MedNEXT Journal of Medical and Health Sciences

Major integrated orthodontic-surgical approaches in Cass III malocclusion: a systematic review

Amanda Fernandes Albano — 2025-06-07

Introduction: Skeletal class III malocclusion in adults is one of the most serious and difficult to correct maxillofacial deformities. The prevalence of Class III malocclusion in Caucasians ranges from 0.8 to 4% and up to 12% in Chinese and Japanese populations. It has been shown that more than 60% of cases of Class III malocclusion are due to skeletal discrepancies, requiring an integrated orthodontic-surgical treatment approach. Objective: It was to carry out a systematic review of literary findings on the main approaches and outcomes of clinical studies of orthodontic-surgical treatment in patients with class III malocclusion. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from February to March 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 125 articles were found, and 58 articles were evaluated in full and 56 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 07 studies with a high risk of bias and 15 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=74.7%>50%. It was concluded that orthodontic-surgical treatment in Class III patients must be based on the diagnosis so that the treatment is implemented to correct the compromised structures instead of being compensated in places not affected by the malocclusion. The degree of involvement of the maxilla and mandible must be assessed so that the treatment is directed to that bone base and truly achieves its objectives and impacts of facial improvement. Redirecting growth in Class III cases is indicated as soon as the anomaly is diagnosed, as the displacement processes that occur in the midface can only be affected with treatment as long as the growth zones are capable of responding to the biomechanical stimulus. Therefore, the younger the Class III patient is treated, the better the facial correction effects will be.

Major considerations and outcomes of the periodontal diseases and infective endocarditis: a concise systematic review

Lívia Bosquilia Caselli — 2025-06-06

Introduction: Infective endocarditis (IE) is a bacterial infection of the heart's inner lining. Substantial evidence supports a link between oral health and IE, with the oral microbiome impacting multiple aspects of IE, including pathogenesis, diagnosis, treatment, and mortality rates. Objective: It was to conduct a concise systematic review of the major guidelines by the American Heart Association and work related to bacterial resistance in periodontal diseases and infective endocarditis. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from February to March 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 105 articles were found, and 27 articles were evaluated in full and 14 were included and developed in the present concise systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 28 studies with a high risk of bias and 20 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=74.7%>50%. It was concluded that there is a significant association between periodontitis and increased cardiovascular risk, promoting integrated health approaches. Infective endocarditis, although relatively uncommon, is a disease that causes substantial morbidity and mortality. Although advances in diagnosis and treatment have improved antimicrobials, prevention is still an important factor. Protocols for the use of prophylactic antibiotics have been used in medical and dental procedures likely to generate the development of the disease in high-risk patients. Thus, the use of antibiotic prophylaxis is associated with a reduced risk of infective endocarditis after invasive dental procedures.

Major clinical outcomes of pulsed-dye laser treatment for vascular melasma: a concise systematic review

Yoav Ulises Macedo Valverde — 2025-06-03

Introduction: In recent years, dermatology has advanced in its treatments with the introduction of laser technology. In particular, the pulsed-dye laser (PDL) has a wavelength of approximately 595 nm and is used to destroy hemoglobin in blood vessels. Melasma is an important target for PDL treatment. Objective: It was carried out a concise systematic review to highlight the major clinical studies on the use of pulsed-dye lasers in the treatment of melasma. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from February to April 2025 in the Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 87 articles were found, 19 articles were evaluated in full and 09 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 15 studies with a high risk of bias and 27 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=87.7%>50%. It was concluded that the combination of pulsed dye laser with low-fluence Q-switched Nd: YAG laser can be considered a safe and effective treatment for patients with melasma who present visibly dilated capillaries on dermoscopy. Both pulsed dye laser and intense pulsed light were effective and safe treatment modalities for the lightening of melasma. Furthermore, melasma lesions that present subtle or subclinical telangiectatic erythema can be improved by combining targeted vascular laser therapy and low-level fractional diode laser therapy. A parallel improvement in telangiectatic erythema suggests a relationship between the underlying vasculature and hyperpigmentation.

Main clinical approaches to conservative and aesthetic treatment after tooth extraction for dental implants: a systematic review

Ana Beatriz Makhoul — 2025-05-28

Introduction: In the aesthetic context after tooth extraction for dental implants, the conservative nature, favorable long-term prognosis, cost-benefit ratio, and, more recently, the aesthetic predictability provided by the restoration of a single tooth with an implant stand out. Objective: This study aimed to highlight the main clinical approaches to conservative and aesthetic treatment after tooth extraction for dental implants with safety and efficacy. Methods: The PRISMA Platform systematic review rules were followed. The search was conducted from January to February 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 116 articles were found, 36 articles were evaluated in full and 26 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 14 studies with a high risk of bias and 26 studies that did not meet GRADE and AMSTAR-2. According to the GRADE instrument, most studies presented homogeneity in their results, with X²=92.7%>50%. It was concluded that to successfully treat patients facing the loss of a single tooth in an area of high aesthetic importance, the implant team should use a comprehensive strategy that begins with a systematic functional and aesthetic assessment, aiming to identify the factors that can improve or impair the final aesthetic result. This allows the selection and sequencing of the unique combination of orthodontic, surgical-periodontal, and prosthetic techniques on implants, necessary to ensure a harmonious restoration. An extraction socket filled with xenograft results in better preservation of the alveolar bone dimension, less crestal resorption, and better healing of soft and hard tissues with better satisfactory results. Six considerations should assist clinicians in clinical decision-making, highlighting the presence of infection, inability to achieve primary stability in the restored position, presence of damaged socket, periodontal phenotype, aesthetic demands, and systemic conditions.

Best practices in palliative dentistry to improve patients’ quality of life: a systematic review

Izabely Cristina Garcia de Souza — 2025-05-21

Introduction: Palliative Care (PC) is an approach that promotes the quality of life of patients and their families who face life-threatening illnesses through the prevention and relief of suffering. Oral care plays an important role in patient comfort and effective palliative care strategies for relieving oral complications. Objective: This study aimed to analyze the main considerations of palliative care that should be applied by dentists to better understand the best practices of palliative dentistry to improve the quality of life of patients, as well as mitigate the increase in complications after the diagnosis of a disease. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from November 2024 to January 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 177 articles were found, and 50 articles were evaluated in full, and 18 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 24 studies with a high risk of bias and 27 that did not meet the GRADE and AMSTAR-2 criteria. According to the GRADE instrument, most studies presented homogeneity in their results, with X²=85.7%>50%. It was concluded that the understanding of palliative care has changed. Previously, it was defined as an approach to the patient when there was nothing else to do. Still, it is currently defined as comprehensive care for a patient who presents with intense health-related suffering due to a serious, life-threatening illness. The goal of palliative care in dentistry is to improve the quality of life of patients, their families, and their caregivers. Based on the literature researched, it can be concluded that the most common oral conditions among palliative patients are xerostomia, candidiasis, mucositis, dysphagia, and dysgeusia. These conditions reduce the patient's quality of life, causing pain and discomfort. In addition, xerostomia is an important factor in the emergence of other conditions. Therefore, the presence of a dentist in the palliative care team is imperative to promote oral health.

Major clinical outcomes of parendodontic surgery in patients with chronic non-communicable diseases: a systematic review

Brenda Lemes dos Reis — 2025-05-15

Introduction: In the context of chronic diseases and the challenges of endodontic surgery, there are some cases where, even after the correct use of endodontic resources, treatment fails, and the endodontist's first option is to perform retreatment. Objective: It was to develop a systematic review to list the main approaches and clinical challenges of endodontic surgery. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from November to December 2024 in Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 230 articles were found, and 37 articles were evaluated in full and 26 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 33 studies with a high risk of bias and 53 studies that did not meet GRADE and AMSTAR-2. It was concluded that periodontal surgery is a viable, safe, and effective alternative for patients with chronic diseases. Proper planning, where indications are taken into account, is directly linked to the success rate of clinical cases. Apicoectomy combined with apical curettage significantly improves the prognosis of the case. Mineral Trioxide Aggregate is the material most often described as having the highest positivity for retrofilling. The best way to perform a retroperitoneal preparation is with the aid of ultrasound. The laser is a technological advance in the decontamination of the apical region, and the microscope is a magnificent aid in visualizing the operated area, increasing the rate of surgical success. Through a correct diagnosis and the technique chosen to perform the surgical treatment, it is possible to have a successful surgery and an excellent prognosis. Thus, the success rates of endodontic surgeries depend on the indication of the surgical modality, retro-obturator materials, previous quality of the root canal filling, treatment of the surgical pocket, execution of the surgical technique, and periodontal conditions.

Clinical findings of schistosomotic myeloradiculopathy: a systematic review

Carla Izelli Mazzetti — 2025-05-12

Introduction: Schistosomiasis is caused by a helminth of the genus Schistosoma. Schistosomal myeloradiculopathy (SMR) is the main ectopic manifestation of this species. The diagnosis of SMR is based on neurological symptoms of spinal cord injury, tests that indicate infection by the agent, and exclusion of other causes. Using magnetic resonance imaging of the spinal cord, the diagnosis of this ectopic form of the disease was facilitated. Objective: This was to develop a systematic review to present the main clinical outcomes of the diagnosis and treatment of schistosomal myeloradiculopathy. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from January to February 2025 in the Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 124 articles were found. 22 articles were evaluated, and 16 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 38 studies with high risk of bias and 19 studies that did not meet GRADE. Most studies presented homogeneity in their results, with X²=83.8% >50%. It was concluded that among the main manifestations of schistosomiasis, schistosomal myeloradiculopathy is the most severe ectopic form of the disease, and should be suspected in patients with low back pain, lower limb strength and/or sensitivity disorders, or urinary tract disorders. Early diagnosis and treatment should be performed to reduce severe neurological sequelae. Treatment includes anti-schistosomiasis medications, corticosteroids, and/or surgery that significantly impacts the overall quality of life of affected individuals, reinforcing the importance of efforts to control and eradicate this debilitating disease and suggesting that multidisciplinary clinical management of patients with schistosomiasis would be more appropriate and could potentially improve patient quality of life.

Significance and clinical highlights of bone augmentation using fibrin-rich plasma and Bio-Oss®: a systematic review

Lívia de Paula Ferrari — 2025-05-12

Introduction: The number of dental implant procedures has been increasing worldwide, reaching about one million yearly. In Brazil, in the last decades, there has been a very rapid evolution in implant dentistry with high success rates. The development of biomaterials for use in dental clinics in recent years has represented a powerful therapeutic tool in the correction of bone defects. Objective: This study aimed, through a systematic literature review, to show the processes that involve bone formation for dental implants, with the use of biomaterials such as fibrin-rich plasma and Bio-Oss®. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from November 2024 to January 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 175 articles were found, and 65 articles were evaluated in full, and 56 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 10 studies with a high risk of bias and 20 that did not meet the GRADE and AMSTAR-2 criteria. According to the GRADE instrument, most studies presented homogeneity in their results, with X²=89.5%>50%. Literary findings have shown that Bio-Oss® and PRF work are essential for bone formation processes for dental implants, mainly in joint action.

Systematic review of biomaterials for bone regeneration: clinical findings in bucomaxillofacial

Gabriela Angela Delgado Silva — 2025-05-07

Introduction: In the bone engineering scenario and the molecular and cellular constituents, when grafting procedures are needed, the focus is often on the type of biomaterial to be used and the success and predictability of results do not depend only on the biomaterial. It is also necessary to consider the type of defect to be treated, and its morphology. Objective: It was performed a systematic review of bone regeneration processes using biomaterials and the main molecular and cellular constituents for bone regeneration. Methods: The present study was followed by a systematic review model (PRISMA). The search strategy was performed in the PubMed, Cochrane Library, Web of Science and Scopus, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: The total of 132 articles were found involving implantology and biomaterials. A total of 62 articles were fully evaluated and 17 were included in the systematic review. A total of 34 studies were excluded because they did not meet the GRADE and AMSTAR-2 criteria, and 6 studies were excluded because they had a high risk of bias. The symmetric funnel plot does not suggest a risk of bias between the small sample size studies. According to the aim of this study on bone regeneration processes with the use of biomaterials and the main molecular and cellular constituents for bone regeneration, the symmetric funnel plot does not suggest a risk of bias between the small sample size studies. It was found that the search for a solution to large bone defects guided the studies for regeneration therapy tissue or bone regeneration. These studies can promote the use of fillers and epithelial barriers that help in the treatment as an adjuvant to bone graft techniques, favoring greater predictability in alveolar and peri-implant reconstructions and with a good prognosis. The main filler biomaterials can be plasma rich-fibrin or Bio-Oss®. However, it is necessary to understand the chemical, physical and biological processes of both the biological material and the biological niche of the host, crossing compatible information between microenvironments allows cell recognition and signaling cascades for neovascularization and regeneration and bone filling.

State of the art of surgical techniques with PDO thread in facial aesthetics: a concise systematic review

Karla Sucupira Mota — 2025-04-30

Introduction: The fascination with beauty attracts optimizations of surgical techniques through the use of PDO (polydioxanone) threads. In recent years, the use of barbed tensor threads has gained popularity as a means of rejuvenating the face. Objective: This study presented the main clinical and aesthetic approaches to optimizing techniques using PDO threads for facial rejuvenation. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from December 2024 to January 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 101 articles were found. A total of 17 articles were evaluated and 14 were included in this systematic review. Considering the Cochrane risk of bias tool, the overall assessment resulted in 38 studies with a high risk of bias and 35 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X²=65.7%>50%. It was concluded that the combination of lower blepharoplasty and midface lift using PDO threads is a comprehensive and effective approach for facial rejuvenation. It significantly improves wrinkle reduction, midface lift, and patient satisfaction. Ultrasound-guided thread lift, a method of evaluating and performing midface lift, proves to be safe and efficient. This approach holds promise as a future option in anti-aging cosmetic surgery, presenting a minimally invasive alternative with natural-looking results and reduced downtime. The Cartesian Technique™ with Smart PDOs™ is an effective protocol for skin resurfacing that enhances cellular biostimulation through the release of bioactive drugs. Using PDO threads for midface lifting is simpler, faster, and less invasive than conventional surgical methods, and this method simultaneously achieves satisfactory results. The combination of hyaluronic acid fillers and PDO threads was effective in achieving and maintaining long-term improvements in facial volume and contour. Thread lifting with short, wedge-shaped PDO sutures is safe and effective for facial rejuvenation. The vertical lifting technique has shown advantages over current approaches. Wedgeshaped PDO sutures in a folded configuration are a promising treatment option for deep static wrinkles in the upper face. The “Half Moon Base” incision and use of 4.0 PDO threads have shown significant aesthetic results in the eyebrow.

Major randomized clinical studies on the use of Bio-Oss® with fibrin-rich plasma in the activation of microRNAs for bone augmentation and dental implant: a systematic review

Bruna Grance Lopes — 2025-04-30

Introduction: In the context of bone elevation and dental implants, there are several clinical studies with increasing expectations to establish treatment guidelines. In this aspect, Bio-Oss® is composed of inorganic bovine bone and is widely used in several bone regeneration procedures in oral surgery for dental implants. It was investigated miRNAs whose expression was significantly modified in an osteoblast-like cell line (MG63) cultured with Bio-Oss®, as well as in the presence of fibrin-rich plasma. Objective: It was analyzing the main randomized clinical studies of the use of Bio-Oss® with fibrinrich plasma in the activation of microRNAs for bone augmentation and dental implant. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from June to July 2024 in the Web of Science, Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 133 articles were found. 25 articles were fully evaluated and 11 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 20 that did not meet GRADE and AMSTAR-2. Most studies presented homogeneity in their results, with X²=89.4%>50%. According to the aim of this study on bone regeneration processes with the use of biomaterials and the main molecular and cellular constituents for subsequent dental implantation, it was found that the search for a solution to large bone defects guided the studies for regeneration therapy tissue or bone regeneration. Bio-Oss® is composed of an organic bovine bone and has been widely used in various bone regeneration procedures. The upregulated miRNAs were mir-423, mir-492, mir-191, mir-23a, mir-377, mir-494, mir-214, mir-193b, mir-320), and 4 downregulated miRNAs (mir-27a, mir-24, mir-188, let-7c) were identified for translational regulation in an osteoblast-like cell line (MG63) exposed to Bio-Oss®. However, MiR-214 was positively correlated with osteonecrosis and upregulated in cells exposed to Bio-Oss®. Also, the main filler biomaterials can be fibrin-rich plasma (FRP), Bio-Oss®. However, it is necessary to understand the chemical, physical, and biological processes of both the biological material and the biological niche of the host. Crossing compatible information between microenvironments allows cell recognition and signaling cascades for neovascularization, regeneration, and bone filling for successful posterior dental implants.

Economic impacts of the absence of a multidisciplinary nutritional therapy team (MNTT) in the public service of a state in the amazon region: a review

Vittor Cândido Soares — 2025-04-22

Introduction: Amapá is one of the newest states in the federation and one of the few that lacks a Multidisciplinary Nutritional Therapy Team (MNTT) in the public health service. These teams are mandatory in medium and high-complexity hospitals and are responsible for improving nutritional treatment and early management of malnutrition. Objective: This work consisted of a review of the literature and current legislation on the impacts of the absence of the MNTT service on the cost of medical care offered by the SUS in Amapá. Method: To assess the economic impact of the absence of MNTT, a review was conducted, gathering articles and legislation related to the proposed topic. The search terms included “nutritional therapy,” “multidisciplinary team nutritional therapy team” “multidisciplinary nutritional therapy team,” “enteral nutrition,” “parenteral nutrition,” and “Amapá.” Results: It is estimated that the state incurs additional costs related to malnutrition every month, ranging conservatively between R$ 956,267.52 and R$ 1,072,426.50. These costs could be saved with the presence of MNTT. Conclusion: Investing in the implementation of MNTT in Amapá’s public hospitals is necessary. These teams play a fundamental role in diagnosing, treating, and, most importantly, preventing nutritional diseases, leading to better allocation of public funds and improved patient care.

Clinical results of the importance of zygomatic implant by guided surgery in bone elevation loss: a systematic review of safety and efficacy

Guilherme Augusto Lima Garcia — 2025-04-18

Introduction: Severe maxillary atrophy represents a burden on aesthetic recovery in patients with trauma and tooth loss. Treatment planning for guided prosthetic rehabilitation of the maxilla with Zygomatic Implant (ZI) can be performed digitally. The surgical and prosthetic plan, position, emergence, implant shape, temporary prosthesis position, interarch relationships, and surgical templates can be designed in a fully virtual environment. Objective: The purpose was to present the clinical results of a systematic review demonstrating the importance of zygomatic implants by guided surgery in bone elevation loss. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from November 2024 to January 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 111 articles were found, 25 were evaluated in full and 15 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 31 studies that did not meet GRADE. Most studies did not show homogeneity in their results, with X²=78.5%>50%. It was concluded that the use of virtual tools enables the precision of implant positioning, validating its safety, reliability, and precision of guided surgery for the placement of zygomatic implants. The use of specialized implant planning software is an important tool to achieve predictable results for zygomatic implants and allows a good visualization of the implant-anatomical structures relationship.

Major considerations and findings of clinical studies on zygomatic implant placement in older patients with severe maxillary atrophy: a systematic review

Gean Lucas Martins Torres — 2025-04-14

Introduction: Zygomatic implant (ZI) rehabilitation of edentulous patients with maxillary atrophy is an approach that has been used with well-standardized procedures and considerable survival. Objective: The aim was to address and describe the main considerations and findings of clinical studies on the placement of zygomatic implants in elderly patients with severe maxillary atrophy. Methods: The present study followed a concise systematic review model (PRISMA rules). The search was carried out in the PubMed, Embase, Ovid, Cochrane Library, Web of Science, and Scopus databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 116 articles were found. In total, 41 articles were fully evaluated and 25 were included and evaluated in this study. Of the initial total of articles, 28 articles were excluded because they did not meet the GRADE and AMSTAR-2 classification, and 12 were excluded because they presented a risk of bias that could compromise the credibility of the studies. The symmetric funnel plot does not suggest a risk of bias. According to the GRADE instrument, most studies presented homogeneity in their results, with X²=92.1%>50%. It was concluded that the use of zygomatic implants is an alternative procedure, making implant rehabilitation of extensively atrophic maxillas possible when conventional procedures are not possible. Several anatomical and procedural factors, such as sinus conformation and sinus mucosa thickness, may influence the overall success of zygomatic implant rehabilitation and predispose to a higher occurrence of complications. Furthermore, dynamic navigation technology had better predictability in terms of precision and accuracy.

All-on-four implants using a palatal approach without bone grafts: a systematic review

Suzanna dos Santos Silva — 2025-04-14

Introduction: The all-on-four technique has proven to be beneficial in reducing stress around dental implants and is a very effective treatment option for edentulous patients. Objective: A systematic review was carried out to present the main characteristics and clinical results of the all-in-four technique in implant dentistry. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from June to July 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 82 articles were found, 40 articles were evaluated in full and 22 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 12 studies with a high risk of bias and 10 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=58.9%>50%. It was concluded that technical knowledge and anatomical understanding in all-on-four mandibular surgery are essential for predictable and consistent surgical results. The all-on-four configuration proved to be biomechanically superior to parallel implants, considering the radial stresses on the implants and cortical bone. All-on-four treatments are based on the insertion of two anterior implants and two angled ones to cover a larger area. Therefore, implant-supported prostheses may have higher success and survival rates. The cost of treatment can be reduced. Chewing stress can also be minimized to a greater extent. It was observed that the lowest stress was observed in both lateral and vertical loads in the peri-implant region.

Major approaches and clinical optimizations of zygomatic implants through guided surgery: a systematic review

Anna Júlia Martos Kfouri — 2025-04-14

Introduction: In the dental implant scenario, the graft to treat severely reabsorbed jaws is currently the gold standard procedure, but there are flaws in this procedure from 10.0 to 30.0 % are reported in the literature. Zygomatic implants have shown, in many cases, improved clinical outcomes compared to bone graft and represent an essential alternative for compromised maxillary bone. Objective: It analyzed the main approaches and clinical optimizations of zygomatic implants through guided surgery. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from November 2024 to January 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 195 articles were found, and 48 articles were evaluated in full and 36 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 22 studies with a high risk of bias and 25 studies that did not meet GRADE and AMSTAR-2. According to the GRADE instrument, most studies presented homogeneity in their results, with X²=91.7%>50%. It was concluded the zygomatic implant is revolutionizing the procedure of implants in the posterior atrophic maxilla, eliminating the complications of bone augmentation and sinus elevation, with delayed scarring. Zygomatic implants have in many cases shown better clinical results compared to bone grafts and represent a possible gold standard for dental implants. Robotic placement of zygomatic implants has the potential to produce excellent results.

Clinical outcomes of the importance of minimally traumatic tooth extraction for dental implant and aesthetic: a systematic review

Eduarda Garcia Caldeira — 2025-04-14

Introduction: In the context of tooth extraction, this clinical practice is common for dentists, with the main causes of caries, periodontal disease, and coronal-radicular fractures. The choice for rehabilitation with implants has been growing, and to be carried out, it needs alveolar bone preservation at the implant site and adequate gingival contour, especially in aesthetic regions. However, the new techniques and instruments for minimally traumatic extraction still need to be analyzed, as little research has evaluated the success rate and limitations of these devices. Objective: It was developed a systematic review to highlight the importance of minimally traumatic tooth extraction for dental implants and aesthetics. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from November 2024 to January 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 130 articles were found, 32 articles were evaluated in full and 25 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 21 studies with a high risk of bias and 32 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=81.6%>50%. It was concluded that the use of precise and minimally traumatic techniques enabled satisfactory and functional aesthetic results, as well as improving the patient's aesthetics and self-esteem. The immediate implant placement procedure after tooth extraction preserves bone height and thickness, reduces treatment time and cost, in addition to maintaining the gingival architecture, being important for the aesthetic success of future prosthetic rehabilitation. Also, it presents success rates comparable to implants in fully healed edges, the extraction must be done in a minimally traumatic way, to preserve the maximum bone tissue. The horizontal defects present after the installation of the immediate implant, if they are less than or equal to 3mm, will heal with complete bone filling. However, if they are larger than 3mm, bone graft material and/or membrane should be used so that there is bone healing.

Main clinical findings on the use of the zygomatic implant for compromised maxillary bone: a systematic review

Michele Medeiros da Silva — 2025-04-14

Introduction: In the dental implant scenario, the graft to treat severely reabsorbed jaws is currently the gold standard procedure. Still, there are flaws in this procedure until 30.0 % are reported in the literature. Zygomatic implants have shown, in many cases, improved clinical outcomes compared to bone grafts and represent an essential alternative for compromised maxillary bone. Objective: It was analyzed the main literary findings on the use of the zygomatic implant as a necessary alternative for a dental implant. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from November 2024 to January 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 122 articles were found, 36 articles were evaluated in full and 34 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 24 studies with a high risk of bias and 38 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=83.7%>50%. It was concluded that the zygomatic implant is revolutionizing the procedure of implants in the posterior atrophic maxilla, eliminating the complications of bone augmentation and sinus elevation with delayed cicatrization. Zygomatic implants have, in many cases, shown better clinical results compared to bone grafts and represent a possible gold standard for dental implants.

Relationship between indiscriminate use of psychotropic drugs and the development of sigmoid volvulus: a systematic review

Aidé Pacheco López — 2025-04-08

Introduction: Sigma volvulus is a common cause of intestinal obstruction, especially in vulnerable populations. Psychotropic drugs, widely used for mental disorders, have side effects that can compromise gastrointestinal motility, increasing the risk of sigmoid volvulus. Objective: A brief systematic review was developed to list the central clinical studies and case reports on the relationship between the occurrence of sigmoid volvulus in patients using psychotropic drugs. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from November 2024 to January 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 112 articles were found, 25 articles were evaluated in full and 11 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 31 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=79.5%>50%. The indiscriminate use of psychotropic drugs represents an underestimated risk factor for the development of sigmoid volvulus. It is crucial to constantly monitor gastrointestinal side effects in patients treated with these drugs and to encourage a comprehensive approach in their clinical management. Reducing anticholinergic load and avoiding serotonergic antagonists will also mitigate hypomotility. Previous abdominal surgery and cecal diameter >10 cm was found to be predictive factors for failure of colonoscopic detorsion. Constipation due to psychotropic drug use was a significant predictor of recurrence of sigmoid volvulus. Effective management of constipation is crucial to prevent recurrence.

Maxillary sinus bone augmentation and injectable plateletrich fibrin (I-PRF) for dental implant: a systematic review

Mariana Messias Leonel — 2025-04-02

Introduction: In the context of bone regeneration for dental implants, maxillary sinus augmentation is a well-documented surgical technique and is one of the therapeutic options for implant placement in the atrophic posterior maxilla, particularly when the residual bone height is less than 5 mm. Several surgical techniques can be used to reconstruct the atrophic alveolar ridge, techniques alone or associated with autogenous, allogeneic, xenogenous grafts, and alloplastic biomaterials. Objective: It was carried out a systematic review to present the main scientific documentation on maxillary sinus augmentation and bone regeneration for dental implants. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from November 2024 to January 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Experimental and clinical studies (retrospective, prospective and randomized) with qualitative and/or quantitative analysis were included. Results and Conclusion: A total of 123 articles were found, and 35 articles were evaluated in full and 26 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 31 studies that did not meet GRADE and AMSTAR-2. According to the GRADE instrument, most studies presented homogeneity in their results, with X²=90.8%>50%. It was concluded that the use of small and large bovine xenograft particles for maxillary sinus augmentation provides comparable bone formation, ensuring stable graft dimensions combined with high implant success and healthy peri-implant conditions. However, the small particle size resulted in better bone-graft contact, providing greater osteoconductivity than with the larger particle size. Based on the literary findings, it was shown that the fibrin-rich plasma is favorable for bone formation processes for dental implants, especially when combined with xenografts.

Nutrological therapy as a fundamental basis for the treatment of chronic patients and with obesity: a systematic review

Jefferson Alexandre Azevedo de Araujo — 2025-03-25

Introduction: In the scenario of chronic diseases, patients admitted to the intensive care unit (ICU) are increasingly obese, with an incidence of up to 40%. Objective: It was to describe the main considerations of the importance of nutritional therapy as a fundamental basis for the treatment of chronic patients and with obesity. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from August to September 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 134 articles were found. A total of 57 articles were evaluated in full and 43 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 11 studies with a high risk of bias and 20 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=77.4%>50%. Patients admitted to the intensive care unit (ICU) are increasingly obese. Obesity is observed by nutritional imbalance that alters the qualities of individuals' micronutrient status through a concentrated intake of minerals such as iron, calcium, magnesium, zinc, and copper, as well as vitamins. The goals of nutritional therapy are to prevent morbidity and mortality directly attributable to macro- and micronutrient deficiency and to minimize the loss of lean body mass. There are still gaps in information by ASPEN and ESPEN regarding optimal nutritional therapy for patients with obesity during critical illness. International guidelines, therefore, recommend measuring energy expenditure versus energy savings with indirect calorimetry in obese patients.

Major predictors of bruxism in pediatric dentistry: a systematic review

Guilherme Augusto Lima Garcia — 2025-03-24

Introduction: There is difficulty in determining the prevalence of the habit of bruxism and therefore are important evaluation method, since only 5-20 % of the carrier population of habit are aware that perform the habit. Objective: This study aimed to conduct a quantitative and qualitative overview of the literature findings on the treatment of bruxism in pediatric dentistry. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from November 2024 to January 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 112 articles were found, 42 articles were evaluated in full and 33 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 32 studies that did not meet GRADE. Most studies did not show homogeneity in their results, with X²=94.8%>50%. Some authors concluded that in children, there are several etiological factors of bruxism, such as psychological, local factors, occupational activities, and systemic conditions, factors such as stress and anxiety little considered the influence of allergic phenomena in this dysfunction. According to the author, in the allergic factor, nocturnal bruxism is from a reflex initiated by the increase in negative pressure in the tympanic cavities when there are successive allergic edemas in the mucosa in the Eustachian tubes. It is concluded that there are a large number of jobs in pediatric dentistry using muscle relaxant boards as a treatment for bruxism and temporomandibular disorder and according to the results obtained with a critical significance level, the vast majority of authors have confirmed the benefits of using the plates. It was concluded that bruxism has a multifactorial etiology because there is ample evidence that emotional stress is a major trigger, while occlusal interference is a predisposing factor. But some theories admit that occlusal disharmony is as etiological factor of bruxism.

Positive clinical effect of ozone therapy in dentistry through randomized clinical studies and meta-analysis: a systematic review

Cristina Ponsoni — 2025-03-21

Introduction: In dental treatment and oral health, ozone in low concentrations has been used successfully due to its oxidizing and antimicrobial properties. It also has anti-inflammatory and immunological action. Objective: A systematic review was developed to demonstrate the positive clinical effect of ozone therapy in dentistry through randomized clinical studies and meta-analysis. Methods: The PRISMA Platform systematic review rules were followed. The search was conducted from November 2024 to January 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 111 articles were found, 38 articles were evaluated in full and 13 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 23 studies with a high risk of bias and 30 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=75.8%>50%. It was concluded that ozone therapy is an alternative to accelerate healing and reduce pain in traumatic and autoimmune ulcers. Ozone offers a painless alternative to conventional treatment for dental caries and has been shown to arrest primary root caries, primary pit, and fissure caries, and clinically reverse the lesion. Its antimicrobial action on endodontic microbiota is quite promising. Ozone gel is suggested as an adjunctive therapy in diabetic patients to improve periodontal health. Oxygen-ozone therapy has been shown to enhance post-extraction healing in patients at risk for MRONJ. As for reducing the microbial load for patients undergoing root canal treatment, ozone therapy has inferior results when compared to conventional chemomechanical techniques using NaOCl.

Major clinical considerations of minimally traumatic tooth extraction and aesthetic management: a systematic review

Brenda Marques da Silva — 2025-03-18

Introduction: After tooth extraction, the alveolar ridge will commonly decrease in volume and change morphologically. These changes can difficult or even impede the placement of dental implants and prosthetic rehabilitation. Minimizing bone remodeling means optimizing the esthetics and functional aspects, and mainly, the sucess of implant treatment. To avoid the residual ridge resorption different techniques and bone graft materials have been proposed. Objective: It was to analyze, through a systematic review, the main clinical considerations of minimally traumatic tooth extraction, in order to highlight the best dental and aesthetic management. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from November 2024 to January 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 175 articles were found, and 40 articles were evaluated in full and 29 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 30 studies that did not meet GRADE and AMSTAR-2. According to the GRADE instrument, most studies presented homogeneity in their results, with X²=81.3%>50%. The present study suggests that the alveolar graft technique may increase the risk of disease transmission, cost, and time of treatment. Several studies have stated that the graft material is not fully incorporated into the newly formed bone, indicating less vital bone tissue. Spontaneous cicatrization is still the most used feature since, in intact alveoli and small defects, it is a procedure that does not present significant losses that justify the use of edge preservation techniques. In larger defects, techniques after spontaneous healing, such as a block graft, can be used without the drawbacks of alveolar grafting, such as delayed healing and poor bone quality.

Major approaches and scientific relevance of virtual surgery in implant dentistry: a systematic review

Fábio Renato Braga Marcato — 2025-03-18

Introduction: Dental implant procedures have increased worldwide, reaching approximately one million dental implants per year the optimization of faster and more accurate techniques by dentists and postoperative surgeons with better results and quality of life stimulated the development of numerous software and hardware for performing computer-guided surgeries, the so-called Guided Surgeries (GS). Objective: The present study carried out a systematic review to highlight the optimization of the safety and effectiveness of digital dental implants. Methods: The rules of the Systematic Review-PRISMA Platform were followed. The research was carried out from November 2024 to January 2025 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 112 articles were found. A total of 42 articles were fully evaluated and 14 were included in the systematic review. A total of 32 studies were excluded because they did not meet the GRADE criteria, and 20 studies were excluded because they had a high risk of bias. Preoperative virtual planning and reconstruction of the mandible guided by dental implants through preoperative designs provide high success rates for the implant and dental rehabilitation, benefiting also prosthetic restorations supported by fixed implants. Still, the concept of using personalized implants with the help of 3D virtual treatment planning, stereolithographic models, and computer-assisted design greatly improves mandibular restoration and helps to obtain a good facial profile, and aesthetic and dental rehabilitation, avoiding complications with autologous grafts.

Major considerations on the gingival graft on dental implant: a concise systematic review

Isabella Garcia Costa de Oliveira — 2025-03-15

Modern implant dentistry uses gingival grafts to promote tissue regeneration around dental implants, ensuring the stability and aesthetics of oral rehabilitation. This study addresses the main types of gingival grafts used, including connective-subepithelial grafts, free gingival tissue grafts, and allogeneic grafts, comparing their clinical indications, advantages, and disadvantages. The connective-subepithelial graft stands out for offering superior aesthetic results, being indicated in visible areas, but requires a donor area, which can increase patient discomfort. Free gingival tissue grafts are effective in increasing keratinized gingiva, essential for peri-implant health, while allogeneic grafts, obtained from tissue banks, eliminate the need for additional surgery, becoming a less invasive option. In addition to the characteristics of the grafts, the study also explores the biomaterials used, such as autogenous, xenogeneic, and allogeneic, analyzing their biocompatibility, osteoconduction, and resorption rate properties, which influence graft integration. Autogenous grafts have high biocompatibility and osteoinductive capacity, while xenogeneic and allogeneic grafts have advantages in terms of accessibility and reduced procedures. The cost and accessibility of graft procedures are important factors in choosing the treatment since the value varies according to the type of graft and the technique applied. Procedures with autogenous grafts tend to be more expensive due to the need for additional surgery, while xenogeneic and allogeneic grafts, which are more accessible, present a balance between cost and effectiveness, especially in health systems with limited coverage. This study provided a comprehensive overview of the indications and limitations of the types of gingival grafts, offering support for the choice of treatments that reconcile health, aesthetics, and cost-effectiveness.

Evaluation of the response to photobiomodulation and magnetotherapy in osteonecrosis of the jaws induced by the use of bisphosphonates: a systematic review

Noroel Rosa da Silva Junior — 2025-03-15

Introduction: Bisphosphonates are drugs that act on bone metabolism, inhibiting calcium precipitation and bone resorption. When used for long periods to control osteoporosis, these drugs can cause adverse effects, such as osteonecrosis of the jaws (Bisphosphonate-Related Osteonecrosis of the Jaws - BRONJ), which is more frequent in 8% to 12% of patients when administered intravenously. However, it should be noted that complications, when they occur, are very severe and mutilating, greatly impairing the quality of life of these patients. Energy-based devices (EBD), described in the biophotonic literature, reveal effective anti-inflammatory, analgesic, neoangiogenic, and reparative action. Objective: It was conducted a systematic review to present the main clinical considerations and consequences of the use of bisphosphonates in the occurrence of osteonecrosis of the jaw, as well as to discuss the treatments of photobiomodulation and magnetotherapy. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from November 2024 to January 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 118 articles were found, 30 articles were evaluated in full and 12 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 31 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=88.5%>50%. It is concluded that with the increasing use of bisphosphonates against osteoporosis especially in cases of postmenopausal women with osteopenia, a proportionally higher incidence of the main adverse effect of these drugs in the maxillomandibular region, osteonecrosis of the jaw, has emerged. The "gold standard" therapy of choice proposed for this disease is surgical treatment. Complications, when present, are very severe and mutilating, greatly impairing the quality of life of these patients. Morbidities include extensive resections, secondary infections, lack of tissue for primary closure, dehiscence, and fistulas, which can evolve into multilateral wounds with serious consequences, such as sepsis. In this regard, photobiomodulation therapy and magnetotherapy demonstrated safety and efficacy in the treatment of bisphosphonate-related osteonecrosis of the jaw, through reduction of inflammatory signs, faster healing, and reduction of postoperative morbidity. Thus, it was demonstrated that only four applications of low-intensity laser and magnetotherapy were sufficient to reduce the inflammatory process in the surgical wound, stimulate the tissue repair process, and provide postoperative analgesia.

Major considerations and clinical outcomes of digital implant dentistry in guided bone regeneration: a systematic review

Catia Gerez — 2025-03-12

Introduction: It is estimated that up to 43% of osseointegrated implants require guided bone regeneration (GBR) as part of the patient's rehabilitation. Bone loss or insufficiency presents a major challenge for osseointegration. In this sense, the use of CAD-CAM systems (Computer-Aided Design/Computer-Aided Manufacturing) is highlighted in this process. Objective: It elucidated the current clinical considerations of the use of guided bone regeneration for dental implants through the use of CAD-CAM systems. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from November 2024 to January 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 118 articles were found, 30 articles were evaluated in full and 12 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 31 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=79.5%>50%. Guided bone regeneration is well documented and constitutes a predictable and successful approach to lateral and vertical bone augmentation of atrophic ridges. Thus, guided bone regeneration is considered one of the most commonly applied methods to reconstruct alveolar bone and to treat peri-implant bone deficiencies, as well as to replace lost bone and allow the implant to be fully integrated and maintained during functional loading. The use of digital tools for the automated fabrication of implant parts (CAD-CAM) is an optimizing reality in Dentistry. CAD-CAM enables high-quality, standardized, accurate, and detail-perfect prosthetic restorations. The use of metallic implants in the morse cone system in association with zirconia abutments guarantees a final product with mechanical resistance, biocompatibility, and aesthetics. Also, immunomodulatory guided bone regeneration membranes are developed mainly by improving macrophage recruitment and aggregation as well as regulating macrophage polarization.

Improving buccomaxillofacial surgical techniques and minimally invasive: a systematic review

João Pedro Andrade Freitas de Morais Souza — 2025-03-10

Introduction: In minimally invasive there are several clinical studies with increasing expectations to establish treatment guidelines. Recently, advanced technology in the reconstruction of three-dimensional models based on computed tomography (CT), such as cone beam CT, has opened a new axis in the application of personalized and accurate diagnosis and has been increasingly used in the field of dentistry. Objective: This study aimed to analyze the evolution and consequent importance of improving surgical techniques and minimally invasive treatments in dentistry. It was hypothesized that there were statistically significant results on advances in minimizing trauma, providing patients with quality of life, and better aesthetics. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from June to July 2024 in the Web of Science, Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 139 articles were found. 26 articles were fully evaluated and 15 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 49 studies with a high risk of bias and 34 that did not meet GRADE and AMSTAR-2. Most studies presented homogeneity in their results, with X²=83.8%>50%. The maximum preservation of the integrity of the soft tissues (papillae and free and inserted gingival band) adjacent to the prosthetic spaces should be sought; as preservation of the alveolar bone ridge level. Based on the histological concept living tissues are formed by cells joined by thin elastic tissue and with nerve fibrils, capillaries, lymphatic and blood vessels. The disruption of these cells by surgical trauma provides the release of enzymes that delay healing. For this reason, surgical trauma should be minimized. There are many attempts to minimize the professional effort, reduce surgical time, and alleviate bleeding and inflammatory processes, edema, pain, and ecchymosis that can affect patients. Thus, the maximum preservation of the integrity of the soft tissues adjacent to the prosthetic spaces and the preservation of the level of the ridge of the alveolar bone to achieve a minimization of surgical trauma must be sought.

State of the art in the treatment of knee osteoarthritis using platelet-rich plasma alone or in combination: a systematic review

João Paulo Rodrigues Pacheco — 2025-03-07

Introduction: Bone diseases comprise a large group of common diseases, including fractures, osteoporosis, and osteoarthritis that affect a large number of individuals. Knee osteoarthritis (KOA) refers to a chronic joint disease characterized by degenerative lesions of the knee cartilage, causing pain, swelling, dyskinesia, and other symptoms of the knee joint. According to the World Health Organization (WHO), KOA has an incidence of approximately 10-15%, with the elderly population accounting for 95%. Objective: This was to conduct a systematic review to present state of the art, through randomized clinical trials and meta-analyses, of the treatment of knee osteoarthritis using platelet-rich plasma alone or in combination with bone marrow aspirate concentrate (stem cells and other cells), mesenchymal stem cells, hyaluronic acid, and corticosteroids. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from November 2024 to January 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 126 articles were found, of which 39 articles were fully evaluated and 11 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 31 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=79.9%>50%. The symmetrical funnel plot suggests no risk of bias among studies with small sample sizes. Based on the results, platelet-rich plasma demonstrated a significant advantage over hyaluronic acid, as well as improved symptom relief, lower reintervention rates, and pain improvement. At a minimum follow-up of 6 months, platelet-rich plasma has been shown to significantly improve pain and function in patients with knee osteoarthritis compared with placebo. Furthermore, platelet-rich plasma exhibited the highest values compared to bone marrow aspirate concentrate, hyaluronic acid, and corticosteroids. Furthermore, arthroscopically guided high-dose subchondral injection of primary synovial mesenchymal stem cells cultured in platelet-rich plasma and hyaluronic acid medium can regenerate cartilage defects, improving clinical outcomes. Meta-analyses have shown that the benefits of platelet-rich plasma injections are primarily apparent in the medium- to long-term management of clinical symptoms, including pain relief, improved quality of life, increased activities of daily living, and improved sports capabilities. Clinical outcomes of platelet-rich plasma injections for knee osteoarthritis may be related to the higher dose of platelets.