Does the adjunctive use of autologous platelet concentrate during secondary alveolar bone grafting reduce the risk of wound dehiscence? A systematic review and meta-analysis.

Wound dehiscence is a common complication after secondary alveolar bone grafting (SABG), leading to unfavourable surgical outcomes. Studies have shown that autologous platelet concentrates (APC) may enhance wound healing and improve outcomes. Therefore, this review aimed to evaluate in patients with alveolar clefts, whether using APC and iliac crest bone graft can mitigate the likelihood of wound dehiscence formation compared with those who underwent iliac bone grafting only following SABG. A comprehensive literature search was conducted using various electronic databases, including PubMed, Embase, Scopus, Web of Science, EBSCOhost, Ovid MEDLINE, LILACS, Cochrane Library, and grey literature, to include studies until July 31, 2023, without any restriction to language and time of publication. Only randomized (RCT) and controlled (CCT) clinical trials were included. Two independent reviewers screened the studies based on the predefined criteria, after which a qualitative and quantitative analysis was conducted. The search yielded 821 studies, of which seven were deemed eligible for systematic review. The risk of bias assessment done using "The Cochrane collaboration tool for risk of bias assessment" for six RCTs and the "Risk of Bias in Non-randomized Studies - of Interventions" for one CCT revealed a moderate to high risk of bias. The meta-analysis of five studies showed that the overall risk of developing wound dehiscence was lower in the APC group (RR = 0.33; 95% CI: 0.16, 0.71; p = 0.005; χ2 = 0.82; I2 = 0%). Subgroup analyses based on study design further supported these findings. Although the adjuvant use of APC for alveolar cleft reconstruction reduces the risk of wound dehiscence, more studies with increased scientific rigour and fewer confounding variables are warranted.

Coconut Water Induces Clinical Remission in Mild to Moderate Ulcerative Colitis: Double-blind Placebo-controlled Trial.

BACKGROUND & AIMS: Coconut water (CW) is anti-inflammatory, can manipulate the gut microbiome, and is a rich source of potassium. Gut microbiome modulation improves outcomes in ulcerative colitis (UC), and potassium possesses in vitro anti-inflammatory property. We evaluated the effect of CW as an adjunct therapy for patients with mild-moderate UC. METHODS: This single-center, double-blind, placebo-controlled trial randomized patients with mild to moderate (Simple Clinical Colitis Activity Index [SCCAI]: 3-9) endoscopically active UC (Ulcerative Colitis Endoscopic Index of Severity [UCEIS] >1) in 1:1 ratio to CW + standard medical therapy (SMT) vs placebo + SMT. Four hundred mL of CW was administered for 8 weeks. Primary outcome measure was clinical remission (SCCAI ≤2), and secondary outcome measures were clinical response (SCCAI decline ≥3) and adverse events at 8 weeks. Microbiome was analyzed at baseline and 8 weeks. RESULTS: Of 121 patients screened, 95 were included for modified intention to treat analysis (CW, n = 49; placebo, n = 46) (mean age, 37.2 ± 11.2 years; males, 54.1%; disease duration, 48 months [interquartile range (IQR), 24-90 months]; pancolitis, 26.1%; SCCAI, 5 [IQR, 4-6]; UCEIS, 4 [IQR, 3-5]). Clinical response (57.1% vs 28.3%; odds ratio [OR], 3.4; 95% confidence interval [CI], 1.4-7.9; P = .01), remission (53.1% vs 28.3%; OR, 2.9; 95% CI, 1.2-6.7; P = .02), and proportion of patients with fecal calprotectin (FCP) <150 µg/g (30.6% vs 6.5%; OR, 6.3; 95% CI, 1.7-23.6; P = .003) were significantly higher in CW. The relative abundance of bacterial taxa that had a significant or trend towards negative correlation with SCCAI, UCEIS, or FCP increased at 8 weeks in CW, and this effect was independent of disease activity and dietary fiber. Adverse events were comparable, and no patient developed hyperkalemia. CONCLUSIONS: CW was more effective than placebo for induction of clinical remission in patients with mild to moderate UC. The trial was prospectively registered on Clinical Trials Registry of India (ctri.nic.in, Number: CTRI/2019/03/01827).

Evidence-based suggestions to improve the methodological issues in reporting of prevalence studies on gingival recession.

Gingival recession (GR) is considered a public health problem which is highly prevalent across different populations. Accuracy of psychometric properties of prevalence estimates of GR reported in epidemiological studies is important to facilitate setting public health goals, planning of public health programs, implementation of best practices and thereby developing public health policy. However, the reported prevalence estimates are influenced by the methodological variations among different studies, as observed in our recently published systematic review and meta-analysis on the global prevalence of GR. It substantially limits the comparability between studies and inferences about the true global variation in the prevalence of GR are difficult to establish. To address these issues, this commentary suggests to follow the standardized principles related to study design, clinical examination protocol, and characteristics of study subjects in future epidemiological studies on prevalence estimates of GR. Furthermore, the inclusion of additional domains in the reporting data is suggested for a deeper insight into the patterns of GR in different populations. Our suggestions are derived from a pragmatic approach and their consistent implementation would improve the reporting quality and achieve uniformity in future studies, thus benefitting the research in this area.

Indices for the assessment of radiation-related caries.

Radiation therapy, either used alone or in combination with surgery and or chemotherapy, is the most commonly utilized modality for treating head and neck cancers. Patients undergoing radiation therapy usually experience significant early and late-onset toxicities/adverse effects. Radiation-related caries (RRC) is a common complication that detrimentally affects patients' quality of life (QoL). A clearer understanding and more uniform approach to scoring systems help provide a more accurate diagnosis, form treatment protocols, plan, and evaluate outcomes of preventive initiatives and create scientific databases. Many indices have been used to assess and quantify the dental caries experience after radiotherapy. Considering the need for uniform standards for measuring radiation caries, indices specific to radiation caries have been proposed in the literature to capture postradiation damage to the dentition accurately. This narrative review aims to consolidate the evolution of different indices used for scoring RRC to improve the understanding of radiation caries assessment.

Development and Validation of a Smartphone Application for Telenutrition in Patients with Inflammatory Bowel Disease.

The use of smartphone-based applications as a telenutrition tool could redefine the nutritional management of IBD. We developed and validated a digital health platform in the form of a smartphone application for the nutritional assessment of IBD patients. Our team of gastroenterologists and dieticians at the All-India Institute of Medical Sciences, New Delhi developed a smartphone application titled IBD NutriCare, which was made available in both Android and iOS interfaces in English and seven other Indian languages. The application includes >650 Indian recipes and provides subjective global assessment and IBD clinical activity scores in a patient-friendly manner. The utility of the smartphone app was validated in comparison with the traditional 24-h dietary recall method. A total of 49 IBD patients were enrolled in the study. The mean difference in energy intake between the two dietary assessment methods was −4.776 kJ (95% LOA, range −417.916−408.365 kJ). A total of 94% of patients found the smartphone application convenient and acceptable in comparison to the recall method for dietary assessment. Bland−Altman plots showed a good level of agreement for nutrients and food groups between the two methods. Telenutrition in the form of a smartphone application helps in real-time tracking of dietary details of IBD patients, thus making appropriate interventions and large-scale data acquisition feasible.

Oral manifestations and dental practice recommendations during COVID-19 pandemic.

Oral health is a pivotal sign of overall health, well-being, and quality of life. With the emergence of COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), insights into the relationship between SARS-CoV-2 and oral diseases are urgently needed to elucidate the oral manifestations of SARS-CoV-2. The current review aims at analyzing various reports available on oral symptoms along with possible causation, their relationship to the time of occurrence of clinical symptoms, and to shape guidelines for dental practices that could help in combating this global pandemic. The common symptoms that patients report to the dental office even at the presymptomatic stage are ageusia (loss of taste), non-specific anosmia (loss of smell-not associated with rhinitis), and hyposalivation. Few studies also report unexplained ulcers in the oral cavity, desquamative gingivitis, herpetiform ulcers on attached gingiva, blisters/irregular ulcers on the tongue's dorsal surface enlargement of submandibular glands, and cervical lymph node enlargement. Dental surgeons should abide by the prevalent precautionary guidelines. They are at very high risk due to their close contact with patients and exposure to saliva and blood during treatment.

Palatal volume estimation in operated unilateral and bilateral cleft lip and palate subjects using digital study models.

OBJECTIVE: To quantify and compare palatal volume of operated unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) subjects. SETTING AND SAMPLE POPULATION: This cross-sectional study was conducted on 85 study models comprising of 40 operated UCLP subjects (UG; mean age 10.33 ± 1.76 years), 25 operated BCLP subjects (BG; mean age 10.44 ± 1.92 years) and 20 non-cleft controls (C; mean age 12.90 ± 1.68 years). MATERIALS AND METHOD: The study models were scanned using 3D scanner and palatal volume assessment done using 3-matic software. Kruskal-Wallis test for palatal volume and one-way ANOVA for intercanine (IC), interpremolar (IPM) and intermolar (IM) width comparison were used. Pearson correlation was done between IM, IPM, and IC width, and palatal volume for three groups. The control group sample was evaluated by two observers to evaluate the interobserver reliability. RESULTS: The median palatal volume of C, UG and BG groups was 5814.31 mm3 , 2452.34 mm3 and 1688.39 mm3 , respectively. Significantly smaller palatal volume was found in UG and BG compared to control. Significant difference was seen in IC width between three groups. The IM, IPM and IC width with palatal volume in UG and IM width with palatal volume in BG group showed significant correlation. The ICC showed excellent agreement (>0.9) between observers. CONCLUSION: Palatal volume of UG and BG groups was smaller by 57.82% and 71.1%, respectively, compared to controls. Improving IPM width in UG and IM width in BG seems to have more impact in correction of palatal volume.

Effect of orthodontic forces on levels of enzymes in gingival crevicular fluid (GCF): A systematic review.

OBJECTIVE: Orthodontic force application releases multiple enzymes in gingival crevicular fluid (GCF) for activation, resorption, reversal, deposition of osseous elements and extracellular matrix degradation. The current systematic review critically evaluated all existing evidence on enzymes in orthodontic tooth movement. METHODS: Literature was searched with predetermined search strategy on electronic databases (PubMed, Scopus, Embase), along with hand search. RESULTS: Initial search identified 652 studies, shortlisted to 52 studies based on PRISMA. Quality assessment further led to final inclusion of 48 studies (13 moderately and 35 highly sensitive studies). Primary outcomes are significant upregulation in GCF levels of enzymes-aspartate aminotransferase (AST), alkaline phosphatase (ALP), matrix metalloproteinases (MMPs), lactate dehydrogenase (LDH), ß-glucuronidase (ßG), tartrate resistant acid phosphatase (TRAP), acid phosphatase (ACP) and down regulation in cathepsin B (Cb). Site specificity is shown by ALP, TRAP, AST, LDH, MMP9 with levels at compression site increasing earlier and in higher quantities compared with tension site. ALP levels are higher at tension site only in retention. A positive correlation of LDH, ALP and AST is also observed with increasing orthodontic force magnitude. CONCLUSIONS: A strong evidence of variation in enzymes (ALP, AST, ACP TRAP, LDH, MMPs, Cb) in GCF is found in association with different magnitude, stages and sites of orthodontic force application.

Effect of orthodontic forces on levels of enzymes in gingival crevicular fluid (GCF): A systematic review

Abstract Objective: Orthodontic force application releases multiple enzymes in gingival crevicular fluid (GCF) for activation, resorption, reversal, deposition of osseous elements and extracellular matrix degradation. The current systematic review critically evaluated all existing evidence on enzymes in orthodontic tooth movement. Methods: Literature was searched with predetermined search strategy on electronic databases (PubMed, Scopus, Embase), along with hand search. Results: Initial search identified 652 studies, shortlisted to 52 studies based on PRISMA. Quality assessment further led to final inclusion of 48 studies (13 moderately and 35 highly sensitive studies). Primary outcomes are significant upregulation in GCF levels of enzymes-aspartate aminotransferase (AST), alkaline phosphatase (ALP), matrix metalloproteinases (MMPs), lactate dehydrogenase (LDH), β-glucuronidase (βG), tartrate resistant acid phosphatase (TRAP), acid phosphatase (ACP) and down regulation in cathepsin B (Cb). Site specificity is shown by ALP, TRAP, AST, LDH, MMP9 with levels at compression site increasing earlier and in higher quantities compared with tension site. ALP levels are higher at tension site only in retention. A positive correlation of LDH, ALP and AST is also observed with increasing orthodontic force magnitude. Conclusions: A strong evidence of variation in enzymes (ALP, AST, ACP TRAP, LDH, MMPs, Cb) in GCF is found in association with different magnitude, stages and sites of orthodontic force application.

Resumo Objetivo: a aplicação da força ortodôntica libera múltiplas enzimas no fluído crevicular gengival (FCG), desencadeando a ativação, reabsorção, reversão, deposição de elementos ósseos e degradação da matriz extracelular. A presente revisão sistemática avaliou criticamente toda a evidência disponível sobre os níveis de enzimas durante a movimentação ortodôntica. Métodos: utilizando-se estratégias predeterminadas, foram realizadas buscas em bases de dados eletrônicas (PubMed, Scopus, Embase), sendo também feitas buscas manuais. Resultados: a busca inicial identificou 652 estudos e, com base nas diretrizes do PRISMA, foram selecionados 52 estudos. A avaliação qualitativa resultou na inclusão final de 48 estudos (13 estudos com moderada sensibilidade e 35 com alto nível de sensibilidade). Os desfechos primários foram o aumento significativo dos níveis no FCG das enzimas aspartato aminotransferase (AST), fosfatase alcalina (FA), metaloproteinases de matriz (MMPs), lactato desidrogenase (LDH), β-glucuronidase (βG), fosfatase ácido-resistente ao tartarato (TRAP), fosfatase ácida (FAC) e baixa regulação de catepsina B (Cb). Especificidade quanto ao local foi mostrada para FA, TRAP, AST, LDH e MMP9 com os níveis no lado de compressão aumentando mais rápido e em maiores quantidades, quando comparado ao lado de tensão. Os níveis de FA foram maiores no lado de tensão somente no período de contenção. Uma correlação positiva de LDH, FA e AST também foi observada à medida que a magnitude de força ortodôntica aumentou. Conclusões: há fortes evidências indicando que as variações nas enzimas (FA, AST, FAC, TRAP, LDH, MMPs, Cb) presentes no FCG estão associadas a diferentes magnitudes, estágios e locais de aplicação da força ortodôntica.

A Pristine Approach for the Prominent Premaxilla in Bilateral Cleft Lip and Palate (BCLP) Cases.

OBJECTIVE: The neonate premaxilla in bilateral cleft lip and palate is often protruding and displaced laterally. Surgeons prefer the premaxilla to be repositioned and centralized to allow a tension-free primary lip repair. This report describes the fabrication of a premaxillary bonnet appliance with silicone material and its successful use in 2 cases of bilateral cleft lip and palate (BCLP). PATIENTS, PARTICIPANTS: Two male BCLP patients of ages 34 days and 10 days, respectively. INTERVENTIONS: Nonsurgical repositioning of the premaxillary segment using silicone cup-bonnet appliance. RESULTS: The duration of active treatment by silicone appliance was 36 days in case 1 and 75 days in case 2. The retention period was 2 months and 3 months, respectively. The appliance made of room temperature vulcanizing (RTV) silicone is flexible and softer in comparison to the rigid conventional acrylic appliance and is therefore almost atraumatic. A gentler appliance resulted in enhanced compliance and acceptance by the neonates. There was a noticeable change in the position of the discernible asymmetric premaxilla. Analysis of frontal facial photographs revealed an angular change in the position of the premaxilla (C) by 12° in case 1 and 6° in case 2 in reference to the midfacial plane. CONCLUSION: This silicone appliance provides enhanced compliance and improved retention compared to acrylic appliance since it is a more gentle, flexible, and less traumatic alternative to a rigid acrylic appliance. Further, the RTV silicone appliance can be 3-dimensionally printed for better accuracy following intraoral scanning and thus eliminating the need for impression making in cleft newborns.

Synergistic Effect of BDNF and FGF2 in Efficient Generation of Functional Dopaminergic Neurons from human Mesenchymal Stem Cells.

To understand the process of neurogenesis, generation of functional dopaminergic (DAergic) neurons from human mesenchymal stem cells (hMSCs) is important. BDNF has been reported to be responsible for inducing neuronal maturation and functionality. Previously, we have reported the efficient generation of neurons from human bone marrow derived MSCs using FGF2 alone. We hypothesize that hMSCs from various tissues [(bone marrow (BM), adipose tissue (AD) and dental pulp (DP)], if treated with BDNF on 9th day of induction, alongwith FGF2 will generate functional DAergic neurons. Hence, cells were characterized at morphometric, transcription and translational levels for various markers like MAP2, TH, NGN2, PITX3, DAT, synaptophysin, Kv4.2 and SCN5A. Functionality of in vitro generated neurons was studied by calcium ion imaging. Result analysis depicted that BDNF has effect on expression of dopaminergic neuronal markers at gene and protein levels and functionality of neurons. Among these hMSCs, DP-MSC showed significantly better neuronal characteristics in terms of morphology, expression of neuronal markers and foremost, functionality of neurons. From the present study, therefore, we concluded that i) BDNF has additive effect on neuronal characteristics and functionality ii) DP-MSC are better MSC candidate to study DAergic neurogenesis and perform future studies.

Quantitative and qualitative assessment of anchorage loss during en-masse retraction with indirectly loaded miniscrews in patients with bimaxillary protrusion.

INTRODUCTION: This study provides vital insight in assessing anchorage loss when miniscrews are indirectly loaded. METHODS: The study sample comprised 18 patients with bimaxillary protrusion (14 girls, 4 boys; mean age, 17.3 ± 4.6 years) selected from a database of 89 patients treated with miniscrews. All subjects who were selected required extraction of all first premolars and maximum anchorage. After initial leveling and aligning, miniscrews were placed between the first molar and the second premolar in all 4 quadrants and loaded by the indirect method at 3 weeks after placement with 200-g nickel-titanium alloy closed-coil springs for en-masse retraction. Mean treatment duration was 29.7 ± 6.8 months. Pretreatment and posttreatment lateral cephalograms were analyzed to measure the amount of anchorage loss, incisor retraction, and the incisors' angular change in reference to the pterygoid vertical reference line and were evaluated by the structural superimposition method. RESULTS: The ratio of incisor retraction to molar protraction was 4.2 in the maxilla and 4.7 in the mandible. The first molars showed mean extrusion of 0.20 mm in the maxilla and 0.57 mm in the mandible; these were statistically insignificant. The mean angular change of the first molars was -2.43° in the maxilla and -0.03° in the mandible. The mean anchorage loss in reference to the pterygoid vertical was 1.3 mm in the maxilla and 1.1 mm in the mandible; these were statistically significant. Structural superimpositions showed mean change in molar position of 0.83 mm in the maxilla and 0.87 mm in the mandible, and 5.77 mm in the maxillary incisor and 5.43 mm in the mandibular incisor. These results were compared with the direct anchorage method reported in the literature. CONCLUSIONS: Indirect miniscrew anchorage can be a viable alternative to direct anchorage.

Effect of orthodontic forces on cytokine and receptor levels in gingival crevicular fluid: a systematic review.

This systematic review aimed to generate evidence on role of potent markers of inflammation [cytokines, chemokines, their associated receptors and antagonists] following the application of orthodontic forces. Subsequent to registration with PROSPERO, literature search followed a predetermined search strategy to key databases along with hand search (HS). Seventy-seven articles from PubMed (P), 637 from Scopus (S), 51 from Embase (E), and 3 from hand search (HS) were identified. A total of 39 articles were shortlisted that met strict inclusion and exclusion criteria and quality assessment. Each study was evaluated for participant characteristics, study design, oral hygiene regimen, and gingival crevicular fluid (GCF) handling. Among these studies, biomarkers in the order of frequency were interleukin (IL)-1ß (N=21), tumor necrosis factor (TNF)-α (N=10), IL-8,IL-6(N=8), receptor activator of nuclear factor kappa-B ligand (RANKL) (N=7), monocyte chemoattractant protein (MCP)-1 (N=3), IL-2 (N=4), IL-4, IL-10, RANTES (N=2), IL-1, IL-5, IL-1α, IP-10, osteopontin (OPN) (N=1) and receptors and their antagonists in the order of osteoprotegerin (OPG) (N=8), IL-1RA (N=5), and RANK (N=1). Results revealed an immediate release of inflammatory bone-resorptive mediators, IL-1ß and TNF-α, where IL-1ß increased as early as 1 min to 1 h reaching peak at 24 h while TNF-α increased at 1 h or 1 day. This was accompanied by a fall in bone-protective mediator (OPG) levels at 1 h and 24 h after orthodontic force application. Continuous forces were accompanied by a decrease in mediator levels after attaining peak levels (most commonly at 24 h) while repeated activations in interrupted force upregulated their secretion. Significant correlations of IL-1ß levels with pain intensity, rate of orthodontic tooth movement (OTM) and of activity index (AI) (IL-1ß/IL-1RA) with velocity of tooth movement and growth status of individuals have also been deduced. A greater AI and RANKL/OPG ratio was seen in juveniles as compared to adults or non-growers that were associated with faster rate of OTM in juveniles. None of the studies addressed the effect of estrous cycle in female subjects. Lack of homogeneity in several parameters calls for a better controlled research on the biology of OTM.

Innovative biomechanics for orthodontic correction of torsiversion of maxillary central incisor caused by twin mesiodens.

Mesiodens is the most common type of supernumerary teeth found in the premaxilla between the two central incisors. Early and proper diagnosis and appropriate treatment plan is critical in eluding the extent of treatment needed. This case report presents the successful orthodontic and esthetic management of an unusual case of Indian origin with twin mesiodens in the maxillary arch causing torsiversion and attrition of mandibular incisors due to occlusal trauma.

A study of interleukin 1ß levels in peri-miniscrew crevicular fluid (PMCF).

BACKGROUND: This study provides a vital insight in assessing the clinical and biochemical changes in interleukin (IL)-1ß levels in peri-miniscrew crevicular fluid (PMCF) during the course of orthodontic tooth movement. METHODS: The study comprised the analysis of IL-1ß in peri-miniscrew crevicular fluid obtained from crevices around the miniscrews inserted in 11 patients (eight females and three males, mean age 17.3 ± 4.64 years) with all first premolar extraction and maximum anchorage requirement using miniscrew-supported anchorage. Miniscrews were loaded at 3 weeks after placement by 200-g nitinol closed coil springs of 9-mm length for en masse retraction. Peri-miniscrew crevicular fluid was collected at miniscrew placement (T1), at 3 weeks (T2/baseline) and on loading at 0 (T3) and 1 day (T4), 21 (T5), 72 (T6), 120 (T7), 180 (T8) and 300 (T9) days. IL-1ß levels were estimated by enzyme-linked immunosorbent assay (ELISA). Peri-miniscrew tissue was examined for signs of inflammation, and also, miniscrew mobility was assessed with Periotest and handles of two mouth mirrors. RESULTS: IL-1ß levels in all miniscrews were significantly higher at T1 and peaked again at T4 showing a bimodal peak. However, there was a gradual and statistically significant decrease in IL-1ß till T5, while further changes till the end of the study were statistically not significant. CONCLUSIONS: The changing levels of IL-1ß levels in PMCF over a duration of 300 days are suggestive of the underlying inflammatory process. IL-1ß levels in PMCF show a significant rise during miniscrew insertion and on immediate loading. The trend of gradually reducing IL-1ß levels around the miniscrew over the period after loading towards baseline is suggestive of adaptive bone response to stimulus.