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A case of dengue-related osteonecrosis of the maxillary dentoalveolar bone

Al-Namnam NM, Nambiar P, Shanmuhasuntharam P, Harris M

Aust Dent J, 2017 Jun;62(2):228-232.
PMID: 27743399 DOI: 10.1111/adj.12472

Dengue is a mosquito transmitted flaviviral infection which can give rise to severe haemorrhage (dengue haemorrhagic fever) and with capillary leakage induces hypovolaemic shock (dengue shock syndrome). Although dengue symptoms and complications have been known for many decades, there has only been one documented case of osteonecrosis of the maxilla which was treated by excision of the necrotic bone. In this case of dengue infection, extensive maxillary osteonecrosis and minimal root resorption appeared to follow factitious injury with a toothpick but resolved with non-surgical management.
Fulltext Crouzon syndrome: Genetic and intervention review

Al-Namnam NM, Hariri F, Thong MK, Rahman ZA

J Oral Biol Craniofac Res, 2018 08 29;9(1):37-39.
PMID: 30202723 DOI: 10.1016/j.jobcr.2018.08.007

Crouzon syndrome exhibits considerable phenotypic heterogeneity, in the aetiology of which genetics play an important role. FGFR2 mediates extracellular signals into cells and the mutations in the FGFR2 gene cause this syndrome occurrence. Activated FGFs/FGFR2 signaling disrupts the balance of differentiation, cell proliferation, and apoptosis via its downstream signal pathways. However, very little is known about the cellular and molecular factors leading to severity of this phenotype. Revealing the molecular pathology of craniosynostosis will be a great value for genetic counselling, diagnosis, prognosis and early intervention programs. This mini-review summarizes the fundamental and recent scientific literature on genetic disorder of Crouzon syndrome and presents a graduated strategy for the genetic approach, diagnosis and the management of this complex craniofacial defect.
Is there an optimal initial amount of activation for midpalatal suture expansion? : A histomorphometric and immunohistochemical study in a rabbit model

Alyessary AS, Yap AU, Othman SA, Rahman MT, Al-Namnam NM, Radzi Z

J Orofac Orthop, 2018 May;79(3):169-179.
PMID: 29644389 DOI: 10.1007/s00056-018-0134-4

OBJECTIVE: Accelerated bone-borne expansion protocols on sutural separation and sutural bone formation were evaluated via histomorphometry and immunohistochemistry to determine the optimal initial activation without disruption of bone formation.
MATERIALS AND METHODS: Sixteen New Zealand white rabbits were randomly divided into four groups. Modified Hyrax expanders were placed across the midsagittal sutures and secured with miniscrew implants with the following activations: group 1 (control), 0.5 mm expansion/day for 12 days; group 2, 1 mm instant expansion followed by 0.5 mm expansion/day for 10 days; group 3, 2.5 mm instant expansion followed by 0.5 mm expansion/day for 7 days; and group 4, 4 mm instant expansion followed by 0.5 mm expansion/day for 4 days. After 6 weeks, sutural expansion and new bone formation were evaluated histomorphometrically. Statistical analysis was performed using Kruskal-Wallis/Mann-Whitney U tests and Spearman's rho correlation (p 
Fulltext Synthetic Material for Bone, Periodontal, and Dental Tissue Regeneration: Where Are We Now, and Where Are We Heading Next?

Cheah CW, Al-Namnam NM, Lau MN, Lim GS, Raman R, Fairbairn P, et al.

Materials (Basel), 2021 Oct 15;14(20).
PMID: 34683712 DOI: 10.3390/ma14206123

Alloplasts are synthetic, inorganic, biocompatible bone substitutes that function as defect fillers to repair skeletal defects. The acceptance of these substitutes by host tissues is determined by the pore diameter and the porosity and inter-connectivity. This narrative review appraises recent developments, characterization, and biological performance of different synthetic materials for bone, periodontal, and dental tissue regeneration. They include calcium phosphate cements and their variants β-tricalcium phosphate (β-TCP) ceramics and biphasic calcium phosphates (hydroxyapatite (HA) and β-TCP ceramics), calcium sulfate, bioactive glasses and polymer-based bone substitutes which include variants of polycaprolactone. In summary, the search for synthetic bone substitutes remains elusive with calcium compounds providing the best synthetic substitute. The combination of calcium sulphate and β-TCP provides improved handling of the materials, dispensing with the need for a traditional membrane in guided bone regeneration. Evidence is supportive of improved angiogenesis at the recipient sites. One such product, (EthOss® Regeneration, Silesden, UK) has won numerous awards internationally as a commercial success. Bioglasses and polymers, which have been used as medical devices, are still in the experimental stage for dental application. Polycaprolactone-TCP, one of the products in this category is currently undergoing further randomized clinical trials as a 3D socket preservation filler. These aforementioned products may have vast potential for substituting human/animal-based bone grafts.
Insights and future directions of potential genetic therapy for Apert syndrome: A systematic review

Al-Namnam NM, Jayash SN, Hariri F, Rahman ZAA, Alshawsh MA

Gene Ther, 2021 Nov;28(10-11):620-633.
PMID: 33619359 DOI: 10.1038/s41434-021-00238-w

Apert syndrome is a genetic disorder characterised by craniosynostosis and structural discrepancy of the craniofacial region as well as the hands and feet. This condition is closely linked with fibroblast growth factor receptor-2 (FGFR2) gene mutations. Gene therapies are progressively being tested in advanced clinical trials, leading to a rise of its potential clinical indications. In recent years, research has made great progress in the gene therapy of craniosynostosis syndromes and several studies have investigated its influences in preventing/diminishing the complications of Apert syndrome. This article reviewed and exhibited different techniques of gene therapy and their influences in Apert syndrome progression. A systematic search was executed using electronic bibliographic databases including PubMed, EMBASE, ScienceDirect, SciFinder and Web of Science for all studies of gene therapy for Apert syndrome. The primary outcomes measurements vary from protein to gene expressions. According to the findings of included studies, we conclude that the gene therapy using FGF in Apert syndrome was critical in the regulation of suture fusion and patency, occurred via alterations in cellular proliferation. The superior outcome could be brought by biological therapies targeting the FGF/FGFR signalling. More studies in molecular genetics in Apert syndrome are recommended. This study reviews the current literature and provides insights to future possibilities of genetic therapy as intervention in Apert syndrome.
An injectable poly(caprolactone trifumarate-gelatin microparticles) (PCLTF-GMPs) scaffold for irregular bone defects: Physical and mechanical characteristics

Al-Namnam NM, Kutty MG, Chai WL, Ha KO, Kim KH, Siar CH, et al.

Mater Sci Eng C Mater Biol Appl, 2017 Mar 01;72:332-340.
PMID: 28024594 DOI: 10.1016/j.msec.2016.11.086

Recently, a modified form of a three-dimension (3D) porous poly(caprolactone-trifumarate) (PCLTF) scaffold has been produced using a fabrication technique that involves gelatin microparticles porogen leaching. This poly(caprolactone trifumarate-gelatin microparticles) (PCLTF-GMPs) scaffold has been shown to be biocompatible, more flowable clinically, and has a shorter degradation time as compared to its existing predecessors. In this report, a detailed characterization of this new scaffold was performed by testing its cytocompatibility, analyzing the surface topography, and understanding its thermal, physical and mechanical properties. The result showed that the PCLTF-GMPs has no critical cytotoxic effect. To confirm improvement, the surface properties were compared against the older version of PCLTF fabricated using salt porogen leaching. This PCLTF-GMPs scaffold showed no significant difference (unpaired t-test; p>0.05) in mechanical properties before and after gelatin leaching. However, it is mechanically weaker when compared to its predecessors. It has a high biodegradability rate of 16weeks. The pore size produced ranges from 40 to 300μm, and the RMS roughness is 613.7±236.9nm. These characteristics are condusive for osteoblast in-growth, as observed by the extension of filopodia across the macropores. Overall, this newly produced material has good thermal, physical and mechanical properties that complements its biocompatibility and ease of use.