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Treating periodontitis-a systematic review and meta-analysis comparing ultrasonic and manual subgingival scaling at different probing pocket depths

BMC Oral Health volume 20, Article number: 176 (2020



Mechanical plaque removal has been commonly accepted to be the basis for periodontal treatment. This study aims to compare the effectiveness of ultrasonic and manual subgingival scaling at different initial probing pocket depths (PPD) in periodontal treatment.


English-language databases (PubMed, Cochrane Central Register of Controlled Trials, EMBASE, Medline, and, by January, 2019) were searched. Weighted mean differences in primary outcomes, PPD and clinical attachment loss (CAL) reduction, were estimated by random effects model. Secondary outcomes, bleeding on probing (BOP), gingival recession (GR), and post-scaling residual dental calculus, were analyzed by comparing the results of each study. The quality of RCTs was appraised with the Cochrane Collaboration risk of bias tool. The GRADE approach was used to assess quality of evidence.


Ten randomized controlled trials were included out of 1434 identified. Initial PPD and follow-up periods formed subgroups. For 3-months follow-up: (1) too few shallow initial pocket studies available to draw a conclusion; (2) the heterogeneity of medium depth studies was so high that could not be merged to draw a conclusion; (3) deep pocket studies showed no statistical differences in PPD and CAL reduction between ultrasonic and manual groups. For 6-months follow-up: (1) too few shallow initial PPD studies to draw a conclusion; (2) at medium pocket depth, PPD reduction showed manual subgingival scaling better than ultrasound. No statistical differences were observed in CAL reduction between the two approaches; (3) for deep initial PPD studies, both PPD and CAL reduction showed manual subgingival scaling better. GR results indicated no statistical differences at medium and deep initial pocket studies between the two methods. BOP results showed more reduction at deep pocket depths with manual subgingival scaling. No conclusion could be drawn about residual dental calculus.


When initial PPD was 4-6 mm, PPD reduction proved manual subgingival scaling was superior, but CAL results showed no statistical differences between the two means. When initial PPD was ≥6 mm, PPD and CAL reductions suggested that manual subgingival scaling was superior.

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Effect of Titanium or Zirconia Implant Abutments on Epithelial Attachments After Ultrasonic Cleaning

. 2020;62(3):331-334.

doi: 10.2334/josnusd.19-0332.


Zirconia is widely employed as a material during dental implant work because of its superior esthetics. This study sought to evaluate the impact of titanium or zirconia implant abutments on epithelial attachments after ultrasonic cleaning. These implants were inserted into the extraction socket of rat maxillary first molars. Then, the length of the horseradish peroxidase (HRP) reaction was measured. In addition, titanium and zirconia disks were cleaned using an ultrasonic scaler, surface morphology changes were observed, and the number of epithelial cell attachments to the surface was measured. Ultimately, the surfaces of the titanium disks were easier to damage than those of the zirconia ones. There was no difference in the number of epithelial cell attachments between the two materials with the ultrasonic cleaning. The length of the HRP reaction was shorter on the zirconia implant abutment surface than on the titanium one after mechanical cleaning. In conclusion, zirconia is harder than titanium and a better choice for use in the epithelial tissue attachment. Zirconia is more suitable as a material for implant abutments than titanium.

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Dental Imaging Software: Cloud-Based Versus On-Premise Solutions

Apteryx is a dental imaging solution for both your cloud based and client server needs.
Here is a link to a blog post on Dental Cloud Imaging
Here is a link to a webinar I was recently part of for the same topic

Cloud-based imaging is revolutionizing dental patient care while providing opportunities for cost-savings, more efficient workflows and improving the predictability of treatment outcomes for patients. Driven by the trend toward the migration of practice management software to the cloud and accelerated by the importance of remote access to patient records, cloud-based imaging is rapidly becoming central to viewing, processing, and sharing dental image data, in addition to serving as a facilitator to Artificial Intelligence (AI) based clinical decision support.

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Saliva-based PCR Tests for SARS-CoV-2 Detection

. 2020;62(3):350-351.

doi: 10.2334/josnusd.20-0267.


The outbreak of novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. Nasopharyngeal swabs are widely used in polymerase chain reaction (PCR) test to detect SARS-CoV-2. However, the collection of nasopharyngeal swabs has a series of drawbacks concerning exposure of healthcare staff, difficulty in collection, and discomfort of patients. Therefore, an alternative noninvasive sample for diagnostic of emerging viral diseases is required. The usefulness of saliva screening tests is compared to conventional swab tests in this report. The results suggest that saliva could be a reliable sample for detecting SARS-CoV-2.

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Evaluation of Clinical and Radiographic Parameters as Dental Indicators for Postmenopausal Osteoporosis

Oral Health Prev Dent 18 (2020), No. 3  (08.06.2020)

Open Access ORAL HEALTH, Page 499-504, doi:10.3290/j.ohpd.a44688

Purpose: In the early stages, osteoporosis is relatively a silent disease characterised by low bone density with microarchitectural deterioration of the bone tissue leading to enhanced bone fragility. The objective of this study was to evaluate the relationship between age, body mass index, oral signs, and osteoporosis among postmenopausal women.
Materials and Methods: The study included postmenopausal women who were divided into two groups of subjects. The osteoporotic group comprised 30 patients with osteoporosis who were diagnosed using dual-energy X-ray absorptiometry, and the non-osteoporotic group (control group) comprised 30 subjects with no evidence of osteoporosis. Panoramic radiography was performed, followed by the acquisition of two direct digital intraoral periapical radiographs from the mandibular premolar-molar region.
Results: Chi-square test revealed a statistically significant difference (p = 0.001) in the mandibular cortical shape index between the two groups. However, a statistically non-significant difference in cortical width, the panoramic mandibular index, mandibular alveolar bone resorption degree, fractal dimension, and mean number of teeth was found between the two groups. A statistically significant difference was observed in the mean age between the osteoporotic and non-osteoporotic groups.

Conclusion: The mandibular cortical index findings (MCI) on panoramic radiograph are effective indicators of osseous changes in postmenopausal osteoporosis, thereby determining early prediction of osteoporotic fracture risk and reducing its related morbidity.

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Dental Light-Curing Units: An American Dental Association Clinical Evaluators Panel Survey

. 2020 May 28;S0002-8177(20)30161-6.

doi: 10.1016/j.adaj.2020.03.001. Online ahead of print.


Background: The ability to polymerize light-activated dental materials with dental light-curing units (DLCUs) has revolutionized dentistry. However, proper DLCU use is essential for ensuring the effectiveness and performance of these materials.

Methods: The authors developed an electronic cross-sectional survey in the American Dental Association Qualtrics Research Core platform. The survey included questions about DLCU use, unit type and selection, training, maintenance, technique, and safety measures. The authors deployed the survey to 809 American Dental Association Clinical Evaluators (ACE) panelists on October 9, 2019, and sent reminder links to nonrespondents 1 week later. They conducted exploratory and descriptive analyses using SAS software Version 9.4.

Results: Of the 353 ACE panelists who completed the survey, most used a DLCU in their practices (99%), and light-emitting diode multiwave units were the most common type of DLCU units (55%). Dentists use DLCUs for over one-half of their appointments each day (mean [standard deviation], 59% [22%]). Regarding technique, respondents reported that they modify their curing technique on the basis of material thickness (79%) and material type or light tip-to-target distances (59%). Maintenance practices varied, with two-thirds of respondents reporting that they periodically check their DLCUs’ light output.

Conclusions: DLCUs are an integral part of a general dentist’s daily practice, but maintenance, ocular safety, and technique varied widely among this sample.

Practical implications: Because clinical effectiveness requires delivery of an adequate amount of light energy at the appropriate wavelength, variation in DLCU maintenance, safety, and techniques suggest that dentists could benefit from additional guidance and training on DLCU operation.

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