Dental Caries Occurrence in Inflammatory Bowel Disease Patients: A Systematic Review and Meta-Analysis

Objective: The present review aimed to systematically evaluate the occurrence of caries in patients with inflammatory bowel disease (IBD), either Crohn's disease (CD) or ulcerative colitis (UC), compared to healthy controls. Materials and Methods: MEDLINE (PubMed), Embase, Google Scholar, LILACS, and Cochrane Library electronic databases were screened. Caries experience was measured through the Decayed, Missing, Filled Teeth (DMFT) index. The weighted mean difference (WMD) with 95% confidence interval was calculated between IBD patients and healthy controls. Results: Six studies were selected for the inclusion in the systematic review, 5 of which were also included in the quantitative synthesis of data. The WMD in the DMFT index between IBD and healthy subjects was 3.04 (1.52, 4.56) (p = 0.10). Subgroup analysis showed no difference (p = 0.31) between CD (2.52 [0.54, 4.49]) and UC (4.01 [1.52, 4.56]) subjects. Conclusions: There is a remarkably higher past and present occurrence of dental caries in subjects with IBD than healthy controls. This result should encourage clinicians to include oral health preventive programs in the overall treatment plan of IBD patients

Healthy lifestyles are associated with a better response to periodontal therapy: A prospective cohort study

Aim: To evaluate the association between lifestyle behaviours and clinical periodontal outcomes following Steps 1/2 of periodontal therapy.Methods: A total of 120 subjects with untreated Stage II/III periodontitis participated in this study. At baseline, questionnaires were administered to assess the following lifestyle behaviours: adherence to Mediterranean diet (MD), physical activity (PA) and stress levels, sleep quality, smoking and alcohol use. Participants received Steps 1/2 of periodontal therapy and were re-evaluated after 3 months. A composite outcome of the endpoint of therapy (i.e., no sites with probing pocket depth [PPD] >= 4 mm with bleeding on probing, and no sites with PPD >= 6 mm) was regarded as the primary outcome. Simple and multiple regression analyses were used to evaluate the association between lifestyle behaviours and clinical periodontal outcomes. Disease severity at baseline, body mass index, diabetes, household disposable income and plaque control were considered as confounders.Results: Multiple regression analyses showed significantly lower odds of achieving the endpoint of therapy in subjects with poor sleep quality (odds ratio [OR] = 0.13; 95% confidence interval [CI]: 0.03-0.47; p <.01), smoking (OR = 0.18; 95% CI: 0.06-0.52; p <.05) and alcohol use above the suggested intake (OR = 0.21; 95% CI: 0.07-0.63; p <.01). Subjects with a combination of `unhealthy lifestyles' (low adherence to MD and low PA levels and high levels of stress and poor sleep quality) showed higher proportions of residual PPD >= 6 mm (MD = 1.51; 95% CI: 0.23-2.80; p <.05) and lower odds of achieving the endpoint of therapy (OR = 0.85; 95% CI: 0.33-0.99; p <.05) at re-evaluation.Conclusions: Subjects with unhealthy lifestyle behaviours showed worse clinical outcomes 3 months after Steps 1/2 of periodontal therapy

Alveolos post-extracción: cicatrización espontánea vs implante inmediato

Los cambios dimensionales que acontecen tras la extracción de uno o mas dientes están detenidamente descritos en la literatura científica. Desde los primeros estudios simplemente descriptivos hasta los estudios mas reciente se ha descrito la secuencia de eventos biológicos que llevan a las modificaciones histológicas y dimensionales de la cresta residual. Los cambios dimensionales que acontecen pueden influenciar clínicamente el plan de tratamiento. Entre las opciones plausibles para tratar la zona edentula existe la posibilidad de colocar un implante inmediatamente tras la extracción. Sin embargo existe una evidencia limitada en la literatura sobre las diferencias de cicatrización entre el implante inmediato y la cicatrización espontanea del alveolo, tras la extracción de un diente. Solamente en un estudio publicado por la escuela Sueca (Araujo et al. 2005) ha comparado los acontecimientos biológicos y las alteraciones de la cresta entre el alveolo dejado cicatrizar espontáneamente y la colocación inmediata del implante en la misma hemi-­‐mandíbula. .En ambos grupos el remodelado de la cresta fue muy marcado, y la colocación del implante no fue capaz de contrarrestar este remodelado. Los principales objetivos del presente trabajo de investigación por lo tanto son i) describir los resultados histológicos e histométricos de la comparación entre implante post extracción y cicatrización espontanea de alveolos adyacentes tras un tiempo de 6 semanas de evaluacion (estudio 1); ii) describir la fases de cicatrización temprana de los alveolos tras la extracción de un diente y analizar los cambios dimensionales lineares de las crestas alveolares en sentido vertical y horizontal (estudio 2) y iii) comparar los resultados histométricos e histológicos e los implantes post extracción y de los alveolos adyacentes en las fases temprana de cicatrización. (estudio 3)..

Efficacy of Enamel Derivatives to Improve Keratinized Tissue as Adjunct to Coverage of Gingival Recessions: A Systematic Review and Meta-Analysis

Background: The systematic review was designed to answer the following focused question: Are enamel matrix derivatives able to improve the quantity of keratinized tissue (KT) around natural dentition in patients with recessions defects after their treatment with periodontal plastic procedures? Methods: Only Randomized Clinical Trials (RCT) in English language evaluating root coverage procedures in combination with enamel matrix derivatives (commercially known as Emdogain®—EMD), with at least 10 subjects and a minimum duration of six months, were included. The search was applied to PUBMED and SCOPUS and it consists of a combination of MeSH terms and free text words (from January 2000 to June 2019). Risk of bias in individual studies and across studies was also evaluated. Results: After the full text analysis and the exclusion of further 18 articles, 12 articles were finally included. In total 639 recessions were treated (334 tests and 305 control). The recessions defects were classified according to the classification of Miller (Class I, II, III, IV). Only one trial included Miller Class III recessions (7 in total). Enamel matrix derivatives were applied in conjunction with Coronally Advanced Flap (CAF), Coronally Advanced Flap + Sub Epithelial Connective Tissue Graft (CAF + CTG), Semilunar Flap (SF). For the group CAF vs CAF + EMD the mean difference between the keratinized tissue gain in the two procedures was 0.40 mm (95% Confindence Interval Lower/Upper: 0.014–0.81) (p < 0.058); for the comparison CAF + CTG + EMD vs. CAF + CTG the mean difference between the two groups resulted in −0.06 mm (95% Confindence Interval Lower Upper −0.45 to 0.33) (p = 0.7603). Discussion: Randomized clinical trials included medium-low quality evidence. The application of Enamel Matrix Derivatives to surgical procedures aimed to cover gingival recessions does not add robust clinical benefit to conventional plastic procedure alone

Oroantral Communications: Clinical efficacy of a double-layered technique with/without the palatal connective tissue flap: a superiority, single-center, university-based Randomized Clinical Trial

The aim of this study was to compare the clinical results of combining a pedicle connective palatal flap coupled with the trapezoid buccal flap against the buccal flap alone in the closure of the oroantral fistula. Individuals with oroantral communication were consecutively included and eventually randomly allocated into 2 groups. In the group test, oroantral fistula was treated with the association of a buccal flap with a pedicle palatal connective tissue flap; in group control, a classic buccal sliding flap was performed. Patients’ outcomes were recorded at 48 hours, 1 week, 2 weeks, and 1 month after surgery for assessment of primary (success rate) and secondary endpoints, such as experienced pain, discomfort, and complications. The success rate was 96.6% for the test group and 86.6% for the control group. No significant difference between the 2 groups could be observed regarding discomfort and pain. More pronounced pain was detected in the test group during the early healing period. This surgical procedure was demonstrated to be successful, with a high success rate and low patient discomfort

Efficacy of Behaviour Change Techniques to improve oral hygiene control of individuals undergoing orthodontic therapy. A systematic review

Aim: This study aims to review the available evidence on the efficacy of behaviour change techniques to improve compliance in young orthodontic patients and to compare these with conventional oral hygiene instructions. Methods: The review was conducted according to the PRISMA statement. PICO method was used to define eligibility criteria. Two independent reviewers performed the research, examined electronic databases (MEDLINE, Scopus and CENTRAL) and manually checked relevant journals. Only RCTs with more than 10 participants and 3 months follow-up were included. Data extraction and their qualitative analysis were performed for included studies. Results: Search strategy identified 320 articles. After screening for titles, abstracts and full texts, 10 articles were then selected for qualitative analysis. High methodological heterogeneity was present among studies and therefore no meta-analysis was performed. Low risk of bias was detected for one study only. The most common intervention was “mobile phone communication,” which was investigated in five studies. Motivational interviewing, repeated reinforcements and visual-aided approach were also examined. Conclusion: The interest in remote control of patients compliance appears to be fruitful, nonetheless there is no consensus as to a unique treatment protocol. Every other treatment looks beneficial but higher methodological homogeneity should be sought for in future investigations. © 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Lt

Patients’ illness perception before and after non‐surgical periodontal therapy. A pre‐post quasi‐experimental study

Background: Patient's illness perception, assessed through the Brief-Illness Perception Questionnaire (Brief-IPQ), plays a decisive role in the treatment effectiveness of a wide range of chronic diseases; nonetheless, evidence is still lacking regarding periodontitis. The aim of the present pre-post quasi-experimental study was to evaluate the change in the Brief-IPQ before and after non-surgical periodontal treatment (NST) and to evaluate its ability to foresee the efficacy of NST. Methods: A total of 126 periodontitis participants starting NST were asked to participate in the study. The nine-item Brief-IPQ together with a full periodontal chart were recorded at baseline and at the 3-month follow up (reevaluation) after NST. Pre-post comparisons of psychometric and periodontal variables were carried out through the Wilcoxon signed-rank test (α = 0.05). A predictive model was built to test the ability of the Brief-IPQ items to foresee the efficacy of NST. Results: NST led to a significant reduction in all periodontal parameters (P < 0.001); the proportion of pockets closed was 64.18%. Although the overall sum score of the Brief-IPQ remained fairly stable (P = 0.0673), significant changes occurred for items seven ("understanding") (P < 0.001) and 8 ("emotional response") (P < 0.05). The best model (R2 = 0.068, F = 2.15, P = 0.033) obtained from the multivariate linear regression analysis demonstrated that item five ("identity") (β = 2.340, P = 0.017) and item eight ("emotional response") (β = -2.569, P = 0.008) significantly predict the efficacy of NST (i.e., the proportion of pockets closed at reevaluation). Conclusions: NST significantly ameliorates patient's understanding and emotional burden related to periodontitis. Baseline values of perceived symptoms and emotional response are predictive for the short-term efficacy of NST. © 2021 American Academy of Periodontolog

Early healing of the alveolar process after tooth extraction: An experimental study in the beagle dog

Aim To describe the early healing events in the alveolar socket during the first 8 weeks of spontaneous healing after tooth extraction. Materials and Methods 16 adult beagle dogs were selected and five healing periods were analysed (4 h, 1 week, 2 weeks, 4 weeks, 8 weeks). Mandibular premolars were extracted and each socket corresponding to the mesial root was left to heal undisturbed. In each healing period, three animals were euthanatized, each providing four study sites. Healing was assessed by descriptive histology and by histometric analysis using as landmarks: the vertical distance between buccal and lingual crest (B'L') and the width of buccal and lingual walls at three different levels. Differences between means for each variable for each healing period were compared (ANOVA; p < 0.05). Results B'L' at baseline was 0.45 (0.18) mm and decreased during the healing period to a final value of 0.18 (0.08) mm. The lingual width (Lw) remains almost unchanged while the buccal width (Bw) at 1 (Bw1) and 2 (Bw2) mm was reduced in about 40% of its initial value. Conclusions Minor vertical bone reduction in both the buccal and lingual socket walls were observed. A marked horizontal reduction of the buccal bone wall was observed mostly in its coronal aspect. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Does enamel matrix derivative application provide additional clinical benefits in residual periodontal pockets associated with suprabony defects? A systematic review and meta-analysis of randomized clinical trials

Objective To review the effectiveness of enamel matrix derivative (EMD) in the treatment of periodontal pockets of suprabony defects. Methods Randomized Clinical Trials comparing open flap debridement (OFD) versus EMD in periodontal suprabony defects were identified through electronic and manual search. Screening, data extraction and quality assessment were conducted. The primary outcome measures were tooth survival (TS) and clinical attachment level (CAL) gain. Pocket probing depth (PPD) reduction and recession (REC) increase were secondary outcome measures. Information concerning clinical and radiological bone gain was also collected. Results The search identified 1170 studies, three articles reporting on (99 subjects/358 teeth) met the inclusion criteria and were included. No tooth was lost during follow-up (8-12 months). The adjunctive mean benefit of EMD was: 1.2 mm for CAL gain [confidence interval (CI): (0.9, 1.4), p < 0.00001, I2 = 66%], 1.2 mm for the PPD reduction (CI: [0.8, 1.5], p < 0.0001, I2 = 0%), -0.5 mm for the REC increase (CI: [-0.8, -0.2], p = 0.003, I2 = 0%). Potential risk of bias was identified. Conclusions No differences were noted in TS but EMD application resulted in clinical and radiographic additional benefits compared to OFD alone. Nevertheless, the paucity of data, the risk of methodological and potential publication bias suggests caution in interpreting these results while supporting multicenter studies for this specific application. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.Link_to_subscribed_fulltex