Effects of the hyperbaric oxygen on de novo bone formation during periosteal distraction.

OBJECTIVE: The purpose of this study was to investigate the effect of hyperbaric oxygen (HBO) therapy on de novo bone formation during periosteal distraction (PD). MATERIALS AND METHODS: Periosteal distraction was performed in 24 mature male New Zealand rabbits using a custom-designed device placed on the lateral surface of the mandibular corpus. Twelve rabbits (group H) were given adjunctive HBO treatment, whereas 12 rabbits (group N) were kept in a normal environment (normobaric oxygen). After a 7-day latency period, the same distraction protocol was applied to both groups. However, the rabbits in group H were treated with pure oxygen at 2.4 atm absolute for 25 times. Both groups were further divided into 2 subgroups and killed after consolidation periods of 4 and 8 weeks. Photodensitometric and histologic analyses were performed to evaluate the newly formed bone. RESULTS: There was no significant difference between the 4-week consolidated HBO group and the 8-week consolidated normobaric oxygen subgroup (P = 0.229). Moreover, there was better bone formation in the 8-week HBO group than in the 8-week control group. CONCLUSION: The results of this study indicate that PD with HBO could be used to increase the quality and the quantity of the bone newly formed by PD.

Effect of systemic administered zoledronic acid on osseointegration of a titanium implant in ovariectomized rats.

OBJECTIVE: The aim of this study was to evaluate whether zoledronic acid improves post-implant osseointegration in an ovariectomized rat model. MATERIALS AND METHODS: A total of 36 female Wistar rats were subdivided into three groups: control (CTRL), ovariectomized (OVX) and ovariectomized + zoledronic acid (OVX/ZOL). Both OVX and OVX/ZOL groups underwent ovariectomy procedures, while the CTRL group received a sham operation. After a 90-day waiting period following surgery, the OVX/ZOL group received a weekly intravenous injection of 0.04 mg/kg zoledronic acid over a period of 6 weeks. The CTRL and OVX groups received intravenous injections of 0.9% NaCl, and the injections were administered with a dosing schedule that was identical to that of the OVX/ZOL group. After completing the 6-week injection regimen, every group received a titanium implant that was 1.6 mm in diameter by 4 mm in length, which was placed in the proximal metaphysis of the left tibia. All of the rats were sacrificed after 60 days and the tibia bones were harvested and processed for histological evaluation. RESULTS: The percentage of bone-implant contact (BIC) varied significantly between groups. Histomorphometric analysis demonstrated that BIC was significantly higher in the OVX/ZOL group than in the OVX group. CONCLUSIONS: Systemic zoledronic acid improved tibial titanium implant osseointegration in an oestrogen-deficient rat model.

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.

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.

Is endodontic treatment necessary during coronectomy procedure?

PURPOSE: Close proximity of the inferior alveolar nerve (IAN) to the third molar roots can result in nerve injuries during extraction of third molars. Consequently, it is necessary to determine the relationship of the nerve and roots to avoid damage to the IAN. Computed tomography scans are widely used to determine the correct relationship between the IAN and lower third molars. PATIENTS AND METHODS: The study consisted of 10 patients with 16 lower third molars in close relationship with the IAN who were divided into a study group and a control group. The patients in the study group were treated via coronectomies performed with endodontic treatments. The patients in the control group underwent coronectomies without endodontic treatment. The patients were followed up for at least 1 year. RESULTS: We had to extract 7 of the roots because of the infection in 8 patients belonging to the study group, which were treated endodontically. Moreover, there were 3 cases of IAN damage because of the extraction in the study group. However, in the control group, no infection was determined and IAN damage was absent. CONCLUSION: Coronectomy appears to be a reliable technique to protect the IAN from damage. This procedure has a low incidence of complications. Endodontic treatment does not affect the success of this method according to our results.

The close association between dental and periodontal treatments and oral ulcer course in behcet's disease: a prospective clinical study.

OBJECTIVE: The aim of the study was to evaluate the influence of dental and periodontal treatments to the course of oral ulcers in patients with Behcet's disease (BD). METHODS: Fifty-eight consecutive BD patients with oral ulcers were studied. Twenty-nine patients were in the intervention group (F/M: 15/14, mean age: 39.6 +/- 6.9 years) and 29 (F/M: 15/14, 39.4 +/- 10.6 years) were followed with a conventional treatment approach. In addition to oral hygiene education, dental and periodontal treatments were carried out in the intervention group, whereas the control group was only given oral hygiene education. Patients were evaluated in the pre-treatment observation period (1 month), treatment period (1 month) and 6 months after treatment. RESULTS: An increase in the number of new oral ulcers (4.1 +/- 3.5) was observed within 2 days during the treatment compared with 3-30 days during treatment month (2.3 +/- 1.2) (P = 0.002). However, 6 months after the treatment, the number of oral ulcers (1.9 +/- 1.5) was significantly lower compared with the pre-treatment observation (4.8 +/- 3.2) (P = 0.000) and treatment periods (6.4 +/- 2.3) in the intervention group (P = 0.05), whereas a similar oral ulcer presence was observed in the control group (2.8 +/- 2.4, 3.7 +/- 2.3 and 4.8 +/- 4.3, respectively) (P > 0.05). Dental and periodontal indices were also better in the intervention group during the 6-month follow-up. CONCLUSION: Our results suggest that, in BD patients, dental and periodontal therapies could be associated with a flare-up of oral ulcers in the short term, but may decrease their number in longer follow-up. They also lead to a better oral health.

Flap and incision design in implant surgery: clinical and anatomical study.

OBJECTIVES: The protection of microcircular support which is essential for healing gains importance if implant surgery is considered to affect the blood flow. The aim of the study is to establish the artery territories supplying the blood into the oral mucosa in the cadavers and to demonstrate the mucosal delivery pattern and to evaluate the effects of different incision types on the healing in the patients having the implant application. MATERIALS AND METHODS: The study was planned in two stages as cadaver and clinical investigations. In cadaver investigation, all intra oral vascular territories were shown in ten specimens. The arterial structure and mucosal vascularity of the area were assessed microscopically and macroscopically. With the obtained data, the clinic results were established by making the crestal incision only for Group 1 (n = 30); both crestal and vertical releasing incisions for Group 2 (n = 30) were planned. RESULTS: The results were established anatomically and clinically. In all cases, vascular territories of the mucosa in the maxilla and mandible were evaluated. In stereo microscopic assessment, although vestibule and oral mucosa had rich anastomoses, the crestal line had avascular features. There was no complication in the soft tissues of the cases, performed the vertical releasing incision during the healing period after 8-week follow-up. CONCLUSION: The vascular richness of the oral mucosal area enables the sufficient healing in the areas of applied flap. According to the alveolar anatomical pattern and the amount of the soft tissue over it, the incisions may be applied horizontally and/or vertically.

Unerupted mandibular third molars: symptoms, associated pathologies, and indications for removal in a Turkish population.

OBJECTIVES: To analyze the occurrence of symptoms of unerupted mandibular third molars, to investigate associated pathologies, and to determine indications for removal of unerupted mandibular third molars in a Turkish population. METHOD AND MATERIALS: A retrospective study was performed by reviewing 832 patients referred to Gulhane Military Medical Academy Dentistry Center for evaluation of their mandibular third molars. The patients were clinically examined, and unerupted and partially erupted mandibular third molars were determined from radiographs. The symptoms and pathologies associated with these teeth were analyzed. The indications for removal were classified into 10 groups. RESULTS: Two-thirds of the patients were between 20 and 29 years of age. Of the 832 unerupted mandibular third molars found, 557 (66.9%) teeth were partially erupted and 275 (33.1%) were completely unerupted. A total of 521 (62.6%) of all unerupted third molars had no symptoms, while 311 (37.4%) were associated with symptoms. The most frequent complaints of the patients were pain and swelling. Pericoronitis was observed as the most frequent pathology, in 142 patients. Of 832 unerupted mandibular third molars, 582 (69.9%) had complete root formation, 177 (21.2%) had two-thirds root formation, and 73 (8.9%) had one-third root formation. CONCLUSION: Patients between 20 and 29 years of age had the highest prevalence of unerupted mandibular third molars (69.3%). However, this figure decreased with increasing age. Partially erupted teeth (n = 228) caused the occurrence of symptoms more than completely erupted teeth (n = 83) in a Turkish population.

Osteoma of the mandibular condyle: report of a case with 5-year follow-up.

Osteomas of the mandibular condyle are rare. An unusual case of an osteoma occurring in the mandibular condyle of a 22-year-old man with mandibular deviation and malocclusion is reported; this represents the 14th documented case in the English language literature. The tumor was resected with condylectomy. Postoperatively, mandibular deviation was minimized.

An analysis of maxillofacial fractures: a 5-year survey of 157 patients.

The purpose of this study was to review retrospectively the outcomes for 157 patients treated for maxillofacial fractures between 1994 and 1999 at one military hospital in Turkey. Significant data were collected according to age, gender, time of injury, type of facial injuries, cause of injury, treatment methods, and postinjury and postoperative complications. Fractures resulting from gunshot wounds were excluded in this study. Fractures were examined in two groups according to the type of fracture, i.e., isolated or combined. Methods of fixation with closed or open reduction were used to treat the fractures. Fixation was performed with miniplates, compression plates, microplates, reconstruction plates, and wires for open reduction, and stabilization was performed with arch bars for closed reduction. Complications were recorded in two groups, i.e., postinjury and postoperative complications. There were 151 male patients (96.18%) and 6 female patients (3.82%). The patients ranged in age from 15 to 62 years (mean, 22.8 years). In our study, it was determined that the most significant causes of maxillofacial fractures were traffic accidents (69 cases, 43.95%) and fighting (42 cases, 26.75%). Most fractures were in the mandible (161 fractures). It was observed that most of the mandibular fractures were in the body (49 fractures, 30.43%) and condylar (42 fractures, 26.09%) regions. Of the 223 maxillofacial fractures, 63.68% (142 fractures) were treated with closed reduction and 36.32% (81 fractures) were treated with open reduction. Postinjury complications included infections (local infection or osteomyelitis), nerve injuries (alveolaris inferior, facial, lingual, and infraorbital nerves), and a salivary gland fistula, and postoperative complications included infection, facial asymmetry, and malocclusion.

Morphometric analysis of the furcation anatomy of mandibular molars.

BACKGROUND: Successful treatment of molar furcation defects remains a challenge in clinical practice. Knowledge of anatomic factors facilitates predictable management of furcation involvement lesions. The degree of success in managing furcation involvement is inversely related to the horizontal probing depth. The depth of the horizontal component of attachment loss can vary depending on the external tooth-surface reference points used. However, the anatomical factors affecting horizontal component of attachment loss have not been previously assessed. Therefore, this study determined the bucco-lingual measurements of the cemento-enamel junction and the mesial and distal roots and at the level of root separation. METHODS: One hundred extracted permanent human mandibular first (N = 50) and second (N = 50) molars were studied. Four horizontal bucco-lingual widths were measured with calibrated calipers: 1) furcation entrance/roof (FE); 2) cemento-enamel junction level (CEJ); 3) mesial root width (MRW); and 4) distal root width (DRW). RESULTS: The mean widths at FE, CEJ, MRW, and DRW were, respectively, 5.53 +/- 0.45 mm, 8.71 +/- 0.54 mm, 8.57 +/- 0.54 mm, and 7.97 +/- 0.65 mm in the first molars and 5.61 +/- 0.65 mm, 8.40 +/- 0.65 mm, 7.95 +/- 0.88 mm, and 7.16 +/- 0.84 mm in the second molars. Analysis of variance revealed significant differences between FE and the other variables tested. The results showed that the bucco-lingual width of the furcation roof is considerably shorter than the MRW and DRW. The difference in the mean bucco-lingual dimension between FE and the other measurements occurred in all teeth evaluated and varied between 0.7 and 4.30 mm. CONCLUSIONS: Our findings demonstrate that clinical measurements of horizontal probing depth that use the external surfaces of roots as reference points overestimate the true anatomical component of furcation involvement in mandibular molars. Conversely, positive treatment outcomes in these teeth may be underestimated. This has implications not only for clinical practice but also for clinical research studies evaluating treatment outcomes.

Evaluation of oral or rectal midazolam as conscious sedation for pediatric patients in oral surgery.

This study was undertaken with a view to determine the acceptance and treatment possibilities of midazolam, depending upon its oral and rectal application for pediatric patients requiring an oral surgery procedure (tooth extraction) and having a pretreatment behavioral score of 1 or 2 according to the Frankl Scale. Oral (0.5 mg/kg) and rectal (0.35 mg/kg) midazolam was compared in view of acceptance of the mode of treatment and local anesthesia, level of amnesia, and adverse effects. Although oral or rectal midazolam application has similar characteristics in respect to ease of working, the oral midazolam application should generally be preferred because it is more easily accepted by pediatric patients.

Barrier membrane and bone graft treatments of dehiscence-type defect at existing implant: a case report.

Dehiscence-type bony defects may occur after implant application because of microbial action as well as of biomechanical and occlusal overload. The aim of the treatment of a periimplant defect is to arrest the progression of the bone loss and to achieve a maintainable site for the implant. In these situations, barrier membranes and bone graft materials can be used to achieve complete bone healing around dental implants. Bone regeneration is possible in a periimplant bony defect of a functioning implant if the proper surgical technique is utilized and the etiologic cause is eradicated. This study presents the surgical coverage of a periimplant bony defect around an implant that was inserted 7 years ago. The surgical correction was made using a barrier membrane in conjunction with bone graft materials. A follow-up of 6 months seemed to reveal radiographic bone regeneration.