This meta-analysis evaluates the reliability of published evidence on regenerative endodontic procedures. It summarizes clinical and radiographic findings from studies on treating non-vital immature permanent teeth using regenerative techniques. The analysis finds good success rates for tooth survival and pathology resolution, but variable results for outcomes like apex closure and root development. Regenerative procedures are improving but factors important for success remain unclear, indicating more research is needed.
Assessment of correlation of periodontitis in teeth adjacent to implant and p...Dr. Anuj S Parihar
Aims: The present study was conducted to determine correlation between peri‑implantitis and periodontitis in adjacent teeth. Materials and Methods: The present study was conducted on 58 patients with 84 dental implants. They were divided into two groups, group I (50) was with peri‑implantitis and group II (34) was without it. In all patients, probing depth (PD), gingival recession (GR), and clinical attachment loss (CAL) was calculated around implant, adjacent to implant and on contralateral side. Obtained data were statistically analyzed using statistical software IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp with one‑way analysis of variance. Results: Males were 30 with 52 dental implants and females were 28 with 32 dental implants. CAL was 5.82 ± 0.52 in group I and 3.62 ± 0.63 in group II (P = 0.001) around implants. PD was 4.28 ± 1.26 in group I and 2.20 ± 0.52
in group II around adjacent teeth (P = 0.002). PD around contralateral teeth was significant (P = 0.05) in group I (3.18 ± 1.01) and group II (2.71 ± 0.73). Conclusion: Periodontitis has negative effect on implant success. Teeth adjacent to dental implant plays an important role in deciding the success or failure of implant. Maintenance of periodontal health is of paramount importance for successful implant therapy.
Clinical study of impacted maxillary canine in the Arab population in IsraelAbu-Hussein Muhamad
The objective of the present study was to determine the prevalence of impacted maxillary canine in patients in Arabs
Community in Israel (ARAB48,Israel) visiting our Center For Dentistry,Research & Aesthetics,Jatt,Almothalath,Israel,
4250 patients . This study comprises data from patients who attended the O.P.D.2200 patients between Jun. 2006 to Dec
2013. Patients were examined in order to detect the impacted maxillary canines by intraoral examination, palpation, dental
records and followed by radiographs. It was found that the prevalence of canine impaction was 0,8 % (N=4250), 1,6
(N=2200), 43,9 (N-82) in males and 1,1% (N=4250), 2,1 (N=2200), 56,1 (N-82) in females suggesting that prevalence of
impacted maxillary canines is more in females than males and it is statistically significant. The overall prevalence for
maxillary impacted canines was found to be 3,7 % (N=2200) which suggested that it is much higher than previous studies.
The results of this study were slightly different than other studies, while the dissimilarities may be attributed to the sample
selection, method of the study and area of patient selection, which suggest racial and genetic differences.
An Evaluation of Short Term Success and Survival Rate of Implants Placed in F...DrHeena tiwari
An Evaluation of Short Term Success and Survival Rate of Implants Placed in Fresh Extraction Socket Post Prosthetic Rehabilitation- A Prospective Study
Assessment of correlation of periodontitis in teeth adjacent to implant and p...Dr. Anuj S Parihar
Aims: The present study was conducted to determine correlation between peri‑implantitis and periodontitis in adjacent teeth. Materials and Methods: The present study was conducted on 58 patients with 84 dental implants. They were divided into two groups, group I (50) was with peri‑implantitis and group II (34) was without it. In all patients, probing depth (PD), gingival recession (GR), and clinical attachment loss (CAL) was calculated around implant, adjacent to implant and on contralateral side. Obtained data were statistically analyzed using statistical software IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp with one‑way analysis of variance. Results: Males were 30 with 52 dental implants and females were 28 with 32 dental implants. CAL was 5.82 ± 0.52 in group I and 3.62 ± 0.63 in group II (P = 0.001) around implants. PD was 4.28 ± 1.26 in group I and 2.20 ± 0.52
in group II around adjacent teeth (P = 0.002). PD around contralateral teeth was significant (P = 0.05) in group I (3.18 ± 1.01) and group II (2.71 ± 0.73). Conclusion: Periodontitis has negative effect on implant success. Teeth adjacent to dental implant plays an important role in deciding the success or failure of implant. Maintenance of periodontal health is of paramount importance for successful implant therapy.
Clinical study of impacted maxillary canine in the Arab population in IsraelAbu-Hussein Muhamad
The objective of the present study was to determine the prevalence of impacted maxillary canine in patients in Arabs
Community in Israel (ARAB48,Israel) visiting our Center For Dentistry,Research & Aesthetics,Jatt,Almothalath,Israel,
4250 patients . This study comprises data from patients who attended the O.P.D.2200 patients between Jun. 2006 to Dec
2013. Patients were examined in order to detect the impacted maxillary canines by intraoral examination, palpation, dental
records and followed by radiographs. It was found that the prevalence of canine impaction was 0,8 % (N=4250), 1,6
(N=2200), 43,9 (N-82) in males and 1,1% (N=4250), 2,1 (N=2200), 56,1 (N-82) in females suggesting that prevalence of
impacted maxillary canines is more in females than males and it is statistically significant. The overall prevalence for
maxillary impacted canines was found to be 3,7 % (N=2200) which suggested that it is much higher than previous studies.
The results of this study were slightly different than other studies, while the dissimilarities may be attributed to the sample
selection, method of the study and area of patient selection, which suggest racial and genetic differences.
An Evaluation of Short Term Success and Survival Rate of Implants Placed in F...DrHeena tiwari
An Evaluation of Short Term Success and Survival Rate of Implants Placed in Fresh Extraction Socket Post Prosthetic Rehabilitation- A Prospective Study
Non-surgical adjunctive interventions for accelerating tooth movement in pati...Dr. Yahya Alogaibi
Non-surgical adjunctive interventions for accelerating tooth movement in patients undergoing fixed orthodontic treatment by Ahmed El-Angbawi, Grant T McIntyre, Padhraig S Fleming, David R Bearn ppt
Introduction. The differences in the supporting structure of the implant make them more susceptible to inflammation and bone
loss when plaque accumulates as compared to the teeth. Therefore, a comprehensive maintenance protocol should be followed
to ensure the longevity of the implant. Material and Method. A research to provide scientific evidence supporting the feasibility
of various implant care methods was carried out using various online resources to retrieve relevant studies published since 1985.
Results.The electronic search yielded 708 titles, out of which a total of 42 articles were considered appropriate and finally included
for the preparation of this review article. Discussion. A typicalmaintenance visit for patients with dental implants should last 1 hour
and should be scheduled every 3 months to evaluate any changes in their oral and general history. It is essential to have a proper
instrument selection to prevent damage to the implant surface and trauma to the peri-implant tissues. Conclusion. As the number
of patients opting for dental implants is increasing, it becomes increasingly essential to know the differences between natural teeth
and implant care and accept the challenges of maintaining these restorations.
Aims: This study evaluated the subjective experience of masticatory performance and masticatory efficiency in partially edentulous patients rehabilitated with three different types of removable partial dentures (RPDs). Materials and methods: This was a crossover randomized study, which was carried out at the prosthodontics clinic of the University of Ghana Dental School clinic. Sixteen patients requiring RPDs but had never worn one before were consecutively recruited for the study. Three different RPDs [i.e., cobalt chromium, acrylic, and thermoplastic resin (iFlex)] were fabricated for each patient. Masticatory efficiency was assessed using a singlesieve method after chewing raw carrots. The subjective experience of masticatory performance was also assessed using a questionnaire after 1 week of using each denture. Results: The cobalt-chromium denture recorded the highest masticatory efficiency (31.4%), and the iFlex denture recorded the lowest (27.9%).
Comprehensive assessment of dentists knowledge and awareness about surgical ...Ajay Pacharne
Aim: Accurate treatment planning for implant which considers anatomical factors and prosthetic needs is essential to guarantee a predictable therapy. The aim of this study was to assess the current knowledge and awareness about surgical template among general dental practitioner in kanpur, India. Materials & Methods: This study was entirely attempted on a cross sectional idea. It also used the rational usage of questionnaire. However, after considering some essential aspects, this number was lastly reduced to 100. Authors completed the study by close ended questionnaire containing questions about the present knowledge and awareness about surgical template. Response was recorded and data was processed statistically to evaluate the real-time knowledge and awareness level. Results: Statistical analysis was done using statistical software ‘Statistical Package for the Social Sciences (SPSS)’. The recorded data was subjected to suitable statistical tests to obtain p values, mean, standard deviation, standard error an 95% CI. P ≤ 0.05 was considered as statistically significant. 27 practitioners were unaware of the usage of surgical template. 94 practitioners think that UG dental curriculum is inadequate regarding surgical template. 60 practitioners think that surgical template must be made mandatory for all dental institutions.
A retrospective study in a comprehensive assessment of the various systemic f...AI Publications
In this study, 220 patients from different hospitals in Iraq and distribution Lost follow-up implants and Failed implants of the patient's study for four years, 300 implants. Study showed 220 participants were included, and the average age ranged between 40-60 years with a mean value and standard deviation of 48±7.8.0 This study was designed by adopting an analysis approach for all factors affecting dental implants, and the results were analysed according to the statistical analysis program IBM SPSS Soft. The quality of life (WHO QOL-BREF) was also measured for the purpose of conducting a comprehensive assessment of the various systemic factors of Iraqi patients receiving dental implants. The results which found to be distributed according to gender for 130 male patients with 59.09%, females for 90 patients with 40.09%, Implant insertion torque range achieved in no. of cases (Maxillary dental implants with No. of implants placed 30 for 30±4.9 N and 40 No. of implants placed with Implant insertion torque range achieved in no. of cases 45±7.7 N), (Mandibular dental implants with No. of implants placed for 40 (Implant insertion torque range achieved in no. of cases 34±3.4), (Mandibular dental implants with No. of implants placed 175 and Implant insertion torque range achieved in no. of cases 47±6.6) The effect of dental implants on the quality of life of patients was also identified, and a statistically significant relationship was found at a p-value < 0.05
60.Srinivasan S, Velusamy G, Munshi MAI, Radhakrishnan K, Tiwari RVC. Comparative Study of Antifungal Efficacy of Various Endodontic Irrigants with and without Clotrimazole in Extracted Teeth Inoculated with Candida albicans. J Contemp Dent Pract. 2020 Dec 1;21(12):1325-1330. PubMed PMID: 33893253.
Mathew P, Kattimani VS, Tiwari RV, Iqbal MS, Tabassum A, Syed KG. New Classification System for Cleft Alveolus: A Computed Tomography-based Appraisal. J Contemp Dent Pract. 2020 Aug 1;21(8):942-948. PubMed PMID: 33568619
Sahu S, Patley A, Kharsan V, Madan RS, Manjula V, Tiwari RVC. Comparative evaluation of efficacy and latency of twin mix vs 2% lignocaine HCL with 1:80000 epinephrine in surgical removal of impacted mandibular third molar. J Family Med Prim Care. 2020 Feb;9(2):904-908. doi: 10.4103/jfmpc.jfmpc_998_19. eCollection 2020 Feb. PubMed PMID: 32318443; PubMed Central PMCID: PMC7113948.
65.Izna, Sasank Kuntamukkula VK, Khanna SS, Salokhe O, Chandra Tiwari RV, Tiwari H. Knowledge and Apprehension of Dental Health Professionals Pertaining to COVID in Southern India: A Questionnaire Study. J Pharm Bioallied Sci. 2021 Jun;13(Suppl 1):S448-S451. doi: 10.4103/jpbs.JPBS_551_20. Epub 2021 Jun 5. PubMed PMID: 34447131; PubMed Central PMCID: PMC8375944.
Vohra P, Belkhode V, Nimonkar S, Potdar S, Bhanot R, Izna, Tiwari RVC. Evaluation and diagnostic usefulness of saliva for detection of HIV antibodies: A cross-sectional study. J Family Med Prim Care. 2020 May;9(5):2437-2441. doi: 10.4103/jfmpc.jfmpc_138_20. eCollection 2020 May. PubMed PMID: 32754516; PubMed Central PMCID: PMC7380795
Mittal S, Hussain SA, Tiwari RVC, Poovathingal AB, Priya BP, Bhanot R, Tiwari H. Extensive pelvic and abdominal lymphadenopathy with hepatosplenomegaly treated with radiotherapy-A case report. J Family Med Prim Care. 2020 Feb;9(2):1215-1218. doi: 10.4103/jfmpc.jfmpc_1125_19. eCollection 2020 Feb. PubMed PMID: 32318498; PubMed Central PMCID: PMC7113973.
36.Kesharwani P, Hussain SA, Sharma N, Karpathak S, Bhanot R, Kothari S, Tiwari RVC. Massive radicular cyst involving multiple teeth in pediatric mandible- A case report. J Family Med Prim Care. 2020 Feb;9(2):1253-1256. doi: 10.4103/jfmpc.jfmpc_1059_19. eCollection 2020 Feb. PubMed PMID: 32318508; PubMed Central PMCID: PMC7113959.
More from CLOVE Dental OMNI Hospitals Andhra Hospital (20)
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
Following hit identification, the hits are optimized to improve their efficacy, selectivity, and pharmacokinetic properties, resulting in lead compounds. These leads undergo further refinement to enhance their potency, reduce toxicity, and improve drug-like characteristics, creating drug candidates suitable for preclinical testing. In the preclinical development phase, drug candidates are tested in vitro (in cell cultures) and in vivo (in animal models) to evaluate their safety, efficacy, pharmacokinetics, and pharmacodynamics. Toxicology studies are conducted to assess potential risks.
Before clinical trials can begin, an Investigational New Drug (IND) application must be submitted to regulatory authorities. This application includes data from preclinical studies and plans for clinical trials. Clinical development involves human trials in three phases: Phase I tests the drug's safety and dosage in a small group of healthy volunteers, Phase II assesses the drug's efficacy and side effects in a larger group of patients with the target disease, and Phase III confirms the drug's efficacy and monitors adverse reactions in a large population, often compared to existing treatments.
After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Antimicrobial stewardship to prevent antimicrobial resistanceGovindRankawat1
India is among the nations with the highest burden of bacterial infections.
India is one of the largest consumers of antibiotics worldwide.
India carries one of the largest burdens of drug‑resistant pathogens worldwide.
Highest burden of multidrug‑resistant tuberculosis,
Alarmingly high resistance among Gram‑negative and Gram‑positive bacteria even to newer antimicrobials such as carbapenems.
NDM‑1 ( New Delhi Metallo Beta lactamase 1, an enzyme which inactivates majority of Beta lactam antibiotics including carbapenems) was reported in 2008
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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2. S37
Journal of Pharmacy and Bioallied Sciences ¦ Volume 13 ¦ Supplement 1 ¦ June 2021
Shaik, et al.: Regenerative endodontic therapy in managing non vital teeth
endodontic treatment (RET) is being reported as one
of the feasible treatment alternatives in the treatment
of nonvital, immature permanent teeth. Hence, its
well‑timed for the current literature to re‑evaluate this
shifting landscape of the feasible treatment alternatives
for nonvital immature permanent teeth in young
individuals.[2]
Hereby in this analysis, we aimed to
evaluate the reliability of data published in the current
literature regarding RE treatment in a critical way. This
meta‑analysis is used to summarize and analyze the
various clinical and radiographic findings for infected
immature permanent teeth which are treated using RE
techniques and importantly also to evaluate the quality
of facts provided in the already published literature.
Materials and Methods
A structured electronic search by authors was
undertaken in August 2020 using MEDLINE and
PubMed search engine. Unpublished literature
was electronically searched on Clinical Trials. gov
(www.clinicaltrials.gov) and the National Research
Register (www.controlled‑trials.com). The search
strategy comprised a combination of different key words
along with some Medical Headings relatable to RET.
The chosen parameters studied in this systematic review
were presented in flowcharts and were summarized as
given in Figure 1.
Outcome measures of data analysis
The challenge begins with every clinical procedure
as we try to describe what a good result is in terms
of outcome of revascularization procedures. Evidence
of root development and root formation is taken into
account. It is essential to restore the pulpal function
to measuring the effectiveness of therapy. The data
reviewed in this analysis was analyzed, and the
primary outcome measures which were analyzed were
as follows: (1) Survival of the tooth, (2) Clinical and
radiographic signs of healing if pathology in periapical
areas, (3) Results of constant root formation as seen
according to the decreased size of apical foramen,
evidence of root lengthening, and formation of root
dentin.
Results
Various clinical studies on RET have been conducted
since 2001. The clinical concerns for regenerative
endodontic procedures of the American Association of
Endodontists (2016) describe performance across three
measures:
1. Primary objective (essential): Symptom removal and
proof of bony healing
2. Secondary (desirable) target: Increased thickness of
the root wall and/or increased root length
3. Tertiary target: Positive response to checking for
vitality.
The main objective of resolving the clinical signs
of infection and bone healing is usually attainable,[3]
while disinfection procedures and limited filing have
been related to failed cases as earlier established. In
two recent systematic reviews by Tong et al. 2017[4]
and Torabinejad et al. 2017[5]
showed that the primary
objective of RET could be reliably accomplished.
Study design
In this analysis, three studies[6‑8]
were seen to estimate the
outcomes of the technique, based on types of intracanal
medicaments used. Four studies evaluated the results of
RET based on different scaffolds used in the studies,[9‑12]
8 studies reported the results based on different treatment
options like that of Ca (OH) 2 for apexification or the
use of MTA apical plug technique[6‑8,10,11]
and included
3 failed cases as well.[13‑15]
Primary outcome
Clinical outcome
The two primary clinical outcomes measures as studied
included firstly survival of the tooth and secondly
clinical signs of healing. Except 2 studies, 100%
positivity in tooth survival was reported in all other
studies evaluated.[7,8]
Radiographic outcomes
The parameters included in the evaluation of
radiographic outcomes included are firstly the resolution
of apical pathology, secondly the amount of apical
closure, thirdly the evaluation of increase in root
length, and finally, the thickening of root due to dentine
deposition. Eight researchers have used computerized
tools and image correction, along with measurement
analysis. Among these, two studies further studied
radiographic results using the measurement of relative
Figure 1: Flowchart summarizing the chosen reporting parameters studied
in systematic reviews and meta‑analysis
[Downloaded free from http://www.jpbsonline.org on Sunday, June 6, 2021, IP: 175.101.146.64]
3. S38 Journal of Pharmacy and Bioallied Sciences ¦ Volume 13 ¦ Supplement 1 ¦ June 2021
Shaik, et al.: Regenerative endodontic therapy in managing non vital teeth
radiographic field.[8,9]
Periapical healing and Apical
Closure: In the meta‑analysis, almost all 100% studies
evaluated reported periapical pathology resolution
success rates. Apical closure was reported in 11 studies
with variability and apical closure success rates ranging
within 76%–91%.[4,5,9,16‑19]
Root length and root dentin
thickness: four studies evaluated in this meta‑analysis
mentioned on the success rates of root lengthening and
root dentin formation.[12,18‑20]
The results of estimated
success rates for both ranged from 80% to 94%.
Secondary outcomes
Two studies in this meta‑analysis were found to report
that no consistency in achieving root maturation.
[14,21]
Hence, these outcomes seem to be more variable.
In addition, some long‑term potential studies have
also reported outcomes even past 18 months.[4]
Hence,
long‑lasting retention of RET treated teeth is still
questionable. Secondary outcomes included late‑stage
effects and side effects, which were conflicting through
different researches studied. Two most common observed
late‑stage effects included obliteration of the pulp canals
and the presence of tooth discoloration. Discoloration
was observed in almost 50% of studies.[8,9,20,22,23]
Details
of different study characteristics and their outcome
measures are hereby tabulated in Tables 1 and 2.
Discussion
A data analysis of the RET clinical protocol found
that RET protocols differed greatly across all trials.
Different treatment protocols may lead to different
outcomes of treatment. Therefore, in the literature, it
is not viable to assess the exact treatment outcome of
RET. Nevertheless, the largely most favorable outcome
considered for RET clinically is the continuation of root
development and apex closure.
An immature permanent tooth
Young immature permanent teeth with wide‑open apex
permit both cellular and molecular mechanism of the
innate and adaptive immunity to be effectively carried
to the canal space by pulp blood circulation. As a result,
young, immature permanent teeth are supposed to be
more challenging than mature permanent teeth to carious
infections or trauma. As a result, if such teeth are
affected by caries or trauma, it may take probably more
time for the pulp to become fully necrotic and present
with apical periodontitis. This hypothesis was based on
the findings studied during this meta‑analysis with cases
comprising of young permanent teeth with such pulpal
and periapical pathological conditions. These were
clinically diagnosed with when the canals were probed,
bleeding occurred, or patients encountered pain with
hand files.
Microenvironment and tissue repair mechanisms
In developmental biology, the microenvironment is
described as a precise location that maintains the stem
cell. Micro‑environmental signals, such as stromal cells,
extracellular matrix, adhesion molecules, growth factors
and cytokines, decide the fate of stem cells.[24‑26]
If the
microenvironment is altered, the fate of stem cells is
also said to be will also be altered. The pulpal tissue is
enclosed within canal room’s sterile microenvironment.
This microenvironment should be preserved as similar
as practicable to the original sterile microenvironment of
the pulp canal but it is altered when the teeth become
contaminated due to the accumulation of biofilm on
the canal walls, by bacterial toxins and by resorption.
Even after intracanal irrigation and medication, this
microenvironment is also altered. The stem cell fate
in the treated canals and sterile canals may therefore
be distinct. This may be the possible reason as to
why it becomes tough to regenerate pulp tissue with
infected/necrotic pulp after RET, in accordance with the
immature permanent teeth.[27]
In this meta‑analysis, Most
studies have stated that RET has the potential to facilitate
canal wall thickening and/or continued root growth of
immature permanent teeth with necrotic pulps. It was
suggested by various researchers that cells from the
remnants of pulp or the cells obtained from the papilla
may relocate within the disinfected pulpal canal space,
hereby to deposit secondary dentine on the canal walls
and the root apex, and helps in increasing the thickness
of the canal walls and root length. Histologically, results
of various studies suggest from this meta‑analysis,
that evidence of both Hard and soft connective tissue
formation was observed in the root canal space after
RET even after disinfection. The tissues which were
formed in the canal space of these treated immature
teeth were characterized as bone, cement‑and periodontal
ligament‑like tissue in consequent animal study models
as well.[4,5]
The findings of this meta‑analysis showed that
periapical pathology resolution success rates past RET
were equivalent to MTA or apexification therapy. This
indicates that for bacterial removal, together, disinfection
methods have identical efficiency. We observed that the
accomplishment rates for apical closure, enlargement
in root length, and the formation of dentin were higher
in the case of RET in contrast to the normal. It is
been suggested that a 20% increase in the root length
may be associated with a clinically significant change,
according to these studies.[28]
Substantial heterogeneity
was observed in the reporting of results between
studies studied in the analysis. This includes reporting
of pre‑ and postoperative clinical features and also the
quantification of radiographic interpretations. Thus it
was observed that, due to deficient data regarding the
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4. S39
Journal of Pharmacy and Bioallied Sciences ¦ Volume 13 ¦ Supplement 1 ¦ June 2021
Shaik, et al.: Regenerative endodontic therapy in managing non vital teeth
Table 1: Primary and secondary outcome measures
Study Year Number
of teeth
Tooth
under study
Primary outcome Secondary
outcome/
sideeffects
Clinical
evaluation
Radiographic
evaluation
Apical
cosure
Root length Root
thickness
Healing/
resolution
Chen et al. 2012 20 Incisors and
premolars
Tooth
survival/
vitality
Root
development
Increased root
thickness
PA pathology
resolution
15/20
teeth
20/20 teeth 20/20 teeth 20/20
teeth
Hard tissue
barrier
formation (not
at apex)
PCO
Discoloration
Dabbagh
et al.
2012 16 Incisors
premolars
molars
Tooth
survival/
vitality
Increased
root length
PA pathology
resolution
Not
mentioned
12/16 teeth Not
mentioned
9 Teeth Discoloration
Hard tissue
barrier
MTA material
collapsing into
canal
Jeeruphan
et al.
2012 61 Incisors and
premolars
Tooth
survival
Resolution
of clinical
signs and
symptoms
Apical
closure
Increased
root length
Increased
root thickness
PA pathology
resolution
Periapical
closure
Not mentioned
Mctigue
et al.
2013 32 Incisors and
premolars
Tooth
survival
Sinus
track
resolution
Apical
closure
Increased
root length
Increased
root thickness
PA pathology
resolution
23/32
teeth
21/32 teeth 22/32 teeth 31/32
teeth
Discoloration
Kahler et al. 2014 16 Incisors and
premolars
Tooth
survival
Resolution
of clinical
signs and
symptoms
Apical
closure
Increased
root length
Increased
root thickness
PA pathology
resolution
Periapical
closure
19.4%
complete
closure
2.7%-25.3%
increase
1.9%-72.6%
increase
90.37%
Cases
Discoloration
Alobaid
et al.
2014 20 Incisors and
others
Tooth
survival
Resolution
of clinical
signs and
symptoms
Apical
closure
Increased
root length
Increased
root thickness
PA pathology
resolution
6/18
cases
4/15 cases 4/15 cases 7/8 cases Hard tissue
barrier
formation (not
at apex)
PCO
Discoloration
Contd...
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5. S40 Journal of Pharmacy and Bioallied Sciences ¦ Volume 13 ¦ Supplement 1 ¦ June 2021
Shaik, et al.: Regenerative endodontic therapy in managing non vital teeth
standardized conclusion of presently accessible data,
it has mostly affected the best possible application and
combination of these outcomes, which are necessary for
accurate interpretation of factors affecting the successful
outcome of RET.
Table 1: Contd...
Study Year Number
of teeth
Tooth
under study
Primary outcome Secondary
outcome/
sideeffects
Clinical
evaluation
Radiographic
evaluation
Apical
cosure
Root length Root
thickness
Healing/
resolution
Nagata et al. 2014 23 Incisors Tooth
survival
Resolution
of clinical
signs and
symptoms
Apical
closure
Increased
root length
Increased root
thickness
PA pathology
resolution
8/12
cases
5/12 cases 5/12 cases 6/6 cases Discoloration
Nagy et al. 2014 36 Incisors Tooth
survival
Resolution
of clinical
signs and
symptoms
Apical
closure
Increased
root length
Increased root
thickness
PA pathology
resolution
17/20
cases
16/20 cases 16/20 cases 17/20
cases
Not mentioned
Bezgin et al 2015 20 Incisors and
premolars
Tooth
survival
Resolution
of clinical
signs and
symptoms
Apical
closure
PA pathology
resolution
13/20
cases
18/20 cases 18/20 cases 15/16
cases
Discoloration
Narang et al. 2015 20 - Tooth
survival
Resolution
of clinical
signs and
symptoms
Apical
closure
Increased
root length
Increased root
thickness
PA pathology
resolution
17/20
cases
15/15 cases 15/15 cases 15/15
cases
Not mentioned
Linsuwanont
P et al.
2017 17 Incisors and
premolars
Root
maturation
Fully
formed
roots with
various
apical
shapes
Apical
closure
dimensional
changes
of the root
(0%-73%)
- the pattern
of root
maturation
76%
success
14.38±20.92%
mean change
13.82±11.17%
mean change
Not
mentioned
Incomplete
root
development
with wide
Open apices
and fully
Unpredictable
patterning of
radiopaque
deposits
Estefan BS
et al.
2017 40 Permanent
maxillary
incisors
Tooth
survival
Resolution
of clinical
signs and
symptoms
Apical
closure
Dimensional
changes of
the root
Not mentioned
PA: Periapical Pathology, PCO: Pulp canal obliteration, MTA: Mineral Trioxide Aggregate
Side effects
There was comparatively less reporting of multiple
adverse effects such as decoloration, pulp canal
obliteration, anomalies in root morphology during
the growth process, absence of apical seal/closure,
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6. S41
Journal of Pharmacy and Bioallied Sciences ¦ Volume 13 ¦ Supplement 1 ¦ June 2021
Shaik, et al.: Regenerative endodontic therapy in managing non vital teeth
and eventually loss of pulp/tooth vitality after apical
closure. In 50% of studies, tooth decoloration after
RET treatment has been identified. The discoloration is
commonly reported to be associated with minocycline,
even though calcium hydroxide has also been reported
to be associated with tooth discoloration.[20]
MTA can
also cause tooth discoloration, specifically Bismuth
oxide in MTA, which has shown to cause crown
discoloration. Consequently, after contact with blood,
materials exhibit greater color changes, which has
consequences in RET as they are put in close contact
with the BC scaffold. With the use of present‑day
filling materials such as composites and bonding
agents, reduced interaction between antibiotics
and hemosiderin with dentinal walls is observed.
In different studies, though this approach has been
implemented, its usefulness is unpredictable. The use of
Biodentine instead of MTA to minimize the possibility
of discoloration has been reported in several studies.
In general, bleaching of decolored teeth is effective in
improving the esthetic result.[21,29]
We observed a good
accomplishment rates in terms of survival of the treated
tooth and also in the resolution of any associated
pathology in the apical areas; on the contrary, our
results in relation to apex closure along with constant
root development, our findings from various studies
were quiet variable. We observed that at present, there
is a lack of well‑documented, longitudinal studies in
the literature which can focus on long‑term outcomes
of the treated teeth. The interpretation of the processes
underlying angiogenic reactions to dental pulp is still
not yet fully understood. In relation to the production
of new therapies required to regenerate the pulp tissue,
revascularization is important. Hence, regulation
and expression of growth factors such as vascular
endothelial growth factor and fibroblast growth
factor, new therapeutic technique may be applied to
revascularize the pulp tissue of traumatized teeth.
Regenerative endodontic techniques have tremendous
potential to be an effective, healthy, and biological
way of preserving teeth that have damaged structural
integrity if the problems discussed above are addressed.
To advance regenerative therapeutics to the next stage,
significant research and development efforts are needed.
Conclusions
Regenerative endodontic procedures are constantly
being restructured and enhanced to benefit present‑day
dentistry in all likely ways. Still, many factors which
are important for the success of RET outcomes still
remain unexplained. There are still numerous gaps in
our expertise at the present stage of this study.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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