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.

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 the effects of melatonin and vitamin D on wound healing in immunosuppressive rats following tooth extraction.

BACKGROUND: The aim of this study was to evaluate the effects of melatonin (MLT) and paricalcitol (PRC) on the healing of the extraction socket following tooth extraction in rats with cyclosporine-A (CsA). MATERIAL AND METHODS: 76 male Wistar rats were divided into five different groups, one of which was a control (C) group. All groups other than the control group were applied CsA (10 mg/kg/daily) intraperitoneally 7 days before the tooth extraction. The left upper incisors were extracted on day 8 and CsA injections were continued in all groups until sacrification. Starting from the day of tooth extraction, in group 1 (CsA) were given CsA, in group 2 (CsA+MLT) were applied intraperitoneal MLT injection in a dose of 4 mg/kg, in group 3 (CsA+PRC) were applied intraperitoneal PRC injection in a dose of 200 ng/kg, and in group 4 (CsA+MLT+PRC) were applied intraperitoneal PRC injection and intraperitoneal MLT until the day of sacrification of all groups. The subjects were sacrificed on day 7 and 14 following tooth extraction. For histopathological examination, the subjects stained Hemotoxylin-Eosin and evaluated histologically under the light microscope. The intensity of inflammation in extraction socket was scored based on a four-grade system. RESULTS: The level of inflammation was found to be lower in group C on day 7, while the inflammation value was found to be higher in the group 1 on day 14 (p>0.05). Statistically significant differences were found in the ossification values on day 7 between the groups(p<0.05). The percentage of ossification on day 7 was significantly lower in the group 1 than in the C and group 3, and significantly lower in the group 2 than in the group 3. The percentage of ossification on day 14 in the group 1 was significantly lower than in group C (p<0.05). CONCLUSIONS: CsA has a negative effect on bone healing. The application of MLT and PRC following the toxicity produced by CsA was found to positively affect the healing of the socket that develops after tooth extraction.

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.

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.

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.

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.

Diagnostic importance of MRI and CT scans for synovial osteochondromatosis of the temporomandibular joint.

Since synovial chondromatosis (SC) clinically mimics symptoms of internal derangements of the TMJ, the diagnostic value of MRI and CT, overlooked for years, is discussed in the presented case. Multiple amorphous calcifications in the left infratemporal fossa and upper synovial compartment of the TMJ were detected on the CT and MRI scans. The patient underwent open TMJ arthrotomy and removal of 15 calcified loose bodies. SC may be diagnosed radiographically when sclerosis of the glenoid fossa, soft tissue edema, and intraarticular radio-opaque loose bodies are detected. Advanced imaging of the TMJ, such as MRIs and CTs, are indispensible methods to obtain differential diagnoses for long-standing suspicious pathologies of the temporomandibular joint.

Extraction of upper first molar resulting in fracture of maxillary tuberosity.

Fracture of the maxillary tuberosity sometimes can happen when pneumatization of the maxillary sinus extends between the roots of upper molars. Some factors may lead to this complication including prominent or curved roots, chronic periapical infection, hypercementosis, root ankylosis and tooth fusion. This paper reports a case with fracture of the maxillary tuberosity following extraction of an upper first molar in general dental practice. Prevention from any complication during extractions of maxillary molars with large antral enlargement is possible with careful preoperative examination and accurate surgical planning. The general dentist should be prepared to refer such cases to an oral surgeon when facing difficulties like the presented case.

Effects of hyperbaric oxygen treatment on implant osseointegration in experimental diabetes mellitus.

OBJECTIVE: To evaluate whether hyperbaric oxygen (HBO) treatment has a favorable effect on implant osseointegration in diabetic rabbits. MATERIAL AND METHODS: An experimental diabetes model was induced in 32 New Zealand rabbits through IV injection of alloxan. After the state of diabetes had been confirmed, one dental implant was placed in the metaphysical region of each animal's tibia. After the implants' placements, the animals were divided into two groups. Half of the animals underwent HBO treatment, while the other group did not receive HBO treatment and served as the control group. The animals were euthanized at the 4th and 8th weeks. The osseointegration of the implants were compared by histomorphometry and resonance frequency analysis (RFA). RESULTS: The Bone Implant Contact (BIC) values were significantly higher in the HBO group than in the control group at the 4th week. There was no difference in the BIC values between the groups at the 8th week. There was no significant difference in the RFA scores between the groups both at the 4th and 8th weeks after the operation. CONCLUSION: Histomorphometry findings suggest that HBO has positive effect on implant osseointegration in the early healing period in diabetic rabbits. However, implant stability is not affected by HBO treatment.

Effect of topical ozonetherapy on gingival wound healing in pigs: histological and immuno-histochemical analysis.

OBJECTIVES: In this study, the effects of ozonetherapy on secondary wound healing were evaluated histologically and immuno-histochemically. MATERIAL AND METHODS: Material and Methods: 8 healthy pigs were used in this study. Six wounds with 10 mm in diameter were created through the punch technique on the palatinal gingiva of each pig. Ozone gas was applied on only 3 wounds (test group) and the remaining 3 were left to natural healing (control group). Biopsy samples were taken from one of the wounds in each group on the third day, from another wound of each group on the seventh day, and from another one on the tenth day. Routine histological analysis and immuno-histochemical staining were performed to investigate transforming growth factor-beta (TGF-ß) and (VEGF) expressions. RESULTS: Results: No statistical difference was found between the test and control groups in terms of collagen fibers, epithelial formation and inflammation scores. A VEGF expression found in the test group was statistically higher than control group samples taken on the 3rd and 7th day. There was no statistical difference between the test and control groups in terms of TGF-ß expression on any of the sampling days. CONCLUSIONS: Conclusion: The topical application of ozone gas could be effective in the early stages of wound healing by increasing the amount of VEGF expression. Clinical Relevance: Topical application of ozone gas may be effective in the early stages of oral wound healing.

Bilateral Double Maxillary Paramolars: A Rare Case Report.

Paramolars are rare supernumerary molars occurring buccally or lingually/palatally near the molar row. They may cause complications such as caries, periodontal disease and delay or prevention eruption of permanent teeth. Reports of bilateral entity are rarely found in the dental literature. The present article reports a rare case of bilateral double paramolars in the maxillary molar region in 21-year-old male patient.

Congenital Gingival Granular Cell Tumor: A Case Report.

The congenital gingival granular cell tumor (CGCT), also as known as congenital epulis, is an unusual benign oral mucosal lesion in newborns. A two-day-old female patient was admitted to the Department of Pediatric Dentistry at Gulhane Medical Academy, Ankara, Turkey with her family, and an intraoral examination showed a CGCT located in the buccal region of the maxillary right first primary molar. In this report, we present a case of CGCT in a newborn.

Extremely Rare Form of Impaction Bilateral Kissing Molars: Report of a Case and Review of the Literature.

Kissing molars (KM) or rosette formation is a term that is used to describe impacted teeth contacting occlusal surfaces in a single follicular space and their roots pointing in opposite directions. In some cases kissing molars can be seen but occurrence of bilateral kissing molars is extremely rare phenomenon in the dental literature and the aetiology of this phenomenon is still unknown. In this paper we describe a case and review of the literature and discuss the management of this pathology. In our case, extremely rare form of impacted bilateral kissing molars was extracted surgically. The decision of extraction of asymptomatic kissing molars represents surgical dilemma. There may be many surgical complications; on the other hand in some cases surgical intervention is unavoidable. Few treatment options were described in the literature. This phenomenon can be sign of various medical conditions that may require further investigation. In this paper, our treatment option is in agreement with the literature suggesting the surgical removal of both teeth at either side of the mandible.

Clinical comparison of submucosal injection of dexamethasone and triamcinolone acetonide on postoperative discomfort after third molar surgery.

OBJECTIVE: The aim of the study was to compare the effect of submucosal injection of dexamethasone and triamcinolone acetonide on postoperative pain, swelling, and trismus occurring after impacted mandibular third molar surgery. METHOD AND MATERIALS: A total of 78 patients (aged 18 to 35) with asymptomatic, unilateral, impacted mandibular third molar, and without any systemic disease were included in this study. Patients were divided into three groups randomly (control, dexamethasone, and triamcinolone acetonide). In the experimental groups, dexamethasone and triamcinolone acetonide were injected into submucosa at about 1 cm above the surgical area submucosally. The control group of patients did not take any drug submucosally but the same surgical procedure was applied. Pain evaluation was performed by visual analog scale (VAS). Swelling was measured using a flexible standard ruler measuring the dimensions of the axes between certain points on the face. For trismus evaluation, maximum mouth opening was measured. Measurements taken on the preoperative, and on postoperative first, third, and seventh days were compared with each other and statistically evaluated. RESULTS: There were statistically significant differences between the control and experimental groups on the different days of the postoperative period. The effect of triamcinolone acetonide on pain started on the first day postoperatively and the effect of triamcinolone acetonide on trismus and pain was better than other groups at the third and seventh days. However, there was no statistically significant difference between the effects of dexamethasone and triamcinolone acetonide regarding postoperative complications. CONCLUSION: The submucosal injection of dexamethasone or triamcinolone acetonide might be an effective treatment for postoperative discomfort occurring following impacted mandibular third molar surgery, and triamcinolone acetonide could be applied as an alternative to dexamethasone.

Compound odontoma involving the four quadrants of the jaws: a case report and review of the literature.

Odontomas are the most common odontogenic tumors, representing 70% of all odontogenic tumors. They may present in two specific forms; compound odontoma forms multiple small tooth-like structures, while complex odontoma forms an amorphous calcified mass. In this report, we present a 27-year-old male patient with multiple compound odontoma occupied regions at his jaws. The odontomas involve both alveolar and basal processes of the maxilla and mandible as well as both maxillary sinuses. Converse to conventional recommended treatment, which is surgical excision of the lesion, the management was removal of the lesion and clinical-radiologic followup. The first year's follow-up findings are presented in this case report.

Assessment of the lateral pterygoid plate fractures during Le Fort I osteotomies regarding the angulation of the osteotome.

AIM. This study aimed to clarify the relation between the angulation of the curved osteotome and fracture of the pterygoid plate during Le Fort I osteotomy. MATERIAL AND METHODS. Twenty-one specimens of hemisectioned Turkish skulls were used for the study. The maxilla was sectioned transversely on the floor of the pyriform aperture and posteriorly to the lateral pterygoid plate with a mechanical saw. The pterygomaxillary junction was separated with a curved osteotome by angulating the osteotome with, 0° and -30° to the occlusal plane. The undesired fractures of the lateral pterygoid plate were determined. Among 21 specimens, 7 pterygomaxillary junctions were separated with an angle of +30° , 7 with 0° and 7 with -30° to the occlusal plane. RESULTS. In group +30°, the undesired fracture occured in 6 of the cases. In group -30°, the undesired fracture was determines in one case. In cases where the separation was performed by placing the osteotome paralell to the occlusal plane all plates remained safe. CONCLUSION. Within the limited knowledge of the current study it can be concluded that the osteotome should be placed paralell to the occlusal plane.

Effect of topical ozonetherapy on gingival wound healing in pigs: histological and immuno-histochemical analysis

Abstract In this study, the effects of ozonetherapy on secondary wound healing were evaluated histologically and immuno-histochemically. Material and Methods: 8 healthy pigs were used in this study. Six wounds with 10 mm in diameter were created through the punch technique on the palatinal gingiva of each pig. Ozone gas was applied on only 3 wounds (test group) and the remaining 3 were left to natural healing (control group). Biopsy samples were taken from one of the wounds in each group on the third day, from another wound of each group on the seventh day, and from another one on the tenth day. Routine histological analysis and immuno-histochemical staining were performed to investigate transforming growth factor-beta (TGF-β) and (VEGF) expressions. Results: No statistical difference was found between the test and control groups in terms of collagen fibers, epithelial formation and inflammation scores. A VEGF expression found in the test group was statistically higher than control group samples taken on the 3rd and 7th day. There was no statistical difference between the test and control groups in terms of TGF-β expression on any of the sampling days. Conclusion: The topical application of ozone gas could be effective in the early stages of wound healing by increasing the amount of VEGF expression. Clinical Relevance: Topical application of ozone gas may be effective in the early stages of oral wound healing.

A new preoperative radiological assessment in LeFort I surgery: anterior nasal spine-sphenoidal rostrum.

OBJECTIVE: The aim of this study is to assess the distance between the anterior nasal spine and the sphenoidal rostrum related to the LeFort I surgery in a Turkish population sample. MATERIAL AND METHODS: We retrospectively reviewed multidetector computerized tomography (MDCT) scans of 209 patients (134 males and 75 females). The images were obtained on a 64-MDCT scanner. The imaging parameters were 0.5 × 64 mm slice thickness, 0.5/0.3 mm increment, 120 kV, 250 mAs, 0.5 sn rotation time, 0.641 pitch, and 512 matrix. The distance between the anterior nasal spine and the sphenoidal rostrum was assessed with the Vitrea 2 software program. RESULTS: The study group consisted of 134 male (mean age 57.90 ± 5.86) and 75 female (mean age 54.84 ± 4.31) patients. The distance between the anterior nasal spine and the sphenoidal rostrum was ranging between 40.4 and 70.9 mm (average 58.3 ± 5.9) in males and 45.0 and 63.2 mm in (average 55.2 ± 4.3) females. In addition, no statistically significant differences were found between genders. CONCLUSION: The results of the current study showed that after 40 mm proceeding of the ball end nasal osteotome, the surgeons must be aware of penetrating the sphenoidal rostrum.