Publications by authors named "Antoine Berbéri"

39 Publications

Osteogenic potential of dental and oral derived stem cells in bone tissue engineering among animal models: An update.

Tissue Cell 2021 Feb 24;71:101515. Epub 2021 Feb 24.

Laboratory of Cancer Biology and Molecular Immunology, Faculty of Sciences-I, Lebanese University, Hadath- Beirut, Lebanon. Electronic address:

Small bone defects can heal spontaneously through the bone modeling process due to their physiological environmental conditions. The bone modeling cycle preserves the reliability of the skeleton through the well-adjusted activities of its fundamental cell. Stem cells are a source of pluripotent cells with a capacity to differentiate into any tissue in the existence of a suitable medium. The concept of bone engineering is based on stem cells that can differentiate into bone cells. Mesenchymal stromal cells have been evaluated in bone tissue engineering due to their capacity to differentiate in osteoblasts. They can be isolated from bone marrow and from several adults oral and dental tissues such as permanent or deciduous teeth dental pulp, periodontal ligament, apical dental papilla, dental follicle precursor cells usually isolated from the follicle surrounding the third molar, gingival tissue, periosteum-derived cells, dental alveolar socket, and maxillary sinus Schneiderian membrane-derived cells. Therefore, a suitable animal model is a crucial step, as preclinical trials, to study the outcomes of mesenchymal cells on the healing of bone defects. We will discuss, through this paper, the use of mesenchymal stem cells obtained from several oral tissues mixed with different types of scaffolds tested in different animal models for bone tissue engineering. We will explore and link the comparisons between human and animal models and emphasized the factors that we need to take into consideration when choosing animals. The pig is considered as the animal of choice when testing large size and multiple defects for bone tissue engineering.
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http://dx.doi.org/10.1016/j.tice.2021.101515DOI Listing
February 2021

Comparing the osteogenic potential of schneiderian membrane and dental pulp mesenchymal stem cells: an in vitro study.

Cell Tissue Bank 2021 Jan 1. Epub 2021 Jan 1.

Laboratory of Cancer Biology and Molecular Immunology, Faculty of Sciences-I, Lebanese University, Hadath, Beirut, Lebanon.

Mesenchymal stem cells, being characterized by high self-renewal capacity and multi-lineage differentiation potential, are widely used in regenerative medicine especially for repair of bone defects in patients with poor bone regenerative capacity. In this study, we aimed to compare the osteogenic potential of human maxillary schneiderian sinus membrane (hMSSM)-derived stem cells versus permanent teeth dental pulp stem cells (DPSCs). Both cells types were cultivated in osteogenic and non-osteogenic inductive media. Alkaline phosphatase (ALP) activity assay and quantitative real-time PCR analysis were carried out to assess osteogenic differentiation. We showed that ALP activity and osteoblastic markers transcription levels were more striking in hMSSM-derived stem cells than DPSCs. Our results highlight hMSSM-derived stem cells as a recommended stem cell type for usage during bone tissue regenerative therapy.
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http://dx.doi.org/10.1007/s10561-020-09887-4DOI Listing
January 2021

Differences in osteogenic and odontogenic differentiation potential of DPSCs and SHED.

J Dent 2020 10 22;101:103413. Epub 2020 Jun 22.

Laboratory of Cancer Biology and Molecular Immunology, Faculty of Sciences-I, Lebanese University, Hadath- Beirut, Lebanon. Electronic address:

Objective: Dental pulp stem cells (DPSCs) and stem cells from human exfoliated deciduous teeth (SHED) are types of human dental tissue-derived mesenchymal stem cells (MSCs) that have emerged as an interesting and promising source of stem cells in the field of tissue engineering. The aim of this work is to isolate stem cells from DPSCs and SHED, cultivate them in vitro and compare their odontogenic differentiation potential.

Methods: DPSCs and SHED were extracted from molars, premolars and canines of six healthy subjects aged 5-29 years. The cells were characterized, using flow cytometry, for mesenchymal stem cell surface markers. MTT colorimetric assay was applied to assess cell viability. Alizarin red staining, alkaline phosphatase (ALP) activity, quantitative real-time PCR (qRT-PCR) and western blot were carried out to determine DPSCs and SHED osteogenic/odontogenic differentiation.

Results: DPSCs express higher STRO-1 and CD44 levels compared to SHED. Moreover, the cells differentiate and acquire columnar shape with a level of calcium deposition and mineralization that is the same between DPSCs and SHED. ALP activity, ALP, COLI, DMP-1, DSPP, OC, and RUNX2 (osteogenic/odontogenic differentiation markers) expression levels were higher in DPSCs.

Conclusions: DPSCs and SHED express MSCs markers. Although both cell types had calcium deposits, DPSCs presented a higher ALP activity level. In addition, DPSCs showed higher levels of osteogenic and odontogenic differentiation markers such as COLI, DSPP, OC, RUNX2, and DMP-1. These results suggest that DPSCs are closer to the phenotype of odontoblasts than SHED and may improve the efficacy of human dental tissue-derived mesenchymal stem cells therapeutic protocols.

'clinical Significance': DPSCs are closer than t SHED to the phenotype of odontoblasts. This would be helpful to enable better therapeutic decisions when applying MSCs-based therapy in the field of dentistry.
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http://dx.doi.org/10.1016/j.jdent.2020.103413DOI Listing
October 2020

The Effects of Intracanal Irrigants and Medicaments on Dental-Derived Stem Cells Fate in Regenerative Endodontics: An update.

Stem Cell Rev Rep 2020 08;16(4):650-660

Laboratory of Cancer biology and Molecular Immunology, Faculty of Sciences-I, Lebanese University, Hadath, Beirut, Lebanon.

Regenerative endodontics is a biologically based treatment designed for immature permanent teeth with necrotic pulp to replace dentin and root structures, as well as dental pulp cells. This procedure has become a part of novel modality in endodontics therapeutic manner, and it is considered as an alternative to apexification. In the last decade, numerous case reports, which describe this procedure, have been published. This therapeutic approach succeeded due to its lower financial cost and ease of performance. Although the clinical protocol of this procedure is not standardized and the effects of irrigants and medicaments on dental stem cells fate remain somewhat ambiguous, however when successful, it is an improvement of endodontics treatment protocols which leads to continued root development, increased dentinal wall thickness, and apical closure of immature teeth. To ensure a successful regenerative procedure, it is essential to investigate the appropriate disinfection protocols and the use of biocompatible molecules in order to control the release of growth factors and the differentiation of stem cells. This is the first review in the literature to summarize the present knowledge regarding the effect of intracanal irrigants and medicaments on the dental derived stem cells fate in regenerative endodontic procedures.
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http://dx.doi.org/10.1007/s12015-020-09982-9DOI Listing
August 2020

An update on human periapical cyst-mesenchymal stem cells and their potential applications in regenerative medicine.

Mol Biol Rep 2020 Mar 6;47(3):2381-2389. Epub 2020 Feb 6.

Laboratory of Cancer Biology and Molecular Immunology, Faculty of Sciences-I, Lebanese University, Beirut, Lebanon.

The broad clinical applications of Mesenchymal Stem Cells (MSCs) in the regenerative medicine field is attributed to their ability to self-renew and differentiate into multiple cellular lineages. Nowadays, MSCs can be derived from a variety of adult and fetal tissues including bone marrow, adipose tissue, umbilical cord and placenta. The difficulties associated with the isolation of MSCs from certain tissues such as bone marrow promoted the search for alternative tissues which are easily accessible. Oral derived MSCs include dental pulp stem cells (DPSCs), dental follicle progenitor cells (DFPC), and periodontal ligament stem cells (PDLSC). Being abundant and easily accessible, oral derived MSCs represent an interesting alternative MSC type to be employed in regenerative medicine. Human periapical cyst-mesenchymal stem cells (hPCy-MSCs) correspond to a newly discovered and characterized MSC subtype. Interestingly, hPCy-MSCs are collected from periapical cysts, which are a biological waste, without any influence on the other healthy tissues in oral cavity. hPCy-MSCs exhibit cell surface marker profile similar to that of other oral derived MSCs, show high proliferative potency, and possess the potential to differentiate into different cell types such as osteoblasts, adipocytes and neurons-like cells. hPCy-MSCs, therefore, represent a novel promising MSCs type to be applied in regenerative medicine domain. In this review, we will compare the different types of dental derived MSCs, we will highlight the isolation technique, the characteristics, and the therapeutic potential of hPCy-MSCs.
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http://dx.doi.org/10.1007/s11033-020-05298-6DOI Listing
March 2020

Cytokines, Masticatory Muscle Inflammation, and Pain: an Update.

J Mol Neurosci 2020 May 1;70(5):790-795. Epub 2020 Feb 1.

Laboratory of Cancer Biology and Molecular Immunology, Faculty of Sciences-I, Lebanese University, Hadath, Beirut, Lebanon.

Cytokines are proteins secreted by diverse types of immune and non-immune cells and play a role in the communication between the immune and nervous systems. Cytokines include lymphokines, monokines, chemokines, interleukins, interferons, colony stimulating factors, and growth factors. They can be both pro- and anti-inflammatory and have autocrine, paracrine, and endocrine activities. These proteins are involved in initiation and persistence of pain, and the progress of hyperalgesia and allodynia, upon stimulating nociceptive sensory neurons, and inducing central sensitization. The objective of this review is to discuss several types of pro- and anti-inflammatory mediators and their relation with inflammatory pain in masticatory muscles.
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http://dx.doi.org/10.1007/s12031-020-01491-1DOI Listing
May 2020

Healing of Bone Defects in Pig's Femur Using Mesenchymal Cells Originated from the Sinus Membrane with Different Scaffolds.

Stem Cells Int 2019 30;2019:4185942. Epub 2019 Sep 30.

Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Lebanese University, Beirut, Lebanon.

Objective: Repairing bone defects, especially in older individuals with limited regenerative capacity, is still a big challenge. The use of biomimetic materials that can enhance the restoration of bone structure represents a promising clinical approach. In this study, we evaluated ectopic bone formation after the transplantation of human maxillary Schneiderian sinus membrane- (hMSSM-) derived cells embedded within various scaffolds in the femur of pigs.

Methods: The scaffolds used were collagen, gelatin, and hydroxyapatite/tricalcium phosphate (HA/TCP) where fibrin/thrombin was used as a control. Histological analysis was performed for the new bone formation. Quantitative real-time PCR (qRT-PCR) and immunohistochemistry (IHC) were used to assess mRNA and protein levels of specific osteoblastic markers, respectively.

Results: Histological analysis showed that the three scaffolds we used can support new bone formation with a more pronounced effect observed in the case of the gelatin scaffold. In addition, mRNA levels of the different tested osteoblastic markers Runt-Related Transcription Factor 2 (RUNX-2), osteonectin (ON), osteocalcin (OCN), osteopontin (OPN), alkaline phosphatase (ALP), and type 1 collagen (COL1) were higher, after 2 and 4 weeks, in cell-embedded scaffolds than in control cells seeded within the fibrin/thrombin scaffold. Moreover, there was a very clear and differential expression of RUNX-2, OCN, and vimentin in osteocytes, osteoblasts, hMSSM-derived cells, and bone matrix. Interestingly, the osteogenic markers were more abundant, at both time points, in cell-embedded gelatin scaffold than in other scaffolds (collagen, HA/TCP, fibrin/thrombin).

Conclusions: These results hold promise for the development of successful bone regeneration techniques using different scaffolds embedded with hMSSM-derived cells. This trial is registered with NCT02676921.
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http://dx.doi.org/10.1155/2019/4185942DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6791246PMC
September 2019

Cyst volume changes measured with a 3D reconstruction after decompression of a mandibular dentigerous cyst with an impacted third molar.

Clin Pract 2019 Jan 26;9(1):1132. Epub 2019 Feb 26.

Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon.

The aim of this article is to describe a large mandibular cyst treated with decompression followed by surgical enucleation. Furthermore, we described the utility of cyst volume measurements by using a 3D reconstruction on Cone Beam Computed Tomography (CBCT). The dentigerous cyst is the most common cyst type of epithelial origin, arising from remnants of odontogenic epithelium, asymptomatic and associated with the crown of an unerupted or partially or completely impacted tooth. However, after a long duration and extension of the cyst volume it may provoke significant bone resorption, cortical expansion, tooth displacement and the vitality of neighboring teeth may be affected. The regular treatment of this lesion is enucleation and extraction of the involved tooth. Marsupialization and decompression are proposed when the volume of the cyst is well developed to release the cystic pressure and allow the bone cavity to progressively decrease in volume with the gradual apposition of bone. This report presents a large dentigerous cyst related to impacted mandibular third molar of a 21-year-old male patient. The cyst was treated successfully by decompression and later by surgical enucleation with surgical extraction of the related molar. In conclusion, the combination of decompression and surgical approach showed on the three-dimensional CBCT investigation a significant correlation between the treatment and volume reduction of the cyst. The clinical case described allows us to observe bone formation after decompression and surgical enucleation was performed with less risk on vital anatomic elements.
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http://dx.doi.org/10.4081/cp.2019.1132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6397944PMC
January 2019

Evaluation of the Osteogenic Potential of Different Scaffolds Embedded with Human Stem Cells Originated from Schneiderian Membrane: An Study.

Biomed Res Int 2019 15;2019:2868673. Epub 2019 Jan 15.

Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Lebanese University, Beirut, Lebanon.

Background: Novel treatments for bone defects, particularly in patients with poor regenerative capacity, are based on bone tissue engineering strategies which include mesenchymal stem cells (MSCs), bioactive factors, and convenient scaffold supports.

Objective: In this study, we aimed at comparing the potential for different scaffolds to induce osteogenic differentiation of human maxillary Schneiderian sinus membrane- (hMSSM-) derived cells. hMSSM-derived cells were seeded on gelatin, collagen, or Hydroxyapatite -Tricalcium phosphate-Fibrin (Ha-TCP-Fibrin) scaffolds. Cell viability was determined using an MTT assay. Alizarin red staining method, Alkaline phosphatase (ALP) activity assay, and quantitative real-time PCR analysis were performed to assess hMSSM-derived cells osteogenic differentiation.

Results: Cell viability, calcium deposition, ALP activity, and osteoblastic markers transcription levels were most striking in gelatin scaffold-embedded hMSSM-derived cells.

Conclusion: Our findings suggest a promising potential for gelatin-hMSSM-derived cell construct for treating bone defects.
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http://dx.doi.org/10.1155/2019/2868673DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350594PMC
May 2019

In Vitro Effect of Mastication on the Retention and Wear of Locator Attachments in a Flat Mandibular Ridge Model.

J Prosthodont 2019 Feb 2;28(2):e744-e751. Epub 2018 Jul 2.

Department of Prosthodontics, Lebanese University, Beirut, Lebanon.

Purpose: The effect of masticatory loads on the retention of overdenture attachments is poorly documented. The aim of this in vitro study is to assess the effect of simulated mastication on the retentive properties and dimensions of Locator inserts.

Materials And Methods: 30 specimens simulating nonanatomic edentulous flat ridges with two implant replicas each were fabricated. Overdenture units were connected to the implants with Locator attachments and 3 types of inserts: transparent (Group T; n = 10 pairs), pink (Group P; n = 10 pairs), and blue (Group B; n = 10 pairs). The overdenture units were subjected to simulated bi-axial masticatory loads of 68.6 N. Locator retention was assessed using axial dislodging forces at baseline (T0) and following 100,000 (T1) and 200,000 (T2) masticatory cycles. The inner diameter of the insert (XY) and the diameter of the central core (AB) were measured under stereomicroscope at T0 and T2. Retention changes and dimensional variations of the inserts were statistically analyzed.

Results: The 3 groups showed significantly different retentions with the highest values recorded for group T followed by group P, and finally group B at T0, T1, and T2. Groups T and P were not affected by loading while group B showed a significant mean retention loss from T0 to T1. XY and AB were significantly different between the 3 color-coded inserts at baseline and at T2. No correlation could be established between retention changes and dimensional variations of the 3 types of inserts.

Conclusions: Within the limitations of this in vitro study, simulated mastication seems to significantly affect the extra-light blue Locator inserts but not the more-retentive ones. The transparent and pink inserts may require less frequent replacements and could therefore be recommended under clinical conditions.
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http://dx.doi.org/10.1111/jopr.12940DOI Listing
February 2019

Impact of Cone Beam Computed Tomography Dose in Pre-Surgical Implant Analysis.

Open Dent J 2018 31;12:94-103. Epub 2018 Jan 31.

Department of Oral Surgery, Dental University of Lyon, University Claude Bernard, Lyon 1, France.

Objectives: Cone-Beam Computed Tomography (CBCT) produces vital information required for the accurate and prudent placement of dental implants. Lack of standardization between CBCT machines may result in unsafe patient exposure to harmful radiation; higher doses are not necessarily associated with improved image quality.

Aim: The study aimed to assess the influence of low- and high-dose milliamperage settings on CBCT images for objective and subjective implant planning.

Methods: Two dry skulls (4 hemi-maxillary segments of the maxilla and 4 hemi-maxillary segments of the mandible) were scanned under low (2 mA) and high (6.3 mA) dosage settings using a CBCT (Carestream CS 9300). Cross-sectional slices of both image qualities were evaluated by five expert clinicians, for image quality for implant planning and objective bone measurements.

Results: There were no significant differences in bone measurements taken on high or low dose images ( > 0.05). In qualitative image assessments, assessment and image quality for almost all observers were independent of each other. For planning posterior mandibular implant placement, increased dosage improved concordance and kappa values between low and high dose images.

Conclusion: Reduction in milliamperage did not affect diagnostic image quality for objective bone measurements and produced sufficient intra-rater reliability for qualitative assessment; therefore dose reduction can be achieved without compromising diagnostic decision- making.
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http://dx.doi.org/10.2174/1874210601812010094DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5814949PMC
January 2018

Oral lesions associated with human immunodeficiency virus in 75 adult patients: a clinical study.

J Korean Assoc Oral Maxillofac Surg 2017 Dec 26;43(6):388-394. Epub 2017 Dec 26.

Department of Oral Medicine and Diagnosis, School of Dentistry, Lebanese University, Beirut, Lebanon.

Objectives: The objective of this study was to investigate the presence of oral lesions in human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients in a descriptive cross-sectional study, and to establish their presence according to levels of CD4+ cells (including the CD4+/CD8+ cell ratio).

Materials And Methods: A total of 75 patients infected with HIV were included. Oral lesions were observed and classified using World Health Organization classification guidelines. Potential correlations between the presence and severity of oral lesions and CD4+ cells, including the CD4+/CD8+ cell ratio, were studied.

Results: The most frequent oral lesion detected was oral pseudomembranous candidiasis (80.0%), followed by periodontal disease (40.0%), herpetic lesions (16.0%), hairy leukoplakia (16.0%), gingivitis (20.0%), oral ulceration (12.0%), Kaposi's sarcoma (8.0%), and non-Hodgkin's lymphoma (4.0%). The CD4+ count was <200 cells/mm in 45 cases (60.0%), between 200-500 cells/mm in 18 cases (24.0%), and >500 cells/mm in 12 cases (16.0%). The mean CD4+ count was 182.18 cells/mm. The mean ratio of CD4+/CD8+ cells was 0.26. All patients showed at least one oral manifestation.

Conclusion: There was no correlation between the CD4+/CD8+ cell ratio and the presence of oral lesions. The severity of the lesions was more pronounced when the CD4+ cell count was less than 200 cells/mm.
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http://dx.doi.org/10.5125/jkaoms.2017.43.6.388DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5756795PMC
December 2017

Assessment of the Mental Foramen Location in a Sample of Fully Dentate Lebanese Adults Using Cone-beam Computed Tomography Technology.

Acta Inform Med 2017 Dec;25(4):259-262

Department of Oral and Maxillofacial Surgery; Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon.

Objective: The literature reports that the location of mental foramen shows differences among races. The aim of this study was to assess the mental foramen position in a sample of Lebanese population using cone-beam computed tomography (CBCT) technology.

Materials And Methods: In this study, we investigated CBCT images of 50 fully dentate Lebanese adults (23 males and 27 females). We assessed the horizontal position of the mental foramen in relation with the mandibular premolars in both right and left sides and the vertical position by measuring the distance from the upper border of the foramen to the inferior border of the body of the mandible. The data obtained were statistically analyzed using Chi-square test, and two-sided t-test. Statistical significance was set at p < 0.05.

Results: In our sample, the mental foramen was mostly found in line with the second mandibular premolar in both sides and the mean distance from the superior border of the foramen to the inferior border of the body of the mandible was 13.0120 ± 0.98487 mm on the right and 13.0728 ± 0.96029 mm on the left.

Conclusion: Within the limits of this study, we concluded that in our sample of Lebanese population, there was substantial variability in the mental foramen location.
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http://dx.doi.org/10.5455/aim.2017.25.259-262DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5723193PMC
December 2017

Effect of Simulated Mastication on the Retention of Locator Attachments for Implant-Supported Overdentures: An In Vitro Pilot Study.

J Prosthodont 2020 Jan 15;29(1):74-79. Epub 2017 Sep 15.

Department of Prosthodontics, Faculty of Dental Medicine, Lebanese University, Hadat, Lebanon.

Purpose: Limited information is currently available relative to the effect of masticatory loads on the retentive properties of Locator attachments. The aims of this in vitro study were to assess and compare the effect of simulated mastication on the retention of white, pink, and blue Locator inserts for overdentures retained by 2 implants.

Materials And Methods: Thirty specimens simulating a nonanatomic edentulous flat ridge with two implants and an overdenture were divided into 3 groups according to the color of the fitted insert: transparent clear group (n = 10), pink group (n = 10), and blue group (n = 10). Retention forces were measured in an axial direction initially and after 100,000 cycles of simulated masticatory loads. One-way ANOVA followed by Tukey's post hoc tests were used to compare retention values and percentage retention loss between the 3 groups with significance set at p = 0.05.

Results: The 3 groups presented significant differences in retention at baseline (9.95 ± 1.91 N, 15.43 ± 4.08 N, and 41.73 ± 9.29 N for the blue, pink, and clear groups, respectively) and after simulated mastication (6.37 ± 2.64 N, 14.00 ± 3.89 N, 38.20 ± 5.11 N for the blue, pink, and clear groups, respectively). Within the same group, cyclic loading did not significantly affect retention in the clear and pink groups, while the blue inserts showed a significant retention loss (-37%) after loading.

Conclusions: The results suggest that short-term simulated mastication affects the extra-light blue inserts but not the more-retentive inserts.
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http://dx.doi.org/10.1111/jopr.12670DOI Listing
January 2020

Sinus Floor Augmentation With Ambient Blood and an Absorbable Collagen Sponge: A Prospective Pilot Clinical Study.

Implant Dent 2017 Oct;26(5):674-681

*Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Lebanese University, Beirut, Lebanon. †Clinical Assistant, Department of Oral and Maxillofacial Surgery, School of Dentistry, Lebanese University, Beirut, Lebanon. ‡Professor, Laboratory of Cancer Biology and Molecular Immunology, Department of Biology, Faculty of Science I, Lebanese University, Beirut, Lebanon. §Professor, Department of Pathology, Faculty of Medicine, Lebanese University, Beirut, Lebanon. ¶Assistant Professor, Department of Ear Nose and Throat, Faculty of Medicine, Lebanese University, Beirut, Lebanon.

Purpose: The aim of this study was to clinically, radiologically, and histologically evaluate a sinus augmentation technique using a resorbable collagen sponge to maintain space between the Schneiderian membrane and the residual crestal bone.

Materials And Methods: Patients with partially edentulous maxillae were clinically and radiographically evaluated for implant placement. A total of 10 consecutive patients with the bone height for implant placement (<4.0 mm) were enrolled in the study. The lateral maxillary wall was surgically exposed and the Schneiderian membrane was carefully elevated. A collagen wound dressing was placed in the antral area between the sinus floor and the raised membrane. The vertical sinus floor height was calculated using cone-beam computed tomography before the surgical procedure (baseline) and at 6 months postoperative. Immediately after the second scan, a core biopsy was removed for histological evaluation. The biopsy site was then further prepared for implant placement in the same location.

Results: Biopsies showed mature cancellous bone with a predominantly lamellar structure. Well-vascularized intertrabecular spaces were filled with connective tissue and bone marrow. Analysis of bone height changes showed significant mean (SD) differences before and after procedures in anterior (2.67 ± 0.62 mm and 11.15 ± 1.1 mm), medial (2.98 ± 0.55 mm and 10.96 ± 0.77 mm), and posterior (3.17 ± 0.91 mm and 10.63 ± 0.51 mm) maxillary jaw locations (P = 0.005).

Conclusion: The collagen sponge provided an effective substrate for osseous regeneration of the sinus floor.
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http://dx.doi.org/10.1097/ID.0000000000000631DOI Listing
October 2017

Prevalence of Chronic Erythematous Candidiasis in Lebanese Denture Wearers: a Clinico-microbiological Study.

Mater Sociomed 2017 Mar;29(1):26-29

Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon.

Objective: Chronic erythematous candidiasis also known as denture-related stomatitis refers to inflammatory changes of the denture-bearing mucosa. The aim of this study was to evaluate the prevalence of chronic erythematous candidiasis in a Lebanese population using clinical and microbiological examinations.

Materials And Methods: Ninety-eight patients wearing full acrylic maxillary denture (50 women and 48 men) were included in this study. A clinical oral assessment and a microbiological exam using swab samples collected from the palate of these patients were performed and the data obtained were analyzed statistically.

Results: Sixty-nine point thirty-eight per cent (69.38%) of the patients examined, (68 out of 98; 25 men and 43 women), presented chronic erythematous candidiasis. The statistical analysis showed that patient's gender was a significant predictor of the disease while no statistically significant relationship with the patient's age was found.

Conclusion: Within the limits of this study, the prevalence of chronic erythematous candidiasis is estimated to be high in Lebanon. Women were more affected than men.
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http://dx.doi.org/10.5455/msm.2017.29.26-29DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5402384PMC
March 2017

Micromovement Evaluation of Original and Compatible Abutments at the Implant-abutment Interface.

J Contemp Dent Pract 2016 Nov 1;17(11):907-913. Epub 2016 Nov 1.

Department of Prosthodontics, Faculty of Dental Medicine Saint Joseph's University, Beirut, Lebanon.

Introduction: Use of compatible abutments may increase micromovements between the abutments, and the inner part of the implant may increase the stress on marginal bone level. Also micromovement will change the volume of the inner space of the implant-abutment complex. The resulting pumping effect can transport even initially immobile microorganisms from the exterior to the interior and vice versa.

Objectives: The purpose of the study was to evaluate the mechanical comportment of OsseoSpeed™ Tx implants connected with original and compatible abutments in vitro under simulated clinical loading conditions.

Materials And Methods: A total of 15 OsseoSpeed™ TX implants (4 × 11 mm) were used and divided into three groups (n = 5). Three types of abutments were used in the study; group I: Five original Ti Design™ abutments, group II: Five Natea™ abutments, and group III: Implanet™ abutments. Abutments used in groups II and III were all compatible with Astra Tech Implant System™. Implants were embedded into resin. Simulating the human masticatory cycle, the axial force vector was increased up to a defined maximum (25, 50, 75, 100, 125, 150, 175, and 200 N) and inclined 30° to the implant axis. A radiograph amplifier was used to convert the X-ray projection into a picture. The visual evaluation of the frames and the provided X-ray videos were evaluated for an existing microgap in width and length between the implant and the abutment.

Results: An initial width gap was observed in groups II and III in four of the five samples with an average of 6.5 and 5 μm respectively. When the axial forces reach 75 N, only groups II and III demonstrated a gap width of 5.2 ± 3.63 and 4.8 ± 3.03 μm, and a gap length of 5.2 ± 3.63 and 94 ± 125.3 μm respectively. At 200 N, group I showed a gap width of 8.4 ± 1.67 μm and a gap length of 187.6 ± 43.6 μm, while groups II and III showed a gap width of 12.4 ± 3.29 and 22.8 ± 5.76 μm, and a gap length of 387.2 ± 84.36 and 641.2 ± 122.6 μm respectively.

Conclusion: Within the limitations of this study and under the parameters used and from the resulting data collected, we can presume that the use of compatible components leads to significant micromovement when compared with the use of original ones.

Clinical Significance: The use of compatible prosthetic components with original implants showed significant micromovements when compared with the use of abutment and implant from the same manufacturer. Clinically, the micromovements when associated with leakage leads to bone loss around the neck of the implant and later to peri-implantitis.
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http://dx.doi.org/10.5005/jp-journals-10024-1952DOI Listing
November 2016

In Response.

Implant Dent 2016 12;25(6):729-730

School of Dentistry, Lebanese University, Beirut, Lebanon.

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http://dx.doi.org/10.1097/01.id.0000510825.24224.a7DOI Listing
December 2016

Mesenchymal stem cells with osteogenic potential in human maxillary sinus membrane: an in vitro study.

Clin Oral Investig 2017 Jun 1;21(5):1599-1609. Epub 2016 Sep 1.

ER045, Laboratory of Stem Cells, DSST, PRASE, Lebanese University, Beirut, Lebanon.

Objectives: The aim of our study is to prove and validate the existence of an osteogenic progenitor cell population within the human maxillary Schneiderian sinus membrane (hMSSM) and to demonstrate their potential for bone formation.

Materials And Methods: Ten hMSSM samples of approximately 2 × 2 cm were obtained during a surgical nasal approach for treatment of chronic rhinosinusitis and were retained for this study. The derived cells were isolated, cultured, and assayed at passage 3 for their osteogenic potential using the expression of Alkaline phosphatase, alizarin red and Von Kossa staining, flow cytometry, and quantitative real-time polymerase chain reaction.

Results: hMSSM-derived cells were isolated, showed homogenous spindle-shaped fibroblast-like morphology, characteristic of mesenchymal progenitor cells (MPCs), and demonstrated very high expression of MPC markers such as STRO-1, CD44, CD90, CD105, and CD73 in all tested passages. In addition, von Kossa and Alizarin red staining showed significant mineralization, a typical feature of osteoblasts. Moreover, alkaline phosphatase (ALP) activity was significantly increased at days 7, 14, 21, and 28 of culture in hMSSM-derived cells grown in osteogenic medium, in comparison to controls. Furthermore, osteogenic differentiation significantly upregulated the transcriptional expression of osteogenic markers such as ALP, Runt-related transcription factor 2 (Runx-2), bone morphogenetic protein (BMP)-2, osteocalcin (OCN), osteonectin (ON), and osteopontin (OPN), confirming that hMSSM-derived cells are of osteoprogenitor origin. Finally, hMSSM-derived cells were also capable of producing OPN proteins upon culturing in an osteogenic medium.

Conclusion: Our data showed that hMSSM holds mesenchymal osteoprogenitor cells capable of differentiating to the osteogenic lineage.

Clinical Relevance: hMSSM contains potentially multipotent postnatal stem cells providing a promising clinical application in preimplant and implant therapy.
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http://dx.doi.org/10.1007/s00784-016-1945-6DOI Listing
June 2017

Evaluation of the oral component of Sjögren's syndrome: An overview.

J Int Soc Prev Community Dent 2016 Jul-Aug;6(4):278-84

Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Lebanese University, Beirut, Lebanon.

Sjögren's syndrome is a chronic autoimmune disorder characterized by lymphocytic infiltration, and consequently hypofunction of lacrimal and salivary glands. The loss of salivary function induces oral dryness (xerostomia). This review focuses on methods for determining salivary gland function including clinical signs, salivary flow rate measurements (sialometry), analysis of salivary composition (sialochemistry), histopathological and radiologic examinations, and other recent advanced techniques.
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http://dx.doi.org/10.4103/2231-0762.186802DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4981927PMC
September 2016

Marginal Bone Remodeling around healing Abutment vs Final Abutment Placement at Second Stage Implant Surgery: A 12-month Randomized Clinical Trial.

J Contemp Dent Pract 2016 Jan 1;17(1):7-15. Epub 2016 Jan 1.

Faculty of Dental Medicine, Saint Joseph University Beirut Lebanon.

Background: The periimplant bone level has been used as one of the criteria to assess the success of dental implants. It has been documented that the bone supporting two-piece implants undergoes resorption first following the second-stage surgery and later on further to abutment connection and delivery of the final prosthesis.

Objective: The aim of this multicentric randomized clinical trial was to evaluate the crestal bone resorption around internal connection dental implants using a new surgical protocol that aims to respect the biological distance, relying on the benefit of a friction fit connection abutment (test group) compared with implants receiving conventional healing abutments at second-stage surgery (control group).

Materials And Methods: A total of partially edentulous patients were consecutively treated at two private clinics, with two adjacent two-stage implants. Three months after the first surgery, one of the implants was randomly allocated to the control group and was uncovered using a healing abutment, while the other implant received a standard final abutment and was seated and tightened to 30 Ncm. At each step of the prosthetic try-in, the abutment in the test group was removed and then retightened to 30 Ncm. Horizontal bone changes were assessed using periapical radiographs immediately after implant placement and at 3 (second-stage surgery), 6, 9 and 12 months follow-up examinations.

Results: At 12 months follow-up, no implant failure was reported in both groups. In the control group, the mean periimplant bone resorption was 0.249 ± 0.362 at M3, 0.773 ± 0.413 at M6, 0.904 ± 0.36 at M9 and 1.047 ± 0.395 at M12. The test group revealed a statistically significant lower marginal bone loss of 20.88% at M3 (0.197 ± 0.262), 22.25% at M6 (0.601 ± 0.386), 24.23% at M9 (0.685 ± 0.341) and 19.2% at M9 (0.846 ± 0.454). The results revealed that bone loss increased over time, with the greatest change in bone loss occurring between 3 and 6 months. Alveolar bone loss was significantly greater in the control condition than the test condition.

Conclusion: The results of this prospective study demonstrated the benefit of placing a prosthetic component with a stable connection at second-stage surgery, in terms of reduced marginal bone remodeling when compared with conventional procedure.

Clinical Significance: The use of a stable connection in a healing component during try-in stages prior to final restoration placement leads to less periimplant marginal bone loss.
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http://dx.doi.org/10.5005/jp-journals-10024-1795DOI Listing
January 2016

Subantral Augmentation With Mineralized Cortical Bone Allograft Material: Clinical, Histological, and Histomorphometric Analyses and Graft Volume Assessments.

Implant Dent 2016 Jun;25(3):353-60

*Professor, Oral and Maxillofacial Surgery Department, School of Dentistry, Lebanese University, Beirut, Lebanon. †Clinical Assistant, Oral and Maxillofacial Surgery Department, School of Dentistry, Lebanese University, Beirut, Lebanon.

Purpose: The aim of this study was to clinically and histologically evaluate the effect of using mineralized cortical bone allograft in sinus lift augmentation and to 3-dimensionally quantify volumetric changes in maxillary sinuses augmented over a 2-year period.

Materials And Methods: Eleven patients affected with less than 3 mm of residual ridge were enrolled in the study. After sinus grafting with a mineralized bone allograft, the site was covered with a collagen wound dressing. During implant placement 4 months later, a biopsy was obtained for histological and histomorphometry evaluations. Bone volume changes were also evaluated.

Results: Biopsies showed mature cancellous bone with a predominantly lamellar structure. The well-vascularized intertrabecular spaces were filled with connective tissue and bone marrow. Histomorphometry evaluations revealed a mean 43.76 ± 1.47% of bone marrow, 40.16 ± 1.35% of mineralized bone and 16.59 ± 0.55% of woven bone. The mean of residual particles was 0.47 ± 0.01%. Volumetric measurements showed a mean volume of grafted material 16.24 ± 1.55 cm at T0, 14.48 ± 1.48 cm at T1, and 13.06 ± 1.39 cm at T2. The mean volume retraction was 10.83% of the initial total volume at (T0-T1) and 9.8% at (T1-T2).

Conclusions: The clinical and histological results indicated that mineralized cortical bone allograft promoted de novo bone formation and can be used for sinus lift procedure.
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http://dx.doi.org/10.1097/ID.0000000000000391DOI Listing
June 2016

Deoxyribonucleic Acid Probes Analyses for the Detection of Periodontal Pathogens.

J Contemp Dent Pract 2015 09 1;16(9):727-32. Epub 2015 Sep 1.

Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Lebanese University, Beirut, Lebanon, Phone: +961-3-731173, e-mail:

Background: In clinical microbiology several techniques have been used to identify bacteria. Recently, Deoxyribonucleic acid (DNA)-based techniques have been introduced to detect human microbial pathogens in periodontal diseases. Deoxyribonucleic acid probes can detect bacteria at a very low level if we compared with the culture methods. These probes have shown rapid and cost-effective microbial diagnosis, good sensitivity and specificity for some periodontal pathogens in cases of severe periodontitis.

Materials And Methods: Eighty-five patients were recruited for the study. Twenty-one subjects ranging between 22 and 48 years of age fulfilled the inclusion and exclusion criteria. Seventy-eight samples became available for DNA probe analysis from the deepest pockets in each quadrant.

Results: All 21 patients showed positive results for Prevotella intermedia; also, Prevotella gingivalis was identified in 19 subjects, Aggregatibacter actinomycetemcomitans in 6 subjects. P. intermedia was diagnosed positive in 82% of the subgingival samples taken, 79% for P. gingivalis, and 23% for A. actinomycetemcomitans.

Conclusion: This study shows a high frequency of putative periodontal pathogens by using DNA probe technology, which is semi-quantitative in this study. Deoxyribonucleic acid probes can detect bacteria at very low level about 10(3) which is below the detection level of culture methods. The detection threshold of cultural methods.

Clinical Significance: The three types of bacteria can be detected rapidly with high sensitivity by using the DNA probe by general practitioners, and thus can help in the diagnosis process and the treatment.
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http://dx.doi.org/10.5005/jp-journals-10024-1748DOI Listing
September 2015

Effectiveness of Hexetidine 0.1% Compared to Chlorhexidine Digluconate 0.12% in Eliminating Candida Albicans Colonizing Dentures: A Randomized Clinical In Vivo Study.

J Int Oral Health 2015 Aug;7(8):5-8

Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Lebanese University, Beirut, Lebanon.

Background: Denture hygiene is an important factor in the prevention and treatment of denture stomatitis (DS). This study aimed to evaluate the efficacy of two different mouthwashes (chlorhexidine digluconate 0.12% and hexetidine 0.1%) in eliminating Candida albicans on dentures.

Materials And Methods: A total of 60 denture wearers (20 men, 40 women; age range 40-80 years) with clinical evidence of DS were randomly divided into 2 test groups and 1 control group. The dentures of each test group were treated by immersion in one of the two mouthwashes while those of the control group were immersed in distilled water. Swab samples from the palatal surfaces of the upper dentures were collected before and after of cleaner use and examined mycologically.

Results: Reduction in the number of colony-forming units of Candida albicans after immersion of the dentures with chlorhexidine digluconate 0.12% was significantly greater than that of the group using hexetidine 0.1% and those of the control group.

Conclusion: Hexetidine 0.1% solution tested for the first time as a product of disinfection of the acrylic dentures showed average results after immersion of 8 night hours for 4 days and was less effective than chlorhexidine digluconate 0.12%.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4588790PMC
August 2015

Effectiveness of a Chlorhexidine Digluconate 0.12% and Cetylpyridinium Chloride 0.05% Solution in eliminating Candida albicans Colonizing Dentures: A Randomized Clinical in vivo Study.

J Contemp Dent Pract 2015 06 1;16(6):433-6. Epub 2015 Jun 1.

Department of Oral and Maxillofacial Surgery, School of Dentistry, Lebanese University, Beirut, Lebanon.

Background: Effective denture hygiene is important for patients suffering from denture stomatitis (DS). This study aimed to evaluate the efficacy of a solution containing 0.12% chlorhexidine (CHX) digluconate and 0.05% cetylpyridinium chloride (CPC) in eliminating Candida albicans colonizing dentures.

Materials And Methods: Forty denture wearers (11 men, 29 women; age range 40 to 80 years) with clinical evidence of DS were randomly divided into two groups, one test and one control. The dentures of the test group were treated by immersion in a solution of 0.12% CHX and 0.05% CPC while those of the control group were immersed in distilled water. Swabs were collected from the fitting surfaces of the upper dentures prior and post cleaner use and examined mycologically.

Results: Reduction in the number of colony-forming units (CFU) of Candida albicans after immersion of the dentures in a solution of 0.12% CHX and 0.05% CPC was significantly greater than that of the control group.

Conclusion: A solution of 0.12% CHX and 0.05% CPC tested as a product of disinfection of the acrylic dentures showed significant results after immersion of 8 night hours for 4 days.
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http://dx.doi.org/10.5005/jp-journals-10024-1702DOI Listing
June 2015

Effectiveness of Hexetidine 0.1% in Eliminating Candida albicans Colonizing Dentures: A Randomized Clinical In Vivo Study.

J Int Oral Health 2015 ;7(Suppl 1):1-4

Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Lebanese University, Beirut, Lebanon.

Background: Effective cleaning of dentures is important to maintain a good oral hygiene for patients suffering from denture stomatitis (DS). This study aimed to evaluate the efficacy of hexetidine 0.1% in eliminating C. albicans colonizing dentures.

Materials And Methods: A total of 40 denture wearers (18 men, 22 women; age range 40-80 years) with clinical evidence of DS were randomly divided into 2 groups, 1 test, and 1 control. The dentures of the test group were treated by immersion in hexetidine 0.1% while those of the control group were immersed in distilled water. Swab samples from the palatal surfaces of the upper dentures were collected before and after of cleaner use and examined mycologically.

Results: Reduction in the number of colony-forming units (CFU) of C. albicans after immersion of the dentures with hexetidine 0.1% was evaluated compared to those of the control group.

Conclusion: Hexetidine 0.1% solution tested for the first time as a product of disinfection of the acrylic dentures showed average results after immersion of 8 night hours for 4 days.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4516077PMC
July 2015

Evaluation of Three-Dimensional Volumetric Changes After Sinus Floor Augmentation with Mineralized Cortical Bone Allograft.

J Maxillofac Oral Surg 2015 Sep 24;14(3):624-9. Epub 2014 Dec 24.

Oral and Maxillofacial Surgery Department, School of Dentistry, Lebanese University, P.O. Box 5208-116, Beirut, Lebanon.

Aim: The aim of this retrospective study was to quantify three-dimensional (3D) volumetric bone changes over a two-year period in maxillary sinuses augmented with a mineralized cortical bone allograft material (MCBA) material.

Patients And Methods: Eleven patients (6 males and 5 females) with mean of age of 51.6 (range: 46-61) years were treated to increase the vertical dimension of the alveolar crest by maxillary sinus floor augmentation procedure. Study data were collected from patient records and by analyzing preoperative radiographs and cone beam computed tomography (CBCT) scans taken within the first two weeks after maxillary sinus lift (T0), immediately before implant placement four months after grafting (T1), and after one year of implant loading (T2). All DICOM-formatted images were rendered into volumetric images using software that automatically calculated the volume of the grafted material in cubic centimeters.

Results: Mean graft volume was 16.24 ± 1.54 cm(3) at T0, 14.48 ± 1.48 cm(3) at T1 and 13.06 ± 1.39 cm(3) at T2. Mean volume retraction resulted in 1.76 ± 0.34 cm(3) ΔV1 (T0-T1) and 1.42 ± 0.4 cm(3) ΔV2 (T1-T2) and was 10.83 % of the initial total volume at (T0-T1) and 9.8 % of the total volume (T1-T2).

Conclusion: The present retrospective investigation demonstrated a 20.63 % decrease in graft volume. Volumetric 3D assessment of CBCT scans with the selected software appeared to be a promising approach to quantifying long-term changes in the grafted area.
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http://dx.doi.org/10.1007/s12663-014-0736-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4511887PMC
September 2015

Horizontal and vertical reconstruction of the severely resorbed maxillary jaw using subantral augmentation and a novel tenting technique with bone from the lateral buccal wall.

J Maxillofac Oral Surg 2015 Jun 28;14(2):263-70. Epub 2014 Jun 28.

Oral and Maxillofacial Surgery Department, School of Dentistry, Lebanese University, P.O. BOX: 5208-116, Beirut, Lebanon.

Aim: The aim of this study was to evaluate the effect of using the lateral wall bone in sinus lifting two-dimensional reconstruction on bone augmentation.

Patients And Methods: Ten patients affected by class V or VI maxillary atrophy with less than 3 mm of residual horizontal ridge were selected. Using a piezo-ultrasonic surgery tip bony lateral wall was cut. To expose native bone to the bone graft, multiple perforations, made through the cortical plate of the recipient site with a round bur. Once the bony buccal wall was adjusted it was fixed away from the ridge with two 1.5 x 13 mm bone fixation screws. Deficiencies created between the bony buccal wall and the ridge was filled with a mineralized cortical bone. A pericardium membrane was then placed on the graft. A biopsy for histologic evaluation was made.

Results: The data analysis in bone volume changes reported significant differences between the anterior and posterior locations before and after grafting (p < 0.05). The biopsy shows mature cancellous bone with predominantly lamellar structure.

Conclusion: The use of the lateral wall bone in sinus lift surgery showed significant increase in bone volume.
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http://dx.doi.org/10.1007/s12663-014-0635-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4444692PMC
June 2015

Epidemiology of Oropharyngeal Candidiasis in Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome Patients and CD4+ Counts.

J Int Oral Health 2015 Mar;7(3):20-3

Assistant Professor, Department of Pathology and Diagnosis Science, School of Dentistry, Lebanese University, Beirut, Lebanon.

Background: The present study was directed to evaluate the forms of oropharyngeal candidiasis (OPC) and their correlation with CD4+ cell counts in human immunodeficiency virus (HIV) patients.

Materials And Methods: This was a descriptive and analytical cross-sectional study carried out for a 2-year period, in which quantitative data collection methods were used. 50 patients with HIV infection were evaluated. Relationship between OPC and CD4+ was investigated.

Results: Five different clinical forms were noticed on examination: pseudomembranous candidiasis 20/38 (P) was the most common one (52.6%) followed by erythematous 5/38 (13.15%), angular cheilitis 5/38 (13.15%) (AC), a combination of AC and E 4/38 (10.52%) or AC, E and P 4/38 (10.52%). Candida albicans was the most frequent specie isolated in 35 cases of OPC (92%). Candida tropicalis was isolated in 2 cases (5.26%) and Candida glabrata in 1 case (2.64%). The majority of patients with OPC had cell counts 28/38 (73%) <200 cells/mm(3), followed by 9/38 (23%) at CD4+ cell counts of 201-499 cells/mm(3).

Conclusion: Oral Candida colonization and invasive infection occur more frequently in HIV-positive patient and is significantly more common in patients with CD4+ cell counts <200 cell/mm(3).
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4385720PMC
March 2015

Epidemiology and Relationships between CD4+ Counts and Oral Lesions among 50 Patients Infected with Human Immunodeficiency Virus.

J Int Oral Health 2015 Jan;7(1):18-21

Lecturer, Director Postgraduate Program of Oral Pathology, Departments of Oral and Maxillofacial Surgery and Pathology and Diagnosis Science, School of Dentistry, Lebanese University, Beirut, Lebanon.

Background: The aim of this study was to evaluate the clinical lesions of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome patients in the oral cavity, head and neck region and to determine their associations with level of immune suppression as measured by the CD4+ count.

Materials And Methods: In a descriptive cross-sectional study, 50 patients with a proven HIV infection were evaluated. Based on the clinical findings and CD4+ counts, the relationships between oral lesions and CD4+ cell count were investigated.

Results: The CD4+ count (cells/mm(3)) was <200, 200-500, and >500 in 32 cases (64%), 16 cases (32%) and 2 cases (4%) respectively, and the mean CD4+ count was 169.82 cells/mm(3) in males and 142.8 cells/mm(3) in females. All patients showed at least one oral manifestation. The most common oral lesion identified was pseudomembranous candidiasis accounting for 76% (38/50) followed by periodontal disease 34% (17/50), herpetic lesions and hairy leukoplakia 10% for each (5/50), gingivitis 8% (4/50), oral ulceration 8% (4/50), Kaposi's sarcoma 6% (3/50), and Non-Hodgkin lymphoma 2% (1/50).

Conclusion: The CD4+ count was decreasing the presence, and the severity of oral lesions was increasing in this study. The presence of oral lesions may lead to a positive diagnostic of HIV. Disease progression is characterized by increased prevalence of some oral lesions as candidiasis, hairy leukoplakia, and Kaposi sarcoma. The severity of oral lesions was more pronounced with a CD4+ count <200 cells/mm(3).
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336654PMC
January 2015