Pulp Vitality of Maxillary Canines After Alveolar Cleft Bone Grafting: Pulse Oximetry Versus Electric Pulp Test Versus Cold Test.

OBJECTIVES: Assessment of pulp vitality is necessary prior to any dental treatment. The purpose of this study was to assess pulp vitality of bilateral canines in unilateral cleft patients following alveolar bone graft surgery using pulse oximetry, electrical pulp test, and cold test. METHODS: This analytical, cross-sectional study was conducted on canines of 20 unilateral cleft patients who had alveolar bone graft surgery. Pulp vitality of canines was evaluated postoperatively by pulse oximetry, electrical pulp test, and cold test. Data were analyzed using t test, Mann-Whitney test, and χ2 test. P ≤0.05 was considered statistically significant. RESULTS: The mean pulp SpO2 was significantly lower in canines at the cleft side compared with the normal side (85.04 ±â€Š4.65 versus 87.78 ±â€Š4.01, P = 0.05). The response to cold test was not significantly different (P = 0.056). The mean response to electrical pulp was not significantly different between the 2 sides either (P = 0.62). CONCLUSION: The mean SpO2 of canines was lower at the cleft side than normal side but both sides had adequate blood supply and were vital.

Facial nerve repair with Gore-Tex tube and adipose-derived stem cells: an animal study in dogs.

PURPOSE: Synthetic conduits have been considered a viable option in nerve reconstructive procedures. They address the goal of entubulization and eliminate the disadvantages of autografts. However, despite all successful reports, none has contained regeneration characteristics, such as growth factors or essential cells, for nerve repair. The authors evaluated the capability of adipose-derived stem cells in Gore-Tex tubes to enhance facial nerve repair. MATERIALS AND METHODS: Undifferentiated mesenchymal stem cells were extracted from the autogenous adipose tissues of 7 mongrel dogs. The frontal branch of the facial nerve was transected. A gap size of 7 mm was repaired with an expanded polytetrafluoroethylene tube filled with undifferentiated adipose-derived stem cells encapsulated in alginate hydrogel. The control sides were repaired with the tube and alginate alone. The healing phase was 12 weeks. RESULTS: Except in 2 control sides, an organized neural tissue was formed within the tubes. Compared with the normal nerve diameter, there was a decreased ratio of 29% and 39% in the experimental and control groups, respectively. Neurofilament-positive axon counts were 67% of normal values in the 2 groups. There was no significant difference between groups in histomorphometric parameters. Nerve conduction velocity in the experimental group (28.5 ± 3.5 m/s) was significantly greater than in the control group (16.2 ± 7 m/s). The experimental group also exhibited a greater maximal amplitude of action potential (1.86 ± 0.24 mV) than the control group (1.45 ± 0.49 mV). CONCLUSIONS: Addition of stem cells in the Gore-Tex tube enhanced the neural repair from a functional standpoint. However, for better functional and histologic results, differentiated Schwann cells and other mediators may be warranted.

Investigation of the effect of fibrin glue as a sealant in the unilateral alveolar bone grafting successes.

Background: Bone grafting is the primary treatment for the alveolar cleft. Due to the reduced complications by the sealant materials, this study aimed to evaluate fibrin glue's effect on the success rate of unilateral alveolar bone grafting. Materials and Methods: This study was a single-blind clinical trial performed on 20 patients with a unilateral alveolar cleft. Patients were randomly divided into groups: group A patients as a control group underwent bone grafting without fibrin glue, and in Group B, patients were grafted using fibrin glue. The subject was followed up through routine examination and the cone-beam computed tomography systems technique for up to 4 months. Paired t-test and Chi-square tests were used to analyze the data and the P < 0.05 was considered the significance threshold. Results: The mean age, gender, and cleft side distribution did not represent significant differences. Before surgery, the average alveolar cleft volume in Group A and B patients was 0.95 ± 0.25 cm3 and 0.99 ± 0.22 cm3, respectively, which was not statistically different. After the surgery procedure, the alveolar cleft volume in Group A and B patients was determined to be 0.31 ± 0.10 cm3 and 0.23 ± 0.11 cm3, which represented 66.7% ± 8.9% cm3 and 76.2 ± 11.4 cm3 bone formation, respectively, with no remarkable difference. Our examination did not reveal any necrosis and infection in both groups. However, despite no dehiscence observation in fibrin glue treatment patients, one subject showed dehiscence complication in the control group. Conclusion: According to results, fibrin glue may increase the percentage of bone volume formed and prevent dehiscence.

Relation of CAD/CAM zirconia dental implant abutments with periodontal health and final aesthetic aspects; A systematic review.

Background: Using dental implants to replacing missing teeth and satisfy both functional and aesthetic needs is one of the mainstream dental treatments. New approaches including computer-aided design and computer-assisted manufacture (CAD/CAM) have been introduced to improve these elements. This systematic review aimed to compare CAD/CAM zirconia (Zr) implant abutments with other available abutments in terms of peri-implant health and aesthetics. Material and Methods: Five electronic databases (PubMed, Web of Science, Scopus, ProQuest, and Embase) were scoured for clinical studies evaluating Zr abutments reporting on the outcomes of interest including interproximal papilla stability (PS), papilla recession (REC), pink and white esthetic score (PES, WES), marginal bone level (MBL), color, and soft tissue contour. A hand searches in English language journals until September 2020 complemented the search. Two tools of Joanna Briggs Institute and Jaded Score calculation were used for the risk of bias assessment. No quantitative synthesis of the data was done due to high heterogeneity. Results: A total of six studies from the 412 ones obtained from the search were included. The study designs were either prospective cohort (n=3) or randomized clinical trial (n=3). Papilla fill, WES, PES, and the distance from the bone crest of adjacent teeth to the contact point (CPB) and inter-tooth-implant distance (ITD) was not significantly different between Zr CAD/CAM and Zr stock abutments. However, soft tissue stability and REC index were better in Zr CAD/CAM abutments. Conclusions: Higher soft tissue stability can be achieved for Zr compared to titanium abutments with either stock or CAD/CAM abutments. Key words:Dental implants, Dental abutment, Computer-Assisted Design, Computer-Aided Manufacturing, Zirconia abutment, Soft tissue stability.

Effectiveness of fibrin adhesive in facial nerve anastomosis in dogs compared with standard microsuturing technique.

PURPOSE: Epineural suturing is the most common technique used for peripheral nerve anastomosis. In addition to the foreign body reaction to the suture material, the surgical duration and difficulty of suturing in confined anatomic locations are major problems. We evaluated the effectiveness of fibrin glue as an acceptable alternative for nerve anastomosis in dogs. METHODS: Eight adult female dogs weighing 18 to 24 kg were used in the present study. The facial nerve was transected bilaterally. On the right side, the facial nerve was subjected to epineural suturing; and on the left side, the nerve was anastomosed using fibrin adhesive. After 16 weeks, the nerve conduction velocity and proportion of the nerve fibers that crossed the anastomosis site were evaluated and compared for the epineural suture (right side) and fibrin glue (left side). The data were analyzed using the paired t test and univariate analysis of variance. RESULTS: The mean postoperative nerve conduction velocity was 29.87 ± 7.65 m/s and 26.75 ± 3.97 m/s on the right and left side, respectively. No statistically significant difference was found in the postoperative nerve conduction velocity between the 2 techniques (P = .444). The proportion of nerve fibers that crossed the anastomotic site was 71.25% ± 7.59% and 72.25% ± 8.31% on the right and left side, respectively. The histologic evaluation showed no statistically significant difference in the proportion of the nerve fibers that crossed the anastomotic site between the 2 techniques (P = .598). CONCLUSIONS: The results suggest that the efficacies of epineural suturing and fibrin gluing in peripheral nerve anastomosis are similar.

Dental implants immediate loading versus the standard 2-staged protocol: an experimental study in dogs.

The endeavors to shorten implant treatment time have led to the concept of immediate loading. This research was designed to compare the immediate loading and the 2-staged methods on implant placement from a clinical, histological, and histomorphometric standpoint. Three months postextraction of 12 premolars of 3 dogs, 12 implants were inserted. Bone-implant contact (BIC), implant stability quotient (ISQ), the bone type in a 2-mm periphery around the implant, and the marginal bone loss (MBL) were recorded for unloaded implants (n  =  6) and immediately loaded ones (n  =  6). BIC, ISQ, MBL in the mesial, and the bone types around the implants were not significantly different in the 2 groups. The distal MBL was higher in the immediately loaded group. Immediate loading does not appear to be perilous for osseointegration, BIC, or new bone type around implants.

Cone-beam computed tomographic comparison of chin symphysis bone particles and allograft versus iliac crest bone graft alone for reconstruction of alveolar bone defects in cleft patients.

Objectives: The aim of this study was to compare morbidities and duration of surgery, as well as bone formation in alveolar defects reconstructed with symphysis bone combined with allograft and iliac crest bone graft in patients with cleft palate. Patients and. Methods: This randomized clinical trial was performed with 22 patients with unilateral alveolar cleft with a follow-up period of 12 months. In 12 patients, alveolar defects were reconstructed with chin bone graft plus allograft (Group A), while for the other 10 patients, iliac bone crest was used as donor site (Group B). Duration of surgery as well as occurrence of morbidities and complications were recorded. In addition, cone-beam computed tomographic (CBCT) scans were performed before surgery and 12 months after surgical procedures in order to compare bone formation between the two groups. Results: Postoperative CBCT demonstrated a mean bone fill percentage of 76.9% of the alveolar defect in Group A, compared with 77.0% in Group B. Paresthesia in the lower lip or chin did not occur in any patients of Group A. The mean duration of the surgical process was significantly shorter for Group A (40 minutes vs 76 minutes, P<0.001). In addition, patients in Group A regained normal gait faster than patients in Group B (1 day vs 9.5 days). Conclusion: Mandibular symphysis bone graft in combination with allograft results in favorable outcomes in patients with unilateral alveolar clefts.

Clinical and radiological evaluation of implants placed with osteotome sinus lift technique: 19-month follow-up.

AIMS: Implant placement in the posterior region of the maxilla might be problematic due to poor regional bone quality. The aim of this study was to clinically and radiologically evaluate implants which were placed in the posterior region of the maxilla (with insufficient bone height) with osteotome sinus lift technique after 19-month follow-up. MATERIALS AND METHODS: Twenty-four patients with posterior maxillary alveolar height ranging from 5 to 8 mm were chosen for this prospective study. After breaking of the cortical bony sinus floor, sufficient bone substitute was placed, and sinus floor was elevated. In this way, a new sinus floor was created, which was designated for further implants placement. Fifty implants were placed immediately after osteotomy sinus lift technique. The mean clinical and radiological follow-up period was 19 months (with a range of 14-24 months). Success factors such as the absence of mobility, pain, infection, and the amount of crestal bone loss were determined in this study. For data analyzing, Kruskal-Wallis and Mann-Whitney tests were used. RESULTS: After 19 months, results showed 96% success rate. Two out of fifty implants failed due to mobility. The mean depth of implants in sinus, mean height of residual crestal bone before surgery, and the mean rate of crestal bone loss were 3.8, 7.9, and 0.71 mm, respectively. CONCLUSION: Osteotome sinus lift technique is a noninvasive surgical method for enhancing a desired length. Furthermore, implants insertion was successful after osteotome sinus lift technique in cases with insufficient bone height.

Ewing's sarcoma in mandibular similar to dental abscess.

Ewing's sarcoma is a rare malignant neoplasm that comprises approximately 4-6% of primary bone tumors. In most cases, femur and pelvis are affected, and less commonly the head and neck areas (in the jaws, usually the mandible). These tumors have been reported more frequently in males, mostly aged 5-20 years old. Systemic symptoms and signs such as fever, weight loss, anemia, leukocytosis, and elevated erythrocyte sedimentation rate (ESR) may be the first signs in oral Ewing's sarcoma. Such signs and symptoms are also seen in odontogenic infections and abscess. In one case, the patient went to a dentist with pain, swelling, and abscess similar to odontogenic infection and patient's tooth was pulled due to misdiagnosis. This tumor has an aggressive clinical behavior and is identified with rapid growth and high probability of metastasis at diagnosis. Thus, it is necessary to differentiate it from a dental abscess. As for the treatment of Ewing's sarcoma, first the tumor must undergo chemotherapy to reduce its size and, eventually, it undergoes extensive surgery. This case report deals with a 16-year-old patient wrongly diagnosed with odontogenic infection and abscess, and hospitalized. As the symptoms did not remit, biopsy was carried out and the patient was operated on with Ewing's sarcoma diagnosis.

Neurosensory changes of palatal mucousa following Le Fort I osteotomy.

BACKGROUND: This study evaluated the sensation of palatal mucosa before and after Le Fort I osteotomy and compared it based on whether greater palatine nerve has been dissected or not. METHODS: Sixteen patients were studied within one week before surgery and then one week, 6 weeks, 3 months and 6 months after surgery. Four tests including sharp-blunt discrimination, cold perception, pin prick sensation and electrical stimulation were performed. RESULTS: Mean values of electrical stimulation were significantly higher 6 months after surgery (p < 0.05), on the other hand mean values of pin-prick sensation were significantly lower (p < 0.05). All patients regardless of the condition of greater palatine nerve were responsive to cold perception and sharp-blunt discrimination 6 months after surgery. CONCLUSIONS: Following Le Fort I osteotomy, palatal responsiveness to electrical stimulation decreases and mechanical hyper sensitization occurs. Dissection of greater palatine nerve was shown to have no effect on the results.