Evaluation of the Lingual Splitting Patterns and the Lateral Bone Cut Ends Following Mandibular Bilateral Sagittal Split Osteotomy Using Cone Beam Computed Tomography (CBCT)

The bilateral sagittal split osteotomy (BSSO) is the most popular orthognathic procedure performed by maxillofacial surgeons to treat skeletal class II and class III and to correct mandibular asymmetries. The study aimed to evaluate the lingual splitting patterns and lateral bone cut end (LBCE) in bilateral sagittal split osteotomy (BSSO) and their relation with the ramal thickness and the presence of impacted third molars using cone beam computed tomography (CBCT). This prospective observational study included patients with mandibular prognathism who were treated with BSSO with or without Le Fort I osteotomy. Cone beam computed tomography was used to measure the ramal thickness preoperatively and to evaluate the LBCE, and the lingual splitting patterns postoperatively. Twenty-one patients (42 sides) were included in this study. The most commonly observed lingual splitting pattern was type III (47.6%), while the most common LBCE was type B (59.5%). The bad split was encountered 8 times on 42 sides (16.7%). A nonsignificant relationship between the ramal thickness and bad splitting was observed ( P =0.901). Impacted third molars were present in 16 of the 42 sides (38.1%) and had no significant effect on the occurrence of bad splitting ( P =0.063). Type III lingual splitting pattern and type B LBCE were the most commonly observed patterns. No direct association was observed concerning the presence of impacted mandibular third molars and the thickness of the ramus with the occurrence of bad splitting.

Gingival tissue samples from periodontitis patients demonstrate epithelial-mesenchymal transition phenotype

OBJECTIVE

To determine the expression of key epithelial-mesenchymal transition (EMT) markers in gingival tissue samples collected from patients with periodontitis.

BACKGROUND

Epithelial-mesenchymal transition is a process responsible for shifting epithelial-phenotype to mesenchymal-phenotype leading to loss of epithelial-barrier function. Thus, EMT could be involved as a pathogenic mechanism in periodontitis as both conditions share common promoters and signalling pathways.

MATERIALS AND METHODS

Gingival tissue samples were collected from patients with periodontitis (case) and healthy periodontium (control). Periodontal parameters including bleeding on probing, probing pocket depth (PPD), and clinical attachment loss were recorded. Paraffinized tissue samples were processed and immunohistochemically stained to determine the expression of key EMT markers which included E-cadherin, β-catenin, Snail1 and vimentin.

RESULTS

The majority of cases (n = 65, 72.2%) were diagnosed with periodontitis stage 3 or 4, grade b or c vs 25 (27.8%) subjects with intact healthy periodontium. Discontinuity of epithelium was detected in up to 80.9% of periodontitis cases associated with reduced number of epithelial layers as compared to controls. Immunohistochemical expression of epithelial markers (E-cadherin and β-catenin) was significantly downregulated in periodontitis patients as compared with controls. Periodontitis cases exhibited significant upregulation of Snail1 expression. Furthermore, cytoplasmic vimentin (66.2%) and nuclear β-catenin (27.7%) were solely expressed in periodontally diseased tissues compared with control. Epithelial markers, E-cadherin and β-catenin, were significantly negatively correlated with increasing PPD, while vimentin showed positive correlation with this parameter.

CONCLUSION

There were marked downregulation of epithelial molecules and upregulation of mesenchymal markers in gingival tissues derived from periodontitis patients, suggesting expression of the EMT phenotype in the pathological epithelial lining of periodontal pockets.

Reliability of two difficulty indexes in predicting the surgical extraction difficulty of impacted mandibular third molars

Introduction: The aim of this study was to compare the reliability and the agreement of the Pederson and Pernambuco difficulty indexes in predicting the surgical extraction difficulty of the impacted mandibular third molars. Materials and methods: A prospective observational cohort study was conducted on 83 patients who had undergone surgical removal of impacted mandibular third molar. The difficulty of extraction was determined preoperatively according to the total scores obtained from the Pederson and Pernambuco difficulty indexes, the operative difficulty was determined by the surgical technique and the duration of extraction. The accuracy of prediction of the surgical difficulty and the degree of agreement of the two indexes were calculated. Results: The accuracy of Pederson and Pernambuco indexes in predicting the operative difficulty measured by duration of surgery was 36.1% and 55.4% respectively, and with operative difficulty measured by the technique was 21.7% and 37.3% respectively with statistically significant differences. The agreement between the 2 indexes was poor. Conclusion: Both indexes were limited in predicting the surgical difficulty of impacted mandibular third molars although the Pernambuco index was better than the Pederson index and the agreement between the two indexes was poor.

Pathogenesis of periodontitis - A potential role for epithelial-mesenchymal transition

Epithelial mesenchymal transition (EMT) is a process comprising cellular and molecular events which result in cells shifting from an epithelial to a mesenchymal phenotype. Periodontitis is a destructive chronic disease of the periodontium initiated in response to a dysbiotic microbiome, and dominated by Gram-negative bacteria in the subgingival niches accompanied by an aberrant immune response in susceptible subjects. Both EMT and periodontitis share common risk factors and drivers, including Gram-negative bacteria, excess inflammatory cytokine production, smoking, oxidative stress and diabetes mellitus. In addition, periodontitis is characterized by down-regulation of key epithelial markers such as E-cadherin together with up-regulation of transcriptional factors and mesenchymal proteins, including Snail1, vimentin and N-cadherin, which also occur in the EMT program. Clinically, these phenotypic changes may be reflected by increases in microulceration of the pocket epithelial lining, granulation tissue formation, and fibrosis. Both in vitro and in vivo data now support the potential involvement of EMT as a pathogenic mechanism in periodontal diseases which may facilitate bacterial invasion into the underlying gingival tissues and propagation of inflammation. This review surveys the available literature and provides evidence linking EMT to periodontitis pathogenesis.

The Effect of Recipient Jaw and Implant Dimensions on Pre- and Post- Loading Dental Implant Stability: A Prospective Clinical Study

Background: Implant stability is a mandatory factor for dental implant (DI) osseointegration and long-term success. The aim of this study was to evaluate the effect of implant length, diameter, and recipient jaw on the pre- and post-functional loading stability. Materials and methods: This study included 17 healthy patients with an age range of 24-61 years. Twenty-two DI were inserted into healed extraction sockets to replace missing tooth/ teeth in premolar and molar regions in upper and lower jaws. Implant stability was measured for each implant and was recorded as implant stability quotient (ISQ) immediately (ISQ0), and at 8 (ISQ8) and 12 (ISQ12) weeks postoperatively, as well as post-functional loading (ISQPFL). The pattern of implant stability changes throughout the study period and its correlation with the recipient jaw and the DI dimensions were evaluated. Results: There was a significant difference in ISQ values throughout the study. DI stability in the maxilla was significantly higher than that in mandible for the ISQ0, with no significant effect for the rest time points. The effect of implant diameter was significant with DI of 4.1mm diameter being more stable. While for the length, there was no significant difference regarding its effect on ISQ values through-out the study period. Conclusions: DI inserted in the maxilla demonstrated better primary stability with no effect of recipient jaw on secondary stability and after functional loading, also DI with wider diameter had better stability throughout the study whereas DI length showed no significant effect on stability

The effect of osseodensification on implant stability and bone density: A prospective observational study

Background

The aims of this study were to evaluate the effect of implant site preparation in low-density bone using osseodensification method in terms of implant stability changes during the osseous healing period and peri-implant bone density using CBCT.

Material and Methods

This prospective observational clinical study included 24 patients who received 46 dental implants that were installed in low-density bone using the osseodensification method. CBCT was used to measure the bone density pre- and postoperatively and implant stability was measured using Periotest® immediately after implant insertion and then after 6 weeks and 12 weeks postoperatively. The data were analyzed using paired t-test and the probability value <0.05 was considered statistically significant.

Results

Of the 46 implants, 43 were osseointegrated making the early survival of the implants 93.5%. There was a significant increase in bone density postoperatively; 337.6 ±182.9 compared to 265.3 ±173.9 Hounsfield units preoperatively. The primary implant stability was -2.7 ± 2.13 Periotest values (PTV), at the 6th week it decreased significantly (p<0.0001) to become 0.7 (± 4) PTV, and at the 12th week (secondary stability) it increased significantly (p<0.0001) to become -2.1 (± 2.8) PTV. The difference between primary and secondary stability was statistically non-significant (p=0.0814).

Conclusions

Osseodensification resulted in high primary stability and increased peri-implant bone density but it did not prevent the implant stability drop during the first 6 weeks after insertion of implants.

Key words:Osseodensification, implant stability, low-density bone.

Surgical Treatment Outcome of Salivary Gland Tumors

Background: Salivary gland neoplasms constitute a group of heterogeneous lesions with complex clinicopathologic characteristics and distinct biological behavior. Numerous studies have suggested geographical variation, therefore the aims of this study were to analyze the characteristics of salivary gland neoplasms in two Iraqi centers and to analyze the postoperative complications that are encountered after surgical treatment of these tumors. Materials and Methods: A retrospective study of the patients who were treated for major and minor epithelial salivary gland tumors was conducted. The analyzed data included; demographic information (age and gender), the site of the tumor, the clinical manifestations, the histological type of the tumor, the type of the treatment and the postoperative complications. Results: Fifty seven patients were included in this study. The parotid gland was involved in most patients (n=37, 64.9%). Thirty five patients (61.4%) had benign tumors while 22 patients (38.6%) had malignant tumors. The mean age of patients with malignant tumors was 52.05 (±17.3) while of patients diagnosed with benign tumors was 41.6 (±11.4) years, the difference was statistically significant (p= 0.008). Surgical treatment consisted of superficial parotidectomy, total parotidectomy, surgical excision of the submandibular gland, surgical excision of minor salivary glands and maxillectomy. The most common complication was weakness of one or multiple branches of the facial nerve, complications were significantly associated with patients’ age, whereas gender and type of tumor whether benign or malignant did not affect the complication rate Conclusions: benign salivary gland tumors are more common than malignant tumors with no gender predilection and that patients who are diagnosed with malignant tumors are significantly older that patients with benign tumors, parotid gland is the most commonly affected gland with pleomorphic adenoma as the most frequent diagnosis. Facial nerve dysfunction was the most common complication and the complication rate was significantly associated with the age of patients.

The accuracy of ridge mapping procedure in determining the alveolar ridge width

Background: Post-extraction alveolar ridge resorption is unavoidable phenomenon ending with insufficient ridge width. Measuring the physical dimensions of the available bone before implant surgery is an important aspect of diagnosis and treatment planning. Bone height can be calculated from radiographs, while bucco-lingual ridge width can be measured by conventional tomography, CT scanning and ridge mapping. Radiographic techniques have certain disadvantages. Therefore the ridge mapping technique was used as an option for determining alveolar ridge width. The purpose of this study was to compare the validity of alveolar ridge width measurements obtained with ridge mapping technique before surgical flap reflection against direct caliper measurement following surgical exposure of the bone. Materials and Methods: This prospective observational clinical study included 21 patients; 9 males (42.9%) and 12 females (57.1%) with mean age of 40.8. A vacuum formed acrylic stent was fabricated for each subject. The stent provided two buccal/lingual pairs of consistent measurement points to provide a reference of measurement for each implant site located 3 and 6 mm from the crest of alveolar soft tissue. Measurements (n=216) were made at 54 implant sites, the measurements obtained from the two techniques were compared and then accuracy of these methods was assessed. The mean, standard deviation, standard error of mean were calculated and subjected to statistical analysis using Student’s unpaired t- test, values <0.05 were considered statistically significant. Results: There was no statistically significant difference between ridge mapping technique and intra-operative measurement in determining alveolar ridge width. Conclusion: The ridge mapping technique is a useful method in determining alveolar ridge width for its exactitude, low cost, the immediate result and no need of radiation.