Basic Informations

C.V

• graduated from faculty of oral and dental medicine, Mansoura university at 2002

• obtained a diplomat of oral surgery from Cairo university at 2008

• obtained a master degree of oral biology from Cairo university at 2012

• obtained a phd of oral biology from Ain Shams university at 2017

Master Title

Accuracy of electronic apex locator in relation to the condition of human dental pulp

Master Abstract

This study was performed to evaluate the accuracy of electronic root length determination (using i-ROOT apex locator) in relation to pulp pathosis compared with periapical radiograph. This study included 50 patients which are diagnosed for endodontic treatment for different reasons. Preoperative x-ray was performed to the patient to determine the presence of periapical radiolucency. Endodontic procedures was performed with root length determination by apex locator (i-Root) and another radiograph was taken while the file in place to verify the working length then the pulp was extirpated for histological and histochemical analysis. According to the x-ray and histological analysis, the pulps were classified into 5 groups (10 cases in each group): Group I of normal pulp, Group II of acute inflamed pulp, Group III of chronic inflamed pulp, Group IV of degenerated pulp and Group IV of degenerated pulp with periapical radiolucency. The x-ray films taken before and after root legth measurements were digitalized to the computer using HP scanjet G2710. Then measurement the distance between the file tip and radiographic apex was performed using Digora soft ware. The light microscopic examination of group I revealed that in the coronal pulp: The collagen fibers formed a fine network, the fibroblasts were scattered between them and the odontoblastic layer appeared as a continuous layer. In some cases the odontoblasts appeared as a discontinuous layer or detached from some areas due to tearing of this area by the file during pulp extirpation. While in the radicular pulp: the collagen fibers increased and tended to be organized into bundles and the odontoblastic layer became cuboidal and flattened. In the pulps extirpated from old age patients, the collagen fibbers tended to be organized into bundles also. The blood vessels of the pulp seemed to be within normal size, not filled with RBCs and its endothelial lining was intact not interrupted and chronic inflammatory cells were mildly distributed in the pulp while the acute inflammatory cells were nearly absent. The histochemical examination revealed that: presence of +ve PAS reaction for neutral mucopolysaccharide and –ve aclcianophilic reaction for acidic mucopolysaccharide in almost all of the pulp. The radiographic examination revealed that: the apex locator readings showed the same radiographic measurements in 4 cases. On the other hand, the readings were shorter than the radiographic measurements in 5 cases while in one case the reading was longer than the radiographic measurement The histological examination of the group II which was acutely inflamed revealed that the odontoblastic layer was disrupted in some areas and absent in most cases. The collagen fibers in this group were irregularly arranged and the connective tissue was aedemetous and some area of necrosis appeared in the connective tissue. In some cases the collagen fibers started to undergo degeneration and its fibroblast decreased in number. In the majority of the cases these blood vessels seemed to be dilated and filled with red blood cells. In some cases blood vessels endothelial lining were interrupted So, extravasated RBCs were present in the connective tissue while in other cases thrombus formation were found. The lymphocytes were infiltrated in all the pulp tissue. While eosinophils and neutrophils were present in all the pulp tissue or scattered between the chronic inflammatory cells. The histochemical examination revealed that: most of the dental pulp gave strong +ve aclcianophilic reaction for acidic mucopolysaccharide. In small areas in the pulp there were PAS +ve aclcianophilic reaction appeared as in the wall of blood vesseles. The radiographic examination revealed that: the apex locator readings showed the same radiographic measurements in 5 cases. On the other hand, the readings were shorter than the radiographic measurements in 3 cases while in 2 cases the readings were longer than the radiographic measurement. The histological examination of group III which was chronic inflamed revealed that the odontoblastic layer was disrupted in most cases. The blood vessels of the pulp seemed to be dilated and it had interrupted endothelial lining but it was not filled with red blood cells except in few cases while in a lot of cases there was enlarged blood vessels engorged with coagulated blood in addition to thrombus formation was present. The connective tissue in this group showed a lot of variation. The variety was starting from irregularity in the shape and orientation of collagen fibers, fibrosis of collagen fiber was formed, hyaline degeneration, Finally fatty degeneration of connective tissue. In addition: pulp stone may be found. In some cases the inflammatory cells were heavily infiltrated or moderate infiltrated in the pulp tissue. The histochemical examination revealed that: large areas of the dental pulp gave strong +ve aclcianophilic reaction for acidic mucopolysaccharide. In small areas in the pulp there was +ve PAS reaction for neutral mucopolysaccharide. In the coagulated blood there was PAS +ve aclcianophilic reaction. The radiographic examination revealed that: the apex locator readings showed the same radiographic measurements in 5 cases. On the other hand, the readings were shorter than the radiographic measurements in 4 cases while in one case the reading was longer than the radiographic measurement. The light microscopic examination of group IV revealed that the pulp consisted of degenerated connective tissue not surrounded by a layer of odontoblast. In some cases the collagen fiber formed a fine network but there was no fibroblast inside it in addition to presence of large areas of necrosis in the connective tissue. The blood vessels of the pulp were dilated, the endothelial lining was degenerated and it was filled with remnant of RBCs or thrombus formation. By higher magnification: in some cases hyaline degeneration involved all the pulp tissue, in other cases the connective tissue was completely necrotic in addition: all types of cells were absent except from scattered acute inflammatory cells which were seen in few number of cases . The histochemical examination revealed that: most of the dental pulp gave weak +ve aclcianophilic reaction for acidic mucopolysaccharides except in coagulated blood and necrosis areas that gave PAS +ve alcianophilic reaction. In few cases there was +ve PAS reaction for neutral mucopolysaccharide. The radiographic examination revealed that: The apex locator readings showed the same radiographic measurements in 7 cases. on the other hand, the readings were shorter than the radiographic measurements in one case while in 3 cases the reading were longer than the radiographic measurement In group V: the pulp was completely degenerated by liquefaction necrosis so there were no histological samples. While the radiographic examination revealed that: the apex locator readings showed the same radiographic measurements in one case. On the other hand, the readings were shorter than the radiographic measurements in 2 cases while in 7 cases the readings were longer than the radiographic measurement. From the previous result we concluded that: (1) Electronic root length determination is affected presence of pulp tissue in the canal. (2) Electronic root length determination is affected presence of periapical radiolucency. (3) 5th generation apex locator tends to give short reading compared with x- ray in case of presence of normal or inflamed pulp tissue in the canal. (4) 5th generation apex locator tends to give over reading compared with x- ray in case of presence of periapical radiolucency. (5) The most accurate reading of 5th generation apex locator is obtained in case of degenerated pulp without periapical radiolucency.

PHD Title

Effect of mesenchymal stem cells injection on induced stomatitis in chemotherapy treated rats

PHD Abstract

The goals of chemotherapy induced mucositis management are to prevent or reduce the severity of the drug toxicity and to manage the associated symptoms. Mucositis management allows the continued delivery of treatment without interruption or dose reduction leading to improvement of overall prognosis. But unfortunately there is no standard protocol that is used to completely cure or prevent oral mucositis. Nowadays stem cells are a subject of interest as a potentially revolutionary new way to treat diseases and injuries, with wide-ranging medical benefits as wound healing, ulcer treatment and management of side effects of chemotherapy. So, this study was evaluating the effect of intravenous injection of mesenchymal bone marrow stem cells on induced stomatitis in rats receiving chemotherapy. 56 male Wister rats weighting around 250 grams were used in the present study. Mesenchymal bone marrow stem cells (MBSCs) were purchased from biochemistry department in faculty of medicine Cairo University which was were labeled with PKH26 die. While 5-Fluorouracil was used as a chemotherapeutic drug. Rats were divided into 4 groups (3 experimental and 1 control): Group 1: Rats were exposed to stomatitis induction only, Group 2: Rats were injected with 5-FU and exposed to stomatitis induction , Group 3: Rats were injected with 5-FU and treated with stem cells at the same time then exposed to stomatitis induction, and Group 4: Rats were injected with 5-FU followed by stomatitis induction then treated with stem cells. Each group was subdivided into 2 subgroups according to the time of scarification as follow: Subgroup A: 1A, 2A, 3A and 4A (7 rats were sacrificed at day 8). Subgroup B: 1B, 2B, 3B, and 4B (7 rats were sacrificed at day 10). group 2, 3, and 4 were Intraperitoneally injected with 5-Fluorouracil (5-fu) at day 1 and 3. Then all the animals were subjected to scratching of buccal mucosa by a tip of needle at day 3, 4 and 5. Group 3 were injected with stem cells before stomatitis induction while group 4 was injected with stem cells after stomatitis induction. Clinical examination (including mucositis scoring system and body weight loss monitoring), Routine histological examination, Immunohistochemical profile using PCNA stain, Florescent microscope examination and analysis of all the data with SPSS software were performed to investigate the effect of stem cells in the treatment of stomatitis. By analyzing the statistical data of the OMS we found that, the descending order of the mean values of OMS for all groups was: subgroup 3A, followed by subgroup 2A, subgroup 3B, subgroup 4A, subgroup 2B, subgroup 4B, subgroup 1A and finally subgroup 1B. Comparison of the animal's weight at first and last day in each group revealed that in group 1, there was a high significant gain in the body weight at the end of the experiment. In contrast, group 3 showed a significant loss in the body weight at the end of the experiment followed by gr. 2 and finally gr. 4 which was the least group in weight loss. Florescent microscope examination of the specimens showed successful migration of stem cells to the buccal mucosa of group 3 and 4 at day 8 and 10 but it was noticed that stem cells aggregates were more numerous in subgroup A than subgroup B. Histological examination of the buccal mucosa of the animals revealed that, subgroup 1 was the superior in tissue regeneration at day 8 and day 10. On the other hand, subgroup 3A was the worst group in tissue healing followed by subgroup 2A and subgroup 4A at day 8. Finally at day 10 subgroup 4B showed better improvement than the other groups as ulcers were almost completely closed and the inflammatory cells markedly decreased. The Statistical results of immunohistochemical stain at day 10 revealed that, the mean values of PCNA stain of experimental groups (gr. 2B, 3B) only showed a significant decrease than that of the control group (gr. 1B) which indicated no improvement in these groups. While the experimental group 4B showed a non-significant decrease in mean value than that of the control group (gr. 1B) which indicated better improvement in this group than the other groups. From the present study we concluded that, intravenous injection of bone marrow mesenchymal stem cells after stomatitis induction in rats receiving F-florouracil chemotherapy leads to improvement of stomatitis score, accelerate healing of buccal mucosa and restore body weight loss after chemotherapy treatment. While intravenous injection of bone marrow mesenchymal stem cells before stomatitis induction has no role in prevention of chemotherapy induced stomatitis.