In the United States, 1 in 5 Americans develop keratinocyte carcinoma (KC) by age 70, placing the disease among the five most expensive cancers based on Medicare expenditure. Current preventative measures have failed to stem rising KC rates, highlighting the need for alternative strategies. Evolving evidence indicates that lasers conventionally used to treat photoaging, may provide protective effects against the development of KC and precursor lesion, actinic keratosis (AK). This review first delves into existing evidence on fractional infrared laser-based KC and AK prevention. Next, the work discusses potential underlying mechanisms that might explain fractional infrared lasers' prophylactic effects. A comprehensive literature search of PubMed and Web of Science databases was conducted from inception to April 2024 using preselected search terms. Interventional human and animal studies, epidemiological analyses, and case reports on fractional infrared laser-based prevention of KC or AK were screened according to predefined inclusion/exclusion criteria. Included evidence demonstrates that ablative fractional lasers reduce and delay development of AK/KC, shown in two controlled trials of photodamaged patients and two murine studies (i.e. Er: YSGG and CO2 lasers). Weaker evidence of KC prevention by nonablative infrared lasers is provided by a retrospective cohort study. In the laser literature, three mechanisms are proposed to drive these prophylactic effects, including the ability of infrared lasers to (i) remove DNA-damaged epidermal cells, (ii) activate the insulin-like growth factor-1 pathway by reducing fibroblast senescence, and (iii) initiate immunomodulating effects. Based on current evidence, infrared fractional lasers show promise particularly for secondary KC prevention in photodamaged populations. • Current prophylactic efforts have failed to stem rising rates of skin cancer, highlighting the need for alternative prevention strategies.• Ablative and nonablative fractional infrared lasers have the potential to reduce and delay development of skin cancer and precursor lesions.• Multiple mechanisms are proposed to drive these prophylactic effects, including removal of DNA-damaged epidermal cells, activation of the insulin-like growth factor-1 pathway, and immunomodulation.
Artificial daylight photodynamic therapy with methyl aminolevulinate is an effective and almost painless treatment approach for actinic keratoses. The objective of the prospective, non-interventional, multicentre study ArtLight (NCT05725213) was to gain comprehensive insights into the cosmetic effect of methyl aminolevulinate-artificial daylight photodynamic therapy in patients with actinic keratoses using different artificial daylight systems under real-world conditions. The study enrolled patients with Olsen grade 1 or 2 actinic keratoses on the face and scalp in Germany. Patients were treated with methyl aminolevulinate-artificial daylight photodynamic therapy. The cosmetic effect was assessed via photodamage parameters (global score for photoaging, mottled pigmentation, tactile roughness, telangiectasias, fine lines). Each photodamage variable was recorded on a 5-point scale (0-4). In total, 224 patients (median age: 75.0 years [range 50-91], 85.3% male, 62.5% Olsen grade 2, 55.4% treatment-naive) were treated with methyl aminolevulinate-artificial daylight photodynamic therapy. At month 3, all 5 parameters of photoaging were significantly reduced from baseline (p < 0.001). The majority of patients (81.3%) and investigators (83.6%) rated the cosmetic result as good or very good. Beyond effective eradication of actinic keratoses, field-directed methyl aminolevulinate-artificial daylight photodynamic therapy can improve photoaging symptoms, including tactile roughness, mottled pigmentation, telangiectasis, and fine lines. Thus methyl aminolevulinate-artificial daylight photodynamic therapy provides additional benefits, particularly for patients concerned with cosmetic outcomes during or after treatment.
Infrared fractional lasers that target tissue water are traditionally divided into nonablative and ablative devices. The 1927 nm fractional thulium fiber laser (FTL) may, due to an intermediate water absorption coefficient, offer a range of nonablative-to-ablative effects. This study explored dynamic 1927 nm FTL-tissue interactions produced by different pulse energies in in vivo human skin, using non-invasive optical coherence tomography (OCT) and line-field confocal OCT (LC-OCT) imaging. FTL exposure was performed on in vivo antero-lateral forearm skin at 0, 3, 15, or 20 mJ pulse energy using two separate laser tips (spot size: 200 μm (C1); 350 μm (C5)) at 20-watt power. Immediately after, LC-OCT and OCT imaging enabled qualitative description of microthermal treatment zone (MTZ) morphology, as well as semiquantitative measurement of MTZ diameter and ablation depth. Ranging from nonablative subepidermal effects to frank ablation, imaging revealed a variety of MTZ morphologies depending on pulse energy and laser tip. At low 3 mJ pulse energy, effects were generally limited to the epidermis, with MTZs consisting of subepidermal clefts (C5) or disruptions through the viable epidermis (C1) under a residual stratum corneum. Rising 15-20 mJ pulse energies expanded thermal effects in the lateral and vertical plane, leading to wider MTZs (e.g., C1: 3 mJ vs. 20 mJ: 213 vs. 357 μm), more extensive stratum corneum involvement, and increasing ablation depth to the superficial dermis (e.g., C1: 3 mJ vs. 20 mJ: 93 vs. 101 μm). Visualized by combined LC-OCT and OCT imaging, FTL-tissue interactions are highly modifiable and span the nonablative to ablative spectrum depending on pulse energy and laser tip.
The outcome in the treatment of furcation defects is often unsatisfactory. The reasons are morphologic and pathologic peculiarities as well as extensive changes in shape caused by resective treatment of periodontal lesions in multi-rooted teeth. Therefore, augmentative strategies are suggested to improve the prognosis. However, the success rate decreases with increasing severity of the disease. In contrast, if the affected roots are not extracted but are extruded after hemi- or trisection, this leads to a coronal displacement of the disease process and a significantly improved situation for hygiene. At the same time, the resection of inflammatory tissue of the periodontal pockets is accompanied by vertical and horizontal bone apposition. The results are predictable and stable in the long term. The burden for the patient is low. ((Quintessence Int 2022;53: 884-891; Originally published (in German) in Quintessenz Zahnmedizin 2020; 71(9): 1024-1032; doi: 10.3290/j.qi.b3418205).
Searches were made for relevant data using Medline and the International Poster Journal of Dentistry and Oral Medicine online database (see ipj.quintessenz.de). Meta-analyses, randomised controlled trials (RCT), clinical trials and other experimental designs were considered. Because of heterogeneity of study designs and drugs used, a qualitative synthesis was conducted. Seventeen publications were identified of which 15 were included. Of these, six were RCT, four were clinical trials/ controlled clinical trials, and five were other types experimental studies. The studies in total involved 1224 patients. The rate of those lost to followup reached 30% in some studies. The drugs used to treat oral submucous fibrosis (OSF) were categorised into steroids, enzymes, cardiovascular drugs, antioxidants, vitamins and microelements. There are few high-quality studies available and the present drug treatments are in general empirical and treat only symptoms. There is a need for high-quality RCT in this area, especially studies involving combined and sequential therapy.
Many treatment options accepted for unsalvageable traumatized teeth in adults would seem contraindicated in children and adolescents. Instead, growing patients need interim restorative measures, thus extensively preserving their local bone and soft tissue structures and, ideally, preparing the involved site for later definitive restoration while they transform to skeletal maturity. This narrative topic review addresses the interim management in case of very deep intra-extra-alveolar fractures, extensive infection-related root resorption, tooth ankylosis, and anterior tooth loss in growing patients, and seeks to empower the clinician to select the appropriate treatment approach. The literature up to 2021 was reviewed based on several scoping searches on PubMed and the Cochrane Library using relevant terms. Due to the complexity of the topic (with various poor prognosis scenarios and the differing therapeutic options), a systematic review was deemed inappropriate. Suitable interim treatment options include extrusion of teeth showing deep intra-extra-alveolar fractures, and decoronation of ankylosed teeth as well as resin-bonded fixed dental prostheses, natural tooth pontics, and primary tooth autotransplantations after tooth loss. The interim management options described in this article represent compromises chosen in the absence of better alternatives after a careful risk-benefit analysis. However, if adequately performed, the presented treatment options have the potential to achieve the temporary restoration of function and esthetics in growing patients. Close clinical and (if appropriate) radiologic monitoring of these patients is considered mandatory to ensure early detection of possible complications that might jeopardize or could render impossible subsequent therapeutic measures. (Quintessence Int 2022;53:722-731; doi: 10.3290/j.qi.b3236409; Modified from a previously published article (in German) Quintessenz 2022;73(2):162-169).
The following article deals with various considerations concerning the frequently observed occurrence of dental erosion in athletes. It summarizes the basics of erosive tooth wear development as well as special etiologic factors for groups of athletes with increased prevalence of dental erosion and concludes with preventive advice. (Originally published (in German) in Quintessenz Zahnmed 2021;72:1008-1017).
The aim of this systematic review was to provide comprehensive access to and an analysis of the specialist literature published through December 2005 describing a correlation between orthopedic (leg-length inequality, pelvis obliquity, column diseases and head posture) and dental findings (occlusion, mandibular position, temporomandibular joints, masticatory muscles). Four medical and dental internet sources (PubMed; Medpilot.de; databases of the Deutsche Arzte-Verlag and Quintessenz-Verlag) were screened for relevant articles using carefully selected retrieval strategies and keywords. Bibliographies of relevant articles were examined for further pertinent publications. All relevant articles were tabulated according to their year of publication, the subject area discussed, and the levels of scientific evidence. Our electronic inquiry yielded 359 relevant articles (electronic search: 195, search in bibliographies: 164), 355 of which could be analyzed. A correlation between dental findings and spinal column diseases was described in 266 articles, head posture in 216, pelvis obliquity in 53, and leg-length inequality in 35 papers. In 131 publications, conclusions were drawn from dental to orthopedic findings, whereas they were drawn from orthopedic to dental findings in 171 articles. The number of relevant articles rose significantly, particularly since the 1980's. Classification in levels of evidence reveals three publications (0.8%) with level II (randomized controlled trials), 63 (17.7%) with level III (experimental studies with no randomization, cohort studies, or case-control studies), 178 (50.1%) with level IV (non-experimental studies, such as cross-sectional trials, case series, case reports), and 111 (31.3%) with level V (narrative review or expert opinion without explicit critical appraisal). 1) While there is great interest in possible correlations between orthopedic and dental findings in the specialist literature, most publications fail to provide the hard facts and solid evidence characteristic of high-quality research. 2) This literature analysis attests to the importance of searching electronic databases while making the inherent weaknesses of such searches obvious. Manual literature searches remain essential.
When dental trauma occurs, initial management on the day of injury has a determining influence on healing and thus on the prognosis of the affected teeth. Improper, delayed, and/or inconsistent treatment often has far-reaching consequences that cannot be reversed later, even with great effort, especially in children and adolescents. In most cases, it is unrealistic or impossible for the patient to get to a specialized dental trauma facility in time. Therefore, it is every dental practitioner's duty to provide adequate initial diagnosis and treatment of dental trauma at their dental practice, even if they do not have routine experience in this area. This article serves as a guide to the initial management of dental trauma. It utilizes a three-tiered approach to illustrate which initial management measures are absolutely essential (MUSTS), which should ideally be performed (SHOULDS), and which are not top priorities but can be performed (CANS) if the necessary time, training and experience, and equipment and facilities are available. For further treatment, dental practitioners should realistically assess the limits of their ability to treat complex dental trauma cases and, if necessary, they should refer the patient to a specialist or specialized treatment center. (Quintessence Int 2020;51:763-774; doi: 10.3290/j.qi.a45103; modified from a previously published article (in German) Quintessenz 2019;70(9):990-1002).
Data sourcesMedline via Pubmed and the Cochrane Library were searched from January 1980 to September 2013. This was complemented by a manual search of the magazines Deutsche Zahnaerztliche Zeitung, Quintessenz, Zeitschrift für Zahnärztliche Implantologie, Schweizerische Monatszeitschrift and Implantologie. Additionally, the list of reference s of all selected full-text articles and related reviews were further scrutinised for potential included studies in English or German.Study selectionThree review authors independently searched for clinical trials that assessed the muscular activity in the intervention groups: edentulous patients treated with implant-overdentures (IODs) and implant-supported fixed dental prostheses (ISFDPs) and the comparison groups: dentates and edentulous patients treated with mucosa-borne complete removable dental prostheses (CRDPs).Data extraction and synthesisThe primary outcome was the muscular activity (measured by electromyography [EMG]) in masseter or temporalis muscle of the participants during clenching and chewing. The data extraction of each included study consisted of author, year, age range, treatment, number of participants, number of implants inserted, arch treated, opposite jaw, kind and side of the muscles that were measured. EMG gain or loss (unit measured: volt) was considered by using the effect size. For the meta-analyses only the studies that included masseter muscle measured separately from temporalis were considered. Concerning the side of measurement (right and left side measured together or right and left side measured separately), only the dominant type in each category was included.ResultsSixteen articles, out of the initial 646 retrieved abstracts, were analysed. The muscular activity of edentulous subjects increased after implant support therapy during clenching (effect size [ES]: 2.18 [95% confidence interval [CI]: 1.14, 3.23]) and during chewing (ES: 1.45 [95 % CI: 1.21, 1.69]). In addition, the pooled EMG data of IODs and ISFDPs were lower than that of dentate subjects during clenching (ES: -1.01 [95% CI: -1.37, -0.65]). However, the ISFDPs showed higher values than dentates during chewing. Among the edentulous patients the IODs and ISFDPs displayed higher pooled values during clenching (ES: 1.12 [95% CI: 0.7, 1.55]) and chewing (ES: 1.33 [95% CI: -0.57, 2.10]). Furthermore, the muscular activity during chewing correlated with the hardness of the food.ConclusionsEdentulous patients with CRDPs can achieve a greater degree of muscular activity after rehabilitation with implant-supported/retained prostheses during clenching and chewing. During clenching, patients with ISFDPs achieved higher EMG-values than those with dentates. The harder the food, the more muscular activity involved.
Digital photography has already established its irrefutable importance in today's world. It is becoming an indispensable tool in various fields. In dentistry specifically, photography can be employed in several ways that can be beneficial to the patient and the dental community. It allows a simple and clear depiction of an otherwise abstract concept, but high-quality pictures are always required. The evolution of mobile cameras has made an enormous impact on digital photography and its accessibility: high-quality pictures can now be easily taken. This article explains the assets of smartphone cameras' evolution and how it led to the conception of Smile Lite Mobile Dental Photography. Applications of dental photography are presented, such as documentation and communication with the laboratory technician and the patient. Mobile dental photography is not confined to dentistry but can also be used for artistic purposes. (Quintessence Int 2020;51:510-518; doi: 10.3290/j.qi.a44365; Originally published (in German) in Quintessenz Zahnmedizin 2019(12);70:1408-1417).
Free mucous membrane grafts and connective soft tissue grafts have been considered the gold standard in oral soft tissue regeneration for a long period of time. Due to the morbidity while harvesting autogenous soft tissue grafts, xenogeneic collagen matrices of porcine origin were recently developed. Next to soft tissue regeneration, these collagen matrices have also been reported to be suitable for bone regeneration in the context of bone graft stabilization and shielding techniques. Collagen matrices are classed as medical devices, and are produced in a complex treatment and cleaning process. With respect to the individual area of indication, collagen matrices are produced from porcine dermis, pericardium, or peritoneum. The advantages and limitations of collagen matrices in comparison to autogenous soft tissue grafts in the different indication areas are controversially discussed. There might be evidence that these collagen matrices are able to reach similar outcomes to autogenous soft tissue grafts in certain indications. Currently, a final assessment of this relevant question is not possible cause of a lack of evidence-based data. Originally published (in German) in Quintessenz Zahnmedizin 2019;70:64-76).
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The low incidence of coronary heart disease among Eskimos is related to their diet rich in marine fatty acids, which contain large amounts of polyunsaturated omega-3 fatty acids, mainly eicosapentaenoic and docosahexaenoic acids. The beneficial effects on atherosclerotic vascular disease result from favorable influence on prostaglandin/thromboxane metabolism. Clinical studies have also reported antiinflammatory effects.
The A3 Imperative (Anything, Anywhere, Anytime) that has left its mark on our information and knowledge society also characterizes the healthcare sector: we see "informed patients" who always consult the Web prior to their visit to the physician or dentist. The problem is that the knowledge concerning their suspected disease is often superficial. It is the task of the treatment provider to make factual information available and to discuss diagnostic aspects and therapeutic concepts with the patient, competently and based on the merits of the individual case. Dentistry is particularly affected by the online information trend, because the available restorative options cover a broad therapeutic spectrum with many conceivable alternatives that present a highly complex picture. Against this background, a dedicated three-dimensional multimedia software program was developed that visualizes all relevant individual dental treatment options in 3D as appropriate to the patient's oral status, actively supporting chairside communication. A 2D and 3D database containing more than 20,000 image and video files was created that visualizes--in several languages--the status of the individual patient and the planned restorative treatment. With this far-ranging concept, the process of patient-shared or participatory decision-making has been raised to new qualitative levels.