Evaluation of Preventive Role of Systemically Applied Erythropoietin after Tooth Extraction in a Bisphosphonate-Induced MRONJ Model.

Background and Objectives: In this experimental study, the prophylactic effect of systemically administered erythropoietin (EPO) in medication-related osteonecrosis of the jaw (MRONJ) was evaluated. Materials and Methods: The osteonecrosis model was established using 36 Sprague Dawley rats. EPO was systemically applied before and/or after tooth extraction. Groups were formed based on the application time. All samples were evaluated histologically, histomorphometrically, and immunohistochemically. A statistically significant difference in new bone formation was observed between the groups (p < 0.001). Results: When new bone-formation rates were compared, no significant differences were observed between the control group and the EPO, ZA+PostEPO, and ZA+Pre-PostEPO groups (p = 1, 0.402, and 1, respectively); however, this rate was significantly lower in the ZA+PreEPO group (p = 0.021). No significant differences in new bone formation were observed between the ZA+PostEPO and ZA+PreEPO groups (p = 1); however, this rate was significantly higher in the ZA+Pre-PostEPO group (p = 0.009). The ZA+Pre-PostEPO group demonstrated significantly higher intensity level in VEGF protein expression than the other groups (p < 0.001). Conclusions: Administering EPO two weeks pre-extraction and continuing EPO treatment for three weeks post-extraction in ZA-treated rats optimized the inflammatory reaction, increased angiogenesis by inducing VEGF, and positively affected bone healing. Further studies are needed to determine the exact durations and doses.

Could Local Application of Hypoxia Inducible Factor 1-α Enhancer Deferoxamine Be Promising for Preventing of Medication-Related Osteonecrosis of the Jaw?

This experimental study investigates the prophylactic effect of deferoxamine (DFO) on medication-related osteonecrosis of the jaw (MRONJ). Thirty-six female Sprague Dawley rats received zoledronic acid (ZA) for eight weeks to create an osteonecrosis model. DFO was locally applied into the extraction sockets with gelatin sponge (GS) carriers to prevent MRONJ. The specimens were histopathologically and histomorphometrically evaluated. Hypoxia-inducible factor 1-alpha (HIF-1α) protein levels in the extraction sockets were quantified. New bone formation rate differed significantly between groups (p = 0.005). Newly formed bone ratios in the extraction sockets did not differ significantly between the control group and the GS (p = 1), GS/DFO (p = 0.749), ZA (p = 0.105), ZA-GS (p = 0.474), and ZA-GS/DFO (p = 1) groups. While newly formed bone rates were higher in the ZA-GS and ZA-GS/DFO groups than in the ZA group, the differences were not significant. HIF-1α levels differed significantly between groups (p < 0.001) and were significantly higher in the DFO and ZA-GS/DFO groups than in the control group (p = 0.001 and p = 0.004, respectively). While HIF-1α levels were higher in the ZA-GS/DFO group than in the ZA group, the difference was not significant. While HIF-1α protein levels and new bone formation rate were elevated in the DFO-treated group, the effect was not significant. Further large-scale studies are needed to understand DFO's preventative effects on MRONJ and the role of HIF-1α in MRONJ pathogenesis.

Dental Education for Prevention of Oral Cancer in Turkey: Needs for Changing the Curriculum.

The aim of the present study is to evaluate the knowledge, attitudes, and behaviors of dental students on oral cancer in Istanbul, Turkey. A self-administered questionnaire adapted from Tanriover et al. consisting of 48 questions was distributed to 311 students enrolled in the fourth and fifth grades of a dental faculty in Istanbul, Turkey. Questions were grouped under 5 main headings: socio-demographic features, knowledge on risk factors and diagnostic procedures, history taking regarding to alcohol and smoking status, opinions and behaviors of oral cancer, and distribution of dental students according to diagnostic practice of oral cancer. The frequencies and percentages were calculated with descriptive analysis. The differences in distributions were analyzed using the chi-squared test. The p value was set at 0.05 for statistical significance. The overall response rate was 98% (305/311). The majority of the students identified tobacco and alcohol as risk factors (82% and 75.1%, respectively), while older age and inadequate consumption of fruits and vegetables were less likely to be known (60.2% and 52.8%, respectively). Almost one-fifth of the students stated that they have never performed oral cancer examinations during their first or subsequent dental examinations of their patients. Female students thought that dentists were authorized to make oral cancer examinations with a higher frequency compared to males (65.8% and 34.2%, respectively; p = 0.006). On the other hand, female students reported that they did not receive adequate education regarding cessation of smoking with a higher frequency compared with males (69.2% female and 30.8% male respectively; p = 0.0001). As this present study revealed that future dentists had insufficient knowledge in some of the main concepts on oral cancer risk factors, and they lacked the confidence in performing oral examinations in their patients, it is concluded that there is a need for a more structured teaching program with greater emphasis on the early signs and risk factors of OC. Reorganization of the dental curriculum, and courses which further draw attention on the responsibility of the dental practitioner in the detection of oral cancers will be beneficial for the creation of awareness on this significant topic among future dental workforce. Understanding the knowledge and perception of dental students on oral cancers is not only limited to a specific country but it is a worldwide critical issue in which information should be exchanged.

A city-wide survey of dental students' opinions on undergraduate oral surgery teaching.

PURPOSE: This study aimed to carry out a city-wide survey to evaluate undergraduate students' opinions on their oral surgery training by measuring their self-confidence. MATERIALS AND METHODS: A cross-sectional survey of 383 3rd year, 412 4th year and 363 5th year undergraduate dental students from six dental schools in Istanbul with a mean age of 22.73 ± 1.55 was conducted towards the end of the academic year. A web link to the questionnaire was sent to the contact person at the participating dental schools. The questionnaires were anonymously evaluated. Descriptive statistics were calculated, and Chi-square tests were performed to examine the data. A P-value of <.05 was considered to be statistically significant. RESULTS: In total, 1158 responses were returned, representing 67% of the overall students in the 2018-2019 academic year. The male respondents were significantly more self-confident than females in the general aspects of surgical skills. More than half of the respondents (53%) felt confident in oral surgery knowledge to undertake independent practice. Although 5th year respondents felt more confident in the general aspect of the questionnaire, their ability of differentiation of odontogenic and non-odontogenic pain was lower than their counterparts. The majority (86%) of the participants disagreed that the only knowledge required for oral surgery was that of tooth and jaw anatomy. CONCLUSION: This survey revealed perceived confidence in tooth and retained root extraction. The male respondents were found to be more self-confident. There is a need for improvement in surgical skills, recognition of malignancies and differentiation of the origin of the pain.

Students' perspectives on undergraduate oral surgery education.

PURPOSE: This study evaluated students' perceptions of their self-confidence regarding aspects of their undergraduate oral and maxillofacial surgical training. It further aimed to develop a reliable Turkish version of the questionnaire originally developed by the Association of British Academic Oral Maxillofacial Surgeons (ABAOMS) Education Committee. METHODS: A cross-sectional survey of 40 fourth-year and 47 fifth-year dentistry students of Yeditepe University Faculty of Dentistry in Turkey with a mean age of 23.30 ± 1.50 was conducted in January and February 2018. The ABAOMS questionnaire was adapted to the Turkish language and culture. The items were organized in five domains (general information, self-confidence in oral surgery, role of outreach, anatomy knowledge in relation to oral surgery, and career aspirations) with most response options on a five-point Likert-type scale. Reliability was assessed through an internal consistency analysis and a test-retest approach. Descriptive statistics, independent samples t-tests, and Chi-squared for contingency tests were used to examine the data. RESULTS: Cronbach's alpha coefficient on the questionnaire was 0.89. The responses reflected general agreement among the respondents. Females were significantly more self-confident than males. Although the fifth-year respondents were more self-confident than the fourth-year respondents on items regarding anatomy knowledge, fourth-year respondents were more self confident in forceps extractions. Other than that no major differences in self-confidence were found between the two groups. CONCLUSION: Though self-confidence was high regarding extraction of teeth and retained roots, the participants of this study lacked self-confidence in performing surgical extractions and its related procedures, recognition of malignancies, and ability to differentiate between pain of odontogenic or non-odontogenic origin. Female students were relatively more self-confident. Teaching should focus on practical applications that support students' sense of self-confidence in their abilities. The Turkish version of the questionnaire was a reliable instrument.

Efficacy of doxycycline release collagen membrane on surgically created and contaminated defects in rat tibiae: A histopathological and microbiological study.

BACKGROUND: The effects of systemic antibiotics on controlling infective pathogens after guided bone regeneration(GBR) procedures especially in membrane exposures are limited. However, local administrations of antibiotics are rare in GBR techniques. AIM: The aim of this study was to investigate the osteogenesis potential and the antibacterial effect of a doxycycline releasing collagen membrane in surgically created and contaminated defects in rat tibiae. MATERIAL AND METHODS: Defects were created in 20 rats that were randomly divided in to two groups: control group (defect contaminated by Porphyromonas gingivalis, filled with bone graft and covered by collagen membrane); test group (defect contaminated by P. gingivalis filled with bone graft and covered by collagen membrane containing 1mg/cm(2) doxycycline. Animals were sacrificed post surgically on the 14th day for microbiologic evaluation and on the 28th day for histopathological evaluation. RESULTS: The degree of osteogenesis in the test group was seen to be significantly higher than control group (p: 0.011; p<0.05). Furthermore in test group, no bacterial growth was observed. The bacteria counts were determined between 1×104 and 268×104CFU/g with a median of 1.32×104 for control group. CONCLUSIONS: Within the limitations of this study, the results of the present study suggests that the use of a doxycycline releasing membrane has a positive effect on contaminated GBR procedures for limiting P. gingivalis infections leading to bone formation following GBR procedures in a rat model.

Evaluation of morphology of the nasopalatine canal using cone-beam computed tomography in a subgroup of Turkish adult population.

PURPOSE: The aim of the study was to evaluate the anatomy and morphology of the nasopalatine canal (NPC) using cone-beam computed tomography (CBCT) and to determine variations of the NPC in relation to age, gender, and status of edentulism of anterior maxilla. METHODS: Patients scheduled for CBCT imaging for further radiographic evaluation of the maxilla with various reasons were consecutively enrolled in this study. Reformatted sagittal and coronal slices were analyzed with regard to dimensions and anatomic characteristics of the NPC. The correlation of age, gender, and status of edentulism of anterior maxilla with all the variables were evaluated. RESULTS: The study comprised 157 subjects with a mean age of 49.64 years. The analysis of the diameter of the incisive foramen revealed a mean of 4.48 mm whereas the diameter of the palatine foramen revealed a mean of 2.88 mm. The mean length of NPC was 10.87 mm and found significantly longer in males and patients with anterior teeth. In terms of incisive foramen and palatine foramen diameter, there was not any significant difference between males and females and between patients with and without anterior teeth (p > 0.05). CONCLUSION: There was relationship between the gender of the patients and the length of the NPC, with significantly lower mean values in females. This result suggests that careful analysis of anatomical structures by taking into consideration some variables would aid the clinician in performing a safer surgical intervention and prevent possible complications. CNCT scanning prior to implant surgery specifically in edentulous patients with severely atrophic maxillae might be a good diagnostic tool to guide the clinician for a safer and predictable procedure.

Dental patients' knowledge and awareness about transmission ways of acquired immune deficiency syndrome (AIDS).

PURPOSE: The aim of this study was to evaluate the patients' attitude, knowledge and awareness about HIV/AIDS. And secondary aim was to assess the need for further education about HIV/AIDS. MATERIALS AND METHODS: A questionnaire of 39 items was used to evaluate the patients' knowledge. 301 patients were included (mean age 37.12±7.85 years, 41.5% male, 58.5% female) in the study. Results were calculated by Students t-test, Chi-square test, Fisher's exact test. RESULTS: Most of the patients had accurate knowledge about transmission ways, however transmission through breastfeeding (31.6%), public restrooms (44.9%), and insects and mosquitos bite (47.2%) were less recognized. Saliva (32.2%), urine (36.9%), tears (58.5%), sweat (54.5%), breast milk (30.6%), feces (36.9%) and cerebrospinal fluid (7.3%) were less recognized body fluids. Generally university and postgraduate educated patients had more accurate knowledge than other groups. 63.1% of patients thought that they need further education about HIV/AI DS. CONCLUSION: The results of this study showed that the knowledge level about HIV/AIDS was almost agreeable. However, the patients had deficiencies with respect to their knowl-edge. Therefore the authors of this study believe that there must be education programs related to HIV/AIDS.

Patients' knowledge and awareness of dental implants in a Turkish subpopulation.

PURPOSE: The purpose of this study was to evaluate the patients' knowledge on dental implants in a Turkish subpopulation. MATERIALS AND METHODS: Five hundred twenty seven Turkish adults referred to Yeditepe University Faculty of Dentistry, Istanbul, Turkey, were presented with a questionnaire including 20 questions regarding the level of information and awareness about the dental implants. The data were collected and statistical analyses were performed with Chi square test to compare the descriptive data. RESULTS: Among 527 subjects, 54% were female and 46% were male with a mean age of 42.2 years. The rate of patients' implant awareness was 27.7%. When the patients were questioned about the treatment options for rehabilitation of tooth missing, 60.9% of patients were informed about fixed partial denture, followed by conventional complete denture (32.5%) and removable partial denture (24.9%). Six percent reported that they were very well informed about the dental implants whereas 48.2% were poorly informed. The information sources of the implants were from the dentist (44.5%), printed media (31.6%) and friends and acquaintances (17.3%), respectively. Sixteen percent of the population believed that their implants would last forever. CONCLUSION: The dentists should give more detailed information to the patients about dental implants and tooth-supported fixed partial dentures in the future.

Photodynamic therapy in dentistry: a literature review.

OBJECTIVES: The purpose of this review was to summarize recent developments regarding photodynamic therapy (PDT) in the field of dentistry. MATERIALS AND METHODS: A review of pertinent literature was carried out in PubMED to determine the current position of PDT applications in dentistry. One hundred thirteen relevant articles were retrieved from PubMED by inserting the keywords "photodynamic therapy", "dentistry", "periodontology", "oral surgery", and "endodontics". It is anticipated that this overview will create a specific picture in the practitioner's mind regarding the current status and use of PDT. RESULTS: In spite of different results and suggestions brought about by different researchers, PDT can be considered as a promising and less invasive technique in dentistry. CONCLUSION: PDT seems to be an effective tool in the treatment of localized and superficial infections. Within the limitations of the present review, it can be concluded that although PDT cannot replace antimicrobial therapy at its current stage, it may be used as an adjunctive tool for facilitating the treatment of oral infections. CLINICAL RELEVANCE: Oral infections (such as mucosal and endodontic infections, periodontal diseases, caries, and peri-implantitis) are among the specific targets where PDT can be applied. Further long-term clinical studies are necessary in establishing a more specific place of the technique in the field of dentistry.

Tenascin-C and matrix metalloproteinase-9 levels in crevicular fluid of teeth and implants.

BACKGROUND: The role of and interaction between bacterial infection and biomechanical impact in the development of peri-implant inflammatory processes is not clear. OBJECTIVE: To determine the amount and concentration of tenascin-C (TNC) in gingival crevicular fluid (GCF) around teeth and in peri-implant sulcus fluid from healthy implants and implants with peri-implantitis, and to correlate it with matrix metalloproteinase-9 (MMP-9) levels. MATERIALS AND METHODS: Seven control individuals and 18 patients with 41 implants with/without peri-implantitis were included. GCF was collected with filter strips and volumes were measured with a Periotron device. The amount of serum albumin per sample was quantified by densitometric analysis of Coomassie-stained sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Relative activity of MMP-9 was determined from the densitometry of zymograms. Amounts and concentrations of TNC were evaluated by ELISA. RESULTS: Relative MMP-9 activity was increased in peri-implantitis. A tendency was observed to measure higher TNC concentrations at teeth than at implants. The amount of TNC in GCF collected from healthy implant sites and the peri-implantitis sites was significantly different. Based on immunoblotting, TNC in GCF seemed degraded. In contrast to TNC, MMP-9 was significantly related to the PD and the volume of GCF. CONCLUSION: TNC is known to be induced in inflammation. The increase found in peri-implantitis was less than expected. In the context of peri-implantitis, TNC might be a marker of bone remodelling rather than inflammation and infection. A possible proteolytic degradation of TNC during peri-implantitis needs to be studied.

Comparison of conventional surgery and CO2 laser on intraoral soft tissue pathologies and evaluation of the collateral thermal damage.

OBJECTIVE: The aim of the study was to compare conventional surgery with carbon dioxide (CO(2)) laser applied on oral soft tissue pathologies and to evaluate the effect of collateral thermal damage on histopathological diagnosis. Anesthesia need, postoperative pain, and intraoperative and postoperative complications were examined as part of the comparison. METHODS: Forty-three patients (32 female and 11 male) with a mean age of 54 (54 +/- 7.0) requiring soft tissue surgeries were randomly assigned to receive treatment either with conventional surgery using a scalpel or with a CO(2) laser technique. Anesthesia method and need, postoperative pain, systemic pain medications if needed, and intra- and postoperative complications were recorded. Excised tissues were evaluated histopathologically for the effect of thermal damage. RESULTS: All patients were anesthetized with local anesthesia in the conventional group whereas only 10 (42%) patients needed local anesthesia after topical anesthetic application in the laser group. In the conventional group, 18 (90%) patients need analgesics after the operation, compared with seven (29%) patients in the laser group. No intra- or postoperative complications were seen for either procedure. Histological examination of 39 specimens showed that collateral thermal damage on the incision line did not affect the histopathological diagnosis. CONCLUSIONS: CO(2) laser is an effective instrument for soft tissue excisional biopsies with minimal intraoperative and postoperative complications and good pain control. CO(2) laser applications are suggested as an alternative method to conventional surgery on oral soft tissues.

Treatment of epulis fissuratum with CO2 laser and prosthetic rehabilitation in patients with vesiculobullous disease.

OBJECTIVE: The purpose of this article is the clinical presentation of the treatment of epulis fissuratum with CO(2) laser and prosthetic rehabilitation of three patients with vesiculobullous diseases (VBDs). BACKGROUND: Oral problems such as blister formation with minimal trauma are usually encountered in the VBDs. With repeated cycles of blistering and healing, oral hygiene is usually compromised, which leads to rapid breakdown of the dentition. Prosthetic rehabilitation includes complete, partial, and implant-supported dentures; however, ill-fitting dentures can cause inflammatory fibrous hyperplasia. Clinical application of CO(2) laser has been recommended to treat benign oral lesions such as epulis fissuratum and fibroma. METHODS: The treatment plan consisted of excision of fibrous tissues, controlling dental plaque, and prosthetic rehabilitation. The excision of fibrous tissue was performed with CO(2) laser, and the wounds formed by laser were left open to secondary epithelization. The dental plaque and calculus deposits were cleaned with ultrasonic scalers and a well-formed acrylic denture for maxilla and mandible were fabricated after a month. RESULTS: There was no recurrent fibrous tissue formation at 1 year follow-up. However, plaque accumulation control was unsatisfactory and the patients were therefore urged to undergo a regular 6-month preventive dental prophylaxis regimen and denture re-evaluation. CONCLUSIONS: The CO(2) laser may be a useful instrument in the treatment of soft tissue pathologies in VBDs patients due to minimal damage to surrounding tissue. Use of complete or partial dentures has been considered a practical, economic, and nonsurgical treatment option for patients who have been diagnosed with VBDs.

Endodontic and surgical management of a maxillary lateral incisor with type III dens invaginatus: a 12-month follow-up.

This article reports the endodontic and surgical management and 12-month follow-up of a maxillary lateral incisor diagnosed as type III dens invaginatus. A 21-year-old male patient presented to our clinics with complaints of pain and swelling in the right maxillary region. Intraoral and radiographical examination disclosed the presence of a peg-shaped maxillary right lateral incisor diagnosed as type III dens invaginatus. Root canal treatment combined with periapical surgery was initiated. After the completion of root canal treatment for both maxillary right central and lateral incisors, periapical surgery was scheduled. During the surgery, periapical granulation tissue was curreted and bovine-derived hydroxil apatite (Unilab-Surgibone, Mississauga, Ontario, Canada) covered with collagen membrane (Unilab-Surgibone) was placed in the resorptive areas. ProRoot MTA (Dentsply, Tulsa, OK) was placed as a root end filling material. Postoperative 12-month follow-up revaled a satisfactory healing process.