PRGF exerts a cytoprotective role in zoledronic acid-treated oral cells

Objectives

Bisphosphonates-related osteonecrosis of the jaw (BRONJ) is a common problem in patients undergoing long-term administration of highly potent nitrogen-containing bisphosphonates (N-BPs). This pathology occurs via bone and soft tissue mechanism. Zoledronic acid (ZA) is the most potent intravenous N-BP used to prevent bone loss in patients with bone dysfunction. The objective of this in vitro study was to evaluate the role of different ZA concentrations on the cells from human oral cavity, as well as the potential of plasma rich in growth factors (PRGF) to overcome the negative effects of this BP.

Material and methods

Primary human gingival fibroblasts and primary human alveolar osteoblasts were used. Cell proliferation was evaluated by means of a fluorescence-based method. A colorimetric assay to detect DNA fragmentation undergoing apoptosis was used to determine cell death, and the expression of both NF-κB and pNF-κB were quantified by Western blot analysis.

Results

ZA had a cytotoxic effect on both human gingival fibroblasts and human alveolar osteoblasts. This BP inhibits cell proliferation, stimulates apoptosis, and induces inflammation. However, the addition of PRGF suppresses all these negative effects of the ZA.

Conclusions

PRGF shows a cytoprotective role against the negative effects of ZA on primary oral cells.

Clinical relevance

At present, there is no definitive treatment for bisphosphonates-related osteonecrosis of the jaw (BRONJ), being mainly palliatives. Our results revealed that PRGF has a cytoprotective role in cells exposed to zoledronic acid, thus providing a reliable adjunctive therapy for the treatment of BRONJ pathology.

     

The Efficacy of Platelets Rich Plasma Injection in the Superior Joint Space of the Tempromandibular Joint Guided by Ultra Sound in Patients with Non-reducing Disk Displacement

Objective

The objective of this study was to determine average improvement during the rest and active mouth opening after ultrasound guided platelets rich plasma injection in the tempromandibular superior joint space for the patients complaining from non-reducing disk displacement.

Patients and Methods

Thirty-four patients with non-reducing disk displacement underwent guided ultrasound injection of platelet rich plasma to the upper joint space. The extent of maximal mouth opening, chewing efficiency, sound intensity of the TMJ, and tenderness of the TMJ and the masticatory muscles at rest, motion and mastication were thoroughly assessed at the beginning of the study and scheduled for next follow-up at 1st, 3rd, and 6th months.

Results

Injection with platelets rich plasma was significantly more effective in improvements of the extent of maximal mouth opening, statistics result demonstrated a significant reduction in the VAS values of pain at rest, motion and mastication compared to the baseline VAS values.

Conclusion

PRP injection to the upper temporomandibular joint space provided improvement in signs and symptoms of patient with non-reducing disk displacement of the temporomandibular joint.

     

An experimental study on the comparison of the effects of triester glycerol oxide on wound repair

Aim

The aim of this study is to assess the effects of triester glycerol oxide (TGO) on cutaneous wound epithelization process.

Material and methods

Fifty-four male Wistar rats were divided into 2 groups of 27 rats each: control(C) and TGO (PX). The groups have been divided into three subgroups which included nine rats each regarding the wound excision on the 3rd, 7th, and 10th days, respectively. The specimens were evaluated according to histological properties and hydroxyproline levels.

Results

Seventh day examination showed that PX and control groups present the same score. HP levels in the control group were significantly lower compared to PX groups.

Conclusion

TGO have positive effects on wound epithelization process by increased collagen synthesis.

     

Recent Advances in Face Lift to Achieve Facial Balance

Introduction

Facial balance is achieved by correction of facial proportions and the facial contour. Ageing affects this balance in addition to other factors. We have strived to inform all the recent advances in providing this balance.

Method

The anatomy of ageing including various changed in clinical features are described. The procedures are explained on the basis of the upper, middle and lower face.

Results

Different face lift, neck lift procedures with innovative techniques are demonstrated.

Conclusion

The aim is to provide an unoperated balanced facial proportion with zero complication.

     

Three-dimensional analysis of tooth dimensions in the <Emphasis Type="Italic">MSX1</Emphasis>-missense mutation

Objectives

A novel, 3D technique to measure the differences in tooth crown morphology between the MSX1 cases and non-affected controls was designed to get a better understanding of dental phenotype-genotype associations.

Materials and methods

Eight Dutch subjects from a single family with tooth agenesis, all with an established nonsense mutation c.332 C > A, p. Ser 111 Stop in exon 1 of MSX1, were compared with unaffected controls regarding several aspects of tooth crown morphology of incisor and molar teeth. A novel method of quantitative three-dimensional analysis was used to detect differences.

Results

Statistically significant shape differences were observed for the maxillary incisor in the MSX1 family compared with the controls on the following parameters: surface area, buccolingual dimension, squareness, and crown volume (P?≤?0.002). Molar crown shape was unaffected.

Conclusions

A better understanding of dental phenotype-genotype associations may contribute to earlier diagnosis of some multiple-anomaly congenital syndromes involving dental anomalies.

Clinical relevance

A “shape database” that includes associated gene mutations resulting from developmental syndromes may facilitate the genetic identification of hypodontia cases.

     

The role of elective superficial parotidectomy in the treatment of temporal region squamous cell carcinoma

Objective

In order to determine rates of metastasis and efficacy of elective superficial parotidectomy, we examine parotid specimens in patients with temporal region cutaneous squamous cell carcinoma treated with local excision and ipsilateral parotidectomy.

Study design

This paper is a retrospective review.

Setting

This study was conducted at a private tertiary referral practice in Fort Worth, Texas, from 1998 to 2013.

Subjects and methods

Ninety-three patients between ages 27 and 98 with primary squamous cell carcinoma of the temporal region greater than or equal to 2 cm were included in this study. Subjects had no evidence of adenopathy or parotid involvement on exam or imaging. Patients were treated with local excision and ipsilateral parotidectomy. The primary tumor was studied for vascular involvement and perineural invasion while the parotid specimen was analyzed for occult cancer. Patients were post-operatively followed for a minimum of three years.

Results

Twenty-three (24.7 %) parotid samples were found to harbor occult malignancy. Of these, nine (39.1 %) patients had vascular involvement of the primary tumor and 14 (60.8 %) had perineural invasion. Thirteen out of 58 affected males and 10 out of 35 affected females were found to have intraparotid node positivity. Vascular involvement (p?=?0.0004) and perineural invasion (p?=?0.0001) in the primary malignancy were found to be greater in patients with positive specimen. Sex was not statistically significant.

Conclusions

In patients with cutaneous squamous cell carcinoma of the temporal region at least 2 cm in size, elective superficial parotidectomy may be a beneficial part of treatment, especially in primary tumors showing perineural and/or vascular involvement.

Level of evidence

Level 2b (retrospective cohort)

     

Bone regeneration with recombinant human bone morphogenetic protein 2: a systematic review

Aim

The aim of this work was to perform a systematic literature review on the clinical application of rhBMP-2 in bone reconstruction prior to placing implants.

Materials and Methods

A PUBMED search was made about the subject and nine clinical trials were selected according to strict inclusion criteria.

Results

Overall success rates of bone regeneration with rhBMP-2 was 81.4% and success of implants placed was 87.4%. Most frequent adverse events were pain, edema and erythema.

Conclusion

It was concluded that the treatment with rhBMP-2 foi satisfactory in most cases and the placement of dental implants in the bone regenerated with rhBMP-2 is feasible.

     

Facial fractures caused by less-lethal rubber bullet weapons: case series report and literature review

Purpose

The present study aims to describe three cases of patients inflicted by rubber bullets with severe facial fractures.

Methods

In addition, a review of English-language literature involving facial fractures by rubber bullets from 1975 to 2016 was performed.

Results

This current study demonstrated that the use of the LLRBW is unsafety even when applied by police enforcements exclusively.

Conclusions

Management of facial fractures caused by LLRBW is done in a usual manner with closed or open reduction associated with bone mini-plates or reconstruction plates when indicated. Special initial wound care should be done to avoid secondary infection and additional procedures.

     

Sub-Periosteal Dissection with Denture-Guided Epithelial Regeneration: A Novel Method for Peri-Implant Soft Tissue Management in Reconstructed Mandibles

Background

In patients with reconstructed mandibles using free fibula flaps, management of soft tissues around implants supporting dental rehabilitation, is often a clinical problem.

Aim

The aim of this paper is to describe a new technique, namely "Sub-periosteal dissection and denture-guided epithelial regeneration (SD-DGER)", as a method of peri-implant soft tissue management in these patients.

Materials and methods

The technique consists of performing a subperiosteal dissection with creation of buccal and lingual flaps. These flaps form the buccal and lingual vestibule. Implants are placed and an interim denture is immediately loaded onto the implants to guide the regenerated epithelium. A keratinized mucosal layer is formed on the bare fibula bone in six months time.

Results

This technique was successful in producing fixed keratinized epithelial tissue around implants in patients with mandibles reconstructed using the free fibula flap in patients who did not undergo radiotherapy.

Conclusion

The sub-periosteal dissection with denture guided epithelial regeneration is a predictable form of peri-implant soft tissue management in selected patients with reconstructed jaws.

     

Bone and Skin-Supported Stereolithographic Surgical Guides for Cranio-Facial Implant Placement

Purpose

Osseointegrated skin-penetrating implants enhance the retention and stability of the craniofacial prostheses and provide the long-term comfort. However, to determine the implant locations is a great challenge facing the surgeon. Implants may either be located in conventional manner or by STL generated surgical guides.

Materials and Methods

Present study reports the CT based 3D virtual modeling, preoperative virtual planning and the implant placement by using a STL surgical guide, in an anotia case.

Results

Employed materials and the methods facilitated the implant surgery while improving the operational security.

Conclusions

CT based 3D virtual modeling of the surgical site, determining the implant locations virtually and the STL guided placement of the craniofacial implants, were found useful applications in order to facilitating the surgical intervention and providing prevention from complications.

     

Comparison of implant versus tooth-supported zirconia-based single crowns in a split-mouth design: a 4-year clinical follow-up study

Objectives

This study aims to evaluate the 4-year clinical performance of tooth versus implant-supported single-unit zirconia crowns (LAVA?) placed on posterior region.

Materials and methods

Twenty-four patients (10 men and 14 women) who had received 48 single crowns (24 implant-supported and 24 tooth-supported) from January 2007 to December 2009, were included. California Dental Association (CDA) quality assessment system, plaque and gingival index scores were used to evaluate the performance of the crowns at baseline and at all follow-up examinations.

Results

During the follow-up period, no fracture of zirconia coping has occurred. Major complication was chipping in three patients that required a new crown fabrication. Except for the failure ones, all crowns in both groups were rated as satisfactory at the follow-up examinations based on the CDA quality assessment criteria. There were no statistically significant differences between tooth and implant-supported crowns in terms of periodontal parameters.

Conclusions

The present 4-year follow-up clinical study demonstrates that single-unit tooth- and implant-supported zirconia crowns have similar prosthetic and periodontal outcomes.

Clinical relevance

Single-unit implant or tooth-supported zirconia crowns may be considered acceptable treatment modalities for restoration of either missing or compromised posterior teeth

     

Complications of Midface Swing for Management of Juvenile Nasopharyngeal Angiofibroma

Introduction

Access osteotomies provide direct exposure to inaccessible areas of the deep part of craniofacial skeleton for treating pathologies involving vital structures. The use of maxillary swing approach for gaining wide access to the nasopharynx, infratemporal fossa, parapharyngeal space, middle fossa of skull base. Though the maxillary swing requires transfacial incision for wide exposure but with careful handling the scar is minimum and this approach can be used in young people.

Materials and Methods

Surgical resection is carried out following preoperative embolization of the involved feeder vessels. Total 16 cases were considered for this study.

Results

This article highlights cases successfully treated in our institution, the mention of complications associated with the cases along with management.

Conclusion

Maxillary swing is a good approach for getting access to the deep pathologies like JNA.

     

“Bone Mapping/Sketching” in Management of Anterior Table Frontal Sinus Fracture

Purpose

The aim of this present article was to know the efficacy of bone mapping/sketching in management of anterior table frontal sinus fracture.

Material and methods

This prospective clinical study includes 10 patients who reported to department of dentistry, AIIMS Bhopal with anterior table frontal sinus fracture. Sterile plain white paper or a glove cover was used for mapping/sketching. The patients were evaluated for post-operative contour of the fractured frontal sinus defect and any mucocele formation.

Results

All the 10 patients had no infection or post-operative mucocele formation and all have excellent aesthetic of the anterior table of the frontal sinus.

Conclusion

Bone mapping/sketching should be done in all comminuted fractures of cranio-maxillofacial region.

     

Salivary and serum interleukin-6 levels in proliferative verrucous leukoplakia

Background

Cytokines and chemokines have been analysed in patients with oral squamous cell carcinoma and potentially malignant disorders. We selected interleukin-6 (IL-6) because it is a multifunctional interleukin reported to be altered in potentially malignant oral disorders and in malignant lesions. To date, this has not been evaluated or tested in proliferative verrucous leukoplakia (PVL), however.

Objectives

This study aimed to analyse the differences in serum and saliva IL-6 levels among patients with PVL, oral squamous cell carcinoma (OSCC) and healthy controls and to examine the relationship between salivary IL-6 levels and the extent of the verrucous area.

Methods

Using an enzyme-linked immunosorbent assay, we determined the serum and saliva IL-6 levels in three groups: 20 patients with PVL, 20 with OSCC and 20 healthy controls.

Results

There were significant (p?<?0.01) differences in the serum and saliva IL-6 levels among the three groups and among the three grades of extent of the verrucous areas (p?=?0.01). In the OSCC group, there was a significant difference in the saliva IL-6 levels between patients with and without lymph node metastasis at diagnosis (p?=?0.02).

Conclusions

We found that patients with OSCC had the highest salivary and serum IL-6 levels, while PVL had lower values than OSCC, but higher than the controls, and these altered levels were associated with the extent of the verrucous areas.

Clinical relevance

Salivary and plasma IL-6 are altered in patients with PVL, with more extensive verrucous areas being associated to the highest IL-6 levels. This could be a significant tool for monitoring patients with PVL, their progression to more advances stages and their recurrences.

     

Increased local recurrence in advanced parotid malignancy treated with mastoidectomy without lateral temporal bone resection

Objective

We analyzed patients with advanced parotid malignancy requiring proximal facial nerve exposure undergoing mastoidectomy versus lateral temporal bone resection to determine differences in local and distant recurrence.

Study design

The study design is a case series with chart review.

Setting

The setting is in Tertiary care practice in Fort Worth, Texas from January1998 to January 2014.

Subjects and methods

The study included 120 patients with advanced parotid malignancy, 82 males between 19 and 87 years, and 38 females between 26 and 83 years. Patients with no overt bone involvement were treated with parotidectomy and mastoidectomy for exposure of the proximal facial nerve, and patients with clinically suspected (radiographic imaging or clinical fixation) bone involvement were treated with parotidectomy and lateral temporal bone resection. Follow up ranged from a minimum of 18 months to 11 years following surgery.

Results

Sixty patients were treated with mastoidectomy and 60 were treated with lateral temporal bone resection. In patients treated with mastoidectomy, 13 had local recurrence and 7 had distal recurrence. In patients treated with lateral temporal bone resection, 2 had local recurrence while 9 had distant recurrence. Statistical analysis revealed that patients treated with mastoidectomy developed local recurrence (p = 0.0022) more commonly than those treated with lateral temporal bone resection. There was no significant difference in distant recurrence between both groups (p = 0.5949).

Conclusions

Patients with advanced parotid malignancy should be treated aggressively with parotidectomy and lateral temporal bone resection regardless of bone involvement due to increased risk of local recurrence in those treated with mastoidectomy alone.

Level of evidence

Level of evidence is a 4 case series.

     

Bifurcation of external jugular vein: an anatomical variation during neck dissection

Background

The pattern of venous drainage of head and neck involves single external jugular vein bilaterally.

Methods and results

We report a case of bifurcation of the external jugular vein observed during a neck dissection procedure.

Conclusions

Anatomical variations in drainage pattern of superficial veins of the head and neck are important for head and neck surgeries including for anastomosis during free tissue transfer for head and neck reconstruction.

     

Upper airway imaging in sleep-disordered breathing: role of cone-beam computed tomography

Objective

To review recent use of three-dimensional (3D) imaging, specifically cone-beam computed tomography (CBCT), in the analysis of the upper airway for diagnosis or treatment outcomes in patients with sleep-disordered breathing (SDB).

Types of studies reviewed

Literature review of relevant medical and dental studies utilizing 3D imaging to assess the upper airway.

Results

Imaging of the upper airway provided insight into potential areas of obstruction. Accessibility of CBCT to dentists is reflected in several applications of upper airway diagnosis, treatment planning, and different treatment outcomes, as well as association with craniofacial development. However, multiple deficiencies in image acquisition, 3D reconstruction, and analysis are evident.

Practical implications

The role of CBCT in the analysis of the upper airway is growing; however, critical limitations remain. An understanding of these limitations, clarification of misconceptions, and improvements in analysis methods are required to ensure proper use and development of CBCT.

     

A Protocol for Management of the Hairs Problem in Oral Cavity Reconstruction by Submental Flap

Background

Submental flap is a useful aid in maxillofacial reconstruction. For intraoral usage the hairs in male patients will create some problems.

Materials and Methods

In a retrospective study, patients in whom submental flap had been used for reconstruction of orofacial region between 2007 and 2013, in the Mashhad University, Ghaem Hospital, were included. The ways in which the problem of hairs was solved in male patients were evaluated.

Results

There were 42 patients in whom submental flap was used for orofacial reconstruction. Sixty percent were males. Three ways had been used for management of intraoral hairs: radiotherapy (9 patients), second surgery (2 patients) and flap de-epithelialization (13 patients).

Conclusion

Deepithelialized variant of submental flap is the best option when submental flap is used for oral cavity reconstruction in male patients. Flap thickness, age, race and postoperative radiotherapy can have strong influence on this strategy.