Use of ultrasound imaging for assessment of the periodontium: A systematic review.

The objective of this study was to systematically review the literature regarding diagnostic applications of ultrasound imaging for evaluation of the periodontium in humans. The search was conducted on Medline, EMBASE, Web of Science, Scopus, Cochrane, and PubMed up to April 3, 2023. The studies included were exclusively human studies that assessed the periodontium with ultrasound (US) imaging (b-mode). Outcomes measured included alveolar bone level, alveolar bone thickness, gingival thickness, and blood flow quantification. References were imported to Covidence. Two reviewers conducted phases 1 and 2. The JBI risk assessment tool for cross-sectional studies was used. Extracted data included the transducer and measurements used and the study's outcomes. The search yielded 4892 studies after removing duplicates. From these, 25 studies were included and selected for extraction. Included studies retrieved outcomes from US examinations of the periodontal tissues. From the selected studies, 15 used US on natural teeth, 4 used US on implants, 2 used US on edentulous ridges, and 4 used color flow/power in US to evaluate the blood flow. The results of the present systematic review suggest that US might be a feasible and valuable diagnostic tool for the periodontium, with the potential to complement shortfalls of current radiographic technologies.

Loricrin and Cytokeratin Disorganisation in Severe Forms of Periodontitis.

OBJECTIVE: The aim of this research was to investigate the role of the cornified epithelium, the outermost layer of the oral mucosa, engineered to prevent water loss and microorganism invasion, in severe forms of periodontitis (stage III or IV, grade C). METHODS: Porphyromonas gingivalis, a major periodontal disease pathogen, can affect cornified epithelial protein expression through chronic activation of signal transducer and activator of transcription 6 (Stat6). We used a mouse model, Stat6VT, that mimics this to determine the effects of barrier defect on P gingivalis-induced inflammation, bone loss, and cornified epithelial protein expression, and compared histologic and immunohistologic findings with tissues obtained from human controls and patients with stage III and IV, grade C disease. Alveolar bone loss in mice was assessed using micro-computerised tomography, and soft tissue morphology was qualitatively and semi-quantitatively assessed by histologic examination for several proteins, including loricrin, filaggrin, cytokeratin 1, cytokeratin 14, a proliferation marker, a pan-leukocyte marker, as well as morphologic signs of inflammation. Relative cytokine levels were measured in mouse plasma by cytokine array. RESULTS: In the tissues from patients with periodontal disease, there were greater signs of inflammation (rete pegs, clear cells, inflammatory infiltrates) and a decrease and broadening of expression of loricrin and cytokeratin 1. Cytokeratin 14 expression was also broader and decreased in stage IV. P gingivalis-infected Stat6VT mice showed greater alveolar bone loss in 9 out of 16 examined sites, and similar patterns of disruption to human patients in expression of loricrin and cytokeratins 1 and 14. There were also increased numbers of leukocytes, decreased proliferation, and greater signs of inflammation compared with P gingivalis-infected control mice. CONCLUSIONS: Our study provides evidence that changes in epithelial organisation can exacerbate the effects of P gingivalis infection, with similarities to the most severe forms of human periodontitis.

Pre-treatment oral microbiome analysis and salivary Stephan curve kinetics in white spot lesion development in orthodontic patients wearing fixed appliances. A pilot study.

BACKGROUND: White spot lesions (WSLs) are a formidable challenge during orthodontic treatment, affecting patients regardless of oral hygiene. Multifactorial in nature, amongst potential contributors to their development are the microbiome and salivary pH. The aim of our pilot study is to determine if pre-treatment differences in salivary Stephan curve kinetics and salivary microbiome features correlate with WSL development in orthodontic patients with fixed appliances. We hypothesize that non-oral hygiene determined differences in saliva could be predictive of WSL formation in this patient population through analysis of salivary Stephan curve kinetics, and that these differences would further manifest as changes in the oral microbiome. METHODS: In this prospective cohort study, twenty patients with initial simplified oral hygiene index scores of "good" that were planning to undergo orthodontic treatment with self-ligating fixed appliances for at least 12 months were enrolled. At pre-treatment stage, saliva was collected for microbiome analysis, and at 15-minute intervals after a sucrose rinse over 45 min for Stephan curve kinetics. RESULTS: 50% of patients developed a mean 5.7 (SEM: 1.2) WSLs. There were no differences in saliva microbiome species richness, Shannon alpha diversity or beta diversity between the groups. Capnocytophaga sputigena exclusively and Prevotella melaninogenica predominantly were found in WSL patients, while Streptococcus australis was negatively correlated with WSL development. Streptococcus mitis and Streptococcus anginosus were primarily present in healthy patients. There was no evidence to support the primary hypothesis. CONCLUSIONS: While there were no differences in salivary pH or restitution kinetics following a sucrose challenge and no global microbial differences in WSL developers, our data showed change in salivary pH at 5 min associated with an abundance of acid-producing bacteria in saliva. The results suggest salivary pH modulation as a management strategy to inhibit the abundance of caries initiators. Our study may have uncovered the earliest predecessors to WSL/caries development.

Impact of a CD36 inhibitor on Porphyromonas gingivalis mediated atherosclerosis.

OBJECTIVE: To determine if AP5055 drug, an inhibitor of CD36, prevents the increase in Porphyromonas gingivalis (P. gingivalis) mediated atherosclerosis in low-density lipoprotein receptor knockout (LDLR KO) mice by targeting CD36. METHODS: Male LDLR KO mice were infected with P. gingivalis by oral lavage to induce periodontal disease and fed a western diet to induce atherosclerosis. Mice were treated with the CD36 inhibitor, AP5055 (1 mg/kg), or vehicle (1% DMSO). Aortae were dissected and stained with oil red-O for morphometric analysis; blood/plasma was collected to determine markers of inflammation by cytokine array and cholesterol levels. P. gingivalis-induced bone loss in mandibles was assessed using micro-CT. P. gingivalis lipopolysaccharide stimulated nuclear factor-kappa B (NF-κB) activity was measured using a reporter gene (secreted alkaline phosphatase) assay in AP5055 treated or untreated RAW-Blue macrophages. RESULTS: Isolated aortae showed a significant decrease in lesion area in the AP5055 treated group as compared to the control group. Mechanistically, in vitro analysis demonstrated that AP5055 inhibited NF-κB activity. Cytokine array showed a decrease in the expression of pro-inflammatory cytokines and decreased levels of plasma cholesterol in AP5055 treated mice. Micro-CT measurements of bone loss were not significant between the two groups. CONCLUSION: CD36 inhibitor AP5055 abrogates atherosclerotic lesion burden associated with periodontal disease, accompanied by a reduction in markers of inflammation. These experiments may support the development of drugs targeting CD36 for human disease.

A 2-plane micro-computed tomographic alveolar bone measurement approach in mice.

PURPOSE: This study introduces a standardized 2-plane approach using 8 landmarks to assess alveolar bone levels in mice using micro-computed tomography. MATERIALS AND METHODS: Bone level differences were described as distance from the cemento-enamel junction (CEJ) to alveolar bone crest (ABC) and as percentages of vertical bone height and vertical bone loss, comparing mice infected with Porphyromonas gingivalis (Pg) to controls. Eight measurements were obtained per tooth: 2 in the sagittal plane (mesial and distal) and 6 in the coronal plane (mesiobuccal, middle-buccal, distobuccal, mesiolingual, middle-lingual, and distolingual). RESULTS: Significant differences in the CEJ-to-ABC distance between Pg-infected mice and controls were found in the coronal plane (middle-lingual, mesiobuccal, and distolingual for the first molar; and mesiobuccal, middle-buccal, and distolingual for the second molar). In the sagittal plane, the distal measurement of the second molar was different. The middle-buccal, mesiobuccal, and distolingual sites of the first and second molars showed vertical bone loss relative to controls; the second molar middle-lingual site was also different. In the sagittal plane, the mesial sites of the first and second molars and the distal site of the second molar showed loss. Significantly different vertical bone height percentages were found for the mesial and distal sites of the second molar (sagittal plane) and the middle-lingual and distolingual sites of the first molar(coronal plane). CONCLUSION: A reliable, standardized technique for linear periodontal assessments in mice is described. Alveolar bone loss occurred mostly on the lingual surface of the coronal plane, which is often omitted in studies.

Detection of mast cells in ameloblastomas and odontogenic keratocysts.

BACKGROUND: MCs (MCs) have been ascribed to mediating several diseases, including malignant neoplasms. These cells can play a role in angiogenesis, tissue remodeling and immune modulation and favor neoplasm progression. Despite the studies analyzing the contribution of MCs in odontogenic lesions, its biological behavior in ameloblastomas (AMBs) and odontogenic keratocysts (OKCs) remains unclear. This study aims to detect MCs in OKCs and AMBs and clarify the role of MCs in these lesions. MATERIAL AND METHODS: A total of 40 odontogenic lesions were analyzed. This included 20 OKCs and 20 AMBs, 10 being the solid type and the other 10 being the unicystic type of AMB. All cases were histologically reviewed in hematoxylin-eosin. Clinical data, such as age, gender, location, size, radiographic presentation and, histologic patterns were collected from the clinical charts. The Mann-Whitney U test (MWU) was used verify the hypothesis, through inferential statistics. The level of significance used in the statistical test was 0.5%. RESULTS: MCs were observed in 60% of OKCs, and 35% of AMBs. The ratio of MCs observed in OKCs was 0.37, 0.48 in solid AMBs and 0.01 in unicystic AMBs. There was no significant difference between number of MCs in AMBs and OKCs, however, a significant difference was observed between solid and unicystic AMBs (p ≤ 0.01). CONCLUSIONS: MCs may play an important role in the biological behavior of AMBs and OKCs. However, in this study it was not possible to confirm the contribution of MCs in the biological behavior of these lesions and more studies are needed to clarify this relation. Key words:AMB, OKC, MCs, histochemistry, toluidine blue.

Surgically accelerated orthodontic techniques and periodontal response: a systematic review.

BACKGROUND: Reduction in orthodontic treatment time is gaining popularity due to patient demands. Several new techniques of acceleratory orthodontic treatment have been introduced to effectively treat the malocclusion in a shorter time period with minimal adverse effects. OBJECTIVE: The objective of this systematic review is to critically evaluate the potential effect of accelerated surgically assisted orthodontic techniques on periodontal tissues. MATERIALS AND METHODS: Electronic databases used to perform the search were Medline (Ovid), EMBASE, PubMed, Scopus, Cochrane, Google Scholar, and hand searching of the literature was also performed. SELECTION CRITERIA: Only randomized control trials (RCTs) that assessed the relationship between accelerated surgically assisted orthodontic techniques and its effects on periodontium were included. DATA COLLECTION AND ANALYSIS: The Joanna Briggs Institute (JBI) critical appraisal checklist tool (2016) was used to assess the finally selected studies. Among these studies, five evaluated corticotomy-facilitated orthodontics, two tested accelerated tooth movement with piezocision, one compared corticotomy-facilitated orthodontics with piezocision, and one studied the effects of periodontally accelerated osteogenic orthodontics. The duration of these studies was relatively short and had moderate to high risk of bias. RESULTS: Literature search identified 225 records from 5 databases and 50 articles from the partial grey literature (Google scholar) search. Finally, nine eligible RCTs were included in the review. LIMITATIONS: Most of the included studies were of a high risk of bias due to high experimental heterogeneity and small sample size. Long-term follow-up of the periodontal response to these interventions was also lacking. CONCLUSIONS: There is an absence of evidence considering the lack of long-term follow-up and small sample size therefore, the results of this review should be carefully interpreted. IMPLICATIONS: Due to the need for more studies with less risk of bias, these techniques should be implemented in dental practice with caution. With stronger evidence, the study may be confirmed to provide quicker desired results for orthodontic patients. REGISTRATION: This study protocol was not registered. FUNDING: No funding was obtained for this systematic review.

Prevalence of Periodontitis in Young Populations: A Systematic Review.

PURPOSE: To assess the prevalence of periodontitis in young populations (previously termed aggressive periodontitis - AgP) and report on the earliest known occurrence of this disease. MATERIALS AND METHODS: A search was performed covering the last 18 years utilising the following databases: Medline (Ovid), PubMed and Embase. Four reviewers evaluated each study. Review findings were summarised using the PRISMA Statement for reporting and Joanna Briggs Institute (JBI) Critical Appraisal tools for quality assessment, respectively. Twenty-two articles were included in this systematic review, consisting of 6 prevalence studies and 16 case reports. Only prevalence studies were considered for prevalence estimates. RESULTS: The average reported prevalence of periodontitis in young populations was 1.7% (ranging from 0.66% in Argentina to 5.9% in Israel). The prevalence was higher for the localised form of this disease. Permanent teeth were the most common dentition affected (114 out of 115 affected patients). In terms of age, the prevalence was 0.6%, 0.8% and 1.6% for the age groups 2-12, 20-25 and 13-20, respectively. There was no significant difference noted between males and females. The earliest age diagnosed with periodontitis was 3 years 7 months. CONCLUSION: The prevalence of periodontitis in young patients is ranges widely, which could indicate populational predispositions, underdiagnosing or lack of standardisation in diagnosis.

Diagnosis of aggressive periodontitis: A dilemma?

Periodontitis is one of the leading causes of tooth loss in the adult population. This disease can be classified into various categories, and one of the most destructive amongst them is aggressive periodontitis (AgP). The incidence of AgP is lower than other types of periodontitis. However, it affects young individuals and can cause severe destruction of tooth-supporting structures including tooth loss if left untreated. The current classification for diagnosing periodontal disease was established by the American Academy of Periodontology (AAP) in 1999. This classification provided strict guidelines to aid in AgP diagnosis. These include three main factors: systemically healthy individual, rapid loss of clinical attachment, and familial aggregation. In spite of these specific guidelines, AgP diagnosis is often missed clinically due to various reasons. There is still a vast variation in the diagnostic criteria for identifying AgP and not all practitioners utilize the AAP guidelines for their diagnosis. Furthermore, the definition of the disease might be changing in the future to better represent the current understanding of the disease. Since early diagnosis and prompt treatment is key in treating these patients, it is important to have calibration in the diagnosis process. This review aims to identify sources of variation and ambiguity in diagnosing AgP among dental practitioners. For this purpose, we have conducted an extensive literature search and outlined the various diagnostic aids for AgP patients reported in the literature. Understanding and correcting these variations can simplify the diagnostic process leading to faster treatment of patients affected with AgP. This review also emphasizes the importance of minimizing the bias in identifying patients with AgP and highlights the best tools for this purpose.

Citotoxicity evaluation of three dental adhesives on vero cells in vitro.

BACKGROUND: To evaluate, in vitro, the potential cytotoxicity of three different dental adhesives systems (Adper Single Bond 2 -SB, Silorane System Adhesive Bond -SSAB and Single Bond Universal -SBU) on cultivated Vero cells after different contact times. MATERIAL AND METHODS: The cells were cultured in a concentration of 2 x 105 cells/mL for 24h and grown to sub-confluent monolayers. VERO cells were exposed to 25µl of conditioned extracts obtained from 24h, 48h and 72h immersion of adhesive samples in culture medium (DMEM), immediately after polymerization. Fresh DMEM was used as negative control. Cell metabolism was evaluated by the MTT assay (3-(4,5-dimethylthiazol-2-yl)-2, 5diphenyl-tetrazolium bromide). The data were analyzed statistically by ANOVA, considering a significance of 5%. RESULTS: The values of cell viability ranged from 94.2% at 72h (SBU) to 109.6% at 48h (SB). The mean percentage of viability after exposure to the extracts of SB, SSAB and SBU were 103.2%, 100.63% and 97.43%, respectively. There was no statistically significant difference (p= 0.342) between the experimental and negative control groups. CONCLUSIONS: At all exposure times, all adhesives tested in this study presented no cytotoxicity to Vero cells in vitro. Key words:Biocompatibility, cytotoxicity, dental adhesives, Vero cells.

Evaluation of volumetric changes of teeth in a Brazilian population by using cone beam computed tomography.

The purpose of this study was to test the usefulness of some morphometric parameters of the teeth in 5 different age groups through images of Cone Beam CT. 118 upper central incisors clinically acquired of 60 women and 58 men aged between 22 and 70 years were selected. The hard tissue volume and the pulp cavity volume of each tooth was obtained and computed by the software DentalSlice(®) and the measures were assessed (pulp cavity volume, hard tissue volume, tooth volume and pulp cavity/tooth volume ratio). The pulp cavity volume and the pulp cavity/tooth volume ratio showed significant differences between age groups (p < 0.001). Linear regression analysis showed a coefficient of determination of 0.21 which suggests that there is a weak correlation between the pulp cavity/tooth volume ratio and age.

Avaliação morfológica da região retromolar para enxertos ósseos através de tomografia computadorizada (TC) de feixe cônico: um estudo com 60 pacientes / Morphological evaluation of the retromolar region for bone grafting procedures using cone-beam tomography: a study with 60 patients

A perda dentária possui forte impacto na qualidade de vida, ocasionando problemas de ordem funcional e emocional. Após a perda do elemento dental, o rebordo alveolar passa por um processo de reabsorção e isso impossibilita a colocação de implantes, por esse motivo, o enxerto ósseo é a técnica de escolha para solucionar tal problema. O objetivo deste estudo foi avaliar a morfologia da região retromolar, uma área utilizada para remoção de enxertos ósseos, em imagens de tomografia computadorizada (TC) tipo cone-beam para a reconstrução volumétrica, com a finalidade de determinar a altura e a espessura da área doadora disponível nessa região, utilizando como referência as corticais do canal mandibular e estabelecer uma média de quantidade óssea dessa região em uma amostra da cidade do Recife, Brasil. Material e Métodos: nesta amostra foram incluídos pacientes de ambos os sexos, com idade acima de 28 anos e sem limite de idade, que tinham presença dos segundos molares superiores e ausência de terceiros molares inferiores. A ferramenta de mensuração linear em milímetros foi utilizada para obter as medidas. Resultados e Conclusão: os homens apresentaram maior altura do canal mandibular do que as mulheres (p < 0,001), o sexo feminino apresentou maior quantidade de osso medular em comparação com o sexo oposto (p < 0,001), a quantidade de osso compacto foi relativamente maior do que o osso medular em ambos os gêneros

Tooth loss has a strong impact on quality of life, causing functional and emotional problems. After tooth loss, the alveolar ridge undergoes resorption and this precludes implant placement; therefore, bone grafting techniques are indicated for such situations. The aim of this study is to evaluate the morphology of the retromolar region through CBCT scanning for available heights and widths using the mandibular canal as reference point in a population of Recife, Brazil. Materials and methods: 200 patients of both genders above 28 years with their second molar teeth and the lack of lower third molars were selected. A linear measurement tool was used to generated data. Results and conclusions: from the final 60 selected patients and within the limits of this study, the height of the alveolar mandibular canal was higher in male than in female (p < 0.001), the female presented more medulary bone (p < 0.001), and the compact bone quantity was higher than medulary bone for both genders.

Avaliação dos conhecimentos de ergonomia em acadêmicos do ciclo profissional em uma Faculdade de Odontologia do sistema público de educação superior em Pernambuco¹ / Evaluation of the ergonomics knowledge in undergraduate of the professional course in a Dentistry's Faculty of the higher education public system in Pernambuco

Objetivo: avaliar o nível de conhecimento, de aplicação e de cobrança da Ergonomia na prática clínica. Material e Métodos: estudo descritivo, observacional de corte transversal realizado com 174 alunos, de ambos os gêneros, regularmente matriculados entre o 4º e o 9º período do currículo antigo de uma Faculdade de Odontologia do sistema público de educação superior em Pernambuco, por meio de um questionário contendo 16 conhecimentos básicos de Ergonomia e 10 situações ergonômicas a serem exigidas pelas disciplinas clínicas. Resultados: a amostra foi predominantemente feminina (67,2%). Como o conceito mais apreendido pelos estudantes, tem-se: No conceito de ergonomia não podem faltar às palavras conforto, segurança e eficiência (92,0%), e o menos apreendido foi o seguinte: A maioria dos equipos da faculdade é conceito ISO/FDI 3/ (13,2%). Apenas um conhecimento se associou ao gênero, dois, à idade, e treze, ao período cursado. A melhor taxa de acertos foi do 9º período, e a pior, a do 7º. A situação ergonômica mais exigida pelas disciplinas se relacionou ao uso correto do EPI (50,7%), e a menos exigida, à ginástica laboral (2,7%). A disciplina com maior média de exigência dos conhecimentos de Ergonomia e de sua aplicação foi a Clínica Integrada II (2,40), e a de menor média, a Prótese Fixa II (1,55). Todas as situações ergonômicas se associaram ao período cursado. Conclusões: os conhecimentos de Ergonomia perdem-se ao longo do tempo, e essa perda se deve, em parte, à falta de exigência das disciplinas. A disciplina de Clínica Integrada II é quem mais exige esses conhecimentos e sua aplicação.

Objective: To investigate the level of ergonomics' knowledge and its application in clinical practice. Material and Methods: descriptive and observational study of a sectional cross realized with 174 students, of both genders enrolled between 4th and 9th semesters of the old curriculum of the Dentistry's Faculty of the higher education public system in Pernambuco by applying a survey containing 16 regards basic knowledge of Ergonomics and 10 ergonomic situations to be required by the clinical disciplines. Results: The sample was predominantly female (67.2%). The concept was perceived by the most in the Concept of ergonomics can not miss words to comfort, safety and efficiency (92.0%) and was apprehended less Most equipos of faculty concept is ISO / FDI 3 / (13.2%). Only a knowledge is linked to gender, to age two, and thirteen of the period attended. The best accuracy rate was the 9th time and the worst of the 7. The most ergonomic situation was related disciplines required by the correct use of PPE (50.7%) and less required was related to gymnastics (2.7%). The discipline with the highest average requirement of ergonomics' knowledge and its application was the Integrated Clinic II (2.40) and lowest average was the Fixed Prosthodontics II (1.55). All cases were associated with ergonomic period attended. Conclusions: The knowledge of ergonomics are lost over time and this loss is partly due to lack of demand disciplines. Discipline of Integrated Clinic II is looking more demands that knowledge and its application.