Comparison of Crestal Bone Loss Around Dental Implants Placed in Healed Sites Using Flapped and Flapless Techniques: A Systematic Review

Background : The aim of the present systematic review is to compare the crestal bone loss (CBL) around dental implants placed in healed sites using flapped and flapless surgical techniques. Methods: The focused question was, “Does flapped and flapless surgical technique influence CBL around dental implants placed in healed sites?” Databases were searched from 1975 up to and including May 2014 using different combinations of the following keywords: “crestal bone loss”; “dental implant”; “surgery”; “flap”; and “flapless.” Unpublished data, experimental studies, letters to the editor, review articles, case reports, commentaries, and articles published in languages other than English were excluded. In all studies, the test group comprised implants placed using flapless surgery, and the control group, implants placed after reflection of a full‐thickness mucoperiosteal flap. Results: Ten clinical studies were included. In five studies, CBL around implants was comparable between the test and control groups. In four studies, implants in the test group showed significantly less CBL compared with the control group. In one study, CBL was significantly higher in the test group than the control group. Conclusion: CBL around dental implants placed in healed sites using flapped and flapless techniques is comparable.     

Is Titanium Sensitivity Associated with Allergic Reactions in Patients with Dental Implants? A Systematic Review

Background: A worrying correlation which seems to be overlooked by clinicians is allergic reactions to titanium (Ti) in patients with dental implants. Purpose: The aim of the present review study was to assess whether or not Ti sensitivity is associated with allergic reactions in patients with dental implants. Materials and Methods: To address the focused question “Can Ti cause allergic reactions in patients with dental implants?”, databases were explored from 1977 until May 2010 using a combination of the following keywords: “allergy,”“dental,”“hypersensitivity,”“implant,”“oral,” and “Titanium.” Letters to the editor and unpublished data were excluded. Results: Seven studies (six clinical and one experimental) were included. The participants were aged between 14.3 and 84.1 years. In five clinical studies, Ti implants were inserted in the mandible. Five studies reported dermal inflammatory conditions and gingival hyperplasia as allergic reactions in patients with Ti dental implants. A case report presented swelling in submental and labial sulcus and hyperemia of soft tissues in a patient with Ti dental implants. Two studies reported that Ti implants are well tolerated in host tissues. The patch test was performed in two clinical studies for the diagnosis of allergic reactions. Memory lymphocyte immunostimulation assay and lymphocyte transformation tests were also performed. Conclusion: The significance of Ti as a cause of allergic reactions in patients with dental implants remains unproven.     

Oral health status in children with acute lymphoblastic leukemia

Leukemia is a malignancy of the bone marrow. Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy and accounts for nearly 75% of all newly diagnosed leukemias and 25% of all malignancies in childhood. The aim of the present study was to review the oral health status in children with ALL. Databases were explored using various combinations of the following keywords: "acute lymphoblastic leukemia", "children", "inflammation", "pediatric", "periodontal disease" and "periodontitis". Oral inflammatory conditions including chelitis, gingivitis, herpetic gingivostomatitis, mucositis, oral candidiasis, periodontitis and ulcerations are common manifestations in children with ALL. RESULTS: Periodontal inflammatory conditions and oral mucositis were reported to be significantly higher in children with ALL as compared to healthy controls. Tooth morphological disorders including agenesis, microdontia, short roots and developmental defects in the enamel and dentin were more often observed in children with ALL as compared to healthy controls. Children with ALL have a reduced salivary flow rate, which makes them more susceptible to dental caries as compared to healthy children. Malocclusion due to microdontia may also trigger temporomandibular joint disorders in children with ALL; however, this relationship needs further investigations. CONCLUSION: Oral inflammatory conditions including mucositis and gingivitis are common in children with ALL as compared to healthy children. Tooth morphological disorders including microdontia and enamel and dentin are common manifestations in children with ALL.     

Efficacy of metformin in the management of periodontitis: A systematic review and meta-analysis

Periodontitis is characterized by inflammation of the periodontium and leads to loss of teeth if untreated. Although a number of surgical and pharmacological options are available for the management of periodontitis, it still affects a large proportion of population. Recently, metformin (MF), an oral hypoglycemic, has been used to treat periodontitis. The aim of this review is to systematically evaluate the efficacy of MF in the treatment of periodontitis. An electronic search was carried out using the keywords ‘metformin’, ‘periodontal’ and ‘periodontitis’ via the PubMed/Medline, ISI Web of Science and Google Scholar databases for relevant articles published from 1949 to 2016. The addressed focused question was: ‘Is metformin effective in reducing bone loss in periodontitis? Critical review and meta-analysis were conducted of the results obtained in the selected studies. Following the removal of the duplicate results, the primary search resulted in 17 articles and seven articles were excluded based on title and abstract. Hence, 10 articles were read completely for eligibility. After exclusion of four irrelevant studies, six articles were included. The topical application of MF resulted in improved histological, clinical and radiographic outcomes. Additionally, results from the meta-analysis indicated that application of metformin improved the clinical and radiographic outcomes of scaling and root-planing, but at the same time heterogeneity was evident among the results. However, because of a lack of histological and bacterial studies, in addition to short follow-up periods and risk of bias, the long-term efficacy of MF in the treatment of bony defects is not yet ascertained. Further studies are needed to envisage the long-term efficacy of MF in the management of periodontitis.     

Transcultural barriers and cultural competence in dental hygiene practice

AIM: The aim of this paper is to highlight the need to integrate cultural care into dental hygiene practice. BACKGROUND: Culture can be better understood through the concepts, beliefs, and norms of the culturally diverse population of the United States. It is important to understand cultural perceptions of oral health in order to manage transcultural barriers that may arise during the utilization of oral healthcare services. It is assumed cultural competence can only be achieved through the knowledge of various cultural backgrounds in an extremely diverse US population. CONCLUSIONS: There is a need to integrate cultural awareness, knowledge, identification, and respect into the dental hygiene curriculum through the incorporation of competencies and standards associated with dental hygiene practice. Future dental hygienists should be culturally competent to render oral care to an ever expanding and diversified US population.     

Toxicity of fungicides to Pisum sativum: a study of oxidative damage,growth suppression,cellular death and morpho-anatomical changes

Considering the fungicidal threat to the sustainable agro-environment, the toxicological impacts of three fungicides, namely kitazin, hexaconazole and carbendazim, on the biological, chemical and morpho-anatomical changes of peas were assessed. Fungicide applications in general caused a slow but gradual reduction in growth, symbiosis and yields of peas, which, however, varied appreciably among species and concentrations of the three fungicides. Of the three fungicides, carbendazim had the most lethal effect, in which it delayed seed germination and also diminished the overall pea growth. Carbendazim at 3000 μg kg⁻¹ maximally reduced the germination, SVI, size of roots and shoots and total dry matter accumulation in roots, shoots and whole plants distinctly by 40%, 84%, 72%, 73%, 68%, 75% and 73% (p ≤ 0.05), respectively. Hexaconazole at 120 μg kg⁻¹ significantly (p ≤ 0.05) declined total chlorophyll, carotenoids, grain yields, grain protein, root P and shoot N by 19%, 28%, 46%, 69%, 48% and 51%, respectively, over the control. The synthesis of stress biomarkers and oxidative stress were increased with increasing dosage rates of fungicides. Proline content in roots, shoots, leaves and grains, MDA, electrolyte leakage and H₂O₂ of plants grown in soil treated with 288 μg kg⁻¹ kitazin were increased significantly (p ≤ 0.05) by 73%, 52%, 41%, 24%, 59%, 40% and 27%, respectively, relative to the control. Antioxidant defence enzymes were greater in pea foliage. The SEM and CLSM images revealed an obvious alteration in root tips, enhanced cellular damage and cell death when plants were raised under fungicide stress. Also, morpho-anatomical variations in fungicide-treated foliage were visible in the SEM images. Overall, the present study suggests that a careful and secure strategy should be adopted before fungicides are chosen for enhancing pulse production in different agro-climatic regions.

Considering the fungicidal threat to the sustainable agro-environment, the toxicological impacts of three fungicides, namely kitazin, hexaconazole and carbendazim, on the biological, chemical and morpho-anatomical changes of peas were assessed.     

Efficacy of systemic bisphosphonate delivery on osseointegration of implants under osteoporotic conditions: Lessons from animal studies

Background

The aim was to systematically review the role of systemic bisphosphonate (BP) delivery on osseointegration of implants under osteoporotic conditions.

Methods

The addressed focused question was “Does systemic BP delivery enhance osseointegration of implants under osteoporotic conditions?” PubMed/MEDLINE and Google-Scholar databases were searched from 1994 up to and including December 2013 using different combinations of the following keywords: “bone to implant contact”, “implant”, “bisphosphonate”, “osseointegration” and “osteoporosis”. Review articles, case-reports, commentaries, letters to the Editor, unpublished articles and articles published in languages other than English were excluded.

Results

Fifteen animal studies fulfilled our eligibility criteria. Osteoporotic conditions were induced via bilateral ovariectomy (OVX). BPs used in the studies were ibandronate, zoledronic acid and alendronate. Results from 12 studies showed that systemic BP delivery significantly increased bone volume and bone-to-implant contact under osteoporotic conditions. Two studies reported no significant difference in osseointegration among OVX animals with and without systemic BP delivery. In one study, systemic BP delivery negatively influenced implant osseointegration. Rough-surfaced and polished implants were used in 11 and one study respectively. In 3 studies implant surface characteristics remained unclear.

Conclusion

Within the limits of the present study, it is concluded that systemic BP delivery enhances implant osseointegration in animals with induced osteoporotic conditions. However, in a clinical scenario, the potential risk of BP related ONJ in osteoporotic patients undergoing dental implant therapy cannot be disregarded.     

Effect of cigarette smoking on the clinical outcomes of periodontal surgical procedures

IntroductionExperimental studies have revealed that nicotine upregulates the expression of receptors of advanced glycation end products and retards fibroblastic cell migration in the gingiva of smokers compared with nonsmokers, thereby inducing a proinflammatory effect. The aim of this study was to review the effect of cigarette smoking on the clinical outcomes of periodontal surgical procedures.MethodsTo address the focused question, “What is the effect of cigarette smoking on clinical outcomes after periodontal surgical interventions?”, databases were searched from 1968 to May 2010 using various combinations of the following key words: inflammation, mucoperiosteal flap, periodontal surgery, smoking and tobacco. The inclusion criteria included all levels of available evidence. Articles published only in the English language were evaluated, and unpublished data were not sought.ResultsTwenty-four clinical studies were included. The duration of smoking habit ranged from at least 5 years to 27.8 years. Sixteen studies showed that reductions in probing depth and gains in clinical attachment levels were compromised in smokers in comparison with nonsmokers. Three studies showed residual recession after periodontal surgical interventions to be significantly higher in smokers compared with nonsmokers. Three case reports showed periodontal healing to be uneventful in smokers.ConclusionCigarette smoking has a negative effect on periodontal wound healing after surgical interventions.     

First Indications of Omsk Haemorrhagic Fever Virus beyond Russia

Omsk haemorrhagic fever virus (OHFV) is the agent leading to Omsk haemorrhagic fever (OHF), a viral disease currently only known in Western Siberia in Russia. The symptoms include fever, headache, nausea, muscle pain, cough and haemorrhages. The transmission cycle of OHFV is complex. Tick bites or contact with infected small mammals are the main source of infection. The Republic of Kazakhstan is adjacent to the endemic areas of OHFV in Russia and febrile diseases with haemorrhages occur throughout the country—often with unclear aetiology. In this study, we examined human cerebrospinal fluid samples of patients with suspected meningitis or meningoencephalitis with unknown origins for the presence of OHFV RNA. Further, reservoir hosts such as rodents and ticks from four Kazakhstan regions were screened for OHFV RNA to clarify if this virus could be the causative agent for many undiagnosed cases of febrile diseases in humans in Kazakhstan. Out of 130 cerebrospinal fluid samples, two patients (1.53%) originating from Almaty city were positive for OHFV RNA. Screening of tick samples revealed positive pools from different areas in the Akmola region. Of the caught rodents, 1.1% out of 621 were positive for OHFV at four trapping areas from the West Kazakhstan region. In this paper, we present a broad investigation of the spread of OHFV in Kazakhstan in human cerebrospinal fluid samples, rodents and ticks. Our study shows for the first time that OHFV can not only be found in the area of Western Siberia in Russia, but can also be detected up to 1.600 km away in the Almaty region in patients and natural foci.