Dosimetric evaluation of the effect of dental restorative materials in head and neck radiotherapy.

Background: The aim of our study is to assess the dose enhancement from scattered radiation due to dental restorative materials used for occlusal and mesio-occlusal-distal (MOD) cavity filling during simulated head and neck radiotherapy. Methods: We have studied the dose enhancement ratio (DER) of conventional amalgam, high-copper amalgam, and resin composite dental restorative materials at cadaver mandible teeth using 2 therapeutic photon energies of 1.25 MeV (Co-60 gamma ray) and 6 MV (Linac X-ray) for irradiation. Results: DER values at buccal position for Co-60 and 6 MV X-ray were 1.250 ± 0.013 and 1.151 ± 0.012, respectively. For dental cavity fillings, DER values for 6 MV X-ray were 1.065 ± 0.021, 1.100 ± 0.014, and 1.162 ± 0.016 for resin composite filling, low-copper amalgam filling, and high-copper amalgam filling, respectively. Our results revealed that DER regarding irradiation energy was minimum for 6 MV X-rays. With respect to dental restorative filling material, DER was minimum for resin composite filling. Regarding the cavity type, our results with standard deviation (SD) calculations revealed that DER was slightly but not significantly different for both Co-60 gamma ray (1.25 MeV) and 6 MV X-ray energies for both occlusal and MOD cavities. Conclusion: Our dosimetric results for a single beam geometry suggest that, among the three types of filling, resin composite filling is an ideal restorative filling material with minimal morbidity-inducing radiation dose enhancement that may result in increased osteoradionecrosis and secondary caries risk. There is a need for further dosimetric studies with actual clinical beam arrangements.

Congenital Gingival Granular Cell Tumor: A Case Report.

The congenital gingival granular cell tumor (CGCT), also as known as congenital epulis, is an unusual benign oral mucosal lesion in newborns. A two-day-old female patient was admitted to the Department of Pediatric Dentistry at Gulhane Medical Academy, Ankara, Turkey with her family, and an intraoral examination showed a CGCT located in the buccal region of the maxillary right first primary molar. In this report, we present a case of CGCT in a newborn.

Delayed retrieval of a displaced maxillary third molar from infratemporal space via trans-sinusoidal approach: a case report and the review of the literature.

AIM: The aim of this case report is to present the trans-sinusoidal pathway used to remove a displaced maxillary third molar from the infratemporal fossa and review the English literature regarding the techniques used. CASE REPORT: A 21-year-old male patient was referred with the findings of an oroantral fistula on the left maxillary vestibular first molar region and slight restriction of mouth opening. The patient underwent a maxillary sinus surgery in order to remove a sinus retention cyst via Caldwell-Luc access in a dental clinic 4 years ago. A computerized tomography scan showed the inverted third molar to be located in the infratemporal fossa, just between zygomatic arch and lateral pterygoid plate. The tooth was accessed through the remaining lateral bone defect from the Caldwell-Luc approach of the lateral sinus wall. The bone defect was extended. The posterior bony wall of the maxillary sinus was removed via a surgical burr. After that, the displaced tooth was exposed. The tooth was mobilized via Warwick James elevator downwards and removed with a forceps. CONCLUSION: Access for surgical removal of the tooth from the infratemporal fossa is not only difficult but also has potential for morbidity due to the structures running through it. Wide incision in the maxillary sulcus and blunt dissection are reported with lower success rates and usually necessitate a second intervention via extraoral route. Trans-sinusoidal approach might be an old fashioned but relatively successfully attempt in the removal of the upper third molars from the infratemporal fossa. Considering the time of removal, if no symptoms were present, it is beneficial to wait for a couple of weeks thus facilitating development of fibrous surrounding around the tooth.

Extremely Rare Form of Impaction Bilateral Kissing Molars: Report of a Case and Review of the Literature.

Kissing molars (KM) or rosette formation is a term that is used to describe impacted teeth contacting occlusal surfaces in a single follicular space and their roots pointing in opposite directions. In some cases kissing molars can be seen but occurrence of bilateral kissing molars is extremely rare phenomenon in the dental literature and the aetiology of this phenomenon is still unknown. In this paper we describe a case and review of the literature and discuss the management of this pathology. In our case, extremely rare form of impacted bilateral kissing molars was extracted surgically. The decision of extraction of asymptomatic kissing molars represents surgical dilemma. There may be many surgical complications; on the other hand in some cases surgical intervention is unavoidable. Few treatment options were described in the literature. This phenomenon can be sign of various medical conditions that may require further investigation. In this paper, our treatment option is in agreement with the literature suggesting the surgical removal of both teeth at either side of the mandible.

Volumetric Evaluation of Safe Zone for Bone Harvesting From Symphysis Region by Using Cone Beam Computed Tomography.

OBJECTIVES: The aim of the present study was to retrospectively make a volumetric evaluation of symphysis sites of patients by the use of cone beam computed tomography (CBCT). METHODS: This retrospective study evaluated dentate symphysis region of the mandibles in CBCT scans taken for different reasons in 90 patients (45 women and 45 men). Three-dimensional (3D) data were obtained using a CBCT device Kodak 9000 3D CMOS sensor with optical fiber. CBCT images were then transferred as digital imaging and communications in medicine files and imported into a volumetric-rendering software 3D DOCTOR (Able Software Corp., Lexington, MA) capable of measurements of vector based-segmentation technology for volumetric measurements. RESULTS: The total average bone volume is 2616.45 mm. Significant differences in average bone volume were found between group I and group IV (P < 0.001). Higher bone volume was obtained in the male groups (2903.01 mm) than in the female groups (2329.88 mm). CONCLUSIONS: CBCT is a good candidate for 3D assessment of high-contrast structures in the oral region. We suggest that the use of 3D computed tomography in combination with a software program is a dependable means of measuring the volume of the symphysis bone graft.

Primary malignant melanoma.

Malignant melanomas (MM) of the oral cavity are extremely rare, accounting for 0.2% to 8.0% of all malignant melanomas. Malignant melanomas is more frequently seen at the level of the hard palate and gingiva. Early diagnosis and treatment are important for reducing morbidity. Malignant melanoma cells stain positively with antibodies to human melanoma black 45, S-100 protein, and vimentin; therefore, immunohistochemistry can play an important role in evaluating the depth of invasion and the location of metastases. A 76-year-old man developed an oral malignant melanoma, which was originally diagnosed as a bluish reactive denture hyperplasia caused by an ill-fitting lower denture. The tumor was removed surgically, and histopathological examination revealed a nodular-type MM. There was no evidence of recurrence over a 4-year follow-up period.

Histomorphometric and microtomographic evaluation of the effects of hyperbaric oxygen and systemic ozone, used alone and in combination, on calvarial defect healing in rats.

PURPOSE: The aim of this study was to compare the efficacy of hyperbaric oxygen and systemic ozone, used separately and in combination, on the healing of bone defects. MATERIAL AND METHODS: Sixty male Wistar rats were divided into 4 groups (n = 15) according to treatment (control, hyperbaric oxygen [HBO], ozone [O], and HBO plus O [HBO-O]) and divided further into 3 subgroups according to day of sacrifice (postsurgical days 5, 15, and 30). Surgery was performed under general anesthesia to create a critical-size bone defect (5 mm in diameter) in the cranium. After sacrifice, microtomographic images of all samples were recorded, and histomorphometric analysis was performed. RESULTS: Histologic and radiologic measurements showed that the values of all experimental groups were higher than those of the control group. Histologic scores for all experimental groups were statistically higher than those for the control group day 30 (O, P = .045; HBO, P = .049; HBO-O, P = .042). Histologic scores also were statistically higher for the HBO group on day 5 (P = .045) and day 15 (P = .009) compared with the control group. Microtomographic scores were higher for the experimental groups than for the control group, with statistically significant differences for group O on day 5 (P = .033) and day 30 (P = .0045) and for group HBO on day 15 (P = .005). Histologic and radiologic analyses showed positive correlations. CONCLUSION: Within the limitations of this study, the use of hyperbaric oxygen and ozone, separately and in combination, were shown to be effective in increasing bone healing. Combined usage was no more effective in stimulating bone healing than separate usage.

Clinical comparison of submucosal injection of dexamethasone and triamcinolone acetonide on postoperative discomfort after third molar surgery.

OBJECTIVE: The aim of the study was to compare the effect of submucosal injection of dexamethasone and triamcinolone acetonide on postoperative pain, swelling, and trismus occurring after impacted mandibular third molar surgery. METHOD AND MATERIALS: A total of 78 patients (aged 18 to 35) with asymptomatic, unilateral, impacted mandibular third molar, and without any systemic disease were included in this study. Patients were divided into three groups randomly (control, dexamethasone, and triamcinolone acetonide). In the experimental groups, dexamethasone and triamcinolone acetonide were injected into submucosa at about 1 cm above the surgical area submucosally. The control group of patients did not take any drug submucosally but the same surgical procedure was applied. Pain evaluation was performed by visual analog scale (VAS). Swelling was measured using a flexible standard ruler measuring the dimensions of the axes between certain points on the face. For trismus evaluation, maximum mouth opening was measured. Measurements taken on the preoperative, and on postoperative first, third, and seventh days were compared with each other and statistically evaluated. RESULTS: There were statistically significant differences between the control and experimental groups on the different days of the postoperative period. The effect of triamcinolone acetonide on pain started on the first day postoperatively and the effect of triamcinolone acetonide on trismus and pain was better than other groups at the third and seventh days. However, there was no statistically significant difference between the effects of dexamethasone and triamcinolone acetonide regarding postoperative complications. CONCLUSION: The submucosal injection of dexamethasone or triamcinolone acetonide might be an effective treatment for postoperative discomfort occurring following impacted mandibular third molar surgery, and triamcinolone acetonide could be applied as an alternative to dexamethasone.

Congenital granular cell tumor in newborn.

The congenital granular cell tumor (CGCT) is quite scarce at the infant. The patient, who has a 2-day-old female newborn, was admitted to the Department of Pediatric Dentistry. Baby had a smooth surfaced, non-fixated mass, found on the anterior part of the mandibular alveole, developing from the gingival mucosa. Clinical examination showed a 1 cm × 1 cm × 1.8 cm pedunculated, regular, pink colorful soft-tissue gob on the alveolar crest to the left side of the mandible. The gob was removed on the seventh postnatal day under general anesthesia. Then, the specimen was evaluated histopathologically. Post-operative recovery and surgical site healing was satisfactory. The CGCT is a rare, degenerative or reactive lesion of the oral cavity. The mass may surgically remove if the diagnosis is not definite clinically and this can lead therapeutic effect.