Effects of combination TGF-B1 transfection and platelet rich plasma (PRP) on three-dimension chondrogenic differentiation of rabbit dental pulp-derived mesenchymal stem cells.

Aim: The aim of this study was to evaluate the effects of standard culture medium and chondrogenic differentiation medium with PRP on chondrogenic differentiation of rabbit dental pulp-derived mesenchymal stem cells (rabbit DPSCs) that are transfected with transforming growth factor-beta 1 (TGF-B1) gene, based on the hypothesis of TGF- B1 and PRP can be effective on the chondrogenesis of stem cells. Materials and Methods: Rabbit DPSCs were characterized by using flow cytometry, immunofluorescent staining, quantitative Real Time Polymerase Chain Reaction (qRT-PCR) and differentiation tests. For the characterization, CD29, CD44 and CD45 mesenchymal cell markers were used. Rabbit DPSCs were transfected with TGF-B1 gene using electroporation technique in group 1; with PRP 10% in group 2; with chondrogenic medium in group 3; with both chondrogenic medium and PRP in group 4. DPSCs were cultured in medium with 10% inactive PRP in group 5, chondrogenic medium in group 6, chondrogenic medium with PRP 10% in group 7. SOX9, MMP13 and Aggrecan gene expression levels were evaluated in 3, 6, 12. and 24. days by qRT-PCR. Results: The expression levels of SOX9, MMP13 and Aggrecan were higher in group 2, 3 and group 7 in 3th day however in 24th day group 7 and group 2 were found higher. The expression levels changed by time-dependent. The extracellular matrix of the cells in experimental groups were positively stained with safranin O and toluidine blue. Conclusion: The combination in culture medium of TGF-B1 gene transfection and 10% PRP accelerates the chondrogenic differentiation of DPSCs.

Vascular Complications in Le Fort I Osteotomy: Incidence, Reasons, and Management of the Intraoperative Hemorrhage.

PURPOSE: The aim of this study was to investigate the incidence, types, and reasons for the intraoperative hemorrhage during Le Fort I osteotomy. METHODS: The study sample was composed of the population of the patients who underwent orthognathic surgery from April 2011 to February 2017. The vascular complications of the patients who underwent Le Fort I osteotomy during the surgery were identified. Type of the bleeding, suspected vessel, amount of the intraoperative blood loss, cause, and management of the bleeding were specified and investigated. Descriptive statistics were computed for each study variable. RESULTS: A total of 200 patients underwent Le Fort I osteotomy. The sample's mean age was 22.4 ± 5.8 and 55.5% of patients were female. The intraoperative vascular complication was seen in only 10 (5%) samples. The suspected source of the hemorrhage was the descending palatine artery (DPA) in 8 (4%) cases, while the pterygoid venous plexus in the other 2 (1%) cases. The cause of the bleeding was suspected down-fracture in 8 cases, while pterygomaxillary junction (PMJ) separation in the other 2 cases. DPA was ligated with ligation clips and cauterized in arterial injury cases. The hemorrhage was taken under control using a hemostatic matrix with thrombin (Surgiflo, Ethicon, USA) in the venous bleeding cases. CONCLUSIONS: The down-fracture of the maxilla was found to be more related to the occurrence of vascular complications. Severe bleeding was managed by the use of the hemostatic matrix with thrombin and this hemostatic agent can be used to control this type bleedings in orthognathic surgery.

Is Ultrasonic Bone Scalpel Useful in Le Fort I Osteotomy?

PURPOSE: Safety and precision are 2 main goals in research to improve bone cutting in maxillofacial surgery. The aim of this prospective clinical study was to analyze the outcomes using an ultrasonic bone scalpel versus a piezoelectric surgical device and the conventional technique in a Le Fort I osteotomy. MATERIALS AND METHODS: We designed a prospective, randomized, single-blind cohort study. The predictor variables were the devices used to perform the Le Fort I osteotomy, divided into 3 groups: 1) ultrasonic bone scalpel (BoneScalpel; Misonix, Farmingdale, NY), 2) piezoelectric surgical device, and 3) conventional technique (Lindeman burr and reciprocal saw). The primary outcome of the study was cutting time, whereas secondary outcomes were length of the procedure, total blood loss, intraoperative complications, and postoperative edema. Other variables of interest were age and gender. Data were analyzed using 1-way analysis of variance and the Kruskal-Wallis test. RESULTS: The study sample was composed of 34 patients with a mean age of 21.5 years, and 63.3% of patients were women. The mean cutting time (P < .001) and length of the procedure (P = .012) were significantly shorter with the bone scalpel than with the other types of surgery. The ultrasonic bone scalpel showed a significant reduction in intraoperative blood loss of up to 45% compared with the piezoelectric surgical device and the conventional technique (P = .038). CONCLUSIONS: The results of this study suggest that the ultrasonic bone scalpel is an effective ultrasonic bone-cutting instrument in a Le Fort I osteotomy as evidenced by the significant decrease in the cutting time, intraoperative blood loss, and postoperative edema compared with the other techniques.

Evaluation of the Pterygomaxillary Separation Pattern in Le Fort I Osteotomy Using Different Cutting Instruments.

PURPOSE: Pterygomaxillary separation (PMS) is considered the main reason for serious complications associated with Le Fort I osteotomy. The aim of this study was to evaluate whether a piezo surgery, ultrasonic bone scalpel, or conventional bur used in Le Fort I osteotomy has an influence on PMS patterns. MATERIALS AND METHODS: Using a retrospective cohort study design, we enrolled a sample composed of patients who underwent orthognathic surgery. The primary predictor variables were the cutting instruments (ultrasonic bone scalpel, piezo surgery, and Lindeman bur) used to perform Le Fort I osteotomy. Other variables were demographic and anatomic parameters. The outcome variable was the type of PMS pattern, classified as follows: type 1, PMS at the pterygomaxillary junction (ideal PMS); type 2, PMS at the greater palatine foramen; type 3, PMS from the posterior wall of the maxillary sinus; and type 4, PMS with lateral or medial pterygoid fracture. Anatomic parameters, that is, the thickness and width of the pterygomaxillary junction and distance of the greater palatine foramen, were measured on preoperative cone-beam computed tomography images. The pattern of PMS was evaluated on postoperative cone-beam computed tomography. Data were analyzed using analysis of variance and the Pearson χ2 test. P < .05 was considered statistically significant. RESULTS: This study sample was composed of 96 PMSs in 48 patients. The most common type of PMS was type 1 (58), followed by type 4 (21), type 2 (10), and type 3 (7). A statistically significant relation was found between the cutting instrument and the ideal separation (type 1 PMS) pattern (P = .032), and the highest rate of the ideal separation pattern was seen in the ultrasonic bone scalpel group, at 24 of 32, compared with 22 of 38 in the piezo surgery group and 12 of 26 in the conventional bur group. CONCLUSIONS: According to the study, the ultrasonic bone scalpel is safer than other cutting instruments in terms of the ideal separation of the pterygomaxillary junction.

Risk Factors Influencing Recovery of Neurosensory Disturbances Following Sagittal Split Ramus Osteotomy.

PURPOSE: The aim of this study is to determine the risk factors influencing the recovery time of neurosensory disturbances (NSD) following sagittal split ramus osteotomy. METHODS: One hundred twenty-seven patients (254 operated sites) underwent sagittal split ramus osteotomy due to dentofacial deformities between the period of 2011 and 2017. These patients were followed up for at least 1 year, and the data obtained from changes in sensation of inferior alveolar nerve were recorded subjectively. The subjects were categorized according to age, gender, type of deformity, nerve manipulation, side of the jaw, and the amount of the mandibular movement. The relationship between the above-mentioned parameters, and the recovery time of NSD were investigated. Pearson χ analysis was used, and the value of significance was accepted as P < 0.05. RESULTS: The recovery time of NSD is significantly correlated with the age of the patients, the amount of the mandibular movement (>7 mm), and the nerve manipulation (P < 0.05). There was no statistically significant correlation found between the recovery time of NSD and gender, type of deformity, side of the jaw (P > 0.05). CONCLUSIONS: The recovery time of NSD may prolong in cases of large amounts of mandibular movements more than 7 mm or the nerve manipulation. The older age may increase the risk of permanent NSD.

Does Single-Dose Preemptive Intravenous Ibuprofen Reduce Postoperative Pain After Third Molar Surgery? A Prospective, Randomized, Double-Blind Clinical Study.

PURPOSE: The aim of the present study was to identify the preemptive analgesic effect of intravenous (IV) ibuprofen before and after mandibular third molar surgery. MATERIALS AND METHODS: We randomly divided 75 patients into 3 groups. Group 1 received IV ibuprofen 60 minutes before surgery and IV placebo (100 mL of saline) after surgery. Group 2 received IV placebo (100 mL of saline) before surgery and IV ibuprofen 60 minutes after surgery. Finally, group 3 received IV placebo (100 mL of saline) 60 minutes before and after surgery. Postoperative pain was recorded using a visual analog scale at 1, 2, 4, 6, 8, 12, and 24 hours within the postoperative period. The total dose of rescue acetaminophen intake was recorded during the first 24 hours of the postoperative period. RESULTS: The efficacy of postoperative analgesia was greater within the preoperative IV ibuprofen group compared with the other groups (P < .001). The placebo group had required more rescue analgesia within the first hour compared with the other groups. The average dose of acetaminophen administered in group 1 was 640 mg compared with 1240 mg in group 2 and 1840 mg in group 3 within the first 24 hours after surgery (P < .001). CONCLUSIONS: The present study has shown that the preemptive use of IV ibuprofen resulted in less pain and a decrease in the requirement for rescue analgesia during the first 24 hours after third molar surgery.

Evaluation of Vestibular Bone Thickness in Class I Malocclusion Treatment With Corticotomy-Assisted Rapid Orthodontics.

BACKGROUND: Corticotomy-assisted rapid orthodontics is a widely used method for speeding up conventional orthodontics. This study (i) evaluates the effects of corticotomy alone, corticotomy combined with bone graft, and corticotomy with platelet-rich fibrin (PRF) on vestibular alveolar bone thickness in patients with class I malocclusion; (ii) compares the treatment time with a conventional orthodontic therapy group, and (iii) investigates the periodontal health of patients who have undergone corticotomy-assisted rapid orthodontics. METHODS: The patients were divided into 3 groups: Group 1 (n = 10) underwent corticotomy alone; Group 2 (n = 10) underwent corticotomy combined with bone graft, and Group 3 (n = 10) underwent corticotomy combined with PRF. In the following stage, vestibular alveolar bone thicknesses were evaluated using 3-dimensional cone-beam computed tomography images. RESULTS: The findings showed that Group 2 achieved a more significant augmentation of the vestibular alveolar bone than Groups 1 and 3 (P = 0.001, P = 0.003), while corticotomy-assisted rapid orthodontics decreased treatment times. Sufficient alveolar bone thickness and preservation of the periodontal health were achieved when the corticotomy procedure was either combined with a bone graft or with PRF in the Class-I malocclusion patients. CONCLUSION: Bone grafts provided better bone thickness at the buccal surface of the anterior teeth of the mandible and maxilla, whereas the thickness of the keratinized gingiva was better with PRF.

The changes of self-esteem, sensitivity to criticism, and social appearance anxiety in orthognathic surgery patients: A controlled study.

OBJECTIVES: To evaluate the changes of psychologic parameters, such as self-esteem, sensitivity to criticism, and social appearance anxiety, in skeletal Class III patients undergoing orthognathic surgery and to compare the psychologic status of skeletal Class III patients with control subjects. METHODS: The first group consisted of 60 patients with a mean age of 22.07 ± 1.30 years who did not need orthognathic surgery. The second group comprised 45 patients with skeletal Class III malocclusion (mean age 21.40 ± 2.02 years) who were evaluated in terms of psychologic changes from before to after surgery. A third group consisted of 50 Class III patients (mean age 20.09 ± 2.59 years) who were evaluated before surgery and a different 50 Class III patients (mean age 22.15 ± 2.03 years) who were investigated after surgery. The Rosenberg Self-Esteem Scale and the Social Appearance Anxiety Scale were used to evaluate psychologic parameters both before and after surgery. Analysis was carried out with the use of independent- and dependent-sample t tests, 1-way analysis of variance, and post hoc Tukey test. RESULTS: Self-esteem of the patients with skeletal Class III malocclusion increased, and sensitivity to criticism and social appearance anxiety decreased significantly after the surgery (P <0.001). In the patients with Class III malocclusion, self-esteem was significantly lower and social appearance anxiety significantly higher before orthognathic surgery than in the control group, and at the postoperative evaluation Class III patients had significantly higher self-esteem than the control group (P <0.001). CONCLUSIONS: Through the improvement in facial appearance after surgery, patients' self-esteem increases and their sensitivity to criticism and social appearance anxiety decrease.

Does Guided Bone Regeneration Prevent Unfavorable Bone Shapes in Distraction Gap?

PURPOSE: Complications related to distraction osteogenesis can cause degradation of newly regenerated bone. Additionally, an unfavorable shape of the regenerated bone at the distraction gap can reduce the quantity of regenerated bone. The aim of the present study was to report on the prevention of unfavorable shapes of regenerated bone using guided bone regeneration during distraction. MATERIALS AND METHODS: Bilateral alveolar distraction was performed in 10 beagle dog mandibles. One side of the mandible formed the experimental group and the other side served as the control group. In the experimental group, guided bone regeneration was performed simultaneously with distraction osteogenesis. In the control group, only alveolar distraction was applied. At the end of a 1-week latent period, all mandibles were distracted 10 mm (1 mm/day). After the distraction period, 3 months were allowed for consolidation. After consolidation, all the dogs were euthanized, and the shape of the regenerated bone was determined to be either favorable or unfavorable. Densitometric evaluation and area measurements were performed using computed tomography scans. Statistical evaluation was performed using the independent t test, with a significance level of P < .05. RESULTS: In the experimental group, no unfavorable bone shape developed in the distraction gap, and the new bone had a surface and volume similar to those of the segments. In contrast, in the control group, 4 mandibles had an unfavorable bone shape in the distraction gap and 4 showed favorable bone healing with no defect. The surface area of the regenerating bone in the experimental group was significantly greater than that in the control group. Also, the surface area differed significantly between the experimental and control groups (P < .05). However, the densitometric values did not differ between the 2 groups (P < .05). CONCLUSIONS: Concomitant use of guided bone regeneration with distraction osteogenesis could be an optimal method for generating a favorable bone shape within the distraction gap.

Improved Dental Implant Drill Durability and Performance Using Heat and Wear Resistant Protective Coatings.

The dental implant drilling procedure is an essential step for implant surgery, and frictional heat in bone during drilling is a key factor affecting the success of an implant. The aim of this study was to increase the dental implant drill lifetime and performance by using heat- and wear-resistant protective coatings to decrease the alveolar bone temperature caused by the dental implant drilling procedure. Commercially obtained stainless steel drills were coated with titanium aluminum nitride, diamond-like carbon, titanium boron nitride, and boron nitride coatings via magnetron-sputter deposition. Drilling was performed on bovine femoral cortical bone under the conditions mimicking clinical practice. Tests were performed under water-assisted cooling and under the conditions when no cooling was applied. Coated drill performances and durabilities were compared with those of three commonly used commercial drills with surfaces made from zirconia, black diamond. and stainless steel. Protective coatings with boron nitride, titanium boron nitride, and diamond-like carbon have significantly improved drill performance and durability. In particular, boron nitride-coated drills have performed within safe bone temperature limits for 50 drillings even when no cooling is applied. Titanium aluminium nitride coated drills did not show any improvement over commercially obtained stainless steel drills. Surface modification using heat- and wear-resistant coatings is an easy and highly effective way to improve implant drill performance and durability, which can improve the surgical procedure and the postsurgical healing period. The noteworthy success of different types of coatings is novel and likely to be applicable to various other medical systems.

A New Detection Method for Submerged Implants: Oral Tattoo.

PURPOSE: To evaluate the marking potential of tattoo ink in determining the definitive locations of submerged implants at the time of surgical exposure of the implants. MATERIALS AND METHODS: In total, 104 implants in 32 patients were included in this study. After placement of the implants, cover screws were inserted. Overlying mucosa was marked with tattoo ink using a 20 g needle through the center of the cover screw. At the time of surgical exposure the tattoo marks were evaluated relative to visibility. RESULTS: At the time of the surgical exposures, tattoo ink was clearly visible at 91 implants, slightly visible at 8 implants, and not visible at 5 implants. After detection and classification of tattoo ink, the overlying mucosa was gently removed by tissue punch under local anesthesia. CONCLUSION: The results of this study seemed to indicate that marking the location of implants with tattoos at the time of implant placement can be an inexpensive, easy, healthy, and practical way to identify the location of marked submerged dental implants.

Comparison of Ozone and Photo-Biomodulation Therapies on Mental Nerve Injury in Rats.

PURPOSE: This study compared photo-biomodulation (PBM) and ozone therapy (OT) for mental nerve injury by counting Schwann cells (SCs) and fasciculated nerve branches and measuring fascicular nerve areas. MATERIALS AND METHODS: The effects of OT and PBM on mental nerve injury were evaluated. Mental nerves of 27 rats were partly sutured and allocated into 3 groups. Group 1 received no treatment, group 2 received OT, and group 3 received PBM. The number of fascicules beyond nerve branches and the number of SCs before and after nerve injury were evaluated histologically. RESULTS: A better healing pattern was observed in the treatment groups. The number of SCs was markedly larger in the OT and PBM groups than in the control group. CONCLUSIONS: Oral and maxillofacial surgeons should be familiar with the differential diagnosis, prevention, and management of neurosensory disturbances. This study provides insights into the management of neurosensory disturbances related to mental nerve injury using OT and PBM. This study clearly suggests that OT and PBM are promising novel methods for the treatment of mental nerve injury.

Effects of Surgical and Nonsurgical Rapid Maxillary Expansion on Palatal Structures.

AIM: The aim of the present study was to compare the effects of surgical and nonsurgical rapid maxillary expansion (RME) in skeletally mature patients. MATERIALS AND METHODS: Surgically assisted rapid maxillary expansion (SARME) was used in 18 patients (2 males, 16 females) with a mean age of 19.90 years. Two nonsurgical RME groups were constructed to compare the expansion changes of SARME. Eighteen patients in maximum pubertal peak (12 males, 6 females) with a mean age of 13.04 years comprised the growing RME group, while the nongrowing RME (NG-RME) group consisted of 18 skeletally mature patients (1 male, 17 females) with a mean age of 16.41 years. Thirteen linear and 2 angular measurements were made on the study models taken before expansion (T0) and after 3 months of retention period (T1). Intragroup differences were evaluated with paired t test and the intergroup differences were analyzed with 1-way analysis of variance. RESULTS: All groups showed significant transversal skeletal and dental expansion. The palatal width changes at gingival and midpalate levels were the highest in the NG-RME group (6.85 and 5.84 mm, respectively). The most molar tipping was in the NG-RME group (15.00°) and the palatal vault angle showed the most increase in the SARME group (9.77°). The greatest expansion at the base of palatal vault was in the SARME group (4.42 mm). CONCLUSIONS: The pattern of expansion was rotation of the maxillary halves for SARME and lateral displacement of the dentoalveolar structures for NG-RME. Patients with severe skeletal discrepancy or increased age are good candidates for SARME.

Comparison of ketamine-propofol and ketamine-dexmedetomidine combinations in children for sedation during tooth extraction.

OBJECTIVE: To evaluate the efficiency of ketamine-propofol and ketamine-dexmedetomidine drugs in children for sedation during tooth extraction. METHODS: The randomised, prospective study was conducted at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erciyes University, Kayseri, Turkey, from September to November 2013, and comprised children who were due to undergo tooth extraction. Non-invasive blood pressures (systolic and diastolic), peripheral oxygen saturation, heart and respiratory rates and Ramsay Sedation Scores were assessed at baseline, after applying the drugs and then every 5 minutes thereafter. Further, the ketamine-propofol group received 1mg kg-1 of ketamine and propofol, and the ketamine-dexmedetomidine group received 1mg kg-1 of ketamine + 0.5 µg kg1 of dexmedetomidine. RESULTS: Of the 60 participants, there were 30 (50%) in each group. No statistically significant differences were found in terms of heart rate, non-invasive blood pressures at any time and the number of drug repetitions (p>0.05). Nausea-vomiting was statistically higher in the ketamine-dexmedetomidine group (p<0.05). CONCLUSIONS: Ketamine-propofol might be a better option due to lower vomiting and nausea episodes and higher surgeon satisfaction levels.

Intravenous ketamine, propofol and propofol-ketamine combination used for pediatric dental sedation: A randomized clinical study.

BACKGROUND AND OBJECTIVE: Dental treatments cannot bealways performed under local anesthesia inpediatric non-cooperative patients. For this purpose, differentanesthetic techniques have been applied to increase patient comport to dental treatments. METHODS: Sixty children classified as ASA I-II, between aged 3 to 9, who were scheduled to undergo tooth extraction, were enrolled for this randomized study. Group K received 1 mg/kg ketamine, Group P received 1 mg/kg propofol, and Group KP received 0.5 mg/kg propofol plus 0.5 mg/kg ketamine intravenously for anesthesia induction. RESULTS: Recovery time was significantly lower in Group P than Group KP. No significant differences were found between groups regarding HR, before and after the induction, at tenth minute. Fifth minute's HR was higher in Group K than Group KP. Mean arterial pressure (MAP) values were similar at baseline, before and after the induction, and at tenth minute, whereas significantly lower values were found in Group P and Group KP than in Group K at fifth minute. CONCLUSIONS: Although ketamine, propofol and ketamine-propofol combination are effective for sedation in tooth extraction in pediatric patients, propofol may be an excellent alternative, with the shortest recovery, no nausea and vomiting, and reasonable surgical satisfaction.

Determination of lingual vascular canals in the interforaminal region before implant surgery to prevent life-threatening bleeding complications.

OBJECTIVES: Profuse hemorrhage and airway obstruction may occur during or after the implant surgery in the interforaminal region. The prevention from this complication requires identifying the location of the mandibular lingual vascular canals (MLVCs). The purpose of this study was to evaluate the anatomical variations of MLVCs and to determine the safety margins for implant placement in interforaminal region. MATERIALS AND METHODS: Computer tomography (CT) images of 200 consecutive patients were reexamined retrospectively by a radiologist and a maxillofacial surgeon to evaluate the presence of the MLVCs entering the mandible. The diameter and the number of the canals, the distance between the entrance of the canal and mandibular midline, and the height of the entrances of the canals from the inferior mandibular margin were measured. RESULTS: Two hundred and thirty-six median lingual canals (MLCs) and 159 lateral lingual canals (LLCs) were found in 200 patients. Significant differences were found between the number of lingual canals in the midline and canine regions (P < 0.001). CONCLUSION: There is a potential risk of complications due to the injuries of the vessels entering the lingual cortical bone through a number of bone canals during implant placement in the interforaminal region.

Effect of platelet-rich plasma on fibrocartilage, cartilage, and bone repair in temporomandibular joint.

PURPOSE: The purpose of the present study was to explore the potential use of platelet-rich-plasma (PRP) in the treatment of temporomandibular joint osteoarthritis (TMJ-OA). MATERIALS AND METHODS: Surgical defects were created bilaterally on the condylar fibrocartilage, hyaline cartilage, and bone to induce an osteoarthritic TMJ in rabbits. PRP was applied to the right joints of the rabbits (PRP group), and the left joints received physiologic saline (control group). After 4 weeks, the rabbits were sacrificed for histologic and scanning electron microscopy (SEM) examinations. The data were analyzed statistically. RESULTS: The new bone regeneration was significantly greater in the PRP group (P < .011). Although the regeneration of the fibrocartilage and hyaline cartilage was greater in the PRP group, no statistically significant difference was found between the 2 groups. SEM showed better ultrastructural architecture of the collagen fibrils in the PRP group. CONCLUSIONS: PRP might enhance the regeneration of bone in TMJ-OA.

Reliability of panoramic radiography in determination of neurosensory disturbances related to dental implant placement in posterior mandible.

INTRODUCTION: During implantology procedures, one of the most serious complications is the damage of the inferior alveolar nerve, which may result in neurosensory disturbances (NSD). Panoramic radiographs have been considered for a primary evaluation to determine the bone height and implant-mandibular canal distance. MATERIALS AND METHODS: One thousand five hundred ninety-seven panoramic radiographs of patients, who were treated with 3608 dental implants in Erciyes University, Oral and Maxillofacial Hospital between 2007 and 2012, were examined. Forty-eight implants were determined to be near the mandibular canal using a 2-dimensional software program. RESULTS: A total of 48 implants were closer than 2 mm to the mandibular canal. A range of 0 to 1.9 mm distance was detected between the mandibular canal and these implants. Fourteen implants (29.16%) placed in a distance less than 1 mm to the mandibular canal, and 34 (70.83%) between 1 and 2 mm. One patient had NSD. CONCLUSION: Determination of the dental implant length using panoramic radiography is a reliable technique to prevent neurosensory complications. However computed tomography or cone-beam computed tomography based planning of dental implants may be required for borderline cases.

Cholesterol granuloma of the jaws: report of two cases.

Cholesterol granuloma (CG) is a foreign body reaction to the deposition and inadequate drainage of cholesterol crystals that are frequently found in association with chronic middle ear diseases but an uncommon entity in maxillary sinuses. The clinical symptoms are non-specific and depend on the localization and extent in each individual case. Bone erosion may be seen in cholesterol granuloma showing expansive growth. The differential diagnosis of CG includes cysts, mucocoeles and neoplasms. Radiological and histopathological findings are essential for diagnosis of CG. In this report it is aimed to introduce two new CG cases with its clinical, histopathological and radiological findings

Multidisciplinary approach for the rehabilitation of central giant cell granuloma: a clinical report.

The central giant cell granuloma (CGCG) is benign, nonodontogenic, and intraosseous lesion of the jaw. Aggressive subtypes of CGCG have a tendency to recur after excision and require wide resection that leads to major defects in the jaw. In this case report a patient who had severe mandibular bony deficiency as a result of excision of aggressive CGCG, orthodontic, and prosthetic treatment was described. The defect was reconstructed with iliac bone graft. Four years later vertical distraction osteogenesis was performed on the grafted mandible in order to obtain a satisfactory bony height of mandibular ridge. After healing period three endosseous dental implants were placed to grafted region. Because of pubertal growth stage, a hybrid removable denture was constructed. The construction of a hybrid removable denture markedly improved the patient's speech, mastication, and appearance. After pubertal growth stage, a fixed partial denture construction was planned and future parts of treatment procedures were described to the patient. Distraction osteogenesis and endosseous dental implants can be a good alternative method for the unsatisfactory reconstructions of mandibular deficiencies.