Confocal microscopy in oral cancer and oral potentially malignant disorders: A systematic review.

OBJECTIVE: To systematically identify and summarise current research on the utility of confocal microscopy in oral squamous cell carcinoma and oral epithelial dysplasia in oral potentially malignant disorders. METHODS: Databases Medline, Embase, Evidence-Based Medicine, and Web of Science were searched with articles screened and included if their primary objective was the use of a confocal microscope in diagnosis of oral cancer or epithelial dysplasia, in vivo or ex vivo. RESULTS AND DISCUSSION: Twenty-eight relevant studies were identified of which 21 studies included oral squamous cell carcinoma specimens. Fifteen studies included in vivo use. The studies included both qualitative and fluorescence confocal microscope and reflectance confocal microscope analysis along with quantitative analysis of carcinoma and dysplasia. Thirteen studies reported the predictive value of their confocal device in the diagnosis of dysplasia and carcinoma. The quantitative software-based studies show promise in objectifying the diagnostic process for identifying abnormalities within the microstructure of the oral mucosa. CONCLUSIONS: There was heterogeneity in the criteria for diagnosis of dysplasia and oral squamous cell carcinoma with experience levels of assessors impacting method efficacy. Both qualitative and quantitative confocal assessment methodologies have been explored, the latter highlighting the potential of future machine-augmented diagnostic precision.

Patient satisfaction with esthetics, phonetics, and function following implant-supported fixed restorative treatment in the esthetic zone: A systematic review.

OBJECTIVE: To determine patient satisfaction with esthetics, phonetics, and function following implant-supported fixed restorative treatment in the esthetic zone by measuring the Oral Health Related Quality of Life (OHRQoL). MATERIALS AND METHODS: This systematic review follows the "Preferred reporting items for systematic review and meta-analysis protocols" (PRISMA-P) 2015 statement. Studies were searched in the databases Ovid, PubMed, Web of Science, Scopus, and the Cochrane Library. The quality of the studies included in the review was scored using the GRADE system. The impact of the findings was analyzed by calculating effect size and standardization of results across different OHRQoL measurements was achieved by calculating the percentage equivalent. RESULTS: A total of 13 studies were selected to be included in his systematic review after application of the inclusion criteria. A total of six studies recorded pre- and post-treatment OHRQoL results, while the remaining seven studies provided only post-treatment results. CONCLUSIONS: This review concluded that implant-supported fixed restorations in the esthetic zone have an overall positive impact on OHRQoL. However, patient satisfaction from this treatment reduced as the number of missing teeth replaced by implants was increased. CLINICAL SIGNIFICANCE: When implant-supported fixed restorations are being planned in the esthetic zone, dentists need to consider the patient's perception and the subsequent impact of these restorations on the patient's quality of life. Clinicians can be assured that patient OHRQoL will increase; however, clinicians should also keep in mind the importance of the gingival frame. Furthermore, they should be aware of the challenges when planning cases with larger numbers of implants in the esthetic zone as this could lead to a lowering of a patient QoL.

Acquisition and annotation in high resolution in vivo digital biopsy by confocal microscopy for diagnosis in oral precancer and cancer.

Introduction: Scanned fibre endomicroscopes are full point-scanning confocal microscopes with submicron lateral resolution with an optical slice thickness thin enough to isolate individual cell layers, allow active positioning of the optical slice in the z-axis and collection of megapixel images. Here we present descriptive findings and a brief atlas of an acquisition and annotation protocol high resolution in vivo capture of oral mucosal pathology including oral squamous cell carcinoma and dysplasia using a fluorescence scanned fibre endomicroscope with 3 topical fluorescent imaging agents: fluorescein, acriflavine and PARPi-FL. Methods: Digital biopsy was successfully performed via an acquisition protocol in seventy-one patients presenting for investigation of oral mucosal abnormalities using a miniaturized, handheld scanned fibre endoscope. Multiple imaging agents were utilized and multiple time points sampled. Fifty-nine patients had a matched histopathology correlating in location with imaging. The images were annotated back to macrographic location using a purpose-built software, MouthMap™. Results: Acquisition and annotation of cellular level resolved images was demonstrated with all 3 topical agents. Descriptive observations between clinically or histologically normal oral mucosa showed regular intranuclear distance, a regular nuclear profile and fluorescent homogeneity. This was dependent on the intraoral location and type of epithelium being observed. Key features of malignancy were a loss of intranuclear distance, disordered nuclear clustering and irregular nuclear fluorescence intensity and size. Perinuclear fluorescent granules were seen in the absence of irregular nuclear features in lichenoid inflammation. Discussion: High resolution oral biopsy allows for painless and rapid capture of multiple mucosal sites, resulting in more data points to increase diagnostic precision. High resolution digital micrographs can be easily compared serially across multiple time points utilizing an annotation software. In the present study we have demonstrated realization of a high-resolution digital biopsy protocol of the oral mucosa for utility in the diagnosis of oral cancer and precancer..