In-vivo assessment of application of folinic acid and botulinum toxin A in cleft lip surgical defects.

INTRODUCTION: Folinic acid and botulinum toxin A have shown promising results in wound healing in different studies. This study aimed to compare the effects of these approaches on wound healing after simulating cleft lip surgery in rats. METHODS: In this experimental animal study, after creating lip defects, 30 rats were randomly divided into three groups and received normal saline (CTL), botulinum toxin A (BOT), and folinic acid (FOL). Biopsy from the skin wounds was performed after 14- and 28-days. These samples were stained with haematoxylin and eosin and Masson trichrome staining. Finally, each pathological parameter of wound healing was rated in this study. RESULTS: While the inflammatory response was not different among the study groups, fibroblast proliferation and collagen deposition were significantly higher in FOL group compared to BOT group. Moreover, both BOT and FOL facilitated epithelial healing and 14-day angiogenesis as compared with normal saline. CONCLUSIONS: Improved wound healing was observed using both botulinum toxin A and folinic acid in rat animal models. However, the application of botulinum toxin A caused less fibroblast proliferation and collagen deposition which can potentially lead to less scar formation, which can be particularly important in the aesthetic zone.

Gingivectomy with Diode Laser Versus the Conventional Scalpel Surgery and Nonsurgical Periodontal Therapy in Treatment of Orthodontic Treatment-Induced Gingival Enlargement: A Systematic Review.

Background and objective: Some studies support the superiority of diode laser gingivectomy to scalpel surgery and nonsurgical treatments. However, a systematic review on this topic is lacking. This study aimed to compare gingivectomy with diode laser versus the conventional scalpel surgery and nonsurgical periodontal therapy (NSPT) in the treatment of orthodontic treatment-induced gingival enlargement (GE). Materials and methods: In this systematic review, an electronic search of the relevant literature was conducted in Web of Science, Medline/PubMed, Scopus, Cochrane Central Register of Controlled Trials, and ProQuest with no language restriction. Randomized clinical trials published between 1985 and 2020 on comparative treatment of orthodontic treatment-induced GE by diode laser gingivectomy and scalpel surgery or NSPT regarding intraoperative and postoperative bleeding and/or pain were included. Risk of bias was assessed by the Cochrane 1 tool. Results: Of the initially retrieved 288 articles, 40 were duplicates and excluded; 236 articles were excluded following title and abstract screening, and 5 others were excluded following full-text assessment. Finally, 7 studies underwent systematic review. In the risk-of-bias assessment, 5 studies scored 2, and 2 studies scored 3 out of 6. Intraoperative and postoperative bleeding and pain were found to be significantly lower in the laser group. Conclusions: Within the limitations of this systematic review and with respect to the quality of evidence, the present results revealed lower level of pain and bleeding in diode laser gingivectomy compared with the conventional scalpel surgery and NSPT for treatment of orthodontic treatment-induced GE.

Subcutaneous Tissue Response to Adseal and Sure-Seal Root Sealers in Rats: a Histopathological Study.

Introduction and objectives: One of the essential phases of root canal treatment is root canal obturation. Solid or semi-solid materials are the most common obturating materials (paste or softened form). Sealer is a biomaterial that enables the sealing process to be carried. This study aimed to evaluate the inflammatory response to Adseal sealer and Sure-Seal Root sealer in rats. Materials and methods:This experimental study was conducted on 28 Wistar rats that were divided into four groups of seven animals per group based on four time periods (7, 14, 30 and 60 days). Each rat received subcutaneous implants containing Adseal sealer (Meta Biomed, Cheongju, Korea) and Sure-Seal Root sealer (Sure Dent Corporation, Gyeonggi-do, South Korea) tubes as well as an empty tube as a control. After the insertion of the tubes, the first to fourth groups were sacrificed on days 7, 14, 30 and 60, respectively, by injecting a high dose of anesthetics. Subsequently, the histopathologic features of the samples were investigated. Data were analyzed in SPSS software (version 26) using Freidman, Wilcoxon, Kruskal-Wallis and Mann-Whitney U tests. A p-value less than 0.05 was considered statistically significant. Results:On day 7, the severity of inflammation was higher in the Adseal sealer and Sure-Seal Root sealer groups compared to the control group. Moreover, on day 14, the level of inflammation was higher in the Sure-Seal Root sealer group than the Adseal sealer and control groups. In addition, on days 30 and 60, the severity of inflammation was similar in both the case and control groups and decreased in all samples. Formation of granulation tissue was observed in all samples on day 14. There was fibrosis tissue in the Sure-Seal Root sealer samples (71.4%) on day 60; however, no fibrosis tissue was observed in the Adseal sealer and control groups. Conclusion:It is concluded that the Sure-Seal Root sealer might lead to a more inflammatory response compared to the Ad Seal sealer. However, due to decreasing inflammation in sealers over time, both sealers are biocompatible.

Histologic Evaluation of the Effects of Folinic Acid Chitosan Hydrogel and Botulinum Toxin A on Wound Repair of Cleft Lip Surgery in Rats.

The aim of the present study was to compare the effects of folinic acid chitosan hydrogel and botulinum toxin A on the wound repair of cleft lip surgery in rat animal models. Cleft lip defects were simulated by triangular incisions in the upper lip of 40 Wistar rats. Then, the rats were randomly assigned to four groups: control (CTRL), chitosan hydrogel (CHIT), and folinic acid chitosan hydrogel (FOLCHIT), in which the wounds were covered by a gauze pad soaked in normal saline, chitosan hydrogel, and folinic acid chitosan hydrogel, respectively for 5 min immediately after closure; and botulinum toxin A (BOT) with the injection of 3 units of botulinum toxin A in the wound region. Fibroblast proliferation, collagen deposition, inflammatory cell infiltration, neovascularization, and epithelial proliferation and each parameter were rated on days 14 and 28. Statistical analysis was performed by Kolmogorov-Smirnov test, Shapiro-Wilk test, Kruskal-Wallis, and post-hoc tests (α = 0.05). The mean score for fibroblast proliferation was significantly higher in the FOLCHIT group compared with the BOT group at days 14 and 28 (p < 0.001, p = 0.012, respectively). At day 28, collagen deposition was significantly higher in the FOLCHIT group compared with the BOT group (p = 0.012). No significant difference was observed between the inflammatory infiltration of the study groups at the two time points (p = 0.096 and p = 1.000, respectively). At day 14, vascular proliferation of group FOLCHIT was significantly higher than groups CTRL and CHIT (p = 0.001 and p = 0.006, respectively). The epithelial proliferation in the FOLCHIT group was significantly higher than groups CHIT and CTRL at day 14 (p = 0.006 and p = 0.001, respectively) and day 28 (p = 0.012). In simulated lip cleft defects, topical application of folinic acid induces faster initial regeneration by higher inflammation and cellular proliferation, at the expense of a higher tendency for scar formation by slightly higher fibroblast proliferation and collagen deposition. While injection of botulinum toxin A provides less fibroblast proliferation and collagen deposition, and thus lower potential for scar formation compared with the folinic acid group. Therefore, in wounds of the esthetic zone, such as cleft lip defects, the application of botulinum toxin A shows promising results.

Oral and jaw lymphoma in an Iranian population.

INTRODUCTION: Lymphoma is the second most common malignancy of head and neck. Many studies have been carried out in different population groups to detect the subtypes of oral and jaw lymphoma, but such research has not been conducted in Iran. The purpose of this study was to determine the subtypes of oral and jaw lymphoma by immunohistochemistry. MATERIALS AND METHODS: A total of 36 paraffin-embedded blocks (25 males and 11 females) with primary diagnosis of non-Hodgkin lymphoma were studied by immunohistochemical markers according to cellular morphology. RESULTS: The frequencies were diffuse large B-cell (41.1%), low-grade B-cell (35.2%), peripheral T-cell (11.7%), Burkitt (5.8%), and Hodgkin lymphomas (5.8%). The involved sites were salivary gland (26.4%), maxillary bone (23.5%), mandibular soft tissues (17.6%), maxillary sinus (14.7%), mandibular bone (8.8%), tonsils and tongue (5.7%), and lip and vestibule (2.9%), and 2 cases (5.5%) turned out to be undifferentiated carcinomas. The most common lymphomas in male and females were diffuse large B-cell and low-grade B-cell lymphomas, respectively. CONCLUSIONS: The epidemiology of different types of oral lymphoma in a sample of Iranian population was not similar with other populations of the world. Immunohistochemistry and molecular methods are required to prove the diagnosis in addition to typing of lymphoma.

Serum and Salivary Level of Nitric Oxide (NOx) and CRP in Oral Lichen Planus (OLP) Patients.

STATEMENT OF THE PROBLEM: Oral lichen planus (OLP) is a chronic inflammatory oral mucosal disease with unclear etiology while a few cases of disease become malignant. PURPOSE: This study aimed to evaluate the level of nitric oxide (NOx) and C-reactive protein (CRP) as oxidative stress and inflammation status in sample of OLP patients. MATERIALS AND METHOD: In this case-control study, serum and salivary NOx and CRP levels were evaluated in twenty two OLP patients as the case group confirmed by clinical and histopathological diagnosis, and twenty two healthy control groups collected from Tooba Oral Pathology Laboratory in Sari in 2016. The data were analyzed by using independent-samples t-test, Mann-Whitney U-test and Chi-square by using SPSS version 21. The statistical significant level was considered at p< 0.05. RESULTS: Salivary and serum NOx levels in case group showed statistically significantly higher than healthy control group (p= 0.035 and p= 0.001, respectively). CRP values were significantly higher both in serum (p= 0.001) and in saliva (p= 0.035). A significant correlation was found between CRP and NOx values in serum (r= 0.521, p= 0.0001) and saliva (r= 0.427, p= 0.045). CONCLUSION: Oxidative stress causes damage to organs in the human body. Correct understanding of oxidative stress and its association with free radicals and inflammatory markers related to oral disease are important for effective treatments. The results of the study advocate the effects of NOx and CRP levels in pathogenesis of OLP. Therefore, antioxidant drugs might probably be considered in the treatment of OLP.

Relation between Periodontitis and Prediabetic Condition.

STATEMENT OF THE PROBLEM: Prediabetic condition, which is characterized by impaired glucose tolerance, impaired fasting blood glucose, and hemoglobin A1c (HbA1c) higher than normal might be associated with periodontitis. Early diagnosis of this condition might decrease consequent tissue damage caused by periodontitis. PURPOSE: The present study aimed to evaluate the association between prediabetes and periodontitis. MATERIALS AND METHOD: This cross-sectional study was conducted on 108 prediabetic patients screened by primary fasting blood sugar (FBS) test (100-125 mg/dL). Three subsequent blood tests including FBS, HbA1C, and oral glucose tolerance test (GTT) were performed for ultimate diagnosis of these patients. The periodontal health was evaluated by employing bleeding on probing (BOP), clinical attachment loss (CAL), and plaque index (PI), Lِe-Silness gingival index (GI), and pocket depth (PD). Data were analyzed by SPSS version 16, using t-test, ANOVA, and chi-square tests. RESULTS: The sample included 20 (19%) male and 88 (81%) female individuals with mean age of 49 years and mean BMI of 27.5. The mean FBS, GTT, and HbA1C were 107 MG/DL, 137MG/DL, and 5.9%, respectively. Clinical evaluation showed 33% of patients involved with periodontitis. The mean CAL, BOP, PI, PD, GI was 3.7, 0.62, 1.9, 2.1, 1.5, respectively (p< 0.05). A significant difference in periodontal index was found among patients with prediabetes. Moreover, in the patients with periodontitis, a statistically significant relationship between FBS and BMI, BOP and GTT, and finally between CAL and HbA1C was detected. CONCLUSION: Periodontitis is associated with prediabetic condition. While diabetes is an important risk factor for periodontitis, the risk of periodontitis would be greater if glycemic control is poor. Glycemic control in prediabetic patients can reduce the severity of periodontal disease. Early diagnosis and prevention is crucial to avoid the largely irreversible tissue damage that occurs in periodontitis.

Immunohistochemical Study of p53 Expression in Patients with Erosive and Non-Erosive Oral Lichen Planus.

STATEMENT OF THE PROBLEM: Oral lichen planus is a common mucocutaneous lesion with a chronic inflammatory process mediated by immune factors while a few cases of the disease become malignant. PURPOSE: This study aimed to determine the frequency of p53 marker as a tumor suppressor in patients with erosive and non-erosive oral lichen planus (OLP) by using immunohistochemical methods. MATERIALS AND METHOD: This descriptive cross-sectional study investigated the p53 expression in 16 erosive OLP, 16 non-erosive OLP samples, and 8 samples of normal oral mucosa through immunohistochemistry. The percentage of stained cells in basal and suprabasal layers, and inflammatory infiltrate were graded according to the degree of staining; if 0%, <10%, 10-25%, and >50% of the cells were stained, they were considered as (-), (+), (++), (+++) and (++++), respectively. The obtained data was statistically analyzed and compared by using Chi square and Fisher's exact test. RESULTS: The mean percentage of p53 positive cells in erosive OLP (34.5±14.2) was considerably higher than that in non-erosive OLP (23.8±10.4) and normal mucosa (17.5±17). There was a significant difference among the three groups of erosive, non-erosive and control in terms of staining intensity. No significant difference existed between the patients' age and sex in the two OLP groups. CONCLUSION: The increased incidence of p53 from normal mucosa to erosive OLP indicated the difference between biological behavior of erosive and non-erosive OLP. It can be claimed that the erosive OLP has great premalignant potential compared with the non-erosive one.

Association of dietary vitamin C and e intake and antioxidant enzymes in type 2 diabetes mellitus patients.

BACKGROUND: Diabetes mellitus consist of a various metabolic diseases such as hyperglycemia, increase glycosylated hemoglobin (HbA1c) and disorder in antioxidant enzymes activity, hence supplementing with antioxidant nutrients, mainly vitamin C and E seems to reduce oxidative injure in patients with type 2 diabetes mellitus (T2DM). AIM: To evaluate outcome of vitamin C and E supplementation on type 2 DM patients. SETTING AND DESIGN: The study was completed in 170 T2DM on consumption of vitamin C, E, combination of C & E and placebo. MATERIALS AND METHODS: The cases groups of this study consist of two major groups, which were named supplementation and placebo group. The group of supplementation consisted of 3 sub-groups, which received three capsules per day for a phase of three months. The parameters such as HbA1c, glucose, superoxide dismutase (SOD) and glutathione peroxides (GSH) were evaluated in baseline and after three months with supplementation. STATISTICAL ANALYSES: The statistical analyses were evaluated with the use of mean ± SD, ANOVA-test and paired-sample t-test. RESULTS: Mean age of 170 patients, 84 male and 86 female were 53.82±5.26 in the range of 30-60 years. The blood pressure results showed significant differences between the all supplement groups in baseline as compared to after receiving supplements (p<0.05). Use of vitamin C, E, and E & C showed significant differences in concentration of plasma FBS and HbA1c (p<0.05 & <0.001), but there was no significant differences in placebo groups. SOD and GSH enzymes levels showed a significant increased after consumption of vitamins in supplementation groups (p<0.001). CONCLUSION: This research confirmed that subjects with T2DM after three months supplementation of vitamins demonstrated significantly low level of hypertension, decrease levels of blood glucose, and increase SOD and GSH enzyme activity that can probably reduce insulin resistance by enhanced lowering oxidative stress parameters.

Immunohistochemical study of p53, Ki-67, MMP-2 and MMP-9 expression at invasive front of squamous cell and verrucous carcinoma in oral cavity.

Squamous cell carcinoma (SCC) is the most common malignancy in the oral cavity. Verrucous carcinoma (VC) is a lower grade subtype of SCC with pathological similarities but different management. Tumor invasive front (TIF) is a dynamic location in the differentiation of malignancies. p53 is a tumor suppressor and Ki-67 a proliferation marker. Matrix metalloproteinases 2 and 9 are involved in the tumor invasiveness. We assessed these markers in TIF of oral SCC and VC to find more precise grading scales. We studied the expression of markers in the invasive front of 42 cases of SCC (21 high and 21 low grade), 20 cases of VC and 8 cases of normal oral mucosa using immunohistochemistry. There were significant differences among the study groups regarding the number of cells expressing p53, MMP-2 and 9. Except for Ki-67, other studied markers can be used for the histological grading of SCC and its differentiation from VC. MMP-9 is the most reliable one for invasive SCC grading. The extent of the expression of these markers is related to the infiltration pattern of SCC at the invasive front. The less invasive nature of VC can be associated with the expression pattern of these markers.