March's Study Club highlights indirect pulp therapy, treatment for permanent molars with irreversible pulpitis, direct pulp capping with resin based materials, the human factor in healthcare, and arch width changes.
Join us on March 23rd, 2023 at 7:00pm CST for our study club to discuss the following articles. We recommend reading the articles 1 week prior and taking notes on your insights to bring to the group for discussion.
#1 - Two-year Outcomes of Coronal Pulpotomy in Young Permanent Molars with Clinical Signs Indicative of Irreversible Pulpitis Seda Elmas, DDS, Derya Akay Kotan, DDS, PhD, Mesut Enes Odabaş, DDS, PhD
Purpose: The purpose of this study was to assess the outcome of coronal pulpotomy using mineral trioxide aggregate (MTA) in mature and immature teeth with symptoms indicative of irreversible pulpitis.
Methods: Fifty permanent molars with symptomatic irreversible pulpitis were divided into two groups according to complete or incomplete radicular growth (25 teeth in each group). Coronal pulpotomy was performed with MTA. Clinical follow-up evaluations were scheduled at the third, sixth, ninth, 12th, 18th, and 24th months. Follow-up radiographs were taken at the sixth, 12th, 18th, and 24th months. Pain levels were scored preoperatively and two days post-treatment.
Results: At two years of recall, 10 patients were lost to follow-up and the success of molars with complete or incomplete radicular growth were 100 percent and 95 percent, re- spectively. All teeth with periapical rarefaction were present preoperatively and showed complete radiographic healing. Radiographic evidence of dentin bridge formation was discernable in 31 of 38 cases.
Conclusions: Full coronal pulpotomy using mineral trioxide aggregate was successful in controlling pain and any infections after two years in 39 of 40 teeth regardless of whether they had immature or mature roots.
#2 - A Retrospective Evaluation of a Program’s Use of Indirect Pulp Therapy for Primary Molars
Patrick Ruck, DDS, Jennifer L. Cully, DMD, MEd, Sarat Thikkurissy, DDS, MS
Purpose: The purpose of this retrospective study was to assess how procedural code trends reflect the adoption of evidence-based best- clinical-practice guidelines in a hospital-based pediatric dental residency program.
Methods: Data on frequency of indirect pulp therapy (IPT) and primary pulpotomy (P) utilization were assessed from 2008 to 2020.
Results: The rate of procedural change between IPT and P significantly differed (P<0.001) over 12 years. The total procedural frequency of IPT overcame P around the years 2014 to 2015.
Conclusions: From 2008 to 2020, indirect pulp therapy became the vital pulp therapy of choice in a hospital-based pediatric dental residency program. This trend likely reflects guidelines from major publications on the subject matter and changing philosophies on vital pulp therapy at this hospital-based residency program. Using available data (in this case, procedural codes), dental education programs can identify shifts in care and teaching trends on capstone procedures like vital pulpotomy.
#3 - Light-Cured Calcium Silicate–Based Cements as Pulp Therapeutic Agents
LF García-Mota, L Hardan, R Bourgi, JE Zamarripa-Calderón, JA Rivera-Gonzaga, JC Hernández-Cabanillas, CE Cuevas-Suárez
To determine the clinical performance of light-cured calcium silicate-based cement for direct or indirect pulp capping. The research question was as follows: in teeth with deep caries lesions, does the use of resin-modified calcium silicate-containing composites improve the radiological success and prevent irreversible pulpitis and pulpal necrosis compared with other pulp-capping agents?
The following databases were screened until September 2021: PubMed, Web of Science, Scielo, Scopus, Embase, and The Cochrane Library. Randomized clinical trials reporting the clinical evaluation of a resin-modified calcium silicate material as an agent for pulp therapy were included. Meta-analysis was performed using the Rev Manager v5.4.1 software. The risk difference and 95% confidence interval of the dichotomous outcome (restoration failure or success) were calculated for comparison.
Ten studies were considered for qualitative analysis and meta-analysis. Studies evaluating the performance of light-cured calcium silicate-based cement from 1 month to a maximum follow-up period of 36 months and comparing it with the performance of CaOH, mineral trioxide aggregate, or Biodentine were included. In the global analysis for direct pulp capping at 6-month follow-up, no statistical differences were observed between the experimental group using the light-cured calcium silicate-based cement and control group (P = .28). However, at 12-month follow-up, global analysis favored the control group (P < .001). For indirect pulp capping, at 6- and 24-month follow-ups, no statistically significant differences were observed between the experimental and control groups (P = .88; P = .21).
Light-cured calcium silicate-based cement showed a limited clinical performance as a direct pulp capping agent, especially when evaluated in the long term. However, using it as an indirect pulp capping agent may be a reliable and easy-to-use option for restoring teeth with deep caries.
This systematic review provides evidence that supports the use of light-cured calcium silicate-based cement as an indirect pulp capping agent
#4 -Attention to Human Factors Can Improve Staff Performance and Patient Care
PA Brennan, J Hardie, RS Oeppen
Human error is inevitable, and therefore can be considered as a 'normal' part of everyday life. Unfortunately, error can never be eliminated completely. However, learning from our mistakes can help reduce problems in future. Fifty years ago, most clinicians paid little or no attention to the human factors (HF) that can affect individual and team performance. It has only been in the last 20-25 years that colleagues in healthcare have truly begun recognizing the importance of HF and non-technical skills in medicine and dentistry and how their application can significantly improve patient safety and aid better team working and staff morale in the clinical setting and laboratory.
Personal factors such as stress, tiredness, hunger and dehydration all reduce human performance and can raise the risk of mistakes. In addition, how we work and interact with the wider team is important since many errors can occur because of ineffective communication, steep hierarchal (authority) gradients and loss of situational awareness. This short HF overview in the 50th commemorative special of JOPM issue is timely. It provides a contemporary overview of human factors and performance that the authors consider important for oral medicine and pathology colleagues and which can affect individuals and teams This article also discuss ways to reduce the chances of medical and dental error and improve patient safety.
#5 - Arch width changes from 6 weeks to 45 years of age
Samir E. Bishara, BDS, D Ortho, DDS, MS, a Jane R. Jakobsen, BA, MS, b Jean Treder, DDS, MS, c and Arthur Nowak, DDS, MS d
The purpose of this study was to evaluate on a longitudinal basis, the changes in intercanine and intermolar widths over a 45-year span. The subjects in this study were from two pools of normal persons: (1) 28 male and 33 female infants evaluated longitudinally at approximately 6 weeks, 1 year, and 2 years of age (before the complete eruption of the deciduous dentition); and (2) 15 male and 15 female subjects from the Iowa facial growth study evaluated at ages 3, 5, 8, 13, 26, and 45. Arch width measurements on maxillary and mandibular dental casts were obtained independently by two investigators. Intraexaminer and interexaminer reliability were predetermined at 0.5 mm. From the findings in the current study, the following conclusions can be made: (1) Between 6 weeks and 2 years of age, i.e., before the complete eruption of the deciduous dentition, there were significant increases in the maxillary and mandibular anterior and posterior arch widths in both male and female infants. (2) Intercanine and intermolar widths significantly increased between 3 and 13 years of age in both the maxillary and mandibular arches. After the complete eruption of the permanent dentition, there was a slight decrease in the dental arch widths, more in the intercanine than in the intermolar widths. (3) Mandibular intercanine width, on the average, was established by 8 years of age, i.e., after the eruption of the four incisors. After the eruption of the permanent dentition, the clinician should either expect no changes or a slight decrease in arch widths. In conclusion, although the dental arch widths undergo changes from birth until midadulthood, the magnitude as well as the direction of these changes do not provide a scientific basis for expanding the arches, in the average patient, beyond its established dimensions at the time of the complete eruption of the canines and molars. Both patients and clinicians should be aware of these limitations.
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