[Salivary gland disorder: consider IgG4-related disease]

A 73-year-old man was presented with painless, bilateral swelling of the submandibular salivary glands and unilateral swelling of the parotid gland on the right side, and complaints of dry mouth. A parotid biopsy was taken and a serologic exam was carried out, resulting in the diagnosis of IgG4-related disease. IgG4-related disease is a rare systemic disorder that can cause symptoms in the head and neck region. Usually there are complaints of bilateral, painless swelling of the submandibular, parotid and/or lacrimal glands, with or without complaints of dryness of the mouth and eyes.

Longitudinal evaluation of major salivary gland functioning in Sjögren's disease patients in a prospective standard-of-care cohort

OBJECTIVES

To evaluate changes in major salivary gland functioning over time using salivary gland ultrasonography (SGUS), salivary flow measurements (sialometry), and patient-reported outcome measures (PROMs) in patients diagnosed with primary Sjögren's disease (SjD).

METHODS

Consecutive outpatients from the ongoing prospective REgistry of Sjögren Syndrome LongiTudinal (RESULT) cohort, all fulfilling the ACR-EULAR classification criteria for SjD, were included. SGUS images assessed with the Hocevar and OMERACT scoring system, unstimulated and stimulated whole saliva (UWS/SWS), unstimulated and stimulated submandibular/sublingual saliva (uSMSLS/sSMSLS) and parotid saliva, EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI) general dryness, oral dryness, and Xerostomia Inventory were assessed at baseline (BL), 2-year (Y2) and 5-year (Y5) follow-up.

RESULTS

In total, BL and Y2 data were available for 253 patients and 75 patients had already reached Y5. At group level, SGUS Hocevar (i.e., mean±SD: 22±10 at BL, 22±10 at Y2 and 23±10 at Y5), OMERACT scores, UWS, SWS and PROMs remained stable over time (all p>0.05). Slightly decreased uSMSLS (p=0.025) and sSMSLS (p=0.004) were observed at Y5. At individual patient level, a similar proportion showed an increase or decrease of ≥25% for Hocevar, UWS and SWS. At baseline, poor associations were observed between SGUS and PROMs and fair associations between sialometry and PROMs. Over time, changes in objective assessments did not correlate with changes in PROMs.

CONCLUSIONS

Overall, major salivary gland functioning assessed with SGUS, sialometry and PROMs did not change significantly up to 5 years of follow-up in a standard-of-care cohort of SjD patients from daily clinical practice.

Can ultrasound of the major salivary glands differentiate Sjögren's disease from its major mimics?

OBJECTIVES

Ultrasound of the major salivary glands (SGUS) is widely used to assess the major salivary glands in Sjögren's disease (SjD). Little is known, however, regarding the diagnostic accuracy of SGUS to differentiate SjD from its mimics. This study aims to investigate the diagnostic accuracy of SGUS in differentiating SjD from other diseases with salivary gland involvement.

METHODS

SGUS was performed in 20 consecutive patients with SjD and 20 consecutive patients with well-established systemic disease, i.e., with either sarcoidosis, amyloidosis, HIV infection or chronic HCV infection. Images were scored independently by two blinded observers using the Hocevar scoring system. Diagnostic accuracy to discriminate between the patient (sub-)groups was explored.

RESULTS

The accuracy of SGUS to differentiate SjD from other systemic diseases was excellent (area under ROC curve of 0.91). The optimal cut-off value to define positive or negative ultrasound for SS was 15. Sensitivity, specificity, positive predictive value and negative predictive value were high, varying from 85-90%, and diagnostic odds ratio was 51. SGUS was positive in the vast majority of SjD patients (n=18), but also in 2 patients with HIV infection and one patient with sarcoidosis. SGUS score differed significantly between patients with SjD and other systemic diseases (median 27 vs. 10, p<0.001) as well as between SjD patients and patients with either sarcoidosis, amyloidosis, HIV or HCV infection (all p<0.05).

CONCLUSIONS

This study indicates that SGUS has a potentially high diagnostic accuracy to discriminate SjD from systemic diseases which can also cause salivary gland involvement.

Impact of COVID-19 Dentistry-Related Literature: An Altmetric Study

INTRODUCTION

Scientific literature on COVID-19 has grown rapidly during the pandemic. The aim of this study was to provide a comprehensive overview of the popularity on the web of the available dental publications on COVID-19 and to examine associations amongst article characteristics, online mentions, and citations.

MATERIALS AND METHODS

An Altmetric Explorer search was conducted for COVID-19 articles published in dental journals using 3 keywords: COVID-19, SARS-CoV-2, and pandemic. The following Altmetric data were collected: Altmetric attention score (AAS), mentions by news outlets, tweets, Mendeley readers, and Web of Science citations. Additionally, article title, type, topic, origin and open access status, journal title, quartile of impact factor (IF) distribution, and time lapse between COVID-19 pandemic onset and publication date were analysed.

RESULTS

In all, 253 articles published in 48 dental journals were eligible for the study. AAS was significantly influenced by article topic, type, origin, and journal IF quartile. There was a negligible correlation between AAS and Web of Science citations. Mendeley was the only Altmetric source highly correlated with citations.

CONCLUSIONS

There was substantial online interest in COVID-19 dentistry-related literature, as depicted by the AAS of the reviewed articles and social media metrics. Mendeley reader counts were highly correlated with citations, and they may therefore be valuable in research impact evaluation.

Success rate of sialendoscopy. A systematic review and meta-analysis

OBJECTIVE

To perform a systematic review and meta-analysis on the efficacy and safety of sialendoscopy in the treatment of obstructive diseases of the major salivary glands.

MATERIALS AND METHODS

We searched four databases for literature. The primary outcome assessed was the success rate. Secondary outcomes included the use of supportive devices, number of sialadenectomies and complications. Risk of bias was assessed. Meta-analyses with subgroup analysis were performed.

RESULTS

In total, 91 studies were included, comprising 8218 patients undergoing 9043 sialendoscopic procedures. The majority of studies had a medium or high risk of bias. The incidence of sialadenectomy varied from 0% to 14%. No major complications were reported. Meta-analysis revealed a weighted pooled success rate of 80.9%. Subgroup analyses showed the weighted pooled success rate in patients with sialoliths (89.6%), stenoses (56.3%), submandibular glands (88.3%), parotid glands (81.2%), patients treated by an endoscopic-assisted transoral removal of a sialolith (86.3%), patients treated by a combined approach of the parotid gland (78.2%), patients with JRP (67.0%) and with RAIS (45.8%).

CONCLUSION

The success rate of sialendoscopy did not considerably change in the last 9 years. Sialendoscopy is an efficient and safe procedure for the treatment of major salivary gland obstructive disease.

"Dear Doctor, greetings of the day!": A 1-year observational study of presumed predatory journal invitations

BACKGROUND

This study aimed at investigating the predatory publishing phenomenon in orthodontics by analyzing the content of unsolicited e-mail invitations received within 12 months.

METHODS

All electronic invitations for manuscript submission, review and editorial membership received between 1 October 2021 and 30 September 2022 were collected from an orthodontist's inbox. The following data were recorded for each e-mail: date, journal title and origin, requested contribution, e-mail language, relevance to the researcher's discipline, journal characteristics (claimed metrics, editorial services, article types accepted, and publication fees), journal/publisher contact information and online presence. Journal/Publisher legitimacy and publishing standards were evaluated by listing in the Beall's list of potential predatory journals and publishers, the Predatory Reports of Cabell's Scholarly Analytics, and the Directory of Open Access Journals.

RESULTS

A total of 875 e-mail invitations deriving from 256 journals were retrieved within the observation period, with most of them soliciting article submissions. More than 76% of the solicitations originated from journals and publishers included in the blocklists used in the study. Salient features of predatory journals like flattering language, abundant grammatical errors, unclear publication charges and wide variety of article types and topics accepted for publication were confirmed for the examined journals/publishers.

CONCLUSIONS

Nearly 8 out of 10 unsolicited e-mail invitations sent to orthodontists for scholarly contribution may be related to journals suspicious for publishing malpractices and suboptimal standards. Excessive flattering language, grammatical errors, broad range of submissions, and incomplete journal contact information were commonly encountered findings. Researchers in orthodontics should be alert to the unethical policies of illegitimate journals and their harmful consequences on the scientific literature.

Harvesting anterior iliac crest or calvarial bone grafts to augment severely resorbed edentulous jaws: a systematic review and meta-analysis of patient-reported outcomes

The aim of this systematic review was to compare patient-reported outcomes after harvesting calvarial or anterior iliac crest bone grafts to repair severe jaw defects and enable implant placement. The MEDLINE, Embase, Cochrane Central Register of Controlled Trials databases, and OpenGrey were searched for studies on patient satisfaction, pain, disturbances in daily functioning, sensory alterations, donor site aesthetics, and complication rates. Of the 1946 articles identified, 43 reporting 40 studies fulfilled the inclusion criteria; the studies were one randomized controlled clinical trial, one retrospective controlled clinical trial, and 23 prospective and 15 retrospective cohort studies. A meta-analysis of two studies (74 patients) showed no difference in satisfaction (mean difference (MD) - 0.13, 95% confidence interval (CI) - 1.17 to 0.92; P = 0.813) or postoperative pain (directly postoperative: MD -2.32, 95% CI -5.20 to 0.55, P = 0.113; late postoperative: MD -0.01, 95% CI -0.14 to 0.11, P = 0.825) between donor sites. However, the level of evidence is limited, due to the retrospective, non-randomized design of one study. Postoperative gait disturbances were highly prevalent among the anterior iliac crest patients (28-100% after 1 week). The incidence rates of sensory disturbances and other complications were low, and the donor site aesthetic outcomes were favourable for both graft types. To conclude, harvesting bone grafts from the calvarium or anterior iliac crest to augment the severely resorbed edentulous jaw results in similar patient satisfaction. However, the findings for postoperative pain and disturbances in daily living suggest a trend in favour of calvarial bone grafts if harvested using an adjusted technique.

World Workshop on Oral Medicine VIII: Development of a core outcome set for dry mouth: A Consensus Study

OBJECTIVE

This study aimed to develop a consensus-based core outcome set (COS) to be used in clinical trials assessing dry mouth interventions.

STUDY DESIGN

Through 2 systematic literature reviews and interviews with dry mouth patients, we identified relevant outcome domains for dry mouth assessment. A Delphi survey was presented to health care providers attending the American Academy of Oral Medicine annual meeting in Memphis, Tennessee, USA, on May 2022 (n = 104) and 10 dry mouth patients at Cork University Dental School and Hospital, Republic of Ireland. The outcome domains for which no consensus was reached were subsequently discussed in a second consensus process led by a virtual Special Interest Group of 11 oral medicine experts from the World Workshop on Oral Medicine VIII dry mouth working group.

RESULTS

After the 2-step consensus process, a consensus was reached for 12 dry mouth outcome domains (i.e., salivary gland flow, signs of hyposalivation, mucosal moisture/wetness, the severity of xerostomia, duration of xerostomia, the overall impact of xerostomia, impact on physical functioning, impact of hyposalivation on general health, impact on social activities, quality of life, the economic impact of dry mouth, patient satisfaction) to be included in the final COS.

CONCLUSIONS

We propose a consensus-based COS to assess dry mouth interventions in clinical trials. This COS includes the minimum but mandatory set of domains that all clinical trials evaluating dry mouth treatments should assess.

World Workshop on Oral Medicine VIII: Development of a core outcome set for dry mouth: The Patient Perspective

OBJECTIVE

We conducted a qualitative study of patients' perspectives on dry mouth outcomes to explore their personal experiences and investigate which outcomes are most important to them. This work was part of the WONDER initiative (World Workshop on Oral Medicine Outcomes Initiative for the Direction of Research) exploring Core Outcome Measures in Effectiveness Trials.

STUDY DESIGN

Using a study-specific topic guide, we conducted digitally recorded, semi-structured interviews of focus groups of patients with dry mouth secondary to Sjögren syndrome and head and neck radiotherapy. We conducted interviews until data saturation had been achieved and evaluated all transcripts for accuracy before we anonymized the data.

RESULTS

Two focus groups consisting of 4 participants per group identified 4 distinct themes: (1) impact on oral health and function, (2) social isolation and withdrawal, (3) frustration with dry mouth management, and (4) limited knowledge of the medical community and lack of understanding of family and friends.

CONCLUSIONS

The diversity of self-reported outcomes and the complexity of patient perceptions identified in our work may represent additional barriers to successful dry mouth management that should be considered in the design of future clinical trials.

World Workshop on Oral Medicine VIII: Development of a Core Outcome Set for Dry Mouth: A Systematic Review of Outcome Domains for Xerostomia

OBJECTIVE

The purpose of this study was to identify all outcome domains used in clinical studies of xerostomia, that is, subjective sensation of dry mouth. This study is part of the extended project "World Workshop on Oral Medicine Outcomes Initiative for the Direction of Research" to develop a core outcome set for dry mouth.

STUDY DESIGN

A systematic review was performed on MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases. All clinical and observational studies that assessed xerostomia in human participants from 2001 to 2021 were included. Information on outcome domains was extracted and mapped to the Core Outcome Measures in Effectiveness Trials taxonomy. Corresponding outcome measures were summarized.

RESULTS

From a total of 34,922 records retrieved, 688 articles involving 122,151 persons with xerostomia were included. There were 16 unique outcome domains and 166 outcome measures extracted. None of these domains or measures were consistently used across all the studies. The severity of xerostomia and physical functioning were the 2 most frequently assessed domains.

CONCLUSION

There is considerable heterogeneity in outcome domains and measures reported in clinical studies of xerostomia. This highlights the need for harmonization of dry mouth assessment to enhance comparability across studies and facilitate the synthesis of robust evidence for managing patients with xerostomia.

Immune markers and microbial factors are related with periodontitis severity in people with HIV

OBJECTIVE

The objective of the study is to assess systemic immune markers and microbial factors related to periodontitis severity in people living with HIV.

METHODS

Eighty people living with HIV (PLWH), who exhibited in the last two viral load measurements < 40 copies/mL, underwent full-mouth periodontal examinations and sub-gingival plaque sampling. Periodontitis was classified according to the CDC-AAP case definition. Inflammation, immune-activation, and immunosenescence markers were assessed, microbiological analyses were performed, and oral care routines and HIV characteristics were noted.

RESULTS

From our group of PLWH, 42.5% and 57.5% suffered from moderate and severe periodontitis, respectively. Oral care habits did not differ between PLWH with moderate and severe periodontitis. Bacterial subgingival plaque loads were higher, and Porphyromonas gingivalis was more prevalent in PLWH with severe periodontitis than with moderate periodontitis (53% vs 7%, respectively). Mean C-reactive protein levels [CRP, 1.6 mg/L versus 0.8 mg/L, p = 0.020] and percentages of senescent CD28-CD57 + CD8 + T-cells in peripheral blood [16.5 versus 8.9, p = 0.035] were higher with severe periodontitis. Infection duration, CD4 count, CD4/CD8 ratio and type of antiretroviral therapy did not differ between both groups.

CONCLUSIONS

Periodontitis severity is related to increased prevalence of Porphyromonas gingivalis, elevated CRP levels, and higher frequencies of circulating CD8 + senescent cells in PLWH.

World Workshop on Oral Medicine VIII: Development of a Core Outcome Set for Dry Mouth: A Systematic Review of Outcome Domains for Salivary Hypofunction

OBJECTIVE

To identify all outcome measures used to assess salivary gland hypofunction (i.e., objective measures used to determine actual changes in saliva quantity or to assess response to treatment of salivary gland hypofunction) and to group these into domains.

STUDY DESIGN

A systematic review including clinical trials and prospective or retrospective observational studies involving human participants with dry mouth, with any type of intervention where the objective assessment of salivary gland hypofunction was described.

RESULTS

Five hundred fifty-three studies involving 31,507 participants were identified. Most assessed salivary gland hypofunction and xerostomia (68.7%), whereas 31.3% assessed salivary gland hypofunction alone. Most studies investigated the "amount of saliva," and the highest number of outcome measures were within the domain of "clinical/objective signs of salivary gland hypofunction."

CONCLUSIONS

Seven domains encompassing 30 outcome measures were identified, confirming the diversity in outcomes and outcome measures used in research regarding salivary gland hypofunction. Identified items will be used in conjunction with those identified regarding xerostomia to create a core outcome set for dry mouth quantification for use in future clinical trials, with the overall goal of improving the standardization of reporting, leading to the establishment of more robust evidence for the management of dry mouth and improving patient care.

Effects of Upper Blepharoplasty Techniques on Headaches, Eyebrow Position, and Electromyographic Outcomes: A Randomized Controlled Trial

The aim of this study was to assess changes in headaches, eyebrow height, and electromyographic (EMG) outcomes of the frontalis and orbicularis oculi muscles, after an upper blepharoplasty with or without resecting a strip of orbicularis oculi muscle. In a randomized controlled trial, 54 patients received an upper blepharoplasty involving either only removing skin (group A) or removing skin with an additional strip of orbicularis muscle (group B). Preoperative, and 6 and 12 months postoperative headache complaints were assessed using the HIT-6 scores and eyebrow heights were measured on standardised photographs. Surface EMG measurements, i.e., electrical activity and muscle fatigue, were assessed for the frontalis and orbicularis oculi muscles preoperatively and 2, 6, and 12 months postoperatively. Significantly fewer headaches were reported following a blepharoplasty. The eyebrow height had decreased, but did not differ between groups. Regarding the surface EMG measurements, only group A's frontalis muscle electrical activity had decreased significantly during maximal contraction 12 months after surgery (80 vs. 39 mV, p = 0.026). Fatigue of both the frontalis and the orbicularis oculi muscles did not change significantly postoperatively compared to baseline. EMG differences between groups were minor and clinically insignificant. The eyebrow height decreased and patients reported less headaches after upper blepharoplasty irrespective of the used technique.

Public interest in Invisalign in developed and developing countries: A Google Trends analysis

Objective:

To investigate long-term changes and possible seasonal variations in Google search volumes related to Invisalign in developed and developing countries.

Design:

Cross-sectional, Google search-based study.

Methods:

Google Trends (GT) was accessed to retrieve the Relative Search Volume (RSV) of Google queries related to the search term ‘Invisalign’ in 10 countries selected on the basis of population size, Internet usage and socioeconomic criteria between 1 January 2004 and 30 June 2021. The countries examined were the following: Australia, Brazil, Italy, Mexico, Philippines, Saudi Arabia, Spain, Thailand, UK and USA. By applying the time series decomposition method, the trend component and the seasonal variation were identified.

Results:

Overall, RSVs regarding Invisalign have increased significantly in all countries with the developed countries outperforming developing countries throughout most of the observation period. There was no meaningful pattern when the trends were compared either on a monthly or quarterly basis. Similar peaks and valleys were found in Australia - Brazil, UK - USA, Italy - Spain and Saudi Arabia - Philippines - Thailand.

Conclusions:

Public interest in online information for Invisalign has grown significantly over the years across countries of diverse socioeconomic and cultural backgrounds while seasonal patterns were observed in the related Google searches. Seasonal fluctuations seemed to follow the academic calendar. The study results may have direct implications on practice management and professional development.

POS0754 PATIENT ACCEPTABLE SYMPTOM STATE (PASS) IN PATIENTS WITH PRIMARY SJÖGREN’S SYNDROME IN DAILY CLINICAL PRACTICE

Background

Primary Sjögren’s syndrome (pSS) has great impact on all aspects of patients’ lives, not only physically, but also mentally, socially and financially.1 Sicca symptoms are mainly treated with local treatment, but no systemic immunosuppressive treatment is registered yet for pSS, which may have significant consequences on whether patients find their symptom state acceptable (PASS). In a previous study, a cut-off for acceptable symptom state based on the EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI, score <5) was developed for inclusion of patients with an unacceptable symptom state in clinical trials.2

Objectives

To explore the presence of PASS in a standard of care cohort of pSS patients and to compare patient characteristics and disease activity including ESSPRI between patients with and without PASS.

Methods

Consecutive outpatients with pSS from the REgistry of Sjögren Syndrome LongiTudinal (RESULT) cohort, who fulfilled the ACR/EULAR classification criteria and had available PASS data at baseline were included. Patient-reported outcomes were reported through questionnaires, which included the PASS (“Considering all the different ways your disease is affecting you, if you were to stay in this state for the next few months, do you consider your current state satisfactory?”; yes/no) and ESSPRI (“How severe has your dryness, fatigue and pain been during the last two weeks?”; scale 0-10). An acceptable ESSPRI symptom state has been defined as <5.2 Systemic disease activity was assessed with EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI). Independent samples t-test, Mann-Whitney U test or Chi Square test were used to analyse differences between patients with or without PASS.

Results

Of 277 included pSS patients, 248 (90%) were female, median age was 54 years (IQR 43-64) and disease duration 5 years (2-11). 198 (71%) patients scored their symptom state as acceptable according to PASS. Patients with PASS were significantly older and had a longer disease duration compared to patients without PASS. Furthermore, patients with PASS had more often a low disease activity according to ESSDAI, and less often moderate disease activity (Table 1). The difference in ESSDAI activity was mainly observed in the articular and constitutional domains. ESSPRI was significantly lower in patients with PASS (median 5 vs. 7). No differences were seen in functional or laboratory parameters (Table 1). Of all included patients, only 86 (31%) patients had an acceptable symptom state according to the pre-defined cut-off point for ESSPRI (score <5). Sensitivity and specificity of this ESSPRI cut-off point for reaching PASS was 40% and 92%, respectively.

Table 1.

Baseline characteristics of pSS patients with and without PASS

PASS (n=198)Without PASS (n=79)Gender (female)177 (89)71 (90)Age (years)57 (44-65)*49 (41-60)*Disease duration (years)6 (2-12)*5 (2-8)*ESSDAI (total)4 (2-6) (n=191)4 (2-9) (n=75)<5127 (66)*38 (51)*5-1452 (27)*32 (43)*≥1412 (6)5 (7)ESSPRI (total)5 (4-7)**7 (6-8)**<580 (40)**6 (8)**Schirmer’s test (mm)4 (1-10) (n=179)4 (1-10) (n=72)Ocular staining score2 (1-4) (n=190)2 (0-4) (n=77)Unstimulated whole salivary flow (ml/min)0.05 (0.01-0.14) (n=187)0.08 (0.01-0.19) (n=76)Stimulated whole salivary flow (ml/min)0.54 (0.15-0.99) (n=189)0.58 (0.21-0.97) (n=76)SSA positive172/197 (87)66/79 (84)IgG (g/L)14 (11-19) (n=196)14 (10-19) (n=79)Rheumatoid factor (IU/ml)12 (3-39) (n=196)16 (2-47) (n=78)

Data presented as median (IQR) or n (%)

*Significant difference p<0.05

***Significant difference p<0.001

Conclusion

The majority (71%) of pSS patients reported being in an acceptable symptom state according to the PASS question in our standard of care cohort in daily clinical practice, despite high ESSPRI scores (60% with score ≥5). Further analyses of influences of treatment in these patients will be conducted.

References

[1]Vieira et al. Clin Exp Rheum 2021;39(Suppl. 133):S14-S16.

[2]Seror et al. Ann Rheum Dis 2016;75:382-389.

Acknowledgements

Unrestricted grants from the Dutch Arthritis Patients Association (ReumaNL), Bristol-Myers Squibb and Novartis

Disclosure of Interests

Liseth de Wolff: None declared, Suzanne Arends: None declared, Esther Mossel: None declared, Greetje S. van Zuiden: None declared, Jolien F. van Nimwegen Speakers bureau: Bristol-Myers Squibb, Consultant of: Bristol-Myers Squibb, Lisette Olie: None declared, Alja J. Stel: None declared, Konstantina Delli: None declared, Gwenny M. Verstappen: None declared, Frans G.M. Kroese: None declared, Arjan Vissink: None declared, Hendrika Bootsma Speakers bureau: Bristol Myers Squibb and Novartis, Consultant of: Bristol Myers Squibb, Roche, Novartis, Medimmune, Union Chimique Belge, Grant/research support from: Unrestricted grants from Bristol Myers Squibb and Roche

Effect of ruxolitinib on the oral mucosa of patients with steroid-refractory chronic Graft-versus-Host disease and oral involvement

BACKGROUND

Chronic Graft-versus-Host Disease (cGVHD) can impact quality of life, especially in patients with oral involvement. Half of the patients with cGVHD do not respond to first-line therapy with corticosteroids and calcineurin inhibitors. Ruxolitinib is effective in steroid-refractory (SR)-cGVHD cases, but the long-term effects of ruxolitinib on the oral mucosa are unknown.

OBJECTIVE(S)

This study aims to assess the effect of ruxolitinib on the oral mucosa of SR-cGVHD patients with oral involvement.

MATERIALS AND METHODS

An observational longitudinal patient study was conducted in 53 patients with SR-cGVHD and oral involvement who were treated with ruxolitinib. The baseline condition of the oral mucosa was compared to its condition at 4 and 12 weeks after starting ruxolitinib.

RESULTS

The overall response was 81% (43/53), with a complete response in 53% (28/53) and partial response in 28% (15/53) after 12 weeks (p < 0.001). Men and patients concurrently using immunosuppressive therapy responded better than women (p = 0.005) and patients with ruxolitinib monotherapy (p = 0.02), respectively. At a longer follow-up (median 20 months), oral symptoms were comparable to the 12-week symptoms (p = 0.78), regardless of ruxolitinib use (p = 0.83).

CONCLUSION

Ruxolitinib treatment of SR-cGVHD patients with oral involvement was associated with a significant response of the oral manifestations at 12 weeks.

CLINICAL RELEVANCE

The oral mucosa of SR-cGVHD patients is likely to improve after 4 and 12 weeks of ruxolitinib treatment. Symptom severity at baseline does not affect the response of the oral mucosa.

Diagnostic accuracy of physical examination findings for midfacial fractures: a systematic review and meta-analysis

Objectives

To conduct a systematic review and meta-analysis to assess the diagnostic accuracy of physical examination findings and related clinical decision aids for midfacial fractures in comparison to computed tomography and cone beam computed tomography.

Material and methods

A systematic review was performed by searching the MEDLINE, Cochrane, EMBASE, and CINAHL databases. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled sensitivity, specificity, and diagnostic odds ratios with the corresponding 95% confidence intervals were calculated for each physical examination finding and reported clinical decision aids.

Results

After screening 2367 records, 12 studies were included. High risk of patient selection bias was detected in three studies (25%). Additionally, high concerns regarding applicability were found for the patient selection in five studies (41.7%), and for the reference standard in eleven studies (91.7%). Of the total 42 individual physical examination findings, only 31 were suitable for a meta-analysis. High specificity and low sensitivity were found for most findings. The pooled diagnostic odds ratio ranged from 1.07 to 11.38. Clinical decision aids were reported by 8 studies, but none were constructed specifically for midfacial fractures.

Conclusion

Based on the current available evidence, the absence of physical examination findings can successfully identify patients who do not have a midfacial fracture, but the presence of individual findings does not necessarily mean that the patient has a midfacial fracture. Although various clinical decision aids were presented, none focused on exclusively midfacial fractures.

Clinical relevance

The diagnostic accuracy of physical examination findings can be used to diagnose a midfacial fracture so as to reduce unnecessary imaging, health care costs, and exposure to ionizing radiation.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00784-022-04423-y.

Diagnostic challenges in a diffuse large B-cell lymphoma of the maxilla presenting as exposed necrotic bone

Lymphoma is the second most common malignancy in the head and neck area, affecting both nodal and extranodal sites, including oral soft and hard tissues, usually in the form of non-Hodgkin’s lymphoma (NHL). However, lymphomas of the jaws, including diffuse large B-cell lymphoma (DLBCL), the most common type of NHL, are very rare and may cause significant diagnostic challenges resembling common jaw pathologies, such as periapical lesions, osteomyelitis and osteonecrosis. The aim of this paper is to present a rare case of DLBCL in an 84-years-old diabetic male patient on methylprednisolone treatment for autoimmune hemolytic anemia. The lesion appeared clinically as exposed necrotic bone of the maxilla with surrounding soft tissue ulceration and radiographically as an extensive osteolytic lesion with ill-defined borders. Despite the resemblance of the lesion with osteonecrosis or osteomyelitis that could be theoretically related to diabetes and/or systemic use of corticosteroids, histopathologic examination, necessitating a repeat biopsy in order to acquire sufficient tissue, revealed the final diagnosis of lymphoma. The need for increased clinical awareness and vigilance of this possible diagnostic conundrum is emphasized.

Key words:Diffuse large B-cell lymphoma, exposed bone, oral, malignancy, maxilla, jaw osteonecrosis, differential diagnosis.

Histopathology, salivary flow and ultrasonography of the parotid gland: three complementary measurements in primary Sjögren's syndrome

OBJECTIVE

The involvement of salivary glands in primary Sjögren's syndrome (pSS) can be assessed in different ways: histopathology, salivary flow and ultrasonography. To understand the relative value of these different approaches, it is crucial to understand the relationship between them. As we routinely perform these three modalities in the parotid gland for disease evaluation, our aim was to investigate the construct validity between these modalities in one and the same gland.

METHODS

Consecutive sicca patients underwent a multidisciplinary diagnostic work-up including parotid gland biopsy, collection of parotid gland-specific saliva and parotid gland ultrasonography. Patients who were classified as pSS according to the ACR-EULAR criteria were included. Construct validity was assessed using Spearman's correlation coefficients.

RESULTS

The 41 included pSS patients completed a full work-up within mean time interval of 2.6 months. Correlations between histopathological features and stimulated parotid salivary flow were fair (ρ=-0.123 for focus score, and ρ=-0.259 for percentage of CD45+ infiltrate). Likewise, poor correlations were observed between stimulated parotid salivary flow and parotid ultrasonography (ρ=-0.196). Moderate to good associations were found between the histopathological items focus score and percentage of CD45+ infiltrate, with parotid ultrasound scores (total ultrasound score: ρ = 0.510 and ρ = 0.560; highest for homogeneity: ρ = 0.574 and ρ = 0.633).

CONCLUSION

Although pSS associated ultrasonographic findings did correlate with histopathological features, the three modalities that evaluate salivary gland involvement assess different (or at best partly related) constructs. Therefore, histopathology, salivary flow and ultrasonography are complementary measurements and cannot directly replace each other in the work-up of pSS.

Linear and profilometric changes of the mucosa following soft tissue augmentation in the zone of aesthetic priority: A systematic review and meta-analysis

OBJECTIVES

To assess the outcomes of soft tissue augmentation, in terms of change in level and thickness of mid-buccal mucosa, at implants sites in the zone of the aesthetic priority.

MATERIAL AND METHODS

MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials databases were searched (last search on 1 June 2020). Inclusion criteria were studies reporting outcomes of different materials and timing of grafting in patients undergoing soft tissue augmentation at implant sites in the aesthetic zone with a follow-up of ≥1 year after implant placement. Outcome measures assessed included changes in level and thickness of mid-buccal mucosa, implant survival, peri-implant health and patients' satisfaction.

RESULTS

Eighteen out of 2,185 articles fulfilled the inclusion criteria. Meta-analysis revealed a significant difference in vertical mid-buccal soft tissue change (0.34 mm, 95% CI: 0.13-0.56, p = .002) and mid-buccal mucosa thickness (0.66 mm, 95% CI: 0.35-0.97, p < .001) following immediate implant placement in favour of the use of a graft versus no graft. Mean difference in mid-buccal mucosa level following delayed implant placement (0.17 mm, 95% CI: 0.01-0.34, p = .042) was also in favour of the use of a graft versus no graft. With regard to mucosa thickness, the use of a graft was not in favour compared with no graft following delayed implant placement (0.22 mm, 95% CI: -0.04-0.47, p = .095). Observed changes remained stable in the medium term.

CONCLUSION

Soft tissue augmentation in the zone of the aesthetic priority results in less recession and a thicker mid-buccal mucosa following immediate implant placement and less recession in mid-buccal mucosa following delayed implant placement compared with no graft.

Impact of upper blepharoplasty, with or without orbicularis oculi muscle removal, on tear film dynamics and dry eye symptoms: A randomized controlled trial

PURPOSE

Upper blepharoplasty may be related to dry eye symptoms since the function of the orbicularis oculi muscle may affect the tear film. We aimed to assess the effect of blepharoplasty with or without the removal of a strip of orbicularis oculi muscle on tear film dynamics and dry eye symptoms.

METHODS

A double-blind, randomized, controlled trial comparing upper blepharoplasty without (group A) or with (group B) orbicularis oculi muscle excision was performed on 54 healthy Caucasian patients. Tear film dynamics and dry eye symptoms were evaluated using multiple dry eye parameters, i.e. tear osmolarity, Schirmer test I, corneal/conjunctival staining, tear break-up time (TBUT), Oxford Scheme, Sicca Ocular Staining Score and Ocular Surface Disease Index questionnaire. All the parameters were assessed preoperatively and 6 and 12 months after upper blepharoplasty. All the groups' outcomes were compared.

RESULTS

The differences were not significant between the two upper blepharoplasty techniques regarding most of the above-mentioned outcomes. Subjective symptoms of ocular irritation, consistent with dry eye disease and vision-related impairment, were reduced after upper blepharoplasty independent of the type of the technique applied, while the pre and postoperative outcomes of the objective tear dynamics did not differ 12 months after surgery. However, group B demonstrated a significant increase in tear osmolarity and TBUT at the 6-month follow-up visit.

CONCLUSION

An upper blepharoplasty alleviates subjective dry eye complaints in the long term, while not changing the tear dynamics. The improvement was independent of the blepharoplasty technique used.

The effect of implant-abutment connections on peri-implant bone levels around single implants in the aesthetic zone: A systematic review and a meta-analysis

Objective

To systematically review literature about the effect of different implant‐abutment interface designs on peri‐implant bone level changes, implant loss and mid‐buccal mucosa changes around single implants in the anterior maxilla. Reviewing three connection configurations: Platform switched conical (PS‐conical); Platform switched parallel (PS‐parallel); Platform matched parallel (PM‐parallel).

Methods

A detailed search was carried out in Pubmed, EMBASE, Cochrane, Scopus, Open Gray and African journals Online (until December 1, 2020) and was restricted to clinical prospective studies of at least 1 year and with at least 10 human participants. A meta regression analysis was carried out primarily on the pooled peri‐implant bone level changes followed by implant loss and mid‐buccal mucosa level change. Risk of bias was assessed with RoB 2.0 and ROBINS‐I. The manuscript complied with the PRISMA guidelines and was registered in the PROSPERO database (ID: 225092).

Results

A total of 5513 hits gave 44 eligible articles for the analyses. Bone level change did not differ significantly between the two platform switched connections; their bone loss scores were significantly lower than PM‐connection. The PS‐conical connections have significantly lower implant losses than the PM connection. Mid‐buccal mucosa level change was comparable between the three connection configurations. Moderate to high risk of bias was detected in the included studies.

Conclusions

The performance of PS‐conical and PS‐parallel connection configurations both favored bone loss scores compared to the PM‐parallel connection configuration. All three demonstrated mid‐buccal mucosa changes that were small and did not differ significantly amongst the groups.

Tracking trends of transgender health research online: are researchers and the public on the same page?

Altmetric Explorer was searched for the most popular online articles published in Pubmed-indexed journals. The 75 articles with the highest Altmetric Attention Score (AAS) were screened for article information (date, journal, access), authorship (number of authors, affiliation and origin of the corresponding author), and research (type, subject, funding). The reviewed articles displayed a mean AAS of 241.52, were broadcast 17.03 times by news agencies, posted on Twitter 101.47 times, downloaded by 67.21 Mendeley readers, and received 62.67 citations. There was intense online interest in the transgender health literature, mainly related to mental health and social well-being. Online visibility of transgender health articles was not significantly correlated with citation counts, implying that the public, likely including transgender persons and allies, may place emphasis on different health issues than scholars. Monitoring altmetrics and interactions on electronic media may help researchers conduct research that is more meaningful to transgender individuals, and to society in general.

Author self-citation in orthodontics is associated with author origin and gender

BACKGROUND

The aims of this bibliometric study were to determine author self-citation trends in high-impact orthodontic literature and to investigate possible association between self-citation and publication characteristics.

METHODS

Six orthodontic journals with the highest impact factor as ranked by 2017 Journal Citation Reports were screened for a full publication year (2018) for original research articles, reviews, and case reports. Eligible articles were scrutinized for article and author characteristics and citation metrics. Univariable and multivariable negative binomial regression was used to examine associations between self-citation incidence and publication characteristics.

RESULTS

Medians for author self-citation rate of the most self-citing authors and self-citations were 3.03% (range 0-50) and 1 (range 0-19), respectively. In the univariable analysis, there was no association between self-citation counts and study type (P = 0.41), article topic (P = 0.61), number of authors (P = 0.62), and rank of authors (P = 0.56). Author origin (P = 0.001), gender (P = 0.001) and journal (P = 0.05) were associated with self-citation counts and in the multivariable analysis only origin and gender remained strong self-citation predictors. Asian authors and females self-cited significantly less often than all other regions and male authors.

CONCLUSIONS

Authors in orthodontics do not self-cite at a frequency that suggests potential citation manipulation. Author origin and gender were the only variables associated with citations counts. More bibliometric research is necessary to draw solid conclusions about author self-citation trends in orthodontic literature.

Salivary Gland Ultrasonography in Sjögren's Syndrome: A European Multicenter Reliability Exercise for the HarmonicSS Project

Objectives: Salivary gland ultrasonography (SGUS) is increasingly applied for the management of primary Sjögren's syndrome (pSS). This study aims to: (i) compare the reliability between two SGUS scores; (ii) test the reliability among sonographers with different levels of experience.

Methods: In the reliability exercise, two four-grade semi-quantitative SGUS scoring systems, namely De Vita et al. and OMERACT, were tested. The sonographers involved in work-package 7 of the HarmonicSS project from nine countries in Europe were invited to participate. Different levels of sonographers were identified on the basis of their SGUS experience and of the knowledge of the tested scores. A dedicated atlas was used as support for SGUS scoring.

Results: Twenty sonographers participated in the two rounds of the reliability exercise. The intra-rater reliability for both scores was almost perfect, with a Light's kappa of 0.86 for the De Vita et al. score and 0.87 for the OMERACT score. The inter-rater reliability for the De Vita et al. and the OMERACT score was substantial with Light's Kappa of 0.75 and 0.77, respectively. Furthermore, no significant difference was noticed among sonographers with different levels of experience.

Conclusion: The two tested SGUS scores are reliable for the evaluation of major salivary glands in pSS, and even less-expert sonographers could be reliable if adequately instructed.

Clinical Phenotyping of Primary Sjögren Syndrome Patients Using Salivary Gland Ultrasonography: Data From the RESULT Cohort

OBJECTIVE

To investigate salivary gland ultrasound (SGUS) abnormalities in relation to clinical phenotype and patient characteristics, disease activity, and disease damage in patients with primary Sjögren syndrome (pSS).

METHODS

Consecutive outpatients included in our REgistry of Sjögren Syndrome LongiTudinal (RESULT) cohort were selected. Patients with pSS who were included were classified according to the American College of Rheumatology/European League Against Rheumatism (EULAR) criteria and underwent full ultrasonographic examination (Hocevar score 0-48) at baseline. Total SGUS scores of ≥ 15 were considered positive. Patient characteristics, disease activity, and disease damage were compared between the different SGUS groups.

RESULTS

In total, 172 of 186 patients with pSS were eligible, of whom 136 (79%) were SGUS positive. Compared with patients who were SGUS negative, SGUS-positive patients had significantly longer disease duration, higher EULAR Sjögren Syndrome Disease Activity Index, higher Sjögren Syndrome Disease Damage Index, and were more likely to have a positive parotid gland biopsy, anti-SSA/SSB antibodies, and abnormal unstimulated whole saliva (UWS) and ocular staining score (OSS), and higher levels of IgG and rheumatoid factor. Regarding patient-reported outcome measurements (PROM), patients who were SGUS positive scored significantly lower on the EULAR Sjögren Syndrome Patient-Reported Index for fatigue and pain, and more often found their disease state acceptable compared with patients who were SGUS negative. SGUS total score showed significant associations with various clinical and serological variables, and with PROM. Highest associations were found for UWS (ρ = -0.551) and OSS (ρ = 0.532).

CONCLUSION

Patients who were SGUS positive show a distinct clinical phenotype in all aspects of the disease compared with patients who were SGUS negative: clinical, functional, serological, and PROM. SGUS could be a helpful tool in selecting patients for clinical trials and estimating treatment need.

Incorporation of Salivary Gland Ultrasonography Into the American College of Rheumatology/European League Against Rheumatism Criteria for Primary Sjögren's Syndrome

Objective

To assess whether the addition of salivary gland ultrasonography (SGUS) or replacement of current criteria items by SGUS influences the performance of the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria for primary Sjögren's syndrome.

Methods

Included were consecutive patients with complete data on all ACR/EULAR items (n = 243) who underwent SGUS in our primary Sjögren's syndrome expertise center. Clinical diagnosis by the treating physician was used as the gold standard. Separate analyses were performed for patients who underwent labial or parotid gland biopsies. The average score for hypoechogenic areas in 1 parotid and 1 submandibular gland was determined (range 0–3). Next, performance of the ACR/EULAR criteria was evaluated after addition of SGUS or replacement of current items by SGUS.

Results

Receiver operating characteristic analysis showed an optimal cutoff value of ≥1.5 for SGUS. The optimal weight for SGUS positivity was 1. Cutoff for ACR/EULAR fulfilment remained ≥4. In patients who underwent a labial gland biopsy (n = 124), the original criteria showed an area under the curve (AUC) of 0.965, sensitivity of 95.9%, and specificity of 92.2%. After the addition of SGUS, the AUC was 0.966, with a sensitivity of 97.3% and specificity of 90.2%. In patients who underwent a parotid gland biopsy (n = 198), similar results were found. Sensitivity of the criteria decreased substantially when SGUS replaced salivary gland biopsy or anti‐SSA antibodies, while performance remained equal when SGUS replaced the ocular staining score, Schirmer's test, or unstimulated whole saliva flow.

Conclusion

Validity of the ACR/EULAR criteria remains high after incorporation of SGUS. With SGUS, clinicians are offered a larger array of tests to evaluate fulfillment of the ACR/EULAR criteria.

OP0162 ABATACEPT TREATMENT FOR PATIENTS WITH EARLY ACTIVE PRIMARY SJÖGREN’S SYNDROME: OPEN-LABEL EXTENSION PHASE OF A RANDOMIZED CONTROLLED PHASE III TRIAL

Background:

Abatacept (CTLA-4-Ig) targets the CD80/CD86:CD28 co-stimulatory pathway required for full T-cell activation and T-cell dependent activation of B-cells. The Abatacept Sjögren Active Patients phase III (ASAPIII) trial is a mono-center, investigator-initiated, placebo controlled study with an open-label extension phase (NCT02067910), which assessed the efficacy and safety of weekly subcutaneous abatacept (125mg) in patients with early active primary Sjögren’s syndrome (pSS). Previous analyses of the double blind phase showed no significant effect of abatacept treatment compared to placebo on the primary endpoint, difference in EULAR Sjögren’s syndrome disease activity index (ESSDAI) at week 24.1

Objectives:

To evaluate the efficacy and safety of extended (48 weeks) open label abatacept treatment in pSS patients.

Methods:

Included patients had biopsy-proven pSS, fulfilled the AECG and ACR-EULAR criteria, had disease duration ≤7 years (median 2 years), ESSDAI ≥5, and 89% were anti–SSA positive. All 40 patients who received abatacept (ABA) in week 0-24 were subsequently treated with abatacept from week 24-48. Of the 40 patients who received placebo (PLB) in week 0-24, 2 were lost to follow up, and 38 were treated with abatacept from week 24-48. Systemic disease activity (ESSDAI), patient reported symptoms (ESSPRI), serological outcomes (RF and IgG), ocular staining score (OSS) and unstimulated whole salivary flow (UWS) were assessed. We evaluated whether outcomes improved within treatment groups, from week 0 to subsequent visits and from week 24 to subsequent visits:

GEE modeling was used to test significance of changes over time. Missing data were not imputed.

Results:

ESSDAI and ESSPRI were improved within ABA/ABA patients between week 0-48 with additional efficacy after week 24, and within PLB/ABA patients after switching to ABA. Significant decreases in ESSDAI and ESSPRI were also seen within PLB treated patients between week 0-24 (Figure 1). IgG and RF were improved within ABA/ABA patients between week 0-48 with additional efficacy after week 24, and within PLB/ABA patients after switching to ABA. OSS was improved within ABA/ABA treated patients between week 0-48. UWS only showed significant improvement in week 36 within ABA/ABA treated patients. No changes in IgG, RF, OSS or UWS were seen within PLB treated patients. No deaths occurred. One serious adverse event possibly related to intervention occurred during ABA treatment.

Conclusion:

ESSDAI and ESSPRI improved significantly during 48-week treatment with abatacept. Placebo treated patients also showed significant improvement in both indices and further improvement occurred after switching to abatacept. Biological activity was decreased by abatacept treatment. 48-week abatacept treatment improved OSS, and might improve UWS. Abatacept was well tolerated by pSS patients.

References:

[1]van Nimwegen et al. Lancet Rheumatol.Published online 31-01-2020

Acknowledgments:

This study was funded by Bristol-Myers Squibb. We thank all patients for participation in the ASAP-III trial.

Disclosure of Interests:

Suzanne Arends Grant/research support from: Grant/research support from Pfizer, Jolien F. van Nimwegen Consultant of: Bristol-Myers Squibb, Speakers bureau: Bristol-Myers Squibb, Esther Mossel: None declared, Greetje S. van Zuiden Speakers bureau: Roche, Konstantina Delli: None declared, Alja J. Stel: None declared, Bert van der Vegt Consultant of: Advisory board member for Philips and Visiopharm., Erlin A. Haacke: None declared, Lisette Olie: None declared, Leoni Los: None declared, Gwenny M. Verstappen: None declared, Sarah A. Pringle: None declared, Fred K.L. Spijkervet: None declared, Frans G.M. Kroese Grant/research support from: Unrestricted grant from Bristol-Myers Squibb, Consultant of: Consultant for Bristol-Myers Squibb, Speakers bureau: Speaker for Bristol-Myers Squibb, Roche and Janssen-Cilag, Arjan Vissink: None declared, Hendrika Bootsma Grant/research support from: Unrestricted grants from Bristol-Myers Squibb and Roche, Consultant of: Consultant for Bristol-Myers Squibb, Roche, Novartis, Medimmune, Union Chimique Belge, Speakers bureau: Speaker for Bristol-Myers Squibb and Novartis.

How has the dental literature evolved over time? Analyzing 20 years of journal self-citation rates and impact factors

Objective: As journal impact factors (IFs) can be artificially inflated by excessive journal self-citation practices, research quality evaluation based solely on IF ranking may be manipulated and, therefore, ethically challenged. This study aimed to analyze the longitudinal development of journal self-citation rates (SCRs) and IFs in dental literature and to determine possible confounders.Methods: Twenty-eight journals with scope within general dentistry and (sub)specialties listed in 1997-2016 Journal of Citation Reports^® were scrutinized. The following information was retrieved: publication year, total number of citations, number of self-citations, IF, corrected IF, and SCR.Results: Endodontic journals had the highest SCR (median = 35.3, IQR = 21.6-47.5), journals related to periodontics had the lowest (median = 14.7, IQR = 8.9-25.5). Periodontics had the highest IF (median = 2.1, IQR= 1.7-2.8) and general dentistry had the lowest (median = 0.9, IQR = 0.7-1.2). SCR significantly decreased over time (p < .0001) by 1 unit per year. Additionally, 1 unit increase in corrected IF resulted in 15.2 units decrease in SCR. IFs significantly increased 0.06 units per year (p < .000).Conclusions: Overall, favourable changes in citation metrics have been observed for dental journals during the 20-year observation period. SCR significantly decreased per observation year whereas IFs significantly increased, indicating a healthy publishing environment in the dental literature. SCR was regulated both by time and corrected IF.

What is the optimal timing for implant placement in oral cancer patients? A scoping literature review

BACKGROUND

Oral cancer patients can benefit from dental implant placement. Traditionally, implants are placed after completing oncologic treatment (secondary implant placement). Implant placement during ablative surgery (primary placement) in oral cancer patients seems beneficial in terms of early start of oral rehabilitation and limiting additional surgical interventions. Guidelines on the ideal timing of implant placement in oral cancer patients are missing.

OBJECTIVE

To perform a scoping literature review on studies examining the timing of dental implant placement in oral cancer patients and propose a clinical practice recommendations guideline.

METHODS

A literature search for studies dealing with primary and/or secondary implant placement in MEDLINE was conducted (last search December 27, 2019). The primary outcome was 5-year implant survival.

RESULTS

Sixteen out of 808 studies were considered eligible. Both primary and secondary implant placement showed acceptable overall implant survival ratios with a higher pooled 5-year implant survival rate for primary implant placement 92.8% (95% CI: 87.1%-98.5%) than secondary placed implants (86.4%, 95% CI: 77.0%-95.8%). Primary implant placement is accompanied by earlier prosthetic rehabilitation after tumor surgery.

CONCLUSION

Patients with oral cancer greatly benefit from, preferably primary placed, dental implants in their prosthetic rehabilitation. The combination of tumor surgery with implant placement in native mandibular bone should be provided as standard care.

Abatacept treatment for patients with early active primary Sjögren's syndrome: a single-centre, randomised, double-blind, placebo-controlled, phase 3 trial (ASAP-III study)

BACKGROUND

Several small open-label studies have suggested efficacy of abatacept-a co-stimulation inhibitor-in patients with primary Sjögren's syndrome. These promising results warranted further evaluation. We therefore aimed to further assess the safety and efficacy of abatacept compared with placebo in patients with primary Sjögren's syndrome.

METHODS

We did a single-centre, randomised, double-blind, placebo-controlled, phase 3 trial at the University Medical Center Groningen (Groningen, Netherlands). We included patients with primary Sjögren's syndrome fulfilling the American-European Consensus Group criteria, aged 18 years or older, with positive salivary gland biopsies, time from diagnosis of 7 years or less, and a European League Against Rheumatism Sjögren's Syndrome Disease Activity Index (ESSDAI) score of 5 or more. Independent pharmacists randomly allocated patients (1:1) to either the abatacept group or placebo group using a computer-generated sequence stratified by previous use of disease-modifying anti-rheumatic drugs. Patients received at-home subcutaneous injections of abatacept (125 mg) or placebo once a week for 24 weeks. The primary outcome was the between-group difference in ESSDAI score at week 24. Efficacy was analysed in patients who received at least one drug dose and for whom post-baseline data were collected. Safety was analysed in all patients who received at least one drug dose.

FINDINGS

Between Aug 14, 2014, and Aug 23, 2018, 580 patients were reviewed for eligibility, of which 80 patients were randomly assigned to receive study treatment. Efficacy was analysed in 40 patients receiving abatacept and 39 patients receiving placebo (one patient in this group was lost to follow-up). The primary outcome did not significantly differ between the treatment groups. The adjusted mean difference in ESSDAI score at week 24 between the abatacept group and placebo group was -1·3 (95% CI -4·1 to 1·6). No deaths or treatment-related serious adverse events occurred. In 38 (95%) of 40 patients in the abatacept group, 103 adverse events occurred, including one serious adverse event and 46 infections. In 38 (95%) of 40 patients in the placebo group, 87 adverse events occurred, including four serious adverse events and 49 infections.

INTERPRETATION

On the basis of this trial, we cannot recommend abatacept treatment as standard of care to reduce systemic disease activity in patients with primary Sjögren's syndrome. Further studies should evaluate whether patients with specific clinical manifestations and biological characteristics might benefit from abatacept treatment.

FUNDING

Bristol-Myers Squibb.

World Workshop on Oral Medicine VII: Prognostic biomarkers in oral leukoplakia: A systematic review of longitudinal studies

OBJECTIVE

To identify the prognostic biomarker candidates for stratification and long-term surveillance of oral leukoplakia progressing to cancer via a systematic literature review.

MATERIALS AND METHODS

Systematic searches with no date restrictions were conducted on March 29, 2018, targeting the databases PubMed (Ovid), EMBASE (Ovid), EBM (Ovid), and Web of Science (ISI). Bias was assessed using the Quality in Prognosis Studies tool. Biomarkers were stratified based on hallmarks of cancer.

RESULTS

Inclusion criteria were met by 25 of 3,415 studies. A range of biomarkers were evaluated experimentally for risk stratification, prognosis, and surveillance of oral leukoplakia in tissue, blood, and saliva. However, the studies were highly heterogeneous and require further validation. Biomarkers reported in these studies included inflammatory or oxidative markers, growth factors, ion channels, genetic and cellular regulatory factors, and epigenetic biomarkers. Studies tended to include small sample sizes, under-reported or variably reported histopathological data, did not address potential confounding, reported limited/variable follow-up data, or lacked a control group. Inclusion of subsets from chemoprevention trials may have introduced bias regarding reported malignant transformation rates and accuracy of prognostic biomarkers.

CONCLUSIONS

This review identified insufficient longitudinal evidence to support validated prognostic biomarkers for oral leukoplakia. Further studies are needed to identify molecular targets with the potential to mitigate risk of malignant transformation.

World Workshop on Oral Medicine VII: Biomarkers predicting lymphoma in the salivary glands of patients with Sjögren's syndrome-A systematic review

OBJECTIVE

To conduct a systematic review of studies exploring potential biomarkers for development, course, and efficacy of treatment of lymphomas in salivary glands of patients with Sjögren's syndrome.

MATERIAL AND METHODS

Eligible studies were identified through a comprehensive search of two databases, that is, PubMed and EMBASE. Quality of included articles was assessed with the "Quality In Prognosis Studies" (QUIPS) tool. The "CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies" (CHARMS) was used to facilitate data extraction.

RESULTS

Fifty-eight studies met the inclusion criteria. Only one study assessed the progression of lymphoma. Moderate risk of bias was detected in "outcome measurement," "study participation," and "study confounding" domains. Parotid gland enlargement, mixed monoclonal cryoglobulins, and low C4 levels represented strongest predictors of lymphoma development. The role of histological biomarkers, and specifically germinal centers, remains controversial. Clinical and methodological heterogeneity across studies precluded conduct of a meta-analysis.

CONCLUSIONS

Specific biomarkers in combination with clinical manifestations represent potential candidates for advancing precision medicine approaches to lymphoma prediction in patients with Sjögren's syndrome. Current focus has increasingly been on genetic and epigenetic markers as candidate predictors. Predictive accuracy of key biomarker candidates remains to be tested in well-designed prospectively followed Sjögren's syndrome cohorts.

[The level of oral health and oral care in patients with Sjögren syndrome]

Sjögren syndrome, characterised by, among other things, dry mouth, can be associated with an increased risk of caries and oral infections. The level of oral care and oral health in a group of 50 patients with Sjögren syndrome was assessed. These findings were compared with a group of 61 healthy controls. Damage to the cervical area of the teeth was much more frequently seen in patients with Sjögren syndrome than in the control group (p smaller 0,001). Moreover, patients with Sjögren syndrome paid more attention to their oral care. This expressed itself, among other things, by the more frequent use of interdental cleaning agents (p = 0.004) and fluoride mouthwashes (p smaller 0.001). It is recommended that dentists and dental hygienists see their patients often; every three months, for example, on account of, among other things, the increased risk of developing caries.

Concurrent validity and reliability of cephalometric analysis using smartphone apps and computer software

OBJECTIVES

To assess the diagnostic accuracy of two smartphone cephalometric analysis apps compared with Viewbox software.

MATERIALS AND METHODS

Pretreatment digital lateral cephalograms of 50 consecutive orthodontic patients (20 males, 30 females; mean age, 19.1 years; SD, 11.7) were traced twice using two apps (ie, CephNinja and OneCeph), with Viewbox used as the gold standard computer software program. Seven angular and two linear measurements, originally derived from Steiner cephalometric analysis, were performed.

RESULTS

Regarding validity, intraclass correlation coefficients (ICCs) ranged from .903-.983 and .786-.978 for OneCeph vs Viewbox and CephNinja vs Viewbox, respectively. The ICC values for intratool reliability ranged from .647-.993. None of the CephNinja measurements was below the recommended cutoff values of ICCs for reliability.

CONCLUSIONS

OneCeph has a high validity compared with Viewbox, while CephNinja is the best alternative to Viewbox regarding reliability. Smartphone apps may have a great potential in supplementing traditional cephalometric analysis.

Is there an effect of crown-to-implant ratio on implant treatment outcomes? A systematic review

OBJECTIVES

High crown-to-implant ratios may lead to complications due to unfavorable occlusal forces, including nonaxial forces, on the bone surrounding the neck of the implant and within the connection of the crown and implant itself. The aim of this study was to perform a systematic review on the influence of crown-to-implant ratio of single-tooth, nonsplinted, implants on biological and technical complications.

MATERIALS AND METHODS

MEDLINE (1950-January 2018), EMBASE (1966-January 2018), and Cochrane Central Register of Controlled Trials database (1800-January 2018) were searched to identify eligible studies. Inclusion criteria were as follows: crown-to-implant ratio of single-tooth, nonsplinted, implant-supported restorations in the posterior maxilla or mandible and follow-up of at least 1 year. Main outcome measures were as follows: implant survival rate, marginal bone level changes, biological complications, and technical complications. Two reviewers independently assessed the articles. A meta-analysis was carried out for implant survival rate and peri-implant bone changes.

RESULTS

Of 154 primarily selected articles, eight studies fulfilled the inclusion criteria. Study groups presented a mean crown-to-implant ratio varying from 0.86 (with 10-mm implants) to 2.14 (with 6-mm implants). The meta-analysis showed an implant survival of more than 99% per year and mean peri-implant bone changes of <0.1 mm per year. Limited biological and technical complications were reported.

CONCLUSION

Data reviewed in the current manuscript on crown-to-implant ratio, ranging from 0.86 to 2.14, of single-tooth, nonsplinted, implants did not demonstrate a high occurrence of biological or technical complications.

Looking Beyond Traditional Metrics in Orthodontics: An Altmetric Study on the Most Discussed Articles on the Web

Objective

To evaluate the online visibility of the most popular orthodontic articles in Web platforms in relation to publication details and citations.

Materials and Methods

Altmetric Explorer (Altmetric LLP, London, UK) was searched for articles published in 11 orthodontic journals without time limits in publication and citation on social media. The 200 articles with the highest Altmetric Attention Score (AAS) were collected and screened for data related to publication (date, journal, access), authorship (number of authors, affiliation and origin of the corresponding author), and research (type, subject, funding). Citation counts were harvested from Scopus.

Results

The top 200 articles presented a median AAS of 8.0 (range: 5.0-196.0), and were mostly bookmarked in Mendeley (median: 16.6 references; range: 0-199.0). American Journal of Orthodontics & Dentofacial Orthopedics, European Journal of Orthodontics and The Angle Orthodontist contributed 86 per cent of the total number of research outputs. Studies investigating socio-demographics had significantly higher AAS compared to diagnostic studies (median AAS: 19.0; range: 7.0-34.0; versus median AAS: 6.0; range: 5.0-10.0. No other study parameter was found to be statistically significant. AAS did not correlate to the number of citations as reported in Scopus.

Limitations

The early stage of altmetrics and their complementary role in assessing together with the citation-based metrics the research impact need to be acknowledged in the interpretation of the results.

Conclusions

Visibility of orthodontic articles on the Web is not significantly correlated with citations. Studies on socio-demographics had significantly higher number of online mentions. More constructive online presence of orthodontic journals is needed to reinforce dissemination of research data among scholars and non-scholars.

Severe periodontitis is more common in HIV- infected patients

OBJECTIVE

To assess periodontitis prevalence and severity in HIV infected patients as compared to controls. Furthermore, to assess whether HIV infection characteristics are associated with periodontitis.

DESIGN

cross-sectional controlled study.

METHODS

We assessed prevalence and severity of periodontitis in 258 HIV-infected patients and 539 historical controls with the Dutch Periodontal Screening Index (DPSI). HIV characteristics were collected from medical charts. Age-related diseases and oral care were assessed with questionnaires.

RESULTS

Severe periodontitis (DPSI 4) was more prevalent in HIV-infected patients than in controls (66% vs. 36%, p = 0.002). HIV-infection, increasing age and male sex were significant risk factors for severe periodontitis. In particular, older male HIV patients have a higher risk of severe periodontitis. Clinical, immunological and virologic characteristics, and antiretroviral therapy were not associated with periodontitis prevalence or severity. HIV-infected patients rate the importance of their oral health as high, although many do not disclose their HIV infection to their dentists.

CONCLUSIONS

Prevalence and severity of periodontitis are higher in HIV-infected patients compared to controls, particularly in older males. Awareness of the increased prevalence of periodontitis associated with HIV-infection among patients and health-care professionals could significantly improve oral health and quality of life of HIV-infected patients.

Ultrasound of the Major Salivary Glands is a Reliable Imaging Technique in Patients with Clinically Suspected Primary Sjögren's Syndrome

OBJECTIVE

 To assess the inter- and intraobserver reliability of ultrasound of major salivary glands in patients clinically suspected of having primary Sjögren's syndrome (pSS) as well as to assess sources of variation in outcomes of ultrasonographic evaluation.

METHODS

 80 consecutive outpatients with clinically suspected pSS underwent ultrasound evaluation. The following ultrasound variables of the parotid and submandibular salivary glands were assessed: echogenicity, parenchymal homogeneity, presence of hypoechogenic areas, hyperechogenic reflections and clearness of posterior glandular border, according to the scoring system of Hocevar et al. (total score range: 0 - 48). Images were scored independently by three blinded observers in two sessions.

RESULTS

 The intraobserver reliability of the total ultrasound score was excellent, with an intraclass correlation (ICC) ranging from 0.89 to 0.96. The interobserver reliability was good to excellent, with ICCs of 0.84 and 0.76 for the total ultrasound score in the two sessions. The kappa value ranged from 0.60 to 0.83 depending on the applied cut-offs (cut-off score ≥ 15 and ≥ 17). Hypoechogenic areas and homogeneity of parotid glands showed the highest interobserver reliability. The median kappa for echogenicity was low. The total ultrasound scores varied more between observers in patients with higher ultrasonographic scores (approximately scores ≥ 20).

CONCLUSION

 Ultrasound of major salivary glands is a reliable imaging technique for patients with clinically suspected pSS. Discrepancies between observers in assessing the severity of ultrasound findings may interfere with detecting 'true' changes over time. When monitoring the progression of pSS or treatment efficacy, it is advised that a particular patient be scored by the same ultrasonographer at every time point.

Patient-reported change of sensibility and pain after parotid and labial gland biopsy applied for primary Sjögren's syndrome diagnostics: one-year follow-up study

OBJECTIVES

To assess how patients perceived pain and change of sensibility of the biopsied area after having undergone parotid and labial gland biopsy as part of the diagnostic work-up of primary Sjögren's syndrome (pSS).

METHODS

Simultaneously, parotid and labial salivary gland biopsies were taken under local anesthesia. One week, 6 months and 12 months post-operatively, each patient was sent a postal questionnaire to quantify the severity of pain and change of sensibility in the biopsied areas with a visual analogue scale (VAS; range 0-100).

RESULTS

110 patients were included. The median age of patients was 54 years (IQR=47-65) and 92% were female. Changes in sensibility and pain in the biopsied area were significantly higher after a parotid gland biopsy than after a labial gland biopsy at one week and 6 months post-operatively, but rather minor in both areas. At 12 months post-operatively, the change in sensibility and pain level was negligible in most patients and comparable for both biopsied areas. The duration of the technique, outcome of the biopsy, exposure of nerve branches during the biopsy and bleeding during the biopsy did not affect the reported change of sensibility or pain in the biopsied area. ESSPRI was not related to pain level or change of sensibility at any time point (r<0.3 and p>0.05).

CONCLUSIONS

Patient-reported post-operative change of sensibility and pain in the area of the parotid and labial gland biopsy are minor and comparable. Parotid and labial gland biopsies are diagnostic techniques well tolerated by patients suspected with pSS.