Badr A. Al-Jandan

Thickness of buccal bone in the mandible and its clinical significance in mono-cortical screws placement. A CBCT analysis

The aim of this study was to determine the safest length of monocortical screws that can be inserted for the treatment of mandibular fractures following Champys technique. Fifty cone-beam computed tomography (CBCT) scans of hemi-mandibles were studied. Linear measurements were taken from the buccal cortical plate to the tooth apex, from the canine to the second premolar, and from the buccal cortical plate to the tooth apex and the inferior alveolar canal in the molar area. The minimum values of the horizontal distances both at the level of the apex and the inferior alveolar canal at the second molar were found to be 4 mm, which is greater than those of the first molar. At the canine, first premolar and second premolars, the minimum values of the horizontal distances at the level of the apex was found to be 2 mm, 2.33 mm and 2 mm, respectively. Stabilizing miniplates using 4 mm screws both at the level of the apex and the inferior alveolar canal is safe in the second molar area, anterior to this, there is a risk of injury to tooth root and inferior alveolar nerve.

Simulation-based local anaesthesia teaching enhances learning outcomes

OBJECTIVE The aim of this study was to evaluate the efficacy of simulation-based local anaesthesia teaching strategies compared to the traditional classroom lecture format on the acquisition of knowledge by students. SUBJECTS AND METHODS Two groups of 10 students each were included in our study. Each of the dental students was enrolled in their third year of the programme. None of the students had ever received instructions in local anaesthesia. Group I received a 45-min instructional module that was delivered in the classroom in the traditional PowerPoint lecture format. Group II received a 45-min instructional module in the simulation laboratory as a short tutorial that was followed by an integrated practical demonstration and a hands-on practice session using local anaesthesia simulation phantoms. An identical 15-question multiple-choice test was used to test student knowledge acquisition at the end of the given session. RESULTS There was a statistically significant difference between the two groups, as the participants in group II had higher score results than those of group I. CONCLUSION In contrast to the traditional classroom lecture format, simulation-based local anaesthesia teaching is an effective tool to enhance the acquisition of theoretical knowledge by students.

Desmosomal adhesion and pemphigus vulgaris: the first half of the story

Abstract Pemphigus vulgaris (PV) is a paradigm of autoimmune disease affecting intercellular adhesion. The mechanisms that lead to cell–cell detachment (acantholysis) have crucial therapeutic implications and are currently undergoing major scrutiny. The first part of this review focuses on the classical view of the pathogenesis of PV, which is dominated by the cell adhesion molecules of the desmosome, namely desmogleins (Dsgs). Cloning of the DSG3 gene, generation DSG3 knock-out mice and isolation of monoclonal anti-Dsg3 IgG have aided to clarify the pathogenic mechanisms of PV, which are in part dependent on the fate of desmosomal molecules. These include perturbation of the desmosomal network at the transcriptional, translational, and interaction level, kinase activation, proteinase-mediated degradation, and hyper-adhesion. By the use of PV models, translational research has in turn helped shed light into the basic structure, function, and dynamics of assembly of desmosomal cadherins. The combined efforts of basic and applied research has resulted in tremendous advance into the understanding of epidermal adhesion and helped debunk old myths on the supposedly unique role of desmogleins in the mechanisms of cell–cell detachment in PV.

Allograft for Maxillary Sinus Floor Augmentation: A Retrospective Study of 90 Cases

Purpose: The aim of this study is to demonstrate the clinical applicability and efficacy of an allograft for maxillary sinus augmentations in patients requiring placement of dental implants. Patients and Methods: Sixty consecutive patients underwent a total of 90 sinus augmentations. Twenty-nine were women and 31 men, with a mean age of 54 years. Twenty-six patients received a bilateral procedure and 34 unilateral. All cases were treated with the lateral wall technique. Allograft consisted of demineralized freeze-dried blocks in 6 cases, particulate in 82 cases, and a combination of both in 2 cases. In 30 patients, it was combined with platelet-rich plasma. A total of 84 implants were inserted. Bone samples of grafted areas were obtained in two patients for histological examination. Results: Seventy-three implants were clinically successful at the reentrytime. Eleven implants in seven patients were removed between 15 days and 6 months after their placement. Seven of these implants were replaced and received prostheses as well, for an overall postloading success rate of 95.2%. Follow-up for all patients after final restoration was between 12 and 96 months. Specimens histological evaluation revealed bone formation and evidence of inflammatory infiltrate. Conclusions: Based on the findings of this study, it can be suggested that the use of the demineralized freeze-dried bone allograft from the Banco de Huesos y Tejidos Fundación Cosme y Damian for sinus augmentation is effective and constitutes a feasible therapeutic alternative for implant placement.

Determination of the position of mental foramen and frequency of anterior loop in Saudi population. A retrospective CBCT study

Objectives To determine the position of mental foramen (MF) and frequency of anterior loop (AL) using dental cone beam computed tomography (CBCT). Materials and methods The study involved the evaluation of 302 CBCT scans (196 males, 106 females). The position of MF was determined with respect to adjacent teeth, nearest root apex of adjacent teeth and mandibular borders. MF position was also assessed based on gender and age. In addition, prevalence of anterior loop was evaluated by categorizing the inferior alveolar canal (IAC) patterns into linear, perpendicular and anterior looping. Results The study revealed that the most common position of MF was below the apex of 2nd premolar accounting for a total of 52.8% of scans whereas, only 29.6% observed MF between 1st and 2nd premolar (p > 0.05). 38.7% of MF were located at a distance of 1–3 mm from the nearest root apex (2nd premolar), followed by a distance of less than 1 mm in 17.05 of cases. 63.2% of foramen on left side of the mandible were observed below the apex of 2nd premolar in females (p = 0.023). Statistically significant findings were observed with regards to position of MF in different age groups (p < 0.05). The most common IAC pattern observed was linear in nature which accounted for 46.2% of cases followed by perpendicular pattern (38.6%). AL was found only in 15.2% of cases. Conclusions Our sample population most commonly exhibited MF below the apex of 2nd premolar with linear IAC pattern. AL was regarded as the least common pattern in Saudi population.

The effectiveness of using different pulp-capping agents on the healing response of the pulp.

BACKGROUND Some of the disadvantages of calcium hydroxide Ca(OH) 2 as pulp-capping material are related to the inflammatory response, and its poor sealing ability. Cyanoacrylate glue was proposed in this study as pulp-capping agent because of its sealing ability, and diprogenta, on the other hand, was proposed because of its anti-microbial and anti-inflammatory effects. The aim of this study is to evaluate and compare the histopathological response of the pulp toward cyanoacrylate and diprogenta in direct pulp capping (DPC). MATERIALS AND METHODS Cyanoacrylate, diprogenta, and calcium hydroxide were applied on 20 permanent teeth of 6 rabbits divided into four groups, each contains five teeth, as follow: G1: Diprogenta and calcium hydroxide. G2: Cyanoacrylate. G3: Diprogenta and cyanoacrylate. G4: Calcium hydroxide (control group). RESULTS A remarkable dentin bridge formation was found in all groups. No pulp necrosis was found in any tooth of the four groups. Pathological reactions of the pulp were found in 25%, 40%, 20%, and 100% of groups 1, 2, 3, and 4, respectively. Differences between study and control groups were found statistically significant ( P < 0.05). CONCLUSION All materials used in this study were biocompatible and suggested to be studied further on human teeth. These materials when used in combination with Ca(OH) 2 , may give better results.

Effects of sunitinib targeted chemotherapy on the osseointegration of titanium implants

Targeted chemotherapies are novel therapeutic approaches for many malignancies. In contrast to conventional chemotherapies, which are given for a predetermined duration, treatment with targeted chemotherapies like sunitinib is routinely continuous over longer periods, sometimes years. During this prolonged treatment period, patients may need to restore their missing teeth with dental implants. The aim of this study was to examine the effect of the anti-angiogenic substance sunitinib targeted chemotherapy on the osseointegration of titanium implants in a rabbit model. Fourteen white New Zealand rabbits were randomly assigned to two groups of either oral sunitinib at 10 mg/kg twice per week dose for 4 weeks (n = 7) or placebo (n = 7). The first dose was given 2 days before the surgical intervention. Each rabbit received one titanium dental implant in the right distal femoral condyle. Four weeks following implant insertion, rabbits were sacrificed and bone specimens containing the implants were retrieved. Osseointegration of the implants was analyzed using micro-computed tomography and histomorphometric evaluation. Both micro-computed tomography and histomorphometric analysis showed that the osseointegration parameters, including the ratio of bone volume to total volume and bone-implant contact percent for the sunitinib group were significantly lower than those in the control group (P ≤ 0.05). Sunitinib targeted chemotherapy had a negative effect on the osseointegration of titanium implants inserted in a rabbit model.

Guerin sign in midfacial fractures

We report a patient with multiple fractures of the midface and Guerin sign bilaterally after maxillofacial trauma. To the best of our knowledge, this is the first time that this rare presentation of Guerin sign has been published.

Assessment of dental students' psychomotor skills using oral surgery simulation models

Aim: The aim of this study was to determine the validity of using oral surgery simulation models as a tool to assess the psychomotor skills of dental students. Materials and Methods: All students in the 4 th year of a 6 years dental program were enrolled in the study. 23 dental students were asked to display their competency in the injection of local anesthesia and dental extraction in two summative testing environments namely; in the simulation and in the outpatient clinic. A panel of four experts assessed the students′ performance during the injection of local anesthesia and tooth extraction on patients and simulation using a pre-validated checklist. Students′ scores were compared in both settings. Results: The results showed no significant correlation between the scores on patients and simulation in the two settings (P = 0.759). Conclusion: The study revealed that the real patient remains the gold standard in summative assessment of dental students′ psychomotor skills.

An observation of the concentration and type of fluoride compound present in "over-the-counter" adult toothpastes available in Saudi Arabia

Objectives: This study was performed to observe the type and level of fluoride compounds existent in ′over-the-counter′ (OTC) adult toothpastes available in the open market of Saudi Arabia and to compare them with local and international guidelines. Materials and Methods: More than 100 hyper stores, shops and pharmacies of Dammam and Al Khobar cities were selected randomly and searched for the availability of fluoride containing adult toothpastes. Only toothpastes in which fluoride was present as an active ingredient were included and name of the compound of fluoride and its concentration stated on the packaging of the toothpaste were noted. Results: There were 59 different commercial brands of OTC toothpastes in which sodium fluoride was found in 59.3% of the toothpaste brands (35 of 59), 32.2% of the brands (19 of 59) had sodium monofluorophosphate, 3.3% toothpaste brands (2 of 59) had a combination of sodium fluoride and sodium monofluorophoshpate as an active ingredient, and 5% of the brands (3 of 59) mentioned the fluoride concentration in parts per million (ppm) but did not indicate the type of compound of fluoride present in them. Fluoride concentration found in toothpastes ranged between 1,000-1,470 ppm. Conclusions: Types of fluoride compounds found in toothpastes were consistent with internationally published guidelines. However, majority of toothpastes had 1,450 ppm fluoride which was consistent with Gulf Cooperation Council (GCC) and European guidelines but exceeded the normal range set by United States Food and Drug Administration (US-FDA) and American Dental Association (ADA). Care should be taken when these toothpastes are being used to prevent possible side-effects of fluoride over-exposure.