Customizing the prefabricated fiber post: A case report

Customizing the prefabricated fiber post to direct anatomic post possesses advantages of intimate adaptation of the cast metal post and similar modulus of elasticity of prefabricated fiber post, thus optimizing the properties of both. This report presents the case of a 30-year-old female patient with a grossly decayed upper right central incisor having a history of intermittent pain and swelling since 2 weeks. Patient presented with a history of trauma 2 years back and recurring sinus formation since 6 months. A diagnosis of chronic periapical abscess was established and the endodontic treatment followed by direct anatomic post and crown were recommended for the affected tooth. One year conclusive outcome of the presented case highlights that customizing the prefabricated fiber post is relatively simple, minimally invasive and requires only few additional steps in single appointment beyond those needed to lute a prefabricated fiber post.

Comparative Metabolomics Reveals the Microenvironment of Common T-Helper Cells and Differential Immune Cells Linked to Unique Periapical Lesions

Periapical abscesses, radicular cysts, and periapical granulomas are the most frequently identified pathological lesions in the alveolar bone. While little is known about the initiation and progression of these conditions, the metabolic environment and the related immunological behaviors were examined for the first time to model the development of each pathological condition. Metabolites were extracted from each lesion and profiled using gas chromatography-mass spectrometry in comparison with healthy pulp tissue. The metabolites were clustered and linked to their related immune cell fractions. Clusters I and J in the periapical abscess upregulated the expression of MMP-9, IL-8, CYP4F3, and VEGF, while clusters L and M were related to lipophagy and apoptosis in radicular cyst, and cluster P in periapical granuloma, which contains L-(+)-lactic acid and ethylene glycol, was related to granuloma formation. Oleic acid, 17-octadecynoic acid, 1-nonadecene, and L-(+)-lactic acid were significantly the highest unique metabolites in healthy pulp tissue, periapical abscess, radicular cyst, and periapical granuloma, respectively. The correlated enriched metabolic pathways were identified, and the related active genes were predicted. Glutamatergic synapse (16–20),-hydroxyeicosatetraenoic acids, lipophagy, and retinoid X receptor coupled with vitamin D receptor were the most significantly enriched pathways in healthy control, abscess, cyst, and granuloma, respectively. Compared with the healthy control, significant upregulation in the gene expression of CYP4F3, VEGF, IL-8, TLR2 (P < 0.0001), and MMP-9 (P < 0.001) was found in the abscesses. While IL-12A was significantly upregulated in cysts (P < 0.01), IL-17A represents the highest significantly upregulated gene in granulomas (P < 0.0001). From the predicted active genes, CIBERSORT suggested the presence of natural killer cells, dendritic cells, pro-inflammatory M1 macrophages, and anti-inflammatory M2 macrophages in different proportions. In addition, the single nucleotide polymorphisms related to IL-10, IL-12A, and IL-17D genes were shown to be associated with periapical lesions and other oral lesions. Collectively, the unique metabolism and related immune response shape up an environment that initiates and maintains the existence and progression of these oral lesions, suggesting an important role in diagnosis and effective targeted therapy.

Prevalence of unculturable bacteria in the periapical abscess: A systematic review and meta-analysis

Objective To assess the prevalence of unculturable bacteria in periapical abscess, radicular cyst, and periapical granuloma. Methods PubMed, Scopus, Science Direct, and Ovid databases were systematically searched from January 1990 to May 2020. All the included studies were cross-sectional design. The risk of bias was assessed using Joanna Briggs Institute check-list. Heterogeneity was described using meta-regression and mixed-effects model for lesion, country, and sequence technique moderators. Funnel plot and unweighted Egger’s regression test were used to estimate the publication bias. Microbiome data on diversity, abundance, and frequency of unculturable bacteria in the periapical lesions were reviewed, analysed, and the principal component analysis (PCA) was performed. Results A total of 13 studies out of 14,780, were selected for the final analysis. These studies focused on the prevalence of unculturable bacteria in periapical abscesses and related lesions. Approximately 13% (95% CI: 7–23%) of the cumulative number of bacteria derived from periapical abscesses was unculturable. Country moderator significantly (P = 0.05) affects the diversity summary proportion. While the pooled frequency of unculturable bacteria was 8%; 95% CI: 5, 14%, the estimate of the pooled abundance of unculturable bacteria was 5%; 95% CI: 2, 12% with a significant (P = 0.05) country moderator that affects the abundance summary proportion. Of the 62 unculturable bacteria, 35 were subjected to PCA and Peptostreptococcus sp. oral clone CK035 was the most abundant species in periapical abscesses. Hybridization techniques were found to be the most reliable molecular methods in detecting the abundance and frequency of unculturable bacteria. Conclusion The significant prevalence of unculturable bacteria in the periapical abscess, suggests that they are likely to play, a yet unknown, critical role in the pathogenesis and progression of the disease. Further research remains to be done to confirm their specific contributions in the virulence and disease progression.

Acute Dental Periapical Abscess and New-Onset Atrial Fibrillation: A Nationwide, Population-Based Cohort Study

There are limited data on the relationship of acute dental infections with hospitalisation and new-onset atrial fibrillation (AF). This study aimed to assess the relationship between acute periapical abscess and incident AF. This was a retrospective cohort study from a French national database of patients hospitalized in 2013 (3.4 million patients) with at least five years of follow up. In total, 3,056,291 adults (55.1% female) required hospital admission in French hospitals in 2013 while not having a history of AF. Of 4693 patients classified as having dental periapical abscess, 435 (9.27%) developed AF, compared to 326,241 (10.69%) without dental periapical abscess that developed AF over a mean follow-up of 4.8 ± 1.7 years. Multivariable analysis indicated that dental periapical abscess acted as an independent predictor for new onset AF (p < 0.01). The CHA2DS2VASc score in patients with acute dental periapical abscess had moderate predictive value for development of AF, with Area Under the Curve (AUC) 0.73 (95% CI, 0.71–0.76). An increased risk of new onset AF was identified for individuals hospitalized with dental periapical abscess. Careful follow up of patients with severe, acute dental periapical infections is needed for incident AF, as well as investigations of possible mechanisms linking these conditions.

Thermography as a non-ionizing quantitative tool for diagnosing periapical inflammatory lesions

Background Thermography is a contemporary imaging modality based on acquiring and analyzing thermal data using non-contact devices. The aim of the present study was to assess the validity of thermography, compared with that of the reference-standard, for the diagnosis of periapical inflammatory lesions and to evaluate the temperature ranges for acute pulpitis with apical periodontitis (AAP), acute periapical abscess (AA) and chronic periapical abscess (CA). Methods AAP, AA and CA were diagnosed based on clinical and radiographic criteria. Thermographic data were acquired using the FLIR E-5 Infrared Camera. Extraoral thermal images were taken from the front and right and left sides of patients whose mouths were closed, and one intraoral thermal image was taken from the palatal perspective. Agreement in the diagnoses based on the combination of clinical and radiographic assessments and the thermographic evaluation was calculated. The temperature ranges of the three diagnostic subgroups were also measured. Results A total of 80 patients were enrolled in this study. The mean intraoral thermal image temperature for AA was 37.26 ± 0.36, that for CA was 35.03 ± 0.63 and that for AAP was 36.07 ± 0.45. The differences between the mean intraoral thermal temperatures of the three diagnostic groups were statistically significant (P < 0.001). The result of the Kappa coefficient of agreement between the combination of clinical and radiographic assessments and the thermographic evaluation was significant (P < 0.001). Conclusions Thermography is an effective, quantitative and nonionizing approach that can be used for the diagnosis of periapical inflammatory lesions. The results of the present study indicated that the highest thermal image temperatures were recorded for AA. Thermography might be able to detect inflammatory reactions during the preclinical stage, leading to early diagnosis.

Acute dental periapical abscess and new-onset atrial fibrillation: A nationwide, population-based cohort study

Funding Acknowledgements Type of funding sources: None. Background There are limited data on whether there is an association between hospitalisation with dental periapical abscess and new-onset atrial fibrillation (AF) which is independent of main cardiovascular risk factors. Purpose To investigate whether there is an association between hospitalisation with dental periapical abscess and new-onset AF. Methods A retrospective cohort study from a national database of patients hospitalised in 2013 (3.4 million patients) with at least five years of follow up, unless deceased. International Classification of Diseases (ICD) codes were used to compare the risk of developing new-onset AF for adults with and without dental periapical abscesses using univariate and multivariable analysis and hazard ratios (HR). Results In total, 4,693 patients classified as having dental periapical abscess, 435 (9.27%) developed AF, compared to 326,241 (10.69%) without dental periapical abscess over a mean follow-up of 4.8 ± 1.7 years. Multivariable analysis indicated that dental periapical abscess acted as an independent predictor for new onset AF (p &lt; 0.01). Conclusions An increased risk of new onset AF was identified for individuals hospitalised with dental periapical abscess. Careful follow up of patients with severe, acute dental periapical infections are needed for incident AF, as well as investigations of possible mechanisms linking these conditions. Predictors of new-onset AF during FU Univariate analysis Multivariate analysis HR, 95%CI P HR, 95%CI P Age, years 1.077 (1.076-1.077) &lt;0.0001 1.076 (1.075-1.076) &lt;0.0001 Gender (male) 1.640 (1.629-1.651) &lt;0.0001 1.0498 (1.487-1.509) &lt;0.0001 Hypertension 2.849 (2.829-2.869) &lt;0.0001 1.114 (1.487-1.509) &lt;0.0001 Diabetes mellitus 1.951 (1.935-1.968) &lt;0.0001 1.106 (1.096-1.116) &lt;0.0001 Heart failure 3.893 (3.857-3.930) &lt;0.0001 1.434 (1.416-1.452) &lt;0.0001 Ischaemic stroke 2.289 (2.23902.340) &lt;0.0001 1.140 (1.114-1.165) &lt;0.0001 smoker 0.903 (0.891-0.917) &lt;0.0001 1.052 (1.036-1.069) &lt;0.0001 Liver disease 1.141 (1.119-1.164) &lt;0.0001 1.082 (1.059-1.105) &lt;0.0001 Previous myocardial infarction 2.128 (2.082-2.176) &lt;0.0001 0.903 (0.880-0.926) &lt;0.0001 Inflammatory disease 1.036 (1.020-1.052) &lt;0.0001 0.978 (0.964-0.994) 0.005 Cognitive impairment 2.368 (2.326-2.410) &lt;0.0001 0.821 (0.807-0.836) &lt;0.0001 Illicit drug use 0.288 (0.263-0.317) &lt;0.0001 0.940 (0.855-1032) 0.19 Dental periapical abscess 0.855 (0.778- 0.939) 0.001 1.107 (1.008-1.216) 0.03 At least 5 years of follow-up (mean follow-up 4.8 ± 1.7 years). Abstract Figure. Flow Chart of the study patients

Thermography as a Non-ionizing Quantitative Tool for Diagnosing Endo-perio Lesions

Background: Thermography is a contemporary imaging modality based on acquiring and analyzing thermal data using non-contact devices. The aim of the present study was to assess the validity of thermography, compared with that of the gold standard, for the diagnosis of endo-perio lesions and to evaluate the temperature ranges for acute pulpitis with apical periodontitis (AAP), acute periapical abscess (AA) and chronic periapical abscess (CA).Methods: AAP, AA and CA were diagnosed based on clinical and radiographic criteria. Thermographic data were acquired using the FLIR E-5 Infrared Camera. Extraoral thermal images were taken from the front and right and left sides of patients whose mouths were closed, and one intraoral thermal image was taken from the palatal perspective. Agreement in the diagnoses based on the combination of clinical and radiographic assessments and the thermographic evaluation was calculated. The temperature ranges of the three subdiagnostic groups were also measured.Results: A total of 80 patients were enrolled in this study. The mean thermal image temperature for AA was 37.26±0.36, that for CA was 35.03±0.63 and that for AAP was 36.07±0.45. The differences between the mean thermal temperatures of the three diagnostic groups were highly statistically significant (P<0.001). The result of the Kappa coefficient of agreement between the combination of clinical and radiographic assessments and the thermographic evaluation was highly significant (P<0.001). The rates of change in temperature with time for each diagnostic group were highly statistically significantly different (P<0.001).Conclusions: Thermography is an effective, quantitative and nonionizing approach that can be used for the diagnosis of endo-perio lesions. This technology is able to distinguish different forms of infection by identifying the range of temperature increases related to each form.

Acute Apical Abscess Treatment with an Iranian Folk Remedy: A Case Report

Background: There are only a few treatment approaches for periapical abscess as a prevalent complication and as the most common type of dental abscess. Drainage and/or antibiotic therapy is the first step to treat this infection, depending on its severity and symptoms. Case Presentation: Amoxicillin/clavulanate (TID for 3 days), clindamycin (QID for 3 days), and a single local dose of an Iranian home remedy called metmeto, a mixture of toasted flour and ghee covered with a sterile piece of cotton fabric-, were respectively prescribed, for a 32-year-old male patient with a spreading periapical abscess. The first two antibiotics were not able to mitigate the symptoms (pain, inflammation,infection, etc.), while the abscess disappeared remarkably the morning after using a single dose of metmeto “as a dressing” for 6 hours. To eliminate the possible riskof recurrence, the patient underwent an endodontic retreatment after 2 weeks. Conclusion: Some folk home remedies such as metmeto can be considered for treatment of dental problemsas noninvasive and safe choices. Further studies are necessary to conclude a causal association.