The Frequency of Occipital Spurs in Relation to the Cephalic Index: An Anatomorphometric Cone Beam CT Study.

BACKGROUND: The occipital spur (OS) can be described as an abnormal elongation of the external occipital protuberance (EOP). The cephalic index (CI) refers to the ratio of width to length in any skull. AIM: The aim of the present study was to evaluate the frequency and types of OS. It also aimed to determine the mean CI and the distribution of skull types using cone beam computed tomography (CBCT). And to determine if there was a relationship between the cephalic index and the presence and types of OS. METHODS: CBCT scans from 523 patients were included in the study. OSs were classified as type 1 (flat), type 2 (crest), and type 3 (spine). Skull length and width were measured on axial sections and the CI was calculated. Based on the cephalic index (CI), skull types were classified as dolichocephalic (CI < 75), mesocephalic (75 < CI < 80), brachycephalic (80 < CI < 85), and hyperbrachycephalic (CI > 85). RESULTS: The most common cranial types in the study group were brachycephalic (44.7%), mesocephalic (28.3%), hyperbrachycephalic (21.2%), and dolichocephalic (5.7%). Regarding the presence of OS, 54.3% of the participants had no OS, 23.1% had flat type, 15.3% had crest type, and 7.2% had spin type OS. There was a statistically significant difference (P < 0.05) in the frequency of OS according to skull type. CONCLUSION: This study, the first to evaluate CI and OS using CBCT, concludes that brachycephaly is the most common cranial type. OS is more common in mesocephalic and dolichocephalic skulls, at older ages, and in males.

A retrospective study: Do all impacted teeth cause pathology?

OBJECTIVE: The objective of this study is to determine the incidence of impacted teeth and the frequency of pathologies they caused by cone beam computed tomography (CBCT) retrospectively. MATERIALS AND METHODS: In this study, 608 patients' CBCT images were analyzed retrospectively. Detected impacted teeth were classified as incisor, canine, premolar, molar, third molar, and supernumerary teeth. The pathologies caused by impacted teeth are classified as cysts or tumors, tooth decay, root resorptions, and periodontal bone loss. RESULTS: Impacted teeth were detected in 34.37% of the 608 CBCT images included in the study. The distribution of impacted teeth was 9.4% incisor, 29.4% canine, 9.9% premolar, 2.9% molar, 9.3% supernumerary, and 39.9% third molar teeth. Approximately 63.7% of the impacted teeth caused a pathology. The pathology that was most commonly caused by impacted teeth was periodontal bone loss (44.4%), and respectively others were root resorptions (33.3%), cysts or tumors (8.6%), and tooth decay (2.3%). The most common cause of this pathology was right mandibular third molar teeth. CONCLUSION: Impacted teeth were common and they often caused a pathology. CBCT is a useful device to assess the impacted teeth. When the impacted teeth are evaluated, each tooth should be assessed within itself. If the impacted teeth are not caused by pathology, they can be kept under control.

Matrix metalloproteinase-7 in periodontitis with type 2 diabetes mellitus.

BACKGROUND AND OBJECTIVE: Elevated levels of matrix metalloproteinase-7 (MMP7) have been observed in serum samples of subjects with type 2 diabetes mellitus (T2DM) and in gingival tissues of subjects with periodontitis. The aim of the present study was to collect in vivo and in silico evidence on the role of MMP7 in the interplay between T2DM and generalized periodontitis (GP). MATERIAL AND METHODS: The extent of MMP7 expression and localization were immunohistochemically analyzed in gingival tissues of patients with GP with T2DM (T2DM/GP, n = 11), systemically healthy patients with GP (n = 7), and systemically and periodontally healthy controls (n = 11). An in silico network model was built to determine the interactions between MMP7 and T2DM pathways. Regulation of neutrophil transmigration by MMP7 was analyzed in a knock-out mice model. RESULTS: In human gingival tissues, the proportion of cells with robust MMP7 expression was elevated in patients with T2DM/GP in comparison to controls (P = .014). According to the in silico analysis, "hydroxyl radical" and "hydrogen peroxide" compounds were among the most central nodes of the network, and were within the shortest paths connecting "glucose" to "MMP7." In MMP7 knock-out mice, an intense accumulation of neutrophils was observed in the gingival epithelium as compared to wild-type mice (P = .0001). CONCLUSION: Elevated MMP7 expression in gingival tissues of patients with T2DM/GP is related to the activation of reactive oxygen species by hyperglycemia. Suppression of MMP7 expression results in impaired neutrophil transmigration in gingiva.

Investigation of prevalence of dental anomalies by using digital panoramic radiographs.

BACKGROUND: This study was performed to evaluate the prevalence of all types and subtypes of dental anomalies among 6- to 40-year-old patients by using panoramic radiographs. MATERIALS AND METHODS: This cross-sectional study was conducted by analysing digital panoramic radiographs of 1200 patients admitted to our clinic in 2014. Dental anomalies were examined under 5 types and 16 subtypes. Dental ano-malies were divided into 5 types: (a) number (including hypodontia, oligodontia and hyperdontia); (b) size (including microdontia and macrodontia); (c) structure (including amelogenesis imperfecta, dentinogenesis imperfecta and dentin dys-plasia); (d) position (including transposition, ectopia, displacement, impaction and inversion); (e) shape (including fusion-gemination, dilaceration and taurodontism). RESULTS: The prevalence of dental anomalies diagnosed by panoramic radiographs was 39.2% (46% in men and 54% in women). Anomalies of position (60.8%) and shape (27.8%) were the most common types of abnormalities and anomalies of size (8.2%), structure (0.2%) and number (17%) were the least in both genders. Anomalies of impaction (45.5%), dilacerations (16.3%), hypodontia (13.8%) and taurodontism (11.2%) were the most common subtypes of dental anomalies. Taurodontism was more common in the age groups of 13-19 years. The age range of the most frequent of all other anomalies was 20-29. CONCLUSIONS: Anomalies of tooth position were the most common type of dental anomalies and structure anomalies were the least common in this Turkish po-pulation. The frequency and type of dental anomalies vary within and between populations, confirming the role of racial factors in the prevalence of dental ano-malies. Digital panoramic radiography is a very useful method for the detection of dental anomalies. (Folia Morphol 2018; 77, 2: 323-328).

The Intraoral Ultrasonography in Dentistry.

Ultrasonography (USG) is a diagnostic method that the ultrasonic image is created by ultrahigh-frequency sound waves, which have an acoustic frequency above the threshold of human hearing. Compared to other medical imaging methods, USG has several advantages of being real time, portable, inexpensive, radiation free, and noninvasive. In the medicine, most of the USG applications are transcutaneous. However, intraoral USG has been a relatively rare application, it has recently been drawing more interest. Intraoral USG is also used in dentistry for examining the salivary glands and ducts, as well as the mouth floor, the buccal, labial, and palatal mucosa, the tongue, periodontal tissues, and periapical lesions. The main purpose of this review is to provide detailed information about intraoral USG applications in dentistry.

Evaluation of enamel pearls by cone-beam computed tomography (CBCT).

OBJECTIVE: The aim of this study was to evaluate the frequency of enamel pearls according to population, sex and tooth groups on Cone-Beam Computed Tomography (CBCT) or Dental Volumetric Tomography (DVT) scans of patients, retrospectively. STUDY DESIGN: In this study, 15185 teeth belonging to 768 patients, 430 female and 338 male, was performed cross-sectional examination by CBCT. The volumetric Computed Tomography used in the study is Newton FP based on flat-panel. The data were analyzed with Pearson chi-squared test. RESULTS: Enamel pearls were detected in 36 subjects (4.69%). Of these enamel pearls, 19 were detected in male and 17 were in male. There was no statistically a significant association between prevalence of enamel pearls and sex. All of enamel pearls were detected in molar teeth, for prevalence 0.83%. CONCLUSION: All of enamel pearls are found upper and lower molar teeth, especially the most commonly in maxillary second and third molars.

Oxidative stress and myeloperoxidase levels in saliva of patients with recurrent aphthous stomatitis.

OBJECTIVE: Recurrent aphthous stomatitis (RAS) is the most common oral ulcerative condition affecting 5-25% of the general population. The aim of this study was to evaluate the oxidative stress parameters in saliva of patients with RAS and to investigate the relationship among these parameters in either group. MATERIALS AND METHODS: The study involved 50 patients with RAS of whom 24 were male and 26 were female, and 25 healthy controls of whom 13 were male and 12 were female. RESULTS: There was no statistically significant difference in the salivary total antioxidant capacity, total oxidant status, oxidative stress index levels, and myeloperoxidase activity between patients with RAS and those in the control group. CONCLUSIONS: The results show that reactive oxygen species may not play a role in the etiology of RAS.

Dental panoramic radiography in the diagnosis of osteoporosis.

Osteoporosis is common in the elderly and the dentist is often the only healthcare professional that they visit regularly. Since dental panoramic radiographs (DPRs) are widely used for routine examinations when planning treatment, this study evaluated whether the presence of osteoporosis might be apparent in a population of patients who underwent DPR. The mandibular cortical index (MCI) and a new method of measuring the mandibular radiographic density (m-RD), which used DPR that incorporated an aluminium step-wedge, were compared with the total vertebral bone mineral density (v-BMD) of the lumbar vertebrae measured using dual energy X-ray absorptiometry (DXA) in 25 osteoporotic women. Although there was only a weak correlation between m-RD and v-BMD, significant correlation was found between MCI and v-BMD. Since both m-RD and MCI were related to vBMD, dental radiographic density and MCI may be useful in clinical dental practice to identify osteoporotic women with previously undetected low BMD.

Clinical and pharmacological variables as a risk factor for nifedipine-induced gingival overgrowth.

BACKGROUND: Gingival enlargement is usually noted within one to two months after the initiation of nifedipine therapy. The aetiology of nifedipine-induced gingival overgrowth is uncertain. The aim of this study was to determine the relationship between plasma and gingival crevice fluid (GCF) nifedipine concentrations and the degree of gingival overgrowth in patients treated with nifedipine, and also to assess the correlations between clinical and pharmacological variables. METHODS: Eighteen patients taking nifedipine in regular doses for at least six months participated in the study. Gingival enlargement was evaluated with two indices to score vertical and horizontal overgrowth. Gingival index (GI), plaque index (PI), gingival bleeding time index (GBTI), probing depth (PD) and clinical attachment level (CAL) were also evaluated. GCF and plasma nifedipine concentrations were determined by using high performance liquid chromatography. RESULTS: There was no significant difference between responders and non-responders for PI, GI and GBTI. The mean concentration of nifedipine in GCF was significantly greater than concentration in plasma. No significant difference was observed for GCF and plasma nifedipine concentration between responders and non-responders. CONCLUSIONS: The present study showed that neither GCF nor plasma nifedipine levels appeared to be a risk factor for nifedipine-induced gingival overgrowth. Improving the oral hygiene in patients using nifedipine may help control the degree of drug-induced gingival enlargement.

Evaluation of hyaluronic matrix efficacy in sinus augmentation: a randomized-controlled histomorphometric and micro-computed tomography analysis.

The objective of the present study was to test the hypothesis that the addition of hyaluronic acid-based matrix to collagenated heterologous bone graft for sinus augmentation would enhance bone formation compared to collagenated heterologous bone graft alone in the early healing period, by micro-computed tomography and histomorphometry. Thirteen systemically healthy patients requiring bilateral two-stage maxillary sinus augmentation (residual crest height≤4mm) were enrolled in this split-mouth prospective randomized controlled study. One sinus side as a control group was grafted with only collagenated heterologous bone graft; the other region as a test group was grafted with hyaluronic matrix and collagenated heterologous bone graft. Bone biopsy samples were taken after 4 months during the dental implant surgery and analyzed using micro-computed tomography and histomorphometric parameters. According to the micro-computed tomography and histomorphometric results, a significantly higher percentage of new bone was observed in the test group when compared to the control group after 4 months of healing. This study confirmed the hypothesis that the addition of hyaluronic matrix to collagenated heterologous bone graft for sinus augmentation enhances bone formation compared to collagenated heterologous bone graft alone in the early healing period.

An investigation of the factors that affect surgical hand disinfection with polyvidone iodine.

This study investigated the factors influencing the effectiveness of 7.5% polyvidone iodine as a surgical antiseptic. The study involved 100 operating staff (75 doctors and 25 nurses) from hospital surgical teams. Fingertips of both hands of the subjects were pressed on to agar culture before and after washing and after completion of surgery. Handwashing lasting for more than 3 min led to a significant decrease in the number of colonies compared with handwashing lasting for less than 3 min. Moreover, the number of colonies was significantly higher when surgery lasted for longer than 95 min. However, the handwashing style (with or without brushing) was not found to have a significant effect on the outcome of the disinfection procedure in terms of bacterial colonization. Subjects who had colonization of their hands after surgery were found to have significantly higher colony counts before handwashing compared with those who did not have any colonization on their hands after surgery. The results of this study revealed that in order to attain effective disinfection with polyvidone iodine, the duration of handwashing should be at least 3 min. The risk of recolonization increases when the duration of surgery exceeds 95 min.

Investigation of OH-proline contents of hernia sacs in children and comparison with adults.

PURPOSE: One of the factors suggested to be causative in hernia formation is defective collagen metabolism. In this study, we investigated whether there is any relationship between the collagen contents of indirect hernial sacs and certain demographic and anatomic parameters. METHODS: Hernial sac hydroxyproline levels were measured in 100 pediatric and 23 adult indirect inguinal hernia cases as indicators of collagen concentrations. Hydroxyproline levels were compared between boys and girls, right and left sided hernias, unilateral and bilateral cases, children and adults. Whether there was any relationship between patient age and hydroxyproline level was also investigated. RESULTS: No difference was found between males and females (p > 0.05), right and left sided hernias (p > 0.05) or unilateral and bilateral cases (p > 0.05). Hydroxyproline levels of adults were found to be significantly higher than those of children (p = 0.000). There was also a positive correlation between age and hydroxyproline levels of boys (r = 0.285, p = 0.023). CONCLUSION: Although a relationship between direct inguinal hernia and collagen structure has been shown by some investigators, we were unable to point to any significant findings which would indicate such a relationship in indirect inguinal hernia cases. Further studies on hydroxyproline levels in peritoneal samples will be necessary to understand the role of peritoneal hydroxyproline levels in hernia formation.

Effects of endogenous sex hormones on the periodontium--review of literature.

Hormones are specific regulatory molecules that have potent effects on the major determinants of the development and the integrity of the skeleton and oral cavity including periodontal tissues. It is clear that periodontal manifestations occur when an imbalance of these steroid hormones take place. The authors conducted a Medline search up to 2004 and in addition, a manual search was also performed including bibliographies of relevant papers, review articles and books. This review focuses on the effects of endogenous sex hormones on the periodontium and the goal was to inform and update practitioners' knowledge about the impact of these hormones on periodontal status. In addition, this review article will analyze how these hormones influence the periodontium at different life stages such as puberty, menstruation, pregnancy, menopause and post-menopause. Moreover, the effects of contraceptives and hormone replacement therapies on the periodontium will be discussed. It is clear that endogenous sex steroid hormones play significant roles in modulating the periodontal tissue responses. A better understanding of the periodontal changes to varying hormonal levels throughout life can help the dental practitioner in diagnosis and treatment.

The osseous and dental changes of patients with chronic renal failure by CBCT.

OBJECTIVES: The aim of the present study was to evaluate the osseous changes of the jaws of patients with chronic renal failure (CRF) by CBCT. METHODS: On CBCT scans obtained from 15 patients with CRF and 15 control patients (7 males and 8 females), the mean was calculated for the antegonial index (AI), mental index (MI), panoramic mandibular index (PMI) and mandibular cortical index (MCI). The MI, AI and PMI, pulp chamber size, number of teeth with pulp calcification and lamina dura loss were compared using the paired t-test, and the MCI values were analysed using the χ(2) test. RESULTS: There were no statistically significant differences in the PMI, MI and AI values in patients with CRF and the control group. With regard to MCI, the cortical margins of the mandible were more porous in patients with CRF than in the control group, and also soft-tissue calcifications, lamina dura loss and radiolucent defects were more common in patients with CRF. There were no statistically significant differences in pulp chamber size and pulp calcifications between patients with CRF and the control group. CONCLUSIONS: Radiographic changes in the jawbones of patients with CRF may be commonly seen. CBCT is a valuable diagnostic tool for the evaluation of osseous findings, pulp chamber, soft-tissue calcifications and MCIs and allows indices measurement in three dimensions without any superposition.

Changes in Exfoliative Cell of Oral Mucosa in Kidney Transplant Patients.

OBJECTIVES: The aim of this study was to investigate quantitative cytologic changes in oral mucosal smears collected from kidney transplant patients by modern stereologic methods. METHODS: We enrolled 32 kidney transplant patients. Smears were obtained from the buccal mucosa transplant patients before and 12 months after kidney transplantation. Smears from each individual were stained using the Papanicolaou method and were analyzed using a stereological method. RESULTS: Statistically, the nuclear volumes and cytoplasmic volumes in the cells of buccal mucosa were markedly higher after kidney transplantation (P < .05). There was a decreased positive cell density in the oral epithelial cells after kidney transplantation compared with before renal transplantation (P < .05). CONCLUSIONS: These findings suggest that there are alterations in the oral epithelial cells after kidney transplantation, which are detectable by microscopy and cytomorphometry.

Determination of pseudocholinesterase activity in the gingival crevicular fluid, saliva, and serum from patients with juvenile periodontitis and rapidly progressive periodontitis.

By use of a spectrophotometric method, pseudocholinesterase (PCE) activities were determined in gingival crevicular fluid (GCF), saliva, and serum from patients with juvenile periodontitis (JP) and rapidly progressive periodontitis (RPP) and from controls. The PCE activity in the GCF samples was 181 +/- 48 U/L in the JP group, 588 +/- 135 U/L in the RPP group, and 88.5 +/- 29.1 U/L in the control group. Saliva PCE activity levels were 9.1 +/- 1.7 U/L in the JP group, 21.8 +/- 4.5 U/L in the RPP group, and 12.7 +/- 0.8 U/L in the control group. GCF contained a higher PCE activity than saliva but a lower one than that of serum. The RPP group had a significantly higher PCE activity in both the GCF and saliva samples. No significant differences could be found regarding serum enzyme levels. Also, no significant correlations were present between biochemical values and the severity of periodontal disease. GCF may be an important source for the PCE content of saliva. It is suggested that the increased PCE activity seen in RPP patients might be caused by either the direct production of esterases by bacteria or the induction of esterases during periodontal destruction.

The effect of periodontal therapy on salivary pseudocholinesterase activity.

The effects of different stages of periodontal therapy on salivary pseudocholinesterase (PCE) activity in patients with periodontitis were determined by use of a spectrophotometric method. The mean PCE activity in whole saliva was 17.95 U/L in the pre-treatment phase, 4.67 U/L after scaling and oral hygiene instructions, and 1.93 U/L following surgical procedures. It was observed that the mean salivary PCE activity in patients with periodontitis showed a tendency to decrease in both phases of treatment, and PCE levels at the end of periodontal therapy were similar to those of healthy subjects.

The clinical effects of nifedipine on periodontal status.

The present study was conducted to determine the clinical effects of nifedipine on the gingiva of 97 patients. Patients were examined for changes in periodontal status and divided into subgroups, based on their age, gender, duration of drug intake, presence/absence of plaque and gingival inflammation, and according to the presence and severity of gingival overgrowth. Gingival overgrowth was noticed in 29% of the patients. Among the recorded parameters, duration of drug intake, presence/severity of gingival inflammation, and gender seemed to have the greatest effect on the development of gingival overgrowth. Patients with higher gingival inflammation scores, those on nifedipine medication for more than 4 years, and males were likely to have an increased tendency for higher incidence and severity of gingival overgrowth. The findings of the present study suggest that nifedipine medication induces gingival overgrowth and that certain local factors are involved in the pathogenesis of drug-induced gingival overgrowth. However, individual ability and sensitivity to metabolize the drug and its metabolites also seem to be important etiological factors.

The importance of data presentation regarding gingival crevicular fluid myeloperoxidase and elastase-like activity in periodontal disease and health status.

BACKGROUND: The enzymatic profile of gingival crevicular fluid (GCF) is being analyzed with increasing interest, but related studies lack a general consensus on most methodological points, including the appropriate mode of data presentation. METHODS: GCF myeloperoxidase (MPO) and elastase-like activity (ELA) levels were spectrophotometrically determined on a total of 60 subjects who were divided into three equal subgroups as early-onset periodontitis (EOP), adult periodontitis (AP), and healthy. GCF enzyme levels were calculated and evaluated both as total enzyme activity and enzyme concentration. The correlations between these GCF enzymes and clinical periodontal status were also analyzed. RESULTS: With both modes of data presentation, the results regarding MPO activity were consistent. When presented either as total MPO activity or MPO concentration, the periodontally healthy group showed significantly lower MPO activity than the two patient groups (P<0.05). However, two modes of data presentation did not match when GCF ELA was concerned. When data were reported as total ELA, the healthy group exhibited lower enzyme activity (0.02 +/- 0.001 U) than EOP (0.04 +/- 0.01 U) and AP (0.06 +/- 0.02 U) groups; but when reported as concentration, the highest ELA levels were seen in the healthy group (221 +/- 31.53 nmol/min/ml), followed by AP (98.63 +/- 23.03 nmol/min/ml) and EOP (70.49 +/- 12.02 nmol/min/ml) (P<0.05). A strong-positive and significant correlation existed between GCF MPO and ELA. Correlations with clinical parameters were mostly observed with total activities. CONCLUSIONS: The findings of the present study confirm the relationship between GCF ELA and MPO activity and periodontal disease and also support the functional relativity between the two enzymes. Furthermore, based on these findings, it can be suggested that data presentation by use of total activity seems to be more sensitive in both the reflection of the actual enzymatic profile of GCF and also the existing clinical periodontal status. For each GCF component, the validity of different modes of data presentation should be considered.

The histological investigation of gingiva from patients with chronic renal failure, renal transplants, and periodontitis: a light and electron microscopic study.

The clinical and histological appearance of gingiva was evaluated in renal transplant recipients (RTR) receiving immunosuppressive drugs, in patients with chronic renal failure (CRF) undergoing hemodialysis, and systemically healthy individuals with periodontitis. Although the amount of bacterial plaque accumulation was similar among the groups (P greater than 0.05), the gingival inflammation was significantly less in RTR when compared to the other 2 groups (P less than 0.05). In light microscopic investigation the overall appearance of the connective tissue was similar in all of the groups. A mononuclear cell infiltration was present in all of the specimens; however, the number of inflammatory cells in patients with periodontitis was significantly higher than the other 2 groups (P less than 0.05). Prominent epithelial changes in the superficial layers of the oral epithelium; i.e., areas showing desquamation-like appearance, were noticed in patients with CRF. In electron microscopic investigation, fibroblasts and plasma cells with well-developed granular endoplasmic reticulum were found in connective tissue in RTR patients. In patients with CRF, epithelial cells presented swollen granular endoplasmic reticulum cisternae resembling vacuoles, indicating the presence of degeneration. It was suggested that with the use of immunosuppressive drugs the response to bacterial plaque did not diminish completely.