Is the collateral circulation pattern in the hard palate affected by cleft deformity?

OBJECTIVES: To evaluate the influence of collateral vascularization on surgical cleft palate closure and deformities. MATERIALS AND METHODS: Corrosion casting was performed using red-colored acrylic resin in twelve fresh adult cadavers with a normal hard palate. Additionally, white-colored barium sulfate was injected into a fetus with a unilateral complete cleft palate, and layer-by-layer tissue dissection was performed. Both substances were injected into the external carotid arteries. Corrosion casting involved dissolving the soft and hard tissues of the orofacial area utilizing an enzymatic solution. RESULTS: In normal palates, bilateral intraosseous infraorbital arteries formed a network in the premaxilla with the intraosseous nasopalatine- and greater palatine arteries (GPAs). The perforating GPAs anastomosed with the sphenopalatine artery sub-branches. Bilateral extraosseous GPA anastomoses penetrated the median palatine suture. Complex vascularization in the retrotuberal area was detected. In the cleft zone, anastomoses were omitted, whereas in the non-cleft zone, enlarged GPAs were distributed along the cleft edges and followed the anatomical course anteriorly to initiate the network with facial artery sub-branches. CONCLUSIONS: The anatomical subunits of the palate exhibited distinct anastomosis patterns. Despite omitted anastomoses with collateral circulation in the cleft zone, arteries maintained their anatomical pattern as seen in the normal specimen in the non-cleft zone. CLINICAL RELEVANCE: Based on the findings in normal- and cleft palates, surgeons may expect developed anastomosis patterns in the non-cleft zone. Due to the lack of microcirculation in the cleft zone, the existent anastomoses should be maintained as much as possible by the surgical technique. This applies anteriorly in the incisive canal territory, alveolar ridges, and posteriorly in the retrotuberal area.

Rate of tooth movement and dentoskeletal effects of rapid canine retraction by dentoalveolar distraction osteogenesis: A prospective study.

INTRODUCTION: The purpose of this study was to test the null hypothesis that duration of orthodontic treatment can be significantly reduced by accelerating canine retraction using dentoalveolar distraction (DAD). METHODS: Thirty-six maxillary canines of 19 patients comprised the DAD group, and 28 canines of 14 patients were included in the distalization group (DG). The initial mean ages were 15.8 ± 1.96 years for the DAD group and 16.02 ± 2.8 years for the DG. A custom-made, rigid, tooth-borne intraoral distraction device was used for the DAD group, and intraoral elastics were applied for canine distalization in the DG. Six skeletal and 11 dental variables were measured for the cephalometric evaluation. RESULTS: Canine retraction was 7.9 ± 1.49 mm in 11.8 ± 1.3 days and canine distal tipping was 11.48° ± 4.37° after DAD; the canines were distalized 5.29 ± 2.01 mm and tipped 13.64° ± 9.54° in 200 ± 57 days in the DG. The rates of posterior canine movement were 0.67 ± 0.14 mm per day after DAD and 0.03 ± 0.01 mm per day in the DG. No significant first molar anchorage loss was observed after DAD, although the DG showed some vertical and sagittal first molar movement. CONCLUSIONS: We failed to reject the null hypothesis. DAD can reduce the duration of orthodontic treatment time by accelerating canine retraction in extraction patients without undesirable side effects.

Detecting Gram-positive anaerobic cocci directly from the clinical samples by multiplex polymerase chain reaction in odontogenic infections.

PURPOSE: Gram-positive anaerobic cocci (GPAC) can be isolated as pathogens from odontogenic infections. Culturing GPAC is time consuming and labor intensive. The objectives of the present study were to examine the utility of polymerase chain reaction (PCR) in directly detecting the presence of GPAC in clinical samples obtained from patients with odontogenic infections and to compare the distribution of GPAC in infected and healthy tissue. MATERIALS AND METHODS: In the present case-control study, the infected tissue from patients and oral mucosal swabs from healthy control subjects were subjected to anaerobic culture and direct PCR analysis for the presence of GPAC. The McNemar, chi-square, and Fisher exact tests and kappa analysis were used for the statistical analyses. P < .05 was regarded as significant. RESULTS: The patient group included 13 men and 14 women, including 9 patients diagnosed with granulation of tooth extraction, 6 with impacted tooth follicles, 4 with peri-implantitis, 3 with abscesses, 2 with epithelial cysts, 2 with infected cysts, and 1 with an oroantral fistula. The control group included 14 men and 12 women. All the patient and control samples contained at least 1 GPAC. The groups did not differ by method of determining GPAC presence, but more microorganisms were detected when clinical samples were directly used for PCR analysis than when cultured bacteria were used (P = .001). CONCLUSIONS: The presence of GPAC in infected tissue cannot be directly related to the development of odontogenic infections. PCR performed directly on clinical material is a sensitive and specific method that can detect GPAC and save time.

Micronucleus assay assessment of possible genotoxic effects in patients treated with titanium alloy endosseous implants or miniplates.

The use of titanium and its alloys (Ti-6Al-4V) for oral surgery has increased dramatically in recent years. Ti is a stable biocompatible metal suitable for oral applications and it has been used for endosseous subperiosteal implants and miniplate fixation for more than 25 years. Dental implants are typically made of Ti or Ti alloys. The alloys are potentially toxic due to release of vanadium and aluminum. We tested the possible genotoxicity of Ti alloy endosseous implants and miniplates on the oral mucosal tissues of two groups of patients: 17 patients receiving Ti miniplate and screw fixation, and 37 endosseous dental implant placement patients. Preoperative and postoperative mucogingival cell samples were collected. Genotoxicity was assessed by the micronucleus assay (MN). There were slight but not statistically significant increases in the frequencies of MN (p=0.087 and p=0.047) post-operation in both groups. In summary, neither of the applications showed genotoxicity in the oral epithelial cells of patients.

A simple solution for vector control in vertical alveolar distraction osteogenesis.

One of the important and frequent complications in alveolar distraction osteogenesis is vectorial change of the transport segment. This report presents a simple solution for vector angulation control by placing intermaxillary fixation screws intraoperatively. Advantages of the technique are also discussed.

Dentoalveolar transport osteodistraction and canine distalization.

The orthodontic treatment period with extractions is prolonged in many cases because of the limited rate of biological tooth movement. An approach using transport distraction osteogenesis was designed to reduce orthodontic and orthognathic treatment time. Overall management of selected alveolar cleft cases with wide defects may also be optimized and simplified through transport distraction of a tooth-bone segment. We will discuss our experience with 73 cases, both conventional orthodontic cases and orthognathic patients, in which dentoalveolar distraction was used to reduce orthodontic treatment time and to treat wide alveolar clefts with compromised soft tissues to facilitate optimal outcome.

Rapid tooth movement and orthodontic treatment using dentoalveolar distraction (DAD). Long-term (5 years) follow-up of a Class II case.

The purpose of this report is to describe the dentoalveolar distraction (DAD) technique and to present its effects on the surrounding structures by presenting a Class II case. A 15-year-old skeletal and dental Class II female patient with an overjet of 9 mm was treated by DAD osteogenesis. A custom-made, rigid, tooth-borne intraoral distraction device was used for rapid canine retraction. Osteotomies surrounding the canines were made to achieve rapid movement of the canines within the dentoalveolar segment, in compliance with distraction osteogenesis principles. The amount of canine retraction was 7.5 mm in 12 days at a rate of 0.625 mm per day, with no posterior anchorage loss. The canine teeth showed 1.6 mm extrusion and 11 degrees inclination change (distal tipping) during the same period. Orthodontic treatment continued for 6 months with no clinical and radiographic evidence of complications such as root fracture, root resorption, ankylosis, and soft tissue dehiscence. The DAD technique is an innovative method, because it reduces overall orthodontic treatment time by about 50%, with no unfavorable effects on periodontal tissues and surrounding structures and with no need to use any intraoral or extraoral anchorage appliances.

Histomorphometric evaluation of the effects of zoledronic acid on mandibular distraction osteogenesis in rabbits.

PURPOSE: To assess the effect of systemic administration of zoledronic acid (ZA) on mineralization of newly formed bone and to determine strain-related osteoporosis on surrounding bone during lengthening of immature rabbit mandible. MATERIALS AND METHODS: Eighteen New Zealand white rabbits were divided randomly into 2 groups, and bone lengthening was carried out in the left portion of the mandible through distraction osteogenesis with a rate of 0.5 mm every 12 hours for 5 days. The experimental group was administered 0.1 mg/kg ZA intravenously. The control group was given saline infusion only during operation. All animals were sacrificed at the end of the 28-day consolidation period. The mandibles of all animals were removed and regenerate was evaluated. Osteoblasts, osteoclasts, collagen fibers, and fibroblasts were marked within 0.1-mm(2) area and newly formed bone area was measured within 0.5-mm(2) area. All data were analyzed using Mann-Whitney U test. RESULTS: Although irregular bone destruction spots were seen in the control group, the experimental group showed regular ossification areas and significant difference between osteoblast and osteoclast numbers (P < .05). In the regenerate zone, there was considerable difference between the 2 groups in terms of osteoblast, osteoclast, and collagen amounts (P < .05). Additionally, newly formed bone areas and fibroblast count were higher in experimental group. CONCLUSIONS: The results of this study showed that ZA had positive effects on the new bone formation, which may potentially shorten the consolidation period.

Ten-year follow-up of a patient with hemifacial microsomia treated with distraction osteogenesis and orthodontics: an implant analysis.

INTRODUCTION: Distraction osteogenesis (DO) has become an accepted treatment method for patients requiring mandibular lengthening because of congenital malformations. However, the skeletal growth pattern of a distracted mandible in the long term has still not been clearly shown in the literature. The purpose of this report was to analyze the dentofacial changes observed during a 10-year follow-up period in a patient treated with mandibular DO. METHODS: The patient was a 12-year-old girl with hemifacial microsomia who had undergone DO with an external device. Morphologic changes during the observation period were evaluated on panoramic radiographs and posteroanterior and lateral cephalograms. Six Björk-type titanium implants were placed bilaterally in the mandible under local anesthesia to analyze the mandibular skeletal changes over time. RESULTS: Marked lengthening was achieved during the active phase of mandibular distraction. The ratio between the ramus heights of the affected and normal sides improved significantly in the affected side's favor as the mandible was lengthened, but this ratio returned to its initial value after 10 years. CONCLUSIONS: Although there was some growth on the affected side during the follow-up period, it was not enough to catch up with the growth on the normal side. The original asymmetry recurred as a consequence of the growth pattern in this patient with hemifacial microsomia.

Evaluation of the Short-Term Efficacy of Transdermal Ozone Therapy in Turkish Patients with Internal Derangement of the Temporomandibular Joint

Objective: To investigate the efficacy of transdermal high-frequency ozone therapy in the management of pain and pain-related restricted jaw movements in patients with internal derangement of the temporomandibular joint (TMJ). Material and Methods: This retrospective study included 40 patients who had received transdermal high-frequency ozone therapy for the management of disc displacement with reduction of the TMJ. Subjects were treated 3 times for one week with a bio-oxidative high-frequency ozone generator with an intensity of 80% for ten minutes bilaterally. Pain scores and maximal interincisal opening (MIO) values of the patients were evaluated before and after the treatment. Results: An increase in the mean MIO value was achieved following the ozone therapy, however, the difference was not statistically significant (p=0.350). A statistically significant decrease in the mean pain score (48.13 ± 27.75) was observed following the ozone therapy. Conclusion: Transdermal application of high frequency ozone may be a good alternative for management of pain and pain-related restricted jaw movements in patients with internal derangement of the TMJ.

Management of fractures of the condyle, condylar neck, and coronoid process.

Proper anatomic reduction of the fracture and accelerated complete recovery are desirable goals after trauma reconstruction. Over the recent decades, significant headway in craniomaxillofacial trauma care has been achieved and advancements in the management for the injuries of the mandibular condyle have also proved to be no exception. A trend in operative and reconstructive options for proper anatomic reduction and internal fixation has become notable as a result of newly introduced technology, surgical techniques, and operative expertise.

Response of ramus following vertical lengthening with distraction osteogenesis.

Vertical lengthening of the mandibular ramus is considered to be one of the least stable surgical procedures in the management of musculoskeletal maxillofacial deformities. The aim of this study was to evaluate the response of the mandibular ramus following vertical lengthening by means of distraction osteogenesis. This study included eight non-syndromic adult patients with temporomandibular joint ankylosis. The vertical height deficiency of the mandibular ramus and the ramus/condyle unit on the affected side were simultaneously reconstructed by transportation of a bone segment using distraction osteogenesis following gap arthroplasty. Lateral and posteroanterior (PA) cephalograms taken postoperatively before active distraction, at the completion of distraction and 6, 12, 24 months after distraction, were compared to evaluate the changes of the ramus height. In all cases the vertical ramus and ramus/condyle unit height loss were successfully reconstructed by distraction osteogenesis. There was no relapse in the amount of height gained by distraction osteogenesis at the 24 months follow-up review (p>0.05). Acute one stage vertical lengthening of the mandibular ramus is considered to be one of the least stable musculoskeletal procedures with relapse being a significant adverse outcome. In this clinical study gradual vertical lengthening of the ramus through ramus/condyle unit distraction osteogenesis has maintained the initial vertical ramus height gained for 24 months.

Development of a visio-haptic integrated dental training simulation system.

The use of haptic devices in the medical field has become widespread in the last decade. In this study, a visio-haptic dental training system is developed using haptic and stereoscopic devices. Several advantages are offered by such a simulation system, including effective learning without any fear of making mistakes on a patient, possibility of repeating various dental operations, ease of evaluating student performance, and low-cost dental training even without an instructor. In this study, the biomechanical properties of enamel, dentin, pulp, and caries were modeled, and the parameters were fine-tuned to provide more realistic haptic sensations. Maxillary and mandibular dental arches and various dental instruments such as mouth mirror, probe, and dental drills were modeled in a 3D virtual environment. Probing and cavity preparation on teeth were implemented in the training system. Various graphical rendering methods (Surface Rendering in CPU, Iso-Surface Rendering, and Ray-Casting in GPU) were implemented and compared in performance. The implementation details and the software structure used are described. Finally, detailed performance tests by a group of dentists are conducted, and the results of these tests are presented. The performance tests found that dentists have a strong motivation to use the system and that in the aspects of usability, clarity, effectiveness, help/support provided, and satisfaction, the users' responses were above average.

Long-term results of arthrocentesis in degenerative temporomandibular disorders.

OBJECTIVES: Long-term efficacy of arthrocentesis was investigated in patients with degenerative temporomandibular disorder (TMD) in this clinical study. STUDY DESIGN: Twenty-two joints of 15 patients with degenerative TMD were included as the study group, and 16 joints of 10 patients served as the control group. Arthrocentesis procedures in upper joint spaces were performed. The study group patients' mean follow-up period was 36.7 +/- 18.7 months, whereas the control group were kept for an average 9.9 +/- 2.8 months. Results were statistically compared using 1-way repeated analysis of variance and t test. RESULTS: Pretreatment maximal interincisal opening increased significantly from 33.6 +/- 6.0 mm to 37.8 +/- 6.0 mm in the study group. Pretreatment pain and crepitus scores decreased significantly from 71.0 +/- 6.6 to 27.0 +/- 16 and 0.73 +/- 0.4 to 0.6 +/- 0.5, respectively, in the study group. CONCLUSIONS: Arthrocentesis was found to be a useful method for the treatment of degenerative TMDs, and the outcomes of treatment provide long-term cure for degenerative temporomandibular joints.

Methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis of the mandible.

Methicillin-resistant Staphylococcus aureus (MRSA) is a type of Staphylococcus that is resistant to certain antibiotics, such as methicillin, oxacillin, penicillin, and amoxicillin. This nosocomial pathogen has become a great threat in hospitals globally. Up to 40% of the normal population carries S. aureus in the anterior nares, and this rate is often higher in hospitalized patients and their attendants. This case report presents a patient with serious MRSA osteomyelitis of the mandible demonstrating purulent discharge. The patient failed to recover despite prolonged postoperative treatment and the administration of several antibiotics. There was a resulting nonunion along with chronic MRSA infection. The treatment protocol involved a multimodal approach with parenteral clindamycin infusion, local rifampicin irrigation, and intermaxillary fixation of the jaws.

Difficulties in anesthetic management of patients with micrognathia: report of a patient with Stickler syndrome.

Stickler syndrome is an autosomal dominant multisystem disorder with characteristic midface hypoplasia, retromicrognathia, cleft palate and a "moon-shaped" appearance. Progressive myopia and retinal degeneration are frequent. It is estimated that one third of all Pierre Robin patients have Stickler syndrome. Patients with a mandibular hypoplasia like Stickler syndrome present the anesthesiologist considerable problems when mask ventilation or endotracheal intubation is attempted. In this case report the difficulties in anesthetic management of patients with micrognathia and repeated anesthetic courses of a child with Stickler syndrome are presented. It is vital to detect the syndrome in early stages so that adequate counseling and treatment may be given to avoid the potentially irreversible and disabling consequences.

Rhinolithiasis: an uncommon entity of the nasal cavity.

Rhinoliths are uncommon foreign bodies of the nose formed by in situ calcification of intranasal endogenous or exogenous foreign material. They are often an asymptomatic condition diagnosed accidentally during a routine examination. Although nasal foreign bodies are more frequently seen in children, and appear to be more common in women, they have been reported in patients of all ages. This article describes a case of rhinolith involving a 38-year-old male. The etiology, thin-sectioned microscopic findings, differential diagnoses, and treatment are also discussed.

Alterations in gingival dimensions following rapid canine retraction using dentoalveolar distraction osteogenesis.

The aim of this clinical prospective study was to evaluate the alterations that occurred in the gingival dimensions of canine teeth following dentoalveolar distraction (DAD) during a 12 month follow-up period.The study sample comprised 36 maxillary canines of 18 growing or adult subjects with a mean age of 16.94 years (13.08-25.58 years) at the start of treatment. Full retraction of the canines was achieved in 10.36 +/- 1.93 days (range 8-14 days) at a rate of 0.8 mm/day using a custom-made intraoral rigid tooth-borne distraction device. Before surgery (pre-DAD), immediately after removal of the device (post-DAD), and at 1, 6, and 12 months post-DAD, the plaque index (PI), gingival index (GI), pocket depth (PD) and width of keratinized gingiva were recorded and the width of attached gingiva was calculated. The alterations in clinical measurements among different evaluation periods were analysed by Friedman and repeated measure ANOVA tests. There were significant differences between pre- and post-DAD for PD measurements for all sites, with the highest at the distal site. The palatal sites likewise showed significant differences at the 1, 6, and 12 month follow-up periods compared with the post-DAD period. The buccal sites showed no significant changes at any time point. The width of keratinized gingiva also showed no significant change during the follow-up period, while the width of attached gingiva was significant only between the pre- and post-DAD periods (P < 0.01). On the basis of the above findings, it could be concluded that DAD is an innovative technique with no unfavourable long-term effects on the gingival tissues of rapidly retracted canine teeth.

Rapid canine retraction and orthodontic treatment with dentoalveolar distraction osteogenesis.

PURPOSE: Duration of treatment is one of the things orthodontic patients complain about most. To shorten treatment time, a new technique of rapid canine retraction through distraction osteogenesis was introduced. The effects of dentoalveolar distraction on the dentofacial structures are presented in this article. MATERIAL: The study sample consisted of 20 maxillary canines in 10 growing or adult subjects (mean age, 16.53 years; range, 13.08-25.67 years). First premolars were extracted, the dentoalveolar distraction surgical procedure performed, and a custom-made intraoral, rigid, tooth-borne distraction device was placed. The canines were moved rapidly into the extraction sites in 8 to 14 days, at a rate of 0.8 mm per day. RESULTS: Full retraction of the canines was achieved in a mean time of 10.05 (+/-2.01) days. The anchorage teeth were able to withstand the retraction forces with minimal anchorage loss. The mean change in canine inclination was 13.15 degrees +/- 4.65 degrees, anterior face height and mandibular plane angle increased, and overjet decreased significantly at the end of dentoalveolar distraction. No clinical and radiographic evidence of complications, such as root fracture, root resorption, ankylosis, periodontal problems, and soft tissue dehiscence, was observed. Patients had minimal to moderate discomfort after the surgery. CONCLUSIONS: The dentoalveolar distraction technique is an innovative method that reduces overall orthodontic treatment time by nearly 50%, with no unfavorable effects on surrounding structures.