Faculty Bibliography

Data sourcesRelevant databases were searched for the review such as the Cochrane Oral Health Group Trials Register, Medline, EMBASE, clinical trials.gov, WHO International Clinical Trials Registry Platform.Study selectionRandomised controlled trials comparing adhesively bonded versus non-bonded class I and II amalgam restorations in permanent molars and premolars.Data extraction and synthesisTwo reviewers independently screened papers and extracted data.ResultsOne trial with 31 patients who received 113 restorations was included. At two years, 50 out of 53 restorations in the non-bonded group survived and 55 of 60 restorations survived with five unaccounted for at follow-up. Post insertion sensitivity was not statistically significant at baseline and for the two-year follow-up. No fractures or differences in the marginal adaptation were reported.ConclusionsThere is no evidence either to claim or to refute a difference in survival between bonded and non-bonded amalgam restorations. In view of the lack of evidence on the additional benefit of adhesively bonding amalgam in comparison with non-bonded amalgam, it is important that clinicians be mindful of the additional costs that may be incurred.

Data sourcesMedline and Embase databases and bibliographies of all included articles and relevant review articles were screened for possible inclusion.Study selectionLongitudinal studies were included reporting on implant survival, success, incidence of peri-implantitis, bone loss and periodontal status and on partially dentate patients with a history of treatment for periodontitis. There were no language restrictions for the included studies.Data extraction and synthesisAuthors independently and in duplicate assessed the studies for eligibility and data extraction. Disagreements were resolved by discussion and consensus. The methodological quality assessment of the included studies was done using an adapted Newcastle-Ottawa Scale (NOS). Confounding factors such as smoking, systemic disease influencing osseointegration, chemotherapy and radiation were assessed and adjusted in the analysis. Data were organised into tables and grouped in accordance with the study design.ResultsTwenty-four studies reported in 27 publications were included. Implant survival and success rate were higher in periodontally healthy patients.Twelve prospective cohort studies, five case series with a control group, four retrospective cohort studies and three studies with a sub group comparison were included.Bone loss and peri-implantitis were increased in patients with a history of treated periodontitis. More complications were reported in patients presenting with more severe forms of periodontitis. High heterogeneity among the studies in terms of study design, population, therapy, unit of analysis, inconsistent definitions of baseline and outcomes, inadequate reporting and confounding factors meant a meta-analysis could not be performed.Most of the studies showed better implant survival rates for the non-periodontitis group ranging from 91.67% to 100% compared to the treated periodontitis group 79.22% to 100% over a 1.2 to 16 year follow-up.ConclusionsImplants placed in patients treated for periodontal disease are associated with higher incidence of biological complications and lower success and survival rates than those placed in periodontally healthy patients. Severe forms of periodontal disease are associated with higher rates of implant loss. The conclusion of the review is limited by the strength of the evidence.

Data sourcesA broad computerised search with similar key terms was performed in different databases that included: Ovid Medline, Thomson's ISI Web of Science, PubMed, Science Direct, EMBASE and the Cochrane Library. Grey literature, dissertations, abstracts and theses were searched too. Reference lists of the selected articles were hand-searched.Study selectionThe inclusion criteria included in vivo randomised clinical trials and quasi-randomised clinical trials using gingival retraction techniques with and without cord. Studies were included if they examined the primary outcome from the review: efficiency of haemostasis control, the amount of gingival displacement and the influence of the techniques on gingival/periodontal health. Secondary outcomes accepted for the review included subjective factors reported by the patient such as pain, sensitivity, unpleasant taste and discomfort and operator's experience with both techniques. Non-English papers, clinical reports, animals studies or in vitro studies were excluded.Data extraction and synthesisTwo authors independently searched and screened the articles. Disagreements were resolved by discussion. A third reviewer participated in the eligibility of the studies. The risk of bias was assessed using the Cochrane Collaboration tool. Due to the heterogeneity of measurement variables across the studies and the differences among the studies, a meta-analysis was not performed. A narrative assessment was performed for the outcomes: moisture/bleeding control, gingival displacement, gingival/periodontal health and the subjective outcomes.ResultsFrom the initial search that retrieved 1,342 articles, 19 potential relevant full-text articles were considered for the review. Seven studies were selected for the systematic review. Four randomised clinical trials were included. Sample size ranged from eight to 252 participants per study. Five studies were conducted on patients requiring any indirect fixed restorations on prepared teeth. Two studies were done on unprepared teeth. In all studies, participants were in good health, had a healthy gingival condition and a sound periodontal status.ConclusionsBoth techniques are reliable in achieving gingival retraction. The review supports the observation that gingival retraction paste can more effectively help to achieve a dry field and at the same time be less injurious to soft tissues, however its ability to displace gingival tissues, compared to retraction cord, was compromising. Rather than considering the cost of material or the individual preference of the operator, choosing the right technique to maximise clinical efficiency should be based on scientific evidence. It seems that impregnated gingival cords are more effective on thick gingival tissue whereas paste is more effective when minimal retraction is required for haemostasis control, preservation of the gingiva and less tissue displacement.

Data sourcesThe resources searched included: Medline, PubMed, Embase, CINAHL, CAB Abstracts, the Cochrane Library and Google Scholar. The PRISMA guidelines for reporting systematic reviews were followed. Study selection was limited to the English language. Hand searching for additional references was performed. An intensive search was conducted for published articles describing the use of hilotherapy following oral and maxillofacial surgery.Study selectionInclusion criteria involved patients using hilotherapy after oral and maxillofacial surgery. Non-human studies were excluded. All articles were evaluated for study design, perioperative data, ethical suitability, follow-up data and surgical data reporting.Data extraction and synthesisTwo authors independently judged articles for suitability for the review. A kappa statistic test was used to calculate and to measure concordance in the author's final decisions to include studies. The agreement was 83% and considered moderate. Following data extraction a meta-analysis was conducted. Heterogeneity was calculated due to the variability among the studies (different number of surgical procedures, patient age, duration of the device application, different methods of postoperative pain measurement and analgesics protocol). Standard mean differences (SMD) with 95% confidence interval (CI) were calculated for the continuous measurements. The studies were assessed and rated using the Oxford Centre for Evidence-Based Medicine Levels of Evidence criteria (all studies were rated as 2b). Publication bias was assessed.ResultsThe initial search identified 552 results. Twelve papers were included in the review, and five with a total of 206 patients were used for the meta-analysis. The studies analysed were prospective comparative studies of patients undergoing oral maxillofacial surgery. Hilotherapy reduced pain (ten point visual analogue scale) at 48 hrs (P <0.010) and 72 hrs (P<0.050) as well as postoperative facial oedema (P <0.010) compared to ice-cooling treatment. Trismus and facial neurological scores were also improved (P<0.08). Patients preferred hilotherapy to other cooling methods (P< 0.010).ConclusionsHilotherapy appears to be effective in reducing postoperative facial pain, oedema and trismus and in improving patient-reported outcomes.

BACKGROUND:Resin-based composite (RBC) is currently accepted as a viable material for the restoration of caries for posterior permanent teeth requiring surgical treatment. Despite the fact that the thermal conductivity of the RBC restorative material closely approximates that of natural tooth structure, postoperative hypersensitivity is sometimes still an issue. Dental cavity liners have historically been used to protect the pulp from the toxic effects of some dental restorative materials and to prevent the pain of thermal conductivity by placing an insulating layer between restorative material and the remaining tooth structure. OBJECTIVES:The objective of this review was to assess the effects of using dental cavity liners in the placement of Class I and Class II resin-based composite posterior restorations in permanent teeth in children and adults. SEARCH METHODS:Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 25 May 2016), the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 4) in the Cochrane Library (searched 25 May 2016), MEDLINE Ovid (1946 to 25 May 2016), Embase Ovid (1980 to 25 May 2016) and LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; 1982 to 25 May 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA:We included randomized controlled trials assessing the effects of the use of liners under Class I and Class II posterior resin-based composite restorations in permanent teeth (in both adults and children). We included both parallel and split-mouth designs. DATA COLLECTION AND ANALYSIS:We utilized standard methodological procedures prescribed by Cochrane for data collection and analysis. Two review authors screened the search results and assessed the eligibility of studies for inclusion against the review inclusion criteria. We conducted risk of bias assessments and data extraction independently and in duplicate. Where information was unclear we contacted study authors for clarification. MAIN RESULTS:Eight studies, recruiting over 700 participants, compared the use of dental cavity liners to no liners for Class I and Class II resin-based composite restorations.Seven studies evaluated postoperative hypersensitivity measured by various methods. All studies were at unclear or high risk of bias. There was inconsistent evidence regarding postoperative hypersensitivity (either measured using cold response or patient-reported), with a benefit shown at some, but not all, time points (low-quality evidence).Four trials measured restoration longevity. Two of the studies were judged to be at high risk and two at unclear risk of bias. No difference in restoration failure rates were shown at one year follow-up, with no failures reported in either group for three of the four studies; the fourth study had a risk ratio (RR) 1.00 (95% confidence interval (CI) 0.07 to 15.00) (low-quality evidence). Three studies evaluated restoration longevity at two years follow-up and, again, no failures were shown in either group.No adverse events were reported in any of the included studies. AUTHORS' CONCLUSIONS:There is inconsistent, low-quality evidence regarding the difference in postoperative hypersensitivity subsequent to placing a dental cavity liner under Class I and Class II posterior resin-based composite restorations in permanent posterior teeth in adults or children 15 years or older. Furthermore, no evidence was found to demonstrate a difference in the longevity of restorations placed with or without dental cavity liners.

Data sourcesCochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Clinical Trials.gov and the WHO International Clinical Trials Registry Platform. There were no language restrictions.Study selectionRandomised controlled trials which compared the relief of pain with systemic antibiotics and analgesics against placebo and analgesics in the preoperative phase of irreversible pulpitis. The primary interest was pain control with an antibiotic or without one in the presence of analgesics. The secondary outcomes were type, dose and frequency of medication for pain relief and any adverse effects related to hypersensitivity or other reactions to either the antibiotic or analgesics.Data extraction and synthesisTwo authors independently assessed the results of the searches. Data extraction and risk bias assessment were also carried out independently. A third reviewer settled any disagreement on inclusion. Since only one study was included a meta-analysis could not be performed.ResultsOnly one double blind randomised clinical trial involving 40 participants with a diagnosis of irreversible pulpitis in one of their teeth was included in this review. This was a low risk, well-constructed double blind study. Half of the participants were treated with penicillin 500 mg, the other with a placebo every six hours over a seven- day period. In addition, all the participants were instructed to initially take one tablet of ibuprofen every 4-6 hours as needed and to take acetaminophen with codeine (two tablets every 4-6 hours) only if the ibuprofen did not relieve the pain.There was no significant difference in the mean total number of ibuprofen tablets over the study period; 9.2(standard deviation (SD) 6.02) in the penicillin group versus, 9.6 (SD 6.34) in the placebo group; mean difference -0.40 (95% CI -4.23 to 3.43); P value = 0.84.The mean total number of Tylenol tablets, 6.9 (SD 6.87), used in the penicillin group versus 4.45 (SD4.42) in the placebo group; mean difference 2.45 (95%CI -1.23 to 6.13; P value = 0.19). The study did not address adverse events.ConclusionsThere is insufficient evidence to accept or refute the benefit of using penicillin to control pain intensity associated with irreversible pulpitis. This study primarily found that antibiotics given preoperatively (before definitive root canal therapy) do not appear to significantly reduce toothache caused by irreversible pulpitis. Between the two groups, those taking the antibiotics and those taking the placebo, there was no statistical difference in the amount of oral analgesics taken to relieve the pain.

Data sourcesCochrane Oral Health group Trials Register, the Cochrane Central Register of Controlled Trials, Medline, US National Institutes of Health Trials Register, WHO-Clinical Trials Registry Platform for ongoing trials.Study selectionOnly randomised and quasi-randomised studies were pursued. No restrictions were placed on language or date of publication. The primary outcome sought was treatment success (complete healing or incomplete healing), uncertain healing and failure after one year of treatment, between one and four years and more than four years after treatment. Secondary outcomes considered for the inclusion criteria included outcomes related to the advantage of using a given magnification device in the clinical procedure such as; greater accuracy, the ease of removing broken instruments from the canal, quality of visualisation, quality of root end filling for the retrograde treatment, quality of perforation repair and the total time required for completing the clinical procedure.Data extraction and synthesisData would have been extracted by two review authors independently using a standardised data extraction form, and any disagreement would have been resolved by discussion and a third reviewer would have been consulted. Two review authors would have independently undertaken an assessment of the risk of bias.ResultsThe searches retrieved 1,234 studies. None of these satisfied the selection criteria, therefore no analysis was completed.ConclusionsNo article was identified in the current literature for the review that satisfied the inclusion criteria. It is unknown if and how the type of magnification device affects the treatment outcome considering the high number of factors that may have a significant impact on the success of endodontic therapy.

Data sourcesThe electronic databases searched included: PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (Central) and Web of Science until June 2015. There was no restriction to language and the reference lists from relevant studies were searched for further articles.Study selectionRandomised and prospective controlled trials that compared the effect of submucosal injection of dexamethasone with that of placebo after impacted third molar surgery in humans. Studies involving volunteers with decompensated metabolic disease were excluded.Data extraction and synthesisStudy selection, data extraction and quality assessment (risk of bias) were assessed by two reviewers. All disagreements were resolved through discussion. A meta-analysis was performed for all continuous variables (oedema, pain and trismus) when at least two of the studies analysed the same data type.ResultsEight studies involving a total of 476 patients of which six were included in the meta-analysis. All of the surgical procedures were performed on the lower molars, submucosal injections of dexamethasone were used in concentrations of 4 mg, 8 mg, or 10 mg, and saline was used as a control. Antibiotic medications were administered prophylactically before surgery or by continuous use after the procedure. Seven of the eight studies identified the impactions according to the Pell and Gregory Classification. Oedema was measured using facial contours of pre-established reference points. The meta-analysis presented a mean difference (MD) of -2.20 (95% CI -2.70 to -1.70), with a statistically significant difference favouring dexamethasone (P< 0.00001). Trismus (assessed using inter-incisal distance upon maximum opening) had a MD of -2.92 (95% CI -7.13 to 1.29) and showed no statistically significant difference between groups. Pain was assessed using both visual analogue scales and number of analgesic taken; however, only studies including a VAS were used for meta-analysis. Pain presented with a MD of -1.79 (95% CI -3.28 to -0.30) and showed a statistically significant difference favouring dexamethasone.ConclusionsThe review found moderate quality evidence that submucosal injections of dexamethasone reduced post-operative oedema and pain compared to a placebo following impacted third molar surgery. There was no significant difference, in regards to trismus, between placebo and dexamethasone.