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Thorough knowledge of a patient's medical history and medications is necessary for providing safe oral surgery care, and may be considered a form of risk management. This study investigated the prevalence of medical conditions and medication types in patients referred to an Australian postgraduate oral surgery clinic over 2 years. A retrospective cross-sectional study of the clinical records of 233 randomized patients referred to the Griffith University (Queensland, Australia) postgraduate oral surgery clinic in 2018 and 2019 was performed. Medical conditions and medications were counted and categorized, and descriptive statistics were generated. In all, 133 patients (57%) had at least one medical condition. 58% of them (77) had two or more categories of medical conditions, representing nearly a third (33.0%) of all sampled patients. The most prevalent category of medical conditions was psychiatric (25.3%), followed closely by cardiovascular (24.5%) diseases. Cardiovascular medications were the most prevalent, comprising 23.6% of all medications recorded, followed by psychotropics (18.3%). Over half of patients referred to the postgraduate oral surgery clinic had at least one systemic medical condition. Nearly a third of patients referred had at least two distinct systemic medical conditions. With an ageing population and the accompanying rise in multimorbidity globally, dental school curricula must adapt to prepare students to meet these challenges in their careers.

Our study examined how different titanium alloy Ti6Al4V (Ti64) and zirconia (ZrO2) surfaces, ranging from rough to very smooth, affect the expression of elastase (NE), matrix metalloproteinase (MMP)-8, MMP-9, and extracellular traps (NETs) by neutrophils. Discs of Ti64 and ZrO2, 10 mm in diameter and 1.5 mm thick, were created using diamond-impregnated polishing burs and paste to produce rough (Ra > 3 µm), smooth (Ra ≥ 1 to 1.5 µm), and very smooth (Ra < 0.1 µm) surfaces. Neutrophils from Wistar rats were cultured on these surfaces, and the culture supernatants were then examined for NE, MMP-8, and MMP-9 using ELISA. At the same time, NET formation was demonstrated immunohistochemically by staining neutrophils with CD16b and DNA with DAPI. Overall, the expressions of NE and MMP-8 were significantly higher from neutrophil culture on Ti64 and ZrO2 rough surfaces compared to the very smooth surface (R > S > VS) after 2 h and 4 h of culture. The expression of MMP-9 also increased with culture time; however, no significant surface effects on expression were observed. Similarly, rough Ti64 and ZrO2 surfaces (R & S) also showed significantly larger NET formation compared to the very smooth surface (VS) after 4 h and 8 h cultures. Our findings suggest that increasing surface roughness on Ti64 and ZrO2 triggers higher NE, MMP-8, and NET formation secretion.

Objectives This systematic review aimed to assess in vitro studies that evaluated neutrophil interactions with different roughness levels in titanium and zirconia implant surfaces. Material and Methods An electronic search for literature was conducted on PubMed, Embase, Scopus, and Web of Science and a total of 14 studies were included. Neutrophil responses were assessed based on adhesion, cell number, surface coverage, cell structure, cytokine secretion, reactive oxygen species (ROS) production, neutrophil activation, receptor expression, and neutrophil extracellular traps (NETs) release. The method of assessing the risk of bias was done using the toxicological data reliability assessment tool (TOXRTOOL). Results Ten studies have identified a significant increase in neutrophil functions, such as surface coverage, cell adhesion, ROS production, and NETs released when interacting with rough titanium surfaces. Moreover, neutrophil interaction with rough–hydrophilic surfaces seems to produce less proinflammatory cytokines and ROS when compared to naive smooth and rough titanium surfaces. Regarding membrane receptor expression, two studies have reported that the FcγIII receptor (CD16) is responsible for initial neutrophil adhesion to hydrophilic titanium surfaces. Only one study compared neutrophil interaction with titanium alloy and zirconia toughened alumina surfaces and reported no significant differences in neutrophil cell count, activation, receptor expression, and death. Conclusions There are not enough studies to conclude neutrophil interactions with titanium and zirconia surfaces. However, different topographic modifications such as roughness and hydrophilicity might influence neutrophil interactions with titanium implant surfaces.

Purpose The aim of this paper is to explore the current theories about pretreatment assessment and dental management of patients receiving head and neck radiotherapy, and the therapeutic options to treat osteoradionecrosis of the jaws, based on the literature review. Discussion Osteoradionecrosis is one of the most serious oral complications of head and neck cancer treatment. Osteoradionecrosis is a severe delayed radiation-induced injury, characterized by bone tissue necrosis and failure to heal. Osteoradionecrosis either stabilizes or gradually worsens and is notoriously difficult to manage. Because most cases occur in patients who were dentulous in the mandible at tumor onset, proper dental management is the single most important factor in prevention. Conclusions Complete dental clearance before treatment is no longer necessary. Controversy exists regarding the management of osteoradionecrosis of the maxillofacial skeleton because of the variability of this condition. The treatment of osteoradionecrosis has included local wound care, antibiotic therapy, surgical procedures, and the administration of hyperbaric oxygenation. Recently, new methods of treatment were introduced, according to the new theory about its pathophysiology.

Guided bone regeneration (GBR) is a promising technique in bone tissue engineering that aims to replace lost or injured bone using resorbable scaffolds. The promotion of osteoblast adhesion, migration, and proliferation is greatly aided by GBR materials, and surface changes are critical in imitating the natural bone structure to improve cellular responses. Moreover, the interactions between bioresponsive scaffolds, growth factors (GFs), immune cells, and stromal progenitor cells are essential in promoting bone regeneration. This literature review comprehensively discusses various aspects of resorbable scaffolds in bone tissue engineering, encompassing scaffold design, materials, fabrication techniques, and advanced manufacturing methods, including three-dimensional printing. In addition, this review explores surface modifications to replicate native bone structures and their impact on cellular responses. Moreover, the mechanisms of bone regeneration are described, providing information on how immune cells, GFs, and bioresponsive scaffolds orchestrate tissue healing. Practical applications in clinical settings are presented to underscore the importance of these principles in promoting tissue integration, healing, and regeneration. Furthermore, this literature review delves into emerging areas of metamaterials and artificial intelligence applications in tissue engineering and regenerative medicine. These interdisciplinary approaches hold immense promise for furthering bone tissue engineering and improving therapeutic outcomes, leading to enhanced patient well-being. The potential of combining material science, advanced manufacturing, and cellular biology is showcased as a pathway to advance bone tissue engineering, addressing a variety of clinical needs and challenges. By providing this comprehensive narrative, a detailed, up-to-date account of resorbable scaffolds’ role in bone tissue engineering and their transformative potential is offered.

The purpose of this in vitro study is to evaluate the effectiveness of incorporating a new irrigation system into a surgical guide and monitor its effect on heat generation during implant bed preparation. A total of 48 surgically guided osteotomies were performed on 12 bovine ribs divided into 4 groups, using different irrigation techniques: Group A (test) had entry and exit channels incorporated into the guide; Group B had a similar design with an entry channel only; Group C had conventional external irrigation; and Group D (control) had no irrigation. Heat generation during the osteotomies was measured using thermocouples placed at a depth of 2 mm and 6 mm. The lowest mean temperature was observed in Group A (22.1 °C at 2 mm and 21.4 °C at 6 mm), which was statistically significant when compared with Groups C and D (p < 0.001). Group A showed a lower mean temperature compared with Group B as well; however, it was statistically significant only at 6 mm depth (p < 0.05). In conclusion, the proposed surgical guide has significantly reduced heat generation during implant osteotomy compared to conventional external irrigation. The integration of an exit cooling channel can resolve limitations found in previously designed surgical guides such as debris blockage and can be easily incorporated into computer designing and 3D printing software.

Purpose The advantages of rigid fixation over wire osteosynthesis are well established for the management of facial trauma. Miniplates in the frontozygomatic area are traditionally applied to the lateral face of the orbital rim, but with some undesirable effects, such as palpability, visibility, and risk of penetration into the anterior cranial fossa. The aim of this study was to perform an anatomical study to validate the use of miniplates on the temporal face of the frontozygomatic region. Methods Osseous thickness measurements were performed in 30 skulls, on four points above and four below the suture, at 3-mm intervals, perpendicular to the bone surface. Results There is enough bone thickness to apply the screws, ranging between 4 and 6.5 mm. The first hole over the frontozygomatic suture should receive the smallest screws and the other areas can receive screws up to 6 mm. All drillings are made from the temporal fossa to the orbit, and its contents should therefore be protected during the perforations. At the measured points there is no risk of anterior cranial fossa penetration. Conclusion This study suggests that it is possible to use miniplates at the temporal aspect of the frontozygomatic suture.

Purpose To assess the analgesia and side effects of codeine phosphate associated with paracetamol (test medication) as compared to paracetamol (control medication) after the extraction of impacted mandibular third molars. Materials and methods Forty-seven patients removed the right and left impacted mandibular third molars. After one surgery, patients took the test medication and after the other surgery, they took the control medication. Patients with exacerbated pain were prescribed to use the rescue medication instead of the medication initially administered and were included in the rescue group. They were evaluated for 7 days postoperatively, and the mean score of the visual analogue scale (VAS) of pain between test and control medications was assessed by the Poisson distribution. The side effects of these medications were assessed by the patient’s complaints. A P value of < .05 was considered to be statistically significant. Results The mean score of the VAS of pain was not statistically different between test and control medications in the non-rescue group, but it was significantly greater in patients previously using paracetamol in the rescue group. The most common side effects reported in both groups, predominantly in patients using the test medication, were drowsiness, dizziness, and nausea. Conclusion The use of codeine phosphate associated with paracetamol after the extraction of impacted mandibular third molars is a better choice to control the postoperative pain rather than paracetamol, but with more side effects, which are clinically acceptable.

Purpose The aim of this paper is to explore the current theories about definition, classification, incidence and physiopathology of osteoradionecrosis (ORN) of the jaws. Moreover, it is discussed the predisposing and risk factors for the development of osteoradionecrosis based on the literature review. Discussion Osteoradionecrosis is one of the most serious oral complications of head and neck cancer treatment. Osteoradionecrosis is a severe delayed radiation-induced injury, characterised by bone tissue necrosis and failure to heal. Osteoradionecrosis either stabilises or gradually worsens and is notoriously difficult to manage. The most widely accepted theory to explain its cause until recently was the theory of hypoxia, hypovascularity and hypocellularity. A new theory for the pathogenesis of osteoradionecrosis was proposed. The clinical presentations of osteoradionecrosis are pain, drainage and fistulation of the mucosa or skin that is related to exposed bone in an area that has been irradiated. The tumour size and location, radiation dose, local trauma, dental extractions, infection, immune defects and malnutrition can predispose its development. Conclusions A better understanding of risk factors for the development ORN and of the underlying pathophysiology may improve our ability to prevent this complication and help to improve the prognosis for those being treated for osteoradionecrosis.

Introduction: The treatment of mandibular osteoradionecrosis includes antibiotics and curettage, hyperbaric oxygen, surgery, and more recently, therapeutic ultrasound. The aim of this thesis was to establish the possible mechanisms of action of therapeutic ultrasound, that could explain its excellent clinical results. Material and Methods: Two ultrasound machines were evaluated, a 'traditional' (1 MHz and 3 MHz) and a 'long wave' machine (45 kHz). Ultrasound was applied to human mandibular osteoblasts, gingival fibroblasts, peripheral blood monocytes (PBMc) and mice calvaria. The following in vitro assays were performed: cell proliferation, collagen and non-collagenous protein (NCP) synthesis, bone resorption, cytokines and angiogenesis factors production using ELISA and RT-PCR techniques, and nitric oxide production. To evaluate the effects of ultrasound on angiogenesis in vivo, the chick chorioallanlbic membrane assay (CAM) was used. The use of near infrared spectroscopy (NIRS) for the measurement of radiotherapy effects in the mandible (deoxyhaemoglobin concentrations) was also evaluated. Results: Ultrasound stimulated bone formation in the mice calvaria. Cell proliferation assays showed an increase of DNA synthesis in fibroblasts and osteoblasts, up to 52%. Collagen/NCR synthesis was also enhanced, in fibroblasts up to 48%, and in osteoblasts up to 112%. Bone resorption, part of the bone turnover process, was promoted, and there is suggestion that the cyclo-oxygenase pathway is involved. In relation to cytokine production, a slight stimulation of IL-1beta was noted in all cell types. There was no difference in IL-6 and TNFalpha levels. The angiogenesis factors, IL-8 and bFGF, were significantly stimulated in osteoblasts, and VEGF was significantly stimulated in fibroblasts, osteoblasts and PBMc. RT-PCR showed that ultrasound induces mRNA transcription for several cytokines and bone related proteins, with the most evident effect being the induction of VEGF transcription in osteoblasts. The CAM assay showed that direct ultrasound application and insonated medium from fibroblasts induced angiogenesis in vivo. The best overall stimulatory intensities were 15 and 30 mW/cm2(SA) with 45 kHz ultrasound, and 0.1 and 0.4 W/cm2(SAPA) with 1 MHz ultrasound. The NIRS evaluation showed that it is very sensitive to measure deoxyhaemoglobin concentrations, however these measurements are not reproducible. No age correlations could be performed, and the differences between normal and radiotherapy mandibles was not significant because of the great variability in the measurements. Conclusions: These results show that ultrasound can correct hypocellularity, hypoxia and hypovascularity observed in osteoradionecrosis. It stimulates cell proliferation, bone formation, healing, and angiogenesis. Further in vivo experiments are recommended as well as prospective clinical trials using therapeutic ultrasound for the treatment and prevention of osteoradionecrosis, but NIRS cannot be used to measure the outcome of treatment. Therapeutic ultrasound is a viable option for the management of mandibular osteoradionecrosis, since it is effective, inexpensive and readily available.