Root surface biomodification in periodontal therapy: Biological rationale and clinical applications.

Regenerative periodontal therapy aims to form new cementum, periodontal ligament, and alveolar bone, all sealed by gingival tissue. The root surface acts as the wound margin during this regeneration process. Root surface biomodification (root conditioning/root decontamination), therefore, seems instrumental in promoting surface decontamination and enhancing tissue attachment by removing the smear layer, exposing collagen fibrils, and facilitating blood clot formation and stabilization. This review attempted to provide an all-encompassing, evidence-based assessment of the role of root surface biomodification in regenerative periodontal therapy, particularly in intrabony defects, furcation defects, and root coverage procedures. The reviewed evidence suggested that root conditioning agents, whether used independently or in conjunction with bone graft materials, biological agents, membranes, or connective tissue grafts, do not offer any clinical advantage regarding clinical attachment gain. Thus, integrating chemical methods with the mechanical root instrumentation process does not necessarily contribute to superior clinical outcomes.

Ten-year prognostic outcomes of molar survival using the Miller-Mcentire Periodontal Prognostic Index - A longitudinal prospective study.

Background: A 10-year survival analysis was performed to assess the predictive validity of the periodontal risk score (formerly known as Miller-McEntire Periodontal Prognostic Index [MMPPI]) to predict long-term survival of periodontally diseased molars in a longitudinally assessed cohort. Materials and Methods: The MMPPI scores were computed at baseline by summarizing scores allocated for individual factors. The cohort was treated, followed up, and placed under regular periodontal maintenance. Molar survival data collected up to 10 years of follow-up were analyzed. Cox proportional regression was performed, and hazards ratio (HR) were computed for each prognostic factor and the MMPPI score. To estimate the predictive value of MMPPI, a receiver operating curve (ROC) curve analysis was performed. Results: From 1032 molars, 155 molars were extracted over the 10-year follow-up duration. Cox proportional hazard analysis showed significant hazard ratios for tooth loss for the component variables significant HR was noted for age: 4.92 (3.34:7.27), smoking: 1.74 (1.38-2.22), diabetes: 1.66 (1.49-1.86), molar type: 1.39 (1.15-1.67), probing depth: 2.00 (1.63-2.46), furcation: 2.64 (2.30-3.03), mobility: 3.45 (2.98-4.01), and total MMPPI score: 1.98 (1.85-2.12). ROC curve analysis showed an area under the curve value of 0.94 for the MMPPI index as a predictor of molar loss at 8 years, and the Youden index was maximized at the optimal cutoff point score of 7. Conclusions: All component scores of MMPPI showed significant hazard ratios at 10 years. These findings support the previous results from the 5-year analysis of this university-based cohort and warrant validation in independent cohorts.

Residual vertical defects: risk of disease progression, retreatment rates, and cost: a retrospective analysis.

OBJECTIVES: This study aimed to explore the relationship between Radiographic Residual Vertical Defects (RVDs) and the progression of periodontitis in patients undergoing periodontal maintenance therapy (PMT). MATERIALS AND METHODS: Teeth with RVDs were compared to the same contralateral teeth in the same patient. The study investigated the effect of smoking, diabetes, compliance, disease Stage, and Grade, baseline probing depth (PD), periodontal risk score (PRS), baseline pocket closure (PC) (≤ 4 mm), and tooth mobility on disease progression. We calculated the need for retreatment during PMT and its associated cost. Generalized estimation equations and linear and multilevel logistic regression analyses were employed for data analysis. RESULTS: Each group had 139 teeth, accounting for 80 patients. Although the group with RVDs had similar PD reduction compared to the control teeth, the prevalence of PC at the last follow-up was reduced to half in the RVDs group (odds ratio OR = 0.5; p-value = 0.028), regardless of PC status at the baseline. RVDs were also significant predictors of tooth loss due to periodontitis (TLP), with an OR of 2.28 (p = 0.043). Patients with diabetes, Stage IV, higher mobility, and higher PRS scores had a higher risk of tooth loss due to periodontitis (OR = 4.71, 3.84, 3.64, and 5.97, respectively (P < 0.01). Incidences of sites requiring retreatment were similar in both groups, but the cost of treatment was 30% higher for teeth with RVDs. Grade C had the most significant influence on receiving retreatments (OR = 18.8, p = 0.005). CONCLUSION: Teeth with RVDs represent a risk indicator for tooth loss compared to identical contralateral teeth with similar PD in the same patient. Teeth with RVD had more risk of pocket opening during follow-up. CLINICAL RELEVANCE: While teeth with RVDs can be maintained long-term, they have twice the risk of pocket opening and tooth loss due to periodontitis during follow-up. Patients with systemic and local risk factors need to be monitored closely as they are at the highest risk of losing teeth with RVDs. The increased cost of retreatment for teeth with RVDs also has implications in terms of retention versus extraction and replacement.

Impact of smoking on cost-effectiveness of 10-48 years of periodontal care.

The study aims were (1) to explore whether "periodontal treatment" consisting of surgical therapy (flap, resective, or regenerative) or scaling and root planing treatment with long-term periodontal maintenance treatment, is cost-effective in terms of preventing periodontitis-attributable tooth extraction and replacement by implant-supported crowns ("extraction/replacement"); (2) to assess the effect of cigarette smoking on this cost-effectiveness. Data for this observational retrospective study were collected from dental charts of patients who had received periodontal therapy and at least annual follow-up visits for >10 years were analyzed by linear regression generalized estimating equations and generalized linear models. Among 399 adults (199 males, 200 females), those with the least mean annual treatment cost experienced the greatest mean annual costs for extraction/replacement, indicating general cost-effectiveness. Cigarette smoking adversely impacted this cost-effectiveness, with current heavy smokers experiencing no cost-effectiveness. Former smokers with Grade C periodontitis benefitted most, whereas smoking did not influence cost-effectiveness for Grade B periodontitis. Assessed by mean annual costs of "extraction/replacement," periodontal treatment was cost-effective, which decreased in a dose-response manner by former and current smoking intensity. Cigarette smoking should be factored into treatment planning and cost-effective analyses of periodontal treatment. Smoking cessation should be encouraged.

Performance of three artificial intelligence (AI)-based large language models in standardized testing; implications for AI-assisted dental education.

INTRODUCTION: The emerging rise in novel computer technologies and automated data analytics has the potential to change the course of dental education. In line with our long-term goal of harnessing the power of AI to augment didactic teaching, the objective of this study was to quantify and compare the accuracy of responses provided by ChatGPT (GPT-4 and GPT-3.5) and Google Gemini, the three primary large language models (LLMs), to human graduate students (control group) to the annual in-service examination questions posed by the American Academy of Periodontology (AAP). METHODS: Under a comparative cross-sectional study design, a corpus of 1312 questions from the annual in-service examination of AAP administered between 2020 and 2023 were presented to the LLMs. Their responses were analyzed using chi-square tests, and the performance was juxtaposed to the scores of periodontal residents from corresponding years, as the human control group. Additionally, two sub-analyses were performed: one on the performance of the LLMs on each section of the exam; and in answering the most difficult questions. RESULTS: ChatGPT-4 (total average: 79.57%) outperformed all human control groups as well as GPT-3.5 and Google Gemini in all exam years (p < .001). This chatbot showed an accuracy range between 78.80% and 80.98% across the various exam years. Gemini consistently recorded superior performance with scores of 70.65% (p = .01), 73.29% (p = .02), 75.73% (p < .01), and 72.18% (p = .0008) for the exams from 2020 to 2023 compared to ChatGPT-3.5, which achieved 62.5%, 68.24%, 69.83%, and 59.27% respectively. Google Gemini (72.86%) surpassed the average scores achieved by first- (63.48% ± 31.67) and second-year residents (66.25% ± 31.61) when all exam years combined. However, it could not surpass that of third-year residents (69.06% ± 30.45). CONCLUSIONS: Within the confines of this analysis, ChatGPT-4 exhibited a robust capability in answering AAP in-service exam questions in terms of accuracy and reliability while Gemini and ChatGPT-3.5 showed a weaker performance. These findings underscore the potential of deploying LLMs as an educational tool in periodontics and oral implantology domains. However, the current limitations of these models such as inability to effectively process image-based inquiries, the propensity for generating inconsistent responses to the same prompts, and achieving high (80% by GPT-4) but not absolute accuracy rates should be considered. An objective comparison of their capability versus their capacity is required to further develop this field of study.

Factors associated with furcation involvement and fixed prostheses: A cross-sectional study.

OBJECTIVE: The study aims to explore the relationship between horizontal and vertical furcation involvement (FI) in teeth with or without a single unit fixed prosthesis (FP). MATERIALS AND METHODS: Adult subjects presenting to the periodontics department requiring cone beam computed tomography (CBCT) analysis were recruited for this study. 79 patients, with a total of 200 teeth, were split into two groups based on the presence or absence of FP within the same patient. Our analysis considered patient-level factors like smoking, diabetes, and periodontal severity and tooth-level factors including root trunk length (RTL), probing depth (PD), periodontal supracrestal tissue height (STH), supracrestal tissue attachment (STH-PD), interproximal bone distance (IPBD) to the cementoenamel junction (CEJ) (control) or crown margin (Test), and the distance from the furcation to the CEJ (control) or crown margin (Test). Subsequently, we developed a predictive model for FI. RESULTS: The presence of a prosthesis had a significant association with FI, with an odds ratio (OR) of 12.8 (p < 0.001). Other factors significantly correlated with FI were periodontitis (OR = 10.9; p = 0.006), buccal furcation site (OR = 5.70; p < 0.001), and PD (OR = 1.90; p = 0.027). FP placement increased IPBD by 1.08 mm (p < 0.001). The predictive model built for FI demonstrated a sensitivity of 92.9% and a specificity of 66.7%. CONCLUSIONS: Fixed prosthesis significantly influenced FI only in periodontitis patients. Factors such as periodontitis Stage, probing depth, and buccal site contribute to FI. The high sensitivity of the predictive model highlights the importance of considering these correlations during treatment planning. CLINICAL RELEVANCE: Comprehending FI factors is vital for devising customised treatment plans to halt disease progression and enhance outcomes of periodontal regenerative therapies.

Association between asthma and periodontitis: A case-control analysis of risk factors, related medications, and allergic responses.

AIMS: This study aimed to investigate the association between asthma, related allergies and medication use, and the presence and severity of periodontitis among individuals at the University of Michigan School of Dentistry. METHODS: Employing a case-control design, the study analyzed data from 892 patients, half with asthma and half without asthma. Data collection included demographics, asthma history, medication use, allergies, and periodontal examination outcomes, including probing pocket depth (PPD), mobility, furcation involvement, and radiographic bone loss (RBL). Logistic regression models assessed the relationship between asthma and periodontitis, adjusting for confounders. RESULTS: Asthmatic patients exhibited significantly lower odds of periodontitis (OR = 0.10, p < .001) and were less likely to present with advanced stages (OR = 0.23, p < .001) and grades of the disease (OR = 0.31, p < .001) compared to non-asthmatic patients. The study also found a higher proportion of females in the asthmatic group (67% vs. 51.8%, p < .001). Smoking was identified as a significant factor associated with periodontitis in patients with asthma, with former smokers at more than double the odds (OR = 2.28, p = .035) and current smokers at a slightly lower yet significant odds (OR = 1.87, p = .050). Additionally, asthmatic patients on adrenergic inhalers had an increased likelihood of developing periodontitis (OR = 1.76, p = .045). Allergies to codeine and latex were associated with higher odds of periodontitis, with ORs of 3.41 and 6.09, respectively. CONCLUSIONS: Asthma was found to be associated with lower odds of periodontitis. However, this association appears to be modified by smoking habits and the use of certain asthma medications, which are related to an increased likelihood of periodontitis among asthmatic patients.

Utilizing Individualized Titanium Frames for Protected Alveolar Bone Augmentation: A Feasibility Case Series.

Despite the various treatments proposed with barrier membranes, one of the main challenges for guided bone regeneration (GBR) is maintaining space for large defects and ensuring an adequate blood supply. The presented feasibility case series aims to introduce an original titanium frame (TF) design, customized for each defect, as a modification of well-known principles and materials for GBR to achieve an enhanced and more predictable horizontal and vertical bone augmentation. Three patients with significant horizontal defects were treated with pre-trimmed TFs to create needed space, and then a 50/50 mixture of autograft and bovine xenograft was placed and covered with a collagen membrane. After 8 months of healing, the sites were reopened, and the titanium screws were removed with the frame. An average of 8.0 ± 1.0 mm of horizontal and 3.0 ± 0.0 mm of vertical bone gain were achieved at the time of reentry and implant placement surgery. Bone core biopsy sample was obtained during the implant placement. Histomorphometric analysis revealed that 42.8% of the sample was new vital bone, 18.8% was residual bone graft particles, and 38.4% was bone marrow-like structures. After 3 to 4 months from implant placement, the implants were restored with provisional crowns and then finalized with zirconia screw-retained crowns. This case series suggests that GBR utilizing TFs with or without collagen membranes can be considered a suitable approach for horizontal and vertical bone augmentation. However, based on only three reported cases, the results should be carefully interpreted.

History of periodontitis as a risk factor for implant failure and incidence of peri-implantitis: A systematic review, meta-analysis, and trial sequential analysis of prospective cohort studies.

INTRODUCTION: Dental implants are widely employed as dependable replacements for lost teeth. However, it is crucial to establish, solely through prospective cohort studies, whether a history of periodontitis indeed constitutes a significant risk factor for implant failure. METHODS: A systematic literature search was conducted in October 2022 in several electronic databases with subsequent manual updates. Only original prospective cohort studies evaluating the implant (loss) rate ≥1 year after implant loading were included. Logarithmic risk ratio and weighted mean differences were calculated. Study results were summarized using random effects meta-analyses evaluated by trial sequential analyses. The Newcastle-Ottawa scale evaluated study bias and the GRADE approach assessed the certainty/quality of the evidence. RESULTS: A total of 14 publications reporting on 12 prospective cohort studies were included. Low evidence certainty/quality evidence due to the absence of randomized clinical trials revealed significantly greater odds of failure in patients with a history of periodontitis at follow-ups both after ≤5 years (RR = 1.62; 95% CI: 1.71-2.37; p = 0.013) and >5 years (RR = 2.26; 95% CI: 1.12-4.53; p = 0.023). The incidence of peri-implantitis (RR = 4.09; 95% CI: 1.93-8.58; p < 0.001) and the weighted mean (WM) of marginal bone loss (WM difference = 0.75 mm; 95% CI: 0.18-1.31; p < 0.05) were statistically significantly greater in the periodontally compromised group, whereas there was no significant difference between the two groups for peri-implant probing depth. CONCLUSION: A history of periodontitis can be considered a significant risk factor for incident implant failure, peri-implantitis, and greater marginal bone loss.

The economic and societal impact of periodontal and peri-implant diseases.

Periodontal and peri-implant diseases result from a chronic inflammatory response to dysbiotic microbial communities and are characterized by inflammation in the soft tissue and the ensuing progressive destruction of supporting bone, resulting in tooth or implant loss. These diseases' high prevalence, multifactorial etiology, extensive treatment costs, and significant detriment to patients' quality-of-life underscore their status as a critical public health burden. This review delineates the economic and sociocultural ramifications of periodontal and peri-implant diseases on patient welfare and healthcare economics. We delve into the implications of diagnosis, treatment, supportive care, and managing destructive tissue consequences, contrasting these aspects with healthy patients.

25 years of Clinical Implant Dentistry and Related Research (CIDRR): A modern bibliometric and Altmetrics network analysis.

INTRODUCTION: Since its establishment in 1999, the journal of Clinical Implant Dentistry and Related Research (CIDRR) has consistently disseminated notable clinical and translational research within the domain of oral implantology. As the journal approaches its milestone 25th anniversary, this study endeavors to systematically delineate the publication trends, level of evidence, and bibliometric indices characterizing the initial quarter-century of CIDRR's scholarly activity. Notably, the investigation adopts a contemporary methodology by incorporating Altmetric analysis, thereby enriching the evaluation with an assessment of the broader societal and online impact of the published research. METHODS: A comprehensive search was performed in SCOPUS and PubMed to access the bibliographic data of all articles published in the journal from 1999 to 2024. Additionally, Altmetric database was used to obtain social media attention scores (AAS). Journal's overall performance via impact factor and quartile range was assessed. Most cited papers were identified and the most prolific authors, institutions and countries and the collaboration networks among those were assessed. The level of evidence of all articles was determined based on Oxford level of evidence scale. All articles were categorized based on their major topic in the field of implant dentistry. RESULTS: Throughout its first 25 years of activity, CIDRR published 1912 articles with an annual growth rate of 2.67% and consistently being ranked at Q1 quartile in "Dentistry (miscellaneous)" and "Oral Surgery" journal categories. When clinical studies are considered, level I and II evidence constituted 22.82% and 11.82% of all articles, respectively. Sweden, the USA, and Italy as well as Göteborgs Universitet, Sahlgrenska Akademin. and Malmö Högskola were the most prolific countries and institutions respectively. "Implant system/design/characteristics," "Bone Augmentation," and "Implant Prosthesis" were the top most investigated topics. CONCLUSIONS: The examination of the journal's initial 25 years highlighted that CIDRR has surpassed similar dental research journals in publishing a greater number of high-level evidence articles. It also showcased diverse country- and author-collaboration networks. However, the journal's social media presence is still evolving. This article, presenting a comprehensive overview of the journal's scientometric and bibliographic activities, serves as a valuable reference for researchers, clinicians, and stakeholders, offering insights into both traditional and contemporary perspectives.

Short (≤6 mm) compared with ≥10-mm dental implants in different clinical scenarios: A systematic review of randomized clinical trials with meta-analysis, trial sequential analysis and quality of evidence grading.

AIM: To systematically identify, synthesize and critically summarize the available scientific evidence from randomized controlled trials (RCTs) regarding whether short (≤6 mm) perform as well as long (≥10 mm) implants regarding implant survival, marginal bone loss, and biologic and prosthetic complications in different clinical scenarios. MATERIALS AND METHODS: Cochrane Collaboration's risk of bias tool and the GRADE approach were applied. Results were synthesized using random-effects meta-analyses assessed by trial sequential analyses. RESULTS: Forty reports on 19 RCTs comprising 2214 (1097 short; 1117 long) implants were included. Moderate/high certainty/quality evidence demonstrated similar 5-year survival rates for ≤6-mm and ≥10-mm implants in non-augmented bone and full-mouth rehabilitation in either jaw, and for 6-mm implants in the maxilla instead of sinus lift. Nevertheless, the evidence for 5-year survival rates remains inconclusive or insufficient for the remaining combinations of implant lengths and clinical scenarios. They include 4-mm and 5-mm implants as alternatives to sinus lift as well as placing all implant lengths ≤6 mm instead of vertical ridge augmentation with long implants. Marginal bone level and short- and long-term biologic or prosthetic complications were similar. CONCLUSIONS: Based on moderate/high certainty/quality evidence from 5-year RCTs, implants ≤6 mm may be viable alternatives to ≥10-mm implants in either jaw in native bone and full-arch rehabilitation, and 6-mm implants may be used as an alternative to sinus lift. TRIAL REGISTRATION: PROSPERO ID: CRD42021254365.

Mucosal cyst aspiration in conjunction with maxillary sinus elevation: A clinical cohort study.

INTRODUCTION: Patients with mucosal cysts in the maxillary sinus require special consideration in patients who require implant therapy for the restoration when undergoing implant therapy for the restoration of the posterior maxillary dentition. Treatment strategies for these clinical situations remain controversial in the literature. Thus, this study seeks to describe a safe and effective therapeutic strategy for sinus augmentation in patients with pre-existing maxillary antral cysts. METHODS: A total of 15 patients and 18 sinuses were consecutively enrolled in this cohort study and underwent maxillary antral cyst treatment by needle aspiration and simultaneous maxillary sinus augmentation (MSA). During surgical procedures, threeimplants (Zimmer Biomet, Indiana, USA) were positioned in 11 sinuses and two implants (Zimmer Biomet, Indiana, USA) were positioned in 5 sinuses. RESULTS: Overall implant success and survival rates were 100% and 97.8%, respectively at 1 year and 5-year follow-ups. Crestal bone resorption averaged 0.3 ± 0.2 mm 5-year post-loading, showing bone stability. Implant survival rate at 5-year follow-up expressed predictability of the technique comparable to historical data when MSA was performed alone. Crestal bone resorption averaged 0.3 ± 0.2 mm 5 years post-loading and shows bone stability utilizing mucosal cyst aspiration with concomitant MSA procedures. Quality of life evaluation at 1-week post-op showed similar results to published historical data. In 81% (13 sinuses), the CBCT examination at 5-year follow-up showed no cyst reformation, in 19% (3 sinuses) cyst reformation was visible, but smaller in size when compared to the pre-op CBCT evaluation, and all the patients were asymptomatic. CONCLUSIONS: Maxillary sinus mucosal cyst aspiration with concomitant MSA, may be a viable option to treat maxillary sinus cyst.

Survival, immune response and growth of Penaeid shrimp as affected by immunostimulants: A meta-analysis.

Immunostimulants represent the most innovative approach for combating shrimp diseases. They are molecules that effectively enhance the host's nonspecific defenses against invading microorganisms. However, methodological differences exist among immunostimulants based on the same source. Therefore, conducting a meta-analysis is essential to derive valid conclusions. The effect size value utilized in this study was Hedges' d. Heterogeneity among studies was assessed using the DerSimonian and Laird tests (Q-statistic). Meta-regression analysis was conducted to explore the sources of heterogeneity in treatment effects. In this study, dose served as a covariate because it was the only continuous variable that significantly contributed to the observed heterogeneity. Funnel plots and the fail-safe number were employed to assess publication bias within the datasets. The article collection process followed the PRISMA methodology. Based on the results of the meta-analysis and meta-regression conducted with 83 articles, it can be concluded that immunostimulants have a significant effect, characterized by high category standard mean difference (SMD) values, on the survival, growth, and immune response of Penaeid family shrimp. Among potential immunostimulants options, algae ingredients exhibited the most favorable effects on the survival, growth, and immune response of Penaeid family shrimp. Subgroup analysis outcomes revealed that various extraction methods significantly impacted the efficacy of immunostimulants, with the ethanol solvent method proving to be the most effective. Among different administration methods, no significant effect was observed on immunostimulant efficacy across all parameters, with positive SMD values for all administration methods. Regarding challenged test pathogens, immunostimulants were observed to enhance immune response, survival, and weight gain against various pathogens. Meta-regression results indicated that algal treatments had a lower optimal dose point, leading to decreased efficacy as the dose increased. In contrast, fungi exhibited a higher optimum dose point, resulting in increased efficacy at higher doses.

Indications for implant-supported rehabilitation of the posterior atrophic maxilla: A multidisciplinary consensus among experts in the field utilising the modified Delphi method.

PURPOSE: To establish consensus-driven guidelines that could support the clinical decision-making process for implant-supported rehabilitation of the posterior atrophic maxilla and ultimately improve long-term treatment outcomes and patient satisfaction. MATERIALS AND METHODS: A total of 33 participants were enrolled (18 active members of the Italian Academy of Osseointegration and 15 international experts). Based on the available evidence, the development group discussed and proposed an initial list of 20 statements, which were later evalu-ated by all participants. After the forms were completed, the responses were sent for blinded ana-lysis. In most cases, when a consensus was not reached, the statements were rephrased and sent to the participants for another round of evaluation. Three rounds were planned. RESULTS: After the first round of voting, participants came close to reaching a consensus on six statements, but no consensus was achieved for the other fourteen. Following this, nineteen statements were rephrased and sent to participants again for the second round of voting, after which a consensus was reached for six statements and almost reached for three statements, but no consensus was achieved for the other ten. All 13 statements upon which no consensus was reached were rephrased and included in the third round. After this round, a consensus was achieved for an additional nine statements and almost achieved for three statements, but no consensus was reached for the remaining statement. CONCLUSION: This Delphi consensus highlights the importance of accurate preoperative planning, taking into consideration the maxillomandibular relationship to meet the functional and aesthetic requirements of the final restoration. Emphasis is placed on the role played by the sinus bony walls and floor in providing essential elements for bone formation, and on evaluation of bucco-palatal sinus width for choosing between lateral and transcrestal sinus floor elevation. Tilted and trans-sinus implants are considered viable options, whereas caution is advised when placing pterygoid implants. Zygomatic implants are seen as a potential option in specific cases, such as for completely edentulous elderly or oncological patients, for whom conventional alternatives are unsuitable.

Neurochemical Predictors of Generalized Learning Induced by Brain Stimulation and Training.

Methods of cognitive enhancement for humans are most impactful when they generalize across tasks. However, the extent to which such "transfer" is possible via interventions is widely debated. In addition, the contribution of excitatory and inhibitory processes to such transfer is unknown. Here, in a large-scale neuroimaging individual differences study with humans (both sexes), we paired multitasking training and noninvasive brain stimulation (transcranial direct current stimulation, tDCS) over multiple days and assessed performance across a range of paradigms. In addition, we varied tDCS dosage (1.0 and 2.0 mA), electrode montage (left or right prefrontal regions), and training task (multitasking vs a control task) and assessed GABA and glutamate concentrations via ultrahigh field 7T magnetic resonance spectroscopy. Generalized benefits were observed in spatial attention, indexed by visual search performance, when multitasking training was combined with 1.0 mA stimulation targeting either the left or right prefrontal cortex (PFC). This transfer effect persisted for ∼30 d post intervention. Critically, the transferred benefits associated with right prefrontal tDCS were predicted by pretraining concentrations of glutamate in the PFC. Thus, the effects of this combined stimulation and training protocol appear to be linked predominantly to excitatory brain processes.

Simultaneous Measurement of GABA, Glutathione, and Glutamate-Glutamine in the Thalamus using Edited MR Spectroscopy: Feasibility and Applications in Traumatic Brain Injury.

BACKGROUND: MR spectroscopy (MRS) is a noninvasive tool for evaluating biochemical alterations, such as glutamate (Glu)/gamma-aminobutyric acid (GABA) imbalance and depletion of antioxidative glutathione (GSH) after traumatic brain injury (TBI). Thalamus, a critical and vulnerable region post-TBI, is challenging for MRS acquisitions, necessitating optimization to simultaneously measure GABA/Glu and GSH. PURPOSE: To assess the feasibility and optimize acquisition and processing approaches for simultaneously measuring GABA, Glx (Glu + glutamine (Gln)), and GSH in the thalamus, employing Hadamard encoding and reconstruction of MEscher-GArwood (MEGA)-edited spectroscopy (HERMES). STUDY TYPE: Prospective. SUBJECTS: 28 control subjects (age: 35.9 ± 15.1 years), and 17 mild TBI (mTBI) patients (age: 32.4 ± 11.3 years). FIELD STRENGTH/SEQUENCE: 3T/T1-weighted magnetization-prepared rapid gradient-echo (MP-RAGE), HERMES. ASSESSMENT: We evaluated the impact of acquisition with spatial saturation bands and post-processing with spectral alignment on HERMES performance in the thalamus among controls. Within-subject variability was examined in five controls through repeated scans within a week. The HERMES spectra in the posterior cingulate cortex (PCC) of controls were used as a reference for assessing HERMES performance in a reliable target. Furthermore, we compared metabolite levels and fitting quality in the thalamus between mTBI patients and controls. STATISTICAL TESTS: Unpaired t-tests and within-subject coefficient-of-variation (CV). A P-value <0.05 was deemed significant. RESULTS: HERMES spectra, acquired with saturation bands and processed with spectral alignment, yielded reliable metabolite measurements in the thalamus. The mean within-subject CV for GABA, Glx, and GSH levels were 18%, 10%, and 16% in the thalamus (7%, 9%, and 16% in the PCC). GABA (3.20 ± 0.60 vs 2.51 ± 0.55, P < 0.01) and Glx (8.69 ± 1.23 vs 7.72 ± 1.19, P = 0.03) levels in the thalamus were significantly higher in mTBI patients than in controls, with GSH (1.27 ± 0.35 vs 1.22 ± 0.28, P = 0.65) levels showing no significant difference. DATA CONCLUSION: Simultaneous measuring GABA/Glx and GSH using HERMES is feasible in the thalamus, providing valuable insight into TBI. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 2.

Minimally invasive periodontal regeneration with the buccal approach: a systematic review and meta-analysis of clinical studies.

OBJECTIVE: The aim of this study was to investigate clinical periodontal parameters after treatment using the Minimally Invasive Surgical Technique (MIST), Modified Minimally Invasive Surgical Technique (M-MIST), and/or any technique for papilla preservation, such as Entire Papilla Preservation (EPP), modified-papilla preservation technique (M-PPT), or simplified-papilla preservation technique (SPPT). METHODS: The focus question was "For patients with periodontal intrabony defects (P), what is the best minimally invasive regenerative approach (I), comparing MIST, M-MIST, and papilla preservation techniques' outcomes (C) to improve PD, CAL, GR, and periodontal stability (O)?" An online search was conducted on PubMed, Cochrane Library, and Embase. Only randomized clinical trials and case series with a minimum of 10 enrolled patients were included. The risk of bias was evaluated using the Critical Appraisal tools in JBI Systematic Reviews. The meta-analysis compared the data obtained for the periodontal parameters analyzed, and the heterogeneity was verified. RESULTS: After the screening, nine articles were included. Seven studies applied MIST and its modifications; two used M-PPT, one SPPT, and one approached EPP. A general statistically significant PD reduction and CAL gain were noted between the groups, comparing baseline and follow-up for all articles, independently of the technique or materials used. Also, all studies showed a non-significant increase in the gingival recession. Four studies had a low risk of bias, four had a moderate risk, and only 1 had a high risk. Moderate heterogeneity was found in one analysis for CAL (65.73%); moderate and substantial heterogeneity was found in the PD results (71.91% and 89.19%); and no heterogeneity was found within all analyses for gingival recession (0%). CONCLUSION: MIST, M-MIST, and papilla preservation techniques demonstrated their potential and efficacy to improve periodontal conditions of sites with intrabony defects with minimal morbidity.

Vertical Ridge Augmentation Using Collagen Membrane and Tenting Screws in the Esthetic Zone: A Case Series.

Successful rehabilitation of severely atrophic, short-span edentulous ridges in esthetic regions can seldom be done without some form of vertical ridge augmentation (VRA). The best available evidence shows that guided bone regeneration procedures may present a very predictable option with reduced potential for complications compared to alternative options. The present case series presents a novel technique to achieve predictable VRA with a low complication rate using tenting screws and cross-linked resorbable membranes. A total of 10 patients (5 men, 5 women) with severe vertical defects in the esthetic zone participated in this study. Following a mean healing time of 9.3 months, the mean defect resolution was 80%, with a mean vertical bone gain of 6.2 ± 1.61 mm. Only one case presented with reduced defect resolution (50%); however, the bone gain for this case was 6 mm.

Periodontitis stage and grade modifies the benefit of regular supportive periodontal care in terms of need for retreatment and mean cumulative cost.

AIM: This study aimed to characterize the periodontal breakdown during supportive periodontal care (SPC) and to quantify the corresponding cost-effectiveness of periodontal therapy. MATERIALS AND METHODS: Data were obtained from charts of patients who received active periodontal therapy (APT) with a minimum follow-up of ≥10 years. Analysis was done to identify factors associated with the incidence of additional sub-gingival instrumentation (SGI) and/or surgery (SUR) during SPC and mean cumulative cost of recurrence was calculated. All relevant data were collected. RESULTS: In all, 442 patients were included. Over the follow-up period, 62% of Stage I and II patients and 72% of Stage III and IV patients required further treatment following the APT; 56.5% of SGI patients and 78.6% of SUR patients received a second intervention. SUR patients received more SUR during the follow-up period (p = .035). Stage III and IV patients received more SUR during SPC than Stage I and II patients (p = .001). Grade C patients received more SUR during the follow-up period (p < .05). During the 5-year period preceding retreatment, the mean SPC visits were lower for patients who did not require retreatment (p < .001). Risk factors such as regularity of maintenance, smoking and diabetes were related to a higher chance of receiving SUR during the follow-up period (p < .05). The mean cumulative costs indicated less recurrence cost for compliers in Stage III and IV or Grade B and C but not for those in Stage I and II or Grade A. CONCLUSIONS: The risk of relapse in the maintenance population may be correlated with higher stage and grade, patient compliance, modifiable risk factors and the nature of the treatment provided during APT. The total cost of treatment of recurrences was lower for compliers in Stage III/IV and Grade B/C compared with erratic compliers with the same severity and risk.