The role, safety, and efficacy of hyperbaric oxygen therapy in aesthetic practice-An evidence-based review.

BACKGROUND: Hyperbaric oxygen therapy (HBOT) involves patients breathing 100% oxygen in a pressurized chamber, above 1 atmosphere. Many centers are now promoting the use of HBOT for skin rejuvenation. However, the current indications for HBOT do not encompass aesthetic applications. AIM: The aim of this evidence-based review was to assess the existing literature regarding the utilization of HBOT in medical aesthetics and rejuvenation, evaluate its effectiveness and safety, and conduct a cost analysis. MATERIALS AND METHODS: PubMed Interface, Cochrane Library, Google Scholar, and Embase searches were carried out. The Best Bets methodology was used, and the risk of bias was appraised using the Quality Assessment Tool for Quantitative Studies. RESULTS AND MAIN FINDINGS: This review included a total of 17 human studies with a total of 766 participants. Three studies were classified as level II evidence, three studies were of level III evidence, and 11 were of level IV evidence. All the included studies were judged at high risk of bias. The most relevant findings supported by level II evidence were that HBOT decreased the shedding rate post-FUE hair transplant (27.6 ± 2.6% vs. 69.1 ± 2.4%) but this did not affect the final outcome between HBOT (96.9 ± 0.5%) and the control (93.8 ± 0.6%). Moreover, level III evidence demonstrated that following HBOT, there was a significant increase in elastic fiber length (p ≤ 0.0001, effect size = 2.71) and a significant decrease in fiber fragmentation (p = 0.012). There was also a significant increase in collagen fiber density following HBOT (p = 0.0001, effect size = 1.10). However, there was no significant effect of antioxidant vitamins A, C, and E with HBOT. The inflammatory response significantly decreased after 7 days of HBOT with a decreased expression of IL-12p40, MIP-1ß, and PDGF-BB and a higher expression of IL-1Ra. Moreover, HBOT was used prophylactically prior to abdominoplasty to decrease the risk of complications. In this study, complications were decreased from 32.6% (89 patients) to 8.4% (7 patients) with a p < 0.001, and in a multivariate analysis, preoperative HBOT was an independent protective factor against postoperative complications (p < 0.001). CONCLUSION AND RECOMMENDATIONS: There is conflicting evidence on how the method of action of HBOT can have a beneficiary effect in aesthetic and whether the treatment is justifiable. To our knowledge, this is the first comprehensive review discussing the available evidence regarding the use of HBOT in many aesthetic clinical scenarios, including preventive, medical, and surgical settings. However, randomized clinical trials with longer follow-up and better patient selection are needed to be able to generate a reliable conclusion.

Soft tissue expansion using self-inflating osmotic hydrogel expanders prior to bone augmentation: healing and complications. Evidence-based review.

AIM: This review aims to assess complication rates, soft tissue gain, and bone gain associated with the use of self-inflating osmotic hydrogel tissue expanders (SOHTEs) for soft tissue expansion (STE). METHODS: A comprehensive search on Pubmed and Google Scholar databases was conducted to identify human studies using SOHTEs for STE; last searched in March 2023. Expansion phase details and expander variables were documented. Complication rates, soft tissue gain, and bone gain reported in each study were also recorded. The inclusion criteria encompassed human studies ranging from evidence levels II-IV (Oxford Centre for Evidence-Based Medicine Levels of Evidence), without specific date limits. For assessing bias in randomized controlled trials (RCTs), a Risk of Bias tool was employed. The synthesised results were presented through tables, sunburst plots, and bar charts. RESULTS: A total of 13 studies were identified, comprising 4 RCTs, 1 cohort study, and 8 case-series. Employment of SOHTEs yielded an overall complication rate of 17% (24/140 sites), with expander perforation accounting for 9.3% (13/140) of the sites. Specific complication rates included dehiscence (1.4%, 2/140 sites), paraesthesia (1.4%, 2/140 sites), and infection (1.4%, 2/140 sites). All randomized controlled trials (RCTs) were categorised at Level II. The remaining investigations primarily consisted of Level IV case-series lacking controls. All studies demonstrated some concerns towards bias. CONCLUSION: STE studies using SOHTEs exhibit a reduction in complications associated with bone augmentation in scenarios of inadequate soft tissue coverage. Preliminary evidence suggests potential benefits even in cases with sufficient soft tissue. Adherence to procedural precautions may reduce the risk of expander perforations, further diminishing complications. Subsequent studies should incorporate individual patient and expander variables in their reports to explore the impact of expansion phases on complication rates, as well as bone and soft tissue augmentation.

Efficacy and safety of using antibiotics to prevent post-operative complications in oral implant treatment: evidence-based review.

AIMS: To identify and critically appraise available evidence on the efficacy and safety of antibiotics in preventing complications following oral implant placement treatment. METHODS: An electronic search was performed using PubMed, Ovid MEDLINE and Cochrane Library databases up to July/21 for the purpose of answering the research question: In[healthy adults treated with dental implants]the use of[different antibiotics before or immediately after treatment]in comparison to[treatment without antibiotics]is safe and effective in terms of[infection, pain, swelling, wound dehiscence, soft tissue healing, early/late implant failure]? Following the Best Evidence Topic methodology, the included studies were categorised based on the Oxford Centre for Evidence-Based Medicine (OCEBM) ratings. The critical appraisal skills programme CASP checklist was used for the methodological analysis. The risk of bias assessment was performed according to the Cochrane Methodology for Systematic Reviews of Interventions. RESULTS: 26 of the 245 initially identified articles met our inclusion criteria for analysis after applying rigorous filters. The included human studies demonstrated significant methodological heterogeneity, precluding meta-analysis. These studies spanned evidence levels II to IV, as per OCEBM 2011 classifications, with the United States contributing the most studies (19.2%, n = 5), all at level III. The United Kingdom and Spain followed with three studies each (11.5% each), two from the UK and one from Spain classified at level II. Most studies had less than 1 year of follow-up (21%). Our analysis included 26 studies, with 38 antibiotic patient groups totalling 7459 patients. Amoxicillin was the predominant antibiotic, with various dosage regimens. Complications were observed in studies across different amoxicillin regimens at a cumulative incidence of 5%. CONCLUSION: The evidence on antibiotics to prevent implant failure presents uncertain and heterogeneous findings. High-risk bias and underpowered studies were prevalent. Future research should prioritise multicentre, double-blinded RCTs with larger samples and longer follow-ups. Structured methodologies, antibiotic stewardship, and adherence to guidelines are needed. Amoxicillin (2 g) was commonly prescribed, but guidelines recommend 3 g, which results in relatively low complications yet there is limited evidence to support it. Clindamycin was favoured for penicillin allergies, but caution is advised due to potential implant failure risk. Consistent use of antiseptic mouthwash was observed. Future research should explore alternatives to antibiotics and antibiotic stewardship. Establishing a well-funded research consortium could yield conclusive results for clinical practice.

Noninvasive lipolysis modalities in aesthetic medicine.

BACKGROUND: Adipose tissue is a vital metabolic organ that takes part in body homeostasis. However, an increase in fat tissue can be detrimental for one's health and lead to undesirable changes in body shape. Noninvasive lipolysis is becoming an increasingly popular method to destroy and remove excess body fat and improve one's satisfaction with their body appearance. AIM: The aim of this study was to perform an evidence-based review of the clinical efficacy and safety of noninvasive lipolysis modalities in fat reduction. MATERIALS AND METHODS: An evidence-based review was performed to evaluate the scientific evidence available on the subject. Three electronic databases (PubMed, Scopus, and Embase) were searched between February and May 2022 for randomized controlled trials and observational studies performed on adult population in the last 20 years investigating the clinical outcomes of noninvasive lipolysis modalities. The selected studies were divided by modality type (cryolipolysis, ultrasound therapy, radiofrequency, and laser therapy), and the data on the efficacy and safety were extracted. RESULTS: In total, the search identified 55 papers which met the inclusion criteria. All four energy-based modalities, including cryolipolysis, ultrasound therapy, radiofrequency, and laser therapy, were shown to be clinically effective in terms of both objective body measurements, such as fat layer thickness or circumference reduction, and subjective patient satisfaction. Furthermore, the abovementioned methods were proven to have a low side effect profile. CONCLUSION: In conclusion, although evidence supports safety and efficacy, further well-designed trials are needed to strengthen confidence in long-term effectiveness and safety of noninvasive lipolysis.

Positive correlational shift between crevicular antimicrobial peptide LL-37, pain and periodontal status following non-surgical periodontal therapy. A pilot study.

BACKGROUND: Periodontitis has a high prevalence and uncertain recurrence. Unlike the pro-inflammatory cytokine profile, little is known about the anti-inflammatory cytokine and antimicrobial peptide overview following treatment. The present study aimed to evaluate if any of the antimicrobial peptide LL-37, interleukin (IL) 4, 10 and 6 together with the volume of gingival crevicular fluid (GCF) and total protein concentration in GCF could be used as correlative biomarkers for the severity in periodontitis as well as prognostic factors in the management of the disease. METHODS: Forty-five participants were recruited and allocated to the healthy (15), Stage I-II (15) or Stage III-IV periodontitis (15) group. Along with periodontal examination, GCF samples were obtained at baseline and 4-6 weeks following scaling and root planing (SRP) for the periodontitis groups. GCF samples were analyzed by ELISA kits to quantify LL-37 and IL-4, -6 and - 10. One-way ANOVA followed by Dunnett's test was used to determine differences among the three groups at baseline. Two-way ANOVA followed by Sidak's post-hoc test was used to compare between pre- and post-SRP in the two periodontitis groups. RESULTS: The amount of GCF volume was significantly correlated to the severity of periodontitis and decreased following SRP, particularly in the Stage III-IV group (p < 0.01). The levels of LL-37, IL-6, and pain and periodontal clinical parameters were significantly correlated to the severity of periodontitis. IL-4 and IL-10 in the periodontitis groups were significantly lower than the healthy group (p < 0.0001) and barely improved following SRP up to the level of the healthy group. CONCLUSIONS: With the limitations of this study, crevicular LL-37 may be a candidate for a biomarker of periodontitis and the associated pain upon probing. TRIAL REGISTRATION: The study was registered in clinical trials.gov, with number NCT04404335, dated 27/05/2020.

Topical growth factor preparations for facial skin rejuvenation: A systematic review.

BACKGROUND: Cosmeceutical preparations containing growth factors (GFs) are widely used for facial rejuvenation. OBJECTIVE: We performed a systematic review to assess the evidence regarding their safety and effectiveness for facial rejuvenation. METHODS: Electronic databases (Cochrane Library, EMBASE, MEDLINE, and Scopus) were searched from 2000 to October 2022 for prospective trials and case series assessing topical GF preparations for facial rejuvenation in 10 or more participants. RESULTS: Thirty-three studies, including 9 randomized controlled trials (RCTs) and 24 uncontrolled case series, representing 1180 participants receiving 23 different topical preparations containing GFs met the inclusion criteria and were included. Of the 33 studies, nine used a placebo or active control. The GF preparations were applied twice daily in all except two studies, with a mean treatment duration of 3 months. Based on the investigator's assessment, preparations containing GFs induce a modest improvement in skin texture (median < 50%), fine lines/wrinkles (median < 35%), and overall facial appearance (median < 20%) versus baseline. Participant-assessed improvement was generally higher than investigator-assessed response. Three comparative RCTs showed no statistically significant differences between treatments. Studies were limited by heterogeneity with regard to the source and number of GFs used in the preparations, information about additional ingredients, and lack of standardization in the outcome measures. The preparations were associated with a low risk of adverse events. The persistence of the clinical improvements beyond 6 months is not known. CONCLUSIONS: Administration of topical preparations containing GFs appears to be effective for facial skin rejuvenation, as demonstrated by the investigator- and participant-reported outcome measures.

Evidence-based review: Screening body dysmorphic disorder in aesthetic clinical settings.

BACKGROUND: Body dysmorphic disorder (BDD) is a psychiatric disturbance with high incidence in aesthetic clinical settings. Early recognition may avoid unnecessary elective procedures with ethical and medicolegal consequences. AIMS: To identify validated BDD screening tools and critically appraise current literature regarding its implementation and efficacy in aesthetic medicine and surgery scenarios, with the purpose of transposing the findings to the broad clinical settings in the field. METHODS: Data was collected using advanced search from PubMed (MEDLINE). Having satisfied the search parameters, 12 studies referring BDD definition according to Diagnostic and Statistical Manual of Mental Disorder (DSM-5) criteria and including a BDD screening tool in clinical aesthetic settings were selected. RESULTS: While BDD screening enables the recognition of at-risk individuals, further work is required to uncover the best screening tool for general aesthetic clinical practice. Level III evidence favored BDD Questionnaire (BDDQ)/BDDQ-Dermatology Version (DV), and The Dysmorphic Concern Questionnaire (DCQ) among the limited available validated screening instruments to be used outside the psychiatric environment. Based on level II self-classification, one study selected BDDQ-Aesthetic Surgery (AS) version for rhinoplasty patients. The validation process of both BDDQ-AS and Cosmetic Procedure Screening Questionnaire (COPS) had limitations. For BDD screening potential in avoiding postoperative complications, the limited studies found evaluating the outcomes following aesthetic treatments using validated BDD screening measures showed a trend toward less satisfaction with aesthetic treatment outcome among positive screening population against non-BDD counterparts. CONCLUSION: Further research is necessary to establish more effective methods to identify BDD and evaluate the impact of positive findings on aesthetic intervention outcomes. Future studies may elucidate which BDD characteristics best predict a favorable outcome and provide high-quality evidence for standardized protocols in research and clinical practice.

Is More Better? Benefits of Hyaluronic Acid Soft Tissue Filler on the Psychological- and Social-Related Quality of Life Dimensions.

Background: Hyaluronic acid (HA) soft tissue fillers are popular for volumizing, sculpting, or rejuvenating the face. Their effect beyond these cosmetic benefits remains poorly defined, especially the changes in the psychological and social dimensions of health following cosmetic HA filler injections. Objectives: To determine whether injecting more facial aesthetic units with HA soft tissue filler will improve the health-related quality of life dimension of patients. Methods: A prospective study was conducted to assess the psychological and social benefits of treating multiple facial aesthetic units with HA soft tissue filler using 3 validated FACE-Q scales at baseline and 4 weeks posttreatment between January and August 2022. Results: Data for 28 participants (n = 26 females [93%]; mean age: 49.7 ± 10.1 years) are available and reveal significant improvements on the psychological (+24.5; P < .001) and social functioning (+18.5; P < .001) FACE-Q scales and a reduction in the appearance-related distress score (-17.8; P < .001) posttreatment compared to baseline. A mean volume of 4.7 mL (range 1.0-15.2 mL) was injected. However, patients who had >2 facial aesthetic units injected did not statistically score better on the FACE-Q scales. Conclusions: Facial treatment with HA fillers was associated with a marked improvement in the health-related quality of life dimension. While understanding patients' aims and motivation, an individualized treatment approach is strongly encouraged instead of a "whole-face" approach.

Impact of botulinum toxin for facial aesthetics on psychological well-being and quality of life: Evidence-based review.

BACKGROUND: There has been a steady growth of non-surgical minimally invasive procedures. In parallel, an ever-broadening range of clinicians has been engaging with botulinum toxin (BoNT) for aesthetic procedures, with reportedly compound positive impact on social health and psychological well-being. OBJECTIVE: To identify and critically appraise current literature on the impact of BoNT injections into the upper face, as a sole treatment/combination with other modalities on facial aesthetics, psychological well-being, and quality-of-life. METHODS: An evidence-based review was performed using advanced search from PubMed, Cochrane Library of Systematic Reviews, and Central Register of Controlled Trials databases . Only literature from inception to August, 2021 were considered. Eligibility criteria included human studies, FDA-approved BoNT applications, formulations, and dosages as a sole/multimodal approach; studies including patient-reported outcome tools psychometrically validated and facial lines-specific. Observer-reported outcome instruments were also considered for a thorough evaluation of outcomes. RESULTS: Based on data investigations and participant assessments, all studies showed statistically significant improvement in psychosocial well-being and quality-of-life domains with a trend for highest impact when multiple upper facial areas are treated in a multimodal approach. CONCLUSION: Aesthetic BoNT showed links to true health benefits for well-selected patients in addition to physical amelioration. However, the biological rational remains ambiguous. Well-designed controlled trials are needed, without pharmaceutical laboratories bias, in real clinical scenarios of patients paying for the interventions, often involving multiple areas with/without combined treatments. The persistence of positive outcomes following repetitive treatments provided by less experienced practitioners, potentially involving suboptimal patient selection and/or aesthetic results, warrants further investigation.

Botulinum toxin A in dentistry and orofacial surgery: an evidence-based review - part 2: cosmetic applications.

Objective An evidence-based review on the role of botulinum toxin type A (BoNTA) on diverse cosmetic applications of interest to dental practitioners and allied specialities. In this context, to identify the cosmetic treatments that have an evidence-based rationale against areas requiring further research, with a view to assess the safety and efficacy of BoNTA.Data source and selection A comprehensive search was conducted using Cochrane Library of Systematic Reviews, Cochrane Central Register of Controlled Trials, and PubMed (Medline) electronic databases. Thirty-nine studies of variable quality were included. The Best Evidence Topics (BETs) Critical Appraisal Tool was used to facilitate the quality assessment of relevant studies.Data extraction Based on current level II evidence, BoNTA was safe and effective to improve facial contour, reduce volume and thickness of bilateral hypertrophic masseter. Conservative doses using a combined approach of BoNTA and hyaluronic acid was recommended as a safe and effective treatment for perioral enhancement supported by level II evidence. There was limited evidence, not higher than level III, to support BoNTA effectiveness for gummy smile associated to perioral musculature hyperactivity, while jawline sculpting targeting the platysma muscle had lower level IV evidence up to this date.Conclusion BoNTA has been widely used off-label for the investigated cosmetic orofacial conditions, with reports of 'good patient and practitioner satisfaction'. However, there is limited high-quality evidence to support the long-term safety and effectiveness of repetitive BoNTA injections. Additionally, no studies were found that provided a cost-effectiveness evaluation of BoNTA formulations against other current cosmetic interventions. Well-designed clinical trials, including long-term follow-up, would help to provide robust evidence-based recommendations for clinical practice, supporting BoNTA popularity, independently or in a combined approach.

Botulinum toxin A in dentistry and orofacial surgery: an evidence-based review - part 1: therapeutic applications.

Objective An evidence-based review on the safety and efficacy of botulinum toxin type-A (BoNTA) in orofacial conditions, focusing on the therapeutic applications and role of BoNTA as an adjuvant treatment.Data source and selection Data was collected using PubMed (Medline), Cochrane Library of Systematic Reviews and Cochrane Central Register of Controlled Trials electronic databases. Having satisfied the search parameters, 32 studies for therapeutic applications and 26 for BoNTA as an adjunctive treatment were included. The quality of relevant studies was assessed using the Best Evidence Topics (BETs) Critical Appraisal Tool.Data extraction The highest level of evidence (LOE) behind BoNTA safety and efficacy was for wound healing and scar management in the orofacial surgery context, where BoNTA was presented as an adjunctive modality. Level-I evidence was controversial for temporomandibular disorders and bruxism. However, it showed promising results for painful temporomandibular disorders of myogenic origin refractory to conservative therapies, and to decrease muscle contraction intensity in sleeping bruxism. There was only one level-II study for persistent recurrent aphthous stomatitis. Data showed limited level-III evidence for orofacial pain conditions (temporomandibular joint recurrent dislocation and pain, burning mouth syndrome or atypical odontalgia), oral cancer complications, or as an adjuvant to maxillofacial and orthognathic surgeries. Benefits of BoNTA in prosthodontics had weak level-IV evidence. No evidence was found among the periodontology field.Conclusion There is growing evidence to support the safety and efficacy of BoNTA in the investigated orofacial pathological conditions, with high levels of satisfaction from the patient and clinician perspective. However, there are some inconsistencies and limited high-quality evidence available. Well-designed controlled clinical trials are necessary to evaluate long-term safety, efficacy and cost-effectiveness before BoNTA is widely adopted with irrefutable evidence-based clinical guidelines.

Topical growth factors and home-based microneedling for facial skin rejuvenation.

BACKGROUND: Cosmeceutical products are an important therapeutic option for facial rejuvenation. Of these, topical application of growth factors has been shown to increase dermal collagen synthesis, improve skin texture, and reduce fine lines and wrinkles. Limited data exist for the use of growth factors in combination with microneedling. OBJECTIVE: This prospective, single-center, uncontrolled study evaluated the efficacy of topical growth factor treatment in conjunction with transdermal delivery of growth factors via home-based microneedling for facial skin rejuvenation. PATIENTS/METHODS: Eleven healthy female individuals aged 33-61 years, with mild-moderate facial wrinkling were included in the study. Over 3 months, participants received twice-daily application of a topical recombinant human growth factor preparation (SkinGenuity® Regenerative and Reparative Serums) along with twice-weekly transdermal delivery of growth factors using a home-based microneedling (0.2 mm) device. Objective skin analysis (VISIA® ) and a subjective patient-reported outcome (FACE-Q® ) assessment measuring satisfaction with appearance were performed at baseline and after 3 months. RESULTS: Objective skin analysis showed a significant improvement in skin texture (17.6%, p < 0.001), wrinkles (17.3%, p < 0.001), red areas (12.4%, p =0.004), and brown spots (6.0%, p =0.03) at 3 months follow-up. FACE-Q scales showed a significant improvement from baseline, including satisfaction with skin, facial appearance, nasolabial folds, cheeks, and lower face/jawline (all p ≤ 0.02). Numerical improvement in adverse effects related to skin was also observed (p = 0.07). No serious adverse effects were reported. CONCLUSIONS: Three months of twice-daily topical growth factor treatment in conjunction with transdermal delivery of growth factors via microneedling improved skin analysis parameters and participant-reported outcome measures, indicative of facial skin rejuvenation.

Injectable platelet-rich fibrin for perioral rejuvenation as assessed by 3D lip volume imaging.

BACKGROUND: Various injectable autologous platelet aggregate preparations have been developed and used for facial rejuvenation. Limited evidence exists for the use of these for augmentation of the lip. OBJECTIVES: This prospective, uncontrolled, single-center study evaluated the qualitative and quantitative effects of an injectable platelet-rich fibrin preparation (known as i-PRF+) for lip augmentation. PATIENTS/METHODS: PRF® PROCESS system technology was used to prepare i-PRF+ supernatant. Ten healthy females were included in the study and received a single intradermal injection of i-PRF+ in the upper and lower lips (5 ml in each quadrant, total ~2 ml). Participants were followed for 3 months post-procedure. The efficacy of the procedure was assessed qualitatively by a subjective patient-reported outcome (FACE-Q) assessment and quantitatively by objective 3D skin surface volume analysis (ProFace® ) at baseline and after 3 months. RESULTS: FACE-Q scales that measure satisfaction with skin and lip showed a statistically significant improvement from baseline (p = 0.04 and p = 0.02, respectively). Satisfaction with lip lines showed a numerical improvement with mean total scores for adverse effect scales related to the skin and lips reduced at 2 weeks post-procedure (p = 0.03 and p = 0.13, respectively). Overall lip volume at 3-month follow-up was unchanged (p = 0.11). The treatment was well tolerated with only minor adverse effects. CONCLUSIONS: A single session of i-PRF+ injections resulted in significant lip rejuvenation at 3-month follow-up, shown by improved patient-reported outcome measure. No significant change in lip volume was observed.

Injectable platelet-rich fibrin for facial rejuvenation: A prospective, single-center study.

BACKGROUND: Autologous platelet-derived preparations have been used in many surgical fields to improve healing outcomes, with benefits reported in several aesthetic indications. AIMS: This single-center, prospective, uncontrolled study evaluated the efficacy of injectable platelet-rich fibrin (i-PRF) for facial skin rejuvenation using an objective skin analysis system and validated patient-reported outcome measures. PATIENTS/METHODS: PRF® PROCESS system technology was used to prepare i-PRP. Eleven healthy female individuals were included in the study and over 3-months received monthly intradermal injections of i-PRF in 3 facial regions: malar areas (1 mL each side), nasolabial fold (0.5 mL each side), and upper lip skin above the vermilion border (1 mL). The efficacy of the procedures was assessed by objective skin analysis (VISIA® ) and a subjective patient-reported outcome (FACE-Q) assessment at baseline and after 3 months. RESULTS: A significant improvement in skin surface spots (P = .01) and pores (P = .03) was seen at 3-months follow-up. Other variables, such as skin texture, wrinkles, ultraviolet spots, and porphyrins, showed a numerical improvement. FACE-Q scales that measure satisfaction with appearance all showed a significant improvement from baseline, including satisfaction with skin (P = .002), satisfaction with facial appearance (P = .025), satisfaction with cheeks (P = .001), satisfaction with lower face and jawline (P = .002), and satisfaction with lips (P = .04). No major adverse effects were reported. CONCLUSIONS: A series of three i-PRF injections resulted in significant rejuvenation of the face skin at 3-month follow-up, as shown by improved skin analysis parameters and patient self-assessment scores.

Dental needle foreign body in the neck: a case report.

Foreign body (FB) ingestion is commonly seen in the ear nose and throat (ENT) field, with different presentations and sequelae. FBs can arrest in the upper aerodigestive tract or continue further down into either the airway tract to the bronchus or the digestive tract to the intestines. The pathway of an FB depends on the size and shape of the FB and how sharp its edges are. Since the 20th century, the use of disposable stainless-steel needles in the oral cavity has proven to be an effective and safe method for performing various intraoral procedures like dental infiltration or a root canal wash. Complications from their use are rare. Generally, dental needle breakages are caused by patients biting the needle, incorrect injection techniques, or inadequate preventative measures. The sudden movement of a patient during a procedure is one of the most common causes of breakage. Occasionally, needles are swallowed during dental procedures such as a root canal. Here, we report a case of a patient that swallowed a broken needle during a dental procedure. A few days later, the patient presented with neck pain, swelling, and a FB sensation. When the patient presented, she claimed that her symptoms had onset after consuming a meal containing duck meat. Initially, the patient was diagnosed as having ingested a duck bone. However, intraoperatively, the FB was discovered to be an injection needle that had migrated from the throat to the neck.

Cross-linked pH-sensitive pectin and acrylic acid based hydrogels for controlled delivery of metformin.

The purpose of present study is to load Metformin HCl into pH-sensitive hydrogels to have sustained release over a period of time. The hydrogel was synthesized from naturally occurring polysaccharide pectin and monomer acrylic acid (AA) using ethylene glycol dimethacrylate (EGDMA) as cross-linker under controlled conditions for polymerization at 45°C for one hr, 50°C for two hrs, 55°C for three hrs, 60°C for four hrs and finally 65˚C for 12 hrs. Hydrogels were characterized for dynamic/equilibrium swelling, sol-gel fraction analysis, diffusion coefficient and percentage porosity. Hydrogels were tested by FTIR, XRD and SEM for structure and surface morphology respectively. Experimental in-vitro drug release data was applied to kinetic models. Formation of strong bonding between pectin and AA was supported by FTIR. The intensity of XRD peaks was reduced in non-loaded and loaded hydrogels compared to active drug substance. The non-loaded hydrogel showed discrete porous structure whereas loaded hydrogels were fibrous and smooth. Hydrogels showed higher swelling in the solutions of pH 6.5 and 7.5 as compared to in the solutions of pH 1.2 and 5.5. The diffusion coefficient decreases with the increase of AA and pectin concentrations. It was observed upon increasing the EGDMA concentration porosity decreases. The release of drug from all compositions of hydrogels took place through non-Fickian diffusion mechanism.

Dental needle foreign body in the neck: a case report

Foreign body (FB) ingestion is commonly seen in the ear nose and throat (ENT) field, with different presentationsand sequelae. FBs can arrest in the upper aerodigestive tract or continue further down into either the airwaytract to the bronchus or the digestive tract to the intestines. The pathway of an FB depends on the size andshape of the FB and how sharp its edges are. Since the 20th century, the use of disposable stainless-steelneedles in the oral cavity has proven to be an effective and safe method for performing various intraoral procedureslike dental infiltration or a root canal wash. Complications from their use are rare. Generally, dental needlebreakages are caused by patients biting the needle, incorrect injection techniques, or inadequate preventativemeasures. The sudden movement of a patient during a procedure is one of the most common causes of breakage.Occasionally, needles are swallowed during dental procedures such as a root canal. Here, we report a caseof a patient that swallowed a broken needle during a dental procedure. A few days later, the patient presentedwith neck pain, swelling, and a FB sensation. When the patient presented, she claimed that her symptomshad onset after consuming a meal containing duck meat. Initially, the patient was diagnosed as having ingesteda duck bone. However, intraoperatively, the FB was discovered to be an injection needle that had migratedfrom the throat to the neck.

Rapid urease test (RUT) for evaluation of urease activity in oral bacteria in vitro and in supragingival dental plaque ex vivo.

BACKGROUND: Urease is an enzyme produced by plaque bacteria hydrolysing urea from saliva and gingival exudate into ammonia in order to regulate the pH in the dental biofilm. The aim of this study was to assess the urease activity among oral bacterial species by using the rapid urease test (RUT) in a micro-plate format and to examine whether this test could be used for measuring the urease activity in site-specific supragingival dental plaque samples ex vivo. METHODS: The RUT test is based on 2% urea in peptone broth solution and with phenol red at pH 6.0. Oral bacterial species were tested for their urease activity using 100 µl of RUT test solution in the well of a micro-plate to which a 1 µl amount of cells collected after growth on blood agar plates or in broth, were added. The color change was determined after 15, 30 min, and 1 and 2 h. The reaction was graded in a 4-graded scale (none, weak, medium, strong). Ex vivo evaluation of dental plaque urease activity was tested in supragingival 1 µl plaque samples collected from 4 interproximal sites of front teeth and molars in 18 adult volunteers. The color reaction was read after 1 h in room temperature and scored as in the in vitro test. RESULTS: The strongest activity was registered for Staphylococcus epidermidis, Helicobacter pylori, Campylobacter ureolyticus and some strains of Haemophilus parainfluenzae, while known ureolytic species such as Streptococcus salivarius and Actinomyces naeslundii showed a weaker, variable and strain-dependent activity. Temperature had minor influence on the RUT reaction. The interproximal supragingival dental plaque between the lower central incisors (site 31/41) showed significantly higher scores compared to between the upper central incisors (site 11/21), between the upper left first molar and second premolar (site 26/25) and between the lower right second premolar and molar (site 45/46). CONCLUSION: The rapid urease test (RUT) in a micro-plate format can be used as a simple and rapid method to test urease activity in bacterial strains in vitro and as a chair-side method for testing urease activity in site-specific supragingival plaque samples ex vivo.

Plaque pH in caries-free and caries-active young individuals before and after frequent rinses with sucrose and urea solution.

OBJECTIVE: To examine pH in the approximal dental biofilm after acid and alkali formation from sucrose and urea, after an adaptation period to these substances, in caries-free (CF) and caries-active (CA) individuals. Saliva flow and buffer capacity, and aciduric bacteria in saliva and plaque were also examined. MATERIAL AND METHODS: Twenty adolescents and young adults (15-21 years) with no caries (n = 10, D(m + i)MFS = 0) or ≥1 new manifest lesions/year (n = 10, DmMFS = 3.4 ± 1.8) participated. After plaque sampling, interproximal plaque pH was measured using the strip method before (baseline) and up to 30 min (final pH) after random distribution of a 1-min rinse with 10 ml of 10% sucrose or 0.25% urea. This procedure was repeated after a 1-week adaptation period of rinsing 5 times/day with 10 ml of the selected solution. After a 2-week washout period the second solution was similarly tested. Mutans streptococci, lactobacilli and pH 5.2-tolerant bacteria were analyzed by culturing. RESULTS: In the CF group, acid adaptation resulted in lowering of baseline and final plaque pH values after a sugar challenge, and in increased numbers of bacteria growing at pH 5.2, which was increased also after alkali adaptation. In the CA group, the final pH was decreased after acid adaptation. No clear effects of alkali adaptation were seen in this group. CONCLUSION: One-week daily rinses with sucrose and urea had the most pronounced effect on the CF group, resulting in increased plaque acidogenicity from the sugar rinses and increased number of acid-tolerant plaque bacteria from both rinses.

pH and bacterial profile of dental plaque in children and adults of a low caries population.

OBJECTIVE: This study compares pH and microbiological profile of dental plaque in children and adults of a low caries population. MATERIAL AND METHODS: Thirty-nine children, 12-14 years of age and 45 adults between 20 and 39 years of age in 5 Karen villages of the Tak province, Northern Thailand were examined for plaque, calculus, caries (DMFT) and pH measurements in resting plaque and after a sucrose rinse. Information on dietary and oral hygiene habits was obtained through interviews using a fixed questionnaire. Microbiological profile of plaque samples was analyzed with DNA-DNA checkerboard technique. RESULTS: Mean DMFT was 0.77 ± 1.56 and 87% of the adults and 67% of the children were caries free (p < 0.05). The mean resting pH was for both age groups in the range of 7.0-7.1 and significantly higher than a Swedish caries free reference group. Karen adult men had significantly lower pH minimum than females and children (p < 0.05). Supragingival plaque samples showed high levels of low acidogenic and anaerobic species, which dominated over strong acid producers such as streptococci. CONCLUSION: The study indicates that the Karen children and adults has a plaque physiology and microbiology predominating by low acidogenic anaerobes, which in addition to the low sucrose intake explains the low caries prevalence in this population.