Dental injury offenses and compensation imposed by Spanish courts, before and during Covid-19. A cross-sectional study.

Injuries to the dentofacial region caused by third parties can affect physiological, sensory and esthetic functions with legal repercussions. The personal and social circumstances generated by Covid-19 and the governmental measures taken to control it, have increased the risk factors for violence and with it, the resulting injury rate. The aim of the present investigation was to compare the amount of civil liability for dental injury crimes agreed by Spanish courts, in certain Autonomous Communities, before and during the pandemic situation caused by Covid-19. For this purpose, a analytic cross-sectional study was carried out by analyzing sentences from the database of the Judicial Documentation Center. A comparison of means (one-way ANOVA) was used on the amount of compensation between the different years, and between the Autonomous Communities of Madrid, Catalonia Cataluña, Andalusia, the Canary Islands and the Valencian Community. It was observed that the year 2020 stood out for the increase in the number of cases of dental injury offenses. For its part, the Autonomous Community of Andalusia showed the highest amount of compensation during the pandemic, although the highest number of cases corresponded to the Community of Madrid. The statistical analysis yielded a probability of more than 0.05, which eliminated the possibility of significant differences in each of the comparisons.

Effect on osseointegration of dental implants treated with carboxyethylphosphonic acid and functionalized with BMP-2: preliminary study on a minipig model.

Introduction: Rough titanium surfaces biofunctionalised by osteogenic proteins, such as BMP-2, have been shown to accelerate the osseointegration process and reduce waiting times for prosthetic loading. The preclinical study presented here compared the bone in contact with the implant and bone neoformation and density between titanium (Ti) implants with a conventional etched surface (SLA type) and others treated with carboxyethylphosphonic acid (CEPA) and bone morphogenetic protein 2 (BMP-2), after 4 weeks of implantation in the tibia of a minipig model. Methods: Sixteen implants (eight experimental and eight control) of Ti-Al16-V4 with a tapered screw design and internal hexagonal connection were randomly inserted into the tibiae of four minipigs, four in each tibia. The experimental implants were treated with CEPA and BMP-2 and sterilised with gamma radiation (25 KG). The insertion torque was 40 N and primary stability was measured with the Osstell® device (ISQ 64 ± 2.6). Five bone parameters were evaluated: bone in contact with the implant (BIC), bone in contact with the corrected implant (BICc), new bone formation (BV/TV), bone density between threads (BAI/TA) and peri-implant bone density (BAP/TA). A histomorphometric study was performed and the samples were digitised with Adobe Photoshop Cs6. Statistical analysis of the variables was performed using SAS 9.4. Results: After a period of 4 weeks, no significant clinical signs were observed and all implants were integrated. Light microscopy of the experimental group revealed an ICB with no signs of fiber tissue, but with areas of ectopic new bone in the medullary space. Statistical analysis showed significant results for BIC and BICc (p = 0.0001 and p = 0.001, respectively). No statistical signification was found for the other parameters evaluated. Conclusion: Despite the limitations of this study, our results demonstrated that dental implant surfaces treated with CEPA and BMP-2 improve their biological response to osseointegration.

Antioxidant, anti-inflammatory and antimicrobial activity of natural products in periodontal disease: a comprehensive review.

Periodontal diseases (PD) are common chronic inflammatory oral pathologies that are strongly linked to others not found in the mouth cavity. The immune system mediates the host response, which includes the upregulation of proinflammatory cytokines, metalloproteinases, and reactive oxygen species (ROS); the latter may play an important role in the establishment and progression of inflammatory diseases, particularly periodontal disease, via the development of oxidative stress (OS). Natural antioxidants have powerful anti-inflammatory properties, and some can reduce serum levels of key PD indicators such tumor necrosis factor (TNF) and interleukin IL-1. This review compiles, through a thorough literature analysis, the antioxidant, anti-inflammatory, and antibacterial effects of a variety of natural products, as well as their therapeutic potential in the treatment of PD.

Role of BMP-7 on biological parameters osseointegration of dental implants: Preliminary results of a preclinical study.

The aim of this work was to analyze and compare the effect of bone morphogenetic protein-7 on biological parameters related to implant osseointegration in an experimental animal model. Sixteen dental implants were placed in the tibias of four randomly selected minipigs for the following dental implant surface treatments: Group A: conventional treatment of the dental implant surface by SLA (n = 8) and Group B: treatment of the dental implant surface with carboxyethylphosphonic acid and bone morphogenetic protein-7 (n = 8). The animals were sacrificed one month after dental implants placement and a histomorphometric study was performed for the evaluation of bone-to-implant contact, corrected bone-to-implant contact, new bone formation, interthread bone density and peri-implant density using Student's t-test and the non-parametric Mann-Whitney test. The histomorphometric parameters bone-to-implant contact and corrected bone-to-implant contact showed statistically significant differences between the study groups; 34.00% ± 9.92% and 50.02% ± 10.94%, respectively (p = 0.004) for SLA and 43.08% ± 10.76% and 63.30% ± 11.30%, respectively (p = 0.003) for BMP-7. The parameters new bone formation, interthread bone density and peri-implant density did not show statistically significant differences between the study groups (p = 0.951, p = 0.967 and p = 0.894, respectively). Dental implant surfaces treated with carboxyethylphosphonic acid and BMP-7 improve the biological response of dental implants to osseointegration.

Cadaveric Identification through Macroscopic Analysis of Dental Implants Subjected to High Temperatures-An Experimental Model.

The aim of this study was to determine the possibility of identifying a dental implant through the measurement of the apical width and the interspiral distance in a periapical radiograph after being subjected to high temperatures for certain lengths of time. In total, 11 fresh human anatomical models were selected, in which 137 implants were placed. Previous periapical radiographs were performed using parallelizers in each implant. Subsequently, the anatomical models were introduced into a crematory oven at different temperatures and for various durations: 500 °C/15 min, 500 °C/30 min, 700 °C/15 min, 800 °C/15 min, 800 °C/45 min, 500 °C/15 min, 700 °C/15 min, and finally, 1000 °C/120 min. After this, X-rays were taken via a parallel technique, and the apical width and interspiral distance were measured. The implants were disinserted, and the coronal width was used to calculate magnification or possible distortion. All data were analyzed by the Mann-Whitney U test. There were no statistically significant differences for the apical width parameter, except when the temperature was raised to 700 °C/15 min and to 800 °C/45 min. For the interspiral distance parameter, there were no statistically significant differences, except when the implants were subjected to 800 °C/15 min and 1000 °C/120 min. It was determined that there were changes in some groups based on the increase in temperature and exposure time. Neither of the two parameters were completely useful for the identification because some of the groups studied in both variables presented differences, which makes them difficult to identify correctly.

Effectiveness of biomolecule-based bioactive surfaces, on os-seointegration of titanium dental implants: A systematic review and meta-analysis of in vivo studies.

Titanium and alloy osseointegrated implants are used to replace missing teeth; however, some fail and are removed. Modifications of the implant surface with biologically active substances have been proposed. MEDLINE [via Pubmed], Embase and Web of Science were searched with the terms "titanium dental implants", "surface properties", "bioactive surface modifications", "biomolecules", "BMP", "antibacterial agent", "peptide", "collagen", "grown factor", "osseointegration", "bone apposition", "osteogenic", "osteogenesis", "new bone formation", "bone to implant contact", "bone regeneration" and "in vivo studies", until May 2022. A total of 10,697 references were iden-tified and 26 were included to analyze 1,109 implants, with follow-ups from 2 to 84 weeks. The ARRIVE guidelines and the SYRCLE tool were used to evaluate the methodology and scientific evidence. A meta-analysis was performed (RevMan 2020 software, Cochane Collaboration) with random effects that evaluated BIC at 4 weeks, with subgroups for the different coatings. The heterogeneity of the pooled studies was very high (95% CI, I2 = 99%). The subgroup of BMPs was the most favorable to coating. Surface modification of Ti implants by organic bioactive molecules seems to favor osseointegration in the early stages of healing, but long-term studies are necessary to corroborate the results of the experimental studies.

Role of chitosan in titanium coatings. trends and new generations of coatings.

Survival studies of dental implants currently reach high figures. However, considering that the recipients are middle-aged individuals with associated pathologies, research is focused on achieving bioactive surfaces that ensure osseointegration. Chitosan is a biocompatible, degradable polysaccharide with antimicrobial and anti-inflammatory properties, capable of inducing increased growth and fixation of osteoblasts around chitosan-coated titanium. Certain chemical modifications to its structure have been shown to enhance its antibacterial activity and osteoinductive properties and it is generally believed that chitosan-coated dental implants may have enhanced osseointegration capabilities and are likely to become a commercial option in the future. Our review provided an overview of the current concepts and theories of osseointegration and current titanium dental implant surfaces and coatings, with a special focus on the in vivo investigation of chitosan-coated implants and a current perspective on the future of titanium dental implant coatings.

Relevant Aspects of Titanium and Zirconia Dental Implants for Their Fatigue and Osseointegration Behaviors.

Osseointegration capacity and good mechanical behavior are key to the success of the dental implant. In many investigations, comparisons of properties are made using different dental implant designs and therefore the results can be influenced by the macrodesign of the dental implant. In this work, studies were carried out with the same dental implant model using different roughness and different materials-commercially pure titanium (grade 4) and zirconia. For this purpose, 80 smooth passivated titanium (Ti), 80 smooth zirconia (ZrO2), and 80 rough passivated titanium (Ti-R) dental implants were used. The samples were characterized by their roughness, wettability, surface energy, residual stresses, and fatigue behavior. The implants were implanted in minipigs for 4 and 12 weeks. The animals were sacrificed, and histological studies were carried out to determine the osseointegration parameters for each of the implantation times. Ti and ZrO2 dental implants have very similar wettability and surface energy properties. However, the roughness causes a decrease in the hydrophilic character and a decrease of the total surface energy and especially the dispersive component, while the polar component is higher. Due to the compressive residual stresses of alumina sandblasting, the rough dental implant has the best fatigue behavior, followed by Ti and due to the lack of toughness and rapid crack propagation the ZrO2 implants have the worst fatigue behavior. The bone index contact (BIC) values for 4 weeks were around 25% for Ti, 32% for ZrO2, and 45% for Ti-R. After 12 weeks the Ti dental implants increased to 42%, for Ti, 43% for ZrO2, and an important increase to 76% was observed for Ti-R implants. In vivo results showed that the key factor that improves osseointegration is roughness. There was no significant difference between ZrO2 and Ti implants without sandblasting.

Possible Association of Periodontal Diseases With Helicobacter pylori Gastric Infection: A Systematic Review and Meta-Analysis.

Some research has suggested that dental plaque and saliva could be reservoirs of Helicobacter pylori (H. pylori) and be capable of infecting or re-infecting the gastric mucosa after eradication, with certain studies showing a significant association between PD and gastric infection by this bacterium. An electronic search was performed in PubMed, EMBASE, and Web of Science databases with the terms "Helicobacter pylori AND periodontal diseases"; "Helicobacter pylori AND gingivitis"; "Helicobacter pylori AND chronic periodontitis"; "Helicobacter pylori AND periodontitis"; "Helicobacter pylori AND dental plaque", to identify articles up to September 2021. The Newcastle-Ottawa scale was used to assess study quality. A meta-analysis was performed using RevMan 2020 (Cochane Collaboration) software. A total of 1,315 studies were identified and 12 were included, analyzing 226,086 patients with mean age between 10.5 and 63.4 years. The prevalence of H. pylori in the oral cavity ranged from 5.4 to 83.3%. A random-effects model was used to analyze the presence of H. pylori and subgroups were made according to the method of evaluation (PCR or RUT). Statistical significance was found in the overall analysis (p = 0.01). There is no clear evidence that H. pylori present in oral bacterial plaque causes gastric infection and vice versa. Systematic Review Registration: www.INPLASY.COM, identifier: INPLASY2021100097.

Bone Quantification Around Chitosan-Coated Titanium Dental Implants: A Preliminary Study by Micro-CT Analysis in Jaw of a Canine Model.

Surface treatments of Ti in the dental implant industry are performed with the aim of in-creasing its bioactivity and osseointegration capacity. Chitosan (Cht) is a polysaccharide that has been proposed as a promising biomaterial in tissue engineering and bone regeneration, due to its ability to stimulate the recruitment and adhesion of osteogenic progenitor cells. The aim of our preliminary study was to evaluate, by micro-computed tomography (micro-CT), the osseointegration and bone formation around Cht-coated implants and to compare them with conventional surface-etched implants (SLA type). Four im-plants (8.5 mm length × 3.5 mm Ø) per hemiarch, were inserted into the jaws of five dogs, divided into two groups: chitosan-coated implant group (ChtG) and control group (CG). Twelve weeks after surgery, euthanasia was performed, and sectioned bone blocks were obtained and scanned by micro-CT and two bone parameters were measured: bone in contact with the implant surface (BCIS) and peri-implant bone area (PIBA). For BCIS and PIBA statistically significant values were obtained for the ChtG group with respect to CG (p = 0.005; p = 0.014 and p < 0.001 and p = 0.002, respectively). The results, despite the limitations, demonstrated the usefulness of chitosan coatings. However, studies with larger sample sizes and adequate experimental models would be necessary to confirm the results.

Oral Manifestations of COVID-19: Updated Systematic Review With Meta-Analysis.

There is increasing evidence for oral lesions and manifestations of COVID-19. The aim of this meta-analysis was to investigate the types of oral manifestations of COVID-19 and their prevalence. PubMed/Medline, Scopus, Web of Science, and Google Scholar databases were used to search for publications on oral manifestations in patients with PCR-confirmed COVID-19. A total of 310 records were selected, and 74 were included. Oral lesions in COVID-19 were classified according to their etiologies, including iatrogenic lesions caused by intubation and opportunistic infections. Of the included studies, 35 reported oral lesions probably caused by severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2) infection. Meta-analysis of prevalence data on oral manifestations and aphthous lesions indicated high heterogeneity, while meta-analysis of xerostomia prevalence data revealed a pooled prevalence, with considerable heterogeneity. In conclusion, the meta-analysis yielded high heterogeneity between studies: oral lesions yielded a prevalence of 0.33 (95% CI 0.11-0.60), xerostomia lesions a prevalence of 0.44 (95% CI 0.36-0.52) and aphthous lesions 0.10 (95% CI 0.01-0.24). In addition, a gap in the evidence regarding the prevalence of oral lesions in COVID-19 was identified and the need for further observational studies focusing on this issue and on the causal relationships between oral lesions and COVID-19 was highlighted.

Trends in Antibiotic Self-Medication for Dental Pathologies among Patients in the Dominican Republic: A Cross-Sectional Study.

The World Health Organisation has warned of the increase in antibiotic resistance, estimating that by 2050 it could become the leading cause of death worldwide. Several studies and literature reviews show a correlation between antibiotic use and bacterial resistance, with unnecessary broad-spectrum antibiotics, such as amoxicillin/clavulanic acid and azithromycin, being one of the main causative factors. An interview-based survey of 2160 participants was conducted to assess the prevalence in the practice of self-medication with antibiotics among dental patients in the Dominican Republic. A series of open-ended questions regarding self-medication and class of antibiotics were put to the patients. Over a third of the study population (39.7%) admitted to the practice of antibiotic self-medication. Most of the respondents (58.4%) who indulged in self-medication were females, and it was prevalent in the older adults between 32-42 years old (36%). There was a negative correlation between age and self-medication practice (p < 0.001) observed with point biserial correlation test. Binary logistic regression analysis found an odds ratio of 0.97 (p < 0.001). The most consumed antibiotics were amoxicillin/clavulanic acid (52%), amoxicillin (31.1%), and azithromycin (10.1%). It is imperative to educate patients about the harmful effects of self-medication and to stress the need for governments to implement stricter laws on non-prescription drug availability.

Knowledge, Attitudes, and Practices among Dental Practitioners Regarding Antibiotic Prescriptions for Pregnant and Breastfeeding Women in the Dominican Republic.

In this study, we aimed to explore the trends among dentists in the Dominican Republic of providing antibiotic prescriptions to pregnant/breastfeeding dental patients. A survey was conducted among 98 dentists, using a self-administered questionnaire, about their knowledge and attitudes regarding antibiotic usage in pregnant/lactating women and the translation of these into practice. The majority of the survey population were female dentists (63.3%) aged 45-54 years. A chi-square test showed statistically significant differences in the knowledge sources between older and younger dentists, with a minority having chosen scientific literature as a source (p-value of 0.04). There were statistically significant associations between gender and certain attitudes and practice-based questions, with p-values of 0.04 and 0.01, respectively. The Spearman's correlation test showed a statistically significant correlation between knowledge and attitude (p-value 0.001), whereas no correlation was found with practice (p-value 0.23). A multiple response analysis showed that the majority of the respondents chose the second and third trimester for antibiotic prescriptions for acute conditions such as cellulitis, periodontal abscess, and pericoronitis. Most dentists had sufficient knowledge about antibiotic usage in pregnant/lactating women, but it did not translate into practice, and a certain proportion of the participants followed incongruent drug prescription. These findings can be used to focus on judicious antibiotic usage by dentists in the Dominican Republic.

Histomorphometric Comparison between Two Types of Acellular Dermal Matrix Grafts: A Mini Pig Animal Model Study.

Acellular dermal matrix grafts (ADMG) have been used as soft tissue graft substitutes for autografts in periodontal plastic surgical procedures. They have benefits like avoiding a second surgical site and patient morbidity that have been associated with autografts, but there is limited evidence available on their tissue response and wound healing process. This histomorphometric animal model study was carried out in mini pigs and it aimed to compare the two types of ADMG materials of porcine derivative with a control group through observation of parameters like epithelial and Keratinized layer thickness, angiogenesis, cellularity, matrix resorption, and inflammatory infiltrate. The surgical technique involved punctures on the edentulous areas stripping the epithelial tissue and exposing the underlying connective tissue, placement of the ADMGs in the appropriate control and test sites. Following this, gingival biopsies were procured at three different time intervals of 15, 45, and 90 days. There were significant differences in epithelial and Keratinized layer thickness among the three groups. This study concluded that there was no clear consensus on which graft material was superior but it gave an insight into the tissue response and wound healing process associated with the graft materials.

Clinical and Histological Differences between Guided Tissue Regeneration with Acellular Dermal Matrix of Porcine Origin and Autologous Connective Tissue: An Animal Study.

This research aims to evaluate the clinical and histological parametric differences concerning keratinized tissue that result from two regeneration techniques, the subepithelial autologous connective tissue graft (ACTG) and the acellular dermal matrix (MD) of porcine origin, performed on surgical beds on edentulous spaces in an animal model. The parameters of the MD and ACTG groups were compared with samples of the control group (CG) after 15, 45, and 90 days. Nine female white pigs (Sus scrofa domestica) were used, and each animal provided 20 study areas (12 MD and 8 ACTG). At 15 days, the keratin layer thickness in the MD group was greater than those of the ACTG (25.27 vs. 19.95 µm) and the CG (21.2 µm). After 45 days, the MD and ACTG thickness values decreased but were higher than the CG. At 90 days, MD (19.46 µm) obtained a value close to that of CG, and the ACTG decreased to CG (15.53 µm, p < 0.001). The use of an MD may be a viable alternative to the ACTG because of its ability to provide increased keratinized tissue in comparison to the ACTG.

Role of Probiotics in Halitosis of Oral Origin: A Systematic Review and Meta-Analysis of Randomized Clinical Studies.

Halitosis or oral malodor is a condition caused by the putrefaction of sulfur-containing amino acids. It affects 30-50% of the population and causes social rejection, reducing quality of life, and self-esteem. Probiotics, especially Lactobacillus species, have been proposed for the treatment of genuine halitosis, due to their ability to reduce bacterial colonization. Our objective was to evaluate their use for the treatment of oral halitosis. Applying the PRISMA statement guidelines, we searched PubMed, EMBASE, and Web of Science databases for scientific articles from the last 15 years, up to July 2021. The keywords used were "Probiotics"; "Halitosis"; "Mouth diseases"; "Oral health"; "Humans"; "Randomized Clinical Trials" according to the question, "Are probiotics effective for the reduction or elimination of oral halitosis?" Fourteen studies were identified, although only four met the inclusion criteria. We evaluated 283 participants treated with two different probiotics, with a follow-up of at least 2 weeks. Risk of bias was assessed using the Cochrane Collaboration tool. A fixed-effects meta-analysis was performed. No statistical significance was found (p = 0.53). Despite the limitations of this meta-analysis, we believe that some probiotics have a beneficial effect on halitosis, although more clinical trials are needed to establish real evidence on this aspect. Systematic Review Registration: https://doi.org/10.37766/inplasy2021.9.0009, identifier: INPLASY20211900.

Conformación de conductos de doble curvatura con sistemas rotatorios de lima única / S-shape root canal shaping with one-file rotary systems

Objetivo. Comparar la modificación de conductos simulados con doble curvatura después de su preparación con 4 sistemas de lima única. Material y métodos. Se usaron 40 bloques de resina con conductos simulados de doble curvatura y divididos en 4 grupos (ni=10). Los bloques fueron preparados hasta una lima 25 usando los sistemas Reciproc (R25), Wave One Gold (Primary), One Shape y F360 (25). Se obtuvieron imágenes pre- y post-instrumentación y se superpusieron para su análisis. Se dividió la doble curvatura en 11 niveles. Se calculó la distancia desde la pared no instrumentada hasta la instrumentada. Para comparar el ensanchamiento del conducto en cada nivel se utilizó el test ANOVA, las comparaciones dos a dos se hicieron mediante el test de Tukey. El nivel de significación se estableció en p<0,05. Resultados. Todos los sistemas de lima única estudiados modifican de manera importante la curvatura apical. Wave One Gold ensanchó más en la pared interna de la curvatura apical, manteniendo un ensanchamiento más proporcional en la curvatura coronal; mientras que F360 removió más material desviando el conducto hacia la parte interna en ambas curvaturas, siendo estas diferencias estadísticamente significativas. Conclusiones. La morfología del conducto, tras instrumentación, se mantiene más fiel a la forma inicial en los sistemas Wave One Gold y One Shape

Objective. To compare the modification of simulated double curvature root canals after preparation with four single file systems. Material and methods. Forty resin blocks with simulated double curvature canals were divided into four groups (n=10), respectively instrumented to file size 25 using the Reciproc (R25), Wave One Gold (Primary), One Shape and F360 systems (25). Pre- and post-instrumentation images were obtained and overlapped for analysis. The double curvature was divided into 11 levels. The distance from the non-instrumented to the instrumented wall was calculated. Comparison of canal widening at each level was made using analysis of variance, with the Tukey test for two-by-two comparisons. Statistical significance was considered for p<0.05. Results. All the studied single file systems produced important modifications of the apical curvature. Wave One Gold resulted in greater internal wall widening in the apical curvature, with more proportional widening in the coronal curvature. In comparison, the F360 system removed more material, deviating the canal towards the internal portion in both curvatures - the differences being statistically significant. Conclusions. Canal morphology after instrumentation was seen to more closely reproduce the initial morphology when using the Wave One Gold and One Shape systems

[Factors associated with length of stay and the risk of readmission in an acute psychiatric inpatient facility: A retrospective study]. / Factores asociados con la duración de estadía y riesgo de re-internación en un hospital psiquiátrico monovalente de agudos: estudio de cohortes.

OBJECTIVE: to investigate factors in?uencing length of stay and predictors for the risk of readmission at an acute psychiatric inpatient unit. METHOD: retrospective cross-sectional clinical fle audit ranging four years back, a random selection of 378 patients was reviewed, including 178 cases and 200 controls. A case control study was employed in the study of length of stay, and for predictors of risk of readmission a retrospective cohort study was used. RESULTS: the 7 variables that were associated with length of stay were: 1- instruction level, 2- place of origin, 3- use of restraints, 4- gender, 5- marital status, 6- drug class, and 7- number of visits. The 9 variables associated with risk of readmission were: 1- history of previous admission, 2- cognitive status, 3- use of seclusion, 4- diagnostic category (personality cluster, bipolar disorder, substance use disorder, adaptive disorder, situational crisis, acute alcoholic intoxication), 5- risk to others at the time of index admission, 6- instruction level, 7- age at frst admission. Proactive and assertive treatment after discharge decreased the risk of readmission. CONCLUSIONS: Length of stay has predictable multifactorial determinants which are diffcult to modify clinically, as inpatient quality of care was not associated with it. Good community network assisting practices appeared to be more likely to reduce risk of readmission.