The interference of age and gender on smile characterization analyzed on six parameters: a clinical-photographic pilot study

Background and Objective: This study aimed to evaluate six smile-esthetic parameters (deviation of the upper dental midline from the facial midline, upper lip curvature, smile line, smile arch, smile width, and shape of the maxillary central incisors), correlating them with age and gender. Materials and methods: Caucasian individuals (N = 114) were grouped by gender (male and female) and age (group I-18 to 30 years old; group II-31 to 50 years old; and group III-over 50 years old). Using a digital camera, extra and intraoral pictures were taken to analyze the variables above-mentioned. The data were statistically evaluated, considering a significance level of p < 0.05. Results: Most participants found deviations of the upper dental midline, straight upper lip curvature, and the medium smile line coincided with the facial midline. The parallel smile arch exposing 9 to 11 upper teeth, the absence of exposure of lower teeth when smiling, and oval upper incisors were prevalent parameters. Regarding gender, significant results were found for the curvature of the upper lip (p = 0.049), the smile arch (p = 0.001), and the shape of the upper central incisors (p = 0.004). For age, the association with the curvature of the upper lip (p = 0.032), the smile line (p = 0.001), the smile arch (p = 0.007), the width of the smile exposing lower teeth (p = 0.002), and the shape of the upper central incisors (0.012) were significant. Conclusions: Within this study's limitations, gender and age affect the anterior teeth shape and upper lip curves; gender and age did not influence the coincidence between dental and facial midlines.info:eu-repo/semantics/publishedVersio

Bisphosphonates and their influence on the implant failure: a systematic review

Objective: The goal of this systematic review was to study the relationship between the use of bisphosphonates (oral or intravenous) and its effect on implant osseointegration. Methods: The focused question was “In patients medicated with bisphosphonates and who underwent surgery to place dental implants, what is the influence of that medication (of different generations) on the failure of dental implants (O)?” Following specific eligibility criteria, four databases (PubMed/MEDLINE, Scopus, Web of Science, DOAJ) were electronically screened to search the articles. Specific MeSH terms were used in combinations with Boolean Operators “AND” and “OR” for the research. In addition, a manual search was done. The data extracted were the (i) author, (ii) year of publication, (iii) country, (iv) research question, (v) study design, (vi) patient information, (vii) the number of patients included, (viii) patient/implant status, (ix) the number of implants evaluated, (x) type of implant, (xi) risk factors, and (xii) findings obtained. Moreover, the following were also registered: the (i) type, generation, duration, and route for BP administrated; (ii) the presence of any systemic condition and drug treatment; (iii) follow-up (months); and (iv) implant failure rate (%). The quality assessment of the included studies was carried out using the Modified Newcastle–Ottawa scale. Results: A total of 491 articles were found (183 in PubMed/MEDLINE, 171 in Scopus, 65 in Web of Science, and 72 articles in DOAJ), and 17 articles were considered for full-text reading. After the exclusion of 3 articles, 14 were included in this systematic review (11 case reports, 2 retrospective, and 1 prospective study). The reasons for the bisphosphonates intaking included osteoporosis, multiple myeloma, breast cancer, knee cancer, and osteogenesis imperfecta. The oral administration involved Alendronato (eight studies), Risedronate (three studies), and Ibandronate (three studies); whereas the intravenous administrations were Zoledronate (seven studies), Clodronato (one study), and Pamidronato (three studies). The duration of use of bisphosphonates at the time of implant placement was diverse; it ranged from no interruption of bisphosphonate intaking up to its discontinuation for 2, 3, or 6 months before surgery, with respective use being resumed 1, 3, or 8 months after surgery. Antibiotic treatment (amoxicillin + clavulanic acid) was performed before the intervention in two cases and after the intervention in three cases. Finally, the percent of implant failure rate when intaking BPs had an average of 49.96%. Conclusions: Within the limitation of this systematic review, it was possible to conclude that a high mean failure rate of implant osseointegration (49.96%) was found, regardless of the generation of bisphosphonates used. Moreover, the failure rate was lower in patients using second generation bisphosphonates (Alendronate and Pamidronate) and was higher with the IV administration compared to the oral administration of bisphosphonates.info:eu-repo/semantics/publishedVersio

Histological assessment of bone regeneration in the maxilla with homologous bone graft: a feasible option for maxillary bone reconstruction

Bone biomaterials have been increasingly used to reconstruct maxillary atrophic ridges. Thus, the aim of this study was to evaluate bone reconstruction in the maxilla using a homologous cortico-cancellous FFB (lyophilized) graft and verify its reliability. Eight individuals were included from 2014 to 2018. The first surgery was performed to install homologous bone blocks in the maxilla. The period of the second intervention varied between 5 months and 15 days to 11 months (≈7.93 months). The biopsies were taken from the central region of the matured graft during the surgery for implant placement. All patients presented clinical and radiographic conditions for the installation of dental implants. There was a 100% of survival rate. The histological assessment showed that the homologous block bone graft was an osteoconductive biomaterial, with connective tissue present, and newly formed bone juxtaposed on its surface. There were bone trabeculae with osteocytes and active osteoblasts with connective tissue in the mineralization process; the remodeling process can be found through the reverse lines. A limited focus of necrosis with fibrosis was detected, with small resorption and areas of inflammatory infiltrate, but without clinical significance. The homologous block bone graft can be considered a feasible option to substitute the autogenous bone graft (gold standard), with predictable clinical and favorable histological results. The patients had a shorter surgical period, low morbidity, and an unlimited amount of biomaterial available at an accessible cost.info:eu-repo/semantics/publishedVersio

Impact of COVID-19 on Portuguese dental students: a cohort study

Introduction: The goal of this study was to assess the impact of COVID-19 on Portuguese dental students on their depression, anxiety, temporomandibular dysfunction, academic degree, and oral behaviors. Methods: The target of this population study was to enroll third-, fourth-, and fifth-year students of the Integrated Master’s degree in Dental Medicine at the Universidade Católica Portuguesa—Faculty of Dental Medicine (Viseu, Portugal) in the academic year 2021–2022. Temporomandibular disorders (TMD) symptoms, oral behaviors, anxiety, and depression were assessed using validated questionnaires. The variables under study were (a) age, gender, marital status, academic level, academic degree, medication, and any existing pathologies; (b) questions related to taste changes or thoughts that would indicate (or not) worsening psychological conditions (anxiety and depression). After data collection (Google Forms®), data were transferred to an Excel file and entered into SPSS® software. A chi-square test allowed the independence between ordinal or nominal variables. The Spearman correlation test was used to analyze the relationship between variables in the study (significant if p ≤ 0.05). Results: 98.2% of the students answered the questionnaire. TMD had a prevalence of 35%, and anxiety and depression a prevalence of 29% and 24%, respectively. The results showed that the female gender was the most affected by psychological and temporomandibular disorders. Statistically significant correlations were identified between variables, such as gender and anxiety, TDM, and depression (respectively, p = 0.0001, p = 0.014, and p = 0.026); between TDM and anxiety and depression (respectively, p = 0.001 and p < 0.001); and between performing oral behaviors and TMD, anxiety, and depression (respectively, p = 0.0001, p = 0.0001, and p = 0.006). The variables, such as age and academic degree, did not establish a statistically significant relationship with TMD, oral behaviors, and the two psychological conditions. Conclusions: It was possible to conclude that there was a moderate prevalence of TMD, anxiety, and depression in the period studied. Moreover, a statistically significant relationship was found between TMD, anxiety, and depression with gender and frequency of OBs; however, no significant association was found for TMD, anxiety, and depression with the age of students and with the academic degree.info:eu-repo/semantics/publishedVersio

Mixed-Thickness Tunnel Access (MiTT) through a linear vertical mucosal incision for a minimally invasive approach for root coverage procedures in anterior and posterior sites: technical description and case series with 1-year follow-up

Purpose: The goal of this article was to introduce a new root coverage (RC) technique, the mixed-thickness tunnel access (MiTT) technique, which approaches a full-split design and intends to augment soft tissues coronal to the gingival margin. It was shown step-by-step, and the results were presented in a case series. Methods: Healthy individuals (non-diabetics) and non-smokers with gingival recession (GR) type 1 or 2 (RT1 or RT2) were included. After evaluation, prophylaxis was performed 14 days before the surgical procedure. During the surgical appointment, one or two vertical incision(s) on the mucosa (around 1–2 mm apical to the MGJ), lateral to the papilla base, was/were performed after anesthesia. Initially, there was a partial incision to detach the mucosa of the muscles (split design). It was permitted (but not mandatory) to perform intrasulcular incisions. Through the vertical incision, internally, subperiosteal access from the MGJ toward the gingival margin (coronally) was performed to create a full-thickness tunnel. Then, communication from the vertical incision with the gingival sulcus and the papilla base occurred, keeping the papilla tip intact. A connective tissue graft was harvested and inserted through the linear incision or intrasulcularly. There were interrupted sutures. An adjunctive material may be applied (e.g., Endogain). The root coverage was measured using a periodontal probe and considered fully covered when the gingival margin was 1 mm coronal to the cementum–enamel junction (CEJ). Results: Nine healthy individuals (seven females and two males) aged 19 and 43 were enrolled. They were treated following the MiTT steps. Four cases had a single GR; two patients had two teeth involved; and three others had three or four GR. There were seven cases of RT1 and two RT2. All RT1 cases achieved 100% RC, while the mean RC obtained for RT2 was around 80%. Conclusion: The MiTT technique can be considered a more straightforward approach for minimally invasive surgical techniques, which is a feasible option to treat RC with a high success rate, predictability, and esthetic preservation. Therefore, there is a technical sensitivity to performing the full-split design procedure.info:eu-repo/semantics/publishedVersio

Sinus lift associated with leucocyte‐platelet‐rich fibrin (second generation) for bone gain: a systematic review

The purpose of this systematic review was to analyze sinus lifting procedures and to compare the efficiency of this treatment associated with the second generation of platelet‐rich fibrin related to its effects on bone gain and to clarify the regenerative efficacy in sinus lift procedure, whether alone or as a coadjutant to other bone graft materials. The PICOT question was, “In clinical studies with patients needing a maxillary sinus lift (P), does the use of PRF either alone (I) or in conjunction with other biomaterials (C) improve the clinical outcome associated with bone gain and density (O), with at least three months of follow‐up (T)?” An electronic search was conducted in the MEDLINE (PubMed), Science Direct, and Scopus databases through a search strategy. A total of 443 articles were obtained from the electronic database search. Sixteen articles met all criteria and were included in this review. Within the limitation of this study and interpreting the results carefully, it was suggested that a higher risk for implant failure after a sinus elevation might be seen in patients with residual bone ≤4 mm, and PRF application was effective, suggesting reducing the time needed for new bone formation.info:eu-repo/semantics/publishedVersio

Facial Hemiplegia Treated with Botulinum Toxin: A Case Report

Facial hemiplegia happens when the seventh cranial nerve is inflamed, causing a dysfunction of the facial nerve in specific regions. This case report brings a complex case of facial hemiplegia, a non-temporary lesion caused by a traumatic accident, which had a more conservative approach, treating the patient with botulinum toxin. After explanation of treatment outcomes, the patient favored treatment on a unilateral side with botulinum toxin applied locally to the muscles. It was applied on her left side, in order to change the muscles tonus and improve the esthetic. The patient adhered to immediate and short-term instructions following the procedure, including movement limitation and skin exposure avoidance. At 2 weeks, the patient returned to follow-up, and the result was checked. After around 6-month follow-up, the patient was reassessed, and a new application was done. The patient tried to contract the procerus and corrugator muscles which were treated, and periorbicular region that was corrected. After contracting the frontal muscle, a satisfactory result was also seen in the frontal area. While limited to a single case presentation, botulinum toxin may be an effective short-term tool for treatment of facial hemiplegia to establish an effective esthetic result

Impact of the COVID-19 Pandemic Period on Patients with Head and Neck Carcinoma: A Systematic Review

Introduction: The COVID-19 pandemic has significantly impacted all public life and the global economy. Since its discovery, the disease has spread rapidly, which led to an unprecedented public health crisis and the adoption of extreme measures to limit community and hospital spread. As a result of a confluence of extraordinary circumstances caused by this pandemic, the doctrines of treatment for patients with head and neck carcinoma had to be reanalyzed, guaranteeing the well-being of both patients and health professionals as well as society itself. Objective: The aim of our systematic review was to study the impact of the COVID-19 pandemic period on head and neck cancer patients, the effects on the health care provided and on patient health. Materials and Methods: This systematic review was based on the PRISMA guidelines and PICO strategy, with the focus question, “How has the COVID-19 pandemic period conditioned the treatment of patients with head and neck carcinoma?” Thus, electronic research was carried out on six databases: LILACS, PubMed/MedLine, Web of Science, the Cochrane COVID-19 Study Register, Scielo, and Scopus, aiming to answer the research question by considering the objective and defined criteria. The following information was extracted: author and year of the publication, patients’ age, gender, time until the first appointment, time from the first appointment to the surgery, the period in the hospital, time in intensive care, TNM, general stage of cancer, diagnostic procedures, oncological procedures, reconstructive surgery, and postoperative complications. Results: Initially, 837 articles were found. After removing duplicates, we obtained 471 studies. After screening by title and abstract, 67 articles were selected for full-text reading (k = 92) in order to assess their eligibility. Thus, nine articles were included (k = 1.0). All data and statistical results were obtained and contrasted. The included studies made it possible to reveal distinct impacts felt in different institutions of several countries, not allowing generalizable conclusions to be drawn. However, some of the variables analyzed are worrying, namely, the limitations that occurred in some types of oncological surgeries, as well as the increase in the number of patients admitted with higher TNM classifications and more debilitated general conditions. Conclusion: Within the limitation of this review, the results showed efforts made to prevent the pandemic from affecting the healthcare provided. There were no significant differences in days inside the intensive care unit, postoperative complications, and, in most cases, length of stay in the hospital. There were no differences in the number of patients admitted with a history of recurrence or neoadjuvant treatment. However, some variables raise concerns, such as the increase in patients with more advanced stage and TNM classification and a decrease in certain oncological procedures

Bone tissue regeneration in peri-implantitis: A systematic review of randomized clinical trials

Objectives: The goal of this systematic review was to analyze, in randomized controlled clinical trials (RCTs), regenerative techniques used to treat peri-implantitis (PI). Methods: Three databases (PubMed/Medline, EMBASE, and On-Line Knowledge Library) were accessed, applying the PICO strategy (Population [P], Intervention [I], Comparison [C], and Outcomes [O]), with the following focused questions: (i) “In patients who received regenerative treatments for peri-implantitis (P), is the regenerative surgical treatment (I) clinically effective and predictable compared to non-regenerative (C) to treat PI (O)?”; and (ii) “In patients who received regenerative treatments for peri-implantitis (P), the regenerative approach (I), compared to non-regenerative (C), significantly increase the prognosis and implant survival rate in the mid- and long-term (O)?” The inclusion criteria were RCTs published in English between 2012 and 2022, with at least a one-year follow-up, which applied regenerative techniques to treat peri-implantitis. Cochrane’s collaboration tool for assessing the risk of bias was used. Main results: Nine articles were included with 404 patients (225 females and 179 males; mean age of 60.44 years). One study evaluated patients after 48 months and another after 88 months. The techniques and devices used were: (i) implantoplasty with Er:YAG laser, (ii) blood concentrate (growth factors), and (iii) EMD, with no statistically significant outcome. Two studies considered the use of titanium granules with a significant increase in radiographic bone identification, whereas regenerative techniques with bone graft (autogenous, alloplastic, and xenograft) were the majority chosen, associated or not, with a collagen membrane. Xenograft had better results radiographically when compared to the autogenous bone graft and presented better results for bone level. There was an overall decrease in bleeding on probing, independent of the control or test group, and a reduction in pocket depth in the groups analyzed. Titanium granules, EMD, Er:YAG laser, and CGF had non-significant results; better results were observed when using bone grafts. The RoB showed a low risk in four studies (44.44%), three with moderate (33.33%), and two with high risk (22.23%). Conclusion: Surgical regenerative treatment was a predictable option in the management of PI and in improving the clinical parameters of peri-implant tissues in the short term, mainly when using porous titanium granules, alloplastic bone grafts, and xenografts

Deep Carious Lesions Management with Stepwise, Selective, or Non-Selective Removal in Permanent Dentition: A Systematic Review of Randomized Clinical Trials

Objective: The goal of this systematic study was to investigate the effectiveness of selective, stepwise, and non-selective removal techniques for caries removal in permanent teeth with deep carious lesions. The primary focus was the results found comparing techniques for caries removal to check whether there was pulp exposition; the secondary was the materials used for pulp protection and clinical findings reported within the included studies. Methods: The search was performed in two databases (PubMed/MEDLINE and Web Of Science). The studies included in this systematic review were selected based on eligibility criteria. The inclusion criteria were: (1) randomized controlled trials (RCTs), (2) that compared the total removal of carious tissue with selective removal in permanent teeth with deep carious lesions, (3) with a follow-up period of at least 6 months, and (4) publications in English. Regarding the exclusion criteria, the following were not considered: (1) articles published in other languages, (2) articles that did not compare the different types of total/selective decay removal, and (3) articles published before January 2008. The risk of bias and the quality of the included studies were independently assessed by two reviewers using the RoB 2 tool. Results: 5 out of 105 potentially eligible studies were included. Regarding the teeth included in the study, three articles performed management only on permanent molars, while other studies also performed management on incisors/canines/premolars/molars. Management protocols were divided into nonselective caries removal and partial caries removal (selective/stepwise). The theory of non-selective caries removal was considered an excessive, unnecessarily invasive option and a form of outdated management, and selective removal was preferred. Conclusion: The selective removal technique presented a higher success rate and fewer incidences of pulpal exposure than total removal, after up to 18 months of follow up. Moreover, only one session seemed to be a better management choice compared to two sessions because the cavity re-opening procedure is more prone to pulp exposure and highly depends on patient commitment. Otherwise, at 5 years of follow up, there was no difference between selective removal and total removal in management longevity. In addition, there were also no differences between the success of the materials used for definitive restorations in teeth subjected to any of the techniques evaluated