Patient-Reported Outcomes of Maxillomandibular Surgery for Obstructive Sleep Apnea Treatment: A Scoping Review.

(1) Background: The present scoping review aims to scrutinize all existing patient-reported outcomes and assess the perspectives of obstructive sleep apnea patients after maxillomandibular surgery. (2) Methods: The review was carried out according to the extensions for scoping reviews using the PRISMA-ScR guidelines. Several databases were used to carry out the initial search. This study included randomized controlled trials, cohort studies, cross-sectional and case-control studies. The included studies considered patients with obstructive sleep apnea who were submitted to orthognathic surgery as the main subjects, and the patient's perception of quality of life, satisfaction, treatment experience and side effects were assessed. (3) Results: From 1407 examined articles, a total of 16 were included. Most of the included studies used more than one questionnaire to assess quality of life, except for five articles. The most commonly referred instruments were the Epworth Sleepiness Scale, SF-36, the Functional Outcomes of Sleep and Ottawa Sleep Apnea. The most commonly assessed outcomes were sleep quality, daytime function, facial aesthetics, dental function and emotional health. (4) Conclusions: The number of variables that can be evaluated from a patient's perspective are endless, as are the tools available to assess them. Not all of these tools, which are generally questionnaires, assess all the various outcomes, and some do not compare the pre- and post-surgical situations. Most of them are generic and lack specificity for obstructive sleep apnea.

In Vitro Characterization of Reversine-Treated Gingival Fibroblasts and Their Safety Evaluation after In Vivo Transplantation.

Reversine is a purine derivative that has been investigated with regard to its biological effects, such as its anticancer properties and, mostly, its ability to induce the dedifferentiation of adult cells, increasing their plasticity. The obtained dedifferentiated cells have a high potential for use in regenerative procedures, such as regenerative dentistry (RD). Instead of replacing the lost or damaged oral tissues with synthetic materials, RD uses stem cells combined with matrices and an appropriate microenvironment to achieve tissue regeneration. However, the currently available stem cell sources present limitations, thus restricting the potential of RD. Based on this problem, new sources of stem cells are fundamental. This work aims to characterize mouse gingival fibroblasts (GFs) after dedifferentiation with reversine. Different administration protocols were tested, and the cells obtained were evaluated regarding their cell metabolism, protein and DNA contents, cell cycle changes, morphology, cell death, genotoxicity, and acquisition of stem cell characteristics. Additionally, their teratoma potential was evaluated after in vivo transplantation. Reversine caused toxicity at higher concentrations, with decreased cell metabolic activity and protein content. The cells obtained displayed polyploidy, a cycle arrest in the G2/M phase, and showed an enlarged size. Additionally, apoptosis and genotoxicity were found at higher reversine concentrations. A subpopulation of the GFs possessed stem properties, as supported by the increased expression of CD90, CD105, and TERT, the existence of a CD106+ population, and their trilineage differentiation capacity. The dedifferentiated cells did not induce teratoma formation. The extensive characterization performed shows that significant functional, morphological, and genetic changes occur during the dedifferentiation process. The dedifferentiated cells have some stem-like characteristics, which are of interest for RD.

Reconstruction of Oronasal Fistula with Tongue Flap: A Cleft Palate Report.

Oronasal fistula can persist after conventional secondary alveolar bone graft surgery, which may lead to functional issues, such as regurgitation of fluids from the oral to the nasal cavity. This manuscript describes a clinical case of a patient with a bilateral cleft lip and palate that underwent tongue graft surgery for closure of an oronasal fistula after three failed local mucosa flap surgeries. The multidisciplinary treatment was comprised of orthodontic treatment, mucosa and alveolar grafts for palate closure and aesthetic rehabilitation of the anterior maxillary teeth. Smile aesthetics were noticeably improved, enhancing the patient's self-perception and confidence.

Effectiveness of photodynamic therapy on treatment response and survival of patients with recurrent oral squamous cell carcinoma: a systematic review protocol.

OBJECTIVE: This review aims to systematically examine the effectiveness of photodynamic therapy for the treatment of patients with recurrent oral squamous cell carcinoma. INTRODUCTION: Oral squamous cell carcinoma is a significant public health problem, and is the seventh most common cancer. Its incidence is mainly due to tobacco use, alcohol consumption, and HPV infection. The survival rates are poor due to diagnosis at advanced stages, with high recurrence rates. Although current evidence does not point to photodynamic therapy as a first-line option, this treatment might be suitable for treating recurrent stages of the cancer where conventional treatments were ineffective. Despite the potential of photodynamic therapy, there is a need to verify the scientific evidence to support its indication for the treatment of recurrent oral squamous cell carcinoma. INCLUSION CRITERIA: This review will consider studies on any stage of recurrent oral squamous cell carcinoma treated with photodynamic therapy after receiving first-line conventional treatments. Patients of any age, gender, and geographic location will be included. The primary outcomes will be to evaluate response to treatment, focusing on remission, recurrence, change in size of the lesion, alleviation of symptoms, and survival. Secondary outcomes will be postoperative complications, presence of necrosis, patient quality of life after treatment, and patient satisfaction. METHODS: Studies will be searched using a combination of index terms and keywords in MEDLINE, Cochrane Central, Web of Science, Embase, and ClinicalTrials.gov. No date limits will be applied. Articles written in English, French, Spanish, or Portuguese will be considered. Findings will be provided as a narrative synthesis, structured around the photodynamic therapy protocol used. A meta-analysis is planned and subgroup analysis will be conducted if possible. The certainty of findings will be assessed. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020141075.

Impairment of the angiogenic process may contribute to lower success rate of root canal treatments in diabetes mellitus.

AIM: To investigate the association between root canal treatment outcome, diabetes mellitus, and alterations of the angiogenic process. METHODOLOGY: A retrospective observational study was conducted in healthy (control group, CG) and diabetic (type II diabetes mellitus group, DG) patients after root canal treatment. The follow-up appointments were performed to clinically and radiographically observe symptoms, the healing of periapical lesions and the quality of root fillings. In the animal model study, diabetic Goto-Kakizaki (GK) rats and control Wistar rats were used. After 21 days of pulp exposure and the development of apical periodontitis (AP), the mandibles were removed for scintigraphic, radiographic, histopathological and molecular analyses. Chi-square tests were performed to examine the variables related to endodontic outcome and differences between animal groups were assessed using the Student's t-test. RESULTS: The group of patients with diabetes had a significantly lower rate of success following root canal treatment than the CG (p < .001). Logistic regression suggested that diabetes is a risk factor for success of root canal treatment. In the animal study, GK rats had significantly higher fasting glycaemia at t0 and t21 (p < .001) and triglycerides levels (p < .05) and area under the curve (AUC) during the insulin tolerance test at t21 (p < .001). AP area was significantly greater in GK rats (p < .05). Histologically, diabetic rats had increased signs of periodontal ligament inflammation 21 days after the induction of apical periodontitis, with fibro-hyaline matrix filling and vessel with undefined walls. Wistar rats had significantly increased vascular endothelial growth factor (VEGF) levels and VEGF/Ang-2 ratio 21 days after AP induction (p < .08; p < .07). GK rats had intrinsically lower levels of VEGF than control rats (p < .05), which did not change after AP. CONCLUSION: Diabetes mellitus should be considered as an important factor in the prognosis of root canal treatment and its outcomes over time. Future strategies to improve angiogenesis and tissue repair should be pursued to achieve better root canal treatment outcomes in diabetic patients.

Evaluation of dentinogenesis inducer biomaterials: an in vivo study

Abstract When exposure of the pulp to external environment occurs, reparative dentinogenesis can be induced by direct pulp capping to maintain pulp tissue vitality and function. These clinical situations require the use of materials that induce dentin repair and, subsequently, formation of a mineralized tissue. Objective: This work aims to assess the effect of tricalcium silicate cements and mineral trioxide aggregate cements, including repairing dentin formation and inflammatory reactions over time after pulp exposure in Wistar rats. Methodology: These two biomaterials were compared with positive control groups (open cavity with pulp tissue exposure) and negative control groups (no intervention). The evaluations were performed in three stages; three, seven and twenty-one days, and consisted of an imaging (nuclear medicine) and histological evaluation (H&E staining, immunohistochemistry and Alizarin Red S). Results: The therapeutic effect of these biomaterials was confirmed. Nuclear medicine evaluation demonstrated that the uptake of 99mTc-Hydroxymethylene diphosphonate (HMDP) showed no significant differences between the different experimental groups and the control, revealing the non-occurrence of differences in the phosphocalcium metabolism. The histological study demonstrated that in mineral trioxide aggregate therapies, the presence of moderate inflammatory infiltration was found after three days, decreasing during follow-ups. The formation of mineralized tissue was only verified at 21 days of follow-up. The tricalcium silicate therapies demonstrated the presence of a slight inflammatory infiltration on the third day, increasing throughout the follow-up. The formation of mineralized tissue was observed in the seventh follow-up day, increasing over time. Conclusions: The mineral trioxide aggregate (WhiteProRoot®MTA) and tricalcium silicate (Biodentine™) present slight and reversible inflammatory signs in the pulp tissue, with the formation of mineralized tissue. However, the exacerbated induction of mineralized tissue formation with the tricalcium silicate biomaterial may lead to the formation of pulp calcifications

Effects of Electronic Cigarettes on Oral Cavity: A Systematic Review.

INTRODUCTION: The increase in the use of electronic cigarettes (e-cigs) in young people and the lack of knowledge of the health effects of smoking in the short and long term are worrying. Although the oral cavity is the first to interact directly with the e-cig aerosol, studies on potential oral cavity lesions are still limited and there is some controversy about safety. OBJECTIVE: To perform a systematic review to evaluate the adverse effects of e-cigs on oral health. MATERIALS AND METHODS: The research was conducted using Cochrane Library, Embase, PubMed, and Web of Science. The research was limited to articles in English, Portuguese, and Spanish, published between January 2003 and November 2018. The research question was formulated according to the population, intervention, comparison, outcome (PICO) strategy. The quality of the methodology of each study was evaluated following the guidelines described in the Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool. RESULTS: The initial search resulted in 432 articles, of which only eight were included for analysis. Periodontal and peri-implant clinical and radiographic parameters (plaque index, clinical attachment loss, probing depth, peri-implant bone loss, and radiographic bone level) are worse, and proinflammatory cytokine levels are higher among electronic and conventional cigarette smokers than among nonsmokers. Bleeding on probing was higher in nonsmokers than in conventional cigarette smokers and e-cig users. Nine different lesions of the oral mucosa were detected, with nicotinic stomatitis, hairy tongue, and angular cheilitis being more prevalent in e-cig consumers. CONCLUSION: The results suggest that e-cigs are less harmful than conventional cigarettes. However, there is also a greater susceptibility of e-cig consumers to developing alterations in oral biological tissues than ex-smokers or nonsmokers. There is still a clear need for the development of new studies.

Oculo-Facio-Cardio-Dental Syndrome: A Case Report about a Rare Pathological Condition.

(1) Background: Oculo-facio-cardio-dental (OFCD) syndrome is a rare pathological condition with an X-linked dominant trait that only occurs in females; no males are born with OFCD syndrome. This syndrome is characterized by congenital cataracts with secondary glaucoma ocular defects, ventricular and atrial septal defects, or mitral valve prolapses. Facial traits are a long narrow face and a high nasal bridge with a bifid nasal tip. Dental anomalies include radiculomegaly, oligodontia, root dilacerations, malocclusion, and delayed eruption. (2) Methods: This clinical report describes a 26-year-old girl who suffers from OFCD syndrome and who was treated with a multidisciplinary approach. The treatment plan included orthodontic treatment, orthognathic surgery, namely LeFort I and a Bilateral Sagittal Split Osteotomy, and occlusal rehabilitation with implants. (3) Discussion: Early diagnosis and multidisciplinary treatment of orthodontic, orthognathic surgery and occlusal rehabilitation with implants make it possible to maintain tooth function and improve aesthetics with good prognoses for success. In this paper, we report a case of a female patient with OFCD syndrome, who was referred for orthodontic treatment and occlusal rehabilitation and treated with a multidisciplinary approach.

Dental caries and bacterial load in saliva and dental biofilm of type 1 diabetics on continuous subcutaneous insulin infusion

Abstract Objectives Since most of the studies evaluates diabetics on multiple daily injections therapy and continuous subcutaneous insulin infusion may help gain better metabolic control and prevent complications, the objective of this study was to evaluate the prevalence of dental caries, the unstimulated salivary flow rate and the total bacteria load, Streptococcus spp. levels and Lactobacillus spp. levels in saliva and supragingival dental biofilm of type 1 diabetics on insulin pump. Material and Methods Sixty patients with type 1 diabetes on insulin pump and 60 nondiabetic individuals were included. The dental caries evaluation was performed using ICDAS and the oral hygiene was assessed according to Greene and Vermillion Simplified Oral Hygiene Index. Unstimulated saliva and supragingival dental biofilm were collected. Total bacteria, Streptococcus spp. and Lactobacillus spp. was quantified by qPCR. Results Patients with type 1 diabetes had a higher prevalence of dental caries and filled and missing teeth when compared with the control group. These patients were associated with more risk factors for the development of dental caries, namely a lower unstimulated salivary flow rate and a higher bacterial load in saliva and dental biofilm. Conclusion Some risk factors related to dental caries were associated with type 1 diabetics. An early diagnosis combined with the evaluation of the risk profile of the diabetic patient is imperative, allowing the dental caries to be analyzed through a perspective of prevention and the patient to be integrated into an individualized oral health program.

Effects on gastric mucosa induced by dental bleaching--an experimental study with 6% hydrogen peroxide in rats.

UNLABELLED: The value of aesthetic dentistry has precipitated several developments in the investigation of dental materials related to this field. The free marketing of these products is a problem and it is subject to various interpretations regarding its legality. There are several techniques for tooth whitening, the most used one being the external bleaching. It is the later version of such technique that poses the greatest danger of ingesting the product. The present study analysed the systemic effect of these products when they are swallowed. OBJECTIVE: This experimental study aimed to observe the effects of a tooth whitening product, whose active agent is 6% hydrogen peroxide, on the gastric mucosa of healthy and non-tumour gastric pathology animals. MATERIAL AND METHODS: Fifty Wistar-Han rats were used and then distributed into 5 groups, one for control and four test groups in which the bleaching product was administered in animals with and without non-tumour gastric pathology (induced by the administration of 1 sample of 50% ethanol and 5% of drinking water during 6 days) at different times of study by gavage. There was a decrease in body weight in animals of groups handled during the study period, which was most pronounced in IV and VA groups. Changes in spleen weight relative to body weight revealed no statistically significant changes. An analysis of the frequency was performed on the results of macroscopic observation of the gastric mucosa. RESULTS: The gastric mucosa revealed lesions in all manipulated groups, being more frequent in groups III and IV. It appears that there is a synergism when using hydrogen peroxide and 50% ethanol in the same group. CONCLUSION: Therefore, it seems that there are some signs of toxicity 3 to 4 days after administration of 6% hydrogen peroxide. The prescription of these therapies must be controlled by the clinician and the risks must be minimized.

Effects on gastric mucosa induced by dental bleaching – an experimental study with 6% hydrogen peroxide in rats

The value of aesthetic dentistry has precipitated several developments in the investigation of dental materials related to this field. The free marketing of these products is a problem and it is subject to various interpretations regarding its legality. There are several techniques for tooth whitening, the most used one being the external bleaching. It is the later version of such technique that poses the greatest danger of ingesting the product. The present study analysed the systemic effect of these products when they are swallowed.Objective This experimental study aimed to observe the effects of a tooth whitening product, whose active agent is 6% hydrogen peroxide, on the gastric mucosa of healthy and non-tumour gastric pathology animals.Material and Methods Fifty Wistar-Han rats were used and then distributed into 5 groups, one for control and four test groups in which the bleaching product was administered in animals with and without non-tumour gastric pathology (induced by the administration of 1 sample of 50% ethanol and 5% of drinking water during 6 days) at different times of study by gavage. There was a decrease in body weight in animals of groups handled during the study period, which was most pronounced in IV and VA groups. Changes in spleen weight relative to body weight revealed no statistically significant changes. An analysis of the frequency was performed on the results of macroscopic observation of the gastric mucosa.Results The gastric mucosa revealed lesions in all manipulated groups, being more frequent in groups III and IV. It appears that there is a synergism when using hydrogen peroxide and 50% ethanol in the same group.Conclusion Therefore, it seems that there are some signs of toxicity 3 to 4 days after administration of 6% hydrogen peroxide. The prescription of these therapies must be controlled by the clinician and the risks must be minimized.

Effect of calcium hydroxide as intracanal medication on the apical sealing ability of mineral trioxide aggregate (MTA): an in vitro apexification model / Efeito da medicação intracanal de hidróxido de cálcio na capacidade seladora do mineral trióxido agregado (MTA): um modelo de apicificação in vitro

Objective - To evaluate the effect of calcium hydroxide premedication on the apical seal of White MTA, placed as an apical barrier in permanent teeth with simulated immature apices. Furthermore, we intended to compare potential changes, under the influence of calcium hydroxide, in the apical seal of MTA over time. Methods - Thirty-four single-rooted extracted teeth were prepared in order to simulate a divergent open apex. Two experimental groups of 10 teeth were created: group 1 (G1) and group 2 (G2) with and without calcium hydroxide intracanal medication previous to the placement of MTA apical plug. Two control groups, positive and negative, each with 7 teeth were created. On the 7th and on the 28th day after placement of the MTA apical plug, the apices of the teeth were submersed in a solution of sodium pertechnetate (99mTcO4Na) for 3 hours. The radioactivity was measured using a gamma camera. Results - Results revealed statistically significant differences between the 2 control groups and the 2 experimental groups with respect to the microleakage. Within the experimental groups no statistically significant differences were found; nor between the two observed periods. Conclusion - Based on the results obtained in this study, it was concluded that intracanal medication with calcium hydroxide did not affect the sealing ability of WMTA, placed as an apical plug, neither on the 7th, nor on the 28th day.

Objetivo - Avaliar o efeito do hidróxido de cálcio como medicação intracanal, no selamento apical do MTA branco, colocado como uma barreira apical em dentes permanentes com ápices imaturos simulados. Métodos - Trinta e quatro dentes unirradiculares extraídos foram preparados para simular um ápice aberto divergente. Foram separados em dois grupos experimentais (n=10): G1 e G2 com e sem medicação intracanal de hidróxido de cálcio antes da colocação do tampão apical com o MTA e dois grupos controle, positivos e negativos (n=7 em cada). Em 7 e 28 dias após a colocação do tampão apical de MTA, os ápices dos espécimes foram submersos em uma solução de pertecnetato de sódio (99mTcO4Na) por 3 horas. A radioatividade foi medida usando uma câmara gama. Resultados - Os resultados revelaram diferenças estatisticamente significativas entre os grupos controle e os grupos experimentais com relação a microinfiltração. Não houve diferença entre os grupos experimentais nos dois períodos. Conclusão - Com base nos resultados obtidos neste estudo, concluiu-se que a medicação intracanal com hidróxido de cálcio não influenciou na capacidade seladora do MTA.

Limas endodônticas: esterilizar ou descartar

Objetivo: o objetivo desse trabalho foi comparar, qualitativa e quantitativamente, a presença de matéria orgânica em limas endodônticas depois de utilizadas, descontaminadas e esterilizadas. Métodos: foram usadas 30 limas tipo K #30, das quais 5 serviram como grupo controle positivo e 5 como negativo. Instrumentaram-se 10 molares suínos pela técnica Crown-Down, inserindo uma lima por canal num total de 25 limas. As limas do grupo 1 (n=10) foram esterilizadas em autoclave. As limas do grupo 2 (n=10) foram colocadas em banho de ultrassom com solução enzimática e posteriormente esterilizadas em autoclave. As do grupo 3 (n=5) foram utilizadas, mas não foram esterilizadas; e as do grupo 4(n=5) não foram utilizadas nem esterilizadas. As limas experimentais e de controle foram posteriormente coradas com solução de Van Gieson, observadas ao microscópio óptico e atribuído um valor representativo da quantidade de matéria orgânica ainda existente na lima, de acordo com uma escala previamente estabelecida. Essa quantificação foi realizada nos terços apical, médio e cervical da parte ativa de cada lima, e foram elaboradas tabelas comparativas entre os diferentes grupos. Resultados:os resultados demonstraram que ambos os grupos experimentais apresentaram resultados significativamente inferiores aos das limas do grupo controle positivo.Conclusão: comparando-se os grupos experimentais,as limas imersas em banho de ultrassom com solução enzimática apresentaram valores inferiores aos daquelas que não foram submetidas a esse procedimento.