Head & Face Medicine最新文献

Background: Minocycline, doxycycline, and chlorhexidine are widely used as adjuncts to non-surgical periodontal therapy. Although their efficacy has been demonstrated in clinical trials, comparative real-world safety data across diverse populations remain limited. This study aimed to characterize and compare adverse drug reaction (ADR) profiles associated with these agents using global pharmacovigilance data.

Materials and methods: This cross-sectional pharmacovigilance study analyzed ADR reports for minocycline, doxycycline, and chlorhexidine retrieved from the World Health Organization (WHO) VigiAccess database. ADRs were classified by System Organ Classes (SOCs) and Preferred Terms (PTs) according to the Medical Dictionary for Regulatory Activities (MedDRA). Disproportionality analysis was performed using reporting odds ratios (RORs) with 95% confidence intervals (CIs).

Results: A total of 78,891 ADR reports were analyzed (16,917 minocycline, 49,980 doxycycline, and 11,994 chlorhexidine), revealing distinct safety signal patterns. Minocycline showed prominent disproportionality signals for endocrine disorders (ROR = 9.64, 95% CI: 7.73-12.02) and hepatobiliary disorders (ROR = 3.69, 95% CI: 3.43-3.96). Doxycycline signals were mainly concentrated in gastrointestinal disorders (ROR = 1.55, 95% CI: 1.51-1.60) and psychiatric disorders (ROR = 1.41, 95% CI: 1.32-1.50). Chlorhexidine exhibited a distinct profile characterized by product-related issues (ROR = 4.52, 95% CI: 3.89-5.25) and a high number of oral-specific PT-level signals (n = 79). ADRs were more frequently reported in females (56.9-60.8%) and adults aged 18-44 years (26.7-39.6%). Serious outcomes were uncommon, with mortality rates of 0.143%, 0.10%, and 0.07% for minocycline, doxycycline, and chlorhexidine, respectively.

Conclusions: Adjunctive antimicrobial agents used in periodontal therapy demonstrate heterogeneous real-world safety signal profiles. Disproportionality patterns indicate that local administration does not preclude systemic biological relevance, underscoring the need for agent-specific, guideline-concordant risk-benefit assessment in clinical decision-making.

Background: Extensive retraction of mandibular incisors in Class III treatment may increase the risk of orthodontically induced apical root resorption (OIARR). This retrospective cohort study aimed to assess the incidence and severity of OIARR in Class III patients treated nonsurgically with lingual high precision fixed appliances (HPFAs) and significant anterior tooth retraction.

Methods: Eligible for inclusion were adolescent and adult Class III patients treated with lingual HPFAs (WIN, DW Lingual Systems GmbH) and extraction of lower premolars, who completed treatment between 2015 and 2024. Pre- (T0) and post-treatment (T1) panoramic radiographs were measured for root and crown lengths, with relative root resorption (rRR, %) calculated for each tooth. Clinically relevant OIARR was assessed using the Malmgren index (scores 1-4). Statistical significance of mean rRR (%) changes was assessed using one-sample t-tests (α = 0.05).

Results: A total of 25 patients (mean age at T1 26.8 ± 9.7 years; 12 females, 13 males; mean Wits at T0 -6.7 ± 2.5 mm) and 350 mandibular teeth were analyzed. The mean rRR for anterior teeth was 3.15 ± 4.05%, with no cases of severe resorption (Malmgren score 4) and only 6.7% of roots exhibiting clinically relevant shortening (Malmgren score 3). There was no increased risk of OIARR in anterior teeth compared to premolars and molars (3.15% vs. 3.31%).

Conclusion: Extensive bodily retraction of lower anterior teeth was not associated with significant OIARR in this Class III cohort. Excellent torque control using HPFAs enabled considerable retraction with low risk of OIARR, supporting this approach as a safe nonsurgical alternative for Class III camouflage.

Objective: To evaluate the clinical efficacy of digital occlusal splints in alleviating pain and dysfunction in patients with temporomandibular disorders (TMD) and underlying mechanisms.

Methods: TMD patients were enrolled and divided into digital and conventional occlusal splint groups (n = 66/group). Clinical outcomes, including visual analog scale (VAS) scores and temporomandibular function indices [Craniomandibular Index (CMI), Dysfunction Index (DI), Palpation Index (PI)], were assessed pre- and post-treatment. Cone-beam computed tomography (CBCT) was used to analyze condylar positional changes and joint space adaptation, while quantitative polymerase chain reaction and enzyme-linked immunosorbent assay measured serum levels of inflammatory markers. Correlations between clinical, structural, and biochemical parameters were examined.

Results: Both groups exhibited significant post-treatment reductions in VAS scores, CMI, DI, and PI (P < 0.05), with the digital group demonstrating superior improvements in VAS, PI, and CMI compared to controls (P < 0.001). CBCT revealed favorable structural adaptations in both groups, though the digital group showed greater enhancements in glenoid fossa depth and medial joint space (P < 0.05). Biochemical analysis confirmed significant decreases in tumor necrosis factor-α (TNF-α), fibroblast growth factor receptor 3 (FGFR3), and nitric oxide synthase 2 (NOS2) levels, with additional reductions in nerve growth factor (NGF) and human leukocyte antigen B (HLA-B) observed exclusively in the digital group (P < 0.05).

Conclusion: Digital occlusal splints effectively mitigate TMD-related pain and dysfunction, likely through synergistic mechanisms involving occlusal stabilization, joint structural optimization, and inflammatory modulation. This technology represents a promising precision-based approach for personalized TMD management.