Effect of collagen sponge and flowable resin composite on pain management after free gingival graft harvesting: A randomized controlled clinical trial.

The aim of this study was to compare the effect of the application of a flowable resin composite coating, over a collagen sponge stabilized with suture, on postoperative pain after free gingival graft harvesting. Thirty-two free gingival grafts were harvested from the palate in 32 patients, who were subsequently randomized to have only a collagen sponge stabilized with sutures applied to the palatal wound (control), or to have the collagen sponge coated with a flowable resin composite (test). Patients were observed for 14 days, and the pain level was evaluated by using a numerical rating scale. The consumption of analgesics during the postoperative period and the characteristic of the graft were also analyzed. The patients in the test group reported having experienced significantly less pain statistically than the patients in the control group throughout the study. The consumption of analgesics was lower in the test group. The dimensions of harvested grafts in the control and test groups showed no significant differences in height, width, and thickness. In conclusion, the addition of flowable resin composite coating to the hemostatic collagen sponge on the palatal wound following free gingival graft harvesting helped to minimize postoperative pain.

Influence of graft thickness on tunnel technique procedures for root coverage: a pilot split-mouth randomized controlled trial.

OBJECTIVE: To compare the clinical outcomes of the tunnel technique (TUN) combined with either thin connective tissue graft (CTG) (TUN + thin CTG) (1 mm) or thick CTG (TUN + thick CTG) (2 mm) for the treatment of localized gingival recession (GR). MATERIAL AND METHODS: Twelve patients, with 24 maxillary localized type RT1 GR were randomly assigned into two groups. Clinical, esthetic, and patient-reported outcomes were evaluated at baseline and at 6-month follow-up. RESULTS: The TUN + thin CTG group showed a higher mean GR reduction (1.53 ± 0.66) (primary outcome variable) than the TUN + thick CTG group (1.44 ± 0.89), but no statistically significant difference was detected at the 6-month follow-up (p = 0.77). No statistically significant differences were found between TUN + thin CTG and TUN + thick CTG concerning complete root coverage (CRC) (58.3% versus 41.7%, respectively), gingival ticknness (GT) or Root-coverage Esthetic Score (RES) at 6 months. Regarding patient-reported outcomes, both groups reported having experienced similar pain at 7 days (p > 0.05). No statistically significant differences were found between the groups in the analysis of the aesthetic score. CONCLUSION: Both treatments showed a similar reduction in GR. In addition, similar CRC, GT, RES, pain and self-reported esthetics were achieved in both groups. CLINICAL RELEVANCE: Application of thin CTG provided a similar result than thick CTG for the treatment of RT1 localized GR.

Clinical efficacy of lip repositioning technique and its modifications for the treatment of gummy smile: systematic review and meta-analysis.

OBJECTIVE: To systematically review the literature regarding the clinical efficacy of reducing excessive gingival display (EGD) using the surgical lip repositioning technique (LRT) and its modifications. The question to address was: "What is the clinical efficacy of the surgical LRT and its modifications in patients with EGD?" MATERIAL AND METHODS: Four databases (MEDLINE-PubMed, Scopus, EMBASE, and CENTRAL) were searched up to December 2021 (PROSPERO-CRD42020205987). Randomized, non-randomized controlled and prospective case series with a minimum of 6-month follow-up were eligible for inclusion. Two meta-analyses were performed using the mean difference (MD) between baseline and different follow-up periods (6 and 12 months). Subgroup analyses were performed using the different modifications of LRT. RESULTS: The electronic research retrieved 783 studies. Only 13 met the inclusion criteria and were included in the statistical analysis. Six modifications of the original LRT were identified. An overall EGD reduction of -3.06 mm (95%CI: -3.71-2.40), -2.91 mm; (95%CI: -3.66-2.15) and -2.76 mm; (95%CI: -3.83--1.70) was achieved after 6, 12, and 36 months, respectively, compared to baseline (P < 0.01). Meta-analysis revealed that the use of LRT with periosteal suturing showed the greatest decrease in EGD with 5.22 mm (95% CI: 4.23-6.21; P < 0.01) at 6 months and 4.94 mm (95% CI: 3.86-6.02; P < 0.01) at 12 months. CONCLUSIONS: Both the original LRT and its different modifications reduce EGD and provide good results and overall patient satisfaction at 6, 12, and 36 months of follow-up. CLINICAL RELEVANCE: Evaluating the different modifications of the LRT can be a guiding aspect for the clinical and surgical approach to be used in patients with EGD.

Analysis of YFP(J16)-R6/2 reporter mice and postmortem brains reveals early pathology and increased vulnerability of callosal axons in Huntington's disease.

Cumulative evidence indicates that the onset and severity of Huntington's disease (HD) symptoms correlate with connectivity deficits involving specific neuronal populations within cortical and basal ganglia circuits. Brain imaging studies and pathological reports further associated these deficits with alterations in cerebral white matter structure and axonal pathology. However, whether axonopathy represents an early pathogenic event or an epiphenomenon in HD remains unknown, nor is clear the identity of specific neuronal populations affected. To directly evaluate early axonal abnormalities in the context of HD in vivo, we bred transgenic YFP(J16) with R6/2 mice, a widely used HD model. Diffusion tensor imaging and fluorescence microscopy studies revealed a marked degeneration of callosal axons long before the onset of motor symptoms. Accordingly, a significant fraction of YFP-positive cortical neurons in YFP(J16) mice cortex were identified as callosal projection neurons. Callosal axon pathology progressively worsened with age and was influenced by polyglutamine tract length in mutant huntingtin (mhtt). Degenerating axons were dissociated from microscopically visible mhtt aggregates and did not result from loss of cortical neurons. Interestingly, other axonal populations were mildly or not affected, suggesting differential vulnerability to mhtt toxicity. Validating these results, increased vulnerability of callosal axons was documented in the brains of HD patients. Observations here provide a structural basis for the alterations in cerebral white matter structure widely reported in HD patients. Collectively, our data demonstrate a dying-back pattern of degeneration for cortical projection neurons affected in HD, suggesting that axons represent an early and potentially critical target for mhtt toxicity.

Resistance to torsion of cement vs screw-retained abutments under a tangential load: A pilot study.

AIM: To compare the resistance to torsion between two implant systems with internal hexagon connection, one using screw-retained abutments (Titanium Fix) and the other using cementable abutments (ITEC) under a tangential load. MATERIALS AND METHODS: An in vitro experimental study was carried out. Fourteen implants, seven implants from each system, were included in this study. The implants were placed at a 45-degree angle into metal blocks to simulate their position in the maxilla. Then, implants were subjected to a resistance test on a CMT5L universal testing machine, and the maximum load was applied to each sample. The maximum force with which the torsion was achieved in each sample was analyzed. The data were tested using the Shapiro-Wilk test and showed normal distribution. Student t-test was used to examine statistical significance between the two groups, and the p-value was set at P < 0.05. RESULTS: There was a statistically significant difference between the two groups (P = 0.001). ITEC implants with a cementable abutment showed greater flexural strength compared to the Titanium fix with a screwed abutment implant system. CONCLUSIONS: The cemented abutment showed more resistance to torsion against a tangential load in comparison with the screwed abutment.

The benefits of propolis in periodontal therapy. A scoping review of preclinical and clinical studies.

ETHNOPHARMACOLOGICAL RELEVANCE: The treatment of periodontal disease (PD) is aimed at adequate control of bacterial plaque. In many patients mechanical methods are unable to eliminate this plaque leading to the need for adjuvant chemical products. Propolis is a natural product that has demonstrated therapeutic properties and has shown to be effective as an anti-inflammatory and antibacterial agent in dentistry. AIM OF THE STUDY: Considering the beneficial effects of propolis on various oral conditions, this study aimed to review, update and summarize the available evidence on the benefits of propolis in in vitro studies, animal models, and human clinical trials on non-surgical periodontal therapy. MATERIALS AND METHODS: An electronic search in three databases was performed up to December 2021. The search strategy included the terms "propolis" and "periodontal disease" to identify relevant studies on the potential advantages of propolis in periodontal therapy in in vitro studies, animal models, and human clinical trials. RESULTS: The search yielded 538 results, discarding 459 studies that did not clearly meet the inclusion criteria. A total of 42 studies were included: 18 in vitro, one animal, and 23 randomized clinical trials. In vitro studies have demonstrated that propolis has antimicrobial activity against periodontal pathogens and clinical studies have reported its use as an adjunct to non-surgical periodontal therapy. The clinical effects of propolis have been reported in conjunction with prophylaxis, polishing, and scaling and root planing (SRP). It has shown to have anti-plaque activity and improve gingival health. Propolis was found to be more effective in improving clinical parameters than conventional treatment (SRP alone) and demonstrated similar efficacy in treating chronic periodontitis compared to positive controls. Only one study reported an allergic reaction. CONCLUSION: The evidence available on the benefits of propolis in in vitro studies, animal models, and clinical trials suggests that propolis could be a promising adjunct to conventional therapy of gingivitis and periodontitis. However, further studies are needed to determine its superiority to other therapies in the treatment of PD.

Preclinical Evidence for the Use of Oral Mesenchymal Stem Cell-Derived Extracellular Vesicles in Bone Regenerative Therapy: A Systematic Review.

The development of extracellular vesicles (EVs) therapies has revolutionized personalized medicine, opening up new possibilities for treatment. EVs have emerged as a promising therapeutic tool within this field due to their crucial role in intercellular communication across various cell types and organisms. This systematic review aims to evaluate the therapeutic potential of oral mesenchymal stem cell (MSC)-derived EVs for bone regeneration, specifically focusing on findings from preclinical models. Sixteen articles meeting the inclusion criteria were selected following document analysis. The biological effects of oral MSC-derived EVs predominantly involve the upregulation of proteins associated with angiogenesis, and inflammation resolution, alongside the downregulation of proinflammatory cytokines. Moreover, these therapeutic agents have been found to contain a significant quantity of different molecules (proteins, lipids, DNA, microRNAs, etc) further contributing to their modulatory potential. The findings from this systematic review underscore that oral MSC-derived EVs, irrespective of their specific population, have the ability to enhance the osteogenic repair response in maxillary bone or periodontal defects. In summary, this systematic review highlights the promising potential of oral MSC-derived EVs for bone regeneration based on evidence from preclinical models. The comprehensive assessment of their biological effects and the presence of microRNAs underscores their therapeutic significance. These findings support the utilization of oral MSC-derived EVs in enhancing the osteogenic repair response in various maxillary bone or periodontal defects, providing insights into the mechanisms involved and potential therapeutic applications in the field of personalized medicine.

Clinical-Epidemiological Profile of Dental Professionals Associated with COVID-19 Infection in Southern Peru: A Cross-Sectional Study.

Dental professionals have been identified as being at high risk for COVID-19 infection due to close contact with patients and the nature of dental treatments. However, the prevalence of infected dentists in Peru has not been determined. An online electronic survey was sent to dentists registered with the College of Dentists of Arequipa to collect sociodemographic data, medical conditions, and employment characteristics during the COVID-19 pandemic. The clinical characteristics and adverse effects of dentists diagnosed with COVID-19 were also recorded. The overall prevalence of COVID-19 infection was 44%. The highest number of diagnosed patients ranged in age from 31 to 40 years (n = 111; 48.9%). A total of 45.9% of female and 41.6% of male dentists were diagnosed with COVID-19 (p = 0.425). A relationship was found between the district of origin and infection, and dentists working in the public sector during 2021 showed a greater trend of becoming infected (57.6%) (p < 0.05). The antigen swab test was the diagnostic test most frequently used (38%), and cough was the symptom most reported. Only 0.6% reported being hospitalized, 10.6% reported needing oxygen during hospitalization, and 0.6% were admitted to an intensive care unit. As in previous studies in other countries, the rate of COVID-19 infection among Peruvian dentists is high. It is recommended that dentists carry out infection control measures while ministries of health and dental associations take measures to ensure their safety.

Povidone-Iodine Solution: A Potential Antiseptic to Minimize the Risk of COVID-19? A Narrative Review.

OBJECTIVES: Patients are mask-free during dental attention. In addition, dentists and dental staff after working for hours need to hydrate or eat. Removing the mask makes them vulnerable to the risk of contamination. For those cases, a prophylactic decontamination protocol could be useful as an adjunct to the most recommended biosecurity protocols. This article aims to provide a comprehensive review of the published evidence about the use of povidone-iodine (PVP-I) against SARS-CoV-2 and to propose a prophylactic protocol for dental attention using PVP-I during the COVID-19 pandemic. MATERIALS AND METHODS: An electronic search in Medline via PubMed, Scopus, Cochrane Library and Scielo databases was performed up to July 24, 2020, to identify relevant literature focusing on Povidone Iodine, SARS-CoV-2, COVID-19, SARS-COV, MERS, antiviral mouthwashes, and oral cavity. RESULTS: Clinical studies on the virucidal effectiveness of PVP-I against SARS-CoV-2 have not yet been reported. We identify a recent in vitro study showing PVP-I effectiveness at 0.5, 1, and 1.5% within 15s of contact. Moreover, another in vitro study has shown ≥99.99% virucidal activity as 1% mouthwash and 0.45% throat spray. The only study in SARS-CoV-2 confirmed patients reported a significant 3h drop in viral load after rinsing with 15 mL of 1% PVP-I for 1min. CONCLUSIONS: Although no clinical trials have reported the efficacy of PVP-I on SARS-CoV-2, recent studies in patients with positive PCR to SARS-CoV-2 found a significant 3-h drop in viral load. We believe that an oral prophylactic protocol with PVP-I for dental healthcare workers and patients as an adjunct to the current biosecurity protocol could minimize the transmission risk during COVID-19 pandemic.

The Mental Health Consequences of Coronavirus Disease 2019 Pandemic in Dentistry.

With the spread of coronavirus disease 2019 (COVID-19), strict isolation strategies to limit virus transmission have been applied worldwide. The lockdown has affected and challenged different medical areas. Doctors, nurses, dentists, and other health care workers are concerned about contagion, not only for themselves, but also for their families and colleagues. Furthermore, the oral mucosa has been accepted as a high-risk route of transmission for COVID-19. In many countries, dentists have been forced to stop working during quarantine until further notification. Isolation and its financial impact have produced physical and psychological pressure, depression, social anxiety, and other mental health concerns. This article aims to provide a comprehensive review of the consequences of past epidemics on mental health and to assess possible aspects that might be associated with mental implications in dentists during the COVID-19 pandemic. Finally, some concrete actions to avoid subsequent potential consequences are recommended.

Predictability in Lip Repositioning with Botulinum Toxin for Gummy Smile Treatment: A 3-Year Follow-up Case Series.

The aim of this case series was to describe the successful treatment of excessive gingival display (EGD) using a lip repositioning technique (LRT) and botulinum toxin injections (BTIs) for long-term stability. Eight patients diagnosed with EGD were enrolled. A partial-thickness horizontal incision was made from the right first molar to the left first molar along the mucogingival line, leaving the midline frenum intact. The next day, all patients received BTIs. Mean reductions in gingival display between baseline and 3, 6, 12, 18, 24, and 36 months after surgery were considered. BTIs prevent movement of the upper lip during the healing phase of the LRT, improving the results and offering long-term outcomes with a follow-up period of 3 years.

Reabsorción del reborde alveolar pos colocación de implantes inmediatos con restauración inmediata / Resorption of the alveolar ridge after immediate implant placement with immediate restoration

La literatura ha establecido que la extracción dentaria siempre es seguida por la reducción de la cresta alveolar en sentido bucolingual y apico-coronal. Aunque se ha intentado neutralizar esta reabsorción fisiológica con la colocación de injertos óseos e implantes dentales, la mayoría de casos no se ha tenido resultados favorables. El siguiente articulo muestra un reporte de caso donde se perdieron dos implantes pos extracción con restauración inmediata en el tratamiento de una paciente con agenesia de incisivos laterales superiores permanentes.

The literature has established that dental extraction is always followed by the reduction of the alveolar ridge in bucco-lingual and apico-coronal direction. Although many attempts have been made to neutralize this physiological resorption with bone graft and dental implants placement, most cases had no favorable results. The following article shows a case report where two implants were lost post extraction with immediate restoration in the treatment of a patient with agenesis of permanent upper lateral incisors.