A Systematic Review and Meta-Analysis of the Clinical Outcomes for Adjunctive Physical, Chemical, and Biological Treatment of Dental Implants With Peri-Implantitis.

The present systematic review evaluated the efficacy of adjunctive therapies in the treatment of peri-implantitis. Studies comparing the outcome of conventional surgical- or nonsurgical mechanical debridement with the addition of an adjunctive therapeutic modality were identified through an electronic and hand search of available literature. Following data extraction, meta-analyses were performed on the primary outcome measures. The effects of the adjunctive therapies on bleeding on probing (13 studies), probing pocket depth (9 studies), and radiographic bone level changes (7 studies) were analyzed to evaluate potential clinical benefit. Heterogeneity was expressed as the I2 index. Fixed and random effect models were demonstrated. The potential benefit of adjunctive therapies over control procedures was evaluated in 18 studies, representing a total of 773 implants. Quality assessment of the studies found only 3 studies to be at a low risk of bias. Meta-analysis among the different additional modalities revealed chemical therapy demonstrating significant effects in probing pocket depth reduction (0.58 mm; 0.44-0.72) and radiographic bone level gain (0.54 mm; 0.16-0.92). No significant improvements in bleeding on probing reduction were found using any adjunctive therapy. Available evidence on the benefits of adjunctive therapy to nonsurgical or surgical mechanical debridement in the treatment of peri-implantitis is limited by low numbers of standardized, controlled studies for individual therapies, heterogeneity between studies, and a variety of outcome measures. The lack of effect of any adjunctive therapy in reducing bleeding on probing questions the overall effectiveness over conventional treatment. The long-term clinical benefit potential of these therapies is not demonstrated.

Sleep health primary care clinical resource.

BACKGROUND: Obstructive sleep apnoea (OSA) and insomnia are the two most common sleep disorders and are frequent reasons for presentation in Australian general practice. OBJECTIVE: This article describes the development, content and suggested uses of the online sleep health primary care clinical resource, which provides general practitioners and other primary healthcare professionals with evidence-based information on the aetiology, assessment, management, referral and ongoing care for OSA and chronic insomnia. DISCUSSION: The Royal Australian College of General Practitioners-accepted clinical resource for the management of OSA and chronic insomnia in primary care was developed by the Australian National Centre for Sleep Health Services Research. The resource is designed to be used during consultations (eg following the steps in assessment and management and the use of online questionnaires for the assessment of OSA [Epworth Sleepiness Scale/OSA50/STOP-Bang] and insomnia [Sleep Condition Indicator/and Insomnia Severity Index]) and as an education/training tool (eg evidence on the role of continuous positive airway pressure/mandibular advancement splints for management of OSA and brief behavioural therapy for insomnia/cognitive behavioural therapy for insomnia for the management of insomnia).

One Month Dosing of Atomoxetine plus Oxybutynin in Obstructive Sleep Apnea: A Randomized, Placebo-controlled Trial.

Rationale: The combination of noradrenergic and antimuscarinic agents has recently been shown to improve upper-airway function and reduce obstructive sleep apnea (OSA) severity in short-term (⩽1 wk) proof-of-concept studies. Objectives: To determine the safety, tolerability, and potential efficacy of longer term use of different doses of the noradrenergic agent atomoxetine combined with the antimuscarinic oxybutynin (ato-oxy). Methods: Thirty-nine people with predominantly severe OSA received 80/5 mg ato-oxy, 40/5 mg ato-oxy, 40/2.5 mg ato-oxy, or placebo nightly for 30 days in a double-blind, randomized, parallel design. Participants completed three in-laboratory sleep studies (baseline, Night 1, and Night 30) to assess efficacy. Vital signs and objective measures of alertness and memory were assessed. In men, potential effects on prostate function were assessed using the International Prostate Symptom Score at baseline and Night 30. Potential adverse events were assessed during in-laboratory visits and via weekly phone calls. Results: Side effects were generally mild and consistent with known side-effect profiles of each individual drug (i.e., dose-dependent increases in dry mouth with oxybutynin). Heart rate increased by Night 30 in two active drug arms (mean ± standard deviation 8 ± 10 beats/min [P = 0.01] with 80/5 mg and 9 ± 14 beats/min [P = 0.02] with 40/2.5 mg vs. placebo). No clinically relevant changes in blood pressure, International Prostate Symptom Score, and measures of alertness and memory were observed between conditions. Apnea-hypopnea index (AHI) with 4% oxygen desaturation and hypoxic burden decreased by ∼50% with 80/5 mg ato-oxy from baseline but not versus placebo (e.g., AHI with 3% oxygen desaturation and AHI with 4% oxygen desaturation difference at Night 30 was -8.2 [95% confidence interval, -22.5 to 6.2] and -8.5 [95% confidence interval, -18.3 to 1.3] events/h, respectively). Conclusions: One month of nightly noradrenergic and antimuscarinic combination therapy was generally well tolerated, with a side-effect profile consistent with each agent alone, and was associated with an ∼50% reduction from baseline in a key OSA severity metric, the hypoxic burden with the highest dose combination. These findings highlight the potential to target noradrenergic and antimuscarinic mechanisms for OSA pharmacotherapy development. Clinical trial registered with www.anzctr.org.au (ACTRN 12619001153101).

Is there clinical evidence to support alveolar ridge preservation over extraction alone? A review of recent literature and case reports of late graft failure.

Since its introduction in 1998, alveolar ridge preservation has become a popular technique, currently accounting for approximately 29% of all procedures involving bone substitute materials. The global cost of bone substitute materials for alveolar ridge preservation is estimated at $190 million annually and is expected to rise by approximately 11.4% per year.Numerous randomised controlled trials have compared alveolar ridge preservation to extraction alone. A recent Cochrane review reported that, in terms of socket dimensional change, the mean difference between alveolar ridge preservation and extraction alone is 1.18 mm horizontally and 1.35 mm vertically. The clinical impact of this is uncertain, for there is no significant difference in the need for graft procedures at implant placement between ridge preservation and extraction alone. There are no randomised controlled trials comparing aesthetic or functional outcomes.A systematic review of the histological outcomes of ridge preservation demonstrates that, compared to extraction alone, many bone substitute materials can significantly delay the bone healing process. No bone substitute material achieves statistically more new bone formation than extraction alone and many commonly used materials achieve significantly less bone formation. Grafted sites can demonstrate high levels of residual graft and granulation tissue.In the absence of good-quality clinical evidence to support alveolar ridge preservation, the technique must be questioned as the treatment of choice at extraction sites. This paper assesses recent systematic reviews and presents two case reports of late graft failure.

BSP implementation of the 2017 classification of periodontal diseases: a practice retrospective.

Introduction The new world classification of periodontal diseases and conditions was developed in 2017. The British Society of Periodontology and Implant Dentistry (BSP) implemented the classification in a series of papers published in the British Dental Journal in January 2019.Aims and objectives This study aimed to investigate if the BSP implementation was workable in general dental practice and to reveal if any lessons were learnt from its regular use two years following its release.Materials and methods This was a cross-sectional, retrospective, non-intervention analysis of a patient population (n = 891) drawn from a complete list of a private dental surgeon. Diagnostic and demographic data were drawn from the patient records, collated and analysed using SPSS Statistics v26.Results Diagnoses derived from the new classification were identified for 92% of subjects, indicating a high level of implementation. In total, 20.9% of subjects were diagnosed with periodontitis, and of these, 57% were unstable, 39% stable and 4% in remission. The mean bleeding on probing score across the cohort was 7.7%. Moreover, 76% of the non-periodontitis patients were diagnosed with 'clinical gingival health', 23% with localised gingivitis and 1% with generalised gingivitis.Conclusion The new classification has been found to be readily implemented in a general practice setting. Use of the new classification allows for close monitoring of periodontal status, and as a result, close monitoring of the effectiveness of pathways of care.

Long-term adherence of human brain cells in vitro is enhanced by charged amine-based plasma polymer coatings.

Advances in cellular reprogramming have radically increased the use of patient-derived cells for neurological research in vitro. However, adherence of human neurons on tissue cultureware is unreliable over the extended periods required for electrophysiological maturation. Adherence issues are particularly prominent for transferable glass coverslips, hindering imaging and electrophysiological assays. Here, we assessed thin-film plasma polymer treatments, polymeric factors, and extracellular matrix coatings for extending the adherence of human neuronal cultures on glass. We find that positive-charged, amine-based plasma polymers improve the adherence of a range of human brain cells. Diaminopropane (DAP) treatment with laminin-based coating optimally supports long-term maturation of fundamental ion channel properties and synaptic activity of human neurons. As proof of concept, we demonstrated that DAP-treated glass is ideal for live imaging, patch-clamping, and optogenetics. A DAP-treated glass surface reduces the technical variability of human neuronal models and enhances electrophysiological maturation, allowing more reliable discoveries of treatments for neurological and psychiatric disorders.

A historical review of additives and modifiers used in paving asphalt refining processes in the United States.

The U.S. asphalt paving industry has evolved over time to meet various performance specifications for liquid petroleum asphalt binder (known as bitumen outside the United States). Additives to liquid petroleum asphalt produced in the refinery may affect exposures to workers in the hot mix paving industry. This investigation documented the changes in the composition and distribution of the liquid petroleum asphalt products produced from petroleum refining in the United States since World War II. This assessment was accomplished by reviewing documents and interviewing individual experts in the industry to identify current and historical practices. Individuals from 18 facilities were surveyed; the number of facilities reporting use of any material within a particular class ranged from none to more than half the respondents. Materials such as products of the process stream, polymers, elastomers, and anti-strip compounds have been added to liquid petroleum asphalt in the United States over the past 50 years, but modification has not been generally consistent by geography or time. Modifications made to liquid petroleum asphalt were made generally to improve performance and were dictated by state specifications.

A review of changes in composition of hot mix asphalt in the United States.

This review researched the materials, methods, and practices in the hot mix asphalt industry that might impact future exposure assessments and epidemiologic research on road paving workers. Since World War II, the U.S. interstate highway system, increased traffic volume, transportation speeds, and vehicle axle loads have necessitated an increase in demand for hot mix asphalt for road construction and maintenance, while requiring a consistent road paving product that meets state-specific physical performance specifications. We reviewed typical practices in hot mix asphalt paving in the United States to understand the extent to which materials are and have been added to hot mix asphalt to meet specifications and how changes in practices and technology could affect evaluation of worker exposures for future research. Historical documents were reviewed, and industry experts from 16 states were interviewed to obtain relevant information on industry practices. Participants from all states reported additive use, with most being less than 2% by weight. Crumb rubber and recycled asphalt pavement were added in concentrations approximately 10% per unit weight of the mix. The most frequently added materials included polymers and anti-stripping agents. Crumb rubber, sulfur, asbestos, roofing shingles, slag, or fly ash have been used in limited amounts for short periods of time or in limited geographic areas. No state reported using coal tar as an additive to hot mix asphalt or as a binder alternative in hot mix pavements for high-volume road construction. Coal tar may be present in recycled asphalt pavement from historical use, which would need to be considered in future exposure assessments of pavers. Changes in hot mix asphalt production and laydown emission control equipment have been universally implemented over time as the technology has become available to reduce potential worker exposures. This work is a companion review to a study undertaken in the petroleum refining sector that investigated current and historical use of additives in producing petroleum-derived asphalt cements.

A novel fast-neutron tomography system based on a plastic scintillator array and a compact D-D neutron generator.

Very few experimental imaging studies using a compact neutron generator have been published, and to the knowledge of the authors none have included tomography results using multiple projection angles. Radiography results with a neutron generator, scintillator screen, and camera can be seen in Bogolubov et al. (2005), Cremer et al. (2012), and Li et al. (2014). Comparable results with a position-sensitive photomultiplier tube can be seen in Popov et al. (2011). One study using an array of individual fast neutron detectors in the context of cargo scanning for security purposes is detailed in Eberhardt et al. (2005). In that case, however, the emphasis was on very large objects with a resolution on the order of 1cm, whereas this study focuses on less massive objects and a finer spatial resolution. In Andersson et al. (2014) three fast neutron counters and a D-T generator were used to perform attenuation measurements of test phantoms. Based on the axisymmetry of the test phantoms, the single-projection information was used to calculate radial attenuation distributions of the object, which was compared with the known geometry. In this paper a fast-neutron tomography system based on an array of individual detectors and a purpose-designed compact D-D neutron generator is presented. Each of the 88 detectors consists of a plastic scintillator read out by two Silicon photomultipliers and a dedicated pulse-processing board. Data acquisition for all channels was handled by four single-board microcontrollers. Details of the individual detector design and testing are elaborated upon. Using the complete array, several fast-neutron images of test phantoms were reconstructed, one of which was compared with results using a Co-60 gamma source. The system was shown to be capable of 2mm resolution, with exposure times on the order of several hours per reconstructed tomogram. Details about these measurements and the analysis of the reconstructed images are given, along with a discussion of the capabilities of the system and its outlook.

Antibiotic prophylaxis for dental treatment after prosthetic joint replacement: exploring the orthopaedic surgeon's opinion.

BACKGROUND: Antibiotic prophylaxis before dental treatment is routinely recommended by orthopaedic surgeons to prevent prosthetic joint infection (PJI). This recommendation is at odds with current guidelines. METHODS: A postal survey of 9 checkbox or short-answer questions was completed by 633 orthopaedic surgeons. RESULTS: The majority of respondents (n = 186 of 260, 72%) believe that antibiotic prophylaxis is required indefinitely for dental treatment. A small number (n = 43, 15%) seek a dentist's opinion before elective joint replacement. The surgeons reported low numbers of PJIs, although 24% (n = 68 of 280) believed that they were associated with dental treatment. CONCLUSIONS: Australian orthopaedic surgeons continue to recommend antibiotic prophylaxis for dental treatment. The recording of PJI in relation to dental procedures into clinical registries would enable the development of consistent guidelines between professional groups responsible for the care of this patient group.

Polyethylene wear after total elbow arthroplasty.

BACKGROUND: Articular wear is considered to be a possible long-term complication of the use of stemmed, coupled elbow replacements with the capacity to correct deformity and restore function. There have been no reports on this topic, to our knowledge. METHODS: A review of the results of 919 replacements with the semi-constrained linked Coonrad-Morrey total elbow implant, performed between 1981 and 2000, revealed that twelve patients (1.3%) had undergone an isolated exchange of the articular bushings as a result of polyethylene wear. The status of these patients was assessed clinically and radiographically. RESULTS: The mean age of the twelve patients at the time of the initial total elbow replacement was forty-four years compared with a mean age of sixty-two years in the overall group (p < 0.001). Seven of the twelve patients had posttraumatic arthritis, and five had rheumatoid arthritis. Nine patients had extensive deformity. The group consisted of seven women and five men, and ten patients had involvement of the right dominant elbow. The mean age at the bushing revision was fifty-two years, and the bushings were revised at an average of 7.9 years after implantation. All twelve patients reported pain, and five reported crepitus or a squeaking sound. None had extensive osteolysis. The mean duration of follow-up after the bushing exchange was sixty-five months. The mean arc of motion improved from 89 degrees before the surgery to 109 degrees after it. Three of the twelve patients underwent an additional articular revision at fifty-three, fifty-four, and 136 months after the initial bushing exchange. At the time of final follow-up, all twelve patients had functioning elbows. CONCLUSIONS: Isolated bushing exchange can be a successful revision procedure in patients with a semi-constrained linked total elbow prosthesis. Younger patients with a posttraumatic condition and/or severe pre-existing deformity are at greater risk for the development of excessive bushing wear. Patients should be cautioned against exceeding the recommended activity and lifting restrictions.

Pharmacokinetics and immunogenicity of a recombinant human butyrylcholinesterase bioscavenger in macaques following intravenous and pulmonary delivery.

Recombinant (r) and native butyrylcholinesterse (BChE) are potent bioscavengers of organophosphates (OPs) such as nerve agents and pesticides and are undergoing development as antidotal treatments for OP-induced toxicity. Because of the lethal properties of such agents, regulatory approval will require extensive testing under the Animal Rule. However, human (Hu) glycoprotein biologicals, such as BChE, present a challenge for assessing immunogenicity and efficacy in heterologous animal models since any immune responses to the small species differences in amino acids or glycans between the host and biologic may alter pharmacodynamics and preclude accurate efficacy testing; possibly underestimating their potential protective value in humans. To establish accurate pharmacokinetic and efficacy data, an homologous animal model has been developed in which native and PEGylated forms of CHO-derived rMaBChE were multiply injected into homologous macaques with no induction of antibody. These now serve as controls for assessing the pharmacokinetics and immunogenicity in macaques of multiple administrations of PEGylated and unmodified human rBChE (rHuBChE) by both intravenous (IV) and pulmonary routes. The results indicate that, except for maximal concentration (Cmax), the pharmacokinetic parameters following IV injection with heterologous PEG-rHuBChE were greatly reduced even after the first injection compared with homologous PEG-rMaBChE. Anti-HuBChE antibody responses were induced in all monkeys after the second and third administrations regardless of the route of delivery; impacting rates of clearance and usually resulting in reduced endogenous MaBChE activity. These data highlight the difficulties inherent in assessing pharmacokinetics and immunogenicity in animal models, but bode well for the efficacy and safety of rHuBChE pretreatments in homologous humans.

Monosodium glutamate intake, dietary patterns and asthma in Chinese adults.

OBJECTIVES: Emerging evidence shows that diet is related to asthma. The aim of this analysis was to investigate the association between monosodium glutamate (MSG) intake, overall dietary patterns and asthma. METHODS: Data from 1486 Chinese men and women who participated in the Jiangsu Nutrition Study (JIN) were analyzed. In this study, MSG intake and dietary patterns were quantitatively assessed in 2002. Information on asthma history was collected during followed-up in 2007. RESULTS: Of the sample, 1.4% reported ever having asthma. MSG intake was not positively associated with asthma. There was a significant positive association between 'traditional' (high loadings on rice, wheat flour, and vegetable) food pattern and asthma. No association between 'macho' (rich in meat and alcohol), 'sweet tooth' (high loadings on cake, milk, and yoghurt) 'vegetable rich' (high loadings on whole grain, fruit, and vegetable) food patterns and asthma was found. Smoking and overweight were not associated with asthma in the sample. CONCLUSION: While a 'Traditional' food pattern was positively associated with asthma among Chinese adults, there was no significant association between MSG intake and asthma.

Reimplantation of a total elbow prosthesis following resection arthroplasty for infection.

BACKGROUND: The best approach for treatment of infection after total elbow arthroplasty is not clearly defined. The purpose of this study was to report our experience with reimplantation of a total elbow prosthesis following a prior resection arthroplasty to treat infection. METHODS: Between 1976 and 2003 at our institution, twenty-nine patients were treated with reimplantation of a total elbow prosthesis after a prior resection arthroplasty following a deep periprosthetic infection. Eleven of the twenty-nine patients had had at least one procedure performed on the elbow prior to the primary arthroplasty. The mean time interval between the resection arthroplasty and the reimplantation was 72.5 weeks. Patients were followed for an average of 7.4 years after the reimplantation. All patients were assessed clinically, and their medical records were retrospectively reviewed. RESULTS: The mean total Mayo Elbow Performance Score (MEPS) was 35.5 points (range, 15 to 60 points) before the reimplantation and 66.3 points (range, 20 to 100 points) postoperatively (p < 0.001). The most common infecting organism was Staphylococcus epidermidis, which was present in thirteen (45%) of the twenty-nine elbows, followed by methicillin-sensitive Staphylococcus aureus, which was present in seven (24%). The infection was not eradicated in eight elbows (28%). CONCLUSIONS: Reimplantation of a total elbow prosthesis after a prior resection arthroplasty is a reasonable option for the treatment of infection. Improvement in function can be expected in most patients. However, the chance of the infection recurring and requiring additional revision surgery is high.

Dose-dependent protection against or exacerbation of disease by a polylactide glycolide microparticle-adsorbed, alphavirus-based measles virus DNA vaccine in rhesus macaques.

Measles remains an important cause of vaccine-preventable child mortality. Development of a low-cost, heat-stable vaccine for infants under the age of 6 months could improve measles control by facilitating delivery at the time of other vaccines and by closing a window of susceptibility prior to immunization at 9 months of age. DNA vaccines hold promise for development, but achieving protective levels of antibody has been difficult and there is an incomplete understanding of protective immunity. In the current study, we evaluated the use of a layered alphavirus DNA/RNA vector encoding measles virus H (SINCP-H) adsorbed onto polylactide glycolide (PLG) microparticles. In mice, antibody and T-cell responses to PLG-formulated DNA were substantially improved compared to those to naked DNA. Rhesus macaques received two doses of PLG/SINCP-H delivered either intramuscularly (0.5 mg) or intradermally (0.5 or 0.1 mg). Antibody and T-cell responses were induced but not sustained. On challenge, the intramuscularly vaccinated monkeys did not develop rashes and had lower viremias than vector-treated control monkeys. Monkeys vaccinated with the same dose intradermally developed rashes and viremia. Monkeys vaccinated intradermally with the low dose developed more severe rashes, with histopathologic evidence of syncytia and intense dermal and epidermal inflammation, eosinophilia, and higher viremia compared to vector-treated control monkeys. Protection after challenge correlated with gamma interferon-producing T cells and with early production of high-avidity antibody that bound wild-type H protein. We conclude that PLG/SINCP-H is most efficacious when delivered intramuscularly but does not provide an advantage over standard DNA vaccines for protection against measles.

Titanium surface modification and its effect on the adherence of Porphyromonas gingivalis: an in vitro study.

AIM: Titanium dental implants are an important treatment option in the replacement of missing teeth. Implant failures can, however, occur and may be promoted by the loss of tissue as a result of local bacterial infection (peri-implantitis). OBJECTIVES: Bacterial adherence to implant surfaces is believed to be influenced by material surface roughness and surface-free energy parameters. Consequently, the aim of this study was to modify these properties of titanium and identify what effect these modifications had on subsequent bacterial adherence. MATERIALS AND METHODS: In this study, 16 titanium samples of different roughness (R(a) 34.57-449.42 nm) were prepared using specific polishing procedures. A further six samples were chemically altered by argon plasma discharge treatment and immersion in silane solutions to produce different surface hydrophobicities. An in vitro adhesion assay using Porphyromonas gingivalis was used to assess the effect of modification on bacterial adherence. RESULTS: A significant reduction in adhesion to materials categorised as being 'very smooth' (R(a) 34.57+/-5.79 nm) was evident. This reduction did not occur with 'smooth' (R(a) 155.00+/-33.36 nm), 'rough' (R(a) 223.24+/-9.86 nm) or 'very rough' (R(a) 449.42+/-32.97 nm) surfaces. Changing material surface hydrophobicity was also not found to effect bacterial adhesion. CONCLUSIONS: Adhesion of P. gingivalis to titanium was inhibited at surface roughness levels below those generally encountered for implant collars/abutments (R(a) 350 nm). Considerations of these findings may be beneficial in the production of titanium implants in order to reduce bacterial colonisation.