Journal of Dentistry, Shiraz University of Medical Sciences
Volume:18 Issue: 3, 2017 Sep

Temporomandibular joint disorders (TMDs) usually present with symptoms and signs such as pain, mandibular movement, dysfunction, or joint sounds. Botulinum toxin type A (BTX-A) is a biologic toxin which inhibits skeletal muscle through hindering the production of acetylcholine in the nerve endings. This toxin is used for the treatment of hyperactivity of lateral pterygoid muscle and TMD symptoms. This comprehensive review aimed to evaluate the effect of BTX-A injections in the lateral pterygoid muscle on treatment of TMDs symptoms. In this study, online databases including Scopus, Medline, Ebsco, Cochrane, EMBASE, and Google scholar were searched for the keywords “pterygoid muscle” and “Onabotulinumtoxin A”.
Twenty-four articles were eligible to be enrolled in the study. In 4 interventional studies and 20 descriptive studies, BTX-A was used for the treatment of TMDs. The dosage and number of injections were different in each study; however, the injection methods were relatively similar. Regardless of the type, number of injections, and dosage, injection of BTX-A in lateral pterygoid seems effective in reducing the click sound and other TMJ-related muscle disorders such as pain, hyperactivity, and dysfunction.

Statement of the Problem: Aloe vera gel contains various components with antibiotic and anti-inflammatory characteristics, which may have potential advantages to treat periodontal diseases.
The aim of this study was to evaluate the effects of local application of aloe vera gel as an adjunct to scaling and root planning in the treatment of patients with chronic periodontitis.
This single-blind clinical trial, performed in a split mouth design, was conducted on 20 patients with moderate to severe chronic periodontitis. Following a baseline examination at first day which included the assessments of plaque index (PI), gingival index (GI), and probing depth (PD); patients randomly received either SRP in one quadrant (control group), or SRP combined with aloe vera gel in another quadrant (experimental group). All cases were examined again, assessing PI, GI, and PD at 30th and 60th day.
There was no significant difference in PI in the three stages between control and experimental groups. In all patients, there was a significant improvement in the three stages in GI and PD for both quadrants treated only with SRP or combination of SRP and aloe vera. However, experimental group presented significantly lower GI (p= 0.0001) and PD (p= 0.009) than the control group at the end of study period.
This study revealed that local application of aloe vera gel could be considered as an adjunctive treatment with scaling and root planning for chronic periodontitis.

Statement of the Problem: Researchers have long been in search of products to enhance healing and patient comfort postoperatively.
This study aimed to assess the efficacy of propolis extract in combination with Coe-PakTM dressing for pain relief and wound healing after crown lengthening surgery.
This randomized clinical trial was performed on 36 patients who were randomly divided into two groups of Coe-PakTM dressing with (trial group) and without (control group) propolis extract. Pain and burning sensation by use of visual analog scale (VAS) and number of analgesics taken were asked from patients. Gingival color and consistency, bleeding on probing (BOP) and presence of infection were studied 7 days after dressing removal.
Although a large number of patients in the trial group did not have burning sensation, this difference was not significant between the two groups (p> 0.05). In both groups, the majority of patients experienced moderate and mild pain and there was no pain in the trial group after three days. No significant difference was noted between the two groups in pain score and number of analgesics taken (p> 0.05). The two groups were not significantly different in terms of inflammation and healing process (BOP, gingival consistency and color), after 7 days (p> 0.05).
The study results showed no difference in use of Coe-PakTM dressing with and without propolis extract in terms of postoperative pain and healing process following the crown lengthening surgery. More studies are required to confirm these results.

Statement of the Problem: The most important risk factor for inferior alveolar nerve (IAN) damage is the proximity of the mandibular root apices to the alveolar canal. Failure to position the patient’s head at standardized orientation during cone beam computed tomography (CBCT) scans might adversely affect the relative position of the alveolar canal and mandibular root apices with subsequent treatment failure.
The purpose of the present study was to investigate the influence of the orientations of the skull during the scanning procedure on the accuracy of CBCT images in determining the positional relationship of the mandibular tooth apices to the alveolar canal.
CBCT scans of 7 human dry skulls were obtained by using NewTom VGi CBCT in standard, tilt, flexion, extension and rotation positions of the head. The shortest radiographic distance between the mandibular tooth apices and the IAN canal of 20 points were measured on cross sectional images of CBCT in all position scans. A sample t-test was used to compare the measurements at different head position with the standard position values.
Significant differences were found in the measurements of normal and tilt orientations. However, there was no statistically significant difference between the measurements in standard position and other deviated positions. The mean errors in all head positions were less than 0.5mm.
Alteration of patient head positioning during CBCT scanning does not affect the relative position of the IAN and the apices of posterior teeth.

Statement of the Problem: Temporomandibular disorder (TMD) is a clinical term used for clinical signs and symptoms that affect the temporomandibular joints, masticatory muscles, and associated structures. Surgical and non-surgical treatments can be used for management of TMD. Non-surgical route is the main part of the treatment, since clinicians prefer non-aggressive treatment for TMD such as pharmacological and physical therapy. Low-level laser therapy (LLLT) and transcutaneous electrical nerve stimulation (TENS) are the main procedures in physical therapy.
The aim of this study was to evaluate the effectiveness of TENS and LLLT in treatment of TMD patients who did not respond to pharmacological therapy.
This clinical trial was performed on 45 patients who randomly received either TENS or LLLT for 8 sessions. LLLT was applied with diode laser (Ga-Al-As, 980nm, dose 5j/cm2) and TENS by using two carbon electrodes with 75 Hz frequency (0.75 msec pulse width). Helkimo index and visual analogue scale (VAS) were measured during the treatment period and throughout the follow-up sessions.
Significant reduction in the VAS and Helkimo index was observed in both TENS and LLLT group. There was no significant difference between the two methods during the treatment; however, TENS was more effective in pain reduction in follow-ups.
This study justified the use of TENS therapy as well as LLLT in drug-resistant TMD. Both were useful in relieving the pain and muscles tenderness, although, TENS was more effective than LLLT.

Statement of the Problem: Individuals with oral clefts exhibit considerably more dental anomalies than individuals without clefts. These problems could initially be among the symptoms of their disease and/or they may be the side effect of their treatments. Pushback palatoplasty could cause some interference during the development of teeth and result in tooth defects.
The study was performed to assess the prevalence and characteristics of developmental dental anomalies in orofacial cleft patients who attended Shiraz Orthodontics Research Center-Cleft Lip and Palate Clinic. We managed to compare dental anomaly traits based on gender and cleft side.
Eighty out of 121 cleft patients were included in this cross-sectional study. All the patients used pushback palatoplasty in their palate closure surgeries. Intraoral photographs, panoramic and intraoral radiographs, cone-beam computed tomography (CBCT) and dental and medical histories were examined and recorded by two observers. Data were analyzed using SPSS PC version 20.0. The differences in the side of cleft and dental anomalies were compared using the Mann-Whitney test.
The mean age of patients was 14.27 years (SD=5.06). The most frequent cleft type was unilateral cleft lip and palate (50%) followed by bilateral cleft lip and palate (43.75%), cleft palate (2.5%) and cleft lip (1.25%). Male predominance (70%) was observed. 92.5 percent had at least one developmental dental anomaly. The most prevalent anomalies were hypodontia (71.25%) followed by microdontia (30%), root dilacerations (21.25%) and supernumerary teeth (15%).
The most prevalent cleft types were unilateral and bilateral cleft lip and palate with male and left side predominance. Hypodontia, microdontia, dilacerations and supernumerary teeth were the most prevalent developmental dental anomalies among Iranian southwestern cleft patients. The surgical technique used to repair their cleft palate may have played a role in developmental dental defects.

Statement of the Problem: Considering the high diagnostic accuracy and wide dynamic range of photostimulable phosphor plates (PSPs), they can be a good alternative for radiographic films.
This study was aimed to assess the effects of delay in scanning PSPs on the diagnostic accuracy of detection of approximal caries.
Radiographs from fifty-two extracted molar and premolar teeth were radiographed using DIGORA PSP (Soredex Corporation, Helsinki, Finland). The teeth were either intact or with non-cavitated approximal caries. The plates were scanned immediately (time zero) and at 10 min, 30 min, 60 min and 120 min after exposure. Sixty-five images were obtained and evaluated for presence or absence of approximal caries by two oral and maxillofacial radiologists and 2 restorative specialists. The diagnostic accuracy of approximal caries detection was measured using a 5-point rating scale. Definite presence of caries was confirmed using a stereomicroscope. Analysis of caries detection data was performed by calculating sensitivity and specificity using repeated measures with ANOVA.
Significant differences were found in complete negative predictive value, absolute negative predictive value and complete dentine sensitivity value between different scan times (p 0.05). The accuracy of approximal caries detection at 120 min was less than at 60 min and at 60 min was less than at 30 min.
In order to detect approximal caries more accurately, DIGORA PSPs should be scanned within 30 min after exposure.

Statement of the Problem: Squamous cell carcinoma (SCC) is the most frequent oral cancer whose 5-year survival rate is 80% for early-detected lesions and nearly 30-50% for advanced lesions. Early detection of oral cancers and precancerous lesions can improve the patient’s survival and decrease the morbidity.
This study aimed to evaluate and compare the Ki-67 and MCM3 expression in cytologic smear of oral SCC (OSCC).
We examined 48 oral brush biopsies including 28 OSCC and 20 healthy non-smoking samples. Immunocytochemistry staining was performed for Ki-67 andMCM3 by using an EnVision-labeled peroxidase system, and labeling index (LI) was calculated.
Out of 28 OSCC cases, 27(96.4%) cases contained MCM3 positive cells and 22(78%) cases contained Ki-67 positive cells. All normal mucosa were Ki-67 and MCM3 negative. MCM3 and Ki-67 LI were significantly higher in OSCC than normal mucosa (p Immunocytologic evaluation of Ki-67 and MCM3 can be used for early detection of OSCC. Furthermore, MCM3 may be a more sensitive cytologic biomarker than Ki-67 in SCC patients.

Statement of the Problem: School is one of the places with the greatest prevalence of occurrence of traumatic dental injuries.
The aim of this study was to assess the knowledge levels and attitudes of elementary school teachers towards dental trauma and its management.
In this cross-sectional study, 281 elementary school teachers were selected through cluster sampling to answer the prepared questionnaire. The data obtained from the questionnaires were analyzed in SPSS software by using ANOVA test and t-test. p Value The total knowledge and attitude were low and normal, respectively. No previous exposure to or close observation of a dental trauma was reported by 61.2% of teachers; while, 12.5% were trained on dental traumas first aid management. There was statistically significant relationship between the teacher’s knowledge and previous first aids training.
The knowledge of schoolteachers on emergency management of dental trauma is poor. Therefore, it seems to be helpful to consider the management of dental injuries especially avulsed teeth as a part of teacher's education.

Statement of the Problem: Evidence shows thiabendazole has the potential to inhibit angiogenesis in melanoma and fibrosarcoma; however, its effect on oral squamous cell carcinoma has not been previously studied.
This study sought to assess the cytotoxic effects of thiabendazole on HN5 head and neck squamous carcinoma cell line.
HN5 cell lines were exposed to different concentrations of thiabendazole (prepared from 99% pure powder) for 24, 48 and 72 hours. Cell viability was assessed by the methyl thiazol tetrazolium assay, and IC50 of thiabendazole was calculated. Cells were also exposed to different concentrations of thiabendazole for 48 hours to determine its effect on expression and transcription of vascular endothelial growth factor gene. Expression of vascular endothelial growth factor mRNA was assessed by real-time polymerase chain reaction. The vascular endothelial growth factor release was assessed by the enzyme-linked immunosorbent assay test.
In all concentrations of thiabendazole except for 200 and 550μM, cell viability was significantly different at different time points (p Thiabendazole inhibited the proliferation of HN5 cells in a dose-dependent and time-dependent manner. It also inhibited the expression of vascular endothelial growth factor gene.

Primary oral melanomas are uncommon malignant neoplasm of melanocytes origin. The most common site of oral melanoma is maxillary gingiva and hard palate. Oral mucosal melanoma exhibit a pathobiological behavior and clinical features different from cutaneous melanomas. Oral melanomas are often clinically silent which may consequently result in delayed diagnosis; thus, making the prognosis extremely poor.
This case report presents clinical, histopathological and immunohistochemical features of two cases of advanced oral melanoma, one pigmented or melanotic melanoma in a 46-year-old female and another amelanotic melanoma in a 59-year-old male patient, with chief complaint of swelling in oral mucosa.
Most oral melanomas are usually asymptomatic lesions with quick growing. Thus, the most cases are detected in late stage of diagnosis. Early diagnosis with careful examination by dentists, and early biopsy of pigmented and suspicious non-pigmented lesions would have an imperative role in more survival rate and better prognosis.

Ameloblastic fibro-odontoma is a relatively rare, benign odontogenic tumor that usually occurs in children and adolescents with unerupted teeth. This article reports an ameloblastic fibro-odontoma in the anterior mandible as a “bump on her gum” in a 7-month-old girl. This is the first case under 9 months old reported to date. Radiographic and histologic findings as well as the treatment are discussed.