Additive Manufacturing Titanium Dental Implants Placed in Sinuses Grafted with 70HA:30-TCP: A One-Year Retrospective Study for Evaluation of Survival Rate.

The present short-term retrospective study evaluated the implant survival rate and peri-implant bone loss around additive-manufactured titanium implants placed in sinuses grafted with Plenum Osshp (Plenum Bioengenharia, Jundia, SP, Brazil) (70HA:30ß-TCP) material. A total of 39 implants were inserted after 23 sinus floor elevation procedures in 16 consecutive patients. Prosthetic rehabilitation included fixed partial prostheses (three units), single crowns (eleven units), and fixed full arches (three units). Clinical and radiographic parameters of implant-supported restorations were evaluated after at least one year of occlusal loading. The implant-crown success criteria included the absence of pain, suppuration, and clinical mobility, an average distance between the implant shoulder and the first visible bone contact (DIB) < 1.0 mm from the initial surgery, and the absence of prosthetic complications at the implant-abutment interface. The overall cumulative implant survival rate was 97.43%. No prosthetic complications at the implant-abutment interface were reported. After one year, the mean DIB was 0.23 mm ± 0.14. Within the limits of this retrospective study, it can be concluded that 70 HA:30 ß-TCP allowed stable and reliable bone support to maintain healthy conditions around titanium dental implants produced by additive manufacturing.

Peri-implantitis: Knowledge and attitudes of implantology clinicians regarding the disease management: Peri-implantitis knowledge.

OBJECTIVES: Since peri-implantitis is an increasing and prevalent concern in clinical practice and there is no consensus regarding the best therapeutic protocol, this study evaluated the knowledge and behaviours of dentists working in Implantology regarding implant-related infections modulating factors and therapeutic protocols used in the management of peri-implantitis. METHODS: Cross-sectional study was conducted with 86 Brazilian Implantology clinicians. Data were collected using a structured and online questionnaire evaluating socioeconomic characteristics, education, work/clinical practice, knowledge and attitudes regarding the risk factors and management of peri-implantitis. The reliability of the questionnaire was evaluated by test-retest technique. The questionnaire was developed based on the last consensus on peri-implant diseases (2018) and the current evidence related to implant-related infections. Descriptive, bivariate and logistic regression analyses were conducted adopting a significance level of 5%. RESULTS: In this study, 89.5% of included dentists reported that already treated patients with peri-implantitis. Approximately 80% of dentists use antibiotics and mouth rinses during the treatment, and surgical procedures seem the main choice to treat peri-implantitis (91.8%) by dentists. As a preventive approach, 94.2% of dentists reported that routinely assessed biofilm accumulation in the follow-up visits after implant placement. Logistic regression showed that the self-reported ability to treat peri-implantitis was statistically (p < 0.05) higher among dentists who reported abilities to diagnose the disease and use laser for peri-implantitis treatment. CONCLUSION: Dentists working in Implantology have a good level of knowledge and behaviors in the management of peri-implantitis. However, the lack of consensus regarding the best treatment protocols may reflect dentist's behaviours because different treatment protocols have been used by evaluated clinicians.

Efficacy of a novel three-step decontamination protocol for titanium-based dental implants: An in vitro and in vivo study.

AIM: The aim of the study was to evaluate several mechanical and chemical decontamination methods associated with a newly introduced biofilm matrix disruption strategy for biofilm cleaning and preservation of implant surface features. MATERIALS AND METHODS: Titanium (Ti) discs were obtained by additive manufacturing. Polymicrobial biofilm-covered Ti disc surfaces were decontaminated with mechanical [Ti curette, Teflon curette, Ti brush, water-air jet device, and Er:YAG laser] or chemical [iodopovidone (PVPI) 0.2% to disrupt the extracellular matrix, along with amoxicillin; minocycline; tetracycline; H2 O2 3%; chlorhexidine 0.2%; NaOCl 0.95%; hydrocarbon-oxo-borate-based antiseptic] protocols. The optimal in vitro mechanical/chemical protocol was then tested in combination using an in vivo biofilm model with intra-oral devices. RESULTS: Er:YAG laser treatment displayed optimum surface cleaning by biofilm removal with minimal deleterious damage to the surface, smaller Ti release, good corrosion stability, and improved fibroblast readhesion. NaOCl 0.95% was the most promising agent to reduce in vitro and in vivo biofilms and was even more effective when associated with PVPI 0.2% as a pre-treatment to disrupt the biofilm matrix. The combination of Er:YAG laser followed by PVPI 0.2% plus NaOCl 0.95% promoted efficient decontamination of rough Ti surfaces by disrupting the biofilm matrix and killing remnants of in vivo biofilms formed in the mouth (the only protocol to lead to ~99% biofilm eradication). CONCLUSION: Er:YAG laser + PVPI 0.2% + NaOCl 0.95% can be a reliable decontamination protocol for Ti surfaces, eliminating microbial biofilms without damaging the implant surface.

In-vitro polymicrobial oral biofilm model represents clinical microbial profile and disease progression during implant-related infections.

AIM: Clinically relevant in-vitro biofilm models are essential and valuable tools for mechanistically dissecting the etiopathogenesis of infectious diseases and test new antimicrobial therapies. Thus, the aim of this study was to develop and test a clinically relevant in-vitro oral polymicrobial biofilm model that mimics implant-related infections in terms of microbial profile. METHODS AND RESULTS: For this purpose, 24-well plate system was used to model oral biofilms, using three different microbial inoculums to grow in-vitro biofilms: (1) human saliva from periodontally healthy patients; (2) saliva as in inoculum 1 + Porphyromonas gingivalis strain; and (3) supra and subgingival biofilm collected from peri-implant sites of patients diagnosed with peri-implantitis. Biofilms were grown to represent the dynamic transition from an aerobic to anaerobic community profile. Subsequently, biofilms were collected after each phase and evaluated for microbiological composition, microbial counts, biofilm biomass, structure, and susceptibility to chlorhexidine (CHX). Results showed higher live cell count (P < .05) for biofilms developed from patients' biofilm inoculum, but biomass volume, dry weight, and microbiological composition were similar among groups (P > .05). Interestingly, according to the checkerboard DNA-DNA hybridization results, the biofilm developed from stimulated human saliva exhibited a microbial composition more similar to the clinical subgingival biofilm of patients with peri-implantitis, with proportions of the main pathogens closer to those found in the disease. In addition, biofilm developed using saliva as inoculum was shown to be susceptible to CHX with significant reduction in bacteria compared with biofilms without exposure to CHX (P < .05). CONCLUSION: The findings suggested that the in-vitro polymicrobial biofilm developed from human saliva as inoculum is a suitable model and clinically relevant tool for mimicking the microbial composition of implant-related infections.

Oral microbial colonization on titanium and polyetheretherketone dental implant healing abutments: An in vitro and in vivo study.

STATEMENT OF PROBLEM: Although polyetheretherketone (PEEK) implant healing abutments have become popular because of their esthetic, mechanical, and chemical properties, studies analyzing oral polymicrobial adhesion to PEEK abutments are lacking. PURPOSE: The purpose of this in vitro and in vivo study was to evaluate oral microbial adhesion and colonization on titanium (Ti) and PEEK healing abutments. MATERIAL AND METHODS: Ti (N=35) and PEEK substrates (N=35) were evaluated in vitro in terms of the initial adhesion (1 hour) or biofilm accumulation (48 hours) of Candida albicans and a polymicrobial inoculum using stimulated human saliva to mimic a diverse oral microbiome. Surface decontamination ability was evaluated after 24 hours of in vitro biofilm formation after exposure to an erbium-doped yttrium aluminum garnet (Er:YAG) laser. Conventional and flowable composite resin veneering on PEEK was also tested for microbial adhesion. In addition, an in vivo model with 3 healthy volunteers was conducted by using a palatal appliance containing the tested materials (3 or 4 specimens of each material per appliance) for 2 days to evaluate the effect of substrate on the microbial profile. Biofilms were evaluated by live cell counts and scanning electron microscopy images, and the microbial profile by Checkerboard deoxyribonucleic acid (DNA)-DNA hybridization. The t test and Mann-Whitney test were used to compare the groups (α=.05). RESULTS: PEEK and Ti materials showed similar fungal adhesion (P>.05). Although the PEEK surface limited the initial in vitro polymicrobial adhesion (approximately 2 times less) compared with Ti (P=.040), after 48 hours of biofilm accumulation, the microbial load was statistically similar (P=.209). Er:YAG laser decontamination was more effective on PEEK than on Ti surfaces, reducing approximately 11 times more microbial accumulation (P=.019). Both composite resins tested showed similar microbial adhesion (1 hour). In vivo, the PEEK material showed reduced levels of 6 bacterial species (P<.05), including the putative pathogen Treponema denticola. CONCLUSIONS: Although PEEK and Ti had similar bacterial and fungus biofilm attachment and accumulation, PEEK promoted a host-compatible microbial profile with a significantly reduced T. denticola load.

Clinical efficacy of triclosan-containing toothpaste in peri-implant health: A systematic review and meta-analysis of randomized clinical trials.

STATEMENT OF PROBLEM: Recent evidence suggests that toothpaste containing 0.3% triclosan (TCS) is more effective than regular toothpaste in improving clinical periodontal conditions. However, a consensus on whether TCS favors a healthy peri-implant environment is limited. PURPOSE: The purpose of this systematic review and meta-analysis of randomized clinical trials was to determine the effects of TCS-containing toothpaste on dental implant health based on clinical, immunological, and microbiological parameters, as well as on reported adverse events. MATERIAL AND METHODS: Clinical studies comparing peri-implant conditions in participants by using TCS toothpaste versus conventional fluoride toothpaste (control) were extracted from 9 databases. The studies were assessed with the Cochrane risk-of-bias tool for randomized clinical trials (RoB 2). Datasets for bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), gingival index (GI), plaque index (PI), osteo-immunoinflammatory mediators, and bacterial load were plotted, and the standard mean difference (SMD) quantitative analysis was applied by using the Rev Man 5.3 software program. Adverse effects reported by the studies were also tabulated. The certainty of evidence was assessed by using the grading of recommendations assessment, development, and evaluation approach. RESULTS: Six studies were included in the meta-analyses. BOP was higher in the control group than in the TCS toothpaste group at 3 months (SMD -0.59 [-1.11, -.07] P=.002, I2=77%) and 6 months (SMD -0.59 [-0.83, -0.34] P=.009, I2=79%). PD (SMD -0.04 [-0.08, -0.00] P=.04, I2=0%) was also deeper in the control group versus TCS toothpaste at 6 months (SMD -0.41 [-0.73, -0.10] P=.04, I2=77%). CAL, GI, and PI did not differ between groups (P>.05). Among the osteo-immunoinflammatory mediators, IL-10 levels increased, and IL-1ß and osteoprotegerin levels decreased in the TCS toothpaste group (P<.05). Microbiological findings found that TCS toothpaste prevented the growth of periodontal pathogens, specifically in up to approximately 20% of the Prevotella intermedia. Adverse effects were not reported after toothbrushing in either group. However, most studies had "some" or "high" risk of bias, and the certainty of the evidence was considered to be "very low." CONCLUSIONS: Most studies were short-term (3 and 6 months) analyses, and the results found that, although TCS-containing toothpaste had positive osteo-immunoinflammatory and microbiologic results, clinical parameters, including CAL, GI, and PI, were not influenced.

Unraveling the effectiveness of antibiotics for peri-implantitis treatment: A scoping review.

BACKGROUND: Antibiotics are the most effective adjuncts in the treatment of periodontitis. However, the benefits of these agents in treating peri-implantitis are still debatable and demand further analysis. PURPOSE: The aim of this review was to critically appraise the literature on the use of antibiotics to treat peri-implantitis, with the ultimate goal of supporting evidence-based clinical recommendations, defining gaps in knowledge and guiding future studies on this topic. METHODS: A systematized literature search was conducted in MEDLINE/PubMed and Cochrane Library databases for randomized clinical trials (RCTs) on patients with peri-implantitis treated by mechanical debridement-only or with adjunctive use of local or systemic antibiotics. Clinical and microbiological data were extracted from the RCTs included. The findings were critically reviewed, interpreted, and discussed. An overview of antibiotic-loaded dental implant materials in peri-implantitis treatment was also provided. RESULTS: Twelve RCTs testing local/systemic antibiotics were included. Although not always statistically significant, all antibiotic-treated groups had greater reductions in mean PD than those treated by mechanical debridement-only. The only clinically relevant antibiotic protocol supported by one RCT with low risk of bias and long-lasting benefits was systemic metronidazole (MTZ). Studies using ultrasonic debridement reported better outcomes. No RCTs to date have tested MTZ-only or with amoxicillin (AMX) as adjuncts to open-flap implant debridement. In vitro/animal studies suggested that biomaterials with antimicrobial properties are promising to treat peri-implantitis. CONCLUSION: There are insufficient data to support a particular evidence-based antibiotic protocol to treat peri-implantitis using surgical or nonsurgical therapy, but some conclusions may be drawn. Systemic MTZ adjunct to ultrasonic debridement is an effective protocol to improve the outcomes of nonsurgical treatment. Future studies should assess the clinical and microbiological effects of MTZ and MTZ + AMX as adjuncts to optimal nonsurgical implant decontamination protocols or open-flap debridement. In addition, new locally delivered drugs and antibiotic-loaded surfaces should be assessed by RCTs.

Newly identified pathogens in periodontitis: evidence from an association and an elimination study.

We assessed the level of evidence for the presence of new periodontal pathogens by (i) comparing the occurrence of non-classical periodontal taxa between healthy vs. periodontitis patients (Association study); (ii) assessing the modifications in the prevalence and levels of these species after treatments (Elimination study). In the Association study, we compared the prevalence and levels of 39 novel bacterial species between periodontally healthy and periodontitis patients. In the Elimination study, we analyzed samples from periodontitis patients assigned to receive scaling and root planing alone or with metronidazole+ amoxicillin TID/ 14 days. Levels of 79 bacterial species (39 novel and 40 classic) were assessed at baseline, 3 and 12 months post-therapy. All samples were analyzed using Checkerboard DNA-DNA hybridization. Out of the 39 novel species evaluated, eight were categorized as having strong and four as having moderate association with periodontitis. Our findings suggest strong evidence supporting Lancefieldella rimae, Cronobacter sakazakii, Pluralibacter gergoviae, Enterococcus faecalis, Eubacterium limosum, Filifactor alocis, Haemophilus influenzae, and Staphylococcus warneri, and moderate evidence supporting Escherichia coli, Fusobacterium necrophorum, Spiroplasma ixodetis, and Staphylococcus aureus as periodontal pathogens. These findings contribute to a better understanding of the etiology of periodontitis and may guide future diagnostic and interventional studies.

Biomaterial engineering surface to control polymicrobial dental implant-related infections: focusing on disease modulating factors and coatings development.

INTRODUCTION: Peri-implantitis is the leading cause of dental implant loss and is initiated by a polymicrobial dysbiotic biofilm formation on the implant surface. The destruction of peri-implant tissue by the host immune response and the low effectiveness of surgical or non-surgical treatments highlight the need for new strategies to prevent, modulate and/or eliminate biofilm formation on the implant surface. Currently, several surface modifications have been proposed using biomolecules, ions, antimicrobial agents, and topography alterations. AREAS COVERED: Initially, this review provides an overview of the etiopathogenesis and host- and material-dependent modulating factors of peri-implant disease. In addition, a critical discussion about the antimicrobial surface modification mechanisms and techniques employed to modify the titanium implant material is provided. Finally, we also considered the future perspectives on the development of antimicrobial surfaces to narrow the bridge between idea and product and favor the clinical application possibility. EXPERT OPINION: Antimicrobial surface modifications have demonstrated effective results; however, there is no consensus about the best modification strategy and in-depth information on the safety and longevity of the antimicrobial effect. Modified surfaces display recurring challenges such as short-term effectiveness, the burst release of drugs, cytotoxicity, and lack of reusability. Stimulus-responsive surfaces seem to be a promising strategy for a controlled and precise antimicrobial effect, and future research should focus on this technology and study it from models that better mimic clinical conditions.

Underestimated microbial infection of resorbable membranes on guided regeneration.

Barrier membranes are critical in creating tissuecompartmentalization for guided tissue (GTR) and bone regeneration (GBR) therapies. More recently, resorbable membranes have been widely used for tissue and bone regeneration due to their improved properties and the dispensable re-entry surgery for membrane removal. However, in cases with membrane exposure, this may lead to microbial contamination that will compromise the integrity of the membrane, surrounding tissue, and bone regeneration, resulting in treatment failure. Although the microbial infection can negatively influence the clinical outcomes of regenerative therapy, such as GBR and GTR, there is a lack of clinical investigations in this field, especially concerning the microbial colonization of different types of membranes. Importantly, a deeper understanding of the mechanisms of biofilm growth and composition and pathogenesis on exposed membranes is still missing, explaining the mechanisms by which bone regeneration is reduced during membrane exposure. This scoping review comprehensively screened and discussed the current in vivo evidence and possible new perspectives on the microbial contamination of resorbable membranes. Results from eligible in vivo studies suggested that different bacterial species colonized exposed membranes according to their composition (collagen, expanded polytetrafluoroethylene (non-resorbable), and polylactic acid), but in all cases, it negatively affected the attachment level and amount of bone gain. However, limited models and techniques have evaluated the newly developed materials, and evidence is scarce. Finally, new approaches to enhance the antimicrobial effect should consider changing the membrane surface or incorporating long-term released antimicrobials in an effort to achieve better clinical success.

Psychometric properties of an oral health literacy scale for people living with diabetes.

This study evaluated the construct validity of the instrument Oral Health Literacy among diabetics. A probabilistic random sample of 239 diabetics from an infinite population answered the 10 items of the questionnaire. The structural validity was assessed by confirmatory factor analysis and goodness of fit, chi-square per degrees of freedom ratio (X2/df), comparative fit index (CFI), goodness-of-fit index (GFI), and root-mean-square error of approximation (RMSEA). Internal consistency was estimated by the average variance extracted (AVE) and composite reliability (CR). The scores were dichotomized with the upper limit of the 95% confidence interval as the cutoff point. The three-dimensional model presented good quality parameters (X2 /df = 2.459; CFI = 0.988; TLI = 0.981) and poor RMSEA (0.078). Internal consistency was adequate; AVE for the Access, Understand/appraise, and Apply subscales were 0.831, 0.981, and 0.954 and the CR for these subscales were 0.893, 0.962, and 0.822, respectively. Inadequate literacy ranged from 41.8 to 48.1%. The three-dimensional model identified (access, understand/appraise, and apply) showed structural validity, good internal consistency, and understandability.

Recent advances of polypyrrole conducting polymer film for biomedical application: Toward a viable platform for cell-microbial interactions.

Polypyrrole (PPy) is one of the most studied conductive polymers due to its electrical conductivity and biological properties, which drive the possibility of numerous applications in the biomedical area. The physical-chemical features of PPy allow the manufacture of biocompatible devices, enhancing cell adhesion and proliferation. Furthermore, owing to the electrostatic interactions between the negatively charged bacterial cell wall and the positive charges in the polymer structure, PPy films can perform an effective antimicrobial activity. PPy is also frequently associated with biocompatible agents and antimicrobial compounds to improve the biological response. Thus, this comprehensive review appraised the available evidence regarding the PPy-based films deposited on metallic implanted devices for biomedical applications. We focus on understanding key concepts that could influence PPy attributes regarding antimicrobial effect and cell behavior under in vitro and in vivo settings. Furthermore, we unravel the several agents incorporated into the PPy film and strategies to improve its functionality. Our findings suggest that incorporating other elements into the PPy films, such as antimicrobial agents, biomolecules, and other biocompatible polymers, may improve the biological responses. Overall, the basic properties of PPy, when combined with other composites, electrostimulation techniques, or surface treatment methods, offer great potential in biocompatibility and/or antimicrobial activities. However, challenges in synthesis standardization and potential limitations such as low adhesion and mechanical strength of the film must be overcome to improve and broaden the application of PPy film in biomedical devices.

Effect of Processing Methods of Human Saliva on the Proteomic Profile and Protein-Mediated Biological Processes.

The use of saliva as a protein source prior to microbiological and biological assays requires previous processing. However, the effect of these processing methods on the proteomic profile of saliva has not been tested. Stimulated human saliva was collected from eight healthy volunteers. Non-processed saliva was compared with 0.22 µm filtered, 0.45 µm filtered, and pasteurized saliva, by liquid chromatography-mass spectrometry. Data are available via ProteomeXchange with identifier PXD039248. The effect of processed saliva on microbial adhesion was tested using bacterial and fungus species and in biological cell behavior using HaCaT immortalized human keratinocytes. Two hundred and seventy-eight proteins were identified in non-processed saliva, of which 54 proteins (≈19%) were exclusive. Saliva processing reduced identified proteins to 222 (≈80%) for the 0.22 µm group, 219 (≈79%) for the 0.45 µm group, and 201 (≈72%) for the pasteurized saliva, compared to non-processed saliva. The proteomic profile showed similar molecular functions and biological processes. The different saliva processing methods did not alter microbial adhesion (ANOVA, p > 0.05). Interestingly, pasteurized saliva reduced keratinocyte cell viability. Saliva processing methods tested reduced the proteomic profile diversity of saliva but maintained similar molecular functions and biological processes, not interfering with microbial adhesion and cell viability, except for pasteurization, which reduced cell viability.

Income- and education-based inequalities of edentulism and dental services utilization in Brazil.

OBJECTIVE: Tooth loss is a worldwide public health problem affecting mainly socioeconomically disadvantaged groups. Dental services utilization may increase access to preventive actions and conservative treatment, reducing the prevalence of tooth loss. This study evaluated the income- and education-based inequalities in edentulism according to the utilization of dental services among adults and older adults in Brazil. METHODS: Data from the National Oral Health Survey (SB Brazil, 2010) of adults (ages 35-44 years, n = 9779) and older adults (ages 65-74 years, n = 7619) were analysed. Socioeconomic indicators (SES) included education and income. The magnitude of inequality in edentulism by education and income levels was estimated by the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII). The changes in the RII and SII according to the utilization of dental services were estimated. Regression models estimated the association between SES and edentulism and whether dental services utilization modified this association. RESULTS: Higher edentulism prevalence was observed among those with lower education and income levels. The utilization of dental services changed the education-based inequality index in edentulism for adults, with percentage changes of 17.4% (RII) and 56.8% (SII). For adults with low education (0-4 years of study), the odds of edentulism were 80% (OR 0.2; 95% CI 0.1-0.6) and 90% (OR 0.1; 95% CI 0.01-0.2) lower for those who had used dental services within the preceding year and within 1-2 years compared with those who had used such services within the preceding 3 or more years, respectively. CONCLUSION: There was a social gradient in the prevalence of edentulism in adults and older adults, and the education-based inequalities in edentulism were lower among adults reporting utilization of dental services in the preceding year.

Polymicrobial biofilms related to dental implant diseases: unravelling the critical role of extracellular biofilm matrix.

Biofilms are complex tri-dimensional structures that encase microbial cells in an extracellular matrix comprising self-produced polymeric substances. The matrix rich in extracellular polymeric substance (EPS) contributes to the unique features of biofilm lifestyle and structure, enhancing microbial accretion, biofilm virulence, and antimicrobial resistance. The role of the EPS matrix of biofilms growing on biotic surfaces, especially dental surfaces, is largely unravelled. To date, there is a lack of a broad overview of existing literature concerning the relationship between the EPS matrix and the dental implant environment and its role in implant-related infections. Here, we discuss recent advances in the critical role of the EPS matrix on biofilm growth and virulence on the dental implant surface and its effect on the etiopathogenesis and progression of implant-related infections. Similar to other biofilms associated with human diseases/conditions, EPS-enriched biofilms on implant surfaces promote microbial accumulation, microbiological shift, cross-kingdom interaction, antimicrobial resistance, biofilm virulence, and, consequently, peri-implant tissue damage. But intriguingly, the protagonism of EPS role on implant-related infections and the development of matrix-target therapeutic strategies has been neglected. Finally, we highlight the need for more in-depth analyses of polymicrobial interactions within EPS matrix and EPS-targeting technologies' rationale for disrupting the complex biofilm microenvironment with more outstanding translation to implant applications in the near future.

Unraveling the signs and symptoms of oral conditions that affect daily life activities and oral health-related quality of life.

OBJECTIVES: Since oral conditions negatively affect oral health-related quality of life (OHRQoL), this study evaluated which oral clinical condition, signs, and symptoms are associated with the impact on OHRQoL, its domains, and specific daily life activities among adults. MATERIALS AND METHODS: Data from a probabilistic sample of adults (35-44 years old) was used. The Oral Impacts on Daily Performance (OIDP) was used to evaluate OHRQoL, its domains (physical, psychological, and social), and nine daily life activities. Signs and symptoms of oral diseases (dental caries, periodontal disease, need for dental prothesis, and tooth loss) and oral self-perception were considered. Descriptive, bivariate, and multi-level analyses were conducted. RESULTS: A total of 5,834 adults were included, of which 52.9% had some negative impact of oral conditions on OHRQoL. Difficulty in eating was the most affected daily life activity. For multiple models, dental caries lesions (cavities), filled teeth with caries, gingival bleeding, periodontal pocket, dental pain, need for upper or lower dental prosthesis, and oral health self-perception were associated (p < 0.05) with overall OHRQoL or at least one of its domains. The impact on daily life activities of each individual was associated with at least one oral condition. Dental caries lesions (cavity) and dental pain were associated (p < 0.05) with the impact on most daily life activities evaluated. CONCLUSIONS: Different signs and symptoms of prevalent oral diseases are associated with the impact on specific daily life activities among adults, which may compromise the OHRQoL. CLINICAL RELEVANCE: Knowledge of how signs, symptoms, and oral conditions affect OHRQoL and daily life activities can provide essential information for clinicians to establish proper disease management and preventive strategies focusing on improving patients' lives.

Microbiological effects of amoxicillin plus metronidazole in the treatment of young patients with Stages III and IV periodontitis: A secondary analysis from a 1-year double-blinded placebo-controlled randomized clinical trial.

BACKGROUND: Despite the body of evidence supporting the clinical benefits of metronidazole (MTZ) and amoxicillin (AMX) in the treatment of young patients with periodontitis, the microbiological outcomes of this antibiotic protocol have been less explored. This study evaluated the microbiological effects of adjunctive MTZ+AMX in the treatment of young patients with periodontitis. METHODS: Subjects with periodontitis Stages III or IV and ≤30 years old were randomly allocated to receive scaling and root planing (SRP) with placebo (n = 15) or with MTZ (400 mg) and AMX (500 mg) three times a day for 14 days (n = 15). Nine subgingival biofilm samples per subject (three samples from each probing depth (PD) category: ≤3, 4-6, and ≥7 mm) were collected at baseline and 3-, 6-, and 12-months post-treatment and individually analyzed for 40 bacterial species by checkerboard DNA-DNA hybridization. RESULTS: Thirty subjects (15/group) with mean ages 27.6 ± 3.5 (control) and 26.8 ± 3.9 (test) were included. At 12 months post-therapy, the antibiotic group harbored lower proportions of red complex (1.3%) than the placebo group (12.5%) (p < 0.05). SRP + MTZ+AMX was more effective than mechanical treatment in reducing levels/proportions of several pathogens and increasing proportions of Actinomyces species (p < 0.05). Levels/proportions of Aggregatibacter actinomycetemcomitans were only reduced in the antibiotic group (p < 0.05). This group also exhibited greater reduction in the number of sites with PD ≥5 mm and higher percentage of subjects reaching the clinical end point for treatment (≤4 sites with PD ≥5 mm) than the control group (p < 0.05). CONCLUSION: SRP+MTZ+AMX allowed for establishing a long-term healthier subgingival biofilm community and periodontal clinical condition, than SRP only.

Psychometric properties of an oral health literacy scale for people living with diabetes

Abstract This study evaluated the construct validity of the instrument Oral Health Literacy among diabetics. A probabilistic random sample of 239 diabetics from an infinite population answered the 10 items of the questionnaire. The structural validity was assessed by confirmatory factor analysis and goodness of fit, chi-square per degrees of freedom ratio (X2/df), comparative fit index (CFI), goodness-of-fit index (GFI), and root-mean-square error of approximation (RMSEA). Internal consistency was estimated by the average variance extracted (AVE) and composite reliability (CR). The scores were dichotomized with the upper limit of the 95% confidence interval as the cutoff point. The three-dimensional model presented good quality parameters (X2 /df = 2.459; CFI = 0.988; TLI = 0.981) and poor RMSEA (0.078). Internal consistency was adequate; AVE for the Access, Understand/appraise, and Apply subscales were 0.831, 0.981, and 0.954 and the CR for these subscales were 0.893, 0.962, and 0.822, respectively. Inadequate literacy ranged from 41.8 to 48.1%. The three-dimensional model identified (access, understand/appraise, and apply) showed structural validity, good internal consistency, and understandability.

Translating the determinant aspects on the study design in the dental implant field.

Objective: In this article, we analyzed the important categories capable of interfering with the determinants of scientific advancement in the type of study, considering seven leading journals over a 20-year. Methodology: A bibliometric review was performed at the website of well-established implant dentistry journals in five-time points defined to represent a 20-year period of observation. The measures associated with the type of study design were: the country of origin of the article, country income, continent of the corresponding author, inter-institutional collaboration, interdisciplinary collaboration, type of funding, and topic of research. Logistic regression was used in the multiple models to identify the exploratory factors associated with the type of study. Results: From a total of 1,944 articles, 50.6% comprised clinical studies. High-income countries and continents stood out for developing more clinical research than others. Since research funders request more collaborative research, overall clinical studies depended upon more inter-institutional collaboration than the others. Most clinical studies were partly supported by research institutes or universities and by industry. About the research topic, the majority of the clinical and animal studies disclosed surgical procedures. Conclusions: High-income countries and continents are more likely to develop clinical studies in the surgical procedures field. The highest collaborations in terms of the number of institutions and funding sources are more prevalent in clinical research designs. Indeed, most in vivo studies in dental implant fields are performed to evaluate new materials or even new surgical procedures.

Oral Microorganisms and Biofilms: New Insights to Defeat the Main Etiologic Factor of Oral Diseases.

The oral cavity presents a highly diverse community of microorganisms due to the unique environmental conditions for microbial adhesion and growth [...].