Volumetric Evaluation of Safe Zone for Bone Harvesting From Symphysis Region by Using Cone Beam Computed Tomography.

OBJECTIVES: The aim of the present study was to retrospectively make a volumetric evaluation of symphysis sites of patients by the use of cone beam computed tomography (CBCT). METHODS: This retrospective study evaluated dentate symphysis region of the mandibles in CBCT scans taken for different reasons in 90 patients (45 women and 45 men). Three-dimensional (3D) data were obtained using a CBCT device Kodak 9000 3D CMOS sensor with optical fiber. CBCT images were then transferred as digital imaging and communications in medicine files and imported into a volumetric-rendering software 3D DOCTOR (Able Software Corp., Lexington, MA) capable of measurements of vector based-segmentation technology for volumetric measurements. RESULTS: The total average bone volume is 2616.45 mm. Significant differences in average bone volume were found between group I and group IV (P < 0.001). Higher bone volume was obtained in the male groups (2903.01 mm) than in the female groups (2329.88 mm). CONCLUSIONS: CBCT is a good candidate for 3D assessment of high-contrast structures in the oral region. We suggest that the use of 3D computed tomography in combination with a software program is a dependable means of measuring the volume of the symphysis bone graft.

Histomorphometric and microtomographic evaluation of the effects of hyperbaric oxygen and systemic ozone, used alone and in combination, on calvarial defect healing in rats.

PURPOSE: The aim of this study was to compare the efficacy of hyperbaric oxygen and systemic ozone, used separately and in combination, on the healing of bone defects. MATERIAL AND METHODS: Sixty male Wistar rats were divided into 4 groups (n = 15) according to treatment (control, hyperbaric oxygen [HBO], ozone [O], and HBO plus O [HBO-O]) and divided further into 3 subgroups according to day of sacrifice (postsurgical days 5, 15, and 30). Surgery was performed under general anesthesia to create a critical-size bone defect (5 mm in diameter) in the cranium. After sacrifice, microtomographic images of all samples were recorded, and histomorphometric analysis was performed. RESULTS: Histologic and radiologic measurements showed that the values of all experimental groups were higher than those of the control group. Histologic scores for all experimental groups were statistically higher than those for the control group day 30 (O, P = .045; HBO, P = .049; HBO-O, P = .042). Histologic scores also were statistically higher for the HBO group on day 5 (P = .045) and day 15 (P = .009) compared with the control group. Microtomographic scores were higher for the experimental groups than for the control group, with statistically significant differences for group O on day 5 (P = .033) and day 30 (P = .0045) and for group HBO on day 15 (P = .005). Histologic and radiologic analyses showed positive correlations. CONCLUSION: Within the limitations of this study, the use of hyperbaric oxygen and ozone, separately and in combination, were shown to be effective in increasing bone healing. Combined usage was no more effective in stimulating bone healing than separate usage.

Effects of the hyperbaric oxygen on de novo bone formation during periosteal distraction.

OBJECTIVE: The purpose of this study was to investigate the effect of hyperbaric oxygen (HBO) therapy on de novo bone formation during periosteal distraction (PD). MATERIALS AND METHODS: Periosteal distraction was performed in 24 mature male New Zealand rabbits using a custom-designed device placed on the lateral surface of the mandibular corpus. Twelve rabbits (group H) were given adjunctive HBO treatment, whereas 12 rabbits (group N) were kept in a normal environment (normobaric oxygen). After a 7-day latency period, the same distraction protocol was applied to both groups. However, the rabbits in group H were treated with pure oxygen at 2.4 atm absolute for 25 times. Both groups were further divided into 2 subgroups and killed after consolidation periods of 4 and 8 weeks. Photodensitometric and histologic analyses were performed to evaluate the newly formed bone. RESULTS: There was no significant difference between the 4-week consolidated HBO group and the 8-week consolidated normobaric oxygen subgroup (P = 0.229). Moreover, there was better bone formation in the 8-week HBO group than in the 8-week control group. CONCLUSION: The results of this study indicate that PD with HBO could be used to increase the quality and the quantity of the bone newly formed by PD.

The effect of cigarette smoking on the healing of extraction sockets: an immunohistochemical study.

The aim of this study was to investigate immunohistochemically the influence of cigarette smoking on the socket healing after tooth extraction in rats. Eighty-four male rats were divided into 3 groups; 2 groups were considered as experimental and the other as control. The animals in test 1 were exposed to smoking regimen before the surgery and after the surgery, but the animals in test 2 were exposed to the smoking regimen only before surgery. All animals' maxillary right central incisors were extracted and killed at the 3rd, 7th, 15th, and 28th day. The samples taken on third day after tooth extraction were stained immunohistochemically with fibronectin antibody and the other with type I collagen antibody. On the third day after tooth extraction, samples in the control group were intense stained (3) (+++); in the test 1 they were slight positive (1) (+) and in the test 2 they were moderate positive (2) (+ +). As a result of scoring type I collagen antibody, there was no statistically significant difference between the groups at seventh day, but there were statistically significant differences between the groups at the 15th and 28th day (P = 0.000 and P = 0.001, respectively). Comparison of the paired intense scores of type I collagen antibody staining according to days within each groups were not statistically significant. As a result, we have found out that the healing process of the tooth extraction socket is negatively affected by cigarette smoke.

Evaluation of periodontal pathogens of the mandibular third molar pericoronitis by using real time PCR.

OBJECTIVES: The aim of this study was to investigate the mandibular third molar pericoronitis flora by using real-time polymerase chain reaction (PCR). MATERIALS AND METHODS: The quantitative values of Aggregatibacter actinomycetemcomitans (Aa), Campylobacter rectus (Cr), Fusobacterium nucleatum (Fn), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi) and Tannerella forsythia (Tf) were evaluated in comparison with the healthy third molar flora by using real time PCR. RESULTS: Aa, Cr, Pg, and Pi were not statistically significant but numerically higher than the pericoronitis group. In contrast to samples from control subjects, statistically significant higher numbers of Tf were detected in samples from pericoronitis patients. The study revealed the strong relation between risk of pericoronitis and the presence of Tf. Individuals who have Tf in their samples present with an almost eight times relative risk of pericoronitis as the individuals with an absence of Tf in their samples. CONCLUSION: Tf plays an important role in the development of clinical symptoms related to pericoronitis.

Clinical and microbiological comparison of knotless/barbed and silk sutures for impacted third-molar surgery.

BACKGROUND: Several types of suture materials are available for oral surgery. However, the most used non-resorbable suture in oral surgery is 3/0 silk. The aim of the present study was to compare the effectiveness of knotless/barbed sutures with silk sutures during the postoperative period after the third molar surgery in terms of clinical and microbiological parameters. METHODS: The study comprised 38 patients who underwent surgical extraction of a mandibular impacted third molar. The patients were divided into two groups. The mucoperiosteal flap was closed using 3/0 knotless/barbed sutures for the test group and 3/0 silk sutures for the control group. The duration of suturing was recorded during surgery. Pain level, postoperative edema, and trismus were measured at 3 and 7 days after surgery. The status of plaque formation on the sutures was scored using the Plaque Index at 3 and 7 days after the surgery. At 7 days, the suture materials were removed and submitted to the laboratory for microbiological analysis. The level of pain during suture removal was also recorded by a Visual Analog Scale. RESULTS: The duration of suturing in the barbed sutures group was found significantly lower than in silk sutures (P<0.05). There was no significant difference between the suture types in terms of trismus and edema at 3 and 7 days after surgery (P>0.05). On the third day after surgery and during suture, removal pain scores were statistically significantly lower in the barbed suture group than in the silk suture group (P<0.05). The Plaque Index values of the barbed sutures were statistically significantly lower than that of the silk sutures at 3 and 7 days after surgery (P<0.05). Aerobic, anaerobic, and aerobic/anaerobic mean colony forming units (CFUs) were statistically significantly lower in the barbed suture group than in the silk suture group (P<0.05). CONCLUSIONS: Barbed sutures increase the ease of operation and patient comfort with less postoperative pain than silk sutures. Additionally, less plaque accumulation and lower bacterial colonization were found on the barbed/knotless sutures than on the silk sutures.

Radiologic assessment of the relationship between the maxillary artery and the lateral pterygoid muscle.

OBJECTIVE: The course of the second part of the maxillary can vary among different races. The aim of this study was to evaluate the relation between the maxillary artery and the lateral pterygoid muscle in a white population sample on computed tomographic (CT) angiograms. MATERIALS AND METHODS: We retrospectively reviewed multidetector CT angiograms of 209 patients (134 men and 75 women). The images were taken using a 64-row multidetector CT scanner. The imaging parameters were 0.5 × 64-mm slice thickness, 0.5- or 0.3-mm increment, 120 kV, 250 mA s, 0.5-second rotation time, 0.641 pitch, and 512 matrix. The relationship between the pterygoid portion of the maxillary artery and the lateral pterygoid muscle was assessed on axial, sagittal, and coronal multiplanar reformatted images with the Vitrea 2 software program. RESULTS: A total of 572 maxillary arteries in 286 patients were assessed. Of these maxillary arteries, 418 (68.42%) had a superficial course to the pterygoid muscle and 132 (31.58%) had a deep course. In 165 (78.94%) of 286 patients, there was a cross-lateral symmetry of the course of the artery; that is, both vessels were superficial or deep. In 44 (21.1%) of 209 patients, an asymmetric course was observed. CONCLUSIONS: Because of the incidence of the asymmetric presentations, generalization regarding such a controversial topic should not be based on findings of cadaveric studies and each hemi head should be considered as a single entity. Therefore, advanced imaging systems are useful tools in preoperative planning and play a key role in the avoidance of hemorrhagic complications.

Anthropometry of the medial canthal ligament related to naso-orbitoethmoidal fractures.

OBJECTIVE: Medial canthal ligament (MCL) and lacrimal system are often associated with naso-orbitoethmoidal fractures. The MCL anchors tarsal plate to medial orbit and has an important role in lacrimal pump system. The purpose of this study was to describe the anatomy of the MCL and present the anthropometric measurements on cadaveric specimens. METHODS: Dissections were performed on 14 formalin-fixed cadavers. The length, thickness, width of the MCL, width of the nasal dorsum, and intercanthal distance were measured with a digital caliper. A surgical microscope and an digital photo camera were used in all dissections. Means, SDs, and paired-samples t test were computed. RESULTS: The mean lengths of the right and left MCLs were measured as 8.01 (SD, 2.27) and 7.93 (SD, 2.43) mm. The mean thicknesses of the right and left MCLs were 1.63 (SD, 2.41) and 1.75 (SD, 2.44) mm. The mean widths of the right and left MCLs were 4.20 (SD, 0.75) and 4.17 (SD, 0.61) mm. The intercanthal distance was 31.7 (SD, 1.7) mm. The width of the nasal dorsum was measured as 14.37 (SD, 1.9) mm. Length and thickness differed on both sides. Asymmetric insertion of medial canthi was observed in 5 specimens. CONCLUSIONS: Reconstruction of traumatic telecanthus requires reaproximation of medial canthi and the displaced nasoethmoid bony fragment with transnasal wiring or microplates. Identification and reconstruction of detached medial canthi could be accomplished successfully with anatomic familiarity of the region. The most developed and firmly adherent was the anterior limb of the MCL. Reattachment of that part seems to be adequate for repair of a detached canthus.

Management of obstructive sleep apnea by maxillomandibular advancement surgery in an edentulous patient.

BACKGROUND: Maxillomandibular advancement (MMA) surgery is a surgical treatment option for treating the patients with obstructive sleep apnea (OSA). Surgical treatment of OSA by MMA surgery is a problem when it is encountered with an edentulous patient because of the intermaxillary fixation problem of the jaws. A paucity of information is available concerning MMA surgery for edentulous patients. MATERIALS AND METHODS: In this case report, we present the preoperative planning, orthognathic surgery, and postoperative phases of a 49-year-old edentulous severe OSA (apnea hypopnea index, 81.9 event/hr) patient who underwent MMA surgery. RESULTS: Polysomnographic examination 9 months after surgery revealed normalization of the somnographic evaluations (apnea hypopnea index, 1.3). CONCLUSIONS: The results reported in the present case showed that the surgical treatment of OSA by MMA surgery in edentulous patients could be successfully done. Further critical evaluations of this approach for the surgical treatment of edentulous OSA patients are needed.

Rectangular body ostectomy for the treatment of severe mandibular prognathism.

OBJECTIVE: The aim of this article was to present the surgical technique and the outcomes of rectangular body ostectomy in the treatment of severe mandibular prognathism. METHODS: Mandibular setback by bilateral rectangular body ostectomies combined with Le Fort I level maxillary advancement was performed. The deep bony concavity of paranasal area was grafted with bone blocks harvested from the ostectomized segments of the mandible. RESULTS: Satisfactory functional and aesthetic outcomes were obtained by rectangular body ostectomy combined with Le Fort I level maxillary advancement and an acceptable profile was provided for the patient. CONCLUSIONS: The mandibular rectangular ostectomy remains a safe and versatile procedure with predictable results in well-selected cases.

The efficacy of mylohyoid nerve anesthesia in dental implant placement at the edentulous posterior mandibular ridge.

The aim of this study is to evaluate the anesthetic efficacy of mylohyoid and buccal nerve anesthesia at the posterior edentulous mandible versus regional anesthetic block to the inferior alveolar nerve in dental implant surgery. The study was composed of 2 groups. In the first group (group A), 14 voluntary adults (7 female and 7 male) received local infiltrations of 1 mL articaine HCl 4% with epinephrine 1/200,000 to the ipsilateral mylohyoid and buccal nerves. In the second group (group B, control; 9 female and 5 male adults), the inferior alveolar and the buccal nerve blocks were performed. Visual analog scales were obtained from patients to determine the level of pain during incision, drilling, implant placement, and suturing stages of implant surgery. A combination of buccal and mylohyoid nerve block offered an acceptable level of anesthesia. Two patients from group A stopped the ongoing surgery and had extraregional anesthesia by inferior alveolar nerve block. In group B, patients were operated on successfully. Local anesthetic infiltrations of the mylohyoid and the buccal nerve may be considered alternative methods of providing a convenient anesthetic state of the posterior mandibular ridge.

An excessive coronoid hyperplasia with suspected traumatic etiology resulting in mandibular hypomobility.

There are multiple theories as to the causes of coronoid process hyperplasia of the mandible, including trauma, temporalis muscle hyperactivity, hormonal stimulus, and genetic inheritance. The excess growth of the coronoid process can cause impingement on the zygomatic processes and may result in mandibular hypomobility. A case of an excessive unilateral coronoid hyperplasia with suspected traumatic etiology, which was successfully treated by coronoidectomy and postoperative physiotherapy, is presented. The patient was a 21-year-old man whose maximum mouth opening was 23 mm. The attachments of the temporalis muscle were stripped and the coronoid process was accessed using the Al-Kayat and Bramley approach. The coronoid process was then resected via an intraoral pathway. One week after surgery, physiotherapy was started and the maximum mouth opening had increased to 38 mm. In the case presented, a coronoidectomy with postoperative physiotherapy for treatment of coronoid process hyperplasia produced satisfactory results in the correction of coronoid-malar interference.

A case of a benign cementoblastoma treated by enucleation and apicoectomy.

Cementoblastoma is a rare, benign, odontogenic neoplasm of ectomesenchymal origin, representing less than 6% of all odontogenic tumors. Despite its well-known typical features, there are still controversies regarding the management of the condition. This article presents the case of a benign cementoblastoma in a 17-year-old girl. The lesion was typical and associated with the mandibular right first molar. Endodontic treatment of the involved tooth, enucleation of the cementoblastoma, and apicoectomy of the affected roots were performed. Removal of the tumor while preserving the associated tooth resulted in normal osseous healing and no evidence of recurrence after one year. Based on the findings of the current report, it can be suggested that, in properly selected cases, it is possible to remove cementoblastomas that affect molars without extracting the involved teeth.

Idiopathic synchronous central giant cell granulomas involving both the maxilla and mandible: a case report.

The central giant cell granuloma is a well-defined lesion of the jaws and reports of multiple lesions are very uncommon. The authors report the case of a patient with idiopathic synchronous multiple central giant cell granulomas involving both the maxilla and the mandible. Surgical curettage of the lesions was performed. At the end of the 24 months follow-up, no recurrence was detected.

Evaluation of the Efficiency of the Graft Material Combined with Ozonized Blood in Maxillary Sinus Lifting Applications in Rabbits.

Objectives: The aim of this study is to investigate the effect of the graft material combined with ozonized blood on bone healing in rabbit in maxillary sinus lifting applications histomorphometrically, immunohistochemically and microtomographically. Materials and Methods: Twenty-eight New Zealand rabbits were randomly divided into 2 groups as experimental (n = 14) and control (n = 14). In experimental group, 5 ml (milliliter) blood obtained from the ear vein of each rabbit was ozonized by 80 µl (µl)/ml concentration ozone-oxygen mixture. Graft material was combined with this ozonized blood. In control group, the graft was combined with saline solution at 0.9% concentration. A 5 mm (millimeter) in diameter window was created on right maxillary sinus window in each rabbit under general anesthesia by local anesthesia support. Sinus membrane was elevated and the space was augmented by 1 cc (cubic centimeter) graft material. One rabbit from the control group which was planned to sacrifice at the end of 8 weeks could not participate in the evaluation because of the extensive inflammation at the operation site. Newly formed bone area and bone density were measured using by image analysis program. Bone morphogenetic protein-2 (BMP-2), vascular endothelial growth factor (VEGF) and collagen-1 (COL-1) analyses were carried out immunohistochemically. The amount of the newly generated bone and the amount of the total augmented space were calculated volumetrically by microtomography. Results: According to histomorphometrical analysis, although newly formed bone area has increased in both experimental and control group with time, statistically significant results were obtained when only O-8 (ozone-treated experimental group planned to be sacrificed after 8 weeks) and O-4 (ozone-treated experimental group planned to be sacrificed after 4 weeks) groups were compared (p = 0,037). The increase in new bone density was seen in both experimental and control groups with time and the results were statistically significant when O-8 group compared to O-4 and C-4 group (ozone-free control group planned to be sacrificed after 4 weeks) (p = 0,07 and p = 0,04, respectively) and C-8 (ozone-free control group planned to be sacrificed after 8 weeks) group compared to C-4 group (p = 0,023). According to immunohistochemical analysis, the intensity and the severity of field staining with anti-BMP-2 have increased in experimental group whereas it has decreased in control group but despite that there was no statistically significance among all groups compared to each other. The number of new vessels stained with anti-VEGF has increased in both experimental and control group with time and multiple comparison results were statistically significant when O-8 group compared with O-4 and C-4 (p = 0,000, p = 0,000, respectively), O-4 group compared with C-8 (p = 0,000) and C-8 group compared with C-4 (p = 0,000). Although the intensity and the severity of field staining with anti-COL-1 have increased in both experimental and control group with time, there was no statistically significance among all groups compared to each other. According to microtomographical analysis, the percentage of the volume of the newly generated bone in the total augmented space volume has decreased with time in both experimental and control groups. Conclusions: Considering the results of this study, the graft material combined with the ozonized blood increased the density of the newly generated bone and the number of new vessels in maxillary sinus lifting applications in rabbits. Clinical Relevance: We suggest further studies should be done combining the graft with ozone by different methods, dosages and exposure times.

Focal osteoporotic hematopoietic bone marrow defect formation around a dental implant: a case report.

Focal osteoporotic bone marrow defects usually appear as asymptomatic radioluencies in the edentulous posterior mandible of middle-aged women. The exact causative factor in the majority of focal osteoporotic bone marrow defects is still unknown. Because of their radiological similarity with many intraosseous lesions, accurate diagnosis is possible only with histopathological examination. A focal osteoporotic bone marrow defect that occurred 2 years postoperatively apical to an implant is presented with clinical, radiographic, and histopathologic features. According to the literature scan, this is the first case report of this phenomenon caused by a dental implant. Int J Oral Maxillofac Implants 2011;26:e1-e4.

Rigid external maxillary distraction and rhinoplasty for pyknodysostosis.

AIM: This article reports the treatment of an 33-year-old female patient with pyknodysostosis by rigid external distraction II midface distraction system. STUDY DESIGN: The patient with pyknodysostosis described in this report had severe midfacial hypoplasia. Correction of this by use of routine orthognathic surgery would require osteosynthesis and bone grafting. Risk of infection and/or nonunion after such a surgical procedure was considered too great, and therefore the possibility of treatment by distraction osteogenesis of the maxilla was evaluated. The rigid external distraction II midface distraction system was used to relocate the hypoplastic maxilla at anterior-inferior projection. CONCLUSIONS: Distraction osteogenesis should be considered as the primary reconstructive method for maxillofacial deformities in patients with sclerosing bone dysplasias, since this is the second reported case treated successfully with rigid external distraction.

Management of a laterally luxated upper incisor caused by the hit of a rifle stock.

Lateral luxation is the displacement of the tooth in a direction other than axial, which is accompanied by comminution or fracture of the alveolar socket. Lateral luxation is one of the most prevalent dental injuries among the general population, resulting in up to 27% of all dental wounds. All physical activities have an associated risk of orofacial injuries due to falls, collisions, and contact with hard surfaces. Just like any other training activities, military training exercises present a significant risk of dental traumas, which comprise 2% to 8% of all military dental emergencies. The aim of this report was to present a case of a dental lateral luxation caused by the hit of a rifle stock during close combat training. The tooth was extruded from its bony lock, temporarily filled with a calcium hydroxide-based paste, replaced into its original anatomic position, and secured with Ivy loop wirings. The permanent endodontic treatment was performed 4 weeks after repositioning. At the end of the 8-months follow-up, the tooth was asymptomatic and any pathological alterations were absent.

Early detection of alterations in the resonance frequency assessment of oral implant stability on various bone types: a clinical study.

This study was undertaken to evaluate the relation between bone quality and alterations of implant stability quotient values measured during the initial phase of healing. Nineteen patients treated with 106 implants were included in the current study. The mean bone density of the implant recipient area was measured using Simplant 11 software incorporated in the computerized tomography (CT) machine. Mean bone density measurements were recorded in Hounsfield units. The implant recipient sites were subdivided into 5 groups according to bone quality. The numbers of the structures on the recipient site belonging to D1 and D5 types showed no statistical significance and were excluded. Standard 2-stage surgical technique was utilized to prepare the surgical sites. The implant stability quotient (ISQ) value at implant placement was recorded and did not influence the treatment procedure. The ISQ was measured by an Osstell instrument. The ISQ was further registered on the 21st and 60th days. SPSS statistical software was used for the statistical analysis. In comparison with the time of insertion, the mean values of the ISQ were decreasing for the first 21 days. However, on subsequent days, the ISQ values of all bone types have increased and on the 60th day reached the values recorded at the time of insertion. Analysis of the relation between changes in stability and bone type does not reveal statistical significance. With knowledge of the current clinical study, it can be concluded that bone quality in the recipient bone site does not effect changes in implant stability at the early stages of the osseointegration process.