Effects of respiratory exercises in sleep bruxism and associated obstructive sleep apnea: a double-blind, placebo-controlled randomized clinical trial.

PURPOSE: The aim of this study is to assess the effects of respiratory exercises (inspiratory and expiratory) in individuals with sleep bruxism (SB) and associated obstructive sleep apnea (OSA). METHODS: This is a double-blind, placebo-controlled randomized clinical trial including individuals with SB and associated respiratory events in OSA. Respiratory physical therapy was performed using inspiratory (Threshold® IMT), expiratory (Threshold® PEP) muscle training, and compared with a placebo group. A total of 30 daily respiratory cycles (inspiration and expiration) were performed five times a week for 12 weeks. Individuals were reassessed at two times, at baseline (T1) and after 12 weeks of training (T2) by means of the Pittsburgh Sleep Quality Index and Polysomnography. RESULTS: Awakening was significantly different (p ≤ 0.05) between the inspiratory group and placebo 12 weeks after respiratory physical therapy. The number of contractions of the masseter muscle differed between the inspiratory, expiratory, and placebo groups (p ≤ 0.05). CONCLUSION: Respiratory physical therapy for OSA improved awaking levels in 80 and 67% of the number of masseter muscle contractions, when compared to placebo. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (No. RBR-9F6JKM).

Relationship Between Chloroquine or Hydroxychloroquine Use and Hearing Disorders: A Systematic Review and Meta-Analysis.

Background and Objectives: Chloroquine and its analog hydroxychloroquine are derivatives of 4-aminoquinoline and are regularly used in the treatment of malaria and autoimmune diseases. Among the side effects of these drugs, alterations associated with the auditory system are frequently mentioned. Thus, the aim of this systematic review is to systematically review publications on hearing disorders and chloroquine or hydroxychloroquine use. Materials and Methods: Inclusion criteria were observational or interventional studies on audiological assessment in participants who were using chloroquine or hydroxychloroquine. The methodological quality was independently assessed by two reviewers using the Meta-Analysis of Statistics: assessment and review Instrument. The certainty of the evidence was assessed using the GRADE tool. Results: A total of 1,372 non-duplicate papers were screened, out of which 17 were included in the final qualitative synthesis, and 5 studies in the meta-analysis. The odds ratio for the two subgroups evaluated did not show significance with no heterogeneity between the effects observed between the different diseases (I2=0%) and obtaining the global estimate of 0.76 (95% confidence interval [CI]=0.41-1.39; p>0.05). Despite the inclusion of papers with different disease samples, the heterogeneity observed in the analysis was low (I2= 0%) and prediction interval (95% PI=0.32-1.80; p>0.05) remained close to that estimated by the CI (95% CI=0.41-1.39; p>0.05). The certainty of the evidence assessed by the GRADE tool was considered very low due to the risk of bias, indirect evidence, and imprecision. Conclusions: The findings of this study suggest that the use of chloroquine/hydroxychloroquine is not associated with hearing disorders.

Prevalence of orofacial injuries resulting from trauma in individuals with cerebral palsy: A systematic review and meta-analysis.

Individuals with cerebral palsy (CP) may have cognitive, sensitive, behavioral, communicative, and convulsive disorders. Because defensive reflexes are reduced by CP, the risk of orofacial trauma is greater in these individuals. This study aimed to evaluate the prevalence of orofacial injuries resulting from trauma in patients with CP. This review was reported according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) and registered in the International Prospective Register of Systematic Reviews (PROSPERO-CRD42022293570). The search was performed for articles published until January 2023 in Embase, Latin American and Caribbean Literature on Health Sciences (LILACS), PubMed/Medline, Scopus, and Web of Science databases. Gray literature was also consulted through Google Scholar, OpenGrey, ProQuest Dissertations, and Theses. Studies in which orofacial injuries due to trauma were prevalent in individuals with CP were included. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tool. Additionally, a random-effects meta-analysis was conducted. Twelve studies were included in the synthesis, of which nine presented a low risk of bias and three presented a moderate risk. When considering the general prevalence of orofacial injuries in patients with CP, a prevalence of 34% [95% CI = 18%-52%; I2 = 98%] was observed, with enamel and dentin fractures being the most common orofacial injuries. Approximately one in three patients with CP showed at least one type of orofacial injury involving dental trauma. There is a lack of literature assessing the prevalence of these traumas in soft tissues and the evidence for this outcome remains uncertain.

Impact of dentofacial deformity on the chance of being hired for a job.

Objective: This study aimed to determine the impact of dentofacial deformity on an individual's chances of being hired for a hypothetical job involving customer service. Materials and methods: Face photographs (frontal and lateral) of 15 patients with moderate to severe dentofacial deformity, taken before and after orthodontic-surgical correction, were selected and randomized between two different questionnaires. In addition, five patients without dentofacial deformity were used as controls in both questionnaires. These questionnaires were taken by adults responsible for hiring personnel to work in commerce and business activities, graduates or postgraduates in business administration, with experience in recruiting and hiring personnel. The evaluation took place using a Likert scale with values ranging from 0 to 10 (in which 0 corresponded to complete disagreement and 10 to complete agreement), considering the following variables in a first impression judgment: honesty, intelligence, productivity at work, and hiring chance. Data were tabulated and statistical analysis was performed using a linear regression model for the explanatory variables that showed statistical significance in the analysis of variance (ANOVA). Effect size through Cohen's d has been corrected for all comparisons performed. Results: All re-examined domains demonstrated statistical differences even when included in a multivariate model (p < 0.05), with lower mean values for those requiring pre-treatment (presenting deformity), although the effect size was small for all comparisons. Conclusion: Dentofacial deformity influenced the hiring chance, although not appearing to be a preponderant factor for hiring, acting as a tiebreaker among the candidates adopted.

Diagnosis of TMJ degenerative diseases by panoramic radiography: is it possible? A systematic review and meta-analysis.

OBJECTIVE: The objective of this work was to determine the diagnostic accuracy of panoramic radiography in detecting degenerative diseases of the temporomandibular joint. METHOD: The protocol was registered at the PROSPERO website. To consider the eligibility of studies to be included/excluded from this review, the acronym "PIRDS" was used and appropriate word combinations and truncations were adapted in the following electronic databases: PubMed/Medline, EMBASE, Latin American and Caribbean Literature on Health Sciences, Web of Science, Scopus, and Cochrane Library. RESULTS: A total of 2572 references, after the removal of duplicates, were retrieved from the eight electronic databases. After reading the titles and abstracts, a total of 26 articles were selected for full reading, of which ten were excluded, resulting in 16 articles included for qualitative synthesis. All in vivo studies were classified as having a low risk of bias. Regarding in vitro studies none of the included studies scored below 80% in the overall evaluation. CONCLUSIONS: Both in vitro and in vivo studies consistently report a low accuracy in detecting degenerative diseases of the temporomandibular joint using panoramic radiography. CLINICAL RELEVANCE: Cone-beam computed tomography offers a superior image quality without overlapping structures and a higher accuracy compared to panoramic radiography. However, panoramic radiography can still serve as an initial examination when combined with a clinical assessment. CBCT should be reserved for cases where there are evident clinical and/or radiographic alterations that recommend its use. This approach ensures a judicious and cost-effective use of CBCT resources.

Auditory and Vestibular Findings in Brazilian Adults Affected by COVID-19: An Exploratory Study.

INTRODUCTION: The aim of the study was to describe auditory and vestibular findings in Brazilian adults after COVID-19 in a municipality from the outskirts of the São Paulo state. METHODS: This was a transversal and exploratory study comprising sixteen participants infected by the SARS-CoV-2 virus, confirmed through RT-PCR detection, aged 20 to 55 years. Subjects underwent anamnesis, vestibular and auditory testing. Fisher's exact test was used to evaluate medication use, chemical and physical exposure, and occupational risk and McNemar test was used to compare auditory and vestibular symptoms pre- and post-COVID-19. RESULTS: Most patients were women (75%) and had been exposed to the virus over 90 days before testing (50%). 18.8% used hydroxychloroquine, 68.8% used ivermectin, and 87.5% used azithromycin to treat COVID-19. Auditory complaints were reported by 31.2% and vestibular by 18.7%. There was no statistical difference before and after the disease. Other reported symptomatology was hair loss, pain, fatigue, memory loss, difficulty to concentrate, and headache. Auditory findings were relevant in contralateral acoustic reflex, in the distortion-product otoacoustic emissions, and in the brainstem auditory evoked potential, characterizing a neurosensorial compromise. 43.74% of patients had altered vectonystagmography. When comparing both ears, no statistical relevance was found; however, when results were crossed with medication use and exposures, there was statistical relevance in the amplitude of the V wave for medications and absolute latency of the V wave to exposure to physical agents. DISCUSSION/CONCLUSION: This study demonstrated auditory and vestibular findings of neurosensorial nature, considering hearing and of a peripheral vestibulopathy. As it is a study of transversal nature, it is not possible to extend results to general population; yet it may be a finding to future studies.

Impact of orthognathic surgery on voice and speech: a systematic review and meta-analysis.

BACKGROUND: Orthognathic surgical procedures, whether in one or both jaws, can affect structures regarding the articulation and resonance of voice and speech. OBJECTIVE: Evaluating the impact of orthognathic surgery on voice and speech performance in individuals with skeletal dentofacial disharmony. SEARCH METHODS: Word combinations and truncations were adapted for the following electronic databases: EMBASE, PubMed/Medline, Scopus, Web of Science, Cochrane Library, and Latin American and Caribbean Literature in Health Sciences (LILACS), and grey literature. SELECTION CRITERIA: The research included studies on nonsyndromic adults with skeletal dentofacial disharmony undergoing orthognathic surgery. These studies assessed patients before and after surgery or compared them with individuals with good facial harmony using voice and speech parameters through validated protocols. DATA COLLECTION AND ANALYSIS: Two independent reviewers performed all stages of the review. The Joanna Briggs Institute tool was used to assess risk of bias in the cohort studies, and ROBINS-I was used for nonrandomized clinical trials. The authors also performed a meta-analysis of random effects. RESULTS: A total of 1163 articles were retrieved after the last search, of which 23 were read in full. Of these, four were excluded, totalling 19 articles for quantitative synthesis. When comparing the pre- and postoperative periods, both for fundamental frequency, formants, and jitter and shimmer perturbation measures, orthognathic surgery did not affect vowel production. According to the articles, the main articulatory errors associated with skeletal dentofacial disharmonies prior to surgery were distortions of fricative sounds, mainly/s/ and/z/. CONCLUSIONS: Orthognathic surgery may have little or no impact on vocal characteristics during vowel production. However, due to the confounding factors involved, estimates are inconclusive. The most prevalent articulatory disorders in the preoperative period were distortion of the fricative phonemes/s/ and/z/. However, further studies must be carried out to ensure greater robustness to these findings. REGISTRATION: PROSPERO (CRD42022291113).

Prevalence of signs and symptoms related to temporomandibular disorders and orofacial pain in patients indicated for orthognathic surgery: a meta-analysis.

OBJECTIVE: To evaluate the prevalence of signs and symptoms related to temporomandibular disorders (TMD) and orofacial pain in patients with indication for orthognathic surgery. METHODS: The search was carried out in seven electronic databases and gray literature. Studies that evaluated the frequency of signs and symptoms related to TMD and orofacial pain were included. The risk of bias was assessed using the Joanna Briggs Critical Appraisal tool. A meta-analysis of proportions with a random effect model was performed and the GRADE tool judged the certainty of evidence. RESULTS: After searching the databases, 1859 references were retrieved, 18 of which were selected for synthesis. The prevalence of individuals with at least one TMD symptom was 51% [CI95% = 44-58%], and 44% of the subjects had temporomandibular joint click/crepitus [CI95% = 37-52%]. Additionally, 28% exhibited symptoms related to muscle disorders [CI95% = 22-35%], 34% had disc displacement with or without reduction [CI95% = 25-44%], and 24% had inflammatory joint disorders [CI95% = 13-36%]. The prevalence of headache was 26% [CI95% = 8-51%]. The certainty of evidence was considered very low. CONCLUSION: Approximately 1 in 2 patients with dentofacial deformity presents some sign and symptom related to TMD. Myofascial pain and headache may be present in approximately a quarter of patients with dentofacial deformity. CLINICAL RELEVANCE: A multidisciplinary treatment is necessary for these patients, involving a professional with expertise in the management of TMD.

Effect of Tinnitus on Sleep Quality and Insomnia

Abstract Introduction Tinnitus is a conscious perception of a sound resulting from abnormal activity within the nervous system. A relevant percentage of tinnitus patients report symptoms severe enough to significantly affect quality of life, including sleep disorders. Objectives To analyze the sleep quality, insomnia, daytime sleepiness, and risk of obstructive sleep apnea (OSA) in participants with tinnitus. Methods The sample comprised 18 adults and older adults aged between 18 and 85 years old (mean age = 58.7 ± 17.5 years old), females and males, with complaint of continuous tinnitus for > 1 month. The instruments used were the Tinnitus Handicap Inventory (THI) questionnaire, the Insomnia Severity Index, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, and the STOP-Bang questionnaire. Results By means of the THI questionnaire, the tinnitus severity degree reported by most participants was mild (27.8%) and moderate (27.8%), having a positive (r = 0.582) and significant (0.011) correlation to sleep quality, measured by means of the Pittsburgh questionnaire. There was a positive correlation between the Insomnia Severity Index and tinnitus handicap (r = 0.499; p = 0.035). A total of 72.2% of the participants self-assessed their sleep quality as poor, in addition to moderate insomnia (27.8%), although there is low risk of OSA (66.7%), without complaints of excessive daytime sleepiness (72.2%). Conclusion Subjects with tinnitus complaint self-rated their sleep quality as poor. Moreover, the higher the reported tinnitus handicap, the greater the symptoms of insomnia. There was no influence of tinnitus in relation to daytime sleepiness and no relationship between the severity of tinnitus and the risk of OSA.

Effect of Tinnitus on Sleep Quality and Insomnia.

Introduction Tinnitus is a conscious perception of a sound resulting from abnormal activity within the nervous system. A relevant percentage of tinnitus patients report symptoms severe enough to significantly affect quality of life, including sleep disorders. Objective To analyze the sleep quality, insomnia, daytime sleepiness, and risk of obstructive sleep apnea (OSA) in participants with tinnitus. Methods The sample comprised 18 adults and older adults aged between 18 and 85 years old (mean age = 58.7 ± 17.5 years old), females and males, with complaint of continuous tinnitus for > 1 month. The instruments used were the Tinnitus Handicap Inventory (THI) questionnaire, the Insomnia Severity Index, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, and the STOP-Bang questionnaire. Results By means of the THI questionnaire, the tinnitus severity degree reported by most participants was mild (27.8%) and moderate (27.8%), having a positive (r = 0.582) and significant (0.011) correlation to sleep quality, measured by means of the Pittsburgh questionnaire. There was a positive correlation between the Insomnia Severity Index and tinnitus handicap (r = 0.499; p = 0.035). A total of 72.2% of the participants self-assessed their sleep quality as poor, in addition to moderate insomnia (27.8%), although there is low risk of OSA (66.7%), without complaints of excessive daytime sleepiness (72.2%). Conclusion Subjects with tinnitus complaint self-rated their sleep quality as poor. Moreover, the higher the reported tinnitus handicap, the greater the symptoms of insomnia. There was no influence of tinnitus in relation to daytime sleepiness and no relationship between the severity of tinnitus and the risk of OSA.

Association between atypical swallowing and malocclusions: a systematic review.

OBJECTIVE: This systematic review aims to answer the following focus question: "Is there an association between atypical swallowing and malocclusions?". METHODS: Appropriate word combinations were chosen and tailored specifically for each of the following electronic databases: EMBASE, Latin American and Caribbean Literature in Health Sciences (LILACS), LIVIVO, PubMed/Medline, Scopus, Web of Science, and gray literature, without any restrictions, up to February 2021. According to the selection criteria, only cross-sectional studies were included. The following inclusion criteria were considered: a sample composed of children, adolescents, and adults; patients clinically diagnosed with atypical swallowing; patients with normal swallowing; and outcome of interest of atypical swallowing in patients with malocclusion. The data consisted of study characteristics, sample characteristics, results, and conclusion of each study. The risk of bias was assessed using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies, and the certainty of evidence was assessed using the GRADE tool. RESULTS: 4,750 articles were identified. After a two-step selection, four studies were included. A higher frequency of distal occlusion, extreme maxillary overhang, and open bite was related to swallowing disorders; most studies pointed to posterior crossbite as a malocclusion more associated with atypical swallowing. All studies had a moderate to high risk of bias, and the certainty of evidence was very low. CONCLUSION: The results indicate that atypical swallowing is associated with malocclusions and that posterior crossbite is the main malocclusion found, but only in the young population (3-11 years). REGISTRATION: PROSPERO (42020215203).

Impact of bariatric surgery on oral health: a systematic review and meta-analysis.

OBJECTIVE: To evaluate the impact of bariatric surgery (BS) on the oral health status of obese individuals. MATERIAL AND METHODS: The search was performed on the Cochrane Library, Embase, Latin American and Caribbean Literature on Health Sciences (LILACS), LIVIVO, PubMed/Medline, Scopus, and Web of Science databases. Grey literature was also consulted through Google Scholar, OpenGrey, ProQuest, and MedRxiv. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal tool. Pre- and post-surgical moments were compared through random effects meta-analysis. The GRADE (Grading of Recommendations, Assessment, Development and Evaluations) assessment tool was used to judge the certainty of evidence. RESULTS: After searching the databases, 908 references were retrieved, with 30 articles selected for synthesis. When comparing the pre- and postoperative moments, there was no difference in the index of decayed, missing, or filled teeth. Furthermore, salivary flow and probing depth presented a slight increase. Post-surgery patients showed an increase (%) in tooth wear at the dentin level [MD = -6.23; IC95% = -8.45--4.01; I2 = 0%]. CONCLUSION: Patients undergoing BS show no difference when considering the rate of caries or missing teeth and little to no effect was observed on salivary flow rates and periodontal probing depth. On the other hand, greater attention should be given to dentin wear in post-surgical patients of BS. CLINICAL RELEVANCE: Patients undergoing BS should receive careful monitoring regarding oral health by doctors, dentists, and the entire multidisciplinary team involved before and after the surgical procedure.

Evaluating the Quality of Rigid Optic Videolaryngoscopy Image Taken Through Dental Protection Cap and Its Feasibility as Additional Barrier Method Against COVID-19.

Videolaryngoscopy screening is essential to help assessing human larynx. The use of 70° optical fiber in association with image recording by analog or digital cameras is one of the methods adopted to perform this examination. Endoscopic exams can contaminate the equipment with several microorganisms. The pandemic caused by the new coronavirus reinforces the importance of developing efficient barrier methods to be adopted in videolaryngoscopy procedures. Although dental intraoral camera covers are a barrier method authorized by Brazilian health organs, it has not yet been used in videolaryngoscopy examinations. The aim of the current longitudinal, individualized, single-blind, prospective, self-controlled, and accurate study is to evaluate the quality of images generated through, and confidence level of, diagnosis based on videolaryngoscopy performed with intraoral dental camera equipped with disposable protection cap and connected to 70° rigid laryngoscope in vocally healthy individuals. Videolaryngoscopy examinations based on 70° rigid optics were performed in 13 euphonic and asymptomatic volunteers at an otorhinolaryngology specialist clinic; only 1 patient was excluded from the study. Images were taken with, and without, disposable intraoral dental camera protection cap; high-grade disinfection protocol was applied between examinations. Recorded videos were randomly distributed in a single-blind manner in order to be evaluated by four otorhinolaryngologists, who answered a questionnaire comprising three questions. Statistical analysis was used to compare groups - which were defined by the use, or not, of protection cap - based on Wilcoxon nonparametric test. Statistical significance was set at 5% with 95% confidence interval. There was no statistically significant difference in image quality between examinations performed with, and without, protection cap (P= 0.646) or in the diagnosis confidence level of examinations performed with, or without, the barrier method. The use of disposable protection cap on intraoral dental camera did not significantly change the quality of images taken through videolaryngoscopy performed with 70° rigid optics in vocally healthy patients.

Effects of COVID-19 on auditory and vestibular function in an adult patient: a longitudinal case study / Efeitos da COVID-19 na função auditiva e vestibular em paciente adulta: um estudo de caso longitudinal

ABSTRACT COVID-19 is a viral infection that mainly affects the lower respiratory tract and with the affinity of the Spike protein to the Angiotensin 2 converter enzyme, inducing a prothrombotic state which may lead to compromising of the cardiovascular, central nervous, auditory, and vestibular systems. Viral infections knowingly affect vestibular and auditory systems. This study aimed to present the auditory and vestibular findings of a woman without otoneurological complaints, before the infection with SARS-CoV-2. This is a longitudinal case report, presenting the evolution of the otoneurological clinical picture accompanied by the results of a battery of tests. The results evidenced a unilateral, permanent, cochlear sensorineural hearing loss through altered otoacoustic emissions albeit with normal tonal thresholds, accompanied by peripheral vestibular hypofunction which worsened with time, without any other factor that could justify these findings. This study shows the importance of the complete protocol of tests performed over time for a better understanding of long-time implications of the SARS-CoV-2 infection.

RESUMO A COVID-19 é uma infecção viral que afeta, principalmente, a via respiratória inferior e, com a afinidade da proteína Spike com a Enzima Conversora de Angiotensina 2, gerando estado protrombótico, pode haver comprometimento dos sistemas cardiovasculares, nervoso central e renal. As infecções virais são capazes, também, de causar alterações nos sistemas auditivo e vestibular. O presente estudo teve por finalidade apresentar os achados auditivos e vestibulares de uma mulher sem queixas otoneurológicas, previamente à infecção pela SARS-CoV-2. Trata-se de um relato de caso longitudinal, com apresentação da evolução do quadro clínico otoneurológico acompanhado de uma bateria de exames. Os resultados evidenciaram o aparecimento de uma perda auditiva neurossensorial unilateral prevista por emissões otoacústicas alteradas na presença limiares tonais normais. Com a sequência de exames, observou-se piora dos limiares auditivos e alteração da função vestibular, de maneira permanente, sem qualquer outro histórico que pudesse justificar a instalação do quadro. Em quadros infecciosos faz-se importante a longitudinalidade de avaliação com uso de protocolo completo de exames para melhor compreensão dos efeitos tardios.

Periodontal parameters in orthodontically tractioned teeth: A systematic review and meta-analysis.

Objective: This systematic review aimed to evaluate periodontal parameters in orthodontically tractioned teeth compared with the respective non-tractioned contralateral teeth. Methods: Search strategies were developed for six electronic databases and gray literature. Random-effects meta-analyses were performed for the outcomes of interest. Furthermore, the certainty of the evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) tool. Results: Overall, 2,082 articles were identified, of which 24 were selected for the qualitative synthesis. A significant difference was observed between the impacted and contralateral teeth (mean difference [MD] = 0.25; 95% confidence interval [CI] = 0.10-0.40; I2 = 0%) when the gingival index was evaluated. Additionally, impacted teeth showed a greater probing depth, with a significant mean difference between the groups (MD = 0.14; 95% CI = 0.07-0.20; I2 = 6%). Most studies had a low risk of bias; however, the certainty of the evidence was very low owing to the design of existing studies. Conclusions: The evidence in the literature indicated that tractioned teeth might show worsening of periodontal parameters related to the gingival index and probing depth; however, the evidence remains uncertain about this outcome. Furthermore, probing depth should be considered regarding its clinical significance because of the small effect size observed.

Comparison of orthodontic root resorption of root-filled and vital teeth: A meta-analysis.

BACKGROUND: In this systematic review, the authors aimed to answer the following question: Do vital teeth differ in the level of external root resorption induced by means of orthodontic treatment compared with root-filled teeth? TYPES OF STUDIES REVIEWED: The search strategy was performed in 6 electronic databases and in gray literature for articles published until July 29, 2021. Two reviewers independently assessed potentially eligible studies according to the following criteria: studies that evaluated patients undergoing fixed orthodontic therapy and compared the mean difference in millimeters of orthodontically induced external root resorption in endodontically treated teeth with the vital contralateral tooth. Only randomized, quasi-randomized, nonrandomized, cohort, case-control, or cross-sectional studies were considered eligible. There were no restrictions on language or publication time. Two reviewers also independently extracted data on the characteristics of the included studies, methods, and results, and performed risk-of-bias analysis using the Meta-Analysis of Statistics Assessment and Review instrument. Estimates of interest were calculated using random-effects meta-analyses. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool. RESULTS: Eleven studies were included in the quantitative synthesis. Endodontically treated teeth had a lower level of root resorption (mean difference, 0.45 mm; 95% CI, -0.69 to -0.21 mm). However, the level of certainty of the evidence was considered very low owing to confounding factors. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Endodontically treated teeth may have a lower level of orthodontically induced root resorption than vital teeth, but the evidence is still uncertain about this outcome. Furthermore, owing to the small effect size, this difference might not be clinically significant (up to 1 mm).

Front lines of the COVID-19 pandemic: what is the effectiveness of using personal protective equipment in health service environments?-a systematic review.

PURPOSE: This systematic review aimed to evaluate the effectiveness of the use of personal protective equipment (PPE) in closed environments, similar to waiting or exam rooms of healthcare facilities, in the face of exposure to a bioaerosol. METHODS: Combinations of words were selected for six electronic databases and for the gray literature. To consider the eligibility of the studies to be included/excluded, the acronym "PECOS" was used: humans and/or experimental models that simulate aerosol (Population); aerosol exposure and the use of masks/respirators (exposition/intervention); controlled or not controlled (comparison); effectiveness of PPE and the receiver exposure (outcomes); and randomized clinical studies or not, observational or laboratory simulation studies (Studies design). RESULTS: A total of 4820 references were retrieved by the search strategy. Thirty-five articles were selected for complete reading, of which 13 articles were included for qualitative synthesis. A surgical mask or N95 respirator reduced the risk of transmission, even over short distances. The use of masks, even those with less filtering power, when used by all individuals in the same environment is more effective in reducing risk than the use of respirators with high filtering power for only some of the individuals present. CONCLUSION: The use of mask in closed environments is effective in reducing the risk of transmission and contagion of a contaminated bioaerosol, with greater effectiveness when these devices are used by the source and receiver, regardless of the equipment's filtering power. (PROSPERO 2020 CRD 42020183759).

Risk factors associated with the stability of mini-implants and mini-plates: systematic review and meta-analysis.

OBJECTIVE: The objective of this systematic review is to assess the risk factors associated with the stability of mini-implants and mini-plates in patients undergoing orthodontic treatment using temporary anchorage devices. MATERIAL AND METHODS: Search strategies were developed for each electronic database (PubMed/Medline, LILACS, Scopus, Web of Science, Embase, and Cochrane Library) and gray literature (Google Scholar, Proquest, and Open Grey). The risk of bias was assessed using the Cochrane Collaboration tool for assessing the risk of bias and Meta-Analysis of Statistics Assessment and Review Instrument. The certainty of the evidence was assessed using the GRADE tool. Meta-analyses and meta-regressions of random effects were performed for the outcomes of interest. RESULTS: A total of 1517 articles were found, of which seven were selected for quantitative synthesis. When comparing the risk of failure between mini-implants and mini-plates, the risk values approached the threshold of statistical significance (p = 0.07) (RR = 1.83; 95% CI = 0.96-3.50; I2 = 69%), showing significance after sensitivity analysis (p < 0.05) and a greater risk for mini-implants. Mandible installation presented a higher risk of failure (RR = 1.85; 95% CI = 1.17-2.91). CONCLUSIONS: The evidence found indicates that failure in the stability is related to the type of device and that there is a greater risk by using isolated mini-implants, especially when positioned in the mandible. CLINICAL RELEVANCE: These findings help the orthodontist and/or the surgeon to stipulate risks, learn about the predictability of techniques, and communicate with the patient in an easier way.

Effects of respiratory training on obstructive sleep apnea: systematic review and meta-analysis.

PURPOSE: This systematic review sought to answer the following focused question: "What are the effects of respiratory training devices on obstructive sleep apnea (OSA) outcomes in adults?" METHODS : The acronym "PICOS" was used to determine eligibility criteria, which consists of (P population) = adults with mild to moderate OSA, (I intervention) = spirometry devices or breathing exercises, (C comparison) = compared to no breathing exercises in adults (> 18 years) with mild to moderate OSA, (O outcomes) = improved sleep quality (sleep quality indexes) and improved apnea-hypopnea indexes (AHI), (S study types) = randomized, pseudo-randomized, and non-randomized clinical trials. The search was performed in the following databases: PubMed/Medline, LILACS, Scopus, Web of Science, Scopus, and Cochrane Library, in addition to gray literature through Google Scholar, Proquest, and Open Grey. The risk of bias was assessed using the Cochrane Collaboration tool. The certainty of the evidence was assessed using the GRADE tool. Meta-analyses of random effects were performed for the outcomes of interest. RESULTS: A total of 1171 references were found. Applying the eligibility criteria, six studies were included in qualitative synthesis. Expiratory exercises showed a decrease in the apnea-hypopnea index (AHI) when compared to baseline (MD = - 8.4; 95% CI = - 12.4 to - 4.4; I2 = 19%). There was a decrease in values compared to baseline (MD = - 4.4; 95% CI = - 8.2 to - 0.6; I2 = 0%) for the Epworth Sleepiness Scale (ESS), when considering the inspiratory exercises. Both groups of breathing exercises showed a significant decrease in the mean index assessed by the Pittsburgh Sleep Quality Index (PSQI). CONCLUSION: Results of this meta-analysis suggests that breathing exercises lead to a measurable improvement in AHI for patients with mild to moderate OSA, as well as an improvement in sleep quality and daytime sleepiness. SYSTEMATIC REVIEW REGISTRATION: CRD42020148513 (PROSPERO).

Effect and longevity of botulinum toxin in the treatment of gummy smile: a meta-analysis and meta-regression.

OBJECTIVE: The aim of this systematic review is to synthesize the evidence on the effectiveness and longevity of the botulinum toxin in the treatment of individuals with excessive gingival exposure. METHODS: The search was adapted to six electronic databases and gray literature. The risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool for Non-Randomized and Randomized Studies of Interventions. Meta-analyses and meta-regression were performed using random effects models. RESULTS: A total of 5247 articles were collected during the final search in the database, resulting in 17 articles included. There was a mean decrease of 3.42 mm [95% CI = -4.50 to -2.34; I2 = 97%] in the level of gingival exposure 2 weeks after the application of botulinum toxin. The application time explained 29.58% of the observed variance (p < 0.001), with a tendency for the effect size to decrease from the second week of application onwards, with values returning close to baseline levels in 24 weeks. CONCLUSION: Botulinum toxin is an alternative technique considered effective for reducing gummy smile, especially for gummy smiles up to 4 mm, with a longevity of at least 12 weeks, returning close to initial values within 24 weeks after application. CLINICAL RELEVANCE: The knowledge about the longevity and effectiveness of botulinum toxin in the treatment of gummy smile allows for a more adequate clinical planning for these cases, as well as for clinical decisions, as for prognostic factors.