Evidence-based dentistry最新文献

Design: This retrospective cohort study aimed to investigate whether antibiotic prophylaxis reduced or increased post-operative complications following dental extractions.

Sample selection: The cohort included 269,003 patients. In terms of participants, this sample consisted of Veteran Affairs Dental patients, who attended for a dental extraction between 01/01/2015- 31/12/2019. The intervention and comparator was whether or not patients had received an antibiotic prescription prior to their extraction, with the primary outcome a specified post-extraction complication (oral infection, dry socket or fever within 7 days of the extraction). Data was collected on patient demographics, medical history, and details regarding the extraction.

Data analysis: Multivariable logistic regression models were used to determine the association between antibiotic prescription prior to extraction and outcomes, alongside a sensitivity analysis that excluded antibiotics prescribed by a medical provider.

Results: The cohort included 269003 patients, who attended 385,880 dental visits. During 122,810 visits (31.8%), patients received antibiotics prior to extraction, with amoxicillin the most frequently prescribed. Antibiotics were more commonly prescribed in those who received a surgical extraction. In total, 3387 patients experienced a complication. Of these patients, 1272 had received antibiotics, compared with 2115 who had not. The regression analysis determined that diabetes was a statistically significant modifier of an association. For patients without diabetes, receiving antibiotics increased the odds of a post-extraction complication.

Conclusions: In this sample of older people, there was no association between being prescribed antibiotics and post-extraction complications.

Background: Isolation with cotton rolls does not always provide as complete isolation as rubber dam, especially in procedures where absolute moisture control is critical. Therefore, this review aims to summarize and analyze previous studies evaluating the retention and marginal integrity of pit & fissure sealant using rubber dam and cotton roll isolation techniques during dental treatment in children.

Material and methods: In accordance with PRISMA guidelines, search yielded 1361 articles, with seven RCTs and one non-RCT design meeting the inclusion criteria. Data were extracted on study design, sample size, sealant type, follow-up duration, retention rates, and caries incidence.

Results: The comparison of retention rate between rubber dam and cotton roll at six months difference was non-significant (OR:1.15; p = 0.64) while there was significant difference at 12 month (OR:2.23; p < 0.001). The difference for the marginal integrity was statistically significant at six months (OR:2.00; p = 0.03) while non-significant difference observed (OR:1.74; p = 0.10) at 12 months.

Conclusion: The sealant placed using a rubber dam as an isolation technique showed higher retention than the cotton roll after 12 months. In terms of marginal integrity, the performance of the rubber dam and cotton roll was equivalent at the end of 12 months.

Background: Type I immediate implant placement has its own advantages like reduced treatment time, number of surgeries and post-extraction bone loss, however, the presence of insufficiently keratinized mucosa poses a challenge for flap adaptation and hinders the achievement of primary stability. Additionally, scientific evidence supports the notion that post-extraction bone loss is a natural biological occurrence that can impact the success of treatments.

Objectives: The primary outcome was to find out the hard and soft tissues changes around the implant following immediate placement and immediate loading. The secondary outcome was to record the adverse events post implant placement such as infection during the course of healing and after restoration, implant failure which would include surgical and post restoration, and over- all success and survival rate of implant.

Material and methods: A detailed electronic literature search of the articles published in English language was undertaken in October 2023 on online search engines Medline/PubMed and Cochrane databases with no restriction on year of search to include studies on immediate implant placement and loading with a mean follow-up time of at least 1 year. Weighted means of soft and hard tissue changes were obtained by the inverse variance method.

Results: A total of 16 studies were included. There was no difference in crestal bone levels in immediate or delayed implant placement with immediate provisionalization in the anterior maxilla. The peri-implant margin remained and no differences in papillary loss was seen when compared to the delayed implant placement cases. Papilla were more stable or showed less recession in flapless approach compared to full thickness flap approach. Among the studies which filled the GAP with bone graft materials, no significant changes were found in the bone level changes. In case of recession, immediate implant placement with provisionalization did result in approximately 1 mm less facial gingival recession compared with that in the group that had a socket graft. Implant related complications occurred more in immediate implant placement and provisionalization compared to delayed group. And almost similar implant success and survival rates were seen in comparison to delayed implant placement groups.

Conclusions: Despite the similar implant survival rates observed in comparison to delayed implant placement groups, more long-term studies are necessary to determine the success of immediate implant placement and immediate loading. Special attention has to be given to aesthetic outcomes.

Introduction: Photobiomodulation (PBM) with low-level laser therapy (LLLT) is a non-invasive method for accelerating orthodontic tooth movement (OTM). Several systematic reviews (SRs) have assessed the effectiveness of LLLT on OTM acceleration. However, the interpretations and analysis of the findings of these SRs are inconclusive and inconsistent due to the substantial heterogeneity of their results, mainly due to the wide variety of parameters employed in the primary studies. This umbrella review (UR) aims to (i) Evaluate and summarize the findings of SRs evaluating the effect of LLLT on OTM acceleration. (ii) Suggest an evidence-based protocol with the most predictable application LLLT parameters for OTM acceleration.

Methods: Medline (PubMed), Web of Science, and Scopus were searched from inception to December 2023. AMSTAR-2 and ROBIS were used to evaluate methodological quality and risk of bias respectively.

Results: Six SRs met the inclusion criteria. All the SRs suggest that PBM with LLLT tends to be effective in accelerating OTM. However, the high heterogeneity of SRs hinders a precise evaluation of the LLLT's effect on OTM acceleration. The parameters most associated with OTM acceleration are LLLT frequency: At least twice a month, irradiation points: 4-10 points, irradiation time per point: 3-50 s, output power: 20-150 mW, energy density: 5.3 J/cm2 and wavelength range:780-810 nm. The risk of bias assessment identified that 50% of the included SR had a risk of bias ranging from uncertain to high. Similarly, three SRs obtained a "Critically low-quality" assessment.

Conclusions: Although, all the SRs included in this UR suggest that LLLT may accelerate OTM in comparison to control groups. The primary goal of future studies examining the influence of LLLT on the acceleration of OTM should be to create standardised protocols for the use of LLLT, allowing the development of more predictable therapies. The research protocol was registered on the Prospero CRD42024497420.

Objectives: This systematic review aimed to assess the effectiveness of Artificial Intelligence (AI)-based Deep Learning (DL) models in the detection of dental caries on intraoral images.

Methods: This systematic review adhered to PRISMA 2020 guidelines conducting an electronic search on PubMed, Scopus, and CENTRAL databases for retrospective, prospective, and cross-sectional studies published till 1st June 2024. Methodological and performance metrics of clinical studies utilizing DL models were assessed. A modified QUADAS risk of bias tool was used for quality assessment.

Results: Out of 273 studies identified, a total of 23 were included with 19 studies having a low risk and 4 studies having a high risk of bias. Overall accuracy ranged from 56% to 99.1%, sensitivity ranged from 23% to 98% and specificity ranged from 65.7% to 100%. Only 3 studies utilized explainable AI (XAI) techniques for caries detection. A total of 4 studies exhibited a level 4 deployment status by developing mobile or web-based applications.

Conclusion: AI-based DL models have demonstrated promising prospects in enhancing the detection of dental caries, especially in terms of low-resource settings. However, there is a need for future deployed studies to enhance the AI models to improve their real-world applications.

Background: Understanding the interplay between nutrition and oral health-related quality of life (OHRQoL) in older adults is crucial amidst the global aging population. This systematic review and meta-analysis aimed to explore this association, recognizing the growing prevalence of older individuals and the imperative of addressing their health needs for enhanced well-being.

Materials and methodology: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, relevant studies were identified through electronic database searches and manual screening. Included were studies investigating the relationship between nutritional status, assessed via the Geriatric Oral Health Assessment Index (GOHAI), and OHRQoL in individuals aged 60 years and older. Quality assessment adhered to Joanna Briggs Institute (JBI) criteria, and statistical analysis was conducted using Comprehensive Meta-Analysis Software Version 3.

Results: Out of 566 initial records, 14 full-text articles were assessed, with 4 studies meeting the inclusion criteria for meta-analysis. A consistent association emerged between lower nutritional assessment scores and poor OHRQoL among the older adults. Significant relationships were identified between poor oral health indicators, as measured by GOHAI, and an elevated risk of malnutrition. Particularly noteworthy was the role of negative self-perception of oral health as a significant predictor of nutritional deficits, emphasizing the importance of OHRQoL instruments in complementing clinical measurements.

Discussion: The findings underscore the predictive capacity of oral health indicators in assessing nutritional well-being in older individuals. Despite previous studies reporting mixed findings, this review contributes to a comprehensive understanding of the association between nutrition and OHRQoL, highlighting the significance of addressing oral health concerns to enhance overall nutritional outcomes in the older adult population.

Conclusion: This systematic review and meta-analysis emphasize the significant association between nutrition and OHRQoL among older adults. Highlighting the importance OHRQoL instruments that can complement objective clinical measurements and serve as predictors of malnutrition, particularly among this population. Offering vital insights for stakeholders, policymakers, and public health officials to promote the overall well-being and quality of life of older adults.