The methodological quality is insufficient in clinical practice guidelines in the context of COVID-19 : systematic review

Objectives The number of published clinical practice guidelines related to COVID-19 has rapidly increased. This study explored if basic methodological standards of guideline development have been met in the published clinical practice guidelines related to COVID-19. Study Design and Setting Rapid systematic review from February 1 until April 27, 2020 using MEDLINE [PubMed], CINAHL [Ebsco], Trip and manual search, including all types of healthcare workers providing any kind of healthcare to any patient population in any setting. Results There were 1342 titles screened and 188 guidelines included. The highest average AGREE II domain score was 89% for scope and purpose, the lowest for rigor of development (25%). Only eight guidelines (4%) were based on a systematic literature search and a structured consensus process by representative experts (classified as the highest methodological quality). The majority (156; 83%) was solely built on an informal expert consensus. A process for regular updates was described in 27 guidelines (14%). Patients were included in the development of only one guideline. Conclusion Despite clear scope, most publications fell short of basic methodological standards of guideline development. Clinicians should use guidelines that include up-to-date information, were informed by stakeholder involvement, and employed rigorous methodologies

Successful Management of Peri-Implantitis around Short and Ultrashort Single-Crown Implants: A Case Series with a 3-Year Follow-Up

Introduction and Aim. In case of peri-implantitis, resective surgery is contraindicated for short and ultrashort implants, limiting the treatment options to regenerative surgery or to implant removal. This retrospective case series presents the clinical and radiographic outcomes of a surgical regenerative procedure to treat peri-implantitis around short and ultrashort implants. Materials and Methods. The study is a retrospective evaluation of patients suffering from peri-implantitis and those who underwent access flap surgery, concomitant chemical and mechanical decontamination of implant surface, and bone grafting using a self-hardening mixture of bone substitutes and biphasic calcium sulfate. No membranes were applied to cover the grafting material, and primary tension-free closure was achieved. The retrospective protocol was reviewed and approved by the Ethics Committee for Clinical Sperimentation (CESC) of Verona and Rovigo, Italy (based in the University of Verona) (Prog. 1863CESC. Date of approval: 2018-07-04). Results. 15 patients (17 implants) have been diagnosed with peri-implantitis after a mean follow-up of 24 months after loading. Implant length was between 5 and 8 mm. 8 patients (10 implants) had a history of periodontitis. At baseline, the mean PD (probing pocket dept) at the deepest site was 8.12 mm, with an average mBI (modified bleeding index) of 2.35 and a mean BD (bone defect depth) of 3.04 mm. At the 3-year follow-up, the CSR was 100%, the mean mBI was 0.88 (average reduction: -1.47), the mean PD was 3.35 mm (mean PD reduction: 4.77 mm), and the mean bone defect was reduced by 1.74 mm, with a mean bone fill of 55%. Conclusions. The results of the present case series suggest that if accurate surface decontamination is achieved, high survival rate and good clinical and radiographic results can be obtained after 3 years. However, only the histological examination could confirm the growth of new bone in direct contact with the implant surface or if the grafted material only fills the space left by the peri-implant defect

Bioceramic materials in pediatric dentistry

Although there has been a substantial decrease in mean caries experience in children, the profession is still confronted with a high-risk group where dental caries with pulpal involvement is present. Besides a proper diagnosis of the pulp condition, the appropriate endodontic treatment must be selected and performed. While for decades, extension for prevention with deep excavation was the preferred treatment method with full pulp extirpation or mortal amputations in the permanent dentition and formocresol or iodoform therapies in primary molars; in recent years, the knowledge on the dentin–pulp complex and biological mechanisms has substantially expanded. It is nowadays recommended to preserve the dental pulp in order to maintain tooth structure and function (Tziafas and Kodonas, J Endod 36(5):781–9, 2010). The same is true for the treatment of deep carious lesions in permanent immature molars and permanent immature incisors after traumatic injury, where full endodontics was the therapy of choice. In all cases, one should decide for repair or regeneration of dental pulp (Simon et al., J Endod 40(4 Suppl):S70–5, 2014). The development of tricalcium silicate–based cements supported this approach of biological dentistry. Within this chapter, pulpotomy in primary molars, deep carious lesions in immature permanent molars, and pulpotomy following trauma in young permanent incisors will be discussed