Fractal analysis for the assessment of trabecular peri-implant alveolar bone using panoramic radiographs.

OBJECTIVES: There is no consensus on the relationship between fractal dimension and trabecular bone complexity. Our aims were to examine the changes in fractal dimension (FD) from peri-implant alveolar bone on digital panoramic radiographs 6 and 12 months after prosthodontic loading and to compare these with baseline values calculated just after loading. MATERIAL AND METHODS: Three panoramic radiographs taken from 76 implant patients taken (1) after prosthodontic loading (3 months ± 2 weeks after insertion = baseline), (2) 6 months ± 2 weeks after loading, and (3) 12 months ±2 weeks after loading were considered for the study. Panoramic images were obtained using storage phosphor plates of the Digora PCT system and saved into a computer. Three regions of interest from mesial, distal, and apical areas were selected for each implant on three consecutive panoramic images. Statistical analysis of the data was performed using two-way repeated measures ANOVA, independent t test and paired t test, and pairwise comparisons (P < 0.05). RESULTS: Mean FD values at baseline were 1.202, 1.224, and 1.199 for apical, mesial, and distal areas. The FD values were calculated as 1.121, 1.113, and 1.128 at the 6th month. The differences between values calculated at baseline and the 6th month were statistically significant for all aspects, indicating a significant decrease in FD 6 months after prosthodontic loading (P < 0.05). FD values calculated at the 12th month were 1.121, 1.110, and 1.121 for apical, mesial, and distal aspects, respectively, with no significant differences from corresponding values obtained at the 6th month (P > 0.05). CONCLUSIONS: FD values of trabecular bone around implants 6 months after prosthodontic loading are significantly lower than the baseline values. However, no significant decrease or increase was observed at 12 months, which revealed comparable results with peri-implant alveolar bone at 6 months. CLINICAL RELEVANCE: Trabecular bone around successful dental implants exhibits lower fractal dimension values 6 months after prosthodontic loading and displays stable bony microstructure at 12 months of follow-up.

Holter ECG assessment of the effects of three different local anesthetic solutions on cardiovascular system in the sedated dental patients with coronary artery disease.

OBJECTIVE: The purpose of the study is to compare the effects of lidocaine alone, epinephrine-combined lidocaine and prilocaine with octapressin on the cardiovascular system during minor oral surgery of sedated cardiac dental patients under local anesthesia. METHODS: Connected to a Holter electrocardiogram (ECG) monitor for a total of 5 hours starting 1 hour before the procedure, twenty patients with high risk of coronary artery disease were included in the prospective cohort study. All the patients had three operations at 3 different appointments with at least one-week intervals and each operation was performed under local anesthesia achieved by 3.6 mL of 3% prilocaine with octapressin, 3.6 mL of 2% lidocaine with 1:80.000 epinephrine and 3.6 mL of 2% lidocaine without a vasoconstrictor. Data of the Holter ECG device assessed at the end of every hour and evaluated statistically. Repeated measures ANOVA, Friedman test, and Wilcoxon signed ranks test were used to perform statistical analysis. RESULTS: Heart-rate showed significant differences between lidocaine with epinephrine and pure lidocaine in an hour following the injection (p<0.05 for all). Cardiac rhythm showed significant differences between prilocaine with octapressin and pure lidocaine at the second hour after its administration (p<0.05 for all). There were no significant differences between 3 local anesthetics in terms of ST segment deviation. CONCLUSION: In minor oral operation on the sedated patients with cardiac disease, the use of 3.6 mL or a less amount of local anesthetic injection containing epinephrine appears to be a predictable and safe method.

Treatment of nonsyndromic dentigerous cysts in primary dentition.

OBJECTIVE: Dentigerous cysts are benign odontogenic cysts that are associated with the crowns of permanent teeth. They usually occur singly and are located in the mandible. Nonsyndromic bilateral dentigerous cysts (NSBDC) are rarely seen during childhood. The aim of this study was to determine the long-term effects of the marsupialization technique in growing children with NSBDC. STUDY DESIGN: Seven patients with NSBDC (4 female, 3 male) ranging in age from 7 to 9 years (mean 8.35 years) were involved in the study. All the individuals were treated by marsupialization. Space-maintaining appliances were applied during permanent teeth eruption. Intraoral photographs, and panoramic and periapical films were taken before surgery and during healing. RESULTS: The NSBDC were successfully treated by the marsupialization technique and rapid healing period was observed in the growing patients, without any loss of permanent teeth. No recurrence was seen in the long-term follow-up period (3-10 years). CONCLUSION: Our clinical and radiological results revealed that using the marsupialization technique in children with NSBDC provided safe healing of permanent teeth around the dentigerous cysts in a short period. However, treatment planning and regular clinical follow-ups are necessary to ensure clinical success.

Myofibroma of the gingiva: report of a case.

Myofibroma is a benign mesenchymal neoplasm composed of myofibroblasts which has been described with different synonyms since the first report in 1951. It occurs most commonly as a solitary lesion of soft tissue, skin, or bone in infancy. The prognosis of oral myofibromas is excellent, and surgical excision is curative. Recurrence is rare. Awareness and recognition of this benign tumor is important to establish the correct diagnosis and avoid morbidity of unnecessary aggressive therapy. This report describes a myofibroma of the gingiva in a 14 year old girl and is reported together with the conventional histologic, and immunohistochemical findings. The tumor showed rapid increase in size and clinical features suggestive of malignancy. However on histopathologic evaluation it was diagnosed as a benign neoplasm, and this diagnosis was supported by immunohistochemical markers. The spindle cells were immunopositive for smooth muscle actin, and vimentin but were negative for desmin and S-100 protein. The patient was treated with surgical excision, and is followed-up for 33 months without any signs of recurrence.

Oral mucosal ulceration: a manifestation of previously undiagnosed pulmonary tuberculosis.

BACKGROUND: Tuberculosis, or TB, is a chronic infectious disease that can affect any part of the body, including the mouth. Oral lesions may be the only finding of primary pulmonary TB, in which case proper diagnosis by dentists is vital. CASE DESCRIPTION: The authors present a case in which the patient sought treatment for a painful oral lesion. A histopathologic examination revealed characteristics of TB. Subsequently, pulmonary lesions were detected, and a diagnosis of pulmonary TB was confirmed. The patient underwent antituberculosis therapy, and his oral and systemic conditions improved rapidly. CLINICAL IMPLICATIONS: Although oral manifestations of TB are rare, clinicians should be aware of their possible occurrence in their patient populations. Such awareness can help diagnose TB at an early stage, thereby preventing complications and potential contaminations.