Effects of polymethylmethacrylate on the stability of screw fixation in mandibular angle fractures: A study on sheep mandibles.

Aim: Malfixed miniplates can impair fracture healing, and the screw pilot holes may widen during repeated fixation trials. This in vitro study explored the extent to which screw fixation of mandibular angle fractures could be improved by augmenting the drilling holes with polymethylmethacrylate (PMMA). Materials and Methods: We measured stabilization by recording specimen displacement under a vertical force of 50 N applied using a hydraulic tester. We included 20 hemimandibles from sheep (average weight 40 kg). The specimens were randomly divided into two groups of 10 and pilot holes were created in the angulus region using a drill 1.2 mm in diameter. Next, we performed osteotomies simulating angulus fracture repair. In group 1, the fracture site was fixed using non-compression miniplates and four screws were inserted to the maximal possible extent employing a mechanical screwdriver. In group 2, the pilot drill holes were filled with PMMA prior to miniplate fixation. Then vertical forces of 50 N were applied to the molar region and the displacements were measured. The Shapiro-Wilks test was used to compare the two groups. Result: The maximum average displacement in the experimental group was significantly lower than that in the control group (p=0.026). Thus, PMMA-augmented screws better stabilized bone, affording reliable fixation.

A new method to estimate dental age.

OBJECTIVE: The aim of this study was to evaluate the accuracy of Demirjian's method in estimating the dental age in Turkish children and to estimate the validity of Demirjian's standards for the studied population. MATERIALS AND METHODS: Panoramic radiographs of 756 northwestern Turkish children aged 5-13 years were examined. The new method for dental age estimation for both genders was studied to determine the relationship between dental age, chronological age and Demirjian's scores. Descriptive statistics were used and analysis of correlation was carried out between chronological age, dental age and Demirjian's scores. The difference between dental age and the chronological age was determined with the paired t-test. RESULTS: The results showed that northwestern Turkish children had delays in dental maturity. The new method was applied to Demirjian's scores and dental age scales for both genders were obtained. The tables were used to adapt Demirjian's scores to dental age determination in Turkish children using the new formula. CONCLUSIONS: The developmental standards used by Demirjian are not suitable for northwestern Turkish children. The methods for determining dental development must have population-specific standards. The established gender-specific equations and the new tables are more appropriate for dental age assessment in northwestern Turkish children.

Oral and maxillofacial considerations in Gardner's Syndrome.

Gardner's Syndrome is a variant of familial adenomatosis polyposis (FAP) with a triad consisting of polyps of the colon, multiple osteomas and surface tumors of soft and hard tissue. The intestinal polyps have a %100 risk of undergoing malignant transformation, therefore early identification of this disease is very important. There are several symptoms of Gardner's syndrome in the oral and maxillofacial surgery, which can be discovered during routine dental examination. We report a case of a 25-year old male patient with Gardner's syndrome who has not any intestinal polyps but osteomas in the mandible and jaw deformalities.

Iatrogenic mandibular fracture associated with third molar removal.

Third molar extraction is one of the most common procedures performed in oral and maxillofacial surgery units. It is sometimes accompanied by complications such as alveolar osteitis, secondary infection, hemorrhage, dysesthesia and, most severely, iatrogenic fracture. This article describes two mandibular angle fractures that occurred in two patients during the surgical extraction of one erupted and one unerupted third molar, including a brief review of the literature.

Evaluation of light-emitting diode (LED-660 nm) application over primary osteoblast-like cells on titanium surfaces: an in vitro study.

BACKGROUND: The goal of this study was to evaluate the behavior of neonatal rat calvarial osteoblast-like cells cultured on different implant surfaces and exposed once or three times to a 660-nm light-emitting diode (LED). METHODS: An LED with a 660-nm wavelength was applied once or three times to cultured cells on standard and modified sandblasted acid-etched surfaces (SLA and SLActive; Straumann, Basel, Switzerland). To analyze the effect of the LED on cell proliferation, numbers, and viability, cells were cultured on titanium discs, and measurements were taken after 72 h. Cell proliferation rates were assessed using a bromodeoxyuridine immunohistochemical technique. Cell morphologies were evaluated by scanning electron microscopy (SEM). RESULTS: Osteoblast-like cells proliferated on all tested surfaces, with differences among groups in cell counts and DNA synthesis values. The application of one LED treatment caused a significant increase in cell count in the SLActive group in comparison with the SLA group (p = 0.001), whereas the application of three LED treatments caused a significant decrease in cell count in the SLA group compared with the SLActive group (p < 0.001). After 72 h, the number of cells was highest in the SLActive group exposed once to the LED. CONCLUSIONS: One LED application in the SLActive group resulted in significantly increased cell numbers. However, these findings were not exactly compatible with the SEM findings, which demonstrated fewer cells and weak attachments between cells and to the surface. Thus, further studies using different LED application times are needed to clarify the reason for the increased number of cells that are apparently incapable of attaching to the titanium surfaces after 72 h.

Use of cone-beam computerized tomography for evaluation of bisphosphonate-associated osteonecrosis of the jaws in an experimental rat model.

BACKGROUND: Bisphosphonate-induced osteonecrosis of the jaw (BONJ) is a frequently reported complication. The aim of this study was to investigate the clinical and histopathological presentation of BONJ with the Hounsfield score and to evaluate the reliability of the score for determining necrosis in an animal model. MATERIAL/METHODS: Eighty rats were prospectively and randomly divided into two groups of 40 each: a control group and an experimental group. Half of the animals from each group underwent extraction of the left mandibular molars, and the other half underwent extraction of the left maxillary molars under pentobarbital-induced general anesthesia. All animals were euthanized 28 days after tooth extraction. Maxillae and mandibles were extracted, cone beam computed tomography (CBCT) was performed, and Hounsfield scores were evaluated. RESULTS: The Hounsfield scores of the experimental group were found to be compatible with chronic osteomyelitis and periosteal reactions. The Hounsfield scores of the control group were compatible with a healthy healing period. CONCLUSION: In light of these results, both cone beam computed tomography (CBCT) and the Hounsfield Units (HU) evaluations together are thought to be efficient in the diagnosis of BONJ.

Pleomorphic adenoma of the palate.

Pleomorphic adenoma is the most common mixed benign tumor of major salivary glands. Approximately 80% of these tumors arise in the parotid gland, whereas 7% arise in the minor salivary glands. The most common sites for minor salivary gland where pleomorphic adenoma arises are the palates followed by lips and cheek. We report a palate mass in a 46-year-old male patient. The initial cytologic diagnosis by fine-needle aspiration biopsy was pleomorphic adenoma. This report describes a case of pleomorphic adenoma regarding all distinctive diagnoses with the review of the literature.

In Vitro Antifungal Activity of Ankaferd Blood Stopper Against Candida albicans.

BACKGROUND: Candida albicans is a memeber of the oral flora that can lead to various complications in immunosupresive patients after oral surgery processes. Ankaferd Blood Stopper® (ABS) is a medical plant extract that is safe to use in patients with dental surgery bleedings in Turkey. OBJECTIVE: The study evaluated the antifungal activity of ABS medicinal plant extract against C albicans using the agar diffusion and broth microdilution methods. METHODS: The plant extract antifungal activity was assessed in vitro either by applying the ABS extract directly and by applying different concentrations of ABS onto Candida culture. For these experiments, an agar diffusion method was used. To determine the minimum inhibitory concentration (MIC), a broth microdilution method was used. RESULTS: Different volumes of the active substance (10, 20, 30, and 40 µL) were applied onto Candida (0.5 McFarland solution) cultivated plate; Candida growth was inhibited in accordance with the volumes of ABS. However, when various dilutions of ABS (1:2, 1:20, 1:40, and 1:80) were added as drops containing 20 µL, no antifungal effects were found. No MIC values were identified using broth microdilution. When different dilutions of ABS containing 100 µL of 0.5 McFarland solution of C albicans were cultured depending on the time (10, 20, 30, and 40 minutes), the effect of the duration was not significant. CONCLUSION: The various tests were carried out to investigate antifungal effects of ABS on Candida, but none were found.

Peripheral facial nerve paralysis after upper third molar extraction.

Peripheral facial nerve paralysis (PFNP) after mandibular interventions has been reported in the literature. In most cases, paralysis begins immediately after the injection of the mandibular anesthesia, and duration of facial weakness is less than 12 hours. However, there are few documented cases of PFNP after maxillary dental or surgical procedures. A variety of mechanisms have been associated to PFNP, including viral reactivation, demyelination, edema, vasospasm, and trauma. The purpose of this presentation was to report a rare case of facial paralysis that occurred after an upper third molar extraction. The cause of the PFNP and the importance of the multidisciplinary approach in the management are emphasized.

Comparison of the efficiency of alveolar decortication and low level laser therapy on orthodontic tooth movement and alveolar metabolism in rats.

BACKGROUND/PURPOSE: Reducing orthodontic treatment duration has many advantages for both clinicians and patients. This study was designed to compare the effects of alveolar decortication and low level laser therapy methods on tooth movement rate and alveolar bone metabolism. MATERIALS AND METHODS: A total of 42 Wistar albino rats were divided into three main groups as: Alveolar decortication (AD), low level laser therapy (LLLT) and only orthodontic force (F). The groups were evaluated at 7 and 14 day time points. Tooth movement rates were calculated by measuring the space between the contact points of the first and second molars. Comparisons regarding the alveolar bone metabolism were accomplished by evaluating osteoclast counts and RANKL - OPG expressions. RESULTS: The rate of tooth movement, at all time points, was significantly higher for the AD group than the other groups and was significantly higher in the LLLT group than the F group. At both time points, the RANKL and OPG expression in the AD group was significantly higher than the other groups and these parameters in the LLLT group was significantly higher than the F group. The osteoclast count values in the AD and LLLT groups were significantly higher than the F group and there were no significant differences between these two groups at all time points. CONCLUSION: This study shows that, to be more effective at AD, both AD and LLLT therapy significantly increases the level of tooth movement in the early period through their stimulating effects on the alveolar bone metabolism.

Healing of Oral Lichenoid Lesions following Replacement of Dental Amalgam Restorations with Feldspathic Ceramic Inlay-Onlay Restorations: Clinical Results of a Follow-Up Period Varied from Three Months up to Five Years.

OBJECTIVE: Previous studies have shown the effect of amalgam removal on the healing of oral lichenoid lesions (OLLs); however, no specific replacement materials have been suggested. The present series evaluated long-term results following the complete replacement of amalgam restorations with feldspathic ceramic inlay-onlay restorations for a group of patients with OLLs whose lesions were suspected to be related to amalgam restorations. MATERIALS AND METHODS: Twenty-four patients who had OLLs suspected to be related to their amalgam restorations were initially recruited. The patients underwent patch tests for a series of dental materials, in addition to clinical and histopathological examination. Sixteen (67%) of the 24 patients had their amalgam replaced with feldspathic ceramic inlay-onlay restorations and were examined within a follow-up period of 3 months to 5 years. RESULTS: After 3 months of clinical follow-up, complete healing (63%) was noted in all patients with OLLs whose lesions were in only close contact with their amalgam restorations. Healing was significantly related to the combination of lesions with close contact with the amalgam restoration and a diagnosis of OLL (x2 test, P=0.02). CONCLUSION: Feldspathic ceramic can be safely used as a replacement material for patients with OLLs to diminish adverse reactions to amalgam restorations.

Myxofibroma of the maxilla, current concepts, and differential diagnosis.

Odontogenic myxomas represent a small portion of all odontogenic tumors. A myxoma of the bone is a rare lesion that occurs almost exclusively in the jaws. An odontogenic myxoma has a variable clinical and radiological appearance, and it should be considered in the differential diagnosis of radiolucent and mixed radiolucent-radiopaque lesions of both jaws in all age groups. Myxomas consist of an accumulation of mucoid ground substance with little collagen, the amount of which determines whether it is called a myxofibroma. This paper presents the case of a 39-year-old male with a solid whitish red, nonulcerative, nontender expansion of both the buccal and palatal sides of the right upper alveolar bone. Results of a radiological examination revealed a unilocular radiolucency with cortical expansion and displacement of both the right upper second premolar and the first molar. The lesion was totally excised, and the histopathological examination showed a myxofibroma. Healing was uneventful, and there was no recurrence 12 months after surgical excision. Complete removal of the tumor, leaving no remnants attached to the soft tissue or bone, should be considered because of the well-known potential of myxofibromas to recur.

In Vitro Evaluation of Manual Torque Values Applied to Implant-Abutment Complex by Different Clinicians and Abutment Screw Loosening.

Preload is applied to screws manually or using a torque wrench in dental implant systems, and the preload applied must be appropriate for the purpose. The aim of this study was to assess screw loosening and bending/torsional moments applied by clinicians of various specialties following application of manual tightening torque to combinations of implants and abutments. Ten-millimeter implants of 3.7 and 4.1 mm diameters and standard or solid abutments were used. Each group contained five implant-abutment combinations. The control and experimental groups comprised 20 and 160 specimens, respectively. Implants in the experimental group were tightened by dentists of different specialties. Torsional and bending moments during tightening were measured using a strain gauge. Control group and implants with preload values close to the ideal preload were subjected to a dynamic loading test at 150 N, 15 Hz, and 85,000 cycles. The implants that deformed in this test were examined using an optical microscope to assess deformities. Manual tightening did not yield the manufacturer-recommended preload values. Dynamic loading testing suggested early screw loosening/fracture in samples with insufficient preload.

The Accuracy of New and Aged Mechanical Torque Devices Employed in Five Dental Implant Systems.

PURPOSE: Friction-style and spring-style torque wrenches are used to tighten implant abutments and prosthetic screws. The mechanical stability of these torque wrenches is crucial for the implant-abutment connection. The purposes of this study were to assess the performance of five brands (Straumann, Zimmer, Implant KA, Bredent, and Biohorizons) of wrench and to evaluate possible changes in applied torque values of aged wrenches. MATERIALS AND METHODS: Five new and aged wrenches that had been used approximately 250 times in a 1-year period were tested. The torque applied by friction- and spring-style wrenches was measured with a specially designed strain gauge indicator. Descriptive statistics, the one-sample t-test, and the independent-samples t-test were used to analyze values obtained from all torque wrenches. RESULTS: The accuracy of new and aged torque devices of all brands except Bredent differed significantly from the target values, but the mean values for aged and new wrenches did not differ significantly from each other (p > 0.05). Values for the spring- and friction-type torque wrenches deviated from the target values by 11.6% and 10.2%, respectively. CONCLUSION: The accuracy of aged torque wrenches is adequate for prosthetic screw tightening, but that of new torque wrenches is unsatisfactory and must be examined carefully before delivery.

Tooth extraction from a patient with cavernous hemangioma in maxillofacial region: case report.

Hemangiomas are benign vascular tumors which represent a rapid growth pattern followed by the involution phase. Generally, they are located in the soft tissues and are usually diagnosed in the first decade of life. Hemangiomas are mostly asymptomatic and rarely affect jaw bones. Mandible is affected more often than maxilla. If there is no complication present, treatment may not be necessary. Treatment planning of hemangiomas should be done by considering the location and the size of the lesion as well as the proximity to vital anatomical structures. The aim of this case report is to describe the procedures of tooth extraction in a patient who had been diagnosed as having maxillary cavernous hemangioma.

Monostotic fibrous dysplasia presenting in maxilla: a case report.

Fibrous dysplasia (FD) is a bone disorder in which fibrous tissue replaces normal bone. FD can be monostotic (10%-25%) or polyostotic (50-90%) and is typically diagnosed accidentally on radiographs. Craniofacial lesions are typically unilateral and are diagnosed by clinical assessment and radiographic evaluation. This report describes the case of a 50-yearold female patient who had presented with painless swelling of the right maxilla and was diagnosed with FD. Subsequent bone scintigraphy identified the lesion as monostotic. Based on the patient's age and the radiographic data, contour correction was performed. However, 1 year after surgery, the lesion regrew and the treatment was repeated.

Intraosseous and extraosseous variants of dentinogenic ghost cell tumor: two case reports.

This paper aims to present both intraosseous and extraosseous variant of dentinogenic ghost cell tumor as well as a review of the literature. An 11-year old female patient presented a swelling and pain in the molar area of the mandible and a 15-year-old female patient reported a complaint of swelling in the right vestibular region of teeth 12 and 13(FDI 2-digit classification system). Microscopic examinations showed similar features which characterized by ameloblastoma-like islands of epithelial cells, containing numerous ghost cells. The patients have been disease-free for one year. This paper aims to describe this rare tumor and to increase the number of cases in the literature to better understand its biologic behavior and treatment options.

Large rhinolith causing nasal obstruction.

Rhinoliths are calcified masses located in the nasal cavity and may cause symptoms such as nasal obstruction, fetid odour and facial pain. They are usually diagnosed incidentally on radiographic examinations or depending on the symptoms. In this paper we report a 27-year-old Caucasian woman with a calcified mass in the right nasal cavity causing nasal obstruction, anosmia and facial pain. The calcified mass was removed by endonasal approach.

Odontogenic cysts: a clinical study of 90 cases.

The maxillofacial region is affected by a greater number of cysts than any other part of the body. In this study, 90 odontogenic cysts were collected from 90 patients over a five-year period. Patients with radicular cysts, dentigerous cysts and odontogenic keratocysts were further analyzed with regard to age, sex and anatomical distribution. Using the histological classification of the World Health Organization, 53 cases (59%) were classified as radicular cysts, 24 (27%) as keratocysts and 13 (14%) as dentigerous cysts. Radicular cysts occurred most frequently in the anterior region of the maxilla, odontogenic keratocysts in the ramus and angular region of the mandible, and dentigerous cysts in the mandible. No recurrences were observed during the limited follow-up period.

Focal cemento-osseous dysplasia of mandible.

Fibro-osseous lesions are disturbances in bone metabolism in which normal bone is replaced by a connective tissue matrix that then gradually develops into cemento-osseous tissue. Typically, the lesion is asymptomatic and is detected on routine radiographic examination. Radiologically, this lesion has three stages of maturation: pure radiolucent, radiopaque/mixed radiolucent, and radiopaque appearance. During these stages the lesion can be misdiagnosed. In this case report a 69-year- old patient with a a complaint of painless swelling of the left mandibular molar and premolar area is presented along with a review of the differential diagnoses considered in order to reach a final diagnosis of focal cemento-osseous dysplasia.