Mucormycosis of the Mandible and Tongue: A Systematic Scoping Review.

AIM: Mucormycosis is a rare human infection associated with Mucorales, a group of filamentous moulds found in different environmental niches. Its oral manifestations may occur in the mandible and tongue despite being rare. We aimed to systematically review the data on clinical manifestations, risk factors, diagnostic approaches, treatment options, and outcomes of mandibular and tongue mucormycosis. METHODS: An electronic search of articles published between January 1975 and November 2022 in PubMed, Web of Science, and EMBASE databases was performed. A total of 22 articles met the inclusion criteria and reported 27 cases of oral mucormycosis in total. RESULTS: Fourteen patients had mandibular mucormycosis signs unrelated to COVID-19 infection, 6 had SARS-CoV-2-related mandibular mucormycosis, and 6 had manifestations in the tongue. All published case reports during the COVID-19 pandemic were from India. Patient ages ranged from 4 months old to 82 years, and most patients had important comorbidities, such as blood dyscrasias related to immune deficiency and uncontrolled type 2 diabetes mellitus. The signs and symptoms of mandibular and tongue mucormycosis varied from dental pain, loose teeth, and nonhealing sockets to dysphagia and paraesthesia of the lip. Some patients also reported trismus, draining sinus tract, and facial pain. The diagnosis of oral mucormycosis was based on a combination of clinical, radiographic, and histopathologic findings by demonstrating fungal hyphae in tissue specimens. In most cases, mucormycosis was managed with systemic amphotericin B, strict glycaemic control, and aggressive surgical debridement of infected tissue, minimising the progression of the fungal infection and thus improving the survival rate. In some cases, combined antifungal therapy, antibiotic therapy, and chlorhexidine mouthwashes were used successfully. CONCLUSIONS: Recognition of the signs and symptoms by oral care providers is pertinent for the early diagnosis and treatment of tongue and mandibular mucormycosis, and providers should be aware of the possibility of this opportunistic fungal infection in patients with COVID-19. A multidisciplinary approach is recommended for the management of this lethal infection.

Recrudescence of Scarlet Fever and Its Implications for Dental Professionals.

A significant increase in the incidence of scarlet fever, mainly in Europe, has been noted during the COVID-19 postpandemic period. Scarlet fever is caused by a pyrogenic exotoxin-producing streptococcus-Streptococcus pyogenes-responsible for more than 500,000 deaths annually worldwide. Superantigens (SAgs) secreted by this Group A streptococcus (GAS) usually overstimulate the human immune system, causing an amplified hypersensitivity reaction leading to initial symptoms such as sore throat, high fever, and a sandpaper-like skin rash. There could be concurrent oral manifestations known as "strawberry tongue" or "raspberry tongue," which may be first noted by oral health professionals. The early diagnosis and treatment of this disease is critical to obviate the development of local and systemic sequelae such as acute rheumatic fever, endocarditis, and glomerulonephritis. Antibiotics should be prescribed early to mitigate its duration, sequelae, and community spread. Dental practitioners should be aware of the early symptoms of scarlet fever for infection detection, emergency patient management, and appropriate referral. This concise review outlines the prevalence, pathogenicity, oral and systemic manifestations, as well as the dental implications of scarlet fever.

The Effect of Osseodensification on Ridge Expansion, Intraosseous Temperature, and Primary Implant Stability: A Pilot Study on Bovine Ribs.

Osseodensification is a novel technique based on nonsubtractive drilling to preserve and condense bone during osteotomy preparation. The aim of this ex vivo study was to compare osseodensification and conventional extraction drilling technique with regard to intraosseous temperatures, expansion of alveolar ridge width, and primary implant stability using different implant geometries: tapered and straight walled. A total of 45 implant sites were prepared in bovine ribs following osseodensification and conventional protocols. Changes in intraosseous temperatures were recorded at 3 depths using thermocouples, and ridge width was measured at 2 different depths before and after osseodensification preparations. The primary implant stability was measured using peak insertion torque and the implant stability quotient (ISQ) following placement of straight and tapered implants. A significant change in temperature was recorded during site preparation for all techniques tested but not at all depths. Osseodensification recorded higher mean temperatures (42.7°C) than conventional drilling, particularly at the midroot level. Statistically significant ridge expansion was observed at both the crestal and apical levels in the osseodensification group. The ISQ values were significantly higher only for tapered implants placed in osseodensification sites when compared with conventional drilling sites; however, there was no difference in the primary stability between tapered and straight implants within the osseodensification group. Within the limitations of the present pilot study, osseodensification was found to increase the primary stability of straight-walled implants without overheating the bone and significantly expanded the ridge width. However, further investigation is required to determine the clinical significance of the bone expansion created by this new technique.

A Novel Antimicrobial Hydrogel for the Management of Periodontal Diseases.

OBJECTIVES: This study aimed to synthesise a drug-delivery system based on a porous polymer hydrogel, with antimicrobial properties against Porphyromonas gingivalis and potential to be used in tissue regeneration. MATERIAL AND METHODS: 2-Hydroxyethyl methacrylate monomers were polymerised using thermal and photoactivation in the presence of silver nitrate (AgNO3) and/or chlorhexidine digluconate. Poly-2-hydroxyethyl methacrylate (pHEMA) hydrogels containing silver nanoparticles (AgNPs) and/or 0.12% chlorhexidine (CHX) were produced and characterised using cryo-SEM and confocal microscopy. Hydrogel degradation and leaching of AgNP were tested for 1.5 months. The antimicrobial properties were tested against P. gingivalis using broth culture system and disk diffusion tests. RESULTS: Our methodology manufactured porous polymeric hydrogels doped with AgNPs and CHX. Hydrogels showed a successful delivery of CHX and sustainable release of AgNPs in a steady hydrogel degradation rate determined based on the weight loss of samples. Hydrogels with AgNPs or CHX had a significant antimicrobial effect against P. gingivalis, with CHX-hydrogels exhibiting a stronger effect than AgNP-hydrogels in the short-term assessment. AgNP-CHX hydrogels showed a compounded antimicrobial effect, whereas control hydrogels containing neither AgNPs nor CHX had no influence on bacterial growth (P < .05). CONCLUSIONS: The dual-cured pHEMA hydrogel loaded with antimicrobial agents proved to be an efficient drug-delivery system against periodontopathogens, with the potential to be used as a scaffold for tissue regeneration.

Do dental implant therapies arouse signs and symptoms of temporomandibular disorders? A scoping review.

OBJECTIVE: To delineate and discuss the literature about TMD in the context of dental implantology. METHODS: The PRISMA-ScR and Joanna Briggs guidelines for scoping reviews were used as methodological parameters. In vivo studies published in the English language showing interplay between dental implant therapy and TMD were included. A systematic screen strategy was applied in two platforms to obtain a broad range of relevant literature published in English. RESULTS: The literature review indicated that prolonged surgical procedure may be a risk for TMD. Conversely, implant-supported prostheses were found to contribute to the mitigation of some TMD aspects. Empirical principles for the best practice in implant dentistry concerning the TMD were discussed in the present study. CONCLUSION: The included clinical studies suggest that factors associated with the implant placement, such as long duration of surgical procedures, may represent risk factors for TMD. They also indicate long-term benefits of implant-supported restorations.

Comparison of heat production and bone architecture changes in the implant site preparation with compressive osteotomes, osseodensification technique, piezoelectric devices, and standard drills: an ex vivo study on porcine ribs.

This study aimed at investigating differences in heat generation and bone architecture following four different implant site preparation techniques: compressive osteotomes, conventional drills, osseodensification (OD mode with osseodensification drills), and piezoelectric systems. Porcine rib bones were used as a model for implant surgery. Thermocouples were employed to measure temperature changes, and micro-CT to assess the bone architecture. The primary stability and insertion torque values of the implants placed in the differently prepared sites were assessed. The temperature changes were higher with Piezo. The average primary stability using the ISQ scale was the greatest for drills (76.17 ± 0.90) and the lowest for osteotomes (71.50 ± 11.09). Insertion torque was significantly higher with the osseodensification method (71.67 ± 7.99 Ncm) in comparison to drills, osteotomes, and piezo. Osteotomes showed the highest bone to implant contact percentage (39.83 ± 3.14%) and average trabecular number (2.02 ± 0.21 per mm), while drills exhibited the lowest (30.73 ± 1.65%; 1.37 ± 0.34 per mm). Total implant site bone volume was the highest with osseodensification (37.26 ± 4.13mm3) and the lowest for osteotomes (33.84 ± 3.84mm3). Statistical analysis showed a high primary stability and decrease in temperature during implant site preparation with osseodensification technique. The results support the use of osseodensification technique for implant site preparation.

Probiotic Bifidobacteria in Managing Periodontal Disease: A Systematic Review.

Although various probiotic organisms have been evaluated for their utility in the management of periodontitis, their strain-specific mechanisms of action are still unclear. We aimed to systematically review the effect of bifidobacterial probiotics on periodontopathogens and host immune responses in periodontal diseases. An electronic search of articles published until June 2022 in Medline, PubMed, Web of Science, and Cochrane Library databases was performed. Randomised controlled trials (RCTs) and in vitro and animal studies were assessed, and the data regarding antimicrobial properties, immunomodulation, and clinical outcomes were analysed. A total of 304 studies were screened, but only 3 RCTs and 6 animal and in vitro studies met the inclusion criteria. The use of different strains of bifidobacteria led to (1) a reduction of key players of the red complex periodontopathogens; (2) reduced levels of pro-inflammatory cytokines (eg, interleukin [IL]1-ß and IL-8) and higher levels of anti-inflammatory cytokines (IL-10); (3) enhanced levels of osteoprotegerin and reduced levels of receptor activator of nuclear factor kappa-B ligand; and (4) a reduction of the dental plaque, bleeding on probing, alveolar bone loss, and clinical attachment loss. Bifidobacterial probiotic adjuvant supplementation, especially with Bifidobacterium animalis subspecies lactis, appears to help improve clinical periodontal parameters and develop a healthy plaque microbiome through microbiological and immunomodulatory pathways. Further human and animal studies are warranted prior to the therapeutic use of bifidobacteria in the routine management of periodontal infections.

Implant rehabilitation of edentulous maxilla in digital dentistry: A case report utilizing CAD/CAM technologies.

The replacement of missing teeth utilizing dental implants and digital dental technologies has gained significant popularity in daily clinical practice over the last decade. Partially dentate patients present more anatomical references to guide the implant position and prosthetic reconstruction as compared to completely edentulous arches. Therefore, the management of edentulous maxilla using implant digital dentistry represents a challenging clinical situation where a thorough treatment plan is paramount to achieve a final prosthetic result that meets both functional and esthetic requirements. This case report discusses the oral rehabilitation of an edentulous maxilla and partially dentate mandible using a digital workflow for both the surgical and prosthetic phases of the implant therapy. Protocols for clinical assessment, treatment planning, and restorative management are described to provide a predictable and prosthetic-driven treatment for implant-supported prostheses.

Short Dental Implants (≤7mm) Versus Longer Implants in Augmented Bone Area: A Meta-Analysis of Randomized Controlled Trials.

AIM: The aim of this systematic review was to compare the survival rate and the marginal bone loss between short implants (≤7 mm) placed in the atrophic area and longer implants placed in the augmented bone area of posterior regions of maxillaries. METHODS: Electronic search using three databases was performed up to May 2017 to identify Randomized Controlled Trials (RCT) assessing short implants survival with a minimal follow-up of 12 months post-loading. For the meta-analysis, a Risk Difference (RD) with the 95% Confidence Interval (CI) was used to pool the results of implant failure rate for each treatment group. For the marginal bone changes, Mean Differences (MD) with 95% CI were calculated. RESULTS: Seven randomized controlled trials met the inclusion criteria, being included in qualitative and quantitative analyses. The RD between the short implant group and the control group was -0.02 (95% CI: -0.04 to 0.00), I2=0 and Chi2=3.14, indicating a favorable survival rate for short implant, but with no statistical significance (p=0.09). DISCUSSION: For marginal bone loss, the mean difference was -0,13 (95%CI: -0.22 to -0.05), favoring the test group with statistical significance (p=0.002). The studies showed more heterogeneity for bone loss compared to survival rate. Short and longer implants showed similar survival rates after one year of loading, however the marginal bone loss around short implants was lower than in longer implants sites. CONCLUSION: Placement of implants ≤7 mm of length was found to be a predictable alternative for the rehabilitation of atrophic posterior regions, avoiding all the disadvantages intrinsic to bone augmentation procedures.

The role of probiotic bacteria in managing periodontal disease: a systematic review.

INTRODUCTION: The frequent recolonization of treated sites by periodontopathogens and the emergence of antibiotic resistance have led to a call for new therapeutic approaches for managing periodontal diseases. As probiotics are considered a new tool for combating infectious diseases, we systematically reviewed the evidences for their effectiveness in the management of periodontitis. AREAS COVERED: An electronic search was performed in the MEDLINE, SCOPUS and Cochrane Library databases up to March 2016 using the terms 'periodontitis', 'chronic periodontitis', 'probiotic(s)', 'prebiotic(s)', 'symbiotic(s)', 'Bifidobacterium and 'Lactobacillus'. Only randomized controlled trials (RCTs) were included in the present study. Analysis of 12 RCTs revealed that in general, oral administration of probiotics improved the recognized clinical signs of chronic and aggressive periodontitis such as probing pocket depth, bleeding on probing, and attachment loss, with a concomitant reduction in the levels of major periodontal pathogens. Continuous probiotic administration, laced mainly with Lactobacillus species, was necessary to maintain these benefits. Expert commentary: Oral administration of probiotics is a safe and effective adjunct to conventional mechanical treatment (scaling) in the management of periodontitis, specially the chronic disease entity. Their adjunctive use is likely to improve disease indices and reduce the need for antibiotics.

Probiotic lactobacilli inhibit early stages of Candida albicans biofilm development by reducing their growth, cell adhesion, and filamentation.

We evaluated the inhibitory effects of the probiotic Lactobacillus species on different phases of Candida albicans biofilm development. Quantification of biofilm growth and ultrastructural analyses were performed on C. albicans biofilms treated with Lactobacillus rhamnosus, Lactobacillus casei, and Lactobacillus acidophilus planktonic cell suspensions as well as their supernatants. Planktonic lactobacilli induced a significant reduction (p < 0.05) in the number of biofilm cells (25.5-61.8 %) depending on the probiotic strain and the biofilm phase. L. rhamnosus supernatants had no significant effect on the mature biofilm (p > 0.05), but significantly reduced the early stages of Candida biofilm formation (p < 0.01). Microscopic analyses revealed that L. rhamnosus suspensions reduced Candida hyphal differentiation, leading to a predominance of budding growth. All lactobacilli negatively impacted C. albicans yeast-to-hyphae differentiation and biofilm formation. The inhibitory effects of the probiotic Lactobacillus on C. albicans entailed both cell-cell interactions and secretion of exometabolites that may impact on pathogenic attributes associated with C. albicans colonization on host surfaces and yeast filamentation. This study clarifies, for the first time, the mechanics of how Lactobacillus species may antagonize C. albicans host colonization. Our data elucidate the inhibitory mechanisms that define the probiotic candicidal activity of lactobacilli, thus supporting their utility as an adjunctive therapeutic mode against mucosal candidal infections.

Use of Silver Nanoparticles Reduces Internal Contamination of External Hexagon Implants by Candida albicans.

Since the dental implant/abutment interface cannot totally seal the passage of microorganisms, the interior of implant becomes a reservoir of pathogenic microorganisms that produce and maintain chronic inflammation in the tissues around implants. Silver nanoparticles (nano-Ag) are potent and broad-spectrum antimicrobial agents. The aim of this study was to evaluate the capacity of the nano-Ag to prevent the contamination of the implant internal surface by Candida albicans, caused by the implant/abutment microgap infiltration. Thirty-six implants were used in this experiment. Three study groups were performed: experimental group (implants receiving an application of nano-Ag in their inner cavity before installation of the abutment); positive-control group (implants receiving sterile phosphate buffer saline application instead of nano-Ag) and negative-control group (implants receiving the application of nano-Ag in the inner cavity and immersed in a sterile medium). In the positive-control and experimental groups, the implants were immersed in a Candida albicans suspension. The abutments of all three groups were screwed with a 10 N torque. After 72 h of immersion inC. albicans suspension or sterile medium, the abutments were removed and the inner surface of the implants was sampled with absorbent paper cone for fungal detection. No C. albicans contamination was observed in the negative-control group. The positive-control group showed statistically higher values of colony forming units (CFUs) of C. albicans compared with the experimental group. In conclusion, silver nanoparticles reduced C. albicans colonization inside the implants, even with low torque screw abutment.

Use of Silver Nanoparticles Reduces Internal Contamination of External Hexagon Implants by Candida albicans

Abstract: Since the dental implant/abutment interface cannot totally seal the passage of microorganisms, the interior of implant becomes a reservoir of pathogenic microorganisms that produce and maintain chronic inflammation in the tissues around implants. Silver nanoparticles (nano-Ag) are potent and broad-spectrum antimicrobial agents. The aim of this study was to evaluate the capacity of the nano-Ag to prevent the contamination of the implant internal surface byCandida albicans, caused by the implant/abutment microgap infiltration. Thirty-six implants were used in this experiment. Three study groups were performed: experimental group (implants receiving an application of nano-Ag in their inner cavity before installation of the abutment); positive-control group (implants receiving sterile phosphate buffer saline application instead of nano-Ag) and negative-control group (implants receiving the application of nano-Ag in the inner cavity and immersed in a sterile medium). In the positive-control and experimental groups, the implants were immersed in a Candida albicans suspension. The abutments of all three groups were screwed with a 10 N torque. After 72 h of immersion inC. albicans suspension or sterile medium, the abutments were removed and the inner surface of the implants was sampled with absorbent paper cone for fungal detection. No C. albicans contamination was observed in the negative-control group. The positive-control group showed statistically higher values of colony forming units (CFUs) of C. albicans compared with the experimental group. In conclusion, silver nanoparticles reduced C. albicans colonization inside the implants, even with low torque screw abutment.

Resumo: A interface implante/pilar não pode ser totalmente selada para passagem de microrganismos, com isso o interior do implante torna-se um reservatório de microrganismos patogênicos que promovem e mantêm a inflamação crônica nos tecidos em volta dos implantes. Nanopartículas de prata são agentes antimicrobianos potentes e de amplo espectro. O objetivo deste estudo foi avaliar a capacidade das nanopartículas de prata em evitar a contaminação porCandida albicans do interior de implantes, originada da infiltração do fungo através da interface implante/pilar. 36 implantes foram utilizados neste experimento. Três grupos de estudo foram estabelecidos: grupo experimental (os implantes receberam aplicação de nanopartículas de prata na sua cavidade interna, antes da instalação do pilar); grupo controle positivo (os implantes receberam PBS estéril em vez das nanopartículas de prata) e grupo controle negativo (implantes receberam aplicação de nanopartículas de prata na cavidade interna, mas os implantes foram imersos em meio estéril). Nos grupos controle positivo e experimental, os implantes foram imersos em suspensão deCandida albicans. Os pilares protéticos de todos os grupos foram parafusados com torque de 10 N. Após 72 h imersos na suspensão deC. albicans ou em meio estéril, os pilares foram removidos e amostras da superfície interna dos implantes foram coletadas com cone de papel absorvente para a detecção de Candida. No grupo controle negativo não foi observada contaminação por C. albicans. O grupo-controle positivo mostrou valores de unidades formadoras de colônia deCandida estatisticamente maiores quando comparado com o grupo experimental. Conclui-se que nanopartículas de prata reduzem a colonização de C. albicans dentro dos implantes, mesmo quando o pilar é parafusado com torque baixo.

Avaliação da influência do ácido acético na eficiência da higienização de próteses totais / Evaluation of acetic acid influence in complete dentures hygiene effectiveness

Introdução: A manutenção da higiene das próteses é de grande importância para a saúde de seus usuários.O objetivo deste trabalho é avaliar a influência do ácido acético na eficiência da higienização de prótesestotais. Métodos: Para o estudo caso-controle, vinte e seis usuários de próteses totais foram selecionados emcasas de repouso em São Paulo. Os grupos receberam instruções sobre higiene das próteses totais, sendo ogrupo-controle instruído a deixá-las imersas em água durante a noite e o caso instruído a deixá-las imersasem vinagre pelo mesmo período. Nenhum paciente foi informado sobre o tipo de líquido utilizado. Resultadose Conclusão: Como resultado, obteve-se uma redução de placa no grupo estudado de 49% enquantono grupo-controle houve um aumento de 4%. Assim, é possível afirmar a eficácia do ácido acético na melhorada higienização de próteses totais

Introduction: The maintenance of complete denture is important for the patient?s health. The aim of thisstudy is to evaluate the influence of the acetic acid in complete dentures hygiene effectiveness. Methods:Twenty six wearers of complete dentures were selected in households in São Paulo City. Instructions weregiven on hygiene and they were instructed to keep their dentures in a certain liquid. Results and Conclusion:It was found a plaque reduction of 49% in the acetic acid group and an increase of 4% in the controlgroup. Thus, it was possible to affirm the efficiency of the acetic acid in the improvement of the completedentures? hygiene