Autogenous graft versus collagen matrices for peri-implant soft tissue augmentation. A systematic review and network meta-analysis.

OBJECTIVE: The primary objective of this review is to compare autogenous soft tissue grafts (connective tissue graft - CTG and free gingival graft-FGG) with different type of matrices (acellular dermal matrix-ADM, xenograft collagen matrix-XCM, volume-stable collagen matrix-VCMX) used to increase peri-implant soft tissues. MATERIALS AND METHODS: A search on electronic databases was performed to identify randomized and non-randomized controlled trials (RCTs and CCTs, respectively) with either parallel or split-mouth design, and treating ≥ 10 patients. A network meta-analysis (NMA) was used to compare different matrices. Soft tissue thickness dimensional changes and keratinized width (KMW) changes were the primary outcome measures. The secondary outcomes were to evaluate: a) PROMs; b) volumetric changes; c) surgical operating time; and d) different periodontal measurements. RESULTS: A total of 23 studies were included in the qualitative analysis, and 16 studies (11 RCTs and 5 CCTs) in the quantitative analysis. A total of N = 573 sites were evaluated for NMA. CTG resulted the best material for increasing peri-implant soft tissue thickness, at 180 and 360 days after surgery. The use of an ADM showed good results for buccal thickness increase, primarily in the first three months after surgery. Vestibuloplasty + FGG resulted in the most effective technique for peri-implant KMW augmentation, after 180 days. CONCLUSIONS: While CTG demonstrated better performance in all the comparison and FGG showed to be the best graft to increase keratinized mucosa up to 90 days, ADM and VCMX may be used to increase soft tissue horizontal thickness with lower patients' morbidity. LIMITATIONS: The limits of this NMA are the following: a) limited number of included studies; b) high heterogeneity among them (number of patients, treatment sites, surgical techniques, outcome measures, and follow-ups). CLINICAL RELEVANCE: Many studies compared the efficacy of autogenous and non-autogenous grafts in terms of gingival thickness, volume, and keratinized width increase. However, there is still not clear overall evidence on this topic. This NMA helps clinicians to choose the right material in different peri-implant soft tissue procedures. Recommendations for future studies are mandatory.

Artificial intelligence for radiographic imaging detection of caries lesions: a systematic review.

BACKGROUND: The aim of this systematic review is to evaluate the diagnostic performance of Artificial Intelligence (AI) models designed for the detection of caries lesion (CL). MATERIALS AND METHODS: An electronic literature search was conducted on PubMed, Web of Science, SCOPUS, LILACS and Embase databases for retrospective, prospective and cross-sectional studies published until January 2023, using the following keywords: artificial intelligence (AI), machine learning (ML), deep learning (DL), artificial neural networks (ANN), convolutional neural networks (CNN), deep convolutional neural networks (DCNN), radiology, detection, diagnosis and dental caries (DC). The quality assessment was performed using the guidelines of QUADAS-2. RESULTS: Twenty articles that met the selection criteria were evaluated. Five studies were performed on periapical radiographs, nine on bitewings, and six on orthopantomography. The number of imaging examinations included ranged from 15 to 2900. Four studies investigated ANN models, fifteen CNN models, and two DCNN models. Twelve were retrospective studies, six cross-sectional and two prospective. The following diagnostic performance was achieved in detecting CL: sensitivity from 0.44 to 0.86, specificity from 0.85 to 0.98, precision from 0.50 to 0.94, PPV (Positive Predictive Value) 0.86, NPV (Negative Predictive Value) 0.95, accuracy from 0.73 to 0.98, area under the curve (AUC) from 0.84 to 0.98, intersection over union of 0.3-0.4 and 0.78, Dice coefficient 0.66 and 0.88, F1-score from 0.64 to 0.92. According to the QUADAS-2 evaluation, most studies exhibited a low risk of bias. CONCLUSION: AI-based models have demonstrated good diagnostic performance, potentially being an important aid in CL detection. Some limitations of these studies are related to the size and heterogeneity of the datasets. Future studies need to rely on comparable, large, and clinically meaningful datasets. PROTOCOL: PROSPERO identifier: CRD42023470708.

Short-term data suggests cognitive benefits in the elderly with single-implant overdentures.

DESIGN: This study was an extension of a randomized crossover clinical trial approved by the institutional ethics committee (approval number: D2014-148) and adhered to the CONSORT guidelines. The original study juxtaposed patient contentment with single-implant overdentures (1-IODs) against conventional complete dentures (CCDs), with patient satisfaction being the primary focus. In this follow-up study, the cognitive function of edentulous patients receiving 1-IODs was assessed, specifically monitoring for the emergence of mild cognitive impairment (MCI) throughout a three-year period. Patient outcomes were systematically recorded at predetermined intervals: initially, two months post-1-IOD placement, after one year (with groups alternated between denture types at eight-month marks), then after two and three years. A prosthodontist with a decade of expertise performed all denture-related procedures. This follow-up emphasized the cognitive outcomes using the Montreal Cognitive Assessment (MoCA-J), considering it alongside previously documented results on masticatory function, bone resorption, survival rates, and patient-reported outcomes. CASE SELECTION: Between 2015 and 2016, a follow-up study enrolled edentulous patients over 50 years of age who were proficient in Japanese, had sufficient mandibular bone for implants, and were free of systemic health issues and habits that could impact oral health. The participants were randomly divided into two groups after receiving a central mandibular implant. Group 1 initially used 1-IODs, and Group 2 used unloaded CCDs. After two months and subsequent periods, they swapped denture types. Eventually, all patients chose 1-IODs for continued use. Implant success was monitored over three years. The design featured block randomization and accounted for a sample size of 22, determined to be sufficient for evaluating the primary outcome of patient satisfaction. All patients underwent careful allocation and received customized dental interventions, with detailed radiographic planning and surgical precision guiding the implantation process. DATA ANALYSIS: Multivariable linear mixed models were used to assess within-group changes in both overall and specific cognitive function scores across five timepoints. Age, assessment interval, and upper jaw denture status were incorporated as consistent variables, while individual participants were considered variable elements in the analysis. SPSS software version 22.0 was utilized to conduct the statistical tests, and a p value threshold of 0.05 was predetermined to establish statistical significance. RESULTS: Twenty-two patients with edentulous mandibles received 1-IODs. Memory and executive functions saw significant score increases at multiple timepoints over the three-year period, with statistical significance. Though one participant dropped out and another passed away, and two did not complete the 3-year follow-up, the remaining 18 participants provided comprehensive data. Age and type of maxillary denture were significant factors, influencing MoCA-J scores with older participants and those with fixed dentures showing lower scores in certain domains. Overall, the findings illustrated the positive correlation between 1-IODs and cognitive function in older adults. CONCLUSIONS: Older adults with no natural teeth left in their mandible showed improved cognitive function after one and three years of using 1-IODs, as reflected by their total and specific cognitive domain scores. The study suggests that such implant therapy may offer protective benefits against cognitive decline, demonstrating clinical relevance for patient care, regardless of the maxillary arch (antagonist) condition.

Recent advances of drugs monitoring in oral fluid and comparison with blood.

The use of alternative matrices in toxicological analyses has been on the rise in clinical and forensic settings. Oral fluid (OF), as non-invasive fluid, has attracted attention in the field of drug screening, both for therapeutic and forensic purposes, as well as for medical diagnosis, clinical management, on-site (real time) doping and for monitoring environmental exposure to toxic substances. A good correlation between OF and blood is now established for drug concentrations. Therefore, OF might be a potential substitute of blood, especially for long-term surveillance (e.g., therapeutic drugs) or to screen a large number of patients, as well as for the development of salivary point-of-care technologies. In this review, we aimed to summarize and critically evaluate the current literature that focused on the comparison of drugs detection in OF and blood specimens.

Clinical outcomes of full-arch immediate fixed prostheses supported by two axial and two tilted implants: A retrospective cohort study with 12-15 years of follow-up.

PURPOSE: To retrospectively assess clinical and radiographic outcomes of immediately loaded full-arch fixed prostheses supported by axial and tilted implants up to 15 years of function. MATERIALS AND METHODS: Patients with one completely edentulous arch received an immediate full-arch fixed prosthesis supported by two anterior axial and two posterior tilted implants. Definitive prosthesis consisting of a CAD-CAM titanium framework and acrylic teeth was delivered 6 months later. Patients were regularly followed to assess clinical parameters and marginal bone level (MBL) change. Multilevel regression analysis was performed to investigate factors affecting implant failure and MBL. RESULTS: Six hundred ninety-two implants were placed in 72 maxillae and 101 mandibles. Seven maxillary implants (5 axial and 2 tilted) in 6 patients and 12 mandibular implants (6 axial and 6 tilted) in 5 patients failed. 15-year cumulative implant survival was 97.51% and 96.91% in maxilla and mandible, respectively (p = .64). After 10 years, the difference in MBL between axial and tilted implants was not significant in the maxilla (p = .47, 65 patients), while it was in the mandible (p < .001, 80 patients). Significant higher bone loss was reported in the mandible at both 5- and 10-year follow-up (p < .001 and p = .004, respectively). Mixed-effect multilevel linear regression evidenced a correlation between arch and bone loss at 5- and 10-year follow-up, while no correlation was found with age, gender, smoking, diabetes, and history of periodontal disease. CONCLUSION: This long-term study suggests that the present technique can be considered a viable treatment modality for the immediate rehabilitation of both maxilla and mandible.

Effect of guided tissue regeneration on the success of surgical endodontic treatment of teeth with endodontic-periodontal lesions: A systematic review.

BACKGROUND: Endodontic-periodontal lesions may need surgical approach and the application of guided tissue regeneration (GTR) to be treated by a combined approach. OBJECTIVES: The aim of the present study was to evaluate the effects of GTR on the success (clinical and radiological healing) of teeth with endodontic-periodontal lesions treated by modern surgical endodontic treatment, by means of a systematic review of the literature. METHODS: An exhaustive electronic (Medline, Embase and Scopus searched from inception to August 2020) and manual literature search combined with strict inclusion and exclusion criteria was undertaken to identify any clinical (prospective case series or comparative trials) studies that assessed the added benefit of GTR in modern surgical endodontic treatment of teeth with endodontic-periodontal lesions. The success of the treatment was assessed based on radiographic healing and clinical evaluations. The risk of bias of the identified studies was evaluated using the Cochrane's collaboration RoB 2.0 tool and the Joanna Briggs Institute (JBI) critical appraisal tools. RESULTS: A systematic literature search for eligible reports retrieved three randomized controlled trials (RCTs) and one prospective single arm study with a total of 125 teeth in 125 subjects. One of the RCTs has a low risk of bias, while the other two raised some concerns, using the RoB 2.0 tool. Due to the heterogeneity of the results, it was not possible to perform a comparative meta-analysis and the results are presented in a narrative manner and by calculating pooled outcomes. Pooling together the data from all the included studies, the reported outcome was of complete healing in 58.4% of all cases, of scar tissue formation/incomplete healing in 24% of cases, of uncertain healing in 12.8% of cases, and of failure in 4.8% of all analysed teeth, with a follow-up ranging from 12 to 60 months. DISCUSSION: The scientific evidence about the use of GTR in modern surgical endodontic treatment of endodontic-periodontal lesion is sparse, and the available results are derived from very heterogeneous studies, thus not permitting to clarify which is the most effective treatment option in these cases. CONCLUSIONS: There is an absence of studies comparing GTR versus no GTR. REGISTRATION: The protocol for this review was registered in the PROSPERO database with the registration ID number CRD42022300470.

Treatment of pulpal and apical disease: The European Society of Endodontology (ESE) S3-level clinical practice guideline.

BACKGROUND: The ESE previously published quality guidelines for endodontic treatment in 2006; however, there have been significant changes since not only in clinical endodontics but also in consensus and guideline development processes. In the development of the inaugural S3-level clinical practice guidelines (CPG), a comprehensive systematic and methodologically robust guideline consultation process was followed in order to produce evidence-based recommendations for the management of patients presenting with pulpal and apical disease. AIM: To develop an S3-level CPG for the treatment of pulpal and apical disease, focusing on diagnosis and the implementation of the treatment approaches required to manage patients presenting with pulpitis and apical periodontitis (AP) with the ultimate goal of preventing tooth loss. METHODS: This S3-level CPG was developed by the ESE, with the assistance of independent methodological guidance provided by the Association of Scientific Medical Societies in Germany and utilizing the GRADE process. A robust, rigorous and transparent process included the analysis of relevant comparative research in 14 specifically commissioned systematic reviews, prior to evaluation of the quality and strength of evidence, the formulation of specific evidence and expert-based recommendations in a structured consensus process with leading endodontic experts and a broad base of external stakeholders. RESULTS: The S3-level CPG for the treatment of pulpal and apical disease describes in a series of clinical recommendations the effectiveness of diagnosing pulpitis and AP, prior to investigating the effectiveness of endodontic treatments in managing those diseases. Therapeutic strategies include the effectiveness of deep caries management in cases with, and without, spontaneous pain and pulp exposure, vital versus nonvital teeth, the effectiveness of root canal instrumentation, irrigation, dressing, root canal filling materials and adjunct intracanal procedures in the management of AP. Prior to treatment planning, the critical importance of history and case evaluation, aseptic techniques, appropriate training and re-evaluations during and after treatment is stressed. CONCLUSION: The first S3-level CPG in endodontics informs clinical practice, health systems, policymakers, other stakeholders and patients on the available and most effective treatments to manage patients with pulpitis and AP in order to preserve teeth over a patient's lifetime, according to the best comparative evidence currently available.

Accuracy of automated 3D cephalometric landmarks by deep learning algorithms: systematic review and meta-analysis.

OBJECTIVES: The aim of the present systematic review and meta-analysis is to assess the accuracy of automated landmarking using deep learning in comparison with manual tracing for cephalometric analysis of 3D medical images. METHODS: PubMed/Medline, IEEE Xplore, Scopus and ArXiv electronic databases were searched. Selection criteria were: ex vivo and in vivo volumetric data images suitable for 3D landmarking (Problem), a minimum of five automated landmarking performed by deep learning method (Intervention), manual landmarking (Comparison), and mean accuracy, in mm, between manual and automated landmarking (Outcome). QUADAS-2 was adapted for quality analysis. Meta-analysis was performed on studies that reported as outcome mean values and standard deviation of the difference (error) between manual and automated landmarking. Linear regression plots were used to analyze correlations between mean accuracy and year of publication. RESULTS: The initial electronic screening yielded 252 papers published between 2020 and 2022. A total of 15 studies were included for the qualitative synthesis, whereas 11 studies were used for the meta-analysis. Overall random effect model revealed a mean value of 2.44 mm, with a high heterogeneity (I2 = 98.13%, τ2 = 1.018, p-value < 0.001); risk of bias was high due to the presence of issues for several domains per study. Meta-regression indicated a significant relation between mean error and year of publication (p value = 0.012). CONCLUSION: Deep learning algorithms showed an excellent accuracy for automated 3D cephalometric landmarking. In the last two years promising algorithms have been developed and improvements in landmarks annotation accuracy have been done.

Treatment of Alzheimer's Disease: Beyond Symptomatic Therapies.

In an ever-increasing aged world, Alzheimer's disease (AD) represents the first cause of dementia and one of the first chronic diseases in elderly people. With 55 million people affected, the WHO considers AD to be a disease with public priority. Unfortunately, there are no final cures for this pathology. Treatment strategies are aimed to mitigate symptoms, i.e., acetylcholinesterase inhibitors (AChEI) and the N-Methyl-D-aspartate (NMDA) antagonist Memantine. At present, the best approaches for managing the disease seem to combine pharmacological and non-pharmacological therapies to stimulate cognitive reserve. Over the last twenty years, a number of drugs have been discovered acting on the well-established biological hallmarks of AD, deposition of ß-amyloid aggregates and accumulation of hyperphosphorylated tau protein in cells. Although previous efforts disappointed expectations, a new era in treating AD has been working its way recently. The Food and Drug Administration (FDA) gave conditional approval of the first disease-modifying therapy (DMT) for the treatment of AD, aducanumab, a monoclonal antibody (mAb) designed against Aß plaques and oligomers in 2021, and in January 2023, the FDA granted accelerated approval for a second monoclonal antibody, Lecanemab. This review describes ongoing clinical trials with DMTs and non-pharmacological therapies. We will also present a future scenario based on new biomarkers that can detect AD in preclinical or prodromal stages, identify people at risk of developing AD, and allow an early and curative treatment.

Detection and sensing of oral xenobiotics in edentulous patients rehabilitated with titanium dental implants: Insights from a scoping review.

STATEMENT OF PROBLEM: Titanium has been considered the standard element in implant manufacturing. Recent studies have evaluated the role of titanium as a biological modulator of oral health. However, evidence regarding the association between the release of metal particles and peri-implantitis is lacking. PURPOSE: The purpose of this scoping review was to evaluate the literature regarding the release of metal particles in peri-implant tissues correlated with the methods of detection and the local and systemic implications. MATERIAL AND METHODS: The study was performed in adherence with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines and was registered with the National Institute for Health Research PROSPERO (Submission No. 275576; ID: CRD42021275576). A systematic search was conducted in the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE via PubMed, Scopus, and Web of Science bibliographic databases, complemented by a manual evaluation. Only in vivo human studies written in the English language and published between January 2000 and June 2022 were included. RESULTS: In total, 10 studies were included according to eligibility criteria. Different tissues and analytic techniques were reported: the characterization technique most used was inductively coupled plasma mass spectrometry. All 10 studies analyzed the release of metal particles in patients with dental implants, continuously detecting titanium. None of the studies reported a significant association between metal particles and biological effects. CONCLUSIONS: Titanium is still considered the material of choice in implant dentistry, despite the detection of metal particles in peri-implant tissues. Further studies are necessary to evaluate the association between analytes and local health or inflammatory status.

Influence of implant diameter on implant survival rate and clinical outcomes in the posterior area: a systematic review and meta-analysis.

OBJECTIVE: The aim of the present systematic review was to test the hypothesis that the diameter of implants inserted in the posterior area affects implant survival rate, prosthetic survival rate and peri-implant parameters (bleeding on probing (BoP), marginal bone loss (MBL), pocket probing depth (PPD)). MATERIALS AND METHODS: An electronic search of studies published until December 2021 was done on three databases (Pubmed, Scopus, Cochrane) independently by two authors. Clinical trials comparing implant survival rate, BoP, MBL and PPD among narrow diameter implants (NDI: ≥ 3.0 mm to < 3.75 mm) and regular diameter implants (RDI ≥ 3.75 mm to < 5 mm) were included. Data were independently extracted by two reviewers. Risk of bias was evaluated according to the Cochrane risk-of-bias tool for randomized studies and to the Joanna Briggs Institute Critical Appraisal tools for non-randomized ones. A pair-wise meta-analysis was conducted on the included studies. RESULTS: Seven articles were included out of the 4291 identified from the digital research. Overall, a total of 939 implants were inserted (319 NDI, 620 RDI). Only one study was judged at serious risk of bias. No statistically significant difference was found in implant survival rate (risk ratio 1.01 (95% CI [0.98 to 1.04], P = 0.67)) while the difference was significant for BoP (mean difference 2.89 (95% CI [0.30 to 5.48] mm, P = 0.03)) with higher values for NDI. Higher MBL was identified among regular diameter implants (mean difference -0.15 mm (95% CI [-0.32 to 0.01 mm], P = 0.07). No statistically significant differences were identified for prosthetic survival and PPD. CONCLUSIONS: No differences were found in implant survival rate between narrow and regular implants. A higher BoP was identified among narrow implants, but there was no higher bone loss. It is not possible to draw definitive conclusions about the use of narrow-diameter implants in the posterior region.

Soft tissue dimensional changes after alveolar ridge preservation using different sealing materials: a systematic review and network meta-analysis.

BACKGROUND: Alveolar ridge preservation (ARP) is a proactive treatment option aiming at attenuating post-extraction hard and soft tissue dimensional changes. A high number of different types of biomaterials have been utilized during ARP to seal the socket, but their effectiveness in terms of soft tissue outcomes has rarely been investigated and compared in the literature. OBJECTIVE: To evaluate the efficacy of different types of membranes and graft materials in terms of soft tissue outcomes (keratinized tissue width changes, vertical buccal height, and horizontal changes) after ARP, and to assign relative rankings based on their performance. MATERIALS AND METHODS: The manuscript represents the proceedings of a consensus conference of the Italian Society of Osseointegration (IAO). PUBMED (Medline), SCOPUS, Embase, and Cochrane Oral Health's Information Specialist were utilized to conduct the search up to 06 April 2021. English language restrictions were placed and no limitations were set on publication date. Randomized controlled trials that report ARP procedures using different sealing materials, assessing soft tissue as a primary or secondary outcome, with at least 6-week follow-up were included. Network meta-analysis (NMA) was performed using mean, standard deviation, sample size, bias, and follow-up duration for all included studies. Network geometry, contribution plots, inconsistency plots, predictive and confidence interval plots, SUCRA (surface under the cumulative ranking curve) rankings, and multidimensional (MDS) ranking plots were constructed. RESULTS: A total of 11 studies were included for NMA. Overall, the level of bias for included studies was moderate. Crosslinked collagen membranes (SUCRA rank 81.8%) performed best in vertical buccal height (VBH), autogenous soft tissue grafts (SUCRA rank 89.1%) in horizontal width change (HWch), and control (SUCRA rank 85.8%) in keratinized mucosa thickness (KMT). CONCLUSIONS: NMA confirmed that the use of crosslinked collagen membranes and autogenous soft tissue grafts represented the best choices for sealing sockets during ARP in terms of minimizing post-extraction soft tissue dimensional shrinkage. CLINICAL RELEVANCE: Grafting materials demonstrated statistically significantly better performances in terms of soft tissue thickness and vertical buccal height changes, when covered with crosslinked collagen membranes. Instead, soft tissue grafts performed better in horizontal width changes. Non-crosslinked membranes and other materials or combinations presented slightly inferior outcomes.

Sealing materials for post-extraction site: a systematic review and network meta-analysis.

AIM: By means of a systematic review and network meta-analysis, this study aims to answer the following questions: (a) does the placement of a biomaterial over an extraction socket lead to better outcomes in terms of horizontal and vertical alveolar dimensional changes and percentage of new bone formation than healing without coverage? And (b) which biomaterial(s) provide(s) the better outcomes? MATERIALS AND METHODS: Parallel and split-mouth randomized controlled trials treating ≥ 10 patients were included in this analysis. Studies were identified with MEDLINE (PubMed), Embase, Cochrane Central Register of Controlled Trials, and Scopus. Primary outcomes were preservation of horizontal and vertical alveolar dimension and new bone formation inside the socket. Both pairwise and network meta-analysis (NMA) were undertaken to obtain estimates for primary outcomes. For NMA, prediction intervals were calculated to estimate clinical efficacy, and SUCRA was used to rank the materials based on their performance; multidimensional ranking was used to rank treatments based on dissimilarity. The manuscript represents the proceedings of a consensus conference of the Italian Society of Osseointegration (IAO). RESULTS: Twelve trials were included in the qualitative and quantitative analysis: 312 sites were evaluated. Autologous soft tissue grafts were associated with better horizontal changes compared to resorbable membranes. A statistically significant difference in favor of resorbable membranes, when compared to no membrane, was found, with no statistically significant heterogeneity. For the comparison between crosslinked and non-crosslinked membranes, a statistically significant difference was found in favor of the latter and confirmed by histomorphometric NMA analysis. Given the relatively high heterogeneity detected in terms of treatment approaches, materials, and outcome assessment, the findings of the NMA must be interpreted cautiously. CONCLUSIONS: Coverage of the healing site is associated with superior results compared to no coverage, but no specific sealing technique and/or biomaterial provides better results than others. RCTs with larger sample sizes are needed to better elucidate the trends emerged from the present analysis. CLINICAL RELEVANCE: Autologous soft tissue grafts and membranes covering graft materials in post-extraction sites were proved to allow lower hard tissue shrinkage compared to the absence of coverage material with sealing effect. Histomorphometric analyses showed that non-crosslinked membranes provide improved hard tissue regeneration when compared to crosslinked ones.

Benefits and Implications of Resveratrol Supplementation on Microbiota Modulations: A Systematic Review of the Literature.

Resveratrol is a polyphenol that has been shown to possess many applications in different fields of medicine. This systematic review has drawn attention to the axis between resveratrol and human microbiota, which plays a key role in maintaining an adequate immune response that can lead to different diseases when compromised. Resveratrol can also be an asset in new technologies, such as gene therapy. PubMed, Cochrane Library, Scopus, Web of Science, and Google Scholar were searched to find papers that matched our topic dating from 1 January 2017 up to 18 January 2022, with English-language restriction using the following Boolean keywords: ("resveratrol" AND "microbio*"). Eighteen studies were included as relevant papers matching the purpose of our investigation. Immune response, prevention of thrombotic complications, microbiota, gene therapy, and bone regeneration were retrieved as the main topics. The analyzed studies mostly involved resveratrol supplementation and its effects on human microbiota by trials in vitro, in vivo, and ex vivo. The beneficial activity of resveratrol is evident by analyzing the changes in the host's genetic expression and the gastrointestinal microbial community with its administration. The possibility of identifying individual microbial families may allow to tailor therapeutic plans with targeted polyphenolic diets when associated with microbial dysbiosis, such as inflammatory diseases of the gastrointestinal tract, degenerative diseases, tumors, obesity, diabetes, bone tissue regeneration, and metabolic syndrome.

Oral Rehabilitation of Bilateral Cleft Lip and Palate Patient with Simultaneous LeFort I Osteotomy and Zygomatic Implants: A Case Report.

The aim of this study is to evaluate Le Fort I Osteotomy and zygomatic implantation without any graft placement for management of a cleft lip and palate patient. This case report describes oral rehabilitation of a 33-year-old patient with bilateral cleft lip-palate and oronasal fistula and atrophic pre-maxilla. As treatment, the patient received simultaneous Le Fort I osteotomy, palatoplasty and two zygomatic implant insertions. The prosthetic superstructure included zygomatic implant-supported removable hybrid prosthesis on bar locator and metal-ceramic fixed bridges in the posterior region. As conclusion, this protocol can be promising for management of patients with cleft lip-palate and malocclusion.

EFFICACY OF 67% SODIUM BICARBONATE TOOTHPASTE FOR PLAQUE AND GINGIVITIS CONTROL: A SYSTEMATIC REVIEW AND META-ANALYSIS.

OBJECTIVE: Previous studies demonstrated a dose-dependent efficacy of sodium bicarbonate when added to dentifrices for the mechanical control of dental biofilm. The present systematic review and meta-analysis aimed to evaluate the efficacy of a 67% sodium bicarbonate-based toothpaste for gingival health parameters improvement in subjects with gingivitis. MATERIALS AND METHODS: An electronic search on MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL), was performed using a combination of keywords, followed by a hand search on pertinent Journals. Randomized controlled trials (RCTs) and prospective comparative studies in English language were included. There was no publication date and language restriction. The data regarding gingival, bleeding, and plaque index were extracted from the selected studies. Included studies underwent risk-of-bias assessment. When at least 3 studies reporting the same outcome were found, a meta-analysis was undertaken, to estimate the combined effect. Trial Sequential Analysis (TSA) was also performed to evaluate the power of the meta-analysis for primary outcomes. RESULTS: The search strategy yielded 83 articles. After screening, 7 RCTs were included. Three were at high risk, one at moderate risk, and 3 at low risk-of-bias. Significant improvement of gingival index, bleeding index, and plaque index was observed in patients using 67% sodium bicarbonate toothpaste as compared with control subjects. TSA showed sufficient power for modified Gingival index and bleeding scores. CONCLUSIONS: The clinical use of 67% sodium bicarbonate toothpaste can improve periodontal health in patients with gingivitis.

Antibiotics to prevent complications following tooth extractions.

BACKGROUND: The most frequent indications for tooth extractions, generally performed by general dental practitioners, are dental caries and periodontal infections. Systemic antibiotics may be prescribed to patients undergoing extractions to prevent complications due to infection. This is an update of a review first published in 2012. OBJECTIVES: To determine the effect of systemic antibiotic prophylaxis on the prevention of infectious complications following tooth extractions. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health Trials Register (to 16 April 2020), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2020, Issue 3), MEDLINE Ovid (1946 to 16 April 2020), Embase Ovid (1980 to 16 April 2020), and LILACS (1982 to 16 April 2020). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: We included randomised, double-blind, placebo-controlled trials of systemic antibiotic prophylaxis in patients undergoing tooth extraction(s) for any indication. DATA COLLECTION AND ANALYSIS: At least two review authors independently performed data extraction and 'Risk of bias' assessment for the included studies. We contacted trial authors for further details where these were unclear. For dichotomous outcomes, we calculated risk ratios (RR) and 95% confidence intervals (CI) using random-effects models. For continuous outcomes, we used mean differences (MD) with 95% CI using random-effects models. We examined potential sources of heterogeneity. We assessed the certainty of the body of evidence for key outcomes as high, moderate, low, or very low, using the GRADE approach. MAIN RESULTS: We included 23 trials that randomised approximately 3206 participants (2583 analysed) to prophylactic antibiotics or placebo. Although general dentists perform dental extractions because of severe dental caries or periodontal infection, only one of the trials evaluated the role of antibiotic prophylaxis in groups of patients affected by those clinical conditions. We assessed 16 trials as being at high risk of bias, three at low risk, and four as unclear.  Compared to placebo, antibiotics may reduce the risk of postsurgical infectious complications in patients undergoing third molar extractions by approximately 66% (RR 0.34, 95% CI 0.19 to 0.64; 1728 participants; 12 studies; low-certainty evidence), which means that 19 people (95% CI 15 to 34) need to be treated with antibiotics to prevent one infection following extraction of impacted wisdom teeth. Antibiotics may also reduce the risk of dry socket by 34% (RR 0.66, 95% CI 0.45 to 0.97; 1882 participants; 13 studies; low-certainty evidence), which means that 46 people (95% CI 29 to 62) need to take antibiotics to prevent one case of dry socket following extraction of impacted wisdom teeth. The evidence for our other outcomes is uncertain: pain, whether measured dichotomously as presence or absence (RR 0.59, 95% CI 0.31 to 1.12; 675 participants; 3 studies) or continuously using a visual analogue scale (0-to-10-centimetre scale, where 0 is no pain) (MD -0.26, 95% CI -0.59 to 0.07; 422 participants; 4 studies); fever (RR 0.66, 95% CI 0.24 to 1.79; 475 participants; 4 studies); and adverse effects, which were mild and transient (RR 1.46, 95% CI 0.81 to 2.64; 1277 participants; 8 studies) (very low-certainty evidence).  We found no clear evidence that the timing of antibiotic administration (preoperative, postoperative, or both) was important. The included studies enrolled a subset of patients undergoing dental extractions, that is healthy people who had surgical extraction of third molars. Consequently, the results of this review may not be generalisable to all people undergoing tooth extractions. AUTHORS' CONCLUSIONS: The vast majority (21 out of 23) of the trials included in this review included only healthy patients undergoing extraction of impacted third molars, often performed by oral surgeons. None of the studies evaluated tooth extraction in immunocompromised patients. We found low-certainty evidence that prophylactic antibiotics may reduce the risk of infection and dry socket following third molar extraction when compared to placebo, and very low-certainty evidence of no increase in the risk of adverse effects. On average, treating 19 healthy patients with prophylactic antibiotics may stop one person from getting an infection. It is unclear whether the evidence in this review is generalisable to patients with concomitant illnesses or patients at a higher risk of infection. Due to the increasing prevalence of bacteria that are resistant to antibiotic treatment, clinicians should evaluate if and when to prescribe prophylactic antibiotic therapy before a dental extraction for each patient on the basis of the patient's clinical conditions (healthy or affected by systemic pathology) and level of risk from infective complications. Immunocompromised patients, in particular, need an individualised approach in consultation with their treating medical specialist.

Customized CAD/CAM titanium meshes for the guided bone regeneration of severe alveolar ridge defects: Preliminary results of a retrospective clinical study in humans.

OBJECTIVES: To present the results of guided bone regeneration (GBR) of atrophic edentulous ridges with customized CAD/CAM titanium meshes. MATERIAL AND METHODS: Forty-one patients, presenting with 53 atrophic sites, were enrolled between 2018 and 2019. GBR was obtained with titanium meshes filled with autogenous bone chips and bovine bone mineral (BBM). After a mean of 7 months (range: 5-12 months), meshes were removed and 106 implants placed. After a mean of 3.5 months (range: 2-5 months), implants were uncovered and prosthetic restorations started. The outcomes were vertical and horizontal bone augmentation changes, biological complications and implant survival. RESULTS: Out of 53 sites, 11 underwent mesh exposure: eight of them were followed by uneventful integration of the graft, while three by partial bone loss. The mean vertical and horizontal bone gain after reconstruction was 4.78 ± 1.88 mm (range 1.00-8.90 mm) and 6.35 ± 2.10 mm (range 2.14-11.48 mm), respectively. At the time of implant placement, mean changes of initial bone gain were -0.39 ± 0.64 mm (range -3.1 to + 0.80 mm) and -0.49 ± 0.83 mm (range -3.7 to +0.4 mm), in the vertical and horizontal dimensions, respectively. Reduction of bone volume was significantly higher (p < .001 for both dimensions) in the exposed sites. The mean follow-up of implants after loading was 10.6 ± 6.5 months (range: 2-26 months). The survival rate of implants was 100%. CONCLUSION: Customized titanium meshes can represent a reliable tool for GBR of severely atrophic sites, with simplification of the surgical phases.

Immediate Oral Rehabilitation With Quad Zygomatic Implants: Ultrasonic Technique vs Conventional Drilling.

Inserting zygomatic implants is a challenging surgery and requires special care and great precision. Piezoelectric surgery offers several advantages: more precise bone cutting with improved intraoperative visibility and a low temperature increase. The aim of this case-control study was to evaluate whether ultrasonic instruments can be as effective as standard drilling instruments for zygomatic implant surgery in terms of clinical outcomes. Ninety-two patients with atrophic maxilla were included in the study. Implant sites were prepared with the ultrasonic technique (test group = 47 patients) or traditional drilling (control group = 45 patients). In total, 368 zygomatic implants were inserted (202 with the extrasinus technique, 77 with the sinus slot technique, and 89 with the Brånemark technique). Complete arch provisional prostheses were delivered 3 to 5 hours after the surgical operations. The mean follow-up after surgery was 24 months (range = 12-32 months). The primary outcome evaluations were based on implant survival rates and postoperative complications. Operative time and surgeon's stress were evaluated as secondary outcomes. Implant survival rate was 100% in the test and 98.89% in the control group. Postoperative complications were seen in 9 patients (4 in the test and 5 in the control group); the difference was not statistically significant. Operative time was longer in the test group; however, surgeons were more comfortable using ultrasonic instruments. Within the limitations of this preliminary study, the ultrasonic technique was a feasible alternative to traditional drilling for zygomatic implant surgery.

Dual-section versus conventional archwire for en-masse retraction of anterior teeth with direct skeletal anchorage: a finite element analysis.

BACKGROUND: The aim of this study is to compare the biomechanical effects of the conventional 0.019 × 0.025-in stainless steel archwire with the dual-section archwire when en-masse retraction is performed with sliding mechanics and skeletal anchorage. METHODS: Models of maxillary dentition equipped with the 0.019 × 0.025-in archwire and the dual-section archwire, whose anterior portion is 0.021 × 0.025-in and posterior portion is 0.018 × 0.025-in were constructed. Then, long-term tooth movement during en-masse retraction was simulated using the finite element method. Power arms of 8, 10, 12 and 14 mm length were employed to control anterior torque, and retraction forces of 2 N were applied with a direct skeletal anchorage. RESULTS: For achieving bodily movement of the incisors, power arms longer than 14 mm were required for the 0.019 × 0.025-in archwire, while between 8 and 10 mm for the dual-section archwire. The longer the power arms, the greater the counter-clockwise rotation of the occlusal plane was produced. Frictional resistance generated between the archwire and brackets and tubes on the posterior teeth was smaller than 5% of the retraction force of 2 N. CONCLUSIONS: The use of dual-section archwire might bring some biomechanical advantages as it allows to apply retraction force at a considerable lower height, and with a reduced occlusal plane rotation, compared to the conventional archwire. Clinical studies are needed to confirm the present results.