Marginal Bone Loss Evaluation Postdental Implants Placed with Platelet-Rich Plasma: An Original Research.

Introduction: Various materials are used to improve the longevity of the dental implants. In our study, we assessed the marginal bone loss around dental implants after implantation with platelet-rich plasma. Materials and Methods: We conducted a prospective clinical study among 200 subjects who were grouped equally as those with and without the application of PRF in the implantation. The radiographic and clinical features for the marginal bone loss were assessed and compared keeping P < 0.05 as statistically significant. Results: We observed no significant variation between the groups for the mobility, bleeding on probing, plaque index, and marginal bone loss. Conclusion: We can conclude that the application of PRP concentrate did not significantly affect the marginal bone loss in the dental implantation.

Low-Level Laser Therapy Role in Surgical Extractions: An Original Research.

Introduction: Low-level laser therapy (LLLT) has been of interest in the clinical application in dentistry. Hence, we evaluated the LLLT on the wound healing in the mandibular surgical extraction. Materials and Methods: We conducted a prospective clinical study with 50 male subjects, equally distributed as controls and cases. Routine surgical extraction was done for control group, and in case group, LLLT was applied after the extraction. Evaluation was done for various parameters and after comparison the P value was less than 0.05 which was considered as significant. Results: Significant difference was seen between the groups for the socket depth on 7th day, swelling on 1st, 3rd, and 5th days, and pain on all the days. Conclusion: LLLT can be successfully used for the surgical extractions.

CD44-positive cancer stem cells from oral squamous cell carcinoma exhibit reduced proliferation and stemness gene expression upon adipogenic induction.

We proposed to assess adipogenic differentiation and its effect on the proliferation and stemness markers in CD44 + OSCC CSCs. D44 + CSCs were sorted by magnetic sorting from the single-cell suspension of the OSCC tumor. Adipogenic differentiation was induced by an adipogenic induction medium. Lipid droplet formation was confirmed by oil red O staining. The expression of the cell surface marker was analyzed by flow cytometry. Real-time qPCR was performed to examine the gene expression activity. CD44 + OSCC CSCs can differentiate into adipocytes and adipogenesis in these cells decrease their proliferation and stemness gene expression. Adipogenic induction can make the cancer stem cells from OSCC tumors lose their stemness potential. Oral cancer, especially OSCC, is a huge burden worldwide. Similar to other stem cells, cancer stem cells can differentiate into other lineage cells. Our study shows that the proliferation and stemness gene expression in the CSCs from OSCC tumors can be thwarted by inducing them to differentiate into adipocytes, which could be advantageous to find out new clinical approaches in the treatment of cancers, like OSCC.

Use of Collagen Membrane in the Treatment of Periodontal Defects Distal to Mandibular Second Molars Following Surgical Removal of Impacted Mandibular Third Molars: A Comparative Clinical Study.

The study aims to assess the efficacy of using collagen membrane in the treatment of distal periodontal defects of mandibular second molars following the removal of mesioangularly or horizontally impacted mandibular third molars surgically. Forty sites in twenty patients with bilaterally impacted mandibular third molars (mesioangular or horizontal) were considered for the study. In 20 test sites (Group A), after surgical removal of the mandibular third molar, a resorbable collagen membrane barrier was placed on the distal aspect of the mandibular second molar to cover the post-surgical bone defect. In the other control 20 sites (Group B), the same surgical procedure was repeated without placing any membrane barrier. The clinical parameters recorded were Oral Hygiene Index Simplified (OHI-S), Probing pocket depth (PPD), Clinical attachment level (CAL), and radiographic assessment of alveolar bone level (ABL). OHI-S score of most of the patients was observed to be satisfactory. Group A was observed to achieve a statistically significant reduction in PPD, CAL, and ABL gain compared to Group B. The improvements indicated that the use of collagen membrane facilitates early wound stabilization and promotes primary closure of the defect. This recovery is achieved through its unique property to assist fibrinogenesis over osteoconduction. Further longitudinal studies are needed to confirm the present findings.

Detection of Nail Oncometabolite SAICAR in Oral Cancer Patients and Its Molecular Interactions with PKM2 Enzyme.

Oncometabolites are known to drive metabolic adaptations in oral cancer. Several oncometabolites are known to be shared between cancer cells and non-cancer cells including microbiotas to modulate the tumor microenvironment. Among potential oncometabolites, succinylaminoimidazolecarboxamide ribose5'-phosphate (SAICAR) supports the growth and invasiveness of cancer cells by pyruvate kinase M2 (PKM2) enzyme in a glucose starved tumor microenvironment. There is a significant gap that shows the detection of SAICAR in biological samples including nails of oral cancer patients. Metabolite identification of SAICAR was investigated in the nails of oral cancer patients using novel vertical tube gel electrophoresis (VTGE) and LC-HRMS. Further molecular docking and molecular dynamics simulations (MDS) were employed to determine the nature of molecular interactions of SAICAR (CHEBI ID:18319) with PKM2 (PDB ID: 4G1N). Molecular docking of SAICAR (CHEBI ID:18319) was performed against pyruvate kinase M2 (PDB ID: 4G1N). Data suggest the presence of oncometabolite SAICAR in nails of oral cancer. Molecular docking of SAICAR with PKM2 showed appreciable binding affinity (-8.0 kcal/mol) with residues including ASP407, THR405, GLU410, ARG443, GLY321, ARG436, HIS439, LYS266, and TYR466. Furthermore, MDS confirmed the specific binding of SAICAR within the activator site of PKM2 and the stability of SAICAR and PKM2 molecular interactions. In conclusion, SAICAR is a promising oncometabolite biomarker present in the nails of oral cancer patients. A significant activation potential of SAICAR exists with the PKM2 enzyme.

A 5-Year Satisfaction Outcome Study of Patients Receiving Six-Implant-Supported Fixed Prosthesis.

The aim of the study was to analyze the satisfaction of patients treated with a protocol of six-implant-supported fixed prosthesis (6IFP) throughout 5 years of service. This retrospective study collected the data of all patients who had full-arch rehabilitations using 6IFP and followed them for 5 years. After applying the research inclusion/exclusion strategy, 37 cases were finally included in the study. All the patients had no previous complete dentures because they were partially edentulous, not interested in pursuing complete denture rehabilitation, had immediate dental extractions, implantation used the 2-stage protocol, and there was minor peri-implant socket grafting. Cases with severe bone loss that required extensive grafting were excluded. A total number of 222 implants were placed in the maxillary or mandibular arches in a total of 37 patients. The data presented the satisfaction outcomes concerning mastication, phonetics, and comfort during the first 5 years of the recall plan. The former was achieved based on the clinical record reviews, follow-up visits, and recall phone calls at the preoperative stage as well as annually thereafter. The mean satisfaction rate was 94.5%, with a mean record of 8.21 ± 1.7 out of 10, there was no gender predilection significance, and no age range variation significance was validated. Regarding the smoking status, the t-test score exhibited no significant effect on phonetics and mastication (p = 0.12, p = 0.16, respectively), whereas comfort was found to be significantly affected (p = 0.03). The comfort level was found to be slightly less at the immediate postoperative period among smokers when compared to non-smokers. In conclusion, partially edentulous patients who received the rehabilitation plan of arch dental extractions, six immediate implantations, and delayed prosthetic loading were found to be highly satisfied.

The Growth Factors and Cytokines of Dental Pulp Mesenchymal Stem Cell Secretome May Potentially Aid in Oral Cancer Proliferation.

BACKGROUND: Growth factors and cytokines responsible for the regenerative potential of the dental pulp mesenchymal stem cell secretome (DPMSC-S) are implicated in oral carcinogenesis. The impact and effects of these secretory factors on cancer cells must be understood in order to ensure their safe application in cancer patients. OBJECTIVE: We aimed to quantify the growth factors and cytokines in DPMSC-S and assess their effect on oral cancer cell proliferation. MATERIALS AND METHODS: DPMSCs were isolated from patients with healthy teeth (n = 5) that were indicated for extraction for orthodontic reasons. The cells were characterized using flow cytometry and conditioned medium (DPMSC-CM) was prepared. DPMSC-CM was subjected to a bead-based array to quantify the growth factors and cytokines that may affect oral carcinogenesis. The effect of DPMSC-CM (20%, 50%, 100%) on the proliferation of oral cancer cells (AW123516) was evaluated using a Ki-67-based assay at 48 h. AW13516 cultured in the standard growth medium acted as the control. RESULTS: VEGF, HCF, Ang-2, TGF-α, EPO, SCF, FGF, and PDGF-BB were the growth factors with the highest levels in the DPMSC-CM. The highest measured pro-inflammatory cytokine was TNF-α, followed by CXCL8. The most prevalent anti-inflammatory cytokine in the DPMSC-CM was IL-10, followed by TGF-ß1 and IL-4. Concentrations of 50% and 100% DPMSC-CM inhibited Ki-67 expression in AW13516, although the effect was non-significant. Moreover, 20% DPMSC-CM significantly increased Ki-67 expression compared to the control. CONCLUSIONS: The increased Ki-67 expression of oral cancer cells in response to 20% DPMSC-CM indicates the potential for cancer progression. Further research is needed to identify their effects on other carcinogenic properties, including apoptosis, stemness, migration, invasion, adhesion, and therapeutic resistance.

Malondialdehyde, an Oxidative Stress Marker in Oral Squamous Cell Carcinoma-A Systematic Review and Meta-Analysis.

OBJECTIVE: To qualitative and quantitatively review published literature assessing the oxidative stress marker malondialdehyde (MDA) in oral squamous cell carcinoma (OSCC). METHODOLOGY: Pubmed (MeSH), Science Direct, Scopus, Web of Science, Willey Online Library, Cochrane, and Cross Reference were searched for studies assessing MDA levels in OSCC samples. RESULTS: From the 1008 articles identified, 849 were excluded based on title and abstract screening due to duplication and irrelevance to the topic of interest. Full-text assessment of the remaining 159 articles led to the inclusion of only 46 articles that satisfied the selection criteria. Of these, only 26 studies had data compatible for quantitative analysis. The MDA levels in OSCC groups are significantly increased (p < 0.00001) in plasma, serum, and saliva samples in the majority of the studies evaluated. In contrast, MDA levels in OSCC tissue samples are significantly attenuated (p < 0.00001) compared to healthy controls, supported by fewer studies. CONCLUSIONS: The augmented MDA levels in plasma, serum, and saliva samples of the OSCC reflect the heightened oxidative stress level accurately. Further studies are required to understand the attenuated MDA levels in the tissue samples of OSCC. Correlation analysis between MDA levels with established clinicopathological prognostic markers could aid in formulating oxidative stress-based prognostication and treatment planning.

Assessment of extracting molars and premolars after root canal treatment: A retrospective study.

BACKGROUND: The loss of dentition after root canal treatment is a multifactorial entity which might differ between different teeth. The extraction can be more critical, as well as the rehabilitation options. AIM: To analyze if the etiology of extracting root canal treated teeth is different between premolars and molars. MATERIALS AND METHODS: The study included a total of 403 cases with non-surgical root canal therapy (NSRCT) and crown coverage that was referred to the oral surgery clinic for extraction. Tooth type, patient's age, gender, time since treatment completion, and the reason for extractions were recorded and analyzed. RESULTS: The most frequently extracted teeth were molars (55.6%), followed by premolars (30.3%) and anterior teeth (14.1%). The reasons for extraction were subgingival decay (SGD) (62.5%), vertical root fractures (VRF) (25.3%), and patient demands after uncomfortableabscess discharge (12.2%). Most of the teeth survived between 13 and 36 months after NSRCT. The statistical power of 0.92 was demonstrated, and a P-value of less than 0.05 presented significant correlations. CONCLUSION: Molars were extractedafter NSRCT due to SGD followed by premolars, which were extracted due to VRF. Special care should be taken while planning NSRCT treatment for molars, in particular, with emphasis on the importance of oral hygiene and follow-up visits.

Effects of mineral trioxide aggregate, calcium hydroxide, biodentine and Emdogain on osteogenesis, Odontogenesis, angiogenesis and cell viability of dental pulp stem cells.

BACKGROUND: Vital pulp therapy preserves and maintains the integrity and the health of dental pulp tissue that has been injured by trauma, caries or restorative procedures. The enhancement of cells viability and formation of reparative dentine and new blood vessels are vital determinants of the success of direct pulp capping. Therefore, the aims of this study was to evaluate and compare the in vitro osteogenic, odontogenic and angiogenic effects of mineral trioxide aggregate (MTA), calcium hydroxide [Ca(OH)2], Biodentine and Emdogain on dental pulp stem cells (DPSCs) and examine the effects of the tested materials on cell viability. METHODS: DPSCs were treated with MTA, Ca(OH)2, Biodentine or Emdogain. Untreated cells were used as control. The cell viability was measured by MTT assay on day 3. Real-Time PCR with SYBR green was used to quantify the gene expression levels of osteogenic markers (alkaline phosphatase and osteopontin), odontogenic marker (dentin sialophosphoprotein) and angiogenic factor (vascular endothelial growth factor) on day 7 and day 14. RESULTS: All capping materials showed variable cytotoxicity against DPSCs (77% for Emdogain, 53% for MTA, 26% for Biodentine and 16% for Ca(OH)2 compared to control (P value < 0.0001). Osteopontin (OPN) and dentin sialophosphoprotein (DSPP) gene expression was increased by all four materials. However, alkaline phosphatase (ALP) was upregulated by all materials except Emdogain. Vascular endothelial growth factor (VEGF) expression was upregulated by all four tested materials except Ca(OH)2. CONCLUSIONS: Our results suggest MTA, Biodentine and Emdogain exhibit similar attributes and may score better than Ca(OH)2. Emdogain could be a promising alternative to MTA and Biodentine in enhancing pulp repair capacity following dental pulp injury. However, further future research is required to assess the clinical outcomes and compare it with the in vitro findings.

Severity and causality of maxillofacial trauma in the Southern region of Saudi Arabia.

OBJECTIVE: The purpose of this study was to examine the causality and severity of maxillofacial trauma (MFT) among patients referred to a tertiary heath care center in the Southern Aseer region of Saudi Arabia. MATERIALS AND METHODS: The charts of all MFT patients referred to the tertiary care center from September 2010 to November 2011 were retrospectively reviewed. Pertinent data, including patient age, gender, and cause of injury, were obtained from 101 selected charts. RESULTS: Male patients comprised 91% of the 101 selected cases. The highest percentage of MFT cases (88.7%) were caused by road traffic accidents (RTAs) while physical altercations and sports injuries accounted for approximately 6% and 2.8% of MFT cases, respectively. A high fracture: patient ratio of 2.4:1 was observed, which was likely due to vehicular speeding (high energy trauma) involved in RTAs in the mountain regions. CONCLUSION: RTAs are a major cause of MFT in the southern region of Saudi. These accidents cause a heavy burden on the health care sector.

Preservation of posterior mandibular extraction site with allogeneic demineralized, freeze-dried bone matrix and calcium sulphate graft binder before eventual implant placement: a case series.

OBJECTIVE: This case series reports short- and long-term healing, before and after placement of an implant, in posterior mandibular extraction sites grafted with demineralized, freeze-dried bone matrix (DFDBM) allograft mixed with calcium sulphate graft binder. METHODS: Three patients who underwent surgical extraction of a posterior mandibular molar experienced partial loss of the buccal bone plate at the extraction site. Alveolar bone reconstruction with a DFDBM allograft mixed with calcium sulphate graft binder was performed immediately. The graft was covered with a biodegradable regenerative membrane. For each of the 3 patients, the implant and healing abutment were placed after 6, 9 and 12 months, respectively, followed by crown placement 3, 5 and 5 months later, respectively. The implants were periodically re-evaluated, both clinically and radiographically, between 10 and 39 months after final insertion of the crown. An implant stability device was used to evaluate the long-term biological and functional stability of the implants. RESULTS: Upon exposure and implant placement, the grafted alveolar ridge in all patients presented appropriately sized, dense and well-vascularized bone, wide enough to receive the planned wide-platform implant. The long-term interface stability quotient ranged from 87 to 90. CONCLUSIONS: Posterior mandibular extraction sites with compromised buccal alveolar bone may be effectively managed by immediate alveolar augmentation using a mixture of DFDBM allograft and calcium sulphate graft binder. This approach provides ideal alveolar form and consistency for eventual placement of the implant.

Reconstruction of the alveolar cleft: effect of preoperative extraction of deciduous teeth at the sites of clefts on the incidence of postoperative complications.

Our objective was to find out if the extraction of deciduous teeth at the sites of clefts 3-8 weeks before alveolar bone grafting (ABG) would reduce the number of postoperative complications. Chart reviews were reviewed retrospectively of patients who had had ABG from March 2006 to June 2009. To reduce variables only healthy, non-syndromic, cooperative patients were included. Eleven patients had had their deciduous teeth extracted at the cleft sites 3-8 weeks before ABG and 10 patients had had the extractions done intraoperatively at the same time as ABG. There was a single case of postoperative infection and no wound dehiscence in the preoperative extraction group, and there were no delays in postoperative orthodontic treatment. In the intraoperative group there were 3 cases of local wound infection and 6 cases of minor dehiscence, and orthodontic treatment was delayed for 3-6 months in all patients with complications. All patients had successful ABG, eruption of teeth, and orthodontic treatment; but patients who had their deciduous teeth at the cleft sites extracted preoperatively had fewer wound complications than patients whose extractions were done at the same time as the ABG.

Efficacy of reconstruction of alveolar bone using an alloplastic hydroxyapatite tricalcium phosphate graft under biodegradable chambers.

Our aim was to test the efficacy of a synthetic alloplastic graft under biodegradable chambers to reconstruct a horizontal bony deficiency as an alternative to autogenous, allogeneic, or xenogenic grafts. We used 11 New Zealand white rabbits. On each rabbit's mandible one test sample (grafted chamber) was placed on the (right or left) body, while its control sample (empty (E) chamber) was placed on the other side. Twelve weeks postoperatively the animals were sacrificed and the samples extracted for gross assessment, micro-computed tomographic imaging, and histological and histomorphometric analyses. There was significantly more new bone with a greater surface area in the test group than in the control group, and the alloplastic graft was osteoconductive when used as an onlay graft under a synthetic biodegradable chamber. Synthetic products can be efficient alternatives to autogenic, allogeneic, or xenogenic grafts.