The International Journal of Periodontics & Restorative Dentistry
The aim of this study was to compare radiographic and clinical status and peri-implant sulcular f... more The aim of this study was to compare radiographic and clinical status and peri-implant sulcular fluid (PISF) prostaglandin E2 (PGE2) levels among patients with and without peri-implant disease. Patients with peri-implant mucositis (PiM) (Group 1) and peri-implantitis (Group 2) and individuals without peri-implant disease (Group 3) were included. Demographic information was collected, and peri-implant modified plaque and bleeding indices (mPI and mBI), probing depth (PD), and crestal bone loss (CBL) were recorded. PISF samples were collected and PGE2 levels measured. Statistical significance was set at P < .01. A total of 22 patients with PiM, 22 with peri-implantitis, and 23 without peri-implant disease (controls) were included. Scores of mPI (P < .01), mBI (P < .01), and PD (P < .01) were higher in patients with PiM and peri-implantitis than the controls. The volumes of collected PISF were significantly higher in patients with peri-implantitis (P < .01) compared to p...
International Journal of Oral and Maxillofacial Surgery, Mar 1, 2017
Background: Majority of macrocheilia is seen as normal ethnic variations in Afro-Caribbean and As... more Background: Majority of macrocheilia is seen as normal ethnic variations in Afro-Caribbean and Asian populations. Various other aetiologies have been reported, which include glandular hypertrophy, vascular malformations, granulomatous disorders and trauma. Congenital causes include double lip and labial pits. Clinical features mostly are related to aesthetic problems but functional problems due to incompetent lips like drooling and speech have also been reported. Lip enhancement complications (e.g. postoperative infection or overfilling with fillers) and trauma-related scar formation are additional indications for lip reduction surgery. Dentofacial abnormalities resulting in pseudo-macrocheilia has to be recognised before any irreversible damage is done. Acute inflammation and psychiatric instability are contraindications for lip reduction surgery. Management: Principles of surgical correction are to correct any underlying dento-osseous deformities and establish a balance between upper and lower lip tailored to the individual patient. We present a case of a 26-year-old Asian male with hypertrophic upper and lower lip who requested lip reduction surgery purely for aesthetic reasons. Oral and maxillofacial surgeons should be aware that "cheiloplasty" is a simple procedure, which is reliable and has predictable results when surgical principles are adhered to and contraindications are kept in mind.
International Journal of Oral and Maxillofacial Surgery, 2018
The objective of this study was to assess changes in patient quality of life (QoL) after orthogna... more The objective of this study was to assess changes in patient quality of life (QoL) after orthognathic surgery at the Kuwait University Dental Clinic. A selfadministered Arabic version of the Orthognathic Quality of Life Questionnaire (OQLQ) and two different visual analogue scales (VAS) were used. Sixty-six patients participated (63.6% female). The deformities were corrected by bimaxillary jaw surgery (83.3%), Le Fort I (9.1%), and bilateral sagittal split osteotomy (7.6%). The most important reasons given for undertaking the surgery were facial aesthetics (80.3%) and bite correction (75.8%). Of the patients who had reported moderate to high levels of problems pre-surgery, the majority reported improvements in facial appearance (91.3%), appearance of the teeth (97.0%), biting (96.3%), chewing (92.3%), and eating function (76.5%). Overall, 93.9% of patients reported better conditions after surgery, and the satisfaction level was very high (VAS 91.6%). The VAS score for QoL increased significantly from pre-surgery (73.0%) to post-surgery (93.6%) (P = 0.0001). The OQLQ score was also significantly decreased after surgery, reflecting improvements in the 'social aspects of dentofacial deformity', 'facial aesthetics', 'oral function', and 'awareness of dentofacial aesthetics' domains (P = 0.0001). Overall, the patients who underwent orthognathic surgery were satisfied and had improved QoL. The satisfaction rate in the present study reflects successful treatment with orthognathic surgery.
Background: The fixed tooth-implant connection remains a controversial issue. This private practi... more Background: The fixed tooth-implant connection remains a controversial issue. This private practice-based retrospective study aimed to evaluate the clinical outcomes of a contemporary fixed partial denture (FPD) design for connecting natural teeth and implants (TI-FPD), over an 11.8 years observation period. Material and Methods: The data of 91 partially edentulous patients (44 males and 47 females, mean age of 47.7 years) treated with a newly designed TI-FPD retained on 1 implant and 1 natural tooth were analyzed retrospectively. Teeth were covered with electroformed copings and a CAD/CAM made bridge was fixed over the abutments with provisional cement. Two different implant systems were used: Camlog (N=22; anterior areas) and Straumann tissue level (N=69; posterior areas). Results: The survival rate for both implants and teeth was 100%. 19/21 (90%, 95%CI 82-95%), 16/21 (66%, 95%CI 66-84%), and 16/21 (66%, 95%CI 66-84%) patients were free of biological complications after 5 years, 10 years, and 15 years post-loading, respectively. 23/35 (90%, 95%CI 54-74%), 21/35 (61%, 95%CI 50-70%), and 21/35 (61%, 95%CI 50-70%) were free of technical complications following 5 years, 10 years, and 15 years post loading, respectively. Conclusions: Despite limitations of the study, the findings demonstrated that the use of a recently designed TI-FPD could be used for the tooth-implant connection in cases of partial edentulism and this may widen the treatment modalities by reducing the cost and need for extensive bone tissue augmentations. Further controlled longitudinal studies with larger patient groups are needed.
Non-resorbable PTFE membranes are frequently used in dental-guided bone regeneration (GBR). Howev... more Non-resorbable PTFE membranes are frequently used in dental-guided bone regeneration (GBR). However, there is a lack of detailed comparative studies that define variations among commonly used PTFE membranes in daily dental clinical practice. The aim of this study was to examine differences in physicochemical and mechanical properties of several recent commercial PTFE membranes for dental GBR (CytoplastTM TXT-200, permamem®, NeoGen®, Surgitime, OsseoGuard®-TXT, OsseoGuard®-NTXT). Such differences have been rarely recorded so far, which might be a reason for the varied clinical results. For that reason, we analyzed their surface architecture, chemical composition, tensile strength, Young’s modulus, wettability, roughness, density, thickness and porosity. SEM revealed different microarchitectures among the non-textured membranes; the textured ones had hexagonal indentations and XPS indicated an identical spectral portfolio in all membranes. NeoGen® was determined to be the strongest an...
British Journal of Oral and Maxillofacial Surgery, 2018
The goal of reconstruction of the alveolar cleft in patients with cleft lip and palate is to impr... more The goal of reconstruction of the alveolar cleft in patients with cleft lip and palate is to improve the quality of tissue, the structural stability, and increase the volume of bone. This study is a systematic review with meta-analysis of volumetric bony filling using autogenous bone and various tissue-engineered bone substitutes. We made an electronic search on MEDLINE, EMBASE, SCOPUS, WEB OF SCIENCE, "grey" publications (materials and research produced by organisations outside traditional channels for commercial or academic publishing and distribution), and relevant cross references according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies that reported the outcomes of volumetric grafting were included in the meta-analysis. Of 1276 studies, 26 were included in the meta-analysis. Pooled analysis of 25 studies that used autogenous bone showed a significant reduction in the volume of the cleft equivalent to 62.0% bone fill (95% CI 54.3 to 69.6), in contrast to 10 studies that used a tissue-engineered material and reported bone filling of 68.7% (95% CI 54.5 to 82.8). The estimated sizes of pooled effects across studies showed that there was no significant difference between the two major intervention groups (p value 0.901). Our statistical analysis showed that autogenous bone grafts did not differ significantly from tissue-engineered materials in their ability to fill clefts. Systematic review registration: International Prospective Register of Systematic Reviews, PROSPERO (CRD42017065045).
This study was undertaken to investigate the integration of titanium micro-implants installed in ... more This study was undertaken to investigate the integration of titanium micro-implants installed in conjunction with previously dentin-grafted areas and to study the morphological appearance, mineral content, and healing pattern of xenogenic EDTA-conditioned dentin blocks and granules grafted to cavities in the tibial bone of rabbits. Demineralized and non-demineralized dentin blocks and granules from human premolars were implanted into cavities prepared on the lateral aspects of the tibias of rabbits. After a healing period of six months, micro-implants were installed at each surgical site. Histological examinations were carried out after 24 weeks. Characterization of the EDTA-conditioned dentin blocks was performed by means of light microscopy, dental X-rays, scanning electron microscopy, and energy dispersive X-ray analysis (EDX). No implants were found to be integrated in direct contact with the dentin particles or blocks. On the EDTA-conditioned dentin surface, the organic marker ...
Guided tissue regeneration (GTR) membranes are used for treating chronic periodontal lesions with... more Guided tissue regeneration (GTR) membranes are used for treating chronic periodontal lesions with the aim of regenerating lost periodontal attachment. Spatially designed functionally graded bioactive membranes with surface core layers have been proposed as the next generation of GTR membranes. Composite formulations of biopolymer and bioceramic have the potential to meet these criteria. Chitosan has emerged as a well-known biopolymer for use in tissue engineering applications due to its properties of degradation, cytotoxicity and antimicrobial nature. Hydroxyapatite is an essential component of the mineral phase of bone. This study developed a GTR membrane with an ideal chitosan to hydroxyapatite ratio with adequate molecular weight. Membranes were fabricated using solvent casting with low and medium molecular weights of chitosan. They were rigorously characterised with scanning electron microscopy, Fourier transform infrared spectroscopy in conjunction with photoacoustic sampling a...
International Journal of Environmental Research and Public Health
The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on dental education... more The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on dental education worldwide. Due to the rapid spread of COVID-19 across Kuwait, it was essential for the Faculty of Dentistry (FoD) at Kuwait University to make appropriate modifications to the functioning of the dental school. The FoD’s goal was not only to ensure a safe environment for its staff, students, and patients but also to sustain the students’ academic progression. The FoD adopted several measures including the establishment of a COVID-19 response team, adoption of a blended-learning model, and phase-wise re-opening of the dental center. This paper discusses on the strategies that the FoD adopted, in response to the challenges posed by the pandemic.
The present study was undertaken to evaluate the healing pattern of xenogenic demineralized denti... more The present study was undertaken to evaluate the healing pattern of xenogenic demineralized dentin onlay grafts in comparison with autogenous bone grafts to the rabbit tibia. Eight 6-month-old New Zealand male rabbits were used in the experiments. Standardized sized dentin blocks from human premolars and similar autogenous bone blocks harvested from tibia were grafted as onlay blocks on each tibia (n = 8 × 2). All animals were killed after a healing period of 12 weeks. Healing was uneventful for all animals. In general, both the dentin and bone block grafts were fused to the bone, resorbed, and replaced by bone and connective tissue to a varying degree. Both types of grafts were still present after 12 weeks, on an average to approximately one third of the original sizes. Resorption cavities could be seen in the dentin with bone formation. Zones of osseous replacement resorption of the dentin could be noted. In both graft types, higher rate of bone formation was seen at the interface between graft and recipient site. Demineralized xenogenic dentin onlay grafts showed similar resorption characteristics as autogenous bone onlay grafts, being resorbed in a similar rate during 12 weeks. New bone formation occurred mainly in terms of replacement resorption in the interface between dentin/bone graft and native bone.
The International journal of periodontics & restorative dentistry
This experiment was conducted to study the histologic feasibility and biologic impact of Ti02 imp... more This experiment was conducted to study the histologic feasibility and biologic impact of Ti02 impregnation of an extracellullar matrix (ECM) membrane in guided bone regeneration. Eighteen adult New Zealand White rabbits were used. Bilateral bone defects were created in edentulous areas of the maxilla. The defects were filled with demineralized freeze-dried bone (DFDB). ECM was randomly pretreated with a suspension containing saline and 3 mg Ti02 granules. A regular ECM membrane served as a control on the contralateral side. Healing periods were 2, 4, and 8 weeks. Histologic and histomorphometric analyses were performed. The parameters assessed were (1) zone of inflammatory cells adjacent to ECM membrane, (2) presence of cellullar ingrowth into ECM, and (3) presence of Ti02 particles within the ECM barrier membrane. In general, no adverse reactions toward both groups of ECM membranes could be noted. The Ti02 particles remained within the ECM after 8 weeks of healing, making histologi...
The aim of this study was to evaluate the rate of postoperative infection and other complications... more The aim of this study was to evaluate the rate of postoperative infection and other complications after the surgical removal of impacted mandibular third molars. Subjects and Materials: Medical records of 110 consecutive patients with 130 consecutive surgical extractions of impacted lower third molar teeth performed under local anesthetic using strict aseptic techniques were reviewed and analyzed. No systemic antibiotics were administered or prescribed after the surgery. The rates of postoperative infection and other complications were evaluated clinically. Results: Of the 130 surgical removals, 110 in 90 patients met the inclusion criterion of nonuse of antibiotics. Fifty-nine were female and the remaining 31 were male. Average age was 25.2 years. Of the 110 surgeries, postoperative infection occurred in 6 (5.5%). Other complications were alveolar osteitis (n = 9, 8.2%), pain lasting more than 1 week (n = 5, 4.3%) and sensory dysfunction of the inferior alveolar nerve (n = 2,0.8%). Conclusion: The low rates of postoperative infection and other complications observed in this study encouraged us to continue surgical removal of impacted mandibular third molars without routine prescription of antibiotics unless indicated for other medical reasons.
First-aid knowledge in Kuwaiti parents is lacking for avulsion and replantation of teeth despite ... more First-aid knowledge in Kuwaiti parents is lacking for avulsion and replantation of teeth despite a high level of knowledge of how to manage simple body injuries. Knowledge of firstaid measures regarding avulsion and replantation of teeth should be increased by intervention programs.
Dentoalveolar ankylosis with osseous replacement is often seen after replantation of avulsed teet... more Dentoalveolar ankylosis with osseous replacement is often seen after replantation of avulsed teeth, and this process may be used for preservation of alveolar crests after trauma. Its exact mechanisms with regard to osteoinductive properties are not yet fully understood and need to be systematically investigated. Dentin can possibly act as a slow-releasing carrier of bone morphogenic proteins (BMP), and this property of dentin has been proposed to be used as an alternative or supplement to bone grafting in the maxillofacial region. We aimed to initially asses host tissue reactions to dentin by implanting dentin blocks of autogenic and xenogenic human origin in rabbit connective tissue of the abdominal wall and femoral muscle. Animals were sacrificed after a period of 3 months, and histological processing, sectioning and examinations were carried out. Bone formation, cell counts and thickness of capsule surrounding the grafts were evaluated. Only minor signs of heterotopic bone formation were seen. There were no significant differences between autografts and xenografts or grafts implanted in connective tissue or muscle with regards to tissue reactions except for a significant difference (P = 0.018) in findings of more local inflammatory cells in relation to grafts placed in connective tissue in the autograft group. We conclude that during the time frame of this study, non-demineralized dentin, whether autogenous or xenogenic did not have the potential to induce bone formation when implanted in non-osteogenic areas such as the abdominal wall and abdominal muscle of rabbits.
From traumatology, it is well known that dentoalveolar ankylosis results in osseous replacement a... more From traumatology, it is well known that dentoalveolar ankylosis results in osseous replacement and formation of new bone. This principle is used after decoronation for preservation of the height and width of the alveolar bone crest after trauma. Dentin possesses bone-forming properties and may possibly also be used as a bone augmentation material prior to implant placement. The aim of this study was to investigate whether xenogenic dentin particles inserted into the marrow space of rabbit tibia, a space where there is no solid bone tissue initially, would contribute to new bone formation. Dentin chips from human teeth were inserted into tibias of ten New Zealand rabbits. The tibial bones were processed for histology after 6 months, and new bone formation was quantified. Bone formation was ranging from 0 to 86% on the dentin fragments, and there was minor inflammation. Bone formation was seen to a larger extent on dentin grafts located close to the native tibial bone wall. There was a significant correlation (r = -0.579, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) between the amount of bone formation around the dentin graft and distance to the tibial cortical wall. Dentin promotes new bone formation when located close to native cortical bone and may have a potential as a bone augmentation material.
The aims of this study were to evaluate knowledge level among parents regarding tooth avulsion an... more The aims of this study were to evaluate knowledge level among parents regarding tooth avulsion and replantation and to evaluate a simple leaflet as an information tool to enhance this knowledge. One Hundred and fifty parents in a primary school in Kuwait City participated in the study. Half of the parents received a leaflet with basic first aid message regarding what to do in case of tooth avulsion. One week after reading the leaflet, the parents who had received the leaflet were evaluated by using a questionnaire. The other half of the parents who had not seen the leaflet served as control. The level of knowledge was measured in the following categories: General knowledge of tooth avulsion, knowledge of replantation and primary vs permanent teeth, knowledge of how to clean an avulsed tooth, knowledge of extra-oral time, knowledge of storage methods and storage media. By scoring the knowledge, the level of knowledge was calculated. The results showed that knowledge level was low among Kuwaiti parents. Improvement was seen in all categories of knowledge as a result of reading the leaflet. A simple leaflet can be a valuable tool to convey important basic information and enhance knowledge of tooth avulsion and how parents should act in such a situation, although there are limitations in conveying the message for a complete understanding. Measuring the knowledge by scoring can give valuable feedback in developing various educational tools.
School teachers can play an important role in improving the prognosis of avulsed permanent teeth ... more School teachers can play an important role in improving the prognosis of avulsed permanent teeth of school children after they are informed about the immediate and proper dental first aid steps to be taken at the time of an accident. The aims of this study were: (i) to assess the knowledge level of emergency measures for tooth avulsion in Kuwaiti intermediate school teachers and (ii) to determine if a short lecture about tooth avulsion and replantation could improve teachers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; knowledge on this topic. Eighty-five teachers at two intermediate schools (children 10-14 years old) in Kuwait were interviewed using a questionnaire about their first-aid knowledge with particular focus on the following five categories: General knowledge of teeth and avulsion, replantation of primary and permanent teeth, how to clean an avulsed tooth before replantation, extra-oral time and storage methods and media for an avulsed tooth. For each category, a score ranging from 0-3 was possible. An informative 30-min lecture about tooth avulsion and replantation was presented to a group of 43 teachers. After the lecture, the knowledge level of the teachers was re-tested using the same method. Descriptive statistics was used to describe and analyze the data. Improvement in teacher knowledge to an adequate (score of 2) or complete (score of 3) level was observed after the lecture in all five categories. The general knowledge of tooth avulsion and replantation improved from 39% to 97% and knowledge of avulsed permanent and primary teeth from 8% to 71%. Knowledge of how to clean an avulsed tooth improved from 5% to 93%. The knowledge level on the importance of extra-alveolar time before replantation increased from 1% to 74% and knowledge of a suitable storage medium for the avulsed tooth improved from 4% to 86%. Many avulsed permanent teeth in school children can be saved by replantation if school teachers learn what to do when a tooth is avulsed. A lecture followed by discussion proved to be an effective and efficient method of intervention to enhance the knowledge level of teachers so that proper dental first-aid procedures can be achieved.
The degree of damage is one of the most important prognostic factors in the replantation of a kno... more The degree of damage is one of the most important prognostic factors in the replantation of a knockedout (avulsed, exarticulated) tooth; the tooth needs to be placed back in its socket as soon as possible to avoid further damage to the periodontal membrane (1-5). The prognosis is related to the injury of the periodontal membrane during the time the tooth is out of its socket (6). Dry storage of the tooth will result in an irreversible injury to the periodontal membrane, with the result that the replanted tooth will be lost over time (2-5, 7). Wrapping the tooth in plastic wrap could prevent evaporation for at least
Alveolar cleft repair is performed via bone grafting procedure to restore the dental arch continu... more Alveolar cleft repair is performed via bone grafting procedure to restore the dental arch continuity. A suitable bone substitute materials should possess osteoinductive and osteoconductive properties, to promote new bone formation, along with a slowly resorbable scaffold that is subsequently replaced with functionally viable bone. Calcium phosphate biomaterials have long proved their efficacy as bone replacement materials. Dentin in several forms has also demonstrated its possibility to be used as bone graft replacement material in several studies. The purpose of this study was to evaluate bone regeneration pattern and quantify bone formation after grafting pre-established experimental alveolar clefts defects model in rabbits using composite xenogenic dentin and β-TCP in comparison to β-TCP alone. Unilateral alveolar cleft defects were created in 16 New Zealand rabbits according to previously described methodology. Alveolar clefts were allowed 8 weeks healing period. 8 defects were ...
Journal of biomedical materials research. Part B, Applied biomaterials, Jan 25, 2018
The purpose of this study was to evaluate bone healing in calvarial defects using two bone graft ... more The purpose of this study was to evaluate bone healing in calvarial defects using two bone graft substitute materials; biphasic beta-tricalcium phosphate/hydroxyapatite in hydrogel (ß-TCP/HA) versus composite non-demineralized xenogenic dentin with ß-TCP/HA mixture. Full thickness critical-sized defects were created bilaterally in 10 New Zealand male rabbits. Seven defects were left empty, six filled with biphasic tricalcium phosphate putty, and seven were filled with composite non-demineralized xenogenic dentin with biphasic tricalcium phosphate. Animals were sacrificed at eight weeks postoperatively and the healing of the biomaterial-filled defects was compared radiographically and by histomorphometry. Micro-computed tomography (μCT) was utilized to analyze the osteogenesis and healing patterns of the defects. Quantitative analysis of volume fraction (%) of the newly formed bone and remaining graft material (FV=filling volume/TV=tissue volume) and mean intensity [HU] in the defect...
The International Journal of Periodontics & Restorative Dentistry
The aim of this study was to compare radiographic and clinical status and peri-implant sulcular f... more The aim of this study was to compare radiographic and clinical status and peri-implant sulcular fluid (PISF) prostaglandin E2 (PGE2) levels among patients with and without peri-implant disease. Patients with peri-implant mucositis (PiM) (Group 1) and peri-implantitis (Group 2) and individuals without peri-implant disease (Group 3) were included. Demographic information was collected, and peri-implant modified plaque and bleeding indices (mPI and mBI), probing depth (PD), and crestal bone loss (CBL) were recorded. PISF samples were collected and PGE2 levels measured. Statistical significance was set at P < .01. A total of 22 patients with PiM, 22 with peri-implantitis, and 23 without peri-implant disease (controls) were included. Scores of mPI (P < .01), mBI (P < .01), and PD (P < .01) were higher in patients with PiM and peri-implantitis than the controls. The volumes of collected PISF were significantly higher in patients with peri-implantitis (P < .01) compared to p...
International Journal of Oral and Maxillofacial Surgery, Mar 1, 2017
Background: Majority of macrocheilia is seen as normal ethnic variations in Afro-Caribbean and As... more Background: Majority of macrocheilia is seen as normal ethnic variations in Afro-Caribbean and Asian populations. Various other aetiologies have been reported, which include glandular hypertrophy, vascular malformations, granulomatous disorders and trauma. Congenital causes include double lip and labial pits. Clinical features mostly are related to aesthetic problems but functional problems due to incompetent lips like drooling and speech have also been reported. Lip enhancement complications (e.g. postoperative infection or overfilling with fillers) and trauma-related scar formation are additional indications for lip reduction surgery. Dentofacial abnormalities resulting in pseudo-macrocheilia has to be recognised before any irreversible damage is done. Acute inflammation and psychiatric instability are contraindications for lip reduction surgery. Management: Principles of surgical correction are to correct any underlying dento-osseous deformities and establish a balance between upper and lower lip tailored to the individual patient. We present a case of a 26-year-old Asian male with hypertrophic upper and lower lip who requested lip reduction surgery purely for aesthetic reasons. Oral and maxillofacial surgeons should be aware that "cheiloplasty" is a simple procedure, which is reliable and has predictable results when surgical principles are adhered to and contraindications are kept in mind.
International Journal of Oral and Maxillofacial Surgery, 2018
The objective of this study was to assess changes in patient quality of life (QoL) after orthogna... more The objective of this study was to assess changes in patient quality of life (QoL) after orthognathic surgery at the Kuwait University Dental Clinic. A selfadministered Arabic version of the Orthognathic Quality of Life Questionnaire (OQLQ) and two different visual analogue scales (VAS) were used. Sixty-six patients participated (63.6% female). The deformities were corrected by bimaxillary jaw surgery (83.3%), Le Fort I (9.1%), and bilateral sagittal split osteotomy (7.6%). The most important reasons given for undertaking the surgery were facial aesthetics (80.3%) and bite correction (75.8%). Of the patients who had reported moderate to high levels of problems pre-surgery, the majority reported improvements in facial appearance (91.3%), appearance of the teeth (97.0%), biting (96.3%), chewing (92.3%), and eating function (76.5%). Overall, 93.9% of patients reported better conditions after surgery, and the satisfaction level was very high (VAS 91.6%). The VAS score for QoL increased significantly from pre-surgery (73.0%) to post-surgery (93.6%) (P = 0.0001). The OQLQ score was also significantly decreased after surgery, reflecting improvements in the 'social aspects of dentofacial deformity', 'facial aesthetics', 'oral function', and 'awareness of dentofacial aesthetics' domains (P = 0.0001). Overall, the patients who underwent orthognathic surgery were satisfied and had improved QoL. The satisfaction rate in the present study reflects successful treatment with orthognathic surgery.
Background: The fixed tooth-implant connection remains a controversial issue. This private practi... more Background: The fixed tooth-implant connection remains a controversial issue. This private practice-based retrospective study aimed to evaluate the clinical outcomes of a contemporary fixed partial denture (FPD) design for connecting natural teeth and implants (TI-FPD), over an 11.8 years observation period. Material and Methods: The data of 91 partially edentulous patients (44 males and 47 females, mean age of 47.7 years) treated with a newly designed TI-FPD retained on 1 implant and 1 natural tooth were analyzed retrospectively. Teeth were covered with electroformed copings and a CAD/CAM made bridge was fixed over the abutments with provisional cement. Two different implant systems were used: Camlog (N=22; anterior areas) and Straumann tissue level (N=69; posterior areas). Results: The survival rate for both implants and teeth was 100%. 19/21 (90%, 95%CI 82-95%), 16/21 (66%, 95%CI 66-84%), and 16/21 (66%, 95%CI 66-84%) patients were free of biological complications after 5 years, 10 years, and 15 years post-loading, respectively. 23/35 (90%, 95%CI 54-74%), 21/35 (61%, 95%CI 50-70%), and 21/35 (61%, 95%CI 50-70%) were free of technical complications following 5 years, 10 years, and 15 years post loading, respectively. Conclusions: Despite limitations of the study, the findings demonstrated that the use of a recently designed TI-FPD could be used for the tooth-implant connection in cases of partial edentulism and this may widen the treatment modalities by reducing the cost and need for extensive bone tissue augmentations. Further controlled longitudinal studies with larger patient groups are needed.
Non-resorbable PTFE membranes are frequently used in dental-guided bone regeneration (GBR). Howev... more Non-resorbable PTFE membranes are frequently used in dental-guided bone regeneration (GBR). However, there is a lack of detailed comparative studies that define variations among commonly used PTFE membranes in daily dental clinical practice. The aim of this study was to examine differences in physicochemical and mechanical properties of several recent commercial PTFE membranes for dental GBR (CytoplastTM TXT-200, permamem®, NeoGen®, Surgitime, OsseoGuard®-TXT, OsseoGuard®-NTXT). Such differences have been rarely recorded so far, which might be a reason for the varied clinical results. For that reason, we analyzed their surface architecture, chemical composition, tensile strength, Young’s modulus, wettability, roughness, density, thickness and porosity. SEM revealed different microarchitectures among the non-textured membranes; the textured ones had hexagonal indentations and XPS indicated an identical spectral portfolio in all membranes. NeoGen® was determined to be the strongest an...
British Journal of Oral and Maxillofacial Surgery, 2018
The goal of reconstruction of the alveolar cleft in patients with cleft lip and palate is to impr... more The goal of reconstruction of the alveolar cleft in patients with cleft lip and palate is to improve the quality of tissue, the structural stability, and increase the volume of bone. This study is a systematic review with meta-analysis of volumetric bony filling using autogenous bone and various tissue-engineered bone substitutes. We made an electronic search on MEDLINE, EMBASE, SCOPUS, WEB OF SCIENCE, "grey" publications (materials and research produced by organisations outside traditional channels for commercial or academic publishing and distribution), and relevant cross references according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies that reported the outcomes of volumetric grafting were included in the meta-analysis. Of 1276 studies, 26 were included in the meta-analysis. Pooled analysis of 25 studies that used autogenous bone showed a significant reduction in the volume of the cleft equivalent to 62.0% bone fill (95% CI 54.3 to 69.6), in contrast to 10 studies that used a tissue-engineered material and reported bone filling of 68.7% (95% CI 54.5 to 82.8). The estimated sizes of pooled effects across studies showed that there was no significant difference between the two major intervention groups (p value 0.901). Our statistical analysis showed that autogenous bone grafts did not differ significantly from tissue-engineered materials in their ability to fill clefts. Systematic review registration: International Prospective Register of Systematic Reviews, PROSPERO (CRD42017065045).
This study was undertaken to investigate the integration of titanium micro-implants installed in ... more This study was undertaken to investigate the integration of titanium micro-implants installed in conjunction with previously dentin-grafted areas and to study the morphological appearance, mineral content, and healing pattern of xenogenic EDTA-conditioned dentin blocks and granules grafted to cavities in the tibial bone of rabbits. Demineralized and non-demineralized dentin blocks and granules from human premolars were implanted into cavities prepared on the lateral aspects of the tibias of rabbits. After a healing period of six months, micro-implants were installed at each surgical site. Histological examinations were carried out after 24 weeks. Characterization of the EDTA-conditioned dentin blocks was performed by means of light microscopy, dental X-rays, scanning electron microscopy, and energy dispersive X-ray analysis (EDX). No implants were found to be integrated in direct contact with the dentin particles or blocks. On the EDTA-conditioned dentin surface, the organic marker ...
Guided tissue regeneration (GTR) membranes are used for treating chronic periodontal lesions with... more Guided tissue regeneration (GTR) membranes are used for treating chronic periodontal lesions with the aim of regenerating lost periodontal attachment. Spatially designed functionally graded bioactive membranes with surface core layers have been proposed as the next generation of GTR membranes. Composite formulations of biopolymer and bioceramic have the potential to meet these criteria. Chitosan has emerged as a well-known biopolymer for use in tissue engineering applications due to its properties of degradation, cytotoxicity and antimicrobial nature. Hydroxyapatite is an essential component of the mineral phase of bone. This study developed a GTR membrane with an ideal chitosan to hydroxyapatite ratio with adequate molecular weight. Membranes were fabricated using solvent casting with low and medium molecular weights of chitosan. They were rigorously characterised with scanning electron microscopy, Fourier transform infrared spectroscopy in conjunction with photoacoustic sampling a...
International Journal of Environmental Research and Public Health
The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on dental education... more The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on dental education worldwide. Due to the rapid spread of COVID-19 across Kuwait, it was essential for the Faculty of Dentistry (FoD) at Kuwait University to make appropriate modifications to the functioning of the dental school. The FoD’s goal was not only to ensure a safe environment for its staff, students, and patients but also to sustain the students’ academic progression. The FoD adopted several measures including the establishment of a COVID-19 response team, adoption of a blended-learning model, and phase-wise re-opening of the dental center. This paper discusses on the strategies that the FoD adopted, in response to the challenges posed by the pandemic.
The present study was undertaken to evaluate the healing pattern of xenogenic demineralized denti... more The present study was undertaken to evaluate the healing pattern of xenogenic demineralized dentin onlay grafts in comparison with autogenous bone grafts to the rabbit tibia. Eight 6-month-old New Zealand male rabbits were used in the experiments. Standardized sized dentin blocks from human premolars and similar autogenous bone blocks harvested from tibia were grafted as onlay blocks on each tibia (n = 8 × 2). All animals were killed after a healing period of 12 weeks. Healing was uneventful for all animals. In general, both the dentin and bone block grafts were fused to the bone, resorbed, and replaced by bone and connective tissue to a varying degree. Both types of grafts were still present after 12 weeks, on an average to approximately one third of the original sizes. Resorption cavities could be seen in the dentin with bone formation. Zones of osseous replacement resorption of the dentin could be noted. In both graft types, higher rate of bone formation was seen at the interface between graft and recipient site. Demineralized xenogenic dentin onlay grafts showed similar resorption characteristics as autogenous bone onlay grafts, being resorbed in a similar rate during 12 weeks. New bone formation occurred mainly in terms of replacement resorption in the interface between dentin/bone graft and native bone.
The International journal of periodontics & restorative dentistry
This experiment was conducted to study the histologic feasibility and biologic impact of Ti02 imp... more This experiment was conducted to study the histologic feasibility and biologic impact of Ti02 impregnation of an extracellullar matrix (ECM) membrane in guided bone regeneration. Eighteen adult New Zealand White rabbits were used. Bilateral bone defects were created in edentulous areas of the maxilla. The defects were filled with demineralized freeze-dried bone (DFDB). ECM was randomly pretreated with a suspension containing saline and 3 mg Ti02 granules. A regular ECM membrane served as a control on the contralateral side. Healing periods were 2, 4, and 8 weeks. Histologic and histomorphometric analyses were performed. The parameters assessed were (1) zone of inflammatory cells adjacent to ECM membrane, (2) presence of cellullar ingrowth into ECM, and (3) presence of Ti02 particles within the ECM barrier membrane. In general, no adverse reactions toward both groups of ECM membranes could be noted. The Ti02 particles remained within the ECM after 8 weeks of healing, making histologi...
The aim of this study was to evaluate the rate of postoperative infection and other complications... more The aim of this study was to evaluate the rate of postoperative infection and other complications after the surgical removal of impacted mandibular third molars. Subjects and Materials: Medical records of 110 consecutive patients with 130 consecutive surgical extractions of impacted lower third molar teeth performed under local anesthetic using strict aseptic techniques were reviewed and analyzed. No systemic antibiotics were administered or prescribed after the surgery. The rates of postoperative infection and other complications were evaluated clinically. Results: Of the 130 surgical removals, 110 in 90 patients met the inclusion criterion of nonuse of antibiotics. Fifty-nine were female and the remaining 31 were male. Average age was 25.2 years. Of the 110 surgeries, postoperative infection occurred in 6 (5.5%). Other complications were alveolar osteitis (n = 9, 8.2%), pain lasting more than 1 week (n = 5, 4.3%) and sensory dysfunction of the inferior alveolar nerve (n = 2,0.8%). Conclusion: The low rates of postoperative infection and other complications observed in this study encouraged us to continue surgical removal of impacted mandibular third molars without routine prescription of antibiotics unless indicated for other medical reasons.
First-aid knowledge in Kuwaiti parents is lacking for avulsion and replantation of teeth despite ... more First-aid knowledge in Kuwaiti parents is lacking for avulsion and replantation of teeth despite a high level of knowledge of how to manage simple body injuries. Knowledge of firstaid measures regarding avulsion and replantation of teeth should be increased by intervention programs.
Dentoalveolar ankylosis with osseous replacement is often seen after replantation of avulsed teet... more Dentoalveolar ankylosis with osseous replacement is often seen after replantation of avulsed teeth, and this process may be used for preservation of alveolar crests after trauma. Its exact mechanisms with regard to osteoinductive properties are not yet fully understood and need to be systematically investigated. Dentin can possibly act as a slow-releasing carrier of bone morphogenic proteins (BMP), and this property of dentin has been proposed to be used as an alternative or supplement to bone grafting in the maxillofacial region. We aimed to initially asses host tissue reactions to dentin by implanting dentin blocks of autogenic and xenogenic human origin in rabbit connective tissue of the abdominal wall and femoral muscle. Animals were sacrificed after a period of 3 months, and histological processing, sectioning and examinations were carried out. Bone formation, cell counts and thickness of capsule surrounding the grafts were evaluated. Only minor signs of heterotopic bone formation were seen. There were no significant differences between autografts and xenografts or grafts implanted in connective tissue or muscle with regards to tissue reactions except for a significant difference (P = 0.018) in findings of more local inflammatory cells in relation to grafts placed in connective tissue in the autograft group. We conclude that during the time frame of this study, non-demineralized dentin, whether autogenous or xenogenic did not have the potential to induce bone formation when implanted in non-osteogenic areas such as the abdominal wall and abdominal muscle of rabbits.
From traumatology, it is well known that dentoalveolar ankylosis results in osseous replacement a... more From traumatology, it is well known that dentoalveolar ankylosis results in osseous replacement and formation of new bone. This principle is used after decoronation for preservation of the height and width of the alveolar bone crest after trauma. Dentin possesses bone-forming properties and may possibly also be used as a bone augmentation material prior to implant placement. The aim of this study was to investigate whether xenogenic dentin particles inserted into the marrow space of rabbit tibia, a space where there is no solid bone tissue initially, would contribute to new bone formation. Dentin chips from human teeth were inserted into tibias of ten New Zealand rabbits. The tibial bones were processed for histology after 6 months, and new bone formation was quantified. Bone formation was ranging from 0 to 86% on the dentin fragments, and there was minor inflammation. Bone formation was seen to a larger extent on dentin grafts located close to the native tibial bone wall. There was a significant correlation (r = -0.579, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) between the amount of bone formation around the dentin graft and distance to the tibial cortical wall. Dentin promotes new bone formation when located close to native cortical bone and may have a potential as a bone augmentation material.
The aims of this study were to evaluate knowledge level among parents regarding tooth avulsion an... more The aims of this study were to evaluate knowledge level among parents regarding tooth avulsion and replantation and to evaluate a simple leaflet as an information tool to enhance this knowledge. One Hundred and fifty parents in a primary school in Kuwait City participated in the study. Half of the parents received a leaflet with basic first aid message regarding what to do in case of tooth avulsion. One week after reading the leaflet, the parents who had received the leaflet were evaluated by using a questionnaire. The other half of the parents who had not seen the leaflet served as control. The level of knowledge was measured in the following categories: General knowledge of tooth avulsion, knowledge of replantation and primary vs permanent teeth, knowledge of how to clean an avulsed tooth, knowledge of extra-oral time, knowledge of storage methods and storage media. By scoring the knowledge, the level of knowledge was calculated. The results showed that knowledge level was low among Kuwaiti parents. Improvement was seen in all categories of knowledge as a result of reading the leaflet. A simple leaflet can be a valuable tool to convey important basic information and enhance knowledge of tooth avulsion and how parents should act in such a situation, although there are limitations in conveying the message for a complete understanding. Measuring the knowledge by scoring can give valuable feedback in developing various educational tools.
School teachers can play an important role in improving the prognosis of avulsed permanent teeth ... more School teachers can play an important role in improving the prognosis of avulsed permanent teeth of school children after they are informed about the immediate and proper dental first aid steps to be taken at the time of an accident. The aims of this study were: (i) to assess the knowledge level of emergency measures for tooth avulsion in Kuwaiti intermediate school teachers and (ii) to determine if a short lecture about tooth avulsion and replantation could improve teachers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; knowledge on this topic. Eighty-five teachers at two intermediate schools (children 10-14 years old) in Kuwait were interviewed using a questionnaire about their first-aid knowledge with particular focus on the following five categories: General knowledge of teeth and avulsion, replantation of primary and permanent teeth, how to clean an avulsed tooth before replantation, extra-oral time and storage methods and media for an avulsed tooth. For each category, a score ranging from 0-3 was possible. An informative 30-min lecture about tooth avulsion and replantation was presented to a group of 43 teachers. After the lecture, the knowledge level of the teachers was re-tested using the same method. Descriptive statistics was used to describe and analyze the data. Improvement in teacher knowledge to an adequate (score of 2) or complete (score of 3) level was observed after the lecture in all five categories. The general knowledge of tooth avulsion and replantation improved from 39% to 97% and knowledge of avulsed permanent and primary teeth from 8% to 71%. Knowledge of how to clean an avulsed tooth improved from 5% to 93%. The knowledge level on the importance of extra-alveolar time before replantation increased from 1% to 74% and knowledge of a suitable storage medium for the avulsed tooth improved from 4% to 86%. Many avulsed permanent teeth in school children can be saved by replantation if school teachers learn what to do when a tooth is avulsed. A lecture followed by discussion proved to be an effective and efficient method of intervention to enhance the knowledge level of teachers so that proper dental first-aid procedures can be achieved.
The degree of damage is one of the most important prognostic factors in the replantation of a kno... more The degree of damage is one of the most important prognostic factors in the replantation of a knockedout (avulsed, exarticulated) tooth; the tooth needs to be placed back in its socket as soon as possible to avoid further damage to the periodontal membrane (1-5). The prognosis is related to the injury of the periodontal membrane during the time the tooth is out of its socket (6). Dry storage of the tooth will result in an irreversible injury to the periodontal membrane, with the result that the replanted tooth will be lost over time (2-5, 7). Wrapping the tooth in plastic wrap could prevent evaporation for at least
Alveolar cleft repair is performed via bone grafting procedure to restore the dental arch continu... more Alveolar cleft repair is performed via bone grafting procedure to restore the dental arch continuity. A suitable bone substitute materials should possess osteoinductive and osteoconductive properties, to promote new bone formation, along with a slowly resorbable scaffold that is subsequently replaced with functionally viable bone. Calcium phosphate biomaterials have long proved their efficacy as bone replacement materials. Dentin in several forms has also demonstrated its possibility to be used as bone graft replacement material in several studies. The purpose of this study was to evaluate bone regeneration pattern and quantify bone formation after grafting pre-established experimental alveolar clefts defects model in rabbits using composite xenogenic dentin and β-TCP in comparison to β-TCP alone. Unilateral alveolar cleft defects were created in 16 New Zealand rabbits according to previously described methodology. Alveolar clefts were allowed 8 weeks healing period. 8 defects were ...
Journal of biomedical materials research. Part B, Applied biomaterials, Jan 25, 2018
The purpose of this study was to evaluate bone healing in calvarial defects using two bone graft ... more The purpose of this study was to evaluate bone healing in calvarial defects using two bone graft substitute materials; biphasic beta-tricalcium phosphate/hydroxyapatite in hydrogel (ß-TCP/HA) versus composite non-demineralized xenogenic dentin with ß-TCP/HA mixture. Full thickness critical-sized defects were created bilaterally in 10 New Zealand male rabbits. Seven defects were left empty, six filled with biphasic tricalcium phosphate putty, and seven were filled with composite non-demineralized xenogenic dentin with biphasic tricalcium phosphate. Animals were sacrificed at eight weeks postoperatively and the healing of the biomaterial-filled defects was compared radiographically and by histomorphometry. Micro-computed tomography (μCT) was utilized to analyze the osteogenesis and healing patterns of the defects. Quantitative analysis of volume fraction (%) of the newly formed bone and remaining graft material (FV=filling volume/TV=tissue volume) and mean intensity [HU] in the defect...
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Papers by Adel al-Asfour