Turned versus anodised dental implants: a meta‐analysis

The aim of this meta‐analysis was to test the null hypothesis of no difference in the implant failure rates, marginal bone loss (MBL)and post‐operative infection for patients being rehabilitated by turned versus anodised‐surface implants, against the alternative hypothesis of a difference. An electronic search without time or language restrictions was undertaken in November 2015. Eligibility criteria included clinical human studies, either randomised or not. Thirty‐eight publications were included. The results suggest a risk ratio of 2·82 (95% CI 1·95–4·06, P < 0·00001) for failure of turned implants, when compared to anodised‐surface implants. Sensitivity analyses showed similar results when only the studies inserting implants in maxillae or mandibles were pooled. There were no statistically significant effects of turned implants on the MBL (mean difference‐MD 0·02, 95%CI ?0·16–0·20; P = 0·82) in comparison to anodised implants. The results of a meta‐regression considering the follow‐up period as a covariate suggested an increase of the MD with the increase in the follow‐up time (MD increase 0·012 mm year^?1), however, without a statistical significance (P = 0·813). Due to lack of satisfactory information, meta‐analysis for the outcome ‘post‐operative infection’ was not performed. The results have to be interpreted with caution due to the presence of several confounding factors in the included studies.     

Efficacy of low‐level laser therapy in the treatment of TMDs: a meta‐analysis of 14 randomised controlled trials

This study was designed to evaluate the efficacy of low‐level laser therapy (LLLT) in the treatment of temporomandibular disorders (TMDs). We searched electronic databases and references lists of relevant articles, retrieved all of the published randomised controlled trials in regard to these issues and then performed a meta‐analysis. Fourteen highly qualified RCTs reporting on a total of 454 patients, which evaluated the effectiveness of LLLT for patients suffering from TMDs were retrieved. The results indicated that LLLT was not better than placebo in reducing chronic TMD pain (weighted mean difference = ?19·39; 95% confidence interval = ?40·80–2·03; P < 0·00001; I² = 99%). However, the LLLT provided significant better functional outcomes in terms of maximum active vertical opening (MAVO) (weighted mean difference = 4·18; 95% confidence interval = 0·73–7·63; P = 0·006; I² = 73%), maximum passive vertical opening (MPVO) (weighted mean difference = 6·73; 95% confidence interval = 01·34–12·13; P = 0·06; I² = 73%), protrusion excursion (PE) (weighted mean difference = 1·81; 95% confidence interval = 0·79–2·83; P = 0·59; I² = 0%) and right lateral excursion (RLE) (weighted mean difference = 2·86; 95% confidence interval = 1·27–4·45; P = 0·01; I² = 73%). The results of our meta‐analysis have provided the best evidence on the efficacy of LLLT in the treatment of TMDs. This study indicates that using LLLT has limited efficacy in reducing pain in patients with TMDs. However, LLLT can significantly improve the functional outcomes of patients with TMDs.     

Transcutaneous neuromuscular electrical stimulation can improve swallowing function in patients with dysphagia caused by non‐stroke diseases: a meta‐analysis

There is still debate over whether the effect of transcutaneous neuromuscular electrical stimulation (NMES) in dysphagia rehabilitation is superior to traditional therapy (TT). The purpose of this meta‐analysis was to assess the overall efficacy by comparing the two treatment protocols. Published medical studies in the English language were obtained by comprehensive searches of the Medline, Cochrane and EMBASE databases from January 1966 to December 2011. Studies that compared the efficacy of treatment and clinical outcomes of NMES versus TT in dysphagia rehabilitation were assessed. Two reviewers independently performed data extraction. Data assessing swallowing function improvement were extracted as scores on the Swallowing Function Scale as the change from baseline (change scores). Seven studies were eligible for inclusion, including 291 patients, 175 of whom received NMES and 116 of whom received TT. Of the seven studies, there were two randomised controlled trials, one multicentre randomised controlled trial and four clinical controlled trials. The change scores on the Swallowing Function Scale of patients with dysphagia treated with NMES were significantly higher compared with patients treated with TT [standardised mean difference (SMD) = 0·77, 95% confidence interval (CI): 0·13 to 1·41, P = 0·02]. However, subgroup analysis according to aetiology showed that there were no differences between NMES and TT in dysphagia post‐stroke (SMD = 0·78, 95% CI: ?0·22 to 1·78, P = 0·13, 4 studies, 175 patients). No studies reported complications of NMES. NMES is more effective for treatment of adult dysphagia patients of variable aetiologies than TT. However, in patients with dysphagia post‐stroke, the effectiveness was comparable.     

The effect of oral appliances that advanced the mandible forward and limited mouth opening in patients with obstructive sleep apnea: A systematic review and meta‐analysis of randomised controlled trials

Oral appliances (OAs) have demonstrated efficacy in treating obstructive sleep apnea (OSA), but many different OA devices are available. The Japanese Academy of Dental Sleep Medicine supported the use of OAs that advanced the mandible forward and limited mouth opening and suggested an evaluation of their effects in comparison with untreated or CPAP. A systematic search was undertaken in 16 April 2012. The outcome measures of interest were as follows: Apnea Hypopnea Index (AHI), lowest SpO₂, arousal index, Epworth Sleepiness Scale (ESS), the SF‐36 Health Survey. We performed this meta‐analysis using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Five studies remained eligible after applying the exclusion criteria. Comparing OA and control appliance, OA significantly reduced the weighted mean difference (WMD) in both AHI and the arousal index (favouring OA, AHI: ?7·05 events h^?1; 95% CI, ?12·07 to ?2·03; P = 0·006, arousal index: ?6·95 events h^?1; 95% CI, ?11·75 to ?2·15; P = 0·005). OAs were significantly less effective at reducing the WMD in AHI and improving lowest SpO₂ and SF‐36 than CPAP, (favouring OA, AHI: 6·11 events h^?1; 95% CI, 3·24 to 8·98; P = 0·0001, lowest SpO₂: ?2·52%; 95% CI, ?4·81 to ?0·23; P = 0·03, SF‐36: ?1·80; 95% CI, ?3·17 to ?042; P = 0·01). Apnea Hypopnea Index and arousal index were significantly improved by OA relative to the untreated disease. Apnea Hypopnea Index, lowest SpO₂ and SF‐36 were significantly better with CPAP than with OA. The results of this study suggested that OAs improve OSA compared with untreated. CPAP appears to be more effective in improving OSA than OAs.     

Prophylactic antibiotic regimen and dental implant failure: a meta‐analysis

The aim of this meta‐analysis was to investigate whether there are any positive effects of prophylactic antibiotic regimen on implant failure rates and post‐operative infection when performing dental implant treatment in healthy individuals. An electronic search without time or language restrictions was undertaken in March 2014. Eligibility criteria included clinical human studies, either randomised or not. The search strategy resulted in 14 publications. The I² statistic was used to express the percentage of the total variation across studies due to heterogeneity. The inverse variance method was used with a fixed‐ or random‐effects model, depending on the heterogeneity. The estimates of relative effect were expressed in risk ratio (RR) with 95% confidence interval. Six studies were judged to be at high risk of bias, whereas one study was considered at moderate risk, and six studies were considered at low risk of bias. The test for overall effect showed that the difference between the procedures (use versus non‐use of antibiotics) significantly affected the implant failure rates (P = 0·0002), with a RR of 0·55 (95% CI 0·41–0·75). The number needed to treat (NNT) to prevent one patient having an implant failure was 50 (95% CI 33–100). There were no apparent significant effects of prophylactic antibiotics on the occurrence of post‐operative infections in healthy patients receiving implants (P = 0·520). A sensitivity analysis did not reveal difference when studies judged as having high risk of bias were not considered. The results have to be interpreted with caution due to the presence of several confounding factors in the included studies.     

Chlorhexidine gel and less difficult surgeries might reduce post‐operative pain,controlling for dry socket,infection and analgesic consumption: a split‐mouth controlled randomised clinical trial

Reports on post‐surgical pain are a few, controversial and flawed (by statistics and analgesic consumption). Besides, it is not known if chlorhexidine can reduce post‐extraction pain adjusting for its effect on prevention of infection and dry socket (DS). We assessed these. A total of 90 impacted mandibular third molars of 45 patients were extracted. Intra‐alveolar 0·2% chlorhexidine gel was applied in a split‐mouth randomised design to one‐half of the sockets. None of the included patients took antibiotics or analgesics afterwards. In the first and third post‐operative days, DS formation and pain levels were recorded. Predictive roles of the risk factors were analysed using fixed‐effects (classic) and multilevel (mixed‐model) multiple linear regressions (α = 0·05, β≤0·1). In the first day, pain levels were 5·56 ± 1·53 and 4·78 ± 1·43 (out of 10), respectively. These reduced to 3·22 ± 1·41 and 2·16 ± 1·40. Pain was more intense on the control sides [both P values = 0·000 (paired t‐test)]. Chlorhexidine had a significant pain‐alleviating effect (P = 0·0001), excluding its effect on DS and infection. More difficult surgeries (P = 0·0201) and dry sockets were more painful (P = 0·0000). Age had a marginally significant negative role (P = 0·0994). Gender and smoking had no significant impact [P ≥ 0·7 (regression)]. The pattern of pain reduction differed between dry sockets and healthy sockets [P = 0·0102 (anova )]. Chlorhexidine can reduce pain, regardless of its infection‐/DS‐preventive effects. Simpler surgeries and sockets not affected by alveolar osteitis are less painful. Smoking and gender less likely affect pain. The role of age was not conclusive and needs future studies.     

Transcranial direct current stimulation and exercises for treatment of chronic temporomandibular disorders: a blind randomised‐controlled trial

To evaluate the effect of adding transcranial direct current stimulation (tDCS) to exercises for chronic pain, dysfunction and quality of life in subjects with temporomandibular disorders (TMD). Participants were selected based on the RDC/TMD criteria and assessed for pain intensity, pressure pain threshold over temporomandibular joint and cervical muscles and quality of life. After initial assessment, all individuals underwent a 4‐week protocol of exercises and manual therapy, together with active or sham primary motor cortex tDCS. Stimulation was delivered through sponge electrodes, with 2 mA amplitude, for 20 min daily, over the first 5 days of the trial. A total of 32 subjects (mean age 24·7 ± 6·8 years) participated in the evaluations and treatment protocol. Mean pain intensity pre‐treatment was 5·5 ± 1·4 for active tDCS group, and 6·3 ± 1·2 for sham tDCS. Both groups showed a decrease in pain intensity scores during the trial period (time factor – F_4·5,137·5 = 28·7, P < 0·001; group factor – F_1·0,30·0 = 7·7, P < 0·05). However, there were no differences between the groups regarding change in pain intensity (time*group interaction – F_4·5,137·5 = 1·5, P = 0·137). This result remained the same after 5 months (t‐test t = 0·29, P > 0·05). Pressure pain thresholds decrease and improvement in quality of life were also noticeable in both groups, but again without significant differences between them. Absolute benefit increase was 37·5% (CI 95%: ?15·9% to 90·9%), and number needed to treat was 2·66. This study suggests that there is no additional benefit in adding tDCS to exercises for the treatment of chronic TMD in young adults.     

Dental implants inserted in male versus female patients: a systematic review and meta‐analysis

The aim of this meta‐analysis was to test the null hypothesis of no difference in the failure rates, marginal bone loss (MBL) and post‐operative infection for implants inserted in male or female patients, against the alternative hypothesis of a difference. An electronic search without time or language restrictions was undertaken in December 2014. Eligibility criteria included clinical human studies, either randomized or not. Ninety‐one publications were included, with a total of 27 203 implants inserted in men (1185 failures), and 25 154 implants inserted in women (1039 failures). The results suggest that the insertion of dental implants in male patients statistically affected the implant failure rates (RR 1·21, 95% CI 1·07–1·37, P = 0·002). Due to the limited number of studies reporting results on MBL, it is difficult to estimate the real effect of the insertion of implants in different sexes on the marginal bone level. Due to lack of satisfactory information, meta‐analysis for the outcome ‘post‐operative infection’ was not performed. The results have to be interpreted with caution due to the presence of several confounding factors in the included studies.     

Sensory recovery of non‐innervated free flaps and nasolabial island flaps used for tongue reconstruction of oncological defects

The aims of this study were to assess sensory recovery and impact on life quality after tongue reconstruction of oncological defects using different flap types. Thirty‐two patients who underwent tongue reconstruction for oncological defects 9·3 months after surgery with non‐innervated radial forearm free flaps (RFFFs) (N = 16), non‐innervated anterolateral thigh free flaps (ALTFFs) (N = 8) and nasolabial island flaps (NLIFs) (N = 8), and 20 age‐ and gender‐matched healthy controls participated in the study. The modalities assessed were cold detection threshold, warm detection threshold (WDT), cold pain threshold, heat pain threshold (HPT), mechanical detection threshold (MDT), mechanical pain threshold (MPT) and the Chinese version of Oral Health Impact Profile‐49. ALTFFs was significantly more sensitive than RFFFs (P = 0·005) and NLIFs (P = 0·014) for WDT, and showed a better sensory recovery than RFFFs for HPT (P = 0·011). ALTFFs and NLIFs showed significantly better sensory recovery than RFFFs for MDT (P < 0·005). NLIFs showed the best sensory recovery for MPT, followed by ALTFFs and lastly RFFFs (P = 0·004). NLIFs also showed the least impact on quality of life measures related to psychological discomfort compared to RFFFs and ALTFFs (P < 0·019). All modalities of sensory recovery in RFFFs did not depend on gender and post‐operative radiotherapy (P > 0·05). Different flaps for tongue reconstruction of oncological defects appear to have different patterns of sensory recovery and impact on quality of life measures. A longer follow‐up period and larger number of participants will be needed in future studies.     

Effect of occlusal reduction on postendodontic pain: A systematic review and meta‐analysis of randomised clinical trials

The purpose of this systematic review was to assess the effect of occlusal reduction on post‐operative pain following root canal treatment and was performed in accordance with the PRISMA statement being registered in the PROSPERO database (CRD42018089941). Two reviewers independently conducted a systematic literature search in the PubMed (MEDLINE), Dentistry & Oral Sciences Source and the Cochrane Library databases. Seven studies were included, of which three were used to perform meta‐analysis for 6 days post‐operative and the rest for qualitative synthesis. Three studies were assessed as low risk of bias, three as some concern, and one as high risk of bias. Occlusal reduction diminishes the post‐operative pain (SMD ?1.10 (95%CI ?2.06, ?0.15) I² = 96.9%) at 6 days for teeth diagnosed as irreversible pulpitis, and, overall, likely reduces post‐operative pain for patients presenting with irreversible pulpitis and/or symptomatic apical periodontitis. Future high‐quality clinical trials are needed to better understand the role of occlusal reduction.     

DEEP Study: does EQ‐5D‐5L measure the impacts of persistent oro‐facial pain?

The EQ‐5D‐5L is a generic quality of life (QOL) measure widely used throughout the world, which has the advantage that it allows health‐state preferences to be elicited. The aim of this study was to examine whether: a) variation in the standardised reference period for EQ‐5D‐5L from ‘today’ to ‘the last month’ had a minimal clinically meaningful difference; (b) EQ‐5D‐5L had convergent validity with a multidimensional pain measure in quantifying the impacts of pain. As part of a larger study into the effectiveness and efficiency of care pathways for persistent orofacial pain (POFP) ( http://research.ncl.ac.uk/deepstudy ), participants with POFP (n = 100) completed two versions of the EQ‐5D‐5L at the same time with different reference periods (‘today’ vs. ‘last month’). Participants also completed the first section of the West Haven–Yale Multidimensional Pain Inventory (v3) to assess convergent validity. Two‐tailed nonparametric inferential statistics, intra‐class correlation coefficients (ICC), and within‐subject change scores were used to compare the two EQ‐5D‐5L versions. Convergent validity was assessed using Spearman's rho correlation coefficients. Health‐state valuations were significantly different (P < 0·01), and there was good similarity between the two versions' ICC 0·86 (95% CI 0·79–0·91). The within‐subject mean change was 0·03 (95% CI 0·01–0·06). For convergent validity, all relationships were significant (P < 0·05) and in the expected directions. EQ‐5D‐5L demonstrates sufficient convergent validity to be used with POFP, and a change in the standard reference period may be unnecessary if a multidimensional pain measure is also used.     

Correlation between the levels of non‐specific physical symptoms and pressure pain thresholds measured by algometry in patients with temporomandibular disorders

Recent studies showed that patients with chronic TMD pain also feature increased sensitivity in other craniofacial regions, and even in remote peripheral areas, suggesting that nociceptive processing is centrally facilitated in this patient population. The aim of this study was to investigate the existence of a negative correlation between the levels of non‐specific physical symptoms and pressure pain thresholds measured by algometry at sites distant from the chief complaint of oro‐facial pain in patients with TMD. A total of 20 female patients were evaluated comprising 11 patients diagnosed with myofascial pain (Group I of RDC/TMD) and 9 patients with arthralgia (Group III of RDC/TMD), with both reporting chronic TMD pain for at least 3 months. Patients were tested by the pressure algometry technique, and, in the same visit, clinical diagnosis and levels of non‐specific physical symptoms, including pain‐related issues or not, were obtained. The raw scores were then standardised into a T‐score. The possible correlation between the dependent variable levels of non‐specific physical symptoms and pressure pain thresholds measured by algometry at sites distant from the chief complaint of oro‐facial pain was assessed with Spearman's correlation coefficient. Results were considered statistically significant, which stood a lower than 5% probability of occurring by chance (P < 0·05). A statistically significant (P = 0·02) negative correlation (?0·51) was found to exist between the levels of non‐specific physical symptoms, only if including issues involving pain‐related symptoms, and experimental pressure pain thresholds in patients with painful TMD.     

Implant surgery using bone‐ and mucosa‐supported stereolithographic guides in totally edentulous jaws: surgical and post‐operative outcomes of computer‐aided vs. standard techniques

Objectives: The aim of this study was to compare the surgical and post‐operative outcomes of a computer‐aided implant surgery performed by bone‐ and mucosa‐supported stereolithographic (SLA) guides against the standard technique. Material and methods: Multiple‐ and single‐type SLA guides from two commercial manufacturers were produced and a total of 341 implants were placed to 52 patients using the standard technique (Control group), bone‐ (bone‐supported guide [BSG] group) and mucosa‐supported SLA guides (Flapless group) in 21, 16 and 15 patients, respectively. Surgical duration (min), number of analgesics (tablets) as well as hemorrhage, difficulty in mouth opening (or trismus) and other incidences were recorded. Pain and swelling was assessed using the visual analog scale (VAS). Parametric and non‐parametric tests were used for statistical analysis (P<.05). Results: The mean surgery duration (23.53±5.48 min) and the number of analgesics consumed (four tablets) in the Flapless group were lower than those in the control (68.71±11.4 min and 10 tablets) and BSG groups (60.94±13.07 min and 11 tablets, P<0.01). The change in pain scores (VAS) and the number of analgesics consumed in time were statistically significant (P<0.01 and 0.05, respectively) and the Flapless group reported a lower pain score than the BSG (P<0.01) and Control groups (P<0.001). The Flapless group experienced less hemorrhage (χ²=4.12, P=0.041 on the day of surgery) and fewer instances of trismus (χ²=6.91, P=0.031 the day after surgery). The differences in early‐term failures were not statistically significant between the groups (log‐rank test: P=0.782). Conclusion: The use of mucosa‐supported single SLA guides for flapless implant placement may help reduce the surgery duration, pain intensity, related analgesic consumption and most other complications typical in the post‐implant surgery period. However, there are particular drawbacks in both guide types and further studies are required to confirm the prosthodontic conformity and long‐term success of implants placed using computer‐assisted techniques. To cite this article:
Ar?san V, Karabuda CZ, Özdemir T. Implant surgery using bone‐ and mucosa‐supported stereolithographic guides in totally edentulous jaws: surgical and post‐operative outcomes of computer‐aided vs. standard techniques.
Clin. Oral Impl. Res. 21 , 2010; 980–988.
doi: 10.1111/j.1600‐0501.2010.01957.x     

Comparison of utility weighted DMFT with patient‐reported oral well‐being

This study investigated a method of measuring oral health, as opposed to measuring disease. The objective was to compare DMF score and whole mouth utility scores to a patient‐reported outcome measure (PROM). Disutility values for lost and restored teeth were used to weight the decayed, missing and filled teeths(DMFTs) of 10 adult patients. This gave two whole mouth utility scores (WMU). These scores were then compared with a patient‐reported oral health outcome measure recorded by the use of a visual analogue scale (VAS). The anchors for the VAS were ‘my mouth could not be worse’ and ‘my mouth could not be better’. There was a positive correlation (r = 0·6457) between WMU1 and the patient‐reported outcome measure (P < 0·05) and a negative correlation (r = ?0·8383) between WMU1 and DMFT which was significant at the P < 0·01 level. There was a statistically significant positive correlation of r = 0·7926 between WMU2 and the patient‐reported outcome measure (P < 0·01) and a negative correlation (r = ?0·9393) between WMU2 and DMFT (P < 0·01). The Pearson's correlation between DMFT and the patient‐reported outcome measure was ?0·8757, which was significant at the 0·01 level. Patient reports of their perceived level of health correlate well with DMFT scores. Weighting DMFT scores according to the differential values assigned to missing, or missing and filled, teeth does not increase the degree of correlation between the measure and the patients’ personal quantification of their oral health. Decayed, missing and filled teeth therefore seems to adequately capture the patient's sense of well‐being.     

Practice‐based clinical evaluation of metal–ceramic and zirconia molar crowns: 3‐year results

This practice‐based study evaluates the clinical performance of conventionally luted metal–ceramic and zirconia molar crowns fabricated with pronounced anatomical core design and a prolonged cooling period of the veneering porcelain. Fifty‐three patients were treated from 07/2008 until 07/2009 with either metal–ceramic crowns (MCC) (high‐noble alloy + low‐fusing porcelain) or zirconia crowns (Cercon System, DeguDent, Germany). Forty‐nine patients (30 women/19 men) with 100 restorations (metal–ceramic: 48/zirconia: 52, mean observational period: 36·5 ± 6 months) participated in a clinical follow‐up examination and were included in the study. Time‐dependent survival (in situ criteria), success (event‐free restorations) and chipping rates (defects of the veneering ceramics) were calculated according to the Kaplan–Meier method and analysed in relation to the crown fabrication technique, using a Cox regression model (P < 0·05). Three complete failures (metal–ceramic: 1, zirconia: 2) were recorded (survival rate after 3 years: metal–ceramic: 97·6%, zirconia: 95·2%). Of the metal–ceramic restorations, 90·9% remained event‐free (two ceramic fractures, one endodontic treatment), whereas the success rate for the zirconia was 86·8% (two ceramic fractures, one endodontic treatment, one secondary caries). No significant differences in survival (P = 0·53), success (P = 0·49) and ceramic fracture rates (P = 0·57) were detected. The combination of a pronounced anatomical core design and a modified firing of the veneering porcelain for the fabrication of zirconia molar crowns resulted in a 3‐year survival, success and chipping rate comparable to MCC.     

Oral health and caries related microflora in children during the first three months following renal transplantation

There is little information on the oral health of children undergoing renal transplantation during the early transplant period. Methods. Twenty‐four children undergoing renal transplantation aged 4–13·2 years and their matched controls were recruited. The dmfs, dmft, DMFS and DMFT, plaque, gingivitis and gingival enlargement scores were recorded. The oral microflora was sampled and cultured for S. mutans, Lactobacllus species and Candida species. Results. There was a significantly lower mean dmfs (0·3 ± 0·9; P = 0·03), dmft (0·3 ± 0·9; P = 0·03), DMFS (2·3 ± 5·3; P = 0·01) and DMFT (1·5 ± 2·6; P = 0·02), respectively, in the transplant group. There was a significantly greater mean plaque score (14·7 ± 11) for the permanent dentition, at baseline only, compared with 90 days post‐transplantation (9·4 ± 10·4; P = 0·02). There was a significantly greater gingival enlargement score (1·8 ± 1·4; P = 0·04) 90 days post‐transplantation compared with baseline. The S. mutans and Lactobacillus counts were significantly lower both at baseline (P = 0·0001 and P = 0·004) and 90 days post‐transplantation (P = 0·02; and P = 0·05), respectively, compared with the controls. Conclusions. The transplant children had less active dental disease than the controls although gingival enlargement needs careful monitoring.     

Short‐term post‐operative pain and discomfort following insertion of mini‐implants for retaining mandibular overdentures: a randomized controlled trial

The retention of removable dentures by mini‐implants is a relatively recent treatment modality and may lead to minimal post‐operative trauma. This study compared post‐operative pain and discomfort following the insertion of mini‐implants (two or four) or two standard‐size implants for the retention of mandibular overdentures. One hundred and twenty edentulous participants (mean age 59·5 ± 8·5 years) were randomly allocated into three groups according to received treatment: (GI) four mini‐implants, (GII) two mini‐implants or (GIII) two standard implants. Seven days after implant insertion, patients answered questions (100‐mm VAS) relating to pain, swelling, and discomfort with chewing, speech and hygiene, considering their experiences during the 1st and 6th day. Groups were compared by two‐way anova (α = 0·05). All participants (GI: 38; GII: 42; GIII: 40) were analysed after 7 days. At the 6th day, GI felt significantly higher pain than GII and GIII. GI also reported more difficulty in performing oral hygiene practices than GIII during the 1st day. There was no significant difference between groups for the other questions and periods. No participant suffered unexpected side effects. The use of four mini‐implants induces more intense post‐operative pain at the 6th day than the insertion of two mini‐ or conventional fixtures, as well as more difficult oral hygiene on the 1st day. Clinicaltrials.gov, NCT01411683; FAPESP, 2011/00688‐7 and 2011/23347‐0.     

Development of the Chinese version of the Oro‐facial Esthetic Scale

The aim of this study was to investigate the psychometric properties of the Oro‐facial Esthetic Scale among Chinese‐speaking patients. The original Oro‐facial Esthetic Scale was cross‐culturally adapted in accordance with the international standards to develop a Chinese version (OES‐C). Unlike the original Oro‐facial Esthetic Scale, the version employed in this study used a 5‐point Likert scale with items rated from unsatisfactory to most satisfactory. Psychometric evaluation included the reliability and validity of the OES‐C. The reliability of the OES‐C was determined through internal consistency and test–retest methods. The validity of OES‐C was analysed by content validity, discriminative validity, construct validity and convergent validity. The corrected item‐total correlation coefficients of the OES‐C ranged from 0·859 to 0·910. The inter‐item correlation coefficients between each two of the eight items of the OES‐C ranged from 0·766 to 0·922. The values of ICC ranged from 0·79 (95% CI = 0·54–0·98) to 0·93 (95% CI = 0·87–0·99), indicating an excellent agreement. Construct validity was proved by the presence of one‐factor structure that accounted for 83·507% of the variance and fitted well into the model. Convergent validity was confirmed by the association between OES‐C scores and self‐reported oral aesthetics and three questions from the Oral Health Impact Profile related to aesthetics (correlation coefficients ranged from ?0·830 to ?0·702, P < 0·001). OES‐C scores discriminated aesthetically impaired patients from healthy controls. This study provides preliminary evidence concerning the reliability and validity of the OES‐C. The results show that the OES‐C may be a useful tool for assessment of oro‐facial esthetics in China.     

The influence of bilateral sagittal split ramus osteotomy on submental‐cervical aesthetics

The effect of orthodontic‐surgical treatment on submental‐cervical region was evaluated in a very limited number of studies. The aim of this study was to evaluate submental‐cervical soft tissue contour changes following mandibular advancement and set‐back procedures via bilateral sagittal split ramus osteotomy. Sixty‐seven patients were included in this study. Group 1 consisted of 27 skeletal Class II patients who underwent mandibular advancement surgery, whereas Group 2 consisted of 40 skeletal Class III patients who underwent mandibular set‐back surgery. Various linear and angular measurements were performed on pre‐operative and sixth month post‐operative cephalometric radiographs. A new method was used to evaluate the amount of sagging at submental region. The submental length did not change in Group 1; however, it decreased significantly in Group 2 (P < 0·05). The angle between submental plane and facial plane decreased to 95·9° from 98·8° in Group 1(P < 0·05), whereas it increased to 93·1° from 88·2° in Group2 (P < 0·05). The change of submental soft tissue sag was almost stable in Group 1, while 0·34 mm increase of sag was observed in Group 2. This increase was not statistically significant (P > 0·05). Mandibular set‐back and advancement procedures do not remarkably change the submental sag following approximately 6 mm jaw movement. Although mandibular advancement did not significantly effect submental length, soft tissue followed mandibular set‐back with a ratio of 1:1 at C‐point to projection of soft tissue pogonion and 1:0·7 at C‐point to soft tissue menton distances.     

Microbiological assessment of saliva from children subsequent to atraumatic restorative treatment (ART)

Summary. Aims. The aim of this study was to evaluate mutans streptococci (MS) in the saliva following use of the atraumatic restorative treatment (ART) technique. Methods. Sixteen 5–7‐year‐old children had restorations using the ART technique and employing FUJI IX glass‐ionomer cement as the restorative material. Decayed tissue was manually excavated without local anaesthesia, being careful to avoid discomfort. Saliva was collected for microbiological assessment using Kit Caritest MS before treatment, one week, four weeks and one year after ART was used. The procedure for saliva collection, incubation, storage, and comparative reading of MS counts followed the manufacturer's instructions. The data were statistically analysed, using non‐parametric tests (Wilcoxon Signed Ranks and Sign Test) at a significance level of 0·05. Results. The results showed a significant reduction of MS levels in saliva when comparing the results before treatment with those obtained one week (95·95%; P = 0·003), four weeks (93·27%; P = 0·000) and one year (95·56%; P = 0·002) after ART. Conclusions. It is concluded from the results that the ART technique proved satisfactory and appeared to have produced a significant and sustained reduction in levels of MS. These results need to be confirmed in a larger study.