The use of guided tissue regeneration in endodontic Microsurgery: Setting a threshold.

Aim: We aimed to compare the radiographic outcomes of conventional and regenerative approaches in endodontic microsurgery (EMS) and set a critical defect size for healing in conventional and regenerative therapies. Methodology: The study evaluated 53 root canal-treated teeth (33 patients) with periapical lesions. Among them, 19 teeth (35.8 %) were treated with regenerative treatment, whereas 34 teeth (64.1 %) were managed with the conventional approach. Conventional and regenerative approaches were performed by endodontic and periodontic residents under consultants' supervision. Healing was evaluated after a minimum period of 6 months by comparing pre- and post-operative cone-beam computed tomography (CBCT) findings. The radiographic interpretation was conducted by a single examiner who was not participating in the surgeries and was blind on the type of treatment prior to CBCT evaluation. New healing criteria were proposed owing to the limitations on the present criteria in evaluating endodontic surgery after regenerative treatment. Critical measurements were calculated for each approach based on periapical lesion dimensions. Results: The regenerative approach presented significantly better healing than conventional treatment (mean, 1.21 and 1.59, respectively; p = 0.047). Based on the critical-point calculations, the conventional approach was effective in lesions of up to 3 mm depth and height, whereas the regenerative approach resulted in better healing rates in lesions with 3-9 mm depth and 3-6 mm height. Conclusions: Performing the regenerative approach in EMS resulted in better healing rates than those of the conventional approach. The conventional approach is recommended for small periapical lesions, whereas the first had better results in larger lesions.

The Effect of Oral Health Knowledge, Attitude, and Practice on Periodontal Status among Dental Students.

OBJECTIVES: The primary aim of the current study is to relate oral health knowledge, attitude, and oral hygiene practice with the periodontal condition of both undergraduate and postgraduate dental students. MATERIALS AND METHODS: Data were collected through a combination of self-reported questionnaire and clinical examination. The estimated sample size was 246. Probing depths and clinical attachment loss were measured in interproximal sites, whereas the gingival index was calculated based on Ramfjord teeth. The Centers for Disease Control and the American Academy of Periodontology classification was used for periodontal diagnosis. The subjects were divided into three groups. Group 1 was composed of undergraduate, preclinical dental students, group 2 consisted of undergraduate clinical-year dental students, whereas group 3 included postgraduate residents. RESULTS: A total of 296 dental students participated in this study. Significant differences were found among the groups in their oral health knowledge, attitude, and practice scores. Gingival disease was detected among most of the participants (99.2-100%) with significant differences between different educational levels (group 1 = 1.13, group 2 = 1.16, group 3 = 0.96, p-value = 0.001). Sixty percent of dental students were diagnosed with periodontal disease regardless of its severity. A positive correlation was established between oral health knowledge and attitude and oral hygiene practice. In addition, gingival inflammation severity and the severity of periodontal disease showed a positive correlation. CONCLUSIONS: This study highlighted the need to improve the oral health knowledge, attitude, and practice of dental students. Gingival and periodontal inflammation was highly prevalent among participants.

Smad2 overexpression induces alveolar bone loss and up regulates TNF-α, and RANKL.

OBJECTIVE: The aim of the current study was to investigate whether Smad2 overexpression in JE cells induced alveolar bone loss, and to understand the mechanisms regulating the bone loss. METHODS: A mouse line was created that used a cytokeratin 14 (K14) promoter to overexpress Smad2 in the epithelium of the transgenic mice (K14-Smad2). Micro CT radiographs (µCT) were used to assess bone loss, bone volume, and bone density. The expression of Tnfα, Il1-ß, Ifγ, Rankl, and Opg were assessed by RT-PCR. Western blots were used to detect the protein levels of TNF-α and IL1-ß. Tartrate-resistant acid phosphatase (TRAP) was used as a marker for osteoclasts. Wild type (WT) mice were used as controls in all steps of the current study. RESULTS: K14-Smad2 mice had 52.5% (±4.2) root exposed compared to 32.4%(±3.2) in the WT mice. There was a significant difference in alveolar bone volume in the K14-Smad2 mice when compared to WT mice 2.65mm3 (±0.3) and 4.3mm3 (±0.35) respectively. K14-Smad2 mice also had reduced bone density 696.8mg/cc (±70) at 12 months when compared to WT mice 845.9mg/cc(±10). The mRNA levels of Tnfα and Rankl increased by 3.26- and 2.5-fold respectively in the K14-Smad2 mice when compared to controls. The protein level of TNF-α was also significantly increased to 2.8-fold in K14-Smad2 mice when compared to WT mice. Smad2 overexpression increased the total numbers of osteoclasts in K14-Smad2 mice (3.4±0.2)-fold when compared to WT mice. CONCLUSION: Smad2 overexpression induces alveolar bone loss and increases the numbers of osteoclasts. Also, Smad2 overexpression up-regulates TNF-α and RANKL.

Olmsted syndrome with oral involvement, including premature teeth loss.

INTRODUCTION: Olmsted syndrome is a rare palmoplantar keratodermal disease that has not previously been reported to have an association with periodontal disease. The aim of this study is to report and document a case of Olmsted syndrome with evidence of severe periodontal disease. CASE REPORT: A 38-year old Saudi male patient presented to the dental clinic diagnosed previously with Olmsted syndrome. Clinical and radiographic examinations were done and provided evidence of the typical clinical findings in Olmsted syndrome and evidence of severe periodontal disease. The patient had severe generalized hyperkeratotic lesions on the palms, soles, and perioral skin as well as hyperkeratosis of oral mucosa at multiple sites. CONCLUSION: This case report documents the first reported case of Olmsted syndrome to be associated with severe periodontal disease. The altered differentiation of oral mucosa linked to Olmsted syndrome may contribute to the periodontal disease. Patients diagnosed with this syndrome should receive a comprehensive oral examination to determine whether periodontal destruction is a significant component of their disease or not.