Evaluation of Sinus Membrane Perforation in Osteotome Sinus Floor Elevation With and Without Grafting.

The purpose of this study was to evaluate, using cone-beam computerized tomography (CBCT), the rate of sinus membrane perforation in osteotome sinus floor elevation (OSFE) performed with and without a graft material. Thirty patients with 52 OSFE sites were included in the study. Patients were divided into the control group (OSFE performed without graft material) and test groups (OSFE performed with autograft or xenograft). The autograft was harvested from the maxillary tuberosity using bone forceps. The xenograft was a commercial product originating from bovine bone. Graft volume was measured using the water displacement method. CBCT was performed at the initial examination and immediately after surgery to measure the residual bone height and to evaluate the endo-sinus bone gain and membrane perforation. The rate of sinus membrane perforation was 15.4%. Of the 52 OSFE procedures, 26.9% were performed without grafting and 34.6% and 38.5% were performed with autografts and xenografts, respectively. Membrane perforation was significantly higher in the autograft group (P = .033). The median volume of graft materials was 0.3 mL. The difference in graft volume between the autograft and xenograft was not statistically significant (P = .768). The mean endo-sinus bone gain was 6.55 mm in patients without membrane perforation and 8.71 mm in patients with membrane perforation; this difference was statistically significant (P = .035). The volume and physical properties of graft materials are important factors in membrane perforation. Further clinical studies with larger and standardized samples are needed to confirm the effect of graft materials on sinus membrane perforation in OSFE.

Can Hyaluronidase Be an Alternative Postoperative Anti-edema Agent to Dexamethasone? Preliminary Results of an Animal Study.

PURPOSE: Recombinant human hyaluronidase (rHuPH20) is widely used as a spreading factor, which enhances the absorption of subcutaneously injected medicines. The anti-inflammatory and anti-edema effects of the enzyme were demonstrated in previous studies. In the present study, the anti-edema effect of rHuPH20 was compared with that of dexamethasone in a traumatic rat paw edema model. MATERIALS AND METHODS: Twenty-four Sprague-Dawley rats (weight 200 to 450 g) were divided into 3 groups: control (group 1), rHuPH20 (group 2), and dexamethasone (group 3). Traumatic edema was induced in the right hind paws of the rats using Feeney's weight-drop model. After edema induction, 0.4 mL of rHuPH20 (100 U/kg = 0.88 µg/kg dose) and 0.4 mL of dexamethasone (0.5 mg/kg dose) were injected into the right hind paws of the rats in groups 2 and 3. The paw volumes were measured before edema induction and at 3, 6, 12, 24, 48, and 72 hours after induction using a plethysmometer. The Mann-Whitney U test was used for the statistical analyses. Probabilities < .05 were accepted as statistically significant. RESULTS: The between percentage change in the edema mean values of groups 1 and 3 showed no significant difference at all time points; however, group 2 showed significantly less change in the edema mean values at 3, 6, 12, 24, and 48 hours after edema induction (P < .05) compared with group 1. The change in the edema mean value for group 2 was significantly less than that for group 3 at 3, 6, 12, 24, and 48 hours after edema induction (P < .05). CONCLUSIONS: Local rHuPH20 injection more effectively reduced the edema that was induced traumatically in rat paws than did dexamethasone. However, further clinical studies are needed regarding the use of rHuPH20 as a postoperative anti-edema agent in place of dexamethasone.

Treatment of oroantral fistulas using bony press-fit technique.

PURPOSE: The objective of this study was to determine the effectiveness of the bony press-fit technique in closing oroantral communications (OACs) and oroantral fistulas (OAFs) and in identifying potential intraoral donor sites. PATIENTS AND METHODS: Ten patients, 4 with OACs and 6 with OAFs, were treated with autogenous bone grafts using the bony press-fit technique. In 9 patients, dental extractions caused OACs or OAFs; in 1 patient, an OAC appeared after cyst enucleation. Donor sites included the chin (3 patients), buccal exostosis (1 patient), maxillary tuberosity (2 patients), ramus (1 patient), and the lateral wall of the maxillary sinus (3 patients). The preoperative evaluation of the patients, surgical technique, and postoperative management were examined. RESULTS: In all 10 patients, a stable press fit of the graft was achieved. Additional fixation methods were not needed. In 2 patients, mucosal dehiscence developed, but healed spontaneously. In 2 patients, dental implant surgery was performed in the grafted area. CONCLUSION: Treatment of 10 patients with OACs or OAFs was performed, with a 100% success rate. The bony press-fit technique can be used to safely close OACs or OAFs, and it presents some advantages compared with other techniques.

A comparison of residual smear layer and erosion following different endodontic irrigation protocols tested under clinical and laboratory conditions.

OBJECTIVE: To compare the smear layer removal efficacy and erosive effects of different irrigation protocols under clinical and laboratory conditions. MATERIALS AND METHODS: Mandibular third molars (n = 32) of 30-45 year-old patients were instrumented with rotary files and were randomly assigned to one of the following groups for final irrigation: (1) 5.25% NaOCl; (2) 17% EDTA; and (3) BioPure MTAD. Thereafter, the teeth were immediately extracted and processed for micromorphological investigation. In vitro specimen pairs were prepared by repeating the clinical experiments on freshly-extracted mandibular third molars. To compare open and closed systems, laboratory experiments were repeated on 32 additional teeth with enlarged apical foramen. The cleanliness of the root canals and the extent of erosion were assessed by environmental scanning electron microscopy. RESULTS: Specimens prepared under clinical and laboratory conditions had similar cleanliness and erosion scores (p > 0.05). Under both conditions, the tested solutions were more effective in removing the smear layer in the coronal and middle regions than in the apical one. Comparison of closed and open systems showed similar levels of cleanliness and erosion in all regions (p > 0.05), with the exception of 17% EDTA showing significantly higher levels of cleanliness and erosion in the apical third of open-end specimens. CONCLUSIONS: Based on clinical correlates of in vitro root canal cleanliness and erosion, laboratory testing of root canal irrigants on extracted teeth with closed apices can serve as a reliable method to simulate the clinical condition. EDTA was the most effective final irrigation solution in removing the smear layer at the expense of yielding the greatest erosive effect.

Effects of Stabilization of the Sinus Membrane by Dental Implant Insertion and Membrane Suturing on Endo-Sinus Bone Gain in Cases of Lateral Sinus Lift Performed Without Graft Material.

PURPOSE: The aim of this study was to investigate the effects of membrane stabilization by suturing the sinus membrane and dental implant insertion on endo-sinus bone formation in lateral sinus lifting performed without grafting. MATERIALS AND METHODS: Maxillary sinus lift surgery using the lateral approach was performed bilaterally in 30 New Zealand white rabbits. The maxillary sinus areas were divided into control and test groups. In the control group, a titanium screw was placed after sinus membrane elevation, while in the test group, the sinus membrane was sutured to the lateral walls and a titanium screw was placed in the center of the alveolar crest. The animals were sacrificed at 4 and 8 weeks. Samples were collected, and micro-computed tomography (micro-CT) analysis was performed. The volume of newly formed bone, percentage of osseointegration, sinus volume, residual bone height, and protrusion length of the implants were measured using micro-CT analysis. RESULTS: The sinus volume, volume of newly formed bone, and percentage of osseointegration in the test group were significantly higher than those in the control group at 4 weeks (p = 0.01, p = 0.04, p = 0.02, respectively) While the volume of newly formed bone was 17.1 ± 3.08 mm3 in the control group, it was 26.9 ± 14.26 mm3 in the test group at 4 weeks. The volume of newly formed bone was significantly decreased from 26.9 ± 14.26 mm3 to 17 ± 3.66 mm3 at 8 weeks (p = 0.02). No significant difference in residual bone height was found at 4 and 8 weeks (p = 0.07). No significant difference in implant protrusion length was found between the control and test groups (p = 0.18). Protrusion length and new bone formation in the sinus showed a negative relationship (p = 0.01). CONCLUSION: Suturing the sinus membrane to the lateral sinus wall is an effective approach for increasing osseointegration, bone volume, and sinus volume in the short-term. A slow-absorbing suture material can be used to maintain sinus and bone volumes in the long-term.

Interdisciplinary treatment of an adult patient with old extraction sites.

This case report describes the interdisciplinary treatment of a 31-year-old female patient showing a protrusive profile, maxillary constriction, mandibular crowding, a Class III canine relationship complicated with multiple missing teeth, old atrophic extraction sites, and periodontal defects. The lower dental arch irregularity was eliminated by air-rotor stripping (ARS). The upper extraction site was opened for prosthetic rehabilitation, whereas closure of the lower extraction space was preferred. The narrow alveolar crest of the atrophic bone was augmented with the use of autogenous bone, beta-tricalcium phosphate (Cerasorb), and autogenous platelet-rich plasma. A functional and esthetic occlusion in an improved facial profile was established at the end of orthodontic treatment combined with ARS technique, surgery, and prosthodontics.

Hereditary intraosseous vascular malformation of the craniofacial region: an apparently novel disorder.

Primary intraosseous vascular anomaly, previously called intraosseous hemangioma, is a very rare malformation that is usually seen in the vertebral column and in the skull. It is exclusively described in sporadic cases and no hereditary component has yet been reported. The most commonly affected bones in the skull are the mandible and the maxilla, and life-threatening bleeding after a simple tooth extraction is frequently observed. Here, we report two consanguineous families containing a total of four affected patients manifesting primary intraosseous vascular malformation (VMOS (vascular malformation osseous)) of the craniofacial region. The phenotypic expression is remarkably similar in both families. The characteristic findings include severe blood vessel expansions within the craniofacial bones and midline abnormalities such as diastasis recti, supraumbilical raphe, and hiatus hernia. Malformation is restricted to the mandibular and maxillary area in the prepubertal age, and rapid expansion starts after age 12 or 13. A 15-year follow-up of one of the patients demonstrated that the vascular malformation did not extend beyond the craniofacial region despite severe involvement of almost all bones in the skull. Detailed clinical and radiological evaluation provided neither evidence of soft-tissue involvement nor any sign of gross arterial, venous, or combined malformations, indicating that bone changes are a primary rather than a secondary effect due to any other vascular anomaly in the craniofacial region. An antibody against a universal proliferation marker, Ki-67, detected nonproliferative, single-layered endothelial cells, suggesting that this abnormality is a vascular malformation rather than a hemangioma. alpha-actin staining (antibody against perivascular tissue such as smooth muscle cells (SMCs) and/or pericytes) demonstrated that pathologic vessels lost their surrounding supportive tissues, as was previously seen in other types of vascular anomaly. Homozygosity mapping excluded the following loci and/or genes: multiple cutaneous venous malformation (VMCM1; gene, TIE2) on chromosome 9p21; venous malformation with glomus cells (VMGLOM) on chromosome 1p22-p21; hereditary hemorrhagic telangiectasia type 1 (HHT1; gene, endoglin) and type 2 (HHT2; gene, activin) on chromosomes 9q34.1 and 12q11-q14, respectively; and cerebral cavernous malformation type 1 (CCM1; gene, KRIT1), type 2 (CCM2), and type 3 (CCM3) on chromosomes 7q11.2-q21, 7p15-p13, and 3q35.2-q27, respectively. To the best of our knowledge, this is a new disorder, which we call hereditary intraosseous vascular malformation of the craniofacial region.

Recurrence rate of odontogenic keratocyst treated by enucleation and peripheral ostectomy: Retrospective case series with up to 12 years of follow-up

BACKGROUND: Odontogenic keratocysts have been reported with high recurrence rates in the literature so various treatment modalities from simple enucleation to resection have been performed to achieve the cure. The purpose of this retrospective study was to investigate the recurrence rate of odontogenic keratocysts (OKCs) treated by enucleation and peripheral ostectomy. MATERIAL AND METHODS: An electronic search of the database of the Hacettepe University, Faculty of Medicine, Department of Pathology, was undertaken to identify patients histologically diagnosed with OKCs treated at Department of Oral and Maxillofacial Surgery between 2001 and 2015. RESULTS: In total, 81 patients were studied. The mean age at the time of diagnosis was 42 years, and the male:female ratio was 1:0.7. OKCs were located primarily in the posterior mandibular region (41%). Twenty-seven patients were re-examined to determine the recurrence rate. The mean follow-up period was 5 years (range, 1-12 years). The recurrence rate was 14.8%. The relationship between location of the lesion and recurrence was not statistically significant (p= 0.559). There was also no statistically significant relation between the recurrence rate and treatment option of teeth involved in the lesion (p= 0.579). CONCLUSIONS: The authors conclude that treatment of OKCs by enucleation with peripheral ostectomy is associated with minimal morbidity and is preferred over other aggressive treatment modalities. Meticulous radiographic examination and careful surgical resection may decrease the recurrence rate of OKCs

Double inverted mesiodentes: report of an unusual case.

This report presents an extremely rare occurrence of two inverted mesiodentes in a child patient. Extraction of both mesiodentes was indicated, owing to the axial rotation of the permanent central incisors caused by these impacted supernumerary teeth. Radiographic evidence of complete healing was observed 24 months following surgical removal of the inverted mesiodentes.

The zymographic evaluation of gelatinase (MMP-2 and -9) levels in acute and chronic periapical abscesses.

OBJECTIVE: This study investigated the presence and levels of matrix metalloproteinases (MMP)-2 and -9 in periapical abscesses. STUDY DESIGN: Eighteen samples of intracanal exudates containing pus were collected from teeth with clinically and radiographically verified primary or secondary acute and chronic apical abscesses. Pro- and active forms of MMP-2 and MMP-9 levels were analyzed by using substrate gel zymography followed by an image analysis system. Statistical analysis was performed using the Kruskall-Wallis and Mann-Whitney U tests with Bonferroni adjustment. RESULTS: Both forms of MMP-9 were detected in all pus samples and demonstrated marked differences among the experimental groups (P < .05). Primary or secondary acute apical abscess samples demonstrated significantly higher MMP-9 levels compared with MMP-2 levels (P < .01). However, MMP-2 could not be detected in chronic apical abscesses. CONCLUSION: According to the results of this study, gelatinases might affect the pathogenesis of acute and chronic periapical abscesses.

Micromorphology of sialoliths in submandibular salivary gland: a scanning electron microscope and X-ray diffraction analysis.

PURPOSE: Sialoliths are common in the submandibular gland and its duct system. The exact cause of formation of a sialolith is still a matter of debate. The aim of this study was to analyze 6 sialoliths ultrastructurally to determine their development mechanism in the submandibular salivary glands. MATERIALS AND METHODS: Six sialoliths retrieved from the hilus and duct of the submandibular salivary glands of 6 patients with sialadenitis were analyzed ultrastructurally by scanning electron microscope and x-ray diffractometer. RESULTS: Scanning electron microscope revealed mainly irregular, partly rudely hexagonal, needle-like and plate-shaped crystals. The cross-section from the surface to the inner part of the sialoliths showed no organic material. X-ray diffraction showed that the sialoliths were composed of hydroxyapatite crystals. Energy dispersive x-ray microanalysis showed that all of the samples contained high levels of Ca and P, and small amounts of Mg, Na, Cl, Si, Fe, and K. CONCLUSION: The main structures of the submandibular sialoliths were found to be hydroxyapatite crystals. No organic cores were observed in the central parts of the sialoliths. In accordance with these preliminary results, sialoliths in the submandibular salivary glands may arise secondary to sialadenitis, but not via a luminal organic nidus.