Dental injury offenses and compensation imposed by Spanish courts, before and during Covid-19. A cross-sectional study.

Injuries to the dentofacial region caused by third parties can affect physiological, sensory and esthetic functions with legal repercussions. The personal and social circumstances generated by Covid-19 and the governmental measures taken to control it, have increased the risk factors for violence and with it, the resulting injury rate. The aim of the present investigation was to compare the amount of civil liability for dental injury crimes agreed by Spanish courts, in certain Autonomous Communities, before and during the pandemic situation caused by Covid-19. For this purpose, a analytic cross-sectional study was carried out by analyzing sentences from the database of the Judicial Documentation Center. A comparison of means (one-way ANOVA) was used on the amount of compensation between the different years, and between the Autonomous Communities of Madrid, Catalonia Cataluña, Andalusia, the Canary Islands and the Valencian Community. It was observed that the year 2020 stood out for the increase in the number of cases of dental injury offenses. For its part, the Autonomous Community of Andalusia showed the highest amount of compensation during the pandemic, although the highest number of cases corresponded to the Community of Madrid. The statistical analysis yielded a probability of more than 0.05, which eliminated the possibility of significant differences in each of the comparisons.

Effect on osseointegration of dental implants treated with carboxyethylphosphonic acid and functionalized with BMP-2: preliminary study on a minipig model.

Introduction: Rough titanium surfaces biofunctionalised by osteogenic proteins, such as BMP-2, have been shown to accelerate the osseointegration process and reduce waiting times for prosthetic loading. The preclinical study presented here compared the bone in contact with the implant and bone neoformation and density between titanium (Ti) implants with a conventional etched surface (SLA type) and others treated with carboxyethylphosphonic acid (CEPA) and bone morphogenetic protein 2 (BMP-2), after 4 weeks of implantation in the tibia of a minipig model. Methods: Sixteen implants (eight experimental and eight control) of Ti-Al16-V4 with a tapered screw design and internal hexagonal connection were randomly inserted into the tibiae of four minipigs, four in each tibia. The experimental implants were treated with CEPA and BMP-2 and sterilised with gamma radiation (25 KG). The insertion torque was 40 N and primary stability was measured with the Osstell® device (ISQ 64 ± 2.6). Five bone parameters were evaluated: bone in contact with the implant (BIC), bone in contact with the corrected implant (BICc), new bone formation (BV/TV), bone density between threads (BAI/TA) and peri-implant bone density (BAP/TA). A histomorphometric study was performed and the samples were digitised with Adobe Photoshop Cs6. Statistical analysis of the variables was performed using SAS 9.4. Results: After a period of 4 weeks, no significant clinical signs were observed and all implants were integrated. Light microscopy of the experimental group revealed an ICB with no signs of fiber tissue, but with areas of ectopic new bone in the medullary space. Statistical analysis showed significant results for BIC and BICc (p = 0.0001 and p = 0.001, respectively). No statistical signification was found for the other parameters evaluated. Conclusion: Despite the limitations of this study, our results demonstrated that dental implant surfaces treated with CEPA and BMP-2 improve their biological response to osseointegration.

Role of BMP-7 on biological parameters osseointegration of dental implants: Preliminary results of a preclinical study.

The aim of this work was to analyze and compare the effect of bone morphogenetic protein-7 on biological parameters related to implant osseointegration in an experimental animal model. Sixteen dental implants were placed in the tibias of four randomly selected minipigs for the following dental implant surface treatments: Group A: conventional treatment of the dental implant surface by SLA (n = 8) and Group B: treatment of the dental implant surface with carboxyethylphosphonic acid and bone morphogenetic protein-7 (n = 8). The animals were sacrificed one month after dental implants placement and a histomorphometric study was performed for the evaluation of bone-to-implant contact, corrected bone-to-implant contact, new bone formation, interthread bone density and peri-implant density using Student's t-test and the non-parametric Mann-Whitney test. The histomorphometric parameters bone-to-implant contact and corrected bone-to-implant contact showed statistically significant differences between the study groups; 34.00% ± 9.92% and 50.02% ± 10.94%, respectively (p = 0.004) for SLA and 43.08% ± 10.76% and 63.30% ± 11.30%, respectively (p = 0.003) for BMP-7. The parameters new bone formation, interthread bone density and peri-implant density did not show statistically significant differences between the study groups (p = 0.951, p = 0.967 and p = 0.894, respectively). Dental implant surfaces treated with carboxyethylphosphonic acid and BMP-7 improve the biological response of dental implants to osseointegration.

Effectiveness of biomolecule-based bioactive surfaces, on os-seointegration of titanium dental implants: A systematic review and meta-analysis of in vivo studies.

Titanium and alloy osseointegrated implants are used to replace missing teeth; however, some fail and are removed. Modifications of the implant surface with biologically active substances have been proposed. MEDLINE [via Pubmed], Embase and Web of Science were searched with the terms "titanium dental implants", "surface properties", "bioactive surface modifications", "biomolecules", "BMP", "antibacterial agent", "peptide", "collagen", "grown factor", "osseointegration", "bone apposition", "osteogenic", "osteogenesis", "new bone formation", "bone to implant contact", "bone regeneration" and "in vivo studies", until May 2022. A total of 10,697 references were iden-tified and 26 were included to analyze 1,109 implants, with follow-ups from 2 to 84 weeks. The ARRIVE guidelines and the SYRCLE tool were used to evaluate the methodology and scientific evidence. A meta-analysis was performed (RevMan 2020 software, Cochane Collaboration) with random effects that evaluated BIC at 4 weeks, with subgroups for the different coatings. The heterogeneity of the pooled studies was very high (95% CI, I2 = 99%). The subgroup of BMPs was the most favorable to coating. Surface modification of Ti implants by organic bioactive molecules seems to favor osseointegration in the early stages of healing, but long-term studies are necessary to corroborate the results of the experimental studies.

Role of chitosan in titanium coatings. trends and new generations of coatings.

Survival studies of dental implants currently reach high figures. However, considering that the recipients are middle-aged individuals with associated pathologies, research is focused on achieving bioactive surfaces that ensure osseointegration. Chitosan is a biocompatible, degradable polysaccharide with antimicrobial and anti-inflammatory properties, capable of inducing increased growth and fixation of osteoblasts around chitosan-coated titanium. Certain chemical modifications to its structure have been shown to enhance its antibacterial activity and osteoinductive properties and it is generally believed that chitosan-coated dental implants may have enhanced osseointegration capabilities and are likely to become a commercial option in the future. Our review provided an overview of the current concepts and theories of osseointegration and current titanium dental implant surfaces and coatings, with a special focus on the in vivo investigation of chitosan-coated implants and a current perspective on the future of titanium dental implant coatings.

Relevant Aspects of Titanium and Zirconia Dental Implants for Their Fatigue and Osseointegration Behaviors.

Osseointegration capacity and good mechanical behavior are key to the success of the dental implant. In many investigations, comparisons of properties are made using different dental implant designs and therefore the results can be influenced by the macrodesign of the dental implant. In this work, studies were carried out with the same dental implant model using different roughness and different materials-commercially pure titanium (grade 4) and zirconia. For this purpose, 80 smooth passivated titanium (Ti), 80 smooth zirconia (ZrO2), and 80 rough passivated titanium (Ti-R) dental implants were used. The samples were characterized by their roughness, wettability, surface energy, residual stresses, and fatigue behavior. The implants were implanted in minipigs for 4 and 12 weeks. The animals were sacrificed, and histological studies were carried out to determine the osseointegration parameters for each of the implantation times. Ti and ZrO2 dental implants have very similar wettability and surface energy properties. However, the roughness causes a decrease in the hydrophilic character and a decrease of the total surface energy and especially the dispersive component, while the polar component is higher. Due to the compressive residual stresses of alumina sandblasting, the rough dental implant has the best fatigue behavior, followed by Ti and due to the lack of toughness and rapid crack propagation the ZrO2 implants have the worst fatigue behavior. The bone index contact (BIC) values for 4 weeks were around 25% for Ti, 32% for ZrO2, and 45% for Ti-R. After 12 weeks the Ti dental implants increased to 42%, for Ti, 43% for ZrO2, and an important increase to 76% was observed for Ti-R implants. In vivo results showed that the key factor that improves osseointegration is roughness. There was no significant difference between ZrO2 and Ti implants without sandblasting.

Effectiveness of Biofunctionalization of Titanium Surfaces with Phosphonic Acid.

Surface functionalization of dental implant surfaces has been a developing field in biomaterial research. This study aimed to obtain self-assembled monolayers (SAMs) using carboxyethylphosphonic acid on the surface of titanium (Ti) screws, and assessed the surface characteristics, biomechanical, and cellular behavior on the obtained specimens. This study had three groups, i.e., a control (untreated screws), a test group treated with phosphonic acid, and a third group with treated acid and bone morphogenetic protein (BMP-2) for in vitro analysis of cell lines. The assessed parameters included surface wettability, surface characteristics using scanning electron microscopy (SEM), protein immobilization, and cellular behavior of fibroblasts and mesenchymal stem cells of adipose tissue (MSCat cells). For surface wettability, a Welch test was performed to compare the contact angles between control (67 ± 1.83) and test (18.84 ± 0.72) groups, and a difference was observed in the mean measurements, but was not statistically significant. The SEM analysis showed significant surface roughness on the test screws and the cellular behavior of fibroblasts, and MSCat cells were significantly improved in this group, with fibroblasts having a polygonal shape with numerous vesicles and MSCat cells stable and uniformly coating the test Ti surface. Surface biofunctionalization of Ti surfaces with phosphonic acid showed promising results in this study, but remains to be clinically validated for its applications.

Oral Manifestations of COVID-19: Updated Systematic Review With Meta-Analysis.

There is increasing evidence for oral lesions and manifestations of COVID-19. The aim of this meta-analysis was to investigate the types of oral manifestations of COVID-19 and their prevalence. PubMed/Medline, Scopus, Web of Science, and Google Scholar databases were used to search for publications on oral manifestations in patients with PCR-confirmed COVID-19. A total of 310 records were selected, and 74 were included. Oral lesions in COVID-19 were classified according to their etiologies, including iatrogenic lesions caused by intubation and opportunistic infections. Of the included studies, 35 reported oral lesions probably caused by severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2) infection. Meta-analysis of prevalence data on oral manifestations and aphthous lesions indicated high heterogeneity, while meta-analysis of xerostomia prevalence data revealed a pooled prevalence, with considerable heterogeneity. In conclusion, the meta-analysis yielded high heterogeneity between studies: oral lesions yielded a prevalence of 0.33 (95% CI 0.11-0.60), xerostomia lesions a prevalence of 0.44 (95% CI 0.36-0.52) and aphthous lesions 0.10 (95% CI 0.01-0.24). In addition, a gap in the evidence regarding the prevalence of oral lesions in COVID-19 was identified and the need for further observational studies focusing on this issue and on the causal relationships between oral lesions and COVID-19 was highlighted.

Knowledge, Attitudes, and Practices among Dental Practitioners Regarding Antibiotic Prescriptions for Pregnant and Breastfeeding Women in the Dominican Republic.

In this study, we aimed to explore the trends among dentists in the Dominican Republic of providing antibiotic prescriptions to pregnant/breastfeeding dental patients. A survey was conducted among 98 dentists, using a self-administered questionnaire, about their knowledge and attitudes regarding antibiotic usage in pregnant/lactating women and the translation of these into practice. The majority of the survey population were female dentists (63.3%) aged 45-54 years. A chi-square test showed statistically significant differences in the knowledge sources between older and younger dentists, with a minority having chosen scientific literature as a source (p-value of 0.04). There were statistically significant associations between gender and certain attitudes and practice-based questions, with p-values of 0.04 and 0.01, respectively. The Spearman's correlation test showed a statistically significant correlation between knowledge and attitude (p-value 0.001), whereas no correlation was found with practice (p-value 0.23). A multiple response analysis showed that the majority of the respondents chose the second and third trimester for antibiotic prescriptions for acute conditions such as cellulitis, periodontal abscess, and pericoronitis. Most dentists had sufficient knowledge about antibiotic usage in pregnant/lactating women, but it did not translate into practice, and a certain proportion of the participants followed incongruent drug prescription. These findings can be used to focus on judicious antibiotic usage by dentists in the Dominican Republic.

Trends in Antibiotic Self-Medication for Dental Pathologies among Patients in the Dominican Republic: A Cross-Sectional Study.

The World Health Organisation has warned of the increase in antibiotic resistance, estimating that by 2050 it could become the leading cause of death worldwide. Several studies and literature reviews show a correlation between antibiotic use and bacterial resistance, with unnecessary broad-spectrum antibiotics, such as amoxicillin/clavulanic acid and azithromycin, being one of the main causative factors. An interview-based survey of 2160 participants was conducted to assess the prevalence in the practice of self-medication with antibiotics among dental patients in the Dominican Republic. A series of open-ended questions regarding self-medication and class of antibiotics were put to the patients. Over a third of the study population (39.7%) admitted to the practice of antibiotic self-medication. Most of the respondents (58.4%) who indulged in self-medication were females, and it was prevalent in the older adults between 32-42 years old (36%). There was a negative correlation between age and self-medication practice (p < 0.001) observed with point biserial correlation test. Binary logistic regression analysis found an odds ratio of 0.97 (p < 0.001). The most consumed antibiotics were amoxicillin/clavulanic acid (52%), amoxicillin (31.1%), and azithromycin (10.1%). It is imperative to educate patients about the harmful effects of self-medication and to stress the need for governments to implement stricter laws on non-prescription drug availability.

Assessment of the Tissue Response to Modification of the Surface of Dental Implants with Carboxyethylphosphonic Acid and Basic Fibroblastic Growth Factor Immobilization (Fgf-2): An Experimental Study on Minipigs.

The aim of this study was to evaluate the effect of implant surface treatment with carboxyethylphosphonic acid and fibroblast growth factor 2 on the bone-implant interface during the osseointegration period in vivo using an animal model. The present research was carried out in six minipigs, in whose left tibia implants were inserted as follows: eight implants with a standard surface treatment, for the control group, and eight implants with a surface treatment of carboxyethylphosphonic acid and immobilization of FGF-2, for the test group. At 4 weeks after the insertion of the implants, the animals were sacrificed for the histomorphometric analysis of the samples. The means of the results for the implant-bone contact variable (BIC) were 46.39 ± 17.49% for the test group and 34.00 ± 9.92% for the control group; the difference was not statistically significant. For the corrected implant-bone contact variable (BICc), the mean value of the test group was 60.48 ± 18.11%, and that for the control group, 43.08 ± 10.77%; the difference was statistically significant (p-value = 0.035). The new bone formation (BV/TV) showed average results of 27.28 ± 3.88% for the test group and 26.63 ± 7.90% for the control group, meaning that the differences were not statistically significant (p-value = 0.839). Regarding the bone density at the interthread level (BAI/TA), the mean value of the test group was 32.27 ± 6.70%, and that of the control group was 32.91 ± 7.76%, with a p-value of 0.863, while for the peri-implant density (BAP/TA), the mean value of the test group was 44.96 ± 7.55%, and that for the control group was 44.80 ± 8.68%, without a significant difference between the groups. The current research only found a significant difference for the bone-implant contact at the cortical level; therefore, it could be considered that FGF-2 acts on the mineralization of bone tissue. The application of carboxyethylphosphonic acid on the surface of implants can be considered a promising alternative as a biomimetic coating for the immobilization of FGF-2. Despite no differences in the new bone formation around the implants or in the interthread or peri-implant bone density being detected, the biofunctionalization of the implant surface with FGF-2 accelerates the mineralization of the bone-implant interface at the cortical level, thereby reducing the osseointegration period.

Histomorphometric Comparison between Two Types of Acellular Dermal Matrix Grafts: A Mini Pig Animal Model Study.

Acellular dermal matrix grafts (ADMG) have been used as soft tissue graft substitutes for autografts in periodontal plastic surgical procedures. They have benefits like avoiding a second surgical site and patient morbidity that have been associated with autografts, but there is limited evidence available on their tissue response and wound healing process. This histomorphometric animal model study was carried out in mini pigs and it aimed to compare the two types of ADMG materials of porcine derivative with a control group through observation of parameters like epithelial and Keratinized layer thickness, angiogenesis, cellularity, matrix resorption, and inflammatory infiltrate. The surgical technique involved punctures on the edentulous areas stripping the epithelial tissue and exposing the underlying connective tissue, placement of the ADMGs in the appropriate control and test sites. Following this, gingival biopsies were procured at three different time intervals of 15, 45, and 90 days. There were significant differences in epithelial and Keratinized layer thickness among the three groups. This study concluded that there was no clear consensus on which graft material was superior but it gave an insight into the tissue response and wound healing process associated with the graft materials.

Clinical and Histological Differences between Guided Tissue Regeneration with Acellular Dermal Matrix of Porcine Origin and Autologous Connective Tissue: An Animal Study.

This research aims to evaluate the clinical and histological parametric differences concerning keratinized tissue that result from two regeneration techniques, the subepithelial autologous connective tissue graft (ACTG) and the acellular dermal matrix (MD) of porcine origin, performed on surgical beds on edentulous spaces in an animal model. The parameters of the MD and ACTG groups were compared with samples of the control group (CG) after 15, 45, and 90 days. Nine female white pigs (Sus scrofa domestica) were used, and each animal provided 20 study areas (12 MD and 8 ACTG). At 15 days, the keratin layer thickness in the MD group was greater than those of the ACTG (25.27 vs. 19.95 µm) and the CG (21.2 µm). After 45 days, the MD and ACTG thickness values decreased but were higher than the CG. At 90 days, MD (19.46 µm) obtained a value close to that of CG, and the ACTG decreased to CG (15.53 µm, p < 0.001). The use of an MD may be a viable alternative to the ACTG because of its ability to provide increased keratinized tissue in comparison to the ACTG.

Evaluation of the Current Knowledge About Bacterial Endocarditis Prevention Among General Dentists in the City of Santo Domingo, Dominican Republic.

Infective endocarditis (IE) is a life-threatening disease caused by bacterial adherence to the lining of the heart and heart valve, and it can be caused by bacterial contamination of the bloodstream during invasive dental procedures. The American Heart Association (AHA) recommended guidelines for antibiotic prophylaxis in 2008 before invasive dental procedures; however, in the Dominican Republic, no official guidelines or regulations on this topic have been yet established. This study aimed to evaluate the current knowledge about bacterial endocarditis prevention among dentists in Santo Domingo. The study participants were dentists who attended a conference organized by Universidad Federico Henríquez y Carvajal (n = 95), of which 74 responded to the questionnaire survey. Seventy-eight percentage of the participants responded that an indication of antibiotics is recommended in cases of prophylaxis for IE. The prescription of antibiotics was applied to patients with prosthetic valves (78.4%), presented a history of previous IE (77%) among others. Among all the interventions in which the respondents would prescribe antibiotics, tooth extraction (70.7%) was the most frequent. Amoxicillin was the preferred drug choice (63.5%) and clindamycin was the antibiotic of choice in allergic patients (55.4%). Even though the choice of antibiotics were according to AHA guidelines (2008), majority of the dentists (58.82 and 55.4%) were not aware of the correct dosage and timing of administration of azithromycin and clindamycin in drugs in patients allergic to penicillin.

Antimicrobial Prescription Habits of Dentists Performing Dental Implant Treatments in Santo Domingo, Dominican Republic.

The use of antibiotics in implant treatments is controversial. The purpose of this research was to study the behaviors of Santo Domingo dentists who prescribe antimicrobials to patients for the placement of dental implants. A total of 99 dentists participated in the study. A share of 1.2% of dentists prescribed antimicrobials solely in the preoperative period, 8.6% after surgery, 44.4% before and after, 19.8% only in specific situations, and 25.9% did not prescribe at all. Amoxicillin was the predominant antimicrobial of choice. A cross-sectional, observational, survey-based study was conducted. The items studied were demographics, self-assessment of knowledge about antibiotics and when they are used, as well as their recommended dosage and duration, in healthy and non-allergic patients. Notable variability was found in the prescription behaviors of antimicrobials. Bridging gaps in knowledge on the subject could help to standardize prescription guidelines.

Relationship between Implant Length and Implant Stability of Single-Implant Restorations: A 12-Month Follow-Up Clinical Study.

Background and Objectives: Implant stability in vivo is contingent on multiple factors, such as bone structure, instrument positioning and implant surface modifications, implant diameter, and implant length. Resonance-frequency analysis is considered a non-invasive, reliable, predictable, and objective method by which to evaluate implant stability, due to its correlation with bone-to-implant contact. The purpose of this study was to evaluate the effect of implant length on the primary and secondary stability of single-implant crown rehabilitations, as measured by resonance-frequency analysis at different times. Materials and Methods: Implants of 10 and 11.5 mm were placed, and the resonance frequency was measured at the time of surgery (T0), as well as at 3 (T1), 6 (T2), and 12 (T3) months post-surgery. Results: A total of 559 implants were placed in 195 patients. Significant differences were observed when comparing the implant stability quotient (ISQ) values at T1, with values for 10-mm implants being greater than those for 11.5-mm implants (p = 0.035). These differences were also observed when comparing ISQ values for buccal and lingual areas. At T0, T2, and T3, no significant differences in ISQ values were observed. The use of 10-mm implants in the anterior maxilla yielded significantly greater values at T0 (p = 0.018) and T1 (p = 0.031) when compared with 11.5-mm implants. Significant differences in measurements were observed only for buccal areas (p = 0.005; p = 0.018). When comparing the sample lengths and sex, women with 11.5-mm implants showed significantly lower results than those with 10-mm implants (p < 0.001). Conclusions: There is a direct relationship between implants of a smaller length and greater ISQ values, with this relationship being most evident in the maxilla and in women.