Autologous platelet-rich-fibrin-induced revascularization sequelae: Two case reports

BACKGROUND

A key requirement for biomimetic regeneration of tissues is a 3D scaffold. The gold standard scaffold for revascularization is the blood clot, however, an adequate blood clot cannot always be achieved in narrow canals or mature roots. Hereby, we document the effects of platelet-rich fibrin (PRF) for the regenerative endodontic treatment (RET) of two immature permanent teeth with necrotic pulps for up to 48 mo.

CASES SUMMARY

The first patient was a 22-year-old female with history of trauma in tooth #9 with a sinus tract and a large periapical lesion. The second was a 9-year-old male presenting with a badly decayed tooth #14. Both cases were treated with RET and PRF prepared from the patients’ blood. PRF and its extract were used as a scaffold for RET. Patients were followed-up to 9 and 48 mo (4 years), respectively. Both patients, were asymptomatic after treatment. At the 9-mo-follow-up of case #1, there was radiographic evidence of periapical bone healing, however, the root apex was still open. In case #2, the roots exhibited apical closure and normal periapical bone architecture at 12-mo follow-up, while no root lengthening was observed. After 48 mo, case #2 showed extensive intracanal calcification in all root canals that complicated conventional root canal treatment.

CONCLUSION

RET with PRF and its extract could be used in revascularization of immature permanent teeth. However, proper case selection to comply with long-term follow-up is necessary and adverse events such as calcification and canal obliteration should be planned for.

Molar incisor hypomineralization and pre-eruptive intracoronal lesions in dentistry-diagnosis and treatment planning

The aim of this study is to report the diagnostic features, prevalence, mineral content, clinical significance and treatment options of molar incisor hypomineralization (MIH) and pre-eruptive intracoronal lesions (PEIR), in order to minimize miss-treatment of primary and permanent teeth in young children. MIH was defined as the occurrence of hypomineralization of one up to four permanent first molars from a systemic origin and frequently associated with affected incisors. PEIR are lesions that are located in the occlusal portion of the crown of unerupted permanent or primary teeth. The prevalence of MIH was reported between 2.5%-40% in the permanent first molars and 0%-21.8% in primary second molars. PEIR was observed in 2%-8% of children, mainly in mandibular second premolars and second and third permanent molars. A number of possible causes for MIH were mentioned, including environmental changes, diet and genetics in prenatal and postnatal periods, but all are questionable. In PEIR, the resorption of the intracoronal dentine begins only after crown development is complete and is caused by giant cells resembling osteoclast observed histologically on the dentine surface close to the pulp. The mineral content in MIH is reduced in comparison to normal enamel and dependent on the severity of the lesion. In PEIR the resorbed surface of enamel showed less mineral content. The hypomineralized enamel in MIH is not suitable for restorations with amalgam or composite materials, and the best material should be based on remineralization material like glass-ionomers. Similar, the resorbed dentin surface in PEIR should be covered by the biocompatible and re-mineralizing glass-ionomer cement.

Dental pulp stem cells: Novel cell-based and cell-free therapy for peripheral nerve repair

The regeneration of peripheral nerves comprises complicated steps involving a set of cellular and molecular events in distal nerve stumps with axonal sprouting and remyelination. Stem cell isolation and expansion for peripheral nerve repair (PNR) can be achieved using a wide diversity of prenatal and adult tissues, such as bone marrow or brain tissues. The ability to obtain stem cells for cell-based therapy (CBT) is limited due to donor site morbidity and the invasive nature of the harvesting process. Dental pulp stem cells (DPSCs) can be relatively and simply isolated from the dental pulps of permanent teeth, extracted for surgical or orthodontic reasons. DPSCs are of neural crest origin with an outstanding ability to differentiate into multiple cell lineages. They have better potential to differentiate into neural and glial cells than other stem cell sources through the expression and secretion of certain markers and a range of neurotropic factors; thus, they should be considered a good choice for PNR using CBT. In addition, these cells have paracrine effects through the secretion of neurotrophic growth factors and extracellular vesicles, which can enhance axonal growth and remyelination by decreasing the number of dying cells and activating local inhabitant stem cell populations, thereby revitalizing dormant or blocked cells, modulating the immune system and regulating inflammatory responses. The use of DPSC-derived secretomes holds great promise for controllable and manageable therapy for peripheral nerve injury. In this review, up-to-date information about the neurotrophic and neurogenic properties of DPSCs and their secretomes is provided.

Autism spectrum disorder: Review of literature and dental management

With an increase in the number of cases of autism spectrum disorder (ASD), dental professionals need to be aware of the different techniques required to ensure safe dental treatments for affected patients. The concerns and preferences of the parents and the medical and dental history of each patient should be considered. The aim of this article was to provide a comprehensive update on the medical and dental health of patients with ASD. A detailed search of the electronic database PubMed/Medline/Lilacs was performed for the terms “Autism”, “Autistic”, “Autism Spectrum Disorder”, “ASD”, “Dentistry” and “Dentist”, in the period between 2006 and 2017. Systemic reviews, research articles, and literature reviews were included. Expert opinions, case series, and case reports were excluded from the search. A detailed family-centered approach based on the preferences and concerns of parents is an important foundation for appropriate individualized dental treatment of patients with ASD. In addition, the knowledge of disruptive behaviors and patient´s challenges may guide dental practitioners in improving treatment planning, oral management, and the overall oral health of patients with ASD.

Next generation sequencing in oral disease diagnostics

DNA sequencing is the method of identifying the precise order of DNA nucleotides within a molecule. The information of DNA sequencing is of prime requisite for basic biological research as well as in various clinical specialties. They can be used to determine the individual genetic sequence, larger genetic regions, chromosomes as well as to sequence RNA and proteins. Since the first DNA sequencing in 1970s, there has been tremendous advancements in the technologies aimed to determine the entire human genome. The need for rapid and accurate sequencing of human genome has resulted in the introduction of next generation sequencing (NGS) technology. NGS refers to the second-generation DNA sequencing technologies where millions of DNA can be sequenced simultaneously. Some of the next gen sequencing methods employed are Roche/454 life science, Illumina/Solexa, SOLiD system and HeliScope. Application of NGS in decoding the genomic database of various oral diseases may possess therapeutic and prognostic value. This presentation provides an overview of the basics of NGS and their potential applications in oral disease diagnostics.

Minireview of the clinical efficacy of platelet-rich plasma, platelet-rich fibrin and blood-clot revascularization for the regeneration of immature permanent teeth

The aim of this mini-review was to investigate and compare the clinical efficacy of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), vs blood clot revascularization (BCR) for the regeneration of immature permanent teeth. The clinical efficacy of PRP, PRF, and BCR to regenerate 90 immature permanent teeth after one year, were compared for their ability to accomplish apical closure, a periapical lesion healing response, root lengthening, and dentinal wall thickening. The 90 cases were published in three different articles. The mean success rate for apical closure after one year was: PRP (89.2%) PRF (80%), and BCR (75.6%). The mean success rate for root lengthening after one year was: BCR (88.9%), PRP (68.2%), and PRF (65%). The periapical lesion healing response was 100% for BCR and 100% for PRP. Dentinal wall thickening was 100% for BCR, and 100% for PRP. All the PRP, PRF, and BCR treatments appeared to be effective. The published clinical results for PRP, PRF, and BCR indicate that these treatments are effective for the regeneration of immature permanent teeth.

Impact of different types of herpesviral infections in the oral cavity

The herpesviruses are ubiquitous, doubled-stranded DNA viruses that can reactivate under conditions such as immunosuppressive therapy, acquired immunodeficiency syndrome, malnutrition, and immunosenescence. There are eight types of herpesviruses: Human herpesvirus simplex (HSV) type I (HSV-1) and HSV type II (HSV-2), varicella-zoster virus (VZV), epstein-Barr virus (EBV), cytomegalovirus, human herpesvirus (HHV)-6, HHV-7, and HHV-8 or Kaposi’s sarcoma herpesvirus. Some of these viruses can infect the oral cavity, leading to different types of lesions. Specifically, labial herpes (HSV-1 and less frequently HSV-2), zoster (VZV), infectious mononucleosis and oral hairy leukoplakia (EBV), and Kaposi’s Sarcoma (HHV-8) are the most common viruses infecting the oral cavity. Some of these viruses can act in synergy with other herpesviruses or as distinct infectious agents. Other herpesviruses may have indirect effects in periodontal disease. The diagnosis is frequently based on signs and symptoms and depends on the experience of the examiner. Cytopathologic and/or histopathologic examination as well as immunological methods such as ELISA could help to elucidate cases. In addition, molecular techniques which can be sensitive and specific have been reported in the literature. These methods require low amounts of sample and could offer results faster than other traditional methods.

Effects of energy and sports drinks on tooth structures and restorative materials

Sports and energy drinks are consumed by more people than ever. Sports and energy drinks may enhance physical resistance, stimulate metabolism, prevent rehydration and replace electrolytes during high activity efforts. However, these drinks often have a low pH and are acidic, which can erode enamel and dentin, and increase dentine hypersensitivity. In addition to the adverse effects of sports and energy drinks on tooth structures, they often have the potential to damage restorative materials. These drinks often contain artificial colors which have potential to discolor resin composite materials and glass ionomers. The acidic nature of these drinks could also lead to a degradation, increase in wear, and roughening of the surface of the restorative materials. Many of the negative consequences of sport and energy drinks can be related to their over-consumption among children and teenagers. Patients should be advised to have a healthy diet, and consume soft and energy drinks in moderation, to avoid any negative dental or health consequences. The over-consumption of sports and energy drinks which are high in sugar and have the lowest pH are most likely to cause avoidable dental problems.

Tooth agenesis and craniofacial morphology in pre-orthodontic children with and without morphological deviations in the upper cervical spine

AIM: To analyze differences in prevalence and pattern of tooth agenesis and craniofacial morphology between non syndromic children with tooth agenesis with and without upper cervical spine morphological deviations and to analyze associations between craniofacial morphology and tooth agenesis in the two groups together.

METHODS: One hundred and twenty-six pre-orthodontic children with tooth agenesis were divided into two groups with (19 children, mean age 11.9) and without (107 children, mean age 11.4) upper spine morphological deviations. Visual assessment of upper spine morphology and measurements of craniofacial morphology were performed on lateral cephalograms. Tooth agenesis was evaluated from orthopantomograms.

RESULTS: No significant differences in tooth agenesis and craniofacial morphology were found between children with and without upper spine morphological deviations (2.2 ± 1.6 vs 1.94 ± 1.2, P > 0.05) but a tendency to a different tooth agenesis pattern were seen in children with morphological deviations in the upper spine. In the total group tooth agenesis was associated with the cranial base angle (n-s-ba, r = 0.23, P < 0.01), jaw angle (ML/RLar, r = 0.19, P < 0.05), mandibular inclination (NSL/ML, r = -0.21, P < 0.05), mandibular prognathia (s-n-pg, r = 0.25, P < 0.01), sagittal jaw relationship (ss-n-pg, r = -0.23, P < 0.5), overjet (r = -0.23, P < 0.05) and overbite (r = -0.25, P < 0.01).

CONCLUSION: Etiology of tooth agenesis in children with upper spine morphological deviations was discussed. The results may be valuable for the early diagnosis and treatment planning of non syndromic children with tooth agenesis.

Concepts and challenges of alveolar ridge preservation and augmentation

The loss of the post-extraction alveolar ridge vertical and horizontal volume constitutes an irreversible process and presents a considerable impact on the prosthetic rehabilitation, particularly when implant-supported. Therefore, alveolar ridge resorption has become a challenge in contemporary clinical dentistry and alveolar ridge preservation and augmentation are an interesting therapeutic approach. The employment of biomaterials, as a therapeutic alternative to preserve bone in height and volume, has been frequently studied over the years, due to its conceptual attractiveness and its simple technique. The purpose of this paper is to review and discuss current methods to optimize the alveolar bone repair while maintaining its horizontal and vertical dimensions. This paper is based on scientific studies published in English including systematic reviews and also animal and human studies that were searched using the keywords “alveolar ridge preservation,”“bone substitute”, “biomaterials”, “bone graft” and “grafting”. Either autogenous bone as xenogenic and alloplastic materials, platelet rich plasma and use of membrane are alternatives. It becomes fundamental to understand that alveolar bone loss is still a clinical challenge and alveolar ridge preservation techniques can minimize, but not completely, eliminate the resorption process. The goal of alveolar ridge preservation and augmentation is to use a combination of bone or biomaterials to create bone which is sufficient for dental implant placement. Freeze-dried bone is generally recognized as giving more predictable treatment outcomes than synthetic materials or platelet rich plasma, and membranes must always be used to separate hard and soft tissues to promote optimal tissue healing.

Autotransplantation of a premolar to the maxillary anterior region in young children - how long should the donor root be? A case report

Autotransplantation of premolars to anterior region after incisor loss due to trauma is accepted as the best restoration procedure with very long follow-ups. There are two main protocols: Premolars with only two thirds of the root or premolars with complete root development. Premolars with two thirds of the root completed remain vital and show complete pulp obliteration while premolars with closed apex require root canal treatment. The problem arises when the child is very young and the root of the donor premolar is developed for only one third. This case report describes the outcome of an autotransplantation of a lower first premolar with only a third of developed root to the anterior region. The donor tooth was extracted with his follicle and placed instead of tooth No. 21. For the first month esthetics was restored with a glass-fibers ribbon attached to tooth No. 11 and composite material. After a month, the crown erupted and was reshaped to mimic an incisor with composite. Orthodontic movement was performed after 5 mo, in order to alleviate the gingival contour. The final restoration was performed after 15 mo. Follow up showed full root development with normal mobility, continuous periodontal ligament and complete pulp obliteration. A multidisciplinary approach and meticulous preparation are necessary for a positive result in autotransplantation of premolars with only a third of root development to the anterior region and this case report show that this method can be performed in very young children.

Laser assisted periodontics: A review of the literature

Over the years, the use of the laser within health field and more particularly dentistry has been increasing and improving. The application of laser in the periodontal treatment takes part of a non-surgical and surgical approaches, is used for the decontamination of periodontal pockets due to its bactericidal effect, and the removal of granulation tissues, inflamed and diseased epithelium lining, bacterial deposits and subgingival calculus. However in spite of all the marketing surrounding, the use of laser highlighting its beneficial effect, the capacity of laser to replace the conventional treatment for chronic periodontitis is still debatable. In fact there is no evidence that any laser system adds substantial clinical value above conventional treatments of chronic periodontitis. Some studies showed a significant positive effect on clinical attachment level gain and probing depth reduction. In the other hand, several articles demonstrated no evidence of the superior effectiveness of laser therapy compared to root planing and scaling. Our aims is to review the literature on the capacity of erbium:Yttrium-aluminum-garnet and neodymium:Yttrium-aluminium-garnet laser to either replace or complete conventional mechanical/surgical periodontal treatments.

About gravity and occlusal forces in the jaws: Review

Mechanical forces resulting from gravitation seem to be essential for structural adaptation and remodeling of skeletal bones. These forces have the capability of delivering powerfully distorting stimuli to skeletal bones in a very short time, several times a day, in a uniform direction. Facial and jaw bones are not subjected to gravity impact forces. These bones need a mechanism of “compensation” for this deficiency. The goal is achieved by a unique mechanism that substitutes for gravity impact forces - the mechanism of occlusal load transmission to the bone via the periodontal apparatus space. In cases of early loss of teeth and loss of periodontal ligament this mechanism will be missing resulting in premature bone aging.

When will RNA-based tests similar to Oncotype DX be used for oral cancer?

Methods for detection, diagnosis and predicting treatment outcomes for oral squamous cell carcinoma (OSCC) have not changed in decades. Information from studies about molecular changes that occur with these tumors are not useful in the clinic. This is in contrast to breast cancer where global gene expression analysis in the form of the Oncotype DX and Mammaprint tests are used routinely to determine ideal treatment for a large subset of breast tumors. While the first large scale studies of gene expression in both cancer types were done over a dozen years ago, research on OSCC has not led to gene expression profiles that are useful in the clinic. Global gene expression data for well over a thousand breast tumors linked to clinical outcomes has been available online for nearly ten years. This accelerated the development and validation of multiple RNA classifiers used to predict breast cancer treatment outcomes. Molecular characterization of oral and head and neck cancer research has been handicapped primarily due to low sample numbers. The recent release from The Cancer Genome Atlas of global gene expression analyses of over 500 head and neck tumors, including 308 oral tumor samples, obtained by standardized methods, along with linked clinical outcome data, should change this. It makes the vision of including gene expression analysis in OSCC treatment planning an obvious and attainable goal that could occur in the next five years.

Retrieving dental instruments through endoscopy: A literature review

Clinical accidents involving dental instruments and materials inside the oral cavity are reported in the medical literature. Specifically, ingestion and aspiration of foreign bodies have greater prevalence in the routine of medicine and dentistry. Despite being less harmful than aspirations, the accidental ingestion of dental instruments does not always culminate in favorable prognoses. Mostly, complex conditions require medical intervention through endoscopy or surgical approaches. The present research aims to review the literature pointing out the specialties of dentistry most involved with accidental ingestion of dental instruments, highlighting the important role of endoscopy for accurately locating and retrieving foreign bodies. Prosthodontics, operative dentistry, orthodontics, and maxillofacial surgery arose as the specialties in which these accidents are more prevalent. Based on that, general dentists and specialists must be aware for the essential care to avoid such clinical accidents, as well as to know the available tools, such as endoscopy, to overcome these situations in the routine of dentistry.

Diagnostic aids in detection of oral cancer: An update

Oral cancer is the sixth most common malignancy with almost 500000 new cases reported worldwide annually. The diagnosis of oral cancer at an early stage has a good prognosis as the survival rate is high (around 80%). However, the majority of oral cancer cases are diagnosed at a later stage with a considerably poor 5-year survival rate of 50% according to World Health Organization statistics. Thus, an effective management strategy for oral cancer will depend on its early identification and intervention which would pave the way for superior prognosis. Despite the obvious advantage of earlier diagnosis of oral cancer, no approach has yet proven to be a reliably successful in diagnosis of oral cancer at an early stage. Currently; the primary line of screening of oral cancer is performed by visual inspection, which is a subjective examination. Among the screening tests or diagnostic aids now available for oral cancer, few (toluidine blue, brush biopsy, salivary and serum bio-markers) have been utilised and studied for many years while others have recently become commercially available. The authors in the present article review all the modalities of screening aids used in oral cancer detection and provide an update on the latest screening tools used in oral cancer detection.

Salivary gland disorders: A comprehensive review

Salivary glands are complex in nature. They could be either tubulo acinar, merocrine or exocrine glands secreting mainly saliva. Salivary gland is one of the main soft tissue structures in the maxillofacial area. Saliva is a clear, slightly acidic muco serous fluid that coats the teeth, mucosa and thereby helps to create and maintain a healthy environment in the oral cavity. Salivary glands may be affected by a number of diseases: local and systemic and the prevalence of salivary gland diseases depend on various etiological factors. The glands may be infected by viral, bacterial, rarely fungal or its ductal obstruction which may cause painful swelling or obstruction, affecting their functions. The salivary gland may also be affected by a various benign and malignant tumours. This review article briefly describes about the various salivary gland disorders, diagnostic techniques and their management including the recent advances and the future perspective.

Periosteal pedicle graft for the treatment of gingival recession: A viable alternative to sub-epithelial connective tissue graft

Treating gingival recessions is important to satisfy the functional and aesthetic needs of the patients. Among various available techniques to treat gingival recessions, the subepithelial connective tissue graft technique is still considered to be the best despite its inherent disadvantages. The recent innovation utilising periosteum as a pedicle graft to treat gingival recession defects has drawn considerable attention and may provide a viable alternative to subepithelial connective tissue graft.

Diagnostic imaging: Morphological and eruptive disturbances in the permanent teeth

This paper reviewed the literature on newer three-dimensional imaging techniques and their applications in diagnosis and treatment planning of various dental anomalies. Developmental anomalies can occur during any of the developmental stages and are manifested clinically after the tooth is fully formed. These dental anomalies may involve a single tooth, a group of teeth, or the entire dentition. Two-dimensional diagnostic imaging, including periapical, occlusal, panoramic, or cephalometric radiographs are essential in localization and management of morphological and eruptive disorders. However, due to their inherent limitations such as insufficient precision because of unusual projection errors and lack of information about spatial relationships, these methods are considered unreliable. Thus, the use of newer image acquisition techniques that allow comprehensive three dimensional imaging and visualization of dental abnormalities is highly recommended for making a confirmatory diagnosis. The significance of accurate endodontic, surgical and orthodontic treatment planning in dental abnormalities cannot be overstated as it pertains to critical anatomic landmarks such as proximity to adjacent teeth or the mandibular canal. The precise information on spatial relationships provided by multiplanar imaging helps the dental surgeon to establish more accurate diagnosis, management strategies and also increases the patient safety. This review highlights the use of high-end diagnostic imaging modalities in diagnosis of the various morphologic and eruptive dental abnormalities.

Oral graft vs host disease: An immune system disorder in hematopoietic cell transplantation

Graft vs host disease (GVHD) is a complication of patients who are treated by hematopoietic cell transplantation. National Institutes of Health in 2005 by Working Group on Diagnosis and Staging Consensus Development Project on Criteria for Clinical Trials in Chronic GVHD (cGVHD) established 2 principal categories of oral GVHD, acute and chronic. The oral mucosa may be the first site of manifestation of the disease. Clinical diagnosis needs to be confirmed by a biopsy of oral mucosa and minor salivary glands. Microscopic results have played a major role in the diagnosis and management of acute and chronic oral GVHD. Development of second malignancies is the greatest risk of oral cGVHD patients, mostly regarding squamous cell carcinoma. The focus of oral GVHD therapy is to improve symptoms and maintain oral function. The aim of this review article is to update the information on the oral GVHD in its clinical, microscopic features and their complications.

Platelet preparations in dentistry: How? Why? Where? When?

The aim of this article is to review the outcomes of platelet preparations in dentistry. A structured electronic search discovered 348 articles, which described the use of autologous platelet concentrates with a relevance to clinical dentistry. Among these articles, 220 articles investigated platelet rich plasma, 99 investigated platelet rich fibrin, 22 investigated plasma rich in growth factors and 7 investigated the use of concentrated growth factors. Several studies reported beneficial treament outcomes in terms of enhanced bone and soft tissue regeneration.

Effects of different root canal preparation methods on root fracture resistance: A systematic review of the literature

AIM: To study the root fracture resistance after root canal preparation with Ni-Ti rotary instruments and stainless hand instruments by means of meta-analysis.

METHODS: Literature was researched in CNKI and CBMDisc, PubMed, CALIS, Proquest, Web of Science and 11 kinds of Chinese or English dentistry journals. Retrieval time on Internet was in all years and hand retrieval time was from January 2013 to October 2013. The literatures were selected through reading abstracts and full texts by two reviewers independently and Revman 5 software was used to analysize the literature.

RESULTS: Six articles met the inclusion criteria. According to Meta-analysis of tooth root bending properties, total standardized mean difference (SMD) was 0.63 (95%CI: -0.24-1.50, P > 0.05). That indicated there was no statistically significant between the two groups. Subgroup analysis was carried out. SMD were 2.22 (95%CI: 0.23-4.20, P < 0.05) and -0.61 (95%CI: -1.05- -0.17, P < 0.05) when the premolar teeth with a single canal or the mesiobuccal roots of molars were used as the materials for tests to compare the effects of different root canal preparation methods on root fracture resistance. That only indicated that there were statistically significant in two subgroups.

CONCLUSION: In vitro experiments, the effects on the fracture resistance of root had no statistical difference with Ni-Ti rotary instruments and stainless steel hand instruments in root canal preparation.

Controversy of silver amalgam as a restorative material

Silver amalgam contains mercury leading to concerns about the potential toxic effects of amalgam on the health of dental patients. The debate over the toxicity of silver amalgam restorations has divided the dental profession for over a century. The use of amalgam restorations for anterior teeth have been declining worldwide due to patient’s safety concerns and preference for tooth colored restorations. Nevertheless, amalgam has served the dental profession for decades and benefited hundreds of millions of patients because of its longevity as a dental restorative material. Amalgam is still the World’s most widely used restorative material for posterior teeth.

Klippel-feil: A syndrome in the occipital-cervical spine field and its dentofacial manifestations

Klippel-Feil syndrome (KFS) is defined by congenital cervical vertebral spine fusion and is seen with a wide spectrum of dental manifestations and craniofacial profiles. Previous studies on lateral cephalograms have documented an association between fusion of the cervical vertebrae and deviations in the craniofacial profile in non-syndromic patients with severe malocclusion. To our knowledge, no previous studies have described the craniofacial profile including the cranial base of KFS patients on lateral cephalograms. Therefore KFS and its craniofacial and dental manifestations were described according to existing literature and additionally the craniofacial profile and cranial base was analysed on lateral cephalograms of two patients with KFS. According to the literature the dental manifestations of KFS-patients included oligodontia, overjet, cross bite, open bite and deep bite. The craniofacial profile was clinically described as reduced lower facial height, midfacial hypoplasia, and mandibular prognathia. The analyses of the two lateral cephalograms showed increased mandibular inclination, increased vertical jaw-relationship, increased jaw angle and maxillary retrognathia. The cranial base was normal in both cases. The sagittal jaw relationship and mandibular prognathia varied between the two cases. The literature review and the analyses of the two lateral cephalograms have shown that deviations in the occipital and cervical spine field as KFS were associated with deviations in the teeth and craniofacial profile.

Treatment of mouth and jaw diseases with intralesional steroid injection

Many lesions of the oral region are treated with surgical methods such as curettage and resection. Chemotherapy and radiation therapy with or without surgical intervention can be used as an adjunct in some cases. Intralesional steroid injection is a conservative procedure which is already used in various regions of the body and joints. This technique is used also for a number of mouth and jaw lesions. Localized langerhans cell histiocytosis, central giant cell granuloma, oral submucous fibrosis, oral lichen planus, lichen sclerosus of the oral mucosa, lymphatic malformations and orofacial granulomatosis can be considered among these diseases. The purpose of this review is to investigate the effects of intralesional steroid injections in the treatment of oral diseases.

Oral lichenoid lesion: A review of the literature

The oral lichenoid lesion (OLL) is response that occurs on the oral mucosa. The OLL include allergic response to the dental materials, drugs, and on graft-vs-host disease (GVHD). OLL to dental material happen when restorative materials, most commonly amalgam, are in direct contact with the mucosa in sensitized individuals. Medications that produce OLL are oral hypoglycemic agents, angiotensin-converting enzyme inhibitors, and nonsteroidal anti-inflammatory agents. GVHD is a complication in bone marrow transplantation and OLL is a common lesion observed in this disease especially in chronic GVHD. The clinical and histological aspects of OLL are similar to oral lichen planus and turn it difficult to make a differential diagnosis. The purpose of this paper is review about OLL related to the dental materials, drug use and GVHD.

Angina bullosa hemorrhagica an enigmatic oral disease

Angina bullosa hemorrhagica (ABH) is an enigmatic oral disorder described for the first time by Badham in 1967 to define blisters with a hematic content in the oral cavity and oropharynx unrelated to any hematological, dermatological or systemic disease. The ABH is an uncommon disease of the oral cavity distinctively affecting adults, with the highest incidence over the 5^th decade of life. This process is considered nowadays to have a multifactorial etiopathogenesis, where mild oral traumatisms can trigger the blisters in susceptible individuals. Certain association on the onset of the lesion with the chronic use of inhaled steroids and, more controversially, with triggering systemic disorders, such as, diabetes or hypertension has been described. Characteristically, the ABH blisters are acute and are located on the lining mucosa, more frequently on the soft palate. Usually, the lesions are solitary and rupture easily, resulting in a superficial ulceration that heals quickly without scarring. The histopathological analysis shows a subepithelial blister containing blood and direct immunofluorescence on the epithelium is negative. The differential diagnosis should consider all oral vesiculo-bullous disorders with hematic content, including mucocutaneos, hematological or cystic pathology. The diagnosis of ABH is clearly clinical, although the biopsy might be helpful on atypical or abnormally recurrent cases. The general prognosis of ABH is good and the treatment is symptomatic.

Unraveling the role of epidermal growth factor receptor in oral lesions: Key to non surgical treatment modes

Epidermal growth factor receptor (EGFR) is a transmembrane receptor with tyrosine kinase activity, mediating actions of various growth factors including EGF, transforming growth factor-α, and neuregulins. Protein binding to ligand induces receptor modification, tyrosine autophosphorylation leading to cell signaling resulting in cellular proliferation. This receptor plays diverse roles in maintaining homeostasis and recent molecular advances identify that EGFR mutations are linked to several carcinomas. EGFR plays important roles in the development and maintenance of various oral structures, tooth development, eruption and morphogenesis. EGFR expression has also been studied in diverse oral pathologies like squamous cell carcinomas, potentially malignant lesions, lichen planus, salivary gland tumors and odontogenic cysts and tumours. The present review delves into the various general features of EGFR with an insight into its physiological and pathological role in the oral cavity. The clinical implications and upcoming role of EGFR inhibitors in the nonsurgical treatment of oral lesions has also been discussed.

Oral lichenplanus: Etiology, pathogenesis, diagnosis, and management

Oral Lichen planus (OLP) is a common chronic mucocutaneous disorder with an immune mediated pathogenesis. Its appearance may vary from presence of keratotic to erythematous areas. Etiology of OLP is unknown, but it is thought to be the result of an autoimmune process with an unknown predisposing factor. Oral lichen planus is a complex and poorly understood clinical condition with periods of remissions and exacerbations. Management of the OLP is diversified with few lesions requiring treatment for years and few others are mild, requiring no treatment.

Melkersson-Rosenthal syndrome

Melkersson-Rosenthal syndrome (MRS) is a rare, non-caseating granulomatous disorder of unknown etiology and undefined diagnostic criteria. The classical triad of recurrent orofacial edema, relapsing facial paralysis, and fissured tongue, is not frequently seen in its complete form, and many patients remain misdiagnosed or undiagnosed for years. The purpose of this study is to review the findings in the literature describing the Melkersson-Rosenthal syndrome with aim to identify its clinical and histopathological characteristics and correlate them with definitive diagnostic criteria and effective treatment modalities. A systematic review and analysis of more than 100 publications met eligibility criteria performed by the authors. Orofacial edema of unknown etiology is the most typical clinical feature of the Melkersson-Rosenthal syndrome. Its coexistence with of facial nerve palsy or fissured tongue could be characterized as an oligosymptomatic MRS. Many investigators suggest cheilitis granulomatosa as a monosymptomatic form of MRS, while patients with facial palsy and fissured tongue, without orofacial edema, should not be considered having MRS. Histological evidence is not necessary. Corticosteroids are generally accepted as the mainstay treatment.

Unusual aggressive behavior of central giant cell granuloma following tooth extraction

Central giant cell granuloma (CGCG) is found exclusively in jaws. Its etiopathogenesis is unclear; however it is suggested that it can arise as a reactive response to trauma. This report describes an aggressive variety of CGCG which raises a question; can extraction of tooth modify the behavior of CGCG? A 46 years old male had reported with a rapidly increasing intraoral and extraoral swelling of lower jaw following tooth extraction. Radiographic examination revealed a large multilocular lesion involving the body and ramus of mandible which had been proved to be aggressive CGCG on histopathological examination. The importance of radiographic examination prior to extraction of teeth and importance of inclusion of CGCG in jaw swellings associated with mobility of teeth or failure of healing sockets is emphasized.

Non-surgical periodontal therapy: An update on current evidence

Periodontal disease is an inflammatory condition that involves a complex interaction between pathogenic bacteria, environmental and acquired factors and host related factors. Till recently periodontal treatment was directed primarily towards reduction of bacterial load by subgingival debridement of root surfaces and modification of environmental risk factors. The current paradigm of periodontal disease stresses greater role of host-mediated inflammatory response in tissue destruction characteristic of periodontal disease. Various therapeutic modalities have been developed adjuvant to mechanical periodontal therapy. The use of laser and photodynamic therapy show great promise but their effectiveness has still not been conclusively proven. Chemotherapeutic agents, either systemic and local antimicrobials or host modulating drugs, played pivotal role in better and more predictable management of periodontal disease. The present review focuses on the best available evidence, for the current management of the chronic periodontal patients, gathered from systematic reviews and meta-analysis of mechanical non surgical periodontal therapy (NSPT) (subgingival debridement, laser therapy and photodynamic therapy) and the adjunctive chemotherapeutic approaches such as systematic and local antibiotics and antiseptics, subgingival pocket irrigation and host modulation therapies. The review also attempts to briefly introduce future developments in some of these modalities. At the end, the review summarizes the analysis of the current evidence that suggests that thorough subgingival debridement remains the mainstay of NSPT and that adjunct use of chemotherapeutic agents may offer better management of clinical parameters in periodontitis patients.

Pierre Robin sequence from orthodontic and surgical perspective

Pierre Robin sequence (PRS) is a triad of micrognathia, glossoptosis, and cleft palate that results in an obstruction of the airway on inspiration and impeding feeding. The tongue of infants with PRS fall back toward the posterior pharyngeal wall (glossoptosis) due to receding chin produced by mandibular micrognathia (small jaw) or retrognathia. This causes a serious condition with potentially severe, life-threatening airway obstruction. If untreated, this problem can lead to exhaustion, cardiac failure, and ultimately death, especially during the early months of life. Actually, in the majority of PRS infants, these symptoms can be managed by placing the infant in the prone position until adequate growth of the jaw occurs. If this type of treatment fails, the infant then should be considered for other conservative therapies or surgical interventions. This paper reviews surgical interventions such as tongue-lip adhesion, mandibular traction, mandibular distraction, tracheotomy and conservative orthodontic approaches, and presents a baby treated successfully with an orthodontic appliance.

Tissue restoration after improper laser gingivectomy: A case report

We report the case of 27-year-old female patient applied to our clinic with several pain at her upper teeth and weakness complaints. Anamnesis revealed that she experienced laser gingivectomy to have remarkable teeth. Clinical examination showed that maxillar alveolar bone was partially uncovered with gingivae and periosteum. Interproximal necrosed area was observed. She had sensitivity at her maxillar anterior teeth. Furthermore, she was so anxious and depressed. In order to ensure more blood supply and clot formation, perforations on uncovered cortical bone was prepared. Avoiding from infection antibiotic, antiseptic gel and for epithelization vitamin E gel were prescribed. During one month she was recalled every third day. Recall times diminished periodically, as new tissue evolves. Although laser’s irreversible photothermal effects on soft and hard tissue, after a year all denuded areas were covered with healthy tissues without any surgical procedures. Histopathologic comparing showed severe lymphocyte infiltration and increased fibrosis and kollagenization in restored gingiva, additionally epithelial loss was observed. Since there is not a case report about the complications of laser gingivectomy in literature, we tried to represent a treatment plan that may be elucidative for clinicians.

Host-derived biomarkers in gingival crevicular fluid for complementary diagnosis of apical periodontitis

Apical periodontitis (AP) develops as a result of the host’s immune inflammatory response to pulpal infection of the dental root canals that leads to the generation of an apical lesion of endodontic origin (ALEO) and potentially to systemic metabolic alterations. Misdiagnosed ALEO is not infrequent due to the lack of diagnostic tools to differentiate apical lesions of different natures. Despite the conservative endodontic treatment shows a high success rate, there are refractory cases that can not be identified early enough during follow up. This evidences the need to develop complementary diagnostic tools, such as oral fluid biomarker analysis. Gingival crevicular fluid (GCF) is a serum transudate that becomes an exudate under inflammatory conditions, carrying molecules from local periodontal tissues and general circulation than can be harvested non-invasively. We aimed to review the available literature analyzing GCF composition in AP patients to evaluate whether GCF has any potential for complementary diagnosis. To the date, only few studies addressing changes of GCF components in AP are available. Most studies support GCF modifications in specific components in AP-affected teeth, suggesting that it might reflect periapical inflammation. GCF has potential for diagnostic tool, treatment follow-up and eventually to assess systemic comprise.

Relationship between periodontitis and cardiovascular diseases: A literature review

Periodontitis and cardiovascular disease have a complex etiology and genetics and share some common risk factors (i.e., smoking, age, diabetes, etc.). In recent years, the relationship between periodontal disease and cardiovascular disease has been investigated extensively. This research mostly focused on the fact that periodontitis is an independent risk factor for cardiovascular disease. Our aim in this article is to investigate the etiological relationship between periodontal disease and cardiovascular disease and the mechanisms involved in this association. According to the current literature, it is concluded that there is a strong relationship between these chronic disorders.

Subconscious temporomandibular dysfunction therapy: A new therapeutic approach for temporomandibular disorders

AIM: To evaluate a new therapeutic approach that may permanently address excessive involuntary muscle activity which causes temporomandibular disorders (TMD).

METHODS: A cohort of 69 TMD patients (33 men and 36 women, age range 14-71 years) was treated with Subconscious Temporomandibular Dysfunction (STeDy) therapy. A thick awareness splint assisted patients to gradually recognize the interdependence between psychological pressure and subconscious muscle activity. The STeDy therapy lasted for one year and involved three stages: (1) data collection including medical history, clinical examination and psychological evaluation; (2) application of the awareness splint and consultation on a monthly basis; and (3) final evaluation.

RESULTS: About 10% of patients (3 men and 4 women) quit the STeDy therapy within the first 3-6 mo due to severe health problems or psychosocial reasons. Based on the absence of objective and subjective clinical symptoms as well as on radiographic findings, the temporomandibular dysfunction treatment was successful in all remaining 62 patients that completed the year-long therapy. Symptoms, including recurrent headache, morning fatigue, clicking sound or painful temporomandibular joint disorders, were eliminated in all patients within the first six months. By completion of the STeDy therapy, all patients had learned to recognize stressful conditions and cognitively avoided displaying excessive bruxism or other subconscious activity of the stomatognathic muscles. A follow-up after at least one year indicated the permanent nature of the cognitive treatment in all patients, illustrating the fact that subconscious muscle activity due to stress plays a principal role in the great majority of TMD, at least in adults.

CONCLUSION: The STeDy therapy successfully and permanently resolved TMD problems of all patients that completed the year-long treatment.

Stomatological management of head and neck cancer patients treated with chemotherapy and radiotherapy

Treatment of head and neck cancer with radiotherapy and/or chemotherapy can cause oral damage. Long-term treatment can damage the salivary glands, the oral mucosa, and the maxilla, leading to altered production of saliva and to multiple infections. These lesions can be prevented, limited or avoided by thorough evaluation prior to treatment and by therapeutic follow-up and preventive measures. The dentist must have strong medical knowledge of the possible short-, medium-, and long-term oral complications of the cancer treatment, and must have knowledge of the protocols for oral management of cancer patients. The availability of a multidisciplinary medical team together with a dentist to attend to the patient prior to the cancer treatment, as well as close communication between team members during and after treatment, is crucial. The aim of the present study was review the stomatological management of head and neck cancer patients treated with chemotherapy and radiotherapy and summarizing current treatments, therapeutic innovation and tissue regeneration perspectives.

Accuracy of linear vs spiral tomography: Alveolar crest to sinus/nasal floor height

AIM: To determine the accuracy of tomography in the linear measurement of alveolar bone at maxillary sinus/nose location.

METHODS: Two dry skulls each marked with 10 pairs of guttaperchas placed on buccal and lingual sides of the maxillary ridge were used in this in vitro study. The distance between the alveolar crest and the sinus/nasal floor was measured on tomographic views, prepared by linear and spiral techniques. The ridges were then sectioned so that each section would include one pair of buccal and lingual guttaperchas. The actual distances directly measured on the sections were compared to those of the equivalent tomographic sections (the magnification co-efficient was applied). Paired t-test was used to statistically analyze the data.

RESULTS: The measurement error with the application of linear tomography and spiral tomography was shown to be 0.455 ± 0.838 mm (P = 0.029) and 0.17 ± 0.78 mm (P = 0.347), respectively. There was a statistically significant difference between the liner tomography values and actual values (P = 0.029). This difference was representative of underestimation. McNamara’s test was used to assess the ± 1 mm error; 73.7% of the linear values and 84.2% of the spiral values were within the ± 1 mm error limit. McNamara’s test did not show any significant differences between the 2 methods in this regard (P = 0.625). The linear values were significantly different to the actual values (P = 0.029) but not to the spiral values (P = 0.185).

CONCLUSION: Spiral tomography has enough accuracy for the measurement of alveolar ridge height. Although linear tomography somewhat underestimates the actual values it provides satisfactory accuracy.

Soft tissue aneurysmal bone cyst of the mandible: Report of a case

We report the case of a 17-year-old boy with a soft tissue aneurysmal bone cyst (STABC) located in the posterior aspect of the right mandible. Conventional radiography revealed no positive findings. On the computed tomography scan, the lesion appeared to have a non-uniform intralesional density. Magnetic resonance imaging revealed an abnormal soft tissue masses with cystic component in the superficial part of right mandibular body and angle with intact cortex. Following histopathological examination, fibro-histiocytic proliferation, blood-filled spaces and multinucleated giant cells were seen and the lesion was diagnosed as a STABC. The mass together with underlying bone and periosteum on its periphery was surgically resected under general anesthesia. Thirty-six months after surgery the patient was assessed at outpatient clinic and found no sign of recurrence This may be only the first reported case of the mandible in the English literature of this extremely rare benign tumor occurring in soft tissue.

Surgical obturator duplicating original tissue-form restores esthetics and function in oral cancer

Oral cancer treatment primarily focused on the surgical removal of cancer tissues followed by surgical/prosthetic reconstruction. Restoration of the missing structures immediately after surgery shortens recovery time and allows patient to return to community as a functioning member. The most practiced surgical obturators are simple resin prosthetic bases without incorporation of the teeth. This article highlights a technique to fabricate a surgical obturator that duplicates patient’s original tissue form including teeth, alveolus and palatal tissues. The obturator is placed immediately after surgery and make patient feel unaware of surgical deformity. The obturator prosthesis fabricated with this technique supports soft tissues and minimizes the scar contracture. We have clinically tried this technique in 11 patients. Patients’ satisfaction level was recorded on visual analogue scale (VAS) and it ranges between 74% and 94% (with average of 87%). Four different prosthodontists have visually evaluated facial asymmetry of patients at 6 mo recall and their average perception on VAS varies between 71% and 93% (with average of 84%).

Pharmacogenomics in oral diseases

The availability of newer technologies for identification and characterization of the human genome has enabled our understanding of the genetic variations in a majority of human diseases. Human genomic sequence varies in less than 1% among the different population group and these differences known as gene polymorphisms are the primary reasons for differences in individuals’ response to various drug therapy. Also understanding the genetic changes may enable implementation of targeted therapy, thus providing for effective treatment strategies and minimizing the adverse side effects. Pharmacogenomics is a recent development in the field of personalized medicine which focuses on the genetic determinants of drug response at the levels of entire human genome. It primarily deals with tailoring of drug therapy for every individual based on their genetic make-up and identifying new target in various diseases for drug therapy. While the application of pharmacogenomics in systemic illness is well researched, its role in oral diseases needs documentation. Identifying specific targets in periodontitis, head and neck cancer, infections and genetic disorders can be beneficial in discovery of new drugs. This editorial provides an overview of basics of pharmacogenomics, its current role in disease management and its potential role in various head and neck diseases.

Cytotoxicity of a silorane-based dental composite on human gingival fibroblasts

AIM: To evaluate the direct and indirect biocompatibility of Filtek Silorane on human gingival fibroblastic cells.

METHODS: Sixty-three standardized cylindrical specimens (8 mm diameter and 2 mm thickness) of restorative material were prepared using a light emitting diode-curing unit. The sample were built up in one increment and divided in 2 groups. In the first group, 21 samples (unpolished samples) were left without a specific polishing procedure; in the second one, 42 samples (polished samples) were polished with 4 different grains of discs. Fibroblast cultures, obtained from gingiva of 2 subjects without systemic and oral disease, were used to assess the direct and indirect biocompatibility. Cells cultured for 48 h in normal culture medium were used as a control.

RESULTS: The scanning electron microscope observations of fibroblasts cultured on the silorane samples, either polished or unpolished, confirmed the good biocompatibility of the material, favouring the cellular spreading. 3-dimethylthiazol-2, 5-diphenyltetrazolium bromide tests showed a significant reduction (P < 0.01) of gingival fibroblasts viability cultured both in polished samples (90.05% ± 19.00%) and unpolished samples (78.15% ± 11.00%) compared with the control. Cells growth in medium conditioned with the samples for 1 wk showed a significant viability reduction (P < 0.01) compared to the control. A reduction of cell viability was observed even in the groups containing the material for 3 wk (polished: 89.45% ± 10.00%; unpolished: 65.97% ± 10.00%), even if the cytotoxicity was reduced after this long time exposure.

CONCLUSION: Although the poor chromatic availability of this material remains a big limit that restricts its use to posterior sectors, the silorane-based material can be considered an option to perform restorations when aesthetic demands are not the priority, such as the class II restorations

Molecular biomarkers of cell proliferation in ameloblastomas

Cell proliferation is a vital biological process that is important for all living organisms because of its role in growth and the maintenance of tissue homeostasis. The control of this important process differs greatly among benign and malignant neoplasms, and the evaluation of cell proliferation in neoplasms has become a common tool used by pathologists to provide useful information pertaining to diagnosis, clinical behavior, and treatment. The usefulness of information regarding cell proliferation has led to numerous studies on the value of these methods for diagnosing different types of tumors and for clinical decision making. Ameloblastomas are no exception. This review discusses the use of several classical molecular proliferation markers, including Ki-67, proliferating cell nuclear antigen, cyclin D1 and DNA topoisomerase II alpha, to characterize ameloblastomas and proposes the use of new proliferation markers used previously to characterize other neoplasms. The use of these biomarkers offers valuable opportunities to evaluate the biological behavior of this type of odontogenic tumor.

Evaluation of factors affecting the success rate of orthodontic mini-implants by survival analysis

AIM: To investigate the success rate of mini-implants and its characteristics and risk factors by survival analyses.

METHODS: Three hundred and ninety-four mini-implants of the same type were placed by a single clinician. Age, gender, treatment duration, time of failure, side and jaw of implantation and the soft tissue at placement site were recorded. Odds ratio, survival curves, and Cox proportional hazard model were applied to evaluate the factors influencing the mini-implants’ success rate.

RESULTS: The cumulative success rate was 88.1%. The maxilla had a significantly higher success rate than that of the mandible (91.7% vs 83.7%, respectively, P = 0.019). Placement of mini-implants in the attached gingiva (AG) showed a higher success rate than that of the mucogingival junction (MGJ) and mucous membrane (MM) (AG, 94.3%; MGJ, 85.8%; MM, 79.4%; P < 0.001). Significant association was found between the jaw and the gingival tissue type (P < 0.001). There were no significant differences between maxilla and mandible when compared within each placement site.

CONCLUSION: The gingival tissue type had the most significant effect on the success rate of the mini-implant with higher success rate in the attached gingiva.

Dental stem cells: Progress and perspectives

Dental pulp stem cells (DPSCs) are thought to contribute to reparative dentin formation, and that they may correspond to heterogenous populations of precursor cells or represent distinct differentiation stages along the odontoblastic lineage. DPSCs share many similarities with mesenchymal stem cells of the bone marrow (BMSCs). It appears that the distribution of tissue stem cells is not random and, within the dental pulp, there are potentially several distinct niches of stem/progenitor cells. In addition to DPSCs, other dental stem cell populations have been isolated. As for DPSCs, further studies are still needed to evaluate their potential of differentiation and their regenerative activity. Up today, (1) the formal demonstration that pulpal resident stem cells are actually the reparative dentin-forming cells recruited in response to injury is still lacking; and (2) the origin, localization and precise identity of odontogenic stem cells remain largely unknown. Dental clonal cell lines may represent valuable tool to answer some fontamental questions concerning the dental stem cell biology. Altogether, the presence of dental cell populations displaying stem cell properties has opened new paths for considering regenerative therapies. This might be a prerequisite to design alternative strategies for capping and endodontic treatment, using stem cells.

Management of missile injuries to the maxillofacial region: A case series

AIM: To assess our management of patients suffering from missile injuries to the maxillofacial region.

METHODS: From December 2009 to September 2012, 40 patients with missile injuries (high velocity gunshot and bullet wounds, explosive injuries and shrapnel etc.) affecting the maxillofacial region were treated. All except for 2 patients were males. All had soft tissue injuries with or without bone injuries. These patients were referred to the plastic and maxillofacial surgery ward of our hospital. The patients were 19 to 65 years of age (mean 45 years). In 19 cases, there were missile injuries to other parts of the body, especially the lower extremities. All of the patients were managed by early soft tissue debridement, comprehensive reconstruction and antibiotics. This retrospective study was approved by the IRB and ethical committees.

RESULTS: The majority of injuries were caused by high velocity projectiles (88%) and the remaining by car explosions or dynamite blasts (12%). 40 patients were treated surgically. Thirty patients had soft tissue loss (75%) and 20 patients (50%) had bone loss; there was combined soft tissue and bone loss in 10 (25%) patients. Facial fractures were in the orbital bones in 10 cases, maxillary in 7, nasal in 5 and the mandible in 3 cases. We used primary repair in the majority of soft tissue defects (25 of 40 cases). Bone repair was done primarily at the same stage using miniplates, titanium screws or wires. In some cases with a bone defect, iliac bone grafts were used simultaneously or in the later stages (mandibular defects). There was no failure of bone reconstruction in our cases. Infections occurred in two cases and were treated with systemic antibiotics and dressing changes, without any long term sequelae.

CONCLUSION: Our principles for soft tissue reconstructions were according to the reconstructive ladder and included primary repair, local flaps, skin grafts and regional flaps depending on the extent of damage. Primary repair in facial missile defects was not associated with increased morbidity or complications in this series. We recommend this approach when feasible.

Basic properties and types of zirconia: An overview

This paper describes types and characteristics of zirconia materials in relation to their applications in dentistry. The zirconia material typically used today by most manufacturers is a tetragonal polycrystalline zirconia, partially stabilized with yttrium oxide. The mechanical properties of zirconia have been extensively investigated in the scientific literature and zirconia clearly measures up to any other equivalent manufactured material. The biocompatibility of zirconia has also been extensively evaluated and no local or systemic adverse reactions or cytotoxic effects have been found in relation to it. However, ceramic bonding, ageing, light transmission and manufacturing processes are all factors that need to be further evaluated in order to guide the successful use of zirconia as a prosthetic restorative material. Milling zirconia to full-contour might be an alternative to traditionally veneered restorations. A potential adhesion mechanism appears to be the combination of air abrasion with aluminum oxide particles (silanated or not), followed by sintering with materials containing special reactive monomers. Changes in zirconia properties before and after the sintering process have also been investigated. It was found that after sintering, surface roughness was greater, and micro hardness was slightly reduced; however, accurate precision of fit was not affected by the sintering process. Currently, zirconia restorations are manufactured by either soft or hard-milling processes, with the manufacturer of each claiming advantages over the other. Chipping of the veneering porcelain is reported as a common problem and has been labeled as its main clinical setback. As zirconia has demonstrated good mechanical and biological performance, future technology is attempting to improve esthetics and minimize veneer fracture, aiming to create confidence in the dental community towards this all-ceramic system. Milling zirconia to full-contour might be an alternative to traditionally veneered restorations. Finally, implications are drawn for manufacturing, machining, and widespread use of these materials.

Clinical evaluation of implants in patients with maxillofacial defects

AIM: To show the efficacy of reconstruction and rehabilitation of large acquired maxillofacial defects due to tumor resections and firearm injuries.

METHODS: The study group comprised of 16 patients (10 men and 6 women) who were operated on because of their maxillofacial defects under local and general anesthesia between June 2007 and June 2011. Prosthetic treatment with the aid of dental implants was performed for all of the patients. Eight patients received an implant supported fixed prosthesis; six patients received implant supported overdentures and two patients received both. Patients were followed up postoperatively for 1 to 4 years. Implant success and survival rates were recorded. Panoramic radiographs were taken preoperatively, immediately after surgery, immediately after loading and at every recall session. Peri-implant and prosthetic complications were recorded. Subjects were asked to grade their oral health satisfaction after treatment according to 100 mm visual analog scale (VAS) and the oral health related quality of life of the patients was measured with the short-form Oral Health Impact Profile.

RESULTS: Five implants (3 in the mandible, 2 in the maxilla) in five patients were lost, while the other 53 survived, which brings an overall survival rate of 91.37% on the implant basis, but 68.75% on patient basis. All the failed implants were lost before abutment connection and were therefore regarded as early failures. For all failed implants, new implants were placed after a 2 mo period and the planning was maintained. The mean marginal bone loss (MBL) was 1.4 mm on the mesial side and 1.6 mm on the distal side of the implants. Five of the implants showed MBL > 2 mm (mean MBL = 2.3 mm) but less than 1/2 of the implant bodies and therefore were regarded as not successful but surviving implants. The VAS General Comfort mean score was 85.07, the VAS Speech mean score was 75.25 and the VAS Esthetics mean score was 82.74. No patient reported low scores (score lower than 50) of satisfaction in any of the evaluated factors. The mean of OHIP-14 scores was 5.5.

CONCLUSION: Although further follow up and larger case numbers will give more information about the success of dental implants as a treatment modality in maxillofacial defects patients, the actual results are encouraging and can be recommended for similar cases.

Quantitative scintigraphic analysis of the apical seal in Thermafil/Topseal and RealSeal 1/Realseal filled root canals

AIM: To investigate the microleakage of two different root canal obturation systems, using the nuclear medicine approach.

METHODS: Twenty-six single-rooted extracted teeth were selected. The crowns were sectioned to obtain 15-mm long root segments and each tooth was prepared using rotary ProFile^® instruments. The roots were divided into 2 experimental groups using RealSeal 1 and RealSeal sealer or Thermafil and TopSeal sealer as well as two control groups. On the 7^th and the 28^th day the apices were submersed in a solution of ^99mTc-Pertechnetate during 3 h. The radioactivity was counted using a γ camera.

RESULTS: The present study showed that none of the root canal-filled teeth was leakage free. The statistical analyses were made using Kruskal-Wallis and statistical significance was assessed using α = 0.05. Although apical leakage measured in counts per minute (cpm) in the Thermafil/TopSeal group was lower than in the RealSeal/RealSeal group (363 916 ± 180 707.7 cpm vs 533 427 ± 414 020.6 cpm) on 7^th day and (1 678 200 ± 567 217.4 cpm vs 2 240 518 ± 383 356.7 cpm) on 28^th day, there was no statistical difference (P > 0.05). In the Thermafil/TopSeal group and RealSeal 1/RealSeal group it was found that over time, the number of counts increased between 7 d and 28 d (363 916 ± 180 707.7 cpm vs 1 678 200 ± 567 217.4 cpm) and (533 427 ± 414 020.6 cpm vs 2 240 518 ± 383 356.7 cpm), respectively, with statistically significant differences (Thermafil/TopSeal group, P = 0.015 and RealSeal 1/RealSeal group, P = 0.036).

CONCLUSION: Both carrier-based Realseal 1 and Thermafil techniques showed a similar sealing effect, but none of the materials was leakage free.