Do Antimicrobial Photodynamic Therapy and Low-Level Laser Therapy Influence Oral Health-Related Quality of Life After Molar Extraction?

PURPOSE: Most individuals experience significant deterioration in their oral health-related quality of life (OHRQoL) in the first few days after tooth extraction. This study aimed to evaluate the impact of antimicrobial photodynamic therapy (aPDT) and low-level laser therapy (LLLT) protocols on OHRQoL after extraction of lower molars. METHODS: The investigators designed a double-blind, randomized controlled clinical trial study. Patients with indications for lower molar extraction were included in the study and randomized into four groups: control group, antimicrobial photodynamic therapy group, LLLT group (LLLT.G), and aPDT and LLLT group (aPDT + LLLT.G).The Oral Health Impact Profile (OHIP-14) questionnaire was used through an interview with the participants before the extraction (T0 - baseline) and on the 7th (T1) and 30th (T2) days after extraction. Other variables were age, sex, ethnicity, decayed-missing-filled teeth (DMFT) and tooth types. Appropriate univariate and bivariate statistics were computed, and statistical significance was set at a value P < .05. RESULTS: The sample was composed of 40 patients with a mean age of 41.25 ± 13.97 and 25 (62.5%) were women. The mean OHIP-14 scores were significantly different in the intervals at T0 versus T1 and T0 versus T2 for all domains (P < .001), demonstrating a positive impact on the OHRQoL. The total scores indicated a significant improvement in the OHRQoL in the aPDT (7.10, standard deviation 4.18, P = .043), LLLT (6.40, SD 5.87, P = .025), and aPDT + LLLT (5.30, SD 3.59, P = .012) groups compared to that in the control group (12.90, SD 6.64) at T1. Patients undergoing extraction of lower mandibular molars with aPDT + LLLT had the lowest mean OHIP-14 total score at T1 (5.30) and T2 (0.70). CONCLUSION: The aPDT and LLLT protocols had a positive impact on the participants' OHRQoL. These procedures can be applied in everyday surgical practice.

Genetic polymorphism in the tumour necrosis factor alpha gene (G-308A) is associated with persistent apical periodontitis in Brazilians.

AIM: To investigate if there was an association between genetic polymorphisms in tumour necrosis factor (TNF)-⍺ and its receptors TNFRSF1A and TNFRSF1B with persistent apical periodontitis (PAP) in Brazilian subjects. METHODOLOGY: Patients who had pulpal necrosis and apical periodontitis at the time of treatment, with at least 1-year of follow-up after non-surgical root canal treatment were recalled. Three hundred and seventy eight subjects were included, 150 subjects with signs/symptoms of PAP and 228 subjects with root canal-treated teeth exhibiting healthy perirradicular tissues (healed). Genomic DNA was extracted from saliva and used for TNF-⍺ (rs1800629), TNFRSF1A (rs1800693) and TNFRSF1B (rs1061622) genotyping by real-time PCR. Genotypes and alleles frequencies were evaluated by c2 or Fisher's exact tests and odds ratios were implemented (α = 5%). RESULTS: The genetic polymorphism in TNF-α (rs1800629) was associated as a protective factor for the development of PAP (p < .05), once subjects who presented at least one allele A (AA+AG X GG), had a higher chance to lesion repair (p < .05). The polymorphisms rs1800693 and rs1061622 in TNF receptors (TNFRSF1A and TNFRSF1B, respectively) were not associated with the development of PAP (p > .05). CONCLUSIONS: The observed results demonstrate that polymorphism in TNF-α but not in its receptors is associated with PAP.

Association between single-nucleotide polymorphisms in serotonin receptor 2A and melatonin receptor 1A genes and pain after root canal treatment.

AIM: This study aimed to investigate whether single-nucleotide polymorphisms (SNPs) in the genes encoding 5-HTR2A (5-Hydroxytryptamine (serotonin) receptor 2A) and MTNR1A (melatonin receptor 1A) may contribute to postoperative pain perception after root canal treatment. We hypothesised that SNPs in HTR2A and MTNR1A genes were associated with postoperative pain after root canal treatment. METHODOLOGY: This genetic cohort study enrolled patients with single-rooted teeth diagnosed with pulp necrosis and asymptomatic apical periodontitis before root canal treatment. Root canal treatment was performed in one session using a standardized protocol. Postoperative pain and tenderness were assessed using a visual analogue scale (recorded every day for 7 days and on the 14th and 30th days after root canal treatment). Genomic DNA was extracted from saliva and used to genotype the SNPs in HTR2A (rs4941573 and rs6313) and MTNR1A (rs6553010, rs6847693 and rs13140012) using real-time polymerase chain reaction. Genotypes were compared using univariate and multivariate Poisson regression with generalized estimating equations (p < .05). RESULTS: In total, 108 patients were enrolled in this study. The SNPs rs6553010 (MTNR1A), rs4941573 and rs6313 (HTR2A) were associated with an increased risk of developing pain after root canal treatment (p < .05). CONCLUSIONS: This study suggests that SNPs in HTR2A and MTNR1A influence pain response after root canal treatment.

Impact of malocclusion treatments on Oral Health-Related Quality of Life: an overview of systematic reviews.

OBJECTIVE: To perform an overview of systematic reviews (SR) assessing the impact of malocclusion treatments (Orthodontic Treatment - OT and/or Orthodontic Surgical Treatment - OST) on Oral Health-Related Quality of Life (OHRQoL). MATERIALS AND METHODS: A search strategy was conducted in electronic databases until June 7th, 2021, followed by a manual search in grey literature and registration databases. Two independent authors applied the eligibility criteria, extracted the data, assessed the risk of bias (AMSTAR-2), and performed the certainty of evidence (GRADE) evaluation. Meta-analysis was planned to be carried out in RevMan 5.3 (with 95% confidence intervals (CI) considering p < 0.05), in case of homogeneous studies considering OHRQoL instrument and time of follow-up. RESULTS: A total of 126 articles were accessed on the database, 18 registers, 33 records on grey literature and 3 articles by means of citation searching. After duplicates removal and eligibility criteria analyses, 15 SR were included. From that, 13 showed improvement in OHRQoL after OT and/or OST. The methodological quality ranges from high (n = 2), to critically low (n = 9). Meta-analysis was conducted. Improvement on OHRQoL after a 6-month OST using the OQLQ-22 (p < 0.00001; 19.65; CI: 12.60-26.70) and OHIP-14 instruments (p < 0.00001; 10.70; CI: 9.89-11.51); and after a 6-month OT using the CPQ 11-14 instrument (p = 0.010; 3.57; CI: 0.86-6.28) with very low certainty of the evidence for all outcomes was observed. CONCLUSIONS: Although most SR selected in this overview are characterized by a critically low quality, as well as very low certainty of the evidence, OT and/or OST seem to have a positive impact in improving the OHRQoL. CLINICAL RELEVANCE: The overview of existing systematic reviews compiled that OT and/or OST seem to have a positive impact on improving the OHRQoL. This information will facilitate clinical decision-making considering the clinical and psychological parameters.

Evaluation of composite restorations in primary molars subjected to selective caries removal associated with antimicrobial photodynamic therapy: A randomized controlled trial.

BACKGROUND: Antimicrobial photodynamic therapy (aPDT) has been used as an adjunct treatment of deep caries lesions; however, studies on the effects of aPDT on the longevity of restorations are still limited. AIM: To evaluate the clinical performance of composite restorations in primary molars subjected to selective caries removal (SCR) associated with aPDT. DESIGN: A randomized clinical trial was designed. Primary molars of patients (mean age 6.15 years) with deep caries lesions without signs and symptoms of pulpal involvement were selected. A total of 64 teeth were randomly divided into groups G1 (SCR, 32 teeth) and G2 (SCR + aPDT, 32 teeth) for treatment, restored with composite, and evaluated after a week (T0 ), 6 months (T1 ), and 12 months (T2 ) according to the criteria of FDI. Groups were compared using the Rao-Scott chi-squared test and the logistic regression analysis for complex designs to account for multiple observations per subject (alpha = 0.05). RESULTS: From all FDI criteria evaluated, the marginal adaptation for the SCR + aPDT group was significantly better in comparison with the SCR group at T0 and T2 in the logistic regression analysis (T0: OR = 0.151; 95% CI = 0.03-0.068, P = .015; and T2: OR = 0.201; 95% CI = 0.05-0.79, P = .022). CONCLUSION: The marginal adaptation of primary molar resin restorations was positively affected by aPDT after 12 months of follow-up.

Does selective caries removal in combination with antimicrobial photodynamic therapy affect the clinical performance of adhesive restorations of primary or permanent teeth? A systematic review with meta-analysis.

Antimicrobial photodynamic therapy (aPDT) is an adjunct to a selective caries removal (SCR) technique for deep caries lesion treatment. The knowledge about chemical and structural changes affecting the remaining dentin surface after the use of this therapy is still unknown. OBJECTIVE: to answer the following question: Does the SCR technique in combination with aPDT affect the clinical performance of adhesive restorations in deep carious lesions of primary or permanent teeth? STUDY DESIGN: a systematic review was conducted. Five databases, supplemented by trial registers, google scholar, manual search, personal communications, and grey literature were investigated. Randomized clinical trials were included. Two independent reviewers selected the studies, extracted qualitatively the data, and evaluated the risk of bias (using Cochrane Collaboration's tool and Robot Reviewer program). The certainty of the evidence was accessed based on The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. A meta-analysis of comparable data was performed with RevMan software 5.3. RESULTS: A total of 39 articles and 3 studies were found. The final selection included 3 articles with a total of 82 participants. No studies were found on permanent teeth. The studies presented low risk of bias. Considering the treatment in the experimental (SCR + aPDT) or control groups (SCR), no difference on clinical performance of adhesive restorations in deep caries of primary teeth was observed after 6 months (p = 0.78; CI -0.01 (-0.09, 0.07)) or 12 months (p =0.75; CI -0.02 (-0.12, 0.08)). All outcomes presented moderate certainty of evidence mainly due to the small sample size that downgrade the GRADE scores. CONCLUSIONS: based on moderate certainty of the evidence, the clinical use of aPDT as an adjuvant of SCR has potential indication for treatment in deep caries of primary teeth. However, studies with more follow up and on permanent teeth are missing with the necessity for further research.

Evidence of Association between MTRR and TNF-α Gene Polymorphisms and Oral Health-Related Quality of Life in Children with Anterior Open Bite.

Genetic polymorphisms could explain the inter-individual differences in the oral health-related quality of life (OHRQoL) of children with anterior open bite (AOB). OBJECTIVE: To assess the impact of AOB on OHRQoL in children and to evaluate whether MTR (rs1805087), MTRR (rs1801394), TGFß1 (rs1800469) and TNF-α (rs1799964, rs1799724 and rs1800629) genes are potential biomarkers for OHRQoL in children with AOB. STUDY DESIGN: A cross-sectional study was performed with 173 children aged between 2-6 years. The Brazilian version of Early Childhood Oral Health Impact Scale (ECOHIS) was applied. Genetic polymorphisms were analyzed using real-time PCR. Mann-Whitney U-test and Chi-square were used. RESULTS: The overall mean ECOHIS scores were 5.49 (SD= 5.72) and 3.45 (SD = 4.49) (p < 0.01) in the AOB and control groups, respectively. Children with the CC genotype of TNF-α (rs1799724) had a significantly higher psychological QoL level. The MTRR AA genotype group showed a lower QoL level in the child subscale (p = 0.006), function (p = 0.017), and psychological (p = 0.006) domains. There was no significant difference between OHRQoL and the genetic polymorphisms in MTR and TGFß1. CONCLUSIONS: Genetic polymorphisms in TNF-α and MTRR are associated with the impact on the OHRQoL in children with AOB.

Effect of Treatment with Selective Caries Removal Associated to Antimicrobial Photodynamic Therapy on Children's Oral Health-Related Quality of Life: A Non-Randomized Clinical Study.

How patients perceive impact of diseases is an essential component when characterising different disease impacts, and effects of dental treatments should be perceived by the patients. This study aimed to assess the impact of conservative treatment of deep caries lesions using the selective caries removal (SCR) associated to a low laser therapy (antimicrobial photodynamic therapy-aPDT) on oral health-related quality of life (OHRQoL). STUDY DESIGN: A non-randomized clinical before-and-after study was conducted on children aged 4 to 8 years. The data was obtained applying the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS) to the caretakers in an interview before and after treatment. The paired T-student test considering p<0.05 and the treatment responsiveness detecting the effect size by means of standardized response mean (SRM) was evaluated. RESULTS: The mean impact on OHRQoL on the total scale was 5.46 ± 4.54 for before and 2.42 ± 3.54 for after treatment (p<0.01). The ECOHIS demonstrated satisfatory longitudinal responsiveness except for psychological, self-image/social interaction and Family function domain (SRM<0.5). CONCLUSION: This study demonstrated that the association of a low laser therapy (aPDT) with SCR did not influence negatively on OHRQoL. In the practice of pediatric dentistry, this conservative dental treatment improved the OHRQoL after 3 months of follow up.

Effect of photobiomodulation on post-operative symptoms in teeth with asymptomatic apical periodontitis treated with foraminal enlargement: A randomized clinical trial.

AIM: To assess the efficacy of photobiomodulation in reducing post-operative symptoms and use of analgesics in teeth with asymptomatic apical periodontitis treated with foraminal enlargement in a single visit. METHODOLOGY: This prospective double-blind, controlled, superiority, randomized clinical trial enrolled 70 patients requiring root canal treatment of one single-rooted tooth with asymptomatic apical periodontitis. The participants were randomized into one of the following two groups: 35 patients in the control group (C.G) - root canal treatment with foraminal enlargement, without any additional treatment and 35 patients in the photobiomodulation group (PBM.G) - root canal treatment with foraminal enlargement associated with photobiomodulation (antimicrobial photodynamic therapy and low-level laser therapy). The outcome variables were post-operative pain, tenderness, oedema and the use of analgesics. Pain intensity was measured using a visual analogue scale (recorded every day for 7 days, then the 14th and 30th days after root canal treatment). Facial oedema was assessed subjectively by two independent evaluators using photographs taken by one of the researchers at 48 h, 72 h and 7 days after the procedures. Data were tabulated and analysed using the Mann-Whitney U, Chi-Square, Fisher`s Exact, Student T and Ordinal Logistic Regression by Generalized Estimating Equations tests in SPSS software. RESULTS: There were no significant differences in post-operative pain and tenderness between the groups at any observation period (p > .05). Photobiomodulation (beta = -0.77 / p = .01), time (beta = -0.23 / p < .01), and male gender (beta = -1.20 / p < .01) were associated with decreased post-operative pain. Only time (beta: -0.10; p < .01) and male gender (beta: -1.04; p < .01) were associated with decreased tenderness. For oedema and use of analgesics, there was no difference between the groups (p > .05). CONCLUSIONS: Photobiomodulation had no significant effect on post-operative pain, tenderness, oedema and the use of analgesics after root canal treatment with foraminal enlargement, in single-rooted teeth treated in a single visit. Register of Clinical Trials: NCT03704857. Research Ethics Committee: no 2.353.996 / CAAE 74185417.9.0000.5626.

Genetic variation involved in the risk to external apical root resorption in orthodontic patients: a systematic review.

OBJECTIVE: To perform a systematic review/meta-analysis to elucidate the scientific basis for the association between genetic variations and risk of external apical root resorption (EARR) in orthodontic patients. MATERIALS AND METHODS: Four databases (PubMed, Web of Science, Scopus, LILACS) were electronically searched until November 22, 2020, followed by manual and gray literature search. Case-control or cross-sectional studies that evaluated genes involved in the susceptibility of orthodontic patients to EARR were eligible. Two reviewers applied the inclusion and exclusion criteria, extracted qualitative data, as well as assessed methodological quality using instrument proposed for genetic studies. For synthesis results, narrative and quantitative data (meta-analysis) were performed. The certainty of the evidence was tested using the GRADE Working Group approach. RESULTS: Of 201 articles in total, 16 studies were included in the review. Of these, 11 presented moderate and 5 of high methodological quality. In the narrative analysis, from 16 studies, 15 studies (10 genes) showed a significant association with EARR and 9 studies were included in the meta-analysis. Only the polymorphism rs208294 in P2RX7 (dominant model) was associated with EARR (OR = 0.52, 95%CI = 0.29-0.95, p = 0.03) and presented a very low certainty of the evidence. CONCLUSION: Narrative analyses of individual studies demonstrated an association of many genes. The number of studies for each genetic variation was very low, and methodological heterogeneity between the studies was observed. Quantitative analyses (meta-analysis) could only show an involvement for P2RX7 (rs208294) in the risk of orthodontic patients to EARR at a very low certainty of evidence. (CRD42018085411). CLINICAL RELEVANCE: The knowledge regarding the molecular aspects involved in the etiology of EARR will allow orthodontists to use a personalized treatment and early diagnosis of risk patients. This systematic review demonstrates that more studies are necessary to unravel the role of genetic variation for patients' risk to EARR during orthodontic tooth movement.

Impact of traumatic dental injury treatment on the Oral Health-Related Quality of Life of children, adolescents, and their family: Systematic review and meta-analysis.

BACKGROUND/AIM: Measures of oral health-related quality of life (OHRQoL) are useful in clinical trials to evaluate treatment outcomes. To detect the treatment impact of traumatic dental injuries (TDI) on OHRQoL is extremely relevant. The aim of this study was to assess whether there is scientific evidence of the impact of TDI treatment on OHRQoL of children, adolescents, and their families. MATERIAL AND METHODS: A systematic review and meta-analysis were conducted selecting articles from PubMed, Web of Science, Scopus, Cochrane Library, and Virtual Health Library until May 22nd, 2020. The gray literature, clinical trial registers, and a manual search were performed. Two independent reviewers selected the studies, extracted the data, and assessed the ROBINS-I risk of bias. A meta-analysis was performed using RevMan 5.4 program. The certainty of the evidence was evaluated using the GRADE system. RESULTS: In the electronic search, 413 abstracts and one registered study were found. After removing the duplicates and eligibility application, six studies were included. Individually, the studies presented low to moderate risk of bias and they found that TDI treatment reduces the negative impact on OHRQoL. In the meta-analysis, TDI treatment improved OHRQoL for 8- to 10-year-old children (p = .03; CI 5.19 [0.62, 9.75]) (detected by CPQ 8-10 questionnaire). In the perception of parents, the children, and adolescents who had suffered TDI also had their OHRQoL improved (p = .04; CI 14.77 [0.95, 28.60]) (detected by PPQ and P-CPQ questionnaire) but both evaluations had very low certainty of evidence. CONCLUSION: Treatment of traumatic dental injuries reduces the impact on the OHRQoL of children and adolescents. However, more studies are necessary to detect the TDI treatment influence on OHRQoL of preschoolers and in the family as well to estimate the effects due to outcomes that had a very low certainty of evidence (#CRD42018091210).

Evaluation of the impact of a dental trauma care program on oral health-related quality of life of children and their families.

BACKGROUND/AIM: A traumatic dental injury (TDI) may have physical and psychosocial consequences for children and their families, and it may impact their oral health-related quality of life (OHRQoL). The aim of this study was to assess the OHRQoL of children affected by TDI and their families after enrollment in the Dental Trauma Care Program (DTCP). METHODS: This longitudinal clinical study involved a consecutive sample of 2- to 6-year-old children registered in the DTCP over a period of six years. Parents/caregivers were interviewed and the OHRQoL questionnaire was completed. The Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS) was used before and after treatment. The Andreasen criteria were used to classify TDIs. The patients were treated (minimal intervention/invasive intervention) according to TDI severity (uncomplicated/complicated). Based on the Kolmogorov-Smirnov test, the Wilcoxon non-parametric test was used to compare the ECOHIS total scale/subscales/domains before and after enrollment in the DTCP. The longitudinal changes were calculated using effect size measured by the Standardized Response Means (SRM). TDI severity and treatments were also evaluated. RESULTS: The total ECOHIS mean scores were 7.4 ± 9.2 and 0.8 ± 2.5, before and after TDI treatment (p < .001), respectively. ECOHIS scores dropped by 6.6 points after treatment, demonstrating a positive reduction in the impact on OHRQoL, as reflected by the satisfactory responsiveness of ECOHIS (0.9). The changes following treatment, independent of TDI severity and type of treatment, were significant (p < .001) in children and the family section. CONCLUSIONS: The impact of TDI on OHRQoL reduced after the enrollment of patients and their families in the DTCP.

Do Antimicrobial Photodynamic Therapy and Low-Level Laser Therapy Minimize Postoperative Pain and Edema After Molar Extraction?

PURPOSE: This study was designed to examine the efficacy of antimicrobial photodynamic therapy (aPDT) and low-level laser therapy (LLLT) in reducing postoperative pain and edema after molar extractions. METHODS: The investigators designed a single-blind randomized controlled study and enrolled subjects requiring extraction of at least one of the first or second molars. They were randomized to one of the following four groups: control group, aPDT group, LLLT group, and aPDT and LLLT group. Patients were blinded to the group assigned. The outcome variables were postoperative pain and edema. Pain intensity was measured on a visual analog scale (recorded every day for 7 days after tooth extraction). Facial edema was assessed by measuring the perimeter between the tragus, base of the jaw, and labial commissure, which was recorded once before surgery and then on the third and seventh days after surgery. Other variables were age, sex, ethnicity, decayed/missing/filled teeth, and tooth types. Appropriate univariate and bivariate statistics were computed and statistical significance was set at a value of P < .05. RESULTS: The sample was composed of 40 patients with a mean age of 41.25 ± 13.97 years and 25 (62.5%) of them were women. There were 10 subjects in each treatment group. The mean of postoperative pain within the groups was associated with a significant continuous decrease over time (P < .05). Postoperative pain was lowest in the aPDT + LLLT group in the 1st, 2nd, 3rd, 5th, 6th, and 7th day after tooth extraction (P < .05). There were no significant differences in edema among the groups (P > .05). CONCLUSION: The combined use of aPDT and LLLT was effective in reducing postoperative pain. These procedures can be applied in everyday surgical practice.

Minimally invasive treatment of an extruded deciduous tooth - Case report.

When a traumatic dental injury affects the deciduous teeth, the main management is to regularly review the patient until the successor permanent tooth erupts to avoid further consequences to the affected tooth and, especially, sequelae in the tooth germs of the successor permanent tooth. This report describes a case of a tooth extrusion in a 4-year-old male treated with a minimally invasive approach. After 4 years of follow-up, there was a mild disturbance (demarcated opacity in the vestibular surface) and a satisfactory result with normal eruption of the permanent successor tooth.

GHR and IGF2R genes may contribute to normal variations in craniofacial dimensions: Insights from an admixed population.

INTRODUCTION: This study aimed to determine whether single nucleotide polymorphisms in the growth hormone receptor (GHR) and insulin-like growth factor 2 receptor (IGF2R) genes are associated with different craniofacial phenotypes. METHODS: A total of 596 orthodontic and 98 orthognathic patients from 4 cities in Brazil were included for analyses. Angular and linear cephalometric measurements were obtained, and phenotype characterizations were performed. Genomic DNA was collected from buccal cells and single nucleotide polymorphisms in GHR (rs2910875, rs2973015, rs1509460) and IGF2R (rs2277071, rs6909681, rs6920141) were genotyped by polymerase chain reactions using TaqMan assay. Genotype-phenotype associations were assessed in the total sample (statistical significance was set at P <8.333 × 10-3) and by a meta-analytic approach implemented to calculate the single effect size measurement for the different cohorts. RESULTS: Rare homozygotes for the GHR rs2973015 showed increased measurements for the lower anterior facial height (ANS-Me) and mandibular sagittal lengths (Co-Gn and Go-Pg). In contrast, common homozygotes for the IGF2R rs6920141 presented reduced measurements for these dimensions (ANS-Me and Go-Pg). Furthermore, the less common homozygotes for IGF2R rs2277071 had reduced maxillary sagittal length (Ptm'-A'). The meta-analytical approach replicated the associations of rs2973015 with ANS-Me, rs2277071 with Ptm'-A', and rs6920141 with Go-Pg. CONCLUSIONS: Our results provide further evidence that GHR contributes to the determination of mandibular morphology. In addition, we report that IGF2R is a possible gene associated with variations in craniofacial dimensions. Applying meta-analytical approaches to genetic variation data originating from likely underpowered samples may provide additional insight regarding genotype and/or phenotype associations.

Is dental agenesis associated with craniofacial morphology pattern? A systematic review and meta-analysis.

BACKGROUND/OBJECTIVE: Craniofacial discrepancies have been associated with congenital dental anomalies. The aim of this study was to determine if there is any scientific evidence in the literature regarding the association between dental agenesis and craniofacial morphology. MATERIALS AND METHODS: A systematic review and meta-analysis following the PRISMA Statement were conducted and registered in PROSPERO database. A broad search was conducted on databases (PubMed, Virtual Health Library, Web of Science, and Scopus) and grey literature. Articles that were selected based on predetermined eligibility criteria were assessed for quality and risk of bias according to the guidelines described by Folkes and Fulton. Those articles with similarities were submitted to meta-analysis using the RevMan 5.3 program. The certainty of the evidence was tested using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation). RESULTS: An electronic search of 975 articles resulted in 12 articles. These and four articles identified through manual search were eligible to be assessed for methodological quality and the risk of bias. Eleven articles presented moderate to high methodological quality. The included articles observed a reduced mandibular plane, a smaller maxilla and more differences with the increase in the severity of dental agenesis. Seven articles were included in the meta-analyses. Dental agenesis presented smaller SNA angle (P < 0.0001/CI -1.74 [-2.55, -0.92]) with moderate certainty of the evidence; and smaller ANB angle (P = 0.01/CI -0.80 [-1.44, -0.17]), with low certainty of the evidence. CONCLUSIONS: This systematic review and meta-analysis demonstrated that dental agenesis may be associated with specific craniofacial morphology. Further studies are necessary due to the variation of the certainty of the evidence. CONFLICT OF INTEREST: none declared. REGISTRATION: PROSPERO (CRD42017055882).

Does traumatic dental injury impact oral health-related to quality of life of children and adolescents? Systematic review and meta-analysis.

OBJECTIVE: This systematic review aimed to evaluate the association of traumatic dental injury (TDI) on oral health-related to quality of life (OHRQoL) in children and adolescents. METHODS: A focused structured question using Population (P), Exposition (E), Comparisons (C), Outcomes (O) (PECO) was designed: "Does traumatic dental injury impact OHRQoL of children and adolescents?" A broad search according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was conducted. Evaluation criteria of methodological quality and risk of bias control were applied to selected articles. A fixed-effect model was used for the meta-analysis, and the quality of the evidence was performed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: Nineteen studies were qualified with moderate to high quality, and 11 studies were considered for meta-analysis. Negative impact on OHRQoL was detected for children in the symptoms domain (P = .005; IC; -0.07 [-0.12, -0.02]) with moderate certainty of evidence quality level (GRADE). For adolescents, the total scale and all domain presented statistical significance (P < .05) with moderate certainty of evidence in the areas of functional limitation and social well-being (GRADE). CONCLUSIONS: Based on articles with moderate to high quality, the impact of TDI on OHRQoL in children under age 10 was only significant in the symptom domain using Early Childhood Oral Health Impact Scale (ECOHIS). The impact of TDI on OHRQoL in early adolescents aged 11 to 14 was significant in every assessed domain using Child Perception Questionnaire (CPQ11-14). However, future studies should be done improving the available certainty of evidence considered moderate. (CRD42016035686).

The influence of kinematics of engine-driven nickel-titanium instruments on root canal shape assessed by micro-computed tomography: a systematic review.

AIM: To evaluate if the kinematics of engine-driven instruments affect the root canal shape. METHOD: The systematic review was registered in PROSPERO (CRD 42017077043). A broad search was performed for articles published before 26 September 2018 in the electronic databases: pubmed, scopus, web of science and Lilacs using MeSH and free terms. Only in vitro studies with human teeth that evaluated root canal shape by volume, surface area and unprepared surface area using reciprocating and rotary system assessed by micro-computed tomography were included. A modified checklist for randomized controlled trials from the Joanna Briggs Institute was used to assess the risk of bias. RESULTS: Twenty-one articles were selected. According to quality assessment, all studies were considered 'moderate methodological quality'. Eighteen articles analysed volume increase, only four studies showed statistically significant difference, three indicating that the reciprocating movement obtained a greater increase in volume than the rotary system and one rotary system obtained a greater increase. Twelve studies analysed surface area, only three studies showed statistically significant difference, two presented a reciprocating system revealing greater amount of surface area and one showed a rotary system obtained a greater amount of surface area. Ten articles evaluated unprepared surface area, two studies that analysed total length, one study presented that the rotary system revealed lower unprepared surface area while another study showed reciprocating with less unprepared area. One study analysed middle and apical third, and observed that the rotary system presented lower unprepared surface area in the middle third. CONCLUSIONS: Both the rotary and reciprocating kinematics produce changes in volume and surface area and leave unprepared areas in the root canal, however reciprocating system showed greater increase of volume and surface area, while the rotary system maintains less unprepared surface area.

RANKL is associated with persistent primary teeth and delayed permanent tooth emergence.

BACKGROUND: Tooth eruption is a process that is not fully understood. AIM: To evaluate whether genetic polymorphisms for RANK/RANKL/OPG are associated with delayed tooth emergence. To evaluate whether the relative expression of this genes is associated with persistent primary teeth. DESIGN: To evaluate whether genetic polymorphisms for RANK/RANKL/OPG could be involved in delayed tooth emergence, saliva samples from 160 children, aged 6-13 years old, were analysed. To test if there is correlation between gene expression of RANK/RANKL/OPG in children with delayed tooth emergence and persistent primary teeth, periapical tissue from 15 children with persistent primary teeth and from 15 control subjects were collected for qPCR analysis. RESULTS: Fifty-six children with delayed tooth emergence (35%) had at least one permanent tooth with delayed emergence. The T allele in RANKL (rs9594738) increased the risk of delayed tooth emergence (P = 0.02; OR = 1.71, 95%CI 1.09-2.75). The relative gene expression for RANKL and the ratio RANKL/OPG in children with delayed tooth emergence and persistent primary teeth were lower compared to controls (P = 0.02 and P = 0.005, respectively). CONCLUSIONS: Data suggest that the polymorphism rs9594738 in RANKL is associated with delayed permanent tooth emergence. Moreover, reduced relative gene expression of RANKL in periapical tissue is associated with persistent primary teeth.

The Impact of Mixed Dentition Malocclusion on the Oral Health-Related Quality of Life for Children and Their Families: A Case-Control Study.

Objective: The aim of this study was to investigate the relation between malocclusion in mixed dentition and its impact on the oral health-related quality of life OHRQoL of children and their families as well to determine if there were any reported differences in OHRQoL due to malocclusion severity. Study design: A total of 144 subjects, which included 70 children (aged 8-10 years) and their parents, were recruited on the basis of predetermined criteria and divided into the following groups: children with malocclusion (case group) and children without malocclusion (control group). The OHRQoL was assessed using the Child Perceptions Questionnaire (CPQ8-10) and the Family Impact Scale (FIS). The severity of malocclusion was assessed using the Dental Aesthetic Index. The specific types of malocclusions (anterior open bite, anterior/ posterior crossbite and overjet) and their severity were considered for the statistical analyses by applying the Mann-Whitney and Kruskal-Wallis tests, respectively, with a set at p<0.05. Results: The CPQ8-10 and FIS scores demonstrated higher impact on OHRQoL in the case group (p<0.01). There were no reported differences in OHRQoL according to the dental aesthetic index severity (p>0.05) and no differences between specific types of malocclusion (p>0.05) Conclusions: Mixed dentition malocclusion impacted the oral-health quality of life for children and their families independently of the severity.