Development of a Minimum Data Set for Dental Implants Registry.

Objectives: Registries are powerful tools for the collection and distribution of valid and reliable data. The initial step in health information management is to design a minimum data set that can improve the collection of high-quality data from the registry. The present pilot study aimed to determine the optimal minimum data set for dental implants to effectively utilize at Tehran University of Medical Sciences, Tehran, Iran. Materials and Methods: This descriptive cross-sectional study was conducted in 2019 at Tehran University of Medical Sciences. A minimum data set checklist was developed based on our previous systematic review. The content validity of the minimum data set was approved by the recruited experts and the final minimum data set was established using the Delphi technique. Results: The minimum data set for dental implants consists of two separate sections - administrative and clinical data. The administrative portion includes two main segments: patient demographic data and clinic data, consisting of 12 data elements. The clinical part includes five main segments (patient clinical data, implant data, implant complications, implant loss, and implant follow-up), and contains 96 data elements. Conclusion: This study suggests a minimum set of data for dental implants that can aid in efficient management of information, facilitate evidence-based decision-making, and enable high-quality clinical research, evaluation of treatment results, monitoring, and benchmarking of care.

Design and Evaluation of Web-Based Dental Implant Registry (DIR) for Better Clinical Outcomes.

INTRODUCTION: Identification of dental implant system in undocumented patients is a major challenge for dentists due to the vast variety of tools and technologies that are used in dental care. It also takes a long time to identify the type of connection or length and diameter of implant. To obtain accurate and timely information, it is necessary to have a Dental Implant Registry (DIR). In the present study, a DIR was designed, developed, and evaluated at the Dental Implant Research Center of Tehran University of Medical Sciences. MATERIALS AND METHODS: This is an applied, developmental, and cross-sectional study that was conducted between 2018 and 2020. In the present study, after determining the objectives of DIR system, its conceptual model was designed by EDraw Max 7.9 software. Then, the registry was developed in Visual Studio 2018 environment with the C# programming language and, finally, it was evaluated by Nielsen's ten principles of usability assessment. RESULTS: After creating the registry, its data entry search and report functions were tested. Also, in the exploratory evaluation, the highest number of problems related to the principles of system clarity and compatibility between the system and real world was identified. CONCLUSION: The web-based DIR created in C# programming language has the ability to gather data, provide report with different access levels, and send text messages to patients for follow-up. This tool enables physicians to quickly identify the components of dental implant. The web-based DIR also provides support for health research, quality assessment, and dental performance assessment.

Comparison of bacterial disinfection efficacy using blue and red lights on dental implants contaminated with Aggregatibacter actinomycetemcomitans.

OBJECTIVES: The purpose of this study was to determine the bacterial disinfection efficacy of four photosensitizers (PSs; curcumin, riboflavin, toluidine blue O, and phycocyanin) with blue diode laser (Blue DL) and blue light-emitting diode (Blue LED) or Red DL and Red LED in dental implants contaminated with Aggregatibacter actinomycetemcomitans. MATERIALS AND METHODS: A total of 60 dental implants were contaminated with A. actinomycetemcomitans. All implants were then randomized into ten different disinfection modalities (n = 6 implants per group). The irradiation wavelength in Blue DL and Blue LED or Red DL and Red LED was 450, 430-460, 635, and 630 nm, respectively and its applied energy density was 60 J/cm2 in all groups. Group IX was served as the control group and in group X disinfection was performed with 0.2% chlorhexidine. After the treatments, the colony forming units (CFUs)/ml were calculated to determine antimicrobial effects of each treatment. RESULTS: All disinfection methods significantly reduced bacteria amounts of dental implants inoculated with A. actinomycetemcomitans compared to control group. The CFU/ml in LED group was significantly lower than the DL in all studied groups. CONCLUSION: aPDT could be an effective supplement in dental implants disinfection. The LED, proved to be better in reducing CFU/ml of A. actinomycetemcomitans on dental implants surface than DL.

Nanostructures as Targeted Therapeutics for Combating Oral Bacterial Diseases.

Pathogenic oral biofilms are now recognized as a key virulence factor in many microorganisms that cause the heavy burden of oral infectious diseases. Recently, new investigations in the nanotechnology field have propelled the development of novel biomaterials and approaches to control bacterial biofilms, either independently or in combination with other substances such as drugs, bioactive molecules, and photosensitizers used in antimicrobial photodynamic therapy (aPDT) to target different cells. Moreover, nanoparticles (NPs) showed some interesting capacity to reverse microbial dysbiosis, which is a major problem in oral biofilm formation. This review provides a perspective on oral bacterial biofilms targeted with NP-mediated treatment approaches. The first section aims to investigate the effect of NPs targeting oral bacterial biofilms. The second part of this review focuses on the application of NPs in aPDT and drug delivery systems.

Dental implant quality registries and databases: A systematic review.

BACKGROUND: The importance of dental implant quality register has been well-documented. However, no systematic review conducted on dental implant quality register can be found in the literature. Therefore, the purpose of this study was to study the existed dental implant quality registries to explain the goals, data elements, and reports of dental implant quality registries. MATERIALS AND METHODS: This systematic study was conducted in PubMed, Scopus, Web of Science, and Embase databases. For evaluating dental implant quality registers, all studies in the English language were examined with no time limitation. Case reports, conference abstracts, and letters to the editor were excluded. The analysis of the quality of the studies was done by the STrengthening the Reporting of OBservational studies in Epidemiology checklist. RESULTS: The primary search identified 5565 articles. After eliminating duplicate articles and articles that did not meet the inclusion criteria and reviewing 40 full texts, 11 studies were included in this study. In this review, seven countries as Sweden, the USA, Canada, Germany, Finland, Australia, and South Korea had dental implant quality registers. Furthermore, the goals of dental implant quality registers were classified into the categories of research, epidemiology, administrative, clinical, and surveillance. CONCLUSION: The results of this study provide dentists and other stakeholders useful information on the existed dental implant quality registers and databases worldwide. It also provides a framework of the goals, data elements, and reports of dental implant quality registry. The establishment of dental implant quality register will be beneficial for societies and also allows them to control the complications of dental implants in future.

Linear Momenta Transferred to the Dental Implant-Bone and Natural Tooth-PDL-Bone Constructs Under Impact Loading: A Comparative in-vitro and in-silico Study.

During dental trauma, periodontal ligament (PDL) contributes to the stability of the tooth-PDL-bone structure. When a dental implant is inserted into the bone, the dental implant-bone construct will be more prone to mechanical damage, caused by impact loading, than the tooth-PDL-bone construct. In spite of the prevalence of such traumas, the behavioral differences between these two constructs have not been well-understood yet. The main goal of this study was to compare the momentum transferred to the tooth-PDL-bone and dental implant-bone constructs under impact loading. First, mechanical impact tests were performed on six canine mandibles of intact (N = 3) and implanted (N = 3) specimens using a custom-made drop tower apparatus, from release heights of 1, 2, and 3 cm. Next, computed tomography-based finite element models were developed for both constructs, and the transferred momenta were calculated. The experimental results indicated that, for the release heights of 1, 2, and 3 cm, the linear momenta transferred to the dental implant-bone construct were 33.1, 31.0, and 27.5% greater than those of the tooth-PDL-bone construct, respectively. Moreover, results of finite element simulations were in agreement with those of the experimental tests (error <7.5%). This work tried to elucidate the effects of impact loading on the dental implant-bone and tooth-PDL-bone constructs using both in-vitro tests and validated in-silico simulations. The findings can be employed to modify design of the current generation of dental implants, based on the lessons one can take from the biomechanical behavior of a natural tooth structure.

Photo-sonodynamic antimicrobial chemotherapy via chitosan nanoparticles-indocyanine green against polymicrobial periopathogenic biofilms: Ex vivo study on dental implants.

BACKGROUND: Antimicrobial photodynamic therapy (aPDT) is a treatment to deal with microorganisms, which is limited to treating microbial biofilms due to poor light penetration. Sonodynamic antimicrobial chemotherapy (SACT) can be used for circumventing the limitations of aPDT to inhibit the polymicrobial biofilms. The objective of this study has been focused on the simultaneous use of aPDT and SACT, which is called photo-sonodynamic antimicrobial chemotherapy (P-SACT) to inhibit the biofilms of periopathogens bacteria on surfaces of the titanium dental implants. MATERIALS AND METHODS: Following synthesis and confirmation of Chitosan Nanoparticles-Indocyanine green (CNPs-ICG) as photo-sonosensitizer, the mature biofilm model of the polymicrobial synergism of periopathogens was formed on the surface of the titanium dental implants. The quantitative and qualitative evaluations of periopathogens biofilms were performed using microbial viability and scanning electron microscopy analysis of the following groups of treatment modalities (n = 5): 1- Control (periopathogens biofilm without treatment), 2- ICG, 3- CNPs-ICG, 4- diode laser, 5- aPDT/ICG, 6- aPDT/CNPs-ICG, 7- ultrasound, 8- SACT/ICG, 9- SACT/CNPs-ICG, 10- PSACT/ICG, 11- PSACT/CNPs-ICG, and 12-0.2% chlorhexidine (CHX). RESULTS: A significant reduction in the log10 CFU/mL of periopathogens was observed in the groups treated with aPDT/ICG, aPDT/CNPs-ICG, SACT/ICG, SACT/CNPs-ICG, PSACT/ICG, PSACT/CNPs-ICG, and 0.2% CHX up to 5.3, 6.5, 5.6, 6.6, and 8.8 log, respectively, when compared with control group (P < 0.05). PSACT/CNPs-ICG group demonstrated significantly higher capacity in eliminating the periopathogens biofilm compared with other groups (P < 0.05). However, there was no significant difference between PSACT/CNPs-ICG and 0.2% CHX (P > 0.05). Microscopic images revealed that biofilms treated with PSACT were comprised mainly of deformed and dead cells. CONCLUSIONS: These results highlight the potential of PSACT/CNPs-ICG for the decontamination of the dental implant surfaces from the polymicrobial synergism of periopathogens biofilm.

Effect of Antimicrobial Photodynamic Therapy Using Indocyanine Green Doped with Chitosan Nanoparticles on Biofilm Formation-Related Gene Expression of Aggregatibacter actinomycetemcomitans.

OBJECTIVES: Eradication of Aggregatibacter actinomycetemcomitans (A. actionmycetemcomitans), as an opportunistic periodontopathogen, and inhibition of its virulence factor expression require a new adjunctive therapeutic method. In this study, we accessed the expression level of rcpA gene, as a virulence factor associated with A. actinomycetemcomitans biofilm formation, following treatment by antimicrobial photodynamic therapy (aPDT) using indocyanine green (ICG) doped with chitosan nanoparticles (CS-NPs@ICG). MATERIALS AND METHODS: CS-NPs@ICG was synthesized and examined using scanning electron microscopy (SEM). A. actinomycetemcomitans ATCC 33384 strain was treated with CS-NPs@ICG, as a photosensitizer, which was excited with a diode laser at the wavelength of 810 nm with the energy density of 31.2 J/cm2. Quantitative real-time polymerase chain reaction (qRT-PCR) was performed to determine the changes in rcpA gene expression level. RESULTS: Synthetized CS-NPs@ICG was confirmed via SEM. The results revealed that CS-NPs@ICG-mediated aPDT could significantly decrease rcpA gene expression to 13.2-fold (P<0.05). There was a remarkable difference between aPDT using CS-NPs@ICG and ICG (P<0.05). The diode laser, ICG, and CS-NPs@ICG were unable to significantly downregulate rcpA gene expression (P>0.05). CONCLUSION: aPDT with CS-NPs@ICG leads to a decrease of the virulence factor of A. actinomycetemcomitans and can be used as an adjunct to routine treatments for successful periodontal therapy in vivo.

The impact of Aggregatibacter actinomycetemcomitans biofilm-derived effectors following antimicrobial photodynamic therapy on cytokine production in human gingival fibroblasts.

BACKGROUND: Antimicrobial photodynamic therapy (aPDT) is an effective adjunctive therapeutic modality for the treatment of local infections, including periodontitis and peri-implantitis. After receiving aPDT, microbial cells in the biofilm structure may produce and/ or release soluble biofilm-derived effectors (BDEs), which may affect the biology of the host cells in the community context of their surrounding microenvironment. Given the fact that no study has investigated the role of BDEs following aPDT in the pathogenesis of infectious diseases, the aim of the current study was to determine the effect of BDEs of Aggregatibacter actinomycetemcomitans following exposure to sub-lethal doses of indocyanine green (ICG)-aPDT on human gingival fibroblasts (HGFs) in terms of cytokines produced. MATERIALS AND METHODS: In this study, we evaluated the effect of biofilm-conditioned medium (BCM) resulting from the treatment of A. actinomycetemcomitans biofilm with a sub-lethal dose of aPDT on cytokines production, including IL-6, IL-8, CXCL10, TGF-ß, and bFGF of HGFs using enzyme-linked immunoassays (ELISA). The sensitivity of cytokines to BDEs was determined by micro-titer plates. RESULTS: The maximal sub-lethal dose of ICG-PDT was 20.15 µM/mL ICG at a fluence of 31.2 J/cm2. The BCM of ICG-PDT-treated viable A. actinomycetemcomitans significantly reduced IL-6, IL-8, and CXCL10 levels compared to the BCM of untreated viable A. actinomycetemcomitans (78-, 93-, and 61.6-fold reduction, respectively; all P < 0.01). TGF-ß and bFGF were strongly induced by BCM of ICG-PDT treated viable A. actinomycetemcomitans (by 57.7 and 36.1 folds, respectively; both P < 0.05). The BCM of untreated viable A. actinomycetemcomitans degraded most of the CxCL10, TGF-ß and bFGF (58.8, 61.5, and 71.6%, respectively) in 24 h, while it degraded 9.3% of IL-6 and 15.1% of IL-8 after 24 h. CONCLUSION: The results of the current study revealed that a sub-lethal dose of ICG-aPDT through the effect of BCM on HGFs could not only significantly reduce the production of pro-inflammatory cytokines but also promoted their role in periodontal regeneration due to increasing the bFGF level. Altogether, ICG-aPDT, with it's antimicrobial effects reduces inflammation and induces of tissue regeneration resulting from BCM, can be considered an efficient adjunctive therapeutic method for the treatment of local infections.

Antimicrobial photodynamic therapy assessment of three indocyanine green-loaded metal-organic frameworks against Enterococcus faecalis.

BACKGROUND: Antimicrobial photodynamic therapy (aPDT) has emerged as one of the promising non-invasive adjuvant treatments of endodontic infections. The key part of this technique is application of an optimized nontoxic photosensitizer (PS), like indocyanine green (ICG) which when activated by light can destroy bacterial contaminants. Notwithstanding all featured properties of ICG, this PS mainly suffers from the lack of stability and concentration-dependent aggregation. A variety of nanomaterials (NMs) has been widely exploited to improve the stability and efficiency of ICG. The objective of this study was to evaluate and compare the efficiency of three high capacious metal organic frameworks (MOFs) to produce MOF-ICG as novel PSs improving ICG loading, stability and antimicrobial activity. This is first report on ICG-loaded MOFs for aPDT against endodontic infections. MATERIALS AND METHODS: Three different nano-MOFs were synthesized (denoted as Fe-101, Al-101 and Fe-88), and employed for ICG loading (MOF-ICG). The stability of immobilized ICG, antimicrobial and anti-biofilm properties of MOF-ICG against Enterococcus faecalis (E. faecalis) as one of the main factors of endodontic infections as well as expression ratio of the esp gene in E. faecalis were evaluated. RESULTS: Fe-101 and Al-101 showed acceptable ICG loading (ICG loading capacity of 16.93 ± 0.32 and 18.17 ± 0.31, respectively) as well as considerable enhanced aqueous stability (percent of degradation were only 14% and 17%, respectively) in comparison to free ICG (percent of degradation was 95%) after 10 days. ICG-free MOFs could surprisingly suppress the viability of E. faecalis after laser irradiation up to 18.1%, 28.8%, and 38.3% for Al-101, Fe-88 and Fe-101, respectively. ICG loaded MOFs mediated aPDT could significantly reduce the count of E. faecalis to 60.72%, 45.12%, and 62.67%, respectively (p < 0.05). The Fe-88-ICG-PDT, Fe-101-ICG-PDT and Al-101-ICG-PDT considerably dropped the biofilm formation of E. faecalis by 37.54%, 47.01% and 53.68% (p < 0.05). The expression of esp gene was also remarkably declined to 4.4-, 6.0- and 6.2-fold after aPDT in the presence of Fe-88-ICG, Al-101-ICG and Fe-101-ICG, respectively (P < 0.05). CONCLUSION: Owing to the significant features of the Fe-101 including acceptable ICG loading and stability, as well as reasonable antimicrobial effect after ICG loading in comparison to free ICG, it could be considered as a promising nano-PSs in aPDT to remove E. faecalis.

Association between vitamin D receptor gene polymorphisms (Fok1 and Bsm1) and osteoporosis: a systematic review.

Osteoporosis is a health concern characterized by reduced bone mineral density (BMD) and increased risk of fragility fractures. Many studies have investigated the association between genetic variants and osteoporosis. Polymorphism and allelic variations in the vitamin D receptor gene (VDR) have been found to be associated with bone mineral density. However, many studies have not been able to find this association. Literature review was conducted in several databases, including MEDLINE/Pubmed, Scopus, EMBASE, Ebsco, Science Citation Index Expanded, Ovid, Google Scholar, Iran Medex, Magiran and Scientific Information Database (SID) for papers published between 2000 and 2013 describing the association between Fok1 and Bsm1 polymorphisms of the VDR gene and osteoporosis risk. The majority of the revealed papers were conducted on postmenopausal women. Also, more than 50% studies reported significant relation between Fok1, Bsm1 and osteoporosis. Larger and more rigorous analytical studies with consideration of gene-gene and gene-environment interactions are needed to further dissect the mechanisms by which VDR polymorphisms influence osteoporosis.