Guide bone regeneration (GBR) reconstruction of extensive alveolar bone defect due to infected radicular cyst enucleation: 2 case reports.

INTRODUCTION AND IMPORTANCE: Reconstruction of alveolar bone defects caused by radicular cysts is challenging for oral and maxillofacial surgeons. CASE PRESENTATION: Two Indonesian females had similar complaint of swelling in the vestibule area of the right mandible. Panoramic radiography showed radiolucent lesions. Participants underwent guided bone regeneration (GBR) reconstruction, which used pericardium membrane in the first case and amnion membrane in the second case. Post-surgery condition showed an improved prognosis and histology showed a radicular cyst. DISCUSSION: The use of pericardium membrane is easier compared to the amnion membrane, where success requires regular follow-up. CONCLUSION: Alveolar bone defect reconstruction based on GBR requires meticulous preparation regarding patient condition, case selection and technical comprehension to ensure better treatment outcomes.

Effect of α-Mangostin on Interleukin-11 and Runt-related Transcription Factor-2 Gene Expression on Cell Line Osteoblast Cultures Induced with Lipopolysaccharide.

Background: Loss of permanent teeth after tooth extraction without replacement of missing teeth can result in impaired masticatory, esthetic, phonetic functions, and impaired balance of the masticatory organ in the mouth. Therefore, a method is needed to inhibit the alveolar bone resorption process so that the dimensions of the tooth socket can be maintained vertically or horizontally until the time of implant placement, which is called the socket preservation procedure. α-mangostin is known to have a potential anti-inflammatory effect and most likely can be used as a potential therapeutic agent to inhibit bone resorption caused by posttooth extraction inflammatory processes. Aims: The aim of the study was to determine the effect on the inflammatory process and osteogenesis on osteoblast cell line culture by induction with lipopolysaccharide (LPS) and α-mangostin. Materials and Methods: This was an in vitro laboratory experimental study on mouse osteoblast cell line culture. The treatment was given with LPS, α-mangostin, and combination on osteogenic medium, using the same concentration for all concentrates. The sample will then be processed and analyzed using the real-time polymerase chain reaction. Results: The highest interleukin-11 (IL-11) gene expression was found in α-mangostin treatment, but there was no significant difference in IL-11 expression between the study groups. The highest runt-related transcription factor-2 (RUNX-2) gene expression was found in a group that received induction with LPS and α-mangostin, and from these results, it was found that there was a significant difference in RUNX-2 expression between the study groups. Conclusions: LPS and α-mangostin can increase osteogenesis in osteoblast cell culture in the osteogenic medium.

Decision-Making Criteria of Odontectomy or Surgical Exposure in Impacted Maxillary Canine Based on Treatment Difficulty Index Modification.

OBJECTIVE: Canine impaction is a difficult condition to treat, and it usually necessitates a combination of surgical exposure and orthodontic traction or surgical extraction. An accurate assessment of the maxillary canine's position can help determine the severity of the impaction, the difficulty of therapy, and the treatment's prognosis. MATERIALS AND METHODS: A total of 55 impacted canines were studied and selected retrospectively. Difficulty indexes were used to measure the severity of impaction with pretreatment panoramic radiographs. STATISTICAL ANALYSIS: Pearson correlation was used to test the validity of the difficulty index modification score. Regression statistical analysis was used to evaluate any correlation between total scoring from each index with surgical treatment. RESULTS: The validity test on the variable modification index score showed a valid value (p = 0.000). According to both treatment difficulty and modification index, odontectomy group showed higher mean of total scoring than surgical exposure group. Treatment difficulty and modification index showed a significant correlation with surgical treatment (p = 0.003 and p = 0.001). CONCLUSIONS: The higher the severity of canine impaction, the greater is the possibility of odontectomy than surgical exposure. Both indexes can consider to be used in determining surgical treatment planning.

Postoperative Complications of Impacted Mandibular Third Molar Extraction Related to Patient's Age and Surgical Difficulty Level: A Cross-Sectional Retrospective Study.

Mandibular third molar surgical extraction, either partially erupted or fully impacted, is the most common surgical procedure in oral and maxillofacial surgery (OMFS). However, this procedure can be associated with many postoperative complications including persistent pain, swelling, trismus, and paresthesia due to nerve injury. This study aimed to identify the correlation of postoperative complications with patient's age, sex, and surgical difficulty level. This study was a cross-sectional retrospective and single-center research conducted on patients with a history of mandibular third molar surgical extraction in the period between 2017 and 2019 at Dental and Oral Hospital Universitas Airlangga, Surabaya, Indonesia. The researchers assessed the factors of age, sex, and surgical difficulty level regarding postoperative complications on the first day of the surgery and after one week on the 7th day of it. Among 916 respondents, the majority of the sample was females (59%) and the dominant age group (60.9%) was the age group of 21-30 years while the dominant surgical difficulty level was shown by the advanced cases group (77%). The statistical analysis showed that there was a significant correlation between surgical difficulty level and postoperative complications including pain, trismus, and paresthesia on the first-day assessment. On the other hand, age was significantly related to complications like pain, swelling, and trismus on the first-week assessment. Age and surgical difficulty level were the most common risk factors of the mandibular third molar extraction postoperative complications. Dentists should take into consideration that older patients (≥51 years) and patients with complex surgical level are more vulnerable to severe postoperative complications.

Analyses of Bone Regeneration Capacity of Freeze-Dried Bovine Bone and Combined Deproteinized-Demineralized Bovine Bone Particles in Mandibular Defects: The Potential Application of Biological Forms of Bovine-Bone Filler.

OBJECTIVE: This study aimed to evaluate bone regeneration capacity of FDBX granules compared to composite DBBM/DFDBX granules for filling of bone defect in rabbit mandible. MATERIAL AND METHODS: Critical size defects were created in 45 rabbits' mandible. The defect in the control group is left untreated, while in other groups the defects were filled with FDBX granules and composite DBBM/DFDBX granules, respectively. Specimens were collected at 2, 4, and 8 weeks for histology and immunohistochemical analyses. Significant difference is set at p-value < 0.05. RESULTS: The osteoblast-osteoclast quantification, osteoblast expression of Runx2, alkaline phosphatase, collagen-I, and osteocalcin, and osteoclast expression of receptor activator of NF-kB ligand (RANKL) and osteoprotegerin (OPG) in FDBX groups were statistically comparable (p > 0.05) with the composite group, while OPG/RANKL ratio, bone healing scores, and trabecular area were significantly higher (p < 0.05) in the composite compared to FDBX group. CONCLUSION: Composite DBBM/DFDBX granules, within the limitation of this study, has better bone forming capacity than FDBX granules for filling of bone defects in the mandible.

In Vivo Analyses of Osteogenic Activity and Bone Regeneration Capacity of Demineralized Freeze-Dried Bovine Bone Xenograft: A Potential Candidate for Alveolar Bone Fillers.

BACKGROUND: Deproteinized bovine bone mineral (DBBM) particle is the commonly used bone graft substitute in implant surgery which is mainly osteoconductive and has very slow degradation. Demineralized freeze-dried bovine bone xenograft (DFDBBX) particle is being developed as a novel xenogeneic bone filler. OBJECTIVES: The study aimed to analyze osteogenic activity and bone-forming capacity of DFDBBX particles compared to DBBM particles in alveolar bone defects in rabbit mandibles models. Material and Methods. This study investigated bone defects whether filled with DBBM particles or DFDBBX particles or left unfilled in 30 rabbit mandibles. Specimens were processed for histology, immunohistochemistry, and micro-CT scanning. Statistical difference was set at a p value < 0.05. RESULTS: The quantitative assessment showed a significantly lower number of osteoclasts and a higher number of osteoblasts in the DFDBBX group compared to the DBBM group in 2 and 4 weeks (p < 0.05). Immunostaining analyses showed significantly higher expression of RUNX2, collagen type I, alkaline phosphatase, and osteocalcin in the DFDBBX group compared to the DBBM group in 2 and 4 weeks. Bone healing score in the DFDBBX group was comparable to the DBBM group. Micro-CT presented no significant difference in the volume percentage of the mineralized tissue in the DBBM and DFDBBX groups in spite of the different healing patterns in both groups. CONCLUSION: DFDBBX particles induced higher osteoblastic activities than DBBM particles at the early stage of healing. Meanwhile, the capacity of bone formation in DFDBBX particles was comparable with DBBM particles at the later stage of healing. Considering the limitation of this study, the results presented DFDBBX particles as potential bone filler candidates.

Human Umbilical Cord Mesenchymal Stem Cells Over Platelet Rich Fibrin Scaffold for Mandibular Cartilage Defects Regenerative Medicine

ABSTRACT Objective: To evaluate the regeneration of mandibular cartilage defect after implantation of human umbilical cord mesenchymal stem cells (hUCMSC) over platelet rich fibrin (PRF) as scaffold. Material and Methods: 20 male Wistar rats were randomly divided into four experimental groups consisting of: a control group featuring untreated mandibular defects (C), experimental groups whose mandibular defects were implanted with hUCMSC (E1), mandibular defects implanted with PRF (E2), mandibular defects implanted with hUCMSC and PRF scaffold (E3). The subjects were sacrificed after six weeks of observation for immunohistochemical examination in order to evaluate the expression of Ki67, Sox9, FGF 18, type 2 collagen, and aggrecan, in addition to histology examination to evaluate chondrocyte number and cartilage thickness. Data was analyzed with univariate analysis (ANOVA). Results: The implantation of hUCMSC and PRF scaffold proved capable of regenerating mandibular cartilage defect through the expression of FGF 18, Sox9, Ki67, chondrosis counts, type 2 collagen, aggrecan, and cartilage thickness. The regeneration were significantly higher in group E3. Conclusion: Human umbilical cord mesenchymal stem cells in platelet rich fibrin scaffold proved capable of regenerating mandibular cartilage defect.

Stability of Tissue Augmented with Deproteinized Bovine Bone Mineral Particles Associated with Implant Placement in Anterior Maxilla.

BACKGROUND: Implant placement in defective anterior maxilla poses a great challenge regarding functional and aesthetic outcomes. Therefore, it requires predictable alveolar ridge augmentation. Deproteinized bovine bone mineral (DBBM) particle has commonly been used for bone grafting. However, it is associated with low resorption rates which potentially compromise the outcome of horizontal augmentation in conjunction with implant placement. AIMS: This study is aimed at evaluating the stability of tissue augmented with DBBM particle associated with implant placement in the anterior maxilla. MATERIALS AND METHODS: The inclusive criteria consist of patients being treated with guided bone regeneration (GBR) incorporating the use of DBBM particles with either a simultaneous or staged approach. The parameters analyzed include the implant survival rate, post-GBR clinical stability based on tissue resorption level, and the tissue stability between simultaneous and staged approaches. Statistical analysis using Mann-Whitney test is performed with significance determined at p value < 0.05. RESULTS: Seventeen patients with 23 implant placements satisfy the criteria for this study. Simultaneous approach is adopted in 18 (78.3%) implants and a staged approach in 5 (21.7%) implants. The implant survival rate is 100%. The evaluation of horizontal tissue stability reveals a low resorption level in 19 (82.6%) implants, while moderate and high resorption levels are found in 3 (13.0%) and 1 (4.3%) implants, respectively. The statistical analysis shows that the simultaneous approach produces significantly (p = 0.005) lower resorption level compared to the staged approach. CONCLUSION: Horizontal ridge augmentation using DBBM particles associated with implant placement in the anterior maxilla produces good clinical stability. The stability appears to be higher in the simultaneous approach compared to the staged approach.