The reliability of using gingival crevicular blood to measure blood glucose and hba1c levels in the dental setting: a systematic review and meta-analysis.

OBJECTIVE: There are 500 million patients living with diabetes mellitus worldwide and 50% of them remain undiagnosed. Routine periodontal probing provides gingival crevicular blood in patients with gingivitis. Gingival blood may be useful for diabetes screening without the need for any expensive, painful or time-consuming method by using convenient glucometers. Therefore, the objective of this systematic review and meta-analysis is to answer the question to "is there a difference in glucose or HbA1c levels (O) in patients with positive gingival bleeding (P) measured on gingival crevicular blood (GCB) (I) compared to finger prick capillary blood (CB) (C). MATERIALS AND METHODS: The authors performed an electronic search of six databases using identical MeSH phrases. Only human clinical studies without limitations on the year of publication were considered. Data extraction was done by using standardized data collection sheets. Risk of bias assessment were conducted using QUADAS-2 and QUADAS-C. Meta-analyses were carried out with the random effects model to aggregate the correlation coefficients and the difference between the means between gingival and capillary blood reading, using 95% confidence intervals. RESULTS: The database and manual search yielded 268 articles, from which the selection procedure provided 36 articles for full-text screening, and the final pool of eligible articles composed of 23 studies with 1680 patients. Meta-analysis results on glycemic levels showed differences between the GCB and CB procedures in patients with and without diabetes with values of -6.80 [-17.35; 3.76] and - 4.36 [-9.89; 1.18], respectively. Statistically significant correlations were found (p = 0.001) between GCB and CB measurements in patients with (0.97 [0.927; 0.987]) and without diabetes (0.927 [0.873; 0.958]). CONCLUSION: Gingival blood could prove to be useful to identify patients with undiagnosed diabetes when the necessary amount of uncontaminated blood is present. However, this technique is limited by the possibility of contamination, prandial status and inaccuracies, so it is unsuited to address the patient's glycemic control accurately.

Evaluation of dental education during the pandemic of COVID-19-Results from an online survey among dental students.

INTRODUCTION: The aim of this study was to assess the students' experience with education during the COVID-19 pandemic, as well as to investigate their views moving forward after resumption of face-to-face education. MATERIALS AND METHODS: A questionnaire was administered to dental students in clinical dental education at seven dental schools. The questionnaire included 33 items organized in three sections: (a) Demographics, (b) Perceptions/activity during lockdown, and (c) Perceptions/activity upon resumption of face-to-face teaching. RESULTS: A total of 286 students from seven universities in Europe and Asia participated. Students' satisfaction with education during the pandemic varied among universities and ranged between 36%-80%, but students engaged in delivering emergency care had a significantly higher opinion (p = .001). Students who felt that their workload decreased, were commonly 24 years old or older (p = .015), male (p = .05) reported lower concentration and motivation, experienced a more severe disruption and valued lower the efforts of their universities to ensure the continuity of education (p = .009). The majority of the students (80.3%) felt confident to resume clinical training after the lockdown. In general, female students experienced a higher disruption of their education during the pandemic (p = .043) and expressed lower confidence to continue clinical training in comparison to their male colleagues (p = .001). CONCLUSION: Students' perception of their workload during the COVID-19 lockdown was very diverse, with those experiencing a reduction in workload being more likely to express lower satisfaction as well. Female students experienced a higher level of disruption. Engaging students in the delivery of emergency care had a positive effect on their appreciation of the education.

Extraoral Root-End Resection May Promote Pulpal Revascularization in Autotransplanted Mature Teeth-A Retrospective Study.

Tooth germ autotransplantation of open apices of the teeth exhibits high pulpal healing rates, whereas that of mature permanent teeth normally causes irreversible pulpal necrosis. Extraoral root-end resection (EORER) during transplantation may promote pulpal revascularization (PRV) in transplanted mature teeth and reduce endodontic treatment requirement. This study compared the primary outcomes of survival rates, PRV, and root resorption and determined relevant confounders in autotransplanted mature and immature teeth. The medical charts of consecutive patients who underwent tooth autotransplantation between January 2017 and March 2021 were evaluated. Teeth with a documented follow-up of at least 1 year were included. During the study period, 59 teeth were transplanted in 44 patients. Overall, 2 teeth were excluded owing to missing data; 57 teeth were analyzed, including 25 mature teeth additionally treated with EORER. After a mean follow-up of 21.2 ± 16.1 months, no significant differences in primary outcomes were detected. Fifty-five teeth remained in situ (96.5%), and radiological signs of root resorption were detected in 9/57 teeth (15.8%). PRV was positive in 54/57 teeth (94.7%). Surgical duration and PRV failure were significantly associated with high incidences of root resorption. Mature teeth autotransplantation with EORER yielded similar results to immature teeth autotransplantation and is a feasible treatment option. Long surgery and failed revascularization increased root resorption rates. More factors should be evaluated in larger trials with longer observation periods.

Growth Factor Release within Liquid and Solid PRF.

Aim: The purpose of this study was to obtain data concerning growth factor release within liquid and solid platelet-rich fibrin (PRF) matrices and to estimate the amount of potential interindividual variations as a basis for further preclinical and clinical trials. Therefore, we aimed to determine possible differences in the release of growth factors between liquid and solid PRF. Materials and Methods: Blood samples obtained from four subjects were processed to both liquid and solid PRF matrices using a standard centrifugation protocol. Five growth factors (vascular endothelial growth factor, VEGF; epidermal growth factor, EGF; platelet-derived growth factor-BB, PDGF-BB; transforming growth factor-ß1, TGF-ß1; and matrix metallopeptidase 9, MMP-9) have been evaluated at six time points by ELISA over a total observation period of 10 days (1 h, 7 h, 1 d, 2 d, 7 d, and 10 d). Results: Growth factor release could be measured in all samples at each time point. Comparing liquid and solid PRF matrices, no significant differences were detected (p > 0.05). The mean release of VEGF, TGFß-1, PDGF-BB, and MMP-9 raised to a peak at time point five (day 7) in both liquid and solid PRF matrices. VEGF release was lower in liquid PRF than in solid PRF, whereas those of PDGF-BB and MMP-9 were higher in liquid PRF than in solid PRF at all time points. EGF had its peak release already at time point two after 7 h in liquid and solid matrices (hour 7 EGF solid: mean = 180 pg/mL, SD = 81; EGF liquid: mean = 218 pg/mL, SD = 64), declined rapidly until day 2, and had a second slight peak on day 7 in both groups (day 7 EGF solid: mean = 182 pg/mL, SD = 189; EGF liquid: mean = 81 pg/mL, SD = 70). Conclusions: This study detected growth factor release within liquid and solid PRF matrices with little variations. Further preclinical trials are needed to precisely analyze the growth factor release in larger samples and to better understand their effects on wound healing in different clinical indications.

Intravenous ibuprofen versus diclofenac plus orphenadrine in orthognathic surgery: a prospective, randomized, double-blind, controlled clinical study.

OBJECTIVES: The aim of this prospective, randomized, double-blind, controlled clinical study was to evaluate the analgesic effect of ibuprofen versus diclofenac plus orphenadrine on postoperative pain in orthognathic surgery. MATERIAL AND METHODS: Patients who underwent orthognathic surgery were randomized into two groups to receive intravenously either 600 mg of ibuprofen (I-group) or 75 mg diclofenac plus 30 mg orphenadrine (D-group), both of which were given twice daily. Additionally, both groups were given metamizole 500 mg. Rescue pain medication consisted of acetaminophen 1000 mg and piritramide 7.5 mg as needed. To assess the pain intensity, the primary end point was the numeric rating scale (NRS) recorded over the course of the hospital stay three times daily for 3 days. RESULTS: One hundred nine patients were enrolled (age range, 18 to 61 years) between May 2019 and November 2020. Forty-eight bilateral sagittal split osteotomies (BSSO) and 51 bimaxillary osteotomies (BIMAX) were performed. Surgical subgroup analysis found a significant higher mean NRS (2.73 vs.1.23) in the BIMAX D-group vs. I-group (p = 0.015) on the third postoperative day. Additionally, as the patient's body mass index (BMI) increased, the mean NRS (r = 0.517, p = 0.001) also increased. No differences were found between age, gender, length of hospital stay, weight, operating times, number of patients with complete pain relief, acetaminophen or piritramide intake, and NRS values. No adverse events were observed. CONCLUSION: The results of this study demonstrate that ibuprofen administration and lower BMI were associated with less pain for patients who underwent bimaxillary osteotomy on the third postoperative day. Therefore, surgeons may prefer ibuprofen for more effective pain relief after orthognathic surgery. CLINICAL RELEVANCE: Ibuprofen differs from diclofenac plus orphenadrine in class and is a powerful analgetic after orthognathic surgery.

Does the timing of implant placement and loading influence biological outcomes of implant-supported multiple-unit fixed dental prosthesis-A systematic review with meta-analyses.

OBJECTIVE: To investigate the impact of timing of implant placement and loading on implant survival and biological outcomes of multiple-unit implant-supported fixed dental prosthesis (FDPs). MATERIAL AND METHODS: A literature search was performed by three independent reviewers for studies reporting on ≥10 patients with FPDs supported by ≥two implants over ≥3 years of follow-up. Data were analyzed on implant survival and biological complications as primary outcomes and biological events, including changes in peri-implant marginal bone level (MBL), probing depth, soft-tissue level, and health condition as secondary outcomes. RESULTS: 7002 titles were identified, 360 full-texts were screened, and 14 studies were included. These comprised 6 randomized controlled studies (RCTs), 5 cohort studies, and 3 case series with identifiable implant placement and loading protocols in five of 09 possible combinations. All groups but one (IPIL) showed implant survival rates >90%. A meta-analysis based on 3 RCTs found no differences in survival rate between DPIL and DPDL (p = .227). CONCLUSIONS: High survival rates for all studied implant placement and loading combinations were shown for FPDs over ≥3 years of follow-up. When a delayed implant placement protocol is applied, immediate or delayed loading demonstrated similar survival rates. The heterogeneity of the data did not allow to draw any further conclusions on the occurrence of biological complications related to timing of implant placement/loading.

Effects of Pre-Operative Risk Factors on Intensive Care Unit Length of Stay (ICU-LOS) in Major Oral and Maxillofacial Cancer Surgery.

OBJECTIVE: This study aimed to investigate the effect of certain pre-operative parameters directly on the post-operative intensive care unit (ICU)-length of stay (LOS), in order to identify at-risk patients that are expected to need prolonged intensive care management post-operatively. MATERIAL AND METHODS: Retrospectively, patients managed in an ICU after undergoing major oral and maxillofacial surgery were analyzed. Inclusion criteria entailed: age 18-90 years, major primary oral cancer surgery including tumor resection, neck dissection and microvascular free flap reconstruction, minimum operation time of 8 h. Exclusion criteria were: benign/borderline tumors, primary radiation, other defect reconstruction than microvascular, treatment at other centers. Separate parameters used within the clinical routine were set in correlation with ICU-LOS, by applying single testing calculations (t-tests, variance analysis, correlation coefficients, effect sizes) and a valid univariate linear regression model. The primary outcome of interest was ICU-LOS. RESULTS: This study included a homogenous cohort of 122 patients. Mean surgery time was 11.4 (±2.2) h, mean ICU-LOS was 3.6 (±2.6) days. Patients with pre-operative renal dysfunction (p < 0.001), peripheral vascular disease-PVD (p = 0.01), increasing heart failure-NYHA stage categories (p = 0.009) and higher-grade categories of post-operative complications (p = 0.023) were identified as at-risk patients for a significantly prolonged post-operative ICU-LOS. CONCLUSIONS: At-risk patients are prone to need a significantly longer ICU-LOS than others. These patients are those with pre-operative severe renal dysfunction, PVD and/or high NYHA stage categories. Confounding parameters that contribute to a prolonged ICU-LOS in combination with other variables were identified as higher age, prolonged operative time, chronic obstructive pulmonary disease, and intra-operatively transfused blood.

Is there a hidden blood loss in orthognathic surgery and should it be considered? Results of a prospective cohort study.

The aim of this prospective observational study was to investigate the parameter 'hidden blood loss' (HBL) in the context of orthognathic surgery, incorporating undetected bleeding volumes occurring intra- and postoperatively. Orthognathic bleeding volumes were recorded at three different time points. At the end of the operation the visible intraoperative blood loss (VBL) was measured. Additionally, the perioperative blood loss was calculated 24 h and 48 h postoperatively using the 'haemoglobin balance method'. Analysis of the HBL was based on the difference between the visible intraoperative blood loss (VBL) and calculated blood loss (CBL), determined 48 h after surgery. 82 patients (male 33, female 49) were included in this study, of whom 41 underwent bimaxillary surgery and of whom 41 underwent Bilateral Sagittal Split Osteotomy (BSSO). Statistically significant differences with reference to the absolute bleeding volumes were found when comparing the two treatment modalities. In terms of HBL, a bleeding volume of 287.2 ml (±265.9) in the bimaxillary group and 346.9 ml (±271.3) in the BSSO cohort was recorded. This accounted for 32.2% (bimaxillary surgery) and 62.6% (BSSO) of the CBL after 48 h (BIMAX vs. BSSO, p < 0.001). HBL is a valuable adjunct to record within the perioperative management of orthognathic surgery to further improve patient safety and postoperative outcomes.

Robin Sequence: 5-Year Speech Outcomes-A Case-Control Study.

BACKGROUND: Pierre Robin sequence (Robin sequence) is defined as the triad of micrognathia, glossoptosis, and airway obstruction. It is frequently associated with palatal clefting. In recent years, increased interest in speech outcomes of cleft patients diagnosed with Robin sequence has been shown. METHODS: Speech outcomes of cleft patients with Robin sequence were assessed at age 5 in comparison with a cleft palate-only cohort. Speech parameters were evaluated according to the Cleft Audit Protocol for Speech-Augmented and analyzed using the National Audit Standards for Speech (United Kingdom). All patients were treated in the same institution during the same period (2005 to 2012). Subjects who needed nasopharyngeal airway support and those whose airway was managed by positioning only were eligible. RESULTS: Fifty-one cleft patients diagnosed with Robin sequence were included in this study. Outcomes were compared to those of 128 nonsyndromic cleft palate-only patients.Patients with Robin sequence were shown to present with a significantly higher rate of cleft speech characteristics in comparison to the reference cohort (p = 0.001). Furthermore, it was shown that Robin sequence is associated with a significantly higher rate of secondary speech surgery for velopharyngeal dysfunction before the age of 5 (p = 0.016). Robin sequence patients with a nasopharyngeal airway presented with a higher rate of cleft speech characteristics compared to Robin sequence patients managed with positioning only. CONCLUSION: Cleft patients with Robin sequence are more likely to need further surgery to correct velopharyngeal dysfunction before the age of 5 and are more prone to present with cleft speech characteristics at the age of 5. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Computed tomography data collection of the complete human mandible and valid clinical ground truth models.

Image-based algorithmic software segmentation is an increasingly important topic in many medical fields. Algorithmic segmentation is used for medical three-dimensional visualization, diagnosis or treatment support, especially in complex medical cases. However, accessible medical databases are limited, and valid medical ground truth databases for the evaluation of algorithms are rare and usually comprise only a few images. Inaccuracy or invalidity of medical ground truth data and image-based artefacts also limit the creation of such databases, which is especially relevant for CT data sets of the maxillomandibular complex. This contribution provides a unique and accessible data set of the complete mandible, including 20 valid ground truth segmentation models originating from 10 CT scans from clinical practice without artefacts or faulty slices. From each CT scan, two 3D ground truth models were created by clinical experts through independent manual slice-by-slice segmentation, and the models were statistically compared to prove their validity. These data could be used to conduct serial image studies of the human mandible, evaluating segmentation algorithms and developing adequate image tools.

Clinical evaluation of semi-automatic open-source algorithmic software segmentation of the mandibular bone: Practical feasibility and assessment of a new course of action.

INTRODUCTION: Computer assisted technologies based on algorithmic software segmentation are an increasing topic of interest in complex surgical cases. However-due to functional instability, time consuming software processes, personnel resources or licensed-based financial costs many segmentation processes are often outsourced from clinical centers to third parties and the industry. Therefore, the aim of this trial was to assess the practical feasibility of an easy available, functional stable and licensed-free segmentation approach to be used in the clinical practice. MATERIAL AND METHODS: In this retrospective, randomized, controlled trail the accuracy and accordance of the open-source based segmentation algorithm GrowCut was assessed through the comparison to the manually generated ground truth of the same anatomy using 10 CT lower jaw data-sets from the clinical routine. Assessment parameters were the segmentation time, the volume, the voxel number, the Dice Score and the Hausdorff distance. RESULTS: Overall semi-automatic GrowCut segmentation times were about one minute. Mean Dice Score values of over 85% and Hausdorff Distances below 33.5 voxel could be achieved between the algorithmic GrowCut-based segmentations and the manual generated ground truth schemes. Statistical differences between the assessment parameters were not significant (p<0.05) and correlation coefficients were close to the value one (r > 0.94) for any of the comparison made between the two groups. DISCUSSION: Complete functional stable and time saving segmentations with high accuracy and high positive correlation could be performed by the presented interactive open-source based approach. In the cranio-maxillofacial complex the used method could represent an algorithmic alternative for image-based segmentation in the clinical practice for e.g. surgical treatment planning or visualization of postoperative results and offers several advantages. Due to an open-source basis the used method could be further developed by other groups or specialists. Systematic comparisons to other segmentation approaches or with a greater data amount are areas of future works.

Temporal and spatial variability of chemical and isotopic composition of soil solutions from cambisols - field study and experiments.

The chemical and isotopic composition of soil solutions is highly relevant for environmental and forensic tasks. We investigated interstitial solutions from soil horizons of three cambisols in Styria (Austria). The soils consisted mainly of quartz, feldspar and clay minerals with a vertical variability. Two soil solution fractions from meso-, macro- and micropores (m) and micropores only (µ) were extracted at two subsequent hydraulic pressure steps corresponding to matrix potentials of up to pF 5.43 and from 5.43 to 5.73, respectively. While solute concentrations indicated diverse distribution in soil solution fractions m and µ, heavy stable hydrogen and oxygen isotopes of H2O (-92.5‰<δ2H<-34.4‰; -11.9‰<δ18O<-4.0‰, VSMOW) are clearly enriched in the µ versus m fractions. Principal component analysis on the hydrochemical data set indicates that the intensity of the overall silicate weathering is higher in autumn versus spring, whereas the anthropogenic impact on weathering behaves inversely. The anthropogenic impact is related to seasonal variability of nitrification of N-fertilizers. In consequence of evaluated signals for overall silicate weathering about three-fourths of the soil solutions sampled in autumn indicated elevated total dissolved solid concentration vs. those in spring accompanied with washing out solutes from the soil cover following precipitation events in autumn before sampling. Isotopic shift of soil solutions from the local meteoric water line in spring obviously followed an evaporation trend because of less precipitation and high evaporation before sampling. Experimentally simulated evaporation of soil samples confirmed the observed isotopic evaporation trend. Wetting experiments indicated the infiltration of water within minutes into the micropores of the soils. Exchange of water molecules between micro-, meso- and macropores is an almost instantaneous process and soil solutions in micropores are not as isolated from the soil water system as it was formerly suggested, e.g. for plant uptake. Highly dynamic and complex mechanisms in the gas-water-solid system of soils have to be considered for the application of elemental and isotope proxies related to environmental, forensic and agricultural tasks.

The influence of ambient lighting on the detection of small contrast elements in digital dental radiographs.

OBJECTIVES: The aim of this study was to evaluate the effect of ambient light on the detection of contrast elements in digital dental radiographs. MATERIALS AND METHODS: A high-contrast standardized digital radiograph of an aluminum step wedge containing 32 boreholes of different depth was cut into 40 isometric images. Images were presented at random on a 17-in cathode ray tube (CRT) monitor at different ambient background illuminations of 0, 50, 200, and 500 lx. Twenty observers stated twice their blinded decision whether or not they could perceive a dark spot on a five-point confidence scale. Areas (Az) under receiver operating characteristic curves were calculated and compared between the four different ambient illuminations using the Friedman test. Statistical significance was set at p < 0.05. Overall agreement was estimated determining the intraclass correlation coefficient. RESULTS: The Az values (0.735 for 0 lx, 0.728 for 50 lx, 0.735 for 200 lx, and 0.788 for 500 lx) did not significantly differ (p = 0.796) between the four ambient lighting levels. CONCLUSIONS: The detection of small contrast features in digital dental radiographs on a CRT monitor seems to be comparable over a wide range of ambient background illumination. CLINICAL RELEVANCE: The ambient light in dental offices of <500 lx may not negatively impact the diagnostic performance of digital dental radiographs.

Coping with stress: its influence on periodontal therapy.

BACKGROUND: Individual stress coping strategies appear to influence periodontal disease: individuals with inadequate stress behavior may be at greater risk of developing disease. The purpose of this 24-month prospective study was to examine the influence of different coping behaviors on a non-surgical periodontal therapy and on the course of periodontal disease. METHODS: In 80 patients with chronic periodontitis, a non-surgical periodontal treatment was conducted after their individual stress coping strategies had been recorded. After 2 years of regular maintenance, their periodontal condition was evaluated. The stress coping questionnaire was used to obtain psychodiagnostic data. Clinical attachment loss (CAL) served as the clinical parameter. RESULTS: Patients with a defensive coping style had statistically significant poorer attachment values (P= 0.000) after 2 years compared to patients with other coping behaviors. The percentage of sites with slight to moderate CAL (<5 mm) was significantly less in patients with a defensive coping style than in patients with other coping strategies (P = 0.000). The number of sites with severe advanced CAL (>5 mm) was significantly correlated with a suppressive coping style (P= 0.0001). None of the individual stress coping styles revealed significant overall changes over time. The subtest of drug use (alcohol, nicotine, tranquilizers) as well as changes in this subtest over time were significantly correlated with the CAL (P = 0.003); an increase in the t value of the subtest of drug use was accompanied by a significant increase in CAL. CONCLUSIONS: The results of this study show that passive coping strategies were more pronounced in advanced disease as well as in cases of poor response to a non-surgical periodontal treatment, whereas patients with active coping modes had milder disease and a more favorable course of treatment. Thus, maladaptive behavior, especially in association with behavior-related risk factors such as smoking, are of great importance in the medical history, treatment, and maintenance of patients with periodontal disease.

Study of the extent of torque, protrusion and intrusion of the incisors in the context of Class II, division 2 treatment in adults.

AIM: The aim of this study was to analyze the relative contribution of torque and protrusion to the change in incisor inclination in the treatment of Class II, Division 2 malocclusion with fixed appliances. Furthermore, the extent of incisor intrusion was to be evaluated. The second part of the study was aimed at documenting the stability of the therapeutic outcome in terms of inclination and intrusion within the framework of a follow-up examination. PATIENTS AND METHOD: The study sample comprised 25 adult patients, and the follow-up sample eleven patients. The intrusion and change in inclination of the incisors as well as their stability were analyzed by evaluating and superimposing lateral cephalograms taken before and after treatment as well as after retention. RESULTS: Although the mean value of inclination at the end of the therapy was in accordance with the standard value (102 degrees), there was a marked interindividual variation. In the maxilla, the mean torque component was 58%, and the mean protrusion component 42%. In the mandible, the torque: protrusion ratio was 37%:63%. The mean intrusion was 1 mm in both dental arches. The follow-up examination showed that the intrusion was relatively stable. In cases where the change in inclination relapsed, the ratio of protrusion to torque was almost equal to that previously used to induce the change during the course of treatment. CONCLUSION: It is concluded that therapy with torque movement and intrusion offers a more stable result in adults than protrusion movement alone.