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American Journal of Translational... 2024Tissue regeneration is the procedure of renewal, restoration and growth of injured tissues and defective organs including nerve, bone, tooth, cartilage and blood... (Review)
Review
Tissue regeneration is the procedure of renewal, restoration and growth of injured tissues and defective organs including nerve, bone, tooth, cartilage and blood vessels. Repair process of damaged tissues needs non-invasive methods; so, the scientists have recently focused on alternative treatment pathways. Nano gels based on Poly Lactic-co-Glycolic Acid have been designed for different purposes in medicine. It is a biodegradable and biocompatible polymer composite. Also, human dental pulp stem cells embedded in the Poly Lactic-co-Glycolic Acid scaffold have proliferation ability and differentiation potential. They can differentiate into different cell lineages, including bone, cartilage, nerve, tooth and other tissues. So, this treatment technology can be used for tissue engineering in regenerative medicine. On the other hand, this structure is a promising application for targeted cancer therapy. Therefore, this review studied tissue, especially tooth regeneration based on the new designed Nano composite scaffolds embedded with Poly Lactic-co-Glycolic Acid hydrogel and dental pulp stem cells.
PubMed: 38883345
DOI: 10.62347/QBKO6417 -
Cureus May 2024There are two main treatment options for immature teeth with necrotic pulp and apical periodontitis. Apexification creates a mineralized tissue barrier, while... (Review)
Review
There are two main treatment options for immature teeth with necrotic pulp and apical periodontitis. Apexification creates a mineralized tissue barrier, while revitalization aims to regenerate vital tissue in the canal space. There is no conclusive evidence to determine the most effective procedure regarding root length and dentin wall thickness. The objective of this systematic review was to compare the outcomes of revitalization and apexification procedures in immature non-vital teeth in terms of root length and dentin wall thickness. A literature search was conducted using the PubMed, ScienceDirect, Google Scholar, and Embase databases. Articles relevant to the study topic were gathered according to the selection criteria, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The included studies had to be published in English, conducted over a six-year period, and compared the outcomes of revitalization and apexification procedures in immature non-vital teeth. Data were collected using appropriate keywords from the eligible studies. Six articles were included for qualitative and quantitative analysis. The eligible studies showed a low risk of bias. In all revitalization cases, the root length increased significantly (mean difference (MD) (%) = 5.91; 95% confidence interval (CI) = 2.39-9.43; p = 0.0010; MD (mm) = 2.43; 95% CI = 2.05-2.80; p < 0.00001). The dentin wall thickness was statistically significant in most cases (MD (%) = 10.94; 95% CI = 7.01-14.88; p < 0.00001), MD (mm) = 0.16; 95% CI = 0.07-0.25; p = 0.0007). The systematic review and meta-analysis showed both procedures to be credible treatment options for necrotic immature teeth. Apexification had a positive impact, to some extent, on the development of root length. Revitalization yielded a significantly greater increase in root length and root dentin wall thickness and appeared to be superior in promoting root development.
PubMed: 38883120
DOI: 10.7759/cureus.60357 -
International Journal of Paediatric... Jun 2024Understanding of socioeconomic context might enable more efficient evidence-based preventive strategies in oral health. (Review)
Review
BACKGROUND
Understanding of socioeconomic context might enable more efficient evidence-based preventive strategies in oral health.
AIM
The study assessed the caries-related socioeconomic macro-factors in 12-year-olds across European countries.
DESIGN
This systematic review involved epidemiological surveys on the caries status of 12-year-olds from 2011 to 2022. DMFT was analyzed in relation to gross national income (GNI), United Nations Statistical Division geographical categorization of European countries (M49), unemployment rate, Human Development Index (HDI), and per capita expenditure on dental health care. A meta-analysis was performed for countries reporting data on DMFT, stratified by GNI, and geographical location of European countries, using a random-effects model.
RESULTS
The study involved 493 360 children from 36 countries in the geographic region of Europe. The analysis confirmed a strong negative correlation between income and caries experience (p < .01). Children living in higher-income countries showed 90% lower odds of poor oral health than in middle-income countries. Children living in West Europe showed 90% lower odds of poor oral health than children living in East Europe.
CONCLUSION
The strong effect of macro-level socioeconomic contexts on children's oral health suggests favoring upstream preventive oral health strategies in countries with economic growth difficulties, Eastern and Southern parts of Europe.
PubMed: 38881267
DOI: 10.1111/ipd.13224 -
Clinical and Experimental Dental... Jun 2024Special needs dentistry (SND) is a vast and fragmented field of study. This comprehensive bibliometric analysis aimed to evaluate the scope of SND, including the...
OBJECTIVES
Special needs dentistry (SND) is a vast and fragmented field of study. This comprehensive bibliometric analysis aimed to evaluate the scope of SND, including the existing knowledge base, distribution structure, quantitative relationships, and research trends.
MATERIAL AND METHODS
A systematic search was conducted on March 10, 2022, using the Web of Science Core Collection database, covering the period from 1985 to 2021, focusing on studies reporting on special needs populations in a dentally relevant context. Records were title-screened and analyzed for key bibliometric indicators.
RESULTS
Among 48,374 articles, 13,869 underwent bibliometric analysis. Peak SND research occurred during 1985-1997. United States led in productivity, trailed by Brazil and Japan. University of Sao Paulo excelled in Brazil, University of Washington and University of North Carolina in the United States. The Journal of Dental Research was the most productive source of research and also had the highest number of citations, followed by Community Dentistry and Oral Epidemiology. Keyword analysis revealed that "elderly", "caries", and "epidemiology" were the most commonly used author keywords.
CONCLUSIONS
This study represents the first bibliometric analysis of SND literature. It emphasizes the need for increased collaboration between institutions and authors. Furthermore, it suggests focusing on research input from non-dental disciplines and populations with rarer intellectual or developmental conditions.
Topics: Bibliometrics; Humans; Dental Research; Dental Care for Disabled
PubMed: 38881256
DOI: 10.1002/cre2.896 -
Clinical and Experimental Dental... Jun 2024Self-performed oral hygiene is essential for preventing dental caries, periodontal, and peri-implant diseases. Oral irrigators are adjunctive oral home care aids that... (Review)
Review
OBJECTIVES
Self-performed oral hygiene is essential for preventing dental caries, periodontal, and peri-implant diseases. Oral irrigators are adjunctive oral home care aids that may benefit oral health. However, the effects of oral irrigation on oral health, its role in oral home care, and its mechanism of action are not fully understood. A comprehensive search of the literature revealed no existing broad scoping reviews on oral irrigators. Therefore, this study aimed to provide a comprehensive systematic review of the literature on oral irrigation devices and identify evidence gaps.
METHODS
The Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines were utilized to prepare the review. Four databases and eight gray literature sources were searched for English publications across any geographical location or setting.
RESULTS
Two hundred and seventy-five sources were included, predominantly from scientific journals and academic settings. Most studies originated from North America. Research primarily involved adults, with limited studies in children and adolescents. Oral irrigation was safe and well-accepted when used appropriately. It reduced periodontal inflammation, potentially by modulating the oral microbiota, but further research needs to clarify its mechanism of action. Promising results were reported in populations with dental implants and special needs. Patient acceptance appeared high, but standardized patient-reported outcome measures were rarely used. Anti-inflammatory benefits occurred consistently across populations and irrigant solutions. Plaque reduction findings were mixed, potentially reflecting differences in study designs and devices.
CONCLUSIONS
Oral irrigators reduce periodontal inflammation, but their impact on plaque removal remains unclear. Well-designed, sufficiently powered trials of appropriate duration need to assess the clinical, microbiological, and inflammatory responses of the periodontium to oral irrigation, particularly those with periodontitis, dental implants, and special needs. Patient-reported outcome measures, costs, caries prevention, and environmental impact of oral irrigation need to be compared to other oral hygiene aids.
Topics: Humans; Therapeutic Irrigation; Oral Hygiene; Oral Health; Dental Caries; Periodontal Diseases
PubMed: 38881230
DOI: 10.1002/cre2.912 -
Health system strengthening in fragile and conflict-affected states: A review of systematic reviews.PloS One 2024Globally, there is growing attention towards health system strengthening, and the importance of quality in health systems. However, fragile and conflict-affected states... (Review)
Review
BACKGROUND
Globally, there is growing attention towards health system strengthening, and the importance of quality in health systems. However, fragile and conflict-affected states present particular challenges. The aim of this study was to explore health system strengthening in fragile and conflict-affected states by synthesising the evidence from published literature.
METHODS
We conducted a review of systematic reviews (Prospero Registration Number: CRD42022371955) by searching Ovid (Medline, Embase, and Global Health), Scopus, Web of Science, and the Cochrane Library databases. Only English-language publications were considered. The Joanna Briggs Institute (JBI) Critical Appraisal Tool was employed to assess methodological quality of the included studies. The findings were narratively synthesised and presented in line with the Lancet's 'high-quality health system framework'.
RESULTS
Twenty-seven systematic reviews, out of 2,704 identified records, considered key dimensions of health systems in fragile and conflict-affected states, with the 'foundations' domain having most evidence. Significant challenges to health system strengthening, including the flight of human capital due to safety concerns and difficult working conditions, as well as limited training capacities and resources, were identified. Facilitators included community involvement, support systems and innovative financing mechanisms. The importance of coordinated and integrated responses tailored to the context and stage of the crisis situation was emphasised in order to strengthen fragile health systems. Overall, health system strengthening initiatives included policies encouraging the return and integration of displaced healthcare workers, building local healthcare workers capacity, strengthening education and training, integrating healthcare services, trust-building, supportive supervision, and e-Health utilisation.
CONCLUSION
The emerging body of evidence on health system strengthening in fragile and conflict-affected states highlights its complexity. The findings underscore the significance of adopting a comprehensive approach and engaging various stakeholders in a coordinated manner considering the stage and context of the situation.
Topics: Humans; Delivery of Health Care; Armed Conflicts; Global Health
PubMed: 38875266
DOI: 10.1371/journal.pone.0305234 -
Journal of Stroke and Cerebrovascular... Jun 2024Since the efficacy and safety of endovascular thrombectomy (EVT) in patients with acute ischemic stroke with a large infarct area is still inconclusive, we sought to...
BACKGROUND
Since the efficacy and safety of endovascular thrombectomy (EVT) in patients with acute ischemic stroke with a large infarct area is still inconclusive, we sought to compare functional and neurological outcomes with the use of endovascular thrombectomy versus medical care alone.
METHODS
We searched MEDLINE (via PubMed), Embase, Cochrane Library, ClinicalTrials.gov, and the International Clinical Trials Registry Platform (ICTRP) to retrieve all the relevant randomized controlled trials (RCTs) on this topic. Review manager (RevMan) was used to perform meta-analyses using a random-effect model. Dichotomous outcomes were pooled using risk ratios (RR) with 95% confidence intervals (CIs).
RESULTS
Our meta-analysis included 6 RCTs with a total of 1665 patients. Most studies included patients with an ASPECTS score of 3-5. Our results demonstrate that endovascular thrombectomy significantly increased the rates of functional independence (mRS ≤ 2) (RR, 2.49; 95% CI, 1.89-3.29) and moderate neurological outcome (mRS ≤ 3) (RR, 1.90; 95% CI, 1.50-2.40) at 90 days. The benefit of EVT for these outcomes remained the same at 1-year follow-up. Endovascular thrombectomy was associated with increased rates of early neurological improvement (RR, 2.22; 95% CI, 1.53-3.22), excellent neurological recovery (mRS ≤ 1) (RR, 1.75; 95% CI, 1.02-3.03), and decreased rate of poor neurological recovery (mRS 4-6) (RR, 0.81; 95% CI, 0.76-0.86). No significant difference was found between the two groups regarding all-cause mortality (RR, 0.86; 95% CI, 0.72-1.02), decompressive craniectomy (RR, 1.32; 95% CI, 0.89-1.94), and the incidence of serious adverse effects (RR, 1.39; 95% CI, 0.83-2.32) between the two groups. Endovascular thrombectomy significantly increased the rates of any intracranial hemorrhage (RR, 1.94; 95% CI, 1.48-2.53) and symptomatic intracranial hemorrhage (RR, 1.73; 95% CI, 1.11-2.69).
CONCLUSION
Endovascular thrombectomy (EVT) significantly improves neurological and functional outcomes in patients who present within 6 hours of stroke onset with ICA and proximal M1 occlusions, and ASPECTS scores ranging from 3 to 5, compared to medical therapy alone, with an increased risk of symptomatic intracranial hemorrhage.
PubMed: 38871260
DOI: 10.1016/j.jstrokecerebrovasdis.2024.107818 -
BMC Oral Health Jun 2024To determine the prevalence, case-fatality rate, and associated risk-factors of Noma in children in Nigeria. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To determine the prevalence, case-fatality rate, and associated risk-factors of Noma in children in Nigeria.
METHODS
Search was conducted in PubMed, Google Scholar, and Cochrane Library databases. Data were extraction using a double-blind approach. Discrepancies were resolved by a third reviewer. Heterogeneity was evaluated using I statistics. Random-effects model was used for the meta-analysis and subgroup analysis was conducted. The study quality was evaluated using standard Critical-Appraisal-Checklist.
RESULTS
Of the 1652 articles identified, 12 studies that met the inclusion criteria included 871 cases of Noma. Two studies had high-risk of bias and were excluded in the meta-analysis. Pooled prevalence of Noma was 2.95% (95%CI:2.19-3.71; Z = 7.60; p < 0.00001, I:100.0). Case fatality was reported in one study. Sex-distribution had a male-to-female ratio of 1.1:1. Malnutrition (88.42%, 95%CI:52.84-124.00; I:100.0), measles (40.60%; 95% CI:31.56-49.65; I:100.0) and malaria (30.75%; 95% CI:30.06-31.45; I:100.0) were the most notable associated risk-factors. Prevalence of Noma was non-significantly lower in southern (1.96%,95%CI:1.49-2.44;6 studies) than in northern (4.43%; 95%CI:-0.98-9.83; 4 studies) Nigeria. One study reported the prevalence of Noma in children younger than 5 years.
CONCLUSIONS
About every 3 in 100 children in Nigeria had Noma and the prevalence was non-significantly higher in northern than southern Nigeria. Malnutrition, measles, and malaria were major associated risk-factors. Case-fatality rate and prevalence based on different age-groups were inconclusive.
Topics: Humans; Nigeria; Prevalence; Risk Factors; Child; Noma; Child, Preschool
PubMed: 38867180
DOI: 10.1186/s12903-024-04451-y -
Evidence-based Dentistry Jun 2024The aim of this systematic review was to comprehensively explore the current trends and therapeutic approaches in which an operating microscope (OM) is used in...
OBJECTIVES
The aim of this systematic review was to comprehensively explore the current trends and therapeutic approaches in which an operating microscope (OM) is used in periodontics and dental implant surgeries.
MATERIALS AND METHODS
A systematic search strategy was built to detect studies including various surgical techniques performed under an OM. PubMed, EMBASE, and SCOPUS databases were searched. No limitations in terms of time and language were applied. The data regarding the study design, type of procedure, treatment groups, and surgical outcomes were collected and analyzed descriptively. In addition, a bibliometric analysis was performed concerning the co-authorship and keyword co-occurrence network.
RESULTS
Out of 1985 articles, finally, 55 met the inclusion criteria. Current periodontal and implant microsurgery trends consist of: periodontal therapy, dental implant microsurgery, soft tissue grafting and periodontal plastic surgery, bone augmentation, ridge preservation, and ortho-perio microsurgery. The bibliometric analysis revealed "guided tissue regeneration", "periodontal regeneration" and "root coverage" being the most repeated keywords (landmark nodes). 132 authors within 29 clusters were identified, publishing within the frameworks of "periodontal and implant microsurgery".
CONCLUSION
Within its limitations, this systematic review provides an overview of the latest trends in periodontal and implant microsurgery when considering the use of an OM as the magnification tool. Also, it discusses the reported success and outcomes of the mentioned procedures.
PubMed: 38867104
DOI: 10.1038/s41432-024-01024-4 -
Acta Odontologica Scandinavica Jun 2024Non-surgical therapeutics to reconstruct lost interdental papilla are evolving; these include hyaluronic acid injection. The aim of this systematic review is to evaluate...
OBJECTIVE
Non-surgical therapeutics to reconstruct lost interdental papilla are evolving; these include hyaluronic acid injection. The aim of this systematic review is to evaluate the efficacy, safety, and long-term outcomes of hyaluronic acid injection in the treatment of black triangles and reconstruction of lost interdental papilla in anterior teeth.
MATERIALS AND METHODS
The protocol was registered in PROSPERO (CRD42023446875) and in accordance with the Cochrane Handbook of Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 'PRISMA'. The search involved four databases, PubMed/MEDLINE, The Cochrane Library, Google Scholar, and ProQuest for ''grey literature' with additional manual search for studies published up to May 2024. Human clinical studies of a prospective nature (randomised clinical trials and prospective cohort studies) were included. Exclusion criteria were case reports, case series, review articles, letter to editor, personal opinion, and animal studies. Furthermore, studies which utilised hyaluronic acid injection in conjunction with other therapeutic material, tissue graft, or any surgical procedure were also excluded. The data were extracted independently by the two authors and incorporated after consensus. The risk of bias was assessed using the RoB2: the revised Cochrane risk of bias tool for randomised clinical trials and the Newcastle Ottawa scale for prospective cohort studies.
RESULTS
24 studies, 15 prospective clinical studies and nine randomised clinical trials, were included with a total of 898 interdental papillae injected with hyaluronic acid. The studies showed promising outcomes in the reconstruction of lost interdental papilla with minimal adverse reactions. Risk of bias assessment among prospective clinical studies revealed 13 good quality studies with only two poor studies while the randomised clinical trials consisted of three with low, one with some concern, and five studies with high risk of bias. However, due to the high heterogeneity, a meta-analysis was not feasible. Conclusion: Hyaluronic acid injection is an effective minimally invasive approach in treating black triangles and reconstructing lost interdental papilla in the anterior teeth. Further long-term well-designed randomised clinical trials employing standardised procedures are essential to validate this treatment and provide better quality of evidence.
Topics: Hyaluronic Acid; Humans; Dental Papilla
PubMed: 38864684
DOI: 10.2340/aos.v83.40864