Efficacy of surgical methods for peri-implantitis: a systematic review and network meta-analysis.

BACKGROUND: Peri-implantitis is the most difficult biological complication associated with dental implants, often requiring surgical treatments in advanced stages. This study compares the effectiveness of different surgical methods for peri-implantitis. METHODS: Randomized controlled trials (RCTs) of different surgical treatments for peri-implantitis were extracted from EMBASE, Web of Science, Cochrane Library databases, and PubMed systematically. Pairwise comparisons and network meta-analyses (NMA) were conducted to analyze the effect of surgical treatments on probing depth (PD), radiographic bone fill (RBF), mucosal recession (MR), bleeding on probing (BOP), and clinical attachment level (CAL). In addition, risk of bias, quality of evidence, and statistical heterogeneity of the selected studies were evaluated. A total of 13 articles were included in this study, involving open flap debridement (OFD), resective therapy (RT), and augmentative therapy (AT) with and without adjunctive treatments (laser therapy, photodynamic therapy, local antibiotics, phosphoric acid, and ozone therapy). RESULTS: AT improved RBF and CAL more than OFD, but does not outperform OFD in reducing peri-implant soft-tissue inflammation. AT, OFD and RT did not significantly alter the levels of MR. Addition of ozone therapy improved the effect of AT, but addition of photodynamic therapy did not affect PD reduction and CAL gain significantly. Similarly, adjuvant treatment with phosphoric acid during RT did not significantly change the outcome of BOP. CONCLUSIONS: Within the limitation of this systematic review and NMA, AT was superior to OFD in improving peri-implantitis outcomes. While adjunct use of ozone therapy may further improve the efficacy of AT, the limited evidence supporting this combination therapy argues for cautionary interpretation of these results.

A Universal and Reversible Wet Adhesive via Straightforward Aqueous Self-Assembly of Polyethylenimine and Polyoxometalate.

The excellent adhesion of mussels under wet conditions has inspired the development of numerous catechol-based wet adhesives. Nevertheless, the performance of catechol-based wet adhesive suffers from the sensitivity toward temperature, pH, or oxidation stimuli. Therefore, it is of great significance to develop non-catechol-based wet adhesives to fully recapitulate nature's dynamic function. Herein, a novel type of non-catechol-based wet adhesive is reported, which is readily formed by self-assembly of commercially available branched polyethylenimine and phosphotungstic acid in aqueous solution through the combination of electrostatic interaction and hydrogen bonding. This wet adhesive shows reversible, tunable, and strong adhesion on diverse substrates and further exhibits high efficacy in promoting biological wound healing. During the healing of the wound, the as-prepared wet adhesive also possesses inherent antimicrobial properties, thus avoiding inflammations and infections due to microorganism accumulation.

Toward the Discovery and Development of PSMA Targeted Inhibitors for Nuclear Medicine Applications.

BACKGROUND: The rising incidence rate of prostate cancer (PCa) has promoted the development of new diagnostic and therapeutic radiopharmaceuticals during the last decades. Promising improvements have been achieved in clinical practice using prostate specific membrane antigen (PSMA) labeled agents, including specific antibodies and small molecular weight inhibitors. Focusing on molecular docking studies, this review aims to highlight the progress in the design of PSMA targeted agents for a potential use in nuclear medicine. RESULTS: Although the first development of radiopharmaceuticals able to specifically recognize PSMA was exclusively oriented to macromolecule protein structure such as radiolabeled monoclonal antibodies and derivatives, the isolation of the crystal structure of PSMA served as the trigger for the synthesis and the further evaluation of a variety of low molecular weight inhibitors. Among the nuclear imaging probes and radiotherapeutics that have been developed and tested till today, labeled Glutamate-ureido inhibitors are the most prevalent PSMA-targeting agents for nuclear medicine applications. CONCLUSION: PSMA represents for researchers the most attractive target for the detection and treatment of patients affected by PCa using nuclear medicine modalities. [99mTc]MIP-1404 is considered the tracer of choice for SPECT imaging and [68Ga]PSMA-11 is the leading diagnostic for PET imaging by general consensus. [18F]DCFPyL and [18F]PSMA-1007 are clearly the emerging PET PSMA candidates for their great potential for a widespread commercial distribution. After paving the way with new imaging tools, academic and industrial R&Ds are now focusing on the development of PSMA inhibitors labeled with alpha or beta minus emitters for a theragnostic application.

Mebendazole in simultaneous combination with dexamethasone-(C21-phosphoramidate)-[anti-EGFR] generated utilizing a novel synthesis regimen: dual anti-neoplastic cytotoxicity against pulmonary adenocarcinoma (A549).

PURPOSE: The short and long-term resolution of neoplastic conditions with conventional low molecular weight chemotherapeutics is frequently restricted by limitations associated dose-dependent toxic sequelae. Penetration into neoplastic cells occurs non-selectively where their intracellular concentration following simple passive diffusion from the extracellular fluid compartment becomes essentially equivalent to levels found in normal healthy cell populations residing within tissues and organ systems. Selective "targeted" delivery of conventional low molecular weight chemotherapeutics represents one molecular strategy that can both increase potency and reduce dose-dependent toxic sequela. A second strategy is the identification of synergistic or additive combinations of chemotherapeutics and pharmaceutical agents, in addition to the discovery of re-purposed pharmaceutical agents that possess anti-cancer properties. DISCUSSION: Mebendazole evoked anti-neoplastic cytotoxicity as both a single entity, and contributed to the potency of the covalent immunoglucocorticoid, dexamethasone-(C21-phosphoramidate)-[anti-EGFR] when applied in a dual-combination challenge against populations of pulmonary adenocarcinoma (A549). In this capacity mebendazole demonstrated a role as a candidate re-purposed pharmaceutical that possessing potential as a [-i-] substitute alternative for conventional tubulin inhibitors in scenarios of idiosyncratic reactions, therapeutic resistance, or anticipated toxic sequelae; [-ii-] a new monotherapy; or [-iii-] a component in the design of new multi-therapeutic protocols.

New Nucleoside Analogues for the Treatment of Hemorrhagic Fever Virus Infections.

Eight different compounds, all nucleoside analogues, could presently be considered as potential drug candidates for the treatment of Ebola virus (EBOV) and/or other hemorrhagic fever virus (HFV) infections. They can be considered as either (i) adenine analogues (3-deazaneplanocin A, galidesivir, GS-6620 and remdesivir) or (ii) guanine analogues containing the carboxamide entity (ribavirin, EICAR, pyrazofurin and favipiravir). All eight owe their mechanism of action to hydrogen bonded base pairing with either (i) uracil or (ii) cytosine. Four out of the eight compounds (galidesivir, GS-6620, remdesivir and pyrazofurin) are C-nucleosides, and two of them (GS-6620, remdesivir) also contain a phosphoramidate part. The C-nucleoside and phosphoramidate (and for the adenine analogues the 1'-cyano group as well) may be considered as essential attributes for their antiviral activity.

The effects of hybrid light activation and enamel acid etching on the effectiveness, stability and sensitivity after a single session in-office bleaching: A 12-month clinical trial.

BACKGROUND: The use of hybrid-light (HL) during in-office teeth bleaching can provide faster and reliable results after a single bleaching session, especially if associated with previous acid etching. The present in vivo, interventional, split-mouth, triple-blinded and randomized study evaluated the efficiency of a HL, with and without prior enamel acid etching, assessing the gel application time, degree of color change, sensitivity and treatment stability up to 12 months. METHODS: Thirty-four patients were selected and randomly divided into four groups. The color was evaluated using a spectrophotometer with the CIELab color system, and a VAS questionnaire was used to evaluate the sensitivity. Both upper and lower hemiarches (GI and III) received enamel acid etching with 37% phosphoric acid for 15 s prior to the application of 35% hydrogen peroxide gel (HP). For GI and II, HP was applied on both dental arches for 3-4 consecutive applications and activated by HL (2 × 3' activations with 1' interval); and 3 × 15' (HP) for GIII and IV without HL. Patients returned in 24 h, 1 week, 1-, 6- and 12-months intervals. The clinical operator was different from the clinical measurements operator. RESULTS: After 3-way ANOVA, Tukey's, Wilcoxon and Mann-Whitney tests, all with p < 0.05, no statistical differences were observed between the groups regarding color change (ΔE) and sensitivity in all evaluations. The lowest gel application time was observed for GII (acid etch + HL), followed by GI (HL). CONCLUSIONS: The present study's results reveal the advantages of HL associated with acid etching prior to in office bleaching.

Dental Fluorosis Treatment Can Improve the Individuals' OHRQoL? Results from a Randomized Clinical Trial.

This study aimed to evaluate the effect on oral health-related quality of life (OHRQoL) of two treatment protocols for dental fluorosis in individuals enrolled in a randomized clinical trial. Seventy volunteers, who lived in a fluorosis endemic area in Brazil, and had at least four maxillary anterior teeth showing fluorosis with a Thylstrup and Fejerskov index from 1 to 7, were randomized into two treatment groups (n= 35): GI- enamel microabrasion; or GII- microabrasion associated with at-home bleaching. Microabrasion was performed using 37% phosphoric acid and pumice, and at-home tooth bleaching with 10% carbamide peroxide in a tray. Volunteers completed a questionnaire at baseline and 1-month post treatment to assess changes in OHRQoL, using the Oral Impact on Daily Performance (OIDP). Differences in overall impact scores between and within treatment groups were analyzed with Wilcoxon (within) and Mann-Whitney (between) tests. Changes in performance scores were analyzed using Wilcoxon tests (a< 0.05). One month after treatment, subjects reported improvement in OHRQoL. Both groups showed lower OIDP scores (p< 0.001), but there was no difference between them. Eating, cleaning teeth, smiling and emotional state performance scores were lower after treatment for the whole sample. In conclusion, the treatment with microabrasion improved the OHRQoL in this sample of individuals living in a fluorosis endemic area regardless of the addition of at-home bleaching.

Dental fluorosis treatment can improve the individuals' ohrqol? results from a randomized clinical trial

Abstract This study aimed to evaluate the effect on oral health-related quality of life (OHRQoL) of two treatment protocols for dental fluorosis in individuals enrolled in a randomized clinical trial. Seventy volunteers, who lived in a fluorosis endemic area in Brazil, and had at least four maxillary anterior teeth showing fluorosis with a Thylstrup and Fejerskov index from 1 to 7, were randomized into two treatment groups (n= 35): GI- enamel microabrasion; or GII- microabrasion associated with at-home bleaching. Microabrasion was performed using 37% phosphoric acid and pumice, and at-home tooth bleaching with 10% carbamide peroxide in a tray. Volunteers completed a questionnaire at baseline and 1-month post treatment to assess changes in OHRQoL, using the Oral Impact on Daily Performance (OIDP). Differences in overall impact scores between and within treatment groups were analyzed with Wilcoxon (within) and Mann-Whitney (between) tests. Changes in performance scores were analyzed using Wilcoxon tests (a< 0.05). One month after treatment, subjects reported improvement in OHRQoL. Both groups showed lower OIDP scores (p< 0.001), but there was no difference between them. Eating, cleaning teeth, smiling and emotional state performance scores were lower after treatment for the whole sample. In conclusion, the treatment with microabrasion improved the OHRQoL in this sample of individuals living in a fluorosis endemic area regardless of the addition of at-home bleaching.

Resumo Este estudo teve como objetivo avaliar o efeito na qualidade de vida relacionada à saúde bucal (QVRSB) de dois protocolos de tratamento para fluorose dentária, em indivíduos incluídos em um ensaio clínico randomizado. Setenta voluntários, os quais viviam em uma área de fluorose endêmica no Brasil, e que possuíam pelo menos quatro dentes ântero-superiores com índice de Thylstrup e Fejerskov de 1 a 7, foram randomizados em dois grupos de tratamento (n= 35): GI- microabrasão de esmalte; ou GII- microabrasão associada com clareamento caseiro. A microabrasão foi realizada com ácido fosfórico 37% e pedra pomes e, o clareamento caseiro com peróxido de carbamida 10% e uso de moldeira. Os voluntários responderam um questionário antes e 1 mês após o tratamento, visando avaliar mudanças na QVRSB através do instrumento Oral Impact on Daily Performance (OIDP). Diferenças nos escores de impacto geral entre e nos mesmos grupos de tratamento foram analisadas através dos testes Wilcoxon (mesmo grupo) e Mann-Whitney (entre grupos), respectivamente. Alterações no escores dos domínios foram analisadas usando o teste Wilcoxon (a<0.05). Um mês após o tratamento, os indivíduos relataram melhora na QVRSB. Ambos os grupos apresentaram menores escores do OIDP (p<0,001), sem diferença entre eles. Os escores dos domínios comer, limpar os dentes, sorrir e estado emocioal diminuíram após o tratamento para toda a amostra. Concluiu-se que o tratamento com microabrasão melhorou a QVRSB de indivíduos vivendo em uma área de fluorose endêmica independentemente da associação com o clareamento caseiro.

Effect of surface treatments on the bond strength of self-etching adhesive agents to dentin.

The aim of this study was to investigate the influence of different surface treatments on the shear bond strength (SBS) of self-etching adhesive systems to dentin. Ninety freshly extracted noncarious human molars were sectioned mesiodistally and embedded in chemically cured resin with the buccal or lingual surfaces facing upward. Superficial dentin was exposed, and specimens were randomly assigned to 3 groups, according to the self-etching adhesive system utilized: Clearfil SE Bond (2-step), Scotchbond Universal (1-step), and Clearfil S³ Bond Plus (1-step). These groups were assigned to 5 subgroups (n = 12), according to the following treatments: G1, distilled water (control); G2, 35% phosphoric acid gel; G3, ultrasonic vibration; G4, sandblasting; G5, pumice slurry. For the 1-step self-etching adhesives, no significant differences in SBS values were observed between the different surface treatment groups and their control subgroup (P > 0.05). For the 2-step adhesive, mean values were significantly higher in the ultrasonic vibration and pumice-treated groups than in the control subgroup (P < 0.05). Overall, the use of vibration resulted in superior mean SBS values to dentin for all adhesives tested, although the values were not always significantly higher.

The effect of pre-etching with 37% orthophosphoric acid on the shear bond strength of orthodontic brackets bonded using self-etching primer-adhesive system.

OBJECTIVES: The purpose of this study was to compare the effect of pre-etching with 37% orthophosphoric acid on the shear bond strength (SBS) of orthodontic brackets bonded using self-etching primer (SEP). MATERIALS AND METHODS: Two hundred freshly extracted human premolars were divided randomly into two groups based on pre-etching with 37% orthophosphoric acid: Group 1 (control, n = 50) without pre-etching and Group 2 (experimental, n = 150) with pre-etching. Group 2 was further divided into three sub groups 2a, 2b, and 2c with 50 teeth each and was first pre-etched with 37% orthophosphoric acid for 10, 30, and 60 s, respectively. Brackets were bonded on the teeth in both the groups using SEP and light cure adhesive. The SBS were determined using universal testing machine. The comparison of SBS was done using one-way analysis of variance and Tukey's honest significant difference test. RESULTS: The SBS of experimental Group 2 was significantly higher than the control Group 1 (p < 0.0001). Further, the SBS of Group 2a was highest, followed by Group 2b and 2c (p < 0.0001). CONCLUSION: It was found that pre-etching for 10 s prior to application of SEP-adhesive system increases the SBS of orthodontic brackets.

'Pitted' to 'Pleasing' in 20 min.

In recent times, as a result of extensive drinking water fluoridation, the number of patients affected by fluorosis has increased considerably. The purpose of this clinical report is to describe the use of enamel microabrasion for a patient with severe fluorosis using 37% phosphoric acid and pumice mixture. The results were pleasing, and hence 37% phosphoric acid can be recommended as a safe and easily available alternative in microabrasion procedures.

Acceptability, efficacy and safety of two treatment protocols for dental fluorosis: a randomized clinical trial.

OBJECTIVES: This parallel randomized clinical trial evaluated the efficacy of two treatments for removing fluorosis stains. METHODS: Seventy individuals living in an area endemic for fluorosis, with at least four maxillary anterior teeth presenting fluorosis with a Thylstrup and Fejerskov index from 1 to 7, were randomized into two treatment groups (n=35): GI - enamel microabrasion or GII - microabrasion associated with at-home bleaching. Microabrasion was performed using 37% phosphoric acid and pumice and, at-home tooth bleaching was performed with 10% carbamide peroxide. Areas of enamel opacities were recorded by digital camera at baseline and 1-month (1M) after treatment. Two blinded examiners evaluated the reduction in the area (mm(2)) of opacity using software. Two visual analogue scales were used: one for recording tooth sensitivity and/or gingival irritation ranging from 1 (none) to 5 (severe) and the other to evaluate participant satisfaction with the treatment used ranging from 1 (no improvement) to 7 (exceptional improvement). RESULTS: 1M after treatment, both groups showed a significant reduction in the area of enamel opacity (p=0.0001) and there was no difference between groups (p=0.1). Most of the participants from both treatment groups reported no or mild tooth sensitivity and gingival irritation (p>0.05). Participants reported that they were happy with the improvement in dental appearance, however, individuals from GII reported that they were happier than those from GI (p=0.004). CONCLUSIONS: Both treatment protocols were effective in reducing fluoride stains, however, when home bleaching was associated to enamel microabrasion, patients reported a major satisfaction with dental appearance.

The effect of different enamel surface treatments on the microleakage of fissure sealants.

The aim of this study was to evaluate the effects of different techniques of surface treatment on the microleakage of a fissure sealant in molar teeth. A total of 50 freshly extracted noncarious human third molars were randomly assigned to one of five groups. Occlusal fissures were treated with one of the following: acid etching with 35% orthophosphoric acid (group 1); fissurotomy with a Fissurotomy Micro NTF metal bur (group 2); laser etching with an Er,Cr:YSGG laser at 2 W and 20 Hz (group 3); laser etching with an Er,Cr:YSGG laser at 2 W and 40 Hz (group 4); and air abrasion for 20 s with 30-µm Al(2)O(3) particles via a CoJet Prep device (group 5). After surface pretreatment, a resin-based sealant was applied to the fissures. The sample teeth were subjected to thermocycling and stored in distilled water at 37°C for 1 month. Following immersion in 0.5% basic fuchsin solution for 24 h, three buccolingual slices of each sample tooth were scored under a stereomicroscope, and the morphological appearance of the area between the enamel surface and fissure sealant was examined under a scanning electron microscope. The Kruskal-Wallis test and one-way ANOVA revealed significant differences in marginal leakage, as follows: group 1 showed significantly lower scores than groups 2 and 5, the scores of groups 1, 3 and 4 were not significantly different, and group 2 showed significantly higher scores than groups 3 and 4. Laser irradiation, the metal bur, and the CoJet Prep device did not eliminate the need for acid etching of the enamel prior to placement of a fissure sealant. Laser etching at 2 W (20 Hz or 40 Hz) may be an alternative to conventional acid-etching.

Effect of organic acids and mannanoligosaccharide on excretion of Salmonella typhimurium in experimentally infected growing pigs.

The effect of organic acids and mannanoligosaccharide addition to the diet was assessed in pigs orally inoculated with Salmonella typhimurium. Forty-six growers were distributed among four treatments: Basal Diet (BD); BD+encapsulated organic acids; BD+free organic acids; BD+mannanoligosaccharide. Seroconversion was monitored, and feces and tissue samples were tested for Salmonella isolation. No treatment prevented the carrier state, but a tendency of lower fecal excretion was observed in the group treated with mannanoligosaccharide.

Efficacy of sodium hypochlorite, ethylenediaminetetraacetic acid, citric acid and phosphoric acid in calcium hydroxide removal from the root canal: a microscopic cleanliness evaluation.

Rooted molars were subjected to standardized canal instrumentation to a master apical file (MAF). The samples were dressed with Ca(OH)(2), and after 7 days, teeth were reopened and Ca(OH)(2) medication was removed by 1 of 4 different experimental procedures: 2.5% sodium hypochlorite (NaOCl) (n = 10); 17% EDTA-T (n = 10); 10% citric acid (n = 10); or 37% phosphoric acid (n = 10). This was followed by reinstrumentation with MAF plus 15 mL saline solution. The roots were prepared for scanning electron microscopic analysis of the cervical, middle, and apical thirds. Statistical analysis was performed with the Kruskal-Wallis test. EDTA-T and phosphoric acid gave the best results in the apical third, with significant statistical differences compared with other groups. NaOCl gave the worst results. Irrigation with 17% EDTA-T and 37% phosphoric acid is more effective than sodium hypochlorite and citric acid in the removal of calcium hydroxide from the apical third.

Removal of surgical smear layer.

INTRODUCTION: During apicoectomy and retrograde cavity preparation, a smear layer, which contains microorganisms and necrotic pulpal tissues, is formed on the dentinal surfaces cut by the instruments. Bacteria can survive and proliferate inside or below the smear layer. The purpose of this study was to evaluate in vitro two different procedures for the removal of the smear layer in retrocavities prepared with ultrasonic retrotips. METHODS: Twenty-eight single-rooted teeth were cleaned, shaped, and obturated with gutta-percha and sealer. The apical 3 mm of each root were cut with a carbide bur, and retrograde cavities were prepared with ProUltra ultrasonic retrotips (Maillefer Dentsply, Baillagues, Switzerland) at a depth of 3 mm. Teeth in group A were treated with a gel of 35% orthophosphoric acid for 15 seconds, and teeth in group B were treated with a gel of 24% EDTA at a neutral pH for 2 minutes. The samples were prepared for scanning electron microscopic observation and scored for the presence of the smear layer on the retrocavity walls. RESULTS: Eighty percent of the teeth in group A showed an optimal degree of cleanliness of the walls, with dentinal tubules completely open. The majority of analyzed samples coming from group B showed dentinal tubules covered with the smear layer. CONCLUSIONS: The analysis of the samples showed that orthophosphoric acid is more effective than EDTA in removing surgical smear layer even with less time of action.

Conservative approach for a clinical resolution of enamel white spot lesions.

Enamel white spot lesions in anterior teeth that compromise esthetics are common. Microabrasion is indicated, since it affects enamel superficially. An acid-abrasive slurry with 37% phosphoric acid with pumice was used on the enamel for a controlled time period. Home bleaching with hydrogen peroxide was then used, further improving the final result. The method is safe, easy, and conservative and provides good esthetic results.

Urease inhibitors as potential drugs for gastric and urinary tract infections: a patent review.

INTRODUCTION: Urease is the enzyme that catalyzes the hydrolysis of urea, which is involved in serious infections caused by Helicobacter pylori in the gastric tract, as well as Proteus and related species in the urinary tract. The necessity to treat such infections has stimulated intensive studies on various groups of urease inhibitors. AREAS COVERED: Patent literature on urease inhibitors with possible applications in medicine is reviewed in this paper. Hydroxamic acids, phosphoramidates, urea derivatives, quinones and heterocyclic compounds constitute the major classes of structures with such activity. EXPERT OPINION: Until now, only one compound, acetohydroxamic acid, has been clinically used for the treatment of urinary tract infections by urease inhibition. Unfortunately, it exhibits severe side effects. Thus, it seems that the full potential of urease inhibition has not yet been fully explored. Several Japanese patents related to the use of herbal extracts as sources of polyphenolic urease inhibitors have been considered as complementary or alternative therapy; however, their accessibility is quite possibly due to reduced restrictions for the introduction of natural products to the market.

Scanning electron microscopic investigation of the effectiveness of phosphoric acid in smear layer removal when compared with EDTA and citric acid.

INTRODUCTION: The smear layer adheres to dentinal surface, thus occluding the dentinal tubules. Because this layer disfavors the penetration of irrigant solutions and root canal fillings, it should be removed. The aim of this study was to compare the effectiveness of 37% phosphoric acid with that of 17% EDTA and 10% citric acid in the removal of smear layer. MATERIALS AND METHODS: Fifty-two maxillary single-rooted human canines were accessed and instrumented. Between each instrument used, the canals were irrigated with sodium hypochlorite. After instrumentation, the teeth were irrigated with distilled water and then divided into groups according to the time and substances employed. The substances used were 17% EDTA, 10% citric acid, and 37% phosphoric acid solution and gel. The experimental time periods were of 30 seconds, 1 minute, and 3 minutes. The samples were prepared and observed by means of scanning electron microscopy. Three photomicrographs (2,000×) were recorded for each sample regarding the apical, middle, and cervical thirds. A score system was used to evaluate the images. RESULTS: None of the substances analyzed in this study was effective for removing the smear layer at 30 seconds. In the 1-minute period, the phosphoric acid solution showed better results than the other substances evaluated. In the 3-minute period, all the substances worked well in the middle and cervical thirds although phosphoric acid solution showed excellent results even in the apical third. CONCLUSIONS: These findings point toward the possibility that phosphoric acid solution could be a promising agent for smear layer removal.