Daniele Masterson Tavares Pereira Ferreira

Upper airway dimensions in patients undergoing orthognathic surgery: a systematic review and meta-analysis.

The objective of this systematic review was to evaluate the effect of different types of orthognathic surgery on the dimensions of the upper airways assessed using three-dimensional images. An electronic search was performed in Cochrane Library, Medline, Scopus, VHL, Web of Science, and the System for Information on Grey Literature in Europe, ending January 2015. Inclusion criteria encompassed clinical studies in humans, patient age >15 years, patients submitted to maxillary or mandibular advancement or setback surgery, isolated or in combination, and presentation of airway measures, specifically volume and/or minimum cross-sectional area (CSA), obtained from computed tomography or magnetic resonance imaging. Additional searches were conducted on the references of included articles and in the NLM catalogue. An assessment of the risk of bias was performed. A total of 1180 studies were retrieved, of which 28 met the eligibility criteria; one was later excluded as it presented a high risk of bias. A meta-analysis was performed. There is moderate evidence to conclude that the upper airway minimum CSA increases significantly (124.13 mm(2)) after maxillomandibular advancement (MMA); the total volume increases significantly after MMA (7416.10mm(3)) and decreases significantly after maxillary advancement+mandibular setback (-1552.90 mm(3)) and isolated mandibular setback (-1894.65 mm(3)).

Does trauma in the primary dentition cause sequelae in permanent successors? A systematic review.

This systematic review sought scientific evidence (in the literature) that trauma in the primary incisors cause sequelae in permanent successors. Also this work verified whether there was a relation between the presence and type of sequelae in permanent teeth with the childs age at the time of injury and type of trauma. Electronic databases, including the PubMed, Scopus, The Cochrane Library, LILACS, and Web of Science were used to search for original articles up to June 2013. Prospective and retrospective studies that assessed the association of trauma in deciduous incisors and developmental disturbances in permanent successors were selected. Two authors independently reviewed and extracted the data from the included studies. A methodological quality assessment evaluation of the selected studies was performed. The search retrieved 258 citations. Initially, 19 studies fulfilled the selection criteria; however, one (1) was excluded, leaving 18 for the final selection. Despite some limitations in the study designs were observed, especially the lack of a control group in most studies, the evidence found suggests that individuals with trauma in their primary incisors have more developmental disorders in the permanent successors than individuals without a previous trauma. Furthermore, the younger the child is at the time of injury, the more frequent and more severe are the sequelae to the permanent successor incisors. More severe traumas such as intrusion and avulsion are associated to more serious developmental disorders. These results should be analyzed carefully because very few studies evaluated had a control group.

Does Smear Layer Removal Influence Root Canal Therapy Outcome? A Systematic Review.

OBJECTIVE The aim of this systematic review was to determine whether the smear layer (SL) removal procedure influences the outcome of root canal treatment. STUDY DESIGN We performed a search on Pubmed, Scopus, ISI Web of Science, Cochrane Library, Lilacs and SIGLE. We included randomized controlled clinical trials (RCT), with clinical and radiographic outcomes, conducted on subjects who had undergone root canal therapy. The protocol differed only in the SL removal or maintenance procedure. We evaluated the papers for risk of bias according to the Cochrane assessment tool. RESULTS A total of 1,983 articles were found, after removal of duplicates, 892 remained. We included two studies in this review. One study revealed a low risk of bias and a high success rate for the SL removal group compared to the non SL removal group (P = 0.04), while the other study had a high risk of bias and found no difference between the SL removal and non SL removal groups (P = 1.00). CONCLUSION We concluded that the SL removal for root canal treatment of primary teeth with initial clinical signs and symptoms or pulpal necrotic status, could benefit the outcome, although further RCT should be performed to achieve evidence.

Does flavoured dentifrice increase fluoride intake compared with regular toothpaste in children? A systematic review and meta-analysis

BACKGROUND Toothpaste manufacturers encourage through aggressive marketing strategies the overconsumption of fluoridated dentifrices. There are conflicting results regarding fluoride intake from toothpastes in children. AIM The aim of this systematic review and meta-analysis was to determine whether dentifrice flavour increases fluoride ingestion by children. DESIGN We included clinical trials on children that evaluated the use of flavoured dentifrice - FD vs regular dentifrice - RD to identify the fluoride intake. An electronic search was performed in PubMed, Web of Science, Scopus, The Cochrane Library, LILACS/BBO, and grey literature followed by manual search. The methodological quality of the studies was assessed using the Cochrane Collaboration common scheme for bias and ROBINS-I tool. Data were analysed in subgroups such as low (G1) and ordinary (G2) fluoride concentrations of dentifrices. We carried out heterogeneity and sensitive analyses. RESULTS For G1, the fluoride intake from RD was significantly higher than from FD [standardised mean difference = -2.57 (-3.26, -1.89), P < 0.00001]. For G2, the fluoride ingestion from RD was significantly higher than from FD [mean difference = -0.00 (-0.00, -0.00), P = 0.02]. CONCLUSIONS There is evidence to support the null hypothesis that flavouring from dentifrice does not increase fluoride intake in young children.

Duration of effectiveness of Botulinum toxin type A in excessive gingival display: a systematic review and meta-analysis

Botulinum toxin type A is effective in reducing excessive gingival display caused by hyperfunctional upper lip elevator muscles; however, this effect is transient. This study aimed to determine the duration of the effectiveness of botulinum toxin type A on a gummy smile. A systematic search was conducted using Medline (PubMed), Scopus, and Web of Science electronic databases, from 1970 to March 2017 with no language restriction; the search included studies evaluating adult patients with excessive gingival display who were treated with botulinum toxin and were followed-up for at least 3 months. OpenGrey and Clinical Trial Registry were also consulted. Quality assessment was applied to determine the level of evidence and bias, and a meta-analysis was performed. Of 2181 full texts, 71 were obtained, with 3 prospective studies meeting the selection criteria. The gingival display was significantly reduced to baseline with 2, 4, and 8 weeks of treatment. The gingival display considerably reduced at the baseline-2-week comparison (-4.44 mm using raw data and-4.05 mm using the standard difference) and increased throughout the weeks of follow-up. There is scant evidence to determine the duration of the effectiveness of toxin type A on a gummy smile. The effect tends to be stable until at least 8 weeks of follow-up, and the gingival exposure may not return to baseline within 12 weeks of follow-up. Well-designed randomized clinical trials with a minimum of 6 months of follow-up are necessary to strengthen the evidence.

Longevity of defective direct restorations treated by minimally invasive techniques or complete replacement in permanent teeth: A systematic review

OBJECTIVES This systematic review aimed to verify if there is difference in the longevity of minimally invasive techniques compared to the complete replacement for the treatment of defective direct restorations in permanent teeth. DATA The data included randomized controlled clinical trials comparing the clinical performance of defective dental restorations treated by a complete replacement technique or minimally invasive techniques on permanent teeth. Evaluation of the risk of bias was performed using the Cochrane Collaboration common scheme for bias and the evidence was qualified using the GRADE tool. SOURCE A comprehensive search was performed in the electronic databases: PubMed, Scopus, ISI Web of Science, The Cochrane Library, LILACS, BBO, SIGLE, followed by manual search in the reference lists of the included studies, without any restrictions. STUDY SELECTION From 5554 retrieved studies, 10 met the eligibility criteria and were submitted to data extraction and quality assessment. The repair technique presented similar results to replacement and superior results when compared to sealing. In addition, refurbishment demonstrated to be a useful treatment for localized anatomical form defects. All the studies presented low risk of bias and high quality evidence for repair and refurbishment and moderate for the sealing technique. CONCLUSIONS The direct restorations treated by the repair, seal and refurbishment techniques did not present a significant difference in clinical longevity in comparison to the replacement technique in permanent teeth with overall moderate quality of evidence. CLINICAL SIGNIFICANCE The present findings demonstrated that the best treatment for defective restorations is conservative management. The evidence demonstrated here helps and encourages clinicians during the decision-making process. Moreover, it suggests not replacing imperfect restorations, but to managing them in a minimally invasive way, allowing the structure to be preserved.