Influence of a novel suturing technique on periodontal health of mandibular second molar following impacted third molar surgery: a split-mouth randomized clinical trial.

BACKGROUND: Surgical extraction of the third molar is the most common surgical procedure in the oral surgery field and is associated with several complications. This study aimed to compare the effects of a newly presented suturing technique with the routine suture after surgical removal of the third molar on the postoperative complications. MATERIALS AND METHODS: This randomized clinical trial was designed as a split-mouth double-blinded investigation. Twenty patients were involved in the current study. After the surgical removal of the third molar, the new suturing technique was used to close the wound on one side of the patient randomly (case side), and the other side was sutured by the routine simple interrupted stitches (control side). Pain, edema, trismus, pocket depth, and the attachment loss of the distal of the second molar were assessed following the surgery. The data were statistically analyzed and compared between the sides. RESULTS: Pain and edema following the surgery in the control side were significantly less than in the case side. The pocket depth and the gingival attachment loss of the distal aspect of the second molar in the case side were significantly less than in the control side. No case of dry socket was observed in the case side. CONCLUSION: It seems that the newly presented suturing technique is able to keep the wound margins close to each other and may be helpful in reducing the periodontal complication of the second molar following the surgical removal of the impacted third molars.

Knowledge and attitudes of Iranian dental students regarding infection control during the COVID-19 pandemic.

COVID-19 is an emerging and rapidly-evolving situation. This study aimed to measure the level of knowledge and attitude of the Iranian dental students towards COVID-19 and its infection control strategies. This cross-sectional study was designed using a web-based method. The questionnaire associated with COVID-19 was sent to all Iranian students in the clinical course. The extracted data regarding the knowledge and attitude of the students were statistically analyzed. In this study, 531 dental students of the clinical course in 32 Iranian universities were included. The mean age of the participants was 23.13 ± 2.29 years. The average percentage of knowledge and attitude scores were 59.7% (moderate) and 66.0% (neutral), respectively. The association between the attitude of the students and their semesters was statistically significant (r = 0.183, p < 0.001). The age of the students was also significantly associated with their attitudes (r = 0.150, p = 0.001). The outbreak of COVID-19 might resurge due to re-opening of the dental faculties. Training courses on COVID-19 infection prevention strategies should be held for dental students, especially the junior ones, and the guidelines should be sent to all of them.

Comparison of lidocaine with articaine buccal injection in reducing complications following impacted mandibular third molar surgery: a split-mouth randomized clinical trial.

BACKGROUND: Complications following impacted third molar surgery significantly affect patients' quality of life during the immediate postoperative period. This study aimed to achieve the proper anesthesia method by comparing the effect of the application of lidocaine alone with the application of lidocaine and articaine simultaneously in reducing the complications during and following impacted mandibular third molar surgery. METHODS: The study design was a split-mouth double-blind randomized clinical trial. The study was conducted on 13 patients (26 samples) referred for elective surgical removal of bilateral impacted mandibular third molar with similar difficulty on both sides. Each patient underwent similar surgical procedures on two separate appointments. Each patient randomly received 2% lidocaine for conventional inferior alveolar nerve block and 4% articaine for local infiltration before the surgery on one side (group A) and 2% lidocaine alone (for both block anesthesia and infiltration) before the surgery on the other side (group B). Intraoperative and postoperative variables for both groups were established and statistically analyzed. RESULTS: The findings showed that pain on the first day after surgery in group A was significantly lower than that in group B. The patients in group A mentioned experiencing less discomfort following the surgery. The increased horizontal swelling on the first and third days following surgery and oblique swelling on the seventh day in patients in group B were statistically significant. CONCLUSION: Choosing an appropriate anesthetic drug for oral surgery, specifically impacted third molar surgery, is dependent on the clinician's opinion, however; it seems that the combination of lidocaine and articaine may control the patient's pain significantly better than lidocaine alone.

Knowledge and attitudes of Iranian dental students regarding infection control during the COVID-19 pandemic

Abstract COVID-19 is an emerging and rapidly-evolving situation. This study aimed to measure the level of knowledge and attitude of the Iranian dental students towards COVID-19 and its infection control strategies. This cross-sectional study was designed using a web-based method. The questionnaire associated with COVID-19 was sent to all Iranian students in the clinical course. The extracted data regarding the knowledge and attitude of the students were statistically analyzed. In this study, 531 dental students of the clinical course in 32 Iranian universities were included. The mean age of the participants was 23.13 ± 2.29 years. The average percentage of knowledge and attitude scores were 59.7% (moderate) and 66.0% (neutral), respectively. The association between the attitude of the students and their semesters was statistically significant (r = 0.183, p < 0.001). The age of the students was also significantly associated with their attitudes (r = 0.150, p = 0.001). The outbreak of COVID-19 might resurge due to re-opening of the dental faculties. Training courses on COVID-19 infection prevention strategies should be held for dental students, especially the junior ones, and the guidelines should be sent to all of them.

Mandibular Setback as an Adjunctive Strategy for Reconstruction after Tumor Resection: A Technical Note and Case Report.

Mandibular defects due to surgical resection of pathologies are common challenges for maxillofacial surgeons. In some clinical situations, alteration or combination of different surgical procedures is needed to reduce the size of bony defects and improve the success rate of bone grafts. In the current study, an 18-year-old female with a pathological lesion (ameloblastoma) in the mandible is presented. After tumor resection, bony defect reconstruction with autogenous bone graft was combined with a mandibular setback to facilitate the procedure. In this case, the simultaneous combination of orthognathic mandibular setback movement with tumor resection in a single surgical session helped to reduce the bony defect size. The adoption of this approach led to a decrease in the volume of graft harvesting and improved the success rate of the grafting procedure.

Comparison of Envelope and Modified Triangular Flaps on Incidence of Dry Socket after Surgical Removal of Impacted Mandibular Third Molars: A Double-blind, Split-mouth Study.

AIM: This study aimed to investigate the impact of modified triangular flap (MTF) compared with the envelope flap (EF) on the incidence of dry socket and healing degree after lower-impacted third molar surgery. MATERIALS AND METHODS: Present research was executed on 31 patients between the ages 17 and 24 years with the indication of removing impacted mandibular third molars in both sides with similar difficulty. The impacts of MTF and EF on degree of incidence of dry socket and healing on 3rd day and 1 week after surgery were recorded and investigated in a double-blinded manner. The significant changes in mentioned indices in two groups were statistically judged using Chi-squared and Wilcoxon's statistical tests. RESULTS: Three patients were excluded during the survey and 28 patients (56 samples) remained. The patients' average age was 20.1 years. Totally, 19 patients were female and 11 of them had academic education. Degree of dry socket incidence in MTF group was 11.76% and it was 41.17% in EF group (p = 0.042). In the follow-up session after 3 days since the surgery, healing degree mean in MTF group was 3.16 ± 1.5 and it was 4.37 ± 1.8 in EF group (p = 0.112). In follow-up session 7 days after the surgery, mean healing degree in MTF group was 0.037 ± 0.6 and it was 0.89 ± 0.73 in EF group (p = 0.005). CONCLUSION: Present study indicated that application of MTF may lead to a reduction in dry socket incidence and an increase of healing after 7 days since lower-impacted third molar surgeries. CLINICAL SIGNIFICANCE: Reducing postsurgery complication incidences following third molar surgery is an important issue, which could easily be achieved by designing appropriate flaps.

Evaluation of the Changes in the Quality of Life in Patients Undergoing Orthognathic Surgery: A Multicenter Study.

Orthognathic surgery can affect patients' quality of life. The aim of the present study was to assess changes in quality of life during combined orthodontics-surgery treatment and effect of orthodontist-surgeon teamwork on final patient's satisfaction. Twenty-six orthognathic patients who were referred to oral and maxillofacial department of 3 hospitals in Tehran were included in the study. Orthognathic quality of life questionnaire (OQLQ) was given to patients 1 week before, 4 weeks and 4 months after surgery. Two self-designed forms were used for evaluating mood and comfort of patients 1 week before surgery and 4 days after surgery. Self-designed forms were given to the orthodontists and the maxillofacial surgeons to assess quality of teamwork and difficulty of the procedure. Twenty-four patients (15 females and 9 males) with the mean age of 22.62 ±â€Š3.57 completed the study. Quality of life increased from 1 week before surgery to 4 months after surgery (P < 0.013) and the difference was statistically significant between OQLQ score at 1 week before surgery and that of 4 months postoperative. Esthetic and social domain showed significant changes during the studied period. Orthognathic quality of life questionnaire at 4 months postoperative was correlated with surgery difficulty and duration. It can be concluded that orthognathic surgery can improve quality of life, especially in esthetic and social aspects.

Comprehensive Treatment of Upper Lip Arteriovenous Malformation.

Arteriovenous malformations are uncommon congenital disorders in vascular development. They frequently involve craniofacial structures and result in a morphogenic abnormality with ominous arteriovenous shunting. We present a huge AVM of the upper lip in an 18-year-old patient who was successfully treated by the combination method of presurgical endovascular embolization and complete resection of the lesion. Subsequent surgical defect in upper lip, which involved more than two-third of the lip length, was reconstructed via Webster's modification of cheek advancement flap.

Nonsyndromic Isolated Temporal Bone Styloid Process Fracture.

INTRODUCTION: Fracture of the styloid process (SP) of the temporal bone is a rare traumatic injury in normal individuals who are not suffering from Eagle's syndrome. Diagnosis and management of this problem requires comprehensive knowledge about its signs and symptoms. This study aimed to present an isolated styloid process fracture in a nonsyndromic patient. CASE PRESENTATION: A 50-year-old male patient was referred to our department with a complaint of sore throat. However, presentation of the problem resembled the symptoms of temporomandibular joint disorder (TMD). Fracture of the SP of the temporal bone was detected on the radiographs. Conservative treatment was undertaken for the patient. The symptoms diminished after about four months. CONCLUSIONS: Physicians should be aware of the signs and symptoms of different pain sources to prevent misdiagnosis and maltreatment.

Limitation of Mandibular Movement: A Rare Case Report of Unilateral Zygomatico-Coronoid Interference.

INTRODUCTION: Zygomatico-coronoid interference is a rare type of mandibular extracapsular ankylosis. There is a lack of information on the treatment of these cases in the literature. Condylectomy and coronoidectomy are not always the best options for the treatment of limitations in mandibular movement. CASE PRESENTATION: A 51-year-old woman presented with mouth-opening limitation due to zygomatic bone displacement and interference with the coronoid process. The treatment plan was bilateral coronoidectomy through an intraoral approach and osteotomy of the right zygomatic arch through an extraoral incision. The patient was able to open her mouth to approximately 40 mm after surgery. The patient underwent physiotherapy during follow-up appointments. There was no relapse after three months of follow-up. CONCLUSIONS: This study shows that simultaneous arch osteotomy and coronoidectomy may be an appropriate treatment procedure for zygomatico-coronoid interference.

Ability of Oral and Maxillofacial Surgery Residents in Diagnosing Jaw Cysts: A Retrospective 20 Years Study.

INTRODUCTION: Diagnosis of odontogenic cysts despite of their benign nature is a critical and challenging problem especially among undergraduate and postgraduate students. AIM: This study aimed to evaluate the capability of oral and maxillofacial surgery residents in diagnosing odontogenic cysts. MATERIALS AND METHODS: This cross-sectional study was executed on 312 patient records over the past 20 years since October 1995 till December 2014 in Taleghani Hospital, Tehran, Iran. All recorded data was based on 2005 World Health Organization (WHO) classifications. The differential diagnosis was made by 65 residents based on clinical and paraclinical evaluations established in the charts. Differential diagnoses made by the residents were compared to the histopathological examination as the gold standard for identifying the nature of the cysts. Weighted kappa test was used to show the degree of agreement. RESULTS: Data extracted from 312 records were analyzed. The mean age of examined patients was 27.6 years. The accuracy of diagnosis among the residents was moderate (kw=0.5). The diagnosis made by the residents was significantly related to the radiographic view of the cysts (p<0.05). The residents were able to identify odontogenic keratocysts and dentigerous cysts in most cases. CONCLUSION: There are several factors associated with the occurrence of pathologic odontogenic cysts which could help either the clinician or the pathologist in diagnosing the odontogenic cysts of the jaws. The surgeons should consider these related factors before the final diagnosis and choosing the appropriate treatment plan.

Utility of a Newly Designed Film Holder for Premolar Bitewing Radiography.

INTRODUCTION: Bitewing radiography is a valuable technique for assessment of proximal caries, alveolar crest and periodontal status. Technical errors during radiography result in erroneous radiographic interpretation, misdiagnosis, possible mistreatment or unnecessary exposure of patient for taking a repeat radiograph. AIM: In this study, we aimed to evaluate the efficacy of a film holder modified from the conventional one and compared it with that of conventional film holder. MATERIALS AND METHODS: Our study population comprised of 70 patients who were referred to the Radiology Department for bilateral premolar bitewing radiographs as requested by their attending clinician. Bitewing radiographs in each patient were taken using the newly designed holder in one side and the conventional holder in the other side. The acceptability of the two holders from the perspectives of the technician and patients was determined using a 0-20 point scale. The frequency of overlap and film positioning errors was calculated for each method. RESULTS: The conventional holder had greater acceptability among patients compared to the newly designed holder (mean score of 16.59 versus 13.37). From the technicians' point of view, the newly designed holder was superior to the conventional holder (mean score of 17.33 versus 16.44). The frequency of overlap was lower using the newly designed holder (p<0.001) and it allowed more accurate film positioning (p=0.005). CONCLUSION: The newly designed holder may facilitate the process of radiography for technicians and may be associated with less frequency of radiographic errors compared to the conventional holder.

Diagnostic Factors of Odontogenic Cysts in Iranian Population: A Retrospective Study Over the Past Two Decades.

BACKGROUND: Early diagnosis of odontogenic cysts due to their silent progression is always a challenging problem for clinicians. OBJECTIVES: The current study aimed to evaluate the frequency of odontogenic cysts and related factors in a selected Iranian population. PATIENTS AND METHODS: The current cross-sectional study was conducted on 312 patients' recorded data in Taleghani Hospital, Tehran, Iran, from April 1993 to December 2013. All related data were extracted from the records and categorized in tables. The correlation between the variables was analyzed by either chi-square or multinominal logistic regression tests. The P values < 0.05 were considered significant. RESULTS: Evaluation of 312 patients' records (185 males and 127 females) with the mean age of 27.6 showed that Odontogenic Keratocyst (OKC) was the most common odontogenic cyst of all followed by the dentigerous cyst as the second most common lesion. Most of the patients were in the second or third decades of their lives, although there was no statistically significant age distribution. The finding of the current study showed that calcifying odontogenic cyst (COC) occurrence was significantly related to the history of trauma. Enucleation and curettage of the odontogenic cysts were the most common treatment plans of all. CONCLUSIONS: The current study showed that clinicians should consider the many factors associated with the occurrence of odontogenic cysts.

Etiologies and Treatments of Odontogenic Maxillary Sinusitis: A Systematic Review.

CONTEXT: Maxillary sinusitis is an important issue in dentistry and maxillofacial surgery. This study aims to present a systematic review of etiologies and treatments of odontogenic maxillary sinusitis. EVIDENCE ACQUISITION: An electronic database search was performed based on related MeSH keywords. Articles published between January 2001 and December 2014 was selected according to the inclusion criteria. The information extracted from various studies was categorized in various tables. RESULTS: The study selected 19 studies. In most studies, oroantral fistula (OAF) was the most common etiology of odontogenic sinusitis. Alpha-hemolytic streptococcus was the most common flora in sinusitis with dental origin. The literature shows that the Caldwell-Luc approach may be the best method for treating sinusitis in cases of displaced teeth. CONCLUSIONS: OAF is a common cause of odontogenic maxillary sinusitis and may easily be treated by endoscopy and fistula closure. Maxillofacial surgeons and dentists should consider this problem to avoid misdiagnosis and prevent complications.

Evaluation of alveolar crest bone loss via premolar bitewing radiographs: presentation of a new method.

PURPOSE: This study aimed to assess the interdental bone level in premolar bitewing radiographs while retracting the cheeks. METHODS: Seventy-two horizontal bone defects were created on dried mandibles and maxillae. The distance from the bone level to the cement-enamel junction of premolars was detected by a modified digital caliper (considered the gold standard). The reliability of all radiographs was assessed by intraclass correlation coefficient (ICC), and the validity was compared to the gold standard using the analysis of variance test. P-values less than 0.05 were considered statistically significant. RESULTS: This study showed that the reliability of radiographs without a cheek simulator and with 0.16 second exposure time was significantly higher than that of the two other groups (ICC=0.96 compared to 0.93 and 0.88, respectively). The results from the radiographs without a cheek simulator and with 0.16 second exposure time were more similar to the gold standard measures than those of the two other groups, although the difference was not statistically significant. CONCLUSIONS: Retracting the buccal soft tissue plays an important role in increasing the accuracy of radiographs in detecting the interdental alveolar bone level and produces more accurate results than increasing the exposure time, although it does not have a significant role in reliability of results.

Evaluation of neo-adjuvant, concurrent and adjuvant chemotherapy in the treatment of head and neck squamous cell carcinoma: a meta-analysis.

OBJECTIVE: Squamous cell carcinoma (SCC) is the most common malignancy of the oral cavity. This study aims to evaluate different treatment procedures including neo-adjuvant, concurrent and adjuvant therapy in treating squamous cell carcinoma of the head and neck by a meta-analysis. MATERIALS AND METHODS: The authors searched all electronic databases (Medline, Embase and Cochrane) for all the articles published from 1970 to January 2011. Data of the evaluated treatment procedures (chemotherapy or radiotherapy), number of patients, publishing date and the authors' names have all been extracted from the articles and have been categorized in a table. RESULTS: Forty-six researches are included in this study. All three ways show that using chemotherapy after or with radiotherapy improves the vitality rate significantly (p-value< 0.01). CONCLUSION: It is concluded that after deciding not to perform a surgery for treating SCC, the recommended treatment plan is chemotherapy and radiotherapy simultaneously.

The effects of low-level laser irradiation on cellular viability and proliferation of human skin fibroblasts cultured in high glucose mediums.

Delayed wound healing is one of the most challenging complications of diabetes mellitus (DM) in clinical medicine. This study has aimed to evaluate the effects of low-level laser therapy (LLLT) on human skin fibroblasts (HSFs) cultured in a high glucose concentration. HSFs were cultured either in a concentration of physiologic glucose (5.5 mM/l) or high glucose media (11.1 and 15 mM/l) for either 1 or 2 weeks after which they were subsequently cultured in either the physiologic glucose or high concentration glucose media during laser irradiation. LLLT was carried out with a helium-neon (He-Ne) laser unit at energy densities of 0.5, 1, and 2 J/cm(2), and power density of 0.66 mW/cm(2) on 3 consecutive days. HSFs' viability and proliferation rate were evaluated with the dimethylthiazol-diphenyltetrazolium bromide (MTT) assay. The LLLT at densities of 0.5 and 1 J/cm(2) had stimulatory effects on the viability and proliferation rate of HSFs cultured in physiologic glucose (5.5 mM/l) medium compared to their control cultures (p = 0.002 and p = 0.046, respectively). All three doses of 0.5, 1, and 2 J/cm(2) had stimulatory effects on the proliferation rate of HSFs cultured in high glucose concentrations when compared to their control cultures (p = 0.042, p = 0.000, and p = 0.000, respectively). This study showed that HSFs originally cultured for 2 weeks in high glucose concentration followed by culture in physiologic glucose during laser irradiation showed enhanced cell viability and proliferation. Thus, LLLT had a stimulatory effect on these HSFs.

Effect of low-level laser therapy on the release of interleukin-6 and basic fibroblast growth factor from cultured human skin fibroblasts in normal and high glucose mediums.

INTRODUCTION: This study evaluated the effects of low-level laser therapy (LLLT) on human skin fibroblasts (HSFs) that have been cultured in high glucose concentration media. MATERIALS AND METHODS: HSFs were cultured under physiological glucose condition medium, and then cultured in high glucose concentration medium (15 mM/L) for 1 or 2 weeks prior to LLLT. Experimental HSFs were irradiated with three energy densities (0.5, 1, and 2 J/cm(2)) once daily for three consecutive days. Release of interleukin-6 (IL-6) and basic fibroblast growth factor (bFGF) was evaluated using the enzyme-linked immunosorbent assay (ELISA) method. RESULTS: Statistical analysis showed three doses of 0.5 (p = 0.049), 1 (p = 0.027), and 2 J/cm(2) (p = 0.004) stimulated the release of IL-6 in HSFs cultured in high glucose concentration medium compared with that of non-irradiated HSFs that were cultured in the same medium. LLLT with 2 J/cm(2) induced the release of bFGF from HSFs cultured in high glucose concentration medium for 1 or 2 weeks (both p = 0.04). CONCLUSION: Our study showed that LLLT stimulated the release of IL-6 and bFGF from HSFs cultured in high glucose concentration medium. LLLT was more effective in releasing IL-6 and bFGF while HSFs which were cultured in physiologic glucose concentration medium during laser irradiation.

Effects of different growth factors and carriers on bone regeneration: a systematic review.

OBJECTIVE: The application and subsequent investigations in the use of varied osteogenic growth factors in bone regeneration procedures have grown dramatically over the past several years. Owing to this rapid gain in popularity and documentation, a review was undertaken to evaluate the in vivo effects of growth factors on bone regeneration. STUDY DESIGN: Using related key words, electronic databases (Medline, Embase, and Cochrane) were searched for articles published from 1999 to April 2010 to find growth factor application in bone regeneration in human or animal models. RESULTS: A total of 63 articles were matched with the inclusion criteria of this study. Bone morphogenetic protein 2 (BMP-2) was the most studied growth factor. Carriers for the delivery, experimental sites, and methods of evaluation were different, and therefore articles did not come to a general agreement. CONCLUSIONS: Within the limitations of this review, BMP-2 may be an appropriate growth factor for osteogenesis.

Appearance of anatomical structures of mandible on panoramic radiographs in Iranian population.

PURPOSE: Currently panoramic radiography is used for diagnosis of dental and bone lesions, but anatomical structures also can be seen and may be useful in dental managements. This study aimed to investigate the visibility of some important mandibular features relating to neurovascular structures in Iranian population. MATERIALS AND METHODS: Panoramic radiographs were taken by Planmeca machine from 412 patients using standard exposure. The position of patient was in compliance with standard protocol. Then mandibular incisive canal was evaluated and data were analyzed statistically. RESULTS: Mental foramen, anterior loop of mental nerve and incisive canal could be observed in 84.2, 66 and 51.7% of the cases. Respectively, lingual foramen was observed in only 6.1% of the radiographs. Gender doesn't affect on the visibility of these structures. There was a relationship between mandibular foramen and canal with age. CONCLUSION: Mandibular incisive canal was considered in 51.7% of cases, it was observed that the result obtained was more than those of other researches.