Therapeutic Approach for Trigeminal Neuralgia: A Systematic Review.

This umbrella review aimed to determine the various drugs used to treat trigeminal neuralgia (TN) and to evaluate their efficacies as well as side effects by surveying previously published reviews. An online search was conducted using PubMed, CRD, EBSCO, Web of Science, Scopus, and the Cochrane Library with no limits on publication date or patients' gender, age, and ethnicity. Reviews and meta-analyses of randomized controlled trials pertaining to drug therapy for TN, and other relevant review articles added from their reference lists, were evaluated. Rapid reviews, reviews published in languages other than English, and reviews of laboratory studies, case reports, and series were excluded. A total of 588 articles were initially collected; 127 full-text articles were evaluated after removing the duplicates and screening the titles and abstracts, and 11 articles were finally included in this study. Except for carbamazepine, most of the drugs had been inadequately studied. Carbamazepine and oxcarbazepine continue to be the first choice for medication for classical TN. Lamotrigine and baclofen can be regarded as second-line drugs to treat patients not responding to first-line medication or for patients having intolerable side effects from carbamazepine. Drug combinations using carbamazepine, baclofen, gabapentin, ropivacaine, tizanidine, and pimozide can yield satisfactory results and improve the tolerance to the treatment. Intravenous lidocaine can be used to treat acute exaggerations and botulinum toxin-A can be used in refractory cases. Proparacaine, dextromethorphan, and tocainide were reported to be inappropriate for treating TN. Anticonvulsants are successful in managing trigeminal neuralgia; nevertheless, there have been few studies with high levels of proof, making it challenging to compare or even combine their results in a statistically useful way. New research on other drugs, combination therapies, and newer formulations, such as vixotrigine, is awaited. There is conclusive evidence for the efficacy of pharmacological drugs in the treatment of TN.

Evaluation of Platelet-Rich Fibrin Matrix as a Regenerative Material in the Surgical Management of Human Periodontal Intraosseous Defects - A Randomized Controlled Trial.

Background: Platelet-rich fibrin matrix (PRFM) has not been extensively studied as other platelet concentrates such as Choukron's platelet-rich fibrin (PRF). This randomized controlled trial aimed to evaluate PRFM regenerative ability in human periodontal intrabony defects. Materials and Methods: Fifteen patients (age: 30-55 years) having probing pocket depth (PPD) ≥6 mm, and radiographic evidence of bilateral vertical intrabony defects were recruited. A split-mouth design was used in each patient; one quadrant of the arch was treated with open flap debridement (OFD) alone (control group) and the other quadrant with OFD + PRFM (test group). The PRFM was prepared by dual-spin technology using a patented thixotropic separator gel. Outcome measures comprising plaque index, gingival index (GI), PPD, clinical attachment level (CAL), depth of the defect, defect fill (DF), and percentage of DF (PDF) were recorded at baseline, after 3 months and 6 months. The parameters were applicably analyzed using the Friedman test, Fisher's exact test, t-test, paired t-test, repeated measures ANOVA, and Post Hoc-Bonferroni correction. Results: The GI, a net reduction in CAL, and PPD of the test group were significantly better than the control group at 3 months and 6 months (P < 0.05), while DF and PDF showed significant results at 6 months (P < 0.05). A consistent early wound healing index of 1 at 1 week was displayed in the test group (66.7%) in comparison to the control group (33.7%). Conclusion: PRFM can be a clinically significant periodontal regenerative material in the treatment of vertical intraosseous defects.

Influence of Dental Glass Fibers and Orthopedic Mesh on the Failure Loads of Polymethyl Methacrylate Denture Base Resin.

The aim of the present study was to evaluate the fracture loads of polymethyl methacrylate (PMMA) complete denture bases reinforced with glass-fiber mesh and orthopedic casting tape (OCT) in comparison to conventional PMMA dentures under artificial aging. Dental fiberglass framework (Group 1) and OCT (Group 2 and 3) reinforced PMMA acrylic dentures were fabricated on the edentulous ridge. Ten PMMA dentures without reinforcement (Group 4) were included as controls. All specimens were placed in a chewing simulator chamber, and fatigue load was applied. To assess the fracture loads, static loads with a universal testing machine were applied. Fractured specimens in each group were evaluated under a scanning electron microscope. The data were statistically analyzed employing analysis of variance and Tukey post-hoc test. The association of denture weight and thickness on fracture load was assessed using Pearson and Spearman correlations. Dental fiberglass (Group 1) displayed the highest fracture load (692.33 ± 751.41 N), and Group 4 (control) exhibited the lowest fracture loads (281.41 ± 302.51 N). Dentures reinforced with fiberglass mesh framework exhibited intact fractures. In contrast, Group 2 and 3 specimens using OCT demonstrated ditching fractures. It was observed that the thickness and weight of all the reinforced specimens influenced the load required to fracture the dentures (p < 0.001). Denture specimens strengthened with OCT (Groups 2 and 3) exhibited failure loads lower than dental fiberglass (Group 1) specimens but higher than unreinforced controls.

Four narrow dental implants and conventionally cast bar-supported removable hybrid acrylic complete denture as a therapeutic modality for terminal dentition.

The report portrays four narrow implants and cast bar-supported removable hybrid acrylic complete dentures and other terminal dentition treatment options in the maxilla. The therapeutic module could be efficient and satisfactory to patients.

Oral rehabilitation of a cleft palate patient with tooth-supported, telescopic magnetic overdenture.

A 49-year-old male patient with residual cleft palate and missing pre-maxilla presented with an ill-fitting and unaesthetic maxillary denture. The posterior teeth were periodontally sound but crowded and had defective restorations and secondary caries. We restored the bilateral maxillary canines and first premolars with conical telescopic crowns having magnetic keepers. A metal-reinforced acrylic overdenture with magnetic attachments corresponding to the keepers of the telescopic crowns was fabricated. The telescopic crowns provided a single path of insertion, retention and stability to the prosthesis. The magnetic attachments provided additional retention and self-centring properties. The prosthesis effectively sealed the oronasal communication and enhanced the function, aesthetics and oral hygiene. The 6-month and 1-year follow-ups revealed that the patient was delighted, and the prosthesis provided excellent obturation and function. Periodic follow-up, maintenance, patient education and meticulous oral hygiene are vital for long-term success of such prostheses.

The Tooth Size Discrepancy among Orthodontic Patients and Normal Occlusion Individuals from Saudi Arabia: A Three-Dimensional Scan Analysis of Diagnostic Casts.

BACKGROUND/PURPOSE: Tooth size discrepancy is one of the causative factors of malocclusion. This study aimed to establish the TDS among various malocclusion classes and normal occlusion subjects in a Southern Saudi population. MATERIALS AND METHODS: The study casts of orthodontic patients from Southern Saudi Arabia (mean age: 19.6 years ± 2.45; n = 120) were randomly selected and grouped into eight equal classes based on Angle's classification and gender. An additional 30 study casts, devoid of malocclusion, having excellent intercuspation and class I occlusion, were grouped into two controls (n = 15) based on gender. The study casts were three-dimensional scanned to measure mesiodistal widths of all the teeth. The calculated anterior ratios (AR) and overall ratio (OR) were statistically analyzed with analysis of variance and t-tests. RESULTS: There were no significant differences in "OR" and "AR" between the genders (P > 0.05) and among the malocclusion and control subgroups (P > 0.05). The mean "OR" (92.01 ± 0.18) and "AR" (78.60 ± 0.27) of the malocclusion group were significantly higher than that of Bolton's ratios (P > 0.05). The "AR" of the control group was significantly higher than Bolton's standards (P = 0.048). However, "OR" was no different (P = 0.105). Malocclusion patients displayed a discrepancy (±2 standard deviation) in "AR" of 22.5% and 'OR' of 6.7% from Bolton's mean (BM). Similarly, the control group displayed a discrepancy in "AR" of 20% and "OR" of 10% from BM. CONCLUSION: The mean "OR" and "AR" of the Southern Saudi population showed no sexual dimorphism and no significant difference among various malocclusion and control subgroups. The "AR" of the malocclusion and control subgroups did not comply with Bolton's standards.

Cytokine physiognomies of MSCs from varied sources confirm the regenerative commitment post-coculture with activated neutrophils.

The interaction of mesenchymal stromal cells (MSCs) with paracrine signals and immunological cells, and their responses and regenerative commitment thereafter, is understudied. In the current investigation, we compared MSCs from the umbilical cord blood (UCB), dental pulp (DP), and liposuction material (LS) on their ability to respond to activated neutrophils. Cytokine profiling (interleukin-1α [IL-1α], IL-2, IL-4, IL-6, IL-8, tumor necrosis factor-α [TNF-α], interferon-γ [IFN-γ], transforming growth factor-ß [TGF-ß]), cellular proliferation and osteogenic differentiation patterns were assessed. The results showed largely comparable cytokine profiles with higher TNF-α and IFN-γ levels in LSMSCs owing to their mature cellular phenotype. The viability and proliferation between LS/DP/UCB MSCs were comparable in the coculture group, while direct activation of MSCs with lipopolysaccharide (LPS) showed comparable proliferation with significant cell death in UCB MSCs and slightly higher cell death in the other two types of MSC. Furthermore, when MSCs post-neutrophil exposure were induced for osteogenic differentiation, though all the MSCs devoid of the sources differentiated, we observed rapid and significant turnover of DPMSCs positive of osteogenic markers rather than LS and UCB MSCs. We further observed a significant turnover of IL-1α and TGF-ß at mRNA and cytokine levels, indicating the commitment of MSCs to differentiate through interacting with immunological cells or bacterial products like neutrophils or LPS, respectively. Taken together, these results suggest that MSCs have more or less similar cytokine responses devoid of their anatomical niche. They readily switch over from the cytokine responsive cell phenotype at the immunological microenvironment to differentiate and regenerate tissue in response to cellular signals.

Bone Marrow Mesenchymal Stromal Cells (BMMSCs) Augment Osteointegration of Dental Implants in Type 1 Diabetic Rabbits: An X-Ray Micro-Computed Tomographic Evaluation.

Background and objectives: The study aimed to investigate the effect of bone marrow mesenchymal stromal cells (BMMSCs) on implant-bone osseointegration in type I diabetic New Zealand rabbits. Materials and methods: BMMSCs harvested from healthy rabbits were processed and validated for purity and osteocyte differentiability. Mandibular incisors of diabetic and control rabbits were carefully extracted, and the sockets were plugged with collagen sponges. Platelet-rich plasma (PRP) containing osteoinductive BMMSCs, and plain PRP were injected into the collagen sponge of the right and left sockets respectively. Dental implants of 2.6 mm diameter and 10 mm length were inserted into the collagen sponge of both sockets. All the animals were sacrificed six weeks post surgery to evaluate an early stage of osseointegration; the mandibles scanned by X-ray microcomputed tomography (µCT) and subjected to 3D analysis. The µCT parameters of the right implant were paired against that of the left side of each animal and analyzed by paired T-test. Results: The preclinical evaluation of the viability and osteocyte differentiation of the BMMSCs were consistent between both the donor samples. The osseointegration of dental implants with stem cell therapy (BMMSCs + PRP + collagen) in normal and diabetic rabbits was significantly higher than that of implants with adjunctive PRP + collagen only (p < 0.05). Conclusion: Stem Cell therapy with osteoinductive BMMSCs and PRP can offer a novel approach to enhance the osseointegration of dental implants in uncontrolled diabetic patients.

Implant-supported fixed hybrid acrylic complete dentures opposing fully restored mandibular metal ceramic restorations.

This report presents a full-mouth rehabilitation case. A patient came with a failing dentition in maxilla, and after the treatment, the patient had a shortened full-arch, implant-supported, screw-retained hybrid acrylic complete denture in the maxilla and full-arch metal ceramic restorations in the mandible. The report describes the steps involved in the prosthodontic rehabilitation; a cost-effective treatment plan, the restoration of vertical dimension, an immediate denture, an implant-level impression, a verified-master cast, the fabrication of definitive prosthesis, the occlusal scheme and multiple follow-ups in 6 months. We discussed the merits/demerits of screw-retained prosthesis, impression techniques and various types of fixed complete dentures. We learnt the difficulty in hygiene measures and dissatisfaction of the patient with the hygienic gaps under the acrylic fixed dentures.

An Anthropometric Study of Cranio-Facial Measurements and Their Correlation with Vertical Dimension of Occlusion among Saudi Arabian Subpopulations.

BACKGROUND: Determining and restoring physiological vertical dimension of occlusion (VDO) is the critical step during complete mouth rehabilitation. The improper VDO compromises the aesthetics, phonetics and functional efficiency of the prosthesis. Various methods are suggested to determine the accurate VDO, including the facial measurements in the clinical situations with no pre-extraction records. The generalisation of correlation between the facial measurements to VDO is criticised due to gender dimorphism and racial differences. Hence, it is prudent to verify the hypothesis of facial proportion and correlation of lower third of the face to remaining craniofacial measurements in different ethnic groups. The objective of the study was to evaluate the correlation of craniofacial measurements and OVD in the Saudi-Arabian ethnic group. METHODOLOGY: Total of 228 participants from Saudi-Arabian Ethnic group were randomly recruited in this cross-sectional study. Fifteen craniofacial measurements were recorded with modified digital Vernier callipers, and OVD was recorded at centric occlusion. The obtained data were analysed by using the Spearman's correlation and linear regression analysis. RESULTS: The Mean OVD in male participants was higher (69.25 ± 5.54) in comparison to female participants (57.41 ± 5.32). The craniofacial measurement of Exocanthion-right labial commissure and the Mesial wall of the right external auditory canal-orbitale lateral had a strong positive correlation with VDO. The strong correlation was recorded with a trichion-upper border of right eyebrow line and trichion-Nasion only in males. Meanwhile, the length of an auricle recorded the positive correlation in female participants. CONCLUSIONS: Being simple and non-invasive technique, craniofacial measurements and linear equations could be routinely utilised to determine VDO.

Radiographic Screening of Patients in a Dental School using the Prosthodontic Diagnostic Index.

INTRODUCTION: Organization of the findings associated with various diagnostic aids plays a key role in formulating the treatment plan of the patients undergoing dental and medical treatment. Enhanced consistency in diagnosing and classifying prosthodontic patients is the basic purpose of various classification systems. Hence, we planned this study to classify partially edentulous patients and completely dentate patients at the undergraduate clinics using the prosthodontic diagnostic index (PDI). MATERIALS AND METHODS: This study included classification of 13,599 edentulous patients who attended the clinics of undergraduate students of all the levels. Screening of all the patients was done radiographically with a digital orthopantomograph (OPG), and the data were saved in the computer system. The intraoral periapical radiographs (IOPA) taken for all the affected areas were also saved in the system. Based on the OPG and IOPA, the patients were classified into various classes. All the data of the patients were recorded and analyzed. RESULTS: Total number of patients screened was 17,220, out of which 3,621 were under 18 years of age and were excluded from the study. Most of the patients belonged to the age group of 31 to 45 years: 5,360 (39.4%) patients (3,817 [43.0%] males and 1,543 [32.5%] females) were class I; 2,730 (20.0%) patients (1,729 [19.5%] males and 1,001 [21.1%] females) were class II; 4,576 (33.7%) patients (2,835 [32.0%] males and 1,741 [36.8%] females) were class III; and 933 (6.9%) patients (483 [5.5%] males and 450 [9.5%] females) were class IV. CONCLUSION: There is a need to introduce PDI as a screening tool during the initial examination of the patient and to achieve a proper distribution of the patients among various levels of students, interns, and postgraduates. CLINICAL SIGNIFICANCE: Introduction of PDI will improve the treatment planning and prognosis of edentulous patients.

Effect of Reinforcement Using Stainless Steel Mesh, Glass Fibers, and Polyethylene on the Impact Strength of Heat Cure Denture Base Resin - An In Vitro Study.

BACKGROUND: The impact strength of denture base resin is of great concern and many approaches have been made to strengthen acrylic resin dentures. The objective of this study was to compare the impact strength of the denture base resin with and without reinforcement and to evaluate the impact strength of denture base resin when reinforced with stainless steel mesh, glass fiber, and polyethylene fibers in the woven form. MATERIALS AND METHODS: The specimens (maxillary denture bases) were fabricated using a standard polyvinylsiloxane mold with conventional heat cured polymethyl methacrylate resin. The specimens were divided into four groups (n = 10). Group I specimens or control group were not reinforced. Group II specimens were reinforced with stainless steel mesh and Group III and Group IV specimens were reinforced with three percent by weight of glass fibers and polyethylene fibers in weave form respectively. All the specimens were immersed in water for 1-week before testing. The impact strength was measured with falling weight impact testing machine. One-way analysis of variance and Tukey's post-hoc test were used for statistical analysis. RESULTS: Highest impact strength values were exhibited by the specimens reinforced with polyethylene fibers followed by glass fibers, stainless steel mesh, and control group. CONCLUSIONS: Reinforcement of maxillary complete dentures showed a significant increase in impact strength when compared to unreinforced dentures. Polyethylene fibers exhibit better impact strength followed by glass fibers and stainless steel mesh. By using pre-impregnated glass and polyethylene fibers in woven form (prepregs) the impact strength of the denture bases can be increased effectively.