Assessment of the approach to managing medical emergencies during dental procedures.

OBJECTIVE: This study aims to investigate the knowledge of dental interns and post-graduated doctors regarding dental emergencies and their occurrence in the clinic and examine the doctors' ability to intervene in these emergencies. METHODS: Note that, 150 dental interns and 101 post-graduated doctors were surveyed with sixteen questions regarding their knowledge and experience with syncope, orthostatic hypotension, myocardial infarction, angina pectoris, asthma, and anaphylactic shock. Also, post-graduate doctors answered nine additional questions about their emergency response capabilities. RESULTS: This study found that interns and doctors exhibited similar knowledge about emergencies. Nonetheless, the count of dental interns encountering emergencies is relatively limited. Syncope was the most frequently encountered condition (61.8%). Doctors' increase in years of experience correlated positively with a higher rate of intervention in epilepsy, orthostatic hypotension, and anaphylactic shock (p = 0.001, 0.024, and 0.02, respectively). The ability to check the carotid pulse and to perform intramuscular injections was high in post-graduated doctors (90.09% and 81.2%, respectively). DISCUSSION: Although interns believe their knowledge about emergencies to be sufficient, their intervention skills may need to be improved due to the low frequency of encounters. After graduation, their inability to intervene adequately during emergencies in the clinic can lead to fatal consequences. The lack of improvement in doctors' knowledge and intervention abilities with experience could be attributed to insufficient training after completing their formal education. To prevent such scenarios, regular training sessions should be provided to interns and doctors, focusing on the emergencies they may encounter.

Incidence, treatment method and recurrence rate in giant cell granulomas: Retrospective study.

Central and peripheral giant cell granulomas are benign entities mostly seen in mandibular anterior region at female individuals, usually with observed recurrence. Their etiology is still unclear, as is the optimal method for treating them. The aim of this study was to evaluate the incidence, treatment methods, recurrence rates, and initial and definitive correlation of central and peripheral giant cell granulomas. Patients who were referred to our clinic between 2013 and 2023 and who had the lesions' definitive diagnosis as "central giant cell granuloma" (CGCG) or "peripheral giant cell granuloma" (PGCG) were included in the study. Demographic data, recurrence rates, treatment methods, lesion location, clinical behaviors, and sizes were noted on the reports. A total of 30 lesions in 23 patients (14 PGCG and 9 CGCG) were evaluated in this study. The mean follow-up time was 62.6 months; 8 of 23 patients had systemic disease. While only 1 patient was observed to have cortical bone destruction in PCGC, all patients were found to have cortical bone destruction in CGCG (p < 0.05). In both lesions, the correlation of preliminary and definitive diagnosis was evaluated, and it was found to be 50% in PGCG while it was 77.7% in CGCG. The recurrence rates were 21.4% in PGCG and 33.3% in CGCG. Curettage was applied in all patients. Additional treatments (intralesional steroid injections, denasumab applications, resection, and graft application) were performed in 5 patients who were found to have CGCG (p = 0.004). However, there was no significant relation between treatment method and recurrence in CGCG (p > 0.05). Various peripheral lesions could mimic PGCG; thus, curettage therapy could be appropriate in the treatment of PGCG. Nevertheless, in some cases of CGCG, additional treatment methods could be more effective for preventing recurrence and any other complications.

Assessment of jaw bone mineral density, resorption rates, and oral health in patients with severe hemophilia: a case-control study.

OBJECTIVE: Knowledge about oral hygiene, gingival bleeding, mineral density, and resorption of jaw bones in patients with hemophilia is limited. We evaluated the periodontal and bone status in such patients.  Material and methods: Forty-eight patients with severe type A/B hemophilia and 49 age- and sex-matched controls were included. Assessments included simplified oral hygiene index (OHI-S), calculus index, debris index, gingival index (GI), gingival bleeding time index (GBTI), and decayed, missing, and filled teeth index (DMFTI). Bone resorption was evaluated using panoramic mandibular index (PMI), mental index (MI), and alveolar crest ratio (ACR). Mineral density in the condyle, angulus, and premolar areas was assessed using fractal analysis, with fractal dimensions denoted as condyle fractal dimension (CFD) for the condyle, angulus fractal dimension (AFD) for angulus, and premolar fractal dimension (PFD) for premolar region. RESULTS: The mean scores were DMFTI = 11.77, OHI-S = 2.44, PMI = 0.268, MI = 5.822, GI = 3.02, GBTI = 2.64, ACR = 2.06, CFD = 1.31, AFD = 1.31, and PFD = 1.17 in the hemophilia group and DMFTI = 11.449, PMI = 0.494, MI = 7.43, GI = 0.67, GBTI = 0.98, OHI-S = 1.45, ACR = 2.87, CFD = 1.35, AFD = 1.35, and PDF = 1.23 in the control group. Differences were significant for all parameters (p < 0.005) except for the DMFTI index.  Conclusions: Because of poor oral hygiene, high bone resorption, and low bone mineral density in these patients, clinicians should consider potential bone changes when planning to treat these patients.

Can locally applied risedronate be an effective agent when combined with xenografts? An animal study.

BACKGROUND: To examine the effects of local risedronate application with xenografts on healing of rabbit skull defects using histological, histomorphometric, immunohistochemical, and three-dimensional radiological methods. METHODS: Two critical-sized defects with a diameter of 10 mm were created in 16 rabbits and filled with xenogenic bone graft and xenogenic bone graft + 5 mg risedronate in the control I and risedronate (RIS) groups, respectively. Residual graft, new bone, soft tissue areas, and bone volume were evaluated in the 4- and 8-week study groups. RESULTS: In both the 4- and 8-week samples, the RIS group samples had significantly higher mean new bone area values than the C group (p < 0.05). In both groups, the values for the new bone area were significantly higher in the 8-week-old samples than in the 4-week-old samples (p < 0.05). The h scores obtained for sialoprotein and osteopontin did not differ significantly between the groups at either time point (p > 0.05). The results of radiological evaluation showed that the bone density value was significantly higher in the C group than in the RIS group at either time point (p < 0.05). CONCLUSIONS: Although this study aimed to demonstrate the effect of risedronate on the osteoconductive properties of xenografts when applied locally, targeted results could not be achieved.

Effects of a locally administered risedronate/autogenous bone graft combination on bone healing in a critical-size rabbit defect model.

BACKGROUND: Risedronate is a bisphosphonate with poor oral absorption. An extremely hydrophilic molecule that has a high affinity for bone, risedronate also inhibits the farnesyl diphosphate synthase enzyme, inhibiting osteoclastic activity and reducing bone turnover and resorption. Autogenous bone grafts contain osteogenic cells and osteoinductive factors that are essential for bone regeneration and are therefore considered the gold standard. Thus, this study aimed to investigate the impact of local risedronate administered with autogenous bone grafts on the healing of defects in rabbit skulls using histological, histomorphometric, immunohistochemical, and three-dimensional radiological methods. METHODS: Two 10-mm-diameter critical-size defects were created in 16 rabbits and filled with autogenous bone graft and autogenous bone graft + 5 mg risedronate in the control (C) and risedronate (RIS) groups, respectively. Residual graft, new bone, soft tissue areas, and bone volume were evaluated in the 4- and 8-week study groups. RESULTS: There were no statistically significant differences in bone graft, new bone, or soft tissue area between the groups at 4 weeks (p > 0.05). At 8 weeks, the new bone area was significantly higher in the RIS group than in the C group (p < 0.05). The h scores obtained from sialoprotein and osteopontin did not differ significantly between the groups (p > 0.05). The radiologically measured total bone volume was significantly higher in the RIS group than in the C group at both time points (p < 0.05). CONCLUSIONS: In this study, risedronate enhanced the osteoconductive properties of autogenous bone grafts and rapidly created better-quality bone. This could improve future patient outcomes.

Intraosseous Mucoepidermoid Carcinoma of the Mandible Detected as an Asymptomatic Swelling.

Intraosseous mucoepidermoid carcinoma (IMEC) is a rare neoplasm of the jawbones. Although hypotheses focused on the malignant transformation of the epithelial mucosa of odontogenic cysts or ectopic salivary gland tissue have been suggested, the etiology of the disease is still unclear. It is more frequent in middle-aged individuals, has a slight female predilection, and is more common in the mandible than in the maxilla. Cortical enlargement is the most common symptom, while some lesions are detected by coincidence on radiography. This paper reports an IMEC of the mandible of a 35-year-old female, possibly arising from the remains of an odontogenic cyst associated with an unerupted mandibular molar, which was operated in an external center 5 years ago before IMEC diagnosis.

Effect of Locally Administered Denosumab on Bone Graft Healing in Rabbit Critical-Size Calvarial Defects.

Background/Aim: Denosumab is a human monoclonal immunoglobulin G2 antibody developed from the ovarian cells of Chinese hamsters. We aimed to histomorphometrically and radiologically evaluate the effects of xenografts used with local denosumab on the healing of defect sites using rabbit skulls. Materials and Methods: Two 10-mm diameter critical-size defects were created in 16 rabbits. The defect areas were filled with xenografts and xenograft + 3 mg denosumab in the control and denosumab groups (DEN), respectively. We evaluated new bone, residual graft, soft tissue areas, and bone volume in 4- and 8-week study groups. Results: Histomorphometrically, there were no statistically significant differences between groups at both 4 and 8 weeks regarding residual graft, new bone, and soft tissue area (p > 0.05). The 4-week residual graft control group values were significantly higher than the 8-week values (p < 0.05). The soft tissue area was significantly greater in the 4-week compared with the 8-week DEN group (p < 0.05). The radiologically measured total bone volume was significantly greater in the 8-week specimens than in the 4-week specimens (p < 0.05). Conclusion: In this study, denosumab used locally with bone grafts, showed no direct effect on new and total bone volume.

Evaluation of the effects of locally applied rosuvastatin on bone formation in a three-dimensional reconstruction rabbit xenograft model

Background/aim: Guided bone regeneration (GBR) is commonly performed to repair bone defects, and rigid occlusive titanium barriers play a vital role in bone formation in regions with no prior bone tissue. The statin, rosuvastatin (RSV), strongly affects bone apposition when applied locally. Here, we aimed to evaluate the anabolic effects of locally applied RSV with a xenograft placed on rabbit calvaria. Materials and methods: Two rigid occlusive titanium caps were used in 16 rabbits after decorticating the calvarial bone. In the control group, the area under the cap was filled with a xenograft, while in the RSV group, a xenograft in combination with RSV (1 mg) was used. In both groups, at 6 and 12 weeks, new bone, residual graft, soft tissue areas, and histological and radiological bone volume were evaluated. Results: At 12 weeks, histologically, the RSV group exhibited superior new bone proportion values, and radiologically, new bone and total bone volume in the RSV group were significantly higher than in the control group (p < 0.05); there were no significant differences at 6 weeks (p > 0.05). Conclusion: According to our results, RSV applied locally under a titanium barrier on an area to be repaired with bone grafts increases new bone and total bone volume.

Clinical and histopathological comparative study of two equine-derived bone graft: a human study.

OBJECTIVE: To compare the performance of collagenated bone graft substances with different collagen ratios after sinus floor augmentation. METHODS: The cross-sectional study was conducted at Hacettepe University, Ankara, Turkey, from September 2011 to September 2013. Sinus floor augmentation was done with two different equinederived xenografts in patients before dental implant application. Of the two randomised groups, one was treated with 100% collagenated bone mix (Group A), and the other half with 90% collagenated bone mix + 10% collagen gel (Group B).Six months after sinus augmentation, prior to dental implant surgery, a specimen was taken from the implant socket with trephine drill for histopathological evaluation of new bone, connective tissue and residual graft material at each augmented site. SPSS 19 was used for data analysis. RESULTS: Of the 19 patients, 12(63%) were females and 7(37%) were males. The overall mean age was 51.68±11,96 years (range: 24-69 years). A total of 30 sinus floor augmentations were done. New bone formation was significantly better in Group A(15 sinus floor augmentation) than in Group B (the other 15 sinus floor augmentation) (p<0.05), but there was no significant difference in connective tissue formation and residual graft materials between the groups (p>0.05). CONCLUSIONS: Collagenated bone mix was found to be a suitable graft material for sinus floor augmentation, but increased collagen ratio did not improve new bone formation over the 6-month healing process.

Locally administrated single-dose teriparatide affects critical-size rabbit calvarial defects: A histological, histomorphometric and micro-CT study.

OBJECTIVE: The aim of this study was to evaluate the effect of teriparatide (PTH 1-34, rhPTH) on a rabbit defect model with local xenogen grafts histomorphometrically and radiologically. METHODS: For this purpose, two 10 mm diameter critical-size defects were created in the calvaria of 16 rabbits. In the control group, the defect area was filled with a xenogen graft, while in the teriparatide group (PTH 1-34), a xenogen graft combination with 20 mcg teriparatide was used. For both 4 - week and 8 - week study groups, new bone, residual graft, and soft tissue areas were evaluated as well as bone volume histomorphometrically and radiologically. RESULTS: Histomorphometrically, there was a significant difference in new bone area values at the 8th week (p < 0.05), but there was no significant difference between the 4 - week values (p > 0.05). There was no statistically significant difference between the groups at both 4 and 8 weeks (p > 0.05). In the radiologically measured total bone volume values, PTH1-34 group values were found to be significantly higher for both 4 - and 8 - weeks values compared to the control groups (p < 0.05). CONCLUSION: In this study, rhPTH, which is used locally in defect areas to be repaired with bone grafts, increases both new bone volume and total bone volume.

Hemostatic effects of adrenaline and Ankaferd (blood stopper) during orthodontic attachment bonding

Background/aim: Moisture prevention during the bonding of orthodontic attachments on impacted teeth is crucial for accomplishment. It was aimed to compare the hemostatic effects of adrenaline and Ankaferd Blood Stopper (ABS) during the surgical exposure of the impacted maxillary canine. Materials and methods: The study consists of 20 patients, whose orthodontic treatments were outlined with the surgical exposure of maxillary impacted canine. Patients were divided into groups of 10; where each group was treated with one of the two medicines to control bleeding. Group A was treated with adrenaline, and group B was treated with Ankaferd Blood Stopper (ABS). The bleeding period was recorded as the time from the exposure of the crown until the inception of bonding. Results: It was observed that both the bleeding period and the cumulative duration were significantly shorter in group B (the ABS group) than in group A (the adrenaline group) (P < 0.05), but no significant deviation in bonding times was recorded. Conclusion: ABS is a good alternative hemostatic agent for the prevention of bleeding at the surgical exposure of impacted teeth without affecting the bonding.

Effects of local alendronate administration on bone defect healing. Histomorphometric and radiological evaluation in a rabbit model.

PURPOSE: To performed a histomorphometric and radiological study to evaluate the effects of alendronate sodium administered locally in mandibular bone defects created in rabbits. METHODS: Two circular defects 5 mm in diameter were created bilaterally in the mandibular corpus of 20 New Zealand rabbits (i.e., four defects per animal). Each defect received one of four treatments: no treatment (EC group), alendronate irrigation (AL group), autogenous bone grafting (AG group), or alendronate irrigation with autogenous bone grafting (AL+AG group). Histomorphometric and radiological assessments were conducted at 4 and 8 weeks after surgery. RESULTS: Between-group comparisons of the new bone area, the value of the AL+AG group was significantly lower thanthe remaining three groups at 4 weeks postoperatively. In all groups, the new bone area was significantly larger at 8 weeks than at 4 weeks. The residual graft area at 4 and 8 weeks was significantly higher in the AL+AG group than in the AG group, although it was significantly smaller at 8 weeks than at 4 weeks in both these groups. CONCLUSION: The use of alendronate sodium in conjunction with autogenous bone grafting improves the osteoconductive properties of the graft, enhances graft retention in the defect, and improves ossification.

Effects of local alendronate administration on bone defect healing. Histomorphometric and radiological evaluation in a rabbit model

Abstract Purpose: To performed a histomorphometric and radiological study to evaluate the effects of alendronate sodium administered locally in mandibular bone defects created in rabbits. Methods: Two circular defects 5 mm in diameter were created bilaterally in the mandibular corpus of 20 New Zealand rabbits (i.e., four defects per animal). Each defect received one of four treatments: no treatment (EC group), alendronate irrigation (AL group), autogenous bone grafting (AG group), or alendronate irrigation with autogenous bone grafting (AL+AG group). Histomorphometric and radiological assessments were conducted at 4 and 8 weeks after surgery. Results: Between-group comparisons of the new bone area, the value of the AL+AG group was significantly lower thanthe remaining three groups at 4 weeks postoperatively. In all groups, the new bone area was significantly larger at 8 weeks than at 4 weeks. The residual graft area at 4 and 8 weeks was significantly higher in the AL+AG group than in the AG group, although it was significantly smaller at 8 weeks than at 4 weeks in both these groups. Conclusion: The use of alendronate sodium in conjunction with autogenous bone grafting improves the osteoconductive properties of the graft, enhances graft retention in the defect, and improves ossification.

The relationship of enuresis nocturna and adenoid hypertrophy.

OBJECTIVES: This study was organized to assess the relationship of enuresis nocturna (EN) and upper airway obstruction (UAO) in children. MATERIAL AND METHODS: This study was multi-centrically and prospectively designed including 79 children who presented to a urology clinic with symptoms of EN between January 2013 and February 2014. Sixty-four age-matched children with no history of urological complaints were randomly recruited from children admitted to a pediatric clinic as a control group. All children and parents were asked to fill out a dysfunctional elimination syndrome (DES) questionnaire and children were examined by an ear, nose and throat (ENT) specialist to evaluate the UAO. Descriptive statistics, chisquare and Mann-Whitney-U tests were used to compare variables. RESULTS: The mean ages of the 79 children (48 male, 31 female) in the study group and the 64 children (41 male, 23 female) in the control group were 10.14+/-3.38 and 9.17+/- 2.85, respectively. Family history of the study showed that 19% of the children's mothers, 10% of the children's fathers and 37% of the children's siblings had experienced EN. There was a significant difference between the study and the control groups in terms of urge to urinate, bladder emptying, bowel symptoms and psychological stress. There was also a significant difference between rates of tonsillar hypertrophy and nasopharynx obstruction in the EN group (p = 0.009). CONCLUSION: In this study we found that half of the children with EN had tonsillar hypertrophy, which was significantly higher than in the control group. Further studies are needed to clarify the exact relationship between UAO and EN.

Effects of maxillary molar intrusion with zygomatic anchorage on the stomatognathic system in anterior open bite patients.

The aim of this study was to evaluate the effects of intrusion of the maxillary posterior teeth with zygomatic anchorage on the dentofacial system, on electromyographic (EMG) activity of the masticatory muscles, and on vibration of the temporomandibular joint. The study sample consisted of 19 subjects (13 females, 6 males) with a mean age of 17.7 years. Lateral cephalometric and posteroanterior (PA) radiographs, EMG, and electrovibratographic (EVG) records were obtained before (T0) and after (T1) intrusion. Paired t- and Wilcoxon signed ranks tests were used for statistical evaluation. Maxillary molar intrusion of 3.37 ± 1.21 mm was obtained with a force of 400 g in an average period of 6.84 ± 1.64 months. At T1, all measurements showed that facial growth direction, ANB angle, convexity, and overjet were decreased (P < 0.05). SNB angle, facial depth, and overbite were significantly increased (P < 0.05). Upper lip-E plane distance was increased (P < 0.05). Evaluation of the PA radiographs showed that the right and left molar reference angles were unchanged. EMG and EVG analysis showed that the stomatognathic system at T0 was maintained at T1. Intrusion of the maxillary posterior teeth with zygomatic anchorage is an effective treatment alternative for anterior open bite correction.

Isolated bilateral macrodontia of mandibular second premolars: A case report.

Isolated bilateral macrodontia of mandibular second premolars is an extremely rare dental anomaly with only 5 cases reported to date. This case report presents clinical and radiographic findings of isolated bilateral macrodontia in a 12-year-old child. The patient was referred to the clinic with local crowding of mandibular posterior teeth. Radiographic findings revealed the presence of impacted macrodont mandibular second premolars and their distinct morphological appearance, characterized by large, multitubercular, molariform crowns, and tapering, single roots. Following surgical removal of the impacted premolars, orthodontic therapy was initiated to correct the malocclusion. Along with the features and treatment of this rare anomaly, this case report also illustrates the benefits, in terms of treatment planning and surgical technique, of supplementing conventional radiography with cone-beam computed tomography to localize the macrodont premolars and accurately establish their relationship with the neighboring roots and anatomic structures.

Spontaneous postmenopausal urethral prolapse: a case report and review of literature.

Urethral prolapse is a circular protrusion of the distal urethra through the external meatus. It is very rare condition seen mostly in black premenercheal black girl and occasionally in postmenopausal white women. We present a case of spontaneous urethral prolapse in 63-year-old postmenopousal white women with succesful management with estrogen treatment.

Comparative radiopacity of bone graft materials.

The aim of this study was to investigate the radiopacity of bone graft materials (BGMs) in comparison with bovine mandibular cortical bone and human dentine. Eight samples of each material (8 mm in diameter and 3 mm in thickness) were prepared from Dexabone(®) (DB), Bio - Oss(®) (BO), 4BONE SBS (4B), KASIOS(®) TCP (KA), S.C. PONETI (PO), and Apatite-Wollastonite (AW). The optical densities of each material, along with one tooth section (human canine tooth 1 mm slice), bovine mandibular cortical bone (BC) samples, and an aluminum step wedge, were measured from radiographic images using a transmission densitometer. The data were analyzed by nonparametric one-way ANOVA (Kruskal-Wallis) and Duncan's multiple range tests for post hoc comparison (α = 0.05). BC and AW had statistically lower optical density values than BO, 4B and human dentine (p < 0.05). Among BGMs, AW (3.681 ± 0.409 mm eq Al) had the highest radiopacity values whereas BO (1.925 ± 0.176 mm eq Al) had the lowest one. The radiopacity values of DB and KA did not reveal a statistically significant difference when compared with other materials (p > 0.05). The radiopacity of all BGMs investigated seemed to be too low to be detected radiographically when placed in the mandibular cortical bone.

Aneurysmal bone cyst of mandibular condyle: a case report and review of the literature.

An aneurysmal bone cyst (ABC) in the right mandibular condyle and ramus of a 37-year-old woman was surgically resected and immediately reconstructed with a costochondral graft. She was followed up for 5 years. A review of the 10 cases of condylar-ABC available in the literature revealed mean age of 16.8 (± 7.6) years, with equal distribution between men and women. In all cases symptoms included swelling and asymmetry, while temporomandibular disorder/dysfunction symptoms were reported in 50%. Parasthesia was not reported, except for self-limited postoperative neuropathy. Curettage or resection was employed equally and recurrence rates were 60% after curettage, 20% after resection; which are higher than reported in non-condylar-ABC's. All recurrences occurred within 12 months. Thus close post-operative follow up, for at least 12 months, is warranted.