Patients journey to diagnosis and treatment of oral mucosal lesions: A report on three cases.

Delays in diagnosis and management of patients with oral mucosal lesions have serious implications for the patients. Early referral and collaboration between HCPs and OM specialists are essential in improving patients' quality of life and outcomes.

YouTube as a Source of Patient Information on Oral Manifestations of COVID-19: A Cross-Sectional Evaluation of Its Utility, Dependability, and Content.

Objectives This study aims to assess the quality of the most viewed videos on the YouTube website describing the oral manifestations of COVID-19 and appraise the medical information in the content. Materials and methods The top 200 most-viewed videos on YouTube using the keywords "COVID-19 oral manifestation," "oral symptoms of COVID-19," "oral lesions of COVID-19," "coronavirus and oral findings," and "dental manifestation of COVID-19" were analyzed. Two independent reviewers classified the English-language videos as useful, misleading, or personal views and identified the source of the videos. Reliability was calculated on a 5-point scale adapted from the DISCERN tool. The global quality scale (GQS) was used to determine the quality of the videos. In addition, the completeness of the information regarding the clinical presentation, pathogenesis, diagnostic tests, and treatment of COVID-19 oral manifestations was evaluated. Results After excluding non-English and irrelevant videos, 55 videos were analyzed. Thirty-two videos were classified as useful. Independent users uploaded the most videos (19, 51%). The mean reliability and GQS scores for useful videos were (3.24+1.4) and (2+0.75), respectively. The GQS score was significantly related to the reliability score (p<0.01). Videos scoring high in GQS also show high-reliability scores. In addition, videos with high GQS scores showed more comprehensive content, scoring >9 in the content aspect. The COVID tongue was the most discussed topic, followed by oral ulcers and oral mucormycosis. Conclusions Most of the YouTube videos were useful and had moderate quality. However, they show low reliability and lack comprehensive medical information on the topic. Healthcare providers should play a more active role in the educational information given on social media (SM) during global disease outbreaks.

A COVID-19 University-Based Dental Clinic Experience and Infection Control Protocol Modification for Safe Clinical Education.

OBJECTIVES: The aim of the study was to share our experience of the development and application of a modified infection control protocol at the Dental Teaching Hospital, Umm Al-Qura University (UQUDENT) during the second wave of the COVID-19 pandemic. A second aim was to evaluate the impact of the implemented strategies on preparations for future requirements in clinical dental education. MATERIALS AND METHODS: In this descriptive study, we evaluated the challenges facing dental practice and categorized them into four domains: challenges facing dental practice during the pandemic, the risk of acquiring COVID-19 infection, the design of student clinics, and the financial challenges. The impact of strategies established to deal with such challenges was studied by comparing the number of treated patients from September 1, 2020, to March 01, 2021, with the number treated during the same months pre-COVID-19. The COVID-19 polymerase chain reaction (PCR) confirmed students and health care workers (HCWs) were expressed in numbers and percentages in each category of the study group. RESULTS: Policies were set up to deal with the challenges in each domain, after training all the hospital personnel in mitigation of the spread of infection within the hospital. We left a non-working clinic between every two operating clinics, and the patient risk was assessed by triage scoring and health status checks by a Saudi mobile application at the entrance. The hospital delivered more personal protective equipment and obligated all students and HCWs to wear KN95 or N95 masks during procedures. Over 1,500 patients were treated during the study period with more than a 30% reduction in comparison to those in the pre-COVID-19 period, but only 20 UQUDENT personnel had confirmed COVID-19 infection, and all proved to be community-acquired by contact tracing. CONCLUSION: The measures implemented in this study proved effective. With the challenges and limited resources, UQUDENT managed to resume the operation of its dental clinics and training while preventing cross-infection, and it ensured that dental students graduated with the required competency. Sharing experiences between educational institutes will help to graduate safe competent practitioners.

Evaluation of hyaluronic acid gel with or without acellular dermal matrix allograft in the treatment of class II furcation defects in dogs: A histologic and histomorphometric study.

Aim: To evaluate the histologic and histomorphometric effects of hyaluronic acid (HA) gel with or without acellular dermal matrix allograft (ADMA) on periodontal regeneration in Class II furcation defects in dogs. Materials and methods: Class II furcation defects were surgically created in the mandibular first and second premolars bilaterally in eight beagle dogs. The Class II furcation defects were assigned randomly, using the split-mouth design, into the test and control sides. The teeth on the test sides were equally and randomly divided into the HA/ADMA group (n = 8) treated with 0.8% HA gel followed by ADMA, and the HA-only group (n = 8) treated with 0.8% HA only. The furcation defects of the control sides (n = 16) were subjected to open flap debridement (OFD group). The animals were euthanized for histologic and histomorphometric analyses after one month (n = 4) and three months (n = 4). Results: At one month, the newly formed bone area (NFBA) was larger in the HA/ADMA (6.23 ± 1.41 mm2) and HA-only (5.90 ± 1.43 mm2) groups than in the OFD group (2.42 ± 1.62 mm2) (p < 0.05). The newly formed cementum (NFAC) and periodontal ligament (NFPL) were similar in the HA/ADMA and HA-only groups but significantly lesser in the OFD group (p < 0.05.) At three months, the NFBA, NFAC, and NFPL were greater in the HA/ADMA group than in the HA-only group (p < 0.05). New regenerative tissue was significantly greater in both the test groups than in the OFD group (p < 0.05), while epithelial downgrowth predominated the healing in the latter. Conclusions: These results suggest that HA with ADMA positively affects the periodontal regeneration and wound healing in Class II furcation defects.

Cone-Beam Computed Tomography (CBCT)-Based Assessment of the Alveolar Bone Anatomy of the Maxillary and Mandibular Molars: Implication for Immediate Implant Placement.

Purpose This study aims to examine specific aspects of socket morphology, including buccal and palatal/lingual bone width, interradicular bone (IRB) width, and assessments of root apices and furcation proximity to the vital structures of the maxillary and mandibular first and second molars using cone-beam computed tomography (CBCT). Materials and methods The study involved the analysis of 400 maxillary and mandibular first and second molars. Various measurements were taken to assess socket morphology, including mesiodistal (MD) and buccolingual (BL) width, buccal and lingual bone thickness at 2 mm apical to the alveolar crest, IRB width at 2 mm from the furcation, and the distance between the root apices and furcation to vital structures, such as the floor of the maxillary sinus (FMS) and inferior alveolar nerve (IAN). Results The mesiobuccal (MB) root of the second molar commonly intruded into the sinus, followed by the palatal root of the maxillary first molar. The mean FMS-F distance was 7.17 + 3.98 mm, and it was 7.2 + 2.72 mm for maxillary first and second molars, respectively. The mean IRB width was 2.77 + 0.96 and 2.29 + 0.74 mm for the first and second molars. The mandibular second molar had the shortest distance to the IAN in comparison to the first molar. For maxillary teeth, 7% of the first and 4% of the second molars presented alveolar anatomy adequate for immediate implant placement, compared to 84% and 50% of mandibular first and second molars. Conclusion Understanding the local alveolar bone anatomy of molars and its relationship to vital structures is crucial for the effective planning of implant treatments.

Should the Quality of Glycemic Control Guide Dental Implant Therapy in Patients with Diabetes? Focus on Implant Survival.

INTRODUCTION: Optimal glycemic control is crucial to dental implant long-term functional and esthetic success. Despite HbA1c levels of 7% or lower used is as an indicator for good glycemic control, however, this level may not be attainable for all diabetic patients. Most dentists do not consider patients with poor glycemic control candidates for implant therapy due to higher implant failure, infection or other complications. AIM: This review challenges the concept of one size fits all and aims to critically appraise the evidence for the success or failure rate of dental implants and peri-implant health outcomes in patients with less than optimal glycemic control. DISCUSSION: Evidence suggests that estimating glycemic control from HbA1c measurement alone is misleading. Moreover, elevated preoperative HbA1c was not associated with increased mortality and morbidity after major surgical procedures. Literature for the survival or success of implants in diabetic patients is inconsistent due to a lack of standardized reporting of clinical data collection and outcomes. While a number of studies report that implant treatment in patients with well controlled diabetes has a similar success rate to healthy individuals, other studies suggest that the quality of glycemic control in diabetic patients does not make a difference in the implant failure rate or marginal bone loss. This discrepancy could indicate that risk factors other than hyperglycemia may contribute to the survival of implants in diabetic patients. CONCLUSION: In the era of personalized medicine, the clinician should utilize individualized information and analyze all risk factors to provide the patient with evidence-based treatment options.

The Impact of Nonsurgical Periodontal Therapy on Serum Levels of Dickkopf-Related Protein-1 in Smokers and Nonsmokers with Periodontitis: A Prospective Comparative Study.

Purpose: This study aimed to evaluate and compare Dickkopf-related protein-1 (DKK1) serum levels and periodontal clinical parameters of smokers and nonsmokers with periodontitis at baseline and after nonsurgical periodontal treatment. Patients and Methods: A prospective comparative study was conducted among 24 patients with periodontitis who were divided according to the smoking habits into two groups: nonsmokers (G1) and smokers (G2). All the participants were assessed clinically by recording the probing depth (PD), clinical attachment loss (CAL), plaque index (PI), and bleeding index (BI), and immunologically by measuring the DKK1 serum levels at baseline and six weeks after nonsurgical periodontal therapy. Results: The two groups showed a significant decrease in PI, BI, and CAL after periodontal therapy (p < 0.05), while PD was significantly reduced in G1 (p = 0.005). The PI mean value was significantly higher at the baseline in G2 versus G1 (p = 0.050), while PD, BI, and CAL values were not significantly different between the groups (p = 0.056, p = 0.241, and p = 0.381, respectively). For DKK1 serum levels, there was a statistically significant decrease after treatment compared to the baseline for both groups (G1: p < 0.001; G2: p < 0.001) but no significant difference before (p = 0.131) and six weeks after treatment (p = 0.334) between the two groups. Conclusion: Although nonsurgical periodontal treatment effectively improved periodontal clinical parameters and reduced DKK1 serum levels, there were no significant differences in the DKK1 serum levels among the smokers and nonsmokers with periodontitis.

Temporomandibular joints disorders (TMDs) prevalence and their relation to anxiety in dental students.

Background: Temporomandibular joint disorders (TMDs) are very common disorders affecting the population and causing pain. Researchers have reported a high prevalence of TMDs among university students due to increased distress. The aims of this study were to determine the frequency of TMDs in Umm al-Qura University (UQU) dental students using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), and to examine the relationship between anxiety, bruxism, and TMDs among those students. Methods: The DC/TMD pain screener questionnaire was completed by dental students. Students who reported TMD pain or had at least one positive TMD symptom were invited to the dental clinic for a full TMJ evaluation. History of bruxism was documented and an ultra-brief tool for detecting anxiety and depression (Patient Health Questionnaire-4 PHQ) was completed by all students. Results: A total of 240 students responded to the TMD pain screener in which 119 reported at least one TMJ symptom. Only 93 dental students presented to clinical examination in which 64.5% (n=60) of them had temporomandibular joint disorders. Disc displacement with reduction and local myalgia (38.7% & 32.25%, respectively) were the most frequent diagnosis. A total of 29% (n=27) of students had more than one diagnosis. Overall, 41 participants (44.09%) reported a positive response to the anxiety scale and (n=38) 40% of participants reported parafunctional habits. Both the history of bruxism and anxiety were significantly related to TMDs (P=0.0002) and also significantly higher in women of higher academic years (P≤0.01). Conclusions: This study found a high prevalence of TMDs among UQU dental students. Disc displacement with reduction was the most prevalent disorder. Bruxism and anxiety were associated with painful TMDs.

Should Quality of Glycemic Control Guide Dental Implant Therapy in Patients with Diabetes? Focus on: Peri-Implant Diseases.

BACKGROUND AND AIM: Traditionally patients with metabolic conditions such as diabetes mellitus are considered not suitable candidates for dental implant therapy due to increased risk of infection, impaired bone healing or the potential for vascular complications. Peri-implantitis as the more progressive form of peri-implant disease involves bone loss and estimated to occur in nearly half of all implant cases long-term. Despite extensive research on association of hyperglycemia with dental implants in preclinical and animal models, translational effort to clinical practice is hampered by discrepancies in reported outcome indicators for peri-implantitis in patients with a spectrum of glycemic profiles. This review aims to evaluate clinical evidence for peri-implant disease in metabolically compromised patients and in particular in patients with poorly-controlled diabetes in order to inform clinical management of peri-implant disease. MATERIALS AND METHODS: A comprehensive literature review was performed utilizing PubMed database and using the key word 'diabetes' combined with "dental implant" or "Periimplantitis" or/and "Preimplant disease". RESULTS: Clinical studies with follow up more than 1year, systematic review and meta-analysis that evaluated peri-implant disease in diabetic patients in relation to glycemic control were taken into consideration in this review. CONCLUSION: Studies reported conflicting results regarding the long-term effect of diabetes on peri-implant health regardless of the level glycemic control. Therefore, interpretation of finding and relevance to clinical practise should be considered on individual bases.

Periodontal Disease as a Predictor of Undiagnosed Diabetes or Prediabetes in Dental Patients.

OBJECTIVES: The study investigates whether periodontal parameters can identify subjects with undiagnosed diabetes mellitus (DM) or pre-DM in patients seeking dental treatment at a university dental hospital. MATERIALS AND METHODS: Adults older than 35 years, not being diagnosed with DM before and have at least one of the risk factors of DM were included in the study. All subjects received a complete periodontal examination, filled a medical history survey, and a fasting blood glucose measurement was obtained. A multiple logistic regression test using a backward elimination method to assess factors that predict if the participant is healthy, prediabetic or diabetic was done. A p-value of <0.05 was considered significant. RESULTS: A total of 61 subjects were enrolled with an average age of 42.9 ± 9.4 years. Having a family member diagnosed with DM was reported by 64.5% of the subjects; 59% were diagnosed with advanced periodontal disease. The final logistic regression model included smoking, hypertension, family history of DM, and percentage of clinical attachment loss >3 mm was statistically significant (P < 0.001). The model explained 47.7% of the diabetes condition and correctly classified 69.4% of cases. Participants with a family history of diabetes are 4.98 times more likely to exhibit prediabetic or diabetic status. Each unit increase in the percentage of clinical attachment loss increases the likelihood of participant to be prediabetic or diabetic by 1.104 times. CONCLUSION: Dental patients presenting with severe clinical attachment loss and family history of DM have increased likelihood of undiagnosed DM or pre-DM and would benefit from screening at the dental office.

Effect of root conditioning agents hyaluronic acid, EDTA and chlorhexidine on the attachment of human gingival fibroblasts to healthy root surface.

BACKGROUND: The gold standard treatment of periodontal diseases is scaling and root planing (SRP). Different adjunctive root conditioning agents such as hyaluronic acid (HA), ethylenediaminetetraacetic acid (EDTA), and chlorhexidine (CHX) have been used with SRP to improve the smear layer removal and the healing of periodontal tissues. The aim of this study was to compare the effect of manual scaling with or without HA, EDTA, or CHX root conditioning on the attachment and viability of human gingival fibroblasts (GF). METHODS: Fifteen healthy single rooted teeth were co llected and divided randomly into a scaled (n = 12) and non-scaled control group (n = 3). The scaled roots were subdivided equally into four groups; the first group did not receive any chemical treatment, while the remaining groups were treated with the conditioning agents HA or 17% EDTA or 0.2% CHX gel. Gingival fibroblasts were seeded on the top of each root and incubated for 48 h to allow attachment to the roots. The viability of fibroblasts attached to the root surface was assessed using MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) cell viability assay. RESULTS: The cell viability was the highest in the scaled only group (p = 0.0001) while the lowest was in the scaled with EDTA group (p > 0.05). The scaled group was the highest followed by the HA and CHX groups, while the EDTA group showed the lowest mean value. CONCLUSION: SRP remains the superior method for regaining cell attachment to the root surface, leading to better periodontal health, and adjunctive therapies did not enhance the GF attachment to the root surface beyond the effect of SRP. Further studies are needed to investigate the effect of root conditioning agents on periodontally diseased teeth in vitro and compare them in vivo.

A Proposed Framework to Develop, Describe and Evaluate Peer-Assisted Learning Programs.

PHENOMENON: Peer-assisted learning (PAL) is increasingly used in different fields of education, including medical education, due to its established advantages. However, there are scarce data about the best practice guidelines for PAL program evaluation. The aim of this work was to develop a framework that can describe and develop PAL programs and consequently provide a tool for evaluation and comparison of PAL programs among different institutions. APPROACH: A thorough literature review was made for assessment of different PAL programs development and implementation strategies, and PAL leaders at the University of Umm Al-Qura in Saudi Arabia were interviewed for development and revision of a framework for PAL program development, description and evaluation. FINDINGS: A framework of four sections was developed ie context, theory, implementation processes and outcomes, and emergence. The context includes the learning objectives and the logistics. The theory includes the content nature, program design, number of tutees and tutors, participation, program orientation, program duration and timing, tutor recruitment and preparation and faculty involvement. Implementation process and outcome section includes the feedback collection and the pre- and post-intervention students' assessment. The emergence includes tracking the program evolution. INSIGHTS: Development of a clear well-defined framework for description, implementation and evaluation of a PAL educational program can provide a foundation to unify the terms organizations use to communicate the parameters of PAL programs and overcome the jargon about PAL in the literature. It also can provide comparisons between the programs in an attempt to set best practice guidelines in the future for PAL program developing and implementation.

Impact of Secretory Immunoglobulin A Level on Dental Caries Experience in Asthmatic Children.

OBJECTIVES: To assess the association between different factors in saliva and dental caries experience in children with bronchial asthma. MATERIALS AND METHODS: A total of 60 asthmatic children and 60 healthy controls of both genders with age ranging from 4- to 12-year-old. The asthmatics were grouped according to disease severity into mild, moderate, or severe asthma. All the children were clinically examined to assess their dental caries experience (deft/DMFT), and stimulated saliva samples were collected to measure the saliva pH, flow rate, ά-amylase, and secretory immunoglobulin A (sIgA)-level changes. The data were statistically analyzed using the SPSS program (v. 23) to test for significance at p ≤ 0.05. RESULTS: Asthmatic children presented significantly higher deft mean value (6.77 ± 1.69), as well as significantly reduced stimulated saliva flow (0.82 ± 0.2) and sIgA (29.42 ± 6.31) when compared to healthy control. The sIgA of asthmatics showed statistically significant negative correlation with deft and DMFT. Severe asthmatics presented significantly the lowest sIgA mean level (23.61 ± 5.33) and the most reduced saliva flow rate (0.64 ± 0.20). CONCLUSION: The reduction in saliva flow rate and secretory immunoglobulin A render asthmatic children more prone to increased dental caries progression mainly of primary dentition. HOW TO CITE THIS ARTICLE: Arafa A, AlDahlawi S, Hussien A, et al. Impact of Secretory Immunoglobulin A Level on Dental Caries Experience in Asthmatic Children. Int J Clin Pediatr Dent 2019;12(5):414-418.

The dome technique: a new surgical technique to enhance soft-tissue margins and emergence profiles around implants placed in the esthetic zone.

Achieving symmetry of the soft-tissue margins between anterior maxillary dental-implant restorations and adjacent teeth is a therapeutic challenge for both the implant surgeon and the restorative dentist. This article describes a modified procedure utilizing autogenous connective-tissue grafts to improve primarily buccal soft-tissue margins and secondarily inter-proximal tissues around tooth-bound single dental implants. This technique has the advantage of allowing for coronal augmentation of the peri-implant soft tissue while maximizing the blood supply to the area by using tunneling-technique principles. A detailed description of the technique and a case with a stable result over 24 months after crown placement is presented.

Evaluation of chemokine CXCL10 in human gingival crevicular fluid, saliva, and serum as periodontitis biomarker.

PURPOSE: The aim of this study was to evaluate CXCL10 as a biomarker for periodontitis by determining the CXCL10 levels in saliva, serum, and gingival crevicular fluid (GCF) samples from periodontally healthy control subjects and adult subjects with chronic periodontitis. PATIENTS AND METHODS: Adult patients seeking dental treatment at Umm Al-Qura University dental clinic underwent a complete periodontal examination, and saliva, serum, and GCF samples were collected. Subjects were classified as chronic periodontitis patients (n=31) if they have a periodontal probing depth (PD) of ≥4 mm and/or clinical attachment level (CAL) of ≥3 mm in >30% of the teeth. The control group (n=25) had PD ≤3 mm and/or CAL ≤2 mm. ELISA was performed to determine the concentration of CXCL10 in saliva, serum, and GCF samples. Student's t-test was carried out to evaluate the significant difference between different groups. Spearman's correlation test was used to analyze the relationship between the levels of CXCL10 and the clinical periodontal parameters. P-value of ≤0.05 was considered significant. RESULTS: Significantly higher concentrations of CXCL10 were found in saliva and serum in chronic periodontitis patients as compared with the controls (272±60.4 pg/mL and 72±13.4 pg/mL vs 130±22.2 pg/mL and 44.08±4.5 pg/mL, P≤0.05). The CXCL10 levels in GCF were higher in the periodontitis group as compared with the control group (66.36±32.0 pg/mL and 44.56±17.5 pg/mL, respectively); the difference did not reach statistical significance (P≥0.05). Moreover, serum CXCL10 level was significantly higher in periodontitis patients with moderate to severe bone loss as compared with those with mild bone loss (71.05±4.7 pg/mL vs 54.8±7.7 pg/mL, P≤0.05). The serum CXCL10 levels were found to be related to CAL measurements (r=0.3, P=0.026), while the saliva CXCL10 levels were related to PD measurements (r=0.8, P=0.0007). CONCLUSION: CXCL10 is significantly increased in periodontitis subjects as compared with controls and could be used as a marker for periodontal disease.

The effect of implant placement torque on crestal bone remodeling after 1 year of loading.

PURPOSE: The aim of this study was to evaluate and compare crestal bone levels (CBLs) after 1 year of loading of self-tapping bone condensing implants placed with high insertion torque (IT) compared to those placed with lower IT. MATERIALS AND METHODS: A retrospective chart review of 66 consecutive patients who received at least one self-tapping bone condensing implant and were in function for at least 1 year was conducted. On the basis of intrasurgical notes documenting the implant IT, the patient population was divided into group A (implant IT, >55 Ncm) and group B (IT, <55 Ncm). Radiographs taken immediately after insertion and during annual follow-up appointments were evaluated for detecting crestal bone loss. The relationship between IT and crestal bone loss, bone density, and jaw location were analyzed, and a P-value of 0.05 was considered to be statistically significant. RESULTS: A total of 113 self-tapping bone condensing NobelActive™ implants were placed. The average follow-up period from the placement of the implant restoration was 12.87 (±4.83) months. Six implants were classified as failures resulting in overall survival rate of 94.6%. Implants in group A had a mean IT of 67.35 ± 4.0 Ncm, whereas implants in the group B had a mean IT of 37.9 ± 12.62 Ncm. Implants in group A had statistically significant crestal bone loss compared to implants in group B (0.95 ± 1.60 and 0.18 ± 0.68 mm, respectively). Group A implants placed in the mandible showed significantly more pronounced crestal bone loss (2.12 ± 1.99 mm) compared to those placed in the maxilla (0.25 ± 0.65 mm; P<0.05); however, this was not the case in group B implants. CONCLUSION: Implants inserted with high IT (>55 Ncm) showed more peri-implant bone remodeling than implants inserted with a less assertive IT (<55 Ncm). Bone density and jaw location affect IT and CBLs.

Assessment of the oral health status of asthmatic children.

OBJECTIVES: To assess the oral health status and salivary composition in a group of children suffering from bronchial asthma. MATERIALS AND METHODS: The sample consisted of sixty asthmatic children, sixty healthy negative controls, and sixty healthy positive controls of both sexes with age ranging from 4 to 12 years old. The asthmatics were grouped according to disease severity into mild, moderate, or severe asthmatic. All the children were clinically examined to assess their dental caries experience (decayed, indicated for extraction, and filled primary tooth [def] and decayed-missing-filled permanent tooth [DMF]), dental erosion condition (tooth wear index), and gingival health condition (gingival index [GI]). Salivary samples were collected and assessed for salivary flow rate, salivary pH, and the level of calcium, sodium, and potassium. RESULTS: The results of this study revealed that asthmatic children presented significantly higher def, DMF score, and GI mean values compared to the control groups. Severe asthmatics significantly presented the highest def and GI score. Salivary analysis revealed reduced stimulated salivary flow rate and altered salivary pH. In addition, significantly elevated mean salivary calcium level found to be associated with higher GI mean score. CONCLUSIONS: Children suffering from bronchial asthma should receive special dental preventive attention as presented with greater risk for oral and dental diseases as compared to the healthy controls.

Complications During Maxillary Sinus Augmentation Associated with Interfering Septa: A New Classification of Septa.

PURPOSE: A new classification of maxillary sinus interfering septa based on its orientation is presented along with its relationship to the prevalence and severity of sinus membrane perforations. Additionally, the impact of membrane perforation on post-operative complications and marginal bone loss during the first year of loading is evaluated. MATERIALS & METHODS: Retrospective chart review of 79 consecutive sinus lift procedures with lateral window technique and 107 implants. Preoperative Cone Beam Computed Tomography (CBCT) images were evaluated for the incidence and the direction of maxillary septa. Chart notes were examined for the incidence of membrane perforation and postoperative complications. Measurements of mesial and distal marginal bone levels and average bone resorption adjacent to each implant were calculated in intraoral radiographs taken at implant placement and during follow up appointments. RESULTS: Interfering septa were identified in 48.1 percent of sinuses. 71.1 percent of them had the septum oriented in a buccal-lingual direction (Class I). The overall incidence of membrane perforation was 22.8 percent, and the presence of an interfering septum on CBCT scan was found to be significantly associated with the occurrence of a sinus membrane perforation (P<0.001). The mean implant marginal bone loss for sinuses, which did not experience a membrane perforation, was 0.6±0.8mm, compared with 0.9 ± 0.9 mm for the sinuses that did experience a perforation (P = 0.325). CONCLUSION: Septa should be identified, classified and managed with a meticulous attention to technical details. A classification based on the septal orientation is proposed since the orientation of the septa can complicate the surgical procedure and requires modification of the surgical technique.

The alphavbeta6 integrin plays a role in compromised epidermal wound healing.

The alphavbeta6 integrin is an exclusively epithelial integrin that is highly expressed during fetal development. In adult tissue, alphavbeta6 integrin is expressed during inflammation, carcinogenesis, and in wound healing. We previously reported that alphavbeta6 integrin is highly expressed in poorly healing human wounds and its over-expression is associated with chronic wounds in a mouse model. The objective of this study was to investigate the role of alphavbeta6 integrin in compromised wound healing induced by hydrocortisone treatment or aging by using young and old mice deficient in or overexpressing the beta6 integrin subunit in the epidermis. Untreated aged beta6 integrin-deficient (beta6-/-) animals showed a significant delay in wound healing when compared to their age-matched controls or younger beta6-/- mice. The most significant delay was observed at the stages where granulation tissue deposition was occurring. Hydrocortisone treatment significantly delayed wound healing in wild-type and beta6 integrin-deficient mice in comparison with the untreated controls. However, hydrocortisone treatment in beta6 integrin overexpressing animals did not cause a significant delay in wound healing. The results of this study suggest that alphavbeta6 integrin plays an important role in wound healing in animals compromised by either age or stress mimicked by hydrocortisone.