Pressure Infusor Assisted Arthrocentesis.

Temporomandibular joint internal disorders commonly present with limited mouth opening and pain. Treatment options range from invasive surgical procedures to minimally invasive interventions. This technical note aims to introduce a modification to the arthrocentesis technique in which a pressure infusion cuff (VBM Classic Infusor, Medizintechnik GmbH, Germany) is used for irrigation instead of syringes or peristaltic pumps. A pressure infusion cuff (bag) is an inflatable bag with a hand pump and a sphygmomanometer that allows monitorization of the pressure, and it is intended to apply pressure on intravenous fluid bags to assist with rapid infusion of fluids. This allows the operator to maintain an efficient and stable flow pressure throughout the procedure while avoiding occupational hand and wrist problems resulting from manual irrigation with syringes. Furthermore, pressure monitoring, as read on the sphygmomanometer of the cuff, facilitates the manipulation of the needles and adjustment of the pressure should the patient experience discomfort. This increases the patient's compliance, physician's comfort, and allows the collection of quantitative data in clinical studies.

Biomechanical validation of a modified genioplasty distractor.

PURPOSE: Genioplasty is a surgical procedure that is used to enhance the shape and appearance of the chin. It can be performed alone or in combination with other jaw-related surgeries either for medical or cosmetic purposes. Recently many studies have been reported for mandibular reconstruction with distraction osteogenesis. However, these distractors can cause some complications such as incorrect prolongation of hard tissues due to the lack of guiding section. The purpose of this study is to manufacture a novel genioplasty distractor and measure its biomechanical stability and reliability for different activation lengths in mandibular bone. METHODS: The modified genioplasty distractor was manufactured from grade 2 and grade 5 (Ti6AI4V) titanium alpha + beta alloy which was biocompatible and adequately rigid for possible in situ application in the future and a sample holder was manufactured for compressive strength testing. RESULTS: Test results showed that our modified genioplasty distractors withstood 300 N compression force for activation lengths from 0 to 11 mm. Recorded stress values were in the range of 0.110 MPa to 0.389 MPa. CONCLUSION: The modified genioplasty distractor developed and tested here is a promising surgical tool that has the potential to reduce genioplasty related complications especially in demanding cases.

Does peri-implant bone loss affect the LL-37 and proteinase 3 levels in peri-implant sulcus fluid?

BACKGROUND: Inactive human cathelicidin antimicrobial peptide is present in neutrophils, and proteinase 3 activates this peptide by producing active LL-37 peptide. LL-37 acts as a defensive peptide in the oral tissues. In the present study, the aim was to evaluate LL-37 and proteinase 3 levels in peri-implant sulcus fluid (PISF) in implants with and without peri-implantitis. METHODS: Patients who simultaneously had dental implants with peri-implantitis and without peri-implantitis were included in the study. Forty-four samples with peri-implantitis and 34 samples without peri-implantitis from 16 patients were obtained. Intraoral evaluations such as pocket depth, modified sulcus bleeding index, and modified plaque index were noted. Enzyme-linked immunosorbent assay was used for the evaluation of PISF LL-37 and proteinase 3 levels. RESULTS: PISF volume was significantly increased in the implants with peri-implantitis than those without peri-implantitis (p < 0.05). No difference was present between PISF LL-37 and proteinase 3 total amounts between the implants with and without peri-implantitis (p > 0.05). Pocket depths and PISF LL-37 and proteinase 3 levels were not correlated in the groups (p > 0.05). CONCLUSIONS: PISF volume might be increased in response to peri-implant bone destruction. However, peri-implant tissue destruction caused by peri-implantitis does not seem to affect PISF LL-37 and proteinase 3 levels.

Prospective randomized single-blind study of post-operative bleeding after minor oral surgery in patients with cirrhosis.

BACKGROUND/AIMS: The management of patients with cirrhosis requiring dental extractions is complicated due to an increased risk of post-operative bleeding. Topical hemostatic agents are usually required to control bleeding in these cases, as an adjunct to systemic measures of hemostasis. The aims of this randomized, prospective, single-blind clinical study are twofold. The primary aim is to compare the hemostatic efficacy of chitosan and surgicel in patients with cirrhosis after a tooth extraction, and the secondary aim is to assess the value of the current setting as a clinical model of post-operative bleeding following minor oral surgery. MATERIAL AND METHODS: Fifty patients with cirrhosis scheduled for a tooth extraction under local anesthesia were prospectively included in the study in a randomized fashion. Patients were blinded to the treatment group they were in. The cirrhosis classification, bleeding time, trauma score, and corrected bleeding time (during post-operative reviews) were recorded. Statistical evaluations were done. RESULTS: Study groups had an equal number of teeth extractions (40 teeth each). There were no statistically significant differences between the groups with respect to patient demographics, cirrhosis classification, trauma score, and bleeding time. No side effects were noted. CONCLUSION: Both Celox and Surgicel are effective for controlling bleeding and are safe after a tooth extraction in patients with cirrhosis.

A stepped approach for the management of symptomatic internal derangement of the temporomandibular joint.

BACKGROUND: Internal derangement is the clinical and pathological condition of disc displacement of the temporomandibular joint. Management of these cases involve conservative and surgical treatment options. Minimally invasive surgical procedures namely arthrocentesis and arthroscopy are promising techniques in the management of internal derangement. However patient selection algorithms, indications for minimally invasive procedures and details of the techniques should be further studied for safe and cost effective management of these cases. This manuscript aims to retrospectively analyze the significance of a stepped surgical treatment approach (arthrocentesis under local anaesthesia as the first line of treatment, followed by arthroscopic lysis and lavage under general anaesthesia in unresolving cases) of internal derangement with or without osteoarthritis. METHODS: This is a retrospective cohort study. Case notes of 1414 patients that were managed with a standard protocol were reviewed. Appropriate inclusion and exclusion criteria were set. Thirty-three patients were eligible for inclusion. Parameters recorded were pain-free inter-incisal opening, spontaneous pain, pain on function, difficulty on chewing, and perceived disability on jaw movements. Pre-operative and post-operative (at the end of the follow up period) pain free maximum interincisal opening values were compared with paired t test and the subjective parameters were evaluated with Chisquare analysis. Treatment outcome and success rate according to American Association of Oral and Maxillofacial Surgeons were descriptively shown. RESULTS: Interincisal opening values increased, and the number of patients with severe or medium rated subjective parameters were reduced at discharge. These improvements were found to be statistically significant. Clinical (Wilkes) staging of internal derangement pre-operatively and at discharge remained either unchanged or was lower. Treatment outcome and success according to American Association of Oral and Maxillofacial Surgeons criteria was 94%. CONCLUSION: The stepped approach for the management of symptomatic internal derangement with or without osteoarthritis is a successful treatment strategy with favourable therapeutic outcomes.

The evaluation of peri-implant sulcus fluid osteocalcin, osteopontin, and osteonectin levels in peri-implant diseases.

BACKGROUND: Peri-implant mucositis is an inflammation of the soft tissues surrounding an implant. Peri-implantitis refers to a process characterized by peri-implant bone loss along with an inflammation of the soft tissues. Osteocalcin, osteopontin, and osteonectin proteins are related to bone remodeling. The aim of the present study was to investigate peri-implant sulcus fluid (PISF) osteocalcin, osteopontin, and osteonectin levels in peri-implant mucositis and peri-implantitis. METHODS: Fifty-two implants with peri-implantitis, 46 implants with peri-implant mucositis, and 47 control implants were included in the study. Clinical parameters including probing depth, modified sulcus bleeding index and modified plaque index were recorded. PISF osteocalcin, osteopontin, and osteonectin levels were analyzed by ELISA kits. RESULTS: There were no significant differences in PISF osteocalcin, osteopontin, and osteonectin total amounts between healthy controls, peri-implant mucositis and peri-implantitis groups (P > 0.05). Probing depths were not correlated with PISF osteocalcin, osteopontin, and osteonectin levels in the study groups (P > 0.05). CONCLUSIONS: Soft tissue inflammation around dental implants does not cause a change in osteocalcin, osteopontin, and osteonectin levels in PISF. Also, peri-implantitis does not seem to give rise to an increase in PISF levels of osteocalcin, osteopontin, and osteonectin.

The effect of teeth in mandibular fracture lines.

BACKGROUND/AIM: The decision to retain or extract teeth in the line of mandibular fractures has been a subject of debate in the scientific literature, and there is a need for further evidence to clear this issue. Thus, the aim of this study was to investigate the effects on healing of teeth in the line of mandibular fractures in order to contribute to the field. MATERIAL AND METHODS: The case notes of 100 patients with teeth in the line of 106 mandibular fractures were reviewed. Open reduction and rigid internal fixation (ORIF) was used if elastic intermaxillary reduction failed to achieve a satisfactory occlusion and/or anatomical reduction in the fragments as assessed by orthopantomogram (OPG) and clinical examination. The remaining cases had maxillomandibular fixation (MMF) with an arch bar and bridle wire. RESULTS: Three of the 106 teeth involved in the fracture lines healed with complications. In the cases where the teeth had been removed prior to fracture treatment, or in cases of delayed extractions, no complications were noted. CONCLUSION: The factors which should be considered for removal include the condition of the teeth and alveolar bone, the timing and the type of treatment. This decision should be made on an individual basis considering potential risks to avoid complications.

Lidocaine versus mepivacaine in sedated pediatric dental patients: randomized, prospective clinical study.

UNLABELLED: Dental anxiety is usually seen in the pediatric patients. specially in the case of minor oral surgical procedures and exodontia, cooperation of the patients and their families with the dentist will lead to superior treatment outcomes. Pain control is important in dentistry. The aim of this randomized prospective clinical study is to compare the local anaesthetic and haemodynamic effects of 2% lidocaine (Group 1) and 3% mepivacaine (Group 2) in sedated pediatric patients undergoing primary tooth extraction. STUDY DESIGN: 60 pediatric patients undergoing sedation for elective primary tooth extraction was prospectively included in the study in a randomized fashion. Inclusion and exclusion criteria were assigned. Patients were given premedication via oral route. Local anesthesia was achieved before extraction(s). RESULTS: There were no significant differences between the groups in patient demographics, number of teeth extracted, duration of the operation and time from the end of the procedure to discharge (p ≥ 0.05). FLACC pain scale scores were not statistically significant between the groups, except at 20 minutes post-operatively when the score is significantly lower in Group 2 (p=0.029). CONCLUSION: Prevention of pain during dental procedures can nurture the relationship of the patient and dentist. Tooth extraction under sedation in pediatric patients could be safe with both local anesthetics.

Malnutrition due to bisphosphonate-related osteonecrosis of the jaw in a chronic dialysis patient: case report.

Adequate nutrition is imperative for a successful outcome in dialysis patients. Excellent oral hygiene and an efficient mastication can help to correct several metabolic and endocrine disturbances as well as delay initiation of dialysis in patients with chronic renal failure. However, concerns exist about the risk of malnutrition and protein depletion. On the other hand, intravenous bisphosphonates are the current standard of care for the treatment of hypercalcemia of malignancy and for the prevention of skeletal complications associated with bone metastases. Recently, retrospective case studies have reported an association between long-term bisphosphonate therapy and osteonecrosis of the jaws. This complication occurs either spontaneously or after minor dento-alveolar surgery including extraction of teeth. A malnourished dialysis patient who showed the typical clinical features of bisphosphonate-related osteonecrosis of the jaw (BRONJ) without any obvious radiological changes in his panoramic radiograph is reported. To minimize the risk of BRONJ, patients initiated on bisphosphonates should optimize routine dental care and have their baseline oral health evaluated by both clinical and radiographic examinations before initiation of bisphosphonate therapy.

Analysis of calvarial bone defects in rats using microcomputed tomography: potential for a novel composite material and a new quantitative measurement.

Reconstruction of craniomaxillofacial defects is a challenge for surgeons and has psychological and functional burdens for patients. Undoubtedly, there is a need for improved biomaterials and techniques for craniomaxillofacial reconstruction. We assessed the potential regeneration of bone using three modifications of a novel composite and explored the validity of a new measurement using microcomputed tomography (micro-CT). We placed three different composite samples in calvarial defects in rats and analysed healing with micro-CT. The results showed that polycaprolactone (PCL) with phosphate glass fibre is promising for non-load bearing applications in the craniomaxillofacial region. Also, the new micro-CT measurement of the temporal characterisation of the mineralisation of bone (TCBM) has the potential to evolve into a reliable predictor of bony healing and its quality.

Quantitative morphometric evaluation of critical size experimental bone defects by microcomputed tomography.

Our aim was to show that microcomputed tomography is a useful tool for acquiring high-resolution three-dimensional tomographic images to assess bone healing, the interface with materials, and the biocompatibility of bone substitutes. Acquired images can be used for non-invasive quantitative morphometric analysis of regenerating bone, leaving the option for conventional histology to be an adjunct used at defined intervals. The temporal characterisation of the mineralisation of bone potentially has a critical role in the understanding of the dynamics of mineralisation of healing bone. This has applications both for degradable and bioactive materials and for pharmaceutical products that act on bone. Formal validation of this promising new technique will be a critical part of continuing studies.

Thirty-five percent carbamide peroxide application causes in vitro demineralization of enamel.

OBJECTIVES: The objective of this in vitro study was to investigate whether a high concentration 'in-office' bleaching agent affected the mineral content of enamel and dentin. METHODS: A commercially available 35% carbamide peroxide bleaching agent was applied for 2h to sectioned teeth (n=11). Specimens were then immersed in artificial saliva at 37 degrees C for a further 24h to simulate the oral environment. Tomographic images of these sections were obtained (micro-CT 80, Scanco, Switzerland) prior to and post-bleach application. Eight three-dimensional regions of interest (ROI), starting from the enamel surface extending to the dentinoenamel junction, were selected for each section. The hydroxyapatite equivalent mineral concentrations (g/cm(3)) of the ROIs were calculated. Any changes in mineral content as a consequence of the bleaching procedure were calculated in relation to each ROI. RESULTS: There was a significant reduction in the mineral content of enamel specimens post-bleach application extending to a depth of 250microm (paired t-test, p<0.05); this reduction in mineral content was greatest in the ROI's closest to the tooth surface. There was, however, no significant difference in the mineral content of dentin as a consequence of bleaching. SIGNIFICANCE: This in vitro study has shown that significant demineralization of enamel occurred following bleaching with 35% carbamide peroxide. The concept that 'in-office' bleaching is a non-destructive cosmetic procedure should be reconsidered.

Microcomputerised tomography evaluation of 10% carbamide peroxide applied to enamel.

OBJECTIVES: There is still some controversy in the dental literature whether carbamide peroxide bleaching causes demineralization of teeth. One of the reasons for this controversy is that there is as yet no reliable, non-destructive in vitro method for assessing mineral loss in bleached teeth. The objective of this study was to investigate the possible demineralization effect of 10% carbamide peroxide bleaching agent on enamel and dentine non-destructively. METHODS: microCT images were obtained of 12 human molar tooth sections. These sections had 10% carbamide peroxide applied for eight hours a day over a period of 15 days. Further tomographic images were obtained and the mineral content prior to and post bleaching assessed. RESULTS: A total of 144 regions were evaluated using the image processing language available in the work station. The application of 10% carbamide peroxide was found to cause demineralization of the enamel extended to a depth of 50 microm below the enamel surface (Paired t-test, p<0.05). CONCLUSIONS: This study confirmed that microCT was indeed a highly suitable method for assessing mineral content of dental enamel after bleach application. It is recommended that application of bleaching agents should be carefully considered in patients susceptible to caries and tooth wear.

A modified method for preparing platelet-rich plasma: an experimental study.

PURPOSE: In this study, our aim was to prepare low-cost autogenous platelet-rich plasma (PRP) for use in minor bone grafting procedures. This was the preliminary study of an experimental study concerning augmentation of bony defects with a mixture of PRP and beta-tricalcium phosphate. MATERIALS AND METHODS: Venous blood was collected from marginal ear veins of New Zealand White rabbits in EDTA (K3) vacutainer tubes. Blood samples were divided into 2 groups, and PRP was prepared through 2 methods, 1 of which is a variant of the other. The 2 PRP preparation methods described in this study were modified from Landesberg et al (J Oral Maxillofac Surg 58:297, 2000) after several trials, because the platelet enrichment percentages we obtained using their method were very low. Complete blood counts of venous blood samples, PRP, and platelet poor plasma (PPP) were made. Statistical analyses were performed using SPSS for Windows (SPSS, Chicago, IL). RESULTS: It took approximately 30 minutes to prepare PRP with both methods. Platelet counts in PRP were increased with respect to venous blood platelet counts. The differences between the experimental groups and genders were evaluated statistically with Mann-Whitney U tests (P < .05). Correlations between the groups and genders were also evaluated (P < .05). CONCLUSION: It was experimentally shown that PRP with high platelet counts can be prepared using this modified method without the need for costly autotransfusion systems.