Delayed Healing of Tooth Extraction Sockets After Vascular Endothelial Growth Factor Inhibition by Bevacizumab.

PURPOSE: This study aimed to explore the effect of the chemotherapeutic agent bevacizumab on the extraction socket healing process in New Zealand rabbits. MATERIALS AND METHODS: The animals received intraperitoneal bevacizumab treatment for 6 consecutive weeks (3 mg/kg per week). The right mandibular first premolar was extracted in the second week of the experiment, and the jaw bone containing the socket tissues was harvested at the end of the treatment period. The healing of the removed socket was analyzed histologically and radiographically using a micro-computed tomography scan. RESULTS: Quantitative morphometric and histologic assessments of the healing process of the extraction sockets in rabbits showed a marked (P ≤ .05) decrease in the bone volumetric mass after angiogenesis suppression by bevacizumab therapy (n = 5) compared with the control group (n = 5). CONCLUSIONS: The results of this study indicate the physiological significance of angiogenesis in extraction socket healing. Moreover, this study highlights the risks and precautions that should be considered in clinical practice in patients undergoing targeted chemotherapy.

Articaine Versus Lidocaine Concentration in the Palatal Tissues After Supraperiosteal Buccal Infiltration Anesthesia.

PURPOSE: Palatal local anesthetic injection is a painful procedure. Previous studies have reported successful extraction of maxillary teeth using only buccal infiltration of 4% articaine without palatal anesthesia. The aim of the present study was to determine levels of 4% articaine solution in palatal bone and mucosal tissues after buccal injection and compare those levels with 2% lidocaine solution in New Zealand white rabbits. MATERIALS AND METHODS: Eight rabbits received 2 different injections of 0.6 mL of 4% articaine with 1:100,000 epinephrine and 0.6 mL of 2% lidocaine with 1:100,000 epinephrine buccal to the right and left maxillary first molar, respectively, in a split-mouth study design using quantitative syringes. All injections were administered using the buccal infiltration technique without any palatal injection. Ten minutes later, palatal bone and mucosa specimens were collected for analysis. Levels of the 2 local anesthetic agents were measured in palatal tissues using high-performance liquid chromatography (HPLC). RESULTS: HPLC analysis showed markedly higher 4% articaine solution values (0.319 ± 0.037) in palatal mucosal tissues compared with palatal mucosal concentrations of 2% lidocaine solution (0.0839 ± 0.017). In palatal bone, the mean concentration of 2% lidocaine solution was markedly lower than the mean concentration of 4% articaine solution (0.085 ± 0.012 vs 0.155 ± 0.012, respectively). There was no relevant difference between levels of 2% lidocaine in the palatal bone and mucosal tissues. However, the mean concentration of 4% articaine in the palatal mucosa was markedly higher than its concentration in palatal bone. CONCLUSIONS: The buccal vestibule-palatal diffusion of 4% articaine solution with 1:100,000 epinephrine is greater than 2% lidocaine solution with 1:100,000 epinephrine in a rabbit model.

Should Surgical Burs Be Used as Single-Use Devices to Avoid Cross Infection? A Case-Control Study.

OBJECTIVE: The purpose of this study was to evaluate and compare the rate of bacterial contamination of reused and new unused burs after different sterilization sessions. MATERIALS AND METHODS: The test group consisted of 40 used fissure burs, and the control group of 40 unused new fissure burs (total n = 80). The burs from both groups were precleaned according to standard protocols and then subjected to two sterilization sessions (high- and low-steam pressure autoclaving). After each sterilization session, the burs were transferred into incubation tubes which contained thioglycollate culture medium and were monitored daily for a period of 48 h to detect any bacterial growth. Data were collected and statistical analysis was done using Fisher's exact test. RESULTS: Of the 40 burs of the test group, 2 burs (5%) showed positive bacterial growth, whereas no bur from the control group showed any sign of bacterial growth after high-pressure autoclaving. The colony structure and Gram staining were compatible with the growth of Staphylococcus epidermis. After a second sterilization session at low-pressure steam autoclaving, no bacterial growth was observed for the test group, but 1 bur (2.5%) from the control group showed bacterial growth and Gram-positive staining matched well with the growth of Brevibacterium species. CONCLUSIONS: The new and unused burs were 100% sterile after high-pressure steam autoclaving, whereas 5% of the reused burs appeared positive with bacterial contamination. After low-pressure steam autoclaving, reused burs were 100% sterile, but 1 new bur demonstrated bacterial contamination.

Desmoplastic fibroma of the mandible: report of a misdiagnosed case.

Several odontogenic and non-odontogenic tumors and related lesions affecting the jaws share clinical presentation and imaging appearance. However, all cases have to be approached and treated on an individual basis, based on a reliable anatomic pathology diagnosis. The present paper describes a case of a desmoplastic fibroma, which was misdiagnosed as an odontogenic keratocyst, and spotlights the potential benefit and conclusive role of a second opinion in oral and maxillofacial pathology diagnosis. A brief review of the literature is also provided.

Impact of COVID-19 on the self-esteem, psychological and dental esthetics of dental students.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has badly affected the mental health, quality of life, and self-esteem of students worldwide. OBJECTIVE: The current study aimed to evaluate the psychological impact and self-esteem of dental students using Rosenberg self-esteem scale and PIDAQ during the COVID-19 pandemic. METHOD: This cross-sectional research was conducted amongst the dental students studying at various dental colleges in Karachi, Pakistan from January to May 2022. Evaluation of psychological aspect and self-esteem of students was carried out using "Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ)", and "Rosenberg self-esteem scale" as perceived by students during the pandemic. For data analysis SPSS v24 was used. Data analysis comprised of descriptive analysis, Spearman correlation, One-way Anova and Linear regression. The level of significance of p value was less than 0.05. RESULTS: Overall 332 students participated, among which there were 181 females (54.5%), 151 males (45.5%). Dental self-confidence showed a negative relationship with social influence, psychological effect, and aesthetic concern, while it was positively linked with self-esteem during the pandemic. Social impact demonstrated association with psychological impact, aesthetic concern, and self-esteem, while it was negatively correlated with dental confidence. Rosenberg score showed positive correlation with all the variables. Statistically significant association was identified for variables when compared with gender. Regression analysis indicated association of age with dental confidence and RSS, while gender with social influence. CONCLUSION: The pandemic, aside from affecting the health of individuals worldwide, also badly affected the well-being, mental health, and self-esteem of the dental students. Dental aesthetics plays a crucial role in the mental wellbeing and self-esteem of the students.

A Bibliometric analysis of scientific publication on Peri-Implantitis from 1990 to 2020.

Background: Peri-implantitis can involve about 13% of implants and 20% of patients, it has been reported that its incidence increases from about 0.4 to 43.9% in 3-5 years. The purpose was to analyze, using bibliometric indicators, the scientific efficiency of different organization, countries, and researchers that published articles on Peri-implantitis in various dental journals during the period from 1990 to 2020. Material and Methods: The search was carried out using Scopus database on publications related to Peri-implantitis from 1990 to 2020 using VOSviewer 1.6.15. The selected search encompassed title of article, citation count, year of publication, authors, institution, country and keywords. Data maps were obtained from VOS viewer based on number of papers, citation count, sources, countries and authors. A density visualization analysis was performed to interpret the data. Bibliometric analysis with reference to citation and documents, authors, journals and keywords was also evaluated. Results: An upsurge in number of cumulative papers published on Peri-implantitis from 1990 to 2020 was observed. The top three countries that published most research papers on Peri-implantitis included United States, Sweden and Switzerland respectively. The most productive organization in the field was Blekinge Institute of Technology, Karlskrona, Sweden. The maximum numbers of papers were published in "Clinical Oral Implants Research", while the most published and cited author was Niklaus P. Lang, with 50 papers, 5391 citations with 107.82 average citations per paper. Conclusions: There is a tremendous increase in number of publications on peri-implantitis through collaboration of authors, nations and institutes. Among the leading countries from where evidence is originating includes, USA, Sweden and Switzerland. The leading institutes whose work received most citations included, Kristiansand University (Sweden), Blekinge Institute of Technology (Sweden), Trinity college (Dublin) and University Of Bern (Switzerland). A positive trend of highly collaborative work was observed among the institutes and authors on peri-implantitis. Key words:Bibliometric analysis, Peri-Implantitis, Scopus, Dental implants.

Lateral wall sinus floor elevation for implant placement: revisiting fundamentals and the surgical technique.

Sinus floor augmentation procedure is indicated to reconstruct the posterior maxilla with a sufficient amount of bone to allow for successful implant placement. This paper reviews the contemporary lateral wall technique, the related anatomy and some concepts and properties concerning graft materials currently available.

Silicone Facial Implants, to Fixate or Not to Fixate: A Narrative Review.

Silicone implants are one of the most widely used implants for facial augmentation, especially in the chin, mandibular angle, and malar area, utilizing different surgical approaches. Despite their various advantages, many complications have also been reported, including hematoma, infection, bone resorption, numbness, displacement, and asymmetry. This study aims to evaluate the need for facial-implant fixation and compare and contrast fixated and nonfixated facial silicone implants in different facial sites. A narrative review of the topic of facial-implant stabilization using the PubMed database inclusion criteria included articles that discussed the topic of facial implants, were published in English, and included critical information such as the location of the implant, type of stabilization, follow-up periods, and complications. A total of 11 studies were included. Of these, two were prospective clinical studies, three were case series, and the remaining six were retrospective clinical studies. The studies were published between 1995 and 2018. The sample size varied from 2 to 601 cases. Stabilization includes suturing, monocortical screws, or no stabilization. Complications were reported in most of these studies, including asymmetry, bone resorption or erosion, displacement, dissatisfaction, edema, hematoma, infection, mucosal irritation, pain, and paresthesia. The follow-up period ranged from one month to 17 years. Despite the varied settings of these studies, silicone facial implant complications were reported in both fixated and nonfixated implants, with a lack of significant differences between fixated and nonfixated facial silicone implants regarding the method of fixation.

Allograft for maxillary sinus floor augmentation: a retrospective study of 90 cases.

PURPOSE: The aim of this study is to demonstrate the clinical applicability and efficacy of an allograft for maxillary sinus augmentations in patients requiring placement of dental implants. PATIENTS AND METHODS: Sixty consecutive patients underwent a total of 90 sinus augmentations. Twenty-nine were women and 31 men, with a mean age of 54 years. Twenty-six patients received a bilateral procedure and 34 unilateral. All cases were treated with the lateral wall technique. Allograft consisted of demineralized freeze-dried blocks in 6 cases, particulate in 82 cases, and a combination of both in 2 cases. In 30 patients, it was combined with platelet-rich plasma. A total of 84 implants were inserted. Bone samples of grafted areas were obtained in two patients for histological examination. RESULTS: Seventy-three implants were clinically successful at the reentry time. Eleven implants in seven patients were removed between 15 days and 6 months after their placement. Seven of these implants were replaced and received prostheses as well, for an overall postloading success rate of 95.2%. Follow-up for all patients after final restoration was between 12 and 96 months. Specimen's histological evaluation revealed bone formation and evidence of inflammatory infiltrate. CONCLUSIONS: Based on the findings of this study, it can be suggested that the use of the demineralized freeze-dried bone allograft from the Banco de Huesos y Tejidos Fundación Cosme y Damian for sinus augmentation is effective and constitutes a feasible therapeutic alternative for implant placement.

Psychological Impact of the COVID-19 Pandemic on Students, Assistants, and Faculty of a Dental Institute of Saudi Arabia.

This study aimed to assess the perceived stress levels in students, assistants, and faculty members of the College of Dentistry, Imam Abdulrahman Bin Faisal, University (IAU), Kingdom of Saudi Arabia (KSA) during the novel coronavirus disease 2019 (COVID-19) pandemic. Using the Cohen's perceived stress scale (PSS) questionnaire (consisting of 14 items, hence called PSS-14), an online observational survey was conducted. The PSS 14 was rated on a 5-point Likert scale ranging from 0 (never) to 4 (very often). The scores ranging from 0-18 represented low stress, 19-37 represented moderate stress, and 38-56 represented high stress. The second-and third-year students were designated as junior year students, while fourth-year onwards were considered senior year students. Out of total 265 participants, 65% (173) were female, and the majority of the participants were dental students 70% (185) with a mean age of 26.71 ± 9.26 years. In the present study, the average PSS score for the participants was computed as 29.89 (range score: 0-56) which shows moderate stress levels among the respondents. The PSS score for the students was 31.03; for the faculty, it was 28, while for the assistants, it was 27.05. Among the three participant groups, the students were found more on the severe stress side (19%) (p-value = 0.002), and among them, the senior year students (6th year) showed significantly higher stress levels compared to the junior year students (p-value = 0.005). Age-wise, the participants below 20 years were most stressed (21%), followed by those 20-30 years old (18%). Female participants were more severely stressed than males (17% vs. 10%, respectively). It was concluded that the students experienced more stress, followed by the faculty members and dental assistants. In addition, younger participants, females, and senior year students were more stressed than their counterparts. Future studies directed at evaluating stress levels of these groups from different dental institutes could provide an opportunity for policymakers to offer various resources to improve their mental health.

Mandibular angle augmentation using solid silicone implants.

BACKGROUND: The demand for facial esthetics has increased dramatically to overcome the ongoing aging process and/or improve facial appearance. OBJECTIVES: The aim of this study was to evaluate the outcomes of using bilateral silicone implants for mandibular angle augmentation. MATERIAL AND METHODS: The study involved a prospective analysis of the outcomes of the mandibular angle region augmentation with bilateral silicone implants in 58 patients (2 males and 56 females) within 1 year. All the data was collected either from patients' interviews or their records, after receiving the ethical approval from the relevant hospital. The collected patients' data was analyzed based on 3 main outcomes: occurrence of implant displacement, presence of postoperative infection and patient satisfaction. Only the patients who completed a follow-up of 6 months postoperatively were included in this study. RESULTS: A total of 58 patients received bilateral silicone implants at the mandibular angle with a total of 116 implants, out of which 96 were found intact, with no evidence of complications. The total number of implants that were infected was 5 (4.3%), 16 implants were found displaced (13.8%) and only 3 patients of those without complications were dissatisfied with the final facial appearance (6%). CONCLUSIONS: Using solid silicone implants in the augmentation of the mandibular angle resulted in low postoperative infection and displacement rates, as well as in high patient satisfaction.

Effects of sunitinib targeted chemotherapy on the osseointegration of titanium implants.

Targeted chemotherapies are novel therapeutic approaches for many malignancies. In contrast to conventional chemotherapies, which are given for a predetermined duration, treatment with targeted chemotherapies like sunitinib is routinely continuous over longer periods, sometimes years. During this prolonged treatment period, patients may need to restore their missing teeth with dental implants. The aim of this study was to examine the effect of the anti-angiogenic substance sunitinib targeted chemotherapy on the osseointegration of titanium implants in a rabbit model. Fourteen white New Zealand rabbits were randomly assigned to two groups of either oral sunitinib at 10 mg/kg twice per week dose for 4 weeks (n = 7) or placebo (n = 7). The first dose was given 2 days before the surgical intervention. Each rabbit received one titanium dental implant in the right distal femoral condyle. Four weeks following implant insertion, rabbits were sacrificed and bone specimens containing the implants were retrieved. Osseointegration of the implants was analyzed using micro-computed tomography and histomorphometric evaluation. Both micro-computed tomography and histomorphometric analysis showed that the osseointegration parameters, including the ratio of bone volume to total volume and bone-implant contact percent for the sunitinib group were significantly lower than those in the control group (P ≤ 0.05). Sunitinib targeted chemotherapy had a negative effect on the osseointegration of titanium implants inserted in a rabbit model.

Pharyngeal pack placement in minor oral surgery: A prospective, randomized, controlled study.

We conducted a prospective, randomized, controlled study to investigate the influence of pharyngeal pack placement on postoperative nausea, vomiting, and throat pain after minor oral surgery. Our study group was made up of 80 patients-45 men and 35 women, aged 19 to 52 years (mean: 27.3)-who underwent a minor oral surgical procedure under general anesthesia. Patients were randomly assigned to one of three groups: 20 patients who received a pharyngeal pack under videolaryngoscopic guidance (video guidance group), 20 who had a pack placed blindly (blind insertion group), and 40 patients who received no pack at all (control group). Postoperative nausea occurred in only 4 patients (20%) in the blind insertion group (p < 0.007). No patient experienced postoperative vomiting. Postoperative throat pain occurred in all 20 video guidance patients (100%), in 17 of the blind insertion patients (85%), and in 20 of the controls (50%). The difference between the controls and each of the two pack groups was statistically significant (p < 0.006); the difference between the two pack groups was not significant.

Malocclusion and Craniofacial Characteristics in Saudi Adolescents with Sickle Cell Disease.

BACKGROUND: Sickle cell disease can result in dentofacial abnormalities. However, in Saudi Arabia, there are limited data with respect to orthodontic manifestations in patients with sickle cell disease. OBJECTIVE: To determine the malocclusion and craniofacial characteristics in sickle cell disease adolescents and compare them with that of controls from the Eastern Province of Saudi Arabia. METHODS: This comparative cross-sectional study included 112 Saudi patients with sickle cell disease, aged 12-18 years, and 124 age-matched Saudi controls from three major hospitals in Al Khobar and Dammam, Saudi Arabia. The Dental Aesthetic Index was used to assess malocclusion and orthodontic treatment needs. Digital lateral cephalometric radiographs were recorded for each patient and control, and its analysis included linear and angular measurements. RESULTS: The prevalence of malocclusion was 87.5% in sickle cell disease patients and 54% in controls (P = 0.0001). The percentage of sickle cell disease patients with severe malocclusion that required orthodontic treatment was higher than that of controls (37.5% vs. 26.6%). In the sickle cell disease cohort, incisal segment crowding (72.4%), overjet (67.3%) and maxillary misalignment in the anterior segment (56%) were the most prevalent types of malocclusions and were significantly higher than that of controls (P < 0.05). About 38% and 67% of the sickle cell disease patients had openbite and posterior crossbite, respectively, compared with 19.3% (P = 0.001) and 37.1% (P = 0.0001) of controls, respectively. Cephalometric analysis showed that SNA (86.7°) and ANB (9.9°) angles were significantly higher in sickle cell disease patients than in controls (81.5° and 2°, respectively). In addition, lower central incisor-to-Frankfort horizontal plane (55°) and interincisal angles (121.5°) were significantly lower in sickle cell disease patients than in controls. CONCLUSION: Adolescents with sickle cell disease had a higher prevalence of malocclusion and greater orthodontic treatment needs than controls. Similarly, they had greater incisal crowding, overjet, openbite and posterior crossbite and demonstrated higher SNA, ANB and lower interincisal angles than controls. The findings of this study suggest that adolescents with sickle cell disease should be provided frequent dental examinations and early orthodontic treatment to improve their oral health, and thus quality of life.

Guerin sign in midfacial fractures.

We report a patient with multiple fractures of the midface and Guerin sign bilaterally after maxillofacial trauma. To the best of our knowledge, this is the first time that this rare presentation of Guerin sign has been published.

Effects of cisplatin chemotherapy on the osseointegration of titanium implants.

PURPOSE: The effect of chemotherapy on the osseointegration of dental implants has received less interest compared with radiotherapy. Thus, the aim of the current study was to investigate the effect of cisplatin chemotherapy on the osseointegration of dental implants in a rabbit model. MATERIALS AND METHODS: Sixteen New Zealand White rabbits were randomly assigned to two groups of treatment of either cisplatin at 2.5 mg/kg/week for 4 weeks (n = 8) or placebo (n = 8), in which the first dose was administered 2 days prior to the surgical procedure. Each rabbit received one titanium dental implant inserted in the right distal femoral condyle. Four rabbits from each group were sacrificed 4 and 8 weeks after implant insertion. Osseointegration of the dental implants was analysed using micro-computed tomography and histomorphometric evaluation. RESULTS: Analysis of micro-computed tomography data and histomorphometric data showed that the osseointegration parameters, including the ratio of bone volume to total volume (BV/TV) and bone-implant contact (BIC%) for the cisplatin group, were significantly lower compared to the control group at 4 and 8 weeks. (P ≤ 0.05). CONCLUSION: Cisplatin chemotherapy had a negative effect on the osseointegration of dental implants when inserted throughout the chemotherapeutic regimens in a rabbit model.

Effect of Video Triggering During Conventional Lectures on Final Grades of Dental Students in an Oral Biology Course: A Two-Year Retrospective Study.

The aim of this study was to analyze the effect of the inclusion of video triggers in conventional face-to-face lectures on the final grades of dental students in an oral biology course. The study consisted of two groups of students taking the course in two academic years at a dental school in Saudi Arabia: group 1, 2013-14 (control); and group 2, 2014-15. The total sample comprised 163 students (n=163; group 1: 71 and group 2: 92). Group 1 received lectures without any videos, whereas group 2 received lectures that included two to three videos of one to five minutes in duration with triggering effect (a video was shown every 10-15 minutes into the lecture). The final examination grades of the students were accessed retrospectively, and the data were compared with a chi-square test. The results confirmed that a higher number of students who received video triggering during lectures (group 2) performed better than their counterparts who did not receive video triggers (group 1); the difference was statistically significant (p<0.05). Among the group 2 students, 26% achieved a grade of A, and 37% achieved a grade of B. In contrast, only 7% of the group 1 students obtained a grade of A, and 31% achieved a grade of B. These results suggest that video triggers may offer an advantage over conventional methods and their inclusion in lectures can be a way to enhance students' learning.