Comparison of the analgesic effects of single-dose 75 mg oral pregabalin versus single-dose 400 mg oral ibuprofen after impacted third mandibular molar surgery: A randomized, double-blind, split-mouth clinical trial.

BACKGROUND: Pain is the most prevalent complication after dentoalveolar surgery. Failure in effective pain control could potentially lead to systemic sequels, such as tachycardia, hypertension, improper nutrition, and central sensitization. Pregabalin is a gamma-aminobutyric acid (GABA) analog with inhibitory and analgesic effects on the central nervous system (CNS). Prescribing gabapentinoids as complementary analgesics reduces the consumption of opioid and non-opioid analgesics, and consequently their side effects. OBJECTIVES: The main purpose of the present study was to compare the analgesic effects of pregabalin (single-dose 75 mg) vs. ibuprofen (single-dose 400 mg) on patients' pain levels after impacted third mandibular molar surgery. MATERIAL AND METHODS: In this randomized, double-blind, split-mouth clinical trial, 24 patients aged 19-34 years volunteered for 2 consecutive (1 month apart) third mandibular molar surgeries (the contralateral teeth). The patients were randomly placed into 2 groups: group G1 (n = 12) was prescribed pregabalin (single-dose 75 mg) after the 1st surgery and ibuprofen (single-dose 400 mg) after the 2nd surgery; and group G2 (n = 12) was prescribed the exact opposite of the G1 arrangement. During the first 24 h post-surgery, the patients recorded the number of complementary analgesics they took (single-dose 400 mg ibuprofen) and their level of pain on a visual analog scale (VAS) every 2 h. RESULTS: The average level of pain at 2 h post-surgery (T1) was significantly lower when pregabalin was prescribed (p < 0.05). Most patients needed complementary analgesics at 4 h post-surgery (T2). However, during the first 24 h post-surgery, the patients required significantly more complementary analgesics when ibuprofen was prescribed. CONCLUSIONS: In comparison with oral ibuprofen (single-dose 400 mg), oral pregabalin (single-dose 75 mg) had a stronger analgesic effect at 2 h after impacted third mandibular molar surgery (p < 0.05). Pregabalin resulted in a significantly lower consumption of complementary analgesics in the first 24 h post-surgery as compared to ibuprofen.

Investigating the effect of poly (ɛ-caprolactone) nanofibers scaffolds with random, unidirectionally, and radially aligned morphologies on the Fibroblast cell's attachment and growth behavior.

In the last decade, significant progress in tissue engineering, repairing, and replacing organs has been achieved. The design and production of scaffolds for tissue engineering are one of the main areas which have attracted the researcher's interest. In this regard, electrospinning is one of the most popular methods of nanoscale scaffold similar to extracellular matrix production. This paper reports the fabrication of scaffolds consisting of radially aligned PCL nanofibers by utilizing a collector composed of a central point electrode and a peripheral ring electrode. The chemical and physical properties were compared using SEM, FTIR, XRD, and DSC experiments, as well as biological performance using the MTT method and cell morphology with nanofibers with random and unidirectionally morphology. Results of this study showed greater physical and biological properties for radially aligned nanofibers which make them an excellent candidate for wound healing applications due to the guided cell growth on this type of nanofiber.

abkBA toxin-antitoxin system may act as antipersister modules in Acinetobacter baumannii clinical isolates.

Aim: Persistence cells comprise a subpopulation of bacteria that is resistant to treatment. In this study, the role of the toxin-antitoxin (TA) system in the formation of persistence cells of Acinetobacter baumannii isolates was investigated. Methods: After confirming all isolates, TA systems abkBA, mqsRA and higBA were identified. Persister cells were confirmed using the standard method. Real-time PCR was used to compare the expression of TA systems in isolates in persistence and normal states. Results: The abkAB system was present in all isolates; 4% of isolates formed persister cells. The expression level of the abkB gene in persistent isolates showed a sevenfold increase compared with nonpersistent isolates. Conclusion: The abkBA system is proposed as an antipersistence target in A. baumannii isolates.

How does the Number of Implants Affect Stress Distribution in Fibula Graft at the Posterior of the Mandible? A Finite Element Analysis.

Objectives: Evidence about the implant protocol and success in the osseous microvascular grafts is not sufficient. Stress distribution around dental implants is one of the important factors determining treatment success. The purpose of this study was to evaluate stress distribution in the bone supporting the implants inserted in the fibula free flap, in patients with large defects in the posterior of the mandible by finite element analysis (FEA). Materials and Methods: The CBCT was obtained from one patient with fibula free flap in the posterior of the mandible and also from a 4.1 × 10 mm implant (Zimmer, Zimmer dental, Carlsbad, USA). Two 3D finite models were designed containing three or four implants. The implants were splinted by a suprastructure. Vertical load (300 N) and oblique load (50 N) were applied to the suprastructure. The von Mises stress distribution and the micromotion of implants were evaluated. Results: No significant difference was observed between implants micromotion in two models. According to stress distribution analysis and determining maximum stress regions, the model with four implants imposes more stress on titanium components and surrounding bone. Conclusion: The stress distribution around the implants of mandibular models with posterior defect that was reconstructed with fibula free flap is better in models with three fixtures versus four fixtures.

Worldwide Prevalence of Colistin Resistance among Enterobacteriaceae: a Systematic Review and Meta-Analysis.

BACKGROUND: The aim of the present meta-analysis is to estimate the prevalence of colistin resistance among the Enterobacteriaceae family. METHODS: Articles from various databases (Medline, Scopus, Web of Science, and Embase) examining colistin resistance among Enterobacteriaceae in human, animal, and environmental specimens were searched from 2016 to 2021 using related keywords. The Cochran's Q-test and I2 were applied to evaluate heterogeneity and a random-effects model was used to assess the pooled prevalence. The meta-regression method was applied to determine heterogeneity among the studies. RESULTS: Of 5,145 articles, 60 articles with a sample size of 404,856 was included. The pooled estimate for prevalence of bacterial resistance were 9.13% (95% CI: 6.96 to 11.56; I-squared = 99.4%) in total, 8.34% (95% CI: 5.87 to 11.16; I-squared = 99.3%) for Klebsiella spp. subgroup and 3.44% (95% CI: 2.46 to 4.57; I-squared = 98.4%) for E. coli subgroup. The pooled prevalence for human and animal settings were 9.07% (95% CI: 6.77 to 11.67; I-squared = 99.3%) and 9.73% (95% CI: 484 to 16.02; I-squared = 99.4%), respectively. The continent (coefficient: 3.51; 95% CI: 0.08 to 6.94, p: 0.045) and bacterial type (coefficient: 0.03; 95% CI: 0.01 to 0.05 p: 0.042) had significant effects on heterogeneity among studies. CONCLUSION: The results of this study showed that the prevalence of colistin resistance in Enterobacteriaceae was similar between animals and humans, with the highest colistin resistance found in Klebsiella strains.

The Effect of Rainbow Trout (Oncorhynchus mykiss) Collagen Incorporated with Exo-Polysaccharides Derived from Rhodotorula mucilaginosa sp. on Burn Healing.

Burn is one of the physically debilitating injuries that can be potentially fatal; therefore, providing appropriate coverage in order to reduce possible mortality risk and accelerate wound healing is mandatory. In this study, collagen/exo-polysaccharide (Col/EPS 1-3%) scaffolds are synthesized from rainbow trout (Oncorhynchus mykiss) skins incorporated with Rhodotorula mucilaginosa sp. GUMS16, respectively, for promoting Grade 3 burn wound healing. Physicochemical characterizations and, consequently, biological properties of the Col/EPS scaffolds are tested. The results show that the presence of EPS does not affect the minimum porosity dimensions, while raising the EPS amount significantly reduces the maximum porosity dimensions. Thermogravimetric analysis (TGA), FTIR, and tensile property results confirm the successful incorporation of the EPS into Col scaffolds. Furthermore,the biological results show that the increasing EPS does not affect Col biodegradability and cell viability, and the use of Col/EPS 1% on rat models displays a faster healing rate. Finally, histopathological examination reveals that the Col/EPS 1% treatment accelerates wound healing, through greater re-epithelialization and dermal remodeling, more abundant fibroblast cells and Col accumulation. These findings suggest that Col/EPS 1% promotes dermal wound healing via antioxidant and anti-inflammatory activities, which can be a potential medical process in the treatment of burn wounds.

Effect of Local Injection of Lidocaine and Articaine plus Epinephrine on Methemoglobin Level during General Anesthesia.

Statement of the Problem: Methemoglobinemia is a potentially life-threatening rare medical condition, which refers to an increase in the level of oxidized form of hemoglobin (methemoglobin). Excessive replacement of hemoglobin with methemoglobin leads to functional hypoxia and even fatal conditions. Purpose: The aim of this study was to evaluate the effect of two common local anesthetic agents namely lidocaine and articaine administered for hemostasis during surgery on methemoglobin level. Materials and Method: This prospective cohort study was conducted from January 2017 to December 2019. Demographic data including age, gender, and weight of patients were collected. Sixty patients were randomly divided into three groups (n=20) regarding the local anesthetic agent administered for hemostasis during surgery as lidocaine group (group 1), articaine group (group 2), and control group (no local anesthetic; group 3). The patients were candidates for orthognathic surgery, reconstruction of the maxillary and mandibular atrophic ridges with autogenous grafts, and reconstruction of maxillofacial fractures. The methemoglobin level was measured before surgery and six hours after the initiation of surgery. Results: The mean age and weight of patients were not significantly different among the three groups (p= 0.891 and p= 0.416, respectively). No significant differences were observed among the three groups regarding the gender distribution (p= 0.343) or type of surgery (p= 0.990). Statistical analysis did not show any significant difference in the mean baseline methemoglobin level among the three groups (p= 0.109). Although the mean methemoglobin values increased in the three groups, paired sample t-test did not show any significant change in the values at six hours after the initiation of surgery compared with baseline in any of the three groups (p= 0.083 for group 1, p= 0.096 for group 2, and p= 0.104 for group 3). Conclusion: The results demonstrated that administration of lidocaine and articaine plus epinephrine for hemostasis during general anesthesia are equally safe.

Does Bruxism Affect Marginal Bone Level around Single Tooth Implants in the Posterior Mandible?

Background: Parafunctional forces are a potential risk factor for implant-related complications. This study aimed to evaluate the possible relationship of bruxism with implant-related complications and marginal bone loss (MBL). Methods: In this prospective cohort study, patients were divided into two groups with and without bruxism, and received single-tooth implants in the posterior mandible. Patients in the bruxer group were requested to use a customized fabricated night guard. Bone quality was also assessed based on CBCT scans. The MBL, crown detachment, and porcelain fracture were evaluated, and clinical assessments were made at the 12-month follow-up. Results: Seventy patients were studied in two groups (n = 35 in each group). None of the implants in any of the two groups showed pain, sensitivity, suppuration, exudation, clinically detectable mobility, or peri-implant radiolucency. No significant difference was observed between the two groups in the mean MBL at the 12-month follow-up (p = 0.60). Regarding bone quality, there was no significant difference in the mean MBL among different types of bone qualities (p = 0.66). There were no significant differences regarding crown detachment and porcelain fracture between the two groups either (p = 0.32 and p = 0.30, respectively). Conclusion: According to the results of this study, dental implant treatment according to the suggested protocol in bruxers yielded promising outcomes.

Underestimated Craniomaxillofacial Fractures Due to Firework.

BACKGROUND: Iranian people celebrate the last Wednesday of the year also known as Chahar Shambeh Soori (CSS) using low explosive pyrotechnics classified as fireworks. Mishaps and accidents are common and maxillofacial fractures may occur which have a negative impact on the quality of life. This study aimed to assess maxillofacial fractures (fx) caused by explosive agents. METHODS: This cross-sectional descriptive study assessed 283 patients suffering maxillofacial fxs caused by explosive agents during CSS ceremonies between 2009 and 2019 referred to our craniomaxillofacial (CMF) surgery center. The data assessed included age, sex, cause, type, site, and severity of injury, fracture patterns, treatment modalities, and complications. All maxillofacial injuries were evaluated and treated by Craniomaxillofacial staff surgeons. RESULTS: Among 283 patients, 72.8% (206) and 27.2% (77) were men and women, respectively. The mean age of patients was 17.35 years. The most common maxillofacial fracture was in the mid-face; with the distribution of fractures being: 39.9% zygomatic fractures, 32.1% nasal bone fractures, 63.2% dentoalveolar fracture, 43.1% Le Fort (Le Fort I, Le Fort II, Le Fort III), 31.4% orbital, and 43.1% mandible fractures. The most frequent type of treatment was Open Reduction and Internal Fixation (ORIF) (77.4%). CONCLUSION: The most common site of maxillofacial fractures and most frequent treatment used were similar to military or ballistic injuries. ORIF was common treatment.

Efficacy of low-dose local clindamycin in different times for microbial decontamination of autogenous particulate bone graft.

BACKGROUND: Clindamycin in low concentration (20 µg/mL) is safe for vitality and osteogenic potential of bone cells. The aim of this study was to evaluate the efficacy of local clindamycin (20 µg/mL) in two different exposure times, for microbial decontamination of particulate bone graft, collected during implant site preparation. This non-randomized parallel-group study was conducted on samples from 17 patients. The particulate bone collected during implant site preparation was divided into three portions by weight: in group S1, the particulate bone was immersed in thioglycolate broth without any antibiotic treatment; in group S2, the collected particulate bone was irrigated with 100 mL clindamycin solution (20 µg/mL); and in group S3, the collected particulate bone was soaked in one ml clindamycin solution (20 µg/mL) for 3 min. Samples in the three groups were cultured in aerobic and anaerobic media and species and CFU count of isolated bacteria were determined. RESULTS: Analysis of the data demonstrated a significant difference among the three groups in the mean count of total microorganisms (P = 0.001). The difference in the mean count of anaerobic and aerobic microorganisms in the three groups was statistically significant as well (P = 0.001). Pseudomonas aeruginosa was the only microorganism that was not affected with the mentioned antibiotic. CONCLUSIONS: Local use of low-dose clindamycin (20 µg/mL)-irrigation or 3 min immersing-is effective for the decontamination of particulate bone grafts.

Does the Lag Time Between Injury and Treatment Affect Recovery of Infraorbital Nerve Disturbances in Zygomaticomaxillary Complex Fractures?

STUDY DESIGN: A cross-sectional study. OBJECTIVE: Neurosensory disturbances (NSDs) of the infraorbital nerve (ION) are common following orbito-zygomaticomaxillary complex (ZMC) fractures. This study aimed to evaluate the effect of lag time between injury and treatment on recovery of NSDs of the ION following open reduction internal fixation. METHODS: Subjects who had ZMC fracture and paresthesia were studied. The lag time between injury and treatment was considered as the predictive factor. The level of NSDs according to the brush test and two-point discrimination (TPD) test and self-reported NSD were the outcomes of this study. Self-reported NSD was quantified using a visual analog scale. RESULTS: Forty patients were studied. The lag time between injury and treatment had a significant correlation with the result of the TPD test and the self-reported level of NSD. In 73.6% of patients who had NSD following ZMC fracture, every 1-day delay in treatment increased the incidence of self-reported paresthesia by 0.44. CONCLUSIONS: It seems, a delay in treatment of ZMC fractures increased the risk of NSD.

Huge central intravascular papillary endothelial hyperplasia of the mandible: a case report and review of the literature.

Masson's tumor or intravascular papillary endothelial hyperplasia is an inflammatory soft tissue lesion that rarely occurs in the maxillofacial region and skeletal system. Precise clinical and para-clinical investigation is necessary for the accurate diagnosis and correct treatment of this lesion. This paper presents a massive intravascular papillary endothelial hyperplasia lesion in the bony tissue of the mandible. Histopathology features, clinical appearance, and suitable management are discussed, with a complete review of the literature. The patient underwent composite resection of the lesion as well as reconstruction. No recurrence was observed during 6 years of follow-up. To the best of our knowledge, this is the fourth case of Masson's tumor in mandibular skeletal tissue, which has unique and distinctive features due to its size and location. A rare occurrence in skeletal tissue, complex clinical presentations, and complicated histopathologic findings present diagnostic challenges for treatment of this lesion.

Lateral cephalometric measurements of Iranians with surgically repaired unilateral cleft lips and palates.

OBJECTIVES: Since results of surgical correction of unilateral cleft lip and palate (UCLP) are controversial, and there is no study in this regard among Iranians, this study was conducted to document lateral cephalometric measurements of such cases, with respect to age, gender, and cleft side. METHODS: In this cross-sectional study, 45 lateral cephalographs of individuals with UCLP who had undergone surgery but not orthodontic treatment were traced and 30 skeletal, dental and soft-tissue cephalometric measurements were measured. Parameters were compared between patients with UCLP and cephalometric norms. They were also compared between males and females, two age groups (≤8 and>8 years), and sides of cleft using the Student's t-test. RESULTS: Only S-N-Pog and U1-SN values were significantly different between this sample and cephalometric norms. The variables were not significantly different between males and females. However, the values of ANB, Wits appraisal, Go-Gn, Go-Pog, U1-SN, interincisal angle, distance of upper lip to Ricketts E-line, and nasopharyngeal depth were significantly different between patients≤8 and>8 years (P<0.05). The S-N-Pog angle, Wits appraisal, Go-Gn, Go-Pog, U1-SN, interincisal angle and hypopharyngeal depth were significantly different between patients with right- and left-side clefts (P<0.05). CONCLUSION: Measurements of patients with repaired UCLP were similar to cephalometric norms except for two parameters.

Complications after craniofacial reconstruction with calcium phosphate cements: a case report and review of the literature.

Among different graft materials for craniofacial reconstruction, calcium phosphate cements have the advantages of alloplastic grafts and wide use. The authors report a case of foreign body reaction following frontal reconstruction with JectOS (an injectable calcium orthophosphate cement; Kasios) and reviewed the literature on complications of this material after craniofacial reconstruction from 2002 to 2017. Complications were categorized into two groups: immunologic reactions (consisting of seroma collection, chronic sinus mucosa swelling, and foreign body reaction) and non-immune events (infection, fragmentation, and ejection). It is wise to use calcium phosphate-based material only in selected cases with small defects, and long-term follow-up is needed to observe their consequences.