Ramy Mubarak

Background: Subcutaneous facial emphysema (SFE) is a rare but potentially serious complication of dental procedures involving pressurised air. While most historically reported cases were associated with air‐driven handpieces, more recent literature has also implicated air‐polishing systems. However, reports related to the use of subgingival air‐polishing nozzles in periodontal pockets remain limited. Case Presentation: The presented case demonstrates an SFE that occurred following the use of an air‐polishing system in a deep periodontal pocket. A glycine‐based air‐powder abrasion was used in a 5 mm deep periodontal pocket for biofilm eradication. After which, a periorbital and right cheek swelling arose. Hospitalisation was essential for close surveillance, and antibiotics were administered to control microbial spread. After 3 days, the patient was discharged in a stable condition and without any further complications. Conclusion: SFE may occur during subgingival air polishing, even during supportive periodontal therapy and at sites without bleeding on probing or suppuration. This case highlights that the safety of subgingival air‐polishing procedures should not be generalised across all devices and protocols. Careful case selection, strict adherence to device‐specific instructions, and early recognition of swelling and crepitus are essential for prompt diagnosis and management.

The urge to implement innovative approaches that align with eco-friendly practices and hold promise for enhancing oral health while promoting environmental sustainability has been increasing. This current work aims to develop a sustainable treatment for oral traumatic ulcers using licorice-based hydrogels (LHGs) containing hydroxyethyl cellulose (HEC) as the green gelling agent. Licorice root aqueous extract was phytochemically profiled using UPLC-ESI-MS/MS. Forty-three compounds were detected, with Glycyrrhizic acid being the major component of the extract (34.85 ± 2.77%). By implementing a Quality by Design (QbD) approach, the study investigates the effects of different licorice extract and HEC concentrations on key variables such as pH and viscosity of the prepared formulations, ulcer and wound healing scores, and tissue growth factors via a Full Factorial Experimental Design. The LHGs exhibited desirable consistency, spreadability, and clarity. Statistical analysis, employing an ANOVA test, revealed the high significance of the constructed models with the licorice concentration being the key independent factor affecting all dependent outputs. The pH as well as the viscosity of the prepared LHGs were positively influenced by licorice extract concentration, with higher concentrations leading to increased alkalinity and viscosity. Rheological behavior analysis revealed a pseudoplastic flow with demonstrated thixotropy which is advantageous for application and prolongation of residence time. The wound healing process was assessed through ulcer size, traumatic ulcer healing score (UHS), collagen-1 expression (COL-1), growth factors (EGF, VEGF), pro-inflammatory markers (TNF-α), wound healing score (WHS). LHGs prepared using higher levels of both factors, 30% dried licorice root extract and 4% HEC, demonstrated enhanced wound healing, elevated growth factor expression of 66.67% and 23.24%, respectively, and 88% reduced inflammation compared to the control group, indicating their potential in expediting oral ulcer recovery. Overall, these findings highlight the promising role of green licorice-based hydrogels in promoting sustainable oral mucosal healing.

Background: The innovation of leukocyte platelet-rich fibrin (L-PRF) has added enormous impact on wound healing dynamics especially the field of periodontal regeneration. The release of growth factors (GF) is thought to improve the clinical outcomes in infrabony defects. The aim of this study was to evaluate the clinical effect of covering L-PRF contained infrabony defects with collagen membranes (CM), and to compare their GF release profile to uncovered L-PRF defects and open flap debridement (OFD).Methods: Thirty non- smoking patients with infrabony pockets participated to be randomly assigned to OFD group (n = 10), L-PRF group (n = 10), or L-PRF protected CM group (n = 10). Plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL) and the radiographic defect base fill (DBF) were measured at baseline and at 6 month following surgical intervention. Gingival crevicular fluid samples were obtained on days 1, 3, 5, 7, 14, 21 and 30 days following surgery for the Platelet Derived Growth Factor-BB (PDGF-BB) and Vascular Endothelial Growth Factors (VEGF) release profile evaluation.Results: For all patients, a statistically significant (P ≤ 0.05) reduction in PI, GI, PD and CAL were reported throughout the study period. Differences between the three treatment modalities were not statistically significant. PRF + CM showed a statistically significant DBF compared to OFD and L-PRF groups at follow up. Quantitative analysis of PDGF-BB and VEGF levels demonstrated a statistically significant (P < 0.001) decline between measurement intervals for all groups with no statistically significant differences between the three groups.Conclusion: Within the limitations of this study, L-PRF coverage with CM may augment defect base fill through its mechanical protective effect without enhancement in the release profile of VEGF and PDGF. The non-significant intergroup differences question the validity of the claimed extra physiologic concentration of GF offered by L-PRF harvests.Trial registration: The present study was registered at ClinicalTrials.gov (NCT05496608), (11/08/2022).