The effect of one-time abutment placement on clinical and radiographic outcomes: A 5-year randomized clinical trial.

OBJECTIVE: The aim of this study was to evaluate the long-term (5 years) clinical efficacy of the one-abutment one-time protocol (test) versus the standard of care by placing the definitive abutment on the day of the prosthetic delivery (control). MATERIALS AND METHODS: In this study, 39 subjects with 60 implants were randomly allocated to either the test or the control group. Changes in the radiographic interproximal bone levels (DIB), modified sulcus bleeding index, probing depth, modified plaque index, papilla fill (Jemt score), incidence of peri-implantitis and peri-implant mucositis as well as patient-reported outcomes measures (PROMs) were collected and compared at 1, 3 and 5 years. RESULTS: At 5 years, the control group showed a greater, although not statistically significant, change in mean DIB values (0.97 mm vs. 0.53 mm). Regarding the other clinical parameters evaluated, no statistically significant differences were observed between groups at any time point. At 5 years, 51% of the implants presented peri-implant mucositis (25.5% in the control and 23.5% in the test), and only one implant in the test group developed peri-implantitis. CONCLUSIONS: The connection and disconnection of healing abutments during the healing period was not associated with higher long-term bone loss. Clinical outcomes and PROMs were similar between groups.

Orthodontic tooth movement after periodontal regeneration of intrabony defects.

The prevalence of intrabony defects in patients with advanced periodontitis stages III and IV is high. These patients usually need both periodontal treatment and orthodontic therapy, including tooth movement through bone defects, to improve masticatory function, aesthetics, and overall quality of life. Clinical practice guidelines recommend periodontal regenerative surgical interventions to resolve these defects and propose initiating orthodontic tooth movement (OTM) once periodontal therapy goals have been met. Surgical interventions using various regenerative technologies like barrier membranes and enamel matrix proteins, combined or not with bone replacement grafts, have proven effective in regenerating lost periodontal tissues. However, the combination of periodontal and orthodontic treatments requires consideration of how periodontal regenerative therapies influence OTM. Studies suggest that regenerated bone may differ in density, composition, vascularity, and cellular activity, potentially affecting the speed and efficiency of OTM, and potential root resorption of moved teeth. Understanding the sequence and timing of implementing OTM after regenerative periodontal interventions is crucial due to their interlinked processes of bone resorption and formation. This narrative review aims to uncover scientific evidence regarding these combined treatments, examining the impacts of different regenerative technologies on OTM and delineating their advantages, limitations, and best practices.

Risk of bias in dentistry-related randomized controlled trials in spanish language journals

Objectives: To assess the risk of bias (RoB) of randomized controlled trials (RCTs) published in dental journals in the Spanish language. Methods: A systematic retrospective survey was conducted of all RCTs published from 1980 to 2019 in dentistry Spanish and Latin American journals. We extracted data and performed RoB assessments using the Cochrane Risk of Bias tool. Results: 292 RCTs published in 51 journals were included. The best-rated domains were incomplete outcome data, selective reporting, and other biases. The domains assessed with higher proportions of an unclear or high risk of bias were sequence generation, allocation concealment, and blinding of outcome assessment. There is a low proportion of RCTs published in Spanish language journals. However, the number has been increasing over the years, and the low risk of bias assessment rates across domains show an increasing trend. Conclusions: A low percentage of Spanish-language dental journals issue RCTs. Our assessment of these RCTs' RoB suggests higher difficulties in the design and conduction phase than in the posterior reporting stage.

Synergy of Regenerative Periodontal Surgery and Orthodontics Improves Quality of Life of Patients with Stage IV Periodontitis: 24-Month Outcomes of a Multicenter RCT.

In stage IV periodontitis patients with pathologic tooth migration (PTM), interdisciplinary treatment includes regenerative periodontal surgery (RPS) with an application of biomaterials and orthodontic therapy (OT) to restore function, esthetics and thereby quality of life (QoL). In a 24-month randomized trial we explored the synergy between regenerative medicine and biomechanical force application. The following methods were used: Forty-three patients had been randomized to a combined treatment comprising RPS and subsequent OT starting either 4 weeks (early OT) or 6 months (late OT) post-operatively. Clinical periodontal parameters and oral health-related QoL (GOHAI) were recorded up to 24 months. We obtained the following results: Mean clinical attachment gain (∆CAL ± SD) was significantly higher with early OT (5.96 ± 2.1 mm) versus late OT (4.65 ± 1.76 mm) (p = 0.034). Pocket closure (PPD ≤ 4 mm) was obtained in 91% of defects with early OT compared to 90% with late OT. GOHAI-scores decreased significantly from 26.1 ± 7.5 to 9.6 ± 4.7 (early OT) and 25.1 ± 7.1 to 12.7 ± 5.6 (late OT). Inconclusion, teeth severely compromised by intrabony defects and PTM can be treated successfully by RPS followed by early OT with the advantage of an overall reduced treatment time. As a result of the combined periodontal-orthodontic therapy, the oral health-related QoL of patients was significantly improved. Early stimulation of wound healing with orthodontic forces had a favorable impact on the outcomes of regenerative periodontal surgery.

Multi-stakeholder contribution to the identification of a core outcome set and measurements in implant dentistry (ID-COSM initiative) using the Delphi methodology.

AIM: To obtain input from multiple stakeholders and generate agreement on essential outcomes in implant dentistry using the Delphi methodology and incorporate them into an international consensus defining a core outcome set. MATERIALS AND METHODS: Candidate outcomes in implant dentistry were generated from scientific evidence through five commissioned systematic reviews and from people with lived experience in dental implants (PWLE) through four international focus groups. A steering committee identified stakeholders among representatives from dental professionals, industry-related experts and PWLE. Participants underwent a three-round Delphi survey using a multi-stakeholder approach; they assessed candidate outcomes and additional outcomes identified in the first Delphi round. The process followed the COMET methodology. RESULTS: From the 665 potential outcomes identified in the systematic reviews and 89 in the PWLE focus group, the steering committee selected 100 and organized them into 13 categories, to be included in the first-round questionnaire as candidate outcomes. A total of 99 dental experts, 7 dental-industry-related experts and 17 PWLE participated in the first round, and 11 additional outcomes were added to the second round. There was no attrition between the first and second rounds, where 61 (54.9%) outcomes exceeded the pre-established threshold of agreement. PWLE and experts participated in the third round that applied "a priori" standard filters to distil a list of candidate essential outcomes. CONCLUSION: This Delphi study utilized a standardized, transparent and inclusive methodology and preliminarily validated 13 essential outcomes organized into four core areas. These results informed the final stage of the ID-COSM consensus.

Association between Eruption Sequence of Posterior Teeth, Dental Crowding, Arch Dimensions, Incisor Inclination, and Skeletal Growth Pattern.

BACKGROUND: We conducted research to investigate the effects of the eruption sequence of posterior teeth, arch dimensions, and incisor inclination on dental crowding. MATERIAL AND METHODS: A cross-sectional analytic study was performed on 100 patients (54 boys and 46 girls; mean ages: 11.69 and 11.16 years, respectively). Seq1 (canine-3-/second premolar-5-) or Seq2 (5/3) eruption sequences were recorded in maxilla, and Seq3 (canine-3-/first premolar-4-) or Seq4 (4/3) eruption sequences in mandible; tooth size, available space, tooth size-arch length discrepancy (TS-ALD), arch lengths, incisor inclination and distance, and skeletal relationship were noted. RESULTS: The most common eruption sequences in the maxilla and mandible were Seq1 (50.6%), and Seq3 (52.1%), respectively. In the maxilla, posterior tooth sizes were larger in crowded cases. In the mandible, anterior and posterior tooth sizes were larger in crowded patients. No relationship between incisor variables and the maxillo-mandibular relationship and dental crowding was found. A negative correlation between inferior TS-ALD and the mandibular plane was found. CONCLUSIONS: Seq1 and Seq 2 in the maxilla and Seq 3 and Seq 4 in the mandible were equally prevalent. An eruption sequence of 3-5 in the maxilla and 3-4 in the mandible is more likely to cause crowding.

Multi-stakeholder contribution to the identification of a core outcome set and measurements in implant dentistry (ID-COSM initiative) using the Delphi methodology.

AIM: To obtain input from multiple stakeholders and generate agreement on essential outcomes in implant dentistry using the Delphi methodology and incorporate them into an international consensus defining a core outcome set. MATERIALS AND METHODS: Candidate outcomes in implant dentistry were generated from scientific evidence through five commissioned systematic reviews and from people with lived experience in dental implants (PWLE) through four international focus groups. A steering committee identified stakeholders among representatives from dental professionals, industry-related experts and PWLE. Participants underwent a three-round Delphi survey using a multi-stakeholder approach; they assessed candidate outcomes and additional outcomes identified in the first Delphi round. The process followed the COMET methodology. RESULTS: From the 665 potential outcomes identified in the systematic reviews and 89 in the PWLE focus group, the steering committee selected 100 and organized them into 13 categories, to be included in the first-round questionnaire as candidate outcomes. A total of 99 dental experts, 7 dental-industry-related experts and 17 PWLE participated in the first round, and 11 additional outcomes were added to the second round. There was no attrition between the first and second rounds, where 61 (54.9%) outcomes exceeded the pre-established threshold of agreement. PWLE and experts participated in the third round that applied "a priori" standard filters to distil a list of candidate essential outcomes. CONCLUSION: This Delphi study utilized a standardized, transparent and inclusive methodology and preliminarily validated 13 essential outcomes organized into four core areas. These results informed the final stage of the ID-COSM consensus.

Randomized clinical trial on the effect of intermittent vibrational force application during orthodontic treatment with aligners on RANKL and OPG concentrations in crevicular fluid.

Application of intermittent forces by vibration is proposed as an easy-to-use accelerator of dental movement. The purpose of this study was to determine the effect of intermittent vibrational force application during orthodontic aligner treatment on receptor activator of nuclear factor-kappa B ligand (RANKL) and osteoprotegerin (OPG) concentrations in crevicular fluid as markers of bone remodeling. This three-arm parallel randomized clinical trial included 45 candidates for malocclusion treatment with aligners, randomly assigned to: Group A (vibrational forces from onset of treatment); Group B (vibrational forces at 6 weeks after treatment onset); or Group C (no vibration). The frequency of aligner adjustment also differed among groups. At different time points, a paper tip was used to draw crevicular fluid samples from a moving lower incisor for RANKL and OPG analysis using ELISA kits. Mixed-model ANOVA found no significant differences in RANKL (A: p = 0.31, B: p = 0.8, C: p = 0.49) or OPG (A: p = 0.24, B: p = 0.58, C: p = 0.59) over time in any group or as a function of the application/non-application of vibration or the frequency of aligner adjustments. Application of this accelerator device did not significantly affect bone remodeling in patients undergoing orthodontic treatment with aligners. However, a nonsignificant improvement in biomarker concentrations was observed when aligners were changed every 7 days and vibration was also applied. Further research is warranted to establish protocols for the application of vibration and the timing of aligner adjustments.

Retention procedures for stabilising tooth position after treatment with orthodontic braces.

BACKGROUND: Without a phase of retention after successful orthodontic treatment, teeth tend to 'relapse', that is, to return to their initial position. Retention is achieved by fitting fixed or removable retainers to provide stability to the teeth while avoiding damage to teeth and gums. Removable retainers can be worn full- or part-time. Retainers vary in shape, material, and the way they are made. Adjunctive procedures are sometimes used to try to improve retention, for example, reshaping teeth where they contact ('interproximal reduction'), or cutting fibres around teeth ('percision'). This review is an update of one originally published in 2004 and last updated in 2016. OBJECTIVES: To evaluate the effects of different retainers and retention strategies used to stabilise tooth position after orthodontic braces. SEARCH METHODS: An information specialist searched Cochrane Oral Health Trials Register, CENTRAL, MEDLINE, Embase and OpenGrey up to 27 April 2022 and used additional search methods to identify published, unpublished and ongoing studies.  SELECTION CRITERIA: Randomised controlled trials (RCTs) involving children and adults who had retainers fitted or adjunctive procedures undertaken to prevent relapse following orthodontic treatment with braces. We excluded studies with aligners. DATA COLLECTION AND ANALYSIS: Two review authors independently screened eligible studies, assessed risk of bias and extracted data. Outcomes were stability or relapse of tooth position, retainer failure (i.e. broken, detached, worn out, ill-fitting or lost), adverse effects on teeth and gums (i.e. plaque, gingival and bleeding indices), and participant satisfaction. We calculated mean differences (MD) for continuous data, risk ratios (RR) or risk differences (RD) for dichotomous data, and hazard ratios (HR) for survival data, all with 95% confidence intervals (CI). We conducted meta-analyses when similar studies reported outcomes at the same time point; otherwise results were reported as mean ranges. We prioritised reporting of Little's Irregularity Index (crookedness of anterior teeth) to measure relapse, judging the minimum important difference to be 1 mm. MAIN RESULTS: We included 47 studies, with 4377 participants. The studies evaluated: removable versus fixed retainers (8 studies); different types of fixed retainers (22 studies) or bonding materials (3 studies); and different types of removable retainers (16 studies). Four studies evaluated more than one comparison. We judged 28 studies to have high risk of bias, 11 to have low risk, and eight studies as unclear.  We focused on 12-month follow-up.  The evidence is low or very low certainty. Most comparisons and outcomes were evaluated in only one study at high risk of bias, and most studies measured outcomes after less than a year. Removable versus fixed retainers Removable (part-time) versus fixed   One study reported that participants wearing clear plastic retainers part-time in the lower arch had more relapse than participants with multistrand fixed retainers, but the amount was not clinically significant (Little's Irregularity Index (LII) MD 0.92 mm, 95% CI 0.23 to 1.61; 56 participants). Removable retainers were more likely to cause discomfort (RR 12.22; 95% CI 1.69 to 88.52; 57 participants), but were associated with less retainer failure (RR 0.44, 95% CI 0.20 to 0.98; 57 participants) and better periodontal health (Gingival Index (GI) MD -0.34, 95% CI -0.66 to -0.02; 59 participants). Removable (full-time) versus fixed   One study reported that removable clear plastic retainers worn full-time in the lower arch did not provide any clinically significant benefit for tooth stability over fixed retainers (LII MD 0.60 mm, 95% CI 0.17 to 1.03; 84 participants). Participants with clear plastic retainers had better periodontal health (gingival bleeding RR 0.53, 95% CI 0.31 to 0.88; 84 participants), but higher risk of retainer failure (RR 3.42, 95% CI 1.38 to 8.47; 77 participants). The study found no difference between retainers for caries.  Different types of fixed retainers Computer-aided design/computer-aided manufacturing (CAD/CAM) nitinol versus conventional/analogue multistrand One study reported that CAD/CAM nitinol fixed retainers were better for tooth stability, but the difference was not clinically significant (LII MD -0.46 mm, 95% CI -0.72 to -0.21; 66 participants). There was no evidence of a difference between retainers for periodontal health (GI MD 0.00, 95% CI -0.16 to 0.16; 2 studies, 107 participants), or retainer survival (RR 1.29, 95% CI 0.67 to 2.49; 1 study, 41 participants). Fibre-reinforced composite versus conventional multistrand/spiral wire  One study reported that fibre-reinforced composite fixed retainers provided better stability than multistrand retainers, but this was not of a clinically significant amount (LII MD -0.70 mm, 95% CI -1.17 to -0.23; 52 participants). The fibre-reinforced retainers had better patient satisfaction with aesthetics (MD 1.49 cm on a visual analogue scale, 95% CI 0.76 to 2.22; 1 study, 32 participants), and similar retainer survival rates (RR 1.01, 95% CI 0.84 to 1.21; 7 studies; 1337 participants) at 12 months. However, failures occurred earlier (MD -1.48 months, 95% CI -1.88 to -1.08; 2 studies, 103 participants; 24-month follow-up) and more gingival inflammation at six months, though bleeding on probing (BoP) was similar (GI MD 0.59, 95% CI 0.13 to 1.05; BoP MD 0.33, 95% CI -0.13 to 0.79; 1 study, 40 participants). Different types of removable retainers Clear plastic versus Hawley When worn in the lower arch for six months full-time and six months part-time, clear plastic provided similar stability to Hawley retainers (LII MD 0.01 mm, 95% CI -0.65 to 0.67; 1 study, 30 participants). Hawley retainers had lower risk of failure (RR 0.60, 95% CI 0.43 to 0.83; 1 study, 111 participants), but were less comfortable at six months (VAS MD -1.86 cm, 95% CI -2.19 to -1.53; 1 study, 86 participants). Part-time versus full-time wear of Hawley There was no evidence of a difference in stability between part-time and full-time use of Hawley retainers (MD 0.20 mm, 95% CI -0.28 to 0.68; 1 study, 52 participants). AUTHORS' CONCLUSIONS: The evidence is low to very low certainty, so we cannot draw firm conclusions about any one approach to retention over another. More high-quality studies are needed that measure tooth stability over at least two years, and measure how long retainers last, patient satisfaction and negative side effects from wearing retainers, such as tooth decay and gum disease.

ANTECEDENTES: Sin una fase de retención tras un tratamiento de ortodoncia exitoso, los dientes tienden a "recaer", es decir, a volver a su posición inicial. La retención se consigue colocando retenedores fijos o removibles para proporcionar estabilidad a los dientes y evitar al mismo tiempo daños en dientes y encías. Los retenedores removibles pueden llevarse a tiempo completo o parcial. Los retenedores varían en la forma, el material y el modo de fabricación. A veces se utilizan procedimientos complementarios para intentar mejorar la retención, por ejemplo, remodelando los dientes en la zona de contacto ("reducción interproximal") o cortando fibras alrededor de los dientes ("pericisión"). Esta revisión es una actualización de una publicada originalmente en 2004 y actualizada por última vez en 2016. OBJETIVOS: Evaluar los efectos de los diferentes retenedores y estrategias de retención utilizados para estabilizar la posición de los dientes después del tratamiento con aparatos de ortodoncia. MÉTODOS DE BÚSQUEDA: Un documentalista realizó búsquedas en el Registro de ensayos del Grupo Cochrane de Salud oral (Cochrane Oral Health), en CENTRAL, MEDLINE, Embase y OpenGrey hasta el 27 de abril de 2022 y utilizó métodos de búsqueda adicionales para identificar estudios publicados, no publicados y en curso. CRITERIOS DE SELECCIÓN: Ensayos controlados aleatorizados (ECA) con niños y adultos a los que se les colocaron retenedores o se les realizaron procedimientos complementarios para prevenir la recaída tras el tratamiento con aparatos de ortodoncia. Se excluyeron los estudios con alineadores. OBTENCIÓN Y ANÁLISIS DE LOS DATOS: Dos autores de la revisión realizaron de forma independiente la revisión de los estudios elegibles, evaluaron el riesgo de sesgo y extrajeron los datos. Los desenlaces fueron la estabilidad o recaída de la posición dental, el fracaso del retenedor (es decir, roto, desprendido, desgastado, mal ajustado o perdido), los efectos adversos en dientes y encías (es decir, índices de placa, gingivales y de sangrado) y la satisfacción de los participantes. Se calcularon las diferencias de medias (DM) para los datos continuos, las razones de riesgos (RR) o las diferencias de riesgos (DR) para los datos dicotómicos, y los cociente de riesgos instantáneos (CRI) para los datos de supervivencia, todos ellos con intervalos de confianza (IC) del 95%. Se realizaron metanálisis cuando estudios similares informaron desenlaces en el mismo punto temporal; de lo contrario, los resultados se informaron como rangos medios. Se dio prioridad a la notificación del Little's Irregularity Index (torcedura de los dientes anteriores) para medir la recaída, considerando que la diferencia mínima importante era de 1 mm. RESULTADOS PRINCIPALES: Se incluyeron 47 estudios con 4377 participantes. Los estudios evaluaron: retenedores removibles versus fijos (ocho estudios); diferentes tipos de retenedores fijos (22 estudios) o materiales adhesivos (tres estudios); y diferentes tipos de retenedores removibles (16 estudios). Cuatro estudios evaluaron más de una comparación. Se consideró que 28 estudios tenían un alto riesgo de sesgo, 11 un riesgo bajo y en ocho estudios fue incierto. El centro de atención de esta revisión fue el seguimiento a los 12 meses. La evidencia es de certeza baja a muy baja. La mayoría de las comparaciones y los desenlaces se evaluaron en un solo estudio con alto riesgo de sesgo, y la mayoría de los estudios midieron los desenlaces después de menos de un año. Retenedores removibles versus fijos Removible (a tiempo parcial) versus fijo Un estudio informó que los participantes que llevaban retenedores de plástico transparente a tiempo parcial en la arcada inferior presentaron más recaídas que los participantes con retenedores fijos de múltiples barras, pero la cantidad no fue clínicamente significativa (Little's Irregularity Index [IIL] DM 0,92 mm; IC del 95%: 0,23 a 1,61; 56 participantes). Los retenedores removibles tuvieron más probabilidades de causar molestias (RR 12,22; IC del 95%: 1,69 a 88,52; 57 participantes), pero se asociaron con menos fracaso del retenedor (RR 0,44; IC del 95%: 0,20 a 0,98; 57 participantes) y mejor salud periodontal (Gingival Index [IG] DM ­0,34; IC del 95%: ­0,66 a ­0,02; 59 participantes). Removible (a tiempo completo) versus fijo Un estudio informó que los retenedores removibles de plástico transparente utilizados a tiempo completo en la arcada inferior no proporcionaron efectos beneficiosos clínicamente significativos en la estabilidad dental en comparación con los retenedores fijos (LII DM 0,60 mm; IC del 95%: 0,17 a 1,03; 84 participantes). Los participantes con retenedores de plástico transparente tenían mejor salud periodontal (sangrado gingival RR 0,53; IC del 95%: 0,31 a 0,88; 84 participantes), pero mayor riesgo de fracaso del retenedor (RR 3,42; IC del 95%: 1,38 a 8,47; 77 participantes). El estudio no encontró diferencias entre los retenedores en las caries. Diferentes tipos de retenedores fijos De nitinol con diseño asistido por ordenador/fabricación asistida por ordenador (DAO/FAO) versus de múltiples barras convencional/analógico Un estudio informó que los retenedores fijos de nitinol con DAO/FAO fueron mejores para la estabilidad dental, pero la diferencia no fue clínicamente significativa (LII DM ­0,46 mm; IC del 95%: ­0,72 a ­0,21; 66 participantes). No hubo evidencia de una diferencia entre los retenedores en la salud periodontal (GI MD 0,00; IC del 95%: ­0,16 a 0,16; dos estudios, 107 participantes) ni en la supervivencia del retenedor (RR 1,29; IC del 95%: 0,67 a 2,49; un estudio, 41 participantes). Composite reforzado con fibra versus alambre de múltiples barras/en espiral convencional Un estudio informó que los retenedores fijos de composite reforzado con fibra proporcionaron una mayor estabilidad que los retenedores de múltiples barras, pero no fue clínicamente significativa (LII DM ­0,70 mm; IC del 95%: ­1,17 a ­0,23; 52 participantes). Los retenedores reforzados con fibra tuvieron una mejor satisfacción del paciente con respecto a la estética (DM 1,49 cm en una escala visual analógica; IC del 95%: 0,76 a 2,22; un estudio, 32 participantes) y tasas similares de supervivencia del retenedor (RR 1,01, IC del 95%: 0,84 a 1,21; siete estudios; 1337 participantes) a los 12 meses. Sin embargo, los fracasos se produjeron antes (DM ­1,48 meses; IC del 95%: ­1,88 a ­1,08; dos estudios, 103 participantes; seguimiento de 24 meses) y más inflamación gingival a los seis meses, aunque el sangrado al sondaje (SS) fue similar (GI DM 0,59; IC del 95%: 0,13 a 1,05; SS DM 0,33; IC del 95%: ­0,13 a 0,79; un estudio, 40 participantes). Diferentes tipos de retenedores removibles Plástico transparente versus Hawley Cuando se llevó en la arcada inferior durante seis meses a tiempo completo y seis meses a tiempo parcial, el plástico transparente proporcionó una estabilidad similar a los retenedores Hawley (LII DM 0,01 mm; IC del 95%: ­0,65 a 0,67; un estudio, 30 participantes). Los retenedores Hawley tuvieron un menor riesgo de fracaso (RR 0,60; IC del 95%: 0,43 a 0,83; un estudio, 111 participantes), pero resultaron menos cómodos a los seis meses (EVA DM ­1,86 cm; IC del 95%: ­2,19 a ­1,53; un estudio, 86 participantes). Hawley a tiempo parcial versus a tiempo completo No hubo evidencia de una diferencia en la estabilidad entre el uso a tiempo parcial y a tiempo completo de los retenedores Hawley (DM 0,20 mm; IC del 95%: ­0,28 a 0,68; un estudio, 52 participantes). CONCLUSIONES DE LOS AUTORES: La evidencia es de certeza baja a muy baja, por lo que no fue posible establecer conclusiones firmes sobre un método de retención en detrimento de otro. Se necesitan más estudios de alta calidad que midan la estabilidad de los dientes durante al menos dos años, así como la duración de los retenedores, la satisfacción de los pacientes y los efectos secundarios negativos del uso de retenedores, como caries y enfermedades de las encías.

Long-term tooth survival and success following primary root canal treatment: a 5- to 37-year retrospective observation.

OBJECTIVES: The aims of the present longitudinal retrospective observational case series study were to investigate the survival and success rates of primary non-surgical endodontic therapy. MATERIALS AND METHODS: Patients with at least one endodontically treated tooth (ETT), with 5 years of follow-up and in compliance with the recall programme of at least 1 time per year in a private practice setting, were recruited. Kaplan-Meier survival analyses were performed considering (a) tooth extraction/survival and (b) endodontic success as the outcome variables. A regression analysis was performed to evaluate prognostic factors associated with tooth survival. RESULTS: Three hundred twelve patients and 598 teeth were included. The cumulative survival rates showed 97%, 81%, 76% and 68% after 10, 20, 30 and 37 years, respectively. The corresponding values for endodontic success were 93%, 85%, 81% and 81%, respectively. CONCLUSIONS: The study demonstrated high longevity in symptomless function as well as high success rates of ETT. The most significant prognostic factors associated with tooth extraction were the presence of deep (> 6 mm) periodontal pockets, the presence of pre-operative apical radiolucency and the lack of occlusal protection (no use of a night guard). CLINICAL RELEVANCE: The favourable long-term (> 30 years) prognosis of ETT must encourage clinicians to rely on primary root canal treatment when taking the decision regarding whether a tooth with pulpal and/or periapical diseases should be saved or be extracted and replaced with an implant.

The efficacy of implant surface decontamination using chemicals during surgical treatment of peri-implantitis: A systematic review and meta-analysis.

AIM: To answer the following PICOS question: "In adult patients with peri-implantitis, what is the efficacy of surgical therapy with chemical surface decontamination of implant surfaces in comparison with surgical therapy alone or surgery with placebo decontamination, on probing pocket depth (PD) reduction and bleeding on probing (BoP)/suppuration on probing (SoP), in randomized controlled clinical trials (RCTs) and non-RCTs with at least 6 months of follow-up?" MATERIALS AND METHODS: Six databases were searched from their inception up to 20 May 2022. Data on clinical outcome variables were pooled and analysed using mean differences (MDs), risk ratios (RRs), or risk differences (RDs) as appropriate, 95% confidence intervals (CIs), and prediction intervals (PIs) in the case of significant heterogeneity. Primary outcomes were determined as changes in PD and BoP/SoP. Secondary outcomes were radiographic marginal bone loss (MBL), implant loss, and disease resolution. PROSPERO registration number: CRD42022325603. RESULTS: Six RCTs-two with moderate, three with high, and one with low risk of bias (RoB)-were included. These studies test the adjunctive effect of photodynamic therapy (PDT), chlorhexidine (CHX), and administration of local antibiotics (LAbs) during surgery on the clinical outcome. In a single 12-month study, the adjunctive use of local antibiotics showed a clinically relevant reduction of PD [MD = 1.44; 95%CI (0.40 to -2.48)] and MBL [MD = 1.21; 95%CI (0.44-1.98); one trial, 32 participants]. PDT showed a small but significant reduction in BoP [MD = 7.41%; 95%CI (0.81-14.00); p = 0.028; two trials; 42 participants]. Treatment with CHX resulted in no significant changes in PD, BoP, or MBL compared to placebo (saline solution). None of the interventions affected disease resolution and implant loss. Certainty of the evidence was very low for all outcome measures assessed. CONCLUSIONS: Within the limitations of this systematic review and the meta-analysis, adjunctive use of chemicals such as PDT, CHX, and LAbs for surface decontamination during surgery of peri-implantitis cannot be recommended as superior to standard debridement procedures (mechanical debridement with or without saline).

Comparison between Digital Casts and Cone Beam Computed Tomography for Measuring Maxillary Transverse Dimensions in Patients with Impacted Canines.

Cone beam computed tomography (CBTCT) scans (n = 45) and digital dental casts (n = 45) were both used to measure the maxillary transverse dimensions in patients with impacted maxillary canines. The objectives were to explore the associations of these dimensions with the impaction and patient characteristics, and to compare the measurements between these techniques. The maxillary width was measured on scans and casts at the Walaridge, and the intermolar width and interpremolar width levels were measured at the first and second premolars (measured from the buccal grooves and the palatal cuspids, and the palatal and lingual amelocemental junctions). Two examiners independently compared the measurements between the control quadrants (without impaction) and the case quadrants (with impaction) in patients with unilateral impactions, and between the unilateral and bilateral impaction groups. The interclass correlation coefficient (ICC) was calculated to assess the interexaminer reliability and paired or independent Student's t-tests and ANOVAs were used for comparisons. The ICCs were 0.887 and 0.919, globally, for the measurements on the CBCT scans and casts, respectively, which indicates the excellent interexaminer reliability. On the CBCT scans, statistically significant differences were found between the case and control quadrants in the transverse measurements at the lingual level on the upper first molars, and at the WALA ridge level on the upper second premolars (p < 0.05) in the unilateral impaction group. Significant differences were found between the case quadrants in the unilateral versus the bilateral groups at the WALA ridge on the second premolars in casts (p < 0.05), and at the lingual point on the first molars on the CBCT scans (p < 0.05). No statistically significant differences in the transverse measurements were observed between the impacted buccal and palatal canines on either the casts or CBCT scans. To the best of our knowledge, this is the first study to compare the transverse measurements between digital models and CBCT scans.

Effect of orthodontic therapy in periodontitis and non-periodontitis patients: a systematic review with meta-analysis.

AIM: To answer these PICO questions: #1: In adult patients with malocclusion, what are the effects of orthodontic tooth movement (OTM) on clinical attachment level (CAL) changes in treated periodontitis patients with a healthy but reduced periodontium compared to non-periodontitis patients? #2: In adult patients with treated periodontitis and malocclusion, which is the efficacy of skeletal anchorage devices compared to conventional systems in terms of orthodontic treatment outcomes? MATERIAL AND METHODS: Seven databases were searched until June 2020 looking for randomized, non-randomized trials and case series. Mean effects (ME) and 95% confidence intervals (CIs) were calculated. RESULTS: Twenty-six studies with high risk of bias were included. PICO#1: In 26 patients without periodontitis and in 69 treated periodontitis patients, minimal changes in periodontal outcomes were reported after orthodontic therapy (p > 0.05). A significant CAL gain (mm) (ME = 3.523; 95% CI [2.353; 4.693]; p < 0.001) was observed in 214 patients when periodontal outcomes were retrieved before a combined periodontal and orthodontic therapy. PICO#2: Orthodontic variables were scarcely reported, and objective assessment of the results on orthodontic therapy was missing. CONCLUSIONS: Based on a small number of low-quality studies, in non-periodontitis and in stable treated periodontitis patients, OTM had no significant impact on periodontal outcomes.

Effect of antibiotic prophylaxis for preventing infectious complications following impacted mandibular third molar surgery. A randomized controlled trial / Efecto de la profilaxis antibiótica para prevenir complicaciones infecciosas después Cirugía de tercer molar mandibular impactado. Un ensayo controlado aleatorio

Background: The objective of this study was to determine the effect of antibiotic prophylaxis in preventing post-operative infections after extraction of impacted mandibular third molars.Material and Methods: A Parallel-group, randomized, blind, placebo-controlled trial was performed. 154 patientswere randomly allocated to 2 groups; experimental (n=77) receiving 2g amoxicillin 1 hour prior to surgery andcontrol (n=77) receiving placebo. Primary outcome was postoperative infections and secondary outcome was theneed for rescue analgesia.Results: 4.5% of patients developed postoperative infections, five patients of the control group (4 alveolar osteitis,1 surgical site infection) and two of the experimental group (1 alveolar osteitis, 1 surgical site infection). Dif-ference between groups was not statistically significant, RR=0.4 (95%CI 0.08-1.99,p=0.41) NNTB=26. Rescueanalgesia intake was significantly higher in the control group (41 vs 18 patients of experimental group) RR=0.49(95%CI 0.32-0.75, p<0.05) NNTB=3.Conclusions: The use of 2g amoxicillin 1 hour before surgery was not effective in significantly reducing the risk ofpostoperative infections from impacted mandibular third molars extraction, when compared to placebo. Neverthe-less, antibiotic prophylaxis was associated with a reduced need for rescue analgesia.(AU)

The effect of timing of orthodontic therapy on the outcomes of regenerative periodontal surgery in patients with stage IV periodontitis: A multicenter randomized trial.

AIM: To compare the outcomes after early (4 weeks post surgery) or late (6 months post surgery) orthodontic therapy (OT) following regenerative surgery of intra-bony defects (IDs). MATERIALS AND METHODS: In a multi-center, parallel-group, randomized clinical trial, 43 patients with stage IV periodontitis were randomized to receive either early (n = 23) or late OT (n = 20) following regenerative surgery of IDs. Primary outcome was change in clinical attachment level (CAL) in one target ID at 12 months after surgery. Secondary outcomes were changes of probing pocket depth (PPD), bleeding on probing (BOP), and frequency of pocket closure. RESULTS: No statistically significant differences between groups could be observed for CAL gain (5.4 mm [±2.1 mm] for early; 4.5 mm [±1.7 mm] for late OT). PPD was reduced by 4.2 mm (±1.9 mm) in the early group and by 3.9 mm (±1.5 mm) in the late group (p > .05). Pocket closure (PPD ≤ 4 mm) was obtained in 91% of defects in early compared to 85% in late OT. CONCLUSION: In the inter-disciplinary treatment of periodontitis stage IV, OT can be initiated already 4 weeks after regenerative surgery of IDs with favourable results, thus reducing the overall treatment time.

Sexual dimorphism in the long-term stability (10 years) of skeletal Class III treatment.

BACKGROUND: Class III malocclusion is associated with high sexual dimorphism, especially in individuals older than 13 years of age, with significant differences in growth between males and females during the pubertal and postpubertal stages, and in adulthood. The aim of this research was to examine differences between males and females in long-term stability (10 years) of treatment for skeletal Class III malocclusion. METHODS: Thirty patients (15 males and 15 females) with skeletal Class III malocclusion, who had been treated with rapid maxillary expansion (RME) combined with face mask protraction followed by fixed appliances, were selected sequentially. Thirty patients (15 males and 15 females) with skeletal Class I and mesofacial patterns treated only with fixed appliances for dental problems served as the control group. Differences between groups and sexes were evaluated using lateral cephalograms taken at the start of treatment (T0), immediately after the end of treatment (T1), and after 10 years (T2). The long-term treatment success rate was calculated. RESULTS: Ten years after Class III treatment, overjet and overbite relapse occurred similarly in females (- 0.68 ± 0.7 mm; - 0.38 ± 0.75 mm, respectively) and males (- 1.09 ± 1.47 mm; - 0.64 ± 0.9 mm, respectively); the ANB angle and Wits appraisal became significantly more negative in males (- 1.37 ± 1.06°; - 2.7 ± 2.53 mm) than in females (- 0.18 ± 1.26°; - 0.46 ± 1.94 mm). The success rate was 73.3% in males and 80% in females. CONCLUSIONS: Significant differences in the long-term stability of Class III treatment outcomes have been found between males and females, with a larger skeletal Class III relapse and lower long-term success rates in males.

Bond Strength of Metallic or Ceramic Orthodontic Brackets to Enamel, Acrylic, or Porcelain Surfaces.

Bonding strategies within different brackets and dental materials are still a challenge concerning adhesion and dental surface damage. This study compared the shear and tensile bond strength of orthodontic ceramic and metallic brackets to enamel, acrylic, and ceramic surfaces after thermal cycling. Dental surfaces were divided into three groups: enamel, ceramic, and acrylic. Each group received stainless-steel and ceramic brackets. After thermal cycling, specimens were randomly divided into two subgroups considering tensile (TBS) or shear bond strength (SBS) test. After the mechanical testing, scanning electron and optical microscopy were performed, and the adhesive remnant index (ARI) was determined. The two-way ANOVA full factorial design was used to compare TBS, SBS, and ARI on the surface and bracket type (α = 0.05). There were significant differences in TBS, SBS, and ARI values per surface (p < 0.001 and p = 0.009) and type of bracket (p = 0.025 and p = 0.001). The highest mean SBS values were recorded for a ceramic bracket bonded to an acrylic surface (8.4 ± 2.3 MPa). For TBS, a ceramic bracket bonded to acrylic showed the worst performance (5.2 ± 1.8 MPa) and the highest values were found on a metallic bracket bonded to enamel. The adhesion of metallic or ceramic brackets is enough for clinical practice although the damage of the enamel surface after debonding is irreversible and harmful for the aesthetic outcome of the teeth.

Novel Sub-Clustering of Class III Skeletal Malocclusion Phenotypes in a Southern European Population Based on Proportional Measurements.

Current phenotypic characterizations of Class III malocclusion are influenced more by gender or ethnic origin than by raw linear skeletal measurements. The aim of the present research is to develop a Class III skeletal malocclusion sub-phenotype characterization based on proportional cranial measurements using principal component analysis and cluster analysis. Radiometric data from 212 adult subjects (115 women and 96 men) of southern European origin affected by Class III skeletal malocclusion were analyzed. A total of 120 measurements were made, 26 were proportional skeletal measurements, which were used to perform principal component analysis and subsequent cluster analysis. The remaining 94 supplementary measurements were used for a greater description of the identified clusters. Principal component analysis established eight principal components that explained 85.1% of the total variance. The first three principal components explained 51.4% of the variance and described mandibular proportions, anterior facial height proportions, and posterior-anterior cranial proportions. Cluster analysis established four phenotypic subgroups, representing 18.4% (C1), 20.75% (C2), 38.68% (C3), and 22.17% (C4) of the sample. A new sub-clustering of skeletal Class III malocclusions that avoids gender influence is provided. Our results improve clinicians' resources for Class III malocclusion and could improve the diagnostic and treatment approaches for this malocclusion.

Adjunctive effect of systemic antimicrobials in periodontitis therapy: A systematic review and meta-analysis.

AIM: To answer the following PICOS questions: in patients with periodontitis, which is the efficacy of adjunctive systemic antimicrobials, in comparison with subgingival debridement plus a placebo, in terms of probing pocket depth (PPD) reduction, in randomized clinical trials with at least 6 months of follow-up? MATERIAL AND METHODS: A systematic search was conducted: 34 articles (28 studies) were included. Data on clinical outcome variables changes were pooled and analysed using weighted mean differences (WMDs), 95% confidence intervals (CI) and prediction intervals (PIs), in case of significant heterogeneity. RESULTS: For PPD, statistically significant benefits (p < .001) were observed in short-term studies (WMD = 0.448, 95% CI [0.324; 0.573], PI [-0.10 to 0.99]) and long-term studies (WMD = 0.485, 95% CI [0.322; 0.648], PI [-0.11 to 1.08]). Additionally, statistically significant benefits were also found for clinical attachment level, bleeding on probing, pocket closure and frequency of residual pockets. The best outcomes were observed for the combination of amoxicillin plus metronidazole, followed by metronidazole alone and azithromycin. Adverse events were more frequently reported in groups using systemic antimicrobials. CONCLUSIONS: The adjunctive use of systemic antimicrobials in periodontal therapy results in statistically significant benefits in clinical outcomes, with more frequent adverse events in test groups using systemic antimicrobials.

The efficacy of pocket elimination/reduction compared to access flap surgery: A systematic review and meta-analysis.

AIM: To assess the efficacy and adverse effects of resective surgery compared to access flap in patients with periodontitis. METHODS: Randomized controlled trials with a follow-up ≥6 months were identified in ten databases. Screening, data extraction, and quality assessment were conducted by two reviewers. The primary outcome was probing pocket depth, and the main secondary outcome was clinical attachment level. Data on adverse events were collected. Meta-analysis was used to synthesize the findings of trials. RESULTS: A total of 880 publications were identified. Fourteen publications from nine clinical trials met the inclusion criteria and were included for analysis. Meta-analysis was carried out using all available results. The results indicated superior pocket depth reduction following resective surgery compared to access flap after 6-12 months of follow-up (weighted mean difference 0.47 mm; confidence interval 0.7-0.24; p = .010). After 36-60 months of follow-up, no differences were found between the two treatments in pocket depth and attachment level. The prevalence of adverse effects was not different between the groups. Post-operative recession tended to be more severe for the resective approaches. CONCLUSION: Resective surgical approach was superior to access flap in reducing pocket depth 6-12 months post-surgery, while no differences between the two modalities were found at 36-60 months of follow-up.