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"recession"
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Laterally closed tunnel technique with and without adjunctive photobiomodulation therapy for the management of isolated gingival recession—a randomized controlled assessor-blinded clinical trial
The objective of this prospective randomized controlled single-center clinical trial was to prove the efficacy of adjunctive photobiomodulation in improving selected outcomes following the use of laterally closed tunnel technique for the management of isolated gingival recession. Nineteen participants (with isolated gingival recession) each treated by laterally closed tunnel technique were randomized to either add on treatment with control (sham laser application) or test group (photobiomodulation with 660 nm diode, 3.5 J/cm2 per point of application). The primary outcome variable was change in recession depth and secondary variables included recession width, width of keratinized gingiva, periodontal biotype, and VAS score for pain assessment and EHS index for early wound healing assessment. Analysis was performed using a linear mixed effects model. There were no significant differences in the gingival recession depth (p = 0.8324) and recession width (p-0.969) at 3-month follow-up. The VAS scores were significantly lower for the test (laterally closed tunnel technique + photobiomodulation) group as compared to control (laterally closed tunnel technique + sham laser) over time (p = < 0.0001) as well as per site (p = 0.0006) The Early Wound Healing Index scores were significantly higher in the test (laterally closed tunnel technique + photobiomodulation) group as compared to control (laterally closed tunnel technique + sham laser) group (p < 0.0001). The adjunctive use of photobiomodulation did not show a better outcome concerning recession depth but appears to provide faster healing of the surgical wounds and better patient comfort. The result needs further evaluation in particular with respect to long-term effect and due to limitation in sample size. Clinical Trial Registry of India: CTRI/2019/11/022012.
Journal Article
Effectiveness of vestibular incision subperiosteal tunnel access (VISTA) technique with or without A-PRF in treatment of multiple adjacent gingival recession defects (MAGRD): A 12 months CBCT study
In order to treat MAGRD in the maxillary anterior region, the VISTA approach was evaluated and compared with and without A-PRF.
A split mouth RCT was designed with 216 MAGRD that were assigned to VISTA alone and VISTA with A-PRF. The complete root coverage (CRC) and gingival thickness (GT) were measured using CBCT at baseline and 12 months post-operatively, while the clinical parameters of probing depth (PD), clinical attachment level (CAL), width of keratinized gingival (WKG), gingival recession depth (GRD), and gingival recession width (GRW) were recorded at baseline, 6 months, and 12 months.
From baseline to 12 months, there was a significant decrease in the mean values of GRD and GRW with an increase in WKG. CBCT scans showed a significant increase in GT mean values. According to these results, the Test group's CRC was higher (95.92%) than the Control groups (85.02%).
In contrast to the Control group, the Test group demonstrated superior MAGRD resolution in achieving a decrease in GRD and GRW as well as a higher increase in WKG and GT. These findings resulted into a substantially more CRC for the Test group.
Registration no. CTRI/2022/09/045845. Registered on: 26/09/2022.
Journal Article
Output Spillovers from Fiscal Policy
For a large number of OECD countries we estimate the cross-country spillover effects of government purchases on output. Following the methodology in Auerbach and Gorodnichenko (2012a, b), we allow these multipliers to vary smoothly according to the state of the economy and use real-time forecast data to purge policy innovations of their predictable components. Our findings suggest that cross-country spillovers have an important impact. The findings also confirm those of our earlier papers--namely that fiscal shocks have a larger impact when the affected country is in recession.
Journal Article
Effects of photobiostimulation and antimicrobial photodynamic therapy associated with gingival grafts for root coverage: three-arm randomized clinical trial
To compare the effects of different laser therapies as adjuncts to root coverage of multiple gingival recessions (MGR) through a three-arm parallel study. Fifty-four patients with MGR underwent standardized treatment with subepithelial connective tissue graft of 1 mm. The patients were divided into three groups: control group (C)—scaling only + sham (
n
= 18), antimicrobial photodynamic therapy (APDT) group (
n
= 18): toluidine blue O 10 mg/ml acidic pH + InAlGaP laser 660 nm; 100 mW, 2.32 W/cm
2
; 3 J, 30 s/tooth, (23 J/cm
2
/point), and photobiostimulation therapy (PBM) group (
n
= 18): InAlGaP laser 660 nm; 100 mW, 2.32 W/cm
2
; 7 J, 70 s/flap, 161 J/cm
2
(23 J/cm
2
/point), a total of eight applications, each 48 h, within a 14-day period. Patient-Reported Outcome Measures (PROMs), and quality of life questionnaires (OHIP- 14) were collected up to 12 months. A total of 180 gingival recessions were treated, with the PBM group exhibiting superior outcomes in terms of complete root coverage (CRC) at 6 and 12 months. Complementary clinical outcomes showed no significant differences among groups. The PBM group achieved the highest frequency of completely covered teeth (100%) at six months, compared to the other groups (
p
: 0.021 PBM vs. APDT and
p
: < 0.001 PBM vs. C). Despite the study's limitations, the PBM group exhibited more favorable outcomes in CRC and demonstrated superior results in PROMs. The findings suggest that PBM may have contributed to accelerating root coverage outcomes, with positive effects observed as early as 3 months postoperatively and the results were sustained at 6 and 12 months. NCT03462368.
Journal Article
On DSGE Models
The outcome of any important macroeconomic policy change is the net effect of forces operating on different parts of the economy. A central challenge facing policymakers is how to assess the relative strength of those forces. Economists have a range of tools that can be used to make such assessments. Dynamic stochastic general equilibrium (DSGE) models are the leading tool for making such assessments in an open and transparent manner. We review the state of mainstream DSGE models before the financial crisis and the Great Recession. We then describe how DSGE models are estimated and evaluated. We address the question of why DSGE modelers—like most other economists and policymakers—failed to predict the financial crisis and the Great Recession, and how DSGE modelers responded to the financial crisis and its aftermath. We discuss how current DSGE models are actually used by policymakers. We then provide a brief response to some criticisms of DSGE models, with special emphasis on criticism by Joseph Stiglitz, and offer some concluding remarks.
Journal Article
Gingival recession: its causes and types, and the importance of orthodontic treatment
abstract Gingival recession has direct causes and predisposing factors. Orthodontic treatment is able to prevent recession and even contribute to its treatment, with or without periodontal approach, depending on the type and severity of gingival tissue damage. There is no evidence on the fact that orthodontic treatment alone might induce gingival recession, although it might lead the affected teeth (usually mandibular incisors or maxillary canines) to be involved in situations that act as predisposing factors, allowing direct causes to act and, therefore, trigger recession, especially when the buccal bone plate is very thin or presents with dehiscence. Several aspects regarding the relationship between orthodontic treatment and gingival recession have been addressed, and so has the importance of the periosteum to the mechanism of gingival recession formation. Clinical as well as experimental trials on the subject would help to clarify this matter, of which understanding is not very deep in the related literature. Resumo As recessões gengivais têm causas diretas e fatores predisponentes. O tratamento ortodôntico pode prevenir as recessões e, até, contribuir para o seu tratamento, com ou sem uma abordagem por parte do periodontista, dependendo do tipo e da severidade do comprometimento dos tecidos gengivais. Não há evidências de que o tratamento ortodôntico possa induzir, de forma primária, as recessões gengivais, muito embora possa levar os dentes envolvidos (comumente, os incisivos inferiores e os caninos superiores) a situações que ajam como fatores predisponentes para que as causas diretas possam atuar e produzir recessões - em especial, quando deixa-se uma tábua óssea vestibular muito fina ou, até, com deiscência. Vários aspectos da relação entre o tratamento ortodôntico e as recessões gengivais já foram abordados, assim como a importância do periósteo no mecanismo de formação delas. Trabalhos clínicos e experimentais sobre o assunto ajudariam a esclarecer o assunto, que ainda se apresenta muito pouco aprofundado na literatura pertinente.
Journal Article
Fluctuations in Uncertainty
Uncertainty is an amorphous concept. It reflects uncertainty in the minds of consumers, managers, and policymakers about possible futures. It is also a broad concept, including uncertainty over the path of macro phenomena like GDP growth, micro phenomena like the growth rate of firms, and noneconomic events like war and climate change. In this essay, I address four questions about uncertainty. First, what are some facts and patterns about economic uncertainty? Both macro and micro uncertainty appear to rise sharply in recessions and fall in booms. Uncertainty also varies heavily across countries—developing countries appear to have about one-third more macro uncertainty than developed countries. Second, why does uncertainty vary during business cycles? Third, do fluctuations in uncertainty affect behavior? Fourth, has higher uncertainty worsened the Great Recession and slowed the recovery? Much of this discussion is based on research on uncertainty from the last five years, reflecting the recent growth of the literature.
Journal Article
What Happened
At the onset of the recent global financial crisis, the workhorse macroeconomic models assumed frictionless financial markets. These frameworks were thus not able to anticipate the crisis, nor to analyze how the disruption of credit markets changed what initially appeared like a mild downturn into the Great Recession. Since that time, an explosion of both theoretical and empirical research has investigated how the financial crisis emerged and how it was transmitted to the real sector. The goal of this paper is to describe what we have learned from this new research and how it can be used to understand what happened during the Great Recession. In the process, we also present some new empirical work. We argue that a complete description of the Great Recession must take account of the financial distress facing both households and banks and, as the crisis unfolded, nonfinancial firms as well. Exploiting both panel data and time series methods, we analyze the contribution of the house price decline, versus the banking distress indicator, to the overall decline in employment during the Great Recession. We confirm a common finding in the literature that the household balance sheet channel is important for regional variation in employment. However, we also find that the disruption in banking was central to the overall employment contraction.
Journal Article
Escaping the Great Recession
We show that policy uncertainty about how the rising public debt will be stabilized accounts for the lack of deflation in the US economy at the zero lower bound. We first estimate a Markov-switching VAR to highlight that a zero-lower-bound regime captures most of the comovements during the Great Recession: a deep recession, no deflation, and large fiscal imbalances. We then show that a microfounded model that features policy uncertainty accounts for these stylized facts. Finally, we highlight that policy uncertainty arises at the zero lower bound because of a trade-off between mitigating the recession and preserving long-run macroeconomic stability.
Journal Article