Hyaluronic acid in Dentoalveolar regeneration: Biological rationale and clinical applications

Background

Hyaluronic acid (HA) is found in different locations in the periodontium, including mineralized tissues (i.e., cementum and alveolar bone) and non-mineralized tissues (i.e., gingiva and periodontal ligament). In addition, it seems to play an essential part in regulating the underlying mechanisms involved in tissue inflammatory reactions and wound healing. HA has the potential to regulate periodontal tissue regeneration and treat periodontal disease.

Aim

The current review of the literature was conducted to assess how HA plays its part in periodontal therapy and examine the contemporary literature's viewpoint on its use in periodontal regeneration.

Conclusion

HA has a multifunctional character in periodontal regeneration, and healing and appears to provide promising outcomes in different periodontal regenerative applications.

The increasing importance of the oral microbiome in periodontal health and disease

Herein, the aim is to discuss the current knowledge of microbiome and periodontal diseases. Current treatment strategies include mechanical therapy such as root planing, scaling, deep pocket debridement and antimicrobial chemotherapy as an adjuvant therapy. Among promising therapeutic strategies, dental probiotics and oral microbiome transplantation have gained attention, and may be used to treat bacterial imbalances by competing with pathogenic bacteria for nutrients and adhesion surfaces, as well as probiotics targeting the gut microbiome. Development of strategies to prevent and treat periodontal diseases are warranted as both are highly prevalent and can affect human health. Further studies are necessary to better comprehend the microbiome in order to develop innovative preventative measures as well as efficacious therapies against periodontal diseases.

The potential role of the gingival crevicular fluid biomarkers in the prediction of pregnancy complications

Early and minimally invasive methods are required to predict the risk of multiple adverse pregnancy outcomes. A potential technique with growing interest utilizes the gingival crevicular fluid (GCF), a physiological serum exudate found in the healthy gingival sulcus and in the periodontal pocket in inflammatory conditions. Analysis of biomarkers in the GCF is a minimally invasive method that can be feasible and cost-effective. The potential use of GCF biomarkers along with other clinical indicators in early pregnancy may provide reliable predictors of several adverse pregnancy outcomes, therefore, reducing both maternal and fetal morbidities. Various studies have reported that increased or decreased concentrations of different biomarkers in GCF are associated with a high risk of developing pregnancy complications. In particular, such associations have been commonly demonstrated with gestational diabetes, pre-eclampsia, and pre-term birth. However, limited evidence is available regarding other pregnancy complications such as preterm premature rupture of membranes, recurrent miscarriage, small for gestational age, and hyperemesis gravidarum. In this review, we discuss the reported association between individual GCF biomarkers and common pregnancy complications. Future research is required to provide more solid evidence of the predictive value of those biomarkers in estimating women's risk for each disorder.

Drug Delivery Systems in Regenerative Medicine: An Updated Review

Modern drug discovery methods led to evolving new agents with significant therapeutic potential. However, their properties, such as solubility and administration-related challenges, may hinder their benefits. Moreover, advances in biotechnology resulted in the development of a new generation of molecules with a short half-life that necessitates frequent administration. In this context, controlled release systems are required to enhance treatment efficacy and improve patient compliance. Innovative drug delivery systems are promising tools that protect therapeutic proteins and peptides against proteolytic degradation where controlled delivery is achievable. The present review provides an overview of different approaches used for drug delivery.

Salivary macrophage chemokines as potential biomarkers of gingivitis

OBJECTIVE

The present study aimed to analyze the salivary levels of macrophage-activating factor (MAF), macrophage-chemotactic factor (MCF), and macrophage migration inhibitory factor (MIF) in healthy and gingivitis patients, and to correlate between the concentrations of these chemo attractants with the intensity of gingival inflammation clinically.

METHODS

Sixty saliva specimens were collected from periodontally healthy (n = 30), and gingivitis patients (n = 30). Bleeding on probing (BOP), Visible Plaque Index (VPI), and Simplified Modified Gingival Index (SMGI) were recorded through clinical examination. Salivary MAF, MCF, and MIF concentrations were assayed using enzyme-linked immunosorbent assays (ELISA). Statistical analysis was performed using SPSS (version 28). Total mean score for each biomarker was determined, and descriptive bivariate statistics were conducted to characterize the levels of biomarkers among the study groups. The difference in the biomarker levels among the study groups were analyzed by independent sample t test and one-way ANOVA. The diagnostic ability of the biomarkers was further tested by ROC curve analysis.

RESULTS

Salivary levels of MAF was not significantly different between periodontally healthy individuals and gingivitis patients. The difference in MCF and MIF levels between patients with gingivitis and those with healthy periodontium was statistically significant (p 0.05 and p 0.001, respectively). When examined across the various stages of disease progression, MIF showed statistically significant difference among the three biomarkers (p 0.05). ROC curve analysis further revealed that area under the curve (AUC) for MIF has a better diagnostic capacity than MCF (AUC 0.981 vs. 0.673).

CONCLUSIONS

Our results suggest that MIF could be considered as a potential salivary biomarker for gingivitis.

Papillary Reconstruction using Hyaluronic Acid: A Review

PURPOSE

The aim of this review is to analyse the use of hyaluronic acid injection in the interdental space to reconstruct the papilla in animal models and humans.

MATERIALS AND METHODS

Electronic databases were searched up to May 2022, and additional hand searching was performed. The search strategy was implemented according to the PRISMA guidelines. The inclusion criteria were: studies written in English, studies using hyaluronic acid, in vivo studies, studies with a precise number of specimens, case series with ≥6 patients, and studies published after 2010. The risk of bias was assessed for each study that could be evaluated.

RESULTS

A total of 19 articles were selected and reviewed in this review. Due to the great heterogeneity of the protocols and materials, comparison between studies was not possible. However, using this technique, the studies found statistically significant improvements in most cases. The filling percentages ranged from 19% to 100%. Regarding patient satisfaction, the few studies that evaluated this parameter found statistically significant results with most patients willing to repeat the experience. Regarding side effects, only two studies reported them. Moreover, the procedure does not seem to be very painful.

CONCLUSION

The results suggest that hyaluronic acid injections seem to be effective in reconstructing papillary volume. However, to date, too few clinical trials with a high level of proof have been conducted on this technique. Future studies will have to work on the size of the sample, the concentration of the product, the number of injections and the injection method.

Association Between Periodontitis and Preterm Birth in a Cohort of Pregnant Women in Ivory Coast

PURPOSE

The aim of this study was to investigate the possible association between periodontitis and preterm birth in Ivory Coast.

MATERIALS AND METHODS

A cohort study including 446 volunteers (pregnant women) aged 15-50 years was performed in the Gynecology-Obstetrics Department of the University Hospital Center of Cocody-Abidjan in Ivory Coast. Socioeconomic and periodontal status was obtained during pregnancy. After delivery, obstetric data was collected. Periodontitis was diagnosed according to the new 2018 EFP/AAP classification of Periodontal and Peri-Implant Diseases and Conditions, as follows: a subject presenting with interdental CAL at two non-adjacent teeth or buccal/oral CAL ≥ 3 mm with pocketing > 3 mm was diagnosed with periodontitis. Any birth before the 37th week was considered a preterm birth (PTB).

RESULTS

The prevalence of periodontitis and preterm birth were 59.47% and 18.34%, respectively. Periodontitis was mainly stage 1. PTB was statistically significantly higher in pregnant women with periodontitis compared to women without periodontitis (p = 0.0002). Multivariate analysis showed that periodontitis was associated with PTB (p = 0.0002). Logistic regression showed that periodontitis is a risk factor for preterm birth (OR = 3.62; 95% CI: 1.80-7.31; p = 0.0003).

CONCLUSION

The results of this study suggest that periodontitis is an additional risk factor for preterm birth in Ivory Coast.

Photodynamic Therapy for Peri-Implant Diseases

Peri-implant diseases are frequently presented in patients with dental implants. This category of inflammatory infections includes peri-implant mucositis and peri-implantitis that are primarily caused by the oral bacteria that colonize the implant and the supporting soft and hard tissues. Other factors also contribute to the pathogenesis of peri-implant diseases. Based on established microbial etiology, mechanical debridement has been the standard management approach for peri-implant diseases. To enhance the improvement of therapeutic outcomes, adjunctive treatment in the form of antibiotics, probiotics, lasers, etc. have been reported in the literature. Recently, the use of photodynamic therapy (PDT)/antimicrobial photodynamic therapy (aPDT) centered on the premise that a photoactive substance offers benefits in the resolution of peri-implant diseases has gained attention. Herein, the reported role of PDT in peri-implant diseases, as well as existing observations and opinions regarding PDT, are discussed.

Effect of 970 nm low-level laser therapy on orthodontic tooth movement during Class II intermaxillary elastics treatment: a RCT

This prospective randomized clinical trial aimed to evaluate the effect of low-level laser therapy on tooth movement during Class II intermaxillary elastics treatment. Forty-two patients with Class II malocclusion were included, and their maxillary quadrants were allocated into two groups: treatment with an active diode laser and a placebo group. In each group, the time taken to obtain Class I occlusion after 6 months, rate of movement, total displacement of the maxillary canine to Class I occlusion and pain were recorded. The time to reach Class I occlusion in the active laser group (2.46 ± 2.1 months) was not significantly different from that in the placebo group (2.48 ± 2.0 months) (p = 0.938). Interestingly, the total distance of movement on the active laser side (2.27 ± 1.5 mm) was significantly greater than that on the placebo side (1.64 ± 1.3 mm) (p = 0.009). The pain levels on days 1, 2 and 3 were not significantly different between the laser and placebo sections. The rate of distance change toward Class I occlusion in the laser group (1.1 ± 0.7 mm/month) was significantly higher than that in the placebo group (0.74 ± 0.6 mm/month) (p = 0.037). Low-level laser therapy (970 nm) did not reduce the time needed to obtain Class I occlusion, but a significant acceleration in tooth movement was observed in the irradiated group.

Trial registration: NCT02181439. Registered 04 July 2014—https://www.clinicaltrials.gov/ct2/results?term=cinelaser.

Differences in platelet-rich plasma composition influence bone healing

AIM

Platelet-rich plasma (PRP) is an autologous blood-derived material that has been used to enhance bone regeneration. Clinical studies, however, reported inconsistent outcomes. This study aimed to assess the effect of changes in leucocyte and PRP (L-PRP) composition on bone defect healing.

MATERIALS AND METHODS

L-PRPs were prepared using different centrifugation methods and their regenerative potential was assessed in an in-vivo rat model. Bilateral critical-size tibial bone defects were created and filled with single-spin L-PRP, double-spin L-PRP, or filtered L-PRP. Empty defects and defects treated with collagen scaffolds served as controls. Rats were euthanized after 2 weeks, and their tibias were collected and analysed using micro-CT and histology.

RESULTS

Double-spin L-PRP contained higher concentrations of platelets than single-spin L-PRP and filtered L-PRP. Filtration of single-spin L-PRP resulted in lower concentrations of minerals and metabolites. In vivo, double-spin L-PRP improved bone healing by significantly reducing the size of bone defects (1.08 ± 0.2 mm³ ) compared to single-spin L-PRP (1.42 ± 0.27 mm³ ) or filtered L-PRP (1.38 ± 0.28 mm³ ). There were fewer mast cells, lymphocytes, and macrophages in defects treated with double-spin L-PRP than in those treated with single-spin or filtered L-PRP.

CONCLUSION

The preparation method of L-PRP affects their composition and potential to regenerate bone.

The effect of aging on the bone healing properties of blood plasma

OBJECTIVES

Age-related changes in blood composition have been found to affect overall health. Thus, this study aimed to understand the effect of these changes on bone healing by assessing how plasma derived from young and old rats affect bone healing using a rat model.

METHODS

. Blood plasma was collected from 6-month and 24-month old rats. Differences in elemental composition and metabolome were assessed using optical emission spectrometry and liquid mass spectrometry, respectively. Bilateral tibial bone defects were created in eight rats. Young plasma was randomly applied to one defect, while aged plasma was applied to the contralateral one. Rats were euthanized after two weeks, and their tibiae were analyzed using micro-CT and histology. The proteome of bone marrow was analyzed in an additional group of three rats.

RESULTS

Bone-defects treated with aged-plasma were significantly bigger in size and presented lower bone volume/tissue volume compared to defects treated with young-plasma. Histomorphometric analysis showed fewer mast cells, macrophages, and lymphocytes in defects treated with old versus young plasma. The proteome analysis showed that young plasma upregulated pathways required for bone healing (e.g. RUNX2, platelet signaling, and crosslinking of collagen fibrils) whereas old plasma upregulated pathways, involved in disease and inflammation (e.g. IL-7, IL-15, IL-20, and GM-CSF signaling). Plasma derived from old rats presented higher concentrations of iron, phosphorous, and nucleotide metabolites as well as lower concentrations of platelets, citric acid cycle, and pentose phosphate pathway metabolites compared to plasma derived from young rats.

CONCLUSION

bone defects treated with plasma-derived from young rats showed better healing compared to defects treated with plasma-derived from old rats. The application of young and old plasmas has different effects on the proteome of bone defects.

Combination of bone substitutes and vectors in periodontology and implantology: A systematic review

The aim of the systematic review was to analyze the use of combination of bone substitutes and vectors in periodontology and implantology among animals models and humans. Electronic databases were searched, and additional hand search was performed. The research strategy was achieved according to the PRISMA guidelines. The including criteria were: combination of bone substitutes and vectors, in vivo studies, a precise number of specimens, histological and radiographic analysis, written in English. The risk of bias was evaluated for individual studies. Thirty-two articles were selected and investigated in this systematic review. The results do not show a superiority of the use of composite biomaterial in comparison with simple biomaterial but suggest the efficacity of their utilization as a carrier of bioactive agents. Future studies need to identify the suitable association of bone substitutes and vectors and explore interest in their use such as the support of growth factors.

Periodontal Diseases and Adverse Pregnancy Outcomes: Review of Two Decades of Clinical Research

Purpose: The aim of this study was to review the literature and chart the clinical studies that have focused on periodontal diseases and adverse pregnancy outcomes since 1996. Materials and Methods: Medline, Cinahl, and Cochrane databases were searched for original studies focused on pregnancy outcomes and periodontal status in humans. The most recent search was conducted on April 30, 2020. Results: Of the 633 articles identified, 232 articles (n = 119,774 participants) were selected for analysis. The majority of studies highlighted a statistically significant association between periodontal diseases and preterm birth (71 of 111 articles; 63.96%), low birth weight (46 of 64 articles; 71.87%), preterm low birth weight (29 of 49 articles; 59.18%), preeclampsia (31 of 45 articles; 68.89%) and other pregnancy complications, such as preterm, prelabor rupture of membranes (17 of 26 articles; 65.38%). Geographical analysis revealed that clinical studies were conducted in 51 countries, primarily in the United States (42 studies, 18.10%), Brazil (33 studies, 14.22%) and India (25 studies, 10.78%). Irrespective of geographical location, analysis showed various degrees of evidence of a relationship between periodontal diseases and adverse pregnancy outcomes. Conclusion: The majority of the studies found a statistically significant link between periodontal diseases and some complications of pregnancy. The strength of such a link varies according to type of study, type of variable and outcome measure selected.

Periodontitis, erectile dysfunction, reproductive hormones, and semen quality: A systematic review

BACKGROUND

There is increasing evidence that periodontitis may affect male sexual health (MSH) (erectile function, production of sex hormones, and semen quality). However, a limited number of clinical studies demonstrate the association between MSH and periodontitis.

OBJECTIVES

The aim of this study was to explore the relationship between periodontitis and MSF.

MATERIALS AND METHODS

A comprehensive systematic review of the published literature in MEDLINE, PubMed, Scopus, Cochrane, EMBASE, and Web of Science databases from the earliest available online indexing year until October 2020 was performed, in accordance with the PRISMA guidelines. Keywords related to periodontitis were combined with words describing MSH.

RESULT

A total of 19 studies were included and discussed in the systematic review. The number of study participants ranged from 53 to 197,136 individuals, aged between 18 and 95 years (mean age, 41.2 years). Six studies did not report the age of the participants. Out of nine studies, eight found a significant association between erectile dysfunction (ED) and periodontitis. Only three studies evaluated the association between sex hormone levels and periodontitis, and two of these studies showed that patients with periodontitis are expected to exhibit higher levels of testosterone. Finally, out of five studies, two demonstrated a significant association between semen quality and periodontitis.

DISCUSSION

The findings in this review were limited by the quality and the few available studies. Results from the observational studies might have been affected by recall bias and confounded by cofactors.

CONCLUSION

The results of this systematic review revealed a significant association between periodontitis and ED, although the responsible mechanisms remain unclear. The potential associations between sex hormone levels, semen quality, and periodontitis are yet to be demonstrated. In order to improve patient management, dentists and physicians need to be aware of the association between male sexual health problems and periodontitis.

Effect of Reinforced Oral Hygiene on Periodontally Healthy Dental Students: A Four-year Follow-up Clinical Trial

PURPOSE

In periodontally healthy individuals, mean crevicular depth ranges from 1 to 3 mm. This depth threshold has been used as an indicator to differentiate a physiological dentoalveolar sulcus from a periodontal pocket needing further treatment. Because many studies have shown the important contribution of oral hygiene status to periodontal health, the purpose of this study was to explore the clinical effect of reinforced oral hygiene on the periodontal status of periodontitis-free dental students.

MATERIALS AND METHODS

In our longitudinal observational clinical study, we assessed the periodontal status of healthy individuals attending the dental school by measuring the periodontal pocket depth, bleeding on probing, and plaque index. The follow-up reassessment was carried out four years later at the end of the dental curriculum.

RESULTS

The study showed that oral hygiene improvement led to a slight but significant reduction in the mean sulcus depth (-0.049 mm; p<0.0001).

CONCLUSIONS

Reinforcement of oral hygiene contributes to the reduction of probing depth even in periodontally healthy patients.

Periodontal pockets: A potential reservoir for SARS-CoV-2?

Periodontal pockets are the major clinical manifestation of Periodontitis, a chronic inflammatory oral disease affecting the teeth-supporting tissues and has high prevalence in the adult population. Periodontal pockets are ideal environments for subgingival bacterial biofilms, that interact with the supragingival oral cavity, mucosal tissues of the pocket and a peripheral circulatory system. Periodontal pockets have been found to harbor viral species such as the Herpes simplex viruses' family. Recently, the SARS-CoV-2 has gained major interest of the scientific/medical community as it caused a global pandemic (Covid-19) and paralyzed the globe with high figures of infected people worldwide. This virus behavior is still partially understood, and by analyzing some of its features we hypothesized that periodontal pocket could be a favorable anatomical niche for the virus and thus acting as a reservoir for SARS-CoV-2.

Educational gaming for dental students: Design and assessment of a pilot endodontic-themed escape game

INTRODUCTION

The concept of escape games dedicated to dental students is a new learning experience that has not yet been extensively explored. The aim of this pilot study was to assess the impact and perceived value of an endodontic-themed escape game as assessed by fourth-year dental students.

METHODS

This study was conducted at the University of Nantes, Faculty of Dental Surgery using a cross-sectional pre- and post-test research design to assess students' changes in performance. Students in the fourth year of dental surgery study (n = 18) were divided in four groups for this study. The answers to the pre-test/post-test were 50 true/false questions. Moreover, a 20-question perception survey was given to all the participants after completion of the escape game. The study data were collected in May 2019. An unpaired t test analysed the mean differences between the groups.

RESULTS

The results showed a statistically significant increase in post-test results (75.33% ± 10.17% of correct answers) compared to the pre-test results (67.33% ± 5.94% of correct answers) P < .05. Analysis of variance revealed that this change in score was not significantly different between the four groups. The students perceived the endodontic-themed escape game to be relevant. A one-sample t test indicated that students' mean (SD) perception 4.4 (0.7) was statistically significantly higher than the mean value of the evaluation scale P < .001. The students found this educational game to be a useful experience that helped them recall/apply knowledge whilst promoting teamwork.

CONCLUSION

Therefore, this type of game can enhance students' learning and motivation.

Platelet Concentrate Treatments for Temporomandibular Disorders: A Systematic Review and Meta-analysis

OBJECTIVES

This systematic review compared platelet concentrates (PCs) versus hyaluronic acid (HA) or saline/Ringer's solution injections as treatments of temporomandibular osteoarthritis and disc displacement in terms of pain and maximum mouth opening (MMO).

METHODS

PubMed, Cochrane, and Scopus were searched up to March 6, 2020. Inclusion criteria were randomized clinical trials (RCTs). Exclusion criteria were case series, observational studies, animal studies, and reviews. The Effective Public Health Practice Project (EPHPP) quality assessment tool was used to assess the risk of bias in the included studies. The weighted mean difference was used to compare the results.

RESULTS

Nine RCTs were included with a total of 407 patients. The numbers of joints treated were 262, 112, and 112 in the PC, HA, and saline groups, respectively. The quality of studies was rated as strong in 4 studies, moderate in 4 studies, and weak in 1 study. The meta-analysis revealed that PCs decreased pain visual analogue scale (VAS) scores compared to HA by an average of -1.11 (CI, -1.62 to -0.60; P < 0.0001) and -0.57 (CI, -1.55 to 0.41; P = 0.26) at 3 and 12 mo follow-up respectively. Also, the average decrease in pain scores with PC compared to saline was -1.33 (CI, -2.61 to -0.06; P = 0.04), -2.07 (CI, -3.46 to -0.69; P = 0.003), and -2.71 (CI, -4.69 to -0.72; P = 0.008) at 3, 6, and 12 mo, respectively. Regarding MMO measurements, PC was comparable to HA, but it was significantly better than saline after 3 and 6 mo [2.9 mm (CI,1.47 to 4.3; P < 0.0001), and 1.69 mm (CI, 0.13 to 3.25; P = 0.03) respectively].

CONCLUSION

PC reduces pain VAS scores compared to HA during the first 3 m after treatment, and when compared to saline, it reduces pain and increases MMO for longer durations. However, due to differences between groups regarding PC preparation protocols and study heterogeneity, further standardized RCTs are required.

KNOWLEDGE TRANSFER STATEMENT

This study provides researchers and clinicians with quantitative and qualitative analyses of the current evidence regarding the clinical outcomes of platelet concentrate injections in the treatment of temporomandibular joint osteoarthritis and disc displacement in terms of pain control and maximum mouth opening.

Postimplantation radiation therapy in head and neck cancer patients: Literature review

There is no recommendation regarding the timing for implant surgery in patients with head and neck cancer (HNC) who require postoperative radiation therapy (RT). This systematic review focused on the literature about the outcomes of implants placed during ablative surgery in patients with HNC who underwent postoperative RT. Implants placed after radiation therapy and implants placed in reconstructed jaws were excluded. Four comparative studies involving 755 native mandible primary implants were analyzed. The survival rate with postimplantation RT was 89.6% vs 98.6% in patients with no additional radiation. The overall success of implant-retained overdenture in patients with RT performed postimplantation was 67.4% vs 93.1% in patients with implant surgery that was carried out 1 year after the completion of radiation therapy. Only five cases of osteoradionecrosis (ORN) of the jaw were reported. The outcomes for implant survival rates appear to be positive for irradiated implants.

Periodontal Diseases and Age-Related Macular Degeneration: Is There a Link? A Review

BACKGROUND

Age-related macular degeneration (AMD) induces irreversible loss of vision in older people. The exact physiopathology remains unclear, but numerous studies highlight the role of inflammation and multiple risk factors. Recent data show an altered periodontal condition subject to AMD. Periodontal diseases lead to the destruction of tooth-supporting tissues, mainly caused by the periodontal infection inducing a chronic inflammation. Periodontal diseases are known to be associated with several extraoral diseases such as diabetes, polyarthritis (rheumatoid arthritis), cardiovascular disease, and preeclampsia.

OBJECTIVES

To assess emerging evidence suggesting an association between periodontitis and AMD.

METHODS

To support this review, we performed a literature search using PubMed, Cochrane, and Google Scholar databases, completed by manual searches in periodontology journals. We included only the original studies published before July 2017 reporting data on periodontal diseases and AMD. No restrictions were made on the language.

RESULTS

Persons with AMD showed more periodontal diseases, fewer teeth, and more alveolar bone loss than those without AMD. Also, a significant association was observed between periodontal diseases and AMD, but only in the youngest individuals studied.

CONCLUSION

According to the studies included in this review, periodontal disease may be a plausible risk factor for AMD and may have a potential role in the earlier stages of this eye disease. Further studies should be encouraged for better understanding of this potential new relationship.

Periodontal regenerative medicine using mesenchymal stem cells and biomaterials: A systematic review of pre-clinical studies

The aim of the systematic review was to analyze the use of mesenchymal stem cells (MSC) and biomaterial for periodontal regeneration from preclinical animal models and human. Electronic databases were searched and additional hand-search in leading journals was performed. The research strategy was achieved according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The including criteria were as follows: MSC, biomaterial, in vivo studies, with histologic and radiologic analysis and written in English. The risk of bias was assessed for individual studies. A total of 50 articles were selected and investigated in the systematic review. These results indicate that MSC and scaffold provide beneficial effects on periodontal regeneration, with no adverse effects of such interventions. Future studies need to identify the suitable association of MSC and biomaterial and to characterize the type of new cementum and the organization of the periodontal ligament fiber regeneration.

Regenerative Effect of Platelet Concentrates in Oral and Craniofacial Regeneration

Platelet concentrates (PCs) are biological autologous products derived from the patient's whole blood and consist mainly of supraphysiologic concentration of platelets and growth factors (GFs). These GFs have anti-inflammatory and healing enhancing properties. Overall, PCs seem to enhance bone and soft tissue healing in alveolar ridge augmentation, periodontal surgery, socket preservation, implant surgery, endodontic regeneration, sinus augmentation, bisphosphonate related osteonecrosis of the jaw (BRONJ), osteoradionecrosis, closure of oroantral communication (OAC), and oral ulcers. On the other hand, no effect was reported for gingival recession and guided tissue regeneration (GTR) procedures. Also, PCs could reduce pain and inflammatory complications in temporomandibular disorders (TMDs), oral ulcers, and extraction sockets. However, these effects have been clinically inconsistent across the literature. Differences in study designs and types of PCs used with variable concentration of platelets, GFs, and leucocytes, as well as different application forms and techniques could explain these contradictory results. This study aims to review the clinical applications of PCs in oral and craniofacial tissue regeneration and the role of their molecular components in tissue healing.

Dental Management of Neurofibromatosis Type 1: A Case Report and Literature Review

Neurofibromatosis type 1 (NF1) is a clinically heterogeneous neurocutaneous genetic disorder that manifests in the form of coffee-milk spots on the skin, Lish nodules, lentigines on the underarms and on the inguinal region, and neurofibromas. Orofacial manifestations of NF1 are common. Through a review of the literature, bone lesions, orthodontic and dental abnormalities, periodontal manifestations, and caries related to NF1 will be explored. In this study, we present a clinical case of a patient with neurofibroma in the oral cavity and infraocclusion of primary molars, as well as his dental management.

Multidisciplinary Clinical Management of a Localized Aggressive Periodontitis diagnosed in a Child with Glanzmann's Thrombasthenia

Localized aggressive periodontitis (LAP) in child involving primary dentition is a rare disease. The main characteristics of LAP are deep periodontal pockets, bone loss, tooth mobility, and, sometimes, spontaneous tooth loss. The LAP involves only some specific teeth. Glanzmann’s thrombasthenia (GT) is a rare autosomal recessive bleeding disorder. The paper’s aim is to present the case of a 5-year-old girl with GT presenting LAP, and discuss her clinical management.

How to cite this article: Prud’homme T, Roy E, Soueidan A, Fouassier M, Dajean-Trutaud S, Badran Z. Multidisciplinary Clinical Management of a Localized Aggressive Periodontitis diagnosed in a Child with Glanzmann’s Thrombasthenia. Int J Clin Pediatr Dent 2018;11(4):344-348.

Delivery systems of local anesthetics in bone surgery: are they efficient and safe?

Management of postoperative pain following bone surgery includes administration of local anesthetics (LAs). Smart delivery systems, including triggered systems, have been designed to provide a continuous release of LA in situ. However, these systems can provide a high level of LA locally. This review will examine the state-of-the-art regarding the LA delivery systems optimized for management of postoperative pain in bone surgery and will discuss the potential adverse effects of LAs on the overall pathways of bone healing, including the inflammation response phase, hemostasis phase, tissue repair phase and remodeling phase. There is a clinical need to document these effects and the potential impacts on the clinical outcome of the patient.

Evaluation of a hydrogel membrane on bone regeneration in furcation periodontal defects in dogs

The aim of the study was to evaluate bone regeneration using a canine model with surgically created periodontal defects filled for 12 weeks using a stratified biomaterial consisting in a biphasic calcium phosphate (BCP) covered with a crosslinking hydrogel acting as polymer membrane of silated hydroxypropyl methylcellulose (Si-HPMC) as the tested new concept. Bilateral, critical-sized, defects were surgically created at the mandibular premolar teeth of six adult beagle dogs. The defects were randomly allocated and: (i) left empty for spontaneous healing or filled with: (ii) BCP and a collagen membrane; (iii) BCP and hydrogel Si-HPMC membrane. At 12 weeks, the experimental conditions resulted in significantly enhanced bone regeneration in the test BCP/Si-HPMC group. Within the limits of this study, we suggest that the hydrogel Si-HPMC may act as an occlusive barrier to protect bone area from soft connective tissue invasion and then effectively contribute to enhance bone regeneration.

Twenty Years of Full-Mouth Disinfection: The Past, the Present and the Future

Background:

Conventional periodontal treatment, performed quadrant by quadrant in multiple visits, was re-evaluated in the early 1990s when the full-mouth disinfection concept was introduced. Over the years, several modifications to the full-mouth disinfection approach have been suggested.

Objective:

The purpose of this article is to review the evolution of full-mouth disinfection during the past 20 years, to specify its indications and to consider the prospects for this approach.

Materials and Methods:

An electronic and manual search of the literature, ending in December 2016, was performed by two independent researchers. Only pivotal studies and randomized controlled clinical trials published in the English language that evaluated a new approach to full-mouth disinfection were selected.

Results:

According to the studies included in our analysis (21 articles), several modified full-mouth disinfection protocols have been designed including: full-mouth treatment without chlorhexidine, the extension of hygiene methods and an increase in the duration of post-treatment chlorhexidine use, the replacement of chlorhexidine with other antiseptics, supplementation with antibiotics or probiotics, full-mouth antimicrobial photodynamic therapy and one-stage full-mouth disinfection combined with a periodontal dressing.

Conclusion:

Since 1995, several modifications have been suggested to improve the effectiveness of full-mouth disinfection. The majority of the studies demonstrate that the results obtained with full-mouth disinfection and its variants are equivalent to each other and to those obtained with the conventional quadrant method. Currently, the selection of this technique remains empirical and depends on the preferences of the practitioner and the patient. In the future, a patient-centered approach should be the best indication for the use of this technique.

Clinical Performance of Narrow-Diameter Titanium-Zirconium Implants: A Systematic Review

PURPOSE

Implant-supported prosthetic rehabilitations are in constant augmentation in everyday dental practice. This is largely due to increasing demand from patients for fixed or implant-stabilized prosthesis, although they are frequently reticent to complex preimplant bone augmentation surgeries, whenever bone volume is lacking. Narrow-diameter implants (NDI; ≤3.5 mm) have been developed to offer relatively simple implant solutions in challenging bone-deficient sites. However, concerns regarding their mechanical properties have been raised. Special titanium-zirconium material (Ti-Zr), with superior mechanical resistance, compared with pure titanium alloys has been introduced into the market. The purpose of this systematic review was to determine the available data on clinical performance of Ti-Zr NDI.

MATERIALS AND METHODS

A literature search of all available clinical articles dealing with Ti-Zr NDI has been carried out. After including only prospective clinical trials, 14 papers were retrieved for thorough reviewing.

CONCLUSION

Short-term results from preliminary clinical reports are quite promising, although the number of published studies and the follow-up periods are still insufficient to determine the real benefit of this hybrid material compared with titanium, especially when using NDI.

Strategies for Optimizing the Soft Tissue Seal around Osseointegrated Implants

Percutaneous and permucosal devices such as catheters, infusion pumps, orthopedic, and dental implants are commonly used in medical treatments. However, these useful devices breach the soft tissue barrier that protects the body from the outer environment, and thus increase bacterial infections resulting in morbidity and mortality. Such associated infections can be prevented if these devices are effectively integrated with the surrounding soft tissue, and thus creating a strong seal from the surrounding environment. However, so far, there are no percutaneous/permucosal medical devices able to prevent infection by achieving strong integration at the soft tissue-device interface. This review gives an insight into the current status of research into soft tissue-implant interface and the challenges associated with these interfaces. Biological soft/hard tissue interfaces may provide insights toward engineering better soft tissue interfaces around percutaneous devices. In this review, focus is put on the history and current findings as well as recent progress of the strategies aiming to develop a strong soft tissue seal around osseointegrated implants, such as orthopedic and dental implants.

* Extracellular Matrices for Bone Regeneration: A Literature Review

The gold standard material for bone regeneration is still autologous bone, a mesenchymal tissue that consists mainly of extracellular matrix (ECM) (90% v/v) and little cellular content (10% v/v). However, the fact that decellularized allogenic bone grafts often present a clinical performance comparable to autologous bone grafts demonstrates the crucial role of ECM in bone regeneration. For long, the mechanism by which bone allografts function was not clear, but recent research has unveiled many unique characteristics of ECM that seem to play a key role in tissue regeneration. This is further confirmed by the fact that synthetic biomaterials with composition and properties resembling bone ECM present excellent bone regeneration properties. In this context, ECM molecules such as glycosaminoglycans (GAGs) and self-assembly peptides (SAPs) can improve the performance of bone regeneration biomaterials. Moreover, decellularized ECM derived either from native tissues such as bone, cartilage, skin, and tooth germs or from cells such as osteoblasts, chondrocytes, and stem cells has shown promising results in bone regeneration applications. Understanding the role of ECM in bone regeneration is crucial for the development of the next generation of biomaterials for bone tissue engineering. In this sense, this review addresses the state-of-the-art on this subject matter.

Silicon Nitride (Si3N4) Implants: The Future of Dental Implantology?

For decades titanium has been the preferred material for dental implant fabrication, with mechanical and biological performance resulting in high clinical success rates. These have been further enhanced by incremental development of surface modifications aimed at improving speed and degree of osseointegration and resulting in enhanced clinical treatment options and outcomes. However, increasing demand for metal-free dental restorations has also led to the development of ceramic-based dental implants, such as zirconia. In orthopedics, alternative biomaterials, such as polyetheretherketone or silicon nitride, have been used for implant applications. The latter is potentially of particular interest for oral use as it has been shown to have antibacterial properties. In this article we aim to shed light on this particular biomaterial as a future promising candidate for dental implantology applications, addressing basic specifications required for any dental implant material. In view of available preclinical data, silicon nitride seems to have the essential characteristics to be a candidate for dental implants material. This novel ceramic has a surface with potentially antimicrobial properties, and if this is confirmed in future research, it could be of great interest for oral use.

An in vitro analysis model for investigating the staining effect of various chlorhexidine-based mouthwashes

Background

There are different mouthwashes containing chlorhexidine in different concentrations, as well as various excipients. Chlorhexidine induce stains or discoloration in teeth and mucous membranes. The aim of this work was to design a model to reproduce in vitro staining associated with the use of different mouthwashes containing chlorhexidine.

Material and Methods

We used as substrates of natural teeth and elephant ivory slices. Different incubation baths were conducted over 21 days in culture dishes at 37°C. At the beginning of experiment before incubation (D0) and after 21 days (D21) of incubation with different mouthwashes, pictures of substrates were taken in a standardized manner and an image analysis software was used to analyse and quantify the staining under the various conditions by using the 3 main colours (Red, Green, Blue, RGB).

Results

The results of this work demonstrate a very good reproducibility of the protocol, and secondly, a different expression statistically significant of the primary blue colour. We suggest that for a given concentration of chlorhexidine, the staining effects may vary depending on the excipients used.

Conclusions

This replicable model, easy to implement over a relatively short duration, can be used for evaluation of existing mouthwashes, and to test the excipients anti discoloration proposed by manufacturers.

Key words:In vitro, chlorhexidine, mouthwashes, dental stain, tooth discoloration.

Clinical management of an atypical dental invagination

Dental invagination (DI) is a tooth malformation that usually affects permanent teeth. Its precise etiology is still controversial and represents a clinical challenge as it can favor the development of carious lesion or periodontal inflammation. This paper presents a case of a 23-year-old Caucasian male, where an atypical buccal DI could not be completely diagnosed in the dens invaginatus category. Furthermore, other differential diagnoses could not be confirmed. The dental malformation was seen on a permanent maxillary first incisor and was associated with periodontal inflammation and attachment loss. Successful clinical management of this case consisted of surgical restorative treatment and regular follow-up, accompanied by thorough oral hygiene procedures.

Oral Infections and Pregnancy: Knowledge of Gynecologists/Obstetricians, Midwives and Dentists

PURPOSE

To establish an inventory of knowledge, attitudes and daily pratice of dental and medical practitioners in France regarding oral health care and its relationship to pregnancy, particularly to preterm delivery and low birth-weight infants.

MATERIALS AND METHODS

A questionnaire was distributed to health-care professionals (n= 460), consisting of 100 prenatal care practitioners (obstetricians, midwives) and 360 dentists, about their knowledge of oral alterations during pregnancy, the possible association between periodontal disorders and preterm/low birth weight, and their conduct toward their patients.

RESULTS

Bleeding gums and pregnancy gingivitis were the oral manifestations most often cited by all the practitioners. In contrast, prenatal care practitioners were unaware of epulis and a greater percentage of them than dentists believed caries risk to increase during pregnancy. The most adverse pregnancy outcomes cited were risk of premature delivery and chorioamniotis. Only dentists had received initial training on pregnancy complications. Finally, all health professionals point out the lack of continuing education on this topic.

CONCLUSION

The present results underline the need for a better initial professional education and continuing education regarding pregnancy and oral health conditions and emphasise the need to update the guidelines in health care practices for pregnant women for a more effective prevention of risk-related adverse pregnancy outcomes, such as pre-term birth or pre-eclampsia.

Relationship between removable prosthesis and some systemics disorders

This article reviews the dental literature concerning the potential impact of the removable prosthesis (RP) on the health status of patients with certain systemic diseases. Literature was surveyed using Medline/PubMed database resources, as well as a manual search, up to 2015 to identify appropriate articles that addressed the aim of this review. The research used keywords about associations between RP and six pathologies: Human immunodeficiency virus infection, diabetes mellitus, pulmonary diseases, gastric-Helicobacter pylori, cancer, and cardiovascular diseases. Analysis of literature showed that in patients with dentures having one or more of the six general conditions listed, Candida albicans organism is more frequently found in the oral flora compared to healthy denture wearer. Although causality has not been established and pending further research on this topic, the hygienic practices necessary to minimize the risk of numerous pathologies should be strengthened in the case of these patients, all the more in the presence of physical or psychological disability. The relationship between the general diseases and increasing of oral candidiasis denture patients is not explained. Therefore, attention to oral hygiene and professional care for removing C. albicans may be beneficial in these medically compromised patients.

Periodontitis as a risk factor for systemic disease: Are microparticles the missing link?

Periodontitis is an oral inflammatory disease affecting the teeth supportive tissue. Its bacterial infectious etiology is well established. Periodontitis has been associated with increased prevalence of systemic diseases such as cardiovascular diseases, diabetes, rheumatoid arthritis, preeclampsia, preterm birth and inflammatory bowel disease. The rational of considering periodontitis as risk factor for systemic disease is the passage of inflammatory cytokines and/or bacteria in the bloodstream, thus affecting distant organs. Membrane microparticles are released by multiple cells in inflammatory environment. Recent data suggested the role of these microparticles in the pathogenic process of many systemic diseases, that can be also associated to periodontitis. We hypothesized that periodontitis could be a chronic reservoir of microparticles, hence elucidating partially the interaction with systemic diseases initiation or progression.

The association of hydrogel and biphasic calcium phosphate in the treatment of dehiscence-type peri-implant defects: an experimental study in dogs

Hydrogel polymers have many applications in regenerative medicine. The aim of this study in dogs was to investigate bone regeneration in dehiscence-type peri-implant defects created surgically and treated with (i) biphasic calcium phosphate (BCP) granules alone; (ii) a composite putty hydroxypropyl methylcellulose (HPMC)/BCP (MBCP/putty); and (iii) a polymer crosslinked membrane of silanized-HPMC (Si-HPMC/BCP) compared with empty controls. At 3 months, new bone formation was significantly more important in defects filled with HPMC/BCP or Si-HPMC/BCP compared with spontaneous healing in control (P = 0.032 and P = 0.046 respectively) and more substantial compared with BCP alone. Furthermore, new bone formation in direct contact with the implant surface was observed in all three groups treated with BCP. The addition of HPMC to the BCP granules may have enhanced the initial stability of the material within the blood clot in these large and complex osseous defects. The Si-HPMC hydrogel may also act as an occlusive membrane covering the BCP, which could improve the stability of the granules in the defect area. However, the crosslinking time of the Si-HPMC is too long for easy handling and the mechanical properties remain to be improved. The composite MBCP/putty appears to be a valuable bone-graft material in complex defects in periodontology and implantology. These encouraging results should now be confirmed in clinical studies.

Assay of in vitro osteoclast activity on dentine, and synthetic calcium phosphate bone substitutes

Resorption of synthetic bone substitute materials is essential for the integration of these materials into the natural bone remodeling process. Osteoclast behavior in the presence of calcium phosphate bioceramics (CaPB) is partially understood, and a better understanding of the underlying mechanisms is expected to facilitate the development of new synthetic bone substitutes to improve bone regeneration. In the present study, our aim was to investigate osteoclastic resorption of various synthetic CaPB. We used neonatal total rabbit bone cells to generate osteoclasts. Osteoclast-generated resorption on dentine and multiple CaPB was investigated by quantifying the surface resorbed and measuring tartrate resistant acid phosphatase (TRAP) enzyme activity. In this study, we observed that osteoclastic cells responded in a different way to each substrate. Both dentine and CaPB were resorbed but the quantitative results for the surface resorbed and TRAP activity showed a specific response to each substrate and that increased mineral density seemed to inhibit osteoclast activity.

Treatment of periodontal defects in dogs using an injectable composite hydrogel/biphasic calcium phosphate

An injectable composite silanized hydroxypropyl methyl cellulose/biphasic calcium phosphate (Si-HPMC/BCP) has been investigated in humans with promising results. The aim of this study was to evaluate his efficacy for treating periodontal defects (canine fenestration and premolar furcation) in dog models. At 3 months, we observed that bone formation around BCP particles in furcation model is more discernible but not statistically significant in defects filled with Si-HPMC/BCP compared to healing in control. We suggest that BCP particles sustain the bone healing process by osteoconduction, while the Si-HPMC hydrogel enhances intergranular cohesion and acts as an exclusion barrier. Furthermore, bone ingrowth is not so distinctive in superficial defects where the biomaterial appears unstable. These results with Si-HPMC/BCP are encouraging. In addition, this biomaterial is easy to use and simplifies the process of filling periodontal lesions. However, more researches are needed to improve the viscosity and hardness to adjust the material to the specificities of periodontal defects.

Laser-induced fluorescence for subgingival calculus detection: scientific rational and clinical application in periodontology

OBJECTIVE

To review the data available on the laser-induced calculus fluorescence phenomenon and the calculus detection devices as well as to determine the clinical relevance of using commercialized calculus detection devices in periodontal treatment.

METHODS

In vitro or in vivo English publications found on Medline.

RESULTS

In vitro and in vivo studies showed that the devices on the market had a satisfactory detection capacity. Very few studies demonstrated that the erbium:yttrium-aluminium-garnet (Er:YAG) laser debridement, when performed with automatic calculus detection, could lead to improvements at the clinical level, and the outcome was similar to that obtained with conventional treatments.

CONCLUSIONS

Although preliminary data were encouraging, there was a lack of scientific data concerning the calculus detection devices. Therefore, future studies are crucial for determining the clinical relevance of such equipment.

Gallium modulates osteoclastic bone resorption in vitro without affecting osteoblasts

BACKGROUND AND PURPOSE

Gallium (Ga) has been shown to be effective in the treatment of disorders associated with accelerated bone loss, including cancer-related hypercalcemia and Paget's disease. These clinical applications suggest that Ga could reduce bone resorption. However, few studies have studied the effects of Ga on osteoclastic resorption. Here, we have explored the effects of Ga on bone cells in vitro.

EXPERIMENTAL APPROACH

In different osteoclastic models [osteoclasts isolated from long bones of neonatal rabbits (RBC), murine RAW 264.7 cells and human CD14-positive cells], we have performed resorption activity tests, staining for tartrate resistant acid phosphatase (TRAP), real-time polymerase chain reaction analysis, viability and apoptotic assays. We also evaluated the effect of Ga on osteoblasts in terms of proliferation, viability and activity by using an osteoblastic cell line (MC3T3-E1) and primary mouse osteoblasts.

KEY RESULTS

Gallium dose-dependently (0-100 microM) inhibited the in vitro resorption activity of RBC and induced a significant decrease in the expression level of transcripts coding for osteoclastic markers in RAW 264.7 cells. Ga also dramatically reduced the formation of TRAP-positive multinucleated cells. Ga down-regulated in a dose-dependant manner the expression of the transcription factor NFATc1. However, Ga did not affect the viability or activity of primary and MC3T3-E1 osteoblasts.

CONCLUSIONS AND IMPLICATIONS

Gallium exhibits a dose-dependent anti-osteoclastic effect by reducing in vitro osteoclastic resorption, differentiation and formation without negatively affecting osteoblasts. We provide evidence that this inhibitory mechanism involves down-regulation of NFATc1 expression, a master regulator of RANK-induced osteoclastic differentiation.

[Update on side effects of alcohol-containing antiseptic mouthwashes]

Antiseptic mouthwashes are widely prescribed in odontostomatology. Also, they are increasingly integrated in routine oral hygiene programs. Graded ethanol is present in many of the available mouthwashes. This has continuously raised the concern about their safety and potential side effects of the alcohol in their composition. Alcohol was associated in many reports to cancers of the oral and pharyngeal region. Xerostomia was also suggested as a potential side effect of alcohol-containing mouthwashes. Although substantial evidence supports the association of ethanol to oral cancer, the supposed association lacks of consistency and scientific evidence. Future research is needed to determine the causal relationship of alcohol-containing mouthwashes and oral cancers. On the other hand, the benefit of alcohol in mouthwashes composition is not scientifically established.

Bisphosphonates in periodontal treatment: a review

Periodontitis is a multifactorial disease involving bacterial biofilms and the generation of an inflammatory response. The latter causes the major part of the periodontal tissue breakdown. Alveolar bone resorption is a major component of the periodontal destruction observed in periodontitis. Novel treatment modalities of periodontitis intend to control and modulate the host response to bacterial aggression. Drugs such as bisphosphonates (BPs) are proven antiresorptive agents that can potentially inhibit the alveolar bone resorption. This review describes the potential use of BPs in periodontal treatment and could be said that BPs have an in vitro and in vivo capability of reducing bone resorption. Only a few studies have been carried out on the improvement of clinical periodontal parameters after the administration of BPs. Therefore, the published data are not sufficient to establish an evidence-based relevance for the use of these drugs in the treatment of periodontal diseases.