Associated factors and treatment options for sleep bruxism in children: an umbrella review

Data on clinical management options for sleep bruxism in the primary dentition are inconclusive. This umbrella review aimed to synthesize the available evidence from systematic reviews (SRs) on the associated factors and treatment approaches for clinical management of sleep bruxism in children. A search was conducted in the MEDLINE/PubMed, Web of Science, Embase, and OpenGrey databases up to March 2022. SRs published on sleep bruxism in children containing data on associated factors or treatment outcomes were included. The AMSTAR-2 tool was used to assess the methodological quality of SRs. The search identified 444 articles, of which six were included. Sleep conditions, respiratory changes, personality traits, and psychosocial factors were the associated factors commonly identified. Treatments included psychological and pharmacological therapies, occlusal devices, physical therapy, and surgical therapy. All SRs included presented a high risk of bias. Overlapping of the included studies was considered very high. The best evidence available to date for the management of sleep bruxism in children is based on associated factors, with sleep duration and conditions, respiratory changes, as well as personality traits and psychosocial factors being the most important factors commonly reported by studies. However, there is currently insufficient evidence to make recommendations for specific treatment options

Randomized clinical study, double blind, of the defects intra-bony treatment effect with the enamel matrix protein. Results after two years

O objetivo deste trabalho foi comparar os parâmetros clínicos periodontais após tratamento de defeitos infra-ósseos com retalho de espessura total (RET) associado ou não à proteína da matriz do esmalte (PME). Foram selecionados 10 pacientes com saúde geral boa, apresentando periodontite crônica e com um par ou mais de defeitos infra-ósseos (PCS >= 6 mm), totalizando 38 defeitos. Todos os pacientes receberam instruções de higiene bucal, raspagem e alisamento radicular, prévio a cirurgia. Foram divididos em dois grupos: grupo PME recebeu retalho de espessura total associado à proteína da matriz do esmalte; e o grupo RET recebeu apenas retalho de espessura total. Todos os pacientes passaram por sessões de controle e manutenção bucal a cada 3 meses, até o final do experimento. Após 24 meses observamos redução na média da PCS de 4,21 mm (PME) e 3,28 mm (RET),do início ao final do experimento, resultado significativo para ambos os grupos (p = 6 mm), totalizing 38 defects. All the patients received instructions of buccal hygiene, scaling and root planning, previous surgery. They were divided into two groups: group PME received open flap debridement associated to the enamel matrix protein; and the group OFD just received open flap debridement. All the patients passed by control sessions and buccal maintenance every 3 months, until the experiment end. After 24 months, a mean reduction of PPD was 4,21 mm (EMD) and 3,28 mm (OFD), beginning at the end of the experiment, significant result for both groups (p < 0,001), however, EMD showed PPD reduction statistically superior to OFD, at 24 months (p = 0,030). For the relative attachment level (RAL) the mean gain was 5,69 mm (EMD) and 5,24 mm (OFD), being these significant for both groups (p < 0,001) compared the beginning at the end of the experiment, however, there was not significant difference when compared to the means between both groups, at the end of the work (p = 0,59). With regard to PI, it was detected a significant reduction in the two groups along the treatment (p=0,022 to EMD; P=0,005 to OFD), 60% to the group EMD and 80% to the group OFD, without however a statistically significant difference between groups be observed (p=0,46). When observed GI, so much in the EMD as in OFP, it was detected a significant reduction along the experiment (p<0,001), however, there was not significant difference between groups in no experiment moment (p=0,34). RG was larger for EMD than for OFP (p<0,001), for EMD increased 1,02 mm, although of this result, the mean values of GR were not different statistically when compared between groups (p=0,68). There was not significant alteration in the keratinized tissue quantity in EMD (p = 0,23), while in the OFD there was a significant reduction in the keratinized tissue band along time of 0,78 mm (p=0,010), without differentiating significant statistics between groups. The dental mobility did not suffer changes along time in both group (p=0,90). In conclusion, the intra-bony periodontal defects treatment through the enamel matrix protein association with the open flap debridement results in more reduction to the probing clinical depth when compared to the open flap debridement, after 24 months

Treatment of infrabony defects with or without enamel matrix proteins: A 24-month follow-up randomized pilot study

Objective: To evaluate a comparison of open-flap debridement (OFD) with or without the use of enamel matrix proteins (EMP) for the treatment of infrabony defects. Method and Materials: Ten volunteers (38 infrabony defects) were randomized to receive OFD + EMP (test site) and OFD (control site). Clinical outcomes included mean changes in Plaque Index, Gingival Index, probing pocket depth (PPD), relative attachment level (RAL), gingival recession, width of keratinized tissue, and dental mobility at baseline and at 24 months. Results: A significant reduction of 4.21 +/- 0.97 mm was observed in PPD for the OFD + EMP group (from 6.30 +/- 0.99 mm to 2.09 +/- 0.97 mm) and of 3.28 +/- 1.23 mm for the OFD group (from 6.13 +/- 0.88 mm to 2.85 +/- 1.42 mm) (P < .001). The reduction in PPD was statistically significantly greater for OFD + EMP compared to OFD (P = .03). The mean RAL decreased from 13.26 +/- 1.88 mm to 7.57 +/- 2.05 mm for the OFD + EMP group (a gain of 5.69 +/- 1.96 mm) and from 13.37 +/- 1.71 mm to 8.13 +/- 1.34 min (P < .001) for the OFD group (a gain of 5.24 +/- 1.55 mm). Gingival recession was higher it) the OFD + EMP group than in the OFD group. The mean keratinized tissue significantly decreased from 4.41 +/- 1.39 mm to 3.63 +/- 1.54 mm for OFD flap group (P < .01). Conclusion: Both treatment modalities were efficient in improving RAL and PPD. Within groups, there was a significant reduction in keratinized tissue for OFD and a significant postoperative recession for the OFD + EMP group. Infrabony defects treated with OFD + EMP showed significantly more PPD reduction when compared to OFD. (Quintessence Int 2010;41:125-134)State of Sao Paulo Research Foundation (FAPESP)Sao Paulo, SP, Brazil[00/12285-0

Effect of enamel matrix proteins on the treatment of intrabony defects: a split-mouth randomized controlled trial study O efeito da proteína da matriz do esmalte no tratamento de defeitos infra-ósseos: um estudo clínico controlado randomizado boca-dividida

The objective of this split-mouth, double-blind, randomized controlled trial was to compare the clinical effect of treatment of 2- or 3-wall intrabony defects with open flap debridement (OFD) combined or not with enamel matrix proteins (EMP). Thirteen volunteers were selected with one pair of or more intrabony defects and probing pocket depth (PPD) > 5 mm. All individuals received instructions regarding oral hygiene and were submitted to scaling and root planing. Each participant received the two treatment modalities: test sites were treated with OFD and EMP, and control sites received only OFD. After 6 months, a significant reduction was observed in PPD for the EMP group (from 6.42 ± 1.08 mm to 2.67 ± 1.15 mm) and for the OFD group (from 6.08 ± 1.00 mm to 2.00 ± 0.95 mm) (p < 0.0001), but with no significant difference between groups (p = 0.13). A significant gain in relative attachment level (RAL) was observed in both groups (EMP: from 13.42 ± 1.88 mm to 10.75 ± 2.26 mm, p < 0.001; OFD: from 12.42 ± 1.98 mm to 10.58 ± 2.23 mm, p = 0.013), but with no significant difference between groups (p = 0.85). Gingival recession (GR) was higher in the EMP group (from 1.08 ± 1.50 mm to 2.33 ± 1.43 mm; p = 0.0009) than in the OFD group (from 0.66 ± 1.15 mm to 1.16 ± 1.33 mm; p = 0.16), but this difference was not significant (p = 0.06). In conclusion, the results showed that OFD combined with EMP was not able to improve treatment of intrabony defects compared to OFD alone.<br>O objetivo deste estudo clínico controlado, randomizado, duplo-cego, tipo boca-dividida foi comparar o efeito clínico do tratamento de defeitos infra-ósseos de 2 ou 3 paredes com retalho de espessura total (RET) associado ou não com a proteína da matriz do esmalte (PME). Treze voluntários com 1 par ou mais de defeitos infra-ósseos foram selecionados com profundidade clínica de sondagem (PCS) > 5 mm. Todos receberam instruções de higiene bucal, raspagem e alisamento radicular. Cada participante recebeu os dois tipos de tratamento: o lado teste foi tratado com RET e PME, e o lado controle recebeu somente RET. Após 6 meses, foi observada uma redução significante na PCS para o grupo PME (de 6,42 ± 1,08 mm para 2,67 ± 1,15 mm) e para o grupo RET (de 6,08 ± 1,00 mm para 2,00 ± 0,95 mm) (p < 0,0001), mas não houve diferença significante entre os grupos (p = 0,13). Um ganho significante de nível clínico de inserção relativo (NCIR) foi observado em ambos os grupos (PME: de 13,42 ± 1,88 mm para 10,75 ± 2,26 mm, p < 0,001; RET: de 12,42 ± 1,98 mm para 10,58 ± 2,23 mm, p = 0,013), mas não houve diferença significante entre os grupos (p = 0,85). A retração gengival (RG) foi maior para o grupo PME (de 1,08 ± 1,50 mm para 2,33 ± 1,43 mm; p = 0,0009) do que para o grupo RET (de 0,66 ± 1,15 mm para 1,16 ± 1,33 mm; p = 0,16), mas essa diferença não foi significante (p = 0,06). Concluiu-se que o tratamento de defeitos infra-ósseos com RET associado à PME não mostrou resultados melhores que o uso de RET sozinho

Two-year randomized clinical trial of enamel matrix derivative treated infrabony defects: radiographic analysis

Background\ud This split-mouth, double-blind randomized controlled trial evaluated radiographic changes in infrabony defects treated with open flap debridement (OFD) or OFD associated with enamel matrix derivative (EMD) after a 24–month follow-up. The radiographic distance from the CEJ to the bottom of the defect (BD) was considered the primary outcome. CEJ-BC and defect angle were secondary outcomes.\ud \ud \ud Methods\ud Ten patients presenting 2 or more defects were selected. An individualized film holder was used to take standardized radiographs of the 43 defects, at baseline and after 24 months. Images were digitized and used to measure the distances from the cemento-enamel junction (CEJ) to the alveolar crest (AC), CEJ to the bottom of the defect (BD) and infrabony defect angle. Statistical analysis was performed in SPSS for Windows (version 5.2). Paired samples t test was used to compare test and control groups and to evaluate changes within each group. The level of significance was set at α = 0.05%.\ud \ud \ud Results\ud After 24 months, a significant crestal bone loss was observed for EMD (1.01 mm; p = 0.049) but not for OFD (0.14 mm; p = 0.622). However, no differences were detected between groups (p = 0.37). Reduction of the bone defect depth was significant for OFD (0.70 mm; p = 0.005) but not for EMD (0.04 mm; p = 0.86), while no differences were detected between them (p = 0.87). Both EMD (0.69°; p = 0.82) and OFD (5.71°; p = 0.24) showed an improvement in defect angle measurements but no significant differences were observed after 24 months or between the groups (p = 0.35).\ud \ud \ud Conclusion\ud Linear radiographic analysis was not able to demonstrate superiority of EMD treated infrabony defects when compared to ODF after 24 months.\ud \ud \ud Trial registration\ud ClinicalTrials.gov: \ud NCT02195765\ud \ud . Registered 17 July 2014.Fundação de Amparo à Pesquisa do Estado de São Paulo\ud (FAPESP) [00/12285-0

Worldwide Dissemination of <i>bla</i>_KPC Gene by Novel Mobilization Platforms in <i>Pseudomonas aeruginosa</i>: A Systematic Review

The dissemination of blaKPC-harboring Pseudomonas aeruginosa (KPC-Pa) is considered a serious public health problem. This study provides an overview of the epidemiology of these isolates to try to elucidate novel mobilization platforms that could contribute to their worldwide spread. A systematic review in PubMed and EMBASE was performed to find articles published up to June 2022. In addition, a search algorithm using NCBI databases was developed to identify sequences that contain possible mobilization platforms. After that, the sequences were filtered and pair-aligned to describe the blaKPC genetic environment. We found 691 KPC-Pa isolates belonging to 41 different sequence types and recovered from 14 countries. Although the blaKPC gene is still mobilized by the transposon Tn4401, the non-Tn4401 elements (NTEKPC) were the most frequent. Our analysis allowed us to identify 25 different NTEKPC, mainly belonging to the NTEKPC-I, and a new type (proposed as IVa) was also observed. This is the first systematic review that consolidates information about the behavior of the blaKPC acquisition in P. aeruginosa and the genetic platforms implied in its successful worldwide spread. Our results show high NTEKPC prevalence in P. aeruginosa and an accelerated dynamic of unrelated clones. All information collected in this review was used to build an interactive online map