Comparison of Extramaxillary Anchored Implants, Tilted Implants, or Sinus Elevation Concepts on Stress Distribution in Atrophic Maxilla: A Finite Element Analysis.

PURPOSE: To determine the von Mises stress values of extramaxillary implants anchored in zygomatic bone, known as zygomatic implants, abutments, superstructures, and principal stress values of bone under occlusal forces and to compare them with tilted implants and sinus elevation concepts. The hypothesis of the study was that there would be higher stress on zygomatic implants under occlusal forces compared with tilted implants and the sinus elevation technique due to the more angled placement of the zygomatic implants. MATERIALS AND METHODS: Finite element analysis (FEA) was used to apply a force of 600 N (75 N premolars and 150 N first molar) vertically and at an angle of 20 degrees to the hybrid prosthesis with three different concepts-zygomatic implants, tilted implants, and sinus elevation-in D2 bones in six separate models. The posterior implants were tilted in zygomatic implant models (45 degrees) and tilted implant models (30 degrees). The von Mises and principal stress values formed in the models were compared by FEA. These values were also compared with the physiologic stress limit of the bone. RESULTS: In the zygomatic implant models, the von Mises stress values on both anterior and posterior implants were less than other models under both loading conditions. In addition, the lowest principal stress values were seen in these models. The highest von Mises stress among all models was found to be posterior implants in tilted implant models under oblique loading. In addition, the highest principal stress values were seen at posterior implants in the sinus elevation model under oblique loading. Vertical loading was found to induce less stress than loading at a 30-degree angle. CONCLUSION: Although zygomatic implants have a more angled placement, the stress values on the bone and implants are lower.

Is zirconium or stainless steel the most suitable crown material for less dentin stress in endodontically treated teeth?

BACKGROUND: Stainless steel crowns (SSCs), which have been used frequently in the treatment of first permanent molars in children until now, has become less applicable due to its poor aesthetic appearance. Zirconia crowns (ZCs) have become more popular due to their aesthetic advantage. However, stress transmission of ZCs to dental tissues under occlusal forces in endodontically treated teeth has not been described. OBJECTIVE: The aim of this study was to compare the stress distribution of different crown materials (ZCS, SSCs) and adhesive materials on dentin in endodontically treated permanent teeth and to specify the crown-adhesive model with lower stress. METHODS: Finite element analysis (FEA) was used to apply a force of 300 N from the inner part of the buccal tubercles (vertical loading) and a lingo-buccal at an angle of 30 degrees (oblique loading) of the first permanent molars (FPM) with different crown (ZCS, SSCs) and adhesive (Glass ionomer cement, Resin modified glass ionomer cement, Resin cement) materials in twelve separate models. The von Mises values obtained from the models were compared and the optimal stress values were determined by FEA. RESULTS: The lowest stress values of dentin were found in zirconia crown model with glass ionomer cement (GIC) adhesive under vertical loading (26,793 Mpa). In the zircon crown and GIC adhesive model, less von Mises stress occurred on the dentin under all conditions. CONCLUSIONS: ZCs and GIC adhesive may be recommended for teeth with a high probability of dentin fracture.

Dentist-patient communication on dental anxiety using the social media: A randomized controlled trial.

The purpose of the present study was to assess the effects of dentist-patient communication via social media on dental anxiety and to determine the appropriate timing of such communications. In this randomized, double-blinded and controlled trial, we used Instagram's quick replies system to answer patients' questions to alleviate dental anxiety for patients undergoing impacted teeth extraction under local anesthesia. Patients were assigned randomly into four groups according to the timing of such communications: only after (group 1, n = 36), only before (group 2, n = 35), before and after the operation (group 3, n = 36), and a control group who received no communication on social media (group 4, n = 36). Dental anxiety was evaluated one week before (pre-op) and after the operation (post-op) using recognized assessment scales -the Spielberger's State-Trait Anxiety Inventory, Modified Dental Anxiety Scale (MDAS), and Visual Analogue Scale (VAS). The results showed that the post-op values of group 4 had higher anxiety scores than the groups 2 and 3 according to VAS (p < 0.05). Within the groups, the anxiety levels showed a decreasing trend after surgery according to MDAS and VAS scores (p < 0.05). The results of this study suggest that communication with patients before the operation is sufficient to reduce their dental anxiety.

Comparison of the Efficacy of Botulinum Toxin, Local Anesthesia, and Platelet-Rich Plasma Injections in Patients With Myofascial Trigger Points in the Masseter Muscle.

PURPOSE: Masticatory myofascial trigger points (TrP) are one of the major causes of nondental pain in the orofacial region. Intramuscular injections are considered the first-line treatment for myofascial TrPs. The objectives of this study were to evaluate and compare the effectiveness of local anesthesia (LA), botulinum toxin (BTX), and platelet-rich plasma (PRP) injections for the treatment of myofascial TrPs in the masseter muscle. METHODS: In this retrospective study, the sample was composed of patients with myofascial TrPs in masseter muscle who were treated between 2016 and 2019. Patients were divided into 3 groups according to treatment methods: group I (LA injection), group II (BTX injection), and group III (PRP injection). Primary outcome variable was the average pain level at rest and while chewing, and pressure pain intensity (PPI), Jaw Functional Limitation Scale (JFLS) value, and quality-of-life (measured using Oral Health Impact Profile-14 (OHIP-14)) were secondary outcomes. The outcome variables were assessed at diagnosis, and 1, 3, and 6 months post-treatment. RESULTS: The study consisted of 82 patients (group I, 27; group II, 26; group III, 29). At 1 and 3 months, improvement in all parameters was recorded in all groups. Groups I and II showed superior improvement in all parameters compared with group III at 3 months. Improvements in VAS pain, JFLS, and OHIP-14 values were significantly better in group II than group I at 3 months (P = .009; P = .004; P = .002). At 6 months, significant improvement in VAS pain, JFLS, and OHIP-14 (P = .008; P < .001; P < .01) values was recorded only in group II. CONCLUSIONS: All procedures successfully improved the symptoms of TrPs in the masseter muscle at 1 and 3 months. However, BTX injection seemed superior at the 3-month follow-up and remained effective up to 6 months.

A comparative study between zirconia and titanium abutments on the stress distribution in parafunctional loading: A 3D finite element analysis.

BACKGROUND: Zirconia has become a popular biomaterial in dental implant systems because of its biocompatible and aesthetic properties. However, this material is more fragile than titanium so its use is limited. OBJECTIVES: The aim of this study was to compare the stresses on morse taper implant systems under parafunctional loading in different abutment materials using three-dimensional finite element analysis (3D FEA). METHODS: Four different variations were modelled. The models were created according to abutment materials (zirconia or titanium) and loading (1000 MPa vertical or oblique on abutments). The placement of the implants (diameter, 5.0 × 15 mm) were mandibular right first molar. RESULTS: In zirconia abutment models, von Mises stress (VMS) values of implants and abutments were decreased. Maximum and minimum principal stresses and VMS values increased in oblique loading. VMS values were highest in the connection level of the conical abutments in all models. CONCLUSIONS: Using conical zirconia abutments decreases von Mises stress values in abutments and implants. However, these values may exceed the pathological limits in bruxism patients. Therefore, microfractures may be related to the level of the abutment.

Buccal vascular malformation with multiple giant phleboliths: a rare case presentation and review of the literature.

PURPOSE: The purpose of this study was to describe a case and to review the diameters, symptoms, locations, and treatment methods for vascular malformations (VMs) with phleboliths. Our case report is probably the first to mention this observation because of sizes and large number of phleboliths in buccal region. CASE PRESENTATION: A 26-year-old male patient was referred to Ordu University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery for the evaluation and management of a painless tender swelling in the left buccal region. Clinically, a bluish mucosal lesion of the posterior region of the left buccal mucosa and lip is apparent. Panoramic radiography and CT were obtained for radiographical examinations. Multiple giant phleboliths with the largest dimension of 32 mm were seen in this region. Left maxillary first molar teeth extraction was indicated. An aspiration was performed and revealed that there is a risk of severe hemorrhage. The patient did not want to take MRI and stated that he only wanted to have dental treatment. Therefore, it was decided that the maxillary first molar should be retained in the region and endodontic treatment should be done, if necessary. CONCLUSIONS: The clinic of phlebolith patients is painless swelling and can reach up to 6 cm. The localization is not specific but is found in the masseter and parotid regions generally. Treatment may be invasive or non-invasive depending on, location, accessibility, depth of invasion, age, cosmetic issues, and risk of severe hemorrhage, as with the current case.

Results of Combined, Single-Session Arthrocentesis and Dextrose Prolotherapy for Symptomatic Temporomandibular Joint Syndrome: A Case Series.

OBJECTIVE: Arthrocentesis and prolotherapy are nonsurgical treatments for temporomandibular joint (TMJ) diseases. This study aimed to evaluate the treatment of hypermobility, pain, and displacement of the TMJ by consecutively performing arthrocentesis and prolotherapy in the same session. MATERIALS AND METHODS: In this study, 10 adults with disc displacement and painful, hypermobile TMJ were selected. Arthrocentesis and prolotherapy were consecutively performed using a 30% dextrose solution that was simultaneously injected into five areas: posterior disc attachment, superior joint space, superior and inferior capsular attachments, and stylomandibular ligament. Paired t-test, McNemar test, and chi-square test were used to assess the maximum mouth opening, clicking sounds, pain, and subluxation of the TMJ. Patients with rheumatoid arthritis and parafunctional habits such as teeth clenching and grinding and biting of the cheeks or any other objects and those who had undergone surgery were excluded from this study. RESULTS: A total of 10 participants (36.20 ± 7.06 years old, 7 women and 3 men) received a single treatment session of combined arthrocentesis and prolotherapy at the same office visit. Subluxation frequency and pain significantly decreased after the first week of treatment (p < 0.05). Subluxation also decreased at the 3-month follow-up (p < 0.05). Clicking sound values did not significantly change at any of the follow-up time points. Maximum mouth opening values decreased at all follow-up time points compared to baseline (p < 0.05). CONCLUSION: A single session of combined arthrocentesis and prolotherapy to treat symptomatic TMJ safely and significantly improved the subluxation and pain after 1 week and subluxation after 3 months compared to baseline status. The maximum mouth opening significantly decreased at all follow-up time points. Future studies assessing multiple treatment sessions are warranted.

The prevalence of foreign bodies in jaw bones on panoramic radiography.

OBJECTIVE: Foreign bodies can be deposited in the oral cavity either by traumatic or iatrogenic injury. The most common foreign bodies of iatrogenic origin encountered are restorative materials, like amalgam, and root canal fillings. The aim of this study was to determine the prevalence of foreign bodies detected with panoramic radiography in the jawbones, as well as to evaluate the etiology and characteristics of these pathologies. MATERIALS AND METHODS: From March 2012 to January 2014, 11,144 panoramic radiographs were taken and retrospectively reviewed. The number, characteristics, location of the foreign bodies, age, and gender of the patients were recorded. RESULTS: Of the 11,144 patients reviewed, 62 of them have a foreign body with a frequency of 0.6%. The patients who had a foreign body were between 14 and 81 years old. Female patients showed more foreign bodies than male patients. Among the 62 patients, 63 filling materials, one stapler, and five shrapnel were detected. Only 8 patients had symptoms associated with foreign bodies and these foreign bodies excised surgically. CONCLUSION: If possible, these pathologies must be removed at the time of detection to prevent further complications; however, in asymptomatic cases, according to location and the characteristic of the foreign body, they can be kept under observation without performing any operations.