Eruption of an impacted canine in an adenomatid odontogenic tumor treated with combined orthodontic and surgical therapy.

An adenomatoid odontogenic tumor is an uncommon asymptomatic lesion that is often misdiagnosed as a dentigerous cyst. It originates from the odontogenic epithelium. Enucleation and curettage is the usual treatment of choice. Marsupialization may be attempted instead of extraction of the impacted tooth, since it provides an opportunity for tooth eruption. This case report is the first to report on the eruption of an impacted canine in an adenomatoid odontogenic tumor treated with combined orthodontics and marsupialization. The impacted canine erupted uneventfully, with no evidence of recurrence 3 years after the treatment.

Effects of osteoformin in the rapid distraction osteogenesis of rabbit mandibles.

OBJECTIVE: To evaluate the effects of osteoformin on mineralisation and quality of the new bone formation during rapid distraction osteogenesis. METHODS: This multi-centre study was conducted at the Karadeniz Technical University, Middle East Technical University and Selcuk University. The experimental study was conducted from January 2010 to September 2012 and comprised New-Zealand rabbits that were randomly divided into three groups. In group I distraction rate was 1 mm/day while in groups II and III distraction rates were 2mm/day and 1 mm/day. In groups I and II 100µg/kg osteoformin was injected after the latency period. Distraction region was evaluated by radiological, histomorphometrical and dual energy X-ray absorptiometry analyses. SPSS 17 was used for statistical analysis. RESULTS: There were 18 rabbits with each of three groups having 6(33.3%). Accelerated bone healing was noted in groups I and II compared with group III (p<0.05). No significant differences were indicated between groups I and II (p>0.05). CONCLUSIONS: Local injection of osteoformin was effective in the craniomaxillofacial distraction osteogenesis in rabbits. Further experimental studies are recommended before using osteoformin on humans.

Analysis of Satisfaction Levels in Completely Edentulous Patients Treated with Different Configurations of Implant Supported Rosthesis.

PURPOSE: The aim of this study is to evaluate and compare patient satisfaction levels in edentulous patients treated with different configurations of implant supported prosthesis. Also, the effect of previous prosthesis experience before implant treatment on patient satisfaction was investigated. MATERIALS AND METHODS: A study population of 142 patients was identified. Patients seperated into four treatment types. Group 1 comprised 43 patients treated with implant supported overdenture for mandible and conventional complete denture for maxilla while group 2 comprised 32 patients treated with implant supported overdentures for maxilla and mandible. Group 3 comprised 26 patients treated implant supported overdenture for mandible and fixed prosthesis for maxilla. Group 4 comprised 41 patients treated with implant supported maxillomandibular fixed restorations. A questionnaire consisting of specific issues about masticatory performance, pronunciation, comfort, social ability were used to evaluate treatment outcomes. RESULTS: The patients in group 4 were significantly more satisfied regarding masticatory performance than other treatment modalities. VAS scores of Group 3 and group 4 regarding comfort and social ability were similar while scores of these two groups were significantly higher than that of group 1 and 2. The patients who used conventional removable prosthesis before implant treatment were more satisfied with their implant supported prosthesis regarding social ability.(p=.03) Conclusion: It was found that treatment design of that implant supported fixed prosthesis on maxilla and implant overdenture on mandible provided comparable level of satisfaction with maxillomandibular fixed prosthesis for edentulous patients. Implant supported fixed prosthesis for maxilla and implant supported overdenture for mandible served as a practical alternative to satisfy patients especially in patients with mandibular atrophy who would demand extensive surgeries for maxillomandibular fixed prosthesis. Satisfaction level of implant supported overdenture was not superior to conventional prosthesis for maxilla. Previous removable prosthesis experience may influence social comfort of patients.

Is Incisive Papilla a Good Landmark to Predict Clinical Outcomes and the Esthetic Perceptions of Edentulous Patients Treated with Implant-Supported Fixed Prostheses on Maxillae?

Purpose: To investigate the effect of incisive papilla on esthetic ratings and lip support for patients who are treated with implant-supported fixed prostheses on edentulous maxillae. Materials and Methods: A study population of 118 patients with maxillomandibular edentulism was identified. A self-administered questionnaire was used to evaluate treatment outcomes through a patient perspective. Also, clinical factors such as smile line, maxillary resorption, incisive papilla position, and lip support were evaluated. Results: Lip support has a significant effect on the facial esthetic scores of patients, while smile line and incisive papilla localization have not had a proven statistically significant effect on esthetic and facial esthestic scores of patients treated with implant-supported fixed prostheses on maxillae. Conclusion: Although the patients were diagnosed with disadvantageous clinical factors such as crestally localized incisive papilla, they still noted higher esthetic scores with their fixed prostheses. Factors that affect the esthetic perception of patients or their priorities should be investigated more to understand the reasons for patient satisfaction with prostheses.

Evaluating the changes in nasal airway volume and nasal airflow after surgically assisted rapid maxillary expansion.

OBJECTIVE: This study aims to compare the changes in the nasal airway volume and nasal airflow using acoustic rhinometry (AR), rhinomanometry (RMN), and dental volumetric tomography (DVT) after surgically assisted rapid maxillary expansion (SARME). STUDY DESIGN: Our study consists of 13 adults, 3 male and 10 female patients, aged between 15 and 26, with completed skeletal development. In our study, DVT imaging was obtained twice, preoperation and 3 months after expansion. AR and RMN measurements were recorded, and Visual Analog Score (VAS) and Nasal Obstruction Symptom Evaluation (NOSE) Scale surveys were scored at preoperation and 3 months after expansion. Nasopharyngeal-oropharyngeal airway volume and areas were calculated using the Romexis 3.8.3.R (Planmeca, Helsinki, Finland) and Nemotec V2019 (Madrid, Spain) software programs. IBM SPSS Statistics 22 (SPSS IBM, Armonk, New York) was used for statistical analysis. RESULTS: Comparing the preoperation and postexpansion measurements by both software programs revealed a statistically significant increase in the nasopharyngeal airway volume. No statistically significant change was observed in the oropharyngeal airway volume. Furthermore, we found a statistically significant increase in VAS but a significant decrease in NOSE. CONCLUSION: According to our findings, nasal airway volume increased after SARME, and although there was no significant change in nasal resistance, patients' quality of life increased significantly.

Stability of dental implants with sandblasted and acid-etched (SLA) and modified (SLActive) surfaces during the osseointegration period.

Background. The surface properties of implants are effective factors for increasing the osseointegration and activity of osteoprogenitor cells. This study compared the stability of dental implants with sandblasted and acid-etched (SLA) and modified surfaces (SLActive) using the resonance frequency analysis (RFA). Methods. In a split-mouth design, 50 dental implants with either SLA surface properties (n=25) or modified (SLActive) surface properties (n=25) were placed in the mandibles of 12 patients with a bilateral posterior edentulous area. Implant stability was measured using RFA (Osstell) at implant placement time and every week for 1, 2, and 3 months before the conventional loading time. Results. One week following the implantation, implant stability increased from 70 to 77.67 for SLA and from 71.67 to 79 for SLActive (P < 0.05). Stability improved each week except in the 4th week in SLActive surface measurements. No significant differences were observed between the groups at 2 and 3 months (P > 0.05). Conclusions. For both implant surfaces, increased stability was observed over time, with no significant differences between the groups.

Orthodontic treatment of an ankylosed maxillary central incisor through osteogenic distraction.

Tooth ankylosis is one of the various problems in dentistry and requires special treatment approaches for satisfactory results. In the orthodontic treatment of an ankylosed tooth, different treatment modalities have been put into practice including both orthodontic and orthodontic-surgical approaches. For favorable results, gingival margin esthetics must be considered as much as leveling the ankylosed tooth in the arch. Distraction osteogenesis accompanied by orthodontic mechanics is a sensible way of achieving this goal. However, devices used in the distraction protocol are high in price and bulky in shape, causing functional and esthetic problems for the patient. This report describes treatment of an infrapositioned ankylosed incisor with continuous distraction forces produced by conventional orthodontic mechanics. In conclusion, the ankylosed tooth was leveled in the upper arch successfully with a harmonic gingival margin.

A preferable technique for protecting the inferior alveolar nerve: coronectomy.

PURPOSE: The aim of this study was to evaluate the effectiveness of coronectomy for teeth whose root apices are very close to the inferior alveolar canal. PATIENTS AND METHODS: The 43 patients of this study needed removal of their lower third molar, whose root apices were very close to the inferior alveolar canal. These patients underwent 47 coronectomies. RESULTS: The mean follow-up period was 9.3 months (range, 1 to 48 months). The mean total amount of root movement was 3.4 mm at 6 months, 3.8 mm at 12 months, and 4.0 mm at 24 months. CONCLUSIONS: The technique of coronectomy is defined as removing the crown of a tooth but leaving the roots untouched, so that the possibility of nerve damage is reduced. Coronectomy is a preferable technique for patients who run a risk of injury to the inferior alveolar nerve during third molar surgery.

Effects of recombinant human erythropoietin on mandibular distraction osteogenesis.

PURPOSE: To evaluate the effects of subcutaneous administration of recombinant human erythropoietin (rHuEPO) on regeneration formation and quality during mandibular distraction osteogenesis. MATERIALS AND METHODS: Sixteen adult male New Zealand rabbits were used in this study. Ethical approval was obtained from the Animal Research Institute of Selcuk University, Konya, Turkey. Subjects were randomly divided into 2 groups. Distraction osteogenesis (DO) was performed with a custom-made distractor on the left mandibles of rabbits. In the experimental group, 4 doses of 150 IU/kg rHuEPO were administered at 48-hour intervals. The first dose was given immediately after surgery. Control subjects received 0.5 mL/kg isotonic solution in the same manner. After 2 days of latency, mandibles were distracted 1 mm/day at 12-hour intervals for 5 days. A 5-mm lengthening was achieved. All animals were sacrificed after 30 days of consolidation. Afterward, samples were prepared for histomorphometric evaluation of newly formed bone area. RESULTS: The number of osteoblasts and blood vessels was significantly higher, whereas the number of osteoclasts was significantly lower, in the experimental group than in the control group (P < .05). In the experimental group, the area of new bone formation was greater than in the control group (P < .05). Moreover, fibroblast and collagen numbers per unit area were higher in the experimental group. However, this finding was not statistically significant (P > .05). CONCLUSION: The subcutaneous administration of rHuEPO improves the rate and quality of bone-healing during distraction osteogenesis. However, the short-term favorable effects of rHuEPO in this study should be extended with long-term investigations before clinical application.

Evaluation of stress distribution in critical anatomic regions following the Le Fort I osteotomy by three-dimensional finite element analysis.

In this study, we aimed to measure the stresses both on the pterygoid plates and the cranial base during the down-fracture and at the time of pterygomaxillary osteotomy by using the finite element analysis method to have an idea about the possible causes of complications. Three different surgical approaches were applied to the obtained models. In the Model 1, Le Fort I cuts without pterygomaxillary separation was applied. In the Model 2, same standard Le Fort I cuts were applied with pterygomaxillary separation. Then both models were subjected to a force of 150 N over the anterior spina nasalis to simulate down-fracture. In the third model, same standard Le Fort I cuts were applied. Following this procedure, a force of 50 N was applied with a sharp osteotome to the pterygomaxillary junction to simulate osteotomy. According to the results of this experimental study, the cranial base stress values decreased during the down-fracture in the Model 2. Moreover, it was found that the force transmitted to the base of the skull is less when the height of the pterygomaxillary osteotome is limited to 1 cm as we applied in Model 3.

Histomorphometric evaluation of the effects of zoledronic acid on mandibular distraction osteogenesis in rabbits.

PURPOSE: To assess the effect of systemic administration of zoledronic acid (ZA) on mineralization of newly formed bone and to determine strain-related osteoporosis on surrounding bone during lengthening of immature rabbit mandible. MATERIALS AND METHODS: Eighteen New Zealand white rabbits were divided randomly into 2 groups, and bone lengthening was carried out in the left portion of the mandible through distraction osteogenesis with a rate of 0.5 mm every 12 hours for 5 days. The experimental group was administered 0.1 mg/kg ZA intravenously. The control group was given saline infusion only during operation. All animals were sacrificed at the end of the 28-day consolidation period. The mandibles of all animals were removed and regenerate was evaluated. Osteoblasts, osteoclasts, collagen fibers, and fibroblasts were marked within 0.1-mm(2) area and newly formed bone area was measured within 0.5-mm(2) area. All data were analyzed using Mann-Whitney U test. RESULTS: Although irregular bone destruction spots were seen in the control group, the experimental group showed regular ossification areas and significant difference between osteoblast and osteoclast numbers (P < .05). In the regenerate zone, there was considerable difference between the 2 groups in terms of osteoblast, osteoclast, and collagen amounts (P < .05). Additionally, newly formed bone areas and fibroblast count were higher in experimental group. CONCLUSIONS: The results of this study showed that ZA had positive effects on the new bone formation, which may potentially shorten the consolidation period.

Biomechanical evaluation of hybrid fixation method of sagittal split ramus osteotomy in mandibular advancement.

PURPOSE: In this study, eight different fixation methods applied after sagittal split ramus osteotomy (SSRO) were compared experimentally. MATERIALS AND METHODS: SSRO was performed to 48 sheep hemimandibles in eight groups of 6 each. Group A- a four hole standard miniplate; Group B- a four hole standard miniplate and one bicortical screw; Group C-a four hole locking plate; Group D-a four hole locking plate and one bicortical screw; Group E-a six hole straight miniplate; Group F-a six hole straight miniplate and one bicortical screw; Group G- a sliding plate, which was specifically designed for SSRO; Group H- sliding plate and one bicortical screw. RESULTS: In terms of measured values of displacement, the highest degrees of displacement were observed in decreasing order in Groups G, C, A, and E. The least displacement values were detected in Groups H, F, D and B with values being very close to each other. For linear force applied up to 70N, 3 mm or higher displacement values were not seen in any fixation system. CONCLUSION: According to the results of study, all systems are suitable for clinic usage. However, intermaxillary fixation or functional elastics may be needed for sliding plate systems during the healing period of hard tissue.

Rapid canine distalization through segmental alveolar distraction osteogenesis.

OBJECTIVE: The objectives of this study were to achieve rapid canine distalization by segmental alveolar distraction method in first premolar extraction cases, to examine the changes in the periodontal tissues surrounding canines, to evaluate the displacement of the canine and first molar teeth, to assess the effects of the procedure on the pulpal vitality of the canines, and to determine the amount of root resorption in retracted canines. MATERIALS AND METHODS: The sample of the study consisted of 20 teeth in eight patients (four females and four males, mean age 18.5 years). Pre- and posttreatment dental casts, panoramic radiographs, and standard periapical radiographs were taken from all patients. An electrical vitality test was applied before and after the distraction procedure and during the follow-up period (6 months after the completion of the procedure). In addition, six periodontal indices were used to examine the health of the periodontal tissues. RESULTS: The distraction procedure was completed in 12 to 28 days (mean 14.65 +/- 3.49). The anchorage loss ranged from 0 to 3 mm (mean 1.2 +/- 0.83). The distal displacement of the canines ranged from 3 to 8 mm (mean 5.35 +/- 1.22). The canines showed a mean of 9.1 degrees distal tipping, whereas there was no statistically significant change in the axial inclinations of first molars after distraction. CONCLUSION: We believe that rapid canine distalization by segmental distraction osteogenesis will become a routine protocol and a popular method among orthodontic applications.

Immediate mechanical stability of sagittal split ramus osteotomy fixed with resorbable compared with titanium bicortical screws in mandibles of sheep.

Ten fresh mandibles from adult sheep were stripped of all soft tissues and sectioned in the midline. We did sagittal split osteotomies and 5 mm advancement on all the 20 hemimandibles. Ten hemimandibles were fixed with three 2.0 mm x 13 mm titanium bicortical screws, and the other 10 were fixed with three 2.0 mm x 13 mm poly-l-lactic acid/polyglycolic acid (PLLA/PGA) bicortical screws in an inverted L pattern. All the hemimandibles were then mounted in a servohydraulic testing unit and tested to permanent deformation. Maximum forces that the mandibles resisted before breaking, maximum displacements, and the displacement values under 20, 60, 120, and 150 N were compared using the Mann-Whitney U-test. There were no significant differences in stability between the bones fixed with titanium and those fixed with resorbable screws.

Management of central giant cell granuloma of the jaws with intralesional steroid injection and review of the literature.

PURPOSE: We report the results of the intralesional steroid injections for the management of central giant cell granuloma (CGCG) of the jaws. METHODS: Seven CGCGs were treated with intralesional injection of corticosteroids. To accomplish this, 3.5 mL of triamcinolone and 3.5 mL of 0.5 % marcaine with 1/200,000 epinephrine (total 7 mL) were mixed. An adequate amount of steroid was injected into different areas of the lesion. This procedure was repeated on a weekly basis for 6 weeks. RESULTS: Clinical and radiological examination showed complete resolution and ossification of the lesions in four patients. Partial recovery was achieved in two patients. One patient did not respond to the treatment and underwent surgical curettage. CONCLUSIONS: We suggest that intralesional steroid injection is safe and effective for the treatment of CGCG, especially in non-aggressive lesions.

Biomechanical evaluation of different fixation systems after Le Fort I osteotomy in polyurethane models of unilateral clefts.

We compared the stability of three different titanium plate-and-screw fixation systems after Le Fort I osteotomy in polyurethane models of unilateral clefts. Thirty-six models were divided into 3 groups. In the first group, we adapted standard Plates 1mm thick with 2.0mm screws and placed them bilaterally on the zygomatic buttress and the piriform rim. In the second group, we did the same and added Plates 0.6mm thick with 1.6mm screws between the standard 2mm miniplates on both sides. In the last group, we placed Plates 1.4mm thick with 2.0mm screws bilaterally on the maxillary zygomatic buttress and piriform rim. Each group was tested in the inferosuperior (IS) and anteroposterior (AP) directions with a servo-hydraulic testing unit. In the IS direction, displacement values were not significantly different up to 80N, but between 80 and 210N, those in the 2×1.4mm group were better. In the AP direction, displacement values were not significantly different up to 40N, but between 40 and 180N, they were better in the standard with 1.6×0.6mm group and the 2×1.4mm group. When normal biting forces (90 - 260N) in the postoperative period are considered, the greatest resistance to occlusal loads was seen in the 2×1.4mm group. In the others, the biomechanical properties were better in the AP direction.

The use of autogeneous mandibular bone block grafts for reconstruction of alveolar defects.

OBJECTIVE: Purpose of this retrospective study was to evaluate outcomes autogenous bone block grafts obtained from mandible for different indications. The healing of the donor and recipient sites in the postoperative period, morbidity and the resorption of the graft were investigated. PATIENTS AND METHODS: Twenty-nine patients grafted with mandibular bone block graft were participated in the present study. Grafting was applied in these patients for three indications; reconstruction of alveolar cleft, lateral crest augmentation before dental implantation and sinus floor augmentation. All operations were performed under local anesthesia and in some cases sedation was used as well. RESULTS: Minimal exposure of the block graft occurred in three alveolar cleft patients. Secondary epithelization was achieved in all cleft patients with no symptoms of infection. In one patient infection was seen in donor site 1-week after the operation. The region was curetted and antibiotics administrated again. Two patients showed an infection of recipient site, after 4 weeks the grafts were removed. In all the patients, as the screw head became apparent until 1 thread, amount of the resorption were considered <1.5 mm. CONCLUSION: The usage of mandibular block grafts is a simple and effective treatment modality for reconstruction of different types of alveolar defects and it also reduces cost of treatment.

The reconstruction of oral defects with buccal fat pad.

QUESTIONS UNDER STUDY: 1) To evaluate the success of buccal fat pad used in the reconstruction of oral defects, 2) to clarify its indications and size limitations, 3) to identify risk factors if there were any. METHODS: In this prospective clinical study, buccal fat pad was used in 26 patients with different indications which included 5 defects resulting from tumour excisions, 3 maxillary cysts, 3 secondary maxillary cyst defects and 15 oro-antral communications. All defects were in the maxilla with a maximum size of 5x 3 cm. Patients were evaluated for signs of flap epithelialisation, infection, fistulae recurrence and facial contour deficiency. RESULTS: The epithelialisation process was completed after 3 to 4 weeks without any complications in 22 patients. However, partial dehiscence of the graft occurred in 2 patients with large maxillary defects. We also observed serious bleeding during the operation of one of our cases. Because of the small fistula, 1 patient was re-operated. CONCLUSION: The results of this series support the view that the use of buccal fat pad is a simple, convenient, and reliable method for the reconstruction of small to medium-sized oral defects.