Evaluation of photodynamic therapy efficacy vs. conventional antifungal therapy in patients with poor-fitting dentures suffering from denture stomatitis. A prospective clinical study

BACKGROUND

The long-term use of antifungal therapy in denture stomatitis (DS) treatment could be accompanied by antifungal-resistant strain onset, leading to compromised therapeutic procedure and disease reappearance. Photodynamic therapy (PDT) has shown the ability to eradicate oral infections and resistance strains. This prospective clinical study aimed to assess the PDT's effectiveness compared to the conventional treatment on clinical and microbiological parameters in patients with DS without denture wear during the treatment and follow-ups.

METHODS

Forty-two patients diagnosed with DS were randomly assigned to one-session single PDT application (test group) or conventional antifungal therapy (control group). Clinical and microbiological parameters were assessed and analyzed before and at 3rd, 15th, and 30th day following the treatments. Microbiological samples were analyzed by a Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. The data was statistically analyzed.

RESULTS

Prior to the treatment, Candida species, including C. albicans (100%), C. glabrata (33%), C. tropicalis (31%), C. krusei (31%) were isolated in all patients. Both treatment procedures demonstrated a statistically significant reduction in C. albicans at all follow-up time intervals (p < 0.05). However, PDT displayed a statistically significant reduction in C. krusei compared to the conventional treatment at all follow-up periods (p < 0.05). Clinical parameters improved considerably in the test group compared to the control group at the 3rd and 15th day of follow-up.

CONCLUSION

One-session single PDT application demonstrated significant improvement in both clinical and microbiological outcomes in a short-term period, resulting in complete Candida spp. eradication compared to conventional antifungal therapy.

Comparison of preemptive etoricoxib and dexamethasone in third molar surgery - a randomized controlled clinical trial of patient-reported and clinical outcomes

OBJECTIVES

To compare preemptive single-dose etoricoxib and dexamethasone on postoperative patient satisfaction (pPS) and clinical parameters following the impacted mandibular third molar (IMTM) extraction.

MATERIALS AND METHODS

A parallel-group, triple-blinded, controlled clinical study included a total of 90 patients (n = 30), randomized to receive: etoricoxib 90 mg, dexamethasone 4 mg, or no premedication (control group) 1 h before surgery. Paracetamol 500 mg was prescribed as rescue medication (RM). Check-ups were scheduled at 24 h, 48 h, and day 7 post-surgery. At each time point, pPS was assessed using the 5-point Likert scale. RM parameters, swelling, trismus, and the occurrence of adverse events were also recorded, and patients were instructed to rate the perceived pain on Visual Analogue Scale.

RESULTS

In all the follow-up periods, data indicated significantly higher pPS scores in the preemptive medication groups when compared to the control group (p < 0.05). Both regimens delayed the first RM intake when compared to controls. In the etoricoxib group, a significantly lower total RM consumption was observed (p < 0.05). Dexamethasone significantly decreased swelling at each check-up and increased mouth opening at day 7 after the surgery (p < 0.05).

CONCLUSIONS

Preemptive etoricoxib and dexamethasone elevate pPS after IMTM surgery. Etoricoxib improves RM parameters, while dexamethasone ameliorates the patient's postoperative functional ability.

CLINICAL RELEVANCE

Preemptive etoricoxib and dexamethasone use may decrease patients' discomfort following the impacted mandibular third molar extraction.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05791721. Date of Registration: 28/03/2023 (retrospectively registered).

Immediate Vs. Early Loading of Bone Level Tapered Dental Implants with Hydrophilic Surface in Fully Edentulous Maxilla:Clinical and Patient-Centered Outcomes

ABSTRACT  The aim was to: (i) compare changes among primary and secondary implant stability between immediate and early loaded implants in edentulous maxilla, (ii) evaluate oral health related quality of life (OHRQoL) and (iii) determine patient satisfaction with 6-implant supported fixed full-arch dentures. A prospective, randomized controlled clinical trial was conducted on 24 edentulous maxilla patients. The BLT SLActive® implants in 12 patients were immediately loaded with temporary restorations while12 patients did not receive temporary restorations. Definitive (final) dentures were delivered to all patients after 6 weeks. Stability of the implants were assessed by Insertion Torque (IT) and Resonance Frequency Analysis (RFA). Oral Health Impact Profile-19 ( OHIP-19) questionnaire was used to evaluate OHRQoL and a Visual Analogue Scale (VAS) for patient satisfaction. The IT value of implants assigned for immediate and early loading group was 27.17±9.55Ncm and 25.01±11.06Ncm, respectively. Changes in implant stability from baseline to week 6 were similar in both groups when measured by Penguin ® (p=0.881) and Ostell ® (p= 0.828).  Patients in the immediate load group reported significantly lower OHIP physical pain scores (p=0.016),  OHIP psychological disability score (p=0.046) and significantly higher VAS function score (p=0.009) and VAS aesthetics score (p=0.009). Implant loading protocols don't have a significant effect on the change in implant stability 6 weeks after implantation, however, immediate loading significantly improves OHRQoL and satisfaction of patients with maxillary edentulism treated by fixed full-arch dentures. Future trials will determine the role of immediate loading protocol in clinical scenarios with various amounts of available jaw bone using different numbers of implants to retain a fixed prosthetic restoration in the edentulous maxilla.

Adjunctive Application of Systemic Antibiotics in Non-surgical Aggressive Periodontitis Treatment: Clinical and Microbiological Findings

BACKGROUND: Aggressive periodontitis (AgP) is associated with an extensive and rapid destruction of periodontal tissues. Unpredictable treatment outcomes of the disease are consequences of various cross-linked factors. Antimicrobial adjunctive treatment is routinely used as a part of non-surgical periodontal treatment (NSPT) of AgP. AIM: Therefore, the aim of this study was to compare the effects of active periodontal treatment (APT) combined with systemic antibiotics with mechanical debridement alone, in patients with generalized AgP (GAgP). METHODS: Two groups, consisting of 10 participants each, were randomly formed. Both groups were clinically and microbiologically tested and monitored for 3 months. Test group received APT with antimicrobial supplementation (amoxicillin and metronidazole [AMX-MET]). Patients from the control group were treated by APT only. Clinical and microbiological parameters were recorded at baseline and 3 months following the NSPT. Clinical measurements involved probing depth, clinical attachment level, bleeding on probing, and plaque index. Samples of subgingival crevicular fluid were analyzed by qualitative polymerase chain reaction. RESULTS: Significant improvement of all clinical parameters was observed 3 months following the NSPT (p < 0.05), but significant difference between groups was not found (p > 0.05). Periodontal pathogens’ detection between baseline and 3 months follow-up was also not statistically significant in both examined groups (p > 0.05). CONCLUSION: Similarity of results obtained in both treatment groups underlined the key role of APT in the treatment of AgP. The AMX-MET supplementation did not improve clinical and microbiological outcomes, when compared to APT alone. Longer follow-up period, with larger sample, could provide a more comprehensive insight into this issue.

Reconstruction of Interimplant Papilla by Demineralized Freeze-dried Bone Allograft Block Fixed by Titanium Screw in Maxillary Esthetic Zone

AIM

To evaluate effectiveness of demineralized freeze-dried bone allograft (DFDBA) block fixed by titanium screw for reconstructing interimplant papilla in maxillary esthetic zone during one-stage early loading multiple implant procedure.

MATERIALS AND METHODS

A total of 20 implants were placed in 10 systemically healthy patients (2 implants per patient) for replacement of multiple teeth by early loading one-stage implants along with interimplant papilla reconstruction using DFDBA block fixed by titanium screw. At the baseline, 6 months, and at 1 year, clinical measurements (interimplant papillary height measurement, papilla contour) and radiographic measurements were recorded.

RESULTS

At 1 year, mean gain in interimplant vertical crestal bone was 1.7 mm, and complete reconstruction of the papilla was observed in 90% cases.

CONCLUSION

Demineralized freeze-dried bone allograft block fixed by titanium screw for reconstruction of interimplant papilla in maxillary esthetic zone during one-stage early loading multiple implant procedure is effective.

CLINICAL SIGNIFICANCE

Presence of interimplant papilla is of utmost importance for esthetically successful implant-supported restoration in the anterior region. This technique leads to reconstruction of interimplant papilla, thus providing esthetic appearance.

Schmerzhafte artifizielle Ekchymosen an Hals und Gesicht

Es wird über den Fall einer 13-jährigen Patientin mit neu aufgetretenen, auf Druck schmerzhaften Hautveränderungen beidseits am Hals und im Gesicht berichtet. Auf Nachfrage traten die Effloreszenzen episodisch im Rahmen von Stresssituationen auf. Im Verlauf kam es zu einer Spontanheilung mit Narbenbildung und mehreren Rezidiven. Nach erfolgter Probebiopsie wurde ein Gardner-Diamond-Syndrom ausgeschlossen und der Verdacht auf selbstinduzierte Hautläsionen geäußert.

[Multiple well demarcated skin erosions and ulcers following exanthematous drug eruption after sultamicillin therapy]

This article presents the case of a patient with newly developed skin erosions and ulcerations following an exanthematous drug eruption due to sultamicillin therapy. The skin lesions were treated topically with clobetasol and prednicarbate and orally with methylprednisolone. A skin smear revealed massive growth of Escherichia coli bacteria. Blood cultures were negative. The cause for developing ecthyma gangrenosum in our patient were iatrogenic immunosuppression and transient bacteremia.

The influence of three different apical implant designs at stability and osseointegration process: experimental study in rabbits

OBJECTIVES

The aim of this study was to perform a histomorphometric and biomechanical comparison of three implants with different designs of the apical area to promote a better bone initial stability and its correlation with the osseointegration.

MATERIAL AND METHODS

Fifty-four tapered implants with same length, diameter and surface properties but with three different apical configurations (Group I: MK4: Group II: C1 and Group III: MK7) were inserted in the tibia of rabbits. Implant stability and bone formation were evaluated by resonance frequency analysis measured at 0, 6, 8 and 12 weeks and by histomorphometric analysis performed at 6, 8 and 12 weeks.

RESULTS

Statistical test to compare the stability through the implant stability quotient in the four times showed few differences between the groups and time periods proposed, with significance set at P < 0.05. In the bone-implant contact, by comparing the groups in the three times proposed, it was possible concluded that there is a similar behavior among the three implant design (P < 0.05).

CONCLUSION

With the limitations of this animal study, it can be concluded that the design of the apical area influences the implant stability and the bone-to-implant contact.

Histopathological comparative analysis of peri-implant soft tissue response after dental implant placement with flap and flapless surgical technique. Experimental study in pigs

AIM

The aim of this study was comparing the effect of flapless vs. flap technique of implant placement on inflammation degree of peri-implant soft tissue, through histopathological analysis.

METHOD

The experiment was conducted on five domestic pigs. Nine weeks after tooth extraction, implants were installed. Each animal received six implants in mandible. According to split-mouth design, randomly one side was used for flapless technique using mini-incision, while on the other side, flap was raised. After 7, 14, 21, 28, and 90 days, the experimental animals were sacrificed. Samples for histopathological analyzes were taken from the buccal side of peri-implant mucosa next to the neck of implants, from three levels. The degree of inflammatory response in the peri-implant soft tissue was estimated through ordinal scores from 0 to 3.

RESULTS

In the flap group Score 3 indicating high degree of inflammation was present from day 7 to day 21, in contrast to flapless group where Score 3 was not recorded during the entire follow-up. Three months after implantation, there were no signs of inflammation neither around flap nor around flapless implants.

CONCLUSION

Flapless surgical implantation technique using mini-incision decreases peri-implant soft tissue inflammatory reaction compared with flap surgery.

Connective Tissue Characteristics around Healing Abutments of Different Geometries: New Methodological Technique under Circularly Polarized Light

PURPOSE

To describe contact, thickness, density, and orientation of connective tissue fibers around healing abutments of different geometries by means of a new method using coordinates.

MATERIALS AND METHODS

Following the bilateral extraction of mandibular premolars (P2, P3, and P4) from six fox hound dogs and a 2-month healing period, 36 titanium implants were inserted, onto which two groups of healing abutments of different geometry were screwed: Group A (concave abutments) and Group B (wider healing abutment). After 3 months the animals were sacrificed and samples extracted containing each implant and surrounding soft and hard tissues. Histological analysis was performed without decalcifying the samples by means of circularly polarized light under optical microscope and a system of vertical and horizontal coordinates across all the connective tissue in an area delimited by the implant/abutment, epithelium, and bone tissue.

RESULTS

In no case had the connective tissue formed a connection to the healing abutment/implant in the internal zone; a space of 35 ± 10 μm separated the connective tissue fibers from the healing abutment surface. The total thickness of connective tissue in the horizontal direction was significantly greater in the medial zone in Group B than in Group A (p < .05). The orientation of the fibers varied according to the coordinate area so that internal coordinates showed a higher percentage of parallel fibers in Group A (p < .05) and a higher percentage of oblique fibers in Group B (p < .05); medial coordinates showed more oblique fibers (p < .05); and the area of external coordinates showed the highest percentage of perpendicular fibers (p < .05). The fiber density was higher in the basal and medial areas (p < .05).

CONCLUSIONS

Abutment geometry influences the orientation of collagen fibers; therefore, an abutment with a profile wider than the implant platform favors oblique and perpendicular orientation of collagen fibers and greater connective tissue thickness.

An Evaluation of European Countries' Health Systems through Distance Based Analysis

INTRODUCTION

The issue of evaluating the efficiency of health systems has been elaborated upon frequently. Since "health" is a multi-faceted concept, many variables of different measurement units must be included in its analysis; consequently, this presents a great obstacle for researchers to overcome.

MATERIALS AND METHODS

A novel statistical approach for evaluating the efficiency of organizational units is here proposed, which can also be easily applied to the health sector. For these purposes, the health status of the 27 countries belonging to the European Union has been examined by employing a statistical Ivanovic-Jeremic Distance Based Analysis (DBA) on various health indicators.

RESULTS

The subsequent outcome of the Distance Based Analysis has shown that Cyprus and Ireland have a most efficient health system sectors. Greece also has exceptional indicators of health service, yet health on the individual level is not comparable.

LIMITATIONS

Since it synthesizes many variables into an efficiency score, a DBA can be easily applied to other regions/countries. However, the choice of input and output variables can be considered to be potential limitations since a different choice of variables may cause different efficiency scores for the countries selected.

CONCLUSIONS

A DBA approach contributes significantly to the efficiency in the field of research measurement. This analysis can be additionally performed alongside DEA and SFA methods, as a new measure of efficiency.

A 1-year prospective cohort study on mandibular overdentures retained by mini dental implants

AIM

The aim of this 1-year prospective cohort study was to evaluate the outcomes and complications of immediately loaded mini dental implants used for stabilizing mandibular overdentures in edentulous patients wearing conventional complete dentures.

MATERIALS AND METHODS

Thirty patients received mandibular conventional complete dentures that were subsequently retained by 4 immediately loaded mini dental implants placed in the interforaminal region. Overdenture success, implant success and biological and prosthetic complications were evaluated after the first year of service. Quality of life using the Oral Heath Impact Profile (OHIP)- EDENT test, satisfaction with dental prosthesis and chewing efficiency using questionnaires and a Visual Analogue Scale (VAS) were evaluated twice: after they had received mandibular complete dentures, and again after they had received mandibular overdentures.

RESULTS

After 1 year, no overdenture failed and 2 implants did not osseointegrate, resulting in a 98.3% success rate for loaded implants and 95.9% for total implants used (3 out of 123 were not loaded due to fracture). A flap surgical approach was performed in 7 patients, 3 implants fractured during insertion, 3 overdentures fractured, occlusion balancing was necessary for 11 dentures and relining for 8. Implant rehabilitation provided significant improvement in quality of life, stability, comfort, chewing and speaking ability while no significant differences were found in quality of maintenance of hygiene and for aesthetics.

CONCLUSIONS

Mini dental implant retained overdentures can be a successful therapeutic procedure for treating mandibular edentulism that improves quality of life, patient satisfaction and chewing ability in patients wearing maxillary dentures. Longer follow-ups are needed to validate this therapy in the medium and long-term.

The closure of oroantral communications with resorbable PLGA-coated beta-TCP root analogs, hemostatic gauze, or buccal flaps: a prospective study

OBJECTIVE

The aim of this study was to compare the treatment of oroantral communications (OACs) with bioresorbable root analogs made of poly(lactide-co-glycolide) (PLGA)-coated beta-tricalcium phosphate (beta-TCP), hemostatic gauze or a buccal flap technique.

STUDY DESIGN

In this prospective clinical study, 30 patients with oroantral communications were randomly assigned to a treatment. Clinical success, vestibular depth at the defect site, pain, and swelling were monitored.

RESULTS

The OAC closure was successful in all cases. The vestibular depth stayed constant in the groups treated with the PLGA-beta-TCP composite or hemostatic gauze. In contrast, a vestibular depth reduction of 1.2 +/- 0.2 mm was observed in the buccal flap group, indicating atrophy of the alveolar ridge in these patients. Furthermore, pain and swelling were more pronounced in this group.

CONCLUSION

Closures of OACs with PLGA-beta-TCP composite or hemostatic gauze are reliable minimally invasive methods that minimize atrophy of the alveolar ridge, swelling, and pain compared with a buccal flap technique.

Effectiveness of dexamethasone and low-power laser in minimizing oedema after third molar surgery: a clinical trial

Postoperative oedema is common following removal of impacted lower third molars. Several types of drug therapy (corticosteroids, non-steroidal anti-inflammatory drugs, enzymes) have been tried. The aim of this study was to compare the effectiveness of low-power laser (LPL) and dexamethasone after surgical removal of impacted lower third molars under local anaesthesia (2% lidocaine/epinephrine).

MATERIAL AND METHODS

There were 120 healthy patients divided into four groups of 30 each. Group 1 received LPL irradiation immediately after operation (energy output 4 J/cm2 with constant power density of 50 mW, wavelength 637 nm); group 2 also received i.m. injection of 4 mg dexamethasone (Dexason) into the internal pterygoid muscle; group 3 received LPL irradiation supplemented by systemic dexamethasone (Dexason), 4 mg i.m. in the deltoid region, followed by 4 mg of dexamethasone intraorally 6h postoperatively; and the fourth (control) group received only the usual postoperative recommendations (cold packs, soft diet, etc.).

RESULTS

LPL irradiation with local use of dexamethasone (group 2) resulted in a statistically significant reduction of postoperative oedema in comparison to the other groups. No adverse effects of the procedure or medication were observed.

CONCLUSION

LPL irradiation after lower third molar surgery can be recommended to minimize swelling. The effect is enhanced by simultaneous local intramuscular use of dexamethasone.

[Medical aspects of adolescent sexuality]

The increase of sexual activity among the adolescents has become a danger to their reproductive health. The goal of this study was to explore sexual behaviour of young people, to establish risks that endanger their reproductive health, and to find out the ways to reduce the consequences of adolescent sexuality. The study was conducted in the Mother and Child Health Care Institute of Serbia over a 2-year period. The sexual and reproductive behaviour, attitudes toward sexuality and contraception, as well as the prevalence rates of unintended pregnancy and Chlamydia trachomatis genital infections were analyzed in 300 sexually active adolescent females, aged 19 years. The first sexual intercourse was in 16.9 years, in average. Less than one-third of the total number (31.3%) of these persons had contraceptive protection at the first intercourse; condom was most frequently used (28.3%). Motives for the initiation of sexual activity were: love (45.7%), curiosity (35.7%), physical attraction and passion (8.3%), peer pressure (5.0%), on the boyfriend's insistence (4.7%), need for love (0.3%) and without answer (0.3%). Two-thirds of adolescent females (63.7%) reported more than one partner, 21.7% more than three and 10.2% more than five sexual partners. Almost half of girls (40.7%) experienced sexual intercourse in casual acquaintance, and 10.3% with a 10 or more years older partner. Use of contraceptive methods during each sexual encounter was inconsistent and sporadic. More than half of adolescent females (54.3%) relied on traditional forms of contraception, like withdrawal of the phallus. Condom was the method of contraceptive choice in one-third (34.3%) of girls, "birth-control pill" in 10.7% and spermicides in 0.7% of subjects. With a new sexual partner condom was used regularly by 55.6% of adolescents; and the remaining percentage of girls used condom irregularly (24.7%), or never (19.7%). The time interval between the initiation of sexual activity and the first gynaecological examination was more than 6 months in 56.7% of cases, and from one to three years in 31.0% of tested adolescent females. The reasons for the first gynaecological visit were as follows: fear of getting pregnant (22.0%), suspicion of contracting a sexually transmitted disease (22.0%) and symptoms indicating a pelvic inflammatory disease (18.3%). Only one-third of girls (37.7%) had their first gynaecological examination as a regular control examination or to get some contraceptive advice. During the adolescence unwanted pregnancy was noted in 16.0% of examined girls. One legal abortion had 14.4% of girls, two 1.3% and three 0.3% of adolescent females. Chlamydia trachomatis genital infection was found in 30.3% of girls. In the girls' opinion the improved knowledge about sexuality, reproduction and contraception is the best way of popularizing contraception among youth. This could be done by introduction of sexual education in school programmes (51.0%) or through mass media (33.3%). A successful health care service for young people should include: a gynaecologist who will have enough time and patience for an adolescent patient (91.3%); a female gynaecologist (36.7%); and a kind other health care workers (21.3%). In order to increase the number of adolescents who will use a condom, the following measures are necessary: a better quality of condoms (54.0%), installation of condom machines (15.6%), mass media education programmes on the significance of the condom role in the prevention of sexually transmitted diseases (10.0%), attractive design of condoms (7.0%), free condoms (6.7%), and universal accessibility of condoms (1.0%). The reproductive health of adolescent girls in Belgrade has been endangered by: their sexual behaviour, poor acceptance of healthy life styles, lack of responsibility in sexual relationships and high prevalence rates of unintended pregnancy and sexually transmitted diseases. Improvement of adolescent reproductive health could be achieved by: educational programmes for adolescents about sexuality, reproduction and contraception; appropriate adolescent advisory health care services; and a better condom quality.

Double modulation of 5-fluorouracil by leucovorin and low-dose methotrexate in advanced colorectal cancer

A phase II study was carried out to evaluate the efficacy and toxicity of a double biochemical modulation of 5-fluorouracil (5-FU) by methotrexate (MTX) and leucovorin (LV) in patients with advanced unresectable colorectal cancer. Forty-two patients with measurable metastases of colorectal cancer were treated with 5-FU in daily doses of 600 mg/m2 given in a 6-hour intravenous (i.v.) infusion on days 1-5, LV 50 mg/m2 i.v. on days 2,3 and 5, and MTX 40 mg/m2 i.v. on days 1 and 4, every 4 weeks. Twenty-eight patients had a single metastatic site, eleven double, whereas three had more than two metastatic sites. Objective response (one complete response) was observed in 12 of 40 patients (30%) (95% confidence interval 16-48), stable disease in 19 patients (47%) and progression in 9 patients (23%). Overall median survival was 12 months. Median time to progression was 6 months. Treatment was generally well tolerated. The most frequent adverse reactions were stomatitis (38%), nausea and vomiting (35%), diarrhea (31%), leukopenia (18%), and plantar-palmar erythroderma (15%). The combination of 5-FU, LV and MTX seems to be an active regimen in advanced colorectal cancer.

Immunohistochemical demonstration of mitochondria in routinely processed tissue using a monoclonal antibody

We report results obtained using the monoclonal antibody M-II 68, which recognizes inner mitochondrial membrane in routinely processed (formalin-fixed and paraffin-embedded) tissue by light microscopic immunohistochemistry. In ten normal brains, the range of immunoreactivity in various cell types and locations was defined. The most intense staining was observed in Purkinje cells, in neurons of cranial nerve nuclei, pons and substantia nigra, as well as in choroid plexus epithelial cells. By comparison with this control group, one case of primary mitochondrial encephalomyopathy exhibited increased staining of endothelial and vascular smooth muscle cells, choroid plexus epithelial cells, and neurons of various locations. Scattered ragged-red fibres were heavily labelled in one case of mitochondrial myopathy, while ten muscles without mitochondriopathy were left unstained. Our method is able to detect accumulations of mitochondria and increases in mitochondrial cristae density. It could prove useful for differential diagnosis of routine biopsy material and for clarification of cell types involved in mitochondrial cytopathies.