Histological evaluation of effectiveness of platelet-rich fibrin on healing of sinus membrane perforations: A preclinical animal study.

The aim of this study was to evaluate the effectiveness of platelet-rich fibrin (PRF) in repairing of Schneiderian membrane perforations in rabbit maxillary sinus. A total of 42 female New Zealand rabbits were randomly divided into two groups. Symmetrical bony defects were created 1 cm in diameter and the sinus membranes were exposed. The Schneiderian membranes were elevated in both sinuses and each membrane was perforated with a 1 cm incision. No treatment was applied to the right perforations in both groups. Left-sided perforations were closed with collagen membrane in the first group and PRF membrane in the other group. Seven animals randomly selected from each group were sacrificed at weeks 1, 2 and 4 in order to be able to examine the amounts of lymphocytes, fibroblasts, veins, and collagen fibers in the area where the membranes were applied. Histological analyses showed that there were no statistically significant differences between the collagen membrane and the PRF membrane in the healing of sinus perforation area. PRF may be considered as an alternative application to collagen membrane in sinus membrane perforations.

Biomechanical evaluation of different fixation systems after Le Fort I osteotomy in polyurethane models of unilateral clefts.

We compared the stability of three different titanium plate-and-screw fixation systems after Le Fort I osteotomy in polyurethane models of unilateral clefts. Thirty-six models were divided into 3 groups. In the first group, we adapted standard Plates 1mm thick with 2.0mm screws and placed them bilaterally on the zygomatic buttress and the piriform rim. In the second group, we did the same and added Plates 0.6mm thick with 1.6mm screws between the standard 2mm miniplates on both sides. In the last group, we placed Plates 1.4mm thick with 2.0mm screws bilaterally on the maxillary zygomatic buttress and piriform rim. Each group was tested in the inferosuperior (IS) and anteroposterior (AP) directions with a servo-hydraulic testing unit. In the IS direction, displacement values were not significantly different up to 80N, but between 80 and 210N, those in the 2×1.4mm group were better. In the AP direction, displacement values were not significantly different up to 40N, but between 40 and 180N, they were better in the standard with 1.6×0.6mm group and the 2×1.4mm group. When normal biting forces (90 - 260N) in the postoperative period are considered, the greatest resistance to occlusal loads was seen in the 2×1.4mm group. In the others, the biomechanical properties were better in the AP direction.

Management of central giant cell granuloma of the jaws with intralesional steroid injection and review of the literature.

PURPOSE: We report the results of the intralesional steroid injections for the management of central giant cell granuloma (CGCG) of the jaws. METHODS: Seven CGCGs were treated with intralesional injection of corticosteroids. To accomplish this, 3.5 mL of triamcinolone and 3.5 mL of 0.5 % marcaine with 1/200,000 epinephrine (total 7 mL) were mixed. An adequate amount of steroid was injected into different areas of the lesion. This procedure was repeated on a weekly basis for 6 weeks. RESULTS: Clinical and radiological examination showed complete resolution and ossification of the lesions in four patients. Partial recovery was achieved in two patients. One patient did not respond to the treatment and underwent surgical curettage. CONCLUSIONS: We suggest that intralesional steroid injection is safe and effective for the treatment of CGCG, especially in non-aggressive lesions.

Combined use of alveolar distraction osteogenesis and segmental osteotomy in anterior vertical ridge augmentation.

INTRODUCTION: Vertical defects of the anterioral veolar ridge are challenging cases in implant dentistry. Various techniques, such as onlay bone grafting, segmental osteotomy (SO) oral veolar distraction osteogenesis (ADO), have been suggested to manage those situations. ADO has an advantage of being capable of enhancing both hard and soft tissue simultaneously. PRESENTATION OF CASE: One of the possible complications of ADO is rotation ortilting the transport segment (TS). In this report, we present a 30-year old woman who had a severe anterior vertical deficiency. ADO was started to manage the case, but advancement of the TS lagged on the left side and the segment rotated. A SO was planned and the lagged side was corrected. Two years after the surgery, hard and soft tissue gains were found to be preserved. DISCUSSION: Vertical alveolar bone deficiencies are challenging cases for dental implantology. Alveolar DO promotes soft tissue along with hard tissue, and the bone regeneration process and shows lower infection rates and greater stability over the long term. However, the technique has some disadvantages and can lead to complications, such as breaking of the distraction device, nerve injury or paresthesia, fracture of transport bone, hematoma, wound dehiscence, severe bleeding, and even jaw fractures. Deviation of the TS from the distraction path is another undesired situation. The rigidity of the device, the width of the mucosa, the volume of the transport and anchor segments, and the amount of augmentation can affect vector deviation. CONCLUSION: We suggest that SO can be used in similar cases in which TS could not be distracted on a straight vector line.

Effect of 2 flap designs on postoperative pain and swelling after impacted third molar surgery.

OBJECTIVE: The aim of this study was to evaluate 2 flap designs (envelope and modified triangular flap) for postoperative pain and swelling after mandibular impacted third molar surgery. STUDY DESIGN: Thirty patients who had symmetric bilateral fully impacted mandibular third molars were selected. Left teeth were approached with an envelope flap, and right teeth were removed using a modified triangular flap. Postoperative pain and swelling were evaluated until the seventh day by using 2 verbal rating scales. RESULTS: Statistical analyses showed that there were no significant differences between the 2 incision techniques regarding postoperative pain and swelling (P > .05). CONCLUSIONS: There is no significant difference between the envelope and modified triangular flap regarding postoperative pain and swelling after impacted third molar surgery.

The use of stereophotogrammetry in oral surgery: measurement of area changes after secondary epithelization and grafting vestibuloplasties.

OBJECTIVE: Stereophotogrammetry (SPT) is a method in which three-dimensional coordinates are calculated from multiple two-dimensional projections. The purpose of this study was to compare the surface area changes between the secondary healing and grafting vestibuloplasty techniques in the mandible by using a stereophotogrammetric technique (SPT). PATIENTS AND METHODS: Thirteen patients were included in this study: six patients were managed by using full-thickness skin or palatal mucosa grafts (two full-thickness palatal mucosal grafts and four full-thickness skin grafts); the remaining seven patients, who did not accept a second surgery for graft harvesting, underwent secondary epithelization vestibuloplasties. Postoperative changes of surgical areas were measured by using SPT. STATISTICAL ANALYSES: The Wilcoxon (intragroup comparisons) and Mann-Whitney U (intergroup comparisons) tests were used for analysis of data. RESULTS: In the grafting vestibuloplasty group, the surface area gain was statistically significant (P < 0.05). In the secondary epithelization vestibuloplasty group, there was no significant difference (P > 0.05), with even decrease of surface area being noted in some cases. CONCLUSION: SPT is a valid method for measurement of intraoral soft tissue changes.

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.

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.

A preferable technique for protecting the inferior alveolar nerve: coronectomy.

PURPOSE: The aim of this study was to evaluate the effectiveness of coronectomy for teeth whose root apices are very close to the inferior alveolar canal. PATIENTS AND METHODS: The 43 patients of this study needed removal of their lower third molar, whose root apices were very close to the inferior alveolar canal. These patients underwent 47 coronectomies. RESULTS: The mean follow-up period was 9.3 months (range, 1 to 48 months). The mean total amount of root movement was 3.4 mm at 6 months, 3.8 mm at 12 months, and 4.0 mm at 24 months. CONCLUSIONS: The technique of coronectomy is defined as removing the crown of a tooth but leaving the roots untouched, so that the possibility of nerve damage is reduced. Coronectomy is a preferable technique for patients who run a risk of injury to the inferior alveolar nerve during third molar surgery.

Histological evaluation of the effects of bioglass, hydroxyapatite, or demineralized freeze-dried bone, grafted alone or as composites, on the healing of tibial defects in rabbits.

OBJECTIVES: To compare the effectiveness of bioactive glass (BG), natural hydroxyapatite (HA), and demineralized freeze-dried bone (DFDB) in bone defects. METHODS: All animal experiments were conducted in Faculty of Veterinary Medicine, Selcuk University, Konya, Turkey, under the Selcuk University Guidelines for Animal Experimentation, in 2005. Eighteen New Zealand rabbits were used for the experiment. Four cavities were prepared on right and left tibias. The cavities on the right tibia were filled with either BG, HA or DFDB. One cavity was left empty as a control. The cavities on the other tibial bone were grafted with HA(+)BG, HA(+)DFDB, BG(+)DFDB and HA(+)BG(+)DFDB composites. Histological examinations were performed at first, third, and sixth postoperative months. RESULTS: According to histomorphometric findings, the mixture containing HA(+)BG(+)DFDB obtained the best histological results (p<0.05). CONCLUSION: The composite graft of HA, BG and DFDB is more effective than when used as individual agents.

Septic pulmonary embolism secondary to dental focus.

A 24-year-old female was admitted to an infectious diseases unit with complaints of dyspnea and fever. She had suffered from multiple episodes of fever for 1 year. The diagnostic workup revealed multiple pulmonary nodules on the chest CT scan, suggesting septic pulmonary embolism, and a periapical abscess around the maxillary right central incisor. Because no other infectious source was found and resolution of the fever and the pulmonary lesions occurred only after extraction of the affected tooth and antibiotic therapy, the condition was diagnosed as a periapical abscess complicated by septic pulmonary embolism.

Comparison of stability of absorbable and titanium plate and screw fixation for sagittal split ramus osteotomy.

Six unembalmed adult sheep mandibles were stripped of all soft tissues and sectioned at the midline. Each side had a sagittal split ramus osteotomy (SSRO) and was advanced 5 mm. Six of the hemimandibles were fixed with four-hole extended titanium miniplates and titanium screws, and the other six were fixed with four-hole extended absorbable plates and absorbable screws. All specimens were mounted in a servohydraulic testing unit, and a range of forces (0-140 N) was applied. Displacement of each proximal segment was recorded at 10 N increments from 0 to 140 N. Values for the two groups were compared using the Mann-Whitney U-test, and significant differences in displacement were seen only at loads between 10 and 50 N. The results indicate that when absorbable miniplates are used intermaxillary fixation may be necessary to stabilise the bony fragments in the early postoperative period.