Evaluating the Therapeutic Properties of Natural Products in Orthodontic and Surgical Treatment of Dentofacial Deformities: A Systematic Review of Clinical Trials.

The use of natural products as alternatives to traditional pharmacological treatments in orthodontics is gaining interest due to their anti-inflammatory, antibacterial, and antioxidant properties. This systematic review synthesizes evidence from clinical trials to evaluate the efficacy of natural products in reducing inflammation and bacterial presence in orthodontic and orthognathic treatment settings. The database search was conducted across PubMed, Scopus, and Embase up to January 2024. The review focused on randomized controlled trials only. The selected studies centered on the anti-inflammatory, antibacterial, and antioxidant effects of natural products, adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines for data extraction. Nine studies, totaling 358 participants, were included. Significant findings demonstrated a reduction in gingival inflammation by over 40% with the use of Aloe vera compared to chlorhexidine. Another study noted a decrease in bleeding on probing by 13.6 points in the treatment group over placebo. Additionally, honey showed a rapid modulation of plaque pH and significantly reduced bacterial counts of Streptococcus mutans. Furthermore, the use of resveratrol emulgel was linked to substantial improvements in gingival health, with a reduction in the gingival index and probing pocket depth. The results indicate that natural products can significantly enhance orthodontic treatment outcomes by reducing inflammation and bacterial levels. These products offer effective alternatives to traditional treatments and show potential for integration into routine orthodontic care protocols. Further research is encouraged to standardize application methods and dosages to maximize clinical benefits and patient satisfaction.

Male and Female Discrepancies in Anxiety, Depressive Symptoms, and Coping Strategies among Orthognathic Patients: A Cross-Sectional Analysis.

With an increasing understanding of the differences between men and women's psychological experiences, this study aimed to probe the sex-based differences in anxiety, depressive symptoms, and coping strategies among orthognathic patients. The study hypothesis was that female patients would show higher levels of anxiety and depressive symptoms than males, and that coping mechanisms would differ between male and female sexes. A cross-sectional design was adopted, examining orthognathic patients from the Department of Oral and Maxillo-Facial Surgery at the Emergency Clinical Municipal Hospital in Timisoara, Romania, from 2020 to 2023. Eligible participants (18+ years with no prior orthognathic treatment) completed a comprehensive online questionnaire 6 weeks before scheduled surgery. This was composed of validated self-report instruments comprising the SF-36, GAD-7, and the PHQ-9, and the COPE-60, along with additional sociodemographic data. Of the 127 orthognathic patients analyzed (68 men and 59 women, aged 18 to 65 years, mean age 32), men rated their physical health status slightly better on the SF-36 scale. However, the most notable difference was in mental health, with females scoring higher on both the PHQ-9 (indicative of depression) and the GAD-7 (indicative of anxiety) scales. Specifically, female participants exhibited average PHQ-9 scores 1.8 points higher and GAD-7 scores 1.5 points higher than their male counterparts. Coping mechanisms also varied: 42% of male patients primarily employed "Disengagement" strategies, while 58% of females predominantly used "Engagement" and "Emotion Focused" strategies. Emotion-focused coping was associated with a 1.6-fold increased risk of depressive symptoms. Sex differences play a crucial role in the psychological experiences of orthognathic patients, evident in anxiety and depression levels, perceived health status, and coping strategies. This underlines the importance of sex-tailored psychological support in the preoperative phase for orthognathic surgery patients.

Age-Related Quality of Life and Psychosocial Impact of Chin Asymmetry in Adolescents and Young Adults Undergoing Orthodontic and Orthognathic Correction.

Craniofacial asymmetry can have significant psychosocial implications, affecting the quality of life in adolescents and young adults. This study aimed to assess the impact of age and complexity of craniofacial asymmetry on quality of life and psychosocial outcomes in patients undergoing orthodontic and orthognathic correction. A cross-sectional study was conducted on 149 patients aged 13-26 years with moderate or severe craniofacial asymmetry that had a gnathion deviation higher than 2 mm, according to the American Association of Orthodontists. Participants were divided into three groups: teenagers (n = 53), adults (n = 46), and a control group (n = 50) with relative craniofacial asymmetry. Quality of life and psychosocial impacts were evaluated using validated questionnaires that measure health-related quality of life (SF-36), body image satisfaction and self-acceptance (BIQLI), anxiety and depression levels (HADS), and perceived stress (PSS-10). These tools provided an encompassing appraisal of the psychological and social implications associated with craniofacial asymmetry before and six months after orthodontic and orthognathic correction. Before the intervention, adults had higher mental health scores compared to teenagers (p = 0.037). At the 6-month follow-up, no significant differences in mental health scores were observed between the two groups (p = 0.121). BIQLI results showed significant differences in satisfaction with appearance and self-acceptance between teenagers and adults, both before intervention (p = 0.045 and p = 0.051, respectively) and at six months (p = 0.062 and p = 0.031, respectively). HADS results showed significant differences in anxiety levels before intervention (p = 0.039) but not at six months (p = 0.133). PSS-10 results showed no significant differences in perceived stress between the groups. In conclusion, this study demonstrates that craniofacial asymmetry significantly impacts the quality of life and psychosocial well-being of adolescents and young adults. Specifically, teenagers, as compared to young adults, reported lower satisfaction with their appearance and lower self-acceptance before intervention, underscoring the profound psychosocial challenges that adolescents with craniofacial asymmetry may experience. These age-related differences underscore the importance of tailored interventions to address unique psychosocial needs at different developmental stages.

Emotional and Social Impact of Halitosis on Adolescents and Young Adults: A Systematic Review.

Background and Objectives: Halitosis is a condition characterized by unpleasant breath smell that is starting to receive serious scientific attention, considering it reflects on people's social and personal life. While most studies focus on the prevalence of halitosis, its medical etiology, and the psychological impact on adults, there is a lack of evidence regarding the social impact of halitosis on the younger population. Therefore, this systematic review aimed to observe the social and emotional impact that halitosis has on adolescents and young adults. Materials and Methods: The review followed the PRISMA protocol, and four electronic databases (Scopus, Scholar, Web of Science, and ProQuest) were searched. From a total of 593 studies retrieved, only 6 were included in the study after assessing the eligibility criteria. Results: The main results showed that the levels of self-reported halitosis ranged from 23.1% to 77.5%, with an average of 44.7%, indicating a significant heterogeneity among the studies reporting this issue. Adolescents and young adults who experienced bad breath were feeling more anxious and depressed according to the non-standardized questionnaires and the standardized questionnaires (OHIP-14 and SCL-9-R). The respondents were isolated from social interactions and consequently had lower self-esteem and impaired quality of life. Conclusions: The conclusions drawn indicate the need for action on a medical level, as well as on a psychological level, in order to improve people's oral health and help them navigate through the difficulties of maintaining social interactions as they live with halitosis.

Clinical Presentation and Risk Factors of Infective Endocarditis in the Elderly: A Systematic Review.

Infective endocarditis (IE) is a bacterial infection with high morbidity and mortality rates, particularly among the elderly. This systematic review was conducted to determine the clinical characteristics of IE in older adults and the risk factors that could lead to adverse outcomes. The research employed three databases (PubMed, Wiley, and Web of Science), with a primary search for studies that have described cases of IE in patients older than 65 years. From a total of 555 articles, 10 were selected for inclusion in the current study, comprising a total of 2222 patients with a confirmed diagnosis of IE. The primary findings were an increased incidence of staphylococcal and streptococcal infections (33.4% and32.0%, respectively), an increased prevalence of comorbidities, namely, cardiovascular disease, diabetes, and cancer, and a significantly greater mortality risk than the younger group. Regarding mortality risks, the pooled odds ratio for cardiac disorders was OR = 3.81, septic shock OR = 8.22, renal complications OR = 3.75, and advancing age OR = 3.54 were most frequently mentioned. Taking into consideration the fact that the majority of the elderly population suffers from significant complications and is unable to undergo surgery due to an increased risk of complications after the procedure, it is imperative that effective treatment methods should be investigated.

Eruption Timing and Sequence of Primary Teeth in a Sample of Romanian Children.

Teething is considered a significant event in the growth and development of the child by parents and especially by paediatric dentists and forensic scientists. They constantly need an "up-to-date mirror" of its variability for different geographic regions. The aims of the current study were to determine the timing and sequence of primary tooth emergence, and to establish a correlation between tooth eruption and general growth and external parameters in a sample of Romanian children. This study included 70 healthy children (53% girls and 47% boys), and the analysed data resulted from the questionnaires completed by parents during the whole process. General and specific data on primary teeth eruption were obtained. The differences between sexes were insignificant, except for the maxillary and mandibular canines (p = 0.047 and p = 0.018) and lower temporary second molars (p < 0.001), which were significantly increased in boys. The differences found between the two hemiarches were insignificant (p = 0.197). The mean age of eruption of the first tooth erupted was 7.07 ± 1.990 months. The unpaired t-test was used for comparison of the timings of eruption of the first primary teeth, according to the number of previous births and type of diet, and it was insignificant (p = 0.665 and p = 0.983 respectively).

Toxicological Assessment of an Acrylic Removable Orthodontic Appliance Using 2D and 3D In Vitro Methods.

Malocclusion is a global health problem, mainly affecting children and adolescents. For this reason, orthodontic treatment must be, on the one hand, safe, non-toxic, and effective and, on the other hand, it must have the best possible esthetic profile. Thus, the use of orthodontic appliances is addressed to all age groups, including young children, for a long period of time, which is why their safety profile is a matter of real interest. For this reason, the purpose of the present study was to evaluate the safety and biocompatibility of an acrylic removable orthodontic appliance made of polymethylmethacrylate and stainless steel alloy made by our team of researchers. To verify the biocompatibility of the medical device, it was immersed in artificial saliva with three different pHs (3, 7, and 10) for a period of ten days. Subsequently, the three types of saliva were tested on human keratinocytes (HaCaT cell line) in terms of viability and modification of cell morphology. Finally, the use of 3D reconstructed human epidermis verified the cytotoxic and irritating potential of the medical device, thus providing relevant information regarding its biocompatibility. The results revealed that by maintaining the orthodontic device in the saliva there is no release of substances with a toxic effect on the human keratinocytes and on the 3D reconstructed human epidermis. There were also no significant changes in cell morphology. In conclusion, it is suggested that the acrylic removable appliance has a safety profile recommended for in vivo use.

Radiographic methods for locating impacted maxillary canines.

Maxillary canine impaction is a fairly common phenomenon in dental practice. Most studies indicate its palatal position. For a successful orthodontic and∕or surgical therapy, it is necessary to correctly identify the impacted canine in the depth of the maxillary bone, using conventional and digital radiological investigations, each with their advantages and disadvantages. Dental practitioners must indicate the most "targeted" radiological investigation. This paper aims to review the various radiographic techniques available for determining the location of the impacted maxillary canine.

Space Maintainers Used in Pediatric Dentistry: An Insight of Their Biosecurity Profile by Applying In Vitro Methods.

Space maintainers have presented an increased interest due to their chemical composition which influences the electrochemical and electrolytic processes of the oral cavity, leading to important biological activity. The present study was purported to evaluate the biological in vitro activity of three types of space maintainers (S1, S2, and S3, differing from each other in terms of metal composition) used in pediatric dentistry, in terms of their antimicrobial effect and biosecurity profile using two types of keratinocytes (PGK: primary gingival keratinocytes, and HaCaT: human immortalized keratinocytes) by assessing the morphology, viability, cytotoxicity, and gene expression of the cells. Statistical differences were calculated by the one-way ANOVA test, followed by Tukey's post-test. Antimicrobial screening highlighted a dilution-dependent influence that, in the case of all strains tested, did not show inhibition or stimulation of bacterial growth. The in vitro evaluations revealed that the test samples did not induce important cytotoxic potential on both keratinocyte cell lines (HaCaT and PGK), with the cells manifesting no morphological alteration, a good viability rate (above 90%: PGK-S1, * p < 0.05), and a low cytotoxic activity (less than 11%: PGK, S1 *** p < 0.001 and S3 * p < 0.05; HaCaT, S1 ** p < 0.01). The data obtained in this study highlight the fact that the samples analyzed are biocompatible and do not develop the growth of the studied bacteria or encode the gene expression of primary and immortalized keratinocytes.

External cervical resorption: Radiological diagnosis and literature (Review).

External cervical resorption (ECR) is a relatively unknown and insidious pathology characterized by the loss of hard dental tissues such as: Enamel, cementum and dentine due to clastic function. It begins as a localized resorptive process that initiates on the area of the root beneath the epithelial attachment and the coronal part of the alveolar process, involving vital and non-vital tissues. Despite the fact that there are several potential predisposing factors related to ECR, its aetiology still remains poorly understood and more research is needed to establish the cause-and-effect relationship of all the etiological factors. Improved radiographic detection using cone-beam computed tomography (CBCT) is required in order to correctly classify and assess this entity. This provides a three-dimensional insight into the lesion, regarding the location, the size, the depth and the circumferential spread of the ECR defect. It also allows establishment of the most efficacious treatment plan and management. The purpose of this literature review is to cover the relevant literature concerning the etiology, pathogenesis, clinical and radiological presentation and management of ECRs (based on the CBCT findings).

Updating Standards of Facial Growth in Romanian Children and Adolescents Using the Anthropometric Method-A Pilot Study.

The anthropometric method is an important tri-dimensional and non-invasive assessment instrument for accurate diagnosis in paedodontics, orthodontics, and other medical fields. Our aim was to propose a technique that is accessible for clinicians and to determine the reference values for Romanian children and adolescents for the facial parameters selected. We proposed three basic instruments: a plastic compass, a ruler, and a digital caliper. Eighty-five children and adolescents (62% girls and 38% boys), aged between 3.5 and 14.5 years, were included in the study. We selected eight transversal, 12 vertical, and three sagittal measurements. Facial indices, according to Farkas L.G., were directly determined. The correlations between facial and general growth parameters, using Pearson correlation coefficient, for the entire sample were significant, direct, and strong for the following: Zy-Zy, Go-Go, N-Gn, N-Sn, Sto-Gn, Tr-Gn, Tr-Sn, Tr-Tr (r = 0.526-0.925, p < 0.001), and insignificant for Sn-Sto (r = 0.099-0.124, p > 0.354). The highest correlation coefficient is exhibited by Tr-Gn (r = 0.893 with height and r = 0.925 with weight). When performing a gender related comparison, we noticed that the vertical and transversal linear parameters and some facial indices are increased in boys (p < 0.05), depending on the age group. The simplified anthropometric technique represents an accessible method to every clinician, bringing important information related to dentofacial growth, diagnosis, and treatment planning in dentistry.

Conservative Approach in the Management of Large Periapical Cyst-Like Lesions. A Report of Two Cases.

Background and Objectives: Periapical cystic lesions are a pathology frequently addressed to endodontic specialists. Although their therapy is still not standardized, the treatment should be as conservative as possible and by endodontic means, as they are lesions of endodontic origin. The present case report describes two cases of upper central incisors with large cyst-like periapical lesions, and their one-year follow up. Materials and Methods: Endodontic orthograde treatment was performed under copious irrigation with sodium hypochlorite, in association with calcium hydroxide as an intra-canal medication for both teeth. Root canal filling was achieved in a separate appointment using the continuous wave of condensation technique. A decompression procedure was used in association with endodontic therapy in the second case to reduce the pressure inside the cystic lesion and to allow its drainage, and only because the root canal could not be dried three weeks after medication. Initial cone beam computed tomography (CBCT) investigations, as well as at the one-year follow up, were used to compare the evolution of the lesion. Results: Both cases had a favorable outcome. New bone formation in the periapical region and complete resolution of the lesion was observed at the one-year control in the first case. In the second case, although the lesion was still not completely healed at 12 months, a significant reduction in its size could be observed, showing active signs of healing. Conclusions: Endodontic treatment is the first choice option in the management of teeth with pulpal necrosis and large periapical cystic-like lesions. Decompression is the only surgical procedure recommended when the canals cannot be dried and obturated. Large surgical interventions are unnecessary in cases where endodontic treatment can be performed.

Prevention perspective in orthodontics and dento-facial orthopedics.

In the present context of the public health directions, considering WHO main objective, that "all people of the world could reach the highest possible health level", in medicine, the accent is put on prevention. In spite of the important progresses achieved in orthodontics field, the treatment still remains a symptomatic one. In this context, we must ask ourselves what are the prevention theoretical and practical coordinates in orthodontics, which measures are available or could be elaborated for preventing the malocclusions development. From the clinical point of view, the most important element of the new perspective is that most of the cases of anomalies which in the present are cured by orthodontics are induced by functional and environmental factors and they can theoretically be prevented. Thus, the identification, control and guidance of the environmental factors which adjust the growing of the maxillaries and of the other cranio-facial structures would be the main target of a prevention program in orthodontics.