Genes involved in metastasis in oral squamous cell carcinoma: A systematic review.

Background and Aims: Oral squamous cell carcinoma is the most prevalent malignancy in the oral cavity, with a significant mortality rate. In oral squamous cell carcinoma patients, the survival rate could decrease because of delayed diagnosis. Thus, prevention, early diagnosis, and appropriate treatment can effectively increase the survival rate in patients. In this systematic review, we discussed the role of different genes in oral squamous cell carcinoma metastasis. Herein, we aimed to summarize clinical results, regarding the potential genes that promote oral squamous cell carcinoma metastasis. Methods: This systematic review was carried out under the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. An electronic search for all relevant articles published in English between January 2018 and April 2022 was performed using Scopus, PubMed, and Google Scholar search engines. All original studies published in English were included, and we excluded studies that were in a non-English language. Results: A total of 4682 articles were found, of which 14 were relevant and detected significant genes in oral squamous cell carcinoma progression. These findings investigated the overexpression of interferon-induced proteins with tetratricopeptide repeats 1 and 3 (IFIT1, IFT3), high-mobility group A2 (HMGA2), transformed growth factor-beta-induced, lectin galactoside-binding soluble 3 binding protein (LGALS3BP), bromodomain containing 4, COP9 signaling complex 6, heterogeneous nuclear ribonucleoproteins A2B1 (HNRNPA2B1), 5'-3' exoribonuclease 2 (XRN2), cystatin-A (CSTA), fibroblast growth factors 8 (FGF8), forkhead box P3, cadherin-3, also known as P-cadherin and Wnt family member 5A, ubiquitin-specific-processing protease 7, and retinoic acid receptor responder protein 2 genes lead to promote metastasis in oral squamous cell carcinoma. Overexpression of some genes (IFIT1, 3, LGALS3BP, HMGA2, HNRNPA2B1, XRN2, CSTA, and FGF8) was proven to be correlated with poor survival rates in oral squamous cell carcinoma patients. Conclusion: Studies suggest that metastatic genes indicate a poor prognosis for oral squamous cell carcinoma patients. Detecting these metastatic genes in oral squamous cell carcinoma patients may be of predictive value and can also facilitate assessing oral squamous cell carcinoma development and its response to treatment.

Evaluation and comparison of the effects of a new paste containing 8% L-Arginine and CaCO3 plus KNO3 on dentinal tubules occlusion and dental sensitivity: a randomized, triple blinded clinical trial study.

BACKGROUND: Dentin hypersensitivity, often occurring after dental treatments or from erosive lesions, is a prevalent patient complaint. This study introduces a paste combining 8% L-arginine, calcium carbonate, and potassium nitrate to evaluate its impact on dentinal tubules occlusion, dentin permeability, and tooth sensitivity. METHODS: Dentin surfaces from 24 third molars (thickness: 2 mm) were divided into two groups of 12. One received the experimental paste, while the other received a placebo without desensitizer. Permeability and sealing ability were assessed through scanning electron microscopy (SEM) and dentin permeability measurement. The pastes' effects on hypersensitivity were then examined in a triple-blind, randomized parallel-armed clinical trial with 16 eligible patients. Sensitivity to cold, touch, and spontaneous stimuli was recorded using the VAS scale at various intervals post-treatment. Statistical analysis was conducted using Shapiro-Wilk, Mann-Whitney U, Friedman, and Wilcoxon tests (α = 0.05). RESULTS: The permeability test demonstrated a significant reduction in dentin permeability in the experimental group (P = 0.002) compared to the control (P = 0.178). SEM images revealed most dentinal tubules in the intervention samples to be occluded. Clinically, both groups showed a significant decrease in the three types of evaluated sensitivity throughout the study. However, no significant difference in sensitivities between the two groups was observed, with the exception of cold sensitivity at three months post-treatment (P = 0.054). CONCLUSION: The innovative desensitizing paste featuring 8% L-arginine, calcium carbonate, and potassium nitrate effectively occluded dentinal tubules and reduced dentin permeability. It mitigated immediate and prolonged dentin hypersensitivity to various stimuli, supporting its potential role in managing dentin hypersensitivity. TRIAL REGISTRATION: http://irct.ir : IRCT20220829055822N1, September 9th, 2022.

Necroptosis has a crucial role in the development of chronic periodontitis.

Background and aim: Periodontitis is a non-communicable chronic inflammatory disease that affects the entire periodontium and its severe types cause irreparable destruction. The purpose of this study was to determine the type of cell death in chronic periodontitis (CP) with the expression of receptor-interacting protein kinase (RIPK) type1 and RIPK3 genes. Materials and methods: This cross-sectional study was carried out from September 2019 to 2020. The samples (38 participants) were divided into two groups: 20 recently diagnosed CP patients and 18 healthy individuals. Participants' data was collected in the periodontology Department, Dental school, Mashhad University of Medical Sciences and sent to the Immunology Lab for assessment of RIPK1 and RIPK3 expressions using quantitative real time-PCR. Results: The study sample consisted of 30 females (78.9%) and 8 males (21.1%) with a mean age of 34 ± 5 years. The expression of the genes of interest in CPs exhibited an opposite pattern. Although, RIPK3 gene expression was significantly greater in CP patients compared to the control group (P = 0.024), the expression of RIPK1 decreased (p < 0.001). Moreover, no significant correlation was observed between age and gender with these molecules in CPs. Conclusion: The RIPK3 selectively contributes to necroptosis, therefore, it seems that RIPK3-mediated necroptosis is involved in chronic periodontitis. RIPK1 also participates in necroptosis, but mostly in apoptosis. Therefore, necroptosis as an unprogrammed inflammatory cell death induced by pathogenic damages seems to be another mechanism complicated in periodontitis and could be used as a novel target for CP therapy.

Three Different Fixation Modalities following Mandibular Setback Surgery with Sagittal Split Ramus Osteotomy: A Comparative Study using Three-dimensional Finite Elements Analysis.

Background: The provision of sufficient stability after maxillofacial surgery is essential for the reduction of complications and disease recurrence. The stabilization of osteotomized pieces results in rapid restoration of normal masticatory function, reduction of skeletal relapse, and uneventful healing at the osteotomy site. We aimed to compare qualitatively stress distribution patterns over a virtual mandible model after bilateral sagittal split osteotomy (BSSO) bridged with three different intraoral fixation techniques. Methods: This study was conducted in the Oral and Maxillofacial Surgery Department of Mashhad School of Dentistry, Mashhad, Iran, from March 2021-March 2022. The mandible computed tomography scan of a healthy adult was used to generate a 3D model; thereafter, BSSO with a 3mm setback was simulated. The three following fixation techniques were applied to the model: 1) two bicortical screws, 2) three bicortical screws, and 3) a miniplate. The bilateral second premolars and first molars were placed under mechanical loads of 75, 135, and 600N in order to simulate symmetric occlusal forces. Finite element analysis (FEA) was carried out in Ansys software, and the mechanical strain, stress, and displacement calculations were recorded. Results: The FEA contours revealed that stress was mainly concentrated in the fixation units. Although bicortical screws presented better rigidity than miniplates, they were associated with higher stress and displacement readings. Conclusion: Miniplate fixation demonstrated the most favorable biomechanical performance, followed by fixation with two and three bicortical screws, respectively. Intraoral fixation with miniplates in combination with monocortical screws can serve as an appropriate fixation arrangement and treatment option for skeletal stabilization after BSSO setback surgery.

The Beneficial Effect of Preoperative Dexmedetomidine in Controlling Postoperative Pain, Nausea, and Vomiting After Orthognathic Surgery: A Triple-blind Randomized Clinical Trial.

PURPOSE: Controlling postoperative pain and nausea (PONV) following orthognathic surgery can be challenging. The aim of the study was to assess the efficacy of dexmedetomidine (DEX) in reducing pain and preventing nausea and vomiting in subjects undergoing orthognathic surgery. METHODS: The authors implemented a triple-blinded, randomized clinical trial. Healthy adults with class III jaw deformity scheduled for bimaxillary orthognathic surgery were included. Subjects were randomized to the DEX or placebo groups. The DEX group received premedication with DEX 1 µg/kg IV over 10 minutes followed by a maintenance dose (0.2 µg/kg/hour) while the placebo group received normal saline. The primary outcome variables were postoperative pain, postoperative nausea, and postoperative vomiting . Pain was assessed using a visual analog scale at 1, 3, 6, 12, 18, and 24 hours, postoperatively). Nausea and vomiting were recorded throughout the postoperative period. Statistical analysis was performed using χ2, t test, and repeated measures ANOVA with a P value < .05 considered significant. RESULTS: A total of 60 consecutive subjects with a mean age of 24.6 ± 3.5 years completed the study. There were 38 females (63.33%) and 22 males (36.66%). The mean visual analog scale was significantly lower in the DEX group at all time-points (P < .05). There was a significantly greater demand for rescue analgesics in the placebo group compared to the DEX group (P = .01). Fourteen subjects (46.7%) in the placebo group and one subject (3.3%) in the DEX group reported nausea (P < .001). Postoperative vomiting was not observed in any of the subjects. CONCLUSION: Premedication with DEX can be considered a viable treatment option for reducing postoperative pain and postoperative nausea after bimaxillary orthognathic surgery.

Using Platelet-Rich Fibrin in Combination With Allograft Bone Particles Can Induce Bone Formation in Maxillary Sinus Augmentation.

BACKGROUND: Sinus pneumatization secondary to posterior maxillary tooth extraction can hinder proper implant installation. Maxillary sinus floor augmentation is a surgical procedure that has been proposed to overcome this issue. PURPOSE: The aim of this study was to evaluate and compare the histomorphometric outcomes of sinus floor elevation using allograft bone particles with or without platelet-rich fibrin (PRF). STUDY DESIGN, SETTING, SAMPLE: This randomized clinical trial included patients scheduled for maxillary sinus floor elevation in the Implant Department of Mashhad Dental School. Healthy adults with an edentulous maxilla and residual alveolar bone height of 3 mm or less were eligible to participate and were randomly allocated to intervention (A) or control (B) groups. Bone biopsies were obtained 6 months postoperatively. PREDICTOR VARIABLE: The predictor variable was using a PRF membrane for maxillary sinus augmentation. In group A, sinus floor elevation was performed using PRF combined with bone allografts, while in group B only allograft particles were used. MAIN OUTCOME VARIABLES: The primary outcome variables were the recorded postoperative histologic parameters, as in the area of newly formed bone, new bone marrow, and residual graft particles (µm2). The secondary outcome variables were the radiographically measured postoperative bone height and width at the graft site. COVARIATES: Age and sex. ANALYSES: Independent sample t-test was employed to compare the postoperative histomorphometric parameters between groups A and B. P value ≤ .05 was considered statistically significant. RESULTS: A total of 20 patients (10 per group) completed the study. The mean rate of new bone formation was 43.25 ± 5.22% in group A and 38.25 ± 7.01% in group B. This difference was statistically insignificant (P = .087). The mean amount of newly formed bone marrow was significantly more in group A compared to group B (6.81 ± 2.19% vs 10.23 ± 4.49%; P = .044). The average amount of remaining particles was also significantly less in group A patients (9.35 ± 3.43% vs 13.18 ± 3.67%; P = .027). CONCLUSION AND RELEVANCE: Incorporating PRF as an adjunctive grafting material results in fewer residual particles of allograft and in more bone marrow formation and may serve as a treatment option for developing the atrophic posterior maxilla.

The Effect of Covid-19-Related Social Distancing Restrictions on Maxillofacial Fractures Epidemiology.

Background: The purpose of the present study was to evaluate the changes in maxillofacial fracture epidemiology and etiology regarding Covid-19-related social distancing restrictions in an Iranian population. Methods: A retrospective cross-sectional study was undertaken in six major trauma center hospitals in Iran in a period of two years (March 2018 until March 2020). The primary outcome variable was the maxillofacial fractures incidence. Patients' demographic data, date of injury as well as fracture characteristics, fracture etiology, type, and site were all recorded, compared, and analyzed in the control and experimental groups. Results: The patients consisted of 520 (83.6%) males and 102 (16.4%) females. Patients sustaining maxillofacial fractures over this two-year period displayed a mean age of 31.24±14.44, with an age range of 2 to 88 years. The incidence of maxillofacial fractures significantly decreased in all age groups (p<0.001). After social distancing restrictions were placed; there was a significant drop in the number of subjects attending due to motorcycle collisions and road traffic accidents, whereas the number of fractures caused by assaults and domestic violence significantly increased (p<0.001 for each). Conclusion: The investigators realized that social distancing restrictions were able to change the trends and patterns in maxillofacial fracture incidence and etiology.

Emergence from Anesthesia: A Comparison between Isolated Mandibular Setback and Bimaxillary Orthognathic Surgeries in Skeletal Class III Patients.

Background: We aimed to compare the emergence from anesthesia between the isolated mandibular setback and bimaxillary orthognathic surgeries in Skeletal Class III Patients. Methods: All healthy patients with skeletal class III deformity admitted to Mashhad Dental School, Mashhad, Iran from the years 2017 to 2018 were included in this study. They were candidates for either bimaxillary orthognathic surgery (Bimax surgery) through a combination of mandibular setback surgery plus maxillary advancement or isolated mandibular setback (Monomax surgery). The predictor variable was the type of jaw displacement and anesthesia duration, while the outcome variable was the duration of emergence from general anesthesia. The duration of emergence from anesthesia was calculated from the time the patient was transported to the recovery room until the time of safely discharging from the recovery room. For statistical analysis, the significance level was set at 0.05 using SPSS 21. Results: A total of 81 consecutive patients, comprising 45 (55.6%) males and 36 (44.4%) females, with an average age of 23.15±4.58 years were recruited. Among the participating patients, 56 (69.1%) underwent bimaxillary surgery while the other 25 (30.9%) were treated with Monomax surgery. Regardless of the type of performed surgery, the duration of general anesthesia was the only factor to be significantly correlated to the length of emergence from anesthesia (P= 0.001). Conclusion: Increased exposure time to general anesthesia might result in a longer emergence from anesthesia, despite the type of performed orthognathic surgery. Further clinical trials are needed to support the relevancy.

Is Preemptive Oral Tizanidine Effective on Postoperative Pain Intensity after Bimaxillary Orthognathic Surgery? A Triple-Blind Randomized Clinical Trial.

Background: We aimed to investigate the effect of preoperative administration of oral tizanidine on postoperative pain intensity after bimaxillary orthognathic surgery. Methods: All healthy skeletal class III patients who were candidates for bimaxillary orthognathic surgery were enrolled in this triple-blind randomized clinical trial. The study was carried out in the Maxillofacial Surgery Department of Qaem Hospital, Mashhad, Iran; from January 2021 to November 2021. The consecutive patients were randomly divided into tizanidine and placebo groups. One hour prior to anesthesia induction, the tizanidine group received 4 mg Tizanidine dissolved in 10 ml apple juice, whereas the placebo group received an identical glass of plain apple juice. All operations were performed by the same surgical team, under the same general anesthesia protocol. Postoperative pain was measured using the Visual Analogue Scale (VAS) at 3, 6, 12, 18, and 24 hours. For statistical analysis; the significance level was set at 0.05 using SPSS 23. Results: A total of 60 consecutive patients, consisting of 36 females (60%) and 24 males (40%) with an average age of 25.4 ± 6.0 were recruited. An increasing trend was noticed in the amount of perceived postoperative pain from the 3rd till 12th hour, and then decreased afterward. Nevertheless, the average amount of pain was significantly lower in the tizanidine compared to the placebo group, in all the evaluated time intervals (P<0.001). Moreover, there was a significantly higher requirement for postoperative opioid analgesics in the placebo compared to the tizanidine group (P=0.011). Conclusion: The addition of oral tizanidine was effective in reducing postoperative pain following bimaxillary orthognathic surgery. Further studies are necessary for more relevancy.

Combined Platelet-Rich Plasma and Hyaluronic Acid can Reduce Pain in Patients Undergoing Arthrocentesis for Temporomandibular Joint Osteoarthritis.

PURPOSE: The benefit of adjuvant medications, such as platelet-rich plasma (PRP) and hyaluronic acid (HA), following arthrocentesis remains controversial. The purpose of this study was to evaluate the efficacy of PRP and HA injection following arthrocentesis in subjects with symptomatic temporomandibular joint osteoarthritis (TMJ-OA). METHODS AND MATERIALS: The authors implemented a prospective randomized single-blinded pilot clinical study. Healthy adults diagnosed with TMJ-OA who were treated with nonsurgical treatments initially, but failed to respond, participated in this study. Subjects were randomly allocated to HA, PRP, or combined HA+PRP groups following arthrocentesis. The primary outcome variable was the change in pain at 1 and 6 months postoperatively, using the Visual Analogue Scale (VAS). The secondary outcome variables were the changes in maximum mouth opening (MMO), lateral and protrusive mandibular movements, and pathologic TMJ sounds at 1 and 6 months postoperatively. Descriptive and bivariate statistics were computed. The significance level was set at P value < .05, using SPSS 19. RESULTS: A total of 30 consecutive patients (15 males and 15 females) with a mean age of 29.63 ± 8.34 years were followed for 6 months in this study. The mean reduction in pain at 6 months was 4.1 ± 0.9, 4.1 ± 1.1, and 5.1 ± 1.0 for HA, PRP, and HA/PRP, respectively (P < .05). In all 3 treatment groups, mean VAS parameters had significantly reduced after treatment and these postoperative values were significantly lower in the PRP+HA group (P < .001). The mean increase of MMO after 6 months was 8.0 ± 2.8, 8.0 ± 3.0, and 10.1 ± 3.3 for HA, PRP, and HA/PRP, respectively (P < .05). MMO, lateral, and protrusive mandibular movements significantly improved after treatment in all 3 groups (P < .001). TMJ noises were significantly reduced in all treatment groups (P < .001), but the PRP+HA group exhibited a greater reduction. CONCLUSION: Combined HA and PRP injection following arthrocentesis is more effective than HA or PRP alone in the management of TMJ-OA.

Does Mandibular Advancement Orthognathic Surgery Lead to TMJ Dysfunction in Skeletal Class 2 Patients? A Quasi-Experimental Trial in an Iranian Population.

BACKGROUND: We aimed to evaluate the possibility of temporomandibular joint (TMJ) dysfunction following mandibular advancement surgery in skeletal class 2 patients. Methods: All healthy non-syndromic patients with Class 2 deformity, who were eligible for mandibular advancement surgery, were included in this before-after quasi-experimental study. The main intervention was mandibular advancement through bilateral sagittal split osteotomy (BSSO). Maxillary impaction or setback surgery using LeFort 1 osteotomy was simultaneously performed in some cases. Variables such as TMJ pain, clicking, crepitus, or any other type of sounds or complaint as well as the amount of maximum mouth opening (MMO) were evaluated before surgery and two months postoperatively. Results: Thirty patients including 15 men and 15 women with a mean age of 23.3 ±2.7 yr were studied. The mean amount of mandibular advancement displacement was 3.30 ± 0.87 mm. The rate of TMJ dysfunctions and complaints was relatively low two months postoperatively when compared to the preoperative state. Postoperative evaluation demonstrated that there was no significant correlation between the presence of TMJ symptoms and dysfunctions and the type of surgery. After treatment was completed, the mean MMO reduced significantly from 39.03±5.86 to 38.12±6.05 (P<0.001). Conclusion: Mandibular advancement with BSSO surgery in skeletal class 2 patients did not clinically lead to TMJ dysfunctions. Among all the investigated factors, only preoperative pain, noises, or complaints were proven to have predictive value for postoperative TMJ dysfunction.

Bimaxillary Orthognathic Surgery Does Not Induce Obstructive Sleep Apnea in Skeletal Class III Patients.

PURPOSE: Since the relationship between mandibular setback surgery and obstructive sleep apnea (OSA) occurrence still remains controversial, the aim of this study was to assess the impact of bimaxillary orthognathic surgery on the probability of OSA development, using a home sleep test (HST) device. METHODS: The authors implemented a double-blinded prospective cohort study. All healthy patients with skeletal class III deformity were included in this study. Subjects were candidates for bimaxillary orthognathic surgery. OSA monitoring was performed by the pulmonologist, week 1 preoperatively (T0), 1 and 6 months postoperatively (T1, T2), with a specific brand of a HST device. The predictor variables were the amount of mandibular setback and maxillary advancement, separately. Changes in apnea-hypopnea index (AHI) and SpO2 1 and 6 months after surgery relative to T0 were the outcome variables. OSA severity was measured using AHI, and classified as mild (530). Age, sex, and body mass index were the study covariates. The outcome assessor (pulmonologist), and the data analyzer were blind in this study. The significance level was set at 0.05, using the SPSS19. RESULTS: The sample was composed of 30 patients, (15 females, 15 males) with an average age of 25.73 ± 5.26 years and a mean body mass index of 19.90 ± 3.6 kg/m2. The mean amount of mandibular setback was 4.5 ± 1.1 (ranged from 2-7 mm), while the average maxillary advancement was 2.9 ± 1.2 mm (ranged 1-5 mm). Mean AHI at T0, T1, and T2 was 1.8 ± 1.0, 3.4 ± 1.5, and 1.9 ± 0.9 events per hour events, respectively. The AHI scores increased from T0 to T1 but again decreased until T2, which were statistically significant (P < .001). The mean amount of SpO2 at T0, T1, and T2 was 96.7 ± 0.9, 94.0 ± 1.3, 96.7 ± 0.7%, respectively. Postoperative AHI in T1 and T2 had direct statistical significant relationships with the amount of mandibular setback (Rsp = .404, .574, respectively and P < .05). Postoperative AHI scores were lower in patients with <5 mm mandibular setback in comparison to subjects who underwent ≥5 mm setback (P < .05). CONCLUSIONS: Bimaxillary orthognathic surgery (concomitant maxillary advancement and mandibular setback) did not increase the incidence of OSA in young healthy non-obese class III patients, in the case of mandibular setback up to 7 mm.

What Is the Effect of Pre-Emptive Oral Montelukast on Postoperative Pain Following Bimaxillary Orthognathic Surgery? A Triple-Blind Randomized Clinical Trial.

PURPOSE: The aim of this study was to assess the effect of preoperative administration of oral montelukast on the amount of postoperative pain following bimaxillary orthognathic surgery. METHODS AND MATERIALS: All healthy skeletal class III deformity candidates for bimaxillary orthognathic surgery were included in this triple-blind randomized clinical trial. The subjects were randomly divided into placebo and montelukast groups. One hour before the surgery, a 10 mL of apple juice was given to each and every patient; however, a 10 mg tablet of montelukast was dissolved in the juice for the intervention group. All operations were performed by the same surgical team, under the same general anesthesia protocols. The outcome variable was the amount of postoperative pain (1-, 3-, 6-, 12-, 18-, and 24-hour intervals) which was measured during the first 24 hours using a Visual Analog Scale. For statistical analysis, the significance level was set at 0.05 using SPSS 23. RESULTS: A total of 60 consecutive patients, comprising 31 females (51.7%) and 29 males (48.3%) with an average age of 25.2 ± 2.2 were recruited. The average surgical duration was 193 ± 28.0 minutes. In general, pain intensity exhibited an increasing trend from the first hour postoperatively, reaching its peak in the 12th hour and decreasing thereafter. Nevertheless, the average amount of pain was significantly higher in the placebo group compared with the montelukast group, in all the studied time intervals (P < .05). The number of patients who required postoperative opioid analgesics was significantly higher in the placebo group compared to the montelukast group (P = .024). Moreover, the duration of surgery had a direct and significant effect on the postoperative pain intensity (P < .001). CONCLUSIONS: It might be concluded that preoperative administration of montelukast is effective in reducing postoperative pain following bimaxillary orthognathic surgery. Further studies are necessary for more relevancy.

Surgical Treatment of a Huge Pleomorphic Adenoma in the Hard Palate of a Young Female Adult: A Case Report.

Pleomorphic adenoma is the most common salivary gland tumor. This tumor mostly involves the parotid gland; however, if it occurs in the minor salivary glands, the palate would be the most common site. This lesion is more prevalent in patients with 40 to 60 years of age. Regarding the literature, the incidence of giant pleomorphic adenoma of the palate in young patients is considered a rare finding. Hereby, we present a rare case of pleomorphic adenoma of the palate, with an astonishing size, found in a 27-year-old patient. Furthermore, the surgical treatment of this lesion is described. This case was effectively treated with surgical curettage and tumor resection, emphasizing the significance of early detection in order to minimize complications. Surgical treatment, was beneficial to help the patient resume to normal life. Additionally, the clinical, radiological, and histopathological aspects and potential surgical treatments are discussed.

Dal Pont vs Hunsuck: Which Technique Can Lead to a Lower Incidence of Bad Split during Bilateral Sagittal Split Osteotomy? A Triple-blind Randomized Clinical Trial.

BACKGROUND: We aimed to assess the incidence of bad split fractures during Bilateral Sagittal Split Osteotomy (BSSO) mandibular setback surgery using Dal Pont and Hunsuck techniques. METHODS: All healthy adults with skeletal class III discrepancy, who were candidates for mandibular setback surgery were enrolled in this randomized clinical trial in the Maxillofacial Surgery Department of Qaem Hospital, Mashhad, Iran; from 2018-2020. These patients were randomly divided into two equal groups; one group underwent BSSO using Dal Pont osteotomy while the Hunsuck osteotomy was employed for the other group. A bad split fracture which identified through intra-operative clinical and postoperative radiographic examination was the outcome variable. The significance level was set at 0.05 using SPSS 16. RESULTS: Overall, 104 consecutive patients, comprising of 52 (50%) males with an average age of 23.09±3.08 were recruited. The average duration of osteotomy and splitting was reported to be 22.74±3.06 min. 10 bad split fractures (9.62%) were observed; 7 of which occurred in the Dal Pont group and 3 in the Hunsuck group. However, this difference was not significant. In 80% of the cases, bad split osteotomy occurred in the proximal segment, while this finding was identified in the distal segment in 20% of cases. The average duration of osteotomy and splitting was significantly longer in the Dal Pont group (P<0.001). CONCLUSION: The duration of osteotomy and splitting is much shorter when the Hunsuck technique is employed, and the incidence of unfavorable fractures is also less compared to the Dal Pont osteotomy technique.

Is Mini-Plate Removal Necessary for Oral and Maxillofacial Surgery Patients? A Five-Year Case-Control Study.

OBJECTIVES: The purpose of this study was to determine the mini-plate and screw removal rate and reasons in maxillofacial surgery patients under previous semi-rigid fixation treatment in the past five years at the main trauma center of Mashhad. MATERIALS AND METHODS: This was a census-based retrospective study. All the candidates who admitted to our department for maxillofacial plate removal due to symptomatic or infected mini-plates were included in this study. The patients' age and gender, plate removal etiologies, and the time between plate insertion and removal were analyzed. RESULTS: Mini-plates were inserted for 1026 patients. However, only 94 patients with a mean age of 29.4±11.1 years were candidates for plate removal. The plate removal rate was 9.16%. Infection and exposure were the most common causes of plate removal. The most prevalent removal site was the mandible (angle and body). The interval between mini-plate insertion and removal was an average of 12.9±5.6 months. It is noteworthy that the shortest lasting duration was when plate removal was secondary to pain (6.67 months) and infection (11.45 months). CONCLUSION: This research showed that the routine removal of plates does not appear to be generally indicated in healthy subjects unless there is an obvious and definitive clinical indication.

Antibacterial Effect of Juglans Regia Bark against Oral Pathologic Bacteria.

Background. In this study antimicrobial effect of ethanolic and aqueous extracts of Juglans regia bark in Iran was evaluated on four different oral bacteria, Streptococcus mutans, Streptococcus salivarius, Streptococcus sanguis, and Staphylococcus aureus. Methods. Aqueous and ethanol extracts of Juglans regia bark were prepared by using disk diffusion technique and Minimal Inhibitory Concentration (MIC) methods. Tetracycline 30 µ g and Erythromycin 15 µ g were used as positive control and water as negative control in disk diffusion and MIC methods. Data were analyzed by ANOVA test. Results. The results showed that S. sanguis and S. mutans were the most sensitive and the most resistant bacteria against ethanolic and aqueous extracts, respectively. Ethanolic extract had significant antibacterial effect against all tested bacteria. Aqueous extract did not show antibacterial effect on S. mutans, in contrast to ethanolic extract. Aqueous extract had significantly antibacterial effect against Staphylococcus aureus, S. salivarius, and S. sanguis compared to control (P < 0.0001), but it did not show effect on S. mutans when compared with Erythromycin. According to the obtained MIC values, ethanol extract of Juglans regia bark had the lowest rate. Conclusion. The results may provide the basis for using natural antimicrobial substance for oral hygiene prophylaxis purposes.