Efficacy of Adjunctive Local Antimicrobials to Non-Surgical Periodontal Therapy in Pocket Reduction and Glycemic Control of Patients with Type 2 Diabetes: A Network Meta-Analysis.

OBJECTIVE: This network meta-analysis [NMA] investigated the efficacy of adjunctive use of subgingivally delivered antimicrobials to non-surgical periodontal therapy [NSPT] in the glycemic control and periodontal pocket depth (PPD) reduction in patients with type 2 diabetes (T2D). METHODS: Seven databases, grey literature, and registry platforms were searched up to February 2024 to identify randomized clinical trials (RCT) fulfilling the eligibility criteria. The risk of bias was assessed through Cochrane's tool (RoB 2). Two frequentist NMA were performed using a random-effects model to calculate mean differences (MD) as an effect measure and to quantitatively evaluate the glycated hemoglobin (HbA1c) and PPD. The certainty of evidence was assessed through the GRADE approach in a partially contextualized framework for interpreting results. Ten RCTs were included. RESULTS: In total, 261 patients were treated with eight different local antimicrobials adjuvants to NSPT (azithromycin gel, clarithromycin gel, tetracycline fiber or ointment, chlorhexidine gel, doxycycline nanospheres, minocycline gel, and satranidazole gel), while 249 patients received NSPT alone or associated to placebo. Considering PPD reduction (8 included studies), the best results were found after six months for satranidazole gel (MD -2.64mm; 95%CI -3.56, -1.72; moderate evidence certainty). For HbA1c control (7 included studies), doxycycline gel (MD - 0.80%; 95%CI -1.70, 0.10), chlorhexidine gel (MD -0.68%; 95%CI -1.34, -0.02), and tetracycline fiber (MD -0.62%; 95%CI -0.85, -0.39) showed promising results after three months (low evidence certainty). CONCLUSION: The adjunctive use of satranidazole gel probably reduces PPD after a 6-month follow-up, while doxycycline gel, chlorhexidine gel, and tetracycline fiber may decrease HbA1c values in patients with T2D and periodontitis treated with NSPT after a 3-month follow up.

Morphologic texture characterization allied to cigarette smoke increase pigmentation in composite resin restorations.

STATEMENT OF THE PROBLEM: The staining effect of tobacco smoke on resin color is clinically observed. However, there is no evidence determining whether this staining is increased on texturized surfaces or if the color change is superficial and can be removed by repolishing procedures. OBJECTIVE: To evaluate the effect of tobacco smoke on the color of a composite with smooth or texturized surfaces, before and after repolishing. MATERIALS AND METHODS: Forty composite specimens were allocated into four groups (N = 10): Smooth surface not exposed (G1) and exposed to tobacco smoke (G2), texturized surface not exposed (G3), and exposed to tobacco smoke (G4). During 21 days, G2 and G4 were daily exposed to the smoke from 20 cigarettes. Color measurements were carried out at baseline, after 21 days, and after repolishing. Variables L* (luminosity), b* (blue-yellow), and DeltaE (total color change) were statistically analyzed (repeated measures analysis of variance/Tukey). RESULTS: Texturized and smooth specimens presented similar luminosity at baseline. Tobacco smoke significantly reduced L* in G2 and G4, and increased b* in G4. After repolishing, L* increased and b* reduced in stained groups, but values continued to be different from baseline ones. Repolishing significantly reduced DeltaE, but values from stained groups were still greater than that from unstained groups. CONCLUSION: Tobacco smoke changes the color of composite, and surface texture can increase the staining. Repolishing reduces superficial staining, but this procedure may not return the composite to baseline color. CLINICAL RELEVANCE: Smokers that will receive anterior composite restorations should be warned about the negative cosmetic effect of the smoking habit on the color of restorations.

Effect of cigarette smoke inhalation and estrogen deficiency on bone healing around titanium implants: a histometric study in rats.

BACKGROUND: It has been shown that cigarette smoke inhalation (CSI) and estrogen deficiency (OVX) may affect bone quality around titanium implants; however, their association has not been evaluated. Therefore, this study aimed to verify the effects of CSI associated with OVX on bone healing around titanium implants. METHODS: The tibia surface of 45 female Wistar rats was surgically exposed, and screw-shaped titanium implants were placed. The animals were randomly assigned to OVX (ovariectomized rats; n = 15), SHAM (sham-operated rats; n = 15), and CSI + OVX (4 months of intermittent cigarette smoke inhalation, starting 2 months before implant placement in ovariectomized rats; n = 15). The implants were placed at the time of OVX or SHAM surgery. After 60 days, the animals were sacrificed and undecalcified sections obtained. The percentages of mineralized tissue (bone density [BD]) in a 500-microm-wide zone lateral to the implant, bone filling (BF) within the limits of the threads, and bone-to-implant contact (BIC) were measured in cortical (zone A) and cancellous (zone B) bone. RESULTS: In zone A, the CSI + OVX group showed a significant difference regarding BIC and BD (P <0.05) compared to the other groups. In zone B, data analysis showed that the CSI + OVX group presented the lowest percentage of BD and BIC, followed by the OVX and SHAM groups, respectively (P <0.05). CONCLUSION: Within the limits of the present study, it can be concluded that cigarette smoke inhalation amplified the deleterious effects of estrogen deficiency, affecting both preexisting and newly formed bone in the cortical and cancellous bone around titanium implants.