A systematic review assessing occurrence of medication-related osteonecrosis of the jaw following dental procedures

Aim: This study aimed to systematically review existing literature regarding the association between dental procedures­such as tooth extractions and periodontal therapy­and occurrence of medication-related osteonecrosis of the jaw (MRONJ) in individuals using bone-modifying drugs. Methods: Search strategies were performed in PubMed, Scopus, Web of Science and Cochrane Library for a timeframe ending in December 2021. Study selection, data extraction and risk of bias were analyzed independently by two researchers. Three meta-analyses were performed, estimating the crude risk ratio (RR), the adjusted odds ratio (OR) and the adjusted hazard ratio (HR) for the association between tooth extraction and MRONJ. Results: Of the 1,654 studies initially retrieved, 17 were ultimately included. The majority of patients with MRONJ in these studies were female, with a mean age of 64 years. Zoledronic acid was the most commonly used drug among patients with MRONJ, and cancer was the most frequent underlying health condition. Regarding the performed meta-analyses, crude and adjusted analyses demonstrated that tooth extraction increased the risk for MRONJ by 4.28 (95% confidence interval [95%CI]: 1.73­10.58), the OR for MRONJ by 26.94 (95%CI: 4.17­174.17), and the HR for MRONJ by 9.96 (95%CI: 4.04­24.55). Conclusion: It was concluded that performing dental procedures, especially tooth extraction, in patients using bone-modifying drugs increased the risk of MRONJ occurrence and, therefore, should be avoided. Further studies, using adjusted data, are warranted

Is professionally applied topical fluoride effective in treating incipient caries? A systematic review

Abstract The present systematic review aimed to investigate the effectiveness of professionally applied topical fluoride as therapeutic agent for incipient carious lesions in permanent teeth. Randomised clinical trials (RCTs) comparing the effectiveness of professionally applied topical fluoride (varnish or gel) with that of placebo, no intervention, and toothbrushing (control group) in the treatment of incipient carious lesions in permanent dentition were included. An electronic search was performed in the PubMed, Web of Science, Scopus, Virtual Health Library, Embase, and Cochrane databases, in the grey literature, and in clinical trials registered until January 2021. Two reviewers independently screened titles and abstracts and assessed the risk of bias using the Cochrane tool. The certainty of evidence was classified using GRADE. A total of 2,223 articles were screened using titles/abstracts. After full-text reading of the 22 selected studies, nine RCTs were included. Five RCTs found that topical fluoride may be effective in reversing incipient carious lesions in permanent teeth. Overall, five studies were classified as having a low risk of bias and four as having some concerns. Only descriptive analysis was performed because of the heterogeneity of the data. Studies comparing fluoride varnish with usual home care oral hygiene have demonstrated topical fluoride does not appear to be more effective in improving the appearance of incipient carious lesions. Therefore, usual home care oral hygiene with fluoride toothpaste may be sufficient to treat incipient carious lesions in permanent dentition. Further studies with greater methodological rigor are, however, required to reduce bias, to allow a meta-analysis, and to draw well-founded conclusions (CRD42019120406).

Avaliação do efeito da termociclagem na estabilidade de cor e rugosidade superficial de duas resinas compostas comerciais / Evaluation of thermocycling effect on color stability and surface roughness of two commercial resin composite

Objetivo: Avaliar o efeito do envelhecimento térmico por termociclagem na estabilidade de cor e rugosidade superficial de duas resinas compostas, avaliar grau de conversão (GC), sorção (SO), solubilidade (SL) e microdureza. Material e método: Foram confeccionados 10 espécimes (6 mm x 1 mm) para cada resina: Filtek Z350 XT (Z350XT) e Estelite Sigma Quick (ES). Foram avaliados: GC, utilizando um espectrofotômetro no infravermelho, SO e SL. A avaliação da microdureza Vickers (MV) e densidade de ligações cruzadas foi realizada antes e após a imersão em etanol por 24 h. A rugosidade superficial e a estabilidade de cor (CIEDE2000) foram avaliadas antes e após envelhecimento térmico por 2000 ciclos, alternando 30 s a 5°, 37° e 55° C. A estabilidade de cor e translucidez foram avaliadas com um espectrofotômetro. Os dados foram submetidos ao teste t (α=0,05). Resultados: ES apresentou resultados de GC maiores (62,5% ± 3,7) que Z350XT (48,7% ± 6,9) (p=0,004). Ambas resinas apresentaram resultados de SO e SL similares. A MV final da ES diminuiu 13% com relação a inicial (p=0,115). Z350XT apresentou diminuição de 17% (p=0,004). ES apresentou aumento de 115% na rugosidade superficial após a termociclagem (p=0,001), enquanto a Z350XT apresentou diminuição de 35% (p=0,299). ES apresentou menor alteração de cor (0,280 ± 0,093), quando comparada a Z350XT (0,549 ± 0,183). A translucidez foi similar para ambos materiais (ES=30,80; Z350XT=30,35). Conclusão: A termociclagem influenciou na alteração de cor e rugosidade superficial das resinas compostas, demonstrando que podem ser alteradas pela degradação na matriz polimérica.

Objective: To evaluate the thermocycling effect on color stability and surface roughness of two resin composites and also evaluate the degree of conversion (GC), sorption (SO), solubility (SL) and microhardness. Material and method: 10 specimens (6 mm x 1 mm) were made for each resin: Filtek Z350 XT (Z350XT) and Estelite Sigma Quick (ES). The following were evaluated: GC, using an infrared spectroscopy, SO and SL. Vickers microhardness (MV) and cross-link density evaluation was performed before and after immersion in ethanol for 24 hours. Surface roughness and color stability (CIEDE2000) were evaluated before and after thermal aging for 2000 cycles, alternating between 30 s at 5°, 37° and 55° C. Color stability and translucency were assessed with a spectrophotometer. Data were submitted to t test (α= 0.05). Results: ES presented higher GC results (62.5% ± 3.7) than Z350XT (48.7% ± 6.9) (p= 0.004). Both resins showed similar SO and SL results. The final MV of ES decreased 13% in relation to the initial (p= 0.115). Z350XT decreased by 17% (p= 0.004). ES showed a 115% increase in surface roughness after thermocycling (p= 0.001), while the Z350XT showed a 35% decrease (p= 0.299). ES showed less color change (0.280 ± 0.093) when compared to Z350XT (0.549 ± 0.183). The translucency was similar for both materials (ES= 30.80; Z350XT= 30.35). Conclusion: Thermocycling influenced the change in color stability and surface roughness of composite resins, demonstrating that they may be altered by degradation in the polymer matrix.