The application of zebrafish model in the study of cleft lip and palate development: A systematic review

Objective

Craniofacial growth and development are more than a scientific curiosity; it is of tremendous interest to clinicians. Insights into the genetic etiology of cleft lip and palate development are essential for improving diagnosis and treatment planning. The purpose of this systematic review was to utilize a zebrafish model to highlight the role of the IRF6 gene in cleft lip and palate development in humans.

Data

This review adhered to the guidelines outlined in the PRISMA statement. Nine studies were included in the analysis.

Sources

This study used major scientific databases such as MEDLINE, EMBASE, Web of Science, and the Zebrafish Information Network and yielded 1275 articles. Two reviewers performed the screening using COVIDENCE™ independently, and a third reviewer resolved any conflicts.

Study selection

After applying the inclusion and exclusion criteria and screening, nine studies were included in the analysis. The Systematic Review Center for Laboratory Animal Experimentation's (SYRCLE's) risk-of-bias tool was used to assess the quality of the included studies.

Results

The main outcome supports the role of the IRF6 gene in zebrafish periderm development and embryogenesis, and IRF6 variations result in cleft lip and palate development. The overall SYRCLE risk of bias was low-medium.

Conclusion

In conclusion, this review indicated the critical role of the IRF6 gene and its downstream genes (GRHL3, KLF17, and ESRP1/2) in the development of cleft lip and palate in zebrafish models. Genetic mutation zebrafish models provide a high level of insights into zebrafish craniofacial development.

Clinical relevance

this review provides a productive avenue for understanding the powerful and conserved zebrafish model for investigating the pathogenesis of human cleft lip and palate.

Impact of Bone-Grafting Materials on the Rate of Orthodontic Tooth Movement: A Systematic Review

Orthodontists may encounter patients with alveolar bony defects, which are often treated with various bone-grafting materials. The effects of different bone-grafting materials on orthodontic tooth movement (OTM) are of concern to orthodontists. Therefore, we aimed to evaluate the current status of the literature that reports on the effects of different bone-grafting materials on OTM in terms of the rate and side effects. An electronic search of the PubMed and Scopus databases and Google Scholar was performed. Two reviewers independently conducted the screening process using COVIDENCE™, and a third reviewer resolved any conflicts. SYRCLE's (Systematic Review Centre for Laboratory Animal Experimentation's) risk-of-bias tool for animal studies was utilized to assess the quality of the included studies. Out of 457 initial titles, 11 studies were finally included for data extraction. All of the included studies were animal experiments, and none of them were considered to have a low risk of bias. The included studies had varied results. However, a general tendency existed, whereby OTM in surgically treated areas with no bone grafting presented the highest OTM rate. In cases where a bone graft was used, xenografts revealed the highest OTM rate, followed by alloplasts. Lastly, the use of allografts resulted in the slowest OTM rates. The most common side effect was root resorption. In conclusion, there is a lack of high-quality evidence regarding the effects of bone-grafting materials on OTM rate. Due to the lack of human subjects, RCTs, and the heterogeneity of subjects in the current literature, the impact of bone-grafting materials on OTM deserves further investigations using more rigorous scientific methodologies.

Prevalence and Patterns of Orofacial Clefts among Children from Different Regions of Saudi Arabia: A Systematic Review

Aim and objective

To report on the prevalence and patterns of orofacial clefts (OFC) among Saudi Arabian children by analyzing the results of the studies that have been reported in the literature.

Materials and methods

A data search was carried out for the articles that had reported on the prevalence of OFC among the Saudi Arabian population in databases like Web of Science, PubMed, Google Scholar, Scopus, and Saudi Digital Library. Articles that were published over the last 15 years were included in this study, following which 13 studies were assessed for qualitative data. Newcastle-Ottawa Quality Assessment Scales for cross-sectional studies were used for analyzing the methodological quality of these studies.

Results

The prevalence of OFC was within the range of 0.65-1.9/1,000 live births. The highest was witnessed in the Medina region. Parent's consanguinity was the most common risk factor in OFC cases in the included studies. OFC was found to be higher among the male population in comparison with the female.

Conclusion

The prevalence of OFC in Saudi Arabian children follows the global patterns of OFC. Isolated cleft lip (CL) and cleft palate (CP) are the most common forms of OFC. The prevalence of orofacial anomalies was reported more among children born to parents who had consanguineous marriages. Considering the higher rate of consanguinity among this population, there is an urgent need of developing educational and counseling programs to address the genetic consequences.

How to cite this article

Albalawi F Alsaeed S, Alalola B, et al. Prevalence and Patterns of Orofacial Clefts among Children from Different Regions of Saudi Arabia: A Systematic Review. Int J Clin Pediatr Dent 2023;16(1):124-130.

Treatment of Obstructive Sleep Apnea Using Oral Appliances in Saudi Arabia: Are We following the Guidelines?

BACKGROUND

This study aimed to assess sleep medicine physicians' knowledge and attitudes toward the role of oral appliances (OAs) in managing obstructive sleep apnea (OSA) in Saudi Arabia.

METHODS

An online questionnaire was administered to the registered physicians practicing sleep medicine (otolaryngology, internal medicine, pulmonology, and family medicine) in Saudi Arabia. The questionnaire included 26 questions under five domains. All the collected data were analyzed using descriptive statistics and Chi-square tests.

RESULTS

One hundred sleep physicians (43% Saudi, 75% male) from Saudi Arabia participated in this study. Almost 43% of participants reported inadequate knowledge of the treatment of OSA patients using OAs. Half of the participants were unaware of how OAs work in managing OSA. Most physicians (62%) never referred the patient for treatment of OSA using OAs, whereas 4% referred at least one patient every month. The majority (60%) believed that there are barriers to referring a case for OA treatment, mainly the lack of knowledge of the suitable cases (60%) and the lack of qualified dentists in this area (43%).

CONCLUSION

Most sleep physicians reported poor knowledge of OA indications and mechanism of use, with most never referring a case for OA therapy.

Socioeconomic inequalities in pediatric obstructive sleep apnea

STUDY OBJECTIVES

To examine the association between multiple measures of socioeconomic status (SES) and objectively measured obstructive sleep apnea (OSA) in a Canadian pediatric population.

METHODS

This was a cross-sectional study of 188 children (4-17 years, mean age 9.3 ± 3.5 years) prospectively recruited from two hospital sleep clinics in Canada, using multivariable-adjusted linear and logistic regression of five measures of SES including parental education, income, social class, geographic location, and perceived SES based on the MacArthur Scale of Subjective Social Status, assessed in relation to four polysomnographic OSA variables including apnea-hypopnea index, apnea index, mean oxygen saturation level, and oxygen desaturation index.

RESULTS

Overall, low household-level SES appeared to be associated with both frequency (apnea index ≥ 1 events/h) and severity (apnea-hypopnea index ≥ 5 events/h) of OSA in children, with maternal education showing the most consistent and significant associations. Specifically, children with mothers reporting less than high school education had nearly three times the odds of having OSA after controlling factors including body mass index (odds ratio 2.96 [95% confidence interval, 1.05-8.37]), compared to university-educated participants. Consistent associations were also observed for geographic location with less frequency and severity of OSA among nonurban children. Perceived SES was minimally inversely associated with our outcomes.

CONCLUSIONS

This cross-sectional, multicenter study demonstrated that SES factors are linked to the occurrence and severity of OSA in children. Results indicated the need to incorporate the screening of SES in the diagnostic process of pediatric OSA to provide more targeted intervention and patient-centered care.

CITATION

Park JW, Hamoda MM, Almeida FR, et al. Socioeconomic inequalities in pediatric obstructive sleep apnea. J Clin Sleep Med. 2022;18(2):637-645.

Long-term periodontal changes associated with oral appliance treatment of obstructive sleep apnea

STUDY OBJECTIVES

To characterize the mandibular anterior teeth crown height as a marker of periodontal changes and bone loss as a side effect of an oral appliance (OA) worn for a minimum of 4.5 years.

METHODS

This retrospective study conducted on patients with healthy baseline periodontiu m recruited participants from consecutive sleep apnea patients treated with an OA between 2004 to 2014. Eligible participants were recalled for a follow-up visit where a periodontal exam was performed, a lateral cephalogram and dental impressions were obtained. Clinical crown height for mandibular anterior teeth and cephalometric variables were measured and compared before and after treatment. A full periodontal evaluation was performed at the follow-up visit.

RESULTS

21 patients enrolled with a mean treatment length of 7.9±3.3 years. For the mandibular anterior teeth, clinical crown height did not change over the evaluated period. At follow-up, all the periodontal assessed variables were within normal limits, with the mean probing depth of 1.4±0.5 mm, recession 0.6±1.1 mm and Clinical Attachment Loss (CAL) 0.8±1.0 mm. Compared to baseline, there was a significant proclination of mandibular incisors (mean increase of 5.1°) with the continued use of OA. Gingival levels were maintained with clinically insignificant changes during the observation period.

CONCLUSIONS

Inclination of the mandibular incisors increases significantly with the use of an OA in patients with obstructive sleep apnea (OSA). Positional changes in these teeth were not associated with any measured evidence of increase in clinical crown height or gingival recession.

Dental Implant Length and Diameter: A Proposed Classification Scheme

PURPOSE

To propose a length-and-diameter-based classification scheme for dental implants to standardize terminology in the dental literature and communication between interested parties.

MATERIALS AND METHODS

This study was mainly based on searching two major resources: published scientific research papers and 14 of the most popular dental implant manufacturers. Indexed databases were searched from January 2004 up to and including February 2016 using the keywords "dental implant length" and "dental implant diameter." Retrieved titles and abstracts were screened, and related full-text articles were reviewed. Full-text articles that clearly stated the terms and measurements of implants used were included and considered for proposing this classification scheme.

RESULTS

The initial search for implant diameter and length yielded 1007 and 936 articles, respectively. A total of 85 studies (41 about diameter, 44 about length) were selected and reviewed. The remaining studies (966 about diameter, 892 about length) that did not abide by the eligibility criteria were excluded. The terms "long," "short," "standard," "wide," and "narrow" were the most commonly used terms in the literature. A classification scheme for implants by diameter and length was proposed.

CONCLUSIONS

Indexed publications contain a variety of terms used by authors to describe diameter and length of dental implants without conformity and standardization. The classification scheme proposed in this article could serve as a reference for interested parties.