Post Extraction Research Articles

English

Complex crown root fracture has been reported to be 5 % among the traumatic injuries to permanent teeth. In children, when fracture line extended sub gingivally, the treatment option remained was the extraction of tooth. This extraction led to alveolar bone loss and compromised the outcome of final prosthesis. Root submergence is one of the treatments options which can prevent bone loss and prepare future pontic site in a better way. In children, this technique can prevent not only bone loss but also the occurrence of space loss and development of tongue thrusting habit. Crown-root fracture is defined as a fracture involving enamel, dentin and cementum. It is reported in about 5 % of dental trauma to young children where root completion has not occurred.1 Treatment of these complex tooth fractures in aesthetic zone in growing age is always challenging for the paedodontists. The treatment should not interfere with the growth and development. Depending upon the extension of the fracture line which can result in exposure of the pulpal tissue, the crown-root fracture can be divided into two groups: complicated and uncomplicated. 2 Treatment options in cases of complicated crownroot fractures are complex, and require a multidisciplinary approach. Dental traumatology guideline and American Academy of Paediatric Dentistry has suggested fragment reattachment, orthodontic or surgical extrusion of apical portion followed by post placement, root submergence and extraction. 3 Factors like extension and direction of fracture line, pulpal involvement, tooth maturity and the length of root remaining in the alveolus govern the treatment choice. 4,5 Among above mentioned factors, position of facture line is the most important. As in case of subgingival facture line, risk of bacterial contamination is present and further this may result in gingival inflammation.6 When crown root fracture to permanent tooth occurs in mixed dentition period, goals of treatment are to preserve the tooth in arch without disturbing the growth & development of root and arch. But in case of complicated crown root fracture, when extraction is the only choice of treatment, future complications like space loss, crowding, habits like tongue thrusting and importantly loss of alveolar bone height should be kept in mind. Goals of treatment plan in such cases should be elimination of space loss, development of deleterious habit and maintenance of alveolar ridge for future pontic or implant site. Root submergence is the technique with which we can achieve these goals, keeping this in mind this case was planned and reported.

The effect of 3% binahong leaf extract gel on the wound healing process of post tooth extraction

Background: One of the common frequently performed procedures in dentistry is tooth extraction. After tooth extraction, a series of biological events occurs in the alveolar socket that ultimately results in healing of the socket. Binahong (Anredera cordifolia) is an herbaceous plant that contains active compounds that may accelerate the wound healing process. Purpose: The aim of this study is to investigate the effect of 3% binahong leaf extract gel on the healing process of the postextraction wound. Methods: 3% binahong leaf extract gel was prepared with the composition of 1 g carbopol, 1 g hydroxypropilmethylcellulose (HPMC), 4 g glycerin, 3 g triethanolamine (TEA), 0.04 g Nipagin, 0.04 g Nipasol, 1.2 g binahong leaf extract and Aq ad 40 g. A total of 18 people were subjected to tooth extraction and were then divided into two groups, with nine people in the binahong group and nine in the control group. Following that, residual socket volume (RSV) was examined on days 3, 7 and 14 after the extraction in both the binahong and control groups. The RSV value was obtained by calculating the mesiodistal x bucolingual width x the depth probing and measured using a calliper and probe. Repeated analysis of variance (ANOVA) and Friedman test followed by Wilcoxon and dependent t-test (p<0.05) were used to analyse data. Results: Significant difference in the mean RSV between the control and binahong groups was observed on days 3, 7 and 14 post tooth extraction. The RSV value in the binahong group was lower when compared to the control group (p <0.05). Conclusion: 3% binahong leaf extract gel can accelerate the process of healing socket wounds.

Effect of Needle Free Jet Anesthesia Comfort-in™ on post extraction bleeding and inflammation in children

Introduction: After tooth extraction, it is normal for the area to bleed and then clot, generally within a few minutes. It is abnormal if bleeding continues without clot formation, or lasts beyond 8 to 12 hours; this is known as post-extraction bleeding (PEB). Such bleeding incidents can cause distress for patients, who might need emergency dental consultations and interventions. The causes of PEB can be local, a systemic disease, or a medication Objective of this study to assess the needle free jet anesthesia comfort-in™ on post extraction bleeding and inflammation in children. Materials & Methods: The study was performed on 50 Egyptian children patients who are attending the pediatric dental clinic for treatment at Pedodontics and Oral Health Department, Faculty of Dental Medicine, Boys, Cairo, Al-Azhar University. Results: It was found that using jet technique result in less inflammatory mediators than using syringe technique. Conclusion: jet technique is a promising technique in anaesthesia with a high success rate and showing competitive properties to syringe technique. It has the power to be an alternative for syringe technique.

Effect of the Combination of Demineralization Freeze Dried Dentin Matrix (DFDDM) and Moringa oleifera Lam on Osteoprotegerin (OPG) and Receptor Activator of Nuclear Factor Kapa B Ligand (RANKL) as a Marker of Bone Remodeling

Background: The socket preservation has important role in alveolar bone resorption after tooth extraction. Various graft materials can be used in socket preservation must have osteoconductive, osteoinductive and osteoproliferation properties. Autogenous bone graft from dentin can be used because it has good osteoinductive and osteoconductive properties. One of the active substances of Moringa oleifera (MO) is flavonoids that have several beneficial characteristics as an anti‑inflammatory. The combination of anti-inflammatory with MO extract and Demineralization Freeze Dried Dentin Matrix (DFDDM) is expected to provide a good response to bone formation. Aim: To determine the potential of combination Moringa oleifera and DFDDM in formation of OPG and RANKL expression post extraction cavia cobaya’s tooth. Method: The mandibular incisors of 45 Cavia cobaya were extracted and divided into five groups subjected to different socket preservation treatments sequentially with MO, DFDDM, combination of MO and DFDDM, Gamacha® and polyethylene glycol (PEG). The cavia cobaya were examined on days 7, 14 and 21 after which the specimens were sacrificed and examined using an immunohistochemical technique. The resulting data were then analyzed using one‑way ANOVA and Tukey’s honestly significant difference tests. Result: The One Way Anova test results showed a significant difference in OPG and RANKL between the groups (p

Anti-inflammatory Activity of Mollugo cerviana Methanolic Extract in LPS-induced Acute Inflammatory RAW 264.7 Macrophages.

The management of acute inflammation, which arises from complex biological responses to harmful stimuli, is an important determinant in the recovery from an otherwise detrimental outcome such as septicemia. However, the side effects and limitations of current therapeutics necessitate the development of newer and safer alternatives. Mollugo cerviana is a common medicinal herb of the Indian subcontinent and has been traditionally used for its fever mitigating anti-microbial and hepatoprotective action. We have already reported the rich presence of radical scavenging phytochemicals in the plant extracts and their strong antioxidant properties. In the present study, we have evaluated the anti-inflammatory effects of methanolic extract (ME) of the areal parts of M. cerviana in a lipopolysaccharide (LPS)-induced acute inflammatory cell culture model. RAW 264.7 mouse macrophage cells were stimulated by the bacterial endotoxin LPS at a concentration of 1 μg/mL. Cytotoxicity and anti-inflammatory potential of ME were carried out. The concentration of M. cerviana extract up to 150 μg/ml was found to be non-toxic to cells (MTT and NRU assay). LPS induces acute inflammation by binding to TLR-4 receptors, initiating a downstream signalling cascade that results in pro-inflammatory cytokine secretion. Extract treatment at 100 μg/ml suppressed LPS-induced gene expression (qPCR) and secretion (ELISA) of pro-inflammatory cytokines IL-1β, IL-6 and TNF-α, and the chemokine CCL2, leading to dampening of the acute inflammatory cascade. LPS-induced elevation of ROS level (DCFDA method) was significantly reduced by extract treatment. Nitric oxide production, as indicated by nitrite level, was significantly reduced post extract treatment. This study demonstrated that M. cerviana methanolic extract has a potent antiinflammatory effect in the in vitro acute inflammation model of LPS-stimulated RAW 264.7 cells. There is no reported study so far on the anti-inflammatory properties of M. cerviana in an LPSinduced acute inflammatory model, which closely mimics a human bacteremia response. Hence, this study highlights the therapeutic potential of this extract as a source of anti-inflammatory lead molecules.

Effectiveness of Honey and Aloe Vera on the Post Extraction Healing Among Young Adults: A Randomized Clinical Trial

INTRODUCTION: "Dry socket" was first described by Crawford in literature in 1896. When people are recognizing that current medicine is not the soul cure for diseases, we look back to the past for potential remedies with the least possible side-effectiveness. So the objective of this study was to evaluate the effectiveness of honey and aloevera on healing of post extraction wounds. MATERIAL AND METHODS: Honey and aloe-vera were prepared by mixing with sterilized cotton. The socket involved was separated by dry autoclaved cotton rolls from the rest of the oral cavity, then honey/aloe-vera was inserted into the respective groups. All patients were advised to avoid solid and liquid diets for 30 minutes after the treatment. Dressings were changed on 3rd day and on 7th day and sockets were evaluated. RESULTS: When the intra-group comparison of honey (p-value=0.003) and aloe-vera (p-value=0.000) was done, both were found to be statistically significant in the healing of dry socket. When the inter-group comparison was done between honey and aloe-vera, Aloe-vera had high healing capacity and was found to be highly statistically significant (p-value=0.001). DISCUSSION: When the intra-group comparison of honey and aloe-vera was done, both were found to be statistically significant in the reduction of dry socket. When the inter-group comparison was done between honey and aloe-vera, Aloe-vera had high healing capacity and was found to be highly statistically significant (p-value=0.00). CONCLUSION: From the analysis, it can be inferred that aloe vera and honey are healthy, natural and user-friendly substitute adjuncts that might be feasible to promote healing of extraction sockets.

COMPARISON OF POST EXTRACTION SOCKET HEALING WITH AND WITHOUT USING PLATELET RICH FIBRIN (PRF) – A CLINICAL AND RADIOGRAPHIC STUDY

AIM: The aim of this study is to comparatively evaluate the post extraction socket healing clinically and radiographically with and without using Platelet Rich Fibrin (PRF). MATERIALS AND METHODS: Fifty, otherwise healthy individuals undergoing dental treatment in the department of Oral and Maxillofacial surgery, Vivekananda Dental College for women, Thiruchengode, were randomly selected and the participants were divided into two groups – test group(PRF, n=25) and control group (Blood clot, n=25). Blood was freshly obtained from the participants of the test group and PRF was prepared. PRF was placed in the sockets of the test group and followed by the pressure application and suturing. Control group were allowed to heal naturally. Clinically, soft tissue healing and socket closure were assessed. Radiographic analysis of socket healing done by comparison of pre- and post-operative radiographs. The clinical follow-up assessments were done at an interval of 3 days, 1 week and 4 weeks and the data obtained were assessed. The patients were aged above 18 years, i RESULT: ncluding 33 females and 17 males. The soft tissue and socket healing were higher in the test group when compared with the control group clinically and the mean proportion of radiographic bone ll was signicantly higher in the test group in all the time intervals of 3 days, 1 week and 4 weeks, respectively. Outcome of the study CONCLUSION: demonstrate that the PRF placement in the extraction socket accelerates soft tissue healing and socket healing and increases the bone ll and reduces the bone resorption using clinical and radiographic methods.

Comparative evaluation of the synbiotics, antibiotics and analgesics in post extraction healing of tooth sockets- A randomized control trial

The emergence of antibiotic resistance and its side effects have restricted their use in array of prophylactic options in present scenario. Indeed, some new strategies and alternative therapies like herbal medicines and laser therapies have already minimised the use of antibiotic prevent/cure health related issues or oral diseases. Nowadays many authors are trying to prove influence of synbiotics in oral health maintenance so this study was done to check the usage of synbiotics and its benefits in the post extraction tooth socket. The aim of this research is to study the effect of synbiotics supplements on post-surgical complications and oral wound healing after extraction of tooth. To determine the clinical effectiveness and cost-effectiveness of synbiotics over antibiotics and analgesics in post extraction of tooth socket. This study is a randomized controlled trial, parallel group, multicentre trial comparing the efficacy of synbiotics in healing of post extraction sockets that was conducted in three centres of Lucknow city-India including BBD dental college of dental sciences. Three groups were made with 80 patients in each group. The primary outcome measures were observed in each group on 3rd day, 5th day and 7th day. We could find significant difference between the 3 groups regarding the evaluated parameters. In age and gender distribution was observed. Wound related complications like bleeding, swelling and gut flora disturbance at the surgical site was present more in group 2 and group 3 as compared to group 1 which is found statistically significant with p value 0.02, 0.01 and 0.01. In the cost analysis during the treatment among the study subjects was noted where statistical significant results were obtained between groups 1 vs group 2; group 1 vs group 3 and group 2 vs group 3 at p ≤ 0.01. Since this was a novel approach in comparing the post extraction wound healing and as the results showed a definite positive effect by synbiotics. Further studies with a larger sample and different formulation would be recommended to be put into clinical use.

A longitudinal study to evaluate the bleeding pattern of patients on low dose aspirin therapy following dental extraction.

Background and Aims:Antiplatelet dugs are often interrupted preceding invasive dental extraction because of concern of bleeding complications. The fear of uncontrolled bleeding often prompts medical and dental practitioners to stop aspirin intake for 7 to 10 days before any surgical procedure, which puts the patient at risk from adverse thrombotic events. The aim of the study conducted was to evaluate the bleeding pattern after routine dental extraction among patients on low dose long term aspirin therapy.Methods:A total of 104 subjects in the age group of 30-65 years, who continued to have aspirin intake during extraction were included in the study. Dental extraction was performed without stopping aspirin therapy under local anesthesia. The post-operative blood loss was quantified by weighing the gauze pre and post operatively and adding total volume of fluid in the suction jar.Results:Of these 104 patients treated, 87% of patients had mild bleeding (<20 ml) and 13% of patients had moderate bleeding (20-30 ml). The total study population showed a mean blood loss of 16.15 ± 3.5 ml.Conclusion:Within in the limitations, our study concluded that the routine dental extraction in patients under low dose aspirin therapy did not cause clinically significant post extraction hemorrhage. Aspirin intake can be continued during routine dental extraction as post extraction bleeding encountered will be negligible.

Evaluation of marginal bone loss after Immediate implant placement in maxillary esthetic zone with coral bone versus xenograft

Conclusion: Results demonstrated a small amount of marginal bone loss in both groups yet it was statistically significant, there was more marginal bone loss in group A (with xenograft ) than group B (with coral bone) but it was not statistically significant. The aim of the study is to evaluate marginal bone loss using coral bone graft which is a xenograft of marine origin versus xenograft of bovine origin in immediate implant placement in maxillary esthetic zone as a gap filling material. Materials and Methods: Ten patients were participated in this study (3 males and 7 females), with a mean age of 34 years having non restorable single or multiple maxillary anterior teeth (18 fresh extraction sockets were conducted in the study). patient's sockets were divided randomly and equally into 2 groups : Group A (control group): included 9 extraction sockets in 5 patients (one male and 4 females) which recived immediate post extraction implant placement with xenograft between the residual labial bone and implant surface. Group B (study group): included 9 extraction sockets in 5 patients(2 males and 3 females) which received immediate post extraction implant placement with coral bone between the residual labial bone and implant surface. Cone beam CT was taken immediately post operative and 4 months postoperatively to measure the amount of marginal bone loss in each group and then the percentage of bone loss in each group.

The link between gender and post-extraction complications of teeth

Extraction of teeth is a common procedure in dentistry. Recalling patients for monitoring wound healing is a concern in surgical procedures. It allows foreseeing signs or/and symptoms possibly related to surgical complications. Therefore, it is of interest to document the link between gender and complications in post extraction. The null hypothesis was age and gender had no impact on post dental extraction. We used patient records at Saveetha Dental College, India for this study. The overall follow-up rate post-extraction is less compared to known literature. Data shows that males outnumbered the females and those “above 40 years” than “below 40 years” in follow-up. Thus, we report that factors such as gender, age and the presence of a post-operative complication play a key role in determining whether a patient reports back for follow-up after routine extractions.

Preparation and biodegradable properties of hydroxyapatite nanoparticle composite coated with poly lactic-co-glycolic acid/polyvinyl alcohol for bone regeneration.

Bone loss rapidly increases 6 months post tooth extraction, which causes the atrophy of the alveolar bone. Two kinds of biomaterials which can stimulate bone regeneration are bioceramics and polymers. Making a composite of biomaterials results in better physical and biomolecular characteristics in comparison with a bioceramic or a polymer alone. Hydroxyapatite nanoparticles (HANPs) are one of the bioceramics commonly used for bone regeneration; they can degrade faster than hydroxyapatite (HA) microparticles, but have an insufficient pore size. Polyvinyl alcohol (PVA) and poly lactic-co-glycolic acid (PLGA) are polymers which have been used for biomedical applications. However, PLGA alone has insufficient cell attachment and PVA alone slowly degrades in the bone tissue. The aim of the present study was to analyze the biodegradation properties of the HANP/PLGA/PVA composites and investigate the pore size. The HANP/PLGA/PVA composites were prepared using the freeze-drying method, with 20% (w/w) of HANP and 20% (w/w) of PLGA. Morphology and the pore size were determined by means of the field emission scanning electron microscopy (FE-SEM) analysis. Biodegradation properties were determined by calculating water uptake and water loss for 1, 3 and 6 weeks. Statistical analysis was performed based on the one-way analysis of variance (ANOVA) at p < 0.05. The HANP/PLGA/PVA composites had the greatest mean pore size and a rougher surface than others (176.00 ±61.93 μm; p < 0.05). Moreover, the HANP/PLGA/PVA composites had the greatest water uptake, significantly in the 3rd (730.46%; p < 0.05) and 6th weeks (731.07%; p < 0.05), and water loss in the 6th week (67.69%; p < 0.05). The HANP/PLGA/PVA composites have optimal pore size, morphology and degradability, which shows their high potential as an effective bone scaffold to repair the alveolar defect post tooth extraction.

Influence of Post-operative Instructions on Wound Healing. A Randomized, Single-blinded Clinical Trial.

Postoperative instructions that are properly delivered can play a major role in treatment outcomes, especially excellent wound healing. This study aimed to examine the mode of delivering postoperative instructions in decreasing the side effects of poor wound healing following simple tooth extraction. This single-blinded, randomized clinical trial was conducted on 400 patients presented for simple extraction of unimpacted teeth. The patients were randomly assigned to two groups of verbal and verbal plus written instructed groups. Collected data were analysed using descriptive and inferential statistics at a significance level of 95%. More men (51.5%) were seen. The participants' mean age was 37.3 ± 14.3 years (range, 18-87 years). The results showed that the mode of delivering instructions had a marked relation with socket healing. The post-extraction healing score was significantly higher in the verbal and written instructed group compared with the verbal instructions alone (P = 0.00). The age (P = 0.04) and type of instruction (P = 0.00) were significantly associated with excellent wound healing. Only the type of instruction that independently predicted the excellent wound healing (OR = 0.12; P = 0.00). The mode of delivering post-operative instruction affected the post extraction socket healing. Patients who received written and verbal instructions reported excellent post extraction socket healing than those who had verbal instructions only. All medical practitioners are recommended to use both verbal and written post-operative instruction

Evaluation of systolic and diastolic blood pressure, pulse rate and SPO2 levels pre and post dental extraction under local anesthesia

Aim: To evaluate the changes in blood pressure, pulse rate and SpO2 pre during and post extraction procedure under local anesthesia. Materials and Method:A total of 150 patients were included in the study. Pulse oximeter was placed to evaluate the parameters and changes were investigated before administering local anesthesia, during anesthesia, during extraction procedure and post extraction. Data was tabulated and statistical analysis was done using 20 SPSS software. Results:Almost of the patients has increase in the systolic blood pressure and pulse rate during administration of local anesthesia and during extraction procedure. Very minimal change was observed in diastolic blood pressure and SpO2 levels. Conclusion:Significant changes are noted in changes in systolic blood pressure and pulse rate pre administration of local anesthesia, during administration of local anesthesia, during extraction, and post extraction procedure. Diastolic blood pressure and SpO2 has no significant differences. Keywords:Blood pressure, Pulse rate, SpO2, Dental extraction, Local anesthesia

Do preoperative cutaneous bleeding time tests predict the outcome of intraoral surgical bleeding?

To determine whether cutaneous bleeding time (BT) is related to perioperative bleeding outcome measures after tooth extraction. To determine whether this investigation is reliable to predict bleeding outcome after an intraoral surgical procedure. A prospective clinical pilot study of 30 subjects. Cutaneous BT was evaluated before tooth extraction. After extraction, an oral BT was determined. Subjects were contacted 2-5 hours after extraction to assess further post operative bleeding. The mean cutaneous BT was 2.3 minutes (range 1.5-3.5). The mean oral BT was 9.1 (range 7-12). Cutaneous BT did not correlate with oral BT or any other measures of prospective bleeding. However, the time necessary for extraction correlated with extraction site bleeding 2-5 hours after surgery. There was no relationship between cutaneous and oral post extraction BT. The use of BT test as a screening procedure is unnecessary for prediction of prolonged bleeding after tooth extraction or minor surgical procedures in the present situation.

Repeatability and agreement of corneal thickness measurements by three methods of pachymetry in small incision lenticule extraction eyes

ABSTRACT Background: The accurate evaluation of corneal thickness (CT) post small incision lenticule extraction (SMILE) is clinically relevant to reduce the risk of complications. We aimed to analyze repeatability and agreement of central corneal thickness (CCT), thinnest corneal thickness (TCT), and mid-peripheral corneal thickness (MPCT) measurements using Scheimpflug imaging, anterior segment swept-source optical coherence tomography (AS-SS-OCT, CASIA 1000, Tomey), and ultrasound pachymetry (USP, SP-3000, Tomey) in eyes with previous SMILE. Methods: Ninety-one eyes of 91 patients were included. Within-subject standard deviation (Sw), test-retest repeatability (TRT), intraclass correlation coefficient (ICC), and coefficient of variation (CoV) were used to evaluate repeatability. Agreement was assessed by repeat-measurement analysis of variance and Bland–Altman analysis. Results: The above three instruments revealed that Sw was <5.91 µm, CoV was <1.08%, TRT was <16.38 µm, and ICC was >0.94. The 95% limits of agreement were relatively narrow and Bland–Altman plots were more concentrated at the CCT, at the TCT, and at the CT2mm. However, it was shown to be wide at the CT5mm. Conclusions: The three devices provide good repeatability of CT measurements in patients who undergone SMILE. Agreement between measurements at the CCT, TCT, and CT2mm were high, but measurement agreements among CT5mm revealed poor agreement.

The Impact of Double Layer Membrane Technique on Bone Regeneration in Postextraction Alveoli – A Pathohistological Experimental Study in Dogs

Abstract Post extraction alveolar ridge preservation is a preventive oral surgical procedure aimed to preserve the dimensions of the alveolar ridge after removal of the teeth. According to literature data, the utilization of guided bone regeneration for this purpose is absolutely justified. The aim of this study was to examine the effect of resorbable collagen membranes placed in two layers in respect to the application of membranes placed in one layer to the degree of bone regeneration after a tooth extraction. This experimental study was conducted on six adult dogs. In the first phase all four premolars were extracted on both sides in the lower jaw. After the volume-standardisation with bone drill, three post extraction alveoli were filled with bone substitute of equine origin and then covered with: collagen bioresor bable membrane of porcine origin; collagen bioresorbable membrane of equine origin; pericardial bioresorbable membrane of equine origin. The membranes on the left side were placed in single-layer and on the right side in double-layer manner. After different monitoring periods, histopathological analysis of the samples taken from the experimental regions was performed. A different degree of bone regeneration was achieved between experimental regions in which membranes were placed in one layer and those where membranes were placed in two layers. There was no difference between regions where membranes of different origin were placed in the same manner. The procedure of covering the post extraction alveoli, filled with bone substitute and with resorbable membranes placed in two layers resulted in a higher degree of bone regeneration compared to those where resorbable membranes were placed in one layer.

Efficacy of platelet rich plasma (PRP) on mouth opening and pain after surgical extraction of mandibular third molars

Introduction: Surgery of mandibular third molar teeth for removal is one of the most common procedures undertaken in oral and maxillofacial surgery departments. The complications created by the post extraction wound healing and physiological consecution of third molar surgery can affect patients' quality of life. Platelet rich plasma (PRP) is an autologous concentrate of platelets suspended in the Plasma that accelerates healing by concentration of growth factors which lessen the inflammation and as a result pain and trismus. Materials and methods: A Study was conducted on 130 patients at the department of Oral and Maxillofacial Surgery, FUCD Islamabad, for a period of 6 months after ethical approval. The patients with impacted mandibular wisdom teeth were selected and divided equally into two equal groups. The pain score was measured using the visual analogue scale (VAS) and trismus was measured using Vernier caliper before the surgery, immediately after surgery, on 3rd and 7th follow up visits. Results: The mean postoperative pain on 7th day was significantly lower in the PRP group with statistically significant P-value &lt;0.0001. Trismus was also less reported in the PRP group with P-value &lt;0.00065. Conclusion: Platelet Rich Plasma is effective to lessen trismus and pain after surgical removal of mandibular third molar teeth.

Ex-vivo quantification of ovine pia arachnoid complex biomechanical properties under uniaxial tension

BackgroundThe pia arachnoid complex (PAC) is a cerebrospinal fluid-filled tissue conglomerate that surrounds the brain and spinal cord. Pia mater adheres directly to the surface of the brain while the arachnoid mater adheres to the deep surface of the dura mater. Collagen fibers, known as subarachnoid trabeculae (SAT) fibers, and microvascular structure lie intermediately to the pia and arachnoid meninges. Due to its structural role, alterations to the biomechanical properties of the PAC may change surface stress loading in traumatic brain injury (TBI) caused by sub-concussive hits. The aim of this study was to quantify the mechanical and morphological properties of ovine PAC.MethodsOvine brain samples (n = 10) were removed from the skull and tissue was harvested within 30 min post-mortem. To access the PAC, ovine skulls were split medially from the occipital region down the nasal bone on the superior and inferior aspects of the skull. A template was used to remove arachnoid samples from the left and right sides of the frontal and occipital regions of the brain. 10 ex-vivo samples were tested with uniaxial tension at 2 mm s−1, average strain rate of 0.59 s−1, until failure at < 5 h post extraction. The force and displacement data were acquired at 100 Hz. PAC tissue collagen fiber microstructure was characterized using second-harmonic generation (SHG) imaging on a subset of n = 4 stained tissue samples. To differentiate transverse blood vessels from SAT by visualization of cell nuclei and endothelial cells, samples were stained with DAPI and anti-von Willebrand Factor, respectively. The Mooney-Rivlin model for average stress–strain curve fit was used to model PAC material properties.ResultsThe elastic modulus, ultimate stress, and ultimate strain were found to be 7.7 ± 3.0, 2.7 ± 0.76 MPa, and 0.60 ± 0.13, respectively. No statistical significance was found across brain dissection locations in terms of biomechanical properties. SHG images were post-processed to obtain average SAT fiber intersection density, concentration, porosity, tortuosity, segment length, orientation, radial counts, and diameter as 0.23, 26.14, 73.86%, 1.07 ± 0.28, 17.33 ± 15.25 µm, 84.66 ± 49.18°, 8.15%, 3.46 ± 1.62 µm, respectively.ConclusionFor the sizes, strain, and strain rates tested, our results suggest that ovine PAC mechanical behavior is isotropic, and that the Mooney-Rivlin model is an appropriate curve-fitting constitutive equation for obtaining material parameters of PAC tissues.

Flood severity mapping from Volunteered Geographic Information by interpreting water level from images containing people: A case study of Hurricane Harvey

With increasing urbanization, in recent years there has been a growing interest and need in monitoring and analyzing urban flood events. Social media, as a new data source, can provide real-time information for flood monitoring. The social media posts with locations are often referred to as Volunteered Geographic Information (VGI), which can reveal the spatial pattern of such events. Since more images are shared on social media than ever before, recent research focused on the extraction of flood-related posts by analyzing images in addition to texts. Apart from merely classifying posts as flood relevant or not, more detailed information, e.g. the flood severity, can also be extracted based on image interpretation. However, it has been less tackled and has not yet been applied for flood severity mapping.In this paper, we propose a novel three-step process to extract and map flood severity information. First, flood relevant images are retrieved with the help of pre-trained convolutional neural networks as feature extractors. Second, the images containing people are further classified into four severity levels by observing the relationship between body parts and their partial inundation, i.e. images are classified according to the water level with respect to different body parts, namely ankle, knee, hip, and chest. Lastly, locations of the Tweets are used for generating a map of estimated flood extent and severity. This process was applied to an image dataset collected during Hurricane Harvey in 2017, as a proof of concept. The results show that VGI can be used as a supplement to remote sensing observations for flood extent mapping and is beneficial, especially for urban areas, where the infrastructure is often occluding water. Based on the extracted water level information, an integrated overview of flood severity can be provided for the early stages of emergency response.