Evaluating osteogenic potential of a 3D-printed bioceramic-based scaffold for critical-sized defect treatment: an in vivo and in vitro investigation.

The integration of precision medicine principles into bone tissue engineering has ignited a wave of research focused on customizing intricate scaffolds through advanced 3D printing techniques. Bioceramics, known for their exceptional biocompatibility and osteoconductivity, have emerged as a promising material in this field. This article aims to evaluate the regenerative capabilities of a composite scaffold composed of 3D-printed gelatin combined with hydroxyapatite/tricalcium phosphate bioceramics (G/HA/TCP), incorporating human dental pulp-derived stem cells (hDPSCs). Using 3D powder printing, we created cross-shaped biphasic calcium phosphate scaffolds with a gelatin layer. The bone-regenerating potential of these scaffolds, along with hDPSCs, was assessed through in vitro analyses and in vivo studies with 60 rats and critical-sized calvarial defects. The assessment included analyzing cellular proliferation, differentiation, and alkaline phosphatase activity (ALP), and concluded with a detailed histological evaluation of bone regeneration. Our study revealed a highly favorable scenario, displaying not only desirable cellular attachment and proliferation on the scaffolds but also a notable enhancement in the ALP activity of hDPSCs, underscoring their pivotal role in bone regeneration. However, the histological examination of calvarial defects at the 12-wk mark yielded a rather modest level of bone regeneration across all experimental groups. The test and cell group exhibited significant bone formation compared to all other groups except the control and cell group. This underscores the complexity of the regenerative process and paves the way for further in-depth investigations aimed at improving the potential of the composite scaffolds.

3D-printed MgO nanoparticle loaded polycaprolactone ß-tricalcium phosphate composite scaffold for bone tissue engineering applications: In-vitro and in-vivo evaluation.

Magnesium (Mg) plays an important role in controlling bone apatite structure and density and is a potential bioactive material in repairing critical-sized bone defects. In this study, we aimed to evaluate the effect of adding NanoMgO to polycaprolactone/beta-tricalcium phosphate (PCL/ß-TCP) scaffolds on bone regeneration. Novel 3D-printed porous PCL/ß-TCP composite scaffolds containing 10% nanoMgO were fabricated by fused deposition modeling (FDM) and compared with PCL/ß-TCP (1:1) scaffolds (control). The morphology and physicochemical properties of the scaffolds were characterized by ATR-FTIR, XRD, scanning electron microscope-energy dispersive X-ray analysis (SEM-EDX), transmission-electron-microscopy (TEM), water contact angle, and compressive strength tests and correlated to its cytocompatibility and osteogenic capacity in-vitro. To evaluate in-vivo osteogenic capacity, bone-marrow-derived stem cell (BMSC)-loaded scaffolds were implanted into 8 mm rat critical-sized calvarial defects for 12 weeks. The hydrophilic scaffolds showed 50% porosity (pore size = 504 µm). MgO nanoparticles (91.5 ± 27.6 nm) were homogenously dispersed and did not adversely affect BMSCs' viability and differentiation. Magnesium significantly increased elastic modulus, pH, and degradation. New bone formation (NBF) in Micro-CT was 30.16 ± 0.31% and 23.56 ± 1.76% in PCL/ß-TCP/nanoMgO scaffolds with and without BMSCs respectively, and 19.38 ± 2.15% and 15.75 ± 2.24% in PCL/ß-TCP scaffolds with and without BMSCs respectively. Angiogenesis was least remarkable in PCL/ß-TCP compared with other groups (p < .05). Our results suggest that the PCL/ß-TCP/nanoMgO scaffold is a more suitable bone substitute compared to PCL/ß-TCP in critical-sized calvarial defects.

Periosteum as a covering vascular flap in posterior mandibular augmentation: A retrospective cohort study.

OBJECTIVE: To analyze the impact of creating periosteal vascular flaps on the amount of bone augmentation following inlay bone grafting (IBG) and cortical autogenous tenting (CAT). MATERIALS AND METHODS: This was a retrospective cohort study enrolling a sample cohort of patients presented to a private clinic in 2015 and 2019 for posterior mandibular ridge augmentation before dental implant placement. The predictor variables were surgical methods: CAT vs. CAT in conjunction with periosteal flap (CATP) vs. IBG vs. IBG in conjunction with periosteal flap (IBGP). The primary outcome variables were supra bundle bone (SBB) superior to the inferior alveolar canal (ΔH) and crestal width difference (ΔW) at a 4-month follow-up. Appropriate statistics were computed at 0.05 significance level. RESULTS: A total of 29 cases (10 males and 19 females) with a mean age of 57.96±7.14 years were included. A total of 33 sites were augmented through CATP, 16 sites through IBGP, 33 sites through CAT, and 11 sites through IBG techniques. All patients healed uneventfully without permanent neurosensory changes, and adequate horizontal (ΔW:3.33±0.71 mm) and vertical (ΔH:5.10±2.04 mm) bone dimensions were restored that allowed implant placement. Using periosteal vascular flaps significantly increased bone augmentation in both vertical and horizontal dimensions (P < 0.01). CONCLUSION: Periosteal vascular flaps can increase the efficacy of mandibular augmentation techniques and decrease post-surgical complications.

Gnathodiaphyseal dysplasia with a novel genetic variant in a large family from Iran.

BACKGROUND: Gnathodiaphyseal dysplasia (GDD) is an ultrarare autosomal dominant bone dysplasia characterized by cementoosseous lesions of the jawbones, bone fragility, frequent bone fractures at the young age, bowing of tubular bones, and diaphyseal sclerosis of long bones associated with generalized osteopenia. GDD is caused by point mutations in anoctamin-5 (ANO5) on chromosome 11p14.3. For the past few years, next generation sequencing (NGS) technology has facilitated the discovery of causative variants in genetically heterogeneous diseases. METHODS: In this study, exome sequencing (ES) was performed using the DNA sample of the proband. Family histories and clinical information were collected through comprehensive medical examination and genetic counseling. RESULTS: ES results identified a heterozygous variant, NM_213599.3:c.1078T>C(p.Cys360Arg) in the ANO5 gene. Sanger sequencing was performed to confirm the detected pathogenic variant in DNA samples of the entire family (except deceased individuals), which segregated with the disease within the family. Finally, in silico analysis was applied to test the pathogenicity of the variant using various online software. CONCLUSION: In summary, our investigation identified a novel pathogenic variant in the ANO5, responsible for gnathodiaphyseal dysplasia in a large Iranian family. Therefore, based on the present study, this variant can be helpful for diagnosis and effective management of GDD patients.

Effect of Photobiomodulation on Relapse in an Experimental Rapid Maxillary Expansion Model in Rat.

Rapid maxillary expansion (RME) is performed on transversely deficient maxilla. As all orthodontic treatments, retention is important in maintaining therapeutic outcomes. Fixed /removable retainers are used post-RME causing hygiene and compliance problems. Given photobiomodulation's positive effects on the quantity and quality of bone regeneration, its effect on post-RME relapse was studied. Thirty Sprague Dawley rats were randomly divided into group R, non-irradiated RME-treated (n = 12), group P, irradiated RME-treated (n = 12) and group C, non-RME non-irradiated (n = 6). A 1.5 mm metal ring inserted between maxillary incisors at days 0 and 15 was expanded until 1.5 mm space was obtained at day 30. In group P, Ga-Al-As diode laser (810 nm, 100 mW, 4J/cm2 , 30 secs) was applied on days 0, 2, 4, 6, 8, 10, 12 and 14 as predictor variable. The relapse was measured as the space lost between incisors for 30 days after appliance removal (primary outcome variable) and compared with t-test. In week 2, space loss in group P was significantly lower (P < 0.05) than all other groups. The relapse during weeks 2 and 3 was significantly lower in group P than group R. However, no significant difference in relapse amount was found between groups during first and fourth week. There was a significant difference (P < 0.05) between groups in relapse rates (secondary outcome variable) but not in total relapse after 4 weeks. Photobiomodulation proved beneficial in resisting relapse in our study, and it is suggested to be continued until the end of expansion.

Antimicrobial Photodynamic Therapy with Diode laser and Methylene blue as an adjunct to scaling and root planning: A clinical trial.

INTRODUCTION: Chronic periodontitis, the most common periodontal disease, is the destruction of tooth supporting structures and alveolar bone which may result in teeth exfoliation. Conventionally, treatment aims at decreasing bacterial load by mechanical debridement and systemic or local delivery of antibiotics. Antimicrobial photodynamic therapy (aPDT) is a safe alternative adjunct therapy for elimination of pathogenic bacteria in periodontal pocket. The aim of this study was to evaluate the effect of aPDT with 660 nm diode laser and methylene blue as an adjunct to scaling and root planning (SRP) on clinical periodontal parameters. MATERIALS AND METHODS: In this clinical trial, we assessed aPDT as an adjunct to scaling and root planning (SRP) in chronic periodontitis treatment. A total of 50 subjected were enrolled. The case group received SRP and aPDT with methylene blue solution as photosensitizer and diode laser (wavelength= 660 nm, power = 150 mW) irradiation. The control group received only SRP. The effect on clinical parameters, namely Plaque index (PI), Gingival index (GI), and probing depth (PD) was recorded at baseline, 6 weeks, 3 months and 6 months. RESULTS: There were no significant differences between participants for clinical parameters at baseline. PI, GI and PD significantly improved compared to baseline (P < 0.05). CONCLUSION: It can be concluded that aPDT can be considered a safe and efficient technique in addition to SRP for reducing the pocket depth in chronic periodontitis patients.

Critical-sized bone defects regeneration using a bone-inspired 3D bilayer collagen membrane in combination with leukocyte and platelet-rich fibrin membrane (L-PRF): An in vivo study.

OBJECTIVES: We aim to develop a 3D-bilayer collagen (COL) membrane reinforced with nano beta-tricalcium-phosphate (nß-TCP) particles and to evaluate its bone regeneration in combination with leukocyte-platelet-rich fibrin (L-PRF) in vivo. BACKGROUND DATA: L-PRF has exhibited promising results as a cell carrier in bone regeneration in a number of clinical studies, however there are some studies that did not confirm the positive results of L-PRF application. METHODS: Mechanical & physiochemical characteristics of the COL/nß-TCP membrane (1/2 & 1/4) were tested. Proliferation and osteogenic differentiation of seeded cells on bilayer collagen/nß-TCP thick membrane was examined. Then, critical-sized calvarial defects in 8 white New Zealand rabbits were filled with either Col, Col/nß-TCP, Col/nß-TCP combined with L-PRF membrane, or left empty. New bone formation (NBF) was measured histomorphometrically 4 & 8 weeks postoperatively. RESULTS: Compressive modulus increases while porosity decreases with higher ß-TCP concentrations. Mechanical properties improve, with 89 % porosity (pore size ∼100 µm) in the bilayer-collagen/nß-TCP membrane. The bilayer design also enhances the proliferation and ALP activity. In vivo study shows no significant difference among test groups at 4 weeks, but Col/nß-TCP + L-PRF demonstrates more NBF compared to others (P < 0.05) after 8 weeks. CONCLUSION: The bilayer-collagen/nß-TCP thick membrane shows promising physiochemical in vitro results and significant NBF, as ¾ of the defect is filled with lamellar bone when combined with L-PRF membrane.

Population Survey of Knowledge about Oral Cancer and Related Factors in the Capital of Iran.

Knowledge about oral cancer risk factors and signs is thought to improve prevention and early diagnosis, and in turn, increases survival. In this population-based survey, knowledge about oral cancer was assessed in Iran. A total of 1800 self-administered questionnaires (collecting sociodemographic data and questions regarding oral cancer risk factors and signs) were distributed through random sampling. Final scores ranged between 0 and 15 for the risk factors and 0-11 for the signs. Scores below the median indicated a low level of knowledge, scores representing the third quartile of correct answers indicated a moderate level of knowledge, and scores representing the upper quartile indicated a high level of knowledge. Statistical tests were used for analysis of knowledge level in different sociodemographic categories. A total of 1312 participants completed the questionnaires. The average of knowledge scores for risk factors was 5.3 ± 3.0 and for signs was 4.5 ± 2.9. Overall, 75 and 56% respectively were able to identify major risk factors (smoking and alcohol); 23.5% could not define any related signs and symptoms. Dividing scores into quartiles indicated that three out of four people had "low" knowledge about risk factors and 58% had "low" knowledge about signs and symptoms. Females and highly educated people had more knowledge of oral cancer. Significant difference was found between job and level of knowledge (P = 0.001). This survey revealed that public knowledge of oral cancer was not satisfactory in Iran. Efforts should be done to inform and educate people with risk factors, initial clinical presentation, and symptoms, in order to improve prevention and promote early diagnosis.

Therapeutic Metallic Ions in Bone Tissue Engineering: A Systematic Review of The Literature.

An important field of bone tissue engineering (BTE) concerns the design and fabrication of smart scaffolds capable of inducing cellular interactions and differentiation of osteo-progenitor cells. One of these additives that has gained growing attention is metallic ions as therapeutic agents (MITAs). The specific biological advantage that these ions bring to scaffolds as well as other potential mechanical, and antimicrobial enhancements may vary depending on the ion entity, fabrication method, and biomaterials used. Therefore, this article provides an overview on current status of In-vivo application of MITAs in BTE and the remaining challenges in the field. Electronic databases, including PubMed, Scopus, Science direct and Cochrane library were searched for studies on MITAs treatments for BTE. We searched for articles in English from January-2000 to October-2019. Abstracts, letters, conference papers and reviews, In-vitro studies, studies on alloys and studies investigating effects other than enhancement of new bone formation (NBF) were excluded. A detailed summary of relevant metallic ions with specific scaffold material and design, cell type, animal model and defect type, the implantation period, measured parameters and obtained qualitative and quantitative results is presented. No ideal material or fabrication method suited to deliver MITAs can yet be agreed upon, but an investigation into various systems and their drawbacks or potential advantages can lead the future research. A tendency to enhance NBF with MITAs can be observed in the studies. However, this needs to be validated with further studies comparing various ions with each other in the same animal model using critical-sized defects.

Medicinal plants for gingivitis: a review of clinical trials.

OBJECTIVES: Periodontal diseases are among prevalent oral health problems which may ultimately lead to severe complications in oral cavity. Herbal products can be designed as single or multicomponent preparations for better oral health. This study aims to review current clinical trials on the effectiveness of herbal products in gingivitis. MATERIALS AND METHODS: Electronic databases, including PubMed, Scopus, ScienceDirect and Cochrane library were searched with the keywords "gingivitis" in the title/abstract and "plant/ extract/ herb" in the whole text for clinical trials on herbal treatments for gingivitis. Data were collected from 2000 until January 2018. Only papers with English full-texts were included in our study. RESULTS: Herbal medicines in the form of dentifrice, mouth rinse, gel, and gum were assessed in gingivitis via specific indices including plaque index, bleeding index, microbial count, and biomarkers of inflammation. Pomegranate, aloe, green tea, and miswak have a large body of evidence supporting their effectiveness in gingivitis. They could act via several mechanisms such as decrease in gingival inflammation and bleeding, inhibition of dental plaque formation, and improvement in different indices of oral hygiene. Some polyherbal formulations such as triphala were also significantly effective in managing gingivitis complications. CONCLUSION: Our study supports the efficacy and safety of several medicinal plants for gingivitis; however, some plants do not have enough evidence due to the few number of clinical trials. Thus, future studies are mandatory for further confirmation of the efficacy of these medicinal plants.

Drug-related Dysgeusia: A Systematic Review.

PURPOSE: Dysgeusia is an unpleasant alteration in taste. It can affect the nutritional and psychological status and decrease the quality of life of patients. It may be caused by nerve injury, head and neck trauma or surgery, infections, radiotherapy and drugs, but certain aetiological factors have not yet been identified. Understanding dysgeusia as a drug side effect is important for practitioners. The aim of this systematic review was to provide detailed information about dysgeusia in patients receiving different common medications. MATERIALS AND METHODS: An electronic search was conducted in MEDLINE, Google Scholar and Scopus databases, and studies were selected according to our inclusion criteria. We included studies on human subjects that reported dysgeusia as a drug side effect. RESULTS: Thirty-four eligible studies were included in the systematic review. Thirty-five drugs were found in the literature to be correlated to dysgeusia. The most commonly reported offending drugs were from keratolytic agents, chemotherapeutic and cancer medication, antihistamine, antibiotics and angiotensin-converting enzyme inhibitors. CONCLUSION: The quality of evidence was low in most reviewed studies. More studies with standard methodology are needed in this field. However, physicians and dental practitioners must consider the probability of dysgeusia as an adverse side effect when prescribing certain medications.