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Abstract: Introduction: Little is known about ill-defined pain that persists after endodontic procedures, including an estimate of the problem''s magnitude. We conducted a systematic review of prospective studies that reported the frequency of nonodontogenic pain in patients who had undergone endodontic procedures. Methods: Nonodontogenic pain was defined as dentoalveolar pain present for 6 months or more after endodontic treatment without evidence of dental pathology. Endodontic procedures reviewed were nonsurgical root canal treatment, retreatment, and surgical root canal treatment. Studies were searched in four databases electronically, complemented by hand searching. A summary estimate of nonodontogenic tooth pain frequency was derived using random-effects meta-analysis. Results: Of 770 articles retrieved and reviewed, 10 met inclusion criteria, and nine had data on both odontogenic and nonodontogenic causes of pain. A total of 3,343 teeth were enrolled within the included studies and 1,125 had follow-up information regarding pain status. We identified 48 teeth with nonodontogenic pain and estimated a 3.4% (95% confidence interval, 1.4%-5.5%) frequency of occurrence. In nine articles containing data regarding both odontogenic and nonodontogenic causes of tooth pain, 56% (44/78) of all cases were thought to have a nonodontogenic cause. Conclusions: Nonodontogenic pain is not an uncommon outcome after root canal therapy and may represent half of all cases of persistent tooth pain. These findings have implications for the diagnosis and treatment of painful teeth that were previously root canal treated because therapy directed at the tooth in question would not be expected to resolve nonodontogenic pain. [Copyright &y& Elsevier]

Abstract: Introduction: Little is known about the frequency of persistent pain after endodontic procedures even though pain is a core patient-oriented outcome. We estimated the frequency of persistent pain, regardless of etiology, after endondontic treatment. Methods: Persistent tooth pain was defined as pain present ≥6 months after endodontic treatment. Endodontic procedures included in the review were pulpectomy, nonsurgical root canal treatment, surgical root canal treatment, and retreatment. Four databases were searched electronically complemented by hand searching. Two independent reviewers determined eligibility, abstracted data, and assessed study quality. A summary estimate of persistent all-cause tooth pain frequency was established by using a random-effects meta-analysis. Using subgroup analyses, we explored the influence of treatment approach (surgical/nonsurgical), longitudinal study design (prospective/retrospective), follow-up rate, follow-up duration, initial treatment versus retreatment, and quality of reporting (Strengthening the Reporting of Observational Studies in Epidemiology rankings) on the pain frequency estimate. Results: Of 770 articles retrieved and reviewed, 26 met inclusion criteria. A total of 5,777 teeth were enrolled, and 2,996 had follow-up information regarding pain status. We identified 168 teeth with pain and derived a frequency of 5.3% (95% confidence interval, 3.5%-7.2%, p < 0.001) for persistent all-cause tooth pain. High and statistically significant heterogeneity among studies (I 2 = 80%) was present. In subgroup analysis, prospective studies had a higher pain frequency (7.6%) than retrospectives studies did (0.9%). Quality of study reporting was identified as the most influential reason for study heterogeneity. Conclusions: The frequency of all-cause persistent tooth pain after endodontic procedures was estimated to be 5.3%, with higher report quality studies suggesting >7%. [Copyright &y& Elsevier]

Abstract: The carob tree (Ceratonia siliqua) has been included in a national list of priority forest genetic resources as a target for conservation and management in Lebanon, a country bordering the eastern Mediterranean shores. To provide baseline information for the development of a conservation strategy for the species, the current status of remaining semi-natural carob populations in Lebanon was assessed through an ecogeographic survey, a bio-climatic distribution study, and a genetic analysis. Field explorations were carried out throughout the reported natural distribution range of the target taxon (≤750m altitude) and all areas where carob was found, were mapped. Data including land use, main associated vegetation, major threats, percentage of grafted trees, and landform were recorded for each population. Climate data were interpolated as functions of geographic parameters to create maps for mean minimum temperature of the coldest month (m), mean maximum temperature of the warmest month, and annual precipitation. These were then used to calculate the pluviometric quotient (pmq) as a measure of aridity. The largest populations encountered in the study were targeted for molecular analysis. Polymorphic amplification products of RAPD were analyzed for 10–15 trees from each population. The ecogeographic survey revealed that most remaining populations are very small consisting of low numbers of individuals. Anthropomorphic activities such as coppicing, grafting and/or grazing were evident in all populations, however, it was clear that these populations were abandoned and had become part of the Mediterranean maquis vegetation. Overlays of soil maps and carob distribution data indicated that the species occurs preferentially on Terra Rossa soils, which have typically poor agricultural capability. An examination of the climatic conditions in which carob could be found showed that the distribution of carob is limited by (m) of less than 1°C and a pmq below 60. Analysis of RAPD products indicated that the populations did not cluster based on geographic proximity and revealed a significant difference between and within populations suggesting that the remaining populations constitute a valuable germplasm. The prospects for conservation of carob in the Lebanese context are discussed. [Copyright &y& Elsevier]