2021 Apr-Jun; Vol 12, No 2
Complications and Management of Patients with Inherited Bleeding Disorders During Dental Extractions: a Systematic Literature Review
J Oral Maxillofac Res 2021;12(2):e1
Objectives: The systematic literature review aims to assess patients' dental extraction with inherited bleeding disorders, to understand the type, dosage, and modality of administration of the haemostatic agents for safe intra- and postoperational results.
Material and Methods: The search was undertaken in MEDLINE (PubMed) databases and Cochrane library for articles published in English from 1 January, 2010 till 31 October, 2020. Before the full-text articles were considered, titles and abstracts were screened.
Results: A total of 78 articles were screened, from which 3 met the necessary criteria and were used for the review. Minor complications, such as postoperative bleedings from the socket and epistaxis, were observed, but they were resolved with proper medical care. No major fatal complications were reported. Generally, all the articles provided evidence of successful extractions with correct treatment plans made by haematologists and surgeons.
Conclusions: Available clinical trials demonstrate that local and systemic haemostatic therapies in combination are effective in preventing bleeding during dental extractions in patients with coagulopathies.
Keywords: hemophilia A; hemophilia B; hemorrhage; postoperative hemorrhage; surgical hemostasis; tooth extraction.
Periosteum-Derived Mesenchymal Stem Cells Secretome - Cell-Free Strategy for Endogenous Bone Regeneration: Proteomic Analysis in Vitro
J Oral Maxillofac Res 2021;12(2):e2
Objectives: Millions of people worldwide are affected by diseases or injuries which lead to bone/tooth loss and defects. While such clinical situations are daily practice in most of the hospitals, the widely used treatment methods still have disadvantages. Therefore, this field of medicine is actively searching new tissue regeneration techniques, one of which could be stem cell secretome. Thus, the purpose of this research study was to perform the detail proteomic analysis of periosteum-derived mesenchymal stem cells secretome in order to evaluate if it is capable to induce osteo-regenerative process.
Material and Methods: Periosteum-derived mesenchymal stem cells (PMSCs) were extracted from adult male New Zealand White rabbits. Cells were characterised by evaluating their differentiation potential. After characterisation PMSCs secretomes were collected and their proteomic analysis was performed.
Results: PMSCs were extracted from adult male New Zealand White rabbits. In order to characterise the extracted PMSCs, they were differentiated in the directions which mainly describes MSC multipotency - osteogenic, myogenic and adipogenic. A total of 146 proteins were detected. After characterisation PMSCs secretomes were collected and their proteomic analysis was performed. The resulting protein composition indicates the ability to promote bone regeneration to fully mature bone.
Conclusions: Bioactive molecules detected in periosteum-derived mesenchymal stem cells secretome initiates the processes required for the formation of a fully functional bone.
Keywords: bone regeneration; mesenchymal stem cells; periosteum.
Estimation of Blood Loss in Oral and Maxillofacial Surgery by Measurements of Low Haemoglobin Levels in Mixtures of Blood, Saliva and Saline: a Laboratory Study
J Oral Maxillofac Res 2021;12(2):e3
Objectives: Estimating blood loss is an important factor in several surgical procedures. The accuracy of blood loss measurements in situations where blood is mixed with saliva and saline is however uncertain. The purpose of this laboratory study was to ascertain if blood loss measurements in mixtures of blood, saline, and saliva are reliable and could be applicable in a clinical setting.
Material and Methods: Venous blood and resting saliva were collected from six volunteers. Saliva, saline, and combinations thereof were mixed with blood to obtain different concentrations. A portable spectrophotometer was first used to measure the haemoglobin concentration in undiluted venous blood followed by measurements of the haemoglobin concentration after each dilution. To examine the strength of linear relationships, linear regression and Pearson correlations were used.
Results: The measurements of haemoglobin concentrations in mixtures of blood, saline, and saliva were proven to be accurate for haemoglobin measurements > 0.3 g/dl (correlation = 0.986 to 1). For haemoglobin measurements < 0.3 g/dl, a small increase in haemoglobin values were reported, which was directly associated to the saliva concentration in the solution (correlation = 0.983 to 1). This interference of saliva was significantly eliminated by diluting the samples with saline, mimicking the clinical situation.
Conclusions: The results suggest that a portable spectrophotometer can be used clinically to preoperatively measure the haemoglobin value of a venous blood sample and postoperatively measure the haemoglobin value of the collected liquids, including shed blood, thereby achieving a highly accurate method of measuring blood loss during oral and maxillofacial surgery.
Keywords: oral surgery; postoperative hemorrhage; saliva; surgical blood loss.
Does Appliance Design Affect Treatment Outcomes of Class II Division 1 Malocclusion? A Two-Center Retrospective Study
J Oral Maxillofac Res 2021;12(2):e4
Objectives: The purpose of this retrospective study was to compare the pre- and post-treatment values of patients treated with monoblock and twin-block appliances with the values of the skeletal Class I individuals.
Material and Methods: The initial lateral cephalometric radiographs of the pubertal untreated skeletal class I patients and cephalometric radiographs of 60 (30 monoblock, 30 twin-block) patients before and after the functional treatment were included in the study. Skeletal, dental, and soft tissue measurements were performed by a single researcher using Dolphin Imaging software version 11.95 (Dolphin Imaging, Chatsworth, CA, USA). Paired t-test was used for statistical evaluation and P < 0.05 was considered statistically significant.
Results: In both monoblock and twin-block groups, there was a statistically significant increase in the measurements of the lower jaw and the vertical direction values (sella nasion B point (SNB), pogonion nasion perpendicular, Y-axis, sella nasion-gonion gnathion, palatal-mandibular angle, anterior facial height, mandibular length P < 0.05); however, in the Twin-block group, the lower jaw was found to be displaced more forward (change for twin-block; SNB = 2.35, Wits appraisal = -4.77). The most measurements of the twin-block treated group were similar to the control group.
Conclusions: Both functional appliances have been identified to be useful in achieving treatment targets; however, with twin-block, results closer to ideal values are obtained.
Keywords: growth and development; mandible; orthodontics; retrognathia; treatment outcome.
Craniofacial Morphology and Upper Airway Dimensions in Patients with Hypermobile Ehlers-Danlos Syndrome Compared to Healthy Controls
J Oral Maxillofac Res 2021;12(2):e5
Objectives: The aims of the present case-control study were to compare craniofacial morphology, airway minimum cross-sectional area and airway volume between patients with hypermobile Ehlers-Danlos syndrome and healthy controls.
Material and Methods: The sample comprised 18 hypermobile Ehlers-Danlos syndrome (hEDS) patients (16 females, 2 males, mean age 34.1 [SD 10.35] years), clinically diagnosed and genetically tested in order to exclude other types of EDS, and 16 controls (14 females, 2 males, mean age 37.9 [SD 10.87] years) with neutral occlusion and normal craniofacial morphology. Craniofacial morphology was assessed on lateral cephalograms. Minimum cross-sectional area and upper airway volume were assessed on cone-beam computed tomography and analysed by standard and well-validated methods. Differences were tested by logistic regression analysis adjusted for age, gender and body mass index (BMI).
Results: No significant differences in craniofacial morphology were found between hEDS patients and controls. Airway minimum cross-sectional area (P = 0.019) and airway volume (P = 0.044) were significantly smaller in hEDS patients compared to controls. When adjusted for age, gender and BMI no significant differences were found. However, minimum cross-sectional area was almost significant (P = 0.077).
Conclusions: The craniofacial morphology and airway dimensions of hypermobile Ehlers-Danlos syndrome patients were comparable to controls, with a tendency towards a smaller minimum cross-sectional area in the hypermobile Ehlers-Danlos syndrome group. The results may prove valuable for understanding the effect of hypermobile Ehlers-Danlos syndrome on craniofacial morphology and the upper airways.
Keywords: adult; cone-beam computed tomography; face; pharynx; syndrome.
Therapeutic Approach in the Treatment of Medication-Related Osteonecrosis of the Jaw: Case Series of 3 Patients and State of the Art on Surgical Strategies
J Oral Maxillofac Res 2021;12(2):e6
Background: Bisphosphonates and receptor activator of nuclear factor kappa-B ligand inhibitors are currently the most widely used antiresorptive therapies in bone metabolism diseases treatment. Unfortunately they can evoke medication-related osteonecrosis of the jaws. The present case series study proposes to evaluate clinical features, evolution and the surgical therapeutic approaches in three patients affected by medication-related osteonecrosis of the jaw and to review the state of art regarding the management of this complication in light of the most recent literature.
Methods: Three cases of medication-related osteonecrosis of the jaws are discussed, two related to bisphosphonates therapy (ibandronic acid) and one due to denosumab.
Results: All three patients were aged female and had probably a dental trigger agent. The lesions located in posterior mandible were treated in one case with the surgical approach alone and, in the other case, with surgical approach associated with Erb-YAG laser. The lesion related to denosumab was treated with surgical approach and platelet rich fibrin application. A complete healing was always achieved.
Conclusions: Dentists should be aware of the potential risk of developing medication-related osteonecrosis of the jaws for patients who take or had taken antiresorptive drugs. The side effects of denosumab and bisphosphonates are partly overlapping and currently there is still no consensus about the therapeutic surgical options. Prevention and early detection of the lesions should be the primary strategy.
Keywords: antiresorptive drugs; laser therapy; oral surgery; osteonecrosis; platelet-rich fibrin.