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Background It is unclear if an intact buccal bony plate is a prerequisite for immediate implant placement in post-extraction sockets. The aim of this 5-year randomized controlled trial was therefore comparison of peri-implant soft and hard tissue parameters, esthetic ratings, and patient-reported satisfaction of immediate implant placement in post-extraction sockets with buccal bony defects of >= 5 mm in the esthetic zone, with delayed implant placement after ridge preservation.Methods Patients presenting a failing tooth in the esthetic region and a buccal bony defect of >= 5 mm after extraction were randomly assigned to immediate (Immediate group, n = 20) or delayed (Delayed group, n = 20) implant placement. Second-stage surgery and placement of a provisional restoration occurred 3 months after implant placement in both groups, followed by definitive restorations 3 months thereafter. The follow-up was 5 years. Marginal bone level (primary outcome), buccal bone thickness, soft tissue parameters, esthetics, and patient-reported satisfaction were recorded.Results Mean marginal bone level change was -0.71 +/- 0.35 mm and -0.54 +/- 0.41 mm in respectively the Immediate group and the Delayed group after 5 years (P = 0.202). This difference, and in other variables, was not significant.Conclusions Marginal bone level changes, buccal bone thickness, clinical outcomes, esthetics, and patients' satisfaction following immediate implant placement, in combination with bone augmentation in post-extraction sockets with buccal bony defects of >= 5 mm, were comparable to those following delayed implant placement after ridge preservation in the esthetic zone.

In this study, modified kappa-carrageenan/pectin hydrogel patches were fabricated for treatment of buccal fungal infections. For this purpose, kappa-carrageenan-g-acrylic acid was modified with different thiolated agents (L-cysteine and 3-mercaptopropionic acid), and the thiol content of the resulting modified kappa-carrageenan was confirmed by elemental analyzer. Then, the hydrogel patches were fabricated, and characterized by Fourier-transform infrared spectroscopy, thermogravimetric analysis, ex vivo mucoadhesion test, and swelling behavior. Triamcinolone acetonide was added either directly or by encapsulating within the poly(lactic-co-glycolic acid) nanoparticles. The release amount of the drug from the directly loaded patch was 7.81 mg/g polymer, while it was 3.28 mg/g polymer for the encapsulated patch with the same content at 7 hr. The hydrogel patches had no cytotoxicity by cell culture studies. Finally, the drug loaded hydrogel patches were demonstrated antifungal activity against Aspergillus fumigatus and Aspergillus flavus. These results provide that the novel modified kappa-carrageenan and pectin based buccal delivery system has promising antifungal property, and could have advantages compared to conventional buccal delivery systems. WOS:000723711600001 34846796 Q2

Objectives The aim of the present retrospective study was to evaluate papillae filling rate and buccal margins coronal growth in implant‐supported prostheses which were over‐contoured at the apical buccal third to form a rearmost collar zone, thus mimicking a false root. Material and methods The influence of adjacent elements, teeth, implants, or pontics was examined. One‐hundred and three crowns have been assessed in photographs taken on 61 patients after prosthesis delivering and at last follow‐up (mean 2.8 years). The Jemt index was adopted to evaluate papillae growth at the baseline and follow‐up as follows: 0, absence of papilla; 1, less than half of interdental embrasure height; 2, more than half of interdental embrasure height; 3, fully papilla filled interdental embrasure. Index score 4, papilla hyperplasia was not included. Moreover, the coronal growth (or recession) of buccal mucosa in implant‐supported crowns was assessed. Results At baseline, a total of 29 papillae had a 0 score, while only two scored 3 with complete papilla formation. On follow‐up, only one papilla scored 0, while 46 scored 3 with complete interdental embrasures filling. The highest papilla score was registered from first year crown insertion and likewise in interdental embrasures located between two implants or implants and pontics. Moreover, the buccal margin growth was observed in almost 80% of crowns. Such findings seem to indicate that buccal margin and papilla around implant‐supported crowns presented a coronal growth over time, especially during its first year. The average papilla growth between two implants was no lower than that observed in papilla present between implants and natural teeth. Conclusions Recessed areas at collar of implant‐supported prostheses appear to positively influence papillae and buccal margin growth, especially in its first year. Papilla growth between two implants was similar to that observed between implants and natural teeth.

OBJECTIVES Comparing PES/WES scores, modified success rate, survival, success, buccal bone thickness and patient-reported outcomes of immediate dental implants placed in fresh alveolar sockets using a flap or a minimal split-thickness envelope flap (MSTEF). MATERIALS AND METHODS Implants following random assignment into a flap or MSTEF group were placed immediately in anterior and premolar areas. Guided bone regeneration and autogenous connective tissue graft were used in all cases. A temporary prosthesis was provided followed by the final prosthesis at 16-18 weeks. Success and survival rates together with radiographic buccal bone thickness and patient satisfaction were evaluated at 12-month post-loading. The aesthetic outcome was evaluated through the Pink (PES) and White (WES) Aesthetic Score by 8 blind clinicians of different training background and incorporated in modified success criteria. RESULTS 28 implants were placed on 28 patients. No statistically significant differences were noted in PES (10.54 control versus 10.80 test), WES scores (6.97 control versus 6.95 test) or success criteria including aesthetic parameters (modified success criteria) for the different specialty groups (Range 69%-92%). In addition, no statistically significant differences were noted in survival (100%), success (100%), buccal wall thickness between control (0.72 ± 0.22) and test group (0.92 ± 0.31) and patients' reported outcomes. CONCLUSIONS Immediate dental implant treatment with flap/ MSTEF provided similar mean PES/WES scores, modified success rate, survival, mean buccal bone levels and patients' satisfaction. However, aesthetic failures were common in both groups.

This article reports the results obtained from the investigation of the influence of miconazole administration on the physiological fluctuation of the markers of the steroid profile included in the “steroidal module” of the Athlete Biological Passport. Urines collected from male Caucasian subjects before, during, and after either systemic (i.e., oral and buccal) or topical (i.e., dermal) treatment with miconazole were analyzed according to validated procedures based on gas chromatography coupled to tandem mass spectrometry (GC–MS/MS) (to determine the markers of the steroid profile) or liquid chromatography coupled to MS/MS (LC–MS/MS) (to determine miconazole urinary levels). The results indicate that only after systemic administration, the markers of the steroid profile were significantly altered. After oral and buccal administration, we have registered (i) a significant increase of the 5α‐androstane‐3α,17β‐diol/5β‐androstane‐3α,17β‐diol ratio and (ii) a significant decrease of the concentration of androsterone, etiocholanolone, 5β‐androstane‐3α,17β‐diol, and 5α‐androstane‐3α,17β‐diol and of the androsterone/etiocholanolone, androsterone/testosterone, and 5α‐androstane‐3α,17β‐diol/epitestosterone ratios. Limited effects were instead measured after dermal intake. Indeed, the levels of miconazole after systemic administration were in the range of 0.1–12.5 μg/ml, whereas after dermal administration were below the limit of quantification (50 ng/ml). Significant alteration started to be registered at concentrations of miconazole higher than 0.5 μg/ml. These findings were primarily explained by the ability of miconazole in altering the kinetic/efficacy of deglucuronidation of the endogenous steroids by the enzyme β‐glucuronidase during the sample preparation process. The increase of both incubation time and amount of β‐glucuronidase was demonstrated to be effective countermeasures in the presence of miconazole to reduce the risk of uncorrected interpretation of the results., The results obtained from the investigation of the influence of miconazole administration on the parameters included in the “steroidal module” of the Athlete Biological Passport were presented. After oral and buccal administration of miconazole, the levels of the markers of the steroid profile were significantly altered, whereas no effects were registered after topical administration. These findings were primarily explained by the effect of miconazole on the kinetics/efficacy of the enzymatic hydrolysis during the sample preparation process.

Objective Transplantation of minor salivary glands (MSGs) to the conjunctiva is a treatment option for patients suffering from dry eye disease. As there is not enough information about labial and buccal MSGs in dogs, the aim of this study was to provide evidence of the presence of these glands and to investigate their spatial arrangement and excretory ducts. Methods The oral mucosa of the lower lip of 4 dogs and the whole lower jaw of 1 dog were used for histological and microCT analysis. Presence, number, volumes and the tissue depth of MSGs were assessed. Results Histological analysis showed that compact tubulo‐acinar glands were located in the submucosal connective tissue. MicroCT images revealed that 9 to 21 MSGs were arranged in a single row at the level of the dental alveolae. The volume of the MSGs increased from rostral to caudal and the total volume of glandular tissue per animal ranged from 35.01 mm3 to 549.43 mm3. The mean tissue depth of MSGs ranged from 0.57 mm to 1.37 mm (upper surface of glands) and between 1.43 mm and 3.09 mm (lower surface of the glands). Excretory ducts left the dorsal part of the glands and ran in dorso‐rostral direction. Conclusions The location, number and volume of the labial and buccal MSGs in the dog could be detected and described using microCT scans and histology. The present results can provide valuable information for future transplantation of labial MSGs as therapeutic measure against keratoconjunctivitis sicca.

Mucoadhesive buccal patch is a promising dosage form for a successful oral drug delivery, which provides unique advantages for various applications such as treatment of periodontal disease and postdental surgery disorders. The aim of this study is to synthesize a novel multifunctional mucoadhesive buccal patch in a multilayer reservoir design for therapeutic applications. The patches were fabricated through simultaneous electrospinning of chitosan/poly(vinylalcohol) (PVA)/ibuprofen and electrospraying of phenylalanine amino acid nanotubes (PhNTs) containing metronidazole into the electrospun mats through a layer-by-layer process. An electrospun poly(caprolactone) (PCL) was used as an impermeable backing layer to protect the mucoadhesive component from tongue movement and drug loss. Buccal patches were characterized using scanning electron microscopy (SEM) and field emission scanning electron microscopy (FESEM) and also evaluated in terms of physicomechanical parameters such as pH, weight, thickness, tensile strength, folding endurance, and mucoadhesive properties. The swelling index of the patches was examined with respect to the PVA/chitosan ratio. The effect of genipin addition to the electrospinning solution was also studied on mucoadhesive and swelling properties. The cell viability of buccal patches was assessed by methylthiazolydiphenyl-tetrazolium bromide test on L929 fibroblast cell line. The patch with an optimal amount of mucoadhesive polymers (PVA/chitosan 80:20) and crosslinking agent (0.05 g) indicated an ideal hemostatic activity along with antibacterial properties against Streptococcus mutans bacteria. The synthesized multifunctional mucoadhesive patch with a novel composition and design has a great potential for oral therapeutic applications.

Aim To determine the healing outcome following grafting with deproteinized porcine bone mineral (DPBM) with or without collagen membrane coverage in two‐wall (both buccal and lingual)‐damaged extraction sockets. Materials and methods Distal roots of three mandibular premolars in six beagle dogs were extracted, and the whole buccal and lingual bony walls were surgically removed. Three treatment protocols were then applied according to the following group allocation: no graft (None), grafting DPBM (BG), and grafting DPBM with coverage by a collagen membrane (BG + M). Two observational periods (2 and 8 weeks) were used with the split‐mouth design, and quantitative and qualitative analyses were performed by microcomputed tomography and histology. Results The dimensions of the alveolar ridge at both grafted sites (BG and BG + M) remained similar to those of the pristine ridge in the histologic and radiographic analyses, whereas the ungrafted sites (None) collapsed both vertically and horizontally. Both grafting protocols produced substantial bony regeneration, but the addition of a covering membrane enhanced the proportion of mineralized tissue within the augmented area, and the BG + M group also showed a significantly larger area of regenerated ridge than the None group (p

Objectives To report the surgical technique and postoperative outcome of corneal repair with autologous buccal mucous membrane grafts in dogs and cats with descemetoceles, deep corneal ulcers, and perforated corneal ulcers with or without iris prolapse. Animal studied Twelve cats (13 eyes) and fourteen dogs (14 eyes) were treated. Procedures Grafts were harvested from the unpigmented superior labial mucosa using a biopsy punch. The corneal lesion was carefully debrided and cleaned. The graft was secured to the healthy cornea with a combination of simple interrupted and continuous 9-0 polyglycolic acid sutures. In 25/27 treated eyes, an overlying pedicle conjunctival graft was also performed. A temporary nictitating membrane flap was used in all cases. The pedicle conjunctival graft was trimmed about 10-20 days postoperatively. The median follow-up period was 549.2 days (range 14-2691 days). Results No surgical intra-operative complications were observed. The ulcers healed and the integrity of the globe was restored in 24/27 treated eyes. Different grades of corneal fibrosis and/or vascularization and/or pigmentation were observed in all cases at the long-term follow-up. In two cases, enucleation was performed due to postoperative complications and one animal developed phthisis bulbi. A total of 22/27 treated eyes appeared to have regained effective visual function at the last clinical evaluation. Conclusions Autologous buccal mucous membrane grafts appear to successfully manage severe corneal ulcers in dogs and cats, providing a useful and economical alternative to other corneal grafts.

Introduction The purpose of this case report is to document the 8.5 years result of treatment of a mandibular incisor having a buccal Cairo Recession Type 2 (RT2) gingival recession defect (GRD) using a double-layer technique using an acellular dermal matrix (ADM) with a coronally advanced flap (CAF). To the author's knowledge, no long-term results of this treatment modality in the mandibular incisor area have been reported. Case presentation A 65-year-old non-smoking female presented with an RT2 GRD on the buccal aspect of tooth #25 (International Standards Organization, ISO #41). Her overall periodontal status was healthy. This GRD was treated using a double-layer of an ADM with a CAF. Tension-free flap advancement was permitted by eliminating a frenum pull. Improved root coverage and stable gingival margins were found after 8.5 years. Conclusion This report provides evidence to support the use of a double-layer technique using an ADM with a CAF to treat a mandibular incisor with an RT2 GRD.

Background:\ud \ud Oral swellings can be attributed to various causes, both odontogenic and non‐odontogenic in nature. This paper will discuss a buccal swelling caused by a haematoma.\ud \ud Case presentation:\ud \ud A 76‐year‐old edentulous male patient presented to a dental student outreach clinic with a three‐day history of a right‐sided facial swelling. No dental cause could be confirmed and so the patient was referred to the local secondary oral surgery department. The patient was examined, and an ultrasound of the swelling was arranged on the same day. The swelling was aspirated, and a haematoma was deemed the likely cause. After aspiration and a course of antibiotics, the swelling reduced rapidly. Blood tests were undertaken, and no underlying cause could be identified.\ud \ud Conclusions:\ud \ud Although uncommon, haematoma should be considered within differential diagnoses when dental pathology has been ruled out. A course of antibiotics is indicated where symptoms appear consistent with a systemic infection and timely referral to local dental hospital services is recommended. Blood tests should be requested to identify any undiagnosed coagulopathies or platelet abnormalities and liaison with local haematology services if resolution is not achieved would be appropriate.

Objective To investigate the effect of a bone substitute material combined with fibroblast growth factor-2 (FGF-2) loaded barrier membrane on the preservation of alveolar ridge after tooth extraction. Materials and methods Four dogs were included. Six extraction sockets of each animal received the 3 treatments and were randomly divided into three groups. Group A: negative control; Group B: bovine xenografts + membrane; Group C: bovine xenografts +FGF-2-loaded membrane. CBCT and histological analysis were performed to evaluate changes in the width and height of alveolar ridges and extraction socket bone healing 8 weeks post-extraction. Results CBCT showed that the alveolar bone in Group A was significantly thinner than that in Group B and Group C at 1 and 3 mm apically from the alveolar crest. The alveolar width at 1 mm in Group C (60.99 ± 15.36%) was significantly thicker than that in Group B (39.75 ± 30.18%). Histomorphmetrical measurements showed that the buccal alveolar width at 1 mm was significantly thicker in Groups B and C than in Group A. Additionally, buccal bone height and lingual bone width at 1 mm in Group C (87.06 ± 10.34%, 89.09 ± 10.56%) were significantly greater than in Group A (53.48 ± 23.94%, 82.72 ± 12.59%). Conclusion The present findings indicate that application of bovine bone combined with barrier membrane with or without FGF-2 over tooth sockets can effectively reduce ridge absorption, especially in terms of ridge width and FGF-2 modified membrane seems to improve the outcomes obtained with membrane alone.

Objectives To verify the utility of triangular extension of a hinge flap in buccal mucosal staged urethroplasty to resolve stomal stenosis after the first stage and ultimately prevent restenosis. Methods A total of 23 patients (triangular extension group) were studied in 2013-2019. In the first stage, buccal mucosa was transplanted, and an extended triangle portion of the mucosa was placed beside the proximal and/or distal stoma that was created when the stricture segment of the urethra was resected. In the second stage, during tubularization of the urethral plate, an incision was made at the stoma to increase the caliber to which the triangular extension was inserted. The procedure was considered successful when a 17-Fr flexible cystoscope passed through the reconstructed urethra at 6 months after the second-stage urethroplasty and no additional surgery or bougie dilation required. The clinical course of the triangular extension group was compared with 24 patients who underwent conventional staged urethroplasty (control group). Results In total, 20 patients from each group underwent second-stage surgery. No patients in the triangular extension group required additional revision surgery because of stomal stenosis after first-stage surgery, whereas five (20%) control patients did. Urethroplasty was successful in 19 patients (95%) in the triangular extension group and in 19 patients (95%) in the control group. Uroflowmetry after the second-stage surgery indicated that the mean maximum urinary flow rate was 21.5 and 15.8 mL/s after triangular extension and the control procedure, respectively (P = 0.027). Conclusions The triangular extension technique reduces the need for revision surgery and prevents postoperative restenosis.

OBJECTIVES To assess platelet function, buccal mucosal bleeding time and plasma von Willebrand factor concentration in dogs with chronic inflammatory and/or fibrotic liver disease and to compare results with those obtained in healthy dogs. MATERIALS AND METHODS Preliminary study including 18 dogs with chronic inflammatory and/or fibrotic liver disease undergoing liver biopsy and 18 healthy age-matched control dogs. Platelet function was assessed by measuring closure time with the PFA-100® analyser using adenosine diphosphate (ADP) as an agonist. Buccal mucosal bleeding time, closure time and plasma von Willebrand factor antigen were measured in dogs in both groups. After undergoing ultrasound-guided needle biopsy, dogs were monitored for haemorrhage to determine if there was an association of any measurement with post-biopsy bleeding. RESULTS The closure time was not different between the liver disease group (median 76.3; range 53 to 118.5 seconds) and control group (72.8; 57 to 89.5 seconds). The buccal mucosal bleeding time was longer in the liver disease group (median 138; range 95 to 229 seconds) than the control group (103; 63 to 200 seconds). The plasma von Willebrand factor antigen concentration was not different between the liver disease group (median 203; range 109 to 351%) and control group (165.5; 63 to 246%). CLINICAL SIGNIFICANCE In this study, dogs with chronic necroinflammatory and/or fibrotic liver disease did not have overt, clinically relevant derangements in platelet function as assessed by buccal mucosal bleeding time, closure time and von Willebrand factor analysis. In addition, none of the dogs undergoing percutaneous ultrasound-guided biopsy in the study exhibited bleeding complications post-biopsy procedure.

INTRODUCTION A thick peri-implant mucosa is of importance to prevent recession, color alterations, bone remodeling and promote "creeping attachment." A volume stable porcine cross-linked collagen matrix has been recently introduced for soft tissue regeneration and volume maintenance. The aim of this study was to investigate peri-implant soft tissue healing and stability on 40 consecutive patients treated with buccal pedicle flap combined with the use of the collagen matrix. CASE SERIES The buccal pedicle flap combined with a volume stable collagen matrix was executed at second stage surgery. The average initial mucosa thickness was 1.32 mm whereas the average band of keratinized mucosa was 1.65 mm and the height 1.3 mm. Four months after surgical procedure and before delivering the final restoration, the peri-implant soft tissue measurements were significantly increased: the average band of keratinized mucosa was 5.10 mm, the mucosa thickness was 3.27 mm, and the mucosa height was 3.32 mm. After 2 years of follow-up, the superimposition of 3D models described an overall volumetric stability of the augmented mucosa with no signs of soft tissue collapse. CONCLUSION The proposed modified buccal pedicle flap was demonstrated to perform well in terms of decreased morbidity, maintenance of blood supply, stabilization of the pedicle, superior haemostasis, and speed of treatment. No significant variations of the keratinized tissue were registered when the buccal pedicle flap was executed in conjunction with the collagen matrix that however provided color match with the surrounding tissue as well as an increased mucosa thickness.

OBJECTIVES: To compare the effectiveness of deproteinized bovine bone mineral with 10% collagen alone (DBBMC) or with enamel matrix derivative (DBBMC-EMD) in ridge preservation. METHODS: 42 maxillary anterior teeth were extracted and received either a DBBMC (control) or DBBMC-EMD (test) treatment protocol. CBCT taken before and 4 months after the extraction procedure was used to measure changes in alveolar ridge width (RW), buccal bone height (BH) and palatal bone height (PH). Bone cores were harvested during implant osteotomy preparation and the samples processed histomorphometrically to assess the fraction of new bone (%NB), residual graft (%RG), and soft tissue matrix (%STM). RESULTS: Overall, both treatment groups showed significant reductions in mean RW from baseline to 4 months after extraction, but no significant change in either mean BH or PH over this time. When CBCT measurements were analysed according to the initial thickness of the buccal wall (BT

Objective: To histologically evaluate healing following grafting a xenogenous bone substitute in the buccal gap around the immediately placed one-piece zirconia implant. Materials and methods: The third and fourth premolars (PM3 and PM4) in both quadrants of the mandible of nine Mongrel Hound dogs were used for this experiment. They have been removed, and the recipient sites were prepared. The implants were placed in a lingual position in the socket. In one side of the jaw, the gap between the implant and the socket walls was grafted (test) while no grafting was performed in the contralateral side (control), randomly selected. After 6 months of healing, biopsies were obtained and prepared for histological analysis. Vertical and horizontal measures were recorded in buccal and lingual surface. Results: The hard tissue was in a coronal position on the test side compared with the control side. The bone thickness around ZLA (zirconia large-grit sandblasted and acid-etched surface) level was larger on the test side. On the test side, the first bone-implant contact and bone crest, at the buccal aspect, were more coronal to ZLA in PM4 while in PM3 the same happened with the bone crest. The width of the buccal bone wall was larger in PM4 than in PM3 at the ZLA level and 1 mm apical to ZLA. Conclusion: The placement of a xenograft in the gap between 1-piece zirconia implant and the buccal wall in dogs modified the process of hard tissue healing, providing additional amount of hard tissue. This project was supported by a research grant from the ITI Foundation (number 1215_2017).

Objective The objective of this randomized controlled trial was to evaluate the radiographic changes and histologic healing following alveolar ridge preservation (ARP) using autogenous whole tooth (AWTG), test group, versus autogenous demineralized dentin graft (ADDG), control group. Material and methods Twenty non-molar teeth indicated for extraction were randomized into two groups (n = 10/group). Extracted teeth were prepared into AWTG or ADDG (0.6N HCl; 30 min), inserted into extraction sockets and covered by collagen membranes. Cone-beam computed tomography (CBCT) scans at baseline and six months were compared to assess ridge-dimensional changes. At six months, bone biopsies of engrafted sites were harvested and analyzed histomorphometrically. Results All sites healed uneventfully. Reduction was 0.85 ± 0.38 mm and 1.02 ± 0.45 mm in ridge width, 0.61 ± 0.20 mm and 0.72 ± 0.27 mm in buccal and 0.66 ± 0.31 mm and 0.56 ± 0.24 mm in lingual ridge height for the AWTG and ADDG group, respectively (p > .05). Histologically, no inflammatory reactions were noticeable and all samples showed new bone formation. Qualitatively, graft-bone amalgamations were more pronounced in ADDG samples. Histomorphometrically, new bone, graft remnants and soft tissue occupied 37.55% ± 8.94%, 17.05% ± 5.58% and 45.4% ± 4.06% of the areas in the AWTG group and 48.4% ± 11.56%, 11.45% ± 4.13% and 40.15% ± 7.73% in the ADDG group of the examined areas, respectively (p > .05). Conclusions AWTG and ADDG are similarly effective in ARP. Yet, histologically ADDG seems to demonstrate better graft remodeling, integration and osteoinductive properties.

Background The best treatment approach for wide oral leukoplakia (OL) remains to be determined. Aims To evaluate the outcomes of using an allograft dermal matrix (ADM) for reconstructing large oral epithelial defects following resection of OLs. Patients and methods A total of 27 OLs in 26 patients were excised, and residual large lingual and buccal epithelial defects were reconstructed using an ADM, which ranged in size from 3.0 × 5.0 to 6.0 × 6.0 cm. The patients were classified into mild (n = 1), moderate (n = 13), and severe dysplasia (n = 12) groups; 57.7% of the patients were tobacco smokers, 46.2% were alcoholics, 47.2% were both smokers and alcoholics, and 11.5% were both smoking and betel quid chewers. Patients who underwent surgery were advised to quit smoking, drink alcohol in moderation, or quit betel quid chewing. Results Two patients developed slight hematomas that resolved spontaneously within 2 weeks. A total of 76.9% of the smokers followed the advice to quit smoking, 83.3% of the alcoholics followed the advice to drink in moderation, and all three betel quid chewers followed the advice to quit chewing betel quid. The mean follow-up was 26.7 months. No MT occurred and recurrence was seen in two patients. Conclusions Large epithelial defect reconstruction using an ADM following resection of wide lingual and buccal OLs was safe and reliable for preventing MT of OL. The recurrence of OL may be related to patient habits such as tobacco smoking or/and drinking alcohol.

Objective Interleukin-4 is proven to regulate bone metabolism. This study aimed to assess the effect of exogenous interleukin-4 on orthodontic relapse. Materials and methods Bilateral maxillary first molars of 25 male Sprague Dawley rats were moved mesially for 3 weeks using orthodontic appliances an activating force of 50 g. After tooth movement, exogenous interleukin-4 was injected into the buccal and palatine sides of the right maxillary first molars (experimental group), and phosphate-buffered saline was injected at the same sites on the left side (negative control group). At the end of the study, the relapse distance between the mesial fissure of the first molar and the distal fissure of the second molar was measured. Three different histological stains were used to visualize the changes in the periodontium. Results After interleukin-4 injection, the relapse distance significantly reduced. Time-dependent effects played a more important role than the dose-dependent effects, and there was no correlation between these factors. Tissue staining showed that interleukin-4 reduced osteoclastogenesis and promoted osteoblastogenesis. Conclusion Exogenous interleukin-4 reduced the relapse of orthodontically treated teeth by promoting osteoblastogenesis and inhibiting osteoclastogenesis. Our findings can potentially benefit specialists in the future by improving their patients' treatment outcomes.

Objective Buccal cells are an ideal surrogate tissue for studying biologic effects of carcinogens or drugs, however inherent fragility and salivary RNAses limit RNA yield. We conducted healthy volunteer trials to optimize collection conditions. Methods We conducted: (a) a single‐arm crossover study evaluating four test conditions on RNA yield by buccal cytobrush; (b) a single‐arm prospective study evaluating RNA yield by investigator vs self‐collection. Results Antecedent toothbrushing, time of day, and number of cytobrush strokes did not significantly impact RNA yield. RNA yield was doubled by using 2 vs 1 cytobrush per buccal surface (P = .0054). Self‐collection of buccal cells for RNA was feasible; 36 of 50 (72%) samples passed quality control. Conclusion RNA yield was doubled by using two cytobrushes per buccal surface. Healthy volunteers can self‐collect sufficient buccal RNA for gene expression studies. Techniques from these pragmatic trials could enhance availability of a limited tissue for serial biomarker measurements. Level of Evidence 1b—Prognosis Study (Individual prospective cohort study)., Buccal cells are an ideal surrogate tissue for studying biologic effects of carcinogens or drugs, however inherent fragility and salivary RNAses limit RNA yield. We conducted two clinical trials evaluating various collection conditions to optimize RNA yield. We observed that yield is doubled by using 2 cytobrushes per buccal surface and that self‐collection is both feasible and sufficient for buccal mRNA for gene expression studies.

This study aimed to evaluate the effects of fat content on the textural and in vivo buccal breakdown properties of soy yogurt (SY) at different pH (5.4, 5.0, and 4.6). The microbial analysis, textural and rheological properties, and interfacial protein composition of all the samples were monitored. Microbial results suggested that the increased fat content in SY-5.0 and SY-4.6 resulted in significantly high viable cell counts of lactic acid bacteria (LAB). Textural studies demonstrated that the presence of a low fat content (1-3%) significantly reduced the hardness, springiness, and gumminess of the sample, but this effect was negligible with the addition of fat content (4-5%). The apparent viscosity and thixotropy of the SY-4.6 sample increased as the fat content increased. in vivo buccal digestion showed that a high fat content (2-4%) reduced the number of chews and chewing durations, which might be correlated with high oil droplet release (%) after mastication.

Aim To evaluate the prevalence of buccal peri-implant soft tissue dehiscence (PISTD) in anterior implants and to identify the risk/protective indicators of PISTD in implants not suffering peri-implantitis. Materials and methods 240 randomly selected patients from a university clinic database were invited to participate in the present cross-sectional study. Those who accepted, after the evaluation of their medical and dental records, were clinically examined to assess the prevalence of buccal PISTD in non-molar implants. Multilevel multivariate logistic regression analyses were then carried out to identify those factors associated either positively (risk) or negatively (protective) with buccal PISTD in implants without peri-implantitis. Results 92 patients with a total of 272 dental implants were analysed. At implant-level, the prevalence of buccal PISTD was 16.9%, while when selecting only implants without peri-implantitis it was 12.0%. Buccal PISTD was present in 26.7% of the implants diagnosed with peri-implantitis. The following factors were identified as risk/protective indicators of buccal PISTD in implants without peri-implantitis: malposition (too buccal vs. correct: OR=14.67), thin peri-implant phenotype (OR=8.31), presence of at least one adjacent tooth (OR=0.08) and presence of abutment (OR=0.12). Conclusions PISTD are highly prevalent among patients with dental implants in this university-based population, and several factors were identified as risk and protective indicators of PISTD in implants not suffering peri-implantitis.

OBJECTIVES To evaluate bone height and thickness in the mandibular buccal shelf region and to compare differences between anatomical sites according to gender, side and vertical and sagittal skeletal patterns. SETTINGS AND SAMPLE POPULATION Multislice computed tomography (MSCT) images of 94 subjects (51 females and 43 males) were previously obtained as part of preoperative planning for orthognathic surgery. METHODS Measurements were performed in three different regions of the mandibular buccal shelf: mesially, towards the central groove and distally to the second molars. Bone thickness measurements were obtained perpendicularly 3, 5 and 7 mm below the bone crest towards the mandible outer cortex. Bone height was measured 3 mm away from the bone crest perpendicularly to the outer cortex of the base of mandible. RESULTS There was an increase in bone thickness in the posterior and basal directions. The increase in bone thickness ranged from 1.8 to 7.1 mm. Greater bone height was found in the anterior direction. The increase in bone height ranged from 17.5 to 22.5 mm. Hypodivergent and Class III subjects showed significantly greater bone thickness (P

Background This study investigates the influence of insulin on pulp tissue healing after pulp capping in diabetic dogs. Methods Diabetes mellitus was induced in four dogs, and their blood glucose levels were adjusted by insulin to normoglycemic level in two dogs (normoglycemic group) and to hyperglycemic level in two dogs (hyperglycemic group). Class V buccal cavities were performed in 15 teeth in each diabetic dog and two normal dogs (control group). The three groups (30 teeth each) were divided according to the capping materials into three subgroups (10 teeth each) including: subgroup A - mineral trioxide aggregate (MTA), subgroup B - bioaggregate (BA), and subgroup C - calcium hydroxide (Ca(OH)2 ). Each subgroup was divided into two subdivisions according to the evaluation period, subdivision 1: 1 month and subdivision 2: 2 months. Qualitative and quantitative evaluations of the inflammation and dentine bridge formation were assessed histologically. Results The hyperglycemic diabetic group exhibited significant higher inflammatory cell count and scores and lower dentine bridge thickness than those of the normoglycemic diabetic and control groups (P .05). Conclusion Insulin has favourable effects on the pulp tissue healing after pulp capping in diabetic dogs.

Objectives This clinical randomized study aimed to evaluate the early plaque formation on nonresorbable polytetrafluoroethylene (PTFE) membranes having either a dense (d‐PTFE) or an expanded (e‐PTFE) microstructure and exposed to the oral cavity. Material and Methods Twelve individuals were enrolled in this study. In a split‐mouth design, five test membranes (e‐PTFE) with a dual‐layer configuration and five control membranes (d‐PTFE) were bonded on the buccal surfaces of posterior teeth of each subject. All study subjects refrained from toothbrushing during the study period. Specimens were detached from the teeth at 4 and 24 hr and subjected to viability counting, confocal microscopy, and scanning electron microscopy. Plaque samples were harvested from neighboring teeth at baseline, 4, and 24 hr, as control. Wilcoxon signed rank test was applied. Results No bond failure of the membranes was reported. Between the early and late time points, viable bacterial counts increased on all membranes, with no difference between the test and control. The number of Staphylococcus spp. decreased on the tooth surfaces and increased on both membranes overtime, with a significant difference compared to teeth. The total biomass and average biofilm thickness of live and dead cells were significantly greater at the d‐PTFE barriers after 4 hr. Conclusion This study demonstrated that the e‐PTFE membrane was associated with a lesser degree of biofilm accumulation during the initial exposure compared to the d‐PTFE membrane. The present experimental setup provides a valuable toolbox to study the in vivo behavior of different membranes used in guided bone regeneration (GBR).

Introduction A special interest has been raised regarding the role of the peri-implant mucosa as a critical factor for long-term maintenance of the artificial fixtures as well as the final esthetic outcome that may significantly affect patient satisfaction. It is then imperative to develop minimally invasive and easy-to-apply plastic surgical methods to increase the volume of the peri-implant mucosa. Case presentation The limited scientific evidence regarding possible techniques to treat esthetic soft tissue defects around endosseous implants is encouraging a preventive soft tissue augmentation of mucosa deficiencies and thin phenotypes. Several techniques have been proposed to augment the volume of the mucosa to achieve the so-called pink esthetics. Among these the buccal pedicle flap seems to be less invasive in terms of morbidity since it does not necessitate any soft tissue harvesting. Its low morbidity allows it to treat patients without the need of postoperative medications since it reduces pain, the risk of infections, alteration of the sensitivity of the donor site and significantly reduces the period of healing which is generally longer when associated with connective tissue grafts. A modified surgical approach is based on the combination of the buccal pedicle flap with a stable collagen matrix to boost a biomimetic peri-implant mucosa and generate a convex pink interface with the final restoration. Conclusion The proposed modified buccal pedicle flap seems to be promising in terms of decreased morbidity and maintenance of the blood supply, and conducive to an increased patient acceptance rate.

Aim To evaluate clinical performance and side effects of two commercially available 0.2% chlorhexidine mouthwashes after periodontal surgery, one with (test) and one without (control) an anti‐discoloration system. Materials and methods This single‐centre, crossover clinical trial included 38 patients undergoing two sessions of periodontal flap surgery. The participants used two different 0.2% chlorhexidine products, one with and one without an anti‐discoloration system, in the 14‐day post‐operative periods. Plaque, gingival inflammation, tooth staining, side effects and patient preference were evaluated. Results The control mouthwash (without an anti‐discolouring system) produced significantly lower plaque (p = 0.02) and gingival index (p = 0.01) compared to the test mouthwash. The test mouthwash produced significantly less staining in the gingival (p = 0.002) and approximal areas (p = 0.0004), but no difference was detected in the buccal area of the teeth. The patients did not show preference for any of the mouthwashes. Conclusion Chlorhexidine mouthwash without an anti‐discoloration system resulted in significantly lowered plaque and gingival index compared to chlorhexidine mouthwash with an anti‐discoloration following periodontal surgery. No difference in patient preference was found despite less side effects produced by the chlorhexidine mouthwash with the anti‐discoloration system.

Midazolam is an established probe drug to assess cytochrome P450 3A activity (phenotyping). Microdosed midazolam is increasingly used for this purpose; a buccal formulation might be of advantage, but buccal absorption might occur. We therefore tested in a single-center, open-label clinical trial with 12 healthy volunteers the absolute bioavailability of 10 μg of midazolam after buccal administration in relation to buccal exposure time. In relation to a drinking solution, there was an increase of midazolam exposure (area under the plasma concentration-time curve from time 0 to infinity) with increasing buccal exposure time with an apparent saturation at 100-second buccal exposure. Absolute bioavailability increased from 27.8% (95% confidence interval, 23.5-32.9) for the drinking solution (0 seconds) to 66.1% (95% confidence interval, 60.0-72.8) after 100-second buccal exposure with no further increase after 150 seconds. A Hill equation described the time dependency of midazolam bioavailability with maximal bioavailability as 64.5% and buccal exposure time resulting in half maximal bioavailability increase as 16 seconds. In conclusion, midazolam bioavailability is highly dependent on buccal exposure time, and even a few seconds of buccal exposure will increase bioavailability due to buccal absorption. This needs to be taken into account for any buccal administration of midazolam.

Aim To evaluate the clinical, aesthetic and radiographical outcome of single immediate implant placement (IIP) after 10 years (a) and to identify putative risk factors for advanced mid-facial recession (b). Material and methods Periodontally healthy patients with a thick gingival biotype and intact buccal bone wall were consecutively treated with a single immediate implant and crown in the aesthetic zone (15-25). Flapless surgery and socket grafting with deproteinized bovine bone mineral were performed. Seven patients received a connective tissue graft (CTG) at 3 months due to obvious alveolar process deficiency (n = 5) or advanced mid-facial recession (n = 2). Clinical, aesthetic and radiographical outcomes at 10 years were compared to those at 5 years and CBCTs were taken at 10 years. Results Twenty-two patients (10 women; mean age 50) were consecutively treated and 18 could be re-examined. Two implants failed and two patients died. None of the parameters differed between the 5- and 10-year re-assessment (marginal bone loss: 0.31 mm; plaque score: 15%; probing depth: 3.4 mm; bleeding on probing: 32%; pink aesthetic score: 10.61; mesial papillary recession: -0.03 mm; distal papillary recession: 0.22 mm; mid-facial recession: 0.58 mm). Six implants (33%) demonstrated ≥1 mm mid-facial recession. Putative risk factors were merely based on descriptive statistics and included buccal shoulder position, no CTG, convex emergence profile and central incisor position. Three implants (17%) had no visible buccal bone on CBCT. One of these was too buccally positioned, another yielded peri-implant mucositis and another demonstrated peri-implantitis. Conclusions Advanced mid-facial recession is common in the long term following IIP. Therefore, caution is required for IIP in the aesthetic zone.

This study aimed to determine and compare soft tissue healing outcomes following implant placement in grafted (GG) and non-grafted bone (NGG).Patients receiving single implant in a tooth-bound maxillary non-molar site were recruited. Clinical healing was documented. Volume and content of wound fluid (WF; at 3, 6, and 9 days) were compared with adjacent gingival crevicular fluid (GCF; at baseline, 1, and 4 months). Buccal flap blood perfusion recovery and changes in bone thickness were recorded. Linear mixed model regression analysis and generalized estimating equations with Bonferroni adjustments were conducted for repeated measures.Twenty-five patients (49 ± 4 years; 13 males; nine NGG) completed the study. Soft tissue closure was slower in GG (P 0.01). Differential response in WF/GCF protein concentrations was detected for ACTH (increased in GG only) and insulin, leptin, osteocalcin (decreased in NGG only) at day 6 (P ≤0.04), with no inter-group differences at any time(P 0.05). Blood perfusion rate decreased immediately postoperatively (P 0.01, GG) followed by 3-day hyperemia (P 0.05 both groups). The recovery to baseline values was almost complete for NGG whereas GG stayed ischemic even at 4 months (P = 0.05). Buccal bone thickness changes were significant in GG sites (P ≤ 0.05).History of bone grafting alters the clinical, physiological, and molecular healing response of overlying soft tissues after implant placement surgery.

Made available in DSpace on 2020-12-12T02:13:14Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-01-01 This study evaluated both telomere length (TL) and micronucleus (MN) as indicators of genome instability in 40 anesthesiologists occupationally exposed to anesthetics and in 40 physicians without occupational exposure to anesthetics who were matched by age, sex, and lifestyle. Blood and buccal samples were collected from both groups at the same period. Anesthetic exposure assessment was performed. The studied groups were assessed regarding relative TL by quantitative polymerase chain reaction and MN by buccal MN assay. Mean trace concentrations of anesthetics were below two parts per million. No significant differences between groups were found for both biomarkers. However, MN frequency was slightly increased (1.9-fold; p =.094) in the exposed group compared to the control group and in the exposed males (2.4-fold; p =.090) compared to unexposed males. TL and age showed a significant negative correlation. Anesthetic occupational exposure below recommended levels is not associated with changes in TL and MN in anesthesiologists. GENOTOX Laboratory Department of Anesthesiology Botucatu Medical School São Paulo State University – UNESP GENOTOX Laboratory Department of Anesthesiology Botucatu Medical School São Paulo State University – UNESP

Background There is no consensus regarding the most effective anaesthetic solution for children; nerve block, especially mandibular, can be difficult for general dentists. Therefore, the study aims to compare the efficacy and the adverse events of articaine 4% with epinephrine 1:100 000 with lidocaine 2% with epinephrine 1:100 000 for primary molar extraction using buccal infiltration. Methods These are data from a parallel triple-blind randomised controlled trial with a computer-generated allocation treatment. Forty-three children aged 6-10 years with a clinical and radiographic indication of primary molar extraction were enrolled. The intervention was local buccal infiltration with articaine 4% compared with lidocaine 2%. The main outcome was pain during anaesthetic injection and tooth extraction. Adverse events were examined as secondary outcomes. Children were treated in a University setting from April to June 2019. Results Both solutions had similar anaesthetic efficacy in primary molar extraction when applied by the infiltrative technique (β -0.47; 95% CI -3.19 to 2.24; P = .76); however, children reported higher mean pain during articaine deposition (β 2.43; 95% CI 0.28-4.57; P = .02). The measured lidocaine pH was 3.19 (0.15) and articaine was 2.43 (0.00) (P = .04). Post-operative pain, oedema and nausea were observed without differences between the groups. Conclusions There was no difference in the efficacy of articaine compared to lidocaine for primary molar extraction. Articaine was more painful during the injection. Practical implications Primary molar extractions can be performed with both articaine and lidocaine buccal infiltration.

Aim: To test whether or not buccal vertical bone dehiscences (≤5 mm) around posterior implants left for spontaneous healing (SH) result in the same clinical and radiologic outcome as dehiscences treated with guided bone regeneration (GBR) at 7.5 years after implant placement (IMPL). Materials and methods: Twenty-two patients receiving 28 posterior implants with a small non-contained buccal bone dehiscence (≤5 mm) were randomly assigned to the SH or the GBR group. Implants were loaded at 6 months. Clinical parameters (probing depths, sulcus bleeding index, plaque index) and approximal marginal radiographic bone levels were assessed regularly up to at least 6.8 years. The vertical extension of the dehiscences was measured clinically at IMPL and abutment connection and radiographically on cone beam computed tomographys at a mean follow-up time of 7.5 years. Results: Twenty patients with a total of 26 implants were recalled at 7.5 years (9.1% dropout). The implant/crown survival rates were 100% in both groups. Stable peri-implant tissues were observed in both groups showing only minimal signs of inflammation. During the entire study period (IMPL-7.5-year follow-up), the median buccal vertical bone gain measured 1.61 mm for the GBR group and 0.62 for the SH group showing no significant difference between the groups. Also, at 7.5 years, the median approximal marginal bone levels (GBR: 0.53; SH: 0.68) were not significantly different between the two groups (p = .61) while the remaining median buccal vertical dehiscences were larger in the SH group (2.51 mm) compared to the GBR group (1.66 mm; p = .02). Conclusions: Implants with small non-contained buccal bone dehiscences exhibited high implant survival rates and healthy peri-implant tissues at 7.5 years. In the GBR group, the buccal vertical bone levels were higher compared to the SH group but remained stable over the entire study period for both treatments. Keywords: bone substitute; dental implant; guided bone regeneration; small buccal defects; spontaneous healing. © 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Introduction Gummy smile (GS) is an esthetic issue which causes a person to show a larger than average amount of gum tissue when smiling. Lip repositioning procedure is a surgical treatment option performed by removing a partial thickness strip from the maxillary buccal vestibular mucosa and suturing back the lip mucosa to the mucogingival line. High rate of relapse has been recorded with this procedure. In this study, different treatment options were applied according to the etiology and clinical background of each individual case in an attempt to overcome relapse. Furthermore, modification of the conventional lip repositioning procedure and the clinical outcome of this technique will be demonstrated in this report. Case series Among the four selected patients who requested correction of their GS, the amounts of gingival display (GD) measured using digital Vernier were from 5 to 7 mm. Clinical examination revealed variation in the length of the clinical crowns, and vestibular depth and width of keratinized gingiva. Since the causes of their GS were different, different surgical modalities were applied to address GS in this case series. The procedures were gingivectomy, osteoplasty, and modification of lip repositioning procedure performed by removing a partial thickness ribbon of the keratinized attached gingiva and then suturing the labial alveolar mucosa to the attached gingiva at a level more coronal to its previous position. Conclusion One-year follow-up showed that all these surgical procedures reduced excessive GD by 2 mm without relapse and the patients were satisfied with the esthetic outcome.

Objective The present study aimed to evaluate the histological outcome of tunnel β-TCP blocks grafting in extraction sockets missing the buccal bone wall, after 6 months of healing. Background Tunnel β-tricalcium phosphate (β-TCP) blocks made of randomly organized tunnel-shaped β-TCP ceramics appeared promising for alveolar ridge preservation in tooth extraction sockets missing the buccal bone, in a previous study in dogs, with a 2-month healing time. Methods In six beagle dogs, the maxillary first premolars were extracted and the buccal bone was surgically removed to create bone defects of 4 mm (mesio-distal) × 5 mm (apico-coronal) × 4 mm (bucco-palatal). Thus, extraction sockets missing the buccal bone plate were grated with tunnel β-TCP blocks (test) or left empty for spontaneous healing (control). Histology/histomorphometry was performed after 6 months of healing. Results The horizontal bucco-palatal width of the alveolar ridge was significantly greater at test sites than at control sites. The amount of mineralized tissue was greater at test sites (57.8% ± 11.1%) than at control sites (28.9% ± 8.5%), while the amount of connective tissue was significantly greater at control sites (41.7% ± 6.4%) than at test sites (19.6% ± 9.2%). No significant difference was found between sites in terms of basic multicellular units and bone marrow. Residual β-TCP at test sites was 5.8% ± 3.2%. Conclusion Grafting with tunnel β-TCP block significantly limited the resorption of the alveolar ridge at extraction sockets missing the buccal bone compared with sites left to heal spontaneously, even after 6-month follow-up.

OBJECTIVES To test the non-inferiority of demineralized bovine bone mineral (DBBM) compared to demineralized bovine bone mineral with 10% collagen (DBBM-C) for the maintenance of the soft tissue contour after tooth extraction in the esthetic zone. MATERIAL AND METHODS Sixty-five patients randomly received ridge preservation at a single site in the anterior maxilla with DBBM or DBBM-C. Both, DBBM and DBBM-C were covered with a collagen matrix. Profilometric analyses were performed at baseline (BL), immediately after treatment (PO) and at 4 months (FU; day of implant placement). The main outcome was the horizontal mean change (HC) at the buccal aspect. The measurements also included changes of the estimated soft tissue thickness (eTT) at 1mm, 3mm and 5mm below the buccal gingival margin. Descriptive analysis was performed and differences between groups were analyzed using independent samples t-test. The non-inferiority test was performed for HC. RESULTS At 4 months, the horizontal mean change (HC) was -1.43mm (±0.53mm) (DBBM-C) and -1.32mm (±0.53mm) (DBBM). Change of the estimated soft tissue thickness (eTT) between baseline (BL) and four months of follow-up (FU) at 1mm, 3mm and 5mm amounted to -4.58mm (±2.02mm), -2.40mm (±0.97mm) and -1.37mm (±0.78mm) for DBBM-C and to -4.12mm (±1.80mm), -2.09mm (±0.91mm) and -1.23mm (±0.72mm) for DBBM. The differences between the groups were not statistically significantly for any of the outcome measures (p > .05). CONCLUSIONS DBBM is non-inferior to DBBM-C for the maintenance of the soft tissue contour 4 months after tooth extraction.

BACKGROUND Oral modiolus reconstruction is important in unilateral oral commissure removal including the modiolus. However, the proper procedure is not yet established. We performed free-flap reconstruction for full-thickness oral defects involving the oral commissure combined with oral modiolus reconstruction using a fascial sling. PATIENTS AND METHODS From 2008 to 2018, six oral carcinoma patients, aged 65 to 86 years, underwent free-flap modiolus reconstruction after tumor resection. The resulting lip defects of 10% to 80% were labial (two patients), buccal (two patients), and mixed (two patients). RESULTS Five anterolateral thigh flaps including one perforator and one radial forearm flap were performed. The oral defects were covered with folded flaps (size, 11 × 6-18 × 7.5 cm2 ). The orbicularis oris stumps were connected to the masseter with a fascia lata or palmaris longus tendon (length, 15-20 cm), arranged in a Y-shape in four patients and a V-shape in two patients. All the flaps survived without complications. Almost all the patients achieved good oral static effects (lip deviation and drooping) and dynamic effects (mouth opening, oral commissure narrowing, and diet) in the 6 to 65 months' follow-up. CONCLUSION Free-flap reconstruction combined with oral modiolus reconstruction using a fascial sling achieves good oral static and dynamic effects for full-thickness oral reconstruction involving the oral commissure.

A 10-year-old Guatemalan girl with past medical history of Epstein-Barr virus-associated smooth muscle tumors (EBV-SMT) and combined immunodeficiency presented for evaluation of painful intraoral lesions. On examination, she was noted to have multiple, white to flesh-colored, soft, flat-topped papules, and plaques on the buccal and labial mucosa. Human papillomavirus type 13 was detected on PCR with PGMY primers of previously biopsied buccal tissue, confirming a diagnosis of Heck's disease (multifocal epithelial hyperplasia). We present an immunosuppressed, pediatric patient with two rare, virus-associated neoplastic disorders that have not been previously reported to occur in the same individual.

Introduction A single-flap approach (SFA) is the elevation of a periodontal flap to access the defect only from one side. Several studies have reported that the SFA is at least as clinically effective as the elevation of a flap at both buccal and palatal/lingual aspects. However, studies regarding the SFA have reported only 6 to 10 months follow-up clinical outcomes. The purpose of this case series was to investigate the outcomes of the SFA for periodontal regeneration with a collagen membrane and bone grafts in regard to linear bone defect fill and clinical parameters such as gingival recession (GR), pocket depth (PD), and clinical attachment level (CAL) for the 15-month follow-up. Case series Based on the deepest pocket depth site, the flap retraction side for each case, either buccal or palatal/lingual, was determined. After retraction of a one-side full thickness flap, complete removal of granulation tissue and thorough scaling and root planing were performed. Demineralized ground cortical bone grafts were gently packed into the defect areas and an absorbable collagen membrane was placed over the grafts in 13 cases from 11 patients. Conclusion This case series demonstrated that the SFA for periodontal regeneration with a collagen membrane and bone grafts resulted in decreased PD with minimum GR, gain in CAL, and bone fill at defect sites for the 15-month follow-up.

Objectives To assess through cone-beam computed tomography (CBCT) buccal alveolar bone alterations after immediate implant placement using the following techniques: open flap and grafting (flap-graft), open flap and no grafting (flap-nograft) and flapless and no grafting (noflap-nograft). Materials and methods This was a three-armed parallel group randomized clinical trial with allocation ratio 1:1:1. Patients were eligible in case they needed immediate implant replacing teeth in maxillary premolar area, with sufficient buccal bone support. CBCT was performed immediately after the intervention and 6 months later. The main outcomes were CBCT measurements performed at apical (A-EA), medial (M-EM) and external and internal implant bevel level (B-EB, B-IB) and vertical defect depth (DP). Pain and discomfort, time of surgery and complications were recorded. Differences between groups were estimated through ANOVA tests and post-hoc Scheffe's analysis for pairwise comparisons. Multiple regressions were conducted to estimate influence of gingival biotype and baseline marginal gap dimension. Results Forty-five patients were recruited and randomized to treatments with one lost to follow-up. Analysis of variance showed that the effect of treatment technique was not relevant for all horizontal and vertical outcomes. The three techniques exhibited almost complete fill of marginal gap, with a mean residual vertical gap of 0.27 mm and horizontal gap of 0.5 mm. Regression models indicated a positive effect of thick biotype on gap filling and dimensional bone reduction. The noflap-nograft technique resulted less painful. Conclusions The option of noflap-nograft surgery in post-extraction implants allows for minimal surgical intervention with comparable buccal bone changes and gap filling after a follow-up of 6 months in sites with sufficient buccal bone support.

Background The primary purpose of this study was to histologically determine if there is a significant difference in new bone formation, residual graft material, and connective tissue/other when ridge preservation is accomplished using a bovine versus a porcine xenograft. Methods Forty-four patients needing a single rooted tooth extraction and ridge preservation in preparation for dental implant placement were recruited in the study. After minimally traumatic tooth extraction, alveolar ridge dimensions were measured using a custom-fabricated acrylic stent. Patients were then randomized 1:1 to receive ridge preservation using either bovine or porcine xenograft material. A trimmed dense polytetrafluoroethylene (d-PTFE) membrane was overlaid on the graft material, the mucoperiosteal flaps were replaced, and the surgical site was sutured. After 18 to 20 weeks of wound healing, sites were surgically re-entered, ridge dimensions were again measured using the previously fabricated acrylic stents and a bone core sample of the grafted site was harvested for histomorphometric analysis. Results Thirty eight of the 44 enrolled patients completed the study, 17 from the bovine group and 21 from the porcine group. Histologically, there were no statistically significant differences between the groups for mean percentage of vital bone formation (bovine = 36.21%, porcine = 31.27%, P = 0.49), residual graft material (bovine = 20.47%, porcine = 19.52%, P = 0.82) and connective tissue/other (bovine = 43.32%, porcine = 49.21%, P = 0.19). For secondary outcomes, there were no significant differences between the groups for mean change in buccal ridge height, lingual ridge height, and ridge width. However, a higher number of patients in the porcine group had additional grafting at the time of implant placement, either because of thin buccal plate or failure of implant stability. Conclusion The findings suggest that ridge preservation with porcine xenograft results in comparable histomorphometric outcomes and dimensional stability with bovine xenograft.

When using non-FTA cards in commercial multiplex STR kits for direct PCR, pretreatment steps with specific buffers are recommended. Here, we designed a rapid direct PCR method utilizing a non-FTA card, Oral Cell Sampling Kit, by omitting the pretreatment step involving Prep-n-Go™ Buffer, and it showed compatibility with the GlobalFiler™ Express PCR Amplification Kit, GlobalFiler™ PCR Amplification Kit, and PowerPlex® Fusion system. To optimize the PCR conditions, we tested the method with different final PCR volumes and cycles. Finally, we conducted a performance test using 50 Korean buccal samples and confirmed the high performance of the method, detecting more than 90% of the samples with full profiles when using GlobalFiler™ PCR Amplification Kit and PowerPlex® Fusion system at 29 cycles in a 10 μL final PCR volume. Thus, we report a simple direct PCR set-up to analyze reference samples collected using a non-FTA card manufactured in Korea.

Background Little evidence is available regarding the benefit of ridge preservation (RP) at molar sites. The primary objective of this three-arm cohort study was to histologically compare the healing outcome between natural healing after molar tooth extraction and two different techniques of RP using freeze-dried bone allograft (FDBA) and a nonresorbable dense polytetrafluoroethylene (dPTFE) membrane, or an absorbable collagen sponge as a barrier. Methods Seventy-nine patients requiring extraction and delayed implant placement were placed into three groups: extraction alone (control); ridge preserved using FDBA; and either dPTFE (Test1) or collagen sponge (Test2). Bone cores were harvested from implant osteotomies at ≈3 months after extraction for histomorphometric analysis to determine the percentage of vital bone, residual graft, and connective or other tissue. Ridge dimension changes were also evaluated radiographically (cone-beam computed tomography). Results The percentage of vital bone was significantly greater in control group compared with Test1 but was not statistically different among other groups. Test2 showed significantly less connective or other tissue than control and Test1. The percentage of residual graft was significantly lower in Test1 compared with Test2. There was no significant correlation between the percentage of vital bone or residual graft and the following parameters: healing time, patient age, gender, buccal plate thickness, or radiographic changes in ridge dimensions. Conclusion RP at molar sites using FDBA and an absorbable collagen sponge may be a sufficient and economic way to preserve the ridge dimension without interfering with the amount of new bone formation.