Does Presurgical Nasoalveolar Molding Reduce the Need for Future Bone Grafting in Cleft Lip and Palate Patients? A Systematic Review and Meta-Analysis.

OBJECTIVE: Nasoalveolar molding (NAM) is a technique that is utilized in patients with cleft lip/palate before performing lip surgery. This procedure has been shown to result in a more aesthetic nose with lesser columellar deviation and reduced scaring. The aim of our study was to evaluate the long-term results of NAM and gingivoperiosteoplasty in patients with cleft lip and palate. METHODS AND MATERIALS: An electronic search of databases (ie, PubMed, ISI Web of Science, EMBASE, Scopus, and Google Scholar) from inception to March 2021 was performed and after selecting the eligible studies, relevant data were collected using piloted extraction forms. The success rate of NAM and gingivoperiosteoplasty, and Bergland score were pooled using random-effects inverse variance meta-analysis. RESULTS: Seven studies were included in this meta-analysis and systematic review. The pooled mean success rate of NAM with gingivoperiosteoplasty (GPP) based on the continuity of alveolar bone structure was 71% (95% confidence interval [CI] = 54-85). This means that in 71% of cases NAM + GPP treatment eliminated the need for future bone grafts. Also, no significant difference between the success rate (risk ratio = 1.00, 95% CI = 0.64-1.58) and mean Bergland score (mean difference = 0.64, 95% CI = -1.04 to 2.31) of NAM + GPP and skeletal bone graft was found. CONCLUSIONS: Nasoalveolar molding and gingivoperiosteoplasty was successful in 71% of cases treating patients with cleft lip and palate. This treatment is similar with the secondary alveolar bone graft in both the success rate and the alveolar height that it generates while being less invasive and with lower morbidity.

Molecular Genetics of Cleidocranial Dysplasia.

BACKGROUND: Cleidocranial dysplasia (CCD) is a genetic disorder with an autosomal dominant inheritance pattern. CCD characterized by abnormal clavicles, patent sutures and fontenelles, supernumerary teeth and short stature. Approximately 60-70% of CCD patients have mutations in the RUNX2 gene. The RUNX2 gene is an essential transcription factor for chondrocyte maturation, osteoblast differentiation and bone formation. Runx2 regulates mesenchymal cell proliferation in sutures and suture closure by inducing the signaling pathways of the genes of Fgf, Pthlh, hedgehog and Wnt. Material and Methods: We summarized molecular genetics aspects of CCD. Result: Approximately 94% of CCD patients have dental anomalies, the most common of which are supernumerary tooth. Dental anomalies are not determined solely by gene mutations of RUNX2, but are also affected by modifier genes, environmental factors, epigenetic factors and copy number variations. Conclusion: a definite diagnosis of CCD should include the patient's clinical history, symptoms and signs, as well as genetic analyses.

The effects of photobiomodulation therapy for treatment of alveolar osteitis (Dry Socket): Systematic review and meta-analysis.

INTRODUCTION: Dry socket (alveolar osteitis) is one of the most common complications that occur after the extraction of permanent teeth. The aim of this review was to evaluate and compare the effectiveness of photobiomodulation (PBT) with other treatment methods on alveolar osteitis. METHODS AND MATERIALS: MEDLINE, Web of Science, EMBASE, Scopus and Cochrane's CENTRAL online databases were searched based on the search strategy. Also, the prominent laser journals and the references of relevant studies were hand searched for eligible studies and then the data were extracted from the retrieved studies were extracted using piloted custom forms. The data were combined and analyzed using inverse-variance random-effect meta-analysis. RESULTS: For the treatment of dry socket, pain perception based on the VAS score, PBT on average has a 3.41 higher pain level reduction compared to alveogyl which seems to be both statistically and clinically significant. In addition, based on the GRADE score, the evidence seems to be of moderate quality. Also, in the individual studies which were included in this systematic review, PBT seems to be more effective than other methods (Salicept, zinc-oxide eugenol, ozone, and photodynamic therapy) in pain reduction of patients with alveolar osteitis. CONCLUSIONS: PBT, in general, has a higher ability in decreasing pain levels for patients with alveolar osteitis (dry socket) compared to alveogyl. Therefore, PBT could be used as an appropriate method for treatment and controlling the signs of dry socket.

Evaluation of the accuracy and related factors of the mechanical torque-limiting device for dental implants.

OBJECTIVE: Accurate delivery of torque to implant screws is critical to generate ideal preload in the screw joint and to offer protection against screw loosening. Mechanical torque-limiting devices (MTLDs) are available for this reason. In this study, the accuracy of one type of friction-style and two types of spring-style MTLDs at baseline, following fatigue conditions and sterilization processes were determined. MATERIALS AND METHODS: Five unused MTLDs were selected from each of Straumann (ITI), Astra TECH and CWM systems. To measure the output of each MTLD, a digital torque gauge with a 3-jaw chuck was used to hold the driver. Force was applied to the MTLDs until either the friction styles released at a pre-calibrated torque value or the spring styles flexed to a pre-calibrated limit (target torque value). The peak torque value was recorded and the procedure was repeated 5 times for each MTLD. Then MTLDs were subjected to fatigue conditions at 500 and 1000 times and steam sterilization processes at 50 and 100 times and the peak torque value was recorded again at each stage. RESULTS: Adjusted difference between measured torque values and target torque values differed significantly between stages for all 3 systems. Adjusted difference did not differ significantly between systems at all stages, but differed significantly between two different styles at baseline and 500 times fatigue stages. CONCLUSION: Straumann (ITI) devices differed minimally from target torque values at all stages. MTLDs with Spring-style were significantly more accurate than Friction-style device in achieving their target torque values at baseline and 500 times fatigue.