Efficacy of antimicrobial photodynamic therapy in reducing oral yeasts growth in individuals wearing implant overdentures: A systematic review of clinical trials

OBJECTIVE

The aim was to systematically review clinical studies that investigated the efficacy of antimicrobial photodynamic therapy (aPDT) in reducing oral yeasts growth (OYG) in individuals wearing implant overdentures (IO).

METHODS

The focused question was "Is aPDT effective in reducing OYG in patients wearing IO?" Literature search was performed in accordance with PRISMA guidelines. Indexed databases were searched without time and language restrictions up to and including January 2024. Clinical studies were included; and letters to the Editor, case-reports/case-series, perspectives/commentaries, in-vitro/ex-vivo studies, studies on animal models and expert opinions were excluded. The risk of bias was also assessed.

RESULTS

Two clinical studies were included and processed for data extraction. The study population comprised of 100 (mean age: 58.5 years) and 53 (mean age: 58.5 years) individuals. The numbers of males and females included in these studies ranged between 33 and 35 males and 18-67 females, respectively. In both studies, follow-up evaluations were performed after 60 days. In both studies, aPDT was performed using a 660 nm diode laser at a power of 100 mW and using methylene-blue as photosensitizer. Results from both studies showed that aPDT is effective in significantly reducing oral yeasts CFU/ml and improvement of OHRQoL of individuals using IO.

CONCLUSION

The aPDT is useful in reducing OYG on IO; however, further well-designed and power-adjusted studies are needed in this area of research.

Application of advanced platelet-rich fibrin for through-and-through bony defect during endodontic surgery: Three case reports and review of the literature

BACKGROUND

The use of advanced platelet-rich fibrin (A-PRF) membranes for guided bone and tissue regeneration in through-and-through defects after endodontic surgery was explored in three cases.

CASE SUMMARY

Herein, three patients presented to the endodontic clinic suffering from apical periodontitis, associated with large bone resorption and related to previously endodontically treated teeth. Periapical surgery was indicated in these cases and the osteotomy site was covered by A-PRF membrane. Cone-beam computed tomography (CBCT) was used to assess the cases before and after the surgery.

CONCLUSION

Four months post-surgery, the recall CBCT scan showed complete obliteration of the osteotomy with newly formed bone. A-PRF membrane showed promising results and was an advantageous addition to surgical endodontic treatment.

Periodontal and peri-implant status and whole salivary interleukin 1-beta levels among individuals using selective serotonin reuptake inhibitors: an observational study

OBJECTIVE

Selective serotonin reuptake inhibitors (SSRI) are commonly used for managing psychological diseases such as depression. These disorders are also directly associated with periodontal and peri-implant diseases, namely periodontitis and peri-implantitis, respectively. It is hypothesized that there is no difference in periodontal and peri-implant clinicoradiographic status and unstimulated whole salivary interleukin (IL)-1β levels in participants using selective serotonin reuptake inhibitors (SSRI) and controls (individuals not using SSRI). The aim of the present observational case-control study was to compare periodontal and peri-implant clinicoradiographic statuses and whole salivary IL-1β in participants using SSRI and controls.

METHODS

Users of SSRI and controls were included. In all participants, periodontal (plaque index [PI], gingival index [GI], probing depth [PD], clinical attachment loss [AL] and marginal bone loss [MBL]) and peri-implant (modified PI [mPI], modified GI [mGI], PD and crestal bone loss [CBL]) were assessed. Unstimulated whole saliva was collected and IL-1β levels were determined. Information related to duration of implants in function, duration of depressive symptoms and treatment of depression was retrieved from healthcare records. Sample-size was estimated using 5% error and group comparisons were performed. P < 0.05 was considered statistically significant.

RESULTS

Thirty-seven SSRI users and 35 controls were assessed. Individuals using SSRI had a history of depression of 4.2 ± 2.5 years. The mean age of SSRI-users and controls were 48.7 ± 5.7 and 45.3 ± 5.1 years, respectively. Tooth brushing twice daily was reported by 75.7% and 62.9% SSRI-users and controls, respectively. There was no statistically significant difference in PI, mPI, GI, mGI, PD, clinical AL, numbers of MT and mesial and distal MBL and CBL among individuals using SSRI compared with controls (Tables 3 and 4). The unstimulated whole salivary flow rate in individuals using SSRI and controls was 0.11 ± 0.003 and 0.12 ± 0.001 ml/min, respectively. Whole salivary IL-1β levels in individuals using SSRI and controls were 57.6 ± 11.6 pg/ml and 34.6 ± 5.2 pg/ml, respectively.

CONCLUSION

Users of SSRI and controls demonstrate healthy periodontal and peri-implant tissue statuses with no marked differences in whole salivary IL-1β levels provided oral hygiene is stringently maintained.

Assessment of Knowledge towards Radiation Protection Measures among Newly Graduated Dentists from Egypt and the Kingdom of Saudi Arabia: A Questionnaire-Based Cross-Sectional Study

Background: It is hypothesized that knowledge towards ionizing radiation (IR) protection measures is lacking among newly graduated dentists from Egypt and Saudi Arabia. The purpose of the present questionnaire-based study was to compare the IR protection knowledge among newly graduated dentists from Egypt and the Kingdom of Saudi Arabia (KSA). Methods: The present investigation was a questionnaire-based study and had a cross-sectional observational analytical design. Newly graduated dentists were defined as individuals who had graduated from a credentialed dental institution within the past 36-months. The questionnaire was related to knowledge about radiation safety, awareness and practices. The questionnaire comprised of 17 multiple choice questions. Questionnaires in which all the 17 questions were not answered or had missing pages were excluded. Odds ratios were computed for the number of correct and incorrect responses and 95% confidence intervals were determined. Individuals that provided up to 40%, 41% to 70% and >70% correct answers were categorized as having “low competence”; “moderate competence” and “high competence” in IR knowledge. p-values less than 0.05 were considered statistically significant. Results: The mean percentage of correct answers provided by dentists from Egypt and KSA were 56.9% and 67.4%, respectively. There was no statistically significant difference in the percentages of correct responses for the 17 questions submitted by respondents from Egypt and KSA. The overall percentage of correct responses ranged between 40.2−71.2% and 45.4−81.4% for respondents from Egypt and KSA, respectively. The odds ratios and 95% confidence intervals showed no statistically significant correlation in the responses from respondents from Egypt and KSA for each of the 17 questions addressed. Conclusion: Newly graduated dentists from Egypt and KSA are moderately competent regarding IR doses and related safety measures. It is recommended that modifications in the undergraduate dental education curriculum with emphasis on IR safety and practice would help enhance the knowledge and competence of students and newly graduated dentists. Moreover, routine continuing dental education seminars/programs may help enhance the IR knowledge of dental students and dentists.

Myrrh mixed with silver nanoparticles demonstrates superior antimicrobial activity against Porphyromonas gingivalis compared to myrrh and silver nanoparticles alone

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Myrrh mouthwash (MM) is used against an oral health microbe that causes gingivitis.

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Adding silver nanoparticles (SN) may increase antimicrobial activity (AA).

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Our laboratory analysis compared AA between MM with and without SN.

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After 48 h, AA between MM with and without SN was similar.

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Adding SN to MM does not increase antimicrobial activity.

Introduction

Gingivitis is an oral condition characterized by inflammation and bleeding of the gingiva (gums), largely caused by Porphyromonas gingivalis. Oral hygiene options for controlling P. gingivalis include mouthwash containing Commiphora myrrha (myrrh), which has been shown to be effective against the microbe. Silver nanoparticles (SN) have been studied for their antibacterial effect in different oral health applications, including mouthwash. This was an in vitro laboratory study of the anti-microbial actions of myrrh and SN against P. gingivalis.

Methods

We compared the anti-microbial properties against P. gingivalis of four solutions: a) placebo solution, b) myrrh solution (MS), c) MS mixed with silver nanoparticles (MSN), and d) SN suspension alone. Sixteen agar plates were divided into four groups of four plates, and each group was treated with one of the solutions/suspensions. The solution/suspension was administered on the agar disc diffusion method, and inhibition zones (IZs) were measured after 24 (time 1), 48 (time 2), and 72 h (time 3). To characterize MSN and SN, Fourier-transform infrared spectroscopy (FT-IR) was used. UV–Vis spectroscopy and energy dispersive X-ray (EDX) were used to further characterize MSN.

Results

After 24 h, the median IZ for the MS plates was 16 mm, and the median IZ for MSN plates was 15 mm. At time 2, the MS median IZ was 15 mm, but the MSN median IZ increased to 18 mm, and the interquartile ranges (IQRs) did not overlap. At time 3, the median IZs was similar again, with MSN and MS having IZs of 16 mm and 15 mm, respectively. SN alone showed no anti-microbial activity.

Conclusions

Our findings show that MSN displayed superior anti-microbial activity against P. gingivalis compared to MS and SN after 48 h of incubation, but not after 24 h. Also, the increased anti-microbial activity had ceased by 72 h.

Effect of multiple sessions of photodynamic therapy on bone regeneration around dental implants among patients with peri-implantitis

OBJECTIVE

The aim of the present study was to assess the effect of multiple sessions of antimicrobial photodynamic therapy (aPDT) on bone regeneration around dental implants among patients with peri-implantitis.

METHODS

Patients with peri-implantitis were included. Therapeutically, patients were randomly divided into 4 groups: (a) Group-I: Mechanical debridement (MD) alone; (b) Group-II: MD at baseline followed by a single session of adjunct a PDT; (c) Group-III: MD at baseline followed by aPDT at baseline and at 3-months of follow-up; and Group-IV: MD at baseline followed by aPDT at baseline and at 3- and 6-months of follow-up. Demographic data was collected and peri-implant clinical (plaque index [PI], gingival index [GI], and probing depth [PD]) and radiographic (crestal bone loss [CBL]) parameters were assessed at baseline and after 9 months. Sample-size estimation was done on data from a pilot investigation and group comparisons were done using one-way analysis of variance and Bonferroni post-hoc adjustment tests. Level of significance was set at P<0.01.

RESULTS

Twenty-two, 22, 22 and 22 patients with peri-implantitis were enrolled in groups -I, -II, -III and -IV. The mean age of individuals in groups -I, -II, -III and -IV were 59.2 ± 5.3, 60.5 ± 2.8, 59.6 ± 3.1 and 58.7 ± 0.8 years, respectively. Compared with Group-I, there was a statistically significant reduction in PI (P<0.01), GI (P<0.01) and PD (P<0.01) in all groups at 9-months follow-up. There was no significant difference in PI, GI and PD in groups -II, -III and -IV at 9-months follow-up. There was no statistically significant difference in CBL in all groups at baseline and at 9-months-follow-up.

CONCLUSION

The use of aPDT as an adjunct to MD reduces the severity of peri-implant mucositis but does not contribute towards bone regeneration in peri-implant osseous defects.

Association between Periodontitis and Genetic Polymorphisms in Interleukins among Patients with Diabetes Mellitus

There is a perplexity in the association between interleukin (IL) polymorphisms and periodontitis among patients with and without diabetes mellitus (DM). The aim of the present study was to evaluate indexed data regarding the association between periodontitis and genetic polymorphisms in interleukins among patients with and without DM. The addressed question was “Is there an association between periodontitis and polymorphisms in interleukins among patients with and without DM?” Original studies were included. Indexed databases were searched, and the pattern of the present literature review was customized to summaries’ the pertinent information. Eight studies were included and processed for data extraction. Two studies showed that polymorphisms in IL-1B genes aggravate periodontitis in patients with type-2 DM, and two studies showed that IL-1B genes either do not or are less likely to contribute towards the progression of periodontitis in patients with type-2 DM. Two studies reported that IL genes do not show cross-susceptibility with periodontitis and type-2 DM. One study reported that the primary factor that governs the occurrence and progression of periodontitis in patients with and without type-2 DM is poor routine oral hygiene maintenance. Seven studies had a high risk of bias. The role of IL gene polymorphisms in the development and progression of periodontitis in patients with and without DM remains controversial.

Case Report: An association of the gubernacular canal, supernumerary tooth and odontoma with an impacted canine on cone-beam computed tomography

This report describes a clinical case of asymptomatic compound odontoma in the anterior left side of the maxilla associated with an impacted canine and supernumerary tooth with a gubernacular canal of a 47- year-old female with no relevant medical history. Cone-beam computed tomography (CBCT) was performed for precise three-dimensional localization of each structure and assessment of their spatial relationship with the associated structures before surgery. The treatment protocol involved surgical enucleation of the odontoma and open extraction of both impacted and supernumerary teeth. The patient had uneventful healing and proceeded with the prosthodontic treatment plan.

The dentist should be aware of the probability of a close relationship between the development of odontoma and presence of the gubernacular tract, which could be used as a future radiographic diagnostic criterion of an odontoma. Also, we recommend that more studies be performed in this field to deeply analyze the imaging characteristics of GT and its spatial association with various pathological lesions in the future.

Comparison of peri-implant clinical and radiographic inflammatory parameters among cigarette and waterpipe (narghile) smokers and never-smokers

BACKGROUND

The authors hypothesized that peri-implant clinical and radiographic inflammatory parameters are worse in waterpipe smokers (WS) and cigarette smokers (CS) compared with never-smokers (NS). The aim of the present retrospective study is to compare peri-implant clinical and radiographic inflammatory parameters among WS, CS, and NS.

METHODS

Forty-four CS (group 1), 41 WS (group 2), and 43 NS (group 3) were included. Demographic data were collected using a questionnaire. Peri-implant plaque index (PI), bleeding on probing (BOP), and probing depth (PD) were measured, and crestal bone loss (CBL) was assessed on standardized digital radiographs. Sample size was estimated, and statistical analyses were performed using Kruskal-Wallis and Wilcoxon rank-sum tests. For multiple comparisons, Bonferroni post hoc test was performed. P values < 0.05 were considered statistically significant.

RESULTS

Peri-implant PI and PD were higher in groups 1 (P < 0.05) and 2 (P < 0.05) compared with group 3. Peri-implant BOP was significantly higher in group 3 compared with individuals in groups 1 (P < 0.01) and 2 (P < 0.01). Peri-implant total marginal bone loss was significantly higher in groups 1 (P < 0.05) and 2 (P < 0.05) compared with group 3. There were differences in PI, BOP, PD, and CBL among participants in groups 1 and 2.

CONCLUSIONS

Peri-implant soft tissue inflammatory parameters and CBL are worse in CS and WS compared with NS. There is no difference in these parameters between CS and WS.

Role of problem-based learning in undergraduate dental education: a questionnaire-based study

BACKGROUND

There is a debate regarding the significance of problem-based learning (PBL) model in educational systems. The aim of this study was to assess the awareness of dental students at the Princess Nourah Bint Abdulrahman University (PNU), Saudi Arabia, toward PBL.

METHODS

The present cross-sectional study was performed at the College of Dentistry, PNU, Riyadh, Saudi Arabia. An anonymous, standardized and self-administered questionnaire (based on nine items) coded as 1, 2, 3 and 4 was distributed to the first-, second-, third- and fourth-year undergraduate students, respectively, after a seminar that focused on the perceptions of PBL among the students at the end of the academic year 2017. The questionnaire was developed following an exhaustive search of indexed databases. Based on the students' responses (yes/no) to the questions, group mean differences (95% CI) were computed and Pearson's chi-squared test was used for data analysis. Cronbach's alpha coefficient was also determined. The level of significance was set at P<0.05.

RESULTS

In total, 238 female undergraduate dental students (61 first-year, 59 second-year, 60 third-year and 58 fourth-year students) were included. The Cronbach's alpha coefficient ranged between 0.82 and 0.93. Group comparisons (95% CI) showed no statistically significant difference in the responses (yes) of students in the first, second, third and fourth year of academic years related to the perceptions listed earlier (P>0.05).

CONCLUSION

Perception of female undergraduate dental students at the PNU was inconclusive. Further studies are warranted in this regard.

Impact of cigarette smoking and vaping on the outcome of full-mouth ultrasonic scaling among patients with gingival inflammation: a prospective study

OBJECTIVES

There are no studies that have assessed the oral soft tissue response to full-mouth ultrasonic scaling (FMUS) among cigarette-smokers (CS) (group 1), individuals vaping electronic-cigarettes (E-cigs) (group 2), and never-smokers (NS) (group 3). The aim was to assess the impact of cigarette smoking and vaping on periodontal tissues following FMUS.

MATERIALS AND METHODS

In a clinical prospective study, 89 male individuals were divided into three groups: CS (group 1), E-cig users (group 2), and NS (group 3). A questionnaire was used to gather demographic data and information regarding duration and daily frequency of CS and vaping. Full-mouth plaque index (PI), bleeding on probing (BOP), clinical attachment loss (AL), and probing depth (PD) were measured at baseline and 3 and 6 months after FMUS (without root surface debridement). Numbers of missing teeth (MT) were also recorded.

RESULTS

In groups 1, 2, and 3, 30, 28, and 31 individuals, respectively were included. In group 1, there was no statistically significant difference in mean PI and PD and numbers of sites with PD ≥ 4 mm at 6 months' follow-up compared with baseline and 3 months' follow-up. In groups 2 and 3, there was no significant difference in PI, BOP, and PD at 3 months' (P > 0.05) and 6-months' (P > 0.05) follow-up. There were no pockets with PD ≥ 4 mm at 3 and 6 months' follow-up in groups 2 and 3. There was no difference in the numbers of MT and none of the individuals exhibited clinical AL in all groups.

CONCLUSION

Following FMUS, gingival inflammation is worse in CS compared with individuals vaping E-cigs and NS.

CLINICAL RELEVANCE

Periodontal inflammatory parameters are worse in cigarette-smokers than individuals vaping electronic cigarettes and never-smokers following FMUS. However, these findings should be interpreted with extreme caution as a number of factors may have influenced the present results.

Effect of local zoledronate delivery on osseointegration: a systematic review of preclinical studies

PURPOSE

The aim of the present systematic review was to assess the effect of local zoledronate (ZOL) delivery (topical or as implant surface coatings) on osseointegration.

MATERIALS AND METHODS

In this systematic review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. To address the focused question, 'Does local zoledronate delivery enhance osseointegration?' indexed databases were searched without time or language restrictions up to and including April 2017 using various combination of the following keywords: 'zoledronate', 'bisphosphonates', 'osseointegration' and 'topical administration'. Letters to the Editor, historic reviews, commentaries, case-series and case-reports were excluded.

RESULTS

Initially, 383 articles were identified out of which, 23 experimental studies fulfilled the inclusion criteria. In 18 studies, ZOL was incorporated into implants surfaces as a coating and in five studies ZOL was applied topically (bone graft or irrigation) into the bone cavities. Results from 87% studies reported that local delivery of ZOL (coating or topical) is effective in enhancing osseointegration or new bone formation around implants.

CONCLUSIONS

Local ZOL delivery (coating or topical) seems to enhance osseointegration in animals; however, from a clinical perspective, further randomized control trials with long-term follow-up are needed in this regard.

Toxicological impact of waterpipe smoking and flavorings in the oral cavity and respiratory system

Waterpipe smoking (WS), an emerging trend has major health concerns. It is prevalent worldwide as a recreational activity both indoors and outdoors. The aim of this review was to assess the impact of waterpipe smoke on the oral and respiratory system (oral cavity and pulmonary tissues). A number of studies have shown that periodontal health status is compromised in waterpipe smokers when compared with nonsmokers. Some studies have associated WS with oral premalignant and malignant lesions; however, due to the poor quality of these studies, the presented outcomes should be interpreted with caution. Although cigarette smoking has been considered as a potential risk factor for dental caries; there are no studies in indexed literature that have shown an association to exist between dental caries and WS. Inhaled waterpipe smoke imposes oxidative stress and inflammatory responses and compromises the ventilatory capacity of the lungs and may lead to an increased risk of decline in lung function. WS may cause oral and pulmonary diseases, such as periodontal disease and chronic obstructive airway disease, respectively. The association between WS and development of dental caries and oral pre-cancer and their relationships with chronic airways disease requires investigations. This review discusses the current evidence of waterpipe smoke effects on the oral health and respiratory system based on basic and clinical science and provides future directions for research and regulatory science on how WS can affect the oral cavity and the respiratory/pulmonary system.

Is salivary IgA level a potential biomarker for immunosuppression in HIV-positive children? A systematic review and meta-analysis

The aim of this systematic review was to determine whether or not assessment of salivary secretory immunoglobulin A (sIgA) levels could be a potential biomarker for immunosuppression in HIV-positive children. The Patient, Exposure, Comparative, Outcome question was "Is sIgA level a potential biomarker for immunosuppression in HIV-positive children?" Electronic and manual literature searches were conducted in indexed databases (MEDLINE, PubMed, EMBASE, ScienceDirect, and SCOPUS databases) up to and including June 2017. The primary outcome was total mean salivary levels of IgA among HIV seropositive and seronegative children (controls). The weighted mean differences (WMD) of outcomes and 95% confidence intervals (CI) for total mean salivary IgA levels were calculated using a random effect model. Six studies were included. Three studies showed significantly lower salivary IgA levels in HIV-infected children compared with controls. Two studies showed comparable IgA levels in HIV infected and controls. One study showed significantly higher levels of salivary IgA in HIV-infected children as compared to controls. Considering the total mean salivary IgA levels among HIV seropositive and seronegative children, a high degree of heterogeneity (Q value = 254.09, P < .0001, I²  = 98.82%) was noticed among both groups. The overall WMD was not significant (WMD = -1.18, 95% CI, -1.91 to -0.44, P = .39). Whether salivary IgA level is a potential biomarker for immunosuppression in HIV-positive children remains debatable because of limited information available in the current literature. Further, high-quality case-control studies with larger sample size and more solid methodological aspects are required.