth were randomly assigned into 4 experimental groups of 8 teeth: A1, sodium hypochlorite (NaOCl) + a blood clot; A2, NaOCl + platelet-rich plasma (PRP); B1, NaOCl + modified triantibiotic paste (mTAP) + a blood clot; and B2, NaOCl + mTAP + PRP. Teeth were monitored radiographically for 6 months regarding healing of periapical radiolucencies, thickening of the dentinal walls, and apical closure of roots.

Results: Significant differences (P < .05) between the 4 groups were evident in the percentage of teeth showing improvement of periapical radiolucencies (62.5%), continued radiographic thickening of radicular walls (53.1%), radiographic apical closure (43.8%), and deposition of hard tissue on radicular dentin walls (53.1%). Group B2 showed maximal improvement in the 3 variables assessed (P < .05). Group A1 showed the minimum percentages in the 3 parameters assessed (P < .05).

Conclusions: These results suggest that an intracanal dressing of mTAP and the use of PRP as scaffold improves the success rate of the revascularization procedure.
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http://dx.doi.org/10.1016/j.joen.2015.05.002DOI Listing
August 2015

Viruses in pulp and periapical inflammation: a review.

Odontology 2016 May 22;104(2):184-91. Epub 2015 Mar 22.

Department of Odonto-Stomatology, School of Dentistry, University of Barcelona, Barcelona, Spain.

The presence of viruses in endodontic disease has been studied in the last decade. Their presence is associated with periapical radiolucency and with clinical findings, such as pain. The aim of this review is to analyze the scientific evidence currently published about viruses in pulp and periapical inflammation, and its possible clinical implications. A literature review was carried out using the Medline/Pubmed database. The search was performed, in English and Spanish, using the following keyword combinations: virus AND endodontic; virus AND periapical; virus AND pulpitis; herpesvirus AND periapical; papillomavirus AND periapical. We subsequently selected the most relevant studies, which complied with the search criterion. A total of 21 articles were included, of which 18 detected the present of viruses in the samples. In 3 of the studies, viral presence was not found in the samples studied. The Epstein-Barr virus was found in about 41 % of cases compared to controls, in which it was present in about 2 %. The main association between viruses and endodontic pathosis is between Cytomegalovirus and Epstein-Barr virus; these are found in 114 of the 406 samples of different endodontic pathosis. Some evidence supports that the Epstein-Barr virus is present in a significant number of endodontic diseases, without exact knowledge of their action in these diseases.
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http://dx.doi.org/10.1007/s10266-015-0200-yDOI Listing
May 2016

Glycated hemoglobin levels and prevalence of apical periodontitis in type 2 diabetic patients.

J Endod 2015 May 7;41(5):601-6. Epub 2015 Feb 7.

Department of Stomatology, School of Dentistry, University of Sevilla, Sevilla, Spain. Electronic address:

Introduction: The purpose of this investigation was to study the possible association between the prevalence of apical periodontitis (AP) and the glycemic control of type 2 diabetic patients.

Methods: In a cross-sectional study, the radiographic records of 83 type 2 diabetic patients were examined. Glycemic control was assessed by the mean glycated hemoglobin (HbA1c level). AP was diagnosed as radiolucent periapical lesions (RPLs) using the periapical index score. The Student t test, chi-square test, and logistic regression analysis were used in the statistical analysis.

Results: Based on the HbA1c levels, 2 groups of diabetic patients were established: the HbA1c good control group (GCG, n = 24, HbA1c <6.5%) and the HbA1c poor control group (PCG, n = 59, HbA1c ≥6.5%). In the total sample, RPLs in 1 or more teeth were found in 62.7%, and no significant differences between GCG and PCG groups were observed (P = .13). At least 1 root-filled tooth was found in 32.5% of diabetic patients; this percentage was comparable in both HbA1c groups (P = .68). The prevalence of RPLs in RFT (29.6%) was similar in the GCG compared with the PCG (P = .94). Multivariate logistic regression analysis showed that worse periapical status correlated significantly with HbA1c levels ≥6.5% in type 2 diabetic patients (odd ratio = 3.8; 95% confidence interval, 1.1-13.0; P = .03).

Conclusions: HbA1c levels of diabetic patients are associated with periapical status. Data reported in the present study, together with the results of previous studies, further support a relationship between glycemic control and periapical inflammation in diabetic patients.
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http://dx.doi.org/10.1016/j.joen.2014.12.024DOI Listing
May 2015

Root canal disinfection of immature dog teeth with apical periodontitis: Comparison of three different protocols.

J Clin Exp Dent 2014 Oct 1;6(4):e357-63. Epub 2014 Oct 1.

Department of Stomatology (Endodontic Section), School of Dentistry, University of Sevilla, C/ Avicena s/n, 41009-Sevilla, Spain.

Objectives: The present in vivo study was designed to assess the efficacy of 3 root canal disinfection protocols in immature dog teeth with apical periodontitis (AP).

Material And Methods: Forty immature premolars with pulp necrosis and AP of five Beagle dogs were used. Three experimental disinfection protocols were established. After irrigation with 40 ml 5.25% sodium hypochlorite using the Endovac system, in Group 1 canals were flushed with QMix solution; in Group 2, canals were flushed with QMix solution and 2% chlorhexidine gel dressing was placed for two weeks; and in Group 3, triantibiotic paste dressing was placed for two weeks. Canals were sampled after periapical lesions were radiographically visible (S1), after the first disinfection session (S2) and, in groups 2 and 3, after dressing (S3).

Results: After the first session of the disinfection protocol (S2), there was significant (p < 0.05) bacterial reduction in the three experimental groups. Microorganisms were absent in 100% of S2 samples in groups 1 and 2, and in 75% of group 3 (p > 0.05). After dressing, 87.5% of the S3 samples showed increased bacterial count: in group 2, CFU counts (median = 891) were significantly higher than in group 3 (median = 18) (p = 0.03).

Conclusions: In immature dog teeth with AP, root canal irrigation using QMix solution, with or without chlorhexidine gel dressing, or a triantibiotic paste dressing, provides the same level of disinfection than irrigation with 5.25% sodium hypochlorite alone in only one session. Key words:Apical periodontitis, chlorhexidine, Endovac, immature teeth, QMix solution, root canal disinfection, triantibiotic paste.
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http://dx.doi.org/10.4317/jced.51475DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4282901PMC
October 2014

Leptin promotes dentin sialophosphoprotein expression in human dental pulp.

J Endod 2015 Apr 10;41(4):487-92. Epub 2015 Jan 10.

Department of Stomatology (Endodontics Section), University of Sevilla, Sevilla, Spain. Electronic address:

Introduction: Leptin, an inflammation-related adipokine, and its receptor (LEPR) are expressed in human dental pulp. Dentin sialophosphoprotein (DSPP) is involved in dentinogenesis and the dental pulp reparative response. The cell type expressing LEPR in dental human pulp and the resultant effect of the binding of leptin to LEPR remain unknown. This study describes the immmunohistochemical localization of LEPR and the effect of leptin on DSPP expression in human dental pulp.

Methods: Twenty-five dental pulp specimens were obtained from freshly extracted caries-free and restoration-free human third molars. LEPR localization was examined by immunohistochemistry using the antihuman LEPR monoclonal antibody. The effect of leptin on DSPP expression was determined by immunoblot analysis and quantitative real-time polymerase chain reaction.

Results: Immunoreactivity for LEPR concentrated in the odontoblast layer but was not evident in the central zone of the dental pulp. Leptin dose dependently stimulated DSPP expression. Western blot analysis revealed the presence of a protein with an apparent molecular weight of ∼00 kDa, the estimated molecular weight of DSPP. The expression of DSPP messenger RNA was confirmed by quantitative real-time polymerase chain reaction, and the size of the amplified fragments (298 bp) was confirmed by agarose gel electrophoresis.

Conclusions: The present study shows that human dental pulp is immunoreactive for LEPR, with the immunoreactivity concentrated in the odontoblast layer, and that leptin stimulates, in a dose-dependent manner, DSPP protein and messenger RNA (mRNA) expression in human dental pulp. These findings further support the functional role of leptin in the dentin mineralization process and/or in dental pulp reparative and immune responses.
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http://dx.doi.org/10.1016/j.joen.2014.11.026DOI Listing
April 2015

Protocol for oral implant rehabilitation in a hemophilic HIV-positive patient with type C hepatitis.

Implant Dent 2014 Oct;23(5):622-5

*Associate Professor, Department of Stomatology, School of Dentistry, University of Seville, Seville, Spain. †Chairman, Hemophilia Unit, Hematology Service, Virgen del Rocío University Hospital, Seville, Spain. ‡Professor, Department of Stomatology, School of Dentistry, University of Seville, Seville, Spain. §Professor and Chairman, Special Care Dentistry, Department of Stomatology, School of Dentistry, University of Seville, Seville, Spain.

Case Report: A 46-year-old man with severe hemophilia A, stage A2 HIV infection and chronic hepatitis C genotype 1A, for whom the treatment plan included implant-supported prostheses in 2 mandibular edentulous sections. The protocol followed included factor VIII replacement concentrate and oral antifibrinolytic therapy. The right mandibular section was fitted with 3 Straumann implants (Ø 4.1 mm, length 10 mm), and the left mandibular section received 2 implants of the same characteristics. The patient showed no postoperative complications. After implant placement, the patient attended scheduled review appointments. After a 3-month period of osseointegration, the prosthesis was fitted.

Conclusions: Although, in this case, the treatment proved successful 2 years postrehabilitation and the protocol used seems safe and effective, long-term prospective studies are needed to evaluate the implant success rate in these patients.
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http://dx.doi.org/10.1097/ID.0000000000000145DOI Listing
October 2014

Influence of state anxiety and trate anxiety in postoperative in oral surgery.

Med Oral Patol Oral Cir Bucal 2014 Jul 1;19(4):e403-8. Epub 2014 Jul 1.

Facultad de Odontología de Sevilla, C/ Avicena s/n 41009, Sevilla, Spain,

Introduction: The aim of this article was to study the influence of anxiety (both state and trait) in postoperative recovery after extraction of third molar together, to establish the role of each of the aspects of anxiety in the results you obtained in an independent and complementary way.

Material And Method: We performed a prospective study of a consecutive series of 88 patients who underwent lower third molar extractions. Before being provided with any information about the operation, patients were asked to complete the Spielberger State-Trait Anxiety Inventory- Trait and State. We have evaluated postoperative swelling and pain, patients completed a 10-point visual analog scale (VAS) at home each day (at approximately the same time of day as the operation) until day 8 after surgery, when the sutures were removed.

Results: Regarding postoperative variables between positive and negative trait anxiety groups, consumption of analgesic drugs was higher in positive trait anxiety group in a statistically significant way, while these differences were detected only on specific occasions regarding pain and swelling.

Discussion: In the present study, anxiety was taken into account and showed a significant effect in explaining postoperative pain and taking analgesics.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4119318PMC
http://dx.doi.org/10.4317/medoral.19604DOI Listing
July 2014

Radiolucent periapical lesions and bone mineral density in post-menopausal women.

Gerodontology 2015 Sep 28;32(3):195-201. Epub 2013 Oct 28.

Department of Stomatology, School of Dentistry, University of Sevilla, Sevilla, Spain.

Purpose: To investigate the relationship between radiolucent periapical lesions and bone mineral density in post-menopausal women.

Material And Methods: Seventy-five post-menopausal women were recruited for the study. Bone mineral density was measured using dual-energy X-ray absorptiometry. Three groups were established: healthy bone group, osteopenic group and osteoporotic group. Periapical radiolucencies were diagnosed on the basis of examination of digital panoramic radiographs. Statistical analysis was carried out using anova and chi-squared tests, and logistic regression analysis.

Results: In both the osteopenic and osteoporotic groups, 25% of women showed at least one periapical radiolucency, whereas this was only 7.4% in the healthy bone group (odds ratio = 4.2; p = 0.061). After multivariate logistic regression analysis adjusting for covariates (age, number of teeth, number of root-filled teeth and number of teeth with coronal restorations), a marginally significant association was evident between bone mineral density and the presence of periapical radiolucencies (odds ratio = 1.9; CI 95% = 1.0-3.8; p = 0.050).

Conclusions: After adjusting for covariates, low bone mineral density is marginally associated with a higher frequency of radiolucent periapical lesions.
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http://dx.doi.org/10.1111/ger.12076DOI Listing
September 2015

Medical treatment of post-dental extraction peripheral painful traumatic trigeminal neuropathy.

Quintessence Int 2013 Oct;44(9):703-6

Department of Odontostomatology, School of Dentistry, Barcelona University, Health Campus University of Bellvitge, Barcelona, Spain.

Pain arising from surgical procedures that damage the inferior alveolar nerve typically responds poorly to classic therapies. The present case reports the successful medical treatment of this problem with a 10-day course of a corticosteroid and a concomitant 30-day course of an anticonvulsant.
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http://dx.doi.org/10.3290/j.qi.a29791DOI Listing
October 2013

Confocal microscopy: a valid approach to evaluate the three-dimensional characteristics of root-end cavities.

Med Oral Patol Oral Cir Bucal 2013 May 1;18(3):e542-6. Epub 2013 May 1.

University of Seville, Faculty of Odontology, c/Avicena s/n. 41009-Sevilla, Spain.

Objective: To analyze, using confocal microscope, the three-dimensional characteristics of the root-end cavity preparations completed in root apices of extracted teeth determining their area, perimeter, circularity and cavo-surface angle.

Study Design: Thirty-two single-rooted extracted teeth underwent endodontic treatment and apical resection. Root-end cavities were prepared according to 4 protocols, as follows: Group 1, stainless steel ultrasonic tips (SST) at 33 KHz power; Group 2, SST at 30 KHz power; Group 3, diamond-coated ultrasonic tips (DCT) at 30 KHz power; and Group 4, DCT at 33 KHz power. Finally, root-end cavity was evaluated using a confocal microscope, recording its area, perimeter, circularity and cavo-surface angle.

Results: The largest cavity perimeter was found in the Group 2 (4.8 ± 1.6 mm) (p > 0.05). Root-end cavities performed using SST showed larger areas than those performed with DCT (p = 0.03). The power of vibration or the tip type did not show correlation with the perimeter, circularity and cavo-surface angle of the root-end cavity (p > 0.05).

Conclusions: Confocal microscopy is a useful approach to study the three-dimensional characteristics of the root-end cavity.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3668887PMC
http://dx.doi.org/10.4317/medoral.18440DOI Listing
May 2013

Management of perforating internal root resorption with periodontal surgery and mineral trioxide aggregate: a case report with 5-year follow-up.

Int J Periodontics Restorative Dent 2013 Mar-Apr;33(2):e65-71

Department of Stomatology, School of Dentistry, University of Sevilla, Sevilla, Spain.

Internal root resorption (IRR) is characterized by progressive loss of tooth substance initiating at the root canal wall as a result of clastic activity. The use of periodontal surgery and mineral trioxide aggregate is a good approach to repair lesions with periodontal communication (perforating IRR). This case describes the treatment and follow-up of a maxillary central incisor with perforating IRR in a 56-year-old male patient where root canal treatment, periodontal surgery, and white mineral trioxide aggregate were employed to achieve complete repair and to restore function. Clinical findings and periapical radiographs indicated success after a 5-year follow-up.
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http://dx.doi.org/10.11607/prd.1417DOI Listing
February 2014

A comparison of the dental status and treatment needs of older adults with and without chronic mental illness in Sevilla, Spain.

Med Oral Patol Oral Cir Bucal 2013 Jan 1;18(1):e71-5. Epub 2013 Jan 1.

Department of Stomatology, (section of Gerodontology), School of Dentistry, University of Sevilla, Spain.

Objectives: To study the dental status and treatment needs of institutionalized older adults with chronic mental illness compared to a non-psychiatric control sample.

Study Design: The sample size was 100, in which 50 were psychogeriatric patients (study group; SG) classified according to DSM-IV, with a mean age of 69.6 ± 6.7 years, and 50 non-psychiatric patients (control group; CG), with a mean age of 68.3 ± 6.9 years. Clinical oral health examinations were conducted and caries were recorded clinically using the Decayed, Missing and Filled Teeth Index (DMFT). Results were analyzed statistically using the Student's t-test or analysis of variance.

Results: Caries prevalence was 58% and 62% in SG and CG, respectively. DMFT index was 28.3 ± 6.6 in SG and 21.4 ± 6.07 in CG (p < 0.01). Mean number of decayed teeth was higher in SG (3.1) compared to CG (1.8) (p=0.047). Mean number of missing teeth were 25.2 and 16.4 in SG and CG respectively (p<0.05). DMFT scores were higher in SG in all the age groups (p < 0.01). Mean number of teeth per person needing treatment was 3.4 in SG and 1.9 in CG (p= 0.037). The need for restorative dental care was significantly lower in the SG (0.8 teeth per person) than in the CG (1.7 teeth per person) (p = 0.043).

Conclusions: Institutionalized psychiatric patients have significantly worse dental status and more dental treatment needs than non-psychiatric patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3548649PMC
http://dx.doi.org/10.4317/medoral.18332DOI Listing
January 2013

Evaluation of apical preparations performed with ultrasonic diamond and stainless steel tips at different intensities using a scanning electron microscope in endodontic surgery.

Med Oral Patol Oral Cir Bucal 2012 Nov 1;17(6):e988-93. Epub 2012 Nov 1.

Faculty of dentistry, University of Seville, Sevilla, Spain.

Objective: The objective of our study is to analyse (with the help of scanning electron microscopes) the quality of the dental root surface and the appearance of dental cracks after performing apical preparations using two different types of ultrasonic tips.

Study Design: We used 32 single-rooted teeth that underwent a root canal and apical resection. Afterwards, the teeth were divided into 4 groups of 8 teeth each, with preparations of the apical cavities in the following manner: Group 1: stainless steel ultrasonic tip at 33 KHz. Group 2: stainless steel ultrasonic tip at 30 KHz. Group 3: diamond ultrasonic tip at 30 KHz. Group 4: diamond ultrasonic tip at 33 KHz. The quality of the root surface and the presence of cracks were evaluated by one single observer using a scanning electron microscope.

Results: All of the teeth in our study had cracks after the apical preparations. The mean number of cracks per tooth ranged between 6. ± 1.9 (group 1) and 3.5 ± 2.4 (group 4), with a significantly higher number found in the groups that used stainless steel tips (P=.03). The types of cracks produced involved: 8 complete cracks (4.5%), 167 incomplete cracks (94.4%), and 2 intradentinal cracks (1.1%), with no significant differences observed between the different frequencies used for each group.

Conclusions: Stainless steel ultrasonic tips provoked a larger number of cracks than diamond tips. The frequency of vibration used did not have any effect on the number of cracks found.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505721PMC
http://dx.doi.org/10.4317/medoral.17961DOI Listing
November 2012

Influence of root canal instrumentation and obturation techniques on intra-operative pain during endodontic therapy.

Med Oral Patol Oral Cir Bucal 2012 Sep 1;17(5):e912-8. Epub 2012 Sep 1.

Department of Endodontics, School of Dentistry, University of Sevilla, Facultad de Odontología, C/ Avicena s/n, 41009-Seville, Spain.

Objective: To analyse the influence of root canal instrumentation and obturation techniques on intra-operative pain experienced by patients during endodontic therapy.

Method And Materials: A descriptive cross-sectional study was carried out in Ponferrada and Sevilla, Spain, including 80 patients (46 men and 34 women), with ages ranged from 10 to 74 years, randomly recruited. Patient gender and age, affected tooth, pulpal diagnosis, periapical status, previous NSAID or antibiotic (AB) treatment, and root canal instrumentation and obturation techniques were recorded. After root canal treatment (RCT), patients completed a 10-cm visual analogue scale (VAS) that ranked the level of pain. Results were analysed statistically using the Chi-square and ANOVA tests and logistic regression analysis.

Results: The mean pain level during root canal treatment was 2.9±3.0 (median=2) in a VAS between 0 and 10. Forty percent of patients experienced no pain. Gender, age, arch, previous NSAIDs or AB treatment and anaesthetic type did not influence significantly the pain level (p>0.05). Pain during root canal treatment was significantly greater in molar teeth (OR=10.1; 95% C.I.=1.6-63.5; p=0.013). Root canal instrumentation and obturation techniques did not affect significantly patients' pain during root canal treatment (p>0.05).

Conclusion: Patients feel more pain when RCT is carried out on molar teeth. The root canal instrumentation and obturation techniques do not affect significantly the patients' pain during RCT.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3482542PMC
http://dx.doi.org/10.4317/medoral.18234DOI Listing
September 2012

Tobacco smoking and radiographic periapical status: a retrospective case-control study.

J Endod 2012 May 23;38(5):584-8. Epub 2012 Mar 23.

Department of Odontostomatology, School of Dentistry, University of Barcelona, Barcelona, Spain.

Introduction: The aim of this study was to investigate radiographically the relationship of tobacco smoking and periapical status by using a retrospective case-control study design.

Methods: The records of 79 controls and 79 age- and sex-matched cases were examined. Case was defined as a patient who has at least 1 radiographically detectable periapical lesion in a tooth. Control was defined as a patient who has no radiographically detectable periapical lesion in any teeth. Periapical status was assessed by using panoramic radiographs and the periapical index score. The history of smoking and diabetes, the number of teeth and root-filled teeth, and the quality of root fillings were recorded. Statistical analyses were conducted by using the Cohen kappa test, χ(2) test, Student's t test, and logistic regression analysis.

Results: Among the case subjects, 75% had antecedents of smoking, whereas in the control group only 13% had been smokers (odds ratio, 20.4; 95% confidence interval, 8.8-46.9; P = .0000). After multivariate logistic regression analysis adjusting for covariates (age, gender, number of teeth, root-filled teeth, root-filled teeth with a root filling technically unsatisfactory, and diabetes), a strong association was observed between the presence of at least 1 radiographically detectable periapical lesion and antecedents of smoking (odds ratio, 32.4; 95% confidence interval, 11.7-89.8; P = .0000).

Conclusions: After adjusting for age, gender, number of teeth, endodontic status, quality of root filling, and diabetic status, tobacco smoking is strongly associated with the presence of radiographically diagnosed periapical lesions.
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http://dx.doi.org/10.1016/j.joen.2012.02.011DOI Listing
May 2012

Computer-aided system for morphometric mandibular index computation. (Using dental panoramic radiographs).

Med Oral Patol Oral Cir Bucal 2012 Jul 1;17(4):e624-32. Epub 2012 Jul 1.

School of Dentistry, Department of Odonto-stomatology, University of Barcelona, Barcelona, Spain.

Objective: We propose and validate a computer-aided system to measure three different mandibular indexes: cortical width, panoramic mandibular index and, mandibular alveolar bone resorption index.

Study Design: Repeatability and reproducibility of the measurements are analyzed and compared to the manual estimation of the same indexes.

Results: The proposed computerized system exhibits superior repeatability and reproducibility rates compared to standard manual methods. Moreover, the time required to perform the measurements using the proposed method is negligible compared to perform the measurements manually.

Conclusions: We have proposed a very user friendly computerized method to measure three different morphometric mandibular indexes. From the results we can conclude that the system provides a practical manner to perform these measurements. It does not require an expert examiner and does not take more than 16 seconds per analysis. Thus, it may be suitable to diagnose osteoporosis using dental panoramic radiographs.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3476026PMC
http://dx.doi.org/10.4317/medoral.17637DOI Listing
July 2012