Impact of surface chemical treatment in surgical regenerative treatment of ligature-induced peri-implantitis: A canine study.

BACKGROUND: Implant surface decontamination is a critical step in peri-implantitis treatment. The aim of this study was to assess the effect chemotherapeutic agents have on reosseointegration after treatment on ligature-inducted peri-implantitis. METHODS: Six male canines had 36 implants placed and ligatures were placed around them for 28 weeks to establish peri-implantitis. The peri-implant defects were randomly treated by 1 of 3 methods: 0.12% chlorhexidine (CHX test group), 1.5% sodium hypochlorite (NaOCl test group), or saline (Control group). Sites treated with NaOCl and CHX were grafted with autogenous bone, and all sites then either received a collagen membrane or not. Histology sections were obtained at 6 months postsurgery to assess percentage of reosseointegration. RESULTS: Thirty-five implants were analyzed (CHX: 13; NaOCl: 14; Control:8). NaOCl-treated sites demonstrated reosseointegration with direct bone-to-implant-contact on the previously contaminated surfaces (42% mean reosseointegration), which was significantly higher than Controls (p < 0.05). Correspondingly, clinical improvement was noted with a significant reduction in probing depth from 5.50 ± 1.24 mm at baseline to 4.46 ± 1.70 mm at 6-months postsurgery (p = 0.006). CHX-treated sites demonstrated a nonsignificant reosseointegration of 26% (p > 0.05); however, in the majority of cases, the new bone growth was at a distance from the implant surface without contact. Probing depths did not improve in the CHX group. The use of membrane did not influence reosseointegration or probing depths (all p > 0.05). CONCLUSION: Titanium implants with peri-implantitis have the capacity to reosseointegrate following regenerative surgery. However, treatment response is contingent upon the chemotherapeutic agent selection. Additional chemical treatment with 1.5% NaOCl lead to the most favorable results in terms of changes in defect depth and percentage of reosseointegration as compared to CHX, which may hinder reosseointegration.

Low energy intake and nutritional maladaptation in terminal stage IV periodontitis.

AIM: Impairment of masticatory function in elderly patients with terminal dentition due to stage IV periodontitis (TDS4P) may lead to lower nutritional intake. The study aimed to report the dietary intake and nutrition status of elderly patients with TDS4P and compare them with those of the elderly Chinese population and the Chinese Dietary Reference Intakes (DRIs). MATERIALS AND METHODS: Fifty-one consecutive subjects (≥55 years old) with TDS4P were enrolled. Average dietary intake was evaluated based on a 3-day 24-h dietary recall (24HR) and food frequency questionnaire (FFQ). The daily intake of fresh vegetables and fruits, dietary energy as well as macro and micronutrients were calculated and compared with matched national data and the Chinese DRIs. Nutritional status was assessed by Short-Form Mini-Nutritional assessment. RESULTS: Of the subjects, 19.6% (95% CI: 7.2%-28.1%) were at risk of malnutrition. The mean daily energy intake was 1517.4 kcal (95% CI: 1400.5-1634.3) for males and 1110.7 kcal (95% CI: 1001.5-1219.9) for females, which were very low compared with both the national data and the DRIs. Females derived a higher percentage of energy from fat. The mean daily intake of vegetables was 151.4 g (95% CI: 128.1-174.8) by FFQ and 130.9 g (95% CI: 104.6-157.3) by 24HR. Both results were significantly lower than the national reports (95% CI: 310.3-340.1) and the DRIs (300-450 g). Insufficient micronutrient intake, especially vitamins A, C and E, was also found. CONCLUSIONS: Elderly subjects with TDS4P had a lower daily energy intake, vegetable and fruit consumption and essential macro and micronutrient intake. More studies are needed to clarify the impact of periodontitis and tooth loss/replacement on nutrition and healthy ageing.

The potential causal path between periodontitis stage diagnosis and vegetable consumption is mediated by loss of posterior functional tooth units and masticatory function.

AIM: Emerging evidence points to a two-way relationship between periodontitis and dietary choices and, thus, nutrition. This study aimed to assess the potential cause-effect relationship between the periodontitis stage, loss of functional tooth units (FTUs), masticatory function, and intake of different food groups using path analysis. MATERIALS AND METHODS: A single calibrated examiner determined the periodontitis stage of a consecutive sample of 241 Chinese subjects reporting for tooth replacement. Their masticatory function was quantified by the mixing ability of a two-colour chewing gum. Validated food frequency questionnaires were used to calculate the intake of 33 food group items by an experienced calibrated rater. After verification of assumptions, visual structural equation modeling was performed with Amos 23. The consistency of results and the potential modifying effect of age were assessed in 9043 subjects from the NHANES database. RESULTS: Highly significant models were constructed using periodontitis stage and age as exogenous factors. Periodontitis stage diagnosis significantly affected the number of posterior FTUs and oral health-related quality of life (OHRQoL, path coefficient [PC] = -0.55 and -0.20, p < .05, respectively). In the model, FTUs also had an independent effect on OHRQoL (PC = 0.23, p < .05). FTUs determined the level of masticatory function (PC = -0.38, p < .05), which in turn affected vegetable intake but not fruit or meat intake (PC = -0.18, p < .0.5, PC = 0.06, NS and PC = 0.11, NS, respectively). The effect of age was significant for vegetable and meat intake and was also correlated with periodontitis stage diagnosis. Analysis of the NHANES database confirmed the negative impact of periodontitis on the number of occluding pairs and vegetable consumption for the 18-44, 45-60 and >60 age groups. CONCLUSIONS: Periodontitis showed a potential cause-effect pathway affecting vegetable intake across cultures and age groups. The size of the effect is potentially of clinical and public health significance. Additional studies, including intervention trials, are required to test this potential mechanism linking oral health to nutrition.

Single-cell sequencing identifies inflammation-promoting fibroblast-neutrophil interaction in peri-implantitis.

AIM: To reveal the cellular composition and molecular environment of the periodontal and peri-implant inflammatory infiltrates through a single-cell sequencing technique, which may explain the pathological difference between these two diseases. A special focus was placed on the phenotypes and potential roles of neutrophils and fibroblasts in peri-implant/periodontal tissue immunity. MATERIALS AND METHODS: High-throughput single-cell transcriptomic profiling of peri-implant tissues from patients with peri-implantitis as well as periodontal tissues from patients with periodontitis and healthy donors was performed. Immunofluorescence analysis was carried out to further validate the identified cell subtypes and their involvement in peri-implantitis and periodontitis. RESULTS: Based on our single-cell resolution analysis, a quantified proportional increase of neutrophil (Neu) subtypes was shown in peri-implantitis. Among these, a predominance of Neutro_CXCR2 was revealed. We also found the involvement of inflammation-promoting fibroblasts as well as a predominance of CXCL8+ fibroblast-CXCR2+ neutrophil interaction in peri-implantitis. CONCLUSIONS: Our study indicated that the predominance of CXCL8+ fibroblast-CXCR2+ neutrophil interaction might underline the enhanced host response in peri-implantitis compared with periodontitis. This information offers a molecular basis by which fibroblast and neutrophil subtypes might be diagnostically and therapeutically targeted in peri-implantitis.

Microbiome-based therapies for periodontitis and peri-implantitis.

OBJECTIVES: Periodontitis and peri-implantitis are oral infectious-inflammatory diseases associated with oral microbial dysbiosis. Microbiome-based therapies, characterized by manipulation of the microbiota, are emerging as promising therapeutic approaches to resolve the microbial dysbiosis and associated dysregulation of immune system. This review aims at summarizing recent progress on microbiome-based therapies in periodontitis and peri-implantitis, promoting a further understanding of the related therapeutic mechanisms. SUBJECTS AND METHODS: Pertinent literatures focused on microbiome-based therapies for periodontitis and peri-implantitis are obtained from PubMed and Web of Science. RESULTS: In this article, we review the roles and therapeutic mechanisms of four microbiome-based therapies, including probiotics, postbiotics, predatory bacteria and phages, and microbiota transplantation, in the management of periodontitis and peri-implantitis. Challenges facing this field are also discussed, highlighting the areas that require more attention and investigation. CONCLUSIONS: Microbiome-based therapies may serve as effective treatment for periodontitis and peri-implantitis. This review presents a new viewpoint to this field.

Involving people with lived experience in developing a core outcome set for implant dentistry research. The Implant Dentistry-Core Outcomes Sets and Measures (ID-COSM) project.

AIMS: The aims of this project were to establish the outcomes for dental implant research that are important to people with lived experience (PWLE) and to achieve consensus with those developed by dental professionals (DPs) for a core outcome set (COS). This paper reports the process, outcomes and experiences of involving PWLE in developing a COS for dental implant research: the Implant Dentistry Core Outcome Sets and Measures project. MATERIALS AND METHODS: Overall methods were guided by the Core Outcome Set Measures in Effectiveness Trials (COMET) initiative. Initial outcome identification was achieved from focus groups with PWLE employing calibrated methods across two low-middle-income countries (China and Malaysia) and two high-income countries (Spain and the United Kingdom). Following consolidation of the results, the outcomes were incorporated into a three-stage Delphi process with PWLE participation. Finally, consensus between PWLE and DPs was achieved using a mixed live and recorded platform. The experiences of PWLE involvement in the process was also evaluated. RESULTS: Thirty-one PWLE participated in four focus groups. Thirty-four outcomes were suggested across the focus groups. Evaluation of the focus groups revealed a high level of satisfaction with the engagement process and some new learning. Seventeen PWLE contributed to the first 2 Delphi rounds and 7 to the third round. The final consensus included 17 PWLE (47%) and 19 DPs (53%). Out of the total of 11 final consensus outcomes considered essential by both PWLE and health professionals, 7 (64%) outcomes mapped across to ones that PWLE initially identified, broadening their definition. One outcome (PWLE effort required for treatment and maintenance) was entirely novel. CONCLUSIONS: We conclude that engaging PWLE in COS development can be achieved across widely different communities. Furthermore, the process both broadened and enriched overall outcome consensus, yielding important and novel perspectives for health-related research.

Involving people with lived experience in developing a core outcome set for implant dentistry research. The Implant Dentistry-Core Outcomes Sets and Measures (ID-COSM) project.

AIMS: The aims of this project were to establish the outcomes for dental implant research that are important to people with lived experience (PWLE) and to achieve consensus with those developed by dental professionals (DPs) for a core outcome set (COS). This paper reports the process, outcomes and experiences of involving PWLE in developing a COS for dental implant research: the Implant Dentistry Core Outcome Sets and Measures project. MATERIALS AND METHODS: Overall methods were guided by the Core Outcome Set Measures in Effectiveness Trials (COMET) initiative. Initial outcome identification was achieved from focus groups with PWLE employing calibrated methods across two low-middle-income countries (China and Malaysia) and two high-income countries (Spain and the United Kingdom). Following consolidation of the results, the outcomes were incorporated into a three-stage Delphi process with PWLE participation. Finally, consensus between PWLE and DPs was achieved using a mixed live and recorded platform. The experiences of PWLE involvement in the process was also evaluated. RESULTS: Thirty-one PWLE participated in four focus groups. Thirty-four outcomes were suggested across the focus groups. Evaluation of the focus groups revealed a high level of satisfaction with the engagement process and some new learning. Seventeen PWLE contributed to the first 2 Delphi rounds and 7 to the third round. The final consensus included 17 PWLE (47%) and 19 DPs (53%). Out of the total of 11 final consensus outcomes considered essential by both PWLE and health professionals, 7 (64%) outcomes mapped across to ones that PWLE initially identified, broadening their definition. One outcome (PWLE effort required for treatment and maintenance) was entirely novel. CONCLUSIONS: We conclude that engaging PWLE in COS development can be achieved across widely different communities. Furthermore, the process both broadened and enriched overall outcome consensus, yielding important and novel perspectives for health-related research.

Accuracy of photogrammetric imaging versus conventional impressions for complete arch implant-supported fixed dental prostheses: A comparative clinical study.

STATEMENT OF PROBLEM: Clinical studies on the accuracy of the photogrammetric imaging technique for complete arch implant-supported fixed dental prostheses are lacking. PURPOSE: The purpose of this clinical study was to evaluate the accuracy (trueness) of photogrammetric imaging for complete arch implant-supported prostheses by comparing photogrammetric imaging with verified conventional splinted impressions. MATERIAL AND METHODS: Completely edentulous arches with at least 4 implants were included. Both photogrammetric imaging and conventional splinted impressions were performed in each jaw. The conventional casts were verified and scanned by using a laboratory scanner as the control. The distances and angulations between different implants (interimplant distances and interimplant angulations) were measured in all photogrammetric and conventional standard tessellation language (STL) files by using a reverse-engineering software program. The distance deviations between the photogrammetric and conventional impressions of the same participant were calculated as the primary outcome, and the angular deviations were obtained as the secondary outcome with descriptive analyses. The comparison between distance deviations and the clinically acceptable level of deviations (150 µm) was conducted by using the 1-sample t test. The effect of interimplant distances, interimplant angulations, and jaw (maxilla or mandible) on deviations was analyzed by using the Spearman correlation analysis, Kruskal-Wallis test, or Student t test, depending on the type of data (α=0.05 for all tests). RESULTS: Fourteen edentulous jaws were included. The overall distance deviation of photogrammetric imaging was 70 ±57 µm, significantly lower than the clinically acceptable level of misfit (150 µm; P<.001). The overall angular deviation was 0.432 ±0.348 degrees. The distance deviations were correlated with interimplant distances with a correlation coefficient (r) of 0.371 (P=.002). Interimplant angulation was not correlated with distance or angular deviations (P=.914, P=.914). Jaw was not correlated with distance or angular deviations either (P=.190, P=.209). CONCLUSIONS: The accuracy (trueness) of photogrammetric imaging of complete arch implant-supported prostheses was within a clinically acceptable range of errors. Distance deviations increased with greater interimplant distances. Interimplant angulations and jaw (maxilla or mandible) had no significant effect on the accuracy of photogrammetric imaging.

Clinical, radiographic, and esthetic evaluation of immediate implant placement with buccal bone dehiscence in the anterior maxilla: A 1-year prospective case series.

OBJECTIVES: To evaluate the clinical, radiographic, and esthetic outcomes of immediate implant placement with buccal bone dehiscence in the anterior maxilla. METHODS: In this case series, implants were inserted immediately after tooth extraction in sockets with buccal bone dehiscence. Guided bone regeneration (GBR) with a papilla preservation flap and simultaneous connective tissue grafting (CTG) was used. The following outcome variables were measured: mid-facial mucosal recession, probing depth, bleeding on probing, Pink Esthetic Score (PES), marginal bone loss, and thickness of buccal bone plate (TBP). RESULTS: 12 patients were recruited. Stable mid-facial mucosal level (-0.03 ± 0.17 mm) and excellent soft-tissue esthetic outcomes (PES, 9.17 ± 0.72) were achieved at 1 year. The TBP at platform level was 2.01 ± 0.31 mm at 1-year follow up with a resorption rate of 28.90% ± 15.14%. CONCLUSIONS: Immediate implant placement using GBR performed with a papilla preservation approach and simultaneous CTG is a feasible treatment procedure in compromised extraction sockets in the anterior region. Favorable esthetic outcomes and buccal bone thickness were obtained. Further studies were needed to evaluate the long-term tissue alteration.

Surgical interventions for implant placement in the anterior maxilla: A systematic scoping review with evidence mapping.

OBJECTIVES: Simplification and standardization of interventions are critical challenges to improving performance in implant dentistry. This study aimed to systematically identify and schematically present the evidence base of the implant dentistry surgical interventions for the anterior maxilla as a basis for further development and standardization. METHODS: Electronic searches were conducted in PubMed, Embase and Cochrane CENTRAL. Primary clinical studies reporting surgical interventions in the anterior maxilla, with a sample size of at least ten patients, were included. Bibliometric information and study details were extracted. Descriptive analysis and a mind map approach were used to describe the documentation of different surgical interventions. RESULTS: Two hundred and seventy-two studies reporting on 9001 patients were included. Within the past two decades, the number of literatures on implant placement in the anterior maxilla has increased dramatically (7 studies before 2005, 151 studies after 2016). Overall, the evidence map identified six primary operations and 33 variations. For hopeless tooth extraction, immediate implant placement was the most frequently reported (141 studies, 4670 patients); flapless implant placement with hard tissue augmentation and immediate provisionalization was the most commonly reported variation (33 studies, 987 patients). Type 3/4 implant placement (62 studies, 1902 patients) and implant site augmentation (33 studies, 788 patients) were frequently reported for missing teeth. Geographical differences were observed, with type 2 placement studies almost exclusively from Europe. CONCLUSIONS: Research on immediate implant placement was the most reported surgical intervention in the anterior maxilla. Hard tissue augmentation was frequently reported simultaneously with or before implant placement. Immediate provisionalization was mainly used for type 1 implant placement. The finding that six primary operations with 33 variations have been reported indicates the need for additional research to simplify and consolidate the surgical approach.

Association of the number of natural teeth with dietary diversity and nutritional status in older adults: A cross-sectional study in China.

AIM: To investigate the association of the number of natural teeth with overall dietary diversity and nutritional status in a nationally representative study among older adults in China. MATERIALS AND METHODS: A cross-sectional analysis was conducted among community-dwelling adults aged 65 years or older from the Chinese Longitudinal Healthy Longevity Study. According to the self-reported number of natural teeth, participants were categorized into ≥20, 10-19, 1-9 natural teeth, and edentulous. Dietary diversity score (DDS) was constructed based on intake frequencies of 10 food groups assessed by a simplified food frequency questionnaire. The geriatric nutritional risk index was used to measure the malnutrition status (i.e., normal, mild malnutrition, and moderate-to-severe malnutrition) among a subgroup of participants. Linear and multinomial logistic regression models were used to examine the corresponding associations. RESULTS: Among 54,796 study participants, the mean (SD) age was 87.86 (11.45) years, 82.7% had poor dentition (<20 natural teeth), and 27.3% wore dentures. After multivariable adjustment, participants with poor dentition had lower DDSs (ßedentulous  = -0.39, 95% confidence interval [CI], -0.48, -0.30; ß1-9 teeth  = -0.46, 95% CI, -0.55, -0.37; ß10-19 teeth  = -0.36, 95% CI, -0.46, -0.26) than those with 20 natural teeth or more. For individual food items, edentulous, 1-9 and 10-19 natural teeth were associated with lower odds of regular intake of fresh fruits, fresh vegetables, meat, fish and aquatic products, eggs, legumes, preserved vegetables, tea, and garlic, but higher odds of regular intake of sugar and sweets. Among participants with poor dentition, individuals without dentures had lower intake frequencies of most food groups than those wearing dentures. In addition, poor dentition was related to lower odds of normal nutritional status (odds ratio = 0.49, 95% CI, 0.27, 0.89). CONCLUSIONS: Older adults with poor dentition had significantly lower dietary diversity and worse nutritional status. Future studies are warranted to identify effective interventions to improve the dietary quality and nutrition status among partially and fully edentulous individuals, including those with Stage IV periodontitis.

Clinical evaluation of narrow-diameter implants versus standard-diameter implants with lateral bone augmentation in posterior jaws: Three-year results of a randomized controlled trial.

BACKGROUND: The aim of this study was to compare the 3-year clinical outcomes of narrow-diameter implants (NDI) with standard-diameter implants (SDI) in conjunction with lateral bone augmentation in atrophic posterior jaws. MATERIALS AND METHODS: Fifty patients were included and randomly assigned into two groups: Patients in Group 1 received NDI (Ø3.5 mm); patients in Group 2 received SDI (Ø4.3 mm) with simultaneous lateral bone augmentation. Implant survival rates, complications, crestal bone loss, peri-implant conditions, treatment cost, and patient satisfaction were compared. RESULTS: Three patients dropped out the follow-up. No implant loss was observed. The difference in technical complication rates between the two groups was 3.8% (95% CI: -13.7% to 21.3%). No significant differences in crestal bone loss were found between two groups at 3-year follow-up (0.55 ± 0.76 vs 0.41 ± 0.41 mm, p = .429). A total of 20.8% (5/24) of NDI were diagnosed with mucositis and 8.3% (2/24) with peri-implantitis. A total of 17.4% (4/23) of SDI showed mucositis and (1/23) 4.3% showed peri-implantitis. The total cumulative cost of treatment per patient in Group 1 (2849.6 USD, 95% CI: 2726.8-2972.4) was significantly lower than that in Group 2 (3581.4 USD, 95% CI, 3460.9-3701.9) over the 3-year follow-up (p < .01). The patient satisfaction rating of operation was significantly higher in Group 1 (85.42 ± 7.41 vs 80.48 ± 7.95, p = .033). DISCUSSION: NDI yielded favorable implant survival, acceptable technical and biological complications, and high patient satisfaction supporting single crowns in the atrophic posterior region after 3-year follow-up. NDI might be a reasonable alternative in horizontally deficient posterior jaws. TRIAL REGISTRATION: Clinicaltrials.gov identifier: ChiCTR1800020426.

Effects of Dental Implants and Nutrition on Elderly Edentulous Subjects: Protocol for a Factorial Randomized Clinical Trial.

Background: Loss of masticatory function consequent to tooth loss has been associated with changes in food choices and insufficient nutritional intake. To date, interventions based on dental prostheses alone did not significantly improve nutrient intake. Pilot studies have shown positive impacts of interventions combining implant-supported fixed dental prosthesis with brief dietary advice. The relative contribution and the potential synergy of the components of such interventions need to be determined as it has major public health implications for the community-dwelling aging population that continues to disproportionately suffer from tooth loss and its consequences. Objective: To assess the effect of rehabilitation of masticatory function with fixed implant supported dentures and nutrition education in older subjects with terminal dentition (stage IV periodontitis) or full edentulism. Methods: A 2 × 2 factorial randomized controlled trial with 16-month follow-up of eligible adults (≥60 years) with loss of masticatory function consequent to full arch edentulism or terminal dentition (n = 120) will be conducted to test whether the rehabilitation of masticatory function with fixed implant supported dentures, nutrition education and/or their combination improves intake of fresh fruits and vegetables for aging subjects. The study has been designed to detect changes in fresh fruits and fresh vegetables intake at 4 months using the 24-h dietary recall method. Changes in protein as percentage of total energy, nutritional biomarkers, plasma metabolomics, oral and gut microbiome, quality of life and masticatory function will also be assessed. Discussion: We hypothesize that receiving rehabilitation of masticatory function with fixed implant dentures together with nutrition education is the most effective intervention for improving nutrient intake in aging community-dwelling subjects with extensive tooth loss. The results of this study will assist in designing better treatment regimens, guide medical care for individual subjects, and inform public health and policy. Clinical Trials Registration: NCT05334407.

Long-term clinical outcomes of short implant (6mm) in relation to Implant Disease Risk Assessment (IDRA).

AIM: To evaluate the long-term survival of short implants and to investigate the association of the Implant Disease Risk Assessment (IDRA) with the occurrence of biological complications. MATERIAL AND METHODS: This study was designed as a cohort study with a median follow-up of 10.0 years. Patients who had received 6-mm implants were reviewed and assigned into low-, moderate-, and high-risk groups (Group L, M, and H) based on the IDRA tool. The implant survival, biological complications, soft tissue condition, hardware complications, and marginal bone loss (MBL) were evaluated. Kaplan-Meier curves and Cox regression were performed for survival analysis. RESULTS: A hundred and ten patients were included. The overall cumulative survival rate was 90.9% (L:100.0%, M: 93.3%, and H: 80.6%). A higher risk profile was significantly associated with a decreased implant survival (hazard ratio: 4.11, 95% CI: 1.17-14.36, p < .05). Higher risk profile (hazard ratio: 2.63, 95% CI: 1.32-5.25, p < .05) was a potential risk factor for biological complications. At follow-up, significant differences in bleeding index, modified plaque index, and peri-implant probing depth were found among groups (p < .01). No significant difference was found in MBL. CONCLUSION: Acceptable long-term clinical outcomes could be achieved after 10 years for short implants. Despite a statistically nonsignificant difference in MBL, patients with a high-risk profile of IDRA seem to be at greater risk of implant loss and biological complications.

Evidence and risk indicators of non-random sampling in clinical trials in implant dentistry: A systematic appraisal.

AIM: Analysis of distribution of p-values of continuous differences between test and controls after randomization provides evidence of unintentional error, non-random sampling, or data fabrication in randomized controlled trials (RCTs). We assessed evidence of highly unusual distributions of baseline characteristics of subjects enrolled in clinical trials in implant dentistry. MATERIALS AND METHODS: RCTs published between 2005 and 2020 were systematically searched in Pubmed, Embase, and Cochrane databases. Baseline patient data were extracted from full text articles by two independent assessors. The hypothesis of non-random sampling was tested by comparing the expected and the observed distribution of the p-values of differences between test and controls after randomization. RESULTS: One-thousand five-hundred and thirty-eight unique RCTs were identified, of which 409 (26.6%) did not report baseline characteristics of the population, and 671 (43.6%) reported data in forms other than mean and standard deviation and could not be used to assess their random sampling. Four-hundred and fifty-eight trials with 1449 baseline variables in the form of mean and standard deviation were assessed. The study observed an over-representation of very small p-values [<.001, 1.38%, 95% confidence interval (CI) 0.85-2.12 compared to the expected 0.10%, 95% CI 0.00-0.26]. No evidence of over-representation of larger p-values was observed. Unusual distributions were present in 2.38% of RCTs and more frequent in non-registered trials, in studies supported by non-industry funding, and in multi-centre RCTs. CONCLUSIONS: The inability to assess random sampling due to insufficient reporting in 26.6% of trials requires attention. In trials reporting suitable baseline data, unusual distributions were uncommon, and no evidence of data fabrication was detected, but there was evidence of non-random sampling. Continued efforts are necessary to ensure high integrity and trust in the evidence base of the field.

[Short-term comparison of the clinical efficacy of angulated screw-retained implant crowns and cemented implant crowns in esthetics region].

PURPOSE: To compare the clinical efficacy of angulated screw channel abutments and prefabricated titanium abutments on the restoration of single implant crowns in esthetics region. METHODS: The study was a prospective, single center, randomized controlled trial. Patients with the need of restoration of single tooth in esthetics region were included from June 2018 to June 2019. Forty patients were randomly assigned into two groups: screw-retained crowns with angulated screw channel abutments(angulated group, AG) and cemented crowns with prefabricated Ti abutments (cemented group, CG). Clinical and radiological evaluations were performed on the day of final crowns delivery and 6 months later. Implant survival rate, marginal bone loss (MBL), mechanical complications, peri-implant conditions (Probing depth, PD; bleeding on probing, BOP%), pink esthetics score/white esthetics score(PES/WES) and patients' satisfaction were assessed. The data was analyzed with SPSS 19.0 software package. RESULTS: Thirty-six patients (AG: 19, CG: 17) attended the 6-month clinical trial. Implant survival rates were both 100% in two groups. The MBL was (0.21±0.18) mm for AG and (0.38±0.40) mm for CG (P>0.05). The BOP% was significantly higher in AG than that in CG (P=0.04). No significant difference of mechanical complications, PD, PES/WES and patients' satisfaction was found between the two groups(P>0.05). CONCLUSIONS: Based on the present results, both treatment options show acceptable clinical outcomes in the short term. Angulated screw-retained crowns may benefit the peri-implant soft tissue; however, studies with long-term follow-up are needed to verify the results.

Single-Cell RNA Sequencing Identifies New Inflammation-Promoting Cell Subsets in Asian Patients With Chronic Periodontitis.

Periodontitis is a highly prevalent chronic inflammatory disease leading to periodontal tissue breakdown and subsequent tooth loss, in which excessive host immune response accounts for most of the tissue damage and disease progression. Despite of the imperative need to develop host modulation therapy, the inflammatory responses and cell population dynamics which are finely tuned by the pathological microenvironment in periodontitis remained unclear. To investigate the local microenvironment of the inflammatory response in periodontitis, 10 periodontitis patients and 10 healthy volunteers were involved in this study. Single-cell transcriptomic profilings of gingival tissues from two patients and two healthy donors were performed. Histology, immunohistochemistry, and flow cytometry analysis were performed to further validate the identified cell subtypes and their involvement in periodontitis. Based on our single-cell resolution analysis, we identified HLA-DR-expressing endothelial cells and CXCL13+ fibroblasts which are highly associated with immune regulation. We also revealed the involvement of the proinflammatory NLRP3+ macrophages in periodontitis. We further showed the increased cell-cell communication between macrophage and T/B cells in the inflammatory periodontal tissues. Our data generated an intriguing catalog of cell types and interaction networks in the human gingiva and identified new inflammation-promoting cell subtypes involved in chronic periodontitis, which will be helpful in advancing host modulation therapy.

Clinical, radiographic, and immunological evaluation of angulated screw-retained and cemented single-implant crowns in the esthetic region: A 1-year randomized controlled clinical trial.

BACKGROUND: Screw-retained implant crowns are considered more biologically compatible than cemented crowns due to the absence of excess cement. However, traditional screw-retained implant crowns are not viable when the access hole of the screw channel would need to be located in an esthetic area, which would compromise the esthetic outcome of the treatment. PURPOSE: To evaluate the clinical, radiographic, and immunological outcomes of angulated screw-retained and cemented single-implant crowns in the esthetic region. MATERIALS AND METHODS: The study was a single-center, open-label, randomized controlled clinical trial. Eligible patients were randomly placed in two groups: angulated screw-retained group (AG) and cemented group (CG). Implant survival rate, bleeding on probing rate (BOP%), probing depth (PD), modified plaque index (mPI), marginal bone loss (MBL), concentrations of pro-inflammatory cytokines (TNF-α, IL-6) in peri-implant crevicular fluid (PICF), mechanical complications, and pink esthetic score/white esthetic score (PES/WES) were evaluated. RESULTS: Fifty-six patients (AG: 29, CG: 27) attended the 1-year examination. The drop-out rate was 6.67%. No implant failure was found in both groups during the observation period. BOP% was significantly lower in the AG than that in the CG (mean, 21.84% ± 19.97% vs. 37.04% ± 26.28%, p = 0.018). The concentration of TNF-α in PICF was significantly higher in the AG than that in the CG (median, 13.54 vs. 4.62, p = 0.019). No significant difference of PD, mPI, MBL, IL-6, or mechanical complication rates was found between the two groups. Mean scores for PES/WES were 21.71 and 21.64 in the AG and CG, respectively. CONCLUSION: Based on the present results, both treatment options showed acceptable clinical outcomes in the short term. Angulated screw-retained crowns might benefit the peri-implant soft tissue. However, studies with long-term follow-up are needed to confirm whether the higher concentration of TNF-α will compromise the long-term outcomes of treatment.

Circ_0008542 in osteoblast exosomes promotes osteoclast-induced bone resorption through m6A methylation.

With an increasing aging society, China is the world's fastest growing markets for oral implants. Compared with traditional oral implants, immediate implants cause marginal bone resorption and increase the failure rate of osseointegration, but the mechanism is still unknown. Therefore, it is important to further study mechanisms of tension stimulus on osteoblasts and osteoclasts at the early stage of osseointegration to promote rapid osseointegration around oral implants. The results showed that exosomes containing circ_0008542 from MC3T3-E1 cells with prolonged tensile stimulation promoted osteoclast differentiation and bone resorption. Circ_0008542 upregulated Tnfrsf11a (RANK) gene expression by acting as a miR-185-5p sponge. Meanwhile, the circ_0008542 1916-1992 bp segment exhibited increased m6A methylation levels. Inhibiting the RNA methyltransferase METTL3 or overexpressing the RNA demethylase ALKBH5 reversed osteoclast differentiation and bone resorption induced by circ_0008542. Injection of circ_0008542 + ALKBH5 into the tail vein of mice reversed the same effects in vivo. Site-directed mutagenesis study demonstrated that 1956 bp on circ_0008542 is the m6A functional site with the abovementioned biological functions. In conclusion, the RNA methylase METTL3 acts on the m6A functional site of 1956 bp in circ_0008542, promoting competitive binding of miRNA-185-5p by circ_0008542, and leading to an increase in the target gene RANK and the initiation of osteoclast bone absorption. In contrast, the RNA demethylase ALKBH5 inhibits the binding of circ_0008542 with miRNA-185-5p to correct the bone resorption process. The potential value of this study provides methods to enhance the resistance of immediate implants through use of exosomes releasing ALKBH5.

Influence of Different Factors on the Accuracy of Digital Impressions of Multiple Implants: An In Vitro Study.

PURPOSE: To investigate the effect of implant angulation, non-free-end partial edentulism, and number of scan bodies on the accuracy of digital impressions of multiple implants in partially edentulous arches. MATERIALS AND METHODS: Four reference models of partially edentulous mandibles with implants (RM1, RM2, RM3, and RM4) representing different intraoral situations were each scanned 10 times by an intraoral scanner. Reference scans were obtained by a laboratory scanner. Test scans were compared with reference scans to obtain the distance deviations (Δd) and angular deviations (Δθ) between scan bodies for trueness assessment. Differences among the repeated test scans of each model were measured and recorded as Δdp and Δθp for precision assessment. The Student t test (α = .05) was used to compare Δd, Δθ, Δdp, and Δθp of different reference models, including RM2 vs RM1 (effect of non-free-end partial edentulism), RM3 vs RM1 (effect of implant angulation), and RM4 vs RM1 (effect of number of scan bodies). RESULTS: The implant with 17-degree angulation in RM3 showed significantly lower Δd, Δθ, and Δθp compared with the parallel implant in RM1 (Δd: P = .0382, Δθ: P = .0267, Δθp: P = .0417). The RM2 of non-free-end partial edentulism had lower distance and angular deviations than RM1, but without a significant difference. The number of scan bodies had no significant effect on the Δd, Δθ, Δdp, and Δθp of RM4 and RM1. CONCLUSION: Angulated implants showed better accuracy of digital impressions in partially edentulous arches compared with parallel implants. Non-free-end partial edentulism was attributed to improved accuracy, while the number of scan bodies showed no effect.