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Objectives: Patients with xerostomia manifest various clinical signs of oral dryness, which has an impact on oral functions and wearing of dental prosthese?s, 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.

A limited number of studies have reported an association between male factor infertility (MFI) and dental health status (DHS). The aim of the present study was to assess the association between DHS and MFI through a systematic review of indexed literature. To address the focused question-"Is there a relationship between DHS and MFI?"-indexed databases were searched up to March 2016 using various key words "infertility," "periodontal disease," "periodontitis," "dental infection," "caries," and "odontogenic infection." Letters to the editor, case reports, commentaries, historic reviews, and experimental studies were excluded. In total seven studies were included in the present systematic review and processed for data extraction. All the studies reported a positive association between MFI and DHS. The number of study participants ranged between 18 and 360 individuals. Results from six studies showed a positive association between chronic periodontitis and MFI. Three studies reported a positive relationship between MFI and odontogenic infections associated to necrotic pulp, chronic apical osteitis, and radicular cysts. One study reported a relationship between caries index and MFI. From the literature reviewed, there seems to be a positive association between MFI and DHS; however, further longitudinal studies and randomized control trials assessing confounders are needed to establish real correlation. Dentists and general practitioners should be aware that oral diseases can influence the systemic health. Andrological examination should include comprehensive oral evaluation, and physicians detecting oral diseases should refer the patient to a dentist for further evaluation.

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.

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.

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.

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, EMBASE, 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., (Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. All rights reserved.)

Objective: The aim of this comprehensive review was to assess the effectiveness of erbium lasers in the removal of all ceramic fixed dental prostheses (FDPs)., Overview: Indexed databases were searched without language or time restriction up to and including December 2017 using different combinations of the following keywords: "lasers"; "phototherapy"; "crowns"; "prostheses and implants"; "inlays"; "ceramics"; "dental porcelain"; "zirconium"; "removal"; "debonding"; "fixed dental prostheses"; "veneers"; "laminates"; and "fixed bridge." All levels of available evidence including experimental studies, case reports and case series were included. Six clinical studies reporting a total of 13 cases and 6 experimental studies were included. Results from all studies showed that erbium lasers are effective reducing the shear bond strengths of all ceramic FDPs, in terms of easy removal of the restorations with none or minimal damage to teeth or ceramic surfaces., Conclusion: Laser-assisted removal of all ceramic FDPs is a promising treatment protocol. Further well-designed controlled clinical trials and longitudinal prospective studies are needed to determine the precise laser parameters and duration of irradiation that could be used for removal of ceramic restorations with varying thicknesses., Clinical Significance: Benefits of lasers over mechanical instrumentation for crown removal encompass efficient restoration retrievability without restoration or teeth surfaces damages; and relatively easier and time effective procedure with no prerequisite for anesthetic agents. It is however imperative for clinicians to be well-trained and exhibit adequate knowledge regarding recommended power settings and laser-safety parameters with reference to interactions between light and different tissues and ceramics., (© 2017 Wiley Periodicals, Inc.)

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., (© 2018 American Academy of Periodontology.)

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.

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., (© 2016 by the American College of Prosthodontists.)

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.

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., (Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

To evaluate the effects of orthodontic palatal plate therapy (OPPT) in the treatment of orofacial dysfunction in children with Down syndrome (DS). Indexed databases were searched. Clinical trials in DS allocated to test (treatment with palatal plates) versus control group (without palatal plates/special physiotherapy for orofacial stimulation) with follow-up of any time duration and assessing mouth closure, tongue position, active and inactive muscle function as outcomes. Study designs, subject demographics, frequency and duration of palatal plate therapy, method for assessment, follow-up period and outcomes were reported according to the PRISMA guidelines. Eight clinical studies were included. The risk of bias was considered high in three studies and moderate in 5 studies. The number of children with DS ranged between 9 and 42. The mean age of children with DS at the start of the study ranged between 2 months and 12 years. The duration of palatal plate therapy ranged between 4 months and 48 months. The follow-up period in all studies ranged from 12 to 58 months. All studies reported OPPT to be effective in improving orofacial disorders in children with DS. Most of the included studies suggest that palatal plate therapy in combination with physiotherapy/orofacial regulation therapy according to Castillo Morales/speech and language intervention seems to be effective in improving orofacial disorders in children with DS. However, the risk of bias of the included studies was high to moderate. Longitudinal trials with standardized evaluation methods, age of children at treatment initiation, treatment duration and standard orofacial outcomes are recommended., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

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.

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., (Copyright © 2017. Published by Elsevier B.V.)

Background: The aim of the present systematic review and meta-analysis was to assess the efficacy of antimicrobial photodynamic therapy (aPDT) as a therapeutic protocol for oral decontamination., Methods: In order to address the focused question: Is aPDT a useful therapeutic protocol for oral decontamination?, an electronic search without time or language restrictions was conducted up to July 2017 in indexed databases using the combination of different key words including photochemotherapy, lasers, photodynamic therapy, disinfection, mouth, saliva and oral. The exclusion criteria included reviews, case-reports, case-series, commentaries, letters to the editor, interviews, and updates. Four randomized control trials were included and processed for data extraction., Results: All studies reported that aPDT was effective in reducing the overall oral microbial load in saliva. Considering the effects of aPDT+photosensitizer (PS) compared with PS alone, there was no heterogeneity noticed for aPDT+PS (Q value=0.15, P=0.69, I 2 =0%). The overall mean difference for bacterial count in CFU/ml between aPDT+PS and PS alone was also not significant (weighted mean difference=-0.41, 95% CI=-1.12 to 0.29, p=0.24) at follow-up., Conclusion: The efficacy of aPDT for oral decontamination remains unclear. Further well-designed randomized clinical trials assessing the efficacy of aPDT reducing the oral microbial load are need., (Copyright © 2017 Elsevier B.V. All rights reserved.)

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.

Purpose: 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) into the bone cavities. Results from 87% studies reported that local delivery of ZOL (coating or topical) is effective in enhancing osseointegration or new bone formation around implants., Conclusions: Local ZOL delivery (coating or topical) seems to enhance osseointegration in animals; however, from a clinical perspective, further randomized control trials with long-term follow-up are needed in this regard.

The aim of the present cross-sectional retrospective 2-year follow-up clinical study was to assess the influence of implant location on clinical and radiographic parameters around dental implants placed in patients with and without type 2 diabetes mellitus (T2DM). Twenty-seven patients with T2DM and 25 non-diabetic controls were included. Implants were classified into three zones according to their location: (1) anterior zone: implant/s replacing anterior teeth, (2) middle zone: implant/s replacing premolars, and (3) posterior zone: implant/s replacing molars. Peri-implant bleeding on probing (BOP), probing depth (PD), and crestal bone loss (CBL) were measured. P-values less than 0.05 were considered statistically significant. The mean age of patients with T2DM was 42.5 years and that of non-diabetic controls was 40.6 years. The mean fasting blood glucose levels of patients with and without T2DM were 74.5mg/dl (66-80mg/dl) and 82.5mg/dl (79-88.1mg/dl), respectively. The mean duration of T2DM was 4.3 years. There was no significant difference in BOP, PD, or CBL around implants placed in any of the zones in the jaws of patients with and without T2DM. There is no influence of implant location on clinical and radiographic parameters around dental implants placed in patients with and without T2DM., (Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

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.

Purpose: The aim of this systematic review was to compare the crestal bone loss around splinted and nonsplinted adjacent implants., Materials and Methods: To address the focused question, "Is crestal bone loss around adjacent implants different with splinted from that with nonsplinted restorations?," indexed databases were searched from 1965 up to and including May 2016 using various combinations of the following keywords: "implant," "splinted," "nonsplinted," "unsplinted," "connected," "unconnected," "nonconnected," and "bone loss." Letters to the editor, commentaries, historic reviews, case reports, case series, animal studies, and studies on full-arch rehabilitation were excluded., Results: Six studies were included with titanium implants ranging from 114 to 1187 implants. All studies had nonsplinted and splinted restorations that ranged from 20 to 234 restorations and from 60 to 970 restorations, respectively. In all the studies, the follow-up period after the restoration placement ranged between 1 and 22 years, with a mean follow-up ranging between 3 and 10.18 ± 3.18 years. In all studies, the mean crestal bone loss for implants restored with nonsplinted restorations ranged between 0.30 ± 0.65 and 1.3 ± 0.2 mm, whereas the mean crestal bone loss for implants restored with splinted restorations ranged between 0.50 ± 0.8 and 1.22 ± 0.95 mm., Conclusion: Within the limitations of this review it is concluded that adjacent implants restored with splinted and nonsplinted fixed restorations did not exhibit a difference in crestal bone loss. The evidence from this systematic review suggests further investigation., (© 2016 by the American College of Prosthodontists.)

There is controversy regarding whether locally delivered alendronate enhances osseointegration. The aim of this systematic review was to assess the role of local alendronate delivery (topical, or as a coating on implant surfaces) in the osseointegration of implants. The focused question was, "Does the local delivery of alendronate affect osseointegration around implants?". To address this question, indexed databases were searched, without time or language restriction, up to and including January 2017. Various combinations of the following key words were used: "alendronate", "bisphosphonates", "osseointegration", and "topical administration". letters to the editor, historic reviews, commentaries, case series, and case reports were excluded. In total, 18 experimental studies were included: alendronate-coated implants were used in 13 of these studies and local delivery in five studies. The results of 11 of the studies showed that alendronate coating increased new bone formation, the bone volume fraction, or bone-to-implant contact (BIC) and biomechanical properties. Results from two studies in which alendronate was administered topically indicated impaired BIC and/or biomechanical fixation around implants. On experimental grounds, local alendronate delivery seems to promote osseointegration. From a clinical perspective, the results in animal models support phase 1 studies in healthy humans (without co-morbidities other than edentulism)., (Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

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., (Copyright © 2017 John Wiley & Sons, Ltd.)

Objective: The aim was to assess the efficacy of antimicrobial photodynamic therapy (aPDT) in the inactivation of oral fungal colonization among cigarette smokers and non-smokers with denture stomatitis (DS)., Methods: A questionnaire was used to gather demographic information. Clinical oral examination was performed to determine location of denture in the jaws and oral erythematous lesions. Presence of fungal hyphae in smokers and non-smokers was confirmed using exfoliative cytology. In both groups, aPDT was performed and colony forming units per milliliter (CFU/ml) were assessed im both groups at 3-months follow-up. Level of significance was et at P<0.05., Results: Twenty-two males with DS (12 smokers and 10 non-smokers) were included. The mean ages of smokers and non-smokers was 73.8±2.5 and 70.5±1.2years, respectively. The duration and daily frequency of cigarette smoking was 20.6±4.5years and 12.3±1.5 cigarettes daily, respectively. Smokers and non-smokers had been wearing complete dentures since 6.2±0.8 and 5.8±0.4years, respectively. At 3-months follow-up, there was a statistically significant decrease in the mean fungal CFU/ml among smokers (25.5±8.3 CFU/ml) compared with their respective baseline values 106.7±6.3 CFU/ml (P<0.01). Among non-smokers, the mean CFU/ml values were 12.7±0.8 CFU/ml compared with their respective baseline values (93.6±8.4 CFU/ml) (P<0.01). At 3-months follow-up, fungal CFU/ml levels were statistically significantly higher among smokers (25.5±8.3 CFU/ml) compared with non-smokers (12.7±0.8 CFU/ml) (P<0.05)., Conclusion: aPDT is effective in the inactivation of oral fungal colonization among cigarette smokers and non-smokers with. The role of denture is also emphasized., (Copyright © 2017. Published by Elsevier B.V.)

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., (Copyright © 2017 Elsevier B.V. All rights reserved.)

The purpose of the present study was to review systematically the association between periodontal diseases (PDs) and polycystic ovary syndrome (PCOS). To address the focused question, 'Is there a relationship between PD and PCOS?' indexed databases were searched up to October 2016 without time or language restrictions using different combinations of the following key words: PCOS, ovarian cysts, PD, periodontitis, gingival diseases and gingivitis. Letters to the Editor, commentaries, historic reviews, case-report, unpublished articles and animal/experimental studies were excluded. Seven case-control studies were included. The number of study participants ranged between 52 and 196 females aged between 15 and 45 years. In three and three studies, proinflammatory cytokines were assessed in gingival crevicular fluid and saliva samples, respectively. In one study, salivary microbes were investigated. All studies reported that a positive association exists between PD and PCOS. In conclusion, there is a positive association between PD and PCOS; however, further well-designed longitudinal controlled clinical trials are needed in this regard. It is recommended that physicians should refer patients with PCOS to oral health-care providers for comprehensive oral evaluation and treatment.

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.

The objective of this study was to assess the oral Candida carriage and species prevalence in denture stomatitis (DS) patients with and without diabetes mellitus (DM). To address the focused question “In patients receiving dentures, how does having diabetes compared to no diabetes influences the carriage and species prevalence of oral Candida?” Indexed databases were explored without time or language restrictions up to and including February 2017. Nine studies were included. In these studies, the number of diabetics ranged between 14 patients and 405 individuals with mean ages ranging between 33 years and 66.4 years. In five studies, the percentage of hyperglycemic patients in the diabetic group ranged from 14.3% to 100%. In one study, all diabetic patients were normoglycemic. Seven studies reported Candida-associated DS to be significantly higher among diabetics than non-diabetics. Candida albicans was the most prevalent species isolated among diabetics and non-diabetics with DS. Denture-wearers with DM are more susceptible to Candida-associated DS as compared to non-diabetics.

Nicotine has been associated with vasoconstriction and an impaired cellular healing response. It is therefore likely that nicotine jeopardizes osseointegration. This systematic review and meta-analysis was performed to assess pre-clinical studies on the effect of nicotine on implant osseointegration. Databases were searched up to and including March 2016 for animal/non-human studies using the following Keywords: bone to implant contact; implant; nicotine; osseointegration; bone healing; and new bone formation. In total eight in vivo design studies were included and processed for data extraction. Five studies reported no significant influence of nicotine on healing around implants. Quantitative analysis of the effects of nicotine on the osseointegration of dental implants showed a significant difference in bone-to-implant contact between test and control subjects (Z=-2.49; P=0.014). From the studies included in the present review; it appears that nicotine has an effect on implant osseointegration., (Copyright © 2016. Published by Elsevier Ltd.)

Background and Aim: Limited evidence exists regarding the role of scaling and root planning (SRP) with adjunct neodymium yttrium aluminum garnet (Nd:YAG) laser therapy in reducing periodontal parameters (plaque index [PI], bleeding on probing [BOP] and probing pocket depth [PPD]) and levels of proinflammatory cytokines in the gingival crevicular fluid (GCF) among patients with periodontal disease (PD). The aim was to assess the effect of SRP with and without adjunct Nd:YAG laser therapy on clinical periodontal parameters and GCF interleukin 1-beta (IL-1β) and tumor necrosis factor-alpha (TNF-α) levels among patients with PD., Methods: Demographic data was collected using a questionnaire. Mandibular right and left quadrants were randomly divided into test- (SRP+Nd:YAG laser) and control-sites (SRP alone). PI, BOP and PPD were assessed and GCF IL-1β and TNF-α levels were measured at baseline and at 3- and 6-month follow-up. Level of significance was set at P<0.05., Results: Twenty-eight male patients with PD were included. At 3- and 6-month follow-up, PI (P<0.01), BOP (P<0.01) and PPD (P<0.01) were significantly higher in the control-sites than test-sites. In the test-sites, PI, BOP and PPD and GCF IL-1β and TNF-α levels were comparable at 3- and 6-month follow-up. At 6-month follow-up, IL-1β (P<0.05) and TNF-α (P<0.05) levels were significantly higher in control-sites than test-sites at 3- and 6-month follow-up., Conclusion: At 3- and 6-month follow-up, SRP+Nd:YAG therapy was more effective in reducing periodontal inflammatory parameters and GCF IL-1β and TNF-α levels compared with SRP alone., (Copyright © 2017. Published by Elsevier B.V.)

There is a debate over the association between low testosterone levels in body fluids and the occurrence of chronic periodontitis (CP). The aim of the present systematic review was to assess whether low testosterone levels in body fluids reflect CP. In order to identify studies relevant to the focus question: "Is there a relationship between low testosterone levels in body fluids and CP?" an electronic search without time or language restrictions was conducted up to June 2016 in indexed databases using different keywords: periodontitis, chronic periodontitis, periodontal diseases, testosterone, and gonadal steroid hormones. A total of eight studies were included in the present systematic review. The number of study participants ranged from 24 to 1,838 male individuals with ages ranging from 15 to 95 years. Seven studies measured testosterone levels in serum, two studies in saliva, and one study in gingiva. Four studies reported a negative association between serum testosterone levels and CP. Two studies reported a positive association between decreased testosterone levels in serum and CP. Increased levels of salivary testosterone among patients with CP were reported in one study; whereas one study reported no significant difference in the concentration of salivary testosterone between patients with and without CP. One study identified significant increase in the metabolism of testosterone in the gingiva of patients with CP. Within the limits of the evidence available, the relationship between low testosterone levels and CP remains debatable and further longitudinal studies and control trials are needed.

Background and Aim: The efficacy of neodymium-doped yttrium aluminium garnet (Nd:YAG) laser-assisted non-surgical 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 6months' follow-up. Periimplant crestal bone loss (CBL) was measured at baseline and at 6months' 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., (Copyright © 2017. Published by Elsevier B.V.)

Aims: The aim of this systematic review was to assess the efficacy of bisphosphonate therapy as an adjunct to scaling and root planing (SRP) in the management of periodontitis., Methods: Databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Cochrane Oral Health Group Trials Register databases) were searched up to and including July 2016. The primary outcome was probing depth (PD), and the secondary outcomes were changes in clinical attachment level (CAL) and bone defect (BD) fill. The mean differences (MD) of outcomes and 95% confidence intervals (CI) for each variable were calculated using random effect model., Results: Eight clinical studies were included. Seven studies used alendronate as an adjunct to SRP; of these, four studies used topical application and three used oral alendronate. Considering the effects of adjunctive bisphosphonates as compared to SRP alone, a high degree of heterogeneity for PD (Q value = 39.6, P < 0.0001, I 2  = 87.38%), CAL (Q value = 13.65, P = 0.008, I 2  = 70.71%), and BD fill (Q value = 53.26, P < 0.0001, I 2  = 92.49%) was noticed among both the groups. Meta-analysis showed a statistically significant PD reduction (MD = -1.18, 95% CI = -1.91 to -0.44, P = 0.002), CAL gain (MD = -0.69, 95% CI = -1.20 to -0.18, P = 0.008) and BD fill (MD = -2.36, 95% CI = -3.64 to -1.08, P < 0.001) for SRP + bisphosphonate treatment vs. SRP alone., Conclusions: Adjunctive bisphosphonate therapy appears to be effective in managing periodontitis, however, due to the potential risk of osteonecrosis of the jaws and short-term follow-up of the studies, their clinical application is debatable., (© 2016 The British Pharmacological Society.)

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.

Objective: The purpose of the present study was to review indexed literature and provide an update on the effectiveness of high-frequency radio waves (HRW) application in modern general dentistry procedures., Data Sources: Indexed databases were searched to identify articles that assessed the efficacy of radio waves in dental procedures., Results: Radiosurgery is a refined form of electrosurgery that uses waves of electrons at a radiofrequency ranging between 2 and 4 MHz. Radio waves have also been reported to cause much less thermal damage to peripheral tissues compared with electrosurgery or carbon dioxide laser-assisted surgery. Formation of reparative dentin in direct pulp capping procedures is also significantly higher when HRW are used to achieve hemostasis in teeth with minimally exposed dental pulps compared with traditional techniques for achieving hemostasis. A few case reports have reported that radiosurgery is useful for procedures such as gingivectomy and gingivoplasty, stage-two surgery for implant exposure, operculectomy, oral biopsy, and frenectomy. Radiosurgery is a relatively modern therapeutic methodology for the treatment of trigeminal neuralgia; however, its long-term efficacy is unclear. Radio waves can also be used for periodontal procedures, such as gingivectomies, coronal flap advancement, harvesting palatal grafts for periodontal soft tissue grafting, and crown lengthening., Conclusion: Although there are a limited number of studies in indexed literature regarding the efficacy of radio waves in modern dentistry, the available evidence shows that use of radio waves is a modernization in clinical dentistry that might be a contemporary substitute for traditional clinical dental procedures.

Background: The aim of this study is to compare peri-implant soft tissue parameters (plaque index [PI], bleeding on probing [BOP], and probing depth [PD] ≥4 mm) and crestal bone loss (CBL) around immediately loaded (IL) and delayed loaded (DL) implants in smokers and non-smokers., Methods: Thirty-one patients with IL implants (16 smokers and 15 non-smokers) and 30 patients with DL implants (17 smokers and 13 non-smokers) were included. Personal data regarding age, sex, and duration and daily frequency of smoking were gathered using a questionnaire. Peri-implant PI, BOP, and PD ≥4 mm were recorded, and mesial and distal CBL was measured on standardized digital radiographs. Multiple group comparisons were performed using the Bonferroni post hoc test (P <0.05)., Results: All implants replaced mandibular premolars or molars. Mean scores of PI (P <0.05) and PD ≥4 mm (P <0.05) were statistically significantly higher in smokers compared with non-smokers in patients with IL and DL dental implants. The mean score of BOP (P <0.05) was statistically significantly higher in non-smokers compared with smokers in both groups. CBL (P <0.05) was statistically significantly higher in smokers compared with non-smokers in both groups. There was no statistically significant difference in PI, BOP, PD ≥4 mm, and total CBL among smokers with IL and DL implants., Conclusions: Tobacco smoking enhances peri-implant soft tissue inflammation and CBL around IL and DL implants. Loading protocol did not show a significant effect on peri-implant hard and soft tissue status in healthy smokers and non-smokers.

Statement of Problem: Titanium implant surfaces have been modified to improve osseointegration; however, the evidence for incorporating zinc into titanium implants to improve new bone formation and osseointegration is not clear., Purpose: The purpose of this systematic review was to assess the efficacy of treating titanium surfaces with zinc on the osseointegration of implants., Material and Methods: The focused question addressed was, "Does incorporating zinc in titanium implant surfaces influence osseointegration?" Indexed databases were searched up to January 2016 using the key words "Bone to implant contact"; "implant"; "zinc"; "osseointegration." Letters to the editor, case reports/case series, historic reviews, and commentaries were excluded. The pattern of the review was customized to summarize the pertinent data., Results: Ten experimental studies were included, all of which were performed in animals (5 in rabbits, 4 in rodents, and 1 in goats). The number of titanium implants placed ranged from 10 to 78. The results from all studies showed that incorporating zinc into titanium implants enhanced new bone formation and/or bone-to-implant contact around implants. One study reported that zinc enhanced the removal torque on implants., Conclusions: The current available evidence on adding zinc to titanium implants surfaces to enhance osseointegration remains unclear. Further investigation is necessary to assess its effectiveness and safety in humans and to establish a standard methodology and ideal compound for incorporating zinc ion into titanium implant surfaces in a clinical setting., (Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

With the increasing use of low level laser therapy (LLLT) in clinical dentistry, the aim of the present study was to assess the effectiveness of diode lasers in the management of orofacial pain. Indexed databases were searched without language and time restrictions up to and including July 2016 using different combinations of the following key words: oral, low level laser therapy, dental, pain, diode lasers, discomfort and analgesia. From the literature reviewed it is evident that LLLT is effective compared to traditional procedures in the management of oro-facial pain associated to soft tissue and hard tissue conditions such as premalignant lesions, gingival conditions and dental extractions. However, it remains to be determined which particular wavelength will produce the more favorable and predictable outcome in terms of pain reduction. It is highly recommended that further randomized control trials with well-defined control groups should be performed to determine the precise wavelengths of the diode lasers for the management of oro-facial pain. Within the limits of the present review, it is concluded that diode lasers therapy is more effective in the management of oro-facial pain compared to traditional procedures.

Objective: The aim of the present study was to assess the efficacy of laser therapy (LT) and antimicrobial photodynamic therapy (aPDT) as adjunct to mechanical debridement (MD) on the management of halitosis., Data Sources: In order to address the focused question "Is MD with adjunct LT and/or aPDT more effective in the management of halitosis compared with MD alone?" an electronic search without time or language restrictions was conducted up to January 2017 in indexed databases using the combination of different key words including photochemotherapy, lasers, light, photodynamic therapy, halitosis, and bad breath. The exclusion criteria included qualitative and/or quantitative reviews, case reports, case series, commentaries, letters to the editor, interviews, and updates., Results: Six randomized control trials were included and processed for data extraction. Results from all studies reported that MD with adjunct LT or aPDT is more effective in reducing halitosis and/or volatile sulfur compounds concentration associated with oral conditions compared with MD alone. One study reported a significant reduction in bacterial colony forming units on the dorsum of the tongue among patients with coated tongue receiving MD with aPDT compared with MD alone., Conclusion: The efficacy of aPDT and/or LT on halitosis management remains unclear. Further well-designed randomized clinical trials assessing the efficacy of mechanical debridement with LT or aPDT on the halitosis treatment are needed.

Background/objective: We hypothesized that nonsurgical-periodontal-therapy (NSPT) with adjunct Nd:YAG laser therapy is more effective in reducing periodontal inflammatory parameters (plaque index [PI], bleeding-on-probing [BOP], and probing-pocket-depth [PPD]) and serum interleukin-1beta (IL-1β) and matrix metalloproteinase-9 (MMP-9) levels in patients with and without coronary artery disease (CAD) than NSPT alone. The aim of this short-term pilot study was to assess the effect of NSPT + Nd:YAG laser therapy on periodontal parameters and serum IL-1β and MMP-9 levels in patients with and without CAD., Study Design: A prospective randomized clinical study was conducted on 87 patients who were divided into two groups: Group-1: 44 patients with CAD and periodontal disease (PD) and Group-2: 43 patients with PD alone. Treatment-wise, these individuals were randomly divided into two subgroups: (i) NSPT alone and (ii) NSPT + Nd:YAG laser therapy. Demographic information was collected using a self-completed questionnaire. Periodontal parameters (PI, BOP, and PPD) and serum IL-1β and MMP-9 levels were measured at baseline and after 3 months of treatment. P-values <0.05 were considered statistically significant., Results: At 3 months follow-up, PI (P < 0.01), BOP (P < 0.01), PPD ≥ 4 mm (P < 0.01), and serum IL-1β (P < 0.01) and MMP-9 (P < 0.01) levels were significantly higher in patients treated with NSPT alone than those treated with NSPT + Nd:YAG laser therapy. Among patients that underwent NSPT + laser therapy in both groups, periodontal parameters and serum IL-1β, and MMP-9 levels were comparable at 3-months follow-up., Conclusion: NSPT + Nd:YAG laser therapy may be more effective in reducing periodontal inflammation and serum IL-1β and MMP-9 levels in patients with and without CAD than NSPT alone. Lasers Surg. Med. 48:929-935, 2016. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Objective: The aim was to assess the efficacy of mechanical debridement (MD) with and without adjunct antimicrobial photodynamic therapy (aPDT) in reducing periimplant inflammation among cigarette-smokers and non-smokers., Methods: Cigarette-smokers and non-smokers were randomly divided into 2 groups. In the test-group, participants underwent full mouth scaling and periimplant MD with adjunct aPDT; and in the control-group, the participants underwent full mouth scaling and periimplant MD alone. Periimplant bleeding on probing (BOP), probing depth (PD) and crestal bone loss (CBL) were measured at baseline and at 6- and 12-months follow-up. Statistical analysis was performed using the Kruskal-Wallis test. P-values<0.05 were considered statistically significant., Results: Eighty-four smokers (41 patients in the test group and 43 in the control group) and 82 non-smokers (40 patients in the test group and 42 in the control group) were included. Among smokers and non-smokers, periimplant PD was significantly higher in the control-group compared with the test-group (P<0.05) at 6-months of follow-up. There was no statistically significant difference in BOP, PD and CBL among smokers and non-smokers in the test- and control-groups at 12-months of follow-up. BOP was comparable among smokers at all time intervals., Conclusion: In the short-term, MD with adjunct aPDT is more effective in reducing periimplant probing depth than MD alone in smokers and non-smokers. However, in the long-term outcomes of MD either with or without aPDT among smokers and non-smokers are comparable., (Copyright © 2016 Elsevier B.V. All rights reserved.)

The aim of the present cross-sectional retrospective study was to compare the peri-implant clinical and radiographic inflammatory parameters and whole salivary destructive inflammatory cytokine profile among obese and non-obese men. Thirty-five obese and 37 non-obese men were included. Information regarding age, obesity, systemic health status, and habits was collected using a questionnaire. Clinical examination to evaluate peri-implant parameters and radiographic examination to assess marginal bone loss were conducted. Levels of interleukin (IL)-6 and IL-1β in collected un-stimulated whole saliva were measured using enzyme-linked immunosorbent assay. Data was statistically analyzed using Kruskal Wallis test. The mean scores of peri-implant bleeding on probing (P<0.05) and peri-implant probing depth (P<0.05) were significantly higher among obese compared with non-obese individuals. The mean marginal bone loss was also statistically significantly higher among individuals in the test-group compared with the control-group (P<0.05). Whole salivary IL-1β (P<0.001) and IL-6 (P<0.001) levels were significantly higher among individuals in the test-group compared with the control-group. Clinical and radiographic peri-implant inflammatory parameters were worse, and whole salivary IL-6 and IL-1β were higher in obese than non-obese subjects. Obese patients are at greater risk of peri-implant inflammation than non-obese healthy subjects. It is highly recommended that clinicians should educate obese patients seeking implant treatment regarding the association between obesity and peri-implant inflammation. In addition, obese patients with osseointegrated implants must follow strict oral hygiene regimen to prevent inflammation and maintain optimum peri-implant tissue health., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: The aim of the present review was to study the efficacy of scaling and root planing (SRP) with and without adjunct antibacterial photodynamic therapy (aPDT) on the expression of cytokines in the gingival crevicular fluid (GCF) of patients with periodontitis., Methods: In order to address the focused question: "What is the efficacy of SRP with and without aPDT on the expression of cytokines in the GCF of patients with periodontitis" an electronic search without time or language restrictions was conducted up to and including July 2016 in indexed databases using various key words. The exclusion criteria included reviews, laboratory and experimental studies, case reports, commentaries, letters to the editor, interviews, updates, studies where intervention group received aPDT without previous SRP, and studies where local delivery of antibiotics was used as adjunctive therapy to aPDT., Results: Six randomized control trials were included in the present systematic review. All studies included a control group which received only SRP. Results from 34% of studies reported lower cytokine levels among individuals receiving adjunct aPDT to SPT compared to patients receiving SRP alone. Selective cytokines reduction in the GCF following SRP with adjunct aPDT compared with SRP alone was reported in 50% of the studies. In one study SRP with adjunct aPDT failed to reduce GCF cytokine concentration., Conclusion: From the literature reviewed the efficacy aPDT as adjunct to SRP in downregulating GCF cytokines remains debatable. Further well-designed studies are needed in this regard., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Objective: The aim of the present 2-year follow-up study was to assess the effect of oral hygiene maintenance on hemoglobin Alc (HbA1c) levels and peri-implant parameters around immediately-loaded dental implants placed in type-2 diabetic patients with varying glycemic levels., Material and Methods: Ninety-one individuals were divided into three groups. In group 1, 30 systemically healthy individuals were included (HbA1c < 6%). Patients in group 2 and 3, comprised of 30 patients with T2DM (HbA1c 6.1-8%); and 31 patients with T2DM (HbA1c 8.1-10%) respectively. In all groups, patients received immediately loaded bone level implants. All participants were enrolled in a 6 monthly periodontal/peri-implant maintenance program. Peri-implant bleeding on probing (BOP), probing depth (PD), and marginal bone loss (MBL) were measured at 6, 12, and 24 months of follow-up., Results: Mean preoperative HbA1c levels in patients in groups 1, 2, and 3 were 4.5%, 6.8%, and 8.7% respectively. In group-1, there was no significant difference in HbA1c levels at all follow-up durations. Among patients in groups 2 and 3, there was a significant decrease in HbA1c levels at 24-months follow-up than 6-months follow-up. At 6 months follow-up, BOP, PD, and MBL were significantly higher among patients in group-3 than group-1. At 12 and 24 months follow-up, there was no significant difference in BOP, PD, and MBL in all groups., Conclusions: Oral hygiene maintenance reduces hyperglycemia and peri-implant inflammatory parameters around immediately loaded dental implants placed in type 2 diabetic patients., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The aim of the present study was to review the pertinent literature on the effects of mechanical curettage (MC) with and without adjunct photodynamic therapy (PDT) for the management of peri-implantitis., Methods: The addressed focused question was "Is PDT effective in the treatment of peri-implantitis?" A search without language or time restrictions up to March 2016 was conducted using various key words. The exclusion criteria included; review papers, in vitro Studies, case reports, commentaries, interviews, and letters to the editors., Results: In total 9 studies were included. Among them 5 studies were clinical and 4 were experimental. All the studies used PDT as an adjunctive to MC in their test groups. The laser wavelengths used ranged from 660nm to 830nm. One study showed significant reduction of the bleeding scores, inflammatory exudates and Aggregatibacter actinomycetemcomitans count in group with PDT as an adjunctive when compared to MC and 0.2% chlorhexidine. However, in four clinical studies comparable periodontal parameters were reported when PDT is used as an adjunct to MC was compared to MC in treatment of peri-implantitis. In three experimental studies, outcomes were significantly better in group with PDT as an adjunct to MC when compared to MC alone at follow-up., Conclusion: The role of PDT as an adjunct to MC in the treatment of peri-implantitis is debatable. Further longterm randomised control trails are needed to justify the role PDT as an adjunct to MC in treatment of peri-implantitis., (Copyright © 2016. Published by Elsevier B.V.)

To our knowledge from indexed literature, the role of laminins in the expression of osteogenic biomarkers and osseointegration enhancement has not been systematically reviewed. The aim of the present systematic review was to assess the role of laminin coatings on implant surfaces in promoting osseointegration. To address the focused question, "Do laminin coatings on implant surfaces influence osseointegration?", indexed databases were searched from 1965 up to and including November 2015 using various combination of the following keywords: "Bone to implant contact"; "implant"; "laminins"; and "osseointegration". Letters to the Editor, case-reports/case-series, historic reviews, and commentaries were excluded. The pattern of the present systematic review was customized to primarily summarize the pertinent data. Nine studies were included. Six studies were prospective and were performed in animals and 5 studies were in vitro. Results from 8 studies showed that laminin coatings enhanced new bone formation around implants and/or bone-to-implant contact. One study showed that laminin coated implants surfaces did not improve osseointegration. On experimental grounds, laminin coatings seem to enhance osteogenic biomarkers expression and/or osseointegration; however, from a clinical perspective, further randomized control trials are needed to assess the role of laminin coatings in promoting osseointegration around dental implants., (Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.)

Objective: There are no studies that have assessed the efficacy of mechanical debridement (MD) with and without adjunct antimicrobial photodynamic therapy (aPDT) in the treatment of periimplant inflammation in patients with type 2 diabetes mellitus (T2DM). The aim of the present 12-month follow-up study was to assess the efficacy of MD with and without adjunct aPDT in the treatment of periimplant inflammation in patients with T2DM., Methods: Sixty-seven patients with diagnosed periimplant inflammation and T2DM were included. Treatment-wise, the patients were divided into 2 groups: (a) test-group (n=34): patients receivedMD+aPDT; and (b) control group (n=33): patients received MD only. Periimplant bleeding on probing (BOP), probing depth (PD) ≥4mm and mesial and distal marginal bone loss (MBL) were measured at baseline and after 6 and 12 months of therapy in both groups. The Kruskal-Wallis test was used to compare the periimplant BOP, PD, MBL and HbA1c levels in both groups. P-values less than 0.05 were considered statistically significant., Results: Mean preoperative hemoglobin A1c (HbA1c) for patients in the control group and test group were 8.5% and 8.8%, respectively. In the control group, there was no significant difference in HbA1c levels at all follow-up durations. Among patients in test group, there was a significant decrease (P<0.05) in HbA1c levels at 6 and 12 months of follow-up. Both PD and BOP were significantly lower in the test group compared to the control group at all follow-up durations. At 6 and 12 months of follow-up, there was no significant difference in MBL in both groups., Conclusion: In patients with T2DM, MD with adjunct aPDT is more effective in the treatment of periimplant inflammation compared with MD alone., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Objective: The aim of the present systematic review was to assess the efficacy of parathyroid hormone supplementation on the osseointegration of implants., Methods: The addressed focused question was Does parathyroid hormone supplementation affect osseointegration around implants? Indexed databases were searched from 1965 up to and including April 2015 using various key words including: Bone to implant contact; implant; parathyroid hormone; and osseointegration. Letters to the Editor, case-reports/case-series, historic reviews, commentaries and articles published in languages other than English were excluded. The pattern of the present systematic review was customized to primarily summarize the pertinent data., Results: Eighteen studies fulfilled the eligibility criteria. Evidence was limited to preclinical animal studies only (11 studies in rodents, 4 in dogs and 3 in rabbits). Number of titanium implants placed ranged between 20 and 80 implants. Results from 16 studies showed that PTH supplementation enhanced new bone formation and/or BIC around implants. One study suggests that PTH-coated implants improve BIC and BA. One study showed no significant difference in BIC and new bone formation around implants with PTH hydrogel placement., Conclusion: Efficacy of PTH supplementation on osseointegration of implants shows promising results in animal models, however further investigation is necessary to assess the effectiveness in humans.