2018 Jan-Mar; Vol 9, No 1
Accuracy of Guided Surgery via Stereolithographic Mucosa-Supported Surgical Guide in Implant Surgery for Edentulous Patient: a Systematic Review
J Oral Maxillofac Res 2018;9(1):e1
Objectives: The purpose of the present study is to systematically review the accuracy of implant placement with mucosa-supported stereolithographic surgical guide and to find out what factors can influence the accuracy.
Material and Methods: An electronic literature search was performed through the MEDLINE (PubMed) and EMBASE databases. The articles are including human studies published in English from October 2008 to October, 2017. From the examination of selected articles, deviations between virtual planning and actual implant placement were analysed regarding the global apical, global coronal, and angulation position.
Results: A total of 119 articles were reviewed, and 6 of the most relevant articles that are suitable to the criteria were selected. The present data included 572 implants and 93 patients. The result in the present systematic review shows that mean apical global deviation ranges from 0.67 (SD 0.34) mm to 2.19 (SD 0.83) mm, mean coronal global deviation ranges from 0.6 (SD 0.25) mm to 1.68 (SD 0.25) mm and mean angular deviation - from 2.6° (SD 1.61°) to 4.67° (SD 2.68°).
Conclusions: It’s clearly shown from most of the examined studies that the mucosa-supported stereolithographic surgical guide, showed not exceeding in apically 2.19 mm, in coronally 1.68 mm and in angular deviation 4.67°. Surgeons should be aware of the possible linear and angular deviations of the system. Accuracy can be influenced by bone density, mucosal thickness, surgical techniques, type of jaw, smoking habits and implant length. Further studies should be performed in order to find out which jaw can have better accuracy and how the experience can influence the accuracy.
Keywords: computer-assisted surgery; dental implant; dimensional measurement accuracy; edentulous jaw; osseointegration; review.
Dental Stem Cells Harvested from Third Molars Combined with Bioactive Glass Can Induce Signs of Bone Formation In Vitro
J Oral Maxillofac Res 2018;9(1):e2
Objectives: The aim of this study was to assess the interaction of a bioactive glass scaffold with cells derived from dental pulp, dental follicle and periodontal ligament.
Material and Methods: Impacted third molars were surgically removed from three young donors. Cells from the dental pulp, follicle and periodontal ligament tissues were isolated and expanded. Different cell populations were characterised using specific CD markers. Expanded pulp, follicle and periodontal cells were then seeded onto bioactive glass scaffolds and cultured in osteogenic medium or basic medium. Cell attachment, viability, proliferation and alkaline phosphatase activity were assessed.
Results: This study revealed good biocompatibility of the specific bioactive glass configuration tested and the osteogenic induction of cells derived from dental pulp, dental follicle and periodontal ligament. Osteogenic medium seemed to increase the differentiation pattern and dental pulp stem cells showed the most positive results compared to periodontal ligament and dental follicle stem cells.
Conclusions: Dental pulp stem cells combined with a bioactive glass scaffold and exposed to osteogenic medium in vitro represent a promising combination for future study of hard tissue regeneration in the cranio-maxillofacial skeleton.
Keywords: tissue engineering; third molar; stem cells; bone regeneration.
Immunohistochemical Study of Laminin-332 γ2 Chain and MMP-9 in High Risk of Malignant Transformation Oral Lesions and OSCC
J Oral Maxillofac Res 2018;9(1):e3
Objectives: Oral squamous cell carcinoma is associated with alterations in basement membrane. Laminin-332 is present in basal lamina and performs multiple biologic effects by γ2 chain. Matrix metalloproteinase acts disrupting extracellular components and was related to poor prognosis in cancer. Here, molecular profile of laminin-332 γ2 chain and matrix metalloproteinase-9 was assessed in oral lesions.
Material and Methods: The expression of laminin-332 γ2 chain and matrix metalloproteinase-9 (MMP-9) was examined by immunohistochemistry in 10 patients with high risk of malignant transformation oral lesions and 26 cases of oral squamous cell carcinoma (OSCC). Associations between microscopic and clinicopathologic features were established.
Results: Immunostaining of laminin-332 γ2 chain in high risk oral lesions was most detected in basement membrane which is continuous, while the majority of OSCC cases showed a discontinuous membrane (P = 0.001). It was observed a positive reaction for γ2 chain in invasive fronts and a higher expression in epithelial compartment of smoking patients with OSCC (P < 0.0001). In epithelium, MMP-9 expression was presented in all layers with no difference between lesions. However, an elevated immunostaining in stromal cells was associated with male patients (P = 0.0054), older than 60 years (P = 0.0101) and with OSCC.
Conclusions: Present study results support the hypothesis of changes in molecules expression in high risk oral lesions and oral squamous cell carcinoma. A relation between clinical and molecule profile was observed. Those molecules may represent a useful tool to predict oral cancer behaviour.
Keywords: carcinogenesis; laminin; matrix metalloproteinase 9; oral cancer; oral pathology; squamous cell carcinoma.
An Investigation of the Morphology of the Petrotympanic Fissure Using Cone-Beam Computed Tomography
J Oral Maxillofac Res 2018;9(1):e4
Objectives: The purpose of the present study was: a) to examine the visibility and morphology of the petrotympanic fissure on cone-beam computed tomography images, and b) to investigate whether the petrotympanic fissure morphology is significantly affected by gender and age, or not.
Material and Methods: Using Newtom VGi (QR Verona, Italy), 106 cone-beam computed tomography examinations (212 temporomandibular joint areas) of both genders were retrospectively and randomly selected. Two observers examined the images and subsequently classified by consensus the petrotympanic fissure morphology into the following three types: type 1 - widely open; type 2 - narrow middle; type 3 - very narrow/closed.
Results: The petrotympanic fissure morphology was assessed as type 1, type 2, and type 3 in 85 (40.1%), 72 (34.0%), and 55 (25.9%) cases, respectively. No significant difference was found between left and right petrotympanic fissure morphology (Kappa = 0.37; P < 0.001). Furthermore, no significant difference was found between genders, specifically P = 0.264 and P = 0.211 for the right and left petrotympanic fissure morphology, respectively. However, the ordinal logistic regression analysis showed that males tend to have narrower petrotympanic fissures, in particular OR = 1.58 for right and OR = 1.5 for left petrotympanic fissure.
Conclusions: The current study lends support to the conclusion that an enhanced multi-planar cone-beam computed tomography yields a clear depiction of the petrotympanic fissure’s morphological characteristics. We have found that the morphology is neither gender nor age-related.
Keywords: arthroscopy; cone-beam computed tomography; temporal bone; temporomandibular joint.
Lichen Sclerosus of the Upper Lip: Report of a Case, Utilizing Shikata's Modified Orcein Stain, and Review of the Literature
J Oral Maxillofac Res 2018;9(1):e5
Objectives: Lichen sclerosus is a rare chronic inflammatory disorder, affecting mainly the skin and the anogenital mucosa, while oral lesions can be the primary or the only manifestation of the disease. A rare case of oral lichen sclerosus, assessed histopathologically and histochemically, is presented, along with a thorough review of the English language literature.
Material and Methods: A 32-year-old female presented an asymptomatic white patch affecting the skin and the mucosa of the upper lip, without other mucocutaneous involvement. A partial biopsy of the lesion was performed, along with the histochemical Shikata’s modified orcein stain for elastin fibres detection. A literature review was also performed, discussing the epidemiological data, clinical presentation, and treatment modalities of all published cases with oral involvement.
Results: The histopathological evaluation revealed the presence of acellular zone underneath the basal layer of the epithelium, accompanied by deep band-like chronic inflammation. Shikata’s modified orcein stain exhibited scarcity or loss of elastin fibres in the acellular subepithelial area. The diagnosis of lichen sclerosus was made. Topical application of corticosteroids was prescribed and resolution of the lesion was observed. Literature review revealed that oral lichen sclerosus is predominantly presented in females, as asymptomatic lesions of the lips and buccal mucosa; few cases have extraoral manifestations and topical corticosteroids are the main treatment intervention.
Conclusions: Despite its rarity, lichen sclerosus should be considered in the clinical and histopathological differential diagnosis of white patches of the oral mucosa. For rendering proper diagnosis, the histochemical Shikata’s modified orcein stain is a useful assessment tool.
Keywords: cheilitis; elastin; lichen sclerosus; lichenoid eruptions; oral pathology.