Does non-surgical periodontal treatment influence on rheumatoid arthritis? A systematic review and meta-analysis

ObjectiveThe objective of this systematic review was to evaluate the efficacy of non-surgical periodontal therapy on rheumatoid arthritis activity.Material and methodsArticles published until April 2019 were electronically searched and screened using PubMed / MEDLINE, Scopus, and Cochrane databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). This study was recorded in the international PROSPERO database (CRD42019132205). The PICO question (population, intervention, comparison, results) was: in adult patients with rheumatoid arthritis and periodontitis (P), does non-surgical periodontal treatment (I), as compared to no treatment (C), provides better outcomes in rheumatoid arthritis activity (O).ResultsAfter searching the databases, seven articles were selected for qualitative and five for quantitative analysis. The total number of participants included was 292, with an average age of 50.5 years. All patients had rheumatoid arthritis and periodontal disease. Non-surgical periodontal treatment significantly reduced Disease Activity Score 28 (P = 0.004; I² = 92%) and erythrocyte sedimentation rate (P = 0.01; I² = 78%), but with no significant effect on C-reactive protein (P = 0.34; I² = 92%).ConclusionsIt can be concluded that non-surgical periodontal treatment can benefit patients with rheumatoid arthritis.     

Does non-surgical periodontal treatment influence on rheumatoid arthritis? A systematic review and meta-analysis

ObjectiveThe objective of this systematic review was to evaluate the efficacy of non-surgical periodontal therapy on rheumatoid arthritis activity.Material and methodsArticles published until April 2019 were electronically searched and screened using PubMed / MEDLINE, Scopus, and Cochrane databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). This study was recorded in the international PROSPERO database (CRD42019132205). The PICO question (population, intervention, comparison, results) was: in adult patients with rheumatoid arthritis and periodontitis (P), does non-surgical periodontal treatment (I), as compared to no treatment (C), provides better outcomes in rheumatoid arthritis activity (O).ResultsAfter searching the databases, seven articles were selected for qualitative and five for quantitative analysis. The total number of participants included was 292, with an average age of 50.5 years. All patients had rheumatoid arthritis and periodontal disease. Non-surgical periodontal treatment significantly reduced Disease Activity Score 28 (P = 0.004; I² = 92%) and erythrocyte sedimentation rate (P = 0.01; I² = 78%), but with no significant effect on C-reactive protein (P = 0.34; I² = 92%).ConclusionsIt can be concluded that non-surgical periodontal treatment can benefit patients with rheumatoid arthritis.     

Does periodontal treatment improve glycemic control in diabetic patients? A meta-analysis of intervention studies

Previous analyses regarding effects of periodontal treatment on glycemic control included studies where causal association might not be assumed, or the results were reported non-quantitatively. We initiated this meta-analysis of 10 intervention studies to quantify the effects of periodontal treatment on HbA1c level among diabetic patients, to explore possible causes for the discrepant reports, and to make recommendations for future studies. Data sources were MEDLINE (January, 1980, to January, 2005), the EBMR, Cochrane Register, and bibliographies of the published articles. Three investigators extracted data regarding intervention, outcomes, and effect size. A total of 456 patients was included in this analysis, with periodontal treatment as predictor and the actual change in hemoglobin A1c level as the outcome. The weighted average decrease in actual HbA1c level was 0.38% for all studies, 0.66% when restricted to type 2 diabetic patients, and 0.71% if antibiotics were given to them. However, none was statistically significant.     

Is there a temporal trend in the reported treatment efficacy of periodontal regeneration? A meta‐analysis of randomized‐controlled trials

Background/Aim: The aim of study was to conduct a meta‐analysis to investigate whether or not there was a temporal trend in the treatment efficacy reported in the randomized‐controlled trials (RCTs) on guided tissue regeneration (GTR) or enamel matrix protein derivatives (EMD) in the treatment of infrabony defects. Material and Methods: The treatment outcomes were changes in probing pocket depth (PPD) and clinical attachment level (CAL). Weighted multilevel and ordinary regression analyses were performed to test the temporal relationship between treatment effect difference or treatment effectiveness and publication years. Results: For PPD reduction, non‐significant positive relationships were found in the treatment effect difference or treatment effect of both GTR and flap operation. For CAL gain, a small positive relationship was found in the treatment effect difference, but a significant positive trend in the treatment effect of flap operation was found. No significant temporal trend was found in the treatment effect difference for EMD. Conclusions: There was no evidence to support or refute a temporal trend in the treatment effect of regenerative procedures, but a positive trend was observed in the control group. These results suggest that only RCTs should be included in the meta‐analysis, as the treatment effect of the control group may not be constant.     

Does computerized anaesthesia reduce pain during local anaesthesia in paediatric patients for dental treatment? A systematic review and meta‐analysis

This systematic review and meta‐analysis analysed whether pain and disruptive behaviour can be decreased by the use of computerized local dental anaesthesia (CDLA) in children. The literature was screened to select randomized clinical trials that compared computerized and conventional anaesthesia. The primary outcome was pain perception during anaesthesia; the secondary, disruptive behaviour. The risk of bias of individual papers and the quality of the evidence were evaluated. After search, 8389 records were found and 20 studies remained for the qualitative and quantitative syntheses. High heterogeneity was detected for both outcomes. For the pain perception, the overall analysis showed a standard mean difference of ?0.78 (?1.31, ?0.25) favouring CDLA; however, when only studies at low risk of bias were analysed (subgroup analysis), there was no difference between the two techniques [?0.12(?0.46, 0.22)]. For disruptive behaviour, no differences were detected for continuous [?0.26 (?0.68, 0.16)] or dichotomous data [0.81 (0.62, 1.06)]. The quality of evidence was judged as low for pain perception and very low for disruptive behaviour. It is concluded that there is no difference in the pain perception and disruptive behaviour in children subjected to computerized or conventional dental local anaesthesia. Notwithstanding, the quality of the available evidence is low.     

Can palpation-induced muscle pain pattern contribute to the differential diagnosis among temporomandibular disorders, primary headaches phenotypes and possible bruxism?

Background

The evaluation of possible differences in the distribution or characteristics of palpation-induced pain in the masticatory muscles could be valuable in terms of diagnostic assessment. The aim of this study was to evaluate the impact of different combinations of anterior temporalis (AT) and masseter palpation-induced pain in the diagnostic of temporomandibular disorder (TMD), primary headaches and bruxism.

Material and Methods

A total of 1200 dental records of orofacial pain adult patients were analyzed. The outcomes were dichotomously classified (presence/absence) as following: a) AT and/or masseter palpation-induced pain; b) myogenous TMD; c) temporomandibular joint (TMJ) arthralgia (arthrogenous TMD); d) migraine; e) tension-type headache (TTH); f) self-reported bruxism. Binomial logistic regression model (α = 5%) was applied to the data considering the palpation-induced muscle pain as the dependent variable.

Results

Mean age (SD) were 35.7 years (13.4) for 635 included dental records (83% females). Myogenous and arthrogenous TMD, migraine, TTH and bruxism were mainly associated with, respectively, masseter palpation-induced pain (p<0.001 - OR=5.77, 95%CI 3.86-8.62), AT or masseter palpation-induced pain (p<0.001 - OR=2.39, 95%CI 1.57-3.63), bilateral AT palpation-induced pain (p<0.001 - OR=2.67, 95%CI 1.64-4.32), masseter and AT palpation-induced pain (p=0.009 - OR=1.62, 95%CI 1.12-2.33) and bilateral masseter palpation-induced pain (p=0.01 - OR=1.74, 95%CI 1.13-2.69).

Conclusions

Palpation-induced pain in the masticatory muscles may play a role in the differential diagnosis among painful TMD, primary headaches and bruxism. Key words:Diagnosis, temporomandibular joint disorders, migraine, tension-type headache, bruxism.     

Can sonographic features be efficacy predictors of robotic massage treatment for masseter and temporal muscle in patients with temporomandibular disorder with myofascial pain?

Objective: The aim of this study was to detect sonographic predictors for the efficacy of massage treatment of masseter and temporal muscle in temporomandibular disorders (TMDs) patients with myofascial pain.

Methods: Thirty-seven TMD patients with myofascial pain (6 men and 31 women, a median age of 45 years) were enrolled. An oral rehabilitation robot massaged the patient’s masseter and temporal muscles with a standard massage pressure of 10 N for 16 min. The standard treatment protocol was set five sessions every 2 weeks. The median total duration of treatment was 9.5 weeks. Efficacy of treatment was evaluated based on maximum mouth opening and visual analog scale scores of muscle pain and daily life impediments. The intramuscular echogenic bands and elasticity index ratios of the masseter muscles were evaluated on sonographic or sonoelastographic images obtained before treatment and after the third and last treatment sessions.

Results: The sonographic features detected different changes after the third treatment session between the therapy-effective and therapy-ineffective groups: in the therapy-effective group, the frequency of visibility of the distinct echogenic bands increased, and the elasticity index ratio decreased.

Conclusion: Sonographic features after the third treatment session may be useful as predictors of therapeutic efficacy.     

Sustained-release delivery of antimicrobial drugs for the treatment of periodontal diseases: Fantasy or already reality?

Periodontal diseases are prevalent in humans. Conventional means of combating these diseases involve basic oral hygiene, mostly toothbrushing, use of mouthwashes, and flossing. Supplementary means of treatment, either clinical or pharmaceutical, are often necessary. The use of sustained-release delivery systems, applied locally to the periodontal pocket, seems to be one feasible approach: local sustained-release delivery of antibacterial agents to treat periodontal diseases is conceivable. The use of local (intrapocket) sustained-release delivery systems has numerous clinical, pharmacologic, and toxicologic advantages over conventional treatments for periodontal diseases. Sustained-release technology has been proven to be effective over the last few decades. Films, gels, and fibers are the three main classical intrapocket pharmaceutical delivery systems. Research today is more focused on improving drug delivery, and less on introducing new drugs. New approaches, eg, those making use of nanotechnology, are emerging for local drug-delivery systems. The local sustained-release delivery system concept is innovative and a few products are already commercially available.     

Three-dimens?onal cone-beam computed tomography for diagnos?s of keratocystic odontogenic tumours; Evaluation of four cases

The keratocystic odontogenic tumour (KCOT), formerly known as the odontogenic keratocyst (OKC) is a benign intraosseous lesion that derives from remnants of the dental lamina. Due to its characteristics, clinical and histopathological features and various treatment approaches, this pathology is different comparing with other odontogenic cysts. Radiographically the KCOT appears as well-defined unilocular or multilocular radiolucency with thin radiopaque borders. In most cases, conventional radiographic imaging, such as panoramic views and intraoral periapical films, are adequate to determine the location and estimate the size of an KCOT. However, the clinical use for cone-beam computed tomography (CBCT) in oral and maxillofacial surgery increases and provides additional information about the contents and borders of the large lesions. In the present cases, the diagnostic performances of CBCT versus panoramic radiograph for four KCOTs were evaluated. It was concluded that appearance of lesions in the maxillofacial region could be better documented in the correct dimensions by CBCT versus panoramic radiograph. Key words:Odontogenic keratocyst, cone-beam computed tomography, three dimensional, panoramic radiograph.     

Does periodontal treatment have an effect on clinical and immunological parameters of periodontal disease in obese subjects? A systematic review and meta-analysis

Aim

The aim of this study was to systematically review the literature to answer the questions: (i) “Is periodontal treatment effective to improve clinical and immunological conditions in obese subjects?”; (ii) “Do obese subjects present different clinical and immunological response after periodontal therapy when compared to non-obese subjects?”

Methods

Searches were performed in six databases up to August 2014. Interventional studies were included if the following data were described: (1) Obesity/overweight assessment; (2) definition of periodontal disease; (3) periodontal therapy; (4) inflammatory marker in serum/plasma, and/or clinical parameters of periodontal disease. Assessment of quality was performed with the Downs and Black scale. Meta-analyses were conducted with the available data.

Results

Of 489 articles, 5 were included, and only 3 proceeded to meta-analysis of clinical outcomes. Included studies presented fair methodological quality. Statistical analysis demonstrated that periodontal therapy in obese subjects was effective to improve clinical outcomes. No clinical differences between post-therapy results of obese and non-obese were observed. Effects of periodontal therapy on inflammatory markers remain unclear.

Conclusions

Periodontal treatment seems to be effective to improve healing in obese individuals. No differences on periodontal healing between obese and non-obese subjects were observed; however, only limited and fragile base of evidence was available for analysis.

Clinical relevance

Periodontal treatment is effective to improve clinical and immunological periodontal parameters in adults. Also, obesity seems to not modify the periodontal healing after treatment.

     

Value of videoroscopy in the detection of alterations of? Actinic Cheilitis?and the selection of biopsy areas

Background

To demonstrate the value of videoroscopy in identifying lesions and alterations not seen by oroscopy and to select the area for biopsy.

Material and Methods

Eighty patients were subjected to anamnesis, physical exam, videoroscopy exam, toluidine blue test and biopsy. A diagram of the lips was created to record the exact location where the lesion was found.

Results

Physical exam identified 287 lesions, and videoroscopy identified 587 lesions; erythema and white lesions were the most common lesions associated with actinic cheilitis. Of the 59 performed biopsies, 32 (52.4%) cases were identified by videoroscopy that showed lesions that were not detected during physical examination.

Conclusions

The establishment of a diagram of the lip permitted registration of the precise location of the lesion. Videoroscopy was effective in locating lesions not seen by oroscopy. Both videoroscopy and the diagram of the lips allowed for better and earlier diagnosis and better patient follow-up for those with actinic cheilitis. Key words: Actinic cheilitis, potentially malignant disorder, videoroscopy, dermatoscopy, lip. oroscopy, diagram of lip.     

Is manual reduction adequate for intraoperative control of occlusion during fixation of mandibular fractures? A systematic review and meta-analysis

The aim of this systematic review was to find out if manual intraoperative control of occlusion is adequate for the reduction of mandibular fractures in comparison with intermaxillary fixation (IMF). We searched PubMed, Embase, the Cochrane Library and Clinical Trials Registry, and the references of included trials. Our primary outcomes of interest were the reduction of fracture anatomically and radiographically, occlusal disturbances, and the incidence of revision procedures due to poor occlusion or reduction. Our secondary outcomes of interest were operating time and infective complications. Of the 257 studies retrieved (manual reduction = 136, IMF = 121), four were included. The studies had an unclear risk of bias. Nevertheless, the overall effect was statistically significant and in favour of manual reduction, with a lower number of adverse events in the manual reduction group (n = 43) than in the IMF group (n = 78), odds ratio 0.42 (95% CI 0.27 to 0.64). An absolute reduction in adverse events was seen in occlusion disturbances (120 fewer/1000), revision procedures (164 fewer/1000), and infective complications (178 fewer/1000). The evidence to support manual reduction over IMF for the intraoperative control of fracture fragments and occlusion was derived from few studies with an unclear risk of bias, and the quality was low. The results were not different when condylar fractures were present. The overall certainty of evidence was moderate. Clinicians should select the appropriate technique based on the injury pattern, and the treating surgeon’s experience and available resources.     

Comparative study of DFDBA in combination with enamel matrix derivative versus DFDBA alone for treatment of periodontal intrabony defects at 12 months post-surgery

The aim of this randomized double-blind, clinical trial was to compare the use of enamel matrix derivative (EMD) and demineralised freeze-dried bone allografts (DFDBA) with DFDBA alone for the treatment of human periodontal intrabony defects at 12 months post-surgery. Fifty-six intrabony osseous defects in 56 periodontis patients were randomly assigned to the test group (DFDBA + EMD) or the control group (DFDBA) for periodontal treatment. Clinical and radiographic measurements were made at the baseline and after 12 months. Compared to baseline, the 12-month results indicated that both treatment modalities resulted in significant changes in all clinical parameters (gingival index, bleeding on probing, probing depth (PD), clinical attachment level (CAL), gingival recession; P < 0.05) and radiographic parameters (hard tissue fill (HTF) and bone depth reduction; P < 0.05). Furthermore, statistically significant differences were found in the test group compared to the control group in PD reduction (5.0 mm vs. 4.0 mm; P < 0.05), CAL gain (4.0 mm vs. 3.25 mm), and HTF (4.0 mm vs. 3.5 mm; P < 0.05). In the test group, 25% of sites gained >4 mm of CAL, while in the control group, 7.1% of sites gained >4 mm of CAL. Both treatments showed a good soft and hard periodontal tissue response. At 12 months post-surgery, the combined use of DFDBA and EMD seemed to produce a statistically significant improvement of PD reduction, CAL gain, and HTF.     

Effect of hypnosis on induction of local anaesthesia,pain perception,control of haemorrhage and anxiety during extraction of third molars: A case–control study

IntroductionSystemic conditions are considered limiting factors for surgical procedures under local anaesthesia in the oral cavity. All the pharmacological methods to control pain in patients have some disadvantages, such as side effects and extra costs for rehabilitation. Therefore, in such cases alternative treatment modalities are considered, such as hypnosis in dentistry. The aim of the present study was to evaluate the effect of hypnosis on haemorrhage, pain and anxiety during the extraction of third molars.Materials and methodsIn this case–control study, 24 female and male volunteers were included. The subjects had been referred to the Department of Oral and Maxillofacial Surgery, Kerman University of Medical Sciences, for extraction of third molars. Demographic data for all the subjects were recorded. Patients with chronic medical conditions were excluded. The patients were used as their own controls, with the third molars on one side being removed under hypnosis and on the opposite side under local anaesthetic.Hypnosis was induced by one of the two methods, either fixing the gaze on one point or Chiasson's technique; both these methods are appropriate for patients in the dental chair. The Spielberger State-Trait Anxiety Inventory was used to determine patient anxiety levels before hypnosis and anaesthesia. Pain was scored using VAS (visual analogue scale). After surgery the patient was asked to bite on a sterile gauze pad over the surgical site for 30 min when haemorrhage from the area was evaluated. If there was no haemorrhage the patient was discharged. If haemorrhage persisted, the gauze pad was left in place for another 30 min and the area was re-evaluated. Any active oozing from the area after 30 min was considered haemorrhage. Haemorrhage, anxiety and pain were compared between the two groups. Data was analyzed using the t-test, McNemar's test and Wilcoxon's signed rank test using SPSS 18 statistical software.ResultsTwenty-four patients were evaluated; there were 14 males (58.3%) and 10 females (41.7%). The mean age of the subjects was 24.1 ± 2.7 years (age range = 18–30 years). A total of 48 third molars were extracted. In each patient, one-third molar was extracted under hypnosis and the other under local anaesthesia. All the patients were in the ASA 1 category (normal) with no significant medical history.Of the subjects who underwent hypnosis, only two subjects (8.3%) reported pain after induction of hypnosis. In the local anaesthetic group, 8 subjects (33.3%) reported pain. There was a significant difference between the two groups. The results of the study showed that patients in the hypnosis group had less pain during the first few hours post-operatively. Anxiety scores in the two groups were very close to each other and no statistically significant differences were observed in general and when each person was compared with himself or herself. Pain intensity in the two groups at 5- and 12-h post-operatively exhibited significant differences. In the hypnosis group, 10 patients (41.7%) took analgesic medication; in the local anaesthesia group, 22 patients (91.7%) took the analgesic medication (P = 0.0001). In other words, patients reported less pain when they were under hypnosis.ConclusionThe results of the study showed that hypnosis can effectively reduce anxiety, haemorrhage and pain. More studies are necessary to collect data on the effect of hypnosis on oral and maxillofacial surgeries.     

Does the adjunctive use of statins provide additional benefits to nonsurgical periodontal treatment? A systematic review and meta‐analysis

Adjunctive therapeutic agents may be used to improve the response to nonsurgical periodontal therapy. Local delivery of statins (simvastatin, artovastatin and rosuvastatin) is a promising adjunct to scaling and root planing (SRP). Thus, the aim of this review is to evaluate if adjunctive local delivery of statins is more effective than SRP alone. Randomized clinical trials that presented a test group evaluating local delivery of statins as adjuncts in healthy, diabetic and smoking patients were included. Medline and the Cochrane library database were searched up to November 2016. Random effects meta‐analyses were conducted for pocket depth change and clinical attachment gain. One hundred and twenty‐five studies potentially related to the aim of this review were screened, but only 10 were included. The majority of the trials reported additional clinical benefits in the groups that were treated with adjunctive local delivery of statins. Pooled calculations showed that local delivery of statins resulted in additional reduction of pocket depth and clinical attachment gain in healthy people, smokers and diabetic patients. Local statins may offer additional clinical benefits to SRP, even in smokers and diabetics.     

Narrow-diameter implants: Are they a predictable treatment option? A literature review

Objective: To evaluate the predictability of narrow-diameter implants as a treatment option in routine clinical practice. A literature review was performed of studies reporting clinical results obtained with these implants. Survival rates, peri-implant bone loss and related complications were evaluated. The working hypothesis was that narrow-diameter implants offer clinical results similar to those obtained with implants of greater diameter. Material and Methods: A Medline-PubMed search covering the period between 2002 and 2012 was carried out. Studies published in English and with a follow-up period of at least 12 months were considered for inclusion. A manual search was also conducted in different journals with an important impact factor. Results: Twenty-one studies meeting the screening criteria were included in the literature review. A total of 2980 narrow-diameter implants placed in 1607 patients were analyzed. Conclusions: The results obtained from the literature indicate that narrow-diameter implants are a predictable treatment option, since they afford clinical results comparable to those obtained with implants of greater diameter. Key words:Narrow implant, survival rate, peri-implant bone loss, related complications.     

Is bromelain an effective drug for the control of pain and inflammation associated with impacted third molar surgery? Systematic review and meta-analysis

The aim of this systematic review was to determine whether bromelain is an effective drug for the control of pain and inflammation associated with third molar surgery. Randomized, controlled clinical trials on the subject were identified through a systematic search of the literature using the PubMed/MEDLINE, Scopus, and Cochrane Library databases. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two independent, blinded reviewers selected studies based on the inclusion criteria. Divergences of opinion were resolved by consensus. A meta-analysis was performed for the outcomes pain and trismus and was based on the inverse variance method for continuous outcomes, considering the mean difference (MD) and corresponding 95% confidence interval (CI). A total of 186 articles were initially retrieved from the databases. After the different stages of the selection process, five articles reporting data for a total 252 patients remained and were included in the review. Bromelain proved to be effective at controlling postoperative pain at 48–72 h after surgery (P = 0.03; MD ?0.89, 95% CI ?1.70 to ?0.09), but did not achieve a significant effect in comparison to the control group with regard to oedema or trismus.     

Role of salivary anti-SSA/B antibodies for diagnosing primary Sj?gren’s syndrome

The diagnosis of primary Sjögren’s syndrome (pSS) is complex, and the saliva test is a potential method to improve the existing diagnostic criteria.Objective: To estimate the diagnostic accuracy of salivary anti-SSA/B antibodies in primary Sjögren’s syndrome (pSS), and to analyze their correlations with clinical and laboratory profiles. Study Design: This study enrolled 100 pSS patients and 140 non-pSS controls, including 40 rheumatoid arthritis (RA) patients, 40 systemic lupus erythematosus (SLE) patients, and 60 healthy controls. Unstimulated whole saliva and stimulated parotid saliva samples were collected from the subjects. Salivary anti-SSA/B antibodies were measured using an enzyme-linked immunosorbent assay (ELISA). Clinical and laboratory data were retrieved from the medical records. Results: In the pSS group, the sensitivity of anti-SSA and anti-SSB antibodies in whole saliva was 49% and 29%, respectively, and the specificity was 87.5% and 95%. The sensitivity of anti-SSA and anti-SSB antibodies in parotid saliva was 32% and 8%, respectively, and the specificity was 95.52% and 97.86%, respectively. In the pSS group, the diagnostic accuracy of anti-SSA/B antibodies in whole saliva was significantly higher than in parotid saliva (p<0.05), but was significantly lower than in serum (p<0.05). The salivary flow rate in the pSS group positive for whole salivary anti-SSA was significantly lower than in the negative group (p<0.05). The prevalence of rheumatoid factor and antinuclear factor were significantly higher in salivary SSB-positive pSS patients than in SSB-negative patients (p<0.05). Conclusions: Compared to parotid saliva, whole saliva is a more suitable diagnostic fluid. Using salivary anti-SSA/B antibodies as a single test item is insufficient given the relatively low sensitivity. Further studies should investigate the possibility of combining tests for different salivary autoantibodies as a method for diagnosing pSS. Key words:Primary Sjögren’s syndrome, salivary diagnostics, anti-SSA autoantibodies, anti-SSB autoantibodies.