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Nano-topographical surface engineering for enhancing bioactivity of PEEK implants (in vitro-histomorphometric study).

Dental implants are currently becoming a routine treatment decision in dentistry. Synthetic polyetheretherketone (PEEK) polymer is a prevalent component of dental implantology field. The current study aimed to assess the influence of Nd:YAG laser nano-topographical surface engineering combined with ultraviolet light or platelet rich fibrin on the bioactivity and osseointegration of PEEK implants in laboratory and animal testing model. Computer Aided Design-Computer Aided Manufacturing (CAD CAM) discs of PEEK were used to fabricate PEEK discs (8mm × 3mm) N = 36 and implant cylinders (3mm × 6mm) N = 72. Specimens were exposed to Nd:YAG laser at wavelength 1064nm, and surface roughness topography/Ra parameter was recorded in nanometer using atomic force microscopy. Laser modified specimens were divided into three groups: Nd:YAG laser engineered surfaces (control), Nd:YAG laser/UV engineered surfaces and Nd:YAG laser/PRF engineered surfaces (N = 12 discs-N = 24 implants). In vitro bioactivity test was performed, and precipitated apatite minerals were assessed with X-ray diffraction analysis (XRD) and scanning electron microscopy (SEM). In vivo histomorphometric analysis was performed in rabbits with BIC% calculation. Ra mean value of PEEK laser engineered surfaces was 125.179nm. For the studied groups, XRD patterns revealed distinctive peaks of different apatite minerals that were demonstrated by SEM as dispersed surface aggregations. There was a significant increase in the BIC% from control group 56.43 (0.97) to laser/UV surfaces 77.30 (0.78) to laser/PRF 84.80 (1.29) (< 0.0001). Successful engineered nano-topographical biomimetic PEEK implant could be achieved by Nd:YAG laser technique associated with improving bioactivity. The combination with UV or PRF could be simple and economic methods to gain more significant improvement of PEEK implant surface bioactivity with superior osteointegration.

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Halitosis: etiology, prevention, and the role of microbiota.

This study aims to review halitosis research, discuss its various causes, and propose effective interventions based on the underlying etiologies and mechanisms. The main research question is to identify the primary factors contributing to halitosis and appropriate strategies to address them. A comprehensive literature review was conducted on halitosis and its associated causes, including oral pathological factors, oral microbial influences, microbial metabolic pathways, gastrointestinal diseases, and gut microbiota dysbiosis. Unhealthy eating habits and an imbalance of microorganisms in the oral cavity and gastrointestinal tract were identified as primary causes of halitosis. Dental caries, periodontal disease, xerostomia, and digestive disorders like gastritis and irritable bowel syndrome were also found to be related to the development of halitosis. Due to poor oral hygiene or antibiotic use, disruption of microbial communities can result in dysbiosis, inflammation, and halitosis. Halitosis is a multifactorial condition with various underlying causes, including oral and systemic diseases. Effective interventions should be tailored based on the specific etiologies and mechanisms involved. Understanding the factors contributing to halitosis is crucial for developing appropriate treatment strategies. Enhancing oral hygiene habits, using antimicrobial drugs, or administering probiotics may help regulate oral or intestinal flora, thereby improving halitosis and overall oral health.

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A novel porous hydroxyapatite scaffold (pHAMG) enhances angiogenesis and osteogenesis around dental implants by regulating the immune microenvironment.

The purpose was to evaluate whether a novel porous hydroxyapatite (HA) scaffold with a 25-30-µm groove structure (pHAMG) may improve bone osteogenesis, angiogenesis, and bone integration of titanium dental implants in animal models. The pHAMG was prepared by chemical precipitation method and its elemental composition and crystal structure were evaluated. The ability of the scaffolds to induce ectopic osteogenesis and the ability of scaffolds combined with titanium dental implants to induce orthotopic peri-implant angiogenesis, osteogenesis, and osteointegration were tested after implantation into the femur muscle pocket in rats and the mandibular defects in beagle dogs, respectively. The elemental composition was evaluated by SEM-EDS; the expression of the relevant osteogenic/inflammation marker and the anti-/pro-inflammation markers was evaluated by immunostaining and immunofluorescence, respectively. In animal experiments with ectopic and peri-implant osteogenesis, pHAMG resulted in significantly larger neovascularization by hematoxylin-eosin staining, as well as deposition of collagen fibers by Masson staining than HA. Meanwhile, microgrooves in pHAMG upregulate more bone morphogenetic protein (BMP) 2 and interleukin-4 (IL-4) and -10 (IL-10) and downregulate more IL-1β and tumor necrosis factor-α (TNF-α) than that in HA. The pHAMG showed greater expression of arginase (Arg)-1 and lower expression of inducible nitric oxide synthase (iNOS) than HA. The novel pHAMG can better repair bone defects in ectopic and orthotopic model. It also transfers macrophages to anti-inflammatory phenotypes, promoting angiogenic and osteogenesis in scaffolds, and bone integration in implants. The novel pHAMG induce greater osteogenesis and angiogenesis which could be utilized in the clinical treatment.

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Modulation of monocyte subtypes in diabetes after non-surgical periodontal treatment.

The current study aims to evaluate the effect of non-surgical periodontal treatment on the modulation of monocyte phenotype, in the presence or absence of diabetes. The identification, quantification, and phenotypic characterization of monocyte subtypes (classical, intermediate, and non-classical) were performed by flow cytometry, at baseline and 1month after the end of non-surgical periodontal treatment, in patients with periodontitis, associated or not with diabetes. There was an increase in non-classical monocytes after treatment and a reduction in intermediate monocytes, without differences for the classical subtype, regardless of the diabetes status. Furthermore, there was a reduction in intermediate monocytes and an increase in non-classical and classical monocytes after treatment in the diabetes group, while no significant differences were observed for classical, intermediate, and non-classical monocytes in the group without diabetes. Comparisons between the two groups showed significant differences for classical, intermediate, and non-classical monocytes at baseline; these differences were not found one month after treatment. Non-surgical periodontal treatment leads to modulation of monocytes to a less inflammatory phenotype, especially in individuals with diabetes. A better understanding of the role of these biomarkers in the periodontitis contex may constitute a new strategic target for a better treatment of patiens with diabetes associated to periodontitis. Brazilian Registry of Clinical Trials-RBR-35szwc. Jhefferson Miranda Alves and Danielle Borges Germano contributed equality to this study and should be considered first authors.

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Three-dimensional evaluation of social smile asymmetry in patients with unilateral impacted maxillary canine: a 3D stereophotogrammetry study.

This study aimed to evaluate social smile asymmetry in patients with unilateral impacted maxillary canine on 3D stereophotogrammetric images. The 3D social smile images of participants with unilateral impacted maxillary canine (n:20) and without impaction as a control group (n:20) were included. The images were recorded with a hand-held 3D stereophotogrammetry device (Fuel3D® Scanify®) and Geomagic Essentials 2 reverse engineering software were used for analyses. After the orientation process of the 3D records, the tissues around the smile area were divided into five morphological regions: cheek, upper lip lateral and medial, and lower lip lateral and medial. The deviation margins in the negative and positive directions for the 95% mesh rate and the total percentages of meshes between - 0.5- and + 0.5-mm deviations were calculated. ICC, paired samples t test, independent samples t test, and the Mann-Whitney U test were used for statistical analyses. In individuals with impacted canine, the amount of maximum positive deviation in the upper lip medial was 5.64mm ± 1.46 and maximum negative deviation was - 4.6mm ± 1.17. In the control group, mean of deviation limits for all parameters was less than 1.19mm ± 2.62, while in individuals with unilateral impacted maxillary canine, the maximum value was 8.34mm ± 2.23. The mesh percentage between - 0.5 and 0.5-mm deviations was over 95% in all morphological areas in the control group, while in the impacted canine group, the number of meshes within the specified deviation limits was less than 95%. Individuals with unilateral impacted maxillary canine exhibit greater asymmetry in social smile compared to the control group, with the asymmetry being most prominent near the corners of the mouth and cheeks. Amount of asymmetry was higher in impaction group compared to the control group in social smile. The quantification of a possible smile asymmetry due to the impacted canine is crucial for the diagnosis and treatment planning of orthodontic and/or orthognathic cases for ideal aesthetic results. Hence, smile asymmetry should not be overlooked and should be considered in diagnosis and treatment planning.

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Effects of enamel matrix derivative in nonsurgical periodontal therapy on pro-inflammatory profiles, microbial environment and clinical outcome: a randomized clinical trial.

This study aimed to evaluate the impact of enamel matrix derivative (EMD) application following subgingival instrumentation of residual pockets in periodontitis patients on inflammatory host response, microbiological composition, and clinical outcome. In this double-blinded randomized controlled trial, a total of 22 patients with generalized periodontitis stage III or IV presenting with ≥ 6mm probing pocket depth (PPD) at re-evaluation after initial periodontal therapy were included. Participants were randomly allocated at a 1:1 ratio to subgingival instrumentation with (EMD +) or without (EMD-) non-surgical EMD application into the pocket. PPD, clinical attachment level (CAL), bleeding on probing (BoP), plaque index (PI), as well as a panel of pro-inflammatory cytokines and periodontal pathogen count in the gingival crevicular fluid (GCF) of the respective sites were evaluated at baseline (T0) and six months afterwards (T1). Both treatment groups showed a significant PPD reduction (EMD + 1.33 ± 1.15mm, p < 0.001; EMD- 1.32 ± 1.01mm, p < 0.001) as well as CAL gain (EMD + 1.13 ± 1.58mm, p < 0.001; EMD- 0.47 ± 1.06mm, p = 0.005) from T0 to T1. While no intergroup differences for PPD reduction were observed, CAL gain was higher in EMD + sites compared to EMD- (p = 0.009). No essential effects on cytokine expression as well as bacterial count were detected. Application of EMD as an adjunct to subgingival instrumentation of residual pockets yielded benefits regarding CAL gain; however, effects on PPD reduction, inflammatory cytokines, and bacterial count were negligible. ClinicalTrials.gov (NCT04449393), registration date 26/06/2020. Based on the obtained results, additional non-surgical EMD application compared to subgingival instrumentation alone showed no clinically relevant effects on treatment outcome and underlying biological mechanisms.

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Influence of intracanal medicaments on the periodontal and periapical healing in concurrent endodontic-periodontal lesions with/without communication: a systematic review and meta-analysis.

The purpose of this review is to determine the effectiveness of intracanal medicament (ICM) on periodontal and periapical healing (PH) of concurrent endodontic-periodontal lesions with/without communication in permanent teeth. The pre-defined protocol was registered in PROSPERO, and a literature search using keywords was conducted on PubMed, Scopus, Cochrane, Embase electronic databases, and Gray literature and was hand-searched until August 2023. Two reviewers independently screened the title and abstracts using the inclusion criteria. Randomized or non-randomized clinical trials, cohort studies, and case-control studies were included in the review. The same reviewers extracted the study-level data and assessed the risk of bias using the Cochrane Risk of Bias 2.0 and the Newcastle-Ottawa Scale (NOS) independently. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to assess the certainty of evidence. Random effects meta-analysis was performed on eligible studies using Revman software. A total of 598 records were identified from the database search; seven studies met the inclusion criteria and were included in the review. Four randomized clinical trials, two prospective cohorts, and one retrospective case-control study with 362 patients were included. Calcium hydroxide (CH) was the most commonly used ICM, followed by using chlorhexidine gel in four studies. Periodontal therapy was performed as initial scaling and root planning (SRP) in all studies, along with open flap debridement (OFD) in three randomized clinical trials. The time lapse between two treatment protocols was variable (ranging from 1 week to 3 months). All studies exhibited a decrease in probing depth (PD) and an increase in clinical attachment level (CAL) after the treatment. Meta-analysis showed insignificant differences between different ICM materials, and the certainty of evidence was low. In patients with/without concurrent endodontic-periodontal lesions, intracanal medication improved clinical periodontal parameters following endodontic therapy. In terms of influence on periapical healing, the results were inconclusive. Two-visit RCT may be considered since it allows for the placement of an ICM in endodontic-periodontal lesions with/without communication. Sufficient time should be allowed after endodontic therapy for any potential periodontal regeneration to occur.

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Investigation of aging resistance for dental resin composites with and without glass flakes.

Outstanding physical-mechanical properties and aging resistance are key requirements for dental resin composite since it will be placed in the oral environment for a long time. In this work, a new dental resin composite mainly modified by glass flakes was fabricated, and the aging resistance was evaluated by comparing with commercial composites without glass flakes. The new dental resin composite was produced through hand blending of inorganic glass flakes/Si-Al-borosilicate glass (58wt%:7wt% of dental resin composite), POSS-MA (5wt% of resin matrix), Bis-GMA/TEGDMA(64.4wt%:27.6wt% of resin matrix), and CQ/EDMAB (0.9wt%:2.1wt% of resin matrix) together. The flexural strength, elasticity modulus, and hardness, as well as wear were tested for evaluating the aging resistance of different dental resin composite. Among 6 kinds of commercial composites in this study, after 6-month water storage, the maximum percentage of performance degradation is that the flexural strength decreased 39.96%, elasticity modulus decreased 51.53% and hardness decreased 12.52%. In contrast, the new synthesized material decreased 14.53%, 20.88%, and 0.61%, respectively, and performed lesser wear depth compared to some other groups (P < 0.05). It was observed that the new dental resin composite performed better performance stability and wear resistance when compared with commercial dimethacrylate-based or low shrinkage dental resin composite tested in this study. This possibly paves a path for designing tailored dental composite for practical application. Since the aging resistance of dental resin composite modified by glass flakes is superior, it has the potential to be used for promoting the durability of dental resin composite.

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The recent ethics boom in dentistry-moral fig leaf, fleeting trend or professional awakening?

"Ethics in dentistry" seems to be gaining importance as more and more dental institutions, professional associations and dental schools are addressing ethical issues. The aim of this paper is to highlight this ongoing development and to analyze and evaluate its relevance for future dentistry and the dental profession. A qualitative analysis of literature and Internet sources served as the methodological basis. Recent trends were first illustrated using striking examples and then compared with the status quo in medicine and the medical profession, where ethics have a long professional tradition. It is discussed to what extent it seems worthwhile to transfer existing structures and initiatives in medicine to dentistry. There is a broad variety of ethical announcements and initiatives in international dentistry (e.g., dental codes of ethics, adjustments to dental licensure regulations, professional publications, textbooks, awards, podcasts). It should be noted that ethical issues arise not only in life-threatening situations, but also in everyday dental practice. Existing ethical structures in medicine can be adapted or provide guidance for education, clinical practice and research. Teaching ethical competence in dental education, clinical practice and research can make an important contribution to the professionalization of dentists-quite similar to medicine. Furthermore, a broad integration of ethics in dentistry strengthens the public image of dentists. Dealing confidently with ethical issues is a key competence for successful work as a dentist-both in practice and in science.

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Association between rheumatoid arthritis and pulpal-periapical pathology: a systematic review.

Rheumatoid arthritis (RA) is a debilitating disease where numerous pro-inflammatory cytokines have a proven role in its pathology. These cytokines are also involved in the pathogenesis of apical periodontitis (AP) where they have a pro-inflammatory role and induce bone resorption. Patients with RA may therefore be more prone to develop pulpal-periapical pathology (PPP). This study systematically reviewed the existing literature evaluating the association between RA and PPP. Studies including human participants with both RA and PPP were included. The search was performed in PubMed, Web of Science, and The Cochrane Library databases using keywords and Medical Subject Headings (MeSH) search terms. The risk of bias was assessed using Newcastle-Ottawa Quality Assessment Scale. The following parameters were extracted and analyzed by the reviewers; author, journal, year, design of the study, diagnostic criteria for periapical pathology, the association between rheumatoid arthritis and periapical pathology, and the evidence level. The search identified 142 records. Inclusion criteria were as follows; studies in the English language, including human participants only, including patients with RA and PPP, cohort studies, cross-sectional studies, clinical trials, and case-control studies. According to the inclusion criteria, 5 studies were included in this systematic review. Three of the five studies reported significant association between RA and PPP. Existing evidence suggests there may be an association between RA and PPP. Clinicians should be aware that RA patients can be more prone to develop PPP which may result in a reduced quality of life.

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