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THE EFFECT OF PLATELET RICH-FIBRIN WITH AND WITHOUT AUTOGENOUS BONE GRAFT ON BONE REGENERATION FOLLOWING ENUCLEATION OF MAXILLARY CYSTS

Alaa M. Zain Elabdin, Ahmed A. Sharara, Hala R. Ragab

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Introduction: Reconstruction of bony defects represents a challenging problem for the surgical community. Autologous  bone grafting involves utilizing bone obtained from the same individual receiving the graft. Bone can be harvested from the mandibular symphysis (chin area). Autologous platelet rich-fibrin (PRF) is considered to be a healing biomaterial, which has been widely used for accelerating soft and hard tissue regeneration. The use of bone graft in combination with platelet rich-fibrin helps in rapid bone regeneration when compared to natural healing. Objectives: is to compare the effect of platelet rich-fibrin with and without autogenous bone graft on bone regeneration following enucleation of maxillary cysts. Materials and methods: Twenty-one patients with maxillary cysts had been treated with autogenous bone graft with platelet-rich fibrin versus platelet rich-fibrin without autogenous bone graft following cyst enucleation, and the follow up was done for 6 months using Cone Beam Computerized Tomography (CBCT) to evaluate bone regeneration in the defect site. Results: All groups showed increasing in bone density. Group A showed the best results with a mean 330.71, while Group B showed results with a mean 184. Group C showed results with a mean 117.71. Conclusions: PRF can be considered a healing biomaterial, as it features all the necessary parameters permitting bone regeneration without any adverse reaction. The addition of autogenous bone graft to PRF accelerates the regenerative capacity of bone. They give a predictable clinical and radiographic evidence of bone formation and faster healing than using PRF alone. Keywords: maxillary cyst, autogenous bone graft, platelet rich fibrin


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CHEMOPREVENTIVE EFFECT OF GREEN TEA AND CURCUMIN IN INDUCED ORAL SQUAMOUS CELL CARCINOMA: AN EXPERIMENTAL STUDY

Mai M. Saleh, Zeinab E. Darwish, Manal I. El Nouaem, Ghada M. Mourad, Omneya R. Ramadan

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Oral squamous cell carcinoma (OSCC) has the highest mortality rates among all carcinomas and is the most common head and neck cancer. Several natural compounds and micronutrients have been under investigation for their efficacy in head and neck cancer chemoprevention. Green tea contains various cancer preventive catechins that have a role in preventing cancer recurrence in various organs in humans. Curcumin, a natural polyphenol, is one of the most investigated biomolecules from Mother Nature. Curcumin has been shown to exert significant growth inhibitory effect on oral precancerous and carcinoma cell lines, and the effect is synergistic with epigallocatechin gallate, the most abundant polyphenol in tea. Objectives: To assess the chemopreventive effects of green tea and curcumin through induction of hamster buccal pouch carcinoma by using an apoptotic marker and compare their effect each alone and in combination. Materials and methods: Squamous cell carcinoma was chemically induced in fifty Syrian golden hamsters divided into 5 groups (10 each). The first group was used as normal control group. The second group received the carcinogenic agent only. The other three groups received green tea, curcumin and combination of both, respectively. Results: Normal control group (A) revealed neither pathological nor inflammatory changes in the buccal pouch with 1.72% of the cells underwent apoptosis while the cells of positive control group (B) resulted in 11.57% apoptosis. In the study groups, treatment of the cells with green tea (C), curcumin (D) and both of them (E) resulted in  78.91%, 96.63% apoptosis respectively. The fluorescent image by confocal laser scanning in group B showed increase of the red fluorescence in the nucleus and cytoplasm of the squamous cell carcinoma cells indicating high proliferating cells while the fluorescent image of group C, D and E showed decrease of the red florescence in the nuclei of the squamous cell carcinoma cells indicating low proliferation


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EVALUATION OF GLUTAMINE COMBINED WITH TOPICAL CORTICOSTEROIDS IN THE TREATMENT OF EROSIVE ORAL LICHEN PLANUS

Marwa M. Gebril, Eglal M. Moussa, Hanaa S. Raslan

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Introduction: Lichen planus (LP) is an inflammatory skin disease of unknown etiology. Increased oxidative stress has been implicated in the pathogenesis of erosive oral lichen planus (EOLP). Glutamine (Gln) is a source of energy for fibroblasts, immunocompetent cells, and intestinal epithelial cells involved in collagen production. It promotes protein and collagen synthesis, imparts immunity, and maintains the alimentary canal mucosa structure. Objectives: The aim of this study was to evaluate the effect of Glutamine combined with topical corticosteroid in the treatment of erosive OLP. Materials and methods: This randomized, parallel, controlled clinical study was conducted on thirty patients with a confirmed clinical and histopathological diagnosis of OLP who were randomly divided into two groups. Group 1 treated with topical steroids plus antifungal; Group 2 treated with Glutamine combined with topical steroids plus antifungal. Subjective symptoms and Visual Analogue Scale (VAS) were recorded at base line, after one month and at three months. The objective sign clinical score was recorded at baseline, one and three months post-treatment. Results: Both groups showed decrease in lesion size and symptoms of OLP. The glutamine treated group showed a significantly higher decrease in pain score in comparison to the corticosteroid treated group. Regarding the healing score, there was no statistically significant difference between the two groups. Conclusions: Glutamine as adjunctive to topical corticosteroid is effective in the treatment of EOLP; it resulted in a decrease in symptoms of the disease and more control of pain when compared to the conventional therapy. However, it has no effect on the signs of the disease. Keywords: Erosive oral lichen planus, Glutamine, Lichen planus.


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THE ROLE OF TUMOR-ASSOCIATED MACROPHAGES IN THE PATHOGENESIS OF ORAL SQUAMOUS CELL CARCINOMA CORRELATED WITH THE CLINICOPATHOLOGICAL PARAMETERS

Samar H. Ramadan, Zeinab E. Darwish, Manal I. Elnouaem, Ibrahim M. Zeitoun, Marwa M. Essawy

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Introduction: Oral cancer is a major health problem, causing high morbidity and mortality rates. Oral squamous cell carcinoma (OSCC) accounts for 90-95% of all oral malignancies. During the last decade, significant evidence has suggested that inflammatory tumor microenvironment (TME) plays an important role in tumorigenesis.  The inflammatory cells and their signals are indispensable participants in the neoplastic process, fostering proliferation, survival, and migration of cancer cells. The macrophages are the most abundant and important stromal cells in the TME, which orchestrate the inflammatory response. They control the cellular proliferation and survival by stimulating the immune cells and by promoting integrated processes of inflammation and tissue repair. Therefore, the tumor associated macrophages (TAMs) may be of great prognostic significance in different types of tumors. Objectives: This study was conducted to assess the TAMs density in OSCC using CD163 in metastasizing and non-metastasizing OSCC. Moreover, the correlation of TAM density with the lymph node status and the different histopathological grades of OSCC was assessed. Materials and methods: The density of TAM was calculated in 30 surgical specimens taken from OSCC patients. Biopsies were taken from the primary tumor of 15 cases with lymph node metastasis and 15 cases with no lymph node metastasis. Fifteen normal mucosal tissues were taken from healthy individuals indicated for alveoloplasty as a control group. Immunohistochemical staining using the CD163 antibody was performed, using Labeled Strept-Avidin Biotin complex method. Positive cells were counted using the Image J free software package. Results: CD163 was expressed in human OSCC and the TAMs count was significantly correlated with lymph node metastasis and with the tumor differentiation. Higher density was detected in metastatic tumors and in the poorly differentiated OSCC than in the well and moderately differentiated cases.  


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COMPUTER-ASSISTED SURGERY IN MANAGEMENT OF MANDIBULAR FRACTURE USING A CUSTOM-MADE TITANIUM MESH TRAY

Ahmed M. Helmy, Nagy H. El Prince, Riham M. Fliefel

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Introduction: The mandible is the second most common facial fracture due to its prominence and position. Continuous clinical and biomechanical studies implemented in order to improve the techniques and materials used, leading to reduction in the immobilization period and augmentation of rigid fixation. Computer assisted surgery technology, greatly plays an important role in designing the surgery, facilitating adaptation and fixation. Objectives: To evaluate clinical and radiographic outcomes of fixation of mandibular fractures using custom-made titanium mesh adapted on 3D model by virtual planning. Materials and methods: Fifteen patients with recent mandibular fracture were treated using custom-made titanium mesh on 3D model. Clinical follow up was conducted after 24-hours, one, four, six, twelve weeks and six months. In addition, a radiographic investigation was performed immediately postoperatively and after six months to estimate the mean bone density across the fracture line. Results: All cases showed normal lower lip sensation both preoperatively and postoperatively with no statistical significance, improved occlusal and intercuspal relation in addition to stabilized intrafragmentary mobility. A statistically significant decrease in intensity of pain was detected based on the Visual Analogue Scale (VAS). Two cases showed disturbed wound healing. The mean bone density after twelve weeks showed a statistically significant increase in its values when compared to the immediately postoperative values (p<0.001). Conclusions: The use of custom-made titanium mesh adapted on a 3D model resulted in a satisfactory outcome, in terms of achieving adequate reduction and fixation. Keywords: Mandible, Fracture, Computer-assisted, Titanium mesh, 3D model.


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EFFECT OF CAD/CAM NASOALVEOLAR MOLDING APPLIANCE ON CORRECTION OF THE NASAL DEFORMITY IN COMPLETE BILATERAL CLEFT LIP AND PALATE

Kenda I. Hanno, Ahmed M. Al-Shimy, Mona S. Saad, Ahmed M.A. Habib, Ibrahim M. El-Fahham

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Introduction: Cleft lip and palate (CLP) affects about 1.5 per 1000 live births (250,000 new cases per year) worldwide. They can be either unilateral or bilateral, complete or incomplete. The bilateral cleft lip and palate (BCLP) deformity typically arises with a protrusive premaxilla. The nasal deformity includes deficient columella, with flared lateral alar cartilages which usually require additional surgeries to improve the nasal symmetry. NasoAlveolar Moulding (NAM) technique, aims to align the alveolus, lip, and nose properly; reduce the severity of the nasal deformity, and lengthen the columella without surgery. Objectives: The study aims to quantify the effect of NAM therapy, fabricated by CAD/CAM additive manufacturing, in the improvement of nasolabial deformity in terms of bialar width, columellar length and width in infants with complete BCLP. Materials and methods: Ten infants with non-syndromic BCLP (age < 1 month) were selected. Impressions were obtained. The casts obtained from the impressions were scanned using a 3D laser scanner. Designing and 3D printing of the appliances were completed. The appliances were inserted and retained using surgical tapes. Nasal stents were incorporated 60 days after the start of the treatment. Nasal measurements were obtained before treatment and at the end of treatment (after four months). Results: Data was collected and statistically analyzed. After NAM therapy, there was a statistically significant increase in columellar length and a statistically significant decrease in both columellar width and bialar width. Conclusions: CAD/CAM PNAM therapy has proved its effectiveness in BCLP by showing an improvement in the columellar and bialar presurgical presentation. CAD/CAM PNAM therapy should be considered a routine procedure in the treatment protocol for BCLP. Keywords: Cleft Lip and Palate, Nasolalveolar Molding, CAD/CAM, Columella.


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