The role of probiotic therapy on clinical parameters and human immune response in peri-implant diseases: a systematic review and meta-analysis of randomized clinical studies

Background

Peri-implant diseases (peri-implant mucositis and peri-implantitis) are pathologies of an infectious-inflammatory nature of the mucosa around dental implants. Probiotics are microorganisms that regulate host immunomodulation and have shown positive results in the treatment of peri-implant diseases. The objective of the systematic review and meta-analysis was to evaluate the efficacy of probiotics in the treatment of peri-implant oral diseases.

Methods

According to the PRISMA guidelines, the research question was established: Are probiotics able to favorably modify clinical and immunological biomarkers determinants of peri-implant pathologies? and an electronic search of the databases MEDLINE/PubMed, Embase, Cochrane Central, Web of Science, (until December 2023) was performed. Inclusion criteria were established for intervention studies (RCTs), according to the PICOs strategy in subjects with peri-implant pathology (participants), treated with probiotics (intervention) compared to patients with conventional treatment or placebo (control) and evaluating the response to treatment (outcomes). Results- 1723 studies were obtained and 10 were selected. Risk of bias was assessed using the Cochrane Risk of Bias Tool and methodological quality using the Joanna Briggs Institute for RCTs. Two meta-analyses were performed, one to evaluate probiotics in mucositis and one for peri-implantitis. All subgroups were homogeneous (I2 = 0%), except in the analysis of IL-6 in mucositis (I2 = 65%). The overall effect was favorable to the experimental group in both pathologies. The analysis of the studies grouped in peri-implantitis showed a tendency to significance (p=0.09).

Conclusion

The use of probiotics, as basic or complementary treatment of peri-implant diseases, showed a statistically significant trend, but well-designed studies are warranted to validate the efficacy of these products in peri-implant pathologies.

Use of antidepressants in the treatment of chronic orofacial pain caused by temporomandibular disorders: A randomized controlled clinical trial

BACKGROUND AND OBJECTIVE

Temporomandibular disorders (TMDs) are a common pathology, associated with pain in the facial territory and with associated psychological disorders, such as anxiety and depression. The aim of this study was to evaluate the efficacy of antidepressants in the treatment of pain associated with TMD.

MATERIALS AND METHODS

Sixty four patients suffering from chronic orofacial pain, randomly distributed in 3 groups: control group treated with night splint, group treated with 10mg/day of citalopram and group treated with 25mg/day of amitriptyline. Pain intensity was assessed, randomly, by a single blinded evaluator, according to the VAS at baseline and after one, three, six and nine weeks.

RESULTS

All groups showed a reduction of pain throughout the period of time evaluated, however, the group treated with amitriptyline showed the best pain reduction results 3.3±1.5, 1.5±1.4 and 0.9±1.3 at 3, 6 and 9 weeks, respectively.

CONCLUSIONS

Low doses of amitriptyline appear to be a good therapeutic option in patients with TMDs suffering from chronic orofacial pain.

Efficacy of music therapy on stress and anxiety prior to dental treatment: a systematic review and meta-analysis of randomized clinical trials

Introduction

Stress and anxiety are emotional states that often accompany patients who have to receive dental treatments, leading them to postpone or avoid treatments with the consequent deterioration of their oral health and, hence, their general condition. Music therapy has been shown to be an alternative to other treatments that are invasive and not without danger, such as anxiolytics or sedation. This systematic review and meta-analysis evaluated the effect of music therapy on anxiety and stress prior to dental treatments.

Methods

Studies published in PubMed (through Medline), Web of Science (WOS), Embase, and Cochrane Library databases were consulted up to October 2023. The inclusion criteria were established for intervention studies (randomized controlled trials, RCTs) according to the PICOS (population, intervention, comparison, outcomes, and study) strategy in subjects with dental stress and anxiety (participants) treated with music therapy (intervention) in comparison with patients without music therapy (control) and evaluating the response to treatment (outcomes).

Results

A total of 154 results were obtained, with 14 studies finally selected. The risk of bias and the methodological quality were assessed using the Cochrane Risk of Bias Tool and the Jadad scale, respectively. A random-effects meta-analysis was used to quantify the results of the pooled studies, while a fixed-effects meta-analysis was used for studies in the pediatric population. The meta-analysis of pooled studies found statistical significance in the subgroups of anxiety and anxiety-stress (p = 0.03 and p = 0.05, respectively), with an overall effect in favor of the intervention group (p = 0.005). Meta-analysis of the studies in the pediatric population showed considerable statistical significance for the experimental group (p < 0.00001).

Conclusion

Music therapy as a treatment for stress and anxiety, prior to dental treatment, proved to be effective in both children and adults although more well-designed randomized clinical studies are needed to validate its efficacy.

Systematic review registration

INPLASY, identifier 202312000.

Impact on the alveolar ridge of chitosan-coated implants: Preliminary study by micro-Ct and Rx in a canine model

BACKGROUND

The preclinical study presented here compared crestal bone loss between titanium implants with a conventional etched surface (SLA type) and others coated with chitosan, after 12 weeks of immediate implantation in the mandible of a canine model.

MATERIAL AND METHODS

Forty-eight implants (24 experimental and 24 control) of Ti-Al16-V4 with an internally connected tapered screw design were randomly inserted into six maxillary canines, four per hemiarch. The experimental implants were coated with Chitosan by immersion and sterilization with ethylene oxide. Primary stability was measured using the Osstell® device. No grafting materials were used, and three-dimensional micro-CT measurements included crestal bone volume (CBV) and bone volume change in crestal area (∆CBV), which were considered outcome measures. Parallelized periapical radiographs were also taken at the time of implant placement and after 12 weeks to assess changes in crestal bone levels.

RESULTS

In terms of volumetric changes, it was observed, that the experimental group showed better results than the control group (p=0.049 and p=0.303, respectively). Regarding the implantation sites, no significant differences were found between the experimental implants and the control group, only the implants placed at P4 level in the experimental group obtained the best result (p=0.041). The linear data obtained from the periapical radiographs indicated greater bone loss in the control group compared to the experimental group (3.2±0.45 and 2.75±0.55 mm, respectively).

CONCLUSIONS

Despite the better results obtained for the chitosan-coated surface group, further preclinical studies would be necessary to confirm our results.

Antioxidant, anti-inflammatory and antimicrobial activity of natural products in periodontal disease: a comprehensive review

Periodontal diseases (PD) are common chronic inflammatory oral pathologies that are strongly linked to others not found in the mouth cavity. The immune system mediates the host response, which includes the upregulation of proinflammatory cytokines, metalloproteinases, and reactive oxygen species (ROS); the latter may play an important role in the establishment and progression of inflammatory diseases, particularly periodontal disease, via the development of oxidative stress (OS). Natural antioxidants have powerful anti-inflammatory properties, and some can reduce serum levels of key PD indicators such tumor necrosis factor (TNF) and interleukin IL-1. This review compiles, through a thorough literature analysis, the antioxidant, anti-inflammatory, and antibacterial effects of a variety of natural products, as well as their therapeutic potential in the treatment of PD.

Efficacy of adjuvant metronidazole therapy on peri-implantitis: a systematic review and meta-analysis of randomized clinical studies

Peri-implant diseases are pathological conditions that affect the survival of dental implants. Etiological studies are limited, accepting a prevalence of 20% at the implant level and 24% at the patient level. The benefits of adjuvant metronidazole are controversial. A systematic review and meta-analysis of RCTs according to PRISMA and PICOS was performed with an electronic search over the last 10 years in MEDLINE (PubMed), WOS, Embase, and Cochrane Library. The risk of bias was measured using the Cochrane Risk of Bias tool and the methodological quality using the Jadad scale. Meta-analysis was performed with RevMan version 5.4.1, based on mean difference and standard deviation, with 95% confidence intervals; the random-effects model was selected, and the threshold for statistical significance was defined as p < 0.05. A total of 38 studies were collected and five were selected. Finally, one of the studies was eliminated because of unanalyzable results. All studies reached a high methodological quality. A total of 289 patients were studied with follow-up periods from 2 weeks to 1 year. Statistical significance was only found, with respect to the use of adjunctive metronidazole, in the pooled analysis of the studies (p = 0.02) and in the analysis of the radiographic values reported on peri-implant marginal bone levels, in the studies with a 3-month follow-up (p = 0.03). Discrepancies in the use of systemic metronidazole require long-term randomized clinical trials (RCTs) to determine the role of antibiotics in the treatment of peri-implantitis.

Preliminary Findings of the Efficacy of Botulinum Toxin in Temporomandibular Disorders: Uncontrolled Pilot Study

Temporomandibular disorders are a common pathology affecting up to 70% of the population, with a maximum incidence in young patients. We used a sample of twenty patients recruited in the Maxillofacial Surgery Service of the University Hospital of Salamanca (Spain), who met the inclusion criteria, with unilateral painful symptomatology of more than three months' duration. All patients were randomly treated by intramuscular and intra-articular injections of botulinum toxin (100 U) in eight predetermined points. Pain symptomatology was assessed by the visual analog scale (VAS) at the different locations, together with joint symptomatology, at baseline and six weeks after treatment. Adverse effects were also evaluated. In 85% of the patients, pain upon oral opening improved and 90% showed improvement in pain upon mastication. A total of 75% of the patients reported improvement in joint clicking/noise. Headaches improved or disappeared in 70% of the patients treated. Despite the limitations of the study and the preliminary results, intramuscular and intra-articular infiltrations with botulinum toxin were effective in the treatment of symptoms associated with temporomandibular disorders (TMDs), with minimal adverse effects.

Role of BMP-7 on biological parameters osseointegration of dental implants: Preliminary results of a preclinical study

The aim of this work was to analyze and compare the effect of bone morphogenetic protein-7 on biological parameters related to implant osseointegration in an experimental animal model. Sixteen dental implants were placed in the tibias of four randomly selected minipigs for the following dental implant surface treatments: Group A: conventional treatment of the dental implant surface by SLA (n = 8) and Group B: treatment of the dental implant surface with carboxyethylphosphonic acid and bone morphogenetic protein-7 (n = 8). The animals were sacrificed one month after dental implants placement and a histomorphometric study was performed for the evaluation of bone-to-implant contact, corrected bone-to-implant contact, new bone formation, interthread bone density and peri-implant density using Student's t-test and the non-parametric Mann-Whitney test. The histomorphometric parameters bone-to-implant contact and corrected bone-to-implant contact showed statistically significant differences between the study groups; 34.00% ± 9.92% and 50.02% ± 10.94%, respectively (p = 0.004) for SLA and 43.08% ± 10.76% and 63.30% ± 11.30%, respectively (p = 0.003) for BMP-7. The parameters new bone formation, interthread bone density and peri-implant density did not show statistically significant differences between the study groups (p = 0.951, p = 0.967 and p = 0.894, respectively). Dental implant surfaces treated with carboxyethylphosphonic acid and BMP-7 improve the biological response of dental implants to osseointegration.

Medium-Term Effect of Treatment with Intra-Articular Injection of Sodium Hyaluronate, Betamethasone and Platelet-Rich Plasma in Patients with Temporomandibular Arthralgia: A Retrospective Cohort Study

Temporomandibular joint disorders are associated with pain and reduced jaw mobility. The aim of this study was to compare the long-term effect on pain of intra-articular TMJ injections of betamethasone, sodium hyaluronate and platelet-rich plasma. The sample was made up of 114 patients, who were randomly distributed into three groups at least three years ago and who achieved a total remission of pain after treatment. We found that the median number of months without pain was, according to each group, as follows: platelet-rich plasma: 33; sodium hyaluronate: 28; betamethasone: 19. Both platelet-rich plasma and sodium hyaluronate lead to significant pain-free time after treatment; when we compare bethametasone with the two other substances, it proved to be very ineffective.

Effectiveness of biomolecule-based bioactive surfaces, on os-seointegration of titanium dental implants: A systematic review and meta-analysis of in vivo studies

Titanium and alloy osseointegrated implants are used to replace missing teeth; however, some fail and are removed. Modifications of the implant surface with biologically active substances have been proposed. MEDLINE [via Pubmed], Embase and Web of Science were searched with the terms “titanium dental implants”, “surface properties”, “bioactive surface modifications”, “biomolecules”, “BMP”, “antibacterial agent”, “peptide”, “collagen”, “grown factor”, “osseointegration”, “bone apposition”, “osteogenic”, “osteogenesis”, “new bone formation”, “bone to implant contact”, “bone regeneration” and “in vivo studies”, until May 2022. A total of 10,697 references were iden-tified and 26 were included to analyze 1,109 implants, with follow-ups from 2 to 84 weeks. The ARRIVE guidelines and the SYRCLE tool were used to evaluate the methodology and scientific evidence. A meta-analysis was performed (RevMan 2020 software, Cochane Collaboration) with random effects that evaluated BIC at 4 weeks, with subgroups for the different coatings. The heterogeneity of the pooled studies was very high (95% CI, I2 = 99%). The subgroup of BMPs was the most favorable to coating. Surface modification of Ti implants by organic bioactive molecules seems to favor osseointegration in the early stages of healing, but long-term studies are necessary to corroborate the results of the experimental studies.

Role of chitosan in titanium coatings. trends and new generations of coatings

Survival studies of dental implants currently reach high figures. However, considering that the recipients are middle-aged individuals with associated pathologies, research is focused on achieving bioactive surfaces that ensure osseointegration. Chitosan is a biocompatible, degradable polysaccharide with antimicrobial and anti-inflammatory properties, capable of inducing increased growth and fixation of osteoblasts around chitosan-coated titanium. Certain chemical modifications to its structure have been shown to enhance its antibacterial activity and osteoinductive properties and it is generally believed that chitosan-coated dental implants may have enhanced osseointegration capabilities and are likely to become a commercial option in the future. Our review provided an overview of the current concepts and theories of osseointegration and current titanium dental implant surfaces and coatings, with a special focus on the in vivo investigation of chitosan-coated implants and a current perspective on the future of titanium dental implant coatings.

Possible Association of Periodontal Diseases With Helicobacter pylori Gastric Infection: A Systematic Review and Meta-Analysis

Some research has suggested that dental plaque and saliva could be reservoirs of Helicobacter pylori (H. pylori) and be capable of infecting or re-infecting the gastric mucosa after eradication, with certain studies showing a significant association between PD and gastric infection by this bacterium. An electronic search was performed in PubMed, EMBASE, and Web of Science databases with the terms “Helicobacter pylori AND periodontal diseases”; “Helicobacter pylori AND gingivitis”; “Helicobacter pylori AND chronic periodontitis”; “Helicobacter pylori AND periodontitis”; “Helicobacter pylori AND dental plaque”, to identify articles up to September 2021. The Newcastle-Ottawa scale was used to assess study quality. A meta-analysis was performed using RevMan 2020 (Cochane Collaboration) software. A total of 1,315 studies were identified and 12 were included, analyzing 226,086 patients with mean age between 10.5 and 63.4 years. The prevalence of H. pylori in the oral cavity ranged from 5.4 to 83.3%. A random-effects model was used to analyze the presence of H. pylori and subgroups were made according to the method of evaluation (PCR or RUT). Statistical significance was found in the overall analysis (p = 0.01). There is no clear evidence that H. pylori present in oral bacterial plaque causes gastric infection and vice versa.

Bone Quantification Around Chitosan-Coated Titanium Dental Implants: A Preliminary Study by Micro-CT Analysis in Jaw of a Canine Model

Surface treatments of Ti in the dental implant industry are performed with the aim of in-creasing its bioactivity and osseointegration capacity. Chitosan (Cht) is a polysaccharide that has been proposed as a promising biomaterial in tissue engineering and bone regeneration, due to its ability to stimulate the recruitment and adhesion of osteogenic progenitor cells. The aim of our preliminary study was to evaluate, by micro-computed tomography (micro-CT), the osseointegration and bone formation around Cht-coated implants and to compare them with conventional surface-etched implants (SLA type). Four im-plants (8.5 mm length × 3.5 mm Ø) per hemiarch, were inserted into the jaws of five dogs, divided into two groups: chitosan-coated implant group (ChtG) and control group (CG). Twelve weeks after surgery, euthanasia was performed, and sectioned bone blocks were obtained and scanned by micro-CT and two bone parameters were measured: bone in contact with the implant surface (BCIS) and peri-implant bone area (PIBA). For BCIS and PIBA statistically significant values were obtained for the ChtG group with respect to CG (p = 0.005; p = 0.014 and p < 0.001 and p = 0.002, respectively). The results, despite the limitations, demonstrated the usefulness of chitosan coatings. However, studies with larger sample sizes and adequate experimental models would be necessary to confirm the results.

Role of Probiotics in Halitosis of Oral Origin: A Systematic Review and Meta-Analysis of Randomized Clinical Studies

Halitosis or oral malodor is a condition caused by the putrefaction of sulfur-containing amino acids. It affects 30–50% of the population and causes social rejection, reducing quality of life, and self-esteem. Probiotics, especially Lactobacillus species, have been proposed for the treatment of genuine halitosis, due to their ability to reduce bacterial colonization. Our objective was to evaluate their use for the treatment of oral halitosis. Applying the PRISMA statement guidelines, we searched PubMed, EMBASE, and Web of Science databases for scientific articles from the last 15 years, up to July 2021. The keywords used were “Probiotics”; “Halitosis”; “Mouth diseases”; “Oral health”; “Humans”; “Randomized Clinical Trials” according to the question, “Are probiotics effective for the reduction or elimination of oral halitosis?” Fourteen studies were identified, although only four met the inclusion criteria. We evaluated 283 participants treated with two different probiotics, with a follow-up of at least 2 weeks. Risk of bias was assessed using the Cochrane Collaboration tool. A fixed-effects meta-analysis was performed. No statistical significance was found (p = 0.53). Despite the limitations of this meta-analysis, we believe that some probiotics have a beneficial effect on halitosis, although more clinical trials are needed to establish real evidence on this aspect.

Systematic Review Registration:https://doi.org/10.37766/inplasy2021.9.0009, identifier: INPLASY20211900.

Effectiveness of Antibacterial Surfaces in Osseointegration of Titanium Dental Implants: A Systematic Review

Titanium (Ti) dental implant failure as a result of infection has been established at 40%, being regarded as one of the most habitual and untreatable problems. Current research is focused on the design of new surfaces that can generate long-lasting, infection-free osseointegration. The purpose of our study was to assess studies on Ti implants coated with different antibacterial surfaces, assessing their osseointegration. The PubMed, Web of Science and Scopus databases were electronically searched for in vivo studies up to December 2020, selecting six studies that met the inclusion criteria. The quality of the selected studies was assessed using the ARRIVE (Animal Research: Reporting of In Vivo Experiments) criteria and Systematic Review Center for Laboratory animal Experimentation's (SYRCLE's) risk of bias tool. Although all the included studies, proved greater osseointegration capacity of the different antibacterial surfaces studied, the methodological quality and experimental models used in some of them make it difficult to draw predictable conclusions. Because of the foregoing, we recommend caution when interpreting the results obtained.

Effectiveness of Propolis in the Treatment of Periodontal Disease: Updated Systematic Review with Meta-Analysis

In recent times, the use of natural products has gained momentum, either as a treatment or as adjuvants for other drugs in the treatment of different conditions. Propolis is a natural substance produced by bees which has proven useful for treating periodontal disease. This systematic review and meta-analysis gather evidence of the effectiveness of propolis in this kind of condition. The MEDLINE, CENTRAL, PubMed, EMBASE and Web of Science databases were searched for scientific articles to identify the findings published up to October 2020. The MeSH phrases used in the search were: “periodontal diseases AND propolis treatment”; “gingivitis AND propolis treatment”; “periodontitis AND propolis treatment”; “propolis treatment AND oral health”; “propolis AND oxidative stress AND periodontitis”. The Boolean operator “AND” was used to combine the searches. Randomized trials where propolis was used in the treatment of different periodontal conditions were included. Non-randomized clinical studies were systematically reviewed and 224 studies were detected, eight of which met the criteria for inclusion in the meta-analysis. Only three of these were selected for quantitative synthesis. In conclusion, propolis is safe to use and can improve the results of periodontal disease treatment, reducing probing pocket depth compared with treatment with a placebo (difference in means, fixed effects −0.67 [95% CI: −0.84, −0.50]).

Systematic Review of Effectiveness of Chitosan as a Biofunctionalizer of Titanium Implants

Simple Summary

The low bioactivity of titanium limits its applications. The biofunctionalization of its surfaces with certain polymers could improve and accelerate the osseointegration process. Chitosan is a natural polysaccharide derived from chitin, which has been proposed in biomedical engineering. This systematic review evaluated in vivo studies with chitosan-coated titanium implants compared with non-functionalized implants.

Abstract

Chitosan is a natural polysaccharide extracted from the shells of crustaceans that has been proposed as a scaffold in tissue engineering. Certain studies have proven a greater osseointegration of titanium surfaces that are functionalized with chitosan. The MEDLINE, CENTRAL, PubMed, and Web of Science databases were electronically searched for in vivo studies. Seven studies met the inclusion criteria. Animal models, implant site, chitosan incorporation methods, and methods of analysis were emphasized. The selected studies were individually discussed regarding the coatings, osseointegration potential, and suitability of the experimental models used, analyzing their limitations. We concluded that chitosan-biofunctionalized titanium surfaces have greater osseointegration capacity that uncoated control titanium alloys.

Retraction: López-Valverde, N.; et al. Use of Virtual Reality for the Management of Anxiety and Pain in Dental Treatments: Systematic Review and Meta-Analysis. J. Clin. Med. 2020, 9, 1025

The authors of a recent published paper [...].

The Unknown Process Osseointegration

Although it was already described more than fifty years ago, there is yet no in-depth knowledge regarding the process of osseointegration as far as its mechanism of action is concerned. It could be one of the body’s ways of reacting to a foreign body, where the individual’s immune response capacity is involved. It is known that the nervous system has an impact on bone health and that the role of the autonomic nervous system in bone remodeling is an attractive field for current research. In the future, immuno/neuromodulatory techniques will open new and exciting lines of research.

Bioactive Surfaces vs. Conventional Surfaces in Titanium Dental Implants: A Comparative Systematic Review

Animal studies and the scarce clinical trials available that have been conducted suggest that bioactive surfaces on dental implants could improve the osseointegration of such implants. The purpose of this systematic review was to compare the effectiveness of osseointegration of titanium (Ti) dental implants using bioactive surfaces with that of Ti implants using conventional surfaces such as sandblasted large-grit acid-etched (SLA) or similar surfaces. Applying the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, the MEDLINE, PubMed Central and Web of Science databases were searched for scientific articles in April 2020. The keywords used were “dental implants”, “bioactive surfaces”, “biofunctionalized surfaces”, and “osseointegration”, according to the question: “Do bioactive dental implant surfaces have greater osseointegration capacity compared with conventional implant surfaces?” Risk of bias was assessed using the Cochrane Collaboration tool. 128 studies were identified, of which only 30 met the inclusion criteria: 3 clinical trials and 27 animal studies. The average STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) and ARRIVE (Animal Research: Reporting of In Vivo Experiments) scores were 15.13 ± 2.08 and 17.7±1.4, respectively. Implant stability quotient (ISQ) was reported in 3 studies; removal torque test (RTT)—in 1 study; intraoral periapical X-ray and microcomputed tomography radiological evaluation (RE)—in 4 studies; shear force (SF)—in 1 study; bone-to-implant contact (BIC)—in 12 studies; and BIC and bone area (BA) jointly—in 5 studies. All animal studies reported better bone-to-implant contact surface for bioactive surfaces as compared to control implants with a statistical significance of p < 0.05. Regarding the bioactive surfaces investigated, the best results were yielded by the one where mechanical and chemical treatment methods of the Ti surfaces were combined. Hydroxyapatite (HA) and calcium–phosphate (Ca–Ph) were the most frequently used bioactive surfaces. According to the results of this systematic review, certain bioactive surfaces have a positive effect on osseointegration, although certain coating biomolecules seem to influence early peri-implant bone formation. Further and more in-depth research in this field is required to reduce the time needed for osseointegration of dental implants.

Use of Virtual Reality for the Management of Anxiety and Pain in Dental Treatments: Systematic Review and Meta-Analysis

Background: Dental treatments often cause pain and anxiety in patients. Virtual reality (VR) is a novel procedure that can provide distraction during dental procedures or prepare patients to receive such type of treatments. This meta-analysis is the first to gather evidence on the effectiveness of VR on the reduction of pain (P) and dental anxiety (DA) in patients undergoing dental treatment, regardless of age. Methods: MEDLINE, CENTRAL, PubMed, EMBASE, Wiley Library and Web of Science were searched for scientific articles in November 2019. The keywords used were: “virtual reality”, “distraction systems”, “dental anxiety” and “pain”. Studies where VR was used for children and adults as a measure against anxiety and pain during dental treatments were included. VR was defined as a three-dimensional environment that provides patients with a sense of immersion, transporting them to appealing and interactive settings. Anxiety and pain results were assessed during dental treatments where VR was used, and in standard care situations. Results: 31 studies were identified, of which 14 met the inclusion criteria. Pain levels were evaluated in four studies (n = 4), anxiety levels in three (n = 3) and anxiety and pain together in seven (n = 7). Our meta-analysis was based on ten studies (n = 10). The effect of VR was studied mainly in the pediatric population (for pain SMD = −0.82). In the adult population, only two studies (not significant) were considered. Conclusions: The findings of the meta-analysis show that VR is an effective distraction method to reduce pain and anxiety in patients undergoing a variety of dental treatments; however, further research on VR as a tool to prepare patients for dental treatment is required because of the scarcity of studies in this area.

Different Treatments in Patients with Temporomandibular Joint Disorders: A Comparative Randomized Study

BACKGROUND AND OBJECTIVES

Temporomandibular joint disorders (TMJDs) are associated with pain and reduced jaw mobility. The aim of this study was to compare the outcome of patients with TMJ arthralgia when submitted to four different treatment modalities, in some cases using intra-articular injections of substances with anti-inflammatory properties and in others, a more conservative approach consisting only of a bite splint. Materials and Methods: The sample was made up of 80 patients, randomly distributed into 4 groups of 20 patients each. Each patient was given a nocturnal bite splint. One of the groups was treated with the bite splint only, while each patient in the other 3 was injected with betamethasone, sodium hyaluronate, or platelet-rich plasma in addition to using the bite splint. Two variables were assessed, namely pain intensity between 0 to 10 according to the visual analogue scale and maximum pain-free mouth opening in mm. The patients were evaluated at four different points: at the beginning of the treatment, as well as one week, one month and six months after initiation.

RESULTS

The results showed that maximum pain-free mouth opening improved in all the groups that made up the sample, with either a reduction in pain severity or with no pain. However, the group injected with platelet-rich plasma yielded the best results after six months, while patients treated with sodium hyaluronate or betamethasone obtained the best results at the end of the first week.

CONCLUSIONS

We concluded that all the treatments used caused a reduction in pain and increased pain-free mouth opening. The splint combined with the platelet-rich plasma injection achieved long-term success.

Gingival hyperplasia as an early manifestation of acute myeloid leukemia. A retrospective review

Background

We study the prevalence of acute myeloid leukemia (AML) among patients with severe gingival enlargement.

Material and Methods

We retrospective reviewed the clinical records of patients with severe gingival enlargement, between 2011 and 2018. The Saxer and Mühlemann index were used to measure inflammation and gingival bleeding. The degree of dental mobility was measured by the Nyman and Lindhe technique.

Results

A correlation analysis was carried out to test whether there were any associations among the different variables. In the sample of 117 patients the mean gingival bleeding index was ≥3 and the degree of dental mobility ≥2.3. 1.7% of patients, with severe gingival hyperplasia were diagnosed with AML. We found a significant association between gingival bleeding and aging (p<0.001) and a trend (0.54) between bleeding and suffering from AML.

Conclusions

Severe gingival enlargement, abundant gingival bleeding, and dental mobility could be early manifestations of a blood dyscrasia. Key words:Acute myeloblastic leukemia, gingival hyperplasia, bleeding, tooth motility, oral health.

Effect of Strontium-Coated Titanium Implants on Osseointegration in Animal Models: A Literature Systematic Review

PURPOSE

This study represents a systematic review of the literature to assess the effectiveness of strontium-coated titanium surfaces on osseointegration in experimental assays with healthy, nonosteoporotic and/or nonosteopenic animals.

MATERIALS AND METHODS

An electronic search was conducted of the databases MEDLINE/PubMed, Wiley Library, and Web of Science through 2018, with the aim of identifying studies on the osseointegration of titanium implants modified with strontium.

RESULTS

A total of 255 papers were found, of which 11 were included in this systematic review. The primary result was the percentage of bone-to-implant contact (BIC) around the titanium implants with or without a strontium-coated surface. The different techniques used to coat titanium surfaces with strontium recorded significant results in terms of the improvement in the implant's quality, as they increased its contact with the bone, bone area, and bone formation, as well as enhanced its biomechanical properties.

CONCLUSION

Nine of 11 studies reported that titanium implants coated with strontium showed significantly higher BIC (P < .001 to P < .05). This coating also improved the implants' biomechanical properties.

Genetic study in patients operated dentally and anesthetized with articaine-epinephrine

Aims: In this study we wanted to figure out if there was a correlation between OPRM1 N40D, TRPV1 I316M, TRPV1 I585V, NOS3 −786T>C and IL6 −174C>G polymorphisms and the response to locally applied articaine-epinephrine anesthetic.

Methods: In this observational study, 114 oral cell samples of patients anesthetized with articaine-epinephrine (54 from men 60 from women), were collected from dental centers in Madrid (Spain). High molecular weight DNA was obtained from oral mucosa cells. The analysis of OPRM1 N40D (rs1799971), TRPV1 I316M (rs222747), TRPV1 I585V (rs8065080) and IL6 −174C>G polymorphism was performed through real-time PCR allelic discrimination using TaqMan probes. Polymorphism NOS3 −786T> C (rs2070744) was analyzed using RFLP-PCR.

Results: The studied polymorphisms are involved neither in the response to the anesthetic, nor in the intensity of perceived dental pain. However, in a subset of female patients we found that TRPV1 I316M was associated with a delayed onset of anesthesia.

Conclusions: There is no association among these polymorphisms and the time elapsed between the application of the anesthetic and the onset of its effect.

Manifestations in the Oral Mucosa of Erythromelalgia. A Case Report

Introduction:

Erythromelalgia or erythermalgia, is a peripheral paroxysmal vascular disease of the distal extremities, although it can also affect the face, ears and knees. It is characterized by increased skin temperature, erythema and intermittent episodes of burning pain. Likewise, it can also be characterized by lesions of the oral mucosa.

Case report:

Here we present the case of a 6-year old female with EM presenting ulcerative and scaly lesions in the oral cavity and whitish linear branching ulcerative lesions on the tongue. Fabry disease and rheumatoid conditions were ruled out and there were no mutations in SCN9A gene. Treatment with voltage-gated sodium channel blockers (oxcarbacepine-Trileptal®) and anticonvulsants (Perampanel-Fycompa®) did not improve pain symptoms, however, performing moderate physical activity, use of comfortable footwear, and local application of cold resulted in the restoration of patient´s quality of life

Conclusion:

To our knowledge, this report described for the first time, the successful treatment of ulcerative lesions of the oral mucosa in Erythromelalgia. We believe that the treatments described here (exercise, comfortable footwear and local application of cold) could improve the quality of life of Erythromelalgia patients.

Changes in crevicular cytokines after application of melatonin in patients with periodontal disease

Background

A clinical trial was designed to evaluate the effects of topical application of melatonin on the crevicular fluid levels of interleukins and prostaglandins and to evaluate changes in clinical parameters.

Material and Methods

A consecutive sample of 90 patients were recruited from the Health Centre of Pinos Puente in Granada, Spain and divided into 3 groups: 30 patients with diabetes and periodontal disease, who were given melatonin; 30 patients with diabetes and periodontal disease, who were given a placebo, and 30 healthy individuals with no history of systemic disease or clinical signs of periodontal disease, who were also given a placebo. The 30 patients with diabetes and periodontitis were treated with topical application of melatonin (1% orabase cream formula) for 20 days by. The rest of the patients with diabetes and periodontitis and healthy subjects were treated with a placebo of orabase cream. We measured the gingival index by exploring the percentage of standing teeth bleeding on probing. The periodontogram was performed with a Florida Probe.

Results

In the diabetic patients who were given topical melatonin, there was a statistically significant decrease in the two clinical parameters. By contrast, in diabetic patients who were given the topical placebo, there was no statistically significant variation.

Conclusions

In patients with diabetes and periodontal disease, treatment with topical melatonin was associated with a significant improvement in the gingival index and in pocket depth, and a statistically significant reduction in concentrations of interleukin-1β, interleukin-6 and prostaglandin E2 in gingival crevicular fluid.

Key words:Melatonin, periodontal disease, diabetes mellitus, interleukin-1β, interleukin-6, prostaglandin E2.

Peri-implant and Paracrestal Inflammatory Biomarkers at Failing Versus Surviving Implant Sites in a Beagle Dog Study

PURPOSE

This study sought to quantify three biochemical mediators of inflammation (tumor necrosis factor alpha [TNF-α], superoxide anion [SOA], and myeloperoxidase [MPO]) by analyzing crestal (peri-implants) and paracrestal gingival biopsy samples obtained from an experimental study on beagle dogs treated with implants inserted immediately into fresh sockets with circumferential defects.

MATERIALS AND METHODS

In 10 beagle dogs, 4 roughened titanium implants (3.8 mm wide × 8 mm high) were placed in the distal sockets of the third and fourth premolars, where a circumferential defect (5 mm wide and 5 mm deep) had been previously created by trephination. After varying follow-up periods, ranging from 80 to 190 days, the dogs were explored clinically to assess implant survival, peri-implant pocket depth, and implant stability. The levels of three biochemical mediators of inflammation (MPO, TNF-α, and SOA) were investigated using the crestal and paracrestal gingival biopsy samples with ELISA tests.

RESULTS

It was found that 37.5% of the implants were either absent or mobile. Higher levels of the inflammatory mediators were found in the crestal samples than in the paracrestal samples. The final implant stability values were significantly correlated with the final probing depth (r = -0.83, P < .01), but neither of the clinical measures were significantly correlated with any biochemical marker. The risk of implant failure was significantly proportional to the level of MPO (odds ratio: 1.1) and TNF-α (odds ratio: 1.1) in both the crestal and paracrestal regions.

CONCLUSION

All the inflammatory mediators studied were higher in the crestal areas than in the paracrestal regions, but only the values of MPO and TNF-α were significant predictors of implant failure.

Accuracy in the legal age estimation according to the third molars mineralization among Mexicans and Columbians

Objectives

This study aims to assess the accuracy of age estimation according to two cut-off points of Demirjian's developmental stages (G and H) in the wisdom teeth, using panoramic radiographs from Colombian and Mexican teenagers.

Study design

The degree of maturation of the third molars was classified according to Demirjian in 8 stages (from A to H) by a blinded trained assessor. The sensitivity, specificity and efficacy of two cut-off points (G and H) were calculated for both samples.

Results

The orthopantomographies of 316 subjects, 171 Colombians (54.1%) and 145 Mexicans (45.9%), were analyzed. The stage H was found to be the best threshold for detecting juveniles (because the high specificity) in all the third molars assessed. The specificity was higher for lower third molars than for upper third molars, but no asymmetrical discrepancy was noted.

Conclusions

The stage H is the best cut-off point for detecting the adulthood when a high-specificity test is required.

Oral health-related quality of life in 6- to 12-year-old schoolchildren in Spain

BACKGROUND

There is a lack of large epidemiological studies researching the major factors of the oral well-being in schoolchildren.

AIMS

To quantify the impact of the different clinical conditions related to caries and periodontal and dento-facial anomalies on the quality of life captured by the Child-OIDP.

DESIGN

A standardized epidemiological study was conducted on 2041 Spanish schoolchildren, aged 6-12 years, to assess caries and periodontal and dento-facial disease. Data on oral health-related quality of life were collected using the Child-OIDP. Bivariate and multivariate analyses were performed to evaluate the modulating factors in the perceived oral well-being.

RESULTS

The prevalence of impact in this sample was 45.7%, mostly for eating (24.3%) but also for smiling (16.2%); however, 72.5% of the subjects had at least one type of normative needs, mainly for periodontal treatment (52.3%), followed by caries (32.3%) and orthodontic treatments (20.6%). The main predictors of the impact on quality of life were perceived dental treatment needs, caries, and periodontal diseases. Also, some demographic (age and gender) and behavioural factors (consumption of sweets) modulated the impact on several domains. Moreover, subjects who rated their general health as good or very good reported a significantly better oral well-being than their counterparts.

CONCLUSIONS

Pain and aesthetic-related domains (i.e., problems when eating or smiling) are the major components of the oral health-related quality of life perceived by Spanish schoolchildren. Perceived treatment needs as well as dental and periodontal status were the strongest predictors of oral well-being.

The role of personality traits in self-rated oral health and preferences for different types of flawed smiles

Symmetric, aligned and luminous smiles are usually classified as 'beautiful' and aesthetic. However, smile perception is not strictly governed by standardised rules. Personal traits may influence the perception of non-ideal smiles. We aimed to determine the influence of personality traits in self-rated oral health and satisfaction and in the aesthetic preference for different strategically flawed smiles shown in photographs. Smiles with dark teeth, with uneven teeth, with lip asymmetry and dental asymmetry were ordered from 1 to 4 as a function of the degree of beauty by 548 participants, of which 50·7% were females with a mean age of 41·5 ± 17·6 years (range: 16-89 years). Self-assessment and oral satisfaction were recorded on a Likert scale. Personality was measured by means of the Big Five Inventory (extraversion, agreeableness, conscientiousness, neuroticism and openness), and the Life Orientation Test was used to measure optimism and pessimism. Of the four photographs with imperfect smiles, dental asymmetry was the most highly assessed in 63% of the sample, and the worst was lip asymmetry, in 43·7% of the sample. Some personality traits (above all conscientiousness and openness) were significantly correlated with the position assigned to the photographs with dental and lip asymmetry or with misaligned teeth. The extraversion, agreeableness and openness traits were correlated with the self-perceptions of oral health and aesthetics of the participants. Dental asymmetry seems to be better tolerated than lip asymmetry. Personality traits are weakly but significantly correlated with the aesthetic preference and oral health values, conscientiousness and openness being the most relevant domains in this sense.

Clinical and sociodemographic predictors of oral pain and eating problems among adult and senior Spaniards in the national survey performed in 2010

BACKGROUND

Pain and chewing difficulties have been identified as the strongest predictors of oral disadvantage. The aim of this study is to analyze and quantify the sociodemographic, behavioural and clinical factors modulating the oral pain and eating difficulties reported by Spanish adults and elderly Spanish people in the last National Oral Health Survey performed in 2010.

STUDY DESIGN

Data concerning pain and chewing difficulties were acquired on a Likert‑scale format from a representative sample of the Spanish general population with ages between 35-44 years (n=391) and 65‑74 years (n=405). Risk factors were identified using bivariate analysis, after which the crude association between risk factors (sociodemographic, behavioural and clinical) and outcome variables (pain and eating problems) was assessed by adjusted odds ratios, calculated by means of multivariate logistic regression.

RESULTS

Eating problems and oral pain were mainly associated with prosthetic and caries treatment needs as clinical predictors, but female sex was also seen to be a relevant and significant risk factor for suffering pain and eating restrictions. Paradoxically, after taking into account all the aforementioned predictors, the adults had an almost two‑fold higher risk of reporting pain or eating difficulties than the elderly subjects.

CONCLUSIONS

In agreement with the results from the last national oral health survey, prosthetic and caries treatment needs should be considered key factors in determining the oral well‑being of the Spanish population. In sociodemographic terms, the women and adults were seen to be at a significantly higher risk of suffering pain and eating restrictions.

Electromyographic and patient-reported outcomes of a computer-guided occlusal adjustment performed on patients suffering from chronic myofascial pain

Objectives: Muscular hyperactivity is a potential source of symptoms in patients with temporal-mandibular disorders. An adequate occlusal adjustment may relieve such symptoms. This study aims to measure the effect of shortening the protrusive disclusion time (DT) and balancing the center of occlusal forces (COF) on the EMG recordings and assess the pain reported by chronic patients one month after the computer-guided occlusal adjustment. Study Design: The sample studied comprised 34 patients suffering from chronic facial pain in which the EMG activity of both masseters was recorded by electromyography. By selective grinding we alleviated all the occlusal interferences during the mandibular protrusion from the habitual closure position in order to establish an immediate posterior disclusion and an equilibration of the COF. Results: At follow-up 76.5% of the patients reported no facial pain. Moreover, the EMG activity and protrusive DT were significantly reduced, and occlusal and muscular function were significantly more symmetric than at baseline. Conclusions: According to this EMG study, this computer-guided occlusal adjustment is able to reduce the activity of the masseters and the self-reported muscular pain of patients one-month after treatment.

Key words:Myofascial pain, occlusal adjustment, electromyography, T-Scan III, occlusal interferences.

Comparison of Clinical and Histologic Outcomes of Zirconia Versus Titanium Implants Placed in Fresh Sockets: A 5-Month Study in Beagles

Purpose: This study evaluated the clinical and histomorphometric results of titanium (Ti) and custom-made zirconia (Zr) implants placed into fresh extraction sockets in beagles that did not receive oral hygiene attention or a softened diet during postoperative healing. Materials and Methods: The roughness of the Ti and Zr implant surfaces was assessed by confocal microscopy. In eight beagle dogs, four implants each (two Ti and two Zr) were placed in the distal sockets of the third and fourth premolars with the implant shoulder at the bone crest and subjected to submerged healing. Standardized radiographs were taken after placement and 5 months after placement (at sacrifice). Histologic and histomorphometric measurements were performed on nondecalcified histologic sections. The main outcome measures included implant survival, bone-implant contact (BIC), and bone loss on the buccal and lingual plates. Results: Topographic analysis showed significant differences between the Zr and Ti surfaces. Roughness was higher for Ti than for Zr implants, kurtosis was close to 3 for Ti, and skewness was negative for Zr. After 5 months, the mean BIC was similar for the Zr (57.0% ± 15.2%) and Ti (56.5% ± 14.4%) implants, and the most severe bone loss site was observed on the buccal wall. The risk of failure was significantly higher for the Zr (43.8%) than for the Ti (12.5%) implants. Conclusion: The implant failure rate for the Zr implants was 3.5 times higher than that of the Ti implants. This may be partially explained by the less favorable topography of the Zr implants, which had, on average, significantly lower roughness (Ra = 0.85 ± 0.04 μm), negative skewness of the surface profile (-1.56 ± 0.27), and higher kurtosis (7.88 ± 1.99).

[Pain assessment using the Facial Action Coding System. A systematic review]

Self-reporting is the most widely used pain measurement tool, although it may not be useful in patients with loss or deficit in communication skills. The aim of this paper was to undertake a systematic review of the literature of pain assessment through the Facial Action Coding System (FACS). The initial search found 4,335 references and, within the restriction «FACS», these were reduced to 40 (after exclusion of duplicates). Finally, only 26 articles meeting the inclusion criteria were included. Methodological quality was assessed using the GRADE system. Most patients were adults and elderly health conditions, or cognitive deficits and/or chronic pain. Our conclusion is that FACS is a reliable and objective tool in the detection and quantification of pain in all patients.

State anxiety and depression as factors modulating and influencing postoperative pain in dental implant surgery. A prospective clinical survey

Objetives: To determine whether preoperative state anxiety and depression modulate or influence objective and subjective postoperative pain following dental implant insertion. Study Design: Prospective, clinical study with 7-day follow-up of a sample of 105 subjects who preoperatively completed the state anxiety questionnaire (STAI-E) and Beck Depression Inventory (BDI) and postoperatively, at 2 and 7 days, recorded objective pain with the Semmes-Weinstein mechanical esthesiometer (SW test) and subjective pain with the Visual Analog Scale (VAS). Results: 85.6% and 81.5% of patients, respectively, recorded no signs of state anxiety or depression. The correlation between anxiety and depression for both maxillary bones was the lower (P=0.02). The correlation between subjective and objective pain at 2 and 7 days, and the anatomic regions intervened, was statistically significant in the mandible at day 7 (P<0.01), and highly significant (P<0.001) for the other variables. The correlation between state anxiety and objective pain at day 7 was nearly statistically significant (P=0.07). Conclusions: The correlation between state anxiety and depression, and objective and subjective pain at day 7 was not statistically significant. A strong correlation was found between objective and subjective pain in the immediate postoperative period.

Key words:Anxiety, depression, postoperative pain, dental implants.

Action of melatonin on squamous cell carcinoma and other tumors of the oral cavity (Review)

Melatonin (MLT; N-acetyl-5-metoxy-tryptamine) is a hormone that is principally synthesized in the pineal gland. MLT has been shown to exhibit a variety of functions. The hormone, which is a free radical scavenger, plays an immunomodulatory role, stimulates the proliferation and synthesis of type I collagen and promotes bone formation. Moreover, MLT exerts oncostatic activity through several biological mechanisms, including antiproliferative functions, stimulation of anticancer immunity, modulation of oncogene expression and anti-inflammatory, antioxidant and antiangiogenic effects. In addition, MLT inhibits human cancer cell growth in culture, and previous clinical studies have also confirmed its anticancer properties in vivo. With regard to the underlying mechanisms of MLT in tumor processes, including oral cavity tumors such as epidermoid carcinoma, knowledge of the role played by the MT1 and 2 membrane receptors, MT3 and the calmodulin cytosolic binding sites, as well as the nuclear receptors of the RZR/ROR family, is increasing. It has been hypothesized that exogenous restoration of MT1 (MTNR1A) expression inhibits the growth of oral squamous cell carcinoma cells lacking the expression of the receptor. The tumor suppressing functions of MLT and the presence of the MT1 receptor in various tumors indicate that the receptor may play a pivotal role in oral carcinogenesis. The current review discusses the clinical significance of MLT in oral cancer.

Effect of gingival application of melatonin on alkaline and acid phosphatase, osteopontin and osteocalcin in patients with diabetes and periodontal disease

Objectives: To assess the effect of topical application of melatonin to the gingiva on salivary fluid concentrations of acid phosphatase, alkaline phosphatase, osteopontin, and osteocalcin. Study Design: Cross-sectional study of 30 patients with diabetes and periodontal disease and 30 healthy subjects. Diabetic patients were treated with topical application of melatonin (1% orabase cream formula) once daily for 20 days and controls with a placebo formulation. Results: Before treatment with melatonin, diabetic patients showed significantly higher mean salivary levels of alkaline and acid phosphatase, osteopontin and osteocalcin than healthy subjects (P < 0.01). After treatment with melatonin, there was a statistically significant decrease of the gingival index (15.84± 10.3 vs 5.6 ± 5.1) and pocket depth (28.3 ± 19.5 vs 11.9 ± 9.0) (P < 0.001). Also, use of melatonin was associated with a significant reduction of the four biomarkers. Changes of salivary acid phosphatase and osteopontin correlated significantly with changes in the gingival index, whereas changes of alkaline phosphatase and osteopontin correlated significantly with changes in the pocket depth. Conclusions: Treatment with topical melatonin was associated with an improvement in the gingival index and pocket depth, a reduction in salivary concentrations of acid phosphatase, alkaline phosphatase, osteopontin and osteocalcin.

Key words:Melatonin, diabetes mellitus, alkaline phosphatase, acid phosphatase, osteopontin, osteocalcin.

MTNR1A receptor expression in normal and pathological human salivary glands

AIM

To analyze and compare the expression of MTNR1A receptor in normal and pathological major and minor salivary glands.

MATERIALS AND METHODS

Twenty samples of major and minor salivary glands and 10 with Warthin's tumor were studied. Expression of the MTNR1A receptor (goat polyclonal antibody raised against a peptide mapping at the N-terminus of MEL-1A R of human origin) was analyzed.

RESULTS

The excretory ducts of major salivary glands demonstrated intense intracytoplasmic positivity but scant cytoplasmic membrane positivity for MTNR1A. The studied Warthin's tumors showed intense cytoplasmic positivity for MT1 receptor in all cylindrical epithelial cells lining spaces and a less intense positivity in basal cells. The lymphoid component accompanying the tumor was negative for MT1 receptor.

CONCLUSION

Intense intracytoplasmic positivity for the MTNR1A receptor in the excretory ducts of human major and minor salivary glands and Warthin's tumor was found. The intense expression of MTNR1A receptors observed in this study in the excretory ducts of major and minor salivary glands may be related to salivary regulation.

MT1 melatonin receptor expression in Warthin's tumor

We contribute the first immunohistochemical study of MT1 melatonin receptor in Warthin's tumor and normal parotid gland. All 14 Warthin's tumors studied showed intense cytoplasmic positivity for MT1 receptor in all cylindrical epithelial cells lining spaces and a less intense positivity in basal cells. The lymphoid component accompanying the tumor was always negative for MT1 receptor. The parotid structure surrounding the tumor showed intense cytoplasmic positivity in all cells lining excretory ducts (lobar and lobulillar), with a lesser and focal positivity in cells of the acinar component. The biological activity of MT1 receptor in epithelial cells lining parotid excretory ducts may resemble its activity in Warthin's tumor cells. Hence, we propose Warthin's tumor as a useful positive control in immunohistochemical studies of MT1 melatonin receptor.

Role of melatonin in cancer treatment

Melatonin has revealed itself to be a pleiotropic and multitasking molecule. The mechanisms that control its synthesis and the biological clock processes that modulate the circadian production of melatonin in the pineal gland have been well-characterized. A feature that characterizes melatonin is the variety of mechanisms it employs to modulate the physiology and molecular biology of cells. Research has implicated the pineal gland and melatonin in the processes of both aging and age-related diseases. The decline in the production of melatonin with age is thought to contribute to immunosenescence and potential development of neoplastic diseases. Melatonin has been shown to inhibit growth of different tumors under both in vitro and in vivo conditions. There is evidence that the administration of melatonin alone or in combination with interleukin-2 in conjunction with chemoradiotherapy and/or supportive care in cancer patients with advanced solid tumors, has been associated with improved outcomes of tumor regression and survival. Moreover, chemotherapy has been shown to be better tolerated in patients treated with melatonin.

Validation of the oral health impact profile (OHIP-20sp) for Spanish edentulous patients

Objectives: The purposes of this study are to validate the indicator of Oral Health Impact Profile for edentulous patients (OHIP-20sp) in the Spanish population and to analyze the factorial construct of the prosthetic well-being. Study Design: A total of twenty-one (n=21) edentulous patients wearing mandibular implant-over dentures on Locator® (LO) and twenty (n=20) with complete dentures (CD) were retrospectively evaluated in this study. All participants were recruited consecutively and were treated in the previous academic year 2009-2010 by professors of the University of Salamanca. Reliability analyses and validity tests were performed in order to evaluate the psychometric properties of OHIP-20sp employing two different total score methods (additional and simple count). A retrospective evaluation of the impact of the prosthetic treatment was captured with an evaluative instrument derived from OHIP-20, and named POST-OHIP-13. Results: The reliability coefficient (Cronbach’s alpha = 0.91) has shown a high internal consistency. Item-total correlations coefficients ranged from 0.46 and 0.81. Five factors, named as disability, functional comfort, psychosocial impact, pain-discomfort and functional limitations were identified as principal components of the construct, explaining almost 85% of the variance. The 48% of the sample felt at least one impact in an occasional or more frequently manner (generally food packing). The global transition judgment of the prosthetic treatment using the POST-OHIP-13 was significantly higher in group LO than in the CD group. Conclusions: OHIP-20 seems to be a reliable and valid indicator to measure oral impact and satisfaction in the Spanish edentulous population. The underlying construct is comprised by 5 factors named as disability, functional comfort, psychosocial impact, pain-discomfort and functional limitations.

Key words:Oral health-related quality of life, edentulous, satisfaction, validation.

Europe's oldest jaw: evidence of oral pathology

Atapuerca, in the north of Spain, is the archaeological site where the oldest hominid remains within Europe have been found. In 2008 a jaw fragment, corresponding to the symphyseal area, was discovered in the area called the 'Elephant's pit'. Its age has been estimated at 1.2 million years and it is considered to be the oldest human fossil found in Europe and is from the lower Pleistocene. This work analyses the dental and skeletal damage to the specimen, detected in a macroscopic study of possible horizontal and vertical bone loss at the level of support of the remaining teeth. The limited presence of dental scale, the pattern of destruction and the decreased bone density due to increased marrow spaces suggest the presence of possible periodontal disease.

A retrospective study of the risk factors for ridge expansion with self-tapping osteotomes in dental implant surgery

PURPOSE

To analyze the risk factors associated with the survival of self-threading implants placed with the ridge expansion technique using self-tapping osteotomes after at least 24 months.

MATERIALS AND METHODS

This retrospective study followed patients for at least 2 years in whom implants had been inserted by means of the ridge expansion technique. The patient was taken as the unit of analysis, and the loss of any implant as a result of mobility at any time during the follow-up period was considered as a failure. A number of patient variables were recorded: sociodemographic (age/sex), anatomical (bone quantity/quality, expansion zone), infection history (prior antibiotic therapy for active infection), prosthodontic (type of provisional prosthesis and type of definitive rehabilitation), and surgical (number of surgical stages, the use of biomaterials or atraumatic maxillary sinus elevation). Risk factors were expressed as values of relative risk (RR) and the odds ratio.

RESULTS

Seventy-four patients (157 implants) were followed over a mean period of 38.8 ± 7.7 months. Most patients (91.9%) did not lose any implants, and failures occurred mainly after implant loading (5.4%). Sociodemographic factors (sex and age) were not associated with a significant risk of implant failure. However, the existence of previous local infection (RR = 34.0), the use of an immediate fixed provisional prosthesis (RR = 15.0), and type D3 bone (RR = 5.1) were seen to be the main risk factors involved in this technique for the period assessed.

CONCLUSIONS

The risk of failure when implants are placed using self-tapping osteotomes was highest in patients who had active local infection; immediate provisionalization and less dense bone were also associated with additional risk of failure.

The occupational role of dental conditions among a consecutive sample of Spanish workers

OBJECTIVES

To assess the occupational impact of the mouth in terms of days of work loss in the last year and the perception of the working performance disturbance because of the oral conditions.

STUDY DESIGN

A consecutive sample (n=269) of the Regional Government staff of the province of Granada (Spain) was recruited. Participants were asked about work loss related to health problems in the past 12 months, capturing the aetiological entities, the frequency of the work absent and the total days loss. Also subjects reported if they believed that mouth affects their occupational performance, and if they have perceived difficulties for carrying out work because of the mouth. Data on sociodemographic, behavioural and clinical factors were also gathered. Chi-squared test, Odds ratio (OR) and relative risk (RR) of perceived occupational role were used to quantify the effect of the modulating factors.

RESULTS

Almost 40% of individuals were absent from work during the last year spending on average 5.4 days for recovering. Colds and musculoskeletal pathology were the major causes of sick leave. Dental disease caused short work absences (4 days on average) only in 2.8% of participants. However most of workers (62.5%) considered mouth to influence their occupational performance, mainly because of the pain-related events (61.7%), but only 4.1% of workers reported difficulties in carrying out their work in the past 12 months. Females (RR=1.3), participants attending regular dental visits (RR=1.4) and denture wearers (RR=2.5) were shown to have significantly higher risk of perceiving an occupational role of the mouth. Those workers reporting that mouth influences their work have significantly poorer oral health than counterparts.

CONCLUSIONS

Most workers considered that mouth influences their occupational performance but dental disease has demonstrated to be a minor occupational cause of sick leave in terms of prevalence and magnitude of work loss.