Advanced platelet-rich fibrin plus and osseous bone graft for socket preservation and ridge augmentation - A randomized control clinical trial

Objective

To compare the clinical and radiographic effectiveness of A PRF Plus as an adjuctive material to osseous bone graft in socket preservation and ridge augmentation.

Methods

Twenty patients with need to preserve extraction socket in non-molar sites planning for further prosthetic rehabilitation were divided into two groups. Test Group (Group A) was treated with A PRF Plus membrane and Sybograf plus ™ (70% HA and 30 %β TCP) bone graft. The Control Group (Group B) was treated with Sybograf plus ™ (70% HA and 30% βTCP) bone graft. Both groups had same socket preservation surgical technique.

Results

Both Group A and Group B showed significant improvement in clinical and radiographic parameters. Mean socket length, Vertical Resorption reduction in Group A was 1.48 whereas in Group B was 1.67 which is statistically significant. (p ​≤ ​0.05). Changes in Horizontal width reduction at 1,3, and 5 ​mm depth of the socket for both groups were not statistically significant. The Gain in socket fill for Group A and B 6 months postoperatively was 1185.30HU ± 473.21 and 966.60 HU ± 273.27 respectively. But intergroup comparison was not statistically significant. (p ​= ​0.17). There were no significant statistical differences in postoperative pain in Group A and Group B as subjects experienced moderate amount of pain. The assessment of post-operative swelling showed that only 30% subjects in Group A reported with swelling. Whereas 80% subjects in Group B complained of post-operative swelling.

Conclusion

The results of the present study proved utilisation of A PRF Plus as a promising adjunct to conventional regenerative therapy for socket preservation.

High-dose salvage re-irradiation for recurrent/progressive adult diffuse glioma: healing or hurting?

PURPOSE

To report survival outcomes and identify prognostic factors of salvage re-irradiation (re-RT) in recurrent/progressive glioma.

METHODS

Medical records of patients treated with high-dose re-RT as part of multi-modality salvage therapy for recurrence/progression of adult diffuse glioma from 2010 to 2019 were analyzed retrospectively.

RESULTS

A total of 111 patients developing recurrent/progressive high-grade glioma after adequate upfront treatment at initial diagnosis were included. The first course of radiotherapy (RT) had been delivered to a median dose of 59.4 Gy with an inter-quartile range (IQR) of 54-60 Gy. Median time to recurrence/progression was 4.3 years (IQR = 2.3-7.4 years) while the median time to re-RT was 4.8 years (IQR = 3.6-7.9 years). Re-RT was delivered with intensity-modulated radiation therapy (IMRT) using 1.8 Gy/fraction to a median dose of 54 Gy (IQR = 50.4-55.8 Gy) for a cumulative median equivalent dose in 2-Gy fractions (EQD2) of 104.3 Gy (IQR = 102.6-109.4 Gy). At a median follow-up of 14 months after re-RT, the 1-year Kaplan-Meier estimates of post-re-RT progression-free survival (PFS) and overall survival (OS) were 42.8 and 61.8%, respectively. Univariate analysis identified histological grade at recurrence/progression; histological subtype; disease-free interval (DFI) and time interval between both courses of RT; performance status at re-RT; dose at re-RT and cumulative EQD2; isocitrate dehydrogenase (IDH) mutation; and O⁶-methyl-guanine DNA methyl transferase (MGMT) gene promoter methylation as significant prognostic factors. Preserved performance status, longer DFI, prolonged time interval between both courses of RT, and presence of IDH mutation were associated with significantly improved PFS on multi-variate analysis. However, only performance status retained independent prognostic significance for OS on multi-variate analysis. Post-treatment changes were seen in 33 (30%) patients on follow-up imaging, with higher cumulative dose (EQD2 ≥ 104.3 Gy) being associated with increased risk of post-re-RT pseudo-progression.

CONCLUSION

This clinical audit reports encouraging survival outcomes and identifies key prognostic factors associated with high-dose salvage re-RT in recurrent/progressive glioma.

Oral manifestations in chronic kidney disease patients undergoing hemodialysis: a hospital-based study

BACKGROUND

Chronic kidney disease (CKD-HD) patients undergoing routine hemodialysis have been reported to have oral signs and symptoms due to disease process or various comorbidities like diabetes mellitus (DM). Both CKD and DM can cause oral changes. Hence this study aimed to evaluate the prevalence of oral symptoms and signs in CKD-HD patients and to rule out DM as possible confounding factor for the oral findings.

METHODS

Oral manifestations were assessed in 102 CKD-HD patients, and compared with 100 DM patients and 101 non-diabetic patients with no renal impairment.

RESULTS

Most common symptom reported by patients with CKD-HD were xerostomia, altered taste. The most prevalent objective findings were oral dryness. There was statistically significant difference in symptoms and signs between CKD-HD and non-CKD patients. However, no significant difference between CKD-HD with and without DM.

CONCLUSIONS

This study showed increased prevalence of oral findings in CKD patients. It also revealed that Diabetes mellitus cannot be a contributing factor for increased prevalence of oral manifestations in CKD patients.

Awareness About Medication-Related Osteonecrosis of the Jaw Among Dental Professionals: A Multicentre Study

PURPOSE

Bisphosphonates and non-bisphosphonate antiangiogenic and antiresorptive agents are widely used in the management of bone diseases and cancer. A subset of patients receiving these drugs can manifest with medication-related osteonecrosis of the jaw (MRONJ) and it is one of the major complications faced in dental practice. Dentoalveolar and periodontal surgery are the major risk factors associated with it. Therefore, a dentist must have adequate knowledge to promptly identify patients at risk and efficiently manage the condition. This multicentre study was designed with an aim to assess the level of knowledge and awareness regarding MRONJ among dentists from six dental schools.

METHODS AND MATERIALS

An online self-administered questionnaire was sent to all the dentists from six dental schools through Google forms. The results obtained were statistically analysed. The Kolmogorov-Smirnov test was performed to check for normality of data, while the Mann-Whitney U-test and chi-square test were used to compare the responses to each question.

RESULTS

The questionnaire was sent to 570 dentists, out of which 234 responses were obtained. The majority of participants were aware of the term 'MRONJ' (83.3%), clinical indications of bisphosphonates (61.5%) and its mechanism of action (72.2%). However, 68.4% and 61.5% of dentists had no knowledge about the 'drug holiday' concept and risk factors associated with MRONJ, respectively.

CONCLUSION

Although most of the participants had knowledge regarding certain aspects of MRONJ, such as mechanism of action and clinical indications of bisphosphonates, there was a lack of awareness about the drug holiday concept and drug-associated risk factors. This emphasises the need to spread awareness among the dental community, not only in tertiary healthcare centres, but also among private dentists and dental interns to prevent cases of MRONJ.

Numerical Three-dimensional Finite Element Modeling of Cavity Shape and Optimal Material Selection by Analysis of Stress Distribution on Class V Cavities of Mandibular Premolars

Aim:

Adhesive restoration does not depend primarily on the configuration of the shape of the cavity. Under varying loading conditions, it is essential to know the stress concentration and load transfer mechanism for distinct cavity shapes. The aim of this study was to evaluate and compare the biomechanical characteristics of various cavity shapes, namely oval, elliptical, trapezoidal, and rectangular shapes of class V cavities on mandibular premolars restored with amalgam, glass ionomer cement, and Cention N using three-dimensional (3D) finite element analysis.

Materials and Methods:

A 3D prototype of a mandibular premolar was generated by Digital Imaging and Communications in Medicine (DICOM) images obtained from the cone beam computed tomography and imported to 3D modeling software tool, SpaceClaim. The four distinct load magnitudes of 100, 150, 200, and 250N were applied as a pressure load perpendicular to the lingual plane of the lingual cusp of the occlusal surface (normal load) and at 45° to same (oblique load). The stress distribution patterns and the maximum von Mises stresses were analyzed and compared.

Results:

The occlusal stresses were distributed from the force loading point in an approximate actinomorphic pattern, and when the force load was close to the margin, the stress was much greater.

Conclusion:

Ovoid cavity showed lesser stress concentration and deformation for each of the tested restorative material.

Comparison of Conventional Techniques and Higher Imaging Modalities in the Evaluation of Relation between the Third Molar and Inferior Alveolar Nerve Canal: A Pilot Study

Context:

Mandibular third molars are the most commonly impacted teeth, and their surgical removal can be associated with inferior alveolar nerve (IAN) injury. To avoid the deleterious complication of nerve injury on patients, a thorough visualization of IAN and its localization are essential.

Aims and Objectives:

The aims and objectives of this study were to evaluate the efficacy of two conventional localization techniques in determining the relationship of mandibular third molars to IAN and to assess its reliability in comparison with computed tomography (CT).

Settings and Design:

Panoramic radiograph (PR) was taken using Kodak 8000C Digital Panoramic and Cephalometric system. Intraoral periapical radiographs (IOPAs) were taken using Kodak 2200 Intraoral X-ray machine. CT scan images were taken using multidetector CT scans.

Materials and Methods:

Two IOPAs (0° and −20° vertical angulation) and PR and CT scan images of thirty mandibular third molars were taken. Two combinations were used (i) a combination of two IOPAs and (ii) a combination of PR and IOPA (−20°). Tube-shift localization technique was applied to both these combinations to derive the relation between third molar and IAN canal as “in contact,” “separate,” “buccal,” “lingual,” and “in line with the apex” and the results were compared with CT images.

Statistical Analysis:

Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using SPSS software version 15.0.

Results:

The combination of PR and IOPA radiographs showed 14 teeth to be in contact with IAN. This gave a sensitivity of 100%, specificity of 94.1%, PPV of 92.9%, and a NPV of 100% in determining the relation as “in contact” or “separate.” 78.3%, 85.7%, 94.7%, and 54.5% were the sensitivity, specificity, PPV, and NPV in localizing it as “buccal,” “lingual,” or “in line with apex.” These results were better than that of the combination of the two IOPAs.

Conclusions:

Localization using PR and IOPA could better deduce the relation between IAN and mandibular third molar.

Erratum: Epigenome-wide association of father's smoking with offspring DNA methylation: a hypothesis-generating study

[This corrects the article DOI: 10.1093/eep/dvz023.][This corrects the article DOI: 10.1093/eep/dvz023.].

Evaluation and Comparison of Stress Distribution in Restored Cervical Lesions of Mandibular Premolars: Three-dimensional Finite Element Analysis

Objectives:

Restorative materials are used in the treatment of cervical lesions and restoration of the dental tooth. The objective of this study was to assess the suitability of the three commonly used restorative materials by dentists and the evaluation of stress distribution and deformation using Von Mises stress in cervical lesions of mandibular premolars under varying loading condition.

Materials and Methods:

A computerized model of restored class V cavity of mandibular premolar tooth was created using three dimensional modeling software SpaceClaim. It was subjected to occlusal pressure load of 100, 150, 200 and 250MPa at right angle to buccal cusp and was analyzed for stress distribution and deformation in different restorative materials using Finite Element analysis, ANSYS Workbench.

Results:

The analysis carried on the class V restored tooth from biomechanical point of view indicates that restorative material glass–ionomer cement exhibited better bonding with the tooth structure using ionic bonds with the calcium ion present in the tooth structure. The variation of 8%–9% of stress concentration is observed in cavity region across varied pressure loads with glass–ionomer cement to Cention N.

Conclusion:

Glass–ionomer cement had showed better results than amalgam in terms of biomechanical property which is in agreement with the clinical findings. The stress values of Cention N were comparable to that of glass–ionomer cement.

Epigenome-wide association of father's smoking with offspring DNA methylation: a hypothesis-generating study

Epidemiological studies suggest that father's smoking might influence their future children's health, but few studies have addressed whether paternal line effects might be related to altered DNA methylation patterns in the offspring. To investigate a potential association between fathers' smoking exposures and offspring DNA methylation using epigenome-wide association studies. We used data from 195 males and females (11-54 years) participating in two population-based cohorts. DNA methylation was quantified in whole blood using Illumina Infinium MethylationEPIC Beadchip. Comb-p was used to analyse differentially methylated regions (DMRs). Robust multivariate linear models, adjusted for personal/maternal smoking and cell-type proportion, were used to analyse offspring differentially associated probes (DMPs) related to paternal smoking. In sensitivity analyses, we adjusted for socio-economic position and clustering by family. Adjustment for inflation was based on estimation of the empirical null distribution in BACON. Enrichment and pathway analyses were performed on genes annotated to cytosine-phosphate-guanine (CpG) sites using the gometh function in missMethyl. We identified six significant DMRs (Sidak-corrected P values: 0.0006-0.0173), associated with paternal smoking, annotated to genes involved in innate and adaptive immunity, fatty acid synthesis, development and function of neuronal systems and cellular processes. DMP analysis identified 33 CpGs [false discovery rate (FDR)  < 0.05]. Following adjustment for genomic control (λ = 1.462), no DMPs remained epigenome-wide significant (FDR < 0.05). This hypothesis-generating study found that fathers' smoking was associated with differential methylation in their adolescent and adult offspring. Future studies are needed to explore the intriguing hypothesis that fathers' exposures might persistently modify their future offspring's epigenome.

P14.50 Clinicopathological spectrum of intracranial germ cell tumors: an Indian tertiary cancer center experience

BACKGROUND

Incidence of intracranial germ cell tumors (ICGCT) in Western literature is low (0.3–0.6 %) as compared to East Asia (3–4 %), & their clinicopathological features are well documented. However, there are scant studies on ICGCT from India.

MATERIAL AND METHODS

Retrospective observational study of all ICGCT histologically diagnosed in our hospital from 2007–2018. Metastasis were excluded. Clinicopathological features were retrieved from hospital’s electronic medical records.

RESULTS

We diagnosed 82 primary ICGCT, forming approx. 0.54 % of all primary brain tumors, & 3.5% of pediatric brain tumors. Age range: 2 months-32 yrs (Median age 14 yrs). M:F ratio: 1.82:1 (53M,29F). Nearly 80% patients were pediatric (<18 yrs), & 8 very young (<3 yrs, 7M1F). Majority were suprasellar & pineal (31/82, 37% each), with one bifocal presentation. Other rarer sites: posterior fossa (4), midbrain (1), corpus callosum (1) & 11 non midline (4 thalamic, 4 frontal, 2 cerebellar, 1 CP angle). Predominant histology was germinoma (G) (51/82, 62%), while non germinomatous (NGGCT) were 31/82 (38%), of which 9 were mixed. Pure teratoma were 11 (9 immature (IT), 2 mature), & 5 pure yolk sac tumor (YST). Interestingly, all very young age group patients (<3 yrs), showed only NGGCT histology (5/8 IT, 3/8 pure YST). In contrast, G histology formed nearly 70% of all patients >3 yrs. Females were associated mainly with G (21/29, 72%). NGGCT were predominantly seen in males (M:F=2.9:1). Also, pure IT (9) were seen only in males. Posterior fossa tumors were all IT (4/4). Spinal tumors were NGGCT (1 mature teratoma, 1 YST). Majority of suprasellar tumors (25/31, 80.6%), other midline locations like corpus callosal, midbrain, & all thalamic tumors were G. However, pineal tumors showed equal distribution of G (15/31) & NGGCT (16/31). Spine screening was positive in 8 patients (6 G, 2 IT)- 7 on MRI and 1 only on CSF cytology. Serum tumor markers were raised in 13/54 cases- 6/34G(17.6%), vs 7/20 NGGCT (35%). CSF tumor markers were raised in 14/34-10/23 G (43.4%), vs 4/11 NGGCT (36.3%). Follow up was available for 37 patients (Duration 3 months-10 yrs, median 2 yrs). On f/u 6/15 (40%) NGGCT showed progression/death, while only 2/32 G relapsed (6.5%). Four deaths in G group were not directly attributable to the tumor.

CONCLUSION

Frequency of ICGCT in our hospital similar to western data rather than Asian, albeit with less striking male preponderance. ICGCT were tumors of 2nd decade & majority occurred in pineal/suprasellar areas. About 2/3rd were pure G on histology, and showed good prognosis. NGGCT were common in infants, males and in posterior fossa. IT were seen exclusively in males and pure YST mainly in males. Although majority of ICGCT are in midline, rarely non midline involvement also occurs, and it’s essential to exclude metastasis before considering primary ICGCT. Expectedly, NGGCT showed poorer prognosis, compared to pure germinomas.

Variations in the retromandibular approach to the condyle-transparotid versus anteroparotid transmasseteric - a prospective clinical comparative study

BACKGROUND

The management of mandibular condylar fracture remains controversial many surgeons still favour the open reduction and internal fixation (ORIF) which provides good result and immediate functioning as compared to closed reduction. With proven consensus for ORIF, dilemma remains in choosing the surgical approach to condyle due to proximity of complex and important anatomic structure. Various extra-oral surgical approaches are available for ORIF including preauricular, submandibular, retromandibular, transmasseteric anteroparotid etc. Variations in retromandibular approach such as transparotid, retro-parotid and anteroparotid are reported in literature. In our study we compared the retromandibular transparotid and retromandibular anteroparotid transmasseteric variations.

METHODOLOGY

Thirty condylar fracture in 26 patients, 15 in each group (group A - Retromandibular transparotid approach & group B - Retromandibular anteroparotid approach) were treated under general anaesthesia with naos-tracheal intubation and by the same surgeon having 20 years of experience in maxillofacial surgeries. We evaluated time taken for the procedure, amount of bone exposure, intra-operative haemorrhage. Postoperative presence of infection, sinus and fistula formation at the incision site, parotid fistula formation, facial nerve functioning using House-Brackman scale in immediate postoperative period, 3^rd month postoperatively and 6 month postoperatively.

RESULT

The mean average time taken for group A was 78.2minutes and mean average time taken for group B was 64.8minutes. None of the patient had haemorrhage intra-operatively in both the groups. Exposure was sufficient in both the groups with same length of the incision. None of the patient suffered from postoperative infection in both the groups. Parotid fistula formation was present in 2 patients in group A while none of the patient had parotid fistula in group B. Three patients out of 15 had the transient facial nerve weakness in group A which got resolved in 6 month while none of the patient had facial nerve weakness in group B. All patients had adequate mouth opening with no occlusal discrepancies.

CONCLUSION

Retromandibular anteroparotid approach as described in this study has proven to be an extremely useful approach provides good access, and associated with minimal complications and morbidity compare to retromandibular transparotid approach. It is hence safe to say that this approach is relatively useful for an inexperienced and novice surgeon as well.