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.

Relationship between oral lesions and severe SARS-CoV-2 infection in intensive care unit patients.

OBJECTIVE: Oral lesions received increased attention as likely new signs or secondary manifestations of COVID-19. Therefore, we clinically examined oral cavity of patients with COVID-19 and investigated oral lesions and patient comorbidities as possible risk factors of COVID-19 disease outcome. METHODS: From January to March 2022, a prospective study was conducted by recruiting all COVID-19 patients admitted to the Intensive Care Unit and Respiratory Intensive Care Unit of Maxi-Emergencies Hospital in Bari, Italy. RESULTS: From the enrolled 103 COVID-19 patients, 46.6% were females and 53.4% were males. Findings show that risk of presenting with severe COVID-19 disease was higher in patients who developed oral lesions related to COVID-19 than those with no oral lesions (RR = 7.998, p = .002). Next, patients with concomitant autoimmune diseases were at higher risk of a negative COVID-19 disease outcome than those without comorbidities (OR = 8.838, p = .026). CONCLUSIONS: COVID-19-related lesions of oral mucosa should not be ignored as they can be early and easily detectable signs of severe COVID-19 disease condition, thus, serving as a prevention measure for any potential unfortunate event. Findings of this study, without implying causation, offer a direction for future investigations that aim to confirm the presence of specific oral lesions in COVID-19 patients as signs of severe disease progression.

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.

Research efficacy of gaseous ozone therapy as an adjuvant to periodontal treatment on oxidative stress mediators in patients with type 2 diabetes: a randomized clinical trial.

BACKGROUND: Chronic inflammation and cumulative oxidative stress have been theorized as two common pathways of the interconnection between periodontitis and diabetes. Improvement in oxidizing status has been demonstrated in periodontal patients with diabetes treated with proper non-surgical periodontal treatment. In addition to periodontal treatment, Gaseous ozone therapy has been reported to possess anti-inflammatory properties and the ability to stimulate the endogenous antioxidant defence mechanism. To date, the antioxidant effect of gaseous ozone, in addition with periodontal treatment in diabetic patients, has been examined in only one study. The aim of this study was to determine the efficacy of gaseous ozone therapy as an alternative approach to supporting non-surgical periodontal therapy (NSPT), aimed at improving antioxidant machinery and interfering with ROS production on plasma levels in diabetic individuals diagnosed with moderate or severe periodontitis. METHODS: One hundred and eighty patients with periodontitis and type 2 diabetes mellitus were randomly assigned to receive non-surgical periodontal treatment (NSPT) plus gaseous ozone therapy (A) NSPT alone (B). Clinical and periodontal parameters -Bleeding on probing (BOP), Periodontal pocket depth (PPD), and Clinical attachment Level (CAL)- and plasma levels of oxidant-antioxidant (TOS- TAOS) levels, glutathione (GSH), and malondialdehyde (MDA) were recorded at baseline and at 3- (T1) and at 6-months (T2) after treatment. RESULTS: Both treatments were efficacious in reducing clinical parameters. However, there were no significant differences regarding oxidative stress parameters in group A compared to group B. CONCLUSIONS: In the present study, gaseous ozone therapy did not enhance the effect of periodontal treatment in reducing oxidative stress in plasma levels of periodontitis patients with type II diabetes. TRIAL REGISTRATION: The study was registered with ISRCTN1728169 (23/07/2022).

Growth differentiation factor-15 and circulating biomarkers as predictors of periodontal treatment effects in patients with periodontitis: a randomized-controlled clinical trial.

BACKGROUND: During the last decades, in patients with periodontitis, periodontal treatment has been shown to reduce the potential release of local and systemic biomarkers linked to an early risk of systemic inflammatory disorders. This study evaluated the efficacy of non-surgical-periodontal treatment (NSPT) on growth differentiation factor 15 (GDF-15) and related circulating biomarkers such as glutathione peroxidase 1 (GPx-1), c-reactive protein (hs-CRP), and surfactant protein D (SP-D) in periodontal patients and explored whether subjects who had high GDF-15 levels at baseline showed increased clinical benefits following NSPT at 6-months follow-up. METHODS: For this two-arm, parallel randomized clinical trial, patients with periodontitis were randomly allocated to receive quadrant scaling and root-planing (Q-SRP, n = 23, median age 51 years old) or full-mouth disinfection (FMD, n = 23, median age 50 years old) treatment. Clinical and periodontal parameters were recorded in all enrolled patients. The primary outcome was to analyse serum concentrations changes of GDF-15 and of GPx-1, hs-CRP, and SP-D at baseline and at 30, 90, and 180-days follow-up after NSPT through enzyme-linked immunosorbent assay (ELISA) and nephelometric assay techniques. RESULTS: In comparison with FMD, patients of the Q-SRP group showed a significant improvement in clinical periodontal parameters (p < 0.05) and a reduction in the mean levels of GDF-15 (p = 0.005), hs-CRP (p < 0.001), and SP-D (p = 0.042) and an increase of GPx-1 (p = 0.025) concentrations after 6 months of treatment. At 6 months of treatment, there was a significant association between several periodontal parameters and the mean concentrations of GDF-15, GPx-1, hs-CRP, and SP-D (p < 0.05 for all parameters). Finally, the ANOVA analysis revealed that, at 6 months after treatment, the Q-SRP treatment significantly impacted the reduction of GDF-15 (p = 0.015), SP-D (p = 0.026) and the upregulation of GPx-1 (p = 0.045). CONCLUSION: The results evidenced that, after 6 months of treatment, both NSPT protocols improved the periodontal parameters and analyzed biomarkers, but Q-SRP was more efficacious than the FMD approach. Moreover, patients who presented high baseline GDF-15 and SP-D levels benefited more from NSPT at 6-month follow-up. TRIAL REGISTRATION: NCT05720481.

Oral ecological environment modifications by hard-cheese: from pH to microbiome: a prospective cohort study based on 16S rRNA metabarcoding approach.

BACKGROUND: The oral ecosystem conditions dental health, and is known to be positively modified by oral hygiene which cannot always be performed between meals, especially outside home. It is therefore important to identify the practices to be adopted to influence the oral environment in an anticariogenic direction. Milk and cheese are considered functional foods and have a role on oral health. There are several mechanisms by which cheese exerts its beneficial effects on teeth. The aim of the present study was to examine whether short term consumption of hard cheese would affect the oral pH and microbial flora of healthy adults modifying ecological oral environment. The Next Generation Sequencing (NGS) approach was applied to study the effect of Italian Grana Padano (GP), as a prototype of typical hard cheese, on the oral microbiota composition. Finally, we explored Streptococcus mutans/sanguinis ratio as a marker of protective biofilm composition. METHODS: Nine oral-healthy adults were instructed to eat 25 gr of GP cheese for 5 consecutive days. Three time points were chosen for supragingival samples collection and pH measurement. 16S rRNA-gene sequences were obtained both from oral samples and GP cheese using the MiSeq platform and analyzed against the expanded Human Oral Microbiome Database (eHOMD). ProgPerm was used to perform statistical analyses to investigate strain differential representation after cheese consumption. RESULTS: Taxonomic analyses of the oral microbiota revealed that Firmicutes was the most abundant phylum, followed by Proteobacteria and Actinobacteria. GP cheese significantly modifies oral pH, causing a shift toward basic conditions which are kept for a few hours. The Streptococcus mutans/Streptococcus sanguinis ratio lowers in the last observed timepoint. CONCLUSION: Our results reveal that a portion of GP cheese eaten after dinner provides important micronutrients (i.e. calcium, vitamins and some aminoacids such as arginine) and changes oral pH toward basic conditions, resulting in a light modification of the oral microbiome towards the reduction of the overall amount of acidophilic bacteria. Furthermore, the S. mutans/S. sanguinis ratio is reduced, contributing to obtain a more protecting environment towards caries establishment and evolution.

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.

Effectiveness of SARS-CoV-2 Vaccines for Short- and Long-Term Immunity: A General Overview for the Pandemic Contrast.

BACKGROUND: The recent COVID-19 pandemic produced a significant increase in cases and an emergency state was induced worldwide. The current knowledge about the COVID-19 disease concerning diagnoses, patient tracking, the treatment protocol, and vaccines provides a consistent contribution for the primary prevention of the viral infection and decreasing the severity of the SARS-CoV-2 disease. The aim of the present investigation was to produce a general overview about the current findings for the COVID-19 disease, SARS-CoV-2 interaction mechanisms with the host, therapies and vaccines' immunization findings. METHODS: A literature overview was produced in order to evaluate the state-of-art in SARS-CoV-2 diagnoses, prognoses, therapies, and prevention. RESULTS: Concerning to the interaction mechanisms with the host, the virus binds to target with its Spike proteins on its surface and uses it as an anchor. The Spike protein targets the ACE2 cell receptor and enters into the cells by using a special enzyme (TMPRSS2). Once the virion is quietly accommodated, it releases its RNA. Proteins and RNA are used in the Golgi apparatus to produce more viruses that are released. Concerning the therapies, different protocols have been developed in observance of the disease severity and comorbidity with a consistent reduction in the mortality rate. Currently, different vaccines are currently in phase IV but a remarkable difference in efficiency has been detected concerning the more recent SARS-CoV-2 variants. CONCLUSIONS: Among the many questions in this pandemic state, the one that recurs most is knowing why some people become more seriously ill than others who instead contract the infection as if it was a trivial flu. More studies are necessary to investigate the efficiency of the treatment protocols and vaccines for the more recent detected SARS-CoV-2 variant.

Cephalometric measurements performed on CBCT and reconstructed lateral cephalograms: a cross-sectional study providing a quantitative approach of differences and bias.

BACKGROUND: Cephalometric analysis is traditionally performed on skull lateral teleradiographs for orthodontic diagnosis and treatment planning. However, the skull flattened over a 2D film presents projection distortions and superimpositions to various extents depending on landmarks relative position. When a CBCT scan is indicated for mixed reasons, cephalometric assessments can be performed directly on CBCT scans with a distortion free procedure. The aim of the present study is to compare these two methods for orthodontic cephalometry. METHODS: 114 CBCTs were selected, reconstructed lateral cephalometries were obtained by lateral radiographic projection of the entire volume from the right and left sides. 2D and 3D cephalometric tracings were performed. Since paired t-tests between left and right-side measurements found no statistically significant differences, mean values between sides were considered for both 2D and 3D values. The following measurements were evaluated: PNS-A; S-N; N-Me; N-ANS; ANS-Me; Go-Me; Go-S; Go-Co; SNA, SNB, ANB; BaSN; S-N^PNS-ANS; PNS-ANS^Go-Me; S-N^Go-Me. Intraclass correlation coefficients, paired t-test, correlation coefficient and Bland-Altman analysis were performed to compare these techniques. RESULTS: The values of intra- and inter-rater ICC showed excellent repeatability and reliability: the average (± SD) intraobserver ICCs were 0.98 (± 0.01) and 0.97(± 0.01) for CBCT and RLCs, respectively; Inter-rater reliability resulted in an average ICC (± SD) of 0.98 (± 0.01) for CBCT and 0.94 (± 0.03) for RLC. The paired t-tests between CBCT and reconstructed lateral cephalograms revealed that Go-Me, Go-S, PNS-ANS^Go-Me and S-N^Go-Me measurements were statistically different between the two modalities. All the evaluated sets of measurements showed strong positive correlation; the bias and ranges for the 95% Limits of Agreement showed higher levels of agreement between the two modalities for unpaired measurements with respect to bilateral ones. CONCLUSION: The cephalometric measurements laying on the mid-sagittal plane can be evaluated on CBCT and used for orthodontic diagnosis as they do not show statistically significant differences with those measured on 2D lateral cephalograms. For measurements that are not in the mid-sagittal plane, the future development of specific algorithms for distortion correction could help clinicians deduct all the information needed for orthodontic diagnosis from the CBCT scan.

Treatment of Class III Malocclusion and Anterior Crossbite with Aligners: A Case Report.

The article describes the orthodontically treated case of a 25-year-old patient with skeletal and dental class III malocclusion, anterior crossbite, which caused functional and aesthetic problems, occlusal trauma, and incisor wear. Treatment with transparent aligners was proposed to meet the patient's needs, using the sequential distalization protocol. While sequential distalization is well documented for class II malocclusion treatment in maxillary arch teeth, further investigations are necessary for class III malocclusions. In fact, lower teeth movements are more complex due to mandibular bone density and the presence of the third molars, which are often extracted to perform distalization. In addition, the use of intermaxillary elastics helps control the proclination of the anterior teeth as a reaction to distalizing forces. At the end of the treatment, the patient reached molar and canine class I and positive overjet and overbite. The inclination of lower incisors and the interincisal angle have improved, resulting in aesthetic and functional enhancement.

Cannabinoids Drugs and Oral Health-From Recreational Side-Effects to Medicinal Purposes: A Systematic Review.

BACKGROUND: marijuana, the common name for cannabis sativa preparations, is one of the most consumed drug all over the world, both at therapeutical and recreational levels. With the legalization of medical uses of cannabis in many countries, and even its recreational use in most of these, the prevalence of marijuana use has markedly risen over the last decade. At the same time, there is also a higher prevalence in the health concerns related to cannabis use and abuse. Thus, it is mandatory for oral healthcare operators to know and deal with the consequences and effects of cannabis use on oral cavity health. This review will briefly summarize the components of cannabis and the endocannabinoid system, as well as the cellular and molecular mechanisms of biological cannabis action in human cells and biologic activities on tissues. We will also look into oropharyngeal tissue expression of cannabinoid receptors, together with a putative association of cannabis to several oral diseases. Therefore, this review will elaborate the basic biology and physiology of cannabinoids in human oral tissues with the aim of providing a better comprehension of the effects of its use and abuse on oral health, in order to include cannabinoid usage into dental patient health records as well as good medicinal practice. METHODS: the paper selection was performed by PubMed/Medline and EMBASE electronic databases, and reported according to the PRISMA guidelines. The scientific products were included for qualitative analysis. RESULTS: the paper search screened a total of 276 papers. After the initial screening and the eligibility assessment, a total of 32 articles were considered for the qualitative analysis. CONCLUSIONS: today, cannabis consumption has been correlated to a higher risk of gingival and periodontal disease, oral infection and cancer of the oral cavity, while the physico-chemical activity has not been completely clarified. Further investigations are necessary to evaluate a therapeutic efficacy of this class of drugs for the promising treatment of several different diseases of the salivary glands and oral diseases.

3D cephalometry on reduced FOV CBCT: skeletal class assessment through AF-BF on Frankfurt plane-validity and reliability through comparison with 2D measurements.

OBJECTIVES: To test the validity of a novel protocol for 3D sagittal jaw discrepancy assessment (skeletal class determination) through comparison with common 2D indexes by the use of reduced FOV (10 × 10) CBCT which shows at least from the Frankfurt plane to the B point vertically, and from the most anterior between A and B point to Po point horizontally. METHODS: A sample of CBCT scans of 109 adult patients (46 females; 63 males; mean age 30 years ± 11.6) equally distributed between I, II and III class was selected. Skeletal class was evaluated with specific software using the distance of A and B point's projection (AF-BF) on FHp (Frankfurt horizontal plane) and compared to 2D common indexes (ANB and Witts appraisal). The validity and reliability of the aforementioned analyses were determined using intra-class correlation coefficients, quadratic weighted Cohen's K and sensitivity. RESULT: A selected range of values of 2.5 ± 2.5 AF-BF showed a solid correlation with the ANB angle (r = 0.846, K = 0.838, p < 0.001) and moderate with Wits appraisal (r = 0.723, K = 0.720, p < 0.001). CONCLUSIONS: AF-BF showed high reliability in skeletal class determination on reduced FOV CBCT without the use of S and N cephalometric landmarks. KEY POINTS: • Reduced FOV CT allows skeletal class determination for orthodontic purposes. • A new 3D-reduced FOV cephalometry is proposed. • AF-BF is a reliable alternative to ANB.

Implant-Supported Immediately Loaded Complete Arch Rehabilitations with a Mean Follow-up of 10 Years: A Prospective Clinical Study.

PURPOSE: To evaluate the complication-free and failure-free survival rates of porcelain fused to zirconia (PFZ) and all-resin complete arch fixed implant-supported prostheses over a mean follow-up of 10 years. MATERIAL AND METHODS: Subjects with either all-resin or PFZ complete arch fixed implant-supported prostheses on 4 or 6 implants were followed prospectively for 10 years. Cumulative survival rates of prostheses without any catastrophic mechanical complications (resolved without replacing the prosthesis) and free of prosthesis failure (requiring the replacement or removal of the prosthesis) were calculated using life table analysis for up to 10-year period. Additional descriptive variables for various prosthesis events were recorded, such as sex, smoking and drinking status of subjects. RESULTS: A total of 36 subjects with a total of 68 prostheses (53 all-resin and 15 PFZ) were available for evaluation with a mean follow-up of 10 years (SD 1.47; range: 8-13 years). The study registered an overall 90% prostheses survival rate-78% for males and 94% for females; 91% for PFZ and 87% for all-resin; and a 31% complication-free prosthesis survival rate-13% for males and 38% for females; 29% for PFZ and 31% for all-resin at 10 years. A slight decrease in survival rate was identified in the first 3 years since the initial treatment (from 100% to 93%). The number of complications increased with time, especially after the 6th year after the initial treatment. CONCLUSION: Despite the number of reparable mechanical complications, the results confirmed the long-lasting features of both PFZ and all-resin complete arch fixed implant-supported prostheses over a 10-year period. There was however an increased number of mechanical complications after 6 years which may entail additional treatment cost for patients.

Bilateral Blindness in a Patient With Temporal Arteritis After Wisdom Tooth Extraction.

A 78-year-old woman reported pain in her right hemiface (middle and upper portions) together with nuchal headache, some days after upper right wisdom tooth extraction. She was treated with nonsteroidal anti-inflammatory drugs by her dentist. Three weeks later, a localized headache over her right superficial temporal artery was reported, and progressive bilateral blindness appeared. A biopsy showed a late stage of temporal arteritis. All the symptoms disappeared following corticosteroid treatment, except blindness. The possible complications linking oral bacteria and extraoral infections and diseases should always be attentively considered during the clinical management of fragile patients.

Implant-Supported Immediately Loaded Full-Arch Rehabilitations: Comparison of Resin and Zirconia Clinical Outcomes in a 5-Year Retrospective Follow-Up Study.

PURPOSE: We analyzed complications and failures of final full-arch implant-supported rehabilitations, comparing resin and zirconia prosthesis materials. Prostheses were retrospectively followed up for 5 years. MATERIALS AND METHODS: One hundred twenty-five patients who received one or two four to six implant-supported immediately loaded full-arch rehabilitations in resin (166 prostheses) or zirconia (48 prostheses) were analyzed. RESULTS: One hundred thirteen patients (53 men, 60 women), with 214 full-arch prostheses (105 maxillary, 109 mandibular), were analyzed. During the follow-up interval, the prosthesis annual complication rate was 6.6%, free complications survival was 75.5% (60 months). Age, number of implants, and prosthesis material did not influence complication risk. Men had a higher risk of complications than women. Prosthesis annual failure rate was 4.6%, free survival was 85.5% (60 months). Age, number of implants, and prosthesis material did not influence failure risk. Men and maxillary arch prostheses had a higher risk of failures than women and mandibular arch prostheses. CONCLUSION: Implant-supported, immediately loaded full-arch rehabilitations supporting resin or zirconia based prostheses were clinically successful in a 5-year follow-up. Prosthesis material did not influence complication risk.

A Quantitative Analysis of Lip Aesthetics: The Influence of Gender and Aging.

INTRODUCTION: The quantitative analysis of sexual dimorphism of facial structures may valuably support reconstructive and feminization surgery, thanks to the estimation of metrical thresholds useful for distinguishing male and female traits. This study aims at verifying the metrical characteristics of female and male lips, to provide indications for aesthetic surgery. METHODS: Thirty healthy Caucasian volunteers (20 men and 20 women) were divided into two groups according to age: 21-34 years and 45-65 years. Arches and the cutaneous (external) and mucosal (internal) labial surfaces were reproduced by stone models, and digitised using a computerised electromechanical instrument. Area, volume and thickness were measured separately for the upper and lower lips, and compared between sexes and ages by Student's t test, and multinomial logistic regression. RESULTS: All lip measurements were larger in males than in females; upper lip thickness best divided males from females, adopting a 9.5-mm threshold (percentage of correct diagnosis: 85 %). Young subjects always showed higher measurements than old subjects; lower lip thickness provided the highest percentage of correct age diagnosis (85 %, adopting a 13.8-mm threshold). CONCLUSION: This study provides novel thresholds that may contribute to the assessment of adequate reconstruction of lips in aesthetic surgery. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Frontotemporal dementia: from genetics to therapeutic approaches.

INTRODUCTION: Frontotemporal dementia (FTD) includes a group of neurodegenerative diseases characterized clinically by behavioral disturbances and by neurodegeneration of brain anterior temporal and frontal lobes, leading to atrophy. Apart from symptomatic treatments, there is, at present, no disease-modifying cure for FTD. AREAS COVERED: Three main mutations are known as causes of familial FTD, and large consortia have studied carriers of mutations, also in preclinical Phases. As genetic cases are the only ones in which the pathology can be predicted in life, compounds developed so far are directed toward specific proteins or mutations. Herein, recently approved clinical trials will be summarized, including molecules, mechanisms of action and pharmacological testing. EXPERT OPINION: These studies are paving the way for the future. They will clarify whether single mutations should be addressed rather than common proteins depositing in the brain to move from genetic to sporadic FTD.

Fifteen-year recall period on zirconia-based single crowns and fixed dental prostheses. A prospective observational study.

AIM: The aim of this study was to evaluate the long-term clinical outcomes of zirconia-based prostheses used for tooth-supported or implant-supported single crowns and fixed dental prostheses (FPD). METHODS: The authors conducted a prospective analysis of 562 zirconia core restorations supported by endodontically treated teeth or titanium implant in 276 patients in a general dental private practice, with a follow-up period of 15 years. The study was stopped after patients achieved 15 yrs of follow-up. The study analyzed the failure and complication rates of single and multiple crowns, based on Kaplan Meier analysis. RESULTS: During follow-up period, there were 26 complications and 156 failures. The crown level analysis revealed a cumulative failure rate of 28.33% and complication rate of 8.47% for zirconia crowns after 15 years. The complication rate was found to be higher for titanium implant-supported than for natural teeth-supported crowns. The different types of crown-based failure include: veener fracture 5.01% (N = 29), metal zirconia led to 14.85% (N = 86) loss of retention, and 1.73% (N = 10) loss of crown due to extraction. CONCLUSION: Based on these findings, zirconia core restorations appear to be a reliable long-term solution for crowns and fixed dental prostheses. CLINICAL RELEVANCE: The study suggests that zirconia restorations can be successfully used for long-term prostheses on natural teeth or implants supported. The study results provide clinicians valuable information when selecting prosthetic restorations material.

Salivary biomarkers for early detection of oral squamous cell carcinoma (OSCC) and head/neck squamous cell carcinoma (HNSCC): A systematic review and network meta-analysis.

Oral cancer became a very common condition. WHO estimates that there are 4 cases of lip and oral cavity cancer for every 100,000 people worldwide. The early diagnosis of cancers is currently a top focus in the health sector. Recent systematic reviews and meta-analyses have identified promising biomarkers for early detection in several original research investigations. However, it is still unclear the quality of these evidence and which biomarker performs the best in terms of early detection. Therefore, the objective was, to map the methodological and reporting quality of available oral squamous cell carcinoma (OSCC) or head/neck squamous cell carcinoma (HNSCC) systematic reviews and meta-analysis. Secondly, to evaluate diagnostic accuracy of salivary biomarkers for common craniofacial cancers and to compare the diagnostic value of different salivary biomarkers. PubMed, Scopus, Web of Science, Embase and Cochrane Library electronic databases were used to map the methodological and reporting quality of the systematic reviews and meta-analysis conducted on the HNSCC, OSCC using the AMSTAR-2 checklist. The inclusion criteria were systematic reviews and meta-analysis published in the topic of HNSCC and OSCC biomarkers. Exclusion criteria were no animal studies; original primary studies, due to limitation of competency in other languages articles with language other than English were excluded. The sensitivity and specificity were calculated for salivary biomarkers and ranked according to network meta-analysis principles. A total of N = 5893 patients were included from four meta-analysis studies. All together, these included n = 37 primary studies. n = 94 biomarkers were pooled from these four meta-analyses and categorised into the stages at which they were detected (I-IV). In OSCC, Chemerin and MMP-9 displayed the highest sensitivity, registering 0.94 (95% CI 0.78, 1.00) and a balanced accuracy of 0.93. Phytosphingosine closely followed, with a sensitivity of 0.91 (95% CI 0.68, 0.99) and a balanced accuracy of 0.87. For HNSCC, the top three biomarkers are Actin, IL-1ß Singleplex, and IL-8 ELISA. Actin leads with a sensitivity of 0.91 (95% CI 0.68-0.99), a specificity of 0.67, and an overall accuracy of 0.79. Subsequently, IL-1ß Singleplex exhibits a sensitivity of 0.62 (95% CI 0.30-0.88), a specificity of 0.89, and an accuracy of 0.75, followed by IL-8 ELISA with a sensitivity of 0.81 (95% CI 0.54-0.97), a specificity of 0.59, and an accuracy of 0.70. In conclusion, there was highest sensitivity for MMP-9 and chemerin salivary biomarkers. There is need of further more studies to identify biomarkers for HNSCC and OSCC.

Arduino Automated Microwave Oven for Tissue Decalcification.

Decalcification of hard tissues such as bone and teeth is a complex process that requires using chemicals such as acids and chelating agents. Acids act faster than chelating agents, but they have a greater risk of damaging biological samples. Increasing the reaction speed of the chelating agent may solve this issue. There are several strategies to speed up this process, and using microwaves seems to be one of the most effective. However, lab-dedicated microwave ovens are expensive, and their purchase may seem unjustified. Therefore, a low-cost modification of a commercial microwave oven, consisting of an Arduino automation device, has been developed. The setup has proven reliable for continuous work, thanks to implementing an electronic safety circuit. In addition, it may reduce the decalcification time using a chelating agent, achieving optimal results regarding tissue preservation and quality of histological sections.