Midpalatal miniscrew insertion: The accuracy of digital planning and surgical placement.

INTRODUCTION: The objective of this study was to investigate the accuracy of palatal miniscrew insertion, evaluating the effect of guide fabrication and surgical placement. METHODS: Guided insertion of bilateral paramedian palatal miniscrews was undertaken using Appliance Designer software (3Shape, Copenhagen, Denmark). A resin surgical guide (P Pro Surgical Guide; Straumann AG, Basel, Switzerland) was used. Superimposition of the miniscrew position relative to the digital design was undertaken using bespoke software (Inspect 3D module, OnyxCeph; Image Instruments GmbH, Chemnitz, Germany) to assess surgical inaccuracy. Miniscrew position relative to the surgical guide was also assessed to isolate the effect of planning inaccuracies. Both horizontal and vertical discrepancies were evaluated at both implant locations. RESULTS: Twenty-seven patients having bilateral palatal insertions were examined. Mean discrepancies were <0.5 mm, both in the horizontal and vertical planes. The mean overall horizontal and vertical discrepancy between the digital design and final miniscrew position on the left side was 0.32 ± 0.15 mm and 0.34 ± 0.17 mm, respectively. The maximum horizontal discrepancy observed was 0.72 mm. No significant differences were observed in relation to the accuracy of mini-implant positioning on the basis of sidedness, either for horizontal (P = 0.29) or vertical (P = 0.86) discrepancy. CONCLUSIONS: High levels of accuracy associated with guided insertion of paramedian palatal implants were recorded with mean discrepancies of less than 0.5 mm both in the horizontal and vertical planes. No difference in accuracy was noted between the left and right sides. Very minor levels of inaccuracy associated both with surgical techniques and surgical guide fabrication were recorded.

Assessment of wear characteristics, longevity and stiffness of Essix-type retainers.

OBJECTIVE: To compare four commercially available Essix-type retainers in terms of longevity, wear characteristics, stiffness and their range of rigidity. MATERIALS AND METHODS: An in vitro study was conducted at Queen Mary University of London. Four groups of thermoplastic materials were included: Duran (PETG), Essix C + (Polypropylene), Vivera and Zendura (Polyurethane). A working typodont was fabricated to evaluate surface wear characteristics using a wear machine with a customized jig. Retainers were measured for tensile test, and water absorption was measured at five different time points up to 6 months after initial immersion in two different physical states and two different solutions. Hydrolytic degradation was also evaluated using FTIR spectroscopy. RESULTS: Essix C + was the most flexible retainer with Vivera the stiffest material. Zendura and Essix C + had the most surface wear (413 µm ± 80 and 652 µm ± 12, respectively) with absorption rates of up to 15 wt% in artificial saliva occurring with Zendura. Only Essix C + displayed signs of degradation following water absorption. CONCLUSIONS: All materials had characteristic levels of flexibility and were susceptible to water absorption. Duran 1.5 mm performed similarly to Vivera in relation to stiffness and wear properties. While Zendura and Vivera have similar chemical structures, they exhibited differences concerning wear resistance and water absorption. Further clinical research evaluating the clinical relevance of these laboratory findings is required. CLINICAL RELEVANCE: Characteristic patterns of wear and rigidity of four commercially available Essix-type retainers were observed. This information should help in the tailoring of retainer material on a case-by-case basis considering treatment-related factors and patient characteristics including parafunctional habits.

Patients with inflammatory bowel disease have more oral health problems and higher costs of professional dental care than healthy controls: The Periodontitis Prevalence in ulcerative Colitis and Crohn disease (PPCC) case-control study.

BACKGROUND: To describe the frequency and impact of oral lesions and professional dental care costs in patients with inflammatory bowel disease (IBD) (i.e., Crohn disease [CD] or ulcerative colitis [UC]) compared to matched controls). METHODS: IBD patients and matched controls were surveyed on general anamnestic information, eating and drinking habits, and oral health- and dental care-related questions; IBD patients were additionally surveyed on oral lesions. Problems related to oral lesions and the amount of money spent for professional dental care in the past 12 months were defined as primary outcome parameters. RESULTS: Answers from 1108 IBD patients and 3429 controls were analyzed. About 30% of the patients indicated having had problems with oral lesions, with CD patients having 46% higher odds and having them more often in a generalized form compared to UC patients. Further, self-reported severe periodontitis increased the odds of having oral lesions by almost 2.3-times. However, only about 12.5% of IBD patients were informed by their physician about oral lesions and about 10% indicated receiving treatment for them. Compared to controls, IBD patients required more often dental treatment and spent more money; specifically, UC and CD patients had 27 and 89% higher odds, respectively, for having spent ≥3000 DKK (ca. 440 USD) at the dentist compared to controls. CONCLUSIONS: IBD patients have more often oral health problems and higher expenses for professional dental care compared to matched controls. This included problems with IBD-related oral lesions, but these are rarely addressed by the medical or dental team.

Health-related quality of life aspects of the 'Periodontitis prevalence in ulcerative colitis and Crohn's disease' (PPCC) cohort.

AIM: To assess whether oral health problems affect disease-specific quality of life (QoL) of inflammatory bowel disease (IBD) patients, and vice versa, whether IBD affects oral-health-related QoL. MATERIALS AND METHODS: Individuals reporting IBD and matched controls were surveyed on general anamnestic information, oral-health-related questions and the Oral Health Impact Profile (OHIP)-5. IBD patients were additionally surveyed on years since diagnosis, disease activity and severity as well as health-related QoL (Short Inflammatory Bowel Disease Questionnaire, sIBDQ). OHIP-5 and sIBDQ were defined as primary outcome parameters, and several predictors and confounders were used in adjusted univariable and multivariable regression analyses. RESULTS: Answers from 1108 IBD patients and 3429 controls were analysed. Compared with controls, IBD patients reported significantly more frequently an oral impact on daily life and worse oral-health-related QoL, with Crohn's disease (CD) patients being more severely affected than ulcerative colitis (UC) patients. The diagnosis of UC and CD, having <20 teeth, severe periodontitis and stressful daily-life experience were associated with a higher prevalence of poor oral-health-related QoL. Among IBD patients, an impaired IBD-specific, health-related QoL was significantly associated with the diagnosis of CD and depression, IBD activity and severity, having <20 teeth, presence of oral lesions and stressful daily-life experience, while a longer time since diagnosis was significantly associated with an improved IBD-specific, health-related QoL. CONCLUSIONS: The results of the present study indicate, for the first time, that oral health problems are associated with an impairment of IBD-specific health-related QoL, and vice versa, IBD is associated with an impaired oral health-related QoL. This emphasizes the potential advantages of including dental professionals in the multi-disciplinary treatment teams of IBD patients.

The Impact of Periodontitis on Inflammatory Bowel Disease Activity.

BACKGROUND: Inflammatory bowel disease (IBD) and periodontitis are chronic, progressive, inflammatory diseases with similarly complex pathogeneses that involve an interplay between dysbiotic microbiota and dysregulated immune-inflammatory responses. However, whether the presence of periodontitis is associated with IBD activity and/or its severity remains unknown. METHODS: An online, questionnaire-based study was answered by 1093 patients with IBD, comprising 527 patients with Crohn's disease and 566 patients with ulcerative colitis. The survey included questions on social demographics; oral health, including the Periodontal Screening Score (PESS); and IBD-related characteristics, including validated disease indices. RESULTS: Irrespective of disease subtype, patients with a reduced number of teeth and those with self-reported severe periodontitis scored significantly higher on the IBD disability index (number of teeth: coefficient, 4.93 [95% confidence interval {CI}, 1.21-8.66; P = .010]; periodontitis: coefficient, 3.54 [95% CI, 0.27-6.80; P = .034]) and reported increased disease activity in the preceding 12 months (number of teeth: odds ratio [OR], 1.91 [95% CI, 1.36-2.69; P < .001]; periodontitis: OR, 1.71 [95% CI, 1.27-2.31; P < .001]). There was also evidence of a weak association between self-reported severe periodontitis and current disease activity (OR, 1.33; 95% CI, 0.95-1.86; P = .099). However, IBD severity, as a composite parameter of a history of surgery due to IBD and/or treatment with biological therapy, was not associated with possessing a reduced number of teeth (OR, 1.18; 95% CI, 0.77-1.80; P = .451), nor with self-reported severe periodontitis (OR, 1.15; 95% CI, 0.79-1.66; P = .467). CONCLUSIONS: Periodontitis and tooth loss were significantly associated with increased IBD-related disability and more disease activity in the preceding 12 months. Our results suggest that greater attention should be paid to IBD patients' oral health.

In this questionnaire-based study among 1093 patients with inflammatory bowel disease (IBD), we demonstrated a significant association between the presence of periodontitis and more IBD disease activity in the last 12 months, as well as increased IBD disability.

Perceived esthetics and value of clear aligner therapy systems: A survey among dental school instructors and undergraduate students

ABSTRACT Objective: To investigate the attractiveness, acceptability, visibility and willingness-to-pay for clear aligner therapy (CAT) systems in first-year and final-year dental students and instructors. Methods: A questionnaire designed to collect information regarding esthetic preferences and intentions related to seven CAT systems was handed out to 120 undergraduate students and instructors at the Academic Centre for Dentistry Amsterdam (ACTA). Proportional odds models and population average generalized estimating equation models were used to examine potential association between participant characteristics, esthetic perceptions and CAT systems. Results: Overall, the examined CAT systems received favorable esthetic ratings. Expertise status was significantly associated with willingness-to-pay additionally for CAT, compared to fixed orthodontic appliances. There was no association between sex, previous orthodontic treatment history, satisfaction with own dental appearance and potential interest in treatment and aligner visibility and willingness-to-pay. CAT system was significantly associated with the perceived aligner visibility, acceptability and attractiveness by students and instructors. Conclusions: CAT systems were considered to a great extent attractive and acceptable for future treatment by dental school instructors and students. Willingness-to-pay for CAT systems was significantly associated with expertise status, with instructors appearing more reluctant to pay for CAT.

RESUMO Objetivo: Comparar diferentes sistemas de tratamento com alinhadores transparentes (CAT), quanto à atratividade, aceitabilidade, visibilidade e disposição a pagar, por parte de alunos (primeiro e último anos) e instrutores de Odontologia. Métodos: Um questionário elaborado para coletar informações sobre preferências e intenções estéticas, em relação a sete sistemas CAT, foi distribuído para 120 alunos de graduação e instrutores do Academic Centre for Dentistry Amsterdam (ACTA). Modelos de riscos proporcionais e modelos de equação de estimação generalizada para a média da população foram usados para examinar a possível associação entre as características dos participantes, percepções estéticas e os sistemas CAT. Resultados: No geral, os sistemas CAT examinados receberam avaliações estéticas favoráveis. O nível de experiência foi significativamente associado com a disposição em pagar mais por sistemas CAT do que por aparelhos ortodônticos fixos. Não houve associação entre sexo, histórico de tratamento ortodôntico anterior, satisfação com a própria aparência dentária, potencial interesse em tratamento, visibilidade do alinhador e disposição em pagar mais. Os sistemas CAT foram significativamente associados à visibilidade percebida, aceitabilidade e atratividade dos alinhadores por alunos e instrutores. Conclusões: Os sistemas CAT foram considerados, em grande parte, atraentes e aceitáveis para tratamentos futuros pelos instrutores e alunos do curso de Odontologia. A disposição em pagar mais pelos sistemas CAT foi significativamente associada ao nível de especialização, com os instrutores parecendo mais relutantes em pagar mais pelo CAT.

The effect of orthodontic treatment on facial attractiveness: a systematic review and meta-analysis.

BACKGROUND: Facial and smile attractiveness are significant motivating factor for patients to seek orthodontic treatment. Although there is a general belief that orthodontic treatment improves facial appearance, this has yet not been systematically evaluated. OBJECTIVE: The objective of this study was to assess the current evidence on the effect of orthodontic treatment on facial attractiveness. SEARCH METHODS: Systematic and unrestricted search of nine databases were performed up to January 2022. SELECTION CRITERIA: Studies evaluating facial attractiveness before and after orthodontic treatment. DATA COLLECTION AND ANALYSIS: Extracted data included study design and setting, sample size and demographics, malocclusion type, treatment modality, and method for outcome assessment. Risk of bias was assessed with the ROBINS-I tool for non-randomized studies and with RoB-2 for randomized controlled trials (RCTs). Random-effects meta-analyses of mean differences and their 95% confidence intervals (CIs) were performed. RESULTS: Twenty studies were included in data synthesis; three randomized controlled clinical trials and 17 non-randomized clinical studies of retrospective or prospective design. One of the RCTs was found to have low risk of bias, one presented some concerns and the third showed a high risk of bias. All non-randomized studies showed either unclear or high risk of bias. Data syntheses showed that orthodontic treatment improved facial attractiveness ratings by 9% when compared with untreated controls (MD: 9.05/95% CI: 4.71; 13.39). A combination of orthodontics and orthognathic surgery also showed a positive effect of 5.5% (MD: 5.51/95% CI: 1.55; 9.47) when compared with orthodontic treatment alone. There was no difference in effect between extraction and non-extraction treatments (MD: -0.89/ 95% CI: -8.72; 6.94) or between different types of Class II correctors (MD: 2.21/95% CI: -16.51; 20.93). LIMITATIONS: With the exception of two RCTs, included studies were of unclear or low quality. CONCLUSIONS: Orthodontic treatment has a clinically weak effect on facial attractiveness when compared to no treatment. The same is true when a combined orthodontic/surgical treatment is compared to orthodontics alone. REGISTRATION: PROSPERO #: CRD42020169904.

Periodontitis prevalence in patients with ulcerative colitis and Crohn's disease - PPCC: A case-control study.

AIM: The aim of this questionnaire-based case-control study was to assess whether self-reported oral health and periodontitis in patients with ulcerative colitis (UC) and Crohn's disease (CD) differ from those in matched controls without inflammatory bowel disease (IBD). MATERIALS AND METHODS: A survey including questions on general anamnestic information, IBD diagnosis, and oral health was distributed online. Self-perceived overall health of teeth and gums, severe periodontitis, and tooth loss were defined as outcome parameters. RESULTS: Analyses were based on answers from 1108 patients with IBD and 3429 controls. Patients with IBD reported significantly worse oral health and more periodontal problems compared to controls. Regression analyses corrected for relevant confounders showed significantly increased odds for fair or poor self-perceived overall health of teeth and gums (odds ratio [OR] 2.147 and 2.736, respectively) and for severe periodontitis (OR 1.739 and 2.574, respectively) for patients with UC and CD compared to controls; patients with CD presented additionally 91% higher odds for having <20 remaining teeth. CONCLUSION: Patients with UC and CD have significantly increased odds for worse self-perceived oral health and severe periodontitis compared to controls, with the former being more severely affected and losing more teeth. It is strongly recommended that patients with IBD are kept under close surveillance to prevent periodontitis development and/or mitigate its progression.

The effect of scoliosis surgery on pulmonary function in spinal muscular atrophy patients: review of the literature and a meta-analysis.

PURPOSE: To determine the effect of surgical instrumentation on pulmonary function after surgery. METHODS: A literature review was performed to identify articles reporting on the effect of scoliosis surgery on the pulmonary function in patients with spinal muscular atrophy (SMA). Data for each patient were extracted from included studies, and a meta-analysis was performed using the values of forced vital capacity (FVC) before and after surgery. RESULTS: A total of 127 articles were reviewed, and ten articles were selected for data extraction according to inclusion criteria. The results of the meta-analysis showed no difference in respiratory function pre-operatively and at last follow-up. Four out of ten studies demonstrated similar results and five studies reported a decrease in pulmonary function after surgery. Only one study showed improvement in lung function. CONCLUSION: At the moment, there is insufficient evidence in the literature to support that spinal surgery can improve respiratory function. According to our meta-analysis study, vital capacity remains either unchanged or the rate of deterioration is decreased after surgery. Nevertheless, these are both considered favorable outcomes taking into account the natural course of the disease with progressive deterioration of pulmonary function over time.

The effect of piezocision vs no piezocision on maxillary extraction space closure: A split-mouth, randomized controlled clinical trial.

INTRODUCTION: The aim of this 2-arm-parallel, split-mouth trial was to investigate the effects of piezocision compared with no piezocision on maxillary canine distalization and to evaluate patient perceptions on the surgical procedure. METHODS: Twenty-two participants requiring extractions of maxillary first premolars were recruited from the Department of Orthodontics (Sydney Dental Hospital) waiting list. After leveling and alignment, a minimum of 3 mm space was required for canine retraction. Piezocision cuts distal to the canines were 4 mm long and 3 mm deep into the buccal cortical plate. The canine retraction was initiated on both sides immediately after surgery, with coil springs delivering 150 g of force per side. Random assignment of piezocision or control intervention on the patient's right side was performed (www.randomisation.com) for the random number generation, and allocation concealment was accomplished with opaque, sealed envelopes. Patients were assessed every 6 weeks for coil activation and alginate impressions over 18 weeks. The primary outcome was the amount of tooth movement in mm. Secondary outcomes were canine rotation, anchorage loss measured on scanned dental models, and patient pain levels and perception on piezocision using visual analog scale questionnaires. Blinding was feasible for the dental model measurements. RESULTS: Twenty patients completed the trial. The treatment × time interaction showed no statistically or clinically significant differences in maxillary extraction space closure (b = -0.02; 95% confidence interval [CI], -0.29 to 0.25; P = 0.89) canine rotation (b = -1.45; 95% CI, -4 to 1.09; P = 0.26) and anchorage loss (b = -0.02; 95% CI, -0.38 to 0.34; P = 0.92). All patients except for one had minimal pain associated with the piezocision surgery but found the procedure tolerable and would recommend it. No harm occurred during the trial. CONCLUSIONS: Piezocision-assisted maxillary canine distalization was similar to distalization with conventional orthodontics with patients tolerating the procedure.

Are cloth masks a substitute to medical masks in reducing transmission and contamination? A systematic review

Abstract: During the COVID-19 pandemic the use of cloth masks has increased dramatically due to the shortage of medical masks. However, the efficiency of this material is controversial. We aimed to investigate the efficiency of cloth masks in reducing transmission and contamination by droplets and aerosols for the general population and healthcare workers. Electronic databases were searched without year or language restrictions. Clinical and laboratorial studies were included. The risk of bias (RoB) was assessed using an adapted quality checklist for laboratory-based studies. ROBINS-I tool and Cochrane RoB 2.0 were used to evaluate non-randomized (n-RCT) and randomized clinical trials (RCT), respectively. The quality of the evidence was assessed through GRADE tool. From the eleven studies selected, eight were laboratory-based studies, one non-randomized and one RCT supported by laboratory data. Between the evaluated fabrics only three presented a filtration efficiency > 90%. Hybrid of cotton/chiffon (95%CI 95.2 to 98.8), hybrid of cotton/silk (95%CI 92.2 to 95.8) and cotton quilt (95%CI 94.2 to 97.8). However, cloth masks are not recommended for healthcare workers. A meta-analysis was not feasible due to a high methodological heterogeneity. The overall quality of evidence ranged from very low to moderate. Despite the lower efficiency compared to medical masks, laboratorial results may underestimate the efficiency of cloth masks in real life. Cloth mask efficiency is higher when made of hybrid fabrics (cotton/chiffon, cotton/silk) and cotton quilt, mainly with multiple layers.

Adequate Reporting of Dental Diagnostic Accuracy Studies is Lacking: An Assessment of Reporting in Relation to the Standards for Reporting of Diagnostic Accuracy Studies Statement.

OBJECTIVE: The objective of this study was to assess the quality of reporting of full-text articles of dental diagnostic accuracy studies published in eight leading speciality dental journals in relation to the Standards for Reporting of Diagnostic Accuracy Studies (STARD) statement. METHODS: The full articles of all included studies were assessed for their adherence to the 30-item STARD checklist by two researchers independently. A score of 0-2 was attributed to each item. Inter-rater agreement was assessed. Univariate and multivariate linear regression analyses were carried out to evaluate differences in reporting qualities between journals and whether certain variables influenced reporting qualities. RESULTS: A total of 145 articles were identified. Full-article STARD checklist items relating to methodology and results were poorly reported. The overall mean quality score for full articles was 28.75. Articles published in the Journal of Cranio-Maxillofacial Surgery obtained the highest quality score. In the multivariate analysis, articles published in the Journal of Cranio-Maxillofacial Surgery had significantly higher reporting quality scores than those published in the European Journal of Orthodontics (ß = -6.97, 95% confidence interval [CI]: -11.62, -2.30, P < .05), the Journal of Prosthetic Dentistry (ß = -8.01, 95% CI: -14.60, -1.41, P < .05) and Oral Diseases (ß = -6.72, 95% CI: -11.57, -1.86, P < .05). Reporting quality improved each year (P < .028). CONCLUSION: Adherence of full articles to the STARD is suboptimal in dental journals.

How old is old for implant therapy in terms of early implant losses?

OBJECTIVES: To assess, retrospectively, whether older age has an impact on implant osseointegration when compared with younger age. METHODS: All patients ≥65 years old at implant installation, in an university setting over a time-period of 11.5 years, with complete anamnestic data and follow-up until prosthetic restoration were included, and any early implant loss (EIL; i.e. lack of osseointegration prior to or at the time-point of prosthetic restoration) was recorded. Further, one implant, from each of the elderly patients, was attempted matched to one implant in a younger patient (35 to <55 years old at implant installation) from the same clinic based on (a) gender, (b) implant region, (c) smoking status and (d) bone grafting prior to/simultaneously with implant installation. The potential impact of various local and systemic factors on EIL in the entire elderly population, and in the matched elderly and younger patient group was statistically assessed. RESULTS: Four hundred forty-four patients ≥65 years old (range 65.1-91.3; 56.8% female) receiving 1,517 implants were identified; 10 patients had one EIL each (implant/patient level: 0.66/2.25%). Splitting this patient cohort additionally into four age groups [65-69.9 (n = 213), 70-74.9 (n = 111), 75-79.9 (n = 80) and ≥80 (n = 40)], EIL was on the implant level 0.41, 0.83, 0.34 and 2.26%, respectively, (p = .102) and on the patient level 1.41, 2.70, 1.25 and 7.50%, respectively, (p = .104); multilevel analysis showed weak evidence of association of increasing age with higher EIL rate (p = .090). Matching was possible in 347 cases, and 5 (1.44%) and 9 (2.59%) EIL in the elderly and younger patients, respectively, were observed (p = .280). EIL could not be associated with any systemic condition or medication intake. CONCLUSIONS: Elderly patients ≥65 years old presented a similarly low EIL rate as younger patients 35 to <55 years old, while patients ≥80 years old may have a slight tendency for a higher EIL rate. Hence, ageing does not seem to compromise osseointegration, and if at all, then only slightly and at a later stage of life.

Cell therapy for orofacial bone regeneration: A systematic review and meta-analysis.

AIM: The objective of the present review was to answer the focused question: what is the effect of cell therapy in terms of orofacial bone regeneration compared to grafting with only biomaterial scaffolds and/or autogenous bone? METHODS: Electronic databases were searched for relevant controlled clinical and pre-clinical (large-animal) studies. Separate meta-analyses of quantitative data regarding histological or radiographic new bone formation were performed. RESULTS: Forty-seven eligible clinical and 57 pre-clinical studies were included. Clinical studies were categorized based on the use of "minimally manipulated" whole tissues (e.g., bone marrow) or ex vivo expanded cells from "uncommitted" (bone marrow, adipose tissue) or "committed" sources (periosteum, bone). Based on limited and heterogeneous clinical evidence, implantation of cells (mostly whole bone marrow), in combination with biomaterial scaffolds results in bone regeneration which is (a) superior compared to implantation of scaffolds alone in sinus and horizontal ridge augmentation, and (b) comparable to autogenous bone in alveolar cleft repair. CONCLUSIONS: Although current evidence points to the benefits of cell therapy in certain clinical indications, it is unclear whether the use of ex vivo expanded cells, either uncommitted or committed, is superior to whole tissue fractions in terms of bone regeneration. The relatively larger effect sizes in favour of cell therapy observed in pre-clinical studies are diminished in clinical trials. Future controlled studies should include cost-effectiveness analyses to guide clinical decision-making.

The therapeutic potential of regulatory T lymphocytes in periodontitis: A systematic review.

This systematic review aimed to: (a) generate a descriptive synthesis of preclinical studies assessing the therapeutic potential of regulatory T lymphocytes (Tregs) to arrest periodontitis, (b) evaluate the methodological heterogeneity of the reviewed animal studies and (c) assess the risk of bias (RoB) of the included studies. The electronic search for animal studies included the MEDLINE, EMBASE, Web of Science and LILACS databases. In addition, a manual search assessed the high-ranked scientific journals in "periodontics/immunology" and the references listed in the included studies. There were no language, year or publication status restrictions. Two independent reviewers selected and extracted the data, and Cohen's Kappa coefficient was calculated to determine the inter-examiner agreement. The Systematic Review Center for Laboratory Animal Experimentation's (SYRCLE) tool was used to assess the RoB. A total of 21 of the 425 studies obtained from the database search were included. Treg function was mainly described in Porphyromonas gingivalis-induced periodontitis (57.1%) in mice (76.2%), where Treg suppression was strongly related to disease progression and Treg induction was strongly related to immuno-inflammatory response reduction. Of those 21 studies, eight included eight animal experiments using three distinct therapeutic approaches, including: P. gingivalis-driven immunization (n = 3), retinoic acid inoculation (n = 2) and anti-inflammatory molecules in polymeric carriers (n = 3), which could modulate the Treg activity through cytokine production (interleukin-10 and transforming growth factor-ß1), CC-chemokine- and CC-chemokine receptor-mediated chemoattraction (CCL22 and CCR4) or Th17-associated receptor activator of nuclear factor κB ligand (RANKL) downregulation. However, the studies with animal experiments did not specify the randomization sequences and housing conditions that were used, and therefore, 42.11% of the entries were rated as unclear RoB. Distinct therapeutic strategies involving Tregs could potentially suppress the immuno-inflammatory response and restore alveolar bone homeostasis during periodontitis. Nevertheless, important methodological variability, poor reporting of treatment effect estimates and unclear RoB suggest using caution when assessing the results of these studies.

The effect of antiresorptive drugs on implant therapy: Systematic review and meta-analysis.

OBJECTIVES: A considerable portion of the adult population has received and/or is receiving treatment with antiresorptive drugs (ARDs). It is thus relevant to assess possible side effects of ARD intake in connection to various aspects of implant therapy. The aim of this study was to answer the focused question "In patients with systemic intake of ARDs, what is the outcome and complication rate of implant therapy including associated bone grafting procedures comparing to patients without systemic intake of ARDs?" MATERIALS AND METHODS: Original studies fulfilled predefined inclusion criteria (e.g., case series, cohort studies, case-control studies, and controlled and/or randomized controlled clinical trials; retro- or prospective design; and ≥10 patients with systemic intake of ARDs). Various patient-, medication-, and intervention-related parameters [i.e., implant loss, grafting procedure complication/failure, peri-implant marginal bone levels/loss, medication-related osteonecrosis of the jaws (MRONJ), and peri-implantitis] were extracted, and meta-analyses and quality assessment were performed. RESULTS: Twenty-four studies with bisphosphonate (BP) intake (mainly low dose for osteoporosis treatment) and seven studies on hormone replacement therapy (HRT), including ≥10 patients, and controls not taking the medication were identified. Furthermore, seven studies on MRONJ associated with implants were included. Meta-analyses based on four studies reporting on patient level and eight studies reporting on implant level showed no significant differences in terms of implant loss between patients on BPs (mainly low dose for osteoporosis treatment) and controls. Furthermore, low-dose BP intake did not compromise peri-implant marginal bone levels. Based on two studies, no negative effect of HRT was observed on the implant level, while HRT appeared to exert a marginally significant negative effect regarding implant survival on the patient level and regarding peri-implant marginal bone levels. Based on six studies reporting single-patient data, MRONJ in patients on BP for osteoporosis appeared in 70% of the cases >36 months after start of drug intake, while in patients with cancer, MRONJ appeared in 64% of the cases ≤36 months after first BP intake. CONCLUSION: Low-dose oral BP intake for osteoporosis treatment, in general, does not compromise implant therapy, that is, patients on ARDs do not lose more implants nor get more implant-related complications/failures comparing to implant patients without BP intake. There is almost no information available on the possible effect on implant therapy of high-dose BPs or other widely used ARDs (e.g., denosumab), or on the success or safety of bone grafting procedures. Patients with high-dose ARD intake for management of malignancies, patients on oral BP over a longer period of time, and patients with comorbidities should be considered as high-risk patients for MRONJ.

Cell Cotransplantation Strategies for Vascularized Craniofacial Bone Tissue Engineering: A Systematic Review and Meta-Analysis of Preclinical In Vivo Studies.

The regenerative potential of tissue-engineered bone constructs may be enhanced by in vitro coculture and in vivo cotransplantation of vasculogenic and osteogenic (progenitor) cells. The objective of this study was to systematically review the literature to answer the focused question: In animal models, does cotransplantation of osteogenic and vasculogenic cells enhance bone regeneration in craniofacial defects, compared with solely osteogenic cell-seeded constructs? Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, electronic databases were searched for controlled animal studies reporting cotransplantation of endothelial cells (ECs) with mesenchymal stem cells (MSCs) or osteoblasts in craniofacial critical size defect (CSD) models. Twenty-two studies were included comparing outcomes of MSC/scaffold versus MSC+EC/scaffold (co)transplantation in calvarial (n = 15) or alveolar (n = 7) CSDs of small (rodents, rabbits) and large animal (minipigs, dogs) models. On average, studies presented with an unclear to high risk of bias. MSCs were derived from autologous, allogeneic, xenogeneic, or human (bone marrow, adipose tissue, periosteum) sources; in six studies, ECs were derived from MSCs by endothelial differentiation. In most studies, MSCs and ECs were cocultured in vitro (2-17 days) before implantation. Coculture enhanced MSC osteogenic differentiation and an optimal MSC:EC seeding ratio of 1:1 was identified. Alloplastic copolymer or composite scaffolds were most often used for in vivo implantation. Random effects meta-analyses were performed for histomorphometric and radiographic new bone formation (%NBF) and vessel formation in rodents' calvarial CSDs. A statistically significant benefit in favor of cotransplantation versus MSC-only transplantation for radiographic %NBF was observed in rat calvarial CSDs (weighted mean difference 7.80% [95% confidence interval: 1.39-14.21]); results for histomorphometric %NBF and vessel formation were inconclusive. Overall, heterogeneity in the meta-analyses was high (I2 > 80%). In summary, craniofacial bone regeneration is enhanced by cotransplantation of vasculogenic and osteogenic cells. Although the direction of treatment outcome is in favor of cotransplantation strategies, the magnitude of treatment effect does not seem to be of relevance, unless proven otherwise in clinical studies.

Non-pharmacological interventions for alleviating pain during orthodontic treatment.

BACKGROUND: Pain is prevalent during orthodontics, particularly during the early stages of treatment. To ensure patient comfort and compliance during treatment, the prevention or management of pain is of major importance. While pharmacological means are the first line of treatment for alleviation of orthodontic pain, a range of non-pharmacological approaches have been proposed recently as viable alternatives. OBJECTIVES: To assess the effects of non-pharmacological interventions to alleviate pain associated with orthodontic treatment. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 6 October 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 9), MEDLINE Ovid (1946 to 6 October 2016), Embase Ovid (1980 to 6 October 2016) and EThOS (to 6 October 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing a non-pharmacological orthodontic pain intervention to a placebo, no intervention or another non-pharmacological pain intervention were eligible for inclusion. We included any type of orthodontic treatment but excluded trials involving the use of pre-emptive analgesia or pain relief following orthognathic (jaw) surgery or dental extractions in combination with orthodontic treatment. We excluded split-mouth trials (in which each participant receives two or more treatments, each to a separate section of the mouth) and cross-over trials. DATA COLLECTION AND ANALYSIS: At least two review authors independently assessed risk of bias and extracted data. We used the random-effects model and expressed results as mean differences (MD) with 95% confidence intervals (CI). We investigated heterogeneity with reference to both clinical and methodological factors. MAIN RESULTS: We included 14 RCTs that randomised 931 participants. Interventions assessed included: low-level laser therapy (LLLT) (4 studies); vibratory devices (5 studies); chewing adjuncts (3 studies); brain wave music or cognitive behavioural therapy (1 study) and post-treatment communication in the form of a text message (1 study). Twelve studies involved self-report assessment of pain on a continuous scale and two studies used questionnaires to assess the nature, intensity and location of pain.We combined data from two studies involving 118 participants, which provided low-quality evidence that LLLT reduced pain at 24 hours by 20.27 mm (95% CI -24.50 to -16.04, P < 0.001; I² = 0%). LLLT also appeared to reduce pain at six hours, three days and seven days.Results for the other comparisons assessed are inconclusive as the quality of the evidence was very low. Vibratory devices were assessed in five studies (272 participants), four of which were at high risk of bias and one unclear. Chewing adjuncts (chewing gum or a bite wafer) were evaluated in three studies (181 participants); two studies were at high risk of bias and one was unclear. Brain wave music and cognitive behavioural therapy were evaluated in one trial (36 participants) assessed at unclear risk of bias. Post-treatment text messaging (39 participants) was evaluated in one study assessed at high risk of bias.Adverse effects were not measured in any of the studies. AUTHORS' CONCLUSIONS: Overall, the results are inconclusive. Although available evidence suggests laser irradiation may help reduce pain during orthodontic treatment in the short term, this evidence is of low quality and therefore we cannot rely on the findings. Evidence for other non-pharmacological interventions is either very low quality or entirely lacking. Further prospective research is required to address the lack of reliable evidence concerning the effectiveness of a range of non-pharmacological interventions to manage orthodontic pain. Future studies should use prolonged follow-up and should measure costs and possible harms.

Are dental researchers asking patient-important questions? A scoping review.

OBJECTIVES: There is an increasing recognition that research outcomes should resonate with patients rather than fixating on technical aspects of interventions. We aimed to assess the nature of outcomes within a representative subset of clinical trials published in leading dental journals. METHODS: Randomized controlled trials published over a 3-year period up to December 31st, 2015 were identified in eight leading general and specialty dental journals: Journal of Dental Research, Journal of Dentistry, American Journal of Orthodontics and Dentofacial Orthopedics, Pediatric Dentistry, International Journal of Prosthodontics, Journal of Endodontics, International Journal of Oral and Maxillofacial Surgery and Journal of Clinical Periodontology. The number and nature of outcomes considered within these trials were assessed. RESULTS: Overall 220 RCTs involving 409 outcomes (257 primary and 152 secondary) were identified. Measures of disease activity were most commonly assessed as both primary (n=91, 35%) and secondary outcomes (n=59, 39%). Quality of life and functional measures were rarely considered as primary outcome domains. Overall, 182 (44%) outcomes were primarily clinician-focused, 140 (34%) were patient-centered, while 22% (n=87) were both patient- and clinician- focused. CONCLUSIONS: There is an undue emphasis on technical, clinician-centered outcomes within dental research common to all specialty areas. Development and adoption of core outcome sets representing the minimum set of data that should be obtained within a dental clinical trial would assist in addressing this issue. CLINICAL SIGNIFICANCE: There is an acceptance that research outcomes should ultimately be of relevance and benefit to patients rather than focusing on technical aspects of interventions. This study points to an undue emphasis on technical, clinician-centered outcomes within dental research common to all specialty areas. Development and adoption of agreed dental core outcome sets would help to remedy this.

Surgical adjunctive procedures for accelerating orthodontic treatment.

BACKGROUND: A range of surgical and non-surgical techniques have received increasing attention in recent years in an effort to reduce the duration of a course of orthodontic treatment. Various surgical techniques have been used; however, uncertainty exists in relation to the effectiveness of these procedures and the possible adverse effects related to them. OBJECTIVES: To assess the effects of surgically assisted orthodontics on the duration and outcome of orthodontic treatment. SEARCH METHODS: We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 10 September 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 8), MEDLINE via OVID (1946 to 10 September 2014), EMBASE via OVID (1980 to 10 September 2014), LILACS via BIREME (1980 to 10 September 2014), metaRegister of Controlled Trials (to 10 September 2014), ClinicalTrials.gov (to 10 September 2014), and the World Health Organization (WHO) International Clinical Trials Registry Platform (to 10 September 2014). We checked the reference lists of all trials identified for further studies. There were no restrictions regarding language or date of publication in the electronic searches. SELECTION CRITERIA: Randomised controlled trials (RCTs) evaluating the effect of surgical adjunctive procedures for accelerating tooth movement compared with conventional treatment (no surgical adjunctive procedure). DATA COLLECTION AND ANALYSIS: At least two review authors independently assessed the risk of bias in the trials and extracted data. We used the fixed-effect model and expressed results as mean differences (MD) with 95% confidence intervals (CI). We investigated heterogeneity with reference to both clinical and methodological factors. MAIN RESULTS: We included four RCTs involving a total of 57 participants ranging in age from 11 to 33 years. The interventions evaluated were corticotomies to facilitate orthodontic space closure or alignment of an ectopic maxillary canine, with the effect of repeated surgical procedures assessed in one of these studies. The studies did not report directly on the primary outcome as prespecified in our protocol: duration of orthodontic treatment, number of visits during active treatment (scheduled and unscheduled) and duration of visits. The main outcome assessed within the trials was the rate of tooth movement, with periodontal effects assessed in one trial and pain assessed in one trial. A maximum of just three trials with small sample sizes were available for each comparison and outcome. We assessed all of the studies as being at unclear risk of bias.Tooth movement was found to be slightly quicker with surgically assisted orthodontics in comparison with conventional treatment over periods of one month (MD 0.61 mm; 95% CI 0.49 to 0.72; P value < 0.001) and three months (MD 2.03 mm, 95% CI 1.52 to 2.54; P value < 0.001). Our results and conclusions should be interpreted with caution given the small number of included studies. Information on adverse events was sought; however, no data were reported in the included studies. AUTHORS' CONCLUSIONS: This review found that there is limited research concerning the effectiveness of surgical interventions to accelerate orthodontic treatment, with no studies directly assessing our prespecified primary outcome. The available evidence is of low quality, which indicates that further research is likely to change the estimate of the effect. Based on measured outcomes in the short-term, these procedures do appear to show promise as a means of accelerating tooth movement. It is therefore possible that these procedures may prove useful; however, further prospective research comprising assessment of the entirety of treatment with longer follow-up is required to confirm any possible benefit.