Evaluation of femoral condyle volumes in patients with trochlear dysplasia: a pilot study.

AIM: To examine the volumes of the medial and lateral femoral condyles and the trochlear groove, and to determine their relationship with trochlear dysplasia. MATERIALS AND METHODS: Computed tomography images of the knees of 21 patients with trochlear dysplasia and 18 healthy individuals were analysed retrospectively. According to the modified Dejour classification, the degree of trochlear dysplasia was recorded, such as type A trochlea being low-grade dysplasia and types B, C, and D trochlea being high-grade dysplasia. Volume of the trochlear groove and medial and lateral femoral condyles were calculated using the three-dimensional (3D) volume-rendering method. RESULTS: The volumes of lateral condyle, medial condyle, and trochlear groove were statistically significantly lower in patients with trochlear dysplasia when compared to healthy participants. When compared according to Dejour types, all parameters were statistically significantly lower in both high- and low-grade dysplasia patients (p<0.05). The correlation between femoral condyle volumes and trochlear groove volume was low in the control group, but there was a moderate positive correlation in the patient group (r=0.50-0.75, p<0.05). CONCLUSION: In trochlear dysplasia, the volume of the trochlear groove decreases and hypoplasia may occur in both lateral femoral and medial femoral condyles. Therefore, hypoplasia of only one condyle should not be interpreted as trochlear dysplasia. A holistic approach to patients is required.

Regenerative Endodontic Therapy with Platelet Rich Fibrin: Case Series.

Regenerative endodontic therapy (RET) provides a novel treatment modality for the immature teeth with pulp necrosis. The aim of this case series was to evaluate RET of immature permanent teeth using platelet rich fibrin (PRF) at 36-month follow-up periods. In the present case series, three immature maxillary incisors diagnosed with pulp necrosis and apical periodontitis were treated with RET. The root canals were irrigated with 1.5% sodium hypochlorite (NaOCl) and medicated with triple antibiotic paste(TAP). At the second visit, TAP was removed and root canals were conditioned with 17% EDTA. PRF was used as a scaffold. MTA was placed over PRF and the teeth were restored with composite resin. Periapical radiographs and cone beam computerized tomography(CBCT) were used to evaluate the healing. At the end of the 36-month follow-up periods, there was no response to pulp sensibility tests with cold and electric pulp tester, but all teeth showed decreased periapical lesions or evidence of healing.

Efficacy of chlorhexidine as a final irrigant in one-visit root canal treatment: a prospective comparative study.

AIM: To evaluate postoperative pain and radiographic evidence of periapical healing in teeth with apical periodontitis treated in one visit with an additional final irrigation using 2% chlorhexidine (CHX) and to compare the results with conventional two-visit root canal treatment (RCT) with an intracanal calcium hydroxide (CH) dressing as a control group. METHODOLOGY: Ninety asymptomatic maxillary anterior teeth with periapical lesions were treated by a single operator. Root canals were prepared using the step-back technique with manual instrumentation with 2.5% NaOCl and 5% EDTA as irrigants. Half of the teeth were randomly assigned to the one-visit (OV) group and received an additional final rinse with 2% CHX before canal filling. The other teeth were treated in two visits (TV) with a CH paste made by mixing CH powder and distilled water as an interappointment dressing. All patients were recalled and investigated clinically and radiographically for 24 months. Postoperative pain at 24-48 h and changes in apical bone density indicating radiographic healing were evaluated statistically using the Mann-Whitney U-test followed by the Friedman and the Wilcoxon tests (α = 0.05). RESULTS: There were no significant differences between two groups regarding the incidence of postoperative pain at 24 h (OV group 50% no pain, 47.6% mild, 2.4% moderate pain/TV group 55% no pain, 42.5% mild, 2.5% moderate pain) and at 48 h (OV group 95% no pain, 5% mild pain/TV group 98% no pain, 2% mild pain). None of the patients reported severe postoperative pain, swelling and/or flare-ups during the follow-up period. There was no significant difference in the radiographic healing rates (OV group 97.6% PAI 1 and/or PAI 2 and 2.4% PAI 3/TV group 95% PAI 1 and/or PAI 2 and 5% PAI 3; P > 0.05). CONCLUSION: Both groups provided favourable and similar postoperative pain and periapical healing rates at 24 months. Thus, one-visit RCT with a final rinse with 2% CHX is an acceptable alternative to two-visit RCT with CH as temporary dressing in maxillary anterior teeth.

Regenerative endodontic treatment of perforated internal root resorption: a case report.

AIM: To present the regenerative endodontic treatment procedure of a perforated internal root resorption case and its clinical and radiographic findings after 2 years. SUMMARY: A 14-year-old female patient was referred complaining of moderate pain associated with her maxillary left lateral incisor. After radiographic examination, a perforated internal resorption lesion in the middle third of tooth 22 was detected. Under local anaesthesia and rubber dam isolation, an access cavity was prepared and the root canal was shaped using K-files under copious irrigation with 1% NaOCl, 17% EDTA and distilled water. At the end of the first and second appointments, calcium hydroxide (CH) paste was placed in the root canal using a lentulo. After 3 months, the CH paste was removed using 1% NaOCl and 17% EDTA solutions and bleeding in the root canal was achieved by placing a size 20 K-file into the periapical tissues. Mineral trioxide aggregate was then placed over the blood clot. The access cavity was restored using glass-ionomer cement and resin composite. After 2 years, the tooth was asymptomatic and radiographic examination revealed hard tissue formation in the perforated resorption area and remodelling of the root surface. KEY LEARNING POINTS: Regenerative endodontic treatment procedures are an alternative approach to treat perforated internal root resorption lesions. Calcium hydroxide was effective as an intracanal medicament in regenerative endodontic treatment procedures.

Antimicrobial and antioxidant activities of the various extracts of Verbascum pinetorum Boiss. O. Kuntze (Scrophulariaceae).

BACKGROUND AND OBJECTIVES: The present study was performed to evaluate the in vitro antimicrobial and antioxidant properties of various extracts of Verbascum (V.) pinetorum, a member of Scrophulariaceae family. While the antimicrobial activity of various extracts of V. pinetorum was determined with agar-well diffusion method, the antioxidant activity was examined with two complementary test systems, namely 1,1-diphenyl-2-picrylhydrazyl (DPPH) free radical scavenging and beta-carotene/linoleic acid test systems. RESULTS: The hexane extract exhibits antimicrobial activity against few microorganisms. However, dichloromethane, direct methanol and methanol/chloroform extracts are effective on a broad range of microorganisms. Among the tested bacteria Haemophilus influenzae was found to be the most sensitive bacterium. The 50% (IC50) inhibition activity of the methanolic extract of V. pinetorum on the free radical DPPH was determined as 13.04 mg/ml. In the case of the linoleic acid system, oxidation of linoleic acid was inhibited by methanolic extract of V. pinetorum, which showed 89.39% inhibition that is quite close to the value of the synthetic antioxidant reagent butylhydroxytoluene (BHT), 92.46%. Iridoid glycosides, flavonoids and saponins were determined as the major natural compounds in the methanolic extracts. The total phenolic components of V. pinetorum were found as 42.45 mg/g gallic acid equivalent. CONCLUSION: The results provide evidence that the extracts of V. pinetorum contained iridoid glycosides, flavonoids, saponins and phenolic compounds which may be responsible for the substantial antimicrobial and antioxidant activities.

Severe skin necrosis after breast reconstruction with a transverse rectus abdominis musculocutaneous flap in methylenetetrahydrofolate reductase deficiency.

We report a case of unexpected severe skin necrosis after autologous transverse rectus abdominis musculocutaneous flap breast reconstruction in a patient with homozygosis for the 5,10- methylenetetrahydrofolate reductase (MTHFR) gene. This genetic deficiency is hypothesised as the cause of this exceptional skin necrosis. A 46-year-old woman underwent a radical mastectomy and immediate rectus abdominis musculocutaneous flap breast reconstruction. At the end of surgery, the blood supply to the flap and the abdominal wall was excellent. On the 5th postoperative day, the patient developed an extensive abdominal skin necrosis and a partial flap necrosis on the reconstructed breast. The rectus abdominis musculocutaneous flap breast reconstruction can be proposed to patients without any haemostatic defect in order to avoid life-threatening complications and unaesthetic results. This procedure requires careful patient selection, detailed preoperative planning, and complete laboratory investigations: However, mutation of the 5,10- methylenetetrahydrofolate reductase gene is too exceptional to form part of the routine preoperative investigation and can be looked for in these cases of extensive necrosis.

Thalamic hyperdensity--is it a diagnostic marker for Sandhoff disease?

Sandhoff disease, also known as GM2-gangliosidoses variant 0, is caused by the deficient activity of both hexosaminidase A and hexosaminidase B. We report a 15-month-old boy diagnosed with Sandhoff disease by demonstrating the enzyme deficiency. The interesting finding was bilateral thalamic hyperdensity on the CT scan. The hyperdensity in all previously published cases was homogeneous and symmetric and limited to the thalamus; the cause still remains unknown. We suggest that the finding of dense thalami may be useful as a specific diagnostic criterion for the GM2-gangliosidoses and especially for Sandhoff disease.