Comparison of single- and double-puncture arthrocentesis for the treatment of temporomandibular joint disorders: A six-month, prospective study.

Objective: To compare the efficacies of single- and double-puncture arthrocentesis in patients with temporomandibular joint (TMJ) with closed lock (CL).Methods: Arthrocentesis procedures were performed in 32 joints from 32 patients with magnetic resonance imaging-based diagnoses of anterior disc displacement without reduction. The patients were randomly divided into two groups according to the surgical procedure received (single-puncture arthrocentesis Type 1 or double-puncture). Maximum mouth opening, pain at rest, pain while chewing, pain at maximum mouth opening, tenderness level, and treatment tolerability were measured. Procedure duration and analgesic required were also considered.Results: The rates of improvement of the outcome variables were not significantly different between the two groups. However, the duration of the single-puncture arthrocentesis technique was significantly longer than the double-puncture (p ˂ 0.0001).Conclusion: Both the single- and double-puncture technique are similarly tolerated and efficacious for the treatment of temporomandibular joint disorders.

Is History of Periodontitis a Risk Factor for Peri-implant Disease? A Pilot Study.

PURPOSE: The aim of this pilot study was to evaluate clinical outcomes of implant treatment in periodontally compromised patients. MATERIALS AND METHODS: Partially edentulous patients who were diagnosed and treated for chronic periodontitis and later rehabilitated with implant-supported single crowns or fixed partial dentures were enrolled in this study. At the final follow-up, data on probing pocket depth and bleeding on probing were collected, and changes in peri-implant bone levels were assessed on periapical radiographs. Accordingly, patients were categorized into peri-implant disease-free (PID-free), peri-implant mucositis (PIM), or peri-implantitis (PI) groups. Additionally, information on the history of systemic diseases was obtained and correlated with the findings. RESULTS: Seven females and six males with a mean age of 55.2 (standard deviation [SD] ± 8.38) years were included in this study. Fifty-five implants were placed in 13 partially edentulous patients with a history of chronic periodontitis. The mean follow-up in the study was 35.1 (SD ± 2.40) months. No implants were lost in the 13 patients, for a cumulative survival of 100%. PI was confirmed in 3 patients and PIM in 8 patients, while 2 patients were found to be PID-free. Diabetes and hypertension were found to be the predominant systemic factors among patients affected by peri-implant diseases. CONCLUSION: Patients with a history of periodontitis are at considerable risk of being affected by peri-implant mucositis, if not by peri-implantitis.

Comparison of the efficiency of irrigation of single and double-needle techniques of temporomandibular joint arthrocentesis: A cadaver study.

OBJECTIVE: To compare the efficacy of the double- and single-needle arthrocentesis techniques in removing methylene blue from the temporomandibular joint (TMJ) space. METHODS: This study was performed in 20 TMJs from 10 fresh cadavers. A total of 1 ml of 10 µM methylene blue solution was injected into the upper joint spaces, just prior to irrigation. Ten arthrocentesis procedures were carried out using the double-needle technique, and the remaining 10 were completed using the single-needle technique. The photo-absorbance values of methylene blue solution injected into and removed from the joint space were measured at a 665 nm wavelength. Statistical analysis was performed using Shapiro-Wilks test and t-test. RESULTS: The t-test analysis showed no statistically significant difference between the two methods in the removal of methylene blue. CONCLUSION: According to the results of the present study, the single-needle technique may be a good alternative with the advantages of easier application in cases where it is not possible to perform the double-needle technique.

Histomorphometric Comparison of Bone Regeneration in Critical-Sized Bone Defects Using Demineralized Bone Matrix, Platelet-Rich Fibrin, and Hyaluronic Acid as Bone Substitutes.

AIM: To compare bone regeneration in the critical-sized bone defects grafted with demineralized bone matrix, platelet-rich fibrin, and hyaluronic acid in rats. MATERIALS AND METHODS: Forty Wistar Albino rats allocated into 4 experimental groups: platelet-rich fibrin (PRF) group, noncross-linked hyaluronic acid gel (HA) group, demineralized bone matrix in putty form (DBM) group, and control group. A critical-sized defect of 8 mm was formed involving the sagittal suture for each rat under anesthetic induction. All animals were sacrificed at 21st day after surgery and histomorphometric parameters of total horizontal length (THL) and total vertical length (TVL) of newly produced bone and longest bone trabecula (LBT) were measured in the histologic slides. The difference between experimental groups for these parameters was analyzed. RESULTS: There was statistically significant difference in THL and LBT but not in TVL. Total horizontal length was significantly increased in DBM group compared with control and HA groups (P < 0.05). There was also statistically significant increase in THL in PRF group compared with control group (P < 0.05). Longest bone trabecula significantly increased in DBM group compared with HA group (P < 0.05). There was also statistically significant increase in HA group compared with control group (P < 0.05) and LBT significantly increased in PRF group compared with HA group (P < 0.05). CONCLUSION: The sole usage of HA does not effectively increase bone regeneration when compared with DBM and PRF. The DBM and PRF do not have superiority to each other in the bone regeneration while they are superior to HA.

Clinical relevance of the utilization of vital Lugol's iodine staining in detection and diagnosis of oral cancer and dysplasia.

OBJECTIVES: The aim of this study is to assess the clinical relevance of the utilization of vital Lugol's iodine staining in detection of oral cancer and dysplastic lesions as well as demarcation of the extent of these lesions. MATERIALS AND METHODS: A prospective, cross-sectional, hospital-based study was performed in Khartoum Teaching Dental Hospital, Sudan. Suspicious oral epithelial lesions indicating incisional biopsy were stained with 10 % Lugol's iodine solution and were clinically designated as "negative" for dysplasia or neoplasia when no unstained lesion (USL) area was observed, or as "positive" when a USL area is observed. Incisional biopsies involving both the unstained portion and the stained portion were obtained and histologically evaluated for definitive diagnosis. RESULTS: Forty-five biopsies were obtained from 28 patients. Histopathological examination of the specimens confirmed some degree of dysplasia or neoplasia in all clinically positive specimens with oral squamous cell carcinoma (OSCC) being the most common definitive diagnosis (17 patients, 60.7 %). Clinical relevance level of vital Lugol's iodine staining in detecting oral cancer and dysplasia was found to be 90.9 % (SE = 0.05, P = 0.05). CONCLUSION: The findings of this study showed that Lugol's iodine is an easy, safe, and effective method of visualizing oral epithelial lesions and differentiating epithelial carcinoma and dysplasia from other benign mucosal lesions. Despite certain limitations, its use is of great value in detection and diagnosis of oral cancer and dysplasia. CLINICAL RELEVANCE: Lugol's iodine staining can effectively be used in detection of the dysplastic and malignant superficial lesions of the oral epithelium.

The Comparison of the Efficacy of Blue Light-Emitting Diode Light and 980-nm Low-Level Laser Light on Bone Regeneration.

The aim of this study is to histologically compare effects of blue light-emitting diode (LED) light (400-490 nm) and Ga-Al-As low-level diode laser light (980 nm) on bone regeneration of calvarial critical-sized defects in rats. Thirty Wistar Albino rats were included in the study. The experimental groups were as follows: blue LED light (400-490 nm) group (LED); 980-nm low-level laser light group (LL); and no-treatment, control group (CL). A critical-sized defect of 8 mm was formed on calvaria of rats. Each animal was sacrificed 21 days after defect formation. Calvarias of all rats were dissected and fixated for histological examination. Histomorphometric measurements of total horizontal length of the newly produced bone tissue, total vertical length of the newly produced bone tissue, and diameter of the newly produced longest bone trabecula were performed with a computer program in micrometers. There was a statistically significant increase in the total horizontal length and total vertical length in LL and LED groups compared to that in the CL group (P < 0.05), while there was no statistical difference between LED and LL groups (P > 0.05). A statistically significant difference was observed in the longest bone trabecula and LL groups compared to that in CL (P < 0.05), but not between LED-CL and LED-LL groups (P > 0.05). In conclusion, blue LED light significantly enhances bone regeneration in critical-sized defects when compared with CL group, but does not have a statistically significant effect on bone regeneration when compared with 980-nm low-level laser light.

The efficacy of Er,Cr:YSGG laser supported periodontal therapy on the reduction of peridodontal disease related oral malodor: a randomized clinical study.

BACKGROUND: This study aims to evaluate the efficacy of Er,Cr:YSGG laser assisted periodontal therapy on the reduction of oral malodor and periodontal disease. METHODS: Sixty patients with chronic periodontitis were included in the study and allocated into two groups each containing 30 patients. The study was planned in a double blind fashion. Conventional periodontal therapy was performed in group 1 and conventional periodontal therapy was performed in association with Er,Cr:YSGG application in group 2. Periodontal parameters of probing depth, clinical attachment level, plaque index and bleeding on probing were measured with a periodontal probe. Quantitative analysis of volatile sulphure compunds (VSCs) were measured with a calibrated halimeter at baseline level and at post-treatment 1st, 3rd and 6th months. P values <0.05 were accepted as statistically significant. RESULTS: There was a statistical significant reduction in VSC values in group 2 at post-treatment 3rd and 6th months (p < 0.05). Pocket depth values at post-treatment 1st month and bleeding on probing values at post-treatment 3rd and 6th months were significantly decreased in group 2 (p < 0.05). Intragroup statistical analysis revealed that there were statistically significant differences for all parameters (p < 0.01). CONCLUSIONS: Er,Cr:YSGG laser assisted conventional periodontal therapy is more effective in reducing oral malodor and improving periodontal healing compared to conventional periodontal therapy alone.

Extensive ameloblastic fibroma of the mandibula in a female adult patient: A case report with a follow-up of 3 years.

Ameloblastic fibroma (AF) is rare benign odontogenic tumour which usually occurs in the first two decades of life. It can occur either the mandible or maxilla but it is most frequently found in the posterior region of the mandible. Treatment of AF in usual is a conservative approach, such as enucleation and curettage but the aggressive lesions require a radical approach. A more radical approach should be considered in older patients who have likely high recurrence tendency. This report describes a case of AF in a 38-year-old female patient identified during a routine radiographic exam. Tomographic examination through three-dimensional reconstruction indicated vestibular fenestration of the cortical bone, with involvement of lingual cortical bone as the lession extended to the posterior region. We removed the tumor under local anesthesia. In this case patient has continued to be followed frequently and has been disease-free for 3 years.

Relationship between activity of gluthatione peroxidase and nitric oxide in synovial fluid and the progression of temporomandibular joint internal derangement.

The purposes of this study were to measure the activity of glutathione peroxidase (GPX) and nitric oxide (NO) in the synovial fluid of patients with temporomandibular joint (TMJ) internal derangement (ID) and to indicate the relationship between the activity of GPX and NO and the progress of the ID. Twenty-six patients with TMJ ID were identified and classified according to Wilkes staging through clinical and radiologic examinations. Levels of GPX were determined indirectly by a coupled reaction with glutathione reductase. Levels of NO were measured colorimetrically. The activity of GPX and NO was observed to be progressively increasing as the stage of the TMJ ID progressed. There were significant correlations between the 2 substances and the Wilkes stages. Oxidative stress may have a role in the pathogenesis of TMJ ID. In synovial fluid, GPX and NO activities are increased as the stage of the disease increased. Increase in the activities of GPX might not be enough to prevent progression of the TMJ ID.

Mandibular hypomobility after orthognathic surgery: a review article.

PURPOSE: To answer 2 specific questions in relation to mandibular hypomobility after orthognathic surgery (OGS): 1) Is hypomobility after OGS permanent? 2) Is there any underlying mechanism? MATERIALS AND METHODS: A Medline and PubMed search was performed to locate relevant articles. To meet inclusion in this review, articles were required to include patients with no pre-existing temporomandibular joint (TMJ) disorders who had been treated by the commonly performed OGS procedures. Case reports, pilot studies, and review articles were excluded. Twelve electronic search articles were identified. Manual search of the reference lists of these articles added another 11 articles. RESULTS: Of the 23 potentially relevant articles, 7 were considered eligible for inclusion. Five articles were retrospective and 2 were prospective. Vertical maxillary excess, Class II malocclusion, and Class III malocclusion were addressed in 344 patients who underwent Le Fort I maxillary osteotomy, sagittal split mandibular ramus osteotomy, or intraoral or extraoral vertical mandibular ramus osteotomy. Mandibular ramus surgeries were performed alone or in combination with Le Fort I osteotomy. Mandibular hypomobility, in terms of incisal range of motion, was measured with a ruler in 5 studies, with a Perspex triangular trismus gauge in 1 study, and with a jaw motion analyzer system in 1 study. Two studies reported permanent decreases in all ranges of mandibular motion 2 years after surgery and 5 studies did not support the notion that OGS affects mandibular mobility permanently. No mechanism for hypomobility after OGS was identified. CONCLUSION: Mandibular hypomobility after OGS is still in need of long-term prospective studies with homogenous patient samples of dentofacial deformities and the same TMJ conditions treated by the same experienced surgeon with adequate follow-up, internal controls, and blinding of examiners.

Immune modulatory and antioxidant effects of melatonin in experimental periodontitis in rats.

Melatonin is an important antioxidant, and through its anti-inflammatory effects it can control immune responses, oxidative stress, and defense cell infiltration. Periodontitis is a disease of the oral cavity and the generation of free radicals is an important consideration in this disease. Therefore, we examined the immune-modulatory and antioxidant roles of melatonin in the treatment of periodontitis. In all, 30 male Wistar rats were randomly divided into three groups: the control group, the periodontitis-induced (PED) group, and the periodontitis+melatonin treatment (MEL+PED) group. The control group received no treatment, whereas periodontitis was induced in both the PED and the MEL+PED groups, with the MEL+PED group being treated with systemic melatonin. For the periodontitis-induced groups, the rats' mandibular first molar teeth were ligatured (3-0 cotton) in a submarginal position for 4 weeks, and then the ligature was removed. After removal of the ligature, melatonin was administered only to the MEL+PED group (an ip dose of 10mg/kg body wt for 15 days at 11:00 PM each day). In the histological examination, the MEL+PED group, which received the melatonin, showed reduced inflammatory cytokines (IL-1ß, from 97.47 to 84.24pg/ml; TNF-α, from 0.22530 to 0.22519pg/ml), regulated oxidative stress parameters (MDA, from 41,458 to 30,708nmol/g; GSH, from 18,166 to 25,858nmol/mg), and less periodontal tissue destruction (CEJ-PL, lingual, from 244.54 to 140.57µm; buccal, from 235.6 to 158.93µm; and CEJ-BC, lingual, from 383.65 to 287.76µm; buccal, from 391.92 to 296.12µm). From these findings we conclude that, even when periodontitis was induced, melatonin reduced the oxidative damage in the rats' periodontal tissue by inhibiting the inflammatory effects and by restoring the antioxidants.

A review of techniques of lysis and lavage of the TMJ.

We systematically reviewed publications in the English language about techniques of lysis and lavage of the temporomandibular joint (TMJ). We describe these techniques and describe their advantages and disadvantages.

An erupted complex odontoma.

Odontomas are benign tumors of odontogenic origin. The cause of the odontoma is unknown, but it is believed to be hereditary or due to a disturbance in tooth development triggered by trauma or infection. Odontomas may be either compound or complex. Although these tumors are seen frequently, erupted odontomas are rare. The purpose of this study is to present a rare case of complex odontoma that erupted into the oral cavity.

Evaluation of volumetry and density of mandibular symphysis bone grafts by three-dimensional computed tomography.

PURPOSE: Bone grafting before implant placing can improve the treatment in traumatized or regular implant patients. The aim of this study was to evaluate the density and maximum amount of harvestable bone graft in the mandibular symphysis. MATERIALS AND METHODS: Data from 15 CT-scans were obtained from 15 adult patients (10 male/five female) for the purposes of this study. The CT data, in DICOM format, were read into Mimics software from Materialize (Leuven, Belgium), with a slice thickness of 0.5 mm. The volume, density, and dimensions based on Hounsfield units (HU) were measured on the 3D symphyseal bone graft using Mimics software. RESULTS: The average bone volume calculated from the mandibular symphysis was 3491.08 +/- 772.12 mm(3). The average sized corticocancellous block that was measured was 38.75 x 11.05 x 7.80 mm. The mean bone density was 958.95 +/- 98.11 HU. CONCLUSION: The use of three-dimensional computed tomography (3D CT) in combination with a software program is a reliable means of determining the density of graft, evaluating maximal volume and dimensions of the graft that can be harvested from the mandibular symphysis region.

Mastication and late mandibular fracture after surgery of impacted third molars associated with no gross pathology.

PURPOSE: This study was undertaken with the null hypothesis that in patients, fully denate or with 1 or 2 teeth missing and older than 25 years, mastication does not affect late mandibular fracture after surgical removal of impacted third molars (M3s) associated with no gross pathology. MATERIALS AND METHODS: Five hundred sixty patients, fully dentate or with 1 or 2 teeth missing and older than 25 years who had no gross pathology associated with their impacted lower M3s, were recruited in this study. They were operated on under local anesthesia using a standard technique and randomly assigned into 2 groups for nonroutine (NR group) and routine (R group) postoperative instructions. In the NR group, patients were postoperatively educated in the possibility of mandibular fracture and were given an emphasis on the necessity of limiting mastication to a soft diet for 4 weeks. In the R group, patients were given no such education or emphasis. Patients were followed up for 2 months, and data concerning patients' age and gender; tooth position, angulation, and depth; date and site of surgery; and occurrence of late mandibular fracture were recorded and statistically analyzed. A value of P less than .05 was considered statistically significant. RESULTS: In no patient group was there a late mandibular fracture recorded. All patients completed the follow-up period, and most of the R group patients had normal eating habits 10 to 14 days after surgery. In no patient group was there a statistically significant difference in relation to gender (P = .735), site of surgery (P = .552), class horizontal space available (P = .427), class highest portion of the M3 crown (P = .424), angulations of the teeth (P = .925), and severity of impaction (P = .445). CONCLUSIONS: In patients, fully dentate or with 1 or 2 teeth missing and older than 25 years who have no jawbone atrophy and no systemic problems that may impair bone strength, mastication seems not to affect late mandibular fracture after surgical removal of impacted M3s associated with no gross pathology. The remote possible risk of the late fracture shown in our patients indicates the need for no special precautions.

Impacted mandibular canines.

AIMS: The aim of the present study was to investigate the incidence of impacted mandibular canines, the associated pathology of these teeth, and to classify them. METHODS AND MATERIALS: This is a retrospective cohort study of 5022 panoramic radiographs taken of patients who presented to the Oral and Maxillofacial Surgery Service of the Faculty of Dentistry at Ataturk University in Erzurum, Turkey between January, 1998 and March, 2006. The panoramic radiographs and clinical data were reviewed. Observations were made on the status of missing permanent mandibular canines; retained deciduous canines; side and number of mandibular canines; sex and age of patients; and any other associated pathology or symptoms as well as treatment methods employed. RESULTS: The incidence of mandibular canine impaction is 1.29% in the 5022 individuals of this Turkish subpopulation. A total of 65 patients had impacted mandibular canines with 33 being females and 32 males. In this study 41 impacted mandibular canines were extracted. Twenty-three canines were attached to bonded buttons for orthodontic eruption purposes. After surgical exposure, one impacted canine was transplanted and the others were left in place for observation. CONCLUSIONS: Maxillary canine impaction is more frequent than mandibular canine impaction. Mandibular canine impaction incidence in this study was found higher than in the published literature to date. This result may be evidence of an actual increase of the number of impacted mandibular canine teeth among patients.

Developmental disturbance of maxillary lateral incisor after trauma.

Traumatic injury to a primary tooth has a potential to damage the underlying permanent tooth germ. It may lead to developmental disturbance of permanent dentition. The impaction of the permanent maxillary central incisor because of the root dilaceration in children is rare. The purpose of this paper is to report a developmental disturbance of a permanent right maxillary lateral incisor in a 12-year-old girl with a history of trauma at an early age.

Submandibular tuberculous lymphadenitis after endodontic treatment of the mandibular first premolar tooth: report of a case.

Cervical tuberculous lymphadenitis (scrofula) is an infectious granulomatous disease that requires a precise diagnosis. The differential diagnosis involves mainly the pathologic conditions involving the regional lymph nodes and the submandibulary salivary glands. Although tuberculous lesions generally develop secondary to pulmonary disease, clinical manifestations are occasionally seen with no evidence of involvement of the lungs. In this report, a case of tuberculous submandibular lymphadenitis developing after endodontic treatment of the mandibular first premolar tooth is described.

A one-year review of craniofacial injuries in amateur soccer players.

The purpose of this study was to investigate the rate of craniofacial injuries in amateur soccer and help us better understand the nature of these injuries. Retrospective study was carried out using records from the patients with craniofacial injuries associated with soccer activities. All data were collected on the basis of sex, age, type and anatomic site of the injury. In the one-year period of this study, 11/53 cases with craniofacial injuries associated with soccer activities have been treated in our clinic. The highest incidence was in the 18 to 24 year age group (mean age 20.7) with male propensity. The majority of the patients suffered from dento-alveolar fractures (36%), followed by temporomandibular joint disorders (27%), mandibular fractures (27%), and nasal fractures (9%). The most common cause of the fractures was impact against another player (63.6%), followed by impact against equipment (18.2%) and impact against the ground (18.2%). These results show that there is a high risk of potential oral and craniofacial injury during soccer activities.