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Abstract : The usage of Connective Tissue Graft (CTG) with Coronally Advanced Flap (CAF) is considered the golden standard for coverage of peri-implant mucosal recessions. As this procedure leaves a second surgical site for the patient and healing may be impaired, it is desired to lower patient morbidity and at the same time shorten the healing phase. Various soft tissue substitutes were evaluated in the past to replace autogenous tissue. In order to replace the harvesting of autogenous tissue, new porcine, porous, resorbable and volume stable collagen matrix were developed allowing for soft tissue volume augmentation. The aim of the present study is to compare the peri-implant soft-tissue recession coverage and esthetic outcomes of two different approaches: xenogeneic collagen matrix (Geistlich Fibro-Gide®) and subepithelial connective tissue graft using the coronal advancement flap for the treatment of soft tissue recession. This study is prospective randomized clinical trial to evaluate treatment of peri-implant soft-tissue recession using subepithelial connective tissue graft and coronal flap advancement compare to xenogeneic collagen matrix (Geistlich Fibro-Gide®) for augmentation soft tissue and recession coverage on implants. Split mouth design is considered, one of the side is control and the other side is case in the same patient. The Study contains 15 patients with bilateral soft tissue recession peri-implant ≥2mm in one implant at least in upper or lower jaw. Therefore 30 affected sites will be treated. The depth of recession and the thickness of Mucosa were evaluated at baseline (T0), and at 3 months, while the width of the mucosa evaluated at baseline (T0), 2weeks (T1), month(T2), 3 months(T3) Pain assessd using Visual Analuge Scale (VAS) with 3 points representing 0(No Pain), 50 (Moderate Pain), 100 (pain as bad as it could possible be/ Severe Pain). Postoperative pain using VAS scores were significantly higher in SCTG group then XCM group. There was Statistically significant difference in recession depth, Mucosa width and Thickness after 3 months. VAS scores for postoperative pain were significantly higher in SCTG group then XCM group. In terms of Surgical time (period from the first incision to the end of procedure), it was statically significant lower in the experimental group for about 15 minutes. The usage of XCM combined with Coronally Advance flap, is a reasonable alternative to CTG for coverage of peri implants mucosal recessions.

Abstract : Bipolar disorder is a disorder characterized by manic and depressive episodes. Bipolar disorder can interfere with social and occupational functioning as well as a person's quality of life. These findings highlight the importance of clinicians recognizing environmental risk factors such as childhood trauma that contribute to bipolar disorder. Bullying is a childhood trauma that can affect a child's mental condition. Both bullies and victims of bullying were found to be at increased risk of non-suicidal self-injury (NSSI) behavior. A female patient, 14 years old was taken to the Udayana University Hospital emergency room because the patient did cutting to her hands. The patient said it was because she felt lonely at home and uncomfortable at school, the patient had just broken up with her boyfriend and was teased by her classmates. The patient hears a voice in her ear and sees scary images, and she got insomnia and hypobulia. The patient was diagnosed with Bipolar Affective Disorder, Current episode Severe depression with Psychotic Symptoms (F31.5), and received medical therapy in the form of Valproate Acid 125 milligrams every 24 hours intraoral in the morning, Risperidone 1 milligram every 24 hours intraoral at night and Lorazepam 0.5 milligrams every 24 hours intraoral at night and non-medical therapy supportive psychotherapy, CBT, family therapy, and family psychoeducation.

Abstract : The gold standard for providing cancer care worldwide is the idea of multidisciplinary teams (MDTs). Objectives: To follow up and management of endometrial cancer treatment in affected women based on the MDT. This cross-sectional observational research involved a supplementary review of previously collected data on 186 women with endometrial carcinoma who had endometrial biopsies (endometrioid/non-endometrioid types) were included. Adjuvant treatment, including vaginal brachytherapy, external beam radiation, chemotherapy, and clinical follow-up (physical exams, imaging modalities and follow-up meetings) were administered individually at the discretion of an MDT group. The mean age of participants was 58.44±10.38 years. Most of them were Muslim (99.5%), Kurdish nationality (90.9%), housewives (76.3%), non-smokers (88.2%), and from rural areas (53.3%) with high BMI (31.64 kg/m2). Most cases of endometrial cancer were identified in (37.1%) 2019, followed by 2021 (21.5%), and then 2020 (14%). The results of the variable survey of the management and follow-up of the disease based on the MDTC showed a significant difference between both groups (p≤0.05). Using MDTC improved the management plan and diagnostic methods, decreased morbidity and increased survival. Also, MDTC guarantees full support to patients during the diagnosis, treatment, and follow-up periods to patients’ satisfaction.

Abstract : This study evaluated the danger zone (D.Z.) in mesial roots of mandibular molars and the correlation between the sex of the patient and the dentin thickness at the danger zone area. And evaluated anatomical references of the D.Z. and some anatomical landmarks, including tooth/root length, inter-canal orifices distance, and the influence of the age and sex of the patient on the dentin thickness at the danger zone area. A total of 301 randomly selected CBCTs were included in this cross-sectional study. Two experienced endodontists assessed the images. The MR length of each specimen was recorded from the cementoenamel junction of M.F.M.s to the apex, using CBCT axial planes, and categorized according to the length of teeth as follows: Short root (9-12mm), medium root (12.1-15 mm), long root (15.1-19mm). Then, the minimum dentin thickness of the distal wall of the ML and M.B. canal was evaluated in the axial view of the CBCT images in sections 3 mm below the furcation. Additionally, the distance between mesiobuccal (M.B.) and mesiolingual (ML) canal orifices of all specimens was recorded at the lowest level of the cementoenamel junction on the buccal aspect of the crown and calculated as the linear distance between the central axe of each orifice, in millimeters. The sample comprised 301 subjects, 118 males (39.2%) and 183 females (60.8%), distributed into five age groups. The Shapiro-Wilk (W) goodness-of-fit test showed non-significant deviation from normality for most of the sample in relation to sexes, so the data were analyzed using parametric tests. There was no significant correlation between root length and the danger zone; there was no significant difference in inter-orifice distance between males and females, but there was a significant difference between the age groups (p value= 0.000). The length of tooth/root and inter-orifice distance of mesial roots of mandibular molars might be predictive factors for the dentin thickness of the D.Z.

Abstract : To evaluate the effect of botulinum toxin type A (BTA) injection into five points in the safe zone of masseter muscle on the volume of mandibular angle and masseter muscle width. Thirteen volunteers received a single session of 25 units of BTA into the safe zone of each masseter muscle. Three-dimensional cone bean computed tomography (CBCT) was conducted before injection and after six months of the injection. Masseter muscle thickness and mandibular angle volume were evaluated. Cross sectional areas and masseter muscle volume were significantly reduced after six month of the injection with 9.8 % reduction in masseter muscle thickness. The mandibular angle volume was also significantly reduced. Single session of BTA injection into the safe zone of each masseter muscle is effective in reduction of masseter muscle width and mandibular angle volume.