Comparison of the effects of fluoxetine and venlafaxine on bone healing in a rat calvarial defect model.

OBJECTIVE: The purpose of this study was to compare the effects of the selective serotonin reuptake inhibitor (SSRI) fluoxetine and the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine on bone defect healing. MATERIALS AND METHODS: Wistar rats were randomly divided into three groups of eight animals each. The first received 0.1 ml/kg sterile saline solution, the second 5 mg/kg fluoxetine, and the third 5 mg/kg venlafaxine, daily by gastric gavage over 7 weeks. At week 3 of drug therapy, 5-mm diameter calvarial defects were created in the parietal bone of all of the animals. All rats were euthanized four weeks after surgery, micro-CT analysis and histomorphometric analysis were carried out to evaluate the following parameters: Bone volume fraction (BV/TV), bone surface (BS), bone surface density (BS/BV; bone surface/bone volume, 1/mm), trabecular number (Tb. N), trabecular thickness (Tb. Th), areas of new bone structure (positive areas), areas of mature bone structure (negative areas). RESULTS: Micro-CT analysis showed the presence of similar levels of bone formation within the defect site in all three groups (p>0.05). Histomorphometric analysis revealed the presence of bone-forming cells at the defect periphery, with less activity indicating bone formation at the center. No statistically significant difference was observed between the groups (p>0.05). CONCLUSION: Based on the findings of this study, it can be said that the use of both antidepressants hasn't any effect on bone defect healing.

Promising results of surgical management of advanced medication related osteonecrosis of the jaws using adjunctive leukocyte and platelet rich fibrin.

BACKGROUND: Leukocyte- and platelet-rich fibrin (L-PRF) is an autologous matrix scaffold which regulates inflammation by stimulating cytokines and growth factors that are involved in the immune response. L-PRF is suggested as a viable adjunctive method to surgical interventions due to its advantages on tissue healing. This study aims to retrospectively evaluate the adjunctive role of L-PRF in surgically treated medication-related osteonecrosis of the jaws (MRONJ) patients. METHODS: Between January 2012 and December 2020, patients with AAOMS stage II and III MRONJ lesions, who were treated surgically with adjunctive use of L-PRF in the authors' institution were enrolled. Surgical interventions consisted of either marginal resection or sequestrectomy with peripheral ostectomy (SPO) or curettage and L-PRF application. Medical records of these patients were retrospectively reviewed and healing was assessed according to certain parameters including mucosal closure and presence of infection, exposed bone, fistula or radiologic markers of disease progression for a minimum of 12 months. RESULTS: Thirteen patients (7 women and 6 men) with an average age of 72.4 years (± 10.61, range 54-84) were included in the study, nine of whom had AAOMS stage III and four stage II MRONJ. Three patients had a marginal resection, nine patients had sequestrectomy with peripheral ostectomy (SPO) and one patient underwent a curettage procedure. All marginal resection and six SPO patients showed complete healing while four patients, who had SPO or curettage experienced incomplete healing. Mean follow up was 20.1 ± 18.29 months. CONCLUSION: The use of L-PRF may be a favorable adjunctive option in the treatment of MRONJ owing to its favorable effects on tissue repair, ease of application, minimally invasive and cost-effective character and autogenous nature. Trial registration Retrospectively registered.

The influence of flap design on sequelae and quality of life following surgical removal of impacted mandibular third molars: A split-mouth randomised clinical trial.

BACKGROUND: Surgical removal of impacted mandibular third molar is one of the most frequently performed interventions in oral and maxillofacial surgery. OBJECTIVES: To compare two different flap designs in terms of sequelae and quality of life following surgical removal of impacted third molars. METHODS: This prospective, randomised, split-mouth clinical study involved patients referred for surgical removal of bilateral symmetrical impacted mandibular third molars. Envelope flap and modified triangular flap techniques were used. The effects of flap design on trismus, swelling, wound dehiscence, alveolar osteitis, haematoma, infection and quality of life were evaluated on post-operative days 3 and 7. Pain levels were assessed on post-operative days 1, 3 and 7. RESULTS: Significant differences were determined between the two groups in terms of trismus, pain and wound dehiscence scores on post-operative day 3. However, on post-operative day 7, this difference was observed only in trismus. Statistically significant differences were also determined between the two groups on post-operative day 3 for social isolation and eating subscale scores as well as total quality of life score. CONCLUSION: Based on the study findings, the modified triangular flap may be superior to the envelope flap in terms of pain, trismus, and wound dehiscence in the first 3 days after impacted third molar surgery and may have a better impact on quality of life during this process.

Analysis of synovial fluid visfatin level in temporomandibular joint disorders.

Background: Biochemical analysis of synovial fluid (SF) is an important means of understanding the pathogenesis of temporomandibular disorder (TMD) and confirming diagnoses made using traditional methods. Objective: The aim of this study was to determine whether or not SF visfatin levels can serve as a biochemical marker in the diagnosis of TMD. Method: Sixty samples of SF were obtained from 60 patients with internal derangement (ID) or osteoarthritis (OA). Visfatin in the SF was examined by enzyme-linked immunosorbent assay (ELISA). Result: Visfatin levels showed positive correlations with TMD pain and ID stage and a negative correlation with maximum mouth opening. In addition, Visfatin levels in joints with OA changes in the condyle were significantly higher in comparison to joints with no OA changes. Conclusion: Within the limitations of this study, it can be concluded that visfatin may play a role in the pathogenesis of TMD.

The potential clinical relevance of anatomical structures and variations of the maxillary sinus for planned sinus floor elevation procedures: A retrospective cone beam computed tomography study.

BACKGROUND: Complications arising from sinus floor elevation (SFE) with lateral approach surgery can be avoided by means of maxillary sinus examination in the preoperative period. PURPOSE: To investigate anatomical variations in the maxillary sinus by making use of cone beam computed tomography (CBCT) in terms of SFE with a lateral approach. MATERIALS AND METHODS: Two hundred twenty eight maxillary sinuses in 114 patients were included. Parameters such as the position and diameter of the posterior superior alveolar artery (PSAA) canal, the frequency and localization of the septa or accessory maxillary ostium (AMO), and lateral wall thickness values were subjected to statistical analysis. RESULTS: Septa were observed in 35.1% of sinuses. The majority of septa were determined in the middle region (48.8%). Additionally, 71.1% of PSAA canals were intraosseous, generally exceeding 1 mm in diameter (68.9%). The shortest mean perpendicular distance between the sinus floor and the PSAA canal was determined in the first molar region (9.22 ± 5.66 mm). Similarly, the highest mean sinus lateral wall thickness was determined in the first molar region, in the area 3 mm distant from the sinus floor (2.42 mm ± 0.88 mm). AMO was detected in 40.8% of sinuses. CONCLUSION: CBCT-guided treatment planning may be beneficial prior to SFE procedures in order to avoid surgical complications.

A decision analysis for periapical surgery: Retrospective Study.

BACKGROUND: Periapical surgery is now a reliable therapeutic procedure for the treatment of teeth with periapical lesions, particularly when orthograde retreatment is problematic. However, little information is available regarding treatment planning of cases referred for periapical surgery. Therefore, this study was conducted to analyze and evaluate the factors that affect the decision-making process for periapical surgery. MATERIAL AND METHODS: This study retrospectively assessed clinical and radiographic data from patients undergoing periapical surgery. The factors involved in deciding to perform periapical surgery were classified into technical, biological, and combined factors. RESULTS: Out of 821 patients, 544 (66.3%) underwent endodontic treatment/retreatment, 204 (24.8%) were treated with coronal restorations and 60 (7.3%) were treated with post. Periapical surgery was indicated for biological reasons in 35% of patients and for technical reasons in 17.9%. The common biological factor was persistent clinical symptoms (19.7%). The most common technical cause was failure of previous endodontic treatment (66.3%). Nearly half of all periapical lesions (45%) were <5 mm in size. Periapical surgery was justified in only 434 (52.9%) subjects. CONCLUSIONS: We suggest that it is very important for patients to be informed and encouraged about endodontic retreatment in order to reduce unnecessary surgical procedures. Key words:Periapical surgery, case selection, treatment planning.

Coexisting sublingual dermoid cyst and heterotopic gastrointestinal cyst: Case report.

A heterotopic oral gastrointestinal cyst coexisting with a lingual dermoid cyst is a rare condition, with only 3 reported cases in the English-language literature. Clinically, both gastrointestinal and dermoid cysts tend to manifest as an asymptomatic swelling. Cysts above the mylohyoid often present with sublingual swelling, whereas those below the mylohyoid present with submental swelling. Increased salivation, altered speech, dyspnea and difficulties in eating, swallowing and respiration may be present, depending on the size of the cyst. This paper describes the case of a 4-year-old girl presenting with swelling of the tongue and floor of the mouth that interfered with normal speech. Two cystic lesions were surgically excised using an intraoral approach, and recovery was uneventful. Histopathological examination of the specimens taken during surgery revealed the first, anterior cyst to be a dermoid cyst and the second, posterior cyst to be a heterotopic oral gastrointestinal cyst (HGIC). Although this situation is very rare, it should be included in the differential diagnosis of swellings in the submandibular region in the pediatric population. Key words:Dermoid cyst, heterotopic gastrointestinal cyst, children, tongue.

Comparing the precision of panoramic radiography and cone-beam computed tomography in avoiding anatomical structures critical to dental implant surgery: A retrospective study.

PURPOSE: The aim of this study was to evaluate the correlations between measurements made using panoramic radiography and cone-beam computed tomography (CBCT) based on certain anatomical landmarks of the jaws, with the goal of preventing complications due to inaccurate measurements in the pre-surgical planning phase of dental implant placement. MATERIALS AND METHODS: A total of 56 individuals who underwent panoramic radiography and a CBCT evaluation before dental implant surgery were enrolled in the study. Measurements were performed to identify the shortest vertical distance between the alveolar crest and neighboring anatomical structures, including the maxillary sinus, nasal floor, mandibular canal, and foramen mentale. The differences between the measurements on panoramic radiography and CBCT images were statistically analyzed. RESULTS: Statistically significant differences were observed between the measurements on panoramic radiography and CBCT for all anatomical structures (P<.05). The correlation coefficients (r) between the paired samples obtained from panoramic radiography and CBCT were closely correlated (P<.05), with r values varying from 0.921 and 0.979 for different anatomical regions. CONCLUSION: The results of this study support the idea that panoramic radiography might provide sufficient information on bone height for preoperative implant planning in routine cases or when CBCT is unavailable. However, an additional CBCT evaluation might be helpful in cases where a safety margin cannot be respected due to insufficient bone height.

A comparison of diode laser and Er:YAG lasers in the treatment of gingival melanin pigmentation.

OBJECTIVES: This study compared the use of diode and Er:YAG lasers in treating gingival melanin pigmentation (GMP) in terms of gingival depigmentation, local anesthesia requirements, postoperative pain/discomfort, depigmentation effectiveness, and total treatment duration. STUDY DESIGN: Twenty patients (13 female, 7 male) referred with GMP were enrolled in the study. Patients were randomly divided into 2 groups. Group 1 was treated with a gallium aluminum arsenide diode laser with a continuous wavelength of 808 nm, and group 2 was treated with an Er:YAG laser with a continuous wavelength of 2,940 nm. Gingival depigmentation was performed by applying the laser at 1 W. Treatment was administered on a weekly basis until a normal pink gingival color was observable in clinical examination and photographs. In addition, patients were asked to evaluate the procedure by using a self-administered questionnaire. RESULTS: Procedures were carried out without the need for any topical or local anesthetic, and no unpleasant events occurred during the actual procedure or the healing period. The total length of treatment was significantly shorter with the diode laser (group 1) than with the Er:YAG laser (group 2; P < .05). No melanin recurrence was detected during any follow-up session. CONCLUSIONS: Diode and Er:YAG lasers administered at 1 W both result in satisfactory depigmentation of GMP.

Local treatment of chronic osteomyelitis with surgical debridement and tigecycline-impregnated calcium hydroxyapatite: an experimental study.

OBJECTIVE: The aim of this study was to determine the efficacy of tigecycline-impregnated hydroxyapatite in the local treatment of chronic osteomyelitis experimentally induced in rat tibias with methicillin-resistant Staphylococcus aureus. STUDY DESIGN: Monocortical defects were established in the left tibias of 32 adult Wistar albino rats. Five rats were randomly selected and injected intramedullarly with saline solution (group 1), whereas chronic osteomyelitis was induced in other rats by intramedullary injection of S. aureus. Infected rats were then randomized and divided into 4 groups: group 2, no further treatment; group 3, debridement only; group 4, debridement followed by implantation of calcium hydroxyapatite; and group 5, debridement followed by implantation of tigecycline-impregnated calcium hydroxyapatite. On day 21 after induction, all rats in groups 2-5 showed signs of osteomyelitis. Rats in groups 1 and 2 were killed on day 21 after induction, whereas rats in groups 3, 4, and 5 underwent debridement surgery on day 21 after induction and were killed 21 days after debridement surgery. Tibias were analyzed histopathologically and cultured for S. aureus. RESULTS: Compared with group 2, histopathologic disease severity scores in groups 3, 4, and 5 were 37%, 44%, and 83% lower, respectively. Nontreated infected rats had the highest bacteria count (mean 5 × 10(5) colony-forming units/g bone), and bacterial count was 26%, 29%, and 79% lower in groups 3, 4, and 5, respectively, compared with group 2. CONCLUSIONS: Tigecycline-impregnated hydroxyapatite can have a potential in the treatment of chronic osteomyelitis of methicillin-resistant S. aureus origin, which may be considered as a therapeutic alternative by surgeons dealing with osteomyelitis.

Soft tissue pathosis associated with asymptomatic impacted lower third molars.

OBJECTIVE: The aim of this study was to identify the prevalence of pathological changes in the pericoronal tissue of asymptomatic impacted lower third molars and to assess the correlation between pathological changes and patient demographic, radiographic and morphological characteristics. STUDY DESIGN: Follicles associated with fully impacted lower third molars were submitted for histological examination after surgical extraction from 50 patients. The correlation between pathological changes in the dental follicle and age, gender, depth of impaction, angular position, and coverage and tooth development was analyzed. RESULTS: Cystic changes were observed in 10% of specimens and inflammatory changes in 62%. Incidence of pathological changes was significantly higher in Class B impacted teeth when compared to Class C impacted teeth. A significant correlation was found between epithelial cell activity and the completion of tooth development. CONCLUSION: We recommend monitoring all third molars whether or not they are symptomatic and conducting histopathological analyses on all surgically extracted follicle tissue.

Prevalence of impacted premolars in a Turkish population and considerations for surgical treatment.

OBJECTIVE: The aim of this study was to identify the prevalence, associated pathology and symptoms, and treatment of impacted premolars in a Turkish population. STUDY DESIGN: This retrospective study examined panoramic radiographs and clinical records of 9,000 patients who presented consecutively at our oral and maxillofacial surgery clinics between January 1998 and January 2009. In addition to demographic data (patient sex and age), data was compiled on the number and location of impacted missing maxillary and mandibular premolars, retained deciduous molars, associated pathologies and symptoms, and treatment methods. RESULTS: A total of 105 impacted maxillary or mandibular premolars were observed in 93 patients (1.03%). Of these, 48 (51.6%) were female (age range: 13-57 years) and 45 (43.4%) were male (age range: 13-58 years). Impacted mandibular second premolars accounted for 55.2% (n=58) of all impacted premolars. Migration was observed in only 11.83% of patients (n=11). Pathological changes and symptoms were noted in 15.05% of patients. CONCLUSION: Our results suggest that the prophylactic extraction of non-migrated impacted premolars may not be necessary. If the patient is cooperative, a "wait and see " approach may be preferable. Orthodontic or prosthetic treatment options should also be considered when planning treatment of non-migrated impacted premolars. Migrated impacted premolars should be kept under observation and should only be removed if they are associated with pathology or if extraction is required for prosthetic or orthodontic treatment.