TMJ arthroscopy with hyaluronic acid: A 12-month randomized clinical trial.

OBJECTIVES: To determine the effects of hyaluronic acid (HA) as an adjunct to temporomandibular joint (TMJ) arthroscopy, relative to standard TMJ arthroscopy, in Wilkes stage-III and stage-IV patients. METHODS: A randomized clinical trial design was utilized (ClinicalTrials.gov NCT04110587). 51 patients were allocated to a TMJ arthroscopy (n = 25) or a TMJ arthroscopy plus HA (n = 26) group. Visual analog scale joint pain scores, maximum mouth opening (MMO), and muscle pain were measured at baseline, and at 3, 6, 9, and 12 months. Disk position on magnetic resonance imaging was evaluated at baseline and 12 months. Oral health-related quality of life (OHRQoL) was assessed at baseline, and at 6 and 12 months. RESULTS: No group differences were observed in clinical or radiographic measurements (p ≥ .05). The results do not indicate any benefit of HA as an adjuvant therapy to arthroscopy during follow-up months 3-12. TMJ arthroscopy improved OHRQoL at 6 and 12 months (Oral Health Impact Profile-14 questionnaire scores of -14.59 and -14.27, 95% confidence intervals = -17.55 to -11.63 and -17.27 to -11.27) respectively, as well as pain and MMO, at all follow-up time points (p < .001). CONCLUSIONS: A beneficial effect of HA injection during TMJ arthroscopy after the 3-month follow-up was not observed.

A comparative study of the expression of cyclin D1, COX-2, and KI-67 in odontogenic keratocyst vs. ameloblastoma vs. orthokeratinized odontogenic cyst.

BACKGROUND: Odontogenic keratocysts (OKCs) and orthokeratinized odontogenic Cysts (OOCs) are distinct clinicopathological entities. OKC appears to behave in a way more similar to that of a neoplasm, such as ameloblastoma (AB). The aim of this study is to compare the influence of Ki-67, Cyclin D1 and COX-2 in the diagnosis and pathogenesis of OKC, OOC and AB. MATERIALS AND METHODS: A cross-sectional observational study of 41 samples was organized into 3 groups: (1) OKC n=22; (2) AB n=13 and (3) OOC n=6. Paraffin blocks were sectioned and stained with hematoxylin and eosin (H&E). Immunohistochemical study using Bond Polymer Refine Red Detection Kit, Leica, Wetzlar, Germany, was performed for the following antibodies: Ki-67, Cyclin D1 and COX-2. Double blind immunostaining was quantified subjectively. Staining: nuclear or cytoplasmic; nuclear (Ki-67 and Cyclin D1>5% positive) and cytoplasmic (COX-2; 1; 1-30 cytoplasm: 2; 31-60 cytoplasm; 3; 61-100 cytoplasm). Considering positive stained 61-100 cytoplasms. RESULTS: The expression of Ki-67 was higher in the OKC group than in the AB group (p<0.05). Cyclin D1 showed a higher expression in OKC vs. OOC and OKC vs. AB (p<0.05). Finally, expression of COX-2 was higher in OKC vs AB (p<0.05). CONCLUSIONS: COX-2, Ki-67 and Cyclin D1 show statistically significant differences between the groups, suggesting that they could be useful tools in the differential diagnosis between OKCs and OOC and a predictive indicator for their biologic behaviour. The higher expressions of these 3 markers of OKC vs AB highlight once more the aggressive behaviour of this now re-considered cystic lesion. These markers could prove useful in the choice of more aggressive surgical treatment in OKCs as their behaviour appears to be similar to that of a neoplasm.

Problem-based learning versus lectures: comparison of academic results and time devoted by teachers in a course on Dentistry in Special Patients.

OBJECTIVES: Problem-Based Learning (PBL) is a teaching-learning technique centred on the complete development of the student. It has been successfully implemented in several universities, notably in the health sciences. The process of creating the European Higher Education Area, initiated in Bologna, encourages European universities to use new methodologies in the teaching-learning process, including PBL. Our objectives were to analyze the results obtained by using PBL with fifth-year Dentistry students. STUDY DESIGN: Comparison of academic results between students receiving lectures and PBL participants, and assessment of differences between them in the time devoted to tasks by students and teachers. RESULTS: PBL participants obtained higher grades compared to those receiving lectures only (p<0.05). The two student groups devoted the same amount of time to this subject but the time distribution of tasks was very different, with PBL students spending more time on group work and analysis of the literature. The teachers devoted much more time to the PBL group. CONCLUSIONS: PBL is a teaching-learning methodology that improves student academic results. PBL diverts student time to more complex tasks but requires a greater commitment from the teachers.

Oral pulse granuloma and oral pulse granuloma associated with odontogenic keratocyst: Two clinical cases and a review of the literature.

Two cases of oral pulse granuloma (OPG) or vegetable granuloma (VG) are presented, one of which was concomitant with an odontogenic keratocyst (OKC), which is an unusual finding. OKC is characterized by the presence of hyaline rings which include vessels, giant cells, other inflammatory cells and collagen fibres. There are two hypotheses as to its histogenesis: firstly, as a reaction to vegetable matter, such as legumes (thus the nomenclature "pulse" or edible seed) and secondly as a degenerative change in the vessel walls as a result of localized vasculitis. Due to the deceptive appearance of OPG, diagnosis can be challenging.

Relationship between oral Kaposi 's sarcoma and HAART: contribution of two case reports.

Two HIV infected patients not receiving Highly Active Antiretroviral Treatment (HAART) presented with epidemic Kaposi's sarcoma of the oral cavity. One patient initially refused HAART, but when the lesion became large enough to be noticeable he agreed to HAART associated with excision of the intraoral lesion by CO2 laser. The other patient developed KS and progressed to AIDS at two years after ceasing HAART due to adverse effects; he was referred to hospital for renewed administration of HAART. In both cases, the lesions observed in the oral cavity were the first clinical manifestation of AIDS. These reports underline the close relationship between the use of HAART and the control of KS lesions, highlighting the important role of the dentist in the identification and early diagnosis of these oral lesions.

Evaluation of 80 implants subjected to immediate loading in edentulous mandibles after two years of follow-up.

AIM: An analysis is made of the clinical and radiological behavior of 80 implants with a new surface subjected to etching with a sulfuric and hydrofluoric acid solution followed by thermal treatment, and subjected to immediate loading in patients with lower overdentures. STUDY DESIGN: A prospective observational study was made of 20 patients with lower overdentures supported by four implants measuring 13 mm in length. All patients were included after the obtainment of informed consent, anamnesis, clinical examination and radiological study, with prior clinical elaboration of the lower dentures. RESULTS: Over two years of follow-up, no important plaque or tartar accumulation was observed (with Silness and Loe indexes of 0-1). Periodontal probing proved favorable, with no pocket depths of over 2 mm in any case. The radiological controls showed no implant failures during follow-up. No cervical bone loss was recorded in the first year in a large proportion of cases (65%), while reabsorption of the cervical half was observed in 10%, and of three-quarters of the cervical portion in the remaining 35%. Performance in the second year was compatible with the standard references--with losses of between 0.5-1.5 mm. CONCLUSIONS: Rehabilitation with lower overdentures should be regarded as a priority indication, and implantological treatment substitution by conventional and/or early resting periods should be considered.

Removal torque and physico-chemical characteristics of dental implants etched with hydrofluoric and nitric acid. An experimental study in Beagle dogs.

OBJECTIVE: To study the composition, surface characteristics and response to removal torque of an implant surface subjected to hydrofluoric acid etching and posterior passivating with hydrofluoric and nitric acid. STUDY DESIGN: Twelve implants were initially selected and their physico-chemical characteristics were evaluated by means of energy-dispersive X-rays (EDS), scanning electron microscopy (SEM) and photoelectron spectroscopy (XPS). In addition, 24 implants - 12 measuring 8 mm and 12 measuring 10 mm in length - were implanted in 6 Beagle dogs. Twelve implants were removed after a recovery period of 6 weeks, followed by removal of the remaining 12 implants after 12 weeks, using a torque calibrator (Gauge Tonichi model BGT150CN-S) with a force registry range of 0-150 Ncm. RESULTS: EDS analysis of the surface chemical composition only revealed the presence of titanium in the etched surfaces. In the same way as with the surfaces of other dental implants, XPS analysis revealed traces of other elements present in the surface, fundamentally carbon. Following dual acid etching, the surface showed the roughness resulting from acid action, with a morphology that proved to be quite homogeneous. The roughness values obtained exceeded 1 mm. The mean removal torque values after 6 weeks were 79.7 Ncm for the 8 mm implants and 115 Ncm for the 10 mm implants. After 12 weeks, these values increased to 101.2 Ncm and 139.7 Ncm, respectively. CONCLUSIONS: Hydrofluoric and nitric acid etching affords optimum surface characteristics comparable to those of other surfaces. The recorded removal torque values raise the possibility of human clinical application for early or immediate loading procedures.

Evaluation of minipigs as an animal model for alveolar distraction.

OBJECTIVE: Alveolar distraction osteogenesis is a relatively novel tissue regeneration technique that remains, in some respects, at an experimental stage. The selection of an experimental animal biomodel is not clearly defined, with reports in the reviewed literature on dogs, sheep, and monkeys. The present objective was to compare 2 experimental biomodels (dog and minipig) using an alveolar distraction protocol with a novel prototype distractor. STUDY DESIGN: Three beagle dogs and 3 Göttingen minipigs were evaluated, placing the distractor at the right hemimandible alveolar ridge after previous extraction of premolars. The radiological examination was carried out immediately after the distraction and at 2 weeks of consolidation. RESULTS: Satisfactory clinical and radiological results were obtained in 2 of 3 beagle dogs after the previous unilateral extraction of mandibular and maxillary premolars. During the consolidation, a height gain of approximately 5 mm was observed, with the appearance of radiodense bone trabeculae in the distraction chamber. The distraction failed in all of the minipigs. CONCLUSION: The minipig was not an appropriate biomodel for the study of alveolar distraction because the investigators were not able to maintain the seal of the distraction chamber or the stability of the distractor.

Clinical and radiographic behaviour of 290 dental implants with a surface treated with hydrofluoric acid and passivated with hydrofluoric and nitric acid: early loading results after 2 years.

OBJECTIVE: This work presents the results of clinical and radiological behaviour, for 2 years, of 290 implants treated with a first etching with HF and a second etching with HF and HNO3 acids and that were loaded 8 weeks after insertion. EXPERIMENTAL DESIGN: It is a prospective study on 290 implants placed in 56 patients with an age range from 28 to 81. The selection was previously made through radiological study with panoramic and tomographic radiographs, followed by the implantological treatment with prosthetic loading and clinical (15 days, 1, 3 , 6, 12, 18 and 24 months) and radiological control (12 and 24 months). RESULTS: During the healing period, 11 implants failed, resulting in a CSR of 96.21%. After prostheses placement at 2 months, 4 implants were retired, successfully remaining 275 implants. CONCLUSIONS: The following and favourable results after the prosthetic loading of 179 implants (CSR of 98.56%), attest that early loading may and must be applied, after rigorous planning and case selection.

Undecalcified bone samples: a description of the technique and its utility based on the literature.

The evaluation of bone regeneration and peri-implantary bone apposition requires laboratory techniques that allow the evaluation of hard tissues without needing to decalcify them. In this study, we describe the cutting-grinding procedure (EXAKT system) for obtaining samples of undecalcified bone and aim to establish the procedures for their histological and histomorphometric evaluation. A review is made of the literature on histological and histomorphometric evaluation using undecalcified samples in surgical and oral implantology procedures in which bone regeneration or bone apposition is produced on the dental implants. The technique is a lengthy process, and is principally indicated in the investigation of bone biology. The use of undecalcified samples allows the differentiation of immature from mature bone, and the quantification of variables such as the bone-implant interface, the density of the bone area and the speed of bone apposition.

Dental management of patients with human immunodeficiency virus.

The demand for dental treatment by human immunodeficiency virus (HIV)-infected individuals is rising. Some professionals are still reluctant to treat these patients, despite the extremely low likelihood of professional transmission, which increases only in patients with a very elevated viral load. The complications rate after dental intervention is very low, even in patients with considerable immunologic deterioration. The dentist should pay special attention to the general clinical situation and immunologic and HIV virologic status of the seropositive patient, and to the presence of hemostasis alterations or of other concomitant diseases. Antiretroviral or any other drug treatments must also be recorded, in order to avoid possible interactions with clinician-prescribed drugs. Tooth extraction is the most common dental treatment and requires no antibiotic therapy except in cases of neutropenia or severe immunosuppression. Other dental treatments do not require special precautions, and the complications index among these patients is similar to that among the uninfected patient population. With this background, there is a need to make the clinician-in-training aware of the importance of regular dental health checkups as part of the health care routine of HIV-infected patients and to familiarize the clinician with their management, while not disregarding the unquestionable requirement to carry out the general and specific prevention measures to be adopted in all cases.