Efficacy of collagen matrix seal and collagen sponge on ridge preservation in combination with bone allograft: A randomized controlled clinical trial

Efficacy of autologous platelet concentrate products for alveolar preservation: A meta-analysis

PURPOSE

The purpose of the study was to systematically evaluate the efficacy of autologous platelet concentrate products in the preservation of the alveolar ridge after tooth extraction through meta-analysis and provide a theoretical basis for the clinical application of autologous platelet concentrates to reduce alveolar bone resorption.

METHODS

This study conducted a meta-analysis of clinical trials between 2013 and 2023, focusing on autologous platelet concentrate products (e.g., PRP, PRF, CGF, and PRCF) used for alveolar ridge preservation after tooth extraction. The analysis included 122 articles and 371 extraction sockets. All statistical analyses were performed using Review Manager version 5.4.

RESULTS

Results indicate that these platelet concentrates effectively reduced changes in horizontal width 1 mm below the alveolar crest and vertical socket height. They also promoted a higher percentage of new bone formation in extraction sockets compared with control groups. However, they did not significantly prevent horizontal bone resorption at 3 and 5 mm below the alveolar crest.

CONCLUSION

In conclusion, autologous platelet concentrates are useful for alveolar ridge preservation, but larger clinical studies are needed to confirm these findings due to the relatively small sample size in this study.

Competence of allogenic demineralized tooth matrix in socket seal surgery for alveolar ridge preservation: a randomized control clinical trial

OBJECTIVES

To assess and compare the clinical, radiological, and histological outcomes of socket seal surgery between two protocols: deproteinized demineralized tooth matrix (dpDTM) and freeze-dried bone allograft (FDBA) each covered with a free gingival graft.

MATERIALS AND METHODS

Twenty extraction sockets in the anterior or premolar region were randomly allocated to either the dpDTM or FDBA protocol (n = 10 per group). Measurements of the alveolar ridge changes were obtained using an intraoral scanner and cone-beam computed tomography at 3 months post-operation. Three-month post surgery, the dental implant was installed (n = 5 per group), bone biopsies were obtained for histomorphometrical and micro-computed tomography analyses. Implant stability quotients (ISQs) were determined and compared at 3 months post-implant.

RESULTS

Lower significant reductions in buccal alveolar ridge height and hard tissue volume were observed in dpDTM group compared to FDBA group at 3 months (0.25 ± 0.35 mm vs. 1.60 ± 0.66 mm [p = .000] and 9.64 ± 15.39% mm3 vs. 31.45 ± 18.11% mm3 [p = .010], respectively). At the same time, lower soft tissue volume reduction was detected in the dpDTM group compared to FDBA group (4.21 ± 5.25% mm3 vs. 5.25 ± 5.79% mm3). No statistically significant difference in the percentage of mineralized tissue formation was found between dpDTM group (53.39 ± 11.16%) and FDBA group (49.90 ± 3.27%). Even though the ISQ in the dpDTM group showed a higher value than the FDBA group at 3 months post-implant, the results were without statistical significance.

CONCLUSIONS

Alveolar ridge preservation using dpDTM is an efficacious procedure for providing the conditions for the development of functional and esthetic implants.

Alveolar Ridge Preservation With Fibro-Gide or Connective Tissue Graft: A Randomized Controlled Trial of Soft and Hard Tissue Changes

OBJECTIVE

The aim of this study was to evaluate the effectiveness of a novel biomaterial (FG) for alveolar ridge preservation compared to CTG in terms of soft tissue thickness and bone dimensional changes.

MATERIALS AND METHODS

A randomized clinical trial was conducted on 30 patients who required extraction of 30 hopeless mandibular posterior teeth. All patients went through atraumatic tooth extraction, and then, they were randomly allocated to either a CTG, an FG, or a spontaneous healing (SH) group (1:1:1). All patients received a dental implant placed 6 months postoperatively. The soft tissue thickness and bone dimensional changes were measured before and 6 months after the procedure.

RESULTS

The study's analysis revealed statistically significant differences in buccal gingival thickness and dimensional bone changes across the three examined groups after 6 months (p < 0.05). The SH group had lower gingival thickness (1.31 ± 0.65 mm) and higher vertical resorption (-1.46 ± 1.67 mm at the buccal aspect) compared with the CTG and FG groups. The CTG and FG groups had similar gingival thickness (2.42 ± 0.70 and 3.00 ± 0.71 mm, respectively) and bone width reduction (+0.86 ± 2.31 and +0.93 ± 2.38 mm, respectively), whereas the CTG group had lower vertical bone loss (-0.30 ± 1.09 mm at the buccal aspect) than the FG group (-0.47 ± 2.30 mm at the buccal aspect).

CONCLUSION

FG and CTG demonstrate equivalent soft tissue thickness and comparable horizontal bone dimension outcomes in ARP.

The effect of platelet-rich fibrin (PRF) versus freeze-dried bone allograft (FDBA) used in alveolar ridge preservation on the peri-implant soft and hard tissues: a randomized clinical trial

BACKGROUND

The effectiveness of alveolar ridge preservation on bone regeneration and tissue healing has been thoroughly documented in the literature. This study aimed to evaluate the peri-implant soft and hard tissue changes after alveolar ridge preservation using either platelet-rich fibrin (PRF) or freeze-dried bone allograft (FDBA) over a 12-month period following the prosthetic loading of implants.

METHODS

In this randomized clinical trial, 40 individuals were recruited for alveolar ridge preservation using (1) FDBA or (2) PRF in incisal/premolar areas. At two follow-up sessions (six- and 12-months post-implant insertion), radiographic imaging and clinical examinations assessed marginal bone loss and soft tissue factors, including gingival recession and bleeding on probing. The differences between study groups were analyzed using Generalized estimating Equations, the Binary logistic regression model, and Cochran's Q test.

RESULTS

There was a statistically significant difference regarding gingival recession at both follow-up evaluations; values in the PRF group were considerably lower compared to the FDBA group (p < 0.05). The mean values for vertical marginal bone loss and bleeding on probing showed no significant differences between the two study groups (p > 0.05).

CONCLUSIONS

Except for gingival recession, applying PRF yielded comparable clinical results to FDBA after one year of implant loading and could be recommended as a potential biomaterial for alveolar ridge preservation following tooth extractions.

CLINICAL TRIAL REGISTRATION

The research protocol was registered in the Protocol Registration and Results System on 13/08/2021, available at https://clinicaltrials.gov/ (NCT05005377).

Learn, unlearn, and relearn post-extraction alveolar socket healing: Evolving knowledge and practices

OBJECTIVE

This review was to offer a comprehensive analysis of currently available evidence on post-extraction alveolar socket healing, including i) the histological and molecular events during alveolar socket healing, ii) the dimensional ridge alterations after socket healing and controversies relating to sinus pneumatisation, iii) the patient-specific factors, procedural elements, and site-related variables influencing socket healing, iv) techniques and effectiveness of alveolar ridge preservation (ARP) procedure, and v) the philosophies and cost-effectiveness of ARP in clinical practice.

SOURCES AND STUDY SELECTION

To investigate the dimensional profiles of the alveolar ridge following unassisted healing, an overview of systematic reviews was conducted in February 2024 by two independent reviewers. Four electronic databases were searched in Pubmed, Embase, Web of science and Cochrane Library between 2004 and 2024 to identify all relevant systematic reviews on post-extraction healing. A further manual search of reviews was also conducted. The articles were further reviewed in full text for relevance. The AMSTAR-2 appraisal tool was adopted to assess methodological quality. Current research pertaining to other listed objectives was objectively analysed in narration.

DATA

11 out of 459 retrieved studies were selected and ultimately covered in this review on the dimensional changes of alveolar ridge following natural healing: Seven systematic reviews and four systematic reviews with meta-analyses. The methodological quality of all included reviews was critically low.

CONCLUSION

This review thoroughly examines the healing profiles of post-extraction alveolar sockets and highlights the dynamic process with overlapping phases and the inter-individual variability in outcomes. ARP procedure is a potential strategy for facilitating prosthetic site development, while the current evidence is limited. Herein, an individualised and prosthetically driven approach is crucial. Further well sized and designed trials with novel biomaterials need to be undertaken, and the role of artificial intelligence in predicting healing and assisting clinical decision-making could be explored.

CLINICAL SIGNIFICANCE

By advancing our understanding of alveolar socket healing and its management strategies, clinicians can make more informed decisions regarding patient and site level assessment and selection, surgical techniques, and biomaterial choices, ultimately contributing to the enhanced healing process with reduced complications and improved quality of life for patients undergoing tooth extraction and dental implant treatments.

Effectiveness of a collagen matrix seal and xenograft in alveolar ridge preservation: an experimental study in dogs

Majority of previous studies on alveolar ridge preservation (ARP) used collagen membranes as barrier membranes, and further evidence for ARP in dehiscent extraction sockets with a deproteinized bovine bone mineral (DBBM) and matrix is needed. The aim of this study is to assess the impact of non-cross linked collagen membranes (membrane) and crosslinked collagen matrices (matrix) on ARP using DBBM in extraction sockets with buccal dehiscence. In six mongrel dogs, the mesial roots of three mandibular premolars (P2, P3, and P4) were extracted 1 month after dehiscence defect induction. Two experimental groups were randomly assigned: (1) DBBM with a membrane (DBBM/membrane group) and (2) DBBM with a matrix (DBBM/matrix group). Three-dimensional (3D) volumetric, microcomputed tomography (μCT), and histologic analyses were performed to assess the ridge preservation. Both groups were effective to maintain the ridge width (p > 0.05), and the DBBM/matrix group showed more favorable soft tissue regeneration and bone quality in the histological analysis (p = 0.05). Based on these results, DBBM/matrix could be better choice for ARP in cases of buccal dehiscence defects.

A Socket Seal Technique With the Use of Autologous Dental Roots for Socket Seal: A Case Series

The literature identified variations in socket seal surgery, each with limitations. This case series aimed to observe the outcome of using autologous dental root (ADR) for socket sealing on socket preservation (SP). A total of 9 patients with 15 extraction sockets were documented. After flapless extraction, the xenograft or alloplastic grafts were placed in the sockets. Autologous dental roots were prepared extraorally and applied to seal the socket entrance. All SP sites healed uneventfully. Cone-beam computed tomography (CBCT) scan was performed after 4-6 months of healing to evaluate ridge dimensions. The preserved alveolar ridge profiles were verified on CBCT scans and during implant surgery. Implants were placed successfully with a reduced need for guided bone regeneration. Histological biopsy specimens were examined in 3 cases. The histological examination demonstrated vital bone formation and osseointegration of graft particles. All patients completed the final restorations and were monitored for 15.56 ± 9.08 months after functional loading. The favorable clinical outcomes support the use of ADR for SP procedures. It was not only accepted to patients but also easy to perform with low complication rates. The ADR technique is thus a feasible method for socket seal surgery.

Synthetic Calcium-Phosphate Materials for Bone Grafting

Synthetic bone grafting materials play a significant role in various medical applications involving bone regeneration and repair. Their ability to mimic the properties of natural bone and promote the healing process has contributed to their growing relevance. While calcium-phosphates and their composites with various polymers and biopolymers are widely used in clinical and experimental research, the diverse range of available polymer-based materials poses challenges in selecting the most suitable grafts for successful bone repair. This review aims to address the fundamental issues of bone biology and regeneration while providing a clear perspective on the principles guiding the development of synthetic materials. In this study, we delve into the basic principles underlying the creation of synthetic bone composites and explore the mechanisms of formation for biologically important complexes and structures associated with the various constituent parts of these materials. Additionally, we offer comprehensive information on the application of biologically active substances to enhance the properties and bioactivity of synthetic bone grafting materials. By presenting these insights, our review enables a deeper understanding of the regeneration processes facilitated by the application of synthetic bone composites.

Clinical evaluation of different alveolar ridge preservation techniques after tooth extraction: a randomized clinical trial

OBJECTIVE

The aim of the present randomized controlled trial (RCT) was to evaluate the efficacy of different alveolar ridge preservation (ARP) techniques on dimensional alterations after tooth extraction, based on clinical measurements.

BACKGROUND

Alveolar ridge preservation (ARP) is a common procedure in every day clinical practice, when dental implants are involved in treatment planning. In ARP procedures, a bone grafting material is combined with a socket sealing (SS) material in order to compensate the alveolar ridge dimensional alterations after tooth extraction. Xenograft and allograft are the most frequently used bone grafts in ARP, while free gingival graft (FGG), collagen membrane, and collagen sponge (CS) usually applied as SS materials. The evidence comparing xenograft and allograft directly in ARP procedure is scarce. In addition, FGG is usually combined with xenograft as SS material, while the evidence combing allograft with FGG is absent. Moreover, CS could probably be an alternative choice in ARP as SS material, since it has been used in previous studies but more clinical trials are required to evaluate its effectiveness.

MATERIALS AND METHODS

Forty-one patients were randomly assigned in four treatment groups: (A) freeze-dried bone allograft (FDBA) covered with collagen sponge (CS), (B) FDBA covered with free gingival graft (FGG), (C) demineralized bovine bone mineral xenograft (DBBM) covered with FGG, and (D) FGG alone. Clinical measurements were performed immediately after tooth extraction and 4 months later. The related outcomes pertained to both vertical and horizontal assessment of bone loss.

RESULTS

Overall, groups A, B, and C presented significantly less vertical and horizontal bone resorption compared to group D. No statistically significant difference was observed between allograft and xenograft, except for the vertical bone resorption at the buccal central site, where xenograft showed marginally statistically significantly reduced bone loss compared to allograft (group C vs group B: adjusted β coef: 1.07 mm; 95%CI: 0.01, 2.10; p = 0.05). No significant differences were observed in hard tissue dimensions when CS and FGG were applied over FDBA.

CONCLUSIONS

No differences between FDBA and DBBM could practically be confirmed. In addition, CS and FGG were equally effective socket sealing materials when combined with FDBA, regarding bone resorption. More RCTs are needed to compare the histological differences between FDBA and DBBM and the effect of CS and FGG on soft tissue dimensional changes.

CLINICAL RELEVANCE

Xenograft and allograft were equally efficient in ARP 4 months after tooth extraction in horizontal level. Xenograft maintained the mid-buccal site of the socket marginally better than the allograft, in vertical level. FGG and CS were equally efficient as SS materials regarding the hard tissue dimensional alterations.

TRIAL REGISTRATION

Clinical trial registration Number: NCT04934813 (clinicaltrials.gov).

Resolvin D1 improves allograft osteointegration and directly enhances osteoblasts differentiation

Introduction

Allografts are the most common bone grafts for repairing osseous defects. However, their use is associated with an increased risk for infections, donor disease transmission and osteointegration deficiency. Resolvin D1 (RvD1) is an endogenous lipid with a scientifically proven pivotal role in inflammation resolution and osteoclastogenesis inhibition. Yet, its biological relevance as a potential bone regenerative drug has been scarcely studied. Here, we aim to investigate the RvD1 effect on allograft osteointegration in the alveolar bone regeneration (ABR) murine model.

Methods

ABR model consisted of osseous defects that were generated by the extraction of the maxillary first molar in C57BL/6 mice. The sockets were filled with allograft and analyzed via RNA sequencing. Then they were locally injected with either RvD1 or saline via single or repeated administrations. The mice were sacrificed 2W after the procedure, and regenerated sites were analyzed using µCT and histology. First, MC3T3-E1 preosteoblasts were plated with IL-17 pro-inflammatory medium, and RANKL/OPG ratio was measured. Secondly, the MC3T3-E1 were cultured w/o RvD1, for 3W. Osteoblasts' markers were evaluated in different days, using qRT-PCR and Alizarin Red staining for calcified matrix.

Results

In vivo, neither allograft alone nor single RvD1 administration promote bone regeneration in comparison to the control of spontaneous healing and even triggered an elevation in NR1D1 and IL1RL1 expression, markers associated with inflammation and inhibition of bone cell differentiation. However, repeated RvD1 treatment increased bone content by 135.92% ± 45.98% compared to its specific control, repeated sham, and by 39.12% ± 26.3% when compared to the spontaneous healing control group (n=7/group). Histologically, repeated RvD1 reduced the number of TRAP-positive cells, and enhanced allograft osteointegration with new bone formation. In vitro, RvD1 rescued OPG expression and decreased RANKL/OPG ratio in IL-17 pro-inflammatory conditions. Furthermore, RvD1 increased the expression of RUNX2, OSX, BSP and OC/BGLAP2 and the mineralized extracellular matrix during MC3T3-E1 osteoblasts differentiation.

Conclusions

Repeated administrations of RvD1 promote bone regeneration via a dual mechanism: directly, via enhancement of osteoblasts' differentiation and indirectly, through reduction of osteoclastogenesis and RANKL/OPG ratio. This suggests that RvD1 may be a potential therapeutic bioagent for osseous regeneration following allograft implantation.

Flapless Decoronation: A Minimally Invasive Approach

Traumatic injuries to the permanent dentition are most common in children. In severe dentoalveolar injuries, especially avulsion and intrusion, dentoalveolar ankylosis is a common complication, leading to adverse effects on the developing alveolar bone and interfering with the eruption of the adjacent teeth. The decoronation procedure was suggested in 1984 to reduce these side effects related to ankylosis. The objective of the current publication is to describe a minimally invasive, flapless decoronation procedure aimed to minimize and simplify the surgical procedure of decoronation, and ease its clinical acceptance, particularly in young children. The technique is described in a detailed protocol and demonstrated in two cases. Under local anesthesia, the dental crown is removed, and the root is reduced by 1.5-2.0 mm apically to the marginal bone crest. The root canal content is then removed, allowing it to fill with blood. The socket is coronally sealed with a porcine-derived collagen matrix (PDCM) sutured using the "parachute" technique over the resected root, allowing close adaptation to the surrounding soft tissue. In conclusion, the presented technique of flapless decoronation is a modification of the classic decoronation procedure, which can be used as a minimally invasive technique to simplify the surgical procedure and the post-operative process.

The short-term effect of different chlorhexidine forms versus povidone iodine mouth rinse in minimizing the oral SARS-CoV-2 viral load: An open label randomized controlled clinical trial study

Several investigations evaluated the possibility of different types of mouth wash rinse in minimizing the SARS-CoV-2 load. However, results still controversial. The study aim is to assess the short-term efficiency of several over-the-counter mouth rinses and lozenges in minimizing the salivary viral load for SARS-CoV-2 in patients with confirmed COVID-19 in comparison to saline. This is a randomized controlled clinical trial with 4 arms. The recruited cases were randomized using a simple randomization technique and were assigned to chlorhexidine digluconate mouth rinse (CHX mouth rinse), 2 mg of chlorhexidine digluconate lozenges (CHX lozenges), povidone iodine mouth rinse (PVP-I mouth rinse) or saline as a control group. Saliva were collected from all study subjects by passive drool technique at two time points. First, prior to intervention with mouth rinse or the lozenges, the baseline saliva sample was collected. Second saliva samples were collected immediately after the mouth rinse. Real time PCR was conducted and the value threshold cycle (Ct) for each sample was recorded. Majority of the participants had an education level of high school or less (60%), were married (68.3), males (58.3%), and non-smokers (58.5%). No statistically significant differences between groups at the two times test (P > .05). However, a significant decrease of salivary viral load in all four groups combined (P-value for E genes = .027, and for S genes = .006), and in PVP-I mouth rinse specifically (P = .003 and P = .045, respectively). Povidone iodine mouth rinse showed a potential influence on the reduction of the viral load on a short-term basis. However, longer-term studies of the effect of these products should be conducted.

Histological and histomorphometric evaluation of alveolar ridge preservation using an allograft and nonresorbable membrane with and without primary closure: A pilot randomized controlled clinical trial

The aim of this article is to assess the formation of new vital bone (VB) using histomorphometric analysis in alveolar ridge preservation (ARP), with and without primary closure. Eight patients needed bilateral tooth extraction and planned for ARP. All patients had a nonresorbable membrane with freeze-dried bone allograft after the extractions. Biopsies were obtained 6 months after ARP and were evaluated using histomorphometric analysis. The study included 6 males and 2 females, with an average age of 54.2 years (standard deviation, 9.7). The teeth requiring extraction included a bilateral canine (1 case), premolars (5 cases), and molars (2 cases). Histomorphometric values of new VB, residual bone (RB) substitute particles, and marrow tissue formation were 71.1 %, 16.2%, and 9.69% for closed flap and 50.9%, 15.3%, and 8.19 for open flap. P values were 0.066, 0.878, and 0.326, respectively. The present findings indicate that leaving the flap without primary closure did not have any effect on new VB, RB particles, and immature bone marrow compared with closed flap. However, the results favored the closed-flap technique.

The perception of smile attractiveness to altered vertical position of maxillary anteriors by various groups

There is a gap in research about the differences in smile attractiveness. The problem the study addresses is how the vertical canine and incisor position affect smile attractiveness. The aim of this study was to assess the perception of the smile attractiveness between Saudi laypersons, orthodontists, non-orthodontist, and various dental students levels, and to determine how the canine and incisor vertical positions affect the attractiveness of smile. The study is a cross-sectional survey and was conducted at King Abdulaziz University, Jeddah, Saudi Arabia. Six groups of subjects participated in the study: Orthodontic residents (n = 31), prosthodontic, restorative, periodontics specialties residents specialties residents (n = 30), interns (n = 31), fifth year students (n = 41), 6th year students (n = 39), and laypeople (n = 39). Participants were asked to rate the attractiveness of a smile of a female subject photographed using a Minolta DiMage 7i digital camera. The image had been manipulated to produce 2 sets of images; 1 to modify the incisors and 1 to change the canines. The subjects were asked to choose the most and least attractive picture. For the best incisor positions, only the laypeople and prosthodontics liked the original picture, the rest liked +0.5 mm which accentuate the smile curve and make it follow the lower lip line. For the worst incisor position, all groups did not prefer the minus 1.5 reversed smile. For the best canine vertical position, all groups preferred the original position where canine was at the level of the incisal plane. For the worst canine position, they all disliked the minus 1.5 reversed smile. Results confirmed past findings that orthodontists are in general more critical about smile attractiveness than laypersons, but just like other dental specialists. The findings can be used in the esthetic dentistry field, but further research on the study population based on other dental design parameters remain necessary.

Food and Nutrient Displacement by Walnut Supplementation in a Randomized Crossover Study

The aim of this article is to evaluate the effect of a daily supplement of walnuts on the overall daily diet and nutrient profile of healthy adults. A randomized controlled trial with crossover design was conducted for two 6-month diet periods in southeast Californian communities. Subjects were randomized to receive a control diet or a walnut-supplemented diet, then switched. The walnut supplement represented approximately 12% of their daily energy intake. Trained nutritionists collected seven 24 h dietary recalls from each participant (a total of 14 recalls for both periods). Ninety participants were able to complete the study, including 50 females and 40 males. The average age of the participants was 54.3 years. Diets in the walnut period had significantly higher vegetable protein, total fat, total PUFA, PUFA 18:2, PUFA 22:6, and total dietary fiber (p < 0.05), while also exhibiting significantly lower PUFA 20:5. All mineral levels were higher on the walnut-supplemented diet. Calcium, phosphorus, magnesium, and zinc were, particularly, significantly higher among the walnut-supplemented group (p < 0.05). Displacement occurred in more than one-third of the entire nuts and seeds group; four-fifths of the non-alcoholic beverages and desserts groups; and the majority of the candy, sugar, and sweets group. Walnut supplementation can lead to favorable modifications in nutrient and food intake profiles that may contribute to chronic disease prevention. Nutrient and food displacement may be a mechanism to explain the favourable association between walnut intake and improved diet.

Medication-Related Osteonecrosis of the Jaw (MRONJ): A Review of Pathophysiology, Risk Factors, Preventive Measures and Treatment Strategies

Medication-related osteonecrosis of the jaw (MRONJ) is a major problem that can occur in people taking certain medications such bisphosphonates and denosumab. It can be used to treat osteoporosis or cancer. Bisphosphonate exposure, dental diseases and procedures, age, sex, anatomical factors, medical issues, and hereditary factors are all variables that enhance the risk of MRONJ. Even though MRONJ and antiresorptive medications have a close association, the pathophysiology of MRONJ is unknown. Careful dental preparation and oral hygiene instructions significantly minimize the risk of osteonecrosis of the jaw (ONJ). It is ideal to start antiresorptive treatment after the completion of required dental treatment; it is not contraindicated and carries low risk in patients who are on oral antiresorptive medications for less than three years. Drug holidays are one proposed solution to address MRONJ. However, there is still inadequate evidence to support their effectiveness. The objectives of this literature review are to recognize the main diagnostic principles and risk factors and to review the pathophysiology, protective procedures and treatment modalities related to MRONJ.

The following topics are covered in the review: epidemiology, diagnostic criteria, risk factors, pathogenesis and mechanism, MRONJ staging and symptoms, clinical and radiographic findings, treatment strategies, prevention and drug holiday.

Characteristics of Oral Manifestations in Symptomatic Non-Hospitalized COVID-19 Patients: A Cross-Sectional Study on a Sample of the Saudi Population

Purpose

Few case reports and letters to the editor have been published regarding oral signs and symptoms in COVID-19 patients. The aim of the study therefore is to investigate different types of oral manifestations in COVID-19 patients as well as their prevalence.

Patients and Methods

The study is a cross-sectional study from a single medical center. A convenience sample was taken from all patients who were COVID-19 confirmed, symptomatic, and non-hospitalized. Demographic information, medical and travel history, general symptoms, and clinical examination results of the oral cavity were collected.

Results

This study included a total of 109 patients. Loss of taste was the most common oral manifestation of COVID-19 (43.4%), followed by erythema/desquamated gingivitis and coated tongue (7.3% each) and ulcers/blisters (6.4%). Loss of taste was the only symptom persisting for 10 days. Oral manifestations appeared as a single symptom (79.3%), and dorsum of tongue was the most common oral location (72.4%).

Conclusion

Loss of taste was the most prevalent specific reported oral manifestation. Other nonspecific oral lesions/symptoms are controversial. It has been suggested that oral examinations of COVID-19 patients should be conducted as part of routine examinations to investigate any possible correlation between the disease and the oral cavity.

Dimensional and histomorphometric evaluation of biomaterials used for alveolar ridge preservation: a systematic review and network meta-analysis

OBJECTIVES

This systematic review and network meta-analysis aimed to answer to the following questions: (a) In patients undergoing alveolar ridge preservation after tooth extraction, which grafting material best attenuates horizontal and vertical ridge resorption, as compared to spontaneous healing?, and (b) which material(s) promotes bone formation in the extraction socket?

MATERIALS AND METHODS

The MEDLINE, SCOPUS, CENTRAL, and EMBASE databases were screened in duplicate for RCTs up to March 2021. Two independent authors extracted the data and assessed the risk of bias of the included studies. Primary outcomes were ridge horizontal and vertical dimension changes and new bone formation into the socket. Both pairwise and network meta-analysis (NMA) were undertaken to obtain estimates for primary outcomes and compare different grafting materials.

RESULTS

Eighty-eight RCTs were included, with a total of 2805 patients and 3073 sockets. Overall, a total of 1740 sockets underwent alveolar ridge preservation with different materials (1432 were covered by a membrane). Pairwise meta-analysis showed that, as compared to spontaneous healing, all materials statistically significantly reduced horizontal and vertical shrinkage. According to the multidimensional scale ranking of the NMA, xenografts (XG) and allografts (AG), alone or combined with bioactive agents (Bio + AG), were the most predictable materials for horizontal and vertical ridge dimension preservation, while platelet concentrates performed best in the percentage of new bone formation.

CONCLUSIONS

Alveolar ridge preservation is effective in reducing both horizontal and vertical shrinkage, as compared to untreated sockets. NMA confirmed the consistency of XG for ridge dimension preservation, but several other materials and combinations like AG, Bio + AG, and AG + alloplasts, produced even better results than XG in clinical comparisons. Further evidence is needed to confirm the value of such alternatives to XG for alveolar ridge preservation. Bio + AG performed better than the other materials in preserving ridge dimension and platelet concentrates in new bone formation. However, alloplasts, xenografts, and AG + AP performed consistently good in majority of the clinical comparisons.

CLINICAL RELEVANCE

XG and Bio + AG demonstrated significantly better performance in minimizing post-extraction horizontal and vertical ridge dimension changes as compared with other grafting materials or with spontaneous healing, even if they presented the worst histological outcomes. Allografts and other materials or combinations (AG + AP) presented similar performances while spontaneous healing ranked last.

Sealing materials for post-extraction site: a systematic review and network meta-analysis

Abstract

Aim

By means of a systematic review and network meta-analysis, this study aims to answer the following questions: (a) does the placement of a biomaterial over an extraction socket lead to better outcomes in terms of horizontal and vertical alveolar dimensional changes and percentage of new bone formation than healing without coverage? And (b) which biomaterial(s) provide(s) the better outcomes?

Materials and methods

Parallel and split-mouth randomized controlled trials treating ≥ 10 patients were included in this analysis. Studies were identified with MEDLINE (PubMed), Embase, Cochrane Central Register of Controlled Trials, and Scopus. Primary outcomes were preservation of horizontal and vertical alveolar dimension and new bone formation inside the socket. Both pairwise and network meta-analysis (NMA) were undertaken to obtain estimates for primary outcomes. For NMA, prediction intervals were calculated to estimate clinical efficacy, and SUCRA was used to rank the materials based on their performance; multidimensional ranking was used to rank treatments based on dissimilarity. The manuscript represents the proceedings of a consensus conference of the Italian Society of Osseointegration (IAO).

Results

Twelve trials were included in the qualitative and quantitative analysis: 312 sites were evaluated. Autologous soft tissue grafts were associated with better horizontal changes compared to resorbable membranes. A statistically significant difference in favor of resorbable membranes, when compared to no membrane, was found, with no statistically significant heterogeneity. For the comparison between crosslinked and non-crosslinked membranes, a statistically significant difference was found in favor of the latter and confirmed by histomorphometric NMA analysis. Given the relatively high heterogeneity detected in terms of treatment approaches, materials, and outcome assessment, the findings of the NMA must be interpreted cautiously.

Conclusions

Coverage of the healing site is associated with superior results compared to no coverage, but no specific sealing technique and/or biomaterial provides better results than others. RCTs with larger sample sizes are needed to better elucidate the trends emerged from the present analysis.

Clinical relevance

Autologous soft tissue grafts and membranes covering graft materials in post-extraction sites were proved to allow lower hard tissue shrinkage compared to the absence of coverage material with sealing effect. Histomorphometric analyses showed that non-crosslinked membranes provide improved hard tissue regeneration when compared to crosslinked ones.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00784-021-04262-3.

Shaping ability of 2Shape and NeoNiTi rotary instruments in preparation of curved canals using micro-computed tomography

Background

Various systems of nickel-titanium (NiTi) instrument have long been commercially available. However, the preparation of narrow and curved root canals has always been challenging. The purpose of this study was to compare the shaping ability of two NiTi systems (2Shape and NeoNiTi) in severely curved root canals with different morphological patterns using micro-computed tomography (Micro-CT).

Methods

A total of 22 human extracted permanent teeth of mandibular first molars, with the exact mesial angle of curvature of 25 and 35 degrees, according to Schneider’s technique, were distributed randomly into two groups (group I: 2Shape, group II: NeoNiTi) based on the rotary system used (n = 22). The groups were subdivided into two subgroups corresponding to the angle of canal curvature (25° and 35°) (n = 11). Canals were scanned using Micro-CT pre- and post-preparation to assess the volume of dentin removed; canal transportation; and canal centering ratio at 3, 6, and 9 mm from the apex. The Mann–Whitney U test was utilized to determine any significant differences between the two systems. The level of statistical significance was set at p < 0.05.

Results

There was no significant difference between the two groups in volume of dentin removed; canal transportation; and centering ability for 25° and 35° canal curvatures at 3, 6, and 9 mm from the apex (coronal, middle, and apical) thirds (p > 0.05). At the middle third, the NeoNiTi group demonstrated a statistically significant increase in volume of dentin removed for 35° canal curvatures compared to the 2Shape group.

Conclusion

Within the limitation of our in vitro study, 2Shape and NeoNiTi systems with severely curved canals were confirmed to be relatively safe in preparation and to respect original canal anatomy. Nevertheless, NeoNiTi instruments produced more centered preparation and minimal canal deviation compared to the 2Shape system.

Infection Control Practices at the Dental Clinics in Jeddah, Saudi Arabia

Purpose

The aims of this study were to determine the rate of compliance of infection control and estimate the incidence of COVID-19 in dental clinics in Jeddah, Saudi Arabia.

Materials and Methods

This is an ecological correlational study of randomly sampled dental clinics in the city of Jeddah. The 32-question survey used in the study was constructed based on the infection control guidelines/protocols during the COVID-19 pandemic released by the ADA, CDC, and SMOH. A sample of clinics from a dental clinic list in Jeddah city, using a simple random technique.

Results

Fifty-three dental clinics consented to participate in our study, while ten refused. Most of the dental clinics checked their patients’ temperature (30.2%) and strictly required them to wear a surgical mask before entering the clinic (58.5%). Glove, gown, and face mask were the most common methods of infection control used during all dental procedures (98.1%, 96.2%, and 94.3%, respectively). Moreover, the incidence of COVID-19 was the highest among receptions/security (18.70%), followed by nurses (14.3%) and dentists (11.79%).

Conclusion

As the incidence of COVID-19 among dental staff will continue to increase in the future, it is highly recommended that infection control guidelines are followed in all dental clinics.

Soft tissue dimensional changes after alveolar ridge preservation using different sealing materials: a systematic review and network meta-analysis

Background

Alveolar ridge preservation (ARP) is a proactive treatment option aiming at attenuating post-extraction hard and soft tissue dimensional changes. A high number of different types of biomaterials have been utilized during ARP to seal the socket, but their effectiveness in terms of soft tissue outcomes has rarely been investigated and compared in the literature.

Objective

To evaluate the efficacy of different types of membranes and graft materials in terms of soft tissue outcomes (keratinized tissue width changes, vertical buccal height, and horizontal changes) after ARP, and to assign relative rankings based on their performance.

Materials and methods

The manuscript represents the proceedings of a consensus conference of the Italian Society of Osseointegration (IAO).

PUBMED (Medline), SCOPUS, Embase, and Cochrane Oral Health’s Information Specialist were utilized to conduct the search up to 06 April 2021. English language restrictions were placed and no limitations were set on publication date. Randomized controlled trials that report ARP procedures using different sealing materials, assessing soft tissue as a primary or secondary outcome, with at least 6-week follow‐up were included.

Network meta-analysis (NMA) was performed using mean, standard deviation, sample size, bias, and follow-up duration for all included studies. Network geometry, contribution plots, inconsistency plots, predictive and confidence interval plots, SUCRA (surface under the cumulative ranking curve) rankings, and multidimensional (MDS) ranking plots were constructed.

Results

A total of 11 studies were included for NMA. Overall, the level of bias for included studies was moderate. Crosslinked collagen membranes (SUCRA rank 81.8%) performed best in vertical buccal height (VBH), autogenous soft tissue grafts (SUCRA rank 89.1%) in horizontal width change (HWch), and control (SUCRA rank 85.8%) in keratinized mucosa thickness (KMT).

Conclusions

NMA confirmed that the use of crosslinked collagen membranes and autogenous soft tissue grafts represented the best choices for sealing sockets during ARP in terms of minimizing post-extraction soft tissue dimensional shrinkage.

Clinical relevance

Grafting materials demonstrated statistically significantly better performances in terms of soft tissue thickness and vertical buccal height changes, when covered with crosslinked collagen membranes. Instead, soft tissue grafts performed better in horizontal width changes. Non-crosslinked membranes and other materials or combinations presented slightly inferior outcomes.

Effect of alveolar ridge preservation on clinical attachment level at adjacent teeth: A randomized clinical trial

PURPOSE

To test whether or not alveolar ridge preservation (ARP) changes the clinical attachment level (CAL) at adjacent teeth of extraction sockets after 6 months.

MATERIAL AND METHODS

Seventeen patients requiring bilateral tooth extractions of the upper molars were recruited. After tooth extraction, the sockets were randomly allocated to two groups applying a split-mouth design: (1) ARP using deproteinized bovine bone mineral containing 10% collagen (DBBM-C) covered by a collagen membrane and (2) spontaneous healing (control). CAL, probing pocket depth (PD), bleeding on probing (BOP), gingival recession (REC), and bone levels were evaluated at the adjacent teeth of the extraction sockets at baseline and after 6 months of follow-up.

RESULTS

A total of 14 patients were available for reexamination. From baseline to 6 months of follow-up mean CAL changes of all six sites at adjacent teeth of the extraction sockets amounted to -0.23 ± 0.65 mm (gain) in ARP group and 0.05 ± 0.86 mm (loss) in the control group with significant differences in favor of ARP (p = 0.04). The CAL gain was significantly more favorable at mesiopalatal sites (p = 0.01). Consistently, the mean reduction of PD of all six sites amounted to -0.68 ± 0.84 mm in ARP and -0.34 ± 0.74 mm in the control group (intergroup p = 0.02). The PD reduction was significant (p = 0.001) at the mesiopalatal sites in ARP. BOP, REC, and bone levels showed no significant differences between the groups (intergroup p > 0.05).

CONCLUSION

Although ARP with DBBM-C revealed a trend toward CAL gain and PD reduction at adjacent teeth of extraction sites, these adjunctive benefits seem to be clinically negligible.

Factors associated with a late visit to dentists by children: A cross-sectional community-based study in Saudi Arabia

Objectives

This cross-sectional study aims to determine children's age at their first visit to dentists and factors associated with these visits.

Methods

This cross-sectional community survey-based study was conducted in 2019 during the events of the 10th Gulf Oral Health Week in Jeddah, Saudi Arabia. All participants including visitors and dentists, with current or previous experience in caring for children aged six months to ten years, provided their consents for the study.

Results

Among the visitors, 348 participated in the survey. Most children, aged three to ten years, first visited the dentist with complaints of pain and dental cavities. The risk of a late visit to the dentist increased (OR: 2.28; CI 95%: 1.01–5.14) among caregivers who did not help their children brush their teeth. Using the Internet for accessing health information negatively impacted the visits (OR: 27.00; CI 95% 1.26–57.35). While employed mothers took their children to the dentist at an earlier age (OR: 2.284; CI 95% 1.08–4.79), early visits were mostly missed by mothers with smaller families (OR: 0.043; CI 95% 0.48–0.98).

Conclusion

The results of our study show that the caregiver's attitude, source of health information, employment, age, and number of children are risk factors associated with late visits to dentists.

Interventions for replacing missing teeth: alveolar ridge preservation techniques for dental implant site development

BACKGROUND

Alveolar bone changes following tooth extraction can compromise prosthodontic rehabilitation. Alveolar ridge preservation (ARP) has been proposed to limit these changes and improve prosthodontic and aesthetic outcomes when implants are used. This is an update of the Cochrane Review first published in 2015.

OBJECTIVES

To assess the clinical effects of various materials and techniques for ARP after tooth extraction compared with extraction alone or other methods of ARP, or both, in patients requiring dental implant placement following healing of extraction sockets.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 19 March 2021), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2021, Issue 2), MEDLINE Ovid (1946 to 19 March 2021), Embase Ovid (1980 to 19 March 2021), Latin American and Caribbean Health Science Information database (1982 to 19 March 2021), Web of Science Conference Proceedings (1990 to 19 March 2021), Scopus (1966 to 19 March 2021), ProQuest Dissertations and Theses (1861 to 19 March 2021), and OpenGrey (to 19 March 2021). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. A number of journals were also handsearched.

SELECTION CRITERIA

We included all randomised controlled trials (RCTs) on the use of ARP techniques with at least six months of follow-up. Outcome measures were: changes in the bucco-lingual/palatal width of alveolar ridge, changes in the vertical height of the alveolar ridge, complications, the need for additional augmentation prior to implant placement, aesthetic outcomes, implant failure rates, peri-implant marginal bone level changes, changes in probing depths and clinical attachment levels at teeth adjacent to the extraction site, and complications of future prosthodontic rehabilitation.

DATA COLLECTION AND ANALYSIS

We selected trials, extracted data, and assessed risk of bias in duplicate. Corresponding authors were contacted to obtain missing information. We estimated mean differences (MD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes, with 95% confidence intervals (95% CI). We constructed 'Summary of findings' tables to present the main findings and assessed the certainty of the evidence using GRADE.

MAIN RESULTS

We included 16 RCTs conducted worldwide involving a total of 524 extraction sites in 426 adult participants. We assessed four trials as at overall high risk of bias and the remaining trials at unclear risk of bias. Nine new trials were included in this update with six new trials in the category of comparing ARP to extraction alone and three new trials in the category of comparing different grafting materials. ARP versus extraction: from the seven trials comparing xenografts with extraction alone, there is very low-certainty evidence of a reduction in loss of alveolar ridge width (MD -1.18 mm, 95% CI -1.82 to -0.54; P = 0.0003; 6 studies, 184 participants, 201 extraction sites), and height (MD -1.35 mm, 95% CI -2.00 to -0.70; P < 0.0001; 6 studies, 184 participants, 201 extraction sites) in favour of xenografts, but we found no evidence of a significant difference for the need for additional augmentation (RR 0.68, 95% CI 0.29 to 1.62; P = 0.39; 4 studies, 154 participants, 156 extraction sites; very low-certainty evidence) or in implant failure rate (RR 1.00, 95% CI 0.07 to 14.90; 2 studies, 70 participants/extraction sites; very low-certainty evidence). From the one trial comparing alloplasts versus extraction, there is very low-certainty evidence of a reduction in loss of alveolar ridge height (MD -3.73 mm; 95% CI -4.05 to -3.41; 1 study, 15 participants, 60 extraction sites) in favour of alloplasts. This single trial did not report any other outcomes. Different grafting materials for ARP: three trials (87 participants/extraction sites) compared allograft versus xenograft, two trials (37 participants, 55 extraction sites) compared alloplast versus xenograft, one trial (20 participants/extraction sites) compared alloplast with and without membrane, one trial (18 participants, 36 extraction sites) compared allograft with and without synthetic cell-binding peptide P-15, and one trial (30 participants/extraction sites) compared alloplast with different particle sizes. The evidence was of very low certainty for most comparisons and insufficient to determine whether there are clinically significant differences between different ARP techniques based on changes in alveolar ridge width and height, the need for additional augmentation prior to implant placement, or implant failure. We found no trials which evaluated parameters relating to clinical attachment levels, specific aesthetic or prosthodontic outcomes for any of the comparisons. No serious adverse events were reported with most trials indicating that the procedure was uneventful. Among the complications reported were delayed healing with partial exposure of the buccal plate at suture removal, postoperative pain and swelling, moderate glazing, redness and oedema, membrane exposure and partial loss of grafting material, and fibrous adhesions at the cervical part of previously preserved sockets, for the comparisons xenografts versus extraction, allografts versus xenografts, alloplasts versus xenografts, and alloplasts with and without membrane.

AUTHORS' CONCLUSIONS

ARP techniques may minimise the overall changes in residual ridge height and width six months after extraction but the evidence is very uncertain. There is lack of evidence of any differences in the need for additional augmentation at the time of implant placement, implant failure, aesthetic outcomes, or any other clinical parameters due to lack of information or long-term data. There is no evidence of any clinically significant difference between different grafting materials and barriers used for ARP. Further long-term RCTs that follow CONSORT guidelines (www.consort-statement.org) are necessary.

Prognosis of single tooth implants following alveolar ridge preservation with two recombinant human bone morphogenetic protein-2 delivery systems

Background

We previously reported similar efficacies of alveolar ridge preservation (ARP) on single extraction socket with two different E. coli derived recombinant human bone morphogenetic protein-2 (rhBMP-2) delivery systems (Cowell BMP, Cowell medi Co, Busan, Korea; β-tricalcium phosphate and hydroxyapatite particle & O-BMP, Osstem Implant Co, Busan, Korea; absorbable collagen sponge). After the trial, we completed implant therapy and observed over an average of 3 years. This follow-up study was performed retrospectively to compare result of implant treatment at the preserved alveolar ridge site.

Methods

Patients who underwent extraction of single tooth and received ARP with one of two rhBMP-2 delivery systems from October 2015 to October 2016 were enrolled. Twenty-eight patients (Group 1: Cowell BMP 14; Group 2: O-BMP 14) who underwent implant therapy and prosthetic treatment were included in study. Stability and marginal bone loss (MBL) of each implant were collected from medical charts and radiographs, and analyzed. The survival and success rates of implants were calculated.

Results

The primary implant stability represented by implant stability quotient (ISQ) for Groups 1 and 2 was 69.71 and 72.86, respectively. The secondary implant stability for Groups 1 and 2 was 78.86 and 81.64, respectively. Primary and secondary stabilities were not statistically different (P = 0.316 and 0.185, respectively). MBL at the latest follow-up was 0.014 mm in Group 1 over 33.76 ± 14.31 months and 0.021 mm in Group 2 over 40.20 ± 9.64 months, with no significant difference (P = 0.670). In addition, the success rate of implants was 100% (14/14) in Group 1 and 92.9% (13/14) in Group 2, with survival rate of 100% (14/14) in Group 1 and 92.9% (13/14) in Group 2.

Conclusions

We confirmed good prognosis in both groups as a result of implant therapy after ARP with each of two rhBMP-2 carriers.

Socket seal surgery techniques in the esthetic zone: a systematic review with meta-analysis and trial sequential analysis of randomized clinical trials

Background

The socket seal surgery (SSS) technique is a common alternative for the management of the post-extraction sockets that requires a primary closure of the wound to promote proper regeneration and ridge preservation.

Objective

To learn about the effect of different SSS techniques on alveolar ridge preservation

Material and methods

Two independent and calibrated reviewers conducted an electronic search in PubMed, Cochrane, and Web of Science for randomized clinical trials (RCT) published up to June 2020. The evaluation of the risk of bias in the included studies was carried out following the Cochrane manual for interventions of systematic reviews, version 5.1.0. A meta-analysis of ridge width changes at − 1, − 3, and − 5 mm cutoff points from bone crest was conducted using a random-effects model. The risk of types I and II errors against accrued data was appraised obtaining the required information size using a trial sequential analysis package (TSA).

Results

A total of 135 sockets located in the esthetic zone were evaluated with a minimum of a 3-month follow-up after tooth extraction in 6 RCTs. The evaluated SSS techniques were free gingival graft (FGG), collagen matrix (CM), collagen sponge (CS), acellular dermal matrix (ADM), and polytetrafluoroethylene membrane (PTFEm). The FGG in sockets without bone filling showed significant results in preserving both buccal and lingual bone height (− 1.42 mm in the experimental group versus − 0.01 in the control group). The comparison of CM and FGG with bone filling did not show clinical differences in terms of dimensional bone changes. No clinical differences were found in either width or gingival thickness when comparing CM and CS. The meta-analyses of RW changes comparing CM versus FGG showed no significant differences, but a trend for lessening horizontal reduction at − 1, − 3, and − 5 mm in favor of FGG. The TSA showed that accrued data did not reach the required information size, and more evidence is required for clinical significance inferences.

Conclusions

There are several predictable SSS techniques to improve clinical results in ridge preservation. More clinical studies in the form of clinical trials are required to demonstrate the superiority of one technique over another.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40729-021-00294-2.

Characteristics of First Cases of Coronavirus Disease 2019 and the Effort to Prevent the Early Spread of COVID-19 in Saudi Arabia

PURPOSE

To characterize the overall trends in early cases of COVID-19 and to identify the key points of the government effort to minimize the infection.

PATIENTS AND METHODS

A retrospective review and data were retrieved through online sources and the Saudi Ministry of Health daily announcements that were available online. The data included the number of infections per day, and the gender, nationality, location, source of infection, incidence, rate of recovery, and the rate mortality of COVID-19 patients in Saudi Arabia between March 1 and March 16, 2020.

RESULTS

The incidence of COVID-19 increased in the first two weeks in Saudi Arabia, from zero cases on March 1 to more than 15 cases per day on March 16, with a total of 133 cases. The majority of patients were males (54.9%), of Saudi descent (54.9%), and had travel as their source of infection (57.1%). Most of the cases were in Makah (37.6%); however, there were increases in cases in all cities. Moreover, the Saudi government enacted several steps to minimize the spreading of infection. There was no statistical significance between source of infection with gender (p = 0.323). However, there was statistical significance between source of infection and nationality (p < 0.001).

CONCLUSION

The incidence of COVID-19 cases is expected to continue to increase. However, the efforts of the Saudi government are crucial in minimizing the spread of this infection.

Effects of Annona muricata Extract on Triple-Negative Breast Cancer Cells Mediated Through EGFR Signaling

Purpose

To evaluate the antiproliferative activity and the mechanisms of action of Annona muricata ethyl acetate (AMEA) extract and one of its active fractions on BT-20 TNBC cells.

Methods

The triple-negative human breast cancer BT-20 cells were used. After the preparation and extraction of Annona muricata ethyl acetate (AMEA), the ethyl acetate extract was exposed to a preparative thin layer chromatography (TLC) plate. From this preparative TLC plate, eight individual bands were collected. Each band was scraped and removed from the plate and soaked in ethyl acetate. After filtration, all eight fractions were then tested on the BT-20 TNBC cells using the MTS cell viability assay. The expressions of EGFR, p-EGFR, AKT, p-AKT, MAPK, p-MAPK, cyclin D1, and NF-κB p65 were measured using Western blot analysis.

Results

The AMEA showed a significant decrease in NF-κB p65 protein expression and BT-20 cell viability, as determined via the MTS assay. Furthermore, the AMEA was subjected to preparative thin layer chromatography (TLC), and eight fractions were obtained. From the eight fractions, only fraction 4 (F4) showed a significant reduction in cell viability in the MTS assay. Immunoblotting analysis revealed that AMEA and F4 formed an antiproliferative effect. These effects were complemented by a downregulation of cyclin D1 assembly, causing cell-cycle arrest at the G1/S phase. Furthermore, NF-κB was measured because of its involvement in the progression of cancers.

Conclusion

The antiproliferative influence is produced through EGFR-mediated signaling pathways, which include AKT, MAPK, NF-κB, and cyclin D1 inhibition. Further studies will be required to demonstrate the possible applications of this natural product in breast cancer therapy.

Soft-Tissue Changes After Using Collagen Matrix Seal or Collagen Sponge With Allograft in Ridge Preservation: A Randomized Controlled Volumetric Study

The objective of this study is to assess alterations in buccal soft-tissue contour after alveolar ridge preservation (ARP) using either a collagen matrix seal (CMS) or a collagen sponge (CS) as barriers with freeze-dried bone allograft (FDBA). Participants (28 total) were randomly assigned to the CMS group or CS group (14 participants each). The same clinical steps were used in both barriers. Cast models were taken at baseline and 4 months, and both models were then optically scanned and digitally superimposed. Volumetric, surface, and distance-adjusted measurements were calculated to assess buccal soft-tissue alterations. Surface area and volume loss in the CMS group were observed to be 71.44 ± 1189.09 mm2 and 239.58 ± 231.89 mm3, respectively. The CS group showed measurements of 139.56 ± 557.92 mm2 and 337.23 ± 310.18 mm3. Mean buccal soft-tissue loss and minimum-maximum distance loss were less in the CMS group (0.88 ± 0.52 mm and 0.2-2.15 mm, respectively) as compared with the CS group (1.63 ± 1.03 mm and 0.3-3.68 mm, respectively), with no statistically significant difference between the groups (P = .2742). Both alveolar ridge preservation barriers were unable to entirely prevent soft-tissue contour changes after extraction. However, collagen matrix seal application was slightly better in minimizing the amount of soft-tissue reduction compared with the CS.

A Simplified Procedure for Biologically-oriented Alveolar Ridge Preservation: Clinical and Histological Findings From a Case Report

INTRODUCTION

A recent systematic review failed to identify one approach for alveolar ridge preservation (ARP) with superior outcomes compared with the others. The present case report presents a novel, simplified technique for ARP, namely the Biologically-oriented Alveolar Ridge Preservation (BARP), based on socket grafting and sealing.

CASE PRESENTATION

After extraction of tooth #19, the socket was filled with a collagen sponge up to 4-5 mm from the most coronal extension of the bone crest (deep collagen layer). A bovine-derived xenograft was placed on top of the collagen sponge to fill the coronal part of the socket (graft layer). Socket sealing was then performed by placing a collagen sponge over the exposed portion of the graft (superficial collagen layer), and the wound healed by secondary intention. At implant insertion (4 months after ARP), limited reduction in bone width and no vertical change in ridge height were observed. Histological analysis of a biopsy specimen retrieved during implant site preparation showed a gradient ranging from interconnected trabeculae of mature, lamellar bone in the apical portion to cancellous bone incorporating a modest number of remodeled graft granules in the central portion. In the coronal portion, non-mineralized tissue with sparse isles of newly formed cancellous bone and residual graft granules was found.

CONCLUSION

The present case report indicates that BARP might provide ideal conditions for preserving the pre-existing alveolar ridge dimensions following tooth extraction while restricting any potential interference of the graft biomaterial with bone healing dynamics to the coronal part of the socket.

Three-Dimensional Volumetric Changes After Socket Augmentation with Deproteinized Bovine Bone and Collagen Matrix

PURPOSE

Socket augmentation decreases the magnitude of alveolar ridge resorption, but the literature is limited in respect to quantifying soft tissue remodeling. The aim of this study was to determine the volumetric and linear dimensional changes at the buccal surface for both hard and soft tissues after socket augmentation treated with a xenogeneic collagen matrix in combination with bone grafting.

MATERIALS AND METHODS

Twenty-four individuals indicated for tooth extraction were enrolled in this investigation. Each participant was randomly assigned to one of two groups: (1) deproteinized bovine bone + collagen plug, or (2) deproteinized bovine bone + xenogeneic collagen matrix. A cone beam computed tomography scan was taken prior to extraction and at 6 months postextraction. Intraoral scanning images were taken at baseline, 3 months, and 6 months postextraction. Hard and soft tissue analyses were performed to compare linear ridge remodeling and volumetric changes by noncontact reverse-engineering software.

RESULTS

Both groups showed bone and soft tissue remodeling. For hard tissue remodeling, there was no significant difference between the collagen plug and collagen matrix groups. For soft tissue remodeling, the collagen matrix group showed a reduced soft tissue loss compared with the collagen plug group. The volumetric analysis demonstrated that the mean buccal soft tissue volume loss for the collagen matrix group was 68.6 mm³ compared with 87.6 mm³ found in the collagen plug group (P = .009) over a 6-month period.

CONCLUSION

This clinical investigation provides early evidence of using the total tissue volume to compare soft and hard tissue remodeling after socket augmentation. The results of this study demonstrated that the use of a xenogeneic collagen matrix reduced the buccal soft tissue loss after tooth extraction, but additional studies are necessary to evaluate the clinical significance of soft tissue augmentation after tooth extraction.

Annual alveolar bone loss in subjects with cardiovascular disease adjusting for associated systemic diseases and risk factors: a retrospective study

BACKGROUND

To detect annual alveolar bone loss in subjects with cardiovascular disease (CVD) adjusting for associated systemic diseases and risk factors.

METHODS

A total number of 132 subjects that reported having CVD from 2008 to 2015 (N = 132). For longitudinal data analysis, 58 subjects eligible for inclusion with at least two exposures of complete mouth set or repeated BW radiographs with at least one-year interval compared with a control group. Alveolar bone level on mesial and distal sites of posterior teeth was measured on bitewing (BW) radiographs available in the electronic health records of each subject.

RESULTS

Subjects who reported having cardiovascular diseases experienced higher annual mean alveolar bone loss (0.062 mm per year) compared to Subjects with no cardiovascular diseases (0.022 mm per year).

CONCLUSION

Subjects who have reported CVD had higher rate of annual bone loss compared to subjects who did not have any CVD. This observation indicates that targeting high-risk individuals for risk assessment is fundamental to provide the best healthcare possible to those who are the most in need. Periodic examination and assessment of periodontal health is an essential key factor for better oral health, however, it has to be more emphasized and prioritized for individuals that are more prone to the disease.

Deproteinized bovine bone mineral is non-inferior to deproteinized bovine bone mineral with 10% collagen in maintaining the soft tissue contour post-extraction: A randomized trial

OBJECTIVES

To test the non-inferiority of demineralized bovine bone mineral (DBBM) compared to demineralized bovine bone mineral with 10% collagen (DBBM-C) for the maintenance of the soft tissue contour after tooth extraction in the esthetic zone.

MATERIAL AND METHODS

Sixty-five patients randomly received ridge preservation at a single site in the anterior maxilla with DBBM or DBBM-C. Both, DBBM and DBBM-C, were covered with a collagen matrix. Profilometric analyses were performed at baseline (BL), immediately after treatment (PO), and at 4 months (FU; day of implant placement). The main outcome was the horizontal mean change (HC) at the buccal aspect. The measurements also included changes of the estimated soft tissue thickness (eTT) at 1, 3, and 5 mm below the buccal gingival margin. Descriptive analysis was performed, and differences between groups were analyzed using independent samples t test. The non-inferiority test was performed for HC.

RESULTS

At 4 months, the horizontal mean change (HC) was -1.43 mm (±0.53 mm) (DBBM-C) and -1.32 mm (±0.53 mm) (DBBM). Change of the estimated soft tissue thickness (eTT) between baseline (BL) and four months of follow-up (FU) at 1, 3, and 5 mm amounted to -4.58 mm (±2.02 mm), -2.40 mm (±0.97 mm), and -1.37 mm (±0.78 mm) for DBBM-C and to -4.12 mm (±1.80 mm), -2.09 mm (±0.91 mm), and -1.23 mm (±0.72 mm) for DBBM. The differences between the groups were not statistically significantly for any of the outcome measures (p > .05).

CONCLUSIONS

DBBM is non-inferior to DBBM-C for the maintenance of the soft tissue contour 4 months after tooth extraction.

Omega-3 Fatty Acids Effects on Inflammatory Biomarkers and Lipid Profiles among Diabetic and Cardiovascular Disease Patients: A Systematic Review and Meta-Analysis

The purpose of this systematic review and meta-analysis was to investigate omega-3 fatty acids’ influence on 12 inflammatory biomarkers—LDL, HDL, total cholesterol, TG, HbA1c, Apo AI, Apo AII, Apo B, CRP, TNF-α, glucose, and fasting blood glucose among diabetic and cardiovascular disease (CVD) patients. We searched articles in six database engines, and 16 of the 696 articles reviewed met the inclusion criteria. Among these, lipid and inflammatory biomarkers investigated commonly included total cholesterol (11 studies), LDL, and TG (10 studies each). Overall, omega-3 was associated with a significant reduction in Apo AII among diabetic patients, as compared to different controls (−8.0 mg/dL 95% CI: −12.71, −3.29, p = 0.0009), triglycerides (−44.88 mg/dL 95% CI: −82.6, −7.16, p < 0.0001), HDL (−2.27 mg/dL 95% CI: −3.72, −0.83, p = 0.002), and increased fasting blood glucose (16.14 mg/dL 95% CI: 6.25, 26.04, p = 0.001). Omega-3 also was associated with increased LDL among CVD patients (2.10 mg/dL 95% CI: 1.00, 3.20, p = 0.0002). We conclude that omega-3 fatty acids may be associated with lower inflammatory biomarkers among diabetic and cardiovascular patients. Clinicians should be aware of these potential benefits; however, it is essential to recommend that patients consult with clinicians before any omega-3 intake.

Prevalence of periodontitis and alveolar bone loss in a patient population at Harvard School of Dental Medicine

Background

Although several studies assessed the prevalence of alveolar bone loss, the association with several risk factors has not been fully investigated. The aim of this article is to measure the prevalence of periodontitis by calculating the mean alveolar bone loss/level of posterior teeth using bitewing radiographs among the patients enrolled in the clinics at Harvard School of Dental Medicine and address risk factors associated with the disease.

Methods

One thousand one hundred thirty-one patients were selected for radiographic analysis to calculate the mean alveolar bone loss/level by measuring the distance between the cementoenamel junction and the alveolar bone crest on the mesial and distal surfaces of posterior teeth. Linear regression with Multi-level mixed-effect model was used for statistical analysis adjusting for age, sex, race, median household income, and other variables.

Results

Mean alveolar bone level of the whole sample was 1.30 mm (±0.006). Overall periodontitis prevalence for the sample was 55.5% (±1.4%). Moderate periodontitis prevalence was 20.7% (±1.2%), while 2.8% (±0.5%) of the whole sample had severe periodontitis. Adjusted mean alveolar bone loss was higher in older age groups, males, Asian race group, ever smokers, and patients with low median household income.

Conclusion

The effect of high household income on the amount of bone loss can be powerful to the degree that high household income can influence outcomes even for individuals who had higher risks of developing the disease. Public health professionals and clinicians need to collaborate with policy makers to achieve and sustain high quality of healthcare for everyone.

The Influence of Different Grafting Materials on Alveolar Ridge Preservation: a Systematic Review

Objectives

The purpose of the present review was to evaluate the effect of different bone substitutes used for alveolar ridge preservation on the post extraction dimensional changes.

Material and Methods

An electronic literature search in MEDLINE (PubMed), EMBASE (OVID) and Cochrane (CENTRAL) were performed, in addition to a manual search through all periodontics and implantology-related journals, up to December 2018. Inverse variance weighted means were calculated for all the treatment arms of the included trials for the quantitative analysis.

Results

Forty randomized controlled trials were included in the quantitative analysis. Dimensional changes were obtained from clinical measurements and three-dimensional imaging. The average amount of horizontal ridge resorption was 1.52 (SD 1.29) mm (allograft), 1.47 (SD 0.92) mm (xenograft), 2.31 (SD 1.19) mm (alloplast) and 3.1 (SD 1.07) mm for unassisted healing. Similarly, for all the evaluated parameters, the spontaneous healing of the socket led to higher bone loss rate than the use of a bone grafting material.

Conclusions

The utilization of a bone grafting material for alveolar ridge preservation reduces the resorption process occurring after tooth extraction. However, minimal differences in resorption rate were observed between allogeneic, xenogeneic and alloplastic grafting materials.

Prospective Clinical and Histologic Evaluation of Alveolar Socket Healing Following Ridge Preservation Using a Combination of Hydroxyapatite and Collagen Biomimetic Xenograft Versus Demineralized Bovine Bone

PURPOSE

This prospective study is aimed at investigating clinically and histologically the effectiveness of a biomimetic magnesium-enriched-hydroxyapatite (MgHA)/collagen-based bone substitute for alveolar socket preservation.

MATERIALS

Patients scheduled for posterior single tooth extraction were included. The alveolar socket was filled either with MgHA or deproteinized bovine bone matrix (DBBM). In DBBM group, a punch of mucosa was taken from the palate and used to cover the graft. Vertical and horizontal dimensional changes of the alveolar process were assessed clinically with a periodontal probe and with 3-dimensional (3D) analysis of a cast model. Postoperative quality of life was assessed through a questionnaire. After 6 months of healing, an alveolar tissue biopsy was taken for histologic and histomorphometric analysis of the newly formed tissue. After checking normality of the distributions, parametric or nonparametric tests were used for statistical comparisons.

RESULTS

Twenty patients (12 males, 8 females, mean age 42.8 ± 5.1 years, range 33-50 years) were treated. After 6 months, vertical and horizontal alveolar ridge resorption was similar in the 2 groups. The 3D analysis of the models showed a significantly higher resorption at the buccal side than at the palatal/lingual side. Histomorphometric analysis showed similar new bone formation for MgHA group (23.07 ± 10.3%) and DBBM (22.77 ± 6.95%), and a significantly higher residual material% for DBBM (15.77 ± 1.95%) than MgHA (5.01 ± 1.04%). Significantly less pain was reported in the first 3 days after surgery in patients of the MgHA group.

CONCLUSION

The MgHA was as safe and effective as DBBM and may represent a feasible bone substitute for alveolar socket preservation.

A Comparison between Primary and Secondary Flap Coverage in Ridge Preservation Procedures: A Pilot Randomized Controlled Clinical Trial

Aims

To assess the bone dimensional changes after extraction and alveolar ridge preservation (ARP) using primary coverage (closed flap technique, CFT) or healing by secondary intention (open flap technique, OFT).

Materials and Methods

Ten patients (split mouth design) were planned for extraction and ARP. All sites received ARP with freeze-dried bone allograft (FDBA) and nonresorbable membrane after extraction. Clinical standardized measurements were used to assess the dimensional alterations of the alveolar ridge.

Results

All patients completed the study, and a total of 20 sites were randomized to CFT or OFT group. Center height (mean difference of 8.1 mm, SD =1.9 CFT, and 7.5 mm, SD= 1.8 OFT) and buccal height (mean difference of 0.8 mm, SD =1.0 CFT, and 0.3 mm, SD= 1.1 OFT) were significantly different within the same group. However, there was no statistically significant difference between groups. In the OFT group, the keratinized tissue width was higher and the pain VAS scores at 24 hours were lower compared with the CFT (p = 0.004 and p = 0.006, respectively).

Conclusions

Leaving the flap open did not have any effects on the dimensional changes of bone height or width. However, there was a wider band of keratinized tissue and less pain with the CFT compared with the OFT. The study protocol was registered at ClinicalTrials.gov, Identifier NCT03136913.

Alveolar Ridge Preservation after Tooth Extraction Using Different Bone Graft Materials and Autologous Platelet Concentrates: a Systematic Review

Objectives

To review and assess the efficiency of different post extraction socket preservation techniques.

Material and Methods

An electronic literature search was performed on the MEDLINE and Embase databases. The review included human studies published between from January 1^st, 2007 to January 1^st, 2018, in English. Outcome measures included dimensional changes and/or histological evaluation of alveolar bone.

Results

Twenty-six full text articles were reviewed, 16 of which met the inclusion criteria and were selected for the study. Autogenous tooth graft prevented vertical resorption the most: -0.28 (SD 0.13) mm, observation period (OP): 4 months, while the least effective approach was beta tri-calcium phosphate (β-TCP): -1.72 (SD 0.56) mm, OP: 4 months. Estimating horizontal resorption, the most effective technique was biphasic calcium sulphate (BCS) with β-TCP and hydroxyapatite (HA) - BCS + TCP + HA: 0.03 (SD 2.32) mm, OP: 4 months, while β-TCP was the least efficient: -1.45 (SD 0.4) mm, OP: 4 months. Evaluating residual graft particles (RG) and newly formed bone (NFB) ratio the best results were achieved with demineralized freeze-dried bone allograft: RG: 8.88%, NFB: 38.42%, OP: 5 months, whereas magnesium-enriched hydroxyapatite was least effective: RG: 40.82%, NFB: 31.85%, OP: 4 months.

Conclusions

This review revealed that even though there are numerous types of biomaterials for socket preservation none of them can completely stop alveolar bone loss after tooth extraction. Furthermore, lack of information about qualitative evaluation of bone was noticed indicating that further studies regarding this topic are needed.

The Effect Of Social Media On The Choice Of Dental Patients: A Cross-Sectional Study In The City Of Jeddah, Saudi Arabia

BACKGROUND AND PURPOSE

In the past few years, social networking sites have received great attention in the health field by health practitioners and researchers, as well as health centers. The aim of this research is to investigate the important factors of patients (male or female) when choosing a dental practice, and the effectiveness of a social media presence for a dental practice to engage with and obtain new patients, as well as the return on investment of social media marketing.

PATIENTS AND METHODS

400 random sample patients in the city of Jeddah, Saudi Arabia participated. The inclusion criteria were the following: patients above the age of 16 years, patients who have previously visited the dentist, patients who use social networking sites, patients who are fluent in Arabic or English, and patients residing in Saudi Arabia. The questionnaire was divided into four main sections and included questions revolving around the person's use of social networking sites and the factors influencing his/her decision to choose his/her dentist, especially those related to social networking sites.

RESULTS

The data collection entailed capturing 400 patients' responses; the majority of participants were between the age of 18 and 25 years old, and more than half of them were males (54.4%). The majority of patients had a social media account (95.3%), however, 4.7% of patients did not have a specific social media account, but they still used social media to get updated. We also found that the most popular platform to use for patients was Snapchat, at 75.1%, followed by Instagram, at 73.8%. Females tended to be more interested in having a social media platform to inform them about a dental practice and almost all factors.

CONCLUSION

The presence of the dentist in social networking sites and correct interaction with them is important to reach new patients and communicate with his/her former patients.