Dentists' perception of third molar surgery in the Kingdom of Saudi Arabia: A cross sectional pilot study

Background/purpose

Concerns about the indications for the surgical removal of third molars have not yet reached a decisive agreement. The aim of the study was to evaluate the perception and practice of Saudi' dentists when encountering third molars clinical situations including diagnosis, treatment, and postsurgical care.

Materials and methods

A cross-sectional survey was conducted and approved by the ethics research committee at Prince Sattam Bin Abdulaziz (PSAU). The survey comprised of four sets of questions with multiple-choice answers including the participants' details and type of practice (private or government), clinical awareness and attitude regarding lower third molars surgery, and the confidence level of dentists when performing third molars extraction. The survey was published online with a timeframe of three months to respond.

Results

196 participants responded to the designated survey (55 dental interns and 141 general dental practitioners (GPs)). Most responses (80.1%) were from Riyadh province (central region). There was a significant difference between GPs and interns in terms of impacted third molars with associated cystic lesions, bony impactions, and diffuse pain (P < 0.05). Male dentists tend to prescribe antibiotics more than female dentists (P = 0.001) and GPs more than interns (P = 0.027). The results also indicated that male dentists were more confident than females when performing third molar extraction. Generally, female dentists preferred to have further training on such surgery (P < 0.05).

Conclusion

Continuing professional development programs both during dental internship and general practice are recommended to improve the required skills of third molar extraction.

The Effect of Full-Scale Exchange of Ca2+ with Zn2+ Ions on the Crystal Structure of Brushite and Its Phase Composition

This study was carried out to investigate the effect of a complete exchange of Ca2+ with Zn2+ ions on the structure of brushite (CaHPO4·2H2O), which might be advantageous in the production process of CaxZn1-xHPO4·nH2O. To acquire the starting solutions needed for the current study, (NH4)2HPO4, Ca(NO3)2·4H2O, and Zn(NO3)2·6H2O were utilized in several molar concentrations. The findings indicate that Ca is partly substituted by Zn when the Zn/Ca molar ratio is below 0.25 and that Zn doping hinders the crystallization of brushite. A continued increase in the Zn/Ca molar ratio to 1 (at which point the supersaturation of the Zn solution rises) led to a biphasic compound of monoclinic brushite and parascholzite precipitate. Elevating the Zn/Ca molar ratio to 1.5 resulted in a precipitate of a parascholzite-like mineral. Finally, increasing the Zn/Ca molar ratio to 4 and above resulted in the formation of the hopeite mineral. Future biomaterial production with specific and bespoke characteristics can be achieved by adjusting the Zn/Ca ratio in the starting solution. It Rhas been established that the Zn/Ca ratio in the starting solution can be adjusted to obtain minerals with specific compositions. Thus, new synthesis methods for parascholzite and hopeite were introduced for the first time in this manuscript.

The Role of the Lateral Pterygoid Muscle in Articular Disc Displacement: A Cross-Sectional Magnetic Resonance Imaging Study

BACKGROUND

Determination of the role of the Lateral Pterygoid Muscle LPM in the articular disc displacement ADD is controversial referring to the variations in the pattern of insertion of the Superior Lateral Pterygoid Muscle SPLM.

INTRODUCTION

it was well understood that the superior head of the lateral pterygoid muscle has only a single insertion pattern among individuals in which the muscle is attached to the articular disc and capsule. However, recent findings in many studies have shown a noticeable variation in the insertion pattern of the upper LPM.

METHODS

MRI examinations were collected at King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia. Scans of 61 patients (41 females, 20 males, mean age 33 years old) with symptoms of temporomandibular dysfunction were reviewed retrospectively. The direction of their articular disc displacement was evaluated through sagittal and coronal views in both open and closed mouth positions.

RESULTS

There was no statistical significance found between the LPM attachment types and TMJ disc position. The chi-square test also showed no significant difference between the type of LPM attachment and the condylar location. Forty-five percent of the articular discs were located between the articular eminence and the glenoid fossa. The majority of the disc displacement was in the anterior direction.

CONCLUSION

There was no statistically significant association between the type of LPM attachments and the direction of disc displacement.

The bidirectional relationship between epilepsy and depression

Introduction

The relationship between epilepsy and depression has been recognized for a long time. In fact, the presence of depression could worsen the disease outcome.

Objectives

we aimed to study the prevalence of depression in patients with epilepsy and to assess the determinant factors of its genesis.

Methods

54 patients with epilepsy, aged more than 18 years, attending the neurology department of Habib Bourguiba Hospital, Sfax, Tunisia, were enrolled for the study. All patients were administered Mini-International Neuropsychiatric Interview (MINI) for evalution of psychiatric comorbid disorders especially depression. Socio-demographic and clinical data were collected.

Results

A total of 54 patients were included, of whom 63% (n =34) were men. Mean duration of epilepsy was 20.13 years. The most frequent type of seizure was generalized 72.7%. Depression was present in 7.3 % of patients. Alcoholism (p=0.027) was significantly associated with occurrence of depression. Drug resistence (p = 0.03) and longer duration of epilepsy (p = 0.046) were significantly associated with occurrence of depression. No significant association was found between type of seizure, seizure frequency, medication compliance and depression. Depression wasn’t associated with anti-epileptic drug. We didn’t find any association between depression and other psychiatric comorbidities.

Conclusions

Depression wasn’t frequent in our study contrary to literature. The possible explanations are the reduced simple size and the sensitivity of the used tool to assess depression in epilepsy. Pursuant to literature, we found significant association between Alcoholism, drug resistance and long duration of epilepsy.

Gayet wernicke encephalopathy: Don’t miss this neuropsychiatric emergency!

Introduction

Gayet Wernicke Encephalopathy (GWE) is a diagnostic and therapeutic neuropsychiatric emergency due to thiamin deficiency (vitamin B1).

Objectives

The purpose of our work is to recall some clinical situations suspecting GWE, along with radiological and evolutionary profile.

Methods

We conducted a retrospective study concerning patients who were hospitalized in the neurology department of Habib Bourguiba Hospital between 2013 and 2020 for management of GWE.

Results

The median age of 7 patients was 39.57 years with sex ratio (H/F):1.33. The most common risk factor found is incoercible vomiting (5 patients), followed by chronic alcoholism (3 patients). Confusional state was the most frequent symptom found in 4 patients. The characteristic clinical triad of confusion, oculomotor disorders and ataxia was only found in 2 patients. Neuroimaging showed a typical aspect in 3 patients. The serum levels of thiamine were low in five patients and normal in two patients. After receiving parental than oral thiamin supplementation, three patients were independent after one month with a mRS score <3.

Conclusions

GWE is an acute neuropsychiatric emergency. Chronic alcoholism is recognized as its most common cause. The clinical triad is not constantly present. MRI shows typically bilateral symmetrical hyperintensities in periaqueductal area, periventricular region, thalami and mammillary bodies. Thiamin level can be normal since it does not accurately represent body thiamine status or in case of mutations in a thiamine-transporter gene. Thiamine therapy is warranted if any component of the GWE triad is present in an appropriate clinical setting to prevent irreversible neurological sequelae.

Psychometric Properties of the Greek Version of FCV-19S

As COVID-19 delivered a devastating blow around Europe, unprecedented mental health issues have arisen. This study outlines the Greek translation and validation of the Fear of COVID-19 Scale (FCV-19S) in the general population. A sample of 3029 Greek-speaking individuals completed the FCV-19S, as part of a large online survey reporting on the aftermath of the coronavirus on the psychological health of Greeks. A total of 2970 participants completed all items without missing values, and their responses were included in the statistical analysis. The confirmatory factor analysis suggested an acceptable model fit. The internal consistency measured by Cronbach's alpha = .87 for the whole scale. All hypothesized correlations were as expected, confirming the construct validity of the scale. The results of the analyses suggest that the psychometric properties of the Greek FCV-19S are sufficient.

P4467PCSK9 and Lp(a) levels of children born after assisted reproduction technologies: results from a pilot study

Background

Since the introduction of Assisted Reproduction Technologies (ART) in clinical practice several studies have addressed concerns regarding the long-term health of the offspring and have revealed indications of an adverse cardiovascular/cardiometabolic outcome. Proprotein convertase subtilisin/kexin type 9 (PCSK9) and lipoprotein (a) (Lp[a]) levels have been associated with cardiovascular risk.

Purpose

To investigate PCSK9 and Lp(a) levels of children born after ART compared with naturally conceived (NC) controls.

Methods

In this case-control study, 73 sex- and age-matched children (mean age 98±35 months) of ART (intracytoplasmic sperm injection [ICSI]: n=33, classic in vitro fertilization [IVF]: n=40) and 73 NC children were assessed. Blood lipid profile, including PCSK9 and Lp(a) levels, was measured. Children were grouped according to age (<8 years, 8–10 years, ≥10 years).

Results

In the univariate model of the overall population, circulating PCSK9 levels were related to total cholesterol (r=0.186, P=0.025), LDL-C (r=0.180, P=0.029) and SBP (r=0.199, P=0.021). Similarly, circulating Lp(a) levels were related to age (r=0.269, P=0.001), apoB (r=0.214, P=0.01), birth weight (r=−0.183, P=0.037), height (r=0.263, P=0.001), waist-to-hip ratio (r=−0.350, P<0.001), HOMA-IR (r=0.319, P<0.001), insulin (r=0.316, P<0.001), and hsCRP (ρ=0.241, P=0.018). No significant differences were observed regarding lipid biomarkers between ART and NC children. (p=0.515 for PCSK9 and p=0.277 for Lp(a) values). It is noteworthy that a significant interaction was found between age groups and conception method (P<0.001) showing that PCSK9 levels increase with age in ART children, while they decline with age in NC offspring (Figure 1). IVF children showed higher levels of adjusted mean Lp(a) than ICSI (13.5 vs. 6.8 mg/dl, P=0.010) and NC children (12.3 vs. 8.3 mg/dl, P=0.048).

Mean LogPCSK9 concentrations with the st

Conclusions

PCSK9 and Lp(a) levels did not differ between ART and NC children. Nonetheless, PCSK9 levels increase with age in ART children indicating a gradual deterioration of lipidemic profile that could lead to increased cardiovascular risk. Moreover, our results imply that ART method may be of importance given that classic IVF is associated with higher levels of Lp(a). The impact of the method of conception on PCSK9 and Lp(a) values should be validated in larger patient series.

Efficiency of Er:YAG utilization in accelerating deep bite orthodontic treatment

Background and aims

The long duration of orthodontic treatment is a major patients' concern. A noninvasive method of accelerating tooth movement in a physiological manner is needed. The aim of the study was to evaluate the effects of Er:YAG laser application during orthodontic treatment of deep bite and to evaluate its analgesic effect during that movement.

Materials and methods

A prospective randomized controlled clinical trial (RCT) was performed on 30 patients with deep bite. Sample was divided into two groups: (A), 15 patients (orthodontic treatment-control group) and (B), 15 patients (orthodontic treatment and Er:YAG Laser - laser group). The tooth movement was evaluated as the primary outcome variable by measuring angular and linear changes on three progress lateral cephalometeric radiographs (T1, T2 and T3); Lateral cephalograms were taken before treatment (T1), immediately after finishing the stage of leveling and alignment (T2) and after completion of the intrusion stage (T3).Laser parameters were 400 mJ/10 Hz/4 W and 400 mJ/15 Hz/6 W, depending on the handpiece used. The levels of pain and discomfort were evaluated and ranked according to a visual analog scale. Paired t-tests or Wilcoxon matched-pairs signed-rank tests were used to detect significant differences.

Results

The main findings of the treatment were (1) significant positive difference in the rates of tooth intrusion movement on the experimental group compared with the control group at the baseline to T2 and T3 interval and the tooth movement rate was approximately 3 times faster in the experimental group. (2) The pain score in the experimental group was significantly lower compared with the control group on day 3 as on day 7.

Conclusion

The application of Er:YAG laser is an effective mean to speed orthodontic tooth movement with a significant reduction in pain and discomfort after application.

Elemental formula associated hypophosphataemic rickets

OBJECTIVES

Hypophosphataemic rickets (HR) is usually secondary to renal phosphate wasting but may occur secondary to reduced intake or absorption of phosphate. We describe a series of cases of HR associated with the use of Neocate^®, an amino-acid based formula (AAF).

METHODS

A retrospective review of cases with HR associated with AAF use presenting to centres across the United Kingdom.

RESULTS

10 cases were identified, over a 9 month period, all associated with Neocate^® use. The age at presentation was 5 months to 3 years. The majority (8/10) were born prematurely. Gastro oesophageal reflux disease (6/10) was the most frequent indication for AAF use. Radiologically apparent rickets was observed after a median of 8 months (range 3-15 months) of exclusive Neocate^® feed. The majority (7/10) were diagnosed on the basis of incidental findings on radiographs: rickets (6/10) or fracture with osteopenia (5/10). All patients had typical biochemical features of HR with low serum phosphate, high alkaline phosphatase, normal serum calcium and 25 hydroxyvitamin D. However, in all cases the tubular reabsorption of phosphate (TRP) was ≥96%. Phosphate supplementation resulted in normalisation of serum phosphate within 1-16 weeks, and levels remained normal only after Neocate^® cessation. In patients with sufficient follow up duration (4/10), normalisation of phosphate and radiological healing of rickets was noted after 6 months (range: 6-8 months) following discontinuation of Neocate^®.

CONCLUSION

The presence of a normal TRP and resolution of hypophosphataemia and rickets following discontinuation of Neocate^® indicates this is a reversible cause likely mediated by poor phosphate absorption. Close biochemical surveillance is recommended for children on Neocate^®, especially in those with gastrointestinal co-morbidities, with consideration of a change in feed or phosphate supplementation in affected children.

Critical Appraisal of Clinical Research

Evidence-based practice is the integration of individual clinical expertise with the best available external clinical evidence from systematic research and patient's values and expectations into the decision making process for patient care. It is a fundamental skill to be able to identify and appraise the best available evidence in order to integrate it with your own clinical experience and patients values. The aim of this article is to provide a robust and simple process for assessing the credibility of articles and their value to your clinical practice.

Protocol Writing in Clinical Research

Writing a research proposal is probably one of the most challenging and difficult task as research is a new area for the majority of postgraduates and new researchers. The purpose of this article is to summarize the most important steps and necessary guidelines for producing a standard research protocol. Academic and administrative success of any project is usually determined by acquiring a grant for the related field of research. Hence, the quality of a protocol is primarily required to achieve success in this scientific competition.

Hemorrhage Secondary to Interforaminal Implant Surgery: Anatomical Considerations and Report of a Case

Understanding the anatomy of the floor of mouth is very important as severe submandibular hemorrhages are life threatening. This case report illustrates the potential hemorrhage consequences of implant surgery within the interforaminal region. The highly vascularized interforaminal region is susceptible to hemorrhage, which can be induced simply by instruments causing vascular trauma. The risk of intraoperative bleeding can be minimized by painstaking preoperative clinical and radiological examination but cannot be averted as it is inherent in the underlying anatomy of the region.

Morphology of root canals in lower human premolars

Background

The knowledge of the root canal morphology and the possible anatomical variations of mandibular premolars are important for the successful endodontic treatment of such cases. The aim of this study was to investigate the presence of two or three root canals in extracted first and second mandibular premolars which were collected from health centers in Syria.

Materials and Methods:

One hundred and ten human mandibular premolars (70 first premolars and 40 second premolars) with fully developed roots were investigated. After access the cavity of the teeth, the root canals were explored and radiographs were taken.

Results:

Premolars with one canal were found in 87% of cases (53% first premolar and 34% second premolar) and premolars with two canals were found in 12% of cases (10% first premolar and 2% second premolar). There was just one case (1%) where a first premolar had three canals. These differences were statistically significant with P<0.05.

Conclusion:

Clinicians should be aware of the anatomical variation in the mandibular premolars and be able to apply this knowledge in radiographical and clinical interpretation.

Reappraisal of the removable partial denture as a treatment option for the shortened dental arch

For patients with shortened dental arches, many treatment options are available. The existing situation can be maintained by stabilizing the present dentition and improving the occlusion without extending the arch. Alternatively, the shortened dental arch can be extended by either a free-end saddle removable partial denture, cantilevered fixed bridge, or by an implant-supported prosthesis. The free-end saddle removable partial denture can be considered a simple, non-invasive, and relatively cheap treatment option for the shortened dental arch. It was believed that such prosthodontic rehabilitation would be beneficial for the patients in terms of improving oral functions. However, the existing literature indicates that the prognosis of free-end saddle removable partial denture is not predictable, it is problematic, and its contribution to oral functions in patients with shortened dental arches is considered to be dubious. This paper reviews and summarizes the current literature about the outcome of extending the shortened dental arch by a free-end saddle removable partial denture. It also outlines factors that may affect the prognosis of this prosthetic treatment.

Immunohistochemical expression of p16 in pleomorphic salivary adenoma

OBJECTIVE

This study aimed to characterize alteration in the immunohistochemical expression of p16 in normal tissue of the salivary gland surrounding pleomorphic adenoma, and the tumor cells of pleomorphic adenomas.

MATERIAL AND METHOD

A selected series of 120 cases of pleomorphic adenomas were examined.

RESULTS

The results showed that p16 expression in non tumor duct cells was strong positive nuclear staining in 98 (81.6%) cases out of 120, while there were 20 (16.6%) with moderate staining, and 2 (1.6%) with weak staining in the components of normal tissue of the salivary gland surrounding pleomorphic adenoma. p16 expression in pleomorphic adenomas showed 71 (59.1%) cases with moderate nuclear staining in the duct cells, 45 (37.5%) cases with nuclear weak staining, and 4 (3.3%) cases with negative staining. p16 nuclear staining in myxochondroid tissue was identified in 4 (3.3%) cases with strong staining, 65 (54.1%) cases had moderate staining, and 51 (42.5%) cases had weak staining.

CONCLUSION

This study suggests alteration of p16 expression in pleomorphic adenomas. P16 might have a role in the development of pleomorphic adenoma.

Ailing and failing oral implants: initial therapy and surgical management

The distinction between ailing and failing implants is clinically important. Changes in the peri-implant soft or hard tissues will indicate whether the implant is ailing, failing, or has failed. This article discusses these clinical situations and provides an overview and description of peri-implant diseases and their treatment alternatives.

Retinol Binding Protein 4 in children with Inflammatory Bowel Disease: a negative correlation with the disease activity

OBJECTIVES

Retinol Binding Protein-4 (RBP-4), the action of which was initially thought to be only the transport of vitamin A, is a major circulating adipocytokine involved in the inflammation. We evaluated the serum RBP-4 levels in children with inflammatory bowel disease (IBD) and correlated them with transthyretin (TTR), inflammation markers, disease activity, and body mass index (BMI).

DESIGN

In 41 children of mean age 11.9 ± 3.6 years (range 5-17.7 y) with IBD (19 with Crohn's disease (CD) and 22 with Ulcerative colitis (UC) serum RBP-4, TTR, Amyloid A (SAA), C-Reactive Protein (CRP), Erythrocyte Sedimentation Rate (ESR), disease activity and BMI were prospectively determined and compared with those of 42 matched controls.

RESULTS

No difference in the RBP-4 and TTR serum levels, between patients and controls as well as between active and remission state of the disease was noticed. A negative correlation of serum RBP-4 with the disease activity, SAA and ESR and a positive correlation with TTR was found, but no significant correlation with CRP or BMI was found. Inflammation markers were significantly increased in patients compared to controls and had a positive correlation with the disease activity.

CONCLUSIONS

RBP-4 negatively correlated with disease activity of children with IBD probably indicating a protective anti-inflammatory mechanism of action in addition to transport of vitamin A.

Factors associated with early and late failure of dental implants

Osseointegration is a good indication of the clinical success of titanium implants referring to the direct anchorage of such implants to the surrounding host bone. Despite the high success rate of endosseous dental implants, they do fail. A lack of primary stability, surgical trauma, and infection seem to be the most important causes of early implant failure. Early signs of infection may be an indication of a much more critical result than if the same complications occur later, because of disturbance of the primary bone healing process. Occlusal overload and periimplantitis seem to be the most important factors associated with late failure. Suboptimal implant design and improper prosthetic constructions are among those risk factors responsible for implant complications and failure. This concise review highlights the main causes associated with early and late implant failure, as thorough knowledge of this unavoidable clinical fact is essential in the field of oral implantology.

Investigation of the effect of ibuprofen on the healing of osseointegrated oral implants

OBJECTIVE

To investigate the effect of a 1-week postoperative course of 600 mg of ibuprofen taken four times a day on marginal bone level around oral implants.

MATERIALS AND METHODS

Twenty-eight patients were allocated to the ibuprofen group (14 patients) or no-ibuprofen group (14 patients). Overall, 57 implants were inserted, 31 implants in the ibuprofen group and 26 in the no-ibuprofen group. The primary outcome measure was the change in marginal bone level around oral implants from baseline (2 weeks postplacement) to the 3- and 6-month radiographic examinations. The paralleling technique and a film holder coupled to a beam-aiming device were used to take the periapical radiographs. Measurement of changes in bone level was made using a viewing box and ×8 magnifier.

RESULTS

Three subjects were withdrawn from the therapy early as they did not complete the dose of ibuprofen (e.g. because of self-reported stomach upset). The mean marginal mesial bone loss from the baseline was 0.37 mm at the 3-month and 0.27 mm at the 6-month follow up for the ibuprofen group, while the corresponding values for the no-ibuprofen group were 0.15 mm and 0.08 mm. The mean marginal distal bone loss from the baseline was 0.42 mm at the 3-month and 0.2 mm at the 6-month follow up for the ibuprofen group, while the corresponding values for the no-ibuprofen group were 0.08 mm and 0.15 mm. There were no significant differences between the ibuprofen and no-ibuprofen groups when comparing the bone changes.

CONCLUSION

Administration of a short course of systemic ibuprofen for postoperative pain management following implant insertion may not have a significant effect on the marginal bone loss around oral implants in the early healing phase.

Radiographic evaluation of healing tissues of early-failing implants after therapy: a case report

Aside from clinical evaluation, the interpretation of radiographic images is one of the most frequently applied diagnostic procedures in patients with oral implants. Radiology is an important part of treatment with tissue-integrated prostheses, both at the pre-operative stage to obtain full assessment of the bony host and at the post- operative stage to assess the clinical result. Radiographic examination of peri-implant tissues is an essential diagnostic prerequisite for the evaluation of success and failure of oral implants. A case of peri-implant radiolucency detected 3 months after surgical placement is presented. A remarkable regression of the radiolucency was noticed after a successful anti-infective therapy. The aim was to stress the role of oral radiology in exploring peri-implant bone defects. At this point, appropriate intervention might save early-failing implants from complete loss of osseointegration.

Preparation of YBa2Cu3O7-δ Superconductor by Sol-Gel Method and Fiber Drawing

Superconducting YBa2Cu3O7-δ, ceramic pieces and fibers were prepared through a sol-gel route from ametal acetate aqueous solution of controlled pH. Concentrating the starting solution by evaporating the solvent provided a transparent viscous sol, from which gel fibers could be drawn. Further concentrating of the viscous solution led to formation of gel pieces. Conversion of gel fibers and pieces to superconductors were investigated in terms of precipitating crystalline species and electrical conductivities.