Is periodontitis a risk indicator for cancer? A meta-analysis.

BACKGROUND: The aim of the present systematic review was to evaluate the hypothesis of an association between periodontitis and the development of cancer. METHODS: Two reviewers independently screened electronic and manual sources for pertinent articles. Primary outcome measures were the occurrence of neoplasm diagnosis in exposed and non-exposed groups, reported to evaluate association between cancer and periodontitis. RESULTS: Of the 490 initially retrieved papers 10 were included in the qualitative synthesis and eight in the quantitative synthesis; the eight papers covered six studies. Considering hazard ratios, a statistically significant association was found for all cancers studied (1.14; CI 95%: 1.04, 1.24), digestive tract cancer (1.34; CI 95%: 1.05, 1.72), pancreatic cancer (1.74; CI 95%: 1.21, 2.52), prostate cancer (1.25; CI 95%: 1.04, 1.51), breast cancer (1.11; CI 95%: 1.00, 1.23), corpus uteri cancer (2.20; CI 95%: 1.16, 4.18), lung cancer (1.24; CI 95%: 1.06, 1.45), hematological cancer (1.30; CI 95%: 1.11, 1.53), esophagus / oropharyngeal cancer pooled together (2.25; CI 95%: 1.30, 3.90) and Non-Hodgkin lymphoma (1.30; CI 95%: 1.11, 1.52). CONCLUSIONS: Despite the sparse scientific evidence and considering the low statistical power of the results, this systematic review revealed a substantial lack of studies with standardized and comparable methods to speculate about the association between periodontitis and cancer; more studies are need in order to explore further the scientific evidence of such correlation.

Coronally Advanced Flap With or Without Subepithelial Connective Tissue Graft for the Treatment of Single Recession: 5-Year Outcomes from a Comparative Study.

Gingival recession can cause an esthetic impairment or dentin hypersensitivity due to root surface exposure to the oral cavity. These conditions may require specific surgical interventions to achieve root coverage. This controlled clinical trial on 20 subjects compared coronally advanced flap (CAF) technique and CAF plus subepithelial connective tissue graft (CTG) for the treatment of single maxillary gingival recession. Recession height (REC) and complete root coverage (CRC) were considered as primary outcomes. The residual REC was 2.90 ± 0.99 mm at baseline, 1.10 ± 0.99 mm after 1 year, and 1.15 ± 1.06 mm after 5 years in the CAF group and 2.70 ± 0.48 mm at baseline, 0.55 ± 0.69 mm after 1 year, and 0.44 ± 0.62 mm after 5 years in the CAF + CTG group. The differences between groups at 5 years of follow-up was statistically significant. CRC was obtained in 60% of teeth in the CAF group and in 70% of teeth in the CAF + CTG group at the 5-year follow-up. The results showed a significant difference between CAF and CAF + CTG techniques for the treatment of single recession with regard to REC; no significant difference was found in the percentage of teeth presenting CRC after 5 years.

Clinically Oriented Patient Maintenance Protocol: A Clinical Consensus of Experts.

The aim of the present survey was to define the most appropriate recall regimen and professional maintenance care protocol, identifying the main relative issues, based on a consensus of experts with long-term clinical experience. The survey consisted of 14 clinically relevant focused questions. The answers of each expert were aggregated to formulate clinical recommendations. The maintenance care protocol must be individually determined and a baseline condition identified. The recall frequency must have a specific periodicity, and bone levels must be radiographically checked at least every 2 years, unless specific needs require a shorter interval.

Efficacy of platelet concentrates in bone healing: A systematic review on animal studies - Part B: Large-size animal models.

In the presence of large bone defects, delayed bone union, or nonunion and fractures, bone reconstruction may be necessary. Different strategies have been employed to enhance bone healing among which the use of autologous platelet concentrates (APCs). Due to the high content of platelets and platelet-derived bioactive molecules (e.g., growth factors, antimicrobial peptides), they are promising candidates to enhance bone healing. However, both preclinical and clinical studies produced contrasting results, mainly due to a high heterogeneity in study design, objectives, techniques adopted, and outcomes assessed. The aim of the present systematic review was to evaluate the efficacy of APCs in animal models of bone regeneration, considering the possible factors that might affect the outcome. An electronic search was performed on MEDLINE and Scopus databases. Comparative animal studies with a minimum follow up of 2 weeks, at least five subjects per group and using APCs for regeneration of bone defects were included. Articles underwent risk of bias assessment and quality evaluation. Fifty studies performed on six animal species (rat, rabbit, dog, sheep, goat, mini-pig) were included. The present part of the review considers studies performed on small ruminants, dogs, and mini-pigs (14 articles). The majority of the studies were considered at low risk of bias. In general, APCs' adjunct positively affected bone regeneration. Animal species, platelet and growth factors concentration, type of bone defect and of platelet concentrate used seemed to influence their efficacy in bone healing. However, sound conclusions were not drawn since too few studies for each large-size animal model were included. In addition, characterization of APCs' content was performed only in a few studies. Further studies with a standardized protocol including characterization of the final products will provide useful information for translating the results to clinical application of APCs in bone surgery.

Efficacy of platelets in bone healing: A systematic review on animal studies.

In presence of large bone defects, delayed bone union, non-union, fractures, and implant surgery, bone reconstruction may be necessary. Different strategies have been employed to enhance bone healing among which the use of autologous platelet concentrates. Due to the high content of platelets and platelet-derived bioactive molecules (e.g., growth factors, antimicrobial peptides), they are promising candidates to increase bone healing. However, a high heterogeneity of both preclinical and clinical studies resulted in contrasting results. Aim of the present systematic review was to evaluate the efficacy of platelet concentrates in animal models of bone regeneration, considering the possible factors which might affect the outcome. An electronic search was performed on MEDLINE and SCOPUS databases. Animal studies with a minimum follow up of 2 weeks and a sample size of five subjects per group, using platelet concentrates for bone regeneration, were included. Articles underwent risk of bias assessment and further quality evaluation was done. Sixty studies performed on six animal species (rat, rabbit, dog, sheep, goat, and mini-pig) were included. The present part of the review considers only studies performed on rats and rabbits (35 articles). The majority of the studies were considered at medium risk of bias. Animal species, healthy models, platelet, growth factors and leukocytes concentration, and type of bone defect seemed to influence the efficacy of platelet concentrates in bone healing. However, final conclusions were not be drawn, since only few included studies evaluated leukocyte, growth factor content, or presence of other bioactive molecules in platelet concentrates. Further studies with a standardized protocol including characterization of the final products will provide useful information for clinical application of platelet concentrates in bone surgery.

Histomorphometric Results After Postextraction Socket Healing with Different Biomaterials: A Systematic Review of the Literature and Meta-Analysis.

PURPOSE: The aim of this systematic review was to investigate which material is the most effective bone substitute for alveolar bone healing by evaluating histomorphometric outcomes after healing of postextraction sockets in humans. MATERIALS AND METHODS: A manual and electronic search (PubMed, EMBASE, Cochrane Library) was performed using a search string prepared ad hoc. Data were statistically analyzed by calculating weighted mean percentage of new bone formation (primary outcome) and weighted mean percentage of residual biomaterial, soft/connective tissue, and nonmineralized tissue (secondary outcomes) in the biopsies. A meta-analysis of the included randomized controlled trials (RCTs) was performed. RESULTS: A total of 802 papers were screened. After application of the inclusion and exclusion criteria, a total of 40 articles were included in the quantitative synthesis while 11 were included in the meta-analysis of comparative studies. The evaluation of comparative studies with empty sites as control showed that bovine bone could lead to a lower proportion of new bone formation compared to sites left to heal spontaneously (P < .00001). Magnesium-enriched hydroxyapatite and porcine bone showed a significantly higher percentage of new bone compared to control sites (P < .00001). Grafting with an allograft did not lead to a higher percentage of new bone formation in comparison with control sites (P = .09). CONCLUSION: There was no evidence for the superiority of a given biomaterial over the others in terms of new bone formation. While calcium sulphate and beta-tricalcium phosphate resorbed faster than other biomaterials, xenografts showed a lower resorption rate than allografts. Comparative studies suggested that bovine bone was related to a lower proportion of new bone volume compared to sites left to heal spontaneously, while porcine bone and magnesium-enriched hydroxyapatite were related to higher new bone volume. Allograft was not related to higher new bone volume than sites healed without any biomaterial.

Osseointegration of Titanium Implants With Different Rough Surfaces: A Histologic and Histomorphometric Study in an Adult Minipig Model.

BACKGROUND: Many chemical and physical modifications of titanium surfaces were introduced, aiming at improving surface bioactivity, but few comparative evidence exists. OBJECTIVE: To evaluate histologically in minipigs the osseointegration of implants made of commercially pure (CP) titanium or titanium alloy, treated by different roughening procedures. MATERIAL AND METHODS: Three sandblasted acid-etched (SA) surfaces, 2 anodized (AN), and 1 double acid-etched (DAE) were compared. Surface microtopography was characterized with scanning electron microscope; surface element composition was also assessed. One implant per group was inserted in each proximal tibia of 2 minipigs. Three months after healing, block biopsies were taken for histomorphometric analysis. Implant stability quotient (ISQ) was measured at insertion and before harvesting. RESULTS: The highest amount of cortical bone-implant contact was observed around SA implants and showed positive correlation with surface roughness. The greatest increase in ISQ was observed in CP-AN implants. In the medullary region, SA implants showed the best osteogenic response, whereas inflammatory cells were found around DAE and alloy-AN implants. CONCLUSIONS: SA surfaces were more osteogenic than anodized or dual acid-etched ones, although not significantly. Surface roughness affected osseointegration.

Analysis of the 100 most-cited articles in periodontology.

AIM: The aim of the present study was to analyze two distinct biomedical electronic databases for the 100 most-cited articles in the field of periodontology. METHODS: Two electronic databases (Scopus [SCO] and Web of Science [WOS]) were used to retrieve lists of the 100 most-cited articles using appropriately-chosen keywords. The correlation between the number of citations and age of publication was evaluated statistically. RESULTS: Sixty-three papers could be found in both lists. The mean number of citations in SCO was 476.7 ± 361.9 and 371.2 ± 249.7 in WOS. The mean age of publication in the SCO list was 21.4 ± 9.4 years and 18.6 ± 6.5 years in the WOS list. No correlation was found between age of publication and number of citations for both databases. CONCLUSIONS: There is a lack of evidence of the correlation between age of publication and number of citations. The concordance between the two databases that were reviewed was relatively significant, even though the rankings of the most-cited articles are dependent on the number of journals covered by one database. The actual value of the number of citations to measure the quality of one article should be carefully evaluated.

Periodontal regeneration in aggressive periodontitis patients: A systematic review of the literature.

The aim of the present study was to systematically review the existing literature on periodontal regenerative procedures in individuals affected by aggressive periodontitis (AgP). An electronic and manual search was performed using an ad hoc prepared search string. All types of study designs were considered acceptable for inclusion. Data about treated patients, baseline clinical parameters, type of surgery, and outcomes were extracted and recorded. A narrative evaluation of the results was performed. After the article-selection process, a total of 22 full-texts were included in the qualitative synthesis. Twelve papers were case reports; one was a retrospective study; six were non-randomized, comparative studies; and three papers were published on two randomized, controlled trials (RCT). Various biomaterials and surgical techniques were described in the included papers. Based on the existing literature, even considering the relatively low level of evidence, periodontal regenerative surgery could be successfully performed in patients affected by AgP. There is a substantial need of high-quality RCT to support this.

Antibiofilm activity of sandblasted and laser-modified titanium against microorganisms isolated from peri-implantitis lesions.

Infections due to biofilm-producing microorganisms are one of the main causes for the failure of dental implants. Increasing efforts have been made in order to develop new strategies to prevent biofilm formation. In this study, the biofilm development on a newly designed laser-modified titanium implant surface was evaluated and compared to that on conventional sandblasted titanium used in implant dentistry. The amount of biofilm produced by Staphylococcus aureus, Pseudomonas aeruginosa and Porphyromonas gingivalis isolated from peri-implantitis was assessed by a semi-quantitative spectrophotometric method and by confocal laser scanning microscopy. Results showed a lower biofilm production on laser-modified surface compared to the sandblasted one. In particular, a significantly lower total volume of the biomass was observed on laser-modified surface, while no significant changes in live/dead bacteria percentages were noticed between materials. Modifying the topography of the conventional implant surface with laser ablation could represent a promising approach for inhibiting biofilm formation.

A Fusion between Domains of the Human Bone Morphogenetic Protein-2 and Maize 27 kD γ-Zein Accumulates to High Levels in the Endoplasmic Reticulum without Forming Protein Bodies in Transgenic Tobacco.

Human Bone Morphogenetic Protein-2 (hBMP2) is an osteoinductive agent physiologically involved in bone remodeling processes. A commercialized recombinant hBMP2 produced in mammalian cell lines is available in different clinical applications where bone regeneration is needed, but widespread use has been hindered due to an unfavorable cost/effective ratio. Protein bodies are very large insoluble protein polymers that originate within the endoplasmic reticulum by prolamine accumulation during the cereal seed development. The N-terminal domain of the maize prolamin 27 kD γ-zein is able to promote protein body biogenesis when fused to other proteins. To produce high yield of recombinant hBMP2 active domain (ad) in stably transformed tobacco plants we have fused it to the γ-zein domain. We show that this zein-hBMP2ad fusion is retained in the endoplasmic reticulum without forming insoluble protein bodies. The accumulation levels are above 1% of total soluble leaf proteins, indicating that it could be a rapid and suitable strategy to produce hBMP2ad at affordable costs.

Maxillary Sinus Floor Elevation Using Platelet-Rich Plasma Combined With Either Biphasic Calcium Phosphate or Deproteinized Bovine Bone.

PURPOSE: Maxillary sinus floor elevation procedure has the objective of augmenting available bone in atrophic posterior maxilla to allow dental implants placement. The main aim of this prospective study was to evaluate clinically and histomorphometrically the performance of biphasic calcium phosphate (BCP) used in conjunction with platelet-rich plasma (PRP) compared with demineralized bovine bone matrix (DBBM) and PRP in sinus floor elevation surgery. MATERIALS AND METHODS: Patients candidate to sinus floor elevation were treated using either BCP and PRP or DBBM and PRP. Biopsies were retrieved using trephine bur during implant placement surgery 6 months after grafting. Clinical success of implants was evaluated 1 year after prosthesis delivery. Histomorphometric analysis was performed assessing the relative volume of newly formed bone. RESULTS: A total of 20 patients were recruited, and 20 sinus augmentation procedures were performed, 10 for each group. A total of 42 implants were placed. One year after prosthetic loading a 100% implant survival rate was reported in both groups. Histomorphometric analysis revealed that the mean amount of new bone formation was 18.6 ±â€Š3.3% in BCP group and it was 21.9 ±â€Š4.9% in DBBM group, without statistically significant difference. In BCP group a greater amount of collagen type I was found with respect to DBBM group. CONCLUSIONS: Both grafting materials led to an excellent performance regarding implant survival rate after 1 year follow-up, without any significant adverse sequelae. A similar capability of inducing new bone formation was observed in both groups, even though the higher quantity of collagen type I in BCP group may suggest a greater potential for bone formation over time as compared with DBBM.

Antimicrobial properties of platelet-rich preparations. A systematic review of the current pre-clinical evidence.

In recent years autologous platelet concentrates (APCs) have become popular in several medicine fields, representing a valuable adjunct to regenerative surgical procedures. Beneficial effects in the control of postsurgical discomfort and infection have also been frequently reported, suggesting that APC may possess anti-inflammatory and antimicrobial properties. The aim of the present review was to summarize the current evidence regarding the antimicrobial effects of platelet concentrates, investigated by in vitro and animal studies. This review was conducted following a systematic approach. An electronic search was performed on MEDLINE, EMBASE and Scopus databases using appropriate search terms, without language or time restrictions. Preclinical studies assessing the antimicrobial activity of APC were included and divided according to the experimental design. Twenty in vitro studies and four animal studies, investigating APC effects on a broad range of microorganisms, were included. In in vitro studies APC reduced the growth of microorganisms during the first hours of incubation, while they could not completely break down the microbial load. In fact, over time a recovery of bacterial growth was always observed, suggesting that APCs display a bacteriostatic rather than a microbicidal activity. All animal studies showed that APC administered by local injections were able to reduce the infection caused by different microorganisms, although to a lesser extent compared to antibiotics. In conclusion, although the exact action mechanisms of interaction with microbial pathogens need further investigation, platelet concentrates proved to have antimicrobial properties, and therefore could represent a useful natural substance for controlling postoperative infections at surgical sites.

Adverse pregnancy outcomes and periodontitis: A systematic review and meta-analysis exploring potential association.

OBJECTIVE: The correlation between periodontal status and systemic conditions, among them pregnancy, is widely described in the scientific literature. The aim of the present systematic review of the literature was to evaluate periodontal diseases as an independent risk factor for adverse pregnancy outcomes. DATA: Case-control studies reporting pregnancy outcomes and periodontal status of the subjects were included. Risk of bias evaluation was performed using a tool developed by the Cochrane Bias Methods Group. After risk of bias evaluation of included studies, a meta-analysis was performed computing the Risk Ratio (RR) for each pregnancy outcome. SOURCES: Electronic databases (MedLine, Embase, Cochrane Central) were searched after preparation of an appropriate search string. STUDY SELECTION: The search resulted in 422 entries that were screened. After application of inclusion and exclusion criteria, a total of 22 studies were included in the review accounting for a total of 17,053 subjects. The computed RR for periodontitis was 1.61 for preterm birth evaluated in 16 studies (P < .001), 1.65 for low birthweight evaluated in 10 studies (P < .001), and 3.44 for preterm low birthweight evaluated in four studies. CONCLUSION: The present systematic review reported a low but existing association between periodontitis and adverse pregnancy outcomes. This assumption is the result of proper corrections of biased methodologies and of heterogeneity of studies. (.

Autologous Platelet Concentrates for Pulp and Dentin Regeneration: A Literature Review of Animal Studies.

INTRODUCTION: The purpose of this study was to evaluate the effectiveness of autologous platelet concentrates (APCs) in promoting pulp and dentin regeneration in animal models. METHODS: An electronic search was performed on MEDLINE, Embase, Scopus, SciELO, LILACS, and CENTRAL. Animal studies using APC as a root filling material after pulpectomy in mature or immature teeth were included. Articles underwent risk of bias assessment. Histologic evaluation of intracanal neoformed tissue was the primary outcome; root development, root wall thickening, apical closure, and periapical healing in apical periodontitis were the secondary outcomes. RESULTS: Seven articles were included. Platelet-rich plasma (PRP) was used as root filling material during regenerative procedures in the experimental group in either mature or immature teeth. After revascularization with PRP alone or in conjunction with stem cells of a different source, the histologic analyses revealed that, in addition to an odontoblastic cell layer or dentinlike structure, the neoformed intracanal tissues were mainly cementumlike, bonelike, and connective tissues. CONCLUSIONS: True regeneration of necrotic pulp may not be achieved with current techniques using PRP, all of which stimulated tissue repair. Benefits of PRP adjunct for pulp tissue regeneration in preclinical studies remain unclear. Further studies with standardized protocols are necessary to assess the actual contribution of PRP in endodontic regenerative therapies.

Histomorphometric outcomes after lateral sinus floor elevation procedure: a systematic review of the literature and meta-analysis.

OBJECTIVES: The aim of the present systematic review of the literature was to evaluate biomaterials performances considering new bone formation estimated through histomorphometric analysis of bone biopsies from human subjects after maxillary sinus floor elevation. MATERIALS AND METHODS: An electronic and manual search was performed to retrieve articles showing histomorphometric data of bone biopsies performed after sinus floor elevation surgery. Recorded data were statistically analyzed evaluating percentage of new bone volume, residual biomaterial, and connective/soft tissues in the biopsies. A meta-analysis of comparative studies was also performed. RESULTS: After article selection process, 84 articles were included in the quantitative synthesis and 16 of them in the meta-analysis of comparative studies. The use of autogenous bone (AB) alone led to a significantly higher new bone formation if compared with bovine bone (BB) alone (P = 0.04), while no significant difference was found when the latter was compared with a mixture of AB and BB (P = 0.52). Grafts composed of BB showed significantly greater new bone formation as compared to hydroxyapatite (HA) (P < 0.001) while a mixture of tricalcium phosphate (TCP) and HA achieved better outcomes than BB (P < 0.001). CONCLUSIONS: Based on histomorphometric evaluation, AB should still be taken into consideration when the highest possible new bone formation is the primary aim in maxillary sinus surgery. When donor site morbidity is a concern, BB and a mixture of TCP and HA could be considered as predictable, showing promising results. More comparative histologic studies are needed to confirm such results.

Magnification devices for endodontic therapy.

BACKGROUND: After the introduction of microsurgical principles in endodontics involving new techniques for root canal treatment, there has been a drive to enhance the visualisation of the surgical field. It is important to know if the technical advantages for the operator brought in by magnification devices such as surgical microscopes, endoscopes and magnifying loupes, are also associated with advantages for the patient in terms of improvement of clinical and radiographic outcomes. This version updates the review published in 2009. OBJECTIVES: To evaluate and compare the effects of endodontic treatment performed with the aid of magnification devices versus endodontic treatment without magnification devices. We also aimed to compare the different magnification devices used in endodontics with one another. SEARCH METHODS: The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 13 October 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2015, Issue 9), MEDLINE via OVID (1946 to 13 October 2015) and EMBASE via OVID (1980 to 13 October 2015). We searched the US National Institutes of Health Trials Register (http://clinicaltrials.gov) and the WHO Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: We considered all randomised controlled trials (RCTs) and quasi-randomised controlled trials comparing endodontic therapy performed with versus without one or more magnification devices, as well as randomised and quasi-randomised trials comparing two or more magnification devices used as an adjunct to endodontic therapy. DATA COLLECTION AND ANALYSIS: We conducted screening of search results independently and in duplicate. We obtained full papers for potentially relevant trials. The Cochrane Collaboration statistical guidelines were to be followed for data synthesis. MAIN RESULTS: No trials met the inclusion criteria for this review. AUTHORS' CONCLUSIONS: No article was identified in the current literature that satisfied the criteria for inclusion. It is unknown if and how the type of magnification device affects the treatment outcome, considering the high number of factors that may have a significant impact on the success of endodontic surgical procedure. This should be investigated by further long-term, well-designed RCTs that conform to the CONSORT statement (www.consort-statement.org/).

Erythritol-Enriched Air-Polishing Powder for the Surgical Treatment of Peri-Implantitis.

Peri-implantitis represents a major complication that can compromise the success and survival of implant-supported rehabilitations. Both surgical and nonsurgical treatment protocols were proposed to improve clinical parameters and to treat implants affected by peri-implantitis. A systematic review of the literature was performed on electronic databases. The use of air-polishing powder in surgical treatment of peri-implantitis was investigated. A total of five articles, of different study designs, were included in the review. A meta-analysis could not be performed. The data from included studies reported a substantial benefit of the use of air-polishing powders for the decontamination of implant surface in surgical protocols. A case report of guided bone regeneration in sites with implants affected by peri-implantitis was presented. Surgical treatment of peri-implantitis, though demanding and not supported by a wide scientific literature, could be considered a viable treatment option if an adequate decontamination of infected surfaces could be obtained.

Platelet-Rich Plasma and Deproteinized Bovine Bone Matrix in Maxillary Sinus Lift Surgery: A Split-Mouth Histomorphometric Evaluation.

PURPOSE: The purpose of this split-mouth controlled study was to evaluate and compare the amount of vital bone after lateral sinus lift surgery using either a mixture of pure platelet concentrate and deproteinized bovine bone mineral (test group) or solely deproteinized bovine bone as grafting material (control group). MATERIALS AND METHODS: Six patients with edentulous posterior maxilla and a residual ridge height of less than 4 mm were recruited in this study. Six months after grafting procedure, 2 bone biopsies per patient were taken bilaterally from the anterolateral sinus wall. Histological and histomorphometrical analysis was carried out. RESULTS: A total of 10 sinus surgeries in 5 patients were analyzed. The mean percentage of vital bone was 22.72% ± 9.21% (range, 11.45%-33.30%) in the control group and 30.70% ± 7.89% (range, 18.30%-39.99%) in the test group. CONCLUSION: The adjunct of pure platelet-rich plasma to deproteinized bovine bone mineral may enhance vital bone formation in the first 6 months after sinus floor augmentation. However, no statistically significant difference was found between groups (P = 0.18).