The Effectiveness of Cold Atmospheric Plasma (CAP) on Bacterial Reduction in Dental Implants: A Systematic Review.

BACKGROUND: The emergence of dental implants has revolutionized the management of tooth loss. However, the placement of clinical implants exposes them to complex oral environment and numerous microscopic entities, such as bacteria. Cold atmospheric plasma (CAP) is often used to treat the surfaces of dental implants, which alters morphological features and effectively reduces bacterial load. PURPOSE: This systematic review aims to assess the existing literature on the bactericidal properties of CAP when used on various kinds of dental implant surfaces. REVIEW METHOD: An in-depth examination of MEDLINE/PubMed and EMBASE was performed to identify relevant studies, with the most recent search conducted in May 2023. Studies were selected based on their exploration of CAP's effects on dental implants compared to control groups, focusing on CAP's bactericidal efficacy. However, studies that lacked a control group or that failed to measure bactericidal effects were excluded. RESULTS: After applying the selection criteria, 15 studies were ultimately included in the systematic review. The collected data suggest that CAP can effectively reduce bacterial loads on dental implant surfaces, including pathogens like Streptococcus mitis and Staphylococcus aureus. Furthermore, CAP appears to combat biofilms and plaques that are key contributors to periimplantitis. CONCLUSION: CAP emerges as a promising treatment option, exhibiting significant bactericidal activity on dental implant surfaces. CAP can decrease the rates of bacterial biofilm and plaque formation, leading to improved outcomes for dental implant patients.

Efficacy of lycopene for management of oral potentially malignant disorders: A systematic review and meta-analysis.

OBJECTIVE: The aim of this study was to investigate the available evidence on the efficacy of lycopene in the management of oral potentially malignant disorders (OPMDs). STUDY DESIGN: PubMed, Scopus, Web of Science, Google Scholar, China National Knowledge Infrastructure, and ProQuest databases were searched up to April 20, 2022. All clinical trials that assessed the efficacy of lycopene (I) on the signs/symptoms (O) of patients with OPMDs (P) in comparison to either active control or placebo (C) were included. Meta-analysis was conducted using the RevMan software (Cochrane Collaboration, London, UK). RESULTS: A total of 27 clinical trials (20 on oral submucosa fibrosis [OSF], 5 on oral lichen planus [OLP], and 2 on leukoplakia) were included. Overall, lycopene was efficacious in reducing signs and symptoms of OSF, OLP, and leukoplakia. The pooled data revealed comparable efficacy of lycopene and prednisolone in reducing pain and promoting clinical resolution of OLP. Additionally, the pooled data reported comparable efficacy of lycopene and conventional controls in improving the mouth opening and tongue protrusion in patients with OSF. CONCLUSIONS: The results reveal promising effects of lycopene in alleviating signs and symptoms of OSF, OLP, and leukoplakia. However, owing to the observed heterogeneity and short follow-up periods, further well-designed studies with long-term therapy and follow-up are highly recommended.

The Sommerlad-Furlow Modified Palatoplasty Technique: Postoperative Complications and Implicating Factors.

OBJECTIVE: To explore the incidence of postoperative complications and investigate the impact of preselected factors on functional and quality of life outcomes following the Sommerlad-Furlow modified palatoplasty technique. STUDY DESIGN: Retrospective cohort. METHODS: A total of 429 patients with cleft palate, who received Sommerlad-Furlow modified technique between 2011-2017 were enrolled. The postoperative complications including oronasal fistula (ONF), velopharyngeal insufficiency (VPI), and inadequate quality of life (QOL) were collected. Data of preselected factors including gender, age at palatoplasty, cleft type, cleft width, palatal width, pharyngeal cavity depth, and operation duration were also collected. RESULTS: Among 429 patients, 40.1% were males whereas 59.9% were females. The mean age at palatoplasty was 1.23 ± 0.69 (0.42-4) years, and the average cleft width was 10.15 ± 2.95 (4-27) mm. The cleft types had recorded rates of about 6.8%, 69.5%, 17.7%, and 6.1% of Veau I, II, III, and IV, respectively. The overall incidence rates of ONF, VPI, and inadequate QOL were 2.3%, 19.4%, and 31.3%, respectively. In both the univariate and multivariate analyses, the cleft type was significantly implicated in ONF formation (p = 0.023 and 0.032, respectively) whereas the velopharyngeal function was impacted by the palatoplasty age (p Ë‚ 0.001). The receiver operating characteristic curve indicated that age of palatoplasty ≥1.3 years (area under the curve = 0.611, p = 0.002) was the cutoff value for predicting the incidence of VPI. CONCLUSIONS: The Sommerlad-Furlow modified technique appears to have appropriate postoperative outcomes, even in the wide cleft palate. The older age at palatoplasty has a major impact on the overall postoperative outcomes. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:822-829, 2023.

EFFICACY OF LASER THERAPY FOR ALVEOLAR OSTEITIS: A SYSTEMATIC REVIEW OF THE AVAILABLE EVIDENCE.

OBJECTIVE: Alveolar osteitis (commonly known as dry socket) is a very common painful complication of dental extraction with no definitive cure. This systematic review assessed the efficacy of laser therapy in the management of alveolar osteitis. METHODS: PubMed, Scopus, Web of Science, Embase, Cochrane Central, and China National Knowledge Infrastructure (CNKI) were searched for all studies published till July 2021 using relevant keywords. All clinical trials that assessed the efficacy of laser in the management of alveolar osteitis were included. Due to missing some numerical data and the substantial heterogeneity across the studies, no meta-analysis was performed. RESULTS: Out of the 296 identified articles, 14 clinical trials comprising 981 patients were included. The laser wavelengths, power output, and energy fluence showed a great variability across the included studies: 632.8 - 2940 nm, 16 mW - 10 W, and 0.2 - 85.7 J/cm2, respectively. All included studies found laser to be efficacious in alleviating pain and accelerating healing in patients with alveolar osteitis. Of the 14 included studies, 13 studies reported superior outcomes in favor of laser therapy as compared to conventional therapies. CONCLUSION: The available evidence suggests a good efficacy of laser therapy in reducing signs and symptoms of alveolar osteitis. However, owing to the marked methodological heterogeneity and the substantial variations in laser parameters among the included studies, more well-designed clinical trials with adequate sample sizes and standardized laser parameters are highly recommended. CLINICAL SIGNIFICANCE: Laser therapy can be applied for the management of dry socket.

Efficacy of hyaluronic acid for recurrent aphthous stomatitis: a systematic review of clinical trials.

OBJECTIVES: Recurrent aphthous stomatitis (RAS) is a very common oral mucosal disease, and its management is quite challenging with no definitive cure being available so far. Many studies have tried hyaluronic acid (HA) for alleviating signs and symptoms of RAS. The present systematic review sought to assess the available evidence regarding the efficacy of HA in management of RAS. METHODS: Two reviewers independently conducted extensive search in four online databases (PubMed, Scopus, Web of Science, and Google Scholar) and the gray literature, with no restriction to date or language of the publication. All clinical trials that assessed the efficacy of HA in reducing signs and symptoms of RAS were included. Risk of bias was assessed by two reviewers independently, using the Cochrane assessment tool. Due to substantial heterogeneity, no meta-analysis was feasible. RESULTS: Out of the 75 identified articles, nine clinical trials involving 538 RAS patients (259 in HA group) were included. The risk of bias was high in five studies, low in one study, and unclear in three studies. The comparative groups varied greatly across the included studies: triamcinolone (in three studies), chlorhexidine mouthwash, lidocaine, placebo, iodine glycerin, diclofenac, and laser therapy. Overall, the results revealed a good efficacy of HA in alleviating pain and shortening the healing time of RAS, without any reported side effects. Compared to triamcinolone, HA showed superior results in one study, and comparable results in two studies. CONCLUSIONS: The available evidence suggests that HA is a promising treatment option for RAS. However, given the huge heterogeneity of the included studies and high risk of bias in some of these studies, the evidence is inconclusive. Further well-designed clinical trials with standardized methodologies and adequate sample sizes are warranted to discern the efficacy of HA for RAS. CLINICAL RELEVANCE: Hyaluronic acid might be a viable alternative therapeutic option for patients with RAS.

Surgical interventions for management of benign parotid tumors: Systematic review and network meta-analysis.

The impact of the extent of parotid surgery on postoperative complications has long been considered a topic of controversy. The aim of the current network meta-analysis (NMA) is to answer the following questions: (1) Does the extent of surgical resection of benign parotid tumors increase the risk of postoperative complications? (2) What is the best surgical intervention for treatment of benign parotid tumors that can provide an acceptable balance between tumor recurrence rate and other postoperative complications? A comprehensive search on PubMed, Embase, Scopus, and Cochrane library was conducted to identify the eligible studies. The outcome was the incidence of tumor recurrence, facial nerve weakness (temporary [TFW] or permanent [PFP]), Frey's syndrome (FS), sialocele, and salivary fistula. The Bayesian network meta-analysis (NMA) accompanied by a random effect model and 95% credible intervals (CrI) were calculated using the GeMTC R package. Forty-four studies with a total of 7841 participants were included in the current NMA comparing five surgical interventions, namely enucleation, extracapsular dissection (ECD), partial superficial parotidectomy (PSP), superficial parotidectomy (SP), and total parotidectomy (TP). Enucleation showed the highest recurrence rate compared to ECD, SPS, SP, and TP. No statistical differences were observed concerning the recurrence rate when ECD, PSP, SP, and TP were compared together. There was an increased incidence of TFW and FS with the increase in the extent of parotid resection, while no significant difference was found when comparing enucleation with ECD and PSP. SP showed the highest incidence of PFP, and salivary fistula compared to ECD, PSP, and TP. The tumor recurrence rates in enucleation, ECD, PSP, SP, and TP were 14.3%, 3.6%, 3.7%, 2.8%, and 1.4%, respectively. The current NMA demonstrated that the risk of TFW and FS increases with the increase in the extent of parotid resection and that ECD and PSP can be considered the treatment of choice for benign parotid tumors, as both provide an acceptable balance between the incidence of tumor recurrence and facial nerve dysfunction.

Zinc supplementation for prevention and management of recurrent aphthous stomatitis: a systematic review.

BACKGROUND: Recurrent aphthous stomatitis (RAS) is a very common oral ulcerative disease with no definitive cure. Growing evidence suggests a significant association between zinc deficiency and RAS. OBJECTIVES: To assess the efficacy of systemic zinc supplementations in the prevention and management of RAS. METHODS: Five databases were searched for all English and Chinese studies published up to November 2020. All clinical trials that assessed the efficacy of zinc supplementations in the management and/or prevention of RAS were included. RESULTS: Seven clinical trials comprising 482 RAS patients (250 in zinc group) fulfilled the inclusion criteria. The follow-up period ranged from three months to one year. Five studies showed significantly better efficacy of zinc in reducing the recurrence rates of RAS, whereas two studies did not report any significant differences compared to the controls. Four studies reported on signs/symptoms of RAS, three of which showed superior outcomes in favour of zinc, while one study reported comparable results. CONCLUSION: Zinc supplementation seems to be efficacious in the management and prevention of RAS. However, further clinical trials with standardized methodologies and adequate follow-up periods are required to confirm the efficacy of zinc supplementations.

Bone Regeneration Assessment of Polycaprolactone Membrane on Critical-Size Defects in Rat Calvaria.

Biomaterials for use in guided bone regeneration (GBR) are constantly being investigated and developed to improve clinical outcomes. The present study aimed to comparatively evaluate the biological performance of different membranes during the bone healing process of 8 mm critical defects in rat calvaria in order to assess their influence on the quality of the newly formed bone. Seventy-two adult male rats were divided into three experimental groups (n = 24) based on the membranes used: the CG-membrane-free control group (only blood clot, negative control), BG-porcine collagen membrane group (Bio-Guide®, positive control), and the PCL-polycaprolactone (enriched with 5% hydroxyapatite) membrane group (experimental group). Histological and histometric analyses were performed at 7, 15, 30, and 60 days postoperatively. The quantitative data were analyzed by two-way ANOVA and Tukey's test (p < 0.05). At 7 and 15 days, the inflammatory responses in the BG and PCL groups were significantly different (p < 0.05). The PCL group, at 15 days, showed a large area of newly formed bone. At 30 and 60 days postoperatively, the PCL and BG groups exhibited similar bone healing, including some specimens showing complete closure of the critical defect (p = 0.799). Thus, the PCL membrane was biocompatible, and has the potential to help with GBR procedures.

Acellular dermal matrix for prevention of Frey's syndrome after superficial parotidectomy of benign tumors.

PURPOSE: To evaluate: 1) the efficacy of acellular dermal matrix (ADM) to prevent Frey's syndrome (FS) after superficial parotidectomy of benign tumors. 2) the effect of different follow-up intervals on the incidence of FS. METHODS: Fifty-five patients with benign parotid gland tumors underwent superficial parotidectomy were divided into two groups: Non-ADM group (n = 31, 56.3%) and ADM group (n = 24, 43.6%). The primary outcomes measure was the incidence of FS. The secondary outcomes were surgical site depression, infection, salivary sialocele, and salivary fistula. Subjective FS was evaluated using a clinical questionnaire submitted via WeChat at 3, 6, 12, 18, 24, and 32 months postoperatively. Objective FS was evaluated using Minor starch-iodine test at 6 and 12 months postoperatively. RESULTS: There was a statistically significant difference in the incidence of subjective and objective FS when ADM compared with Non-ADM groups (P<0.05). The respective incidence of subjective FS at 3, 6, 12, 18, 24, and 32 months was 4.2%, 8.3%,20.8%, 20.8%, 20.8%, 20.8% in ADM group and 3.2%, 9.7%, 29%, 38.7%, 45.2% in Non-ADM group. The incidence of objective FS after 6 and 12 months was 4.2%, 8.3% in ADM group and 8.3% (2/24), 38.7% (12/31) in Non-ADM group respectively. Five patients in ADM group and 1 patient in Non-ADM group developed sialocele, and all patients resolved with conservative management. Surgical site depression was significantly higher in the Non-ADM group (15/31) compared with (5/24) in ADM (P=0.049). No cases of immune rejection, infection, hematoma, or salivary fistula were observed in ADM group. CONCLUSIONS: The current study demonstrated that 1) ADM could reduce the incidence of FS in the patients undergoing superficial parotidectomy. 2) the peak onset of about 18 months appear to be acceptable follow-up for the development of FS.

Association between serum zinc levels and recurrent aphthous stomatitis: a meta-analysis with trial sequential analysis.

OBJECTIVES: The present meta-analysis sought to investigate the potential association between zinc levels and recurrent aphthous stomatitis (RAS). METHODS: A comprehensive search of online databases (PubMed, Scopus, Web of Science, and China National Knowledge Infrastructure (CNKI)) was conducted to identify all English and Chinese studies published up to August 2020. All case-control studies that assessed plasma/serum zinc levels were eligible for inclusion. Data were analyzed using Comprehensive Meta-Analysis software version 2.2.046 (Biostat, Englewood, NJ, USA). Trial sequential analysis (TSA) was conducted with the trial sequential analysis program. RESULTS: Nineteen case-control studies, involving 1079 RAS cases and 965 controls, were included in the meta-analysis. The pooled results of 19 studies showed that zinc level was significantly lower in RAS patients than in healthy controls (weighted difference in means = - 21.092, 95% CI - 26.695 to - 15.490, I2 = 95.375%, P < 0.001). Upon subgroup analysis by geographic distribution of the sample (Chinese vs. others), the association remained significant in each individual subgroup, although the association was more pronounced among Chinese populations. TSA indicated that the current studies surpassed the required information size, confirming that the differences were reliable. CONCLUSION: The results suggest a significant association between low serum zinc levels and the occurrence of RAS. Although TSA confirmed a solid conclusion, conducting large-scale studies with the highest standards of quality is encouraged. CLINICAL RELEVANCE: Determining zinc levels should be considered in diagnosis, management, and prevention of RAS.

Is the Bacterial Cellulose Membrane Feasible for Osteopromotive Property?

Guided bone regeneration was studied to establish protocols and develop new biomaterials that revealed satisfactory results. The present study aimed to comparatively evaluate the efficiency of the bacterial cellulose membrane (Nanoskin®) and collagen membrane Bio-Gide® in the bone repair of 8-mm critical size defects in rat calvaria. Seventy-two adult male rats were divided into three experimental groups (n = 24): the CG-membrane-free control group (only blood clot, negative control), BG-porcine collagen membrane group (Bio-Guide®, positive control), and BC-bacterial cellulose membrane group (experimental group). The comparison periods were 7, 15, 30, and 60 days postoperatively. Histological, histometric, and immunohistochemical analyses were performed. The quantitative data were subjected to 2-way ANOVA and Tukey's post-test, and p < 0.05 was considered significant. At 30 and 60 days postoperatively, the BG group showed more healing of the surgical wound than the other groups, with a high amount of newly formed bone (p < 0.001), while the BC group showed mature connective tissue filling the defect. The inflammatory cell count at postoperative days 7 and 15 was higher in the BC group than in the BG group (Tukey's test, p = 0.006). At postoperative days 30 and 60, the area of new bone formed was greater in the BG group than in the other groups (p < 0.001). Immunohistochemical analysis showed moderate and intense immunolabeling of osteocalcin and osteopontin at postoperative day 60 in the BG and BC groups. Thus, despite the promising application of the BC membrane in soft-tissue repair, it did not induce bone repair in rat calvaria.

Tissue-engineered bone using mesenchymal stem cells versus conventional bone grafts in the regeneration of maxillary alveolar bone: A systematic review and meta-analysis.

PURPOSE: The aim of this study was to compare tissue-engineered bone using mesenchymal stem cells (MSCs) and conventional bone grafts in terms of histomorphometric outcome, bone gained, and implant failure in the atrophic maxilla. MATERIALS AND METHODS: A systematic review and meta-analysis of randomized clinical trials (RCTs) was conducted. An electronic search of several databases was performed. RCTs comparing tissue-engineered bone using MSCs to bone graft alone in rehabilitation of the atrophic maxilla were included. Outcome variables were a mean percentage of new bone formation, residual graft particles, and connective tissue. Bone gained and implant failure rate were also assessed. Risk ratio (RR) or standardized mean differences (SMD) were statistically analyzed. RESULTS: A total of 190 augmented sites enrolled in 12 RCTs were included in this study. Nine of the 12 RCTs included 153 maxillary sinuses that underwent sinus elevation, and three RCTs included 28 patients with bone grafting only. There was no significant increase in new bone formation between the two groups at 3 to 4 months (SMD = -0.232, CI, -0.659 to 0.195, low-quality evidence). However, at 6 months postgrafting, a statistically significant increase in new bone formation was found in favor of the tissue-engineered bone using the MSC group (SMD = 0.869%, CI, -1.98 to 9.310, moderate-quality evidence). No substantial difference was found between the two groups with respect to residual graft particles, connective tissue, bone gained, and implant failure rate (RR = 2.8, CI: 0.517 to 16.6, P = .226, very low-quality evidence). CONCLUSION: There is moderate- to very low-quality evidence supporting the use of tissue-engineered bone using MSC therapy in maxillary alveolar bone regeneration compared with conventional bone grafting without MSCs.