Dentistry Review最新文献

Background

Purpose

Result

Conclusion

OBJECTIVES

The primary objective of this investigation was to determine the types and frequency of PIMs prescribed to geriatric patients at the Dental College of Georgia at Augusta University (DCG) while considering patients’ age groups and American Society of Anesthesiologists (ASA) physical status. The secondary objective was to determine the source of PIMs prescriptions based on the prescribers’ specialty and professional status.

METHODS

The most recent Beers List and STOPP/START criteria were studied, and PIMs identified. A retrospective electronic chart review of patients at DCG aged 65 and above was performed for calendar years 2018, 2019, 2020, 2021 and 2022. Search queries were also generated for the patients’ medical history, along with PIMs prescribers’ specialty and professional status.

RESULTS

Of 10675 geriatric patients identified, 6.2% (n=662) received PIMs prescriptions. Of those, 73.7% had an ASA III status. 77% received one PIM prescription, while others received between two to six. NSAIDs were the most commonly prescribed PIM (60.1% of patients), followed by opioids (32.5% of patients). A dramatic drop in prescribing NSAIDs was detected in recent years. Surprisingly, a similar pattern was not observed with opioids. Both NSAIDs and opioids were largely provided by oral-maxillofacial surgery (OMFS) followed by restorative dentistry and periodontics. Benzodiazepines were mostly prescribed by endodontics, while tricyclic antidepressants (TCAs), muscle relaxants and anticonvulsants were most commonly prescribed by oral medicine. Residents prescribed opioids at similar rates to faculty (p=0.78), but exceeded faculty in prescribing benzodiazepines (p<0.001).

CONCLUSIONS

PIMs are prescribed at low percentages to geriatric patients. However, many of the geriatric patients receiving such prescriptions have an ASA III status. Prescription of PIMs, especially opioids and NSAIDs, is not uncommon, and many patients received more than two PIMs. Further work should be devoted, at both institutional and national levels, to monitor/limit PIMs provided to geriatric patients.

IMPLICATIONS

In geriatric care, it is important to be cognizant of the unique characteristics of this population. Studies like this are important to analyze prescription trends in different populations and dental specialties. We can draw attention to areas which can be improved, while also highlighting what is being done well, for future care.

OBJECTIVES

Hyperbaric oxygen therapy (HBOT) brings several benefits to wound healing in various tissues throughout the body by delivering high concentrations of oxygen under increased atmospheric pressure for small intervals of time. In addition to routine scaling and root planning (SRP), HBOT may be able to further improve pocket depths, revive tissues, and maybe even help to regenerate parts of the periodontal ligament.

METHODS

The Augusta University Greenblatt online library, Google scholar, and Galileo were used to find credible articles. Criteria for finding credible articles included articles that were published within 5 years of 2023, articles that are not literature reviews, articles that report randomized clinical trials, and articles that do not present an obvious bias.

RESULTS

All studies yielded results in favor of the use of HBOT to improve periodontal health. Results included decreases in probing depths, improved clinical attachment levels, decreases in bleeding, and improved gingival indexes. Only one study yielded non-directional results with no noticeable differences between the control group and study group.

CONCLUSIONS

After a thorough review of the selected research articles, it is concluded that HBOT would be an effective adjunct to SRP. Adding HBOT to a patient's treatment plan could be beneficial to many components of the periodontal ligament.

IMPLICATIONS

HBOT would be a good addition to the dental field by offering a less invasive form of therapy to periodontally affected patients. Certain factors like price and duration of treatment could affect the accessibility of HBOT. Further research will help to bring HBOT into the dental field and become a widely accepted adjunct to periodontal therapy.

OBJECTIVES

Be able to identify the effects of oral probiotics and determine the different methods probiotics can be administered. Learn the different ways probiotics can be incorporated daily.

METHODS

This research used the key words oral health, oral microorganisms, probiotics, and periodontal health. Meta-analysis, literature reviews, irrelevant articles, and articles older than five years were excluded.

CONCLUSIONS

Periodontal probing depths decreased throughout all three trials. Bleeding on probing showed substantial reduction signifying a reduction in gingival inflammation. Plaque and gingival indices, although measured in only a subset of trials, also displayed positive trends. Clinical attachment/loss decreased in all trials that included this parameter. Minor increase in recession after a three month recall emphasized further need for investigation In this area.

IMPLICATIONS

Probiotics have gained attention in recent years for their ability to revolutionize dental care. They are inexpensive and easily accessible. They are used to strengthen the number of healthy bacteria in the periodontium by inhibiting the adhesion, growth, and metabolism of harmful bacteria.

OBJECTIVES

The objective of the present study was to find out the benefit of ozonized therapy as an adjunct to nonsurgical periodontal therapy for the management of periodontitis.

METHODS

A specific collection of available literature was selected and reviewed on the topic of ozone therapy and periodontal disease. Ozone Therapy, Ozone gas, Oxygen, Ozone [MeSH], Periodontitis, alveolar bone loss, Periodontal Disease [MeSH] werev the specific keywords and MeSH terms we used.

Regarding the selection criteria for articles, only peer-reviewed articles published within the last five years were considered. Excluded were literature reviews, meta-analyses, books, or documents. However, randomized controlled trials, whether clinical or not, were accepted.

RESULTS

All evaluated studies show the positive outcome of ozone therapy as an adjunct to SRP. Adjunctive ozone therapy resulted in significant improvement in all except one. The first study shows no significant difference in the outcome of both groups in evaluating GCF, PTX-3, IL-1B, and high-sensitivity C-reactive proteins. In the other two studies, clinical parameters of bacterial load, periodontal pocket depth, T. forsythia and T. denticola were decreased and completely eradicated . The total bacteria load and P. gingivalis showed a percentage reduction of 38% and 55% concerning the right-side pockets, respectively. CAL, BOP, and PPD response rates after three months and six months also reduced significantly in the test group after therapy.

CONCLUSIONS

Ozone therapy essentially introduces oxygen into an environment where it usually does not exist. Therefore, it disrupts the stability, replication, and energy source of destructive pathogens.

IMPLICATIONS

The implication of ozone therapy lies in its ability to effectively eliminate periodontal pathogens, particularly anaerobic bacteria like spirochetes and P. gingivalis.

OBJECTIVES

A palatal impaction of the maxillary canine is observed in approximately 1-3% of patients and can present a challenge to the orthodontist. There have been many technique articles published about the repositioning of palatally impacted canines; this article proposes a novel technique to facilitate vertical eruption of the canines which can subsequently be moved into the arch with more conventional therapy.

METHODS

This technique has been comprehensively documented in 2 patients. Once a palatally impacted canine is diagnosed clinically and with appropriate imaging, the canine is exposed with an open-window style technique. Anteriorly, a gold chain connects the exposed crown to the novel eruption spring, or SC spring. Posteriorly, the SC spring is attached to a Modified Nance through a lingual sheath and is secured with composite at the time of placement. The Modified Nance provides anchorage for forces created by the SC spring, resulting in efficient vertical eruption of the impacted canine. Once vertical eruption is achieved, conventional methods of arch alignment and root positioning are utilized to move the canine into the arch.

RESULTS

The Modified Nance and SC Spring design presented here is a novel variation of the extrusion spring with several advantages. It is removable, modifiable, easily constructed, and its lingual point of attachment minimizes occlusal interferences. The SC Spring's removability allows for modification in the vertical, AP and transverse directions. It can be replaced if broken or distorted and provides a more continuous force than elastomerics; when combined with a Modified Nance design its reciprocal forces can be distributed over the palate and maxillary molars.

CONCLUSIONS

The SC Spring, when used in combination with a Modified Nance appliance, is an effective and efficient method in the vertical eruption of palatally impacted canines to facilitate repositioning into more ideal alignment.

IMPLICATIONS

This technique offers a relatively simple and novel method utilizing common materials to vertically erupt palatally impacted canines. The aim of this research is to identify its advantages and disadvantages, and potentially serve as a resource for orthodontists to use in practice.

OBJECTIVES

The 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions established a periodontitis staging and grading scheme that—for the first time—integrates an assessment of disease severity with an appraisal of therapeutic complexity and risk for disease progression. Individuals exhibiting attachment loss attributable to third molar malposition or extraction represent a large cohort of non-periodontitis patients highly likely to respond favorably to treatment. The purpose of this clinical report is to illustrate the value in formally categorizing this common periodontal condition.

METHODS

Two male patients were referred to the Department of Periodontics, Army Postgraduate Dental School, for evaluation of bone and attachment loss limited to distal surfaces of mandibular second molars. Each patient was treated using a combination of guided tissue regeneration and bone replacement grafts.

RESULTS

Favorable clinical and radiographic outcomes were observed over follow-up periods ranging from 4 months to 4 years.

CONCLUSIONS

Treatment outcomes following regenerative periodontal procedures depend in part on patient-related factors. Periodontal defects attributable to anatomic, developmental, and iatrogenic factors in nonperiodontitis patients may respond favorably to therapy with high reliability.

IMPLICATIONS

Many patients experiencing bone and attachment loss attributable to third molar malposition or extraction lack periodontitis risk factors/indicators, have low susceptibility to the disease, and are highly likely to respond favorably to treatment. Future classification systems of periodontal diseases and conditions should formally categorize this commonly encountered periodontal condition.

OBJECTIVES

Examine the current efficacy of Agarose Hydrogel & LRAP (Luciene rich Amelogenin proteins) as biomimetic adjuncts to remineralization by mimicking the beginning stages of amelogenesis; creating new tooth structure.

METHODS

For this review, the articles used were accessed from the Augusta University

Database and published within the past 5 years. We excluded meta-analysis and literature reviews. Used the keywords: enamel regeneration, agarose, hydrogel, enamel remineralization.

RESULTS

(If applicable) In these studies, teeth were disinfected in a 3% sodium hypochlorite solution and layered with Saline buffered with Phosphate. The teeth were then sliced with different methods, and ultrasonically cleansed. They were then etched with 37% phosphoric acid and stored to mimic constant demineralization. All of the adjuncts were shown to have the ability to replicate Hydroxyapatite crystals and the structure of enamel. The LRAP solution maintained a neutral pH level that protects the phosphate and enables it to stabilize enamel regeneration. After 6 days, the Agarose Hydrogel can regenerate mineralized tissues like sound enamel. After being treated with enamel matrix proteins, after 24 hours, the hydroxyapatite crystals formed prismatic structures with a 5 μm diameter.

CONCLUSIONS

Each study indicates that LRAP, Agarose Hydrogel, and Enamel Matrix Proteins could direct enamel regeneration. LRAP is a promising biomolecule for enamel regeneration because of its capacity to affect crystal positioning and form. Comparatively to amelogenesis, Agarose Hydrogel has significantly promising results to replicate sound enamel. The Enamel Matrix Proteins can spontaneously self- assemble into nanosphere structures and attract calcium and phosphate ions like sound enamel.

IMPLICATIONS

Long-term clinical trials would be needed to measure risks & potential adverse effects. Restorative work of this nature may be costly with or without private insurance, it may be beneficial to find more cost- effective biomimetic materials.Treatment would happen over multiple days in private practice. Further studies would be needed to examine the limitations of how much enamel can be synthetically produced.

OBJECTIVES

The goal of this study is to observe the effect of palmitate in the pro-inflammatory response of murine gingival fibroblasts in vitro and the levels of purine metabolizing enzyme CD73 which can ultimately control inflammation through modulation of mitochondrial health-related genes.

METHODS

Murine gingival fibroblasts were extracted from C57BI/6J mice and used between 4th and 8th passages in vitro. Cells were stimulated with palmitate (200 mM) in the presence or absence of IL-1b stimulation and mRNA for inflammatory cytokines, mitochondrial health markers and CD73 were measured by RT-qPCR after 6 hours.

RESULTS

The cytokines Cxcl1, IL-6 and Ccl2, but not chemokine Cxcl2, were significantly upregulated in the presence of palmitate in addition to IL-1b. The levels of CD73 were decreased in IL-1b-stimulated fibroblasts with palmitate only. Genes related to mitochondrial health such as Pink1, Mfn1, Mfn2 or Fis1 were not modulated in the presence of palmitate.

CONCLUSIONS

Palmitate increased IL-1b-induced expression of inflammatory cytokines and decreased CD73 in murine gingival fibroblasts with no effect on mitochondrial health-related genes, at least at the mRNA level.

IMPLICATIONS

This study implicates that there is further investigation needed to better understand the relationship of palmitate with CD73 and its effects on mitochondrial health and inflammation. Once the relationship is explored and defined, this research could be part of the first steps to support the development of biomarkers to detect periodontal inflammation early on and advance current preventive measures.