Does preventive single dose of intravenous dexketoprofen reduce pain and swelling after orthognathic surgery? A prospective, randomized, double blind clinical trial.

BACKGROUND: The purpose of this study was to evaluate the effect of a single-dose intravenous dexketoprofen administration for preventive analgesia on postoperative pain and reducing swelling in double jaw surgery. MATERIAL AND METHODS: The authors designed a prospective, randomized, and double-blind cohort study. Patients who have Class III malocclusion were randomly divided in two groups. 50 mg intravenous dexketoprofen trometamol were administrated 30 minutes before incision in treatment group, while intravenous sterile saline was administrated 30 minutes before incision in placebo group. The primary predictor variable was treatment group. Primary outcomes were pain, swelling and 24-hour opioid intake. Patient- controlled analgesia with tramadol was given for management of postoperative pain. Other variables were demographic and operation related parameters. Visual analogue scale was used to evaluate postoperative pain. 3dMD Face System (3dMD, USA) was used to measure postoperative swelling. Data were analysed using two independent samples t test and Mann Whitney U test. RESULTS: The study sample was composed of 30 patients with a mean age of 20,63 years and 21 were female. Preemptive dexketoprofen administration decreased postoperative tramadol consumption by 25.9% compared to placebo group, and there was a statistically significant decrease in VAS scores (p<0,05). There was no statistically significant difference between the groups in terms of swelling (p>0,05). CONCLUSIONS: Preventive administration of intravenous dexketoprofen provides adequate analgesic effect in the postoperative 24-hour period and reduces opioid consumption in orthognathic surgery.

Brain microstructural changes and cognitive function in non-demented essential tremor patients: a diffusion tensor imaging study.

BACKGROUND: Essential tremor (ET) is disease with both motor and non-motor features. Notable among the non-motor features is cognitive impairment. While this impairment has been attributed to cortico-thalamo-cerebellar pathway pathology, it is likely that a more complicated involvement of brain structures underlies cognitive function in ET. OBJECTIVE: To evaluate the brain microstructural changes of both white matter and grey matter in ET using region of interest based diffusion tensor imaging (DTI), and to correlate these changes with cognitive function assessed during detailed neuropsychological testing. METHOD: Thirty-five non-demented ET patients with a range of cognitive function (Clinical Dementia Rating = 0-0.5, mean age = 57.5 ± 16.7 years, age range = 23-76 years) underwent a comprehensive neuropsychological evaluation and brain magnetic resonance imaging, including DTI. DTI findings were reported as fractional anisotropy, average diffusion coefficient, these values were evaluated for 32 ROIs. Cognitive domains included attention, visuospatial functions, executive function, verbal memory, visual memory, and language. Domain Z-scores were calculated each cognitive domain and compared for each brain region. RESULTS: Microstructural changes in prefrontal cortical areas (dorsolateral, ventrolateral), paralimbic and limbic structures (posterior cingulate cortex, precuneus, hippocampus), basal ganglia (substantia nigra, putamen, caudate nucleus) and white matter bundles (corpus callosum, anterior thalamic radiation, longitudinal fasciculus, frontooccipital fasciculus, etc.) correlated with specific domains of cognitive function in ET patients. CONCLUSION: These data suggest that not only the cerebello thalamocortical pathway, but numerous other brain structures are related to level of cognitive performance and possibly underlie cognitive dysfunction in ET.

Preoperative radiotherapy for rectal cancer: A bibliometric analysis of the 100 most-cited research articles.

Background and Aims: Preoperative long-course radio-chemotherapy (LC-RCHT) or preoperative short-course radiotherapy (SC-RT) are widely used in the treatment of locally advanced rectal cancer (LARC). This study aimed to evaluate the 100 most-cited research articles focused on preoperative radiotherapy for rectal cancer to reveal existing academic trends and the direction of therapeutic research. Materials and Methods: This was a retrospective study based on publicly accessible data. The Web of Science database was used to identify the 100 most-cited articles. Results: The median values for total citation and average citation per year (CPY) were 240.50 (range, 150-3787) and 17.32 (5.03-222.76), respectively. Randomized (median: 24.88 vs 13.32, P = 0.001) and funded (median: 27.33 vs 14.73, P = 0.002) studies had more CPY than those with opposite characteristics. No significant difference was found between studies using SC-RT and LC-RCHT, in terms of average CPY (median: 15.27 for SC-RT vs 18.36 for LC-RCHT, P = 0.303). In terms of the primary aim of the investigation, studies investigating non-operative treatment strategies had higher CPY than those investigating other subcategories (p = 0.029). Conclusion: Randomized studies, funded studies, and studies investigating non-operative treatment were associated with more CPY. There remains equal interest in preoperative SC-RT and LC-RCHT for rectal cancer.

Sonoelastographic evaluation of the masseter muscle before and after mandibular setback surgery.

AIMS: The purpose of this study is to compare the thickness and elasticity of the masseter muscle before and after orthognathic surgery in patients with class III skeletal deformity and to investigate the relationship between the sonographic changes in the masseter muscle and the amount of mandibular setback. SUBJECTS AND METHODS: The study group consisted of 14 patients with skeletal class III malocclusions who had orthognathic surgery. The control group consisted of 14 patients who had dental and skeletal class I occlusion. Muscle thickness measurements were performed with B-mode and high-frequency linear scanning probe of the ultrasound device. Elastography feature and muscle hardness ratio were obtained by applying compression and decompression on muscles at rest and during maximum contraction in the transverse plane. Patients were categorized into two groups according to the mandibular setback as <5 mm and ≥5 mm. RESULTS: The masseter muscle thickness after surgery was found statistically increased bilaterally in both at rest and during contraction for the study group (P < 0.05). No difference was found between preoperative orthognathic measurements and postoperative measurements for elasticity index ratio measurements (P > 0.05). CONCLUSION: We believe that in the present study important findings have been emphasized for further research aiming to investigate the possible relationship between masticatory alterations and surgical outcomes after orthognathic surgery.

Elastosonographic evaluation of endometrium in women using tamoxifen for breast cancer.

OBJECTIVES: A prospective case-control study was carried out to assess the value of elastosonography in identifying endometrial pathology in women using Tamoxifen (TAM) for breast cancer. MATERIALS AND METHODS: In total, 66 women using TAM for breast cancer were enrolled for the study with 61 premenopausal and 61 postmenopausal healthy controls. Ultrasonographic findings (strain ratio, endometrial thickness) were evaluated in regard to the duration of TAM usage, histopathological findings, and menopausal status. RESULTS: Patients with endometrial cancer (EC) and cystic endometrial hyperplasia (CEH) were found to have longer duration of TAM usage, increased endometrial thickness, and higher strain ratios compared with controls. A significant positive correlation was found between duration of TAM usage, endometrial thickness, and the strain ratios. Endometrial thickness and the strain ratios were significant predictors for groups under risk. Cutoff values for endometrial thickness, strain ratios, and duration of TAM usage were 12.55 mm, 2.46, and 18 months in premenopausal group and 7.75 mm, 7.70, and 32 months in postmenopausal group to predict risky population, respectively. CONCLUSION: Endometrial tissue strain ratio was found to be significantly increased in cases with endometrial pathologies. Addition of elastosonography modality to B-mode may improve the diagnostic accuracy during the follow-up of women using TAM for breast cancer.

Effects of curcumin and melatonin on bone formation in orthopedically expanded suture in rats: A biochemical, histological and immunohistochemical study.

OBJECTS: To investigate the effects of curcumin (CUR) and melatonin (MEL) on new bone formation following rapid maxillary expansion (RME) in rats. SETTING AND SAMPLE POPULATION: For this study, 24 12-week-old adult male Wistar albino rats from the Animal Laboratory at Adnan Menderes University, Faculty of Medicine, were used. MATERIALS AND METHODS: The rats were randomly divided into the following 3 groups (n = 8 each): only expansion (OE), expansion plus MEL (MEL) and expansion plus CUR (CUR). CUR and MEL were given to the rats during the study period. After the sacrifice of the animals, biochemical, histological and immunohistochemical examinations were performed. RESULTS: Serum bone alkaline phosphatase levels in the MEL group were statistically (P = .007) higher than in the OE group. Serum glutathione peroxidase and catalase activities in the CUR and MEL groups were significantly higher than in the OE group (P = .007 and P = .021, respectively). Inflammatory cell infiltration, new bone formation and capillary intensity parameters did not demonstrate statistically significant differences between the groups (P = .865, P = .067 and P = .055, respectively). The immunohistochemical findings revealed that IL-1, IL-6 and TNF-α H scores showed considerable differences between the groups (all P < .001). The highest IL-1, IL-6 and TNF-α H scores were found in the OE groups rather than in the other groups (P < .001). CONCLUSION: CUR and MEL treatments may be effective in accelerating new bone formation and beneficial in preventing relapse following the RME procedures.

The Neutrophil-to-Lymphocyte ratio as a marker of recovery status in patients with severe dental infection.

BACKGROUND: The aim of the study was to assess the value of pretreatment neutrophil/lymphocyte (N/L) ratio and mean platelet volume (MPV) and the correlation between these markers with progression in patients with severe odontogenic infection. MATERIAL AND METHODS: A cohort of 100 patients with severe odontogenic infection were divided into 2 groups according to their length of hospital stay. The N/L ratio and MPV was measured in all patients. The correlation in all patients between preoperative fever, preoperative antibiotic doses, postoperative antibiotic doses, total antibiotic doses and hospital stay with N/L ratio and MPV were analyzed. The Youden index was used to identify the optimal cut-off value. RESULTS: There were positive and statistically significant correlations between N/L ratio and prolonged hospital stay and postoperative antibiotic doses and total antibiotic doses. The optimum cut -off level of N/L ratio was 5.19 according to ROC analysis. However, there was no correlation between MPV and any of these parameters. CONCLUSIONS: N/L ratio may be used as a prognostic marker for patients with odontogenic infections. These patients may need a higher dose of antibiotics and stay more than 1 day in hospital for the treatment of odontogenic infection when the N/L ratio is detected to be more than 5.19.

Fertility in dairy cows after artificial insemination using sex-sorted sperm or conventional semen.

The aim of this study was to compare pregnancy per artificial insemination (P/AI) after timed AI with sex-sorted sperm (SS) or conventional semen (CS) in lactating dairy cows. Cyclic cows (n = 302) were synchronized by Ovsynch and randomly assigned into two groups at the time of AI. Cows with a follicle size between 12 and 18 mm and clear vaginal discharge at the time of AI were inseminated with either frozen-thawed SS (n = 148) or CS (n = 154) of the same bull. A shallow uterine insemination was performed into the uterine horn ipsilateral to the side of probable impending ovulation. Pregnancy per AI on Day 31 tended (p = 0.09) to be less for SS (31.8%) than CS (40.9%). Similarly, P/AI on Day 62 was less (p = 0.01) for cows inseminated with SS (25.7%) compared with CS (39.0%). The increased difference in fertility between treatments from Days 31 to 62 was caused by the greater (p = 0.02) pregnancy loss for cows receiving SS (19.2%) than CS (4.8%). Cow parity (p = 0.02) and season (p < 0.01) when AI was performed were additional factors affecting fertility. Primiparous cows had greater P/AI than multiparous cows both on Day 31 (41.7% vs 25.0% in SS and 53.0% vs 31.8% in CS groups) and on Day 62 (33.3% vs 20.5% in SS and 48.5% vs 31.8% in CS groups). During the hot season of the year, P/AI on Day 31 was reduced (p = 0.01) in the SS group (19.6%) when compared with the rates during the cool season (38.1%). In conclusion, sex-sorted sperm produced lower fertility results compared to conventional semen even after using some selection criteria to select most fertile cows.

Reducing the duration between gonadotropin-releasing hormone (GnRH) and prostaglandin F2α treatment in the Ovsynch protocol to 6 days improved ovulation to second GnRH treatment, but inclined to reduce fertility.

The aim of this study was to test Ovsynch (OVS) versus modified OVS (decreasing the interval between first GnRH and PGF2α to 6d) protocols on pregnancy per artificial insemination (AI) and OVS outcomes in cyclic dairy cows. Cyclic cows (n=920) were assigned to 1 of 2 groups: the OVS7 group (n=459) received the OVS protocol [GnRH treatment, PGF2α treatment 7d later, a second GnRH (GnRH2) treatment 56 h later, and timed AI (TAI) 16 to 18 h after the GnRH2 treatment], and the OVS6 group (n=461) received a modified OVS protocol, in which the interval between the first GnRH and PGF2α was decreased to 6d (GnRH treatment, PGF2α treatment 6d later, GnRH2 treatment 56 h later, and TAI 16 to 18h after the GnRH2 treatment). The response to the first GnRH of OVS was similar between OVS7 (54.5%, 250/459) and OVS6 (54.2%, 250/461) groups. The ovulatory response to GnRH2 of OVS was higher in OVS6 (91.3%, 421/461) than OVS7 (84.5%, 388/459). The follicle size (mean ± standard error of the mean) at the time of TAI was smaller in OVS6 (15.23 ± 0.11 mm) than OVS7 (16.04 ± 0.11 mm). When all cows were evaluated, the pregnancy per AI at 31 d tended to be lower in OVS6 (38.0%, 175/461) than in OVS7 (43.8%, 201/459). Moreover, the pregnancy per AI at 31 d was lower in OVS6 (40.9%, 172/421) compared with OVS7 (50.3%, 195/388) in synchronized cows. In conclusion, although the modified OVS protocol decreased the follicle size at the time of AI and increased the ovulatory response to GnRH2 of OVS, it unexpectedly reduced fertility in cyclic lactating dairy cows.

Comparison of infliximab with adalimumab in biologic-naïve patients with Crohn's disease: a single-center 13-year experience.

OBJECTIVE: Long-term comparison studies between infliximab (IFX) and adalimumab (ADA) with or without immunomodulator therapy are still needed in Crohn's disease (CD). In this study, we evaluated IFX and ADA for long-term clinical effectiveness and safety in CD patients who had not previously received a biologic treatment. PATIENTS AND METHODS: The data of adult CD patients were collected retrospectively between December 2007 and February 2021. We compared CD-related hospitalization, CD-related abdominal surgery, steroid use, and serious infections. RESULTS: Out of 224 CD patients, 101 started IFX first (median age: 38.12 years, 61.4% male), while 123 started ADA first (median age: 30.2 years, 64.2% male). The disease durations were 7.01 years and 6.91 years for IFX and ADA, respectively. There were no significant differences between the two groups with respect to age, gender, smoking, immunomodulator usage, and disease activity score at the onset of anti-TNF therapy (p>0.05). Overall, the median follow-up time was 2.36 and 1.86 years after starting anti-tumor necrosis factor-alpha (anti-TNF) therapy in the IFX and ADA groups, respectively. Steroid use (4.0% vs. 10.6%, p=0.109), hospitalization for CD (13.9% vs. 22.8%, p=0.127), abdominal surgery for CD (9.9% vs. 13.0%, p=0.608), and major infections (1.0% vs. 0.8%, p>0.999) did not differ significantly from one another. There were also no significant differences in the rates of these outcomes between concomitant immunomodulator therapy and monotherapy (p>0.05). CONCLUSIONS: In this study, we observed no significant differences in the long-term effectiveness and safety of IFX and ADA in biologic-naïve patients with CD.

A 9-year follow-up of a girl with pyridoxine (vitamin B6)-dependent seizures: magnetic resonance spectroscopy findings.

Being an extremely rare condition makes the diagnosis of pyridoxine-dependent seizures (PDS) difficult. Early diagnosis of PDS is very important to prevent unwanted clinical outcomes. Elevated levels of glutamate and decreased levels of y-aminobutyric acid (GABA) in the frontal and parietal cortices are detected in this disorder. Here we present an 18 year old girl with PDS, who was reported 9 years ago with Magnetic Resonance Spectroscopy (MRS) findings. Present and past MRS findings showed a decrease in N-acetyl-aspartate-to creatine ratio on MRS. In this case it is surprising that neuronal damage has been preceded despite the administration of accurate treatment. That can be because of delay in treatment and/or under treatment.

Brain diffusion-weighted imaging in diabetic patients with retinopathy.

OBJECTIVE: Our aim was to detect whether there is any change in apparent diffusion coefficients (ADC) levels in different sites of the brain, particularly in areas associated with the vision, in diabetic patients with retinopathy by measuring diffusion-weighted imaging (DWI). MATERIALS AND METHODS: Conventional magnetic resonance imaging (MRI) and DWI of the brain were obtained from 45 diabetic patients (15 patients with proliferative diabetic retinopathy (group 1), 15 patients with nonproliferative diabetic retinopathy (group 2), 15 diabetic patients without retinopathy (group 3) and from 15 age-matched healthy volunteers (group 4). ADC values of visual cortex, cingulate gyrus, orbitofrontal, dorsomedial and dorsolateral frontal, corona radiate, and thalamus were obtained. RESULTS: The ADC values of visual cortex, cingulate gyrus and orbitofrontal cortex significantly increased in groups 1 and 2 compared to groups 3 and 4 (p < 0.001). The ADC values of visual cortex significantly increased in group 1 compared to group 2 (p < 0.001). The duration of disease and value of HbAlc positively correlated with ADC values of the visual and orbitofrontal cortexes, and cingulate gyrus. CONCLUSIONS: We found an increase in ADC values supporting the neuronal loss in some regions, especially in visual center by DWI in the diabetic patients with retinopathy. This result supports the association between diabetic retinopathy and brain injury.

Effects of presynchronization with gonadotropin-releasing hormone-prostaglandin F2α or progesterone before Ovsynch in noncyclic dairy cows.

The aim of this study was to evaluate the efficiency of presynchronization with GnRH and PGF(2α) or with progesterone on overall Ovsynch (OVS) outcomes in noncyclic dairy cows. Cows were scanned 7 d apart with ultrasonography to determine cyclicity. Noncyclic cows (n=281; no corpus luteum on ovaries at both examinations) were randomly divided into 3 groups. In the GP group (n=108), the cows received GnRH and PGF(2α) (PGF) administrations 7 d apart, and OVS was started 11 d after PGF (GnRH-7 d-PGF-11 d-OVS). In the P4 group (n=90), the cows were treated for 7d with an intravaginal progesterone (P4) implant (PRID), and then OVS was started 11 d after removal of the implant (7d PRID-11 d-OVS). The control group (CON, n=83) did not receive any presynchronization, and OVS was started at the same time as in the other groups (18 d-OVS). The percentage of cows that became cyclic at the beginning of OVS was lower in the CON group (38.6%; 32/83) than in the presynchronization groups (66.7%, 72/108 in GP; 71.1%, 64/90 in P4). The response to the first GnRH of OVS did not differ among groups (63.9%, 53/83 in CON; 67.6%, 73/108 in GP; 63.3%; 57/90 in P4), and synchronization rates were similar among the groups (74-82%). The cows that responded to presynchronization treatments (GP or P4) had higher pregnancy per artificial insemination (P/AI) than did nonresponding cows. Pregnancy per AI at 31 d did not differ between groups (30.1%, 25/83 in CON; 43.5%, 47/108 in GP; and 35.6%, 32/90 in P4). However, CON cows (24.1%, 20/83) had lower P/AI at 62 d than GP cows (41.7%, 45/108). Embryonic loss was higher in CON (20%, 5/25) compared with the P4 group (3%, 1/32). The administration of GnRH followed by PGF or exogenous progesterone (PRID) similarly increased the percentage of cows that became cyclic before Ovsynch in noncyclic cows, but fertility did not improve. However, the cows that responded to presynchronization had higher fertility rates than the nonresponding cows.

Chiari Type 1 malformation: CSF flow dynamics and morphology in the posterior fossa and craniocervical junction and correlation of these findings with syrinx formation.

BACKGROUND: Chiari type 1 malformation (CMI) is a disorder in which cerebellar tonsils descend below the foramen magnum. Although syringomyelia associated with CMI thought to be caused by hypoplastic posterior fossa and stenosis at the craniocervical junction; it has characteristic neurological and radiological features and the exact mechanism of syringomyelia remains unknown. PURPOSE: The purposes of this study were to gain insight into morphological changes in posterior fossa and to find whether there is a difference in aqueductal stroke volume (ASV) between CMI with syrinx and without syrinx which may be an underlying mechanism of syrinx development. MATERIALS AND METHODS: We consecutively evaluated 85 patients with Chiari malformation between January 2017 and December 2019 who had undergone phase-contrast MRI examination for CSF flow and between 18-60-years-old. We divided patients into two groups as subjects with syrinx (n=19) and without syrinx (n=66). After evaluating morphological changes, peak and average velocity (cm/s), forward and reverse flow volume (µl), net forward flow volume (µl), ASV (aqueductal stroke volume) (µl), aqueductus Sylvi (AS) area (mm2), and prepontine cistern diameter to AS diameter ratio (PPC/AS) were calculated. Distribution of variables from two groups was evaluated by using Shapiro-Wilk normality test. Independent t test was used for groups comparison. RESULTS: The forward and reverse volumes were statistically significantly higher in patients with syrinx (P=0.021, P=0.005 respectively). ASV was significantly increased in patients with syringomyelia (P=0.014). The PPC/AS was significantly lower in patients with syrinx compared to those without (P <0.001). AS area was significantly larger in those with syrinx. (P=0.022). The diameter of foramen magnum was significantly lower in patients with syrinx than those without (P <0.0001). The diameter of the herniated tonsilla at the foramen magnum level was found to be significantly lower in those with syrinx (P=0.011). CONCLUSION: Foramen magnum diameter, ASV, diameter of herniated tonsil, and PPC/AS ratio are important factors in syrinx development.

Primer malignant giant cell tumour of kidney: a case report.

Osteoclast-like giant cell tumours of the kidney are extremely rare and usually accompanied by a conventional urothelial neoplasm such as papillary, transitional renal cell, or sarcomatoid carcinoma. Although they have morphological features similar to those of the giant cell tumours in the skeletal system, their counterparts in the urinary system show highly malignant features. Our case is the third primer malignant giant cell tumour of the kidney in the literature. The patient was a 50-year-old male and underwent nephroureterectomy for a mass of 18×14×13cm in his left kidney. However, the patient died in the second month postoperatively as a result of local recurrences and multiple distant metastases. The general condition of the patient deteriorated progressively; hence, he could not have any adjuvant therapy. Having more information about the pathological and clinical findings of these exceedingly rare tumours can help inform treatment steps.

Investigation of injectable drug utilization in primary care: A focus on different age groups in pediatric population.

OBJECTIVE: The suitability of the injectables may vary across different age groups especially for children; therefore, knowledge on their usage patterns is critical in terms of rational pharmacotherapy. This study aimed to investigate pediatric injectable drug utilization in primary care with a focus on different age groups. METHOD: By simple sampling method, 100 prescriptions that contained at least one injectable drug were randomly selected for each month of the year in 32 provinces of Turkey (n=38.400). Among these prescriptions, injectable drugs that were for children (<18 years) were analyzed. Patterns of injectable drug utilization were compared according to the pediatric age group of "infants", "children", and "adolescents". RESULTS: We identified 5446 patients (14.2%) with a mean age of 7.4±5.2 years and a slight male tendency in distribution (53.8%). The most common indication for these patients was for the respiratory system (65.4%), of which 96.3% were respiratory tract infections. While less pronounced in adolescents than in infants and children, the most commonly prescribed injectable drugs were antibiotics in all age groups (61.5% vs. 78.6% and 79.9%, P<0.0001), which was upheld across all seasons. More than 90% of all prescribed injectable antibiotics consisted of penicillins and cephalosporins; the latter being predominant in infants (67.4%) compared with penicillins in children (53.9%) and adolescents (59.0%). Analgesics and insulin were found to be prescribed more frequently to adolescents than they were to infants and children (P<0.0001 and P<0.0001, respectively). The mean cost of prescription and injectable drugs per encounter was significantly more likely to escalate with increasing age (P<0.0001 and P<0.0001, respectively). CONCLUSION: Considering the predominance of antibiotics as well as the substantially higher prescription of third-generation cephalosporins in primary care, which was especially more marked for younger children, our study indicates an inappropriate use of injectable drugs by primary care physicians for managing medical conditions in the pediatric population.

Is the jet injection effective for teeth extraction?

Pain control is achieved typically by means of injection of local anesthesia for invasive procedures to carry out procedures with as little pain or discomfort as possible. Although this method is highly effective, patients often fear more from the sight of a needle during administration of local anesthetic than from the treatment. Therefore, needleless local anesthesia with a jet injection device has been proposed. With the INJEX®, anesthetic solution is forced under high pressure into the oral mucosa, leading to mechanical infiltration of the compound through the mucosa. With this study, we aimed to show the effectiveness of the needleless injection for infiltrative anesthesia and compare the acceptance and efficacy between jet injection with INJEX and local infiltration anesthesia. 28 adult patients admitted to our department for tooth extraction were included in the study. Two symmetrical teeth in the same jaw were extracted from each of the patients. Jet injection with the INJEX® was performed on one side and classical (needle) infiltration anesthesia on the other side with 0.3 cc Ultracain DS forte (Sanofi Aventis, Istanbul, Türkiye) on buccal and lingual aspects and 0.1 cc on palatal aspects of the teeth. The difference between pain and discomfort scores experienced during tooth extraction was statistically significant (P = 0.026). Accordingly, the pain or discomfort score of the INJEX® method during tooth extraction was significantly higher. Jet injection with the INJEX® was not found to be effective for local infiltrative anesthesia especially teeth extractions. It may be more acceptable when using for previously classical local infiltration anesthesia by patients. The main problem with jet injection was the "pop" sound when the INJEX® device was pressed, and also inadequate suppyling the anesthesia.