Is Horizontal Mattress Suturing More Effective Than Simple Interrupted Suturing on Postoperative Complications and Primary Wound Healing After Impacted Mandibular Third Molar Surgery?

The aim of this clinical study was to compare the influence of 2 different suturing techniques on postoperative complications and wound healing after surgical extractions of impacted mandibular third molars. In this randomized split mouth study, 30 patients were examined in whom 60 consecutive surgical extractions of symmetrically positioned impacted mandibular third molars were performed. After the extractions, the surgical flaps were sutured with either the simple interrupted or horizontal mattress suturing technique. Postoperative swelling and trismus were recorded on the 2nd, 7th, and 10th days. Pain was recorded in a 7-day diary and wound dehiscence was recorded on the10th postoperative day. Statistical evaluation of data was made using Mann-Whitney U test and Pearson correlation. There were no statistical differences between the 2 suturing techniques in terms of postoperative pain, trismus, and swelling (P > 0.05). There was significantly less wound dehiscence in the horizontal mattress suturing group than in the simple interrupted suturing group (P: 0017). According to the results of this study, the horizontal mattress suturing technique is more effective than the simple interrupted suturing technique on wound healing after impacted mandibular third molar surgery, although it does not decrease the levels of pain, trismus, and swelling.

Effects of Ankaferd BloodStopper on bone healing in an ovariectomized osteoporotic rat model.

Bone defects resulting from oncological surgical resections, congenital facial anomalies, trauma or infection represent a significant and common clinical problem. The present study aimed to evaluate the effects of a commercially-available medicinal plant extract product, Ankaferd BloodStopper (ABS), on bone healing. The present study was performed on 24 female ovariectomized (OVX) rats. A defect on each rat calvarium was created using a trephine burr prior to the rats being divided into two groups. Defects were grafted with a gelatin sponge soaked with normal saline (control group) or plant extract (experimental group). Half of the animals were sacrificed after 2 weeks and the others after 4 weeks. In the control group, the defects were not filled with regenerated bone. By contrast, in the experimental group, all defect areas had an increased amount of regenerated bone and connective tissue. Osteoblastic activity appeared to be greater in the experimental group however, osteoclastic activity was observed to be higher in the control group. At 2 and 4 weeks, there was a significant difference in the amount of newly regenerated bone observed in the experimental group compared with the control group (P<0.05). Therefore, the results of the present study indicated that local ABS application had a positive effect on bone healing in the OVX rat model.

Comparison of laser and ozone treatments on oral mucositis in an experimental model.

Oral mucositis (OM) induces severe pain and limits fundamental life behaviors such as eating, drinking, and talking for patients receiving chemotherapy or radiotherapy. In addition, through opportunistic microorganisms, OM frequently leads to systemic infection which then leads to prolonged hospitalization. Severe lesions often adversely affect curative effects in cancer cases. Therefore, the control of OM is important for oral health quality of life and prognosis. Low-level laser therapy (LLLT) and ozone may be useful to accelerate wound healing. In this study, 24 Sprague-Dawley rats were divided into three groups as control, ozone, and laser groups. All groups received 5-fluorouracil intraperitoneally and trauma to the mouth pouch with a needle. After the formation of OM in the mouth, the control group had no treatment; the ozone group was administered ozone, and the laser group, LLLT. Then, all groups were sacrificed and basic fibroblast growth factor (bFGF), transforming growth factor (TGF-ß), and platelet-derived growth factor (PDGF) were evaluated in all groups. LLLT was determined to be statistically significantly more effective than ozone on FGF and PDGF. However, in respect of TGF-ß, no statistically significant difference was observed between the groups. In conclusion, within the limitations of this study, LLLT is more effective than ozone. However, further studies on this subject are required.

How could multimedia information about dental implant surgery effects patients’ anxiety level?

BACKGROUND: To evaluate the effects of different patient education techniques on patients' anxiety levels before and after dental implant surgery. MATERIAL AND METHODS: Sixty patients were randomized into three groups; each contained 20 patients; [group 1, basic information given verbally, with details of operation and recovery; group 2 (study group), basic information given verbally with details of operative procedures and recovery, and by watching a movie on single implant surgery]; and a control group [basic information given verbally «but it was devoid of the details of the operative procedures and recovery»]. Anxiety levels were assessed using the Spielberger's State-Trait Anxiety Inventory (STAI) and Modified Dental Anxiety Scale (MDAS). Pain was assessed with a visual analog scale (VAS). RESULTS: The most significant changes were observed in the movie group (P < 0.05). Patients who were more anxious also used more analgesic medication. Linear regression analysis showed that female patients had higher levels of anxiety (P < 0.05). CONCLUSIONS: Preoperative multimedia information increases anxiety level

Effect of Energy Drink on Bone Formation in the Expanded Inter-Premaxillary Suture.

Maxillary expansion of the median palatal suture is a common procedure in orthodontics. Even after retention, there is a strong tendency to relapse in the expanded suture. The authors' objectives are to accelerate the bone formation process in the expanded suture and to reduce the required retention time by using an energy drink (ED). Twenty rats were divided into 2 groups (n = 20). The expansion-only group was defined as the control group (Group C). The other group was defined as the expansion-plus-energy drink group (Group ED). In Group ED, ED was administered systemically through oro-gastric tubes after the expansion period. After 5 days of expansion, the springs were removed and replaced with short lengths of rectangular retaining wire. Tooth separation was maintained for 12 days. Histomorphometric analysis showed significant differences between the 2 groups in terms of newly formed bone (P = 0.018) and the bone area (P = 0.007). For the parameters that were investigated, Group ED had better results than Group C. These results show that systemic administration of an ED during the early stages of the orthopedic expansion of the inter-maxillary suture areas can stimulate bone formation and decrease the time required for retention.

The Effects of Nigella Sativa Seed Extract on Bone Healing in an Experimental Model.

The purpose of this study was to histologically evaluate the effects on bone healing of nigella sativa seed extract applied on calvarial defects in an ovariectomized rat model. The study included 32 female rats weighing 280 to 310 g with an average age of 3 months. A defect was created with a trephine burr on each rat calvarium. The rats were divided into 2 groups (control and study) of 8 animals each. All the defects were grafted with a gelatin sponge mixed with normal saline. In the study group, nigella sativa seed extract was applied systemically using an oro-gastric tube. Half of the animals in each group were sacrificed after 2 weeks, and the others after 4 weeks. In the control groups, the defects were not completely filled with regenerated bone. Osteoblast cells were observed more in the study groups. A higher rate of osteoclasts was determined in the control groups. In addition, the nigella sativa group had a statistically greater amount of bone formation than the others group at both 2 weeks and 4 weeks (P <0.05). The systemic application of nigella sativa seed extract demonstrated incredibly positive effects on enhanced bone healing in this experimental osteoporotic model.

Risk Factors Associated With Implant Marginal Bone Loss: A Retrospective 6-Year Follow-Up Study.

PURPOSE: To analyze the presented evidence behind suggested reasons for long-term marginal bone loss (MBL) around 600 endosseous titanium dental implants according to the radiological findings up to 60 months. MATERIALS AND METHODS: The data of 151 patients are received from the prosthodontic department of a university clinic and analyzed for the effect of implant brand, location, implant diameter and length, implant occlusal table width, cantilever, and smoking on MBL in a 6-year period. RESULTS: MBL is significantly higher in Zimmer SwissPlus implant system. The bone loss in posterior region was higher than anterior region for maxilla. There was no significant difference in mandible. Kruskal-Wallis test showed that MBL was significantly higher when the crown/implant (C/I) ratio was 1.5/2 (P < 0.05). Occlusal table width/implant diameter (OT/I) ratio was analyzed and it showed that MBL was significantly higher when the ratio was 2.5 to 2.99 and higher than 3. There were no significant associations between smoking and nonsmoking groups. Mann-Whitney U test revealed that cantilever does not affect MBL. CONCLUSION: The marginal bone loss is affected by location of the implants (higher in the maxillary posterior region). In addition, excessive C/I and OT/I ratios increase marginal bone loss.

Comparison of Low-Level Laser Therapy versus Ozone Therapy in the Treatment of Oral Lichen Planus.

BACKGROUND: The treatment options for oral lichen planus (OLP) are numerous and include topical and systemic agents. Intralesional and systemic corticosteroids are used; however, the therapeutic results are often disappointing. OBJECTIVE: To compare the influence of ozone, laser, and topical corticosteroid therapies in the treatment of OLP. METHODS: One hundred twenty adult patients with ≤3 cm atrophic-erosive biopsy-proven OLPs in the tongue or buccal mucosa were recruited into the study. They were randomly assigned, by preoperative envelope drawing, to be treated with low-level laser therapy (LLLT group), ozone therapy (ozonated group), and topical corticosteroid therapy (positive control group). A placebo treatment containing base ointment without the active corticosteroid component was administered to patients in the negative control group. Response rate scores were determined on the basis of changes in the appearance score and pain score of the lesions between baseline and after each treatment. RESULTS: The study subjects consisted of 56 male and 64 female OLP patients with a combined mean age of 42.6±8.3 years (range, 28~55 years). No statistically significant difference was detected in clinical severity among the groups. The sign scores decreased in almost all scoring groups; however, statistically significant improvement was found in the ozonated and corticosteroid-treated groups. Symptom improvement was achieved after treatment with LLLT, ozone, and corticosteroid (p<0.05). The efficacy indices were significantly higher in the ozonated and corticosteroid-treated groups. CONCLUSION: Ozone and corticosteroid therapies were more effective than 808-nm LLLT in the treatment of OLP.

Effectiveness of two different splints to treat temporomandibular disorders.

Nearly 5% of the the world's population has temporomandibular disorder (TMD) severe enough to make them seek treatment. A third of the total population has at least one TMD symptom. There are different types of splints to treat TMD. In our study, we compared the success of two different appliances [stabilization splint (ss), nociceptive trigeminal inhibition splint (NTI)] by using Fonseca's questionnaire, the OHQoL-UK and visual analog scale (VAS). A total of 40 patients suffering from TMD were included in this study and answered questionnaires twice, at the beginning of the treatment and 3 months later. Regarding TMD alone, 39 patients (97.5%) had some degree of the disorder, 7 of of these cases being mild (17.5%), 15 moderate (37.5%), and 17 severe (42.5%). We analyzed posttreatment changes compared to baseline. Pain complaints decreased in both groups, and the OHQoL-UK revealed better quality of life after treatment. Based on the posttreatment Fonseca's questionnaires, significant changes in the patients' complaints in the group SS (p < 0.01) were observed. The group NTI also displayed changes but these were not statistically significant after treatment (p > 0.05). Patients in both groups had fewer TMD complaints after TMJ treatment. According to the Fonseca's questionnaire, the patients' major TMD complaint was clenching-grinding, followed by pain in the craniomandibular joint, or earache.

Recurrent cherubism in an adult patient.

Cherubism is an uncommon, nonneoplastic, fibro-osseous disorder of the jaws in childhood and adolescence. It affects the jaw bones by deforming the cortical shell. Clinical features include progressive painless and mostly bilateral expansion of the mandible and/or maxilla. Because fibrous connective tissue replaces osseous tissue, radiographic features generally include expansile osteolytic lesions and a ground-glass appearance. Several treatment protocols for cherubism have been recommended in the literature; however, despite surgical curettage treatment, recurrences may occur. Our aim was to emphasize the high recurrence rate of cherubic lesions. In this article, we present cherubism in a young girl that relapsed after 5 surgical operations before her appearance to our clinic.

Does watching a video on third molar surgery increase patients' anxiety level?

OBJECTIVE: To identify the effects of watching live taping of third molar removal on patients' anxiety levels before and after extraction. STUDY DESIGN: This study was based on a prospective, cross-sectional, observational investigation of the different patient education techniques about the effect of third molar removal on patients' anxiety level. A total of 333 patients were randomized into three groups: two study groups (for group 1, basic information was given verbally; for group 2, which was the study group, basic information was given verbally and through a movie on third molar extraction); and a control group (basic information was given verbally; it did not include information on operative procedures and recovery). Anxiety levels were assessed by using the Dental Anxiety Scale (DAS) and the Spielberger State-Trait Anxiety Inventory (STAI). Pain was assessed with a visual analog scale. Statistical analysis was performed with SPSS 16.0. RESULTS: Group 2 patients were significantly more anxious before the surgical procedure, and the most significant decreases in DAS and STAI scores were observed in that group. The age, surgery time, and education level were not correlated with anxiety or pain levels; however, female patients had high levels of anxiety (P < .05). CONCLUSION: Preoperative multimedia information increases the anxiety of patients undergoing third molar surgery.

Effects of caffeic acid phenethyl ester on wound healing in calvarial defects.

OBJECTIVE: The aim of this study is to analyze histologically the effect of CAPE on bone healing of Critical Size Defect (CSD) in rat calvaria. STUDY DESIGN: Thirty-two 3-month-old male rats were used. The animals were randomly divided into four groups. Group A received isotonic saline solution, Group B received CAPE (50 mmol/kg) locally, Group C received CAPE (100 mmol/kg) locally and Group D received CAPE (10 mmol/kg/day i.p. for 28 days) systematically. A 5-mm diameter calvarial defect was created in the right side of the parietal bone without damaging the underlying dura mater. Twenty-eight days after the surgery, all the animals were sacrificed. The original defect area was removed from the animal's calvarium bone en bloc. Beginning at the center of the surgical defect, serial sections of 6 µm thick were cut longitudinally. The sections were stained with hematoxylin and eosin for analysis under a light microscope. The sections were analyzed for the presence of inflammatory infiltrate, connective tissue formation and new bone formation. Computer-assisted histomorphometic measurements were carried out with an automated image analysis system. RESULTS: The total new bone areas were significantly greater in group D than in all groups and group C was statistically insignificant from the other groups (p < 0.05). Group B had a greater, but not statistically significant (p > 0.05), amount of total regenerated bone area than the control group. CONCLUSION: The results indicate that 100 mmol/kg topical and 10 mmol/kg/day systemic application of CAPE increases bone healing, especially with systemic application.

Effect of caffeic acid phenethyl ester on bone formation in the expanded inter-premaxillary suture.

BACKGROUND: Narrow maxilla is a common problem in orthodontics and dentofacial orthopedics. To solve this problem, a procedure called rapid maxillary expansion (RME) has been used. However, relapse tendency is a major problem of RME. Although relapse tendency is not clearly understood, various treatment procedures and new applications have been investigated. The present study aimed to investigate the possible effectiveness of caffeic acid phenethyl ester (CAPE) on new bone formation in rat midpalatal suture after RME. MATERIALS AND METHODS: Twenty male Sprague Dawley rats were used in this study. The animals were randomly divided into two groups as control and CAPE group. In the CAPE group, CAPE was administered systemically via intraperitoneal injection. RME procedure was performed on all animals. For this purpose, the springs were placed on the maxillary incisors of rats and activated for 5 days. After then, the springs were removed and replaced with short lengths of rectangular retaining wire for consolidation period of 15 days. At the end of the study, histomorphometric analysis was carried out to assess new bone formation. RESULTS: New bone formation was significantly greater in the CAPE group than the control group (P<0.05). CAPE enhances new bone formation in midpalatal suture after RME. CONCLUSION: These results show that CAPE may decrease the time needed for retention.

Effects of energy drinks on soft tissue healing.

The aim of the present study was to investigate the effects of an energy drink (ED) on soft tissue wound healing in the rat model. Thirty-six male Wistar albino rats were randomly divided into 2 groups. A full-thickness paravertebral linear incision wound model was created. The experimental group (EG) received an ED (Red Bull), and the control group (CG) received water. Red Bull (3.57 mL/kg/d) was administered to the rats by the oral gavage method on the day before the skin incision and continued for 14 days. The rats were sacrificed (n = 6 in each group) on the 3rd, 7th, and 14th day of the study. Sections were obtained from excised linear wound healing site and stained with hematoxylin-eosin and Masson trichrome for morphological analysis. To assess angiogenesis on the sections, immunohistochemical studies were carried out using vascular endothelial growth factor antibody and alpha smooth muscle actin Ab-1. The breaking strength of the wound healing site was measured in Newtons using a tensiometer. Morphological analysis showed that collagen deposition in the wound areas was statistically higher in the EG compared with that of the CG at both the third and seventh days (P < 0.05). Re-epithelialization on healing sites in the EG was statistically higher than in the CG on the seventh day (P < 0.05). The results of the immunohistochemical studies indicated that the numbers of new blood vessels in the wound healing sites of the EG were significantly higher at the 7th and 14th days when compared with the CG (P < 0.05). The breaking strength of the wound healing sites was also significantly higher on the 7th and 14th days in the EG (P < 0.05). The results demonstrate that ED accelerates soft tissue wound healing and that its effect may be due to increased collagen deposition, re-epithelialization, and new blood vessel formation in the wound.

Ectopic tooth in the maxillary sinus diagnosed with an ophthalmic complication.

Ectopic teeth erupt into regions other than the natural position or should be impacted in unusual location. Etiology of these teeth includes trauma, infection, and developmental diseases; however, in many cases, it is idiopathic. In addition, dentigerous cysts that are related with ectopic teeth may also affect adjacent anatomic regions. The occurrence of ophthalmic complications related with ectopic teeth is a rare situation. In this article, we aimed to present a patient who had a blurred vision thought that resulted from the dentigerous cyst associated with the ectopic third molar in the maxillary sinus roof.

Evaluation of the efficacy of mandibular conventional and implant prostheses in a group of Turkish patients: a quality of life study.

PURPOSE: The aim of this study was to compare the satisfaction and quality of life (QoL) in a group of patients using mandibular complete dentures, implant-retained overdentures, removable partial dentures (RPDs), or implant-supported fixed partial dentures (FPDs). MATERIALS AND METHODS: A total of 116 patients (aged 36 to 81, mean age 58 ± 10.03 years) were assigned to four groups (n = 29) and treated with mandibular implant-retained overdentures, implant-supported FPDs (two implants/three unit FPDs), conventional complete dentures, or RPDs. The groups were well matched in terms of gender, age, and the edentulous period. All patients had edentulous maxillary arches and completely or partially edentulous mandibles. All prostheses were mandibular prostheses. The OHIP-14, OHQoL-UK, and SF-36 surveys were used to determine QoL before implant surgery and 1 year after prosthetic treatment. RESULTS: The baseline and 1-year data from 116 patients were analyzed. A significant improvement was found among the QoL scales for all groups (p < 0.05). The most significant improvement was found in the implant-retained overdenture group (15.67 ± 2.47), while the least improvement was found among the implant-supported FPD group (5.14 ± 2.08). The SF-36 test revealed no differences between the before and after treatment scores for general health, pain, vitality, social function, and physical function difficulties (p > 0.05). The only significant difference was found for mental health (p = 0.011). CONCLUSION: A positive influence on oral health-related QoL was observed in all groups. The QoL values were the most improved in the implant-retained overdenture group.

Comparison of the influence of ozone and laser therapies on pain, swelling, and trismus following impacted third-molar surgery.

This study aims to evaluate the efficacy of the ozone and laser application in the management of pain, swelling, and trismus after third-molar surgery. Sixty consecutive patients with asymptomatic impacted mandibular third molars were recruited into the study. Patients were randomized into three treatment groups of 20 patients each: two study groups (group 1 = low-level laser therapy (LLLT), group 2 = ozone therapy) and a control group (no-LLLT or ozone therapy). Twenty teeth extractions were performed in each group. Evaluations of postoperative pain, the number of analgesics tablets taken, trismus, swelling, and quality of life (Oral Health Impact Profile-14 questionnaire) were made. The sample consisted of 28 female and 32 male patients, whose total mean age was 23.5 ± 3.4 (range, 18-25) years. The pain level and the number of analgesics tablets taken were lower in the ozonated and LLLT applied groups than in the control group. This study showed that ozone and low power laser therapies had a positive effect on the patients' quality of life. Trismus in the LLLT group was significantly less than in the ozonated and control groups (p = 0.033). Ozone application showed no superiority in regards of postoperative swelling; however, LLLT group had significantly lower postoperative swelling. This study demonstrates that ozone and laser therapies are useful for the reduction of postoperative pain and they increase quality of life after third-molar surgery. Although the ozone therapy had no effect on postoperative swelling and trismus after surgical removal of impacted lower third molars, LLLT had a positive effect.

Effects of laser and ozone therapies on bone healing in the calvarial defects.

This study aims to analyze the effect of the low-level laser therapy (LLLT) and ozone therapy on the bone healing of critical size defect (CSD) in rat calvaria. A total of 30 Wistar male rats were used. A 5-mm-diameter trephine bur was used to create CSD on the right side of the parietal bone of each rat calvarium. Once the bone was excised, a synthetic biphasic calcium phosphate graft material was implanted to all the bone defect sites. The animals were randomly divided into 3 groups as follows: the control group (n = 10), which received no LLLT or ozone therapy; the LLLT group (n = 10), which received only LLLT (120 seconds, 3 times a week for 2 weeks); and the ozone therapy group (n = 10) (120 seconds, 3 times a week for 2 weeks). After 1 month, all the rats were killed, and the sections were examined to evaluate the presence of inflammatory infiltrate, connective tissue, and new bone formation areas. Histomorphometric analyses showed that in the LLLT and ozone groups, the new bone areas were significantly higher than in the control group (P < 0.05). In the LLLT group, higher new bone areas were found than in the ozone group (P < 0.05). This study demonstrated that both ozone and laser therapies had a positive effect on bone formation in rat calvarial defect, compared with the control group; however, ozone therapy was more effective than LLLT (808 nm; 0.1 W; 4 J/cm(2); 0.028 cm(2), continuous wave mode).

An unforeseen complication arising from inferior alveolar nerve block: is anemia possible?

Complications after administration of local anesthesia for dental procedures are well recognized. We present here 2 cases of patients with anemic areas on their faces resulting from inferior alveolar nerve block (IANB). The precise cause of this complication is unknown; however, it may be derived from anastomosis of the maxillary artery, rapid injection of local anesthetic solution, misdirection of the needle, and spread of the solution to the upper region of the mandible. Although neurologic occurrences resulting from IANB are rare, dentists should keep in mind that certain dental procedures such as administering IANB could cause anemic areas on the face. Henceforth, dentists should consider the possibility of anemia after administration of IANB and pay attention to avoid complications during the procedure.

Comparison of a novel trephine drill with conventional rotary instruments for maxillary sinus floor elevation.

PURPOSE: The purpose of this study was to compare a newly designed trephine drill (SLA KIT, Neobiotech) with conventional rotary instruments for maxillary sinus floor elevation based on operative time, postoperative pain, and perforation rates. MATERIALS AND METHODS: Twenty-five patients were treated with a bilateral sinus floor elevation procedure with rotary trephine and conventional instruments. One side was treated with conventional rotary instruments, while the contralateral side was treated with rotary trephine instruments, with a 2-week gap between surgeries. Operative time was measured with a chronometer in seconds as the time from soft tissue incision to primary closure of the incision with the last suture. Pain was scored on a 10-point visual analog scale at 24 hours after surgery. The presence of tears and perforations was determined by direct visualization and the Valsalva maneuver. RESULTS: Twenty-five patients were included in the study. Operative time was shorter when the trephine drill was used (11.1 ± 2.4 minutes) than with conventional rotary instruments (15.1 ± 2.9 minutes). Sinus membrane perforation was observed in eight patients when conventional rotary instruments were used, while the trephine drill resulted in two sinus perforations. Mean pain scores were 2.01 ± 0.11 after using the trephine drill and 2.25 ± 0.76 when conventional rotary instruments were used. No significant difference was found in postoperative pain scores. CONCLUSION: The trephine drill technique may result in decreased perforation rates and operative time.