Virtual Oral Health across Canada: A Critical Comparative Analysis of Clinical Practice Guidances during the COVID-19 Pandemic.

During the COVID-19 pandemic, teledentistry was suggested as a cost-effective and promising approach to improve access to oral health care. In response, Canadian provincial and territorial dental regulatory authorities (DRAs) published teledentistry-related clinical practice guidances (TCPGs). However, an in-depth comparison between them is needed to understand their gaps and commonalities so as to inform research, practice, and policy. This review aimed to provide a comprehensive analysis of TCPGs published by Canadian DRAs during the pandemic. A critical comparative analysis of these TCPGs published between March 2020 and September 2022 was conducted. Two members of the review team screened the official websites of dental regulatory authorities (DRAs) to identify TCPGs and performed data extraction. Among Canada's 13 provinces and territories, only four TCPGs were published during the relevant time period. There were some similarities and differences in these TCPGs, and we identified gaps pertaining to communication tools and platforms, and measures to safeguard patients' privacy and confidentiality. The insights from this critical comparative analysis and the unified workflow on teledentistry can aid DRAs in their development of new or an improvement to existing TCPGs or the development of nationwide TCP guidelines on teledentistry.

Incidence of osteoradionecrosis of the jaws: a retrospective study of 620 patients with head and neck cancer.

This study aimed to assess systemic and local risk factors for the development of osteoradionecrosis (ORN) of the jaws and its incidence in patients with head and neck cancer undergoing radiotherapy (RT). This was a retrospective cohort study of 620 adults following irradiation for head and neck cancer in 2011 or 2012. Among 181 patients who did not require any tooth extractions, the incidence of ORN was 0.5%. Among 266 patients with a total of 1491 tooth extractions (mean, 5.5 teeth per patient) performed before RT, the incidence of ORN was 3.7%. In all cases, ORN was observed in extraction sites located in the field of radiation. No extractions were performed during RT. Fifteen patients underwent extractions both before and after RT. Of the 53 tooth extractions performed after RT (20 patients; mean, 2.7 teeth per patient), 15 were in the field of radiation. No case of ORN was reported in that group. Among 168 edentulous patients, the incidence of ORN was 1.8%. Within the limitations of this study, the results suggest that the incidence of ORN can be minimized with a meticulous pre-RT dental examination, a comprehensive treatment plan, and diligent post-RT follow-up examinations conducted by an experienced multidisciplinary team.

Effect of personalized musical intervention on burden of care in dental implant surgery: A pilot randomized controlled trial.

OBJECTIVE: To explore a personalized musical intervention's effect on burden of care during dental implants placement. METHODS: Randomized Controlled Trial in 24 dental implant surgery patients. A personalized music intervention (Music Care© application) or an audiobook control condition was administered. Burden of care (a composite outcome including self-reported anxiety, pain, and dissatisfaction felt during surgery), expected pain prior to surgery, pre- and post-surgery affect, memory of pain felt during surgery, and participants' emotional judgments of the music and audiobook listening were assessed. RESULTS: The personalized music intervention significantly reduced the burden of care for dental implant surgery (p = 0.02; d = 1.07). Both groups reported positive affect after surgery, but the music group felt better. The pain remembered after seven postoperative days was significantly lower in the music group (p = 0.02). Participants judged the music listened to during surgery as more relaxing and pleasant than the audiobook (p = 0.002 and p = 0.001, respectively). CONCLUSIONS: Personalized music intervention could be effective in decreasing patients' burden of care during dental implant surgery. These results need to be confirmed by a rigorous randomized control trial. CLINICAL SIGNIFICANCE: The burden of care associated with the pain and anxiety experienced during dental implant surgery can be reduced using a personalized and standardized music intervention. This approach may provide a simple complementary approach to improve surgical care in various settings.

Platelet-rich fibrin as a treatment option for osteoradionecrosis: A literature review.

The aim of this review is to establish the usefulness and effectiveness of using platelet-rich fibrin (PRF) in the treatment of osteoradionecrosis (ORN) lesions. A review of the literature was performed using keywords through the PubMed-Medline and Cochrane Library search engine. Inclusion criteria were: (1) original publication in either the French or the English language, (2) studies conducted in humans, (3) presence of ORN lesions following head and neck radiotherapy (RT), (4) use of PRF or derivates in the treatment of ORN lesions, (5) clinical variables and outcomes mentioned in the study. Overall, four case reports were retained. Two publications were removed from the initial seven results after application of the inclusion criteria. A recent randomised clinical trial was not considered since the group analysed the effectiveness of leukocyte-enriched Plasmas-Rich-Fibrin (LPRF) in preventing ORN, but not in treating it. Therefore, four publications were retained for analysis. Results suggest that using PRF as an adjunct to surgical therapy is beneficial in treating ORN lesions although no controlled studies were found. Therefore, additional controlled clinical studies are warranted to better define the effectiveness and recommendation of this approach.

Do postoperative antibiotics influence one-year peri-implant crestal bone remodelling and morbidity? A double-blinded randomized clinical trial.

OBJECTIVES: The primary objective of this study was to assess whether giving postoperative antibiotics to healthy patients after straightforward platform-switched implant placement would influence peri-implant crestal bone levels and postoperative morbidity after 1 year. METHODS: Thirty-eight healthy individuals were recruited in this pilot, randomized, double-blinded, placebo-controlled clinical trial. The intervention group (n = 18) received two grams of amoxicillin one hour before implant placement followed by a 7 days postoperative regimen (500 mg tid). The control group (n = 20) took the same preoperative dose of amoxicillin and an identical placebo postoperatively. Mesial and distal peri-implant crestal bone levels were measured at baseline, four months and one year later with standardized periapical radiographs. Postoperative pain severity was assessed through self-administered questionnaires for 7 days. Surgery-associated morbidities were evaluated after one, three, 16 weeks and 1 year. Descriptive and bivariate analyses were used. RESULTS: Thirty-seven participants completed the trial. At the one-year follow-up, the mean combined peri-implant crestal bone changes for the intervention (n = 18) and control (n = 19) groups were - 0.44 ± 0.41 mm and - 0.27 ± 0.56 mm, respectively. The difference between the groups (intervention-control) for mean combined crestal bone level changes was not statistically significant. There were no significant differences in surgery-associated morbidities between the intervention and control groups. The one-year implant survival rate was 100% in both groups. CONCLUSIONS: Study results suggest that a routine postoperative antibiotic regimen for healthy patients undergoing straightforward platform-switched implant placement might not be necessary to prevent postoperative peri-implant bone loss and complications.

Predicting price intervals under exogenously induced stress.

We present an experimental protocol to examine the relationship between exogenously induced stress and confidence in a setting applicable to financial markets. Confidence will be measured by a prediction interval for a one period ahead price forecast, based on a series of 100 previous prices; narrower (wider) prediction intervals will be indicative of greater (lower) confidence. Stress will be induced using the Cold Pressor Arm Wrap, a variation of the Cold Pressor Test. Risk attitudes, and personality traits are also considered as mediating factors.

Use of Artificial Intelligence in Dentistry: Current Clinical Trends and Research Advances.

The field of artificial intelligence (AI) has experienced spectacular development and growth over the past two decades. With recent progress in digitized data acquisition, machine learning and computing infrastructure, AI applications are expanding into areas that were previously thought to be reserved for human experts. When applied to medicine and dentistry, AI has tremendous potential to improve patient care and revolutionize the health care field. In dentistry, AI is being investigated for a variety of purposes, specifically identification of normal and abnormal structures, diagnosis of diseases and prediction of treatment outcomes. This review describes some current and future applications of AI in dentistry.

Impact of piezocision-assisted orthodontics on root resorption and alveolar bone: a prospective observational study.

OBJECTIVES: To assess the impact of orthodontic treatment combined with piezocision (OT-PC) on root structure and alveolar bone. MATERIALS AND METHODS: Twelve adults were treated with OT-PC. Pre- and post-treatment CBCT examinations evaluated apical root resorption (ARR) and alveolar bone height and thickness changes. Pre- and post-treatment differences were compared using one-sample t test and Wilcoxon signed-rank test. RESULTS: ARRs were generalized and significantly more severe in both anterior sextants compared with posterior sextants. Bone thickness decreased significantly in the maxilla at mid-root and apex areas. The majority of mandibular alveolar bone dehiscences occurred on the buccal aspect at the mid-root level, especially where thickness was less than 0.3 mm. Overall bone height decreased twice as much on the buccal aspect (1.43 mm, P < 0.001) compared with the lingual aspect (0.67 mm, P = 0.001), most significantly in the lower incisors, where the average median loss was 2.10 mm (P = 0.003). CONCLUSION: OT-PC causes minor negative effects on both alveolar bone and root resorption. CLINICAL RELEVANCE: Orthodontic treatment combined with piezocision causes minor negative effects on periodontal support. Nevertheless, mild bone height loss on the buccal aspect of the mandibular teeth and root resorption in both anterior sextants have been detected with this new treatment.

Prospective randomized clinical trial evaluating the effects of two different implant collar designs on peri-implant healing and functional osseointegration after 25 years.

OBJECTIVES: Evaluate the effects of two different machined-collar lengths and designs on peri-implant healing. MATERIAL AND METHODS: An implant with a microtextured surface and 3.6mm-long internal-connection machined collar was compared to two implants that had an identical 1.2mm-long external-connection machined collar, but one had the microtextured surface while the other's was machined. Participants received the three implants, with microgap at the crest, alternately at five sites between mental foramen, and a full-arch prosthesis. Peri-implant bone levels were measured after 23 to 26 years of function. Keratinized tissue height, plaque, probing depth, bleeding, and purulence were also evaluated. Descriptive and mixed models for repeated\measures analyses were used, with Bonferroni correction for pairwise comparisons. RESULTS: Twenty-two participants (110 implants) were evaluated at the 25-year examination. Microtextured implants with the longer machined collar had significantly greater mean marginal bone loss (-1.77mm ± 0.18, mean ± SE) than machined (-0.85mm ± 0.18, p < .001) and microtextured (-1.00 ± 0.18mm, p < .001) implants with the shorter machined collar. Keratinized tissue height was greater for internal-connection (0.74mm ± 0.10) versus external-connection (0.51 ± 0.08, p =  0.01) microtextured implants. No differences were observed for plaque (p = 0.78), probing depth (p = 0.42), bleeding (p  = 0.07), and purulence (p = 1.00). Implant survival rate was 99%. CONCLUSIONS: Implants with the 1.2mm machined collar limited bone loss to 1mm, while those with the longer machined collar showed > 1.5mm loss after 25 years of function with microgap at the crest. Internal-connection design and fixture surface microtexturing did not result in greater bone preservation. ClinicalTrials.gov Identifier: NCT03862482.

Anti-Vascular Endothelial Growth Factors as a Potential Risk for Implant Failure: A Clinical Report.

Knowledge of the risk factors for implant osseointegration is essential for clinical decision-making and optimizing treatment success. This clinical report presents a rare case of implant failure in a patient who received intravitreal injections of a vascular endothelial growth factor (VEGF) inhibitor for the treatment of age-related macular degeneration. Following CARE guidelines, the report presents a case rehabilitated with a mandibular 2-implant overdenture using the immediate-loading protocol and standard procedures. The implants failed within six weeks of immediate loading although primary stability (≥50 Ncm) was achieved during surgery and clinical follow-ups did not show any deviance from standard implant care or patient-related complications. Further investigation suggested that the intake of a VEGF inhibitor may be the cause of failure. This clinical report highlights the importance of systemic risk factors in implant success and their consideration during planning for implant-assisted treatment.

Piezocorticision-assisted orthodontics: Efficiency, safety, and long-term evaluation of the inflammatory process.

OBJECTIVES: The aim of this work was to compare the duration of treatment between orthodontic treatment combined with piezocorticision (OT-PC) and conventional orthodontic treatment (COT), as well as to evaluate the safety, inflammatory process, periodontal health, and soft tissue healing in the OT-PC group. METHODS: Twelve patients were included in each group, and their treatment times were compared for preliminary bracket alignment (PBA) and for overall treatment. In the OT-PC group, the inflammatory process was evaluated by quantifying cytokines in the gingival crevicular fluid. A calibrated examiner measured the probing depth (PD), the distance between the gingival margin and the cementoenamel junction (GM-CEJ), and the clinical attachment level (CAL), before and after OT-PC. The presence of gingival scars was evaluated. Bone and root injuries were assessed with the use of cone-beam computed tomography. RESULTS: The treatment time was significantly reduced in the OT-PC group for PBA in both maxilla (45%; P = 0.001) and mandible (31%; P = 0.023), as well as for overall treatment (52%; P < 0.0001). Although not statistically significant, several inflammatory mediators demonstrated peaks at 3-5 and 16 weeks. There were not significant changes in PD and GM-CEJ after OT-PC treatment, unlike CAL (0.09 ± 0.12 mm; P = 0.024); 47.5% of piezocorticisions caused gingival scars. Only one patient showed no scars. Four cortical bones did not heal completely, and 2 roots had piezoelectric injuries. CONCLUSION: OT-PC was effective at reducing the orthodontic treatment time.

Dental caries are positively associated with periodontal disease severity.

OBJECTIVES: To examine associations between periodontal disease severity and clinical and microbiological measures of caries in adults. MATERIALS AND METHODS: A cross-sectional study of 94 healthy adults ((mean ± SD) 55.4 ± 13.0 years) was conducted. Data were collected by means of questionnaire and a clinical examination that included the Decayed, Missing, Filled teeth Surfaces (DMFS) index, probing depth (PD), clinical attachment level (CAL), and gingival bleeding and plaque scores. Supra- and subgingival plaque samples were collected to assess the presence of Streptococcus mutans and six periodontal pathogens. Participants were subsequently categorized using Center for Disease Control and Prevention/American Academy of Periodontology (CDC-AAP) definitions and tertiles of percentage of sites with CAL ≥ 3mm. RESULTS: Significant positive associations were found between the periodontal disease severity (CDC-AAP) and the DMFS (aOR = 1.03; 95% CI 1.01-1.05) and DS indices (aOR = 1.18; 95% CI 1.05-1.32) as well as between the tertiles of percentage of sites with CAL ≥ 3 mm and DMFS (aOR = 1.03; 95% CI 1.00-1.05) and DS indices (aOR = 1.12; 95% CI 1.00-1.25). A significant positive association was also found between oral levels of F. nucleatum and S. mutans (aOR = 6.03; 95% CI 1.55-23.45). CONCLUSIONS: A small but positive association was found between clinical measures of caries and periodontal disease severity. Further research is warranted to examine the association between these two common oral diseases. CLINICAL RELEVANCE: Periodontal diseases and caries are the two most common oral diseases. There was a positive association between clinical and microbiological markers of both diseases. Therefore, strategies in oral health education should involve both caries and periodontitis prevention.

A within-subject clinical trial on the conversion of mandibular two-implant to three-implant overdenture: Patient-centered outcomes and willingness to pay.

OBJECTIVES: To examine the impact of adding a third midline implant with stud attachment to a mandibular two-implant overdenture on patient-oriented outcomes. METHODS: In this pre-post design clinical trial, following the standard procedures, mandibular two-implant overdentures of 17 edentulous individuals (61.9 ± 6.6 years) were converted to three-implant overdentures by adding a stud attachment to an unloaded midline implant. Patient-oriented outcomes included patient expectations and satisfaction with implant overdenture as well as willingness to pay the cost of conversion. Data were collected at baseline and at the 6-week follow-up using visual analog and binary scales as well as open-ended questions. Statistical analysis included descriptive statistics, Spearman's correlation, Fisher exact test, Mann-Whitney U test, and the exact sign test. RESULTS: After connecting the third midline implant to the mandibular two-implant overdenture, there was a statistically significant decrease in the anteroposterior movement (p = 0.005) as evaluated by clinicians. Moreover, study participants reported an increase in perceived stability of the overdenture (95% CI; 0.68-1.00, p = 0.002) and in their ability to speak (95% CI; 0.63-1.00, p = 0.008). The addition of a third implant met the expectations of 94% of patients in regard to lower denture stability, 100% for retention, and 82.4% for comfort. The mandibular three-implant overdenture increased patient general satisfaction over a short period of time, but this improvement was not statistically significant. About 80% of patients would recommend this type of prosthesis to their peers but only 47% of them would agree to pay a large increase in the cost of treatment compared to a two-implant overdenture. CONCLUSIONS: The addition of a midline third implant to an existing mandibular two-implant overdenture resulted in several improved patient-reported outcomes.

Does immediate loading affect clinical and patient-centered outcomes of mandibular 2-unsplinted-implant overdenture? A 2-year within-case analysis.

OBJECTIVE: To provide 2-year clinical- and patient-oriented data with regard to mandibular overdenture assisted by 2 immediately loaded unsplinted implants. MATERIAL AND METHODS: In this pre-post design, Phase-I clinical trial, 18 edentate individuals (62.4±7.7years) received a new set of complete denture. Then, following standard procedures, 3 threaded implants (OsseoSpeed TX™, Dentsply Implants, Mölndal, Sweden) were placed in the mandible in each patient, and locator abutments (Zest Anchors LLC, Escondido, U.S.A.) were inserted on the right and left side implants. The midline implant served as a control for within-patient comparison. The immediate loading was conducted within 24h of surgery. Data were collected at baseline (T0), 12 (T1) and 24 (T2) months after immediate loading. The clinical outcomes included implant survival rate, crestal bone level changes and implant stability. These criteria were assessed through clinical and radiographic examinations as well as resonance frequency analysis. Patient-centered outcomes included patient satisfaction and oral health-related quality of life measured using validated questionnaires. Brunner-Langer approach was used for statistical analysis. RESULTS: Implant survival rate for immediate loaded implants was 91.7% at 2-year follow-up. None of the unloaded implants failed. There was no statistically significant difference at baseline and follow-ups with regard to clinical outcomes between loaded and unloaded implants. Patient satisfaction and quality of life improved (p<0.0001) from baseline to 2-year follow-up. CONCLUSION: Immediate loading protocol did not negatively affect clinical outcomes, satisfaction and quality of life of patients wearing 2-unsplinted-implant mandibular overdenture for 2 years. This conclusion requires confirmation by randomized control trials. CLINICAL SIGNIFICANCE STATEMENT: Mandibular overdenture assisted by two immediately-loaded unsplinted implants is successful treatment based on 2-year clinical and patient-based outcomes.

Saliva as a diagnostic tool for oral and systemic diseases.

Early disease detection is not only vital to reduce disease severity and prevent complications, but also critical to increase success rate of therapy. Saliva has been studied extensively as a potential diagnostic tool over the last decade due to its ease and non-invasive accessibility along with its abundance of biomarkers, such as genetic material and proteins. This review will update the clinician on recent advances in salivary biomarkers to diagnose autoimmune diseases (Sjogren's syndrome, cystic fibrosis), cardiovascular diseases, diabetes, HIV, oral cancer, caries and periodontal diseases. Considering their accuracy, efficacy, ease of use and cost effectiveness, salivary diagnostic tests will be available in dental offices. It is expected that the advent of sensitive and specific salivary diagnostic tools and the establishment of defined guidelines and results following rigorous testing will allow salivary diagnostics to be used as chair-side tests for several oral and systemic diseases in the near future.

Patients' expectations, satisfaction, and quality of life with immediate loading protocol.

OBJECTIVES: To examine patients' expectations, the level of satisfaction, and the oral health-related quality of life (OHRQoL) with regard to the implants' immediate loading protocol (ILP) in edentate individuals. METHODS: This pilot trial used a pre-post design to assess patient-centered outcomes in 18 edentate individuals (mean age 62.4 ± 7.7 years) who have received a 2-implant (unsplinted) mandibular overdenture through an ILP. Visual analog scales, the McGill denture satisfaction questionnaire, and the oral health impact profile (OHIP-20) questionnaire were used to evaluate patients' expectations, satisfaction, and OHRQoL at baseline, 2 weeks, 1 month, and 4 months after surgery. Personality trait and socio-demographic information were obtained using the revised NEO personality inventory and a self-administered questionnaire, respectively. Non-parametric methods and Brunner-Langer approach were used to analyze the data. RESULTS: The participants had a wide range of expectations regarding the ILP. Expectations included short-term positive impact on aesthetics (83.3%) and social life (55.7%), as well as negative effects on comfort (5.6%), the ability to chew (11.1%), and the ability to clean the lower denture (11.1%). The ILP satisfied 94.4% of the participants, regardless of socio-demographic and personality profiles. There was a statistically significant improvement in overall satisfaction, comfort, perceived aesthetics, stability of the overdenture, and ability to chew from baseline to 2-week, 1-, and 4-month follow-up (P < 0.001). There was 100% agreement among patients on recommending this procedure to others. There was a statistically significant decrease in the total OHIP scores and all its domains (P < 0.001) from baseline to 2 weeks. These differences remained statistically significant at 4-month follow-up. The ILP improved patients' OHRQoL, regardless of the implant loss, the socio-demographic characteristics, and personality traits. CONCLUSIONS: The ILP of two unsplinted implants with a mandibular overdenture significantly improved satisfaction and short-term OHRQoL, and appears to meet expectations in edentulous elders. There was 100% agreement among patients on recommending this procedure to others.

Effectiveness of an alcohol-free essential oil-containing mouthwash in institutionalised elders receiving long-term care: a feasibility study.

OBJECTIVES: To conduct a feasibility study on investigating the effectiveness of an alcohol-free essential oil mouthwash (AF-EOMW) to reduce plaque accumulation and oral pathogen levels in institutionalised elders receiving long-term care and to obtain preliminary results. BACKGROUND: Although simple, cost-effective strategies to improve oral hygiene in seniors such as the use of mouthwashes have been shown to reduce the risks of respiratory diseases, little information is available on the feasibility of implementing these measures. METHODS: Twenty-five elderly participants with significant loss of autonomy were initially recruited and divided into two groups. A test group rinsed with an AF-EOMW twice a day, and a control group rinsed with tap water. Data on demographic characteristics, dental history and tobacco use were collected from a questionnaire. Problems encountered during recruitment and data collection were documented. Plaque index, denture cleanliness and salivary levels of several pathogens were measured at three time points: baseline (T0 ), day 22 (T1 ) and day 45 (T2 ). RESULTS: Eighteen participants completed the study. Several problems were encountered during recruitment and execution of the study protocol. No significant differences in clinical or microbiological measures were found between the test group and controls at three time points (p > 0.05). CONCLUSION: This pilot study shows that, if sufficient logistical and financial resources are available, it is feasible to conduct randomised clinical trials in a seniors' facility. The use of an AF-EOMW to improve oral hygiene in seniors was not found to be superior to tap water. However, larger controlled clinical studies are needed to confirm these results.