The effects of lyophilised platelet-rich plasma in third molar extraction sockets and its surrounding tissues.

Objective: To determine the effects of repeated placement of quantified lyophilised platelet-rich plasma (LPRP) on the soft and hard tissue components. Methods: Lyophilised platelet-rich plasma was topically placed, and later injected, into fresh sockets using the third molar surgical model, randomised according to the split-mouth approach. The control site received placebo. The application of LPRP was done intraoperatively, one month and two months postoperatively. The measured endpoints included post-operative pain, swelling, trismus, pocket depth at mid-distal adjacent second molar, soft tissue healing, and bone formation (which was assessed radiographically). Fifteen healthy young adults, aged between 21 and 35 years, visiting the Oral and Maxillofacial Surgery Clinic at the University of Malaya were recruited for this study. Results: There was no significant difference in post-operative pain, swelling size, trismus, and bone healing within their specific timelines during this study. However, the LPRP group showed significant reduction in pocket depth at the two-month post-operative period, suggesting that LPRP improves soft tissue healing. Conclusion: Soft tissue healing, measured as the change of periodontal pocket depth, showed significant reduction, suggesting the benefit of LPRP for soft tissue healing. However, bone regeneration and reduction of post-operative sequelae showed no improvement even after quantification and repeated LPRP application.

Three-dimensional assessment of the extraction sockets, augmented with platelet-rich fibrin and calcium sulfate: A clinical pilot study.

OBJECTIVES: This clinical study assessed and compared the linear and volumetric changes of extraction sockets grafted with a combination of Platelet-Rich Fibrin (PRF) and Calcium Sulfate (CS) (PRF-CS), and extraction sockets grafted with a combination of PRF and xenograft (X) (PRF-X). METHODS: Five single maxillary premolar extraction sockets received PRF-CS grafts and five single maxillary premolar sockets received PRF-X grafts. Linear (horizontal and vertical) measurements were accomplished using Cone Beam Computed Tomography (CBCT) images and volumetric changes were assessed using MIMICS software. Soft tissue level changes were measured using Stonecast models. All measurements were recorded at baseline (before extraction) and at 5-months post-extraction. RESULTS: Significant reduction in vertical and horizontal dimensions were observed in both groups except for distal bone height (DBH = 0.44 ±â€¯0.45 mm, p = 0.09) and palatal bone height (PBH = 0.39 ±â€¯0.34 mm, p = 0.06) in PRF-X group. PRF-CS group demonstrated mean horizontal shrinkage of 1.27 ±â€¯0.82 mm (p = 0.02), when compared with PRF-X group (1.40 ±â€¯0.85 mm, p = 0.02). Vertical resorption for mesial bone height (MBH = 0.56 ±â€¯0.25 mm, p = 0.008), buccal bone height (BBH = 1.62 ±â€¯0.91 mm, p = 0.01) and palatal bone height (PBH = 1.39 ±â€¯0.87 mm, p = 0.02) in PRF-CS group was more than resorption in PRF-X group (MBH = 0.28 ±â€¯0.14 mm, p = 0.01, BBH = 0.63 ±â€¯0.39 mm, p = 0.02 and PBH = 0.39 ±â€¯0.34 mm, p = 0.06). Volumetric bone resorption was significant within both groups (PRF-CS = 168.33 ±â€¯63.68 mm3, p = 0.004; PRF-X = 102.88 ±â€¯32.93 mm3, p = 0.002), though not significant (p = 0.08) when compared between groups. In PRF-X group, the distal soft tissue level (DSH = 1.00 ±â€¯0.50 mm, p = 0.03) demonstrated almost 2 times more reduction when compared with PRF-CS group (DSH = 1.00 ±â€¯1.00 mm, 0.08). The reduction of the buccal soft tissue level was pronounced in PRF-CS group (BSH = 2.00 ±â€¯2.00 mm, p = 0.06) when compared with PRF-X group (BSH = 1.00 ±â€¯1.50 mm, p = 0.05). CONCLUSIONS: PRF-CS grafted sites showed no significant difference with PRF-X grafted sites in linear and volumetric dimensional changes and might show clinical benefits for socket augmentation. The study is officially registered with ClinicalTrials.gov Registration (NCT03851289).

Computational fluid dynamics modelling of human upper airway: A review.

BACKGROUND AND OBJECTIVE: Human upper airway (HUA) has been widely investigated by many researchers covering various aspects, such as the effects of geometrical parameters on the pressure, velocity and airflow characteristics. Clinically significant obstruction can develop anywhere throughout the upper airway, leading to asphyxia and death; this is where recognition and treatment are essential and lifesaving. The availability of advanced computer, either hardware or software, and rapid development in numerical method have encouraged researchers to simulate the airflow characteristics and properties of HUA by using various patient conditions at different ranges of geometry and operating conditions. Computational fluid dynamics (CFD) has emerged as an efficient alternative tool to understand the airflow of HUA and in preparing patients to undergo surgery. The main objective of this article is to review the literature that deals with the CFD approach and modeling in analyzing HUA. METHODS: This review article discusses the experimental and computational methods in the study of HUA. The discussion includes computational fluid dynamics approach and steps involved in the modeling used to investigate the flow characteristics of HUA. From inception to May 2020, databases of PubMed, Embase, Scopus, the Cochrane Library, BioMed Central, and Web of Science have been utilized to conduct a thorough investigation of the literature. There had been no language restrictions in publication and study design of the database searches. A total of 117 articles relevant to the topic under investigation were thoroughly and critically reviewed to give a clear information about the subject. The article summarizes the review in the form of method of studying the HUA, CFD approach in HUA, and the application of CFD for predicting HUA obstacle, including the type of CFD commercial software are used in this research area. RESULTS: This review found that the human upper airway was well studied through the application of computational fluid dynamics, which had considerably enhanced the understanding of flow in HUA. In addition, it assisted in making strategic and reasonable decision regarding the adoption of treatment methods in clinical settings. The literature suggests that most studies were related to HUA simulation that considerably focused on the aspects of fluid dynamics. However, there is a literature gap in obtaining information on the effects of fluid-structure interaction (FSI). The application of FSI in HUA is still limited in the literature; as such, this could be a potential area for future researchers. Furthermore, majority of researchers present the findings of their work through the mechanism of airflow, such as that of velocity, pressure, and shear stress. This includes the use of Navier-Stokes equation via CFD to help visualize the actual mechanism of the airflow. The above-mentioned technique expresses the turbulent kinetic energy (TKE) in its result to demonstrate the real mechanism of the airflow. Apart from that, key result such as wall shear stress (WSS) can be revealed via turbulent kinetic energy (TKE) and turbulent energy dissipation (TED), where it can be suggestive of wall injury and collapsibility tissue to the HUA.

A review of fluid-structure interaction simulation for patients with sleep related breathing disorders with obstructive sleep.

Obstructive sleep apnea is one of the most common breathing disorders. Undiagnosed sleep apnea is a hidden health crisis to the patient and it could raise the risk of heart diseases, high blood pressure, depression and diabetes. The throat muscle (i.e., tongue and soft palate) relax narrows the airway and causes the blockage of the airway in breathing. To understand this phenomenon computational fluid dynamics method has emerged as a handy tool to conduct the modeling and analysis of airflow characteristics. The comprehensive fluid-structure interaction method provides the realistic visualization of the airflow and interaction with the throat muscle. Thus, this paper reviews the scientific work related to the fluid-structure interaction (FSI) for the evaluation of obstructive sleep apnea, using computational techniques. In total 102 articles were analyzed, each article was evaluated based on the elements related with fluid-structure interaction of sleep apnea via computational techniques. In this review, the significance of FSI for the evaluation of obstructive sleep apnea has been critically examined. Then the flow properties, boundary conditions and validation of the model are given due consideration to present a broad perspective of CFD being applied to study sleep apnea. Finally, the challenges of FSI simulation methods are also highlighted in this article.

Dental age estimation in Malaysian adults based on volumetric analysis of pulp/tooth ratio using CBCT data.

Forensic odontology plays an important role in human identification and dental age estimation is an integral part of this process. The aim of the study was to investigate the association between chronological age and pulp/tooth volume ratio in a Malaysian population (Malays and Chinese) from cone-beam computed tomography (CBCT) scans, enhanced with Mimics software. Three hundred CBCT scans of 153 males and 147 females, aged between 16 and 65 years were divided into 5 age groups. Volumetric analysis of the pulp/tooth ratio was performed in maxillary left canines, maxillary right canines and maxillary right central incisors. Simple linear regression and Pearson correlation analysis indicated the strongest coefficient of correlation (R) values for maxillary right central incisors (0.83) followed by maxillary right canines (0.74) and maxillary left canines (0.73). Fisher's Z test indicated that dental age estimation is gender independent. The derived regression equations were further validated on an independent group of 126 teeth. The results indicated mean absolute error (MAE) values of 6.48 and 8.58 years for maxillary right central incisors and maxillary canines respectively. It was also noticed that MAE values were higher among the age groups ranging from 46 to 65 years. This study showed that a volumetric change in the pulp cavity with age is a valuable assessment method for dental age estimation among Malaysian population.

Dental age estimation employing CBCT scans enhanced with Mimics software: Comparison of two different approaches using pulp/tooth volumetric analysis.

The methods of dental age estimation and identification of unknown deceased individuals are evolving with the introduction of advanced innovative imaging technologies in forensic investigations. However, assessing small structures like root canal volumes can be challenging in spite of using highly advanced technology. The aim of the study was to investigate which amongst the two methods of volumetric analysis of maxillary central incisors displayed higher strength of correlation between chronological age and pulp/tooth volume ratio for Malaysian adults. Volumetric analysis of pulp cavity/tooth ratio was employed in Method 1 and pulp chamber/crown ratio (up to cemento-enamel junction) was analysed in Method 2. The images were acquired employing CBCT scans and enhanced by manipulating them with the Mimics software. These scans belonged to 56 males and 54 females and their ages ranged from 16 to 65 years. Pearson correlation and regression analysis indicated that both methods used for volumetric measurements had strong correlation between chronological age and pulp/tooth volume ratio. However, Method 2 gave higher coefficient of determination value (R2 = 0.78) when compared to Method 1 (R2 = 0.64). Moreover, manipulation in Method 2 was less time consuming and revealed higher inter-examiner reliability (0.982) as no manual intervention during 'multiple slice editing phase' of the software was required. In conclusion, this study showed that volumetric analysis of pulp cavity/tooth ratio is a valuable gender independent technique and the Method 2 regression equation should be recommended for dental age estimation.