Surgically accelerated orthodontic techniques and periodontal response: a systematic review.

BACKGROUND: Reduction in orthodontic treatment time is gaining popularity due to patient demands. Several new techniques of acceleratory orthodontic treatment have been introduced to effectively treat the malocclusion in a shorter time period with minimal adverse effects. OBJECTIVE: The objective of this systematic review is to critically evaluate the potential effect of accelerated surgically assisted orthodontic techniques on periodontal tissues. MATERIALS AND METHODS: Electronic databases used to perform the search were Medline (Ovid), EMBASE, PubMed, Scopus, Cochrane, Google Scholar, and hand searching of the literature was also performed. SELECTION CRITERIA: Only randomized control trials (RCTs) that assessed the relationship between accelerated surgically assisted orthodontic techniques and its effects on periodontium were included. DATA COLLECTION AND ANALYSIS: The Joanna Briggs Institute (JBI) critical appraisal checklist tool (2016) was used to assess the finally selected studies. Among these studies, five evaluated corticotomy-facilitated orthodontics, two tested accelerated tooth movement with piezocision, one compared corticotomy-facilitated orthodontics with piezocision, and one studied the effects of periodontally accelerated osteogenic orthodontics. The duration of these studies was relatively short and had moderate to high risk of bias. RESULTS: Literature search identified 225 records from 5 databases and 50 articles from the partial grey literature (Google scholar) search. Finally, nine eligible RCTs were included in the review. LIMITATIONS: Most of the included studies were of a high risk of bias due to high experimental heterogeneity and small sample size. Long-term follow-up of the periodontal response to these interventions was also lacking. CONCLUSIONS: There is an absence of evidence considering the lack of long-term follow-up and small sample size therefore, the results of this review should be carefully interpreted. IMPLICATIONS: Due to the need for more studies with less risk of bias, these techniques should be implemented in dental practice with caution. With stronger evidence, the study may be confirmed to provide quicker desired results for orthodontic patients. REGISTRATION: This study protocol was not registered. FUNDING: No funding was obtained for this systematic review.

The rescue of dentin matrix protein 1 (DMP1)-deficient tooth defects by the transgenic expression of dentin sialophosphoprotein (DSPP) indicates that DSPP is a downstream effector molecule of DMP1 in dentinogenesis.

Dentin matrix protein 1 (DMP1) and dentin sialophosphoprotein (DSPP) are essential for the formation of dentin. Previous in vitro studies have indicated that DMP1 might regulate the expression of DSPP during dentinogenesis. To examine whether DMP1 controls dentinogenesis through the regulation of DSPP in vivo, we cross-bred transgenic mice expressing normal DSPP driven by a 3.6-kb rat Col1a1 promoter with Dmp1 KO mice to generate mice expressing the DSPP transgene in the Dmp1 KO genetic background (referred to as "Dmp1 KO/DSPP Tg mice"). We used morphological, histological, and biochemical techniques to characterize the dentin and alveolar bone of Dmp1 KO/DSPP Tg mice compared with Dmp1 KO and wild-type mice. Our analyses showed that the expression of endogenous DSPP was remarkably reduced in the Dmp1 KO mice. Furthermore, the transgenic expression of DSPP rescued the tooth and alveolar bone defects of the Dmp1 KO mice. In addition, our in vitro analyses showed that DMP1 and its 57-kDa C-terminal fragment significantly up-regulated the Dspp promoter activities in a mesenchymal cell line. In contrast, the expression of DMP1 was not altered in the Dspp KO mice. These results provide strong evidence that DSPP is a downstream effector molecule that mediates the roles of DMP1 in dentinogenesis.

Proteolytic processing of dentin sialophosphoprotein (DSPP) is essential to dentinogenesis.

DSPP, which plays a crucial role in dentin formation, is processed into the NH(2)-terminal and COOH-terminal fragments. We believe that the proteolytic processing of DSPP is an essential activation step for its biological function in biomineralization. We tested this hypothesis by analyzing transgenic mice expressing the mutant D452A-DSPP in the Dspp-knock-out (Dspp-KO) background (referred to as "Dspp-KO/D452A-Tg" mice). We employed multipronged approaches to characterize the dentin of the Dspp-KO/D452A-Tg mice, in comparison with Dspp-KO mice and mice expressing the normal DSPP transgene in the Dspp-KO background (named Dspp-KO/normal-Tg mice). Our analyses showed that 90% of the D452A-DSPP in the dentin of Dspp-KO/D452A-Tg mice was not cleaved, indicating that D452A substitution effectively blocked the proteolytic processing of DSPP in vivo. While the expression of the normal DSPP fully rescued the dentin defects of the Dspp-KO mice, expressing the D452A-DSPP failed to do so. These results indicate that the proteolytic processing of DSPP is an activation step essential to its biological function in dentinogenesis.

Failure to process dentin sialophosphoprotein into fragments leads to periodontal defects in mice.

Dentin sialophosphoprotein (DSPP) plays a vital role in dentinogenesis. Previously, we showed that, in addition to dentin, DSPP is also highly expressed in alveolar bone and cellular cementum, and plays a crucial role in maintaining periodontal integrity; Dspp-deficient mice demonstrate severe periodontal defects, including alveolar bone loss, decreased cementum deposition, abnormal osteocyte morphology in the alveolar bone, and apical migration of periodontal ligament. Dentin sialophosphoprotein in dentin and bone is cleaved into NH2 -terminal and COOH-terminal fragments. Whilst our previous study showed that the proteolytic processing of DSPP is critical for dentinogenesis, it is unclear whether the post-translational cleavage of DSPP also plays an essential role in maintaining a healthy periodontium. In this study, we analyzed the periodontal tissues from transgenic mice expressing the uncleavable full-length DSPP in the Dspp knockout (Dspp-KO) background (named 'Dspp-KO/D452A-Tg mice'), in comparison with those from wild-type mice, Dspp-KO mice, and mice expressing the normal Dspp transgene in the Dspp-KO background (designated 'Dspp-KO/normal-Tg mice'). We found that transgenic expression of the normal DSPP fully rescued the periodontal defects of the Dspp-KO mice, whereas this was not the case in Dspp-KO/D452A-Tg mice. These results indicate that proteolytic processing of DSPP is essential to periodontal integrity.

The role of Dentin Sialophosphoprotein (DSPP) in craniofacial development.

DSPP is known to be important in the formation of dentin. In DSPP's absence, a severely hypomineralized dentin is formed, in a condition known as dentinogenesis imperfecta (DGI). DSPP has recently been found in several different tissues, including the mandibular condylar cartilage and craniofacial skeleton. However, there is limited literature on the role of DSPP in these tissues. Therefore, the objective of the present study was to investigate the role of DSPP in craniofacial development. Two mice strains, DSPP knockout and C57BL/6J wild type, were compared at 1, 3, and 6-months of age. Skulls and condyles were investigated through morphological and histological analyses. Cell culture was also conducted to investigate the potential effects of DSPP absence in osteoblasts from the calvaria. Mineralization defects were noticed in the structures of skulls and MCC, with the most significant impact at 1 month of age. Therefore, DSPP is an essential protein for the normal mineralization of craniofacial tissues.

Characterization of SIBLING Proteins in the Mineralized Tissues.

The SIBLING proteins are a family of non-collagenous proteins (NCPs) previously thought to be expressed only in dentin but have been demonstrated in other mineralized and non-mineralized tissues. They are believed to play vital roles in both osteogenesis and dentinogenesis. Since they are tightly regulated lifelong processes and involve a peak of mineralization, three different age groups were investigated. Fifteen wild-type (WT) mice were euthanized at ages 1, 3, and 6 months. Hematoxylin and eosin staining (H&E) was performed to localize various microscopic structures in the mice mandibles and tibias. The immunostaining pattern was compared using antibodies for dentin sialoprotein (DSP), dentin matrix protein 1 (DMP1), bone sialoprotein (BSP), and osteopontin (OPN). Immunostaining of DSP in tibia showed its most noticeable staining in the 3-month age group. DSP was expressed in alveolar bone, cellular cementum, and PDL. A similar expression of DMP1 was seen in the tibia and dentin. BSP was most noticeably detected in the tibia and acellular cementum. OPN was mainly expressed in the bone. A lower level of OPN was observed at all age groups in the teeth. The immunostaining intensity was the least detected for all proteins in the 6-month tibia sample. The expression patterns of the four SIBLING proteins showed variations in their staining intensity and temporospatial patterning concordant with skeletal and dental maturity. These findings suggest some role in this tightly regulated mineralization process.

Failure rates associated with guided versus non-guided dental implant placement: a systematic review and meta-analysis.

OBJECTIVE: The purpose of the systematic review and meta-analysis was to evaluate implant failure rates and their association with guided and free-hand implant placement techniques. MATERIALS AND METHODS: A literature search was conducted across PubMed, Medline via Ovid, Cochrane database, and Google Scholar. The search was completed in September 2020. Series of meta-analyses were conducted to compare implant failure rates with guided and free-hand techniques. RESULTS: A total of 3387 articles were identified from the electronic search. After applying the inclusion criteria, eight articles were selected for qualitative assessment and four for quantitative synthesis (meta-analysis). The included studies had a risk ratio of 0.29 (95% CI: 0.15, 0.58), P < 0.001 for the use of guided implant placement. Implant failure rates were affected by the different placement techniques indicated by the test for overall effect (Z = 3.53, P = 0.0004). The incidence of implant failure in guided surgery versus free-hand surgery was found to be 2.25% and 6.42%, respectively. CONCLUSION: Both guided and free-hand implant placement techniques resulted in a high implant survival rate. However, implant failure rates were almost three times higher in the free-hand implant placement category. A guided implant placement approach is recommended for a successful outcome.

The impact of vaping on periodontitis: A systematic review.

BACKGROUND AND OBJECTIVE: While tobacco cigarette smoking has been proven to be a risk factor for periodontitis, limited information is available regarding vaping, a new alternative to smoking that has been branded as less harmful. Several important in vitro studies have shown that vaping has a similarly damaging effect as cigarette smoking on the health of the periodontium. However, a comprehensive review is lacking in this field. Therefore, we aimed to systematically review the literature about the impact of vaping on periodontitis. METHODS: The research question was created using the PICOs format. A systematic search of the following electronic databases was performed up to March 2020: Medline, Embase, PubMed, Cochrane, and grey literature. Human studies that assessed periodontal status (plaque index, bleeding on probing, clinical attachment loss, marginal bone loss, and probing depth) in e-cigarette users compared to non-smokers (control group) were assessed based on an estimate of fixed effects. The weights of the studies were calculated based on their risks of bias. RESULTS: After duplicates were removed, 1,659 studies were screened and 8 case-control studies that investigated the relationship between vaping and periodontal parameters in humans were selected after their risk of bias assessment. Estimated effects of vaping after weighting results based on their standard deviation showed increased plaque, marginal bone loss, clinical attachment loss, pocket depth, and reduced bleeding on probing. CONCLUSION: This study concluded that there is not enough evidence to fully characterize the impacts of vaping on periodontitis. However, within the limitations of our review and the selected included studies, the available results point to increased destruction of the periodontium leading to the development of the disease.

Prevalence of Periodontitis in Young Populations: A Systematic Review.

PURPOSE: To assess the prevalence of periodontitis in young populations (previously termed aggressive periodontitis - AgP) and report on the earliest known occurrence of this disease. MATERIALS AND METHODS: A search was performed covering the last 18 years utilising the following databases: Medline (Ovid), PubMed and Embase. Four reviewers evaluated each study. Review findings were summarised using the PRISMA Statement for reporting and Joanna Briggs Institute (JBI) Critical Appraisal tools for quality assessment, respectively. Twenty-two articles were included in this systematic review, consisting of 6 prevalence studies and 16 case reports. Only prevalence studies were considered for prevalence estimates. RESULTS: The average reported prevalence of periodontitis in young populations was 1.7% (ranging from 0.66% in Argentina to 5.9% in Israel). The prevalence was higher for the localised form of this disease. Permanent teeth were the most common dentition affected (114 out of 115 affected patients). In terms of age, the prevalence was 0.6%, 0.8% and 1.6% for the age groups 2-12, 20-25 and 13-20, respectively. There was no significant difference noted between males and females. The earliest age diagnosed with periodontitis was 3 years 7 months. CONCLUSION: The prevalence of periodontitis in young patients is ranges widely, which could indicate populational predispositions, underdiagnosing or lack of standardisation in diagnosis.

Diagnosis of aggressive periodontitis: A dilemma?

Periodontitis is one of the leading causes of tooth loss in the adult population. This disease can be classified into various categories, and one of the most destructive amongst them is aggressive periodontitis (AgP). The incidence of AgP is lower than other types of periodontitis. However, it affects young individuals and can cause severe destruction of tooth-supporting structures including tooth loss if left untreated. The current classification for diagnosing periodontal disease was established by the American Academy of Periodontology (AAP) in 1999. This classification provided strict guidelines to aid in AgP diagnosis. These include three main factors: systemically healthy individual, rapid loss of clinical attachment, and familial aggregation. In spite of these specific guidelines, AgP diagnosis is often missed clinically due to various reasons. There is still a vast variation in the diagnostic criteria for identifying AgP and not all practitioners utilize the AAP guidelines for their diagnosis. Furthermore, the definition of the disease might be changing in the future to better represent the current understanding of the disease. Since early diagnosis and prompt treatment is key in treating these patients, it is important to have calibration in the diagnosis process. This review aims to identify sources of variation and ambiguity in diagnosing AgP among dental practitioners. For this purpose, we have conducted an extensive literature search and outlined the various diagnostic aids for AgP patients reported in the literature. Understanding and correcting these variations can simplify the diagnostic process leading to faster treatment of patients affected with AgP. This review also emphasizes the importance of minimizing the bias in identifying patients with AgP and highlights the best tools for this purpose.

Overexpressing the NH2-terminal fragment of dentin sialophosphoprotein (DSPP) aggravates the periodontal defects in Dspp knockout mice.

OBJECTIVE: Previous studies have shown that dentin sialophosphoprotein (DSPP) is not only essential to the formation and mineralization of dentin but also plays an important role in forming and maintaining a healthy periodontium. Under physiological conditions, DSPP is proteolytically processed into the NH2-terminal and COOH-terminal fragments, and these fragments are believed to perform different functions in the mineralized tissues. Previous studies in our group have demonstrated that the NH2-terminal fragment of DSPP inhibits the formation and mineralization of dentin, while the role of this fragment in periodontium is unclear. METHODS: We analyzed the periodontal tissues of the transgenic mice overexpressing the NH2-terminal fragment of DSPP in the Dspp knockout background (referred to as "Dspp KO/DSP Tg" mice), in comparison with wild type mice and Dspp knockout mice. The approaches used in this study included histology, micro-computed tomography, back scattered scanning electron microscopy and resin-casted scanning electron microscopy. RESULTS: Dspp KO/DSP Tg mice exhibited a greater reduction of the alveolar bone, more remarkably altered canalicular systems around the osteocytes, less cementum, more radical migration of the epithelial attachment towards the apical direction, and more severe inflammation in molar furcation region, than in the Dspp knockout mice. CONCLUSION: Overexpressing the NH2-terminal fragment of DSPP worsened the periodontal defects in Dspp knockout mice, indicating that the NH2-terminal fragment of DSPP may exert an inhibitory role in the formation and mineralization of hard tissues in the periodontium.