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Porphyromonas gingivalis Type 9 Secretion System Promotes Dysregulation of Vascular Smooth Muscle Cell Plasticity With Perturbed TGF-β/Smad Signaling
No full textThe Porphyromonas gingivalis type 9 secretion system (T9SS) is known for secreting and anchoring protein cargos to the outer surface of the bacterium, which are then selectively packaged into outer membrane vesicles. We previously identified a link between P. gingivalis-mediated dysregulated aortic smooth muscle cell (AoSMC) plasticity with binding of T9SS outer protein, PorU and select T9SS cargos to AoSMC proteins. To assess the role of T9SS in dysregulated AoSMC plasticity, a PorU-deficient mutant was constructed in P. gingivalis strain A7UF. AoSMC was inoculated with sterile vehicle, wild-type A7UF, or A7UFΔPorU and evaluated for proliferation, migration, and changes in the TGF-β/Smad2/3 signaling axis. Deletion of PorU disrupted T9SS function in P. gingivalis A7UF. Loss of T9SS function impaired P. gingivalis invasion and persistence in AoSMC as well as attenuated microbial-induced effects on AoSMC plasticity. Specifically, direct T9SS/AoSMC interactions were necessary for P. gingivalis-induced AoSMC proliferation. Clarified supernatant from A7UF impaired the migration of infected AoSMC. P. gingivalis T9SS function was perturbed AoSMC TGF-β/Smad3 signaling. Specifically, A7UF-inoculated cells had increased linker and carboxy-terminal phosphorylation of Smad3 that was attenuated in AoSMC inoculated with A7UFΔPorU. In summary, PorU and/or T9SS cargo play a role in P. gingivalis-induced dysregulation of AoSMC plasticity as well as TGF-β/Smad signaling. Microbial manipulation of host cell signaling events is important for cell differentiation and tissue remodeling and would constitute a new virulence function for T9SS
Statistics as a Tool in the Physician\u27s Black Bag
No full textThe era of evidence-based practice began in the 1990s with the hope patient outcomes would be improved by eliminating clinical bias and clinically unsound practices. Clinical guidelines which had been previously written by panels of experts were slowly replaced by careful analysis of existing clinical studies and more rigorous designs of new clinical studies based on sound scientific and statistical principles. This still leaves the practitioner with the responsibility of understanding what the evidence is showing them. This article reviews the statistical thinking that underlies the evidence-based literature. We will review some evolutionary changes to statistical analysis being advocated by statisticians and discuss some nuances related to the use of statistics describing diagnosis and treatment in clinical settings
Skeletal versus conventional anchorage in dentofacial orthopedics: an international modified Delphi consensus study
No full textBackground: To establish consensus of skeletal anchorage versus conventional anchorage in treating: 1. Maxillary transverse deficiency in growing and adult patients, 2. Class II skeletal disharmony due to mandibular retrusion in growing patients, 3. Class III skeletal disharmony in growing patients. Methods: A four-rounds modified Delphi method was conducted. A steering committee performed a literature selection and compiled a list of 33 statements. An international panel of 25 experts in orthodontics agreed to participate. In each round, panelists were asked to rate their level of agreement with each statement using a 5-point Likert scale and provide comments. Statements that reached consensus were either accepted or rephrased. Statements that did not reach consensus were either rephrased, rejected, or split into two statements or merged with another. Results: After the four rounds, 24 statements achieved consensus while 9 were rejected. The distribution of consensus statements was as follows: Maxillary transverse deficiency: 4 statements; Class II skeletal disharmony: 10 statements; Class III skeletal disharmony: 10 statements. Conclusions: This modified Delphi consensus study aimed to provide guidance for orthodontists in choosing between skeletal and conventional anchorage for various treatment conditions. The study generated 24 consensus statements across three key domains. While the Delphi method provides valuable expert opinions, future studies, including randomized controlled trials, are needed to confirm these findings and address remaining uncertainties. Such efforts will aid in refining orthodontic treatment protocols and enhancing patient outcomes
A bright future for the American Journal of Orthodontics and Dentofacial Orthopedics and the American Journal of Orthodontics and Dentofacial Orthopedics Clinical Companion
No full textEffects of the COVID-19 pandemic on the practice of osteopathic manipulative medicine: A survey study
No full textBackground: Because the practice of osteopathic manipulative medicine (OMM) put practitioners at risk of contracting COVID-19, they had to adjust treatment practices for active COVID-19 cases and local restrictions or regulations. Objective: To assess practitioner environment when treating COVID-19 patients with OMM and the general impact of the pandemic on the practice of OMM. Methods: In October 2020 and March 2022, we distributed surveys to DO-Touch.NET members. Both surveys included 11 questions about treating patients with active COVID-19 and practice changes caused by the pandemic. The second survey also included 4 questions about treating long COVID and 1 question about practice changes in the previous 6 months. Results: Of 206 responses, 40 reported local restrictions or regulations prevented use of OMM for patients with active COVID-19, but 57 performed OMM on these patients, mostly through outpatient services. Main reasons for not treating COVID-19 patients were lack of opportunity, local protocol restrictions, and personal health concerns. Of 71 responses for the second survey, 48 treated patients with long COVID, primarily in the outpatient setting. The main reason for not treating these patients was lack of opportunity. The most frequently reported practice changes included adoption of universal COVID precautions and screening for COVID. Conclusion: Study results suggested the COVID-19 pandemic had an immediate, worldwide impact on the practice of OMM by reducing available services to patients with active COVID-19. Although the effectiveness of OMM for treating COVID-19 or long COVID remains unknown, these results may be useful to prepare for future pandemics
Neuromuscular Response to High-Velocity, Low-Amplitude Spinal Manipulation—An Overview
No full textThe clinical use of spinal manipulation to treat musculoskeletal conditions has nearly tripled in the United States since 1980, and it is currently recommended by most global clinical guidelines as a conservative treatment for musculoskeletal pain, despite a lack of knowledge concerning its mechanisms of action. This overview highlights evidence of direct neuromuscular responses to high-velocity, low-amplitude spinal manipulation (HVLA-SM) as delivered by chiropractic, osteopathic, and physical therapy clinicians, with an intent to foster greater interprofessional dialogue and collaborative research to better address current gaps in mechanistic knowledge of the neuromuscular response to HVLA-SM. Three databases (PubMed, CINAHL Ultimate (EBSCO), EMBASE (Elsevier)) were searched from 2000 to December 2024 with specific search terms related to thrust HVLA-SM and the neuromuscular response. To focus strictly on neuromuscular responses related to HVLA-SM, this literature overview excluded articles using non-HVLA-SM manual therapy techniques (i.e., massage, non-thrust joint mobilization, and/or combined HVLA-SM with other forms of treatment such as exercise or non-thrust joint mobilization) and studies in which patient-centered outcomes (i.e., pain scores) were the primary outcomes of the HVLA-SM interventions. Pediatric studies, animal studies, and studies in languages other than English were also excluded. One-hundred and thirty six articles were identified and included in this overview. Neuromuscular findings related to HVLA-SM in the areas of electromyography (EMG), muscle thickness, muscle strength, reflexes, electroencephalogram (EEG), and evoked potential were often mixed; however, evidence is beginning to accumulate either in favor of or opposed to particular neuromuscular responses to HVLA-SM as larger and more scientifically rigorous studies are being performed. Recurrent limitations of many HVLA-SM-related studies are small sample sizes, leading to a lack of generalizability, and the non-standardization of HVLA-SM delivery, which has prevented researchers from arriving at definitive conclusions regarding neuromuscular responses to HVLA-SM. Discussions of future neuromuscular research needs related to HVLA-SM are included for clinicians and researchers inside and outside of the field of manual therapy, to advance this field
World Federation of Orthodontists social media guidelines: Ensuring accuracy, reliability, and objectivity in online orthodontic information
No full textBackground: The World Federation of Orthodontists (WFO) recognizes the growing impact of online media in shaping public understanding of orthodontics. In response to the proliferation of misinformation and disinformation, particularly on digital platforms, the WFO has developed comprehensive guidelines aimed at ensuring accuracy, objectivity, and ethical standards in online orthodontic content. These guidelines serve to inform WFO fellows and affiliates involved in creating or managing web-based orthodontic resources. Methods: A detailed policy framework was established by the WFO to address key elements of digital communication. These include content definition, site ownership and access, payment structures, privacy protocols, sponsorship disclosures, funding transparency, and ethical advertising practices. Special emphasis was placed on promoting source verification, critical appraisal of content, and user engagement strategies to combat misinformation. The policy was developed through expert consensus and informed by best practices in health communication and evidence-based dentistry. Results: The guidelines provide a structured approach to enhancing the credibility and reliability of online orthodontic information. By delineating clear standards for ethical content creation and dissemination, the WFO aims to safeguard public trust and support informed decision-making. The policy addresses modern challenges posed by social media and other user-driven platforms, offering practical strategies for orthodontists to promote evidence-based information and patient education. A commitment to regular review ensures the framework remains adaptive to the evolving digital environment. Conclusions: The WFO online content guidelines establish a robust foundation for ethical, accurate, and transparent communication in orthodontics. By adhering to these principles, WFO members and affiliates can actively contribute to reducing misinformation, enhancing patient understanding, and upholding the integrity of the profession. Ongoing updates will ensure alignment with technological advancements and emerging communication trends
Treatment effects of modified miniscrew-assisted rapid palatal expander and rapid palatal expander for molar distalization
No full textObjectives: To evaluate the treatment effects of the modified miniscrew-assisted rapid palatal expander (MARPE) and rapid palatal expander (RPE) with distalizers in patients with Class II malocclusion and maxillary crowding. Materials and Methods: The sample comprised 28 skeletal Class I adolescents with dental Class II malocclusion and maxillary crowding of .4 mm who received nonextraction treatment. Fourteen patients were treated with a modified MARPE with distalizer (MMD), while another 14 patients were treated with a modified RPE with distalizer (MRD). Lateral cephalograms and study casts were taken at pretreatment (T1) and after expansion, distalization, and at the initiation of alignment (T2). Twentynine variables were compared using a Bonferroni-adjusted independent t-test and a Mann-Whitney U-test. Results: From T1 to T2, the maxillary first molars in the MMD group exhibited distalization of 3.0 mm and 2.4 mm at the crown and root (P \u3c .001) compared with 2.1 mm and 1.4 mm in the MRD group. However, no significant difference was found in distalization between the two groups. The first molars in the MRD group showed a significantly greater distal tipping of 2.8° than in the MMD group (P \u3c.001). Conclusions: Although both groups showed maxillary molar distalization, the MMD group had no distal molar tipping, while there was significant molar tipping in the MRD group. It can be useful to plan nonextraction treatment with maxillary expansion and molar distalization in patients with Class II malocclusion and a narrow maxillary arch
Impact of orthodontic forced eruption timing on root development of impacted maxillary canines: a linear and volumetric analysis using cone-beam computed tomography images
No full textObjectives: To evaluate root development after forced eruption of impacted maxillary canines before or after complete root development of the contralateral canine. Materials and Methods: A total of 50 patients (21 male, 29 female; mean age: 12.4 years) with unilateral impaction of maxillary canines were classified to “Immature group” with incomplete root development of the contralateral canine or “Mature group” with complete root development of the contralateral canine. Volume, total length, crown length, root length, and root/crown ratio (R/C) of the impacted canine and the contralateral canine were measured in the posttreatment cone-beam computed tomography images. Results: In the immature group, total length and root length of impacted canines were 0.68 mm and 0.51 mm shorter than contralateral canines, respectively (P \u3c.05). In the mature group, volume, total length, root length, and R/C of impacted canines were 37.90 mm32.43 mm, 2.53 mm, and 0.26 smaller, respectively, than contralateral canines (P \u3c.001). Crown length also showed a statistically significant difference between impacted canines and contralateral canines (P \u3c.05). When differences between impacted canines and contralateral canines were compared between the immature and mature groups, all variables showed statistically significant differences, with the mean difference in total length and root length being 1.75 mm and 2.02 mm larger, respectively, in the mature group, (P \u3c.001). Conclusions: Regardless of treatment timing, total length and root length of impacted canines were shorter than those of contralateral canines. Forced eruption of the impacted canine undertaken before root development of the contralateral canine showed better root development in both linear and volumetric measurements
Long-Term Assessment (5- to 19-Year Follow-up) of the Incisal-Level Changes in Single Implants Placed in the Anterior Maxilla: An Observational Clinical Study
No full textPurpose: To evaluate the occurrence, incidence rate, and esthetic impact of facial growth in adult patients who need a single implant rehabilitation in the central incisor area to assess the influence of time on changes in the incisal level. Materials and Methods: Patients were included if they received a single implant in the maxillary central incisor site, were at least 19 years old at the time of placement, and had natural adjacent teeth. Standardized images were obtained to evaluate the presence and incidence of incisal linear changes. All rehabilitations followed the same standard of reconstruction, while always keeping the mimetics of the homologous and adjacent tooth the same to provide the same incisal level and achieve the best esthetics for all patients. Thus, at implant placement (T0), the incisal-level difference between the crown and the adjacent tooth was zero. Any modifications in the incisal levels from 1.0 mm of difference were registered. This measurement of 1.0 mm was the cutoff mark because it permits easy observation of a difference, either by the dental professional or the patient. The data obtained were analyzed and correlated statistically. Results: A total of 56 patients and 56 implants were included (age range: 23–63 years; average age: 40.79 ± 12.25 years) in this study. Incisal-level alterations between the tooth and implant were found and had an incidence rate of 19.6%. The study had an average follow-up of 10.7 ± 3.37 years. All implants evaluated had stability and healthy peri-implant tissue conditions throughout the follow-up period, with a 100% survival rate. There was no statistically significant prevalence of incisal-level changes between males (19%) and females (20%) (P =.238); the incidence rate was 41.7% for patients between 20 and 30 years old, 13.3% for patients between 31 and 40 years old, 23.7% for patients between 41 and 50 years old, and 6.3% in the group over 50 years old; note that there were no statistically significant differences (P =.118) among different age groups. Similarly, no statistically significant difference was observed (P =.262) comparing the number of clinical cases in each subgroup with and without change in the incisal level. Conclusions: Changes in the incisal level of maxillary anterior crowns retained by single implants in adult patients were present in 19.6% of the cases evaluated. This prevalence was not influenced by sex or age group; however, it was observed more often in dental implant cases with longer follow-ups