The present study was conducted to compare between extraoral and intraoral approach for botulinum toxin type A (BTX-A) injection into the lateral pterygoid muscle (LPM) in patients suffering from anterior disc displacement with reduction (ADDWR). Fourteen patients suffering from ADDWR were included in this prospective cohort study. Patients were enrolled randomly into 2 groups according to injection approach; where extraoral used in group I, while intraoral approach used in group II. The LPM was injected with 20 IU BTX-A under electromyography (EMG) guidance. Postoperative evaluation of the patients included: mouth opening assessment, LPM tenderness, temporomandibular joint TMJ (clicking), and tenderness. The LPM insertional EMG activity was assessed. Also, magnetic resonance imaging (MRI) was performed to evaluate disc position. Descriptive and inferential analysis was conducted to compare between groups. There was significant patient's convenience during injection and significant injection time reduction in group II. A slight decrease in mouth opening immediate post-injection followed by significant improvement from 8th weeks post-injection was reported in both approaches. There was a significant improvement in TMJ clicking from 1st-week post-injection with no group difference. The EMG assessment documented LPM hyperactivity pre-injection followed by significantly decreased muscle activity at 8 and 16 weeks post-injection without statistical difference. The MRI showed no change in disc position after injection. Conclusion: The BTX-A injection into LPM is a simple technique that can be used with high success and low complication rate for treatment of ADDWR. The intraoral approach was superior to the extraoral concerning patient convenience and injection duration with no statistical difference regarding other clinical outcomes.

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Objective This study aimed to assess the clinical and radiographic findings obtained by using amniotic membrane (AM) to cover nano-hydroxyapatite (nHA) bone grafts coated with platelet-rich fibrin (PRF) and thereby evaluate the osseointegration of posterior mandibular implants inserted simultaneously during alveolar piezoelectric ridge splitting technique (RST). Methods A prospective cohort study was implemented with thirty patients who had a narrow posterior mandibular alveolar ridge and required implant restoration. Patients were distributed randomly into three groups (group I treated by piezoelectric RST and immediate implant insertion, augmented by the nHA bone graft only; group II treated by piezoelectric RST augmented by nHA bone graft and covered by AM; while group III was treated by piezoelectric RST augmented with PRF and nHA graft and covered by AM). Patients were evaluated clinically to assess the implant stability quotient (ISQ) and radiographically to assess horizontal ridge dimension, crestal bone level (CBL), and bone densitometric (BD) parameters. Results ISQ results showed a non-significant clinical difference between groups while CBL values showed a high statistically significant difference over the 12-month interval when comparing groups III and II with group I. BD outcomes showed statistically significant differences at all intervals in comparisons of group III with groups I and II. Conclusions The results of this study suggest that concomitant use of PRF with nHA graft covered with AM for augmentation around the dental implant in a narrow posterior mandible after piezoelectric alveolar ridge splitting accelerate osseointegration and significantly increase bone density around the osseointegrated implant and decrease bone resorption in comparison to that achieved with the graft alone.

The present study aimed to evaluate the enhancing effect of platelet-rich fibrin (PRF) on autogenous bone marrow aspirate (BMA) using in a resorbable matrix for repair of alveolar cleft defects. It was conducted on 12 patients (7 males and 5 females) with unilateral alveolar cleft and oronasal leakage. They divided into two random equal groups (group I and II). In group I, alveolar cleft defect packed with a mixture of PRF, β-Tricalcium phosphate, and BMA, and the same mixture without PRF for group II. Our clinical results revealed that, all patients had uneventful wound healing except some cases in group II. While, densitometric analysis showed a high statistical significant difference between two groups (p=0.011737) at 6 months interval but, at 12 months interval difference was not statistically significant (p=0.142480). Also, volumetric measurements of new bone showed that, there was highly statistical significant difference (p=0.037997) between group I and II at 12 month interval. The present study concluded that PRF may enhance the regeneration capacity of the stem cells when it added to BMA. Thereby, they may accelerate bone regeneration in alveolar cleft defects. Moreover, it may be used as membrane to cover grafted alveolar defect.

Background This randomized clinical trial was designed to evaluate osteogenic potential of Cissus quadrangularis in alveolar distraction to facilitate implant installation. Material and methods Twenty patients with atrophic ridge were treated by alveolar distraction. After completing distractor activation, patients were randomly divided into two equal groups according to administered drug (placebo and Cissus quadrangularis group). After a consolidation period, distractors were removed and implants were inserted. Clinical evaluation was done to assess wound healing, and distractor and implant stability. Histological evaluation was performed at time of implant insertion. Radiographic evaluation was performed to assess bone volume and density after distraction, as well as, density and bone loss around implant. Results Radiographic and histological results showed that bone formation and maturation of study group were faster than that of control group. There was a significant increased bone density in distracted area and around implant in study group than control group. A significant bone loss at end of consolidation period, and around implant at end of the study was reported in control group than study group. Conclusion Cissus quadrangularis administration during the consolidation period is associated with increased osteogenic potential of distracted bone. The histological and radiographic findings of current study proved that Cissus quadrangularis not only enhances rate of new bone formation, but also bone density to withstand the biomechanical requirements of implant placement in a shorter time. Trial registration This study was retrospectively registered on www.ClinicalTrial.gov: NCT04669795-17\12\2020.

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Objective: To compare between double straight miniplates, double inverted L-shaped miniplates ,and three dimensional (3 D) rectangular miniplate in fixation of anterior mandibular (symphyseal / parasymphyseal area) fractures. Patients and methods: Thirty adult patients with anterior mandibular fractures were included in this study. The patients were divided randomly into three equal groups, group I was treated by superior and inferior straight miniplate while group II was treated by double L-shaped miniplates fixation technique and group III was treated by 3D rectangular miniplate. Postoperative clinical, radiographic evaluation and quantitative measurements were performed. Results: Wound healing was optimal in all cases except two cases in group I and one case in group II. Satisfactory occlusion was obtained in all cases except three cases in group I where it had mild to moderate occlusal derangement. Other parameters including maximal mouth opening, sensory nerve function, and patient's tolerance to the plate were comparable. There were the similarity between the density changes for the three groups as there was highly significant difference in G(I) compared to G(II) at six months, and G(I) compared to G(III) at three and six months also between G (II) compared to G(III) at six months.. Conclusion: Both double L-shaped miniplates and 3D rectangular miniplate provided enough stability for proper bone healing, establishment of optimal occlusion and early return to normal function more than with double straight miniplates. Additionally, there is superiority of 3 D rectangular miniplate over double inverted L-shaped miniplates in these parameters.

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