Difficulty of impacted mandibular third molar tooth removal: predictive ability of senior surgeons and residents.

PURPOSE: The present study investigated whether residents are able to estimate the degree of difficulty of mandibular third molar removal to the same extent as senior surgeons. MATERIALS AND METHODS: The study included 2 residents and 2 senior surgeons, each of whom extracted 50 mandibular third molars of similar complexity. The clinical variables evaluated included patient age, gender, body size, maximal mouth opening, and tongue interference. The radiographic variables related to the third molars examined on the panoramic radiographs included spatial positioning, tooth-bone interface, root morphology, and proximity of the tooth to the inferior alveolar canal. Before each extraction, the operating surgeon estimated the level of difficulty of the surgery after considering all the variables. The predicted length of time per operation was regarded as representative of operative difficulty. At the end of each operation, its actual duration was also recorded. RESULTS: The residents and senior surgeons both accurately predicted the difficulty of surgery in just more than one half of the cases. A 57% agreement (κ = 0.24) was found between the senior surgeons' preoperative estimations and actual difficulty, and the agreement was 52% (κ = 0.19) for the residents' estimations. No significant difference was found between the senior surgeons and residents in the accuracy of their estimations of operation length. CONCLUSIONS: The preoperative prediction of the surgical difficulty of mandibular third molar tooth removal was unreliable, not only for the residents, but also for the senior surgeons.

Comparison of lidocaine metabolism for different anesthesia techniques in rabbits with liver disease.

OBJECTIVE: This study was designed to investigate the serum lidocaine concentrations (SLC) after local infiltration anesthesia (IA) and mandibular anesthesias (MA) in rabbits with carbon tetrachloride (CCl4)-induced chronic liver damage (CLD). STUDY DESIGN: Fourteen rabbits were administered CCl4 in group 1, MA (CLD-MA; n = 7); in group 2, IA (CLD-IA; n = 7); in group 3, MA (H-MA; n = 7); and in group 4, IA (H-IA; n = 6) was performed. SLC were measured. RESULTS: SLC showed difference over time. At the 10th minute, mean SLC in IA groups were higher than in MA groups. At the 120th minute, the highest mean concentration was found in the CLD-IA group. CONCLUSIONS: SLC increases in CLD, and serum lidocaine concentration after IA in the mandibular anterior region is higher than it is after MA.

Assessment of the Effects of Curacel and Bone Wax on the Acute Oroantral Opening Site by means of Computer Tomography and Histopathology.

PURPOSE: In this study, the effects of Curacel TM oxidized regenerated cellulose and bone wax on the healing bone were compared to each other by means of CT based bone density measurement and histopathological evaluation. METHODS: The bone density measurements of the control group were significantly higher than those of both Curacel and bone wax groups. RESULTS: There was no significant difference between Curacel and bone wax. Histopathologically, the bone wax group showed more osteoblastic activation than Curacel group. For all measurement parameters (osteoblastic activation, osteoclastic activation, fibrous connective tissue, osseous trabeculae), Curacel and bone wax groups had worse results than control group. It is concluded that Curacel has no superiority over bone wax in terms of osseous healing in the oroantral region. There is no need to use oxidized regenerated cellulose or bone wax for small oroantral openings since the healing is better without any intervention. In addition, bone density measurement and histopathological evaluation were consistent in terms of osseous healing of the oroantral opening.

Comparison of the planimetry and point-counting methods for the assessment of the size of the mandible cysts on orthopantomograms.

OBJECTIVE: The purpose of this study is to compare the computer-assisted planimetry and point-counting methods in evaluating the sizes of the mandibular cysts with respect to their agreement and the time required to analyze. STUDY DESIGN: The surface areas of 46 mandibular cyst lesions on orthopantomograms were estimated using the point-counting and computer-assisted planimetry methods. Three observers evaluated the outlined areas twice, using the point-counting (PC) and computer-assisted planimetry (CAP) methods with an interval of two weeks. In the planimetry technique, digitalized images and ImageJ software were used to measure the surface area of the half mandibles and cysts. The grids were superimposed over the same images and the number of points hitting the interested structures was counted for the point-counting technique. The projection area fraction (PAF) of the cysts within the mandible was estimated using the obtained values by means of the two techniques. Intraclass correlation coefficient was used to assess the level of agreement between the two methods. Inter-rater reliability analysis using the Kappa statistic was performed to determine consistency among raters. RESULTS: CAP and PC techniques showed consistent intra-observer values in all observers. Intraclass correlation between CAP and PC measurements of first, second and third observers were found to be 0.9986, 0.9988 and 0.9994 respectively. The durations of PC technique was 32% higher than the CAP technique. CONCLUSION: PC and CAP methods were seemed to show sufficient agreement to be used interchangeably. The main disadvantage of the PC analysis is it takes more time than CAP method.

Excessive fluoride intake alters the MMP-2, TIMP-1 and TGF-ß levels of periodontal soft tissues: an experimental study in rabbits.

OBJECTIVES: This study evaluated the influence of fluoride on periodontal soft tissues by investigating any alterations in their MMP-2, TIMP-1 and TGF-ß profiles secondary to excessive fluoride intake. MATERIAL AND METHODS: Fluorosis was induced in 18 rabbits (test group) through consumption of fluoride added to drinking water, whereas 10 rabbits consumed regular tap water as daily supply (control group). Following fluorosis verification, animals were sacrificed and their 1st mandibular molar teeth were utilized in the assessments. MMP-2, TIMP-1 and TGF-ß were separately investigated for gingival epithelium (GE), gingival connective tissue (GC) and periodontal ligament (PL) to evaluate periodontal soft tissues. Histological sections were prepared from the groups, the parameters were determined by immunohistochemistry, and their levels were calculated by quantification of the immunostainings. RESULTS: Staining intensity of MMP-2 in GC and PL (p < 0.01); TIMP-1 and TGF-ß of GE, GC and PL (p < 0.01) were higher in the test group compared to those of the control group. Intra-group staining of TIMP-1 was higher than MMP-2 in all test group compartments (p < 0.01) and in the control group GE (p < 0.01). TIMP-1 was also higher than TGF-ß in the GE and PL of the test group (p < 0.05) and in the GE of the control group (p < 0.01). CONCLUSION: These results suggest that excessive fluoride intake may affect periodontal soft tissues by increasing MMP-2, TIMP-1 and TGF-ß, and thereby altering the MMP-2/TIMP-1 and TIMP-1/TGF-ß ratios. CLINICAL RELEVANCE: Excessive fluoride consumption may alter the periodontal tissue homeostasis which may be detrimental in the maintenance of periodontal health.

Immunohistochemical comparison of indermil with traditional suture materials in dental surgery.

The aim of this experimental study was to evaluate the effects of indermil on the closure of oral mucosa wounds in comparison with conventional sutures by investigating interleukin 1ß (IL-1ß) and tumor necrosis factor α (TNF-α) markers immunohistochemically in an animal model.The animals were anesthetized by intraperitoneal injection of ketamine (90 mg/kg body weight). Straight incisions were made to the buccal mucosa of the animals. Animals were randomly assigned to 5 groups. Five different materials were used in the study. These were silk, plain catgut, monocryl, vicryl rapide (polyglactin 910), and indermil (N-butyl-2-cyanoacrylate). The wounds were closed primarily. After the region of wounds was examined clinically at the 2nd, 7th, 14th, and 21st days, excisional biopsies were performed, and the tissue samples were examined histopathologically and immunohistochemically.On the 14th day, TNF-α and IL-1ß levels were high in the plain catgut group, moderate in the indermil group, and mild in the monocryl, silk, and vicryl rapide groups. On the 21st day, TNF-α and IL-1ß levels were moderate in the plain catgut group, mild in the indermil and monocryl groups, and nonsignificant in the silk group. After the second day, TNF-α and IL-1ß levels were mild in the monocryl, silk, and vicryl rapide groups.Plain catgut had more negative effects than indermil on wound healing. Indermil should be applied to oral mucosa wounds together with sutures to provide better tissue support.

Postpubertal nonfamilial cherubism and teeth transposition.

Cherubism is a rare, nonneoplastic, fibro-osseous disease. It is an autosomal-dominant disorder in which the normal bone is replaced by cellular fibrous tissue and immature bone. It is genetically inherited, although many nonfamilial cases have been reported. Cherubism is a bone disease clinically characterized by bilateral, painless enlargements of the jaws. The mandible is the most severely affected craniofacial component, in which uncontrolled growth of the malady deteriorates the aesthetic balance of the face. A malocclusive and abnormal dentition, worse in the mandible, can be seen. Histopathologically, numerous randomly distributed multinucleated giant cells and vascular spaces within a fibrous connective tissue stroma with or without eosinophilic collagen perivascular cuffing were apparent. The appearance of the affected children is normal at birth. Between the ages of 2 and 7 years, swellings within the mandibular body or tuberosities of maxilla appear. This article relates to a postpubertal nonfamilial cherubism case that was noticed with multiple radiolucencies in radiographic examination and its effects on teeth.

Horizontal alveolar distraction of the mandibular canine regions for implant placement.

Horizontal alveolar augmentation by distraction osteogenesis is an alternative method for reconstructing atrophic alveolar bone. A 65-year-old woman with atrophy of the alveolar rim in the anterior lower jaw, which had inadequate width for implant placement, was presented. Under general anesthesia, vertical and horizontal osteotomies of the buccolabial cortical bone were performed in the canine regions bilaterally. Modified horizontal distraction devices were stabilized to the mandible. Distraction proceeded from the seventh postoperative day at a rate of 0.450 mm twice a day for 6 days. After 3 months, distraction osteogenesis occurred and increased the alveolar width from 2 to 7 mm. Two implants were placed in the distracted areas. Marginal bone resorbtion around the implants was not observed 12 months after implant placement.

Treatment of masseteric hypertrophy with botulinum toxin: a report of two cases.

Masseter muscle hypertrophy is a rare condition of unknown cause which is important in the differential diagnosis of head and neck masses, located in the cheek. Several treatment options reported for masseter hypertrophy, which range from simple pharmacotherapy to more invasive surgical reduction. Botulinum toxin type A is a powerful neurotoxin which is produced by the anaerobic organism Clostridium botulinum and when injected into a muscle causes interference with the neurotransmitter mechanism producing selective paralysis and subsequent atrophy of the muscle. Injection of botulinum toxin type A into the masseter muscle is generally considered a less invasive modality and has been advocated for cosmetic sculpting of the lower face. Botulinum toxin type A injection is considered to be a beneficial treatment modality in masseter muscle hypertrophy patients. The aim of this article is to report two cases of masseteric muscle hypertrophy which were treated with botulinum toxin type A injection. Marked changes in facial feature were achieved 3 months after the procedure.

Effects of polyglecaprone 25, silk and catgut suture materials on oral mucosa wound healing in diabetic rats: an evaluation of nitric oxide dynamics.

OBJECTIVES: The purpose of this study is to investigate the effects of monocryl (Polyglecaprone 25), silk and catgut suture materials on wound healing in diabetic rats and to evaluate NO (nitric oxide) dynamics. STUDY DESIGN: Fourty-eight male Wistar-Albino rats weighing 220-270 g were used in this study. The rats were categorized into 2 groups, as control group (n=24) and streptozotocin (STZ) induced diabetic group (n=24). For each group, incision wounds were created on the inner cheek mucosa of the animals and wounds were closed primarily with three different types of sutures. These materials were sized 3-0 monocryl (polyglecaprone 25), silk and catgut sutures swaged on. Excisional biopsies were performed at 2nd, 7th, 14th and 21st day (2 rats per day) from the initial surgical procedure. Effects of these suture materials on wound healing and NOS (nitric oxide synthase) activities were compared immunohistochemically in the study. eNOS and iNOS (Endothelial and induced nitric oxide synthase) activities were classified as mild (+), moderate (++) and severe (+++). RESULTS: Mild eNOS activities were seen in both diabetic and control groups at 2nd day specimens. Activities of silk and catgut were similar both in diabetic and control groups at 14th day, this activity in monocryl was mild. 21st day specimens revealed that monocryl has mild eNOS activity than silk and catgut sutures. iNOS activities in diabetic group were greater than control groups and the degrees of the activity in monocryl, silk and catgut sutures were mild, severe and moderate at the 7th day. At the 14th day there was no iNOS activity in diabetic monocryl group. CONCLUSION: All of the materials have the potential capacity to be well tolerated however monocryl seemed to have more beneficial effects on wound healing in diabetic subjects.

Squamous cell carcinoma arising in a residual cyst: a case report.

AIM: The purpose of this report is to present a case of squamous cell carcinoma (SCC) arising from a mandibular residual cyst. BACKGROUND: Although rare, SCC may arise in the epithelial lining of odontogenic cysts. The diagnosis of the development of carcinoma from the cyst lining can only be established by histopatologic examination. REPORT: A case of SCC arising from a mandibular residual cyst in a 55-year-old man is presented along with a discussion of the critical elements needed for accurate diagnosis and treatment. SUMMARY: The development of SCC from residual cysts is rare but should always be considered in the differential diagnosis. This case report clearly demonstrates the importance of clinician awareness of the malignant potential of apparently innocuous cystic lesions. It also underscores the importance of a careful histological examination and the necessity of obtaining biopsy materials from various areas to prevent a misdiagnosis of large-sized cysts.

A comparison of injection pain with articaine with adrenaline, prilocaine with phenylpressin and lidocaine with adrenaline.

OBJECTIVE: The objective of the present study was to investigate the pain on injection of articaine with adrenaline, prilocaine with phenylpressin , and lidocaine with adrenaline. STUDY DESIGN: The study sample was comprised of 497 consecutively seen patients received 497 maxillary buccal infiltration injections or inferior alveolar block injections of 4% articaine with 1:200.000 adrenaline, 3% prilocaine with 1.08 mcg phenylpressin, or 2% lidocaine with 1:100.000 adrenaline. Immediately after the injection, patients were asked to rate their injection pain on a six-point scale. RESULTS: There were no significant differences among the anesthetic solutions for injection pain. Patients usually reported mild or no injection pain for all of anesthetic administrations. CONCLUSION: Under the conditions of this study that lidocaine with adrenaline, articaine with adrenaline and prilocaine with phenylpressin seemed to be similar for pain on injection and they could be quite painless.

Deciduous tooth extraction & folkloric beliefs in the Samsun region.

This study was designed to investigate the methods of deciduous tooth extraction applied to children, and the effects of parents' educational status and place of residence on the way deciduous teeth are regarded in folklore in Samsun city and neighboring villages. Using questionnaires, this study tried to determine the type of superstitions held by parents living in the city and neighboring village. The questionnaire inquired about methods used to extract their deciduous teeth, what parents had done with them, and their preferred extraction methods. A significant relationship was established between the age at which the parent first visited the dentist and the method used to extract their child's deciduous teeth. Folk beliefs are not related to place, namely urban or rural living, but are concepts handed down through tradition; the educational status of parent is likewise irrelevant to the holding of folk beliefs among parents in this sample.

Fixation of vertically distracted segment with dental implants after breakage of distraction device: case report.

Distraction osteogenesis is an efficient method to augment the mandibular alveolar process for dental implants. Complications of this procedure include fracture of the basal bone, breakage of distractor, wound dehiscenses, undesirable soft tissue changes, and defective movement of the transported segment. We report a case of breakage of the distractor after mandibular alveolar vertical distraction osteogenesis. Mandibular alveolar vertical distraction osteogenesis was applied to 53-year-old woman for prosthetic rehabilitation. Fracture of the distraction device occurred on the 13th day of the activation phase. Radiographic examination revealed the fracture of the distractor rod and lingually displaced alveolar segment. Lingually displaced segment was successfully advanced to the desired position, and fixed to the basal bone using dental implants before the maturation of the distracted bone. We consider that this technique is eligible for the management of these kind of complications.

Factors related to patients' anxiety before and after oral surgery.

PURPOSE: The purpose of this study was to identify factors that may contribute to anxiety of patients undergoing minor oral surgery before and after the operation. PATIENTS AND METHODS: A total of 120 patients who underwent minor oral surgery were included in the study. Each patient's anxiety was measured using Spielberger's State-Trait Anxiety Inventory and Corah's Dental Anxiety Scale immediately before, immediately after, and 1 week after the operation. Anxiety levels for each given situation about the surgery were determined using visual analog scales. The effects of various factors, such as demographic variables, previous dental experience, and postoperative complaints, on anxiety were also analyzed. RESULTS: Postoperative anxiety levels were significantly lower than the preoperative anxiety levels (P<.001). Patients recorded higher anxiety levels for "jaw becoming tired" and "collection of fluid in the mouth" than for "feeling pain during the operation" both before and after the operation. There was a positive correlation between pain expectation with preoperative anxiety and pain actually experienced during surgery with postoperative anxiety (P<.001). Whereas patients' trait anxiety and previous dental experience were correlated with preoperative anxiety (P<.001 and P<.05, respectively), no relationship with postoperative anxiety was found. The difficulty of the procedure was not correlated with anxiety immediately after the operation but was correlated with anxiety during the follow-up visit (P<.05). Postoperative complaints were related to the dental anxiety levels recorded 1 week after surgery (P<.05). CONCLUSIONS: To reduce patients' anxiety, underestimated factors, such as jaw fatigue and fluid collection in the mouth, should be taken into account during oral surgery under local anesthesia. In the postoperative period, swelling and difficulty in eating, as well as pain, should also be considered in relieving patients' anxiety.

Cytokine and chemokine levels in radicular and residual cyst fluids.

BACKGROUND: Cytokines were thought to play an important role for the expansion of odontogenic cysts. The purpose of this study was to evaluate the cytokine and chemokine levels of radicular and residual cyst fluids. METHODS: Cyst fluids were aspirated from 21 patients (11 radicular and 10 residual cysts) and the levels of interleukin-1 alpha (IL-1alpha), tumor necrosis factor-alpha (TNF-alpha), monocyte chemotactic protein-1 (MCP-1), and regulated upon activation normal T cell expressed and secreted (RANTES) were determined by ELISA using commercially available kits. RESULTS: Both radicular and residual cyst fluids contained IL-1alpha, TNF-alpha, MCP-1, and RANTES, concentrations of which were significantly higher in the radicular cyst fluids than those in the residual cysts (P < 0.001 for IL-1alpha, TNF-alpha, and RANTES; P < 0.01 for MCP-1). Compared to the other mediators, the concentration of IL-1alpha was found to be highest in both of the cyst fluids. In addition, positive correlations were found between IL-1alpha, TNF-alpha, MCP-1, and RANTES in radicular and residual cyst fluids. CONCLUSION: If the radicular cyst is inadvertently left behind following tooth extraction, some degree of inflammation may carry on. Residual cysts, although to a lesser extend than radicular cysts, have the potential to expand.

The response of subcutaneous connective tissue to a new endodontic filling material.

The purpose of this histopathologic study was to assess and compare the subcutaneous connective tissue reaction to a new root canal filling material, Resilon and gutta-percha. The test materials were directly inserted subcutaneously into the dorsal connective tissue of Wistar albino rats. Histopathological examinations were done at 7, 15, 30, and 60 days after the implantation procedure. The presence of inflammation, predominant cell types, and the thickness of fibrous connective tissue adjacent to each inserted sample were recorded. There were no differences in tissue reaction between Resilon cone material and gutta-percha cone groups for first three observation periods (p > 0.05). However, there were highly significant differences among observation periods within both groups (7, 15, 30, and 60 days) (p < 0.01). The tissues showed high tolerance to Resilon and gutta-percha at the 60th day. Resilon may serve as an alternative to gutta-percha in terms of biocompatibility.

Use of a Simple Appliance to Prevent Mucosal Irritation by the Distractor Rod during Vertical Distraction: Case Report.

Patient discomfort due to the excessive length of the distractor rod is one of the disadvantages of alveolar distraction osteogenesis. Although this seems to be a minor complication, it can cause severe mucosal irritation on the opposite arch, and uncontrolled forces can lead to the loosening of the screws and the inactivation of the distractor. The purpose of this case report is to introduce an acrylic appliance that is very useful in avoiding the mucosal irritation caused by the long distractor rod. The appliance is simple, effective, and easy to fabricate.

Total impaction of deciduous maxillary molars: two case reports.

AIM: The purpose of this report is to present two cases of totally impacted maxillary deciduous molars, considered a rarity in dental practice. BACKGROUND: Primary tooth impaction is quite rare during the development of primary dentition. Various factors contribute to the impaction of a deciduous tooth, including anklyosis, congenitally missing permanent teeth, defects in the periodontal membrane, trauma, injury of the periodontal ligament, precocious eruption of the first permanent molar, defective eruptive force, or a combination of these factors. REPORTS: Case #1: An 18-year-old male presented with a complaint of spontaneous repetitious pain in the maxillary right premolar region. The maxillary right second premolar was clinically absent. Panoramic and periapical radiographs revealed an impacted second premolar close to the inferior wall of the maxillary sinus and an impacted deciduous molar deeply embedded in bone within the maxillary sinus. Case #2: A 14-year-old girl presented with a complaint of crowding of the maxillary teeth. The maxillary right second premolar and the maxillary permanent canines were clinically absent. A panoramic radiograph revealed an impacted maxillary right second premolar and an impacted deciduous molar embedded within bone close to the inferior wall of the maxillary sinus. SUMMARY: The total impactation of deciduous teeth is a rare condition, and few cases have been reported in the literature. The condition generally affects the mandibular second deciduous molar and the maxillary first deciduous least often. In this paper, two cases of totally impacted maxillary deciduous molars are reported.

Non-syndrome multiple supernumerary teeth: A case report.

AIM: The purpose of this case report is to present a case of a non-syndrome male patient with multiple supplemental supernumerary teeth in three quadrants of his mouth. BACKGROUND: Supernumerary teeth are described as the teeth formed in excess of the number found in a normal dentition. Prevalence of supernumerary teeth varies between 0.1% and 3.8% in the general Caucasian population. Multiple supernumerary teeth are not a common occurrence, although a single or a few supernumerary tooth/teeth in each case have been widely reported in the literature. REPORT: An 11-year-old male presented for a routine preventive dental visit. A routine panoramic radiograph showed the presence of multiple supernumerary teeth which were located in the maxillary right canine incisor region, the maxillary left premolar region, and the mandibular right premolar region. The family's medical history was non-contributory, and an extraoral examination did not reveal any abnormality. SUMMARY: It is rare to find multiple supernumerary teeth in individuals with no other associated diseases or syndromes. This case report presents a case of a non-syndrome male patient with multiple supplemental supernumerary teeth in three quadrants of his mouth.