Pub Date : 2025-03-11DOI: 10.1038/s41432-025-01126-7
Madeline Archer
Fehrenbach J, de Soares J L S, do Nascimento Foly J C S, Miotti L L, Münchow E A Mechanical performance of endocrown restorations in anterior teeth: A systematic review and network meta-analysis. Dent Mater 2025; https://doi.org/10.1016/j.dental.2024.10.012 . A systematic review and network meta-analysis (NMA) of anterior endocrown mechanical performance compared to conventional crowns on endodontically treated teeth (ETT). An online search of major databases was conducted and relevant studies were selected. Data was extracted and meta-analyses performed comparing mechanical outcomes of anterior endocrowns to other crown systems. Endocrowns on the anterior dentition can be considered if mechanical fracture is a concern, however more research needs to be done before definitive case selection. Two independent reviewers searched six electronic databases (PubMed, Scopus, Web of Science, Embase, SciELO and LILACS) using compounded terms like ETT and anterior and endocrown along with their variates. Manual searches were also done from the reference list of chosen studies. Following the search titles were put through Rayyan, an AI-powered systematic reviewer to remove duplicates. The reviewers then screened 25 random titles and abstracts independently and repeated this with a third reviewer. Inclusion criteria were studies examining anterior ETT and endocrown compared with a different restoration. Exclusion criteria were non-experimental studies, theses, languages other than English Spanish or Portuguese and studies not evaluating mechanical performance. From this 24 studies were read in full and 11 were selected for the review. Bias risk assessment was done by two reviewers using the RoBDEMAT tool for in vitro studies and ROBFEAD tool for Finite Element Analysis (FEA) studies. The studies are scored as low, med, or high risk according to each tool’s domains. Two reviewers extracted the data onto Microsoft Excel including authors name and year of publication, tooth type, endocrown depth, distance between the CEJ and finishing line,surface treatment, luting agent, thermocycling method, etc. Data synthesis and analysis was performed by MetaInsight V4 4.0.0 and two independent NMA’s were made. The first NMA used load-to-fracture data and a mean difference outcome while the second used irreparable fracture data and a risk ratio outcome. Both used a 95% credible interval(Crl). Comparisons were evaluated using Surface Under the Cumulative ranking Curve (SUCRA), where a value closer to 100% indicates greater resistance to fracture. Eight studies used in vitro experiments, most of them investigating load-to-fracture and failure mode of fractured restorations and one study the pull-out bond strength. The remaining three studies used FEA models and examined von mises criterion by quantifying a material’s fracture under stress. The first NMA considered load-to-fracture data and examined five studies. The probabilistic analysis showed teeth restored with a Glass Fi
Fehrenbach, de Soares, J L S, do Nascimento Foly, J C S, Miotti, L L, m nchow E, A .前牙内冠修复体力学性能的系统评价和网络meta分析。Dent Mater 2025；https://doi.org/10.1016/j.dental.2024.10.012 .目的和方法：系统回顾和网络荟萃分析（NMA）对根管治疗牙齿（ETT）前牙冠与传统牙冠力学性能的比较。在线检索各大数据库，选取相关研究。提取数据并进行荟萃分析，比较前牙髓与其他牙冠系统的力学结果。如果担心机械骨折，可以考虑在前牙列上使用牙髓冠，但是在确定病例选择之前需要做更多的研究。数据来源：两名独立审稿人检索了六个电子数据库（PubMed, Scopus, Web of Science, Embase， SciELO和LILACS），使用ETT和anterior and endocrown等复合术语及其变量。还从所选研究的参考列表中进行了人工搜索。搜索后的标题将通过人工智能系统审稿人Rayyan来删除重复内容。然后，审稿人独立筛选了25个随机标题和摘要，并与第三位审稿人重复了这一过程。研究选择：纳入标准是检查前路ETT和内冠与不同修复体的比较。排除标准是非实验研究、论文、英语、西班牙语或葡萄牙语以外的语言以及不评估机械性能的研究。从这24项研究中，有11项被选为综述。偏倚风险评估由两位评论者使用体外研究的RoBDEMAT工具和有限元分析（FEA）研究的ROBFEAD工具完成。根据每个工具的领域，这些研究被分为低风险、中等风险或高风险。数据提取与综合：两位审稿人将数据提取到Microsoft Excel中，包括作者姓名、发表年份、牙型、内冠深度、CEJ与终点线的距离、表面处理、luting剂、热循环方法等。采用MetaInsight V4 4.0.0软件对数据进行综合分析，并进行两次独立的NMA。第一个NMA使用载荷-骨折数据和平均差异结果，而第二个NMA使用不可修复骨折数据和风险比结果。两者均使用95%可信区间（Crl）。使用累积等级曲线下的表面（SUCRA）进行比较，其中接近100%的值表示更强的抗破裂能力。结果：8项研究采用了体外实验，其中大部分研究的是断裂修复体的载荷-断裂和破坏模式，1项研究的是拔出键合强度。其余三项研究使用了有限元模型，并通过量化材料在应力下的断裂来检验冯米塞斯准则。第一个NMA考虑了载荷-断裂数据，并检查了五项研究。概率分析显示，玻璃纤维桩(GFP) +复合冠修复牙体的修复效果最佳（SUCRA = 95.23%），其载荷-断裂值（MD 165.0, 95% CRL 28.3, 301.0）高于复合内冠组（MD 78.1, 95% CRL 6.21, 150.0）。排名最低的是GFP +陶瓷冠组，中间有陶瓷内冠和不带桩的陶瓷冠。第二个NMA分析了来自五项研究的不可修复骨折数据。复合内冠组发生灾难性骨折的风险较GFP瓷冠组低（RR = 0.413, 95% Crl = 0.152, 0.859） （RR = 1.36, 95% Crl = 1.09, 1.80）。概率分析显示，复合牙冠发生不可修复性骨折的风险最低（SUCRA = 96.84%），其次为无核陶瓷牙冠组、陶瓷牙冠组和GFP牙冠组。结论：在实验室和模型试验中，牙髓修复体在机械负荷下的表现与其他修复体相似，因此牙髓修复体可能是治疗前牙的可行选择。GRADE评分低，因为偏倚风险高。
{"title":"What about anterior endocrowns?","authors":"Madeline Archer","doi":"10.1038/s41432-025-01126-7","DOIUrl":"10.1038/s41432-025-01126-7","url":null,"abstract":"Fehrenbach J, de Soares J L S, do Nascimento Foly J C S, Miotti L L, Münchow E A Mechanical performance of endocrown restorations in anterior teeth: A systematic review and network meta-analysis. Dent Mater 2025; https://doi.org/10.1016/j.dental.2024.10.012 . A systematic review and network meta-analysis (NMA) of anterior endocrown mechanical performance compared to conventional crowns on endodontically treated teeth (ETT). An online search of major databases was conducted and relevant studies were selected. Data was extracted and meta-analyses performed comparing mechanical outcomes of anterior endocrowns to other crown systems. Endocrowns on the anterior dentition can be considered if mechanical fracture is a concern, however more research needs to be done before definitive case selection. Two independent reviewers searched six electronic databases (PubMed, Scopus, Web of Science, Embase, SciELO and LILACS) using compounded terms like ETT and anterior and endocrown along with their variates. Manual searches were also done from the reference list of chosen studies. Following the search titles were put through Rayyan, an AI-powered systematic reviewer to remove duplicates. The reviewers then screened 25 random titles and abstracts independently and repeated this with a third reviewer. Inclusion criteria were studies examining anterior ETT and endocrown compared with a different restoration. Exclusion criteria were non-experimental studies, theses, languages other than English Spanish or Portuguese and studies not evaluating mechanical performance. From this 24 studies were read in full and 11 were selected for the review. Bias risk assessment was done by two reviewers using the RoBDEMAT tool for in vitro studies and ROBFEAD tool for Finite Element Analysis (FEA) studies. The studies are scored as low, med, or high risk according to each tool’s domains. Two reviewers extracted the data onto Microsoft Excel including authors name and year of publication, tooth type, endocrown depth, distance between the CEJ and finishing line,surface treatment, luting agent, thermocycling method, etc. Data synthesis and analysis was performed by MetaInsight V4 4.0.0 and two independent NMA’s were made. The first NMA used load-to-fracture data and a mean difference outcome while the second used irreparable fracture data and a risk ratio outcome. Both used a 95% credible interval(Crl). Comparisons were evaluated using Surface Under the Cumulative ranking Curve (SUCRA), where a value closer to 100% indicates greater resistance to fracture. Eight studies used in vitro experiments, most of them investigating load-to-fracture and failure mode of fractured restorations and one study the pull-out bond strength. The remaining three studies used FEA models and examined von mises criterion by quantifying a material’s fracture under stress. The first NMA considered load-to-fracture data and examined five studies. The probabilistic analysis showed teeth restored with a Glass Fi","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 1","pages":"10-11"},"PeriodicalIF":0.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-06DOI: 10.1038/s41432-025-01120-z
Manas Dave, Rajpal Tattar
Sukumar S, Rahmanyar Z, El Jurf H Q et al. Mapping the oral resistome: a systematic review. J Med Microbiol 2024; https://doi.org/10.1099/jmm.0.001866 . This systematic review, without meta-analysis, aimed to map the oral resistome by analysing clinical studies that detected bacterial antimicrobial resistance genes (ARGs) in the oral cavity using molecular techniques. The researchers used Medline, Embase, Web of Science, CINAHL and Scopus databases from January 2015 to August 2023. This systematic review included cross-sectional or longitudinal clinical studies that detected ARGs using molecular techniques; specifically polymerase chain reaction (PCR) or next-generation sequencing (NGS) metagenomics for samples from the oral cavity (saliva, gingival biofilm, pulp, or oral mucosa). Studies were excluded if they were in vitro or animal studies, literature reviews and not focused on ARG detection. Five reviewers independently screened titles and abstracts based on inclusion criteria. Full-text reports were then independently assessed for eligibility by three reviewers. Extracted data encompassed publication details, sample size, country, molecular methods used, number of ARGs detected, participants’ health status, antibiotic exposure, and sample location within the oral cavity. Out of 580 initially identified studies, 15 met the inclusion criteria. These studies, published between 2015 and 2023 from 12 different countries, employed either PCR (n = 10) or NGS metagenomics (n = 5) to detect ARGs from a pool of 1486 participants (1 study did not report on the number of participants). PCR-based studies identified an average of 7 ARGs (range 1–20), while NGS studies identified an average of 34 ARGs (range 7–70). In total, 159 unique ARGs conferring resistance to 22 antibiotic classes were identified across six regions of the oral cavity. The supragingival biofilm and saliva exhibited the highest richness of ARGs, defined by the number of unique ARGs detected. Genes conferring resistance to 19 antibiotic classes were present in the supragingival biofilm. Notably, 49 ARGs, including tetracycline and macrolide resistance genes, were found across all sampled locations, indicating a widespread distribution within the oral cavity. Thirteen studies reported on bacterial species associated with ARGs. NGS studies identified a mean of 65 ARG-carrying bacterial species, compared to a mean of 4 species in PCR studies. Specifically, 25 ARG-carrying species were identified in PCR studies, while NGS studies identified 177 species. Four studies reported ARGs associated with streptococcal species implicated in distant-site infections such as infective endocarditis. ESKAPE pathogens (group of highly virulent multidrug-resistant bacteria) were detected with ARGs in various oral sites using both PCR and NGS methods. Comparisons between healthy and diseased states revealed that a healthy oral microbiome harbours a more diverse resistome at the antibiotic class level. Th
Sukumar S, Rahmanyar Z， El Jurf H Q等。绘制口腔抵抗组：系统回顾。中华微生物学杂志2024；https://doi.org/10.1099/jmm.0.001866 .设计：本系统综述未进行meta分析，旨在通过分析使用分子技术检测口腔细菌抗微生物药物耐药基因（ARGs）的临床研究，绘制口腔抵抗组图谱。数据来源：2015年1月至2023年8月，研究人员使用Medline， Embase, Web of Science， CINAHL和Scopus数据库。研究选择：本系统综述包括使用分子技术检测ARGs的横断面或纵向临床研究；特别是聚合酶链反应（PCR）或下一代测序（NGS）宏基因组学，用于口腔样本（唾液，牙龈生物膜，牙髓或口腔粘膜）。排除体外或动物研究、文献综述和不关注ARG检测的研究。数据提取和综合：五名审稿人根据纳入标准独立筛选标题和摘要。全文报告随后由三名审稿人独立评估是否合格。提取的数据包括发表细节、样本量、国家、使用的分子方法、检测到的ARGs数量、参与者的健康状况、抗生素暴露和样本在口腔内的位置。结果：580项初步确定的研究中，15项符合纳入标准。这些研究发表于2015年至2023年间，来自12个不同的国家，采用PCR （n = 10）或NGS宏基因组学（n = 5）从1486名参与者中检测ARGs（1项研究未报告参与者数量）。基于pcr的研究平均鉴定出7种arg（范围1-20），而NGS研究平均鉴定出34种arg（范围7-70）。在口腔的6个区域共鉴定出159种对22种抗生素具有耐药性的独特ARGs。龈上生物膜和唾液显示出最高的ARGs丰度，这是由检测到的独特ARGs的数量来定义的。在龈上生物膜中存在对19种抗生素具有抗性的基因。值得注意的是，包括四环素和大环内酯类耐药基因在内的49种ARGs在所有采样地点均被发现，表明其在口腔内分布广泛。13项研究报告了与ARGs相关的细菌种类。NGS研究平均鉴定出65种携带arg的细菌，而PCR研究平均鉴定出4种。其中，PCR研究鉴定出25种携带arg的物种，而NGS研究鉴定出177种。四项研究报告了ARGs与远端感染（如感染性心内膜炎）相关的链球菌种类。应用PCR和NGS方法检测ESKAPE病原菌（一组高毒力多重耐药菌）在口腔各部位的ARGs。健康和患病状态之间的比较表明，健康的口腔微生物组在抗生素类水平上具有更多样化的抗性组。在健康和疾病中，龈上抵抗组的组成最丰富，在龋齿病例中，四环素ARGs在龈上抵抗组和唾液抵抗组中占主导地位。结论：对这15项研究的口腔抵抗组的分析发现，三个ARGs存在于口腔的所有部位，表明存在一个核心抵抗组。与PCR研究相比，NGS研究提供了更多的见解；然而，整体研究基础有限。需要进一步的综合研究来全面绘制口腔抵抗组。
{"title":"Antimicrobial resistance genes in the oral microbiome","authors":"Manas Dave, Rajpal Tattar","doi":"10.1038/s41432-025-01120-z","DOIUrl":"10.1038/s41432-025-01120-z","url":null,"abstract":"Sukumar S, Rahmanyar Z, El Jurf H Q et al. Mapping the oral resistome: a systematic review. J Med Microbiol 2024; https://doi.org/10.1099/jmm.0.001866 . This systematic review, without meta-analysis, aimed to map the oral resistome by analysing clinical studies that detected bacterial antimicrobial resistance genes (ARGs) in the oral cavity using molecular techniques. The researchers used Medline, Embase, Web of Science, CINAHL and Scopus databases from January 2015 to August 2023. This systematic review included cross-sectional or longitudinal clinical studies that detected ARGs using molecular techniques; specifically polymerase chain reaction (PCR) or next-generation sequencing (NGS) metagenomics for samples from the oral cavity (saliva, gingival biofilm, pulp, or oral mucosa). Studies were excluded if they were in vitro or animal studies, literature reviews and not focused on ARG detection. Five reviewers independently screened titles and abstracts based on inclusion criteria. Full-text reports were then independently assessed for eligibility by three reviewers. Extracted data encompassed publication details, sample size, country, molecular methods used, number of ARGs detected, participants’ health status, antibiotic exposure, and sample location within the oral cavity. Out of 580 initially identified studies, 15 met the inclusion criteria. These studies, published between 2015 and 2023 from 12 different countries, employed either PCR (n = 10) or NGS metagenomics (n = 5) to detect ARGs from a pool of 1486 participants (1 study did not report on the number of participants). PCR-based studies identified an average of 7 ARGs (range 1–20), while NGS studies identified an average of 34 ARGs (range 7–70). In total, 159 unique ARGs conferring resistance to 22 antibiotic classes were identified across six regions of the oral cavity. The supragingival biofilm and saliva exhibited the highest richness of ARGs, defined by the number of unique ARGs detected. Genes conferring resistance to 19 antibiotic classes were present in the supragingival biofilm. Notably, 49 ARGs, including tetracycline and macrolide resistance genes, were found across all sampled locations, indicating a widespread distribution within the oral cavity. Thirteen studies reported on bacterial species associated with ARGs. NGS studies identified a mean of 65 ARG-carrying bacterial species, compared to a mean of 4 species in PCR studies. Specifically, 25 ARG-carrying species were identified in PCR studies, while NGS studies identified 177 species. Four studies reported ARGs associated with streptococcal species implicated in distant-site infections such as infective endocarditis. ESKAPE pathogens (group of highly virulent multidrug-resistant bacteria) were detected with ARGs in various oral sites using both PCR and NGS methods. Comparisons between healthy and diseased states revealed that a healthy oral microbiome harbours a more diverse resistome at the antibiotic class level. Th","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 1","pages":"42-43"},"PeriodicalIF":0.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41432-025-01120-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-05DOI: 10.1038/s41432-024-01096-2
Sophie Rimmer, Marianne Dobson
This single-centre, short-term randomized control trial (RCT) assesses the effect of systemic amoxicillin and metronidazole as an adjunct to SRP in patients with severe periodontitis and type 2 diabetes mellitus (T2DM) on glycaemic control, over a 3-month period. The authors hypothesize that adjunctive systemic antibiotics will decrease systemic inflammation and subsequently improve glucose control. Baseline periodontal examinations and haematological tests were performed for all subjects. Subsequently, subgingival scaling and root planning (SRP) procedures were performed by a single periodontist for both the test and control groups. The test group received 500 mg amoxicillin and 200 mg metronidazole TDS for 7 days in the same week of the SRP procedure. Three months later, periodontal examinations were repeated by blinded examiners and haematological tests were repeated. Maintenance periodontal therapy was provided at this time. A convenience sample of patients visiting the periodontal department between 2016-2022 was used. Participants included were aged 40–75; diagnosed with T2DM for >2 years; HbA1c of 6.5–10%, had stable medication regimens and >15 remaining teeth. Participants had a periodontal diagnosis of generalized severe chronic periodontitis or stage III-IV generalized periodontitis based on the 1999 and 2018 classifications respectively. Exclusion criteria related to coexisting inflammatory or infectious diseases (e.g. malignancy, coronary heart disease or hepatitis); adjustment in diet or glycaemic control strategy; severe diabetic complications; pregnancy or lactation; allergies to amoxicillin or metronidazole; periodontal treatment or antibiotics within 3 months prior; smoking and alcohol abuse. The primary clinical outcome was a change in HbA1c. Secondary outcomes included the effect on periodontal parameters and haematological markers of inflammation. Periodontal parameters measured were probing depth (PD), bleeding index (BI), Plaque index (PI), periodontally inflamed surface area (PISA), and clinical attachment level (CAL). Haematological parameters were glycated haemoglobin (HbA1c), fasting blood glucose (FBG), neutrophil-to-lymphocyte ratio (NLR), and white blood cell (WBC) count. For data analysis, poorly controlled T2DM was defined as baseline HbA1c > 7.5%. Statistical significance was defined as p < 0.05. Analysis within and between the two groups was analysed with Student’s t-tests when data followed a normal distribution and the Mann-Whitney U test for non-normally distributed data. Chi-square testing was used to compare categorical variables. Uni- and multivariable binary logistic regression was employed to analyze the effectors related to HbA1c decrease. Intention-to-treat analysis was carried out for all enroled participants. 49 participants were enroled in the study; 23 were assigned to the SRP-only group and 26 to the SRP + antibiotics group. Nine participants were lost to follow-up. HbA1c levels decrease
{"title":"Should we prescribe systemic antibiotics alongside periodontal therapy for diabetic patients?","authors":"Sophie Rimmer, Marianne Dobson","doi":"10.1038/s41432-024-01096-2","DOIUrl":"10.1038/s41432-024-01096-2","url":null,"abstract":"This single-centre, short-term randomized control trial (RCT) assesses the effect of systemic amoxicillin and metronidazole as an adjunct to SRP in patients with severe periodontitis and type 2 diabetes mellitus (T2DM) on glycaemic control, over a 3-month period. The authors hypothesize that adjunctive systemic antibiotics will decrease systemic inflammation and subsequently improve glucose control. Baseline periodontal examinations and haematological tests were performed for all subjects. Subsequently, subgingival scaling and root planning (SRP) procedures were performed by a single periodontist for both the test and control groups. The test group received 500 mg amoxicillin and 200 mg metronidazole TDS for 7 days in the same week of the SRP procedure. Three months later, periodontal examinations were repeated by blinded examiners and haematological tests were repeated. Maintenance periodontal therapy was provided at this time. A convenience sample of patients visiting the periodontal department between 2016-2022 was used. Participants included were aged 40–75; diagnosed with T2DM for >2 years; HbA1c of 6.5–10%, had stable medication regimens and >15 remaining teeth. Participants had a periodontal diagnosis of generalized severe chronic periodontitis or stage III-IV generalized periodontitis based on the 1999 and 2018 classifications respectively. Exclusion criteria related to coexisting inflammatory or infectious diseases (e.g. malignancy, coronary heart disease or hepatitis); adjustment in diet or glycaemic control strategy; severe diabetic complications; pregnancy or lactation; allergies to amoxicillin or metronidazole; periodontal treatment or antibiotics within 3 months prior; smoking and alcohol abuse. The primary clinical outcome was a change in HbA1c. Secondary outcomes included the effect on periodontal parameters and haematological markers of inflammation. Periodontal parameters measured were probing depth (PD), bleeding index (BI), Plaque index (PI), periodontally inflamed surface area (PISA), and clinical attachment level (CAL). Haematological parameters were glycated haemoglobin (HbA1c), fasting blood glucose (FBG), neutrophil-to-lymphocyte ratio (NLR), and white blood cell (WBC) count. For data analysis, poorly controlled T2DM was defined as baseline HbA1c > 7.5%. Statistical significance was defined as p < 0.05. Analysis within and between the two groups was analysed with Student’s t-tests when data followed a normal distribution and the Mann-Whitney U test for non-normally distributed data. Chi-square testing was used to compare categorical variables. Uni- and multivariable binary logistic regression was employed to analyze the effectors related to HbA1c decrease. Intention-to-treat analysis was carried out for all enroled participants. 49 participants were enroled in the study; 23 were assigned to the SRP-only group and 26 to the SRP + antibiotics group. Nine participants were lost to follow-up. HbA1c levels decrease","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 1","pages":"48-49"},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zhao Z, Attanasio C, Zong C, Pedano M S, Cadenas de Llano-Pérula M. How does orthodontic tooth movement influence the dental pulp? RNA-sequencing on human premolars. Int Endod J 2024; 57: 1783–1801. Sample selection - The study sample consisted of healthy individuals requiring extraction of maxillary or mandibular premolars for fixed appliance orthodontic treatment. Exclusion criteria included systemic diseases, a history of smoking, antibiotic or analgesic use within the past three months, periodontal probing depths greater than 3 mm, alveolar bone resorption, and premolars with prior endodontic treatment. Participants were randomly divided into 3 groups: control, 7-day, and 28-day groups. Extractions were performed prior to orthodontic treatment, and 7 days and 28 days after application of orthodontic forces (OF) in the control, 7-day and 28-day group respectively. The applied orthodontic forces were in the range of 50–150 g. RNA extraction from pulp tissues was performed using the RNeasy mini kit. After total RNA extraction, a library was prepared, and RNA sequencing was conducted to examine and compare the genetic data among the groups within each jaw. Differentially expressed genes (DEGs) were identified in the 7-day and 28-day groups, followed by functional enrichment analysis to understand their biological significance. Furthermore, protein-protein interaction network analysis was conducted to investigate the complex network of protein interactions and locate key genes involved in orthodontic tooth movement. Immune response, hypoxia, DNA damage, and epigenetic regulation were the pulpal reactions reflected after 7 days of OF. Whereas, at 28 days, processes such as cell adhesion, migration, organization, and tissue repair became prominent. Pulp tissues in the maxilla and mandible responded differently to orthodontic force. The maxilla showed minimal changes, primarily involving immune response at 7 days and tissue repair at 28 days. In contrast, the mandible exhibited significant DNA damage and epigenetic regulation at 7 days, with a return to its baseline condition by 28 days. Dental pulp demonstrated different reactions at 7 and 28 days, with maxillary and mandibular pulp tissues presenting distinct responses. The study provided knowledge about gene regulatory mechanisms modulating pulp tissue response to OF.
赵忠，Attanasio C, Zong C, Pedano M S, Cadenas de llano - psamrua M.正畸牙齿移动对牙髓的影响人类前磨牙的rna测序。Int end J 2024；57: 1783 - 1801。设计-横断面设计：样本选择-研究样本包括需要拔除上颌或下颌前磨牙进行固定矫治治疗的健康个体。排除标准包括全身性疾病、吸烟史、过去三个月内使用过抗生素或止痛药、牙周探探深度大于3mm、牙槽骨吸收、前磨牙既往接受过牙髓治疗。参与者随机分为3组：对照组、7天组和28天组。对照组、7天组和28天组分别在正畸治疗前、使用正畸力（orthodontic force, of）后7天和28天进行拔牙。施加的正畸力在50- 150g之间。使用RNeasy迷你试剂盒从牙髓组织中提取RNA。提取总RNA后，建立文库，并进行RNA测序，检查和比较各颌骨内各组间的遗传数据。数据分析：在7天组和28天组中鉴定差异表达基因（differential expressed genes, DEGs），并进行功能富集分析，了解其生物学意义。此外，通过蛋白质-蛋白质相互作用网络分析，研究蛋白质相互作用的复杂网络，定位正畸牙齿移动的关键基因。结果：7 d后的牙髓反应主要表现为免疫应答、缺氧、DNA损伤和表观遗传调控。然而，在第28天，细胞粘附、迁移、组织和组织修复等过程变得突出。上颌和下颌骨的牙髓组织对正畸力的反应不同。上颌骨的变化很小，主要是第7天的免疫反应和第28天的组织修复。相比之下，下颌骨在第7天表现出明显的DNA损伤和表观遗传调控，并在第28天恢复到其基线状态。结论：牙髓在第7天和第28天表现出不同的反应，上颌和下颌牙髓组织表现出明显的反应。本研究提供了关于牙髓组织对OF的基因调控机制的知识。
{"title":"Application of pulp tissue genetic profile in orthodontic tooth movement: a needle in a haystack?","authors":"Soumya Narayani Thirumoorthy, Darshit Shah, Saumiya Gopal","doi":"10.1038/s41432-025-01131-w","DOIUrl":"10.1038/s41432-025-01131-w","url":null,"abstract":"Zhao Z, Attanasio C, Zong C, Pedano M S, Cadenas de Llano-Pérula M. How does orthodontic tooth movement influence the dental pulp? RNA-sequencing on human premolars. Int Endod J 2024; 57: 1783–1801. Sample selection - The study sample consisted of healthy individuals requiring extraction of maxillary or mandibular premolars for fixed appliance orthodontic treatment. Exclusion criteria included systemic diseases, a history of smoking, antibiotic or analgesic use within the past three months, periodontal probing depths greater than 3 mm, alveolar bone resorption, and premolars with prior endodontic treatment. Participants were randomly divided into 3 groups: control, 7-day, and 28-day groups. Extractions were performed prior to orthodontic treatment, and 7 days and 28 days after application of orthodontic forces (OF) in the control, 7-day and 28-day group respectively. The applied orthodontic forces were in the range of 50–150 g. RNA extraction from pulp tissues was performed using the RNeasy mini kit. After total RNA extraction, a library was prepared, and RNA sequencing was conducted to examine and compare the genetic data among the groups within each jaw. Differentially expressed genes (DEGs) were identified in the 7-day and 28-day groups, followed by functional enrichment analysis to understand their biological significance. Furthermore, protein-protein interaction network analysis was conducted to investigate the complex network of protein interactions and locate key genes involved in orthodontic tooth movement. Immune response, hypoxia, DNA damage, and epigenetic regulation were the pulpal reactions reflected after 7 days of OF. Whereas, at 28 days, processes such as cell adhesion, migration, organization, and tissue repair became prominent. Pulp tissues in the maxilla and mandible responded differently to orthodontic force. The maxilla showed minimal changes, primarily involving immune response at 7 days and tissue repair at 28 days. In contrast, the mandible exhibited significant DNA damage and epigenetic regulation at 7 days, with a return to its baseline condition by 28 days. Dental pulp demonstrated different reactions at 7 and 28 days, with maxillary and mandibular pulp tissues presenting distinct responses. The study provided knowledge about gene regulatory mechanisms modulating pulp tissue response to OF.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 1","pages":"61-62"},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-27DOI: 10.1038/s41432-025-01130-x
Larry Z. Lockerman
Zhang J, Chen G, Li W, Xu T, Gao X Upper airway changes after orthodontic extraction treatment in adults: a preliminary study using cone beam computed tomography. PLoS ONE 2015; https://doi.org/10.1371/journal.pone.0143233 . Retrospective study and untreated matched controls. PubMed, journals.plos.org, researchgate.net, Google Scholar. This retrospective study enrolled 18 adults with Class II and hyperdivergent skeletal malocclusion (5 males and 13 females, 24.1 ± 3.8 years of age, BMI 20.33 ± 1.77 kg/m2). And 18 untreated controls were matched 1:1 with the treated patients for age, sex, BMI, and skeletal pattern. Age >18 years; sagittal Class II (ANB > 4.7°) and vertical hyperdivergent (MP/SN > 37.7°) skeletal pattern; convex profile evaluated by E line; no missing teeth except for the third molars; orthodontic camouflage treatment with extraction of four premolars and maximum anchorage using mini-screws; and available CBCT data both before and after treatment. Body mass index (BMI) > 25 kg/m2. Rapid maxillary expansion, protraction facemask therapy, extra-oral force to push molars distally, functional appliances, and orthognathic surgery. History of cleft lip or palate. Hyperplasia of tonsils or adenoids or history of tonsillectomy/adenoidectomy. Snoring or other sleep disorders. Four premolar extraction, upper incisors retracted 7.87 mm, lower incisors retracted 6.10 mm. The cross-sectional area of the upper airway was not changed, but the sagittal dimension between the soft palate and the posterior pharyngeal wall were significantly decreased. The study reported that its null hypothesis was not rejected, with no significant difference in the airway size and significant compression of the sagittal posterior airway.
{"title":"Unmasking the hidden risks: clinical implications of 4 premolar extraction orthodontics on health and upper airway dynamics","authors":"Larry Z. Lockerman","doi":"10.1038/s41432-025-01130-x","DOIUrl":"10.1038/s41432-025-01130-x","url":null,"abstract":"Zhang J, Chen G, Li W, Xu T, Gao X Upper airway changes after orthodontic extraction treatment in adults: a preliminary study using cone beam computed tomography. PLoS ONE 2015; https://doi.org/10.1371/journal.pone.0143233 . Retrospective study and untreated matched controls. PubMed, journals.plos.org, researchgate.net, Google Scholar. This retrospective study enrolled 18 adults with Class II and hyperdivergent skeletal malocclusion (5 males and 13 females, 24.1 ± 3.8 years of age, BMI 20.33 ± 1.77 kg/m2). And 18 untreated controls were matched 1:1 with the treated patients for age, sex, BMI, and skeletal pattern. Age >18 years; sagittal Class II (ANB > 4.7°) and vertical hyperdivergent (MP/SN > 37.7°) skeletal pattern; convex profile evaluated by E line; no missing teeth except for the third molars; orthodontic camouflage treatment with extraction of four premolars and maximum anchorage using mini-screws; and available CBCT data both before and after treatment. Body mass index (BMI) > 25 kg/m2. Rapid maxillary expansion, protraction facemask therapy, extra-oral force to push molars distally, functional appliances, and orthognathic surgery. History of cleft lip or palate. Hyperplasia of tonsils or adenoids or history of tonsillectomy/adenoidectomy. Snoring or other sleep disorders. Four premolar extraction, upper incisors retracted 7.87 mm, lower incisors retracted 6.10 mm. The cross-sectional area of the upper airway was not changed, but the sagittal dimension between the soft palate and the posterior pharyngeal wall were significantly decreased. The study reported that its null hypothesis was not rejected, with no significant difference in the airway size and significant compression of the sagittal posterior airway.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 1","pages":"63-64"},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-26DOI: 10.1038/s41432-025-01125-8
Orion O’Brien, Greig D. Taylor
Feldens C A, de Barros Coelho E M R, Vítolo M R, Rogrigues P H, Kramer P F, Peres K G Effectiveness of a sugar consumption prevention programme in the first year of life on the occurrence of early childhood caries: a multicentric randomized trial in Brazil. Caries Res 2024; https://doi.org/10.1159/000541028 . A multi-centre randomised controlled trial was carried out in Brazil. The intervention group received nutritional counselling based on dietary guidelines produced by UNICEF. The control group received standard dietary and maternal counselling provided by the hospital provider. Randomisation of participants was completed through a computer-based system with an investigator blinded to the recruitment process. Patients were followed up monthly using a combination of phone calls and home visits. Pregnant women were recruited from four hospitals, across three state capitals, participating in the Baby Friendly Hospital Initiative. Mothers were to be at least 18 years of age, testing negative for HIV/HTLV1, and had an uncomplicated pregnancy. Their newborns had to have a gestational age of more than 37 weeks and weigh more than 2.5 kg. A newborn with increased hospital stays due to infection or neonatal conditions which affected breastfeeding were not included. Sample size calculation was undertaken. Baseline data was collected. At 6- and 12-month intervals, a combination of validated questionnaires, including 24-hour recalls, and interviews were used to assess the diet. Oral health assessments were carried out by a blinded, trained and calibrated paediatric dentist. The primary outcome was a reduction in ECC. Effect measures (relative risk [RR]) were calculated to determine the effect of the intervention on not consuming sugar at 6 months and on the mean number of sugary items consumed at 12 months. Baseline demographic data were similar, with no significant differences noted, between the intervention and control groups. The probability of not consuming sugar in the first 6-months was 2.4 times less in the intervention group relative to the control group (p = 0.016). ECC was diagnosed in 17.4% of the whole sample; however, no significant difference was noted between groups at any time point (p = 0.281). Increased intervention to the mother in the first 6-months of life was effective at reducing the amount of sugar intake. However, this did not lead to a statistically significant reduction in ECC.
Feldens C A, de Barros Coelho E M R, Vítolo M R, Rogrigues P H, Kramer P F， Peres K G：一项在巴西开展的多中心随机试验：生命第一年预防糖摄入规划对儿童早期龋齿发生的有效性。龋齿研究2024；https://doi.org/10.1159/000541028 .研究设计：在巴西进行了一项多中心随机对照试验。干预组根据儿童基金会制定的膳食准则接受营养咨询。对照组接受医院提供的标准饮食和产妇咨询。参与者的随机化是通过基于计算机的系统完成的，研究者对招募过程不知情。每月通过电话和家访对患者进行随访。样本：孕妇是从三个州首府的四家医院招募的，她们参加了“爱婴医院倡议”。母亲必须年满18岁，HIV/HTLV1检测呈阴性，并且没有并发症的怀孕。这些新生儿的胎龄必须超过37周，体重必须超过2.5公斤。由于感染或影响母乳喂养的新生儿状况而住院时间增加的新生儿未包括在内。进行样本量计算。数据分析：收集基线数据。每隔6个月和12个月，使用有效问卷的组合，包括24小时回忆和访谈来评估饮食。口腔健康评估由一名盲法、经过培训和校准的儿科牙医进行。主要结局是ECC减少。计算效果测量（相对风险[RR]），以确定干预对6个月时不吃糖和12个月时平均吃糖量的影响。结果：干预组和对照组的基线人口统计数据相似，无显著差异。干预组前6个月不吃糖的概率是对照组的2.4倍（p = 0.016）。17.4%的患者诊断为ECC；然而，各组间在任何时间点均无显著差异（p = 0.281）。结论：在母亲出生后的前6个月增加干预对减少糖的摄入量是有效的。然而，这并没有导致统计学上显著的ECC减少。
{"title":"Can we rely on delaying the uptake of sugar consumption in the prevention of early childhood caries?","authors":"Orion O’Brien, Greig D. Taylor","doi":"10.1038/s41432-025-01125-8","DOIUrl":"10.1038/s41432-025-01125-8","url":null,"abstract":"Feldens C A, de Barros Coelho E M R, Vítolo M R, Rogrigues P H, Kramer P F, Peres K G Effectiveness of a sugar consumption prevention programme in the first year of life on the occurrence of early childhood caries: a multicentric randomized trial in Brazil. Caries Res 2024; https://doi.org/10.1159/000541028 . A multi-centre randomised controlled trial was carried out in Brazil. The intervention group received nutritional counselling based on dietary guidelines produced by UNICEF. The control group received standard dietary and maternal counselling provided by the hospital provider. Randomisation of participants was completed through a computer-based system with an investigator blinded to the recruitment process. Patients were followed up monthly using a combination of phone calls and home visits. Pregnant women were recruited from four hospitals, across three state capitals, participating in the Baby Friendly Hospital Initiative. Mothers were to be at least 18 years of age, testing negative for HIV/HTLV1, and had an uncomplicated pregnancy. Their newborns had to have a gestational age of more than 37 weeks and weigh more than 2.5 kg. A newborn with increased hospital stays due to infection or neonatal conditions which affected breastfeeding were not included. Sample size calculation was undertaken. Baseline data was collected. At 6- and 12-month intervals, a combination of validated questionnaires, including 24-hour recalls, and interviews were used to assess the diet. Oral health assessments were carried out by a blinded, trained and calibrated paediatric dentist. The primary outcome was a reduction in ECC. Effect measures (relative risk [RR]) were calculated to determine the effect of the intervention on not consuming sugar at 6 months and on the mean number of sugary items consumed at 12 months. Baseline demographic data were similar, with no significant differences noted, between the intervention and control groups. The probability of not consuming sugar in the first 6-months was 2.4 times less in the intervention group relative to the control group (p = 0.016). ECC was diagnosed in 17.4% of the whole sample; however, no significant difference was noted between groups at any time point (p = 0.281). Increased intervention to the mother in the first 6-months of life was effective at reducing the amount of sugar intake. However, this did not lead to a statistically significant reduction in ECC.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 1","pages":"36-37"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41432-025-01125-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-25DOI: 10.1038/s41432-025-01129-4
Mariana Pires da Costa, Nicolli de Araújo Meckelburg, Lucas Alves Jural, Andreia Vaz Braga Pintor, Guido Maranon-Vásquez, Tiago Braga Rabello, Marcela Baraúna Magno, Lucianne Cople Maia
To investigate whether the use of sports mouthguards (SMG) influences salivary parameters and oral health indices. Electronic searches were conducted across six major databases and two sources of gray literature in July 2024, with no restrictions on language or publication date. Interventional studies assessing oral parameters in participants with and without SMG were included. Risk of bias (ROB) was evaluated using the NIH—NHLBI Quality Assessment Tools for before-and-after studies. Descriptive synthesis was performed, and the certainty of evidence was assessed with the GRADE approach. Four studies met the inclusion criteria, encompassing a total of 202 male and female athletes aged 8 to 24 years. ROB ratings were classified as fair in three studies (75%) and poor in one study (25%). Evaluated salivary parameters included pH, stimulated and unstimulated flow rates, microbial count, saliva consistency, and buffering capacity. Additionally, oral indices such as full mouth plaque and bleeding scores were assessed. The studies demonstrated high heterogeneity in collection and analysis methods, outcome evaluation, and follow-up duration. Overall, the influence of SMG use on salivary pH (n = 4; 100%) and stimulated flow rate (n = 2; 100%) was inconclusive. SMG use did not affect microbial count (n = 2; 100%) or saliva consistency (n = 1; 100%) but was associated with a decrease in buffering capacity (n = 1; 100%). An increase was noted in unstimulated flow rate (n = 1; 100%) and oral indices (n = 1; 100%) with SMG use. The certainty of the evidence was rated as very low for all evaluated parameters. SMG use appears to impact saliva’s buffering capacity but does not influence its consistency or microbial count. Despite the limited literature and methodological limitations of existing studies, this systematic review provides insights that could inform the design of more rigorous primary research, ultimately strengthening the evidence base on this topic.
{"title":"Does the use of sports mouthguards influence salivary parameters and oral health indices? A systematic review","authors":"Mariana Pires da Costa, Nicolli de Araújo Meckelburg, Lucas Alves Jural, Andreia Vaz Braga Pintor, Guido Maranon-Vásquez, Tiago Braga Rabello, Marcela Baraúna Magno, Lucianne Cople Maia","doi":"10.1038/s41432-025-01129-4","DOIUrl":"10.1038/s41432-025-01129-4","url":null,"abstract":"To investigate whether the use of sports mouthguards (SMG) influences salivary parameters and oral health indices. Electronic searches were conducted across six major databases and two sources of gray literature in July 2024, with no restrictions on language or publication date. Interventional studies assessing oral parameters in participants with and without SMG were included. Risk of bias (ROB) was evaluated using the NIH—NHLBI Quality Assessment Tools for before-and-after studies. Descriptive synthesis was performed, and the certainty of evidence was assessed with the GRADE approach. Four studies met the inclusion criteria, encompassing a total of 202 male and female athletes aged 8 to 24 years. ROB ratings were classified as fair in three studies (75%) and poor in one study (25%). Evaluated salivary parameters included pH, stimulated and unstimulated flow rates, microbial count, saliva consistency, and buffering capacity. Additionally, oral indices such as full mouth plaque and bleeding scores were assessed. The studies demonstrated high heterogeneity in collection and analysis methods, outcome evaluation, and follow-up duration. Overall, the influence of SMG use on salivary pH (n = 4; 100%) and stimulated flow rate (n = 2; 100%) was inconclusive. SMG use did not affect microbial count (n = 2; 100%) or saliva consistency (n = 1; 100%) but was associated with a decrease in buffering capacity (n = 1; 100%). An increase was noted in unstimulated flow rate (n = 1; 100%) and oral indices (n = 1; 100%) with SMG use. The certainty of the evidence was rated as very low for all evaluated parameters. SMG use appears to impact saliva’s buffering capacity but does not influence its consistency or microbial count. Despite the limited literature and methodological limitations of existing studies, this systematic review provides insights that could inform the design of more rigorous primary research, ultimately strengthening the evidence base on this topic.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 3","pages":"146-146"},"PeriodicalIF":2.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143500121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-21DOI: 10.1038/s41432-025-01123-w
Neeraj Gugnani, Shalini Gugnani
Pawinska M, Paszynska E, Amaechi B T, Meyer F, Enax J, Limeback H Clinical evidence of caries prevention by hydroxyapatite: an updated systematic review and meta-analysis. J Dent 2024; https://doi.org/10.1016/j.jdent.2024.105429 . The search strategy for this review aimed at finding the published articles in which hydroxyapatite has been used as an intervention agent for caries prevention, compared with either active control like fluoride-products, placebo, or no interventions. For this, authors used a combination of keywords indicative of various PICOS framework elements. The search was carried out in various electronic databases, including Pubmed, Embase, Scopus, Web of Science, and Google Scholar. Both clinical trials and in-situ studies were included in this review. A total of 1245 articles were retrieved from the search, but 1227 articles were removed as they did not meet the inclusion/exclusion criteria. A total of 18 articles, including clinical trials and in-situ studies, were included in the review. All the included articles were assessed for quality using NHLBI criteria before including them in the meta-analysis. The outcome measures from the clinical trials mainly included the caries incidence, recorded as dmft(s)/DMFT(S) or using ICDAS criteria, while the data for outcome measures from in-situ studies included different surrogate markers. The meta-analysis done for the included clinical trials depicted HAP toothpastes to be significantly better for caries prevention when compared with the placebo toothpastes (pooled OR = 2.51). The results also favored HAP toothpaste when compared with fluoride toothpaste (pooled OR = 1.1) but the results were non-significant. For in-situ studies too, significant results were obtained, favouring HAP toothpaste in terms of lesion depth (overall mean change of 1.15 µm) and bacterial loads (overall mean reduction of 65%), while non-significant results, favouring HAP, were obtained in terms of remineralization (overall mean change of 2.8%). HAP toothpastes are found to be effective in preventing caries and can be considered as good alternative for fluoride.
Pawinska M, Paszynska E, Amaechi B T, Meyer F, Enax J, Limeback H。羟基磷灰石预防龋病的临床证据：最新的系统评价和荟萃分析。[J] Dent 2024；https://doi.org/10.1016/j.jdent.2024.105429 .数据来源：本综述的检索策略旨在找到羟基磷灰石被用作预防龋齿干预剂的已发表文章，与氟化物产品、安慰剂或无干预等主动对照进行比较。为此，作者使用了表示各种PICOS框架元素的关键字组合。检索在各种电子数据库中进行，包括Pubmed， Embase, Scopus， Web of Science和b谷歌Scholar。研究选择：本综述包括临床试验和原位研究。从检索中共检索到1245篇文章，但由于不符合纳入/排除标准，删除了1227篇文章。共纳入18篇文章，包括临床试验和原位研究。数据提取和综合：所有纳入的文章在纳入meta分析之前，均采用NHLBI标准进行质量评估。临床试验的结果测量主要包括龋发病率，记录为dmft(s)/ dmft(s)或使用ICDAS标准，而原位研究的结果测量数据包括不同的替代标记物。结果：对纳入的临床试验进行的荟萃分析显示，与安慰剂牙膏相比，HAP牙膏在预防龋齿方面明显更好（合并OR = 2.51）。与含氟牙膏相比，结果也更有利于含氟牙膏（合并OR = 1.1），但结果不显著。在原位研究中，也获得了显著的结果，在病变深度（总体平均变化1.15µm）和细菌负荷（总体平均减少65%）方面有利于HAP牙膏，而在再矿化方面获得了不显著的结果，有利于HAP牙膏（总体平均变化2.8%）。结论：HAP牙膏具有良好的防龋效果，可作为氟化物的良好替代品。
{"title":"Do we have enough evidence to recommend hydroxyapatite toothpaste for preventing dental caries?","authors":"Neeraj Gugnani, Shalini Gugnani","doi":"10.1038/s41432-025-01123-w","DOIUrl":"10.1038/s41432-025-01123-w","url":null,"abstract":"Pawinska M, Paszynska E, Amaechi B T, Meyer F, Enax J, Limeback H Clinical evidence of caries prevention by hydroxyapatite: an updated systematic review and meta-analysis. J Dent 2024; https://doi.org/10.1016/j.jdent.2024.105429 . The search strategy for this review aimed at finding the published articles in which hydroxyapatite has been used as an intervention agent for caries prevention, compared with either active control like fluoride-products, placebo, or no interventions. For this, authors used a combination of keywords indicative of various PICOS framework elements. The search was carried out in various electronic databases, including Pubmed, Embase, Scopus, Web of Science, and Google Scholar. Both clinical trials and in-situ studies were included in this review. A total of 1245 articles were retrieved from the search, but 1227 articles were removed as they did not meet the inclusion/exclusion criteria. A total of 18 articles, including clinical trials and in-situ studies, were included in the review. All the included articles were assessed for quality using NHLBI criteria before including them in the meta-analysis. The outcome measures from the clinical trials mainly included the caries incidence, recorded as dmft(s)/DMFT(S) or using ICDAS criteria, while the data for outcome measures from in-situ studies included different surrogate markers. The meta-analysis done for the included clinical trials depicted HAP toothpastes to be significantly better for caries prevention when compared with the placebo toothpastes (pooled OR = 2.51). The results also favored HAP toothpaste when compared with fluoride toothpaste (pooled OR = 1.1) but the results were non-significant. For in-situ studies too, significant results were obtained, favouring HAP toothpaste in terms of lesion depth (overall mean change of 1.15 µm) and bacterial loads (overall mean reduction of 65%), while non-significant results, favouring HAP, were obtained in terms of remineralization (overall mean change of 2.8%). HAP toothpastes are found to be effective in preventing caries and can be considered as good alternative for fluoride.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 1","pages":"38-39"},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-20DOI: 10.1038/s41432-025-01127-6
Nicola Goodship, Greig Taylor
Nezhad H M, Ashourioun A, Sadeghdaghighi A The effect of virtual reality for anxiety and pain in dentistry: a systematic review and meta-analysis. Community Dent Health 2024; 41: 248–255. A systematic search was conducted across PubMed and Cochrane Library up to April 2024. The article type was limited to Randomised Controlled Trials, comparing virtual reality (VR) interventions with non-VR methods in dental settings. The selection followed the PRISMA-P guidelines. Using the PICOS framework, studies involving dental patients of any age utilising VR during dental treatments and reporting outcomes on anxiety and pain were included. Data extraction and quality appraisal were conducted independently by two reviewers using both the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach and the Risk of Bias 2 (ROB-2) tool. Meta-analyses used a random-effects model. A total of 263 studies resulted in the inclusion of 27 studies, encompassing several dental treatments. Evidence quality ranged from low to moderate. Meta-analysis of 14 studies, encompassing 957 patients, revealed VR significantly reduced anxiety in children (SMD −1.44, 95% CI −2.24 to −0.63, low quality of evidence). Metal-analysis of five studies (485 patients) revealed VR had no effect on adults’ anxiety (SMD -0.35, 95% CI -1.11 to 0.4, low level of certainty). VR significantly reduced pain in both children (11 studies, 791 participants) (SMD −1.11, 95% CI −1.65 to −0.57, moderate level of certainty) and adults (6 studies, 557 participants) (SMD −0.59, 95% CI −1.187 to −0.001, low evidence quality). Heterogeneity was high across studies. The study concluded that VR is a promising intervention for reducing anxiety and pain in children during dental procedures, and pain reduction in adults. The authors suggested further research is needed to standardise the VR content and explore its impact across different age groups and dental procedures.
相关评论：Nezhad H M, Ashourioun A, Sadeghdaghighi A 虚拟现实对牙科焦虑和疼痛的影响：系统综述和荟萃分析。Community Dent Health 2024; 41: 248-255.Data sources：截至 2024 年 4 月，在 PubMed 和 Cochrane 图书馆进行了系统检索：文章类型仅限于随机对照试验，比较牙科环境中的虚拟现实（VR）干预与非虚拟现实方法。选择遵循 PRISMA-P 指南。利用 PICOS 框架，纳入了涉及任何年龄段的牙科患者在牙科治疗过程中使用 VR 并报告焦虑和疼痛结果的研究：数据提取和质量评估由两名审稿人独立完成，他们同时使用了推荐、评估、发展和评价分级（GRADE）方法和偏倚风险2（ROB-2）工具。元分析采用随机效应模型：共有 263 项研究，最终纳入了 27 项研究，包括多种牙科治疗方法。证据质量从低到中等不等。对 14 项研究（包括 957 名患者）进行的元分析表明，VR 能显著减轻儿童的焦虑（SMD -1.44, 95% CI -2.24 to -0.63，证据质量低）。对五项研究（485 名患者）进行的金属分析表明，VR 对成年人的焦虑症没有影响（SMD -0.35，95% CI -1.11 至 0.4，证据确定性低）。VR 能明显减轻儿童（11 项研究，791 名参与者）和成人（6 项研究，557 名参与者）的疼痛（SMD -0.59，95% CI -1.187 -0.001，证据质量低）。不同研究之间的异质性很高：研究得出结论：VR 是一种很有前景的干预方法，可以减轻儿童在牙科治疗过程中的焦虑和疼痛，并减轻成人的疼痛。作者建议需要进一步研究，以标准化 VR 内容，并探索其对不同年龄组和牙科手术的影响。
{"title":"Can virtual reality reduce anxiety and pain in dental patients?","authors":"Nicola Goodship, Greig Taylor","doi":"10.1038/s41432-025-01127-6","DOIUrl":"10.1038/s41432-025-01127-6","url":null,"abstract":"Nezhad H M, Ashourioun A, Sadeghdaghighi A The effect of virtual reality for anxiety and pain in dentistry: a systematic review and meta-analysis. Community Dent Health 2024; 41: 248–255. A systematic search was conducted across PubMed and Cochrane Library up to April 2024. The article type was limited to Randomised Controlled Trials, comparing virtual reality (VR) interventions with non-VR methods in dental settings. The selection followed the PRISMA-P guidelines. Using the PICOS framework, studies involving dental patients of any age utilising VR during dental treatments and reporting outcomes on anxiety and pain were included. Data extraction and quality appraisal were conducted independently by two reviewers using both the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach and the Risk of Bias 2 (ROB-2) tool. Meta-analyses used a random-effects model. A total of 263 studies resulted in the inclusion of 27 studies, encompassing several dental treatments. Evidence quality ranged from low to moderate. Meta-analysis of 14 studies, encompassing 957 patients, revealed VR significantly reduced anxiety in children (SMD −1.44, 95% CI −2.24 to −0.63, low quality of evidence). Metal-analysis of five studies (485 patients) revealed VR had no effect on adults’ anxiety (SMD -0.35, 95% CI -1.11 to 0.4, low level of certainty). VR significantly reduced pain in both children (11 studies, 791 participants) (SMD −1.11, 95% CI −1.65 to −0.57, moderate level of certainty) and adults (6 studies, 557 participants) (SMD −0.59, 95% CI −1.187 to −0.001, low evidence quality). Heterogeneity was high across studies. The study concluded that VR is a promising intervention for reducing anxiety and pain in children during dental procedures, and pain reduction in adults. The authors suggested further research is needed to standardise the VR content and explore its impact across different age groups and dental procedures.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 1","pages":"59-60"},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41432-025-01127-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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