Adel Al-Asfour

The effect of a leaflet given to parents for first aid measures after tooth avulsion.

The aims of this study were to evaluate knowledge level among parents regarding tooth avulsion and replantation and to evaluate a simple leaflet as an information tool to enhance this knowledge. One Hundred and fifty parents in a primary school in Kuwait City participated in the study. Half of the parents received a leaflet with basic first aid message regarding what to do in case of tooth avulsion. One week after reading the leaflet, the parents who had received the leaflet were evaluated by using a questionnaire. The other half of the parents who had not seen the leaflet served as control. The level of knowledge was measured in the following categories: General knowledge of tooth avulsion, knowledge of replantation and primary vs permanent teeth, knowledge of how to clean an avulsed tooth, knowledge of extra-oral time, knowledge of storage methods and storage media. By scoring the knowledge, the level of knowledge was calculated. The results showed that knowledge level was low among Kuwaiti parents. Improvement was seen in all categories of knowledge as a result of reading the leaflet. A simple leaflet can be a valuable tool to convey important basic information and enhance knowledge of tooth avulsion and how parents should act in such a situation, although there are limitations in conveying the message for a complete understanding. Measuring the knowledge by scoring can give valuable feedback in developing various educational tools.

Kuwaiti parents' knowledge of first-aid measures of avulsion and replantation of teeth.

Objective: The aim of this study was to assess the knowledge level of emergency measures for tooth avulsion among Kuwaiti parents. Subjects and Methods: Sixty-three parents completed an Arabic language questionnaire about their first-aid knowledge. The following fields of knowledge were assessed: general body injury treatment principles, tooth avulsion and replantation principles, avulsed permanent/primary teeth, cleaning of an avulsed tooth before replantation, extra-alveolar time and storage media. For each category, a score ranging from 0 to 3 was possible. Results: Experience of first-aid information or training was seen in 12 (19%) except for dental injuries, which had not been included in such first-aid information. Knowledge was demonstrated in 52 (82%) about first aid of minor body injuries, yet the knowledge of how to manage avulsed teeth was poor, as 50–54 (79–86%) parents had no knowledge of how to manage an avulsed tooth in the specific modes of treatment measured. There was no difference in knowledge between mothers and fathers, young or old, nor was knowledge greater in parents with an academic education. Conclusion: First-aid knowledge in Kuwaiti parents is lacking for avulsion and replantation of teeth despite a high level of knowledge of how to manage simple body injuries. Knowledge of first-aid measures regarding avulsion and replantation of teeth should be increased by intervention programs.

Postoperative infection after surgical removal of impacted mandibular third molars: an analysis of 110 consecutive procedures.

Objective: The aim of this study was to evaluate the rate of postoperative infection and other complications after the surgical removal of impacted mandibular third molars. Subjects and Materials: Medical records of 110 consecutive patients with 130 consecutive surgical extractions of impacted lower third molar teeth performed under local anesthetic using strict aseptic techniques were reviewed and analyzed. No systemic antibiotics were administered or prescribed after the surgery. The rates of postoperative infection and other complications were evaluated clinically. Results: Of the 130 surgical removals, 110 in 90 patients met the inclusion criterion of nonuse of antibiotics. Fifty-nine were female and the remaining 31 were male. Average age was 25.2 years. Of the 110 surgeries, postoperative infection occurred in 6 (5.5%). Other complications were alveolar osteitis (n = 9, 8.2%), pain lasting more than 1 week (n = 5, 4.3%) and sensory dysfunction of the inferior alveolar nerve (n = 2,0.8%). Conclusion: The low rates of postoperative infection and other complications observed in this study encouraged us to continue surgical removal of impacted mandibular third molars without routine prescription of antibiotics unless indicated for other medical reasons.

Healing pattern of experimental soft tissue lacerations after application of novel topical anesthetic agents – an experimental study in rabbits

Topical anesthetics based on a combination of 2.5% lidocaine and 2.5% prilocaine are efficient in eliminating pain from needle stick when placed on skin and oral mucosa. This suggests their application in soft tissue lacerations before suturing to enable pain-free exploration and suturing of traumatic lacerations without prior injection needle stick. The aim of the present study was to study the healing of experimental oral lacerations after topical anesthetic substances were placed in the lacerations. Thirty-six standardized incisions were made bilaterally in the lower and the upper labial mucosa of nine white New Zealand rabbits. All wounds were intentionally contaminated with saliva to simulate laceration wounds in trauma situation. EMLA cream and Oraqix thermosetting gel were applied into 30 lacerations and six lacerations were left untreated as control. In some lacerations the topical anesthetic agent was left in the wound, while in others they were rinsed off by saline before suturing the laceration wound. The rabbits were then killed after 3 days, 2 weeks and 4 weeks of healing and the lips were processed for histological evaluation. Similar normal histological healing patterns were seen in wounds in which EMLA and Oraqix were applied compared with control lacerations at all stages of healing. No adverse tissue or foreign body reactions were seen in any of the lacerations. We conclude that EMLA and Oraqix can be used in oral mucosal lacerations prior to suturing without the risk of adverse tissue reaction.

Host tissue reactions of non‐demineralized autogenic and xenogenic dentin blocks implanted in a non‐osteogenic environment. An experimental study in rabbits

Dentoalveolar ankylosis with osseous replacement is often seen after replantation of avulsed teeth, and this process may be used for preservation of alveolar crests after trauma. Its exact mechanisms with regard to osteoinductive properties are not yet fully understood and need to be systematically investigated. Dentin can possibly act as a slow-releasing carrier of bone morphogenic proteins (BMP), and this property of dentin has been proposed to be used as an alternative or supplement to bone grafting in the maxillofacial region. We aimed to initially asses host tissue reactions to dentin by implanting dentin blocks of autogenic and xenogenic human origin in rabbit connective tissue of the abdominal wall and femoral muscle. Animals were sacrificed after a period of 3 months, and histological processing, sectioning and examinations were carried out. Bone formation, cell counts and thickness of capsule surrounding the grafts were evaluated. Only minor signs of heterotopic bone formation were seen. There were no significant differences between autografts and xenografts or grafts implanted in connective tissue or muscle with regards to tissue reactions except for a significant difference (P = 0.018) in findings of more local inflammatory cells in relation to grafts placed in connective tissue in the autograft group. We conclude that during the time frame of this study, non-demineralized dentin, whether autogenous or xenogenic did not have the potential to induce bone formation when implanted in non-osteogenic areas such as the abdominal wall and abdominal muscle of rabbits.

Histologic analysis of a novel extracellullar matrix membrane for guided bone regeneration: an experimental study in rabbits.

This experiment was conducted to study the histologic feasibility and biologic impact of Ti02 impregnation of an extracellullar matrix (ECM) membrane in guided bone regeneration. Eighteen adult New Zealand White rabbits were used. Bilateral bone defects were created in edentulous areas of the maxilla. The defects were filled with demineralized freeze-dried bone (DFDB). ECM was randomly pretreated with a suspension containing saline and 3 mg Ti02 granules. A regular ECM membrane served as a control on the contralateral side. Healing periods were 2, 4, and 8 weeks. Histologic and histomorphometric analyses were performed. The parameters assessed were (1) zone of inflammatory cells adjacent to ECM membrane, (2) presence of cellullar ingrowth into ECM, and (3) presence of Ti02 particles within the ECM barrier membrane. In general, no adverse reactions toward both groups of ECM membranes could be noted. The Ti02 particles remained within the ECM after 8 weeks of healing, making histologic detection of ECM easy. Histomorphometric analysis revealed low numbers of inflammatory cells adjacent to the ECM surface and adequate preservation and integration of the barrier. Contrasting Ti02 particles impregnated into the ECM membrane can be a very useful tool for the detection of similar biologic materials in in vivo models.

Demineralized Xenogenic Dentin and Autogenous Bone as Onlay Grafts to Rabbit Tibia

Purpose: The present study was undertaken to evaluate the healing pattern of xenogenic demineralized dentin onlay grafts in comparison with autogenous bone grafts to the rabbit tibia. Material and Methods: Eight 6-month-old New Zealand male rabbits were used in the experiments. Standardized sized dentin blocks from human premolars and similar autogenous bone blocks harvested from tibia were grafted as onlay blocks on each tibia (n = 8 × 2). All animals were killed after a healing period of 12 weeks. Results: Healing was uneventful for all animals. In general, both the dentin and bone block grafts were fused to the bone, resorbed, and replaced by bone and connective tissue to a varying degree. Both types of grafts were still present after 12 weeks, on an average to approximately one third of the original sizes. Resorption cavities could be seen in the dentin with bone formation. Zones of osseous replacement resorption of the dentin could be noted. In both graft types, higher rate of bone formation was seen at the interface between graft and recipient site. Conclusion: Demineralized xenogenic dentin onlay grafts showed similar resorption characteristics as autogenous bone onlay grafts, being resorbed in a similar rate during 12 weeks. New bone formation occurred mainly in terms of replacement resorption in the interface between dentin/bone graft and native bone.

Bone regeneration in rabbit calvarial critical-sized defects filled with composite in situ formed xenogenic dentin and biphasic tricalcium phosphate/hyroxyapatite mixture: BONE REGENERATION IN RABBIT CALVARIAL

The purpose of this study was to evaluate bone healing in calvarial defects using two bone graft substitute materials; biphasic beta-tricalcium phosphate/hydroxyapatite in hydrogel (ß-TCP/HA) versus composite non-demineralized xenogenic dentin with ß-TCP/HA mixture. Full thickness critical-sized defects were created bilaterally in 10 New Zealand male rabbits. Seven defects were left empty, six filled with biphasic tricalcium phosphate putty, and seven were filled with composite non-demineralized xenogenic dentin with biphasic tricalcium phosphate. Animals were sacrificed at eight weeks postoperatively and the healing of the biomaterial-filled defects was compared radiographically and by histomorphometry. Micro-computed tomography (μCT) was utilized to analyze the osteogenesis and healing patterns of the defects. Quantitative analysis of volume fraction (%) of the newly formed bone and remaining graft material (FV=filling volume/TV=tissue volume) and mean intensity [HU] in the defects were evaluated. Defects filled with composite dentin with biphasic tri-calcium phosphate showed volume fraction (FV/TV) in the order of 55.81% ± 17.72%, whereas defects filled with only biphasic tricalcium phosphate showed a fraction of 39.84% ± 16.06%, which represent the ratio of remaining graft material and new bone formation to the tissue volume. The empty negative control defects showed a volume fraction of 19.14% ± 8.787%. Histological analysis showed significant percentage increase in bone formation and residual graft with the composite Dentin/ß-TCP group after 8 weeks. The findings suggest that composite xenogenic dentin with biphasic tricalcium phosphate showed improved osteogenesis when compared to biphasic tricalcium phosphate without the addition of non-demineralized dentin.