Cone–beam computed tomographic analysis of maxillary and mandibular changes after high condylectomy combined with orthodontic treatment for active unilateral condylar hyperplasia

Our aim was to evaluate the efficacy of high condylectomy combined with orthodontic treatment for active unilateral condylar hyperplasia in 25 affected patients, by an analysis of the maxillary and mandibular changes on cone–beam computed tomography (CT). High condylectomy was the sole operative treatment. Variables that reflected the canting of the occlusal plane, the height of the maxillary complex, the buccolingual angulation of the maxillary first molar, the height of the ramus, the total length of the mandible, and the deviation of the chin were measured and compared between the two sides and between time intervals: preoperatively (T1) and the end of treatment (T2). The differences between time intervals in the deviation of the chin (p < 0.001) and the canting of the occlusal plane (p < 0.001) were significant, but there were no significant differences in the height of the ramus (p = 0.476) and the total length of the mandible (p = 0.838) between the affected and unaffected sides at T2. There were significant differences between time intervals in the buccolingual angulation on the unaffected side and the height of the maxillary complex on the affected side (p < 0.001). Facial asymmetry was corrected and the occlusal plane was improved. In conclusion, high condylectomy as the sole operative treatment combined with orthodontic treatment can provide an alternative method for correction of facial asymmetry associated with active unilateral condylar hyperplasia.     

Efficacy of nano-hydroxyapatite on caries prevention—a systematic review and meta-analysis

Clinical Oral Investigations - The review systematically explored in vivo or in situ studies investigating the efficacy of nano-hydroxyapatite (nHA) to reduce initiation of or to remineralize...     

Unilateral condylar hyperplasia in hemifacial hyperplasia,is there genetic proof of overgrowth?

Hemifacial hyperplasia (HFH) is characterized by an increase in volume of all affected tissues of half of the face. It is present at birth, subsequently grows proportionally, and stops growing before adulthood. Unilateral condylar hyperplasia (UCH) consists of progressive asymmetric growth of the mandible and develops typically in early adulthood. Both disorders have an unknown aetiology. The overgrowth limited to one body part suggests somatic mosaicism, as this has been found in other similar localized overgrowth disorders. Often this includes a variant in a gene in the (PIK3CA)/PI3K/(PTEN)/AKT1/mTOR pathway. Here we report the case of an HFH patient with asymmetry present at birth, in whom a progressive growth pattern similar to UCH subsequently occurred, causing marked mandibular asymmetry. A condylectomy was successfully performed to stop the progressive growth. Somatic mosaicism for a mutation in PIK3CA was detected in the condylar tissue. This finding might indicate that both HFH and UCH can be caused by variants in genes in the (PIK3CA)/PI3K/(PTEN)/AKT1/mTOR pathway, similar to other disorders that result in asymmetrical bodily overgrowth.     

Molecular basis of unilateral condylar hyperplasia?

Unilateral condylar hyperplasia (UCH) causes progressive asymmetry of the mandible. The aetiology of this growth disorder is unknown. A two-centre prospective study was established, and 10 consecutive adult UCH patients scheduled for high condylectomy were included. The resected condylar tissue was divided into two parts, one for regular histopathology and one for DNA extraction. A panel of eight selected overgrowth genes (AKT1, AKT3, MTOR, PIK3CA, PIK3R2, PTEN, TSC1, TSC2) were sequenced using next-generation sequencing, with coverage of a minimum 500 times in order to be able to detect low-grade mosaicisms. Subsequently, untargeted whole exome sequencing (WES) was performed to detect variants in other genes present in three or more patients. No mutation was detected in any of the overgrowth genes, and untargeted exome sequencing failed to detect any definitively causative variant in any other gene. Ten genes had a rare variant in three or more patients, but these cannot be designated as causative without additional functional studies. The hypothesis that the cause in at least some patients with UCH is a somatic mutation in a gene that controls cell growth could not be confirmed in this study.     

Diagnostic performance of SPECT–CT imaging in unilateral condylar hyperplasia

Nuclear imaging plays an important role in the diagnostic path of patients with unilateral condylar hyperplasia (UCH). The purpose of this study was to determine the performance of single-photon emission computed tomography–computed tomography (SPECT–CT) in a large group of patients with suspected UCH. This study prospectively included 156 patients with a clinical presentation of progressive mandibular asymmetry. All patients underwent ^99 mTc-HDP SPECT–CT and extensive baseline and follow-up documentation. The relative activity of the ipsilateral condyle in relation to the contralateral condyle was calculated for both the mean and maximum count, and the diagnostic accuracy of different cut-off values was determined. The area under the receiver operating characteristic curve of the SPECT–CT scan was 0.892 for the mean count and 0.873 for the maximum count. The optimal cut-off of> 8% (SPECT–CT mean count) resulted in a sensitivity of 87.0% and a specificity of 88.6%. SPECT–CT showed good diagnostic performance in UCH; however the benefit of the CT scan is questionable and the potential disadvantages have to be weighed against the benefits when compared to standard SPECT scanning. When using SPECT–CT in the diagnostic path in UCH, a mean value cut-off of>8% for the relative activity between the condyles is most accurate.     

Efficacy and safety of Chinese patent medicines in the treatment of recurrent aphthous stomatitis: A systematic review

Background

Recurrent aphthous stomatitis (RAS) is the most common chronic oral mucosal condition of the oral cavity. Investigators in clinical trials have evaluated the effectiveness of Chinese patent medicines in the treatment of RAS. However, the results are conflicting rather than conclusive. To evaluate the efficacy and safety of Chinese patent medicines for the treatment of RAS, the authors conducted a systematic review.

Magnetic resonance imaging versus cone beam computed tomography in diagnosis of periapical pathosis – A systematic review

ObjectiveThe diagnosis of any dental pathology can vary from being simple to challenging. While the use of cone beam computed tomography (CBCT) is well established, magnetic resonance imaging (MRI) remains a proof of concept. This systematic review aims to compare the diagnostic ability of MRI with CBCT in diagnosing periapical pathosis.Materials and MethodsThis systematic search was performed using the electronic databases of MEDLINE, Cochrane Library, Google Scholar, and Science Direct to identify relevant articles from 2010 to 2020. The search terms used were magnetic resonance imaging, cone beam computed tomography, diagnosis, and periapical diseases.ResultIn total, 3218 potentially relevant abstracts and titles were identified. After removing duplicates, 1288 articles were reviewed for titles and abstracts, and 29 articles were selected for full-text reading. From those, 19 articles were finally selected that included original research studies, case reports, and case series and were included for systematic review. Most of the studies included in this review suggested that the combined use of CBCT and MRI is needed for a better and more precise diagnosis of complex periapical pathoses. The main advantage of MRI is its ability to image soft tissues usingnonionizing radiation, and the main disadvantage in the case of CBCT is overdiagnosis of the lesion.ConclusionMRI has various advantages over CBCT with similar diagnostic utility. When diagnosing periapical pathogens, both MRI and CBCT are needed for an accurate diagnosis.     

Do in vitro solubility studies on endodontic sealers demonstrate a high level of evidence? A systematic review

Objective: To systematically review the quality of evidence of available in vitro solubility studies on endodontic sealers according to prespecified evidence criteria.

Material and methods: This systematic review was based on the PRISMA guidelines and the AMSTAR measurement tool. A systematic duplicate search of the literature on endodontic sealer solubility studies was conducted in PubMed and Embase databases (until 18 October 2017). Mapping terms to subject headings and free text terms were used and combined with hand searching before exclusion of duplicates. Studies specifically dealing with endodontic sealer solubility were selected. The evidence level was graded (low, medium or high) independently by two investigators following systematic data extraction in pilot forms, which was based on prespecified evidence criteria and the modified CONSORT checklist for in vitro studies on dental materials.

Results: The search retrieved 1053 articles, from which 88 were assessed in full. From the 63 articles retained in the final analysis, 11 were classified as having moderate and 52 as low quality of evidence (0 high). The studies graded as low had low sample size (n?<?10) and/or insufficient details to allow replicability. Most of the studies did not conform to the modified CONSORT checklist and did not include parameters considered relevant in the prespecified criteria.

Conclusions: Existing in vitro studies on the solubility of endodontic sealers do not demonstrate a high quality of evidence. Most of these studies do not present systematic reporting nor employ relevant parameters prespecified in our evidence criteria.     

Efficacy of antimicrobial agents incorporated in orthodontic bonding systems: a systematic review and meta-analysis

Aims: The purpose of this study was to evaluate the efficacy of orthodontic bonding systems containing different antimicrobial agents, as well as the influence of antimicrobial agent incorporation in the bonding properties of these materials.

Methods: Eight databases were searched: PubMed (Medline), Web of Science, Scopus, Lilacs, Ibecs, BBO, Scielo and Google Scholar. Any study that evaluated antimicrobial activity in experimental or commercial orthodontic bonding systems was included.

Data extraction: Data were tabulated independently and in duplicated by two authors on pre-designed data collection form.

Data synthesis: The global analysis was carried out using a random-effects model, and pooled-effect estimates were obtained by comparing the standardised mean difference of each antimicrobial orthodontic adhesive with the respective control group. A p-value?Results: Thirty-two studies were included in the qualitative analysis; of these, 22 studies were included in the meta-analysis. Antimicrobial agents such as silver nanoparticles, benzalkonium chloride, chlorhexidine, triclosan, cetylpyridinium chloride, Galla chinensis extract, acid ursolic, dimethylaminododecyl methacrylate, dimethylaminohexadecyl methacrylate, 2-methacryloyloxyethyl phosphorylcholine, 1,3,5-triacryloylhexahydro-1,3,5-triazine, zinc oxide and titanium oxide have been incorporated into orthodontic bonding systems. The antimicrobial agent incorporation in orthodontic bonding systems showed higher antimicrobial activity than the control group in agar diffusion (overall standardised mean difference: 3.71; 95% CI 2.98 to 4.43) and optical density tests (0.41; 95% CI ?0.05 to 0.86) (p?Conclusions: Although there is evidence of antibacterial activity from in vitro studies, clinical and long-term studies are still necessary to confirm the effectiveness of antibacterial orthodontic bonding systems in preventing caries disease.     

Impact of contracted endodontic cavities on instrumentation efficacy—A systematic review

The aim of the present systematic review was to summarise and evaluate the studies comparing the role of contracted endodontic cavities (CECs) and traditional endodontic cavities (TECs) in terms of instrumentation efficacy. The present systematic review comprised of a search of the online databases of Cochrane, PubMed, Google Scholar and grey literature. The articles which were pertaining to instrumentation efficacy in contracted and traditional endodontic cavities were selected based on the PRISMA checklist. Out of the 660 articles which were obtained, irrelevant articles were excluded and a total of 17 articles were selected for this systematic review which assessed the instrumentation efficacy. Eleven studies compared the volume of dentin removed and canal transportation ability. Four studies compared the pulp debridement, and two studies compared the anti-bacterial efficacy between the two groups. The extrusion of debris between the groups was compared by one study. Out of the 17 studies included, 11 studies proved that contracted endodontic cavities negatively impacted the instrumentation efficacy. Hence, the data suggest that the traditional endodontic access cavities have better results when comparing the instrumentation efficacy.     

Quality of life assessment in patients with dentofacial deformity undergoing orthognathic surgery—A systematic review

The aim of this systematic review was to evaluate the benefits of orthognathic surgery to quality of life, the different motivations and perceptions of patients towards orthognathic surgery, and the various methods that have been used to analyze these changes, in patients who undergo orthognathic surgery for dentofacial deformities. A review of the literature was carried out, and articles published from 2001 to June of 2012 that satisfied the inclusion criteria were included in the review. A total of 21 articles were included. The results indicate that orthognathic patients experience an improvement in quality of life after surgery. Each individual patient has different motivations and expectations from the treatment. Also the use of validated instruments helped in quantifying results. Further research should be aimed at higher levels of evidence in study design, quantifying the changes for different types of dentofacial deformities and surgeries, and have a longer follow-up duration.     

Retention of tooth-colored restorations in non-carious cervical lesions—a systematic review

Objectives

The aim of this review was to assess the effect of different adhesive systems and tooth preparation on the retention of tooth-colored restorative materials placed in non-carious cervical lesions (NCCLs).

Methods

Randomized clinical trials with a minimum of 3 years of follow-up that evaluated the effectiveness of tooth-colored materials, adhesive systems, and preparation techniques for the restoration of NCCLs were selected. The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE (OVID), the Latin American and Caribbean Health Sciences Literature database (LILACS), and Medline (OVID) electronic databases were searched from 1990 to 2013.

Results

Twenty-seven randomized clinical trials were included and reviewed. Meta-analysis was used to determine the relative risk of loss of tooth-colored NCCL restorations between different categories of adhesive systems. The effect of tooth preparation could not be similarly analyzed.

Conclusion

The current best evidence indicates that a glass ionomer cement has a significantly lower risk of loss of a NCCL restoration compared to either a three-step etch-and-rinse or a two-step etch-and-rinse adhesive system; a three-step etch-and-rinse adhesive system has a significantly lower risk of loss of a NCCL restoration compared to a two-step etch-and-rinse adhesive system. No significant difference could be observed in the risk of loss of a tooth-colored NCCL restoration between a three-step etch-and-rinse adhesive system and either a two-step self-etch or a one-step self-etch adhesive system.     

Surface smoothness of resin composites after polishing—A systematic review and network meta-analysis of in vitro studies

A systematic review and network meta-analysis was performed to provide evidence for the best polishing protocol for different types of resin composites to minimize surface roughness. A search was performed in PubMed, Scopus, Web of Science, LILACS, BBO, EMBASE, and Cochrane Library on July 2, 2019 (updated in December, 2020). In vitro studies that included at least two systems for polishing resin composites and analyzed surface roughness were included. The risk of bias was evaluated. A random-effects Bayesian-mixed treatment comparison model was used to compare surface roughness in resin composites with the different types of polishers. Surface under the cumulative ranking curve (SUCRA) analysis was performed to rank the probability for the best polishing system. After removal of duplicates, title and abstract screening yielded 34 studies. Network meta-analysis was not possible for hybrid and microhybrid composites. SUCRA analysis showed that abrasive paper discs allowed greater surface smoothness for nanohybrid and nanofill composites to a probability of between 83% and 91.6%. Silicon carbide brush had a 78.2% probability of being the best system for microfill composites. The use of abrasive paper disc polishers showed a favorable result in nanofill and nanohybrid resin composites. Silicon carbide brush has a greater chance of promoting a smoother surface for microfill resin composites.     

Efficacy and complications of orbital fat decompression in Graves’ orbitopathy: a systematic review and meta-analysis

In Graves’ orbitopathy, surgical decompression is often needed for functional and aesthetic reasons. This meta-analysis was performed to assess the efficacy and safety of fat removal orbital decompression (FROD) alone to treat exophthalmos in Graves’ orbitopathy. A systematic search was conducted in PubMed/MEDLINE, Web of Science, and Cochrane Library for studies published before August 2018. Random-effects meta-analyses were applied; weighted means and weighted proportions with corresponding 95% confidence intervals (CI) were calculated. Study quality and quality of evidence for each individual outcome were analyzed. Of 1908 records initially identified, 13 observational studies were selected, representing 4820 orbits in 2514 patients. Weighted Hertel exophthalmometry was 23.10 mm (95% CI 21.77–24.43 mm) preoperative and 19.31 mm (95% CI 17.81–20.81 mm) postoperative. The weighted mean difference was 3.81 mm (95% CI 3.41–4.21 mm). Five studies reported an improvement of diplopia after surgery, occurring in 943 of 1172 patients (weighted proportion 0.50, 95% CI 0.15–0.85). Persistent new onset diplopia was reported in five studies, or 124 of 1277 patients (weighted proportion 0.15, 95% CI 0.03–0.27). No serious adverse events were reported. Results support the effectiveness and safety of FROD to treat mild-to-moderate exophthalmos in Graves’ orbitopathy. Prospective and controlled trials are needed to improve the level of evidence.     

Clinical aspects of digital three-dimensional intraoral scanning in orthodontics – A systematic review

ObjectiveThis systematic review aimed to investigate the accuracy, reproducibility, scanning time, patient comfort, and operator experience of various commercially available intraoral scanners (IOS) in orthodontics.MethodsAn elaborate and extensive search of literature in the PubMed, Scopus, Google Scholar, Embase, Web of Science, and Cochrane Central databases was performed using various relevant keywords.ResultsA total of 3256 articles were obtained from all the databases, 35 studies were included. The accuracy of IOS was controversial compared to that of conventional impression techniques. Digital scanning demonstrated satisfactory to excellent reproducibility, shorter scanning time, and improved patient comfort compared with conventional techniques.ConclusionIOS are time-efficient, comfortable for patients, and simple to use with a learning curve for the operator. These methods are sufficiently accurate for treatment planning and aligner fabrication in orthodontics.     

The Efficacy of bone graft as monotherapy and in combination with platelet concentrates in grade II furcation defect – A systematic review and meta-analysis

BackgroundThe use of autologous platelet concentrates (PC) in addition to bone graft (BG) in open flap debridement (OFD) has been investigated to improve the efficacy and outcomes of regenerative therapy for furcation defects. This systematic review evaluated efficacy of added benefits of PC to bone grafts in treatment of grade II furcation defects.MethodsA thorough literature search on PubMed, Cochrane Library and Google Scholar databases was conducted. Data on outcomes were extracted only from randomized controlled clinical trials on humans with a minimum follow up of 6 months comparing BG alone and BG + PC in treatment of mandibular grade II furcation defect.Results36 of the 518 screened articles and abstracts were read in full-text, nine of which have been included in the meta-analysis. The addition of PC to BG has resulted in improvement in PD, GR (with smaller effect); V-DBD and H-DBD showed smaller change in experimental group whereas VCAL and HCAL exhibited overall larger changes with smaller effect.ConclusionBone regeneration in terms of defect fill with the addition of platelet concentrates to bone graft remains debatable considering the minimal benefits in the treatment of grade II mandibular furcation defect.