Journal of Emergency Medicine, Trauma and Acute Care - 2 - Unified National Conference of Iraqi Dental Colleges (UNCIDC), March 2024

Background and Aims: One of the critical factors for dental implant success is accurate clinical and radiological assessment. Cone-beam computed tomography systems (CBCT) allow surgeons to determine the quality and quantity before surgery, aiding in treatment planning. This study highlights the importance of such an assessment.

Materials and Methods: A total of 40 patients were referred to CBCT scanning for pre-dental implant assessment in the Oral and Maxillofacial Radiology department at Al-Shaheed Gazi Al Hariri Hospital from 2021 to 2022. The patients were between 18 and 50 years old. All data were analyzed with on-demand 3D software (Kavo OP 3D: Cone Beam 3D imaging Germany).

Results: Regarding the ridge shape:

1. In the upper anterior and posterior regions, the rectangular shape had the highest percentages of (62.5%) and (75%) respectively.
2. In the lower anterior and posterior regions, the pyramidal shape had the highest percentages of (55%) and (60%), respectively, and the hourglass shape was the lowest in all areas.

Regarding bone density:

The highest bone density percentage in the anterior upper region was D3 (67%), while in the upper posterior region, D4 had the highest percentage (77.5%). In the lower anterior region, D2 had a more prominent percentage (52.5%), while in the lower posterior, D3 was predominant (82.6%).

Conclusion: From this study, it can be suggested that CBCT is the best modality for pre-implant radiographic assessment, and ridge shape and bone density are easily assessed using this method.

Background: Autism spectrum disorder (ASD) is a neurodevelopmental condition affecting children, characterized by difficulties in social interaction, communication, and repetitive behavior. Consanguineous marriages increase the likelihood of discovering recessive conditions and promoting gene expression, leading to autosomal recessive disorders. Immunity also plays a vital role in autism development, with changes in pro-inflammatory cytokine concentrations or synthesis indicative of aberrant cellular immunity. This research aims to determine the effects of consanguinity on autism, measure interferon-gamma salivary levels, and examine the relationship between autistic subjects’ dental health condition and caries occurrence.

Materials and Methods: Forty autistic children were divided into mild, moderate, and severe categories according to their symptoms and social impairments. The oral investigation involved calculating decayed, missing, and filled teeth and simplified oral hygiene indices. Salivary samples were collected via the drooling technique, and salivary interferon-gamma levels were measured using an enzyme-linked immunosorbent assay.

Results: Consanguineous marriage was significant in the patient group, and salivary interferon-gamma levels were considerably elevated. A higher occurrence of dental caries was detected in autistic individuals. As disease severity increases, dental caries and oral health conditions also worsen.

Conclusion: Consanguinity increases the incidence of autism due to the likelihood of recessively inherited congenital abnormalities. Autism has higher levels of interferon-gamma, which play a role in the condition’s pathophysiology. Additionally, inadequate oral health was noticed in autistic children.

Background: Odontogenic cysts are characterized by their sluggish growth and ability to enlarge, primarily affecting the oral and maxillofacial tissues. Timely diagnosis and treatment are crucial to prevent potentially serious consequences. The present study aimed to evaluate and compare the immunohistochemical expression of cytokeratin 19 in the epithelium of odontogenic keratocyst, dentigerous, and radicular cysts.

Methods: This study analyzed forty-five formalin-fixed, paraffin-embedded tissue blocks containing odontogenic cysts. The sample consisted of fifteen odontogenic keratocysts, fifteen dentigerous cysts, and fifteen radicular cysts. Immunohistochemical analysis was performed to assess the expression of the cytokeratin 19 epithelial marker in these samples. Statistical analyses were conducted using Statistical Package for Social Sciences version 26, employing the Chi-square test for comparative analysis of cytokeratin 19 expression among the odontogenic keratocyst, dentigerous cyst, and radicular cyst.

Results: This study showed that 80% of basal layer tissue samples in the odontogenic keratocyst group had negative cytokeratin 19 biomarker scores. In contrast, 60% of dentigerous cyst tissue blocks and 53.3% of radicular cyst tissue blocks were +1. This difference was statistically significant (P = 0.034). In comparison, between groups, there was no significant difference (P = 0.103) in CK19 expression in the surface and spinous layers.

Conclusion: The level of epithelial differentiation is correlated with cytokeratin 19 expression. The cysts with well-differentiated epithelium (radicular cyst and dentigerous cyst) express cytokeratin 19, whereas those with less well-differentiated epithelium (odontogenic keratocyst) exhibit low positives. Thus, it serves as a diagnostic tool for distinguishing these three lesions.

Background: Radiation-induced oral mucositis (RIOM) poses a significant challenge in the management of head and neck cancer patients (HNCs). Patients may require adjustments in their cancer treatment, such as dose reductions or treatment delays, which can decrease the effectiveness of the antineoplastic therapy. Numerous clinical investigations have demonstrated that curcumin, an herbal agent, exhibits a wide range of pharmacologic actions, including anti-inflammatory, antibacterial, and anticarcinogenic effects and the ability to enhance wound healing.

Objectives: To evaluate the effect of curcumin oral gel with the magic solution (dexamethasone-based mouthwash) as a standard mouthwash treatment for RIOM in relation to salivary epidermal growth factor (EGF) before and after radiation therapy.

Methods: Thirty-one HNCs who received radiotherapy with a head and neck mask were divided into the curcumin oral gel and the magic-solution groups. Saliva samples were collected before radiation, at the 3rd week of radiation, and post-radiation. Salivary EGF was measured using an enzyme-linked immunosorbent assay. RIOM was assessed using both the WHO and the VAS scales.

Results: Significant differences were found between both groups in the WHO scale (P = 0.027) and VAS score (P = 0.047). Patients who used oral curcumin gel presented with less severe RIOM and elevated salivary EGF levels during the radiation sessions.

Conclusion: Curcumin oral gel might be an effective agent in preventing and managing RIOM, as evidenced by the observed increase in salivary EGF.

Animal studies are a prerequisite for human clinical studies involving exposures to a new therapeutic approach to test the quality of observations and treatment outcomes. Owing to the possibility of studying periodontal diseases longitudinally on both cellular and molecular levels, animal models, despite their known shortcomings, are considered superior to other study models when providing information at the host level.

Aim: Using a dip-coating technique, this study evaluated the microshear bond strength of resin cement to zirconia surfaces coated with nanosilica and nanoalumina.

Methods: Zirconia blocks (n = 56) were categorized into seven groups based on surface treatment: untreated (control), tribochemical silica coating (positive control), dip coating with pure nanosilica, pure nanoalumina, and nanosilica-nanoalumina mixtures at 75:25, 50:50, and 25:75 volume ratios. The coated surfaces underwent characterization using a Scanning Electron Microscope (SEM), Energy Dispersive Spectroscopy (EDS), X-ray Diffraction (XRD), and Atomic Force Microscopy (AFM). Resin cylinders were cemented onto the treated zirconia surfaces, and microshear bond strength testing was performed. Differences in bond strength between groups were analyzed using One-way ANOVA and Tukey’s post-hoc test (p < 0.05).

Results: SEM revealed that nanosilica coatings formed island-like agglomerations, nanosilica-nanoalumina produced porous layers, and nanoalumina formed a dense cover layer. XRD detected only the tetragonal phase in coated zirconia, indicating no phase transformation compared to tribochemical silica coating. Microshear bond strength was higher for all coating groups than for controls (p < 0.05). The 75:25 nanosilica-nanoalumina demonstrated greater bond strength than other ratios.

Conclusion: Dip-coating proved effective in enhancing resin-zirconia bonding without causing surface damage. Among the various ratios, the 75:25 nanosilica-nanoalumina mixture exhibited optimal bond strength.

Background: Dental caries in children is termed as early childhood caries. Early childhood caries (ECC) is an important dental health problem, particularly in people who are poor in society. Additionally, Saliva is very crucial for the development of caries and for preventing it. Antimicrobial peptides are a large group of peptides which protect the mucous membranes of the mouth cavity and various other places and have various roles affect parts of natural response and microbial invasion. Statherin is acidic peptides may also stop microbial organisms such as fungi and bacteria from growing and colonizing that lead to prevent tooth decay specially when Statherin values appeared significant while ß-Defensin-3, a naturally occurring antibacterial. It is consist of from three types (1, 2, and 3), which may reflect the immunological reaction to dental decay.

Materials and Method: Eighty healthy looking Kindergartens children with an age from 4-5 years old, in Baghdad city was registered in this research, 40 Kindergartens children with severe type of ECC detected according to Wyne (1999), classify be chosen as study group and 40 Kindergartens children caries free as control group matching age. All studied groups were subjected to oral examination and decayed missing filling (dmfs) was recorded also un-stimulated saliva was collected for the evaluation of salivary Statherin and ß-Defensin-3 by ELISA assay technique.

Results: Statistical analysis revealed that ß-Defensin-3levels was increase significantly in study group (ECC) compared to caries free group while salivary Statherin was significantly increase in the caries free group than study group (ECC) and appositive significant correlation was detected between dmfs and ß-Defensin-3.

Among the wide range of polymer matrices, polymethyl methacrylate (PMMA)-based matrices can be considered the most common polymer in dental applications. Significant parameters, such as conversion degree and change of color of two commercial brands, nano-filled composite resin, NovaPro (N), and micro-hybrid composite resin, VladMiVa (V), were investigated after curing and immersing the dental specimens in different drinks for one and seven days at 37°C. Raman spectroscopy was used to evaluate the degree of conversion (DC) by measuring the ratio of the absorption bands related to aromatic and methacrylate C=C stretching modes. These ratios were of the same value. CIE (Color Imaging Experiment) was used to investigate the color change of the filling resins. The N composite has a noticeable color change in coffee after 24 hours and almost the exact change after one week. Yogurt also significantly affects the color stability of the same composite just after one week of immersion. Cola dramatically affects the color of the same composite after one week of immersion. For the (V) composite, the effect of the drinks after immersion for 24 hours and after one week was within the acceptable limit and non-noticeable by the naked human eye, which means it has better color stability than the (N).

Background: This study investigates the factors contributing to self-medication among elderly patients in TIU (Tishk International University) and Erbil Infirmary House, utilizing a mixed-methods approach that combines qualitative interviews and quantitative surveys.

Methods: The sample includes elderly patients aged 60 years and above with diverse backgrounds, employing a mixed-methods approach consisting of qualitative interviews and quantitative surveys. The study identifies several factors contributing to self-medication, such as limited access to healthcare, financial constraints, long waiting times, lack of trust in healthcare professionals, family influence, and positive past experiences with self-medication.

The study emphasizes the necessity for targeted interventions to address self-medication in the elderly. This includes improving healthcare access, reducing financial barriers, enhancing healthcare professionals’ communication skills, and educating patients on the risks and benefits of self-medication. Collaboration between providers and the elderly population is crucial for creating a safe environment for appropriate medication use.

Results: The study reveals significant differences in self-medication behavior among the elderly based on demographic factors. Males were more likely to engage in self-medication, and the prevalence was higher among single elderly individuals. Primary education was more prevalent than high school or college education. There was no significant difference in self-medication prevalence between those without medical insurance and those with insurance. The presence of drug information significantly influenced self-medication practices.

Conclusion: Further research is needed to explore the long-term consequences of self-medication and evaluate the effectiveness of intervention strategies in mitigating associated risks. Addressing self-medication among elderly patients is essential to ensure their health and well-being.

Objective: To evaluate the problems patients perceive during orthodontic treatment with removable and myofunctional appliances.

Study Design: Cross-sectional study.

Place and Duration of Study: Prosthodontic Department, College of Dentistry, University of Kerbala, from March 2021 to July 2021.

Methodology: A total of 210 orthodontic patients who had been wearing removable and myo-functional orthodontic appliances for at least four months were included in the study. Patients were divided into two groups aged between 10 to 40 years. A questionnaire comprising 11 items covering physical, functional, psychological, and social problems associated with wearing removable and myofunctional orthodontic appliances was used to analyze the outcome variables. Patients were interviewed at Kerbala University.

Results: In this study, 107 (51%) patients were male, and 103 (49%) were female, with ages ranging from 10 to 40 years. Forty-four (21%) patients reported reeling pain after insertion of removable and myofunctional appliances. A relatively higher percentage of male patients (44.5%) believed the appliance was effective, and 40% found it comfortable. Difficulty in speaking (36.7%) was the most frequent problem reported by the patients in the studied population.

Conclusion: Despite a few problems, wearing removable and myofunctional orthodontic appliances remained an effective and viable treatment option for uncomplicated malocclusions.

Purpose: The main objective of this study is to develop a substance that can enhance the absorption of radiation therapy for head and neck cancer and protect the surrounding tissues of the tumor during radiotherapy.

Materials and Methods: The dimensions of the specimen are 40 mm x 55 mm in length and width, with a thickness of 6 mm based on Iraqi population studies. The sample was composed of four groups, A, B, C, and D. Each group was exposed to two different types of energy, 4 MEV, and 9 MEV, by the VARIANI X2300 radiation machine.

Results: The amount of radiation penetration was measured and statistically analyzed using Levene’s and two-way ANOVA tests to determine the differences and identify the best materials. The data from this study show a highly significant difference (p-value < 0.001) in radiation penetration between all groups.

Conclusion: The stent made with a combination of cold-cure acrylic and tungsten alloy has the lowest radiation penetration at 4 MEV and 9 MEV energy levels, making it the best material stent for protecting healthy tissues against radiation. On the other hand, stents made solely with cold-cure acrylic offer poor radiation protection.

Background: Advancements in dentistry and incorporating 3D printing techniques have numerous benefits over traditional methods. However, the produced resins have shown a lack of good biocompatibility and insufficient mechanical properties. Tantalum oxide, on the other hand, exhibits biocompatibility, excellent physical and mechanical properties, and an antimicrobial effect.

Aim of the study: To assess the tensile strength of tantalum oxide nanoparticles when used with 3D-printed denture-based resins before and after thermocycling.

Materials and Methods: The materials tested in this study were laser-based stereolithography (an additive manufacturing process, SLA). Eighty samples were prepared from 3D-printed resin. The sample was divided into two groups (before and after thermocycling), and each group was subdivided into four subgroups.

Results: There was a statistically significant association between the used concentrations when tested before and after thermocycling, with a high statistical significance (p-value = 0.001). Additionally, there was a high statistical significance for the concentration before thermocycling in relation to after thermocycling with (p-value 0.001).

Conclusion: Using tantalum oxide improved the tensile strength of the 3D-printed resins by promoting characteristic osseointegration and enhancing its ability to promote osteoblast formation, proliferation, and integration into the bone.

Vascular anomalies are localized congenital morphogenetic defects in the blood vessels. They represent a broad spectrum of disorders, ranging from a simple “birthmark” to life-threatening entities. Most (60%) occur in the head and neck region, and each anomaly has a different etiology and clinical behavior; therefore, an accurate diagnosis is crucial for appropriate evaluation and management.

This study aims to briefly elaborate on the vascular anomalies, their etiology, and clinical features and assess the role of sclerosing agents in treating venous malformations. The International Society for the Study of Vascular Anomalies (ISSVA) classifies vascular anomalies into vascular tumors and malformations, with subdivisions of each. This classification is accepted worldwide and has become the official system for classifying vascular anomalies.

Hemangiomas are the most common type of vascular tumors, while venous malformations are the most common type of vascular malformations. Venous malformations can be treated conservatively without surgical disfigurement. Sclerotherapy is the first-line treatment for venous malformations, as it is an easy-to-perform procedure with minimal equipment needed.

Background: Dental caries is a heterogeneous microbial infection affecting the mineralized dental tissues and characterized by a gradual demineralization process. Vitamin D aids in the immunological response to oral infections, and its insufficiency can impact the patient’s general and dental health. Small cationic peptides known as cathelicidins are essential for developing innate immune systems. This study aimed to investigate the impact of vitamin D on the innate immune response by assessing the levels of cathelicidin in children with tooth decay.

Subjects and Methods: This study included 60 children aged 4-5 years, with 30 children having caries and 30 without caries. Oral examinations were conducted and scored using the dmfs index. Saliva samples were collected from all subjects, and ELISA was employed to determine vitamin D and cathelicidin levels.

Results: The current findings revealed that salivary levels of cathelicidin and vitamin D were significantly lower (P < 0.01) in children affected by caries than caries-free children. The results also showed a significant decrease (P < 0.01) in cathelicidin levels compared to the vitamin D sufficient group.

Conclusions: The study concludes that children with caries and vitamin D deficiency exhibit low levels of cathelicidin. The observed link between vitamin D deficiency and caries suggests that vitamin D contributes to the synthesis of cathelicidin.