A novel approach for horizontal augmentation with split box: A method that combines split bone block and ridge split techniques.

PURPOSE: The aim of this study was to investigate the effectiveness of the split-box technique, a novel technique that combines the ridge splitting and split bone block techniques. MATERIALS AND METHODS: In this retrospective study, alveolar ridge defects were grafted using the split-box technique and its modifications, reverse split box and sliding split box. To determine horizontal changes in the alveolar bone, thickness was measured at two levels: crest width (CW) and screw level width (SLW). Alveolar ridge height (ARH) was also measured to detect a possible loss of vertical dimension. Measurements were performed using cone-beam computed tomography taken before the operation (T0) and at five months after the operation (T1). RESULTS: Of a total of 41 patients included, 21 were females and 20 were males with a mean age of 44.5 ± 13.3 years. A total of 64 regions were augmented. Among the augmented regions, split-box technique was used in 31 regions, reverse split-box technique was used in 14 regions, and sliding split-box technique was used in 19 regions. The increase at the SLW, CW and the decrease in ARH from T0 to T1 was statistically significant (p < 0.005). A significant difference was found between split box and its modifications in terms of bone gain at the screw level, and the sliding box technique was associated with more bone gain than the other two methods (p < 0.05). CONCLUSIONS: Split-box technique provides a comparable net gain in the alveolar crest width with lower complication risk than ridge split technique and lower postoperative morbidity than split bone block technique.

Piezosurgery versus conventional rotary surgeryfor impacted third molars: A randomised, split-mouth, clinical pilot trial / Piezocirugía versus cirugía rotatoria convencionalpara terceros molares retenidos: un ensayo piloto clínico aleatorizado, de boca dividida

Background: Few studies have compared the effects of piezosurgery and conventional rotary surgery for impacted wisdom teeth on the quality of life. Among these studies, the inclusion parameters and evaluation methods have varied. Material and Methods: This study aimed to compare the effects of piezosurgery and conventional rotary instruments on the quality of life using a standardised method. Patients with bilateral and symmetric mandibularimpacted wisdom teeth were included based on the Winter and Pell-Gregory scale and Yuasa difficulty index criteria. The primary objective was to assess the effects of the methods on the quality of life using the Oral Health Impact Profile-14 questionnaire. Secondary objectives included comparisons of swelling, trismus, pain, and total operative times. The study was conducted between October 2021 and March 2022. The clinical trial protocol was recorded in the United States National Library of Medicine clinical trial registry (NCT05545553). Results: We enrolled 20 patients (40 wisdom teeth) and found that the removal of impacted teeth using the piezosurgery method positively affected the quality of life and considerably improved swelling, trismus, and pain scores. However, piezosurgery may affect postoperative morbidities such as increased total operative times. Conclusions: Piezosurgery appears to have advantages over conventional rotary surgery for impacted wisdom tooth extraction in terms of quality of life and postoperative symptoms. However, further research should investigate potential drawbacks and confirm these findings.(AU)

Retrospective Analysis of Zygomatic Implants for Maxillary Prosthetic Rehabilitation.

PURPOSE: The aim of this study was to evaluate 141 zygomatic implants for the reconstruction of severely atrophic maxillae. MATERIALS AND METHODS: In this retrospective case series study, zygomatic implants were placed under general anesthesia. Inclusion criteria were as follows: ASA I or ASA II, age older than 18 years, inadequate bone for restoration with conventional implants, alternative augmentation procedures considered either inappropriate or contraindicated, absence of a medical condition related to implant failure, and providing written consent. Zygomatic implants used in the study consisted of three different brands: NobelZygoma, Southern Implants System, and Implantswiss. RESULTS: The study included 45 patients, in whom 141 zygomatic implants were placed. The mean age of the patients was 51.76 (range: 23 to 72) years. Three patients were rehabilitated with removable prostheses, 19 patients with fixed prostheses, and 23 patients with hybrid prostheses. The overall complication rate was 5.67% (two zygomatic implants developed infection [1.4%], one zygomatic implant developed peri-implantitis [0.7%], three zygomatic implants developed sinusitis [2.1%], and two zygomatic implants showed unsuccessful prosthetic rehabilitation [1.4%]). The follow-up period ranged from 6 to 36 months. CONCLUSION: Clinical complications of zygomatic implants are acceptable, and their survival rates are similar to those of endosteal implants. Zygomatic implants can contribute to prosthetic rehabilitation.

Complications related to surgically assisted rapid palatal expansion.

OBJECTIVE: The goals of this retrospective clinical study were to identify surgically assisted rapid palatal expansion (SARPE) complications and assess their incidence, with the aim of informing surgeons and orthodontists of the risks of this widely used procedure before they recommend it to patients. STUDY DESIGN: Between June 2008 and July 2010, 60 patients (23 women and 37 men) underwent SARPE according to a defined multidisciplinary protocol at the University of Marmara, Istanbul, Turkey. RESULTS: Twelve patients (20%) suffered from nasal bleeding. Of these 12, 2 patients suffered late-onset bleeding beginning on postoperative day 8, and in the other 10, nasal bleeding was insignificant. Three patients reported excessive lacrimation postoperatively. Minor problems related to pain and numbness were all temporary. CONCLUSIONS: SARPE procedures have traditionally been reported to be associated with low morbidity, especially in comparison with other orthognathic surgical procedures. However, many complications have been reported.

Potential complications and precautions in vertical alveolar distraction osteogenesis: a retrospective study of 40 patients.

The aim of this retrospective study was to analyse the outcome of 44 cases of vertical alveolar distraction osteogenesis (ADO) and to investigate the complications, precautions, and treatment associated with ADO. The 44 alveolar distractions were performed on 40 patients. Extraosseous distraction was used in all cases. Complications associated with the intraoperative, postoperative, distraction, and consolidation periods were recorded and evaluated. Intraoperative complications were noted in two patients (4.5%) where fracture of the basal bone was evident. Three (6.8%) complications were recorded postoperatively, and 12 (27.3%) complications were recorded during the activation period. During the consolidation period, 4.5% of the patients (n = 2) were affected. The total prevalence of complications was 43.2% (n = 19), and the success rate of the ADO was 95.5%. Most complications occurred in the anterior mandibular region. Although complications associated with vertical ADO were not rare, the use of this procedure for maxillofacial defects results in satisfactory outcomes. Early diagnosis and management of related complications are crucial for increasing the success rate of ADO procedures.

Direct current electric stimulation in implant osseointegration: an experimental animal study with sheep.

In an effort to obtain a high-quality bone-implant interface, several methods involving alteration of surface morphological, physicochemical, and biochemical properties are being investigated. The aim of our study was to increase the osseointegration rate and quality and decrease the waiting period of dental implants before loading by using a microelectric implant stimulator device. It imitates microelectrical signals, which occur in bone fractures described in terms of piezoelectric theory. A single dental implant (Zimmer Dental), 3.7 mm in diameter, was inserted into the tibia of sheep bilaterally. Twenty-four dental implants were inserted into 12 sheep. Implant on the tibia of each sheep was stimulated with 7.5 µA direct current (DC), while the other side did not receive any stimulation and served as a control. Animals were sacrificed 1, 2, and 3 months after implantation. Bone segments with implants were processed with unclassified method. The determination of new bone formation and osseointegration around the dental implants was investigated by means of undecalcified method, histomorphologically. No statistically significant difference in bone-to-implant contact (BIC) ratio, osteoblastic activity, and new bone formation was found between the stimulation group and the control group at the late phase of healing (4, 8, and 12 weeks). No evidence was found that electric stimulation with implanted 7.5 µA DC is effective at late phase implant osseointegration on a sheep experimental model.

Treatment of trigeminal neuralgia with bupivacaine HCL using a temporary epidural catheter and pain pump: preliminary study.

OBJECTIVES: Trigeminal neuralgia (TN) is a rare form of neuropathic facial pain characterised by severe paroxysmal pain in the face. The treatment for trigeminal neuropathic pain disorder continues to be a major therapeutic challenge, as relief provided by medical therapy generally decreases over time. When medical therapy fails either due to poor or diminishing responses to drugs or to unacceptable side effects, peripheral intervention or surgical management of TN should be considered. STUDY DESIGN: Fourteen patients (eight men and six women) who were not responsive to further medical treatment and who were diagnosed with TN previously at other health centres were selected for treatment. For this purpose, the affected nerve was infused with 60 mL (1 mL h(-1)) of 0.5% bupivacaine HCl with a pain pump via an temporary epidural catheter. Patient's visual analogue scores (VAS) were recorded on the fifth preoperative day and on postoperative day 5, 2 weeks, 1, 3, 6 and 9 months. RESULTS: There was a significant difference between mean preoperative and postoperative VAS value at day 5, 2 weeks, 1, 3, 6 and at the end of 9 months ((68.85 ± 1.43) (13.57 ± 6.68) (11.43 ± 6.70) (14.29 ± 6.52) (20.71 ± 6.41) (20.71 ± 6.41) and (21.43 ± 6.10) respectively; ∗P<0.05). Two of 14 patients did not show any pain relief. CONCLUSIONS: Continuous administration of 60 mL of 0.5% bupivacaine HCl at 1 mL h(-1) with a pain pump and epidural catheter can be used as a transition treatment for patients with side effects from high-dose antiepileptic drugs and for patients awaiting neurosurgery or individuals who refuse cranial surgery. It should not be considered as an alternative treatment of neurosurgical approaches, such as MVD, which has a definite long-lasting results.

Evaluating the correlation between the lateral pterygoid muscle attachment type and internal derangement of the temporomandibular joint with an emphasis on MR imaging findings.

OBJECTIVES: Disc displacement is accepted as one of major findings in temporomandibular disorders. Correlation between lateral pterygoid muscle (LPM) attachment type to the disc-condyle complex and TMJ dysfunction has rarely been discussed and still not clarified. The purpose of this study was to assess the prevalence LPM attachment type to the disc-condyle complex, and to investigate whether these attachment types are linked to MR imaging findings of ID and TMJ dysfunction in a Turkish population. STUDY DESIGN: Ninety-eight TMJs in 49 patients (32 males, 17 females, mean age=36 years) with one of either: TMJ clicking, TMJ locking, restricted movement of the jaw, or pain in the TMJ region, were included. According to the clinical findings and data obtained from MRI examinations, TMJs dysfunctions were classified. LPM attachments to the condyle-disc complex were categorized into three different types. Correlation between TMJ dysfunction and LPM attachments to the condyle-disc complex was evaluated. RESULTS: Of 98 TMJs in 49 patients (32 males, 17 females, mean age=36 years), 47 TMJ's (%48) were evaluated as normal, 35 (%35.7) had a disc displacement with reduction and 16 (%16.3) TMJ had a disc displacement without reduction. Arthritis was seen in 49 TMJ's (%50). LPM attachments to the condyle-disc complex were as follows: Type I (29.6%), Type II (40.8%), and Type III (29.6%). There was no statistically significant difference between the type of muscle attachment and the presence or absence of disc displacement (p=0.481), disc degeneration (p=0.752), articular surface degeneration (p=0.117). CONCLUSIONS: There was no statistically significant correlation between the LPM attachment types and TMJ abnormalities.

Effects of midazolam/low-dose ketamine conscious intravenous sedation on pain, swelling, and trismus after surgical extraction of third molars.

PURPOSE: To assess the clinical efficacy of midazolam plus low-dose ketamine conscious intravenous sedation on relief from or prevention of postoperative pain, swelling, and trismus after the surgical extraction of third molars. PATIENTS AND METHODS: Patients admitted for surgical extraction of mandibular third molars (n = 50) were included. All patients received an initial dose of 0.03 mg/kg intravenous midazolam; then patients in the midazolam-placebo (MP) group received 2 mL of a placebo IV, while patients in the midazolam-ketamine (MK) group received 2 mL of a ketamine + saline combination (0.3 mg/kg ketamine + saline) IV. RESULTS: Facial swelling on postoperative days was significantly lower in the MK group than in the MP group (P = .001). Mouth opening on postoperative days was significantly greater in the MK group than in the MP group (P = .001). Pain scores measured on a visual analog scale at 4, 12, and 24 hours after surgery were significantly higher in the MP group than in the MK group (P = .001). CONCLUSIONS: Conscious intravenous sedation with midazolam/low-dose ketamine during surgical extraction of third molars can provide the patient with a comfortable procedure and good postoperative analgesia, with less swelling and significantly less trismus. Intravenous low-dose ketamine may be safe and effective in reducing postoperative pain.

Effects of irrigation temperature on heat control in vitro at different drilling depths.

PURPOSE: Thermal injury during implant bed preparation has a major influence on implant osseointegration and survival. This study investigated the effectiveness of the temperature of the saline solution used for heat control during drilling. MATERIAL AND METHODS: Fresh frozen edentulous segments of bovine mandibles were sectioned into 12 x 6 cm pieces. Thermoresistors were placed 0.5 mm from the drilling cavity walls, at depths of 3, 7, and 12 mm. Signals from the three thermoresistors were analyzed using ORIGIN 5.0 software. RESULTS: The maximum temperatures during drilling without irrigation were 50.9, 47.4, and 38.1 degrees C at depths of 3, 7, and 12 mm, respectively. With irrigation using saline at 25 and 10 degrees C, the maximum temperatures at a depth of 12 mm were 37.4 and 36.3 degrees C, respectively. All other measurements with both 25 and 10 degrees C saline were below body temperature. DISCUSSION AND CONCLUSION: This experimental in vitro study showed that more heat was generated in the superficial part of the drilling cavity than at the bottom. Therefore, external irrigation at room temperature can provide sufficient cooling during drilling. Lower temperature saline was more effective in cooling the bone, and irrigation of the site should be continued between the drilling steps.