Evaluation of the antiapoptotic and anti-inflammatory properties of chitosan in methotrexate-induced oral mucositis in rats.

BACKGROUND: Methotrexate (MTX), a chemotherapeutic agent, is known to cause oral mucositis. Chitosan has been shown to have a protective effect in inflammatory animal models. This research aimed to examine the protective effect of chitosan against oral mucositis caused by MTX. METHODS AND RESULTS: Wistar albino rats were randomly divided into three groups. Control (n = 8), (saline via oral gavage for 5 days), MTX (n = 8), (60 mg/kg single dose MTX intraperitoneally on the 1st day and for the following 4 days saline via oral gavage), and MTX + chitosan (n = 8), (1st day single dose 60 mg/kg MTX intraperitoneally and followed with 200 mg/kg chitosan via oral gavage for 4 days). After 24 h of the last dose, the animals were euthanised. Blood, tongue, buccal and palatal mucosa tissues were collected. Serum interleukin 1-beta (IL1-ß), tumour necrosis factor-alpha (TNF-α), matrix metalloproteinase (MMP-1, and MMP-2) activities, tissue bcl-2/bax ratio and the expression of caspase-3 (casp-3), and casp-9 were detected. The tissues were also examined histologically. Serum TNF-α, IL1-ß, MMP-1 and MMP-2 activities and tissue casp-3 and casp-9 activities significantly increased but the bcl-2/bax ratio significantly decreased in the MTX group compared those of the control group. Histologically, diffuse inflammatory cells were observed in MTX group. However, In the MTX + chitosan group, all the values were close to those of the control group. CONCLUSION: It was demonstrated that chitosan has a protective effect against oral mucosal damage caused by MTX. Thus, it may be a candidate agent against MTX induced oral mucositis.

Comparison of the Postoperative Effects of Local Antibiotic versus Systemic Antibiotic with the Use of Platelet-Rich Fibrin on Impacted Mandibular Third Molar Surgery: A Randomized Split-Mouth Study.

The surgery of the impacted mandibular third molar is the most frequent procedure in dentistry. The prescription of systemic antibiotics after the third molar extraction is widespread among dentists, but this is still argumentative. This study is aimed at evaluating the postoperative effects of local antibiotic mixed with platelet-rich fibrin (PRF) and a postoperative systemic antibiotic prescribed for mandibular third molar surgery. The study included 75 patients divided into a control and 4 test groups (n = 15). In the control group, only PRF was placed into the extracted socket, and no antibiotic was prescribed. In the first and third groups, PRF was applied to the socket; penicillin and clindamycin were prescribed as oral medications, respectively. In the second and fourth groups, only PRF combined with penicillin and clindamycin was applied into the socket, respectively. The outcome variables were pain, swelling, analgesic intake, and trismus. These variables were also assessed based on the first, second, third, and seventh days following the operation. Unpaired Student's t-test and Mann-Whitney U test were used for analysis. There were significant differences in the total VAS pain scores between the control and group 3 (p < 0.05), groups 1 and 2 (p < 0.01), and group 4 (p < 0.001) in ascending order. For analgesic intake, there was no significant difference for group 1 (p > 0.05). However, there were statistical differences between the control group and groups 2 and 3 (p < 0.01) and group 4 (p < 0.001). Trismus and swelling did not differ among the groups (p > 0.05). This study showed that the effects of local and systemic antibiotics with the use of PRF reduced postoperative outcomes. Moreover, local antibiotics with PRF may be a viable method to avoid the possible side effects of systemic antibiotics.

Comparison of the Clinical Outcomes of Buccal Advancement Flap Versus Platelet-Rich Fibrin Application for the Immediate Closure of Acute Oroantral Communications.

The aim of this study was to compare the clinical outcomes of buccal advancement flap surgery to platelet-rich fibrin (PRF) application for the closure of acute oroantral communications (AOACs). In 36 patients, following the extractions of posterior maxillary teeth, AOACs which were larger than 3 mm diameter were detected. In group A, PRF clots were used in 21 patients and group B, classic buccal advancement flap was used in 15 patients. Baseline variables such as pain, the analgesic doses are taken, and swelling was assessed preoperatively. These were also examined on postoperative days 1, 2, 3, and 7, and patients were seen again in the 3rd week. In group A, statistically significant reduction was examined (P < 0.05) in pain and the analgesic doses are taken (sum of 1st, 2nd, 3rd, and 7th days on days 1 and 2) (PRF). The swelling was also significantly less in group A (P < 0.05). The mean duration did not differ between the groups (P > 0.05). In conclusion, both methods were successful for the immediate closure of AOACs. However, a lesser amount of pain and no swelling observed with the use of PRF clots for the immediate closure of AOACs compared to buccal advancement flap surgery.

The Use of Platelet-Rich Fibrin for Immediate Closure of Acute Oroantral Communications: An Alternative Approach.

Currently, the buccal advancement flap, palatal rotational flap, and buccal fat pad techniques are frequently used to close an oroantral communication (OAC). In this study, platelet-rich fibrin (PRF) clots were used for immediate closure of acute OACs after extraction of posterior maxillary molars. Acute oroantral perforations larger than 3 mm in diameter in 21 patients were treated uneventfully using PRF clots. None of the patients had systemic diseases or symptoms of sinus disease. After tooth extraction, the diagnosis of acute OAC was examined by the Valsalva maneuver (compressing the nostrils with the fingers and then blowing out air). After detection of an air leak, a modified ball burnisher instrument 3 mm in diameter was used to determine whether the perforation was larger than 3 mm. The postextraction socket of the tooth was cleaned with sterile physiologic saline solution and the cavity was filled with PRF. PRF clots were sutured to the gingiva to prevent them from migrating to the sinus and for stabilization. On the seventh day of follow-up, healthy granulation tissue was observed; during the third week of follow-up, epithelialized oral mucosa was detected at the extraction site in all cases. The use of PRF enables the closure of OACs without primary flap closure or any other surgical interventions. Thus, the use of PRF for immediate closure of acute OACs will make the treatment of OACs less traumatic and easier and will eliminate the need for special surgical expertise.

Evaluating the biomechanical effects of implant diameter in case of facial trauma to an edentulous atrophic mandible: a 3D finite element analysis.

BACKGROUND: Rehabilitation using an implant supported overdenture with two implants inserted in the interforaminal region is the easiest and currently accepted treatment modality to increase prosthetic stabilization and patient satisfaction in edentulous patients. The insertion of implants to the weakend mandibular bone decreases the strength of the bone and may lead to fractures either during or after implant placement. The aim of this three dimensional finite element analysis (3D FEA) study was to evaluate the biomechanical effects of implant diameter in case of facial trauma (2000 N) to an edentulous atrophic mandible with two implant supported overdenture. METHODS: Three 3D FEA models were simulated; Model 1 (M1) is edentulous atrophic mandible, Model 2 (M2), 3.5x11.5 mm implants were inserted into lateral incisors area of same edentulous atrophic mandible, Model 3 (M3), 4.3x11.5 mm implants were inserted into lateral incisors area of same edentulous atrophic mandible. RESULTS: In M1 and M2 highest stress levels were observed in condylar neck, whereas highest stress values in M3 were calculated in symphyseal area. CONCLUSIONS: To reduce the risk of bone fracture and to preserve biomechanical behavior of the atrophic mandible from frontal traumatic loads, implants should be inserted monocortically into spongious bone of lateral incisors area.

Uncommon Odontogenic Orocutaneous Fistula of the Jaw Treated with Platelet-Rich Fibrin.

Orocutaneous fistula (OCF) of dental origin is a relatively rare condition and continues to be a challenging diagnosis. Misdiagnosis of OCF usually leads to unnecessary and noneffective treatment. A 21-year-old male referred with a complaint of a lesion on the chin which was misdiagnosed as a carbuncle (lesion of nonodontogenic origin) by a physician. After radiological examination, there was a lesion around the apical region of right central incisor. These findings indicated a sinus tract associated with dental origin. After root canal treatment, apical surgery was performed and platelet-rich fibrin (PRF) was administered to the cavity of the lesion as a gel form to improve healing and also used as a membrane form to cut off the relation between infected area and the skin. All procedures were performed intraorally; no extraoral intervention was performed. Three months later, clinical and radiological examination showed total healing without scar formation. The key to successful treatment of OCF is accurate diagnosis. Additionally, the use of PRF after surgical interventions is an effective and innovative therapy to improve healing.

Mandibular incisive canal in relation to periapical surgery.

The aim of the present paper is to emphasize the importance of the mandibular interforaminal neurovascular bundle with a case and make a warning to dentists and surgeons during oral and maxillofacial surgeries, such as implant replacement, bone harvesting, genioplasty, open reduction of a mandibular fracture, and cyst enucleations at this region. In this paper, we present a 58-year-old male who referred with pain and a tingling sensation on the left lower lip. After radiographical, extraoral and intraoral examinations, findings indicated the lesion to be a cyst which was related with a periapical lesion of the canine tooth and extracted socket of first premolar tooth. After removal of a cyst, the mandibular incisive nerve was documented which was in relation to cyst cavity.

Effects of platelet-rich fibrin and piezosurgery on impacted mandibular third molar surgery outcomes.

INTRODUCTION: The aim of this study was the comparision of postoperative outcomes in impacted mandibular third molars that were treated using either platelet-rich fibrin (PRF), a combination of PRF and piezosurgery, or conventional rotatory osteotomy. PATIENT AND METHODS: The study included 20 patients; 40 extractions of impacted mandibular third molars were performed. Patients were divided into two main groups. In group A (n = 20), traditional surgery was performed on one side (Group 1, n = 10); traditional surgery was performed, and PRF was administered to the extracted socket on the other side of same patient (Group 2, n = 10). In group B (n = 20), on one side, piezosurgery was used for osteotomy, and PRF was administered (Group 3, n = 10); on the other side of same patient, traditional surgery was performed (Group 4, n = 10). Parameters assessed at baseline for each patient included pain, the number of analgesics taken, trismus, and cheek swelling. These variables were also assessed on postoperative days 1, 2, 3, and 7. RESULTS: Statistical analysis revealed a significant reduction in postoperative pain (sum of 1(st), 2(nd), 3(rd) and 7(th) days) and trismus (on postoperative day 1) in group 2 (traditional surgery + PRF group), and in postoperative pain, the number of analgesics taken (sum of 1(st), 2(nd),3(rd) and 7(th) days) and trismus (on postoperative day 1) in group 3 (piezosurgery + PRF group) compared to groups 1 and 4 (traditional surgery groups), (p ≤ 0.05). However, swelling on postoperative days 1, 3, and 7 did not differ among the groups (p > 0.05). Only difference was on second day between groups 1-4 and 2-4 (p ≤ 0.05). CONCLUSIONS: The results of our study have shown that the use of PRF with traditional surgery and PRF combined with piezosurgery significantly reduced pain during the postoperative period. In addition, PRF in combination with piezosurgery significantly decreased the number of analgesics taken. Both operations also significantly decreased trismus 24 h after the surgery. As a result of this study, PRF and combination use of PRF and piezosurgery have positive effects in reducing postoperative outcomes after impacted third molar surgery.