Systematic review of clinical practice guidelines for traumatic dental injuries.

BACKGROUND/AIMS: Traumatic dental injuries (TDI) are considered a public health problem due to their high prevalence and associated physical, economic, psychological and social consequences. Hence, good Clinical Practice Guidelines are essential to achieving a favourable prognosis. The aim of this review was to appraise the existing Clinical Practice Guidelines (CPGs) on TDI using AGREE II and AGREE-REX. MATERIALS AND METHODS: A systematic search for existing guidelines on TDI was performed on PubMed, EMBASE, CINAHL, Cochrane Library, ProQuest, National Institute for Health Care Excellence, BMJ Best Practice, Trip database, Guideline International Network, Scottish Intercollegiate Guidelines Network, World Health Organisation, Web of Science and 'Ministry of Health worldwide' databases. Four appraisers independently appraised the included CPGs. The AGREE II tool was applied to assess the methodological quality, while AGREE REX assessed the quality of recommendations of the included guidelines. RESULTS: Of the 7736 titles screened, three guidelines, namely the International Association of Dental Traumatology Guidelines (IADT), and the Italian and Malaysian guidelines, were included for the final analysis. These guidelines were published between 2019 and 2020. The AGREE II analysis demonstrated scores above 80% for the IADT and Italian guidelines for the scope and purpose domain. Overall, the Malaysian guidelines achieved the highest score for all domains. The AGREE REX analysis indicated variability in implementation across the nine items, with five that scored above the midpoint of 4.0 on the response scale. Both the Italian and the IADT guidelines had a similar score for the values and preference domains (36.36%). CONCLUSIONS: Several deficiencies exist in the methodological quality of existing CPGs on TDI. Future guidelines should consider improvements for domains such as 'rigour of development', 'stakeholder involvement' and 'applicability' to overcome the existing limitations.

A Minimally Invasive Approach to Managing Isolated Gingival Recession.

Gingival recession (GR), the apical shift of the gingival margin, results in root surface exposure. Its etiology is multifactorial, including teeth position within the dental arch, bony dehiscence, alveolar mucosa thickness, incorrect toothbrushing, orthodontic treatment, and periodontal disease. Coronally advanced flap (CAF) with a subepithelial connective tissue graft (SCTG) is the gold standard for managing GR. With the introduction of minimally invasive surgery, various techniques proposed for managing GR minimize patient morbidity and maximize surgical outcomes. The present case report is that of a 26-year-old male patient with the primary complaint of sensitivity in the upper right and left back teeth regions. Emdogain was used with SCTG for managing recession on the left side and with the xenogeneic collagen matrix (Mucograft) to cover recession on the right side. Post-operative healing was uneventful, with significant recession reduction and an increase in the width of the attached gingiva at both sites. GR, apart from posing as an esthetic complication, also results in tooth sensitivity. This makes the management of GR very important for which multiple treatment modalities are available. The current case report highlights the success of the minimally invasive tunneling technique in managing isolated GR.

Evaluation of Root Dentin Thickness and Smear Layer Removal Efficacy of Two Novel Nickel Titanium Rotary Instruments - An In Vitro Cone-Beam Computed Tomography and Scanning Electron Microscopy Study.

OBJECTIVE: This study aimed to compare the two nickel-titanium (NiTi) instruments on root dentin thickness using cone-beam computed tomography (CBCT) and ability to remove the smear layer using scanning electron microscope (SEM). MATERIALS AND METHODS: The effect of two NiTi rotary instruments such as XP Endo shaper and ProTaper Gold (PTG) in retaining adequate dentin thickness and debridement (i.e., removal of smear layer) was evaluated in vitro using CBCT and SEM. After cleaning and shaping of the root canal with adequate irrigation, the effect of two NiTi instrument systems at 3 mm (apical), 6 mm (middle), and 9 mm (coronal) levels on buccal, lingual, mesial, and distal aspects in terms of amount of dentin removal and smear layer removal was evaluated. The data were analyzed using student's unpaired t-test with a significance of P ≤ 0.05. RESULTS: Both NiTi instrument systems had no statistically significant difference in amount of dentin removal at all three levels and on all four aspects. In smear layer removal, PTG had significantly better efficacy compared to XP Endo shaper at the coronal third of root canal. CONCLUSION: Instrumentation with XP Endo Shaper and PTG showed a similar amount of dentin removal. PTG has a significant effect on smear layer removal compared to XP Endo Shaper only at the coronal third of root canal.

Laser-assisted Excision of Gingival Overgrowth in an Endodontic Perforation: A Case Report.

With the increase in preventive and restorative dentistry, there is also an increase in the iatrogenic conditions that occur in modern dental practice. The goal of modern dentistry is to provide patients with a holistic solution by providing functional restoration. This case report will highlight one such case where a tooth was diagnosed as having a gingival overgrowth through a perforation during prior endodontic treatment. Proper diagnosis and treatment planning helped restore a tooth that would have been lost.

An In-vitro Assessment of the Physical and Chemical Properties of Toothbrush Bristle Following Decontamination by Three Different Methods: A Pilot Study.

Background Toothbrushes are the most commonly used mechanical plaque control methods, and they are said to harbor microorganisms if not stored properly following usage. Objective An assessment of the influence of a decontaminating agent (sterile water (control)/chlorhexidine mouthwash/herbal mouthwash) on the properties of toothbrush bristles following storage for 24 hrs by means of scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FTIR). Methodology The study involves a total of 24 slim soft toothbrushes (six samples per group) with different decontaminating agents: Group 1: Vented container, Group 2: Sterile water, Group 3: 0.2% Chlorhexidine mouthwash, and Group 4: Herbal mouthwash. The toothbrushes were stored in their respective containers for 24 hours, following which, snippets of toothbrush bristles were collected and tested for the evaluation of wear using SEM and the biochemical alteration occurring in the bristles was assessed using FTIR. Results and conclusion The Group 2 and Group 3 samples showed significant wear (Score 2) under SEM evaluation, and FTIR spectroscopy evaluation revealed that changes occur in the fingerprint region of infrared spectroscopy owing to chemical bond alteration following decontamination. Considering the benefits we acquire in terms of microbial load reduction, decontamination is recommended, though it might necessitate frequent changing of toothbrushes.

Electrically Driven Microengineered Bioinspired Soft Robots.

To create life-like movements, living muscle actuator technologies have borrowed inspiration from biomimetic concepts in developing bioinspired robots. Here, the development of a bioinspired soft robotics system, with integrated self-actuating cardiac muscles on a hierarchically structured scaffold with flexible gold microelectrodes is reported. Inspired by the movement of living organisms, a batoid-fish-shaped substrate is designed and reported, which is composed of two micropatterned hydrogel layers. The first layer is a poly(ethylene glycol) hydrogel substrate, which provides a mechanically stable structure for the robot, followed by a layer of gelatin methacryloyl embedded with carbon nanotubes, which serves as a cell culture substrate, to create the actuation component for the soft body robot. In addition, flexible Au microelectrodes are embedded into the biomimetic scaffold, which not only enhance the mechanical integrity of the device, but also increase its electrical conductivity. After culturing and maturation of cardiomyocytes on the biomimetic scaffold, they show excellent myofiber organization and provide self-actuating motions aligned with the direction of the contractile force of the cells. The Au microelectrodes placed below the cell layer further provide localized electrical stimulation and control of the beating behavior of the bioinspired soft robot.

Natural T Regulatory Cells (n Treg) in the Peripheral Blood of Healthy Subjects and Subjects with Chronic Periodontitis - A Pilot Study.

INTRODUCTION: The T cells play a central role in the aetiopathogenesis of periodontal disease. Natural T regulatory cells (nTreg) are the key stone immunoregulatory elements having an anergic phenotype and play an important role in the suppression of exaggerated immune responses thereby maintaining homeostasis. There are increasing evidences for the role of nTreg in the periodontal disease pathogenesis. AIM: To identify the proportion of natural T regulatory cells in the peripheral blood of periodontally healthy subjects and subjects with chronic periodontitis. MATERIALS AND METHODS: A total of 15 subjects (7 with healthy gingiva and 8 with chronic periodontitis) were recruited for this pilot study. Baseline periodontal parameters were recorded and 5 ml of peripheral blood was collected. The samples from both the groups were analysed for the relative proportion of nTreg (identified by the expression CD45RB+CD4+CD25+FOXP3+) using flow cytometry. RESULTS: The mean percentages of the CD45RB+CD4+CD25+ cells expressing FOXP3 in control and chronic periodontitis group were found to be 14.75±5.04 and 43.13±11.17 respectively. The mean proportion of nTreg were compared between the control and chronic periodontitis sample using Mann-Whitney Test and was found to be statistically significant with (p<0.001). CONCLUSION: A higher proportion of nTreg in the peripheral blood sample of chronic periodontitis subjects were observed as compared to that of healthy individuals.

A Comparison of Platelet Count and Enrichment Percentages in the Platelet Rich Plasma (PRP) Obtained Following Preparation by Three Different Methods.

INTRODUCTION: Platelet rich plasma (PRP) represents an easily accessible and rich source of autologous growth factors. Different manual methods for the preparation of PRP have been suggested. Lacuna in knowledge exists about the efficacy of PRP preparation by these different manual methods. AIMS: This study was performed to determine the effects of centrifugation rate revolutions per minute (RPM) and time on the platelet count and enrichment percentages in the concentrates obtained following the three different manual methods of PRP preparation. SETTING AND DESIGN: In vitro experimental study. MATERIALS AND METHODS: This was an experimental study in which platelet concentration was assessed in the PRP prepared by three different protocols as suggested by Marx R (method 1), Okuda K (method 2) and Landesberg R (method 3). A total of 60 peripheral blood samples, (n=20 per method) were obtained from healthy volunteers. Baseline platelet count was assessed for all the subjects following which PRP was prepared. The platelet count in the PRP was determined using coulter counter (Sysmex XT 2000i). STATISTICAL METHOD: The mean of the platelet count obtained and their enrichment percentage were calculated and intergroup comparison was done (Tukey's HSD test). RESULTS: The number of platelets and enrichment percentage in PRP prepared by method 1 was higher compared to method 2 and method 3; this difference in platelet concentrates was found to be statistically significant (p < 0.05). CONCLUSION: The centrifugation rate and time appear to be important parameters, which influence the platelet yield. Method 1 which had lower centrifugation rate and time yielded a greater platelet count and enrichment percentage.

Root Surface Bio-modification with Erbium Lasers- A Myth or a Reality??

The objective of this literature review was to critically review the evidence available in the literature regarding the expediency of erbium family of lasers for root bio modification as a part of periodontal therapy. The literature search was performed on the Pubmed using MeSH words such as "lasers/therapeutic use, scaling, dental calculus, tooth root/anatomy and histology, ultrasonic therapy". The studies were screened and were grouped as follows: those evaluating a) efficacy for calculus removal with the Erbium family of laser b) root surface changes following Er YAG and Er Cr YSGG application c) comparative studies of the Er YAG, Er Cr YSGG lasers versus conventional methods of root surface modification d) Bio compatibility of root surface following Erbium laser treatment e) Studies on the combined efficacy of laser root modification with conventional methods towards root surface bio-modification f) Studies on effectiveness of root surface bio-modification prior to root coverage procedures. In conclusion, the erbium family has a proven anti-bacterial action, predictable calculus removal, minimal root substance removal, and appears to favor cell attachment. The Erbium family of lasers appears to be a useful adjunct for the management of periodontal disease.