Vitamin C influences antioxidative, anti-inflammatory and wound healing markers in smokers' gingival fibroblasts in vitro.

Background: Saudi Arabia has an overall smoking rate of 15.9%. The link between smoking and periodontal disease has been studied extensively. It is possible for human gingival fibroblasts to accumulate nicotine intracellularly over a period of four hours. Additionally, unmetabolized nicotine is released into the environment. Tobacco presence can impair tissue inflammation, wound healing, and organ development. To counterbalance tobacco toxins, vitamin C has been added to a variety of products. Aim: This study aims to analyze the RNA expression of antioxidant, anti-inflammatory, and wound healing proteins in human gingival fibroblasts from smokers and nonsmokers using polymerase chain reaction. Materials and Methods: hGFs were extracted from clinically healthy periodontium sites of adult male subjects. Both heavy cigarette smokers and never-smokers participated as subjects. Cells were cultured and subcultured in supplemented growth medium. Vitamin C was inducted in the medium at the experimental 6th passage. RNA expression analysis (qRT-PCR) was performed to analyze adhesion, proliferation, and extracellular matrix expression. Results: The results revealed marked expression of a wound healing gene (VEGF-A) in never-smokers (p value = 0.016). GPX3 and SOD3 represent antioxidants that are highly expressed in treated never-smoker cells. SOD2 significantly increased (p value = 0.016) in smokers after vitamin C exposure. The anti-inflammatory markers IL-6 and IL-8 were lower among smokers than among nonsmokers (p < 0.0001). Conclusion: Tobacco smoking suppressed gingival fibroblasts' abilities to regenerate, heal, combat inflammation, and resist free radicals. Vitamin C at cellular levels was beneficial and should be considered in the treatment component of smokers in the dental clinic.

Dental students' attitudes and perceptions about intraprofessional collaboration/education.

Objectives: To investigate dental students' attitudes and perceptions about intraprofessional collaboration/education (IPC/IPE) and shared learning, and to explore the impact of IPC/IPE on the personal and professional development of participating students. Methods: A custom-designed questionnaire was used in this cross-sectional study. The questionnaire comprised 17 questions targeting to capture the student's perceptions about IPC/IPE using three factors: (1) dental students' preference/opinion about the IPC/IPE; (2) dental students' experience about the impact of IPC/IPE on learning outcomes and professional development; and (3) students' feedback about the significance of IPC/IPE in clinical/clinical simulation labs and workplace setting. The students rated each of the 17 statements on the 5-point Likert scale (range: 1 = strongly disagree to 5 = strongly agree). Results: A total of 259 responses were analysed (response rate = 65%). All students were aware of IPC/IPE in the field of dentistry (mean score = 4.22). The students preferred collaborative/shared learning with their own classmates. There was a consensus among students about the positive impact of IPC/IPE on enhanced learning, enhancement of communication skills, and enrichment of professional relationships with supporting staff as well as with the patients. There was also improved analytical and psychomotor skills, understanding of complex problems in the clinic, and understanding of strengths and limitations leading to self-improvement and increased efficiency and productivity. Conclusion: IPC/IPE had a compelling, powerful, and positive impact according to the experience of the participating dental students. It is recommended that a standardized curriculum be designed and guidelines set for IPC/IPE at dental institutions for effective interactions among students of all stages.

A Comparison of Self-Perceived Oral and Facial Esthetics in Patients After Lip Repositioning Surgery With Modified and Conventional Techniques.

BACKGROUND: Patients with excessive gingival display (EGD) are treated with lip repositioning surgeries (LRS). This study used a questionnaire to analyze and evaluate how patients who received LRS with modified and traditional techniques perceived their own oral and facial esthetics at various timelines after their surgeries. METHODS: An orofacial esthetic questionnaire (OEQ) was used in this cross-sectional study. The participants were patients who underwent LRS for the treatment of their EGD. They were divided into control (n=100) and test (n=100) groups. For the control group, LRS were performed using traditional/conventional techniques, and for the test group, LRS were performed using a modified approach. An OEQ was used to record responses. The scale comprised eight questions targeted to capture participating patients' perceptions about their own oral and facial esthetics at four timelines (baseline and one-month, six-month, and one-year follow-up). Patients responded to each question on a 10-point Likert scale (0: very dissatisfied, 10: very satisfied). Data was analyzed by independent samples T-tests using Statistical Package for the Social Sciences (SPSS) version 21.0 software (IBM SPSS Statistics, Armonk, NY). RESULTS: Seven (3.5%) out of the total (N=200) patients were unable to take part in the study's OEQ. At one-year follow-up, the mean and standard deviation (SD) for the test group's gingival display (GD) were 2.48±0.86 mm and 3.77±1.76 mm, respectively, and comparisons revealed that the test group's GD was significantly lower (p=0.000) than the control group. Results from the participant responses to OEQ using the Likert scale at one-year follow-up revealed significant differences between the control and test groups for all questions, except question 5 (p=0.06), as the shape of the teeth will not be affected by LRS. Patients in the test group who underwent LRS with a modified approach have a high level of satisfaction (satisfaction score: >9). Patients in the control group scored their satisfaction less favorably, with certain questions (question 3) receiving scores as low as 0.31. Perception of oral and facial esthetics was significantly higher for the test group at different time points. At one-year follow-up, the mean difference was 4.46, which was the greatest (p=0.000). CONCLUSIONS: EGD improved significantly at one year with the modified lip repositioning technique. The satisfaction level of patients with outcomes of the modified lip repositioning was significantly higher as compared to the satisfaction level of patients who underwent the conventional technique.

Vitamin C stimulates RNA expression of human gingival fibroblasts proliferation and adhesion in cigarette smokers: An in vitro study.

Background: Smoking and the severity of periodontal disease have long been associated. In Saudi Arabia, tobacco smoking is rising, contributing to the increased demand for products that counter its detrimental effects. The antioxidant properties of vitamin C (vit C) make it a powerful countermeasure to tobacco toxicity. Observation of these effects on human gingival fibroblasts (hGFs) would suggest use of vitamin C in future dental applications. Aim: To examine the proliferation, adhesion, and expression of extracellular RNA in human gingival fibroblasts extracted from cigarette smokers when compared to never-smokers, in association with vitamin C. Materials and Methods: Human gingival fibroblasts were extracted from Periodontal free sites of healthy adult male participants. Group 1; consisted of Heavy cigarette smokers (n = 1) while group 2 was never-smokers (n = 1). Collected cells were cultured and subcultured in supplemented growth medium. Vitamin C was then induced in the medium at the experimental sixth passage. RNA expression analysis using quantitative reverse transcriptase-polymerase chain reaction was performed to analyze the adhesion, proliferation, and extracellular matrix expression. Results: Expression of the adhesion gene (CD44) in the smoker group was significantly downregulated than never-smoker group (p-value = 0.024). After the induction of vitamin C, the smoker samples showed a significant improvement in their gene expression levels. The extracellular genes involved in this study (COL1A1, LAMA3, and TGFB3) were significantly affected by the smoking status. In addition, the proliferation of MK167 and CCNB1 genes in smokers and never-smokers was increased. Conclusion: Cigarette smoking affects the overall properties of human gingival fibroblasts' adhesion, proliferation, and extra-cellular matrix formation. Furthermore, the addition of vitamin C affects these cellular properties in a positive manner.

Regenerative Potential of Platelet Rich Fibrin (PRF) in Socket Preservation in Comparison with Conventional Treatment Modalities: A Systematic Review and Meta-Analysis.

BACKGROUND: Platelet rich fibrin (PRF) has shown great potential in osteogenesis; however, some studies still question utilizing it as a grafting material. Thus, the aim of this review is to evaluate the effect of PRF when used in socket and ridge preservation procedures. METHODS: Electronic searches through MEDLINE, EMBASE, and Cochrane, Science Citation Index Expanded databases and manual searches of unpublished data, academic theses, and journals were conducted up until July 2021. The outcomes were to assess the ability of PRF as a graft material to preserve bone width, height, and density after tooth extraction. RESULTS: Twelve studies were included in the review, using PRF showed significant results in all three outcomes when compared to no grafting at all, however when compared to other commonly used grafting materials it showed a lesser effect. On the other hand, most studies included reported mixing PRF with a graft material showed the best result. The meta-analysis also revealed the significant results in using PRF on the three outcomes. CONCLUSION: The meta-analysis of the studies included proved the beneficial effect of PRF in socket preservation surgeries alone or in combination with other graft materials, but further individual multi-centre randomized controlled studies with appropriate sample size are still needed to further confirm our findings.

A Modified Approach in Lip Repositioning Surgery: A Prospective Study in a Twin Population with a 3-Year Follow-up.

This study evaluated long-term clinical and patient satisfaction outcomes following a modified lip repositioning technique that utilized periosteal sutures in a twin population. Twin sisters diagnosed with maxillary lip hypermobility were randomly assigned to either the control group (original LipStaT technique) or test group (addition of periosteal sutures). The participants (n = 12; 6 per group) were evaluated at intervals for up to 3 years postoperative. Clinical measurements, digital images, and patient satisfaction surveys were collected. Descriptive statistics were used to assess outcome variables: average lip width at rest (ALW), vertical lip translation (VLT), and average gingival display (AGD). Student t test, one-way analysis of variance, and Spearman rank correlation tests were used to compare mean values of variables at five time points for both groups. The level of significance was α = .05. In the control group, mean VLT and AGD values showed statistically significant decreases from baseline (14.8 mm and 7.0 mm, respectively) to 2 years (5.7 mm and 2.4 mm, respectively), but a slight increase was seen at 3 years (7.5 mm and 5.0 mm, respectively; P < .0001). In the test group, mean VLT and AGD values showed statistically significant decreases from baseline (14.8 mm and 6.9 mm, respectively) to 3 years (5.5 mm and 3.5 mm, respectively; P < .0001). A higher participant satisfaction score at 3-year follow-up was observed in the test group. The modified lip repositioning technique in a population of twins resulted in more stable outcomes that lasted up to 3 years postoperatively.

The effect of overbite and overjet on clinical parameters of periodontal disease: A case control study.

AIM: To investigate the association of overjet and overbite with clinical parameters of periodontal disease. MATERIAL AND METHODS: The study was performed in Riyadh, Saudi Arabia, from March 2017 to March 2018. 600 Saudi males aged 20-30 years old were included. Participants were divided into three groups (n: 200) depending on the presence of overjet (OJ) or overbite (OB) and its relationship with periodontal disease. Periodontal parameters were assessed clinically and radiographically. One-way analysis of variance was used to test for any significant differences between groups. Tukey's post hoc comparison test was used to evaluate correlations among parameters. RESULTS: OJ exceeding 8 mm was correlated with debris, calculus, and periodontal scores on mandibular anterior teeth, especially on the lingual surfaces.Both OJ and OB groups showed significantly increased PD, compared to that of the control group in measurement at the lingual (P = 0.004, 0.003) and proximal (P = 0.002, 0.002) surfaces of the lower anterior teeth. Finally, the CEJ-AB was statistically significantly higher in the OB group compared to the OJ and control groups (P = 0.091, 0.008). CONCLUSION: The present study found a correlation between OJ and OB and periodontal disease, as measured using specific parameters. This indicates that periodontal treatment may be insufficient unless the overjet or overbite is corrected.

Awareness Toward COVID-19 Precautions Among Different Levels of Dental Students in King Saud University, Riyadh, Saudi Arabia.

PURPOSE: The risk of acquiring coronavirus disease 2019 (COVID-19) among dental professionals is high because they are exposed to aerosol production and body fluids during dental procedures. Therefore, the aim of the study was to determine the level of awareness among the dental students regarding COVID-19. MATERIALS AND METHODS: An online cross-sectional questionnaire with three sections (knowledge, attitudes, practice) was completed by 412 postgraduate and undergraduate dental students and interns from King Saud University in Saudi Arabia. RESULTS: The overall mean survey score was 9.56±1.19 out of 15. A mean score of 2.31±0.32 was recorded for level of knowledge among the dental professionals that indicated a fair level of knowledge among the participants. Similarly, a mean score of 6.5±0.45 was recorded for attitude of dental professionals towards COVID-19 that indicated a moderate level of attitude. "Novel COVID-19 virus transmits through droplets," and "masks should be worn most of the time to prevent infection spread," had the lowest correct answer rates. The practice had a low mean score of 0.81±0.22. The results depicted statistically significant differences in knowledge, with postgraduate students having the highest mean scores, followed by interns and undergraduate students. CONCLUSION: Despite attaining fair scores on knowledge and attitudes, the low practice scores highlight the need for urgent strategies to prevent infection among dental students, including mandatory crash courses and hands-on protection measures.

Rotational relapse of anterior teeth following orthodontic treatment and circumferential supracrestal fiberotomy.

BACKGROUND/PURPOSE: Several factors cause relapse of orthodontically de-rotated teeth after appliance removal. Circumferential supracrestal fiberotomy (CSF) may release the tension on the supra-alveolar fibers following tooth de-rotation, thereby reducing the relapse risk. However, careful identification of the amount and location of relapse enables proper clinical evaluation. We aimed to determine the amount of orthodontic relapse following CSF for de-rotated anterior teeth. MATERIALS AND METHODS: Eleven patients with 90 orthodontically de-rotated anterior teeth were enrolled. CSF was performed after orthodontic treatment, during fixed retainer placement. Rotational correction and relapse were measured on three casts (preorthodontic treatment, cast 1; postorthodontic treatment + CSF, cast 2; and 12-month follow-up, cast 3). The Wilcoxon test was used to assess significant differences in the tooth rotation angles between casts 1 and 2 and casts 2 and 3. The relationship between the magnitude of relapse and pretreatment severity of rotation was assessed by the point biserial correlation test. The Mann-Whitney U test helped in identifying significant differences in the amount of relapse between maxillary and mandibular teeth. RESULTS: The mean amount of rotational correction was 14.05°, while the mean amount and percentage of relapse were 1.1° and 10.8%, respectively [0.81° (8%) and 1.44° (14%) for maxillary and mandibular teeth, respectively]. The relapse amount was proportional to the pretreatment rotation severity, and it was larger for the mandibular canines. There was no significant difference in the amount of relapse between the maxillary and mandibular teeth (P = 0.07). CONCLUSION: Post-treatment rotational relapse of anterior teeth subjected to CSF was minimal and statistically insignificant after 1 year of follow-up. This validates the promising results of CSF when combined with appropriate mechanical retention for an adequate period.

An Evidence-Based Update on the Molecular Mechanisms Underlying Periodontal Diseases.

Several investigators have reported about the intricate molecular mechanism underlying periodontal diseases (PD). Nevertheless, the role of specific genes, cells, or cellular mechanisms involved in the pathogenesis of periodontitis are still unclear. Although periodontitis is one of the most prevalent oral diseases globally, there are no pre-diagnostic markers or therapeutic targets available for such inflammatory lesions. A pivotal role is played by pro- and anti-inflammatory markers in modulating pathophysiological and physiological processes in repairing damaged tissues. In addition, effects on osteoimmunology is ever evolving due to the ongoing research in understanding the molecular mechanism lying beneath periodontal diseases. The aim of the current review is to deliver an evidence-based update on the molecular mechanism of periodontitis with a particular focus on recent developments. Reports regarding the molecular mechanism of these diseases have revealed unforeseen results indicative of the fact that significant advances have been made to the periodontal medicine over the past decade. There is integrated hypothesis-driven research going on. Although a wide picture of association of periodontal diseases with immune response has been further clarified with present ongoing research, small parts of the puzzle remain a mystery and require further investigations.

One-year rotational relapse frequency following conventional circumferential supracrestal fiberotomy.

BACKGROUND: Relapse following orthodontic treatment has been a common problem that can occur due to several factors. It was suggested that surgical circumferential supracrestal fiberotomy (CSF) is an effective measure to reduce this relapse. However, very few studies have reported the amount of relapse that occurs afterward. AIM: To assess the frequency of rotational relapse on anterior teeth 1 year following CSF. METHODS: Eleven adults (six male and five female) with a mean age of 23 years (standard deviation = 5.2), who had a total of 90 rotated anterior teeth, were included in this study. CSF was performed after comprehensive orthodontic treatment involving the use of full-fixed preadjusted edgewise appliances (Victory Series APC, 3M, United States) with a 0.022-inch slot and Roth prescription brackets (Ovation; DENTSPLY GAC, Bohemia, New York, United States) and placement of a fixed lingual retainer from canine to canine in both arches using a 0.016 Australian wire (AJ Wilcock, Australia). Degrees of rotational correction and relapse were measured on three sets of casts [pretreatment, post-treatment (at the debond visit), and 1-year post-treatment]. Rotational relapse was categorized as follows: Unnoticeable relapse (0°), barely noticeable relapse (1°-3°), noticeable relapse (4°-9°), and clearly noticeable relapse (≥ 10°). The percent relapse that had occurred 1 year after teeth were aligned to their ideal position was calculated. Data were analyzed by dental arch type and tooth types. RESULTS: Mean rotational correction was 14.05° during posttreatment. Mean relapse at 1-year follow-up was 1.1° (10.8%). More than half (n = 52, 57.8%) of teeth were categorized as having unnoticeable relapse (0°). Of the remaining teeth, 31 (34.5%) had barely noticeable relapse (1°-3°), 6 (6.6%) had noticeable relapse (4°-9°), and only one (1.1%) had clearly noticeable relapse (> 10°). When analyzed by arch, 54.5% (n = 6) of the relapsed maxillary teeth had barely noticeable relapse (1°-3°). While most of the mandibular teeth (3, 37.5%) fell into noticeable relapse category (4°-9°), only 1 (12.5%) tooth had clearly noticeable relapse (≥ 10°). CONCLUSION: When relapse was measured following CSF, it was found to be more pronounced in maxillary than in mandibular arch. Most frequent relapse was found in maxillary lateral incisors and mandibular canines.

Xenogeneic collagen matrix versus connective tissue graft for the treatment of multiple gingival recessions: A systematic review and meta-analysis.

A systematic review and meta-analysis was performed to understand the efficacy of xenogeneic collagen matrix (CMX) compared with connective tissue graft (CTG) for the treatment of multiple adjacent gingival recessions (MAGRs). A literature search was performed for published randomized controlled trials in adult patients (≥18 years old) with Multiple Adjacent Miller class I and II gingival recessions (MAGRs). The assessments included recession depth, Recession width, complete root coverage, mean root coverage, probing depth, clinical attachment level, and keratinized tissue width. Pooled data were analyzed using fixed- and random-effects models, and Forest plots were constructed. Heterogeneity within studies was calculated to assess publication bias. Four randomized controlled trials were included based on the eligibility criteria. Although the recession depth, complete root coverage, and mean root coverage were significantly lower with CMX (p = .017 and p = .001, p = .001, respectively), there was no statistically significant difference in the Recession width between CMX and CTG (p = .203). CMX showed significantly lower Probing Depth than CTG (p = .023); however, no significant difference in clinical attachment level (p = .060) and keratinized tissue width (p = .052) was observed between the groups. Owing to the heterogeneity in the included studies, firm conclusions cannot be drawn regarding the noninferiority of CMX compared with CTG. Long-term studies are therefore needed to conclusively establish the relative efficacy of CMX in MAGR.

Dental anxiety among dental, medical, and nursing students of two major universities in the central region of the Kingdom of Saudi Arabia: a cross-sectional study.

BACKGROUND: Dental anxiety is one of the most common fears that can eventually lead to avoidance of dental care. Knowing how students will respond to dental treatment will aid in increasing their awareness of oral health and overcoming this fear. The present study measured the prevalence of dental anxiety among dental, medical, and nursing students in Riyadh city, Kingdom of Saudi Arabia. METHODS: A cross-sectional study including undergraduate dental, medical, and nursing students at King Saud University and Almajmaa University was conducted to assess dental anxiety using the Modified Dental Anxiety Scale. Descriptive statistics including means, standard deviations, and percentages were calculated. Group comparisons were analyzed using t-tests and analysis of variance. Multiple group comparisons were conducted using Tukey's post-hoc test. P < 0.05 was considered as the significance level. RESULTS: Two hundred twenty-four participants completed the questionnaire. Medical students accounted for most of the responses (40.6%), followed by nursing (31.7%), and dental students (27.7%). There was no significant difference in dental anxiety with regard to gender. Dental students exhibited the least dental anxiety. A significant difference was found between students with good dental experiences compared with those who had bad dental experiences. CONCLUSION: Dental students had the lowest level of anxiety and anxiety levels were affected by previous dental visits. Increasing awareness and knowledge about oral health, regular dental education, and incorporating dental knowledge into university curriculums can aid in eliminating the fear of dentistry among health sciences students.

Is Bone Graft or Guided Bone Regeneration Needed When Placing Immediate Dental Implants? A Systematic Review.

AIMS: To systematically review the effect and type of bone graft and guided bone regeneration around immediate implants on hard and soft tissue changes. METHODS: Three electronic databases were searched up to June 2015. Outcomes consisted of hard and soft tissue dimensional changes. RESULTS: Eight studies were included according to inclusion criteria. Immediate implants with bone grafting had superior soft tissue stability and preserved horizontal ridge dimension and buccal plate thickness, when compared to no grafting. The use of a barrier alone significantly decreased buccal plate resorption and the remaining defects around the implants, and the use of both bone graft and membrane aided in soft tissue preservation. The optimal type of bone graft material was a combination of cortical autogenous and synthetic particulate when compared to each separately, whereas no difference was found between demineralized allograft and hydroxyapatite in decreasing bone loss. CONCLUSIONS: Quantitative data analysis was not possible due to heterogeneity of the included studies. Further randomized clinical trials with homogenous samples and proper controls are needed to support the results of this report.

Periodontitis and obstructive sleep apnea's bidirectional relationship: a systematic review and meta-analysis.

PURPOSE: The aim of this study is to evaluate the association between periodontal disease and obstructive sleep apnea (OSA). METHODS: Electronic search using PubMed, Cumulative Index to Nursing and Allied Health (CINAHL), Cochrane Central Trial Registry, Cochrane Database of Systematic Reviews, Scopus, and Embase was carried out for randomized controlled trials, longitudinal, cohort, case-control, and epidemiological studies on humans, published until October 2014. Manual searches were also performed. The participants considered were adult subjects with OSA and chronic periodontitis. The authors reviewed all articles and extracted data using a customized data abstraction sheet. Methodological quality assessment was carried out using the Newcastle-Ottawa Quality Assessment Scale. RESULTS: Six studies met the inclusion criteria set for this review. They evaluated the association between periodontal disease and OSA and the efficacy of periodontal interventions on OSA occurrence and severity. The periodontal disease outcome measures included clinical attachment loss, periodontal pocket depth, oral hygiene indices, radiographic alveolar bone loss, and salivary cytokines. Meta-analysis of four studies revealed a statistically significant association between periodontal disease and OSA (pooled odds ratio = 1.65, 95 % confidence interval (CI) = 1.11, 2.46, P = 0.01). There is insufficient evidence on the efficacy of periodontal disease interventions. CONCLUSIONS: There is some evidence to a plausible association between periodontal disease and OSA. Evidence on the efficacy of periodontal disease interventions is insufficient. The causal-effect relationship of periodontal disease and OSA is debatable. Further research with case-control studies is warranted.