Antibacterial Properties of Aloe vera on Intracanal Medicaments against Enterococcus faecalis Biofilm at Different Stages of Development

Exploring the therapeutic potential of medicinal plants and their active principles in dental care: A comprehensive review

Since the human population realized how important it was to maintain overall health and the weight of disease, they have been looking for therapeutic qualities in natural environments. The use of plants having medicinal qualities for the treatment and prevention of illnesses that may have an impact on general health is known as herbal medicine. There has been a noticeable increase in interest lately in the combination of synthetic contemporary medications and traditional herbal remedies. About 80 % of people rely on it for healthcare, particularly in developing nations. One important aspect of overall health is said to be oral healthcare. The World Health Organization views oral health as a crucial component of overall health and well-being. Because they are more readily available, less expensive, and have fewer adverse effects than pharmaceutical treatments, using natural medicines to treat pathologic oro-dental disorders can make sense. The current evaluation of the literature sought to investigate the range and scope of the use of herbal products and their secondary metabolites in maintaining oral health, encompassing several oral healthcare domains such as halitosis, gingivitis, periodontitis, and other oral disorders. Therefore, there are many herbs discussed in this work and their mechanism in the treatment and improvement of many oral ailments. Besides, compounds that are useful in oral treatment with their natural sources and the cases where they can be used. To prevent any possible side effects or drug interactions, a doctor's consultation is necessary before using dental medicine. Although herbal therapy is safe and with minimum side effects, it is also strongly advised to do a more thorough preclinical and clinical evaluation before using herbal medicines officially.

The Efficacy of Aloe vera Against Enterococcus faecalis as an Intracanal Medicament: A Systematic Review and Meta-Analysis

Calcium hydroxide (CaOH) is commonly used as an intracanal medicament due to its antimicrobial properties; its antibacterial property depends on the release of hydroxyl ions. By analyzing experimental in vitro studies related to the research question, many studies carried out bacterial inoculation on extracted human teeth or laboratory Petri dishes. This review article seeks to assess the antimicrobial efficacy of Aloe vera (AV) against Enterococcus faecalis in comparison to CaOH as an intracanal medicament. After being retrieved from databases such as PubMed, Scopus, the Cochrane Library, and EBSCOhost, publications from 2013 to 2024 were screened against our inclusion criteria. As a result, seven papers were included in the systematic review and four in the meta-analysis. Using a meta-analysis (Stata software version 16.0, StataCorp LLC, College Station, TX) to compare colony-forming units (CFUs) formed by CaOH and AV, forest plots were created to record the specimen size, mean, and standard deviation value of the outcome in CFU, at 95% confidence intervals. AV exhibits bactericidal qualities that are equal to or comparable to those of CaOH. AV displayed a nonsignificantly reduced CFU count than CaOH in a meta-analysis (p > 0.05). In summary, AV exhibits antibacterial/antimicrobial capabilities against E. faecalis that are equal to or comparable to CaOH.

Photosensitive Hydrogels Encapsulating DPSCs and AgNPs for Dental Pulp Regeneration

OBJECTIVE

Pulp regeneration with bioactive dentin-pulp complex has been a research hotspot in recent years. Stem cell therapy provided an interest strategy to regenerate the dental-pulp complex. Hence, this study aimed to evaluate the effects of photosensitive gelatin methacrylate (GelMA) hydrogel encapsulating dental pulp stem cells (DPSCs) and silver nanoparticles (AgNPs) for dental pulp regeneration in vitro.

METHODS

First, the AgNPs@GelMA hydrogels were prepared by lithium phenyl-2,4,6-trimethyl-benzoyl phosphinate (LAP) initiation via blue-light emitting diode light. The physical and chemical properties of AgNPs@GelMA hydrogels were comprehensively analysed via scanning electron microscopy (SEM), and mechanical characterisation, such as swelling ability, degradation properties, and AgNP release profile. Then, AgNPs@GelMA hydrogels encapsulated DPSCs were used to establish an AgNPs@GelMA biomimetic complex, further analysing its biocompatibility, antibacterial properties, and angiogenic capacity in vitro.

RESULTS

The results indicated that GelMA hydrogels demontrated optimal characteristics with a monomer:LAP ratio of 16:1. The physico-chemical properties of AgNPs@GelMA hydrogels did not change significantly after loading with AgNPs. There was no significant difference in AgNP release rate amongst different concentrations of AgNPs@GelMA hydrogels. Fifty to 200 μg/mL AgNPs@GelMA hydrogels could disperse E faecalis biofilm and reduce its metabolic activity . Furthermore, cell proliferation was arrested in 100 and 200 μg/mL AgNPs@GelMA hydrogels. The inhibition of 50 μg/mL AgNPs@GelMA hydrogels on E faecalis biofilm was above 50%, and the cell viability of the hydrogels was higher than 90%. The angiogenesis assay indicated that AgNPs@GelMA hydrogels encapsulating DPSCs could induce the formation of capillary-like structures and express angiogenic markers CD31, vascular endothelial growth factor , and von willebrand factor (vWF) in vitro.

CONCLUSIONS

Results of this study indicate that 50 μg/mL AgNPs@GelMA hydrogels encapsulating DPSCs had significant antibacterial properties and angiogenic capacity, which could provide a significant experimental basis for the regeneration of the dentin-pulp complex.

Strategies and mechanisms targeting Enterococcus faecalis biofilms associated with endodontic infections: a comprehensive review

Enterococcus faecalis is one of the main microorganisms that infects root canals, ranking among the most prevalent microorganisms associated with endodontic treatment failure. Given its pervasive presence in persistent endodontic infections, the successful elimination of Enterococcus faecalis is crucial for effective endodontic treatment and retreatment. Furthermore, Enterococcus faecalis can form biofilms - defense structures that microbes use to fight environmental threats. These biofilms confer resistance against host immune system attacks and antibiotic interventions. Consequently, the presence of biofilms poses a significant challenge in the complete eradication of Enterococcus faecalis and its associated disease. In response, numerous scholars have discovered promising outcomes in addressing Enterococcus faecalis biofilms within root canals and undertaken endeavors to explore more efficacious approaches in combating these biofilms. This study provides a comprehensive review of strategies and mechanisms for the removal of Enterococcus faecalis biofilms.

Aloe vera-An Extensive Review Focused on Recent Studies

Since ancient times, Aloe vera L. (AV) has attracted scientific interest because of its multiple cosmetic and medicinal properties, attributable to compounds present in leaves and other parts of the plant. The collected literature data show that AV and its products have a beneficial influence on human health, both by topical and oral use, as juice or an extract. Several scientific studies demonstrated the numerous biological activities of AV, including, for instance, antiviral, antimicrobial, antitumor, and antifungal. Moreover, its important antidepressant activity in relation to several diseases, including skin disorders (psoriasis, acne, and so on) and prediabetes, is a growing field of research. This comprehensive review intends to present the most significant and recent studies regarding the plethora of AV's biological activities and an in-depth analysis exploring the component/s responsible for them. Moreover, its morphology and chemical composition are described, along with some studies regarding the single components of AV available in commerce. Finally, valorization studies and a discussion about the metabolism and toxicological aspects of this "Wonder Plant" are reported.

Anti-bacterial efficacy of Aloe vera against E. Faecalis in comparison to other intracanal medicaments: A systematic review and meta-analysis

Introduction

This review article aims to evaluate the antibacterial efficacy of Aloe vera against Enterococcus faecalis (E. faecalis) in comparison to other intracanal medicaments by assessing experimental in-vitro studies associated with the objective, many of which performed bacterial inoculation on extracted human teeth or directly on laboratory petri dishes.

Materials & Methods

Publications from 2012 to 2022 were retrieved from databases, including PubMed, Scopus, and Cochrane Library, and they were screened against our inclusion criteria, leading to the incorporation of 18 studies into the systematic review and nine into the meta-analysis. Colony-forming units (CFUs) in the Aloe vera group were compared with saline, sodium hypochlorite (NaOCl), chlorhexidine (CHX), and calcium hydroxide (CaOH) using a meta-analysis (Stata software version 16.0), and forest plots were computed to record the sample size, mean and standard deviation value of the outcome CFU, and 95% confidence intervals.

Results

This systematic review indicates that Aloe vera demonstrates bactericidal properties that are higher than or similar to those of saline and CaOH, but CHX, NaOCl, and propolis exhibited higher antibacterial properties against E. faecalis than Aloe vera. In a meta-analysis, Aloe vera showed a non-significantly lower CFU count than CaOH and saline (p > 0.05), while Aloe vera had a higher CFU count than CHX and NaOCl (p > 0.05).

Conclusion

In summary, Aloe vera exhibits antibacterial capabilities against E. faecalis that are superior or equal to those of saline and CaOH, respectively, while CHX and NaOCl showed greater antibacterial efficacy against E. faecalis than Aloe vera (PROSPERO registration no. CRD42022314790).

Multifunctional and biodegradable methacrylated gelatin/Aloe vera nanofibers for endodontic disinfection and immunomodulation

Currently employed approaches and materials used for vital pulp therapies (VPTs) and regenerative endodontic procedures (REPs) lack the efficacy to predictably achieve successful outcomes due to their inability to achieve adequate disinfection and/or lack of desired immune modulatory effects. Natural polymers and medicinal herbs are biocompatible, biodegradable, and present several therapeutic benefits and immune-modulatory properties; thus, standing out as a clinically viable approach capable of establishing a conducive environment devoid of bacteria and inflammation to support continued root development, dentinal bridge formation, and dental pulp tissue regeneration. However, the low stability and poor mechanical properties of the natural compounds have limited their application as potential biomaterials for endodontic procedures. In this study, Aloe vera (AV), as a natural antimicrobial and anti-inflammatory agent, was incorporated into photocrosslinkable Gelatin methacrylate (GelMA) nanofibers with the purpose of developing a highly biocompatible biomaterial capable of eradicating endodontic infection and modulating inflammation. Stable GelMA/AV nanofibers with optimal properties were obtained at the ratio of (70:30) by electrospinning. In addition to the pronounced antibacterial effect against Enterococcus faecalis, the GelMA/AV (70:30) nanofibers also exhibited a sustained antibacterial activity over 14 days and significant biofilm reduction with minimal cytotoxicity, as well as anti-inflammatory properties and immunomodulatory effects favoring healing. Our results indicate that the novel GelMA/AV (70:30) nanofibers hold great potential as a biomaterial strategy for endodontic infection eradication and enhanced healing.

Laser Devices and Autologous Platelet Concentrates in Prevention and Treatment of Medication-Related Osteonecrosis of the Jaws: A Systematic Review

Background and Objectives: Medication-related osteonecrosis of the jaws (MRONJ) is a disease that affects many patients taking anti-angiogenic and antiresorptive medicines. Since the pathogenetic mechanism is still partially unknown, preventive strategies, as well as treatment alternatives, are needed. Therefore, the aim of this research is to describe the main evidence from the last 10 years of clinical trials regarding the use of auxiliary devices such as autologous platelet concentrates (APCs) and laser, other than their effects against MRONJ disease onset or therapy. Advantages in the healing process and recurrence rates were also analyzed. Materials and Methods: A systematic search of the electronic databases of PubMed and Scopus was carried out. Data from the studies were analyzed, and the risk of bias was evaluated. Results: Nineteen studies between interventional studies, observational studies, and cohort studies have been considered in this review. Conclusions: Based on the studies included, the literature analysis shows that APCs could be a beneficial alternative in preventing and treating MRONJ. Laser technology, as a surgical tool or used on the antimicrobial photodynamic or photobiomodulation side, has been becoming increasingly popular in the last few years. The latest proposal concerning the combination of both auxiliary tools suggests interesting effects, but more studies should be conducted to evaluate eventual relapses and long-term consequences.

Which whitening toothpaste with different contents is more effective on color and bond strength of enamel?

OBJECTIVE

To evaluate the effects of six whitening toothpastes with different whitening ingredients as follows: abrasives, polyphosphates, activated charcoal and hydrogen peroxide on the color, and shear bond strength (SBS) of enamel.

MATERIALS AND METHODS

Thirty-five extracted human molars were sectioned in mesiodistal direction, providing 70 enamel specimens and randomly divided into seven groups having different whitening ingredients (n = 10). After baseline color measurements, the specimens were brushed three times daily for the 30 s. At the end of 2 weeks, spectrophotometric readings were repeated, and color change parameters were calculated. Then, composite cylinders were built on the enamel surfaces and the specimens were subjected to SBS test. Failure modes were determined under a stereomicroscope (×10). One specimen from each group was examined with scanning electron microscope (SEM). The data were statistically analyzed using Kruskal-Wallis, Wilcoxon signed, one-way-ANOVA (p = 0.05).

RESULTS

Clinically acceptable color change was observed in all whitening toothpastes. There were no significant differences among the groups for Δa, ΔL, ΔE₀₀ , and ΔWI_D (p > 0.05). The differences among the groups were not significant regarding SBS and failure mode distributions (p > 0.05). SEM findings were in line with the SBS test and failure mode distribution results.

CONCLUSIONS

All the tested whitening toothpastes showed similar and clinically acceptable efficacy on the color change of the enamel and led to comparable SBS values.

CLINICAL SIGNIFICANCE

The tested whitening toothpastes had an acceptable whitening efficacy and did not have a negative effect on the bond strength to the enamel.

Local and Systemic Effects of Porphyromonas gingivalis Infection

Porphyromonas gingivalis, a gram-negative anaerobe, is a leading etiological agent in periodontitis. This infectious pathogen can induce a dysbiotic, proinflammatory state within the oral cavity by disrupting commensal interactions between the host and oral microbiota. It is advantageous for P. gingivalis to avoid complete host immunosuppression, as inflammation-induced tissue damage provides essential nutrients necessary for robust bacterial proliferation. In this context, P. gingivalis can gain access to the systemic circulation, where it can promote a prothrombotic state. P. gingivalis expresses a number of virulence factors, which aid this pathogen toward infection of a variety of host cells, evasion of detection by the host immune system, subversion of the host immune responses, and activation of several humoral and cellular hemostatic factors.

A 7-Week Summer Camp in Antarctica Induces Fluctuations on Human Oral Microbiome, Pro-Inflammatory Markers and Metabolic Hormones Profile

Antarctic camps pose psychophysiological challenges related to isolated, confined, and extreme (ICE) conditions, including meals composed of sealed food. ICE conditions can influence the microbiome and inflammatory responses. Seven expeditioners took part in a 7-week Antarctic summer camp (Nelson Island) and were evaluated at Pre-Camp (i.e., at the beginning of the ship travel), Camp-Initial (i.e., 4th and 5th day in camp), Camp-Middle (i.e., 19th-20th, and 33rd-34th days), Camp-Final (i.e., 45th-46th day), and at the Post-Camp (on the ship). At the Pre-Camp, Camp-Initial, and Camp-Final, we assessed microbiome and inflammatory markers. Catecholamines were accessed Pre- and Post-Camp. Heart rate variability (HRV), leptin, thyroid stimulating hormone (TSH), and thyroxine (T4) were accessed at all time points. Students' t-tests or repeated-measures analysis of variance (one or two-way ANOVA) followed by Student-Newman-Keuls (post hoc) were used for parametric analysis. Kruskal-Wallis test was applied for non-parametric analysis. Microbiome analysis showed a predominance of Pseudomonadota (34.01%), Bacillota (29.82%), and Bacteroidota (18.54%), followed by Actinomycetota (5.85%), and Fusobacteria (5.74%). Staying in a long-term Antarctic camp resulted in microbiome fluctuations with a reduction in Pseudomonadota-a "microbial signature" of disease. However, the pro-inflammatory marker leptin and IL-8 tended to increase, and the angiogenic factor VEGF was reduced during camp. These results suggest that distinct Antarctic natural environments and behavioral factors modulate oral microbiome and inflammation.

Synergistic antimicrobial potential of EGCG and fosfomycin against biofilms associated with endodontic infections

OBJECTIVE

This study aimed to evaluate the cytotoxicity and synergistic effect of epigallocatechin gallate (EGCG) and fosfomycin (FOSFO) on biofilms of oral bacteria associated with endodontic infections.

METHODOLOGY

This study determined minimum inhibitory and bactericidal concentration (MIC/MBC) and fractionated inhibitory concentration (FIC) of EGCG and FOSFO against Enterococcus faecalis, Actinomyces israelii, Streptococcus mutans, and Fusobacterium nucleatum. Monospecies and multispecies biofilms with those bacteria formed in polystyrene microplates and in radicular dentin blocks of bovine teeth were treated with the compounds and control chlorhexidine (CHX) and evaluated by bacterial counts and microscopy analysis. Toxicity effect of the compounds was determined on fibroblasts culture by methyl tetrazolium assays.

RESULTS

The combination of EGCG + FOSFO demonstrated synergism against all bacterial species, with an FIC index ranging from 0.35 to 0.5. At the MIC/FIC concentrations, EGCG, FOSFO, and EGCG+FOSFO were not toxic to fibroblasts. EGCG+FOSFO significantly reduced monospecies biofilms of E. faecalis and A. israelli, whereas S. mutans and F. nucleatum biofilms were eliminated by all compounds. Scanning electron microscopy of multispecies biofilms treated with EGCG, EGCG+FOSFO, and CHX at 100x MIC showed evident biofilm disorganization and substantial reduction of extracellular matrix. Confocal microscopy observed a significant reduction of multispecies biofilms formed in dentin tubules with 84.85%, 78.49%, and 50.6% of dead cells for EGCG+FOSFO, EGCG, and CHX at 100x MIC, respectively.

CONCLUSION

EGCG and fosfomycin showed a synergistic effect against biofilms of oral pathogens related to root canal infections without causing cytotoxicity.

Plasma Cell Gingivitis Treated with Photobiomodulation, with No Recurrence for a Five-Year Follow-Up

INTRODUCTION

Plasma cell gingivitis (PCG) is a chronic inflammatory disease usually affecting the vestibular portion of the gingival mucosa. Clinical presentation is marked by erythematous macules of intense red color, confluent, and delimited from the healthy neighboring mucosa. Generally asymptomatic, the gum lesions sometimes are accompanied by burning sensations and a sense of local tension. Recommended treatment is the use of topical steroids, but with apparent initial healing that is not stable over time. The present case report concerns a patient diagnosed with PCG in November 2017, with a five-year follow-up. This is the first patient with PCG successfully treated with non-surgical periodontal therapies associated with photobiomodulation (PBM).

METHODS

A 64-year-old male patient had intense erythema and edema on the vestibular side of the gingival mucosa area from 1.5 to 2.5. The patient's symptomatic subjectivity parameters were evaluated through dedicated questionnaires. Erythema and gingival bleeding were also evaluated. Periodontal charting was not pathological, but intense bleeding was noted. Multiple biopsies were performed, and microscopic findings confirmed the clinical hypothesis of PCG.

RESULTS

The treatment applied was PBM associated with periodontal therapy. The patient demonstrated a progressive improvement in clinical parameters considered and reported symptoms. During the five-year follow-up, no recurrence of the disease was observed.

CONCLUSIONS

The combined PBM and periodontal therapies have proved to be sufficiently effective in the control of PCG, showing reduction of the intense inflammatory, erythematous component, and gingival bleeding, and are a valid treatment alternative to topical steroids.

Association of Number of Teeth with ADL/IADL in Korean Middle-Aged and Older Adults: An Analysis of the 7th Korean Longitudinal Study of Aging

We determined the association between the number of natural and implant teeth with activities of daily living (ADL) and instrumental ADL (IADL) levels in middle-aged and older adults aged ≥ 55 years. We included 6,925 participants, who underwent a computer-assisted personal interview in the 7th Korean Longitudinal Study of Aging. After controlling for general characteristics, the associations between the number of natural and implant teeth with ADL and IADL levels were examined using multiple regression analysis. The participants had 21.2 natural teeth and 1.08 implant teeth on average. The ADL and IADL levels were 0.61 and 1.56, 0.40 and 1.16, and 1.10 and 0.31 in participants with ≤ 9, 10-19, and ≥ 20 teeth, respectively. There was no significant association between ADL and the number of natural and implant teeth (p > 0.05). However, a one-unit increase in IADL score was associated with a reduced number of natural (β = -0.031, p < 0.001) and implant (β = -0.194, p = 0.006) teeth. Difficulties regarding IADL were associated with fewer natural and implant teeth, suggesting that maintaining and managing the number of teeth is critical to promoting the health of middle-aged and older adults.

Evaluation of Remineralizing Effects of CPP-ACP and Nanohydroxyapatite on Erosive Lesions of Enamel in Deciduous Teeth After Exposure to Acetaminophen Syrup: An in vitro Study

Background:

Oral pediatric liquid medications are commonly used in children who suffer from chronic diseases. Due to acid components in their formulations, these medications may possess a high erosive potential to dental tissues. Erosion is one of the major causes of degradation and demineralization of the enamel. If demineralization causes are not inhibited, it progresses and completely degrades the enamel. So, the dentin is exposed, and, finally, the pulp will be engaged in the process.

Aim:

This study aimed to evaluate the remineralizing properties of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and nanohydroxyapatite on erosive lesions caused by acetaminophen syrup intake in vitro.

Methods:

The microhardness of 34 healthy human primary molars was determined prior to and following a seven-day, three-times-a-day, one-minute exposure to acetaminophen syrup. The teeth were then randomly divided into four groups and were immersed in artificial saliva, fluoride gel, nano-hydroxyapatite, and CPP-ACP for 10 minutes. Then, their final microhardness was measured, and repeated-measures ANOVA analyzed the data.

Results:

Enamel microhardness in two groups decreased after exposure to acetaminophen syrup and increased after applying remineralization agents, CPP-ACP, and nano-hydroxyapatite. The two groups did not show significant differences in terms of microhardness increase (p-value=0.141).

Conclusions:

According to the findings of this study, CPP-ACP and nano-hydroxyapatite can improve the microhardness of enamel, which has been reduced as a result of exposure to medicinal syrups.

Biodegradation of Dental Resin-Based Composite—A Potential Factor Affecting the Bonding Effect: A Narrative Review

In recent years, although resin composite has played an important role in the restoration of tooth defects, it still has several disadvantages, including being biodegraded by saliva, bacteria and other enzymes in the oral cavity, which may result in repair failure. This factor is not conducive to the long-term survival of the prosthesis in the mouth. In this article, we review the causes, influencing factors and prevention methods of resin biodegradation. Biodegradation is mainly caused by esterase in saliva and bacteria, which breaks the ester bond in resin and causes the release of monomers. The mechanical properties of the prosthesis can then be affected. Meanwhile, cathepsin and MMPs are activated on the bonding surface, which may decompose the dentin collagen. In addition, neutrophils and residual water on the bonding surface can also aggravate biodegradation. Currently, the primary methods to prevent biodegradation involve adding antibacterial agents to resin, inhibiting the activity of MMPs and enhancing the crosslinking of collagen fibers. All of the above indicates that in the preparation and adhesion of resin materials, attention should be paid to the influence of biodegradation to improve the prosthesis’s service life in the complex environment of the oral cavity.

Association between Periodontal Treatment and Healthcare Costs in Patients with Coronary Heart Disease: A Cohort Study Based on German Claims Data

There is empirical evidence of an association between periodontitis and coronary heart disease (CHD). However, it is uncertain whether periodontal treatment in CHD patients might lead to reduced healthcare costs. This study aims to assess the association between periodontal treatment and healthcare costs in newly diagnosed CHD patients. Data from 21,263 adults who were continuously insured between 2011 and 2016 and who were newly diagnosed with CHD in 2013 were selected from a German claims database. The study population was differentiated by the utilization of periodontal treatment. The average treatment effect (ATE) of periodontal treatment on healthcare costs (total, inpatient, outpatient, drugs) was investigated using weighted Poisson regression models conditional on covariates and is shown as a ratio (of geometric means). Periodontal treatment was documented for 4.7% of the persons in the study population. Newly diagnosed CHD patients showed an ATE of 0.98 for total healthcare cost (95% CI 0.90–1.06), 0.79 for inpatient costs (95% CI 0.61–1.04), and 0.95 for drug costs (95% CI 0.87–1.04). A statistically significant 7% increase in outpatient costs was shown (95% CI 1.01–1.13). Despite a lack of statistical significance in most cases, the study provides evidence of a meaningful decrease in inpatient costs after periodontal treatment. Further studies are needed.

Oral Microbiome Profiles and Inflammation in Pregnant Women Who Used Orthodontic Appliances

It is common for women to undergo orthodontic treatment during pregnancy, especially through the use of fixed orthodontic devices. In changing the oral microbiome profile, it is crucial to increase the immune responses of pregnant women using fixed orthodontics; however, changes in the microbiomes of pregnant women with orthodontic appliances can be adjusted. Therefore, we aimed to conduct research on the oral cavity microbiome profiles, specifically IL-6 and TNF-α, of pregnant women using fixed orthodontic appliances. We proposed an observational analysis of 30 third-trimester pregnant women. OHI-S was recorded, saliva collection was performed using the passive drool method for IL-6 and TNF-α, and analysis and mucosal swabs were used to determine the oral microbiome profile. Kruskal−Wallis and post hoc Bonferroni tests were used to identify any significant differences with values of p < 0.05. Of these pregnant women, those with orthodontic appliances developed 10 types of bacteria at similar levels (>80%) from the genera Streptococcus, Lactobacillus, and Veillonella. There was no difference between the oral microbiomes of the control group and the pregnant women with a history of orthodontic appliance use. While the level of TNF-α in the women with orthodontic appliances was higher compared with the control group who had never used orthodontic appliances (p < 0.05), there was no difference in the IL-6 levels. The IL-6 and microbiome profile produced normal results, so the use of orthodontic appliances during pregnancy should be allowed with conditions. Pregnant women with orthodontic appliances must keep the oral cavity clean and their appliances well-maintained to avoid oral problems.

Biomimetic Implant Surfaces and Their Role in Biological Integration-A Concise Review

BACKGROUND

The increased use of dental implants in oral rehabilitation has been followed by the development of new biomaterials as well as improvements in the performance of biomaterials already in use. This triggers the need for appropriate analytical approaches to assess the biological and, ultimately, clinical benefits of these approaches.

AIMS

To address the role of physical, chemical, mechanical, and biological characteristics in order to determine the critical parameters to improve biological responses and the long-term effectiveness of dental implant surfaces.

DATA SOURCES AND METHODS

Web of Science, MEDLINE and Lilacs databases were searched for the last 30 years in English, Spanish and Portuguese idioms.

RESULTS

Chemical composition, wettability, roughness, and topography of dental implant surfaces have all been linked to biological regulation in cell interactions, osseointegration, bone tissue and peri-implant mucosa preservation.

CONCLUSION

Techniques involving subtractive and additive methods, especially those involving laser treatment or embedding of bioactive nanoparticles, have demonstrated promising results. However, the literature is heterogeneous regarding study design and methodology, which limits comparisons between studies and the definition of the critical determinants of optimal cell response.

The Effect of Vitamin D3 on the Alignment of Mandibular Anterior Teeth: A Randomized Controlled Clinical Trial

Objectives

To investigate the effect of vitamin D₃ level on the alignment of mandibular anterior teeth in adults and explore the associated root resorption and pain perception. Trial Design. Multicentre, double blinded randomized clinical trial. Subjects and Methods. Adult patients aged 18–30 years, with moderate mandibular incisor crowding [Little's Irregularity index (LII) 3–6 mm], needing nonextraction treatment with fixed orthodontic appliance, were randomly allocated into two groups with 1 : 1 allocation ratio. In the 1^st group (normal vitamin D₃ level group [ND₃G]), vitamin D level was measured and corrected to normal before starting orthodontic treatment, while in the 2^nd group [control group (CG)] the vitamin D level was kept unknown until completion of the alignment phase. Outcome measures included mandibular incisor crowding using LII, orthodontically induced root resorption (OIRR), and pain perception. Independent sample t-test was used to compare the duration of treatment, the effectiveness of alignment, and OIRR between groups, while differences in pain perception were analysed by Mann–Whitney U-test (P < 0.05).

Results

Out of 87 patients recruited from four centres, 33 patients were randomly allocated into two groups (17 patients to ND₃G and 16 patients to CG). Time elapsed for the complete alignment of the mandibular incisor crowding was one month shorter in ND₃G (23.532% faster), and the improvement percentage was significantly higher in all periods when compared to the CG. The amount of OIRR was not significantly different between groups; however, pain during the first three days of alignment was significantly less in ND₃G.

Conclusions

Having optimal vitamin D₃ level reduced the alignment time and pain associated with orthodontic treatment, but it had no role in reducing OIRR. Registration. The trial was registered with ClinicalTrials.gov on 12^th April 2021 (registration number: NCT04837781).

Evaluation of Therapeutic Benefits of a Novel Herbal Ingredient-Based Hyaluronic Acid Gel as Monotherapy for Inflammatory Enlargement of a Patient with Diabetes Mellitus

The reason for the destruction of the attachment apparatus in patients with periodontal disease is the supra- and the subgingival microflora. Hence, the treatment of this inflammatory gingival disease is primarily focused on eliminating the cause. The present case report assessed the therapeutic benefit of adjunctive use of a commercially available topical agent containing 1% hyaluronic acid gel combined with nonsurgical periodontal therapy. A patient aged 64 years with type 2 diabetes mellitus reported to the Department of Periodontology. He complained of gum enlargement and frequent bleeding during brushing. The patient was not under any medication for his diabetes control. On examination, there was a localized papillary gingival enlargement. Therefore, Klirich gel containing hyaluronic acid was applied on the surface of the gingiva during the first visit of the patient. During the follow-up visit, he continued with this adjunctive use of the gel along with the nonsurgical periodontal therapy. In addition, he controlled his blood sugar level with diet and exercise. During the follow-up visit after one year, there was a noticeable clinical change in the overall health of his gingiva.

Corrigendum to "Antibacterial Properties of Aloe vera on Intracanal Medicaments against Enterococcus faecalis Biofilm at Different Stages of Development"

[This corrects the article DOI: 10.1155/2020/8855277.].