Are low serum levels of Vitamin D associated with dental developmental defects in primary teeth? A systematic review.

OBJECTIVE: To identify, qualify and synthesize all studies that assessed if low serum level of 25(OH)D (<50 nmol/L) is associated with dental developmental defects (DDD) in primary teeth. MATERIALS AND METHODS: Observational studies or clinical trials were included if measured 25(OH)D serum levels in pregnant women and/or in their children (up to 3 years old) and evaluated the occurrence of DDD in the primary dentition of offspring associated with the low 25(OH)D levels. Literature reviews, case reports, laboratory and/or animals' studies, conference abstracts, letters to the editor, book chapters and clinical protocols were excluded. Searches were carried out in 6 electronic databases and in the gray literature until March 2023, without restrictions. The study quality was assessed by the Newcastle-Ottawa Scale and the certainty of the evidence by GRADE. Data were descriptively synthesized considering the association between DDD and 25(OH)D levels. RESULTS: Seven studies were included. Only developmental enamel defects (DED) were observed after examination of 6651 children. The incidence of DED ranged from 8.9% to 66%. Six studies found no association between low levels of 25(OH)D and DED. However, one reported correlation between hypomineralization of the primary second molar (HSMD) and low levels of 25(OH)D at birth. Methodological flaws were observed in all studies and the certainty of the evidence was very low. CONCLUSION: Although HSMD was the only DDD associated with low levels of 25(OH)D in children, the available evidence is still not conclusive. More robust studies are needed to endorse the biological plausibility of DDD in primary teeth due to low serum levels of 25(OH)D in pregnant women or in their children. FAPERJ financed this study, which was registered in PROSPERO (CRD42022357511).

Are yellow-brownish opacities in hypomineralized teeth more prone to breakage than white-creamy ones? A systematic review.

OBJETIVE: To evaluate all the available evidence assessing if in hypomineralized teeth, yellow-brownish opacities are more prone to post-eruptive breakdown (PEB) compared to white-creamy opacities. MATERIALS AND METHODS: Observational studies that evaluated the occurrence of PEB in hypomineralized teeth were considered for inclusion. Electronic searches were performed up to January 2022 in MedLine, LILACS, BBO, Cochrane Library, Web of Science, Scopus, and EMBASE. Neither publication date nor language restrictions were imposed to the searches. Two researchers independently performed the study selection, data extraction, and quality assessment of the included studies according to the Newcastle-Ottawa Scale (NOS). Datasets from studies were grouped for narrative synthesis based on the severity of the PEB (enamel or dentin), type of tooth (molar or incisor), unit of analysis (subject or tooth or tooth surface), and follow-up period (in months). The certainty of evidence was evaluated using the GRADE approach. RESULTS: Nine studies were included, five cohort and three cross-sectional. All studies assessed the opacities and PEB by visual examination and diagnosed MIH according to EAPD criteria. In the cohort studies, considering all follow-up periods (ranging from 6 to 36 months), dark opacities fractured more than light opacities, at both enamel and enamel/dentin levels, and molars fractured more than incisors. In two out of three cross-sectional studies, dark opacities also fractured more than light opacities, but the deep of the PEB (enamel or dentin breakdown) or the type of tooth (molar or incisor) was not considered in the analysis. CONCLUSION: Although it seems plausible to state that darker demarcated opacities in MIH patients broke more often than light ones, based on this systematic review of the literature, the certainty of the available evidence about this association is still very low. CLINICAL RELEVANCE: More reliable and valid research is still necessary to support any future recommendation that MIH children who present yellow-brownish opacities should be monitored at shorter intervals compared to those who present only white-creamy opacities.

What is the effectiveness of titanium tetrafluoride to prevent or treat dental caries and tooth erosion? A systematic review.

OBJECTIVES: Answer the question: What is the effectiveness of titanium tetrafluoride (TiF4) when compared to other fluorides, placebo solution or a negative control to prevent or treat dental caries and tooth erosion? MATERIALS AND METHODS: This review is in accordance with PRISMA guidelines. In vivo and in situ studies that used TiF4 over enamel or dentine were included. Electronic searches were conducted on MEDLINE, Scopus, Embase, WOS, Cochrane Library, VLH, Clinical Trials and OpenGrey. Risk of bias (ROB) assessments used RoB2 and ROBINS-I for randomized and non-randomized controlled trials (RCTs and on-RCTs); Syrcle's ROB tool for animal studies; and a modified tool proposed by Hollanders for in situ studies. RESULTS: A total of 28 studies met the eligibility criteria. From these, 6 were in humans (3 RCT and 3 Non-RCT); 4 were in animals and 18 were in situ. For in vivo studies, all RCTs have some concerns related to ROB and all of the non-RCT studies were classified as with serious risk. One animal study had a low and three a high ROB. Regarding in situ studies, seven had a low, ten had an average and only one had a high ROB. The certainty of the evidence (GRADE) ranged from moderate to very low. CONCLUSIONS: Although most of the results suggest a positive effect of TiF4 on the prevention and treatment of caries and dental erosion, it is not possible to have definitive conclusions due to the high studies' methodological heterogeneity, and the low quality of evidence for most outcomes. REGISTRATION: The protocol of this syste. atic review was registered in the OPEN SCIENCE FRAMEWORK database (osf.io/6dgs9) DOI:10.17605/OSF.IO/KUZA7 on 6 August 2020.

Pasta CTZ para abordaje endodóncico de dientes primarios: Una revisión narrativa de la literatura / Pasta CTZ na abordagem endodôntica de dentes decíduos: uma revisão de literatura / CTZ paste for endodontic approach to deciduous teeth: A literature review

Introducción:La afectación pulpar irreversible de los dientes primarios representa un desafío para la endodoncia en odontopediatría. Sobre la base del enfoque de esterilización de lesiones y reparación de tejidos (LSTR- Lesion Sterelization and Tissue Repair), se ha propuesto una técnica endodóncica no instrumental que utiliza pastas antibióticas. La pasta antibiótica CTZ, que contiene una mezcla de cloranfenicol, tetraciclina, óxido de zinc y eugenol, tiene potencial para uso en la técnica endodóncica no instrumental en pacientes pediátricos. Objetivo: El objetivo de este trabajo es presentar una revisión narrativa de la literatura sobre la pasta antibiótica CTZ, en lo relacionado a capacidad antimicrobiana, biocompatibilidad y aspectos clínicos. Materiales y métodos: Se realizaron búsquedas en las bases de datos PUBMED, BVS, WEB OF SCIENCE, COCHRANE y SCOPUS utilizando los términos "ctz paste", "ctz", "tooth, deciduous" y "primary molars" sin restricción de idioma, con fecha limitada de 2015 hasta enero de 2021. Resultados: Después de eliminar los duplicados, se obtuvieron 13 artículos. La pasta CTZ mostró una actividad antimicrobiana satisfactoria en Enterecoccus faecalis, Staphylococcus aureus, Klebisiella pneumonia, Escherichia coli y Candida albicans. Los estudios in vitro e in vivo han demostrado que la pasta tiene biocompatibilidad. La frecuencia de éxito clínico varió del 37% al 100% y el éxito radiográfico del 29,7% al 97,4%. Conclusiones: Aunque se necesitan más estudios que contribuyan a un mejor nivel de la evidencia, puede afirmase que la pasta CTZ una es alternativa para los casos de afectación pulpar en dientes primarios, inclusive en el ámbito de la salud pública

Introdução: O envolvimento pulpar irreversível dos dentes decíduos, representa um desafio à endodontia em odontopediatria. Com base na abordagem de esterilização da lesão e reparo tecidual (LSTR- Lesion Sterelization and Tissue Repair), a técnica endodôntica não instrumental com utilização de pastas antibióticas tem sido proposta. A pasta antibiótica CTZ, que contém uma mistura de cloranfenicol, tetraciclina, óxido de zinco e eugenol, apresenta potencial para uso na técnica endodôntica não instrumental em pacientes pediátricos. Objetivo: O objetivo deste trabalho é apresentar uma revisão narrativa da literatura sobre a pasta antibiótica CTZ, abrangendo capacidade antimicrobiana, biocompatibilidade e aspectos clínicos. Materiais e métodos: Foi realizada busca nas bases de dados PUBMED, BVS, WEB OF SCIENCE, COCHRANE e SCOPUS usando os termos "ctz paste", "ctz", "tooth, deciduous" e "primary molars" com data limitada de 2015 a janeiro de 2021. Resultados: Após a remoção de duplicatas 13 artigos foram obtidos. A pasta CTZ mostrou atividade antimicrobiana satisfatória sobre Enterecoccus faecalis, Staphylococcus aureus, Klebisiella pneumonia, Escherichia coli y Candida albicans. Estudos in vitro e in vivo demonstraram que a pasta apresenta boa biocompatibilidade. A frequência de sucesso clínico variou de 37% a 100% e o sucesso radiográfico de 29,7% a 97,4%. Conclusão: Embora mais estudos que contribuam para um melhor nível de evidência sejam necessários, a pasta antibiótica CTZ apresenta atividade antimicrobiana, biocompatibilidade e resultados clínicos satisfatórios, podendo ser uma alternativa interessante para os casos de comprometimento pulpar de dentes decíduos, inclusive em saúde pública

Introduction: The irreversible pulp changes in primary teeth represent a challenge to endodontics in pediatric dentistry. Based on the Lesion Sterilization and Tissue Repair approach (LSTR), a non-instrumental endodontic treatment (NIET) of primary teeth root canals using an antibiotic paste has been proposed. The CTZ antibiotic paste, which contains a mixture of chloramphenicol, tetracycline, zinc oxide and eugenol, has potential for use in pediatric patients. Objective: The objective of this work is to present a literature review on the CTZ antibiotic paste, covering antimicrobial capacity, biocompatibility, and clinical aspects. Methods: An electronic search on PUBMED, BVS, WEB OF SCIENCE, COCHRANE y SCOPUS databases using the terms "ctz paste", "ctz", "deciduous teeth" and "primary molars" without language restrictions and publication date between 2015 and January 2021. Results: After removing duplicates, a total of 13 articles were included. The CTZ paste showed satisfactory antimicrobial activity on Enterecoccus faecalis, Staphylococcus aureus, Klebisiella pneumonia, Escherichia coli andCandida albicans. In vivo and in vitro studies have demonstrated that the paste presents good biocompatibility. The frequency of clinical success varied from 37% to 100% and radiographic success from 29,7% to 97,4%. Conclusion: Although more studies are needed to contribute to the body of evidence, the CTZ antibiotic paste demonstrated antimicrobial activity, biocompatibility and satisfactory clinical results and may be an alternative for cases of pulp involved primary teeth, including in public health.

Association between Genetic Polymorphisms in RANK, RANKL and OPG and Peri-Implant Diseases in Patients from the Amazon Region.

The present study evaluated polymorphisms in RANK, RANKL and OPG-encoding genes to assess whether they are associated with mucositis and peri-implantitis in a population from the Brazilian Amazon region. One hundred and fourteen patients with dental implants were included in the study. After clinical and radiographic examination, the sample was categorized into 4 groups, according to the peri-implant status: Healthy (n=71), Mucositis (n=30), Peri-implantitis (n=13) and Diseased (Mucositis + Peri-implantitis, n=43). Genomic DNA was extracted from buccal cells from saliva, and the genetic polymorphism in osteoprotegerin (OPG), Kappa nuclear factor activator receptor (RANKL) and nuclear kappa factor activator receptor (RANK) were genotyped by the real time PCR. Univariate and multivariate statistical analyses were performed to compare clinical variables among groups and to evaluate genotypes and alleles distributions and the established alpha was 5%. Age, peri-implant biotype, diabetes and presence of peri-implant biofilm were associated with mucositis (p<0.05) and peri-implantitis (p<0.05). Smoking, alcoholism, and periodontal biofilms were also associated with the presence of peri-implantitis (p<0.05). Univariate and multivariate analysis did not demonstrate an association of peri-implantitis or mucositis with any genetic polymorphism in RANK (rs3826620), RANKL (rs9594738) and OPG (rs2073618) (p>0.05). The studied genetic polymorphism in RANK, RANKL and OPG were not associated with mucositis and peri-implantitis in a Brazilian population from the Amazon region.

Association between genetic polymorphisms in rank, rankl and opg and peri-implant diseases in patients from the Amazon Region

Abstract The present study evaluated polymorphisms in RANK, RANKL and OPG-encoding genes to assess whether they are associated with mucositis and peri-implantitis in a population from the Brazilian Amazon region. One hundred and fourteen patients with dental implants were included in the study. After clinical and radiographic examination, the sample was categorized into 4 groups, according to the peri-implant status: Healthy (n=71), Mucositis (n=30), Peri-implantitis (n=13) and Diseased (Mucositis + Peri-implantitis, n=43). Genomic DNA was extracted from buccal cells from saliva, and the genetic polymorphism in osteoprotegerin (OPG), Kappa nuclear factor activator receptor (RANKL) and nuclear kappa factor activator receptor (RANK) were genotyped by the real time PCR. Univariate and multivariate statistical analyses were performed to compare clinical variables among groups and to evaluate genotypes and alleles distributions and the established alpha was 5%. Age, peri-implant biotype, diabetes and presence of peri-implant biofilm were associated with mucositis (p<0.05) and peri-implantitis (p<0.05). Smoking, alcoholism, and periodontal biofilms were also associated with the presence of peri-implantitis (p<0.05). Univariate and multivariate analysis did not demonstrate an association of peri-implantitis or mucositis with any genetic polymorphism in RANK (rs3826620), RANKL (rs9594738) and OPG (rs2073618) (p>0.05). The studied genetic polymorphism in RANK, RANKL and OPG were not associated with mucositis and peri-implantitis in a Brazilian population from the Amazon region.

Resumo O presente estudo avaliou a associação da predisposição clínica e dos fatores genéticos com a presença de doenças peri-implantares. Cento e quatorze pacientes com implantes dentais instalados na Clínica de Especialização do Amazonas, Brazil, foram incluidos no estudo. Após exame clínico e radiográfico, a amostra foi categorizada em 4 grupos, de acordo com o Status peri-implantar: saúde (n=71), mucosite (n=30), peri-implantite (n=13) e doentes (mucosite + peri-implantite). DNA genômico foi extraído de células orais da saliva, e o polimorfismo genético em osteoprotegerina (OPG), ligante do receptor ativador do fator Kappa nuclear (RANKL) e receptor ativador do fator Kappa nuclear (RANK) foram genotipados por PCR em tempo real. O estudo se propôs a avaliar se os polimorfismos em RANK, RANKL e OPG estão envolvidos na patogênese da mucosite e da peri-implantite, e avaliar também a presença de fatores de risco moduladores da resposta em uma população brasileira. Idade, biotipo peri-implantar, diabetes e presença de biofilme peri-implantar foram associados a mucosite (p<0.05) e peri-implantite (p<0.05). Tabagismo, alcoolismo e biofilme periodontal também foram associados com a presença de peri-implantite (p<0.05). Análise univariada e multivariada não demonstraram associação de peri-implantite ou mucosite com os polimorfismos genéticos em RANK (rs3826620), RANKL (rs9594738) e OPG (rs2073618) (p>0.05). Os polimorfismos genéticos estudados não foram associados com mucosite e peri-implantite em uma população brasileira da região Amazônica.

Effect of photobiomodulation on the stability and displacement of orthodontic mini-implants submitted to immediate and delayed loading: a clinical study.

The aim of this study was to evaluate the effect of photobiomodulation (PBM) on the stability and displacement of orthodontic mini-implants (MIs) submitted to loading. Forty-eight and 35 mini-implants (1.5 × 8 × 1 mm) were assessed for stability and displacement, respectively (19 patients). MIs were allocated according to the intervention in 1-PBM + immediate loading (IL), 2-PBM + delayed loading (DL) (four weeks after implantation), 3-IL only, and 4-DL only. PBM (Therapy XT, DCM) was implemented using a red emission (660 nm, 4 J/cm2, 0.1 W, 20 s) immediately after implantation (day 0) and infrared emissions (808 nm; 8 J/cm2, 0.1 W, 40 s) in the following appointments every 48-72 h during two weeks (days 2, 4, 7, 9, 11, and 14). Loading of 150 gF was applied during three months for all MIs. The stability was assessed by resonance frequency analysis (Osstell ISQ), and images from Cone beam computed tomography were evaluated to determine the amount of the displacement of the MI's head. MIs from the PBM groups presented lower loss of stability (P = 0.0372). When the analysis considered the loading protocol as an additional variable, group two showed the lowest loss of stability, being significantly different from groups that did not receive PBM (P = 0.0161). There was no difference between groups two and four during the period without loading (P > 0.05). DL groups presented lower loss when the effective period of loading was assessed, independently of the application of PBM (P < 0.0001). All groups showed displacement of the MIs head without significant differences (P > 0.05). DL potentiated the effect of PBM, decreasing the loss of stability.

Association between polymorphisms in genes encoding estrogen receptors (ESR1 and ESR2) and excreted bisphenol A levels after orthodontic bracket bonding: a preliminary study.

BACKGROUND: Bisphenol A (BPA) is released from orthodontic composites used for bracket bonding. Genetic variations could modify the metabolism of this chemical within the organism. Considering that free BPA binds to estrogen receptors causing harmful effects to health, the present in vivo study aimed to evaluate the association between genetic polymorphisms in genes encoding estrogen receptors (ESR1 and ESR2) and excreted BPA levels in orthodontic patients. METHODS: Quantification of BPA levels in the urine of 16 patients was performed in a gas chromatograph mass spectrometer before (T0), at 24 h (T1), and 1 week (T2) after bracket bonding. DNA was extracted from saliva, and one genetic polymorphism in ESR1 (rs2234693) and two in ESR2 (rs4986938 and rs1256049) were analyzed by real-time PCR. Increases in BPA levels in the urine at T1 and T2 were grouped according to the genotype, and mean differences were compared by unpaired T test or Mann-Whitney test according to the normality of the data. The established alpha was 5%. RESULTS: BPA levels increased significantly at T1 and T2. There were no statistically significant differences in the increases in BPA levels according to the genotype for any genetic polymorphism (P > 0.05), at neither 24 h nor 1 week after bracket bonding. CONCLUSIONS: The results suggested that there are no association between excreted BPA levels after bracket bonding and the evaluated genetic polymorphisms in ESR1 and ESR2. Further research should be performed in order to confirm these results.

Additional intraoral radiographs may change the judgment regarding the final position of orthodontic mini-implants.

OBJECTIVE: This study aimed to assess if additional vertical bitewing (VBW) and/or occlusal (OC) radiographs may change initial judgment based only on periapical radiograph (PAR) about the final position of orthodontic mini-implants (OMI). METHODS: Subjective and objective analyses were performed. Radiographic images of 26 OMI were divided into four groups: PAR, PAR+VBW, PAR+OC and ALL (PAR+VBW+OC). For subjective analysis, five observers were asked to assess if the position of OMI was favorable to its success, using questionnaires with a four-point scale for responses: 1= definitely not favorable, 2= probably not favorable, 3= probably favorable, or 4= definitely favorable. Each group containing sets of images was presented to them in four different viewing sessions. Objective evaluation compared horizontal distances between OMI tip and the root nearest to the device in PAR and VBW. RESULTS: Most of observers (3 out of 5) changed their initial judgment based on PAR about OMI position when additional radiographs were analyzed. Differences between groups (i.e. PAR vs. PAR+VBW; PAR vs. PAR+OC; and, PARvs.ALL) were statistically significant for these observers. For those that changed their judgment about OMI position, confidence level could significantly increase, decrease or even be maintained, not indicating a pattern. There was no agreement for distances between OMI tip and the root nearest to the device in PAR and VBW. CONCLUSION: Considering the limitations of the study, it is concluded that additional radiographic images may change the judgement about OMI final position without necessarily increasing the degree of certainty of such judgment.

Additional intraoral radiographs may change the judgment regarding the final position of orthodontic mini-implants

ABSTRACT Objective: This study aimed to assess if additional vertical bitewing (VBW) and/or occlusal (OC) radiographs may change initial judgment based only on periapical radiograph (PAR) about the final position of orthodontic mini-implants (OMI). Methods: Subjective and objective analyses were performed. Radiographic images of 26 OMI were divided into four groups: PAR, PAR+VBW, PAR+OC and ALL (PAR+VBW+OC). For subjective analysis, five observers were asked to assess if the position of OMI was favorable to its success, using questionnaires with a four-point scale for responses: 1= definitely not favorable, 2= probably not favorable, 3= probably favorable, or 4= definitely favorable. Each group containing sets of images was presented to them in four different viewing sessions. Objective evaluation compared horizontal distances between OMI tip and the root nearest to the device in PAR and VBW. Results: Most of observers (3 out of 5) changed their initial judgment based on PAR about OMI position when additional radiographs were analyzed. Differences between groups (i.e. PAR vs. PAR+VBW; PAR vs. PAR+OC; and, PARvs.ALL) were statistically significant for these observers. For those that changed their judgment about OMI position, confidence level could significantly increase, decrease or even be maintained, not indicating a pattern. There was no agreement for distances between OMI tip and the root nearest to the device in PAR and VBW. Conclusion: Considering the limitations of the study, it is concluded that additional radiographic images may change the judgement about OMI final position without necessarily increasing the degree of certainty of such judgment.

RESUMO Objetivo: avaliar se a adição de radiografias interproximais verticais (IV) e/ou oclusais (OC) pode alterar o julgamento inicial sobre a posição final dos mini-implantes ortodônticos (MI) baseado somente na radiografia periapical (PA). Métodos: foram realizadas análises subjetivas e objetivas. Imagens radiográficas de 26 regiões contendo MI foram divididas em quatro grupos: PA, PA+IV, PA+OC e TODAS (PA+IV+OC). Na análise subjetiva, cinco observadores foram convidados a avaliar se a posição do MI era favorável para o seu sucesso, utilizando questionários com uma escala de quatro pontos para respostas: 1 = definitivamente não favorável; 2 = provavelmente não favorável; 3 = provavelmente favorável; ou 4 = definitivamente favorável. Cada grupo contendo conjuntos de imagens foi apresentado aos observadores em quatro sessões diferentes. Adicionalmente, uma avaliação objetiva comparou as distâncias horizontais entre a ponta do MI e a raiz dentária mais próxima ao dispositivo na PA e IV. Resultados: a maioria dos observadores (3 de 5) mudou seu julgamento inicial sobre a posição do MI baseado na PA quando radiografias adicionais foram analisadas. Diferenças entre os grupos (ou seja, PA vs PA+IV; PA vs PA+OC; e PAvsTODAS) foram estatisticamente significativas para esses observadores. Para aqueles que mudaram seu julgamento sobre a posição do MI, o nível de confiança das respostas aumentou, diminuiu ou foi mantido, não indicando um padrão. Houve diferença estatisticamente significante entre as distâncias da ponta do MI para a raiz mais próxima ao dispositivo na PA e IV. Conclusão: considerando-se as limitações desse estudo, concluiu-se que imagens radiográficas adicionais podem alterar o julgamento sobre a posição final de MI sem, necessariamente, aumentar o grau de certeza de tal julgamento.