Recent publications
Plastic waste from various sources contributes significantly to environmental and food chain contamination through microplastics (MPs). MPs are defined as plastic particles with dimensions smaller than 5 mm. The short lifespan of plastic packaging materials leads to their rapid accumulation in municipal solid waste. Composting processes face challenges in completely separating plastics, resulting in MP contamination of compost products. This cross-sectional study investigates the prevalence, distribution, and characteristics of MPs in compost produced by three compost factories in Mazandaran province, north of Iran. MP extraction from compost samples was performed using density separation and digestion techniques. Stereomicroscopic analysis was employed for MP characterization. The results revealed a mean MP concentration of 16,981 items/kg across all compost samples. Behshahr compost exhibited the highest average concentration at 18,622 items/kg, while Babol had the lowest at 15,744 items/kg. Kruskal–Wallis analysis indicated no statistically significant differences among sampling stations (p > 0.05). Fibers were the predominant shape (75%), with transparent-white being the most common color (56%). The size range of 500–1000 µm accounted for 40% of observed MPs. Polymer analysis identified the presence of polyurethane (PU), polyamide (PA), low-density polypropylene (LDPE), and polycarbonate (PC). The study demonstrates the ubiquity of MPs in compost from Mazandaran’s compost facilities. To mitigate this issue, strategies for reducing plastic waste input into composting facilities and implementing effective monitoring programs for MP hotspot detection and identification are imperative.
Objective
Fear of childbirth (FOC) is a common problem during pregnancy and can be associated with increased maternal and fetal complications. Therefore, this study aimed to determine the frequency and intensity of FOC and some related individual, family, and social factors.
Methods
This cross-sectional study was performed on 473 nulliparous women selected by convenience sampling. Data was collected by socio-demographic characteristics and factors related to the FOC questionnaire, the Wijma delivery expectation questionnaire, the Jerabeck communication skills inventory, and the Spanier dyadic adjustment questionnaire. Data analysis was performed in SPSS version 21 using descriptive and analytic statistics (the Mann-Whitney U, the Kruskal-Wallis, the Pearson and Spearman correlation coefficients, and linear regression).
Results
The mean scores of FOC, communication skills, and the dyadic adjustment were 53.90 ± 25.20, 112.61 ± 24.34, and 103.00 ± 21.11, respectively. The linear regression results showed a significant relationship between FOC and communication skills, dyadic adjustment, age, knowledge of labor and its stages, socioeconomic class, satisfaction with socioeconomic class, satisfaction with monthly income, spouse’s support, family’s support, support of spouse’s family, friends’ support, fear of damage to the infant, fear of death during labor, fear of childbirth complications, confidence in the ability to give birth, and common social beliefs about natural delivery (P < 0.001).
Conclusion
Considering the significant impact of some factors on fear of childbirth, it becomes crucial to conduct screenings to identify individuals at risk of FOC. Moreover, to prevent this fear and its adverse consequences such as a high rate of elective cesarean section, the following strategies are recommended: helping promote mothers’ awareness about childbirth, offering social support through healthcare providers, and paying attention to risk factors and predictors of childbirth fear such as age and socioeconomic status, communication skills and dyadic adjustment.
Background
Continuous temperature monitoring using a skin sensor is the standard method for temperature measurement in neonatal intensive care units (NICUs). This study aimed to determine the correlation between left axillary temperature and five body sites, including the liver, left flank, area between the xiphoid and umbilicus, right flank, and back, in premature infants hospitalized in the NICU.
Materials and Methods
This cross-sectional study included 185 premature infants placed under radiant warmer in the NICU. The skin temperature at five body sites, including the liver, left flank, between the xiphoid and umbilicus region, right flank, and back, was compared with the results of a digital thermometer measuring the left axillary temperature as a reference temperature. The sensors were placed at 15-min intervals, and the temperature of the left axilla was measured separately and recorded simultaneously with the sensor. The data were then compared using analysis of variance, Pearson’s correlation test, and the Bland–Altman method.
Results
The infants’ mean gestational age and weight were 36.09 and 2808.43 ± 240.654, respectively. The correlations between the temperature of the skin sensor on the left flank, right flank, back skin, liver area, and the area between the xiphoid and umbilicus skin sensors and the digital temperature on the left axilla were 0.804, 0.646, 0.723, 0.746, and 0.766, respectively. The extent of agreement between the temperature of the skin sensor on the left flank, right flank, back skin, liver area, and the area between the xiphoid and umbilicus skin sensors and the digital temperature on the left axilla was 1.528, 1.054, 0.948, 0.9003, and 0.9016, respectively.
Conclusion
There was a significant correlation between the temperature of the skin sensors at the five sites and the digital thermometer in the left axilla as the reference temperature, which was measured simultaneously and separately at each skin sensor site.
Wilms tumor (WT) is a childhood embryonal tumor. Nephrectomy is the standard surgical treatment for children with WT and can be performed using robotic or laparoscopic approaches. This study aims to analyze the surgical outcomes of robotic and laparoscopic approaches in the treatment of Wilms’ tumor. A comprehensive study was conducted focusing on the treatment of Wilms’ tumor by robotic and laparoscopic surgery. We searched PubMed, Scopus, ProQuest, Embase, Web of Science, and Cochran Library without any time or language limitations until 25 April 2024. Following the search technique, each document was scrutinized based on its title or abstract. Studies that treated Wilms’ tumor through laparoscopic and robotic surgery were included in the study. Overall, 24 studies in this study were analyzed. Our analysis shows six types of outcome during the procedure including 1) complete removal of the tumor without rupture, 2) less blood loss, 3) converting to open surgery, 4) difficulty accessing the renal hilum, 5) difficulty maintaining oxygen saturation, and 6) splenic injury during the procedures. Also, six types of postoperative outcomes including 1) without recurrence or medium-term complications, 2) survival, 3) better cosmetic outcome, 4) death and metastases (relapse in the lung, nervous system, and liver), 5) prolonged ileum, and 6) herniation in the umbilical port were reported. Robotic and laparoscopic surgery impacts decreasing the risk of bleeding, prevention of metastasis, kidney preservation, survival, and length of stay in the hospital.
Objective
The prevalence of obesity is increasing globally, necessitating effective treatment strategies. The effectiveness of Metabolic and Bariatric surgery (MBS) as a therapeutic option across different age groups remains debated. This study aimed to compare the outcomes and complications of MBS in patients less than 50 years old and 50 years or older.
Methods and materials
This retrospective study analyzed data from patients who underwent MBS in a referral hospital in Mashhad, Iran, between April 2012 and March 2017. The recorded follow-up information was included for patients with at least six months post-surgery.
Results
The study included 709 patients, 519 patients aged ≤ 50 years, and 190 patients > 50. The average age, weight, and BMI of the participants were 42.7 ± 13.24 years, 126.6 ± 31.23 kg, and 47.2 ± 10.37 kg/m2, respectively. Both age groups demonstrated significant improvements in BMI, cholesterol, and TG levels post-surgery, while significant improvements in FBS levels were observed only in the younger group (p < 0.05). Overall, substantial reductions in the prevalence of obesity-related comorbidity were observed in both age groups post-surgery (p < 0.05). None of the post-surgical complications had a statistically significant difference between the two age groups (p > 0.05).
Conclusion
MBS is effective in reducing obesity-related comorbidities, regardless of age. Age should not be a limiting factor for MBS, as the benefits and complications do not differ significantly between patients under and over 50 years old.
Background
The current study sought to determine the prevalence of elevated estimated pulmonary artery systolic pressure (ePASP) in clinically stable children and adults with sickle cell disease)SCD(worldwide.
Methods
The studies included were identified through a search of databases such as PubMed, Scopus, Science Direct, Web of Science, and Embase, as well as Google Scholar engine, adhering to specific inclusion and exclusion criteria. Heterogeneity among the primary study results was assessed using the I-squared index, while publication bias was evaluated through funnel plots, Egger’s test, and trim and fill analysis. All statistical analyses were conducted using R software, version 4.3.0.
Results
79 primary studies were included, comprising 6,256 children (<18 years old) and 6,582 adults (≥18 years old) with SCD from 22 countries. The prevalence of elevated ePASP was found to be 21.8% (95% confidence interval [CI]: 18.46 to 25.07) in children and 30.6% (95% CI: 27.1 to 34.1) in adults. The prevalence of elevated ePASP among studies with severe SCD genotypes including HbSS and HbS/β⁰ was found to be 19.45% (95% CI: 14.95 to 23.95) in children and 29.55% (95% CI: 24.21 to 34.89) in adults. Furthermore, sex-specific prevalence among SCD patients with elevated ePASP indicated the highest prevalence in male children at 60.35% (95% CI: 54.82 to 65.88) and adult female patients at 54.41% (95% CI: 47.3 to 61.5). A comparative analysis of the mean values of clinical and laboratory results revealed significant differences in several characteristics, including age, oxygen saturation, hemoglobin levels, fetal hemoglobin, white blood cell counts, platelet counts, and reticulocyte counts between patients with elevated ePASP and those without, in both children and adult SCD populations.
Conclusion
Our findings regarding clinically stable SCD patients highlight a high prevalence of elevated ePASP.
Introduction
Echinococcus granulosus is the etiological agent of cystic echinococcosis (CE), a tropical disease that is widely distributed yet often overlooked. As a major zoonotic parasitic disease, it impacts both humans and animals. Given the lack of a viable vaccine, therapy remains the sole preventive option for CE. This systematic review aims to consolidate existing research on biosynthesized nanoparticles as potential drugs for treating hydatid cyst protoscoleces in vitro, in vivo, and ex vivo.
Methods
This study was conducted following the PRISMA guidelines. A comprehensive global search was performed without date restrictions up to October 15th, 2024, using Google Scholar and six English-language databases, EMBASE, ProQuest, PubMed, Scopus, ScienceDirect, and Web of Science, to gather all relevant articles. The keywords used in the search were "protoscolicidal", "scolicidal", "protoscolex", "scolex", "nanoparticle", "nanomedicine", "nanomaterial", "green synthesis", "biosynthesis", "hydatid cyst", "cystic echinococcosis", and "Echinococcus granulosus".
Results
Out of the 2185 studies considered, this systematic review included twenty. Of these, thirteen (65%) were conducted in vitro, three (15%) were in vitro/ex vivo, two (10%) were in vivo, one (5%) was in vitro/ex vivo/in vivo, and one (5%) was in vitro/in vivo. The results indicated that metal nanoparticles, including silver, gold, zinc, copper, and selenium (n = 13, 65%), were the most commonly used biosynthesized nanoparticles in the study. Metal oxide nanoparticles, such as zinc oxide, copper oxide, nickel oxide, and silver-zinc oxide, were the next most frequent (n = 6, 30%). Lastly, a single study (n = 1, 5%) utilized polymeric nanoparticles, specifically chitosan-based ones.
Conclusion
This systematic review highlights the promising potential of biosynthesized nanoparticles as protoscolicidal agents against E. granulosus. The analysis of 20 studies revealed a predominant focus on metal nanoparticles, particularly silver, gold, zinc, copper, and selenium, which exhibited notable efficacy across in vitro, ex vivo, and in vivo settings. The findings emphasize the necessity of exploring diverse nanoparticle types, such as metal oxides and polymeric nanoparticles, to enhance treatment strategies for this neglected zoonotic disease.
Background
Social capital has long been recognized as a determinant of various health outcomes. However, the existence and magnitude of these associations may vary across different health conditions, different communities, and periods. This study aimed to investigate the association between social capital and major depressive disorder (MDD) among participants of the Persian Youth Cohort (PYC) study.
Methods
The PYC study enrolled 11,592 participants aged 15–34 years, from four cities in Iran representing a range of geographic areas. Baseline assessments included measuring lifetime MDD using the Persian version of the Composite International Diagnostic Interview (CIDI-2.1) and a 27-item social capital questionnaire to evaluate voluntary participation, trust, and sense of cohesion. We analyzed the baseline data using logistic regression to identify potential associations.
Results
The prevalence of lifetime MDD was 18.3%. The mean social capital-total score was 73.93 (SD = 13.93). A higher social capital-total score was inversely associated with the likelihood of MDD (AOR: 0.70, 95% CI: 0.66–0.74). Moreover, participants with higher scores in voluntary participation (AOR: 0.88, 95% CI: 0.83–0.92), trust (AOR: 0.65, 95% CI: 0.62–0.68), and sense of cohesion (AOR: 0.72, 95% CI: 0.68–0.75) were less probable to suffer from MDD.
Conclusion
Our study corroborates the existing evidence of the association between MDD and the three dimensions of social capital- participation, trust, and sense of cohesion- highlighting the consistency of these findings across diverse settings including young adults in Iran. The use of a valid diagnostic tool for assessing MDD adds robustness to our results, offering valuable insights for regions with similar social and cultural contexts. These findings suggest that interventions fostering social capital, particularly trust and cohesion, may help reduce the burden of MDD in youth.
Background
Enteral feeding uses feeding tubes for liquid food administration. Enteral feeding maintains gastrointestinal function but has complications like aspiration, diarrhea, and constipation. To avoid complications, nurses in intensive care units must have proper knowledge, attitude, and practice towards enteral feeding.
Method
A systematic review was conducted. The search was restricted to January 2000 to April 2024, encompassing scientific journals accessible via the following online databases: PubMed (including Medline), Cochrane Library, Scopus, Web of Science, and Embase. Google Scholar was searched comprehensively to include all relevant studies. The search strategy employed the following keywords and medical subject headings: [knowledge OR attitude] AND [enteral feeding OR enteral nutrition] AND nurs*. Only cross-sectional studies were included in this systematic review. Two authors independently conducted the selection of eligible studies, data extraction, and risk of bias assessment. Due to the discrepancies in methodologies and research goals among the investigated studies, a narrative synthesis was conducted.
Results
In total, there were 3187 articles found in the initial search across five online electronic databases. Finally, a thorough review was conducted, incorporating 22 studies. Based on the studies analyzed in this systematic review, nurses showed a positive attitude toward enteral feeding; there was a necessity to enhance their knowledge and practice. Continuous education combined with interdisciplinary collaboration can significantly improve nurses’ knowledge and practice of enteral feeding.
Conclusion
Many studies highlight the necessity of enhancing the knowledge and practice of nurses in this area. Implementing educational interventions has positively impacted nurses’ knowledge and performance.
Background
In vitro fertilization (IVF) has been acknowledged as the primary assisted reproductive technique for fertilizing oocytes outside the female reproductive system. Sleep disorders are likely to affect infertility and its treatment. The present study was to investigate the relationship between sleep disturbances and IVF outcomes in infertile women.
Methods
Databases, including PubMed, Embase, Cochrane Library, ProQuest, and Web of Science, were searched for the relevant articles published up to September 2023. The Newcastle–Ottawa Scale was used to assess the methodological quality of the included studies. Moreover, the random and fixed effects models using the STATA (v.11) software program presented the odds ratio with a 95% confidence interval (CI). Ultimately, a funnel plot was recruited to examine the sensitivity analysis.
Results
During the initial search, 426 articles were retrieved, and ultimately, nine studies remained for systematic review, and among them, four studies entered into the meta‐analysis (two cohort and two cross‐sectional studies). According to the fixed effects model of the cross‐sectional studies, the association between sleep quality and pregnancy rate was not confirmed (OR = 0.94; 95% CI = 0.81–1.07). Regarding the fixed effects model of included cohort studies, the results indicated an association between sleep quality and the pregnancy rate (OR = 1.08; 95% CI = 1.03–1.14). According to the random effects model of the cross‐sectional studies, there was no significant association between sleep quality and pregnancy rate (OR = 0.82; 95% CI = 0.37–1.26). Regarding the random effect analysis of included cohort studies, the results indicated an association between sleep quality and the pregnancy rate (OR = 1.08; 95% CI = 1.03–1.14). Based on the total fixed effect analysis of the cross‐sectional and cohort studies, the results also showed a significant association between sleep quality and pregnancy rate among infertile women (OR = 1.06; 95% CI = 1.01–1.11). In contrast, according to the random effect of the total studies, this association was not confirmed (OR = 1.02; 95% CI = 0.90–1.14).
Conclusion
Although the meta‐analysis of the cohort studies showed a significant association between sleep quality and IVF outcomes, such as pregnancy rate, due to the novelty of the subject, more studies have not been published, and this study is considered a preliminary meta‐analysis. Therefore, more studies with a strong methodology need to assess the relationship between sleep disorders and IVF outcomes.
Background
This study aimed to evaluate the moral competence and conflict management styles in emergency nurses
Materials and methods
This cross-sectional study was conducted among emergency department nurses. Convenience sampling was employed. The data collection tools comprised a demographic-occupational questionnaire, a questionnaire assessing the moral competence of clinical nurses, and another questionnaire focused on exploring conflict management styles.
Results
190 emergency department nurses were involved in this study. The study revealed that emergency department nurses’ average moral competence score was 159.81 (SD = 13.00), ranging from 121 to 184 points. Among emergency department nurses, the average score for conflict management styles stood at 105.61 (SD = 10.67), ranging from 41 to 132 points. The study findings revealed statistically significant associations between several factors and nurses’ overall moral competence score; age group (P = 0.004) and type of employment (P = 0.035) showed substantial relationships. Significant associations emerged between the overall conflict management score, job position (P = 0.021), and age group (P = 0.044).
Conclusion
Emergency nurses demonstrated a commendable average score in moral competence and predominantly utilized conflict management styles over participation styles when handling conflicts. A robust and direct correlation between ethical competence and conflict management was also observed.
Aging is a complex and heterogeneous biological process characterized by telomere attrition, genomic instability, mitochondrial dysfunction, and disruption in nutrient sensing. Besides contributing to the progression of cancer, metabolic disorders, and neurodegenerative diseases, these manifestations of aging also adversely affect organ function. It is crucial to understand these mechanisms and identify interventions to modulate them to promote healthy aging and prevent age-related diseases. Vitamins have emerged as potential modulators of aging beyond their traditional roles in health maintenance. There is an increasing body of evidence that hormetic effects of vitamins are responsible for activating cellular stress responses, repair mechanisms, and homeostatic processes when mild stress is induced by certain vitamins. It is evident from this dual role that vitamins play a significant role in preventing frailty, promoting resilience, and mitigating age-related cellular damage. Moreover, addressing vitamin deficiencies in the elderly could have a significant impact on slowing aging and extending life expectancy. A review of recent advances in the role of vitamins in delaying aging processes and promoting multiorgan health is presented in this article. The purpose of this paper is to provide a comprehensive framework for using vitamins as strategic tools for fostering longevity and vitality. It offers a fresh perspective on vitamins’ role in aging research by bridging biological mechanisms and clinical opportunities.
Although recent research on both agency and social justice has paid attention to the role of these constructs in teachers' professionalism, the scope of research on how language teachers' agency and social justice intersect is limited. Drawing on an ecological perspective that captured teachers' temporal and spatial perceptions, and how structural forces shape teacher agency, we explored agency and social justice among Iranian English language teachers. Data were collected from open-ended questionnaires, narrative frames, and semi-structured interviews. The analysis of the data revealed that teachers used their personal histories and experiences, present sense-making processes, and future-oriented perspectives as agentive tools to promote social justice in their educational practices. The findings also showed that teachers used the affordances of their educational setting as a tool for fostering students' criticality and activism. The study concludes with a discussion of implications for teacher educators in how to build on agency in teacher education courses to develop understandings of social justice.
Brain tumor treatment remains a significant challenge due to their high mortality and resistance to current therapies. This paper discusses the promising potential of hydrogel-based nanoparticles as innovative drug delivery systems for brain tumor therapy. Extensive characterization techniques reveal the ability of these Nano-systems to demonstrate prolonged blood circulation and targeted delivery, leading to improved survival rates. Designed with optimized physicochemical characteristics, these nanoparticles effectively cross the blood–brain barrier, circumventing a major impediment to drug delivery to the brain. By delivering drugs directly to the tumor bed, these nanoparticles enhance therapeutic outcomes and minimize adverse effects. In addition, this review investigates the techniques for characterizing, visualizing, and modifying these nanoparticles, as well as the standing challenges and promising research avenues for their clinical application. Further investigations are encouraged by this review to investigate potential advancements in hydrogel-based nanoparticle therapeutic approaches for brain tumors. This includes investigating tailored hydrogels, hybrid systems, computational modeling, and the integration of gene therapy and immunotherapy techniques. The study also addresses the need for enhanced synthesis techniques, stability, scalability, and cost-cutting measures to overcome obstacles and advance the clinical use of hydrogel-based nanoparticles in treating brain tumors.
Graphical abstract
Aptamer-based biosensors, commonly referred to as aptasensors, represent a promising class of diagnostic tools that have garnered significant attention over the past decade. A novel approach in the design of these biosensors involves the incorporation of nanozymes as enzyme-like mimetics, with iron oxide nanoparticles (IONPs) emerging as particularly effective peroxidase mimics due to their ability to facilitate Fenton-like reactions. Aptamers serve dual roles in this context: they act as recognition elements in Fenton-like activity-based sensors and are crucial for the surface functionalization of nanoparticles. The integration of aptamers enhances the performance and selectivity of biosensors by minimizing unwanted background signals associated with colorimetric and fluorescent measurements, thus improving detection limits. This study investigates the impact of buffer optimization and various oligo-aptamer dependent variables on the design of Fenton-like reaction-based aptasensors, utilizing zeta potential measurements as a diagnostic tool. Key factors explored include buffer types and concentrations, aptamer length and sequence, and incubation times. Optimizing these parameters is expected to significantly influence the efficacy of Fenton-like aptasensors. The findings suggest that zeta potential measurement is a valuable technique for real-time monitoring of the surface coating conditions of nanozymes with aptamers, facilitating the optimization of multiple parameters critical for developing effective Fenton-like reaction-based aptasensors.
Background
Legg-Calve-Perthes Disease (LCPD) is described as idiopathic avascular osteonecrosis of the capital femoral epiphysis in pediatrics. LCPD is usually present in children between 2 and 15 years and happens more frequently in boys more than girls; this study aims to compare the outcome of two surgical methods in treating LCPD.
Methods
We included sixty patients with unilateral LCPD who underwent Salter or femoral varus osteotomy from 2007 to 2017. Patients were followed up for at least five years. Patients’ claudication, pain, leg circumference, range of motion, lever arm ratio (LAR), neck shaft angle (NSA), migration index, vertical distance, and the presence of teardrop sign, sagging rope sign, and Trendelenburg sign were evaluated five years after surgery.
Results
The mean neck shaft angle, the lever arm ratio, migration index and, sagging rope sign incidence in patients undergoing femoral varus osteotomy were significantly lower than those undergoing Salter surgery; the thigh circumference was higher in patients undergoing femoral varus osteotomy than those undergoing Salter osteotomy.
Conclusion
There were significant differences in biomechanical indices of hip and acetabulofemoral in salter and femoral varus osteotomy; the results of the current study are highly suggestive of prioritizing femoral varus osteotomy to Salter surgery.
Background
Basic helix-loop-helix protein 40 (BHLHE40) can function as both a transcriptional activator and repressor. Recent studies have reported its regulatory functions in T helper (Th)1 and Th17 immune responses. Rheumatoid arthritis (RA) is an autoimmune inflammatory disease in which joints are involved. Both Th1 and Th17 contribute to the pathogenesis of the disease. In the present study, the levels of BHLHE40, interleukin 17 (IL-17), and interferon-gamma (IFN-γ) were assessed in the RA patients.
Methods
Two groups, including RA patients and healthy individuals, were included in the study. The relative expression levels of BHLHE40, IL-17, and IFN-γ were quantified in peripheral blood mononuclear cells (PBMCs) using real-time PCR.
Results
The results showed that the level of BHLHE40 was significantly higher in RA patients compared to the healthy control (P < 0.001) (11.1-fold increase). Accordingly, a significant increase in the levels of IL-17 (8.1 folds increase) (P < 0.021) and IFN-γ (12.7 folds) (P < 0.001) was observed.
Conclusion
Evaluation of the expression level of BHLHE40 in RA patients showed a significant increase. In line with the elevated level of BHLHE40, a significant increase in the expression level of IL-17 and IFN-γ was also detected. These findings point to the possible role of BHLHE40 in the disease course or severity by elevating the levels of inflammatory cytokines, including IL-17 and IFN-γ. Therefore, BHLHE40 might be considered either as a putative biomarker or as a candidate for therapy in a variety of human diseases.
Background
The aim of this review is to compare the clinical outcomes of different soft tissue grafting materials (connective tissue graft (CTG), platelet-rich fibrin (L-PRF), allogenic and xenogenic substitutes) applied in immediate implant placement with each other.
Methods
Through an electronic search regarding the study’s main question (“In patients with non-restorable teeth, who receive immediate dental implants (P), what is the best adjunctive soft tissue grafting approach among different autogenous, allogenous, and xenogenous grafts (I), to achieve the desired hard and soft tissue structure (O), compared to sites without grafting (C)?”) in PubMed, Scopus, and ISI Web of Science, randomized controlled clinical trials (RCTs) using different soft tissue grafts were identified and analyzed using a Bayesian random-effect network meta-analysis framework. The pink esthetic score (PES), marginal interproximal bone level changes (MIBL), buccal bone thickness changes (BBT), keratinized tissue width changes (KTW), soft tissue thickness changes (STT), papilla height changes (PH), midfacial gingival margin level changes (MGML) were defined as desired outcomes of the study; except for the MIBL with 12 – 24 months of follow-up, 6 – 12 months is considered for other outcomes.
Results
After duplication removal, 903 studies were identified through the electronic search; from which 21 RCTs were included in the review. Among all comparisons in different outcomes, only CTG demonstrated a significantly higher gain in STT compared to not placing soft tissue graft. However, CTG in MIBL, KTW, STT, PH, and MGML, and uni-layer xenogenic collagen matrix in PES were the superior treatments, according to the treatment ranking based on surface under cumulative ranking (SUCRA).
Conclusions
At the time of immediate implantation, there is no significant difference between different soft tissue grafts regarding the clinical outcomes of implants. However, the utilization of CTG can be suggested in cases with thin soft tissue. The acceptable efficacy of allogenic and xenogenic materials and the non-significant difference between them and CTG indicate supporting evidence for the application of these materials to specific clinical situations simultaneously with immediate implantation.
Systematic review registration
CRD42024568586.
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