Objectives: Patients with xerostomia manifest various clinical signs of oral dryness, which has an impact on oral functions and wearing of dental prostheses, but the evidence of xerostomia-related changes in denture performance is unsatisfactorily documented. The purpose of this systematic review was to evaluate whether the available literature can answer the focused question "Is there an association between xerostomia and decreased denture performance among patients wearing removable dentures?" Data sources: Indexed databases were explored without time or language restrictions up to and including March 2019. All levels of available evidence including experimental studies, case reports, and case series were searched using different combinations of the following keywords: saliva, xerostomia, dentures, personal satisfaction, quality of life, oral dryness, and oral complaints. Nine studies were included for qualitative synthesis. Overall, five studies had a cross-sectional design and four studies were case-control studies. In these studies, the number of participants ranged between 35 patients and 493 patients with mean ages from 56 to 82 years; 66% of the patients were completely and 34% were partially edentulous. Conclusion: All studies included patient satisfaction with dentures and recorded the presence of oral dryness. Six out of nine studies demonstrated that xerostomia is significantly associated with the decreased performance of removable dentures. Although the available evidence lacks feedback from randomized, controlled clinical studies, it implies a negative impact of oral dryness on specific denture functions such as speaking, chewing, and retention, which affects both complete and partial denture wearers.

The aim of the present cohort study was to compare oral carriage of Candida in waterpipe smokers (WS), cigarette smokers (CS), and non-smokers (NS). A total of 141 individuals (46 WS, 45 CS, and 50 NS) were included. A questionnaire was used to gather demographic information and data on the daily frequency and duration of smoking habits, the reasons for smoking, and daily oral hygiene maintenance habits. Oral Candida (C.) samples were cultured and yeast species were identified using polymerase chain reaction. Unstimulated whole salivary flow rate (UWSFR) was also recorded. The numbers of missing teeth (MT) were counted and tongue lesions were clinically identified. C. albicans was the most prevalent yeast species isolated from all groups. Oral C. albicans carriage was higher among WS (P < 0.05) and CS (P < 0.05) than among NS. Oral C. tropicalis carriage, age, UWSFR and the number of MT were comparable among the groups. Oral Candida carriage was significantly higher among WS and CS than among NS. Therefore it appears that WS and CS are at an increased risk of developing oral candida infections.

A limited number of studies have reported an association between erectile dysfunction (ED) and chronic periodontitis (CP). The aim of the present study is to assess the association between CP and ED through a systematic review of published literature. To address the focused question, “Is there a relationship between ED and CP?” indexed databases were searched till December 2015 using various key words “erectile dysfunction,” “periodontal disease,” “periodontitis,” “dental infection,” and “impotence.” Letters to the editor, commentaries, historic reviews, and experimental studies were excluded. The pattern of the present systematic review was customized to primarily summarize the pertinent data. Nine studies were included. Seven studies had a cross-sectional design and two studies were randomized control trials. The number of study participants ranged between 53 and 513,258 individuals with age ranging between 20 years and 85 years (median age ranging between 34.9 ± 4.9 years and 50.9 ± 16.6 years). In all studies, a positive relationship between CP and ED was reported. In four studies, odds ratio were reported, ranging between 1.53 and 3.35. From the literature reviewed, there seems to be a positive association between ED and CP; however, further well-designed controlled clinical trials are needed in this regard. It is emphasized that physicians should refer patients with ED to oral health care providers for a comprehensive oral evaluation and treatment.

The purpose of the present systematic review and meta-analysis was to assess the association between obstructive sleep apnea (OSA) and erectile dysfunction (ED). To address the focused question, “Is there an association between OSA and ED?” indexed databases were searched up to May 2017 without time or language restrictions using various key words including: obstructive sleep apnea, sleep apnea syndromes, erectile dysfunction, sleep-disordered breathing, snoring, sexual function, and impotence. Review articles, case-reports and case-series, commentaries, letters to the editor, interviews and updates, studies assessing the efficacy of OSA treatment in the improvement of ED, or studies evaluating the efficacy of ED treatment in the improvement of OSA were excluded. Twenty-eight observational studies were included for qualitative synthesis. Overall, 19 studies had a cross-sectional design, 7 studies were case–control, and 2 were cohort studies. The odds ratios (OR) with a 95% confidence interval were calculated from 10 studies. The combined OR was 0.45, with a 95% confidence interval of 0.18–0.71, indicating that in patients without OSA, the risk of ED is significantly lower compared with patients with OSA. The available evidence shows that OSA is associated with a higher risk of ED; however, further well-designed controlled clinical trials and longitudinal prospective studies are needed in this regard.

Purpose To our knowledge from indexed literature, the present study is the first one to systematically review the influence of local delivery of pamidronate (PAM) and/or ibandronate (IBA) on osseointegration enhancement. The aim of the present systematic review was to assess the efficacy of IBA and/or PAM local delivery (topically or coating on implants surfaces) in promoting osseointegration. Materials and Methods To address the focused question, “Does local IBA and/or PAM delivery enhances osseointegration?,” indexed databases were searched without time or language restrictions up to and including May 2016 using various combinations of the following keywords: “pamidronate,” “ibandronate,” “bisphosphonates,” “osseointegration,” and “topical administration.” Letters to the Editor, historic reviews, commentaries, case series, and case reports were excluded. Results Fifteen studies were included. Fourteen studies were performed in animals and 2 were clinical trials. One study reported an experimental model and a clinical trial in the same publication. Results from 12 experimental studies and 2 clinical studies reported improved biomechanical properties and/or osseointegration around implants with PAM and/or IBA. Two experimental studies showed that PAM and/or IBA did not improve osseointegration. Conclusions On experimental grounds, local IBA and/or PAM delivery seems to enhance osseointegration; however, from a clinical perspective, further randomized control trials are needed to assess the effectiveness of IBA and PAM in promoting osseointegration around dental implants.

The development of cognitive knowledge, motor skills, and artistic sense in order to restore lost tooth structure is fundamental for dental professionals. The course of dental anatomy is taught in the initial years of dental school, and is a component of the basic core sciences program in the faculties of dentistry. The learning objectives of the dental anatomy course include identifying anatomical and morphological characteristics of human primary and permanent teeth; identifying and reproducing tooth surface details in order to recognize and diagnose anatomical changes; and developing student’s psychomotor skills for restoring teeth with proper form and function. The majority of dental schools rely on traditional methods to teach dental anatomy, using lectures to convey the theoretical component; whereas the practical component uses two-dimensional drawing of teeth, identification of anatomical features in samples of preserved teeth, and carving of teeth. The aim of the present literature review is to summarize different educational strategies proposed or implemented to challenge the traditional approaches of teaching dental anatomy, specifically the flipped classroom educational model. The goal is to promote this approach as a promising strategy to teaching dental anatomy, in order to foster active learning, critical thinking, and engagement among dental students.

BACKGROUND:It is hypothesized that (a) self-perceived oral symptoms (OSs) are worse in intravenous heroin addicts (IHA) than controls; and (b) clinical periodontal inflammatory parameters (plaque index [PI], bleeding on probing [BOP], PD and clinical attachment loss [AL]), number of missing teeth (MT), and radiographic marginal bone loss (MBL) are higher in IHA compared with controls. The aim was to compare the self-perceived OSs and periodontal parameters among young IHA and controls.METHODS:Sociodemographic data, self-perceived OSs and duration and daily frequency of intravenous heroin use was gathered using a structured questionnaire. Full-mouth PI, BOP, PD, and clinical AL were measured, and number of MT were recorded. Mesial and distal MBL on all teeth was measured on digital radiographs. Odds ratios (OR) with 95% confidence intervals (CI) were computed for self-perceived OSs and periodontal parameters were assessed using the Mann Whitney U-test and logistic regression analysis. Sample-size was estimated, and level of significance was set at P < 0.05.RESULTS:OR (95% CI) for self-perceived loose teeth (P < 0.001), pain in teeth (P < 0.001), dry mouth (P < 0.001), burning sensation in mouth (P < 0.001), bleeding gums (P < 0.001) and pain during chewing (P < 0.001) were significantly higher in the test than control group. Number of MT (P < 0.05), PI (P < 0.05), clinical AL (P < 0.05), and mesial (P < 0.05) and distal (P < 0.05) MBL were statistically significantly higher among individuals in the test group compared with the control group.CONCLUSION:Self-perceived OSs and periodontal inflammatory parameters were worse in IHA than controls.

The aim of the present study is to review the licensing process and challenges faced by foreign-trained dentists in United States (U.S.), and how incorporating foreign-trained dentists in the dental workforce in the U.S. impacts the population’s dental care. Foreign-trained dentists must complete additional training in a Commission of Dental Accreditation recognized program offered by a U.S. dental school in order to be eligible for licensing. Foreign-trained dentists interested in seeking employment in the U.S. face numerous challenges, including stringent admission processes, high tuition costs, immigration barriers and cultural differences. Opening the U.S. dental profession to foreign-trained dentists provides several advantages, such as increasing the diversity of dentists in the U.S., expanding access to underrepresented communities, and enhancing the expertise of the profession. Foreign-trained dentists are an important resource for a U.S. government seeking to build the human capital base and make the most of global trade opportunities through a “brain gain”. Increasing the diversity in the dental profession to match the general U.S. population might improve access to dental care for minorities and poor Americans, reducing disparities in dental care.

Objective: The past few years have seen a progressive increment in the number of osteomyelitis cases associated with dental implants, raising the interest of a possible role of implant therapy in the development of osteomyelitis. The aim of the present study was to systematically review the association between dental implant therapy and occurrence of osteomyelitis. Data Sources: The focused question addressed was “What is the risk to develop osteomyelitis among patients receiving dental implants?” Indexed databases were searched without language restrictions up to January 2017 using various key words including: “osteomyelitis”; “dental implants”; “osseointegration”; and “risk factors.” Results: Fourteen studies reporting cases of 39 patients who developed osteomyelitis after dental implant placement were identified. Among the 39 patients, 66.6% were women and 28.2% were men. The overall mean age was 60.26 years. Thirty-six patients had osteomyelitis of the mandible; 2 cases were reported in the maxilla, whereas, 1 case reported vertebral osteomyelitis associated with implant therapy. Conclusion: The knowledge of the real impact of osteomyelitis on the outcome of implant therapy and the identification of risk factors associated with this infectious and life-threatening condition are essential for the development of prevention protocols and treatment strategies.

Implant surface modification has been used to improve osseointegration. However, evidence regarding improved new bone formation (NBF) and osseointegration with the use of collagen chondroitin sulfate (CS) matrix coated implants remains unclear. The aim of this study was to assess the efficacy of collagen-CS matrix coating on the osseointegration of implants. The focused question was "Does the incorporation of collagen-CS matrix in implant surfaces influence osseointegration?" To answer the question, indexed databases were searched up to July 2017 using various combinations of the key words "collagen", "chondroitin sulfate", "osseointegration", and "implants". The initial literature search identified 497 articles, of which 18 reporting experimental studies fulfilled the inclusion criteria. Thirteen of the studies included (72%) reported that implants coated with a collagen-CS matrix presented higher NBF, bone-to-implant contact, and/or bone volume density. The strength of this observation was supported by meta-analysis results. Nevertheless, the results should be interpreted with caution due to the lack of standardization regarding the dosage formulation of collagen-CS, short-term follow-up, and lack of assessment of confounders. On experimental grounds, the incorporation of collagen-CS matrix into implant surfaces appears to promote osseointegration. From a clinical perspective, the results from animal models support phase I studies in healthy humans.

There are no studies that have systematically reviewed the influence of involuntary cigarette smoke inhalation (ICSI) on the stability of implants. The aim of the present study was to perform a systematic review and meta-analysis of preclinical studies that assessed the influence of involuntary cigarette smoke inhalation ICSI on osseointegration. Indexed databases (PubMed, Google-Scholar, Scopus, EM BASE, and Web of Knowledge) were searched till September 2017. Titles and abstracts of studies identified using the above-described protocol were independently screened by 2 authors. Full-texts of studies judged by title and abstract to be relevant were independently evaluated for the stated eligibility criteria. Nine studies were included. Six studies showed that ICSI compromised bone area contact around implants. In 4 studies, peri-implant bone mineral density was significantly higher in the control group than among subjects exposed to ICSI. For the effects of ICSI on the osseointegration of dental implants, significant differences could be observed for bone-to-implant contact for test subjects in cancellous (Z = -4.08, p < 0.001) and cortical bone (Z = -4.31, p < 0.001) respectively. ICSI may negatively influence osseointegration of dental implants. It is imperative to educate patients about the negative effects of passive smoking on dental and systemic health.

The aim of this systematic review was to determine whether or not assessment of salivary secretory immunoglobulin A (sIgA) levels could be a potential biomarker for immunosuppression in HIV-positive children. The Patient, Exposure, Comparative, Outcome question was Is sIgA level a potential biomarker for immunosuppression in HIV-positive children? Electronic and manual literature searches were conducted in indexed databases (MEDLINE, PubMed, EMBASE, ScienceDirect, and SCOPUS databases) up to and including June 2017. The primary outcome was total mean salivary levels of IgA among HIV seropositive and seronegative children (controls). The weighted mean differences (WMD) of outcomes and 95% confidence intervals (CI) for total mean salivary IgA levels were calculated using a random effect model. Six studies were included. Three studies showed significantly lower salivary IgA levels in HIV-infected children compared with controls. Two studies showed comparable IgA levels in HIV infected and controls. One study showed significantly higher levels of salivary IgA in HIV-infected children as compared to controls. Considering the total mean salivary IgA levels among HIV seropositive and seronegative children, a high degree of heterogeneity (Q value=254.09, P<.0001, I-2=98.82%) was noticed among both groups. The overall WMD was not significant (WMD=-1.18, 95% CI, -1.91 to -0.44, P=.39). Whether salivary IgA level is a potential biomarker for immunosuppression in HIV-positive children remains debatable because of limited information available in the current literature. Further, high-quality case-control studies with larger sample size and more solid methodological aspects are required.

OBJECTIVE:The aim of this systematic review and meta-analysis was to evaluate the role of osteogenic coatings (placement of a thin film of organic and inorganic osteoinductive and osteoproliferative materials) on implant surfaces in augmenting bone-to-implant contact (BIC) in osteoporotic bone.DATA SOURCES:To answer the focused question "Do osteogenic coatings on implant surfaces increase BIC in osteoporotic bone?" PubMed/MEDLINE, EMBASE, ISI Web of Knowledge, Scopus, and Google-Scholar databases were searched till June 2017 using different combinations of the following key words: bone-to-implant contact, coating, implant surface, osseointegration, and osteoporosis. Letters to the Editor, review articles, case-reports/case-series, and commentaries were excluded.RESULTS:Six animal studies were included, in which osteoporosis was induced by bilateral ovariectomy. In all studies, implant surface roughness was increased by various osteogenic surface coatings including alumina, hydroxyapatite, calcium phosphate, and zoledronic acid. Five studies showed that bone volume and BIC are significantly higher around implants with coated surfaces than noncoated implants. In 1 study, there was no difference in BIC around coated and noncoated implants.CONCLUSION:Although experimental studies have shown that osteogenic coatings are effective in enhancing BIC, their clinical relevance requires further investigations.

AbstractPurpose: The aim of the present systematic review was to assess the effect of local zoledronate (ZOL) delivery (topical or as implant surface coatings) on osseointegration.Materials and methods: In this systematic review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. To address the focused question, ‘Does local zoledronate delivery enhance osseointegration?’ indexed databases were searched without time or language restrictions up to and including April 2017 using various combination of the following keywords: ‘zoledronate’, ‘bisphosphonates’, ‘osseointegration’ and ‘topical administration’. Letters to the Editor, historic reviews, commentaries, case-series and case-reports were excluded.Results: Initially, 383 articles were identified out of which, 23 experimental studies fulfilled the inclusion criteria. In 18 studies, ZOL was incorporated into implants surfaces as a coating and in five studies ZOL was applied topically (bone graft or irrigation)...

BACKGROUND:The aim of the present systematic review was to assess the efficacy of laser-assisted (low level laser therapy [LLLT], high intensity laser therapy [HILT], or antimicrobial photodynamic therapy [aPDT]) scaling and root planing (SRP) compared with SRP alone on the expression of inflammatory cytokines in the gingival crevicular (GCF) of patients with chronic periodontitis (CP).METHODS:In order to address the focused question: "What is the efficacy of SRP with and without laser and/or aPDT on the expression of pro-inflammatory cytokines in the GCF of patients with CP?" an electronic search without time or language restrictions was conducted up to and including February 2017 in indexed databases using various key words.RESULTS:Twenty-two randomized control trials were included in the present systematic review. Nine studies and six studies assessed the efficacy of LLLT and HILT, as adjunct to SRP, respectively. Seven studies assessed the efficacy of aPDT as adjunct to SRP on down-regulating the expression of pro-inflammatory cytokines in the GCF among patients with CP. The outcomes of the studies included based upon the reduction in the levels of pro-inflammatory cytokines were inconsistent.CONCLUSION:The role of laser-assisted SRP on the expression of pro-inflammatory cytokines in the GCF of patients with CP remains unclear. Further long term and well-designed randomized clinical trials are needed in this regard.

AIM:The aim of the present study was to assess the effectiveness of mechanical debridement (MD) with and without adjunct antimicrobial photodynamic therapy (aPDT) in the treatment of periodontal inflammation among patients with prediabetes.METHODS:Demographic information was collected using a questionnaire. Hemoglobin A1c (HbA1c) levels were measured at baseline and at 3 and 6 months' follow-up.TREATMENT:Individuals were randomly divided into 2 groups as follows: (a) Group-1, participants underwent full-mouth MD; and Group-2: participants underwent full-mouth MD with adjunct aPDT. In groups 1 and 2, full-mouth plaque index (PI), bleeding on probing (BOP) and probing pocket depth (PPD) were measured at baseline and at 3 and 6 months' follow-up. In both groups, full-mouth digital intraoral radiographs were also taken. Sample-size was estimated and statistical analysis was performed with level of significance set as P<0.05.RESULTS:In total, 70 prediabetic male individuals (35 patients in group-1 and 35 in group-2) were included. At baseline, PI, BOP, number of sites with PPD ≥4mm were comparable among individuals in groups 1 and 2. In groups 1 and 2, PI (P<0.05), BOP (P<0.05), number of sites with PPD ≥4mm (P<0.05) were significantly higher at baseline compared with 3 months' follow-up. There was no statistically significant difference in PI, BOP, number of sites with PPD ≥4mm at 3 and 6 months' follow-up. At 6 months' follow-up, PI, BOP, number of sites with PPD ≥4mm were comparable to their respective baseline values. There was no statistically significant difference in CBL in both groups at 3 and 6 months' follow-up. There was no statistically significant difference in HbA1c levels among individuals in groups 1 and 2 at all-time intervals.CONCLUSION:In the short-term, MD is effective in reducing periodontal inflammation among patients with prediabetes. The contribution of adjunct aPDT in this regard is insignificant.

Objectives: The aim of this study was to assess whether growth hormone (GH) replacement therapy can enhance implant osseointegration.Materials and Methods: A systematic literature search was conducted from 1982 to March 2016. A structured search using the keywords "growth hormone," "implants," and "osseointegration" was performed to identify preclinical and clinical in vivo controlled studies and was followed by a 2-phase search strategy. Initially, 31 potentially relevant articles were identified. After removal of duplicates and screening by title and abstract, 10 potential studies were included. Studies were assessed for bias and data were synthesized using a random-effects meta-analysis model.Results: All studies were preclinical animal trials, and the follow-up period ranged from 2 to 16 weeks. Seventy percent of the included studies reported an increase in bone-to-implant contact in animals receiving GH compared with controls. Meta-analysis showed a significant mean difference for bone to implant between GH groups versus controls (no GH supplementation) of 10.60% (95% confidence interval: 3.79%-17.41%) favoring GH administration.Conclusion: GH treatment seems to promote osseointegration around implants in preclinical studies; however, these findings must be assessed in highly controlled human clinical trials as a number of confounding factors may have influenced the outcomes of the included studies.

Background and aim: The efficacy of neodymium-doped yttrium aluminium garnet (Nd:YAG) laser-assisted nonsurgical mechanical debridement (MD) in the treatment of periimplant diseases remains uninvestigated. The aim was to assess the efficacy of Nd:YAG laser-assisted non-surgical MD on clinical and radiographic periimplant inflammatory parameters in patients with periimplant disease.Methods: Treatment wise, 63 male patients with periimplant diseases were divided into 2 groups: Group-1 (32 patients): treatment of periimplant disease using MD alone (control group); and Group-2 (n = 31 patients): treatment of periimplant disease using MD with a single application of Nd:YAG laser. Peri-implant inflammatory parameters (plaque index [PI], bleeding on probing [BOP] and probing depth [PD]) were measured at baseline and at 3 and 6 months' follow-up. Periimplant crestal bone loss (CBL) was measured at baseline and at 6 months' follow-up. Statistical analysis was performed using the Kruskall-Wallis and Bonferroni Post hoc tests. P values < 0.05 were considered statistically significant.Results: In both groups, mean age of patients and baseline scores of periimplant PI, BOP and PD were comparable. At 3-month follow-up, scores of periimplant PI, BOP and PD were higher among patients in Group-1 compared with Group-2. At 6-month follow-up, scores of periimplant PI, BOP and PD were comparable among patients in groups 1 and 2. There was no statistically significant difference in periimplant CBL in both groups at all time intervals.Conclusion: Nd:YAG laser-assisted non-surgical MD is more effective in reducing periimplant soft tissue inflammatory parameters than MD alone in short-term but not in long-term. (C) 2017 Published by Elsevier B.V.

Purpose: In indexed literature, a systematic review of the efficacy of statins in enhancing osseointegration is lacking. The aim of this systematic review was to assess the efficacy of local and systemic statin delivery on the osseointegration of implants. Materials and Methods: To address the focused question, "Does local and systemic statin delivery affect osseointegration around implants?", indexed databases were searched from 1965 through November 2015 using various keywords. Letters to the Editor, case reports/case series, historic reviews, and commentaries were excluded. The pattern of this systematic review was customized to primarily summarize the pertinent data. Results: Nineteen studies were included. All studies were experimental and were performed in animal models. In seven studies, statins were delivered systemically via oral, intraperitoneal, intraosseous, subcutaneous, and percutaneous routes. Among the 12 studies, where statins were delivered locally, statin-coated implants were used in seven studies, whereas in the remaining studies, statins were delivered via topical application on the bone cavities. The follow-up duration ranged between 1 and 12 weeks. Results from 18 studies showed that statin administration enhanced new bone formation (NBF) around implants and/or bone-to-implant contact. One study showed that statin-coated implant surfaces impaired osseointegration. Seven studies reported that statin administration enhanced NBF around implants in osteoporotic rats. Conclusion: On experimental grounds, local and systemic statin delivery seems to enhance osseointegration; however, from a clinical perspective, further studies are needed to assess the role of statins in promoting osseointegration around dental implants.

A variety of materials are available to treat exposed dental pulp by direct pulp capping. The healing response of the pulp is crucial to form a dentin bridge and seal off the exposed pulp. Studies have used lasers to stimulate the exposed pulp to form tertiary dentin. The aim of the present systematic review and meta-analysis was to evaluate the evidence on the effects of laser irradiation as an adjunctive therapy to stimulate healing after pulp exposure. A systematic literature search was conducted up to April 2016. A structured search using the keywords “Direct pulp capping,” “Lasers,” “Calcium hydroxide pulp capping,” and “Resin pulp capping” was performed. Initially, 34 potentially relevant articles were identified. After removal of duplicates and screening by title, abstract, and full text when necessary, nine studies were included. Studies were assessed for bias and data were synthetized using a random-effects meta-analysis model. Six studies were clinical, and three were preclinical animal trials; the follow-up period ranged from 2 weeks to 54 months. More than two thirds of the included studies showed that laser therapy used as an adjunct for direct pulp capping was more effective in maintaining pulp vitality than conventional therapy alone. Meta-analysis showed that the success rate in the laser treatment group was significantly higher than the control group (log odds ratio = 1.737; 95 % confidence interval, 1.304–2.171). Lasers treatment of exposed pulps can improve the outcome of direct pulp capping procedures; a number of confounding factors may have influenced the outcomes of the included studies.