Efficacy and safety of sitagliptin added to metformin and insulin compared with voglibose in patients with newly diagnosed type 2 diabetes

OBJECTIVE: To assess the efficacy and safety of sitagliptin compared with voglibose added to combined metformin and insulin in patients with newly diagnosed type 2 diabetes (T2DM). METHODS: In this 12-week prospective, randomized, parallel trial, 70 newly diagnosed T2DM patients with glycosylated hemoglobin (HbA1c) ≥9% and/or fasting plasma glucose (FPG) ≥11.1 mmol/L were randomized (1:1) to receive sitagliptin 100 mg per day + metformin + insulin glargine or voglibose 0.2 mg three times daily + metformin + insulin glargine. Change in HbA1c at week 12 was the primary endpoint. RESULTS: The mean baseline HbA1c was 11.0% in the patients. The changes in HbA1c from baseline were -6.00% in the sitagliptin group and -3.58% in the voglibose group, and the between-group difference was -2.42% (95% CI -1.91 to -2.93, p=0.02). The differences in FPG and homeostatic model assessment of β-cell function (HOMA-β) and the change in body weight between groups from baseline were -2.95 mmol/L (p=0.04), 43.91 (p=0.01) and -2.23 kg (p=0.01), respectively. One patient (2.9%) in the sitagliptin group and three patients (8.6%) in the voglibose group exhibited hypoglycemia. CONCLUSIONS: Sitagliptin added to combined metformin and insulin therapy showed greater efficacy and good safety regarding hypoglycemia in patients with newly diagnosed T2DM compared with voglibose.

Clinical application of a digital whole-process surgical guide plate for immediate implant placement in the molar area / 口腔疾病防治

Objective@#To evaluate the clinical effect of a digital whole-process surgical guide for immediate implantation in the molar area. @*Methods @#Twenty-six patients with molar extraction plans were accepted for preoperative CBCT and model construction. Computer software was used to design the ideal three-dimensional position of the implant. The control group of 13 patients underwent immediate implantation with a free hand operation, whereas the experimental group of 13 patients underwent preparation and implant insertion under the guidance of a surgical guide. Bone grafting was performed, and a good initial stability was achieved. After 5 to 6 months, osseointegration was achieved, and the final restoration was delivered. After surgery, the accuracy of the three-dimensional position of the implants was measured, and at the 6 month return visit, the modified Plaque Index (mPLI), modified Sulcular Bleeding Index (mSBI) and probing depth (PD) were measured. @*Results @# In the control group and experimental group, the vertical errors at the top of the implants were 1.246 ± 0.072 mm and 0.628 ± 0.046 mm (t = 26.078, P < 0.001), respectively, and the horizontal errors were 1.563 ± 0.086 mm and 0.546 ± 0.056 mm (t = 35.813, P < 0.001), respectively; and the vertical errors at the root of the implants were 1.352 ± 0.042 mm and 0.532 ± 0.030 mm (t = 57.021, P < 0.001), respectively, and the horizontal errors were 1.645 ± 0.076 mm and 0.625 ± 0.072 mm (t = 35.086, P < 0.001), respectively. For the experimental group, the mPLI value was 0.923 ± 0.760, the mSBI value was 0.846 ± 0.689, and the PD value was 3.460 ± 0.713 mm, which were significantly lower than those of the control group. For the control group, the mPLI value was 1.769 ± 0.927 (t = 2.546, P = 0.018), the mSBI value was 1.692 ± 0.947 (t = 22.605, P = 0.016) and the PD value was (4.579 ± 0.475) mm (t = 4.709, P < 0.001). @*Conclusion@#A digital surgical guide plate can increase the precision of immediate implantation and the peri-implant health in the molar area.

Occlusion design of edentulous implant prosthesis / 华西口腔医学杂志

The occlusion design of dental implants is related to the growing popularity of dental implantology. This paper discusses the occlusion design of the edentulous implant prosthesis and the relationships between stress change and the alveolar bone and between the occlusal design and implantation complications. The horizontal relationship of condyle, the design of the canine-guided occlusion, and the similarities and differences between the dental implant and the natural teeth on biteforce response are mentioned.

Application of periodontal microsurgery in the augmentation of attached gingiva around an implant / 华西口腔医学杂志

OBJECTIVE@#This study aimed to evaluate the clinical effect of periodontal microscopic surgery on the augmentation of attached gingiva and determined the clinical principle on how to use minimally invasive surgery to improve the surgery success rate.@*METHODS@#Twenty patients with insufficient attached gingiva around implants were selected. Periodontal microscopic surgery for free gingival graft was performed to increase the width of the attached gingiva around the implants. The survival state of the free gingiva was observed after surgery, and the width of the attached gingiva around the implants was recorded before and after surgery and 1 year after surgery. The shrinkage rate of the free gingival flap 1 year after surgery was analyzed to evaluate the stability of the flap.@*RESULTS@#The flaps of the 20 cases all survived. One year after the operation, the width of the attached gingiva was (3.05±0.44) mm, which increased compared with that of preoperation (2.56±0.31) mm
and decreased compared with that of postoperative day (2.13±0.28) mm. The shrinkage rate of the attached gingiva was 41.22%±5.04%.@*CONCLUSIONS@#The application of microscopic surgery on the augmentation surgery of attached gingiva can increase the success rate and improve the quality and quantity of attached gingiva around implants.

Clinical effects of combined application of Er: YAG laser and guided bone regeneration in treatment of peri-implantitis / 口腔疾病防治

Objective @# To evaluate the therapeutic effects of erbium-doped: yttrium aluminium garnet laser (Er: YAG laser) combined with guided bone regeneration (GBR) in the treatment of peri-implantitis bone defect.@*Methods @#A total of 26 implants in 15 patients with peri-implantitis were selected and divided into experimental group (14 implants) and control group (12 implants) randomly. The experimental group was treated with Er: YAG laser combined with GBR, and the control group was treated with mechanical curettage with GBR. Clinical periodontal index test including plaque index (PI), sulcus bleeding index (SBI), probing depth (PD) and clinical attachment level (CAL) were checked at baseline, 3 months and 6 months. All the above data were statistically analyzed. @*Results @#All of the clinical periodontal index were improved after surgery. SBI, PD and CAL of the experimental group was 0.8 ± 0.2 mm, 5.8 ± 0.8 mm, and 2.3 ± 0.7 mm, while they were 1.1 ± 0.2 mm, 6.2 ± 0.6 mm, and 3.6 ± 0.6 mm in the control group. The experimental group showed better results than the control group (P< 0.05), while PI showed no difference between the 2 groups (P> 0.05). @*Conclusion@#The combined application of Er: YAG laser and GBR in the treatment of bone defect in peri-implantitis has good clinical effects.

Histological observation of leptin receptor in skeletal muscle in obese rats with periodontitis / 口腔疾病防治

Objective@#To invesitgate the protein expression for leptin receptor in skeletal muscle in periodontitis and obese rat models, with the aim of exploring the effect of experimental periodontitis on adipokines receptors in insulin-targeting tissues and underlying mechanisms of skeletal muscle insulin resistance. @*Methods @#Forty natal SD male rats were randomly divided into four groups, respectively: obese rats with periodontitis (OB+ CP group), obese rats without periodontitis (OB group), normal rats with periodontitis (CP group) and normal rats without periodontitis (C group). Obese rat model was established by subcutaneous injection of sodium glutamate. Experimental periodontitis was induced by ligation and inoculation of periodontal pathogens. Immunohistochemical analysis of leptin receptor expression in skeletal muscle of four groups was employed. @*Results@#In the skeletal muscle, the protein for leptin receptor in the C group and CP group were popular and strong positive, and there was no statistically significant difference between the groups (P > 0.05). The protein expressions in the OB + CP group and OB group were decreased. Fewer protein expres⁃ sion was detected in the OB + CP group when compared with OB group (P < 0.05). A synergistic interaction between obesity and periodontitis was evident to the expression for the leptin receptor (P < 0.05).@*Conclusion@#Local infection induced by experimental periodontitis can barely down⁃regulate the protein expression for leptin receptor in the skeletal muscle. However, periodontitis can significantly down⁃regulate the protein expressions with the presence of obesity.