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Background: The aim of this study was to evaluate the use of inhaled methoxyflurane (Penthrox®) in the reduction of dental anxiety in patients undergoing mandibular third molar removal in a specialist surgical suite and compare it to the conventional nitrous oxide sedation. Methods: A prospective randomized, non-blinded crossover design study of 20 patients receiving two types of sedation for their third molar extraction who participated in 40 treatment sessions. At first appointment, a patient was randomly assigned to receive either nitrous oxide sedation or intermittent Penthrox® inhaler sedation, with the alternate regimen administered during the second appointment. Peri-procedural vital signs (heart rate and blood pressure) were recorded and any deviations from 20% from the baseline values, as well as any drop in oxygen saturation below 92% were documented. The Ramsay Sedation Scale (RSS) score was recorded every five minutes. Patient cooperation during the procedure, patients' general opinion about the sedation technique, surgeon satisfaction and the occurrence of side effects were all recorded. After the second procedure, the patient was also asked if he or she had any preference of one sedation technique over the other. Results: Levels of sedation were comparable in nitrous oxide and Penthrox® sedation sessions. However, at 15 minutes of sedation it was significantly lighter (p < 0.05) in Penthrox®. No patient in both regimens reached a RSS deeper than a score of 4. Parameters measured for assessment of sedation (patient cooperation, surgeon satisfaction and patient general opinion about sedation technique) were all similarly comparable for both nitrous oxide and Penthrox®. In both sedation sessions, the odour of the inhalational agent was accepted by the patients; half of the patients (10 patients) who received methoxyflurane thought its odour was pleasant. Patients preferred methoxyflurane (Penthrox®) inhalation over nitrous oxide sedation (Fisher's Exact test, p < 0.05). Adverse events were minimal. No patient was either deeply sedated or agitated. Blood pressure was within ± 20% from the baseline values. No patient had oxygen saturation less than 92%. Dizziness was the most frequently encountered side effect in both regimens (four patients each). Two patients had bradycardia (HR < 60 beats/minute) when nitrous oxide was used in comparison to one patient with Penthrox® sedation. Paraesthesia of fingers and heaviness of the chest was encountered only with nitrous oxide sedation (four patients). Mild self-limited shivering occurred in one patient with Penthrox® sedation. Conclusions: The Penthrox® Inhaler can produce a comparable sedation to that of nitrous oxide for the surgical extraction of third molars under local anaesthesia. [ABSTRACT FROM AUTHOR]

This scoping review examines the role of digital solutions in active, participant-centered surveillance of adverse events following initial release of COVID-19 vaccines. The goals of this paper were to examine the existing literature surrounding digital solutions and technology used for active, participant centered, AEFI surveillance of novel COVID-19 vaccines approved by WHO. This paper also aimed to identify gaps in literature surrounding digital, active, participant centered AEFI surveillance systems and to identify and describe the core components of active, participant centered, digital surveillance systems being used for post-market AEFI surveillance of WHO approved COVID-19 vaccines, with a focus on the digital solutions and technology being used, the type of AEFI detected, and the populations under surveillance. The findings highlight the need for customized surveillance systems based on local contexts and the lessons learned to improve future vaccine monitoring and pandemic preparedness.

Bariatric surgery has been shown to significantly affect type 2 diabetes mellitus (T2DM) remission, particularly in obese individuals. This systematic review aims to evaluate the effectiveness of bariatric surgical interventions in inducing remission of T2DM as well as to identify factors influencing surgical outcomes. The systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed across multiple databases, including PubMed, Embase, and Cochrane Library, utilizing text words and controlled vocabulary in various combinations with Boolean operators "AND" and "OR." The search was limited to open-access, full-text articles in English published from 2005 to 2024, including studies involving human subjects. The quality of the included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. In the study selection process for the systematic review, records were initially identified from three databases: Cochrane (31 records), Embase (62 records), and PubMed (52 records). This yielded 145 records. After removing 107 records, 38 records remained for screening. Of these, five records were excluded based on irrelevant problems and irrelevant outcomes. Subsequently, 33 reports were sought for full-text retrieval, with all reports being retrievable. The 33 reports were assessed for eligibility. Out of these, six were excluded due to an inaccessible full-text record. Finally, 33 studies met the inclusion criteria and were included in the review. Bariatric surgery is a highly effective intervention for individuals with T2DM, particularly those with obesity. It leads to significant weight loss and improved glycemic control through mechanisms that reduce stomach size and alter hormonal responses. This surgery not only helps many patients achieve remission from diabetes but also decreases the risk of obesity-related health issues. Beyond physical health, patients often report enhanced psychological well-being and quality of life. Overall, bariatric surgery can transform the health trajectory of select individuals, offering them a renewed sense of control and improved overall health., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mohamed et al.)

Introduction: Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease that primarily affects middle-aged individuals but is increasingly prevalent among the elderly due to longer life expectancies. Treating elderly onset RA (EORA) is challenging for clinicians because of unique disease characteristics, comorbidities, polypharmacy, age-related physiological changes, and limited studies on the safety and efficacy of biological therapies in this population. This review aims to evaluate the use of various biological therapies in elderly RA patients., Areas Covered: This narrative review examines various aspects of RA in the elderly using published literature, randomized control trials, meta-analyses, and recommendations from the National Institute for Health and Care Excellence (NICE) and The European Alliance of Associations for Rheumatology (EULAR)., Expert Opinion: In EORA patients, the initiation of biological therapy is often delayed. Methotrexate remains the first-line treatment for both EORA and young onset RA (YORA). The combination of methotrexate and biological treatment shows comparable safety and efficacy in both EORA and YORA, except for rituximab, which is less effective in patients over 75. For elderly RA patients, biological (b-) disease-modifying antirheumatic drugs (DMARDs) are preferred as the first advanced therapy over targeted synthetic (ts-) DMARDs due to their superior safety profile.

Background & objectives mHealth technologies, with their potential in improving public health, have recently gained considerable interest in India, offering an opportunity to deliver tailored and low cost interventions to the selected populations, especially in resource-poor settings. Project Vayoraksha aimed at developing and pilot testing mHealth technology-assisted strategies (Vayoraksha mobile application and field Vayoraksha network) to improve healthcare delivery and reverse quarantine at the field level among the geriatric population. Methods This field operational research study was implemented in Pathanamthitta, Kerala, from October 2020 to July 2021. The Vayoraksha mobile phone application for the geriatric users and a web interface used by healthcare workers involved in the field Vayoraksha network was developed with multisectoral expertise. Vayoraksha had facilities for symptom surveillance, teleconsultation and assessment of needs and included a community-based system to monitor and meet their needs that can help in reverse quarantine of the geriatric population. Results The project was implemented using the field Vayoraksha campaign involving frontline health workers and community volunteers. A baseline survey of 4782 geriatric population in the study area was conducted in Phase I, and 2383 (49.8%) had access to a smartphone facility to use Vayoraksha. Of these, 1257 (52.7%) were covered under the 'field Vayoraksha campaign' using intersectoral coordination and community participation. A total of 750 (59.6%) geriatric individuals downloaded the application of whom, 452 (60.3%) used the services of Vayoraksha. Needs were registered by 56 (12.3%) individuals of which 46 (82.1%) were medical needs related to the management of chronic diseases. More than 70 per cent of the needs were met through the Vayoraksha field network under the local primary health centre. More than 80 per cent of the geriatric individuals reported symptoms related to COVID-19 during the intervention period. Compliance with quarantine was observed in 77.7 per cent of the geriatric populations. Among those who used Vayoraksha, 26 (5.7%) availed tele-counselling services, and 3 (0.6%) used teleconsultation facilities. It was observed that Vayoraksha users had a higher proportion of the geriatric population who were young, educated, having chronic morbidity and living with family. Regular symptom surveillance was done within this group; only 12 (2.6%) of them tested positive for COVID-19 during this study. Interpretation & conclusions Results of this pilot study are promising, with 60 per cent of the geriatric population downloading and using Vayoraksha within a short time. Technology-assisted interventions can supplement the existing system for improved healthcare delivery among the vulnerable groups and have good potential for scale-up in the near future in developing countries.

Not long after plastic-made material became an inseparable part of our lives, microplastics (MPs) found their way into ecosystems. Aquatic organisms are one of the groups impacted by man-made materials and plastics; however, the varied effects of MPs on these organisms have yet to be fully understood. Therefore, to clarify this issue, 288 freshwater crayfish (Astacus leptodactylus) were assigned to eight experimental groups (2 × 4 factorial design) and exposed to 0, 25, 50, and 100 mg polyethylene microplastics (PE-MPs) per kg of food at 17 and 22 °C for 30 days. Then samples were taken from hemolymph and hepatopancreas to measure biochemical parameters, hematology, and oxidative stress. The aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, lactate dehydrogenase, and catalase activities increased significantly in crayfish exposed to PE-MPs, while the phenoxy-peroxidase, gamma-glutamyl peptidase, and lysozyme activities decreased. Glucose and malondialdehyde levels in crayfish exposed to PE-MPs were significantly higher than in the control groups. However, triglyceride, cholesterol, and total protein levels decreased significantly. The results showed that the increase in temperature significantly affected the activity of hemolymph enzymes, glucose, triglyceride, and cholesterol contents. The semi-granular cells, hyaline cells, granular cell percentages, and total hemocytes increased significantly with the PE-MPs exposure. Temperature also had a significant effect on the hematological indicators. Overall, the results showed that temperature variations could synergistically affect the changes induced by PE-MPs in biochemical parameters, immunity, oxidative stress, and the number of hemocytes., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Awake fiberoptic intubation (AFOI) is the gold standard for managing a difficult airway. To make the patient comfortable and cooperative during the procedure, many drugs such as benzodiazepines, opioids, or dexmedetomidine are used. Most of these intravenously given drugs may cause respiratory depression and hypoxia., Aim: We compared the efficacy of dexmedetomidine through nebulization and transtracheal route with intravenous routes with the primary aim of comparing patient tolerance score (PTS) and secondary objectives of comparing sedation score, cough score, and total duration required for awake fiberoptic nasotracheal intubation., Settings and Design: This study was a prospective randomized double-blind study., Subjects and Methods: Seventy-six patients, scheduled for elective surgery requiring AFOI between 18 and 75 years, were included in the study. They were randomly divided into two groups of 38 each. Group I patients received intravenous dexmedetomidine 1 μg.kg -1 and Group L patients received local dexmedetomidine through nebulization 0.5 μg.kg -1 and transtracheal injection 0.5 μg.kg -1 ., Statistical Analysis Used: Statistical Package for the Social Sciences version 22 was used., Results: Patients who received dexmedetomidine through nebulization and transtracheal route have significantly better PTSs and less cough scores as compared to patients who received dexmedetomidine by intravenous route ( P < 0.05). Hemodynamic parameters and sedation scores between the two groups were statistically insignificant ( P > 0.05). The time required for the procedure was significantly less in Group L compared to Group I ( P < 0.05)., Conclusion: Dexmedetomidine by nebulization and transtracheal route provides optimal conditions for AFOI with good patient tolerance and less cough score as compared to the intravenous route., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Anesthesia: Essays and Researches.)

Background: The exercise stress test (EST) is a non-invasive investigation to diagnose coronary artery disease. This research aimed to determine the relationship between erectile dysfunction (ED), cardiovascular risk factors, and coronary artery disease (CAD) in men referred for EST., Methods: A prospective cohort study enrolling 303 patients from August 2020 through September 2021. All patients filled out the international Index of Erectile Function (IIEF-5) questionnaire. . They underwent an exercise stress test (EST). A two-tailed independent sample t -test, chi-square tests, and binary logistic regression were used for statistical analysis., Results: EST was positive in 110 (36.3%) patients, negative in 154 (50.8%), and inconclusive in 39 (12.8%) patients. ED was present in 225 (74.3%) patients and absent in 78 (25.8%) patients. 278 (91.7%) had one or more cardiovascular risk factors. This study reported a significant relationship between diabetes mellitus (DM), hypertension (HTN), and the results of EST and ED. Compared to patients without ED, patients with ED had a positive EST result. Definite CAD was diagnosed in 21% of patients with ED compared to 1.3% in patients without ED. For a one-unit increase in age, the odds of ED increased by about 5%. Similarly, a negative EST is compared to a positive EST. Negative EST reduced the likelihood of ED by 82%., Conclusions: This research found a statistically significant connection between CAD, certain cardiovascular risk factors, and ED using the EST and IIEF-5 questionnaires. This research is significant because it may alter the way cardiovascular risk stratification is done., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Author(s).)

The current work reports the biosynthesis of silver nanoparticles (AgNPs) using the antimicrobial activities of ethyl acetate extract of Urtica diocia (UD) leaves as a reducing and capping agent. The synthesized UD-AgNPs were characterized using UV−visible spectroscopy, scanning electron microscopy (SEM), transmission electron microscopy (TEM), energy-dispersive X-ray analysis (EDAX), Fourier transform infrared (FTIR) spectroscopy, X-ray diffraction (XRD), and dynamic light scattering (DLS). The UD-AgNPs were evaluated against Gram-positive and Gram-negative bacteria, and their size, shape, and distribution were recorded. The average size of an NP was 19.401 nm. The zone of inhibition (ZOI) for 75 µL of UD-AgNPs against Pseudomonas aeruginosa (P. aeruginosa) was 21 ± 0.4 mm more than that of the control drug Ciprofloxacin (16 ± 10 mm). The minimum inhibitory concentration (MIC) was the lowest against Escherichia coli (E. coli) (36 ± 3 µg/mL) and Staphylococcusepidermidis (S. epidermidis) (38 ± 3 µg/mL). Moreover, the minimum bactericidal concentration (MBC) was the lowest against E.coli (75 ± 00 µg/mL) and Enterococcus faecalis (E. faecalis (83 ± 16 µg/mL). Thus, the UD-AgNPs synthesized using the ethyl acetate extract of UD can be used as a new antimicrobial drug.

Buccal bone remodeling around immediate implants placed in animals with streptozotocin (STZ)-induced diabetes has not been investigated. The present histologic and microcomputed tomography (μCT) in vivo experiment assessed the buccal bone remodeling around immediate implants, extraction socket healing, and bone-to-implant contact (BIC) in dogs with and without STZ-induced diabetes. Three male beagle dogs with STZ-induced diabetes and three healthy dogs (controls) were included. Fasting blood glucose levels were measured using a glucometer. Under general anesthesia, all animals underwent atraumatic tooth extraction of bilateral maxillary and mandibular second premolar teeth using Piezosurgery and immediate implant placement in the distal root socket. Primary closure was achieved for all implants and adjacent socket sites. After 11 months, all animals were sacrificed, and buccal bone thickness (BBT), marginal bone loss (MBL), BIC, and mesial extraction socket bone volume were assessed in control and diabetic animals using histologic and μCT examination. High-resolution μCT analyses were performed to identify the percentage of osteocytes and blood vessels in bone specimens harvested from a mesial extraction socket in each group. BBT and BIC were significantly higher in control dogs (P < .05), and diabetic dogs demonstrated significantly more MBL than control dogs (P < .05). Compared to healthy subjects, the sockets of induced diabetic dogs lost over 50% of bone horizontally and vertically. Control group had more significant osteocytes (38.85%) and blood vessels (37.87%), whereas the same values for STZ-induced diabetic dogs were 27.92% and 27.76%, respectively. Buccal bone loss and MBL were significantly higher around immediate implants placed in dogs with STZ-induced diabetes and were associated with multiple implant buccal thread exposure. A large percentage of socket space in diabetic dogs healed with nonosseous structure following tooth extraction.

Introduction The COVID-19 (coronavirus disease) has affected millions of people, wreaking havoc worldwide. World Health Organization (WHO) labelled this disease as a serious threat to public health since its rapid spread from Wuhan, China. The respiratory manifestations of COVID-19 are common, but myocardium involvement causing myocardial injury and rise in cardiac markers is much less discussed. Materials and methods We conducted this retrospective cohort study from 1st April 2020 to 1st October 2020. Data was collected from the Hospital Management and Information System (HMIS) based on inclusion criteria. We used the Cox proportional hazard regression model for survival analysis, estimated the probability curves of survival using the Kaplan-Meier method, and contrasted it with the log-rank test. Results Among the 466 patients, 280 (69%) were male; the rest were female. The majority were both hypertensive and diabetic, and one-third had a myocardial injury on arrival. The most frequent symptoms in more than half of the patients (51.90%) included a combination of fever, dry cough, and shortness of breath. Out of 466 patients, 266 patients were discharged, and 200 did not survive. In our study, 168 (36.05%) patients had a cardiac injury; among them, 38 (22.61%) were in the discharge group, and the remaining 130 (77.39%) patients were in the nonsurvivor group. Our study results showed that the mortality rate was higher in patients with high cardiac troponin I (cTnI) levels (hazard ratio [HR] 3.61) on admission. Conclusion Our result concluded that measuring cTnI levels on presentation could help predict the severity and outcome in COVID-19 patients. It will allow physicians to triage patients and decrease mortality., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Ali et al.)

Introduction Diabetes mellitus (DM) is a chronic metabolic disease. It is the principal cause behind the high morbidity and mortality attributed to cardiovascular disease. This article's objective was to determine a connection between high glycated haemoglobin levels (HbA1c) and coronary artery disease (CAD). Materials and Methods Cross-sectional research took place at the lady reading hospital, Peshawar, Pakistan, from 1st July 2020 to 31st December 2020. In this study, one hundred fifty-one type II diabetic patients took part. We labelled all of them as acute coronary syndrome (ACS) on arrival. Non-probability consecutive random sampling technique was used for sampling. We categorized patients based on their HbA1c levels into two groups. These groups included good glycemic control (HBA1c ≤ 7. 5%) and patients with poor glycemic control (HBA1c  ≥ 7.5%). We classified the angiographic results of these patients as normal coronary arteries (NCAs), single vessel disease (SVD), double vessel disease (DVD), and triple vessel disease (TVD). Continuous variables such as age, weight, height, and body mass index (BMI) between HBA1c levels were analyzed using the Mann-Whitney U test. The fisher's exact test was performed to compare the categorical variables between the two classes. Results Of the total 151 patients, 89 (58.9%) were males, and the rest were female. The mean age was 55.4 ± 11.2 years. The most common risk factors were diabetes and hypertension, whereas ST-segment elevation myocardial infarction (STEMI) was the most common presentation. 107 (70.86%) patients had poor glycemic control (HbA1c>7.5%). Coronary angiographies showed TVD in 77 (50.99%) patients. Among these patients with TVD, 6 (14%) patients had good glycemic control, while 71 (66%) patients had poor glycemic control, which is significant (P ≤ 0. 001). None of the patients with poor glycemic control had NCAs. Conclusion This article found a link between high levels of HbA1c and the degree of coronary artery disease (CAD) among diabetic patients. Our study's results demonstrated that high HbA1c was related to severe CAD. It would need additional studies with a large sample size to evaluate the more profound impact of HBA1c on coronary arteries., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Khan et al.)

Background and Objectives : Beta-tricalcium phosphate (beta-TCP) has been used for bone regeneration. The objective of this study was to assess longitudinally, the regeneration of critical sized segmental defects (CSSD) in rat femur using beta-TCP with or without recombinant platelet-derived growth factor (PDGF) through in vivo micro-computed tomography (micro-CT). Materials and Methods : Following ethical approval unilateral femoral CSSD measuring 5 mm was surgically created, under general anesthesia, in 30 male Wistar-Albino rats (aged 12-18 months; weighing 450-500 g). CSSD was stabilized using titanium mini-plate (4 holes, 1.0 mm thick with 8 mm bar). Depending upon biomaterial used for regeneration, the animals were randomly divided into: Control group ( N  = 10): CSSD covered with resorbable collagen membrane (RCM) only; Beta-TCP group ( N  = 10): CSSD filled with beta-TCP and covered by RCM; Beta-TCP + PDGF group ( N  = 10): CSSD filled with beta-TCP soaked in recombinant PDGF and covered by RCM. Longitudinal in vivo micro-CT analysis of the CSSD was done postoperatively at baseline, 2nd, 4th, 6th, and 8th weeks to assess volume and mineral density of newly formed bone (NFB) and beta-TCP. Results : Significant increase in NFB volume (NFBV) and mineral density (NFBMD) were observed from baseline to 8-weeks in all groups. Based on longitudinal in vivo micro-CT at 8-weeks, beta-TCP + PDGF group had significantly higher ( p  < 0.01) NFBV (38.98 ± 7.36 mm 3 ) and NFBMD (3.72 ± 0.32 g/mm 3 ) than the beta-TCP (NFBV-31.15 ± 6.68 mm 3 ; NFBMD-2.28 ± 0.86g/mm 3 ) and control (NFBV: 5.60 ± 1.06 mm 3 ; NFBMD: 0.27 ± 0.02 g/mm 3 ) groups. Significantly, higher reduction in beta-TCP volume (TCPV) and mineral density (TCPMD) were 1 observed in the beta-TCP + PDGF group when compared to the beta-TCP group. Conclusion : Addition of recombinant PDGF to beta-TCP enhanced bone regeneration within rat femoral CSSD and increased resorption rates of beta-TCP particles.

Residual tumor after curative intent therapy in patients with Ewing's sarcoma is of great clinical significance. Surgeons use the resection margin to indicate the completeness of a surgical excision. However, this margin may be either nonviable/necrotic or viable. This systematic review examines the 5-year event-free survival rate and local recurrence as a function of positive resection margins that are nonviable/necrotic versus those that are viable. Multiple databases were searched using the Ovid interface. After full text screening, 45 articles that reported either margin or postchemotherapy histology and one or more outcomes of interest were identified, and two articles reported on margin and histology simultaneously. An attempt was made to contact the remaining authors and one author was able to provide additional data. The data from the three studies suggest that prognosis in ES depends on both margin involvement and the postchemotherapy histological response simultaneously. However, radiation therapy likely improves local control in patients with inadequate surgical margins, regardless of histological response. This is an area where there is a paucity of evidence that needs to be rectified to ensure that ES patients are provided the highest quality of evidence-based care., (© 2019 John Wiley & Sons Australia, Ltd.)

Background and objectives : Guided bone regeneration (GBR) is commonly used for osseous defect reconstruction. The objective of this study was to evaluate in real-time ( in-vivo ) the efficacy of equine bone graft for GBR in segmental critical-size defects (CSD) of the femur in a rat model. Materials and methods : Following ethical approval, 30 male Wistar-Albino rats (age 12-14 months/weight 450-500 grams) were included. Under general-anesthesia, a mid-diaphyseal segmental CSD (5 mm) was created in the femur and stabilized using titanium Miniplate(4 holes,1.0 mm thickness). Depending upon material used for GBR, animals were randomly divided into three groups(n = 10/per group). Negative control-Defect covered with resorbable collagen membrane(RCM); Positive control-Defect filled with autologous bone and covered by RCM; Equine bone-Defect filled with equine bone and covered by RCM. Real-time in-vivo Micro-CT was performed at baseline, 2, 4, 6 and 8 weeks to determine volume and mineral density of newly formed bone (NFB) and remaining bone graft particles (BGP). Results: In-vivo micro-CT revealed increase in volume and mineral density of NFB within defects from baseline to 8-weeks in all groups. At 8-weeks NFB-volume in the equine bone group(53.24 ± 13.83 mm 3 ; p < 0.01) was significantly higher than the negative control(5.6 ± 1.06 mm 3 ) and positive control(26.07 ± 5.44 mm 3 ) groups. Similarly, NFB-mineral density in the equine bone group(3.33 ± 0.48 g/mm 3 ; p < 0.01) was higher than the other (negative control-0.27 ± 0.02 g/mm 3 ; positive control-2.55 ± 0.6 g/mm 3 ). A gradual decrease in the BGP-volume and BGP-mineral density was observed. Conclusion : The use of equine bone for GBR in femoral segmental defects in rats, results in predictable new bone formation as early as 2-weeks after bone graft placement.

Background: Antimicrobial resistance (AMR) is an emerging threat to public health worldwide. A significant evidence has suggested that the knowledge and attitude trends among the community, pharmacists and physicians can play a critical role in managing the ever increasing threat of AMR., Methods: A cross-sectional survey was performed using three specific self-administered questionnaires for community members, pharmacists/pharmacy owners and physicians on a randomly selected sample population of 473, 424 and 308 respectively. Bivariate and multivariate logistic regression and Pearson chi-square tests were performed during data analysis., Result: A response rate of 81.2% ( n  = 385), 37.7% ( n  = 160) and 53.9% ( n  = 166) was achieved for general community, pharmacists/pharmacy owners and physicians respectively. More than half of the community participants (55.6%; n  = 214) possess poor knowledge of AMR. Furthermore, knowledge and attitude of the community participants were also found to be significantly correlated (r 2  = 0.02) with each other. In 90.6% ( n  = 145) of the pharmacies included in the survey, a qualified pharmacist was not present at the time of the operations. Only 36.9% physicians ( n  = 60) knew about the environmental route of dissemination of AMR. Majority of the physicians agreed that AMR is a global problem and also recognize the need for initiating AMR stewardship programs., Conclusion: Our study will provide effective assessment and potential insights in designing tri-faceted interventions for rationalizing antibiotics consumption thus controlling the development and dissemination of AMR., Competing Interests: A consent was taken from the participants of the study before giving them questionnaire.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Aim and Objectives: Oral surgical procedures can cause spread of infections in the clinics through visually imperceptible, splattered, and aerosolized blood. The aim of this study was to evaluate visually imperceptible blood contamination of clinical surfaces and personal protective equipment (PPE) in an oral surgery clinic using luminol., Materials and Methods: Following ethical approval, oral surgical procedures were performed under local anesthesia in a disinfected clinic, and PPE was used by the oral surgeon, dental assistant, and patients. After the procedure, clinical surfaces and PPE were evaluated for traces of visually imperceptible blood contamination using luminol. Data regarding blood contamination and the duration of the procedure were collected. Nonparametric tests, with 95% significance level (Epi Info, Stat Calc 7, CDC, Atlanta, USA), were used to identify statistical interactions between the duration of the procedure and the frequency of blood contamination., Results: Blood contamination was detected in flooring below surgical field (86.67%), instrument tray, operating light, dental chair, and suction unit (100%). Except head caps and shoe covers, blood contamination was detected in all the PPE used by the clinical personnel, and the eyewear and chest drapes used by patients. An increase in the surgical time beyond 40 min significantly increased the risk of blood contamination in the handcuffs of the clinical personnel ( P < 0.01)., Discussion and Conclusion: Visually imperceptible blood contamination of the clinical surfaces and PPE is associated with minor oral surgical procedures. This mandates the cleaning and disinfection of all clinical surfaces before and after minor oral surgical procedures and PPE for clinicians and patients during every procedure., Competing Interests: There are no conflicts of interest.

Aim: To investigate the effect of bleaching agents having a neutral pH on the surface of mineral trioxide aggregate (MTA) used as a coronal seal material for nonvital bleaching, beneath the bleaching agent, with the help of energy dispersive X-ray microanalysis and scanning electron microscopy (SEM)., Materials and Methods: Six samples of plastic tubes filled with white MTA (Angelus white) were kept in 100% humidity for 21 days. Each sample was divided into 2 and made into 12 samples. These were then divided into three groups. Group A was exposed to Opalescence Boost 40% hydrogen peroxide (HP) (Ultradent). Group B to Opalescence 10% carbamide peroxide (Ultradent) and Group C (control group) not exposed to any bleaching agent. After recommended period of exposure to bleaching agents according to manufacturers' instructions, the samples were observed under SEM with an energy dispersive X-ray microanalysis system (JSM-6380 LA)., Results: There were no relevant changes in color and no statistically significant surface structure changes of the MTA in both the experimental groups., Conclusion: The present findings suggest that even high concentration HP containing bleaching agents with neutral pH can be used on the surface of MTA without causing structural changes. The superior sealing ability of MTA and the high alkalinity would prevent cervical resorption postbleaching.

Guided bone regeneration (GBR) procedures using graft materials have been used for reconstruction of osseous defects. The aim of the present in vivo micro-computed tomographic (µCT) and histologic study was to assess in real time the bone regeneration at GBR sites in standardized experimental calvarial defects (diameter 3.3 mm) using β-tricalcium phosphate (β-TCP) with and without collagen membrane (CM). A single full-thickness calvarial defect was created on the left parietal bone in young female Wistar albino rats (n = 30) weighing approximately 300 g and aged about 6 weeks. The animals were randomly divided into three groups for treatment, based on calvarial defect filling material: (1) control group (n = 10); (2) β-TCP + CM group (n = 10); (3) β-TCP group (n = 10). Real-time in vivo µCT analyses were performed immediately after surgery and at 2, 4, 6 and 10 weeks to determine the volume and mineral density of the newly formed bone (BVNFB, MDNFB) and remaining β-TCP particles (VRBP, MDRBP). The animals were killed at 10 weeks and calvarial specimens were evaluated histologically. In the control group, MDNFB increased significantly at 6 weeks (0.32 ± 0.002 g/mm(3), P < 0.01) compared to that at baseline. In β-TCP + CM group, BVNFB (1.10 ± 0.12 mm(3), P < 0.01) and MDNFB (0.13 ± 0.02 g/mm(3), P < 0.01) significantly increased at the 4th week than baseline. In the β-TCP group, BVNFB (1.13 ± 0.12 mm(3), P < 0.01) and MDNFB (0.14 ± 0.01 g/mm(3), P < 0.01) significantly increased at 6 weeks compared to that at baseline. Significant reduction in VRBP was neither seen in the β-TCP + CM group nor in the β-TCP group. While in the β-TCP + CM group MDRBP was reduced significantly at 6 weeks (0.44 ± 0.9 g/mm(3), P < 0.01) from baseline (0.98 ± 0.03 g/mm(3)), similar significant reduction in MDRBP from baseline (0.92 ± 0.07 g/mm(3)) was seen only at 10 weeks (0.45 ± 0.06 g/mm(3), P < 0.05) in the β-TCP group. Histologic findings at 10 weeks revealed greater amount of NFB with osteocytes in the matrix, in the β-TCP + CM group than in the β-TCP group. Biomechanical assessment of NFB for hardness (H) and elastic modulus (E) revealed significantly higher values for the β-TCP + CM group (H = 612.6 ± 4.28 Mpa; E = 13.57 ± 0.07 Gpa) when compared to those of the control (H = 192.1 ± 4.93 Mpa; E = 6.76 ± 0.04 Gpa) and the β-TCP groups (H = 241.9 ± 6.29 Mpa; E = 4.34 ± 0.06 Gpa). In conclusion, based on real-time assessment, NFB is formed in calvarial defects as early as 4 weeks following GBR with β-TCP + CM as compared to 6 weeks when β-TCP alone was used.

The aim of the present real time in vivo micro-computed tomography (µCT) and histologic experiment was to assess the efficacy of guided bone regeneration (GBR) around standardized calvarial critical size defects (CSD) using bone marrow-derived mesenchymal stem cells (BMSCs), and collagen membrane (CM) with and without tricalcium phosphate (TCP) graft material. In the calvaria of nine female Sprague-Dawley rats, full-thickness CSD (diameter 4.6 mm) were created under general anesthesia. Treatment-wise, rats were divided into three groups. In group 1, CSD was covered with a resorbable CM; in group 2, BMSCs were filled in CSD and covered with CM; and in group 3, TCP soaked in BMSCs was placed in CSD and covered with CM. All defects were closed using resorbable sutures. Bone volume and bone mineral density of newly formed bone (NFB) and remaining TCP particles and rate of new bone formation was determined at baseline, 2, 4, 6, and 10 weeks using in vivo µCT. At the 10th week, the rats were killed and calvarial segments were assessed histologically. The results showed that the hardness of NFB was similar to that of the native bone in groups 1 and 2 as compared to the NFB in group 3. Likewise, values for the modulus of elasticity were also significantly higher in group 3 compared to groups 1 and 2. This suggests that TCP when used in combination with BMSCs and without CM was unable to form bone of significant strength that could possibly provide mechanical "lock" between the natural bone and NFB. The use of BMSCs as adjuncts to conventional GBR initiated new bone formation as early as 2 weeks of treatment compared to when GBR is attempted without adjunct BMSC therapy.

The aim of this in vivo microcomputed tomographic (μCT) study was to compare the efficacy of Mucograft (MG) vs resorbable collagen membranes (RCMs) in facilitating guided bone regeneration (GBR) around standardized calvarial defects in rats. Forty female Wistar albino rats with a mean age and weight of 6 to 9 weeks and 250 to 300 g, respectively, were used. With the rats under general anesthesia, the skin over the calvaria was exposed using a full-thickness flap. A standardized calvarial defect with a 4.6-mm diameter was created in the left parietal bone. For treatment, the rats were randomly divided into four groups (n = 10 per group): (1) defects covered with MG (MG group); (2) defects covered with an RCM (RCM group); (3) defects filled with xenograft bone particles and covered by MG (MG + bone group); and (4) defects filled with xenograft bone particles and covered by an RCM (RCM + bone group). Primary closure was achieved using interrupted resorbable sutures. The animals underwent high-resolution, three-dimensional μCT scans at baseline and at 2, 4, 6, and 8 weeks after the surgical procedures. Data regarding volume and bone mineral density (BMD) of newly formed bone (NFB) and bone particles revealed an increase in the volume of NFB in all the groups from baseline to 8 weeks. The MG group had the lowest volume of NFB (mean ± standard deviation [SD], 1.32 ± 0.22 mm(3)). No significant differences in mean ± SD values for volume of NFB were observed between the RCM (3.50 ± 0.24 mm(3)) and MG + bone (3.87 ± 0.36 mm(3)) groups, but their values were significantly lower than that of the RCM + bone group (2.95 ± 0.15 mm(3), F = 131.91, dfN = 2, dfD = 27, P < .001). Significant differences in BMD of NFB between the groups (F = 332.46, dfN = 3, dfD = 36, P < .001) and during different data collection periods (F = 97.04, dfN = 3, dfD = 36, P < .01) were observed, with the RCM group having the highest mean ± SD BMD of NFB (0.42 ± 0.05 g/mm(3)). Significant differences in the bone particle volume between the RCM + bone and MG + bone groups (F = 91.04, dfN = 1, dfD = 18, P < .05) and at different data collection periods (F = 314.12, P < .01) were observed, with the RCM + bone group displaying greater reduction in both volume (36.8%) and BMD (19.7%) of bone particles. The present in vivo μCT study demonstrated that RCM is better than MG in enhancing new bone formation in rat calvarial standardized defects when used in combination with mineralized particulate graft material.

The aim of this in vivo microcomputed tomographic (μCT) experiment was to assess in real time the efficacy of a combination of recombinant human bone morphogenetic protein-2 (rhBMP-2) and biphasic calcium phosphate (BCP), with and without resorbable collagen membrane (CM), in regeneration of standardized calvarial defects (SCDs) in rats. A total of 30 female Wistar albino rats (n = 10/group) with a mean age and weight of 7.5 months and 275 g, respectively, were used. With the rats under general anesthesia, the calvaria were exposed using full-thickness periosteal flaps and unilateral SCDs of 4.6 mm diameter were created on the left parietal bone. Defects were left untreated (control group) or randomly filled with either BCP soaked in rhBMP-2 and then covered with CM (BMP + BCP + CM group) or BCP soaked in rhBMP-2 alone (BMP + BCP group). In vivo μCT scans were done at baseline and 2, 4, 6, and 8 weeks. Newly formed bone (NFB) and remaining BCP particles were assessed for their volumes (NFBV, BCPV, respectively) and mineral densities (NFBMD, BCPMD, respectively). In vivo μCT results showed scanty amounts of new bone at the peripheries of the defect in the control group. In the other two groups, near complete defect closure was evident at 8 weeks. The mean NFBV after 8 weeks was 4.63 ± 0.96 mm(3), 11.82 ± 1.17 mm(3), and 13.85 ± 1.89 mm(3) for the control, BMP + BCP + CM, and BMP + BCP groups, respectively. After 8 weeks, the mean NFBMD was 0.38 ± 0.03 g/mm(3), 0.24 ± 0.07 g/mm(3), and 0.35 ± 0.03 g/mm(3) for the control, BMP + BCP + CM, and BMP + BCP groups, respectively. After 8 weeks, the mean BCPV and BCPMD values for the BMP + BCP + CM and BMP + BCP groups were 2.73 ± 0.65 mm(3), 0.33 ± 0.08 g/mm(3), 2.49 ± 0.71 mm(3), and 0.28 ± 0.03 g/mm(3), respectively. The present real-time in vivo μCT experiment demonstrated that BMP + BCP, either with or without CM, was effective in promoting bone regeneration within rat SCDs and enabled new bone formation starting as early as 2 weeks.

Guided bone regeneration (GBR) using a porcine-derived collagen matrix (Mucograft [MG], Geistlich) has not yet been reported. The aim of this histologic and biomechanical study was to compare the efficacy of MG versus resorbable collagen membranes (RCMs) in facilitating GBR around standardized rat calvarial defects. Forty female Wistar albino rats with a mean age and weight of 6 to 9 weeks and 250 to 300 g, respectively, were used. With the rats under general anesthesia, the skin over the calvaria was exposed using a full-thickness flap. A 4.6-mm-diameter standardized calvarial defect was created in the left parietal bone. For treatment, the rats were randomly divided into four groups (n = 10 per group): (1) MG group: the defect was covered with MG; (2) RCM group: the defect was covered with an RCM; (3) MG + bone group: the defect was filled with bone graft particles and covered by MG; and (4) RCM + bone group: the defect was filled with bone graft particles and covered by an RCM. Primary closure was achieved using interrupted resorbable sutures. The animals were sacrificed at 8 weeks after the surgical procedures. Qualitative histologic analysis and biomechanical assessment to identify hardness and elastic modulus of newly formed bone (NFB) were performed. Collected data were statistically analyzed using one-way analysis of variance. Histologic findings revealed NFB with fibrous connective tissue in all groups. The quantity of NFB was highest in the RCM + bone group. Statistically significant differences in the hardness (F = 567.69, dfN = 3, dfD = 36, P < .001) and elastic modulus (F = 294.19, dfN = 3, dfD = 36, P < .001) of NFB were found between the groups. Although the RCM + bone group had the highest mean ± standard deviation (SD) hardness of NFB (531.4 ± 24.9 MPa), the RCM group had the highest mean ± SD elastic modulus of NFB (18.63 ± 1.89 GPa). The present study demonstrated that RCMs are better than MG at enhancing new bone formation in standardized rat calvarial defects when used along with mineralized particulate graft material.

The aim of the present in vivo microcomputed tomography (μCT) and histologic experiment was to assess the efficacy of guided bone regeneration (GBR) around standardized calvarial defects using recombinant human platelet-derived growth factor (rhPDGF) with and without resorbable collagen membrane (RCM). A total of 50 female Wistar albino rats with a mean age of 7.5 months and mean weight of 275 g were used. The calvarium was exposed following midsagittal scalp incision and flap reflection. A full-thickness standardized calvarial defect (4.6 mm diameter) was created. Study animals were randomly divided into five groups based on biomaterials used for GBR within the defect: (1) no treatment (negative control), (2) bone graft alone (BG), (3) bone graft covered by RCM (BG + RCM), (4) bone graft soaked in rhPDGF (BG + rhPDGF), and (5) bone graft soaked in rhPDGF and covered with RCM (BG + rhPDGF + RCM). In vivo μCT for determination of newly formed bone volume (NFBV) and mineral density (NFBMD) and remnant bone particles volume (RBPV) and mineral density (RBPMD) was done at baseline and at 2, 4, 6, and 8 weeks postoperatively. Eight weeks following surgery, the animals were sacrificed and harvested calvarial specimens were subjected to histologic and biomechanical analysis. There was an increase in NFBV and NFBMD associated with a corresponding decrease in RBPV and RBPMD in all the study groups. Two-way analysis of variance revealed significant differences in the measured values within and between the groups across the timelines examined during the study period (P < .05). While the NFBV was significantly higher in the bone graft, BG + RCM, and BG + rhPDGF + RCM groups, the NFBMD was similar in all the groups except negative control. The greatest decreases in RBPV and RBPMD were observed in the BG + rhPDGF + RCM group in comparison to the other groups. Similarly, BG + rhPDGF + RCM groups had hardness and elastic modulus similar to that of natural bone. The in vivo μCT results were validated by the qualitative histologic findings. In real time, new bone formation starts as early as 2 weeks in rat calvarial defects treated with bone graft and rhPDGF, irrespective of the presence or absence of RCM.

The aim of the present in vivo microcomputed tomographic (μCT), histologic, and biomechanical study was to assess the efficacy of bone marrow-derived mesenchymal stem cells (BMSCs) for promoting guided bone regeneration (GBR) in a standardized rat calvarial defect model. Forty female Wistar albino rats with a mean age of 7.5 months and mean weight of 275 g were used. Following calvarial exposure under general anesthesia, a full-thickness standardized calvarial defect (4.6 mm in diameter) was created. The study animals were randomly divided into four groups based on biomaterials used for GBR: (1) no treatment (negative control); (2) bone graft alone; (3) bone graft placed in the defect and covered with a collagen membrane (CM); and (4) bone graft soaked in BMSCs and covered with a CM. Bone volume and bone mineral density (BMD) of newly formed bone (NFB) and remnant bone particles were determined at baseline and at 2, 4, 6, 8, and 24 weeks postoperative using real time in vivo μCT. Histologic and biomechanical analyses of calvarial specimens were performed at 24 weeks, when the rats were euthanized. Statistically significant differences in volume and BMD of NFB were observed between and within the groups at different data collection periods. Significant increases in volume and BMD of NFB occurred as early as week 2 in all groups except the negative control. While the greatest volume of NFB was observed in the bone graft + BMSC + CM group, BMD of NFB was significantly higher in the bone graft + CM group. Statistically significant decreases in volume and BMD of remnant bone particles were also observed between the groups. Histologic analysis revealed NFB in all groups. The hardness and elastic modulus of NFB in the bone graft + BMSC + CM group were significantly higher than that in the other groups and also similar to adjacent natural bone. This study shows that using adjunct BMSCs with bone graft and CM for guided bone regeneration in standardized rat calvarial defects resulted in the highest quality and quantity of NFB.

In vivo microcomputed tomography (μCT) enables real-time assessment of bone regeneration. The aim of this μCT and histologic experiment was to assess guided bone regeneration (GBR) around standardized calvarial defects in rats using particulate graft material (Bio-Oss) with and without collagen membranes (CMs). Eighteen female Sprague-Dawley rats aged 6 weeks and weighing 300 g were used. With the rats under general anesthesia, calvaria were exposed and a full-thickness standardized defect was created on the parietal bone. For treatment, rats were randomly assigned to the following three groups: (1) CM group; (2) Bio-Oss group; and (3) Bio-Oss + CM group. Bone volume and bone mineral density (BMD) of newly formed bone (NFB) and remnant bone particles were measured at baseline and 2, 4, 6, and 10 weeks after the operations using real-time in vivo μCT. At 10 weeks, all animals were sacrificed and calvarial tissues were assessed histologically. In the CM group, a significant increase in mean ± standard deviation (SD) BMD of NFB was observed at 6 weeks (0.32 ± 0.02 g/mm(3)) (P < .01) compared with baseline. In the Bio-Oss group, mean ± SD volume (3.03 ± 0.14 mm(3)) (P < .05) and BMD (0.14 ± 0.01 g/mm(3)) of NFB significantly increased at 6 weeks compared with baseline (P < .01). In the Bio-Oss + CM group, mean ± SD volume (0.98 ± 0.19 mm(3)) and BMD (0.13 ± 0.01 g/mm(3)) of NFB significantly increased at 4 weeks compared with baseline (P < .01). In th Bio-Oss + CM group, mean ± SD volume (3.5 ± 0.7 mm(3)) and BMD (0.44 ± 0.03 g/mm(3)) of remnant bone particles were significantly reduced at 10 weeks compared with baseline values (5.8 ± 0.96 mm(3) and 1.3 ± 0.02 g/mm(3)) (P < .05). Although histologic analysis revealed NFB in all the study groups, the Bio-Oss + CM group exhibited the most. The results of this study revealed that, in real time, new bone formation starts as early as 4 weeks in standardized calvarial defects undergoing GBR with Bio-Oss + CM, compared with new bone formation at 6 weeks in defects undergoing GBR with Bio-Oss alone.

The objective of the present real-time in vivo experiment was to assess guided bone regeneration (GBR) in standardized calvarial defects using particulate graft material (Bio-Oss) and β-tricalcium phosphate (β-TCP) with adjunct recombinant human platelet-derived growth factor (rhPDGF) therapy. Eighteen female Sprague-Dawley rats with a mean age and weight of 8 ± 0.53 weeks and 250 ± 0.49 g, respectively, were used. Following surgical exposure, a full-thickness standardized calvarial defect was created on the parietal bone using a trephine drill with an outer diameter of 4.6 mm. For treatment, rats were randomly divided into three groups (six rats per group): (1) control; (2) rhPDGF + Bio-Oss, and (3) rhPDGF + β-TCP. Volume of newly formed bone (NFB), bone mineral density (BMD) of NFB, volume of remnant bone particles, and BMD of remnant bone particles were assessed using in vivo microcomputed tomography. Measurements were made at baseline and at 2, 4, 6, and 10 weeks after the surgical procedures. At 10 weeks, all animals were sacrificed and calvarial tissues were assessed histologically. In the control group, a significant increase in BMD of NFB was observed at 6 weeks (mean ± standard deviation [SD], 0.32 ± 0.002 g/mm(3)) (P < .01) from baseline, and the defect did not regenerate completely. In the rhPDGF + Bio-Oss group, mean ± SD volume (2.40 ± 0.25 mm(3)) (P < .01) and BMD (0.13 ± 0.01 g/mm(3)) of NFB significantly increased at 4 weeks and 6 weeks, respectively, from baseline (P < .001). In the rhPDGF + β-TCP group, mean ± SD volume (2.01 ± 0.7 mm(3)) and BMD (0.12 ± 0.02 g/mm(3)) of NFB significantly increased at 4 weeks from baseline (P < .01). In the rhPDGF + Bio-Oss and rhPDGF + β-TCP groups, mean ± SD BMD of remnant bone particles (0.31 ± 0.11 g/mm(3) and 0.23 ± 0.01 g/mm(3)) showed significant reduction at 6 and 10 weeks, respectively, compared with baseline values (1.12 ± 0.06 g/mm(3) and 0.92 ± 0.01 g/mm(3), respectively) (P < .001). Histologic results at 10 weeks showed NBF in the rhPDGF + Bio-Oss and rhPDGF + β-TCP groups. In real time assessment, when rhPDGF was added to β-TCP, BMD and bone hardness significantly increased compared with the other two groups.

Objectives: This retrospective clinical study sought to evaluate the survival of immediate implants placed at maxillary and mandibular single-rooted tooth extraction sites and to determine the relationship among implant size, placement site, and implant survival., Methods: Between January 2010 and June 2011, 85 patients (33 males, 52 females; mean age: 45 years) underwent immediate implant placement after extraction of single-rooted teeth. All implants were restored between 12 and 14 weeks after implant placement. The implant survival and its relationship with implant size and implantation site were evaluated by odds ratios (ORs)., Results: Implants were placed at the following sites: upper central incisor (UCI, n = 35), upper lateral incisor (ULI, n = 27), upper second premolar (U2ndP, n = 36), lower incisor (LI, n = 53), and lower premolar (LP, n = 22). Implants of the following sizes were used: 5 × 10 mm (n = 24), 5 × 8 mm (n = 21), 4.3 × 10 mm (n = 77), 4.3 × 8 mm (n = 36), 3.5 × 10 mm (n = 12), and 3.5 × 8 mm (n = 3). After a mean follow-up time of 47 months, the overall implant survival rate was 96%. Survival rate was highest at the LI site (98.1%) and lowest at the ULI site (92.6%). All of the 5-mm implants survived (100%), as did most of the 4.3 × 10 mm implants (96.1%). Implants of 4.3 × 8 mm and 3.5 × 10 mm were the least successful (91.7%). Mandibular implants had a better survival rate (97.3%) than maxillary implants (94.9%). There was no significant OR of increased survival for any particular implant size or site., Conclusions: Immediate implant placement in fresh extraction sockets can give predictable clinical outcomes, regardless of the implant size and site of placement.

Background: The biological effects of hemostatic agends on the physiological healing process need to be tested. The aim of this study was to assess the effects of oxidized cellulose (surgicel) and bone wax on bone healing in goats' feet., Materials and Methods: Three congruent circular bone defects were created on the lateral aspects of the right and left metacarpal bones of ten goats. One defect was left unfilled and acted as a control; the remaining two defects were filled with bone wax and surgicel respectively. The 10 animals were divided into two groups of 5 animals each, to be sacrificed at the 3(rd) and 5(th) week postoperatively. Histological analysis assessing quality of bone formed and micro-computed tomography (MCT) measuring the quantities of bone volume (BV) and bone density (BD) were performed. The results of MCT analysis pertaining to BV and BD were statistically analyzed using two-way analysis of variance (ANOVA) and posthoc least significant difference tests., Results: Histological analysis at 3 weeks showed granulation tissue with new bone formation in the control defects, active bone formation only at the borders for surgicel filled defects and fibrous encapsulation with foreign body reaction in the bone wax filled defects. At 5 weeks, the control and surgicel filled defects showed greater bone formation; however the control defects had the greatest amount of new bone. Bone wax filled defects showed very little bone formation. The two-way ANOVA for MCT results showed significant differences for BV and BD between the different hemostatic agents during the two examination periods., Conclusion: Surgicel has superiority over bone wax in terms of osseous healing. Bone wax significantly hinders osteogenesis and induces inflammation.

Background: The aim was to assess the alveolar ridge alteration around extraction sites with and without immediate implants according to extraction socket classification (ESC) using microcomputed tomography (micro-CT)., Material and Methods: Ten beagle dogs (mean age and weight: 24 ± 0.83 months and 13.8 ± 0.49 kg, respectively) were randomly divided into three groups according to the ESC. In Group 1 (ESC-I), bilateral first and third premolars were extracted and replaced with immediate implants. In Group 2 (ESC-II), two adjacent premolars were extracted with one immediate implant placement in the mesial socket in the maxilla and in the distal socket in the mandible. In Group 3 (ESC-III), three adjacent teeth were extracted and an immediate implant was placed in the central socket. Primary closure was achieved using resorbable sutures. Buccal sites with dehiscence defects were excluded. After 4 months, subjects were sacrificed and alveolar ridge widths were measured at 1 mm interval in axial and sagittal views, using micro-CT in sites with and without immediate implants., Results: In sites without immediate implant placement, alveolar ridge width was significantly higher in Group 1(6.1 ± 1.35mm) than Group 3 (4.14 ± 1.53 mm) (p <.05). In sites with immediate implant placement, the alveolar ridge width was higher among sites in Group 1 (6.4 ± 3.8 mm) than Group 2 (4.8 ± 0.46 mm) (p < .05) and Group 3 (5.02 ± 0.84 mm) (p <.05). Overall, between each corresponding group in both sites with and without immediate implant placement at 1 mm thickness, there was no significant difference in the alveolar ridge widths., Conclusion: With the exception of Group 1 (ESC-I), immediate implant placement did not prevent or minimize bone remodeling in extraction sites according to ESC., (© 2012 Wiley Periodicals, Inc.)

Purpose: To compare the regenerative capacity of goat mandibles following sagittal split osteotomy and distraction osteogenesis with a vertical body osteotomy., Animals and Methods: Bilateral vertical and sagittal body osteotomy was performed on the left and right sides of the mandibles in 18 goats. The distraction period lasted for 10 days at 1 mm/day. Animals were sacrificed at 0, 10, and 35 days post-distraction. Bone mineral density (BMD) and bone volume (BV) were analysed by microcomputed tomography (MCT). Types of bone and cells present in the regenerated defect sites were analysed histologically., Results: At 0, 10, and 35 days, BMD was 0.358 ± 0.012, 0.410 ± 0.012, and 1.070 ± 0.019, respectively, for vertical osteotomy and 0.420 ± 0.013, 0.421 ± 0.009 and 1.182 ± 0.030, respectively, for sagittal osteotomy. BV was 973.310 ± 5.048, 1234.589 ± 4.159, and 2121.867 ± 6.519, respectively, for vertical osteotomy and 995.967 ± 2.781, 1755.938 ± 4.379, and 2618.441 ± 21.429, respectively, for sagittal osteotomy at these three time points. BMD and BV differed significantly at all three times. Histological analysis shows that sagittal splitting was characterized by more robust lamellar bone formation bridging the distraction gap than vertical body osteotomy., Conclusion: Both MCT and histological analyses showed that distraction using the sagittal osteotomy technique resulted in significantly higher BV and BMD than using vertical body osteotomy., (Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Oral Candida colonisation is higher in tobacco smokers as compared to non-smokers; however, it remains unknown whether smokeless tobacco chewers are susceptible to increased oral Candida colonisation. The aim was to determine the oral Candida carriage and species prevalence amongst habitual gutka-chewers and non-chewers in a cohort from Karachi, Pakistan. Forty-five gutka-chewers and 45 non-chewers were included. Information regarding age, sex, duration of gutka-chewing habit, daily frequency of gutka consumption, duration of holding gutka in the mouth, daily frequency of tooth-brushing and tongue brushing was collected using a questionnaire. Oral yeast samples were collected by scraping the dorsum of the tongue and bilateral buccal mucosa with a sterile cotton swab. Identification of yeast species was performed using standard techniques. Tongue lesions were identified and recorded. Unstimulated whole salivary flow rate (UWSFR) was also measured. There was no significant difference in the mean age, UWSFR and oral Candida carriage among gutka-chewers and non-chewers. Individuals were chewing gutka since 4·4 years and were consuming five gutka sachets daily. Candida albicans (C. albicans) was the most common yeast species isolated from 57·8% gutka-chewers and 64.4% non-chewers. In 24.4% gutka-chewers and 22·2% non-chewers, two candidal strains (C. albicans and Candida tropicalis) were isolated. In conclusion, the present results indicated no significant difference in oral Candida carriage in habitual gutka-chewers and non-chewers., (© 2012 The Authors. International Wound Journal © 2012 Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Objective: To assess if overbuilding the buccal plate or using a dual-layer socket grafting technique prevents alveolar bone resorption and enhances final ridge width, height, and volume after tooth loss in an animal model., Material and Methods: In eight beagle dogs bilateral second (P2)-, third (P3)-, and fourth (P4) premolars were endodontically treated. All bilateral mandibular first premolars and distal roots of P2, P3, and P4 were hemisectioned and atraumatically extracted. Animals were randomly divided into four groups: (i) Control-Socket alone, (ii) Particulate allograft in the alveolum, socket covered with high-density polytetrafluoroethylene (dPTFE) membrane and sutured over the alveolum, (iii) Particulate allograft in the alveolum and overbuilding the buccal plate, socket covered with dPTFE membrane and sutured over the alveolum, (iv) Particulate allograft in the alveolum and covered with dual layer (dPTFE placed over collagen membrane), and sutured over the alveolum. After 16 weeks, the animals were sacrificed. Mandibular blocks of the jaws were assessed for bone volume (BV), vertical bone height (VBH), alveolar ridge thickness, and bone mineral density (BMD) using micro-computed tomography., Results: The BV in groups 1, 2, 3, and 4 was 169.5, 207.57, 242.4, and 306.1 mm(3) , respectively. The VBH in groups 1, 2, 3, and 4 was 4.2, 6.4, 6.2, and 7.3 mm, respectively. Ridge widths in groups 1, 2, 3, and 4 were 5.45 ± 0.75, 5.91 ± 0.86, 6.05 ± 0.63, and 6.28 ± 1.01 mm, respectively. There was no significant difference in BMD between the groups., Conclusions: The RP using a dual layer of membrane following tooth extraction results in more BV, VBH, and alveolar ridge width as compared to when a single layer of membrane is used., (© 2012 John Wiley & Sons A/S.)

Purpose: Oral cancer therapy with surgery and radiation is associated with comorbidities; this affects rehabilitation with osseointegrated dental implants. The aim of this systematic review was to evaluate the effect of radiation therapy on osseointegrated dental implant survival in oral cancer patients., Materials and Methods: A review of the literature published between 1990 and June 2012 was conducted. Pertinent studies evaluating the effect of radiation therapy on osseointegration of implants were identified through searches of PubMed, SCIRUS, and Google Scholar. Overall implant survival rates were compared with respect to timing of radiation (prior to or after implantation), site of implant placement (maxilla, mandible, vascularized free flaps, nonvascular bone grafts), radiation dose, time interval between radiation therapy and implant placement, and the effect of hyperbaric oxygen therapy., Results: Thirty-eight articles were eligible for inclusion in the review. Overall implant survival rates with radiation therapy done pre- and postimplantation were 88.9% and 92.2%, respectively. In preimplantation radiation therapy, the implant survival rate was significantly higher for the mandible (93.3%) than for the maxilla (78.9%) or for grafted bone (87.5%). Similarly, the implant survival rate was higher when implants were placed in free flaps (89.3%) than in nonvascularized bone grafts (81.7%). While a radiation dose above 55 Gy significantly decreased implant survival, no significant relationship between increased implant survival and the remaining variables were found., Conclusion: There, was no significant difference in dental implant survival rates between preimplantation and postimplantation radiation therapy. The anatomical site of implant placement in preimplantation radiation therapy was the most pertinent variable affecting implant survival, with a better survival rate in the mandible compared to the maxilla and grafted bone.

Background: It is known that gutka chewing jeopardizes periodontal health; however, severity of periodontal inflammation in gutka chewers with and without prediabetes remains unknown. The aim of this study is to investigate the association of periodontal inflammatory conditions with gutka chewing and prediabetes., Methods: In this cross-sectional study, the effect of gutka use on periodontal health is investigated among 44 individuals with prediabetes and 44 without prediabetes. Demographic information regarding age, sex, duration of prediabetes, and gutka-chewing habits was collected using a questionnaire. Periodontal inflammatory conditions (plaque index [PI], bleeding on probing [BOP], probing depth [PD], marginal bone loss [MBL]) and fasting blood glucose levels (FBGLs) were recorded. Group differences in periodontal inflammatory parameters were tested using univariate and multivariable analyses (α ≤5%)., Results: Periodontal inflammatory parameters (PI, BOP, and PD) were significantly higher in individuals with prediabetes irrespective of gutka-chewing habit (P <0.05). Odds of periodontal inflammation in individuals with prediabetes were nine times higher than in healthy controls (95% confidence interval [CI] = 3.4 to 23.6). Gutka chewing alone, chewing among individuals with prediabetes, and chewing among healthy controls did not significantly increase the odds of periodontal inflammatory conditions. Individuals with prediabetes were significantly more likely to have periodontal inflammation than individuals without prediabetes even after controlling for sex and gutka chewing (odds ratio = 13.2; 95% CI = 4.3 to 40.7)., Conclusion: In medically healthy individuals, periodontal inflammatory conditions are worse in gutka chewers compared to non-chewers; in patients with prediabetes, the severity of periodontal inflammation is governed by hyperglycemia when compared to habitual gutka usage.

Background: To assess the survival rate of implants placed in the posterior maxilla by intentionally perforating the Schneiderian membrane and protruding the implant up to 3mm beyond the sinus floor in cases of reduced crestal bone height (CBH)., Materials & Methods: 56 patients with reduced CBH received 63 implants in the posterior maxilla. All implants intentionally penetrated the Schneiderian membrane and engaged the sinus floor cortical bone. All patients were followed up and implant survival was assessed at the end of one year post implant restoration., Results: Out of 63 implants, there was only one failure (98.4% Survival rate) after a follow up period of one year. 7 patients experienced mild epistaxis during the immediate post-operative period with no associated implant loss. One patient developed sinusitis secondary to the surgical procedure, which was treated by antibiotic therapy and the patient improved clinically with no associated implant loss., Conclusion: An intentional perforation of the Schneiderian membrane using a 2mm twist drill at the time of implant placement and protrusion of the implant up to 3mm beyond the sinus floor does not alter the stability and outcome of dental implants, one year post-restoration. This could be associated with minor complications ranging from epistaxis to sinusitis, which are manageable. How to cite this article: Nooh N. Effect of Schneiderian Membrane Perforation on Posterior Maxillary Implant Survival. J Int Oral Health 2013; 5(3):28-34.

Background: The aim of this study was to review the orofacial manifestations in patients with sickle cell disease (SCD)., Methods: Indexed databases were explored using various combinations of the following keywords: "sickle cell anemia," "sickle cell disease," "oral health status" and "dental inflammation.", Results: Hypoxia has been associated with osteomyelitis of the jaws, particularly the mandible in patients with SCD. Bone marrow hyperplasia in these patients causes depression of nasal bridge, midfacial overgrowth and malocclusion. Mental nerve neuropathy due to osteomyelitis of the mandible causes numbness in the lower lip and chin. A diminished blood supply to teeth causes necrosis of the dental pulp in patients with SCD. Dental caries is a common manifestation in patients with SCD, particularly in those with underprivileged living standards. The association between SCD and periodontal inflammatory conditions remains unclear., Conclusions: Oral health problems in patients with SCD are rare and occur mainly as a result of the poor oral hygiene maintenance.

Bartter's syndrome is an unusual (estimated incidence is 1.2 per million people) but important congenital form of secondary hyperaldosteronism; due to abnormalities in renal handling of electrolytes. It is associated with hypertrophy and hyperplasia of the juxtaglomerular cells, normal blood pressure, and hypokalemic alkalosis withoutedema.We present a 22-year-old woman with Bartter's syndrome underwent bilateral sagittal split osteotomy to correct mandibular prognathic. The anesthetic management of Bartter's syndrome should be relevant to the pathophysiology of the syndrome. Therefore, it should be directed toward maintaining cardiovascular stability, control of associated fluid, electrolyte and acid-base derangements, and the prevention of renal damage.

Aim: The biological mechanism(s) that guide the immunological effectors of lymphocytes to sites of inflammatory response, a feature consistently seen in oral submucous fibrosis (OSF) was evaluated. It is envisaged that endothelial/lymphocyte adhesion cascades involving VCAM-1/α4β1 integrins control the migration of lymphocytes across the vascular endothelium resulting in their homing in these locales., Materials and Methods: The study group comprised 28 OSF cases (M:F = 12:16, age range 18-65 years; mean 55.4 ± 8.5 SD) divided into early (n=17) and advanced (n=11) disease groups. Biopsy specimens of normal buccal mucosa (site compatible) were obtained from 10 healthy volunteers (age and sex matched) who served as control. All the samples were fixed in 10% neutral-buffered formalin and embedded in paraffin. Immunolocalization of β1 subunit associated with α4 integrin was performed by a mouse heterodimer (clone 4B7R, Ig G, R & D Systems Inc., dilution 1:100) using a peroxidase labeled streptavidin-biotin technique. The immunocompetent cell density was expressed as the number of positive cells per mm(2). The Mann-Whitney U-test and Fischer exact test were used to evaluate differences. P<0.05 was considered to be significant., Results: The median percentage of "T" lymphocytes with positive integrin α4β1 expression was 77.7 (an interquartile range of 73.3-83.4) for the test cases and for the controls, it was 28.2 (IQR 24.0-38.3). This difference was significant at 0.001 level. For the endothelial cells the positive expression was 82.8 (IQR 77-90.6) and 22.3 (IQR 18.3-29.2) respectively (P<0.001). When the intensity of integrin expression was considered 26/28 cases (96%) and 2/10 (20%) of controls showed intense expression of integrins α4β1 on T lymphocytes (P<0.001). Similarly, 27/28 cases (92.9%) and 2/10 (20%) of controls showed intense expression on endothelial cells (P<0.001). T lymphocyte-endothelial cell interactions were assessed by evaluating the overexpression of integrins on both the endothelial cells and lymphocytes together. The interaction was positive in 15/17 and 11/11 early and advanced OSF cases respectively (P=0.51)., Conclusion: Following leukocyte activation, the interaction between leukocyte integrin heterodimers and endothelial superfamily adhesion ligands results in a firm adherence of leukocytes to endothelium, leading to leukocyte migration and homing to sites of mucosal inflammation consistently seen in OSF.

Relapse is one of the complications of orthognathic surgery. In this study, we compared the stability of mandibular bilateral sagittal split osteotomy by using two different methods of fixation. In Group 1, eight patients with prognathic mandible underwent BSSO and set back average of 6.0 mm. The method of fixation was positioning screws. In Group 2, eight patients with prognathic mandible underwent BSSO and set back average of 6.0 mm. The method of fixation was plate and monocortical screws. In Group 3, eight patients with retrognathic mandible underwent BSSO and advancement average of 6.0 mm. The method of fixation was positioning screws. In Group 4, eight patients with retrognathic mandible underwent BSSO and advancement average of 6.0 mm. The method of fixation was plate and monocortical screws. The results showed in terms of advancement that there was no significant difference between the groups after one year. However, in terms of set back, this study showed significant difference.