Journal of Emergency Medicine, Trauma and Acute Care - Current Issue

Periodontitis is a multifactorial inflammatory disease brought on by a state of imbalance between the gingival microbiome and the immune responses of the host. Neutrophils are the key cells that play an important role in fighting pathogenic microorganisms in infectious disorders, either by killing them within the cell or secreting antimicrobials attached to large web-like structures known as neutrophil extracellular traps (NETs) through a cell death process known as NETosis. Formation of NETs is important for maintaining homeostasis in periodontal tissues and improvement of health. In periodontitis, an immune-based inflammation impedes NETs formation or causes its destruction, thereby enabling inflammation to progress and destroy periodontal tissues.

Polymorphonulear neutrophils (PMNs) inhibit microorganisms and decrease inflammation by secreting of NETs into the pocket environment. Conversely, elevated NET levels can elicit an inflammatory response and provide an environment that is favorable for pathogenic bacteria. NETs biomarkers may prove to be helpful in the diagnosis of periodontitis. However, it is necessary to make future research on the specific mechanism of NETs and the exact interaction between a single bacterium and NETs.

Aims and Objectives: Temporomandibular disorder is a broad term for the joint musculoskeletal problems. This study was aimed to assess the therapeutic effect of hyaluronic acid (HA) and platelet-rich plasma (PRP) on salivary matrix metalloproteinases (MMPs) 2 and 9 expression in patients with internal derrangment.

Materials and Methods: Fifty-two patients with tempromandibular joint internal derrangment were participated in this study. Patients were separated into two groups: HA and PRP groups. Saliva was obtained before treatment and 6 months after treatment. The expression of MMP-2 and 9 was identified using enzyme-linked immunosorbent assay kit.

Results: The expression of both salivary MMP-2 and 9 was significantly decreased after treatment (p = 0.000). A positive correlation was established between MMP-2 and 9 with the mean pain scale and joint click score. However, a negative correlation was found between MMP-2 and 9 with the maximum mouth opening (MMO).

Conclusion: Both HA and PRP showed a beneficial therapeutic effect revealed through the reduction of salivary MMP-2 and 9 as an inflammatory biomarkers.

Background and Aim: Soft liners are designed to modify the surfaces of prostheses that interact with the mouth’s soft tissues to improve denture performance. One method of improving its mechanical properties involved the application of nanotechnology. This work aimed to determine impact of cerium oxide nanoparticles (CeO2NPs) on acrylic-based soft liner’s surface hardness and shear bond strength.

Materials and Methods: CeO2NPs were added to soft liner monomer with weight percentages of 0%, 2%, and 3%. Sixty samples were prepared for shear bond test and surface hardness test with 30 samples each. Shear bond samples were prepared by constructing two acrylic blocks which assembled over each other creating a square space in the middle with dimensions around 25 mm in length and width and 3 mm in depth for the addition of soft liner material. The surface hardness samples were constructed as a disc with diameter of 35 mm and 6 mm thickness. Instron testing machine with a load of 50 KN and cross-head speed 0.5 mm/min was used for testing the shear bond strength, while surface hardness was tested by Shore A durometer. The morphological features of soft liner samples before and after the addition of CeO2NPs were examined by scanning electron microscopy (SEM). The data were analyzed for normality and homogeneity by Shapiro-Wilk test and for significance by ANOVA and Tukey’s multiple comparisons tests using SPSS version 21 software.

Results: Soft liner samples demonstrated a significant increase in shear bond strength from 11.6 ± 1.51 MPa for the control group to 16.1 ± 1.37 MPa and 18.9 ± 1.29 MPa for 2%wt. and 3%wt. CeO2NPs treated groups, respectively. The surface hardness value of the samples with the addition of 3%wt. CeO2NPs increased significantly to 61.01 ± 0.98 Shore A in comparison to the control group 59.47 ± 0.97. However, the 2%wt. CeO2NPs-treated group exhibited no significant difference with the rest groups. SEM showed that after CeO2NP incorporation, the nanoparticles were homogenously distributed on the sample surface leading to a decrease in surface porosity.

Conclusion: The addition of 2%wt. CeO2NPs improved the shear bond strength of the soft lining material with a non-significant effect on surface hardness. This shows the efficacy of CeO2 in improving some material mechanical properties.

Aim: The aim of the study was to investigate the relationship between delayed eruption of the permanent second molars and dietary habits, body mass index, and lifestyle of the teenagers.

Method: A cross-sectional study was performed at a private dental center. 110 teenagers with an age range of 13–16 years old were screened for delayed permanent second molars. The panoramic X-ray was used to localize the unerupted permanent second molar. The body mass index (BMI) of the patients was calculated. A questionnaire was distributed, and the data were collected via Google Forms. Responses were gathered from February 2024 to March 2024. The questionnaire included three main categories: food type and routine, activity and exercise, and medical and dental health.

Results: The percentage of the orthodontic population of teenagers at the time of the study was 22%. Among the screened teenagers, only 11% had at least one unerupted second molar. A higher prevalence of unerupted permanent second molars was found in girls than boys (58.3%, 41.6%, respectively). The highest percentage of delayed eruption of permanent second molar was found on both sides of the maxilla (83.3%). In regards to food type, fast food (66.6%) and noodles or pasta (33.3%) were found to be a common meal at dinner. Chocolate (75%) and crisps (58.3%) were the major snacks. Calcium rich food and nuts were found to be either never or not regularly consumed by teenagers, 66.6% and 83.3%, respectively. Regarding body activity and exercise, the majority of the participants were normal weight (58%). Only 16.6% were found to be obese. The majority of the participants slept later than midnight (83.3%). All participants used the cell phone, with some spenting 5–10 hours (41.6%) on these devices. In terms of medical and dental health, all participants were healthy except 25% suffered from asthma and/or anemia. All participants were regularly visit the dental clinic; however, 41.6% of participants were not aware of delay eruption of permanent second molars.

Conclusion: The quality of the food may impact the normal time of eruption of the permanent second molars. Female gender and maxillary arch were found to be more likely to have delayed eruptions. Unhealthy lifestyle, such as sitting long hours on electronics, may impact oral health. Additional risk factors should be considered in future research.

Background: Neutrophils destroy pathogens via phagocytosis. Neutrophils are effective innate and acquired immunity phagocytes. Low-density neutrophils are distinct neutrophil phenotypes linked to several systemic and infectious diseases. To our knowledge, low-density neutrophil phagocytosis in periodontitis has not been examined. Opsonized and non-opsonized fluorescent beads mixed with low-density neutrophils were gated and analyzed by flow cytometry to count cells that consumed at least one bead.

Aims of the Study: To estimate the potential impact of antibody (Ab)-labeled and non-labeled phagocytosis capacity of low-density neutrophils in the 60 patients with periodontitis compared to 40 patients with healthy periodontium.

Methods: Blood samples were collected from 100 subjects with no systemic diseases and allocated into a periodontitis group of sixty unstable periodontitis patients compared to a control group of forty subjects with healthy periodontium. Flow cytometry was used to estimate both groups’ Ab-labeled and non-labeled phagocytosis assays of low-density neutrophil groups.

Results: Ab-labeled and non-labeled low-density neutrophil phagocytic assays showed no significant difference (p-value > 0.05) between research groups. In both study groups, low-density neutrophils had higher Ab-labeled phagocytosis than non-labeled. A significant positive correlation was observed between Ab-labeled and non-labeled phagocytosis in the control group.

Conclusion: Low-density neutrophils express the same labeled and non-labeled phagocytic index in both groups (periodontitis and control). However, the intra-group comparison revealed enhanced Ab-labeled phagocytosis compared to non-labeled phagocytosis in both groups (periodontitis and control).

Background: Subclinical hypothyroidism (SH), or so-called mild thyroid failure, is analyzed when serum thyroid stimulating hormone (TSH) levels are beyond the highest limit of the reference range whereas free T4 concentrations are normal.

Aim of the Study: Determine delayed tooth eruption and hemoglobin levels in children with SH.

Methods: Case control study was directed amongst 120 children with age not exceed than 12 years old in Diyala governorate. Thyroid function, hemoglobin level, and a common oral manifestation in children with SH were evaluated to find an association between them and compared with healthy children. Children who have SH, after experiencing thyroid tests, have their mouths examined and their hemoglobin levels inspected; after receiving ethical clearance, informed consent was obtained from the relatives of participants.

Results: Concerning patients (first group), which is comprised of 100 children with SH, control (second group) comprises of 20 children without SH. The delayed eruption of teeth was (7%) in SH children statistically showed a highly significant association. Level of TSH in the children with SH group was statistically highly significant increased as compared with the control group with Mean ± SE (8.93 ± 0.32) versus Mean ± SE (1.84 ± 0.25). In addition, a highly significant association existed when compared the control group and children with SH concerning hemoglobin level, with Mean ± SE (13.09 ± 0.14) versus Mean ± SE (10.89 ± 0.19).

Conclusion: Low level of hemoglobin and high prevalence of delayed tooth eruption were detected in children with SH compared to non-diseased control group.

Background: Aesthetic zone refers to maxillary anterior region, from canine to canine, which is important in smile aesthetics. However, based on smile width, this area may be extended to include premolars. The aim of this study was to navigate the aesthetic zone of the upper premolar region for dental implant treatment.

Methods: This study was conducted at a private dental center in Baghdad. Dental implant cases treated between January 2018 and April 2023 were included in the study. One hundred and ninety-six patients were included in the study.

The demographic data, surgical information, dental implant zones, anterior aesthetic, premolars, and molar non-aesthetic zones, were recorded. Patients with incomplete data were excluded from the study. Descriptive and inferential statistics were implemented. The chi-square test was used to determine the relationship between nominal study variables.

Results: The male-to-female ratio was 1:2. The highest percentage of implant replacement was found in the upper premolar region (28.7%), followed by the lower molar (23.6%), and the upper anterior aesthetic zone: the upper incisors (16.1%), and the upper canines (3.4%). Early success rate was approximately equal in the anterior, premolar, and other zones, but with the highest value in the premolar area (94%).

Conclusion: There is a high demand for upper premolar implants by both genders compared to the aesthetic zone. This highlights the peculiarity of this zone and underpins the suggestion for classifying the upper premolar zone as aesthetic zone II.

Background with Aim of the Study: The intraoral scanner in the market contends with challenges, specifically in accurately detecting metallic surfaces of prostheses affected on the fitness of the restoration; therefore, several scanning agents were used to evaluate the internal fit of the zirconia crown.

Methods: 45 prefabricated titanium abutments (n = 45) were selected for this study. Samples were divided into three groups (n = 15 each) according to the application of scanning aid agents. Group 1 (G1: control) used a scan body; G2: used liquid paint as the scanning aid agent; and G3: used powder spray as the scanning aid agent. Each abutment was applied with an imaging scanning aid agent to scan and mill the crown. All scans were performed using the same intraoral scanner, and the internal fit was analyzed digitally using digital silicone replica techniques and Geomagic Control X software. Statistical analysis was performed using the one-way ANOVA test.

Results: There was no significant difference among the three groups.

Conclusion: Scanning aid agents showed similar accuracies for the internal fit of the crown, with no significant differences observed.