Microbiological Profile and Human Immune Response Associated with Peri-Implantitis: A Systematic Review.

PURPOSE: To evaluate and synthesize the existing evidence on the microbiological and human immune response associated with peri-implantitis in comparison to healthy implants. MATERIALS AND METHODS: Three electronic databases (MEDLINE, Embase, and Cochrane Library) were searched in October 2019 to identify clinical studies evaluating the microbiota and the immune response associated with peri-implantitis. Two reviewers independently screened the studies and used the full text to extract the data. A qualitative synthesis was performed on the extracted data and summary tables were prepared. Due to clinical and methodological heterogeneity among included studies, no meta-analysis was performed. RESULTS: Forty studies were included in this review. Of these, 20 studies compared the microbiological profile of peri-implantitis with healthy implants. Nineteen studies focused on the immune response associated with peri-implantitis in comparison to healthy implants. Three studies focus on gene polymorphism associated with peri-implantitis. The most commonly reported bacteria associated with peri-implantitis were obligate anaerobe Gram-negative bacteria (OAGNB), asaccharolytic anaerobic Gram-positive rods (AAGPRs), and other Gram-positive species. In regard to immune response, the most frequently reported pro-inflammatory mediators associated with peri-implantitis were IL-1ß, IL-6, IL-17, TNF-α. Osteolytic mediator, e.g., RANK, RANKL, Wnt5a and proteinase enzymes, MMP-2, MMP-9, and Cathepsin-K were also expressed at higher level in peri-implantitis sites compared to control. CONCLUSIONS: Peri-implantitis is associated with complex and different microbiota than healthy implants including bacteria, archaea, fungi, and virus. This difference in the microbiota could provoke higher inflammatory response and osteolytic activity. All of this could contribute to the physiopathology of peri-implantitis.

Immediate loading vs. early/conventional loading of immediately placed implants in partially edentulous patients from the patients' perspective: A systematic review.

OBJECTIVES: This systematic review aimed at answering the following PICO question: In patients receiving immediate (Type 1) implant placement, how does immediate compare to early or conventional loading in terms of Patient-Reported Outcome Measures (PROMs)? MATERIAL AND METHODS: Following search strategy development, the OVID, PubMed, EMBASE, and Cochrane Database of Systematic Reviews databases were search for the relevant literature. All levels of evidence including randomized controlled trials, prospective and retrospective cohort studies, and case series of at least five patients were considered for possible inclusion. An additional manual search was performed by screening the reference lists of relevant studies and systematic reviews published up to May 2017. The intervention considered was the placement of immediate implant. Study selection and data extraction were performed independently by two reviewers. RESULTS: The search yielded a list of 1,102 references, of which nine were included in this systematic review. The limited number of studies included and the heterogeneity of the data identified prevented the performance of a meta-analysis. Three studies, one of which was a randomized controlled trial, allowed the extraction of comparative data specific to the aim of the present systematic review. The remaining studies allowed only data extraction for one single treatment modality and were viewed as single cohort studies. Overall, irrespective of the PROMs chosen, patients' satisfaction was overall high with little difference between the two loading protocols. Moreover, studies indicated a positive impact on oral health-related quality of life following immediate implant placement and loading. CONCLUSIONS: Within the limitations of the present systematic review, immediate implant placement and loading in single tooth edentulous space seems to be a well-accepted treatment modality from the patients' perspective and is worthy of consideration in clinical practice. However, the paucity of comparative data limits any definitive conclusions as to which loading protocol; immediate or early/conventional, should be given preference based on PROMs.

Group 3 ITI Consensus Report: Patient-reported outcome measures associated with implant dentistry.

OBJECTIVES: The aim of Working Group 3 was to focus on three topics that were assessed using patient-reported outcome measures (PROMs). These topics included the following: (a) the aesthetics of tooth and implant-supported fixed dental prostheses focusing on partially edentulous patients, (b) a comparison of fixed and removable implant-retained prostheses for edentulous populations, and (c) immediate versus early/conventional loading of immediately placed implants in partially edentate patients. PROMs include ratings of satisfaction and oral health-related quality of life (QHRQoL), as well as other indicators, that is, pain, general health-related quality of life (e.g., SF-36). MATERIALS AND METHODS: The Consensus Conference Group 3 participants discussed the findings of the three systematic review manuscripts. Following comprehensive discussions, participants developed consensus statements and recommendations that were then discussed in larger plenary sessions. Following this, any necessary modifications were made and approved. RESULTS: Patients were very satisfied with the aesthetics of implant-supported fixed dental prostheses and the surrounding mucosa. Implant neck design, restorative material, or use of a provisional restoration did not influence patients' ratings. Edentulous patients highly rate both removable and fixed implant-supported prostheses. However, they rate their ability to maintain their oral hygiene significantly higher with the removable prosthesis. Both immediate provisionalization and conventional loading receive positive patient-reported outcomes. CONCLUSIONS: Patient-reported outcome measures should be gathered in every clinical study in which the outcomes of oral rehabilitation with dental implants are investigated. PROMs, such as patients' satisfaction and QHRQoL, should supplement other clinical parameters in our clinical definition of success.

How health literacy is taught and evaluated in dentistry, medicine, nursing, law, pharmacy, public health, and social work: a narrative review.

BACKGROUND: This narrative review examined the published peer-reviewed literature on how health literacy is taught and evaluated in seven health professional and adjacent disciplines: dentistry, medicine, nursing, law, pharmacy, public health, and social work. The study objectives were to assess how students are educated about health literacy and how their health literacy education and skills are evaluated. METHODS: Study selection followed guidelines outlined in PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). We searched PubMed, CINAHL, SocINDEX (EBSCOhost), Lexis Advance and Public Health (ProQuest) for English-language publications of health literacy education studies across seven disciplines at U.S.-based institutions. Inclusion criteria included: 1) methods describing a primary health literacy educational intervention, 2) professional education in one or more of the seven disciplines, 3) educational institutions in the United States, and 4) articles published in peer-reviewed journals between 2000 and 2020. RESULTS: The searches yielded 44 articles. Health literacy education is evident in six of the seven studied disciplines, and varies widely in the quality, quantity, timing and mode of education and evaluation. Despite the presence of health literacy accreditation requirements, none of the seven disciplines has developed and implemented a standard, rigorous health literacy education program for students. CONCLUSIONS: Graduating institutions and professional accreditation organizations that set the standards for education must lead the way by implementing upstream changes in health literacy professional education. Teaching health literacy to students in health professions is one strategy to help close gaps in patient/client professional communication for graduates and those they serve.

Recurrent caries models to assess dental restorations: A scoping review.

OBJECTIVES: To review the literature on recurrent caries models used to evaluate restorative materials, compare reported methodology and parameters, and devise specific recommendations to be considered in future investigations. DATA: The following were extracted: study design, sample characteristics, source of teeth, name of restorations compared including controls, recurrent caries model type, type of demineralizing and remineralizing solutions, type of biofilm used, methods to detect recurrent caries. SOURCES: Literature searches were performed in OVID Medline, EMBASE, SCOPUS, and Cochrane Library. STUDY SELECTION: For a study to be included, it had to examine dental materials for tooth restoration purposes only with a valid control group and evaluate restorative dental materials regardless of the form of the teeth caries model used or nature of the tooth structure used. A total of 91 studies were included. Most of the studies presented were in vitro. Human teeth were the main source of specimens utilized. Around 88% of the studies used specimens without an artificial gap, and 44% used a chemical model. S. mutans was the main bacterial species used in microbial caries models. CONCLUSION: The findings of this review provided an insight into the performance of available dental materials assessed using different recurrent caries models, yet this review cannot be used as a guideline for material selection. Selecting the appropriate restorative material relies on several patient-related factors such as microbiota, occlusion, and diet that are not comprehensively taken into consideration in recurrent caries models and thus hinder reliable comparison. CLINICAL SIGNIFICANCE: Due to the heterogenicity of variables among studies on the performance of dental restorative materials, this scoping review aimed to provide insights for dental researchers concerning the available recurrent caries models, testing methods used, and aspects of comparison between these materials including their characteristics and limitations.

How we are assessing the developing antibacterial resin-based dental materials? A scoping review.

OBJECTIVES: To identify antibacterial additives and screening/assessment approaches used to evaluate the antibacterial activity of resin-based restorative dental materials containing these additives. DATA: In vitro studies that compared the antibacterial effects of resin-based restorative dental materials with and without antibacterial additives were screened. Risk bias was assessed, and the following data were extracted: antibacterial additive, parental dental material, curing mode, bacterial growth outcome assessment, samples used as a substrate for bacterial growth, inoculum complexity, and culture time as an indicator of biofilm maturity. SOURCE: Arksey and O'Malley's five stages framework using Medline (OVID), EMBASE, and Scopus (Elsevier) databases guided this review. STUDY SELECTION: From 6503 studies initially identified, 348 studies were considered eligible for full-text screening, and 153 were included for data extraction. Almost all studies have a high sampling bias related to both sample size and blindness. Quaternary ammonium monomers were the most investigated additive (45 %), and the most prevailing parental material was resin composite (49 %). There was extensive methodological heterogeneity among the studies for outcome assessment with the majority using resin composite disks (78 %), mono-species Streptococcus mutans as the inoculum (54 %), and a relatively short period of biofilm growth (≤24 h). CONCLUSION: The findings herein present the urgent need for improved biological efficacy studies in this important and exciting field. There is a need for efforts to improve study designs to mimic the oral environment in vivo and to develop standardized methods to help understand and optimize these materials. CLINICAL SIGNIFICANCE: Most studies that incorporate antibacterial additives into resin-based materials claim promising results by bacterial reduction. However, these results should be interpreted with caution due to significant variation in the methods applied for quantifying bacterial growth, the frequent lack of complexity in the biofilms, and the often-short duration of biofilm growth.