Stem Cells for the Oromaxillofacial Area: Could they be a promising source for regeneration in dentistry?

Oromaxillofacial tissues (OMT) are composed of tooth and bone, together with nerves and blood vessels. Such a composite material is a huge source for mesenchymal stem cells (MSCs) that can be obtained with ease from extracted teeth, teeth structures and socket blood, flapped gingiva tissue, and mandibular/maxillar bone marrow. They offer a biological answer for restoring damaged dental tissues such as the regeneration of alveolar bone, prevention of pulp tissue defects, and dental structures. Dental tissue-derived mesenchymal stem cells share properties with bone marrow-derived mesenchymal stem cells and there is a considerable potential for these cells to be used in different stem cell-based therapies, such as bone and nerve regeneration. Dental pulp tissue might be a very good source for neurological disorders whereas gingiva-derived mesenchymal stem cells could be a good immune modulatory/suppressive mediators. OMT-MSCs is also promising candidates for regeneration of orofacial tissues from the perspective of developmental fate. Here, we review the fundamental biology and potential for future regeneration strategies of MSCs in oromaxillofacial research.

Is age a determinant for nausea and vomiting in disabled patients after dental treatment under sedation?

BACKGROUND AND AIM: Postoperative nausea and vomiting (PONV) is one of most frequently encountered problems after dental treatment of mentally and/or motor disabled patients under sedation or general anesthesia. In this study, we aimed to investigate whether PONV incidence in disabled patients differs between adults (≥18 years) and children/teenage (<18 years). Also investigating complication rates related with anesthesia protocols were additional objectives of the study. MATERIALS AND METHODS: We retrospectively evaluated anesthesia reports of 664 cases undergone different dental treatment procedures under deep sedation with various anesthetic agents. Two study groups (Group 1 consisted from patients with special needs <18 years, while Group 2 consisted from patients ≥18 years) were created. PONV incidence and other complications recorded. RESULTS: There was no statistical difference between groups in terms of used anesthetic agent except midazolam (P < 0.017), while higher female/male ratio and longer duration of anesthesia was recorded in Group 2 (P = 0.043 and P = 0.046, respectively). We found significantly higher PONV rates in disabled patients under 18 years (P = 0.006). Hypoxia (peripheral oxygen saturation (SpO2) <90%) and bradycardia (heart rate <50/minute) were observed in only two patients. CONCLUSION: PONV is more common in disabled patients younger than 18 years and dental treatment procedures under deep sedation can be provided with acceptable complication rates in patients with special needs.

Coronal Split Corpus Osteotomy of the Mandible: A Modified Visor Osteotomy Technique for Bone Volume Enhancement.

The bony augmentation of severely atrophied mandible is generally required for the purposes of prosthetic rehabilitations. The treatment strategies have been well defined in the literature ranging from osteotomy techniques to distraction osteogenesis. Visor osteotomy is the milestone of the reconstructive surgery for the atrophied mandible which has received some modifications. In the present study, the authors describe a new modification of visor osteotomy in which a complete coronal split osteotomy down to the inferior border at the mental region has been performed. The main advantage of this modification is to preserve the lingual cortex from the inferior border of the mandible up to the alveolar region without disturbance of the suprahyoid muscle attachments. The procedure is thought to be a "highly sensitive" one and undesired fractures may occur during splitting of the bony segments.

Excision of recurrent synovial sarcoma of the infratemporal fossa.

Synovial sarcoma is a soft tissue sarcoma especially encountered in the lower extremities. The infratemporal fossa is quite a rare location. Since it is a closed location, combined approaches and multidisciplinary planning always need to be considered. This case emphasizes the high-grade character of synovial sarcoma, which causes it to recur often. The difficulty of clear surgical margins in the infratemporal fossa adds to synovial sarcoma a second challenging issue. Therefore, the need of complementary therapy is essential. In this case, we applied postoperative radiotherapy and we did not observe any sign of local, regional or distant metastasis in the one-year follow-up. In this article, we present a 68-year-old male patient together with totally excised synovial sarcoma in the infratemporal fossa by mandibular swing and transzygomatic technique information on the manifestation, imaging, histopathological features and postoperative complications of previous infratemporal fossa synovial sarcomas.

Familial florid osseous dysplasia: a report with review of the literature.

There are three types of osseous dysplasia: periapical cemental dysplasia (PCD), focal cemento-osseous dysplasia (FCD) and florid osseous dysplasia (FOD). While PCD is often observed in mandibular anterior teeth, FCD mainly affects mandibular posterior teeth. FOD, on the other hand, commonly involves both jaws. FOD is a type of sclerosing disease that is characterised by intense opaque masses and many areas with different densities. Genetic heritance of FOD is unusual, with only a few reported cases. We describe a case of FOD that affected three family members, discuss its clinical, radiological and histological characteristics, and review the literature.

Information given by multimedia: influence on anxiety about extraction of impacted wisdom teeth.

Dental fear is the fourth most common fear among the population. Well-informed patients seemed to be less anxious, and have the least anxiety before a planned procedure. Our aim was to find out the ideal way of information required by the patient before extraction of an impacted wisdom tooth. A total of 129 patients listed for extraction of impacted teeth were randomly allocated into three groups: control group (n=42); video dubbed by the surgeon (n=43); and silent video (n=44). Their sociodemographic variables and baseline anxiety scores were comparable, and each group was assessed for anxiety: (1) three days preoperatively, (2) after they had watched a video, (3) immediately preoperatively and (4) postoperatively. Assessments were made with the State-Trait Anxiety Inventory, Modified Dental Anxiety Scale, The Dental Anxiety Questionnaire, and the Visual Analogue Scale for pain. There were no significant differences in anxiety scores among the scales before or after operation. The degree of anxiety was similar throughout the study in all groups. However, patients were more satisfied with the information when they had seen it on video, and said that they would prefer to be told about further procedures in the same way.

Evaluation of bone graft harvesting techniques from anterior ilium.

Autogenous bone harvest from the anterior ilium is a common procedure in the surgical field. In the current study, a retrospective analysis was performed regarding the bone graft harvesting techniques from the anterior ilium. The retrospective analysis with a 1-year period included 16 patients who had undergone iliac bone grafting for oral and maxillofacial reconstruction. Medial and lateral approaches were assessed. No major complications were observed. One patient undergoing medial approach and 2 patients undergoing lateral approach experienced gait disturbances at the postoperative period. Harvesting bone from the anterior ilium did not result in greater donor site morbidity or complications in the early term. The medial approach revealed an earlier recovery time than the lateral one. Anterior ilium is a good choice for the reconstruction of jaws, but donor site morbidity remains a problem and should be considered in the treatment plan.

J-bone graft for the reconstruction of the jaws.

The J-bone graft technique has been used for the reconstruction of glenoid surfaces with significant bone loss in orthopedic surgery in which the J-shaped bicortical bone graft is harvested from the iliac crest. Because of the osteotomy design, the press-fit fixation into the defect is obtained. In this technical note, the authors adopted this technique to oral and maxillofacial surgery and described the technique for the reconstruction of the jaws.

Early treatment of unilateral temporomandibular joint ankylosis: a multidisciplinary approach.

Ankylosis of temporomandibular joint is a condition in which partial or complete immobilization of mandible occurs because of fusion between mandibular condyle and skull base. This condition can be treated orthodontically, surgically, or therapeutically or by prosthodontic rehabilitation. A 10-year-old female patient presented to the Department of Oral and Maxillofacial Surgery, Gazi University Faculty of Dentistry, with limited mouth opening. She got injury in the face when she was 5 years old. Extraoral and intraoral examination findings were facial asymmetry on the left side, micrognathic mandible, and 19-mm mouth opening. After radiographic examination, ankylosis (Shawney type I) on the left side was revealed, and the patient was referred to Department of Orthodontics. After orthodontic clinical examination, we create following multidisciplinary treatment approach: (1) acrylic posterior bite block with spring application, (2) interpositional arthroplasty operation, and (3) physiotherapy (passive mouth-opening exercises). After the follow-up of 9 months, significant improvement (5 mm) was noticed in the opening of the mouth, and we decided to remove appliance and operate on the patient. Surgical procedure was performed under general anesthesia via blinded nasotracheal intubation. To prevent postoperative relapse, temporal fascia was interpositioned and sutured. Passive mouth-opening exercises were started 10 days after the surgery. Thirty-one-millimeter mouth opening was reached after the surgery and passive mouth-opening exercises. Patient's routine controls have been continued for 2 years.

The effect of drill-free and drilling methods on the stability of mini-implants under early orthodontic loading in adolescent patients.

The aim of this study was to compare the stability of mini-implants using drill-free and drilling methods, both before and after early force loading. Sixty-two adolescent patients (24 males and 38 females, mean age 15.7 ± 4.2 years) were randomly assigned to three groups and 112 titanium mini-implants were placed between the upper first molars and second premolars to achieve molar distalization. Groups I (n = 22) and II (n = 20) received pilot drilling with diameters of 1.1 and 0.9 mm, respectively, while the drill-free method was used in group III (n = 20). Distalization forces of up to 200 g were applied with nickel-titanium (NiTi) open coil springs. The Z-test was used for statistical analyses to compare the success rates of the groups with each other. The overall success rate was 77.7 per cent. There was no significant difference between groups I and II either before or after loading. Significant differences were found between groups I and III (P = 0.0002) and between groups II and III (P = 0.045) both before and after loading. Mini-implants using the drill-free method provided the highest success rate before orthodontic force application and also maintained their stability after early loading for 1 month during orthodontic treatment. Smaller drill diameters can contribute to clinical stability of mini-implants in the short-term, however long-term evaluations are needed to clarify the stability of temporary skeletal anchorage devices throughout orthodontic loading.

Stability of surgically assisted rapid maxillary expansion and orthopedic maxillary expansion after 3 years' follow-up.

OBJECTIVE: To evaluate the stability of surgically assisted rapid palatal expansion (SARME) and orthopedic maxillary expansion (OME) after 3 years of follow-up, and compare these changes with a control group. MATERIALS AND METHODS: The subjects of the study were divided into three groups. Group 1 was composed of 10 patients (6 males, 4 females) with a mean age of 15.51 years (range: 13.33-17.58 years) and treated with OME, Group 2 comprised 10 patients (7 males, 3 females) with a mean age of 19.01 years (range: 16.25-25.58 years) and treated with SARME. Group 3 was the control group, consisting of 10 untreated, skeletal Class 1 subjects (6 males, 4 females) with a mean age of 15.27 years (range: 13.42-17.00 years) and matched to the OME group for sex and age. Lateral cephalometric and posteroantererior films were taken before expansion (T1), postexpansion (T2), and 3 years after the retention period (T3). RESULTS: After OME and SARME, significant increases were observed for both dental and skeletal transverse widths (P < .01). After 3 years of follow-up, maxillary basal width decreased 1.35 +/- 0.44 mm in the SARME group and 1.19 +/- 0.41 mm in the OME group, while upper molar width decreased 2.23 +/- 1.24 mm in the SARME group and 2.79 +/- 1.01 mm in the OME group. CONCLUSIONS: Both the OME and SARME procedures remained stable after 3 years of follow-up with some amount of postretention relapse, compared with the control group.

Changes in nasopharyngeal airway following orthopedic and surgically assisted rapid maxillary expansion.

INTRODUCTION: The aim of this study was to compare changes in soft-palate morphology and nasopharyngeal relations after orthopedic rapid maxillary expansion (RME) and surgically assisted RME (SARME). METHODS: A group of 10 patients received RME, a second group of 10 patients received SARME, and a third group of 10 patients served as an untreated control group. Lateral and posteroanterior cephalograms were obtained for each individual at preexpansion/precontrol and postexpansion/postcontrol. In addition to descriptive parameters, the angulation, length, and thickness of the soft palate and superior and inferior pharyngeal spaces and the ratios of the length of the soft palate to the length of the superior and inferior pharyngeal spaces were evaluated. Paired t-tests were performed to analyze changes within groups, and analysis of variance and Duncan tests were used to compare changes among groups. RESULTS: No statistically significant differences were found in changes in measurements related to soft-palate morphology or nasopharyngeal dimensions among the SARME, RME, and control groups; however, increases in soft-palate angulation and superior and inferior pharyngeal spaces after expansion/control were greater in the SARME group than in other groups. CONCLUSIONS: No statistically significant differences were found between changes in the nasopharyngeal airway after RME and SARME.

A case report comparing 3-D evaluation in the diagnosis and treatment planning of hemimandibular hyperplasia with conventional radiography.

INTRODUCTION: Cephalometric radiography is the main investigation used in the diagnosis of maxillofacial deformities. Three-dimensional (3-D) computed tomography (3-D CT) imaging has recently been used in the diagnosis and treatment planning of craniofacial morphology. The purpose of this report was to present the diagnosis and treatment planning of a hemimandibular hyperplasia case by using conventional radiographs and 3-D cephalometric analysis. METHODS: A 24-year-old girl presented with hemimandibular hyperplasia and the main complaint was her facial appearance. Conventional cephalometric analysis including lateral and frontal cephalograms were traced by hand and evaluated by the same clinician. Twenty-one measurements on the lateral cephalograms and 13 measurements on the frontal cephalograms were performed. In addition, axial images were reconstructed into a 3-D model by using medical image processing software. Linear and angular measurements were presented in coronal and sagittal planes. RESULTS: The 3-D CT analysis has a superior image quality when compared with conventional cephalograms. CONCLUSIONS: The 3-D CT analysis provides more advanced diagnostic image information in evaluating craniofacial morphology. We conclude that 3-D CT images can facilitate the diagnosis, treatment planning, and outcome evaluation of severe asymmetry cases.

Osteotomy assisted maxillary posterior impaction with miniplate anchorage.

This case report presents orthodontic treatment with miniplate anchorage accelerated by osteotomy-assisted maxillary posterior impaction in a severe open bite case. A 14-year-old girl with a severe anterior open bite was treated by intrusion of the maxillary posterior teeth. A segmental osteotomy was applied, and the miniplates were fixed to the zygomatic buttress area. The intrusive force was applied with nickel-titanium closed coil springs using a force of 250 g between the miniplates and the upper first and second molar buccal tubes. The intrusion was completed 2.5 months after osteotomy. The treatment was continued with the fixed orthodontic appliances and completed after 12 months. At the end of treatment, optimal occlusion and the correction of the anterior open bite were achieved. The maxillary molars were impacted 4.0 mm, and the mandibular plane showed a counterclockwise autorotation of 3.0 degrees . The results showed that osteotomy-facilitated orthodontic treatment clearly reduced the treatment time and had no adverse effects. In conclusion, this one-stage osteotomy technique can be an effective option to help molar intrusion in severe open bite cases.

The conservative treatment of pediatric mandibular fracture with prefabricated surgical splint: a case report.

The use of rigid fixation in children is controversial and may cause growth retardation along cranial suture lines. Intermaxillary fixation for mandibular fractures should be used cautiously as bony ankylosis in the temporomandibular joint (TMJ) and trismus may develop. The high osteogenic potential of the pediatric mandible allows non-surgical management to be successful in younger patients with conservative approaches. In this case, successful conservative treatment of mandibular fracture of a 3-year-old patient is presented.