Histopathological Examination of the Effects of Local and Systemic Bisphosphonate Usage in Bone Graft Applications on Bone Healing.

BACKGROUND: The effect of bisphosphonates on the resorption process of normal bone tissue has been clearly mentioned in the literature, while their effect on the grafting material is a new research area. Limited former study is not sufficient to determine the strength, reliability and dosage of bisphosphonates. In this study, our aim is to examine the effects of local and systemic use of bisphosphonates in bone graft applications on bone healing, histopathologically. METHODS: Therefore, 32 Sprague-Dawley rats are separated into four groups. In the first group, only an empty bone defect is made on tibia and the tissue is sutured primarily without any other application. In the second group, bone defect is filled with allograft material and closed without any other application. In the third group (LA), alendronate solution is locally added to the graft material before its application to the site of bone defect. In the fourth group, alendronate is applied systemically after the site of bone defect is grafted and primarily closed. After 6 weeks, all rats are killed and the obtained samples are examined histopathologically. RESULTS: Local and systemic application of alendronate increases new bone formation in a statistically significant degree. In LA group, newly formed bone was observed more mature and well developed. Alendronate application does not cause an increase in inflammation, fibrosis and necrosis. There is no increased necrosis with alendronate application. CONCLUSION: Local and systemic application of alendronate in bone grafting increases bone formation without any other complication. But we believe that further research should be made on dosage, usage and possible side effects.

Changes in serological bone turnover markers in bisphosphonate induced osteonecrosis of the jaws: A case control study.

BACKGROUND: There are a lot study confirmed the relationship of bone serum markers changes and skeletal irregularities. But there is no sufficient case control studies about the role of these markers on bisphosphonate induced osteonecrosis of jaws (BRONJ). AIMS: The aim of this study is to find out if there is any derangement of bone markers in bisphosphonate-treated patients with ONJ. METHODS: We obtained serum bone markers and other relevant endocrine assays on 20 patients with osteonecrosis of the jaw (ONJ) and 20 randomized healthy volunteers. All of the ONJ group treated with zoledronic acid and had been withdrawn from bisphosphonate for at least 6 months. Diagnostic criteria for ONJ were those formulated by the American Association of Oral and Maxillofacial Surgeons. Serum levels of several indices of bone remodeling were evaluated using commercial enzyme-linked immunosorbent assays. The biochemical assays were performed on N-Telopeptides of type I collagen (NTX), bone-specific alkaline phosphatase (ALP), calcitonin, osteocalcin, intact parathyroid hormone (PTH), T3, T4, TSH, and Vitamin D 25 hydroxy (Vit-D). RESULTS: In ONJ group, PTH level is statistically higher and TSH, Vit-D, osteocalcin and NTX levels statistically lower compared to control group. CONCLUSION: We conclude that these changes in PTH, Vit-D, TSH, osteocalcin and NTX levels maybe have a role in the pathophysiology of BRONJ. But the data need to be confirmed by future studies.

Evaluation of skeletal changes associated with surgically rapid palatal expansion without pterygomaxillary separation.

INTRODUCTION: To evaluate skeletal and nasal volume changes before and after surgery in surgically assisted rapid palatal expansion (SARPE) without pterygomaxillary separation and compare the dental changes by digital model analysis and radiographic analysis. SETTING AND SAMPLE: Population A total of 18 patients (10 females and 8 males) aged 15-33 years and with completed skeletal development, who were referred to Oral and Maxillofacial Surgery Department, Dentistry Faculty, Istanbul University and who had SARPE indication were included in the study. MATERIALS AND METHODS: Skeletal changes, lower nasal volume, transverse diameters of bony nasolacrimal duct and dental changes have been evaluated by using Cone beam computed tomography (CBCT) before and 6 months after the surgery. CBCT data was determined by Mimics v.18.01. Dental changes have been also evaluated by digital model analysis program 'Shape Orthoanalyzer' and the data are compared with those obtained using CBCT. RESULTS: The results obtained from dental measurements made using CBCT and those obtained using scanning three-dimensional (3D) models were consistent with each other. CBCT demonstrated that lower anterior nasal volume and transverse diameters of bony nasolacrimal duct showed statistically significant increase before and after the surgery. CONCLUSIONS: According to the study findings, SARPE without pterygomaxillary separation was noted to be an effective procedure. Lower nasal volumes were increased and the maxilla expanded in the transverse direction in all patients. Dental evaluations that were performed in this digital model analysis also supported our findings in CBCT. Transverse diameters of the bony nasolacrimal duct were shortened at all patients.

Treatment For The Large Aggressive Benign Lesions Of The Jaws.

OBJECTIVES: Our aim was to evaluate the clinical outcome of the conservative management of the significantly large benign aggressive lesions of the jaws. SUBJECTS AND METHODS: Twenty-two patients were reviewed regarding the demographic, radiographic, and operative findings. Patients were treated by decompression followed by curettage or only with curettage. RESULTS: No bone grafts were used. Mean follow-up time was 56.2 months. The mandible was more affected than the maxilla. Two of the ameloblastoma, two of the keratocystic odontogenic tumours, and one odontogenic myxoma were recurred. CONCLUSIONS: Despite the low number of the patients, it is concluded that the conservative management is predictable for the management of the benign aggressive lesions in order to reduce morbidity instead of directly performing radical surgery. The life during follow-up is mandatory in the situation of performing conservative surgery for the management of large aggressive lesions with high recurrence rate.

The use of reconstruction plates to treat benign mandibular pathological lesions: A retrospective clinical study.

INTRODUCTION: The purpose of this retrospective clinical study was to evaluate the indications for and the utility of reconstruction plates in the management of benign mandibular pathological lesions. The complications associated with plate use were also assessed. PATIENTS AND METHODS: The clinical and radiological data of 23 patients (16 males, 7 females) with large, benign mandibular pathologies were evaluated. During operations, reconstruction plates were used to prevent mandibular fracture or to allow for bone reconstruction after segmental or disarticulation resection. The mean follow-up time was 11.2months. RESULTS: Condylar sag was observed in one patient who had undergone disarticulation resection. A reconstruction plate was removed from one patient because of pain. A plate became exposed in one patient who had undergone a disarticulation resection. Two patients reported slight paraesthesia. Screw-loosening was observed in one patient who had received a non-locking plate. CONCLUSION: Reconstruction plates can be safely used to manage benign mandibular lesions. Preoperative bending of the plates on individualised models is useful for reducing the time required for plate adaptation during operation. Locking reconstruction plates are preferable for preventing screw-loosening. All complications can be managed with careful follow up.

Complications associated with surgically assisted rapid palatal expansion without pterygomaxillary separation.

INTRODUCTION: The purpose of this retrospective clinical study was to evaluate the surgical complications associated with the surgically assisted rapid palatal expansion (SARPE) which does not involve pterygomaxillary separation (PMS). PATIENTS AND METHODS: A total of 40 (25 females, 15 males) skeletally mature patients, who had the diagnosis of maxillary transverse maxillary deficiency (TMD), were treated surgically under local or general anesthesia. The mean follow-up time was 6 months. RESULTS: Recorded perioperative and postoperative complications were discussed within the current literature. No serious complications were observed intraoperatively. Eight patients (20%) showed postoperative complications including neurosensory deficits, maxillary sinus infection, epistaxis, fistula formation and incisional dehiscence. DISCUSSION: Neurosensory deficits were the most common findings. The present findings suggest that minor complications were observed associated with SARPE without PMS. The technique may be performed safely also under local anesthesia.

Does Combined Spinal Epidural Anesthesia Decrease the Morbidity of Iliac Block Bone Grafting for Deficient Alveolar Ridges Compared With General Anesthesia?

PURPOSE: To evaluate the morbidity of iliac block bone grafting performed under general anesthesia (GA) or combined spinal epidural anesthesia (CSEA). MATERIALS AND METHODS: We implemented a retrospective study including patients who underwent anterior iliac block bone grafting for deficient maxillary alveolar ridges. The anesthetic technique (GA or CSEA) was the primary predictor variable. The outcome variables were pain, gait disturbance, neurosensory disturbance (0 to 5 weeks), vomiting tendency (0 to 7 days), and postoperative hospitalization period (0 to 2 days). RESULTS: The sample comprised 22 patients, with 10 in the GA group and 12 in the CSEA group. No surgical complications except sensory disturbance in 2 patients were observed during the study period. Pain during initial healing (P < .001), the gait disturbance rate at 3 weeks after surgery (P = .003), and the vomiting tendency on the day of surgery (P < .001) were significantly higher in the GA group than in the CSEA group; all variables showed significant improvement with time in both groups. The postoperative hospitalization period was also significantly longer for the GA group than for the CSEA group (P < .001). No significant difference was observed between groups with regard to neurosensory disturbance. CONCLUSIONS: Iliac block bone grafting for deficient maxillary ridges can be successful under both GA and CSEA, although CSEA results in less pain and vomiting and early recovery, thus increasing patient comfort.

Benefits of sinogram-affirmed iterative reconstruction in 0.4 mSv ultra-low-dose CT of the upper abdomen following transarterial chemoembolisation: comparison to low-dose and standard-dose CT and filtered back projection technique.

AIM: To evaluate the advantage of sinogram-affirmed iterative reconstruction (SIR) compared to filtered back projection (FBP) in upper abdomen computed tomography (CT) after transarterial chemoembolisation (TACE) at different tube currents. MATERIALS AND METHODS: The study was approved by the institutional review board. Written informed consent was obtained from all patients. Post-TACE CT was performed with different tube currents successively varied in four steps (180, 90, 45 and 23 mAs) with 40 patients per group (mean age: 60±12 years, range: 23-85 years, sex: 70 female, 90 male). The data were reconstructed with standard FBP and five different SIR strengths. Image quality was independently rated by two readers on a five-point scale. High (Lipiodol-to-liver) as well as low (liver-to-fat) contrast-to-noise ratios (CNRs) were intra-individually compared within one dose to determine the optimal strength (S1-S5) and inter-individually between different doses to determine the possibility of dose reduction using the Kruskal-Wallis test. RESULTS: Subjective image quality and objective CNR analysis were concordant: intra-individually, SIR was significantly (p<0.001) superior to FBP. Inter-individually, regarding different doses (180 versus 23 ref mAs), there was no significant (p=1.00) difference when using S5 SIR at 23 mAs instead of FBP. CONCLUSION: SIR allows for an 88% dose reduction from 3.43 to 0.4 mSv in unenhanced CT of the liver following TACE without subjective or objective loss in image quality.

Keratocystic odontogenic tumors: predictive factors of recurrence by Ki-67 and AgNOR labelling.

PURPOSE: The purpose of the present study was to investigate the possible role of Ki-67 and argyrophilic nucleolar organizing regions (AgNOR) between the recurrent and nonrecurrent keratocystic odontogenic tumors (KCOTs). Another aim was to compare the correlation between these two markers. MATERIALS AND METHODS: 22 KCOTs were evaluated retrospectively. The actual proliferative activity of the KCOT was measured by Ki-67 labelling index and argyrophilic nucleolar organizing regions AgNOR count per nucleus. RESULTS: Recurrence occurred in 3 patients (13.6%) during the follow-up period (mean follow-up, 37.8 months) The Ki-67 and AgNOR counts were significantly higher in the recurrent lesions comparing to the non-recurrent lesions. (p=0,045; p=0,049) The correlation between Ki-67 and AgNOR counts was found to be positive (r=0,853 p=0,0001). CONCLUSION: Within the limit of the present study, it is thought that Ki-67 and AgNOR might be helpful as a prognostic marker for the recurrences of KCOTs. These markers reinforced the meaning of the new classification of the lesion as an odontogenic tumor. Enucleation with curettage or decompression following enucleation with curettage is a simple and appropriate surgical model for the treatment of KCOT despite the relative high recurrence rate. On the other hand, the conservative treatment can be chosen only if there is no coronoid invasion, no interruptive cortical lysis and no tissular invasion.

International round-robin study on the Ames fluctuation test.

An international round-robin study on the Ames fluctuation test [ISO 11350, 2012], a microplate version of the classic plate-incorporation method for the detection of mutagenicity in water, wastewater and chemicals was performed by 18 laboratories from seven countries. Such a round-robin study is a precondition for both the finalization of the ISO standardization process and a possible regulatory implementation in water legislation. The laboratories tested four water samples (spiked/nonspiked) and two chemical mixtures with and without supplementation of a S9-mix. Validity criteria (acceptable spontaneous and positive control-induced mutation counts) were fulfilled by 92-100%, depending on the test conditions. A two-step method for statistical evaluation of the test results is proposed and assessed in terms of specificity and sensitivity. The data were first subjected to powerful analysis of variance (ANOVA) after an arcsine-square-root transformation to detect significant differences between the test samples and the negative control (NC). A threshold (TH) value based on a pooled NC was then calculated to exclude false positive test results. Statistically, positive effects observed by the William's test were considered negative, if the mean of all replicates of a sample did not exceed the calculated TH. By making use of this approach, the overall test sensitivity was 100%, and the test specificity ranged from 80 to 100%.

Complication of polymethylmethacrylate bone cement in the mandible.

Polymethylmethacrylate bone cements have been widely used in orthopedic surgery as well as in maxillofacial area. Despite the advantages, it is well known that acrylic bone cements may cause bone or soft tissue necrosis because of the properties of its components and polymerization. This clinical report presents an extensive necrosis of the mandible after the use of the acrylic bone cement to fill the cyst cavity. The purpose of this article was to alert the clinicians about the complications that may occur after the use of the polymethylmethacrylate-based bone cements.

Intraosseous lipoma of the mandible: a case report and review of the literature.

Intraosseous lipoma is a benign tumor of the bone. It is mostly seen in the metaphyses of the long bones and calcaneus. There are few documented cases of intraosseous lipomas in the jaw. Clinically, the lesion is usually silent and radiologically it appears as a radiolucent area rarely including some radio-opacities. Diagnosis is based on clinical, radiological and histopathological features. Surgical removal of the lesion is the recommended treatment. The authors report a rare case of an intraosseous mandibular lipoma in a 45-year-old female, and review previously documented cases in the English literature. The histopathological and radiological features of the lesion are emphasized.

Electromyographic studies on the external anal sphincter in children with operated anorectal malformations.

Fecal incontinence is a common problem after surgical repair in patients with anorectal malformations. A normally functioning external anal sphincter (EAS) mechanism is a major factor for continence. The aim of this study was to assess the function of the EAS in children with operated anorectal malformations by electromyography (EMG) and to refine the sphincter function further. The study group consisted of 8 patients with incontinence problems who were operated for anorectal malformations. The electrical activity of EAS was evaluated by EMG using concentric needle electrodes in all subjects. The presence, localization, integrity and activity of the sphincter were assessed. Seven of 8 patients showed electrical activity of the EAS. Sphincter localization was found to be appropriate in six children. Five children showed a well preserved sphincter integrity and 2 of them disclosed normal EMG activity. In cases of localization or integrity abnormalities, secondary corrective surgery was planned, while in patients showing only abnormal EMG activity, biofeedback treatment was given. In cases of fecal incontinence in patients with operated anorectal malformations, electromyographic study shows the type of sphincter abnormality and further helps to make a decision whether to improve the EAS function with conservative treatment or surgically.

Assessment of the performance of the Ames II assay: a collaborative study with 19 coded compounds.

Nineteen coded chemicals were tested in an international collaborative study for their mutagenic activity. The assay system employed was the Ames II Mutagenicity Assay, using the tester strains TA98 and TAMix (TA7001-7006). The test compounds were selected from a published study with a large data set from the standard Ames plate-incorporation test. The following test compounds including matched pairs were investigated: cyclophoshamide, 2-naphthylamine, benzo(a)pyrene, pyrene, 2-acetylaminofluorene, 4,4'-methylene-bis(2-chloroaniline), 9,10-dimethylanthracene, anthracene, 4-nitroquinoline-N-oxide, diphenylnitrosamine, urethane, isopropyl-N(3-chlorophenyl)carbamate, benzidine, 3,3'-5,5'-tetramethylbenzidine, azoxybenzene, 3-aminotriazole, diethylstilbestrol, sucrose and methionine. The results of both assay systems were compared, and the inter-laboratory consistency of the Ames II test was assessed. Of the eight mutagens selected, six were correctly identified with the Ames II assay by all laboratories, one compound was judged positive by five of six investigators and one by four of six laboratories. All seven non-mutagenic samples were consistently negative in the Ames II assay. Of the four chemicals that gave inconsistent results in the traditional Ames test, three were uniformly classified as either positive or negative in the present study, whereas one compound gave equivocal results. A comparison of the test outcome of the different investigators resulted in an inter-laboratory consistency of 89.5%. Owing to the high concordance between the two test systems, and the low inter-laboratory variability in the Ames II assay results, the Ames II is an effective screening alternative to the standard Ames test, requiring less test material and labor.

Genomic organization and chromosomal mapping of SPARC-like 1, a gene down regulated in cancers.

Human SPARC-like 1 (SPARCL1), also known as MAST9 or hevin, is a member of the SPARC protein family. Originally we identified SPARCL1 as one of the genes down regulated in human non-small cell lung cancer (NSCLC). Recent reports indicate that the down regulation of SPARCL1 also occurs in prostate and colon carcinomas, suggesting that SPARCL1 inactivation is a common event not only in NSCLCs but also in other tumors of epithelial origin. In the present work we report the cloning and mapping of the genomic locus of human SPARCL1. Using fluorescence in situ hybridization analysis, SPARCL1 was localized to chromosome 4q22-25, a region often deleted in human cancers. Furthermore, we show that the intron/exon organization of the human SPARCL1 gene is similar to its murine homologue SC1. SPARCL1 contains 11 exons and 10 introns which span approximately 47 kb of the genome. We also sequenced the 5'-flanking region of the human SPARCL1 gene containing 2.4 kb of the putative promoter region. The data presented herein are a prerequisite for deletion/mutation analysis of the SPARCL1 gene in tumors. In addition, knowledge of the SPARCL1 promoter sequence allows to investigate the regulation of SPARCL1 expression on the transcriptional level. Taken together our results will help to clarify the function of SPARCL1 in tumor formation.