Clinical evaluation of efficacy of transcortical anesthesia for the extraction of impacted mandibular third molars: a randomized controlled trial.

BACKGROUND: This study aimed to compare the pain levels during anesthesia and the efficacy of the QuickSleeper intraosseous (IO) injection system and conventional inferior alveolar nerve block (IANB) in impacted mandibular third molar surgery. METHODS: This prospective randomized clinical trial included 30 patients (16 women, 14 men) with bilateral symmetrical impacted mandibular third molars. Thirty subjects randomly received either the IO injection or conventional IANB at two successive appointments. A split-mouth design was used in which each patient underwent treatment of a tooth with one of the techniques and treatment of the homologous contralateral tooth with the other technique. The subjects received 1.8 mL of 2% articaine. Subjects' demographic data, pain levels during anesthesia induction, tooth extractions, and mouth opening on postoperative first, third, and seventh days were recorded. Pain assessment ratings were recorded using the 100-mm visual analog scale. The latency and duration of the anesthetic effect, complications, and operation duration were also analyzed in this study. The duration of anesthetic effect was considered using an electric pulp test and by probing the soft tissue with an explorer. RESULTS: Thirty patients aged between 18 and 47 years (mean age, 25 years) were included in this study. The IO injection was significantly less painful with lesser soft tissue numbness and quicker onset of anesthesia and lingual mucosa anesthesia with single needle penetration than conventional IANB. Moreover, 19 out of 30 patients (63%) preferred transcortical anesthesia. Mouth opening on postoperative first day was significantly better with intraosseous injection than with conventional IANB (P = 0.013). CONCLUSION: The IO anesthetic system is a good alternative to IANB for extraction of the third molar with less pain during anesthesia induction and sufficient depth of anesthesia for the surgical procedure.

Use of resonance frequency analysis to evaluate the effects of surface properties on the stability of different implants.

OBJECTIVES: We performed a randomized clinical study evaluating the stability of implants with different surfaces (alkali-modified or sandblasted) via resonance frequency analysis (RFA). MATERIALS AND METHODS: Fourteen patients who were bilaterally edentulous in terms of their mandibular molars were enrolled. Implants with alkali-modified (bioactive) and sandblasted surfaces were randomly placed in either hemi-arch; the 50 implants used were identical in terms of diameter and length. RFA was used to measure the implant stability quotient (ISQ) immediately after placement (to assess primary stability) and 2, 6, and 12 weeks later. RESULTS: The average RFA value for alkali-modified implants was significantly higher than that for sandblasted implants immediately after implantation, but the ISQs fell rapidly and were similar in the two groups at 2 and 6 weeks (p > .05); ISQ values were the same in the two groups at 3 months (p > .05). CONCLUSIONS: Implants with alkali-modified surfaces were more stable than implants with sandblasted surfaces at all times after placement. The ISQs of bioactive implants exhibiting high-level primary stability fell to greater extents than did those of implants with sandblasted surfaces at 2 and 6 weeks postoperatively; both types of implant yielded similar clinical results at 12 weeks postoperatively.

Evaluation of Related Factors in the Failure of Endodontically Treated Teeth: A Cross-sectional Study.

INTRODUCTION: The aim of this study was to review the factors related to the failure and extraction of unsuccessful endodontically treated teeth. METHODS: A total of 1000 teeth treated with nonsurgical root canal therapy were analyzed, and the following information was recorded for each patient: reasons for failure and extraction, type of tooth, presence and type of coronal restoration, smoking status, age, gender, and level of education. One main reason was recorded for each failed tooth. The associations between reasons for failure, patient, and tooth were tested by using χ2 analysis. RESULTS: Of the 1000 endodontically failed teeth analyzed in this study, 28.1% (n = 281) were extracted, 66% (n = 660) were re-treated, and 5.9% (n = 59) were treated with apical surgery. Among the reasons for failure, restorative and endodontic reasons were seen most frequently (43.9%, n = 439), whereas orthodontic reasons were seldom seen (0.1%, n = 1). The most common reason for extraction was for prosthetic reasons (40.8%), and perforation/stripping was the least common (2.9%). The mandibular first molars were the most frequently extracted teeth (27.4%, n = 77). CONCLUSIONS: The most common reason for the extraction of endodontically treated teeth was for prosthetic reasons. Among the reasons for failure, restorative and endodontic reasons were the most frequently seen, and orthodontic reasons were the most seldom. The teeth that failed most frequently were mandibular first molars, and the teeth that failed least frequently were maxillary third molars. The most common reason for the extraction of failed endodontically treated teeth was for prosthetic reasons.

Comparison of the efficacy of low doses of methylprednisolone, acetaminophen, and dexketoprofen trometamol on the swelling developed after the removal of impacted third molar

BACKGROUND: The aim of the present study was to compare the efficacy of low doses of methylprednisolone, acetaminophen and dexketoprofen trometamol, which are among the drug groups used in our clinic, on postoperative swelling developing after removal of impacted third molar. MATERIAL AND METHODS: The three group of patients received either 40 mg methylprednisolone or 300 mg acetaminophen or 12.5 mg dexketoprofen trometamol one hour before the procedure, according to the patient groups. The patients in the methylprednisolone group were injected with methylprednisolone at a dose of 20 mg 24 hour after the procedure and prescribed 300 mg acetaminophen as rescue analgesic. During the postoperative period, the doses that were given before the procedure were continued 3 times a day for 2 days in the acetaminophen and dexketoprofen trometamol groups. Maximal swelling was assessed preoperatively and at the postoperative 48 hours by ultrasound images. RESULTS: Swelling was 34% lower in the methylprednisolone than in the other groups; however, no statistically significant difference was found between the groups. The acetaminophen and dexketoprofen trometamol groups exhibited clinical results close to each other. CONCLUSIONS: Combination of low doses of methylprednisolone and acetaminophen provide a safe and adequate clinical success on swelling

Comparison of the efficacy of low doses of methylprednisolone, acetaminophen, and dexketoprofen trometamol on the swelling developed after the removal of impacted third molar.

BACKGROUND: The aim of the present study was to compare the efficacy of low doses of methylprednisolone, acetaminophen and dexketoprofen trometamol, which are among the drug groups used in our clinic, on postoperative swelling developing after removal of impacted third molar. MATERIAL AND METHODS: The three group of patients received either 40 mg methylprednisolone or 300 mg acetaminophen or 12.5 mg dexketoprofen trometamol one hour before the procedure, according to the patient groups. The patients in the methylprednisolone group were injected with methylprednisolone at a dose of 20 mg 24 hour after the procedure and prescribed 300 mg acetaminophen as rescue analgesic. During the postoperative period, the doses that were given before the procedure were continued 3 times a day for 2 days in the acetaminophen and dexketoprofen trometamol groups. Maximal swelling was assessed preoperatively and at the postoperative 48 hours by ultrasound images. RESULTS: Swelling was 34% lower in the methylprednisolone than in the other groups; however, no statistically significant difference was found between the groups. The acetaminophen and dexketoprofen trometamol groups exhibited clinical results close to each other. CONCLUSIONS: Combination of low doses of methylprednisolone and acetaminophen provide a safe and adequate clinical success on swelling.

Complex midfacial reconstruction with an implant-supported framework.

This clinical report describes the treatment of a patient with osseointegrated extraoral implants supporting a framework retainer and acrylic resin mesostructures and a large silicone midfacial prosthesis. A metal framework was used to splint the implants together and provided satisfactory retention for the facial prosthesis. A 2-piece prosthesis that composed of an obturator and facial prosthesis was fabricated. Cosmetic improvements as well as the ability to speak, swallow, and, to a lesser degree, chew, were achieved for this patient.

Conservative Treatment Protocol for Keratocystic Odontogenic Tumour: a Follow-up Study of 3 Cases.

BACKGROUND: The keratocystic odontogenic tumour is classified as a developmental cyst derived from the enamel organ or from the dental lamina. The treatment of keratocystic odontogenic tumour of the jaw remains controversial. The aim of this study was to report the outcome of our conservative treatment protocol for keratocystic odontogenic tumour. METHODS: Three patients with different complaints referred to Oral and Maxillofacial Surgery Clinic, Faculty of Dentistry, Selçuk University. Initial biopsy was carried out in all patients and keratocystic odontogenic tumours was diagnosed subsequent to histopathological examination. The patients with keratocystic odontogenic tumours were treated by enucleation followed by open packing. This conservative treatment protocol was selected because of existing young aged patients. The average follow-up duration of the cases was 2 years. RESULTS: Out of 3 cases, 2 lesions were present in mandible and 1 lesion in maxilla. There was no evidence of recurrence during follow-up. All the cases were monitored continuously with panoramic radiographs, computed tomography and clinical evaluations. CONCLUSIONS: This conservative treatment protocol for keratocystic odontogenic tumours, based on enucleation followed by open packing would be a possible choice with a view of offering low recurrence rate and low morbidity rate particularly in young patients.

Association of serum total antioxidant capacity and total oxidant status with pain perception in patients with myofacial pain dysfunction.

We aimed to find out the association of total antioxidant capacity (TAC) and total oxidant status (TOS) with generalized pressure pain thresholds (PPT) of patients with myofacial pain dysfunction (MPD). PPT scores of patients with MPD (n = 37) and healthy individuals (n = 43) were measured on the hypothenar region of the hand using a mechanical algometer. Serum samples were collected and TAC and TOS were measured by novel methods. The TAC of patients was significantly lower than that of the control subjects. The difference between the TOS measurements of patients and control subjects was not significant. The PPT scores of the patients were significantly lower than that of control subjects. There may be an association between serum antioxidant capacity and MPD. Low serum TAC might also be related with pain perception.

Proinflammatory cytokines in temporomandibular joint synovial fluid before and after arthrocentesis.

OBJECTIVE: The aim of this study was to evaluate the levels of interleukin (IL)-1beta, IL-6, IL-8, IL-11, and tumor necrosis factor (TNF)-alpha in temporomandibular joint (TMJ) synovial fluid of the patients with internal derangement before and 2 weeks after arthrocentesis. STUDY DESIGN: Forty TMJs of 35 patients (29 females and 6 males, mean age 22.9 years) were included to the study. TMJs were divided into 2 groups: disc displacement with reduction (Group 1, n = 24) and disc displacement without reduction (Group 2, n = 16). Synovial fluid samples were obtained before and 2 weeks after arthrocentesis. IL-1beta, IL-6, IL-8, IL-11, and TNF-alpha concentrations were measured by using specific kits. RESULTS: Two weeks after the arthrocentesis procedures, all cytokines were found to be significantly decreased (P < .05) both in Group 1 and Group 2. The difference between 2 groups was insignificant (P > .05). CONCLUSION: Arthrocentesis is an effective technique for eliminating the studied cytokines from the TMJ synovial fluid.

Comparison of stability of titanium and absorbable plate and screw fixation for mandibular angle fractures.

OBJECTIVE: The purpose of this experimental study was to compare the stability of titanium and absorbable plate and screw fixation systems for mandibular angle fractures. STUDY DESIGN: Twenty-one sheep hemimandibles were used to evaluate 3 different plating techniques. The groups were fixated with a single titanium plate, a single absorbable plate and double absorbable plates. A cantilever bending biomechanical test model was used for the samples. Each group was tested with vertical forces by a servohydraulic testing unit. The displacement values in each group at each 10 N stage up to 100 N were compared using the 2-way analysis of variance test. RESULTS: The displacement values for the 3 groups differed significantly (P < .05). The variance analyses showed that titanium plate placement had more favorable biomechanical behavior than others. In addition, the 2 absorbable plates group had more favorable biomechanical behavior than a single absorbable plate group but it was not significantly different at 10 to 40 N. CONCLUSION: The study demonstrated that titanium plate and screw fixation system had greater resistance to occlusal loads than absorbable plate and screw systems. In addition, a second absorbable plate orientation provides a more favorable biomechanical behavior than a single absorbable plate placement.

Pathologic changes in soft tissues associated with asymptomatic impacted third molars.

OBJECTIVE: The aim of this study was to examine the need for routine removal of asymptomatic impacted third molars under the prophylactic indication, based on the incidence of pathologic changes. The frequency and type of pathologic conditions associated with impacted third molars were also evaluated. STUDY DESIGN: One hundred twenty impacted third molar dental follicles were submitted for histopathologic examination. The association between dental follicles and pathologic changes, age, gender, and angular position were statistically evaluated. RESULTS: Among these dental follicles, pathologic conditions were found in 23%. The relation between pathologic changes and angular position was not statistically significant (chi(2) = 2.040; P > .05). Pathologic changes were seen mostly in women who were > or = 20 years old. CONCLUSIONS: Cystic changes may be developed in asymptomatic impacted third molars. Asymptomatic impacted third molars should be removed before pathologic changes can occur.

Routine antibiotic prophylaxis is not necessary during operations to remove third molars.

The purpose of this study was to evaluate the efficacy of antibiotic prophylaxis during removal of impacted third molars. We studied 150 patients with impacted mandibular or maxillary third molars who were divided randomly into three groups. The first was given amoxicillin 2g combined with clavulanic acid, orally daily for 5 days postoperatively; starting at the end of the operation. The second group was given the same drugs but the regimen started 5 days before the operation. The third was given no antibiotics. Pain, infection, swelling, alveolar osteitis, and interincisal mouth opening (mm) were evaluated. There were no significant differences among the groups in the incidence of these complications. We cannot recommend routine oral antibiotic prophylaxis in third molar surgery.

Evaluation of pain perception in patients with temporomandibular disorders.

PURPOSE: The aim of this study was to assess the pain perception of patients with temporomandibular disorders and to investigate a possible association between pain sensitivity and temporomandibular disorders. PATIENTS AND METHODS: Fifty patients with temporomandibular disorders who were diagnosed according to research diagnostic criteria for temporomandibular disorders and 45 healthy volunteers were conducted. Visual analog scale, designed as 0 being no pain and 100 being worst pain ever experienced, was used to determine subjective pain expression during maximum mouth opening in patients and control subjects. All subjects' pressure pain thresholds were measured 3 times on the hypothenar region of the left hand with a mechanical algometer. Mean value of measured scores was assumed to be the general pressure pain threshold of the individual. RESULTS: Patients with temporomandibular disorder had significantly lower general pressure pain threshold values than pain-free subjects. Women had lower general pressure pain threshold values than men within groups as well. In the patient group, those with limited mouth opening (50 mm). However this result was statistically insignificant. CONCLUSIONS: According to the results of this study temporomandibular disorder patients were significantly different in terms of general pain perception. Systemic pain regulation mechanisms might be involved in temporomandibular disorder development. Some symptoms of temporomandibular disorder patients such as movement limitation and subjective pain expression might be originated from pain perception discrepancies besides severity of disease.

An alternative method for splinting of traumatized teeth: case reports.

Injuries to the dentoalveolar complex are fairly common and can be caused by a number of reasons. There are many techniques for repositioning and stabilizing traumatically luxated or avulsed teeth. Many of the splinting techniques previously advocated were time-consuming. Not only were the splints difficult to fabricate and difficult to remove, they also contributed to injury of the soft and hard supporting tissues. Ribbond (Ribbond Inc., Seattle, Wash) is basically a reinforced ribbon which is made from ultrahigh molecular weight polyethylene fiber having an ultrahigh modulus. It is used in dentistry for various purposes. The use of Ribbond appears to be an adequate and easy method for stabilization and fixation. It can be used in the treatment of dental injuries. In this article the use of Ribbond for the treatment of dentoalveolar injuries is described.

Antibacterial effect of selected root-end filling materials.

The purpose of this study was to evaluate the antibacterial activity of leachable components of selected root-end filling materials: amalgam, ProRoot MTA (mineral trioxide aggregate), Intermediate Restorative Material (IRM), Super Bond C&B, Geristore, Dyract, Clearfil APX composite with SE Bond, or Protect Bond. The direct contact test (DCT) with Staphylococcus aureus, Enterococcus faecalis, and Pseudomonas aeruginosa, was used. The materials were tested immediately after application to the microtiter wells (fresh samples) and after setting for 3 days (set samples). Ten microliters of bacterial suspension was added to each well for direct contact with each material for 1 h at 37 degrees C. Growth of surviving bacteria was then measured in a microplate spectrophotometer hourly at 620 nm for 15 h. Twelve uncoated wells using identical inoculum size served as positive controls. The data obtained at the end of 15 h was subjected to one-way ANOVA and post hoc comparisons were done using Tamhane's T2 test. Fresh samples of all materials showed a 3-h delay in exponential growth of both E. faecalis and S. aureus, and a 5-h delay in growth of P. aeruginosa. Set samples of IRM and ProRoot MTA cements showed generally greater antibacterial activity than the other materials: both completely inhibited P. aeruginosa, and both delayed or limited growth of E. faecalis. The DCT, by being quantitative and virtually independent of solubility and diffusion, was found suitable to assay solid root-end filling materials. IRM and ProRoot MTA were generally more potent inhibitors of bacterial-growth than the other tested materials.

Interleukin-1beta, tumor necrosis factor-alpha levels and neutrophil elastase activity in peri-implant crevicular fluid.

The aim of this study was to determine interleukin-1beta (IL-1beta), tumor necrosis factor-alpha (TNF-alpha) levels and neutrophil elastase (NE) activity in peri-implant crevicular fluid (PICF) of smoker and nonsmoker patients, and to investigate their relationships with clinical parameters. A total of 42 endosseous root-form dental implants of 14 patients were clinically examined by modified Plaque index (PI), modified Gingival index (GI) and probing depth (PD). Smoking habits of the patients were recorded. PICF of implants were collected by Periopaper strips and IL-1beta, TNF-alpha levels were determined by enzyme-linked immunosorbent assay (ELISA). NE was analyzed with a neutrophil specific chromogenic substrate, N-methoxysuccinyl-Ala-Ala-Pro-Val-p-nitroanilide. The cytokine and enzyme levels in PICF were expressed as total amount/activity and as concentrations. NE activity in PICF significantly correlated with GI and PD, and IL-1beta levels with GI and PICF volume (P < 0.05). The correlations were stronger when the PICF levels were expressed as total IL-1beta amount and as total NE activity. The implants with inflamed gingiva (GI > 1) had higher levels of IL-1beta and NE activity than implants with noninflamed or slightly inflamed gingiva (GI 3 mm) was greater than the implants with shallow pockets (PD