Sports-related dental injuries and oral health status among Malaysian para-athletes: A cross-sectional study.

BACKGROUND: Athletes with disabilities may be at an even greater risk of orofacial trauma than their counterparts, and the risk may vary depending on the type of sports. This study aimed to assess the incidence of sports-related dental injuries and oral health status among Malaysian para-athletes. METHODS: A questionnaire survey was conducted to assess self-reported dental injuries and knowledge of their management. An intraoral examination was performed using the decayed, missing, and filled teeth (DMFT) index following the World Health Organization guidelines. RESULTS: A total of 61 para-athletes (men = 90.16%, n = 55; women = 9.84%, n = 6) from different sports categories with different disabilities randomly participated in this study. The incidence of self-reported dental injuries was 18.0% (n = 11), with the most common injury being crown tooth fracture (72.7%) and lip laceration (63.6%). However, the majority of the athletes (70.5%, n = 43) did nothing after experiencing dental trauma, and 82.0% (n = 50) were unaware of the immediate management of dental trauma. Based on the intraoral examination, only 9.8% (n = 6) of the athletes had perfectly sound teeth. The mean total DMFT index was 3.49 ± 2.371, while the mean DMFT index for decayed, missing, and filled teeth was 1.28 ± 1.293, 0.74 ± 0.705, and 1.48 ± 1.120, respectively. The mean DMFT index for decayed, missing, and filled teeth and total DMFT index significantly differed among the types of disabilities (P < .05) but not between the sexes (P > .05). CONCLUSION: The most commonly reported injuries among para-athletes are crown tooth fractures and lip lacerations. The total DMFT index among para-athletes is moderate, emphasising the need for improvements.

Antibacterial effectiveness of different zinc salts on Streptococcus mutans and Streptococcus sobrinus: An in-vitro study.

Objectives: This in-vitro study aimed to evaluate the antibacterial effects of four zinc salts namely zinc chloride, zinc sulfate, zinc citrate and zinc acetate against Streptococcus mutans (S. mutans) and Streptococcus sobrinus (S. sobrinus). Methods: Antibacterial susceptibility assay, minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were undertaken to evaluate the inhibitory activities of different zinc salts against the tested bacteria. A scanning electron microscope (SEM) was used to evaluate the morphological changes of bacterial cells following exposure to zinc salts. Kruskal-Wallis and Mann-Whitney tests were used to compare the inhibitory effect of the different zinc salts. Results: All zinc salts tested against S. mutans and S. sobrinus had a statistically and significantly smaller inhibition zone when compared to chlorhexidine, (P < 0.001). However, zinc chloride had the largest inhibition zone (20 mm ± 5.5) against S. sobrinus, which was comparable to chlorhexidine (22 mm ± 4) (P > 0.05). Zinc chloride, zinc sulfate and zinc acetate demonstrated higher MIC and MBC values against S. mutans compared to S. sobrinus. However, zinc citrate revealed the highest MIC and MBC values of 1 mg/mL and > 8 mg/mL for S. sobrinus and > 8 mg/mL for S. mutans, respectively. Conclusion: Different zinc salts have displayed inhibitory growth effects against the common oral bacteria at very low concentrations except for zinc citrate which showed no inhibitory effect against these bacteria in vitro.

Linear and volumetric shrinkage displacements of resin composite restorations with and without debonding.

The study aimed to compare shrinkage displacements of fully and partially bonded resin composite restorations (RCRs). Two groups (n=5) Class-I RCR evaluated: Group 1 (G1) fully bonded and Group 2 (G2) debonded at the floor. Experimental results were compared with predictions from simple theory and finite element analysis (FEA). The experimental linear surface displacement (LSD) was G1 62.5±5.2 µm and G2 32.8±4.0 µm. Theoretically-predicted LSD for G1 60.1±7.4 µm and G2 31.3±7.5 µm. FEA-predicted LSD were G1 65.2 µm and G2 34.6 µm. The experimental volumetric surface displacement (VSD) was G1 1.22±0.2 mm3 and G2 0.63±0.2 mm3. Theoretically-predicted VSD for G1 1.36±0.2 mm3 and G2 0.67±0.2 mm3. No significant difference (p>0.05) was found in LSD and VSD among the experimental, theoretical and FEA in the same group. Significant differences (p<0.05) were noted between the two groups, with LSD and VSD of G2 values being almost half of G1. This pattern gave an insight of a debond restoration characteristics.

Artificial Intelligence Driven Biomedical Image Classification for Robust Rheumatoid Arthritis Classification.

Recently, artificial intelligence (AI) including machine learning (ML) and deep learning (DL) models has been commonly employed for the automated disease diagnosis process. AI in biological and biomedical imaging is an emerging area and will be a future trend in the field. At the same time, biomedical images can be used for the classification of Rheumatoid arthritis (RA) diseases. RA is an autoimmune illness that affects the musculoskeletal system causing systemic, inflammatory and chronic effects. The disease frequently becomes progressive and decreases physical function, causing articular damage, suffering, and fatigue. After a time, RA causes harm to the cartilage of the joints and bones, weakens the tendons and joints, and finally causes joint destruction. Sensors (thermal infrared camera sensor, accelerometers and wearable sensors) are more commonly employed to collect data for RA. This study develops an Automated Rheumatoid Arthritis Classification using an Arithmetic Optimization Algorithm with Deep Learning (ARAC-AOADL) model. The goal of the presented ARAC-AOADL technique lies in the classification of health disorders depending upon RA and orthopaedics. Primarily, the presented ARAC-AOADL technique pre-processes the input images by median filtering (MF) technique. Then, the ARAC-AOADL technique uses AOA with an enhanced capsule network (ECN) model to produce feature vectors. For RA classification, the ARAC-AOADL technique uses a multi-kernel extreme learning machine (MKELM) model. The experimental result analysis of the ARAC-AOADL technique on a benchmark dataset reported a maximum accuracy of 98.57%. Therefore, the ARAC-AOADL technique can be employed for accurate and timely RA classification.

The Association of Early Childhood Caries with Salivary Antimicrobial Peptide LL37 and Mutans Streptococci.

PURPOSE: This study aims to determine the relation of salivary LL37 level and mutans streptococci levels in early childhood caries (ECC). STUDY DESIGN: A case-control study was performed in children ≤71 months old. Unstimulated whole saliva was collected and the level of salivary LL37 was measured using an enzyme-linked immunosorbent assay kit. The mutans streptococci oral bacteria were isolated from saliva and identified using a modified SB-20 culture medium (SB-20M). Data were analyzed using descriptive statistics, bivariate, and Spearman's rank correlation analysis. RESULTS: The was a variability of salivary LL37 level among the children and the level was significantly associated with age and races. The median (IQR) value of salivary LL37 in caries-free (CF) children was significantly higher 393.50 (580.55) ng/mL compared to 172.50 (234.65) ng/mL in the ECC group. The ECC children exhibited a significantly higher count of S. mutans and S. sobrinus compared to the CF children. An inverse weak correlation between salivary LL37 and dmft was also observed. CONCLUSIONS: The low salivary LL37 level and higher S. mutans and S. sobrinus count in ECC supported the protective role of salivary LL37 against dental caries. Further studies are required to explore the definite relation between salivary LL37 levels and dental caries.

Impact of dental plaque control on the survival of ventilated patients severely affected by COVID-19 infection: An overview.

This overview was conducted to highlight the importance of adequate oral hygiene for patients severely affected by coronavirus disease 2019 (COVID-19) due to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). These are patients who were admitted to the intensive care unit (ICU) to receive oxygen through mechanical ventilation due to severe pneumonia as a complication of COVID-19. Various dental plaque removal methods for ventilated patients were discussed with regard to their efficacy. The use of chemical agents was also considered to determine which one might be proposed as the best choice. Also, oral care programs or systems that can be implemented by ICU nurses or staff in the case of these ventilated patients were suggested based on evidence from the literature. These interventions aim to reduce microbial load in dental plaque/biofilm in the oropharynx as well as the aspiration of the contaminated saliva in order to prevent the transmission of the dental plaque bacteria to the lungs or other distant organs, and reduce the mortality rate.

The antibacterial effects of vitamin D3 against mutans streptococci: an in vitro study.

PURPOSE: This study aims to evaluate the antimicrobial effects of the cholecalciferol vitamin D3 against Streptococcus sobrinus (Strep. sobrinus) and Streptococcus mutans (Strep. mutans) bacteria in vitro that is considered the main causative bacteria in dental caries development. MATERIALS AND METHODS: The antimicrobial effects of vitamin D3 were evaluated against Strep. sobrinus and Strep mutans using the agar disc diffusion method. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of vitamin D3 were determined using a microdilution method following the guidelines by the Clinical Laboratory Standards Institute (CLSI). Scanning electron microscope (SEM) was used to evaluate the morphological changes of bacterial cells following exposure to vitamin D3. RESULTS: Strep. sobrinus was more sensitive to vitamin D3 compared to Strep. mutans bacteria. The MIC values of vitamin D3 against Strep. sobrinus and Strep. mutans were 60 µg/ mL and 250 µg/mL respectively whereas the MBC values were 120 µg/mL and 500 µg/mL, respectively. Moreover, significant changes in the bacterial morphology were observed in treated bacterial cells with vitamin D3 as compared to the untreated control bacteria using SEM. CONCLUSION: These findings suggested that vitamin D3 has excellent antimicrobial effects against Strep. sobrinus and Strep. mutans and may be considered as a promising compound in the prevention of dental caries in the future. Further research is recommended to elucidate the mechanism of vitamin D3 on these bacteria.

Serum and Saliva 25(OH)D Levels in Relation to Dental Caries in Young Children.

OBJECTIVE: Several studies have reported that low levels of vitamin D (25(OH)D) are associated with an increased risk of dental caries and that optimal levels may offer protection This study aimed to assess the relationship between serum and saliva 25(OH)D levels and caries among young children. STUDY DESIGN: A total of 120 healthy children were recruited; 93 with caries and 27 caries-free. Dental caries status was evaluated using decayed, missing and filled in primary teeth (dmft) index. Blood and unstimulated whole saliva samples were collected. Laboratory analysis was performed using Enzyme-Linked Immunosorbent Assay Kit. Data were analyzed with descriptive statistics, bivariate and Spearman's rank correlation analysis. RESULTS: There were no significant associations between serum and saliva 25(OH)D levels and caries status (P > 0.05). Levels of 25(OH)D in serum were significantly higher than levels found in saliva (P < 0.05), and a correlation between serum and saliva 25(OH)D levels was observed (P < 0.05). CONCLUSIONS: The association between serum and saliva 25(OH)D and dental caries in young children was inconclusive. However, a positive and significant correlation was observed between serum and saliva 25(OH)D levels. Further studies are warranted to investigate the definite relation between 25(OH)D levels and dental caries and using saliva 25(OH)D as a non-invasive alternative method over blood samples.

Role of Endoscopic Stent Insertion on Management of Gastric Twist after Sleeve Gastrectomy.

PURPOSE: The effectiveness of endoscopic management of twisting of the gastric pouch after sleeve gastrectomy. METHODS: This was a retrospective study on Ain Shams University Hospital. Patients who had obstructive symptoms and diagnosed with twist after gastric sleeve were included in this study. RESULTS: From May 2017 to January 2019, 860 patients underwent LSG as a definitive procedure. Thirty-two (3.7%) patients developed symptoms of gastric obstruction. Twenty-two (2.5%) patients diagnosed with sleeve axial twist were included in this study after excluding 11 patients with sleeve stricture. A total of 72% (16 out of 22) of patients were female, with a mean age of 41. The mean time of presentation was 40 days (20-60 days) after surgery. Gastrografin contrast study was positive in 14 (63%) patients. 3D contrast CT was positive in 100% of cases. The timing of endoscopic intervention was 40 ± 20 days (20-60) after surgery. Endoscopic treatment was successful in 20 patients (91%). Recovery was uneventful in 19 patients; 1 patient had esophageal stricture at the upper end of the stent, which necessitated a session of dilation. The success of endoscopic intervention was 91% with complete relief of symptoms and correction of the gastric pouch axis. Endoscopic intervention failed in only 2 patients (9%) who necessitated laparoscopic exploration after stent removal. CONCLUSION: Gastric pouch twisting is a rare complication; however, it has a rising incidence. Endoscopic stent insertion is highly effective on the management of twisting after SG and it should be tried before any further surgical intervention.

Soaking oro-pharyngeal pack with triamcinolone acetonide lowers discomfort in functional endoscopic sinus surgeries / Pack orofaringeo con triamcinolone disminuye molestias luego de cirugía endoscópica sinusal

BACKGROUND: Postoperative sore throat (POST) is defined as pain or discomfort in the throat following general anesthesia. Throat packs are used by many surgical subspecialties for different benifits, however they may increase the incidence of POST. Many interventions can be used to decrease incidence of POST. Triamcinolone acetonide (TA) is a moderately potent topical corticosteroid preparation. In this study, we hypothesized that soaking the throat pack with TA may decrease POST. METHODS AND MATERIAL: This prospective interventional comparative study was performed on 54 patients planned for Functional Endoscopic Sinus Surgeries (FEES) surgery. After endotracheal intubation, a standard length of oro-pharyngeal pack was placed, then patients were randomly allocated into: Group I: Oro-pharyngeal packs were soaked with 15 mg Triamcinolone acetonide 0.1% and Group II: packs were soaked with the same volume of lubricating gel (K-Y gel®). The patients were postoperatively asked about: sore throat, dysphagia, hoarseness of voice and nausea and vomiting. RESULTS: Thirty minutes and 24 hours after extubation, Group I patients showed lower but statistically insignificant sore throat scores. Two to six hours after extubation, Group I showed a statistically significant reduction in sore throat scores. Six patients suffered dysphagia in group I compared with 8 patients in group II. Hoarseness of voice occurred in 1 patient in group I and 3 patients in group II. No patient complained of nausea or vomiting. cONCLUSIÓN: Soaking oropharyngeal pack with triamcinolone acetonide in orabase gel was able to decrease POST in FESS patients.

Dental caries and vitamin D status in children in Asia.

Dental caries and vitamin D inadequacy are known to affect children worldwide. Vitamin D has a vital role in tooth formation. There is growing evidence linking suboptimal serum vitamin D level with dental caries in children. This paper reviews the literature on both the prevalence of dental caries and of vitamin D deficiency in children in four Asian regions, discusses their associated risk factors, and reviews the global evidence on the association between dental caries and vitamin D in children. Caries prevalence in children ranged from 40% to 97% in Eastern Asia, 38-73.7% in Southern Asia, and 26.5-74.7% in Western Asian countries. Moreover, a higher prevalence of vitamin D deficiency in Asian children was identified, even in countries in equatorial regions, ranging from 2.8% to 65.3% in Eastern Asia, 5-66.7% in Southern Asia, 4-45.5% in Western Asia and 38.1-78.7% in Central Asian countries. Obesity, age, female gender, higher latitude, season, darker skin pigmentation, sunlight protection behaviors, less sunlight exposure and low intake of food containing vitamin D were important factors associated with lower serum vitamin D in Asia. Suboptimal vitamin D level in children may be a significant risk factor for dental caries, and requires further research to ascertain such an association in children in Asia, as well as to understand its exact influence on caries risk and development.

A systematic review on antibacterial activity of zinc against Streptococcus mutans.

OBJECTIVES: The aim of this study was to systematically review the growth inhibition effectiveness of zinc against Streptococcus mutans. The main question was, "Does the zinc inhibit the growth of oral Streptococcus mutans in vitro? METHODS: Literature search on PubMed, Medline, and science direct databases was carried out for in vitro studies published in English from 1990 to 2016, and the reported outcomes of minimum inhibitory concentration (MIC), minimum bactericidal concentrations (MBC), zone of inhibition (ZOI) and bacterial count method using colony forming unit (CFU) were used to assess the antibacterial effectiveness of zinc. RESULTS: Seventeen studies were included in this review. Seven studies reported MIC and MBC. Four studies reported ZOI, and eight studies reported CFU. MIC values using zinc chloride and zinc oxide nanoparticles were ranged from 0.025 to 0.2 mM and 0.390 to 500 ±â€¯306.18 µg/ml respectively. MBC values using zinc oxide nanoparticles have ranged from 3.125 to 500 µg/ml. ZOI ranged from no inhibition zone to 21 ±â€¯1.4 mm using 23.1% zinc oxide. A considerable reduction in the bacterial count was reported after adding zinc. However, only two studies have reported no inhibitory effect of zinc. CONCLUSION: This review indicated a significant growth inhibition effectiveness of zinc even at lower concentrations which indicate it's safely to be used in oral health products.

3D TECA hydrogel reduces cellular senescence and enhances fibroblasts migration in wound healing.

This study was designed to investigate the effect of 3D TECA hydrogel on the inflammatory-induced senescence marker, and to assess the influence of the gel on the periodontal ligament fibroblasts (PDLFs) migration in wound healing in vitro. PDLFs were cultured with 20 ng/ml TNF-α to induce inflammation in the presence and absence of 50 µM 3D TECA gel for 14 d. The gel effect on the senescence maker secretory associated-ß-galactosidase (SA-ß-gal) activity was measured by a histochemical staining. Chromatin condensation and DNA synthesis of the cells were assessed by 4',6-diamidino-2-phenylindole and 5-ethynyl-2'-deoxyuridine fluorescent staining respectively. For evaluating fibroblasts migration, scratch wound healing assay and Pro-Plus Imaging software were used. The activity of senescence marker, SA-ß-gal, was positive in the samples with TNF-α-induced inflammation. SA-ß-gal percentage is suppressed (>65%, P < 0.05) in the treated cells with TECA gel as compared to the non-treated cells. Chromatin foci were obvious in the non-treated samples. DNA synthesis was markedly recognized by the fluorescent staining in the treated compared to non-treated cultures. Scratch wound test indicated that the cells migration rate was significantly higher (14.9 µm2/h, P < 0.05) in the treated versus (11 µm2/h) for control PDLFs. The new formula of 3D TECA suppresses the inflammatory-mediated cellular senescence and enhanced fibroblasts proliferation and migration. Therefore, 3D TECA may be used as an adjunct to accelerate repair and healing of periodontal tissues.

Incidence of Biliary Reflux Esophagitis After Laparoscopic Omega Loop Gastric Bypass in Morbidly Obese Patients.

BACKGROUND: Omega loop gastric bypass is a successful bariatric surgery with numerous favorable circumstances as being basic, effective on weight reduction and treatment of obesity associated metabolic disorder, the short expectation to learn and adapt, and the simplicity of correction and inversion. However, there are arguments about the possibility of biliary reflux and/or the potential danger of gastroesophageal malignancy after the procedure. METHODS: Fifty patients experiencing morbid obesity with body mass index >40 or >35 kg/m2 with two related comorbidities, for example, diabetes type II, hypertension, or dyslipidemia, underwent omega loop gastric bypass with a follow-up period up to 18 months, investigating for any symptom of reflux infection by upper gastrointestinal tract endoscopy and pH metry. RESULTS: Reflux esophagitis (a gastroesophageal reflux disease) was detected in 3 patients (6%); 2 cases (4%) showed (Grade A) acidic reflux esophagitis at 6 and 12 months postoperatively. Just 1 case (2%) had experienced gastroesophageal biliary reflux esophagitis (Grade A) at 12 months. No metaplasia or dysplasia was detected in the endoscopic biopsies. CONCLUSION: Omega loop gastric bypass is a safe and effective bariatric procedure with low incidence of postoperative biliary reflux, metaplasia, or dysplasia at the esophagogastric junction, confirmed 18 months after the operation.

Efficacy of bisphosphonate as an adjunct to nonsurgical periodontal therapy in the management of periodontal disease: a systematic review.

AIMS: The aim of this systematic review was to assess the efficacy of bisphosphonate therapy as an adjunct to scaling and root planing (SRP) in the management of periodontitis. METHODS: Databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Cochrane Oral Health Group Trials Register databases) were searched up to and including July 2016. The primary outcome was probing depth (PD), and the secondary outcomes were changes in clinical attachment level (CAL) and bone defect (BD) fill. The mean differences (MD) of outcomes and 95% confidence intervals (CI) for each variable were calculated using random effect model. RESULTS: Eight clinical studies were included. Seven studies used alendronate as an adjunct to SRP; of these, four studies used topical application and three used oral alendronate. Considering the effects of adjunctive bisphosphonates as compared to SRP alone, a high degree of heterogeneity for PD (Q value = 39.6, P < 0.0001, I2  = 87.38%), CAL (Q value = 13.65, P = 0.008, I2  = 70.71%), and BD fill (Q value = 53.26, P < 0.0001, I2  = 92.49%) was noticed among both the groups. Meta-analysis showed a statistically significant PD reduction (MD = -1.18, 95% CI = -1.91 to -0.44, P = 0.002), CAL gain (MD = -0.69, 95% CI = -1.20 to -0.18, P = 0.008) and BD fill (MD = -2.36, 95% CI = -3.64 to -1.08, P < 0.001) for SRP + bisphosphonate treatment vs. SRP alone. CONCLUSIONS: Adjunctive bisphosphonate therapy appears to be effective in managing periodontitis, however, due to the potential risk of osteonecrosis of the jaws and short-term follow-up of the studies, their clinical application is debatable.

Prevalence of isolated maxillary lateral incisor agenesis in Syrian adolescents.

PURPOSE: This research is designed to obtain a better understanding and provide more insight of this phenomenon through evaluating the prevalence of congenital absence of maxillary lateral incisors in a Syrian population. METHODS: The method involved clinical examination of 8000 school children with an equal number of males and females (age range 12-15 years) to identify students only affected by bilateral or unilateral congenital absence of maxillary lateral incisors. Agenesis was determined based on radiological evidence. RESULTS: The results of this study showed that the prevalence of isolated maxillary lateral incisors agenesis was 1.15%. In the sample studied, 66.3% of the patients were female and 33.7% were male (p < 0.05). Absence was bilateral in 47.8% of patients and unilateral in 52.2%. Of the unilateral cases, 48% occurred on the right side and 52% on the left side, and the contralateral maxillary incisor was found to be microdont in 43.75%, right lateral in 47.6%, and left lateral in 52.4%. CONCLUSION: The results of this study allow the conclusion that the prevalence of isolated maxillary lateral incisors agenesis in a Syrian population is within the average range with regard to other populations. A significant familial component to the etiology of maxillary lateral incisors agenesis was found.

Cytokine Profile in Chronic Periodontitis Patients with and without Obesity: A Systematic Review and Meta-Analysis.

To investigate the cytokine profile as biomarkers in the gingival crevicular fluid (GCF) of chronic periodontitis (CP) patients with and without obesity, MEDLINE/PubMed, EMBASE, ScienceDirect, and SCOPUS databases were combined with handsearching of articles published from 1977 up to May 2016 using relevant MeSH terms. Meta-analyses were conducted separately for each of the cytokines: resistin, adiponectin, TNF-α, leptin, IL-6, IL-8, and IL-1ß. Forest plots were produced reporting standardized mean difference of outcomes and 95% confidence intervals. Eleven studies were included. Three studies showed comparable levels of leptin among obese and nonobese patients with CP. Four studies reported comparable levels of interleukin- (IL-) 6 and resistin whereas five studies reported comparable levels of adiponectin. Two studies reported similar levels of CRP in patients with periodontitis with and without obesity. One study showed higher levels of tumor necrosis factor-alpha in obese patients with CP. One study showed higher levels of IL-1ß and IL-8 in obese patients with CP. The level of localized periodontal inflammation may have a greater influence on the GCF proinflammatory biomarker levels as compared to systemic obesity. Whether patients having chronic periodontitis with obesity have elevated proinflammatory GCF biomarkers levels compared to nonobese individuals remains debatable.

Crestal bone loss and periimplant inflammatory parameters around zirconia implants: A systematic review.

STATEMENT OF PROBLEM: Zirconia implants have been used for oral rehabilitation; however, evidence of their ability to maintain crestal bone and periimplant soft tissue health is not clear. PURPOSE: The purpose of this systematic review was to evaluate crestal bone loss (CBL) around zirconia dental implants and clinical periimplant inflammatory parameters. MATERIAL AND METHODS: The focus question addressed was, "Do zirconia implants maintain crestal bone levels and periimplant soft tissue health?" Databases were searched for articles from 1977 through September 2014 with different combinations of the following MeSH terms: "dental implants," "zirconium," "alveolar bone loss," "periodontal attachment loss," "periodontal pocket," "periodontal index." Letters to the editor, case reports, commentaries, review articles, and articles published in languages other than English were excluded. RESULTS: Thirteen clinical studies were included. In 8 of the studies, the CBL around zirconia implants was comparable between baseline and follow-up. In the other 5 studies, the CBL around zirconia implants was significantly higher at follow-up. Among the studies that used titanium implants as controls, 2 studies showed significantly higher CBL around zirconia implants, and in 1 study, the CBL around zirconia and titanium implants was comparable. The reported implant survival rates for zirconia implants ranged between 67.6% and 100%. Eleven studies selectively reported the periimplant inflammatory parameters. CONCLUSIONS: Because of the variations in study design and methodology, it was difficult to reach a consensus regarding the efficacy of zirconia implants in maintaining crestal bone levels and periimplant soft tissue health.

Efficacy of photodynamic therapy in the management of oral premalignant lesions. A systematic review.

OBJECTIVE: The aim was to systematically review the efficacy of photodynamic therapy (PDT) in the management of oral premalignant lesions. METHODS: The addressed focused question was "Is PDT effective in the management of oral premalignant lesions?" PubMed/Medline, Google-Scholar, EMBASE and ISI Web of Knowledge databases were searched from 1984 till June 2014 using different combinations of the following keywords: photodynamic therapy; oral premalignant lesions; leukoplakia; erythroplakia; erythro-leukoplakia; verrucous hyperplasia; and submucous fibrosis. Review articles, experimental studies, case-reports, commentaries, letters to the Editor, unpublished articles and articles published in languages other than English were not sought. The pattern of the present study was customized to mainly summarize the relevant information. RESULTS: Thirteen studies were included. In these studies, the number of patients ranged between 5 patients and 147 individuals with mean ages ranging between 51 years and 62.2 years. Oral premalignant lesions, which were investigated were leukoplakia, erythroplakia, erythro-leukoplakia and verrucous hyperplasia. Reported number of premalignant lesions ranged between 5 and 225. Laser wavelength, duration of irradiation and power density were 585-660nm, 60s to 16.6min and 100-150mW/cm(2), respectively. Aminolevulinic acid, chlorine-e6, meta-tetrahydroxyphenylchlorin and photofrin were used as photosensitizer. The frequency of PDT application ranged between once and 12 times. Complete, partial and no response to PDT was shown by 27-100%, 5-50% and 0-25% of pre-malignant lesions, respectively. The recurrence rate of pre-malignant lesions was up to 36%. CONCLUSION: PDT is effective in the overall management of oral premalignant lesions.

Efficacy of mechanical debridement with adjunct antimicrobial photodynamic therapy for the management of peri-implant diseases: a systematic review.

The aim was to assess whether or not mechanical debridement with adjunct antimicrobial photodynamic therapy (aPDT) is effective for the management of peri-implant diseases. The addressed focused question was "Is mechanical debridement with adjunct aPDT more effective in treating peri-implant diseases as compared to when mechanical debridement is used alone?" PubMed/MEDLINE and Google-Scholar databases were searched from 1994 till April 2014 using different combinations of the following keywords: antimicrobial photodynamic therapy; bone loss; light activated disinfection; mechanical debridement; and peri-implant diseases. Review articles, case-reports, commentaries, letters to the editor, unpublished articles and articles published in languages other than English were excluded. Twelve studies (six clinical and six experimental) were included. In the clinical and experimental studies, 15-80 implants and 18-150 implants respectively were used. Laser wavelengths, duration of irradiation and power output ranged between 625 nm-830 nm, 10 s-300 s, and 30 mW-200 mW, respectively. Four studies reported mechanical debridement with adjunct aPDT to be effective in the treatment of peri-implant diseases; however, the benefits of aPDT were comparable with conventional treatments. Two studies reported aPDT to reduce bacteria more than when the laser and the photosensitizer were applied alone. In two studies, chemical disinfection and aPDT showed comparable outcomes in terms of bacterial disinfection. In two experimental studies, aPDT was shown to improve bone to implant contact and re-osseointegration. Efficacy of mechanical debridement with adjunct aPDT for the management of peri-implant diseases remains debatable.