The effectiveness of topical forms of dexamethasone in the treatment of oral lichen planus- A systematic review.

The goal of this systematic review was to assess the efficacy of dexamethasone compared to other treatments in oral lichen planus (OLP). The literature search used the following inclusion criteria: randomized controlled trials (RCT) comparing dexamethasone and other treatment strategies in patients with OLP. The outcome measures included relief of symptoms, decrement of erosive area size, and changes in quality of life. A computer and manual search was performed in Pubmed, Web of Science, and Cochrane Library up to January 31, 2021. The risk of bias was measured with the Revised Cochrane risk-of-bias tool for randomized trials. Eight trials with 131 study participants and 132 controls were identified. The following interventions were compared dexamethasone mouthwash, and 5% methylene blue-mediated photodynamic therapy, low-level laser therapy, amlexanox, clobetasol mouthwash, ketoconazole with amitriptyline, and thalidomide 1% paste. The therapeutic outcomes were more advantageous for dexamethasone in comparison with photodynamic therapy (PDT) (2 RCT) and low-level laser therapy (LLLT). Comparable effects were observed for dexamethasone, amlexanox, thalidomide, and PDT (1 RCT). Clobetasol showed more effective action than dexamethasone. Given the small sample sizes, heterogeneity and the few studies included, there is limited evidence to support the selection of treatment for OLP.

Evaluation of the efficacy of treatment modalities in burning mouth syndrome-A systematic review.

OBJECTIVES: Burning mouth syndrome (BMS) is a medical entity characterised by a spontaneous sensation of burning, numbness or pain of the oral mucosa in the absence of clinical symptoms. The goal of this systematic review was to assess the efficacy of various current treatments for BMS. METHODS: The literature search used the following inclusion criteria: randomised controlled trials (RCTs) which compared one or more treatment strategies for patients with primary/idiopathic BMS with a placebo group describing all types of interventions. The primary and secondary outcome measures included: relief of pain/burning sensations, changes in psychosocial factors and feeling of sensation of dryness. A computer and manual search was performed in Pubmed, Web of Science and Cochrane Library up to 5 November 2019 and updated on 28 June 2020. The risk of bias was measured with the Cochrane Collaboration tool. RESULTS: Thirty RCTs which included 727 study participants and 589 controls were identified. The following interventions were introduced: dietary supplements, anticonvulsants, benzodiazepines, antidepressants, analgesics, topical agents, electromagnetic radiation or induction, physical barriers and psychological therapies. The most successful therapeutic outcomes were observed for clonazepam tested in 3 RCTs, where significant pain reduction appeared after both topical and systemic application. Evident pain reduction was also reported for tongue protectors and capsaicin in 2 separate studies. DISCUSSION: Short follow-up periods, low numbers of participants, variability of the metrics used in the evaluation of the results and heterogeneous study design were the main limitations of the reviewed studies. Based on our analysis, clonazepam appears to be the most effective treatment option for BMS.

Evaluation of human osteoblast metabolic activity in modified titanium-conditioned medium.

To evaluate human osteoblast metabolic activity cultured in medium conditioned with commercially pure titanium after surface treatments with alumina or ceramic grit-blasting followed by acid etching. Commercially available, pure Grade 4 titanium disks were used and subjected to seven different surface modifications: (1) machined (MA)-used as the control group; (2) blasted with Al2O3 (Al2O3); (3) blasted with sintered ceramic (HAS); (4) blasted with non-sintered ceramics (HA); (5) blasted with Al2O3 and etched with HCl/H2SO4 (Al2O3 DE); (6) blasted with sintered ceramic and etched with HCl/H2SO4 (HAS DE), and (7) blasted with non-sintered ceramic and etched with HCl/H2SO4 (HA DE). A samples roughness evaluation test was carried out with an interference microscope, and energy-dispersive X-ray spectroscopy was performed to evaluate the presence of aluminum, phosphorus, and calcium deposited during the titanium surface treatment along with carbon contaminants acquired by the surface during processing. A culture medium conditioned with the respective samples was prepared in five dilutions, and its effect on human osteoblast cell viability was evaluated using the relative viability of cells. Human osteoblast metabolic activity was found to be the most intensive for the Al2O3 DE sample. The lowest activity was observed for the HAS DE. The material's cytocompatibility depended on both the surface roughness and its chemical composition. Etching had a dual effect on cell activity, depending on the chemical composition of the titanium surface after blasting.

Effects of a hydroxyapatite coating on the stability of endosseous implants in rabbit tibiae.

BACKGROUND: A dental implant surface which would promote rapid and strong osseointegration is a key factor of success in modern implantology. To achieve this goal, different implant surface modifications are developed. A hydroxyapatite (HA) coating changing a bioinert titanium surface into bioactive is one of them. OBJECTIVES: The objective of the study was to investigate the effects on bone osseointegration in rabbits resulting from the application of a HA coating deposited on titanium endosseous implants using a modified electrochemical method. MATERIAL AND METHODS: Titanium implants with HA coatings and controls with Al2O3 grit-blasted surfaces were embedded into rabbit tibiae. The chemical composition, roughness and morphology of the implants were determined. Implant stability tests were performed, and the Periotest® value (PTV) and the implant stability quotient (ISQ) value for Osstell Mentor were recorded in order to evaluate the osseointegration. RESULTS: The surface characterization of the implants revealed a microstructure with an arithmetical mean height (Sa) in the range of 0.71-1.04 µm. The HA coating was free of contamination, whereas the controls were enriched with corundum. After healing, a statistically significant increase in the mean ISQ and a decrease in the mean PTV for the HA-coated implants was observed. In the case of the control implants, only PTV decreased significantly with time. CONCLUSIONS: The present study found that implant surface properties affected implant stability as determined by Osstell and Periotest measurements. The HA coating reported herein was found to have chemical and physical properties which appear to improve osseointegration compared to grit-blasted implants.

Hydroxyapatite coating on titanium endosseous implants for improved osseointegration: Physical and chemical considerations.

BACKGROUND: For many years, hydroxyapatite (HA) has been used as a bioactive endosseous dental implant coating to improve osseointegration. As such, the coating needs to be of high purity, adequate thickness, crystalline, and of a certain roughness in order to stimulate rapid fixation and form a strong bond between the host bone and the implant. There are a number of ways of preparing the HA coating, resulting in various coating properties. Herein, we report the preparation of the HA coating using a direct electrochemical method without the need for subsequent heat treatment. OBJECTIVES: The aim of this study was to investigate the physicochemical properties of the HP coating, deposited on titanium implants by a modified electrochemical method. MATERIAL AND METHODS: The coating was characterized in terms of surface chemical composition, structure, morphology, coating thickness and roughness. RESULTS: The coating was found to be composed of homogenous HA with Ca/P and Ca/O ratios of 1.62 and 0.35, respectively. No other forms of calcium phosphate were detected. The degree of crystallinity of HA was 92.4%. The surface roughness was moderate (Sa = 1.04 µm) with the coating thickness of 2-3 µm. The scanning electron microscopy (SEM) analysis revealed a uniform, integrated layer of rod-like HA crystals with the longitudinal axes parallel to the implant surface. CONCLUSIONS: The coating reported herein was found to have potentially favorable chemical and physical characteristics fostering osseointegration.

Osteoblastic cell behaviour on modified titanium surfaces.

INTRODUCTION: The surfaces of endoosseous dental implants have been subjected to numerous modifications in order to create a surface which can provide rapid bone healing and fast implant loading. Each modification has involved changes to the chemical composition and topography of the surfaces which have resulted in various biological reactions to the implanted material. AIM: The aim of this study was to evaluate the surface topography and chemistry of various modified titanium surfaces: (1) machined surface (MA), (2) alumina-blasted (Al2O3), (3) alumina-blasted and acid-etched (Al2O3 DE), (4) hydroxyapatite/tricalcium phosphate grit-blasted (HA/TCP) and (5) hydroxyapatite/tricalcium phosphate grit-blasted and acid-etched (HA/TCP DE) and to analyse the effects of surface roughness, and chemical composition on human osteoblast vitality, differentiation, morphology and orientation. MATERIALS AND METHODS: The modified surfaces were subjected to topographic analysis using Scanning Electron Microscopy (SEM), optical profilometry, roughness analysis and chemical composition evaluation using Energy Dispersion Spectroscopy (EDS) analysis. The biological effects of the titanium modifications was analysed using human osteoblasts cell culture where the cell morphology, vitality (MTS assay) and differentiation (ALP activity) was analysed. RESULTS: The machined surfaces were classified as anisotropic, smooth and composed of titanium and oxygen. The blasted surface samples along with the blasted and etched samples were found to be isotropic and rough. The grit-blasting procedure resulted in the incorporation of components from the blasting material. In the case of the blasted and etched samples, etching decreased the surface development as indicated by the Sdr and also reduced the amount of chemical compounds incorporated into the surfaces during the blasting procedure. The attached NHOst cells, proliferated the surfaces. With regard to the MA samples, the cells spread close to the titanium surface, with expanded cytoplasmic extensions and lamelipodia and were oriented in line with the groves left after machining. On the rough substrates, cells were less dispersed and exhibited numerous cytoplasmic extensions, filopodia and interconnections, they were not oriented with respect to the surfaces features. The cell viability of all samples except for Al2O3 decreased after the first day of culture. For all Al2O3, Al2O3 DE and HA samples the viability increased with culture time after an initial reduction. At the end of the culture period the ALP activity was slightly greater on Al2O3 and HA samples compared to the control with the HA DE sample having the same activity as the control. The Al2O3, HA and HA DE ALP samples showed comparable activity and were statistically different from MA and Al2O3 DE samples. CONCLUSIONS: In this study, variously treated titanium surfaces were correlated with osteoblastic cell viability, morphology and differentiation in comparison with the plastic and smooth titanium. All examined surfaces were found to be biocompatible. Favourable cell reactions were observed for Al2O3 and HA blasted surfaces. The surface roughness patterns influenced the growth orientation while the surface topography influenced osteoblast morphology. Further animal studies are necessary to compare the in-vivo effect on osseointegration of these modified titanium surfaces.