Osteoproductivity of Injectable Bone Grafts with and without Ostrich Eggshell Membrane Protein in Rabbit Femur.

BACKGROUND: The aim of this study was to evaluate the biocompatibility and effectiveness in terms of osseointegration of dental implants composed of novel injectable bone grafts with and without ostrich eggshell particles and membrane protein in rabbit femur. METHODS: Sixteen adult male New Zealand rabbits were used in this study. A bone defect was created in each animal's right and left femur, and a dental implant was placed adjacent to the defect. Two graft materials were prepared, one containing the membrane protein and the other not. In two groups, the defects were filled with these materials. In the negative control group (NC, (n:8)), the defects were left empty. A commercial product of biphasic calcium sulfate was used as a positive control material (PC, n = 8). The graft groups were defined as the group with the membrane protein (MP+, (n:8)), and without the membrane protein (MP-, n:8). The animals were euthanized at the 12th week after surgery. The samples were investigated using histology, histomorphometry, and micro-computed tomography. Data were statistically analyzed using one-way ANOVA and Tukey's tests (p = 0.05). RESULTS: Both the PC and MP+ groups had similar newly formed bone areas, and the mean values of these groups were significantly (p < 0.05) higher than those of the MP- and NC groups. The PC group had the highest amount of unresorbed material, while the MP- group had the lowest amount of unresorbed material. The bone-implant contact (BIC) scores of the PC and MP+ groups were significantly higher (p < 0.05) than that of the NC group. The connective tissue area of the PC group was the lowest, which was significantly lower than the other groups (p < 0.05). CONCLUSIONS: The grafts produced are highly biocompatible and also showed osteoproductivity. Their cost-effectiveness and osteoproductive activity require further investigation.

Biocompatibility and Osseointegration of the Biomimetically Coated and Water-Soluble Eggshell Membrane Protein Cross-Linked Ti Alloy Screws.

Background: The surface properties of dental and orthopedic implants are directly related to their osseointegration rate. Coating and/or modifying the implant surface might reduce the time of healing. In this study, we aimed to examine the effects of a hybrid surface consisting of a brushite surface coating and cross-linked water-soluble eggshell membrane protein on the osseointegration of titanium (Ti) screws under in vivo conditions. Methods: Twenty Ti alloy screws were implanted monocortically in anteromedial regions of New Zealand rabbit tibiae. Ten screws were untreated and used as controls. The remaining 10 screws were coated with calcium phosphate and following cross-linked with ostrich eggshell membrane protein. All rabbits were sacrificed six weeks after the surgery. Peri-screw tissues were evaluated by micro-computed tomography (µ-CT), histological and histomorphometrical methods. Results: The µ-CT assessments indicated that the experimental group had significantly higher mean bone surface area (BSA) and trabeculae number (TbN) than those of the control group (p ˂ 0.05). Bone surface area (BV), trabecular separation (TbSp), trabecular thickness (TbTh), and bone mineral density (BMD) scores of the control and experimental groups were quite similar (p > 0.05). The vascularization score of the experimental group was significantly higher than the control group (4.29 vs. 0.92%). No sign of the graft-versus-host reaction was observed. Conclusion: Our findings reveal that coating Ti alloy implants with calcium phosphate cross-linked with ostrich eggshell membrane protein increases the osseointegration of Ti alloy screws by increasing the bone surface area, number of trabeculae and vascularization in the implant site.

Osteoproductivity in Experimentally Induced Cranial Bone Defects in Rabbits.

Background: Autogenous bone grafts are the gold standard for being used as graft materials in maxillofacial surgery. However, a limited amount of these materials is available from the donor site, and there is also more need for a larger operating area and a second surgery, which frequently leads to unreliable graft incorporation, tooth ankylosis, and root resorption. Therefore, newer bone graft substitutes have been developed as alternatives, among which eggshell powder has been introduced as a bone substitute. This study aimed to evaluate the biocompatibility, resorption kinetics, and osteoproductivity of the unprocessed, CMC-coated, and gelatin-coated ostrich eggshell particles. Methods: Four half-thickness calvarial defects were created in each animal. At the end of the 1st and 3rd months, the defected sites were investigated by clinical, histological, radiological and histomorphometrical methods. Results: Coating the eggshell particles with CMC and gelatin facilitated their surgical application and contributed to new bone formation. However, their newly formed bone rate at the 3rd month was lower than those of the unprocessed eggshell particles. The CMC coating was more effective than gelatin coating in the bone modeling process. Conclusion: Ostrich eggshell particles either in native form or coated with CMC could be used as a bone filler for supporting new bone formation and healing in treatment of osseous defects.

Effect of low-dose dexketoprofen trometamol and paracetamol on postoperative complications after impacted third molar surgery on healthy volunteers: A pilot study

OBJECTIVES: The aim of the present study was to investigate the analgesic and anti-inflammatory effects of dexketoprofen trometamol (DT) and paracetamol on deep acute somatic pain and inflammation in patients undergoing impacted third molar surgery. This study was planned to present benefits that we could obtain with low burden of drug. Study DESIGN: Effects of drugs, which were administered preemptively before the procedure, on pain, mouthopening limitation, and swelling were assessed by visual analogue scale (VAS), magnetic resonance imaging (MRI), and mouth-opening measurement. Following surgery, time intervals when the patients first need to receive the drug were measured. RESULTS: The VAS scores of the patients were lower in the side treated with DT than that in the paracetamol treated side. There was no significant difference between the groups in terms of mouth-opening limitation. MRI recordings revealed that swelling was lower in the side treated with paracetamol than DT treated side. CONCLUSIONS: Administration of the drugs before surgery contributed to the postoperative patient comfort. The analgesic activity of 12.5 mg dose of DT was similar to, even better than, the analgesic activity of 500 mg dose of paracetamol; however, DT had insufficient anti-inflammatory efficacy

Effect of low-dose dexketoprofen trometamol and paracetamol on postoperative complications after impacted third molar surgery on healthy volunteers: A pilot study.

OBJECTIVES: The aim of the present study was to investigate the analgesic and anti-inflammatory effects of dexketoprofen trometamol (DT) and paracetamol on deep acute somatic pain and inflammation in patients undergoing impacted third molar surgery. This study was planned to present benefits that we could obtain with low burden of drug. STUDY DESIGN: Effects of drugs, which were administered preemptively before the procedure, on pain, mouth-opening limitation, and swelling were assessed by visual analogue scale (VAS), magnetic resonance imaging (MRI), and mouth-opening measurement. Following surgery, time intervals when the patients first need to receive the drug were measured. RESULTS: The VAS scores of the patients were lower in the side treated with DT than that in the paracetamol treated side. There was no significant difference between the groups in terms of mouth-opening limitation. MRI recordings revealed that swelling was lower in the side treated with paracetamol than DT treated side. CONCLUSIONS: Administration of the drugs before surgery contributed to the postoperative patient comfort. The analgesic activity of 12.5 mg dose of DT was similar to, even better than, the analgesic activity of 500 mg dose of paracetamol; however, DT had insufficient anti-inflammatory efficacy.

Prosthetic Rehabilitation of Partial Ear Defect: 2 Case Reports.

The loss or absence of an auricle may result from trauma, disease or congenital anomalies and causes a considerable aesthetic problem. If the deformity involves the external auditory canal, it can affect hearing. This case report describes the surgical and prosthetic treatment of two patients with partial defects of their right external ears from different causes. Implant-retained auricular prostheses fabricated from heat-temperature-vulcanised silicone were used in both the cases; they were designed to be harmonious with the remaining tissues. The patients experienced improved retention, aesthetics, hearing and quality of life with these prostheses. During the approximately 3 year follow-up, both the prostheses were re-fabricated once; however, problems related to implant stability and peri-implant tissue health were not encountered.

Distracted mandible does not reach the same strength as normal mandible in rabbits.

OBJECTIVE: The aim of this study was to determine the resistance and fracture strength values of the bone with the use of biomechanical tests in different consolidation periods of mandibular distraction osteogenesis. STUDY DESIGN: In this study, 21 mature male New Zeland rabbits were used. After distraction, rabbits were separated into 3 groups to experience 4, 8, and 12 weeks' consolidation periods. Nonoperated hemimandibles of 6 rabbits were used as a control group. After 5 days' latency period, 0.5-mm distraction was applied twice a day, i.e., 1 mm/d lengthening. After the 5-mm lengthening application, we left the animals for 1, 2, or 3 months of consolidation period. Bending stress and strength values of the bone at fracture point were measured with the use of a 3-point bending test. RESULTS: There were significant differences between the control and 3 study groups regarding bending stress and strength values. In addition, each study group was significantly different from each other. CONCLUSIONS: Bending stress and fracture strength of the bone may not reach that of normal bone after completion of 3 months' consolidation. It should be considered to keep in place extraoral appliances or comfortable intraoral distractors for a long period.

Comparison of depth of anesthesia in different parts of maxilla when only buccal anesthesia was done for maxillary teeth extraction.

Objective. Recently, some authors reported that maxillary teeth could be extracted without using palatal anesthesia, but they did not clearly specify the extracted teeth. This is important, because apparently the local anesthetic solution infiltrates the maxilla and achieves a sufficient anesthesia in the palatal side. Thus, thickness of the bone may affect the depth of anesthesia. The aim of this study was to compare the depth of anesthesia in different parts of the maxilla when only a buccal infiltration anesthesia was done. Patients and Method. The maxilla was divided into anterior, premolar, and molar regions. In each region, 15 teeth were extracted with a single buccal infiltration. The patient marked the pain level on a numerical rating scale. Results. Anesthesia depth was sufficient and was not significantly different (P > 0.05) among three maxillary regions. Conclusion. Except for surgical interventions, all maxillary teeth can be extracted using only a buccal infiltration anesthesia.

Comparison of three pain scales after impacted third molar surgery.

OBJECTIVE: Recently, a pain assessment scale called "full cup test" (FCT) has been suggested for pain evaluation. It is claimed to be easier to use for the patient, and it allows using parametric tests for statistical analyses. The aim of this study was to evaluate the validity of the FCT in third molar surgery. STUDY DESIGN: The FCT was compared with 2 well accepted pain scales. Forty-eight patients who had fully impacted lower third molars were included. All patients were asked to fill 3 pain scales--visual analog scale (VAS), verbal rating scale (VRS), and FCT--daily during the first postoperative week. Then the scales were collected and data statistically analyzed. Agreement among VAS, VRS, and FCT was evaluated using the Spearman rank coefficient. RESULTS: Correlations among 3 scales were very high and significant (P < .001). CONCLUSIONS: The FCT can be used to assess the postoperative pain after third molar surgery.

Evaluation of osteoblastic activity around dental implants using bone scintigraphy.

OBJECTIVES: The aim of this study was to evaluate the osteoblastic activity around delay-loaded intraosseous dental implants using nuclear medicine imaging techniques. MATERIAL AND METHODS: Seven totally edentulous patients (two females and five males, between 48 and 57 years of age) were included in the study. Two implants were inserted into mandibular canine regions and removable prostheses were produced after 3 months. Whole-body bone scintigraphies with 20 mCi technetium 99m labelled methylene diphosphonate were taken from the patients before implant insertion, 3 months after implant placement just before the prostheses were made and 1 year after implant placement. Standardized count/pixel (SC/P) rates were calculated for each patient. Preimplantation SC/P values were compared with the 3- and 12-month values. Three-month values were compared with the 12-month values as well. RESULTS: SC/P rates in the third month were significantly higher (P<0.05) than preoperative values and the SC/P rates of the 12th month were significantly lower (P<0.05) than 3-month values. The SC/P rates of the 12th month were relatively higher than first scintigraphies but the difference was insignificant (P>0.05). CONCLUSIONS: Within the limitations of this study, in which delayed loading was applied, we showed that osteoblastic activity persisted more in delay loaded implants than immediate and early loading. After 1 year, there was no cellular activity around two implants and this implied that two implants were sufficient for a total prosthesis.

Kinematic assessment of the temporomandibular joint before and after partial metal fossa eminence replacement surgery: a prospective study.

PURPOSE: This study compared the functional kinematic outcome of the temporomandibular joint (TMJ) in patients with end-stage TMJ osteoarthritis before and after TMJ hemijoint replacement surgery. MATERIALS AND METHODS: Fourteen patients (15 joints), with a mean age of 46.1 years, undergoing metal fossa eminence hemijoint replacement surgery, participated in this study. Each patient's jaw motion was recorded using an electromagnetic tracking device and patient-specific computed tomography images. A visual analog scale patient response questionnaire was used before and after the operation to assess the subjective outcome of the surgery. RESULTS: The mean linear distance (LD) traveled by the incisors increased significantly due to the surgical intervention, from 30.4 +/- 6.9 mm preoperatively to 35.5 +/- 5.3 mm postoperatively (P = .02). The LD of the operated condyle decreased from 14.1 +/- 5.7 mm to 11.4 +/- 6.2 mm, but this was not significant. The mean LD for the unoperated condyle remained similar (preoperative, 13.2 +/- 5.9 mm; postoperative, 13.3 +/- 6.5 mm). The total mandibular rotation increased significantly, from 19.3 +/- 4.9 degrees preoperatively to 24.8 +/- 3.9 postoperatively (P < .01). CONCLUSIONS: Kinematic data support the functional efficiency of hemijoint replacement surgery, with benefits of increased maximal mouth opening, preservation of operated and unoperated condyle translation motion, and increased mandibular rotation.

A method for quantifying condylar motion in patients with osteoarthritis using an electromagnetic tracking device and computed tomography imaging.

PURPOSE: The purpose of this study was to develop a method to accurately study the kinematic changes of the temporomandibular joint (TMJ) in patients treated with hemijoint implant reconstruction for dysfunction of advanced degenerative osteoarthritis. MATERIALS AND METHODS: Mandibular kinematic motion data and patient-specific computed tomography (CT) data were acquired. Patients were fitted with custom dental stents that were embedded with metal markers to link the mandibular kinematics data with the 3-dimensional TMJ CT images. An electromagnetic tracking device was used to collect kinematic motion data during maximal mouth opening and closing. The coordinate systems of the kinematic data and CT data were registered to calculate the motion of the mandibular condyle. RESULTS: This technique was successfully used to study patients with motion aberration of the TMJ due to osteoarthritis. A typical case is illustrated in which the motion of both mandibular condyles was simulated preoperatively and postoperatively. CONCLUSIONS: The results of this study suggest that it is possible to use the proposed methodology to accurately quantify the motion of the mandibular condyle in 3 dimensions. The developed technique is user-friendly and noninvasive to the patient. The proposed methodology is a potential clinical tool that may be used in the management of patients with TMJ dysfunction.

Paresthesia of the mental nerve stem from periapical infection of mandibular canine tooth: a case report.

Sensory disturbances such as paresthesia, anesthesia, hypoesthesia, and hyperesthesia may be present in the oral cavity. Paresthesia is defined as a burning or prickling sensation or partial numbness caused by neural injury. Paresthesia in dentistry can be caused by local or systemic factors. Local factors include traumatic injuries such as mandibular fractures, expanding compressive lesions (benign or malignant neoplasia and cysts), impacted teeth, local infections (osteomyelitis, periapical, and peri-implant infections), iatrogenic lesions after tooth extractions, anesthetic injection, endodontic therapy (overfilling and apical surgery), implantology, orthodontic surgery, and preprosthetic surgery. The main purpose of this case report is to present the treatment and resolution of a mental nerve paresthesia stemming from apical pathosis of a mandibular canine tooth and the follow-up of 3 years.

Evaluation of the biocompatibility and osteoproductive activity of ostrich eggshell powder in experimentally induced calvarial defects in rabbits.

The purpose of this study was to investigate the beneficial effects of particulate ostrich eggshell grafting on the healing of experimentally induced skull defects. The clinical, radiological, histological, and histomorphometrical findings of this material were compared with the results of commercially available demineralized bone matrix (DBM). The study was conducted on 18 adult New Zealand rabbits. One defect served as a control and the remaining ones either were filled with different sized eggshell particles or DBM, in each animal. Clinical and radiological inspections and histologic investigations of the animals were done at the 1st, 3rd, and 6th months of postoperative period. Radiologically, minimal bone regeneration was observed at the empty, control defect sites. The most advanced bone regeneration was in the DBM grafted defects. The eggshell particle grafted defect sites displayed weak bone regeneration at earlier stages, at 1st and 3rd months after operation when compared with demineralized bone matrix. Nevertheless, ossification was satisfactory at 6th month after operation when compared with the control defects. Within the limitations of this study, it was concluded that Ostrich eggshell powder (OSP) is a worth-while bone substitute because it is a safe, cheap, and easily available material. Long-term studies will clarify its possible role in maxillofacial surgery. Further sophisticated experiments should be undertaken before human implantation concerning its osteoproductive activity alone or in combination with other materials.

An unusual association of odontomas with primary teeth.

Odontomas generally appear as small, solitary or multiple radio-opaque lesions found on routine radiographic examinations. Traditionally, odontomas have been classified as benign odontogenic tumors and are subdivided into complex or compound odontomas morphologically. Compound odontomas commonly occur in the incisor-canine region of the maxilla and complex odontomas are frequently located in the premolar and molar region of both jaws. Occasionally, odontoma may cause disturbances in the eruption of teeth such as impaction, delay eruption or retention of primary teeth. In general, odontomas occur more often in the permanent dentition and are very rarely associated with the primary teeth. In this report; two cases of compound odontoma associated with primary teeth is presented. (Eur J Dent 2007;1:45-49).

Effects of preoperative ibuprofen and naproxen sodium on orthodontic pain.

Three experimental groups of 20 patients each, all of whom were to undergo fixed orthodontic treatment, were enrolled in this prospective study. Group 1 was given a placebo, group 2 was given 400 mg ibuprofen, and group 3 was given 550 mg naproxen sodium. All the patients received only one dose that was given one hour before archwire placement. All patients were asked to complete a questionnaire concerning the pain perceived after archwire placement. The questionnaire was in the form of a seven-page booklet that contained 100-mm horizontal Visual Analogue Scale on which the patient marked the degree of discomfort at the indicated time periods. The patients were instructed to make a check on the scale at each time interval to represent the perceived severity of pain during each of four activities, ie, chewing, biting, fitting back teeth together, and fitting front teeth together. Incidence and severity of pain were recorded by the patient at two hours, six hours, nighttime on the day of appointment, 24 hours after the appointment, and two days, three days, and seven days after bonding. The results revealed that patients taking 550 mg naproxen sodium one hour before archwire placement had significantly lower levels of pain at two hours, six hours, and nighttime after adjustment than patients taking placebo or ibuprofen. However, the use of additional postoperative doses was recommended to control orthodontic pain completely.

Long-term follow-up of patients with atypical facial pain treated with amitriptyline.

OBJECTIVE: The aim of this study was to assess the efficacy of low-dose amitriptyline in patients with atypical facial pain for one-year follow-ups. PATIENTS AND METHODS: Sixteen patients, ten females and six males, ranging in age from 15 to 77 years (mean 46.6 +/- 15.95 years), participated in the study. The onset, duration and temporal pattern of pain, events related to pain, drugs used before treatment and side effects of amitriptyline were recorded. The severity of pain was evaluated by using the visual analogue scale (VAS). Patients were followed for up to 12 months. RESULTS: The results showed that the onset of pain was related to dental pain in half of patients; and 10 patients had continuous pain. The mean VAS scores for pretreatment, post treatment, and 1, 3, 6, and 12 months were 9.6, 4.8, 2, 0.8, 0.3 respectively. In 12 patients, pain was reduced at the first month (p<0.05). All patients, except one, were pain-free at 12 months. It was statistically significant in achieving pain relief for 12 months (p<0.05). The common side effects of the drug were dry mouth and drowsiness. CONCLUSION: Data obtained from this study suggested that amitriptyline may be preferred in patients with atypical facial pain for rapid, satisfying analgesic effects. Long-term follow-up should be conducted to determine the analgesic effects and to prevent recurrence, even if the analgesic effect occurs in a short time.

Use of the fertilized hen's egg in the evaluation of embryotoxicity of dental alloys.

In this study, embryotoxic effects of five commercially available dental alloys were investigated by using fertilized hens' eggs. One sample of each alloy was conditioned in one of the conditioning media, physiological saline (PS), 0.1 M phosphate-buffered saline (PBS, pH 7.4), and 0.1 M protein (3% bovine serum albumin, BSA) containing PBS (pH 6.8), respectively. The test solutions were injected into the fertilized hen's eggs via air sac at the beginning of the incubation. Various concentrations of a highly embryotoxic substance, AFB1, was also used as positive control test material. Mortality of the AFB1 treatment groups increased with increasing concentrations of AFB1 and the mortality values were significantly (p < 0.05) higher than those of the controls and eluent injected groups. The eluents of five commercially available dental alloys tested in the study did not have significant embryotoxic effects. Cu- and Pd-containing alloys displayed relatively high but statistically insignificant embryotoxic effects. Chick embryo might be used in determination of the embryotoxic effects of the dental alloys with its several advantages. Nevertheless, the test should be further standardized and new methods such as micronucleus test showing possible genotoxic effects of the materials should be used.

Analysis of chromosomes 8 and 17 aneuploidies in laryngeal squamous cell carcinoma by fluorescence in situ hybridization.

OBJECTIVES/HYPOTHESIS: The objectives were to investigate chromosomes 8 and 17 numerical aberrations by using fluorescence in situ hybridization in laryngeal squamous cell carcinoma and also to determine whether there is any association between chromosomes 8 and 17 aneuploidies and TNM classification and subgroups of laryngeal squamous cell carcinomas. STUDY DESIGN: Descriptive study. METHODS: Tumor and control samples were taken from 23 patients with LSCC by surgical operation. Fluorescence in situ hybridization analysis with chromosomes 8- and 17-specific alpha-satellite DNA probes was performed on the interphase nuclei. RESULTS: The percentages for chromosomes 8 and 17 aneuploidies were 33% (SD = 25.7%) (median value, 26.2%; range, 3.5%-81.8%) and 19.2% (SD = 15.8%) (median value, 9.8%; range, 3.6%-63.7%), respectively. There was a significant difference between stage 2 and stage 3 (P <.05) and between stage 2 and stage 4 for chromosome 8 aneuploidy (P <.05) but not for chromosome 17 aneuploidy (P >.05). There was also a significant difference for the T classification for chromosome 8 aneuploidy (P <.05) but not for chromosome 17 (P >.05). CONCLUSION: Chromosome 8 aneuploidy may be related to stage and T classification of laryngeal squamous cell carcinoma and its progression.

Accidental displacement of impacted maxillary and mandibular third molars.

Displacement of impacted third molars is frequently mentioned in oral and maxillofacial surgery textbooks, but rarely reported. However, should this complication arise in general practice, the clinician should not embark on potentially complicated and hazardous surgical procedures to retrieve the displaced tooth. Administration of prophylactic broad spectrum antibiotics and urgent referral to an oral and maxillofacial surgeon, is recommended.