Publications by authors named "Paloma Montero-Miralles"

7 Publications

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Use of contemporary technologies and new materials in undergraduate Endodontics teaching.

J Clin Exp Dent 2021 Apr 1;13(4):e383-e388. Epub 2021 Apr 1.

DDS, MSc, Doctoral fellow, Department of Stomatology, Section of Endodontics, School of Dentistry, University of Sevilla, C/ Avicena s/n, 41009-Sevilla, Spain.

Background: This study aims to analyze the use of contemporary technologies and materials in undergraduate endodontic teaching in Spain.

Material And Methods: The survey was sent to the undergraduate endodontic programme leads in the 23 Spanish dental schools. The survey asked about the use of magnification, ultrasonic devices, electronic apex locator, rotary instruments, root-filling techniques, and bioceramic cements in the teaching of endodontics.

Results: The response rate was 91%, and the final number of schools included in the study was twenty. Only two schools (10%) used magnification (loupes or operative microscope). Five schools (25%) used ultrasonic devices to prepare the access cavity, and four (20%) to activate the irrigation solution. In 14 dental schools (70%) no type of ultrasonic instrument was used. Electronic apex locators in working length determination was used in 19 schools (95%). All schools used rotary instrumentation in the teaching of endodontics, and 45% of schools used reciprocating instruments. Five schools (25%) used warm vertical compaction technique, four (20%) single cone gutta-percha technique, and four (20%) thermoplastic injection techniques. No school used carrier-based gutta-percha. Bioceramic cements were used in 19 of the schools (95%).

Conclusions: Spanish dental schools have incorporated some of the new endodontic technologies and materials, including the electronic apex locator, rotary instruments, and the new bioceramic cements; however, the modern root filling techniques, magnification, and ultrasonic instruments are not yet used in most dental schools. Bioceramic materials, dental schools, endodontic curriculum, magnification, online survey, rotary instrumentation, ultrasonic devices.
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http://dx.doi.org/10.4317/jced.57795DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8020320PMC
April 2021

Smoking and Radiolucent Periapical Lesions in Root Filled Teeth: Systematic Review and Meta-Analysis.

J Clin Med 2020 Oct 29;9(11). Epub 2020 Oct 29.

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

Aim: This systematic review and meta-analysis aimed to investigate the association between smoking habits and the prevalence of radiolucent periapical lesions (RPLs) in root-filled teeth (RFT).

Methods: The Population, Intervention, Comparison, and Outcome (PICO) question was: in adult patients who have RFT, does the absence or presence of a smoking habit affect the prevalence of RPLs associated with RFT? Systematic MEDLINE/PubMed, Wiley Online Database, Web of Science, Scopus, and PRISMA protocol were used to evaluate and present the results. Studies comparing smokers with control non-smoker subjects, including RFT, and providing data on the prevalence of RFT with RPLs, were included. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used for certainty in the evidence. The risk of bias was assessed according to Cochrane Collaboration common scheme for bias and ROBINS-I tool. Cumulative meta-analysis was performed with a random effects model. PROSPERO registration code: CRD42020165279.

Results: Four studies reported data on inclusion criteria, representing data from 9257 root-filled teeth-4465 from non-smokers and 4792 from smoker patients. The meta-analysis provided an odds ratio indicating a significant association between smoking and higher prevalence of root filled teeth with radiolucent periapical lesions (OR = 1.16; 95% CI = 1.07-1.26; = 0.0004). The certainty of the literature assessment was moderate per GRADE. The ROBINS-I tool classified three studies as low risk of bias, and the fourth as moderate risk of bias.

Conclusions: Moderate, quality scientific evidence indicates a weak but significant relationship between smoking and the prevalence of RPLs in RFT. Smoking can be considered a negative prognostic factor for the outcome of root canal treatment. Endodontic providers should be aware of the relationship between smoking and persistent apical periodontitis, assessed as RPLs, in RFT.
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http://dx.doi.org/10.3390/jcm9113506DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7692336PMC
October 2020

Cigarette Smoking and Root Filled Teeth Extraction: Systematic Review and Meta-Analysis.

J Clin Med 2020 Sep 30;9(10). Epub 2020 Sep 30.

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

Aim: The aim of this systematic review and meta-analysis was to investigate the possible association between smoking habits and the occurrence of root-filled teeth (RFT) extraction.

Material And Methods: The Population, Intervention, Comparison, and Outcome (PICO) question was in adult patients who had RFT, does the absence or presence of smoking habits affect the prevalence of extracted RFT? Systematic MEDLINE/PubMed, Wiley Online Database, Web of Science, and PRISMA protocol was used to evaluate and present the results. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used for certainty in the evidence. The risk of bias was assessed according to Cochrane Collaboration common scheme for bias and ROBINS-I tool. Cumulative meta-analysis was performed with a random effects model. PROSPERO registration code: CRD42020165279.

Results: After search strategy, 571 articles were recovered, seven were selected for full-text analysis, and two reported data on inclusion criteria, including 516 RFT, 351 in non-smokers, and 165 in smoker subjects. The meta-analysis provided an odds ratio indicating significant association between smoking and the prevalence of extracted RFT (OR = 3.43, 95% CI = 1.17-10.05, = 0.02, I² = 64%). The certainty of the literature assessment was low per GRADE. Both studies were considered as moderate risk of bias.

Conclusions: Tobacco smoking should be considered a negative prognostic factor for the outcome of root canal treatment, although the quality of the evidence is low. RFT of smoking patients are three times more likely to be extracted. Continuing to smoke after endodontic treatment may increase the risk of treatment failure. However, the overall strength of evidence is low. This must be considered a limitation of the present study and the conclusion should be valued with caution.
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http://dx.doi.org/10.3390/jcm9103179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7601225PMC
September 2020

Use of antibiotics by spanish dentists receiving postgraduate training in endodontics.

J Clin Exp Dent 2018 Jul 1;10(7):e687-e695. Epub 2018 Jul 1.

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

Background: The incidence of endodontic infections is high. The contribution of Endodontics to the global problem of antibiotic resistance could be significant. The ESE, together with the World Health Organization, are promoting the World Antibiotic Awareness Week (13-19 November 2017) to promote the appropriate use of systemic antibiotics in Endodontics. The objective of this study was to determine the prescription pattern of antibiotics in the treatment of endodontic infections of Spanish dentists attending specialization programs in Endodontics.

Material And Methods: Dentists from five Spanish endodontic postgraduate programs were requested to answer a one-page questionnaire surveying about antibiotics indications. Seventy-three dentists were required to participate in this investigation, and 67 (91.2%) fulfilled satisfactorily the survey and were included in the study. Data were analyzed using descriptive statistics and chi square test.

Results: The average duration of antibiotic therapy was 6.8±1.2 days. All respondents chose amoxicillin as first choice antibiotic in patients with no medical allergies, alone (40%) or associated to clavulanic acid (60%). The first drug of choice for penicillin allergic patients was clindamycin (72%). For cases of irreversible pulpitis, 22% of respondents prescribed antibiotics. For the scenario of a necrotic pulp, symptomatic apical periodontitis and no swelling, 37% prescribed antibiotics. A quarter of dentists prescribed antibiotics for necrotic pulps with asymptomatic apical periodontitis and a sinus tract.

Conclusions: The results of this study show that postgraduate training in Endodontics provides greater awareness of the correct indications of antibiotics. Dentists who have received specialized training in Endodontics have a prescription pattern of antibiotics more adjusted to the guidelines recommended by international organizations and by scientific societies. Antibiotics, apical periodontitis, dental curriculum, endodontic infections, postgraduate endodontic training.
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http://dx.doi.org/10.4317/jced.54894DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057074PMC
July 2018

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

Effectiveness of Nd:YAG Laser on the elimination of debris and Smear Layer. A comparative study with two different irrigation solution: EDTA and QMix® in addition to NaOCl.

J Clin Exp Dent 2018 Jan 1;10(1):e70-e74. Epub 2018 Jan 1.

Universidad de Sevilla. School of Dentistry. Sevilla.

Background: The aim of this study was to evaluate the effectiveness in dentin debris and smear layer removal from root canal walls using EDTA and QMix® alone and also activated with Nd:YAG laser.

Material And Methods: 50 single-rooted teeth were instrumented and divided in 5 groups according to irrigation protocol: 17% EDTA, QMix®, Nd:YAG laser alone, and combination of 17% EDTA - Nd:YAG laser and QMix® - Nd:YAG laser. Samples were evaluated using SEM. Statistical analysis was done using Chi-Square Fisher exact test and McNemar test.

Results: Dentinal debris analysis showed statistically significant differences when comparing 17% EDTA vs Laser and Laser vs QMix® in combination with Laser at the apical third. The Smear Layer analysis also showed statistically significant differences at the apical third when comparing 17% EDTA vs Laser, QMix® vs QMix® in combination with Laser and Laser vs QMix® in combination with Laser.

Conclusions: 17% EDTA was the most efficient irrigant showing the best results. Laser alone was not effective removing either dentinal debris or smear layer. Laser, endodontics, Smear Layer.
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http://dx.doi.org/10.4317/jced.54395DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5899815PMC
January 2018

Effect of the Nd:YAG laser on sealer penetration into root canal surfaces: a confocal microscope analysis.

J Dent 2014 Jun 8;42(6):753-9. Epub 2014 Apr 8.

Faculty of Dentistry, University of Seville (US), C/ Avicena, s/n, 41009 Sevilla, Spain.

Objectives: The objective of this in vitro study was to evaluate the use of the Neodymium:Yttrium-Aluminium-Garnet (Nd:YAG) laser as part of the root canal treatment on the penetration of sealer into dentinal tubules.

Methods: Eighty extracted lower premolars were randomly assigned to two groups (n=40 each): Control group (CG), subjected to a conventional protocol of endodontic instrumentation and obturation; and Laser group (LG), in which Nd:YAG laser irradiations were combined with conventional preparation and obturation. Endodonted samples were sectioned at 3 and 5 mm from the apex and observed under a confocal scanning microscope (CLSM). The penetration depth into the dentinal tubules and the extension of the intracanal perimeter infiltrated by sealer were measured. The Student-Newman-Keuls test was run for between-group comparisons (α=.05).

Results: The depth of sealer penetration into dentinal tubules did not differ among groups. LG samples showed the significantly highest percentage of penetrated perimeter at 3 mm from the root apex. Within each group, the greatest depth of penetration (P=.0001), and the major percentage of penetrated perimeter (P<.001), were recorded at 5 mm.

Conclusions: The application of the Nd:YAG laser after instrumentation did not improve the depth of sealer penetration into the dentinal tubules. The laser enlarged the total penetrable perimeter near the apex.

Clinical Significance: The Nd:YAG laser may be an appropriate complement in root canal treatment, as it enhances the sealer adaptation to the dentinal walls in the proximity of the apex.
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http://dx.doi.org/10.1016/j.jdent.2014.03.017DOI Listing
June 2014