Histopathological investigation of the effect of chitosan on oral mucous wound healing in experimentally established diabetic rats.

BACKGROUND: In our study, it was aimed to histopathologically investigate the effects of chitosan on wound healing in the oral mucosa by applying the gel form of experimentally induced diabetes mellitus. METHODS: In our study, 42 male Sprague Dawley rats weighing 340±20 g, 14-16 weeks old, were used. Diabetes induction was achieved by administering 55 mg/kg streptozotocin intraperitoneally (i.p.) to 32 of the subjects. Those with blood glucose levels above 250 mg/dl as measured at the end of the 2nd and 7th days were considered diabetic and included in the study. Afterwards, a wound of 5 mm in diameter and 1 mm in depth was created in the buccal mucosa of the experimental animals with a disposable punch biopsy tool. Wound healing was evaluated on the 2nd and 5th days after the surgical operation. The samples were evaluated histopathologically in terms of inflammation, fibrosis, epithelial regeneration, necrosis, and foreign body reaction. RESULTS: As a result of the statistical analysis, a significant difference was found between the groups in terms of inflammation levels on the 2nd and 5th days (p<0.05). In the intragroup evaluations, the rate of severe inflammation on the 2nd day in the diabetes+chitosan group was found to be statistically significantly higher than the 5th day (p<0.05). While there was no statistically significant difference between the groups in terms of fibrosis levels on the 2nd day (p>0.05), a statistically significant difference was found in terms of fibrosis levels on the 5th day (p<0.05). CONCLUSION: It was observed that chitosan did not cause foreign body reaction in any of the groups on the 2nd and 5th days.

Radiological examination of the relationship between the pterygomaxillary junction and fracture pattern.

BACKGROUND: Le Fort 1 (LF1) osteotomies are widely used to correct midface deformities. To move the maxilla freely, the ptery-gomaxillary junction (PMJ) must be separated. When performing this osteotomy, the pterygoid plate must remain intact. The objective of this study was to evaluate relationship between the anatomical features of the PMJ and fracture patterns in LF1 osteotomy. METHODS: Pre-operative and post-operative cone-beam computed tomography images of 41 patients (82 samples) who have undergone LF1 osteotomy surgery were radiologically evaluated. Morphologic measurements of the pterygomaxillary fissure area and pterygoid plate were carried out. Moreover, pterygomaxillary separation was divided into the clean-cut, maxillary sinus, and pterygoid plate fracture types. RESULTS: Statistically significant difference was observed between clean-type fracture and pterygoid plate fracture groups' thickness of the pterygoid process and thickness of the pterygomaxillary region. CONCLUSION: Anatomical variations make it difficult to separate the PMJ properly. Low thickness of PMJ increases the risk of unwanted fractures; however, according to our experience, the use of an osteotome with an incorrect angle, excessive force, and inexperienced surgeons can also cause undesirable pterygoid plate fractures.

Comparison of standard miniplates and locked miniplates in post-traumatic fracture stabilization.

BACKGROUND: Bicortical screws (lag and positional) or miniplates with monocortical screws are generally used for the rigid fixa-tion of the sagittal split ramus osteotomy (SSRO) in maxillofacial surgery. However, in this osteosynthesis method, the plate must be perfectly adapted to the bone to prevent misalignment of the bone segment and occlusal changes. In addition, it is necessary to prevent the position of the condyle in the mandibular fossa from changing after fixation. In recent years, locked miniplate systems have been used to overcome these complications. METHODS: The aim of this study is to compare the commonly used 2.0 mm standard miniplate/screw systems and 2.0 mm locking miniplate/screw systems in fresh sheep jaws with Obwegeser-Dal Pont (OD) and Hunsuck-Epker (HE) modifications, by evaluating standard parameters. RESULTS: Our study consists of two main groups and two subgroups. 40 sheep hemimandibulae were randomly divided into two main groups. Each group was randomly divided into two subgroups. There are ten hemimandibulae (n=10) in each subgroup. Linear force test was applied using 4-hole standard miniplate and 4-hole locking miniplate systems on sheep jaws with 5 mm advancement by applying OD and HE techniques, which are two frequently preferred modifications in SSRO. For statistical analysis SPSS® 16.0 (Sta-tistical Package for the Social Sciences, SPSS Inc. Chicago, Illinois, USA) package program was used. It was statistically compared with the 95% confidence interval using the Pearson coefficient, and p<0.05 was interpreted as significant. The values of the loading forces applied to the samples in the groups were subjected to analysis of variance (ANOVA) to confirm the normality of the sample. Multiple comparisons were made between groups using the Tukey test. The mean loadings in the groups were analyzed by one-way ANOVA. CONCLUSION: In general, as the strength of the force increases, the displacement values increase in all groups, but although it was observed that the locked miniplate/screw system was more stable than the standard miniplate/screw system, no statistically significant difference was found.

Retrospective examination of complications observed in orthognathic surgical surgery in 85 patients.

BACKGROUND: The aim of our study is to examine the possible complications, risk factors, and solutions encountered in orthog-nathic surgery in the light of the cases; we performed in our clinic. METHODS: This study includes a retrospective analysis of the records of 85 patients who underwent orthognathic surgery between 2015 and 2020 in Istanbul Pendik District Hospital Oral and Maxillofacial Surgery Service. The types of complications encountered during the operations were recorded in the study. Independent variables such as gender, age, number of operations, surgical site, and type of osteotomy were evaluated. Complications were evaluated according to the Clavien-Dindo classification. The data were pre-sented for statistical analysis with a significance level of 0.05. RESULTS: Of the 85 patients included in the study, 40 were male and 45 were female. Of these patients, 65 had double chin operation and 20 had single chin operation. A total of 150 jaw osteotomies were performed, 78 of them in the maxilla and 72 in the mandible. While the maxilla was operated in 13 of the cases, in which single jaw operation was performed, only the mandible was treated in 7 of them. Complications were observed in 24 (10.57%) of a total of 227 osteotomies. Among the complications encountered, bleeding (8), nerve damage (7), malocclusion (3), infection (2), TMJ problems (2), bad split (1), and deviation at the tip of the nose (1) stand out, while complications were observed equally in men and women, complications were observed more frequently in cases with longer operative time (p<0.05). Complications were observed more frequently in bilateral sagittal split osteotomies (p<0.001) compared to Le Fort 1 osteotomies. Clavien-Dindo grade I complications were most common (72.04%) depending on the treatment. According to the Clavien-Dindo classification, there was no relationship between gender, age, duration of surgery, length of hospital stay, or surgical site, and the degree of complications (p≥0.05). CONCLUSION: Post-operative malocclusion, bleeding, inferior alveolar nerve injury, infection, poor division, and infection are the most common complications in orthognathic surgery. It can be associated with factors such as the duration of the operation, the number of operations, the site of the operation, and the type of osteotomy which performed. It is thought that positive contributions can be made to the success of the surgery by considering these factors in the treatment planning, during the operation and in the post-operative follow-up part.

Retrospective Analysis of Zygomatic Implants for Maxillary Prosthetic Rehabilitation.

PURPOSE: The aim of this study was to evaluate 141 zygomatic implants for the reconstruction of severely atrophic maxillae. MATERIALS AND METHODS: In this retrospective case series study, zygomatic implants were placed under general anesthesia. Inclusion criteria were as follows: ASA I or ASA II, age older than 18 years, inadequate bone for restoration with conventional implants, alternative augmentation procedures considered either inappropriate or contraindicated, absence of a medical condition related to implant failure, and providing written consent. Zygomatic implants used in the study consisted of three different brands: NobelZygoma, Southern Implants System, and Implantswiss. RESULTS: The study included 45 patients, in whom 141 zygomatic implants were placed. The mean age of the patients was 51.76 (range: 23 to 72) years. Three patients were rehabilitated with removable prostheses, 19 patients with fixed prostheses, and 23 patients with hybrid prostheses. The overall complication rate was 5.67% (two zygomatic implants developed infection [1.4%], one zygomatic implant developed peri-implantitis [0.7%], three zygomatic implants developed sinusitis [2.1%], and two zygomatic implants showed unsuccessful prosthetic rehabilitation [1.4%]). The follow-up period ranged from 6 to 36 months. CONCLUSION: Clinical complications of zygomatic implants are acceptable, and their survival rates are similar to those of endosteal implants. Zygomatic implants can contribute to prosthetic rehabilitation.

Genotoxicity of fixation devices analyzed by the frequencies of sister chromatid exchange.

BACKGROUND: Metal alloys utilized in the management of jaw fractures may exert genotoxic effects. Our purpose was to compare the genotoxicity of intermaxillary fixation devices containing nickel and chromium to that of titanium miniplates utilized in treatment of jaw fractures through the analysis of sister chromatid exchange. METHODS: In this prospective study, in a total of 28 non-smoker patients (10 females, 18 males; mean age 33.43±10.76; range 15 to 60 years) with jaw fractures, 14 were treated with intermaxillary fixation by administration of nickel-chromium wire and arch bar and 14 with titanium miniplates to investigate the genotoxicity of different metal alloys. The outcome variable was the frequency of sister chromatide exchange in peripheral lymphoctyes, determined through the analysis of venous blood samples obtained preoperatively and 4 to 6 weeks postoperatively. RESULTS: The frequency of the average sister chromatid exchange was found to be significantly higher in patients treated with the nickel-chromium intermaxillary fixation devices than those treated by titanium miniplates (1.29±0.29 vs. 0.46±0.39, p<0.001). CONCLUSION: Although titanium miniplate osteosynthesis is an invasive technique in comparison with the nickel-chromium-containing intermaxillary fixation devices, titanium seems to exert less genotoxic effect than the nickel-chromium alloy. However, this finding should be supported in clinical studies with a larger sampling size.

Orbital pain and headache secondary to overfilling of a root canal.

A 35-yr-old woman was referred to the Istanbul University, Faculty of Dentistry, Oral Surgery Department with complaints of orbital pain and headache. Panoramic radiographs showed overfilling of a maxillary premolar, which caused a perforation in the maxillary sinus floor. The etiology, clinical manifestations, and treatment of this complication are discussed with emphasis on early surgical intervention to decrease the risk of a superimposed aspergillosis infection.