Oral and dental alterations and growth disruption following chemotherapy in long-term survivors of childhood malignancies.

PURPOSE: More attention has been focused on the long-term side effects of treatment protocols since impressive advances in childhood cancer treatment have resulted in a growing population of patients. The purpose of this study was to investigate the disturbances of dento-facial development in children who were long-term survivors of childhood malignancies. METHODS: Fifty-three children (mean age, 10 years + 4 months) in long-term remission underwent oral/dental and radiographic examinations after completion of therapy. Crown and root malformations, gingival/periodontal status, enamel defects, discolorations, decayed and unerupted teeth, premature apexifications, agenesis, maximal interincisal opening and lateral movement of jaws, and soft tissue abnormalities were noted. Caries were evaluated by the decayed-missing-filled teeth (DMFT) index. Forty healthy children (mean age, 12 years + 4 months) belonging to the same age group and socioeconomic community were served as controls. All participants in the study were evaluated in terms of craniofacial development. RESULTS: The data of the study showed that higher prevalence of root malformation, unerupted teeth, and enamel hypoplasia were detected as a consequence of childhood cancer and/or antineoplastic therapy. Although no differences of craniofacial growth and development were observed between groups (P > 0.05), plaque and gingival index scores were statistically higher in the study group (P < 0.05). CONCLUSION: A range of variations in dental structures is recognized as a side effect of childhood cancer therapy in long-term survivors of pediatric malignancies that may affect their quality of life.

Biomechanical effects of implant number and diameter on stress distributions in maxillary implant-supported overdentures.

STATEMENT OF PROBLEM: Implant-supported overdentures (ISOs) are considered a good alternative to conventional removable dentures. However, varying rates of failure have been reported in some clinical studies. Excessive stress on surrounding tissues is one of the possible causes of implant failure. As stress is transmitted to the bone through the implant, careful planning, correct number of implants, and implant positioning are keys to ensuring appropriate stress distribution. However, research of the optimal number of implants necessary to support a maxillary ISO is insufficient. PURPOSE: The purpose of this in vitro finite element study was to determine the optimal implant location, number, and diameter to support a maxillary ISO. MATERIAL AND METHODS: Three-dimensional models of an atrophic maxilla, dental implants, and ball attachments were modeled, and different loading conditions were applied to simulate realistic conditions. Six models with different numbers and diameters of implants, including mini-dental implants and differently located implants, were formed, and stress values were compared by implementing a finite element analysis. RESULTS: The study showed that, as the implant number increased, decreased stress values were observed in peri-implant bone and implants in the maxillary ISO prosthesis. However, changes in implant diameter had no significant effect on stresses. CONCLUSIONS: Increasing the implant diameter was not advantageous; the use of mini-dental implants may be a viable alternative method. However, using 4 implants for maxillary ISOs is indicated.

The Effects of Transcutaneous and Intraoral Low-Level Laser Therapy After Extraction of Lower Third Molars: A Randomized Single Blind, Placebo Controlled Dual-Center Study.

OBJECTIVE AND BACKGROUND: The surgical removal of impacted third molars is one of the most common procedures performed by oral and maxillofacial surgeons. The purpose of this study is to determine whether either transcutaneous or intraoral low-level laser therapy (LLLT) reduces postoperative pain and assists in the healing of mandibular third molar extraction. MATERIALS AND METHODS: This randomized, placebo controlled, single-blind, split-mouth design study was conducted on 60 patients with full bony impacted similar position mandibular third molars bilaterally. The patients were divided into two groups of 30 each: transcutaneous LLLT and intraoral LLLT and the other side of each group treated with nonactive laser (60 teeth). The laser treatment consisted of administering laser energy immediately before and after the extraction procedure with gallium aluminum arsenide (GaAlAs) 830 nm diode lasers. Postoperative pain and healing of the sockets were compared in transcutaneous and intraoral group with placebo for 1 week following the extraction. Descriptive and bivariate statistics was computed, and the p-value was set at 0.05. RESULTS: Intraoral LLLT application resulted in a statistically significant reduction of postoperative pain in comparison with transcutaneous laser group and placebo. The unhealed socket numbers were compared in two groups at seventh day and no differences were observed. CONCLUSIONS: The results of this study suggest that single-session intraoral LLLT is more effective than extraoral application for reducing postoperative pain. It was postulated that the differences between skin and mucosa could have effect on the results. Although intraoral use would allow closer application to the surgical site, the size of some laser devices precludes their use intraorally.

Management of a Recurrent Pyogenic Granuloma of the Hard Palate with Diode Laser: A Case Report.

INTRODUCTION: Pyogenic granuloma (PG) is a prevalent inflammatory hyperplasia of skin and oral mucosa which is often caused by constant low-grade local irritation, traumatic injury or hormonal factors. In many cases, gingival irritation and inflammation due to poor oral hygiene are precipitating factors. Oral PG occurs predominantly on the gingiva, but it is also encountered on the lips, tongue, buccal mucosa and rarely on the hard palate. Although surgical excision is the first choice of treatment, many other treatment modalities could be counted such as cryosurgery, sodium tetradecyl sulfate sclerotherapy, intralesional steroids, flash lamp pulsed dye laser, neodymium-doped yttrium aluminium garnet (Nd:YAG) laser, carbon dioxide (CO2) laser, erbium-doped yttrium aluminum garnet (Er:YAG) lasers and diode laser have been suggested. After surgical excision recurrence occurs up to 16% of these lesions. It is believed that recurrence ensues as a result of incomplete excision, failure to eliminate etiologic factors or repeated trauma. CASE REPORT: A 50-year-old female was referred to the Department of Oral Surgery, Gazi University, School of Dentistry, complaining of a swelling and growth on the right side of the hard palate for four months. Patient reported a similar growth in the same area about two years earlier, which had turned out to be a PG by histopathology. The treatment plan included surgical excision of the lesion using diode laser. RESULTS: The patient reported no pain after the surgery. She was discharged with a prescription of chlorhexidine mouthwash and necessary post-operative instructions. At 7 days follow up visit, immediate recurrence of the lesion was observed, and it was excised by diode laser with 2 mm margins at its clinical periphery, to a depth up to the periosteum, by the same operator. No recurrence or scarring was observed in 14 months follow-up. CONCLUSION: Although diode laser is a secure and efficient technique for the treatment of intraoral PG, in order to minimize its recurrence, the lesion should be excised with a wider margin down to the periosteum or to the causing agent. Also due to its high recurrence rate, long-term follow-up is recommended.

Histopathological features of bisphosphonates related osteonecrosis of the jaw in rats with and without vitamin d supplementation.

OBJECTIVE: Aim of this study was to investigate the effect of vitamin-D3 on the osteonecrosis of bone that was induced after tooth extraction was conducted on rats that were given zoledronic acid (Z.A). MATERIAL AND METHODS: Animals were divided into four groups. Two of the experimental groups were divided into two subgroups, third study group was not divided into subgroups, and control group was divided into three subgroups. Z.A was administered twice per week over the course of 7 weeks, dexamethasone was administered twice a week during the 5th-6th-7th weeks to all groups. Dental extraction was performed by drilling around the tooth at 7th week. In study-group-1; vitamin-D was administered twice per week during the 5th-6th-7th weeks. In study-group 2; vitamin-D was administered twice per week during the 8th-9th-10th weeks. In study-group-3; vitamin-D was administered twice per week during the 15th-16th-17th weeks. The animals were sacrificed at 10th-15th-17th weeks, and histologic samples were taken. RESULTS: Postoperative-15-group had a lower osteoblast number, which was statistically significant as compared to preoperative-15 and control-15-group. Control-10-group showed significantly lower osteoclast number in comparison to preoperative-10 and postoperative-10-group. Osteoclast number was significantly higher in the osteonecrosis-17-group as compared to control-17-group. Preoperative-10-group showed significantly higher inflammation in comparison to control-10-group. Postoperative-15-group had a lower histologic osteonecrosis, which was statistically significant as compared to the control-15-group. Macroscopic osteonecrosis was significantly higher in the control-17-group in comparison to the osteonecrosis-17-group. CONCLUSIONS: We concluded that there are some proofs for the treatment of BRONJ with systemic using of vitamin-D.

Histopathological Effects of Teriparatide in Medication-Related Osteonecrosis of the Jaw: An Animal Study.

PURPOSE: Osteonecrosis of the jaw after tooth extraction is a major complication in patients using bisphosphonates (BPs) for bone lesions, such as for the treatment of osteoporosis. The purpose of this study was to investigate the histopathologic effects of teriparatide (a synthetic parathyroid hormone) on rats developing osteonecrosis with BP use. MATERIALS AND METHODS: Rats (n = 80) that had been injected intraperitoneally with zoledronic acid for 7 weeks were used. Maxillary first molar extractions and bone defects were established in the same region in the eighth week. Teriparatide was administered subcutaneously to prevent osteonecrosis. Animals were sacrificed and histopathologic changes were examined. Osteoblasts, osteoclasts, inflammatory phase of bone healing, and osteonecrotic areas were evaluated. RESULTS: The osteoclast numbers were larger in the experimental groups (teriparatide administered before and immediately after tooth extraction) than in the control group (administered zoledronic acid). The inflammatory phase of bone healing was more pronounced in the experimental group (teriparatide administered before tooth extraction) than in the control group. There were significant differences in osteoclast numbers and in the inflammatory phase of bone healing between the experimental and control groups (P < .05). The osteoblast numbers and osteonecrotic areas were similar in size between the experimental and control groups. There were no significant differences (P > .05). CONCLUSIONS: BPs have negative effects on osteoclasts and the inflammatory phase of bone healing, whereas teriparatide was found to be effective in eliminating the negative effects of BPs. Teriparatide had positive effects in preventing osteonecrosis; therefore, teriparatide could be an effective agent for MRONJ.

Efficacy of preemptive lornoxicam on postoperative analgesia after surgical removal of mandibular third molars.

OBJECTIVE: Pain is the most encountered complication following third molar surgery. Although nonsteroidal anti-inflammatory drugs are often used for pain control, the effect of preemptive lornoxicam has not been detailed. We compare the analgesic efficacy of preemptive lornoxicam versus postoperative lornoxicam. STUDY DESIGN: Forty-three participants aged 18 to 33 years who had bilateral, symmetrical third molars were included in this double-blind, randomized, placebo-controlled study. All participants took part in each of the 2 groups for a 1-month interval (crossover design). Group Pre received lornoxicam 8 mg intravenously 25 minutes before surgery and 2 mL serum saline postoperatively. Group Post was given the opposite protocol. Pain was evaluated by visual analog scale in the first 12 hours. RESULTS: We observed statistically significant differences in the reduction of the pain level in group Pre (P < .05). These participants felt less pain in the first 5 postoperative hours and needed fewer analgesics in the first 12 postoperative hours. CONCLUSIONS: Preemptive lornoxicam is effective for postoperative pain control.

Psychological well-being, health, and stress sources in Turkish dental students.

This study investigated the psychological well-being and overall health of a group of Turkish dental students and their sources of stress. Two hundred and seventy-seven students (57 percent female) from Gazi University Dental Faculty completed the Dental Environment Stress (DES) questionnaire, the Psychological General Well-Being (PGWB) index, and the SF-36 Health Survey. The results showed that the DES scores increased over the five-year period. Pressure to perform, faculty and administration, workload, and students' perceptions of their self-efficacy were the most stress-provoking factors. Students whose first choice was dentistry experienced less stress and fewer health problems (p<0.05) than students whose first choice had not been dentistry. Psychological well-being and overall health were significantly associated with year of study. Statistically significant gender differences were observed on depressed mood and anxiety dimension scores of PGWB. Female students experienced greater stress than males, while male students had better overall health than females (p<0.01). Students who lived with their parents had lower PGWB scores (p<0.05). Age was significantly related with the DES and PGWB scores. These results found that stress among these Turkish dental students was influenced by gender, year of study, social background, and lifestyle. Based on the results of this study, recommendations can be made for changes in the dental education system in order to reduce stress among dental students especially during the last two years of study.

Osteonecrosis of the jaw in patients with multiple myeloma treated with zoledronic acid.

Intravenous bisphosphonates-the potent inhibitors of osteoclast-mediated bone resorption are among the most commonly prescribed drugs in the management of multiple myeloma (MM). Zoledronic acid (ZA) is a new generation potent intravenous bisphosphonate that has been approved for the treatment and prevention of bone lesions, and/or hypercalcemia associated with MM. Osteonecrosis of the jaw (ONJ) is an emerging serious side effect of the new generation bisphosphonates with a growing number of reports related to this pathological entity. ONJ usually appears following oral surgical and dental procedures but sometimes occur spontaneously. These cases are mostly seen and treated by dentists and oral surgeons. The aim of this study was to discuss the frequency, characteristics, risk factors, management and histopathological features of ZA induced ONJ based on the literature and illustrated with five own cases. Thirty-two patients with MM who received ZA for a median period of 26.5 +/- 18.7 months (min: 5 months, max: 76 months) were evaluated. ONJ was detected in five patients and mean drug duration time was 34 months. The frequency was 15% and the patients were usually symptomatic. There was no significant difference in terms of the duration of ZA in patients with and without ONJ. Management of these established cases were performed with medical treatment, minor debridement, sequestrectomy, and combining bone resection with autologous platelet rich plasma. Our data indicate that ZA therapy has a major role in the development of ONJ a fact that should be considered by physicians treating MM patients.

Evaluation of low-level laser therapy in the treatment of temporomandibular disorders.

OBJECTIVE: The purpose of this study was to assess the effectiveness of low-level laser therapy (LLLT) in the treatment of myogenic originated temporomandibular disorders (TMD). BACKGROUND DATA: Limited studies have demonstrated that LLLT may have a therapeutic effect on the treatment of TMD. METHODS: Thirty-nine patients with myogenic TMD-associated orofacial pain, limited mandibular movements, chewing difficulties, and tender points were included in this study. Twenty-four of them were treated with LLLT for 10 sessions per day excluding weekends as test group, and 15 patients with the same protocol received placebo laser treatment as a control group. These parameters were assessed just before, just after, and 1 month after the treatment. RESULTS: Maximal mouth-opening improvement, and reductions in pain and chewing difficulty were statistically significant in the test group when compared with the control group. Statistically significant improvements were also detected between two groups regarding reduction in the number of tender points. CONCLUSION: Based on the results of this placebo-controlled report, LLLT is an appropriate treatment for TMD and should be considered as an alternative to other methods.

Suspected familial odontogenic keratocysts related to Gorlin Goltz syndrome.

This report represents the suspected familial case series of odontogenic keratocysts OKCs related to Gorlin Goltz syndrome GGS, a rare genetic disorder characterized mainly by multiple basal cell carcinomas, OKCs and other less frequent skeletal and neurological manifestations. Familial cases included grandmother's father, grandmother, father and son. Although they had all OKCs, father additionally possessed some of the other characteristics of GGS. We described all the patients' diagnoses, treatments and long-term follow-ups under the light of current literature.

An unusual presentation of ossifying fibromyxoid tumor of the mandible: a case report.

A 13-year-old boy who complained rapid swelling on the left side of mandible is presented. Histopathological examination revealed ossifying fibromyxoid tumor (OFMT). OFMT is a rare soft-tissue neoplasm that occurs usually in the subcutaneous tissue of the extremties. Head and neck involvement is relatively rare. In this case, we present the diagnosis, surgical treatment and long-term follow-up of an OFMT due to its unusual site of occurrence. The precise clinical behavior of atypical and malignant types of OFMTs is still unclear. Thus, histopathology report is important, leading surgeon to decide how often and how long to follow-up patient with OFMT.

Long-term effects of cancer therapy on dental development: a case report.

As the prognosis of malignant conditions in children improve by cancer therapy, long-term side effects due to antineoplastic treatment may be encountered. This case report demonstrates the long-term alterations on dental development in patient who had been treated for malignant condition. Alterations were observed during radiographic control 8 years after the therapy and included short, blunted, tapered and V-shaped root malformations as well as delayed and ectopic eruptions.

Long-term effects of chemotherapy on orodental structures in children with non-Hodgkin's lymphoma.

The aim of this study was to investigate the late effects of treatment for childhood non-Hodgkin's lymphomas (NHL) on oral health and dental development. Thirty-six long-term survivors that had been treated with chemotherapy of childhood NHL were included in this study and 36 volunteers with similar age and sex distribution served as controls. Both groups underwent a complete orodental examination for decayed, missing and filled teeth and surfaces, gingival and periodontal health according to the Loe-Silness Gingival Index and Sillnes-Loe Plaque Index, enamel defects and discolorations, root malformations, eruption status, agenesis, premature apexifications and microdontia. The severity of these disturbances related to age at the time of NHL diagnosis were also evaluated by creating two groups as < 5 yr and > 5 yr. Although none of the parameters altered with age, patients had significantly higher plaque index, more enamel discolorations and root malformations than did the controls. The results show that long-term survivors of NHL patients exhibit some orodental disturbances that may be attributed to the chemotherapy regimens.

The early tissue response to titanium and LactoSorb screws.

Fractures of the maxillofacial region are common in the elderly people. Titanium and LactoSorb screws are the widely accepted materials for use in the maxillofacial fractures. This study was undertaken to evaluate the early tissue response following the insertion of both titanium and LactoSorb screws composed of 82% PLLA and 18% PGA in an elderly animal model. In this study, 22 titanium and 22 LactoSorb screws were applied to calvaria of 44 guinea pigs that were 10-11 months old. Animals were sacrificed on postoperative days 3, 7, 14, 30 and 60. Screws were retrieved with surrounding bone tissue and the specimens were prepared for routine histologic examination. All the specimens were evaluated by light microscopy. Histometric analysis revealed that there was no significant difference between LactoSorb and titanium screws for the new bone formation. The biodegradation of LactoSorb screws was not complete by the end of day 60. In conclusion, both materials were well tolerated and induced bone formation without causing adverse tissue response in an elderly animal model. Our results suggest that both LactoSorb and titanium miniplates and screws can be used safely, regardless of the increasing age. However, LactoSorb may be the first choice as it does not require a second operation for removal and has late biodegradation in elderly that keeps its support for a relatively longer time during fracture healing.

Long-term results of the application of solvent-dehydrated bone xenograft and duramater xenograft for the healing of oroantral osseous defects: a pilot experimental study.

The aim of this study was to investigate the long-term effects of the use of human cadaveric solvent-dehydrated bone graft and duramater as a barrier membrane for the treatment of oroantral communication. Standard oroantral osseous defects were created in five minipigs. Subjects received cancellous bone graft in the form of block or microchips, duramater or a combination of bone and membrane. Uneventful healing was achieved in all of the subjects, clinically including the control site which did not receive any material. The operated bone segments were evaluated both by radiological and histological examinations after 6 months. Radiological evaluation was carried out using bone density analysis software and histological evaluation made by light microscopy. Radiological and histological results revealed that bone grafting of oroantral osseous defects improved the bone quality. However, application of duramater did not change this activity, both alone or combined with bone grafts. Within the limits of this experimental study, although solvent-dehydrated bone grafts were found superior and could be applied for the healing of osseous oroantral defects, resorbable membranes did not contribute to this process.

Patterns of third molar impaction in a group of volunteers in Turkey.

The aim of this study was to investigate the different variables in mesio-vertically positioned impacted or erupted third molars in a group of volunteers in Turkey to determine the angular changes and levels of eruption radiographically using standardised panoramic radiographs. There were 213 volunteers with impacted and erupted third molars included in this study, most of whom were dental students. Standardised panoramic radiographs were taken from all the volunteers. The radiographic parameters included angulation of tooth, level of eruption, development of root, mesiodistal crown width, retromolar space, and gonial angle. Statistical analysis was done using the t-test for independent groups. It was found that the mesiodistal angulation of third molars was significantly greater while the retromolar space of third molars was significantly smaller in the impacted group (P<0.05). There was also a significant difference in retromolar space/third molar crown width ratio (P<0.05).