Pulse oximetry as a dental pulp test: A scoping review to identify barriers hindering the use of oximeters in clinical practice Rafaela Hartmann Kasper, Mabiéli Rabelo Coelho, Sergio Augusto Quevedo Miguens-Jr, Renata Grazziotin-Soares, Fernando Branco Barletta Saudi Dental Journal, 2024 Background and Objective: Although medical pulse oximeters are considered effective for endodontic diagnoses, the method remains uncommon in current dental practice. The aim of the present scoping review was to investigate clinical factors that exert a negative impact on the use of pulse oximeters in dental practice. Methods: This study followed the PRISMA-ScR guidelines and the protocol was prospectively registered in the Open Science Framework (https://doi.org/10.17605/OSF.IO/3GQCE). A comprehensive search of the MEDLINE (via PubMed), Cochrane Library, and Web of Science databases was performed in December 2022 for articles published in English or Spanish. All types of clinical studies were included, except comments, letters to the editor, and abstracts. Two independent investigators analyzed 45 full-text articles. Data extraction included general characteristics, oxygen saturation levels, and limiting factors/barriers to the use of oximeters as pulp testers. Results: The search of the databases yielded 1,300 records and 38 were included (quantitative data extraction was performed for 35 and three articles were systematic reviews). Publications were highest in number between 2016 and 2017, with an evident reduction occurring after 2021. The oxygen saturation level for sound/vital maxillary anterior teeth was 84.99% (overall mean). The main limiting factors/barriers were i) the difficulty in maintaining the two light-emitting diodes parallel during pulp tests, ii) infrared light diffraction by enamel/dentin/gingiva, and iii) the diversity of patient ages in studies. Conclusion: This scoping review encountered noteworthy findings associated with the impracticability of using medical pulse oximeters as dental pulp testers. The recent decrease in the frequency of published studies compared to approximately seven years ago may imply a negative trend in the use of the method.
Influence of rotary and reciprocating kinematics on the accuracy of an integrated apex locator Verônica de Almeida Gardelin, Júlia Itzel Acosta Moreno Vinholes, Renata Grazziotin‐Soares, Fernanda Geraldo Pappen, Fernando Branco Barletta Australian Endodontic Journal, 2023 We evaluated in vitro the influence of nickel‐titanium instruments kinematics on the accuracy and variation of root canal working length measurements, performed with an integrated apex locator, at glide path and at the end of shaping. Forty‐four mandibular incisors, included in an alginate model, were allocated at random to two groups: reciprocating and rotary. Working length was determined at glide path stage and at the end of shaping. Measurements given by the integrated apex locator were matched with visual measurements. The apex locator accuracy was based on inter‐group comparison. The variation in working length was based on intra‐group comparison. Kinematics influenced the accuracy of measurements only after shaping (p < 0.05), and not in the glide path (p > 0.05). Rotary had values closer to the visual measurements. Diminishing of measures occurred after shaping for reciprocating (p < 0.05); and at glide‐path stage for rotary (p > 0.05). The integrated apex locator was more accurate with rotary kinematics.
Cytotoxicity and Bioactivity of Calcium Silicate-based Cements in a Culture of Stem Cells from the Apical Papilla Adriana Knorr, L. B. Mestieri, L. S. Pinheiro, Roberta Almeida Mendes, Pedro Antonio Gonzalez Hernandez, F. Barletta, F. Grecca Iranian Endodontic Journal, 2021 Introduction: The present in vitro study evaluated the cytotoxicity and bioactivity of commonly-used calcium silicate-based cements in a culture of stem cells from the apical papilla (SCAPs). Materials and Methods: NeoMTA Plus (Avalon Biomed), BiodentineTM (Septodont) and MTA HP Repair (Angelus) cements were evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) and sulphorhodamine-B (SRB) viability assays. Cells were seeded (1*104 cells mL-1) in 96-well plates and exposed to 1:4 diluted extract in 24 h and 72 h. For the analysis of bioactivity, alkaline phosphatase (ALP) enzyme activity and Alizarin Red S (AZR) were assessed after 24 h of cell culture in 12-well plates (1*104 cells mL-1), where cells were exposed to 1:4 diluted extract on days 1 and 7. Minimum Essential Eagle’s Medium alpha modification was used as control. ANOVA and Tukey’s post hoc test were used to compare the different cements at each experimental time point. Results: No significant differences were found between the cements and the control specimens on MTT at 24 h and 72 h (P>0.05); however, the calcium silicate-based cement materials showed higher cell viability compared to the control group (P<0.05). In the 24-h SRB, NeoMTA Plus showed lower cell viability than BiodentineTM and MTA HP Repair (P<0.05), with all groups similar to the control group (P>0.05). Compared to 24-h results, only NeoMTA Plus presented increased cell viability at 72 h (P<0.05). ALP activity was similar across the materials at 1 day (P>0.05). ALP activity was higher for BiodentineTM when compared to NeoMTA Plus (P<0.05), nevertheless, it was similar to MTA HP Repair and control groups (P>0.05) at 7 days. At 1- and 7-day periods of AZR assay, BiodentineTM presented higher levels of mineralized nodule formation (P<0.05). Conclusion: All evaluated calcium silicate-based cements demonstrated cell viability and bioactivity, suggesting that these (bio)materials may be indicated for use in regenerative dentine-pulp complex procedures.
Medications used for prevention and treatment of postoperative endodontic pain: A systematic review Marcus Vinicius So European Endodontic Journal, 2021 Objective: Prevention and management of postoperative endodontic pain is a common challenge for the endodontists. This systematic review was conducted to evaluate the efficacy and safety of medicament therapeutic protocols in the prevention and management of endodontic pain. Methods: A literature search was undertaken in MEDLINE, Cochrane Library, LILACs, and SciELO, for articles published until December 2017, without year restriction and written only in English. An additional search was performed in the references of the retrieved studies. Study eligibility criteria, participants, and interventions: The inclusion criteria were randomised clinical trials that evaluated the use of medications to prevent or control moderate to severe pain in adult patients, using a visual analog scale as a tool for pain measurement. The primary outcome evaluated was the reduction of pain scores. The second outcome evaluated was the need for additional analgesia and the occurrence of adverse events. Study appraisal and synthesis methods: The quality assessment of the included studies was performed following the Jadad scale to measure the likelihood of bias in pain research reports. Results: After removing duplicates and excluding the studies that did not meet the selection criteria, ten studies were included tin the systematic review. Among these studies, five studies administered the medications before the endodontic procedures and five studies after. These studies evaluated non-opioid analgesics (acetaminophen), opioid analgesics (tramadol and codeine), nonsteroidal anti-inflammatories (ibuprofen, flurbiprofen, ketorolac tromethamine, etodolac, tenoxicam, and naproxen), steroidal anti-inflammatory (prednisolone) or the association of medications to prevent or control postoperative pain. It was possible to establish a significant relationship between the use of additional analgesics and periapical diagnosis. Adverse events were not observed when the administration occurred before the endodontic procedure. When it was administered after the procedure, adverse reactions were reported in 2 of 3 trials included in the analysis. Limitations: A restricted number of randomised clinical trials were found, and the difference in the methodology of the studies did not meet the definition of a systemic treatment protocol for prevention or control of postoperative pain. Conclusion: Nonsteroidal anti-inflammatory drugs are the most common medicament to prevent and control postoperative pain, with ibuprofen being the most investigated. There is a significant association between the use of additional analgesics and periapical diagnoses.
Interference of coronal enamel and dentin thickness and ambient light on pulse oximetry interpretation Julio Almeida SILVA, Ana Helena Gonçalves de ALENCAR, Larissa Emanuelle SESTARI, Higor Almeida BARBOSA, Patrícia Correia de SIQUEIRA, Daniel Almeida DECURCIO, Fernando Branco BARLETTA, Carlos ESTRELA Brazilian Oral Research, 2020 This study evaluated the interference of enamel and coronal dentin thickness and ambient light in pulse oximetry interpretation, using SaO2the human finger as a reference. Forty-two intact human permanent mandibular molars were sectioned mesiodistally in the central portion. Buccal and lingual dentin surfaces were drilled, and 4 mm, 3 mm and 2 mm enamel/dentin thicknesses were interposed between finger and device, after which SaO2 levels were measured by finger pulse oximetry. A reference device was designed to align pulse oximeter light-emitting diode, buccal surface of tooth, little finger, lingual surface of tooth and photodiode. Variables were described as means and standard deviation, and the confidence interval was reported. Repeated measures analysis of variance (ANOVA) was used to compare the groups, followed by Bonferroni correction. Student t test for paired samples was used to determine presence of ambient light (α = 0.05). Mean SaO2 level was lower at 4.0 ± 0.2 mm thickness, regardless of presence or absence of ambient light (92.7% and 89.3%). The other thicknesses yielded values of 95.5% and 94.5% at 3.0 ± 0.2 mm, and 96.4% and 96.0% at 2.0 ± 0.2 mm (p < 0.001). There were significant differences between SaO2 values at 4.0 ± 0.2 mm, 3.0 ± 0.2 mm and 2.0 ± 0.2 mm thicknesses, in the presence of ambient light. Mean SaO2 level in positive control was 96.3%, and mean pulse rate was 69.5 bpm in presence of ambient light; in the absence of light, these values were 96% and 70.5 bpm. Enamel and dentin thickness interfere with SaO2, regardless of presence or absence of ambient light. The lowest SaO2 levels were found for the thickest tooth samples.
Removal of Endosequence BC/CPoint endodontic fillings in curved root canals using rotary or reciprocating instruments Raquel Faria, Laila Gonzales Freire, Elaine Faga Iglecias, Renata Grazziotin-Soares, Diego Machado Ardenghi, Giulio Gavini, Fabiana Grecca, Fernando Branco Barletta Dental Press Endodontics, 2020 Objetivo: O presente estudo usou micro-CT para avaliar a quantidade de material obturador remanescente em canais radiculares curvos que tinham sido obturados com cimento Endosequence BC/Cpoint ou com cimento AH/ guta-percha, depois do retratamento utilizando instrumentos rotatórios ou reciprocantes. Métodos: Sessenta canais mesiovestibulares de molares superiores foram instrumentados até MTwo #35.04. As amostras foram randomicamente alocadas em quatro grupos (n=15): os canais do G1 e G2 foram obturados com AH/guta-percha, e os canais do G3 e G4 foram obturados com BC/Cpoint. O material obturador foi removido usando instrumentos rotatórios ou reciprocantes – G1 e G3: R25 Reciproc + reinstrumentação com R40; e G2 e G4: Sistema ProTaper Universal Retratamento + reinstrumentação com MTwo 40.06. Micro-CTs foram usadas para medir a quantidade de material obturador remanescente (mm3 ) para o canal inteiro e para cada terço, em dois momentos: 1) após a remoção do material obturador; e 2) após a reinstrumentação. Resultados: Após a remoção do material obturador, BC/CPoint permaneceu mais dentro do canal do que AH/guta-percha quando o canal inteiro (29,92% x 19,25%, p=0,0290) e o terço apical foram analisados. Após a reinstrumentação, BC/CPoint permaneceu mais do que AH/guta-percha somente no terço apical. Protocolos de tratamento com instrumentos rotatórios ou reciprocantes removeram material obturador sem diferença para AH/guta-percha (G1 e G2: p> 0,05) e BC/CPoint (G3 e G4: p> 0,05). Conclusões: BC/Cpoint é mais difícil de ser removido de canais radiculares curvos do que AH/guta-percha. Instrumentos rotatórios e reciprocantes têm habilidade similar na remoção de material obturador.
Effect of dental bleaching on pulp oxygen saturation in maxillary central incisors - a randomized clinical trial Lorena Ferreira LIMA, Ana Helena Gonçalves de ALENCAR, Daniel de Almeida DECURCIO, Julio Almeida SILVA, Isabella Negro FAVARÃO, Marco Antônio Zaiden LOUREIRO, Fernando Branco BARLETTA, Carlos ESTRELA Journal of Applied Oral Science Revista Fob, 2019 Objective To assess pulp oxygen saturation levels (SaO2) in maxillary central incisors after dental bleaching. Materials and Methods 80 participants (160 teeth) were randomly allocated to four groups: G1 In-office bleaching with two applications of 35% hydrogen peroxide (HP) (20 minutes), followed by at-home bleaching with 10% carbamide peroxide (CP) (2 hours/day for 16 days); G2 - Same protocol as G1, plus desensitizing toothpaste; G3 - In-office bleaching with 35% HP and one application of placebo gel (20 minutes), followed by at-home bleaching with 10% CP (2 hours/day for 16 days); and G4 - Same protocol as G3, plus desensitizing toothpaste. Pulp SaO2 levels were measured before (T0) and immediately after (T1) in-office bleaching; on the 5th (T2), 8th (T3), 12th (T4), and 16th days of at-home bleaching (T5); and on the 7th (T6) and 30th (T7) days. Mean (SD) pulp SaO2 levels were compared within groups by generalized estimating equations (GEE) and Student’s t-test (P<0.05). Results Mean pulp SaO2 at T0 was 84.29% in G1, 84.38% in G2, 84.79% in G3, and 85.83% in G4. At T1, these values decreased to 81.96%, 82.06%, 82.19%, and 81.15% in G1, G2, G3, and G4 respectively, with significant difference in G4 (P<0.05). During home bleaching, pulp SaO2 levels varied in all groups, with 86.55%, 86.60%, 85.71%, and 87.15% means at T7 for G1, G2, G3, and G4, respectively; G2 presented significant difference (P<0.05). Conclusions Pulp SaO2 level in maxillary central incisors was similar at baseline, reducing immediately after in-office bleaching, regardless of using desensitizing toothpaste and increasing at 30 days after dental bleaching.
Mandibular molar with five root canals Fernando Branco Barletta, Sidney Ricardo Dotto, Magda de Sousa Reis, Ronise Ferreira, Rosana Maria Coelho Travassos Australian Endodontic Journal, 2008
