Demineralized dentin matrix for bone regeneration in dentistry: A critical update.

Over the last few decades, several new materials and techniques have been developed for bone regeneration. Scaffolds based on demineralized dentin matrix (DDM) present an attractive option due to their availability and several animal and human studies have been conducted to ascertain their utility in regenerative dentistry. The aim of this review was to summarize the recent studies conducted on DDM and used for bone grafts. PubMed, Web of Science, and Scopus were used to search for studies published within the last 10 years. The keywords and terms used were: "demineralized dentine matrix", "bone grafting", "bone augmentation" and "guided tissue regeneration" in various combinations. Original studies (in vitro, animal and human) and systematic reviews were included in the literature search. The literature search initially identified 23 studies (16 animal studies and 7 clinical reports. Most studies included in this review indicate that DDM has demonstrated promising results in a variety of dental and regenerative medicine applications. Further studies are required to completely comprehend its characteristics and prospective applications. Future studies should also focus on optimizing the processing protocols for the production of DDM-based scaffolds.

The effect of fibroblast growth factor-2 on the outcomes of tooth replantation: A systematic review of animal studies.

Background/Aim: The ideal treatment of tooth avulsion is replantation. However, replanting teeth may lead to root resorption. Fibroblast growth factor-2 (FGF-2) is a cytokine that plays an important role in wound repair and tissue regeneration. Recently, FGF-2 has been studied a potential regenerative agent to prevent root resorption and ankylosis. The aim of this review is to analyze and summarize the currently available literature focusing on using FGF-2 based regenerative modalities to improve the outcomes of tooth replantation. Materials and Methods: An electronic search was conducted via PubMed/Medline, Google Scholar and ISI Web of Knowledge, using the Medical Subject Headings (MeSH) terms "Basic fibroblast growth factor," "Fibroblast growth factor-2," "tooth replantation," and "replantation" for studies published between January 2001 and June 2021. Data was extracted and quality assessment was carried using the ARRIVE guidelines. Results: Nine animal studies were included in this review. In six studies, FGF-2 had a favorable effect on the tissue regeneration around roots of replanted teeth when compared to other treatment groups. However, quality assessment of the studies revealed many sources of bias and deficiencies in the studies. Conclusions: Within the limitations of this study, it may be concluded that FGF-2 may improve the outcomes of delayed replantation of avulsed teeth. However, more long-term animal studies, with improved experimental designs, and clinical trials are required to determine the clinical potential of the growth factor in improving the outcomes of delayed tooth replantation.

Oral bacteriophages: metagenomic clues to interpret microbiomes.

Bacteriophages are bacterial viruses that are distributed throughout the environment. Lytic phages and prophages in saliva, oral mucosa, and dental plaque interact with the oral microbiota and can change biofilm formation. The interactions between phages and bacteria can be considered a portion of oral metagenomics. The metagenomic profile of the oral microbiome indicates various bacteria. Indeed, there are various phages against these bacteria in the oral cavity. However, some other phages, like phages against Absconditabacteria, Chlamydiae, or Chloroflexi, have not been identified in the oral cavity. This review gives an overview of oral bacteriophage and used for metagenomics. Metagenomics of these phages deals with multi-drug-resistant bacterial plaques (biofilms) in oral cavities and oral infection. Hence, dentists and pharmacologists should know this metagenomic profile to cope with predental and dental infectious diseases.

Evaluation of accuracy of deep learning and conventional neural network algorithms in detection of dental implant type using intraoral radiographic images: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: With the growing importance of implant brand detection in clinical practice, the accuracy of machine learning algorithms in implant brand detection has become a subject of research interest. Recent studies have shown promising results for the use of machine learning in implant brand detection. However, despite these promising findings, a comprehensive evaluation of the accuracy of machine learning in implant brand detection is needed. PURPOSE: The purpose of this systematic review and meta-analysis was to assess the accuracy, sensitivity, and specificity of deep learning algorithms in implant brand detection using 2-dimensional images such as from periapical or panoramic radiographs. MATERIAL AND METHODS: Electronic searches were conducted in PubMed, Embase, Scopus, Scopus Secondary, and Web of Science databases. Studies that met the inclusion criteria were assessed for quality using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Meta-analyses were performed using the random-effects model to estimate the pooled performance measures and the 95% confidence intervals (CIs) using STATA v.17. RESULTS: Thirteen studies were selected for the systematic review, and 3 were used in the meta-analysis. The meta-analysis of the studies found that the overall accuracy of CNN algorithms in detecting dental implants in radiographic images was 95.63%, with a sensitivity of 94.55% and a specificity of 97.91%. The highest reported accuracy was 99.08% for CNN Multitask ResNet152 algorithm, and sensitivity and specificity were 100.00% and 98.70% respectively for the deep CNN (Neuro-T version 2.0.1) algorithm with the Straumann SLActive BLT implant brand. All studies had a low risk of bias. CONCLUSIONS: The highest accuracy and sensitivity were reported in studies using CNN Multitask ResNet152 and deep CNN (Neuro-T version 2.0.1) algorithms.

Attitudes, knowledge, and perceptions of dentists and dental students toward artificial intelligence: a systematic review.

Objectives: This research was aimed at assessing comprehension, attitudes, and perspectives regarding artificial intelligence (AI) in dentistry. The null hypothesis was a lack of foundational understanding of AI in dentistry. Methods: This systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted in May 2023. The eligibility criteria included cross-sectional studies published in English until July 2023, focusing solely on dentists or dental students. Data on AI knowledge, use, and perceptions were extracted and assessed for bias risk with the Joanna Briggs Institute checklist. Results: Of 408 publications, 22 relevant articles were identified, and 13 studies were included in the review. The average basic AI knowledge score was 58.62 % among dental students and 71.75 % among dentists. More dental students (72.01 %) than dentists (62.60 %) believed in AI's potential for advancing dentistry. Conclusions: Thorough AI instruction in dental schools and continuing education programs for practitioners are urgently needed to maximize AI's potential benefits in dentistry. An integrated PhD program could drive revolutionary discoveries and improve patient care globally. Embracing AI with informed understanding and training will position dental professionals at the forefront of technological advancements in the field.

Accuracy of digitally coded healing abutments: A systematic review.

The aim of this systematic review was to evaluate the in vitro accuracy of dental implant impressions taken using digitally coded healing abutments (CHAs) compared with impressions taken with conventional techniques (CI) and/or within the CHA group at varying degrees of angulations for multiple implant units. Two independent reviewers conducted a systematic electronic search in the MedLine, PubMed, Google Scholar, Cochrane Library, Web of Science, and Scopus databases. Some of the employed key terms, combined with the help of Boolean operators, were: "digitally coded healing abutments", "encode healing abutment", "dental implants", "impression accuracy", "digital impression", and "conventional impression". Publication dates ranged from January 2010 to November 2022. A total of 7 articles fulfilled the inclusion criteria: 6 studies compared the accuracy of CHA with conventional pick-up impression techniques, and one study only used CHAs at different angulations and heights to compare accuracy within the group. The results were divided into Group A (elastomeric impression of CHA) and Group B (CHA + Intraoral scanner). According to the results of this systematic review, elastomeric impression of CHA performed poorly when compared to CI for multiple implants, although an intraoral scan of CHA appears to be more accurate. Within the CHA group, the angulation and visible height of CHA play a significant role in impression accuracy. However, more studies are needed before CHA can be recommended for all non-parallel multiple implant-supported restorations.

Use of Optical Coherence Tomography in Dentistry.

Optical coherence tomography (OCT) is an optics-based imaging technique, which may be called an "optical biopsy." It can be used to acquire structural information about a tissue at a resolution comparable to histopathology. OCT is based on the principle of low-coherence interferometry where near-infrared (NIR) light is shown on a tissue sample and then cross-sectional images are obtained based on backscattered light and echo time delay. Two main types of OCT are characterized as time-domain OCT (TD-OCT) and Fourier-domain OCT (FD-OCT). The applications of OCT in dentistry can be broadly divided into two groups, i.e., assessment of pathologies and assessment of surfaces and interfaces. Lately, OCT has made its transition from experimental laboratories to mainstream clinical applications. Starting from the short-term training courses, clinicians working in specialities like oral pathology, oral medicine, and oral implantology may find it a useful tool for their practices. It is now clear that OCT will be considered a gold standard diagnostic tool for the detection and characterization of several conditions and lesions of the orofacial region. However, the next challenge will be to incorporate it into the undergraduate and postgraduate curriculum and train dental healthcare staff in the use of these devices.

Viewing of clinical cases on social media by dentists: A cause of motivation or dissatisfaction?

Objective: To evaluate the thoughts and feelings of dentists viewing posted clinical cases (PCCs) on various social media (SM) platforms. Methods: A questionnaire was developed, validated and its reliability was established. It was distributed (in 2022) to 355 dentists who had graduated at least 2 years prior. It had three sections consisting of 20 items pertaining to general information, SM usage, and feelings. Descriptive data were reported using percentages. The chi-squared test was used for inferential analysis. P ≤ 0.05 was considered statistically significant. Results: The response rate was 92%. The majority of respondents were non-post-graduates (63%), and aged ≤40 years (90%) with clinical experience <5 years (41%). Dentists with the most clinical experience (>15 years) shared their clinical work significantly more than their counterparts (p < 0.05). Most of the dentists did not feel motivated after viewing the PCCs (41%), especially those aged >40 years (p = 0.037), and thought that viewing the PCCs was the reason for personal dissatisfaction (50%). They had a belief that they possess skills (36%) and knowledge (42%), but not the necessary equipment to replicate the PCCs (39%). Conclusions: The majority of dentists felt that viewing the PCCs on SM can cause personal dissatisfaction and lack of motivation. They had a belief that they possess the skills and knowledge to replicate the PCCs, but lack equipment. Investing resources in clinical workshops, mentorship, and the procurement of modern equipment early in the career of dentists may improve their mental well-being, satisfaction, and quality of treatment delivered to patients.

Development, physicochemical characterization and in-vitro biocompatibility study of dromedary camel dentine derived hydroxyapatite for bone repair.

This study aimed to produce hydroxyapatite from the dentine portion of camel teeth using a defatting and deproteinizing procedure and characterize its physicochemical and biocompatibility properties. Biowaste such as waste camel teeth is a valuable source of hydroxyapatite, the main inorganic constituent of human bone and teeth which is frequently used as bone grafts in the biomedical field. Fourier Transform infrared (FTIR), and micro-Raman spectroscopy confirmed the functional groups as-sociated with hydroxyapatite. X-ray diffraction (XRD) studies showed camel dentine-derived hydroxyapatite (CDHA) corresponded with hydroxyapatite spectra. Scanning electron micros-copy (SEM) demonstrated the presence of dentinal tubules measuring from 1.69-2.91 µm. The inorganic phases of CDHA were primarily constituted of calcium and phosphorus, with trace levels of sodium, magnesium, potassium, and strontium, according to energy dispersive X-ray analysis (EDX) and inductively coupled plasma mass spectrometry (ICP-MS). After 28 days of incubation in simulated body fluid (SBF), the pH of the CDHA scaffold elevated to 9.2. in-vitro biocompatibility studies showed that the CDHA enabled Saos-2 cells to proliferate and express the bone marker osteonectin after 14 days of culture. For applications such as bone augmentation and filling bone gaps, CDHA offers a promising material. However, to evaluate the clinical feasibility of the CDHA, further in-vivo studies are required.

Anti-bacterial efficacy of Aloe vera against E. Faecalis in comparison to other intracanal medicaments: A systematic review and meta-analysis.

Introduction: This review article aims to evaluate the antibacterial efficacy of Aloe vera against Enterococcus faecalis (E. faecalis) in comparison to other intracanal medicaments by assessing experimental in-vitro studies associated with the objective, many of which performed bacterial inoculation on extracted human teeth or directly on laboratory petri dishes. Materials & Methods: Publications from 2012 to 2022 were retrieved from databases, including PubMed, Scopus, and Cochrane Library, and they were screened against our inclusion criteria, leading to the incorporation of 18 studies into the systematic review and nine into the meta-analysis. Colony-forming units (CFUs) in the Aloe vera group were compared with saline, sodium hypochlorite (NaOCl), chlorhexidine (CHX), and calcium hydroxide (CaOH) using a meta-analysis (Stata software version 16.0), and forest plots were computed to record the sample size, mean and standard deviation value of the outcome CFU, and 95% confidence intervals. Results: This systematic review indicates that Aloe vera demonstrates bactericidal properties that are higher than or similar to those of saline and CaOH, but CHX, NaOCl, and propolis exhibited higher antibacterial properties against E. faecalis than Aloe vera. In a meta-analysis, Aloe vera showed a non-significantly lower CFU count than CaOH and saline (p > 0.05), while Aloe vera had a higher CFU count than CHX and NaOCl (p > 0.05). Conclusion: In summary, Aloe vera exhibits antibacterial capabilities against E. faecalis that are superior or equal to those of saline and CaOH, respectively, while CHX and NaOCl showed greater antibacterial efficacy against E. faecalis than Aloe vera (PROSPERO registration no. CRD42022314790).

Evaluation of deep learning and convolutional neural network algorithms accuracy for detecting and predicting anatomical landmarks on 2D lateral cephalometric images: A systematic review and meta-analysis.

Introduction: Cephalometry is the study of skull measurements for clinical evaluation, diagnosis, and surgical planning. Machine learning (ML) algorithms have been used to accurately identify cephalometric landmarks and detect irregularities related to orthodontics and dentistry. ML-based cephalometric imaging reduces errors, improves accuracy, and saves time. Method: In this study, we conducted a meta-analysis and systematic review to evaluate the accuracy of ML software for detecting and predicting anatomical landmarks on two-dimensional (2D) lateral cephalometric images. The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for selecting and screening research articles. The eligibility criteria were established based on the diagnostic accuracy and prediction of ML combined with 2D lateral cephalometric imagery. The search was conducted among English articles in five databases, and data were managed using Review Manager software (v. 5.0). Quality assessment was performed using the diagnostic accuracy studies (QUADAS-2) tool. Result: Summary measurements included the mean departure from the 1-4-mm threshold or the percentage of landmarks identified within this threshold with a 95% confidence interval (CI). This meta-analysis included 21 of 577 articles initially collected on the accuracy of ML algorithms for detecting and predicting anatomical landmarks. The studies were conducted in various regions of the world, and 20 of the studies employed convolutional neural networks (CNNs) for detecting cephalometric landmarks. The pooled successful detection rates for the 1-mm, 2-mm, 2.5-mm, 3-mm, and 4-mm ranges were 65%, 81%, 86%, 91%, and 96%, respectively. Heterogeneity was determined using the random effect model. Conclusion: In conclusion, ML has shown promise for landmark detection in 2D cephalometric imagery, although the accuracy has varied among studies and clinicians. Consequently, more research is required to determine its effectiveness and reliability in clinical settings.

Applications of Metformin in Dentistry-A review.

Metformin is a versatile drug with numerous medical uses. It is known primarily as an anti-hyperglycemic drug that has become the main oral blood-glucose-lowering medication for managing type 2 diabetes mellitus globally. Its use has been reported in a variety of oral conditions and dentistry in general. Recent clinical trials have indicated the effectiveness of adjunct topical application of metformin in improving the periodontal parameters of patients with diabetes and periodontitis. Additionally, studies have suggested that metformin stimulates odontogenic differentiation and mineral synthesis of stem cells in the tooth pulp. Metformin also stimulates osteoblast proliferation, decreases osteoclast activity and exerts regenerative effects on periodontal bone, thus making it a viable candidate for periodontal regeneration. Metformin monotherapy significantly enhances osseointegration of endosseous implants and has been reported to have anti-cancer effects on oral squamous cell carcinoma by impeding tumor progression. Animal studies have indicated that metformin improves orthodontic tooth movement and resists orthodontic appliance corrosion. This narrative review aims to provide a current summary of research highlighting the prospective uses of metformin in dentistry.

Correction: Mansoor et al. Effect of Currently Available Nanoparticle Synthesis Routes on Their Biocompatibility with Fibroblast Cell Lines. Molecules 2022, 27, 6972.

The authors wish to make the following correction to this paper [...].

Reconstruction of Critical Sized Maxillofacial Defects Using Composite Allogeneic Tissue Engineering: Systematic Review of Current Literature.

The current review aimed to assess the reliability and efficacy of tissue-engineered composite grafts in the reconstruction of large maxillofacial defects resulting from trauma or a benign pathologic disease. A systematic review of the literature was conducted using PubMed/Medline, Embase, and Scopus up to March 2022. The eligibility criteria included patients who had been treated with composite allogeneic tissue engineering for immediate/delayed reconstruction of large maxillofacial defects with minimum/no bone harvesting site. In the initial search, 2614 papers were obtained, and finally, 13 papers were eligible to be included in the current study. Most included papers were case reports or case series. A total of 144 cases were enrolled in this systematic review. The mean age of the patients was 43.34 (age range: 9-89). Most studies reported a successful outcome. Bone tissue engineering for the reconstruction and regeneration of crucial-sized maxillofacial defects is an evolving science still in its infancy. In conclusion, this review paper and the current literature demonstrate the potential for using large-scale transplantable, vascularized, and customizable bone with the aim of reconstructing the large maxillofacial bony defects in short-term follow-ups.

Comparative Study of Frequency of Alveolar Osteitis, with and without using Platelet-Rich Fibrin in Mandibular Third Molar Surgery.

Introduction: Alveolar ostitis (AO) is the dissolution of blood clot due to enhanced local fibrinolysis and is caused by trauma to the jaw (direct) or because of bacterial involvement (indirect), which result in the activation of plasminogen pathway. Platelet-rich fibrin (PRF) is a platelet concentrate that comprises numerous autologous growth factors, and immune cells hence has the potential to expedite the healing process. The objective of the study was to determine the efficacy of PRF in the surgically extracted third molar in the context of its potential progress to AO. Materials and Methods: A total of 180 patients of 18-65 years with unilateral painful mandibular third molars due to caries, failed endodontics treatment, and pericoronitis were included in the study. Exclusion criteria were patients who were medically compromised, smokers, alcoholic, poor oral hygiene, third molar having associated periapical pathology, and receiving antibiotic regime in the last 2 weeks. Before starting surgical procedure, patients were randomly divided into two groups using lottery method. Group I received PRF in the extraction socket, while in Group II, the extraction site was left for normal healing as practiced in a standard procedure. Pain was assessed in terms of pain score, and it was recorded on a 10 mm visual analog scale on the first and third postoperative days. Results: Mean age of the patients was 41.35 ± 9.87 years. The mean age in Group I was 42.84 ± 10.52 years, and in Group II, it was 40.54 ± 9.52 years. Out of 180 patients, 90 (50.0%) were male and 90 (50.0%) were female, with a male-to-female ratio of 1 : 1. Frequency of AO following mandibular third molar surgery in Group I receiving PRF was 2.22% and in non-PRF group 12.22% (p-value = 0.010). Conclusion: The incidence of AO following mandibular third molar surgery was lower when PRF was used.

Effect of Propolis on Root Dentine Microhardness When Used as an Intracanal Medicament: An In Vitro Study.

Application of intracanal medicaments may affect the physical properties of root dentine. Calcium hydroxide (CH), a gold standard intracanal medicament, has proven to decrease root dentine microhardness. A natural extract, propolis, has been shown to be superior to CH in eradicating endodontic microbes, but its effect on the microhardness of root dentine is still not known. This investigation aims to evaluate the effect of propolis on root dentine microhardness compared to calcium hydroxide. Ninety root discs were randomly divided into three groups and treated with CH, propolis, and a control. A Vickers hardness indentation machine with a load of 200 g and dwell time of 15 s at 24 h, 3, and 7 days was used for microhardness testing. ANOVA and Tukey's post hoc test were used for statistical analysis. A progressive decrease in microhardness values was observed in CH (p < 0.01), whereas a progressive increase was observed in the propolis group (p < 0.01). At 7 days, propolis demonstrated the highest microhardness value (64.43 ± 1.69), whereas CH demonstrated the lowest value (48.46 ± 1.60). The root dentine microhardness increased over time when propolis was applied, while it decreased over time after application of CH on root dentine sections.

Effects of metformin on the bioactivity and osseointegration of dental implants: A systematic review.

Dental implants are prosthetic devices that are surgically placed in direct contact with the jawbone to support intra-oral functions and esthetics. Diabetes mellitus may contribute to peri-implant bone loss. During the last few years, there have been attempts to reduce this bone loss and improve the survival rate of implants. Metformin, an anti-diabetic drug known for its osteogenic properties, is thought to prevent peri-implant bone loss in diabetic patients. Although several studies have been conducted to study metformin's effect on diabetic and non-diabetic study models, no systematic review has analyzed and summarized these studies critically. Therefore, the objectives of this systematic review were to summarize the outcomes of these studies and critically appraise them. Seven studies were included in this systematic review. Four studies used only animal models, two used both animal and cell culture models, and one used only cell culture studies. The general characteristics and outcomes of the included studies were summarized, and Animal Research: Reporting of In Vivo Experiments (ARRIVE) guidelines were used to assess the quality of the animal studies. In vitro studies indicate that metformin may induce stem cells to undergo osteoblastic differentiation to produce a higher amount of bone and may also improve osseointegration. Nevertheless, several studies had potential sources of bias. Therefore, it is recommended that emphasis be placed on increasing the quality of future animal studies and human trials to determine the effects of metformin on the osseointegration of dental implants. Future studies are needed with adequate follow-up to evaluate the efficacy of metformin in improving the osseointegration of dental implants.

Onset of Mucormycosis in Patients with COVID-19: A Systematic Review on Patients' Characteristics.

Mucormycosis has a significant impact on patients' standard of living and, therefore, a high clinical suspicion, prediagnosis, and rapid treatment are critical in easing patients' suffering and fast recovery. Our focus is to conduct an organized review based on various variables on the patients' characteristics having mucormycosis in severe novel coronavirus disease 2019 (COVID-19). We examined Embase, PubMed-Medline, LitCovid, Web of Science, Scopus, and the reference lists of included case reports up to September 20, 2021, using the Medical Subject Heading (MeSH) phrases and other keywords related to this topic. Subsequently, we investigated associated comorbidities, patient characteristics, position of mucormycosis, steroids use, body involvements, and outcomes. Overall, 77 studies were conducted and among these, 72 studies mentioned that the patients' age to be 48.13±14.33 (mean±standard deviation [SD]) years. Diabetes mellitus (DM) was reported in 77.9% (n=60) of cases. Studies showed that central nervous system (CNS) and bone involvement were reported in 62.3 (n=48) and 53.2% (n=41), respectively. More fatalities were observed in patients with mucormycosis with the active form of COVID-19. Also, men infected with mucormycosis significantly affected by COVID-19. In the end, mortality was higher in males with mucormycosis. As a result, a solid investigation into the root cause of mucormycosis, especially in COVID-19, should be included in the study plan. If the patient is COVID-19-positive and immunosuppressed, this opportunistic pathogen diagnostic test should not be overlooked.