Assessment of the soft tissue volumetric changes following acellular dermal matrix grafts with cone beam computerized tomography.

OBJECTIVE: The aim of this study was to use cone beam computerized tomography (CBCT), which consistently allowed the determination of the dimensions of the soft tissue, to evaluate acellular dermal matrix grafts (ADMG) used to increase gingival soft tissue thickness (GSTT). METHOD AND MATERIALS: In total, 90 gingival defects were included in the study. Surgical procedures were performed to augment the gingival tissue with ADMG. While GSTT measurements were assessed at baseline and 6, 12, and 18 months post-surgery, ADMG measurements were performed with CBCT at 6, 12, and 18 months post-surgery. RESULTS: All parameters showed statistically significant differences between time intervals. In the ADMG-treated sites, the baseline GSTT was 1.00 ± 0.37 mm and the final thickness was 1.66 ± 0.34 mm. The 6-month measurement of ADMG was 0.79 ± 0.08 mm, and the final measurement was 0.11 ± 0.09 mm. CONCLUSION: High-quality images of the GSTT and ADMG can be consistently obtained with CBCT. The present findings indicate that soft tissue augmentation can be achieved in gingival defects with the use of ADMG.

Outcomes of periradicular surgery of maxillary first molars using a vestibular approach: a prospective, clinical study with one year of follow-up.

PURPOSE: The aim of the present prospective, randomized, controlled, clinical study was to compare the outcomes of periradicular surgery of the maxillary first molar tooth using the vestibular approach between 2 preoperative radiologic evaluation methods: cone beam computed tomography (CBCT) and conventional radiography. PATIENTS AND METHODS: Periradicular surgery was applied to the maxillary first molar tooth in 40 patients. The patients were divided into 2 groups. The patients in group 1 underwent examination and preoperative planning with CBCT, and the patients in group 2 underwent examination and preoperative planning with conventional radiography. The outcomes of the treatment were evaluated radiographically and clinically, and the data were analyzed statistically. RESULTS: The mean operative time was significantly shorter in group 1 than in group 2. According to the radiographic and clinical healing criteria used in the present study, the healing of patients in group 1 was rated as a success in 35%, an improvement in 40%, and a failure in 25%. In the group 2 patients, healing was rated as a success in 42.1%, an improvement in 31.6%, and a failure in 26.3%. Sinus membrane elevation was performed in 92.3% of all patients. Sinus membrane perforation occurred in 20% of the patients in group 1 and 36.8% of the patients in group 2. CONCLUSIONS: Periradicular surgery of maxillary first molars using a vestibular approach is a viable treatment method with a low complication rate. Preoperative CBCT examination demonstrated positive contributions to the treatment outcomes.

Cone-beam computed tomographic evaluation of styloid process: a retrospective study of 208 patients with orofacial pain.

INTRODUCTION: The purpose of this study was to assess the structural characteristics of styloid process (SP) by cone-beam computed tomography (CBCT) examination in a patient population suffering from orofacial pain. The second aim was to assess the prevalence of elongated SP and its relation to gender, site and subjective symptoms in the study population. METHODS: Clinical and radiographic records of 208 patients were evaluated retrospectively. Radiological examinations including measurements of the structure, length, and medial angulations of SP were performed on CBCT images. RESULTS: Out of 208 patients, 96 (46%) had not-elongated SP, 28 (13%) had left side, 16 (8%) had right side, and 68 (33%) had bilateral elongation of SP. The patients with elongated SP had significantly decreased angle values. There were no statistically significant differences in length values of SP between males and females in both groups. Significantly increased prevalence of symptoms except headache was observed in patients with elongated SP. CONCLUSIONS: This study presents the CBCT as an alternative method to CT or panoramic radiographs for the measurement and the assessment of the styloid process. Patients suffering from orofacial pain, who also had elongated SP, had increased rate of corresponding neurological complaints compared with non-elongated ones.

Compound odontoma involving the four quadrants of the jaws: a case report and review of the literature.

Odontomas are the most common odontogenic tumors, representing 70% of all odontogenic tumors. They may present in two specific forms; compound odontoma forms multiple small tooth-like structures, while complex odontoma forms an amorphous calcified mass. In this report, we present a 27-year-old male patient with multiple compound odontoma occupied regions at his jaws. The odontomas involve both alveolar and basal processes of the maxilla and mandible as well as both maxillary sinuses. Converse to conventional recommended treatment, which is surgical excision of the lesion, the management was removal of the lesion and clinical-radiologic followup. The first year's follow-up findings are presented in this case report.

Evaluation of relationship between preoperative bone density values derived from cone beam computed tomography and implant stability parameters: a clinical study.

OBJECTIVES: The aim of this study was to explore the efficacy of bone density value derived from cone beam computed tomography (CBCT) by evaluating its correlation with implant stability parameters including insertion torque value (ITV) and radiofrequency analysis in relation to different clinical variables including location, gender, age, bone quality, and implant diameter. MATERIAL AND METHODS: A total of 65 implants were placed in 17 patients. The bone densities of implant recipient sites were preoperatively recorded using CBCT. Bone quality was subjectively assessed, which depends on the stiffness of the jawbone according to the Lekholm and Zarb index during drilling procedure. The maximum ITV of each implant was recorded using a digital torque meter during implant placement. Resonance frequency measurements were taken using an Osstell Mentor immediately after implant placement. Data were analyzed statistically. RESULTS: The mean bone density, insertion torque, and implant stability quotient values of all implants were 556 ± 80, 37.4 ± 3.3 Ncm, and 73.8 ± 7.2, respectively. Statistically significant correlations were found between bone density values from CBCT and implant stability parameters in relation to all variables. CONCLUSION: Bone density assessment using CBCT is an efficient method and significantly correlated with implant stability parameters and Lekholm and Zarb index. Thus, it is possible to predict initial implant stability and possibility of immediate or early loading using CBCT scans prior to implant placement.

A unique case of Turner syndrome accompanying prolactinoma and unexpected elongated styloid process: Clinical and cone-beam computed tomographic features.

Turner syndrome (TS) is one of the most common chromosomal abnormalities, with an estimated frequency among female live births of 1/2,000-3,000. The syndrome is characterized by the partial or complete absence of one X chromosome (45,X karyotype). We reported a unique case of a 40-year-old woman with TS accompanying unexpected elongated styloid process specific to Eagle syndrome (ES) and followed up-prolactinoma. The present article is the first report to define the cone-beam computed tomographic (CBCT) features of TS accompanying ES. Patients with TS carry various risks that make treatment more complicated; thus advanced imaging techniques for proper treatment and follow-up are extremely important. In the light of CBCT examination, craniofacial abnormalities specific to TS and accompanying syndromes such as the crowding of teeth especially in the maxillary anterior region caused by maxillary narrowness, micrognatic maxilla and mandible, relative mandibular retrusion, malocclusion, open-bite, and an elongated styloid process (length of 32.7 mm) on the right side were illustrated in detail.

Comparison of bovine-derived hydroxyapatite and autogenous bone for secondary alveolar bone grafting in patients with alveolar clefts.

PURPOSE: The aim of this retrospective study was to compare the long-term outcomes of secondary alveolar bone grafting (SABG) using bovine-derived hydroxyapatite versus autogenous bone. PATIENTS AND METHODS: The subjects in this study were 23 patients with unilateral cleft lip and palate (13 male, 10 female) who underwent SABG from 2004 through 2009. The patients were recalled and examined to evaluate the success of the long-term outcomes of SABG. In group 1, there were 12 patients (7 male, 5 female) who underwent grafting with anterior iliac crest bone; in group 2, 11 patients (6 male, 5 female) underwent grafting with bovine-derived hydroxyapatite. RESULTS: The mean ages at grafting were 13 ± 3.76 years in group 1 and 10.82 ± 2.6 years in group 2 (P = .134). The mean lengths of follow-up were 47.33 ± 13.79 months in group 1 and 67.82 ± 10.36 months in group 2 (P = .002). Pocket depth, periodontal index, and gingival index scores were similar and indicated acceptable periodontal status in the 2 groups. The results for patient satisfaction were not statistically different (P > .05). There was no statistically significant difference between the 2 groups when results of the Chelsea scale were analyzed (P > .05). The radiologic results showed an 83.4% success rate in group 1 and a 100% success rate in group 2 (P = .478). When the densitometric values for cleft sites were analyzed, the difference between the 2 groups was not statistically significant (P = .190). CONCLUSIONS: Bovine-derived hydroxyapatite is as successful as the iliac graft for the SABG procedure.

The oral health status of street children in Adana, Turkey.

AIM: To determine the oral health status of street children and compare the results with a group of non-working children in Adana, Turkey. Street children are generally defined as any boy or girl for whom the street has become his or her habitual abode and/or source of livelihood; and who is inadequately protected, supervised, or directed by responsible adults. STUDY DESIGN: Demographic data including education, employment and social insurance of parents and number of siblings, was obtained. A formal interview with structured questions was used in order to determine the oral health behaviour of the children. Oral examinations were performed according to the criteria of the WHO oral examination form. RESULTS: The oral health behaviour of street children was significantly different from non-working children. While DMFT and dmft scores of the street youths were significantly lower than the control group, they had higher CPITN scores (p< or =0.001). CONCLUSION: Street children are commonly faced with oral health problems, especially periodontal problems. Therefore, the dental and periodontal needs of this particular population must be addressed. Oral health policies and preventive services including oral health promotion programmes which aim to give information about dental issues and to make positive changes in behavioural and environmental factors should be developed. The priority should be to control the factors which result in the occurrence of new dental problems.

Postoperative pain after endodontic retreatment: single- versus two-visit treatment.

OBJECTIVE: The purpose of this clinical study was to determine the effect of 1- or 2-visit root canal treatment on the postoperative pain in the retreatment cases. STUDY DESIGN: Two hundred eighteen cases that required retreatment were included in the study. Obturated and unfilled canal space and the status of periapical tissues were evaluated according to the PAI index. The patients were subcategorized in regard to the presence or the absence of preoperative pain. Approximately half of each category was treated in 1 appointment. After removing the previous root canal obturation materials and biomechanic preparation of root canals, the teeth in the 1-visit group were obturated at the first appointment by using AH 26 sealer and laterally compacted gutta-percha, and those in the 2-visit group were medicated with calcium hydroxide-chlorhexidine combination and then closed with a temporary filling material. One week after the initial appointment, patients were asked about the occurrence of postoperative pain. The level of discomfort was rated as no pain, mild pain, moderate pain, or severe pain (flare-up). Data were statistically analyzed using the chi-squared and Fischer exact tests. RESULTS: Eight patients from the 1-visit group and 2 patients from the 2-visit group had flare-ups. There was a statistical difference between the groups (P <.05). Two-visit root canal treatment was more effective in completely eliminating pain than 1-visit treatment of previously symptomatic teeth (P <.05). CONCLUSIONS: Two-visit endodontic treatment with intracanal medication was found to be effective in reducing postoperative pain of previously symptomatic teeth and decreased the number of flare-ups in all retreatment cases.

Perforation risks associated with the use of Masserann endodontic kit drills in mandibular molars.

PURPOSE: The use of Masserann kit is a frequently recommended technique for the removal of canal obstructions. Although this technique is usually successful, it may cause excessive removal of dentin tissue in root canals. The aim of this study is to evaluate the perforation risk and the remaining dentin thickness in mesial canals of mandibular molars following the use of Masserann kit. STUDY DESIGN: Fifty-three extracted human mandibular molars were selected for the study. The teeth were separated into 3 groups based on the degree of curvature of the root canals. By using Radio Visio Graphy and Coral Draw 8.0 software packages, the dentin/cement thickness of root canal was measured before and after the use of Masseran kit drills. RESULTS: In the severely and moderately curved mesial root of mandibular molars, the Masserann Kit increased the risk of creating thin or perforated walls. Additionally, after 7.5mm depth of drilling, the percentage of perforations increased in all groups. CONCLUSIONS: With respect to endangering the dentinal walls towards the apex of root canals, Masserann kit drills were found to increase the risk of perforations in curved canals and in deep preparations.

Long-term results of the application of solvent-dehydrated bone xenograft and duramater xenograft for the healing of oroantral osseous defects: a pilot experimental study.

The aim of this study was to investigate the long-term effects of the use of human cadaveric solvent-dehydrated bone graft and duramater as a barrier membrane for the treatment of oroantral communication. Standard oroantral osseous defects were created in five minipigs. Subjects received cancellous bone graft in the form of block or microchips, duramater or a combination of bone and membrane. Uneventful healing was achieved in all of the subjects, clinically including the control site which did not receive any material. The operated bone segments were evaluated both by radiological and histological examinations after 6 months. Radiological evaluation was carried out using bone density analysis software and histological evaluation made by light microscopy. Radiological and histological results revealed that bone grafting of oroantral osseous defects improved the bone quality. However, application of duramater did not change this activity, both alone or combined with bone grafts. Within the limits of this experimental study, although solvent-dehydrated bone grafts were found superior and could be applied for the healing of osseous oroantral defects, resorbable membranes did not contribute to this process.

Rothmund-Thomson syndrome: a case report.

Rothmund-Thomson syndrome (RTS) is an extremely rare genetic disorder characterized by poikilodermatous skin changes, photosensitivity, and an increased risk of developing skin and bone malignancies. In this case report, the dental and periodontal features of RTS in a 16-year-old female patient are presented. The transmission electron microscopy performed on a gingival biopsy specimen showed structural defects of connective tissue. If the unusual ultrastructural findings of this case are confirmed as being consistent with other RTS patients, it is our opinion that this syndrome can be considered among the systemic diseases associated with early-onset periodontitis.