Investigation of Absorbable and Non-Absorbable Multifilament Suture Materials in Terms of Strength Changes Using Chlorhexidine Mouthwash and Thermal Cycling: An In Vitro Study.

Sutures are natural or synthetic biomaterials utilized to hold tissues together. Following oral surgery, the surgical site and sutures are physically affected by many different factors. This study was conducted to evaluate the effect of artificial saliva (AS) and chlorhexidine mouthwash on the tensile strength of absorbable multifilament PGLA (polyglycolide-co-l-lactide) and non-absorbable multifilament silk sutures. PGLA and silk sutures, which are commonly used in oral surgery, were used to evaluate the change in strength of the sutures. A total of 352 suture samples were divided into eight equal groups (n = 44) and used for the experiments. Tensile strength was tested on days 0, 3, 7, and 14. For the silk sutures, there was a significant decrease in tensile strength in all groups at time T3 compared to T0, T1, and T2, and at times T1 and T2 compared to T0. For PGLA sutures, there was a significant decrease in all groups at time T3 compared to T0, T1, and T2. This study shows that chlorhexidine mouthwash significantly reduces suture resistance for 14 days after surgery.

Using Cone Beam Computed Tomography For Appropriate Nostril Selection in Nasotracheal Intubation.

OBJECTIVES: Nasotracheal intubation is a standard blind procedure associated with various complications. The selection of the appropriate nostril is crucial to preventing most of these complications. The present study aimed to evaluate the predictive ability of CBCT images to select the correct nostril for nasotracheal intubation. METHODS: The study encompassed 60 patients who underwent maxillofacial surgery with nasotracheal intubation under general anesthesia. While the anesthetist made the appropriate nostril selection clinically according to a simple occlusion test and spatula test, the radiologist made the selection after analyzing various CBCT findings such as the angle and direction of nasal septum deviation (NSD), minimum bone distance along the intubation path, and the presence of inferior turbinate hypertrophy. The appropriateness of these choices made blindly at different times was evaluated using descriptive statistics, chi-squared test, and independent samples t-test. RESULTS: The study found that 83.3% of the suggested nostril intubations were successful. We also observed that intubation duration was longer when inferior turbinate hypertrophy was present (p = 0.031). However, there was no statistical relationship between the presence of epistaxis and septal deviation (p = 0.395). Nonetheless, in 64.3% of cases with epistaxis, the intubated nostril and the septum deviation direction were the same. CONCLUSIONS: Pre-operative evaluations using CBCT can aid anesthetists for septum deviation and turbinate hypertrophy, as both can impact intubation success rates and duration.

Evaluation of the Relationship between Impacted Maxillary Canine Teeth and Root Resorption in Adjacent Teeth: A Cross-Sectional Cone Beam Computed Tomography Study.

BACKGROUND: This study aims to determine the position of impacted maxillary canines on cone beam computed tomography (CBCT) images, to determine the presence of resorption in adjacent teeth, and to investigate the position and type of resorption of impacted canines if resorption is present. METHODS: Patients over 14 years of age with maxillary canine teeth who had CBCT images taken for any dental reason were included in the study. Resorption of teeth adjacent to maxillary canines was analyzed according to transversal, vertical, and buccopalatinal positions on the CBCT. The study evaluated 162 maxillary canine teeth on tomography images of 134 patients. RESULTS: Of the affected adjacent teeth, 32.1% of the central incisor, 58.0% of the lateral incisor, and 19.1% of the first premolars showed mild-to-severe resorption. The relationships between transversal position and resorption in the central and lateral incisor, vertical position and resorption in the central incisor and buccopalatinal position and resorption in the first premolars were found to be significant. Maxillary canine teeth can cause mild-to-severe resorption of adjacent teeth, especially lateral incisors. CONCLUSION: For this reason, we think that a detailed examination with CBCT is essential in the early diagnosis of resorption of adjacent teeth.

Risk Assessment of Nasal Cavity Perforation in the Maxilla: A Virtual Implant Placement Study Using Cone Beam Computed Tomography.

Implant surgery in individuals with atrophic maxilla presents challenges, particularly concerning nasal cavity complications such as perforations, implant migration, and airway obstruction. While panoramic radiographs offer diagnostic convenience, their two-dimensional nature limits the evaluation of anatomical structures. Cone beam computed tomography (CBCT) provides a three-dimensional assessment, enhancing surgical planning accuracy and potentially reducing complications. With the aim of understanding the measurement differences between panoramic radiographs and CBCT images, this retrospective study examined CBCT images of patients with severely atrophic maxilla taken between September 2021 and December 2023 at the Ahmet Kelesoglu Faculty of Dentistry. Virtual implants were placed in various tooth regions using OnDemand3D software. The incidence of nasal cavity perforations and vertical bone height differences between panoramic radiographs and CBCT images were evaluated. For this purpose, vertical bone length measurements in panoramic and CBCT images were compared for the virtual implant placement areas. Statistical analyses, including t-tests and ANOVA, were performed to determine significant differences among quantitative measurements, and a chi square test with Bonferroni corrected z-tests were used for possible associations between ratios. CBCT data from 59 patients, totaling 1888 virtual implants, revealed significant differences in implant depths among tooth regions (F = 9.880, p < 0.001). Canine regions showed higher perforation risks, especially with 12 mm and 14 mm implants. Panoramic radiographs often overestimated vertical bone height in canine and first premolar regions compared to CBCT measurements, which could lead to increased perforation risks. Radiographic evaluations using CBCT prior to implant surgery in atrophic maxilla cases are crucial to prevent nasal cavity complications. Panoramic radiographs may inadequately represent three-dimensional anatomy, underscoring the importance of CBCT for accurate implant placement and surgical planning. Further studies should consider varying implant sizes and brands to generalize findings.

Evaluation of Tensile Strength of Surgically Absorbable Suture Materials Used in Oral Surgery after Immersion in Different Beverages: An In Vitro Study.

Suture materials are natural or synthetic biomaterials used to close tissues together. After surgical procedures in the mouth, the surgical site and the sutures are physically affected by many different factors. This study was conducted to evaluate the effects of frequently consumed beverages on the tensile strength of monofilament PGLA (polyglycolide-co-l-lactide) and multi-filament PGCL (polyglycolide-co-caprolactone) absorbable sutures. In particular, PGLA and PGCL absorbable sutures, which are frequently used in oral surgery, were used to evaluate the change in the strength of suture materials. The suture materials were soaked in tea, coffee, and cola drinks five times a day for 5 min each and the rest of the time in artificial saliva. All suture materials were aged via thermal cycling. Tensile strengths were tested at 0, 3, 7, and 14 days. Mixed ANOVA (four replicates: within-group comparison and two factors: between-group comparison) was performed to evaluate the effects of groups and time on the tension levels of the Tekmon and Vicryl suture materials. Analysis of Variance was used for the within- and between-group comparisons, with the Bonferroni corrected t-test for multiple comparisons. For the PGCL suture material, there were significant decreases in tension levels in artificial saliva, tea, coffee, and cola at time T3 compared to T0, T1, and T2, and at T1 and T2 compared to T0. For the PGLA suture material, there were significant decreases in tension levels in artificial saliva, tea, coffee, and cola at time T3 compared to T0, T1, and T2. There was also a significant decrease in tension level at time T2 in cola compared to T0. The present study demonstrates that beverages significantly decrease the strength of suture materials for 14 days after surgery. In particular, cola decreased the resistance of the PGCL suture material more significantly in the first week when compared to other beverages.

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.

Comparison of perineural and systemic dexamethasone use in impacted third molar surgeries in terms of anesthesia duration and postoperative complaints: a controlled, randomized observational study.

BACKGROUND: Surgical extraction of impacted third molars (ITM) often leads to postoperative discomfort including pain, swelling, and limited function. Steroids like dexamethasone (DXN) are commonly used in oral surgery to manage pain and inflammation. Various administration routes for DXN exist, including intravenous (IV), perineural (PN), and oral applications, each with its advantages. Previous studies have shown that adding DXN to local anesthetics can prolong anesthesia duration and reduce postoperative sequelae. However, comparative studies on IV and PN applications with inferior alveolar nerve block (IANB) of DXN in ITM surgeries are limited. METHODS: This controlled, randomized observational study involved patients undergoing Class II position B ITM extraction. Patients were divided into three groups. IANB (1.8 ml of articaine hydrochloride + 1 ml of saline) was performed 1 h after IV-DXN (4 mg/ml DXN) was administered to the IV group. DXN along with IANB (1.8 ml of articaine hydrochloride + 1 ml of 4 mg/ml DXN) was applied to the PN group. Only IANB (1.8 ml of articaine hydrochloride + 1 ml of saline) was applied to the control group. Anesthesia duration was assessed as primary outcomes. Anesthesia duration was evaluated using a vitalometer from the molars. Secondary outcomes included postoperative pain and edema measured on the 1st, 3rd, and 7th days after surgery. Pain was evaluated postoperatively by using a visual analog scale. A p-value < 0.05 was considered statistically significant. RESULTS: The study included 45 patients with similar demographic characteristics across groups. IV application significantly prolonged anesthesia duration compared to the control group. (p = 0.049) Both IV and PN administration of DXN reduced postoperative edema at 3rd (p = 0.048) and 7th day (p = 0.01). Post-procedure pain reduction was significant in the IV group (p = 0.011). On the other hand, it was observed that the pain did not decrease in the PN group at 3rd and 7th days compared to the control and IV groups. CONCLUSIONS: PN and IV DXN administration prolonged anesthesia duration and reduced postoperative edema in ITM surgeries. However, PN DXN administration was associated with increased postoperative pain compared to IV DXN and control groups. Further studies comparing different doses and administration routes of DXN are needed to determine optimal strategies for managing postoperative discomfort in ITM surgeries. TRIAL REGISTRATION: This study was conducted at Ahmet Kelesoglu Faculty of Dentistry with the permission of Karamanoglu Mehmetbey University Faculty of Medicine Ethics Committee (#04-2022/101). Trial registration is also available at clinicaltrail.gov. (NCT06318013, 26/05/2024).

Effectiveness of wearing glasses with green lenses on dental anxiety for third-molar surgery: A randomized clinical trial.

BACKGROUND: Dental anxiety is a common problem for oral surgeries. This study investigated the effectiveness of wearing glasses with green lenses in reducing dental anxiety, blood pressure, heart rate, and intraoperative pain in patients undergoing first-time third-molar surgery. METHODS: The authors planned this study as a randomized and parallel-group clinical trial. Patients' dental anxiety was measured with the use of a visual analog scale and a State-Trait Anxiety Inventory for baseline measurement purposes. At the same time, blood pressure, oxygen saturation, and heart rate values were recorded. Patients were given glasses with clear or green lenses, depending on their group. After 10 minutes, all parameters were measured again for preoperative measurement. Patients wore glasses with either green or clear lenses throughout the operation. After the operation, patients were asked to estimate the degree of intraoperative pain using the visual analog scale. RESULTS: The study included 128 patients. On the basis of the change between baseline and preoperative measurements, the authors found a statistically significant difference in anxiety and heart rate. Intraoperative pain showed a significant difference between groups. No significant changes were found in blood pressure and oxygen saturation. CONCLUSIONS: Patients with anxiety could wear low-cost, easy-to-use glasses with green lenses for 10 minutes before an operation to reduce anxiety and heart rate. In addition, wearing glasses during the surgical procedure can reduce intraoperative pain. PRACTICAL IMPLICATIONS: By means of using glasses with green lenses throughout the procedure, existing anxiety and pain can be reduced. An operation can be performed more comfortably for both the patient and the dentist. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT05584696.

Effectiveness of conventional syringe irrigation, vibringe, and passive ultrasonic irrigation performed with different irrigation regimes in removing triple antibiotic paste from simulated root canal irregularities.

BACKGROUND: This study evaluated the efficacy of a sonic device (Vibringe), passive ultrasonic irrigation (PUI), and conventional syringe irrigation (CSI) in the removal of triple antibiotic paste (TAP) from artificial standardized grooves in the apical and coronal thirds of a root canal. MATERIALS AND METHODS: One-hundred eighteen root canals were prepared using the ProTaper system. The roots were split longitudinally, and a standardized groove was prepared in the apical and coronal parts of one segment. The grooves were filled with TAP, and the roots were reassembled. The roots were randomly divided into nine experimental groups and two control groups, according to the following irrigation methods: (1) CSI with sodium hypochlorite (NaOCl) + ethylenediaminetetraacetic acid (EDTA), (2) CSI/EDTA, (3) CSI/NaOCl, (4) PUI/NaOCl + EDTA, (5) PUI/EDTA, (6) PUI/NaOCl, (7) Vibringe/NaOCl + EDTA, (8) Vibringe/EDTA, and (9) Vibringe/NaOCl. The amount of remaining medicament was evaluated under a stereomicroscope. RESULTS: In the apical third, Vibringe/NaOCl + EDTA and PUI/NaOCl + EDTA were superior to the other groups (P < 0.05); there was no significant difference between the other experimental groups (P > 0.05). In the coronal third, there was no significant difference between the experimental groups (P > 0.05). CONCLUSIONS: The use of the NaOCl/EDTA combination together with sonic or ultrasonic agitation improved the removal of TAP from the apical third.

In Vitro Comparison of Cyclic Fatigue Resistance of ProTaper Next, HyFlex CM, OneShape, and ProTaper Universal Instruments in a Canal with a Double Curvature.

INTRODUCTION: The aim of this study was to compare the resistance to cyclic fatigue of ProTaper Next X2 (PTN X2; size 25, 0.06 taper), Hyflex CM (HCM; size 25, 0.06 taper), OneShape (OS; size 25, 0.06 taper), and ProTaper Universal F2 (PTU F2; size 25, 0.08 taper) nickel-titanium files in an artificial root canal with a double (S-shaped) curvature. METHODS: A total of 160 new PTN X2, OS, HCM, and PTU F2 files were tested in an artificial stainless steel canal with a double curvature. Forty files from each system were rotated until fracture to calculate the number of cycles to failure. The length of each fractured fragment was recorded. Data were analyzed by using one-way analysis of variance and Tukey post hoc tests. RESULTS: The resistance to cyclic fatigue of the PTN X2 and HCM instruments was significantly greater than the OS and PTU F2 instruments in the apical curvature (P < .05). There was no statistical difference in the cyclic fatigue resistance of the PTN X2 and HCM instruments in the apical curvature (P > .05). In addition, there was no statistical difference between the OS and PTU F2 instruments in the apical curvature (P > .05). PTN X2, OS, HCM, and PTU F2 instruments showed similar cyclic fatigue resistance values in the coronal curvature (P > .05). CONCLUSIONS: This study showed that PTN X2 and HCM instruments exhibit greater resistance to cyclic fatigue than OS and PTU F2 instruments in the apical curvature of an artificial canal with a double curvature.

Cyclic fatigue resistance of D-RaCe, ProTaper, and Mtwo nickel-titanium retreatment instruments after immersion in sodium hypochlorite.

OBJECTIVES: The aim of this study was to investigate the effect of immersion in sodium hypochlorite (NaOCl) on cyclic fatigue resistance of three different rotary nickel-titanium (NiTi) retreatment files. MATERIAL AND METHODS: A total of 90 new ProTaper, D-RaCe, and Mtwo retreatment files were tested. Thirty files of the same brand were randomly assigned to two groups (n = 15). Group 1 was no immersion (control group) and 16 mm of group 2 instruments were immersed in 5 % NaOCl at 37 °C for 5 min. All instruments were then tested for cyclic fatigue. Resistance to cyclic fatigue was determined by counting the numbers of cycles to failure in a 60° curve with a 5-mm radius, recording the time in seconds to fracture. Data were analyzed by two-way analysis of variance. RESULTS: Resistance to cyclic fatigue decreased significantly for D-RaCe retreatment files after immersion in NaOCl. ProTaper and Mtwo retreatment files were not affected from immersion to NaOCl. D-RaCe retreatment instruments showed better cyclic fatigue resistance than ProTaper and Mtwo retreatment instruments, and the difference was statistically significant (p < 0.05). There was no significant difference between ProTaper and Mtwo retreatment instrument groups (p > 0.05). CONCLUSIONS: D-RaCe retreatment instruments had the highest cyclic fatigue resistance among retreatment files tested in this study, but immersion to NaOCl decreased the cyclic fatigue resistance of D-RaCe retreatment instrument. CLINICAL RELEVANCE: It should be considered that cyclic fatigue resistance of D-RaCe can decrease in contact with NaOCl during the removal of canal filling material.

Effectiveness of different irrigation procedures for removal of dentin debris from a simulated internal resorption cavity.

PURPOSE: The aim of this study was to compare the efficiency of different final irrigation techniques to remove artificially placed dentinal debris from a simulated internal root resorption (IRR) cavity. METHODS: Seventy teeth were prepared using the ProTaper system. The roots were then split longitudinally into two halves, in each of which standardized IRR cavities were prepared. Five teeth were set aside to serve as negative control group. Each cavity of the remaining 65 teeth was filled with dentin debris mixed with 2.5% NaOCl. Another 5 teeth (positive control) were not subjected to the debris removal procedure. Sixty teeth were randomly divided into four experimental groups (n = 15), according to the final irrigation technique used: conventional syringe irrigation (CSI), the Self-Adjusting File (SAF), passive ultrasonic irrigation (PUI), and the EndoActivator (EA). Ten milliliters of 2.5% NaOCl was used during the debris removal procedure. The root halves were disassembled, and the amount of remaining debris was evaluated under a stereomicroscope at 30× magnification. RESULTS: SAF and PUI removed debris significantly better than CSI and EA (P<.05). CSI was the least effective in debris removal (p<0.05). CONCLUSIONS: None of the irrigation techniques used was able to completely remove debris from simulated IRR cavities.

Evaluation of debris extruded apically during the removal of root canal filling material using ProTaper, D-RaCe, and R-Endo rotary nickel-titanium retreatment instruments and hand files.

INTRODUCTION: The aim of this study was to evaluate the amount of debris extruded apically during the removal of root canal filling material using ProTaper (Dentsply Maillefer, Ballaigues, Switzerland), D-RaCe (FKG Dentaire, La Chaux-de-Fonds, Switzerland), and R-Endo (Micro-Mega, Besançon, France) nickel-titanium (NiTi) rotary retreatment instruments and hand files. METHODS: Sixty extracted single-rooted mandibular premolar teeth were prepared with K-files and filled with gutta-percha and AH Plus sealer (Dentsply DeTrey, Konstanz, Germany). The teeth were then randomly assigned to 4 groups (n = 15 for each group) for retreatment. The removal of canal filling material was performed as follows: hand files, ProTaper, D-RaCe, and R-Endo retreatment instruments. Debris extruded apically during the removal of canal filling material was collected into preweighed Eppendorf tubes. The tubes were then stored in an incubator at 70°C for 5 days. The weight of the dry extruded debris was established by subtracting the preretreatment and postretreatment weight of the Eppendorf tubes for each group. The data obtained were analyzed using 1-way analysis of variance and Tukey post hoc tests. RESULTS: All retreatment techniques caused the apical extrusion of debris. Hand files produced significantly more debris when compared with ProTaper, D-RaCe, and R-Endo rotary systems (P < .05). There was no statistical difference between the ProTaper, D-RaCe, and R-Endo retreatment systems (P > .05). CONCLUSIONS: The findings showed that during the removal of root canal filling material, rotary NiTi retreatment instruments used in this study caused less apical extrusion of debris compared with hand files.