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Restorative

Dentistry Current Awareness Newsletter

DECEMBER 2015

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Contents ................................................................................................................................................................ 4

New from the Cochrane Library .............................................................................................................. 4

New from Up-to-Date ............................................................................................................................. 5

New from the Dental Elf ......................................................................................................................... 6

Current Awareness Database Articles on Restorative Dentistry ............................................................ 7

Peri-implantitis .................................................................................................................................... 7

Bisphosphonate-related osteonecrosis of the jaw ........................................................................... 15

Dental-related cleft lip and palate .................................................................................................... 20

Periodontal disease and antibiotics .................................................................................................. 26

Head and neck oncology and dentistry ............................................................................................ 28

Dental implants ................................................................................................................................. 32

Journal Tables of Contents .................................................................................................................... 39

British Dental Journal .................................................................................................................... 39

Evidence Based Dentistry .............................................................................................................. 39

International Journal of Oral and Maxillofacial Implants ............................................................. 39

International Journal of Prosthodontics ....................................................................................... 39

Journal of Clinical Periodontology ................................................................................................ 39

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New from the Cochrane Library

Interventions for the treatment of oral and oropharyngeal cancers: targeted therapy and immunotherapy

Kelvin KW Chan ; Anne-Marie Glenny

Editorial Group: Cochrane Oral Health Group

Published Online: 1 DEC 2015; Assessed as up-to-date: 3 FEB 2015

Abstract: Oral cancers are the sixth most common cancer worldwide, yet the prognosis following a diagnosis of oral cavity or oropharyngeal cancers remains poor, with approximately 50% survival at five years. Despite a sharp increase in research into molecularly targeted therapies and a rapid expansion in the number of clinical trials assessing new targeted therapies, their value for treating oral cancers is unclear. Therefore, it is important to summarise the evidence to determine the efficacy and toxicity of targeted therapies and immunotherapies for the treatment of these cancers.

On Twitter?

Twitter can be a useful CPD tool. Here are some accounts will help you stay on top of new

developments in the Restorative Dentistry field:

@BSPerio – the Twitter account for The British Society of Periodontology

@BSSPD – the Twitter account for The British Society of Prosthodontics

@BESteethforlife – the Twitter account for The British Endodontic Society

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New from Up-to-Date

Medication-related osteonecrosis of the jaw in patients with cancer

Authors: James R Berenson, MD; Alison T Stopeck, MD

Literature review current through: Nov 2015. | This topic last updated: Aug 18, 2015.

INTRODUCTION — Osteonecrosis of the jaw (ONJ), which was first described in 2002 [1], is a

relatively uncommon but potentially serious side effect of treatment with antiresorptive

agents such as intravenous (IV) high potency bisphosphonates (image 1) and denosumab,

which decrease the risk of skeletal-related events (SREs) in patients with cancer and

metastatic bone disease. The increased dose intensity of anti-resorptive therapy typically

prescribed for cancer indications places cancer patients at a substantially higher risk for ONJ

than are patients who receive them for other conditions such as osteoporosis and Paget’s

disease [2-5].

ONJ has also been described as a complication of cancer therapies that target angiogenesis;

however, this association is more controversial with little confirmatory prospective trial data

available in the setting of monotherapy with an antiangiogenic agent alone. Use of

antiangiogenic agents is clearly a risk factor for medication-related ONJ (MRONJ) among

patients receiving antiresorptive agents for cancer.

This topic review will describe the incidence, risk factors, staging, clinical course, prevention

strategies, and management of MRONJ in patients with cancer who are receiving

antiresorptive agents. The incidence, risk factors, and management strategies for MRONJ in

patients receiving antiresorptive therapy for osteoporosis and other side effects associated

with bisphosphonates and denosumab in patients with cancer are addressed elsewhere

Management of late complications of head and neck cancer and its treatment

Authors: Thomas Galloway, MD; Robert J Amdur, MD

Literature review current through: Nov 2015. | This topic last updated: May 19, 2015.

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INTRODUCTION — Toxicity from cancer therapy is classified as acute or late based upon

when it develops relative to treatment. Acute toxicity develops during or shortly after the

completion of treatment and is usually temporary. Late toxicity presents months to years

after the completion of treatment and is often permanent. The term complication is used

for a treatment toxicity that causes an important medical problem.

This topic will review the late complications of treatment for head and neck cancer. The care

of patients with head and neck cancer during initial therapy, both to treat acute toxicity and

to prevent late complications, is discussed separately

New from the Dental Elf

Oral cancer- monoclonal antibodies combined with standard treatment may improve

outcomes

Dec 8 2015

Worldwide oral cancer is the 6th commonest cancer and 5-year survival rates following

diagnosis remain around 50% globally (63% in the USA) but have only shown limited

improvements since the 1970s. There has been a marked increase in research into

molecularly targeted therapies and these may have benefits for treating oral cancers

although their value is unclear.

Dental implants in atrophic jaws – shorter implants without augmentation may be the

first choice

Dec 2 2015

While the use of dental implants has becomes common sufficient bone volume is required

fro their placement. A range of reconstructive procedures including guided bone

regeneration, onlay or inter-positional grafts, raising of the floor of the maxillary sinus,

distraction osteogenesis, transposition of the alveolar nerve, and the use of shorter implants

have been used where sufficient bone is not available.

The aim of this review was to compare the use of longer implants with augmentation of the

alveolar ridge or shorter implants in native bone in patients with atrophic jaws.

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Current Awareness Database Articles on

Restorative Dentistry

Below is a selection of articles on restorative dentistry recently added to the healthcare databases,

grouped in the following categories:

Peri-implantitis

Bisphosphonate-related osteonecrosis of the jaw

Dental-related cleft lip and palate

Periodontal disease and antibiotics

Dental-related head and neck oncology

Dental implants

If you would like any of the following articles in full text, or if you would like a more focused

search on your own topic, then get in touch: library@uhbristol.nhs.uk

Peri-implantitis

Title: Clinical significance of interleukin-1 genotype in smoking patients as a predictor of peri-implantitis: A case-control study Citation: Medicina Oral, Patologia Oral y Cirugia Bucal, November 2015, vol./is. 20/6(e737-e743), 1698-4447;1698-6946 (November 2015) Author(s): Garcia-Delaney C., Sanchez-Garces M.-A., Figueiredo R., Sanchez-Torres A., Abstract: Background: Interleukin-1 (IL-1) is a proinflammatory cytokine that plays an important role in the pathogenesis of periodontitis, and so it might be useful to detect high-risk cases of peri-implantitis. It has been reported that IL-1 polymorphisms and smoking habit have a synergic effect, increasing the incidence of peri-implantitis. The aim of the present study was to evaluate the relationship between IL-1 gene polymorphisms and peri-implantitis in smoking patients. Material and Methods: A case-control study was performed in 27 patients with peri-implantitis and 27 patients with healthy implants. All patients included were smokers. IL-1A-C889T, IL-1B+C3953T and IL-1RN+T2018C were identified by polymerase chain reaction (PCR) amplification in order to establish a relation between these variables and the presence of peri-implantitis. A bivariate analysis was performed and odds-ratio (OR) were calculated. Results: The incidence of peri-implantitis was significantly higher in patients with previous history of periodontitis (p=0.024; OR=10.9). Both groups were similar regarding IL-1A-C889T, IL-1B+C3953T and IL-1RN+T2018C genotypes. No increased risk in heavy smokers with IL-1 polymorphism was found. Conclusions: IL-1 genotypes do not seem to be good predictors of peri-implantitis in the great majority of smoking patients.

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Furthermore, no synergic effect was found between IL-1 genotypes and heavy smokers. Patients with a previous history of periodontitis were more prone to peri-implantitis.

Title: The effects of Er:YAG on the treatment of peri-implantitis: a meta-analysis of randomized controlled trials Citation: Lasers in Medical Science, November 2015, vol./is. 30/7(1843-1853), 0268-8921;1435-604X (27 Nov 2014) Author(s): Yan M., Liu M., Wang M., Yin F., Xia H. Abstract: The clinical effectiveness of the erbium-doped yttrium-aluminum-garnet (Er:YAG) laser in patients with peri-implantitis remains unclear. The aim of this meta-analysis was to investigate the efficacy and safety of Er:YAG laser (ERL) compared to subgingival mechanical debridement (SMD) for the treatment of peri-implantitis. A systematic electronic literature search was conducted to identify randomized clinical trials (RCTs), followed by a manual search. Results were expressed as weighted mean differences (WMDs) with accompanying 95 % confidence intervals (CIs). The primary outcome measurements were changes in clinical attachment level (CAL) and probing depth (PD). Secondary outcome measurements included changes in gingival recession (GR). The meta-analysis was performed with fixed-effect or random-effect model according to the heterogeneity assessed by I² test. Visual asymmetry inspection of the funnel plot, Egger's regression test, and the trim-and-fill method were used to investigate publication bias. At 6 months, significant difference in PD reduction (p = 0.018) was observed for Er:YAG laser compared to SMD treatment, while no significant differences were detected in CAL gain and GR change; at 12 months, no significant difference was observed for any investigated outcome. The findings of this meta-analysis suggest that use of the Er:YAG laser as alternative to SMD could potentially provide short-time additional benefits, while there is no evidence of long-time superior effectiveness. As all included studies were not at low risk of bias, and only four studies were included in the meta-analysis, future long-term and well-designed RCTs reporting clinical and microbiological outcomes, considering the cost/effectiveness ratio, and having a high methodological quality are needed to clarify the effectiveness of Er:YAG laser.

Title: Prevalence of peri-implant inflammatory disease in patients with a history of periodontal disease who receive supportive periodontal therapy. Citation: Clinical oral implants research, Nov 2015, vol. 26, no. 11, p. 1338-1344 Author(s): Aguirre-Zorzano, Luis Antonio, Estefanía-Fresco, Ruth, Telletxea, Olatz, Abstract: To describe the status of implants in periodontally compromised patients who regularly receive supportive periodontal therapy (SPT) and to determine the factors associated to peri-implant inflammatory disease in those patients. Clinical and radiographic data of implants in periodontal patients who, after being treated and included in a SPT programme, wore implant prostheses for at least 6 months were recorded. The implants

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were classified according to the criteria of the 6th European Workshop on Periodontology in health, mucositis and peri-implantitis. Logistic regression analysis was performed to analyse the individual and adjusted effects of each study variable on mucositis or peri-implantitis, using SUDAAN to account for clustering (multiple implants within the patient). A total of 786 implants were placed in 239 patients. At patient level, 60.3%, 24.7% and 15.1% were classified as healthy, mucositis and peri-implantitis patients, respectively. At implant level, the respective percentages were 77.4%, 12.8% and 9.8%. For mucositis, at implant level, the adjusted ORs indicate a significant association with plaque index (P = 0.050), type of periodontitis (P = 0.030) and location (P = 0.045). For peri-implantitis, the adjusted ORs indicate a significant association with plaque index (P < 0.001) and location (P = 0.002). The prevalence of peri-implant inflammatory disease in periodontal patients who regularly undergo SPT is clinically significant. The factors associated with peri-implant inflammatory disease were plaque index and implant location, and mucositis was also affected by the type of periodontitis the patient had. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Title: Nonsurgical treatment of peri-implantitis using an air-abrasive device or mechanical debridement and local application of chlorhexidine. Twelve-month follow-up of a prospective, randomized, controlled clinical study. Citation: Clinical oral investigations, Nov 2015, vol. 19, no. 8, p. 1807-1814 (November 2015) Author(s): John, Gordon, Sahm, Narja, Becker, Jürgen, Schwarz, Frank Abstract: The purpose of this prospective, parallel group-designed, randomized controlled clinical study was the evaluation of the effectiveness of an air-abrasive device (AAD) for nonsurgical treatment of peri-implantitis. Twenty five patients, showing at least one implant with initial to moderate peri-implantitis, underwent an oral hygiene programme and were randomly treated using either (1) AAD (amino acid glycine powder) or (2) mechanical debridement using carbon curettes and antiseptic therapy with chlorhexidine digluconate (mechanical debridement (MDA)). Clinical parameters were measured at baseline and 12 months after treatment (e.g. bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL)). At 12 months, the AAD group revealed significantly higher (p < 0.05; unpaired t test) decrease in mean BOP scores when compared with MDA-treated sites (41.2 ± 29.5 vs. 16.6 ± 33.4 %). Both groups exhibited comparable PD reductions (AAD = 0.5 ± 0.9 mm vs. MDA = 0.4 ± 0.9 mm) and CAL gains (AAD = 0.6 ± 1.3 mm vs. MDA = 0.5 ± 1.1 mm) (p > 0.05; Mann-Whitney test, respectively). Within its limitations, the present study has indicated that both treatment procedures resulted in comparable but limited CAL gains at 12 months. Furthermore, it could be detected that AAD was associated with significantly higher BOP decrease than MDA. The present results have indicated that nonsurgical therapy of peri-implantitis using both AAD and MDA resulted in comparable PD reductions and CAL gains after 12 months of healing. The BOP reductions were significantly higher in the AAD in comparison to the MDA group. So, AAD may be more effective for nonsurgical therapy of peri-implantitis than MDA.

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Title: The utilization of a diode laser in the surgical treatment of peri-implantitis. A randomized clinical trial. Citation: Clinical oral investigations, Nov 2015, vol. 19, no. 8, p. 1851-1860 Author(s): Papadopoulos, Christos A, Vouros, Ioannis, Menexes, Georgios, Abstract: A comparison of different treatment modalities of peri-implantitis can lead to the development and application of more effective and efficient methods of therapy in clinical practice. This study compares the effectiveness of open flap debridement used alone, with an approach employing the additional use of a diode laser for the treatment of peri-implantitis. Nineteen patients were divided into two groups and treated for peri-implantitis. In the control group (C group), the therapy utilized access flaps, plastic curettes, and sterilized gauzes soaked in saline. The test group (L group) was treated similarly but with additional irradiation using a diode laser. The parameters studied were pocket depth (PD) as the primary outcome variable, clinical attachment level (CAL), bleeding on probing (BOP), and plaque index (PI) as secondary variables. Measurements were performed at three different time points, baseline (BSL), 3 months, and 6 months after treatment. Three months after treatment, a mean PD reduction of 1.19 mm for the control group and 1.38 mm for the laser group was recorded. The corresponding BOP changes were 72.9 and 66.7 %, respectively. These changes were significant and remained at the same levels at the 6-month examination (p < 0.05). CAL was reduced significantly only in group L from 5.25 mm at baseline to 4.54 mm at 3 months, remaining at this level at 6 months (p < 0.05). PI was reduced significantly in group C at 3 months from 37.5 to 6.3 %. The 6-month data showed no statistically significant difference (p < 0.05) from the 3-month measurements. The two methods of therapy for peri-implantitis examined seemed to be equally efficient in the reduction of the PD and BOP 3 months after surgery, with the results sustained at the same levels after 6 months. CAL significantly improved only in the test group after 3 months. PI was reduced and maintained at low levels in both groups. Surgical treatment of peri-implantitis by access flaps leads to improvement of all clinical parameters studied while the additional use of diode laser does not seem to have an extra beneficiary effect. The additional use of a diode laser in the surgical treatment of peri-implantitis offers a limited clinical benefit.

Title: An in vitro evaluation of the responses of human osteoblast-like SaOs-2 cells on SLA titanium surfaces irradiated by different powers of CO2 lasers. Citation: Lasers in medical science, Nov 2015, vol. 30, no. 8, p. 2129-2134 (November 2015) Author(s): Ayubianmarkazi, Nader, Karimi, Mohammadreza, Koohkan, Shima, Abstract: Bacterial biofilms have been identified as the primary etiological factor for the development and progression of peri-implantitis. Lasers have been shown to remove bacterial plaque from titanium surfaces effectively and can restore its biocompatibility without damaging these surfaces. Therefore, the aim of this study was to evaluate the responses (i.e., the cell viability and morphology) of human osteoblast-like SaOs-2 cells to

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sandblasted, large grit, and acid-etched (SLA) titanium surfaces irradiated by CO2 lasers at two different power outputs. A total of 24 SLA disks were randomly radiated by CO2 lasers at either 6 W (group 1, 12 disks) or 8 W (group 2, 12 disks). Non-irradiated disks were used as a control group (four disks). The cell viability rates of the SaOs-2 cells in the control and study groups (6 and 8 W) were 0.33 ± 0.00, 0.24 ± 0.11, and 0.2372 ± 0.09, respectively (P < 0.6). Cells with cytoplasmic extensions and spreading morphology were most prominent in the control group (141.00 ± 29.00), while in the study groups (6 and 8 W), the number of cells with such morphology was 60.40 ± 26.00 and 35.20 ± 5.40, respectively (P < 0.005). Within the limits of this study, it may be concluded that the use of CO2 lasers with the aforementioned setting parameters could not be recommended for decontamination of SLA titanium surfaces.

Title: The role of nicotine, cotinine and caffeine on the electrochemical behavior and bacterial colonization to cp-Ti. Citation: Materials science & engineering. C, Materials for biological applications, Nov 2015, vol. 56, p. 114-124 (November 1, 2015) Author(s): Barão, Valentim A R, Ricomini-Filho, Antonio P, Faverani, Leonardo P, Abstract: Although smoking promotes deleterious effect to bone healing, there is a lack of study investigating its role on the implant structure and biofilm growth. We hypothesized that nicotine, cotinine and caffeine would impair the corrosion resistance of commercially-pure titanium (cp-Ti) and would enhance Streptococcus sanguinis biofilm growth. Neither the smoking products nor the caffeine affected the corrosion tendency (P>.05) and the oxide layer resistance (P=.762) of cp-Ti. Lower capacitance values were noted in the presence of nicotine (P=.001) and cotinine (P=.0006). SEM showed no pitting corrosion, and the EDS spectra did not differ among groups. Nicotine (300μg/mL) induced higher surface roughness (P=.03) and greater surface change of cp-Ti. Nicotine at 3μg/mL, and cotinine at 0.3 and 3μg/mL increased the number of viable cells (P<.05). Biofilm exposed to nicotine (0.3, 3 and 30μg/mL) (P=.025, .030, .040, respectively) and cotinine (3 and 30μg/mL) (P=.027, .049, respectively) enhanced carbohydrate content. Biofilm biomass and protein content were similar among groups (P>.05). These findings suggest a greater biofilm accumulation in smokers, a risk factor that may lead to peri-implantitis. Copyright © 2015 Elsevier B.V. All rights reserved.

Title: A Randomized Clinical Trial of an Adjunct Diode Laser Application for the Nonsurgical Treatment of Peri-Implantitis. Citation: Photomedicine and laser surgery, Nov 2015, vol. 33, no. 11, p. 547-554 Author(s): Arısan, Volkan, Karabuda, Zihni Cüneyt, Arıcı, Selahattin Volkan, Abstract: In this radiographic and microbiologic split-mouth clinical trial, efficacy of a diode laser as an adjunct to conventional scaling in the nonsurgical treatment of peri-implantitis

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was investigated. Eradication of pathogenic bacteria and infected sulcular epithelium presents a significant challenge in the nonsurgical treatment of peri-implantitis. Ten patients (mean age, 55.1 years; SD, 11.4) with 48 two piece, rough-surface implants and diagnosed with peri-implantitis were recruited (NCT02362854). In addition to conventional scaling and debridement (control group), crevicular sulci and the corresponding surfaces of 24 random implants were lased by a diode laser running at 1.0 W power at the pulsed mode (λ, 810 nm; energy density, 3 J/cm(2); time, 1 min; power density, 400 mW/cm2; energy, 1.5 J; and spot diameter, 1 mm); (laser group). Healing was assessed via periodontal indexes (baseline and after 1 and 6 months after the intervention), microbiologic specimens (baseline and after 1 month), and radiographs (baseline and after 6 months). Baseline mean pocket depths (4.71, SD, 0.67; and 4.38, SD 0.42 mm) and marginal bone loss (2.71, SD 0.11; and 2.88, SD 0.18 mm) were similar (p = 0.09 and p = 0.12) between the control and laser groups, respectively. After 6 months, the laser group revealed higher marginal bone loss (2.79, SD 0.48) than the control groups (2.63, SD 0.53) (p < 0.0001). However, in both groups, the microbiota of the implants was found unchanged after 1 month. In this clinical trial, adjunct use of diode laser did not yield any additional positive influence on the peri-implant healing compared with conventional scaling alone.

Title: A Regenerative Approach to the Successful Treatment of Peri-implantitis: A Consecutive Series of 170 Implants in 100 Patients with 2- to 10-Year Follow-up. Citation: The International journal of periodontics & restorative dentistry, Nov 2015, vol. 35, no. 6, p. 857-863 (2015 Nov-Dec) Author(s): Froum, Stuart J, Froum, Scott H, Rosen, Paul S Abstract: This article presents the results of a consecutive case series of 170 treated peri-implantitis-affected implants in 100 patients with follow-up measurements from 2 to 10 years. A total of 51 implants in 38 patients previously reported on were followed for an additional 2.5 years, and 119 additional implants in 62 additional patients were treated with the same protocol and monitored for at least 2 years posttreatment. The treatment consisted of flap reflection, surface decontamination, use of enamel matrix derivative (EMD) or platelet-derived growth factor (PDGF), and guided bone regeneration with mineralized freezedried bone and/or anorganic bovine bone combined with PDGF or EMD and covered with an absorbable membrane and/or subepithelial connective tissue graft. Maintenance and monitoring followed every 2 to 3 months. Two implants were lost 6 months posttreatment, for a 98.8% survival rate. Bleeding on probing was eliminated in 91% of the treated implants. Probing depth reduction averaged 5.10 mm, bone level gain averaged 1.77 mm, and soft tissue marginal gain averaged 0.52 mm. These outcomes were obtained with one surgical procedure on 140 implants, with two procedures on 18 implants, and with three procedures on 10 implants. The results to date with this layered/combined regenerative approach for the treatment of peri-implantitis appear to be encouraging.

Title: Minimizing Excess Cement in Implant-Supported Fixed Restorations Using an Extraoral Replica Technique: A Prospective 1-Year Study.

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Citation: The International journal of oral & maxillofacial implants, Nov 2015, vol. 30, no. 6, p. 1355-1361 (2015 Nov-Dec) Author(s): Frisch, Eberhard, Ratka-Krüger, Petra, Weigl, Paul, Woelber, Johan Abstract: Cementation of implant-supported restorations poses two major challenges: (1) minimizing excess cement (reducing the risk of peri-implantitis), and (2) establishing sufficient retention (reducing the risk of decementation). This study presents the first data on a clinical cementation technique that might address both problems. Between 2011 and 2013, 39 patients were provided with 52 implants supporting 52 single crowns (SCs). All restorations were cemented extraorally using replicas made of pattern resin and zinc oxide cement. All decementation events and the peri-implant soft tissue status were assessed and compared with those from a group of 29 patients with 40 conventionally cemented SCs (control). In the experimental group, after 12 months, decementation was recorded in three individuals (7.69%) with 3 SCs (5.77%). In the control group, after 12 months, no case of decementation was recorded. No cases of peri-implantitis were detected in either group. Within the limitations of this study, the authors conclude that the use of zinc oxide cement initially establishes sufficient retention of implant-supported fixed restorations independent of conventional or replica cementation techniques.

Title: The effect of orally administered probiotic Lactobacillus reuteri-containing tablets in peri-implant mucositis: a double-blind randomized controlled trial. Citation: Journal of Periodontal Research, 2015, vol./is. 50/6(775-785), 00223484 Abstract: Background and Objectives Probiotics create a biofilm and protect the oral tissues against the action of periodontal pathogenic bacteria. The aim of this study was to evaluate the effects of the oral probiotic Lactobacillus reuteri Prodentis upon the peri-implant health of edentulous patients with dental implants and peri-implant mucositis, establishing comparisons vs implants without peri-implant disease. Material and Methods A double-blind, placebo-controlled, prospective cross-over study was made. The patients were all edentulous and were divided into two groups, (A) no peri-implant disease, and (B) peri-implant mucositis affecting one or more implants. Patients with peri-implantitis were excluded. The dosage was one tablet every 24 h over 30 d. All patients in both groups initially received the oral probiotic Lactobacillus reuteri Prodentis, followed by placebo. Patients started with probiotic treatment during 30 d, followed by a 6 mo washout period and the administration of placebo for the same period. The following parameters were studied: crevicular fluid volume, modified plaque index, probing depth, modified gingival index, and concentrations of interleukin 1β, interleukin 6 and interleukin 8. Results A total of 77 implants were evaluated in 34 patients. Group A involved 22 patients with 54 implants without peri-implant alterations, and group B, 12 patients with mucositis affecting one or more implants (23 implants). After treatment with the probiotic, both the patients with mucositis and the patients without peri-implant disease showed improvements in the clinical parameters, with reductions in cytokine levels. In contrast, no such changes were observed with placebo. Conclusions After treatment with the probiotic Lactobacillus reuteri

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in patients with implants presenting mucositis, the clinical parameters improved, and the cytokine levels decreased - in contraposition to the observations in the placebo group. Probiotic administration may be regarded as a good alternative for both the treatment of peri-implant mucositis and its prevention, as it also improved clinical parameters in the healthy individuals. Further studies involving larger patient series are needed regarding the effects of probiotics upon peri-implant health.

Title: Efficacy of air polishing for the non-surgical treatment of peri-implant diseases: a systematic review. Citation: Journal of Clinical Periodontology, 2015, vol./is. 42/10(951-959) Abstract: Focused Question: In patients suffering from peri-implant diseases, what is the efficacy of air polishing on changing signs of inflammation compared with control treatments (i.e. alternative measures for plaque removal with or without adjunctive antiseptic and/ or antibiotic therapy)? Material & Methods: After electronic database and hand search, 10 full-text articles were independently screened by two reviewers. Finally, a total of five studies (six publications) fulfilled the inclusion criteria. The weighted mean difference (WMD) [p; 95% CI] in bleeding on probing-(BOP) (primary outcome) and probing pocket depth-(PD) reductions was estimated using a random effect model. Results: All studies reported on residual BOP scores after therapy. A narrative data synthesis did not reveal any major improvement of bleeding index/ BOP or disease resolution following air polishing over mechanical debridement at mucositis sites. At peri-implantitis sites, WMD in BOP reduction between test and control (mechanical debridement with or without local antiseptic therapy, Er:YAG laser) groups was -23.83% [p = 0.048; 95% CI (-47.47, -0.20)] favouring air polishing over control measures. Conclusions: While glycine powder air polishing is as effective as the control treatments at mucositis sites, it may improve the efficacy of non-surgical treatment of peri-implantitis over the control measures investigated. A complete disease resolution was commonly not obtained.

Title: Bone reconstruction after surgical treatment of experimental peri-implantitis defects at a sandblasted/acidetched hydroxyapatite-coated implant: an experimental study in the dog. Citation: Journal of Clinical Periodontology, 2015, vol./is. 42/10(960-966), Abstract: Objectives: The objective of this study was to evaluate bone formation/osseointegration following surgical treatment of experimental peri-implantitis at dental implants with different surface characteristics exposed to ligature-induced breakdown conditions. Methods: Ten turned (control), 10 sandblasted/acid-etched (SA), and 10 SA/hydroxyapatite nanocoated (HA) implants were installed into the edentulated posterior mandible in five Beagle dogs and allowed to osseointegrate for 12 weeks. Ligature-induced breakdown defects were then induced over 23 weeks using stainless steel wire ligatures. The ligatures were removed and soft tissues were allowed to heal for 3 weeks. Next, exposed implant surfaces were decontaminated followed by guided bone regeneration using a collagen membrane and submerged wound healing. The animals were

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euthanized for histometric analysis at 12 weeks post-surgery. Results: The radiographic analysis showed vertical bone loss following ligatureinduced breakdown without statistically significant differences among implant technologies. The histometric analysis showed significantly enhanced bone formation (height) at SA and SA/HA compared with turned implants (p = 0.028) following reconstructive surgery. Bone formation area was greater at SA/HA compared with turned implants, however the difference did not reach statistical significance. Conclusions: While ligature-induced defect progression does not appear implant surface dependent in this animal model, bone formation at the decontaminated implant surfaces appears more favourable at SA and SA/HA over turned implants following reconstructive surgery.

Bisphosphonate-related osteonecrosis of the jaw

Title: Surgical treatment of bisphosphonate-associated osteonecrosis: Prognostic score and long-term results Citation: Journal of Cranio-Maxillofacial Surgery, November 2015, vol./is. 43/9(1809-1822), 1010-5182;1878-4119 (November 2015) Author(s): Reich W., Bilkenroth U., Schubert J., Wickenhauser C., Eckert A.W. Abstract: Over a century after the first synthesis of bisphosphonates (1897) and a decade (2003) since the initial report on bisphosphonate-related osteonecrosis of the jaw (ONJ), this osteopathy remains a serious clinical challenge. A single center longitudinal study (2005-2014) was carried out to prospectively characterize inpatients with manifest ONJ and to evaluate their outcomes. The data recorded were: medical history, bisphosphonate treatment, localization, imaging, treatment, histomorphological features, and complications. A prognostic score (modified UCONN-Score) was adopted to predict outcomes. Eighty patients were included (mean age 69.4 years; 40 male, 40 female). Breast cancer (n = 25), multiple myeloma (n = 16), and prostate cancer (n = 15) were the three most common malignancies; and cardiovascular disease (n = 31), diabetes mellitus (16), and renal disorders (6) were the most important comorbidities. The severity of ONJ was stage I in three patients, stage II in 37, and stage III in 40, being predominantly localized in the posterior mandible and needing gradual resection. The average duration of bisphosphonate treatment was 38.3 months. The typical histological aspects of ONJ were predominantly osteonecrosis, bone marrow fibrosis, and bacterial colonization (Actinomyces) with suppurative inflammation. Within the resected jawbone a primary malignancy was diagnosed in two cases. The overall success rate was 83.6% (follow-up 23.5 months), with a UCONN-Score >15 predicting unfavorable treatment results (OR = 5.2). The past decade has enhanced experience with ONJ treatment and knowledge about its pathogenesis, which seems to be a multistep process. This study demonstrates the importance of bone and multilayer soft tissue management, preferably as an early intervention. The UCONN-Score

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might help to assess individual prognosis in ONJ surgery and the potential benefit of an antiresorptive drug holiday. To our knowledge it is the first use of a prognostic score in ONJ surgery.

Title: Effects of alendronate and pamidronate on apoptosis and cell proliferation in cultured primary human gingival fibroblasts. Citation: Human & experimental toxicology, Nov 2015, vol. 34, no. 11, p. 1073-1082 Author(s): Soydan, S S, Araz, K, Senel, F V, Yurtcu, E, Helvacioglu, F, Dagdeviren, A, Abstract: Data arising from the recent literature directed the researchers to study on the degree and extent of bisphosphonate toxicity on oral mucosa in further detail. The aim of this study is to determine the half maximal inhibitory concentration of pamidronate (PAM) and alendronate (ALN) on human gingival fibroblasts in vitro using 3-[4.5-thiazol-2-yl]-2.5-diphenyltetrazolium bromide (MTT) assay and to evaluate the effects of both agents on the proliferation and apoptotic indices. Cells used in the study were generated from human gingival specimens and divided into alendronate (n = 240), PAM (n = 240), and control groups (n = 60). Based on the MTT assay results, 10(-4), 10(-5), 10(-6), and 10(-7) M concentrations of both drugs were administered and the effects were evaluated for 6, 12, 24, 48, or 72 h periods. An indirect immunofluorescence technique was used to evaluate apoptotic (anti-caspase 3) and proliferation (anti-Ki67) indices. Toxicity of both PAM and ALN was found to be the most potent at 10(-4)-10(-5) M range. The apoptotic index of PAM group was found to be significantly higher than ALN group for all concentrations especially at 24 h incubation time (p < 0.05). The decrease in the proliferation index was found similar in first 48 h for both drugs; however, after 72 h of incubation decrease in proliferation index in PAM group was found to be significantly higher (p < 0.05). Micromolar concentrations of not only PAM but also ALN rapidly affect cells generated from human oral gingival tissue by inducing apoptosis together with inhibition of proliferation. Cytotoxic effects of both ALN and PAM on primary human gingival fibroblasts, which cause significant changes in apoptotic and proliferative indices as shown in this in vitro study, suggests that the defective epithelialization of oral mucosa is possibly a major factor on the onset of bisphosphonate-related osteonecrosis of the jaw cases. © The Author(s) 2015.

Title: Ibandronate treatment of diffuse sclerosing osteomyelitis of the mandible: Pain relief and insight into pathogenesis. Citation: Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery, Nov 2015, vol. 43, no. 9, p. 1837-1842 (November 2015) Author(s): Otto, Sven, Troeltzsch, Matthias, Burian, Egon, Mahaini, Salah, Probst, Florian, Abstract: Diffuse sclerosing osteomyelitis of the mandible (DSO) is a rare and poorly understood disease. Current treatment protocols, including steroid or analgesic medication

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and corticotomies, show poor or frustrating outcome results and are accompanied by potentially severe side effects. The aim of this study was to determine whether there is a beneficial role of infusions with nitrogen-containing bisphosphonates (ibandronate) in acute conditions of DSO. Eleven patients were enrolled in the study. In acute conditions of treatment-resistant DSO, single-shot infusions of ibandronate (6 mg) were administered. Pain levels were documented 10 days before and after the infusion on a visual analogue scale (VAS). Patients were monitored regularly. Of the 11 patients, 10 showed a distinct improvement in pain (based on VAS scores) within 48-72 h after infusion. The pain levels of the patients were significantly lower after ibandronate infusions (p < 0.01). The majority of patients were free or almost free of complaints over the following months. Four of the 11 patients returned for repeated infusions. At the time of writing, no severe side effects have been observed, and in particular there has been no case of medication-related jaw osteonecrosis. We conclude that single-shot bisphosphonate infusions on demand are promising treatment alternatives in acute DSO. Single-shot bisphosphonate infusions of ibandronate were well tolerated and resulted in distinct, long lasting improvement in subjective pain levels based on VAS scores. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Title: Diagnosis and Staging of Medication-Related Osteonecrosis of the Jaw. Citation: Oral and maxillofacial surgery clinics of North America, Nov 2015, vol. 27, no. 4, p. 479-487 (November 2015) Author(s): Ruggiero, Salvatore L Abstract: The relationship between osteonecrosis of the jaw and bisphosphonate therapy was initially established more than 10 years ago. Since that time our understanding of this disease process has evolved as the direct result of clinical, basic science, and animal research initiatives. Medication-related osteonecrosis of the jaw (MRONJ) is a well-known entity now known to be associated with various antiresorptive therapies and recently with antiangiogenic medications. This article reviews the recently modified diagnostic criteria for MRONJ with a focus on the clinical, histopathologic, and imaging characteristics of this disease process. Copyright © 2015 Elsevier Inc. All rights reserved.

Title: Pharmacogenetics of Bisphosphonate-associated Osteonecrosis of the Jaw. Citation: Oral and maxillofacial surgery clinics of North America, Nov 2015, vol. 27, no. 4, p. 537-546 (November 2015) Author(s): Fung, P L, Nicoletti, P, Shen, Y, Porter, S, Fedele, S Abstract: Osteonecrosis of the jaws (ONJ) is a potentially severe disorder that develops in a subgroup of individuals who have used bisphosphonate (BP) medications. Several clinical risk factors have been associated with the risk of ONJ development, but evidence is limited and in most instances ONJ remains an unpredictable adverse drug reaction. Interindividual

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genetic variability can contribute to explaining ONJ development in a subset of BP users and the discovery of relevant associated gene variants could lead to the identification of individuals at higher risk. No genetic variant has been found to be robustly associated with susceptibility to ONJ. Copyright © 2015 Elsevier Inc. All rights reserved. Source: Medline

Title: Antiresorptive Therapies for Osteoporosis. Citation: Oral and maxillofacial surgery clinics of North America, Nov 2015, vol. 27, no. 4, p. 555-560 (November 2015) Author(s): Weinerman, Stuart, Usera, Gianina L Abstract: Osteoporosis is a disease of low bone density, translating to increased fragility and risk for fracture. It is a significant public health problem that is widely undertreated, despite the many options of treatment available. Among these, the most effective are the antiresorptive medications, such as bisphosphonates. There is an abundance of evidence about the efficacy and safety profile of these medications. However, there is mounting evidence that, after 10 years on treatment with a bisphosphonate, patients are at a higher risk of developing some of the serious side effects of atypical femur fractures and osteonecrosis of the jaw. Copyright © 2015 Elsevier Inc. All rights reserved. Source: Medline

Title: Management of bisphosphonate-related osteonecrosis of the jaw: a literature review. Citation: Oral diseases, Nov 2015, vol. 21, no. 8, p. 927-936 (November 2015) Author(s): Spanou, A, Lyritis, G P, Chronopoulos, E, Tournis, S Abstract: Osteonecrosis of the jaw (ONJ) is a serious side effect of bisphosphonate use in patients with osteoporosis, Paget's disease, hypercalcemia of malignancy, metastatic bone disease and multiple myeloma, although recently this complication has also been reported in patients under non-bisphosphonate medication, such as denosumab and bevacizumab. The occurrence of ONJ is higher in oncology patients treated with high-dose iv bisphosphonates than in osteoporosis patients treated with oral bisphosphonates. Although multiple hypotheses have been proposed, the exact pathogenic mechanism of ONJ still remains unclear. As treatment protocols based on randomized controlled trials (RCTs) do not exist, we critically reviewed the existing data concerning the management of bisphosphonate-related osteonecrosis of the jaw, including the most recent data for the use of teriparatide and hyperbaric oxygen. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Source: Medline

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Title: Denosumab-related osteonecrosis of the jaw: a case report and management based on pharmacokinetics. Citation: Oral surgery, oral medicine, oral pathology and oral radiology, Nov 2015, vol. 120, no. 5, p. 548-553 (November 2015) Author(s): You, Tae Min, Lee, Kang-Hee, Lee, Soo-Hyeon, Park, Wonse Abstract: Denosumab, a monoclonal antibody against the receptor activator for nuclear factor-kappa B ligand (RANKL), is a recently approved antiresorptive drug that suppresses osteoclast formation by targeting preosteclasts, in contrast to the traditional antiresorptive bisphosphonates that target mature osteoclasts. Osteonecrosis of the jaw (ONJ) is a well-known, if rare, side effect of bisphosphonate therapy; however, cases of ONJ have also been reported since 2010 in patients taking denosumab. We describe here a patient who developed ONJ while receiving denosumab; the pharmacokinetics of denosumab and bisphosphonates are discussed in the context of ONJ management. Copyright © 2015 Elsevier Inc. All rights reserved.

Title: Successful long-term mandibular reconstruction and rehabilitation using non-vascularised autologous bone graft and recombinant human BMP-7 with subsequent endosseous implant in a patient with bisphosphonate-related osteonecrosis of the jaw. Citation: The British journal of oral & maxillofacial surgery, Nov 2015, vol. 53, no. 9, p. 870-874 (November 2015) Author(s): Rahim, Ishrat, Salt, Stephen, Heliotis, Manolis Abstract: We describe a case of extensive osteonecrosis of the mandible after a dental extraction in a 71-year-old woman who was taking alendronic acid (Fosamax(®), Merck) for osteoporosis. Bone damaged by bisphosphonate-related osteonecrosis of the jaw (BRONJ), also now known as medication-related osteonecrosis of the jaw (MRONJ), can be regenerated and filled with endosseous implants using non-vascularised autologous grafts. Copyright © 2015. Published by Elsevier Ltd.

Title: Knowledge and attitudes of Brazilian dental students and dentists regarding bisphosphonate-related osteonecrosis of the jaw. Citation: Supportive Care in Cancer, 2015, vol./is. 23/12(3421-3426), Abstract: Purpose: The aim of this study was to evaluate the knowledge of Brazilian dentists (DEN) and dental students (DS) about bisphosphonates (BP) and bisphosphonate-related osteonecrosis of the jaw (BRONJ).Methods: A convenience sample of 104 DEN and 100 DS was randomly selected and invited to answer a questionnaire. The questionnaire was

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structured on the basis of the main information about BP and the risk factors associated with the development of BRONJ. The data obtained were analyzed by the chi-square and Fisher's exact tests, considering significance of 5 %.Results: Seventy-five (72.1 %) DEN and 75 (75 %) DS did not know the BP cited in the questionnaire (p < 0.0001), and their commercial brand names were not recognized by 88 (84.6 %) DEN and 86 (86 %) DS (p < 0.0001). In the same way, 62 (59.6 %) DEN (p = 0.04) and 58 (58 %) DS (p < 0.0001) did not recognize BRONJ as an oral side effect of BP or point out oral conditions that were not associated with the use of BP.Conclusions: Practical initiatives, such as free lectures and workshops, must be taken to broaden the knowledge of DEN and DS about BP and thus contribute to the prevention of BRONJ.

Title: Oral Squamous Cell Carcinoma Presenting in a Patient Receiving Adalimumab for Rheumatoid Arthritis. Citation: Journal of Oral & Maxillofacial Surgery (02782391), 2015, vol./is. 73/11(2136-2141), Abstract: The efficacy of biologic agents in the treatment of inflammatory immune-mediated conditions has been clearly shown, but there also are numerous reports of adverse effects. Most reported adverse effects have been associated with tumor necrosis factor-α (TNF-α) inhibitors and include a possible increased risk of malignancy. There have been some reported cases of oral cancer developing in patients treated with TNF-α inhibitors. This case report describes a patient who was taking adalimumab for rheumatoid arthritis and who presented with a squamous cell carcinoma (SCC) in the mandible. Diagnosis was complicated because the clinical appearance was of a nonhealing extraction socket and the patient had a history of bisphosphonate therapy. An initial diagnosis of bisphosphonate-related osteonecrosis of the jaws was made, which delayed the commencement of appropriate treatment. This case highlights the importance of ruling out SCC in patients taking biological agents with unusual symptoms.

Dental-related cleft lip and palate

Title: Nonsurgical treatment of hemifacial microsomia: A case report Citation: Iranian Red Crescent Medical Journal, November 2015, vol./is. 17/11, 2074-1804;2074-1812 (01 Nov 2015) Author(s): Nouri M., Farzan A. Abstract: Introduction: Hemifacial microsomia (HFM) is a birth defect involving craniofacial structures derived from the first and second branchial arches. Although it is a relatively

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uncommon malformation, it is the second most common craniofacial birth defect after cleft lip and palate (CL/P). Case Presentation: This is a case report about the successful orthodontic treatment of a patient with mild hemifacial microsomia (HFM), using a non-surgical orthopedic and orthodontic treatment approach. The aim of this approach was to make the best noninvasive modality to treat HFM. A 7-year-old boy with a mild HFM presented with a convex profile and slight chin deviation. Orthopedic treatment performed using a hybrid functional and high pulls headgear. Treatment continued by fixed orthodontic straight wire appliance to achieve perfect occlusion. Conclusions: Excellent esthetic and functional results achieved; total treatment duration was about 72 months.

Title: Long-Term Follow-Up of UCLP Patients: Surgical and Orthodontic Burden of Care During Growth and Final Orthognathic Surgery Need. Citation: The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association, Nov 2015, vol. 52, no. 6, p. 688-697 (November 2015) Author(s): Meazzini, Maria Costanza, Capello, Alice Varacca, Ventrini, Francesca, Abstract: The goal of this study was to evaluate the craniofacial morphology at 5 and 10 years of age and at the completion of growth, the need for final orthognathic surgery, and the orthodontic burden in a sample of patients with unilateral cleft lip and palate consecutively treated by the same surgeon with the same two-step protocol. A sample of 62 adult patients with unilateral cleft lip and palate was retrospectively collected (mean age, 17.5 years). Lateral cephalograms at three time points were traced. The need for orthognathic surgery was assessed, subdividing the sample into an orthognathic surgery group and nonorthognathic surgery group. Time and modality of orthodontic treatment were recorded. Cephalometric values related to maxillary growth (SNA, SNAns) and maxillomandibular relation (ANB, NAPg) were significantly different between the two groups already at 5 and 10 years of age. All patients presenting an ANB smaller than 2° at 5 years needed a Le Fort I osteotomy. Mandibular protrusion (SNB, SNPg) was not different at 5 and 10 years, but was different at the completion of growth. Patients with the same initial maxillomandibular relation did not show better growth when subjected to earlier or longer orthodontic treatment. Patients needing final jaw surgery had a more severe skeletal discrepancy during early childhood. The ANB angle at 5 years allowed doctors to identify 45% of the need for orthognathic surgery. The final craniofacial pattern does not seem to change significantly with early or prolonged orthodontic treatment .

Title: Orthognathic Surgeries in Patients With Congenital Craniofacial Anomalies: Profile and Hospitalization Outcomes. Citation: The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association, Nov 2015, vol. 52, no. 6, p. 698-705 (November 2015) Author(s): Allareddy, Veerasathpurush

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Abstract: To examine the occurrence of complications in patients with congenital facial anomalies who underwent orthognathic surgeries and to identify the role of patient-related factors in occurrence of complications. Retrospective analysis of hospital discharge database. Nationwide inpatient sample for the years 2004 to 2010. All patients with a diagnosis of cleft lip and/or palate or congenital craniofacial anomalies and who had an orthognathic surgery were selected. Orthognathic surgery. Occurrence of complications. During the study period, a total of 8340 patients with congenital craniofacial anomalies underwent orthognathic surgeries. The overall complication rate was 9.1%. Six different complications (bacterial infections, hemorrhage, postoperative pneumonia, iatrogenic-induced complications such as accidental punctures/lacerations or pneumothorax, other infections, and respiratory complications) occurred in at least 1% of all patients having orthognathic surgeries. Ninety-five percent of patients were discharged routinely after surgery. Patients with high comorbid burden are at a higher risk for developing complications (P < .05). The current study findings indicate that orthognathic surgeries can be safely performed in patients with congenital craniofacial anomalies. The present study results reflect the practice patterns and hospitalization outcomes across the country and could serve as benchmarks for future well-designed prospective controlled studies to examine risk factors associated with complications for not only orthognathic surgeries but also for a wider range of surgical procedures.

Title: Comparison of Intercanine and Intermolar Width Between Cleft Lip Palate and Normal Class I Occlusion Group. Citation: Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, Nov 2015, vol. 25, no. 11, p. 811-814 (November 2015) Author(s): Wahaj, Aiyesha, Ahmed, Imtiaz Abstract: To determine the mean difference of arch dimensions (both intercanine and intermolar width) between cleft lip palate and normal class I occlusion group. Cross-sectional analytic study. Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, [Dow University of Health Sciences (DUHS)], Karachi, from March 2012 to April 2013. Group 1 consisted of 32 subjects with complete repaired, non-syndromic unilateral and bilateral cleft lip palate. Group 2 consisted of 32 subjects with normal facial morphology and class I occlusion. Exclusion criteria were cleft lip palate subjects with systemic diseases, any arch expansion procedure, incomplete repaired palate, open fistulas, developmental or acquired craniofacial muscular deformities, autoimmune conditions, syndromes, endocrine abnormalities, neurological problems, or previous history of orthodontic treatment and signs and symptoms of temporomandibular disorders, history of trauma, impacted or missing teeth, periodontally involved teeth, subdivision molar classification, skeletal base II and III with molar class I. The transverse width (intercanine and intermolar width) of dental casts was measured with the help of digital caliper. The intercanine width was measured between cusp tips of the canine while the intermolar width distance was measured between mesiobuccal cusp tips of first molars, and buccal grooves of the mandibular first molars in both cleft lip palate and normal class I occlusion group, respectively. There were 64 subjects with mean 14.7 &plusmn;6.8 years in the cleft palate and 14.7 &plusmn;6.3 years in the

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normal group. There was statistically significant differences found between intercanine and intermolar width in maxillary arch (p < 0.001). In mandibular arch, only intercanine width has showed significant difference (p < 0.001) between cleft and normal occlusion class I group. Maxillary and mandibular intercanine width was found to be significantly reduced in cleft lip palate group (both unilateral and bilateral) as compared to normal class I occlusion group.

Title: Structural outcomes in the Cleft Care UK study. Part 2: dento-facial outcomes. Citation: Orthodontics & craniofacial research, Nov 2015, vol. 18 Suppl 2, p. 14-24 (November 2015) Author(s): Al-Ghatam, R, Jones, T E M, Ireland, A J, Atack, N E, Chawla, O, Deacon, S, Abstract: To compare facial appearance and dento-alveolar relationship outcomes from the CSAG (1998) and CCUK (2013) studies. Five-year-olds born with non-syndromic unilateral cleft lip and palate. Those in the original CSAG were treated in a dispersed model of care with low-volume operators. Those in CCUK were treated in a more centralized, high-volume operator model. We compared facial appearance using frontal view photographs (252 CCUK, 239 CSAG) and dental relationships using study models (198 CCUK, 223 CSAG). Facial appearance was scored by a panel of six assessors using a standardized and validated outcome tool. Dento-alveolar relationships were scored by two assessors using the 5-Year-Olds' Index. Ordinal regression was used to compare results between surveys. Excellent or good facial appearance was seen in 36.2% of CCUK compared with 31.9% in CSAG. In CCUK, 21.6% were rated as having poor or very poor facial appearance compared with 27.6% in CSAG. The percentage rated as having excellent or good dento-alveolar relationships was 53.0% in CCUK compared with 29.6% in CSAG. In CCUK, 19.2% were rated as having poor or very poor dento-alveolar relationships compared to 36.3% in CSAG. The odds ratios for improved outcome in CCUK compared to CSAG were 1.43 (95% CI 1.03, 1.97) for facial appearance and 2.29 (95% CI 1.47, 3.55) for dento-alveolar relationships. Facial and dento-alveolar outcomes were better in CCUK children compared to those in CSAG. © 2015 The Authors. Orthodontics & Craniofacial Research Published by John Wiley & Sons Ltd.

Title: Functional outcomes in the Cleft Care UK study - Part 3: oral health and audiology. Citation: Orthodontics & craniofacial research, Nov 2015, vol. 18 Suppl 2, p. 25-35 Author(s): Smallridge, J, Hall, A J, Chorbachi, R, Parfect, V, Persson, M, Ireland, A J, Wills, A K, Abstract: To compare oral health and hearing outcomes from the Clinical Standards Advisory Group (CSAG, 1998) and the Cleft Care UK (CCUK, 2013) studies. Two UK-based cross-sectional studies of 5-year-olds born with non-syndromic unilateral cleft lip and palate undertaken 15 years apart. CSAG children were treated in a dispersed model of care with low-volume operators. CCUK children were treated in a centralized, high volume operator system. Oral health data were collected using a standardized proforma. Hearing was

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assessed using pure tone audiometry and middle ear status by otoscopy and tympanometry. ENT and hearing history were collected from medical notes and parental report. Oral health was assessed in 264 of 268 children (98.5%). The mean dmft was 2.3, 48% were caries free, and 44.7% had untreated caries. There was no evidence this had changed since the CSAG survey. Oral hygiene was generally good, 96% were enrolled with a dentist. Audiology was assessed in 227 of 268 children (84.7%). Forty-three per cent of children received at least one set of grommets - a 17.6% reduction compared to CSAG. Abnormal middle ear status was apparent in 50.7% of children. There was no change in hearing levels, but more children with hearing loss were managed with hearing aids. Outcomes for dental caries and hearing were no better in CCUK than in CSAG, although there was reduced use of grommets and increased use of hearing aids. The service specifications and recommendations should be scrutinized and implemented. © 2015 The Authors. Orthodontics & Craniofacial Research Published by John Wiley & Sons Ltd.

Title: Is Linear Advancement Related to Relapse in Unilateral Cleft Lip and Palate Orthognathic Surgery? Citation: The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association, Nov 2015, vol. 52, no. 6, p. 717-723 (November 2015) Author(s): Watts, Guy D, Antonarakis, Gregory S, Forrest, Christopher R, Tompson, Bryan D, Abstract: To investigate the stability of major versus minor Le Fort I maxillary advancements in unilateral cleft lip and palate (UCLP) patients. A retrospective longitudinal study was undertaken on 30 nonsyndromic UCLP patients treated with the same protocol at The Hospital for Sick Children, Toronto, Canada. Patients were grouped into major and minor movement groups based on planned surgical advancement. Standard lateral cephalometric radiographs were taken preoperatively (T1), immediately postoperatively (T2), and at least 1 year postoperatively (T3). Skeletal and dental variables were measured using cephalometric analysis. Stability was compared between groups using repeated-measures analysis of variance. Linear regression analysis was used to assess the relationship between advancement and relapse for the entire study population. A mean maxillary advancement of 9.8 mm and 4.9 mm was seen for the major (n = 10) and minor (n = 20) movement groups, respectively. The mean skeletal horizontal relapse was 1.8 mm (18%) for the major advancement group and 1.5 mm (31%) for the minor advancement group. There was no significant difference in skeletal horizontal relapse between the groups (P > .05). The correlation coefficient (r) between linear horizontal advancement and relapse was calculated to be .31 (P > .05). Dental horizontal relapse was not significant for either the major or minor groups, and no significant difference was found between the groups (P > .05). Skeletal and dental relapse was found to be unrelated to the amount of maxillary linear advancement using conventional Le Fort I osteotomies in UCLP.

Title: Association Between Dental Arch Widths and Interarch Relationships in Children With Operated Unilateral Complete Cleft Lip and Palate.

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Citation: The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association, Nov 2015, vol. 52, no. 6, p. e196. (November 2015) Author(s): Bittencourt Dutra Dos Santos, Patrícia, Janson, Guilherme, Assis, Vivian Helena, Abstract: Palate and lip repair have great influence on the sagittal and transverse growth of the maxilla. The correlation between arch widths and sagittal interarch relationships in operated patients with complete unilateral cleft lip and palate (UCLP) in the mixed dentition is not clear. The aim of this study was to compare the maxillary arch widths of patients with UCLP and different interarch relationships (GOSLON Yardstick index). The study sample consisted of 144 pairs of dental casts of patients with complete UCLP from 8 to 10 years of age, from a single center. These dental casts were divided into three groups: group I (patients with GOSLON Yardstick 1 and 2 interarch relationships), group II (GOSLON Yardstick 3), and group III (GOSLON Yardstick 4 and 5). The control group consisted of 40 pairs of dental casts of noncleft Class I patients at the same age range. The maxillary and mandibular arch widths were measured at canine, deciduous molars, and permanent first molar regions. Intergroup comparisons were performed by analysis of variance followed by Tukey tests (P < .05). Maxillary arch widths were significantly smaller in all three groups with repaired UCLP compared to the control group. Group III showed reduced intercanine and second deciduous molar widths compared to group I. No intergroup differences were observed for mandibular arch widths. Operated UCLP patients with more severe sagittal discrepancies tend to show more severe transverse maxillary arch deficiencies.

Title: Fast and Early Mandibular Osteodistraction: The Long-Term Follow-Up of Mandibular Distraction Osteogenesis on Teeth Position. Citation: The Journal of craniofacial surgery, Nov 2015, vol. 26, no. 8, p. 2325-2328 (November 2015) Author(s): Cascone, Piero, Basile, Emanuela, Saccucci, Matteo, Di Carlo, Gabriele, Abstract: Pierre Robin Sequence is a congenital pathology defined by the triad micrognathia, glossoptosis and often a U-shaped cleft of soft palate. Newborns affected by airways obstruction may necessitate more invasive options: tongue-lip adhesion, tracheostomy and mandibular distraction osteogenesis. The authors analyzed the effect of fast and early mandibular osteodistraction on deciduous dental development in patients affected by Pierre Robin Sequence. Analysis of the patients treated for severe form was performed by a team composed by maxillofacial surgeons and dentists. Five patients were included for the analysis: before and long term clinical and radiological assessments were considered. All patients underwent fast and early mandibular osteodistraction; two years follow up computed tomography and panorex reconstructions showed bone consolidation, 33 of 35 teeth analyzed before ostedistraction are present after distraction protocol; no positional changes were detected at the follow up analysis either deciduous teeth and molar permanent buds. No deformities regarding molar buds were detected. In conclusion external mandibular distractor devices have been associated with dental injuries and facial

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scaring. Even though, the dental complications identified can not be unambiguously connected to the external distractor devices.

Periodontal disease and antibiotics

Title: Non-surgical periodontal therapy supplemented with systemically administered azithromycin: a systematic review of RCTs. Citation: Clinical oral investigations, Nov 2015, vol. 19, no. 8, p. 1763-1775 (November 2015) Author(s): Buset, Sabrina L, Zitzmann, Nicola U, Weiger, Roland, Walter, Clemens Abstract: Azithromycin may be an alternative adjunctive systemic antibiotic in non-surgical periodontal therapy. This study aims to identify randomized controlled trials evaluating non-surgical periodontal treatment of chronic and/or aggressive periodontitis supplemented with systemically administered azithromycin. A systematic literature search was performed for publications published by 31 March 2014 using electronic databases and hand search. Randomized controlled trials published in English or German language, with a follow-up ≥6 months were included. From 231 titles identified, nine publications were eligible for inclusion. Among the studies included, showing some risk of bias, seven reported on patients with chronic periodontitis and two with aggressive periodontitis. Minor adverse events were described in five studies. A synthesis of results using a vote counting method was applied. Significant (p < 0.05) beneficial effects of azithromycin were shown in six studies for probing depth changes and in five studies for clinical attachment level changes. In contrast to aggressive periodontitis patients, data from this analysis indicate a potential benefit of systemic azithromycin as adjunctive to non-surgical periodontal therapy in chronic periodontitis patients. When contraindications for the standard antibiotics are present, azithromycin (AZM) may be considered as alternative systemically administered antibiotic drug in selected cases of chronic periodontitis.

Title: Practical use of povidone-iodine antiseptic in the maintenance of oral health and in the prevention and treatment of common oropharyngeal infections. Citation: International journal of clinical practice, Nov 2015, vol. 69, no. 11, p. 1247-1256 (November 2015) Author(s): Kanagalingam, J, Feliciano, R, Hah, J H, Labib, H, Le, T A, Lin, J-C Abstract: To better inform medical practitioners on the role of antiseptics in oropharyngeal health and disease, this article focuses on povidone-iodine (PVP-I), an established and widely-available antiseptic agent. Review of the anti-infective profile, efficacy and safety of PVP-I in managing common upper respiratory tract infections such as the common cold,

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influenza and tonsillo-pharyngitis, as well as oral complications resulting from cancer treatment (oral mucositis), and dental conditions (periodontitis, caries). Antiseptics with broad-spectrum anti-infective activity and low resistance potential offer an attractive option in both infection control and prevention. While there is some evidence of benefit of antiseptics in a variety of clinical settings that include dental and oral hygiene, dermatology, oncology, and pulmonology, there appears to be discordance between the evidence-base and practice. This is especially apparent in the management and prevention of oropharyngeal infections, for which the use of antiseptics varies considerably between clinical practices, and is in marked contrast to their dermal application, where they are extensively used as both a prophylaxis and a treatment of skin and wound infections, thus minimising the use of antibiotics. The link between oral and oropharyngeal health status and susceptibility to infection has long been recognised. The high rates of antibiotic misuse and subsequent development of bacterial resistance (e.g. increasing vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA)) in large parts of the world, especially across Asia Pacific, highlight the need for identifying alternative antimicrobials that would minimise the use of these medications. This, together with recent large-scale outbreaks of, for example, avian and swine influenza virus, further underline the importance of an increasing armamentarium for infection prevention and control. © 2015 John Wiley & Sons Ltd.

Title: Practical use of povidone-iodine antiseptic in the maintenance of oral health and in the prevention and treatment of common oropharyngeal infections Citation: International Journal of Clinical Practice, November 2015, vol./is. 69/11(1247-1256), 1368-5031;1742-1241 (November 2015) Author(s): Kanagalingam J., Feliciano R., Hah J.H., Labib H., Le T.A., Lin J.-C. Abstract: Aims To better inform medical practitioners on the role of antiseptics in oropharyngeal health and disease, this article focuses on povidone-iodine (PVP-I), an established and widely-available antiseptic agent. Methodology Review of the anti-infective profile, efficacy and safety of PVP-I in managing common upper respiratory tract infections such as the common cold, influenza and tonsillo-pharyngitis, as well as oral complications resulting from cancer treatment (oral mucositis), and dental conditions (periodontitis, caries). Results Antiseptics with broad-spectrum anti-infective activity and low resistance potential offer an attractive option in both infection control and prevention. While there is some evidence of benefit of antiseptics in a variety of clinical settings that include dental and oral hygiene, dermatology, oncology, and pulmonology, there appears to be discordance between the evidence-base and practice. This is especially apparent in the management and prevention of oropharyngeal infections, for which the use of antiseptics varies considerably between clinical practices, and is in marked contrast to their dermal application, where they are extensively used as both a prophylaxis and a treatment of skin and wound infections, thus minimising the use of antibiotics. Conclusion The link between oral and oropharyngeal health status and susceptibility to infection has long been recognised. The high rates of antibiotic misuse and subsequent development of bacterial resistance (e.g. increasing vancomycin-resistant enterococci (VRE) and methicillin-resistant

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Staphylococcus aureus (MRSA)) in large parts of the world, especially across Asia Pacific, highlight the need for identifying alternative antimicrobials that would minimise the use of these medications. This, together with recent large-scale outbreaks of, for example, avian and swine influenza virus, further underline the importance of an increasing armamentarium for infection prevention and control.

Head and neck oncology and dentistry

Title: Targeting Head and Neck Cancer Stem Cells: Current Advances and Future Challenges. Citation: Journal of dental research, Nov 2015, vol. 94, no. 11, p. 1516-1523 (November 2015) Author(s): Birkeland, A C, Owen, J H, Prince, M E Abstract: Cancer stem cells (CSCs), or tumor-initiating cells, comprise a subset of tumor cells with demonstrated ability for tumor growth, invasion, metastasis, and resistance to chemotherapy and radiation. Targeting of CSCs remains an attractive yet elusive therapeutic option, with the goal of increasing specificity and effectiveness in tumor eradication, as well as decreasing off-target or systemic toxicity. Research into further characterization and targeted therapy toward head and neck CSCs is an active and rapidly evolving field. This review discusses the current state of research into therapy against head and neck CSCs and future directions for targeted therapy. © International & American Associations for Dental Research 2015. Source: Medline

Title: HPV Infection of the Head and Neck Region and Its Stem Cells. Citation: Journal of dental research, Nov 2015, vol. 94, no. 11, p. 1532-1543 (November 2015) Author(s): Pullos, A N, Castilho, R M, Squarize, C H Abstract: The human papillomavirus (HPV) is an etiologic agent associated with the development of head and neck squamous carcinoma (HNSCC)-in particular, oropharyngeal squamous cell carcinoma. The HPV-positive HNSCC is characterized by genetic alterations, clinical progression, and therapeutic response, which are distinct from HPV-negative head and neck cancers, suggesting that virus-associated tumors constitute a unique entity among head and neck cancers. Malignant stem cells, or cancer stem cells, are a subpopulation of tumor cells that self-renew, initiate new tumors upon transplantation, and are resistant to therapy, and their discovery has revealed novel effects of oncovirus infection in cancer. In

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this review, we provide a virus-centric view and novel insights into HPV-positive head and neck pathogenesis. We discuss the influence of cancer stem cells, HPV oncoproteins, altered molecular pathways, and mutations in cancer initiation and cancer progression. We compiled a catalogue of the mutations associated with HPV-positive HNSCC, which may be a useful resource for genomic-based studies aiming to develop personalized therapies. We also explain recent changes in mass vaccination campaigns against HPV and the potential long-term impact of vaccinations on the prevention and treatment of HPV-positive head and neck cancers. © International & American Associations for Dental Research 2015. Source: Medline

Title: Head and Neck Cancer Stem Cells: From Identification to Tumor Immune Network. Citation: Journal of dental research, Nov 2015, vol. 94, no. 11, p. 1524-1531 (November 2015) Author(s): Dionne, L K, Driver, E R, Wang, X J Abstract: Head and neck squamous cell carcinoma (HNSCC) is the most common form of head and neck cancer. Annually, more than half a million individuals are diagnosed with this devastating disease, with increasing incidence in Europe and Southeast Asia. The diagnosis of HNSCC often occurs in late stages of the disease and is characterized by manifestation of a high-grade primary tumor and/or lymph node metastasis, precluding timely management of this deadly cancer. Recently, HNSCC cancer stem cells have emerged as an important factor for cancer initiation and maintenance of tumor bulk. Like normal stem cells, cancer stem cells can undergo self-renewal and differentiation. This unique trait allows for maintenance of the cancer stem cell pool and facilitates differentiation into heterogeneous neoplastic progeny when necessary. Recent studies have suggested coexistence of different cancer stem cell populations within a tumor mass, where the tumor initiation and metastasis properties of these cancer stem cells can be uncoupled. Cancer stem cells also possess resistant phenotypes that evade standard chemotherapy and radiotherapy, resulting in tumor relapse. Therefore, understanding distinctive pathways relating to cancer stem cells will provide insight into early diagnosis and treatment of HNSCC. In this review, we highlight current advances in identifying cancer stem cells, detail the interactions of these cells with the immune system within the tumor niche, and discuss the potential use of immunotherapy in managing HNSCC. © International & American Associations for Dental Research 2015. Source: Medline

Title: Dental amalgam artifact: Adverse impact on tumor visualization and proton beam treatment planning in oral and oropharyngeal cancers. Citation: Practical radiation oncology, Nov 2015, vol. 5, no. 6, p. e583., 1879-8500 (2015 Nov-Dec)

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Author(s): Richard, Patrick, Sandison, George, Dang, Quang, Johnson, Bart, Wong, Tony, Abstract: We evaluated the incidence and impact of dental filling artifacts on the definition of clinical target volume (CTV) for oropharyngeal/oral cavity cancers receiving radiation therapy. We performed phantom proton beam dosimetric analyses using a low-density composite filling to investigate artifact reduction and dose distribution. We reviewed oral cavity/oropharynx radiation treatment plans between 2010 and 2012. Plans were evaluated for artifacts and impact on CTV visualization. We constructed a head and neck phantom, obtaining planning computed tomography images at baseline (native tooth) and for each filling (composite and metal amalgam) interchanged into a tooth adjacent to the tumor. We performed uniform scanning proton plans with each filling, evaluating for planning target volume (PTV) coverage and overall dose distribution. A total of 110 treatment plans were reviewed (71 oropharynx, 39 oral cavity). Artifacts were identified in 81 plans (73.6%), including 53 oropharynx (74.6%) and 28 oral cavity (71.8%). Artifacts obscured the CTV in 77 cases (95%), including 49 of 53 oropharynx cases (92.5%) and all 28 oral cavity cases. On phantom testing, the metal amalgam obscured the tumor while the composite did not. Hounsfield unit (HU) values (range, mean) for the tumor were: baseline (-484.0 to 700.0 HU, 104 HU), composite (-728.5 to 1038.0 HU, 105 HU), metal amalgam (-1023.0 to 807.0 HU, 90.74 HU). The percent of planning target volume receiving 95% of prescription dose of the PTV was baseline (100%), composite (100%), and metal amalgam (92.3%). PTV dose ranges were baseline (98%-106%), composite (98%-107%), and metal amalgam (66%-111%). PTV coverage and dose distributions of the composite and native tooth plans were identical. A high incidence of artifacts was found on the planning scans of oral/oropharyngeal cancer patients, adversely impacting CTV visualization. In our phantom model, metal amalgam impacted tumor and tissue density. The PTV was underdosed with the metal amalgam compared with the composite filling. A potential solution involves exchanging metal fillings with composite before proton treatment planning for improved tumor visualization and dosimetry. Copyright © 2015 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved. Source: Medline

Title: Development of mandibular osteoradionecrosis in rats: Importance of dental extraction. Citation: Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery, Nov 2015, vol. 43, no. 9, p. 1829-1836 Author(s): Bléry, Pauline, Espitalier, Florent, Hays, Alexandra, Crauste, Eléonore, Abstract: To develop an animal model of mandibular osteoradionecrosis (ORN) using a high-energy radiation source (as used in human therapeutics) and to assess the role of tooth extraction on ORN development. Ten animals were irradiated with a single 35- or 50-Gy dose. Three weeks later, the second left mandibular molar was extracted from three animals in each group. Nine weeks after irradiation, the animals were euthanized, with an

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injection of contrast agent in the bloodstream to highlight vascularization. Mandibles were harvested and studied using micro-CT, histology, tartrate-resistant acid phosphatase activity and scanning electron microscopy. This study demonstrates that a single 50-Gy dose associated with molar extraction is necessary for ORN development. In these conditions, absence of healing of the mucosa and bone, dental effects, fibrosis, an increase in osteoclast activity and a decrease in vascularization were observed. We also determined that molar extraction increases the impact of the cellular effects of radiation. The mandibular ORN animal model was validated after 50-Gy irradiation and molar extraction. The results of this study therefore support an animal ORN model and tissue engineering strategies will now be developed to regenerate bone for patients with head and neck cancer. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Title: Oral leukoplakia, the ongoing discussion on definition and terminology Citation: Medicina Oral, Patologia Oral y Cirugia Bucal, November 2015, vol./is. 20/6(e685-e692), 1698-4447;1698-6946 (November 2015) Author(s): van der Waal I. Abstract: In the past decades several definitions of oral leukoplakia have been proposed, the last one, being authorized by the World Health Organization (WHO), dating from 2005. In the present treatise an adjustment of that definition and the 1978 WHO definition is suggested, being: "A predominantly white patch or plaque that cannot be characterized clinically or pathologically as any other disorder; oral leukoplakia carries an increased risk of cancer development either in or close to the area of the leukoplakia or elsewhere in the oral cavity or the head-and-neck region". Furthermore, the use of strict diagnostic criteria is recommended for predominantly white lesions for which a causative factor has been identified, e.g. smokers' lesion, frictional lesion and dental restoration associated lesion. A final diagnosis of such leukoplakic lesions can only be made in retrospect after successful elimination of the causative factor within a somewhat arbitrarily chosen period of 4-8 weeks. It seems questionable to exclude "frictional keratosis" and "alveolar ridge keratosis" from the category of leukoplakia as has been suggested in the literature. Finally, brief attention has been paid to some histopathological issues that may cause confusion in establishing a final diagnosis of leukoplakia.

Title: The Public Recognizes Plastic Surgeons as Leading Experts in the Treatment of Congenital Cleft and Craniofacial Anomalies. Citation: The Journal of craniofacial surgery, Nov 2015, vol. 26, no. 8, p. e684. (November 2015) Author(s): Denadai, Rafael, Junior, Hugo Samartine, Denadai, Rodrigo, Raposo-Amaral,

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Abstract: The aim of this study is to assess the public perception of plastic surgeons (PS) as craniofacial surgery specialists. Members of the public (N = 1514) were asked to choose 1 or 2 specialists that they perceived to be an expert for 13 craniofacial surgery-related scenarios. Response patterns were distributed as "plastic surgeon alone" (PS alone), "PS combined with other specialists", or "no plastic surgeon" (No PS). Sociodemographic data, previous plastic surgery contact, and source of reported information were also collected. "Plastic surgeon alone" was significantly (all P < 0.05) more recognized as experts than all other response patterns particularly in congenital anomalies-related scenarios (83.33%). There was a significantly (all P < 0.05) poor understanding of the role of PSs in head/neck infection management, chronic facial palsy management, dental disease management, head and neck cancer surgery, vascular malformation surgery, and facial fracture surgery. Sex, age, education level, health care professional, prior plastic surgery contact, and source of reported information were not significant (all P < 0.05) determinants of "PS" as the response in bivariate and multivariate analyses. Public recognized PSs as experts primarily in treatment of congenital cleft and craniofacial anomalies, but as the overall scope of craniofacial surgery practice was poorly understood and known, improved public education is needed.

Dental implants

Title: Effect of coupling asynchronous acoustoelectric effects on the corrosion behavior, microhardness and biocompatibility of biomedical titanium alloy strips Citation: Journal of Materials Science: Materials in Medicine, November 2015, vol./is. 26/1, 0957-4530;1573-4838 (18 Nov 2014) Author(s): Ye X., Tang G. Abstract: The coupling asynchronous acoustoelectric effects (CAAE) of the high-energy electropulsing treatment (EPT) technique and ultrasonic surface strengthening modification (USSM) are innovatively combined in improving the surface microhardness, corrosion behavior and biocompatibility of the pre-deformed titanium alloy strips. Experimental results show that EPT and USSM processes facilitate the surface grain refining and USSM brings in the micro-dimples on the materials surface, which is attributed to the atoms diffusion acceleration under EPT and severe surface plastic deformation under USSM. These microstructure changes can not only enhance the corrosion resistance in the acidic simulated body fluids and fluoridated acidic artificial saliva but also improve the biocompatibility of the titanium alloy strip materials. Moreover, the surface microhardness of the titanium alloy strips is enhanced to improve the wear resistance. Therefore, CAAE processing is a high-efficiency and energy-saving method for obtaining biomedical titanium alloys with superior anti-corrosion performance, microhardness and biocompatibility, which can be widely applied in dental implants and artificial joint.

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Title: Superior biofunctionality of dental implant fixtures uniformly coated with durable bioglass films by magnetron sputtering Citation: Journal of the Mechanical Behavior of Biomedical Materials, November 2015, vol./is. 51/(313-327), 1751-6161;1878-0180 (November 01, 2015) Author(s): Popa A.C., Stan G.E., Enculescu M., Tanase C., Tulyaganov D.U., Ferreira J.M.F. Abstract: Bioactive glasses are currently considered the suitable candidates to stir the quest for a new generation of osseous implants with superior biological/functional performance. In congruence with this vision, this contribution aims to introduce a reliable technological recipe for coating fairly complex 3D-shaped implants (. e.g. dental screws) with uniform and mechanical resistant bioactive glass films by the radio-frequency magnetron sputtering method. The mechanical reliability of the bioactive glass films applied to real Ti dental implant fixtures has been evaluated by a procedure comprised of "cold" implantation in pig mandibular bone from a dead animal, followed by immediate tension-free extraction tests. The effects of the complex mechanical strains occurring during implantation were analysed by scanning electron microscopy coupled with electron dispersive spectroscopy. Extensive biocompatibility assays (MTS, immunofluorescence, Western blot) revealed that the bioactive glass films stimulated strong cellular adhesion and proliferation of human dental pulp stem cells, without promoting their differentiation. The ability of the implant coatings to conserve a healthy stem cell pool is promising to further endorse the fabrication of new osseointegration implant designs with extended lifetime.

Title: Evaluation of single implants placed in the posterior mandibular area under immediate loading: A prospective study Citation: International Journal of Oral and Maxillofacial Surgery, November 2015, vol./is. 44/11(1411-1415), 0901-5027;1399-0020 (November 2015) Author(s): Guidetti L.G.C., Monnazzi M.S., Piveta A.C.G., Gabrielli M.A.C., Gabrielli M.F.R., Abstract: The aim of this study was to evaluate the survival of single dental implants subjected to immediate function. Twelve patients with edentulous areas in the posterior mandible were included in the study. All received at least one regular platform dental implant (3.75 mm x 11 mm or 3.75 mm x 13 mm). Clinical and radiographic parameters were evaluated. The survival rate after 12 months was 83.3%. The implants showed no clinical mobility, had implant stability quotient values (ISQ; Osstell) around 70, bone loss of up to 2 mm, and a probing depth of <3 mm. Although the posterior mandible is an area in which the immediate loading of dental implants should be performed with caution, this treatment presented a good success rate in the present study sample.

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Title: Long-term neuroplasticity of the face primary motor cortex and adjacent somatosensory cortex induced by tooth loss can be reversed following dental implant replacement in rats Citation: Journal of Comparative Neurology, November 2015, vol./is. 523/16(2372-2389), 0021-9967;1096-9861 (01 Nov 2015) Author(s): Avivi-Arber L., Lee J.-C., Sood M., Lakschevitz F., Fung M., Barashi-Gozal M., Glogauer M., Sessle B.J. Abstract: Tooth loss is common, and exploring the neuroplastic capacity of the face primary motor cortex (face-M1) and adjacent primary somatosensory cortex (face-S1) is crucial for understanding how subjects adapt to tooth loss and their prosthetic replacement. The aim was to test if functional reorganization of jaw and tongue motor representations in the rat face-M1 and face-S1 occurs following tooth extraction, and if subsequent dental implant placement can reverse this neuroplasticity. Rats (n=22) had the right maxillary molar teeth extracted under local and general anesthesia. One month later, seven rats had dental implant placement into healed extraction sites. Naive rats (n=8) received no surgical treatment. Intracortical microstimulation (ICMS) and recording of evoked jaw and tongue electromyographic responses were used to define jaw and tongue motor representations at 1 month (n=8) or 2 months (n=7) postextraction, 1 month postimplant placement, and at 1-2 months in naive rats. There were no significant differences across study groups in the onset latencies of the ICMS-evoked responses (P>0.05), but in comparison with naive rats, tooth extraction caused a significant (P<0.05) and sustained (1-2 months) decreased number of ICMS-defined jaw and tongue sites within face-M1 and -S1, and increased thresholds of ICMS-evoked responses in these sites. Furthermore, dental implant placement reversed the extraction-induced changes in face-S1, and in face-M1 the number of jaw sites even increased as compared to naive rats. These novel findings suggest that face-M1 and adjacent face-S1 may play a role in adaptive mechanisms related to tooth loss and their replacement with dental implants.

Title: Smoking modulates gene expression of type i collagen, bone sialoprotein, and osteocalcin in human alveolar bone Citation: Journal of Oral and Maxillofacial Surgery, November 2015, vol./is. 73/11(2123-2131), 0278-2391;1531-5053 Author(s): Campos J.M.D., Prati A.J., Cirano F.R., Pimentel S.P., Pastore G.P., Pecorari V.G., Ribeiro F.V., Casati M.Z., Casarin R.C.V. Abstract: Purpose Previous animal studies have shown the negative impact of smoking on bone-to-implant contact, and in humans, a decrease in bone density and implant survival over time. However, the effect of smoking on the human alveolar bone regarding the expression of bone-related markers is unknown. Therefore, the aim of this study was to evaluate the influence of smoking on the gene expression of molecules of bone metabolism in alveolar bone tissue from sites designed to receive dental implants. Materials and

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Methods Biopsy specimens of alveolar bone were collected from smokers (n = 19) and nonsmokers (n = 19) from areas planned to receive dental implants. Gene expression of tumor necrosis factor (TNF)-alpha, transforming growth factor (TGF)-beta, osteoprotegerin (OPG), type I collagen (COL-I), bone sialoprotein (BSP), and osteocalcin (OCN) was quantified by quantitative real-time polymerase chain reaction using glyceraldehyde-3-phosphate dehydrogenase as a reference gene. The results were assessed using multiple regression analysis, with a significance level of 5%. Results Multiple regression analysis indicated that smoking negatively affected mRNA expression of BSP and OCN and positively altered the expression of COL-I (P <.05) despite age, gender, and arch. Moreover, regression analysis did not show a significant correlation between smoking habit and mRNA levels of TNF-alpha, TGF-beta, and OPG (P >.05). Conclusion These results support the hypothesis that some bone markers in alveolar tissue are modulated by smoking, which could explain the negative impact of smoking on bone healing.

Title: Bone augmented with allograft onlays for implant placement could be comparable with native bone Citation: Journal of Oral and Maxillofacial Surgery, November 2015, vol./is. 73/11(2108-2122), 0278-2391;1531-5053 Author(s): Al-Abedalla K., Torres J., Cortes A.R.G., Wu X., Nader S.A., Daniel N., Tamimi F. Abstract: Purpose Bone allograft onlays have great potential in alveolar bone augmentation. However, no comparable cohort study is available in the literature showing whether implants placed in bone augmented with allograft onlays would have a success rate comparable to those placed in native alveolar bone. The objective of the cohort study was to investigate whether the quality of bone augmented with allograft onlays was sufficient to place dental implants and achieve success rates comparable to those in un-grafted bone. Materials and Methods Two cohort studies were performed in 46 and 369 patients, respectively. In the first study, the quality and quantity of bone augmented with allograft onlays (21 patients received 68 allograft onlays) were assessed and compared with those of native alveolar bone (25 patients) using histologic techniques. In the second study, the performance of implants placed in allograft-augmented bone (16 patients) was assessed and compared with implants placed in autograft-augmented bone (43 patients) and native alveolar bone (310 patients). Results The first study showed no significant differences (P =.33) in bone volume between bone augmented with allograft onlay and native alveolar bone. The second study showed that the success rates of implants placed in native bone (95.8%), autograft-augmented bone (96.4%), and allograft-augmented bone (96.8%) were similar to one another. Conclusion The quantity and quality of allograft-augmented bone are similar to those of host native alveolar bone, and the success rate of implants placed in allograft onlays is comparable to those placed in autograft onlays or native alveolar bone.

Title: Microstructured zirconia surfaces modulate osteogenic marker genes in human primary osteoblasts

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Citation: Journal of Materials Science: Materials in Medicine, November 2015, vol./is. 26/1(1-11), 0957-4530;1573-4838 (18 Nov 2015) Author(s): Bergemann C., Duske K., Nebe J.B., Schone A., Bulnheim U., Seitz H., Fischer J. Abstract: In dentistry, zirconia has been used since the early 1990s for endodontic posts, more recently for implant abutments and frameworks for fixed dental prostheses. Zirconia is biocompatible and mechanically strong enough to serve as implant material for oral implants. Although several zirconia implant systems are available, currently the scientific and clinical data for zirconia implants are not sufficient to recommend them for routine clinical use. Here the influence of microstructured yttria-stabilized zirconia (YZ) on human primary osteoblast (HOB) behavior was determined. YZ surfaces were treated by sandblasting (YZ-S), acid etching (YZ-SE) and additionally heat treatment (YZ-SEH). Morphological changes of HOB were determined by scanning electron microscopy. Actin cytoskeleton was investigated by laser scanning microscopy and analyzed by novel actin quantification software. Differentiation of HOB was determined by real time RT-PCR. Improved mechanical interlocking of primary HOB into the porous microstructure of the acid etched and additionally heat treated YZ-surfaces correlates with drastically increased osteocalcin (OCN) gene expression. In particular, OCN was considerably elevated in primary HOB after 3 days on YZ-SE (13-fold) as well as YZ-SEH (12-fold) surfaces. Shorter actin filaments without any favored orientation on YZ-SE and YZ-SEH surfaces are associated with higher roughness (R_a) values. Topographically modified yttria-stabilized zirconia is a likely material for dental implants with cell stimulating properties achieving or actually exceeding those of titanium.

Title: Electrodeposited silk coatings for bone implants Citation: Journal of Biomedical Materials Research - Part B Applied Biomaterials, November 2015, vol./is. 103/8(1602-1609), 1552-4973;1552-4981 (November 2015) Author(s): Elia R., Michelson C.D., Perera A.L., Brunner T.F., Harsono M., Leisk G.G., Kugel G., Kaplan D.L. Abstract: The aim of this study was to characterize the mechanical properties and drug elution features of silk protein-based electrodeposited dental implant coatings. Silk processing conditions were modified to obtain coatings with a range of mechanical properties on titanium studs. These coatings were assessed for adhesive strength and dissolution, with properties tuned using water vapor annealing or glycerol incorporation to modulate crystalline content. Coating reproducibility was demonstrated over a range of silk concentrations from 1% to 10%. Surface roughness of titanium substrates was altered using industry relevant acid etching and grit blasting, and the effect of surface topography on silk coating adhesion was assessed. Florescent compounds were incorporated into the silk coatings, which were modulated for crystalline content, to achieve four days of sustained release of the compounds. This silk electrogelation technique offers a safe and relatively simple approach to generate mechanically robust, biocompatible, and degradable implant

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coatings that can also be functionalized with bioactive compounds to modulate the local regenerative tissue environment.

Title: Comparable analysis of prices for first stage of dental implantation in Ukraine Citation: Value in Health, November 2015, vol./is. 18/7(A417-A418), 1098-3015 Author(s): Got S., Barylyak A., Uhryn M., Fal O. Abstract: Objectives: dental implantation significantly improves the quality of patients' life. However, it is an expensive treatment. We conducted our research to study the best price-quality relationship for dental implants made of different materials: titanium, zirconia and sandblasted and acid etched titanium implants. The objective of the present study was to analyze and compare prices for first stage implantation depending on the material of dental implant in ten private dental clinics in Ukraine. Methods: We compared and analyzed the costs of first stage of dental implantation which was conducted in 10 private dental clinics in Ukraine during the period of 6 month (01 December 2014 - 31 May 2015). For that purpose we selected five leading manufacturers which produce dental implants. Prices for the technologies and materials were set by the Administration of Dental clinic. Statistical analysis of the costs was performed by a computer program x7 2009. Results: The prices for implantation in ten private dental clinics were used for the comparative cost calculation of technologies with five different implants: one zirconia, one titanium and three sandblasted and acid etched titanium implants. According to our research the most accessible on costs and widespread technology of dental implantation was conducted with zirconia or sandblasted/acid etched titanium implants despite their price is much higher than just titanium implants. Ukrainian patients pay out-of-pocket for dental implantation and the main task of stakeholders is to provide the most effective services. Conclusions: The most expensive was the implantation with sandblasted and acid etched titanium implants (p < 0,001) and zirconia implants (p < 0,5). Also we revealed that patients were highly motivated to pay for dental implantation in order to get the best esthetical result.

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Journal Tables of Contents

The most recent issues of key journals. If you would like any of the papers in full text then please email the libray: library@uhbristol.nhs.uk

British Dental Journal

Vol. 219, iss. 10, November 2015

http://www.nature.com/bdj/journal/v219/n10/index.html

Evidence Based Dentistry

Vol. 16, iss. 3, 2015

http://www.nature.com/ebd/journal/v16/n3/index.html

International Journal of Oral and Maxillofacial Implants

Vol. 30, iss. 6 Sept./Oct 2015 http://www.quintpub.com/journals/omi/journal_contents.php?journal_name=OMI&current=1#.VgEBwtJVhBc

International Journal of Prosthodontics

Vol. 28, iss. 6, November/December 2015

http://www.quintpub.com/journals/ijp/journal_contents.php?journal_name=IJP&current=1#.VgECbNJVhBe

Journal of Clinical Periodontology

Vol. 42, iss. 8, August 2015

http://onlinelibrary.wiley.com/doi/10.1111/jcpe.2015.42.issue-8/issuetoc

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