Vaccines for COVID-19: An Overview.

The advent of the COVID-19 pandemic in the final months of 2019 prompted an extraordinary response on the part of the scientific community, with fundamental research on the biology of the virus and the human immune response, and development of testing, therapeutics, and vaccines occurring on an unprecedentedly short timescale. Within a year after the worldwide outbreak of the disease, more than 40 vaccine candidates had emerged, with 21 candidates in phase 3 trials or already being used on an emergency basis. Many of these vaccines have involved innovative platforms. In this concise review, the authors will summarize the characteristics and performance of the leading vaccines and discuss considerations of virus mutations and asymptomatic spread that may affect the ability of the worldwide community to use these vaccines as a means to defeat the pandemic and restore pre-COVID-19 normality.

Increasing Levels of Smoking may Increase the Relative Risk of Dental Implant Failure.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Levels of smoking and dental implants failure: A systematic review and meta-analysis. Naseri R, Yaghini J, Feizi A. J Clin Periodontol. 2020;47(4):518-528. SOURCE OF FUNDING: Information not available. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

Canceling dental procedures due to elevated blood pressure: Is it appropriate?

BACKGROUND: In 1974, the American Dental Association first considered recommending that dental offices measure blood pressure (BP) routinely, and it has been further encouraged since 2006. Investigators in several dental publications have recommended cancellation of dental procedures based solely on BP greater than 180/110 millimeters of mercury for urgent oral health care and greater than 160/100 mm Hg for elective oral health care, in the absence of prior medical consultation. METHODS: The authors reviewed the evidence for cancellation of any dental or surgical procedures by using an Ovid MEDLINE search for the terms dental, elevated blood pressure, and hypertension. In addition, the authors searched resources at ebd.ada.org using the same criteria. The authors collaborated to develop recommendations in view of 2017 guidelines on this subject. RESULTS: To the authors' knowledge, there are no professionally accepted criteria or study evidence indicating a specific BP elevation at which to prohibit oral health care. Researchers of a 2015 review on management of comorbidities in ambulatory anesthesia failed to find increased morbidity from hypertension in the outpatient setting. CONCLUSIONS: To the authors' knowledge, there are no prospective study investigators that have addressed whether or when to cancel dental procedures due to office-measured elevated BP. The authors recommend using current anesthesiology guidelines based on functional status and past BP measurements to prevent unnecessary cancellations. PRACTICAL IMPLICATIONS: It is seldom necessary to cancel dental procedures on the basis of BP measured before a planned procedure for patients under a physician's care.

Stopping Anticoagulation Therapy Before Implant and Bone Grafting Surgery May Not Be Necessary to Prevent Bleeding Events.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Management of anticoagulated patients in implant therapy: a clinical comparative study. Clemm R, Neukam FW, Rusche B, Bauersachs A, Musazada S, Schmitt CM. Clin Oral Implants Res 2016;27(10):1274-82. SOURCE OF FUNDING: Information not available TYPE OF STUDY/DESIGN: Cohort study.

Comparison of two differently processed acellular dermal matrix products for root coverage procedures: a prospective, randomized multicenter study.

BACKGROUND: The purpose of this multicenter randomly controlled clinical trial was to compare two acellular dermal matrix (ADM) materials produced by different processing techniques, freeze-dried (FDADM) and solvent-dehydrated (SDADM) ADM, in their ability to correct Miller Class I and II recession defects. METHODS: Eighty individuals from four study centers, each with a single maxillary anterior Miller Class I or II recession defect were enrolled. Participants were randomly assigned and treated with coronally advanced flap (CAF) + FDADM (n = 42) or CAF + SDADM (n = 38). Gingival thickness, recession depth, recession width, probing depth (PD), clinical attachment level, gingival index, plaque index, patient discomfort, and wound healing index were recorded before surgery (day 0), immediately after surgery (day 1), and 2, 4, 12, 24, and 52 weeks postoperatively. The Student t test, paired t test, and Kruskal-Wallis one-way ANOVA were used to analyze the data. RESULTS: When evaluating the clinical parameters after 1 year, both groups showed significant (P <0.05) improvement for most of the parameters evaluated when compared to baseline (day 0). For example, percentage of root coverage was 77.21% ± 29.10% for CAF + FDADM and 71.01% ± 32.87% for CAF + SDADM. Conversely, no significant differences were observed between the two materials for any clinical parameter tested or for patient satisfaction except PD on the mesial side of the defects (P = 0.03). CONCLUSIONS: Both FDADM and SDADM can be used successfully to correct Miller Class I or II recession defects. There were no statistically significant differences between groups for any of the clinical parameters tested.

Characterization of periodontal structures of enamelin-null mice.

BACKGROUND: Enamelin-null (ENAM(-/-)) mice have no enamel. When characterizing ENAM(-/-) mice, alveolar bone height reduction was observed, and it was hypothesized that enamel defects combined with diet are associated with the periodontal changes of ENAM(-/-)mice. The aim of the present study is to compare the dimension of interradicular bone of ENAM(-/-) (knock-out [KO]) with wild-type (WT) mice, maintained on hard (HC) or soft (SC) chow. METHODS: A total of 100 animals divided into four groups were studied at 3, 8, and 24 weeks of age: 1) KO/HC; 2) KO/SC; 3) WT/HC; and 4) WT/SC. Microcomputed tomography was performed, and the following measurements were made between mandibular first (M1) and second (M2) molars: relative alveolar bone height (RBH), crestal bone width (CBW), bone volume (BV), bone mineral content (BMC), and bone mineral density (BMD). The position of M1 and M2 in relation to the inferior border of the mandible was also determined at 24 weeks. All variables were analyzed by one-way analysis of variance and Dunnett test for pairwise comparisons. Morphologic analyses were conducted on hematoxylin and eosin-stained sections. RESULTS: Radiographically, the enamel layer was absent in ENAM(-/-) mice. Interproximal open contacts were observed exclusively in ENAM(-/-) mice, and the prevalence decreased over time, suggesting that a shifting of tooth position had occurred. Additionally, in the two ENAM(-/-) groups, RBH was significantly lower at 8 and 24 weeks (P <0.02); CBW, BV, and BMC were significantly less (P <0.05) at 24 weeks. No differences in BMD were found among the four groups. The molars migrated to a more coronal position in ENAM(-/-) mice and mice on HC. Histologic findings were consistent with radiographic observations. After eruption, the junctional epithelium was less organized in ENAM(-/-) mice. CONCLUSION: The interdental bone density was not affected in the absence of enamelin, but its volume was, which is likely a consequence of alternations in tooth position.

Systemic Teriparatide Administration Promotes Osseous Regeneration of an Intrabony Defect: A Case Report.

INTRODUCTION: Teriparatide comprises the first 34 amino acids of parathyroid hormone and is a systemic anabolic agent that is Food and Drug Administration approved for the treatment of osteoporosis but not for periodontitis. To our knowledge, this is the first clinical case report to document the treatment of a patient with severe periodontitis using an open-flap debridement procedure in conjunction with teriparatide. CASE PRESENTATION: A 45-year-old female patient was diagnosed with severe chronic periodontitis, including the presence of an intrabony defect on tooth #6. She received open-flap debridement surgery in conjunction with daily systemic administration of 20 µg teriparatide, oral vitamin D, and calcium supplements for 6 weeks. Radiographic, clinical, gingival crevicular fluid (pyridinoline cross-linked carboxy-terminal propeptide of type I procollagen, procollagen type 1 N-propeptide, and osteocalcin), and serum parameters (parathyroid hormone, bone alkaline phosphatase, calcium, and 25-hydroxyvitamin D) were assessed. Treatment outcomes were evaluated over 4 years, with successful radiographic and clinical results throughout the follow-up period. CONCLUSION: Teriparatide administration in conjunction with traditional open-flap debridement surgery offers potential for the treatment of severe intrabony defects resulting from chronic periodontitis.

Evaluating postdoctoral dental candidates: assessing the need and recommendations for a national qualifying examination.

Increasingly, U.S. dental schools report pass/fail grades and do not rank students. In addition, the Joint Commission on National Dental Examinations will report National Board Dental Examination (NBDE) scores as pass/fail after January 1, 2012. This article discusses how these changes will force postdoctoral dental program directors to modify how they assess candidates and how noncognitive evaluations might enhance those assessments. The authors propose developing a national qualifying examination for postdoctoral dental programs that will measure knowledge, decision making, and noncognitive traits including empathy, self-confidence, integrity, and emotional intelligence. Without NBDE scores, class rank, and GPA as a basis for decision making, a single national qualifying examination would assist postdoctoral programs in selecting high-quality candidates based on knowledge, critical thinking skills, and noncognitive traits.

Teriparatide and osseous regeneration in the oral cavity.

BACKGROUND: Intermittent administration of teriparatide, a drug composed of the first 34 amino acids of parathyroid hormone, has anabolic effects on bone. Although teriparatide has been evaluated for the treatment of osteoporosis and for the healing of fractures, clinical trials evaluating it for the treatment of osseous conditions of the oral cavity in humans are lacking. METHODS: A total of 40 patients with severe, chronic periodontitis underwent periodontal surgery and received daily injections of teriparatide (20 µg) or placebo, along with oral calcium (1000 mg) and vitamin D (800 IU) supplementation, for 6 weeks. The patients were followed for 1 year. The primary outcome was a radiographic linear measurement of alveolar bone level. Secondary outcomes included clinical variables, bone turnover markers in serum and oral fluid, systemic bone mineral density, and quality of life. RESULTS: Radiographic linear resolution of osseous defects was significantly greater after teriparatide therapy than after placebo beginning at 6 months, with a mean linear gain in bone at 1 year of 29% as compared with 3% (P<0.001). Clinical improvement was greater in patients taking teriparatide than in those taking placebo, with a reduction in periodontal probing depth of 33% versus 20% (2.42 mm vs. 1.32 mm) and a gain in clinical attachment level of 22% versus 7% (1.58 mm vs. 0.42 mm) in target lesions at 1 year (P = 0.02 for both comparisons). No serious adverse events were reported; however, the number of patients in the study was small. No significant differences were noted with respect to the other variables that were assessed. CONCLUSIONS: Teriparatide, as compared with placebo, was associated with improved clinical outcomes, greater resolution of alveolar bone defects, and accelerated osseous wound healing in the oral cavity. Teriparatide may offer therapeutic potential for localized bone defects in the jaw. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT00277706 .).

Factors associated with the appearance of gingival papillae.

AIM: The purpose of this study was to evaluate factors associated with the fill of inter-dental spaces by gingival papillae. MATERIALS AND METHODS: Ninety-six adult subjects were evaluated. Papilla score (PS), tooth form/shape, interproximal contact length and gingival thickness were recorded for 672 maxillary anterior and first pre-molar interproximal sites. Statistical analyses included a non-parametric chi(2) test, anova, the Mixed Procedure for SAS and Pearson's correlation coefficient (r). RESULTS: Papilla deficiency was more frequent in older subjects (p<0.05), as papilla height decreased 0.012 mm with each year of increasing age (p<0.05). Competent papillae (complete fill inter-dentally) were associated with: (1) crown width: length >or=0.87; (2) proximal contact length >or=2.8 mm; (3) bone crest-contact point or=1.5 mm. Gingival thickness correlated negatively with PS (r=-0.37 to -0.54) and positively with tissue height (r=0.23-0.43). Tooth form (i.e. crown width to length ratio) correlated negatively with PS (r=-0.37 to -0.61). Other parameters failed to show any significant effects. CONCLUSIONS: Gingival papilla appearance was associated significantly with subject age, tooth form/shape, proximal contact length, crestal bone height and interproximal gingival thickness.

Anxiety, stress, depression, and patients' responses to periodontal treatment: periodontists' knowledge and professional behavior.

BACKGROUND: Anxiety, stress, and depression affect the use of health care services, treatment decision-making, and responses to periodontal treatment. This study explored periodontists' confidence in detecting patient anxiety, stress, or depression, as well as their knowledge concerning the relationships between these factors and patients' pain, use of pain medication, and wound healing after periodontal treatment. In addition, this research surveyed if (and which) special accommodations were offered when treating patients with high levels of anxiety, stress, or depression. METHODS: Data were collected from 171 members of the American Academy of Periodontology (response rate = 34.41%). Most respondents were male (82.2%), white (88.2%), and practiced in solo practices (60.9%). RESULTS: The respondents were more knowledgeable about the effects of anxiety and stress on pain, the use of pain medication, and wound healing than about the impact of depression on these outcomes. They agreed more strongly with statements that they were more confident in their ability to perceive when patients were anxious and stressed than when they were depressed. They also offered more special accommodations for patients with anxiety and stress than for patients with depression. CONCLUSIONS: The respondents were significantly less knowledgeable about the impact of depression on patients' responses to periodontal treatment than about the effect of anxiety and stress. Given the evidence concerning the relationships among depression, pain, pain medication use, and wound healing, it is important to educate periodontists about the role of anxiety and stress and the significance of depression on their patients' responses to periodontal therapy.

Surgical versus non-surgical periodontal treatment: psychosocial factors and treatment outcomes.

BACKGROUND: This research explored how patients with surgical versus non-surgical periodontal treatment differ in trait anxiety, depression, perceived stress, and well-being on the day of surgery and in their reported pain and use of pain medication 2 and 4 weeks after treatment. In addition, it was investigated how psychosocial factors affected reported pain, use of pain medication, and wound healing. METHODS: Data were collected from 70 dental patients (34 males and 36 females; average age: 54.79 years; SD=13.206) on the day of their periodontal treatment and 2 and 4 weeks after this treatment. The psychosocial factors (i.e., trait anxiety, depression, perceived stress, and well-being) were measured with standardized scales. The patients' providers assessed their wound healing 2 weeks after treatment. RESULTS: On the day of treatment, non-surgical patients had higher anxiety, depression, and stress, and poorer well-being than surgical patients. However, surgical patients reported a higher level of pain during the second week, and greater consumption of analgesics during the second and fourth week. Anxiety, depression, stress, and well-being correlated with the reported level of pain, the use of pain medication, and wound healing after periodontal treatment. CONCLUSIONS: Psychosocial factors (i.e., anxiety, depression, stress, and well-being) can affect the patients' quality of life on the day of periodontal treatment and the pain experience and medications used after surgical and non-surgical periodontal therapy (4-week period). Patient-provider communication should address the role of these factors in the treatment process.

Comparison of linear tomography and direct ridge mapping for the determination of edentulous ridge dimensions in human cadavers.

OBJECTIVE: The purpose of this study was to compare the accuracy of linear tomography (LT) and direct ridge mapping (RM) for determining alveolar ridge dimensions. STUDY DESIGN: One site in the posterior mandible was selected for evaluation in each of 5 cadaver heads. Vacuum-formed stents made from models of the cadaver ridges were used to identify 3 sets of measurement points for each specimen: coronal (intersection of coronal and middle third of ridge), middle (intersection of middle and apical third), and apical (base of vestibule). The imaging stent contained 2-mm metal balls at each point, while the RM stent had holes drilled at corresponding locations. Linear tomograms and periapical radiographs (PA) were taken of the selected sites. RM measurements were made with calipers. Five blinded examiners measured ridge width at the designated measurement points with both LT and RM as well as distance from the ridge crest to mandibular canal (using PAs for RM group). Mandibles were then sectioned and an independent examiner made direct measurements (DM). MANOVA was used to determine whether LT and RM differed significantly from DM. RESULTS: There were no significant differences between LT and RM for ridge width measurements. However, both techniques underestimated ridge dimensions compared to DM ( P < .05). Measurement of mandibular canal height was accurate when determined by periapical radiographs but not by LT. CONCLUSION: Neither LT nor RM proved to be completely accurate in determining ridge width in the posterior mandible.

Treatment of gingival recession using a collagen membrane with or without the use of demineralized freeze-dried bone allograft for space maintenance.

BACKGROUND: Studies utilizing collagen membranes for guided tissue regeneration (GTR)-based root coverage procedures have reported promising results. However, creating and maintaining space underneath the membrane remains a challenge. Therefore, the purpose of this clinical trial was to determine whether the addition of bone graft (i.e., demineralized freeze-dried bone allograft [DFDBA]) significantly affects the outcome of collagen membrane GTR-based root coverage procedures. METHODS: Twenty patients participated. One Miller's Class I or II recession defect per patient was treated with a collagen membrane covered by a coronally positioned flap. Half of the patients also had DFDBA placed under the membrane. Clinical parameters recorded included: recession depth, recession width, width of keratinized tissue, clinical attachment level, and probing depth, measured to the nearest 0.5 mm. Presurgery and postsurgery (6-month) data were compared using Student's paired t test for parametric data and the Wilcoxon matched pairs test for non-parametric data. RESULTS: Guided tissue regeneration with collagen (COLL) and collagen + DFDBA (COBA) both resulted in statistically significant (P <0.05) reductions in recession depth (2.1 +/- 0.9 mm and 2.5 +/- 0.5 mm), recession width (1.5 +/- 1.7 mm and 2.2 +/- 1.6 mm), increase in keratinized tissue (0.7 +/- 0.8 mm and 1.2 +/- 1.0 mm), and gain of clinical attachment level (2.1 +/- 1.0 mm and 3.0 +/- 1.0 mm), when comparing 6-month data to baseline. Mean root coverage was 68.4 +/- 15.2% with COLL and 74.3 +/- 11.7% with COBA. However, there were no statistically significant differences between groups for recession depth, recession width, width of keratinized tissue, clinical attachment level, and probing depth. CONCLUSIONS: Both techniques are effective in attaining root coverage. Although root coverage tended to be better with the addition of DFDBA, the difference was not statistically significant. Further studies with a larger sample size are needed to determine whether adding DFDBA to GTR-based procedures using collagen membranes is of any benefit.