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Journal of Clinical Periodontology Nov 2023To systematically appraise the available evidence on vertical ridge augmentation (VRA) techniques and estimate a treatment-based ranking on the incidence of... (Meta-Analysis)
Meta-Analysis Review
Comparative evidence of different surgical techniques for the management of vertical alveolar ridge defects in terms of complications and efficacy: A systematic review and network meta-analysis.
AIM
To systematically appraise the available evidence on vertical ridge augmentation (VRA) techniques and estimate a treatment-based ranking on the incidence of complications as well as their clinical effectiveness.
MATERIALS AND METHODS
Searches were conducted in six databases to identify randomized clinical trials comparing VRA techniques up to November 2022. The incidence of complications (primary) and of early, major, surgical and intra-operative complications, vertical bone gain (VBG), marginal bone loss, need for additional grafting, implant success/survival, and patient-reported outcome measures (secondary) were chosen as outcomes. Direct and indirect effects and treatment ranking were estimated using Bayesian pair-wise and network meta-analysis (NMA) models.
RESULTS
Thirty-two trials (761 participants and 943 defects) were included. Five NMA models involving nine treatment groups were created: onlay, inlay, dense-polytetrafluoroethylene, expanded-polytetrafluoroethylene, titanium, resorbable membranes, distraction osteogenesis, tissue expansion and short implants. Compared with short implants, statistically significant higher odds ratios of healing complications were confirmed for all groups except those with resorbable membranes (odds ratio 5.4, 95% credible interval 0.92-29.14). The latter group, however, ranked last in clinical VBG.
CONCLUSIONS
VRA techniques achieving greater VBG are also associated with higher incidence of healing complications. Guided bone regeneration techniques using non-resorbable membranes yield the most favourable results in relation to VBG and complications.
Topics: Humans; Dental Implantation, Endosseous; Bayes Theorem; Network Meta-Analysis; Alveolar Ridge Augmentation; Alveolar Process; Bone Regeneration; Polytetrafluoroethylene; Bone Transplantation; Membranes, Artificial; Dental Implants; Guided Tissue Regeneration, Periodontal
PubMed: 37495541
DOI: 10.1111/jcpe.13850 -
The Journal of Evidence-based Dental... Sep 2023Evidence of oral microbiota perturbations has been accumulated for lung cancers. This review focused on the oral microbiota alterations in population suffering from lung... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Evidence of oral microbiota perturbations has been accumulated for lung cancers. This review focused on the oral microbiota alterations in population suffering from lung cancer. In addition, we also discussed conflicting data about the association between oral microbiota dysbiosis and risk of lung cancer.
METHODS
A systematic search was conducted in Medline, Embase, PubMed, and Cochrane Library databases. The studies evaluated diversity and abundance of oral microbes in healthy and lung cancer individuals as well as association of periodontal disease and pathogens with lung cancer. Of 3559 studies, 28 included studies were performed in qualitative analysis, and 25 studies were used in meta-analyses for quantitative assessment. Heterogeneity was analyzed by using I² and chi-squared Q test statistics. Statistical analyses were performed by using the RevMan 5.4 software.
RESULTS
Compared with the control, lung cancer patients had lower alpha diversity (Shannon: SMD = -0.54; 95% CI, -0.90 to -0.19; P < .01, I = 71%). In nested case-control studies, individuals with decreased alpha diversity tended to have an increased risk of lung cancer (observed species: HR = 0.90; 95% CI, 0.85-0.96; P < .01, I = 0%; Shannon: HR = 0.89; 95% CI, 0.83-0.95; P < .01, I = 0%). Overall, no strong evidence of association of relative abundance with specific oral microbes with lung cancers was found because of inconsistent data. No associations were found between periodontal pathogens and lung cancer risk (red complex: HR = 1.12, 95% CI: 0.42-3.02, P = .82, I = 62%; orange complex: HR =1.77, 95% CI: 0.78-3.98, P = .17, I = 36%), expect for Fusobacterium nucleatum (HR = 2.27, 95% CI: 1.13-4.58, P = .02, I = 0%). The positive association of periodontal disease with lung cancer risk was found (HR = 1.58, 95% CI: 1.25-2.00, P < .001, I= 0%) with increase of periodontal diseases severity (HR = 2.39, 95% CI: 1.57-3.66, P < .001, I = 0%). However, such association was not found in never-smoker participants (HR = 1.00, 95% CI: 0.76-1.31, P = .37, I= 7%).
CONCLUSIONS
Lower alpha diversity of oral microbiome may be associated with a greater risk of lung cancer and might serve as a predictive signal of lung cancer risk. There was no strong evidence of relative abundance of oral microbial taxa and periodontal pathogens in lung cancer patients. Fusobacterium nucleatum might be a potential microbial candidate of biomarkers in lung cancer. Periodontal disease may be positively associated with lung cancer risk by confounding of smoking, but not an independent risk factor.
Topics: Humans; Lung Neoplasms; Case-Control Studies; Microbiota; Periodontal Diseases; Research Design
PubMed: 37689446
DOI: 10.1016/j.jebdp.2023.101897 -
International Endodontic Journal Oct 2023Sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) and/or calcium hydroxide (Ca(OH) ) are commonly used during root canal treatment. Evaluation of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) and/or calcium hydroxide (Ca(OH) ) are commonly used during root canal treatment. Evaluation of their effectiveness regarding clinical and patient-related outcomes requires further understanding.
OBJECTIVES
To assess the effectiveness of root canal irrigation and dressing for the treatment of teeth with apical periodontitis (AP).
METHODS
A search was conducted in the PubMed-MEDLINE, Scopus, EMBASE, Google scholar databases and available repositories, followed by hand searches, until July 2021. Eligibility criteria followed the a priori formulated Population, Intervention, Comparator, Outcomes, Timing, and Study design (PICOTS) framework. Clinical studies restricted to English language were included. The revised Cochrane risk-of-bias tool for randomised trials (RoB 2) was used to assess the quality of included studies. Meta-analyses were performed using the fixed-effect model to obtain Risk Ratio (RR) and 95% Confidence Interval (CI), with sensitivity analysis. Overall quality of evidence of meta-analyses was assessed through the Grading of Recommendations Assessment, Development, and Evaluation tool.
RESULTS
The search identified 1357 records of which six fulfilled the inclusion criteria, providing data for 'irrigation' from 212 teeth and for 'dressings' from 438 teeth. Two studies reported no significant difference regarding the outcome 'pain at 7 days' using 2% chlorhexidine vs. 5.25% NaOCl and EDTA or after using different concentrations of NaOCl (1% vs. 5%). No significant difference was detected between different NaOCl concentrations regarding the reduction of AP. A meta-analysis was possible for the comparison of single-visit (SV) versus multiple-visits including the use of Ca(OH) demonstrating a significant effect in favour of SV (RR: 1.10; 95% CI: 1.03-1.19; p = .007; I = 0). RoB of included studies was moderate to low.
DISCUSSION
The use of Ca(OH) for the treatment of AP may not be beneficial. There is scarce or no evidence fulfilling the proposed PICOTS regarding irrigants and dressings.
CONCLUSIONS
There is moderate certainty that SV treatment is associated with better radiographic evidence of normal periodontal ligament space (strict criteria) compared with the use of Ca(OH) Reduction of AP is comparable after irrigation with 1% and 5% NaOCl, whereas postoperative pain at 7 days for the irrigants assessed is similar.
REGISTRATION
PROSPERO database CRD42021260271.
Topics: Humans; Dental Pulp Cavity; Edetic Acid; Root Canal Therapy; Periapical Periodontitis; Bandages; Root Canal Irrigants
PubMed: 35579074
DOI: 10.1111/iej.13777 -
Journal of Taibah University Medical... Aug 2023This systematic review and meta-analysis was aimed at determining differentially expressed protein-based biomarkers detectable in the saliva for the diagnosis of major... (Review)
Review
OBJECTIVE
This systematic review and meta-analysis was aimed at determining differentially expressed protein-based biomarkers detectable in the saliva for the diagnosis of major periodontal diseases.
METHODS
A literature review was conducted through January 31, 2022. The methodological quality and risk of bias were assessed with the Newcastle-Ottawa scale for case-control studies. Heterogeneity among studies was analysed with the Q statistical test and the I test. p-values lower than 0.10 and I values higher than 50% indicated high heterogeneity among studies; therefore, the random-effects model was used. The analysis of biological pathways associated with the differentially expressed protein markers was performed with the STITCH integration analysis tool and was limited to interactions with high confidence levels (0.7).
RESULTS
Of all protein-based biomarkers detected, 12 were suitable for meta-analysis: IL-1β, MIP-1α, albumin, TNF-α, ICTP, Ig-A, lactoferrin, MMP-8, IL-6, IL-8, IL-17 and PGE2. The salivary markers with high applicability were IL-1β for differentiating patients with chronic periodontal disease from patients with gingivitis with an OE = 73.5 pg/mL; ICTP for differentiating patients with chronic periodontal disease from healthy control patients with an OE = 0.091 ng/mL; and PGE2 for differentiating patients with chronic periodontal disease from healthy control patients with an OE = 36.3 pg/mL.
CONCLUSIONS
The biomarkers with the highest differential expression and the greatest potential for clinical applicability are IL-1β for differentiating periodontitis from gingivitis, and ICTP and PGE2 for differentiating periodontitis from healthy status.
PubMed: 36852252
DOI: 10.1016/j.jtumed.2022.12.004 -
Current Issues in Molecular Biology Dec 2023Prior studies demonstrated an equivocal conclusion about the association between the level of retinol-binding protein 4 (RBP4)/visfatin and periodontitis patients with... (Review)
Review
Prior studies demonstrated an equivocal conclusion about the association between the level of retinol-binding protein 4 (RBP4)/visfatin and periodontitis patients with obesity. The aim of our study (Prospero ID: CRD42023469058) was to systematically review the available articles linking the biofluid levels of RBP4/visfatin to the comorbidity of periodontitis and obesity. Clinical trials were screened in accordance with specific inclusion criteria from seven databases up to November 2023. A quality assessment was performed with the Newcastle-Ottawa Scale and ROBINS-I tools for observational and interventional trials, respectively. The standard mean difference (SMD) with a 95% confidence interval (CI) related to the RBP4 level was recorded; the other indicators related to the visfatin level were measured via the mean difference (MD) with the corresponding 95% CI, and Fisher's Z transformation was measured to reveal the association using Review Manager 5.4. The current evidence was based on five observational studies and two interventional studies. All of them were included in the systematic review, and six of them were in the meta-analysis. Statistical analysis indicated that there was no significant difference in the circulating levels of RBP4 in the periodontitis patients with obesity or without, who were labeled as OP or NP, respectively (155 OP-107 NP: SMD = 1.38; 95% CI: -0.18-2.94, = 0.08), as well as the periodontal healthy patients with a normal weight, who were labelled as NnP (116 OP-79 NnP: SMD = 6.76; 95% CI: -5.34-18.87, = 0.27). Meanwhile, a significant higher level of serum visfatin was found in the OP patients than that of the NP (86 OP-45 NP: MD = 4.21; 95% CI: 2.65-5.77, < 0.00001)/NnP (164 OP-88 NnP: MD = 13.02; 95% CI: 7.34-18.70, < 0.00001) group. In addition, a positive association was observed between the serum RBP4 and body mass index/clinical attachment loss (CAL). And, then, there was a positive association between the serum visfatin and periodontal parameters, including the probing depth, CAL, and plaque index, as well as metabolic parameters, including the total cholesterol, triglycerides, fasting blood glucose, and low-density lipoprotein cholesterol. Here, the circulating RBP4 level was not independently related to the comorbidity of periodontitis and obesity, while serum visfatin was significantly associated with periodontitis and obesity. Notably, the positive association between circulating RBP4/visfatin and the periodontal parameters/metabolic parameters firmly suggested that the higher severity of the obese or periodontal status was associated with an elevated level of serum visfatin or RBP4 in the OP group. With more rigorous longitudinal research, the exact causations between RBP4/visfatin and the patients affected by obesity and periodontitis could be disentangled. RBP4 and visfatin might be novel, enlightening prospective bio-indexes for the targeted treatment of comorbidities.
PubMed: 38132460
DOI: 10.3390/cimb45120614 -
Journal of Prosthodontics : Official... Apr 2024This systematic review was conducted to evaluate the prevalence of interproximal contact loss (ICL) between implant restorations and adjacent teeth in relation to age,... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
This systematic review was conducted to evaluate the prevalence of interproximal contact loss (ICL) between implant restorations and adjacent teeth in relation to age, gender, follow-up time, and arch location.
METHODS
This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in the Open Science Framework (OSF). The formulated population, intervention, comparison, outcome (PICO) question was "What is the prevalence of the ICL between implant restoration and adjacent teeth?" The search strategy used four main electronic databases and an additional manual search was performed until February 2023. Clinical studies that evaluated the prevalence of interproximal open contact between implant restorations and adjacent teeth were included. A qualitative analysis for clinical studies was used to assess the risk of bias. In addition, a single-arm meta-analysis of proportion was performed to evaluate the percentage of mesial versus distal open contact and total ICL between implant restoration and adjacent teeth.
RESULTS
Fifteen studies published between 2014 and 2023 met the eligibility criteria. Seven studies presented ICL rates higher than 20%. All studies evaluated ICL in posterior regions (molar, premolar area). Five studies had an ICL rate lower than 50% and three studies had an ICL rate higher than 50%. One study assessed the interproximal contact at three months post-restoration insertion, four studies assessed the interproximal contact at 1-year follow-up and nine studies evaluated the interproximal contact over 2 years of follow-up. Mesial and distal ICL rates were 44.2% (95% CI: 30.6% to 58.6%) and 27.5% (95% CI: 10.5% to 55.0%), respectively. The heterogeneity between studies was high (I (95% CI) = 87.8% (75.9% to 93.8%).
CONCLUSION
Based on the results of the included studies, the prevalence of ICL was high, occurring more frequently at the mesial contact. There were no significant differences in relation to age, gender, and arch location.
Topics: Humans; Dental Implants; Dental Implantation, Endosseous; Tooth; Mouth, Edentulous; Molar
PubMed: 37794763
DOI: 10.1111/jopr.13780 -
The Journal of Oral Implantology Aug 2023Selective serotonin reuptake inhibitors (SSRI) are commonly prescribed to treat mental health disorders, and previously published literature, although scarce, has shown... (Meta-Analysis)
Meta-Analysis
Selective serotonin reuptake inhibitors (SSRI) are commonly prescribed to treat mental health disorders, and previously published literature, although scarce, has shown a significant association between SSRI use and dental implant failure. This systematic review and meta-analysis aimed to examine whether such an association exists and, if so, to determine its strength. Reviewers performed an extensive search of the literature, last accessed in June 2022 in PubMed/Medline, Embase, and Cochrane databases using MeSH terms. Retrospective and prospective observational cohort and experimental studies evaluating the role of SSRI on dental implant failure among individuals ≥18 years of age, with a minimum follow-up of 6 months after implant placement, were deemed eligible. The search yielded a total of 6 eligible studies, all retrospective cohorts. Statistical analyses were performed using the statistical software R 4.1.3. Results showed higher implant failure rates among SSRI users vs non-SSRI users at both the patient level (5.6%-19.6% vs 1.9%-8.0%) and the implant level (5.6%-12.5% vs 1.9%-5.8%). The pooled relative risk (RR) of implant failure was more than double among SSRI users at the patient level (pooled RR: 2.44, 95% confidence interval [CI]: 1.68-3.55, P < .01) and at the implant level (pooled RR: 2.34, 95% CI: 1.74-3.15, P < .01) compared with non-SSRI users. DerSimonian and Laird estimates showed homogeneity of the studies (I2 = 0%, P > .05), and funnel plots and Egger's test determined no publication bias across all selected studies at both patient and implant levels. In conclusion, SSRI use is significantly associated with higher implant failure. Providers should be aware of this association and educate patients on the risk of implant therapy when obtaining informed consent.
Topics: Humans; Selective Serotonin Reuptake Inhibitors; Dental Implants; Retrospective Studies; Observational Studies as Topic
PubMed: 37527173
DOI: 10.1563/aaid-joi-D-22-00170 -
European Journal of Orthodontics Sep 2023Maxillary incisor and canine teeth are commonly impacted and require multidisciplinary treatment to accommodate them in the dental arch. (Meta-Analysis)
Meta-Analysis
Periodontal outcomes associated with impacted maxillary central incisor and canine teeth following surgical exposure and orthodontic alignment: a systematic review and meta-analysis.
BACKGROUND
Maxillary incisor and canine teeth are commonly impacted and require multidisciplinary treatment to accommodate them in the dental arch.
OBJECTIVES
To assess the periodontal outcomes of impacted maxillary central incisor and canine teeth, which have been successfully aligned in the arch following surgical exposure and orthodontic traction with fixed appliance therapy.
SEARCH METHODS
Systematic literature searches without restrictions were undertaken in eight databases.
SELECTION CRITERIA
Studies reporting surgical interventions in combination with orthodontic traction with fixed appliance therapy to align impacted maxillary incisors or canines published up to January 2023.
DATA COLLECTION
Duplicate independent study selection, data extraction, and risk of bias assessment.
ANALYSIS
Random-effects meta-analyses of aggregate data.
RESULTS
Twenty-three studies (21 retrospective and 2 prospective) were included in the final analysis. Three studies reported outcomes for maxillary central incisors and 20 reported outcomes for maxillary canines. For maxillary central incisors, all three studies were rated as being at moderate risk of bias. For maxillary canines, 17 studies and 1 study were rated at moderate and high risk of bias, respectively. Both prospective studies were rated at a low risk of bias. Meta-analyses comparing aligned impacted maxillary canines to their non-impacted contralateral counterparts found the former had increased Plaque Index scores (mean difference [MD] 0.19; 95% confidence interval [CI] 0.03, 0.35; P = 0.03), increased clinical attachment loss (MD 0.40 mm; 95% CI 0.17, 0.63; P = 0.01), increased pocket probing depth (MD 0.18 mm; 95% CI 0.07, 0.28; P = 0.001), increased bone loss (MD 0.51 mm; 95% CI 0.31, 0.72; P < 0.001), and reduced keratinized gingival width (MD -0.31 mm; 95% CI -0.61, -0.01; P = 0.04).
CONCLUSIONS
Limited evidence suggests that surgical exposure and orthodontic alignment of impacted maxillary central incisor or canine teeth, results in modest adverse effects in the periodontium. These findings should be viewed with caution as our certainty for these outcomes is very low to low due to the bias and heterogeneity. Further well-conducted studies reporting patient centred outcomes are required.
REGISTRATION
PROSPERO (CRD42020225639).
Topics: Humans; Cuspid; Incisor; Prospective Studies; Retrospective Studies; Tooth, Impacted
PubMed: 37643750
DOI: 10.1093/ejo/cjad039 -
Cureus Sep 2023This systematic review aimed to synthesize and analyze a collection of studies focused on comparing conventional veneers (CVs) and minimal or no-preparation veneers... (Review)
Review
This systematic review aimed to synthesize and analyze a collection of studies focused on comparing conventional veneers (CVs) and minimal or no-preparation veneers (MPVs) within the domain of prosthodontics. The review sought to explore various attributes, techniques, outcomes, and considerations associated with these two approaches. The key aspects investigated included esthetics, longevity, periodontal health, patient satisfaction, structural influences such as microleakage and marginal fit, cement thickness, and color stability. A systematic literature search was conducted to identify relevant studies published up to the present date. Studies meeting specific inclusion and exclusion criteria were selected for review. Studies pertaining to various methodologies were identified initially as part of the strategy and bias assessment was performed to determine the credibility of their assessments before inclusion in this review. Four comparative assessments gleaned from the selected studies provided a comprehensive overview of the strengths and limitations associated with CVs and MPVs. MPVs demonstrated advantages such as enhanced survival rates and extended mean success periods, implying their potential as viable long-term restorative options. Meticulous patient management and optimal preparation techniques emerged as crucial factors influencing successful outcomes. Structural attributes, including microleakage and marginal fit, varied depending on the preparation techniques employed. Moreover, considerations related to color changes in veneers underscored the intricate interplay between material properties and fabrication methods. The insights underscore the significance of patient-centric care, precision preparation methodologies, and material choices in guiding successful outcomes. However, the diverse methodologies and constraints of certain studies warrant careful interpretation. This study accentuates the potential for future research directions, interdisciplinary collaboration, and the advancement of evidence-based practices within veneer dentistry.
PubMed: 37799216
DOI: 10.7759/cureus.44638 -
BMC Oral Health Jul 2023Periodontitis is a common and chronic inflammatory disease characterized by irreversible destruction of the tooth surrounding tissues, especially intrabony defects,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Periodontitis is a common and chronic inflammatory disease characterized by irreversible destruction of the tooth surrounding tissues, especially intrabony defects, which eventually lead to tooth loss. In recent years, stem cell-based therapy for periodontitis has been gradually applied to the clinic, but whether stem cell-based therapy plays a positive role in periodontal regeneration is unclear at present.
METHODS
The clinical studies related to the evaluation of mesenchymal stem cells for periodontal regeneration in PubMed, Cochrane Central Register of Controlled trials (CENTRAL), Web of Science (WOS), Embase, Scopus, Wanfang and China national knowledge infrastructure (CNKI) databases were searched in June 2023. The inclusion criteria required the studies to compare the efficacy of stem cell-based therapy with stem cell free therapy for the treatment periodontitis, and to have a follow-up for at least six months. Two evaluators searched, screened, and assessed the quality and the risk of bias in the included studies independently. Review Manager 5.4 software was used to perform the meta-analysis, and GRADEpro GDT was used to evaluate the level of the evidence.
RESULTS
Five randomized controlled trials (RCTs) including 118 patients were analyzed. The results of this meta-analysis demonstrated that stem cell-based therapy showed better therapeutic effects on clinical attachment level (CAL) (MD = - 1.18, 95% CI = - 1.55, - 0.80, P < 0.00001), pocket probing depth (PPD) (MD = - 0.75, 95% CI = - 1.35, - 0.14, P = 0.020), and linear distance from bone crest to bottom of defect (BC-BD)( MD = - 0.95, 95% CI = - 1.67, - 0.23, P = 0.010) compared with cell-free group. However, stem cell-based therapy presented insignificant effects on gingival recession (P = 0.14), linear distance from cementoenamel junction to bottom of defect (P = 0.05).
CONCLUSION
The results demonstrate that stem cell-based therapy may be beneficial for CAL, PPD and BC-BD. Due to the limited number of studies included, the strength of the results in this analysis was affected to a certain extent. The high-quality RCTs with large sample size, multi-blind, multi-centric are still required, and the methodological and normative clinical study protocol should be established and executed in the future.
Topics: Humans; Guided Tissue Regeneration, Periodontal; Alveolar Bone Loss; Periodontitis; Tooth Loss; Chronic Disease; Randomized Controlled Trials as Topic
PubMed: 37454056
DOI: 10.1186/s12903-023-03186-6