Salivary Markers of Oxidative Stress in Patients Undergoing Orthodontic Treatment with Clear Aligners versus Self-Ligating Brackets: A Non-Randomized Clinical Trial.

The aim of this work was to determine advanced the oxidative protein products (AOPPs), total antioxidant capacity (TAC), and myeloperoxidase activity (MPO) in the saliva of patients undergoing orthodontic treatment with clear removable aligners in comparison with another group in treatment with fixed passive self-ligating brackets applying light forces, before treatment, after 30 days, and after 90 days of treatment. This non-randomized clinical trial recruited patients consecutively, all of which were over 18 years of age and due to undergo orthodontic treatment. They were divided into two groups according to treatment type: Group A, 48 patients treated with clear aligners (Invisalign®); and Group B, 19 patients treated with Damon System® 0.22″ self-ligating brackets applying light forces. Saliva samples were collected by a single clinician following the same protocol and underwent three analyses-AOPPs, TAC, and MPO levels-at baseline before placing the apparatus, after 30 days, and after 90 days treatment. Orthodontic treatment, whether with clear aligners or fixed self-ligating brackets and light forces, increased AOPPs after the first 30 days of treatment. During the initial phases of orthodontic treatment, neither clear aligners nor fixed self-ligating brackets applying light forces showed changes in TAC and MPO. Orthodontic treatment with both clear aligners and fixed apparatus self-ligating brackets applying light forces increases oxidative stress (AOPPs) after the first 30 days of treatment. There are no differences in AOPP levels between treatment with clear aligners and self-ligating brackets during the first 90 days of treatment. The antioxidative capacity of saliva during the initial phases of orthodontic treatment, whether with self-ligating brackets or clear aligners, does not undergo significant changes. With either orthodontic technique, the patients' salivary antioxidant capacity is similar.

An example of adaptation: experience of virtual clinical skills circuits of internal medicine students at the Faculty of Medicine, University of Granada (Spain) during the COVID-19 pandemic.

BACKGROUND: The state of alarm declared in Spain in response to the Coronavirus pandemic (COVID-19) has had far-reaching consequences in all areas of life. At the University of Granada's (UGR) Faculty of Medicine, online teaching was implemented immediately without any preexisting plan. Second-year undergraduates in medicine, particularly those enrolled in the subject 'Bases of Internal Medicine,' would normally undergo clinical skills circuits in face-to-face group settings. OBJECTIVE: To facilitate undergraduates' acquisition of specific transversal skills by means of an integrated online working system. DESIGN: Before the pandemic, teaching/learning methods consisted of 1) face-to-face group work; 2) teletutoring; 3) written work uploaded to the PRADO online platform for marking by the teletutor; and 4) presentation of written work to the group. As a result of the lockdown, presentations in class were suspended and replaced by online presentations. The means adopted by students in online presentations were freely chosen using various communication techniques: linear projection systems (6); acting/simulation (4); dramatization (1); and role-playing (1). RESULTS: The number of online clinical skills circuits developed was 12, one for each of the clinical skills circuits established for imparting this subject. A total of 12 presentations were made by the 10 groups, each lasting 15 minutes followed by a 5-minute discussion to settle any questions raised. The presentations were marked jointly by the teaching staff, coordinator, and students. CONCLUSIONS: The transference of classroom learning to the online environment proved an essential resource for teaching/learning clinical/practical skills during the lockdown, which have never before been imparted at distance.

Magnetic detection of sentinel nodes in oral squamous cell carcinoma by means of superparamagnetic iron oxide contrast.

The aim was to evaluate sentinel node detection capacity by means of a magnetic probe in 11 patients with oral squamous cell carcinoma at stages T1-T2 received submucosal injections of a superparamagnetic iron oxide contrast agent (SPIO). A magnetic probe was used for sentinel node biopsy. The use of SPIO and magnetic probes in the early stages of oral cancer may offer an alternative to conventional radioisotope techniques and/or elective neck dissection.

Retraction: Evaluation of periimplant bone neoformation using different scanning electron microscope methods for measuring BIC. A dog study.

In relation to the article of the Journal of Clinical and Experimental Dentistry "Calvo-Guirado JL, Aguilar-Salvatierra A, Guardia J, Delgado-Ruiz R, Ramírez-Fernández MP, Pérez-Sánchez C, Gómez-Moreno G. Evaluation of periimplant bone neoformation using different scanning electron microscope methods for measuring BIC. A dog study. J Clin Exp Dent. 2012 Feb 1;4(1):e8-e13", the authors have used three figures that are the same as those published in three different publications (J Pineal Res 2010; COIR 2010; COIR 2012). The copyright of the mentioned publications was consequently not respected. Retraction of the article is therefore decided.

Correction to: Influence of surface treatment on osseointegration of dental implants: histological, histomorphometric and radiological analysis in vivo.

Dear Professor Dr. Matthias Hannig. Editor-in-Chief Clinical Oral Investigations. Following the publication of our paper by Calvo Guirado et al, 2015 [1] in Clinical Oral Investigations, it came to light that a certain part of the text at the materials and methods and results sections were similar.

Polymethyl Methacrylate Custom-Made Prosthesis: A Novel Three-Dimension Printing-Aided Fabrication Technique for Cranial and/or Orbital Reconstruction.

BACKGROUND: Over the years, many materials have been used in orbital reconstruction and cranioplasty. Among the materials in current use, polymethyl methacrylate (PMMA) offers a high degree of compatibility with human tissue. OBJECTIVE: This work describes a new, custom-made, 3D printing-aided, prosthetic fabrication process for orbital and/or cranial reconstruction using PMMA. METHODS: On the basis of information obtained from computerized tomography scanning processed in Digital Imaging and Communication in Medicine format and exported to treatment planning software, a 3D prosthesis master model was designed and digitally printed. This was then used to create an injection mold from which the prosthesis was cast in PMMA and implanted in the patient. Five patients with cranial and/or orbital defects of tumoral or traumatic etiology were treated by this method. After 5 to 7 years follow-up, no complications occurred to cause the removal of the prostheses. CONCLUSION: This novel method makes it possible to produce customized PMMA prostheses to treat orbital and/or cranial defects that are cost-effective and individualized to each case.

Reconstruction of a Compound Oromandibular Defect by Means of Chimeric Scapular-Parascapular Free Flap Assisted by Virtual Surgical Planning.

BACKGROUND: Reconstruction of an oromandibular defect presents a considerable surgical challenge. But since the advent of microvascularized free flap reconstructive surgery, outcomes have improved significantly so that today almost any defect may be reconstructed. Recently, virtual surgical planning has reduced surgical time, the morbidity associated with surgery, and surgical precision. OBJECTIVE: This article reports a complex patient with a composite oromandibular defect. METHODS: The patient had undergone multiple surgeries with bad results. She presented an orostoma of 5 cm in diameter, osteoradionecrosis and fracture of the left mandibular body, and relapse in the ipsilateral posterior maxilla. Reconstruction was performed by means of a scapular/parascapular chimeric free flap. A customized reconstruction plate was designed virtually based on the mirror image of the contralateral mandibular body. Surgery and the postoperative phase passed without incident. The patient recovered vocal, swallowing, and respiratory function without any problems. At the end of a 1-year follow-up, no complications or tumor relapse had occurred. CONCLUSIONS: Composite defects are a surgical challenge in which free flap reconstruction is an evolution that has facilitated treatment and led to improved outcomes. Virtual treatment planning produces more exact results and greater control of surgical techniques.

Dental implant surgery in patients in treatment by dabigatran.

OBJECTIVES: The aim of this study was to evaluate the incidence of bleeding complications after dental implant placement in patients in treatment by the oral anticoagulant dabigatran following a specific protocol. MATERIAL AND METHODS: Seventy-one patients were divided into two groups: 29 had been taking dabigatran for over 6 months (150 mg orally every 12 h) before implant surgery (dabigatran group) and a control group consisting of 42 healthy subjects. Patients were treated in an outpatient setting. All subjects received dental implants in different positions, dabigatran group patients 12 h after the last dose of dabigatran. Nonabsorbable sutures were used and patients were given gauzes impregnated with tranexamic acid 5% to bite on for 30-60 min. Dabigatran patients resumed medication 8 h after the procedure, resuming usual dosage (every 12 h) the day after surgery. RESULTS: Two dabigatran patients and two control patients presented slight bleeding the day after surgery. Bleeding was managed with gauzes impregnated with tranexamic acid. No statistically significant differences (P = 0.542) were found in relation to bleeding episodes between the groups, with a relative risk of 0.675 based on the pooled groups and a 95% confidence interval of 0.090-5.088. CONCLUSIONS: Dental implant surgery in patients taking dabigatran can be performed safely providing 12 h have passed since the last dose and local hemostatic measures are applied. Normal dosage can be resumed 8 h after implant surgery.

The antibiotic of choice determined by antibiogram in maxillary sinus elevation surgery: a clinical study.

OBJECTIVES: This study set out to make antibiograms of positive bacteria cultures in samples collected when performing maxillary sinus elevations to determine a specific and effective antibiotic in each case. MATERIAL AND METHODS: A total of 174 patients (90 women and 84 men) with a mean age of 55.92 years underwent 227 sinus elevations. As the membrane was lifted, a sample was collected from the maxillary sinus floor with a cotton swab and placed on a blood agar and chocolate agar culture to incubate for 48 h at 37°; the samples then underwent microbiological analysis. Antibiograms were made for each positive culture to identify the most sensitive antibiotic, which were regrouped according to their mechanism of action as: beta-lactam (penicillins), beta-lactam (cephalosporins), macrolides, quinolones, fosfomycin, aminoglycosides, or trimethoprim-sulfamethoxazole. RESULTS: Of 227 cultures, 18.1% were bacteria-positive. Of the germs, 45% were of the Streptococcus genus, most of which belonged to the Streptococcus viridans group (61.1%). The germs studied showed greater resistance to macrolides and greater sensitivity to penicillins, cephalosporins, and ciprofloxacin. The antibiotics that showed the greatest efficacy were as follows: ampicillin, amoxicillin-clavulanate, and ciprofloxacin. CONCLUSIONS: On the basis of antibiograms of positive cultures, the antibiotics presenting the greatest efficacy against possible complications were as follows: ampicillin, amoxicillin-clavulanate, and ciprofloxacin. Clinically, the antibiograms proved useful as they allowed the prescription of specific antibiotics to resolve possible postoperative sinus infections.

Role of mechanical compression on bone regeneration around a particulate bone graft material: an experimental study in rabbit calvaria.

PURPOSE: This experimental study was designed to analyze the effect of different compressive forces on the bone regeneration around a particulate bone graft material. MATERIAL AND METHODS: Eighty 6-mm-diameter defects were created in the calvaria of 20 New Zealand rabbits (4 defects per rabbit calvaria). All the defects were filled with particles of synthetic bone. Two standardized compressive forces were then applied, 4.1 g to half the defects (Test A) and 8.2 g to the other half (Test B), all for 1 min. The graft sites were allowed to heal for 6 weeks, after which the rabbits were euthanized. The calvarium vault of each animal was extracted, radiographed, and prepared for histomorphometric analysis. The percentage of defect fill, bone density, new bone formation, and residual bone graft material were recorded, and the results were subjected to statistical analysis. RESULTS: Histological evaluation found that defect closure among the Test A (lower compression) group ranged from 38.34 (95% lower CI) to 55.8 (95% upper CI) (mean 47 ± 8.5%), while among the Test B group (higher compression), it ranged from 81.26 (95% lower CI) to 95.32 (mean 88 ± 7.3%). Significantly more closure was achieved for the Test B group (P < 0.05). Histomorphometric comparison of the two groups found significantly more new bone formation, higher bone density, and a higher percentage of defect fill in the defects subjected to the higher compression level (P < 0.05). CONCLUSIONS: Increasing the compressive force applied to bone graft particulate used to fill small defects created in rabbit calvaria appears to be beneficial.

Influence of hydroxyapatite granule size, porosity, and crystallinity on tissue reaction in vivo. Part B: a comparative study with biphasic synthetic biomaterials.

OBJECTIVE: The aim of this study was to compare the influence of the physical-chemical properties of synthetic hydroxyapatite (HA) and biphasic commercial materials on the biological behavior of study materials through material characterization and SEM analysis before and after application in rabbit tibias. MATERIALS AND METHODS: Two defects were performed in each tibiae for a total of 180 defects: Group I HA granules (2000-4000 µm), Group II HA granules (1000-2000 µm), Group III HA granules (600-1000 µm), Group IV Ossceram® nano (Bredent medical GmbH & Co. KG, Senden, Germany), Group V 4Bone® granules (MIS Implants Technologies Ltd, Shlomi, Israel), and Group VI: empty defect acted as control. Comparison was performed by mean of material characterization, SEM, and EDX. RESULTS: 4Bone: Pores between 300 µm and 100 µm with intra- and interparticle spaces. Ossceram show also interparticle and intraparticle pores, between 100 µm and 26 µm, but the proportion of interparticles in the 4Bone is clearly minor than in the Ossceram. Related with pure HA, Group III has the greatest porosity (69.3%). For Group I, the intraparticle pores (0.71 µm) are about 8 times larger than those of the other two samples. The analysis of the images of in vivo SEM shown as biphasic groups has presented a more gradual resorption of the material. CONCLUSION: HA-based biomaterials, both pure and biphasic, are an effective means for bone regeneration processes; of these, materials with higher initial and secondary porosimetry allow greater cell colonization and therefore more effective substitution by new bone. The two-phase materials have a higher ion release to the environment in the early stages and thus allow greater colonization by collagen fibers that can be matured into new bone.

Effects on the osseointegration of titanium implants incorporating calcium-magnesium: a resonance frequency and histomorphometric analysis in rabbit tibia.

OBJECTIVE: This study assessed the bone formation around titanium surface incorporating the calcium-magnesium (CaMg) deposited by blasted in rabbit tibia bone to determine whether this surface would further enhance bone healing compared with commercially available implant surface. MATERIAL AND METHODS: The deposition of CaMg on the titanium SLA surface were obtained by blasting formed the experimental group (EX group), while implants with traditional SLA surface were used as control group (CO group), in this study. Fifty cylindrical threaded implants with a length of 8 mm were used (P = 25 per group). Five implants of each group were used to surface characterization by scanning electron microscopy, energy dispersive spectrometry, and optical profilometry. Ten New Zealand white rabbits received 40 implants (n = 20 per group). Resonance frequency analysis was performed three times (0, 4, and 6 weeks). Histomorphometric analysis was performed 4 and 6 weeks after implantation. Statistical significance was set at P < 0.05. RESULTS: Blasted CaMg deposition on SLA implant surface displayed almost identical surface morphologies and R(a) values at the micron scale. In comparing the implant stability quotient at the three time points, highly significant statistic differences were found (P < 0.001). Histomorphological analysis showed higher degrees of bone organization in the samples of test implant surfaces at both implantation times. CONCLUSION: Within the limitations of this study, the results indicate that the deposition of CaMg on the SLA titanium surface may be effective in enhancing the osseointegration of moderately rough grit-blasted implants by increasing the degree of bone-implant contact.

Piezosurgery for Treatment of Large Recurrent Mandibular Osteoma.

BACKGROUND: Osteomas are infrequent benign bone tumors of uncertain etiology. They are usually situated at extremities and their occurrence in the jaws is relatively rare. There are 3 types of osteoma: central, peripheral, and extraskeletal. Preoperative presumptive diagnosis is performed by means of radiography using orthopantomographs, computerized tomographs, or cone beam scans. Treatment is surgical and consists of careful exeresis and curettage of the adjacent tissue. In recent years, piezoelectric surgery has been used to treat bone pathologies in the maxillofacial area, orthopedic surgery, and neurosurgery. When used for the exeresis of a bone lesion, the device minimizes risks and eliminates possible complications arising from affectation of the vascular and nerve structures close to the lesion. OBJECTIVE: This clinical report describes a peripheral mandibular osteoma situated in the left mandibular basilar which recurred 45 years after surgical treatment at another center. METHODS: For resection, the surgical approach followed the scar remaining from the earlier surgery and was performed using piezoelectric surgery. Surgery did not cause hemorrhagic complications, affect the sensitivity of the left labial menton, or cause paralysis of the lower lip. CONCLUSIONS: Based on the present patient, it may be concluded that mandibular osteoma treatment by means of piezoelectric surgery makes precise exeresis possible with less affectation of the important surrounding structures such as the inferior alveolar nerve and the marginal mandibular branch of the facial nerve.

Reconstruction of Liposarcoma Resection Defect With a Made-to-Measure Polyethylene Prosthesis Using Three-Dimensional Digital Technology.

BACKGROUND: Liposarcoma is considered one of the most frequently occurring tumors of the soft tissues, representing 17% to 30% of all mesenchymal cell tumors. It is less common in the head and neck representing <10% of tumors in this region. The reconstruction of defects derived from resection of these tumors presents a surgical challenge. New three-dimensional digital technologies allow more exact surgery, cause less morbidity, and achieve adequate aesthetic outcomes. OBJECTIVE: The aim of this article was to describe the complex reconstruction of a defect caused by the resection of a liposarcoma in the temporal region. METHODS: Three-dimensional technology allowed patient planning and a reconstruction that was as exact as possible. A made-to-measure polymethyl methacrylate prosthesis was used to correct the defect in the zygomatic arch. The temporal fossa was covered with a standard porous polyethylene prosthesis. CONCLUSIONS: Satisfactory esthetic and functional results were achieved using three-dimensional digital technology for treatment planning and to fabricate a made-to-measure polyethylene prosthesis and surgical guide.

Biological effects of compressive forces exerted on particulate bone grafts during socket preservation: animal study.

OBJECTIVES: To compare different compressive forces exerted on a particulate graft material during socket preservation and their effects on bone regeneration. MATERIAL AND METHODS: Six male dogs were used. The second, third, and fourth premolars, and the first molar were extracted bilaterally at the lower jaws. A particulate synthetic biphasic grafting material (60% HA and 40% ß-tricalcium phosphate) was used. Three different standardized compressive forces were applied randomly during the socket preservation. The sample was divided into four experimental groups Test A (10 g), Test B (50 g), Test C (200 g), and Control (empty sockets). Collagen membranes were placed, and primary closure was obtained. Two months after the surgery the animals were sacrificed, and histomorphometric analysis of non-decalcified samples was performed at the coronal, middle, and apical thirds. RESULTS: Grafted sockets resulted in higher bony contour (3 ± 0.43 mm2 ; P < 0.05). The particles penetrated up to the apical third in the group C but not in the other test groups and controls (P < 0.05). The percentage of new bone were higher at the coronal and apical thirds for Controls and group C compared to A and B groups (P < 0.05). The residual graft was higher for group C (53 ± 1.4%), followed by group B (45 ± 3.1%) and group A (35 ± 1.9%; P < 0.05). The percentages of connective tissue were higher at the middle third without differences between groups (P > 0.05). CONCLUSIONS: Within the limitations of this experimental animal study, it might be concluded that grafted sockets compressed with 200 g force will have higher bony contours; higher compressive forces facilitate the penetration of the particulate graft material into the apical area of the socket and results in more bone formation at the coronal, middle, and apical thirds.

Periodontal status during pregnancy and postpartum.

OBJECTIVES: Different studies have documented an association between periodontal disease and low birth-weight delivery. Hence, knowledge of periodontal status during pregnancy and postpartum is important in order to reduce the risks of both diseases. This study aimed to analyze periodontal status at successive stages of pregnancy and 3-6 weeks postpartum in women with initial periodontal alterations. MATERIALS AND METHODS: Ninety-six pregnant women were examined at 8-10 weeks (pregnancy diagnosis, baseline), 21-23 weeks and 34-36 weeks of gestation and at 40 days postpartum to record plaque scores, clinically assessed gingival inflammation and probing depth (mean depth and % sites with depth >3 mm). Bivariate and multivariate analyses were performed. Type 1 (α) error was established at 0.05. RESULTS: Plaque Index increased (p = 0.043) throughout pregnancy (baseline, 42%±0.18); 21-23 weeks, 42.6%±0.14; 34-36 weeks, 45.6%±0.13 and decreased postpartum (44.8%±0-13). Gingival Index increased (p<0.001) throughout pregnancy (baseline, 56.7%±0.20; 21-23 weeks, 66.36%±0.17; 34-36 weeks, 74.5%±0.18) and decreased postpartum (59.3%±0.21). Probing Depth increased (p<0.001) throughout pregnancy (baseline, 2.51±0.05; 21-23 weeks, 2.63±0.053; 34-36 weeks 2.81±0.055) and decreased postpartum (2.54±0.049). Percentage of sites with Probing Depth >3 mm increased (p<0.001) throughout pregnancy (baseline, 17.6%±0.16; 21-23 weeks, 23.9%±0.17; 34-36 weeks, 31.1%±0.17) and decreased postpartum (21.2%±0.17) but remained significantly (p<0.02) higher than at baseline. CONCLUSION: Periodontal status deteriorates during gestation but improves postpartum.

Increased salivary oxidative stress parameters in patients with type 2 diabetes: Relation with periodontal disease. / Incremento de los parámetros de estrés oxidativo salival en pacientes con diabetes tipo 2: relación con la enfermedad periodontal.

OBJECTIVE: The aim of this study was to determine whether there are differences in salivary oxidative stress between patients with diabetes mellitus type 2 (DM2) and healthy non-diabetic patients, and whether this oxidative stress is associated with the presence of periodontal disease in diabetic patients. MATERIAL AND METHODS: This observational study included 70 patients divided into three groups according to metabolic control levels: 19 non-diabetic patients (control group); 24 patients with good metabolic control (HbA1c<7%), and 27 patients DM2 with poor metabolic control (HbA1c>7%). The following oxidative stress parameters were measured in all subjects: glutathione peroxidase (GPx), glutathione reductase (GRd), reduced glutathione (GSH) and oxidized glutathione (GSSG). Periodontal health was determined by means of the community periodontal index (CPI) recommended by the WHO. RESULTS: The diabetic group with good metabolic control showed a significant increase in GPx and GRd activity in comparison with the control group (P<.001). The activity of the enzymes measured was significantly less in patients with poor metabolic control in comparison with the control group and well-controlled diabetic groups (P<.001). Both diabetic groups showed higher GSSG/GSH quotients and CPI in comparison with the control group, and both parameters were significantly higher in diabetic patients with poor metabolic control in comparison with well-controlled diabetic patients. CONCLUSIONS: Poor metabolic control in DM2 patients is associated with higher levels of salivary oxidative stress and worse periodontal health.