Clinical Oral Investigations最新文献

Objectives: Periodontitis is linked with many health conditions, but its genetic basis is not yet understood. This genome-wide association study (GWAS) aimed to investigate the genetic variants associated with periodontitis.

Materials and methods: This study utilised UK Biobank participants of European descent. Individuals were categorised as "having periodontitis" if they self-reported having 'painful gums', 'bleeding gums' or 'loose teeth' (n = 68,482), or as "controls" for those without these symptoms (n = 307,342). We conducted GWAS of this binary periodontitis phenotype using logistic regression models with PLINK2.0 adjusting for age, sex and the first 15 principal components to account for population stratification.

Results: There were 376,611 participants (mean baseline age = 57 ± 7.9 SD) included in the GWAS, and four significant loci were identified: rs775476621 on chromosome 11 (Odds Ratio, OR[T]: 3.08, p = 1.01 × 10^- 8), rs751014048 on chromosome 11 (OR[G]: 3.07, p = 1.04 × 10^- 8), rs149922301 on chromosome 4 near gene RP11-61G19.1 (OR[A]: 1.18, p = 2.71 × 10^- 8) and rs368467810 on chromosome 6 near gene HIST1H3L (OR[TTTA]: 0.96, p = 3.88 × 10^- 8).

Conclusions: Within the current limitations, such as self-reported phenotype and older age of the study population, four loci were detected for periodontitis that have not previously been linked with this condition. Further exploration of the function of these loci may contribute to improved understanding of periodontitis aetiology and subsequent drug development.

Clinical relevance: These findings offer new targets for future research to investigate the genetic impact on periodontitis and aid the future understanding of periodontitis pathology and the disease's progression.

Background: There is currently evidence supporting an association between periodontitis and prostate disease, but further research is needed to establish a causal relationship due to potential confounding factors and uncertainty about the direction of causality. The present study employs a bidirectional Mendelian Randomization (MR) analysis to eliminate confounding factors at the genetic level and determine the causal relationship between periodontitis and prostate diseases.

Methods: Summary data for periodontitis were obtained from the GLIDE consortium (N = 45,563), while data for prostate diseases, including benign prostatic hyperplasia (N = 163,095), prostatitis (N = 134,299), and prostate cancer (N = 146,465), were sourced from the FinnGen database. Various methods were employed in the Mendelian randomization (MR) analysis, including the inverse variance-weighted (IVW) method, MR-Egger regression, weighted median, and weighted mode. Sensitivity analyses, such as the MR-Egger intercept test and MR-PRESSO method, were performed to ensure the reliability and robustness of the results.

Results: Results from the bidirectional MR analysis using the IVW method as the primary approach, indicate that no causal relationship exists between periodontitis and prostate disease. Consequently, there is insufficient evidence to substantiate their association. Moreover, additional sensitivity analyses performed further reinforce the robustness of our findings.

Conclusion: Our MR study did not identify a causal relationship between periodontitis and prostate disease. However, we do not rule out the possibility of an underlying etiological connection and shared mechanisms between the two conditions. Therefore, further large-scale studies using various approaches are needed to explore their association in greater depth and provide more comprehensive and accurate guidance for clinical practice.

Objective: This prospective clinical study aimed to evaluate the two-year clinical performance of conventional composite, bulk-fill composite, and high-filler flowable composite in Class II cavities.

Materials and methods: A total of 259 Class II restorations were performed in 110 patients, applying Clearfil Majesty Posterior (Clearfil) as the conventional composite, Filtek One Bulk Fill Restorative (Filtek) as the bulk-fill composite, and G-aenial Universal Injectable (G-aenial) as the high-fill flowable composite. G-Premio Bond, a universal adhesive system, was applied for all composite resin restorations. Restorations were evaluated using FDI criteria after 2 years. Data were analyzed using the Kruskal-Wallis and Friedman tests.

Results: At the end of two years, the group treated with Clearfil has showed a significantly higher surface gloss score compared to the G-aenial and Filtek groups. Additionally, it was seen that the marginal adaptation scores of the Clearfil group were similar to the Filtek group and significantly higher than the G-aenial group. In intra-group evaluations, the contact point scores of the Clearfil group showed a statistically significant increase compared to baseline and one-year follow-up assessments. The marginal adaptation scores of the Clearfil and Filtek groups also exhibited a statistically significant increase compared to baseline and one-year follow-up assessments.

Conclusions: High-filler flowable composite and bulk-fill composite exhibited better clinical properties regarding surface gloss compared to conventional composite. It was observed that the marginal adaptation property of the conventional composite were similar to the bulk-fill composite and lower than the high- filler flowable composite.

Clinical relevance: The composite resins tested showed similar results in most of the scores evaluated.

Objectives: People with intellectual disabilities often have poor oral hygiene and depend on carers' support. We aimed to investigate, whether automatic toothbrushes could benefit people with Down syndrome (DS).

Materials and methods: In a randomized, single-blinded cross-over study we compared the cleansing efficacy of a horse-shoe shaped automatic toothbrush with that of rotating-oscillating toothbrushing in unassisted domestic use over four weeks by persons with DS. Rustogi Modified Navy Plaque Index (RMNPI) and Gingival Bleeding Index (GBI) were assessed before and after each intervention period. Wilcoxon Signed-Rank Test was used for statistical analysis.

Results: Fifteen participants (mean age 31 ± 8.33 years) finished the study. There were no statistically significant differences in RMNPI between the two brushing modalities after four weeks of unassisted home use, neither in full mouth (Y-brush®: median 59.2%; range 24.8 - 76.7; rotating-oscillating toothbrush: 54.6%; 6.4 - 71.3) (p = 0.484) nor in subgroup analyses. RMNPI was statistically significantly higher after four weeks of automated brushing than baseline. There was no statistically significant difference for full-mouth GBI between the two brushing modalities.

Conclusions: Both, oscillating-rotating and automated toothbrushing resulted in unsatisfactory plaque control after unassisted use by people with DS.

Clinical relevance: Further studies should investigate the impact of caregivers' assistance with auto-cleaning devices to persons with disabilities on plaque removal efficacy. Customization of mouthpieces and simplification of handling modalities might effect a higher cleansing capacity and should be future goals for automatic brushing device manufacturers.

Objectives: To determine the impact of alveolar socket surface area and number of root extractions for developing medication-related osteonecrosis of the jaw (MRONJ) in polypharmacy patients following multiple tooth extractions.

Materials and methods: A retrospective sample of 40 patients was recruited, including 20 polypharmacy patients (109 tooth extractions) who developed MRONJ in at least one of the extraction sites, matched with 20 controls (100 tooth extractions). Tooth-specific alveolar socket surface areas were assessed using CBCT scans from the control group to establish reference values for alveolar socket surface areas in polypharmacy patients with MRONJ. Correlations between the number of extracted tooth roots, alveolar socket surface area, and development of MRONJ were analysed within the polypharmacy group.

Results: 40% of tooth extractions in polypharmacy patients undergoing multiple extractions resulted in the development of MRONJ, with a higher prevalence observed in the mandible (44%). Among the extracted mandibular tooth roots, half were susceptible to MRONJ, and 45% of the exposed socket surface area was affected. Both jaws showed an increased risk (20%) of MRONJ following molar extraction. A strong positive correlation existed between extraction sites that developed MRONJ and both the number of mandibular tooth roots extracted (r = + 0.861; p < 0.001) and the total exposed alveolar socket surface area (r = + 0.757; p < 0.001). However, no significant correlations were observed in the upper jaw.

Conclusions: This study is the first to demonstrate that both mandibular alveolar socket surface area and number of extracted tooth roots are positively related to extraction sites developing MRONJ in polypharmacy patients undergoing multiple tooth extractions.

Clinical relevance: Identifying high-risk patients and implementing preventive strategies can reduce MRONJ incidence, underscoring the need for careful management of polypharmacy patients, especially those undergoing mandibular tooth extractions.

Objectives: To explore the level of peripheral blood immune cells in patients with different stages and grades of periodontitis.

Materials and methods: A total of 229 periodontitis patients and 36 periodontally healthy patients were included in this cross-sectional study. Individuals with systemic diseases were excluded. A periodontal examination and a complete blood cell examination were performed. The percentages of T and B cells and their subsets were analyzed via flow cytometry. Covariance and logistic regression analyses were conducted, and receiver operating characteristic curve analysis was used to assess the predictive ability of the indicators.

Results: The white blood cell (WBC) count, absolute neutrophil count (ANC), neutrophil percentage (NEU%) and neutrophil-to-lymphocyte ratio (NLR) were greater, but the lymphocyte percentage (LYM%) was lower in the periodontitis group than in the healthy control group. Patients with severe periodontitis (Stage III and IV) presented higher WBC, ANC, NEU% and NLR than those with mild and moderate periodontitis (Stage I and II) did. Area under curve (AUC) of the ANC, NEU% and NLR for the prediction of Stage III/IV periodontitis were 0.750, 0.771, and 0.774, respectively. Compared with Grade A or B periodontitis patients, Grade C periodontitis patients had a significantly lower absolute lymphocyte count (ALC) and LYM% but higher NEU% and NLR in Grade C periodontitis. The AUC of the NLR, LYM% and NEU% for predicting Grade C periodontitis were 0.797, 0.799, and 0.793, respectively. In lymphocytes, the proportions of T and B cells were lower in Grade C periodontitis patients than in Grade A or B group. Similarly, immune regulatory cells, including B10 and Treg cells, also decreased. Conversely, the Th17/Treg ratio was greater. Moreover, the Th17/Treg ratio was most strongly correlated with Grade C periodontitis (r = 0.87), followed by Treg cells(r = -0.70) and B10 cells(r = -0.38).

Conclusions: ANC, NEU%, NLR and LYM% are closely correlated with periodontitis. ANC, NEU%, and NLR may serve as potential markers for Stage III/IV periodontitis. LYM%, NEU%, and NLR may serve as potential markers for Grade C periodontitis. An increase in the Th17/Treg ratio is a high-risk factor for Grade C periodontitis.

Clinical relevance: Peripheral immune cell levels vary with the stage and grade of periodontitis and can be used to distinguish the grade and stage of periodontitis.

Objectives: To evaluate the impact of oral health problems on oral health-related quality of life (OHRQoL) among female patients received Radioactive iodine (¹³¹I) therapy.

Materials and methods: This unmatched case-control study was conducted on 40 female patients (20 cancer free controls and 20 patients treated with ¹³¹I therapy). Data were collected via clinical examination, self reported questionnaire including the Oral Health Impact Profile-14 (OHIP-14), salivary tests, socio-demographic and behavioural characteristics. Data were analyzed using descriptive, bivariate and multivariate statistics.

Results: There were significant differences in the total number of decayed, missing and filled surfaces, stimulated and unstimulated salivary flow rates, and periodontal indices between the study and control groups in the unadjusted analysis. Age adjusted analysis revealed significant differences in the stimulated and unstimulated salivary flow rates, periodontal indices, physical pain domain scores between groups. No significant differences were observed between groups in the xerostomia severity and OHRQoL. In study group, the score for the OHIP-14 psychological discomfort domain was negatively correlated with both stimulated and unstimulated salivary flow rates. The total OHIP-14 score and its domain scores of physical pain and psychological disability were correlated positively with the severity of xerostomia, but negatively correlated with number of the repeated ¹³¹I therapy.

Conclusions: Due to xerostomia, patients reported worse OHRQoL in the domains of physical pain, psychological discomfort and disability. They had worse periodontal status and tooth brushing habits than healthy controls.

Clinical relevance: The findings of this study may provide a valuable insight on the oral health problems and needs of target group when planning a a team-based care.

Objectives: This study investigated relationships between bone thickness at the insertion sites of orthodontic anchoring screws (OASs) and periodontal biotype (PB) using cephalograms and cone-beam computer tomography (CBCT).

Materials and methods: The PB at the maxillary central incisors was evaluated to differentiate into three categories. In total, 71 patients were examined to determine the relationship between PB and palatal bone thickness using cephalograms. Of these, 57 patients with CBCT were investigated further to explore the relationship between PB and bone thickness at the palatal and buccal regions. Mann-Whitney U-test and t-test were performed for comparisons in each PB group.

Results: The thickness of the palatal bone (p = 0.010) and cortex (p = 0.006) in patients with thick biotype in posteroanterior (PA) cephalograms was significantly greater than that those with thin biotype. CBCT evaluations showed that the paramedian bone thickness in the section between premolars in thick biotype (8.38 ± 2.61 mm) was significantly greater than that in thin biotype (6.41 ± 2.95 mm, p = 0.000). Regarding the buccal alveolar area, the cortical bone thickness in thick biotype was greater than those in medium and thin biotypes (p < 0.0167).

Conclusions: Thick biotype had thicker paramedian bones and palatal cortexes than with thin biotype in PA cephalograms. From CBCT images, the paramedian bone thickness in the section between premolars significantly differed according to PB. Cortical bone thickness in the buccal area from the first premolar to the second molar in the maxilla demonstrated statistically significant differences among PBs.

Clinical relevance: PB is a potentially useful preoperative screening test for OAS placement.

Objectives: This study aimed to compare the stress produced by three heat-treated flat-side prototype rotary instruments and a non-flat side instrument on the internal walls of simulated canals with three different curvature degrees using the photoelastic technique.

Materials and methods: Thirty-six resin blocks with simulated canals, comprising three curvature types (45°, 60°, and double curvature), were used in the study, with 12 blocks allocated to each curvature type. These blocks were further divided into four experimental groups (n = 9 per group) based on the heat treatment of the instruments: gold, silver, blue, and a control group with non-flat-side gold instruments. The blocks were analyzed using a circular polariscope setup, with real-time birefringence patterns captured by a digital camera. Stress on canal walls was evaluated using a semi-quantitative scale. Supplementary tests (stereomicroscope, SEM, energy-dispersive X-ray spectroscopy, and DSC) were performed to interpret the results further. Data were analyzed using the Kruskal-Wallis test (α = 5%).

Results: Inter- and intra-observer agreements were 0.91 and 1, respectively. All instruments exhibited high stress patterns on canal walls. The highest stress was observed in the 45° and 60° blocks (middle third) and the double curvature blocks (apical third). The flat-side gold instrument recorded the highest stress in the coronal third, and the flat-side blue in the apical third (p < 0.05). All instruments displayed some degree of distortion after use.

Conclusions: Instrument type and canal curvature significantly influenced stress distribution across root canal thirds. All flat-side instruments exhibited high stress patterns, warranting caution in curved canals due to potential distortion and performance impact.

Clinical relevance: This study recommended caution when using newly designed flat-side instruments in curved canals due to potential stress on canal walls and greater distortion, which may affect performance and durability.

Objectives: This study compared the effectiveness of adding autologous platelet concentrates (APCs(+)) and sole bone grafting procedures (APCs(-)) in maxillary sinus augmentation (MSA).

Materials and methods: A systematic search was performed to identify randomized controlled trials (RCTs) from electronic database and clinical registers published up to June 1, 2024. Six evaluation indices comprising percentage of new bone formation (NBF%), percentage of residual bone substitute (RBS%), percentage of fibrous tissue (FT%), implant stability quotient (ISQ), bone height (BH) and bone density (BD) were identified.

Results: We analyzed 14 studies involving 268 lifted sinuses and 119 implants. Compared with the APCs(-) group, the APCs(+) group demonstrated a significant advantage regarding NBF% (weight mean difference (MD)= 4.80, 95% confidence interval (CI) (1.82,8.32), p=0.007) and RBS% (MD=-4.48, 95% CI (-6.01,2.96), p<0.01), with no evident superiority in FT% (MD=-0.11, 95% CI (-0.56,0.35), p=0.64), ISQ (MD=-1.68, 95% CI (-6.77,3.40), p=0.52) and BH (standard mean difference (SMD) =-0.11, 95% CI (-3.04,2.83), p=0.94). While APCs(-) group showed a significant benefit in BD compared to the APCs(+) group (MD=-28.34, 95% CI (-48.98,-7.71), p=0.01).

Conclusion: Compared with APCs(-), APCs(+) could be a better option for promoting NBF% and reducing RBS%, whereas we found no evident influence in FT% and ISQ under MSA. Concerning BD and BH results, there were no additional effects with the addition of APCs, which needs to be treated with caution due to the limited number of studies.

Clinical relevance: APCs(+) procedures show promising results, with a higher NBF% and lower RBS%, making them a potential routine MSA strategy.