The impact of COVID-19 pandemic on patient satisfaction and clinical outcomes after treatment of odontogenic cysts with decompression followed by surgery.

OBJECTIVE: The global pandemic outbreak has caused significant limitations in the public's access to routine dental care. The aim of this study was to evaluate the patient satisfaction and clinical outcomes related to decompression treatment followed by surgery for large odontogenic cysts during COVID-19 pandemic. MATERIALS AND METHODS: The present study were performed in patients (n=11) with large odontogenic cysts treated at our institution between March 2020 to June 2021. Decompression was applied as a part of the conservative approach and followed by surgery. All surgical procedures were performed under local anesthesia. Patient satisfaction related to treatment was recorded via the Likert scale and Visual Analog Scale after the surgery. Gender, age, location of the lesion, histopathological features, pre-and post-decompression size of lesions, decompression time, reduction rate and patients satisfaction values were recorded. RESULTS: The mean age was 27 years and all patients were male. Mean follow-up time was on average 6.45 months. Histologic examination at the time of definitive surgery was 54.5% of the radicular cyst and 45.5% of odontogenic keratocyst. The mean reduction rate was 80.8%. No recurrence were recorded. Patient satisfaction values related to treatment modality were 3.91 for the Likert scale and 79.45% for the VAS scale. 81.8% of patients recommend this treatment modality for prospective patients. CONCLUSIONS: Results of this study supported that conservative management of large cystic lesions of jaws with decompression followed by surgery has favorable patient satisfaction scores and predictable to reduce the effects of radical surgery in COVID-19 pandemic.

Can nocturnal use of implant-retained overdenture improve cardiorespiratory stability of a patient with obstructive sleep apnea? A clinical report.

Few studies have evaluated the interaction between conventional complete dentures (CCD) and the respiratory system and the authors are unaware of any that evaluated the interaction between implant-retained overdentures (IROs) and the respiratory system. This clinical report documented the effects of wearing an IRO on the cardiorespiratory stability of an edentulous patient with obstructive sleep apnea (OSA). A 64-year-old woman was referred to the department of otolaryngology because of daytime sleepiness and morning headaches. The patient refused polysomnographic evaluation because of claustrophobia. Overnight pulse oximetry (PO) was performed to detect cardiorespiratory stability during sleep, and the oxygen desaturation index (ODI) of the patient was found to be 20.9. A mandibular advancement device (MAD) was fabricated; however, the patient did not comply with the treatment and stopped using the MAD because of intraoral discomfort. Therefore, the patient started to wear the conventional complete dentures (CCDs) nocturnally to prevent upper airway collapses. Despite the significant drop in ODI score to 12.6, because of displacement, the mandibular denture was converted to an IRO. The PO tests performed after another 6 months revealed an ODI score of 7.8. Wearing CCDs might improve respiratory stability of patients with edentulism during sleep; however, more favorable results could be obtained with IROs.

Extremely Rare Form of Impaction Bilateral Kissing Molars: Report of a Case and Review of the Literature.

Kissing molars (KM) or rosette formation is a term that is used to describe impacted teeth contacting occlusal surfaces in a single follicular space and their roots pointing in opposite directions. In some cases kissing molars can be seen but occurrence of bilateral kissing molars is extremely rare phenomenon in the dental literature and the aetiology of this phenomenon is still unknown. In this paper we describe a case and review of the literature and discuss the management of this pathology. In our case, extremely rare form of impacted bilateral kissing molars was extracted surgically. The decision of extraction of asymptomatic kissing molars represents surgical dilemma. There may be many surgical complications; on the other hand in some cases surgical intervention is unavoidable. Few treatment options were described in the literature. This phenomenon can be sign of various medical conditions that may require further investigation. In this paper, our treatment option is in agreement with the literature suggesting the surgical removal of both teeth at either side of the mandible.

In Vitro Development of a Mucocutaneous Junction for Lip Reconstruction.

PURPOSE: We present a straightforward and reproducible technique to create, in vitro, a construct containing a mucocutaneous junction (MCJ) with a transitional zone (vermilion) for fabrication of a microvascular prelaminated flap for use in lip reconstruction. MATERIALS AND METHODS: Cultured primary human skin keratinocytes and oral mucosal epithelial cells at premixed ratios of 50% skin cells to 50% oral cells, 25% skin cells to 75% oral cells, and 75% skin cells to 25% oral cells were grown on an AlloDerm dermal equivalent (LifeCell, Branchburg, NJ) to create an MCJ equivalent with a lip or transitional zone (vermilion) using a novel 3-dimensional (3D) culture device with a barrier to separate co-cultured skin and oral cells. The 3 different cell ratios were compared by staining for the following specific differentiation markers to define the different areas of skin and mucosal keratinocytes: filaggrin, cytokeratin 10, cytokeratin 19, and small proline-rich protein 3. RESULTS: Immunohistochemical results showed that MCJ equivalents seeded with premixed cells were similar to the differentiation patterns of tissue-engineered 3D cultures using 100% oral mucosal epithelial cells or skin keratinocytes. The engineered MCJ-equivalent constructs, grown in the 3D device specifically constructed with a cell-free gap at the barrier site, formed a transitional zone (vermilion) at the barrier site with intermingling of the skin and oral keratinocytes. The results showed different and unique expression patterns of filaggrin, cytokeratin 10, cytokeratin 19, and small proline-rich protein 3 by those cells migrating into the gap, which were similar to those seen in human lip tissue. This pattern was not seen in MCJ equivalents created using premixed skin and oral cells. CONCLUSIONS: Using a device to separately co-culture human oral and skin keratinocytes to allow the cells to migrate into a cell-free zone resulted in phenotypic expression closer to what is seen in native tissue, in comparison to premixing the skin and oral cells before seeding.

Thymoma with immunodeficiency with multiple recurrent oral herpetic infections.

Thymomas with immunodeficiency (formerly Good's syndrome) are a rare acquired disease of combined T- and B-cell immunodeficiency accompanying a thymoma. Recurrent opportunistic infections associated with disorders of both humoral and cell-mediated immunity frequently accompany this rare primary, adult-onset immunodeficiency. This is a report of a case of a thymoma with immunodeficiency in a 65-year-old male patient who developed recurrent oral herpetic infections. He consulted us about recurrent vesiculo-ulcerative lesions on his tongue, lower lip, and buccal mucosa. Results of laboratory examinations indicated hypogammaglobulinemia accompanied by diminished B cells in the peripheral blood, which is consistent with the characteristic features of a thymoma with immunodeficiency. After a diagnosis confirming herpes simplex virus infection, systemic antiviral therapy was administered, which was effective for his vesiculo-ulcerative lesions at follow-up. When an intractable infection accompanied by a thymoma is encountered, increased awareness about the clinical and immunological profiles of this primary immunodeficiency may help in its early diagnosis, thereby preventing mortality.

Histomorphometric and microtomographic evaluation of the effects of hyperbaric oxygen and systemic ozone, used alone and in combination, on calvarial defect healing in rats.

PURPOSE: The aim of this study was to compare the efficacy of hyperbaric oxygen and systemic ozone, used separately and in combination, on the healing of bone defects. MATERIAL AND METHODS: Sixty male Wistar rats were divided into 4 groups (n = 15) according to treatment (control, hyperbaric oxygen [HBO], ozone [O], and HBO plus O [HBO-O]) and divided further into 3 subgroups according to day of sacrifice (postsurgical days 5, 15, and 30). Surgery was performed under general anesthesia to create a critical-size bone defect (5 mm in diameter) in the cranium. After sacrifice, microtomographic images of all samples were recorded, and histomorphometric analysis was performed. RESULTS: Histologic and radiologic measurements showed that the values of all experimental groups were higher than those of the control group. Histologic scores for all experimental groups were statistically higher than those for the control group day 30 (O, P = .045; HBO, P = .049; HBO-O, P = .042). Histologic scores also were statistically higher for the HBO group on day 5 (P = .045) and day 15 (P = .009) compared with the control group. Microtomographic scores were higher for the experimental groups than for the control group, with statistically significant differences for group O on day 5 (P = .033) and day 30 (P = .0045) and for group HBO on day 15 (P = .005). Histologic and radiologic analyses showed positive correlations. CONCLUSION: Within the limitations of this study, the use of hyperbaric oxygen and ozone, separately and in combination, were shown to be effective in increasing bone healing. Combined usage was no more effective in stimulating bone healing than separate usage.

An unusual complication of genioglossus advancement surgery.

OBJECTIVE: Genioglossus advancement is a surgical procedure where the base of the tongue is pulled forward, usually to increase airway size due to deformity or a sleep breathing disorder. In this procedure, a small bony window is made in the lower jaw. The piece of bone along with the attachment for the tongue is pulled forward and down, then fastened to the outside of the lower jaw. Here we report a 43 year old male patient which has admitted to our department with the complaints of the mild pain and swelling on the chin area. MATERIAL AND METHODS: The patient underwent a genioglossus advancement surgery 3 months ago. An ortopantomograph revealed a root fracture of the lower left canine. Under mandibular nerve block, the lower left canine was extracted and the root piece was removed via an endodontic K-file. RESULTS: The healing period was uneventfull and no signs or symptoms of a pathology was detected. CONCLUSION: Dental complications related to genioglossus advancement are rarely reported. However, the surgeons should be aware of damage the roots of the adjacent teeth, especially the lower canines.

Clinical comparison of submucosal injection of dexamethasone and triamcinolone acetonide on postoperative discomfort after third molar surgery.

OBJECTIVE: The aim of the study was to compare the effect of submucosal injection of dexamethasone and triamcinolone acetonide on postoperative pain, swelling, and trismus occurring after impacted mandibular third molar surgery. METHOD AND MATERIALS: A total of 78 patients (aged 18 to 35) with asymptomatic, unilateral, impacted mandibular third molar, and without any systemic disease were included in this study. Patients were divided into three groups randomly (control, dexamethasone, and triamcinolone acetonide). In the experimental groups, dexamethasone and triamcinolone acetonide were injected into submucosa at about 1 cm above the surgical area submucosally. The control group of patients did not take any drug submucosally but the same surgical procedure was applied. Pain evaluation was performed by visual analog scale (VAS). Swelling was measured using a flexible standard ruler measuring the dimensions of the axes between certain points on the face. For trismus evaluation, maximum mouth opening was measured. Measurements taken on the preoperative, and on postoperative first, third, and seventh days were compared with each other and statistically evaluated. RESULTS: There were statistically significant differences between the control and experimental groups on the different days of the postoperative period. The effect of triamcinolone acetonide on pain started on the first day postoperatively and the effect of triamcinolone acetonide on trismus and pain was better than other groups at the third and seventh days. However, there was no statistically significant difference between the effects of dexamethasone and triamcinolone acetonide regarding postoperative complications. CONCLUSION: The submucosal injection of dexamethasone or triamcinolone acetonide might be an effective treatment for postoperative discomfort occurring following impacted mandibular third molar surgery, and triamcinolone acetonide could be applied as an alternative to dexamethasone.

Tomographic evaluation on bone morphology in posterior mandibular region for safe placement of dental implant.

The aim of this study was to examine the morphology of submandibular fossae at edentulous posterior regions of dried mandibles and to determine a safe range for proper lingual angulation during the placement of a dental implant in the posterior mandibular region, with a computerized tomographic scan study. Spiral computed tomographic images of 77 dry adult human mandibles were evaluated to determine the deepest area in the submandibular fossa. Then, the proper lingual angulations for the placement of a dental implant at these regions were measured. Pearson's correlation coefficient was calculated to show the relation between the depths of submandibular fossa and lingual implant angulations. "Paired t test" was used for differences between the lingual implant angulations and the depths of submandibular fossa on each side of the mandibles. Depths of the submandibular fossa and lingual implant angulations were varied between 1.1 and 4.6 mm: 62°-84° on right side of the mandibles, and 1.1-4.5 mm, 65°-83° on left side of the mandibles. There were statistically medium negative correlations between the degree of lingual implant angulations and the depth of submandibular fossa on each side of the mandible (r = -0.44, p < 0.001, and r = -0.38, p = 0.001). There was a statistically significant difference between the right and left sides of the mandibles in terms of the depth of submandibular fossa (p = 0.01). Within the limits of this study, the depth of submandibular fossa was measured as ≥ 2 mm in around 71.5 % of examined regions, and lingual implant angulations were between 62° and 84°. These results may be considered by clinicians who are planning the dental implant placement in posterior mandible to avoid potential risk of lingual cortical plate perforation.

The effect of cigarette smoking on the healing of extraction sockets: an immunohistochemical study.

The aim of this study was to investigate immunohistochemically the influence of cigarette smoking on the socket healing after tooth extraction in rats. Eighty-four male rats were divided into 3 groups; 2 groups were considered as experimental and the other as control. The animals in test 1 were exposed to smoking regimen before the surgery and after the surgery, but the animals in test 2 were exposed to the smoking regimen only before surgery. All animals' maxillary right central incisors were extracted and killed at the 3rd, 7th, 15th, and 28th day. The samples taken on third day after tooth extraction were stained immunohistochemically with fibronectin antibody and the other with type I collagen antibody. On the third day after tooth extraction, samples in the control group were intense stained (3) (+++); in the test 1 they were slight positive (1) (+) and in the test 2 they were moderate positive (2) (+ +). As a result of scoring type I collagen antibody, there was no statistically significant difference between the groups at seventh day, but there were statistically significant differences between the groups at the 15th and 28th day (P = 0.000 and P = 0.001, respectively). Comparison of the paired intense scores of type I collagen antibody staining according to days within each groups were not statistically significant. As a result, we have found out that the healing process of the tooth extraction socket is negatively affected by cigarette smoke.

Correlation between the residual ridge height and the perforation limit of sinus membrane in crestal sinus elevation.

OBJECTIVES: The residual alveolar bone height at the implant recipient site plays a key role in determination of the risk of sinus membrane perforation during crestal sinus elevation. In this study, we aimed to determine the correlation between residual ridge height and perforation limit of sinus membrane and to examine the safety range for the sinus membrane continuity in crestal sinus elevation. Formalin-fixed cadavers were used for the experiment to observe outcomes. METHOD AND MATERIALS: Crestal sinus elevations were performed on 14 preserved human cadavers' heads. Residual ridge heights were measured using a bone caliper. The physiodispenser was preset to 30 Ncm and sinus floors were elevated by a concave sinus screw with diameter of 4 mm until sinus membrane perforation occurred. The perforations were identified either as Class I or Class II and the portion of the concave sinus screw in the sinus was measured each time using a ruler. Spearman's correlation coefficient was calculated to show the relation between the residual ridge heights and the membrane elevations at the time of perforation of the sinus membranes. RESULTS: In general, the perforation limit of sinus membrane after elevation was higher with greater residual ridge height. A statistically significant correlation was found between residual ridge heights and perforations of the sinus membrane (r = 0.620, P < .001). CONCLUSION: Although it is not always possible to extrapolate results from cadavers to an in vitro clinical setting, it could be considered to have clinical significance. Our findings suggest that higher subsinusoidal elevation may be achieved when the residual ridge bone height increases. The conclusions of this study should be verified with studies of more rigorous design.

Histological evaluation of the changes in temporomandibular joint capsule and retrodiscal ligaments following autologous blood injection.

INTRODUCTION: In recent years injection of autologous blood into the temporomandibular joint (TMJ) has been reintroduced as a treatment of chronic recurrent TMJ dislocation. The effects of this treatment on components of the TMJ is not fully understood. The purpose of this article is to evaluate the effects of autologous blood on TMJ capsule and the retrodiscal ligament. MATERIAL AND METHODS: A total of 16 healthy adult country bred pig were used in this study. Autologous blood were injected into the upper joint space (4 ml) and around the capsule of TMJ unilaterally (1 ml). This procedure was then repeated on the opposite side only by using 5 ml of 0.9% saline. TMJ capsules and retrodiscal ligaments were examined four weeks following the injections. RESULTS: Histological examination of TMJs injected with autologous blood revealed fibrotic changes in 81.25% of the retrodiscal ligaments and 56.25% of the capsular areas. Whilst no changes were seen in the retrodiscal ligaments nor in the capsules of TMJs injected with saline alone. CONCLUSION: There is little published clinical data on the use of autologous blood injection and as such the mechanism of action is still unclear. The rate of induction of fibrosis within the retrodiscal ligaments in this study were similar to previously reported studies and case series. However, further studies to evaluate the mechanism of this safe and simple technique are needed.

A case of a benign cementoblastoma treated by enucleation and apicoectomy.

Cementoblastoma is a rare, benign, odontogenic neoplasm of ectomesenchymal origin, representing less than 6% of all odontogenic tumors. Despite its well-known typical features, there are still controversies regarding the management of the condition. This article presents the case of a benign cementoblastoma in a 17-year-old girl. The lesion was typical and associated with the mandibular right first molar. Endodontic treatment of the involved tooth, enucleation of the cementoblastoma, and apicoectomy of the affected roots were performed. Removal of the tumor while preserving the associated tooth resulted in normal osseous healing and no evidence of recurrence after one year. Based on the findings of the current report, it can be suggested that, in properly selected cases, it is possible to remove cementoblastomas that affect molars without extracting the involved teeth.

Management of obstructive sleep apnea by maxillomandibular advancement surgery in an edentulous patient.

BACKGROUND: Maxillomandibular advancement (MMA) surgery is a surgical treatment option for treating the patients with obstructive sleep apnea (OSA). Surgical treatment of OSA by MMA surgery is a problem when it is encountered with an edentulous patient because of the intermaxillary fixation problem of the jaws. A paucity of information is available concerning MMA surgery for edentulous patients. MATERIALS AND METHODS: In this case report, we present the preoperative planning, orthognathic surgery, and postoperative phases of a 49-year-old edentulous severe OSA (apnea hypopnea index, 81.9 event/hr) patient who underwent MMA surgery. RESULTS: Polysomnographic examination 9 months after surgery revealed normalization of the somnographic evaluations (apnea hypopnea index, 1.3). CONCLUSIONS: The results reported in the present case showed that the surgical treatment of OSA by MMA surgery in edentulous patients could be successfully done. Further critical evaluations of this approach for the surgical treatment of edentulous OSA patients are needed.

Clinical study on the closure of extraction wounds of partially soft tissue-impacted mandibular third molars.

OBJECTIVE: When a mandibular third molar is partially impacted in the soft tissue, it must be determined whether the extraction wound should be left partially open or completely closed. We hypothesize that a blood clot preserving a surgical wound with easily cleanable surfaces by primary closure and drain application would postoperatively minimize dry socket and/or alveolitis development. METHOD AND MATERIALS: Twenty patients requiring bilateral extraction of partially soft tissue-impacted mandibular third molars in a vertical position were included in the study. The existence of dry sockets, alveolitis, pain, facial swelling, and trismus were evaluated on the second, fifth, and seventh days of the postoperative period. RESULTS: On the second day, pain, trismus, and swelling were higher in the drained group; however, pain reduced progressively in the drained group over time. There were no cases of dry sockets or alveolitis except for a single patient on the seventh day in the drained group over the 7-day study period. On the other hand, in the secondary closure group, the number of dry sockets was 8 (40%) on the second day. The number of alveolitis was 10 (50%) on the fifth day and 4 (20%) on the seventh day. CONCLUSION: Closed healing by drain insertion after removal of partially soft tissue-impacted third molars produces less frequent postoperative dry sockets and/or alveolitis development than occurs with open healing of the surgical wound. In cases with a risk of alveolitis development (lack of oral hygiene, immunocompromised patients, etc), it can be avoided with the "kiddle effect" and related undesired complications by implementing closed healing with drain insertion.

Synchronous ossifying fibromas of the jaws: a review.

According to the World Health Organization, it is proposed that benign fibro-osseous lesions be divided into 3 categories, including fibrous dysplasia, ossifying fibroma (OF), and osseous dysplasia. OF arises from the periodontal ligament, which contains multipotential cells. These benign tumors may become large and aggressive. Slow growth and lack of symptoms are the cardinal features. OF tends to occur in the second and third decades of life, with predilection for women and for the mandibular premolar-molar area. The method of treatment used for large or rapidly expanding lesions is surgical removal (enucleation). Rarely, OFs occur multifocally. We report a 20-year-old man with synchronous OFs of his maxilla and mandible and review other synchronous cases reported. Such lesions can be properly diagnosed and treated by correlating radiographic, clinical, surgical, and histopathologic findings.

Histomorphometric analysis of new bone obtained by osteogenic periosteal distraction in ovariectomized rabbits.

OBJECTIVE: The aim of this study was to evaluate the effects of estrogen deficiency on newly formed bone obtained by osteogenic periosteal distraction histomorphometrically. STUDY DESIGN: Thirty-six female rabbits were divided into 2 groups. The experimental group underwent a bilateral ovariectomy and a sham operation was applied to the control group to equalize the stress of ovariectomy surgery. Four weeks postoperatively, a gradual distraction of the mandibular corpus was performed. RESULTS: In the experimental group, callus formation was delayed and the new bone was less mineralized; conversely, when histomorphometric measurements were compared statistically, there were no significant differences between the ovariectomized and sham-operated subgroups in the mean extent of newly formed bone tissue. CONCLUSIONS: Although osteoporosis caused by the lack of estrogen has negative effects on osteogenic periosteal distraction (OPD), these negative effects do not appear to present a contraindication to OPD.

Management of keratocystic odontogenic tumour with marsupialisation, enucleation and Carnoy's solution application: a case report.

The keratocystic odontogenic tumour (KCOT) is a relatively common oral and maxillofacial lesion that derives from remnants of the dental lamina. It is aggressive, grows rapidly and invades the surrounding tissues. Various treatment modalities and differing recurrence rates have been reported for KCOT. In order to treat a 24-year-old male patient with KCOT the first stage was marsupialisation. This was followed six months later by enucleation with the application of Carnoy's solution. The defect was filled completely with newly formed bone tissue after two years. This case shows that a large KCOT can be treated with a combination of conservative and aggressive methods.

An excessive coronoid hyperplasia with suspected traumatic etiology resulting in mandibular hypomobility.

There are multiple theories as to the causes of coronoid process hyperplasia of the mandible, including trauma, temporalis muscle hyperactivity, hormonal stimulus, and genetic inheritance. The excess growth of the coronoid process can cause impingement on the zygomatic processes and may result in mandibular hypomobility. A case of an excessive unilateral coronoid hyperplasia with suspected traumatic etiology, which was successfully treated by coronoidectomy and postoperative physiotherapy, is presented. The patient was a 21-year-old man whose maximum mouth opening was 23 mm. The attachments of the temporalis muscle were stripped and the coronoid process was accessed using the Al-Kayat and Bramley approach. The coronoid process was then resected via an intraoral pathway. One week after surgery, physiotherapy was started and the maximum mouth opening had increased to 38 mm. In the case presented, a coronoidectomy with postoperative physiotherapy for treatment of coronoid process hyperplasia produced satisfactory results in the correction of coronoid-malar interference.

Psychopathological profile of patients with different forms of bruxism.

The aim of the current study was to evaluate the prevalence of psychopathological symptoms in patients who self-reported different forms of bruxism by means of clinical and anamnestic diagnostic criteria. Eighty-five participants were divided into four groups as sleep bruxers (12), awake bruxers (24), sleep-awake bruxers (33), and non-bruxers (16). A self-report symptom inventory questionnaire (Symptom Checklist-90-Revised (SCL-90-R)) was filled out by all groups to determine their psychopathological symptoms. As regards mean psychopathological scores, patients with sleep-awake bruxism endorsed the highest scores. In addition, patients with awake bruxism showed higher scores than patients with sleep bruxism and non-bruxism in most SCL-90-R subscales. Kruskal-Wallis test revealed significant differences between groups in any of the SCL-90-R subscales, except for the psychoticism subscale. Mann-Whitney test followed by Bonferroni's test correction between non-bruxer and sleep-awake bruxer groups revealed significant differences in depression, anxiety, hostility, phobic anxiety, paranoid ideation, global severity index, positive symptom distress index, and positive symptom total in all SCL-90-R subscales. Statistical analysis of our study showed that differences between groups were significant in all SCL-90-R subscales except for the psychoticism subscale. Better distinction of bruxism forms may help to develop new treatment strategies for bruxism disorder.