Efficacy of Aloe Vera Gel in Dry Socket After Removal of Mandibuler Third Molar

Objective: To evaluate the effectiveness of Aloe Vera gel in management of dry socket after surgical removal of 3rd molar. Study Design & Setting: From December 2020 to November 2021, a descriptive research was conducted in the Section of Oral & Maxillofacial Surgery, Liaquat University of Medical & Health Sciences, Jamshoro, Hyderabad, Sindh. Methodology: Total 70 patients were included and divided equally in two groups i.e. Group-A (Alveora dressing) and Group-B (Controls). Dry socket, pre-operative assessment was carried out on the basis of pain Visual analog scale (VAS) and healing index. Socket was irrigated with sterile saline 0.9% in experimental group. In control group, patient were given tablet Panadol 1gm SOS. Patients were evaluated post operatively at 1st, 2nd, and 3rd day on the basis of pain (VAS) and healing index. Results: In group-A mean postoperative VAS at day-1, day-2 and day-3 was 6.69±2.59, 3.17±2.39 and 1.14±1.03 respectively. In group-B it was 7.77±2.03, 6.97±2.14 and 4.57±2.57. In group-A, mean postoperative healing scale at day-1, day-2 and day-3 was 2.83±0.56, 3.49±0.61 and 4.37±0.73 respectively and in group-B it was 2.31±0.58, 2.63±0.69 and 3.26±0.65 respectively. Significant association of pain intensity at day-2 and day-3 and healing index (at day-1, day-2 and day-3) was observed. Conclusion: Aloe Vera gel significantly reduced postoperative pain and improve healing index. Keywords: Effectiveness, Aloe Vera Gel, Dry Socket, Surgical Removal, Third Molar

ГЕЛЬ «МІРАДОНТ» – НАПРЯМ У ПРАКТИЧНОМУ ЗАГОЄННІ РАНОВОГО ПРОЦЕСУ В ПІСЛЯОПЕРАЦІЙНИЙ ПЕРІОД НА ТКАНИНАХ ПАРОДОНТУ

Мета дослідження – обґрунтування можливості та визначення ефективності застосування гелю «Мірадонт»» зі стандартизованою схемою лікування генералізованого пародонтиту. Методи дослідження. На базі Стоматологічного медичного центру Львівського національного медичного університету імені Данила Галицького проведено оперативне лікування 136 хворих із генералізованими захворюваннями тканин пародонту з використанням медикаментозної терапії в комбінації з гелем «Мірадонт»» або без нього. 82 хворим (60,3% (p˂0,05)) застосовувався гель «Мірадонт» із комплексною терапією (основна група), серед них 34 чоловіки (25% (p˂0,05)) та 48 жінок (35,3% (p˂0,05)); 54 хворим (39,7% (p˂0,05)) не застосовувався гель «Мірадонт» із комплексною терапією (контрольна група), серед них 19 чоловіків (14% (p˂0,05)) та 35 жінок (25,7% (p˂0,05)) Для об’єктивної оцінки були використані параметри EHS (оцінка раннього загоєння ран), індекс раннього загоєння рани (early wound healing index, EHI) та у відстрочені терміни загоєння на 15 та 30 добу в післяопераційний період, результати яких оброблені за допомогою програмного пакета «Statistica 6.0». Наукова новизна. Уперше систематизовано результати та визначено ефективність застосування гелю «Мірадонт» із медикаментозною терапією на клінічному рівні при оперативних втручаннях на тканинах пародонту. Клінічно доведено вплив на процеси перекисного окиснення ліпідів (далі – ПОЛ), які негативно впливають на перебіг загоєння ран. Висновки. Підсумком отриманих результатів стало те, що у хворих (контрольна група), яким не призначили гель «Мірадонт», збагачений флавоноїдами, в комплексі з медикаментозною терапією, негативна тенденція при тотальному загоєнні триває з 24 годин до 30 діб у післяопераційний період порівняно з хворими основної групи, що об’єктивно оцінено відповідними показниками, хоч і з позитивною динамікою. Однією із суттєвих особливостей флавоноїдів, що входять до складу компонентів гелю «Мірадонт», є антиоксидантна дія, яка виявляється завдяки тому, що фенольна структура (завдяки вільним -ОН-групам) дає можливість молекулі взаємодіяти з вільними радикалами, зменшуючи інтенсивність перекисного окиснення ліпідів.

Experimental evaluation of the effectiveness of adipose mesenchymal stem cells in full-thickness skin wounds

BACKGROUND: Currently, numerous techniques or medical devices that allow complete or partial restoration of the lost skin within a short time remain as subjects of development. Many studies have shown the effectiveness of using stem cells in the treatment of full-thickness skin defects, but their use remains very limited. At present, there is no consensus among researchers about the advisability of the use of stem cells in the treatment of burns as well as about the method of their introduction. AIM: This study aimed to examine the possibility of accelerating the reparative histogenesis of tissues in the zone of deep skin burns using cultures of adipogenic mesenchymal cells, as well as to evaluate the effectiveness of various methods of introducing cultures of these cells into the defect zone. MATERIALS AND METHODS: An experimental study was carried out on small laboratory animals (rats). After simulating a grade III burn, mesenchymal stem cells were transplanted and superficially applied to the wound surface or injected under the fascia. In the control group, no wound treatment was performed. To assess the effectiveness of the wound-healing preparations, the appearance of wounds was assessed daily, the nature of the discharge and presence and type of granulations were noted, and the timing of scab rejection and wound healing was recorded. The wound area was assessed using a planimetric method. A histological examination of wound biopsies was carried out on days 7, 14, 21, and 28 of observation. RESULTS: The application of adipogenic mesenchymal stem cells demonstrated the greatest efficiency on the developed burn model. Subfascial administration was less effective, but this method achieved a significant acceleration of wound healing in comparison with the control group. An increase in the healing index by 56.6% demonstrates the highest intensity of reparative regeneration in animals applied with adipogenic mesenchymal stem cells. CONCLUSIONS: The preliminary results show that the application of adipogenic mesenchymal stem cells on the skin defect is more effective than subfascial administration based on the healing index. The use of adipogenic mesenchymal stem cells may substantially increase the effectiveness of the treatment of full-thickness skin defects.

Lengthening of the ulna by callotasis in children with multiple hereditary exostoses: comparison of methods with and without internal fixation

Purpose The goal of this retrospective study was to compare the gradual lengthening of the ulna in children with multiple hereditary exostoses with and without an elastic intramedullary nail. Methods Between 1998 to 2018, the ulna was lengthened in 28 forearms in 21 patients (aged 7.1 to 16.6 years) using a monolateral external fixator when relative ulnar shortening exceeded 15 mm. In total, 16 forearms were lengthened with the external fixator (group I) and 12 forearms with the addition of an intramedullary elastic nail (group II). Subjective assessment of function, range of movement (ROM) of the wrist and elbow and complications were compared. Ulnar shortening, radial head dislocation, radial articular angle (RAA) and percentage of carpal slip and radial bowing were followed radiographically. The difference between the groups has been evaluated statistically. Results The function of the extremity improved partially in 81% of patients in group I and in 83% of patients in group II. ROM was not improved except for radial deviation. Radial head position did not change. The values in group II in comparison with group I are higher for gain of length and lower for bone lengthening index and for bone healing index. Carpal slip decreased insignificantly. The RAA and radial bowing decreased, the comparison of values between groups and age under and over ten years were not statistically significant. Complications were more common in group I. No permanent complications were noted. Conclusion The addition of an intramedullary nail during the gradual ulnar lengthening improves the gain, bone healing index and rate of complications. Level of Evidence III.

The Effectiveness of Advanced Platelet-Rich Fibrin in comparison with Leukocyte-Platelet-Rich Fibrin on Outcome after Dentoalveolar Surgery

Background and Purpose. Some physiological changes may occur following tooth extraction, and symptoms during the postextraction period may affect the patient’s quality of life. Many techniques have been developed to improve postextraction pain and soft tissue healing. Accordingly, this study will compare the postextraction pain and early soft tissue healing characteristics of extraction sites treated with leukocyte-platelet-rich fibrin (L-PRF) and advanced platelet-rich fibrin (A-PRF). The aim is to evaluate the effect of advanced PRF in comparison with L-PRF on soft tissue healing and pain after teeth extraction and to advice dental practitioner to use the advanced PRF in clinic to enhance soft tissue healing and decrease pain. Methods. The study included 60 patients according to sample size calculation, recruited from patients seeking tooth extraction at oral and maxillofacial surgery clinic at Umm Al-Qura University, Faculty of Dentistry. Patients were divided into three groups. Group Ӏ included 20 patients managed by advanced platelet-rich fibrin after extraction. Group ӀӀ included 20 patients managed by leukocyte-platelet-rich fibrin after tooth extraction. Group ӀII included 20 patients left without any addition. Each group was further subdivided into surgical and nonsurgical extraction. Afterwards, patients in each group were assessed for postextraction pain by VAS, number of analgesics, and early soft tissue healing by LWHI. Results. The study outcomes demonstrate that the use of A-PRF significantly reduces postoperative pain in the 1st and 2nd day. VAS pain scores on the first day were significantly higher in the control surgical extraction group and L-PRF nonsurgical extraction group. In early soft tissue healing. The Landry Wound Healing Index (LWHI) was used after 1 and 2 weeks of extraction to evaluate the extraction site. In first week, the A-PRF group and L-PRF group (nonsurgical extraction) had a better healing index when compared to control group, and A-PRF group (surgical extraction) had a best healing index when compared to L-PRF and control groups. In the second week, individuals in the A-PRF group (surgical and nonsurgical extraction) had a better healing index when compared to L-PRF and control groups.

P497 The value of endoscopic healing index monitoring for guiding infliximab dosing in patients with Crohn’s disease

Background The endoscopic healing index (EHI) is a novel multi-protein serum biomarker test developed and validated to assess endoscopic disease activity in patients with Crohn’s disease (CD). Evidence for the use of EHI to guide decision-making during infliximab (IFX) treatment remains scarce. Therefore, we aimed to characterise the relationships between IFX dose, serum IFX concentrations, EHI, and endoscopic remission (ER). Methods Data were obtained from 118 biologic naïve adult patients with CD enrolled in the phase 4 TAILORIX trial (EudraCT 2011 003038 14). All patients had confirmed active CD at baseline based on clinical, biological, and endoscopic criteria. IFX and EHI (scores ranging from 0–100) were measured using a homogenous mobility shift assay (HMSA) and immunoassay, respectively (Prometheus Laboratories). First, the previously published population pharmacokinetic (popPK) model of the TAILORIX study population was revisited to describe the HMSA data. The effect of EHI, faecal calprotectin (FC), C-reactive protein (CRP), and serum albumin (ALB) on IFX clearance was evaluated. Next, a minimal continuous-time Markov model was developed to describe the time course of EHI within patients. EHI was considered as a three-stage ordinal variable (scores 0–19, 20–49, and 50–100) with the lowest score stage (0–19) indicative of ER. The course-modifying effect of IFX on EHI was assessed. Finally, a generalised linear model was used to describe the relationship between EHI and the probability of attaining ER (Simple Endoscopic Score for CD [SES-CD] ≤2). The predictive ability of EHI for ER was compared with that of FC, CRP, ALB, and IFX using a receiver operating characteristic (ROC) curve analysis. Results The revisited two-compartment popPK model described the IFX data with adequate descriptive and predictive accuracies. EHI, FC, CRP, and ALB at week (w)0 were not found to explain interpatient variability in IFX clearance. In contrast, higher IFX at w14 was associated with a higher probability of achieving EHI <20 at w14 (Figure 1). The probability of attaining EHI <20 at w14 was predicted to increase more than four-fold when IFX at w14 was targeted at 10 mg/L instead of 5 mg/L (Table 1). EHI and FC equally well predicted the probability of attaining ER at the same time point (Figure 2, Table 2). Conclusion EHI, FC, ALB, and CRP at w0 should not be considered for a priori IFX dose optimisation. Nevertheless, a posteriori IFX dose optimisation (based on IFX concentrations measurements) towards a predefined IFX concentration at w14 may lead to lower post-induction EHI scores and thus improved ER rates. An IFX target of 10 mg/L at w14 is associated with four-fold higher normalisation of EHI as compared to the commonly used target of 5 mg/L.

Clinical outcomes in pediatric tibial lengthening and deformity correction: a comparison of the Taylor Spatial Frame with the Orthex Hexapod System

Purpose Comparison of two hexapod frame systems in paediatric tibial deformity correction; the Taylor Spatial Frame (TSF) and Orthex Hexapod System. Methods Paediatric patients with congenital and acquired tibial deformities treated with either TSF (between 2014 and 2016) or Orthex (between 2017 and 2019) frames were included in a retrospective comparative study. Outcome measures were healing index, pin infection rate, regenerate quality and density, software residual rate, deformity correction accuracy, strut exchanges and quality of life (QoL). Results The TSF group had 17 patients (18 frames) and the Orthex group had 21 patients (25 frames). The most common indications for tibial deformity correction were fibular hemimelia (14) and septic or traumatic growth arrest (8). The median time in frame was 230 days (TSF) versus 203 days (Orthex) (p= 0.06). The mean lengthening achieved was 54 mm (TSF) and 51 mm (Orthex) (p = 0.41). The healing index was 41 days/cm (TSF) versus 43 days/cm (Orthex) (p = 0.70). Pin site infections occurred more in the TSF cohort (40%) than in the Orthex cohort (18%) (p < 0.001). The regenerate in the Orthex group showed higher density at three months (p = 0.029) and was more homogenous (p = 0.023) at six months after frame application. Strut exchanges were less frequent with the Orthex system (p < 0.0001). QoL measures were similar in both cohorts (p = 0.92). Conclusions This is the first study to compare two hexapod designs in paediatric orthopaedics. The Orthex system showed superiority in regenerate quality and a significant reduction in pin site infection rates. Both systems delivered predictable and accurate limb deformity correction. Level of evidence III

Humerus Lengthening: A Comparison of the Internal Lengthening Nail to External Fixation

Introduction: Magnetic internal lengthening nails (MILNs) have been used for humeral lengthening to avoid complications associated with external fixation. Purpose/Questions: We compared the 1-year Disabilities of the Arm, Shoulder and Hand (DASH) score, adjacent joint range of motion (ROM), bone healing index (BHI), length achieved, distraction rate, and complications when lengthening the humerus using MILN vs using external fixation. Methods: We conducted a retrospective cohort study of 18 patients (22 humeri) from January 2001 to March 2020 divided into 2 groups, the MILN group (7 patients, 7 humeri) and the mono-lateral fixator group (11 patients, 15 humeri). Results: The MILN group showed larger improvement of DASH scores (average 26.8 and 8 for MILN and fixator groups, respectively), less loss of elbow ROM (average 5° and 7° for MILN and fixator groups, respectively), and shorter time to full recovery of elbow ROM (average 39 days and 122 days for MILN and fixator groups, respectively). In the MILN group, there was slower distraction rate (average 0.66 mm/day and 0.86 mm/day for MILN and fixator groups, respectively), less lengthening achieved (average 5.2 cm and 7 cm for MILN and fixator group, respectively), and a lower lengthening percentage (average 19% and 41% for MILN and fixator group, respectively). Bone healing index (BHI) of 0.94 and 0.99 months/cm for the MILN and the fixator groups were similar. Conclusion: Humeral lengthening using the MILN allowed for early full recovery of joint ROM with comparable functional and radiographic outcomes compared with using external fixators.