Prevalence of altered passive eruption in orthodontically treated and untreated patients

Background: some authors have reported that after orthodontic treatment (OT), a 'gummy smile' might develop. Nevertheless, there are no studies in the literature that investigate whether OT increases the presence of altered passive eruption (APE). The primary aim of this cross-sectional study is to evaluate the prevalence of APE after OT (OT group) and compare it with patients who never received OT (control group). A secondary aim is to identify which variables are related to APE. Methods: the study population consisted of 190 patients (95 patients each in the control and OT groups), providing 1,140 anterior teeth for the clinical examination. The following clinical parameters were assessed: presence or absence of APE, clinical crown length, and gingival biotype, which was divided into three categories: thin-scalloped, thick-flat, and thick-scalloped. Results: twenty-eight patients (29.5%) were diagnosed with APE in the control group and 40 (42.1%) in the OT group, although this difference was not statistically significant (P = 0.07). Furthermore, 34 (75.6%) patients with thick-flat biotype were diagnosed with APE, whereas 30 (31.3%) and four (8.2%) with thick-scalloped and thin-scalloped biotypes, respectively, had APE. These differences were statistically significant (P <0.001). Conclusions: it was concluded that: 1) the prevalence of APE is higher after OT but not to a statistically significant degree and 2) APE is more common in individuals with a thick-flat gingival biotype

Could dietary restrictions affect periodontal disease? A systematic review

ObjectiveThis review aimed at evaluating the possible benefits that caloric restriction (CR) may provide to periodontal disease progression and response to treatment.Material and methodsElectronic search on Medline, Embase and Cochrane, and manual search were performed to identify pre-clinical and on human studies reporting the consequences of CR on clinical and inflammatory parameters related to periodontitis. Newcastle Ottawa System and SYRCLE scale were used to assess the risk of bias.ResultsFour thousand nine hundred eighty articles were initially screened, and a total of 6 articles were finally included, consisting of 4 animal studies and 2 studies in humans. Due to the limited number of studies and heterogeneity of the data, results were presented in descriptive analyses. All studies showed that, compared to the normal (ad libitum) diet, CR might have the potential to reduce the local and systemic hyper-inflammatory state as well as disease progression in periodontal patients.ConclusionsWithin the existing limitations, this review highlights that CR showed some improvements in the periodontal condition by reducing the local and systemic inflammation related to the periodontitis and by improving clinical parameters. However, the results should be interpreted with caution since robust research such as randomized clinical trials is still missing.Clinical relevanceThis review shows that some dietary/caloric restrictions approaches may have the potential to improve periodontal conditions and, in addition, highlights a need for human studies with a robust methodology in order to draw stronger evidence-based conclusions

Clinical Approach to Patients with Moderate-to-Severe Atopic Dermatitis: A Spanish Delphi Consensus

Despite emerging evidence and advances in the management of atopic dermatitis there a lack of consensus regarding the diagnostic criteria, therapeutic approach, method to assess severity, and patient follow-up for this condition. An expert consensus study was conducted to provide recommendations on the management of patients with moderate-to-severe atopic dermatitis. The study used Delphi-like methodology based on a literature review, a summary of the scientific evidence, and a 2-round survey. The agreement of 60 panellists on 21 statements was evaluated. Consensus was predefined as >= 80% agreement of all respondents. In the first round 6 statements reached consensus. Unanimous consensus was achieved regarding therapeutic goals and patient satisfaction (maintained in the long term and periodic goals reassessment recommended every 3-6 months). In the second round, half of the statements reached consensus, all related to patient follow-up, treatment goals, and atopic comorbidities. The statements that did not reach consensus were related to diagnosis (biomarkers, allergy, and food testing) and starting patients on conventional systemic treatment rather than advanced treatment. The study assessed expert opinion regarding a variety of topics related to the clinical approach to patients with moderate-to-severe atopic dermatitis, in order to provide guidance on the diagnosis and management of patients with atopic dermatitis

Discutindo a educação ambiental no cotidiano escolar: desenvolvimento de projetos na escola formação inicial e continuada de professores

A presente pesquisa buscou discutir como a Educação Ambiental (EA) vem sendo trabalhada, no Ensino Fundamental e como os docentes desta escola compreendem e vem inserindo a EA no cotidiano escolar., em uma escola estadual do município de Tangará da Serra/MT, Brasil. Para tanto, realizou-se entrevistas com os professores que fazem parte de um projeto interdisciplinar de EA na escola pesquisada. Verificou-se que o projeto da escola não vem conseguindo alcançar os objetivos propostos por: desconhecimento do mesmo, pelos professores; formação deficiente dos professores, não entendimento da EA como processo de ensino-aprendizagem, falta de recursos didáticos, planejamento inadequado das atividades. A partir dessa constatação, procurou-se debater a impossibilidade de tratar do tema fora do trabalho interdisciplinar, bem como, e principalmente, a importância de um estudo mais aprofundado de EA, vinculando teoria e prática, tanto na formação docente, como em projetos escolares, a fim de fugir do tradicional vínculo “EA e ecologia, lixo e horta”.Facultad de Humanidades y Ciencias de la Educació

Inhibition of de novo plaque growth by a new 0.03 % chlorhexidine mouth rinse formulation applying a non-brushing model: a randomized, double blind clinical trial

The aim of this study was to investigate the plaque inhibitory effect of a new 0.03 % chlorhexidine digluconate (CHX) and 0.05 % cetylpyridinium chloride (CPC) mouthrinse formulation and to explore patients' experience and side effects after its use.status: publishe

Patient morbidity and root coverage outcomes after the application of a subepithelial connective tissue graft in combination with a coronally advanced flap or via a tunneling technique: a randomized controlled clinical trial

BACKGROUND AND OBJECTIVE: Subepithelial connective tissue grafts (SeCTG) in conjunction with a coronally advanced flap (CAF) or with tunneling technique (TT) are common periodontal procedures with similar indications for the treatment of a denuded root surface; however, it is unclear whether patient discomfort and postoperative morbidity are comparable in both approaches. The aim of this randomized controlled clinical trial was to compare the patient morbidity and root coverage outcomes of a SeCTG used in combination with a CAF or TT. MATERIALS AND METHODS: For this single-center, randomized, clinical trial, patients were randomly assigned to receive SeCTG + CAF (control group) or SeCTG + TT (test group). Postoperative questionnaires at 3 days post intervention were administered to evaluate postoperative discomfort, bleeding, and inability to masticate. Evaluation of patients' perception of pain was performed using a visual analog scale (VAS). Clinical outcomes including percentage of root coverage (RC) and complete root coverage (CRC) were recorded 12 months postoperatively. RESULTS: Fifty patients (25 SeCTG + CAF and 25 SeCTG + TT) completed the study. Healing was uneventful for all test and control patients. The SeCTG + TT group showed a longer chair time (33.6 (3.6) and 23.6 (4.2) min for the SeCTG + TT and the SeCTG + CAF, respectively), as well as more painkiller consumption: 2736 vs. 1536 mg (p < 0.001). At the same time, the SeCTG + CAF group reported less pain or discomfort in all four sections of the questionnaire: pain experienced within the mouth as a whole, pain experienced throughout the day, pain experienced at night, and edema experienced after the surgery (p = 0.002, p = 0.001, p = 0.001, and p = 0001, respectively). Both treatments showed clinical efficacy in terms of root coverage as no differences per group were observed in the percentage of root coverage (87 vs. 85 %, p = 704) or patients with complete root coverage (60 vs. 52 %, p = 0.569). CONCLUSIONS: SeCTG + TT is associated with a greater incidence of pain and discomfort compared to SeCTG + CAF in early postoperative periods, as well as a longer chair time. Both treatments showed similar clinical efficacy in terms of root coverage. CLINICAL RELEVANCE: The results of this study may influence the surgeon's choice on which root coverage procedure should be performed considering the need of more chair time and more painkiller assumption with the tunneling technique

Evaluation of root coverage with and without connective tissue graft for the treatment of single maxillary gingival recession using an image analysis system: a randomized controlled clinical trial

The aim of this prospective randomized clinical study was to evaluate, by means of an image analysis system, the efficacy of two different surgical procedures for the treatment of Miller Class I and II maxillary gingival recession. Patients treated for maxillary gingival recession were recruited and randomly divided into two groups: patients who received a coronally advanced flap with connective tissue graft (CAF + CTG) or CAF alone. Outcome parameters included complete root coverage, recession reduction, and keratinized tissue amount. Twenty-five patients completed the 12-month follow-up period. Patients in the CAF + CTG group showed a better primary outcome- gingival recession at 12 months-than CAF patients (P = .0001). Gingival recession at 12 months had a median of 0.5 (interquartile range [IQR] 0.5 to 0.6) in the CAF + CTG group and a median of 1.0 (IQR 0.9 to 1.1) in the CAF group. CAF + CTG and CAF groups had similar complete root coverage at 6 and 12 months. Recession and keratinized tissue width significantly decreased over time (P < .0001), with no effect of treatment or of treatment over time. Buccal probing depth had similar values over time (P = .28) and in the two groups (P = .52). Buccal clinical attachment level had similar values in the two groups (P = .87); moreover, mesial and distal clinical attachment levels did not show any variation over time (P = .88 and P = .68, respectively). By means of a computerized image analysis system better outcomes in terms of recession reduction after 12 months of follow-up were measured for maxillary gingival recessions treated with CAF and CTG. Adjunctive application of a CTG under a CAF increased the probability of achieving complete root coverage in maxillary Miller Class I and II defects (61.5% versus 83.3%; P = .38). Both treatments were equally effective in providing a consistent reduction of the baseline recession

Clinical Periodontal Response to Anterior All-Ceramic Crowns with Either Chamfer or Feather-edge Subgingival Tooth Preparations: Six-Month Results and Patient Perception

Subgingival margins are often required for biologic, mechanical, or esthetic reasons. Several investigations have demonstrated that their use is associated with adverse periodontal reactions, such as inflammation or recession. The purpose of this prospective randomized clinical study was to determine if two different subgingival margin designs influence the periodontal parameters and patient perception. Deep chamfer and feather-edge preparations were compared on 58 patients with 6 months follow-up. Statistically significant differences were present for bleeding on probing, gingival recession, and patient satisfaction. Feather-edge preparation was associated with increased bleeding on probing and deep chamfer with increased recession; improved patient comfort was registered with chamfer margin design. Subgingival margins are technique sensitive, especially when feather-edge design is selected. This margin design may facilitate soft tissue stability but can expose the patient to an increased risk of gingival inflammation

Influence of vestibular depth on the outcomes of root coverage therapy: A prospective case series study

BackgroundThe purpose of this study was to investigate the influence of vestibular depth (VD) on the outcomes of root coverage therapy.MethodsPatients presenting gingival recession defects (GRD) with a minimum depth of 2 mm underwent root coverage therapy consisting of a coronally advanced flap plus a connective tissue graft (CAF + CTG). Clinical examinations were performed, and intraoral scans were obtained at baseline, 3 and 6 months after surgery to assess changes in probing depth (PD), keratinized tissue width (KTW), recession depth (RD), GRD area, marginal gingival thickness (MGT), and VD. The influence of VD on percentage of root coverage (%RC) and the likelihood of achieving complete root coverage (CRC) were explored.ResultsA total of 20 patients were enrolled, and 44 teeth were treated. RD decreased and MGT increased in all treated sites. At 6 months, mean %RC was 87.47 ± 18.37 and CRC was observed in 61.4% of sites. Mean baseline VD was 7.33 ± 2.67 mm. Mean VD reduction from baseline to 6 months was 1.98 ± 1.27 mm. %RC and CRC were significantly correlated with baseline VD. Each additional 1 mm of baseline VD implied a gain of 6.58% for %RC and increased 2.75 times the probability of achieving CRC. Narrow baseline KTW and mandibular arch location were associated with inferior treatment outcomes.ConclusionLower %RC and likelihood of achieving CRC can be expected after root coverage therapy via CAF + CTG in sites presenting a shallow vestibulum.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/175444/1/jper10961.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/175444/2/jper10961_am.pd

Drug survival of systemic and biological treatments for moderate-to-severe atopic dermatitis in adults: a multicentre retrospective observational study

Drug survival is a real-life reflection of drug per-formance in routine medical practice and measures thepatient’s persistence under a given treatment. Survival of sys-temic treatment of atopic dermatitis (AD) in routine clinicalpractice has been evaluated in previous analyses.1–3Recently,dupilumab, a fully human monoclonal antibody that targetsthe interleukin-4 receptor a, has been approved for the treat-ment of moderate-to-severe AD. Although its efficacy andeffectiveness have been reported in previous clinical trials4andreal-world evidence publications,5,6the drug survival analysesof dupilumab have, to date, been limite