Evidence-based dentistry: what's new?

Dietary Polyphenols against Oxidative Stress in Head and Neck Cancer: What's New, What's Next

Head and neck cancers (HNC) are a worldwide health problem, accounting for over 5% of all types of cancers. Their varied nature makes it sometimes difficult to find clear explanations for the molecular mechanisms that underline their onset and development. While chemio- and radiotherapy are clearly not to be dismissed, we cannot undervalue the effect that polyphenols - especially dietary polyphenols - can have in helping us to cope with this medical emergency. By influencing several different proteins involved in numerous different metabolic pathways, polyphenols can have a broad spectrum of biological action and can hopefully act synergistically to tackle down head and neck cancer. Moreover, being natural molecules, polyphenols does not present any side effects and can even enhance drugs efficacy, making our clinical therapy against head and neck cancer more and more effective. Certainly, oxidative stress plays an important role, altering several molecular pathways, lowering the body's defenses, and ultimately helping to create a microenvironment conducive to the appearance and development of the tumor. In this regard, the regular and constant intake of foods rich in polyphenols can help counteract the onset of oxidative stress, improving the health of the general population. In this review, we highlight the role of polyphenols in managing oxidative stress, with such positive effects that they can be considered new tools to use in our anti-head and neck cancer strategy.

Radiographic marginal bone level evaluation around two different tissue-level implant systems: a one-year prospective study

BACKGROUND

Marginal bone loss, is a frequently reported variable in the evaluation of dental implants. The primary objective of this study was to evaluate radiographic marginal bone level changes around the two different tissue-level implant systems placed adjacently in the posterior maxilla or mandible. The influence of implant macro-geometry and vertical soft tissue thickness on marginal bone loss were also evaluated.

METHODS

Seven patients were included in the study and a total of 18 implants were analyzed. Each patient received two different implants placed adjacently in the maxilla or the mandible. The implants used in our study were either Straumann® SP cylindrical implants or JD Octa® tapered implants. During the surgery, vertical soft-tissue thickness was measured with a periodontal probe placed on the top of the bony crest and in the center of the future implant site. Healing abutments were then seated. Three months following implant placement, impressions were taken, and screw-retained metal ceramic prostheses were delivered. Standardized intraoral radiographs were taken immediately after implant placement and one year following implant loading in order to assess marginal bone level changes.

RESULTS

Results showed a mean marginal bone loss of 0.55±0.5 mm for Straumann® SP implants and 0.39±0.49 mm for JD Octa® implants after one year of loading and the difference was not statistically significant between the two systems. A statistically significant correlation was found between soft tissue thickness and marginal bone loss; in sites with thin mucosal tissues (≤2 mm), there was significantly greater bone loss compared to sites with thick, soft tissues (> 2 mm) in both implants.

CONCLUSIONS

Radiographic marginal bone loss was not statistically different between the two implant systems at the one-year examination period. Moreover, vertical soft tissue thickness influenced marginal bone loss regardless of the implant system used.

Introspection of the Etiopathological Mechanisms Underlying Noncarious Cervical Lesions: Analysis of the Different Theories and Their Impact on the Mineralized Structures of the Tooth

The noncarious cervical lesions (NCCLs) recognize an etiological framework of onset very different from the carious processes with etiology whose bacteria aggregated in a biofilm play a predominant role, leading in this way to the loss of the mineralized structure of the tooth. The pathological picture of the NCCLs, which manifests itself with a clinical picture of dental wear, differs from caries because it mainly recognizes a series of pathological processes, such as erosion, through the action of generally acidic chemical agents and abrasion, which is basically expressed through repeated mechanical trauma characteristic of tooth brushing. However, in the literature, there is no unanimous agreement in identifying only these two mechanisms, but there are some who propose a more marked role of anomalous occlusal loads, which would be unloaded on some teeth which, in addition to both erosive and abrasive mechanisms, would give rise to abfraction. Therefore, the aim of this review was to collect literature etio-pathological information and discuss the mechanisms underlying NCCLs.

Causes of the Evidence-practice Gap and Its Association with the Effects of Minimal Intervention Dentistry Education to Clinicians

OBJECTIVES

To identify causes of the evidence-practice gap (EPG) in dentistry in Japan and analyze whether these causes are associated with: (a) improvement of EPG in minimal intervention dentistry (MID) following an educational intervention and (b) specific dentist characteristics.

METHODS

We conducted a mixed-methods questionnaire survey among 197 Japanese dentists that integrated both quantitative and qualitative data. Causative factors for the EPG identified in the quantitative survey were clarified by qualitative analysis. We measured the EPG in a baseline survey using an EPG measurement tool based on MID. To examine how feedback using the latest scientific evidence affected change in the EPG, we measured the EPG again immediately after feedback was provided to participating dentists.

RESULTS

Qualitative analysis classified all dentists into one of four "EPG cause" groups, namely "evidence-", "dentist-", "patient-", and "health insurance system-related" causes. Quantitative analysis confirmed that improvement in the EPG following the feedback intervention was indeed associated with group classification. The highest concordance was found for the "evidence-related" group while the lowest concordance was in the "dentist-related" group (p=0.004). Concordance improved after evidence feedback in all groups but was lowest in the "dentist-related" group. More dentists reported practice busyness in the "dentist-related" group.

CONCLUSIONS

In this study, we identified four groups of causes of EPG among Japanese dentists. The degree of concordance between evidence and clinical practice was the lowest in the "dentist-related" group, and the results of this study are expected to provide useful information for the development of intervention methods for closing the EPG in the future.

Labial Frenectomy using Laser: A Scoping Review

Labial frenectomy is a surgical technique, that aims to remove the frenulum with its attachment to the underlying bone. Frenectomy, is indicated if the frenulum attachment causes midline diastema, gingival recession, hindrance in maintaining oral hygiene, or if it interferes with lip movements and for prosthetic needs. A labial frenectomy can be performed either by the routine scalpel technique, electrocautery, and most recently medical lasers. The aim of this study was to evaluate, whether the laser technique is more effective than the conventional surgical technique, and whether there are differences between the different types of lasers. The scoping review was conducted and prepared on the basis of the indications of the PRISMA guidelines (PRISMA Extension for Scoping Reviews, PRISMA-ScR) of PRISMA checklist, and nine papers were considered admissible to the qualitative analysis for the following outcomes: bleeding during intervention, use of sutures, duration of the intervention, and use of analgesic drugs in the days following the intervention. This review suggests that laser-performed labial frenectomy is faster and offers better intra- and postoperative management; however, due to the limited number of available papers, the final results of the present review are not absolute.

Knowledge, attitudes and practices towards Evidence-Based-Dentistry regarding dental practitioner: A cross-sectional study

Introduction

Dental practice experienced two important evolutions: the development of the concept of evidence-based dentistry (EBD) and the changes in the relationship between dentists and patients. Thus, the practitioner is invited nowadays to give a treatment that reflects the best available evidence.

The purpose of this study is to explore knowledge, attitudes, and practices of dentists toward the concept of EBD.

Methods

This is a cross sectional study that was conducted among dentists in public and private sector in Morocco. A self-administered questionnaire with 27 questions was delivered to practitioners. The comparison was carried out using the Khi2 test or Fisher's exact test, t-test or the Mann-Whitney. Logistic regression was performed to assess factors associated with the application of EBD. Linear regression was also performed to identify factors that impact knowledge, attitude and practice score.

Results

A total of 209 responses was received. 58% of the participants were in the private sector, and 32.7% were academics. The main reported obstacles were the lack of time 44% and lack of training on critical appraisal 60.3%. Knowledge of PICO question formulation and previous EBD training was significantly related to the implementation of EBD in multivariate analysis in logistic regression (OR = 8.163- CI95%: 2.095–31.80 and OR = 12.79- CI95%: 2.868–57 respectively). The total score of surveyed dentists was affected by the knowledge of PICO question formulation and the knowledge of relevant information sources (PubMed/Medline, the Cochrane library) (β = 3.04- CI95%: 0.411–5.66, β = 6.29- CI95%: 2.92–9.66 and β = 8.35- CI95%: 5.89–10.81 respectively).

Conclusion

Based on the findings of this study, application of EBD was associated with knowledge of PICO question formulation and previous EBD training. The lack of time was the most common obstacles identified by the participants applying EBD. Therefore, EBD educational programs should be developed for dental practitioners to enhance their knowledge and skills.

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Application of EBD was associated with knowledge of PICO question formulation, previous EBD training and the knowledge of relevant information sources (PubMed/Medline and the Cochrane library).

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The lack of time was the most common obstacles identified by the participants applying EBD.

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EBD educational programs should be developed for dental practitioners to enhance their knowledge and skills.

Overview of Candida albicans and Human Papillomavirus (HPV) Infection Agents and their Biomolecular Mechanisms in Promoting Oral Cancer in Pediatric Patients

Oral carcinoma represents one of the most common malignancies worldwide. Oral squamous cell carcinomas (OSCCs) account over 90% of all oral malignant tumors and are characterized by high mortality in the advanced stages. Early diagnosis is often a challenge for its ambiguous appearance in early stages. Mucosal infection by the human papillomavirus (HPV) is responsible for a growing number of malignancies, particularly cervical cancer and oropharyngeal carcinomas. In addition, Candida albicans (C. albicans), which is the principal fungi involved in the oral cancer development, may induce carcinogenesis through several mechanisms, mainly promoting inflammation. Medical knowledge and research on adolescent/pediatric patients' management and prevention are in continuous evolution. Besides, microbiota can play an important role in maintaining oral health and therefore all human health. The aim of this review is to evaluate epidemiological and pathophysiological characteristics of the several biochemical pathways involved during HPV and C. albicans infections in pediatric dentistry.

Effects of Oral Function Training and Oral Health Status on Physical Performance in Potentially Dependent Older Adults

This study aimed to evaluate the effects of an oral function training program and indicators of oral health status on improvements in physical performance induced by physical function training in dependent older adults. The participants were 131 potentially dependent older adults (age: ≥65 years) who were randomly divided into two groups: an oral intervention and a control group. All participants underwent physical function training, but only the intervention group took part in the oral function training program. In total, 106 participants completed all of the survey components (60 and 46 participants from the intervention and control groups, respectively). The measures of physical fitness examined included the one-leg standing time with eyes open (OLST) and the timed up and go test (TUG). Logistic regression analyses were carried out to determine the effects of the oral function intervention and health status on physical fitness. The results revealed that the oral function intervention significantly improved OLST and TUG times. These findings suggest that evaluations of oral health status and interventions aimed at activating oral functions are associated with improvements in physical fitness among potentially dependent older adults.

Efficacy of bio-activated anti-calculus toothpaste on oral health: a single-blind, parallel-group clinical study

BACKGROUND

Current epidemiologic studies have confirmed the widespread presence of calculus in teenagers and adults of all ages. Among the multiple anti-calculus strategies that have been proposed over the years inhibition of crystal growth has been the most attractive. Current formulations in anti-calculus toothpastes and mothwash, utilise either hydroxyapatite or various pyrophosphate combinations. This study aimed to analyze the efficacy of an anti-calculus tooth paste in combination or not with a mouth rinse.

PATIENTS AND METHODS

Patients (totally 40) used a pyrophosphate-based toothpaste containing Tetrapotassium Pyrophosphate, Pentasodium Triphosphate, Xylitol, Hydroxyapatite, Citric Acid, And Calcium Carbonate (Group A) in combination, with a mouth rinse containing an association of Pentasodium Triphosphate, Tetrapotassium Pyrophosphate and Citric Acid (Group B). A range of parameters were measured for: saliva pH, Volpe Manhold Calculus Index (VMI), Gingival Index (GI), and Plaque Index (PI).

RESULTS

The test mouth rinse Group B showd reductions in VMI, GI, PI, and increases in pH levels, after using the combination of toothpaste and mouth rinse. No changes to the mucosa or teeth were observed in both Groups. Patients perceived that the comitation of products was more effective.

CONCLUSIONS

The results from the three-month calculus examination indicated that both the tested products, modified positively clincal parameters and salivary pH. Moreover, the use of the tested products was not associated with any adverse effects.

Oral Health as a Predictor of Physical Frailty among Rural Community-Dwelling Elderly in an Agricultural County of Taiwan: A Cross-Sectional Study

We conducted a cross-sectional study to clarify the relationship between oral health and physical frailty (PF). A sample of 903 community-dwelling individuals aged ≥ 65 years were enrolled from random communities in Chiayi County. The self-perceived oral health (SPOH) and oral health assessment tool (OHAT), which consists of eight items, was used for the evaluation of their oral health status. PF was assessed based on the Study of Osteoporotic Fracture index. Overall, 14.6% of the participants had PF. In an adjusted model, restricted food types (odds ratio (OR) = 1.59, 95% confidence interval (CI): 1.2–2.09, p = 0.001), self-reported dental status (OR = 1.61, 95% CI: 1.2–2.15, p = 0.001), number of teeth (OR = 0.98, 95% CI: 0.96–0.99, p = 0.006), frequency of tooth cleaning (OR = 0.83, 95% CI: 0.68–1.0, p = 0.049), OHAT score (OR = 1.09, 95% CI: 1.02–1.17, p < 0.017), and saliva items of OHAT (OR = 1.52, 95% CI: 1.11–2.1, p = 0.010) were significantly associated with PF. SPOH is a crucial indicator of PF; longitudinal analyses are necessary to understand the underlying pathway of risk factors for frailty onset.

Rebalancing the Oral Microbiota as an Efficient Tool in Endocrine, Metabolic and Immune Disorders

The current treatment and prevention procedures of oral disorders follow a very targeted approach considering mouth and its structures as a system that is completely independent, than the rest of the body. The main therapeutic approach is to keep the levels of oral bacteria and hygiene in an acceptable range compatible with oral-mouth health, completely separated from systemic microbial homeostasis (eubiosis vs dysbiosis). This can negatively impact the diagnosis of a more complex systemic disease and its progression. Dysbiosis occurs as a consequence of imbalance in oral and gut microbiota which leads to cardiovascular diseases, diabetes mellitus, rheumatoid arthritis, and Alzheimer's disease, as reported in current literature. Likewise, there is a need to highlight and develop a novel philosophical approach in the treatments for oral diseases that will necessarily involve nonconventional approaches.

The Influence of Blade Type and Feeding Force during Resin Bonded Dentin Specimen Preparation on the Microtensile Bond Strength Test

This paper presents the effect of blade type and feeding force during resin-bonded dentin specimen preparation on the microtensile bond strength (μTBS) test. Forty resin-bonded flat middle dentin specimens were divided into four groups. The specimens of each group were sectioned according to type of blade and feeding force as follows: fine grit/20 N, fine grit/40 N, medium grit/20 N, and medium grit/40 N to obtain resin-dentin sticks with a cross-sectional area of 1.0 mm². Four sticks from the center of each tooth were subjected to the μTBS test. Five remaining sticks of each group were selected for surface topography observation under a scanning electron microscope (SEM). As a result, the bond strength of the medium-grit group was higher than that of the fine-grit group (p < 0.001), whereas the feeding force had no influence on bond strength values (p = 0.648). From the SEM, sticks prepared with the fine-grit blade showed a smoother surface integrity and fewer defects on the specimen edges in comparison with the sticks prepared with the medium-grit blade. The grit type of the blade is one of the considerable factors that may affect the bond strength and the surface integrity of resin-dentin specimens for microtensile testing.

Comparison in Four Different Implant Systems of Mechanical Resistance to Maximal Stress in Prosthetic Screws-An In Vitro Study

Micromovements of the implant–abutment connection influence peri-implant bone preservation. This study evaluates and quantifies the maximal torque after a cycle of implant prosthetic screws tightening using original components. A total of 40 samples were tested: Megagen^®—Daegu, South Korea; Dentium^®—Gangnam-Gu, Seoul, Korea; BIOMET 3i^®—West Palm Beach, FL, USA and BTI^®—Álava, Spain. Screws from each manufacturer were subjected to maximal stress force until they fractured. The fracture points were recorded and compared among all samples. To compare the mean values of fracture torques, the reference values associated with each brand and the sample results were used in t-tests. ANOVA (analysis of variance) was used to compare the maximal resistance limit between brands, complemented with Tukey’s multiple-comparison test. The maximal considered level of significance was 5%. The average fracture force for the brands was 40.07 Ncm for Megagen^®, 53.39 Ncm for Dentium^®, 39.74 Ncm for Biomet 3i^®, and 68.84 Ncm for BTI^®. BTI^® screws showed the most resistance to fracture. According to the protocol that was applied, the implant–abutment connection demonstrated good resistance and a precise fit between these interfaces; therefore, in some cases, the presented values showed a lack of quality control and low fracture resistance.

Chronic Periodontitis and Immunity, Towards the Implementation of a Personalized Medicine: A Translational Research on Gene Single Nucleotide Polymorphisms (SNPs) Linked to Chronic Oral Dysbiosis in 96 Caucasian Patients

Chronic periodontitis (CP) is a complex pathology with a significant impact worldwide causing bone loss. Oral dysbiosis is a highly inflammatory condition associated to a long-term insulting infection and represents an underestimated CP key factor associated with an imbalance of pro-inflammatory and anti-inflammatory gene responses. The presence of a single nucleotide polymorphisms (SNPs) in the promoter region of interleukin 10 (IL-10) gene-1082, -819, and -592 was a possible determinant cause. This translational research aimed to provide outcomes on the role of IL-10 gene expression in bone loss diseases in patients affected by CP. Caucasian patients (n = 96) affected by CP were recruited from the Italian population. The subgingival samples were collected using the Bacterial Periodontal Assessment by Biomolecular Diagnostic^® and the characterization of a set of 15 bacterial DNA responsible of periodontitis was performed by real-time multiplex PCR. In addition, two viruses, Epstein-Barr Virus (EBV) and Herpes Simplex Virus 1 (HSV-1), and a pathogenic fungi (Candida albicans) were included as a part of our panel. Our results confirmed an existing association between IL-10 gene polymorphisms and polymorphism of tumor necrosis factor alpha (TNFα), interleukin 1α-β-RN (IL-1α-β-RN), collagen type-l alpha (COLIA1), and vitamin D receptor (VDRs) genes in CP. Further studies are needed to improve diagnosis and endorse more effective therapeutic procedures for periodontal disease.

Adaptation and validation of the Berlin questionnaire of competence in evidence-based dentistry for dental students: a pilot study

BACKGROUND

The purpose of this pilot study was to create a valid and reliable set of assessment questions for examining Evidence-based Dentistry (EbD) knowledge. For this reason, we adapted and validated for dental students the Berlin Questionnaire (BQ), which assesses Evidence-based Medicine (EbM) abilities.

METHODS

The Berlin Questionnaire was validated with medical residents. We adapted it for use in a dentistry setting. An expert panel reviewed the adapted BQ for content validity. A cross-sectional cohort representing four training levels (EbD-novice dental students, EbD-trained dental students, dentists, and EbM-/EbD-expert faculty) completed the questionnaire. A total of 140 participants comprised the validation set. Internal reliability, item difficulty and item discrimination were assessed. Construct validity was assessed by comparing the mean total scores of students to faculty and comparing proportions of students and faculty who passed each item.

RESULTS

Among the 133 participants (52 EbD-novice dental students, 53 EbD-trained dental students, 12 dentists, and 16 EbM-/ EbD-expert faculty), a statistically significant (p < 0.001) difference was evident in the total score corresponding to the training level. The total score reliability and psychometric properties of items modified for discipline-specific content were acceptable. Cronbach's alpha was 0.648.

CONCLUSION

The adapted Berlin Questionnaire is a reliable and valid instrument to assess competence in Evidence-based Dentistry in dental students. Future research will focus on refining the instrument further.

Oral Cancer: A Historical Review

Aim: This historical medical literature review aims at understanding the evolution of the medical existence of oral cancer over times, particularly better comprehending if the apparent lower prevalence of this type of cancer in antiquity is a real value due to the absence of modern environmental and lifestyle factors or it is linked to a misinterpretation of ancient foreign terms found in ancient medical texts regarding oral neoplasms. Methods: The databases MedLne, PubMed, Web of Science, Elsevier's EMBASE.com, Cochrane Review, National Library of Greece (Stavros Niarchos Foundation, Athens) and the Library of the School of Health Sciences of the National and Kapodistrian University of Athens (Greece) were extensively searched&nbsp;for relevant studies published during the past century on the history of oral cancer and its treatment from antiquity to modern times, in addition to the WHO website to analyse the latest epidemiological data. In addition, we included historical books on the topic of interest and original sources. Results: Historical references reveal that the cradle of the oral oncology was in ancient Egypt, the Asian continent and Greece and cancer management was confined to an approximate surgical practice, in order to remove abnormal masses and avoid bleeding with cauterization. In the Medieval Age, little progress occurred in medicine in general, oral cancers management included. It is only from the Renaissance to modern times that knowledge about its pathophysiological mechanisms and histopathology and its surgical and pharmacological treatment approaches became increasingly deep all over the world, evolving to the actual integrated treatment. Despite the abundant literature exploring oncology in past civilizations, the real prevalence of oral cancer in antiquity is much less known; but a literature analysis cannot exclude a consistent prevalence of this cancer in past populations, probably with a likely lower incidence than today, because many descriptions of its aggressiveness were found in ancient medical texts, but it is still difficult to be sure that each single description of oral masses could be associated to cancer, particularly for what concerns the period before the Middle Ages. Conclusions: Modern oncologists and oral surgeons must learn a lot from their historic counterparts in order to avoid past unsuccessful efforts to treatment oral malignancies. Several descriptions of oral cancers in the antiquity that we found let us think that this disease might be linked to mechanisms not strictly dependent on environmental risk factors, and this might guide future research on oral cavity treatments towards strategical cellular and molecular techniques.

Innovative Surgical Management of the Synovial Chondromatosis of Temporo-Mandibular Joints: Highly Conservative Surgical Technique

Synovial chondromatosis (SC) is an uncommon disease characterized by a benign nodular cartilaginous proliferation arising from the joint synovium, bursae, or tendon sheaths. Although the temporomandibular joint is rarely affected by neoplastic lesions, SC is the most common neoplastic lesion of this joint. The treatment of this disease consists in the extraoral surgery with a wide removal of the lesion; in this study, the authors described a more conservative intraoral surgical approach. Patient with SC of temporomandibular joint typically refer a limitation in the mouth opening, together with a persistent not physiological mandibular protrusion and an appearance of a neoformation located at the right preauricular region: the authors reported 1 scholar patient. After biopsy of the neoformation, confirming the synovial chondromatosis, the patient underwent thus to the surgical excision of the tumor, via authors' conservative transoral approach, to facilitate the enucleation of the neoformation. The mass fully involved the pterygo-maxillary fossa with involvement of the parotid lodge and of the right TMJ: this multifocal extension suggested for a trans-oral surgical procedure, in the light of the suspicion of a possible malignant nature of the neoplasm. Our intraoral conservative approach to surgery is aimed to reduce the presence of unaesthetic scars in preauricular and facial regions, with surgical results undoubtedly comparable to the traditional surgical techniques much more aggressive. Our technique could be a valid, alternative, and safe approach to treat this rare and complex kind of oncological disease.

Vitamin D Effects on Osteoblastic Differentiation of Mesenchymal Stem Cells from Dental Tissues

1α,25-Dihydroxyvitamin D₃ (1,25(OH)₂D₃), the active metabolite of vitamin D (Vit D), increases intestinal absorption of calcium and phosphate, maintaining a correct balance of bone remodeling. Vit D has an anabolic effect on the skeletal system and is key in promoting osteoblastic differentiation of human Mesenchymal Stem Cells (hMSCs) from bone marrow. MSCs can be also isolated from the immature form of the tooth, the dental bud: Dental Bud Stem Cells (DBSCs) are adult stem cells that can effectively undergo osteoblastic differentiation. In this work we investigated the effect of Vit D on DBSCs differentiation into osteoblasts. Our data demonstrate that DBSCs, cultured in an opportune osteogenic medium, differentiate into osteoblast-like cells; Vit D treatment stimulates their osteoblastic features, increasing the expression of typical markers of osteoblastogenesis like RUNX2 and Collagen I (Coll I) and, in a more important way, determining a higher production of mineralized matrix nodules.

Management of oral pemphigus vulgaris: A case report and a clinical update

Pemphigus vulgaris (PV) is an uncommon autoimmune intraepithelial blistering disease. In most cases, the oral lesions were the first manifestation of the pathology. We report the case of a 42-year-old woman with a 4-month history of oral ulcerations. The patient reported that the lesions caused considerable discomfort and affected her normal oral function. On intraoral examination, ulcers were observed on the cheek and palatal mucosa and ventral surface of the tongue. No skin lesions were seen on extra oral examination. A diagnosis of PV was made after evaluating the biopsy samples. The main complication of PV is the reduced quality of life related to soreness or pain, particularly in ulcerative/erosive lesions. The presence of lesions among gingival tissues makes oral hygiene procedures very difficult, but plaque control and rigorous oral hygiene are a fundamental requisite for the treatment of any oromucosal disease.

Use of platelet rich fibrin and Bio-OSS/SINT-Oss for implant-prosthetic rehabilitation in maxillary atrophy with sinus pathology: A 48-month follow-up

The maxillary sinus floor elevation procedure has gained popularity with predictable results, and is a safe, acceptable technique for bone augmentation, providing a base for dental implant treatment. Faint radiopaque lesions at the base of the maxillary sinus are frequent diagnoses on radiographs and must be identified during dental implant planning. The use of autografts, xenografts, allografts, and alloplasts or a combination between them has been demonstrated to be effective for increasing bone height and bone volume in maxillary sinus. The objective of this study was to evaluate the outcome of subjects with considerable sinus membrane pathology (test group) undergoing maxillary sinus floor augmentation using Platelet Rich Fibrin (PRF) as a filling material, in association with the Bio-Oss and Sint-Oss and simultaneous implant placement in a one-stage surgical procedure. All patients reported no pain to percussion, no sign of tissue suffering to the soft peri-implant tissues, the presence of an optimal primary stability of the inserted implants, and the increase in the peri-implant bone density. No complications were encountered during follow-up periods in these patients, including no negative evolution in the sinusitis and all implants are functioning successfully. In conclusion, the use of PRF and Piezosurgery reduced the healing time, favoring optimal bone regeneration and allowing sinus membrane integrity to be maintained during surgical procedures, according to evidence-based dentistry.

A systematic review of outcome measurements and quality of studies evaluating fixed tooth-supported restorations

PURPOSE

The purpose of this systematic review was to review clinical studies of fixed tooth-supported prostheses, and to assess the quality of evidence with an emphasis on the assessment of the reporting of outcome measurements. Multiple hypotheses were generated to compare the effect of study type on different outcome modifiers and to compare the quality of publications before and after January 2005.

MATERIALS AND METHODS

An electronic search was conducted using specific databases (MEDLINE via Ovid, EMBASE via Ovid, Cochrane Library) through July 2012. This was complemented by hand searching the past 10 years of issues of the Journal of Oral Rehabilitation, Journal of Prosthetic Dentistry, Journal of Prosthodontics, and the International Journal of Prosthodontics. All experimental and observational clinical studies evaluating survival, success, failure, and complications of tooth-supported extracoronal fixed partial dentures, crowns, and onlays were included. No restrictions on age or follow-up time were placed.

RESULTS

The electronic search generated 14,869 papers, of which 206 papers were included for full-text review. Hand-searching added 23 papers. Inclusion criteria were met by 182 papers and were included for the review. The majority were retrospective studies. Only 8 (4.4%) were randomized controlled trials. The majority of the studies measured survival and failure, and few studies recorded data on success; however, more than 60% of the studies failed to define survival, success, and failure. Many studies did not use any standardized criteria for assessment of the quality of the restorations and, when standardized criteria were used, they were modified, thereby not allowing for comparisons with other studies. There was an increase of 21.8% in the number of studies evaluating outcome measurements of all-ceramic restorations in past 8 years.

CONCLUSIONS

Prosthodontic literature presents with a reduced percentage of RCTs compared to other disciplines in dentistry. The overall quality of recording prosthodontic outcome measurements has not improved greatly in the past 8 years.

Evidence based dental care: integrating clinical expertise with systematic research

Clinical dentistry is becoming increasingly complex and our patients more knowledgeable. Evidence-based care is now regarded as the "gold standard" in health care delivery worldwide. The basis of evidence based dentistry is the published reports of research projects. They are, brought together and analyzed systematically in meta analysis, the source for evidence based decisions. Activities in the field of evidence-based dentistry has increased tremendously in the 21(st) century, more and more practitioners are joining the train, more education on the subject is being provided to elucidate the knotty areas and there is increasing advocacy for the emergence of the field into a specialty discipline. Evidence-Based Dentistry (EBD), if endorsed by the dental profession, including the research community, may well- influence the extent to which society values dental research. Hence, dental researchers should understand the precepts of EBD, and should also recognize the challenges it presents to the research community to strengthen the available evidence and improve the processes of summarizing the evidence and translating it into practice This paper examines the concept of evidence-based dentistry (EBD), including some of the barriers and will discuss about clinical practice guidelines.

Cytokine gene polymorphisms associate with microbiogical agents in periodontal disease: our experience

Periodontics has evolved from a simplistic model to a more complex interplay between infection and host response. Genetic factors have been a new addition to the list of risk factors for periodontal diseases. The processes leading to destruction and regeneration of the destroyed tissues are of great interest to both researchers and clinicians. The selective susceptibility of subjects for periodontitis has remained an enigma and wide varieties of risk factors have been implicated for the manifestation and progression of periodontitis. Emerging pathway models suggest that gene-environment interactions are etiologically important in disease pathogenesis. The current practical utility of genetic knowledge in periodontitis is limited. Allelic variants at multiple gene loci probably influence periodontitis susceptibility. The pro-inflammatory cytokine interleukin-1 (IL-1) is a key modulator of host responses to microbial infection and a major modulator of extracellular matrix catabolism and bone resorption, and polymorphisms in the IL-1 gene cluster have been associated with an increased risk of developing severe adult periodontitis. The aim of this study was to test if polymorphisms of genes of IL-1α(+4845) and IL-1β(+3954) were linked with periodontitis, in a case-control study population, delimited to a specific geographic area, in association with microbiological findings. The polymorphisms observed in IL-1α(+4845) and IL-1β(+3954) single nucleotide polymorphisms (SNPs), was significantly different among the study groups (healthy controls, mild, moderate and severe periodontitis with p<0.05, d.f.=1. We found a significant correlation between the severe form of periodontitis and the presence of composite genotype (p < 0.05, d.f.=1, calculated among healthy vs. severe). Furthermore a statistically significant association between the presence of bacteria and periodontitis was detected (p<0.05, d.f.=1). In the current investigation findings were concordant with literature observations.

Primary prevention of dental erosion by calcium and fluoride: a systematic review

BACKGROUND

Overviews of the current literature only provide summaries of existing relevant preventive strategies for dental erosion.

OBJECTIVES

To perform a systematic review according to the quantitative meta-analysis method of the scientific literature on prevention of dental erosion. The focused question will address primary prevention of dental erosion by calcium and fluoride.

MATERIALS AND METHODS

Randomized clinical trials (RCTs) regarding dental erosion prevention. The search included five databases: Embase, Cochrane database of systematic reviews, PubMed (MEDLINE), FDA publication and Berman medical library of the Hebrew University. The search included data in the English language, with effect on preventing dental erosion always presented as mean enamel loss and measured by profilometer. Statistical meta-analysis was performed by StatsDirect program and PEPI statistical software. Fixed- and random-effect models were used to analyse the data. Heterogeneity tests were employed to validate the fixed-effect model assumption.

RESULTS

A total of 475 articles on dental erosion prevention were located. A four-stage selection process was employed, and 10 RCT articles were found to be suitable for meta-analysis.

CONCLUSIONS

The number of studies on prevention of dental erosion maintaining standards of evidence-based dentistry remains insufficient to reach any definite conclusions. The focused questions of this review cannot be addressed according to the existing literature.

Evidence-based techniques to assess the performance of dental implants

The clinical use of evidence-based medicine has been regarded as one of the most significant medical advancements of the last century. As the costs of medical care escalate, clinical decisions have to be made prudently and with a high degree of efficacy. One of the most expensive treatments in dentistry includes the use of dental implants to rehabilitate partial and fully edentulous patients. Due to the high costs of treatments and the ever increasing varieties of dental implants becoming available, the clinician is often faced with a challenging situation to decide the best prostheses for their patients. Furthermore, navigating through the vast database of literature pertaining to dental implants and their related research can be very time consuming and challenging to a dental surgeon before they can make appropriate clinical decisions. Similar to other orthopedic implants, dental implants need to be evaluated for their long-term efficacy in vivo before they are clinically acceptable. In order to help clinician(s) make patient oriented decisions, evidence-based techniques are becoming increasingly popular. This can be a very useful tool in translating research findings into clinical practice, thus narrowing the gap between research and clinical dentistry. This article discusses ways in which evidence-based techniques can help dental surgeons analyze and make informed clinical decisions about dental implant treatments.

Dental trauma: an evidence-based approach to care

BACKGROUND

One of the key aspects of improving the dental care we offer to our patients is in basing our practice on the best available evidence.

AIM

The main purpose of this paper is to present some basic ways of searching reliable papers on Internet and to introduce some techniques to facilitate the development of strategic search skill to improve the quality of dental care, using dental trauma as an example.

MATERIALS AND METHODS

After formulation of a clinical question on a dental trauma issue, a comparison was made between: data collected in PubMed using a given term; data collected in PubMed using the Medical Subject Headings vocabulary (Mesh) and data collected using the principles of evidence-based research, all by an independent researcher. A number of papers searched about a clinical question on dental trauma and a brief commentary about each Internet research database is presented. The authors reported that the best sites available to perform the sample search were those produced by academic centers, professional organizations and government-sponsored. To get evidence-based clinical papers we did internet search on PubMed, Cochrane, Center of Evidence-Based Dentistry and Knowledge Finder using the clinical question "Emergency Treatment for Avulsed Tooth".

RESULTS

All searched databases were efficient for scientific journals, but when we used the PI strategy, the search seemed to be more relevant and specific. The Cochrane, Center of Evidence-Based Dentistry and Knowledge Finder presented more reliable papers to answer our clinical question about dental trauma treatment.

CONCLUSION

It is imperative that dentists understand the advantages of searching the Internet and learning to use it effectively to guide practice and assist their patients in their pursuit for better oral health.