Evaluation of occlusion types, pain severity, and onset of complaints in 127 patients with temporomandibular disorders: A retrospective study.

Objective: The aims of this study are to evaluate if occlusal types affect the type of temporomandibular disorders and if the onset of complaints are related to the type of internal derangements. Methods: One hundred thirty-four patients were evaluated. Occlusion types were grouped as Angle Class I, II, and III. The temporomandibular disorders were classified as masticatory muscle disorders, anterior disc dislocation with reduction, and anterior disc dislocation without reduction. Results: No significant relationships were found between the occlusion types, pain severity, the onset of the complaints, and the temporomandibular disorders. Premature contacts were found to be significantly higher in Class II and Class III patients, but no significant relations were found between premature contacts and temporomandibular disorders. Discussion: Occlusal features are not discriminant factors in the occurrence of temporomandibular disorders. Also, it cannot be concluded that the longer the patients have temporomandibular disorders, the higher their pain scores will be.

Evaluation of the effects of occlusal splint, trigger point injection and arthrocentesis in the treatment of internal derangement patients with myofascial pain disorders.

PURPOSE: In temporomandibular disorders (TMDs), unless splints are effective, combined therapies are performed. The aim of this study is to show the effectiveness of the local anaesthethic injections (trigger point injections) to the masticatory muscles. MATERIALS AND METHODS: The study was composed of TMD patients and the predictor variables were therapy combinations including stabilization splint (SS) therapy, SS+trigger point injection therapy (TPI) and arthrocentesis. The primary outcome variables were pain and jaw movements. The follow-ups were done at 1st and 3rd months. 56 patients who were treated for TMD with only SS or combined therapies were included in the study. The effects of additional TPIs were compared to SS therapy alone. Also the effect of arthrocentesis was evaluated too. RESULTS: All groups revealed significant decreases in pain scores. Decreases in mouth openings were observed in some of the patients in the injection groups. CONCLUSION: The combined treatment method in which the injections were applied at shorter time intervals, was a more effective method for decreasing VAS scores in TMD patients in this study but further studies are required.

Infratemporal fossa infection with inferior alveolar nerve involvement.

Abscess of the infratemporal fossa is a rare complication which can be difficult to diagnose. It occurs mostly due to dental infection, tooth extraction, fractures and/or infections involving the maxillary sinus. This condition can be life threatening if not dealt with immediately. The maxillofacial surgeon must be aware of the symptoms and clinical findings of the infection of the infratemporal fossa in order to initiate the treatment as soon as possible. In this case report, a patient with an infratemporal fossa infection presenting with an unusual symptom of inferior alveolar nerve involvement is presented.

Measurement of the lingual position of the lower third molar roots using cone-beam computed tomography.

PURPOSE: The aim of this study was to evaluate the distance between the roots of the impacted third molars and the floor of the mouth to predict the risk of lingual root displacement during surgery. MATERIALS AND METHODS: Thirty-one patients (5 men and 26 women) were evaluated for this study using cone-beam computed tomography (CBCT). The teeth were grouped according to their position on the orthopantomogram as vertical, mesioangular, horizontal, and distoangular. The distance between 2 points on the roots and lingual soft tissues was measured. RESULTS: The average distance between the apex of the root, which is in the most lingual position, and the lingual cortical plate was 1.03 mm. The average distance between the most lingual point on the apical half of the root, which is in closer proximity, and the lingual cortical plate was 0.65 mm. CONCLUSION: The distance between the apices and the lingual plate is very short, which allows displacement of broken roots or teeth, especially when the lingual plate is perforated.

The effects of pulsed electromagnetic field (PEMF) on osteoblast-like cells cultured on titanium and titanium-zirconium surfaces.

BACKGROUND: Commercially pure Ti, together with Ti Ni, Ti-6Al-4V, and Ti-6Al-7Nb alloys, are among the materials currently being used for this purpose. Titanium-zirconium (TiZr) has been developed that allows SLActive surface modification and that has comparable or better mechanical strength and improved biocompatibility compared with existing Ti alloys. Furthermore, approaches have targeted making the implant surface more hydrophilic, as with the Straumann SLActive surface, a modification of the SLA surface. PURPOSE: The aim of this study is to evaluate the effects of pulsed electromagnetic field (PEMF) to the behavior of neonatal rat calvarial osteoblast-like cells cultured on commercially pure titanium (cpTi) and titanium-zirconium alloy (TiZr) discs with hydrophilic surface properties. MATERIALS AND METHODS: Osteoblast cells were cultured on titanium and TiZr discs, and PEMF was applied. Cell proliferation rates, cell numbers, cell viability rates, alkaline phosphatase, and midkine (MK) levels were measured at 24 and 72 hours. RESULTS: At 24 hours, the number of cells was significantly higher in the TiZr group. At 72 hours, TiZr had a significantly higher number of cells when compared to SLActive, SLActive + PEMF, and machine surface + PEMF groups. At 24 hours, cell proliferation was significantly higher in the TiZr group than SLActive and TiZr + PEMF group. At 72 hours, TiZr group had higher proliferation rate than machine surface and TiZr + PEMF. Cell proliferation in the machine surface group was lower than both SLActive + PEMF and machine surface + PEMF. MK levels of PEMF-treated groups were lower than untreated groups for 72 hours. CONCLUSIONS: Our findings conclude that TiZr surfaces are similar to cpTi surfaces in terms of biocompatibility. However, PEMF application has a higher stimulative effect on cells cultured on cpTi surfaces when compared to TiZr.

Immediate implant placement without bone grafting: a retrospective study of 110 cases with 5 years of follow-up.

PURPOSE: Immediate implant placement not only reduces the number of surgeries necessary but also decreases the treatment time and treatment costs. The purpose of the study was to present the clinical results of 110 cases of immediate implant placement without using graft materials at the end of 5 years. MATERIALS AND METHODS: One hundred and ten implants in 72 patients were included in the study. Inclusion criteria for the patients were presence of at least 2 mm of bone beyond the root apex, the absence of acute signs of infection or inflammation in the treatment area, and the absence of systemic pathologies that would contraindicate bone healing around implants. In cases where bone grafting was necessary, the implant was excluded from the study. RESULTS: Healing progressed uneventfully in 105 cases. Four implants were lost as a result of infection in the first 3 months and 1 implant was lost 1 year after the functional loading of the prosthesis. The soft tissue anatomy was clinically acceptable in all patients. The implants that were placed in the extraction sockets of infectious teeth had also acceptable survival rates and clinical success. CONCLUSION: With proper patient selection, immediate implant placement without bone grafting has predictable survival rates and clinical success.

Low-level laser therapy vs. pulsed electromagnetic field on neonatal rat calvarial osteoblast-like cells.

To compare the effects of pulsed electromagnetic field (PEMF) and low-level laser therapy (LLLT) on osteoblast cells in a cell culture model. Fifty thousand neonatal rat calvarial osteoblast-like cells per milliliter were seeded and 0.06 mT PEMF, 0.2 mT PEMF, and LLLT at 808 nm were applied for 24 and 96 h on the cells. To evaluate cellular proliferation and differentiation, specimens were examined for DNA synthesis, alkaline phosphatase (ALP) activity, cell numbers, and viability of the cells. Morphological appearances of the cells were observed using scanning electron microcopy after 24 and 96 h of incubation. At 24 and 96 h, the control group had a higher cell proliferation than 0.06 and 0.2 mT PEMF groups (p=0.001). At 96 h, 0.2 mT PEMF group had higher cell proliferation rate than 0.06 mT PEMF and LLLT groups (p=0.001). The cell count and cell viability in 0.2 mT PEMF group were higher than the 0.06-mT PEMF and LLLT groups, although these differences were not statistically significant at 96 h (p>0.05). At 24 and 96 h, cell viability in the control group was higher than the test groups. Alkaline phosphatase levels of the groups were comparable in both time intervals (p>0.05). 0.2 mT PEMF application on osteoblast-like cells led to cell proliferation and differentiation better than 0.06 mT PEMF and LLLT at 808 nm, although a remarkable effect of both PEMF and LLLT could not be detected. The ALP activity of 0.2 and 0.06 mT PEMF and LLLT were comparable.

The effects of freeze drying and solvent dehydration on the bending strength and calcium content of cortical bone.

OBJECTIVE: The aim of this study was to investigate the effects of the freeze drying and solvent dehydration allograft preservation methods on the mechanical properties of the graft material. METHODS: Bone blocks obtained from bovine humeri were divided into three groups. Samples in the first group were freeze dried, samples in the second group were dehydrated by solvents and samples in the third group were used as controls. All samples underwent three point bending test to investigate bending strength and were evaluated for calcium content. RESULTS: Bending strength of both the freeze-dried and solvent-dehydrated samples were found to have decreased significantly compared to that of the control group. The calcium content of the solvent dehydrated group was also significantly lower than that of the control group. CONCLUSION: Our results suggested that both preservation techniques, used to dehydrate bone, have negative effects on the bending strength of bone as they decrease the mechanical properties of the graft material.

Bisphosphonate-related osteonecrosis: laser-assisted surgical treatment or conventional surgery?

Bisphosphonates (BSPs) are used for the treatment of multiple myeloma, metastatic breast and lung cancer, Paget's disease, osteoporosis, hypercalcemia due to malignancy, and many other skeletal diseases. BSPs reduce osteoclastic functions, which result in bone resorption. Bisphosphonates-related osteonecrosis of jaws (BRONJ) is a newly developed term that is used to describe the significant complication in patients receiving bisphosphonates. BSPs are known to exhibit an anti-angiogenetic effect that initiates tissue necrosis of the hard tissue. There is currently no consensus on the correct approach to this issue. The aim of this retrospective study is to compare the effects of laser surgery with biostimulation to conventional surgery in the treatment of BSP-induced avascular bone necrosis on 20 patients who have been treated in our clinic. BRONJ was evaluated in patients with lung, prostate, and breast cancer under intravenous BSP treatment. Twenty patients in this study developed mandibular or maxillary avascular necrosis after a minor tooth extraction surgery or spontaneously. Bone turnover rates were evaluated by serum terminal C-telopeptide levels (CTX) using the electrochemiluminescence immunoassay technique and patients were treated with laser or conventional surgical treatments and medical therapy. Ten patients were treated with laser surgery and biostimulation. An Er:YAG laser (Fotona Fidelis Plus II® Combine laser equipment, Slovenia) very long pulse (VLP) mode (200 mJ, 20 Hz) using a fiber tip 1.3 mm in diameter and 12 mm in length was used to remove the necrotic and granulation tissues from the area of avascular necrosis. Biostimulation was applied postoperatively using an Nd:YAG laser. Low-level laser therapy (LLLT) was applied to the tissues for 1 min from 4 cm distance using an Nd:YAG laser (Fotona-Slovenia) with a R24 950-µm fiber handpiece long-pulse (LP) mode, 0.25-W, 10 Hz power/cm(2) from the mentioned distance the spot size was 0.4 cm(2), and power output was 2.5 J. Energy density from the mentioned distance was calculated to be 6.25 J/cm(2). The other ten patients were treated with conventional surgery. Treatment outcomes were noted as either complete healing or incomplete healing. There were no statistically significant differences between laser surgery and conventional surgery (p > 0.05). CTX values also did not affect the prognosis of the patients. Treatment outcomes were significantly better in patients with stage II osteonecrosis than in patients with stage I osteonecrosis. Our findings suggest that dental evaluation of the patients prior to medication is an important factor in the prevention of BRONJ. Laser surgery is a beneficial alternative in the treatment of patients with this situation. Further randomized studies with larger patient numbers may also improve our understanding of treatment protocols for this situation.

Surgical treatment of oroantral fistulas: a clinical study of 23 cases.

Oroantral communication can be defined as a pathologic space created between the maxillary sinus and the oral cavity. This communication and subsequent formation of a chronic oroantral fistula is a common complication often encountered by oral and maxillofacial surgeons. Although various techniques have been proposed in published studies, long-term successful closure of oroantral fistulas is still one of the most difficult problems confronting the surgeon working in the oral and maxillofacial region. The decision of which treatment modality to use is influenced by many factors, such as the amount and condition of tissue available for repair, the size and location of the defect, the presence of infection, the time to the diagnosis of the fistula, and, even, the surgeon's past experience. In the present study, 23 patients with a chronic oroantral fistula who underwent surgical correction at Istanbul University Faculty of Dentistry, Department of Oral and Maxillofacial Surgery from 2002 to 2009 were included. The fistulas were treated with a buccal advancement flap in 10 patients and a palatal island flap in 13 patients. The advantages, limitations, and complications of each technique are discussed.

Effects of bone morphogenetic proteins on osteoblast cells: vascular endothelial growth factor, calcium, inorganic phosphate, and nitric oxide levels.

PURPOSE: Bone morphogenetic proteins (BMPs) play an important role in the initiation of bone formation by affecting cell growth and differentiation in a variety of cell types including osteoblasts. Vascular endothelial growth factor (VEGF) is an important regulator of angiogenesis and vasculogenesis, and also, VEGF signaling is important for skeletal development. Nitric oxide (NO), calcium (Ca), and inorganic Phosphate (Pi) are important molecules for cell functions. In this study, the effects of BMP on VEGF, Ca, NO, and Pi levels were investigated in an osteoblast cell culture. MATERIALS: Fifty thousand cells per milliliter were seeded and cultured on graft materials for 24 and 48 hours. Different concentrations of BMPs (combination of BMPs numbered from 1 to 14) were supplemented to the medium. RESULTS: BMP was found to increase VEGF (P = 0.00), Ca (P = 0.02), and Pi (P = 0.00) especially in the first 24 hours. The increase in the NO in the experimental groups were found to be statistically insignificant (P = 0.12). CONCLUSION: Our data state that further investigation should be performed on the effects of BMPs on osteoblast cell membranes and membrane receptors and cell signaling, together with their known effects on early phases of bone and vascular epithelial tissue formation.

A technique for atraumatic extraction of teeth before immediate implant placement using implant drills.

PURPOSE: The purpose of this article is to present a minimally invasive technique using the implant drills to help extract teeth before the insertion of immediate implants. MATERIALS AND METHODS: Nine patients (7 women and 2 men) aged 24 to 60 years having root fractures and dental caries were included in this study. Inclusion criteria for the study were presence of at least 4 mm of bone beyond the root apex, the absence of acute signs of infection or inflammation in the treatment area, and the absence of systemic pathologies that would contraindicate bone healing around implants. Heavy smokers were not included in the study. Extraction was done after thinning the root walls by the help of the implant drills. After extraction, implant sites were prepared and implants were inserted. In 2 of the cases, the peri-implant bone defect was filled with autogenous bone graft. RESULTS: Healing progressed uneventfully in all 9 cases. The use of implant drills to thin the root walls provided atraumatic tooth extraction protecting the thin buccal bone. At second stage surgery, all implants were asymptomatic, immobile, and osseointegrated. The soft tissue anatomy was clinically acceptable in all patients. Radiographic examination of all 9 implants showed no peri-implant radiolucency at the end of a year. CONCLUSION: Successful osseointegration and complete bone healing were observed for all patients. The new extraction technique was found to be effective in immediate implant cases in order not to damage the thin plate of buccal bone.

Management of a mandibular fracture accompanying a gunshot wound.

Gunshot injuries of the mandible can result in high rates of complications, especially in cases of bone loss. A fractured mandible accompanying a gunshot wound almost always has an external wound; the fracture is always compound and comminuted. Sometimes management of these injuries may require multiple surgical interventions. In this clinical report, treatment of a patient, who had a mandibular fracture due to a gunshot wound, is presented.A 52-year-old man with a mandibular fracture in the right mandibular body accompanying a gunshot wound was operated on. Owing to a nonunion, a second surgery was performed using reconstruction plates after hyperbaric oxygen treatment. Healing was uneventful after the second surgical intervention.

Accidental displacement of a high-speed handpiece bur during mandibular third molar surgery: a case report.

Removal of third molars is one of the most common surgical procedures performed in oral and maxillofacial surgery. This procedure may result in a number of major and minor complications. Accidental displacement of impacted third molars is a complication that occasionally occurs during these operations, but accidental displacement of a high-speed handpiece bur has never been reported in literature before. The aim of this article is to present a rare and previously unreported case of a foreign body in the submandibular space and to review the possible complications seen after third molar surgery.

Oronasal communication caused by a denture with suction cup: a case report.

Suction cups, which provide high retention, are not being recommended anymore because of the destructive effect of the negative pressure on the palatal tissues. It is known that dentures with suction cups can cause perforations in the palate. In this case report, an oronasal communication caused by a denture with suction cup in a patient who had previously undergone pleomorphic adenoma excision of the palate is presented. Disadvantages of suction cups are emphasized.

Comparative study of the effect of tube drainage versus methylprednisolone after third molar surgery.

OBJECTIVE: The purpose of this study was to compare the effects of tube drainage versus a single dose of methylprednisolone (MP) on maximal mouth opening, facial swelling, and pain after third molar surgery. STUDY DESIGN: Twenty-two patients requiring extraction of bilaterally impacted mandibular third molars were selected. Each patient had 2 operations. In the first operation, a drainage tube was inserted into the buccal fold after the suture procedure and left there for 3 days. In the second operation 1 month after the first surgery, 1.5 mg/kg intravenous methylprednisolone was administered 1 hour before the surgery. The patients were evaluated by the same person for maximal mouth opening, facial swelling, and pain in the immediate preoperative time point and on the second, fifth, and seventh days after surgery. RESULTS: There was a statistically significant difference in mouth opening on fifth and seventh days but none in facial swelling and pain between MP group and drain group. CONCLUSION: We conclude that the use of a drain or methylprednisolone is useful in reducing postoperative discomfort after third molar surgery.

Alveolar distraction osteogenesis before placement of dental implants.

Distraction osteogenesis of the edentulous alveolar ridges may be considered an alternative to many other augmentation oriented surgical techniques. It is now being widely used for treating severe forms of alveolar ridge atrophy, especially before the placement of dental implants. Leibinger Endosseous Alveolar Distraction System (LEAD; Stryker Leibinger, Kalamazoo, MI) is an intraosseous distraction device used for edentulous ridges. In this study, the healing was uneventful in all 5 cases that were treated except 1, in which the vitality of the distraction segment could not be maintained. No complications related to the prosthodontic restoration were observed.

Peripheral giant cell granuloma combined with facial hemangioma. A case report.

Peripheral giant cell granuloma (PGCG) is a relatively uncommon benign tumor of the oral cavity affecting people of all ages and with no racial predilection. The etiology is still unclear but local trauma or chronic irritants may cause the development of this lesion. Hemangioma is a benign process in which there are an increased number of normal or abnormal-appearing blood vessels. In this article the clinical, radiographic and histopathologic characteristics of a patient who had a rare combination of PGCG and facial hemangioma is discussed. Surgery was the effective treatment modality for the lesion in the mandible. The characteristics of facial hemangioma and PGCG have similarities, such as the possibility of bleeding problems during surgery. As the lesion in this case was not small in size, it was not a conservative procedure. Bleeding control was established by electrocauterization. Healing was uneventful and there has been no recurrence since the surgery. A new prosthesis was fabricated for the patient. In these kinds of cases the control of bleeding must be very carefully determined and attention should be paid to the possibility of serious bleeding problems. Based on the data presented we were not able to find any correlation between the PGCG and the facial hemangioma, but new reports might have different views on the subject in the future.

Bilateral oroantral fistulas following devitalization of teeth by arsenic trioxide: a case report.

Although it is well known that prolonged application or leakage of arsenic trioxide can cause severe damage to the periodontal tissues, the substance is still used by some dentists. This paper describes a case of arsenical necrosis of the jaws affecting the right and the left side of the maxilla. As a result of leakage into the tissues of an arsenical paste from the pulp chamber of endodontically treated teeth, bilateral oroantral fistula (OAF) occurred. It is concluded that there is no justification, whatsoever, for the use of arsenic in modern dental practice. In the following case, buccal advancement flap and submucosal palatal island flap techniques were used for to close the OAF. The submucosal palatal island flap technique resulted in successful closure of the OAF.