Evidence Consensus Statement Research Articles

Low-dose Oral Minoxidil in the Treatment of Alopecia: Evidence and Experience-based Consensus Statement of Indian Experts.

Alopecia is a highly prevalent condition worldwide including in India. There are different types of alopecia with differing etiology, presentation, and hence treatment. Androgenetic alopecia represents the most common form of hair loss affecting male as well as female population termed as male and female pattern hair loss, respectively. Several treatment options are available for the treatment of alopecia with often unsatisfactory results resulting in psychological distress among such patients. Topical minoxidil is known to be effective in the treatment of alopecia. However, oral minoxidil is not currently approved for the treatment of alopecia. This expert consensus is prepared to provide guidance to the clinicians regarding the use of oral minoxidil in the treatment of alopecia. Extensive literature review was performed to prepare the draft consensus which was then revised based on the suggestions and comments from the experts. The final draft was circulated to the experts for review and approval. This consensus document provides overview of evidence related to oral minoxidil and consensus from the experts for its use in the treatment of minoxidil.

Oral Tranexamic Acid for the Treatment of Melasma: Evidence and Experience-Based Consensus Statement from Indian Experts.

Melasma, a chronic pigmentary skin condition mainly affecting the face, remains a challenge despite the availability of several options for treatment. Many melasma patients are not satisfied with treatment outcomes. Tranexamic acid (TXA), an anti-fibrinolytic drug has shown promising results in patients with melasma. Evidence from several clinical studies has surfaced on efficacy and tolerability of TXA in these patients. It can be used as monotherapy or adjuvant with other therapies. Currently, there is no published consensus or guideline document for its use in the treatment of melasma. TXA is available for oral use, topical use as well as an injection. In this article, a consensus of Indian experts is prepared based on the available literature and experience with use of oral TXA in melasma. This review article might help clinicians for use of oral TXA appropriately while treating melasma.

American Academy of Periodontology best evidence consensus statement on the use of biologics in clinical practice.

A biologic is a therapeutic agent with biological activity that is administered to achieve an enhanced regenerative or reparative effect. The use of biologics has progressively become a core component of contemporary periodontal practice. However, some questions remain about their safety, indications, and effectiveness in specific clinical scenarios. Given their availability for routine clinical use and the existing amount of related evidence, the goal of this American Academy of Periodontology (AAP) best evidence consensus (BEC) was to provide a state-of-the-art, evidence-based perspective on the therapeutic application of autologous blood-derived products (ABPs), enamel matrix derivative (EMD), recombinant human platelet-derived growth factor BB (rhPDGF-BB), and recombinant human bone morphogenetic protein 2 (rhBMP-2). A panel of experts with extensive knowledge on the science and clinical application of biologics was convened. Three systematic reviews covering the areas of periodontal plastic surgery, treatment of infrabony defects, and alveolar ridge preservation/reconstruction and implant site development were conducted a priori and provided the foundation for the deliberations. The expert panel debated the merits of published data and exchanged experiential information to formulate evidence-based consensus statements and recommendations for clinical practice and future research. Based on an analysis of the current evidence and expert opinion, the panel concluded that the appropriate use of biologics in periodontal practice is generally safe and provides added benefits to conventional treatment approaches. However, therapeutic benefits and risks range based on the specific biologics used as well as patient-related local and systemic factors. Given the limited evidence available for some indications (e.g., gingival augmentation therapy, alveolar ridge preservation/reconstruction, and implant site development), future clinical studies that can expand the knowledge base on the clinical use of biologics in periodontal practice are warranted.

MRI Evaluation of Uterine Masses for Risk of Leiomyosarcoma: A Consensus Statement.

Laparoscopic myomectomy, a common gynecologic operation in premenopausal women, has become heavily regulated since 2014 following the dissemination of unsuspected uterine leiomyosarcoma (LMS) throughout the pelvis of a physician treated for symptomatic leiomyoma. Research since that time suggests a higher prevalence than previously suspected of uterine LMS in resected masses presumed to represent leiomyoma, as high as one in 770 women (0.13%). Though rare, the dissemination of an aggressive malignant neoplasm due to noncontained electromechanical morcellation in laparoscopic myomectomy is a devastating outcome. Gynecologic surgeons' desire for an evidence-based, noninvasive evaluation for LMS is driven by a clear need to avoid such harms while maintaining the availability of minimally invasive surgery for symptomatic leiomyoma. Laparoscopic gynecologists could rely upon the distinction of higher-risk uterine masses preoperatively to plan oncologic surgery (ie, potential hysterectomy) for patients with elevated risk for LMS and, conversely, to safely offer women with no or minimal indicators of elevated risk the fertility-preserving laparoscopic myomectomy. MRI evaluation for LMS may potentially serve this purpose in symptomatic women with leiomyomas. This evidence review and consensus statement defines imaging and disease-related terms to allow more uniform and reliable interpretation and identifies the highest priorities for future research on LMS evaluation.

The Dahl Concept: Best Evidence Consensus Statement.

In a series of publications, Dahl and Krogstad promoted an orthodontic technique for the treatment of severe wear of the anterior teeth that reportedly could induce intrusion of the anteriors and extrusion of the posterior teeth to allow space to restore the worn anterior teeth. The purpose of this Best Evidence Consensus Statement was to evaluate the existing dental literature related to the Dahl Concept. A PubMed search limited to clinical studies, clinical trials, randomized controlled trials, systematic reviews, meta analyses, and journal articles, using the key words Orthodontics, Dahl appliance, Dahl concept and adult, revealed 11 citations, 9 of which were related. An additional 9 citations were culled from the reference lists in the aforementioned articles. The 20 articles that met the initial search criteria were evaluated and rated. The literature largely focused on the restorative materials that are commonly used to apply the Dahl technique. While there is low-level evidence from a few case series that demonstrated the ability to achieve enough space in the anterior region for the restoration of lost anterior tooth structure, there is no compelling evidence to support any theories as to how that space was achieved. In addition, there is no evidence to support the long-term stability of that position and the restorations. Negative position and restorative outcomes have been reported.

Mediotrusive Occlusal Contacts: Best Evidence Consensus Statement.

The impact of mediotrusive (MT) occlusal contacts has been a topic of controversy and confusion in both clinical practice and in the dental literature. The purpose of this Best Evidence Consensus Statement was to explore whether MT interferences are harmful in the natural or therapeutic occlusion directed by 4 focus questions relating to prevalence, jaw function, jaw dysfunction and biomechanical models. An electronic search in October 2020 sought evidence in MEDLINE (Ovid) using (mediotrus* OR nonworking side OR nonworking contact OR balancing side OR interfer* side OR premature contact) in the multipurpose (.mp) search field; and in Google Scholar using permutations of the above. Supplementary articles were sourced from the associated reference lists. There was no language restriction. The search yield was reviewed in duplicate. The electronic search identified 420 articles. Following screening, 164 were selected for eligibility assessments. Of these, 47 were included in the current paper. Non-standardized nomenclature and methodology is used to identify MT interferences in patient populations, with resultant prevalence varying from 0% to 77%, (median = 16%). MT interferences may alter the biomechanics of mandibular function. Together with the presence of repeated high loads resultant strain can manifest as pathophysiology of the temporomandibular joint and associated muscle structures. MT interferences should be avoided in any therapeutic occlusal scheme to minimize pulpal, periodontal, structural and mechanical complications or exacerbation of temporomandibular disorders (TMDs). Naturally occurring molar MT interferences should be eliminated only if signs and symptoms of TMDs are present. Literature supports there being a biomechanical basis which can explain how MT interferences may affect temporomandibular joint morphology and jaw function.

Does the Stomatognathic System Adapt to Changes in Occlusion? Best Evidence Consensus Statement.

The purpose of this Best Evidence Consensus Statement was to evaluate the existing literature on the stomatognathic system's ability to adapt to occlusal changes. The search term stomatognathic system was not useful as it resulted in over 400,000 results nor was the search term temporomandibular joint adaptation with 738 results due to the large number of references not related to the topic. The terms stomatognathic system adaptation to occlusal changes (186 results), teeth flexion (139 results), muscle adaptation to dental occlusion (278 results), and occlusal changes and neuroplasticity (11 results) provided the best selection of articles related to the topic. Limiting the above searches to systematic reviews and randomized controlled clinical trials resulted in multiple publications that were related to the question.9-13 Other literature reviews, data-based publications, and expert opinion resources have been included due to their relationship to the question. From the extensive list of search results, 242 articles were determined to be potentially related to the focus question and were evaluated with 56 being included in this paper. It was determined that the stomatognathic system adapts to occlusal changes through the temporomandibular joint, muscles, teeth and bone. The dynamically modified periosteum on the articulator surfaces of the condyle and fossa has a unique load-bearing morphology with 3 subarticular layers of fibrocartilage that absorb and dissipate both peak (impact) and sustained loads. Adaptability of the TMJs and muscles can be documented through studies where artificially produced occlusal interferences were placed in patients and those study participants with normal temporomandibular joints (TMJs) adapted fairly well whereas those with a previous history of temporomandibular disorders (TMD) did not adapt as well. Available evidence indicates patients generally adapt to the occlusal change inherent in orthodontic treatment, mandibular advancement surgery, and the use of mandibular advancement devices. The head and neck muscles also adapt to occlusal changes in patients without a history of TMD. The dentition adapts to changes through the bone and periodontal ligaments as well as the ability of teeth to undergo slight flexion under masticatory loading. This article is protected by copyright. All rights reserved.

The Effect of Patient Specific Factors on Occlusal Forces Generated: Best Evidence Consensus Statement.

The purpose of this Best Evidence Consensus Statement was to search the literature to determine if there is a relationship between patient specific factors and occlusal force. A literature review was conducted in the following databases: Evidence-Based Medicine Reviews (EBMR), Cochrane Database of Systematic Reviews, Embase, and Ovid MEDLINE(R) and Epub Ahead of Print. Articles on patient factors and occlusal force were compiled by using a combination of the key words: "bite force," "occlusal force," "partial and complete edentulism," "bruxism," and "orthognathic class." Inclusion criteria included meta-analyses, systematic reviews, randomized controlled trials, case series, and journal articles. Exclusion criteria were case reports, studies in children, animals, and bench studies. Of the 1502 articles that met the initial search criteria, 97 related to patient-specific factors affecting occlusal forces. These articles were evaluated, rated, and organized into appropriate categories addressing questions of foci. The range of occlusal force is highly variable among subjects correlated to patient specific factors such as age, gender, partial and complete edentulism, the presence of a maxillofacial defect, location of edentulous area, orthognathic profile, and magnitude of occlusal vertical dimension. Tooth replacement therapies targeted at increasing occlusal contact seem to have a positive effect on increasing occlusal force. Bruxism does not necessarily demonstrate higher occlusal powering but may have greater tooth contact time. Occlusal force is not clearly affected by the type of dental restoration or restorative material used. The clinical significance of the changes in occlusal forces is yet to be determined.

Tooth Wear: Best Evidence Consensus Statement.

The purpose of this Best Evidence Consensus Statement was to evaluate the impact of wear on teeth. A search updated last on the 07th October 2020 using the terms tooth wear, dental erosion, dental abrasion or dental attrition yielded 11,694 results. Limiting the search to clinical trials, cross-sectional investigations, randomized controlled trials, reviews, systematic reviews and meta-analysis yielded 1,769 results. Mechanistic in vitro studies were also added to the list of abstracts supplying additional information of the impact of wear on teeth. All abstracts were reviewed by two authors. Those relating to the focus question formed the evidence base which was used to formulate the response. From the search results, 212 articles were related to the research question and 60 were included in this paper. Although tooth wear prevalence is over 30% of the population in early adulthood and increases as individual's age, the impact on the dentition is poorly investigated in longitudinal clinical studies. Wear on teeth can result in alterations in shape and potentially dentine hypersensitivity depending on the etiology. However, the process is slow and pulpal death is rare. The impact that tooth wear has on the patient depends on patient characteristics to a greater extent than the severity of wear. Tooth wear is a common condition and part of the ageing process. Erosive tooth wear is a term which acknowledges that acids are normally linked to progression, but mechanical actions of attrition and abrasion will cause visible damage. The changes to the shape of teeth on the macro and micro levels are used to investigate the progression, prevention, etiology, and management. The biological impact of wear on teeth is relatively innocuous and management is often a patient driven process. This article is protected by copyright. All rights reserved.

Occlusal Schemes for Implant Restorations: Best Evidence Consensus Statement.

Numerous studies have focused on the various complications with implant-retained restorations and a common thread in these publications is the potential for occlusal overload. The purpose of this Best Evidence Consensus Statement on implant occlusal schemes was to review the literature to determine the level of scientific evidence upon which the articles are based. Limiting the search to Clinical trials, Randomized Controlled Trials, Systematic Reviews, Meta-analyses, the key words: dental implants, occlusion, found no citations. Expanding the search to Journal articles found 1,483 results, 20 of which pertained to the question. Doing a similar search including Journal Articles, the key words: dental implants and occlusal scheme found 47 citations, 17 of which were pertinent to the question. After eliminating duplicates and non-relevant articles, 15 were included in the review. Nineteen additional articles were culled by going through the reference lists in the aforementioned articles. There is a lack of scientific evidence regarding the occlusal scheme utilized with implant restorations that will minimize or eliminate complications. In light of this lack of scientific evidence, the style of occlusion a practitioner utilizes with tooth or mucosal supported prostheses may be used with implant-supported restorations until compelling evidence dictates otherwise.

The Relationship Between Centric Occlusion and The Maximal Intercuspal Position and Their Use as Treatment Positions for Complete Mouth Rehabilitation: Best Evidence Consensus Statement.

The purpose of this Best Evidence Consensus Statement was to evaluate the existing literature relative to two focus questions: How often does centric occlusion coincide with maximal intercuspal position in dentate and partially dentate populations?; and should centric occlusion or maximal intercuspal positions be equivalent for dentate and partially dentate patients undergoing complete mouth rehabilitation? Keywords used in the initial search were: intercuspal position, centric occlusion, centric relation, maximal intercuspal position, prosthodontic rehabilitation, and occlusion. The search was then limited to Systematic Reviews, Randomized Controlled Studies, Meta-analyses and Clinical Trials. The initial search strategy related to the selected search terms resulted in more than 15,000 articles. When the subsequent search was limited to Systematic Reviews, Randomized Controlled Studies, and Meta-Analysis and Clinical Trials, 313 articles were selected for further analysis. Review of the literature reveals that most dentate and partially dentate patients do not have coincident centric occlusion and maximal intercuspal position. There is support for coincidence between centric occlusion and maximal intercuspal position as the preferred occlusal relationship in complete mouth rehabilitations. The literature does not report conclusive evidence of adverse prosthodontic outcomes with complete rehabilitations in centric occlusion or maximal intercuspal position in a healthy population. However, there is support for an association between centric occlusion-maximal intercuspal position discrepancies and occlusal instability as well as temporomandibular joint disorders. Hence, it is concluded that partially and completely dentate patients requiring complete mouth rehabilitation should be restored in centric occlusion.

What Materials and Reproducible Techniques May Be Used in Recording Centric Relation? Best Evidence Consensus Statement.

The purpose of this Best Evidence Consensus Statement was to evaluate the existing literature relative to two focus questions: What are the techniques used and their reproducibility in recording centric relation (CR) in a dentate and partially dentate population and what effect do different recording materials have on the reproducibility of CR? Keywords used in the initial search were: CR, interocclusal records, CR accuracy, CR reproducibility, and CR technique. The search was then limited to Systematic Reviews, Randomized Controlled Studies, Meta-analyses, and Clinical Trials. Initial search related to the selected search terms resulted in more than 3500 articles. When subsequent search was limited to Systematic Reviews, Randomized Controlled Studies, and Meta-Analysis and Clinical Trials, this resulted in 291 articles selected for further analysis. Techniques using chin point guidance, bimanual manipulation, power centric, Gothic arch tracing, leaf gauge, and anterior deprogramming devices to record CR can all be comparable in precision and clinical accuracy in regards to clinical relevance. Practitioner experience and familiarity with a particular technique is critical for accuracy when recording CR. Polyvinyl siloxane and polyether consistently performed better in the broad range of studies on recording materials. Virtual capture of CR could serve as a comparable recording medium but requires further clinical study.

Angle's Classification-A Prosthodontic Consideration: Best Evidence Consensus Statement.

This Best Evidence Consensus Statement evaluated the existing Angle's classification clinical literature to determine if the Angle's classification as historically determined in maximum intercuspal position (MIP) with hand held casts is coincident with the centric occlusion (CO) determined Angle's classification. In addition, it explored the value of using Angle's classification for edentulous patients MATERIALS AND METHODS: The search strategy was related to the focus questions and limited to Meta-analyses, Systematic Reviews (SR), Randomized Controlled Trials (RCT) and Clinical Trials. Searches were completed using the term Angle's classification and Boolean Modifiers (AND) with the key terms: dental occlusion, dental occlusion centric, centric occlusion, centric relation, maximal intercuspation, MIP, intercuspal position, and edentulous patient, retrognathia, determination, and prognathia. Additional related articles were culled from the reference lists in the articles found in the PubMed searches. The search identified 494 articles related to the selected terminology. Titles were reviewed and selected if related to the focus questions for further review. Seven papers could be identified that addressed the specifics of the questions. There is evidence that the Angle's classification for many patients will change when recorded in CO compared to the historical MIP determination/definition. A different Angle's classification recorded in CO is potentially a significant diagnostic finding for patients needing complete mouth rehabilitation. The current definitions of Angle's Classification are not useful in the management of edentulous patients.

Complete Denture Occlusion: Best Evidence Consensus Statement.

The occlusal scheme required for an edentulous patient is controversial. The purpose of this Best Evidence Consensus Statement was to evaluate the existing complete denture literature related to occlusal schemes. A literature search was limited to Meta-analyses, Systematic Reviews (SR), Randomized Controlled Studies (RCT) and Clinical Trials. Key Words were: Complete dentures, occlusion, harm; Complete dentures, occlusion alveolar bone loss; Complete dentures, occlusion, stability; Complete dentures, occlusion. Additional related articles were culled from the authors' library and reference lists in the articles found in the PubMed searches. Of the 165 articles that met the initial search criteria, 34 related to the focus questions and were evaluated and rated. There is strong support that the average denture patient, with good residual ridges and no neuromuscular problems, will function adequately with a properly fabricated complete denture regardless of the occlusal scheme. There is neither strong support for or against bilateral balanced occlusal schemes as it relates to patient satisfaction, preference or chewing ability. There is some support for increased alveolar bone loss with complete dentures that have a non-balanced occlusion. There is a need for bilateral balanced occlusal schemes for patients presenting with loss of stability and retention as a result of their presenting conditions (PDI III and IV).

Bruxism: Best Evidence Consensus Statement.

The purpose of this Best Evidence Consensus Statement is to report on the prevalence, potential causes or association, treatment and cure of bruxism. A literature search limited to Clinical Trials, Randomized Controlled Trials, Systematic Reviews and Meta Analyses, with the key words bruxism, and prevalence identified 22 references, bruxism and causation 21, bruxism, and treatment 117, and bruxism and cure none. Prevalence received 5 references which were relevant to the question researched. Causation received 11 relevant references, treatment 34 relevant references and cure none. Eighteen additional references were culled from the reference lists in the aforementioned articles. Due to variations in demographics and the dependence on anamnestic data, the true prevalence of bruxism in any specific population is unknown. There is moderate evidence that psychosocial factors such as stress, mood, distress, nervousness, and feeling blue are associated with sleep bruxism (SB) as well as caffeine, alcohol, and smoking. There is no consensus on what symptoms of SB or awake bruxism (AB) should be treated. There is some evidence that occlusal devices and bio feedback therapies can be utilized in SB treatment. There is conflicting evidence in the use of Botulinum toxin A and no compelling evidence for the use of drug therapy to treat SB. There is not an established cure for bruxism. The clinician is best served in using caution in the dental rehabilitation of patients with severe occlusal wear.

Occlusal Vertical Dimension: Best Evidence Consensus Statement.

Patients in need of extensive prosthodontic treatment may need restoration of their occlusal vertical dimension (OVD) due to tooth wear, tooth loss, or changes that have occurred to existing prostheses over time. Prosthodontic treatment is based on the clinical application of the available evidence regarding interocclusal distance (IOD), the positional stability of rest vertical dimension (RVD), and the effect of altering the OVD. Hence, the purpose of this consensus document is to examine available data related to IOD, RVD, and alteration of the OVD. The search was limited to Clinical trials, Randomized Controlled Trials, Systematic Reviews and Meta-analyses. Key words were healthy patient, mean, range, interocclusal rest distance; healthy patient, mean, range, freeway space; and dentistry, interocclusal gap, and no citations appeared. Dentistry, interocclusal distance, revealed 5 not relevant citations. Dentistry, inter occlusal rest space, and dentistry, interocclusal rest distance, both had the same single not relevant citation. Dentistry, freeway space revealed over 7,000 citations. Dentistry, occlusal vertical dimension, revealed 253 citations, 7 of which were related to the search question but only 1 which was different from the previous search. Mandible, rest vertical dimension, age changes, found 7 citations, none relative to the question. Expanding the search to include journal article found 260 citations with only one relevant to the question. Mandible, rest vertical dimension, alteration, harm revealed no citations; mandible, occlusal vertical dimension, alteration, revealed 15 citations, 1 of which was relevant; mandible, occlusal vertical dimension, changes, revealed 75 citations, none of which were relevant; mandible, occlusal vertical dimension, rehabilitation revealed 10 citations, none of which were relevant. Expanding the search strategy to include Journal article, mandible, occlusal vertical dimension, alteration, received 159 citations, 4 of which were relevant; mandible, occlusal vertical dimension, restoration revealed 208 citations, 1 of which was relevant. Numerous other articles were culled by going through the reference lists of the aforementioned articles. For IOD, 27 articles were found relevant to the search question, which confirmed a mean of 3.0 mm with ranges from 1 to 9 mm. Five articles revealed little evidence as to whether the RVD changes during life. For OVD, 20 articles, including 4 systematic reviews, revealed some evidence that skeletal growth continues from mid adolescence into mid adulthood; strong anecdotal evidence that some unopposed teeth will continue to erupt; no clinical evidence to support the concept that abraded teeth in occlusion in a patient with bruxism will undergo continuous eruption; and some evidence from clinical case reports that restoring OVD in patients with severe abrasion is a successful treatment. There is a range of dimensions for the interocclusal distance (IOD) with many normal dental patients functioning with a higher or lower IOD than the commonly used 3.0 mm average dimension. The resting vertical dimension (RVD) is a 3-dimensional range with little evidence related to changes in the RVD during life. However, aging can cause a decrease in muscle tone which could affect the RVD. The restoration of the OVD can be successfully accomplished if proper diagnosis and treatment planning are performed.

American Academy of Periodontology best evidence consensus statement on modifying periodontal phenotype in preparation for orthodontic and restorative treatment.

American Academy of Periodontology best evidence consensus statement on modifying periodontal phenotype in preparation for orthodontic and restorative treatment.

American Academy of Periodontology best evidence consensus statement on the efficacy of laser therapy used alone or as an adjunct to non-surgical and surgical treatment of periodontitis and peri-implant diseases.

American Academy of Periodontology best evidence consensus statement on the efficacy of laser therapy used alone or as an adjunct to non-surgical and surgical treatment of periodontitis and peri-implant diseases.

American Academy of Periodontology Best Evidence Consensus Statement on Selected Oral Applications for Cone-Beam Computed Tomography.

The American Academy of Periodontology (AAP) recently embarked on a Best Evidence Consensus (BEC) model of scientific inquiry to address questions of clinical importance in periodontology for which there is insufficient evidence to arrive at a definitive conclusion. This review addresses oral indications for use of cone-beam computed tomography (CBCT). To develop the BEC, the AAP convened a panel of experts with knowledge of CBCT and substantial experience in applying CBCT to a broad range of clinical scenarios that involve critical structures in the oral cavity. The panel examined a clinical scenario or treatment decision that would likely benefit from additional evidence and interpretation of evidence, performed a systematic review on the individual, debated the merits of published data and experiential information, developed a consensus report, and provided a clinical bottom line based on the best evidence available. This BEC addressed the potential value and limitations of CBCT relative to specific applications in the management of patients requiring or being considered for the following clinical therapies: 1) placement of dental implants; 2) interdisciplinary dentofacial therapy involving orthodontic tooth movement in the management of malocclusion with associated risk on the supporting periodontal tissues (namely, dentoalveolar bone); and 3) management of periodontitis. For each specific question addressed, there is a critical mass of evidence, but insufficient evidence to support broad conclusions or definitive clinical practice guidelines.