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Clinical Oral Investigations Aug 2023To investigate the histomorphometric changes occurring in alveolar ridge preservation (ARP) based on the use of different plasma concentrates (PCs) in randomized... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To investigate the histomorphometric changes occurring in alveolar ridge preservation (ARP) based on the use of different plasma concentrates (PCs) in randomized clinical trials (RCT). There is controversy whether the placement of PCs in ARP is effective in the formation of new bone.
MATERIALS AND METHODS
A systematic review search was conducted in PubMed, Scopus, Web of Science, and Cochrane Database to answer the PICO question: In patients undergoing tooth extraction followed by ARP, do PCs alone in the post-extraction socket in comparison with spontaneous healing improve new vital bone formation percentage in histomorphometric analysis after more than 10 weeks? The risk of bias was assessed and a meta-analysis was conducted.
RESULTS
Of 3809 results, 8 studies were considered suitable for inclusion. A total of 255 teeth were extracted in 250 patients. Regarding the PCs used, ARP was performed with platelet- and leukocyte-rich fibrin (L-PRF) in 120 sockets, and with pure platelet-rich plasma (P-PRP) in 31 sockets and 104 sockets were controlled. PCs improved new bone formation in ARP with respect to the spontaneous healing group (SMD = 1.77, 95%C.I. = 1.47-2.06, p-value < 000.1). There were no differences between the different PCs (L-PRF and P-PRP).
CONCLUSION
The results of this meta-analysis support the efficacy of the use of PCs in new bone formation in ARP. With respect to the different types of PCs studied, no differences were observed.
CLINICAL RELEVANCE
When planning implant surgery after tooth extraction, treatment with PCs should be considered for ARP. Any PC increases new bone formation compared to spontaneous healing.
Topics: Humans; Tooth Socket; Alveolar Process; Osteogenesis; Tooth; Platelet-Rich Plasma; Tooth Extraction; Fibrin; Alveolar Ridge Augmentation
PubMed: 37439800
DOI: 10.1007/s00784-023-05126-8 -
BMC Oral Health Mar 2021Understanding the anatomy of the facial alveolar bone (FAB), provides a prognostic tool for estimating the degree of dimensional ridge alterations after tooth... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Understanding the anatomy of the facial alveolar bone (FAB), provides a prognostic tool for estimating the degree of dimensional ridge alterations after tooth extraction. This systematic review and meta-analysis aims to determine the FAB thickness and modifying factors of anterior maxillary teeth measured by CBCT scans. A secondary objective was to assess the facial distance from the cementoenamel junction (CEJ) to the bone crest.
METHODS
An electronic search was made of Medline, Embase, Web of Science, Cochrane Library and Google Scholar up to December 2019. Studies that analyze and quantitatively compare FAB thickness at maxillary teeth by CBCT scans were included. The methodological quality of the included studies was appraised using the ROBINS-I tool and the overall meta-evidence certainty using the GRADE approach. A single means random-effects meta-analysis was performed to obtain the weighted mean for 95% confidence interval. A meta-regression of covariates and subgroup analysis was conducted. The nullity Q test and I index for heterogeneity was estimated.
RESULTS
2560 potentially relevant articles were recorded from which 29 studies were selected for the qualitative analysis, including 17,321 teeth. Seventeen studies considered the facial bone crest, and 12 the CEJ as a reference point for their measurements. Mean FAB thickness was ≤ 1 mm in maxillary incisors and canines (0.75-1.05 mm) and 1-2 mm in premolars. Patients over 50 years of age, females and thin gingival phenotype was associated with thinner FAB at some apico-coronal locations of maxillary incisors and canines. The geographical setting was an effect modifier that could explain up to 87% of the heterogeneity in FAB thickness, being Asian populations that showed the lowest FAB thickness values. The CEJ-bone crest distance was 2-2.5 mm in all teeth analyzed. Population over 50 years of age exhibited greater CEJ-bone crest distances, and males also showed a trend for greater distance. Evidence certainty has shown moderate quality in most analysis subsets.
CONCLUSIONS
Facial alveolar bone at anterior maxillary teeth is thin, heterogeneous in width along its apico-coronal dimensions, and increases in thickness in maxillary premolars. The CEJ-bone crest distance presented homogeneous and similar values in all teeth analyzed.
Topics: Alveolar Process; Cone-Beam Computed Tomography; Female; Humans; Incisor; Male; Maxilla; Tooth Cervix
PubMed: 33752651
DOI: 10.1186/s12903-021-01495-2 -
International Journal of Environmental... Nov 2021(1) Background: To assess orthodontic forced eruption (OFE) as a pre-restorative procedure for non-restorable permanent teeth with subgingival dental hard tissue defects... (Review)
Review
(1) Background: To assess orthodontic forced eruption (OFE) as a pre-restorative procedure for non-restorable permanent teeth with subgingival dental hard tissue defects after dental trauma. (2) Methods: A systematic electronic search of three databases, namely, MEDLINE, Cochrane Library, and EMBASE, revealed a total of 2757 eligible publications. Randomized controlled clinical trials (RCT), retro- and prospective clinical studies, or case series (with a minimum of three patients) were reviewed. (3) Results: Thirteen full-text papers were included: one RCT, one prospective clinical trial, two retrospective cohort studies, and nine case series. Within case series, statistical significance between age and cause of fracture ( < 0.03) was determined. The mean extrusion rate of OFE was 1.5 mm a week within a four to six weeks treatment period followed by retention. Three OFE protocols for maxillary single teeth are available: 1. OFE without migration of gingiva and alveolar bone, 2. OFE with gingival migration and slight alveolar bone migration, and 3. OFE with migration of both gingiva and alveolar bone. (4) Conclusions: The current state of the evidence suggests that OFE is a feasible pre-treatment option for non-restorable permanent teeth. OFE can promote the migration of tooth surrounding hard and soft tissues in the esthetic zone. Root resorption does not seem to be a relevant side effect of OFE.
Topics: Fractures, Bone; Gingiva; Humans; Orthodontic Extrusion; Prospective Studies; Root Resorption
PubMed: 34886307
DOI: 10.3390/ijerph182312580 -
Journal of Materials Science. Materials... Aug 2021To analyze the hemostatic, Dsurgical wounds in donor and recipient areas of free gingival grafts (FGG). Five databases (PubMed, Scopus, Science Direct, Cochrane and Web... (Comparative Study)
Comparative Study
Comparative analysis of the hemostatic, analgesic and healing effects of cyanoacrylate on free gingival graft surgical wounds in donor and recipient areas: a systematic review.
UNLABELLED
To analyze the hemostatic, Dsurgical wounds in donor and recipient areas of free gingival grafts (FGG). Five databases (PubMed, Scopus, Science Direct, Cochrane and Web of Science) were searched up to March 2021 (PROSPERO CRD42019134497). The focus of the study (cyanoacrylate) was combined with the condition (periodontal surgery OR free gingival graft OR free soft tissue graft OR autografts), and outcome (healing OR epithelialization OR pain OR analgesia OR bleeding OR hemostasis OR hemostatic). Studies reporting cyanoacrylate isolated or associated with another substance in FGG stabilization and closure were investigated and assessed for the quality and risk of bias through the Cochrane Manual. Six studies with 323 participants were included. Evaluation of the quality and risk of bias highlighted a low risk for four articles, intermediate for one and unclear for another. The use of cyanoacrylate associated or not with the hemostatic sponge or the platelet-rich fibrin was more effective in healing (three studies), analgesia (four studies), and hemostasis in one study (p < 0.05). However, groups with the association in cyanoacrylate showed superior healing, and analgesic action to the isolated cyanoacrylate group. In addition, two studies demonstrated that cyanoacrylate use reduces surgery duration, one study showed that it reduces postoperative sensibility, and another present hemostatic effect (p < 0.05). There is scarce literature for the use of cyanoacrylate in FGG wounds indicates that it can promote a minor inflammatory response, reduce operation time, does not interfere with healing, relieves postoperative discomfort, and suggests the possibility immediate hemostasis. Its use presents an alternative to suturing in FGG surgeries. But, the limited number of cases and the relative heterogeneity of the included studies suggest caution in generalizing the indication.
CLINICAL RELEVANCE
Cyanoacrylate seems to present analgesic effects and less pain when applied to wound closure and covering donor and recipient areas reducing the need for postoperative analgesic medication; and has a healing effect in the closure of the donor area on the palate. In addition, it can reduce bleeding time after surgery, and prevents late bleeding during the first postsurgical week. Scientific justification: To evaluate the hemostatic, analgesic and healing actions of cyanoacrylate compared to the suture thread and other agents when used to close surgical wounds from periodontal free gingival graft surgical wounds in both the donor and recipient areas of the graft.
MAIN FINDINGS
The use of cyanoacrylate individually or in association with wound dressing agents presents analgesic effects because the patient reports less pain experienced when cyanoacrylate is applied to the wound closure and covering, thereby reducing the need for postoperative analgesic medication. In addition, a healing effect is observed in the closure of the donor area on the palate; as well as it seems to present hemostatic effects, reducing the bleeding time after surgery, and preventing late bleeding during the first postsurgical week.
PRACTICAL IMPLICATIONS
Dentists may cautiously apply cyanoacrylate after periodontal surgeries for free gingival graft in both the donor and recipient areas of the graft. However, they must consider the limitations of the surgery, tension-free positioning, the patient's dyscrasia and postoperative care, constituting a set of predictors for adequate clinical decision-making. Widespread use of such material for all patients and surgical configurations may not be recommended.
Topics: Analgesics; Bandages; Bias; Cyanoacrylates; Gingiva; Hemostasis; Hemostatics; Humans; Palate; Platelet-Rich Fibrin; Re-Epithelialization; Plastic Surgery Procedures; Risk; Surgical Wound; Wound Healing
PubMed: 34406492
DOI: 10.1007/s10856-021-06573-z -
Journal of International Society of... 2021The aim of this study was to systematically review the applications of adipose tissue stem cells (ADSCs) in regenerative dentistry. (Review)
Review
AIM
The aim of this study was to systematically review the applications of adipose tissue stem cells (ADSCs) in regenerative dentistry.
MATERIALS AND METHODS
An electronic search was conducted in Medline (PubMed) and Scopus databases. The original research associated with the role of ADSCs in regeneration of alveolar bone, periodontal ligament (PDL), cementum as well as the dental pulp was evaluated. Among the included studies, three animal studies and one human study had low risk of bias.
RESULTS
A total of 33 relevant studies were included in the review. The animal models, human, and studies revealed that ADSCs had a significant osteogenic differentiation potential. Besides, they had potential to differentiate into PDL, cementum, and dental pulp tissue.
CONCLUSION
The ADSCs may be specifically applied for bone tissue engineering in the management of alveolar bone defects, specifically in dental implants and periodontal disease. However, their role in regeneration of PDL, cementum, and dental pulp requires further investigations. Overall, their applications in regenerative dentistry needs further verification through human clinical trials.
PubMed: 34268188
DOI: 10.4103/jispcd.JISPCD_43_21 -
Medicina (Kaunas, Lithuania) Mar 2022The periodontium has important proprioceptive receptors that prevent teeth from using excessive occlusal forces during chewing. There are other receptors from adjacent... (Review)
Review
The periodontium has important proprioceptive receptors that prevent teeth from using excessive occlusal forces during chewing. There are other receptors from adjacent tissues that replace periodontal ones when teeth are extracted and rehabilitated with prosthesis, although they seem to be less effective. Psychophysical studies investigate tactile sensibility thresholds, which are useful to measure this masticatory efficiency in different prosthetic rehabilitations. There are two types of sensibility depending on the receptors that are activated during these studies: active and passive tactile sensibility. The purpose of this study is to obtain active and passive tactile sensibility threshold figures in natural dentition and prosthetic rehabilitations so we can compare them and understand how this sensibility works in different situations. We performed a systematic review of the available literature, following PRISMA guidelines and including articles from 2004 to 2021 in the MEDLINE database. Only 10 articles were included in this investigation as they provided concrete threshold figures. The mean values of active tactile sensibility thresholds in complete dentures, implant prosthesis and natural dentition are 64 µ, 23.3 µ and 16.1 µ, respectively. The mean values of passive tactile sensibility thresholds in implant prosthesis and natural dentition are 6.7 N and 0.8 N, respectively. Implant prosthesis have lower thresholds, that are very close to those present in natural dentition, than complete dentures due to an increased tactile sensibility. Active tactile sensibility thresholds present fewer differences between values than passive tactile ones; as these are only influenced by receptors from periodontal or periimplant tissues.
Topics: Dentition; Denture, Complete; Humans; Mouth, Edentulous; Sensory Thresholds; Touch
PubMed: 35454340
DOI: 10.3390/medicina58040501 -
Journal of Pharmacy & Bioallied Sciences Jul 2023Although the fact that the association of the periodontitis and the diabetes mellitus is well accepted, the literature has inconsistent findings regarding this...
INTRODUCTION
Although the fact that the association of the periodontitis and the diabetes mellitus is well accepted, the literature has inconsistent findings regarding this connection. The motive in conducting this systematic review was to define whether poorly controlled diabetes was linked to the development or progression of periodontitis.
MATERIALS AND METHODS
Databases from PubMed, Scopus, and Embase were searched electronically. All included articles' reference lists were manually searched. Google Scholar was used to research gray literature. For this review, longitudinal studies (prospective) on the association between periodontitis and diabetes were taken into consideration. Studies have to have included at least two parameters of the evolution of health of the periodontium throughout time. The study's design, as well as unadjusted and adjusted estimates, was recorded. This study calculated the combined impact of diabetes-related hyperglycemia on the start or progression of periodontitis using meta-analysis. To look into possible sources of study heterogeneity, subgroup analyses and meta-regression were used.
RESULTS
With 49,262 participants from 13 studies that met the inclusion criteria, 3197 of whom had been diagnosed with diabetes. Diabetes augmented the likelihood of developing or progressing into periodontitis by 86%, according to meta-analyses of adjusted estimates (RR 1.86; 95% CI 1.3-2.8). On the association between periodontitis and diabetes, there is little data, nonetheless.
CONCLUSIONS
This study provides proof that persons with diabetes have an increased risk of developing periodontitis. Methodological limitations mentioned in this study should be overcome in upcoming prospective longitudinal investigations.
PubMed: 37654263
DOI: 10.4103/jpbs.jpbs_515_22 -
Clinical Oral Investigations Jan 2022Alveolar ridge preservation (ARP) is a proactive treatment option aiming at attenuating post-extraction hard and soft tissue dimensional changes. A high number of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Alveolar ridge preservation (ARP) is a proactive treatment option aiming at attenuating post-extraction hard and soft tissue dimensional changes. A high number of different types of biomaterials have been utilized during ARP to seal the socket, but their effectiveness in terms of soft tissue outcomes has rarely been investigated and compared in the literature.
OBJECTIVE
To evaluate the efficacy of different types of membranes and graft materials in terms of soft tissue outcomes (keratinized tissue width changes, vertical buccal height, and horizontal changes) after ARP, and to assign relative rankings based on their performance.
MATERIALS AND METHODS
The manuscript represents the proceedings of a consensus conference of the Italian Society of Osseointegration (IAO). PUBMED (Medline), SCOPUS, Embase, and Cochrane Oral Health's Information Specialist were utilized to conduct the search up to 06 April 2021. English language restrictions were placed and no limitations were set on publication date. Randomized controlled trials that report ARP procedures using different sealing materials, assessing soft tissue as a primary or secondary outcome, with at least 6-week follow-up were included. Network meta-analysis (NMA) was performed using mean, standard deviation, sample size, bias, and follow-up duration for all included studies. Network geometry, contribution plots, inconsistency plots, predictive and confidence interval plots, SUCRA (surface under the cumulative ranking curve) rankings, and multidimensional (MDS) ranking plots were constructed.
RESULTS
A total of 11 studies were included for NMA. Overall, the level of bias for included studies was moderate. Crosslinked collagen membranes (SUCRA rank 81.8%) performed best in vertical buccal height (VBH), autogenous soft tissue grafts (SUCRA rank 89.1%) in horizontal width change (HWch), and control (SUCRA rank 85.8%) in keratinized mucosa thickness (KMT).
CONCLUSIONS
NMA confirmed that the use of crosslinked collagen membranes and autogenous soft tissue grafts represented the best choices for sealing sockets during ARP in terms of minimizing post-extraction soft tissue dimensional shrinkage.
CLINICAL RELEVANCE
Grafting materials demonstrated statistically significantly better performances in terms of soft tissue thickness and vertical buccal height changes, when covered with crosslinked collagen membranes. Instead, soft tissue grafts performed better in horizontal width changes. Non-crosslinked membranes and other materials or combinations presented slightly inferior outcomes.
Topics: Alveolar Bone Loss; Alveolar Process; Alveolar Ridge Augmentation; Biocompatible Materials; Collagen; Humans; Network Meta-Analysis; Tooth Extraction; Tooth Socket
PubMed: 34669038
DOI: 10.1007/s00784-021-04192-0 -
The Cochrane Database of Systematic... Dec 2019Sickle cell disease is the most common single gene disorder and the commonest haemoglobinopathy found with high prevalence in many populations across the world.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Sickle cell disease is the most common single gene disorder and the commonest haemoglobinopathy found with high prevalence in many populations across the world. Management of dental complications in people with sickle cell disease requires special consideration for three main reasons. Firstly, dental and oral tissues are affected by the blood disorder resulting in several oro-facial abnormalities. Secondly, living with a haemoglobinopathy and coping with its associated serious consequences may result in individuals neglecting their oral health care. Finally, the treatment of these oral complications must be adapted to the systemic condition and special needs of these individuals, in order not to exacerbate or deteriorate their general health. Guidelines for the treatment of dental complications in this population who require special care are unclear and even unavailable in many aspects. Hence this review was undertaken to provide a basis for clinical care by investigating and analysing the existing evidence in the literature for the treatment of dental complications in people with sickle cell disease. This is an update of a previously published review.
OBJECTIVES
To assess methods of treating dental complications in people with sickle cell disease.
SEARCH METHODS
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Review Group's Haemoglobinopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Date of last search: 01 August 2019. Additionally, we searched nine online databases (PubMed, Google Scholar, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, Literature in the Health Sciences in Latin America and the Caribbean database, African Index Medicus, Index Medicus for South East Asia Region, Index Medicus for the Eastern Mediterranean Region, Indexing of Indian Medical Journals). We also searched the reference lists of relevant articles and reviews and contacted haematologists, experts in fields of dentistry, organizations, pharmaceutical companies and researchers working in this field. Date of last search: 07 November 2019.
SELECTION CRITERIA
We searched for published or unpublished randomised controlled studies of treatments for dental complications in people with sickle cell disease.
DATA COLLECTION AND ANALYSIS
Two review authors intended to independently extract data and assess the risk of bias of the included studies using standard Cochrane methodologies; however, no studies were identified for inclusion in the review.
MAIN RESULTS
No randomised controlled studies were identified.
AUTHORS' CONCLUSIONS
This Cochrane Review did not identify any randomised controlled studies assessing interventions for the treatment of dental complications in people with sickle cell disease. There is an important need for randomised controlled studies in this area, so as to identify the most effective and safe method for treating dental complications in people with sickle cell disease.
Topics: Anemia, Sickle Cell; Craniofacial Abnormalities; Dental Care; Humans; Randomized Controlled Trials as Topic; Tooth Diseases
PubMed: 31841224
DOI: 10.1002/14651858.CD011633.pub3 -
PloS One 2020Adjunctive use of laser devices as high reactive-level laser/light therapy (HLLT) or photobiomodulation therapy (PBMT) for periodontal therapy is known to be more... (Meta-Analysis)
Meta-Analysis
Adjunctive use of laser devices as high reactive-level laser/light therapy (HLLT) or photobiomodulation therapy (PBMT) for periodontal therapy is known to be more effective on suppressing pain than conventional therapy, however, there are no systematic reviews addressed its effectiveness. This systematic review and meta-analysis aim to investigate the following clinical question (CQ): does adjunctive use of lasers with conventional therapy suppress the pain associated with periodontal treatment? A systematic and extensive literature search was performed to summarize the currently available knowledge to answer the CQ using the PubMed, Cochrane Library, and Web of Science databases for randomized controlled trials (RCTs) conducted before June 2020. Bias risk was assessed using the Cochrane tool for the risk of bias evaluation. A meta-analysis was performed on quantitative evaluation of pain control based on patient-reported outcomes. After an independent screening of 165 initial records, ten RCTs were included. Six of them focused on surgical procedures and the others on non-surgical periodontal pocket therapy. The protocols of HLLT, PBMT, and combination with HLLT and PBMT were employed in five, four and one RCTs, respectively. Following the assessment of bias risk, it is revealed that all RCTs had methodological weaknesses regarding the blinding of key personnel, although other bias risk factors were not evident. Meta-analysis showed that HLLT using erbium lasers significantly reduced the patient-reported pain immediately after treatment (two RCTs, p < 0.0001), while PBMT using diode lasers significantly reduced pain 2-7 days after treatment (two RCTs, p < 0.0001 to p = 0.03). The presented systematic review and meta-analysis suggest that the alternative use of HLLT using erbium lasers to conventional instrumentation can significantly suppress postoperative pain and that intraoperative or postoperative PBMT using diode lasers combined with periodontal surgery can significantly reduce postoperative pain. However, the evidence is still insufficient and more well-designed RCTs are required.
Topics: Humans; Judgment; Laser Therapy; Low-Level Light Therapy; Pain Management; Patient Reported Outcome Measures; Periodontium; Publication Bias; Risk; Visual Analog Scale
PubMed: 32941479
DOI: 10.1371/journal.pone.0238659