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Endocrine, Metabolic & Immune Disorders... 2023Osseo-integrated implants provide effective treatment results for edentulous patients. However, despite the high success and survival rates of dental implants, several...
BACKGROUND
Osseo-integrated implants provide effective treatment results for edentulous patients. However, despite the high success and survival rates of dental implants, several factors, such as poor oral hygiene and a history of periodontal disease, and systemic diseases, such as diabetes mellitus, could influence the outcome of the treatment. In fact, poor glycemic control can affect the healing process. Diabetes mellitus is considered a relative contraindication for dental implant therapy due to the fact that the success rates of the implants seem to be lower in diabetic patients, even if there is no total agreement among the results reported in the literature. The analysis of peri-implant inflammation indices, bone loss around the implant and glycemic index can provide us with useful information on the relationship between glycaemia in diabetic patients and the course of peri-implantitis, as well as implant success in the short term.
OBJECTIVE
The purpose of this review is to establish how peri-implant inflammation parameters vary in diabetic versus non-diabetic patients.
METHODS
This review was conducted on the basis of PRISMA. The search was conducted by three independent reviewers searching for keywords in three databases: PubMed, Scopus, Web Of Sciences (WOS), and the Cochrane Central Register of Controlled Trial.
RESULTS
A total of 1159 records were identified, and 11 articles were included in the qualitative analysis.
CONCLUSION
The analysis of the extracted data from the included studies suggests that some periimplant inflammation indices, such as bleeding on probing and bone loss around the implant, appear to be increased in diabetic patients with glycometabolic decompensation, compared with control not affected by diabetes mellitus.
Topics: Humans; Peri-Implantitis; Diabetes Mellitus; Inflammation; Hyperglycemia; Glycemic Index
PubMed: 36281861
DOI: 10.2174/1871530323666221021100427 -
Graefe's Archive For Clinical and... Mar 2023Cataract surgery in patients with uveitis is challenging, and postoperative inflammation control is crucial for successful outcomes. No consensus exists regarding the... (Meta-Analysis)
Meta-Analysis
PURPOSE
Cataract surgery in patients with uveitis is challenging, and postoperative inflammation control is crucial for successful outcomes. No consensus exists regarding the optimal method of controlling postoperative inflammation. In this systematic review and meta-analysis, we compared the outcome of intravitreal injection (IVI), including steroid (triamcinolone acetonide) or steroid implant (dexamethasone), with systemic anti-inflammatory therapy (ST), such as systemic steroids with or without immunomodulatory therapy, in patients with uveitis undergoing cataract surgery.
METHODS
We searched PubMed, EMBASE, and Cochrane Library databases for randomized controlled trials (RCTs), comparative cohort studies, and case-control studies published through May 2021 that compared intraoperative IVI of triamcinolone acetonide or steroid implant with ST with or without immunomodulatory therapy. The following outcomes were evaluated: preoperative best-corrected visual acuity, intraocular pressure, laser flare photometry, central macular thickness and cystoid macular edema rate.
RESULTS
Five studies were selected. Our analysis indicated that compared with ST, IVI treatment may be associated with less anterior chamber inflammation and a lower cystoid macular edema rate, but the difference in best-corrected visual acuity, intraocular pressure, or central macular thickness was not significant.
CONCLUSIONS
IVI of steroid or steroid implants might be beneficial in controlling postoperative inflammation for uveitis cataract, especially in patients who cannot tolerate ST. To the best of our knowledge, this is the first meta-analysis to compare the efficacy of intraoperative IVI of steroids with standard-of-care treatment as a prophylaxis for uveitis cataract. However, large-scale RCTs are warranted to compare the IVI of steroid implants and steroids.
Topics: Humans; Triamcinolone Acetonide; Intravitreal Injections; Macular Edema; Phacoemulsification; Uveitis; Glucocorticoids; Inflammation; Cataract; Treatment Outcome
PubMed: 36271933
DOI: 10.1007/s00417-022-05852-x -
Diabetes & Metabolic Syndrome Oct 2022Μany studies suggest the use of antibiotic prophylaxis (AP) as an appropriate preventive measure for patients with diabetes mellitus (DM) due to the increased... (Review)
Review
BACKGROUND AND AIMS
Μany studies suggest the use of antibiotic prophylaxis (AP) as an appropriate preventive measure for patients with diabetes mellitus (DM) due to the increased possibility of an impaired wound healing and infections after surgical procedures in the oral cavity. Existing recommendations regarding antibiotic prophylaxis before surgical procedures are not definitive and are based on expert opinions. The purpose of this study was to review the available scientific data about the necessity of administrating AP as a preventive measure prior to oral surgical procedures.
METHOD
PubMed®, Scopus® και Cochrane Central Register of Controlled Trials (CENTRAL) were used as databases to search for published research. All articles were initially identified and classified based on the title and subsequently on their abstract. For the next level the full scientific paper was read and evaluated.
RESULTS
Overall, 22 articles were included in the study, of which 2 were systematic reviews, 2 cohort studies, 2 case-control studies, 1 case series, 8 case reports and 7 professional association publications.
CONCLUSIONS
In the scientific literature, there is a wide range of recommendations and inconsistency regarding the need to administer AP prior to surgical dental operations in patients with DM, while there is no scientific evidence demonstrating its' effectiveness as a precautionary measure. Both blood glucose level measurements and recent HbA1c measurement should be evaluated before any dental procedure. Poor regulation may result to life-threatening infections after tooth extraction. AP is recommended prior to the placement of dental implant. Randomized, controlled, clinical trials with large number of participants and greater variety of surgical dental procedures are needed.
Topics: Humans; Antibiotic Prophylaxis; Blood Glucose; Dental Implants; Glycated Hemoglobin; Oral Surgical Procedures; Diabetes Mellitus; Anti-Bacterial Agents
PubMed: 36183455
DOI: 10.1016/j.dsx.2022.102621 -
Neurosurgical Focus Oct 2022Neuropathic pain is undertreated in children. Neurosurgical treatments of pediatric chronic pain are limited by the absence of both US Food and Drug Administration... (Meta-Analysis)
Meta-Analysis
Spinal cord stimulation for treatment of chronic neuropathic pain in adolescent patients: a single-institution series, systematic review, and individual participant data meta-analysis.
OBJECTIVE
Neuropathic pain is undertreated in children. Neurosurgical treatments of pediatric chronic pain are limited by the absence of both US Food and Drug Administration approval and pediatric-specific hardware, as well as weak referral patterns due to a lack of physician education. This study presents a single-institution retrospective case series of spinal cord stimulation (SCS) in children ≤ 19 years of age and a systematic review of SCS in children. The authors' findings may further validate the role of SCS as an effective treatment modality for varied neuropathic pain syndromes found in pediatric patients.
METHODS
The study was a single-center, single-surgeon, retrospective case series of individuals treated between July 2017 and May 2022. The outcomes for pediatric patients with chronic neuropathic pain syndromes indicated by the multidisciplinary pain clinic for evaluation for SCS were cataloged. A systematic review and individual participant data (IPD) meta-analysis was performed for cases treated until May 2022, using PubMed, EMBASE, and Scopus to characterize outcomes of children with neuropathic pain treated with SCS.
RESULTS
Twelve patients were evaluated and 9 were indicated for percutaneous or buried lead trials. Seven female and 2 male patients between the ages of 13 and 19 years were implanted with trial leads. Eight of 9 (89%) patients went on to receive permanent systems. The average trial length was 6 days, and the length of stay for both trial and implant was less than 1 day. Complication rates due to CSF leaks were 22% and 0% for trial and implant, respectively. Visual analog scale pain scores decreased from 9.2 to 2.9 (p = 0.0002) and the number of medications decreased from 4.9 to 2.1 (p = 0.0005). Functional status also improved for each patient. A systematic review identified 13 studies describing pediatric patients with SCS, including 12 providing IPD on 30 patients. In the IPD meta-analysis, pain was reduced in 16/16 (100%) of patients following surgery and in 25/26 (96.2%) at last follow-up. Medication use was decreased in 16/21 (76.2%), and functional outcomes were improved in 29/29 (100%). The complication rate was 5/30 (16.7%).
CONCLUSIONS
SCS effectively decreases pain and medication use for pediatric neuropathic pain syndromes. Patients also report improved functional status, including improved matriculation, gainful employment, and physical activity. There is minimal high-quality literature describing neuromodulation for pain in children. Neuromodulation should be considered earlier as a viable alternative to escalating use of multiple drugs and as a potential mechanism to address tolerance, dependence, and addiction in pediatric patients.
Topics: Adolescent; Adult; Child; Chronic Pain; Female; Humans; Male; Neuralgia; Retrospective Studies; Spinal Cord; Spinal Cord Stimulation; Syndrome; Treatment Outcome; Young Adult
PubMed: 36183181
DOI: 10.3171/2022.7.FOCUS22330 -
Molecules (Basel, Switzerland) Aug 2022Hydroxyapatite (HA) is a well-known calcium phosphate ingredient comparable to human bone tissue. HA has exciting applications in many fields, especially biomedical... (Review)
Review
Hydroxyapatite (HA) is a well-known calcium phosphate ingredient comparable to human bone tissue. HA has exciting applications in many fields, especially biomedical applications, such as drug delivery, osteogenesis, and dental implants. Unfortunately, hydroxyapatite-based nanomaterials are synthesized by conventional methods using reagents that are not environmentally friendly and are expensive. Therefore, extensive efforts have been made to establish a simple, efficient, and green method to form nano-hydroxyapatite (NHA) biofunctional materials with significant biocompatibility, bioactivity, and mechanical strength. Several types of biowaste have proven to be a source of calcium in forming HA, including using chicken eggshells, fish bones, and beef bones. This systematic literature review discusses the possibility of replacing synthetic chemical reagents, synthetic pathways, and toxic capping agents with a green template to synthesize NHA. This review also shed insight on the simple green manufacture of NHA with controlled shape and size.
Topics: Animals; Bone and Bones; Cattle; Drug Delivery Systems; Durapatite; Humans; Nanostructures; Osteogenesis
PubMed: 36080349
DOI: 10.3390/molecules27175586 -
Nutrients Aug 2022Phenolic compounds are natural phytochemicals that have recently reported numerous health benefits. Resveratrol, curcumin, and quercetin have recently received the most...
Phenolic compounds are natural phytochemicals that have recently reported numerous health benefits. Resveratrol, curcumin, and quercetin have recently received the most attention among these molecules due to their documented antioxidant effects. The review aims to investigate the effects of these molecules on bone metabolism and their role in several diseases such as osteopenia and osteoporosis, bone tumours, and periodontitis. The PubMed/Medline, Web of Science, Google Scholar, Scopus, Cochrane Library, and Embase electronic databases were searched for papers in line with the study topic. According to an English language restriction, the screening period was from January 2012 to 3 July 2022, with the following Boolean keywords: ("resveratrol" AND "bone"); ("curcumin" AND "bone"); ("quercetin" AND "bone"). A total of 36 papers were identified as relevant to the purpose of our investigation. The studies reported the positive effects of the investigated phenolic compounds on bone metabolism and their potential application as adjuvant treatments for osteoporosis, bone tumours, and periodontitis. Furthermore, their use on the titanium surfaces of orthopaedic prostheses could represent a possible application to improve the osteogenic processes and osseointegration. According to the study findings, resveratrol, curcumin, and quercetin are reported to have a wide variety of beneficial effects as supplement therapies. The investigated phenolic compounds seem to positively mediate bone metabolism and osteoclast-related pathologies.
Topics: Curcumin; Dietary Supplements; Humans; Osteoporosis; Periodontitis; Quercetin; Resveratrol
PubMed: 36079777
DOI: 10.3390/nu14173519 -
Oxidative Medicine and Cellular... 2022Peri-implant mucositis (PiM) is characterized as a reversible inflammatory change of the peri-implant soft tissues without alveolar bone loss or continuing marginal bone... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Peri-implant mucositis (PiM) is characterized as a reversible inflammatory change of the peri-implant soft tissues without alveolar bone loss or continuing marginal bone loss. Without proper control of PiM, the reversible inflammation may advance to peri-implantitis (PI). Mechanical debridement (MD) by the implant surface is the most common and conventional nonsurgical approach to treat PiM but with limitations in complete resolution of diseases. For more than a decade, chlorhexidine (CHX) and active compounds has been investigated in the treatment of PiM. Therefore, the aim of this systematic review and meta-analysis was to evaluate the efficacy of CHX treatment in combination with MD versus MD alone or MD+placebo in patients with PiM on their oral health problems.
METHODS
A search using electronic databases (Ovid MEDLINE, EMBASE, Science Direct databases, and Cochrane Central Register of Controlled Trials) and a manual search up to May 2022 were performed independently by 2 reviewers and included eligible randomized controlled trials (RCTs) comparing MD+CHX versus MD alone or MD+placebo. The assessment of quality for all the selected RCTs was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions. Disease resolution of PiM (absence of BOP), IPPD reduction, IBOP% reduction, and PI% reduction after treatment as primary outcomes were selected as the primary outcomes. Weighted mean differences (WMD) and 95% confidence interval (CI) were for continuous outcomes, and odds ratio (OR) and 95% CI was for dichotomous outcomes using random effect models. This review is registered on the PROSPERO database (CRD42020221989).
RESULTS
After independent screening, nine eligible studies were included in this systematic review and meta-analysis. Meta-analysis showed OR of disease resolution between test and control groups amounted to 1.41 (95% CI (0.43, 4.65), = 0.57, = 65%) not favoring adjunctive CHX treatment over MD alone. Through subgroup analysis, the results indicated that oral irrigation of CHX may have more benefits on the resolution of PiM. Similarly, CHX did not significantly improve IPPD reduction at both short-, medium-, and long-term follow-up. Only a short-term effect has been observed at IBOP% reduction (WMD = 13.88, 95% CI (10.94, 16.81), < 0.00001, = 9%), IPI reduction (WMD = 0.12, 95% CI (0.09, 0.14), < 0.00001, = 0%), and FMPPD reduction (WMD = 0.19 mm, 95% CI (0.03, 0.35), = 0.02, = 0%) with adjunctive CHX application.
CONCLUSION
Adjunctive CHX application may have some benefits to improve the efficacy of MD in PiM treatment by reducing IBOP%, IPI, and FMPPD in short-term. But these benefits disappeared at medium- and long-term follow-up. In order to achieve better disease resolution of PiM, adjunctive CHX irrigation with MD may be suggested and has positive potential. Well-designed large clinical trials are needed in future.
Topics: Chlorhexidine; Humans; Mucositis; Oral Health; Peri-Implantitis
PubMed: 36065438
DOI: 10.1155/2022/2312784 -
Clinical Oral Implants Research Nov 2022To answer the following PICO question: "In patients requiring surgical treatment of peri-implantitis (P), is any implant surface decontamination protocol (I) superior to... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To answer the following PICO question: "In patients requiring surgical treatment of peri-implantitis (P), is any implant surface decontamination protocol (I) superior to others (C) in terms of clinical and radiographic parameters (O)?"
METHODS
Randomized clinical trials (RCTs) comparing two or more decontamination protocols as part of the surgical treatment of peri-implantitis were included. Two authors independently searched for eligible studies, screened titles and abstracts, did full-text analysis, extracted data, and performed the risk-of-bias assessment. Whenever possible, results were summarized through random effects meta-analyses.
RESULTS
Twenty-two manuscripts reporting on 16 RCTs were included, testing mechanical, chemical and physical decontamination protocols. All of them resulted in an improvement in clinical parameters; however, the superiority of specific protocols over others is mainly based on single RCTs. The use of titanium brushes and implantoplasty showed favorable results as single decontamination methods. Meta-analyses indicated a lack of added effect of Er:Yag laser on probing pocket depth (PPD) reduction (n = 2, WMD = -0.24 mm, 95% confidence interval [CI] [-1.10; 0.63], p = .59); while systemic antimicrobials (amoxicillin or azithromycin) showed an added effect on treatment success ([PPD ≤5 mm, no bleeding or suppuration, no progressive bone loss]; n = 2, RR = 1.84, 95% CI [1.17;2.91], p = .008), but not in terms of PPD reduction (n = 2, WMD = 0.93 mm, 95% CI [-0.69; 2.55], p = .26), even if with substantial heterogeneity.
CONCLUSIONS
No single decontamination method demonstrated clear evidence of superiority compared to the others. Systemic antibiotics, but not Er:Yag laser, may provide short-term clinical benefits in terms of treatment success (CRD42020182303).
Topics: Humans; Amoxicillin; Anti-Bacterial Agents; Decontamination; Dental Implants; Peri-Implantitis
PubMed: 36017594
DOI: 10.1111/clr.13992 -
International Journal of Environmental... Aug 2022The use of herbal products in oral cavity has shown an increased popularity and potential benefits due to their additional anti-inflammatory and antioxidant properties... (Review)
Review
BACKGROUND
The use of herbal products in oral cavity has shown an increased popularity and potential benefits due to their additional anti-inflammatory and antioxidant properties as well as the lack of side effects related to their use.
OBJECTIVE
To assess the clinical effectiveness of herbal dental products (mouthwash, dentifrice, gel) when compared to conventional products or placebo in periodontitis patients.
MATERIAL AND METHODS
A systematic review with 22 studies was carried out using MEDLINE/Pubmed, EMBASE and Web of Science databases in addition to hand searches. Randomized and non-randomized clinical trials that evaluated the effect of any herbal dental product and compared it with conventional products or placebo in periodontitis patients and published up to March 2022, were screened.
RESULTS
Herbal products used as adjuncts to scaling and root planing (SRP) or supragingival debridement (SPD) led to superior clinical outcomes than placebo or no adjuncts (8 studies). In conjunction with SRP, these products showed comparable outcomes with chlorhexidine (6 studies) or better (4 studies). When used as adjuncts to SPD, herbal oral care products demonstrated comparable outcomes with chlorhexidine and conventional products (4 studies).
CONCLUSIONS
Within the limitations of this systematic review, herbal oral care products may play a key role in the management of periodontal disease. Further well-designed studies are needed to establish their efficacy.
Topics: Chlorhexidine; Chronic Periodontitis; Humans; Periodontal Diseases; Periodontitis; Root Planing; Treatment Outcome
PubMed: 36011693
DOI: 10.3390/ijerph191610061 -
Medicina Oral, Patologia Oral Y Cirugia... Sep 2022Third molar surgery is frequently associated with postoperative discomfort such as pain, edema and trismus. We aimed to evaluate the current evidence on the efficacy of...
BACKGROUND
Third molar surgery is frequently associated with postoperative discomfort such as pain, edema and trismus. We aimed to evaluate the current evidence on the efficacy of adjunctive corticosteroid therapy in improving patient-centered outcomes following third molar surgery.
MATERIAL AND METHODS
This systematic review assessed and searched PubMed, Google scholar, Scopus, web of science, clinicaltrials.gov and Cochrane central for controlled trials, up to May 2021. The primary outcome measures were patient-centered outcomes such as quality of life following the use of adjunctive corticosteroid therapy in third molar removal. Only randomized controlled trials published in English language were included.
RESULTS
A total of 355 studies were initially identified, and 12 studies were finally included. The results showed that both methylprednisolone and dexamethasone decreased postoperative side effects such as pain, trismus, and edema and consequently were improving patient reported outcomes. In this regard, none of the included papers reported any significant statistical difference between these two drugs (p > 0.05). The analysis regarding the route of administration for the corticosteroids showed that local and intravenous injection of dexamethasone had equivalent effects, and both methods showed better results as compared to simple oral administration.
CONCLUSIONS
Adjunctive use of corticosteroid drugs may improve patient-centered outcomes following third molar surgery. However, there is no significant difference between drugs and routs of administration. Comparing various administration routs, local submucosal injection of dexamethasone seems to be a straightforward, painless and cost-effective adjunctive therapy.
Topics: Adrenal Cortex Hormones; Dexamethasone; Edema; Humans; Molar, Third; Outcome Assessment, Health Care; Pain; Pain, Postoperative; Patient-Centered Care; Quality of Life; Tooth Extraction; Tooth, Impacted; Trismus
PubMed: 35975802
DOI: 10.4317/medoral.25177