Publications

BACKGROUND: Colorectal adenocarcinoma (CRC) remains a leading cause of cancer-related mortality worldwide, with variable patient outcomes despite treatment advances. Traditional prognostic methods based on clinicopathological variables alone do not fully capture the biological complexity of the disease. This study aims to develop a risk scoring system based on genes associated with tumour-infiltrating immune cells (TIIC-associated genes) to improve prognostic assessment in CRC.

METHODS: RNA-seq gene expression and clinicopathological data from The Cancer Genome Atlas Colorectal Adenocarcinoma (TCGA-CRC) database (647 tumour samples, 51 normal tissues) were analysed to identify differentially expressed TIIC-associated genes through comparison with the CIBERSORTx database. Univariate and multivariate Cox analyses were performed to screen for prognostic markers. A Gaussian mixture model was applied to cluster prognostic models and select the model with the most robust gene combination. The resulting risk scoring system was validated in an external cohort (GSE39582) and integrated with clinicopathological variables to develop a prognostic nomogram.

RESULTS: From 128 TIIC-associated genes, an optimal prognostic model comprising CCL8 and Tyrosinase (TYR) was identified. The risk score was calculated as 0.152 × Exp(CCL8)-0.516 × Exp(TYR). Kaplan-Meier analysis confirmed significant survival differences between high-risk and low-risk groups in both TCGA-CRC and GSE39582 (p < 0.05). Time-dependent receiver operating characteristic analysis showed area under the curve (AUC) values ranging from 0.605 to 0.696 for 1-, 3- and 5-year survival in TCGA-CRC and GSE39582. Multivariate Cox analysis identified tumour (T stage), node (N stage) and risk score as independent prognostic factors.

CONCLUSION: Our risk scoring system based on CCL8 and TYR effectively stratifies CRC patients into distinct prognostic groups and could guide treatment decisions, particularly when integrated with TNM staging in a nomogram.

Cirrhosis is the fourteenth leading cause of death globally and significantly increases the risk of hepatocellular carcinoma (HCC). Polymorphisms in the vitamin D receptor (VDR) can influence inflammation, fibrosis progression and cancer susceptibility. We analysed the association of genetic polymorphisms of the VDR (VDR-rs2228570, VDR-rs731236 and VDR-rs7975232) in cirrhosis with or without HCC, considering clinical, biochemical profiles and survival. A total of 158 patients with cirrhosis, with or without HCC, were studied and distributed into Group 1 (G1 = 60): cirrhosis and HCC; Group 2 (G2 = 98): isolated cirrhosis and control group (G3 = 225): without liver disease. Genetic polymorphisms were analysed by real-time polymerase chain reaction; clinical and biochemical profiles were obtained from medical records. A significance level of α = 5% was adopted. The homozygous mutant for VDR-rs731236 and rs7975232 predominated in G1 compared to other groups (p < 0.05). For VDR-rs2228570, the homozygous mutant predominated in patients, while heterozygotes were found in controls (p > 0.05). A positive correlation between vitamin D and parathyroid hormone was observed in patients (R² = 0.3273). VDR-rs2228570 emerged as a protective factor for G2 (p = 0.0057) and was associated with increased survival, as was rs7975232. In conclusion, VDR-rs731236 and VDR-rs7975232 are associated with cirrhosis and HCC, with VDR-rs7975232 identified as independent predictors for isolated cirrhosis. VDR-rs2228570 confers protection and is associated with increased survival in cirrhosis, as well as a better clinical profile for both conditions in the Brazilian cohort. These findings highlight the potential clinical relevance of VDR polymorphisms as biomarkers for risk assessment and prognosis in cirrhosis and HCC.

BACKGROUND: Cervical cancer remains a significant public health issue, particularly in low-income countries. It is the fourth most common cancer among women globally, with an estimated 570,000 new cases and 311,000 deaths in 2018.

OBJECTIVE: This study aimed to examine the stages of cervical cancer at diagnosis and identify factors contributing to late-stage presentation among women in a tertiary care hospital in Nigeria.

METHODS: A retrospective study analysed data from women diagnosed with cervical cancer between 2017 and 2021. Demographic, reproductive and clinical data were extracted from medical records.

RESULTS: Of the 102 women who presented during the study period, only 57 (55.9%) had complete staging, clinical and demographic data; these complete cases were included to ensure data integrity. From this population, 73.7% were aged 50 years or older and 56.1% presented with late-stage disease. Additionally, anaemia (packed cell volume <30%) was present in 75.4% of women. Postcoital bleeding was reported in 35.1% of cases. Women with no formal education had higher odds of late-stage diagnosis odds ratios (OR: 4.40, 95% CI: 1.08-17.82). Postmenopausal women also had higher odds of late-stage diagnosis (OR: 4.46, 95% CI: 1.27-15.70).

CONCLUSION: A late-stage cervical cancer diagnosis is prevalent among women in Nigeria, particularly among those with lower educational levels and postmenopausal women. Targeted awareness programmes, expanded screening (including integration into well-woman/postmenopausal care) and improved healthcare infrastructure, including consistent documentation of screening history and human papillomavirus vaccination, are essential for reducing the burden of cervical cancer in this context.

Multiple myeloma (MM) represents a significant global health challenge, with its incidence and mortality rates steadily increasing over recent decades. This review critically examines the current landscape of MM management, with a specific focus on resource-limited settings, where the disparities in diagnostic capabilities and treatment options are most pronounced. A comprehensive literature search was performed using multiple databases, encompassing peer-reviewed articles, clinical guidelines and conference abstracts from 2010 to 2024. Our analysis delineates the stark differences between therapeutic approaches in high-income versus low- and middle-income countries (LMICs). In high-income settings, the standard of care involves advanced induction regimens, autologous stem cell transplantation and maintenance therapy with novel agents, which collectively have contributed to improved patient outcomes. Conversely, LMICs often rely on more affordable yet less effective treatments, such as bortezomib- or thalidomide-based regimens, largely due to limited access to advanced diagnostics and high-cost therapies. Key challenges identified include late presentation, inadequate diagnostic infrastructure, economic constraints and a paucity of trained healthcare personnel. To address these issues, we propose a multifaceted strategy that emphasises the enhancement of diagnostic capacity, the adaptation of resource-stratified treatment guidelines and the strengthening of healthcare systems through targeted policy interventions and international collaborations. By bridging the gap between evidence-based MM care and the practical realities of under-resourced healthcare systems, this review aims to inform future clinical practice and policy, ultimately improving survival outcomes and reducing global health inequities in MM management.

AIM OF STUDY: This study aimed to histologically evaluate and compare the bone regenerative potential of two grafting materials, demineralized bone matrix (DBM) putty and nanocrystalline hydroxyapatite (ncHA) putty, applied to surgically created intrabony defects in a rat's model, in conjunction with the decortication technique.

MATERIALS AND METHODS: Thirty rats were included. A surgical bone defect measuring W × L × D; 2 × 2 × 1.5 mm with decortication was prepared by small round bur, and the rats were randomly divided into three groups (10 rats each), group I (control): Defect induction and decortication, group II: Defect induction and decortication then, ncHA putty insertion, group III: Defect induction and decortication then DBM allograft putty insertion. Five rats from each group were euthanized at 2 and 4 weeks, respectively. Maxilla excised for histological processing and evaluation using H&E stains to assess the percentage area of newly formed bone. Data were statistically analyzed by one-way ANOVA and post hoc test.

RESULTS: The mean ± SD values at 2 and at 4 weeks were (1.05 ± 0.07, 1.25 ± 0.04) for groups I, group II (8.14 ± 0.16, 15.94 ± 0.21), and group III (8.20 ± 0.25, 13.40 ± 0.55), respectively. Both experimental groups showed significantly greater bone formation than the control at both intervals (p < 0.001). At 4 weeks, group II (ncHA) recorded higher bone regeneration compared to group III DBM (p < 0.001), while the control group showed only a slight increase.

CONCLUSION: Both DBM and ncHA putties enhanced bone regeneration, with ncHA showing superior performance at 4 weeks.

CLINICAL SIGNIFICANCE: Intrabony defects are a clinical challenge, and selecting an effective graft material is crucial for achieving predictable periodontal regeneration. How to cite this article: Dao AM, Abdulrahman M, Mira ES, et al. Histological Comparison of Bone Regeneration Using Two Putty Bone Grafts in Surgically Created Intrabony Defect in Rats with Intramarrow Penetration. J Contemp Dent Pract 2025;26(10):938-944.

AIM: The presence of microbial contaminants in the dental unit waterline poses a potential risk for both patients and healthcare personnel. This study aimed to conduct a qualitative and quantitative assessment of the microflora in the dental unit waterline of dental clinics in Mangaluru city.

METHODS: Water samples were collected from a total of 16 private dental clinics across Mangaluru. For the quantitative assessment, bacterial counts were determined using standard culture media, and the automated identification of the isolated bacterial species was done for qualitative assessment. Following the standards proposed by the United States Centers for Disease Control and Prevention (CDC) and the American Dental Association (ADA), grading was done as a bacterial count below 500 CFU/mL was classified as unsatisfactory. The data was recorded, and statistical analysis was performed on the same.

RESULTS: The bacterial counts were found to range between 37 CFU/mL and 690 CFU/mL. The majority of isolated microorganisms included Bacillus species, Pseudomonas species, and non-fermenting Gram-negative bacilli. Although most tested samples had bacterial counts within acceptable limits, the various isolated bacterial species emphasized their ability to cause potential health hazards even at lower concentrations.

CONCLUSION: The findings of this study indicate that there were no major microbial contaminants in the dental unit waterline of dental clinics in Mangaluru. However, the presence of varied microorganisms, even though in low concentrations, raises the threat of potential contamination.

CLINICAL SIGNIFICANCE: This study indicates that the presence of fewer, yet varied concentrations of microbes can still pose the threat of contamination, and hence it underscores the need for regular supervision and disinfection of the dental unit waterlines in routine clinical practice. How to cite this article: Mense U, Shetty MK, Shetty K, et al. Qualitative and Quantitative Evaluation of the Microflora in Dental Unit Waterline of Dental Clinics in Mangaluru: A Cross-sectional Study. J Contemp Dent Pract 2025;26(10):1001-1005.

AIMS: To assess the effect of dental application of oral probiotics containing Streptococcus salivarius K12 and Lactobacillus brevis CD2 on preventing secondary bacterial pneumonia in patients with severe COVID-19.

MATERIALS AND METHODS: In this randomized, placebo-controlled trial, 60 patients with severe COVID-19 were randomly assigned to receive a 7-day course of oral gel containing S. salivarius K12 (2 billion colony-forming units) and L. brevis CD2 (4 billion colony-forming units) every 8 hours, or placebo, starting on the first intensive care unit (ICU) day. Gel applications were performed by a dentist. The primary outcome was bacterial pneumonia, whereas the secondary outcomes were survival and the 14-day illness-severity status.

RESULTS: Fifty patients completed the 7-day experiment. In which, 26 patients received probiotics (mean age: 58.7 years old, 81% men) and 24 patients received a placebo (60.5 years old, 71% men). The incidence of secondary bacterial pneumonia was 35% for probiotics and 54% for placebo [relative risk: 0.64 (95% CI: 0.34-1.22)]. Compared with placebo, patients treated with probiotics showed similar rates of ICU death [hazard ratio: 1.37 (95% CI: 0.56-3.35)]. The 14-day illness-severity status did not differ between groups.

CONCLUSION: In this phase II trial of patients with severe COVID-19, oral probiotics containing S. salivarius K12 and L. brevis CD2 did not prevent secondary bacterial pneumonia.

CLINICAL SIGNIFICANCE: Intensive care unit patients with COVID-19 are prone to secondary bacterial pneumonia. Probiotics against oral pathogens might prevent lung colonization and avoid pneumonia. How to cite this article: Lauxen JR, Callegari-Jacques SM, Mombelli AS, et al. Oral Probiotic Containing Streptococcus salivarius K12 and Lactobacillus brevis CD2 for Preventing Bacterial Pneumonia in Severe COVID-19: Randomized Clinical Trial. J Contemp Dent Pract 2025;26(10):931-937.

BACKGROUND: This study's objective was to measure the root canal curvature of the mandibular molars distal root using three distinct methods based on periapical radiography evaluation.

MATERIALS AND METHODS: Teeth from the oral and maxillofacial surgery (OMFS) department that were extracted due to a poor prognosis because of dental caries and severe periodontal disease were collected. Six hundred human mandibular molars were used in this study. Curvature angles of the distal root were measured using three different methods, Schneider's, Weine, and long (LA) axis techniques, in the mesiodistal (MD) and buccolingual (BL) dimensions using periapical x-ray, and the results were digitalized on a computer and statistically compared. Analysis of variance (ANOVA) demonstrated that the curvature angle values calculated with each method differed significantly (p < 0.001).

RESULTS: Comparison of curvature angle values in MD dimensions by using Schneider's technique were 15.24° (±13.07), in Weine's technique were 21.15° (± 20.05), and in the LA axis technique were 27.76° (±27.76). Mean curvature angle values using BL dimensions in Schneider's technique were 11.01° (±6.66), in Weine's technique were 16.24° (±10.81), and in the LA axis technique were 14.40° (±11.71). Significant differences were found in mean curvature angle values using MD and BL measurements across techniques.

CONCLUSION: Long axis technique recorded the highest mean curvature angle in MD dimensions, followed by Weine's and Schneider's. The highest mean curvature angle values using the BL dimension were recorded by Weine's technique. All differences were statistically significant (p < 0.001).

CLINICAL SIGNIFICANCE: The knowledge of root canal curvature is crucial regarding the prevention of ledge formation, root perforation, and the possibility of endodontic instruments fracture during endodontic treatments. Failing to realize the curvature of the canal before treatment can leave the canal unprepared and compromise the outcome of the treatment. Therefore, a quantification method of the root canal curvature, as well as the applicability of these methods, is necessary. How to cite this article: Singh T, Bathla S, Gurtu A, et al. Comparative Analysis of Root Canal Curvature Measurement Methods for Permanent Mandibular Molars Distal Root: An Observational Study. J Contemp Dent Pract 2025;26(10):945-949.

AIM: The present study aimed to evaluate the root and canal anatomy of mandibular (MAND) second premolars in a southern Saudi population using high-resolution cone-beam computed tomography (CBCT) imaging and the recent coding system.

MATERIALS AND METHODS: A total of 856 MAND second premolars from 614 CBCT scans were retrospectively analyzed. These scans were evaluated in axial, coronal, and sagittal planes. Then, the MAND second premolars were classified according to root number and canal configuration using the coding system developed by Ahmed and Dummer. Statistical analyses were conducted to assess associations among canal anatomy, gender, and age. A p-value < 0.05 was considered statistically significant.

RESULTS: The majority of MAND second premolars exhibited the single-root with a single canal (1TN1) configuration, which was observed in 834 (97.43%) of the sample. Moreover, most teeth (847, 98.95%) had a single root, and two-rooted (8, 0.93%) and three-rooted (1, 0.12%) cases were rare. No statistically significant differences were found between males and females or among different age-groups (p > 0.05), although the 30-40 age-group exhibited the largest anatomical variation.

CONCLUSION: The present CBCT-based study concluded that the 1TN1 canal configuration is the most prevalent in MAND second premolars. While the most predominant is a single root with a single canal, the study also confirms the existence of complex anatomical variations. Gender and age-group did not have a statistically significant impact on root canal anatomy.

CLINICAL SIGNIFICANCE: Accurate knowledge of MAND second premolar morphology is essential for successful endodontics. Population-specific data and CBCT with a recent coding system enhance diagnosis and support better clinical outcomes. How to cite this article: Alelyani AA. Root Canal Morphology of Mandibular Second Premolars in a Saudi Population: Cone-beam Computed Tomography Analysis with a Recent Coding System. J Contemp Dent Pract 2025;26(10):970-976.

AIM: The study aimed to compare the design of reduced extended denture bases (RIOD) with that of fully extended denture bases for implant overdentures (FIODs).

MATERIALS AND METHODS: A within-subject study design was carried out, involving 20 completely edentulous participants aged from 50 to 70 years who received newly constructed complete dentures. Four parallel implants were installed in the interforaminal region according to a guided surgical and delayed loading protocol. Each participant was provided with an implant overdenture (IOD) retained by a bar attachment and two different overdenture designs: Firstly, an FIOD, then an RIOD. Each participant wore each type of overdenture for a period of 3 months prior to evaluation. The following outcome measures were evaluated: Patient satisfaction, oral health-related quality of life (OHRQoL), and chewing efficiency. Comparison of outcome scores between the two occasions was done using paired sample t-tests and Wilcoxon signed-rank tests, with significance set at p < 0.05.

RESULTS: The RIOD design exhibited significantly higher scores in certain domains of patient satisfaction, such as comfort, function, and overall satisfaction compared to the FIOD design. However, the OHRQoL scores were significantly lower (a higher quality of life) for the RIOD design in all domains, including functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap. Additionally, the RIOD design exhibited significantly higher chewing efficiency compared to the FIOD design (p < 0.05).

CONCLUSION: The RIOD design may be a more favorable option in cases where mandibular implant-supported overdentures are indicated, providing a better balance of comfort and function compared to FIOD.

CLINICAL SIGNIFICANCE: Clinicians should carefully consider the advantages of reduced extensions when designing mandibular implant-supported overdentures, as this may be a more beneficial choice for patients in terms of improving their overall experience and functional performance. How to cite this article: Ibrahim AM, Alokda MM, Elgamal M. Patient Satisfaction, Oral Health-related Quality of Life, and Masticatory Efficiency of Bar-retained Implant-supported Mandibular Overdentures with Reduced Denture Base Extensions. J Contemp Dent Pract 2025;26(10):988-995.