Amir Azarpazhooh

The application of ozone in dentistry: a systematic review of literature.

OBJECTIVES (1) To systematically review the clinical application and remineralization potentials of ozone in dentistry; (2) To summarize the available in vitro applications of ozone in dentistry. SOURCES Ovid MEDLINE, CINAHL, etc. (up to April 2007). STUDY SELECTION In vitro or in vivo English language publications, original studies, and reviews were included. Conference papers, abstracts, and posters were excluded. RESULTS In vitro: Good evidence of ozone biocompatibility with human oral epithelial cells, gingival fibroblast, and periodontal cells; Conflicting evidence of antimicrobial efficacy of ozone but some evidence that ozone is effective in removing the microorganisms from dental unit water lines, the oral cavity, and dentures; Conflicting evidence for the application of ozone in endodontics; Insufficient evidence for the application of ozone in oral surgery and implantology; Good evidence of the prophylactic application of ozone in restorative dentistry prior to etching and the placement of dental sealants and restorations. In vivo: Despite the promising in vitro evidence, the clinical application of ozone in dentistry (so far in management of dental and root caries) has not achieved a strong level of efficacy and cost-effectiveness. CONCLUSIONS While laboratory studies suggest a promising potential of ozone in dentistry, this has not been fully realised in clinical studies to date. More well designed and conducted double-blind randomised clinical trials with adequate sample size, limited or no loss to follow up, and carefully standardised methods of measurement and analyses are needed to evaluate the possible use of ozone as a treatment modality in dentistry.

The Effect of Photodynamic Therapy for Periodontitis: A Systematic Review and Meta-Analysis

BACKGROUND The purpose of this review was to evaluate the effectiveness of photodynamic therapy (PDT) for periodontitis in adults as a primary mode of treatment or as an adjunct to non-surgical treatment of scaling and root planing (SRP) compared to a conventional non-surgical SRP treatment. METHODS MEDLINE, EMBASE, CINAHL, other relevant databases, and the International Pharmaceutical Abstracts were searched from their inception until May 2009 for randomized controlled trials of PDT compared to a placebo, no intervention, or non-surgical treatment in an adult population. Data on changes in clinical attachment level (CAL), probing depth, gingival recession, and full-mouth plaque or bleeding scores were extracted and meta-analyzed, and the pooled mean difference (MD) was reported. RESULTS Five studies were included in this review. These studies had a small sample size for some of the performed analysis with a moderate to high risk of biases. There were clinical heterogeneities among included studies. PDT as an independent treatment or as an adjunct to SRP versus a control group of SRP did not demonstrate statistically or clinically significant advantages. Combined therapy of PDT + SRP indicated a probable efficacy in CAL gain (MD: 0.34; 95% confidence interval [CI]: 0.05 to 0.63) or probing depth reduction (MD: 0.25 mm; 95% CI: 0.04 to 0.45 mm). CONCLUSIONS PDT as an independent treatment or as an adjunct to SRP was not superior to control treatment of SRP. Therefore, the routine use of PDT for clinical management of periodontitis cannot be recommended. Well-designed clinical trials are needed for proper evaluation of this therapy.

Synergistic Effect of Microbubble Emulsion and Sonic or Ultrasonic Agitation on Endodontic Biofilm in Vitro

INTRODUCTION Irrigation dynamics and antibacterial activity determine the efficacy of root canal disinfection. Sonic or ultrasonic agitation of irrigants is expected to improve irrigation dynamics. This study examined the effects of microbubble emulsion (ME) combined with sonic or ultrasonic agitation on irrigation dynamics and reduction of biofilm bacteria within root canal models. METHODS Two experiments were conducted. First, high-speed imaging was used to characterize the bubble dynamics generated in ME by sonic or ultrasonic agitation within canals of polymer tooth models. Second, 5.25% NaOCl irrigation or ME was sonically or ultrasonically agitated in canals of extracted teeth with 7-day-grown Enterococcus faecalis biofilms. Dentinal shavings from canal walls were sampled at 1 mm and 3 mm from the apical terminus, and colony-forming units (CFUs) were enumerated. Mean log CFU/mL values were analyzed with analysis of variance and post hoc tests. RESULTS High-speed imaging demonstrated strongly oscillating and vaporizing bubbles generated within ME during ultrasonic but not sonic agitation. Compared with CFU counts in controls, NaOCl-sonic and NaOCl-ultrasonic yielded significantly lower counts (P < .05) at both measurement levels. ME-sonic yielded significantly lower counts (P = .002) at 3 mm, whereas ME-ultrasonic yielded highly significantly lower counts (P = .000) at both measurement levels. At 3 mm, ME-ultrasonic yielded significantly lower CFU counts (P = .000) than ME-sonic, NaOCl-sonic, and NaOCl-ultrasonic. CONCLUSIONS Enhanced bubble dynamics and reduced E. faecalis biofilm bacteria beyond the level achieved by sonic or ultrasonic agitation of NaOCl suggested a synergistic effect of ME combined with ultrasonic agitation.

Torsional Profiles of New and Used 20/.06 GT Series X and GT Rotary Endodontic Instruments

INTRODUCTION M-Wire (Sportswire LLC, Langley, OK) is reportedly created by altering alloy temperatures during the manufacturing process of GT series X instruments (Dentsply Tulsa Dental Specialties, Tulsa, OK). Currently, there are few published studies looking at torsional profiles of these instruments. The purpose of this study was to investigate the torsional profiles of new and used 20/0.06 GT series X (GTX) and GT (GT) instruments (Dentsply Tulsa Dental Specialties). METHODS Thirty instruments were allocated to one of eight groups and were used 2, 6, or 10 times in simulated canals or remained as unused controls. Testing of torque (TF) and angle at fracture (AF) were conducted in accordance with American National Standards Institute/American Dental Association (ANSI/ADA) specification No. 28. Data analyses were performed by using one- and two- way analysis of variance with honesty significance difference post hoc comparison with alpha = 0.05. RESULTS Overall, there were significant differences in TF and AF among the experimental groups (p < 0.001). GTX instruments showed a significant initial increase in TF with two and six uses (p < 0.001) in contrast to the GT, which showed a linear reduction in TF with increased use (p < 0.004). Both GTX and GT instruments showed no statistical difference in AF of new instruments but did show a significant decrease in AF in all groups except the GT two-use group (p < 0.02). CONCLUSION The GTX instruments had a higher resistance to torsional failure after use as compared with the GT.

Cone-beam Computed Tomography for Detecting Vertical Root Fractures in Endodontically Treated Teeth: A Systematic Review

INTRODUCTION A vertical root fracture (VRF), commonly found in teeth with endodontic treatment, is challenging to diagnose and has poor treatment outcomes. Cone-beam computed tomography (CBCT) has become an increasingly popular imaging modality in endodontics, but image artifacts arising from root-filling materials may hinder VRF detection. The aim of this investigation was to conduct a systematic review to assess the diagnostic ability of CBCT for detecting VRFs in endodontically treated teeth. METHODS A systematic review of in vivo clinical diagnostic literature (initial search December 2014, updated August 2015) was conducted. Assessment of methodological quality was performed by using the modified Quality Assessment of Diagnostic Accuracy Studies tool. RESULTS Four studies with a total of 130 patients were included. The reported ranges of values were 40%-90% for VRF prevalence, 84% (0.64-0.95) to 100% (0.83-1.00) for sensitivity, 64% (0.35-0.87) to 100% (0.03-1.00) for specificity, 71% (0.51-0.87) to 100% (0.63-1.00) for positive predictive value, and 50% (0.01-0.99) to 100% (0.84-1.00) for negative predictive value. All 4 studies revealed multiple items at high risk or unclear risk of bias. CONCLUSIONS Because of the significant imprecision in the range of reported estimates and the biases observed in the included studies, there is currently insufficient evidence to suggest that CBCT is a reliable test in detecting VRFs in endodontically treated teeth.

A practical approach to evidence-based dentistry:Understanding and applying the principles of EBD

Scientific evidence is a crucial underpinning of clinical practice. Nevertheless, the first series of articles aimed at providing clinicians with guidelines for critically appraising the evidence that informs clinical practices did not appear until 1981.1 Ten years later, the term “evidence-based medicine”2 first appeared in the medical literature. Subsequently, between 1993 and 2000, a group of evidence-based medicine enthusiasts3 published a series of 25 articles that aimed at assisting clinicians in understanding and applying the medical literature to their clinical decision making in a clinical setting.4 The concept of evidence-based medicine soon expanded to other clinical areas. The first article to use the term “evidence-based dentistry” (EBD) was published in 1995 by Richards and Lawrence,5 and since then other articles have been published on the topic.6-11 There is, however, still no guide easily accessible for practicing dentists in the United States that addresses the critical appraisal and use of evidence specifically aimed at clinicians in oral health care fields. A series of articles (Box) will be published in The Journal of the American Dental Association, aimed at providing an overview of the basic concepts of EBD to assist oral health care professionals in making use of evidence to inform their clinical decisions. The series will consist of, in addition to this introductory commentary, six core articles that will address the main topics in EBD. In this introductory commentary, we will define EBD, delineate its principles and outline the main steps in the process of EBD. The first core article will describe how to state questions in a format that facilitates searching for the evidence, and where and how to search for such evidence. In the remaining articles, we will explain how to use literature about therapy and prevention, etiology and prognosis, and diagnosis as well as systematic reviews and clinical practice guidelines.

Efficacy of bacteriophage treatment on Pseudomonas aeruginosa biofilms.

INTRODUCTION Bacterial viruses (phages) have been used successfully in the treatment of animal and human bacterial infections. This study examined the potential use of phage therapy against Pseudomonas aeruginosa strain PA14 biofilms in a root canal model. METHODS Part 1: The 24-hour and 96-hour PA14 biofilms grown in microplates were treated with phages identified as possessing potential biofilm-degrading activities, and the post-treatment bacterial biomass was quantified by using crystal violet staining. Part 2: The 24-hour and 96-hour PA14 biofilms grown in prepared root canals of extracted human mandibular incisors were treated with phages identified with potential biofilm-degrading activities. Post-treatment intracanal samples were taken by using paper points and round burs to assess phage and bacterial counts. RESULTS Part 1: We identified 2 phages (JBD4 and JBD44a) with putative biofilm-degrading activities. Treatment of PA14 biofilms with these phages produced a significant reduction in the mean percentage of biomass in 24-hour (P< .05) and 96-hour (P= .08) biofilms. Part 2: In 24-hour and 96-hour PA14 biofilms in a root canal model, no significant difference was found in the number of colony-forming units after phage treatment (P> .05). CONCLUSIONS Phage application significantly reduced the biomass of 24-hour and 96-hour PA14 biofilms grown on microplates but did not produce significant reduction of 24-hour or 96-hour PA14 biofilms grown in the extracted tooth model.

The impact of interferon-alpha treatment on clinical and immunovirological aspects of HTLV-1-associated myelopathy in northeast of Iran

Human T-lymphotropic virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a chronic inflammatory myelopathy. The pathophysiology of HAM/TSP is not yet fully understood; therefore, effective therapy remains a challenging issue. This study was designed to evaluate the efficacy of interferon-alpha (IFN-α) in HAM/TSP patients in the Northeast of Iran. Forty-nine patients with a definite diagnosis of HAM/TSP were enrolled in this clinical trial. For six months, the patients received three million international units of subcutaneous IFN-α-2b per each injection. The dose regimen was daily injection for the first month, three times administration per week for the months 2 and 3, twice weekly injection for the months 4 and 5 and weekly injection for the sixth month. The clinical and laboratory responses were evaluated based on neurologic examinations and immunovirological markers. IFN-α had significant but temporary effect on the motor and urinary functions of the patients. Comparing to the baseline values, proviral load was significantly decreased one month after treatment in responders (495.20±306.87 to 262.69±219.24 p=0.02) and non-responders (624.86±261.90 to 428.28±259.88 p=0.03). Anti-HTLV-1 antibody titers were significantly decreased among responders (1152.1±200.5 to 511.6±98.2 p=0.009) and non-responders (1280.1±368.1 to 537.6±187 p=0.007). Flow cytometry showed no significant changes in CD4, CD8, CD4CD25 and CD16CD56 counts with IFN-α. The positive impact of IFN-α was observed during the treatment period with significant effects on some clinical aspects of HAM/TSP.

Prophylactic oral health procedures to prevent hospital-acquired and ventilator-associated pneumonia: A systematic review

OBJECTIVES Given the severity of hospital-acquired pneumonia and ventilator-associated pneumonia, the purpose of this systematic review was to identify various oral health procedures, in intensive care unit or nursing home setting, shown to help reduce the incidence of hospital-acquired and ventilator-associated pneumonia. DESIGN Randomized controlled trials evaluating the efficacy of at least one prophylactic oral health procedure in reducing hospital-acquired pneumonia or ventilator-associated pneumonia were included. DATA SOURCES MEDLINE, EMBASE, and CINAHL were searched for relevant studies. In addition, references of studies included for full-text review were examined for potentially relevant studies. Grey literature was searched for by reviewing the first 200 results obtained in Google Scholar™. REVIEW METHODS Two authors conducted study selection and data extraction for this review. The Cochrane risk of bias tool was applied to assess the quality of the included trials (namely sequence generation, allocation concealment, blinding, the completeness of data assessment, the lack of selective reporting, and the lack of other miscellaneous biases) based on the information in the original publications. An assessment of a high, unclear, or low risk of bias was assigned to each domain. RESULTS Through review of the 28 trials included in this review, we found that good oral health care was suggested to be associated with a reduction in the risk for hospital-acquired and ventilator-associated pneumonia in high-risk patients. Furthermore, through the review of studies evaluating the efficacy of chlorhexidine, we found that, despite the presence of mixed results, that chlorhexidine may be a particularly effective means of lowering the risk for hospital-acquired and ventilator-associated pneumonia. The efficacy of other prophylactic oral health techniques such as the use of tooth brushing or iodine swab was uncertain. CONCLUSIONS Current evidence suggests that chlorhexidine rinses, gels and swabs may be effective oral disinfectants in patients at high risk for hospital-acquired and ventilator-associated pneumonia. The evidence supporting the effectiveness of other oral care means still remains scarce and methodologically weak. As such, efforts to promote the increase of high-quality studies and to support nursing educational efforts to promote the dissemination of evidence-based knowledge of oral prophylaxis into clinical practice are warranted.

Time loss due to dental problems and treatment in the Canadian population: analysis of a nationwide cross-sectional survey

BackgroundThe purpose of this study was to quantify time loss due to dental problems and treatment in the Canadian population, to identify factors associated with this time loss, and to provide information regarding the economic impacts of these issues.MethodsData from the 2007/09 Canadian Health Measures Survey were used. Descriptive analysis determined the proportion of those surveyed who reported time loss and the mean hours lost. Linear and logistic regressions were employed to determine what factors predicted hours lost and reporting time loss respectively. Productivity losses were estimated using the lost wages approach.ResultsOver 40 million hours per year were lost due to dental problems and treatment, with a mean of 3.5 hours being lost per person. Time loss was more likely among privately insured and higher income earners. The amount of time loss was greater for higher income earners, and those who reported experiencing oral pain. Experiencing oral pain was the strongest predictor of reporting time loss and the amount of time lost.ConclusionsThis study has shown that, potentially, over 40 million hours are lost annually due to dental problems and treatment in Canada, with subsequent potential productivity losses of over