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Clinical and Experimental Dental... Feb 2023To summarize the available evidence on the efficacy of power-driven interdental cleaning tools (PDICTs) as an adjunct to tooth brushing compared to tooth brushing alone... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To summarize the available evidence on the efficacy of power-driven interdental cleaning tools (PDICTs) as an adjunct to tooth brushing compared to tooth brushing alone or tooth brushing combined with any other non-PDICT in terms of interproximal plaque and gingival bleeding reduction in gingivitis patients.
MATERIAL AND METHODS
A systematic literature search was performed in three databases until March 20, 2022 with the following main eligibility criteria: (1) randomized controlled clinical trials (RCTs) with (2) at least 28 days of follow-up in (3) gingivitis patients. Interproximal plaque and bleeding values were defined as the primary outcome variables and used for pair-wise meta-analyses.
RESULTS
Sixteen RCTs were identified including data from 1258 participants at the final evaluation. Eight studies each investigated the effect of either a liquid-based or mechanical PDICT; one of these studies tested additionally a combined liquid-based and mechanical PDICT. Tooth brushing combined with a liquid-based PDICT compared to tooth brushing alone did not result in better interproximal plaque values but in significantly lower interproximal bleeding values. Tooth brushing combined with either a liquid-based PDICT or with a mechanical PDICT compared to tooth brushing and flossing achieved comparable interproximal plaque and bleeding values. The majority of studies reporting on patient compliance/preference favored the use of a PDICT, and except for a single study, which was reporting soft tissue trauma in two subjects from improper use of a mechanical PDICT, none of the studies reported adverse events.
CONCLUSIONS
Daily use of PDICT as an adjunct to tooth brushing significantly reduces interproximal bleeding. This effect appears comparable to that of flossing, while PDICT may achieve higher patient acceptance/compliance.
Topics: Humans; Dental Devices, Home Care; Toothbrushing; Gingivitis; Dental Plaque; Gingiva
PubMed: 36562267
DOI: 10.1002/cre2.691 -
Children (Basel, Switzerland) Nov 2022Evidence on the potential adverse effects of surgically accelerated orthodontic techniques is scarce. The aim of this review was to evaluate the available scientific... (Review)
Review
Evidence on the potential adverse effects of surgically accelerated orthodontic techniques is scarce. The aim of this review was to evaluate the available scientific evidence regarding the adverse effects on periodontium, tooth vitality, and root resorption, associated with these surgical procedures in children, adolescents, and adults. The reporting of this review was based on the PRISMA2020 guidelines. Seven databases and three registers were searched for randomized clinical trials (RCTs) and controlled clinical trials (CCTs) published up to 22 June 2022. Hand searching of the reference lists of the included studies was also performed. The quality of the evidence was assessed with the Cochrane risk of bias and ROBINS-I tools. A total of 887 records were initially screened. Finally, 33 RCTs (713 patients), six CCTs (103 patients), and six ongoing protocols were eligible for this systematic review. The current review indicated that there are no significant adverse effects of surgically accelerated orthodontic techniques on periodontium, root length, or tooth vitality. High-quality clinical trials with less risk of bias should be conducted to allow reliable conclusions regarding the adverse effects of the surgical procedures associated with the acceleration of orthodontic treatment on children, adolescents, and adults.
PubMed: 36553279
DOI: 10.3390/children9121835 -
Cureus Nov 2022Periodontal disease is a chronic, complex, and infectious condition that affects the periodontium. Its progressive form can be identified by the loss and destruction of... (Review)
Review
Comparing the Effectiveness of Ultrasonic Instruments Over Manual Instruments for Scaling and Root Planing in Patients With Chronic Periodontitis: A Systematic Review and Meta-Analysis.
Periodontal disease is a chronic, complex, and infectious condition that affects the periodontium. Its progressive form can be identified by the loss and destruction of the periodontal ligament and the alveolar bone, respectively. Periodontal disease, one of the most prevalent oral cavity diseases, is responsible for tooth loss. Scaling and root planing (SCRP) is a standard, non-invasive periodontal therapy for treating patients with periodontitis. However, there have also been connections to disputed results. According to reports, SCRP alone is ineffective in removing pathogenic microorganisms and their by-products from periodontal pockets. In light of this, our current study aims to determine if using manual or ultrasonic instruments for SCRP in patients with a clinical diagnosis of chronic periodontitis is preferable. This systematic evaluation compares the effectiveness of manual and ultrasonic devices for SCRP, a line of therapy for individuals with a clinical diagnosis of chronic periodontitis. The databases searched were Prospero, PubMed, MEDLINE, CENTRAL, ClinicalTrials.gov, and Cochrane Library, which exclusively included English-language papers. The articles were also manually searched for any information missed during the search process.
PubMed: 36532917
DOI: 10.7759/cureus.31463 -
The Cochrane Database of Systematic... Dec 2022Root canal treatment (RoCT), or endodontic treatment, is a common procedure in dentistry. The main indications for RoCT are irreversible pulpitis and necrosis of the... (Review)
Review
BACKGROUND
Root canal treatment (RoCT), or endodontic treatment, is a common procedure in dentistry. The main indications for RoCT are irreversible pulpitis and necrosis of the dental pulp caused by carious processes, coronal crack or fracture, or dental trauma. Successful RoCT is characterised by an absence of symptoms (i.e. pain) and clinical signs (i.e. swelling and sinus tract) in teeth without radiographic evidence of periodontal involvement (i.e. normal periodontal ligament). The success of RoCT depends on a number of variables related to the preoperative condition of the tooth, as well as the endodontic procedures. RoCT can be carried out with a single-visit approach, which involves root canal system obturation (filling and sealing) directly after instrumentation and irrigation, or with a multiple-visits approach, in which the treatment is completed in two or more sessions and obturation is performed in the last session. This review updates the previous versions published in 2007 and 2016.
OBJECTIVES
To evaluate the benefits and harms of completion of root canal treatment (RoCT) in a single visit compared to RoCT over two or more visits, with or without medication, in people aged over 10 years.
SEARCH METHODS
We used standard, extensive Cochrane search methods. The latest search date was 25 April 2022.
SELECTION CRITERIA
We included randomised controlled trials and quasi-randomised controlled trials in people needing RoCT comparing completion of RoCT in a single visit compared to RoCT over two or more visits. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were 1. tooth extraction and 2. radiological failure after at least one year (i.e. periapical radiolucency). Our secondary outcomes were 3. postoperative and postobturation pain; 4. swelling or flare-up; 5. analgesic use and 6. presence of sinus track or fistula after at least one month. We used GRADE to assess certainty of evidence for each outcome. We excluded five studies that were included in the previous version of the review because they did not meet the current standard of care (i.e. rubber dam isolation and irrigation with sodium hypochlorite).
MAIN RESULTS
We included 47 studies with 5805 participants and 5693 teeth analysed. We judged 10 studies at low risk of bias, 17 at high risk of bias and 20 at unclear risk of bias. Only two studies reported data on tooth extraction. We found no evidence of a difference between treatment in one visit or treatment over multiple visits, but we had very low certainty about the findings (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.09 to 2.50; I = 0%; 2 studies, 402 teeth). We found no evidence of a difference between single-visit and multiple-visit treatment in terms of radiological failure (RR 0.93, 95% CI 0.81 to 1.07; I = 0%; 13 studies, 1505 teeth; moderate-certainty evidence). We found evidence of a higher proportion of participants reporting pain within one week in single-visit groups compared to multiple visit groups (RR 1.55, 95% CI 1.14 to 2.09; I = 18%; 5 studies, 638 teeth; moderate-certainty evidence). We found no evidence of a difference in the proportion of participants reporting pain until 72 hours postobturation (RR 0.97, 95% CI 0.81 to 1.16; I = 70%; 12 studies, 1329 teeth; low-certainty evidence), pain intensity until 72 hours postobturation (mean difference (MD) 0.26, 95% CI -4.76 to 5.29; I = 98%; 12 studies, 1258 teeth; low-certainty evidence) or pain at one week postobturation (RR 1.05, 95% CI 0.67 to 1.67; I = 61%; 9 studies, 1139 teeth; very low-certainty evidence). We found no evidence of a difference in swelling or flare-up incidence (RR 0.56 95% CI 0.16 to 1.92; I = 0%; 6 studies; 605 teeth; very low-certainty evidence), analgesic use (RR 1.25 95% CI 0.75 to 2.09; I = 36%; 6 studies, 540 teeth; very low-certainty evidence) or sinus tract or fistula presence (RR 1.00, 95% CI 0.24 to 4.28; I = 0%; 5 studies, 650 teeth; very low-certainty evidence). Subgroup analysis found no differences between single-visit and multiple-visit RoCT for considered outcomes other than proportion of participants reporting post-treatment pain within one week, which was higher in the single-visit groups for vital teeth (RR 2.16, 95% CI 1.39 to 3.36; I = 0%; 2 studies, 316 teeth), and when instrumentation was mechanical (RR 1.80, 95% CI 1.10 to 2.92; I = 56%; 2 studies, 278 teeth).
AUTHORS' CONCLUSIONS
As in the previous two versions of the review, there is currently no evidence to suggest that one treatment regimen (single-visit or multiple-visit RoCT) is more effective than the other. Neither regimen can prevent pain and other complications in the 12-month postoperative period. There was moderate-certainty evidence of higher proportion of participants reporting pain within one week in single-visit groups compared to multiple-visit groups. In contrast to the results of the last version of the review, there was no difference in analgesic use.
Topics: Humans; Aged; Dentition, Permanent; Root Canal Therapy; Tooth Extraction; Analgesics; Pain
PubMed: 36512807
DOI: 10.1002/14651858.CD005296.pub4 -
Clinical Oral Investigations Jan 2023The aim of this systematic review was to examine the literature on aggressive and chronic periodontitis and orthodontics to clarify the therapy-relevant aspects of... (Review)
Review
OBJECTIVES
The aim of this systematic review was to examine the literature on aggressive and chronic periodontitis and orthodontics to clarify the therapy-relevant aspects of orthodontic treatment with altered biomechanics in periodontally compromised dentition.
MATERIALS AND METHODS
Literature searches were conducted in the electronic databases "PubMed" and "DIMDI" using the keywords "aggressive periodontitis AND ortho*," "aggressive periodontitis AND orthodontics," "chronic periodontitis AND ortho*," and "chronic periodontitis AND orthodontics" for the publication period from January 1990 to July 2022. In addition, a manual search was carried out in the selected trade journals "Community Dental Health," "European Journal of Oral Sciences," and "Parodontologie." Human clinical trials were included, whereas animal experimental studies, case reports, and reviews were generally excluded. The appropriate studies were selected, and the relevant data was tabulated according to different parameters, regarding the study design, the study structure, and the conduct of the study.
RESULTS
A total of 1067 articles were found in the preliminary electronic search. The manual search and review of all related bibliographies resulted in an additional 1591 hits. After the first screening, 43 articles were classified as potentially relevant and reviewed in their original form. After the suitability test, 5 studies with a total of 366 participants were included in the final evaluation. These included one randomized controlled trial and four low-evidence intervention studies. The studies were conducted in two university hospitals and three private practices. All participants underwent scaling and root plaining and periodontal surgery before the orthodontic treatment started. Mean probing pocket depth reduction before and after the interdisciplinary treatment was analyzed in all the included studies; mean difference in clinical attachment level in four of the studies was also included. All participants were enrolled in a continuous recall system. In all studies, orthodontic therapy in periodontally compromised patients improved function and esthetics, resulting in lower probing depths and clinical attachment gains.
CONCLUSIONS
Orthodontic treatment can be used for patients with reduced periodontal support to stabilize clinical findings and improve function and esthetics. The prerequisite for this is a profound knowledge of altered biomechanics and an adapted interdisciplinary treatment approach. Due to the large heterogeneity of the included studies and their limited methodological quality, the results obtained in this review must be considered critically. Further randomized controlled long-term studies with comparable study designs are necessary to obtain reliable and reproducible treatment results.
CLINICAL RELEVANCE
Patients with periodontal impairment can be successfully treated with orthodontics as part of interdisciplinary therapy. Orthodontic treatment has no negative impact on the periodontium; if minimal, controlled forces are used under non-inflammatory conditions.
Topics: Humans; Aggressive Periodontitis; Chronic Periodontitis; Dental Care; Esthetics, Dental; Treatment Outcome
PubMed: 36502508
DOI: 10.1007/s00784-022-04822-1 -
Materials (Basel, Switzerland) Dec 2022The main objective of this systematic review was to compare the apical healing, root maturation and histological characteristics of teeth treated with cell-based versus... (Review)
Review
BACKGROUND
The main objective of this systematic review was to compare the apical healing, root maturation and histological characteristics of teeth treated with cell-based versus cell-free techniques.
METHODS
The methodology of this review was based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search strategy was carried out on PubMed, EMBASE and the Web of Science databases. The last search was done on 1 August 2021. Articles written in languages other than English were excluded. Two researchers independently selected the studies and extracted the data. As no randomized clinical trials were available, animal studies were included.
RESULTS
In total, 26 studies were included in the systematic review: 22 articles only researched the cell-free technique, 3 articles compared the cell-based to the cell-free technique, and 1 article compared the cell-based technique to apexification. In terms of apical healing, qualitative analysis of the data suggested that there seems to be no significant difference between cell-free and cell-based techniques. The results regarding tooth maturation are contradictory. The main difference between the cell-free and the cell-based techniques seems to be the histology of the treated tooth. The cell-free technique seems to result in cementum-like, bone-like or periodontal ligament-like tissue. One study, on the other hand, found that the cell-based technique resulted in regeneration of the whole pulp with an odontoblast layer, connective tissue, blood vessels and neuronal tissue.
CONCLUSIONS
Currently, the number of randomized clinical trials on this topic are very scarce. This is probably due to the limited infrastructure and lack of resources to apply the cell-based technique. Even though both techniques seem to be promising for clinical application, long-term data need to be provided regarding the healing and reparative patterns.
PubMed: 36500098
DOI: 10.3390/ma15238603 -
International Journal of Implant... Dec 2022To assess the dimensional establishment of a bony envelope after alveolar ridge preservation (ARP) with deproteinized bovine bone mineral (DBBM) in order to estimate the... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To assess the dimensional establishment of a bony envelope after alveolar ridge preservation (ARP) with deproteinized bovine bone mineral (DBBM) in order to estimate the surgical feasibility of standard diameter implants placement without any additional augmentation methods.
METHODS
PubMed, Embase and CENTRAL databases were searched for suitable titles and abstracts using PICO elements. Inclusion criteria were as follows: randomized controlled trials (RCTs) comprising at least ten systemically healthy patients; test groups comprised placement of (collagenated) DBBM w/o membrane and control groups of no grafting, respectively. Selected abstracts were checked regarding their suitability, followed by full-text screening and subsequent statistical data analysis. Probabilities and number needed to treat (NNT) for implant placement without any further need of bone graft were calculated.
RESULTS
The initial database search identified 2583 studies. Finally, nine studies with a total of 177 implants placed after ARP with DBBM and 130 implants after SH were included for the quantitative and qualitative evaluation. A mean difference of 1.13 mm in ridge width in favour of ARP with DBBM could be calculated throughout all included studies (95% CI 0.28-1.98, t2 = 1-1063, I2 = 68.0%, p < 0.01). Probabilities for implant placement with 2 mm surrounding bone requiring theoretically no further bone augmentation ranged from 6 to 19% depending on implant diameter (3.25: 19%, RD = 0.19, C = 0.06-0.32, p < 0.01/4.0: 14%, RD = 0.14, C = 0.05-0.23, p < 0.01/5.0: 6%, RD = 0.06, C = 0.00-0.12, p = 0.06).
CONCLUSION
ARP employing DBBM reduces ridge shrinkage on average by 1.13 mm and improves the possibility to place standard diameter implants with up to 2 mm circumferential bone housing; however, no ARP would have been necessary or additional augmentative bone interventions are still required in 4 out of 5 cases.
Topics: Animals; Cattle; Humans; Alveolar Process; Health Status; Dental Implants; Bone Resorption; Alveolar Ridge Augmentation
PubMed: 36477662
DOI: 10.1186/s40729-022-00453-z -
Annals of Anatomy = Anatomischer... Feb 2023This review aimed to investigate the clinical outcomes of autogenous particulated dentin (APD) used for alveolar ridge preservation (ARP), evaluating volume gain,...
PURPOSE
This review aimed to investigate the clinical outcomes of autogenous particulated dentin (APD) used for alveolar ridge preservation (ARP), evaluating volume gain, histologic/histomorphometric data, and associated complications.
MATERIAL AND METHODS
The review followed PRISMA guidelines and was registered in the International Prospective Register of Systematic Reviews (PROSPERO). An automated search was made in four databases (Medline/Pubmed, Scopus, Web of Science, and Cochrane Library) supplemented by a manual search for relevant clinical articles published before March 10th, 2022. The review included human studies of at least four patients in which extraction and subsequent ARP were performed in a single surgery. Both comparative studies and studies that assessed ARP with APD exclusively were admitted. The quality of evidence was assessed with the Cochrane bias assessment tool, the Newcastle-Ottawa Quality Assessment Scale, and the Joanna Briggs Institute Critical Appraisal tool.
RESULTS
Eleven studies fulfilled the inclusion criteria and were included for descriptive analysis, with a total of 215 patients, and 337 alveoli preserved by APD, spontaneous healing (blood clot), or other bone substitutes, obtaining comparatively less vertical and horizontal resorption when APD was used.
CONCLUSIONS
After dental extraction, autogenous dentin was effective in terms of volume maintenance, showing promising results in histologic/histomorphometric analysis, and a low complication rate. Nevertheless, few comparative studies with comparable parameters have been published and so more research providing long-term data is needed to confirm these findings.
Topics: Humans; Alveolar Ridge Augmentation; Bone Transplantation; Bone Substitutes; Minerals; Alveolar Process; Dentin; Tooth Socket; Tooth Extraction
PubMed: 36396018
DOI: 10.1016/j.aanat.2022.152024 -
Journal of Stomatology, Oral and... Feb 2023To summarize published information regarding malignant tumors with metastasis to the oral cavity. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To summarize published information regarding malignant tumors with metastasis to the oral cavity.
MATERIALS AND METHODS
This was a systematic review with meta-analysis. An electronic search of Pubmed, Scopus, and Google Scholar databases from inceptions to February 2022 were performed. Only case reports or case series with histopathological results demonstrating metastasis to the oral cavity were included. The main outcomes included demographics, primary site, metastatic site, clinical manifestations, and patient survival. The quality of primary articles was assessed using the Joanna Briggs Institute - University of Adelaide scorecards for case reports and case series. Descriptive analysis and a Kaplan-Meier survival curve were performed.
RESULTS
273 articles were selected (50 case series and 223 case reports), for a total of 950 cases. The mean age was 57.11 years. Males were more affected (57.5%). The most common primary sites in women and men was breast (29.8%), and lung (24.8%), respectively. In ∼1/3 of the cases, oral metastasis preceded tumor dissemination. Jawbones were more affected (56.7%) than soft tissues (37.9%), with the mandible being the most affected site (45.5%), followed by the gingiva (19.9%). The most common clinical manifestation was a mass or nodule. Most radiographic evidence was radiolucency of the jaw (60.6%). 3-year and 5-year survival rates were 14.2 and 10.7%. In the majority of cases, the primary tumor was the first to be diagnosed, while in 30.4%, metastasis was the first sign of the disseminated disease. This can be implied that the oral metastasis should be included in the differential diagnosis list of the oral diseases.
CONCLUSION
Clinicians should be aware of the possibility of, albeit uncommon, oral metastases. Because the extracted data in this review was relatively generalized, the investigators cannot develop the diagnostic clues of oral metastasis, which require further investigations.
Topics: Male; Humans; Female; Middle Aged; Mouth Neoplasms; Mandible; Gingiva; Diagnosis, Differential
PubMed: 36371023
DOI: 10.1016/j.jormas.2022.11.006 -
International Journal of Environmental... Nov 2022This systematic review aimed to investigate the effectiveness of hyaluronic acid (HA) on the clinical treatment outcomes of patients with gingival recession. A... (Review)
Review
This systematic review aimed to investigate the effectiveness of hyaluronic acid (HA) on the clinical treatment outcomes of patients with gingival recession. A systematic search was performed in PubMed, Cochrane Central Register of Controlled Trials, Embase, Scopus, and Google Scholar for studies up to 15 August 2022. Two reviewers separately selected the papers for eligibility after conducting a thorough search. The study includes randomized controlled clinical trials in which participants were given HA in addition to periodontal treatment surgical procedures. The changes following the treatment protocol were evaluated for complete and mean root coverage as a primary outcome and gingival recession gain as the secondary outcome. Three articles met the eligibility criteria out of 557 titles. In periodontal surgery, HA exhibited better results in complete root coverage and mean root coverage when compared to the control group. Gingival recession reduction, clinical attachment level, and keratinized tissue gain were significantly increased compared to the control groups. However, the comparison presented in the following study might show heterogeneity among the studies and risk of bias in general. Given the scope of this analysis, results suggest that adjunctive treatment with HA gel for root coverage could be clinically beneficial.
Topics: Humans; Gingival Recession; Hyaluronic Acid; Gingiva; Guided Tissue Regeneration, Periodontal; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 36361208
DOI: 10.3390/ijerph192114330