Risks and complications associated with dental implant failure: Critical update.

Risks and complications have been identified with dental implant failure though there is continuous innovation in implant systems and various interceptive treatment modalities. The success rate of dental implants has increased over a period of years as a treatment option for the rehabilitation of missing teeth. The dental implants are designed that best suits the various types of bone. Endosseous implants fail due to many reasons. Different reasons for the implant failure and their contributing factors have been discussed in this review article. A better understanding of the factors responsible for the implant failure will provide clinical decision-making and may enhance the field of implant dentistry. This article summarizes the factors causing implant failure. This paper presents the results of a survey of dentists practicing implant dentistry and updates regarding their knowledge of risk factors that they consider to be important for predicting dental implant failure.

Brain Testosterone-CYP1B1 (Cytochrome P450 1B1) Generated Metabolite 6ß-Hydroxytestosterone Promotes Neurogenic Hypertension and Inflammation.

Previously, we showed that peripheral administration of 6ß-hydroxytestosterone, a CYP1B1 (cytochrome P450 1B1)-generated metabolite of testosterone, promotes angiotensin II-induced hypertension in male mice. However, the site of action and the underlying mechanism by which 6ß-hydroxytestosterone contributes to angiotensin II-induced hypertension is not known. Angiotensin II increases blood pressure by its central action, and CYP1B1 is expressed in the brain. This study was conducted to determine whether testosterone-CYP1B1 generated metabolite 6ß-hydroxytestosterone locally in the brain promotes the effect of systemic angiotensin II to produce hypertension in male mice. Central CYP1B1 knockdown in wild-type (Cyp1b1+/+) mice by intracerebroventricular-adenovirus-GFP (green fluorescence protein)-CYP1B1-short hairpin (sh)RNA attenuated, whereas reconstitution of CYP1B1 by adenovirus-GFP-CYP1B1-DNA in the paraventricular nucleus but not in subfornical organ in Cyp1b1-/- mice restored angiotensin II-induced increase in systolic blood pressure measured by tail-cuff. Intracerebroventricular-testosterone in orchidectomized (Orchi)-Cyp1b1+/+ but not in Orchi-Cyp1b1-/-, and intracerebroventricular-6ß-hydroxytestosterone in the Orchi-Cyp1b1-/- mice restored the angiotensin II-induced: (1) increase in mean arterial pressure measured by radiotelemetry, and autonomic imbalance; (2) reactive oxygen species production in the subfornical organ and paraventricular nucleus; (3) activation of microglia and astrocyte, and neuroinflammation in the paraventricular nucleus. The effect of intracerebroventricular-6ß-hydroxytestosterone to restore the angiotensin II-induced increase in mean arterial pressure and autonomic imbalance in Orchi-Cyp1b1-/- mice was inhibited by intracerebroventricular-small interfering (si)RNA-androgen receptor (AR) and GPRC6A (G protein-coupled receptor C6A). These data suggest that testosterone-CYP1B1-generated metabolite 6ß-hydroxytestosterone, most likely in the paraventricular nucleus via AR and GPRC6A, contributes to angiotensin II-induced hypertension and neuroinflammation in male mice.

Central CYP1B1 (Cytochrome P450 1B1)-Estradiol Metabolite 2-Methoxyestradiol Protects From Hypertension and Neuroinflammation in Female Mice.

Previously, we showed that peripheral administration of 2-ME (2-methoxyestradiol), a CYP1B1 (cytochrome P450 1B1)-catechol-O-methyltransferase (COMT) generated metabolite of E2 (17ß-Estradiol), protects against angiotensin II-induced hypertension in female mice. The demonstration that central E2 inhibits angiotensin II-induced hypertension, together with the expression of CYP1B1 in the brain, led us to hypothesize that E2-CYP1B1 generated metabolite 2-ME in the brain mediates its protective action against angiotensin II-induced hypertension in female mice. To test this hypothesis, we examined the effect of intracerebroventricularly (ICV) administered E2 in ovariectomized (OVX)-wild-type (Cyp1b1+/+) and OVX-Cyp1b1-/- mice on the action of systemic angiotensin II. ICV-E2 attenuated the angiotensin II-induced increase in mean arterial blood pressure, impairment of baroreflex sensitivity, and sympathetic activity in OVX-Cyp1b1+/+ but not in ICV-injected short interfering (si)RNA-COMT or OVX-Cyp1b1-/- mice. ICV-2-ME attenuated the angiotensin II-induced increase in blood pressure in OVX-Cyp1b1-/- mice; this effect was inhibited by ICV-siRNA estrogen receptor-α (ERα) and G protein-coupled estrogen receptor 1 (GPER1). ICV-E2 in OVX-Cyp1b1+/+ but not in OVX-Cyp1b1-/- mice and 2-ME in the OVX-Cyp1b1-/- inhibited angiotensin II-induced increase in reactive oxygen species production in the subfornical organ and paraventricular nucleus, activation of microglia and astrocyte, and neuroinflammation in paraventricular nucleus. Furthermore, central CYP1B1 gene disruption in Cyp1b1+/+ mice by ICV-adenovirus-GFP (green fluorescence protein)-CYP1B1-short hairpin (sh)RNA elevated, while reconstitution by adenovirus-GFP-CYP1B1-DNA in the paraventricular nucleus but not in subfornical organ in Cyp1b1-/- mice attenuated the angiotensin II-induced increase in systolic blood pressure. These data suggest that E2-CYP1B1-COMT generated metabolite 2-ME, most likely in the paraventricular nucleus via estrogen receptor-α and GPER1, protects against angiotensin II-induced hypertension and neuroinflammation in female mice.

Large Periapical or Cystic Lesions in Association with Roots Having Open Apices Managed Nonsurgically Using 1-step Apexification Based on Platelet-rich Fibrin Matrix and Biodentine Apical Barrier: A Case Series.

Teeth having open apices in the absence of a natural apical constriction pose several challenges during conventional endodontic treatment, especially when establishing an apical seal. Treatment is further challenging when these teeth are associated with large periapical or cystic lesions having resulted in expansion and/or thinning of adjacent cortical plates. Although surgical intervention is commonly adopted in the management of such cases, a conservative treatment option offering equally good prognosis is always desirable. This case series describes 3 cases: a 39-year-old woman, a 45-year-old woman, and a 15-year-old boy having teeth with concomitant open apices and large periapical/cystic lesions managed conservatively by (1) following a strict intracanal disinfection protocol, (2) intracanal aspiration with digital decompression of associated swelling, and (3) 1-step apexification for closure of the root apex by placing a preliminary barrier of platelet-rich fibrin (PRF) and a secondary barrier of Biodentine (Septodont, Saint-Maur-des-Fossés, France). In all 3 cases, the treatment outcomes, both clinical and radiographic, were highly satisfactory. PRF and Biodentine collectively rendered an apical plug that proved to be a suitable alternative to commonly used mineral trioxide aggregate in 1-step apexification. Biodentine provides good interfacial adhesion and sealing with dentin attributed to its property of hydroxyapatite crystal deposition at the material-dentin interface. Also, because of its bioactivity, it likely promotes the conversion of adjacent PRF into a calcific barrier, thus reinforcing the apical seal. Additionally, host-modulating responses of PRF contribute in expediting the healing process. Reasonable osseous healing in the periapex could be appreciated as early as 3 months in all patients. The rapidity with which healing occurred may have been an incidental finding but definitely draws attention.

Pleomorphic Adenoma of Soft Palate: Unusual Occurrence of the Major Tumor in Minor Salivary Gland-A Case Report and Literature Review.

Salivary gland tumours constitute about less than 4 % of all head and neck tumours. Pleomorphic adenoma, also called benign mixed tumour, is the most common tumour of the salivary glands. About 80-90 % of these tumours occur in the major salivary glands mainly parotid gland and 10 % of them occur in the minor salivary glands. The most common site for pleomorphic adenoma of the minor salivary glands is the palate, followed by the lips and the cheeks. Other rare sites include the floor of the mouth, tongue, tonsil, pharynx, retromolar area and the nasal cavity. Here, we are reporting a case of pleomorphic adenoma of the minor salivary glands of the soft palate in a 36-year-old Indian female. The mass was removed by wide local excision with adequate margins under general anesthesia. There was no recurrence seen after a follow-up period of 1 year.

Benefits of Alcohol on Arsenic Toxicity in Rats.

INTRODUCTION: It has been demonstrated earlier that exposure to ethanol and/or arsenic compounds (such as sodium arsenite) produces toxic effects as shown by both in vitro and in vivo experiments. Chronic exposure of humans to arsenic through drinking water, pesticides or consumption of alcoholic beverages has produced major health problem and concern in recent years. Water being one of the main ingredients for alcohol formation (beer fermentation process) can lead to contamination with arsenic. Thus, people consuming such alcohol are getting continuously exposed to arsenic compounds as well along with alcohol. AIM: The present study was undertaken to investigate the effect of alcohol co-administration on arsenic induced changes in carbohydrate metabolic status in adult male albino rats. MATERIALS AND METHODS: Adult male albino rats of Wistar strain (weighing~100g) were divided into three groups (n=8 rats/group) including Control or vehicle treated (C), Arsenic treated (As) and Arsenic treated alcohol co-exposed (As+Alc). Treatment with Sodium-arsenite included intra-peritoneal injection consecutively for 14 days at a dose of 5.55 mg/kg (equivalent to 35% of LD50) per day. Absolute alcohol (15% v/v) was fed at a dose of 0.5 ml/100 g body weight per day for five consecutive days from start of the treatment schedule. Distilled water (D/W) was used as vehicle. Blood Glucose (BG) level, levels of glycogen, Pyruvic Acid (PA), Free Amino Acid Nitrogen (FAAN), total protein, Glutamate Oxalate transaminase (GOT) and Glutamate Pyruvate Transaminase (GPT) activity, and glucose-6-phosphatase (G6Pase) activity were measured in tissues including liver, kidney and muscle. RESULTS: Treatment with arsenic decreased the levels of BG, liver glycogen and PA, tissue protein and G6Pase activity, GOT activity in liver and muscle, and increased free amino acid content in kidney and muscle, GPT activity in liver and kidney. Alcohol administration to rats co-exposed to arsenic treatment reversed these changes. CONCLUSION: Thus, it is suggested that combined administration of alcohol with arsenic can result in the suppression of the down-regulating action of arsenic on glucose homeostasis as evidenced by its hypoglycaemic effect and increased gluconeogenesis and transamination in liver.

Zika Virus Diseases - The New Face of an Ancient Enemy as Global Public Health Emergency (2016): Brief Review and Recent Updates.

Zika virus (ZIKV) disease is caused by a virus transmitted by Aedes mosquito. It presents as flu-like symptoms lasting for 5-7 days and shows potential association with neurological and autoimmune complications such as congenital microcephaly and adult paralysis disorder, Guillain-Barré syndrome. Treatment measures are conservative as the disease is self-limiting. ZIKV earlier affected several tropical regions of Africa and Asia from 1951 to 2006. Subsequently, it moved out from these regions to land as outbreaks in Yap Island, French Polynesia, South America, and most recently in Brazil. The WHO declared it as an international public health emergency in 2016 and an extraordinary event with recommendations for improving communications, tightening vigil on ZIKV infections, and improving mosquito control measures. The authors in this article aim to briefly discuss ZIKV infection, its epidemiology, clinical manifestations, management, and prevention.

Newer proposed classification of periimplant defects: A critical update.

The term peri-implantitis is used to describe a destructive inflammatory process affecting the soft and hard tissues around osseo integrated implants, leads to the formation of a peri-implant pocket and loss of supporting bone. Predisposing factors are Poor Plaque Control, inflammation, infection, Smoking, Diabetes and Occlusal Overload. It is diagnosed on the basis of clinical and radiographic interpretation and still no definite criteria have been proposed for the diagnosis and treatment of peri-implantitis. However treatment can be both conservative and surgical. The cumulative interceptive supportive therapy protocol serves as good guide for the treatment of the peri-implantitis. There is lack of a standard classification system to differentiate the various degrees of peri-implantitis, which produces dilemma in evaluating the stages clinical and radiological status, treatment and its outcome. Many classification has been proposed in medical literature with their pros and cons but still there is lack of standard classification system of implant defects and definite treatment protocol according to the same. The classification should be easy to use, clearly understandable and help in communication by clinicians of different speciality. This review aimed to introduce a classification system based on added clinical, and detailed radiological parameters with prognosis and staged treatment algorithms.

The Role of Dentistry in Disaster Management and Victim Identification: An Overview of Challenges in Indo-Nepal Scenario.

BACKGROUND: Recently, natural disasters and terrorist activities have been leading to mass casualty situations unexpectedly around the globe. In addition to the traditional emergency medical services centering around medically trained and paramedic personnel, dental practitioners having vital skills and attributes may be important in responding to a mass casualty situation. OBJECTIVE: This paper aims at discussing the role of dentists in disaster management and the role of forensic odontology in the disaster victim identification (DVI), its status in India and some suggestions to develop the plans for same. MATERIALS AND METHODS: Articles were searched in various medical databases such as Google Scholar, Pubmed Central, Sciencedirect,Wiley online Library, Scopus, Copernicus to gather all relevant information on the subject. Various keywords were used as search tool such as 'Mass disaster', 'Forensic odontology', 'Victim identification'. RESULTS: The search resulted in total of 170 articles which we reviewed. Due to limitation to the list of references we have constricted our review to only 39 articles for more informative literature and supported the topic of the present manuscript 'The Role of Dentistry in Disaster Management and Victim Identification: An Overview of Challenges in Indo-Nepal Scenario' more specifically. CONCLUSION: Every disaster is unique and involves interplay of different factors and circumstances such as nature of disaster, number of victims and extent of body fragmentation that ultimately challenges the disaster response planning. Apart from the victim recovery and evacuation, the disaster response planning must include the established procedures for the identification of the victims of the disaster. The identification of victims essentially relies on forensic anthropology, radiology, DNA typing and fingerprints, as well as odontology.

Botulinum toxin the poison that heals: A brief review.

Botulinum neurotoxins, causative agents of botulism in humans, are produced by Clostridium botulinum, an anaerobic spore-former Gram-positive bacillus. Botulinum neurotoxin poses a major bioweapon threat because of its extreme potency and lethality; its ease of production, transport, and misuse; and the need for prolonged intensive care among affected persons. This paper aims at discussing botulinum neurotoxin, its structure, mechanism of action, pharmacology, its serotypes and the reasons for wide use of type A, the various indications and contraindications of the use of botulinum neurotoxin and finally the precautions taken when botulinum neurotoxin is used as a treatment approach. We have searched relevant articles on this subject in various medical databases including Google Scholar, PubMed Central, ScienceDirect, Wiley Online Library, Scopus, and Copernicus. The search resulted in more than 2669 articles, out of which a total of 187 were reviewed. However, the review has been further constricted into only 54 articles as has been presented in this manuscript keeping in mind the page limitation and the limitation to the number of references. A single gram of crystalline toxin, evenly dispersed and inhaled, can kill more than one million people. The basis of the phenomenal potency of botulinum toxin (BT) is enzymatic; the toxin is a zinc proteinase that cleaves neuronal vesicle-associated proteins responsible for acetylcholine release into the neuromuscular junction. A fascinating aspect of BT research in recent years has been the development of the most potent toxin into a molecule of significant therapeutic utility. It is the first biological toxin which is licensed for the treatment of human diseases. The present review focuses on both warfare potential as well as medical uses of botulinum neurotoxin.

A randomized comparative prospective study of platelet-rich plasma, platelet-rich fibrin, and hydroxyapatite as a graft material for mandibular third molar extraction socket healing.

AIM: The purpose of this study was to compare the efficacy of platelet-rich plasma (PRP), platelet-rich fibrin (PRF), and hydroxyapatite (HA) for reduction of pain and swelling, absence of dry socket, soft tissue healing, and bone regeneration after mandibular third molar extraction in human patients. MATERIALS AND METHODS: Forty patients requiring extraction of mandibular third molars were randomly grouped as control, PRP, PRF, and HA-treated. The patients were assessed for postoperative pain, swelling, dry socket, and soft tissue healing on the 3rd, 7th, and 14th day of postoperative periods depending on the standard methods. Radiological assessment of the extraction site was done at 1, 2, and 6 months interval to compare the change in bone density in the sockets in control and treated patients. RESULTS: Pain and swelling were less on PRP and PRF site when compared to HA and control site. PRP and PRF site showed better soft tissue healing when compared to HA and control site. Radiographic assessment showed comparatively lesser bone density values in PRP, PRF, and control site at 1, 2, and 6 months than HA site. CONCLUSION: Our study showed that PRP and PRF are better graft materials than HA regarding pain, swelling, dry socket, and soft tissue healing. Bone regeneration is induced promptly by HA as compared to other graft materials. However, a more elaborate study with a larger number of clinical cases is very much essential to be more conclusive regarding the efficacy of the graft materials.

Ebola Virus Disease (The Killer Virus): Another Threat to Humans and Bioterrorism: Brief Review and Recent Updates.

Ebola virus disease (EVD) described as "one of the world's most virulent diseases" by WHO was popularly known as Ebola haemorrhagic fever in the past. It is usually considered a severe and deadly illness when humans are concerned. EVD outbreaks have shown to have a very high fatality rate ranging from 50 - 90% with a reported occurrence primarily seen near the tropical rainforests of remote villages in Central and West Africa. The virus is transmitted to people from wild animals and within the human community through human-to-human contact. Natural host for Ebola virus is not yet conclusively identified but the most probable host appears to be the fruit bats of the Pteropodidae family. Five subspecies of Ebola virus are recognized till date, with Zaire Ebola virus being the most aggressive of all varieties and recording up to 90% mortality. All Ebola forms are highly contagious and hence have been classed as Category A Priority Pathogens by WHO. Severely ill patients warrant intensive support therapy. Medical workers working in affected areas need to undertake extensive measures to prevent contracting the disease. Till date, no particular anti-viral therapy has demonstrated effectiveness in Ebola virus infection. Also, no vaccine for use in humans is yet approved by the regulatory bodies. If Ebola was actually misused as a biological weapon, it could be a serious threat. Idea behind this article is to briefly review the history and present recent updates on Ebola virus, its pathogenesis and possible hopes for treatment.

Mandibular Third Molar Extraction Wound Healing With and Without Platelet Rich Plasma: A Comparative Prospective Study.

AIMS: To evaluate the efficacy of autologous platelet rich plasma (PRP) in regeneration of bone and to assess clinical compatibility of the material in mandibular third molar extraction socket. OBJECTIVE OF THE STUDY: To compare the healing of mandibular third molar extraction wounds with and without PRP. MATERIALS AND METHODS: Group A consists of the 30 patients where PRP will be placed in the extraction socket before closure of the socket. Group B consists of 30 patients who will be the control group where the extraction sockets will be closed without any intra socket medicaments. The patients would be allocated to the groups randomly. RESULTS: Soft tissue healing was better in study site compared to control site. The result of the study shows rapid bone regeneration in the extraction socket treated with PRP when compared with the socket without PRP. Evaluation for bone blending and trabecular bone formation started earlier in PRP site compared to control, non PRP site. Also there was less postoperative discomfort on the PRP treated side. CONCLUSION: Autologous PRP is biocompatible and has significant improved soft tissue healing, bone regeneration and increase in bone density in extraction sockets.