Palatal Mucosa Research Articles

Palatal Mucoperiosteum-A Redeemable Barrier in Surgical Management of Rhinocerebral Mucormycosis.

Ever since the commencement of the COVID-19 pandemic, post-recovery complications have been in the highlights, out of which rhinocerebral mucormycosis tops the chart. The surgical management of this disease was always aggressive debridement, resection, and antifungal treatment. Oronasal communication after aggressive surgical management always leads to breathing, feeding, and cosmetic impairments. In this study, cases were managed by leaving the palatal mucosa intact after the removal of all the affected hard and soft tissues including the periosteum attached to the mucosa, to preserve the palatal mucoperiosteum and to improve the postoperative complications in patients by maintaining the oronasal separation. Prospective review of the operated case of rhinocerebral mucormycosis in 20 patients was presented. An intraoral approach for hard and soft tissue resection was employed. The palatal mucoperiosteum was salvaged in all patients. Postoperative complications like oronasal communication, ill-fitting prosthesis, and healing were evaluated. A total of 20 patients underwent maxillectomy for mucormycosis involving the maxilla and palate along with other facial bones. The palatal mucosa was preserved and used for oronasal separation. The expected complications of nasal regurgitation, crustation of the maxillary cavity, ill-fitting prosthesis, etc. were evaded due to this. The administration of Inj. liposomal amphotericin B (LiAB) postsurgically has been the backbone of this procedure.

Super disintegrating oromucosal nanofiber patch of zolmitriptan for rapid delivery and efficient brain targeting

Oromucosal administration of zolmitriptan using electrospun nanofiber can potentially result in blood plasma concentrations analogous to intravenous kinetics and targeting the brain due to anatomical features of the delivery site. Herein, we report the optimization of zolmitriptan and polyvinylpyrrolidone nanofibers using a Quality by Design approach. Fourier transform infrared spectroscopy, and Thermogravimetric analysis ruled out any physical and/or chemical interaction between the drug and excipient. Diffraction studies revealed a sharp decrease in the crystalline index of pure zolmitriptan from 85.75% to 8.35%. Likely, calorimetry studies show a sharp decline in the enthalpy of fusion from 126.4 J/g before electrospinning to 67.24 J/g post electrospinning, demonstrating amorphization of the drug. The disintegration of nanofiber occurs within less than a second, and about 82% of the medicament was released in 60 s in an in vitro test, compared to 67% from the Zomig Rapimelt® tablet. Rapid drug flux of 22.07 and 22.62 μg/cm2/h occurred when nanofiber patches were applied to buccal and soft palate mucosa in an ex vivo permeability test. Biocompatibility studies established that the nanofiber patches were neither toxic nor irritating to the oral epithelium. Groups of rabbits received the zolmitriptan solution intravenously and orally, or optimized nanofibers were applied to the buccal and soft palate mucosa. Pharmacokinetic analysis in blood plasma indicated similar kinetics of oromucosal patches and intravenous administration. More importantly, concentrations achieved in the hindbrain after administration of the patch over the soft palatal mucosa produce significantly higher concentrations than buccal or IV administration (>2-folds). The drug targeting these brain regions likely resulted from rapid dissolution, enhanced permeation, amorphization, and specialized drug transport via a trigeminal nose base-pons-medullary axis.

Histological and histomorphometric study of human palatal mucosa: Implications for connective tissue graft harvesting.

To analyse the histological structure and histomorphometric characteristics of human hard palatal mucosa in order to determine the donor site of choice for connective tissue grafts from a histological point of view. Palatal mucosa samples from six cadaver heads were harvested at four sites: incisal, premolar, molar and tuberosity. Histological and immunohistochemical techniques were performed, as was histomorphometric analysis. In the current study, we found that the density and size of cells were higher in the superficial papillary layer, whereas the thickness of the collagen bundles increased in the reticular layer. Excluding the epithelium, the mean percentage of lamina propria (LP) and submucosa (SM) was 37% and 63%, respectively (p < .001). LP thickness showed similar values in the incisal, premolar and molar regions, and a significantly greater thickness in tuberosity (p < .001). The thickness of SM increased from incisal to premolar and molar, disappearing in the tuberosity (p < .001). As dense connective tissue of LP is the tissue of choice for connective tissue grafts, the best donor site from a histological point of view is tuberosity because it is composed only of a thick LP without the presence of a loose submucosal layer.

Single-cell transcriptomic analysis of oral masticatory and lining mucosa-derived mesenchymal stromal cells.

To reveal the heterogeneity of ex vivo-cultured human mesenchymal stromal cells derived from either masticatory or lining oral mucosa. Cells were retrieved from the lamina propria of the hard palate and alveolar mucosa of three individuals. The analysis of transcriptomic-level differences was accomplished using single-cell RNA sequencing. Cluster analysis clearly distinguished between cells from the masticatory and lining oral mucosa, and revealed 11 distinct cell sub-populations, annotated as fibroblasts, smooth muscle cells or mesenchymal stem cells. Interestingly, cells presenting a mesenchymal stem cell-like gene expression pattern were predominantly found in masticatory mucosa. Although cells of masticatory mucosa origin were highly enriched for biological processes associated with wound healing, those from the lining oral mucosa were highly enriched for biological processes associated with the regulation of epithelial cells. Our previous work had shown that cells from the lining and masticatory oral mucosae are phenotypically heterogeneous. Here, we extend these findings to show that these changes are not the result of differences in averages but rather represent two distinct cell populations, with mesenchymal stem cells more common in masticatory mucosa. These features may contribute to specific physiological functions and have relevance for potential therapeutic interventions.

Management of denture stomatitis: An overview

Abstract Denture stomatitis is a common inflammation of the palatal mucosa beneath removable dentures. The objective of this article was to examine the systematic reviews and clinical trials pertaining to the treatment of denture stomatitis. For this research, electronic databases (PubMed, Embase, Scopus, and ISI Web of Science) were searched from January 2000 to June 2021 using specified MESH keywords. Irrelevant articles were eliminated in three steps based on their titles, abstracts, and body texts. In the final analysis, 47 papers were selected, which included 12 systematic reviews and 35 clinical trials. Herbal compounds and denture disinfection were the interventions most commonly indicated. We concluded that, possibly due to the complex nature of this lesion’s etiology, there is no present definitive therapy guideline for this prevalent lesion.

Anatomical variation of the incisive canal: A CBCT study at Universitas Airlangga Academic Dental Hospital

Incisive canal located in maxillary anterior of hard palate around maxillary central incisor region that acts as a tunnel between the oral cavity and the nose. Incisive canal provide sensory innervation to the nasal septum and the anterior mucosa of the hard palate. The anatomical shape of the incisive canal varies individually, hence, should be considered before surgical intervention in the oral cavity. To determine the distribution of anatomical variations of the incisive canal in the sagittal section at Universitas Airlangga Academic Dental Hospital using Cone Beam Computed Tomography (CBCT). Fifty-four samples were obtained from the interpretation report of sagittal section of CBCT at Universitas Airlangga Academic Dental Hospital from 2015 – 2021. Observations of the incisive canals were carried out by agreement of authors by classifying the variations into cylindrical shape, funnel shape, banana shapes and hourglass shapes. In 54 samples with an age range of 12 - 70 years, the variations of the incisive canal were Cylindrical shape (63%), Banana shape (19%), Funnel shape (17%) and Hourglass shape (2%). Based on gender, Cylindrical shape was most commonly found in men (56%) and women (73%). Four variations of anatomical variations of the incisive canals were found at Universitas Airlangga Academic Dental Hospital, with cylindrical shape as the most prevalent variation. Therefore, observation of the incisive canal anatomy is necessary before surgical intervention.

Epidermolysis bullosa in oral health: clinical manifestations and salivary alterations.

To evaluate clinical manifestations of EB on the oral mucosa and alterations in salivary flow. Sociodemographic and clinical data were obtained from EB individuals. The salivary flow analysis was performed in EB and in non-EB patients. Fischer's exact test was applied to the qualitative variables, and the Mann-Whitney test was applied to the quantitative data. A total of 11 cases of EB were evaluated, and 3 types of EB were diagnosed (recessive dystrophic-RDEB; junctional-JEB; and simplex-EBS). Only individuals with RDEB or JEB showed the oral manifestation of the disease. The most affected sites were the lips (54%), hard palate (36%), and oral mucosa (27%). Ulcer and ankyloglossia were diagnosed in all RDEB cases. Regarding salivary flow, an intragroup comparison revealed an increase in stimulated versus unstimulated collection in the control sample (p = 0.0064). The EB group showed no difference (p = 0.6086). We also observed no differences in salivary volume between the control and EB groups (p = 0.7117 and p = 0.5557, unstimulated and stimulated flows, respectively). No oral manifestations were observed in EBS subjects. It is unclear whether individuals with EB are predisposed to manifest hyposalivation. Severe cases of EB show broad alterations in the oral mucosa, whereas the saliva needs to be better evaluated.

Therapeutic efficacy of adjunctive photodynamic therapy in the treatment of denture stomatitis

BackgroundThe present report assessed the efficacy of curcumin-mediated photodynamic therapy (CUR-mediated PDT) as an adjunct to antifungal gel treatment by evaluating the salivary interleukin-6 (IL-6) and matrix metalloproteinases-8 (MMP-8) levels together with Candida species counts in denture stomatitis (DS) patients. MethodsIn total, 50 DS subjects were randomly categorized into 2 groups: Group-1: subjects who received the antifungal gel treatment and Group-2: participants who received CUR-mediated PDT. The Sabourad Dextrose Agar and CHROMAgar were utilized for evaluating Candida species counts, while the Enzyme-Linked Immunosorbent Assay was employed to estimate the salivary levels of IL-6 and MMP-8. All clinical evaluations were performed at the baseline, 1 month, and 2 months. ResultsIn total, group-2 subjects showed a significant decrease in Candida albicans (C. albicans) counts on both follow-ups (i.e., 1-month and 2-month) than group-1 participants. C. krusei count also reduced in group-2 subejcts than group-1 participants at the 2nd follow-up as compared to the baseline, nevertheless, a slight increase in C. krusei count was noticed in group-2 subjects at the 2nd follow-up than the 1st follow-up. The salivary IL-6 and MMP-8 levels in both groups reduced significantly at both follow-ups than the baseline. According to the stepwise logistic regression analysis, no statistically significant correlation was observed between Candida species count and other parameters such as age and gender of the patient, duration of DS, and frequency of treatment(s). ConclusionCUR-mediated PDT is an efficaciousness therapeutic modality for alleviating Candida species counts on the surface of denture and the palatal mucosa, as well as improving the salivary IL-6 and MMP-8 levels in DS patients.

Management of Chronic Atrophic Candidiasis (Denture Stomatitis)-A Narrative Review.

One of the most common oral diseases affecting people wearing dentures is chronic atrophic candidiasis or denture stomatitis (DS). The aim of the paper is to provide an update on the pathogenesis, presentation, and management of DS in general dental practice settings. A comprehensive review of the literature published in the last ten years was undertaken using multiple databases, including PubMed via MEDLINE, EMBASE, and Scopus. The eligible articles were analyzed to identify evidence-based strategies for the management of DS. Despite its multifactorial nature, the leading cause of DS is the development of oral Candida albicans biofilm, which is facilitated by poor oral and denture hygiene, long-term denture wear, ill-fitting dentures, and the porosity of the acrylic resin in the dentures. DS affects between 17 and 75% of the population wearing dentures, with a slight predominance in elderly females. The mucosal denture surfaces and posterior tongue are the common sites of DS, and the affected areas exhibit erythema, the swelling of the palatal mucosa and edema. Oral and denture hygiene protocols, adjusting or re-fabricating poorly adapting dentures, smoking cessation, avoiding nocturnal denture wear, and the administration of topical or systemic antifungals are the mainstay of management. Alternate treatments such as microwave disinfection, phytomedicine, photodynamic therapy, and incorporation of antifungals and nanoparticles into denture resins are being evaluated for the treatment of DS but require further evidence before routine use in clinical practice. In summary, DS is the most common oral inflammatory lesion experienced by denture wearers. Most patients with DS can be managed in general dental practice settings. Effective management by general dental practitioners may be supported by a thorough understanding of the pathogenesis, the recognition of the clinical presentation, and an awareness of contemporary treatment strategies.

Effect of orodispersible hyaluronic acid film on palatal mucosa wound healing.

The objective of the study was to evaluate the healing effect of hyaluronic acid films on palatal wounds. After making 5-mm diameter palatal wounds, 72 rats were randomly assigned to three groups: control, hyaluronic acid gel, and hyaluronic acid film. The animals were sacrificed at 3, 7, and 21 days after the experiment. Clinical, histological, and RT-PCR analyses were performed. Human ex vivo oral mucosa models were used. Histological analysis and pan-cytokeratin staining were performed at 5 days after wound creation. In rat model, both gels and films showed favorable healing on Days 3 and 7 compared with healing in the control (p < 0.05). Film showed remarkable VEGF and α-SMA expression than did the others (p < 0.05). Immunohistochemical analysis showed that film exhibited significantly lower CD68 and greater α-SMA and vimentin expression levels than those in the others (p < 0.05). In human model, re-epithelialization rate of film group was significantly higher than that of the others. Complete epithelial regeneration was confirmed only in film group using pan-cytokeratin staining. Within the limits of this study, hyaluronic acid film outperformed gels in terms of palatal wound healing in both models.

Oral Microbiota-One Habitat or Diverse Niches? A Pilot Study of Sampling and Identification of Oral Bacterial and Fungal Biota in Patients with Type I Diabetes Mellitus Treated with Insulin Pump.

The oral microbiota is a very complex and dynamic microbial ecosystem. Alterations of its balance can result in oral and systemic diseases. We aimed to characterize the microbiota in particular niches of the oral cavity in adult type 1 diabetes patients treated with continuous infusion of insulin with insulin pump (IP). In addition, we aimed to determine optimal sites of oral microbiota sampling in studies of large research groups of patients with DM I. In this pilot study, we sampled the buccal and soft palate mucosa, tongue, palatal and buccal dental surfaces and gingival pockets of adult DM I patients treated with IP. In total, 23 patients were recruited. The oral microbiota was dominated by Streptococus and Neisseria, with a low incidence of cariogenic S. mutans and Lactobacillus, as well as periodontal pathogens such as Prevotella. There were significant differences in overall CFU counts of all strains, Gram-positive, Staphylococci, Streptococci and S. oralis strains between mucosal and dental surface sites. The overall CFU counts of all strains and Gram-positive strains were higher in dental sites vs. mucosal sites (both p < 0.001). CFU counts of S. oralis were significantly higher in dental sites vs. gingival pocket sites (p = 0.013). Candida species were rare. The mucosal sites on the buccae presented lower diversity and bacterial counts. In the study group of adult DM I patients treated with IP, the microbiota in particular niches of the oral cavity was significantly different. Three distinct and optimally appropriate sampling sites for oral microflora were identified: buccal and palatal mucosa, dental surface and gingival pockets. The results of this study may be the basis for further studies of large groups of patients with DM I.

Effects of Rapid Maxillary Expansion on Upper Airway Volume in Growing Children: A Three-Dimensional Cone-Beam Computed Tomography Study.

Background: Rapid maxillary expansion (RME) is a common orthodontic procedure that widens the maxillary arch to treat moderate to mild overcrowding and transverse skeletal and dental abnormalities. Orthodontic equipment applies lateral tension on posterior maxilla teeth or palate mucosa to the mid-palatal suture. The maxilla may grow transversely when force is applied at right angles to the mid-palatal suture, which is usually inactive in children and adolescents. This study used cone-beam computed tomography (CBCT) and an authorized upper respiratory airway volume measurement approach to compare RME cohort pharyngeal airway volume changes to healthy controls. Materials and Methods: This retrospective analysis included 52 RME patients and 52 healthy controls. The RME category's expansion regimen entailed twisting the screw of expansion on a tooth-attached Hyrax-type expansion equipment by 0.25 mm daily for at least 14 days. After six months, a few RME participants used fixed orthodontic gear. The comparison group used fixed orthodontic appliances for minor malocclusions without extractions (without RME). CBCT scans from 1021 orthodontic patients who visited a dental hospital between 2012 and 2022 were examined. The registry comprised only anonymized photographs. Volume, minimum cross-sectional area (MCA), molar width, and inter-molar width were measured before and after therapy. Results: The control group had 12227.12 mm3 at T0 and 15805.54 mm3 at T1. The control group's T0-T1 volume difference was statistically significant (p = 0.007). The RME group has 12884.84 mm3 at T0 and 17471.08mm3 at T1. The RME group had a significant volume difference at T0 and T1 (p = 0.002). The volume RME effect was ±1011.92and statistically insignificant. (p > 0.05). MCA in the control group was 126.04 mm2 at T0 and 170.61 mm2at T1. MCA at T0 and T1 in the control group was statistically significant (p = 0.041). RME group MCA was 126.53 mm3 at T0 and 164.69 mm2 at T1. The RME group had a significant volume difference at T0 and T1 (p = 0.002). The MCA, RME effect was 5.92 and statistically insignificant (p > 0.05). Both the control and RME groups had statistically significant volume and MCA differences at T0 and T1. However, the intergroup analysis showed no significant differences across the groups. Conclusion: Tooth-borne RME does not affect upper airway or MCA volume in children compared to controls. Upper airway changes were better with younger skeletal ages before treatment. The findings may aid RME for young children.

Clinical application of endoscopic soft palate augmentation in the treatment of velopharyngeal insufficiency

Velopharyngeal structure augmentation with the injection of autologous fat tissue into the nasal mucosa of the soft palate has been reported previously. However, as the injection points in the velopharyngeal space cannot be observed directly, these injections may be difficult to perform accurately. This report describes a new endoscope-assisted approach in which the materials for velopharyngeal structure augmentation are administered while observing the injection points directly, also enabling adjustment of the amount of material injected. A case series of five patients aged 8–16 years who underwent endoscopic soft palate augmentation under general anaesthesia is reported. Autologous fat tissue was injected into the nasal mucosa of the soft palate using a needle-type device of an endoscope, and the effects of the treatment were evaluated. The injections were performed successfully, and the velopharyngeal function was improved. This new technique of endoscopy-assisted augmentation was useful for the treatment of velopharyngeal insufficiency.

EFFECT OF REMOVABLE DENTURES ON COLONIZATION OF AEROBIC BACTERIA IN THE ORAL CAVITY AND ANTIBIOTIC PATTERN OF THE COMMON ISOLATED BACTERIA

Background and aims: Wearing a removable dental prosthesis causes a change in the micro flora of the mouth. The aim of this research was to verify the composition of aerobic bacterial in the oral cavity of patients with removable dentures and with normal teeth (without dentures), and antibiotics pattern for common isolates. Methods: Bacteriological investigations were performed in 122 individuals (61 removable dentures: 61 normal teeth) attending dental clinics of Faculty of dentistry, Sana’a University, Yemen and private dental clinics. The culturing and antibiotic sensitivity were conducted in the Microbiology Department of the National Center of Public Health Laboratories (NCPHL) Sana'a, Yemen. Tongue dorsa and palate mucosa swabs were collected from normal teeth and denture groups, and as well swabs from mucosal part of denture surfaces in prosthetic patients. Cultivation in microaerophilic (5% CO2) and oxygenic conditions were performed on solid selective and non-selective media in addition to media enriched with 5% blood. Results: Regarding the prosthetic patients, the rate of bacterial isolates from the palate, back, tongue and dental plaque smears was higher potential pathogenic bacteria as S. aureus and Enterobacteriaceae spp in denture wearers, as E. coli (6.6% in dentures vs. 1.6% in the absence of dentures), Klebsiella pneumoniae (11.4% in dentures versus 1.6% in the normal teeth) and Pseudomonas aeruginosa (13.1% versus 0.0% ).While in viridians Streptococcus including Strept .mutans, there was a lower colonization rate in denture patients (18% in palate verses, 73.8% in individuals without dentures). Conclusion: The study demonstrated an elevated rate of bacterial isolates from palate, back, tongue and plaque swabs in denture patients of pathogenic bacteria such as S. aureus, E. coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa; while in Streptococcus viridians including S. mutans, there was a lower colonization rate in denture patients verses a very high rate in individuals without dentures. Peer Review History: Received: 7 November 2022; Revised: 13 December; Accepted: 8 January 2023, Available online: 15 January 2023 Academic Editor: Ahmad Najib, Universitas Muslim Indonesia, Indonesia, ahmad.najib@umi.ac.id Received file: Reviewer's Comments: Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. Alfonso Alexander Aguileral, University of Veracruz, Mexico, aalexander_2000@yahoo.com Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, amaka_mgbahurike@yahoo.com Similar Articles: ETIOLOGY AND RISK FACTORS OF STOMATITIS AMONG YEMENI DENTURE WEARERS PREVALENCE AND ASSOCIATED FACTORS OF ORAL NON-CANDIDA ALBICANS CANDIDA CARRIAGE IN DENTURE WEARERS IN SANA'A CITY- YEMEN THE EFFECT OF NANOSILVER AND CHLORHEXIDINE MOUTHWASH ON ANAEROBIC PERIODONTAL PATHOGENS COUNTS

Effects of acrylic dentures on oral mucosa and salivary antimicrobial peptide content in denture wearers

Relevance. Aging of the body leads to the development of an imbalance in the secretory immunity of the oral mucosa, with the loss of natural teeth leading to an even more rapid decline in the host’s oral defense reactions. However, studies on salivary antimicrobial peptides in denture users and their potential role in protecting against the development of inflammation are still scarce at this time.Purpose. To evaluate the effects of full removable acrylic dentures on the oral mucosa and analyze the content of antimicrobial peptides in the saliva of wearers of such dentures.Materials and methods. Sixty-seven (21 men and 46 women) elderly patients (61 to 74 years old) with complete tooth loss were examined and divided into 3 study groups. In the 1st control group the patients did not use any dentures. Patients in groups 2 and 3 were made full removable acrylic dentures for the upper and lower jaws, and in group 2 from the first day of the adaptation period was used domestic denture fixation cream ASEPTA PARODONTAL. Assessment of the denture bed on the hard palate was performed visually using the Schiller – Pisarev test. Microbiological examination for Candida albicans was performed by PCR-diagnostics. The content of antimicrobial peptides in saliva was assessed using ELISA kits by Hycult Biotech.Results. The use of the adhesive cream was found to improve the condition of the palatal mucosa by 25% on the 15th day and by 50% on the 30th day of the adaptation period. Candida albicans was detected in oral material in more than 55% of patients in all groups during their initial examination. In the group of patients using denture fixation cream, a significant decrease in Candida albicans carriage was noted, while an increase in Candida albicans detection of up to 70% was noted in those not using the cream. There was also an increase in the level of cathelicidin LL-37 in the saliva of patients without the use of the cream and with a marked increase in inflammation. One month after dentures in patients without cream use the content of alpha-defensins (HNP 1-3) was significantly lower than that of the group with cream and the control group.Conclusion. On the basis of the carried out clinical and laboratory study, the domestic ACEPTA adhesive cream should be recommended for optimization of the adaptation period to removable acrylic dentures as well as for their permanent use.

Management of palatal entrapment of mini-implant supported pendulum appliance: A case report

This case report describes the surgical management of mucosal entrapment of a mini-implant-supported molar distalization appliance.A 17-year-old female patient was referred for removal of a implant-supported pendulum appliance entrapped in the palatal mucosa, which is used for molar distalization by the Department of Orthodontics. The clinical findings suggested that the overlying soft tissue was non-inflammatory and occurred due to forceful impingement of the wire component on the palatal mucosa.Surgical intervention was planned for removal of the mucosal entrapped appliance. A V-shaped incision was made under local anesthesia to expose the wire. The Appliance was completely removed, and silk sutures were placed for proper primary closure. Healing was uneventful, with minimal discomfort.While there are risks associated with orthodontic treatment with fixed and removable appliances, they can be avoided by adopting the required measures during treatment and educating patients about their responsibilities.

Posterior superior alveolar nerve block alone in the extraction of upper third molars: a prospective clinical study.

Third molar extraction is the most commonly performed minor oral surgical procedure in outpatient settings and requires regional anesthesia for pain control. Extraction of the maxillary molars commonly requires both posterior superior alveolar nerve block (PSANB) and greater palatine nerve block (GPNB), depending on the nerve innervations of the subject teeth. We aimed to study the effectiveness of PSANB alone in maxillary third molar (MTM) extraction. A sample size comprising 100 erupted and semi-erupted MTM was selected and subjected to study for extraction. Under strict aseptic conditions, the patients were subjected to the classical local anesthesia technique of PSANB alone with 2% lignocaine hydrochloride and adrenaline 1:80,000. After a latency period of 10 min, objective assessment of the buccal and palatal mucosa was performed. A numerical rating scale and visual analog scale were used. In the post-latency period of 10 min, the depth of anesthesia obtained in our sample on the buccal side extended from the maxillary tuberosity posteriorly to the mesial of the first premolar (15%), second premolar (41%), and first molar (44%). This inferred that anesthesia was effectively high until the first molars and was less effective further anteriorly due to nerve innervation. The depth of anesthesia on the palatal aspect was up to the first molar (33%), second molar (67%), and lateromedially; 6% of the patients received anesthesia only to the alveolar region, whereas 66% received up to 1.5 cm to the mid-palatal raphe. In 5% of the cases, regional anesthesia was re-administered. An additional 1.8 ml PSANB was required in four patients, and another patient was administered a GPNB in addition to the PSANB during the time of extraction and elevation. The results of our study emphasize that PSANB alone is sufficient for the extraction of MTM in most cases, thereby obviating the need for poorly tolerated palatal injections.

Çok Sayıda Flebolitle İzlenen Oral Hemanjiyom

Hemangioma is a rare, non-reactive, benign vascular tumor, characterized by endothelial cell proliferations and results from vascular malformation. Hemangioma mostly occurs on head and neck skin and regresses spontaneously within 5-10 years in 50-90% of cases. However, oral lesions show less regression than skin lesions. The most commonly affected area is tongue and palatal mucosa, and rarely observed in jaw bones. Diagnosis is based on anamnesis and clinical features. Blanching of the hemangioma under pressure is characteristic clinical finding. Phlebolith is calcified thrombus in veins, venules and sinusoidal walls of hemangiomas. Head and neck phleboliths almost always indicate the soft tissue hemangioma. Phleboliths observed with hemangioma in head and neck region have distinctive appearance on panoramic radiographs. Cone-beam computed tomography provides useful information about location and distribution of phleboliths. In this case report, clinical and radiological features of oral hemangioma and many associated phleboliths are presented.

Stability of palatal rugae after orthodontic/orthopaedic expansion: a scoping review

Abstract Objective The palatal rugae are connective tissue located in the anterior third of the hard palate and present asymmetrically on each side of the palatine raphe. The stability and individualistic features of the palatal rugae have been suggested as an alternative human identification method in forensic medicine. However, there are different views about the tissue’s stability and reliability in individuals undergoing orthodontic expansion, as the palatal mucosa is stretched which likely alters palatal rugal morphology. The present review aims to summarise the available evidence regarding the stability of the palatal rugae after orthodontic expansion. Method Following the PRISMA-Scr guidelines, an extensive search was conducted using three databases (PubMed, Web of Science, and Scopus). Only studies that had control groups were included to allow for comparison. Results A total of six studies were identified. One report did not mention the type of expansion used, another used slow maxillary expansion (SME), and the other four used rapid maxillary expansion (RME). The results related to rugal length, morphological shape, and root mean square were inconclusive, likely because of data heterogeneity in expansion mechanics, the age of inclusion, and measurement outcomes. Conclusion More high-quality research is needed to substantiate the importance of palatal rugae in forensic medicine.

Vascular endothelial growth factor as a response of denture bearing tissues on mechanical stress in diabetes mellitus

Introduction. Vascular endothelial growth factor (VEGF) is signal molecule enrolled in diabetes mellitus type 2 (DM type 2) oral complications, but there are no studies showing the relation between VEGF and pressure caused by denture wearing in diabetic conditions. The aim of this study is to compare tissue VEGF levels in patients and animals with/without DM in conditions of chronic and acute pressure. Methods. Research was conducted on DM type 2 and healthy partial denture wearers for more than 5 years (78), candidates for teeth extractions and experimental animals of the Wistar rats (40). For chronic conditions, VEGF was measured in 2 mucosal samples covered and not covered by denture in all denture wearers. Demonstrating acute conditions, after 3 days of wearing experimental plate VEGF was measured in 2 gingival samples of palatal mucosa of DM (20) and control rats (20). The concentrations of VEGF (pg/ml) in human and animal tissues were measured by commercially available ELISA kit. Results. Tissue VEGF levels in control and diabetic partial denture wearers not covered by denture were without statistical difference. In comparison to noncovered tissue, VEGF decreased in samples covered by denture, being significantly lower in DM type 2, comparing to healthiest. VEGF levels in palatal mucosa without palatal base did not significantly differ in control and DM rats. VEGF levels under palatal base increased being significantly lower in DM rats comparing to controls. Conclusion. Both, chronic and acute mechanical stress caused by wearing palatal denture (plate) decreased the VEGF levels in diabetic conditions comparing the health?s suggesting the altered homeostasis.