Alexandria Dental Journal (2017) Vol.42 Issue (1)

Contents

A COMPARATIVE STUDY OF CORTICAL LAG SCREWS AND MINIPLATES FOR INTERNAL FIXATION OF MANDIBULAR SYMPHYSEAL REGION FRACTURES

Mohamed S. Elhussein, Ahmed A. Sharara, Hala R. Ragab

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INTRODUCTION: The management of facial trauma is one of the most rewarding and demanding aspects of oral and maxillofacial surgery. Being the most prominent mobile bone of the facial skeleton, mandible fracture occurs more frequently than any other fracture.
OBJECTIVES: The aim of this study was to compare the outcomes of treatment by the use of cortical lag screws versus miniplates, in patients who have a fracture in the mandibular symphyseal region.
MATERIALS AND METHODS: The present study was conducted on fourteen patients with age ranged from 19-48 years. The patients had mandibular symphyseal region fractures requiring open reduction and internal fixation. The patients were clinically examined postoperatively by assessment of pain, edema, surgical wound, occlusion, teeth vitality and nerve injury. They also were assessed radiographically using ortho-pantomogram and cone beam computerized tomography (CBCT) to evaluate the adequacy of reduction, healing progression and bone density of the fractured segments.
CONCLUSIONS: Cortical screw fixation using the lag screw principle offers the advantages of fixation, using minimal hardware, and achieving inter-fragmentary compression, and associated with minimal pain and edema when considering the treatment of linear symphyseal region fractures.
KEY WORDS: Lag screw, Miniplate, Symphyseal, fracture.


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MAXILLOMANDIBULAR FIXATION USING ORTHODONTIC MINI-IMPLANTS IN MANAGEMENT OF MANDIBULAR FRACTURES

Mohamed M. Shokry , Riham M. Eldibany

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INTRODUCTION: The use of intermaxillary fixation (IMF) in the treatment of maxillofacial trauma represents the cornerstone of fracture reduction and immobilization. Many modalities of IMF have been described. Recently, to overcome the cumbersome procedure of tooth borne appliances, mini-implants have been introduced into clinical practice.
OBJECTIVES: To evaluate the effectiveness of using mini-implants for IMF for the treatment of mandibular fractures.
MATERIALS AND METHODS: This clinical trial was performed on ten patients with mandibular fractures. The diagnosis, duration of IMF, mini-implants site, bite force recovery, bone density around the fracture line and any associated complications were recorded. Clinical and radiographic follow-up examinations were performed immediately, 3 and 6 months post-operatively until fracture healing was complete.
CONCLUSIONS: The use of mini-implants for IMF has shown to be a useful and safe modality to establish maxillo-mandibular fixation following mandibular fractures.
KEYWORDS: Intermaxillary Fixation, Maxillo-mandibular fixation, Mini-implants, Mandibular Fracture


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EVALUATION OF THE USE OF NARROW IMPLANT FOR REPLACEMENT OF LOWER SINGLE ROOTED TOOTH IN NARROW RIDGE

Ahmed R. Nomer, Saeeda M. Osman, Lydia N. Melek

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INTRODUCTION: The possibility of placing implants can sometimes be limited due to physical conditions e.g. where the horizontal space is limited by adjacent teeth and roots, or in situations with a narrow alveolar ridge. By using a narrow implant, the need for bone augmentation or orthodontic tooth movement can be avoided.
OBJECTIVES: This study was designed to evaluate the use of narrow implants for replacement of lower single rooted teeth in narrow lower ridge.
MATERIALS AND METHODS: Ten patients were selected from the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Alexandria University with missing lower single rooted tooth or teeth and narrow ridge (6mm thick or less) then implants were placed and they were evaluated by radiographic examination to evaluate the bone density around the implants after 1, 3, 6 months.
RESULTS: The mean periimplant probing depth was 2.18 ± 0.55 on the 3rd month and 1.50 ± 0.52 on the 6th month, there was statistically significant decrease. As for the mean marginal bone height was 0 ± 0 immediately postoperative, 0.26 ± 0.14 on the 3rd month and 0.45 ± 0.16 on the 6th month, there was statistically significant increase. Also the results of the present study showed the mean bone density was 79.63 ± 8.55 immediately postoperative then increased on the 3rd month to be 86.35 ± 6.48 and 92.01 ± 5.49 on the 6th month, there was statistically significant increase.
CONCLUSIONS: Narrow diameter implants can be used to restore missing single rooted teeth with narrow ridge.
KEY WORDS: Narrow implant, narrow ridge, bone density.


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ATTITUDES OF DENTAL INTERNS TOWARDS LEARNING COMMUNICATION SKILLS IN ALEXANDRIA UNIVERSITY

Sara M. Atteya, Suzan M. Saleh, Wafaa A. Essam

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INTRODUCTION: Effective communication not only improves dentist-patient relationships, but also enhances the patient’s satisfaction towards the profession. Dental students are generally receptive to learning communication skills during their academic education and their appreciation for the value of these skills can be significantly improved with training.
OBJECTIVES: The objective of this study was to compare the attitudes of dental interns towards learning communication skills at both Faculty of Dentistry Alexandria University (public) and Pharos University (private).
MATERIALS AND METHODS: A cross-sectional study using a s questionnaire was carried out among dental interns graduated from the Faculty of Dentistry of Alexandria University (AU) and Pharos University (PU), in 2014. A self-administered, twenty-four-items, Dental Communication Skills Attitude Scale (DCSAS) that contained both positive (PAS) and negative (NAS) attitude subscales was distributed. Participants’ demographic and education related variables were also recorded. Association of the positive and negative attitudes with these variables was determined using appropriate statistical tests as Pearson’s chi square test, Monte Carlo Exact test, Fisher’s Exact and one way ANOVA.
RESULTS: A total of 240 dental interns from Alexandria University and 162 dental interns from Pharos University participated in the study, with a response rate of 70.59% and 82.65%, respectively. The mean PAS scores and NAS scores in both universities were almost the same, 52/65 and 31/55, respectively with no significant difference between them. These attitudes were significantly associated with certain background and education-related attributes as gender, age, parents education and previous communication skills training.
CONCLUSIONS: Despite the differences in communication skills curriculum, dental interns of both AU and PU had an overall positive and neutral attitude towards communication skills learning with no statistical significant difference between them.
KEY WORDS: communication, learning, dentist-patient relationship, dental interns, Alexandria.


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DIFFERENCES BETWEEN CHILDREN WITH EARLY CHILDHOOD CARIES AND CARIES FREE CHILDREN IN ORAL HEALTH HABITS: A CASE CONTROL STUDY

Yosra A. Hussein, Magda M. El-Tekeya, Karin L. Dowidar, MahaEl Tantawi

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INTRODUCTION: Early Childhood Caries (ECC) is a multifactorial disease and has numerous biological, psychological and behavioral factors. It is a significant public health problem with consequences for the growth and development of affected children
OBJECTIVES: The aim of the study was to assess differences between children with early childhood caries and caries free children in socio-economic background, previous dental visits, oral hygiene practices and dietary habits.
MATERIALS AND METHODS: Parents responded to a questionnaire about children’s background (age, sex, parental occupation and education and birth rank), in addition to previous dental visits, nursing history, tooth brushing frequency, use of fluoridated toothpaste, parental supervision of brushing and dietary habits (snack type, frequency and daily quantity). Clinical examination assessed caries using World Health Organization criteria and plaque using Loe and Silness Plaque index. The sample consisted of 84, 4-5-year-old children who visited the pediatric dentistry clinic of the Faculty of Dentistry, Alexandria University in 2016. Equal number of cases (children with ECC) and controls (caries free children) were included.
RESULTS: Children with ECC were significantly more likely to be first borne compared to caries free children (71.4% and 52.4%, P= 0.006). Previous dental visits were reported in 38.1% of children with ECC compared to 4.8% of caries free children (p<0.0001). Exclusive breast feeding was reported in 83.3% of children with ECC compared to 59.5% of caries free children (p=0.02). Plaque index in children with ECC was significantly higher (0.70±0.53) than that of caries free children (0.39±0.50, p=0.001). CONCLUSIONS: Being first borne, history of previous dental visits, exclusive breast feeding and high plaque index were factors that differed significantly between children with ECC and caries free children. KEYWORDS: preschool children, early childhood caries, plaque, oral health habits.


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CHEMOPREVENTIVE EFFECT OF TOPICAL APPLICATION OF S-ALLYLCYSTEINE IN THE MANAGEMENT OF ORAL DYSPLASTIC POTENTIALLY MALIGNANT DISORDERS

Suzanne M. Meshri, Azza M. Zaki, Hanaa S. Raslan,Mohammed A. Shams El-Din

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INTRODUCTION: Oral potentially malignant disorders (OPMDs) describe mucosal disorders with an increased risk of malignant transformation (MT) to oral squamous cell carcinoma (OSCC). Natural products like garlic represent a promising group of chemopreventive agents. Aged garlic extract (AGE) is one of the most commonly used garlic preparations as it contains more stable organosulfur compounds (OSCs); S-allylcysteine (SAC) is the most abundant organosulfur compound in AGE. SAC has been found to retard the growth of chemically induced and transplantable tumors in several animal models.
OBJECTIVES: To evaluate the cancer chemopreventive effect of topically applied S-Allylcysteine in the management of oral dysplastic potentially malignant disorders.
MATERIALS AND METHODS:10 subjects with oral dysplastic potentially malignant disorders, as proven clinically and histopathologically, were recruited for this study. They received topical S-Allylcysteine for 1 month, and then the lesions were evaluated both clinically and histopathologically after termination of therapy to assess any alterations in the lesions' size, pain score and mucosal dysplasia.
RESULTS: S-allylcysteine was well tolerated by all the patients. After termination of the therapeutic phase (after one month), S-Allylcysteine was found to decrease the pain score in all symptomatic patients. The size of the lesions was also decreased although it was not statistically significant; however, histological improvement was remarkable. Complete histological response was observed in four leukoplakia patients and two lichen planus patients where the mild and moderate dysplastic changes showed histologic remission of dysplasia. However, two leukoplakia cases showed progression in the grade of dysplasia from mild to moderate.
CONCLUSIONS: Topical application of S-Allylcysteine is beneficial for the management of dysplasia associated with oral potentially malignant disorders.
KEYWORDS: Oral potentially malignant disorders, garlic, S-allylcysteine, cancer chemoprevention, dysplasia.


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EFFECT OF CALCITONIN INTRA MUSCULAR INJECTION ON BONE FORMATION AROUND TITANIUM DENTAL IMPLANTS IN DOGS (A HISTOLOGICAL STUDY)

Mohamed L. Gabr, Ahmed R. Kotb, Riham M. El Dibany, Azza S. Koura

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INTRODUCTION: Calcitonin is a major hormone secreted by thyroid gland responsible for bone formation and decrease of blood calcium level. It is a mixture of amino acids plus a modifying agent. It has been proved that the synthetic salmon calcitonin enhanced bone growth in depth as well as in width that is why they used it as a treatment for bone diseases and fractures.
OBJECTIVES: This study was done to evaluate histologically the effect of intra muscular (IM) calcitonin administration on bone healing around titanium dental implants.
MATERIALS AND METHODS: Twelve adult’s Mongrel dogs received one implant in the maxilla in the edentulous space distal to the canine. Six dogs were randomly selected as the test group then they received a single daily dose of calcitonin 50 IU administered IM, for 28 successive days. And six dogs served as control group and no medications were injected. The animals were sacrificed 4, 8, and 12 weeks after surgery.
RESULTS: Through microscopical examination of specimens showed an apparent trend toward increased new bone formation in the osteotomy site in the calcitonin-treated group compared with the controls in fourth and eighth week intervals. While in twelfth interval there was a non-significant difference could be noticed between control and study groups concerning new bone formation which gave firm attachment between host bone tissue and the used implant.
CONCLUSIONS: This study demonstrated that using short, small dose of salmon calcitonin by daily intramuscular injection for 28 days enhanced bone mineral density when compared with the bone density without injection of this material.
KEY WORDS: Calcitonin, Dogs, Bone formation, Dental implants.


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EVALUATION OF AUTOGENOUS FRESH DEMINERALIZED TOOTH GRAFT PREPARED AT CHAIRSIDE FOR DENTAL IMPLANT

Marwan M. El-Said, Ahmed A. Sharara , Lydia F. Melek , Nesma M. Khalil

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INTRODUCTION: Although, the chemical composition of dentin is similar to bone, extracted teeth are still considered a clinical waste and therefore being discarded. With successful extraction of growth factors and bone morphogenic proteins (BMPs) from mammalian teeth, many researchers have supported development of a bone substitute using tooth-derived substances.
OBJECTIVES: To evaluate clinical, radiological and histological efficiency of autogenous fresh demineralized tooth (AFDT) graft prepared at the chairside for alveolar bone grafting in fresh extracted sockets for dental implant surgery
MATERIALS AND METHODS: Ten patients requiring tooth extraction and alveolar bone regeneration for dental implant placement were included in the study. Within 45 minutes the extracted teeth were mechanicaly prepared, grinded, sieved, defatted, demineralized and sterilized. In the same setting, the graft material was used to reconstruct defects at the extraction. After 3 months of uninterrupted healing at time of implant placement bone samples were collected for histological analysis. CBCT were taken preoperative, 3months after grafting and 3 and 6 months after implant placement.
RESULTS: Histologically the osteoconductive, Osteoinductive and Biodegradation of (AFDT) graft was evident. Clinically 100 % success rate of implants was achieved, with no adverse tissue reaction. CBCT have shown increase of bone density at the graft site and stability of marginal bone level around implants.
CONCLUSIONS: (AFDT) graft should be considered as an option given its autogenous origin and favorable clinical, radiographical and histological outcomes when teeth extraction is necessary.
KEY WORDS: Implants, Autogenous, demineralized tooth graft


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EVALUATION OF RHOMBIC THREE DIMENSIONAL PLATE IN TREATMENT OF MANDIBULAR SUBCONDYLAR FRACTURES IN ADULT PATIENTS FROM ALEXANDRIA

Gaafar N. El Halawani, Sherif S. Ayad, Sameh A. Darwish, Ragab S. Hassan

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INTRODUCTION: Open reduction–internal fixation (ORIF) of extracapsular condylar fracture is necessary when there is a displacement of 10–45◦, or a shortening of the ramus by more than 2 mm. The two miniplates is considered the gold standard in fixation of condylar fractures. however, it needs a certain size of the proximal segment restricting its use to low condylar neck fracture. Recently a 3D rhombic plate was introduced, which can be used with high condylar neck fracture, while still providing good anatomical positioning and stability.
OBJECTIVES: To evaluate both clinically and radiographically the three dimensional rhombic plate compared with the two miniplates in the fixation of mandibular subcondylar fractures.
MATERIALS AND METHODS: This prospective clinical study was performed on 20 patients with extracapsular condyle fractures. Patients were divided into 2 groups. Group I was treated with the three dimensional rhombic plate and group II was treated with two miniplates.
RESULTS:There was a significant difference in the maximal mouth opening between the two groups at 3 months postoperatively in favor of the study group, however there was no significant difference in mandibular mobility throughout the follow up period.20% of patients from group (I) and 30% of patients from group (II) had lateral deviation in mouth opening on the first week.This was absent in both groups on the third week postoperatively.The difference between the two groups was not statistically significant one week. The mean bone density in the study group was statistically significantly higher than the control group at 3 and 6 months postoperatively.
CONCLUSIONS: The application of the Rhombic plate for the stable osteosynthesis of condylar fractures ensures satisfactory treatment results, both from the clinical and the radiological points of view.
KEYWORDS: Subcondylar fracture, Rhombic plate, Three dimensional plates.


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CARIOGENIC EFFECT OF DIETARY HABITS AMONG CARIES FREE AND EARLY CHILDHOOD CARIES CHILDREN

Reham S. Soliman, Ahmed Abdel Rahman, Karin ML Dowidar

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INTRODUCTION: Early Childhood Caries (ECC) remains an important childhood disease affecting a considerable portion of young children. ECC has been associated with inappropriate feeding patterns and excess consumption of fermentable carbohydrates.
OBJECTIVES: The purpose of this study was to compare children affected by ECC and S-ECC and those who are caries free regarding their dietary habits.
MATERIALS AND METHODS: Thirty children aged 2-6 years free from any systemic disease were selected for this study. Children were recruited from those attending the outpatient clinic at the Faculty of Dentistry, Alexandria University. The children were divided into three groups. Group 1 consisted of 10 children who had ECC. Group 2 consisted of 10 children presenting with S-ECC, while Group 3 included 10 children who were caries free serving as the control group. After clinical examination, the children's parents were asked to complete a standardized 3-day food diary form where they reported all the foods, beverages and snacks the child consumed over a 3-day period. Finally, a fermentable carbohydrate analysis was performed to determine the average number of exposures per day.
RESULTS: Significant associations were found between the increasing severity of caries and the feeding habits of the children. The total carbohydrate scores for the caries free, ECC, and S-ECC groups were 90.00 ± 17.71, 104.56 ± 38.33, and 161.33 ± 24.12 respectively. There was a statistically significant difference among the three groups (P<0.0001). CONCLUSIONS: The increase in fermentable carbohydrate intake is associated with Early Childhood Caries. KEYWORDS: dietary habits, early childhood caries, severe early childhood caries, fermentable carbohydrates.


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MUCOSAL FLAP VERSUS MUCOPERIOSTEAL FLAP IN RIDGE SPLITTING AND SIMULTANEOUS IMPLANT PLACEMENT USING PIEZOSURGERY(A RANDOMIZED CONTROLLED CLINICAL TRIAL)

Ziad T. Mahmoud , Mostafa M. El-Dibany , Sherif M. El-Ghamrawy , Saeeda M. Osman, Angelo C. Troedhan

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INTRODUCTION: Ridge split procedures are commonly performed for horizontal widening-augmentation of narrow ridges which would otherwise preclude implant placement. Post-surgical vertical and horizontal crestal bone loss that might occur secondary to ridge splitting techniques present a serious obstacle to the success of implant placement and prognosis.
OBJECTIVES: The evaluation of the effectiveness of maintaining the periosteal attachment of the buccal and lingual cortical plates to reduce and/or prevent crestal bone loss that might occur at the crestal margin of dental implants placed immediately in posterior mandibular alveolar ridges splitted using piezosurgery.
MATERIALS AND METHODS: That was a randomized controlled clinical trial. The study population included 16 patients with edentulous posterior mandibular alveolar ridges. The sample was selected conveniently to fulfill a list of inclusion and exclusion criteria. Then the selected participants were allocated randomly into two equal groups each including 8 patients. A full thickness mucoperiosteal flap were performed in the control group patients, while a split thickness mucosal flap was done in the study group patients. All patients had undergone a mandibular ridge splitting technique using piezoelectrical surgical device. After ridge-splitting-porcedure implants with interpositional grafts were placed immediately. Assessments included measurements of the linear changes in the marginal bone surrounding the implants immediately postoperative as baseline, 3, 6 and 9 months postoperative.
RESULTS: The statistical analysis of measurements obtained from both groups showed no significant difference between control and study groups regarding pain and edema assessment, while probing depth, and marginal bone level showed significant difference between both groups in favor to the study group.
CONCLUSIONS: The ridge splitting technique using a partial thickness flap could be a successful option for the reduction of marginal bone loss around immediately inserted implants.
KEY WORDS: Ridge splitting, Piezosurgery, split thickness flap, Full thickness flap, horizontal distraction, posterior edentulous mandible.


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EVALUATION OF THE MICROHARDNESS OF ROOT CANAL DENTIN AFTER DIFFERENT IRRIGATION PROTOCOLS (IN VITRO STUDY)

Soha F. Massoud, Sybel M. Moussa, Seham A. Hanafy, Rania M. El Backly

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ABSTRACT

INTRODUCTION: Different irrigations solutions may cause alteration in the physicochemical properties of dentin structure thereby affecting the microhardness of root canal dentin.
OBJECTIVES: to evaluate the effect of different irrigation protocols on microhardness of human root canal dentin.
MATERIALS AND METHODS: Forty extracted single rooted lower premolars were used. All teeth were instrumented using manual stainless steel files and irrigated by 2ml distilled water between each file, then were sectioned by longitudinal splitting of each tooth. The root halves were randomly assigned into 4 parallel groups (n=10) and immersed for 5 minutes with one of the following irrigants: Group I: 10 ml of 2.5% Sodium Hypochlorite (NaOCL), Group II: 10 ml of 17% ethylene diamine tetra-acetic acid (EDTA) followed by 10 ml of 2.5% NaOCL, Group III: 10 ml of 2.5% NaOCL followed by 10 ml of 2% chlorhexidine digluconate (CHX), Group IV: 10 ml of 2.5% NaOCL followed by 10 ml distilled water then were followed by 10ml of 2% CHX. Ten root halves from each group were prepared to measure dentin microhardness at baseline measurement and after treatment to determine the change in microhardness, using Vickers tester.
RESULTS: Data were analysed using t-test, ANOVA test and Post Hoc test.Group II showed the highest percentage decrease in microhardness values, followed by group III, then group IV and the lowest was group I. All groups showed a significant difference between each other (P < 0.05), except group III and IV. The coronal third showed the highest percentage decrease with significant difference between apical and middle thirds (P < 0.05), in which there was no significant difference between them. CONCLUSIONS: CHX is the best final irrigant if there is excellent intermediate flush for prevention of its precipitation with NaOCL.The coronal third needs conservative approach as it is the most affected third. KEYWORDS: Endodontics, Microhardness, Chlorhexidine, NaOCL, EDTA, Precipitate.


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A COMPARATIVE STUDY OF THE AMOUNT OF APICALLY EXTRUDED DEBRIS AFTER USING DIFFERENT TYPES OF GLIDE PATH FILES

Mai A. Abdallah, Ashraf M. Zaazou, Nayera A. Mokhless

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INTRODUCTION: During root canal preparation; irrigants, dentin chips, pulp tissue and microorganisms may be extruded into the periradicular tissues which may cause postoperative pain and complications.
OBJECTIVES: The aim of this study was to compare the amount of apically extruded debris in mesio-buccal canals of 30 extracted human mandibular molars instrumented with One-Shape file after preparing a proper glide path using G-files, ProGlider and K-files.
MATERIALS AND METHOD: This study was conducted on the mesio-buccal roots of 30 human mandibular molars with curvature of 20 to 35 degrees. All specimens were divided into three groups according to the type of instrument used for glide path management. Group (1): manual instrumentation with K-files (#10, 15), Group (2): G-files: (G1: #0.12mm, G2: #0.17mm), and Group (3): ProGlider: single use rotary file. All teeth were instrumented using One-Shape file. Debris extruded apically from the teeth were collected into pre-weighed Eppendorf tubes. Three consecutive weights were obtained for each tube and the mean value was obtained. The weight of extruded debris was calculated as the difference between the pre and post instrumentation weights of the tubes.
RESULTS: The highest amount of debris was found in the k-file group while the lowest amount with ProGlider group with significant differences between them. Moreover, significant difference was found between ProGlider and G -file while there was no significance between G-file and K -file groups.
CONCLUSIONS: All techniques showed debris extrusion, although the use of NiTi rotary instruments may be rather beneficial.
KEYWORDS: Apical debris, Glide path, Rotary files.


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EVALUATION OF THE EFFECT OF I-GEN TITANIUM MEMBRANE AROUND IMMEDIATE DENTAL IMPLANTS REPLACING POSTERIOR MANDIBULAR TOOTH WITH BUCCAL BONE DEFECT

Aya A. Sakr, Ahmed M. Shaaban, Samraa A. Elsheikh

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INTRODUCTION: Reconstruction of the oral supporting tissues lost by disease or trauma is essential to tooth replacement with dental implant therapy. This treatment requires evidence based augmentative procedures combined with up-to-date and current techniques. Guided bone regeneration (GBR) aims to initialize this process of alveolar ridge reconstruction by utilizing biologically active and supportive materials best coupled to the body’s healing processes. The use of non resorbable, titanium membranes can achieve GBR by ensuring graft stability and space maintenance so as to ensure optimal neovascularization.
OBJECTIVES: evaluate the use of I-Gen titanium membrane used with immediately placed implant replacing a posterior mandibular tooth with buccal bone defect.
MATERIALS AND METHODS: This study was conducted clinically on 10 patients indicated for extraction of a posterior tooth with buccal bone defect, tooth was extracted and an immediate implant, bone graft and I gen titanium membrane were placed. Patients were evaluated clinically and radiographically by using panoramic radiograph and cone beam computed tomography (CBCT).
RESULTS: In this study no severe pain was recorded postoperatively. No signs of inflammation or swelling were observed in almost all of the patients along the follow up period. Sufficient bone thickness which is a minimum of 2 mm was formed in the targeted defect with good stability of the implants after 6 months.
CONCLUSIONS: I gen titanium mesh should be considered as a valuable option for GBR in small and medium sized bone defects.
KEYWORDS: immediate implant, GBR, titanium mesh, buccal defect.


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THE USE OF TITANIUM MESH COATED WITH HYDROXYAPATITE NANOCRYSTALS IN MANDIBULAR FRACTURE (EXPERIMENTAL STUDY)

Asmaa M. Ezzat, Abdel Aziz F. Khalil, Riham M. El-Dibany,Nesma M. Khalil

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INTRODUCTION: Comminuted fractures of the mandible are an important traumatism, in which the mandibular bone is splintered or crushed. Treatment of these types of fractures had always been a challenge to surgeons, considering both the severity of the trauma and the presence of discontinuity defects which require replacement and augmentation in order to treat the bone loss. Titanium mesh was proved to be particularly useful for reconstruction of mandibular discontinuity defects also it can be used as a scaffold for bone grafts. Electrophoretic deposition (EPD) is a coating technique used to increase the osseointegration and increases bone regeneration.
OBJECTIVES: To histologically evaluate the effect of titanium mesh coated with hydroxyapatite nanocrystals using electrophoretic deposition on bone osseointegration and healing following comminuted mandibular fractures.
MATERIALS AND METHODS: A controlled induced comminuted fracture on the inferior border of the mandible extending from the 2nd premolar to the 2nd molar was performed on 12 mongrel dogs. Six dogs were treated using titanium mesh coated with hydroxyapatite nanocrystals (study group) and the other six using uncoated titanium mesh (control group). The dogs were sacrificed at 2, 4 and 6 weeks and the specimens were dissected to be histologically and radiographically evaluated for new bone formation.
RESULTS: The histological outcome showed superior bone healing in the bony defects in the resembling comminuted fracture in the study group than the control group.
CONCLUSIONS: The nano-hydroxyapatite coated titanium mesh is a suitable method for reconstruction of comminuted fractures with bony defects.
KEYWORDS: titanium mesh, hydroxyapatite nanocrystals, electrophoretic deposition, comminuted fracture, mandibular farcture.


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EVALUATION OF STEREOLITHOGRAPHIC SURGICAL GUIDE IN INDIRECT SINUS LIFTING FOR IMPLANT PLACEMENT

Amr Y. Shiha, Abdelaziz F. Khalil, Riham M. Eldibany

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INTRODUCTION: Due to the inherent characteristics of the posterior maxillary bone, oral rehabilitation with implants may present some difficulties related to poor quality and insufficient volume of bone due to sinus pneumatization. Maxillary sinus augmentation procedure is currently considered a highly predictable and safe technique that allows the insertion of implants into the atrophic posterior maxilla. The use of CAD-CAM stereolithographic surgical guide during sinus-lift procedure has been advocated for many years.
OBJECTIVES: This study was designed to evaluate the accuracy of stereolithographic surgical stent in transcrestal sinus lifting for implant placement.
MATERIALS AND METHODS: A total of fifteen implants were placed in 6 patients. They were selected to perform transcrestal sinus lifting with simultaneous implant placement using stereolithographic surgical stent.
RESULTS: Merging the preoperative plan and immediate postoperative CBCT images showed statistically significant values of the accuracy. The mean difference of angulation of the inserted implants compared to the angulation projected by the stereolithographic stent was 7.03° ± 4.53°. The mean of total coronal differences was 1.56 mm ± 1.15 mm, while the mean of total apical differences was 1.75 ± 1.14 mm.
CONCLUSIONS: For beginners, stereolithographic surgical stent is an acceptable tool for transcrestal sinus lifting with simultaneous implant placement especially for single implants.
KEYWORDS: transcrestal sinus lift, stereolithographic surgical stent, accuracy, implants.


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EVALUATION OF THE EFFECT OF HYALURONIC ACID MIXED WITH BIPHASIC CALCIUM PHOSPHATE ON BONE HEALING AROUND DENTAL IMPLANTS(EXPERIMENTAL STUDY)

Mostafa M. Shamma, Sherif S. Ayad, Riham M. El-dibany, Dina A. Nagui

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INTRODUCTION: Biphasic calcium phosphate (BCP) is very widely used as a grafting material around dental implants. The properties of such material can be enhanced by adding interpositional graft materials to enhance osteoinduction. Hyaluronic acid (HyA) is an example of osteopromoting materials that can be added to the BCP to enhance its osteoinductive properties.
OBJECTIVES: Histological evaluation of using HyA with BCP on bone healing around dental implants.
MATERIALS AND METHODS: This study was a split mouth design. It was conducted on 9 mongrel dogs. The dogs were allocated into two groups: Group A (Study Group): The right side of the mandible received dental implants with biphasic calcium phosphate bone graft mixed with hyaluronic acid following extraction of the mandibular third premolar. Group B (Control Group): The left side of the mandible received dental implants with biphasic calcium phosphate bone graft only following extraction of the mandibular third premolar. Dogs were sacrificed at 2, 4 and 6 weeks postoperatively. Segments containing the implant and bone graft were retrieved with adjacent bone to be prepared for histological examination using Haematoxylin and eosin stain and Trichrome stain.
RESULTS: All animals survived well, and remained active and alert all over the course of the experiment. Both groups were characterized by new bone formation. The newly formed bone was more evident in association with group (A).
CONCLUSIONS: HyA accelerates the onset of new bone formation when combined with BCP for bone augmentation in the treatment of osseous defects.
KEY WORDS: Dental implants, biphasic calcium phosphate, mandible, hyaluronic acid, osseointegration


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ANTIBACTERIAL EFFECT OF Er,Cr:YSGG LASER UNDER VARIOUS IRRADIATION CONDITIONS IN ROOT CANALS CONTAMINATED WITH ENTEROCOCCUS FAECALIS(In vitro study)

Saad El-Din S. EL-Gendy, Sybel M. Moussa, Ashraf M. Zaazou, Marwa A. Meheissen

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INTRODUCTION: The fundamental aim of endodontic therapy is to completely disinfect the root canal and its three-dimensional tubular network.
OBJECTIVES: This in-vitro study compared the antibacterial effect of intracanal irradiation with Er,Cr:YSGG laser in dry condition to laser activated irrigation in root canals contaminated with Enterococcus faecalis.
MATERIALS AND METHODS: Twenty-six extracted human single-canaled lower bicuspids were used. Teeth were instrumented and autoclaved, and then three specimens were randomly chosen to serve as negative control. The remaining specimens were inoculated with Enterococcus faecalis for two weeks and then additional three specimens were selected to serve as positive control. The remaining specimens were divided into two equal experimental groups according to the disinfection procedure, Group I: Dry Laser Irradiation, Group II: Laser Activated Irrigation. Bacterial sampling was collected by both paper points and dentin chips from the canal walls and analyzed for the presence of Enterococcus faecalis using culture method. The CFU% reduction of each group was determined in relation to the positive control.
RESULTS: For the paper points method of sampling, a statistically significant difference was found between group II (99.60%) and group I (82.50%) (P=0.012). While for the dentin chips method, a statistically significant difference was found between group II (100.00%) and group I (50.00%) (P=0.005).
CONCLUSIONS: Er,Cr:YSGG dry laser irradiation is not an alternative but a possible supplement to existing protocols for root canal disinfection. The use of NaOCl together with Er,Cr:YSGG laser activation yields superior disinfecting results.
KEYWORDS: Er,Cr:YSGG laser, Dry irradiation, Laser activated irrigation, Enterococcus faecalis, root canal disinfection


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EVALUATION OF PIEZOTOMED ALVEOLAR RIDGE SPLITTING WITH STEREOLITHOGRAPHIC SURGICAL GUIDE FOR IMPLANT PLACEMENT

Mohamed N. Mustafa, Abdelaziz F. Khalil, Lydia N. Melek

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INTRODUCTION: Narrow dentoalveolar ridges remain a serious challenge for the successful placement of endosseous implants. Several techniques for this procedure may be considered, such as guided bone regeneration, bone block grafting, and ridge splitting for bone expansion. The ridge split procedure provides a quicker and a more reliable method. Advances in technology, Stereolithography allow fabrication of surgical guide from 3D generated models for precise implant placement.
OBJECTIVES: Evaluation of minimally invasive ridge splitting procedure aided with surgical guide.
MATERIALS AND METHODS: A clinical study was performed on a total of 7 patients with mandibular free end saddle. The sample was selected conveniently to fulfill a list of inclusion and exclusion criteria. Then the selected participants performed ridge splitting with the aid of surgical guide. After ridge splitting, all patients had simultaneous implant placement followed by clinical and radiographical evaluation over a period of 6 months.
RESULTS: Merging the preoperative, immediate and 6 months postoperative CBCT images showed statistically significant values of accuracy and increase in bone width.
CONCLUSIONS: Alveoalar ridge splitting with the aid of stereolithographic surgical stent is a well acceptable technique for implant placement.
KEYWORDS: ridge splitting, stereolithographic surgical stent, flapless, implants.


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EVALUATION OF THE EFFICACY OF FIBER GLASS SPLINTING FOR FIXATION OF DENTO-ALVEOLAR FRACTURES IN CHILDREN

Hager K. Khidr, Samraa A. El Sheikh, Lydia N. Melek

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INTRODUCTION: Dentoalveolar fractures of children are a common manifestation of trauma, but it is different from trauma in adults. There are several points of differentiation between the two; the most important one is growth.
OBJECTIVES: To evaluate the efficacy of a new fiber glass splint for fixation of dentoalveolar fractures in children.
MATERIALS AND METHODS: This was a prospective clinical trial. Ten children with dentoalveolar fractures were selected from the outpatient clinic of The Oral and Maxillofacial Surgery, Faculty of dentistry, Alexandria University. The patients were treated with closed reduction and fixation with new splint (F-Splint Aid). Clinical and radiographic evaluation were done up to 4 months post operatively for post-operative swelling, Inflammation or infection and stability of fracture segment. The bone density was measured and compared at the first and fourth months' post operatively using cone beam software.
RESULTS: There was a decrease of pain from time of treatment to the seventh day after treatment which was statistically significant, the subsidence of edema and decrease of mobility were also statistically significant, and there was an increase in the mean radiographic bone density from 1month to 4months post operatively which were found to be statistically significant (T value=5.639, P value<0.001). CONCLUSIONS: It was concluded that the use of F. Splint. Aid in the treatment of dentoalveolar fracture of children is cheap, hygienic, esthetic, and non-invasive technique. KEY WORDS: Fiber glass splint,dentoalveolar fracture, bone density, children.


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