Effect of Systemic Oxytocin Administration on New Bone Formation and Distraction Rate in Rabbit Mandible.

PURPOSE: The main disadvantage of distraction osteogenesis is the prolonged treatment protocol. Recently, oxytocin (OT) has been found to have anabolic effects on bone metabolism. In this experimental study, the effects of OT on the mandibular distraction gap in rabbits at 2 different distraction rates were evaluated. MATERIALS AND METHODS: This experimental study was conducted on 28 male New Zealand white rabbits. The animals were divided into 3 experimental groups and 1 control group. Group A (control group, n = 7) consisted of animals with distraction at a rate of 1 mm/day, and group B (n = 7) consisted of animals with a distraction rate of 2 mm/day; groups A and B received postoperative saline solution injection. Group C (n = 7) consisted of animals with distraction at a rate of 1 mm/day, and group D (n = 7) consisted of animals with a distraction rate of 2 mm/day; postoperative OT injection was performed in groups C and D. RESULTS: Both histomorphologic and micro-computed tomography evaluations showed increased bone healing in the OT-treated groups. CONCLUSIONS: On the basis of the evaluation of both the histomorphometric and micro-computed tomographic data, systemic OT administration was found to increase new bone formation and bone healing with distraction osteogenesis.

Clinical Performance of Zygomatic Implants-Retrospective Multicenter Study.

The main objective of this analysis was to evaluate (1) implant survival, (2) biologic complications, and (3) demographics associated with zygomatic implants placed according to the zygomatic anatomy-guided approach (ZAGA). This retrospective multicenter study reviewed data from the charts of 82 consecutive patients who had received 182 zygomatic implants. Patients were fully edentulous (62.2%), partially edentulous (22.0%), or had failing dentition (15.9%). Most patients (87.5%) did not have previous sinusitis and 11.3% had been previously treated for it. Additionally, about half of the patients (53.8%) did not present periodontal pathology, and one-third (36.3%) did, but were subsequently treated. Most implants (93.8%) were loaded immediately, i.e., within 48 h of placement. Implants were followed for 10.5 ± 7.2 months, and all were recorded as surviving and stable at last follow-up. Post-operative complications were infrequent and included sinusitis (10.1%) and peri-implant hyperplasia (0.8%). The low complication rate and 100% implant survival and stability indicate that zygomatic implants offer a viable treatment option when performing graftless restoration of severely resorbed maxilla, including immediate loading protocols.

Oral rehabilitation with implant-supported fixed dental prostheses of a patient with cleidocranial dysplasia.

This clinical report describes the oral rehabilitation with implant-supported fixed dental prostheses in the maxilla and mandible of a patient with cleidocranial dysplasia. Cone-beam computed tomography and a tilted implant protocol in the mandible helped to establish a conservative approach for bone preservation, prevent surgical complications, enable proper implant positioning to avoid anatomic structures, and support the fixed dental prostheses.

Effects of Local Low-Dose Alendronate Injections Into the Distraction Gap on New Bone Formation and Distraction Rate on Distraction Osteogenesis.

Bisphosphonates that constrain bone resorption have a direct effect on osteoclast function. In this experimental study, the effects of low-dose local alendronate injections on the distraction gap (DG) in rabbit mandible at 2 different rates were evaluated.The experimental study was conducted on 20 male, New Zealand white rabbits. The animals were divided into 3 experimental groups and 1 control group. Group 1 consisted of animals with distraction at the rate of 1 mm/day, receiving postoperative local low-dose alendronate local injections into the DG. Group 2 consisted of animals with distraction at the rate of 2 mm/day, receiving postoperative 0.75 µg/kg of alendronate local injections into the DG. Group 3 consisted of animals with distraction at the rate of 2 mm/day, receiving postoperative 0.2 mL local saline injections into the DG. Group 4 consisted of animals with distraction at the rate of 1 mm/day, receiving postoperative 0.2 mL local saline injections into the DG. All the injections were performed immediately postoperatively and for all groups at 1, 2, 3, and 4 weeks following surgery. The distraction zones were evaluated using dual-energy X-ray absorptiometry and histological analysis.Histologically, bone healing was found to be significantly accelerated in Groups 1 and 4 compared with Groups 2 and 3 (P < 0.05). Bone healing was superior in Group 1 and the difference was statistically significant compared with Group 4. There was a significant increase in mean bone mineral density in the 1 mm daily rate groups (Groups 1 and 4) compared with the 2 mm daily rate groups (Groups 2 and 3) (P < 0.05).Local low-dose alendronate injections could be an effective way for improving bone formation in distraction osteogenesis. Furthermore, the results of this study did not support the hypothesis that injections of local low-dose alendronate may allow 2 mm/day instead of 1 mm/day of elongation in the rabbit mandible.

Stress Analysis of Zygomatic Implants on the Augmented Maxillary Sinus: Is It Necessary to Graft?

PURPOSE: Zygomatic implants are becoming an ideal therapy with advanced implant-supported prosthetic treatment for the posterior atrophic maxilla. The purpose of this study is to examine the quantity and distribution of stress, which was caused by zygomatic implants placed using intrasinus method with or without augmentation to the atrophic posterior maxilla. MATERIALS & METHODS: In this study, 3-dimensional atrophic edentulous maxilla models with and without sinus augmentation are designed with computer-aided programs. Stress analysis was carried out on the created computer models for maxillary alveolar cortical bone, for cortical bone in the zygomaticomaxillary suture, and for zygomatic spongy bone at the apex of the zygomatic implant and for metal substructure of Von Misses stress data. RESULTS: Having augmented the maxillary sinus with graft, it was observed that after the loading especially in the posterior region, the tensile and compressive stresses on the alveolar crest was distributed more homogeneously and the stress generated on the cortical bone was reduced through the graft. CONCLUSION: Although zygomatic implants are graftless solutions for athrophic maxilla, sinus augmentation will be useful for bearing stress around the implants.

Spontaneous Healing of Mandibular Noncontinuous Defect Caused by Medication-Related Osteonecrosis of the Jaw.

BACKGROUND: Bisphosphonates are used throughout supportive cancer therapies for the treatment of osteoporosis and metastatic bone diseases, but they invariably induce medication-related osteonecrosis of the jaw (MRONJ). This medicational modality may induce consequential losses that can lead to spontaneous or surgical therapy related bone fractures or defects. MRONJ stages and treatment alternatives are described in the current procedures. Accordingly, treatments for stages 0 and 1 are conservative whereas the treatment for stage 3 is surgical resection of the necrotic bone. Stage III MRONJ therapy is still controversial within the scope of conceivable bone fractures or defects. When the development of MRONJ is refractory to conventional treatment modalities, surgical management can be suggested. The aim of this study was to evaluate the results of the surgical treatment of MRONJ as part of a medical patient. METHODS: A 72-year-old man was referred to our department for extensive pain of the left mandibular region that occurred after tooth extraction. It was identified in his medical history that he had received a nitrogen-containing intravenous bisphosphonate (Zometa; Novartis, East Hanover, NJ) therapy for prostate cancer. He had been administered 4 mg. IV Zolenat 9 times during the first year of therapy, followed by 2 doses of the same amount of Zolenat in the second year. RESULTS: The treatment started with a therapy that combined antibiotics and antibacterial mouth rinse with chlorhexidine for maintaining oral hygiene. After the maturity of the sequestrum was identified through radiographic examination, the patient was treated by the segmental resection of the extensive necrotic bone, resulting in discontinuity of the mandibular corpus. Two years later, spontaneous bone healing occurred along the residual defect on the mandible. CONCLUSION: Treatment options for the defects resulting from MRONJ are still under debate, and no evidence-based guidelines are available. However, due to the results displayed in this patient; it may be a sound approach to closely follow up and observe MRONJ-related bone to prevent additional complications.

Clinical Evaluation of the Use of Tibial Bone Grafting in Dentoalveolar Reconstructive Surgery.

OBJECTIVE: The aim of this study was to evaluate the efficacy of tibial autogenous bone grafting in the treatment of patients with alveolar bone defects. MATERIALS AND METHODS: The study subjects consisted of 12 patients (10 male, 2 female, age: 19-51 years) who underwent reconstructive autogenous bone-grafting procedures. The medial approach to the tibial bone was used to harvest autogenous cancellous bone grafts in all the patients. Clinical parameters (complications at the donor and recipient sites, resorption and volume of the grafts) were evaluated retrospectively. RESULTS: The mean age of the patients was 36.25 ± 0.9 years. Of the 12 patients, 5 (41.7%) received bone grafts for sinus augmentation, 3 (25%) for cyst cavity reconstruction and 4 (33.3%) for alveolar cleft reconstruction procedures. The average follow-up period was 28.4 months (range: 21-40 months). An average of 5.2 cm3 of cancellous bone was harvested for grafting procedures. All the grafting procedures were successful, and there were no surgical complications during the harvesting protocol. In all cases, pain and gait disturbance lasted less than 2 weeks. CONCLUSION: The results of this study suggest that the use of tibial autogenous bone graft harvested using a medial approach was a safe, simple and effective method for grafting various alveolar bone defects where high amounts of cancellous bone grafts were needed with low morbidity.

Combined Endodontic and Surgical Treatment of Dens Invaginatus-Associated Extraoral Fistula: A Case Report with Seven-year Follow-up.

Dens invaginatus (dens in dente) is a developmental malformation of permanent or deciduous teeth that has various complex forms. It most commonly affects permanent maxillary lateral incisor teeth, and rarely affects the mandibular teeth. In this report, a rare case of dens invaginatus of a mandibular lateral tooth with an extraoral fistula is presented. A 10-year-old patient was referred to our clinic with extraoral symptoms that could not be diagnosed by medical doctors. Successful treatment with endodontic treatment and periapical surgery is described. Seven-year follow-up of the case is provided.

Efficacy of platelet rich fibrin in the reduction of the pain and swelling after impacted third molar surgery: randomized multicenter split-mouth clinical trial.

BACKGROUND: Impacted third molar removal is a routine procedure in oral and maxillofacial surgery. Platelet-rich fibrin (PRF) is a second generation platelet concentration which is produced by simplified protocol. The aim of this study was to assess the effectiveness of PRF in the healing process by evaluating the changes in pain and swelling after third molar surgery. METHODS: Fifty-six patients (23 male, 33 female) who provide the inclusion criteria were selected to participate in this study. The evaluation of the facial swelling was performed by using a horizontal and vertical guide. The pain was evaluated in the postoperative period using a visual analog scale (VAS) of 100 mm. RESULTS: Horizontal and vertical measurements showed more swelling at the control side (without PRF) in 3th day postoperatively (p < 0.05). There were no statistically significant differences regarding pain among the groups. CONCLUSION: As a conclusion, PRF seems to be effectiveness on postoperative horizontal swelling after third molar surgery. PRF could be used on a routine basis after third molar extraction surgery.

Finite-Element Analysis of a New Designed Miniplate which is Used via Intraoral Approach to the Mandible Angle Fracture: Comparison of the Different Fixation Techniques.

The mandible is the largest facial bone as well as the most commonly fractured bone in the maxillofacial region. Despite numerous studies conducted to identify optimal treatment modalities and plates configurations for intraoral and transoral approaches, no definitive conclusion has been reached. This study used finite element analysis (FEA) to assess 4 scenarios for treatment of an angle fracture (6-hole noncompression miniplate; 6-hole single plate/Champy's technique, 3D strut plate; 2 parallel 4-hole noncompression miniplates). Analysis included segmental displacement and Von Mises Stress evaluations of a 3D reconstruction of a human mandible. Von Mises Stress values for plates did not vary significantly among treatment groups. Moreover, no significant differences were observed in cumulative displacement of segments subjected to vertical and horizontal loads, with all treatment configurations demonstrating clinical acceptability.

A simple solution for vector control in vertical alveolar distraction osteogenesis.

One of the important and frequent complications in alveolar distraction osteogenesis is vectorial change of the transport segment. This report presents a simple solution for vector angulation control by placing intermaxillary fixation screws intraoperatively. Advantages of the technique are also discussed.

Preservation of a tooth related with central giant cell granuloma with non-invasive curettage: 7 years followed-up case report.

Central Giant Cell Granuloma (CGCG) is defined by the World Health Organization as an intraosseous lesion consisting of cellular fibrous tissue containing multiple foci of hemorrhage, aggregations of multinucleated giant cells, and occasionally trabeculae of woven bone. An 8-year-old patient presented with painless swelling and bleeding in his upper right canine region was referred to our clinic. Incisional biopsy was confirmed that this was a CGCG. The patient was treated with non-invasive curettage and secondary intention healing. Seven-year follow-up of the patient revealed a complete resolution of the lesion and uneventful eruption of the permanent canine tooth. In this case report, a successful long-term outcome of the conservative treatment of the CGCG was presented.

The impact of handicap severity on oral and periodontal status of patients with mental retardation.

AIM: Mental retardation (MR) subjects comprise a considerable amount of the community and are susceptible to oral and periodontal problems due to insufficient oral care. The aim of this cross-sectional study was to determine the oral health and periodontal status of MR patients in Turkey with regard to periodontal indices and Decay missed filling teeth (DMFT) scores and compare findings according to severity of the MR. MATERIALS AND METHODS: One hundred and five MR patients were included to the study and divided into 3 groups according to MR severity diagnoses. Demographic variables like age, gender, disabled sibling, BMI, living an institution and clinical parameters like plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), missing teeth and DMFT scores were recorded from all subjects. Appropriate statistical analyses were used to compare the findings. RESULTS: There were no statistically significant differences between groups according to age, gender, disabled sibling, living status and DMFT scores. Clinical periodontal indices and the number of missing teeth were showed a statistically significant increasing trend with the severity of MR (p < 0.05). Correlation analysis showed significant positive correlations between PI and periodontal disease measures like GI, PD, CAL and BOP and also between PI and DMFT (p < 0.05). CONCLUSION: The deteriorated teeth condition and deprived periodontal health of MR patients may be most likely caused by the poor oral hygiene and may be worsen with the severity of the MR. Clinical significance: Knowledge of oral and periodontal status of mental retardation patients has great importance for public health and family education.

Iatrogenic displacement of impacted mandibular third molar into the pterygomandibular space: a case report.

Accidental displacement of an impacted lower third molar into the pterygomandibular space during extraction is a rare complication. The purpose of this article is to report the case of a lower third molar displaced into the pterygomandibular space during an unsuccessful surgical intervention. A 26-year-old male patient presented with infection and trismus was referred to our clinic. The patient's history revealed that he undergone an unsuccessful impacted third molar removal performed by dentist two years ago. The patient was not referred to oral surgeon after the incident, although, the doctor noticed the iatrogenic displacement. On radiological examination, panoramic radiograph and Computed Tomography (CT) scans showed that the displaced tooth was migrated in the pterygomandibular space over the two-year time. Infection and trismus were controlled by antibiotic therapy and physiotherapy before the surgery and the displaced tooth was recovered under local anesthesia. The post-operative period was uneventful and the patient recovered without any sequel.

Evaluation of preoperative model surgery and the use of a maxillary sinus surgical template in sinus floor augmentation surgery.

Maxillary sinus augmentation is an accepted technique for dental implant placement in presence of insufficient maxillary bone. There are various techniques in the literature, either by crestal or lateral approach in maxillary sinus augmentation that have high percentage of success, while all have complications. Schneiderian membrane perforation is the most common complication encountered during surgery. The aim of this study was to evaluate the benefits of preoperative model surgery and the ease of use of a maxillary sinus surgical template (MSST) during maxillary sinus augmentation surgery with a lateral approach. Ten patients included in the study needed rehabilitation of a partially or totally edentulous maxilla with an implant-supported fixed prosthesis and requiring sinus augmentation. A questionnaire was asked to performing surgeons, and study results showed the use of an MSST was found to be effective in terms of adaptation (62.5%), window preparation (87.5%), ease of elevation (95.9%), ease of grafting (95.9%), reduction of perforation risk (91.7%), and achieving immobility during the procedure (62.5%); however, the use of an MSST was also found to prolong the surgical procedure (100%) and restrict the view of the surgical area (79.2%). Maxillary sinus augmentation appears to be a useful tool for locating an appropriate entrance to the sinus cavity, allowing for safe elevation of the sinus membrane and effectively grafting the sinus floor.

One-and-a-half-barrel vascularized free fibular flap for the reconstruction of segmental mandibular defect.

We designed one-and-a-half-barrel vascularized free fibular flap which is a further modification of the double-barrel technique, and we tried to overcome the discrepancy between mandible and fibula flap. We used this flap in case of a segmental mandibular defect that occurred as a result of a giant cell reparative granuloma excision. This new modification eliminated volume insufficiency of the classical technique and volume excess of the double-barrel technique.A segmental mandibular defect that occurred as a result of giant cell reparative granuloma excision was reconstructed using one-and-a-half-barrel vascularized free fibular flap. The size discrepancy between mandible and free fibula flap is a well-known problem, and this new modification of free fibular flap eliminated volume insufficiency or excess problems of the other techniques.

Piezosurgery versus conventional surgery in radicular cyst enucleation.

OBJECTIVE: This study compared the use of piezosurgery and conventional surgery in radicular cyst enucleation. STUDY DESIGN: The study was conducted with 29 patients who were radiologically and cytologically prediagnosed with radicular cysts in the jaw region. Nineteen patients were treated using piezosurgery, and 10 were treated using conventional surgical procedures. Surgical procedures were evaluated according to the following criteria: hemorrhage, soft-tissue damage, manipulation complexity, major perforation areas on the enucleated cyst tissue, and approximate operation duration. Patients were monitored postoperatively and evaluated for hemorrhaging at 24, 48, and 72 hours following surgery. Follow-up was conducted to check for recurrences and ranged from 5 to 24 months. RESULTS: No complications were observed in any of the 20 patients treated using piezosurgery, although the duration of surgery was longer than expected. Of the 10 patients treated using conventional methods, hemorrhaging that affected the operation occurred in 3 cases, perforation of the cyst epithelium and difficulties in enucleation occurred in 5 cases, postoperative hemorrhage occurred in 2 cases, and recurrence was observed in 2 cases. CONCLUSIONS: Piezosurgery may be considered effective in procedures such as enucleation that require sensitive manipulation, despite the increase in the length of the overall surgical procedure. Given the results of the present study and the current lack of information in the literature regarding postoperative pain, infection, and long-term success rates associated with the use of piezosurgery in cyst enucleation, further study in this area is recommended.

Correction of postsurgical alveolar ridge defect with vertical alveolar distraction of the onlay block graft.

Alveolar bone augmentation for dental implant rehabilitation is one of the greatest challenges for oral and maxillofacial surgeons. Bringing out an inadequate quantity of vertical bone during augmentation compromises correct implant positioning and the resulting prosthetic restoration. Alveolar distraction osteogenesis is now generally used in correcting alveolar ridge atrophy due to trauma, congenital defects, or periodontal defects. Onlay block grafting is a suitable method for restoring the alveolar bony defects. However, it sometimes can become a complicated procedure to repair the horizontal defect accompanying a vertical defect using only bone blocks. This clinical report presents a successful reconstruction of a severe anterior mandibular alveolar bony defect as a result of impacted teeth extraction and periodontal problem in a 50-year-old healthy female patient. The defect was reconstructed with symphysis graft and platelet-rich fibrin in the first step. Vertical alveolar distraction was performed on the grafted site to maintain the suitable bony height 3 months later. Grafted bony segment distraction and the treatment options in similar cases were also discussed in this clinical report among with the literature.

A comparison of the low-level laser versus low intensity pulsed ultrasound on new bone formed through distraction osteogenesis.

OBJECTIVE: To assess and compare the effects of low-intensity pulsed ultrasound stimulation (LIPUS) and low-level laser therapy (LLLT) on the bone mineral density (BMD) of bone formed through distraction osteogenesis (DO) using dual energy x-ray absorptiometry (DEXA). BACKGROUND DATA: LIPUS and LLLT are noninvasive supporting treatment concepts used for wound healing. LIPUS has been used to accelerate bone healing through the therapeutic effect arising from piezoelectric and angiogenetic effects on cell membranes. LLLT known as "photobiomodulation" is used in the treatment of soft and hard tissue injuries. METHODS: The study was conducted with 15 New Zealand rabbits randomly divided into three groups of 5 according to treatment, as follows: Group A: DO was performed with no further treatment; Group B: DO was performed followed by 30 mW/cm(2) LIPUS at 1 Mhz for 20 min/day during the distraction period; Group C: DO was performed followed by 25 mW/cm(2) LLLT at 650 nm for 10 min/day during the distraction period. DEXA was used to examine the treated areas prior to surgery and at 30 and 60 days postoperatively. RESULTS: In the control group, the mean BMD values at both 30 and 60 days postoperatively were below the baseline level, whereas they were above at the same time intervals in the LIPUS group. In the LLLT group, the mean BMD value at 30 days postoperatively was below the baseline level, whereas it was above the baseline level at 60 days postoperatively. CONCLUSIONS: LIPUS and LLLT applied during the distraction period accelerated the DO treatment.

Displacement of avulsed tooth into soft tissue of chin resulting from epileptic attack trauma.

Maxillofacial trauma is the main cause of emergency admittance to dental clinics. Mental retardation and epileptic status are important factors in an increase in the risk of dental injuries. Tooth avulsion, which is the total displacement of a tooth out of its socket, is an infrequently observed entity. Maxillary central incisors are the most commonly affected teeth. The case of a patient with severe dental injury resulting from an epileptic attack is presented. He had several teeth avulsed and displacement of a tooth into the soft tissue of the chin.