Quantification of the Culture Stability of Stem Cell Fractions from Oral-Derived, Human Mesenchymal Stem Cell Preparations: A Significant Step toward the Clinical Translation of Cell Therapies.

A continuing limitation and major challenge in the development and utilization of predictable stem cell therapies (SCTs) is the determination of the optimal dosages of stem cells. Herein, we report the quantification of stem cell fractions (SCF) of human mesenchymal stem cell (MSC) preparations derived from oral tissues. A novel computational methodology, kinetic stem cell (KSC) counting, was used to quantify the SCF and specific cell culture kinetics of stem cells in oral alveolar bone-derived MSC (aBMSCs) from eight patients. These analyses established, for the first time, that the SCF within these heterogeneous, mixed-cell populations differs significantly among donors, ranging from 7% to 77% (ANOVA p < 0.0001). Both the initial SCF of aBMSC preparations and changes in the level of the SCF with serial culture over time showed a high degree of inter-donor variation. Hence, it was revealed that the stability of the SCF of human aBMSC preparations during serial cell culture shows inter-donor variation, with some patient preparations exhibiting sufficient stability to support the long-term net expansion of stem cells. These findings provide important insights for the clinical-scale expansion and biomanufacturing of MSCs, which can facilitate establishing more effective and predictable outcomes in clinical trials and treatments employing SCT.

Periosteum Classification and Flap Advancement Techniques Around the Mental Foramen.

Various surgical flap advancement techniques for bone regeneration have been described in the literature; however, the clinical challenges of managing tissue that contains scars or embedded foreign materials have not been thoroughly described, especially around metal foramen. Fibrotic and thickened scar periosteum as well as mental foramen restrict the tissue from responding in the same way as native tissue. Therefore, additional considerations and approaches must be considered to achieve tension-free flap closure. This article presents a flap advancement classification that describes three common clinical scenarios based on the periosteum and soft tissue quality and provides surgical approaches for tissue management in each classification, with a focus on flap advancement around the mental foramen.

Staging and Grading Discussion of Borderline Cases in Gray Zones.

INTRODUCTION: Staging and grading for chronic periodontal disease, as described in 2018, is designed to focus on key distinctions with the recognition that there is a subset of individuals who are on a different clinical trajectory of disease. The staging and grading framework aids the clinician in generating a periodontal diagnosis, however, some cases fall into gray zones in which the simple diagnostic parameters make it challenging to categorize the patient. These cases do not present with clear clinical findings and medical and dental histories that fit within the simple guidelines defined in the staging and grading tables and subsequent algorithms. CASE PRESENTATION: Two cases are presented and demonstrate typical clinical scenarios that fall into gray zones when it comes to differentiating whether the patient will respond predictably to standard principles of care. Case 1 presents a scenario in which the patient's early history suggests the potential for disease progression and increases the likelihood that the patient may develop a need for complex rehabilitation due to periodontal breakdown. Clinical judgment was used to evaluate whether the patient remained at elevated risk and the potential implications for disease progression. Case 1 was diagnosed with generalized Stage III, Grade B. The initial presentation of Case 2 had a higher severity and complexity and therefore was diagnosed with generalized Stage IV, Grade C. The need for complex rehabilitation in Case 2, however, was not primarily due to periodontitis. CONCLUSION: Decision guidelines and algorithms help in establishing a standardized diagnosis, however cases that fall into gray zones require clinical judgment to establish the most appropriate diagnosis to guide a treatment plan that is personalized based on current knowledge.

Atypical Healing Related to Irritable Bowel Disease.

INTRODUCTION: Irritable bowel disease (IBD) is a gastrointestinal disorder characterized by chronic granulomatous inflammation of the entire digestive system, which includes the oral cavity. Oral manifestations of IBD includes aphthous ulcerations which may appear spontaneously and resemble episodes of active flare ups of IBD. The presence of oral mucosal ulcerations, in addition with other systemic symptoms and exclusion of other etiological causes, requires an interdisciplinary team approach to diagnose and manage. CASE PRESENTATION: A 19-year-old female presented with significant ulcerations next to a surgical site after a tooth extraction and ridge preservation procedure. The patient reported a history of preexisting episodes of ulcerations and continued to develop ulcers while the surgical site was healing. A referral to a gastroenterologist lead to a confirmed diagnosis of IBD. CONCLUSION: This case report presents a case of mucosal ulceration after surgical intervention that lead to the diagnosis of IBD. Appropriate and timely identification of oral manifestations of systemic disease conditions is key in early diagnosis and disease management. Connecting oral lesions to early presentation of systemic conditions potentially reduces a patient's systemic disease burden and improves their quality of life.

Creating a virtual patient for completely edentulous computer-aided implant surgery: A dental technique.

A fully digital workflow for generating a virtual patient for completely edentulous computer-aided implant surgery is described. Existing dentures are temporarily relined with a radiopaque dental silicone material, and a cone beam computed tomography scan is made with the relined denture inserted. Then, scans of the relined denture are made with an intraoral scanner. The radiopaque silicone material increases the stability of the dentures and allows the a cone beam computed tomography images and the scans of the dentures to be superimposed to create a virtual patient. This technique may reduce laboratory work steps, clinical chairside time, and treatment costs.