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Clinical Oral Investigations Dec 2023To conduct a systematic review of the published scientific evidence to evaluate the efficacy of nonsurgical periodontal therapy (NSPT) in treating periodontitis in... (Meta-Analysis)
Meta-Analysis Review
Systematic review and meta-analysis of randomized controlled trials evaluating the efficacy of non-surgical periodontal treatment in patients with concurrent systemic conditions.
OBJECTIVE
To conduct a systematic review of the published scientific evidence to evaluate the efficacy of nonsurgical periodontal therapy (NSPT) in treating periodontitis in patients with concurrent systemic conditions (diabetes, CVD, erectile dysfunction, chronic kidney disease, rheumatoid arthritis, polycystic ovarian syndrome, obesity, pregnancy). We hypothesised that NSPT results in better periodontal outcomes when compared to untreated controls after follow-up.
MATERIALS AND METHODS
A systematic search (PUBMED/EMBASE) was conducted from 1995 to 2023 to identify randomised controlled trials (RCTs) with a minimum follow-up of 3 months. The primary outcome was the difference in mean probing depth (PD), and the secondary outcomes were mean clinical attachment loss (CAL), percentage of sites with PD ≤ 3 mm (%PD ≤ 3 mm) and percentage of sites with bleeding on probing (%BOP) between the treated and untreated control group in patients with comorbidities.
RESULTS
The electronic search resulted in 2,403 hits. After removing duplicates, 1,565 titles and abstracts were screened according to the eligibility criteria, resulting in 126 articles for full-text screening. Following this, 44 studies were analysed. Restricting to studies with low bias or some concerns, NSPT group demonstrated a 0.55 mm lower mean PD (95%CI: -0.69; -0.41) after 3 months compared to the control group.
CONCLUSION
Compared to the untreated controls, NSPT notably reduced mean PD, mean CAL, and %BOP while increasing %PD ≤ 3 mm in patients with concurrent systemic conditions. These findings suggest that NSPT is also an effective procedure in managing periodontitis in patients with concurrent systemic conditions.
TRIAL REGISTRATION
This systematic review was registered under the protocol registration number CRD42021241517/PROSPERO.
Topics: Male; Female; Pregnancy; Humans; Randomized Controlled Trials as Topic; Dental Care; Patients; Arthritis, Rheumatoid; Periodontitis
PubMed: 38147183
DOI: 10.1007/s00784-023-05392-6 -
Journal of Oral and Maxillofacial... Nov 2023Mandibular second molar (M2M) impaction is a serious eruption disorder. The purpose of this systematic review was to analyze the therapeutic approaches for M2M... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Mandibular second molar (M2M) impaction is a serious eruption disorder. The purpose of this systematic review was to analyze the therapeutic approaches for M2M impaction. The objective of the meta-analysis was to summarize the success of the surgical, surgical-orthodontic, and orthodontic treatment.
METHODS
A PRISMA-guided search strategy was conducted by 2 authors in 5 databases up to January 2023. Randomized and nonrandomized clinical trials were considered. Case reports, case series with<5 patients, and reviews were excluded. Methodological quality was assessed using Newcastle-Ottawa scale and Cochrane Collaboration tool for nonrandomized and randomized clinical trials, respectively. Outcomes were as follows: 1) treatment success rate defined by the repositioning of impacted M2M in the dental arch with normal functional occlusal relationship and periodontal health; 2) time-to-repositioning as time-to-event analysis; and 3) complications. Meta-analysis examined treatment success differences with 3 approaches: orthodontic (uprighting maneuvers/traction), surgical (surgical procedures/strategic extractions), and surgical-orthodontic (combined surgical and orthodontic procedures) as the exposure variable. The quantitative analysis also compared the success rate using third molar removal as the secondary predictor variable. The χ test determined the statistical heterogeneity (I2); a cut-off of 70% was used to select the common or random effects model. Odds ratio (OR) and 95% confidence interval (CI) were recorded.
RESULTS
A total of 1,102 articles were retrieved. After full-text reading, 16 articles were included and 1008 M2Ms were analyzed. Nine studies had fair quality, 6 studies had good quality, and 1 had unclear risk of bias. Managing impacted M2Ms showed a moderate to high success rate (66.7 to 100%). Significant differences favoring surgical treatment over orthodontic treatment were observed for M2M uprighting (OR = 4.97; CI: 1.49 to 16.51; P = .01).No differences were detected comparing surgical and surgical-orthodontic treatment (OR = 1.00; CI: 0.03 to 37.44; P = .99), or orthodontic and surgical-orthodontic treatment(OR = 4.14; CI: 0.43 to 40.14; P = .22).Third molar removal showed no significant correlation with M2M uprighting (OR = 1.98; CI: 0.24 to 16.03; P = .5).
CONCLUSION
Despite study limitations, both orthodontic and surgical management of impacted M2M can be effective suggesting that clinicians are able to choose best treatment for most cases.
Topics: Humans; Molar; Tooth Extraction; Dental Care; Tooth, Impacted; Molar, Third
PubMed: 37699532
DOI: 10.1016/j.joms.2023.08.168 -
Clinical Oral Investigations May 2024Recent evidence suggested a link between periodontitis (PD) and dental caries, but the trends and nature of this association remained unclear. The overall aim of this... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Recent evidence suggested a link between periodontitis (PD) and dental caries, but the trends and nature of this association remained unclear. The overall aim of this study was to critically assess the correlation of two disorders.
METHODS
A comprehensive search was conducted within the PUBMED and EMBASE databases including grey literatures up to July 5th, 2023. The Newcastle-Ottawa scale was used to qualitatively evaluate the risk of bias.
RESULTS
Overall, 18 studies were included. In terms of caries risk in PD patients, the prevalence of caries was increased by PD (OR = 1.57, 95%CI:1.20-2.07), both in crown (OR = 1.03, 95%CI:1.01-1.05) and root caries (OR = 2.10, 95%CI:1.03-4.29). Odds of caries were also raised by PD severity (OR = 1.38, 95%CI:1.15-1.66; OR = 2.14, 95%CI:1.74-2.64). Besides, patients with PD exhibited a higher mean number of decayed, missing and filled teeth (DMFT) and decayed and filled root teeth (DFR) [weighted mean difference (WMD) = 0.87, 95%CI: -0.03-1.76; WMD = 1.13, 95%CI: 0.48-1.78]. Likewise, patients with caries had an elevated risk of PD (OR = 1.79, 95%CI:1.36-2.35). However, Streptococcus mutans, one of the main pathogens of caries, was negatively correlated with several main pathogens of periodontitis.
CONCLUSIONS
This study indicated a positive correlation between dental caries and periodontitis clinically, while the two disease-associated pathogens were antagonistic.
CLINICAL RELEVANCE
Further research, including clinical cohort studies and mechanisms of pathogens interaction is needed on this link for better prevention and treatment of PD and caries. In addition, innovative prevention strategies need to be developed and incorporated in dental practices to prevent these two highly prevalent oral diseases.
Topics: Humans; Dental Caries; Periodontitis; Prevalence; Risk Factors
PubMed: 38727727
DOI: 10.1007/s00784-024-05687-2 -
BMC Oral Health Dec 2023The development of deep learning (DL) algorithms for use in dentistry is an emerging trend. Periodontitis is one of the most prevalent oral diseases, which has a notable... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The development of deep learning (DL) algorithms for use in dentistry is an emerging trend. Periodontitis is one of the most prevalent oral diseases, which has a notable impact on the life quality of patients. Therefore, it is crucial to classify periodontitis accurately and efficiently. This systematic review aimed to identify the application of DL for the classification of periodontitis and assess the accuracy of this approach.
METHODS
A literature search up to November 2023 was implemented through EMBASE, PubMed, Web of Science, Scopus, and Google Scholar databases. Inclusion and exclusion criteria were used to screen eligible studies, and the quality of the studies was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology with the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) tool. Random-effects inverse-variance model was used to perform the meta-analysis of a diagnostic test, with which pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, and diagnostic odds ratio (DOR) were calculated, and a summary receiver operating characteristic (SROC) plot was constructed.
RESULTS
Thirteen studies were included in the meta-analysis. After excluding an outlier, the pooled sensitivity, specificity, positive LR, negative LR and DOR were 0.88 (95%CI 0.82-0.92), 0.82 (95%CI 0.72-0.89), 4.9 (95%CI 3.2-7.5), 0.15 (95%CI 0.10-0.22) and 33 (95%CI 19-59), respectively. The area under the SROC was 0.92 (95%CI 0.89-0.94).
CONCLUSIONS
The accuracy of DL-based classification of periodontitis is high, and this approach could be employed in the future to reduce the workload of dental professionals and enhance the consistency of classification.
Topics: Humans; Sensitivity and Specificity; Deep Learning; ROC Curve; Algorithms; Odds Ratio
PubMed: 38114946
DOI: 10.1186/s12903-023-03751-z -
Evidence-based Dentistry Jun 2024This study aimed at determining the association between periodontitis and mild cognitive impairment. For this, different electronic databases, including PubMed, Scopus,... (Meta-Analysis)
Meta-Analysis
DATA SOURCES
This study aimed at determining the association between periodontitis and mild cognitive impairment. For this, different electronic databases, including PubMed, Scopus, Embase and Web of Science, were searched for finding the relevant literature. In addition, hand searching of relevant journals was also done to find gray literature.
STUDY SELECTION
The systematic review included observational studies only. Accordingly, case-control, cohort and cross-sectional studies were searched. The search strategy was based on PECO framework, wherein the studies which included patients with/without periodontitis and patients with/without mild cognitive impairment (MCI) were included.
DATA EXTRACTION AND SYNTHESIS
A total of 7 studies were included and the data from these studies and the data including bibliographic details, demographic data, data about periodontitis, presence of MCI etc. was extracted from the included articles. The extracted data, was then assessed for heterogeneity using clinical parameters and I statistical test. Owing to low heterogeneity, fixed-effects model was used for meta-analysis.
RESULTS
Meta-analysis was done to determine the association between periodontitis and MCI and significantly higher incidence of MCI was found in patients with periodontitis OR = OR, 1.70 (95% CI: 1.24-2.32, p < 0.001). A subgroup analysis was done by including the studies comparing incidence of MCI in patients with severe periodontitis, which resulted in even stronger association with an OR of 2.09 (95% CI: 1.49-2.92, p < 0.001). Lastly, periodontal parameters, including CAL, PPD, and PI were compared amongst patients with/without MCI. Significant differences were observed for both CAL and PI, with worsening of values in patients with MCI. Observed mean difference for CAL and PI were 0.44 (95% CI: 0.12-0.75) and 0.72 (95% CI:0.50-0.93), respectively. NS differences were observed for PPD values with a mean difference of 0.21 and 95% CI as -0.08 to 0.49.
CONCLUSIONS
Strong association between periodontitis and MCI was observed, indicating periodontitis to be a risk factor for MCI.
Topics: Humans; Cognitive Dysfunction; Periodontitis; Risk Factors; Incidence
PubMed: 38724750
DOI: 10.1038/s41432-024-01015-5 -
International Endodontic Journal Oct 2023Revitalization procedures primarily aim to eliminate clinical symptoms and heal periapical lesions. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Revitalization procedures primarily aim to eliminate clinical symptoms and heal periapical lesions.
OBJECTIVES
The objective of the study was to elucidate the effectiveness of revitalization in treating apical periodontitis in necrotic mature and immature permanent teeth based on the following PICO question: In patients with permanent immature or mature teeth and pulp necrosis with or without signs of apical periodontitis (P) what is the effectiveness of revitalization (I) in comparison with calcium hydroxide apexification, apical plug and root canal treatment (C) in terms of tooth survival, pain, tenderness, swelling, need for medication (analgesics and antibiotics), radiographic evidence of reduction of apical lesion size, radiographic evidence of normal periodontal ligament space, radiographic evidence of increased root thickness and length (not for mature teeth), tooth function (fracture and restoration longevity), need for further intervention, adverse effects (including exacerbation, restoration integrity, allergy and discolouration), oral health-related quality of life (OHRQoL), presence of sinus tract and response to sensibility testing (O). (T) = Defined as a minimum of 1 year and maximum of as long as possible for all outcome measures, except 'pain, tenderness, swelling, need for medication (analgesics)', which is a minimum of 7 days and maximum of 3 months and OHRQoL which is minimum of 6 months and a maximum of as long as possible.
METHODS
Three databases (PubMed, Embase and Cochrane Library) were searched for human, experimental and observational studies in English, complemented with hand search, until 31/10/2021. Studies recruiting teeth with pulp necrosis (with/without apical periodontitis), with minimum 10 teeth/arm at the end of the study and with a follow-up of at least 1 year, were included. Records without an abstract and a full text were excluded. The qualitative analysis of the included (non-) randomized controlled clinical trials was performed with the Revised Cochrane risk-of-bias tools (RoB 2 and ROBINS-I). Meta-analysis for survival and success (including a subgroup analysis for mature/immature permanent teeth) was performed using the Mantel-Haenszel method. The certainty of evidence was assessed using GRADE (Grades of Recommendation, Assessment, Development and Evaluation).
RESULTS
From the 365 identified records, five met the inclusion criteria. The 12 months survival rate was 100% for all (im)mature permanent teeth in all groups (3 studies). The success rate at 12 months was 100% for immature permanent teeth for I and C (1 study), however, reduced to 92% and 80% for mature teeth in I and C respectively (1 study, p > .05). The risk of bias for the most critical outcome (survival) was high for two studies and low for one. For the critical outcome success, all assessed studies were highly biased. Meta-analyses provided pooled relative risk with no statistically significant difference between I and C for both survival (RR = 1.00, 95%CI = 0.96-1.04, p = 1.00) and success (RR = 1.06; 95%CI = 0.83-1.35, p = .66). The evidence level for survival was kept 'low' and for success was downgraded to 'very low' due to inconsistency and imprecision.
DISCUSSION
The survival and success rates were favourable in all included studies and for all groups; however, these outcomes are not reliable due to the low certainty level. Clinically, the most reported adverse event was tooth discolouration, hence the application of bismuth oxide containing calcium silicate cements should be avoided in revitalization. Radiographically, caution is needed when assessing periapical bone healing and further root development with periapical radiographs, due to multifactorial inaccuracies of this imaging technique. Methodological and assessment concerns need to be addressed in future clinical trials. Long-term results are necessary for studies reporting revitalization of mature permanent teeth, as they seem to be experimental so far.
CONCLUSIONS
No robust evidence was discovered to support that revitalization is effective to treat apical periodontitis in (im)mature permanent teeth. The success and survival rates of revitalized and fully pulpectomized (im)mature permanent teeth did not differ significantly.
REGISTRATION
Prospero: CRD42021262466.
Topics: Humans; Dental Pulp Necrosis; Quality of Life; Periapical Periodontitis; Pain; Analgesics
PubMed: 35579093
DOI: 10.1111/iej.13778 -
Clinical Oral Implants Research Nov 2023To answer the following PECO question: "In systemically healthy human subjects (P), which are the differences between peri-implantitis (E) and peri-implant... (Meta-Analysis)
Meta-Analysis Review
AIM
To answer the following PECO question: "In systemically healthy human subjects (P), which are the differences between peri-implantitis (E) and peri-implant health/mucositis (C) in terms of bacterial presence/count (O)?"
MATERIALS AND METHODS
Cross-sectional studies fulfilling specific inclusion criteria established to answer the PECO question were included. Two review authors independently searched for studies, screened the titles and abstracts, did full-text analysis, extracted the data from the included reports, and performed the risk of bias assessment through an adaptation of the Newcastle/Ottawa tool for cross-sectional studies and of the JBI critical appraisal checklist. In case of disagreement, a third reviewer author took the final decision. Study results were summarized using random effects meta-analyses.
RESULTS
A total of 12 studies were included, involving 1233 participants and 1513 implants. Peri-implantitis was associated with the presence of S. epidermidis (Odds ratio, OR = 10.28 [95% Confidence interval, CI: 1.26-83.98]), F. nucleatum (OR = 7.83 [95% CI: 2.24-27.36]), T. denticola (OR = 6.11 [95% CI: 2.72-13.76]), T. forsythia (OR = 4.25 [95% CI: 1.71-10.57]), P. intermedia (OR = 3.79 [95% CI: 1.07-13.35]), and P. gingivalis (OR = 2.46 [95% CI: 1.21-5.00]). Conversely, the presence of A. actinomycetemcomitans (OR = 3.82 [95% CI: 0.59-24.68]), S. aureus (OR = 1.05 [95% CI: 0.06-17.08]), and C. rectus (OR = 1.48 [95% CI: 0.69-3.17]) was not associated with peri-implantitis.
CONCLUSIONS
Peri-implantitis is associated with the presence of S. epidermidis and specific periodontopathogens (P. gingivalis, T. forsythia, T. denticola, F. nucleatum, and P. intermedia). (CRD42021254589).
Topics: Humans; Peri-Implantitis; Staphylococcus aureus; Cross-Sectional Studies; Porphyromonas gingivalis; Microbiota; Dental Implants
PubMed: 37523470
DOI: 10.1111/clr.14153 -
Periodontitis severity relationship with metabolic syndrome: A systematic review with meta-analysis.Oral Diseases Oct 2023The objective of this study was to investigate the association between periodontitis severity and metabolic syndrome (MetS) through systematic review, registered in... (Meta-Analysis)
Meta-Analysis Review
The objective of this study was to investigate the association between periodontitis severity and metabolic syndrome (MetS) through systematic review, registered in PROSPERO: CRD42021232120. Selected articles were independently chosen by three reviewers from six databases, including using article reference lists, up until March 2022. Eligible studies were observational, without language limitation, and in subjects aged at least 18 years. The methodological quality of selected studies was assessed using the Newcastle-Ottawa Scale. Random effects models calculated summary measurements (odds ratio-OR, 95% confidence interval, 95%CI). The I test evaluated the statistical heterogeneity of the data. Sensitivity, subgroup, and meta-regression analyses were performed. For the reliability of evidence, the Grading of Recommendations, Assessment, Development, and Evaluations tool was used. A total of 2133 records were identified, and 14 studies were included comprising 24,567 participants. The summary odds ratio showed a positive association between individuals with moderate (OR = 1.26; 95%CI = 2.10-5.37; I = 45.85%), and severe periodontitis (OR = 1.50; 95%CI:1.28-1.71; I = 56.46%), and MetS. Subgroup and meta-regression analyses showed that study effect size was influenced by year of publication, study design, and MetS diagnostic criteria, contributing to inter-study variability. The findings showed that moderate and severe levels of periodontitis are associated with MetS, suggesting a possible dose-response effect.
Topics: Humans; Adolescent; Adult; Metabolic Syndrome; Reproducibility of Results; Periodontitis; Odds Ratio; Databases, Factual
PubMed: 36346175
DOI: 10.1111/odi.14428 -
Clinical and Experimental Dental... Oct 2023The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus causes coronavirus disease 2019 (COVID-19), a respiratory infection that has spread worldwide and... (Review)
Review
OBJECTIVES
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus causes coronavirus disease 2019 (COVID-19), a respiratory infection that has spread worldwide and is responsible for a high death toll. Although respiratory symptoms are the most common, there is growing evidence that oral signs of COVID-19 can also be seen in children. The purpose of this systematic review is to provide a comprehensive analysis of the available data on the oral manifestations of COVID-19 in children and to recommend appropriate methods of diagnosis and treatment.
METHODS
A systematic search of the MEDLINE, EMBASE, Scopus, and Web of Science databases was done to discover relevant papers published between their establishment and January 2023. Articles detailing oral symptoms in pediatric patients with confirmed COVID-19 infection were included, and data on clinical characteristics, diagnosis, treatment, and outcomes were extracted and evaluated.
RESULTS
A total of 24 studies involving 2112 pediatric patients with COVID-19 were included in the review. The most common presentations are oral lesions, taste and smell disorders, oral candidiasis, hemorrhagic crust, tongue discoloration, lip and tongue fissuring, gingivitis, and salivary gland inflammation. These manifestations were sometimes associated with multi-system inflammatory syndrome in children (MIS-C) or Kawasaki disease (KD). Management strategies varied depending on the severity of the oral manifestation and ranged from symptomatic relief with topical analgesics to systemic medications.
CONCLUSION
Oral symptoms of COVID-19 are relatively prevalent in juvenile patients and can be accompanied by severe systemic diseases, such as MIS-C or Kawasaki illness. Early detection and adequate care of these oral symptoms are critical for the best patient results. Understanding the underlying pathophysiology and developing targeted treatments requires more investigation.
Topics: Child; Humans; COVID-19; Databases, Factual; SARS-CoV-2; Practice Guidelines as Topic
PubMed: 37602892
DOI: 10.1002/cre2.776 -
Clinical Oral Investigations Aug 2023This review aimed at evaluating the possible benefits that caloric restriction (CR) may provide to periodontal disease progression and response to treatment. (Review)
Review
OBJECTIVE
This review aimed at evaluating the possible benefits that caloric restriction (CR) may provide to periodontal disease progression and response to treatment.
MATERIAL AND METHODS
Electronic search on Medline, Embase and Cochrane, and manual search were performed to identify pre-clinical and on human studies reporting the consequences of CR on clinical and inflammatory parameters related to periodontitis. Newcastle Ottawa System and SYRCLE scale were used to assess the risk of bias.
RESULTS
Four thousand nine hundred eighty articles were initially screened, and a total of 6 articles were finally included, consisting of 4 animal studies and 2 studies in humans. Due to the limited number of studies and heterogeneity of the data, results were presented in descriptive analyses. All studies showed that, compared to the normal (ad libitum) diet, CR might have the potential to reduce the local and systemic hyper-inflammatory state as well as disease progression in periodontal patients.
CONCLUSIONS
Within the existing limitations, this review highlights that CR showed some improvements in the periodontal condition by reducing the local and systemic inflammation related to the periodontitis and by improving clinical parameters. However, the results should be interpreted with caution since robust research such as randomized clinical trials is still missing.
CLINICAL RELEVANCE
This review shows that some dietary/caloric restrictions approaches may have the potential to improve periodontal conditions and, in addition, highlights a need for human studies with a robust methodology in order to draw stronger evidence-based conclusions.
Topics: Animals; Humans; Periodontal Diseases; Periodontitis; Gingival Diseases; Disease Progression
PubMed: 37199773
DOI: 10.1007/s00784-023-05052-9