AIM:Wolters' classification of pulpitis has been proposed to classify pulpitis into 4 categories (initial, mild, moderate, severe), aiming to guide clinicians to implement the relevant vital endodontic treatment. The main objective of this study was to test the histologic validity and clinical reliability of the Wolters classification. METHODOLOGY:For the validity, before extraction, 52 teeth with pulpitis were examined and classified by one examiner into the appropriate Wolters category. After extraction and histological processing, a blinded pathologist examined the sections and assigned each tooth to a Wolters category. For the reliability, 140 patients with pulpitis were clinically and radiographically examined by two examiners, and pulpal and periapical diagnoses were made independently according to the Wolters and American Association of Endodontists (AAE) classifications. Finally, the diagnoses were unmasked, and the agreement was measured using Cohen's Kappa, weighted Kappa, or intraclass correlation coefficient (ICC). The correspondence between the categories of the Wolters and AAE classifications was examined using the chi-square test and Cramer's V statistics. Statistical significance was set at p < 0.05. RESULTS:The ICC and Kappa analyses indicated poor to fair agreement for the Wolters classification. However, in a re-analysis performed by defining the mild pulpitis category to include a range from no to mild inflammation, the κ coefficients (minimum κ coefficient of 0.4004; p < 0.001) and the ICC value of 0.623 (95% CI: 0.319, 0.791) demonstrated fair to good agreement. Highest sensitivity [0.63 (95% CI: 0.39, 0.82)] and specificity [0.86 (95% CI: 0.69, 0.94)] were found in the severe and mild pulpitis categories, respectively. Regarding the clinical reliability, weighted-Kappa tests (minimum κ coefficient of 0.8118, p < 0.001) and the ICC value of 0.945 (95% CI: 0.923, 0.961) suggested that the interobserver agreement for the Wolters classification was almost perfect to excellent. The Wolters' initial pulpitis category and the moderate and severe pulpitis categories corresponded to the AAE's reversible and irreversible pulpitis categories, respectively. However, the mild pulpitis category was interpreted differently by the examiners. CONCLUSIONS:The Wolters classification demonstrated high clinical reliability; however, its histopathological validity appeared limited. Further research is required to better establish its validity.

This report aims to present the clinical features, treatment approach, and management guidelines for plasma cell gingivitis (PCG) associated with nickel allergy. A 63-year-old woman was admitted to the clinic with complaints of gingival overgrowth and bleeding. Anamnesis and clinical examination revealed that she had been wearing metal-based fixed prostheses for 15 years. A complete blood count was performed and, after excluding malignancy, histopathologic evaluation revealed a diagnosis of PCG. A skin patch test confirmed nickel allergy, supporting the suspected link between the gingival condition and prolonged exposure to nickel-containing dental prostheses. Nickel levels in gingival tissues were evaluated using atomic absorption spectroscopy (AAS) before and after removal of restorations. AAS measurements detected 6.6 μg/g of nickel before removal and no more than blank analysis afterward. Following phase one and surgical periodontal treatment, and systemic steroid therapy, zirconium-supported prostheses were fabricated. The patient's gingival tissues returned to a healthy condition. This case report shows that PCG related to nickel allergy is characterised by gingival overgrowth with a fiery-red appearance. To confirm clinical findings, histopathological evaluation should include nickel quantification whenever possible. Treatment options should prioritise the elimination of nickel-containing prostheses, with substitution by all-ceramic restorations, to achieve resolution and prevent recurrence.

INTRODUCTION:Ameloblastoma (ABL), a common odontogenic tumor in the maxillofacial region, presents primarily as unicystic (U-ABL) and conventional (C-ABL) variants. Despite shared epithelial features, their distinct biological behaviors may stem from interactions between connective tissue and epithelial cells. Vimentin 3 (VIM3), a truncated variant of Vimentin-Full Length (VIMFL), exhibits unique biological properties. This study is the first to investigate VIM3 expression in ABLs. METHODS:Formalin-fixed paraffin-embedded (FFPE) samples of C-ABL (n = 30), U-ABL (n = 30), and dental follicles (DF, n = 30) were analyzed. Immunohistochemical evaluation of VIM3, VIMFL, WNT5a, and MTCO1 was performed, alongside qRT-PCR for VIM3, VIMFL, WNT5a, ROR2, and miR-498. RESULTS:VIM3 expression was significantly higher in C-ABL (p < 0.0001) compared to U-ABL and DFs. VIMFL was absent in the epithelial components of all cases. C-ABL showed significantly higher WNT5a (p < 0.0001) and MTCO1 (p = 0.0327) expression. qRT-PCR revealed significant differences in VIM3 and miR-498 levels between U-ABL and DFs (p < 0.0001). No significant differences were found for WNT5a, VIMFL, or ROR2 (p > 0.05). CONCLUSION:This study identifies VIM3 expression in ABLs, distinct from VIMFL, suggesting its potential as a biomarker. Additionally, mitochondrial dysfunction may play a role in ABL tumorigenesis.

Odontogenic keratocysts (OKC) are locally aggressive jaw lesions characterized by a high recurrence rate. Vimentin 3 (VIM3), a truncated splice variant of full-length vimentin (VIMFL), has recently emerged as a potential biomarker in odontogenic tumors. However, its role in OKC and association with recurrence remain unexplored. Formalin-fixed paraffin-embedded samples from OKC (n = 25) and dentigerous cysts (DC) (n = 25) were analyzed. Immunohistochemical staining for VIM3, VIMFL, p53, and Ki-67 was performed. In parallel, reverse transcription-quantitative polymerase chain reaction was used to assess mRNA expression levels of VIM3, VIMFL, and p53. While VIM3 expression did not significantly differ between OKC and DC, recurrent OKC exhibited significantly higher VIM3 labeling indices compared to non-recurrent cases (p = 0.040). This study demonstrates, for the first time, the expression of VIM3 in OKC. Although the findings are promising, further research with larger cohorts and functional validation is required to clarify the mechanistic role of VIM3 in odontogenic cyst biology.

The clinical outcomes of either extra-oral (eo) or intra-oral (io) de-epithelialized connective tissue graft (DE-CTG) techniques to the recipient site have not been fully elucidated yet. There is an ongoing debate regarding the possible complications caused by incomplete elimination of the epithelial layer. The aim of this study is to compare clinical effectiveness and de-epithelialization efficacy of ioDE-CTG and eoDE-CTG in recession treatment. Forty patients, with a single gingival recession, were treated with coronally advanced flap combined with eo- or ioDE-CTG. Data consisted of surgical chair-time, recipient site periodontal and patient-based variables. To evaluate the efficacy of de-epithelialization, histological analyses were also performed via graft imprints. There was no significant inter-group difference in terms of treatment outcomes. Aesthetic results were also similar for both groups. While chair-time was significantly shorter in the ioDE group, less epithelial remnants were showed with eoDE technique. Similar clinical outcomes were obtained with eo- and ioDE-CTG. While ioDE is less effective in removing the epithelial layer, no long-term complications due to the epithelial residues were detected. Both techniques can be recommended in recession treatment. This study demonstrates that extraoral and intraoral de-epithelialized connective tissue grafts in root coverage procedures led to similar clinical results without any further events. The study protocol was registered at ClinicalTrials.gov (NCT05494294).

Autophagy is a cellular process that is evolutionarily conserved, involving the sequestration of damaged organelles and proteins into autophagic vesicles, which subsequently fuse with lysosomes for degradation. Autophagy controls the development of many diseases by influencing apoptosis, inflammation, the immune response and different cellular processes. Autophagy plays a significant role in the aetiology of disorders associated with dentistry. Autophagy controls odontogenesis. Furthermore, it is implicated in the pathophysiology of pulpitis and periapical disorders. It enhances the survival, penetration and colonization of periodontal pathogenic bacteria into the host periodontal tissues and facilitates their escape from host defences. Autophagy plays a crucial role in mitigating exaggerated inflammatory reactions within the host's system during instances of infection and inflammation. Autophagy also plays a role in the relationship between periodontal disease and systemic diseases. Autophagy promotes wound healing and may enhance implant osseointegration. This study reviews autophagy's dento-alveolar effects, focusing on its role in odontogenesis, periapical diseases, periodontal diseases and dental implant surgery, providing valuable insights for dentists on tooth development and dental applications. A thorough examination of autophagy has the potential to discover novel and efficacious treatment targets within the field of dentistry.

Ameloblastomas are locally invasive and benign odontogenic tumors with a high long-term recurrence rate. These lesions can cause serious anomalies in the facial area and alveolar bones, leading deformity and deterioration of functions. Wide local excision and reconstruction are required for the surgical treatment of these tumors. Aggressive resection effectively eliminates tumors; however, this approach may cause various problems that need reconstruction to restore the oral functions. In the present case report, the rehabilitation of surgically reconstructed partially edentulous mandible with iliac crest graft after ameloblastoma resection with an implant-supported “Toronto Prosthesis” is presented. In the surgical procedure, mandible was partially resected and simultaneous iliac bone graft was applied. Then, four dental implants were inserted into the reconstructed bone and implant-supported Toronto prosthesis was fabricated. The patient was satisfied with the final result of the treatment and recurrence was not observed during the 2-year clinical follow-up.

BACKGROUND:To examine the effects of local risedronate application with xenografts on healing of rabbit skull defects using histological, histomorphometric, immunohistochemical, and three-dimensional radiological methods. METHODS:Two critical-sized defects with a diameter of 10 mm were created in 16 rabbits and filled with xenogenic bone graft and xenogenic bone graft + 5 mg risedronate in the control I and risedronate (RIS) groups, respectively. Residual graft, new bone, soft tissue areas, and bone volume were evaluated in the 4- and 8-week study groups. RESULTS:In both the 4- and 8-week samples, the RIS group samples had significantly higher mean new bone area values than the C group (p < 0.05). In both groups, the values for the new bone area were significantly higher in the 8-week-old samples than in the 4-week-old samples (p < 0.05). The h scores obtained for sialoprotein and osteopontin did not differ significantly between the groups at either time point (p > 0.05). The results of radiological evaluation showed that the bone density value was significantly higher in the C group than in the RIS group at either time point (p < 0.05). CONCLUSIONS:Although this study aimed to demonstrate the effect of risedronate on the osteoconductive properties of xenografts when applied locally, targeted results could not be achieved.

Background Risedronate is a bisphosphonate with poor oral absorption. An extremely hydrophilic molecule that has a high affinity for bone, risedronate also inhibits the farnesyl diphosphate synthase enzyme, inhibiting osteoclastic activity and reducing bone turnover and resorption. Autogenous bone grafts contain osteogenic cells and osteoinductive factors that are essential for bone regeneration and are therefore considered the gold standard. Thus, this study aimed to investigate the impact of local risedronate administered with autogenous bone grafts on the healing of defects in rabbit skulls using histological, histomorphometric, immunohistochemical, and three-dimensional radiological methods. Methods Two 10-mm diameter critical-size defects were created in 16 rabbits and filled with autogenous bone graft and autogenous bone graft + 5 mg risedronate in the control (C) and risedronate (RIS) groups, respectively. Residual graft, new bone, soft tissue areas, and bone volume were evaluated in the 4- and 8-week study groups. Results There were no statistically significant differences in bone graft, new bone, or soft tissue area between the groups at 4 weeks (p > 0.05). At 8 weeks, the new bone area was significantly higher in the RIS group than in the C group (p < 0.05). The h scores obtained from sialoprotein and osteopontin did not differ significantly between the groups (p > 0.05). The radiologically measured total bone volume was significantly higher in the RIS group than in the C group at both time points (p < 0.05) Conclusions In this study, risedronate enhanced the osteoconductive properties of autogenous bone grafts and rapidly created better-quality bone. This could improve future patient outcomes.

INTRODUCTION:Dental implants are frequently preferred method for oral rehabilitation all over the world. The incidence of various complications such as incorrect prosthesis, peri-implant mucositis, and peri-implantitis is high; premature loss of implants is encountered due to osteointegration process not being completed for some unexplained reasons. However, there is no study in the literature examining the nonfunctional period of implants. Closure screws of different implant companies have different designs like surface properties, and areas, where closure screws sit, are important reservoirs for microorganism colonization. Our study aims to evaluate the inflammatory response, epithelial maturation, and epithelial-connective tissue interaction around closure screws.METHODS:For this purpose, 52 implants belonging to five different implant companies were included in the study. Tissues removed over the cover screw during fitting of healing caps were used as biopsy material and for epithelial proliferation Ki-67, for epithelium-connective tissue interaction Syndecan-1, and for macrophage activation CD-68 expressions were evaluated by immunohistochemical analysis. Scanning electron microscopy (SEM) analyzes were performed to evaluate the presence of gap between the implant and the cover screw.RESULTS:As a result of our study, intensity of subepithelial inflammation between groups wasn't statistically different. Differences in CD-68 and Syndecan-1 levels were obtained at the lamina propria level. H score of CD-68 was statistically significantly different in epithelium (p = 0.032), and H score of Syndecan-1 was different in lamina propria (p = 0.022). There wasn't a statistically significant difference between the groups for Ki-67 (p = 0.151).CONCLUSION:Our study results indicate that in addition to the implant surface morphology, the design of the closure screws is important in the inflammatory response and epithelial maturation that develops during wound healing. Although the inflammatory response is required for healing, osteointegration, and implant survival, further investigation is needed to investigate the relationship between initial neck resorption and closure screws with radiographic and microbiological examinations.

Kistler, içi sıvı veya yarı sıvı kıvamda bir materyal ile dolu olabilen, epitel ile döşeli ve bağ dokusu kapsülü ile çevrili patolojik oluşumlardır. Radiküler kist, çenelerde gelişen inflamatuar kistler içerisinde en yaygın görülenidir. Çürük veya travma sonucu gelişen pulpal nekrozun ardından, devital olan dişin apeksinde gelişir. Basit bir apikal granülom olarak beliren lezyon kısa dönemde tedavi edilmediğinde komşu anatomik yapıları etkileyen büyük boyutlu bir kiste dönüşebilir. Bu vaka raporunda maksiller sinüs içerisinde gelişim gösteren bir radiküler kist vakasının tedavisi sunulmuştur.

Background:During physiological root resorption of deciduous teeth, apoptotic cell death triggered by physiological processes might play a role in physiological root resorption in addition to collagen destruction. Little information has been obtained about the sequence of events and the mechanism responsible for the physiological death of pulp tissue cells. Aim:This study evaluated apoptotic cell death in the pulp tissue of deciduous teeth that showed various levels of physiological root resorption. The role of apoptosis in pulp tissue elimination during the physiological resorption of deciduous teeth was also examined. Materials and Methods:For orthodontic reasons, 12 healthy permanent teeth and the pulp of 34 healthy deciduous teeth showing signs of early and advanced root resorption were extracted. To detect apoptotic cells in the pulp tissue, the terminal deoxynucleotidyl transferase dUTP nick end-labeling (TUNEL) method and transmission electron microscopy (TEM) were used. The apoptotic index (AI) values of the study groups were determined using the TUNEL method. This technique required calculating the Apoptag positive(+) fibroblast cell ratio in accordance with the total number of cells. Results:No statistically significant differences were found for the AI values of each study group (p>0.05). Apoptosis was detected in the vascular endothelial cells, the mononuclear inflammatory cells, and the odontoblasts of the connective pulp tissue. In the pulp tissue, evaluated using TEM, various pulp cells were observed at distinct stages of apoptosis. Conclusion:The similarity between the AI values for both study groups suggested that in early and advanced stages of resorption, apoptosis may contribute to the regulation of the pulp cell population in a way that does not relate to the physiological process of deciduous teeth root resorption.

Implant rehabilitation after implant removal is a major challenge, especially in mandibular posterior arches. This case report describes the reconstruction of a severe vertical bone defect using customized titanium mesh covered by collagen membrane and solid advanced platelet-rich fibrin, combined with autogenous bone, deproteinized bovine bone mineral, and injectable platelet-rich fibrin after implant removal caused by advanced peri-implantitis. This individualized titanium mesh may be a reliable technique for severe alveolar ridge reconstruction, with the additional benefits of reduced surgery time and a simplified operation.

BackgroundIn recent years, there has been an intense interest in biomedical imaging applications based on terahertz (THz) wavelengths due to its advantages such as non-invasiveness and non-ionizing radiation.Case Presentation and Differential DiagnosisA total of 10 intraoral lesions were evaluated by using an ACUSON S 2000 (Siemens, Munchen, Germany) color Doppler ultrasonography unit with a 15 MHz intraoperative probe. The borders of the lesion, vascular supply, and internal structure were evaluated. After ultrasonography, excision of lesions was performed under local anesthesia and histopathological examination and spectroscopy by using Terahertz Attenuated Total Reflection (ATR) in the light were performed. On ultrasonographic examination, 6 of the lesions showed a heterogeneous hyperechogenicity with well-defined margins and posterior acoustic shadow with no vascularity. The lesions were diagnosed histopathologically as fibroma with hyperkeratosis, hyperplasia of epidermis, proliferation of fibroblasts, and hyaline degeneration in partially hyperplastic collagen. Three of these lesions were hypoechoic with well-defined hyperechoic borders, with some isoechoic areas indicating internal vascularization. These lesions were histopathologically diagnosed as peripheral giant cell granuloma showing epithelioid cells and macrophages. One lesion showed a heterogeneous echogenic internal structure with clear hyperechoic borders without vascularization on ultrasonographic evaluation. This was histopathologically diagnosed as oral focal mucinosis, appearing as well-circumscribed but non-encapsulated myxomatous connective tissue. Imaging characteristics of the 10 lesions were shown by using the terahertz method with our laboratory settings.ConclusionTerahertz images were found to be promising in terms of assessing intraoral soft tissue lesions. Statement of Ethical Review Written consent and permission was obtained from the patients

Ameloblastoma mine organı ve fibröz stromalı epitelden gelişen odontojen kaynaklı bir tümördür. Cinsiyet ayrımı gözetmeksizin genellikle genç yetişkinlerde izlenen gerçek bir neoplazmdır ve lokal invaziv olarak gelişim gösterir. Histolojik ve radyografik özelliklerine göre bir çok alt tipe ayrılan ameloblastomanın unikistik formu, ameloblastomanın diğer formlarına göre daha az agresif karakterlidir ve vakaların çoğu konservatif olarak tedavi edilebilmektedir. Bu vaka raporunda maksilla sol kanin bölgesinde lokalize şişlik ve ağrı şikayetleri ile kliniğimize başvuran 14 yaşındaki çocuk hastaya ilişkin tedavi prosedürü sunulmaktadır.

Background/Aim:Denosumab is a human monoclonal immunoglobulin G2 antibody developed from the ovarian cells of Chinese hamsters. We aimed to histomorphometrically and radiologically evaluate the effects of xenografts used with local denosumab on the healing of defect sites using rabbit skulls.Materials and Methods:Two 10-mm diameter critical-size defects were created in 16 rabbits. The defect areas were filled with xenografts and xenograft + 3 mg denosumab in the control and denosumab groups (DEN), respectively. We evaluated new bone, residual graft, soft tissue areas, and bone volume in 4- and 8-week study groups.Results:Histomorphometrically, there were no statistically significant differences between groups at both 4 and 8 weeks regarding residual graft, new bone, and soft tissue area (p > 0.05). The 4-week residual graft control group values were significantly higher than the 8-week values (p < 0.05). The soft tissue area was significantly greater in the 4-week compared with the 8-week DEN group (p < 0.05). The radiologically measured total bone volume was significantly greater in the 8-week specimens than in the 4-week specimens (p < 0.05).Conclusion:In this study, denosumab used locally with bone grafts, showed no direct effect on new and total bone volume.

Objective: The purpose of this retrospective study was to evaluate the radiographic and histopathologic features of the pathologic lesions associated with an impacted tooth in the maxilla and mandible of patients who were admitted to three different university hospitals located in different cities. Materials and Methods: One hundred one patients (36 females and 65 males) aged between 8 and 67 and who have radiolucent lesions associated with the impacted teeth were included in this study. Data related to the age and gender of the patients, and the findings of cone-beam computed tomography, and histopathologic diagnosis of the lesions were recorded and analyzed. Results: Majority of the lesions were in the posterior region of the mandible (62.4%), related to the mandibular third molars (59.4%), and were diagnosed as a dentigerous cyst. The most common features of the lesions were unilocular radiolucency (91.1%), well-circumscribed (90.1%), and expansive (85.1%). A statistically significant relationship was found between the migration of the impacted tooth/teeth related to the lesion (p<0.05) and the expansion of the lesion (p<0.01) according to gender. A statistically significant relationship was found between the migration of the impacted tooth/teeth related to the lesion (p<0.05) and the histopathological diagnosis of the lesion (p<0.01) according to age groups. Conclusion: Knowing all of the clinical, radiological and histopathological features of the lesions provide the surgeon to reach the correct diagnosis. Thus, the doctors achieve high success in treatment with the right treatment plan.