Journal of "Regeneration, Reconstruction & Restoration" (Triple R)

Introduction: Leukocyte- and platelet- rich fibrin (L-PRF) is a fibrin matrix in which the platelet cytokines, growth factors and cells are trapped and this material has been recruited in reconstruction of various defects. The aim of this study was to systematically review of the published data on the effectiveness of using L-PRF on regeneration of bone defects in oral and maxillofacial surgeries. Materials and Methods: Medline and Cochrane Central databases were searched for related articles up to and including August 2015. Being English, having ≥ four weeks follow-up, and clinical, radiographic, histological and histomorphometric assessments were the inclusion criteria. Results: Twenty-four animal studies and 45 human trials were included that reported the rate of new bone formation (NBF). Also, 38 human reports with low levels of evidence to list evaluating various applications of L-PRF in oral and maxillofacial reconstructions were assessed. Using L-PRF either solely or mixed in human trials was evaluated and divided into six groups of sinus floor augmentation and guided bone regeneration (GBR) technique, socket preservation, periodontal intra-bony defects (PID)  regeneration, peri-apical and endo-periodontal defects treatment, peri-implant bone regeneration and treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Moreover, other uses of L-PRF with bone regeneration purposes in oral and maxillofacial surgeries were discussed. Conclusion: As a consequence, although L-PRF either solely or mixed showed challengeable outcomes in animal studies, it was shown to be effective used to accelerate and enhance new bone formation in human studies. However, future clinical trials in some treatment areas are needed with larger sample sizes and long follow-ups to arrive at an evidence-based conclusion. 

Introduction: Remarkable advances have been made in the development of scaffolds with favorable characteristics for bone tissue engineering using different techniques. Recently, electrospinning process for fabrication of fibrous matrices have gained popularity, mainly because of structural similarity to the extracellular matrix. In this study, the influence of in situ formation of calcium phosphates (CP) stabled with chitosan (CT) layer on the physicochemical properties of the wet-electrospun poly (ε-caprolactone)/poly (L-lactic) acid (PCL/PLLA) scaffolds was evaluated. Materials and Methods: To prepare three-dimensional (3D) fibrous scaffold, PCL/PLLA 10% (w/v) blend was fabricated via wet-electrospinning technique. The fabricated scaffolds were characterized regarding morphology, porosity, hydrophilicity and mechanical strength using scanning electron microscopy (SEM), liquid displacement technique, contact angle measurement and mechanical tests, respectively. Moreover, cell adhesion and viability of human adipose-derived stem cells (hASCs) seeded on the scaffolds were investigated using SEM, MTT assay and DAPI staining. Results: Wet-electrospun fibers displayed random, dispersive and non-woven morphology. Porosity of the fabricated scaffolds was 80% and CT coating improved the water contact angle value. In vitro seeding of ADSCs on PCL/PLLA/CP+CT demonstrated enhanced cell proliferation and attachment compared to the PCL/PLLA blend. Porosity, wettability, mechanical properties and biocompatibility of the PCL/PLLA scaffolds have significantly influenced by both in situ formation of CP and CT coating. Conclusion: The results indicated that the PCL/PLLA scaffold spun into water/ethanol modified with NaOH (pH~10) coagulation bath with in situ surface formation of CP and CT coating can be a candidate scaffold for bone tissue engineering.

Introduction: Bone thickness in the anterior of the maxilla is one of the major concerns for implant placement. The aim of the present study is to evaluate stability of demineralized freeze- dried bone (DFDB) graft for augmentation of buccal defects during implant placement at the anterior of the maxilla using cone-beam computed tomography (CBCT).

Materials and Methods: The DFDB graft was used for augmentation of buccal defects during implant placement at the anterior of the maxilla. The amount of remnant DFDB was measured in three points: Coronal, middle and apical portion of the buccal sides of implants after one year.

Results: Twenty-two samples were included in this study. All of the exposed implants were osseo-integrated. A significant difference was detected for remnant grafting bone in the coronal and apical portion of the implants between the central site and the lateral site (P<0.05) without any difference in the middle portion. Analysis of data did not show any differences of remnant grafting bone thickness among one-third coronal ,one-third middle and one-third apical portion of the buccal sides of implants after one year (P>0.05).

Conclusion: DFDB could be used successfully for augmentation of buccal defects during implant placement. It is assumed that approximately 50% of DFDB is resorbed one year after grafting. The recipient site may influence the amount of resorption rate.

Introduction: Management of maxillofacial gunshot wounds (MGSWs) has long been challenging and a multidisciplinary approach in planning and reconstructing of MGSWs should be followed. The objective of this study was to retrospectively assess and present gunshot wound cases in a hospital in Iran. Materials and Methods: Fourteen MGSW at Departments of Oral and Maxillofacial Surgery at Jundishapur and Shahid Sadoughi Universities of Medical Sciences from 2011 to 2015 were retrospectively reviewed. Data was analyzed using SPSS version 16.0. Data was presented in the form of descriptive statistics: mean and standard deviation for all quantitative variables and frequency and percentages were presented for qualitative variables like gender, entry site of projectile, etc. Results: Age ranged from 18 to 42 years with mean of 27.34 years. There were 12 (85.7%) male and 2 (14.3%) female cases. From them, Ten (71.5%) patients required airway management. Mandible was the most frequent involved site (i.e, in 11 (78.5 %) patients), while midface was involved in 3 (21.5%) patients. Suicide was the main cause of gunshot (i.e, in 8 (57.1%) patients). Free fibular flap was applied in 4 (28.5%) patients, while 8 (57.1%) patients were managed with regional and distant flaps in combination with reduction internal fixation. The most common type of treatment was two stage delayed reconstruction (35.7%). Most of the patients (i.e, in 12 (85.7%) patients) had complications which trismus and infection were the most frequent complication being reported. Conclusion: This study shows that early management of MGSWs with local flaps results in better psychosocial profile, aesthetics, reduced hospital stay and faster  functional rehabilitation.

Costochondral graft (CCG) is a common treatment modality for temporomandibular joint (TMJ) ankylosis. One of disadvantages of CCG is unpredictability of growth pattern and risk of overgrowth. This report illustrates management of a patient with CCG overgrowth. The patient was a girl, aged 7 years with severe facial asymmetry and TMJ ankylosis. The treatment comprised releasing of ankylotic mass and use of CCG for TMJ reconstruction. Four years later, the patient underwent overgrowth of the grafted side. Following clinical examination and scintigraphy, the grafted side was shaved to prevent more growth and the patient left to pass adolescent growth spurt. Ultimately, remnant deviation may be compensated by mild genioplasty and fat injection

Keratocystic odontogenic tumor (KCOT) is an odontogenic tumor which has the highest rate of recurrence. This report describes a rare case of bilateral ciliated epithelium-lined odontogenic keratocyst in the maxilla of a 15-year-old male. Panoramic radiography showed two lytic lesions on both sides of the maxilla associated with impacted third molars. Computerized tomography image revealed the involvement of both maxillary sinuses by the lesion which was destroying both sinuses’ floors and posterior walls. Histopathologically, the keratinized epithelial-lined cyst of OKC was changed to a ciliated columnar hyperchromatic epithelium, suggesting the fusion of both these epithelia rather than a metaplastic transformation. The patient was treated by surgical enucleation of the cyst and was followed for one year. In this case report the biological behaviour of odontogenic keratocysts and its treatment options are discussed.

Introduction: The post-operative pain and swelling are frequently observed after different surgical procedures. Orofacial pain management is a challenging topic for the dental-medical profession. The main objective of this study was to compare the effects of two designed medical regimens in the context of post-operative management of pain and swelling following simple dental implant surgery. Materials and Methods: In this randomized and double-blinded controlled clinical trial, a total of 39 implants were placed in 31 patients by one clinician. Patients were divided into the test and control groups. Before surgery, each patient in the control group received 1gr of amoxicillin and 400 mgr of ibuprofen, and each one in test group received 1gr of amoxicillin, 400 mgr of ibuprofen and 0.5 mgr of dexamethasone. Antibiotic regimen, together with analgesics and anti-inflammatory treatment was provided after surgery for both groups. Pain was measured using visual analogue scale in days 1, 3 and 6 after surgery. Swelling was evaluated by a verbal scale in day 6. Also, the impact of following factors gender, age, duration of surgery, type and number of implant on pain and swelling was measured by the general linear model analysis. Results: The majority of patients in both study groups reported the pain to be mild, with peak intensity occurring at 24 hours after operation. No significant difference was observed across the groups for any given time. Also, there was no significant difference between two groups regarding their swelling profile. Conclusion: The experiments provide evidence that both of these methods are effective in pain and swelling reduction.

Administration of local anesthetic agents is a safe procedure. However, various localized, distant and systemic complications have been reported. Posterior superior alveolar nerve block (PSAB) and inferior alveolar nerve block (IANB) are the two most common nerve blocks in the jaws. In this mini review, we tend to describe rare complications of these two methods. Rare complications of IANB includenecrosis of the chin skin of, neuritis of the facial nerve, trismus, ischemia and blanching of skin, anemia in the face, numbness of the ear, diplopia , taste disturbance, infra condylar abscess, burning sensation in eye, reduction in visual acuity and atrophy of the optic nerve. Some Rare complications of PSA are diplopia, amaurosis, epiphoria, paralysis, esotropia, hematoma, pupillary dilation and ptosis, paresis of the lateral pterygoid muscle and trismus. Since complications of dental anesthesia are inevitable, their prevention and management are essential. Management of complications requires comprehensive knowledge regarding the management of complications and injection techniques to prevent these complications