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CLINICAL EVALUATION OF DEXTROSE PROLOTHERAPY FOR MANAGEMENT OF TEMPOROMANDIBULAR JOINT DISORDER

Adel M. ELwerfelli, Abd Elaziz F. Kalil, Nevein S. Abdullah

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Introduction: Temporomandibular disorders (TMDs) are clinically significant conditions which can be a source of acute or chronic orofacial pain and dysfunction including limitation of mandibular movement. Simple lysis and lavage in the upper joint space which washes out inflammatory mediators were found to be highly effective in reestablishing normal maximum interincisal opening (MIO), jaw function and relieving the symptoms despite the disc position not have been corrected. Objectives: To evaluate the efficiency of arthrocentesis, used normal saline, followed by injection of dextrose 50%, in a single injection protocol, for management of patients with TMDs. Materials and methods: This study was conducted on fourteen TMD patients have been diagnosed on the bases of the clinical data and MRI findings. The selected patients were divided equally into two groups, each group comprising of seven patients. The group-A: has been treated by arthrocentesis followed by 2 ml of dextrose 50% injected into the superior compartment of TMJ. The group-B: has been treated with arthrocentesis alone. All patients have been evaluated at the end of the 24 hours, 1st, 2nd, 3rd, 4th, 5th and 6th weeks postoperatively. Results: unassisted mouth opening showed an increase at all time intervals. There was a significant improvement in pain, the range of motion, joint effusion and joint sounds. Conclusions: Arthrocentesis followed by 50% dextrose injection is superior to arthrocentesis alone in reducing impairment in patients with TMDs on its clinical outcome. KeywordS: Range of motion, Arthrocentesis, Intra-articular injection, Maximum interincisal opening, Dextrose Prolotherapy.


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THE USE OF CALCIUM ION NANOSTRUCTURE IMPLANT SYSTEM FOR MISSING MAXILLARY ANTERIOR TEETH

Bassant A. Mohamed, Saeeda Osman, Magued H. Fahmy

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Introduction: The goal of modern dentistry is to restore the patient to normal contour, function, comfort, esthetics, speech and health regardless of the atrophy, disease or injury of the stomatognathic system. Dental implant is defined as a prosthetic device alloplastic material implanted into the oral tissues beneath the mucosal or periosteal layer within the bone to provide retention and support for a fixed or removable prosthesis. Objectives: The aim of this study was to evaluate clinically and radiographically the use of calcium ion surface treated nanostructure implant system for missing maxillary anterior teeth. Materials and methods: Eleven patients with anterior maxillary missing tooth were treated with calcium ion nanostructure implant. An implant stability and assessment of the osseointegration progress evaluation was conducted using the resonance frequency analysis technique (Osstell) immediately after implant placement and after one and half month at the loading time. Also, radiographic investigations were performed after one and half and three months to estimate the peri-implant mean bone density. Results: all of the cases showed an uneventful wound healing. Mean bone density after three months showed a statistically significant (p<0.001) increase in its values when compared to the immediately postoperative values. Implant stability showed statistical significant difference detected clinically by Osstell. Conclusions: The calcium ion nanostructure implant system showed an adequate clinical and radiographic performance in the replacement of missing maxillary anterior teeth with and early loading protocol. Keywords: Osstell ISQ, osseointegration, Xpeed.


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THE USE OF BUCCAL ANTROSTOMY BONE AS A GRAFT FOR CLOSURE OF ORO- ANTRAL FISTULA

Mohamed S. Elmaradny, Ahmed S. Elmahalawy, Hala R. Ragab

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Introduction: Oroantral fistula is an epithelialized, pathological and unnatural communication between the oral cavity and the maxillary sinus. Objectives: The aim of this study was to evaluate the use of buccal antrostomy bone as a graft for closure of oroantral fistula clinically and radiographically. Materials and methods: A prospective study was done on 10 patients complaining of oroantral fistulae following extraction of maxillary posterior teeth. The bony defect of the oroantral fistula was closed by anterior wall of maxillary sinus as a graft material and fixed to the surrounding bone using N-Butyl-2-Cyanoacrylate (Histoacryl®), then covered by buccal advancement flap. The patients were followed up clinically after 4, 6, 8 and 12 weeks postoperatively Radiographic evaluation was performed by cone beam computed tomography (CBCT) preoperatively and after 12 weeks postoperatively. Results: Evaluation of the patients revealed that proper healing of the wound occurred in most of the patients except in 3 patients whose bone graft was exposed and removed. Radiographicaly, significant amount of bone was formed comparing the preoperative and postoperative CBCT of the patients. Conclusions: According to the results of the present study, it is concluded that the use of the buccal antrostomy wall as a bone graft fixed with N butyl cyanoacrylate proved successful results in closure of large oroantral fistula. Keywords: Oroantral fistula, anterior wall of maxillary sinus, N-Butyl-2-Cyanoacrylate (Histoacryl®).


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EMG COMPARISON BETWEEN MASTICATORY MUSCLES WHEN USING NARROW DIAMETER IMPLANT ASSISTED MANDIBULAR OVERDENTUES

Mostafa M. Teranelly, Muhammed A. Gad, Adham A. El Ashwah, Rania A. Fahmy, Wafaa S. Elemary

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Introduction: One of the primary objectives of complete dentures is to restore masticatory function in people who have lost their natural teeth. Patients wearing conventional complete denture (CD) often complain of instability of the mandibular denture leading to a feeling of insecurity, inefficient mastication, and overall dissatisfaction with the prosthesis. Implant mandibular overdentures (IOD) constitute a secure therapeutic alternative, affording a great patient’s satisfaction and masticatory efficiency. The most common problem in implant dentistry is the presence of insufficient bone volume to receive the conventional size of dental implants. The 2-pieces narrow diameter implants were introduced into the market combining the undisturbed healing period required for proper osseointegration and the avoidance of time, cost and morbidity of extensive surgeries for bone augmentation. Objectives: The aim of the current work was to evaluate and compare the electromyographic (EMG) activity of masseter and anterior temporalis muscles when using three different treatment protocols i.e. (conventional CDs, two and four IODs). Materials and methods: Eight completely edentulous patients were selected from the prosthetic department, Faculty of dentistry, Alexandria University. Implant mandibular assisted overdentures were constructed for each patient using narrow diameter implants and delayed loading protocol. EMG activity of masseter and anterior temporalis muscles during habitual chewing and maximal voluntary clenching were recorded for each of the studied patients in the three different treatment protocols. Results: EMG activity of masseter and anterior temporalis muscles of IOD was significantly lower with conventional CD than with IOD. Patients with four IOD showed higher EMG activity of masticatory muscles and better function compared to two IOD. Masticatory muscles activity during clenching was significantly higher than during chewing. Conclusions: It was concluded that IODs have great masticatory efficiency when compared to CD. Implants number affect masticatory efficiency and muscle activity in cases of severely resorbed mandibular ridge. Keywords: Narrow implant, overdenture, masticatory efficiency and Electromyography.


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ACCURACY OF IMPLANT PLACEMENT USING TWO DIFFERENT TYPES OF CAD/CAM SURGICAL GUIDES (AN INVITRO STUDY)

Moustafa F. Ahmed, Ahmed M. AbdelHamid, Fayza H. AlAbbasy

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Introduction: Computer-aided implant planning and guided surgery provide high accuracy to dental implant placement and facilitate more predictable prosthetic outcomes than non-guided implant surgery. Objectives: To compare the accuracy of implant placement using 3D printed and machine milled surgical guides. Materials and methods: Twelve polyurethane foam resin mandibular models were used in this study. Implant position was virtually planned using 3D planning software based on the preoperative CBCT of each model. Surgical guides were designed on the software and exported in STL format. Models were randomly divided into 2 groups (n=6 each). Group I: Surgical guides were manufactured using 3D printing. Group II: Surgical guides were manufactured using machine milling. Three implants were placed in each model using CAD/CAM surgical guides. The 3D position of the planned and placed implants, in terms of the linear deviations of the implant head and apex and the angular deviations of the implant axis, was compared by superimposing the pre- and postoperative CBCT using dedicated software. The Mann-Whitney U test was used for comparison (P <0.05). Results: The mean coronal, apical and angular deviation for Group I were 0.72 ± 0.21 mm,  1.1 ± 0.42 mm and 2.5° ± 1.2° respectively, while for Group II they were 0.85 ± 0.3 mm,  1.3 ± 0.37 mm and 3.09° ± 0.89° degrees respectively. No significant differences were found between both groups for any of the measurements. Conclusions: 3D printing gave better results over machine milling; however, both types can be used in manufacturing surgical guides as difference in accuracy is not statistically significant. The accuracy of implants in both groups was within the safety margin of previous studies. Keywords: CAD/CAM, surgical guides, 3D printing, computer guided surgery, CBCT, virtual planning


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STRAIN GAUGE ANALYSIS OF AXIAL AND OFF AXIAL LOADING ON IMPLANTS FOR REPLACING FIRST MANDIBULAR MOLAR (INVITRO STUDY)

Noha M Salah Eldin, Yousreya A Shalaby, Mohammad Salah Nassif

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Introduction: Mechanical overload is thought to be one of the major causes of implant complications. It may induce loosening and fracture of the superstructure and/or implant components. Bone loss may also occur at the implant-bone interface. Increasing the diameter and length of the implant decreased the stress and strain on the alveolar crest, but diameter had a more significant effect than length to relieve the crestal stress and strain concentration. When the mesiodistal dimension is greater than 14 mm, using at least two implants to restore the region should be considered. When two implants replace the molar region, the mesiodistal offset loads to the pros­thesis can be eliminated. Objectives: Evaluation of the axial and off axial loading on implants of different diameters for replacing first mandibular molar. Materials and methods: Fifteen epoxy resin blocks in which implants of different diameters were fixed. Specimens were divided into 3 parallel groups, 5 specimens each according to the implant diameter. Evaluation of the strain distribution around the implants under vertical axial and off axial loading using the strain gauge was done. Results: The total microstrain mean value of the double implants was significantly less than the 6mm wide implant and the 4.7mm diameter implant. Conclusions: On using dental implants for replacing mandibular first molar, double (3.75-3.75) mm diameter implants revealed reducing microstrains than 6-mm-diameter implant and 4.7 diameter implant and give wider support to the crown restoration leading to elimination of the mesiodistal cantilever. Keywords: Strain gauge analysis, Stress analysis, strain, axial loading.


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PREVELANCE OF ORAL AND RESPIRATORY MICROORGANISMS ON THE CAD-CAM VERSUS PRESS FORM OF POLY-ETHER-ETHER KETONE MATERIAL FOR ORAL AND MAXILLOFACIAL PROSTHESIS

Nourhan S. Emam, Faten S. el-deen, Showikar M. Abdel-salam

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Introduction: Biofilm formation differs in accordance to material type and processing technique, which has a crucial impact on maxillofacial prosthetic materials’ practicability. Objectives: to compare the prevalence of the upper respiratory tract and oral microbial flora colonization on the two commercially available forms of polyetheretherketone (modified PEEK); the conventional press form and the CAD-CAM form. Materials and methods: : forty eight circular discs, were processed forming four groups: Group I: twelve BioHPP discs were prepared with CAD-CAM form, Group II: twelve BioHPP discs with conventional press form, Group III: twelve heat polymerized poly methyl meth acrylate (PMMA) to mimic the polished surface Group IV: twelve heat cured PMMA to mimic the fitting surface. Microbiological procedures were performed including microbiological sampling, isolation, purification and identification, biofilm formation and assessment of the normal oral and respiratory flora on modified PEEK and PMMA discs. Results: Acrylic resin fitting surface group had the highest biofilm formation when compared with the three other groups. No statistical significant difference was found between each pair of the three remaining groups, CAD-CAM BioHPP group showed the lowest biofilm formation of all groups according to mathematical data, but it didn’t approach the level of being statistically significant. Conclusions: Both BioHPP processing techniques were positive for biofilm formation, though BioHPP CAD-CAM showed a rougher surface than pressed BioHPP, it showed the least biofilm formation of all groups. Fitting surface of acrylic resin group showed the worst results for biofilm formation. Keywords: Biofilm, PEEK, Acrylic resin, Respiratory flora.


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EFFECT OF TWO REMINERALIZING AGENTS ON MICROHARDNESS OF INITIAL ENAMEL CARIES- LIKE LESIONS IN YOUNG PERMANENT TEETH

Reham H. Abdelaziz, Ahmed A. Mohamed, Dalia M. Talaat

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Introduction: Dental caries in enamel is unique amongst diseases as enamel is both acellular and avascular. Thus, in contrast to other tissues, enamel cannot heal itself by a cellular repair mechanism. Nonetheless, it is now well established that the formation of incipient enamel caries is a reversible process where periods of progression alternates with periods of remineralization. Objectives: The purpose of this study was to compare the effect of Nano-hydroxyapatite paste and casein phosphopeptide-amorphous calcium phosphate fluoride paste remineralizing capacity on initial enamel carious lesions of young permanent teeth. Materials and methods: Sixty extracted young permanent teeth with a standardized window on enamel were immersed in a demineralizing solution for 48 hours to produce subsurface enamel lesions. They were divided into three groups according to remineralizing agents (N=20): group I: Nano-hydroxyapatite paste; group II: casein phosphopeptide-amorphous calcium phosphate fluoride paste; and group III: control (untreated). The enamel surface microhardness (SMH) was measured at baseline, after incipient enamel lesion formation and after treatment. Results: The mean surface microhardness (201.46) was found to be higher in teeth treated with Nano-hydroxyapatite paste than mean surface microhardness (195.61) in those treated with casein phosphopeptide-amorphous calcium phosphate fluoride paste. However, this difference was not statistically significant P=0.26. ConclusionS: Both Nano-hydroxyapatite paste and casein phosphopeptide-amorphous calcium phosphate fluoride paste were effective for remineralization of early caries-like lesions of young permanent teeth. Keywords: Nano-hydroxyapatite, casein phosphopeptide-amorphous calcium phosphate fluoride, young permanent teeth.


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EVALUATION OF THE EFFECT OF SINGLE NUCLEOTIDE POLYMORPHISM 1772C>T IN HIF-α GENE ON THE RESIDUAL RIDGE RESORPTION OF THE MANDIBLE IN THE EGYPTIAN POPULATION

Samar M. Emam, Noha M. Issa, Mohamed S. El-Attar

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Introduction: Atrophic residual ridges have always been an obstacle for a successful prosthodontics treatment. Residual ridge resorption (RRR) was attributed to a combination of anatomical, metabolic and mechanical determinants. Lately, the genetic factor was considered since single nucleotide polymorphisms (SNPs) in relevant genes have been present in patients having severe RRR. Objectives: The aim of the current study was to investigate for the first time the relation between SNP 1772C>T in Hypoxia Inducible Factor-1 alpha (HIF-1α) gene and the presence of severely resorbed edentulous mandibular ridges in a sample of the Egyptian population. Materials and methods: The study was conducted on 50 subjects divided into case and control groups according to the residual ridge height. Saliva was used as a convenient source of DNA in the dental clinic. PCR-Restriction Fragment Length Polymorphism was performed for genotyping. Results: A statistically significant difference in the distribution of the TT genotype between both groups was present. There was also a difference in the distribution of the CC and CT genotypes but it wasn’t statistically significant. The T alleles were more abundant in the case group while the control group showed more frequency of the C allele with no statistical significance. Conclusions: This study concluded that the TT genotype of the 1772C>T polymorphism of HIF-1α gene is related to the presence of severely atrophied residual ridges. This SNP can be used as a marker to predict the future condition of the ridge using saliva samples. Further studies on larger scale are recommended. Keywords: Edentulous mandible, Genetics, Hypoxia inducible factor-1 alpha (HIF1-α), Residual ridge resorption (RRR), Single nucleotide polymorphisms (SNPs)


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EVALUATION OF RAMUS AUTOGENOUS BLOCK GRAFT FOR VERTICAL AUGMENTATION OF MANDIBULAR POSTERIOR ALVEOLAR RIDGE

Sara M. Mandour, Nagy E. Hassan, Ahmed O. Sweedan

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Introduction: Bone defects in the human mandible are common. They are mostly determined by premature loss of teeth due to periodontal disease or traumas. They usually cause reduction of alveolar bone volume, which becomes inconsequence, inadequate for standard treatments with Osseo integrated implants. The predictability of the implant survival and the maintenance of long-term stability of implants in function are directly associated with the quality and quantity of the available bone for implant placement. In the case of alveolar ridges with insufficient bone volume vertical, horizontal or sagittal inter-maxillary relationships, additional surgical procedures can be necessary to reconstruct and augment the deficiency. Bone block graft is the preferred method for many types of augmentation procedures, since it secures both a source of osteogenic cells and a rigid structure for mechanical support. In addition, bone block graft conserves its volume better than particulate grafting. Objectives: This study provides a clinical, radiographic, analysis of the use of mandibular ramus block autografts for vertical alveolar ridge augmentation. The suitability of the bone will be harvested to provide sufficient bone volume to facilitate implant insertion at a second stage. Materials and methods: The present study was conducted on 12 patients with age ranged from20-50 years seeking implantation of their lost posterior mandibular teeth, and have limited bone height. Patients were selected on the basis of history, clinical examination and radiographic examination using panoramic radiography and CBCT. Results: in this study 10 patient out of 12 showed successful vertical bone augmentation with autogenous bone graft harvested from the ramus of the mandible with 83.33% success rate. Conclusions: using ramus autogenous bone graft in augmentation of vertical bone defects in the posterior area of the mandible has significant success. Keywords: Alveolar ridge augmentation; Autogenous bone grafts; Endosseous dental implants; Intraoral donor sites.


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SPECTROPHOTOMETER ANALYSIS OF CAD-CAM ZIRCONIA REINFORCED LITHIUM SILICATE AND LITHIUM DISILICATE GLASS CERAMICS

Sherine A. Saad, Yousreya A. Shalaby, Amir S. Azer, Fatma M. El-Sharkawy

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ntroduction: Matching dental ceramic translucency is the optimal esthetic goal in restorative dentistry. Several types of ceramics evolved over the years in an attempt to optimize physical mechanical and optical properties of the previous types. Objectives: The aim of this study is to compare and analyze   light transmission, light reflection and light absorption of high translucency zirconia reinforced lithium silicate ceramic, low translucency zirconia reinforced lithium silicate ceramic, high translucency lithium disilicate glass-ceramic and low translucency lithium disilicate glass-ceramic. Materials and methods: Serial cutting of the E.max cad and Vita suprinity blocks was done using isomet 4000 micro-saw microtome. Ten ceramic specimens were obtained for each material, 5 of which were 1.5 mm thick and the other 5 were 1 mm thick to be veneered by 0.5 mm of the corresponding veneering material according to manufacturer\'s instruction. Spectrophotometric analysis was carried out for the forty ceramic specimens. Results: Light transmission for the four groups of zirconia reinforced lithium silicate was significantly higher than their corresponding groups of lithium disilicate (p<0.005). Light reflection and light absorption for the four groups of zirconia reinforced lithium silicate was significantly lower than their corresponding groups of lithium disilicate (p<0.005). Veneering increased light transmission and light reflection however it decreased light absorption for both materials significantly. Conclusions: Translucency of zirconia reinforced lithium silicate is better than lithium disilicate. Veneering improved optical properties for both zirconia reinforced lithium silicate and lithium disilicate. Keywords: Spectrophotometer, translucency, zirconia reinforced lithium silicate, lithium disilicate.


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EVALUATION OF NIGELLA SATIVA ON SOCKET HEALING IN RABBITS

Sara M. Abd Elrahman, Salwa A. Younes, Khadiga Y. Kawana

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Introduction: Tooth extraction socket healing is a complex process, which involves tissue repair and regeneration. Concurrent with bone growth into the socket, there is also well-documented resorption of the alveolar ridges. Therefore, the socket preservation concept was introduced. One of the top ranked evidence-based herbal medicines, which has been described as the “miracle herb of the century” is Nigella sativa (NS). N. sativa has been extensively studied for its biological activities and therapeutic potential and shown to possess wide spectrum of activities. Objectives: To evaluate the biological effect of Nigella sativa on socket healing in rabbits. Materials and methods: Twelve healthy rabbits were used in this study, lower first premolars (right and left) were extracted. All right sockets were left for normal healing as a control group, while the left sockets are considered as the study group and they were treated with Nigella Sativa. All sockets were sutured. Rabbits were sacrificed after two weeks. Their mandibles were dissected out to be processed for histological examination under the light microscope. Results: In the control group, the histological examination of the socket revealed randomly arranged thin bony spicules lined by flattened layer of osteoblast cells on its surface, enclosing fibrous bone marrow with limited vascularity. Osteocytes were of moderate size and density. In the Nigella sativa treated group sockets exhibited more active bone formation, thick trabeculae with highly vascular bone marrow and large numerous osteocytes. Certain areas show replacement of woven bone with mature bone where bone remodeling takes place. Conclusions: Use of Nigella sativa after extraction in the healing sockets could enhance bone formation and accelerate the process of socket healing Keywords: Nigella sativa, socket healing, rabbit, bone formation


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EFFECT OF BISPHOSPHONATES ON THE ALVEOLAR BONE OF RATS WITH GLUCOCORTICOIDS INDUCED OSTEOPOROSIS

Hagar S. Abdel Fattah, Nawal A. El Masry, Khadiga Y. Kawana, Nesma M. Khalil

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Introduction: Bone is a unique tissue that undergoes frequent remodeling. An imbalance between bone formation and resorption results in osteoporosis. Glucocorticoids (GCs) are widely used clinically as anti-inflammatory and immunomodulatory.  However, their prolonged use may induce osteoporosis. Currently, evidences revealed that also the alveolar processes are subject to osteoporosis. Bisphosphonates, such as Alendronate, Risedronate and Zoledronate, are recommended by several international guidelines as the first-line therapy for the prevention and treatment of generalized glucocorticoids induced osteoporosis (GIOP). Objectives: To evaluate the effect of bisphosphonates (Risedronate) on the alveolar bone of rats with glucocorticoids induced osteoporosis. Materials and methods: Thirty female albino rats were divided into 3 equal groups (10 rats each) as follows: Group I: control group. Group II: glucocorticoids group (Dexamethasone 0.6mg/kg twice/week subcutaneously). Group III: Risedronate treated group; rats were given Dexamethasone (0.6mg/kg twice/week subcutaneously) and Risedronate (1mg/kg/day orally). After 12 weeks, rats were euthanized, and the mandibular alveolar bone was evaluated histologically by light microscope and ultra-structurally by scanning electron microscopy and energy dispersive X-ray (EDX) microanalysis. Results: Group II showed deterioration of the alveolar bone in comparison to the control group I. The alveolar bone structure in Group III rats, treated by bisphosphonates (Risedronate), showed remarkable improvement both histologically and ultrastructurally in comparison to group II. Moreover, EDX analysis revealed a significant decrease of calcium levels in group II in comparison to group I. However, in group III calcium levels were restored to normal levels comparable to the control group I. Conclusions: Glucocorticoids intake induces loss of the alveolar bone; which, could be counterbalanced by bisphosphonates. Keywords: Bisphosphonates, glucocorticoids, osteoporosis, alveolar bone.


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ROOT SURFACE TREATMENT USING DIODE LASER IN TOOTH REPLANTATION (EXPERIMENTAL STUDY IN RATS)

Karim Y Hafez, Sahar S. Karam, Hanaa M. Ali

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Introduction: Avulsion of teeth radically affects the integrity of the tooth and the supporting tissue, and impairs the natural dentition as a whole; thus, all efforts must be directed to the replantation of traumatically avulsed teeth. However, its success is limited due to the occurrence of external root resorption. The challenge is to follow an effective protocol that reduces the occurrence of root resorption and allow for reestablishment of the natural architecture of the periodontal tissue. Biomodulation provided by low level laser therapy provides a promising tool in managing the inflammatory process and augmentation of the reparative process. Objectives: Was to evaluate the effect of low-level laser therapy (LLLT) on the healing process of rat teeth replanted after delayed replantation. Materials and methods: Thirty healthy Albino male rats had their maxillary left incisors extracted; According to the root surface treatment before the replantation, the teeth were assigned randomly to two groups (n = 15): G1 (control) – no root surface treatment; G2 (study group)-laser diode treatment on the root surface. The teeth were replanted into their respective sockets after 30 minutes, mimicking the natural timing it would take to replant an avulsed tooth. G2 were treated with LLLT performed on the buccal and palatal mucosa every 48 hours for 15 days. The rats were sacrificed after 15, 30 and 45 days of replantation. The specimens were processed for histological and histomorphometric analysis to determine the average root resorption areas and to evaluate the histological events. Results: Histomorphometric analysis showed that the study group (Laser irradiated group) showed lower areas of root resorption and ankylosis, than in control group (non-irradiated group); with a significant statistical difference (p > 0.05). Histological assessment showed restoration of periodontal ligament attachment and increased vascularity in the study group. Conclusions: Laser irradiation reduces external root resorption and ankylosis in delayed tooth replantation.  


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THE EFFECT OF MINERAL TRIOXIDE AGGREGATE ALONE AND IN COMBINATION WITH BIPHASIC CALCIUM PHOSPHATE ON HEALING OF MANDIBULAR DEFECTS IN RABBIT

Gailan M. Galal, Samia S. Abd El Rehim, Sahar S. Karam

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Introduction: Critical sized bone defects above critical size do not heal completely by themselves and thus represent major clinical challenge to reconstructive surgery. Numerous bone substitutes have already been used to promote bone regeneration. Incorporation of bone grafts such as biphasic calcium phosphate (BCP) as osteoconductive materials has been proven to be effective in promoting bone healing in oral surgery. As it is considered a potential candidate for bone regenerating biomolecules which can help in rapid bone repair because of its composition, the biocompatible material \"mineral trioxide aggregate\"(MTA) is suggested to be promising. Objectives: To compare the efficacy of MTA on the process of bone healing alone and the combination of MTA with biphasic calcium phosphate Materials and methods: Sixteen rabbits will be divided into two experimental groups: (1) MTA, (2) MTA+BCP. Right and left critical size bone defects will be performed in the edentulous area of rabbit mandibles (diastema). Right side bone defects will be filled with MTA, while the left side bone defects will be filled with MTA in combination with BCP. The effect of both MTA and BCP on defect healing will be assessed histologically, histomorphometrically and immunohistochemically after 6 weeks postoperatively. Results: Greater amount of new bone formation was noticed in the CSDs loaded with MTA and BCP. The amount of new bone formed was significantly higher in the MTA+BCP group when compared with the MTA group. Also bone cells activities appeared greater in the former group. Conclusions: MTA induces new bone formation via an osteoinductive action and can be added to bone grafts to enhance bone regenerative capacity. Keywords: Mineral Trioxide Aggregate, Biphasic Calcium phosphate, bone defects, rabbit.


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EFFECT OF FLUOXETINE ON THE STRUCTURE OF ALVEOLAR BONE IN RATS WITH INDUCED DEPRESSION

Aya S. Mohamed, Khadiga Y. Kawana, Sahar S. Karam

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Introduction: Depression is one of the most prevalent psychological disorders. It affects all body systems including endocrinal, neurological and immune system. Additionally, it is thought to affect bone homeostasis. Antidepressants are the most commonly prescribed drugs. They are classified into tricyclic and tetra cyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs) and selective serotonin-reuptake inhibitors (SSRIs). Fluoxetine, which is a selective serotonin-reuptake inhibitor, is used for the treatment of depression by selectively acting on serotonin (5-HT). Fluoxetine plays a major role in bone apposition and in maintaining the bone homeostasis. Objectives: To investigate the effect of selective serotonin-reuptake inhibitor (fluoxetine) on the structure of alveolar bone in rats with induced depression. Materials and methods: Thirty adult male rats were divided as follows: Group I: (control group) which consists of 10 rats, Group II: (depression group) 10 rats were exposed to chronic unpredictable stress (CUS) to induce depression, Group III: (fluoxetine group) 10 rats were exposed to chronic unpredictable stress (CUS) to induce depression and at the same time they were orally supplied with 10 mg/kg/day of fluoxetine. After 3 months, the mandibles were dissected out and prepared for histological analysis using light microscope, scanning electron microscope (SEM) and energy dispersive x-ray microanalysis (EDX). Results: In the control group, the alveolar bone surface showed a regular and smooth outline. In the depression group, there was a significant disturbance in the bone architecture. The bone surface showed an irregular outline with multiple osteoclasts lying in How ship\'s lacunae. Deeply stained incremental lines were also evident. In the fluoxetine group, the bone surface restored its regular outline with multiple osteoblasts and osteocytes. The bone showed incremental lines indicating bone formation. Conclusions: Depression can lead to bone loss and osteoporosis. Fluoxetine is an effective drug in enhancing the bone condition and restoring the normal architecture of the alveolar bone.  


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A BIOCHEMICAL STUDY OF THE EFFECT OF HIGH MOLECULAR WEIGHT HYALURONIC ACID IN MANAGEMENT OF TEMPOROMANDIBULAR JOINT OSTEOARTHRITIS IN RATS

Yasmine M. Tolba, Samia S. Omar, Dina A. Nagy

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Introduction: Osteoarthritis is one of the most common degenerative diseases affecting the joints. Adjuvant- induced arthritis (AIA) is an experimental model of polyarthritis which has been widely used for preclinical testing of several anti-arthritic agents and investigating the pathogenesis of arthritis. A modified model of AIA was used in this study, where the disease was induced in one joint. Hyaluronic acid deals with the degenerative effects of arthritis from 3 different aspects: mechanically by maintaining lubrication, metabolically by providing nutritional materials to the articular disc and biologically by decreasing inflammatory effects. Objectives: to study the biochemical actions of high molecular weight hyaluronic acid (HMWHA) in management of temporomandibular joint (TMJ) adjuvant induced arthritis by detecting matrix metalloproteinase-3 (MMP3) concentration in TMJ tissue extract. Materials and methods: 14 male albino rats were divided into 2 equal groups and in each group a split mouth design was used.

  • Study I: Arthritis was induced in 7 animals through a single intra-articular injection of Complete Freund\'s Adjuvant (CFA) in the left TMJs. (50µl)
  • Study II: Arthritis was induced in the other 7 animals through a single intra-articular injection of CFA and treated with an intra-articular injection of HMWHA into their left TMJs, once a week for total of three injections.
7 animals were sacrificed on day 7 of the disease while the other 7 animals were sacrificed one week after the last injection of HMWHA. Elisa test was performed to detect MMP 3 which is considered as a biomarker of the disease progression Results: The concentration of MMP-3 of study I (diseased group) on day 7 was found to be significantly higher than that of study II (treated group) on day 28. Conclusions: High molecular weight hyaluronic acid is capable of management of osteoarthritic TMJs. Keywords: TMJ, Arthritis, High molecular weight hyaluronic acid, MMP-3.


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IMMUNO- MORPHOLOGICAL PATTERNS OF LYMPH NODES DRAINING ORAL SQUAMOUS CELL CARCINOMA

Heba R. Mady, Zeinab Elsayed Darwish, Omneya R. Ramadan, Amany M. Abdel-bary

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Introduction: Head and neck cancer (HNC) is the sixth most common cancer with 500,000 cases diagnosed per year worldwide. Oral squamous cell carcinoma (OSCC) is accounting for more than 90% of total cases. Among all factors influencing the prognosis of OSCC, development of lymphatic metastasis is considered the single most important one. Morphological evaluation of the reactive patterns of regional nodes has aided in understanding the immune response to malignancy. The World Health Organization (WHO) categorized this reactive pattern into lymphocytic predominance, germinal center predominance, sinus histiocytosis, unstimulated pattern and lymphocytic depletion. Assessment of lymph nodes immuno- reactivity is an important indicator of the host response status and prognosis of OSCC. Objectives: To Assess the immuno-morphological patterns of both positive and negative lymph nodes draining OSCC and correlate these patterns with the clinical finding and the histological grading of the primary tumor. Material and Methods: Histopathological examination had been done on 30 cases of OSCC with neck dissection and immuno-morphological patterns had been detected and correlated with the grading of primary tumor. Results: A statistical analysis of the distribution of the 5 patterns of lymph nodes in 3 grades of OSCC was done using chi square test.  Significance difference was revealed only in two patterns (lymphocytic depletion and normal unstimulated patterns) .other 3 patterns was found to be non-significant. Conclusions: lymphocytic depletion and unstimulated mixed patterns of draining lymph nodes was significantly correlated with the grade of the tumor and it could be used as an indicator for prognosis and early metastasis of OSCC. However, no correlation was found between the other patterns and the histological grading. Keywords: OSCC, immuno morphological patterns of lymph node. Running title: Immuno morphological patterns correlated with the grading of OSCC.


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EVALUATION OF SOX2 AS A POTENTIAL STEM CELL MARKER IN BENIGN AND MALIGNANT ODONTOGENIC TUMORS

Amal M. Sobhy, Hamed M.A. Fouad, Sahar M. Riad, Ibrahim M. Zaitoun

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Introduction: Odontogenic tumors (OTs) constitute a wide range of lesions derived from the tooth forming apparatus and its remnants. These tumors are generally benign, yet some are aggressive and have locally invasive behavior with a high rate of recurrence and some are malignant. Tumor stem cells (TSCs) are a unique subpopulation of cells that possess the ability to initiate a neoplasm and sustain self-renewal. Epithelial stem cell (ESC) markers such as sex-determining region Y (SRY)-box 2 (SOX2) are capable of identifying these stem cells which are expressed during the early stages of tooth development. Objectives: To evaluate immunohistochemically the expression of the stem cell proliferating marker SOX2 in benign and malignant epithelial odontogenic tumors. Material and Methods: Immunohistochemical (IHC) study using the SOX2 antibody was done on 30 surgical specimens of benign and malignant epithelial OTs as study group and 5 normal tooth germ tissues as a control group. Results: Malignant OTs biopsies showed intense immune-reactivity to SOX2, while aggressive benign OTs showed medium immune-reactivity with variable intensity. Totally benign tumors were immune-negative. The IHC staining intensity was directly proportional to the state of malignancy of odontogenic tumors. The difference in the expression of SOX2 in malignant and benign OTs was statistically significant. However, the difference in the expression of SOX2 in OTs and control group was not statistically significant in mean of area percent, while it was statistically significant in mean of optical density. Conclusions: SOX2 is highly expressed in malignant OTs biopsies. Medium immune-reactivity with variable intensities is seen in aggressive benign OTs. Keywords: Odontogenic tumors, SOX2, Stem cells, ameloblastic carcinoma. Running title: Tissue Expressions of SOX2 in OTs.


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EFFECT OF OZONE ACTIVATED PLATELET RICH PLASMA ON THE MANAGEMENT OF GRADE II FURCATION INVOLVEMENT (COMPARATIVE EXPERIMENTAL STUDY)

Moustafa S. Abouyoussef, Ahmed M. Hommos, Samia S. Omar, GehanS.Kotry

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Introduction: Furcation defects are a frequent finding in periodontitis patients. Activated platelets release numerous proteins, among them adhesive glycoproteins and growth factors. Ozone (O3) is a triatomic molecule, consisting of three oxygen atoms, and its application in medicine and dentistry has been indicated for the treatment of different pathologies. Aim of the study: The aim of this experimental study was to evaluate the effectiveness of combining Platelet Rich Plasma (PRP) and ozone therapy in the management of surgically created grade II furcation defects. Materials and methods: A split mouth design was carried out using six healthy mongrel dogs. A total of eighteen critical sized grade II furcation defects were surgically created in the third and fourth mandibular premolars, bilaterally. After reflecting a mucoperiosteal flap, the defects in the experimental side were treated with PRP activated by ozone, β-TCP and collagen membranes, whereas, the control side defects were treated with PRP, β-TCP and collagen membrane. The dogs were sacrificed after 4 and 8 weeks. Samples were dissected and prepared for histological evaluation. Results: Histological results showed that PRP activated by ozone led to higher vascularization of the study samples at all time points; this was evident at four weeks in the form of numerous blood vessels entrapping RBCs and at eight weeks by the presence of red bone marrow and blood vessels entrapping RBCs within. Histomorphometry revealed that ozonated PRP accelerated bone regeneration at both time intervals, this acceleration was almost two –fold upon comparing test to controls. Conclusion: Activation of PRP by ozone is effective in enhancing angiogenesis and bone formation during periodontal regenerative therapy in grade II critical –sized furcation defects in dogs. Keywords: Angiogenesis, β-TCP. Grade II furcation Periodontal regeneration, Platelet Rich Plasma.


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