volume-43-issue-2-2018

EXPRESSION OF VASCULAR ENDOTHELIAL GROWTH FACTOR (VEGF) IN HEMANGIOMAS AND INTERMEDIATE VASCULAR LESIONS

Ahmed E Zyton, Hanaa S Raslan, Omneya R Ramadan, Azza Z Abdel Rahman

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INTRODUCTION: Vascular tumors of intermediate malignancy encompass a group of tumors whose biologic potential is intermediate between hemangiomas and angiosarcomas. Angiogenesis is characterized by development of new blood vessels through the division or migration of pre-existing vasculature. VEGF deserves attention because it is associated with the stimulation of endothelial cell proliferation and vascular permeability and promotion of angiogenesis.
OBJECTIVES: to evaluate the immunohistochemical expression of vascular endothelial growth factor (VEGF) in pyogenic granulomas,
hemangiomas and intermediate vascular tumors (hemangioendotheliomas, hemangiopericytomas) and to highlight the possible role of VEGF
in diagnosis of each of these tumors
MATERIALS AND METHODS: Immunohistochemical analysis of 20 cases of vascular and intermediate vascular tumors, with one section from each specimen (20 sections for VEGF antibody) and 5 control cases. Immunohistochemical staining was performed using a Labeled Strept-Avidin Biotin method (LSAB).
RESULTS: Normal gingival tissue showed mild immunoreactivity for VEGF. All the examined cases showed strong positive expression for VEGF antibody, with different intensities.
CONCLUSIONS: The marker VEGF was overexpressed in vascular and intermediate vascular tumors than normal gingival tissue
KEYWORDS: Vascular tumors, Intermediate vascular tumors, Immunohistochemistry, VEGF.


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REVASCULARIZATION IN MATURE PERMANENT TEETH WITH NECROTIC PULP AND APICAL PERIODONTITIS: CASE SERIES

Rasha A. Abou Samra 1 MSc, Rania M. El Backly , Hanaa M. Aly , Samir R. Nouh and Sybel M. Moussa

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INTRODUCTION: Revascularization procedures have been limited to immature teeth but application to mature teeth should be clinically investigated as an alternative to conventional root canal treatment. The translation of regenerative endodontic procedures into treating mature teeth is challenging and depends on efficient root canal disinfection, proper size of the apical foramen, the availability and delivery of stem cells into the root canal system.
OBJECTIVES: Evaluation of revascularization in mature teeth after enlargement of the apical foramen to size 35 K-file.
MATERIALS AND METHODS: Three necrotic incisors with mature roots and apical periodontitis in three patients ranging from 20–30 years old were treated by revascularization procedures. Access opening was performed. The canal was mechanically instrumented to the radiographic apex. The apical foramen was enlarged with a size 35 K-file. Triple antibiotic paste (0.1 mg/ml) was applied in the canal using a syringe. After three weeks, the medication was removed with 20 ml of 1.5% sodium hypochlorite followed by final irrigation with 20 ml of 17% EDTA. Bleeding was induced in the root canal and mineral trioxide aggregate (MTA) was placed approximately 3-4 mm below the CEJ. The tooth was restored with a layer of glass ionomer followed by composite resin. The patient was scheduled for follow up and evaluation of healing after 3 months, 6 months and 9 months. Resolution of apical periodontitis and regression of clinical signs and symptoms were observed during the follow up periods.
RESULTS: After a follow-up period of 9 months, the three teeth demonstrated radiographic evidence of periapical healing with absence of clinical signs and symptoms.
CONCLUSIONS: The present cases demonstrated a favorable outcome of the revascularization procedure in mature necrotic incisors with chronic apical periodontitis.
KEYWORDS:Mature teeth; necrotic pulp; apical periodontitis; periapical healing; pulp tissue regeneration.


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CLINICAL AND RADIOGRAPHIC EVALUATION OF THE USE OF ANTERO-LATERAL WALL OF MAXILLARY SINUS FOR RECONSTRUCTION OF ORBITAL FLOOR DEFECT

Mohamed M. Aamer, Nagy E. Hassan, Hala R. Ragab

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INTRODUCTION: The orbital floor fracture results in disruption of bony continuity, enophtalmos, diplopia and herniation of orbital content which lead to a restriction in eye movement.
Auotogenous bone graft remains as the gold standard for reconstruction of orbital floor defects, the anterolateral wall of maxillary sinus is considered as one of the donor site used in the reconstruction of the orbital floor defects, which has many advantages such as biocompatibility, strength, vascularization and has no immune reaction. In addition, its contour fits exactly the orbital floor defect, a simple harvesting technique from an intraoral donor site which minimizes its morbidity.
OBJECTIVE: We aimed in the present study to evaluate the use of anterolateral wall of maxillary sinus clinically and radiographically in the reconstruction of orbital floor defects in ten patients.
MATERIALS AND METHODS: All operated patients had more or less one or more signs and symptoms of orbital floor fracture as diplopia, enophthalmos, limitation of eye movements and progressive infraorbital nerve hypoesthesia.
The graft harvested with peizosurgery from contralateral side of the fracture, the donor site is covered by a collagen membrane to prevent soft tissue infiltration. The harvested bone graft is adapted to the defect with no other means of fixation. The follow-up schedule was 3 days postoperatively then once weekly for two weeks and then monthly for 3 months.
RESULTS: All patients with preoperative diplopia had significant improvement postoperatively.
8 patients out of 9 with preoperative ocular restriction had improvement in the postoperative follow up visits. 6 patients with preoperative enophthalmos showed improvement in the postoperative follow up visits. 7 patients with infra orbital nerve paresthesia preoperatively, all of them showed improvement in the follow up visits.
CONCLUSION: The study concluded that the anterolateral wall of the maxillary sinus is a suitable material for orbital floor reconstruction, especially in cases of small to medium defects (< 3 cm2). KEYORDS: Anterolateral wall of maxilla, autogenous graft, orbital floor reconstruction, enophtalmos.


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THE USE OF HERBERT CANNULATED BONE SCREW IN THE TREATMENT OF MANDIBULAR FRACTURES (A CLINICAL AND RADIOGRAPHIC STUDY)

Yehia A. El-Mahallawy , Sherief H El-Ghamrawey , Mervat M. Khalil.

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INTRODUCTION: Maxillofacial trauma is in querulous expansion by clinical and biomechanical studies in order to enhance the well-established techniques and to utilize new materials, all are directed towards the reduction in the immobilization period and enhancement of the rigid fixation. Since 1984 the cannulated Herbert Bone Screw (HBS) proves to be a successful mean of fracture fixation in various fields of orthopaedic surgery, nonetheless with no sufficient evidence about its performance in the maxillofacial trauma field.
OBJECTIVES:The aim of the study was to evaluate clinically and radiographically the performance of HBS in the treatment of mandibular fractures.
MATERIALS AND METHODS: Eleven patients with non-comminuted recent mandibular fracture were treated using Herbert bone screw. Clinical follow up was conducted after 24-hours, one week, four weeks, six weeks and twelve weeks. Also, a radiographic investigation was performed immediately postoperative and after twelve weeks to estimate the mean bone density across the fracture line.
RESULTS: By the end of the follow up period, all cases showed normal lower lip sensation, normal occlusal and intercuspal relation, a statistically significant (P value < 0.001) decrease in level of pain intensity score based on the Visual Analogue Scale (VAS) and an uneventful wound healing with no records of developed infection. Mean bone density after twelve weeks showed a statistically significant (p<0.001) increase in its values when compared to the immediately postoperative values. CONCLUSIONS: This study deduced that the use of Herbert screws results in a predictable and satisfactory outcome, in terms of achieving uneventful wound healing and high postoperative mean bone density values. KEYWORDS:Mandibular fracture, Herbert Bone Screw, Cannulated Screw, Traction Osteosynthesis.


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THE EFFECT OF INJECTION OF THE RECOMBINANT HUMAN GROWTH HORMONE INTO INDUCED TEMPOROMANDIBULAR JOINT ARTHRITIS (AN EXPERIMENTAL STUDY)

Mohammed A. Altam, Samraa A. El-Sheikh, Riham M. Eldibany, Nesma M. Khalil

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INTRODUCTION: Recombinant human growth hormone (rHGH) plays a central role for several metabolic functions including remodeling
of bone and cartilage differentiation. Local administration of growth hormone (GH) could be more reasonable due to its more specific effects
and less systemic side effects.
OBJECTIVES: This study was designed to evaluate histological effects of intra-articular HGH injection in induced arthritis in rabbits temporomandibular joint (TMJ).
MATERIALS AND METHODS: This study was conducted on 12 healthy adult white New Zealand rabbits. TMJ arthritis was induced by injecting Complete Freund's Adjuvant (CFA) into TMJ bilaterally. The left side was considered as the study group and injected by rHGH into TMJ, while the right side was considered as the control group and sterile distilled water was injected into TMJ.
RESULTS: The condylar cartilage appeared relatively thick & homogenous allover most of the condylar surface in the study group a mean ± SD= 825.92±61.09 μm while,the condylar cartilage showed marked decrease in cartilage thickness &disturbance in the osteochondral junction in control group a mean ± SD= 496.67 ±54.93 μm .
CONCLUSIONS: From the current study, it can be concluded that the treatment of TMJ arthritis by rHGH leads to a better condition in regeneration of cartilage and bone.
KEYWORDS: TMJ, arthritis, intra-articular injection, human growth hormone, Complete Freund's Adjuvant.


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EVALUATION OF THE EFFECT OF CHOLECALCIFEROL AND CALCIUMON A DELAYED DENTAL IMPLANT ON POST-MENOPAUSAL FEMALES

Engy M. Farid , Magda M. Saleh, Lydia N. Melek.

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INTRODUCTION: The replacement of the natural teeth has been the aim of mankind since ancient time. That’s why we use dental implant and its osseointegration should be enhanced. By using Cholecalciferol and Calcium on postmenopausal females.
OBJECTIVES: The aim of the study was to evaluate the effect of combination of cholecalciferol and calcium on delayed dental implants healing for postmenopausal females.
MATERIALS AND METHODS: A clinical and radiographical study was carried out on 14 postmenopausal female patients with age range from 40 to 60 years having missing maxillary anterior teeth. All the patients received the same implant system. The study group only received cholecalciferol and calcium for 8 months and the control group didn’t receive thing. After placement all implants were evaluated clinically after 4 and 8 months (modified gingival index, papillary bleeding index, and degree of mobility) and radiographically after 4 and 8 months to evaluate marginal bone loss.
RESULTS The study group showed an increase in bone density. Group I(study): was better with a mean of (120.8±39.53) pixel while Group II(control): showed a mean of (90.84±41.6) pixel the difference of the bone density between the two groups was statistically significant (p=0.008).
CONCLUSIONS: The implant placement in postmenopausal female patients may be successful. Cholecalciferol and calcium has systemic effects on accelerating bone formation around titanium implants.
KEYWORDS: Dental implant, Cholecalciferol, Calcium, Postmenopausal females, Osseointegration.


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PALATAL VERSUS BUCCAL ANTRAL APPROACH FOR MAXILLARY SINUS LIFTING AND IMPLANT PLACEMENT

Omar N. EL-prince1 MD, Abdelaziz F. Khalil, Ahmed M. EL-sabbagh,Magued H. Fahmy

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INTRODUCTION: Implant placement in the maxillary posterior alveolar ridge is often complicated by post extraction bone resorption, pneumatization of maxillary sinuses, and poor quality of alveolar bone. In these situations, the residual vertical bone height is reduced making standard implant placement difficult. Elevation of the maxillary sinus floor using the lateral antral approach is one possible solution. Palatal window osteotomy approach for maxillary sinus floor lifting is a new surgical technique used to increase vertical bone height prior to implant placement.
OBJECTIVES: This study was designed for clinical evaluation of the maxillary sinus lifting technique using a palatal approach versus buccal approach.
MATERIALS AND METHODS: this study was carried out as a randomized controlled clinical trial, the study sample included 14 patients. The sample was selected conveniently to fulfill a list of inclusion and exclusion criteria. All patients were divided into two equal groups, had gone maxillary sinus lifting together with implant placement, group1 :( study group) seven patients had sinus lifting through the palatal approach technique simultaneously with implant insertion. In group2 (control group) seven patients had maxillary sinus lifting using buccal antral approach technique simultaneously with implant insertion. Clinical and radiographic evaluation was done through 6 months post-operatively.
RESULTS: Regarding postoperative clinical evaluation, group 1 was superior to that of group 2 in tissue management, because the vestibular anatomy in this group was not altered neither postoperative swelling occurred consequently nor disharmonious soft tissue scarring. Regarding the postoperative radiographic evaluation, group 1 was significantly increased in bone density around dental implants and less marginal bone loss postoperatively, however group 2 had higher vertical amount of bone gained around implants postoperatively.
CONCLUSIONS: The palatal sinus lifting approach permitted higher postoperative comfort, less postoperative edema, less marginal bone loss around implants, and higher bone density around implants postoperatively.
KEYWORDS: Palatal sinus lifting approach, buccal sinus lifting approach, dental implants.
RUNNING TITLE: Palatal window osteotomy for maxillary sinus lifting.


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A COMPARATIVE LABORATORY STUDY OF THE CLEANING EFFICIENCY OF XP ENDO FINISHER AND SONIC IRRIGATION Moshira I. Hammad 1 BDS, Amr M. Abdallah 2 PhD, Nihal A. Leheta 3 PhD

Moshira I. Hammad , Amr M. Abdallah , Nihal A. Leheta

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INTRODUCTION: Debridement of the root canal system is essential for endodontic success. Traditional instruments alone cannot sufficiently clean root canals. There must be an effective delivery system.
OBJECTIVES: was to compare the cleaning efficiency of XP-endo Finisher and the EndoActivator using the scanning electron microscope.
MATERIALS AND METHODS Sixty human mandibular first premolars with single oval canals were used in this study. Teeth were instrumented using One-Shape file. Teeth were then randomly divided into three parallel groups (n=20) according to the agitation method used; Group I: XP-endo Finisher. Group II: EndoActivator. Group III: both XP-endo Finisher and EndoActivator. Teeth were sectioned longitudinally and assessed by the scanning electron microscope using the five-score debris and smear layer indices. Data were analyzed using Kruskal-Wallis, Friedman, and Dunn-Bonferroni tests.
RESULTS: No significant differences were found between XP- endo Finisher and EndoActivator in debris and smear layer removal. In the middle segment, each of the XP-endo Finisher and EndoActivator revealed significantly lower debris scores than both together (P<0.05). In the coronal and apical segments the three groups equally cleaned debris (P>0.05). In smear layer removal, significant differences were found in both the coronal and apical segments between each one of the XP-endo Finisher and EndoActivator compared to both together (P<0.05). While in the middle segment, there were insignificant differences between the three groups in smear layer removal (P>0.05). The apical segment was more efficiently cleaned from debris and smear layer than the other segments in all groups.
CONCLUSIONS: Irrigation of root canals using XP-endo Finisher and EndoActivator solely was more effective in the removal of debris and smear layer than both used together. The apical third was more efficiently cleaned from debris and smear layer than the other segments.
KEYWORDS: Endodontics, smear layer, debris, XP-endo Finisher, EndoActivator, scanning electron microscope.


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COMPARISON OF STRESSES TRANSMITTED TO ONE-PIECE AND TWO-PIECE NARROW-DIAMETER IMPLANTS IN MANDIBULAR OVER DENTURES (A FINITE ELEMENT STRESS ANALYSIS)

Sarah M. Moustafa, Mohamed S. Elattar Tamer M. Ahmed.

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INTRODUCTION: The goal of modern dentistry is to restore the patient to normal contour, function and esthetics. And what makes implant dentistry unique is the ability to achieve this goal regardless of the atrophy, disease or injury. Implants with small diameters can be used successfully in a variety of clinical situations. A main drawback of Narrow-diameter implants is the possibility of not reaching the required primary stability (> 35Ncm). In such cases, being a one-piece implant, occlusal stresses are expected to disturb proper osseointegration. Lately, 2-piece narrow diameter implants were introduced to the market combining the undisturbed healing period required for proper osseointegration and the avoidance of extensive surgeries for bone augmentation.
OBJECTIVES The purpose of this study is to determine, using 3-dimensional finite element analysis, whether 1-piece and 2-piece narrow diameter implants with equivalent geometries exhibit stresses and strains differently under applied loading conditions when used to retain a mandibular overdenture and, to evaluate how stresses are transmitted to the surrounding bone.
MATERIALS AND METHODS: A computer based numerical model is structured for the anterior segment of the mandible with, 2 narrow diameter implants retaining a mandibular overdenture, one being a 1-piece and the other being a 2-piece. A 35N, and a 100N loads were applied through the overdenture, and Von Mises stresses were analyzed along the implants and the surrounding bone.
RESULTS Stresses around the 2-piece design were greater than those around the 1-piece design, but the values recorded were still below the yield strength of implants and bone.
CONCLUSIONS: A 2-piece narrow diameter implant can be a reliable treatment option to retain overdentures in cases where immediate loading is not recommended.
KEYWORDS: narrow-diameter, 1-piece, 2-piece, overdentures, finite element analysis.


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BOTULINUM TOXIN TYPE-A…AN EVOLVING TREATMENT MODALITY IN THE MANAGEMENT OF TEMPOROMANDIBULAR JOINT DISC DISPLACEMENT

Mariam M. Bahgat , Nadia R. El-Helw, Ahmed M. Abdelhamid Mohamed H. Emam.

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INTRODUCTION: Temporomandibular disorders (TMD) is an umbrella term embracing a set of conditions that affect the masticatory muscles and the temporomandibular joint (TMJ) .Internal derangements, specifically disc displacement with reduction (DDr), are one of the major findings in TMD . For the treatment of DDr, occlusal appliances and some pharmacological agents were suggested. Several studies were done evaluating the therapeutic use of Botulinum Toxin Type A (BTX-A) in TMD of myogenic origin. But only few studies investigated its effect in the management of TMD of arthrogenic origin.
OBJECTIVES: This study was done to evaluate the effect of Botulinum Toxin Type A (BTX-A) injection in the lateral pterygoid muscle (LPM) with and without anterior repositioning appliance (ARA) as a treatment modality for DDr.
MATERIALS AND METHODS: Eighteen patients with anterior disc displacement with reduction (DDr) as diagnosed clinically using Research Diagnostic Criteria (RDC/TMD) and confirmed by MRI were enrolled in this study. Patients were randomly assigned into three groups each comprising 6 patients. Group I received ARA, group II received BTX-A while group III received both treatment modalities. After 3 months, evaluation was done subjectively through Helkimo Anamnestic index (Ai) and objectively through electromyography (EMG) as well as MRI.
RESULTS: Clinically, there was significant improvement in TMD symptoms in the three studied groups, while disc position was significantly improved in groups II and III as proved by MRI.
CONCLUSIONS: Anterior repositioning appliance is effective in treating patients with disc displacement with reduction; however, BTX-A with and without ARA proved to be a more valuable treatment modality in the management of disc displacement with reduction.
KEYWORDS: Botulinum Toxin, disc displacement, lateral pterygoid, electromyography


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EVALUATION OF SHEAR BOND STRENGTH OF HIGH-PERFORMANCE POLYMERS TO ITS RESIN VENEERING AND TO DENTIN (IN VITRO STUDY)

Mahinour A. YousryS,Sanaa A. Hussein, Fayza H. Al Abbassy

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INTRODUCTION: : Looking through the wide range of prosthetic options High-performance polymers properties. Needs over layering resin veneer, bonded by a special adhesive, this adds an additional challenge to achieve adequate bond strength, also its bonding to tooth structure remains difficult.
OBJECTIVES: To evaluate shear bond strength of CAD/CAM High-performance polymers (BioHPP) with its CAD/CAM veneering composite using two different adhesives, as well as to dentin using two types of cements.
MATERIALS AND METHODS: This in vitro study, for Group I, twenty BioHPP discs with their CAD/CAM veneering composite, were milled and divided randomly into two subgroups (n =10) according to the adhesive system used. Subgroup IA: using DTK adhesive (dual-hardening adhesive). Subgroup IB: using Combo.lign (dual-hardening adhesive).
For Group II, twenty CAD/CAM High-performance polymers (BioHPP) discs were milled and divided into two subgroups according to the different cements used to lute to dentin surface. Subgroup IIA: using: RelyX Unicem resin cement, subgroup IIB: using Fuji Plus GI cement.
After water storage, thermocycling (1200 cycles, 5°C/55°C) corresponding to one year of clinical service, all the specimens were subjected to shear force until failure and the results in the various groups were compared and statistically analyzed. Modes of failure were assessed.
RESULTS: Mean SBS were as follows: subgroup IA (DTK adhesive 6.238), subgroup IB (combo.lign2.42), subgroup IIA (RelyX Unicem 2.07) and subgroup IIB (Fuji Plus 3.77). Mann-Whitney test demonstrated significant differences between the two subgroups in groups I and II (U= 2.0, P=.001) (U=17, P=.013) respectively. Stereomicroscope revealed that mixed and adhesive failure were the most dominant mode of failure.
CONCLUSIONS MDP-Containing Self-adhesive Resin (DTK adhesive) is recommended as efficient adhesive to increase the shear bond strength of the veneering composite to BioHPP. Also Fuji Plus showed better bond strength than RelyX Unicem with BioHPP and dentin.
KEYWORDS: Polyetheretherketone, PEEK, Shear Strength, Composite Resins.


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BIAXIAL FLEXURAL STRENGTH OF UN-SHADED AND SHADEDMONOLITHIC TRANSLUCENT ZIRCONIA

Maher R. Mohamed, Sanaa H. Abdel Kader, Yehia H. Aboushady, Mona M. Abd El-latif

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colored monolithic (full-anatomic) zirconia. In order to optimize esthetics shading of monolithic zirconia were done by two main approaches, either by powder mixing method or by infiltration technique. The influence of infiltration technique on mechanical properties of zirconia has been reviewed previously, while the influence of powder mixing method on the mechanical properties of shaded zirconia, specially the biaxial flexural strength has not been widely studied before.
OBJECTIVES: To evaluate and compare the biaxial flexural strength and the crystal structure of shaded CAD/CAM monolithic translucent zirconia by powder mixing method with un-shaded ones.
MATERIALS AND METHODS: Twenty fully sintered discs of un-shaded [T 0] and shaded [T S] monolithic translucent zirconia of diameter 12 mm and thickness 1 mm has been divided into 2 parallel groups of 10 discs each. Their biaxial flexural strength was measured using a ball-on-ring test fixture and universal testing machine at room temperature. Statistical significance was measured using One-Way ANOVA test. Then crystallographic analysis was done for both groups using X-ray diffraction. Finally the nature of failures of the tested specimens was examined using confocal laser microscopy.
RESULTS: Biaxial flexural strength test showed no significant difference between un-shaded and shaded specimens. X-ray diffraction spectrum only showed crystals of tetragonal zirconia with no evidence of neither monoclinic zirconia crystals nor coloring oxides crystal phases. Confocal laser microscopy images of both groups showed the classic fracture patterns of monolithic zirconia materials.
CONCLUSIONS: shading of zirconia blocks by powder mixing methods does not significantly (P≥0.05) affect either biaxial flexural strength or crystallographic structure of monolithic translucent zirconia.
KEYWORDS:Monolithic; Zirconia; Shaded; Biaxial Flexural strength.


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CLINICALOUTCOMEOFWEARINGIMPLANT RETAINEDOVER DENTURE IN PATIENTS WITH ATROPHICANTERIORMAXILLARECONSTRUCTED BY SUB NASAL LIFTING (CLINICALSTUDY)

Yassmin A. Tahamawy, Faten S. Abbas, Nevien S. Abdallah

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INTRODUCTION: Maxillary implant overdenture has improved the quality of life for edentulous patients especially patients with atrophic maxilla. Sub-nasal lifting was introduced to solve the problem of severely atrophic anterior edentulous maxilla to allow insertion of dental implants. The type of attachment may influence the retention and stability of the prosthesis and thus, masticatory efficiency. Especially locator attachment is used with great success for improvement of implant-assisted over denture
OBJECTIVES: To evaluate clinically and radiographically the effect of wearing implant- retained over denture in patients with atrophic anterior maxilla which was reconstructed by nasal lifting. Patient satisfaction was also evaluated.
MATERIALS AND METHODS: This clinical trial was conducted on seven patients with edentulous atrophic anterior maxilla rehabilitated by Sub-Nasal Lifting, restored with bilateral two implants and grafted with Platelet-Rich Fibrin. For each patient an implant- retained over denture with locator attachments was constructed. Patient assessment was done using different three method including clinical, radiographic evaluation and patient satisfaction at three intervals: at time of over denture insertion, 3months and 6 months of denture use.
RESULTS: All patients showed increased bone density around dental implants with slight decrease in marginal bone height, no mobility of each implant was detected .All patient showed increased well satisfaction throughout the follow up periods.
CONCLUSIONS Two implant-assisted maxillary over denture is an acceptable treatment for patients with atrophic anterior maxilla and it showed increased patient satisfaction and favorable clinical and radiographic findings.
KEYWORDS:Maxillary over denture, two implants, nasal lifting, patient satisfaction, peri-implant tissue.


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FLAPLESS VERSUS CONVENTIONAL FLAP APPROCH FOR DENTAL IMPLANT PLACEMENT IN THE MAXILLARY ESTHETIC ZONE

Yaser A. Shamsan, Riham M. Eldibany, Gaafar N. El Halawani, Rania A. Fahmy.

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INTRODUCTION: Dental implantology, a special field of dentistry dealing with the rehabilitation of the damaged chewing apparatus due to loss of the natural teeth, is currently the most intensively developing field of dentistry. Missing teeth can be replaced using dental implants, which are inserted into root bearing parts of the mandible or maxilla. The success and long-term prognosis of implant prosthetic therapy depend primarily on the anchorage of the implant in the jaw bone
OBJECTIVES: The main objective of this study was to assess clinically and radiographically the flapless versus conventional flap surgical technique in the maxillary esthetic zone.
MATERIALS AND METHODS: This study was a randomized controlled clinical trial. It included 16 dental implants. The patients were divided in to two groups: group A, eight implants were placed in the maxillary aesthetic region using flapless procedure, and group B eight implants were placed in the maxillary esthetic region using flap procedure. All patients followed by clinical and radio-graphical evaluation over a period of 6 months.
RESULTS: The flap technique showed statistically significant higher mean pain severity and duration, plaque index, probing depth, healing score than the flapless technique. The radiographic evaluation of the flapless implant surgery showed marked decrease in the amount of crestal bone loss in comparison to conventional flap. The mean horizontal and vertical bone loss around implants was significantly less in group A than in group B. There was no difference in bone density between both groups.
CONCLUSIONS: The flapless implant surgery reduces the amount of crestal bone loss, soft tissue inflammation, pain, edema, bleeding and consequently soft tissue recession than the conventional flap technique.
KEYWORDS: Flapless implant techniques, crestal bone loss, esthetic zone, bone density.


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EVALUATION OF BIAXIAL FLEXURAL STRENGTH AND TRANSLUCENCY OF MULTICHROMATIC TRANSLUCENT ZIRCONIA AND LITHIUM DISILICATE CERAMICS

Jihad G. Hamed , Sameer I. Bakry, Sanaa A. Hussein, Fayza H. Al Abbassy

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INTRODUCTION: Full-contour (monolithic) zirconia restorations are gaining in popularity. High translucent zirconia materials and multi-layered zirconia blocks might help to overcome the aesthetic drawbacks of traditional zirconia for fabrication of monolithic restorations
OBJECTIVES: Were to evaluate the biaxial flexural strength and translucency of CAD/CAM: multichromatic ultra-translucent zirconia and comparing it with multichromatic high translucency Lithium Disilicate glass-ceramic.
MATERIALS AND METHODS40 ceramic specimens were divided into two main groups; Group I: CAD/CAM multichromatic ultra-translucent Zirconia( UTML KATANA Zirconia) & Group II: Pressable multichromatic high translucent Lithium Disilicate glass-ceramic (e.max press multi). Each group was subdivided into two sub groups; sub group A: disc specimens (12mm diameter×1.5mm thickness) were fabricated (n=10) & thermocycled (500 cycles, 5°/55°C, 15 sec dwell time).Then, biaxial flexural strength was measured in MPa. Sub group B: rectangular specimens (12mm length × 10mm width × 1.5mm thickness) were fabricated (n=10). Spectrophotometric analysis was conducted to evaluate and compare the degree of translucency by translucency parameter (TP). Data were analyzed using student t-test & ANOVA with repeated measures test.
RESULTS Statistical analysis of Biaxial flexural strength using student t-test revealed that group I (607.24 ± 71.79) showed higher statistically significant biaxial flexural strength values than group II (290.69 ± 41.19) ( p <0.001*). Results of translucency revealed that there were significant statistical differences between the two subgroups where IPS e.max Press Multi provided better translucency than UTML KATANA zirconia. CONCLUSIONS: Multi layered zirconia showed higher mechanical, but lower optical properties than lithium disilicate. The multi layered zirconia showed four layers with different light transmittance capabilities. It might therefore be useful for enhancing the aesthetic appearance of full-contour zirconia restorations made from this material in stress bearing areas. KEYWORDS: Biaxial flexural strength, Translucency, Multichromatic zirconia, Translucent zirconia, lithium disilicate ceramics.


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EVALUATION OF LOW LEVEL LASER THERAPY ON THE STABILITY OF IMPLANTS USING RESONANCE FREQUENCY ANALYSIS (CLINICAL STUDY)

Nada M. Fahmy, Nevein SH. Abdulla, Mervat M. Khalil, Ahmed A. AbdelHakim

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INTRODUCTION: The implant supported overdentures are considered a very successful treatment option for edentulous patients. Low level laser therapy (LLLT) has gained greater awareness in the last decade for implant surgery, reduces postoperative pain after surgery, promotes the osseointegration of implants, particularly, improving stability and enhances new bone formation without causing any tissue destruction.
OBJECTIVES: : The aim of this study was the effect of low-level laser therapy on the biostimulation of bone repair by enhancing or accelerating osseointegration through stimulating the expression of osteoblastic phenotype in cells cultured on Titanium specimens.
MATERIALS AND METHODS: 10 patients with age ranged between 45-60 years old were involved in the study. Each patient received 2 implants in the mandibular edentulous ridge at the canine area. The right side acted as study group has received one implant with a Semi-conductor diode LASER (type IV) application, while the left acted as control one of same patients having normal loading in left mandibular canine area without LLLT application. All implants osseointegration was assessed by Magnetic Resonance Frequency Analysis to evaluate the implant stability.
RESULTS Resonance Frequency Analysis evaluation revealed great difference in the stability after three months when irradiated with LLLT, implant stability quotient changes were found to be statistically significant between the two studied groups. (P2= <0.001). CONCLUSIONS: Effect of LLLT on bone remodeling is evident and improves implant stability. KEYWORDS: dental implants, low level laser therapy, implant stability, Implant supported mandibular overdenture


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COMPARATIVE STUDY BETWEEN AUTOLOGOUS BLOOD AND PLATELET RICH PLASMA IN TREATMENT OF RECURRENT TEMPOROMANDIBULAR JOINT DISLOCATION

Menatallah M Yasso, Magued H Fahmy ., Nevine S Mohamad.

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INTRODUCTION: Temporomandibular joint (TMJ) dislocation is an excessive forward movement of the condyle beyond the articular eminence with complete separation of the articular surfaces and fixation in that position.
OBJECTIVES: the aim of the study was to compare clinically between the effect of autologous blood injection and platelet rich plasma injection in treatment of chronic recurrent temporomandibular joint dislocation through evaluation of mandibular range of motion.
MATERIALS AND METHODS: Twenty patients with bilateral chronic recurrent condylar dislocation were included in this study. In group I 3mL autologous blood was injected. For group II 3ml of concentrated platelet rich plasma (PRP) was injected.
Preoperative and postoperative assessment included a thorough history and physical examination to determine mandibular range of motion.
RESULTS: Mandibular range of motion was significantly reduced post operatively in both groups, however on comparing the two groups there was statistically insignificant difference in mandibular range of motion.
CONCLUSIONS: Both autologous blood and PRP injections are simple, low cost, and minimally invasive approaches which can be easily and safely injected. Both Autologous blood injection and PRP significantly decrease mandibular range of motion to normal range in patients with chronic recurrent TMJ dislocation.
KEYWORDS: Temporomandibular joint, dislocation, platelet rich plasma, blood.


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EFFECT OF THE USE OF THE HUMAN AMNIOTIC MEMBRANE IN HEALING OF SURGICALLY INDUCED SKIN DEFECTS IN RABBITS (HISTOPATHOLOGICAL STUDY)

Alaa M. Abdel Gawad, Ahmed Mamdouh M. Shaaban, Adham A. El Ashwah, Mona AH. Yehia

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INTRODUCTION: Soft tissue defects in Maxillofacial region remain significant health problems. The correct architecture and function of the vastly diverse tissues of this important anatomical region is mandatory. Amniotic membrane (AM) has been recently proposed as cost-effective alternative skin graft. It provides significant benefits by improving the process of wound healing and minimizing scar formation.
OBJECTIVES The aim of the present study was to assess clinically and histologically the effect of the use of the human amniotic membrane in healing of surgically induced skin defects in rabbits.
MATERIALS AND METHODS: This study was performed on 14 White New Zealand rabbits on which skin defects were created on both sides of their back. The right side was grafted with human amniotic membrane (AM) freshly obtained and cryopreserved (side A), and the left side was left to heal spontaneously by secondary intention (side B). The rabbits were divided later in to three groups according to intervals of evaluation and sacrification (1st week, 2nd and 3rd week postoperative). The wounds were examined for gross morphological evaluation, histological and immunohistochemical studies.
RESULTS Percentage of wound closure in AM grafted wounds was significantly higher than control wounds at 1st and 2nd week, but not significant at 3rd week healing wound (P<0.061). Histologically, the wounds of side (A) showed less inflammatory reaction and thicker newly formed epidermis layer. Collagen fibers were arranged in many directions and had higher density than those found in control wounds. Immunohistochemical evaluation showed higher expression of CD31 in side (A) than side (B) wounds indicating better angiogenesis in AM grafted wounds. CONCLUSIONS: AM graft enhanced and speeded up the healing process and wound closure with less scar healthy tissue. KEYWORDS: Amniotic membrane graft, skin defects, wound healing.


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CLINICAL AND RADIOGRAPHIC EVALUATION OF IMMEDIATE IMPLANT PLACEMENT WITH AND WITHOUT "BONE RINGS" IN ESTHETIC ZONE

Nihal A. Elnebairy, Magued H. Fahmy, Nevien S. Mohamed

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INTRODUCTION: Immediate implant placement is now accepted in clinical dentistry for reconstruction of partially or completely edentulous mandible or maxilla.
OBJECTIVES: The aim of the study was to evaluate the role of Maxgraft bone rings on the marginal bone level around dental implants placed in fresh extraction sockets.
MATERIALS AND METHODS: A randomized clinical trial was carried out on fourteen cases with freshly extracted sockets with age range 20 to 50 years. There were 2 groups, study group and control group, the sockets of the study group were filled with the new “Maxgraft bone ring” and an immediate placement of implants were carried out in the graft site, while the control group sockets had immediate implant placement alone. A clinical and radiological evaluation were carried out immediately postoperatively, after 3 & 6 months to assess the osteointegration of the implant placed and to measure the level of the marginal bone around the implant. After 6 months final prosthesis was delivered.
RESULTS: Radiographic evaluation revealed increase in marginal bone level around implants placed in the Maxgraft bone rings than those placed alone with statistical significance (p1 =0.008)
CONCLUSIONS: Increase in marginal bone level using the Maxgraft bone rings due to its osteoconductive properties supporting natural and controlled tissue remodeling together with the trabecular structure of the cancellous bone within the graft allow optimal graft revascularization, rapid formation of new bone tissue and bone remodeling.
KEYWORDS: Alveolar bone, Fish oil, Induced rheumatoid arthritis, Freund's complete adjuvant


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SURFACE ROUGHNESS AND SOLUBILITY OF A NANO-FILLED RESIN MODIFIED GLASS-IONOMER (INVITRO STUDY)

Rana S. Galal, Ahmed S. El Kadi, Mona M. Ghoneim

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INTRODUCTION: Nanotechnology was used in the development of glass ionomer cements to provide some value added features not typically associated with this type of restorative materials.
OBJECTIVES: This study was conducted to evaluate the surface roughness and solubility of a nano filled resin modified glass ionomer cement and to compare it with a conventional type of glass-ionomer cement.
MATERIALS AND METHODS: Forty disc shaped specimens were prepared using Teflon split mold according to manufacturer instructions. Specimens were divided into two group :GroupA (20 specimens prepared from Ketac Nano) and Group B (20 specimens prepared from Ketac Molar). Each group was subdivided into two subgroups of 10 specimens each. Twenty specimens from different subgroups were subjected to
surface roughness test. The other twenty specimens from different subgroups were subjected to solubility test. Data were collected, tabulated
and statistically analyzed.
RESULTS: Concerning surface roughness; Ketac Nano showed statistically significantly lower surface roughness than Ketac Molar where the mean values were 0.27 ± 0.10 μm and 0.48 ± 0.14μm respectively. Concerning solubilty; Ketac Nano showed statistically significant lower solubility than Ketac molar where the mean values were 4.25 ± 1.87 and 12.16 ± 2.89 μg/mm3 respectively.
CONCLUSIONS: It was concluded that the addition of nano-fillers to RMGI seemed to decrease its surface roughness and to improve but without completely eliminating the solubility of the nano-glass ionomers.
KEY WORDS: surface roughness, solubility, nano glass ionomers.


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