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Cureus Nov 2023The peripheral cemento-ossifying fibroma (PCOF) lesion primarily affects females in their second decade of living. These lesions are more frequently associated with the...
The peripheral cemento-ossifying fibroma (PCOF) lesion primarily affects females in their second decade of living. These lesions are more frequently associated with the gingival margin, the anterior surface of the molars, and the maxilla. On clinical examination, PCOF typically appears as a well-differentiated, slowly expanding gingival mass in the interdental papilla region that is less than 2 cm in size. The surface may seem ulcerated, the base may be sessile or sometimes pedunculated, and the colour is either the same as the gingiva or reddish. The histological examination, which identifies cellular connective tissue and the focal presence of bone or calcifications, provides the basis for the final diagnosis. Treatment modalities for the PCOF include surgical excision of the lesion. A 38-year-old female reported slow-growing swelling associated with the maxillary anterior region. Removal of the lesion is done by using a scalpel, and histopathological examination revealed the peripheral type of cemento-ossifying fibroma. This case report demonstrates the management of PCOF lesions with the conventional scalpel approach with the help of proper clinical examination, radiological findings, and histopathological examination, which reveals favourable outcomes in the patient regarding esthetics and improves mastication-related issues and speech.
PubMed: 38073985
DOI: 10.7759/cureus.48410 -
Restorative Dentistry & Endodontics Nov 2023This study aimed to investigate the effectiveness of different topical/systemic agents in reducing the damage caused by bleaching gel to pulp tissue or cells.
OBJECTIVES
This study aimed to investigate the effectiveness of different topical/systemic agents in reducing the damage caused by bleaching gel to pulp tissue or cells.
MATERIALS AND METHODS
Electronic searches were performed in July 2023. and studies evaluating the effects of different topical or systemic agents on pulp inflammation or cytotoxicity after exposure to bleaching agents were included. The risk of bias was assessed.
RESULTS
Out of 1,112 articles, 27 were included. Nine animal studies evaluated remineralizing/anti-inflammatories agents in rat molars subjected to bleaching with 35%-38% hydrogen peroxide (HP). Five of these studies demonstrated a significant reduction in inflammation caused by HP when combined with bioglass or MI Paste Plus (GC America), or following KF-desensitizing or Otosporin treatment ( = 3). However, orally administered drugs did not reduce pulp inflammation ( = 4). Cytotoxicity ( = 17) was primarily assessed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay on human dental pulp cells and mouse dental papilla Cell-23 cells. Certain substances, including sodium ascorbate, butein, manganese chloride, and peroxidase, were found to reduce cytotoxicity, particularly when applied prior to bleaching. The risk of bias was high in animal studies and low in laboratory studies.
CONCLUSIONS
Few studies have evaluated agents to reduce the damage caused by bleaching gel to pulp tissue. Within the limitations of these studies, it was found that topical agents were effective in reducing pulp inflammation in animals and cytotoxicity. Further analyses with human pulp are required to substantiate these findings.
TRIAL REGISTRATION
PROSPERO Identifier: CRD42022337192.
PubMed: 38053785
DOI: 10.5395/rde.2023.48.e39 -
Journal of Oral and Maxillofacial... 2023To understand the approach to interpretation along with challenges encountered in assessing pathological depth of invasion (pDOI) in oral squamous cell carcinoma (OSCC)...
Understanding the approach to interpretation and challenges in measurement of pathological depth of invasion in oral squamous cell carcinoma: A cross-sectional survey of oral and maxillofacial pathologists in India.
OBJECTIVES
To understand the approach to interpretation along with challenges encountered in assessing pathological depth of invasion (pDOI) in oral squamous cell carcinoma (OSCC) as per 8 Edition of TNM-AJCC staging among oral and maxillofacial pathologists in India.
METHOD AND MATERIALS
A cross-sectional web-based survey was conducted (May 2021-October 2021) with a pre-validated 21-item questionnaire. Responses were stored in a Microsoft Excel worksheet and analysed by descriptive statistics using SPSS v 25.0.
RESULTS
About 69.7% of the 267 respondents correctly defined pDOI while 13.1% measured the same from tumour surface. Among those not reporting pDOI, one-third of respondents (36.6%) lacked requisite awareness about 8 edition staging while more than half of them (55.4%) lacked proper tools to measure. The vst majority of the oral pathologists found pDOI measurement practically challenging (85.8%), mostly with difficulty in obtaining adjacent normal mucosa (77.9%). Selection of reference points of adjacent normal mucosa was divided between deepest point of rete ridge (43.1%), the closest rete ridge (28.8%) and the tip of highest submucosal papilla (15%).
CONCLUSION
Underreporting of pDOI was observed owing to inherent challenges in measurement, thus ostensibly substituted with tumour thickness. Elaboration on reference points of adjacent normal mucosa is awaited.
PubMed: 38033975
DOI: 10.4103/jomfp.jomfp_1_23 -
European Journal of Dentistry Nov 2023Recent evidence suggests the immense potential of human mesenchymal stem cell (hMSC) secretome conditioned medium-mediated augmentation of angiogenesis. However,...
Recent evidence suggests the immense potential of human mesenchymal stem cell (hMSC) secretome conditioned medium-mediated augmentation of angiogenesis. However, angiogenesis potential varies from source and origin. The hMSCs derived from the oral cavity share an exceptional quality due to their origin from a hypoxic environment. Our systematic review aimed to compare the mesenchymal stem cells (MSCs) derived from various oral cavity sources and cell-derived secretomes, and evaluate their angiogenic potential. A literature search was conducted using PubMed and Scopus from January 2000 to September 2020. Source-wise outcomes were systematically analyzed using , , and studies, emphasizing endothelial cell migration, tube formation, and blood vessel formation. Ninety-four studies were included in the systematic review, out of which 4 studies were subsequently included in the meta-analysis. Prominent growth factors and other bioactive components implicated in improving angiogenesis were included in the respective studies. The findings suggest that oral tissues are a rich source of hMSCs. The meta-analysis revealed a positive correlation between dental pulp-derived MSCs (DPMSCs) and stem cells derived from apical papilla (SCAP) compared to human umbilical cord-derived endothelial cell lines as a control. It shows a statistically significant positive correlation between the co-culture of human umbilical vein endothelial cells (HUVECs) and DPMSCs with tubule length formation and total branching points. Our meta-analysis revealed that oral-derived MSCs (dental pulp stem cells and SCAP) carry a better angiogenic potential than endothelial cell lines alone. The reviewed literature illustrates that oral cavity-derived MSCs (OC-MSCs) increased angiogenesis. The present literature reveals a dearth of investigations involving sources other than dental pulp. Even though OC-MSCs have revealed more significant potential than other MSCs, more comprehensive, target-oriented interinstitutional prospective studies are warranted to determine whether oral cavity-derived stem cells are the most excellent sources of significant angiogenic potential.
PubMed: 37995732
DOI: 10.1055/s-0043-1776315 -
Journal of Oral & Maxillofacial Research 2023Asperger syndrome is a type of autism spectrum disorder that may affect oral health and dental management. Spongiotic gingival hyperplasia is a rare lesion with unique...
BACKGROUND
Asperger syndrome is a type of autism spectrum disorder that may affect oral health and dental management. Spongiotic gingival hyperplasia is a rare lesion with unique clinicopathological features and unknown pathogenesis that has not been previously reported in a patient with autism spectrum disorder. The purpose of this case report is to present the first case of spongiotic gingival hyperplasia in a child with Asperger syndrome.
METHODS
A 14-year-old boy with Asperger syndrome was referred for diagnosis and management of bright red granular overgrowths of the marginal gingiva and interdental papilla of the mandibular right incisors and marginal gingiva of the mandibular left incisor. A biopsy was performed on the interdental papilla between the mandibular right incisors.
RESULTS
Microscopic examination and cytokeratin 19 immunopositivity confirmed the diagnosis of spongiotic gingival hyperplasia. The parents of the patient declined any further intervention, and four months later the gingival lesions, including the biopsied area, did not show any significant difference from the initial examination.
CONCLUSIONS
Patients with autism spectrum diseases, such as Asperger syndrome, cannot achieve a good level of oral hygiene. Thus, it is expected that the incidence of spongiotic gingival hyperplasia should be higher in this group of patients, in case oral microbiome participates in its pathogenesis. Management of such lesions is challenging, as such patients do not comply with a proper oral hygiene program and do not cooperate with surgical excision.
PubMed: 37969953
DOI: 10.5037/jomr.2023.14305 -
Clinical Oral Investigations Dec 2023To assess the long-term aesthetic and functional aspects of implant-supported crowns in lateral (ISC-L) and canine positions (ISC-C).
OBJECTIVES
To assess the long-term aesthetic and functional aspects of implant-supported crowns in lateral (ISC-L) and canine positions (ISC-C).
MATERIALS AND METHODS
Thirty-two patients (14 males, 18 females, mean age: 23.1, SD:2.0) with an ISC-L or ISC-C participated in this prospective cohort study at baseline (T0) and in the long-term follow-up (T1, mean years: 11.1, SD: 1.0). Twenty-four patients (11 males, 13 females) participated in T1. Patient-reported outcomes (PROM) were rated using surveys with questions related to aesthetics and function. The colour of the implant crown and the buccal gingiva, the appearance of the papilla, periodontal health and temporomandibular disorder (TMD) outcomes were assessed in a clinical examination. The Mann-Whitney, Chi-square and Signed Rank tests were performed.
RESULTS
Patients with an ISC-L and ISC-C were equally satisfied with the crown shape and colour at T0 and T1. No differences in TMD outcomes were reported by the patients and no clinical signs of TMD were observed. At T1, ISC-C had more bleeding on probing and a three mm greater pocket depth than ISC-L (p = 0.03, p = 0.01, respectively). At T0, operators graded the crown colour of ISC-L as being too dark (35%) and ISC-C as being too light (40%). At T1, no difference was seen between the two groups regarding crown colour, gingiva colour and the papilla (p = 0.2749, p = 0.2099, p = 0.8053, respectively).
CONCLUSIONS
The PROM and clinical examination show that ISC-L and ISC-C are equivalent with regard to aesthetics and function in the long term.
CLINICAL RELEVANCE
Although ISC-L and ISC-C are aesthetically and functionally comparable in the long term, ISC-Cs are more likely to impact periodontal health.
Topics: Male; Female; Humans; Young Adult; Adult; Follow-Up Studies; Prospective Studies; Esthetics, Dental; Dental Implants; Crowns; Dental Prosthesis, Implant-Supported
PubMed: 37940682
DOI: 10.1007/s00784-023-05344-0 -
Journal of Clinical Medicine Oct 2023Antioxidant capacity is frequently measured by evaluating superoxide dismutase (SOD) concentration in body fluids. The aim of this study was to compare SOD...
Antioxidant capacity is frequently measured by evaluating superoxide dismutase (SOD) concentration in body fluids. The aim of this study was to compare SOD concentrations in the saliva and plasma of patients with periodontitis to those measured in a group of patients with healthy periodontium, as well as to evaluate the influence of nonsurgical periodontal therapy on salivary and plasma SOD in periodontitis patients. For this purpose, 40 systemically healthy patients aged 30-70 years who had at least 20 teeth were recruited, 20 of whom had periodontitis, and 20 served as healthy periodontitis-free controls. In all participants, periodontal status was assessed via the plaque index (PI), gingival index (GI), papilla bleeding index (PIB), probing depth (PD), and clinical attachment level (CAL), and the SOD concentration in both saliva and plasma was determined by conducting a commercial immunoenzymatic ELISA test. In periodontitis patients, periodontal indices and saliva and blood samples were taken at the beginning of the study, as well as 3 months after periodontal therapy, while in the control group, these data were gathered at the beginning of the study only. SOD values in the saliva of patients with periodontitis (0.244 U/µL) were statistically significantly higher compared with patients with healthy periodontium (0.017 U/µL). Moreover, periodontal therapy led to a statistically significant decrease in this marker in the saliva of patients with periodontitis ( = 0.023), which was comparable with that measured in the control group. On the other hand, no statistically significant differences were noted in plasma SOD values either between the two groups or at follow-up compared with baseline in the group with periodontitis. These findings suggest that the elevated salivary SOD in patients with periodontal disease may represent a mechanism of tissue protection against oxidative stress that occurs in response to periodontal disease.
PubMed: 37892826
DOI: 10.3390/jcm12206688 -
Cells Oct 2023Regenerative therapies to replace cells and tissues damaged due to trauma and dental infections require temporal and spatial controlled recruitment and the...
Regenerative therapies to replace cells and tissues damaged due to trauma and dental infections require temporal and spatial controlled recruitment and the differentiation of progenitor/stem cells. However, increasing evidence shows microbial antigens can interfere with this process. Toll-like receptors (TLRs) are crucial in recognizing pathogen-associated molecular patterns. Stem cells of the apical papilla (SCAP) are required for normal dental development and are intimately involved in the reparative and regenerative capacity of developing teeth. We hypothesized that TLRs are expressed in SCAP and that the activation of TLR2/TLR4 or TLR3 by different ligands results in differential cellular fate, impacting their differentiation into a mineralizing phenotype. We found that most TLRs are expressed as detected by PCR except TLR7 and TLR8; exposure to heat-killed E. coli results in upregulating TLR2 and TLR4 and reducing mineralization capacity. In addition, bacterial exposure resulted in the upregulation of 11 genes, of which 9 were chemokines whose proteins were also upregulated and released, promoting in vitro macrophage migration. On the other hand, TLR3 activation resulted in increased proliferation and a dramatic inhibition of osteogenic and odontoblastic differentiation, which was reversed by inhibition or the knockdown of TLR3 expression. The profound effects of TLR activation resulting in different cell fates that are ligand and receptor-specific warrants further evaluation and represents an important therapeutic target to make regenerative approaches more predictable following dental infections.
Topics: Toll-Like Receptor 2; Toll-Like Receptor 4; Toll-Like Receptor 3; Regenerative Endodontics; Escherichia coli; Toll-Like Receptors; Stem Cells; Ligands
PubMed: 37887345
DOI: 10.3390/cells12202502 -
Dentistry Journal Oct 2023The goal of this article was to introduce a new root coverage (RC) technique, the mixed-thickness tunnel access (MiTT) technique, which approaches a full-split design...
Mixed-Thickness Tunnel Access (MiTT) through a Linear Vertical Mucosal Incision for a Minimally Invasive Approach for Root Coverage Procedures in Anterior and Posterior Sites: Technical Description and Case Series with 1-Year Follow-Up.
PURPOSE
The goal of this article was to introduce a new root coverage (RC) technique, the mixed-thickness tunnel access (MiTT) technique, which approaches a full-split design and intends to augment soft tissues coronal to the gingival margin. It was shown step-by-step, and the results were presented in a case series.
METHODS
Healthy individuals (non-diabetics) and non-smokers with gingival recession (GR) type 1 or 2 (RT1 or RT2) were included. After evaluation, prophylaxis was performed 14 days before the surgical procedure. During the surgical appointment, one or two vertical incision(s) on the mucosa (around 1-2 mm apical to the MGJ), lateral to the papilla base, was/were performed after anesthesia. Initially, there was a partial incision to detach the mucosa of the muscles (split design). It was permitted (but not mandatory) to perform intrasulcular incisions. Through the vertical incision, internally, subperiosteal access from the MGJ toward the gingival margin (coronally) was performed to create a full-thickness tunnel. Then, communication from the vertical incision with the gingival sulcus and the papilla base occurred, keeping the papilla tip intact. A connective tissue graft was harvested and inserted through the linear incision or intrasulcularly. There were interrupted sutures. An adjunctive material may be applied (e.g., Endogain). The root coverage was measured using a periodontal probe and considered fully covered when the gingival margin was 1 mm coronal to the cementum-enamel junction (CEJ).
RESULTS
Nine healthy individuals (seven females and two males) aged 19 and 43 were enrolled. They were treated following the MiTT steps. Four cases had a single GR; two patients had two teeth involved; and three others had three or four GR. There were seven cases of RT1 and two RT2. All RT1 cases achieved 100% RC, while the mean RC obtained for RT2 was around 80%.
CONCLUSION
The MiTT technique can be considered a more straightforward approach for minimally invasive surgical techniques, which is a feasible option to treat RC with a high success rate, predictability, and esthetic preservation. Therefore, there is a technical sensitivity to performing the full-split design procedure.
PubMed: 37886920
DOI: 10.3390/dj11100235 -
BMC Oral Health Oct 2023Gingival papilla defects, which cause an unpleasant appearance and involve the upper anterior teeth, may be triggered by several factors. Several noninvasive and...
Modified interproximal tunneling technique with customized sub-epithelial connective tissue graft for gingival papilla reconstruction: report of three cases with a cutback incision on the palatal side.
BACKGROUND
Gingival papilla defects, which cause an unpleasant appearance and involve the upper anterior teeth, may be triggered by several factors. Several noninvasive and invasive techniques have been proposed for gingival papilla reconstruction. The combination of interproximal tunneling and customized connective tissue grafts (CTGs) has shown promise in papilla augmentation. However, due to the narrowness and limited blood supply of the gingival papilla, the long-term outcomes of these techniques remain unpredictable. Therefore, achieving tension-free coronal advancement of the interdental papilla and proper placement of the CTG is crucial for successful long-term outcomes and could provide widely applicable methods for papilla augmentation.
CASE REPORT
In this study, we enrolled three patients with gingival papilla defects in the maxillary anterior teeth. For reconstruction, we proposed a modified interproximal tunneling (MIPT) technique combined with a CTG. A crucial modification based on previous studies involved adding a cutback incision to the base of the palatal vertical incision, resulting in tension-free healing. Additionally, the CTG was sutured upright to further enhance the height of the gingiva papilla. To evaluate the efficacy of the MIPT technique, the clinical parameters-including the Jemt papilla index and the distance from the tip of the papilla to the interproximal contact point-were examined using a periodontal probe (UNC15, Hu-friedy) at baseline and 12 months after surgery. All three patients achieved satisfactory papilla reconstruction 12 months after the surgery. These three cases were used to evaluate the efficacy of the MIPT technique combined with the customized CTG. An average increase in the Jemt papilla score from 1.6 to 2.8 and a reduction in the distance from the papilla tip to the contact point of adjacent teeth from 2 mm to 0.08 mm were observed 12 months after surgery.
CONCLUSION
The preliminary results confirmed that this technique holds promise for gingival papilla augmentation between tooth/tooth or tooth/implant.
Topics: Humans; Gingiva; Tooth; Dental Implants; Wound Healing; Connective Tissue
PubMed: 37884939
DOI: 10.1186/s12903-023-03525-7