Effects of glucosamine-chondroitin combination on synovial fluid IL-1beta, IL-6, TNF-alfa and PGE2 levels in internal derangements of temporomandibular joint

BACKGROUND: The aim of the present study was to evaluate the effects of glucosamine-chondroitin sulphate combination on internal derangements of temporomandibular joint in clinical and biochemical manners. MATERIAL AND METHODS: This randomized clinical study included 31 cases reporting joint tenderness, in which disc displacement was detected on MR imaging. In all patients, synovial fluid sampling was performed under local anesthesia. In the study group, the patients were prescribed a combination of 1500 mg glucosamine and 1200 mg chondroitin sulphate, while patients in the control group were only prescribed 50 mg tramadol HCl (twice daily) for pain control. After 8 weeks, synovial fluid sampling was repeated in the same manner. The levels of pain, maximum mouth opening (MMO), synovial fluid IL-1ß, IL-6, TNF-alfa and PGE2 measured before and after pharmacological intervention were compared. RESULTS: The reduction in pain levels was significant in both groups. There was no significant difference between two groups in terms of pain reduction. The improvement in MMO was significant in the study group but it was not in the control group. The MMO improvement was significantly higher in the study group compared to the control group. In the study group, significant decrease was observed in PGE2 level, while the decreases in IL-1beta, IL-6 and TNF-alfa levels were not significant. In the control group, no significant decrease was observed in any of the inflammatory cytokines after 8 weeks, moreover IL-1ß and IL-6 levels were increased. Alterations of IL-1ß and IL-6 levels were significant in study group while TNF-alfa and PGE2 levels were not, compared to control group. CONCLUSIONS: In conclusion, these results might suggest that glucosamine-chondroitin combination significantly increases the MMO and decreases the synovial fluid IL1beta and IL6 levels in internal derangements of TMJ compared to tramadol. The modifications of synovial fluid TNF-α and PGE2 levels do not reach statistical significance. This combination also provides efficient pain relief in similar level with tramadol, a narcotic analgesic

Effects of smoking on periimplant health status and IL-1ß, TNF-α, and PGE2 levels in periimplant crevicular fluid: a cross-sectional study on well-maintained implant recall patients.

PURPOSE: The aim of this cross-sectional study was to evaluate the effects of smoking on periimplant health status and inflammatory cytokines interleukin-1ß, tumor necrosis factor-α, and prostaglandin E2 levels in periimplant crevicular fluid (PICF) and to determine their correlation with clinical parameters in well-maintained implant recall patients. MATERIAL AND METHODS: A total of 60 dental implants placed in 60 patients (27 patients were smoker and 33 were nonsmoker) were included in the study. Plaque index, gingival index, probing depth, periimplant bone loss, PICF volume, and biochemical cytokine levels in PICF were determined and analyzed statistically. The correlation between PICF cytokine levels and clinical parameters were also analyzed. RESULTS: All clinical parameters with the exception of plaque scores were significantly higher in the smoker group. Significantly increased levels of cytokines were observed in the smoker group. The correlation between the cytokine levels and clinical parameters were more marked in smokers. CONCLUSIONS: Although the implants of the smoker patients seem to be clinically healthy, the results demonstrate that the implants are relatively at risk even if in a well-maintained population.

Comparison of the effects of warfarin and heparin on bleeding caused by dental extraction: a clinical study.

PURPOSE: Replacement of warfarin with heparin for dental extractions in patients on long-term warfarin therapy is associated with wasted time, consumed labor, and increased treatment expenses. The aim of this study was to evaluate the safety of dental extraction without altering the warfarin regimen in patients with an international normalized ratio from 1 to 4. PATIENTS AND METHODS: Forty patients who underwent tooth extraction were divided into 4 groups: continuation of warfarin without interruption (group 1), warfarin bridged with low-molecular-weight heparin (group 2), warfarin bridged with unfractionated heparin (group 3), and a control group of healthy individuals (group 4). Total amount of bleeding (milligrams) was measured for 20 minutes after tooth extraction. International normalized ratio values on the operative day and number of extra gauze swabs used for bleeding control in the first 48 hours were recorded for each patient. Results were statistically analyzed by analysis of variance, Fisher least-significant difference post hoc test, Pearson correlation, χ(2) test, and Student t test. RESULTS: Mean amounts of bleeding were 2,486 ± 1,408; 999 ± 425; 1,288 ± 982; and 1,736 ± 876 mg for groups 1, 2, 3, and 4, respectively. There was no severe postoperative bleeding in any patient and the number of used extra gauze swabs did not differ significantly among groups. CONCLUSION: With the aid of local hemostatic agents, dental extraction in patients receiving warfarin who have an international normalized ratio from 1 to 4 could be carried out without a significant risk of bleeding and without altering the anticoagulant regimen.

Effect of zoledronic acid on osseointegration of titanium implants: an experimental study in an ovariectomized rabbit model.

PURPOSE: Zoledronic acid (ZA), a new-generation intravenous bisphosphonate, exhibits the greatest affinity for bone mineral with the longest retention, thereby leading to its ability to be dosed at annual intervals in the treatment of osteoporosis. The purpose of this preliminary study was to evaluate the effects of systemic administration of a single dose of ZA on osseointegration and bone healing around titanium dental implants. MATERIALS AND METHODS: Thirty-six female New Zealand rabbits (aged 6-12 months) were used in this study. Rabbits were randomly assigned to 1 of 3 groups: sham control group (SH), ovariectomy group (OVX), and OVX and ZA group (OVX + ZA). Animals in the OVX and OVX + ZA groups were subjected to bilateral ovariectomy, whereas animals in the SH group were sham operated. Eight weeks later, 1 implant was placed in each tibia of the animals. ZA was administered in the OVX + ZA group during the implantation, whereas the OVX and SH groups received saline solution infusions. All of the subjects were sacrificed 8 weeks after the implantation, and tibial specimens were harvested. Histomorphometric bone-to-implant contact analysis, resonance frequency analysis, removal torque testing, and digital radiographic absorptiometry were administered, and the data were statistically analyzed. RESULTS: Histomorphometric, resonance frequency, and radiodensitometric analyses showed significant improvement in osseointegration of implants in the OVX + ZA group compared with the OVX group. However, the differences in removal torque results between the groups were not statistically significant. CONCLUSIONS: The results of this study suggest that systemic ZA administration may improve osseointegration of titanium implants placed in estrogen-deficient states of bone.

Biological aspects and clinical importance of ultrasound therapy in bone healing.

OBJECTIVES: The purpose of this study was to review past and recent literature findings regarding the effects of ultrasound therapy on bone healing and its clinical efficacy in medical and dental interventions. METHODS: A literature review was conducted on the effects of ultrasound therapy on bone healing. The studies regarding clinical applications in long bones and maxillofacial bones were evaluated separately from each other. RESULTS: The effects of therapeutic ultrasound on bone healing have been studied for half a century. Numerous clinical and experimental studies have addressed this relationship, and many of them have shown positive correlations. Although several theories have been proposed to explain the mechanism of action, the exact mechanism has not been fully understood. CONCLUSIONS: Therapeutic ultrasound therapy in clinical settings is a noninvasive application and has no serious complications or side effects. It may be an acceptable treatment of choice in many types of clinical procedures involving maxillofacial bones.

Effects of low-intensity pulsed ultrasound on healing of mandibular fractures: an experimental study in rabbits.

PURPOSE: Pulsed ultrasonic waves have been shown to accelerate fracture healing of the long bones. The aim of this study was to evaluate the effects of low-intensity pulsed ultrasound (LIPU) on healing of mandibular fractures. MATERIALS AND METHODS: Thirty skeletally mature male New Zealand rabbits were used. Animals underwent unilateral mandibular osteotomy. The bone segments were repositioned and fixed with miniplates and miniscrews. Half of the animals received daily ultrasound treatment, 20 min/day, for 20 days. Ultrasound signals consisted of a 1.5-MHz pressure wave administered in pulses of 200 microsec with an average temporal and spatial intensity of 30 mW/cm2. Animals in the control group received sham application. All of the animals were killed on postoperative day 22. Three-point bending test, digital radiodensitometric analysis, and histologic and histomorphometric examinations were performed on the harvested hemimandibles. The data were statistically analyzed. RESULTS: Biomechanical tests revealed significant improvement in the mechanical properties of the healing bone in the LIPU-treated group. This was supported by histologic and radiologic findings. CONCLUSIONS: Results of this study suggest that LIPU improves the bone healing of mandibular fractures in rabbits.

Bony palatal necrosis in a diabetic patient secondary to palatal rotational flap.

Donor site necrosis is a very rare complication of palatal rotational flaps. The aim of this case report is to present a 43-year-old female, Type I diabetic patient with a chronic oroantral fistula in the right second molar region. The patient had bony necrosis in the donor site following palatal rotational flap operation. The treatment approach and the alternative methods are discussed.

Evaluation of patient-controlled remifentanil application in third molar surgery.

PURPOSE: The aim of this study was to evaluate the clinical efficacy and safety of patient-controlled remifentanil application in combination with intravenous (IV) midazolam sedation during third molar surgery. PATIENTS AND METHODS: Twenty healthy patients with symmetrically placed impacted bilateral mandibular third molars were included in this prospective, placebo-controlled, double-blind, cross-over, randomized clinical study. A bolus dose of 0.05 mg/kg intravenous midazolam was applied to each patient. Remifentanil was administered (group MR) by patient controlled infusion (PCI) either in the first or the second operation. In the other operation, a placebo (group MP) was given in the same manner. Perioperative blood samples were obtained to determine the changes in the stress hormone (aldosterone, adrenocorticotropic hormone [ACTH], renin) levels. Vital signs and oxygen saturation were recorded. Ramsey's sedation scale and modified Steward's recovery scale was used for evaluation of consciousness. Pain, patient satisfaction, cooperation score, reaction to local anesthetic injection, and degree of amnesia were also assessed. RESULTS: Remifentanil significantly increased the level of sedation, patient cooperation, and satisfaction; decreased the oxygen saturation, heart rate, and pain. While renin levels were significantly different, ACTH and aldosteron levels did not differ significantly between the 2 groups. Aldosterone and ACTH levels significantly decreased, whereas the renin level significantly increased in both groups during the operations. Remifentanil did not significantly alter the recovery time. CONCLUSION: Patient-controlled remifentanil application in combination with IV midazolam sedation seems to be a safe and reliable method, which effectively eliminates pain and provides a satisfactory sedation level, without any serious side effect.

Gingival melanin pigmentation and its treatment with the CO2 laser.

OBJECTIVE: There are only a few reports in the literature evaluating the effects of the carbon dioxide (CO2) laser on gingival melanin pigmentation (GMP). This study was performed to evaluate the effects of the CO2 laser at superpulse mode, applied for gingival depigmentation. STUDY DESIGN: GMP at the anterior maxillary and mandibular gingiva of 10 patients was treated using the superpulsed CO2 laser (10 watts, 0.8 mm spot size, 20 Hz, 10 milliseconds). Pigmented areas were measured on pre- and postoperative standard digital images by the aid of an image- analyzing software. Statistical analysis of the data was performed by Mann Whitney U test. RESULTS: Ablation of the hyperpigmented gingiva was accomplished with minimal carbonization and almost no bleeding. Postoperative healing was uneventful with no significant postoperative pain. Two cases of partial repigmentation were observed during 24-month follow-up. Statistical analysis of the data revealed a significant difference between pre- and postoperative measurements of pigmented area. CONCLUSION: Application of the superpulse mode of CO2 laser appears to be an effective and safe method for the elimination of GMP.

Multidisciplinary approach for the rehabilitation of dentoalveolar trauma.

Satisfactory dental rehabilitation of dentoalveolar trauma requires intense effort and time. Usually multidisciplinary treatment planning and teamwork are necessary to deal with multitask problems associated with these cases. Dental implants have been successfully used for replacement of missing teeth, but in trauma cases insufficient alveolar bone hinders implantation. In this report we present the multidisciplinary approach for the treatment of a trauma case. Maxillary segmental alveolar osteotomy in conjunction with interpositional and onlay bone grafting was performed to prepare the site for placement of osseointegrated implants. Titanium microplate and screws were used to provide orthodontic anchorage for intrusion of the extruded mandibular incisors. The patient was rehabilitated by implant supported fixed partial denture 6 months after implant placement.

Apical microleakage of root-end cavities prepared by CO2 laser.

This in vitro study in extracted human teeth was designed to compare the degree of dye penetration of root-end cavities prepared by CO2 laser, ultrasonic retrotip, or rotary instrument. Eighty-two human anterior teeth were prepared and obturated with laterally condensed gutta-percha and sealer. Root-end resection was performed at 90 degrees, 3 mm from apex. Root-end cavities were prepared by CO2 laser beam, ultrasonic retrotips, or bur and were filled with amalgam. The teeth were isolated and immersed in basic fuchsin at 36 degrees C for 48 hours. The roots were split longitudinally and examined by a stereomicroscope. Leakage was quantified by linear measurement of dye penetration with the aid of image-analyzing software. Apical leakage in the CO2 laser group was significantly less than in the ultrasonic retrotip and bur groups. The difference between the ultrasonic and bur groups was insignificant. Based on the results of this in vitro study, application of CO2 laser for root-end cavity preparation appears to decrease the apical leakage.

Comparison of the effects of 2 doses of methylprednisolone on pain, swelling, and trismus after third molar surgery.

OBJECTIVE: The aim of this study was to compare the effects of intravenous administration of 1.5 mg/kg and 3 mg/kg of methylprednisolone sodium succinate (MP) on pain, swelling, and trismus after third molar surgery. STUDY DESIGN: Twenty-six healthy patients with symmetrically impacted mandibular third molars were included in this double-blind, cross-over study. Either 1.5 mg/kg or 3 mg/kg of MP was administered by intravenous route one hour prior to the first operation. At the second operation the other dose was applied. Trismus was determined by measuring maximum interincisal opening and facial swelling was evaluated using a tape measuring method. Pain was determined using visual analogue scale and recording the number of pain pills taken. RESULTS: There was no statistically significant difference in trismus, facial swelling, and pain between the two groups. CONCLUSION: No clinical benefit of the higher dose of MP was demonstrated.

Long-term results of the application of solvent-dehydrated bone xenograft and duramater xenograft for the healing of oroantral osseous defects: a pilot experimental study.

The aim of this study was to investigate the long-term effects of the use of human cadaveric solvent-dehydrated bone graft and duramater as a barrier membrane for the treatment of oroantral communication. Standard oroantral osseous defects were created in five minipigs. Subjects received cancellous bone graft in the form of block or microchips, duramater or a combination of bone and membrane. Uneventful healing was achieved in all of the subjects, clinically including the control site which did not receive any material. The operated bone segments were evaluated both by radiological and histological examinations after 6 months. Radiological evaluation was carried out using bone density analysis software and histological evaluation made by light microscopy. Radiological and histological results revealed that bone grafting of oroantral osseous defects improved the bone quality. However, application of duramater did not change this activity, both alone or combined with bone grafts. Within the limits of this experimental study, although solvent-dehydrated bone grafts were found superior and could be applied for the healing of osseous oroantral defects, resorbable membranes did not contribute to this process.