Does the use of preheated restorative resin composite as a luting agent influence the adaptation of fixed dental prostheses? A systematic review.

STATEMENT OF PROBLEM: Although studies have explored the physical and mechanical properties of different composite resins with the preheating technique, evidence that the use of preheated restorative composite resin as a luting agent influences the adaptation of fixed dental prostheses is lacking. PURPOSE: The purpose of this systematic review was to answer the question: Does the use of preheated restorative composite resin as a luting agent influence the adaptation of fixed dental prostheses? MATERIAL AND METHODS: Seven databases and nonpeer-reviewed literature were searched, without language or year restrictions. Studies directly comparing the adaptation of fixed dental prostheses cemented with preheated restorative composite resin or resin cement were considered eligible for inclusion. Assessment of the risk of bias was based on a 9-item checklist. RESULTS: Of 2109 retrieved articles, 4 in vitro studies met the inclusion criteria. Three of them concluded that preheated restorative composite resin produced a greater mismatch than resin cement, and the remaining study reported that composite resin improved the adaptation of fixed dental prostheses. All included studies had a medium risk of bias. The high level of heterogeneity among the studies precluded meta-analysis. CONCLUSIONS: The use of preheated restorative composite resin as a luting agent seems to negatively influence the adaptation of fixed dental prostheses. It was not possible to evaluate whether variables such as the formulation of the resin material or its heating time and temperature influence the adaptation of fixed dental prostheses because of the high heterogeneity of the included studies.

Is there variation in the depth of the curve of Spee in individuals with different dentoskeletal patterns? A systematic review with meta-analysis.

OBJECTIVE: To systematically evaluate all the evidence assessing variations in the depth of the curve of Spee (COS) according to the presence/absence of different dentoskeletal characteristics. SEARCH METHODS AND ELIGIBILITY CRITERIA: The eligibility criteria were outlined following the PECO framework, as follows: studies evaluating individuals with complete permanent dentition including second molars (P), which compared a group with a certain dentoskeletal variation (E) versus another group without the variation (C), regarding the depth of the COS (O). MEDLINE (via PubMed), Scopus, Web of Science, The Cochrane Library, LILACS and BBO (via Virtual Health Library), OpenGrey, and Google Scholar were searched up to September 2021 to identify eligible reports. DATA COLLECTION AND ANALYSIS: Duplicates were removed from all the records retrieved. The selection process and data collection were performed independently by two review members. The risk of bias was also assessed independently and in duplicate, using the guideline described by Fowkes and Fulton. Several meta-analyses (α = 0.05) were conducted to estimate the mean differences (MD) or standardized mean differences (SMD) in the depth of COS between individuals presenting or not certain dentoskeletal characteristics. The certainty of evidence was assessed using the GRADE tool. RESULTS: Thirty-five studies were selected for qualitative synthesis, and 29 of them for quantitative synthesis. All studies had methodological limitations that affected the risk of bias and increased the likelihood that results were due to chance. Syntheses showed that Class II malocclusion (SMD = 0.87; 95% CI: 0.61, 1.13; P < 0.00001; six datasets including 260 subjects analysed), Class II division 1 (SMD = 1.09; 95% CI: 0.62, 1.56; P < 0.00001; 14 datasets including 823 subjects analysed) and Class II division 2 (SMD = 2.65; 95% CI: 1.51, 3.79; P < 0.00001; eight datasets including 476 subjects analysed) had deeper COS than Class I malocclusion. The skeletal Class II also presented higher COS values than skeletal Class I (SMD = 0.57; 95% CI: 0.02, 1.12; P = 0.04; four datasets including 299 subjects analysed). Individuals with Class III malocclusion had flatter COS than the subjects having Class I malocclusion (SMD = -0.57; 95% CI: -1.07, -0.08; P = 0.02; nine datasets including 505 individuals analysed). No difference was shown in the COS depth between skeletal Class III and Class I (P > 0.05). Deep bite individuals had higher COS depth than those with normal overbite (MD = 0.61; 95% CI: 0.41, 0.82; P < 0.00001; two datasets including 250 subjects analysed). In addition, hypodivergent individuals presented deeper COS than normodivergents (SMD = 0.62; 95% CI: 0.37, 0.86; P < 0.00001; six datasets including 305 subjects analysed), and there was no significant difference in the COS depth between hyperdivergent and normodivergent individuals (P = 0.66). The certainty of evidence was rated as very low for all the syntheses. LIMITATIONS: All the quantitative syntheses included results from studies with methodological flaws. Therefore, they are potentially biased. Moreover, the evidence was also mainly affected in terms of the inconsistency of the results and the imprecision of the estimates. CONCLUSIONS: Although an apparent influence of dentoskeletal Class II, Class III malocclusion, deep bite, and the hypodivergent skeletal pattern on the depth of the COS is suggested, it is not possible to make definitive conclusions on the matter due to the very low certainty of the evidence. Further high-quality research is necessary.

A world panorama of bruxism in children and adolescents with emphasis on associated sleep features: A bibliometric analysis.

BACKGROUND AND OBJECTIVES: To present a world panorama of the published papers on bruxism in children and adolescents, emphasising the characteristics of studies related to the sleep features of these patients. METHODS: Literature searches were conducted in six databases without language or date restrictions. Data on the titles, types of study, main subjects, countries of origin, keywords, years of publication, authors and their network collaborations, journals and sleep studies were extracted and analysed using VantagePoint™ software. RESULTS: A total of 725 studies met the eligibility criteria. Most included only children (75.31%), with observational design (66.34%), and risk or aetiology (53.93%) as the main subject. Brazil (18.06%) and Brazilian authors (54.84%) had the largest number of studies, with a low amount of network collaboration. The Journal of Oral Rehabilitation published most of the studies (6.2%); publications in this field have grown considerably from 2000 to 2020. Of the studies, 123 (16.96%) included sleep studies; night sweating, restless sleep, sleep talking, mouth breathing, snoring, obstructive sleep apnoea syndrome, sleep-disordered breathing, nightmares, poor sleep quality and duration, and daytime naps were significantly associated with bruxism in most. CONCLUSION: Studies on bruxism in children and adolescents have increased in the past 20 years, with most being observational, and risk or aetiology as the main subject. Brazil and the Journal of Oral Rehabilitation have published most in the field. Sleep studies have shown some features associated with bruxism, such as night sweating, restless sleep, somniloquy, snoring, breathing problems, nightmares, daytime naps, and poor sleep quality and duration.

Does the application of an adhesive layer improve the bond strength of etched and silanized glass-ceramics to resin-based materials? A systematic review and meta-analysis.

STATEMENT OF PROBLEM: A consensus on whether to use an adhesive layer on glass-ceramics after etching with hydrofluoric acid and applying a silane-coupling agent is lacking. PURPOSE: The purpose of this systematic review and meta-analysis was to determine whether adhesive layer application after etching and silanization influences the bond strength values of glass-ceramics to resin-based materials. MATERIAL AND METHODS: PubMed, ISI Web of Science, and Scopus electronic databases were searched to select in vitro studies comparing bond strength values of etched and silanized glass-ceramics bonded with or without an adhesive layer. No publication year or language restriction was applied. Data sets were extracted, and the mean differences were applied by using the Rev Man 5.3 program. The association between bond strength (shear/microshear or tensile/microtensile) and an adhesive layer application on nonaged and aged specimens was analyzed. RESULTS: Of 4727 potentially eligible studies, 54 were selected for full-text analysis, and 15 were included for qualitative synthesis; of these, 14 were used in the meta-analysis. A total of 2 meta-analyses were performed with heterogeneity varying from high to moderate among study specimens. For shear/microshear studies, both nonaged (MD, 1.36 [95% CI: -0.18, 2.90], P=.080, I2=79%) and aged (MD, 0.89 [95% CI: -1.04, 2.82], P=.370, I2=80%) specimens presented no statistically significant difference between groups bonded with or without an adhesive layer application. For microtensile studies, both nonaged (MD, -1.49 [95% CI: -2.48, -0.50], P=.003, I2=88%) and aged (MD, -3.87 [95% CI: -5.63, -2.11], P<.001, I2=97%) specimens exhibited higher values without an adhesive application. CONCLUSIONS: Regardless of the bond strength test used, an adhesive layer application did not improve the bond strength of etched and silanized glass-ceramics to resin-based materials. The influence of this adhesive layer application should be evaluated under clinical conditions.

Is there evidence for the use of lesion sterilization and tissue repair therapy in the endodontic treatment of primary teeth? A systematic review and meta-analyses.

OBJECTIVE: To assess whether lesion sterilization and tissue repair (LSTR) technique resulted in similar clinical and radiographic success outcomes as compared with pulpectomy in primary teeth. MATERIALS AND METHODS: Randomized clinical trials comparing LSTR with pulpectomy by means of clinical and radiographic parameters were included. Risk of bias was assessed using Cochrane methodology and the certainty of evidence was determined by GRADE. RESULTS: Six articles were included. Conventional pulpectomy was favored with respect to radiographic success frequency in the systematic review. Four studies were included in meta-analyses. Based on the clinical results at 6 months (RR = 0.99, 95% CI, 0.94-1.04, p = 0.67; I2 = 0%), 12 months (RR = 0.97, 95% CI, 0.90-1.04, p = 0.34; I2 = 0%), and 18 months (RR = 0.89, 95% CI, 0.77-1.04, p = 0.14; I2 = 0%) and radiographic findings at 6 months (RR = 0.91, 95% CI, 0.78-1.06, p = 0.23; I2 = 9%), 12 months (RR = 0.87, 95% CI, 0.65-1.18, p = 0.38; I2 = 64%), and 18 months (RR = 0.84, 95% CI, 0.69-1.02, p = 0.08; I2 = 0%), there was no difference observed regarding success between the two treatments. The quality of evidence ranged from moderate to very low. CONCLUSIONS: No difference between the LSTR and pulpectomy approaches could be confirmed by meta-analyses. The quality of evidence according to the GRADE scheme ranged from moderate to very low. CLINICAL RELEVANCE: The present meta-analyses could not demonstrate the superiority of one treatment over the other.

Aesthetic perception, acceptability and satisfaction in the treatment of caries lesions with silver diamine fluoride: A scoping review.

BACKGROUND: Silver diamine fluoride (SDF) causes dental black staining after its application. AIM: Evaluate the aesthetic perception, acceptability, and/or satisfaction of patients, parents, and professionals to the treatment of caries lesions with SDF through a scoping review. DESIGN: A search was performed in seven databases and two key journals with no language or date restrictions. Studies that evaluated the aesthetic perception, satisfaction, and/or acceptability of patients, parents, and professionals to the treatment of carious lesions with SDF were considered eligible. RESULTS: From a total of 1177 articles, 10 studies were full text assessed for eligibility, with nine included in this scoping review. In general, the studies varied by population, study design, and methodologic evaluation. The type of tooth (anterior or posterior), family income, parental schooling, ethnicity, and need for advanced behaviour control methods were factors that influenced the results. The acceptability level increased as the child required more advanced methods of behaviour guidance. In general, the pigmentation caused by SDF did not interfere with the parents' acceptability of the treatment; however, professionals believe that this could have influence. Regarding satisfaction, pigmentation did not influence parental satisfaction. CONCLUSION: Parents were satisfied with and found SDF acceptable, whereas professionals did not.

Does flavoured dentifrice increase fluoride intake compared with regular toothpaste in children? A systematic review and meta-analysis.

BACKGROUND: Toothpaste manufacturers encourage through aggressive marketing strategies the overconsumption of fluoridated dentifrices. There are conflicting results regarding fluoride intake from toothpastes in children. AIM: The aim of this systematic review and meta-analysis was to determine whether dentifrice flavour increases fluoride ingestion by children. DESIGN: We included clinical trials on children that evaluated the use of flavoured dentifrice - FD vs regular dentifrice - RD to identify the fluoride intake. An electronic search was performed in PubMed, Web of Science, Scopus, The Cochrane Library, LILACS/BBO, and grey literature followed by manual search. The methodological quality of the studies was assessed using the Cochrane Collaboration common scheme for bias and ROBINS-I tool. Data were analysed in subgroups such as low (G1) and ordinary (G2) fluoride concentrations of dentifrices. We carried out heterogeneity and sensitive analyses. RESULTS: For G1, the fluoride intake from RD was significantly higher than from FD [standardised mean difference = -2.57 (-3.26, -1.89), P < 0.00001]. For G2, the fluoride ingestion from RD was significantly higher than from FD [mean difference = -0.00 (-0.00, -0.00), P = 0.02]. CONCLUSIONS: There is evidence to support the null hypothesis that flavouring from dentifrice does not increase fluoride intake in young children.

Is caries a risk factor for dental trauma? A systematic review and meta-analysis.

BACKGROUND/AIM: The association between trauma and caries is still controversial in the literature. The aim of this study was to evaluate the possible association between caries and dental trauma through a systematic review with meta-analysis. DESIGN: A systematic literature search was performed in PubMed, Lilacs, BBO, Scopus, Web of Science, Cochrane Library, and Open Grey databases. The MeSH terms used were 'Tooth injuries', 'Tooth fractures', 'Tooth avulsion', 'Tooth movement'; 'Dental caries'; 'DMF index'; and 'Tooth demineralization'. MeSH synonyms, related terms, and free terms were included. The inclusion criteria comprised clinical investigations of subjects with and without caries that had suffered dental trauma. Quality assessment and bias control were carried out. Meta-analysis was performed using the comprehensive meta-analysis software (version 3.2). Heterogeneity was assessed using the I2 index, and the odds ratio was also calculated (P < 0.05). RESULTS: From 1290 abstracts, seven met the inclusion criteria. All studies had high methodological quality and five were included in the meta-analysis. The results demonstrated a positive association (P < 0.001) between dental trauma and dental caries in permanent teeth [OR: 1.490, 95%, CI: 1.209-1.835]. However, for children with primary teeth, the results showed a negative association (P = 0.006) between dental trauma and caries [OR: 0.706, 95%, CI: 0.550-0.906]. CONCLUSIONS: The results demonstrated positive and negative association between the presence of caries and dental trauma in permanent and primary teeth, respectively.

Does Smear Layer Removal Influence Root Canal Therapy Outcome? A Systematic Review.

OBJECTIVE: The aim of this systematic review was to determine whether the smear layer (SL) removal procedure influences the outcome of root canal treatment. STUDY DESIGN: We performed a search on Pubmed, Scopus, ISI Web of Science, Cochrane Library, Lilacs and SIGLE. We included randomized controlled clinical trials (RCT), with clinical and radiographic outcomes, conducted on subjects who had undergone root canal therapy. The protocol differed only in the SL removal or maintenance procedure. We evaluated the papers for risk of bias according to the Cochrane assessment tool. RESULTS: A total of 1,983 articles were found, after removal of duplicates, 892 remained. We included two studies in this review. One study revealed a low risk of bias and a high success rate for the SL removal group compared to the non SL removal group (P = 0.04), while the other study had a high risk of bias and found no difference between the SL removal and non SL removal groups (P = 1.00). CONCLUSION: We concluded that the SL removal for root canal treatment of primary teeth with initial clinical signs and symptoms or pulpal necrotic status, could benefit the outcome, although further RCT should be performed to achieve evidence.

Does trauma in the primary dentition cause sequelae in permanent successors? A systematic review.

This systematic review sought scientific evidence (in the literature) that trauma in the primary incisors cause sequelae in permanent successors. Also this work verified whether there was a relation between the presence and type of sequelae in permanent teeth with the child's age at the time of injury and type of trauma. Electronic databases, including the PubMed, Scopus, The Cochrane Library, LILACS, and Web of Science were used to search for original articles up to June 2013. Prospective and retrospective studies that assessed the association of trauma in deciduous incisors and developmental disturbances in permanent successors were selected. Two authors independently reviewed and extracted the data from the included studies. A methodological quality assessment evaluation of the selected studies was performed. The search retrieved 258 citations. Initially, 19 studies fulfilled the selection criteria; however, one (1) was excluded, leaving 18 for the final selection. Despite some limitations in the study designs were observed, especially the lack of a control group in most studies, the evidence found suggests that individuals with trauma in their primary incisors have more developmental disorders in the permanent successors than individuals without a previous trauma. Furthermore, the younger the child is at the time of injury, the more frequent and more severe are the sequelae to the permanent successor incisors. More severe traumas such as intrusion and avulsion are associated to more serious developmental disorders. These results should be analyzed carefully because very few studies evaluated had a control group.

Do patients with molar incisor hypomineralization have more dental anxiety and behavior management problems? A systematic review with meta-analysis.

This systematic review evaluated the available evidence on whether children with molar incisor hypomineralization (MIH) have more dental fear and anxiety (DFA) and dental behavior management problems (DBMPs) than those without MIH (Prospero CDR42020203851). Unrestricted searches were performed in PubMed, Scopus, Web of Science, Lilacs, BBO, Embase, Cochrane Library, APA PsycINFO, Open Grey, and Google Scholar. Observational studies evaluating DFA and/or DBMPs in patients with and without MIH were eligible. Reviews, case reports, interventional studies, and those based on questionnaires to dentists were excluded. The methodological quality assessment was based on the Newcastle-Ottawa Scale. Random-effects meta-analyses were conducted to synthesize data on DFA. The certainty of evidence was performed according to GRADE. Seven studies that evaluated a total of 3,805 patients were included. All of them presented methodological issues, mainly in the comparability domain. Most studies observed no significant difference in DFA between children with and without MIH. The meta-analysis did not show a significant effect of MIH on the standardized units for the DFA scores (SMD = 0.03; 95%CI: -0.06-0.12; p = 0.53; I2 = 0%). Synthesis including only the results for severe cases of MIH also did not show a significant effect of the condition on DFA scores (MD = 8.68; 95%CI: -8.64-26.00; p = 0.33; I2 = 93%). Two articles found DBMPs were significantly more frequent in patients with MIH. The overall certainty of evidence was very low for both outcomes assessed. The current evidence suggests no difference in DFA between children with and without MIH; DBMPs are more common in patients with MIH. This information should be viewed with caution because of the very low quality evidence obtained.

Knowledge of health professionals about breastfeeding and factors that lead the weaning: a scoping review.

This review evaluated the knowledge of health professionals (HP) about breastfeeding and factors that leading the weaning. A search was performed in four electronics databases and the grey literature. The search strategy included Mesh terms and synonyms. No language or date restrictions were adopted. Studies that evaluated the knowledge of HP about breastfeeding and weaning were considered eligible. The studies retrieved by the searches were evaluated by two independently examiners. From 1,417 studies retrieved, 35 were included. Many countries and professionals from different health areas were analyzed. No studies evaluated the dentists' knowledge. Although the included HP know the benefits of breastfeeding for health, the length of breastfeeding recommended by the World Health Organization, exclusive or not, was not aligned with all professionals' endorsement. Information about weaning is scarce; however, HP are mindful of the main potential causes of early weaning. The knowledge of HP is conflicting about breastfeeding and unusual about weaning. Furthermore, no studies were found that presented data on the knowledge of dentists on the subject. Thus, assessments of dentists' knowledge and education measures for HP are necessary since they are frequently questioned about these issues.

Clinical parameters in soft tissue adjunctive periodontal procedures for orthodontic patients: surgical laser vs scalpel.

OBJECTIVES: To systematically review existing literature regarding clinical parameters comparing surgical laser and conventional surgery with scalpel for soft tissue adjunctive periodontal procedures in orthodontic patients. METHODS AND MATERIALS: MEDLINE, Scopus, Web of Science, The Cochrane Library, LILACS, Bibliografia Brasileira de Odontologia (Brazilian Dental Literature - BBO), Embase, Open Grey, Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Coordination for the Improvement of Higher Education Personnel - CAPES), and Google Scholar were searched up to December 2020 without language restriction. Clinical trials comparing clinical parameters from surgical laser and conventional surgery with scalpel for soft tissue adjunctive periodontal procedures in orthodontic patients were selected. Risk of bias (RoB) assessments were performed using the Cochrane RoB2 tool. Narrative syntheses were performed, and the certainty of evidence was determined using the GRADE tool. RESULTS: Five randomized clinical trials were included. One study was rated as low RoB, whereas others presented some concerns or high RoB. The studies were highly heterogeneous in relation to the procedure performed, laser protocol, outcomes evaluated, and follow-up periods. In general, regardless of the procedure and laser protocol used, the studies did not show significant differences between laser and scalpel for the outcomes of probing pocket depth, clinical crown length, gingival index, and relapse rate. Pain and bleeding were significantly lower with the use of laser compared with the scalpel. The certainty of evidence ranged from moderate to very low. CONCLUSIONS: The existing literature on the subject is scarce and very heterogeneous and has methodological limitations. Based on the available evidence, it is not possible to draw definitive conclusions about the beneficial effect of laser use in orthodontic patients.

Oral manifestations arising from oral piercings: A systematic review and meta-analyses.

OBJECTIVE: The aim of this study was to perform a systematic review of oral manifestations arising from oral piercings. STUDY DESIGN: Literature was searched through January 2022 in PubMed, Scopus, Embase, Web of Science, Cochrane Library and Virtual Health Library, OpenGrey, and Google Scholar to address the question, "Is there an association between oral piercings and oral alterations, complications, or lesions?" Quality was assessed using the Joanna Briggs Institute appraisal tools. Meta-analyses were performed, and certainty of evidence was assessed through Grading of Recommendations Assessment, Development and Evaluation (GRADE). Reporting followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: Fifty-four studies were included, with 15 achieving good methodological quality. Periodontal and tooth damage were the most reported, followed by soft tissue/mucosal injuries, speech disorders, chewing, soft plaque, and saliva. Pain was the most reported complication, followed by infection, swelling, bleeding, inflammation, allergy, and adornment aspiration. Meta-analyses revealed that 33% of participants with piercings had gingival recession (GR) (event rate [ER] = 0.329). In participants with piercings, ER values for nonspecified dental damage (NSDD), tooth chipping, wear/abrasion, and dental fracture (DF) were 27% (ER = 0.270), 22% (ER = 0.219), 34% (ER = 0.344), and 34% (ER = 0.338), respectively. Certainty of evidence was very low. CONCLUSIONS: Alterations, complications, and lesions were associated with oral piercings and adornments, of which GR, DF, and NSDD were the most prevalent.

Efficacy of treatments used to relieve signs and symptoms associated with teething: a systematic review.

The purpose of this review was to systematically evaluate all the existing literature on the efficacy of treatments used to relieve the signs and symptoms associated with teething. A systematic search up to February 2021, without restrictions on language or date of publication, was carried out in MEDLINE/PubMed, SCOPUS, Web of Science, The Cochrane Library, EMBASE, LILACS, BBO, OpenGrey, Google Scholar, Portal de Periódicos da CAPES, clinicaltrials.gov, and the references of the included studies. Clinical studies that evaluated the effect of any intervention to alleviate the signs and symptoms associated with teething in babies and children were included. The risk of bias was assessed using the ROB-2 and ROBINS-I tools. The characteristics and results of the individual studies were extracted and synthesized narratively. The GRADE approach was followed to rate the certainty of the evidence. Three randomized and two non-randomized clinical trials were included. The outcomes of these five articles were classified as high or serious risk of bias. Three studies using homeopathy reported improvement in appetite disorders, gum discomfort, and excess salivation. One study showed a new gel with hyaluronic acid was more effective than an anesthetic gel in improving signs and symptoms such as pain, gingival redness, and poor sleep quality. Another study applied non-pharmacological treatments, which were more effective, especially against excess salivation. Although the present systematic review suggests some therapies could have a favorable effect on signs and symptoms related to teething, definitive conclusions on their efficacy cannot be drawn because of the very low certainty of the evidence. The existing literature on the subject is scarce and heterogeneous and has methodological flaws; therefore, further high-quality investigations are necessary.

Associations and risk factors for dental trauma: A systematic review of systematic reviews.

OBJECTIVE: We sought to revise, qualify and summarize the body of evidence based on current information on the known associations and risk factors for traumatic dental injury (TDI) occurrence with an overview of systematic reviews. METHODS: Electronic searches were performed with no language nor date restrictions.According to the PECO strategy, systematic reviews that investigated participants (P) with (E) and without (O) the presentation of factors relating to TDI and these factors' association with TDI episodes (O) as primary or secondary outcomes were included. Quality assessment and bias control were carried out according to the AMSTAR 2 checklist. In cases of systematic review results of discordance, the Jadad decision algorithm was applied. RESULTS: After titles, abstracts and full texts were read, 19 systematic reviews were included in this overview. Four were classified with critically low, eleven with low and four with moderate methodological quality, respectively. In all studies, 249 cross-sectional, 34 epidemiological surveys, 22 cohort, 9 case-control, 4 longitudinal, 3 ecological and 30 unspecified studies were included. Male gender, child age, greater overjet, inadequate lip coverage, anterior open bite, caries in the permanent dentition, overweight, a previous history of TDI, tongue piercing, the use of alcoholic beverages and participation in sports were all associated with a greater chance of suffering TDI. CONCLUSIONS: Sociodemographic, clinical and environmental factors are associated with a greater chance of TDI occurrence. However, most of the systematic reviews included were of a low quality and may not provide an accurate and comprehensive summary of the available research that addresses the question of interest. Well-designed primary studies on different aspects of TDI are encouraged to provide higher quality scientific evidence.

Does Calcium Hydroxide Reduce Endotoxins in Infected Root Canals? Systematic Review and Meta-analysis.

INTRODUCTION: The purpose of this study was to evaluate the potential of endotoxin reduction by comparing the number of lipopolysaccharides (LPSs) before and after the use of calcium hydroxide (Ca[OH]2) as intracanal medication (ICM). METHODS: Searches were performed up to June 2020. Clinical and experimental studies comparing the amount of LPSs before and after the use of Ca(OH)2 as ICM in infected root canals were included. Risks of bias assessment and data extraction were performed. Meta-analysis was conducted by subgrouping according to Ca(OH)2, the presence of an antimicrobial substance (AS), irrigant solution during chemomechanical preparation (CMP), and the incidence of LPS reduction. The certainty of evidence was determined by the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Nine studies were included in the qualitative synthesis and 7 in the meta-analysis. Three articles had low risk of bias (RB), 1 had moderate RB, 2 had high RB, and 3 "some concerns." Overall, Ca(OH)2, with or without AS, reduced mean LPSs before CMP (standardized mean difference [SMD] = -1.087 [confidence interval {CI}, -1.453 to -0.721], P < .001, I2 = 58.7%) and after CMP (SMD = -0.919 [CI, -1.156 to -0.682], P < .001, I2 = 24.7%). Considering the irrigant solutions, the overall results showed a reduction before (SMD = -1.053 [CI, -1.311 to -0.795], P < .001, I2 = 58.7%) and after CMP (SMD = -0.938 [CI, -1.147 to -0.729], P < .001, I2 = 24,6%). Analyses presented very low certainty of evidence. The incidence of LPS reduction was 98.9% and 61.7% for Ca(OH)2 with and without AS, respectively. CONCLUSIONS: Ca(OH)2 reduces endotoxin levels when used as ICM but is unable to eliminate LPSs completely independent of the irrigating solution used with very low certainty of evidence.

Protective effect of fluorides on erosion and erosion/abrasion in enamel: a systematic review and meta-analysis of randomized in situ trials.

OBJECTIVES: To evaluate the effects of different fluoride types and vehicles when compared to water or placebo, on prevention of enamel erosion and erosive tooth wear progression. DESIGN: A systematic review followed by meta-analysis of randomized in situ trials was conducted. PubMeb, Scopus, Web of Science, LILACS, BBO, Scielo, EMBASE and CENTRAL electronic databases were searched. Studies with fluoride compounds (NaF, AmF, Sn, TiF4) and vehicles (toothpaste, mouth rinse, gel, and varnishes) compared to control (water or placebo) for control of enamel loss progression were included. Reviewers independently screened potentially eligible articles, extracted data, and assessed risk of bias. GRADE approach was used to rate the overall certainty of evidence for toothpastes and rinses under erosive/abrasive challenges. RESULTS: Thirty-two studies were elegible. Under erosive/abrasive challenges, enamel loss was significantly lower than control for NaF toothpastes [Mean difference(MD) -1.14; Confidence Interval(CI) -1.89 to -0.40] and Sn/associations [-6.02; -11.09 to -0.95], while no difference was found for AmF [-13.59; -39.7 to -12.52]. For mouth rinses, Sn/associations solutions were effective [-11.49; -16.62 to -6.37], but NaF showed no significant effect [-2.83; -8.04 to 2.38]. CONCLUSION: Overall, fluoride products are able to reduce enamel loss when compared to control, but results must be interpreted with caution. For toothpastes, NaF provided limited protection, with moderate evidence, while Sn/associations exhibited protective effect with low certainty of evidence. For rinses, NaF was not effective, with very low evidence, while the stannnous enriched fluorides offered higher protection regarding enamel erosion and erosive wear, with moderate certainty of evidence.

Is there a relationship between malocclusion and bullying? A systematic review.

BACKGROUND: Malocclusion is a highly prevalent public health problem, and several studies have shown its negative correlation with quality of life, self-esteem, and social perceptions. However, its association with bullying is still controversial. OBJECTIVES: To evaluate the relationship between malocclusion and bullying in children and adolescents. SEARCH METHODS: The databases used for the electronic researches were PubMed, Scopus, Lilacs/BBO, Web of Science, and Cochrane Library. Grey literature was reviewed through Open Grey literature with no language or date restrictions. Selection criteria, based on the PECO strategy, were considered eligible observational studies that included schoolchildren or adolescents (P) with malocclusion (E), compared to those with normal occlusion (C), in which the relationship between malocclusion and bullying was determined (O). DATA COLLECTION AND ANALYSIS: Risk of bias evaluation was made for the qualitative synthesis by the Fowkes and Fulton criteria. Data regarding the age of participants and types of malocclusion and of bullying were extracted among other reported data. The quality of the evidence analyzed was evaluated through the GRADE approach. RESULTS: From 2744 articles identified in databases, nine met the eligibility criteria and were included in present systematic review, of which two studies were judged with methodological soundness. The quality of the evidence was classified as very low due to very serious problems for "risk of bias" and "other considerations" and serious problems of "indirectness". The age of participants ranged from 9 to 34 years considering a cohort study, with a bullying recalling perspective. Malocclusion was both evaluated by researchers and self-reported by participants addressing dentofacial characteristics mostly related to the incisors relationship. All studies evaluated the verbal type of bullying, while 3 also considered physical type. Both types were reported as related to malocclusion, although the results showed that extreme maxillary overjet (> 4 mm, > 6 mm, > 9 mm), extreme deep overbite, and having space between anterior teeth or missing teeth were the types of malocclusion with the strongest relations to bullying. CONCLUSIONS: With very low certainty of evidence, the results of this systematic review suggest that conspicuous extreme malocclusion may be related to the occurrence of bullying among children and adolescents.

Duration of effectiveness of Botulinum toxin type A in excessive gingival display: a systematic review and meta-analysis.

Botulinum toxin type A is effective in reducing excessive gingival display caused by hyperfunctional upper lip elevator muscles; however, this effect is transient. This study aimed to determine the duration of the effectiveness of botulinum toxin type A on a gummy smile. A systematic search was conducted using Medline (PubMed), Scopus, and Web of Science electronic databases, from 1970 to March 2017 with no language restriction; the search included studies evaluating adult patients with excessive gingival display who were treated with botulinum toxin and were followed-up for at least 3 months. OpenGrey and Clinical Trial Registry were also consulted. Quality assessment was applied to determine the level of evidence and bias, and a meta-analysis was performed. Of 2181 full texts, 71 were obtained, with 3 prospective studies meeting the selection criteria. The gingival display was significantly reduced to baseline with 2, 4, and 8 weeks of treatment. The gingival display considerably reduced at the baseline-2-week comparison (-4.44 mm using raw data and-4.05 mm using the standard difference) and increased throughout the weeks of follow-up. There is scant evidence to determine the duration of the effectiveness of toxin type A on a gummy smile. The effect tends to be stable until at least 8 weeks of follow-up, and the gingival exposure may not return to baseline within 12 weeks of follow-up. Well-designed randomized clinical trials with a minimum of 6 months of follow-up are necessary to strengthen the evidence.