Evaluation of patient satisfaction with pharyngeal airway changes after orthognathic surgery in patients with Class III skeletal anomalies.

Purpose: The aims of our study were to determine the changes in the pharyngeal airway after treating patients with Class III malocclusion who received double jaw surgery, to determine the hard tissue and soft tissue parameters and the hyoid bone and tongue positions after surgery, to determine the changes to compare the pretreatment and post-treatment measurements of the patients in the double jaw group with the measurements of the control group patients, and to evaluate postoperative patient satisfaction. Materials and methods: The study included thirty-two Class III adult patients that received double jaw surgery and twenty-five Class I patients. Cephalometric records were taken before treatment (T1) and after treatment (T2). Results: After double jaw orthognathic surgery, there were statistically significant changes in all pharyngeal airway linear and areal parameters (p<0.001). There were significant superior and posterior movements of the tongue and hyoid bone post-surgery. The post-treatment analysis of the double jaw surgery group and control group were compared, with statistically significant differences in the mandibular dental parameters and pharyngeal airway measurements in patients in the double jaw surgery group. Conclusion: Despite the narrowings detected, high satisfaction scores were observed in the patient satisfaction questionnaire and the patients did not experience respiratory problems.

Comparison of treatment efficacy between hyaluronic acid and arthrocentesis plus hyaluronic acid in internal derangements of temporomandibular joint.

The aim of the study was to compare the effectiveness of hyaluronic acid (HA) injection and arthrocentesis plus HA injection for treating disc displacement with reduction (DDwR) and disc displacement without reduction (DDwoR). In this randomized clinical trial, patients were divided into 2 main groups: group I (DDwR) and group II (DDwoR). Sub-groups were made depending on allocated treatment: group Ia (arthrocentesis plus HA), group Ib (single HA), group Ic (control), group IIa (arthrocentesis plus HA), group IIb (single HA), and group IIc (control). The primary outcome variable was maximum pain on chewing, while maximum pain at rest, maximum non-assisted and assisted mouth opening, chewing efficiency, temporomandibular joint (TMJ) sounds, quality of life, treatment tolerability, and treatment effectiveness were secondary outcomes. The influences of individual study variables (gender, involved side, and duration of symptoms) on clinical outcomes were also examined. The study consisted of 116 TMJs of 90 patients (n = 45 in both main groups, TMJs = 58) aged 15-82 years. At the 6-month follow-up, improvement in all parameters, except for TMJ sounds, was recorded in all treatment groups, with no improvements in control groups. Notably, arthrocentesis plus HA showed superior improvement in chewing efficiency (p = 0.041) and quality of life (p = 0.047) of group I and quality of life (p = 0.004) in group II, compared to single HA. Furthermore, the duration of symptoms correlated with clinical outcomes. Both procedures successfully improved the symptoms of DDwR and DDwoR patients, but arthrocentesis plus HA injection seemed superior.

Influence of implant number, length, and tilting degree on stress distribution in atrophic maxilla: a finite element study.

This study aims to evaluate the stress values, created in peri-implant region as a consequence of loading on fixed hybrid dentures that was planned with different implant numbers, lengths, or tilting angulations. Thirteen three-dimensional (3D) finite element analysis models were generated with four, five, or seven implants (group A, B, and C). Except the distal implants, all implants were modeled at 4.1 mm (diameter) and 11.5 mm (length) in size. Distal implants were configured to be in five different lengths (6, 8, 11.5, 13, and 16 mm) and three different implant inclination degrees (0°, 30°, and 45°). A 150-N load was applied vertically on prosthesis. Released stresses were evaluated comparatively. The lowest von Mises stress values were found in group C, in the 11.5-mm implant model. Tilting the distal implants 30° caused higher stress values. In 45°-tilting implant models, lower stress values were recorded according to the 30°-tilting models. The ideal implant number is seven for an edentulous maxilla. Tilting the implants causes higher stress values. A 45° inclination of implant causes lower stress values according to the 30° models due to a shorter cantilever. The ideal implant length is 11.5 mm.

Biomechanical evaluation of implant-supported prosthesis with various tilting implant angles and bone types in atrophic maxilla: A finite element study.

BACKGROUND AND OBJECTIVE: The purpose of this study is to evaluate and compare bone stress that occurs as a result of using vertical implants with simultaneous sinus augmentation with bone stress generated from oblique implants without sinus augmentation in atrophic maxilla. METHODS: Six, three-dimensional (3D) finite element (FE) models of atrophic maxilla were generated with SolidWorks software. The maxilla models were varied for two different bone types. Models 2a, 2b and 2c represent maxilla models with D2 bone type. Models 3a, 3b and 3c represent maxilla models with D3 bone type. Five implants were embedded in each model with different configurations for vertical implant insertion with sinus augmentation: Model 2a/Model 3a, 30° tilted insertion; Model 2b/Model 3b and 45° tilted insertion; Model 2c/Model 3c. A 150 N load was applied obliquely on the hybrid prosthesis. The maximum von Mises stress values were comparatively evaluated using color scales. RESULTS: The von Mises stress values predicted by the FE models were higher for all D3 bone models in both cortical and cancellous bone. For the vertical implant models, lower stress values were found in cortical bone. Tilting of the distal implants by 30° increased the stress in the cortical layer compared to vertical implant models. Tilting of the distal implant by 45° decreased the stress in the cortical bone compared to the 30° models, but higher stress values were detected in the 45° models compared to the vertical implant models. CONCLUSIONS: Augmentation should be the first treatment option in atrophic maxilla in terms of biomechanics. Tilted posterior implants can create higher stress values than vertical posterior implants. During tilting implant planning, the use of a 45° tilted implant results in better biomechanical performance in peri-implant bone than 30° tilted implant due to the decrease in cantilever length.

The efficacy of low-level 940 nm laser therapy with different energy intensities on bone healing.

The aim of this study was to evaluate the efficacy of low-level 940 nm laser therapy with energy intensities of 5, 10 and 20 J/cm2 on bone healing in an animal model. A total of 48 female adult Wistar rats underwent surgery to create bone defects in the right tibias. Low-level laser therapy (LLLT) was applied immediately after surgery and on post-operative days 2, 4, 6, 8, 10 and 12 in three study groups with energy intensities of 5 J/cm2, 10 J/cm2 and 20 J/cm2 using a 940 nm Gallium-Aluminium-Arsenide (Ga-Al-As) laser, while one control group underwent only the tibia defect surgery. All animals were sacrificed 4 or 8 weeks post-surgery. Fibroblasts, osteoblasts, osteocytes, osteoclasts and newly formed vessels were evaluated by a histological examination. No significant change was observed in the number of osteocytes, osteoblasts, osteoclasts and newly formed vessels at either time period across all laser groups. Although LLLT with the 10 J/cm2 energy density increased fibroblast activity at the 4th week in comparison with the 5 and 20 J/cm2 groups, no significant change was observed between the laser groups and the control group. These results indicate that low-level 940 nm laser with different energy intensities may not have marked effects on the bone healing process in both phases of bone formation.

Peri-implant plastic surgery techniques to hard and soft tissue augmentation in implant rehabilitation.

This report presents the clinical results of peri-implant plastic surgical approaches for hard and soft tissues before and during the implant placement in a patient with vertical ridge deformation and a shallow vestibule sulcus, and the subsequently performed prosthetic rehabilitation. The surgical approaches used in this case reduced the crown-height space and crown-to-implant ratio and ensured that the implants were placed in their ideal positions, and peri-implant tissue health was maintained. In conclusion, developments in the peri-implant plastic surgery enable the successful augmentation of hard and soft tissue defects and provide the implant-supported fixed prosthetic rehabilitation.

The efficacy of low-level 940 nm laser therapy with different energy intensities on bone healing

Abstract The aim of this study was to evaluate the efficacy of low-level 940 nm laser therapy with energy intensities of 5, 10 and 20 J/cm2 on bone healing in an animal model. A total of 48 female adult Wistar rats underwent surgery to create bone defects in the right tibias. Low-level laser therapy (LLLT) was applied immediately after surgery and on post-operative days 2, 4, 6, 8, 10 and 12 in three study groups with energy intensities of 5 J/cm2, 10 J/cm2 and 20 J/cm2 using a 940 nm Gallium-Aluminium-Arsenide (Ga-Al-As) laser, while one control group underwent only the tibia defect surgery. All animals were sacrificed 4 or 8 weeks post-surgery. Fibroblasts, osteoblasts, osteocytes, osteoclasts and newly formed vessels were evaluated by a histological examination. No significant change was observed in the number of osteocytes, osteoblasts, osteoclasts and newly formed vessels at either time period across all laser groups. Although LLLT with the 10 J/cm2 energy density increased fibroblast activity at the 4th week in comparison with the 5 and 20 J/cm2 groups, no significant change was observed between the laser groups and the control group. These results indicate that low-level 940 nm laser with different energy intensities may not have marked effects on the bone healing process in both phases of bone formation.

Is Hyaluronic Acid Injection Effective for the Treatment of Temporomandibular Joint Disc Displacement With Reduction?

PURPOSE: Hyaluronic acid (HA) injections and occlusal splints have been suggested in the treatment of temporomandibular joint (TMJ) derangements, but no sufficient data are available from controlled clinical trials comparing HA injection with another treatment modality. This study compared the effectiveness of a single HA injection, a double HA injection, and splint therapy for the treatment of TMJ disc displacement with reduction (DDR). MATERIALS AND METHODS: A prospective clinical trial was designed. The study sample included patients with TMJ DDR. The primary predictor variable was treatment method. Patients were divided into 4 groups: control, single HA injection, double HA injection, and stabilization splint therapy. Patients were randomly assigned to 1 of 3 treatment groups. The control group was self-selected. The primary outcome variable was pain at rest and during mastication. The secondary outcome variables were TMJ noise, quality of life, and level of jaw movements. Clinical symptoms and jaw movements were evaluated at baseline and at 6-month follow-up. Descriptive, comparative, correlation, and multivariate analyses were conducted. RESULTS: The sample included 51 patients (66 TMJs) 18 to 48 years old. All treatment groups showed significant improvement compared with baseline values for pain, TMJ noise, quality of life, and maximum mouth opening (MMO) at 6-month follow-up (P < .05). However, the 2 HA injection groups indicated superior improvement for pain, MMO, and quality of life compared with the stabilization splint group (P < .05). CONCLUSIONS: The results of this study showed that HA injection and stabilization splinting are acceptably successful treatment modalities to alleviate the clinical signs and symptoms of TMJ DDR.

Reduction of isolated zygomatic arch fractures using dental instrument: Report of 2 cases and review of the literature.

To assess the effectiveness of a dental instrument for reduction of isolated zygomatic arch fractures. Two patients were admitted to our clinic representing isolated unilateral zygomatic arch fracture. The common presenting complaints were pain, swelling and difficulty in mouth opening. Fractures were confirmed with plain radiography and computerized tomography. The fractures were reduced with upper buccal sulcus approach by dental instrument. Patients achieved satisfactory maximum mouth opening within 10 days. At follow up after 6 months, there was complete healing without any complication. This procedure is cost effective, time saving, safe and effective to manage isolated zygomatic arch fractures under local anaesthesia with satisfactory outcomes.

A combined peri-implant plastic surgery approach for implants in the esthetic zone using a novel technique: A series of 10 cases.

OBJECTIVE: In this study, 12-month follow-up clinical results of a combined peri-implant plastic surgery approach for hard and soft tissue augmentation in implant rehabilitation in the esthetic zone are presented. METHOD AND MATERIALS: Ten individuals who required extraction due to severe periodontal destruction in the maxillary and mandibular area were included in the study. Implant surgery was performed in the same session as the combined peri-implant plastic surgeries, which involved guided bone regeneration and free periosteal grafts. Prosthetic treatment was administered in the sixth month following the surgeries. RESULTS: Hard and soft tissue augmentation with sufficient keratinized mucosa width (≥ 2 mm) was achieved with the combined surgical approaches. Pleasing esthetic results were obtained by careful positioning of the implants. CONCLUSIONS: In implant rehabilitation, in cases where there are insufficient hard and soft tissues in the esthetic zone, a combined peri-implant plastic surgery approach not only enables the ideal implant position where both function and esthetics are ensured but also provides effective protection of peri-implant tissue health.

Does laterally rotated flap design influence the short-term periodontal status of second molars and postoperative discomfort after partially impacted third molar surgery?

PURPOSE: To assess the influence of the surgical removal of partially impacted third molars (3Ms) and compare the effects of a 3-cornered laterally rotated flap (LRF) with primary closure (flap 1) and an envelope flap with secondary closure (flap 2) on the short-term periodontal status of the adjacent second molars (2Ms). We also assessed the postoperative complications after removal of the partially impacted 3M. MATERIALS AND METHODS: A split mouth, randomized clinical study was designed. The study sample included patients with bilateral partially impacted 3Ms. The primary predictor variable was the type of flap design (flaps 1 and 2). The primary outcome variable was periodontal status (gingival recession [GR], probing depth [PD], plaque index [PI], and gingival index) of the 2Ms measured preoperatively and 90 days postoperatively. The secondary outcome variables were postoperative complications, including pain, facial swelling, alveolitis, and local wound infection. The other variables included gender, position of the 3Ms, and surgical difficulty. We performed descriptive, comparative, correlation, and multivariate analyses. RESULTS: The sample included 28 patients aged 18 to 28 years. The GR, PD, and PI values with the flap 2 design were greater than those with the flap 1 design (P < .05). Facial swelling with the flap 1 design was significantly greater than with the flap 2 design on the second postoperative day (P < .05). The pain levels with the flap 1 design were significantly greater than those with the flap 2 design on the first and second postoperative days (P < .05). According to the multivariate regression analyses, flap design was closely related to the periodontal status of the 2Ms and postoperative discomfort. CONCLUSION: The results of the present clinical study have shown that the flap design in partially impacted 3M surgery considerably influences the early periodontal health of the 2Ms and postoperative discomfort. However, although the 3-cornered LRF design might cause more pain and swelling, it could be the method of choice for partially impacted 3M surgery because of the early periodontal healing.

Peri-Implant Plastic Surgical Approaches to Increasing Keratinized Mucosa Width.

The long-term efficacy of adequate keratinized mucosa (>2 mm) in dental implants is controversial. Peri-implant plastic surgeries are currently used because they increase keratinized mucosa width (KMW), helping to regain peri-implant health and maintaining it over the long-term. We present the clinical findings using free-gingival-graft (FGG) and free-periosteal-graft (FPG) techniques in peri-implant plastic surgery for implant rehabilitation patients. We included 20 patients with implant indications of inadequate KMW (KMW < 2 mm for postimplantation) in the maxilla and mandible. All underwent clinical and radiographic measurements and a treatment protocol was prepared for implant rehabilitation and subsequent peri-implant plastic surgery. A decision as to whether and when FGG or FPG techniques would be used was made. FGG/FPG was performed pre-implantation (before monocortical block-bone augmentation) or postimplantation (before/during/after stage 2 surgery). KMW was ≥ 2 mm after application of FGG/FPG pre- or post-implantation. Moreover, peri-implant tissue health was regained/maintained in all cases from 6 months to 4 years. Peri-implant plastic surgery techniques can prevent hard- and soft-tissue problems after implant rehabilitation and during treatment of developing problems. However, surgical design and timing, and an interdisciplinary perspective determine the success of peri-implant plastic surgery.

Combined soft and hard tissue peri-implant plastic surgery techniques to enhance implant rehabilitation: a case report.

This case report presents an implant-aided prosthetic treatment in which peri-implant plastic surgery techniques were applied in combination to satisfactorily attain functional aesthetic expectations. Peri-implant plastic surgery enables the successful reconstruction and restoration of the balance between soft and hard tissues and allows the option of implant-aided fixed prosthetic rehabilitation.

The genetic variants of thymic stromal lymphopoietin protein in children with asthma and allergic rhinitis.

BACKGROUND: Thymic stromal lymphopoietin (TSLP) is expressed by airway epithelial cells and plays a key role in immunological events in asthma. Data on the genetic variants of TSLP and its association with asthma and allergic rhinitis are scarce. We aimed to investigate the effects of the genetic variants of TSLP in children with asthma and allergic rhinitis. METHODS: The genetic variants of the TSLP gene were determined by sequencing 25 asthmatic and 25 healthy children. In an association study, a population of 506 asthmatics and 157 healthy controls was screened for the following single-nucleotide polymorphisms (SNPs): rs3806933 and rs2289276 in the promoter region; rs11466741, rs11466742, and rs2289278 in intron 2; rs10073816, rs11466749, and rs11466750 in exon 4, and rs11466754 in 3'-UTR. RESULTS: In Multifactor Dimensionality Reduction analysis, presence of the rs11466749 AA genotype with atopy was significantly associated with a diagnosis of asthma (testing set accuracy: 0.720 and cross validation: 9/10). Two functional SNPs showed a gender-specific association with allergy, i.e. the rs3806933 CC genotype with asthma in boys (p = 0.032, nonsignificant after multiple testing) and the rs2289276 CC genotype with higher eosinophil numbers in asthmatic girls (p = 0.003). The presence of allergic rhinitis in asthmatic children strengthened the association of the rs11466749 GG genotype with asthma (p = 0.001), and rs2289276 was significantly associated with lower FEV1 levels in asthmatics without allergic rhinitis (p = 0.003). CONCLUSION: Variants in the gene encoding the TSLP protein may have differential effects on asthma phenotypes depending on gender, atopy, and the presence of allergic rhinitis.

Challenges in identifying asthma subgroups using unsupervised statistical learning techniques.

RATIONALE: Unsupervised statistical learning techniques, such as exploratory factor analysis (EFA) and hierarchical clustering (HC), have been used to identify asthma phenotypes, with partly consistent results. Some of the inconsistency is caused by the variable selection and demographic and clinical differences among study populations. OBJECTIVES: To investigate the effects of the choice of statistical method and different preparations of data on the clustering results; and to relate these to disease severity. METHODS: Several variants of EFA and HC were applied and compared using various sets of variables and different encodings and transformations within a dataset of 383 children with asthma. Variables included lung function, inflammatory and allergy markers, family history, environmental exposures, and medications. Clusters and original variables were related to asthma severity (logistic regression and Bayesian network analysis). MEASUREMENTS AND MAIN RESULTS: EFA identified five components (eigenvalues ≥ 1) explaining 35% of the overall variance. Variations of the HC (as linkage-distance functions) did not affect the cluster inference; however, using different variable encodings and transformations did. The derived clusters predicted asthma severity less than the original variables. Prognostic factors of severity were medication usage, current symptoms, lung function, paternal asthma, body mass index, and age of asthma onset. Bayesian networks indicated conditional dependence among variables. CONCLUSIONS: The use of different unsupervised statistical learning methods and different variable sets and encodings can lead to multiple and inconsistent subgroupings of asthma, not necessarily correlated with severity. The search for asthma phenotypes needs more careful selection of markers, consistent across different study populations, and more cautious interpretation of results from unsupervised learning.

The effect of chronic temporomandibular joint dislocation: frequency on the success of autologous blood injection.

Autologous blood injection (ABI) is a conservative, non-surgical method of treating chronic temporomandibular joint (TMJ) dislocation. Although many clinicians have reported positive results, procedural success has not been evaluated according to dislocation type. This study investigated the success of ABI on chronic TMJ dislocation with respect to dislocation frequency. ABI was used to treat 27 joints in 17 patients. The patients were divided into two groups based on dislocation frequency: (A) at least twice a week on different days and (B) at least twice a day. The procedure was successful in 13 of the 15 injected joints (86.6 %) in group A and six of the 12 injected joints (50 %) in group B. This difference was statistically significant (p = 0.03814). Autologous blood injection had limited success in patients with very frequent dislocation, while it was useful for treating less frequently dislocated TMJs.

Impact of dental and zygomatic implants on stress distribution in maxillary defects: a 3-dimensional finite element analysis study.

The aim of this study was to evaluate the stress distribution in the bone around dental and zygomatic implants for 4 different implant-supported obturator prostheses designs in a unilaterally maxillary defect using a 3-dimensional finite element stress analysis. A 3-dimensional finite element model of the human unilateral maxillary defect was constructed. Four different implant-supported obturator prostheses were modeled; model 1 with 2 zygomatic implants and 1 dental implant, model 2 with 2 zygomatic implants and 2 dental implants, model 3 with 2 zygomatic implants and 3 dental implants, and model 4 with 1 zygomatic implant and 3 dental implants. Bar attachments were used as superstructure. A 150-N vertical load was applied in 3 different ways, and von Mises stresses in the cortical bone around implants were evaluated. When the models (model 1-3) were compared in terms of number of implants, all of the models showed similar highest stress values under the first loading condition, and these values were less than under model 4 conditions. The highest stress values of models 1-4 under the first loading condition were 8.56, 8.59, 8.32, and 11.55 Mpa, respectively. The same trend was also observed under the other loading conditions. It may be concluded that the use of a zygomatic implant on the nondefective side decreased the highest stress values, and increasing the number of dental implants between the most distal and most mesial implants on the nondefective side did not decrease the highest stress values.

Complicated subgingivally fractured central and lateral incisors: case report.

Dental trauma sometimes causes fractures in the maxillary anterior teeth leading to esthetic, functional and phonetic problems. In this report, we describe the treatment of central and lateral incisors simultaneously subgingivally fractured due to dental trauma. Treatment involved flap surgery, reattachment and splinting of the fractured fragments with glass-fibre and composite resin. This reattachment technique, which uses advanced adhesive systems, is an option that offers satisfactory esthetic and functional outcomes.

High dose calcitriol in osteopetrorickets.

Osteopetrorickets is a rare autosomal recessive disorder of osteoclast function characterized by abnormally dense bone and failure of resorption of calcified cartilage. Rickets is a paradoxical complication of osteopetrosis, resulting from the inability of the osteoclasts to maintain a normal calcium-phosphorus balance in the extracellular fluid. We report a patient with an unusual case of infantile osteopetro-rickets who was admitted with anterior fontanel bulging and was treated with haploidentical bone marrow transplantation.