Shaju Jacob Pulikkotil

Methodological and Reporting Quality of Systematic Reviews and Meta-analyses in Endodontics

Introduction: The aim of this systematic review (SR) was to evaluate the quality of SRs and meta‐analyses (MAs) in endodontics. Methods: A comprehensive literature search was conducted to identify relevant articles in the electronic databases from January 2000 to June 2017. Two reviewers independently assessed the articles for eligibility and data extraction. SRs and MAs on interventional studies with a minimum of 2 therapeutic strategies in endodontics were included in this SR. Methodologic and reporting quality were assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and Preferred Reporting Items for Systematic Review and Meta‐Analyses (PRISMA), respectively. The interobserver reliability was calculated using the Cohen kappa statistic. Statistical analysis with the level of significance at P < .05 was performed using Kruskal‐Wallis tests and simple linear regression analysis. Results: A total of 30 articles were selected for the current SR. Using AMSTAR, the item related to the scientific quality of studies used in conclusion was adhered by less than 40% of studies. Using PRISMA, 3 items were reported by less than 40% of studies, which were on objectives, protocol registration, and funding. No association was evident comparing the number of authors and country with quality. Statistical significance was observed when quality was compared among journals, with studies published as Cochrane reviews superior to those published in other journals. AMSTAR and PRISMA scores were significantly related. Conclusions: SRs in endodontics showed variability in both methodologic and reporting quality. HIGHLIGHTSThe overall methodologic quality and the reporting quality of included systematic reviews and meta‐analyses were found to be moderate.There was no significant difference in quality based on the number of authors and the country of study.A high correlation was found between A Measurement Tool to Assess Systematic Reviews (AMSTAR) and Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) quality assessment scores.AMSTAR and PRISMA are valuable tools that can help the authors to assess and improve the quality of systematic reviews and meta‐analyses.

Efficacy of Biodentine and Mineral Trioxide Aggregate in Primary Molar Pulpotomies—A Systematic Review and Meta-Analysis With Trial Sequential Analysis of Randomized Clinical Trials

Objectives Pulpotomy is the favored treatment for pulp exposure in carious primary teeth. This review aimed to compare the success rates of biodentine (BD) and mineral trioxide aggregate (MTA) pulpotomies in primary molars using meta‐analysis (MA) and trial sequential analysis (TSA) and also to assess the quality of the results by Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Methods PubMed, EBSCOhost, and Scopus databases were searched. Additional searching was performed in clinical trial registry, reference lists of systematic reviews, and textbooks. Randomized clinical trials (RCTs) published in the English language through October 2017 comparing the success of pulpotomies in vital primary molars with a follow‐up of at least 6 months were selected. Study selection, data extraction, and risk of bias assessment were performed. MA by random effects model, TSA, and GRADE were performed. Results Eight RCTs (n = 474) were included. Two RCTs had low risk of bias. No significant difference was observed between MTA and BD in clinical success at 6 months (risk ratio [RR], 1.00; 95% confidence interval [95% CI], 0.97–1.02; I2 = 0%), 12 months (RR, 1.00; 95% CI, 0.96–1.05; I2 = 0%), and 18 months (RR, 1.00; 95% CI, 0.93–1.08; I2 = 0%). No difference was observed in radiographic success at follow‐up of 6 months (RR, 0.99; 95% CI, 0.96–1.02; I2 = 0%), 12 months (RR, 1.02; 95% CI, 0.47–2.21; I2 = 0%), and 18 months (RR, 1.02; 95% CI, 0.91–1.15; I2 = 0%). TSA indicated lack of firm evidence for the results of the meta‐analytic outcomes on clinical and radiographic success. GRADE assessed the evidence from the MA comparing the effect of MTA and BD in pulpotomy to be of low quality. Conclusion BD and MTA have similar clinical and radiographic success rates based on limited and low‐quality evidence. Future high‐quality RCTs between MTA and BD is required to confirm the evidence.

Effect of Nonsteroidal Anti-inflammatory Drug as an Oral Premedication on the Anesthetic Success of Inferior Alveolar Nerve Block in Treatment of Irreversible Pulpitis: A Systematic Review with Meta-analysis and Trial Sequential Analysis

Introduction: Successful anesthesia with an inferior alveolar nerve block (IANB) is imperative for treating patients with irreversible pulpitis in mandibular teeth. This systematic review assessed the efficacy of nonsteroidal anti‐inflammatory drugs (NSAIDs) as oral premedications on the success of IANBs in irreversible pulpitis. Methods: Three databases were searched to identify randomized clinical trials (RCTs) published up until September 2017. Retrieved RCTs were evaluated using the revised Cochrane Risk of Bias Tool. The primary efficacy outcome of interest was the success rate of IANB anesthesia. Meta‐analytic estimates (risk ratio [RR] with 95% confidence intervals [CIs]) performed using a random effects model and publication bias determined using funnel plot analysis were assessed. Random errors were evaluated with trial sequential analyses, and the quality of evidence was appraised using a Grading of Recommendations, Assessment, Development and Evaluation approach. Results: Thirteen RCTs (N = 1034) were included. Eight studies had low risk of bias. Statistical analysis of good‐quality RCTs showed a significant beneficial effect of any NSAID in increasing the anesthetic success of IANBs compared with placebo (RR = 1.92; 95% CI, 1.55–2.38). Subgroup analyses showed a similar beneficial effect for ibuprofen, diclofenac, and ketorolac (RR = 1.83 [95% CI, 1.43–2.35], RR = 2.56 [95% CI, 1.46–4.50], and RR = 2.07 [95% CI, 1.47–2.90], respectively). Dose‐dependent ibuprofen >400 mg/d (RR = 1.85; 95% CI, 1.39–2.45) was shown to be effective; however, ibuprofen ≤400 mg/d showed no association (RR = 1.78; 95% CI, 0.90–3.55). TSA confirmed conclusive evidence for a beneficial effect of NSAIDs for IANB premedication. The Grading of Recommendations, Assessment, Development and Evaluation approach did not reveal any concerns regarding the quality of the results. Conclusions: Oral premedication with NSAIDs and ibuprofen (>400 mg/d) increased the anesthetic success of IANBs in patients with irreversible pulpitis. HIGHLIGHTSA systematic review of the effects of oral premedication for inferior alveolar nerve block identified 13 RCTs.NSAIDs increase inferior alveolar nerve block success in irreversible pulpitis.Trial sequential analysis confirmed meta‐analytic results.

The role of three interleukin 10 gene polymorphisms (− 1082 A > G, − 819 C > T, − 592 A > C) in the risk of chronic and aggressive periodontitis: a meta-analysis and trial sequential analysis

BackgroundPeriodontitis is a major oral health problem and it is considered as one of the reasons for tooth loss in developing and developed nations. The objective of the current review was to investigate the association between IL10 polymorphisms − 1082 A > G (rs1800896), -819C > T (rs1800871), − 592 A > C (rs1800872) and the risk of either chronic periodontitis or aggressive periodontitis.MethodsThis is a meta- analysis study, following the preferred reporting items for systematic reviews and meta- analyses (PRISMA). Relevant studies were searched in the health related electronic databases. Methodological quality of the included studies were assessed using the Newcastle-Ottawa Scale. For individual studies, odds ratio (OR) and its 95%confidence interval (CI) were calculated to assess the strength of association between IL10 polymorphisms (− 1082 A > G, -819C > T, − 592 A > C) and the risk of periodontitis. For pooling of the estimates across studies included, the summary OR and its 95% CIs were calculated with random-effects model. The pooled estimates were done under four genetic models such as the allelic contrast model, the recessive model, the dominant model and the additive model. Trial sequential analysis (TSA) was done for estimation of the required information size for this meta-analysis study.ResultsSixteen studies were identified for this review. The included studies were assessed to be of moderate to good methodological quality. A significant association between polymorphism of IL10–1082 A > G polymorphism and the risk of chronic periodontitis in the non-Asian populations was observed only in the recessive model (OR,1.42; 95% CI:1.11, 1.8,I2: 43%). The significant associations between − 592 A > C polymorphism and the risk of aggressive periodontitis in the non-Asian populations were observed in particular genetic models such as allele contrast (OR, 4.34; 95%CI:1.87,10.07,I2: 65%) and recessive models (OR, 2.1; 95% CI:1.16, 3.82,I2: 0%). The TSA plot revealed that the required information size for evidence of effect was sufficient to draw a conclusion.ConclusionsThis meta-analysis suggested that the IL10–1082 A > G polymorphism was associated with chronic periodontitis CP risk in non-Asians. Thus, in order to further establish the associations between IL10 (− 819 C > T, − 592 A > C) in Asian populations, future studies should include larger sample sizes with multi-ethnic groups.

Effect of root canal debridement on inflammatory cytokine levels

In endodontic infections, inflammatory mediators such as cytokines are released, recruited and retained until the infection is eradicated. Root canal therapy is performed to prevent the spread of infection. The aim of this study was to investigate the effects of root canal debridement (cleaning and shaping) on periapical inflammation by measuring the levels of inflammatory cytokines, Interleukin-8 (IL-8) and Interleukin-10 (IL-10). The study includes twenty patients with pulp necrosis and asymptomatic apical periodontitis. Periradicular sample was collected using paper points before and after root canal debridement. Cytokine levels were determined by Sandwich Enzyme-Linked Immunosorbent Assay (ELISA). Data were analysed using paired t-test (PASW Statistics 18) (P = 0.05). All samples showed the presence of IL-8 and IL-10 prior to root canal debridement. Significantly reduced levels (P < 0.05) of IL-8 and IL-10 were detected after root canal debridement. In conclusion, root canal debridement significantly decreased the levels of the tested pro- and anti-inflammatory cytokine in the periradicular interstitial fluid.

Surgical Management of Ectopic Third Molar in the Mandibular Sub condylar Region without a Pathological Cause: A Case Report

Ectopic third molar teeth are those that are impacted in unusual positions or that have been displaced and are at a distance from their normal anatomic location [1]. It is common have to ectopic eruption of a tooth within the oral cavity but rare in other sites of the jaw [2]. Reports are present with teeth eruption in the nasal septum, ascending ramus of mandible, mandibular condyle, and lower border of mandible, coronoid process, sigmoid notch, palate and maxillary sinus [1-3]. Unilateral as well as bilateral ectopic impacted third molar teeth have been reported in various parts of the mandibular ramus [4].

Effect of the use of snuff on the levels of interleukin-1 β and interleukin-8 in the gingival crevicular fluid of periodontitis patients.

Background: Use of smokeless tobacco in the form of moist snuff placed in the oral cavity is popular in rural India. The aim of the present cross-sectional study was to determine the effect of snuff on periodontitis by assessing interleukin (IL)-1 β and IL-8 levels in gingival crevicular fluid. Materials and Methods: A total of 60 subjects were selected for this study. 40 subjects presented with periodontitis, which included 20 snuff users (SP) and 20 nonsnuff users (NS). 20 periodontally healthy patients formed the controls (healthy control: HC). The clinical parameters recorded were gingival index (GI), plaque index, calculus index, bleeding on probing (BOP), probing depth (PD), recession (RC), and clinical attachment level (CAL). The IL-1 β and IL-8 levels were assessed through enzyme-linked immunosorbent assay (Quantikine®). Analysis of variance (ANOVA), post-hoc Tukeys, Kruskal-Wallis ANOVA and Mann-Whitney test was used for comparison among groups and P > 0.05 was considered statistically significant. Results: No significant difference was seen in levels of IL-1 β and IL-8 between SP and NS groups (P = 0.16, 0.97). However, both the periodontitis groups (SP and NS) had increased IL-β levels when compared to HC group (P = 0.01, 0.001). The snuff users showed significant increase in GI, BOP, RC, and CAL when compared with NS (P = 0.002, 0.001, 0.012, 0.002) whereas NS group had significant increase in PD (P = 0.003). Conclusion: Within the limitations of this study, use of snuff does not affect the host inflammatory response associated with periodontitis and leads to RC and increased CAL due to local irritant effect.

Letter to the Editor: Re: 1% Alendronate Gel as Local Drug Delivery in the Treatment of Class II Furcation Defects: A Randomized Controlled Clinical Trial

To the Editor: Re: 1% Alendronate Gel as Local Drug Delivery in the Treatment of Class II Furcation Defects: A Randomized Controlled Clinical Trial. Pradeep AR, Kumari M, Rao NS, Naik SB. (J Periodontol 2013;84:307-315.)