JOURNAL OF DENTISTRY (SHIRAZ UNIVERSITY OF MEDICAL SCIENCES)
Year:2019 | Volume:20 | Issue:4|Papers Count:12

Statement of the Problem: The periodontal health and marginal stability of gingiva can be negatively affected by a number of dental conditions in association with deficiency of attached gingiva. Purpose: This study aimed to compare the color and width of tissue grafted by two surgical techniques of keratinized gingival augmentation, namely free gingival graft(FGG) and connective tissue graft (CTG) covered by thin mucosal flap. Materials and Method: This clinical trial was performed on 15 adult individuals. The patients showed less than 2mm keratinized gingiva on two different recipient sides. One side was to be treated with CTG as the test group and the other side to be treated with FGG as the control group. The amount of keratinized gingiva before the surgery, size of grafted tissue during the surgery and 6 month after the surgery was documented. Six months after healing, the test and control sides were compared in terms of the width of generated gingiva on both sides, and the color match of the grafted areas with the surrounding gingiva or mucosa. The color of the grafted areas was determined and compared by using both professional evaluation and digital evaluation. Results: In digital evaluation, Δ E (which shows color mismatch) was higher in FGG. In professional evaluation, visual analogue scale (VAS) was used by two blinded periodontists. The mean VAS in FGG was less than CTG. The mean increase of gingival width was higher in CTG. The increased width in CTG technique was more than that in FGG technique. This difference was statistically, but not clinically, significant. Conclusion: Higher Δ E in control side and higher mean VAS CTG both showed better color adaptation of CTG side. FGG can be used in case of increasing keratinized gingiva, vestibular depth, and in patients with low smile line without esthetic concerns. However, using connective tissue in the underlying thin mucosal layer is preferred for gingival augmentation if there are adequate vestibule depth and esthetic concerns, like in maxillary canine.

The Effect of Platelet-Rich Fibrin (PRF), Plasma Rich in Growth Factors (PRGF), and Enamel Matrix Proteins (Emdogain) on Migration of Human Gingival Fibroblasts

Statement of the Problem: Oral mucositis (OM) is a common inflammatory complication consequent to chemotherapy or radiotherapy in cancer patients that affects their quality of life. Therefore, finding an effective treatment for OM is always imperative. Purpose: The purpose of this experimental study was to measure the stereological, antiinflammatory and antioxidant markers of hydro-alcoholic extract of Pistacia Atlantica (P. atlantica) leaves, Trachyspermum Ammi (T. ammi) fruits and their mixture on induced OM in hamsters. Materials and Method: In Experimental study, OM was generated by the method employed by Tanideh et al., in 90 hamsters, by 5-FU (5-fluorouracil 65 mg/kg, IP). All the animals were divided into 5 groups: control, topical gel base, hydro-alcoholic extract 3% of P. atlantica, hydro-alcoholic extract 1% of T. ammi, and a mixture of the extracts of the two plants. On days 13, 15, and 17, the cheek pouch samples were harvested. Stereological scores and the levels of malondialdehyde (MDA), Superoxide dismutase (SOD), myeloperoxidase (MPO), and interleukin-1B (IL-1B) in the pouch tissue were measured. Results: Lower levels of MPO, MDA, and IL-1B and an increase of SOD level were discovered in the mixture-treated group in comparison with other groups. As an aspect of MDA, no significant differences were detected between the topical gel form of P. atlantica and T. ammi groups on days 13 (p= 0. 648), 15 (p= 0. 981) and 17 (p= 0. 540). No variations of MPO were detected among P. atlantica and T. ammi groups on days 13 (p= 0. 159) and 15 (p= 0. 694); however, the MPO activity of the T. ammi group was significantly lower than the P. atlantica group on day 17 (5. 57± 0. 56 vs. 6. 48± 0. 35 U/ml, p<. 001). The volume density of the epithelium increased in the mixture-treated group (p< 0. 05). Conclusion: The results of this study indicated that the mixture of P. atlantica leaves and T. Ammi fruits might be effective in the treatment of OM.

Statement of the Problem: Paxillin is a major cytoskeletal protein aberrantly deregulated in various human cancers and involved in tumor growth and invasion. However, the clinicopathological and prognostic significance of paxillin in salivary gland tumors (SGTs) is still unclear. Purpose: This study was conducted to evaluate the relationship between paxillin expression and clinicopathological features of patients with SGTs. Materials and Method: In this retrospective study, 50 paraffin-embedded tissue samples which were histologically confirmed as benign (pleomorphic adenoma, PA) or malignant (mucoepidermoid carcinoma (MEC), adenoid cystic carcinoma, ACC) SGTs, and 19 specimens from those with normal salivary gland (NSG) as a control group were assessed for paxillin expression using the immunohistochemistry. The paxillin expression in our samples was scored based on the extent and intensity of immunoreactivity and compared with histological type, clinical stage, and distant metastasis. Results: High paxillin expression was identified in 66% of SGTs whereas all patients with NSG showed low expression (p< 0. 0001). Although the expression of paxillin in patients with benign and malignant tumors is similar, there is a significant difference between patients with PA, MEC, and ACC with that of the NSG (p< 0. 0001). Paxillin expression was not correlated with clinicopathological features of patients Conclusion: High expression of paxillin was observed in tumoral tissues compared with the controls that establish an important role of paxillin in SGTs but its prognostic role was unclear and need further evaluation.

Statement of the Problem: The biologic behavior and histopathological features of fibromatosis are intermediate between those of fibroma and fibrosarcoma. Purpose: The aim of the present study was to determine useful histopathologic and immunohistochemical characteristics for the differentiation of these lesions. Materials and Method: In this cross-sectional descriptive study, 40 specimens comprising 20 fibrosarcoma and 20 fibromatosis biopsies were selected. The histopathologic characteristics of these lesions were identified and immunohistochemical staining for Ki67 and β-catenin markers was performed. Sections were examined by light microscopy and positively stained cells were counted. Results were analyzed by SPSS 20 using Chi-square test, Mannwhitney test, and t-test (p< 0. 05). Results: Statistical significant differences were observed between fibromatosis and fibrosarcoma in terms of distribution frequency, mitotic rate, herringbone pattern, cellularity, overlapping of nuclei, mean Ki67 score, and atypia rate. The other features including age, gender, necrosis, clarity of nucleoli and mean β-catenin were not significantly different. Conclusion: The present findings suggest the mitotic figures, Ki67, herringbone pattern, cellularity, and atypia are useful to differentiate fibromatosis from fibrosarcoma.

Statement of the Problem: Sufficient bond strength of composite restoration leads to its durability and survival; therefore, preparation of dentin surface for higher bond strength is essential. Purpose: Our aim is to assess the deproteinizing effect of 3% bromelain enzyme and compare it to 4% titanium tetrafluoride (TiF4) and 5% sodium hypochlorite (NaOCl) regarding the shear bond strength (SBS) of composite resin to dentin. Materials and Method: In this experimental study, 40 intact extracted human maxillary premolars were selected, and the occlusal surfaces of the teeth were sectioned at a depth of 2 mm from dentinoenamel junction. The teeth were divided into 4 groups (n=10). In Group 1, the teeth were etched with 37% phosphoric acid gel. In Group 2, the teeth were etched and deproteinized with 5% NaOCl. In Group 3, the teeth were etched and deproteinized with 4% TiF4. In Group 4, the teeth were etched and deproteinized with 3% bromelain enzyme. In each specimen, composites with 3 mm diameter and 2 mm height were prepared and cured. The test specimens were then stored in distilled water at room temperature for 7 days before conducting the SBS test (MPa). By universal testing machine at a crosshead speed of 1 mm/min, the results were analyzed using one-way ANOVA and Tukey test. Results: One-way ANOVA test demonstrated that pretreatment of dentin with a bromelain enzyme, TiF4 solution, or NaOCl was not statistically different regarding SBS to dentin (p= 0. 790). Conclusion: 3% bromelain enzyme can be as effective as TiF4 and NaOCl and phosphoric acid 37% in terms of the SBS of composite resin to dentin.

Statement of the Problem: One of the major concerns about all ceramic crowns is their fracture resistance. Purpose: The purpose of this in vitro study was to evaluate the effect of two marginal designs (shoulder 90° , shoulder 135° ) on the fracture resistance of zirconia copings. Materials and Method: In this in vitro study, 20 brass dies were prepared using milling machine: 10 with 1mm width shoulder 90° marginal design and the other 10 with 1mm width shoulder 135° finish line design. Zirconia cores with 0. 5mm thickness and 30μ m cement space were fabricated on brass dies. The copings were cemented on the dies and fracture test was done using a universal testing machine. Data were analyzed using Mann-Whitney test. Results: The mean value of fracture resistance for shoulder 90° finish line design were 368. 3± 109. 4 N and for shoulder 135° finish line design were 518. 4± 115. 5 N. Data analysis revealed a statistically significant difference between groups (p< 0. 05). Conclusion: The results of this study showed that the finish line design of zirconia copings influences their fracture resistance. A 135° shoulder finish line design can improve the fracture resistance of zirconia crowns.

Statement of the Problem: Information on patient-centered outcomes of periodontal disease and the impact of different periodontal treatment phases on the life quality of periodontal patients is limited. Purpose: This study sought to compare patients’ perception of their oral health-related quality of life (OHQoL) following one-stage full mouth disinfection (OSFMD) and surgical periodontal treatment. Materials and Method: A pre-and post-interventional study design was conducted in two phases on a single group of patients. Subjects were recruited from moderate to severe chronic periodontitis patients referred to a private clinic. At baseline and after each treatment phase, periodontal parameters were recorded by a blind examiner. Patients received OSFMD, followed by periodontal flap surgeries and completed the validated Iranian version of the OHIP-49 questionnaire (OHIP-35-IR) at three time points (baseline, two weeks post-initial therapy and after completion of surgical phase). Data were analyzed using repeated measure ANOVA, paired and independent t-tests, and multivariate regression analysis by SPSS software version 21. Results: 38 patients (14 men, 24 women, mean age 40. 30± 11. 93) completed the study. Periodontal parameters showed progressive improvement from baseline to the end of the study (p< 0. 05). The total mean OHIP-35-IR score at baseline (89. 25± 19. 26) was significantly improved (reduced) compared to each treatment phase (75. 63± 17. 15 and 74. 22± 15. 46, respectively; p< 0. 001), with no significant difference between treatments. Improvements in subdomains of psychological discomfort, functional limitation, physical pain, and handicap accounted for the changes. The effect size was calculated to be 0. 80 for the first and 0. 66 for the second treatment phases. Conclusion: Within limits, OSFMD and periodontal surgical treatment have positive impacts on the OHQoL of patients. Intensive periodontal non-surgical treatment is as effective as surgical intervention for achieving desirable patient-centered outcomes.

Statement of the Problem: The complete removal of filling material is an important step to regain access to the entire canal and facilitate the disinfection of the root canal system. Rotary nickel– titanium (NiTi) instruments systems have been proposed as an effective removal technique for root canal retreatment. Purpose: The aim of this study was to evaluate the efficacy of Neolix rotary system and ProTaper Universal retreatment system in the removal of gutta-percha combined with two different sealers. Materials and Method: In vivo study, eighty extracted human permanent mandibular premolars were prepared using the ProTaper Universal rotary system to an apical size 30 (F3/0. 06). The specimens were randomly divided into 4 groups (n=20) and subsequently filled with lateral condensation of gutta-percha and two sealers: AH-26 and Sure-Seal Root. The teeth were stored for 4 weeks at 37° C and 100% humidity and then retreated by one of the following rotary systems: Neolix or ProTaper Universal retreatment system. Teeth were then grooved and monitored under a stereomicroscope with 8× magnification. The images were transferred to the computer and the amount of filling material that remained on the root canal walls was scored using AutoCAD 2017 version 1. 1software. Results were analyzed using one-way analysis of variance test and post hoc Tukey-HSD test (p< 0. 05). Results: The mean percentage of remaining gutta-percha and sealer was significantly higher in apical third in all groups (p< 0. 01). Post hoc Tukey test showed that there is significantly higher residual filling material in the group filled with gutta-percha and Sure-Seal Root sealer and retreated by Neoniti rotary system compared with other groups in both coronal and middle third of the canal. Conclusion: The Neoniti rotary system was as effective as ProTaper Universal retreatment system in retreatment of gutta-percha and AH-26 sealer but was significantly less effective in groups obturated with Sure-Seal Root sealer.

Statement of the Problem: Swelling of the surrounding tissue of surgical site is one of the most common, devastating effects after maxillofacial surgery and can have an effect on quality of life and the patients' satisfaction. Purpose: The purpose of this study was to investigate the effect of a custom-made appliance by the method of Computer-aided design/Computer-aided manufacturing (CAD/CAM) compared with conventional dressing for reducing facial swelling after maxillofacial surgery. Materials and Method: This clinical trial accomplished in 14 patients voluntarily referred to the Department of Oral and Maxillofacial Surgery at Bahonar hospital in Kerman. These patients were the candidate for surgical treatment of similar bilateral facial fractures (10 patients) and orthognathic surgery (4 patients). Facial computed tomography (CT) scans of the patients were taken to build up a custom-made appliance. Based on three-dimensional reconstruction from facial CT scan data, custom-made appliance was designed and built. Swelling on one side with custom-made appliance and on the opposite side with conventional dressing measured with paper tape graded before surgery, immediately after surgery, 24 hours, 48 hours, and 7 days later, we divided the patients into two groups of trauma and orthognathic surgical procedures Results: Based on the defined landmarks, all of the measurements were performed on both sides. Statistical analyses do not show any asymmetry before surgery (p= 0. 48). In addition, there was no significant difference between two methods of dressing on the day of surgery and a day later (p= 0. 084, p= 0. 09), but there was a significant difference between two methods of dressing on second and seventh days. The swelling has decreased faster and further in our new method. Conclusion: Regarding the exact adaptation to the surgical site on facial skin, using custommade appliance by the method of CAD/CAM could be an effective tool that reduces swelling after maxillofacial surgery.

Goldenhar syndrome (GHS) is a complex syndrome characterized by relation of mandibular hypoplasia, abnormality of the ear, ocular dermoid and vertebral disorders and hemi facial macrosomia. Treatment protocol depends on the patient’ s age and systemic clinical presentations, with a multidisciplinary method often being required. This case report describes a typical 6-year-old female patient who presented to the Department of Pediatric Dentistry, Faculty of Dentistry, University of Medical Sciences, Kerman, Iran with mandibular hypoplasia, facial asymmetry, ear tags and ocular dermoid after plastic surgery. Diagnosis was based on clinical aspects, radiology and laboratory findings. GHS is a developmental complaint that can disturb many aspects of the patient's life; therefore, immediate treatment from birth is necessary.

Ameloblastomas demonstrate various clinical and microscopic patterns. They typically have been described as possessing three biologic variants including solid, cystic (unicystic) and peripheral, of which about 13% to 21% of all cases are unicystic. Granular cell subtype is a rare variant especially when both the inner and peripheral layers of tumoral islands composed exclusively of eosinophilic granular cells. The purpose of this case report is to present a unique case of cystic ameloblastoma with an unusual radiographic and microscopic pattern affecting a 25-year-old female. Awareness of these rare histopathologic features for oral pathologist is essential to help correct diagnosis.