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Clinical Oral Investigations May 2024The primary objective of this review is to compare autogenous soft tissue grafts (connective tissue graft - CTG and free gingival graft-FGG) with different type of... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The primary objective of this review is to compare autogenous soft tissue grafts (connective tissue graft - CTG and free gingival graft-FGG) with different type of matrices (acellular dermal matrix-ADM, xenograft collagen matrix-XCM, volume-stable collagen matrix-VCMX) used to increase peri-implant soft tissues.
MATERIALS AND METHODS
A search on electronic databases was performed to identify randomized and non-randomized controlled trials (RCTs and CCTs, respectively) with either parallel or split-mouth design, and treating ≥ 10 patients. A network meta-analysis (NMA) was used to compare different matrices. Soft tissue thickness dimensional changes and keratinized width (KMW) changes were the primary outcome measures. The secondary outcomes were to evaluate: a) PROMs; b) volumetric changes; c) surgical operating time; and d) different periodontal measurements.
RESULTS
A total of 23 studies were included in the qualitative analysis, and 16 studies (11 RCTs and 5 CCTs) in the quantitative analysis. A total of N = 573 sites were evaluated for NMA. CTG resulted the best material for increasing peri-implant soft tissue thickness, at 180 and 360 days after surgery. The use of an ADM showed good results for buccal thickness increase, primarily in the first three months after surgery. Vestibuloplasty + FGG resulted in the most effective technique for peri-implant KMW augmentation, after 180 days.
CONCLUSIONS
While CTG demonstrated better performance in all the comparison and FGG showed to be the best graft to increase keratinized mucosa up to 90 days, ADM and VCMX may be used to increase soft tissue horizontal thickness with lower patients' morbidity.
LIMITATIONS
The limits of this NMA are the following: a) limited number of included studies; b) high heterogeneity among them (number of patients, treatment sites, surgical techniques, outcome measures, and follow-ups).
CLINICAL RELEVANCE
Many studies compared the efficacy of autogenous and non-autogenous grafts in terms of gingival thickness, volume, and keratinized width increase. However, there is still not clear overall evidence on this topic. This NMA helps clinicians to choose the right material in different peri-implant soft tissue procedures. Recommendations for future studies are mandatory.
Topics: Humans; Collagen; Network Meta-Analysis; Gingiva; Acellular Dermis; Connective Tissue; Dental Implants; Gingivoplasty
PubMed: 38704784
DOI: 10.1007/s00784-024-05684-5 -
Medicina (Kaunas, Lithuania) Mar 2024Third molar extraction is the most common procedure in oral and maxillofacial surgery. Third molars are considered less functional than other teeth and are often... (Review)
Review
Third molar extraction is the most common procedure in oral and maxillofacial surgery. Third molars are considered less functional than other teeth and are often extracted. Sometimes, they are also used for auto-transplantation for the benefit of oral rehabilitation. Since many biological factors are involved in this surgical approach, herein, we outline a review of the biological characteristics of medico-legal/forensic interest, in addition to presenting a successful clinical case. A scoping review of currently available research data (following the principles of PRISMA-ScR or the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) on third molar auto-transplantation was conducted by drawing upon the main databases (Scopus, PubMed, Google Scholar and LILACS) to evaluate biological and clinical characteristics possibly relatable to forensic issues. All the collected data were summarized and elaborated on for the purpose of this article. A patient underwent extraction of the right upper first molar and auto-transplantation of the unerupted ipsilateral third molar. Many biologic and clinical factors are involved in the success of this clinical procedure. Knowledge of third molar anatomy, of its development and viable surgical approaches are all essential elements; just as important are the treatment of the tooth before and after transplantation and the integrity of the periodontal ligament. Follow-up of the clinical case for 5 years made it possible to verify the stability of the procedure over time. Third molar auto-transplantation is feasible and cost-effective. However, the use of third molars as donor teeth in auto-transplantation may have medico-legal implications. The lack of official protocols and consistent evidence-based guidelines for operators still prevent such a procedure from becoming mainstream; therefore, it is viewed with suspicion by clinicians and patients, even though the biological factors herein detected point to a reasonably high degree of safety. The understanding of many specific biological and clinical factors involved in the stability of third molar auto-transplantation allows for a thorough understanding of the forensic implications relevant to clinical practice. Effective communication and information provision are therefore of utmost importance, in the interest of both patients and doctors.
Topics: Humans; Tooth, Impacted; Molar, Third; Tooth Extraction; Biological Factors
PubMed: 38541199
DOI: 10.3390/medicina60030473 -
Clinical Oral Implants Research May 2024Pigs are emerging as a preferred experimental in vivo model for bone regeneration. The study objective was to answer the focused PEO question: in the pig model (P),... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Pigs are emerging as a preferred experimental in vivo model for bone regeneration. The study objective was to answer the focused PEO question: in the pig model (P), what is the capacity of experimental alveolar bone defects (E) for spontaneous regeneration in terms of new bone formation (O)?
METHODS
Following PRISMA guidelines, electronic databases were searched for studies reporting experimental bone defects or extraction socket healing in the maxillae or mandibles of pigs. The main inclusion criteria were the presence of a control group of untreated defects/sockets and the assessment of regeneration via 3D tomography [radiographic defect fill (RDF)] or 2D histomorphometry [new bone formation (NBF)]. Random effects meta-analyses were performed for the outcomes RDF and NBF.
RESULTS
Overall, 45 studies were included reporting on alveolar bone defects or extraction sockets, most frequently in the mandibles of minipigs. Based on morphology, defects were broadly classified as 'box-defects' (BD) or 'cylinder-defects' (CD) with a wide range of healing times (10 days to 52 weeks). Meta-analyses revealed pooled estimates (with 95% confidence intervals) of 50% RDF (36.87%-63.15%) and 43.74% NBF (30.47%-57%) in BD, and 44% RDF (16.48%-71.61%) and 39.67% NBF (31.53%-47.81%) in CD, which were similar to estimates of socket-healing [48.74% RDF (40.35%-57.13%) and 38.73% NBF (28.57%-48.89%)]. Heterogeneity in the meta-analysis was high (I > 90%).
CONCLUSION
A substantial body of literature revealed a high capacity for spontaneous regeneration in experimental alveolar bone defects of (mini)pigs, which should be considered in future studies of bone regeneration in this animal model.
Topics: Animals; Alveolar Bone Loss; Bone Regeneration; Disease Models, Animal; Swine; Tooth Socket; Wound Healing
PubMed: 38450852
DOI: 10.1111/clr.14253 -
Evidence-based Dentistry Mar 2024A systematic review. (Meta-Analysis)
Meta-Analysis
DESIGN
A systematic review.
AIM
Assess the effectiveness of manual toothbrushes (MTB) and powered toothbrushes (PTB) for people with physical or intellectual disabilities.
DATA SOURCES AND STUDY SELECTION
The following data sources (MEDLINE-PubMed, Cochrane-CENTRAL and EMBASE) were searched from the date of creation to February 2022 for papers which met the inclusion criteria. There were no language limitations set. The included studies were then hand-searched for relevant studies to be included.
DATA EXTRACTION AND SYNTHESIS
Two reviewers screened the studies from the searches using Rayyan web application (Artificial-Intelligence search engine). Studies which met the inclusion criteria were selected. The studies were independently screened for the inclusion/exclusion criteria. Disagreement was resolved by discussion and consensus, or by a third party. Studies were then classified as low/moderate/high risk of bias. Analysis was performed on four subgroups; individual performing the brushing - (1) caregiver or (2) participant, main disability of the participant - (3) physical or (4) intellectual disability. Due to insufficient numerical data, a descriptive analysis was completed in place of the planned meta-analysis.
RESULTS
In total, 16 publications were included within the results. There was no significant difference between manual or powered toothbrushing in both disability groups for the removal of plaque or gingival health. This applied to both self-brushing and caregiver brushing.
CONCLUSIONS
There is no significant difference between powered and manual toothbrushes for effective oral hygiene maintence for people with physical or intellectual disabilities.
Topics: Humans; Toothbrushing; Gingivitis; Intellectual Disability; Oral Hygiene; Gingiva; Equipment Design
PubMed: 38443442
DOI: 10.1038/s41432-024-00981-0 -
Clinical Oral Investigations Mar 2024To investigate the oral manifestations in women of reproductive age using hormonal contraceptive methods. (Review)
Review
OBJECTIVES
To investigate the oral manifestations in women of reproductive age using hormonal contraceptive methods.
MATERIALS AND METHODS
This review is based on the PRISMA statement. A literature search incorporated observational studies from the last 21 years. An investigative question was formulated using the PICO model, studies were selected, and a quality analysis was performed using the modified STROBE guidelines. A bibliometric analysis was performed, and the data were examined.
RESULTS
Thirteen articles were included, with the majority evaluating periodontal status. Others analyzed factors such as the presence of alveolar osteitis, oral candidiasis, and salivary microbiome dysbiosis. Ten articles were deemed to have a low risk of bias.
CONCLUSIONS
Hormonal contraceptives may increase the risk of alveolar osteitis following tooth extraction and increase the presence of the Candida species in the oral cavity. They also affect the periodontium, such as the frequent development of gingivitis, but do not lead to changes in the salivary microbiome.
CLINICAL RELEVANCE
The increasing number of women using hormonal contraceptives and the knowledge that these contraceptives can produce oral cavity alterations underscore the need to evaluate the oral manifestations found in these women.
Topics: Female; Humans; Dry Socket; Contraceptives, Oral, Hormonal; Periodontium; Gingivitis; Contraception
PubMed: 38427087
DOI: 10.1007/s00784-024-05573-x -
The International Journal of Oral &... Feb 2024To determine the characteristics of dental implant transmucosal surfaces that influence soft tissue attachment and marginal bone loss (MBL).
PURPOSE
To determine the characteristics of dental implant transmucosal surfaces that influence soft tissue attachment and marginal bone loss (MBL).
MATERIALS AND METHODS
The PubMed, Embase, and Cochrane Library electronic databases were searched based on predefined PICO eligibility criteria. Data from animal studies that compared junctional epithelium and connective tissue attachment and MBL from 4 days to 72 weeks were analyzed. The risk of bias was performed with the Systematic Review Centre for Laboratory Animal Experimentation tool. A rank analysis evaluation of data was performed, and the most frequently appearing materials/surfaces for each tissue compartment were identified.
RESULTS
The search identified 3,549 studies, 28 of which were eligible for analysis, with an average risk of bias of 28% ± 10%. Machined, polished, etched, sandblasted, or coated titanium and zirconia materials/surfaces were most frequently examined. Several studies investigated lithium disilicate, polyether ether ketone (PEEK) or polyether ketone ketone (PEKK), aluminum oxide, and gold. Based on ranking and frequency of use at different time points, titanium grade IV (Ti-4) microthreads with a polished neck area most frequently supported natural tooth-like junctional epithelial attachment (≤ 1.5 mm), while machined Ti-4 and machined titanium grade V (Ti-5) most frequently supported connective tissue attachment (≤ 1.25 mm) and led to the least MBL (≤ 0.75 mm).
CONCLUSIONS
Analyzed data suggest that Ti-4 microthreads with a polished neck area and machined Ti-4 and Ti-5 were the materials/surfaces of choice for the transmucosal part of implants. However, the extensive heterogeneity in reported studies precludes solid identification of the best materials/surfaces.
Topics: Animals; Dental Implants; Titanium; Bone Diseases, Metabolic; Aluminum Oxide; Epithelial Attachment
PubMed: 38416011
DOI: 10.11607/jomi.10398 -
The International Journal of Oral &... Feb 2024To review experimental peri-implantitis studies using rat models and summarize different peri-implantitis induction techniques and evaluate their effectiveness. (Meta-Analysis)
Meta-Analysis
PURPOSE
To review experimental peri-implantitis studies using rat models and summarize different peri-implantitis induction techniques and evaluate their effectiveness.
MATERIALS AND METHODS
Electronic searches were conducted by two independent examiners to address the following issues. Meta-analyses explored the marginal bone loss (MBL) of four types of peri-implantitis induction methods in rats. The detailed induction tactics-such as the implant design, implant size, surgical process, time cost, induction methods, and endpoint measurements-were summarized.
RESULTS
Of the 18 included studies, 38.9% of the studies placed implants at the maxillary first molar, and 44.4% placed them at the alveolar ridge region anterior to the maxillary first molar. As for the induction method, the numbers of published studies on ligature methods, bacterial inoculation, and bacterial lipopolysaccharide inoculation were equally high among all selected studies. The total implant survival rate at the end was 160 out of 213 implants (75.11%). Eight studies with high pooled heterogeneity (I2 = 98, P < .01) in the meta-analysis reported an overall MBL (μ-CT) of 0.47 mm (95% CI = 0.14 to 0.81). A subgroup analysis estimated an MBL of 0.31 mm (95% CI = 0.12 to 0.50) for bacterial inoculation and 0.66 mm (95% CI = 0.07 to 1.26) for the ligature method. Histopathologic analysis revealed that peri-implantitis in rats was similar to peri-implantitis lesions in humans.
CONCLUSIONS
Implant placement at the maxillary first molar with bacterial inoculation and the silk ligature method to build peri-implantitis rat models is reliable to use for research on peri-implantitis.
Topics: Humans; Animals; Rats; Peri-Implantitis; Alveolar Process; Bone Diseases, Metabolic; Molar
PubMed: 38416001
DOI: 10.11607/jomi.10424 -
Clinical Oral Investigations Feb 2024This study aimed to compare the efficacy of acellular xenogeneic dermal matrix graft (AXDM) compared to connective tissue graft (CTG) in treating multiple gingival... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This study aimed to compare the efficacy of acellular xenogeneic dermal matrix graft (AXDM) compared to connective tissue graft (CTG) in treating multiple gingival recessions.
MATERIALS AND METHODS
A systematic search of electronic databases was conducted to identify randomized clinical trials (RCTs) that compared AXDM and CTG. The selected studies were subjected to bias risk assessment, data extraction, and meta-analyses. Parameters such as gingival recession height, width, mean percentage of root coverage, and complete root coverage were analyzed.
RESULTS
Seven RCTs involving 146 patients were included. The meta-analyses indicated that CTG was statistically superior to AXDM in reducing gingival recession height at the final follow-up (mean difference: -0.104 mm, 95% confidence interval [CI]: -0.180-0.028, p = 0.008) and width at the final follow-up (mean difference: -0.285 mm, 95% CI: -0.541-0.030, p = 0.029). CTG also demonstrated a significantly higher mean percentage of root coverage at the 6-month follow-up (difference in means: -2.761 mm, 95% CI: -4.932-0.590, p = 0.013) and a higher percentage of complete root coverage at the 6-month follow-up (odds Ratio [OR]: 0.598, 95% CI: 0.4-0.892, p = 0.012) compared to AXDM. However, there was no significant difference in the number of teeth with complete root coverage between CTG and AXDM (OR: 1.610, 95% CI: 0.983-2.636, p = 0.058) and aesthetic outcomes (mean difference: 0.148, 95% CI: -0.277-0.573, p = 0.494).
CONCLUSIONS
CTG is more effective than AXDM in treating multiple gingival recessions. This is evidenced by significant reductions in gingival recession height and width, a higher mean percentage of root coverage, and a greater percentage of complete root coverage at the 6-month follow-up.
CLINICAL RELEVANCE
In some clinical situations an alternative to CTG is required for the treatment of multiple gingival recessions. AXDM, despite presenting clinical outcomes that are not as satisfactory as CTG, can be used for this purpose.
Topics: Humans; Gingival Recession; Gingiva; Surgical Flaps; Treatment Outcome; Tooth Root; Esthetics, Dental; Connective Tissue
PubMed: 38409621
DOI: 10.1007/s00784-024-05560-2 -
Clinical Oral Investigations Feb 2024To perform a systematic review of animal studies that compared the histopathological characteristics between teeth with apical periodontitis after endodontic treatment... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To perform a systematic review of animal studies that compared the histopathological characteristics between teeth with apical periodontitis after endodontic treatment in one or two visits.
MATERIALS AND METHODS
This systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) - CRD42022340849. Studies were collected from PubMed/MEDLINE, LILACS, EMBASE, Livivo, SciELO, Web of Science, Scopus, and Cochrane Library and manual and gray literature searches. Animal studies that evaluated histological characteristics after endodontic treatment of teeth with apical periodontitis in one or two visits were included. Risk of bias analysis of the included studies was performed using the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) tool. Data synthesis of the included studies with quantitative data was performed, and meta-analysis was conducted with the Comprehensive Meta-Analysis software, using the random effects model and odds ratio (OR).
RESULTS
Eighteen studies met the inclusion criteria (Kappa = 0.891). Meta-analyses indicated values in inflammatory infiltrate intensity with effect size of 5.5% (95% CI: 0.020-0.148; p < 0.001), periodontal ligament thickness: 25.6% (95% CI: 0.134-0.487; p < 0.001), dentin resorption: 13% (95% CI: 0.015-1.141; p = 0.066), cementum resorption: 7.1% (95% CI: 0.015-0.325; p = 0.001), bone resorption: 1.4% (95% CI: 0.002-0.130; p < 0.001), mineralized tissue resorption: 42.8% (95% CI: 0.110-1.671; p = 0.222), biological apical sealing: 13.1% (95% CI: 0.055-0.314; p < 0.001), and presence of microorganisms: 10.3% (95% CI: 0.014-0.747; p = 0.025).
CONCLUSIONS
When considering animal studies, the two-visit endodontic treatment, using calcium hydroxide-based intracanal medication, resulted in better biological repair characteristics.
CLINICAL RELEVANCE
A two-visit endodontic treatment with calcium hydroxide-based intracanal medication yields superior histopathological outcomes.
Topics: Animals; Humans; Calcium Hydroxide; Dental Care; Bone Resorption; Dental Cementum; Periapical Periodontitis
PubMed: 38407663
DOI: 10.1007/s00784-024-05571-z -
Medicina Oral, Patologia Oral Y Cirugia... Mar 2024Oral Lichen Planus is a common chronic inflammatory disease of the oral mucosa. The prevalence in adults ranges between 0.5% and 2%, while in children is reported to...
BACKGROUND
Oral Lichen Planus is a common chronic inflammatory disease of the oral mucosa. The prevalence in adults ranges between 0.5% and 2%, while in children is reported to be about 0,03%. Clinical features of Oral Lichen Planus could be variable in both adults and children, ranging from painless white hyperkeratotic lesions to painful erythematous atrophic ones. Actually, there are no systematic reviews in the literature on OLP in children, whereby this paper aims to summarize all the pathophysiological aspects and identify all cases described in the literature of Oral Lichen Planus in children, reporting their clinical characteristics.
MATERIAL AND METHODS
A systematic review of the literature was performed in online databases including PubMed, Scopus, Web of Science, Science Direct, EMBASE. In addition, in order to identify reports not otherwise identifiable, an analysis of the gray literature was performed on google scholar and in Open Gray.
RESULTS
By literature analysis, it emerged that most cases were reported from India. The mean age at time of diagnosis of the disease was 11 years, ranging from 3 to 17 years. The most frequent pattern was the reticular pattern followed by plaque-like, erosive, atrophic, sclerosus, and bullous. The buccal mucosa was the most involved oral site, followed by the tongue, lips and gingiva.
CONCLUSIONS
Although Oral Lichen Planus in children is rare, it may cause oral discomfort and need to be differentiated from other oral white lesions and/or chronic ulcers.
Topics: Child; Humans; Atrophy; Databases, Factual; Gingiva; India; Lichen Planus, Oral; Child, Preschool; Adolescent
PubMed: 38288854
DOI: 10.4317/medoral.25938