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.

MMP-8 analysis in gingival crevicular fluid using ELISA and novel chair-side test

AIM: To validate accuracy of a novel chair-side test for matrix metalloproteinase (MMP)-8 as compared to enzyme-linked immunosorbent assay (ELISA) in Periodontal health and disease.

METHODS: Gingival crevicular fluid was collected from 150 subjects, Group 1 (healthy) - 50 subjects, Group 2 (gingivitis) - 50 subjects and Group 3 (chronic periodontitis) - 50 subjects. A chair-side test strip was indigenously prepared using polyclonal antibodies (principle of immunochromatography) to detect the MMP-8 levels. The detection accuracy (sensitivity and specificity) of the MMP-8 levels by chair-side test kit were compared with ELISA at baseline and 3 mo after scaling and root planing among the study population.

RESULTS: The novel chair side test detected MMP-8 levels in accordance with ELISA which at baseline were higher in Group 2 and Group 3 as compared to controls (P < 0.05), and these enzyme levels decreased after therapy (P < 0.05). The chair-side test could differentiate healthy, gingivitis and periodontitis. The detection accuracy of the chair-side test strip were on par with ELISA (sensitivity 92.9% and specificity of 100%) which were statistically significant (P < 0.05). A desire to arouse interest about periodontal health and maintenance in the Indian population provided a strong rationale for us to develop our chair-side test strips to suit our economy. Moreover, this was the first ever effort to develop and validate a chair-side test strip to detect MMP-8 levels in the Indian population. This test can be used on a large scale in private dental practice for the early detection of disease, tapping the sites at risk for disease, alongside helps in patient education and motivation for maintenance.

CONCLUSION: This study shows that the novel chair side test kit detects MMP-8 levels a biomarker of periodontal disease progression accurately making it a good chair side diagnostic tool. Further, it is cost effective and time saving which can make it applicable in private dental practice on a large scale for the early detection of periodontal disease.

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.

What is the purpose of launching the World Journal of Stomatology?

Congratulations to the publisher, members of the editorial board of the journal, all the authors and readers for launching the World Journal of Stomatology (WJS) as a new member of the World series journal family! Significant scientific advances and important breakthroughs need to be published to impact dental care and reach an audience of researchers and clinicians who can create more effective dental treatments for their patients. There is a need to share scientific information, methodologies, therapies, and hypotheses related to stomatology, through an open-access format, to reach the widest possible audience. The WJS was created to fulfill the role of disseminating the most significant, innovative and transformational cutting edge research in dentistry. The WJS is a peer-reviewed open-access periodical centered in stomatology, with a multidisciplinary coverage that will publish high-impact articles in all areas of the dental clinical specialties, applied science, epidemiology, trauma and dental care, dental materials, oral biology and microbiology. The WJS is not scared of controversy or challenges to existing doctrine, since they are supported by high-quality science or unequivocal clinical outcomes. The WJS will avoid publishing confirmatory and low-impact articles. The WJS will only publish articles directly relevant to stomatology and dentistry because this is what our readers expect. If you need to share any exciting dental research discoveries and reach the widest possible audience, you will find in the WJS the most helpful resource to publish your papers!

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.