Evaluation of Patient Comfort and Impact of Different Anesthesia Techniques on the Temporomandibular Joint Arthrocentesis Applications by Comparing Gow-Gates Mandibular Block Anesthesia with Auriculotemporal Nerve Block.

Aim: Temporomandibular disorders (TMDs) are clinical situations that are characterized by pain, sound, and irregular movements of the temporomandibular joints. The most common method in the treatment of TMDs is arthrocentesis. This study aims to compare the effect of conventional extraoral auriculotemporal nerve block (ANB) and Gow-Gates (GG) mandibular anesthesia techniques on patient comfort in an arthrocentesis procedure. Materials and Methods: We performed this study on 40 patients who underwent TMJ arthrocentesis with ANB (n = 20) or GG (n = 20) mandibular anesthesia techniques at the Marmara University Faculty of Dentistry between 2016 and 2019. The predictor variable was the type of an anesthesia technique, and the outcome variables included were pain, maximum mouth opening (MMO), and protrusive movement (PM). They were compared at the preoperative period and 3rd and 6th month periods. Statistical analysis included means with standard deviations, a one-way ANOVA for continuous data, and the results were evaluated at the significance level of p < 0.05. Results: No statistically significant difference was observed between the VAS values, MMO, and PM averages of preoperative, 3rd and 6th months of ANB and GG (p=0.142, p=0.209, and p=0.148). Conclusion: Both anesthesia techniques have provided effective results in terms of pain and functional jaw movements in the postoperative period in arthrocentesis treatment.

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.

Changes in the temporomandibular joint disc and temporal and masseter muscles secondary to bruxism in Turkish patients.

OBJECTIVES: To analyze the relationships between temporalis and masseter muscle hypertrophy and temporomandibular joint (TMJ) disc displacement in patients with severe bruxism using magnetic resonance imaging (MRI). Methods: This retrospective study included 100 patients with severe bruxism, referred to the Department of Oral and Maxillofacial Surgery, University of Marmara and Istanbul Medipol University, Istanbul, Turkey, between January 2015 and December 2016. Patients underwent TMJ MRI with a 1.5-T system in open and closed mouth positions. The masseter and temporalis muscles were measured in the axial plane when the patient's mouth was closed. Results: At its thinnest, the disc averaged was 1.11±0.24 mm. At their thickest, the masseter averaged was 13.65±2.19 mm and temporalis muscles was 12.98±2.4 mm. Of the discs, 24% were positioned normally, 74% were positioned anteriorly, and 2% were positioned posteriorly. The temporalis muscle was significantly thicker in patients with normally positioned discs than in those with anteriorly positioned discs (p=0.035). Conclusions: The temporalis muscle was significantly thicker in patients with normally positioned discs than in those with anteriorly positioned discs (p=0.035). Additional studies should be conducted to evaluate the relationships between all masticatory and surrounding muscles and disc movements in patients with bruxism.

Comparison of alveolar ridge splitting and autogenous onlay bone grafting to enable implant placement in patients with atrophic jaw bones.

OBJECTIVE: To compare alveolar ridge splitting (ARS) and autogenous onlay bone grafting (AOBG) in atrophic jaw bones.  Methods: Forty patients were included in this retrospective, parallel-group study conducted at the Istanbul Medipol University School of Dentistry, Istanbul, Turkey, between 2012-2015. The initial bone thickness was measured by cone beam computed tomography (CBCT). Patients were allocated into ARS (n=17) and AOGB (n=23) groups on the basis of ridge thickness and shape. Follow-up CBCT measurements to assess horizontal bone were repeated 4 to 6 months post augmentation. The diameters of the implants were recorded. Implant bone resorption was measured at one year post implant placement on panoramic radiography. Surgical complications and implant survival were evaluated.  Results: The final bone width in the AOBG group was significantly higher than that in the ARS group (p=0.029). Forty-four implants were inserted in the AOGB group, whereas 33 implants were inserted in the ARS group. There was no significant difference regarding implant diameter (p=0.920). Implant survival rate was 93.9% in the ARS group and 93.1% in the AOGB group. Peri-implant bone resorption at one year was higher in the AOBG group than in the ARS group (p=0.032). There were minor surgical complications, including bad split and wound dehiscence.  Conclusion: The incidence of peri-implant bone resorption for the AOGB technique was higher than that for the ARS technique, but their implant survival rates were similar.

Effect of Ankaferd Blood Stopper on Skin Superoxide Dismutase and Catalase Activities in Warfarin-Treated Rats.

AIM: Ankaferd Blood Stopper (ABS) is a new promising local hemostatic agent, and its mechanism on hemostasis has been shown by many studies. However, the effects of ABS on skin superoxide dismutase (SOD) and catalase (CAT) activities have not been investigated before. The aim of this study was to evaluate the effects of this new generation local hemostatic agent on warfarin-treated rats focusing on its the antioxidant potential in short-term soft tissue healing. METHODS: Twelve systemically warfarin treated (warfarin group) and 12 none treated Wistar Albino rats (control group) were selected for the trial. Rats in the warfarin group were treated intraperitonally with 0.1 mg/kg warfarin, and rats in the control group were given 1 mL/kg saline 3 days earlier to surgical procedure and continued until killing. All rats had incisions on dorsal dermal tissue, which was applied ABS or no hemostatic agent before suturing. Six of each group were killed on day 4, and the other 6 were killed on day 8. Blood and skin samples were taken. Prothrombin time (PT) in blood samples, CAT, and SOD activities in skin samples were determined. RESULTS: Warfarin treatment dose was found to be convenient and warfarin treatment increased the PT levels as expected. Warfarin treatment decreased CAT activity significantly compared to the control group. The ABS treatment significantly increased SOD activities in the warfarin group at the end of the eighth day. CONCLUSION: Ankaferd Blood Stopper acted positively in short-term tissue healing by increasing SOD activity in warfarin-treated rats. Therefore, ABS may be suggeted as a promoting factor in tissue healing.

Analyses of anatomical relationship between mandibular third molar roots and variations in lingual undercut of mandible using cone-beam computed tomography.

BACKGROUND/PURPOSE: Anatomical features of the lingual undercut region is a potential factor that might increase the risk of displacement of a tooth or fragment. The aim of this study was to report the normal anatomical relationship of impacted lower third molar roots to the lingual cortex and soft tissues of mandible and anatomical variations of lingual balcony in the impacted third molar region. MATERIALS AND METHODS: One hundred impacted third molars (54 males, 46 females) from 65 (31 men, 34 women) patients were evaluated for this study using cone-beam computed tomography. Three measurements [bone thickness, angle (Ang) 1 and Ang 2] were recorded on the coronal section slices of cone-beam computed tomography images; in these images, the impacted third molar root was closest to the lingual soft tissues. RESULTS: The average distance between the tooth root and the lingual outer cortical bone layer (bone thickness) was 1.03 mm. The averages of Ang 1 and Ang 2 were 140.61° and 153.44°. Ang 1 and Ang 2 of female patients were larger than those of male patients. CONCLUSION: The narrow angulation of the lingual balcony region and the relationship between roots and lingual soft tissues should be noted to avoid undesirable complication of displacement of a tooth or fragment into sublingual, submandibular, and pterygomandibular spaces. There was no relation in the floor of the mouth between the position of the impacted third molar roots and different lingual undercut angulation variations.

Comparison of the Effects of Topical Ketamine and Tramadol on Postoperative Pain After Mandibular Molar Extraction.

PURPOSE: This study compared the analgesic efficacy of postoperative tramadol versus ketamine for preventing pain after mandibular molar extraction. PATIENTS AND METHODS: Ninety patients who had undergone molar extraction were randomly divided into 3 groups: group T (tramadol 1 mg/kg), group K (ketamine 0.5 mg/kg), and group P (saline 2 mL). The treatment was applied to the extraction sockets using resorbable gelatin sponges. Pain after extraction was evaluated using a visual analog scale (VAS) 0.5, 1, 2, 4, 6, 12, 24, and 48 hours postoperatively. RESULTS: The VAS scores after extraction were statistically higher in group P than in either treatment group. Group K had the lowest pain intensity. CONCLUSION: This study shows that topical tramadol and ketamine are effective alternatives for decreasing pain after molar extractions.

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.

Corticotomy-assisted maxillary protraction with skeletal anchorage and Class III elastics.

OBJECTIVE: To analyze the treatment effects of corticotomy-assisted maxillary protraction with skeletal anchorage and Class III elastics in patients with Class III malocclusions. MATERIALS AND METHODS: The study group consisted of 19 patients with a mean age of 13.12 ± 1.28 years. Initially, patients were monitored for 5 months before treatment to evaluate growth changes. Changes during control, protraction and fixed orthodontic treatment periods were compared with the cephalometric radiographs taken initially, before protraction, after protraction, and after fixed orthodontic treatment. Treatment outcomes also were compared with the growth effects. RESULTS: Sagittal measurements of maxilla showed significant improvements (3.59 ± 1.32 mm) during the protraction period (3.85 ± 1.12 months) whereas no significant changes were seen during the control period. Upper and lower incisor inclinations were increased, and the upper occlusal plane angle showed significant counterclockwise rotation during protraction. Significant soft-tissue changes also reflected the underlying skeletal changes. Maxillary advancement was stable during fixed orthodontic treatment. CONCLUSION: Compared with control period of the patients, this protocol produced significant improvements in skeletal and soft-tissue structures.

Effects of Ankaferd Blood Stopper and Celox on the tissue factor activities of warfarin-treated rats.

The aim of this study is to evaluate the effect of these new generation hemostatic agents on early-stage soft tissue healing of warfarin-treated rats by measuring the tissue factor (TF) activities. Rats in the warfarin group were treated intraperitonally with 0.1 mg/kg warfarin, and rats in the control group were treated with 1 mL/kg saline. All rats had 3 incisions on dorsal dermal tissue applied Celox, Ankaferd Blood Stopper (ABS), or no hemostatic agent. Six rats from each group were killed on day 4, and the other 6 were killed on day 8. Prothrombin time (PT) and TF activities were evaluated, respectively. Both the hemostatic agents positively affected the hemostasis. Warfarin treatment increased the PT levels as expected. Celox-treated dermal tissues had higher TF activity when compared to ABS-treated ones. The ABS affected the early-stage healing positively in clinical aspect, whereas Celox was more effective on hemostasis by means of increasing TF activities.

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.

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.

Comparison of the effects of sedation and general anesthesia in surgically assisted rapid palatal expansion.

OBJECTIVE: To compare the effects of sedation and general anesthesia for surgically assisted rapid palatal expansion (SARPE). METHODS: This randomized prospective study included 30 patients who were scheduled for SARPE, and was performed between January 2008 to February 2010 in the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Marmara University, Istanbul, Turkey. Patients were allocated into Group S - midazolam + fentanyl sedation (n=15), and Group G - general anesthesia (n=15). Hemodynamic parameters, duration of anesthesia, surgery, recovery time, time to discharge, visual analogue scale (VAS) pain scores at 30 minutes (min), one hour (hr), 4 hours, 12 hours, and 24 hours, first consumption of analgesic time, total amount of consumption of analgesics, patient and surgeon satisfaction, nausea, and vomiting were recorded. RESULTS: Analgesic time was significantly longer in Group S (p=0.008), and total analgesic consumption was significantly lower in Group S than in Group G (p=0.031). Patient satisfaction was statistically higher in Group S (p=0.035). At 30 min, one hr, and 12 hrs, VAS satisfaction scores in Group S were statistically lower than those in Group G, and at 4 hrs and 24 hrs there was no statistical difference in VAS scores for both groups. CONCLUSION: The use of sedation for outpatient SARPE resulted in lower pain scores at discharge, lower analgesic consumption, and greater patient satisfaction.

A comparison of the effects of midazolam/fentanyl and midazolam/tramadol for conscious intravenous sedation during third molar extraction.

PURPOSE: This study evaluated the effects of fentanyl and tramadol, used in combination, as sedation for third molar surgical extraction. PATIENTS AND METHODS: This prospective, randomized, double-blind, placebo-controlled study included 60 patients undergoing extraction of a horizontal third molar with an Amsterdam Preoperative Anxiety and Information Scale score above 10 points. All of the patients were first given a 0.03-mg/kg bolus of midazolam, and then they were randomized into 3 groups: group A, midazolam only; group B, midazolam and 1-µg/kg fentanyl; and group C, midazolam and 1-mg/kg tramadol. The vital signs were recorded. Patients were assessed for postoperative pain and adverse effects, and patient and surgeon satisfaction was assessed. RESULTS: No differences were found in the heart rate among groups (P > .05). The mean blood pressure was also similar until the 40th minute, after which the mean blood pressure in the patients in group A was lower than that in the other 2 groups (P < .01). In the postoperative pain assessment, the visual analog scale scores of the patients in group C were lower than those in the other 2 groups in the first postoperative hour (P < .05). The time at which the first rescue analgesic was taken in groups A, B, and C was 3, 3.5, and 5 hours postoperatively, respectively, and was significantly later in group C (P < .01). No difference was found in patient/surgeon satisfaction among the groups. CONCLUSIONS: Tramadol has a better analgesic effect in third molar surgery than fentanyl and placebo.

Effect of the angle of apical resection on apical leakage, measured with a computerized fluid filtration device.

OBJECTIVE: We determined the effect of the angle of apical resection on apical leakage using a computerized fluid filtration meter with a laser system and a digital air pressure regulator in 46 extracted single-rooted human teeth. Orthograde endodontic treatment was performed. The root canals were prepared up to a size 50 K-type file with 17% EDTA solution (Roth International, Chicago, IL) and 5% NaOCl solution as the irrigant. Gates Glidden burs (Maillefer Instruments, Ballaigues, Switzerland) were used to flare the coronal two thirds of the canal. All canals were dried with paper points and then obturated using cold lateral condensation (except for the positive controls) of gutta-percha points and AH plus (Dentsply DeTrey, Konstanz, Germany). All 40 roots were sectioned 3 mm from the apex. Forty teeth were assigned randomly into 1 of 4 experimental groups of 10 teeth each: in group 1, the teeth were resected apically (90° angle) and the cavities were obturated with mineral trioxide aggregate (MTA); in group 2, after apical resection (90° angle), a root-end cavity was prepared using ultrasonic diamond retrotips and the cavities were obturated with MTA; in group 3, the teeth were resected apically (∼45° angle) and the cavities were obturated with MTA; and in group 4, after apical resection (∼45° angle), a root-end cavity was prepared using ultrasonic diamond retrotips and the cavities were obturated with MTA. An additional 6 teeth were used as controls (3 each, negative and positive controls). Apical leakage was measured using a computerized fluid filtration meter with a laser system. RESULTS: The mean apical microleakage was 2.0 ± 0.4 × 10(-4), 1.6 ± 0.6 × 10(-4), 1.6 ± 0.9 × 10(-4), and 1.8 ± 0.7 × 10(-4) µL/cmH(2)O/min(-1) at 1.2 atm, in groups 1 to 4, respectively. Although the mean apical microleakage was greater in group 1, the differences among the 4 groups were not statistically significant (P > .05). CONCLUSIONS: The results of these in vitro studies showed that when an adequate retrograde cavity depth is prepared, variation in the root-end cutting angle does not necessarily cause any difference in microleakage.

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.

Assessment of combined local anesthesia and ketamine for pain, swelling, and trismus after surgical extraction of third molars.

PURPOSE: The aim of this study was to assess the clinical efficacy of combined treatment with local anesthetic and subanesthetic ketamine for the relief or prevention of postoperative pain, swelling, and trismus after the surgical extraction of third molars. PATIENTS AND METHODS: Fifty patients undergoing the extraction of impacted mandibular third molars were included in the study. The patients were randomly divided into 2 groups: local anesthetic alone (LAA) and local anesthetic plus ketamine (LAK). The patients in the LAA group received 5 mL of a local anesthetic and saline combination comprising 2 mL of local anesthetic and 3 mL of saline. The patients in the LAK group received 5 mL of a local anesthetic, ketamine, and saline combination comprising 2 mL of local anesthetic and 0.3 mg/kg ketamine and saline. RESULTS: Facial swelling on postoperative days was significantly lower in the LAK group than in the LAA group (P = .0001). The mouth opening on the postoperative days was significantly greater in the LAK group than in the LAA group (P = .0001). The pain scores on the VAS at 30 minutes and 1, 4, 12, and 24 hours after surgery were significantly higher in the LAA group than in the LAK group (P = .0001, P = .005). CONCLUSION: The combination of a local anesthetic and subanesthetic doses of ketamine during surgical extraction of third molars can produce good local anesthesia while affording a comfortable procedure for the surgeon and patient and providing good postoperative analgesia with less swelling and significantly less trismus.

A comparison of midazolam and midazolam with remifentanil for patient-controlled sedation during operations on third molars.

Our aim was to compare patients' satisfaction and cooperation, and clinical efficacy, of midazolam alone, and midazolam and remifentanil for patient-controlled sedation during removal of third molars. Forty patients, American Society of Anesthesiologists grades I and II, admitted for extraction of impacted mandibular third molars were included in this randomised, prospective study. They were given an intravenous bolus of midazolam 0.03 mg/kg and then allowed to use patient-controlled sedation. In the midazolam group, 2 ml of 0.5 mg/ml midazolam was given automatically. In the midazolam-remifentanil group, 2 ml of 0.5 mg/ml midazolam and 12.5 microg/ml remifentanil were given in the same manner. The lockout period was 5 min. Vital signs and oxygen saturation were recorded. Patients' and surgeons' satisfaction, and the patients' degree of amnesia about the local anaesthetic, drilling, removal of the tooth, and pain during extraction were also assessed. There were no significant differences between systolic and diastolic blood pressures during sedation, but heart rate after 30 min in the combined group was significantly lower than in the midazolam group (p<0.05). Surgeons described the midazolam group as excellent in 9 and good in 11. In the combined group, satisfaction was excellent in 11, good in 7, and satisfactory or unacceptable in 1 of each. Immediately postoperatively, 19 patients in each group ranked their satisfaction as excellent and 1 as good. Twenty-four hours later it was unchanged in the midazolam group, while 15 patients in the other group thought it was excellent, 3 good, and 2 poor. Patient-controlled analgesia with midazolam or midazolam and remifentanil is safe and reliable during extraction of third molars.

Anxiety and extraction of third molars in Turkish patients.

Preoperative anxiety is widespread and adversely affects a patient's physical and psychological outcome. Extraction of third molars is common, and many patients complain of anxiety and emotional disturbance. We assessed the anxiety of patients in Turkey before extraction of third molars. A total of 120 patients were admitted for removal of one or more third molars under local anaesthesia. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) and Spielberger's State Trait Anxiety Inventory (STAI) were used to evaluate anxiety. The results showed that women were significantly more anxious than men; women who had not had a previous operation were more anxious than other women; there was no difference in the anxiety scores of patients who had previously had a local anaesthetic and those who had not; there were no differences in anxiety as measured by trait scores; patients who wanted a lot of information were more anxious.

Management of arsenic trioxide necrosis in the maxilla.

Historically, pulp-necrotizing agents were commonly used in endodontic treatments. They act quickly and devitalize the pulp within a few days. However, they are cytotoxic to gingiva and bone. If such an agent diffuses out of the cavity, it can readily cause widespread necrosis of gingiva and bone, which can lead to osteomyelitis of the jaws. Although the use of arsenic trioxide can cause severe damage to surrounding tissues, producing complications, it is still used in certain areas in the world. This article presents and discusses two cases of tissue necrosis and their surgical management. These cases showed severe alveolar bone loss in the maxilla, which affected the patients' quality of life and limited the restorative possibilities. As dentists, we should be aware of the hazardous effects of arsenic trioxide and should abandon its use. Because of its cytotoxicity, there is no justification for the use of arsenic trioxide in the modern dental practice.