Resistance to vertical root fracture of apicoected teeth using different devices during two root canal irrigation procedures.

The aim of the present work was to measure the fracture resistance of endodontically treated teeth that were apicoected with different procedures. Seventy-two extracted human maxillary anterior teeth were included in this study. The specimens were randomly assigned to three main groups according to the apical surgery procedures and then two subgroups according to the irrigation protocols during root canal treatment and total of six groups were obtained (n = 12). Group 1: served as a control and apical surgery process was not performed in this group. Group 2: apical surgery process was performed with tungsten carbide fissure bur Group 3: apical surgery process was performed with Er:YAG laser. Subgroup a: In this group, the specimens were irrigated with %5 NaOCl. Subgroup b: 15% EDTA solution was filled into the root canal and then agitated using a 1.5 W/100 Hz diode laser. The specimens were filled and mounted in acrylic resin blocks and compression strength test was performed. Statistical analysis was performed using two-way ANOVA. The statistical analysis revealed that there were no statistical significant differences between apical surgery procedures (groups 1, 2, and 3) (p < 0.05). Apical resection procedures did not affect the fracture resistance Significant differences were determined between the subgroups (p < 0.05). Agitation of the EDTA with the diode laser reduced the fracture resistance of the specimens. The different canal irrigation techniques altered resistance to fracture; however, apical surgery procedures did not altered the resistance to fracture when compared with the control group.

Histopathological Effects of Teriparatide in Medication-Related Osteonecrosis of the Jaw: An Animal Study.

PURPOSE: Osteonecrosis of the jaw after tooth extraction is a major complication in patients using bisphosphonates (BPs) for bone lesions, such as for the treatment of osteoporosis. The purpose of this study was to investigate the histopathologic effects of teriparatide (a synthetic parathyroid hormone) on rats developing osteonecrosis with BP use. MATERIALS AND METHODS: Rats (n = 80) that had been injected intraperitoneally with zoledronic acid for 7 weeks were used. Maxillary first molar extractions and bone defects were established in the same region in the eighth week. Teriparatide was administered subcutaneously to prevent osteonecrosis. Animals were sacrificed and histopathologic changes were examined. Osteoblasts, osteoclasts, inflammatory phase of bone healing, and osteonecrotic areas were evaluated. RESULTS: The osteoclast numbers were larger in the experimental groups (teriparatide administered before and immediately after tooth extraction) than in the control group (administered zoledronic acid). The inflammatory phase of bone healing was more pronounced in the experimental group (teriparatide administered before tooth extraction) than in the control group. There were significant differences in osteoclast numbers and in the inflammatory phase of bone healing between the experimental and control groups (P < .05). The osteoblast numbers and osteonecrotic areas were similar in size between the experimental and control groups. There were no significant differences (P > .05). CONCLUSIONS: BPs have negative effects on osteoclasts and the inflammatory phase of bone healing, whereas teriparatide was found to be effective in eliminating the negative effects of BPs. Teriparatide had positive effects in preventing osteonecrosis; therefore, teriparatide could be an effective agent for MRONJ.

A Simplified Way for the Stabilization of Pediatric Mandibular Fracture With an Occlusal Splint.

The management of pediatric mandibular fractures is challenging for maxillofacial surgeons due to ongoing mandibular growth involving tooth buds. The treatment of such fractures has been a topic of much research. Generally accepted methods for the treatment of mandibular parasymphyseal or symphyseal fractures in children are conservative approaches involving the use of acrylic splints, lateral compression with an open-cap splint stabilized by circummandibular wiring, and maxillomandibular fixation with an arch bar and eyelet wiring. The aim of this technical note was to describe a straightforward approach to the treatment of pediatric mandibular fractures, in which an occlusal splint is secured to prevent trauma to the soft tissue, without the need for general anesthesia.

Effects of laser irradiation at different wavelengths (660, 810, 980, and 1064 nm) on transient receptor potential melastatin channels in an animal model of wound healing.

The aim of the present study was to compare the effectiveness of four different laser wavelengths used for low-level laser therapy(LLLT) on healing of mucositis in an animal model of wound healing, by investigating expression of transient receptor potential melastatin(TRPM) ion channels. Forty-five rats were intraperitoneally injected with 100 mg/kg 5-fluorouracil on day 1 and 65 mg/kg on day 3. Superficial scratching on left cheek pouch mucosa was performed on days 3 and 5. After ulcerative mucositis was clinically detected, LLLT was started (660 nm, HELBO; 810 nm, Fotona-XD; 980 nm, ARC-Fox; and 1064 nm, Fidelis-Plus3) at 8 J/cm(2)/day from days 1 to 4. Oval excisional biopsy was performed at the wound site, and expression of TRPM2 to TRPM8 was evaluated. Student's t test was used for evaluation of significance of TRPM gene expression according to "0" value (α = 0.05). In 980-nm group, TRPM4, TRPM6, and TRPM7 were significantly higher than in the control group (p < 0.005). In 660, 810, and 1064 nm groups, only TRPM6 was significantly higher than in control group (p < 0.005). There were no significant differences between control and sham groups (p > 0.05). These findings suggest that expression of TRPM6 gene was significantly affected by irradiation with lasers at different wavelengths, whereas the TRPM4 and TRPM7 genes were only expressed in the 980-nm diode laser group. TRPM6 gene was highly expressed during LLLT, which may lead to accelerated wound healing and tissue repair. In contrast, there was some evidence that the 980-nm diode laser caused increased expression of TRPM4, TRPM6, and TRPM7 which are responsible for stimulation of Ca(2+) and Mg(2+) metabolism, as well as apoptotic pathways of controlled cell death.

Assessment of the effect of laser irradiations at different wavelengths (660, 810, 980, and 1064 nm) on autophagy in a rat model of mucositis.

It is known that high-dose radiation has an effect on tissue healing, but tissue healing does not occur when low dose radiation is applied. To clarify this issue, we compare the treatment success of low dose radiation with programmed cell death mechanisms on wounded tissue. In this study, we aimed to investigate the interactions of low and high-dose radiation using an autophagic mechanism. We included 35 adult Wistar-Albino rats in this study. All animals were injected with 100 mg/kg of 5-fluorouracil (5-FU) on the first day and 65 mg/kg of 5-FU on the third day. The tips of 18-gauge needles were used to develop a superficial scratching on the left cheek pouch mucosa by dragging in a linear movement on third and fifth days. After mucositis formation was clinically detected, animals were divided into five groups (n = 7). Different wavelengths of laser irradiations (1064 nm, Fidelis Plus, Fotona, Slovenia; 980 nm, FOX laser, A.R.C., Germany; 810 nm, Fotona XD, Fotona, Slovenia; 660 nm, HELBO, Medizintechnik GmbH, Wels, Austria) were performed on four groups once daily for 4 days. The laser irradiation was not performed on the control group. To get the tissue from the left cheek at the end of fourth day from all animals, oval excisional biopsy was performed. Molecular analysis assessments of pathological and normal tissue taken were performed. For this purpose, the expression analysis of autophagy genes was performed. The results were evaluated by normalization and statistics analysis. We found that Ulk1, Beclin1, and Atg5 expression levels were increased in the rats when the Nd:YAG laser was applied. This increase showed that a 1064-nm laser is needed to activate the autophagic mechanism. However, in the diode applications, we found that Beclin1, Atg10, Atg5, and Atg7 expressions numerically decreased. Atg5 is responsible for the elongation of autophagosome. Becn1 is a control gene in the control mechanism of autophagy. The reduction of the expression of these genes leads us to think that it may depend on the effect of drug (5-FU) used to form model. Expressions of therapeutic genes increase to ensure hemostasis, but in our study, expressions were found to decrease. More detailed studies are needed.

Peripheral Facial Nerve Paralysis Triggered by Alveolar Osteitis.

Peripheral facial nerve paralysis is the most common cranial nerve disorder; it is determined by the branches of the seventh cranial nerve and results in a characteristic facial distortion that is determined in part by the nerve branches involved. Peripheral facial nerve paralysis during dental treatment is very rare; when it does occur, it can be associated with the injection of local anesthetic, prolonged attempts to remove a mandibular third molar, and subsequent infection. Our article presents the case of a patient admitted with unilateral peripheral facial nerve paralysis occurring simultaneously with alveolar osteitis.

Effects of laser irradiation at different wavelengths (660, 810, 980, and 1,064 nm) on mucositis in an animal model of wound healing.

The aim of the present study was to compare the effectiveness of four different laser wavelengths (660, 810, 980, and 1,064 nm) used for low-level laser therapy (LLLT) on the healing of mucositis in an animal model of wound healing by investigating the expression of platelet-derived growth factor (PDGF), transforming growth factor beta (TGF-ß), and blood-derived fibroblast growth factor (bFGF). Thirty-five male Wistar albino rats with a weight of 250-300 g body mass and 5 months old were used in the study. All animals were intraperitoneally injected with 100 mg/kg of 5-fluorouracil (5-FU) on the first day and 65 mg/kg of 5-FU on the third day. The tip of an 18-gauge needle was used in order to develop a superficial scratching on the left cheek pouch mucosa by dragging twice in a linear movement on third and fifth days. After ulcerative mucositis were clinically detected on the animals' left cheek pouch mucosa, the laser therapy was started. Four different laser wavelengths (660 nm, HELBO, Bredent; 810 nm, Fotona XD, Fotona; 980 nm, ARC Fox; and 1,064 nm, Fidelis Plus 3, Fotona) used for LLLT at ED 8 J/cm(2) daily from the first to the fourth days. Oval excisional biopsy was taken from the site of the wound, and the expression of PDGF, TGF-ß, and bFGF was evaluated. The obtained data were analyzed by one2-way ANOVA, and then Tukey HSD tests were used for pairwise comparisons among groups (α = 0.05). The one-way ANOVA test indicated that expression values of the growth factors, PDGF and bFGF, were significantly affected by irradiation of different wavelengths of lasers (p < 0.001). However, expression value of the TGF-ß was not affected by irradiation of different wavelengths of lasers (p > 0.05). The highest PDGF expression was detected in neodymium-doped yttrium aluminum garnet (Nd:YAG) laser group (p < 0.05), and there were no statistically significant differences among the other groups (p > 0.05). The highest bFGF expression was detected in 980-nm diode and Nd:YAG laser groups (p < 0.05), and there were no statistically significant differences among the other groups (p > 0.05). These findings suggest that low-level Nd:YAG and 980-nm diode laser therapy accelerate the wound healing process by changing the expression of PDGF and bFGF genes responsible for the stimulation of the cell proliferation and fibroblast growth.

A tunnel shape defect on maxillary bone after accidental injection of formocresol instead of anesthetic solution.

Accidental injection or leakages of various chemical disinfectants used during root canal preparation into adjacent tissues have been shown to have deleterious effects on surrounding tissue. Formocresol (FC) is an effective intracanal disinfectant used in endodontic procedures. However, it is known to have harmful effects into adjacent tissues. The aim of this article is to present an unusual case in which a 28-year-old male patient developed gingival and bone necrosis after the accidental injection of FC instead of local anesthetic solution for tooth extraction and to review cases in the literature where complications have occurred due to the use of FC.

Mandibular mucormycosis in immunocompromised patients: report of 2 cases and review of the literature.

Mucormycosis, also known as zygomycosis, is an opportunistic fungal infection caused by a series of fungi in the Mucorales family in people with immune disorders. It is harmless to a healthy person, but when it has invaded the internal organs, it is frequently fatal in immunocompromised patients. It is known for having a very poor prognosis; however, with aggressive medical and surgical management, survival rates are currently thought to exceed 80%. It has 7 predominant clinical forms: rhinocerebral, pulmonary, cutaneous, gastrointestinal, central nervous system, disseminated, and, rarely, miscellaneous (ie, bone, kidney, cardiac, mediastinum, oral). Although oral involvement of this condition has been reported relatively frequently in the literature, mandibular involvement is a rarer condition than oral involvement. The purpose of this article is to report the treatment of isolated cases of mandibular mucormycosis and a review of the literature.

Cytomorphological changes in buccal mucosa of patients treated with low-level 1,064-nm laser radiation.

The aim of this study was to examine the cytomorphological changes occurring in the buccal mucosa in patients treated with low-level 1,064-nm laser radiation. Seventeen individuals (12 males, five females) 18-24 years of age were included in the study. Low-level 1,064-nm laser radiation was applied to the right buccal mucosa near the premolar region; this therapy was repeated for 10 days. Buccal epithelial cells were collected from the right and left premolar regions of the individuals with a brush before and after therapy. The specimens collected from the left side were measured cytomorphometrically and used for the control group. Student's t test was used for statistical comparison of the values of the buccal epithelial cells collected from individuals; a p value < 0.05 was considered statistically significant. None of the patients showed any adverse reactions to the low-level 1,064-nm laser radiation therapy during application. There was no cytogenetic damage to the therapied or non-therapied regions in the buccal mucosa cells, as determined cytomorphologically. The results suggest that low-level 1,064-nm laser radiation therapy has no genotoxic potential. Within the limitations of this study, it can be concluded that low-level 1,064-nm laser radiation therapy may be used safely in dental treatments.

Evaluation of surgical-orthodontic treatments on impacted mandibular canines.

OBJECTIVE: The aim of the study was to evaluate patients treated for impacted mandibular canines through a combined surgical and orthodontic approach. STUDY DESIGN: The cases which were made button operations of impacted mandibular canines were selected from 5100 panoramic radiographs taken from patients who made use of our oral and maxillofacial surgery services between January 1998 to April 2006. All of these selected patients were assessed radiographically. Pertinent information such as sex, age at the time of surgery, site of the unerupted tooth, space availability and any other associated pathoses were also recorded. These patients were called again, and the condition of the mandibular canines was evaluated with panoramic radiographs. If the tooth erupted in the right position and it was functional and asymptomatic, we assumed the treatment to be successful clinically. RESULTS: In the present study, from 5100 patients, 69 patients had impacted mandibular canines and only 21 patients ' teeth (a total of 23 teeth) were treated orthodontically. Sixteen impacted mandibular canine teeth of 14 patients erupted successfully. Two impacted canine were extracted, and only one canine tooth was transplanted to the normal position. Four patients ended the treatment because of failure of eruption. CONCLUSION: If a mandibular canine tooth is impacted, not only is surgical exposure sufficient but also traction force must be applied orthodontically after the surgical exposure. In addition, age influences the success of the treatment on impacted mandibular canine teeth more than the position and impaction level of the teeth.

Placebo-controlled randomized clinical trial of the effect two different low-level laser therapies (LLLT)--intraoral and extraoral--on trismus and facial swelling following surgical extraction of the lower third molar.

The purpose of this study is to compare the effects of extraoral and intraoral low-level laser therapies (LLLT) on postoperative trismus and oedema following the removal of mandibular third molars. Forty-eight patients who were to undergo surgical removal of their lower third molars were studied. Patients were randomly allocated to one of three groups: extraoral LLLT, intraoral LLLT, or placebo. In the study, a Ga-Al-As diode laser device with a continuous wavelength of 808 nm was used, and the laser therapy was applied by using a 1 x 3-cm handpiece. The flat-top laser beam profile was used in this therapy. For both of the LLLT groups, laser energy was applied at 100 mW (0.1 W) for a total of 120 s (0.1 W x 120 s = 12 J). Patients in the extraoral-LLLT group (n = 16) received 12-J (4 J/cm(2)) low-level laser irradiation, and the laser was applied at the insertion point of the masseter muscle immediately after the operation. Patients in the intraoral-LLLT group (n = 16) received 12-J (4 J/cm(2)) low-level laser irradiation intraorally at the operation site 1 cm from the target tissue. In the placebo group (n = 16), the handpiece was inserted intraorally at the operation site and then was touched extraorally to the masseter muscle for 1 min at each site (120 s total), but the laser was not activated. The size of the interincisal opening and facial swelling were evaluated on the second and seventh postoperative days. At the second postoperative day, trismus (29.0 +/- 7.6 mm [p = 0.010]) and swelling (105.3 +/- 5.0 mm [p = 0.047]) in the extraoral-LLLT group were significantly less than in the placebo group (trismus: 21.1 +/- 7.6 mm, swelling: 109.1 +/- 4.4 mm). Trismus (39.6 +/- 9.0 mm [p = 0.002]) in the extraoral-LLLT group at the seventh postoperative day was also significantly less than in the placebo group (29.0 +/- 6.2 mm). However, at the seventh postoperative day in the intraoral-LLLT group, only trismus (35.6 +/- 8.5 [p = 0.002]) was significantly less than in the placebo group (29.0 +/- 6.2 mm). This study demonstrates that extraoral LLLT is more effective than intraoral LLLT for the reduction of postoperative trismus and swelling after extraction of the lower third molar.

Simultaneous occurrence of compound odontoma and arrested root formation as developmental disturbances after maxillofacial trauma: a case report.

Traumatic injury to a primary tooth and/or a bone fracture has the potential to damage the underlying permanent tooth germ which may disturb its development. The extent of the malformation depends on the developmental stage of the permanent tooth and the intensity of the trauma. The presence of infection may be a predictive factor for these abnormalities. Open surgical procedures can also potentially cause impaction and developmental disturbances. Several developmental alterations such as discolouration, hypoplasia, crown dilaceration, root angulation or dilaceration, sequestration of permanent tooth buds and disturbance in eruption have been reported in permanent teeth after trauma. However, odontoma-like malformations and partial or complete arrest of root formation are rare complications developed after trauma. This article presents a rare case with simultaneous occurrence of an odontoma-like malformation and complete and partial arrested root formations as the results of maxillofacial trauma. Almost all pediatric fractures must be managed with closed reduction as much as possible. However, if it is necessary to perform an open reduction, careful attention must be paid during placement of the osteosynthetic plates and screws; and tooth bud development must be followed periodically.

Treatment of traumatized maxillary permanent lateral and central incisors horizontal root fractures.

Traumatic injuries of teeth are the main cause of emergency treatment in dental practice. Horizontal root fractures are more frequently observed in the maxillary anterior region and young male patients. The most common type of root fracture is in the middle third, followed by apical, and coronal part. This case report describes two horizontal root fractures of the maxillary right central and lateral incisors due to a sport injury. The lateral incisor was healed satisfactorily without treatment. The central incisor was endodontically treated.

The effect of Hypericum Perforatum on wound healing of oral mucosa in diabetic rats.

PURPOSE: This study aims to investigate the histopathological and biochemical effects of the topical application of Hypericum perforatum on the healing of surgical wounds created in the oral mucosa of rats with experimentally induced diabetes mellitus. MATERIALS AND METHODS: The study was carried out on 48 adult male Wistar albino rats. The animals were divided into two main groups as control and study groups. Two main groups were divided into three subgroups according to the sacrification days. All rats were given streptozotocin 60 mg/kg, after 72 hours, and those having blood glucose levels above 200 mg/dL were included in the study. Mucosal defects were created in the palatal area of the rats. H. perforatum oil was applied topically twice a day to the wounds of the rats in the study group. Animal were sacrificed on the 3rd, 7th and 10th days and samples taken from the palatal wounds were examined histologically and biochemically. RESULTS: On the 7th day, ulceration, necrosis, epithelialization, polymorphonuclear leucocytes and hydroxyproline variables showed statistically significant differences (p<0.05). Ulceration, necrosis and polymorphonuclear leukocytes values were higher in the control group, whereas epithelialization and hydroxyproline values were found to be higher in the H. perforatum group. Among 10th-day groups, there was only a statistically significant difference between the values of hydroxyproline, whereas H. perforatum-treated group showed high hydroxyproline levels (p<0.05). CONCLUSION: Topically applied H. perforatum did not create any difference on the 3rd day, but it has positively affected the wound healing on the 7th and 10th days in diabetic rats.

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.

Peripheral osteoma of the hard palate: a rare case report and literature review.

Osteomas are benign osteogenic tumors that are composed of cancellous or compact bone. They are usually sessile tumours composed of dense sclerotic, well-formed bone projecting out from the cortical surface. They commonly occur in skull and facial bones, however, excluding the maxillary sinuses, the maxilla is a rare site for osteomas. Therefore, we aim to present a case of maxillary osteoma in a 19-year-old male patient and to provide an overview of current literature on the diagnostic options and treatment modalities. To best of our knowledge, in the English literature, this is the seventh reported case of maxillary osteoma which is located on the hard palate.

Histopathological features of bisphosphonates related osteonecrosis of the jaw in rats with and without vitamin d supplementation.

OBJECTIVE: Aim of this study was to investigate the effect of vitamin-D3 on the osteonecrosis of bone that was induced after tooth extraction was conducted on rats that were given zoledronic acid (Z.A). MATERIAL AND METHODS: Animals were divided into four groups. Two of the experimental groups were divided into two subgroups, third study group was not divided into subgroups, and control group was divided into three subgroups. Z.A was administered twice per week over the course of 7 weeks, dexamethasone was administered twice a week during the 5th-6th-7th weeks to all groups. Dental extraction was performed by drilling around the tooth at 7th week. In study-group-1; vitamin-D was administered twice per week during the 5th-6th-7th weeks. In study-group 2; vitamin-D was administered twice per week during the 8th-9th-10th weeks. In study-group-3; vitamin-D was administered twice per week during the 15th-16th-17th weeks. The animals were sacrificed at 10th-15th-17th weeks, and histologic samples were taken. RESULTS: Postoperative-15-group had a lower osteoblast number, which was statistically significant as compared to preoperative-15 and control-15-group. Control-10-group showed significantly lower osteoclast number in comparison to preoperative-10 and postoperative-10-group. Osteoclast number was significantly higher in the osteonecrosis-17-group as compared to control-17-group. Preoperative-10-group showed significantly higher inflammation in comparison to control-10-group. Postoperative-15-group had a lower histologic osteonecrosis, which was statistically significant as compared to the control-15-group. Macroscopic osteonecrosis was significantly higher in the control-17-group in comparison to the osteonecrosis-17-group. CONCLUSIONS: We concluded that there are some proofs for the treatment of BRONJ with systemic using of vitamin-D.