Effect of high voltage electrical stimulation in temporomandibular disorders: a randomized controlled trial.

OBJECTIVE: To examine the effects of high voltage electrical stimulation (HVES) on pain intensity, maximum mouth opening (MMO), cervical mobility, head position, pressure pain thresholds (PPTs), bite force, joint sounds, and jaw muscle strength in individuals with temporomandibular disorders (TMDs). METHODS: Thirty-four individuals with TMDs were randomly divided into the exercise group (EG) (n = 17) and the HVES group (HG) (n = 17). For 4 weeks, EG received exercise therapy alone, while HG received HVES (12 sessions in total, 3 days a week to anterior temporalis and masseter) in conjunction with exercise. RESULTS: After the treatment, in both groups, pain intensity significantly decreased (p < .001); MMO (7.27 mm in HG and 3.61 mm in EG), cervical mobility, head position, PPTs, bite force, and jaw muscle strength significantly increased (p = .043 to < .001). Joint sounds significantly decreased in the HG (p = .008). Left bite force (p = .040) and left medial pterygoid PPT (p = .013) increased more in EG. The change in left bite force in EG over time was significant (p = .040; ηp2 = .126). The effect sizes of treatments were medium to large (from .527 to 1.602) for the evaluated parameters. CONCLUSION: Although exercise alone was effective in many parameters evaluated, additional application of HVES provided further improvement for pain, MMO, cervical mobility, PPTs, jaw muscle strength and joint sounds. HVES can be routinely used in clinics for individuals with TMDs.

Unusual radiographic images of radiopaque contrast media incidentally observed in intracranial region: two case reports.

The oil-based contrast medium has extremely slow clearance rate from cerebrospinal fluid. The medium known as myodil or pantopaque or iopenydylate was firstly introduced in 1944 to be used in myelography, cisternography and ventriculography. It was commonly used until 1980s but was later replaced by water-soluble mediums in 1990s because of its complication and sequelae. Although rare, images of the remnants may still be encountered on radiograms since its remnants may be seen after six decades. In this article, incidental radiopaque images in panoramic radiography and cone-beam computed tomography (CBCT) were presented in two patients whose myelography was taken before herniated discs' operation. Unusual incidental radiopacities in intracranial region were observed on panoramic radiography image of a male and CBCT image of a female, both of whom underwent myelography more than 30 years ago. Dentomaxillofacial radiologists should be aware of this radiographic appearance, should be able to differentiate it from possible pathologies.

Evaluation of keratocystic odontogenic tumors using cone beam computed tomography.

PURPOSE: The aim of this retrospective study is to determine the radiological features of keratocystic odontogenic tumors (KCOT) using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: CBCT images of 28 patients who had histopathologically-confirmed KCOT were retrospectively reviewed from the archives of the Department of Dentomaxillofacial Radiology, Gazi University Faculty of Dentistry. The location and size of KCOT, cortical expansion, cortical perforation, relation with the impacted teeth, and the impact on the mandibular canal were evaluated. RESULTS: The mean age of patients at initial diagnosis was 34.5 years. Patients with an impacted tooth were significantly younger than those without an impacted tooth (p<0.05). Among KCOTs, 21% were localized in the maxilla whereas 79% were found in the mandible. The lesions localized in the mandible were mostly found in the retromolar-ramus region. Of these patients, 93% had cortical expansion and 75% had bone perforation. Of the 22 mandibular lesions, 20 were in close proximity of the mandibular canal and 18 (90%) of these lesions had caused destruction in the mandibular canal. CONCLUSION: KCOTs exhibit their aggressive nature in the jaw bone. CBCT is a useful radiological imaging method to examine the radiologic characteristics of KCOTs such as bone destruction and their spatial relations with the neighboring anatomic structures.

The prevalence of antral exostoses in the maxillary sinuses, evaluated by cone-beam computed tomography.

BACKGROUND/PURPOSE: Exostoses are outgrowths of normal compact and cancellous bone and may occur in different locations of the jaw. Exostoses are a rare anatomic variation in the maxillary sinuses. The purpose of this study was to investigate retrospectively the prevalence of location, size, shape, and symmetry of exostoses in the maxillary sinus, and to assess the relationship between demographic variables (i.e., age and sex) via cone-beam computed tomography images. MATERIALS AND METHODS: Cone-beam computed tomography images of 1000 patients [521 (52.1%) females and 479 (47.9%) males], aged 10-85 years (mean age, 44 years), were examined. Two investigators examined the exostoses for location (i.e., inferior wall, medial wall, lateral wall, or posterior wall of the maxillary sinuses), size, shape (i.e., broad-based or mushroom-like), and symmetry (i.e., unilateral or bilateral). The age of the patients was categorized into three groups: 10-30 years, 31-50 years, and 51+ years. The data were statistically analyzed by using chi-square test, Fisher's exact test, and the t test. RESULTS: In total, 52 exostoses from 48 patients (4.8%) were identified. Exostoses were more common in females (n = 28, 58.3%) than in males (n = 20, 41.7%); however, there was no statistically significant difference between the sexes (P > 0.05). The presence of exostoses was very similar for all age groups with no statistically significant differences (P > 0.05). CONCLUSION: Most exostoses were unilateral and on the inferior wall of the maxillary sinus. No statistically significant difference existed between the frequency and location of exostoses for sex or age groups (P > 0.05).

Root and canal symmetry in the mandibular anterior teeth of patients attending a dental clinic: CBCT study.

The aims of this study were to evaluate the number of roots/root canals in the mandibular anterior teeth of a Turkish population, to assess the relationship between gender or age and the frequency of two canals in a single root, and to determine the symmetry in root/root canal numbers between contralateral sides among patients. Cone-beam computed tomography images (n = 1128; 6253 teeth) taken at the Department of Dentomaxillofacial Radiology of the Faculty of Dentistry of Gazi University were examined by three observers and a supervisor, all of whom were blinded to patient gender and age. Axial, sagittal, and cross-sectional slices with a thickness of 1 mm were used. Numbers of roots and canals for each type of tooth were recorded. Most teeth had a single root and single root canal. Roots with two canals were more frequent in the incisors (14.9%, 17.2%, and 6.1% of the central incisors, lateral incisors, and canines, respectively). Teeth with two roots were more frequent in the canines (3.1% vs. 0% or 0.1%). Females more often had canines with double root canals (p < 0.001). When at least one tooth had two root canals, bilateral symmetry between contralateral teeth was found in 45.0%, 29.0%, and 28.0% of cases for central incisors, lateral incisors, and canines, respectively. Patients older than 56 years had fewer teeth with double root canals (p ≤ 0.001). A small proportion of the mandibular anterior teeth had two roots or root canals. Double root canals were mostly unilateral. Age and gender were associated with the number of root canals.

Root and canal symmetry in the mandibular anterior teeth of patients attending a dental clinic: CBCT study

The aims of this study were to evaluate the number of roots/root canals in the mandibular anterior teeth of a Turkish population, to assess the relationship between gender or age and the frequency of two canals in a single root, and to determine the symmetry in root/root canal numbers between contralateral sides among patients. Cone-beam computed tomography images (n = 1128; 6253 teeth) taken at the Department of Dentomaxillofacial Radiology of the Faculty of Dentistry of Gazi University were examined by three observers and a supervisor, all of whom were blinded to patient gender and age. Axial, sagittal, and cross-sectional slices with a thickness of 1 mm were used. Numbers of roots and canals for each type of tooth were recorded. Most teeth had a single root and single root canal. Roots with two canals were more frequent in the incisors (14.9%, 17.2%, and 6.1% of the central incisors, lateral incisors, and canines, respectively). Teeth with two roots were more frequent in the canines (3.1%vs. 0% or 0.1%). Females more often had canines with double root canals (p < 0.001). When at least one tooth had two root canals, bilateral symmetry between contralateral teeth was found in 45.0%, 29.0%, and 28.0% of cases for central incisors, lateral incisors, and canines, respectively. Patients older than 56 years had fewer teeth with double root canals (p ≤ 0.001). A small proportion of the mandibular anterior teeth had two roots or root canals. Double root canals were mostly unilateral. Age and gender were associated with the number of root canals.

Assessment of endodontically treated teeth by using different radiographic methods: an ex vivo comparison between CBCT and other radiographic techniques.

PURPOSE: To compare different radiographic methods for assessing endodontically treated teeth. MATERIALS AND METHODS: Root canal treatments were applied in 120 extracted mandibular teeth, which were divided into four groups: (1) ideal root canal treatment (60 teeth), (2) insufficient lateral condensation (20 teeth), (3) root canals filled short of the apex (20 teeth), (4) overfilled root canal treatment (20 teeth). The teeth were imaged using intraoral film, panoramic film, digital intraoral systems (CCD and PSP), CCD obtained with portable X-ray source, digital panoramic, and CBCT images obtained at 0.3 mm(3) and 0.2 mm(3) voxel size. Images were evaluated separately by three observers, twice. Kappa coefficients were calculated. The percentage of correct readings obtained from each modality was calculated and compared using a t-test (p<0.05). RESULTS: The intra-observer kappa for each observer ranged between 0.327 and 0.849. The inter-observer kappa for each observer for both readings ranged between 0.312 and 0.749. For the ideal root canal treatment group, CBCT with 0.2 mm(3) voxel images revealed the best results. For insufficient lateral condensation, the best readings were found with periapical film followed by CCD and PSP. The assessment of teeth with root canals filled short of the apex showed the highest percentage of correct readings by CBCT and CCD. For the overfilled canal treatment group, PSP images and conventional periapical film radiographs had the best scores. CONCLUSION: CBCT was found to be successful in the assessment of teeth with ideal root canal treatment and teeth with canals filled short of the apex.

Use of the dynamic volume spline method to predict facial soft tissue changes associated with orthognathic surgery.

OBJECTIVE: The shape of the face can be estimated before the surgery by using 3-dimensional computer programs that provide tools to guide skill modifications. The aim of this study was to present the dynamic volume spline method to predict facial soft tissue changes after the modification of the skull associated with orthognathic surgery. STUDY DESIGN: Soft tissue volume is modeled by a dynamic volume spline that includes the elastic behavior of the actual tissue. The model is a hybrid of spring-mass model and finite element model, and combines their advantageous properties. It provides fast and realistic soft tissue simulations. Postsurgical shape of the patient's face is estimated by reshaping the skull and letting the soft tissue model relax over the new boundary conditions formed by the new skull shape. Postsurgical estimations were compared with the conventional method's estimations, where the soft tissue is not modeled biomechanically. Also, postsurgical estimations were compared with the actual postsurgical data for 6 orthognathic surgery patients. RESULTS: The mean of the error between the estimated shapes and the actual postsurgical shapes was ∼1.8 mm when the whole face was considered. CONCLUSION: When the facial soft tissue is modeled by the dynamic volume spline, the postsurgical shape is estimated better than by the conventional method and previous methods in the literature.

Unerupted mandibular third molars: symptoms, associated pathologies, and indications for removal in a Turkish population.

OBJECTIVES: To analyze the occurrence of symptoms of unerupted mandibular third molars, to investigate associated pathologies, and to determine indications for removal of unerupted mandibular third molars in a Turkish population. METHOD AND MATERIALS: A retrospective study was performed by reviewing 832 patients referred to Gulhane Military Medical Academy Dentistry Center for evaluation of their mandibular third molars. The patients were clinically examined, and unerupted and partially erupted mandibular third molars were determined from radiographs. The symptoms and pathologies associated with these teeth were analyzed. The indications for removal were classified into 10 groups. RESULTS: Two-thirds of the patients were between 20 and 29 years of age. Of the 832 unerupted mandibular third molars found, 557 (66.9%) teeth were partially erupted and 275 (33.1%) were completely unerupted. A total of 521 (62.6%) of all unerupted third molars had no symptoms, while 311 (37.4%) were associated with symptoms. The most frequent complaints of the patients were pain and swelling. Pericoronitis was observed as the most frequent pathology, in 142 patients. Of 832 unerupted mandibular third molars, 582 (69.9%) had complete root formation, 177 (21.2%) had two-thirds root formation, and 73 (8.9%) had one-third root formation. CONCLUSION: Patients between 20 and 29 years of age had the highest prevalence of unerupted mandibular third molars (69.3%). However, this figure decreased with increasing age. Partially erupted teeth (n = 228) caused the occurrence of symptoms more than completely erupted teeth (n = 83) in a Turkish population.

Intravascular papillary endothelial hyperplasia and osteoma: a case report of an individual with 2 different pathologies.

Intravascular papillary endothelial hyperplasia (IPEH) is an unusual, benign, non-neoplastic, vascular lesion characterized histologically by papillary fronds lined by proliferating endothelium. Osteoma is a benign osteogenic lesion characterized by proliferation of compact or cancellous bone. Osteoma of the maxillary sinus is an uncommon lesion. The purpose of this report is to present a case with 2 different lesions (intravascular papillary endothelial hyperplasia and osteoma) occurring at the same time in 1 patient that may or may not be related to each other and to stress the value of diagnostic imaging.

Dosimetric evaluation of the effect of dental implants in head and neck radiotherapy.

OBJECTIVE: The aim of the study was to examine the dose enhancement from scattered radiation at bone-dental implant interfaces during simulated head and neck radiotherapy. STUDY DESIGN: Four cylindrical titanium dental implants with 3 different sizes and lengths were implanted into a human mandible in 4 different positions. Ionization measurements for 6 MV X, 25 MV X, and Co-60 gamma rays were done. Thermoluminescent dosimeter (TLD 100 ) chips were used to measure radiation dose enhancement due to the scattered electrons from titanium and electronic disequilibrium at the tissue-metal interface. RESULTS: The results showed that for Co-60, there is a 21% maximum increase in dose to alveolar mandibular bone at the close proximity to the titanium. For 6-MV x-rays the dose enhancement increase was almost the same or slightly lower than for Co-60, while for 25-MV high-energy x-rays, dose enhancement was lower than that of others. This increase in dose enhancement fell off rapidly and became insignificant at 2 mm from the interface. CONCLUSION: Total dose that may lead to osteoradionecrosis risk of the mandible is slightly but not significantly affected by the scattered dose of the dental implants of lower jaw in the radiation field exposed to 3 different radiation beams.

Role of fine needle aspiration cytology in the preoperative presumptive diagnosis of ameloblastoma.

OBJECTIVE: To determine the role of fine needle aspiration cytology (FNAC) on the preoperative presumptive diagnosis of ameloblastoma. STUDY DESIGN: Sixty-three patients, diagnosed preoperatively and postoperatively with ameloblastoma, were evaluated between 1990 and 2003. The patients were classified according to whether they were diagnosed with ameloblastoma preoperatively or postoperatively, on histologic examination. RESULTS: The accuracy rate for ameloblastoma was 0.95% for all biopsy methods, while the incisional biopsy rate was 75.00%. Concerning clinical diagnosis, ameloblastoma was mistaken mostly (56.41%) for odontogenic cysts (22 of 39). CONCLUSION: FNAC should be utilized more commonly on intraosseous and soft tissue lesions in the oral and maxillofacial regions, to obtain sufficient material. It is convenient, inexpensive and noninvasive as compared with other biopsy methods.

The role of lipoid proteinosis in gingival hypertrophy.

Hyalinosis cutis et mucosae (lipoid proteinosis, Urbach-Wiethe disease) is a rare syndrome with autosomal recessive inheritance. The disease is characterized by diffuse deposition of a hyalinelike substance in the dermis, submucosal connective tissue, and various internal organs. In this study, the patient demonstrated classic signs and symptoms of lipoid proteinosis except for gingival infiltration. Gingival infiltration is still an unexplainable feature of this disease. In the context of this case, the diagnostic significance of the microscopic findings of the gingival tissues and the possible factors playing a role in gingival hypertrophy, are discussed.

The effects of articaine hydrochloride on wound healing: an experimental study.

PURPOSE: The aim of the study was to examine the effect of articaine hydrochloride (AH) on the healing of surgical wounds and to compare healing with that of lidocaine. MATERIALS AND METHODS: Forty rats were used in this study. The rats were randomly separated into 4 groups. Three groups were given 2% lidocaine, 4% AH, or injectable saline, and the fourth was a control group. Skin specimens underwent the breaking strength test (BST) and histologic examination at 1 week after the surgical procedure. The skin specimens of the rats were subjected to a pulling force of 10 mm/min across the incision line. The strength value at the moment of breaking in the tissue was expressed in Newtons. Histologic examination was performed as well, and wound healing was graded. RESULTS: Both the histologic grade and BST values in the lidocaine and AH groups were significantly lower than those of the control and saline groups (P <.01). Similarly, the histologic and BST values of the AH and lidocaine groups were statistically significant (P <.05, P <.001). Some necrotic regions were observed at the incision region in 2 samples from the AH group. CONCLUSION: The results of the study showed that AH is as safe a local anesthetic agent as lidocaine from the standpoint of wound response.