Clinical and Radiographic Evaluation of Periodontal intra- osseous defects treated with Platelet Rich Plasma and Demineralized Freeze- Dried Bone Allograft
Suzan S Ibrahim*, Hadir F. El-Dessouky*, Mona Abo EL Fotouh.**
Abstract
The purpose of this study was to assess the effectiveness of PRP versus DFDBA alone or in a combination of PRP/DFDBA in treating intra-osseous periodontal defects.
Patient Selection: The present study was conducted on fifteen systemically healthy patients 8 females and 7 males,
with age range (25-45 years). Each patient had at least three periodontal defects, of 2 or 3 intra-osseous wall defects not involving the same inter proximal space. The 45 defects were divided into three groups: Group I: 15 defects treated with PRP alone, Group II: 15 defects treated with PRP /DFDBA combination. Group III: 15 defects treated with DFDBA alone.
Results: Our results showed that, all three treatment modalities resulted in significant reduction in probing pocket
depth when base line parameter were compared to 6 months postoperatively, a significant reduction in Clinical attachment level, a significant increase in bone density 6 months postoperatively, as well as a significant reduction in the depth of the bony defect at 6 months period.
To conclude, we suggest that when PRP is combined with allograft, it would give some benefit, as PRP seems to
improve the rate of bone formation and the quality of bone formed. PRP gel also seems to improve the handling
characteristics of the graft. However, if PRP is applied solely it may give parallel results over a longer time period.
Mast Cell Tryptase in Actinic Cheilitis, Oral Submucous Fibrosis and Oral Lichen Planus
Hadir F. El-Dessouky
Lecturer, Oral Medicine, Periodontology, Oral Diagnosis and Radiology Department. Faculty of Dentistry. Ain Shams University
Iman M. Helmy
Lecturer, Oral Pathology Department, Faculty of Dentistry. Ain Shams University Suzan S. A. Ibrahim
Lecturer, Oral Medicine, Periodontology, Oral Diagnosis and Radiology Department. Faculty of Dentistry. Ain Shams University
Human Mast cells (MCs) are classified by their content of specific serine proteases into either MCs tryptase (MCT), MCs Chymase (MCC), or both MCs tryptase and chymase (MCTC). Thus tryptase and chymase are the current “gold standard” for determining mast cell phenotypes in various tissue compartments. Several studies
have shown that mast cells are significantly increased in several neoplasias, Furthermore, MCs density has been associated with bad prognosis and increased metastasis. Actinic cheilitis is a premalignant lesion that can transform into squamous cell carcinoma of the lip. Unfortunately, the clinical appearance of actinic cheilitis does not always correlate directly with the underlying
histologic changes. Suspicious looking lesions may prove to be remarkably benign, while a small area of actinic cheilosis may in fact represent severe dysplasia or even SCC. WHO classifies OLP as a pre- malignant condition making mucosa more sensitive to exogenous carcinogens and thus to develop oral carcinoma. Mast cell derived chymase and tryptase are thought to play a role in the breakdown of basement membrane structural proteins in conditions such as oral lichen planus. Oral submucous fibrosis (OSF) is a slowly progressive chronic fibrotic disease of the oral cavity and oropharynx, OSF is regarded as a premalignant condition, and many cases of oral cancer have been found coexisting with submucous fibrosis. The present study was undertaken to characterize the significance of mast cell tryptase expression in Actinic Cheilitis, Oral Submucous Fibrosis, and Oral Lichen Planus. The present study was conducted on eighteen patients (Ten patients with Oral Lichen Planus, five patients with Actinic Cheilitis and three patients with Oral submucous fibrosis). Biopsies of the lesions were taken in all cases, histopathologic examination and subsequent immunohistochemical studies were performed. Mast cell tryptase immunoreactivity was assessed by the image analysis software. Computerized calculation of the total surface area of the immunoreactions was expressed as a fraction of the total surface area of the microscopic field (immunostained area fraction (IAF). The results of the present study showed that actinic cheilitis expressed a significantly higher
immunostained area fraction compared
with lichen planus (P-value <0.001). A similar trend was also noted for oral submucous fibrosis, as the later showed a significantly higher immunoreaction compared with lichen planus (P-value
=0.046). Although, actinic cheilitis showed a higher immunoreactive surface area in comparison to oral submucous fibrosis, the difference was not statistically significant. These findings might reflect the role played by mast cells in the etiologies of the malignant potentialities and in the inflammatory processes of these lesions.
ASSESSMENT OF THE USE OF GA-AL-AS DIODE LASER IN THE MANAGEMENT OF INTRAOSSEOUS PERIODONTAL DEFECTS RECEIVING DEMINERALIZED FREEZE-DRIED
BONE ALLOGRAFT
Hala H. A. Hazzaa
*, Hala K. Abd El Gaber
**, Suzan S. Ibrahim
***, Abeer S. Gawish
*****Lecturer in Oral Medicine, Periodontology,, Al Azhar University (Girls).
**Professor and head of Oral Medicine, Periodontology, Oral Diagnosis and Radiology Department
Faculty of Dentistry-Ain Shams University
***Lecturer of Oral Medicine, Periodontology and Oral Diagnosis ,Faculty of Dentistry- Ain Shams University
****Associate Professor of Oral Medicine and Periodontology, Faculty of Dental Medicine (Girls),Al Azhar
University
Abstract
In the present study, fourteen patients (5 males and 9 females). Their age ranged from 38 to 53 (mean age
was 43.8 rears). They were chosen as having nearly similar defects, such that twenty eight infrabony
defects were selected. Four weeks, after defect debridement, the selected defects were reevaluated and
measured such that only defects with pocket depth measuring ≥5mm were included in this study. The
twenty eight defects were divided into four groups, the first group has open flap debridement only, the
second group has open flap debridement then soft laser irradiation, the third group received (DFDBA)
after open flap debridement while the last group has combined therapy using both (DFDBA) and soft
laser irradiation following the same surgical step.
Pocket depth and clinical attachment level were measured while alveolar bone level and bone density were radio graphically evaluated at baseline and six months postoperatively. Statistical analysis of these recorded measurements revealed that there were significant reduction in pocket depth, gain in clinical attachment level, alveolar bone level and bone density, in all the treated groups. Moreover, at six months Combined (demineralized freeze dried bone allograft and low level laser therapy) showed better
reduction in pocket depth (48.8 % 16.3) and greater gain in clinical attachment level (52.2 % 17.6)
compared to other treatment modalities. Furthermore it revealed the best improvement in alveolar bone
level percentage (19.57% 9.22) and increase in bone density (47.21% 22.15) compared to other
treatment modalities.
Expression of Apoptotic Signaling Protein p53 and the Cell Proliferation Associated Protein Ki-67 in Oral Lichen Planus and Oral
Squamous Cell Carcinoma
Suzan Seif Allah Ibrahim *, Hala Abu El-Ela *, Hadir F. El -Dessouky*.
* Lecturer, Oral Medicine, Oral Diagnosis and Periodontology Department, Faculty of Dentistry Ain Shams University .
Abstract
Oral Lichen Planus (OLP) is a chronic inflammatory oral mucosal disease that appears to be related to a cell mediated-immune process. In OLP destruction of the basal cell layer as well as changes in cell proliferation, cell repair and cell death occur in the injured mucosal epithelium. Histologically OLP is characterized by
hyperkeratosis, basal cell liquefaction and intense infiltration of lymphocytes at epithelial- connective tissue interface in a band pattern. It has been suggested that OLP may be a premalignant lesion since oral squamous cell carcinomas (OSCC) have been observed in patients affected by OLP.
Apoptosis is a controlled form of cell death through the interactions of many proteins such as p53 protein, alteration of p53 gene is the most common event in human cancers, including OSCC .Ki-67 can be employed to measure the growth fraction of normal tissues and malignant tumors.
The aim of this study was to examine the expression of apoptotic signaling protein p53 and the cell proliferation associated protein Ki-67 in OLP and OSCC in order to evaluate possible transition of OLP to cancer.
The present study was conducted on twenty patients who were divided into two groups , group I included 10 patients with OLP with age range 36 to 64 years ,while group II included 10 patients with OSCC with age range 44 to 70 years.
Oral mucosal biopsies were obtained from all patients and immunohistochemically stained with p53 and Ki-67 antibodies .For quantification, the number of P53 and Ki-67 positive cells in the basal and para-basal layers of OLP and OSCC was calculated.
The results of the present study revealed that the mean of P53 expression in OLP was 21.90 ± 3.18 and the mean
of Ki-67 expression was 3.50 ± 4.74. Regarding OSCC, the mean of P53 and Ki-67 expression was 48.90 ± 14.75
and 31.30 ± 5.10 respectively.
From the present work it can be concluded that expression of P53 was reported in both OLP and OSCC.
Moreover, the expression of Ki-67 in OSCC was significantly higher than in OLP. Thus, it can be concluded that OLP could be considered as a non premalignant lesion.
Clinical Comparison of the effect of Subepithelial Connective Tissue Graft and Collagen Membrane (GTR)
with the adjunct use of Platelet Rich Plasma in root coverage procedures
Hadir F. El-Dessouky* Suzan S.A. Ibrahim* Hisham S. Sadek**
*Lecturer of Oral Medicine, Oral Diagnosis and Periodontology. Faculty of Dentistry, Ain Shams University
**Lecturer of Oral Medicine, Oral Diagnosis and Periodontology. Faculty of Dentistry, Cairo University
Abstract
The past 20 years have seen an explosion of interest in mucogingival surgery. Accompanied by clinical variations in surgical techniques to treat various mucogingival problems
Hence the purpose of this randomized, controlled trial was to compare the clinical effect of subepithelial connective tissue graft and collagen membrane (guided tissue regeneration) with the adjunct use of Platelet Rich Plasma in root coverage procedures.
Patient’s Selection
Twelve patients (7 males and 5 females) 21 to 35 years of age, mean 27.5 years, with bilateral gingival recessions were selected. 12 arches in the SCTG +PRP group (group 1), and 12 arches in the CG+PRP group (group 2)..
Results
Out of 12 (SCTG+PRP) treated sites, 5 sites achieved 100% root coverage, 3 sites scored
>75% root coverage, and 4sites showed a root coverage ≥50%, non showed less than 50% root coverage. Regarding group 2 (CG+PRP) treated sites, out of 12 sites, 3 achieved a 100% root coverage, 3 achieved >75% root coverage, and 6 sites showed a root coverage ≥50%. Again, non showed less than 50% root coverage.
Conclusion
The results of the study demonstrated that both techniques, either an autogenous connective tissue graft (SCTG) soaked with platelet rich plasma (PRP) or a collagen membrane (CG) soaked with platelet rich plasma (PRP), as a graft material coved by a coronally positioned flap, are effective in the treatment of shallow gingival recession.
Clinical Assessment of Periodontal Disease and Detection of Porphyromonas gingivalis by Polymerase Chain Reaction in
Type I Diabetic Children and Adolescents
By
Wafaa E. Ibrahim*, Nadia E. Metwalli**, Suzan S. Ibrahim***, Manal M. Amin****
Pediatric*, Pediatric Dentistry**, Oral Medicine and Periodontology***, and clinical pathology****
Departments Faculty of Medicine and Faculty of Oral and Dental Medicine Ain Shams University
Abstract
Diabetes type 1 is a systemic disease which affects both children and adults and is associated with oral complications as periodontal disease and dental caries. The mechanism responsible for this relationship remains unclear. The aim of this study is to assess the prevalence of periodontal disease as well as dental caries in a group of diabetic children and adolescents and to study the subgingival microflora (Porphyromonas gingivalis), using PCR technique. This study was conducted on 70 patients with type I diabetes regularly attending the Pediatric Clinic, Ain Shams University Pediatric Hospital. They were 34 males and 36 females ,3-18years (mean10.9±4.1 years). The duration of their diabetes ranged between 3 and 14 years with mean of 7.1±3.1 years. The control group included 20 healthy age-matched children and adolescents. Both patients and controls were subjected to full medical history, thorough clinical examination, caries assessment, periodontal examination, and bacteriological sampling for microbiological testing of Porphyromonas gingivalis for detection, quantification and sequencing using 16S ribosomal RNA based PCR methods. Among the seventy studied patients, 9/70(12.8%) have been diagnosed as periodontitis , 38/70 (54.4%) as gingivitis, and the remaining 23 (32.8%) were periodontally healthy diabetics . Assessment of caries condition showed higher caries scores among diabetics than the controls but this increase was statistically non significant.
The percentage of Porphyromonas gingivalis, organism was significantly higher in periodontitis (66.7%) and gingivitis (31.6%) compared to periodontally healthy diabetics (13.04%), and control (10%) {P<0.05}. On comparing periodontitis and gingivitis patients, P.gingivalis was detected in 6/9 (66.7%) and in 12/38 (31.6%) respectively, this difference was found to be statistically significant (P<0.05). No significant difference could be detected between periodontally healthy diabetics and healthy controls.
Also, significantly higher DNA copies/ml of P. gingivalis was detected in both periodontitis(15983± 2188 )
and gingivitis(7112±3540) subgroups when compared with both periodontally healthy diabetics (2433+-
351) and healthy control(1600+-100) (P<0.05). Porphyromonas . gingivalis DNA copies/ml was also
significantly higher in periodontitis when compared to gingivitis subgroup( p<0.05), and no significant
difference was detected between periodontally healthy diabetics and healthy controls. Correlation
studies showed significant positive correlation between periodontal disease and age of the patient,
