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OBJECTIVES: Postoperative oral health-related quality of life is procedure-dependent and may vary during early healing. There is scarce evidence on patient-reported outcome measures (PROMs) after extraction and guided bone regeneration (GBR) or on the clinical parameters influencing PROMs. This prospective observational study aimed to evaluate PROMs during the first 2 weeks following extraction and GBR and correlate them with clinical parameters. METHODS: Patients undergoing extraction and GBR (bone graft and resorbable membrane) at a single tooth-bound site were recruited. PROMs (pain, swelling, difficulty of mouth opening, and OHIP-14) were recorded immediately preoperatively, and at 2, 7, and 14 days postoperatively. Flap advancement, gingival and mucosal thickness, duration of surgery, and wound opening were the clinical parameters assessed. RESULTS: Twenty-seven patients were included. All PROMs peaked on postoperative day 2, decreased subsequently and were significantly correlated with each other. Although 41-56% of patients reported moderate to severe pain, swelling, or mouth opening difficulty on day 2, most patients experienced mild or no symptoms throughout the postoperative period. Pain, swelling and difficulty of mouth opening were determinants of OHIP-14 and were correlated with all OHIP-14 domains during different time points. Wound opening peaked on day 7. Flap advancement, soft tissue thickness, wound opening, duration of surgery and preoperative PROMs affected postoperative PROMs. CONCLUSIONS: Within the limitations of the present study, postoperative symptoms after guided bone regeneration are worst on day 2 and oral health-related quality of life is significantly impacted by pain, swelling, difficulty of mouth opening, surgery duration and flap advancement. CLINICAL SIGNIFICANCE: This is the first study to report PROMs following extraction and GBR with particulate bone graft and resorbable membrane in preparation for implant placement. It will help guide both practitioners and patients on what should be the anticipated experiences following such a routinely performed surgery.
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Dolor Postoperatorio , Calidad de Vida , Humanos , Extracción Dental , Regeneración Ósea , Medición de Resultados Informados por el Paciente , Implantación Dental EndoóseaRESUMEN
Amongst dental ceramics, nano zirconia (ZrNp) has shown exceptional developments in the field of dentistry in recent years. Zirconia is an oxide that possess superior optical, mechanical, and biological properties. As a novel nanoparticle, it has been widely used in various fields of dentistry due to its improved mechanical properties, biocompatibility, and stable structure. Provision of metal free solutions is one of the prime requirements in dental materials. Many metal alloys used extensively possess unaesthetic colors and display chemical interactions in the oral cavity encouraging use of zirconia for dental use. Use of ZrNp based ceramics has increased due to its resistance to corrosion, superior color matching that enhances esthetics and improved strength compared to conventional biomaterials. This review discusses the recent scientific literature on the synthesis, properties and types, applications, and toxicity of ZrNp in the field of dentistry.
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Mesenchymal stem cells (MSCs) are extensively used in tissue regenerative procedures. One source of MSCs is the periodontal ligament (PDL) of teeth. Isolation of MSCs from extracted teeth is reasonably simple, being less invasive and presenting fewer ethical concerns than does the harvesting of MSC's from other sites. The objectives of this study were to isolate and characterize the PDL stem cells (PDLSC) from healthy adults' extracted teeth and then to characterize them by comparing them with bone-marrow derived MSCs (BMMSC). METHODS: The PDL tissue was scraped from the roots of freshly extracted teeth to enzymatically digest using collagenase. The cells were sub-cultured. Flow-cytometric analysis for the MSC surface-markers CD105, CD73, CD166, CD90, CD34, CD45 and HLA-DR was performed. To confirm the phenotype, total RNA was extracted to synthesize cDNA and which was then subjected to RT-PCR. The gene-expression for Oct4A, Sox2, NANOG and GAPDH was determined by gel-electrophoresis. To assess their multilineage potential, cells were cultured with osteogenic, chondrogenic and adipogenic medium and then stained by Alizarin-red, Alcian-blue and Oil-Red-O respectively. MSCs from the bone-marrow were processed similarly to serve as controls. RESULTS: The cells isolated from extracted teeth expanded successfully. On flow-cytometric analysis, the cells were positive for CD73, CD90, CD105, CD166 and negative for CD34, CD45 and HLA-DR. The PDLSCs expressed Oct4A, Sox2, and NANOG mRNA with GAPDH expression. Cells cultured in the osteogenic, chondrogenic and adipogenic media stained positive for Alizarin-red, Alcian-blue and Oil- Red-O respectively. The surface marker expression and the trilineage differentiation characteristics were comparable to those of the BMMSCs. CONCLUSIONS: The periodontal ligament tissue of extracted teeth is a potential source of therapeutically useful MSCs. Harvesting them is not invasive and are a promising source of MSC as the PDLSCs showed characteristics similar to those of the highly regarded MSC's derived from bone-marrow.
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BACKGROUND: The effects of lipopolysaccharide (LPS) on cell proliferation and osteogenic potential (OP) of MSCs have been frequently studied. OBJECTIVE: to compare the effects of LPS on periodontal-ligament-derived mesenchymal stem cells (PDLSCs) in monolayer and 3D culture. METHODS: The PDLSCs were colorimetrically assessed for proliferation and osteogenic potential (OP) after LPS treatment. The 3D cells were manually prepared by scratching and allowing them to clump up. The clumps (C-MSCs) were treated with LPS and assessed for Adenosine triphosphate (ATP) and OP. Raman spectroscopy was used to analyze calcium salts, DNA, and proline/hydroxyproline. Multiplexed ELISA was performed to assess LPS induced local inflammation. RESULTS: The proliferation of PDLSCs decreased with LPS. On Day 28, LPS-treated cells showed a reduction in their OP. C-MSCs with LPS did not show a decrease in ATP production. Principal bands identified in Raman analysis were the P-O bond at 960 cm-1 of the mineral component, 785 cm-1, and 855 cm-1 showing qualitative changes in OP, proliferation, and proline/hydroxyproline content, respectively. ELISA confirmed increased levels of IL-6 and IL-8 but with the absence of TNF-α and IL-1ß secretion. CONCLUSIONS: These observations demonstrate that C-MSCs are more resistant to the effects of LPS than cells in monolayer cell culture. Though LPS stimulation of C-MSCs creates an early pro-inflammatory milieu by secreting IL-6 and IL-8, PDLSCs possess inactivated TNF promoter and an ineffective caspase-1 activating process.
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Various cases of introduction of air into soft tissues have been reported in the dental literature. Here, we report a rare case of localized sublingual emphysema after alveoloplasty. There was no facial involvement. The patient responded to treatment and recovered uneventfully.
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A 70-year-old male presented with a slow growing, dome shaped and painless mass of the hard palate. The mass was excised. Histopathological examination confirmed the diagnosis of a angioleiomyoma (vascular leiomyoma). A leiomyoma is an uncommon benign tumor of smooth muscle differentiation. True leiomyomas of the oral cavity are rare and most oral tumors are derived from the smooth muscle of walls of blood vessels. Therefore, they are called vascular leiomyomas or angioleiomyomas. Clinically, they may resemble a myriad other conditions both benign and malignant. A definitive diagnosis depends upon histopathological examination of the biopsied tissue in correlation with the tumor cell immunohistochemistry. Tumors are excised and recurrence is rare. The histopathological findings and differential diagnosis of a case of a palatal angioleiomyoma are discussed.
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Angiomioma/patología , Neoplasias de la Boca/patología , Anciano , Humanos , Masculino , Paladar Duro/patologíaRESUMEN
In the present paper, we have utilized the concept of photonic crystals for the implementation of an optical NOT gate inverter. The designed structure has a hexagonal arrangement of silicon rods in air substrate. The logic function is based on the phenomenon of the existence of the photonic bandgap and resulting guided modes in defect photonic crystal waveguides. We have plotted the transmission, extinction ratio, and tolerance analysis graphs for the structure, and it has been observed that the maximum output is obtained for a telecom wavelength of 1.554 µm. Dispersion curves are obtained using the plane wave expansion method, and the transmission is simulated using the finite element method. The proposed structure is applicable for photonic integrated circuits due to its simple structure and clear operating principle.
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Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder characterized by the presence of cutaneous neurofibromas, multiple cafd-au-lait spots and pigmented nodules of the iris known as Lisch nodules. In some cases, the diagnosis can be made at birth while in others the diagnosis is made later in life based on the appearance of additional criteria. We describe radiographic abnormalities of the mandible in a young adult male with NF1.
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Anomalías Maxilomandibulares/etiología , Mandíbula/anomalías , Neurofibromatosis 1/complicaciones , Humanos , Anomalías Maxilomandibulares/patología , Masculino , Neoplasias Mandibulares/etiología , Neoplasias de la Vaina del Nervio/etiología , Adulto JovenRESUMEN
UNLABELLED: Marijuana, prepared from the plant Cannabis sativa, is the most widely used illicit drug in the United States. Marijuana use has been associated with adverse psychosocial and health effects, including effects on oral tissues. Periodontal literature has limited references to the periodontal effects of cannabis use. In this report, we present two cases of marijuana-associated gingival enlargement and review the literature on oral complications of marijuana use. METHODS: Two asymptomatic males, aged 23 and 42 years, presented independently for oral prophylaxis. Both had an unremarkable medical history and related a history of significant marijuana use of 2-16 years duration. Common findings following oral and periodontal examination were nicotinic stomatitis-like lesions, uvulitis and gingival enlargement. Marginal and papillary gingiva of the anterior dentition were the areas primarily affected by gingival enlargement, while some of these areas exhibited a nodular or "pebbly" appearance. RESULTS: Marijuana-associated gingival enlargement was diagnosed in the reported cases. A review of the literature revealed two other reports of marijuana-associated gingival enlargement, all in young adult males with chronic (2 or more years) cannabis use. These authors reported a resemblance to phenytoin-induced enlargement. Biochemical similarities between phenytoin and cannabis active compounds suggest possible common pathogenetic mechanisms. Uvulitis and nicotinic stomatitis appear to be the two most common of the several oral manifestations of marijuana use. CONCLUSIONS: Chronic marijuana use may result in gingival enlargement with clinical characteristics similar to phenytoin-induced enlargement.
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Cannabis/efectos adversos , Sobrecrecimiento Gingival/inducido químicamente , Fumar Marihuana/efectos adversos , Adulto , Cannabinoides/efectos adversos , Cannabis/química , Enfermedad Crónica , Humanos , Masculino , Enfermedades de la Boca/inducido químicamente , Enfermedades Respiratorias/etiología , Estomatitis/inducido químicamente , Úvula/efectos de los fármacos , Adulto JovenRESUMEN
The epithelioid blue nevus (EBN) is considered a cutaneous marker of the Carney complex. Sporadic EBN has been reported in patients not exhibiting the Carney complex. The EBN does not exhibit unique clinical features that help to differentiate it from other lesions and is often provisionally diagnosed as an acquired melanocytic nevus, or a malignant melanoma. A 52-year-old African-American female had a 3-4 mm bluish macule of the left anterior hard palate. An excisional biopsy was performed to rule out an incipient melanoma. Formalin-fixed, hematoxylin and eosin-stained sections were examined microscopically. On the basis of histopathological features, a diagnosis of EBN was rendered. We document a case of the rare EBN affecting the oral mucosa. The patient did not exhibit any features associated with the Carney complex. Two years post-operatively, there is no evidence of a recurrent tumor.
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The osteoma is a benign, bone-forming lesion that is not considered a true neoplasm. It almost exclusively affects the flat bones of the skull and face. Jaw lesions may cause facial deformity and impair oral function. Multiple osteomas may be associated with Gardner's syndrome. Clinically and radiographically, osteomas may need to be differentiated from other bone-forming lesions. This article describes a cancellous osteoma of the left maxillary molar and tuberosity area and differentiates it from other benign and malignant lesions, including the parosteal osteosarcoma.
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Neoplasias Maxilares/patología , Osteoma Osteoide/patología , Anciano , Humanos , Masculino , Neoplasias Maxilares/cirugía , Osteoma Osteoide/cirugíaRESUMEN
We propose a silicon-on-insulator (SOI) photonic crystal waveguide within a hexagonal lattice of elliptical air holes for slow light propagation with group velocity in the range 0.0028c to 0.044c and ultra-flattened group velocity dispersion (GVD). The proposed structure is also investigated for its application as an optical buffer with a large value of normalized delay bandwidth product (DBP), equal to 0.778. Furthermore it is shown that the proposed structure can also be used for time or wavelength-division demultiplexing to separate two telecom wavelengths, 1.31 microm and 1.55 microm, on a useful time-scale and with minimal distortion.
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Materiales Manufacturados , Dispositivos Ópticos , Silicio/química , Simulación por Computador , Diseño Asistido por Computadora , Conductividad Eléctrica , Diseño de Equipo , Análisis de Falla de Equipo , Luz , Miniaturización , Modelos Teóricos , Fotones , Dispersión de Radiación , Propiedades de SuperficieAsunto(s)
Enfermedades Cardiovasculares/fisiopatología , Mediadores de Inflamación/fisiología , Enfermedades Periodontales/fisiopatología , Enfermedades Cardiovasculares/complicaciones , Educación Continua , Humanos , Persona de Mediana Edad , Encuestas Nutricionales , Enfermedades Periodontales/complicacionesRESUMEN
BACKGROUND: The esthetic replacement of teeth has become an important standard for implant dentistry. While defining this goal has not been difficult, the ability to restore implants esthetically has been fraught with obstacles and sometimes has not been attainable. The purpose of this review is to summarize essential anatomical and surgical considerations for cosmetic implant dentistry. METHODS: This article provides a summary of the predominant findings from clinical studies and case reports that help develop implant surgical guidelines for better esthetic outcomes. RESULTS: Soft- and hard-tissue requirements for placing an implant in an ideal position are defined. The authors discuss the best treatment approaches as well as the limitations associated with esthetic implant placement. They evaluate the available data specifically for the maxillary anterior sextant, since this anatomical region has higher esthetic demands. CONCLUSIONS: Several parameters and various surgical techniques have been developed to manipulate soft- and hard-tissue contours and to control the esthetic outcome for implant-supported restorations. CLINICAL IMPLICATIONS: It is essential for practitioners to understand the anatomical basis for and limitations of implant dentistry in the esthetic zone.
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Implantación Dental Endoósea/normas , Implantes Dentales/normas , Proceso Alveolar/patología , Estética Dental , Humanos , Diente/anatomía & histologíaRESUMEN
BACKGROUND: Verruciform xanthoma (VX) is a benign lesion that primarily affects the oral cavity, most frequently the gingiva. VX lesions are characterized by xanthoma cells (lipid-laden macrophages or foam cells) found in the superficial connective tissue. To characterize these foam cells further, immunohistochemical techniques were used to investigate the presence of macrophage subpopulations in oral lesions of VX. METHODS: Sixteen biopsy samples of VX lesions from the oral cavity (six from gingiva, three from palate, and seven from other mucosa) were studied. Immunohistochemical analysis was performed using antibody probes to macrophage subpopulations, including RM3/1 (reparative), 25F9 (resident), and 27E10 (inflammatory). The percentage of antibody-labeled foam cells was determined by visual counts of selected fields within lesional connective tissue. RESULTS: The proportion of VX lesions that demonstrated positive xanthoma cell reactivity with antibodies RM3/1, 25F9, and 27E10 was 100%, 88%, and 50%, respectively. Foam cells that stained positively with RM3/1, 25F9, and 27E10 represented 61.5% +/- 19.6%, 51.8% +/- 29.4%, and 10.9% +/- 14.7% of the counted cells, respectively. When results were analyzed based on anatomic location (gingiva, palate, and other mucosa), there was no difference in the percentage of positively stained cells by anatomic site for any of the three antibodies (P >0.05). Similarly, there were no differences between masticatory (gingiva and palate) and other mucosa (P >0.05). CONCLUSIONS: VX lesions contain primarily reparative and resident foam cells, with limited numbers of inflammatory macrophages, consistent with a chronic reactive process. These findings were independent of the anatomic site.
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Xantomatosis/patología , Análisis de Varianza , Distribución de Chi-Cuadrado , Células Espumosas/patología , Humanos , Técnicas para Inmunoenzimas , Macrófagos/patología , Enfermedades de la Boca/patología , Mucosa Bucal/patología , Fenotipo , Estudios Retrospectivos , Estadísticas no ParamétricasRESUMEN
Heat produced within a root canal during use of an ultrasonic instrument can be conducted through the dentin into periodontal ligament, bone and soft tissue. If severe in intensity or long in duration, it can induce damage to these tissues. This report describes a case in which an ultrasonic endodontic instrument apparently induced severe damage to alveolar bone, gingiva and nasal mucosa in a 42-year-old female. Overheating of a maxillary central incisor caused necrosis of soft tissue and bone on the facial and mesial aspects and triggered a protracted inflammatory response in the adjacent nasal cavity. To relieve the severe discomfort associated with this damage, the patient chose to have her maxillary incisors extracted and replaced by a removable partial denture. A defect in the soft tissue and bone was present at a follow-up visit 10 months after the extractions. While morbidity of this nature is rare, this case reinforces the need to maintain adequate cooling of ultrasonic instruments.
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Quemaduras/etiología , Instrumentos Dentales/efectos adversos , Periodoncio/lesiones , Preparación del Conducto Radicular/efectos adversos , Terapia por Ultrasonido/efectos adversos , Adulto , Proceso Alveolar/lesiones , Quemaduras/complicaciones , Femenino , Encía/lesiones , Calor/efectos adversos , Humanos , Enfermedad Iatrogénica , Incisivo/lesiones , Enfermedades Maxilares/etiología , Mucosa Nasal/lesiones , Osteonecrosis/etiología , Preparación del Conducto Radicular/instrumentaciónRESUMEN
BACKGROUND: Gingival pigmentation is a common finding, may be of endogenous or exogenous origin, and can have diagnostic significance. Diffuse gingival pigmentation may be physiologic in nature or can be due to environmental factors, drugs, endocrine disorders, or genetic conditions. We present four cases of diffuse gingival pigmentation due to traditional gingival tattooing and review the literature on this practice. METHODS: Four black females (aged 19 to 56 years) of West African origin (Mauritania and Senegal), representing three different ethnic groups (Fulani, Mandinka, and Soninke) presented with various chief complaints. All exhibited diffuse pigmentation of the maxillary vestibular gingiva extending to the second premolar areas, without any associated radiographic abnormalities. The color ranged from intense blue gray to light gray or grayish pink. One case was biopsied for histopathologic evaluation. RESULTS: Questioning revealed that the women had had one or more sessions of traditional gingival tattooing. In one case, the procedure was performed in a dental office. The color range appeared to depend on the time that elapsed since the last procedure. The biopsy exhibited dense fibrous connective tissue containing aggregates of foreign material consistent with a foreign body tattoo. CONCLUSIONS: Gingival tattooing, a cultural practice prevalent in certain African ethnic groups, results in diffuse pigmentation. Outside of Africa, it may be misinterpreted as racial pigmentation or pose a diagnostic puzzle. The color and distribution pattern of diffuse gingival pigmentation often are quite suggestive, and the clinical diagnosis should be confirmed by patient history. In selected cases, biopsy may be necessary to exclude other diagnostic considerations.
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Enfermedades de las Encías/etiología , Trastornos de la Pigmentación/etiología , Tatuaje/efectos adversos , Adulto , Cultura , Diagnóstico Diferencial , Femenino , Humanos , Mauritania , Persona de Mediana Edad , SenegalRESUMEN
BACKGROUND: Human gingival fibroblasts actively accumulate fluoroquinolone antimicrobials. Because fibroblasts are prevalent in gingiva, they may help sustain therapeutic fluoroquinolone levels at that site. The purpose of this study was to determine whether mediators associated with infection or injury can enhance ciprofloxacin accumulation by gingival fibroblasts. METHODS: Quiescent fibroblast monolayers were treated for 1, 6, or 24 hours with several concentrations of tumor necrosis factor (TNF)-alpha, transforming growth factor (TGF)-beta1, platelet-derived growth factor (PDGF)-BB, fibroblast growth factor (FGF)-2, or insulin-like growth factor (IGF)-1. Transport was assayed by measuring cell-associated fluoroquinolone fluorescence. RESULTS: All mediators significantly enhanced ciprofloxacin transport in a dose dependent manner (P < 0.05; ANOVA). Except for TNF, this enhancement was associated with a decrease in the Km of ciprofloxacin transport. Maximal enhancement was observed with 10 ng/ml PDGF or FGF and 30 ng/ml TNF, TGF, or IGF. Brief (1 hour) treatment with TNF or FGF upregulated ciprofloxacin accumulation by a maximum of 13% to 14%, whereas TGF, PDGF, and IGF enhanced this process by 19% to 24%. All of the mediators enhanced ciprofloxacin accumulation by a maximum of 19% to 24% after 6 hours and 30% to 38% after 24 hours. The accumulation of other fluoroquinolones (e.g., gatifloxacin) was also slightly enhanced. CONCLUSIONS: Gingival fibroblasts treated with cytokines or growth factors accumulate significantly more ciprofloxacin than untreated controls. This provides a mechanism by which ciprofloxacin could be preferentially distributed to gingival wound or inflammatory sites, yielding local therapeutic levels that are more sustained than in serum.