Biocompatibility and histological responses of eggshell membrane for dental implant-guided bone regeneration.

Guided bone regeneration (GBR) utilizing eggshell membrane (ESM) as a potential biomaterial for dental implant therapy augmentation was explored in this study. ESM, an environmentally friendly waste product, possesses collagen-rich characteristics. The biocompatibility and histological responses of ESM were investigated in a rat model. Twelve young adult Wistar rats were used in this study. ESM samples were implanted in subcutaneous and intramuscular pockets, and samples were collected at 48 hours, 4 weeks, and 8 weeks post-implantation. Histological analysis revealed the changes in ESM over time. Results showed that ESM maintained its structural integrity, induced a moderate cellular response, and exhibited slow degradation, indicating potential biocompatibility. However, the lack of organized collagen arrangement in ESM led to the formation of irregular and polymorphic spaces, allowing cell migration. Encapsulation of ESM by newly proliferating collagen fibers and multinucleated giant cells was observed at later time points, indicating a foreign body reaction. Crosslinking might improve its performance as a separation membrane, as it has the potential to resist enzymatic degradation and enhance biomechanical properties. In conclusion, ESM demonstrated biocompatibility, slow degradation, and lack of foreign body reaction. While not suitable as a complete separation membrane due to irregular collagen arrangement, further research involving crosslinking could enhance its properties, making it a viable option for guided bone regeneration applications in dental implant therapy. This study highlights the potential of repurposing waste materials for medical purposes and underscores the importance of controlled collagen structure in biomaterial development.

Comparison of the Eggshell and the Porcine Pericardium Membranes for Guided Tissue Regeneration Applications.

Guided bone regeneration is frequently used to reconstruct the alveolar bone to rehabilitate the mastication using dental implants. The purpose of this article is to research the properties of eggshell membrane (ESM) and its potential application in tissue engineering. The study focuses on the structural, mechanical, and histological characteristics of ESM extracted from Gallus domesticus eggs and to compare them to a commercially available porcine pericardium membrane (Jason® membrane, botiss biomaterials GmbH, Zossen, Germany). Thus, histology was performed on the ESM, and a comparison of the microstructure through scanning electron microscopy and atomic force microscopy (AFM) was conducted. Also, mechanical tensile strength was evaluated. Samples of ESM were prepared and treated with alcohol for fixation and disinfection. Histological analysis revealed that the ESM architecture is constituted out of loose collagen fibers. However, due to the random arrangement of collagen fibers within the membrane, it might not be an effective barrier and occlusive barrier. Comparative analyses were performed between the ESM and the AFM examinations and demonstrated differences in the surface topography and mechanical properties between the two membranes. The ESM exhibited rougher surfaces and weaker mechanical cohesion attributed to its glycoprotein content. The study concludes that while the ESM displays favorable biocompatibility and resorb ability, its non-uniform collagen arrangement limits its suitability as a guided bone regeneration membrane in the current non-crosslinked native form. Crosslinking techniques may enhance its properties for such applications. Further research is needed to explore modifications and processing methods that could leverage the ESM's unique properties for tissue engineering purposes.

Statistical Comparison of the Mechanical Properties of 3D-Printed Resin through Triple-Jetting Technology and Conventional PMMA in Orthodontic Occlusal Splint Manufacturing.

Dental 3D-printing technologies, including stereolithography (SLA), polyjet (triple-jetting technology), and fusion deposition modeling, have revolutionized the field of orthodontic occlusal splint manufacturing. Three-dimensional printing is now currently used in many dental fields, such as restorative dentistry, prosthodontics, implantology, and orthodontics. This study aimed to assess the mechanical properties of 3D-printed materials and compare them with the conventional polymethylmethacrylate (PMMA). Compression, flexural, and tensile properties were evaluated and compared between PMMA samples (n = 20) created using the "salt and pepper" technique and digitally designed 3D-printed samples (n = 20). The samples were subjected to scanning electron microscope analysis. Statistical analysis revealed that the control material (PMMA) exhibited a significantly higher Young's modulus of compression and tensile strength (p < 0.05). In the flexural tests, the control samples demonstrated superior load at break results (p < 0.05). However, the 3D-printed samples exhibited significantly higher maximum bending stress at maximum load (MPa) (p < 0.05). Young's modulus of tensile testing (MPa) was statistically significant higher for the control samples, while the 3D-printed samples demonstrated significantly higher values for elongation at break (p < 0.05). These findings indicate that 3D-printed materials are a promising alternative that can be effectively utilized in clinical practice, potentially replacing traditional heat-cured resin in various applications.

Improving the Mechanical Properties of Orthodontic Occlusal Splints Using Nanoparticles: Silver and Zinc Oxide.

The goal of the current study was to determine the mechanical proprieties of polymethylmethacrylate (PMMA) and the improved compound, the graphene-based PMMA, with Zn and Ag and to compare the results. Scanning electron microscopy analysis of the samples before and after the mechanical test was conducted. The compression behavior, flexural properties, tensile strength, and shape of the samples were all investigated and compared between the variants of PMMA. Commercially available polymethylmethacrylate was used (Orthocryl®-Dentaurum, Ispringen, Germany) with the salt and pepper technique according to the manufacturer's instructions to produce 20 samples for each mechanical trial with standard cylinders (4 mm diameter × 8 mm length) for compression, parallelepipedal prisms for flexing (2 mm × 2 mm × 25 mm) and flat samples for traction. There was no statistical difference in the mechanical proprieties of the samples evaluated, although there were values that could suggest significance. The graphene-based PMMA demonstrated good mechanical proprieties, like the commercially available PMMA, and appears promising for future clinical use based on its multiple advantages.

Characterization of eggshell as a bio-regeneration material.

Objective: The objective of this study was to identify and summarize the characteristic features of eggshell for regeneration purpose in oral surgery procedures. Methods: A review of literature was undertaken based on the PubMed database. A search to reveal the current state of knowledge and the current uses of the eggshell as a biomaterial was performed. The characteristics of the materials, the specific use, the procedure and the outcome were extracted from the articles. Results: The materials have been found to be used in humans, animals, and in vitro studies. There is a wide use regarding oral surgery especially in experimental models. There have also been attempts to enhance certain properties and improve the capabilities of eggshell as a biomaterial. There is yet a commercial product to be developed and approved for human use. Conclusions: Eggshell can be an important biowaste which can be of use in guided bone regeneration procedures, but it has not yet entered the commercial phase and approval through official regulation channels.

The quality of life after cleft lip and palate surgery.

Background and aims: Labio-maxillo-palatal clefts represent one of the most common congenital malformations, which manifests through aesthetic, functional and psycho-social alterations. The long course of multidisciplinary treatments represent a psycho-emotional and financial burden for both the patient and his family, being an important factor in the complex management of these patients.The study aims to assess the quality of life of parents of children with clefts and the psychosocial impact on the family and society. Methods: The study included 40 subjects who met the inclusion criteria for this study. Following patient informed consent and the approval of the ethics committee, the data were collected by applying the quality-of-life evaluation questionnaire. The evaluation was performed using the Likert scale (1 - not at all to 5 - very satisfactory), and the data were statistically processed. Results: Most of the questionnaires were completed by the mother, who accompanied the child to the regular check-up; 58% of parents believe that their social life is not affected by having a child with a cleft, and 83% say that interfamilial relationships have not been affected. Most parents consider that the postoperative result was very good, which led to improved psycho-social integration of the child. Conclusions: The study confirmed an acceptable quality of life for the children's parents, which was not influenced by the family presence of a child with a cleft. At the same time, the excessive care of the parents for the child with the cleft was confirmed. The postoperative improvement of the aesthetic aspect led to a much better psycho-emotional integration of the child in the society.

Lateral Cephalometric Analytical Uses for Temporomandibular Joint Disorders: The Importance of Cervical Posture and Hyoid Position.

The temporomandibular joint disorder (TMD) is a syndrome that affects the masticatory muscles and temporomandibular joint (TMJ). Its pathophysiology is not yet fully known. Cephalometric analysis is used for routine evaluation regarding orthodontic treatment and other purposes. The aim of this study was to assess if using cephalometric analysis and TMJ conservative therapy to evaluate the hyoid bone position and the cervical posture reduced symptoms in adults with TMDs compared to no intervention. The authors conducted a systematic review of the literature (PubMed, Cochrane, Web of Science, Scopus, and Embase) for clinical studies of TMDs with conservative treatment and lateral cephalometric analysis of the hyoid and cervical posture. To assess the risk of bias for non-randomized clinical trials ROBINS-I tool was used. Out of 137 studies found, 6 remained to be included. Most of them found a link between TMD and lateral cephalometric analysis, but there was a high risk of bias. This review found a possible link between TMDs, the neck and cervical posture. There is a benefit reported regarding the use of the lateral cephalometry as a treatment, but more extensive prospective randomized clinical trials are necessary to be able to draw definitive conclusions.

Intrusion of Maxillary Posterior Teeth by Skeletal Anchorage: A Systematic Review and Case Report with Thin Alveolar Biotype.

This study aimed to review the literature related to the intrusion of maxillary posterior teeth in subjects needing pre-prosthetic restoration or orthodontic treatment due to anterior open bite, and to report a thin alveolar biotype case needing a pre-prosthetic intrusion of maxillary teeth by introducing a novel, personalized method of intrusion measurement. An electronic search was conducted between February 2022 and March 2022 in the following databases: PubMed, Scopus, Embase, Web of Science, and Lilacs; the terms "tooth movement techniques", "orthodontic anchorage procedures", "tooth intrusion", "intrusion", "molar", "premolar", and "human" were surveyed. Eighteen articles were included in this review; the mean amount of intrusion ranged from between 2.1 ± 0.9 mm and 4.57 ± 0.98 mm (being mostly 2-3 mm). The intrusion force varied between 100 and 500 g; 10 articles reported miniscrews (MS), 7 reported zygomatic plates (ZP), and 1 publication reported both anchorage types. The average treatment time was 6.9 months for MS and 7.9 months for ZP. Levelling the occlusal plane by intrusion of the upper posterior teeth can be achieved by skeletal anchorage. The stability of the obtained results, shortening treatment time, and controlling treatment outcome are the main goals for a complex surgical and orthodontic treatment approach.

Polymer-Based Bone Substitutes in Periodontal Infrabony Defects: A Systematic Evaluation of Clinical Studies.

Background and Objectives: The aim was to systematically review the available literature regarding the use of polymers as a bone substitute for the treatment of periodontal infrabony defect. Materials and methods: Three databases (PubMed, Scopus and Web of Science) were searched to find all relevant studies published in English from inception until September 2021 using a combination of keywords. The inclusion criteria consisted of human clinical studies which reported the use of a polymer-based bone substitute in the treatment of infrabony defects. Results: 164 studies were provided from the databases. Of these, five articles were eligible and reported favorable outcome in terms of probing depth, clinical attachment gain and defect fill at the follow-up (3 months and 6 months). Conclusions: Polymer based-bone substitutes may represent a useful alternative in treating infrabony defects. Due to the limited number of studies, more research is needed to sustain the advantages of these products.

Is miRNA Regulation the Key to Controlling Non-Melanoma Skin Cancer Evolution?

Non melanoma skin cancer (NMSC) is one of the most common types of skin cancer. It has a number of subtypes, which include basal cell carcinoma, cutaneous squamous cell carcinoma and Merkel cell carcinoma. MicroRNAs are short, non-coding RNA (ribonucleic acid) molecules, capable of regulating gene expression at a post transcriptional level. They play a pivotal role in a variety of physiologic cellular functions and pathologies, including malignant diseases. The development of miRNAs represents an important study field, which has been extensively exploited in melanoma for almost a decade with promising results, therefore we consider it a stepstone for further research projects also in non-melanoma skin cancers. The aim of our study was to explore the current literature in order to present the role of the different miRNAs in some of the most frequent types of NMSC pertaining to oncogenesis, evolution and therapy. The most relevant and accurate available data from the literature were evaluated. Our study concluded that there are almost 100 miRNAs which can be upregulated or downregulated and can play a role in oncogenesis. They can be easily identified in circulation, are stable and they can be important diagnosis/prognosis and therapy monitoring markers.

The Connection between MicroRNAs and Oral Cancer Pathogenesis: Emerging Biomarkers in Oral Cancer Management.

Oral cancer is a common human malignancy that still maintains an elevated mortality rate despite scientific progress. Tumorigenesis is driven by altered gene expression patterns of proto-oncogenes and tumor-suppressor genes. MicroRNAs, a class of short non-coding RNAs involved in gene regulation, seem to play important roles in oral cancer development, progression, and tumor microenvironment modulation. As properties of microRNAs render them stable in diverse liquid biopsies, together with their differential expression signature in cancer cells, these features place microRNAs at the top of promising biomarkers for diagnostic and prognostic values. In this review, we highlight eight expression levels and functions of the most relevant microRNAs involved in oral cancer development, progression, and microenvironment sustainability. Furthermore, we emphasize the potential of using these small RNA species as non-invasive biomarkers for the early detection of oral cancerous lesions. Conclusively, we highlight the perspectives and limitations of microRNAs as novel diagnostic tools, as well as therapeutic models.

Evaluation of Prognostic Factors for Palatal Fistulae after Cleft Lip and Palate Surgery in a North-Western Romanian Population over a 10-Year Period.

Cleft lip and palate is the most frequent birth anomaly, with increasing reported rates of complications, such as palate fistulae. Current studies concerning the occurrence rate of cleft lip and palate (CLP) report 2 to 10 cases in 10,000 births. The purpose of this study was to investigate the existence of factors that could predict the occurrence of fistulae after cleft lip and palate surgery. A retrospective study was performed by collecting and analyzing data from all patients who were operated for cleft lip and/or palate in the Maxillo-Facial Department of the Emergency Clinical County Hospital of Cluj-Napoca, Romania, between 2010 and 2020. We investigated the existing evidence for possible links between the number of fistulae observed after the primary palatoplasty and the age at which the primary palatoplasty was performed, the sex of the patient, the type of cleft, the timing of the surgical corrections, and the presence of comorbidities. A total of 137 cases were included for analysis. A significant link between the number of fistulae and the type of cleft was found (with fistulae occurring more frequently after the surgical correction of CLP-p < 0.001). No evidence was found for the existence of significant links between the number of fistulae and the patient's sex, the timing of surgery, or the presence of comorbidities. This study concluded that the incidence of palatal fistulae appears to be influenced by the type of cleft (CLP), but not by the sex of the patient, the timing of surgery, or the presence of comorbidities.

Engaging a polylactide copolymer in oral tissue regeneration: first validation of Suprathel® for guided epithelial and osseous healing.

The present study investigated the capacity of Suprathel® (a copolymer membrane, so far validated for skin regeneration) to also regenerate oral tissue - mucosa and bone, by comparing this biomaterial, in a split-mouth rabbit model, to Mucoderm®, a xenogeneic collagen matrix certified for keratinized oral mucosa healing. The clinical reason behind this experimental animal model was to determine whether the benefits of this advanced skin regeneration product (Suprathel®) could be conveyed for future evaluation in clinical trials of oral tissue regeneration in humans. The outcomes of this study validated the use of Suprathel®, a terpolymer of polylactide with trimethylene carbonate and ε-caprolactone, for stimulation of oral epithelium and alveolar bone regeneration in rabbits. Both Suprathel® and Mucoderm® exhibited comparable results and the null hypothesis stating a comparable regenerating effect of these two materials could not be rejected.

An Orthodontic Approach for Garre's Sclerosing Osteomyelitis of the Mandible.

The nonsuppurative osteomyelitis of the mandible is a rare condition that can occur in children due to low-grade inflammatory processes, dental cavities, periodontal lesions as well as the eruption process of the teeth. We submit a case report involving the orthodontic management of a 9-year-old female patient who presented in our service in the mixed dentition period with diagnosed Garre's sclerosing osteomyelitis of the entire mandibular body. After a full work-up, the following symptoms and signs were noted: bilateral temporomandibular joint (TMJ) pain, loss of the leeway space, anterior open bite, distalization of the secondary maxillary right canine, nail biting and tongue thrust. Our orthodontic objectives were to relieve the TMJ pain, limit the eruption process of the teeth and to diminish the evolution of the osteomyelitis, reduce the growth of the inferior lower third of the face and to prevent further invasive treatment of the patient. In the first phase of treatment, we established a centric relationship using an orthopedic appliance (occlusal splint) and physiotherapy to deprogram the muscles and the TMJ. Throughout the second phase of treatment, we used orthopedic appliances to inhibit the overeruption of the secondary molars. After another year of treatment, the osteomyelitis lesions were under control with the permanent teeth in final position, good facial esthetic and as a functional result, no root resorption. We can conclude that by using low physiological forces to direct and control the growth pattern, good results could be obtained in stabilizing and controlling the sclerosing osteomyelitis of the mandible.

Ligature induced periodontitis causes atherosclerosis in rat descending aorta: an experimental study.

INTRODUCTION: In recent years a link between periodontitis and cardiovascular diseases has been proposed. Oxidative stress has been found to be involved in their pathophysiology. OBJECTIVES: The aim of this study was to demonstrate that a wire ligature placed around the first mandibular molars of the rat causes inflammation in the periodontium and lipid deposits in the aorta, via oxidative stress. METHODS: Twenty male Wistar rats were divided randomly into two groups of 10: Control group and Periodontitis group. An orthodontic wire ligature was placed around the cervix of the first mandibular molar and was kept in place for 4 weeks. Clinical attachment loss was determined to assess the gingival recession. Aorta was harvested after 4 weeks and the malondialdehyde (MDA) levels in the aorta tissue homogenate were determined. Lipid deposits were evaluated using Oil Red staining and immunofluorescence under confocal microscopy. Total lipid deposits in the aorta were assessed using a computer morphometry system. RESULTS: Significant gingival recession was observed in the Periodontitis group in comparison with the Control group. Increased MDA levels were present in the aorta in the ligatured rats in comparison with the Control group. Significant lipid deposits were observed in the aorta of the Periodontitis group as opposed to the Control group. CONCLUSIONS: The affixing of an orthodontic wire ligature produces gingival recession, increased oxidative stress and lipid deposits in the rat descending aorta.

Ultrasound dimensional changes of the anterior belly of the digastric muscle induced by orthognathic surgery and botulinum toxin A injection in Class II malocclusion.

OBJECTIVES: The aim of the study is to evaluate the ultrasonographic dimensional changes of the anterior belly of the digastric muscle (ABDM), occurring after intramuscular botulinum toxin A (BTX-A) injection during orthognathic surgery, in a series of five Class II malocclusion patients. METHODS: All the patients received 20 units of BTX-A, into both ABDM, intraoperatively. The length, width and cross-sectional area (CSA) of the ABDM were ultrasonographically measured at three different time points: T0 (preoperatively), T1 (postoperatively at 2 weeks after the surgical intervention), and T2 (postoperatively at 6-9 months). RESULTS: A statistically significant higher length of the ABDM was noted postoperatively, at T1 and T2 compared to T0. The patients showed an increased length by 12.2% at 2 weeks postoperatively and continued to increase, reaching 24.6% at 6 months. A decreased width of ABDM by 6.5% at T1 compared with T0 was also found. CONCLUSIONS: Postoperative ultrasound (US) follow-up measurements in patients with Class II malocclusion, orthognathic surgery and intraoperative BTX-A injection in the ABDM, showed dimensional changes of the muscle, with elongation and thinning. The muscular modifications were more pronounced at 6 months postoperatively, indicating consistency and potential benefit of using BTX-A in reducing the risk of surgical relapse. Further data on longer-term follow-up and larger number of cases are necessary.

The Influence of Eggshell on Bone Regeneration in Preclinical In Vivo Studies.

The aim of this study is to systemically review the available evidence on the in vivo behavior of eggshell as a guided bone regeneration substitute material. Five databases (PubMed, Cochrane, Web of Science, Scopus, EMBASE) were searched up to October 2020. In vivo animal studies with a bone defect model using eggshell as a grafting material were included. Risk of bias was assessed using SYRCLE tool and the quality assessment using the ARRIVE guidelines. Overall, a total of 581 studies were included in the study, 187 after duplicate removal. Using the inclusion and exclusion criteria 167 records were further excluded. The full text of the remaining 20 articles was assessed for eligibility and included in the qualitative and quantitative assessment synthesis. There were different methods of obtaining eggshell grafting materials. Eggshell is a biocompatible grafting material, with osteoconduction proprieties. It forms new bone similar to Bio-Oss and demineralized freeze-dried bone matrix. It can be combined with other materials to enhance its proprieties. Due to the high variability of the procedures, animals, production and assessment methods, no meta-analysis could be performed. Eggshell might be considered a promising biomaterial to be used in bone grafting procedures, though further research is needed.

An Overview of the Post-Traumatic Mandibular Bifid Condyle.

Objectives: To review the main clinical, radiological and treatment aspects of patients with post-traumatic bifid mandibular condyles (BMC), to report a new case of BMC in a patient with history of trauma and to discuss the long term adaptive changes of the opposite condylar head. Methods: An electronic search in major medical databases was accomplished. Case series and case reports, prospective or retrospective cohort studies of patients with characteristics of traumatic BMC were included. Extracted data included demographic variables, clinical aspects, imagining examinations and treatment methods performed. Results: The systematic review included 60 patients with 72 post-traumatic BMC. The unilateral involvement (73.3%) and mediolateral condylar orientation (75%) were the most common types of post-traumatic BMC described. Most of the patients were symptomatic, with ankylosis (60%), limitation in mandibular movements (55%) and facial asymmetry (41.6%) being the most common clinical signs. Conclusion: The presence of the post-traumatic BMC is accompanied by important clinical signs, a correct and an early evaluation being essential for an optimal treatment.

Clinical applications of avian eggshell-derived hydroxyapatite.

The search for bone reconstruction materials and methods is an ongoing challenge. The aim of this review is to systemically search the available literature concerning the clinical performance of eggshell as a substitute material in guided bone regeneration in oral surgery. Five databases (PubMed, Cochrane, Web of Science, Scopus, and Embase) were searched up to February 2020. Clinical trials that used eggshell as a bone substitute material were included in the review. Animal and in vivo studies were excluded from the review. ROBINS-I was used to evaluate the risk of bias. A total of 840 studies were retrieved, out of which 55 full-text articles were screened. Five studies were finally included: one study showed critical and four serious risk of bias. A total of 74 patients and 88 intervention sites were included in the five studies. Clinical and radiological evaluation showed complete healing during the follow-ups. Statistically significant radiological and clinical evidence of new bone formation was achieved for socket preservation, grafting after third molar extraction, and cystic/apicectomy grafting. One patient with complications was reported. Histological analysis and micro computed tomography confirmed that it promotes bone regeneration. A comparison with synthetic hydroxyapatite showed similar healing characteristics. Within the limitations of the included studies, the eggshell can be safely and efficiently used in guided bone regeneration procedures, but more research is needed to completely evaluate the full potential of this material.

Financial efficiency estimation for a dental radiology laboratory.

BACKGROUND AND AIMS: Considering nowadays trend among dentists to install a radiology laboratory beside their current practice, we proposed to investigate the aspect of financial efficiency related to such investment. METHODS: We evaluate two existing options: simple investment, consisting of intra-oral equipment and accessories, or investment in a radiology center that includes panoramic and CBCT equipment. The initial investment includes equipment acquisition, fitting out of the location, radiology accreditation and other miscellaneous expenses. Costs were estimated based on current quotations on the specific market available in Romania. We also described a financial model to estimate the financial risk. RESULTS: The analysis was made under the assumptions that the laboratory is operated by the dentist who made the investment in the form of a legal person and paying corporate tax like all Romanian entities. The analysis took into account current fees for different types of X-rays, usual expenses of such a laboratory, and describes the approach to this analysis, starting with the initial investment estimation and forecast of revenues and expenses. Based on these projections and assessment of the working capital, we have built the cash flows forecast. Following a risk analysis we could assess the financial efficiency of the two investment alternatives. CONCLUSIONS: Our study reveals that the radiology center represents a more profitable investment due to the higher economic return rate.