Clinical and radiographic outcomes of implant-supported zirconia fixed dental prostheses with cantilever extension: A proof-of-principle study with a follow-up of at least 1 year.

OBJECTIVES To test the reliability of full zirconia implant-supported fixed dental prostheses with cantilever extension (FDPCs) after at least 1 year of function. MATERIALS AND METHODS Thirty-five patients in need of implant-supported single unit crowns (SUC) and FDPCs in posterior areas were enrolled. After implant placement, patients were rehabilitated with screw-retained full-zirconia FDPCs. Implant survival rate, pocket probing depth (PPD), presence/absence of bleeding on probing (BoP), and presence/absence of mechanical/technical complications were recorded. Mesial and distal radiographic marginal bone levels (mBLs) from baseline (i.e., recall appointment 3-6 months after implant loading [T0]) to the follow-up examination (i.e., latest recall appointment after at least 12 months after T0 [T1]), were calculated. RESULTS Thirty patients with 34 FDPCs (31 SUCs and 3 FDPs) supported by 37 implants were available for analysis after a mean loading time of 2.6 ± 1.5 years (range: 13-87 months). No implants were lost. MBLs and mean PPD values did not change statistically significantly from T0 to T1 from 0.92 mm ± 0.42 to 0.96 mm ± 0.38 (95% CI: -0.07/0.17; p = .418) and from 2.99 mm ± 0.70 to 3.27 mm ± 0.71 (95% CI: -0.11/0.68; p = .25) respectively. Peri-implant mucositis was diagnosed in 22 cases. Screw-loosening and zirconia chipping occurred 1× in 4 patients. CONCLUSION Within the limitations of the present proof-of-principle study, the use of full-zirconia FDPCs in posterior areas seems a valid and safe short-term treatment option

Enamel matrix derivative as adjunctive to non-surgical periodontal therapy: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVES To assess the potential additional benefit of the local application of enamel matrix derivative (EMD) on the clinical outcomes following non-surgical periodontal therapy (NSPT) (steps 1 and 2 periodontal therapy). MATERIALS AND METHODS A systematic literature search was performed in several electronic databases, including Medline/PubMed, Embase, The Cochrane Register of Central Trials (CENTRAL), LILACS, and grey literature. Only randomized controlled clinical trials (RCTs) were eligible for inclusion. Clinical attachment level (CAL) change (primary outcome), probing pocket depth (PPD), and bleeding on probing (BoP) reductions (secondary outcomes) were evaluated. The Cochrane Risk of Bias tool (RoB 2.0) was used to assess the quality of the included trials. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) between test and control sites were estimated using a random-effect model for amount of mean CAL and PPD change. RESULTS Six RCTs were included for the qualitative analysis, while data from 4 studies were used for meta-analysis. Overall analysis of CAL gain (3 studies) and PPD reduction (4 studies) presented WMD of 0.14 mm (p = 0.74; CI 95% - 0.66; 0.94) and 0.46 mm (p = 0.25; CI 95% - 0.33; 1.26) in favor of NSPT + EMD compared to NSPT alone respectively. Statistical heterogeneity was found to be high in both cases (I2 = 79% and 87%, respectively). CONCLUSIONS Within their limitations, the present data indicate that the local application of EMD does not lead to additional clinical benefits after 3 to 12 months when used as an adjunctive to NSPT. However, due to the high heterogeneity among the studies, additional well-designed RCTs are needed to provide further evidence on this clinical indication for the use of EMD. CLINICAL RELEVANCE The adjunctive use of EMD to NSPT does not seem to additionally improve the clinical outcomes obtained with NSPT alone

Adjunctive laser or antimicrobial photodynamic therapy to non-surgical mechanical instrumentation in patients with untreated periodontitis. A systematic review and meta-analysis.

AIM To compare the adjunctive effects of lasers or antimicrobial photodynamic therapy (aPDT) to non-surgical mechanical instrumentation alone in untreated periodontitis patients. MATERIALS AND METHODS Two focused questions were addressed using the Population, Intervention, Comparison and Outcome criteria as follows: in patients with untreated periodontitis, i) does laser application provide adjunctive effects on probing pocket depth (PPD) changes compared with non-surgical instrumentation alone? and ii) does application of aPDT provide adjunctive effects on PPD changes compared with non-surgical instrumentation alone? Both randomized controlled clinical trials (RCTs) and controlled clinical trials (CCTs) were included. Results of the meta-analysis are expressed as weighted mean differences (WMD) and reported according to the PRISMA guidelines. RESULTS Out of 1'202 records, 10 articles for adjunctive laser and 8 for adjunctive aPDT were included. With respect to PPD changes, 1 meta-analysis including 2 articles (total n = 42; split-mouth design) failed to identify a statistically significant difference (WMD = 0.35 mm; 95%CI:-0.04/0.73; p = .08) in favour of adjunctive aPDT (wavelength range 650-700 nm). In terms of adjunctive laser application a high variability of clinical outcomes at 6 months was noted. Two articles included patient-reported outcomes and 10 reported on the presence/absence of harms/adverse effects. CONCLUSIONS Available evidence on adjunctive therapy with lasers and aPDT is limited by (i) the low number of controlled studies and (ii) the heterogeneity of study designs. Patient-reported benefits remain to be demonstrated

Oral health-related quality of life of patients rehabilitated with fixed and removable implant-supported dental prostheses.

Dental implants have become a mainstream treatment approach in daily practice, and because of their high survival rates over time, they have become the preferred treatment option for prosthetic rehabilitation in many situations. Despite the relatively high predictability of implant therapy and high costs to patients, patient perceptions of success and patient-reported outcome measures have become increasingly significant in implant dentistry. Increasing numbers of publications deal with oral health-related quality of life and/or patient-reported outcome measures. The aim of this paper was to provide an overview of the available evidence on oral health-related quality of life of fully and partially dentate patients rehabilitated with fixed and removable implant-supported dental prostheses. A comprehensive electronic search was performed on publications in English up to 2021. A selection of standardized questionnaires and scales used for the evaluation of oral health-related quality of life were analyzed and explained. The analysis encompassed three aspects: a functional evaluation of oral health-related quality of life, an esthetic assessment of oral health-related quality of life, and a cost-related evaluation of oral health-related quality of life for rehabilitation with dental implants. The data demonstrated that the preoperative expectations of patients markedly affected the outcomes perceived by the patients. As expected, reconstructions supported by implants substantially improved the stability of conventional dentures and allowed improved function and patient satisfaction. However, from a patient's perspective, oral health-related quality of life was not significantly greater for dental implants compared with conventional tooth-supported prostheses. The connection of the implants to the prostheses with locators or balls indicated high oral health-related quality of life. The data also suggest that patient expectation is not a good predictor of treatment outcome. In terms of esthetic outcomes, the data clearly indicate that patients' perceptions and clinicians' assessments differed, with those of clinicians yielding higher standards. There were no significant differences found between the esthetic oral health-related quality of life ratings for soft tissue-level implants compared with those for bone-level implants. Comparison of all-ceramic and metal-ceramic restorations showed no significant differences in patients' perceptions in terms of esthetic outcomes. Depending on the choice of outcome measure and financial marginal value, supporting a conventional removable partial denture with implants is cost-effective when the patient is willing to invest more to achieve a higher oral health-related quality of life. In conclusion, the oral health-related quality of life of patients rehabilitated with implant-supported dental prostheses did not show overall superiority over conventional prosthetics. Clinicians' and patients' evaluations, especially of esthetic outcomes, are, in the majority of cases, incongruent. Nevertheless, patient-reported outcomes are important in the evaluation of function, esthetics, and the cost-effectiveness of treatment with implant-supported dental prostheses, and should be taken into consideration in daily practice

Clinical periodontal diagnosis.

Periodontal diseases include pathological conditions elicited by the presence of bacterial biofilms leading to a host response. In the diagnostic process, clinical signs such as bleeding on probing, development of periodontal pockets and gingival recessions, furcation involvement and presence of radiographic bone loss should be assessed prior to periodontal therapy, following active therapy, and during long-term supportive care. In addition, patient-reported outcomes such as increased tooth mobility, migration, and tilting should also be considered. More important to the patient, however, is the fact that assessment of signs of periodontal diseases must be followed by an appropriate treatment plan. Furthermore, it should be realized that clinical and radiographic periodontal diagnosis is based on signs which may not reflect the presence of active disease but rather represent the sequelae of a previous bacterial challenge. Hence, the aim of the present review is to provide a summary of clinical and radiographic diagnostic criteria required to classify patients with periodontal health or disease

Marginal bone level changes around dental implants with one or two adjacent teeth - A clinical and radiographic retrospective study with a follow up of at least 10 years.

AIM To compare mean bone level (mBL) changes around dental implants with one or two adjacent teeth after a function time of ≥10 years. MATERIALS AND METHODS One hundred thirty three periodontally compromised patients (PCPs) with 551 implants enrolled in supportive periodontal care (SPC) were screened. Implants were categorized either into group TIT (tooth-implant-tooth) or into group TIG (tooth-implant-gap). MBL changes from delivery of restoration (i.e., baseline) to follow-up were calculated in millimeters and compared between implants and adjacent teeth. Survival rates and the need for surgical interventions during SPC were recorded. RESULTS Eighty seven patients with 142 implants were re-evaluated after a mean observation time of 14.5 ± 3.5 years. The mBL at mesial implant sites in the TIT group increased -0.07 ± 0.92 mm and decreased in the TIG group 0.52 ± 1.34 mm, respectively (95% CI: 0.04/1.14, p = .037). At distal implant sites, the mBL in the TIT group increased -0.08 ± 0.84 mm and decreased 0.03 ± 0.87 in the TIG group, respectively (95% CI: -0.20/0.42, p = .48). The overall implant loss rate was 3.5% (n = 5; 2 TIT, 3 TIG), without a statistically significant difference between the two groups (95% CI: 0.18/7.07, p = .892). Tooth loss rates (TIT: 12.3%, TIG: 12.3%) were not statistically significantly different (OR = 1.00, p = .989). CONCLUSION High tooth and implant survival rates were observed in PCPs. The presence of one or two adjacent teeth seemed to have no impact on marginal bone level changes

Clinical evaluation of a novel protocol for supportive periodontal care: A randomized controlled clinical trial.

BACKGROUND The aim of this study was to compare the clinical efficacy and the patient perception of subgingival debridement with either guided biofilm management (GBM) or conventional scaling and root planing (SRP) during supportive periodontal care (SPC). METHODS Forty-one patients in SPC were randomly assigned to either treatment with GBM or SRP every 6 months. The primary outcome was the percentage of bleeding on probing (BoP) at 1 year. Moreover, pocket probing depths (PPD), recession, and furcation involvements were also measured. Full-mouth and specific site analyzes were performed at baseline, 6 and 12 months of SPC. Patient comfort was evaluated using a visual analogue scale (VAS) at 12 months. RESULTS At 1 year, mean BoP percentage decreased from 12.2% to 9.0% (p = 0.191) and from 14.7% to 7.9% (p = 0.004) for the GBM and SRP groups, respectively. Furcation involved multirooted teeth but no through-and-through lesions were significantly fewer in the GBM than in the SRP group after 12 months (p = 0.015). The remaining parameters showed slight improvement in both groups without any statistically significant differences between the two groups after 1 year. Pain evaluation as patient reported outcome measures (pain evaluation) was in favor (p = 0.347) of the SRP group, while overall satisfaction was similar for both groups. Treatment time was not statistically significantly different between the two groups (p = 0.188). CONCLUSION In well-maintained SPC patients, SRP protocols resulted in significant clinical improvements in terms of BoP; however, for the other clinical improvements, similar efficacy for both GBM and SRP was observed

ESTUDO FITOQUÍMICO E AVALIAÇÃO DA CITOTOXICIDADE AGUDA FRENTE À ARTEMIA SALINA (LEACH) DE PLANTAS COMERCIALIZADAS EM FEIRA-LIVRE

A utilização de plantas medicinais como recurso terapêutico constitui uma prática historicamente difundida e muito comum. As espécies Morus nigra, Morus alba, Cordia ecalyculata e Anadenanthera macrocarpa, popularmente conhecidas como amoreira-negra, amoreira-branca, folia-magra e angico, respectivamente, são amplamente utilizadas pela população brasileira para diversos fins. O presente estudo objetivou realizar o screening fitoquímico e avaliar a citotoxicidade aguda das referidas espécies. Realizou-se a triagem fitoquímica através de testes qualitativos, utilizando-se extratos aquosos. A citotoxicidade foi avaliada por meio da determinação da DL50 frente à Artemia salina, submetendo-se 10 náuplios a extratos aquosos nas concentrações de 16,3 mg/mL; 8,15 mg/mL; 4,075 mg/mL; 2,0375 mg/mL e 1,0187 mg/mL. O bioensaio foi realizado em triplicata e a mortalidade avaliada após 24 h. A triagem fitoquímica revelou a presença de cumarinas, flavonoides e taninos condensados nas amoreiras e folia-magra, estando presente também nesta última triterpenos/esteroides. No angico, revelou-se a presença de antraquinonas, saponinas, taninos condensados e triterpenos/esteroides. No teste de citotoxicidade, encontrou-se DL50 de 2.170 µg/mL para a amoreira-negra, 2.243 µg/mL para a amoreira-branca, 1.805,9 µg/mL para a folia-magra e de 6.401 µg/mL para o angico. Os extratos foram classificados como atóxicos mediante os critérios estabelecidos por Meyer e colaboradores (1982). Identificou-se a presença de diferentes metabólitos secundários associados à algumas das atividades terapêuticas relatadas na literatura. Sugere-se a investigação do potencial biológico das espécies em questão, bem como, a pesquisa sobre a genotoxicidade e a mutagenicidade de modo a contribuir com o uso racional das plantas investigadas

ESTUDO FITOQUÍMICO E ANÁLISE DAS ATIVIDADES CITOTÓXICA E ANTIBACTERIANA DAS FLORES MASCULINAS DE Carica sp.

O uso plantas medicinais constitui-se em algo rotineiramente praticado por grande parcela da população como forma de tratamento. O gênero Carica sp conhecido popularmente como mamoeiro é uma das plantas utilizadas com finalidade terapêutica. Frente a isso, o presente estudo teve como objetivo identificar os metabólitos secundários e avaliar as atividades citotóxica e antibacteriana das flores masculinas de Carica sp. As flores estudadas foram obtidas em uma feira livre do município de Ji-Paraná, Rondônia.  Para o estudo preparou-se os extratos aquoso e hidrometanólico das flores frescas nas concentrações de 500 mg/mL; 250 mg/mL, 125 mg/mL; 62,5 mg/mL e 31,25 mg/mL. Logo após, se realizou a identificação qualitativa dos fitoquímicos, o teste de letalidade frente aos microcrustáceos Artemia salina para determinação da dose letal 50 (DL50) e a atividade antibacteriana frente às cepas de Shigella sp, Escherichia coli e Staphylococcus aureus. Os resultados demonstraram a presença de flavonoides; cumarinas; saponinas; antraquinonas; triterpenos e alcaloides. Com relação a determinação da citotoxicidade, observou-se 100% de letalidade nas concentrações testadas, o que inviabilizou o cálculo da DL50. As flores analisadas apresentaram atividade antimicrobiana para os três microrganismos estudados somente no extrato hidrometanólico nas concentrações de 250 e 500mg/mL. Conclui-se que as soluções hidrometanólicas das flores do gênero Carica sp apresentaram citotoxicidade seletiva para todas as espécies de bactérias estudadas. No entanto, devido à diversidade de fitoquímicos identificados, se sugere que o potencial biológico continue a ser investigado considerando concentrações e métodos distintos