Piezoelectric Surgery Versus Conventional Osteotomy in Impacted Lower Third Molar Extraction: Evaluation of Perioperative Anxiety, Pain, and Paresthesia.

PURPOSE: Piezoelectric surgery is a safe and effective osteotomy technique that can decrease the perioperative complications and morbidity in oral-maxillofacial surgery. In this study, we compared piezoelectric surgery and a conventional rotatory technique in the removal of impacted lower third molars. Our primary endpoints were perioperative anxiety, pain, and postoperative discomfort while avoiding the drilling sound of the conventional instrument. MATERIALS AND METHODS: Our study included 21 patients (14 female and 7 male patients) with bilateral, symmetrical impacted lower third molars. The 2 osteotomy techniques were randomly allocated to be performed on the right or left impacted lower third molars. The parameters evaluated were perioperative anxiety (State Trait Anxiety Inventory), postoperative pain (visual analog scale), operation time, and paresthesia. RESULTS: No significant difference was seen between piezoelectric surgery and conventional rotatory techniques in terms of pain, anxiety, and nerve damage. Preoperative anxiety was significantly higher in the female group than in the male group. No correlation was found between preoperative anxiety and postoperative pain. The operation time was significantly longer in the piezoelectric surgery group. CONCLUSIONS: Piezoelectric surgery provides a precise, less aggressive osteotomy compared with conventional rotatory techniques. However, it has not been found to significantly reduce perioperative pain and anxiety.

Investigation of the risk factors associated with the survival rate of dental implants.

PURPOSE: The propose of this article was to evaluate the risk factors associated with the survival rate of the dental implants. MATERIAL AND METHODS: This retrospective study evaluated the survival rate of 940 implants placed at the Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul University, from January 2003 to January 2011. The potential risk factors associated with the survival rate of the implants were investigated. RESULTS: Fifteen (1.5%) of the 940 implants failed during the follow-up period. Smoking did not affect the survival rate of the implants (log-rank, 1.5; P = 0.219). The survival rate of the implants placed in the maxilla was lower than that of the implants placed in the mandible (log-rank, 4.81; P = 0.028). The 5-year survival rate of the dental implants was 98.5%. CONCLUSIONS: There are still conflicting results about the risk factors associated with the survival rate of the implants. According to the results of this study, it is concluded that only the location of the implants is associated with the survival rates of the implants. All implant systems showed high survival rates.

Complications associated with the ball, bar and Locator attachments for implant-supported overdentures.

BACKGROUND: The purpose of this clinical study was to evaluate the complications associated with the different attachments used in implant-supported overdentures, including prosthetic problems and implant failures. A comparison of ball, bar and Locator (Zest Anchors, Inc, homepage, Escondido, CA, USA) attachments, in completely edentulous patients with two, three or four implants, was conducted. MATERIAL AND METHODS: A total of 36 edentulous patients (20 female, 16 male) with a mean age of 66.3 years, were enrolled in the study. The patients were treated with 95 implants, for the prosthetic restoration of the maxilla or the mandible. The mean follow-up time was 41.17 months. Prosthetic complications including, fractured overdentures, replacements of O-ring attachment and retention clips, implant failures, hygiene problems, mucosal enlargements, attachment fractures, retention loss and dislodgement of the attachments were recorded and evaluated. The recall visits at 3, 6, 12 months and, annually thereafter. RESULTS: Fourteen complications in the ballattachment group and 7 complications in the bar group were observed. No complications were observed in the locator group. The difference was found to be as statistically significant (p=0,009). Six of the 95 implants had failed. Totally 39 implant overdentures were applied. Three prostheses were renewed because of fractures. CONCLUSION: Within the limits of the present study, it was concluded that the locator system showed superior clinical results than the ball and the bar attachments, with regard to the rate of prosthodontic complications and the maintenance of the oral function.

An atypical form of necrotizing periodontitis.

BACKGROUND: Necrotizing ulcerative gingivitis/periodontitis are considered necrotizing periodontal diseases. This case report presents an atypical form of necrotizing periodontitis, which does not fit into this classification. METHODS: A 12-year-old child was referred to our clinic for gingival inflammation, extensive alveolar bone loss, and tooth mobility. Clinical and microbiologic examinations were carried out, and radiographs were taken. Clinical examination revealed soft and hard tissue destruction up to the mucogingival junction at the right maxillary premolar and mandibular incisors. Unusual infections or abnormalities in systemic functions were not detected through clinical and laboratory evaluations made at the Pediatrics Department, Istanbul University. Although an intensive established treatment protocol for necrotizing periodontitis was completed, management of long-standing health conditions could not be achieved because of recurrence of the disease, which caused us to repeat this treatment protocol at short intervals. RESULTS: Investigation led to a diagnosis of an atypical form of necrotizing periodontitis because the disease had a recurrent acute phase even under a standard treatment protocol. CONCLUSIONS: Our patient exhibits an unusual, necrotizing form of periodontal disease. The reason for the rapid rate of periodontal disease progression remains unclear.

Effects of different suture materials on tissue healing.

PURPOSE: The purpose of this study was to investigate the healing differences in between four different widely used suture materials in the oral surgery practice, including silk (Perma- Hand; Ethicon, INC., Somerville, NJ, USA), polypropylene (Prolene; Ethicon, INC., Somerville, NJ, USA), coated polyglactin 910 (Ethicon, INC., Somerville, NJ, USA). and polyglecaprone 25 (Ethicon, INC., Somerville, NJ, USA ). MATERIALS AND METHODS: 20 male rats were randomly allocated into two groups depending on their sacrification days (post-operative 1st and the 7th days). Four longitudinal incision wounds, each 1cm in size, were created on the dorsum of each animal which were then primarily closed with four different types of sutures. RESULTS: The effects of these suture materials on soft tissue healing were compared histopathologically, by means of density of the cells, necrosis, fibrosis, foreign body reaction, the presence of cells of acute and chronic infection. No statistically significant difference was observed between the groups regarding the density of the cells, necrosis, fibrosis, foreign body reaction, and the presence of the cells of acute and chronic infections. Of note, propylene showed slightly less tissue reaction among the other materials. CONCLUSION: The results of our study showed that there is no only one ideal suture material for surgical practice. The factors related to the patient, the type of the surgery and the quality of the tissue are important to decide an appropriate suture material.

Reactions of connective tissue to mineral trioxide aggregate and amalgam.

The purpose of this study was to evaluate the subcutaneous connective tissue reactions to ProRoot, mineral trioxide aggregate (MTA; Dentsply), and Oralloy, high-copper amalgam (Coltene). These materials were placed in polyethylene tubes and implanted into dorsal connective tissue of Wistar albino rats, and tissue biopsies were collected and histologically examined 7, 15, 30, 60, and 90 days after the implantation procedure. The presence of inflammation, predominant cell type, calcification, and thickness of fibrous connective tissue were recorded. Scores were defined as follows: 0, none or few inflammatory cells, no reaction; 1, < 25 cells, mild reaction; 2, 25 to 125 cells, moderate reaction; 3, > or = 125 cells, severe reaction. Fibrous capsule was categorized as "thin" when thickness was < 150 microm and "thick" at > 150 microm. Necrosis and formation of calcification were recorded. Both materials were well tolerated by the tissues in a 90-day evaluation period. One notable finding is the presence of dystrophic calcification in connective tissue adjacent to MTA; this finding is consistent with the hypothesis of hard tissue induction by this material.

Orbital pain and headache secondary to overfilling of a root canal.

A 35-yr-old woman was referred to the Istanbul University, Faculty of Dentistry, Oral Surgery Department with complaints of orbital pain and headache. Panoramic radiographs showed overfilling of a maxillary premolar, which caused a perforation in the maxillary sinus floor. The etiology, clinical manifestations, and treatment of this complication are discussed with emphasis on early surgical intervention to decrease the risk of a superimposed aspergillosis infection.

Alzheimer's disease and dental management.

Alzheimer's disease (AD) is a major disorder of old age and the most common cause of dementia. Dementia is loss of intelligence, memory, and cognitive functions. It is usually associated with aging, but there are many possible causes. Older adults are the most rapidly growing segment of the population. To maintain lifelong good oral health, the elderly need regular dental care. This review of AD summarizes the causes, epidemiology, diagnosis, and dental management of patients with AD.

Schizophrenia and dental management: review of the literature.

Schizophrenia is a brain disease that manifests itself with multiple signs and symptoms involving thought, perception, emotion, and behavior. Despite the fact that these manifestations combine in various ways to create considerable diversity among patients, the cumulative effect of the illness is always severe and usually long lasting. Schizophrenia is diagnosed in the presence of certain positive and negative psychotic symptoms, as well as psychologic and cognitive deterioration. In addition to history, medical and psychiatric examinations are used to rule out other possible diagnoses. Schizophrenia is not a rare disorder, and it affects approximately 1% of the general population. Many of these individuals require several hospitalizations, and the financial cost of schizophrenia is substantial. In this article, clinical features of schizophrenia are reviewed, and the important consequences from the perspective of dental practitioners are highlighted.

Surgical management of overfilling of the root canal: a case report.

Overfilling of the root canal is one of the most common errors encountered in dental practice. A 40-year-old woman complained of paresthesia and swelling affecting the left side of the mandible. Panoramic radiographs revealed that the root canal was overfilled; endodontic restorative material extended as far as the mandibular angle. Several months after surgical removal of the tooth and excess filling material, the symptoms subsided.

A comparative evaluation of pain and anxiety levels in 2 different anesthesia techniques: locoregional anesthesia using conventional syringe versus intraosseous anesthesia using a computer-controlled system (Quicksleeper).

OBJECTIVE: The aim of this study was to compare anxiety and pain levels during anesthesia and efficacy of Quicksleeper intraosseous (IO) injection system, which delivers computer-controlled IO anesthesia and conventional inferior alveolar nerve block (IANB) in impacted mandibular third molars. STUDY DESIGN: Forty subjects with bilateral impacted mandibular third molars randomly received IO injection or conventional IANB at 2 successive appointments. The subjects received 1.8 mL 2% articaine. RESULTS: IO injection has many advantages, such as enabling painless anesthesia with less soft tissue numbness and quick onset of anesthesia as well as lingual and palatal anesthesia with single needle penetration. CONCLUSIONS: Although IO injection is a useful technique commonly used during various treatments in dentistry, the duration of injection takes longer than conventional techniques, there is a possibility of obstruction at the needle tip, and, the duration of the anesthetic effect is inadequate for prolonged surgical procedures.

Survival and Success of ITI Implants and Prostheses: Retrospective Study of Cases with 5-Year Follow-Up.

OBJECTIVES: The use of osseointegrated implants as an endoestal anchorage device to provide support for dental prostheses is a reliable and widely accepted treatment modality. The purpose of this study was to evaluate the clinical performance of non-submerged implants placed in the maxilla or in the mandible. METHODS: A total of 146 International Team for Implantology (ITI) (Straumann AG, Waldenburg, Switzerland) implants were placed in 42 patients (20 women, 22 men, mean age 42). The cases were examined retrospectively in order to evaluate the clinical efficiency of non-submerged ITI implants and to determine the success rate of implant retained/supported prosthesis after a 5-year period. All implants were assessed clinically and radiographically on a yearly basis. RESULTS: The 5-year cumulative success rates for maxillary and mandibular implants were 91.00% and 97.81%, respectively. The most common prosthetic complication was abutment accompanied by screw loosing (3.42%). Veneering material fracture was documented in only one patient. CONCLUSIONS: Within the limitations of the observation period and sample number, the present findings confirmed sufficient success and survival rates of ITI implants placed in mandible as well as implants placed in the maxilla after a 5-year period.

A clinical comparison of prosthetic complications of implant-supported overdentures with different attachment systems.

OBJECTIVES: The objective of this clinical study was to evaluate the prosthetic complications of patients with 2 to 4 implants splinted with a round bar or with 2 to 4 unsplinted implants with ball attachments during the follow-up period. METHODS: A total of 26 patients were included in this study. Patients were randomly provided with a round bar or with ball attachments that were used to retain overdentures. During follow-up visits, the following prosthetic complications were recorded: round bar fracture, fractured overdenture, hygiene complications, abutment screw loose, worn O-ring or replacement of O-ring attachment, and fractured retention clip. The functioning period of overdentures in the round bar group ranged from 12 to 72 months (mean 49), and from 12 to 40 months (mean 23) in the ball attachment group. RESULTS: A total of 20 prosthetic complications were recorded in both groups. No differences in prosthetic complications were observed for 2 attachment systems. CONCLUSION: Implant-supported overdentures with bar or ball attachments may be considered to be reliable methods in the treatment of the edentulous individuals.