Faculty Bibliography

BACKGROUND/UNASSIGNED:Children's oral health-related quality of life (COHQoL) measures are well known and widely used. However, rigorous systematic reviews of these measures and analyses of their quality are in absence. OBJECTIVES/UNASSIGNED:To systematically review and quantitatively assess the quality of COHQoL measures through a scoping review. DATA SOURCES/UNASSIGNED:Systematic literature search of PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE (Excerpta Medica database), HaPI (Health and Psychosocial Instruments), and DOSS (Dentistry and Oral Sciences Source). STUDY ELIGIBILITY/UNASSIGNED:The measure's focus was COHQoL; the child age ranged from 5 to 14 years; the publication was either a research article or a systematic review and related to caries; and it was written in English or had an English abstract. Two authors independently selected the studies. Disagreements were reconciled by group discussions with a third author. APPRAISAL/UNASSIGNED:The International Society for Quality of Life Research minimum standards for patient-reported outcome measures were used for quality appraisal. SYNTHESIS/UNASSIGNED:Descriptive analysis. RESULTS/UNASSIGNED:We identified 18 measures. Their quality scores ranged from 9.5 to 15.0 on a scale of 16. The quality appeared to bear no relationship to the citation and use of these measures. However, elements of these measures might be more useful than others, depending on the age-specific use and primary quality concerns. LIMITATIONS/UNASSIGNED:Some of the information on the minimum standards of the 18 measures cannot be found in the existing literature. Measures published without English abstract were not searched. CONCLUSIONS/UNASSIGNED:The quality of these measures is suboptimal. Researchers and practitioners in this field should exercise caution when choosing and using these measures. Efforts at improving the quality of the COHQoL measures, such as refining existing ones or developing new measures, are warranted. KNOWLEDGE TRANSFER STATEMENT/UNASSIGNED:Researchers, clinician scientists, and clinicians can use the results of this study when deciding which oral health-related quality of life measure they wish to use in children.

OBJECTIVES/UNASSIGNED:Cone-beam computed tomography's use (CBCT) in dentistry is increasing. Incidental findings (IFs: discoveries unrelated to the original purpose of the scan), are frequently found as a result of a large field of view. The aim of the systematic review is to analyze present literature on IFs using CBCT. METHODS AND MATERIALS/UNASSIGNED:The authors searched online databases of studies and assessed the prevalence of IFs among patients undergoing head and neck CBCT scans. STROBE criteria was used to evaluate the quality of the studies. RESULTS/UNASSIGNED:The original search retrieved 509 abstracts of which only 10 articles met the inclusion criteria. The sample size varied between 90 - 1000 participants. The frequency of IFs of the selected articles were 24.6 - 94.3 %. The most common non-threatening IFs were found in the airway, such as mucous retention cyst (55.1%) and sinusitis (41.7%). Other non-threatening IFs were soft tissue calcifications such as calcified stylohyloid ligament (26.7%), calcified pineal gland (19.2%), and tonsillolith (14.3%). Threatening IFs were rare findings (1.4%). Three articles reported incidental carotid artery calcifications with a prevalence of 5.7 - 11.6 %. Pathological findings were not common between the articles, but still relevant (2.6%). The studies had a risk of bias varying from moderate to low. CONCLUSIONS/UNASSIGNED:There is a high frequency of IFs, yet not all of them require immediate medical attention. The low prevalence of threatening IFs emphasizes that CBCT should not be considered a substitution for conventional radiographs, but when used, the scans should be evaluated by a maxillofacial radiologist.

Data sources Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 27 September 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 8), MEDLINE Ovid (1946 to 27 September 2017), and Embase Ovid (1980 to 27 September 2017). The US National Institutes of Health Ongoing Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.Study selection Randomised controlled trials of orthodontic treatments to correct prominent upper front teeth (Class II malocclusion) in children and adolescents. The review included trials that compared early treatment in children (two-phase) with any type of orthodontic braces (removable, fixed, functional) or head-braces versus late treatment in adolescents (one-phase) with any type of orthodontic braces or head-braces, and trials that compared any type of orthodontic braces or head-braces versus no treatment or another type of orthodontic brace or appliance (where treatment started at a similar age in the intervention groups). The review excluded trials involving participants with a cleft lip or palate, or other craniofacial deformity/syndrome, and trials that recruited patients who had previously received surgical treatment for their Class II malocclusion.Data extraction and synthesis Review authors screened the search results, extracted data and assessed risk of bias independently. They used odds ratios (ORs) and 95% confidence intervals (CIs) for dichotomous outcomes, and mean differences (MDs) and 95% CIs for continuous outcomes.Results From the 27 studies included in the review:Three trials compared early treatment with a functional appliance versus late treatment for overjet, ANB and incisal trauma. After phase one of early treatment (i.e. before the other group had received any intervention), there was a reduction in overjet and ANB reduction favouring treatment with a functional appliance; however, when both groups had completed treatment, there was no difference between groups in final overjet (MD 0.21, 95% CI -0.10 to 0.51, P = 0.18; 343 participants) (low-quality evidence) or ANB (MD -0.02, 95% CI -0.47 to 0.43; 347 participants) (moderate-quality evidence). Early treatment with functional appliances reduced the incidence of incisal trauma compared to late treatment (OR 0.56, 95% CI 0.33 to 0.95; 332 participants) (moderate-quality evidence). The difference in the incidence of incisal trauma was clinically important with 30% (51/171) of participants reporting new trauma in the late treatment group compared to only 19% (31/161) of participants who had received early treatment. Two trials compared early treatment using headgear versus late treatment. After phase one of early treatment, headgear had reduced overjet and ANB; however, when both groups had completed treatment, there was no evidence of a difference between groups in overjet (MD -0.22, 95% CI -0.56 to 0.12; 238 participants) (low-quality evidence) or ANB (MD -0.27, 95% CI -0.80 to 0.26; 231 participants) (low-quality evidence). Early (two-phase) treatment with headgear reduced the incidence of incisal trauma (OR 0.45, 95% CI 0.25 to 0.80; 237 participants) (low-quality evidence), with almost half the incidence of new incisal trauma (24/117) compared to the late treatment group (44/120). Seven trials compared late treatment with functional appliances versus no treatment. There was a reduction in final overjet with both fixed functional appliances (MD -5.46 mm, 95% CI -6.63 to -4.28; 2 trials, 61 participants) and removable functional appliances (MD -4.62, 95% CI -5.33 to -3.92; 3 trials, 122 participants) (low-quality evidence). There was no evidence of a difference in final ANB between fixed functional appliances and no treatment (MD -0.53°, 95% CI -1.27 to -0.22; 3 trials, 89 participants) (low quality evidence), but removable functional appliances seemed to reduce ANB compared to no treatment (MD -2.37°, 95% CI -3.01 to -1.74; 2 trials, 99 participants) (low-quality evidence). Six trials compared orthodontic treatment for adolescents with Twin Block versus other appliances and found no difference in overjet (0.08 mm, 95% CI -0.60 to 0.76; 4 trials, 259 participants) (low-quality evidence). The reduction in ANB favoured treatment with a Twin Block (-0.56°, 95% CI -0.96 to -0.16; 6 trials, 320 participants) (low-quality evidence). Three trials compared orthodontic treatment for adolescents with removable functional appliances versus fixed functional appliances and found a reduction in overjet in favour of fixed appliances (0.74, 95% CI 0.15 to 1.33; two trials, 154 participants) (low-quality evidence), and a reduction in ANB in favour of removable appliances (-1.04°, 95% CI -1.60 to -0.49; 3 trials, 185 participants) (low-quality evidence).Conclusions Evidence of low to moderate quality suggests that providing early orthodontic treatment for children with prominent upper front teeth is more effective for reducing the incidence of incisal trauma than providing one course of orthodontic treatment in adolescence. There appear to be no other advantages of providing early treatment when compared to late treatment. Low-quality evidence suggests that, compared to no treatment, late treatment in adolescence with functional appliances, is effective for reducing the prominence of upper front teeth.

BACKGROUND:Resin-based composite (RBC) is currently accepted as a viable material for the restoration of caries for posterior permanent teeth requiring surgical treatment. Despite the fact that the thermal conductivity of the RBC restorative material closely approximates that of natural tooth structure, postoperative hypersensitivity is sometimes still an issue. Dental cavity liners have historically been used to protect the pulp from the toxic effects of some dental restorative materials and to prevent the pain of thermal conductivity by placing an insulating layer between restorative material and the remaining tooth structure. This is an update of the Cochrane Review first published in 2016. OBJECTIVES:The objective of this review was to assess the effects of using dental cavity liners in the placement of Class I and Class II resin-based composite posterior restorations in permanent teeth in children and adults. SEARCH METHODS:Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 12 November 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 10) in the Cochrane Library (searched 12 November 2018), MEDLINE Ovid (1946 to 12 November 2018), Embase Ovid (1980 to 12 November 2018) and LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; 1982 to 12 November 2018). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA:We included randomized controlled trials assessing the effects of the use of liners under Class I and Class II posterior resin-based composite restorations in permanent teeth (in both adults and children). We included both parallel and split-mouth designs. DATA COLLECTION AND ANALYSIS:We utilized standard methodological procedures prescribed by Cochrane for data collection and analysis. Two review authors screened the search results and assessed the eligibility of studies for inclusion against the review inclusion criteria. We conducted risk of bias assessments and data extraction independently and in duplicate. Where information was unclear we contacted study authors for clarification. MAIN RESULTS:Eight studies, recruiting over 700 participants, compared the use of dental cavity liners to no liners for Class I and Class II resin-based composite restorations.Seven studies evaluated postoperative hypersensitivity measured by various methods. All studies were at unclear or high risk of bias. There was inconsistent evidence regarding postoperative hypersensitivity (either measured using cold response or patient-reported), with a benefit shown at some, but not all, time points (low-quality evidence).Four trials measured restoration longevity. Two of the studies were judged to be at high risk and two at unclear risk of bias. No difference in restoration failure rates were shown at 1 year follow-up, with no failures reported in either group for three of the four studies; the fourth study had a risk ratio (RR) 1.00 (95% confidence interval (CI) 0.07 to 15.00) (low-quality evidence). Three studies evaluated restoration longevity at 2 years follow-up and, again, no failures were shown in either group.No adverse events were reported in any of the included studies. AUTHORS' CONCLUSIONS:There is inconsistent, low-quality evidence regarding the difference in postoperative hypersensitivity subsequent to placing a dental cavity liner under Class I and Class II posterior resin-based composite restorations in permanent posterior teeth in adults or children 15 years or older. Furthermore, no evidence was found to demonstrate a difference in the longevity of restorations placed with or without dental cavity liners.

Data sources Ovid Medline, Embase, EBM Review, Cochrane Central Register of Control Trials and the Cochrane Database of Systematic Reviews.Study selection Randomised controlled trials or prospective cohort studies published in English with ≥10 patients and ≥6 months follow-up (the longest follow-up period was chosen in longitudinal studies which were published more than once). Experimental animal or in vitro studies were excluded.Data extraction and synthesis Data on the primary outcome reduction in bleeding on probing (BOP) in implants treated surgically for peri-implantitis, and secondary outcomes pocket probing depth (PPD) and RBL (radiographic bone-loss) were extracted and meta-analysis conducted. Results Sixteen papers met the inclusion criteria. Four treatment modalities to supplement mechanical debridement were identified: (1) apically repositioned flap, (2) chemical surface decontamination, (3) implantoplasty and (4) bone augmentation. Inconsistent results were evident which were dependent on several treatment-independent factors. No clinical benefits were identified for the additional use of surface decontamination, while limited evidence demonstrated improvement of clinical and radiographic outcomes after implantoplasty. The effect of bone augmentation appeared limited to 'filling' radiographic defects. The meta-analysis was conducted using eight randomised clinical trials and two controlled prospective cohort studies. Meta-analysis demonstrated that implants treated with surface decontamination had SMD of -0.21 (95% CI: -1.70 to 1.27) for periodontal pocket reduction (PPD) reduction. Only one study reported the effect of implantoplasty on PPD, which shows a significant SMD of -3.33 (95% CI: -4.37 to -2.28 mm). Bone augmentation with grafting materials and the additional use of membrane resulted in SMD of 0.15 mm (95% CI: -0.55 to 0.84 mm) and 0.30 mm (95% CI: -0.31 to 0.91 mm), respectively. In terms of RBL changes, the use of surface decontamination methods resulted in SMD of 0.54 mm (95% CI: -0.20 to 1.28 mm). Implants treated with implantoplasty had SMD of -3.38 (95% CI: -.43 to -2.33 mm). The SMD for RBL changes after the use of bone augmentation was -1.05 (95% CI: -1.80 to -0.31 mm). However, the additional use of membrane had SMD of -0.16 (95% CI: -0.56 to 0.24 mm.Conclusions The outcomes of the currently available surgical interventions for peri-implantitis remain unpredictable. There is no reliable evidence to suggest which methods are the most effective. Further randomised controlled studies are needed to identify the best treatment methods.

OBJECTIVES/OBJECTIVE:To investigate whether silver diamine fluoride (SDF) is effective in preventing new caries lesions in primary teeth when compared to placebo or active treatments. METHODS:Systematic review (CRD42016036963) of controlled clinical trials. Searches were performed in 9 electronic databases, 5 registers of ongoing trials, and reference lists of identified review articles. Two researchers carried out data extraction and quality appraisal independently. The primary outcome was the difference in caries increment (decayed, missing, and filled surfaces or teeth - dmfs or dmft) between SDF and control groups. These differences were pooled as weighted mean differences (WMD) and prevented fractions (PF). RESULTS:Searches yielded 2,366 unique records; 6 reports of 4 trials that randomized 1,118 and analyzed 915 participants were included. Two trials compared SDF to no treatment, 1 compared SDF to placebo and sodium fluoride varnish (FV), and 1 compared SDF to high-viscosity glass ionomer cement (GIC). All studies had at least 1 domain with unclear or high risk of bias. After 24 months of follow-up, in comparison to placebo, no treatment, and FV, SDF applications significantly reduced the development of new dentin caries lesions (placebo or no treatment: WMD = -1.15, PF = 77.5%; FV: WMD = -0.43, PF = 54.0%). GIC was more effective than SDF after 12 months of follow-up but the difference between them was not statistically significant (WMD, dmft: 0.34, PF: -6.09%). CONCLUSION/CONCLUSIONS:When applied to caries lesions in primary teeth, SDF compared to no treatment, placebo or FV appears to effectively prevent dental caries in the entire dentition. However, trials specifically designed to assess this outcome are needed.

Data sourcesAn electronic search without time or language restrictions was undertaken using several databases: PubMed/Medline, Web of Science and the Cochrane Oral Health Group Trials Register and ongoing clinical trials. Manual searches were performed in dental implant related journals and reference lists of identified studies, and relevant reviews were scanned for possible additional studies.Study selectionEligibility criteria included human clinical studies, either randomised or not, comparing implant failure rates, MBL and/or post-operative infection in any group of patients receiving turned (machined) and anodised-surface (TiUnite) implants, both from the same implant manufacturer.Data extraction and synthesisThe titles and abstracts of all reports identified through the electronic searches were read independently by the three authors. For studies appearing to meet the inclusion criteria, or for which there were insufficient data in the title and abstract to make a clear decision, the full report was obtained. Disagreements were resolved by discussion between the authors. Quality assessment of the studies was executed according to the Newcastle-Ottawa scale (NOS), which is a quality assessment tool used when observational studies are also included in systematic reviews.ResultsThirty-eight publications were included. The results suggest a risk ratio =2.82(95%CI, 1.95 - 4.06, P < 0.00001) for failure of turned implants when compared to anodised-surface implants. Sensitivity analyses showed similar results when only the studies inserting implants in maxillae or mandibles were pooled. There were no statistically significant effects of turned implants on the MBL (mean difference [MD]=0.02, (95%CI, 0.16 - 0.20; P = 0 82) in comparison to anodised implants. The results of a meta-regression considering the follow-up period as a covariate suggested an increase of the MD with the increase in the follow-up time (MD increase 0.012 mm year 1), however, without a statistical significance (P = 0.813). Due to lack of satisfactory information, meta-analysis for the outcome 'post-operative infection' was not performed.ConclusionsWithin the limitations of the existing investigations, the present study suggests that turned implants have a statistically higher probability to fail than anodised-surface implants, regardless of whether the implants were placed in maxilla or mandible. There were no statistically significant effects of turned implants on the MBL when compared with anodised implants. A comparison of post-operative infection between the implant types was not possible, due to lack of sufficient information. The reliability and validity of the data collected, the limitations of the quality assessment tool and the potential for biases and confounding factors are some of the shortcomings of the present study. The results have to be interpreted with caution due to the presence of several confounding factors in the included studies.

Data sourcesThe following databases were searched: Cochrane Oral Health Trial Register, Cochrane central register for controlled trials, Medline Ovid and Embase Ovid. The following were searched for ongoing trials: US National Institutes of Health Trials Register and World Health Organization International Clinical Trials Registry Platform. No language, publication year or publication status restrictions were imposed.Study selectionRandomised controlled trials (RCTs) and controlled clinical trials (CCTs) of orthodontic treatment to correct deep bite and retroclined upper front teeth were included. Two independent reviewers scanned and reviewed all papers and abstracts to be included. When necessary, primary authors were contacted, and additional or missing information was obtained. Trials which recruited participants 16 years or less without surgical intervention to correct their class II malocclusion were to be included. Trials that included participants with cleft lip/palate or any other craniofacial syndrome were excluded.Data extraction and synthesisIf data were to be selected, all data would have been complied into a customised data collection form. The following were to be included in the analysis; year of publication, country of origin, setting and source of study funding and details on the type of interventions including appliance type. Additionally, details of the participants including demographic characteristics, criteria for inclusion and exclusion and sample size by study group were to be taken into account. Details of the outcomes reported, including method of assessment, time intervals, details of withdrawals by study group, details of outcomes, including measures and timepoints were also supposed to be compiled for completeness. The risk of bias was planned to be reviewed. Measurements of treatment effect including risk ratios and numbers needed to treat would have been included. A 95% confidence interval and assessment of heterogeneity were to be explored. Data synthesis was planned to follow the Cochrane statistical guidelines using Review Manager Software.ResultsOne thousand three hundred and forty-four records were identified through database searching and one extra article was identified through other sources. Eight hundred and fifty-seven records were isolated after duplicates were removed. All records were rejected. No articles were selected for inclusion. No RCTs or CCTs were found assessing orthodontic treatment without the removal of permanent teeth versus treatment with extraction of permanent teeth versus no treatment at all. Consequently, it is impossible to derive any evidence-based support for clinicians for the treatment of class II division 2 malocclusion in children.ConclusionsThere is no evidence from clinical trials to recommend or discourage any type of orthodontic treatment to correct Class II division 2 malocclusion in children. This situation seems unlikely to change as trials to evaluate the best management of Class II division 2 malocclusion are challenging to design and conduct due to low prevalence, difficulties with recruitment and ethical issues with randomisation.

Data sourcesAn electronic search was performed in PubMed, Web of Science and the Cochrane Library and SciELO databases up to September 2016. References of included studies were also searched. English language restriction was applied.Study selectionClinical monitoring studies with at least six months of follow-up, including retrospective studies, prospective studies, and controlled and randomised clinical trials. Clinical case studies were excluded from the sample and only studies with a minimum of five patients were considered. Adults with osseointegrated implants were considered for these studies. Exclusion criteria encompassed studies performed in vitro, animal studies, non-controlled clinical cases, studies with incomplete data or those unsuitable for data collection.Data extraction and synthesisFour reviewers were involved in the research and screening process and disagreements were resolved by discussion. The quality of the studies was analysed using the bias scale from the Australian National Health and Medical Research Council (NHMRC). Data extracted from the studies included, when available: author, year of publication, study country of origin, number of patients, number of implants and sites, implant type, implant length and diameter, oral rehabilitation installation time, peri-implant bone loss rate, survival rate of implants in each situation analysed, follow-up time of each study, study type and drugs administered for the treatment of osteoporosis. For binary outcomes (implant failure) the estimate of the intervention effect was expressed in the form of a relative risk (RR) with the confidence interval (CI) of 95%. For continuous outcomes (marginal bone loss) the average and standard deviation (SD) were used to calculate the standardised mean difference with a 95% CI. A statistical test was used to express the heterogeneity among the studies. Publication bias was explored as well.ResultsA total of 15 observational studies were included in the review. The total number of patients involved was 8859 (29,798 implants) and the average age was 63.03 years.The follow-up period ranged from 0.75 to 22 years with a mean of 5.85 years. The smallest diameter used was 3.3 mm and the shortest implant length was 7 mm.The relative risk (RR) of implant failure and mean marginal bone loss were analysed within a 95% confidence interval (CI). The main outcome of the meta-analysis indicated that there was no difference in implant survival rate between patients with and without osteoporosis, either at the implant level (RR 1.39, 95% CI 0.93-2.08; P = 0.11) or at the patient level (RR 0.98, 95% CI 0.50-1.89; P = 0.94). However, the meta-analysis for the secondary outcome revealed a significant difference in marginal bone loss around implants between patients with and without osteoporosis (0.18 mm, 95% CI 0.05-0.30, P = 0.005). Data heterogeneity was low. An increase in peri-implant bone loss was observed in the osteoporosis group.ConclusionsThe implant survival rate in bone tissue with osteoporosis was similar to that of the control group at the implant level (P = 0.11) and at the patient level (P = 0.94). In conclusion, implants placed in patients with systemic osteoporosis did not present higher failure rates than those placed in patients without osteoporosis.