Is motor-driven insertion of orthodontic miniscrews more advantageous than manual insertion? A micro-CT evaluation of bone miniscrew contact surface area and cortical microcracks in rabbits.

AIM: This in vitro study aimed to evaluate and compare the bone-miniscrew contact surface area (BMC) and the cortical bone microcracks (CM) resulting from manual (hand-driven) and automated (motor-driven) orthodontic miniscrew (OM) insertion methods. METHODS: Thirty-three OM were inserted in the femurs of nine New Zealand rabbits using manual (n = 16) and automated (n = 17) insertions. After euthanizing the rabbits, bone blocks, each including one OM, were sawed. Micro-CT scanning was performed, and data analysis included reconstruction, binarization and quantification of morphometric parameters of BMC and the number and length of CM. Means and standard deviations for complete BMC, complete BMC proportion, cortical BMC, cortical BMC proportion, and length and number of CM were calculated. Mixed model analysis was used to adjust for more than one sample/CM per animal. A paired t-test was used to compare the number of CM between the two groups. RESULTS: Compared to the automated insertion, manually inserted miniscrews had significantly lower complete BMC (7.54 ± 1.80 mm2 vs. 11.99 ± 3.64 mm2), cortical BMC (5.91 ± 1.48 mm2 vs. 8.48 ± 1.90 mm2) and cortical BMC proportion (79.44 ± 5.84% vs. 87.94 ± 3.66%). However, it was not statistically significant in complete BMC proportion (p = .052). The automated insertion also resulted in a significantly lower mean number of CM than the manual method (p = .012). However, the length of the cracks was shorter in the manual group but with no significant difference (p = 0.256). CONCLUSION: Motor-driven OM insertion results in superior BMC and reduction in the number of CM, which may lead to better miniscrew stability.

Association of Periodontitis and Various Genotypes of Human Papillomavirus in Oral Rinse Specimens.

Objectives To evaluate the relationship between the presence of human papillomavirus (HPV) genotypes in oral rinse samples and periodontitis. Materials and methods This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted in 2013-2014. The primary outcome was the periodontal status, categorized as either no periodontitis or mild periodontitis (combined) versus moderate to severe periodontitis (combined). The primary variable of interest was the presence of different HPV types in oral rinse specimens. Several confounders were selected based on previous evidence that demonstrated a potential association between HPV infectivity and periodontal disease. Results The final sample included 3103 participants. HPV genotypes 6, 35, 39, 55, 59, 71, 72, and 73 showed a statistically significant association with at least one of the periodontal statuses (p-value < 0.05). The presence of any HPV genotype was highly significantly associated with periodontal status, with a p-value of <0.001. Multivariable logistic regression analysis revealed statistically significant associations of HPV 6 and HPV 16 with periodontitis, adjusted for age, gender, diabetes, smoking, race, federal poverty level, last dental visit, and education level. Conclusion Our study highlights a potential link between periodontitis and specific HPV genotypes, such as HPV 6 and HPV 16, in oral rinse specimens. This suggests a complex interplay between periodontal disease and oral HPV infections, underscoring the need for further research to address public health concerns and inform preventive and treatment strategies. Clinical relevance Identifying a link between periodontitis and specific HPV genotypes, such as HPV 6 and HPV 16, in oral rinse samples could prompt early screening and tailored treatment approaches. This underscores the importance of oral health promotion and targeted interventions to address both conditions and improve overall patient outcomes.

Is There a Correlation Between Periodontal Disease Symptoms and the COVID-19 Vaccination?

OBJECTIVE: This study aimed to investigate and compare potential associations between different COVID-19 vaccines and periodontal diseases, mainly gingival bleeding and oral malodor (bad breath). MATERIALS AND METHODS: This cross-sectional study used an online questionnaire consisting of 15 questions regarding demographic information, medical history, type of COVID-19 vaccine received, history of COVID-19, and general and periodontal symptoms after vaccination. The survey was voluntary and privately accessed online using SurveyMonkey®. A total of 2000 participants from three regions of Saudi Arabia participated in the study from October 11, 2021, to October 11, 2022. RESULTS: Of the participants, 95.8% received at least one dose of the available COVID-19 vaccine. Oxford-AstraZeneca was the most administered (41.7%). Patients who suffered from chronic diseases or had a history of COVID-19 infection were less likely to be vaccinated (OR= 0.62, 95% CI 0.40-0.97; OR=0.62, 95% CI 0.39-0.99) compared with people with no chronic diseases or who had a history of COVID-19. The odds ratios for gingival bleeding, oral malodor, mobility, and tooth loss indicated no significant differences regarding vaccination status. CONCLUSION: COVID-19 vaccines might not affect periodontal tissue conditions. People should not avoid vaccination due to concerns with oral or general health, as the benefits of vaccination outweigh the potential side effects.

Effect of preoperative chlorhexidine, essential oil, and cetylpyridinium chloride mouthwashes on bacterial contamination during dental implant surgery: A randomized controlled clinical trial.

Background: Although the role of chlorhexidine and other mouthwashes in periodontal therapy has been elucidated, little information is available on their use as routine preoperative mouth rinses before surgery, especially in periodontal procedures such as dental implant surgery. Objective: This study aimed to compare the efficacy of preoperative chlorhexidine, essential oil, and cetylpyridinium chloride mouthwashes in reducing bacterial contamination at the time of implant placement. Materials and Methods: Eligible patients who underwent dental implant surgery were randomly divided into four groups based on the mouthwash used: (1) 0.12 % chlorhexidine, (2) essential oil, (3) cetylpyridinium chloride, and (4) saline (served as the control group). All the patients of each group rinsed preoperatively with 15 mL of the respective mouthwash for 60 s. Saliva samples before (pre) and immediately after rinsing with the mouthwash (post) and after suturing the flap (end) were collected on the day of the implant placement. Real-time quantitative polymerase chain reaction (qPCR) was performed to analyze the samples and quantify the targeted periodontal pathogens using a propidium monoazide (PMA) dye. Results: Forty patients were included in the study. Real-time qPCR demonstrated a significant reduction in the number of pathogens in the saliva samples of the mouthwash groups compared to that of the control group. A statistically significant difference was observed between the groups for the pre-post and pre-end samples (p < 0.001) but not for the post-end samples (p = 0.203). A statistically significant difference was observed between the chlorhexidine, essential oil, and cetylpyridinium chloride mouthwash groups and the saline group (P < 0.001). The bacterial counts significantly differed with and without the use of the PMA dye. Conclusions: Preoperative chlorhexidine, essential oil, and cetylpyridinium chloride mouthwashes can reduce the bacterial load at the time of implant placement, thereby reducing the incidence of implant-related complications.

Burden of Ischemic and Hemorrhagic Stroke Across the US From 1990 to 2019.

Importance: Stroke is a leading cause of death and disability in the US. Accurate and updated measures of stroke burden are needed to guide public health policies. Objective: To present burden estimates of ischemic and hemorrhagic stroke in the US in 2019 and describe trends from 1990 to 2019 by age, sex, and geographic location. Design, Setting, and Participants: An in-depth cross-sectional analysis of the 2019 Global Burden of Disease study was conducted. The setting included the time period of 1990 to 2019 in the US. The study encompassed estimates for various types of strokes, including all strokes, ischemic strokes, intracerebral hemorrhages (ICHs), and subarachnoid hemorrhages (SAHs). The 2019 Global Burden of Disease results were released on October 20, 2020. Exposures: In this study, no particular exposure was specifically targeted. Main Outcomes and Measures: The primary focus of this analysis centered on both overall and age-standardized estimates, stroke incidence, prevalence, mortality, and DALYs per 100 000 individuals. Results: In 2019, the US recorded 7.09 million prevalent strokes (4.07 million women [57.4%]; 3.02 million men [42.6%]), with 5.87 million being ischemic strokes (82.7%). Prevalence also included 0.66 million ICHs and 0.85 million SAHs. Although the absolute numbers of stroke cases, mortality, and DALYs surged from 1990 to 2019, the age-standardized rates either declined or remained steady. Notably, hemorrhagic strokes manifested a substantial increase, especially in mortality, compared with ischemic strokes (incidence of ischemic stroke increased by 13% [95% uncertainty interval (UI), 14.2%-11.9%]; incidence of ICH increased by 39.8% [95% UI, 38.9%-39.7%]; incidence of SAH increased by 50.9% [95% UI, 49.2%-52.6%]). The downturn in stroke mortality plateaued in the recent decade. There was a discernible heterogeneity in stroke burden trends, with older adults (50-74 years) experiencing a decrease in incidence in coastal areas (decreases up to 3.9% in Vermont), in contrast to an uptick observed in younger demographics (15-49 years) in the South and Midwest US (with increases up to 8.4% in Minnesota). Conclusions and Relevance: In this cross-sectional study, the declining age-standardized stroke rates over the past 3 decades suggest progress in managing stroke-related outcomes. However, the increasing absolute burden of stroke, coupled with a notable rise in hemorrhagic stroke, suggests an evolving and substantial public health challenge in the US. Moreover, the significant disparities in stroke burden trends across different age groups and geographic locations underscore the necessity for region- and demography-specific interventions and policies to effectively mitigate the multifaceted and escalating burden of stroke in the country.

Reducing microbial airborne contamination and particulate matter using different oral suctions in dental clinic: A randomized controlled clinical trial.

Aim: This study aimed to assess oral suction devices in declining microbial airborne contamination level and particulate matter. Materials and methods: This open-label randomized clinical trial was conducted in an educational hospital with 50 participants above 18 years of age, who had scheduled an appointment at a dental hygienist clinic for scaling procedure. Particulate matter and microbial airborne contamination levels were taken at the beginning for 15 min and during of scaling procedure. Participants were randomized to five groups: low suction, high & low suction, intraoral suction (IOS), extra-oral suction (EOS) & low suction, and IOS & EOS. Repeated measured ANOVA analysis was carried out using STATA version 13. Results: Participants had aged 34.4 ± 8.1 years and the average simplified oral hygiene index was 3.5 ± 1.2. Microbial airborne contamination level for each intervention group was different to baseline; low suction, intraoral suction, high & low suction, EOS & low suction, and EOS and intraoral suction were 1089 ± 610, 296.3 ± 321.2, 43.8 ± 52.1, 17.3 ± 7.3 and 14.3 ± 3.9, respectively [P value < 0.05]. Particulate matter shows evidence of no significant difference among oral suctions [P value > 0.05]. Conclusion: Low or intraoral suction was not enough to reduce microbial airborne contamination for better infection control, practitioners highly recommended to use combination of suction devices. Clinical relevance: Using extra-oral with intra-oral suction, or extra-oral suction with low section, or high & low suction are potentially better in microbial airborne contamination reduction compared with low or intraoral suction only. Trial registration: Clinicaltrials.gov (NCT05848245) on April 14, 2023.

Promoting Arabic Sign Language Skills Among Dental Students.

Purpose: While the services available to deaf people in the Middle East have yet to be documented, they need improvement in several countries. The aim of this article was to reduce miscommunication between dentists and deaf patients through the introduction of an optional sign language course for pre-doctoral students and faculty of dentistry at King Abdulaziz University (KAUFD). Patients and Methods: All fourth-year pre-doctoral students were invited to participate in an Arabic sign language course. A survey with 11 multiple choice and 38 true/false questions with an "I don't know" option was distributed, both before and two weeks after the course. This survey was extensively validated and pilot-tested before distribution. Results: The response rate was 141 students (84.9%), 49 of which were males (34.8%) and 92 of which were females (65.2%). The pre-doctoral students had a higher overall knowledge score (mean 22.9±14.8) and sign language skills (11.1±1.7) after the course compared to before the course (9.8±7.1, and 3.7±3.3, respectively) (all P-value <0.001). All the pre-course individual questions had lower scores compared to the post-course questions (P-value <0.05). Conclusion: Deaf people might face difficulties communicating at dental health care clinics, which may be improved by equipping dentistry providers with cultural competency training, like this course.

Hearing Loss Prevalence, Years Lived With Disability, and Hearing Aid Use in the United States From 1990 to 2019: Findings From the Global Burden of Disease Study.

OBJECTIVES: This article describes key data sources and methods used to estimate hearing loss in the United States, in the Global Burden of Disease study. Then, trends in hearing loss are described for 2019, including temporal trends from 1990 to 2019, changing prevalence over age, severity patterns, and utilization of hearing aids. DESIGN: We utilized population-representative surveys from the United States to estimate hearing loss prevalence for the Global Burden of Disease study. A key input data source in modeled estimates are the National Health and Nutrition Examination Surveys (NHANES), years 1988 to 2010. We ran hierarchical severity-specific models to estimate hearing loss prevalence. We then scaled severity-specific models to sum to total hearing impairment prevalence, adjusted estimates for hearing aid coverage, and split estimates by etiology and tinnitus status. We computed years lived with disability (YLDs), which quantifies the amount of health loss associated with a condition depending on severity and creates a common metric to compare the burden of disparate diseases. This was done by multiplying the prevalence of severity-specific hearing loss by corresponding disability weights, with additional weighting for tinnitus comorbidity. RESULTS: An estimated 72.88 million (95% uncertainty interval (UI) 68.53 to 77.30) people in the United States had hearing loss in 2019, accounting for 22.2% (20.9 to 23.6) of the total population. Hearing loss was responsible for 2.24 million (1.56 to 3.11) YLDs (3.6% (2.8 to 4.7) of total US YLDs). Age-standardized prevalence was higher in males (17.7% [16.7 to 18.8]) compared with females (11.9%, [11.2 to 12.5]). While most cases of hearing loss were mild (64.3%, 95% UI 61.0 to 67.6), disability was concentrated in cases that were moderate or more severe. The all-age prevalence of hearing loss in the United States was 28.1% (25.7 to 30.8) higher in 2019 than in 1990, despite stable age-standardized prevalence. An estimated 9.7% (8.6 to 11.0) of individuals with mild to profound hearing loss utilized a hearing aid, while 32.5% (31.9 to 33.2) of individuals with hearing loss experienced tinnitus. Occupational noise exposure was responsible for 11.2% (10.2 to 12.4) of hearing loss YLDs. CONCLUSIONS: Results indicate large burden of hearing loss in the United States, with an estimated 1 in 5 people experiencing this condition. While many cases of hearing loss in the United States were mild, growing prevalence, low usage of hearing aids, and aging populations indicate the rising impact of this condition in future years and the increasing importance of domestic access to hearing healthcare services. Large-scale audiometric surveys such as NHANES are needed to regularly assess hearing loss burden and access to healthcare, improving our understanding of who is impacted by hearing loss and what groups are most amenable to intervention.

Prevalence and severity of dental caries in school children in Saudi Arabia: A nationwide cross-sectional study.

Aim: This nationwide study assessed the prevalence and severity of dental caries in 6-, 12-, and 15-year-old school children across Saudi Arabia. This study examined differences between genders and among regions regarding the mean values of decayed, missing, and filled teeth (dmft/DMFT), the care index (CI), and the significant caries index (SiC index). Materials and methods: Data from 19,870 participants, 10,435 males and 9435 females, were collected using stratified multistage cluster random sampling. The survey team divided Saudi Arabia into five regions (northern, eastern, western, southern, and middle). To represent each respective region, a large city, two random towns (peri-urban), and four random rural areas were selected for surveying. Lastly, the sampling technique was applied by choosing random schools and random classes within the selected schools. Dental caries were assessed using the dmft/DMFT score, CI, and the top 30% and 10% of the sample dmft/DMFT scores (SiC30 and SiC10, respectively). Results: The overall prevalence of caries was 65.6%, with 72.1 occurring in primary teeth and 61.7% in permanent teeth. The percentages of individuals with missing teeth and filled teeth were 9.0% and 20.5%, respectively. The mean dmft was 3.93 ± 3.60, while the mean DMFT was 2.42 ± 2.52; most of the DMFT components were significantly higher in females than males, while the dmft components were higher in males. The northern region had the highest and worst DMFT/dmft ratios of the five regions. The mean SiC30 and SiC10 values were significantly higher than the overall average DMFT/dmft values (P < 0.001). Conclusion: Dental caries remain a public health challenge among school children in Saudi Arabia. The SiC and CI analysis indicated that caries management had a high overall efficacy, but that certain groups of the population may need targeted management in the future.

Validity and Reliability of Polarized vs Non-Polarized Digital Images for Measuring Gingival Melanin Pigmentation.

Aim: This study aimed to compare the validity and reliability of polarized and non-polarized intraoral photography for the measurement of gingival melanin pigmentation. Materials and Methods: A case series study was conducted on ten patients scheduled for gingival depigmentation. A total of 976 polarized and non-polarized image samples were collected, capturing two rows above the gingival margin, for analysis. These images were taken both before and one year after the depigmentation procedure. Three independent evaluators assessed the photographs (an orthodontist, a general dentist, and a layperson). The Dummett Oral Pigmentation Index (DOPI) and Gingival Melanosis Record (GMR) indices were used to measure the level of gingival pigmentation. Results: The study found no significant differences between polarized and non-polarized images taken before and after depigmentation. Both methods of imaging received similar scores from the evaluators. The orthodontist identified more pigmented slides than the layperson and the general dentist. Conclusion: Both polarized and non-polarized photographic methods may be used for assessing gingival pigmentation. However, further research is warranted to confirm this finding and examine additional factors.

Unleashing the power of artificial intelligence for diagnosing and treating infectious diseases: A comprehensive review.

Infectious diseases present a global challenge, requiring accurate diagnosis, effective treatments, and preventive measures. Artificial intelligence (AI) has emerged as a promising tool for analysing complex molecular data and improving the diagnosis, treatment, and prevention of infectious diseases. Computer-aided detection (CAD) using convolutional neural networks (CNN) has gained prominence for diagnosing tuberculosis (TB) and other infectious diseases such as COVID-19, HIV, and viral pneumonia. The review discusses the challenges and limitations associated with AI in this field and explores various machine-learning models and AI-based approaches. Artificial neural networks (ANN), recurrent neural networks (RNN), support vector machines (SVM), multilayer neural networks (MLNN), CNN, long short-term memory (LSTM), and random forests (RF) are among the models discussed. The review emphasizes the potential of AI to enhance the accuracy and efficiency of diagnosis, treatment, and prevention of infectious diseases, highlighting the need for further research and development in this area.

A comparison of the horizontal and vertical bitewing images in detecting approximal caries and interdental bone loss in posterior teeth: A diagnostic accuracy randomized cross over clinical trial.

Background/purpose: Horizontal bitewing radiographs are widely and frequently used in dentistry and are very reliable in diagnosing proximal caries and interproximal alveolar bone level. However, it is challengeable in detecting interproximal root caries, horizontal and/or vertical alveolar bone loss, and furcation involvements. The aim of this article was to assess the accuracy of vertical bitewing images in the diagnosis of caries and alveolar bone level compared to the horizontal bitewing technique. Materials and methods: Each one of the 20 patients had eight bitewing radiographs to get four horizontal bitewing (control) and four vertical bitewing (experimental) images for the same posterior area; a steel wire (3 mm) was used on the sensor plate to help measure the magnification later on. The radiographs were processed digitally and were evaluated for caries by two expert restorative specialists and for bone loss by two experienced periodontists. They were also compared to the "gold standard," which is using of both clinical and radiographic examination for diagnosis. They were blinded to each other during images evaluation. Results: Of the 20-patient sample size, 70% were male and 30% were female, with a mean age of 29.9. The average number of radiographs taken to achieve four standard bitewing radiographs was 5.9 ± 1.7 for vertical bitewings and 5.3 ± 1.3 for horizontal bitewing radiograph. The measurements from the cementoenamel junction (CEJ) to the level of crestal bone didn't show a significant difference between the horizontal and vertical bitewing radiographs. The detection of furcation area in the molar teeth was much higher in the vertical bitewing (100%) compared to the horizontal bitewing (57.5%) (P < 0.0001). Conclusion: The vertical bitewing radiograph has the upper hand over the horizontal bitewing radiograph in the detection of furcation involvement, caries detection, and alveolar bone loss. Therefore, it is highly recommended to use vertical bitewing in caries and patients with periodontal disease rather than the conventional horizontal bitewing.

Clinical, microbiological and immunological short, medium and long-term effects of different strains of probiotics as an adjunct to non-surgical periodontal therapy in patients with periodontitis. Systematic review with meta-analysis.

Introduction/objectives: Probiotics have been proposed as adjuncts to non-surgical periodontal therapy (NSPT), however, the effect of their use remains unclear. The aim of this systematic review and meta-analysis was to analyze the evidence regarding the use of probiotics as an adjunct to NSPT in patients with periodontitis at a clinical, microbiological and immunological level. Data/sources: A comprehensive search to identify clinical studies investigating the use of probiotics as an adjunct to NSPT in patients treated for periodontitis was performed. The data were grouped according to probiotic strain, frequency, form and duration of the probiotic intake. Study selection: A total of 25 articles were included, all articles analysed clinical parameters, 10 included also microbiological findings and only 4 had immunological findings. The difference in probing depth (PD) between the test and the control group was statistically significant in favour of the test group when the probiotics were in the form of lozenges, administered twice a day and when the strain was L. reuteri. In terms of Clinical Attachment Level (CAL) gain the difference was statistically significant in the short and in the medium term but not in the long term. Due to the heterogeneity of the data, it was not possible to compare trough a meta analysis the immunological and the microbiological findings that were therefore analysed only descriptively. Conclusions: The use of probiotics as an adjunct to NSPT in patients with periodontitis appears to provide additional clinical benefits that depend on the duration, the frequency, the form and the strain of probiotic used. Clinical significance: This review not only shows data on the efficacy of probiotics in non-surgical periodontal therapy, but provides important information on their effects over time and which forms of probiotic administration might be most clinically useful.

Attitude, Practice, and Knowledge Regarding Fluoridated Toothpaste, Brushing, and Rinse Usage Among Residents of Jeddah City in Saudi Arabia.

Purpose: To evaluate and compare the attitude, practice, and knowledge of individuals who use fluoridated and non-fluoridated toothpaste in Jeddah city, Saudi Arabia. Methods: A digital questionnaire composed of 43 questions were formulated. The questionnaire was divided into five sections: eligibility questions, demographic data, attitude, practice, and knowledge. Content and face validation were done, and convenience sampling was used. The inclusion criteria were any citizen and resident who lives in Jeddah city, Saudi Arabia. Descriptive statistics, Chi-square, and Fischer's tests were conducted to compare fluoridated and non-fluoridated toothpaste users (α=0.05). Results: A total of 473 completed participants' responses were collected. Attitude: 41.8% of fluoridated toothpaste users reported that it was "very important" to rinse to remove the toothpaste compared to non-fluoridated toothpaste users (58.3%) (P-value<0.001). Healthy teeth were the most important to fluoridated toothpaste users (69.1%) (P <0.001). Practice: 28.6% of non-fluoridated toothpaste users have been using non-fluoridated toothpaste for >1 year, and 35.7% of them <2 years. 73.8% of fluoridated toothpaste users used whitening toothpaste. Significantly higher non-fluoridated toothpaste users (29%) used organic toothpaste (P<0.001). Knowledge: 57% of fluoridated toothpaste users believed that a good diet, tooth brushing, and fluoridated toothpaste are important to prevent caries, and the fluoride would strengthen the teeth (P<0.001). Approximately 60% of non-fluoridated toothpaste users did not know the proper age to start using fluoridated toothpaste (P<0.001). Also, 47.6% of non-fluoridated toothpaste users avoid using fluoride because it is toxic. Conclusion: Significantly higher number of Jeddah residents that used fluoridated toothpaste had a better attitude and knowledge than non-fluoridated toothpaste users. Nonetheless, most residents had similar oral hygiene practices. It is suggested to execute educational campaigns to explain the importance of fluoridated toothpaste to the population. Also, individuals should take caution from the source of obtaining their dental information and consult their dentist.

The Effect of Implant Length and Diameter on Stress Distribution of Tooth-Implant and Implant Supported Fixed Prostheses: An In Vitro Finite Element Analysis Study.

The aim of this study is to evaluate the effectiveness of the implant diameter and length on force dissemination of tooth-implant and implant retained fixed restorations. A finite analysis model was used via a 3D simulation of a unilateral mandibular Kennedy Class I arch. Through thresholding the resultant assembly, a region of interest was selected from the computed tomography (CT) scan. Details of the diameter (D) and length (L) of implant were introduced. Ds used were 3.7, 4.7, and 5.7, while Ls used were 10, 11.5, and 13. The constant was the use of rigid connectors in both designs (implant-implant and implant-tooth fixed partial dentures [FPDs]) and the mesial implant (D 3.7 and L 11.5). Stress in cancellous bone around mesial abutment, which is the second premolar in tooth-implant FPD and mesial implant in the implant-implant FPD, revealed that the stress was significantly lower in tooth-implant FPD when compared with implant-implant FPD (21.1 ± 0.00 vs 46.1 ± 0.00, P < .001). Stress distribution in the bone around any implant depends on several factors such as diameter, length, and tooth-implant vs implant-implant support. The implant diameter was more significant for improved stress distribution than implant length. A moderate increase in the length of the implant consequently reduced stress.

WWOM VII: Effectiveness of systemic pharmacotherapeutic interventions in the management of BMS: A systematic review and meta-analysis.

OBJECTIVES: To determine the effectiveness of systemic pharmacotherapeutic interventions compared to placebo in burning mouth syndrome (BMS) randomized controlled trials (RCTs) based on the core outcome domains recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). METHODS: A systematic literature review of RCTs, concerning systemic pharmacotherapeutic interventions for BMS, published from January 1994 through October 2019, and meta-analysis was performed. RESULTS: Fourteen RCTs (n = 734 participants) were included. Of those, nine were eligible for the quantitative assessment due to the availability/homogeneity of data for at least one of the IMMPACT domains. Pain intensity was the only domain reported in all RCTs. Weighted mean changes in pain intensity, based on visual analogue scale (ΔVAS), were reported in three RCTs at 6 ± 2 weeks and only one RCT at 10+ weeks follow-ups. Quantitative assessment, based on ΔVAS, yielded very low evidence for the effectiveness of alpha-lipoic acid and clonazepam, low evidence for effectiveness of trazodone and melatonin, and moderate evidence for herbal compounds. CONCLUSIONS: Based on the RCTs studied, variable levels of evidence exist that suggest that select pharmacological interventions are associated with improved symptoms. However, the underreporting of IMMPACT domains in BMS RCTs restricts the multidimensional assessment of systemic interventions outcomes. Standardized outcome measures need to be applied to future RCTs to improve understanding of intervention outcomes.

WWOM VII: Effectiveness of topical interventions in the management of burning mouth syndrome: A systematic review.

OBJECTIVES: To assess the effectiveness of topical interventions in the management of burning mouth syndrome (BMS), based on the core outcome domains recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). METHODS: A systematic literature review of RCTs on topical interventions for the management of BMS, published in PubMed, Web of Science, PsycInfo, Cochrane Database/Central, and Google Scholar through May 2021 was performed. RESULTS: Eight RCTs (n = 358 study participants) were included in this study. Due to underreporting of IMMPACT domains, publication bias, high degree of heterogeneity between studies, meta-analysis was not undertaken. Based on changes in visual analogue pain scores (ΔVAS), the most reported outcome, the effectiveness of the topical interventions was demonstrated; however, it is low level of evidence. CONCLUSIONS: High levels of variability (interventions, outcomes, outcome measurement tools, and intervention effects evaluated), heterogeneity, publication bias, and underreporting of IMMPACT domains were observed across the RCTs. This systematic review highlights the need for application of standardized outcome measures to future RCTs. At the present time, there is lack of moderate-strong evidence on short- and long-term outcomes to support or refute the use of any particular topical intervention in managing BMS. Future RCTs with standardized outcome measures are needed.

Incidence of endodontic therapy after complete or partial coverage glass-ceramic restorations with a follow-up time of over 30 years: A prospective clinical study.

STATEMENT OF PROBLEM: Long-term clinical data are lacking on the comparison of the incidence of endodontic therapy in adhesively luted complete and partial coverage glass-ceramic restorations, as well as on the effect of technique and clinical variables. PURPOSE: The purpose of this prospective clinical study was to assess the long-term incidence of teeth requiring endodontic therapy after receiving either complete or partial coverage glass-ceramic restorations. MATERIAL AND METHODS: Participants requiring single anterior complete, posterior complete, or posterior partial (inlay or onlay) coverage restoration, or a combination of these on a vital tooth were recruited from a clinical private practice. Only the participants who chose glass-ceramic partial and complete coverage restorations without the need of endodontic therapy were included in the study. The overall clinical performance of these glass-ceramic restorations was assessed by clinical factors determined at recall. The effect of various clinical parameters (type of restoration, dental arch, tooth position in the dental arch, age and sex of participant, and ceramic thickness) was evaluated by using Kaplan-Meier survival curves to account for attrition bias and other reasons for failure. The statistical significance of differences between parameters was determined by using the log rank test (α=.05). RESULTS: A total of 1800 participants requiring 4511 glass-ceramic anterior and posterior restorations were evaluated. The mean age of the participants at the time of restoration placement was 62 (range 20 to 99 years, 710 men and 1090 women). Of 4511 restorations, 1476 were anterior complete coverage, 2119 posterior complete coverage, and 916 posterior partial coverage. Endodontic therapy after restoration placement was needed for 76 restorations (10 anterior complete, 50 posterior complete, and 16 posterior partial). The total time at risk was 50 436 years providing an estimated need for endodontic therapy risk of 0.15% per year. The estimated 35-year cumulative survival was 97.36%. The majority of endodontic treatments (67%, 52/76) occurred in the first 5 years. The estimated cumulative survival of anterior complete coverage, posterior complete coverage, posterior partial inlay, and posterior partial onlay restorations was 98.89% (n=1476, 10 endodontic treatments), 96.38% (n=2119, 50 endodontic treatments), 96.78% (n=553, 11 endodontic treatments), and 98.53% (n=363, 5 endodontic treatments), respectively. Statistically significant differences occurred between anterior complete coverage, posterior complete coverage, and posterior partial coverage inlay restorations, with a higher incidence in posterior complete coverage and posterior partial inlay restorations (P<.05). First molars had the highest rate of endodontic therapy after restoration in both arches. Age and restoration thickness were significant factors, recording statistically higher number of endodontic treatments in participants >52 years and restorations with all surfaces ≥1 mm (P<.05). Other clinical variables, dental arch and sex of the participants, were not significantly related to endodontic treatments (P>.05). CONCLUSIONS: The clinical performance of 4511 units over 30 years in service was excellent, with the estimated cumulative survival of 97.36%. Posterior complete coverage and posterior partial inlay restorations had a significantly higher need for endodontic therapy than anterior complete coverage restorations. Their overall clinical performance relative to endodontic treatment was excellent with a cumulative survival of 96.38% and 96.78% over 30 years. There was no difference in the endodontic treatment rate between posterior complete and partial coverage restorations. Thickness of the restoration affected the endodontic treatment rate, with ≥1 mm resulting in higher incidence. The age of the participants influenced the endodontic treatment rate, with higher incidence in the >52-year age group. Other confounding clinical variables did not have a significant effect on the endodontic treatment rate.

Assessing knowledge of herbal medicine course for dental students.

BACKGROUND: The aims of this article are to assess dental students' knowledge about herbal medicine usage and the potential benefits and side effects, and to conduct a short course about herbal medicine. METHODS: All fourth-year pre-doctoral students were invited to participate in a herbal medicine course as a test while the sixth-year students were the control group. A survey was tested for validity and reliability. It comprised of 16 multiple choice questions was given before the course and one month after the course. The sum score of knowledge for each participant was calcuated based on the ability to identify the use of herbs in dentistry with high-quality evidence (correct answer) or total answer for periodontal disease and caries. RESULTS: The response rate for completing the study was 112 fourth-year students (73.7%) and 64 sixth-year students (39.0%). More than half of the participants (52.5%) were unsure about the importance of herbal medicine in dentistry. However, the majority also stated that the most common herbs used in dentistry were clove (62.9%), followed by curcuma turmeric (54.7%) and meswak (43.0%). The fourth-year students displayed evidence of a higher overall knowledge score after the course in herbal medicine related to periodontal disease in total and correct answers (mean 4.48 ± 4.13, 3.73 ± 3.31, respectively) compared to before the course (mean 0.84 ± 1.23, 0.74 ± 1.16, respectively) (p-value < 0.001). The post-course periodontal disease total and correct answers were statistically significant between fourth- and sixth-year students. CONCLUSION: Herbal medicine has a potential positive impact on dentistry. However, these effects are not fully investigated and received full attention in academic institute. This short educational program related to medicinal herbs can improve the knowledge of dental students. This will help increase the awareness about the use and potential side effects of herbal medicine in the dental field.

The use of corticosteroids in the lateral sinus augmentation surgical procedure: A systematic review and meta-analysis.

BACKGROUND: The lateral maxillary sinus augmentation (MSA) procedure has good predictability in terms of the success of bone regeneration with a low incidence of postoperative infections, estimated between 2% and 5.6%. Although the use of antibiotics is an established and standardized prophylactic measure for MSA procedures, the addition of corticosteroids still varies among clinician preference and clinical judgment. PURPOSE: The aim of this systematic review was to identify whether the administration of corticosteroids during the MSA surgical procedure affects postoperative symptoms including swelling, pain, and infection rate. MATERIALS AND METHODS: A literature search through PubMed, EMBASE, Ovid MEDLINE, and Web of Science indices, according to PICO criteria, was conducted to identify whether MSA peri-operative use of corticosteroids reduces the incidence of complications and patient morbidity. A single arm meta-analysis was performed due to the lack of randomized controlled trials (RCTs) comparing groups treated with or without peri-operative corticosteroids. The intracluster correlation co-efficient (ICC) and design effect were calculated to adjust for the clustering design. RESULTS: In the 37 studies included, a total of 1599 patients (378 Cort, 1221 No-Cort) were analyzed. Before and after taking account of clustering, there was statistically significant effect of corticosteroids on swelling, pain, wound dehiscence, trismus, and hematoma. The complication rates postoperatively were comparable between the two study groups, however slight differences existed in the incidence of active suppuration (1.7% [95% CI 0.7-3.9] Cort vs. 3.2% [2.2-4.5] No-Cort), wound dehiscence (3.9% [1.3-11.2] Cort vs. 2.1% [1.0-4.1] No-Cort) and trismus (2.7% [0.8-8.4] Cort vs. 1.4% [0.8-2.5] No-Cort). CONCLUSIONS: Although the event rate of the 1-to-2-week postoperative complications did not differ between the two groups, the lack of conclusive data and research comparing peri-operative corticosteroid use makes it impossible to draw definitive conclusions and more evidence and studies designed for this specific purpose are needed.