Stefano Corbella

The passing of the years of life physiologically leads to the accumulation of changes in tissues in the oral cavity, influencing dentition, chewing and swallowing mechanisms, and the oral microbiota. Some diseases and medications can aggravate oral symptoms and negatively influence eating behaviours, increasing the likelihood of becoming malnourished. This could make older individuals more vulnerable to complications when undergoing major orthopaedic surgery. Hidden infection foci in the oral cavity are a recognised cause of post-operative periprosthetic joint infections. Dysfunctional oral problems might also compromise feeding after surgery when good nutrition represents a fundamental aspect of a proper recovery. To manage these shortcomings, in this article, the authors hypothesise a multidisciplinary path of care named the Integrated Oral Health Network applied to major Orthopaedic Surgery (IOHN-OS). This peri-operative initiative would include pre-operative oral health screening and risk management by a dental team, patient education programmes before and after surgery, and bedside gerodontology actions like oral care and meal and eating support for fragile individuals. The IOHN-OS has the potential to reshape the concept of suitability for major orthopaedic surgery and generate momentum for designing community-based surveillance programmes that can keep the mouths of older subjects healthy for a long time.

Background To manage apical periodontitis in root filled maxillary and mandibular molars, root resection techniques may be employed to avoid the loss of the tooth. Objectives The objectives of the study were to systematically analyse the effectiveness of root resection techniques (root resection/crown resection/root amputation) for the management of apical periodontitis with non‐surgical root canal retreatment or apical surgery by the evaluation of clinical and patient‐related outcomes (PROMS), in human experimental studies and longitudinal studies. Methods An electronic literature search in PubMed, MEDLINE via OVID interface, EMBASE and Cochrane Central, supplemented by a manual hand search of the grey literature, was performed up to 25th September 2021. Randomized controlled trials, comparative clinical trials and observational studies reporting on the outcome (tooth survival and patient‐reported outcome measures with a minimum follow‐up of 1 year) of root resection techniques for treating apical periodontitis were identified. The risk of bias was evaluated using the Newcastle–Ottawa scale. Results From a total of 2098 reports, 36 were considered for further screening. Three retrospective studies, published between 2018 and 2020, were included in this systematic review. A high heterogeneity in terms of protocols, study design and the reported outcomes were observed. The risk of bias was scored as low to moderate. These three studies consisted of data from 305 resected teeth, from 254 patients, with a follow‐up period of 1–16.8 years. Overall, 151 teeth were extracted during the follow‐up period. In these studies, root resection treatment was carried out on 42 teeth exclusively for endodontic reasons. One of these studies reported 12 out of 23 teeth lost at follow‐up. None of the studies reported on PROMS. Discussion Although root resection techniques may be used for treating teeth with apical periodontitis, the data are limited. Furthermore, the studies are very heterogeneous and associated with high risk of bias. Conclusions Given the current level of available evidence, it is not possible to recommend, or dismiss, root resection techniques for managing apical periodontitis. Registration PROSPERO database (CRD42021260306).