Publications by authors named "Daniele Manfredini"

144 Publications

Histopathology of the temporomandibular joint disc: Findings in 30 samples from joints with degenerative disease.

J Oral Rehabil 2021 Jun 29. Epub 2021 Jun 29.

School of Dentistry, University of Siena, Siena, Italy.

Aim: The aim of this study is to show the anatomical and histological features of the displaced temporomandibular joint (TMJ) disc in joints with degenerative disease.

Methods: This study was performed on a total of 30 TMJ discs extracted from 22 patients, who underwent surgical discectomy after failure of conservative non-surgical treatment regimens to control pain and/or limited range of motion. All joints had imaging signs of an anteriorized disc position and degenerative joint disease. Samples of the extracted discs were stored in formalin, cut into 3 micron-thick sections imbedded in paraffin and processed with hematoxylin-eosin.

Result: All the samples present irreversible morphologic and histological alterations. The macroscopical evaluation showed that 14 discs were worn and fragmented in several parts, and one disc was perforated. Morphological alterations with deformation and degenerative signs were shown in all discs, which were all severely worn and compromised. Histologically, various alterations were found, such as pre-fibrous sclerosis with myxoid degeneration and collagen deposits (N = 25), an increase in fibro-hyaline and fibrous tissues, with loss of elasticity (N = 25), scattered calcifications (N = 15), and synovial inflammation with microvascular proliferation and increased cellularity, presence of lymphocytes, histiocytes and plasma cells (N = 18). After the intervention, all patients reported decreased pain levels and showed improved function at 6 months.

Conclusion: These observations suggest that degenerative joint disease is accompanied by a anteriorized discs featuring abnormal macroscopical and histological changes. From a clinical viewpoint, this may suggest that, when treatment escalation leads to consider TMJ surgery, total discectomy is the most reasonable approach.
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http://dx.doi.org/10.1111/joor.13218DOI Listing
June 2021

Computer-assisted surgery with custom prostheses and human amniotic membrane in a patient with bilateral class IV TMJ reankylosis: a case report.

Cell Tissue Bank 2021 Jun 27. Epub 2021 Jun 27.

Unit of Oral and Maxillofacial surgery, Ca Foncello Hospital, 31100, Treviso, Italy.

A gold-standard technique has yet to be found for the treatment of temporomandibular joint ankylosis (TMJa), particularly in patients with recurring ankylosis. A 58-year-old male patient, with a history of multiple TMJ surgeries and severe limitation of mouth opening (maximum interincisal distance [MID] was 10 mm). Computerised tomography (CT) imaging highlighted a bilateral type IV ankylosis. The surgical guides were manufactured using a 3D printing method after obtaining a proper design of the osteotomy lines. The positioning of the fossa and condyle components of the custom TMJ prosthesis was digitally performed. Osteotomies were carried out using surgical guides and TMJ prostheses were placed as per the virtual planning. A human amniotic mambrana is inserted between the two prosthetic components to avoid ranchylosis. The post-operative CT showed the correct positioning of the condylar prosthesis. MID after 10 days was 37 mm. Total joint reconstruction surgery using 3D virtual surgical planning may be an effective surgical option for achieving a precise surgical outcome and making use of a single-stage approach in cases of TMJa and the use of the amniotic membrane, thanks to its healing properties and reduction of pain perception, seems to improve the quality of the immediate post-operative period.
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http://dx.doi.org/10.1007/s10561-021-09940-wDOI Listing
June 2021

Temporomandibular Joint Arthrocentesis in Patients with Degenerative Joint Disease: A 10- to 22-year Follow-up.

J Oral Facial Pain Headache 2021 Spring;35(2):113-118

Aims: To report the effectiveness of temporomandibular joint (TMJ) arthrocentesis with viscosupplementation for degenerative joint disease (DJD) over a long-term (ie, 10-22 years) follow-up.

Methods: A total of 103 patients aged between 30 and 91 years (13 men and 90 women; mean age 63.7 years) who received a cycle of five arthrocentesis sessions with HA viscosupplementation to manage their symptoms related to TMJ DJD during the time period from 1998 to 2010 were recalled for clinical evaluation. After the treatment cycle, clinical outcomes were assessed based on the following parameters: maximum mouth opening (MO), pain with function (PF), pain at rest (PR), and self-reported chewing efficiency (CE). Data were collected at baseline (T) and at successive follow-up assessments, after at least 3 months (T) and 1 year (T), as per previous publications. Patients who had received treatment at least 10 years prior were then recalled for this study (T: 10 to 22 years follow-up). Analysis of variance for repeated measures was performed to assess changes over time.

Results: Significant improvement in all clinical parameters was achieved at T and was maintained for up to 10 years (T), with P < .01 for each parameter. At T, treatment effectiveness was perceived as excellent by 56% and as good by 26.5% of subjects, while 10.7% perceived a moderate improvement, and 6.8% referred a slight improvement or did not have any improvement. Only seven individuals required additional treatments after T.

Conclusion: These findings suggest that the symptomatic management of TMJ DJD achieved in the short or medium term with a cycle of arthrocentesis and viscosupplementation was effectively maintained in the long term.
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http://dx.doi.org/10.11607/ofph.2871DOI Listing
June 2021

Sleep bruxism and temporomandibular disorders: A scoping review of the literature.

J Dent 2021 Jun 6;111:103711. Epub 2021 Jun 6.

Professor and Chair, Department of Orofacial pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.

Objective: To provide a scoping review of the literature by assessing all the English-language papers that investigated the relationship between sleep bruxism (SB) and temporomandibular disorders (TMDs).

Study Data And Sources: A search was performed in the National Library of Medicine (PubMed) and Scopus databases, in order to identify all the articles published assessing the relationship between SB and TMDs, by several different approaches. The selected articles were then structurally read and summarized in PICO tables. The articles were selected independently by the two authors.

Study Selection: Out of 185 references that were initially retrieved, 47 articles met the inclusion criteria and were thus included in the review. The studies were divided into four categories based on the type of SB assessment: 1. questionnaire/self-report (n = 26), 2. clinical examination (n = 7), 3. electromyography (EMG) (n = 5), and 4. polysomnography (PSG) (n = 9).

Conclusions: Studies based on questionnaire/self-report SB featured a low specificity for SB assessment, and in general they found a positive association with TMD pain. On the contrary, instrumental studies (i.e., electromyography, polysomnography) found a lower level of association or even a negative relationship between SB and TMD pain. Findings from this updated review confirmed the conclusions of a previous review by Manfredini & Lobbezoo, suggesting that literature findings on the relationship between SB and TMDs are dependent on the assessment strategies that are adopted for SB. Future studies should consider SB as a multifaceted motor behavior that must be evaluated in its continuum spectrum, rather than using a simplified dichotomous approach of presence/absence.
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http://dx.doi.org/10.1016/j.jdent.2021.103711DOI Listing
June 2021

Smartphone-based evaluation of awake bruxism behaviours in a sample of healthy young adults: findings from two University centres.

J Oral Rehabil 2021 May 27. Epub 2021 May 27.

School of Dentistry, University of Siena, Siena, Italy.

A smartphone-based ecological momentary assessment (EMA) strategy was used to assess the frequency of awake bruxism behaviours, based on the report of five oral conditions (ie relaxed jaw muscles, teeth contact, mandible bracing, teeth clenching and teeth grinding). One hundred and fifty-three (N = 153) healthy young adults (mean ± SD age = 22.9 ± 3.2 years), recruited in two different Italian Universities, used a dedicated smartphone application that sent 20 alerts/day at random times for seven days. Upon alert receipt, the subjects had to report in real-time one of the above five possible oral conditions. Individual data were used to calculate an average frequency of the study population for each day. For each condition, a coefficient of variation (CV) of frequency data was calculated as the ratio between SD and mean values over the seven recording days. Average frequency of the different behaviours over the seven days was as follows: relaxed jaw muscle, 76.4%; teeth contact, 13.6%; mandible bracing, 7.0%; teeth clenching, 2.5%; and teeth grinding, 0.5%. No significant differences were found in frequency data between the two University samples. The relaxed jaw muscles condition was more frequent in males (80.7 ± 17.7) than in females (73.4 ± 22.2). The frequency of relaxed jaw muscles condition over the period of observation had a very low coefficient of variation (0.27), while for the different awake bruxism behaviours, CV was in a range between 1.5 (teeth contact) and 4.3 (teeth grinding). Teeth contact was the most prevalent behaviour (57.5-69.7). Findings from this investigation suggest that the average frequency of AB behaviours over one week, investigated using EMA-approach, is around 23.6%.
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http://dx.doi.org/10.1111/joor.13212DOI Listing
May 2021

Transitioning to chronic temporomandibular disorder pain: A combination of patient vulnerabilities and iatrogenesis.

J Oral Rehabil 2021 May 9. Epub 2021 May 9.

Department of Biomedical Technologies, School of Dentistry, University of Siena, Siena, Italy.

Background: Based on a variety of studies conducted in recent years, some of the factors that might contribute to the negative treatment responses of some TMD patients have been elucidated.

Methods: This paper describes known vulnerability factors that make individuals susceptible to developing temporomandibular disorders (TMDs), as well as those that contribute to the perpetuation of such problems. In addition, the topic of iatrogenesis is discussed as a major contributor to the negative outcomes that can be seen in this field.

Results: At the patient level, anatomical, psychosocial and genetic factors may contribute to individual vulnerability. The anatomy and pathophysiology of muscles, joints, disc and nerves may all be involved in predisposing to TMD symptoms, especially when the patients have pain elsewhere in the body. Among the psychosocial factors, some features may be elucidated by the DC/TMD axis II, while others (eg illness behaviour, Munchausen syndrome, lack of acceptance of non-mechanical approaches) require careful evaluation by trained clinicians. Genetic predisposition to first onset TMDs and to chronification of symptoms has been identified for individuals with certain psychological traits, presence of comorbid conditions and certain abnormal clinical manifestations. Regarding iatrogenesis, sins of omission may influence the clinical picture, with the main ones being misdiagnosis and undertreatment. Joint repositioning strategies, occlusal modifications, abuse of oral appliances, use of diagnostic technologies, nocebo effect and complications with intracapsular treatments are the most frequent sins of commission that may contribute to chronification of TMDs. The patients who present with massive occlusal and jaw repositioning changes combined with persistent severe orofacial pain are not a rarity within TMD and orofacial pain canters; these patients are the most difficult ones to manage because of this horrific combination of negative factors.

Conclusions: The information presented in this paper will help clinicians to understand better why some individuals develop temporomandibular disorders, why some of them will progress to becoming chronic patients, and what the appropriate responses may be.
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http://dx.doi.org/10.1111/joor.13180DOI Listing
May 2021

Awake Bruxism-Single-Point Self-Report versus Ecological Momentary Assessment.

J Clin Med 2021 04 15;10(8). Epub 2021 Apr 15.

Department of Oral Rehabilitation, The Maurice and Gabriella School of Dental Medicine, Tel Aviv University, Tel Aviv 6139001, Israel.

Assessment of awake bruxism (AB) is problematic due to the inability to use continuous recordings during daytime activities. Recently, a new semi-instrumental approach was suggested, namely, ecological momentary assessment (EMA), via the use of a smartphone application. With the application, subjects are requested to report, at least 12 times per day, the status of their masticatory muscle activity (relaxed muscles, muscle bracing without tooth contact, teeth contact, teeth clenching, or teeth grinding). The aim of the present study was to test the association between a single observation point self-report and EMA assessment of AB. The most frequent condition recorded by the EMA was relaxed muscles (ca. 60%) and the least frequent was teeth grinding (less than 1%). The relaxed muscle condition also showed the lowest coefficient of variance over a seven-day period of report. Additionally, only the relaxed muscles and the muscle bracing conditions presented an acceptable ability to assess AB-positive and AB-negative subjects, as defined by single-point self-report questions. The combination between self-report and EMA may have the potential to promote our ability to assess AB. We suggest to re-consider the conditions of teeth contact and teeth grinding while using EMA to evaluate AB.
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http://dx.doi.org/10.3390/jcm10081699DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8071231PMC
April 2021

Oral frailty and neurodegeneration in Alzheimer's disease.

Neural Regen Res 2021 Nov;16(11):2149-2153

Frailty Phenotypes Research Unit, "Salus in Apulia Study", National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy.

Frailty is a critical intermediate status of the aging process with a multidimensional and multisystem nature and at higher risk for adverse health-related outcomes, including falls, disability, hospitalizations, institutionalization, mortality, dementia, and Alzheimer's disease. Among different frailty phenotypes, oral frailty has been recently suggested as a novel construct defined as a decrease in oral function with a coexisting decline in cognitive and physical functions. We briefly reviewed existing evidence on operational definitions of oral frailty, assessment and screening tools, and possible relationships among oral frailty, oral microbiota, and Alzheimer's disease neurodegeneration. Several underlying mechanism may explain the oral health-frailty links including undernutrition, sarcopenia linked to both poor nutrition and frailty, psychosocial factors, and the chronic inflammation typical of oral disease. Oral microbiota may influence Alzheimer's disease risk through circulatory or neural access to the brain and the interplay with periodontal disease, often causing tooth loss also linked to an increased Alzheimer's disease risk. On this bases, COR388, a bacterial protease inhibitor targeting Porphyromonas gingivalis implicated in periodontal disease, is now being tested in a double-blind, placebo-controlled Phase II/III study in mild-to-moderate Alzheimer's disease. Therefore, oral status may be an important contributor to general health, including Alzheimer's disease and late-life cognitive disorders, suggesting the central role of preventive strategies targeting the novel oral frailty phenotype and including maintenance and improvement of oral function and nutritional status to reduce the burden of both oral dysfunction and frailty.
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http://dx.doi.org/10.4103/1673-5374.310672DOI Listing
November 2021

Signal acquisition and analysis of ambulatory electromyographic recordings for the assessment of sleep bruxism: A scoping review.

J Oral Rehabil 2021 Jul 2;48(7):846-871. Epub 2021 May 2.

Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus Universitet Tandlageskolen, Aarhus, Denmark.

Background: Ambulatory electromyographic (EMG) devices are increasingly being used in sleep bruxism studies. EMG signal acquisition, analysis and scoring methods vary between studies. This may impact comparability of studies and the assessment of sleep bruxism in patients.

Objectives: (a) To provide an overview of EMG signal acquisition and analysis methods of recordings from limited-channel ambulatory EMG devices for the assessment of sleep bruxism; and (b) to provide an overview of outcome measures used in sleep bruxism literature utilising such devices.

Method: A scoping review of the literature was performed. Online databases PubMed and Semantics Scholar were searched for studies published in English until 7 October 2020. Data on five categories were extracted: recording hardware, recording logistics, signal acquisition, signal analysis and sleep bruxism outcomes.

Results: Seventy-eight studies were included, published between 1977 and 2020. Recording hardware was generally well described. Reports of participant instructions in device handling and of dealing with failed recordings were often lacking. Basic elements of signal acquisition, for example amplifications factors, impedance and bandpass settings, and signal analysis, for example rectification, signal processing and additional filtering, were underreported. Extensive variability was found for thresholds used to characterise sleep bruxism events. Sleep bruxism outcomes varied, but typically represented frequency, duration and/or intensity of masticatory muscle activity (MMA).

Conclusion: Adequate and standardised reporting of recording procedures is highly recommended. In future studies utilising ambulatory EMG devices, the focus may need to shift from the concept of scoring sleep bruxism events to that of scoring the whole spectrum of MMA.
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http://dx.doi.org/10.1111/joor.13170DOI Listing
July 2021

Evaluation of interleukin-1 beta and the ratio of interleukin-1 beta to interleukin-1 receptor antagonist in gingival crevicular fluid during orthodontic canine retraction.

Dent Med Probl 2021 Jan-Mar;58(1):47-54

Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, the Netherlands.

Background: Orthodontic tooth movement (OTM) is a complex phenomenon mediated by cytokines, of which interleukin-1 beta (IL‑1β) is potently involved in the remodeling of the periodontal ligament (PDL) and bone. Whether the pattern of IL‑1β release differs at the sides of tension and compression is not yet clarified.

Objectives: The aim of the present study was to evaluate the level of IL‑1β and the ratio of IL‑1β to interleukin-1 receptor antagonist (IL‑1RA) in gingival crevicular fluid (GCF) at the tension and compression sides during orthodontic canine retraction.

Material And Methods: Seventeen patients scheduled for orthodontic treatment with bilateral extraction of maxillary first premolars and canine retraction were enrolled. Tooth 2.3 was retracted, teeth 1.3 and 3.3 served as controls. Gingival crevicular fluid samples were collected from the tension and compression sides of each tooth at baseline (before the 1st activation - day 0) and at days 2 and 7, and then again before the 2nd activation (day 28) and at days 30 and 35. The levels of IL‑1β and IL‑RA were evaluated with the enzyme-linked immunosorbent assay (ELISA).

Results: After the 1st activation, a statistically significant increase in the level of IL‑1β was observed at teeth 2.3 (p < 0.03 mesially and p < 0.05 distally) and 1.3 (p < 0.05 mesially and distally), both at the tension and compression sides. The 2nd activation resulted in a gradual increase in the IL‑1β level at both canines; however, statistical significance was reached only for tooth 2.3 (p < 0.05 mesially and p < 0.02 distally). In terms of the IL‑1β/IL‑1RA ratio, a significant increase was observed only at the compression side of the experimental tooth (p < 0.01).

Conclusions: An increase in the IL‑1β level in GCF was observed both at the tension and compression sides of the actively retracted canine 2.3 as well as the contralateral canine 1.3; a significant rise in the IL‑1β/IL‑1RA ratio was noted only at the compression side of the experimental tooth 2.3, indicating the zone of active bone resorption.
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http://dx.doi.org/10.17219/dmp/132954DOI Listing
June 2021

Arthrocentesis of the Temporomandibular Joint: Systematic Review and Clinical Implications of Research Findings.

J Oral Facial Pain Headache 2021 Winter;35(1):17-29

Aims: To review randomized clinical trials on arthrocentesis for managing temporomandibular disorders (TMD) and to discuss the clinical implications.

Methods: On March 10, 2019, a systematic search of relevant articles published over the last 20 years was performed in PubMed, as well as in Scopus, the authors' personal libraries, and the reference lists of included articles. The focus question was: In patients with TMD (P), does TMJ arthrocentesis (I), compared to any control treatment (C), provide positive outcomes (O)?

Results/conclusion: Thirty papers were included comparing TMJ arthrocentesis to other treatment protocols in patients with disc displacement without reduction and/or closed lock (n = 11), TMJ arthralgia and/or unspecific internal derangements (n = 8), or TMJ osteoarthritis (n = 11). In general, the consistency of the findings was poor because of the heterogenous study designs, and so caution is required when interpreting the meta-analyses. In summary, it can be suggested that TMJ arthrocentesis improves jaw function and reduces pain levels, and the execution of multiple sessions (three to five) is superior to a single session (effect size = 1.82). Comparison studies offer inconsistent findings, with the possible exception of the finding that splints are superior in managing TMJ pain (effect size = 1.36) compared to arthrocentesis, although this conclusion is drawn from very heterogenous studies (I = 94%). The additional use of cortisone is not effective for improving outcomes, while hyaluronic acid or platelet-rich plasma positioning may have additional value according to some studies. The type of intervention, the baseline presence of MRI effusion, and the specific Axis I diagnosis do not seem to be important predictors of effectiveness, suggesting that, as in many pain medicine fields, efforts to identify predictors of treatment outcome should focus more on the patient (eg, age, psychosocial impairment) than the disease.
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http://dx.doi.org/10.11607/ofph.2606DOI Listing
March 2021

Bruxism definition: Past, present, and future - What should a prosthodontist know?

J Prosthet Dent 2021 Mar 4. Epub 2021 Mar 4.

Professor and Head, Department of Orofacial pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.

Statement Of Problem: The definition of bruxism has evolved, and the dental profession needs to align with the terminologies adopted in the current literature of sleep and orofacial pain medicine.

Purpose: The purpose of this review was to discuss the recent evolution of bruxism concepts and the implications for changing the definition that is currently used by the prosthodontic community.

Material And Methods: A historical perspective on the evolution of the definition of bruxism, as well as a systematic literature review on the validity of polysomnography (PSG)-based criteria for sleep bruxism diagnosis to detect the presence of clinical consequences, is presented. Selected articles were read in a structured Population, Intervention, Comparison, Outcome (PICO) format to answer the question "If a target population with conditions such as tooth wear, dental implant complications, and temporomandibular disorders (P) is diagnosed with sleep bruxism by means of PSG (I) and compared with a population of nonbruxers (C), is the occurrence of the condition under investigation (that is, the possible pathologic consequences of sleep bruxism) be different between the 2 groups (O)?"

Results: Eight studies were eligible for the review, 6 of which assessed the relationship between PSG-diagnosed sleep bruxism and temporomandibular disorder pain, while the other 2 articles evaluated the predictive value of tooth wear for ongoing PSG-diagnosed sleep bruxism and the potential role of sleep bruxism in a population of patients with failed dental implants. Findings were contradictory and not supportive of a clear-cut relationship between sleep bruxism assessed based on available PSG criteria and any clinical consequence. The literature providing definitions of bruxism as a motor behavior and not pathology has been discussed.

Conclusions: The bruxism construct has shifted from pathology to motor activity with possibly even physiological or protective relevance. An expert panel including professionals from different medical fields published 2 consecutive articles focusing on the definition of bruxism, as well as an overview article presenting the ongoing work to prepare a Standardized Tool for the Assessment of Bruxism (STAB) to reflect the current bruxism paradigm shift from pathology to behavior (that is, muscle activity). As such, dental practitioners working in the field of restorative dentistry and prosthodontics are encouraged to appraise this evolution.
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http://dx.doi.org/10.1016/j.prosdent.2021.01.026DOI Listing
March 2021

Research routes on improved sleep bruxism metrics: Toward a standardised approach.

J Sleep Res 2021 Mar 6:e13320. Epub 2021 Mar 6.

Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

A recent report from the European Sleep Research Society's task force "Beyond AHI" discussed an issue that has been a long-term subject of debate - what are the best metrics for obstructive sleep apnoea (OSA) diagnosis and treatment outcome assessments? In a similar way, sleep bruxism (SB) metrics have also been a recurrent issue for >30 years and there is still uncertainty in dentistry regarding their optimisation and clinical relevance. SB can occur alone or with comorbidities such as OSA, gastroesophageal reflux disorder, insomnia, headache, orofacial pain, periodic limb movement, rapid eye movement behaviour disorder, and sleep epilepsy. Classically, the diagnosis of SB is based on the patient's dental and medical history and clinical manifestations; electromyography is used in research and for complex cases. The emergence of new technologies, such as sensors and artificial intelligence, has opened new opportunities. The main objective of the present review is to stimulate the creation of a collaborative taskforce on SB metrics. Several examples are available in sleep medicine. The development of more homogenised metrics could improve the accuracy and refinement of SB assessment, while moving forward toward a personalised approach. It is time to develop SB metrics that are relevant to clinical outcomes and benefit patients who suffer from one or more possible negative consequences of SB.
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http://dx.doi.org/10.1111/jsr.13320DOI Listing
March 2021

Self-reported sleep bruxism among Finnish symphony orchestra musicians: Associations with perceived sleep-related problems and psychological stress.

Cranio 2020 Nov 30:1-8. Epub 2020 Nov 30.

Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland.

: This study aimed to evaluate whether self-reported sleep bruxism among musicians is associated with sleep-related problems and/or psychological stress.: Eight hundred-thirty-one Finnish orchestra musicians completed a questionnaire that covered, among others, indicators of sleep-related problems, possible sleep bruxism, and stress.: In total, 488 questionnaires were completed. The single variable ordinal logistic regression models revealed at least moderate associations between frequency of sleep bruxism and female gender, shorter sleep duration, longer sleep latency, problems in sleeping during concert season, feeling more often tired during the daytime, restless legs, a poor self-rated sleep quality, and more stress experience. The variables that remained in the final model were sleep duration, gender, and stress.: Musicians who sleep 7 hours or less per night report more sleep bruxism, as compared to those who sleep 8 hours or more. Female gender and high-stress experience were associated with more sleep bruxism.
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http://dx.doi.org/10.1080/08869634.2020.1853310DOI Listing
November 2020

Awake bruxism frequency and psychosocial factors in college preparatory students.

Cranio 2020 Oct 14:1-7. Epub 2020 Oct 14.

Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.

Objective: To assess the frequency of reported masticatory muscles activity during wakefulness (i.e., awake bruxism [AB]), levels of anxiety, depression, stress, and the oral health-related quality of life (OHRQoL) in college preparatory students.

Methods: Sixty-nine college preparatory students participated in the study. AB was evaluated by the Oral Behaviors Checklist (OBC) and a smartphone-based ecological momentary assessment (EMA; [Bruxapp®]). Anxiety and depression were measured by the Hospital Anxiety and Depression Scale, stress was evaluated by the Perceived Stress Scale, and OHRQoL was obtained by The Oral Health Impact Profile-14. Data were analyzed by Pearson's correlation coefficient (α = 0.05).

Results: The average EMA-reported frequency of AB behaviors was 38.4%. Significant correlations were found between AB and the OBC, anxiety, depression, stress, and OHRQoL (p < 0.001).

Conclusion: College preparatory students demonstrated moderate frequency of AB, which was significantly correlated with psychosocial factors.
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http://dx.doi.org/10.1080/08869634.2020.1829289DOI Listing
October 2020

Treating Temporomandibular Disorders in the 21st Century: Can We Finally Eliminate the "Third Pathway"?

J Oral Facial Pain Headache 2020 Summer;34(3):206-216

Within the orofacial pain discipline, the most common group of afflictions is temporomandibular disorders (TMD). The pathologic and functional disorders included in this condition closely resemble those that are seen in the orthopedic medicine branch of the medical profession, so it would be expected that the same principles of orthopedic diagnosis and treatment are applied. Traditional orthopedic therapy relies on a "Two Pathway" approach involving conservative and/or surgical treatments. However, over the course of the 20th century, some members of the dental community have created another way of approaching these disorders- referred to in this paper as the "Third Pathway"-based on the assumption that signs and symptoms of TMD are due to a "bad" relationship between the mandible and skull, leading to a variety of irreversible occlusal or surgical corrective treatments. Since no other human joint is discussed in these terms within the orthopedic medicine communities, it has become progressively clear that the Third Pathway is a unique and artificial conceptual creation of the dental profession. However, many clinical studies have utilized the medically oriented conservative/surgical Two-Pathway model to diagnose and treat TMD within a biopsychosocial model of pain. These studies have shown that TMD comprise another domain of orthopedic illness that requires a medically oriented approach for good outcomes while avoiding the irreversible aspects of the Third Pathway. This review presents historical and current evidence that the Third Pathway is an example of unorthodox medicine that leads to unnecessary overtreatment and further proposes that it is time to abandon this approach as we move forward in the TMD field.
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http://dx.doi.org/10.11607/ofph.2608DOI Listing
September 2020

Medications and addictive substances potentially inducing or attenuating sleep bruxism and/or awake bruxism.

J Oral Rehabil 2021 Mar 10;48(3):343-354. Epub 2020 Aug 10.

Foundation for Oral Health and Parkinson's Disease, Oegstgeest, The Netherlands.

Bruxism is a repetitive jaw-muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. It can occur during sleep, indicated as sleep bruxism, or during wakefulness, indicated as awake bruxism. Exogenous risk indicators of sleep bruxism and/or awake bruxism are, among others, medications and addictive substances, whereas also several medications seem to have the potential to attenuate sleep bruxism and/or awake bruxism. The objective of this study was to present a narrative literature on medications and addictive substances potentially inducing or aggravating sleep bruxism and/or awake bruxism and on medications potentially attenuating sleep bruxism and/or awake bruxism. Literature reviews reporting evidence or indications for sleep bruxism and/or awake bruxism as an adverse effect of several (classes of) medications as well as some addictive substances and literature reviews on medications potentially attenuating sleep bruxism and/or awake bruxism were used as starting point and guidelines to describe the topics mentioned. Additionally, two literature searches were established on PubMed. Three types of bruxism were distinguished: sleep bruxism, awake bruxism and non-specified bruxism. Generally, there are insufficient evidence-based data to draw definite conclusions concerning medications and addictive substances inducing or aggravating sleep bruxism and/or awake bruxism as well as concerning medications attenuating sleep bruxism and/or awake bruxism. There are insufficient evidence-based data to draw definite conclusions concerning medications and addictive substances inducing or aggravating sleep bruxism and/or awake bruxism as well as concerning medications attenuating sleep bruxism and/or awake bruxism.
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http://dx.doi.org/10.1111/joor.13061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7984358PMC
March 2021

Correlates and genetics of self-reported sleep and awake bruxism in a nationwide twin cohort.

J Oral Rehabil 2020 Sep 13;47(9):1110-1119. Epub 2020 Jul 13.

Institute for Molecular Medicine Finland FIMM, HiLIFE, University of Helsinki, Helsinki, Finland.

Background: Sleep bruxism (SB) and awake bruxism (AB) have been considered different entities, although co-occurrence between them has been shown. While genetic factors have a marked influence on phenotypic variance in liability to SB, this remains unclear for AB.

Aim: To examine the degree of co-occurrence of SB and AB, and whether they have common correlates and also twin similarity of SB and AB bruxism traits by zygosity and sex.

Methods: A questionnaire was mailed to all twins born 1945-1957 in Finland in 2012 (n = 11 766). Age and sex adjusted logistic regression models were used. Twin similarity was assessed using polychoric correlations, and crosstwin-crosstrait correlations were computed.

Results: The response rate was 72% (n = 8410). Any SB was reported by 14.8% and ≥ 3 nights weekly by 5.0%. Percentages for any AB were 18.4% and 6.3%, respectively. There was substantial co-occurrence (29.5%) between SB and AB, and several shared correlates were found. For SB, the polychoric intra-class correlation was 0.366 in monozygotic (MZ) and 0.200 in dizygotic (DZ) pairs, without gender difference. A twofold crosstwin-crosstrait correlation was observed in MZ twins compared to DZ twins.

Conclusions: The risk factor profiles of SB and AB were largely but not entirely similar. The higher correlation in MZ than in DZ pairs suggests the influence of genetic factors on both SB and AB. The higher crosstwin-crosstrait correlation in MZ than in DZ pairs suggests some degree of genetic influences shared by SB and AB.
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http://dx.doi.org/10.1111/joor.13042DOI Listing
September 2020

Efficacy and Safety of Botulinum Toxin Type A on Persistent Myofascial Pain: A Randomized Clinical Trial.

Toxins (Basel) 2020 06 15;12(6). Epub 2020 Jun 15.

Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas, Sao Paulo 13414-903, Brazil.

This study assessed the safety and efficacy of three different doses of BoNT-A for persistent myofascial pain (MFP). One hundred female subjects were randomly assigned into five groups ( = 20): oral appliance (OA), saline solution (SS) and three BoNT-A groups with different doses. Pain intensity and pressure pain threshold were evaluated up to 24 weeks after treatment. Adverse effects related to muscle contraction, masticatory performance, muscle thickness and mandibular bone volume were also assessed. Changes over time were compared within and between groups. The "nparLD" package and Wilcoxon signed-rank test were used to analyze the data. BoNT-A reduced pain intensity ( < 0.0001) and increased pressure pain threshold ( < 0.0001) for up to 24 weeks compared to the placebo. No differences were found between BoNT-A and OA at the last follow-up. A transient decline in masticatory performance ( < 0.05) and muscle contraction ( < 0.0001), and a decrease in muscle thickness ( < 0.05) and coronoid and condylar process bone volume ( < 0.05) were found as dose-related adverse effects of BoNT-A. Regardless of the dose, BoNT-A was as effective as OA on MFP. Notwithstanding, due to BoNT-A dose-related adverse effects, we suggest the use of low doses of BoNT-A in MFP patients that do not benefit from conservative treatments.
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http://dx.doi.org/10.3390/toxins12060395DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7354430PMC
June 2020

STAB-A response to the commentary "Questions on the clinical applicability on the international consensus on the assessment of bruxism" by Skarmeta and Hormazabal Navarrete.

J Oral Rehabil 2020 Dec 19;47(12):1574-1576. Epub 2020 May 19.

Department of Orofacial pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

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http://dx.doi.org/10.1111/joor.12987DOI Listing
December 2020

Correlation Between Physical and Psychosocial Findings in a Population of Temporomandibular Disorder Patients.

Int J Prosthodont 2020 Mar/Apr;33(2):155-159

Purpose: To assess the correlation between RDC/TMD Axis I and Axis II diagnoses and whether pain could mediate a possible correlation between these two variables.

Materials And Methods: Data of both RDC/TMD axes were collected from 737 consecutive patients who sought TMD advice at the University of Padova, Italy. A descriptive analysis was used to report the frequencies of Axis I and II diagnoses, and Spearman test was performed to assess the correlation between the axes. Subsequently, the sample was divided into two groups (painful vs nonpainful TMD). Frequencies were reported using descriptive analysis, and chi-square test was used to compare groups. The painful TMD group was then divided based on the level of pain-related impairment (low = Groups I and II; high = Groups III and IV). Then, frequencies of depression and somatization were reported using descriptive analysis for each disability group, and chi-square test was used to compare groups.

Results: No correlation levels were found between Axis I and any of the Axis II findings (Graded Chronic Pain Scale, depression, and somatization). The painful TMD group presented higher levels of depression and somatization (P < .05). Comparisons of depression and somatization frequencies between pain-impairment groups showed a significantly higher prevalence of abnormal scores for the severe pain-impairment group.

Conclusion: There is no correlation between specific Axis I and Axis II findings. The presence of pain, independent of the muscle or joint location, is correlated with Axis II findings, and higher levels of pain-related impairment are associated with the most severe scores of depression and somatization.
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http://dx.doi.org/10.11607/ijp.5847DOI Listing
February 2020

Pain Predictors in a Population of Temporomandibular Disorders Patients.

J Clin Med 2020 Feb 6;9(2). Epub 2020 Feb 6.

School of Dentistry, University of Siena, 53100 Siena, Italy.

The aim of the present study was to assess the potential role of some biological, psychological, and social factors to predict the presence of painful temporomandibular disorders (TMDs) in a TMD-patient population. The study sample consisted of 109 consecutive adult patients (81.7% females; mean age 33.2 ± 14.7 years) who were split into two groups based on Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) diagnoses: painful TMD and non-painful TMD. The presence of pain was adopted as the depended variable to be identified by the following independent variables (i.e., predictors): age, gender, bruxism, tooth wear, chewing gum, nail biting, perceived stress level, chronic pain-related impairment (GCPS), depression (DEP), and somatization (SOM). Single-variable logistic regression analysis showed a significant relationship between TMD pain and DEP with an odds ratio of 2.9. Building up a multiple variable model did not contribute to increase the predictive value of a TMD pain model related to the presence of depression. Findings from the present study supported the existence of a relationship between pain and depression in painful TMD patients. In the future, study designs should be improved by the adoption of the best available assessment approaches for each factor.
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http://dx.doi.org/10.3390/jcm9020452DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074020PMC
February 2020

Towards a Standardized Tool for the Assessment of Bruxism (STAB)-Overview and general remarks of a multidimensional bruxism evaluation system.

J Oral Rehabil 2020 May 17;47(5):549-556. Epub 2020 Feb 17.

Department of Orofacial pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

The aim of the present paper was to give an overview of the general project and to present the macrostructure of a comprehensive multidimensional toolkit for the assessment of bruxism, viz. a bruxism evaluation system. This is a necessary intermediate step that will be detailed in a successive extended publication and will ultimately lead to the definition of a Standardized Tool for the Assessment of Bruxism (STAB) as the final product. Two invitation-only workshops were held during the 2018 and 2019 General Session & Exhibition of the International Association for Dental Research (IADR) meetings. Participants of the IADR closed meetings were split into two groups, to put the basis for a multidimensional evaluation system composed of two main axes: an evaluation Axis A with three assessment domains (ie subject-based, clinically based and instrumentally based assessment) and an aetiological/risk factors Axis B assessing different groups of factors and conditions (ie psychosocial assessment; concurrent sleep and non-sleep conditions; drug and substance use or abuse; and additional factors). The work of the two groups that led to the identification of different domains for assessment is summarised in this manuscript, along with a road map for future researches. Such an approach will allow clinicians and researchers to modulate evaluation of bruxism patients with a comprehensive look at the clinical impact of the different bruxism activities and aetiologies. The ultimate goal of this multidimensional system is to facilitate the refinement of decision-making algorithms in the clinical setting.
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http://dx.doi.org/10.1111/joor.12938DOI Listing
May 2020

Relationship between self-reported bruxism and periodontal status: Findings from a cross-sectional study.

J Periodontol 2019 Dec 18. Epub 2019 Dec 18.

Clinical Research Unit (CRU), Egas Moniz Interdisciplinary Research Center (EMIRC), Egas Moniz, CRL, Monte de Caparica, Portugal.

Background: Several studies seek to prove the relationship between bruxism and periodontal status although it remains unclear and debatable. We aimed to assess the association between self-reported (SR) bruxism with the periodontal status in a large scale survey.

Material And Methods: A total of 1064 individuals from the southern region of the Lisbon Metropolitan Area (Portugal) were enrolled. Patients were interviewed for the SR bruxism assessment through a self-report questionnaire. Full-mouth periodontal status was assessed with probing depth (PD), clinical attachment loss (CAL), gingival recession (REC), and bleeding on probing (BoP) being measured. The American Association of Periodontology/European Federation of Periodontology 2018 case definitions were used. Logistic regression analyses provided information on the influence of SR bruxism towards periodontitis.

Results: SR bruxers exhibited lower prevalence of periodontitis. Additionally, SR bruxers with periodontitis had PD and CAL significantly lower than patients with only periodontitis. Multivariate analysis suggests that SR bruxism was significantly associated with a lower risk of periodontitis (odds ratio [OR] = 0.42 95% CI: 0.32-0.56). Mean PD and CAL were significantly lower in SR bruxers. When assessing the type of SR bruxism, significant differences among mean PD, CAL, and BoP levels were also identified.

Conclusion: SR bruxism and periodontal status are negatively associated. SR bruxers exhibit lower odds towards periodontitis and better periodontal clinical characteristics. Further studies are mandatory to clarify these findings.
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http://dx.doi.org/10.1002/JPER.19-0364DOI Listing
December 2019

Comparison between conventional and computerised methods in the assessment of an occlusal scheme.

J Oral Rehabil 2020 Feb 21;47(2):221-228. Epub 2019 Nov 21.

School of Dentistry, University of Siena, Siena, Italy.

Purpose: In the definition of an occlusal scheme, clinicians should choose between conventional and computerised methods based on a careful appraise of the advantages and limitations. This study aims to assess the correlation between the two approaches in a clinical setting.

Methods: Twenty-four patients were included to compare different methods of occlusal contacts assessment on the posterior surfaces of flat mandibular appliances. In supine position, they were asked to clench with maximum strength, in the maximum intercuspation position with a 24 μm articulating paper positioned between the teeth and the appliance surface. An extra-oral photograph of the marks was taken (total N = 2082). They were visually classified based on a pre-defined scale (ie, conventional assessment) and with ImageJ analysis software (ie, photographic software assessment). Additionally, a computerised occlusal analysis was performed (ie, computerised assessment). Correlation analysis of the data achieved with conventional, photographic and computerised assessments was performed.

Results: Correlation between conventional and computerised assessments was weak (r = .265), whilst it was moderate between conventional and photographic assessments (r = .633), as well as between photographic and computerised assessments (r = .476).

Conclusions: This investigation showed a weak-to-moderate correlation between different methods (ie, conventional, photographic and computerised) to assess occlusal marks. None of the three can actually be considered the standard of reference, but based on their specific features, it can bet suggested that the conventional method may be enough for most clinical purposes, unless otherwise proven.
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http://dx.doi.org/10.1111/joor.12905DOI Listing
February 2020

Smartphone-based application for EMA assessment of awake bruxism: compliance evaluation in a sample of healthy young adults.

Clin Oral Investig 2020 Apr 24;24(4):1395-1400. Epub 2019 Oct 24.

Postgraduate School of Orthodontics, University of Ferrara, Ferrara, Italy.

Objective: A smartphone-based ecological momentary assessment (EMA) strategy to collect real time data on awake bruxism (AB) has been recently introduced. The aim of this study was to assess the compliance with its use over 1 week in a sample of healthy young adults.

Method: Sixty (N = 60) healthy young adults (mean age 24.2 ± 4.1 years) used a dedicated smartphone application that sent 20 alerts at random times throughout the day. Upon alert receipt, the subjects had to report in real time their condition among five possible options: relaxed jaw muscles, teeth contact, teeth clenching, teeth grinding, and mandible bracing. Compliance rate with the app was assessed at the individual and group level in terms of percentage of answered alerts as well as number of days that were needed to reach the targeted observation period of 7 days with a compliance of at least 60%.

Results: The mean compliance recorded with the smartphone application was 67.8% of the total alerts. On average, 9.8 ± 3.2 days (range 7-19) have been necessary to achieve the targeted goal of 7 days with a minimum of 60% alerts/day. No gender differences were detected in any compliance data. Response rate was not different during weekdays or weekends.

Conclusions: This investigation is the first attempt to assess individual compliance with EMA for reporting awake bruxism. Results suggest that a smartphone-based strategy can have interesting potential. The compliance rate reported in this study will serve as a comparison standpoint for future investigations.

Clinical Significance: Based on the recent multidisciplinary focus on the study of awake bruxism, EMA has emerged as a potential approach for use in the clinical and research settings. This investigation suggests that compliance with such strategy is good, thus making it worthy of adoption for the assessment of AB and its clinical implications.
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http://dx.doi.org/10.1007/s00784-019-03098-2DOI Listing
April 2020

The bruxism construct: From cut-off points to a continuum spectrum.

J Oral Rehabil 2019 Nov 2;46(11):991-997. Epub 2019 Jul 2.

Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

This commentary discusses the need to move on from the adoption of cut-off points for the definition of the presence/absence of bruxism and justifies the need to embrace an evaluation based on the continuum of jaw motor behaviours. Currently, the number of events per hour, as identified by polysomnography (PSG), is used to define the presence of sleep bruxism (SB). Whilst PSG still remains the indispensable equipment to study the neurophysiological correlates of SB, the scoring criteria based on a cut-off point are of questionable clinical usefulness for the study of oral health outcomes. For awake bruxism (AB), criteria for a definite diagnosis have never been proposed. Some goal-oriented strategies are proposed to identify bruxism behaviours that increase the risk of negative oral health outcomes (eg, tooth wear, muscle and/or temporomandibular joint [TMJ] pain, restorative complications). One possible strategy would embrace an improved knowledge on the epidemiology and natural variability of bruxism, even including study of the amount of PSG/SB and electromyography masticatory muscle activity (EMG/MMA) during sleep and the frequency/prevalence of bruxism behaviours during wakefulness that are needed to represent a risk factor for clinical consequences, if any. There should not be any preclusion about the diagnostic strategies to pursue that goal, and a combination of instrumental and non-instrumental approaches may even emerge as the best available option. Once data are available, large-scale, non-selected population samples representing the entire continuum of EMG/MMA activities are also needed, in the attempt to estimate untreated health risks in the population.
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http://dx.doi.org/10.1111/joor.12833DOI Listing
November 2019

Prevalence of Function-Dependent Temporomandibular Joint and Masticatory Muscle Pain, and Predictors of Temporomandibular Disorders among Patients with Lyme Disease.

J Clin Med 2019 Jun 28;8(7). Epub 2019 Jun 28.

Department of Orofacial Pain and Dysfunction, Academic Centre forDentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands.

The aim was to determine the occurrence of temporomandibular disorders (TMDs) in patients with Lyme disease (LD), and to estimate the contribution of factors that may identify TMD among LD patients. In seventy-six ( = 76) adult patients with LD (mean age 57.6 ± 14.6 years) and 54 healthy non-Lyme volunteers with a mean age of 56.4 ± 13.5 years, possible function (i.e., non-pain) diagnoses were established using the Research Diagnostic Criteria of Temporomandibular Disorders (RDC/TMD). Pain diagnoses were established by means of the function-dependent dynamic and static tests. The two groups did not significantly differ in the frequency of disc displacements diagnoses and function-dependent pain diagnoses. LD showed a significantly higher frequency ( < 0.001) of osteoarthrosis than the control group. For the prediction of pain diagnoses in LD patients, the single regression analyses pointed out an association with age, sleep bruxism (SB), and awake bruxism (AB). Two predictors (i.e., SB ( = 0.002) and AB ( = 0.017)) were statistically significant in the final multiple variable model. The frequency of TMD in patients with LD based on function-dependent tests was not significantly different from that in the control group. This investigation suggests that the contribution of bruxism to the differentiation between patients with Lyme and TMD is high.
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http://dx.doi.org/10.3390/jcm8070929DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6679175PMC
June 2019
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