Buccal Area Research Articles

Oral mucoadhesive drug delivery system: Formulation strategies and evaluation techniques

Mucoadhesive drug delivery systems (MDDS) represent an innovative method for administering drugs through oral routes such as the buccal, sublingual, and gingival areas. These systems leverage natural or synthetic polymers to ensure prolonged adherence to mucosal surfaces, enabling extended and controlled release of medication. Several factors influence the effectiveness of mucoadhesion, including the hydrophilicity of polymers, molecular weight, and environmental factors like pH and moisture levels. MDDS can take various forms, including tablets, films, patches, lozenges, and gels, each offering different drug release profiles such as immediate, sustained, or controlled. These systems enhance drug bioavailability by avoiding first-pass metabolism, making them particularly beneficial for medications with low oral bioavailability or those requiring targeted delivery. Although MDDS offer improved patient compliance and therapeutic effectiveness, they still face challenges like irritation, taste concerns, and the diluting effect of saliva, which can impact drug stability. Despite these challenges, MDDS hold significant promise for advancing drug delivery technologies across various medical applications. This review thoroughly examines the mechanisms, advantages, limitations, and future prospects of mucoadhesive drug delivery systems.

Challenges in the diagnosis and management of soft tissue tumors of the oral cavity.

Soft tissue lesions are among the most prevalent forms of tumors or tumor-like alterations within the oral cavity. They exhibit a wide spectrum of characteristics, ranging from benign, noninvasive lesions to malignant tumors, which collectively present a diagnostic challenge. A 67-year-old patient presented with an incidental finding of induration on the right cheek during dental hygiene. The intraoral examination revealed a soft, non-tender swelling measuring 20 mm in diameter. The sensitivity and percussion tests for the teeth in the fourth quadrant yielded unremarkable results. Panoramic radiography (OPG) revealed tip-ping of the premolars and an unclear apical finding in region 44. Cone-beam computed tomography (CBCT) revealed a sharply defined, lobulated hypodense lesion in the right buccal area. To clarify the diagnosis and optimize perioperative management, a 3 Tesla dental magnetic resonance imaging (MRI) scan was performed. This identified a 23×6×23 mm lipoma along the right mandibular ramus, causing detachment of the buccinator and de-pressor anguli oris muscles. A cinematic rendering reconstruction derived from the MRI data facilitated enhanced visualization for preoperative planning. The surgical excision was performed under local anesthesia, resulting in the successful removal of the neoplasm while preserving the mental nerve and submandibular gland. Histo-pathology confirmed the presence of a lobulated mature cell lipoma. The patient exhibited no complications during the removal of the sutures, with complete wound healing and no recurrence observed. This article highlights the efficacy of advanced MRI diagnostics and post-processing techniques in the management of ambiguous soft tissue neoplasms.

Comparison of Micro-CT and Morphometric Outcomes in a Modified Experimental Rat Model of Periodontitis.

To assess the correlation between micro-computed tomography (micro-CT) and linear morphometric measurements in terms of mandibular bone levels in a modified experimental periodontitis model in rodents to study the mechanisms of association between periodontal destruction and neuroinflammation. The proposed invivo experimental periodontitis model involves the administration of oral rinses with Porphyromonas gingivalis and Fusobacterium nucleatum, four times per week during 4, 8 or 12 weeks, in 24 male Wistar Hannover rats (180 g, 5 weeks old). After euthanasia, hemi-mandibles were collected. One hemi-mandible was analysed using morphometry, while the other was assessed with micro-CT. Linear measurements were taken at the buccal aspect and furcation level for both techniques, and volumetric measurements were also obtained with micro-CT. Passing-Bablok regression analysis was used to compare the results of both techniques, with morphometric measurements serving as the reference. Moreover, Lin's Concordance correlation coefficient was calculated to assess the level of agreement. Periodontal clinical variables with neuroinflammatory parameters from the frontal cortex were used to evaluate the association between the resulting condition and neuroinflammation. Twenty-one out of the initial 24 rats were analysed. The micro-CT linear measurements demonstrated high concordance values with the linear morphometric measurements at the buccal surfaces of the roots in molars (r = 0.714) but not at the furcation area (r = 0.052). At 12 weeks, there was a significant impact on neuroinflammation with significant decreases in iNOS levels and p-mTOR levels at 4 and 8 weeks. The proposed invivo experimental periodontitis model demonstrated a high degree of correlation between morphometric and micro-CT measurements in buccal areas but not at the furcation level. Concomitantly, there was a significant temporary modulation of the neuroinflammatory response.

Comparative Evaluation Of Different Anatomical Sites In Buccal Shelf Region For Mini Screw Insertion In Skeletal Class II And Class III Patients-A CBCT Study

Background: To evaluate different anatomical sites in buccal shelf region at different levels (4mm, 6mm, 8mm, 10mm) from cemento-enamel junction for mini screw insertion in skeletal class II and class III patients using cone beam computed tomography (CBCT). Materials and Methods: The sample consists of cone beam computed tomography images of 48 subjects (24 skeletal class II and 24 skeletal class III) were evaluated. Mandibular buccal shelf area was evaluated at the regions (i) mesial to lower first molar (ML6) (ii) between the mesiodistal roots of the first molar (iii) distal to lower first molar (DL6) (iv) mesial to lower second molar (ML7) (v) between mesiodistal roots of the second molar (vi) distal to lower second molar (DL7) and cortical bone thickness was determined at 4, 6, 8, 10 mm level from cemento-enamel junction Results: Mandibular buccal shelf bone thickness increases from mesial surface of first molar to distal surface of second molar and from cemento-enamel junction to 8 mm level. Comparative evaluation between class II and class III shows significant differences (p<0.05) at the level of 8mm distal to second molar in the mandibular buccal shelf region. Conclusion: Skeletal class III subjects have more cortical bone thickness than class II subjects at the level of 8mm distal to second molar in the buccal shelf region.

Anatomical Study of the Superficial Musculoaponeurotic System in Relation to the Zygomaticus Major.

The superficial musculoaponeurotic system (SMAS) is crucial for the structural integrity and dynamics of facial expressions and is a particularly important consideration during facelift surgeries. This study investigated the anatomical structure and continuity of the SMAS at the site where the zygomaticus major (Zmj) originates, which is where the SMAS extends from the lateral to the anterior aspects of the face. Knowledge of these aspects is crucial for understanding the mechanics of facial movements and also the aging process. Dissections of 66 specimens and histological analyses were used to explore the intricate relationships and attachments between the SMAS and facial muscles. The findings indicated that at the Zmj origin site, the SMAS-connected to the inferior margin of the orbicularis oculi-covered the superficial surface of the Zmj fibers. As it tracked downward, the SMAS was observed to split into two layers lateral to the Zmj fibers, enveloping them both superficially and deeply. Additionally, as the SMAS continued forward, it ceased to be distinctly visible in the buccal area. These results provide a deeper understanding of the complex layering and interconnectivity of the SMAS, which supports facial dynamics and structural integrity. This information could be particularly useful in surgical and aesthetic procedures in the midfacial area.

Beyond the screw: Exploring the recurrence of oral lesions

The integration of skeletal anchorage systems has revolutionized orthodontics, especially with the advent of mini-screws known for their ease of use and minimal invasiveness. The mandibular buccal shelf area, with its ample high-quality bone and low failure rates, has become a preferred extra-alveolar anchorage site. However, complications involving adjacent soft tissues are common with orthodontic bone screw placement. This case report describes the recurrence of reactive oral lesions following placement of orthodontic bone screws in the buccal shelf area. During the course of orthodontic therapy, the patient developed exophytic growths twice, at the same site, on the lower right back buccal mucosa. Diode laser was used in both instances for excision of the lesion and the specimen was sent for histo-pathological analysis. The first lesion was diagnosed as inflammatory fibrous hyperplasia, while the recurrent lesion was identified as pyogenic granuloma. At 12-months follow-up, no new lesions were detected. This report highlights the influence of lesion development time on its clinical and histological presentation. It is postulated that leaving the bone screw in place after initial biopsy could have contributed to its recurrence. Complete excision is the preferred treatment. Treatment options, including laser therapy, are available for such lesions.

Assessment of the Effectiveness of Desensitizing Dentifrices on Management of Dental Hypersensitivity: An In Vitro Study.

The current study aimed to assess the efficiency of two desensitizing dentifrices on the management of dental hypersensitivity. For the purpose of this investigation, 60 extracted human sound premolar teeth that were removed for orthodontic purposes were collected. On the buccal cervical areas, an inverted-cone bur was used to create cavities that were 2 mm deep and 3 mm wide. The blocks were submerged in 17% ethylenediaminetetraacetic acid (EDTA) for 40 minutes in order to ensure the complete dentin tubule opening. Following preparation, all samples were split into three groups, each containing 20 samples, Group A: Control, Group B: Dentifrice containing calcium sodium phosphosilicate, Group C: Dentifrice containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP). Scanning electron microscopy (SEM) was used to assess the occlusion of dentinal tubules. One-way analysis of variance (ANOVA) was used to assess the desensitization efficacy of dentifrices. At a p-value less than 0.05, statistical significance was determined. Before application of different dentifrices, the maximum dentinal tubules opened in dentifrice containing CPP-ACP group (4.24 ± 0.10) followed by control group (4.18 ± 0.01) and dentifrice containing calcium sodium phosphosilicate (4.12 ± 0.06). And there was no significant difference between the different dentifrice groups (p > 0.001). After application of different dentifrices, the highest occlusion of dentinal tubules found in dentifrice containing CPP-ACP group (2.50 ± 0.05) followed by dentifrice containing calcium sodium phosphosilicate (2.84 ± 0.10) and control group (4.02 ± 0.07) and there was a highly significant difference between the different dentifrice groups (p < 0.001). On conclusion, dentifrice containing CPP-ACP exhibited the highest level of dentinal tubule occlusion in comparison to the control group and dentifrice containing calcium sodium phosphosilicate. Dentinal hypersensitivity (DH) is a condition that is frequently experienced. With variable outcomes, a number of products are utilized in the management of DH. Need is felt in dentistry for a material that chemically reacts, physically occludes and adheres intimately to dentinal tubules to reduce the possibility of its recurrence. How to cite this article: Pulipaka S, Ramanna PK, Samson A, et al. Assessment of the Effectiveness of Desensitizing Dentifrices on Management of Dental Hypersensitivity: An In Vitro Study. J Contemp Dent Pract 2024;25(5):494-497.

Variations in the alveolar bone morphology in maxillary molar area: a retrospective CBCT study

BackgroundThis study quantitatively analyzed the anatomic structure of the alveolar bone in the maxillary molar region at three potential locations for Temporary Anchorage Device (TAD) placement. Additionally, the study compared the variability in this region across different age groups, sagittal skeletal patterns, vertical facial types, and sexes.MethodsIn this retrospective cone-beam computed tomography study, the buccal alveolar bone was analyzed in the posterior molar area of 200 patients, the measurement items include buccal alveolar bone height, alveolar bone thickness, interradicular distance, and maxillary retromolar space.ResultsBuccal alveolar height was greatest in the U56 region. The interradicular space was largest in the U56 region and increased from the alveolar crest to the sinus floor. Buccal alveolar bone thickness was highest in the U67 region and generally increased from the alveolar crest to the sinus floor. The maxillary retromolar space gradually increased from the alveolar crest to the root apex.ConclusionsTADs are safest when placed in the buccal area between the maxillary second premolar and the first molar, particularly at the 9 mm plane. The U67 region is the optimal safe zone for TAD placement for maxillary dentition distalization. TADs placement in adolescents can be challenging. Maxillary third molar extraction can be considered for maxillary dentition distalization.

ORTHODONTIC TREATMENT OF VERTICAL DEFORMATIONS OF THE POSTERIOR PART OF THE DENTAL ARCH, AS A PREPARATORY STAGE FOR PROSTHETICS

The numerical distribution of anomalies and deformations of dentition in the adult population of Ukraine actualizes the development of new methods of orthodontic treatment of maxillofacial deformations. The aim. To analyze dental occlusion in young patients who underwent orthodontic treatment before prosthetics to assess the distribution of vertical deformations of the dental rows in the buccal areas and investigate methods of their elimination. Materials and methods. A retrospective investigation of the medical histories of 427 young people (228 women (53.4%) and 199 men (46.6%)) was carried out; consent for treatment was signed by 254 people (179 women and 75 men), which was 59.5% of the number of examined people. The sample identified the following pathological conditions that required orthodontic correction: abnormalities in the number of teeth in 3 persons (1.2%); retention in 1 person (0.4%); an abnormal position of teeth on the upper jaw in 158 people (62.5%) and 198 people (78%) on the lower jaw; malformation of the shape of dental rows in 208 people (82%) on the upper jaw and 220 people (86.6%) on the lower jaw, sagittal malocclusion in 32 people (12.3%), transversal malocclusion in 44 people (17, 2%), vertical malocclusion in 75 people (29.5%). 61 individuals (24%) were identified with partially edentulous dental rows, which were localized, mainly, in the lateral areas of the upper and lower jaws. In the selected sample, men predominated (40 people 65.6%), and a significantly smaller number of women (21 people 34.4%). Spaces with missing two and three teeth were present in some patients on the lower and upper jaws (12.5% of men and 9.5% of women). Distally located edentulous spaces were lesser extent compared to included defects (41% compared to 59%). Dentoalveolar deformities prevailed (95.1%): 38 men 62.3% and 20 women 32.8%. The carried-out treatment with the appliance of the own design proved the effectiveness in the treatment of the II-III levels of vertical dentoalveolar distally located occlusal malformation, where it is difficult to provide anchorage for intrusion. Further research is important for a detailed study of the use of fixed orthodontic appliances depending on the general somatic condition of patients and the condition of the jaw bone.

Management of Severe Odontogenic Infection: Case Report

Introduction: Submandibular abscess caused by odontogenic infection is a frequent case, but in some cases it can be deadly because it spreads and blocks the respiratory tract. The purpose of this study is to described a case of fatal submandibular abscess with early management effective. Case report: A 46 years old male patient with complaints of left submandibular, submental, left buccal and left temporal swelling. History of systemic disease was denied. Patients complain of tightness and changes in voice. Therapeutic intervention consists of Covid- 19 screening, complete blood lab, abscess decompression under local anesthesia, left submandibular and submental through and through drainage incisions, drainage incisions in the buccal area as well as multiple tooth extractions and penrose drain applications both extra oral and intra oral carried out in general narcotics, and swab culture sensitivity and antibacterial resistance tests were carried out. The antibiotics given were ceftriaxone and metronidazole. The patient was followed up and showed good general condition and decreased swelling. Conclusion: Odontogenic infections that spread and block the respiratory tract can be deadly. The abscess can expand even more quickly during preparation for surgery. Decompression of an abscess can be an effective treatment so that the abscess does not spread further and can reduce the risks of the operation being carried out. The management carried out must be complete and comprehensive, in this case a drainage incision and extraction of the focal infection are carried out. Initially, broad spectrum antibiotics can be given, but if the results of the antibacterial resistance test are obtained, it is very important to give more specific antibiotics. Submandibular abscess with poor prognostic consequences obstructed respiratory tract must be treated immediately and closely monitored. Keywords: Abscess, Odontogenic infection, Decompression

Management of Unilateral Buccal Necrotizing Fasciitis Superimposed with Submandibular Abscess At Colli Dextra in a Type 2 Diabetes Mellitus patient : A Case Report

Background: Necrotizing fasciitis (NF) is a relatively rare infectious disease of soft tissues that is characterized by necrosis of subcutaneous tissue and fascia and can even extend to involve the skin and muscles, with the main spread through odontogenic infections. One of the main comorbidities of necrotizing fasciitis is diabetes mellitus. Proper case management is needed because NF can result in severe morbidity and mortality if not treated at an early stage. Study Objective: This case report aims to report the management of patients with buccal necrotizing fasciitis complicated by submandibular abscesses with comorbid type 2 diabetes mellitus. Case Presentation: A 60-year-old woman came to RSHS complaining of swelling on her right cheek 20 days before hospital admission, which further extended to the jaw and neck area. Swelling on the patient's face did not improve after antibiotic treatment, and continued to enlarge to a size of 10x8x7 cm and 8x6x5 cm. The patient has a history of type 2 diabetes mellitus and controlled hypertension. The patient is diagnosed as necrotizing fasciitis and submandibular abscess. Patients are given antibiotic treatment and performed pus-tapping, necrotomy debridement, and tooth extraction. Conclusion : Necrotizing fasciitis involving the facial (especially buccal) area is rare, with the main cause being odontogenic, peritonsillar, or sinugenic. The main management includes debridement, reconstructive measures, and administration of antibiotics. Extensive tissue involvement, and poly-comorbid conditions can worsen the prognosis of necrotizing fasciitis. Keywords : Abscess, Buccal, Colli dextra, Necrotizing fasciitis, Submandibular

Treatment strategies for vertical maxillary excess: Cases with and without anterior open bite

This comprehensive review investigates the treatment of vertical maxillary excess (VME) with and without anterior open bite (AOB) in seven unique case studies. These cases illustrate the implementation of advanced orthodontic techniques, such as miniscrew-assisted intrusion of the maxillary and mandibular arches. The multifaceted nature of AOB must be considered, highlighting the need for clear diagnostic criteria and an understanding of the long-term impacts of treatment strategies. The main goal of treatment is to reduce the vertical dimension of the maxillomandibular complex. A single miniscrew in the midpalatal region for the maxillary arch and two miniscrews in the buccal areas of the mandibular arch can be applied for the effective intrusion of the posterior teeth. The review then delves into the specific challenges and treatment modalities for managing VME without AOB, stressing the critical role of individualized intervention plans. Each case study demonstrates a different aspect of the treatment approach: from differential intrusion of molars to address esthetic concerns and functional issues to comprehensive strategies involving the intrusion of entire dental arches to correct severe malocclusions. The outcomes emphasize the importance of controlled orthodontic mechanics in achieving and maintaining optimal posttreatment stability. This review underscores the effectiveness of these treatment strategies in significantly improving facial profiles and dental function while highlighting the adjunctive use of myofunctional therapy and other retention techniques to prevent relapse. Collectively, these cases provide valuable insights into the tailored treatment of complex orthodontic conditions, offering guidance on achieving long-term success in clinical practice.

Immediate Placement and Loading of Maxillary Single-Tooth with Scalloped Shape Implants and Digitalized Customized Restoration: A 5-Year Prospective Study of Marginal Bone Level.

To evaluate, within a period of 5 years, the bone level in mesial, distal, palatal, and buccal areas around scalloped shape implants immediately placed and loaded with temporary crowns fixed on final prefabricated abutments, and also to evaluate the thickness of buccal bone. 18 implants were inserted and loaded immediately using computer-assisted design/computer-assisted manufacturing technology on 18 patients to replace single tooth in the esthetic part of the maxilla. The marginal bone level across the scalloped implant neck was measured mesially and distally using intraoral standardized radiographs after crown fixations and 1, 3, and 5 years later. Cone beam computed tomography para-axial cuts images were used to measure bone level buccally and palatally from the implant neck to the implant-to bone contact after 5 years of loading and to evaluate the thickness of the buccal bone at the implant neck and 4 mm apically, immediately after implant placement and 5 years later. All implants were assessed clinically and radiologically after 5 years. No implant failure was recorded, and the average marginal bone variation on mesial and distal sites was 0.114 ± 0.135 mm at crown cementation, 0.239 ± 0.158 mm 1 year later, 0.233 ± 0.182 mm 3 years later, and 0.180 ± 0.182 mm 5 years later. Our findings indicate that at T0, the average thickness of the buccal bone was 2.27 mm at implant neck M0 (ranging from 1.9 to 2.4) and 2.33 mm at 4 mm apically to the implant neck M1 (ranging from 1.9 mm to 2.9 mm). By T4, the mean had decreased to 1.94 mm at M0 (with a range of 1.7 mm to 2.3 mm) and 2.14 mm at M1 (with a range of 1.8 mm to 2.4 mm). After 5 years the mean changes at buccal and palatal bone for all implants were &#43;0.187 ± 0.52 mm and &#43;0.06 ± 0.38 mm respectively. Minor prosthetic problems were observed over the five years: incisal ceramic chipping occurred in two crowns, and two crowns were replaced for esthetic reasons after one year. No loosening of crowns or abutments was reported. Scalloped neck implants demonstrated a comparable behavior to regular neck implants with similar designs in an immediate implantation and temporization protocol over a five-year period.

Anatomical Bone Characteristics of the Buccal Step Insertion Site for Mini-Screw Placement in Orthodontic Treatment: A CBCT Study

Background: To analyze the anatomical characteristics of a posterior area in the mandible localized distally to the second molars and extending in the vestibular direction toward the bony step, which we define as “buccal step”, in a patient with different skeletal patterns for mini-screw insertion. Methods: The sample included 85 CBCT (cone beam computed tomography) records selected from the digital archive. Analysis focused on the buccal step area. Sections were obtained in axial view using reference lines, and measurements of cortical and total bone were taken at specific points M0 (starting point, 6 mm apical from CEJc—cementoenamel junction crest), M2 (located 2 mm posterior to M0 in the apical direction), and M4 (positioned 4 mm posterior to M0 in the apical direction) in both directions. Six measurements were recorded for each scan root plane, assessing cortical and total bone depth. Results: The thickness of the bone increases toward the inside of the mouth at all tested sites (M0, M2, M4), which is good for placing mini-screws. Cortical bone thickness decreases toward the inside of the mouth, with no significant differences among the sites except for M0 vs. M4. People with a particular jaw shape (hypo-divergent) have a thicker cortical bone, indicating that facial structure affects bone thickness. Conclusions: The posterior buccal step insertion site has biomechanical advantages and reduces the risk of damaging roots during mini-screw insertions.

Effect of scan body designs and internal conical angles on the 3-dimensional accuracy of implant digital scans

Statement of problemAxial displacement is inevitable when connecting scan bodies to implants for digital scans using intraoral scanners, and axial displacement may reduce implant position accuracy in digital casts. However, studies assessing scan body type and accuracy are lacking. PurposeThe purpose of this in vitro study was to assess the linear and angular displacements of implants in digital casts using 2 scan body types with or without a vertical stop to minimize the axial displacement and 2 internal conical connection implants (ICCIs) with different internal conical angles. Material and methodsTwo identical reference casts were fabricated from epoxy resin by duplicating a partially edentulous mandibular dentiform. Each cast received 3 implants in the left first premolar, first molar, and second molar regions. One cast received an ICCI with a 7-degree internal conical angle (7-degree ICCI), and the other received an ICCI with an 11-degree internal conical angle (11-degree ICCI). A 10-mm polyetheretherketone (PEEK) cube was attached to the buccal area of the mandibular second premolar of each reference cast. A vertical stop was used in the experimental scan bodies to minimize the axial displacement, and conventional scan bodies were hand tightened to the implants in the reference casts. An intraoral scanner was used to fabricate 4 digital cast groups (2 implant types and 2 scan body types; each group had 10 casts). A coordinate measuring machine and digital inspection software program were used to measure the implant platform centroids (x, y, z) and projection angles (θXY, θYZ, θZX) of implant long axes in the reference and digital casts, respectively. One-way analysis of variance (ANOVA) and linear mixed model both with Tukey post hoc and 2-way ANOVA tests were performed to assess the significance of linear and angular displacements between groups (α=.05). ResultsSignificant differences were noted in all linear displacement variables among the 4 digital cast groups, except for Δx in the left first premolar implant. For the 7-degree ICCI, the linear displacement was statistically similar in the experimental and conventional scan bodies. However, for the 11-degree ICCIs, the experimental scan body group resulted in significantly smaller Δy, Δz, and Δd (Δd2=Δx2+Δy2+Δz2) than the conventional scan body group (P<.05). Overall, the 11-degree ICCIs demonstrated a significantly greater linear displacement than the 7-degree ICCI, regardless of the scan body type (P<.05). Significant differences between the test groups were observed for 10 of the 12 angular displacement variables (P<.05). ConclusionsThe 11-degree ICCIs demonstrated significantly greater linear displacements in Δy, Δz, and Δr than the 7-degree ICCIs. The experimental scan bodies with a vertical stop demonstrated significantly smaller linear displacements in the 11-degree ICCIs.

POTENTIAL OF VIRGIN COCONUT OIL PASTE AS EXTRINSIC DENTAL STAIN REMOVAL

Introduction: Dental stain is a common condition in society, apart from being an aesthetic problem it can be a predisposing factor for periodontal disease.One type of dental stain is extrinsic dental stain. Virgin Coconut Oil contains lauric acid which has the potential to remove extrinsic dental stains through the foaming mechanism. This research is to determine the effectiveness of Virgin Coconut Oil paste on removing extrinsic dental stain through an in vitro study. Material and Methods: Twenty-five post extraction premolars with extrinsic dental stain on buccal area were divided into 5 groups that is : K1/Control(given artificial saliva), K2(given placebo paste), K3(given 50% Virgin Coconut Oil paste), K4(given 75% Coconut Oil Paste) and K5(given 100% Virgin Coconut Oil Paste). Difference colour intensity (ΔE) before and after treatment were observed using Adobe Photoshop CC 2018 in the CieLAB system. Results and Discussion: Data were analyzed using One Way ANOVA and Post-Hoc Multiple Comparison test. One Way ANOVA test showed that there were significant differences within groups (p&lt;0.05). Post-Hoc Multiple Comparison test showed that there were significant differences between each groups, except for K2 and K3 groups also K4 and K5 groups (P&gt;0.05). Conclusion: Virgin Coconut Oil Paste is effective on removing extrinsic dental stain in vitro

Immune checkpoint inhibitor monotherapy is sufficient to promote microenvironmental normalization via the type Iinterferon pathway in PD-L1-expressing head and neck cancer.

Immune checkpoint blockers (ICBs) targeting programmed cell death protein 1 (PD-1) have been proven to be an effective first-line therapy against programmed cell death 1 ligand 1 (PD-L1; also known as CD274 molecule)-expressing head and neck squamous cell carcinoma (HNSCC) in recent KEYNOTE-048 trial. However, associated changes in the tumor microenvironment (TME) and underlying mechanisms remain elusive. Oral tumors in C57/BL6 mice were induced by administering 7,12-dimethylbenzanthracene into the buccal mucosa. Single-cell suspension was isolated from tumor tissue; proliferating cells were injected subcutaneously into the left flank of mice to establish Ajou oral cancer (AOC) cell lines. Subsequently, a syngeneic PD-L1-expressing HNSCC model was developed by injecting AOC cells into the buccal or tongue area. The model recapitulated human HNSCC molecular features and showed reliable in vivo tumorigenicity with significant PD-L1 expression. ICB monotherapy induced global changes in the TME, including vascular normalization. Furthermore, the antitumor effect of ICB monotherapy was superior to those of other therapeutic agents, including cisplatin and inhibitors of vascular endothelial growth factor receptor 2 (VEGFR2). The ICB-induced antitumorigenicity and TME normalization were alleviated by blocking the type I interferon pathway. In summary, ICB monotherapy is sufficient to induce TME normalization in the syngeneic model; the type I interferon pathway is indispensable in realizing the effects of ICBs. Furthermore, these results explain the underlying mechanism of the efficacy of ICB monotherapy against PD-L1-expressing HNSCC in the KEYNOTE-048 trial.

Assessment of bone density in edentulous maxillae using cone beam computed tomography (CBCT)

IntroductionIn edentulous maxillae, the anterior maxilla is the region of interest for implant placement due to posterior bone resorption and sinus pneumatization. This study aimed to assess variations in bone density in different regions of the edentulous maxilla according to sex and age, using cone beam computed tomography (CBCT). Materials and methods69 CBCT from edentulous maxilla were analyzed. Six virtual implants were planned between the maxillary sinuses at incisor, canine, and premolar sites. Bone densities (in Hounsfield units HU) were recorded at six points on the neck, body, and apex of the buccal and lingual areas of each virtual implant. We used the two-sample t-test to compare male and female bone densities, and the Spearman correlation coefficient to analyze the correlation between mean bone density and age. One-way analysis of variance with post hoc pairwise t-tests was used to analyze the differences in density between three sites of the edentulous maxilla and the differences in density between three parts of the implant. The significance level was set at 5%. ResultsMean bone density in males was significantly higher than in females. There was a significant correlation between mean bone density and age in females. Incisor sites showed the highest mean bone density, followed by canine and premolar sites. There was a significant decline in bone density from the neck to the apex. ConclusionsBone density varied within and among edentulous maxillae. Bone density of the edentulous maxilla seemed to be influenced by age in women and by sex.

An emerging pathogen found in farm-cultured fourfinger threadfin (Eleutheronema tetradactylum), Edwardsiella piscicida, its genetic profile, virulent genes, and pathogenicity

The diseased fourfinger threadfin (Eleutheronema tetradactylum) exhibited clinical symptoms, such as hemorrhaging in the buccal area and skin. Gross pathological examination revealed hepatic hemorrhage, spleen enlargement, and brain congestion. Histopathological examination revealed multifocal necrosis and the presence of bacteria in various organs, including the heart, liver, spleen, and head kidney. Severe blood vessel congestion was also observed. All bacterial isolates obtained from the liver, spleen, head kidney, and brain were identified as gram-negative, motile, rod-shaped bacilli that displayed α-hemolysis. Utilizing a combination of the API 20 E system and species-specific primer-based polymerase chain reaction assays (EDtA, EDtD, and EDi primer sets), as well as sequencing of the 16S ribosomal DNA (16S rDNA) and iron-cofactor superoxide dismutase (sodB), the findings unequivocally established the identity of all isolates as E. piscicida. Examination of the E. piscicida isolates using transmission electron microscopy revealed the presence of flagella. Furthermore, genetic fingerprinting using enterobacterial repetitive intergenic consensus PCR (ERIC-PCR) demonstrated that the E. piscicida strains isolated from the fourfinger threadfin constituted a distinct genotype separate from the previously identified strains associated with Edwardsiellosis in different fish hosts. The pathogenicity of the representative E. piscicida isolates (E8–E12) was evaluated by subjecting the fourfinger threadfin to intraperitoneal injections. The gross lesions and histopathological alterations observed in experimentally infected fourfinger threadfins closely mirrored those observed in naturally infected fish. This study confirmed that E. piscicida-induced Edwardsiellosis could lead to disease outbreaks in farm-cultured fourfinger threadfin.

"Submarine-Shaped" Radial Forearm Flap for Simultaneous Reconstruction of Oral and Lower Lip Defects".

Reconstruction of the oral cavity commonly results in trismus and lip incompetence. In this study, we aim to describe an innovative design of a radial forearm free flap for resurfacing bilateral buccal defects and simultaneous functional lower lip reconstruction in a single stage. Between January 2010 and December 2019, 6 males underwent simultaneous buccal and lower lip reconstruction with a radial forearm free flap. The mean age of the patients was 57.3 years (range, 50-68 years). The defects were caused by trismus release and due to previous treatments. The mean size of the defects was 17.9 cm in length and 3.25 cm in width. Flaps were harvested, including the proximal perforators of the radial vessels, and the inset began in the buccal area opposite the anastomosis side. Flap size ranged from 16 to 21 × 2 to 4 cm. The recipient vessels used were the superficial temporal (4) and facial (2). All flaps survived. Lip infection was seen in 2 cases and managed conservatively. The mean follow-up was 19.2 months (range, 12-28 months). The mean increase in the interincisal distance was 10.7 mm. Oral continence was good in all patients. Speech intelligibility was considered total in 4 patients and partial in the remaining 2. The radial forearm flap constitutes an option for simultaneous lower lip reconstruction and resurfacing of bilateral buccal areas after trismus release. The procedure provides a thin and pliable reconstruction using only 1 donor site and 1 set of recipient vessels.