Teriparatide and the treatment of bisphosphonate-related osteonecrosis of the jaw: a rat model.

OBJECTIVES: The objectives of this study were to establish a bisphosphonate-related osteonecrosis of the jaw (BRONJ) rat model and to analyse the effects of teriparatide (TP) on this model. METHODS: Sprague-Dawley rats were divided into three groups: I-zoledronic acid (ZA, n = 10); II-ZA and teriparatide (ZA + TP, n = 10); III-control (n = 10). Osteonecrosis was induced by administering zoledronic acid to groups ZA and ZA + TP. A week after the injections, rats underwent extraction of the first left mandibular molar. Following a four week period, TP was administered to the ZA + TP group for 28 days. Upon killing, extraction sockets were examined clinically, radiologically and histopathologically. RESULTS: Clinical examination revealed necrotic bone exposure in none of the animals. MicroCT (µCT) examination showed that bone mineral density of the newly formed bone in the extraction socket was lower in the ZA group than in the ZA + TP group (p < 0.05). Histopathological examination revealed that only the ZA and ZA + TP groups developed osteonecrosis, and the osteonecrotic bone area in the ZA group was larger than that in the ZA + TP group (p < 0.05). Tartrate-resistant acid phosphatase (TRAcP) enzyme histochemistry revealed that the number of detached and large osteoclasts were higher in the ZA group than in other groups, whereas the number of apoptotic osteoclasts in both ZA and ZA + TP groups were higher than in the control group (p < 0.05). CONCLUSIONS: Our data indicate that bisphosphonate-related osteonecrosis of the jaw model used in the present study is an attractive model to investigate treatment modalities and that TP might be an effective treatment in BRONJ.

The usage of digital radiography and cone beam computed tomography among Turkish dentists.

OBJECTIVES: The aim of this study was to determine the prevalence of the use of digital radiography and report how it was used by Turkish dentists. METHODS: The survey was based on 383 dentists who were present at the sixteenth International Congress organized by the Turkish Dental Association. A questionnaire which consisted of 19 questions was given to the dentists who participated in the study. Data were assessed according to frequency distribution and the χ(2) test was used to determine the significance of differences between two independent groups. RESULTS: 376 questionnaires were analysed. The mean age of the dentists who participated in the study was 37.14 ± 9.6 years (range: 20-63 years). The distribution of the dentists according to the 7 regions of Turkey were: Marmara 58%, Aegean 13% and Mediterranean 10%, Central Anatolia 8%, Black Sea 7%, Southeastern Anatolia 3%, Eastern Anatolia 1%. 124 dentists (33%) said they did not work with digital radiography. 95 dentists indicated that they did not use digital radiography owing to cost (60%). 252 dentists (67%) said they used digital radiography. 40% of the participants noted that the repetition of periapical radiographs was due to digital radiography. 166 dentists (55.9%) and 79.1% academicians had knowledge about cone beam CT (CBCT). CONCLUSION: Digital radiography users are increasing in Turkey and levels of knowledge of CBCT and awareness of radiation safety has also increased.

Detection of jaw and root fractures using cone beam computed tomography: a case report.

The aim of this case report is to demonstrate jaw and root fractures using a combination of cone beam CT (CBCT), CT and conventional radiographs. In this presentation a 23-year-old female patient who was referred to our dental clinic with a severe facial trauma is reported. The patient was initially examined by a general dentist and a fracture in the mandibular right canine region was diagnosed on the CT images. Once referred to our clinic, the raw CT images were re-evaluated by three maxillofacial radiologists in the Oral Diagnosis and Radiology Department. Two new fracture lines that were not reported on the original CT analysis were diagnosed among the raw CT images. More detailed information was obtained about dentoalveolar fractures with CBCT compared with CT and conventional radiography.

How many times can we use a phosphor plate? A preliminary study.

OBJECTIVES: Digital radiography has become a useful tool in daily dental practice due to the advances in imaging technologies. Charge coupled devices (CCDs) and photostimulable phosphor plates (PSPs) are currently in use for dental imaging; however, the longevity of PSPs in dental practice is not yet established. The aim of this study was to determine the service life of PSPs in a clinical setting. METHODS: Five unused PSPs were exposed with a conventional X-ray device and converted into digital images with Digora Optime (Soredex, Milwaukee, WI). These were recorded as the baseline images. Subsequent digital images of the plates were obtained after 20, 40, 60, 80, 100, 120, 140, 160, 180 and 200 exposures. All radiographic images were subtracted from the first digital image (baseline) and the mean grey values (MGVs) of the subtracted images were established using software. The data were grouped in 3 classes according to the number of exposures (20-80; 100-140; 160-200), and were analysed using variance analysis and chi(2) tests. RESULTS: The MGVs of the subtracted images varied between 126.25 and 127.59, and the difference was not significant among the groups (P = 0.11). However, the differences between the MGVs of the plates on each exposure settings were significantly different than those of the baseline image (P < 0.05). CONCLUSIONS: The findings of this study revealed that even though a slight deterioration occurred after the first exposure, each plate can be used up to 200 times. Further studies are required to reach a more concrete conclusion.

Survey of dental radiological practice in Turkey.

OBJECTIVES: The aim of this study was to determine the dentist's knowledge about dose reduction techniques, radiographic equipment and quality of dental radiographic service in general dental practice in Turkey. METHODS: The survey was performed on 636 dentists who attended the 11th International Congress organized by the Turkish Dental Association. Information on the demographic characteristics of the dentists, radiographic equipment, techniques and processing they used and radiation protection was obtained with a 32 point questionnaire. RESULTS: The respondents' knowledge concerning the technical details of their equipment was limited, with 512 (86.9%) not knowing the kilovoltage peak (kVp) of their machine. Only 34 (5.5%) respondents reported having rectangular collimators. The dentists had little knowledge about the speed of film they used. D-speed film was the most preferred one with 21.6%. Fifty-eight (10.2%) dentists used E-speed film and the F-speed film was used only by 13 (2.3%) dentists. The most preferred technique (62%) for periapical radiography was the bisecting angle technique. Four hundred and eighty five (82.5%) of the dentists reported that they took the radiographs by themselves. CONCLUSIONS: In the present study, the results indicate that for minimizing any unnecessary radiation, attempts should be made to improve dentists' knowledge about radiation dose reduction techniques.

Reliability and validity of the Modified Dental Anxiety Scale in Turkish patients.

We aimed to determine dental anxiety among Turkish patients and assess the sensitivity, specificity, positive/negative predictive values and reliability of the Modified Dental Anxiety Scale (MDAS) and Corah's Dental Anxiety Scale (DAS). Patients referred to our clinic for dental treatment who had a history of dental anxiety were included in the study. 294 randomly selected patients (mean age 38.8 years) completed a questionnaire combining Corah's DAS and MDAS. They were retested 15 days later. The prevalence of dental anxiety was found to be 9.9% (29/294) for Corah's DAS at the cut-off point > or = 15 and 8.8% (26/294) for the MDAS at the cut-off point > or = 19. Both dental anxiety scales gave acceptable sensitivity, specificity, positive and negative predictive values at these cut-off points.

Incidence of the type and calcification patterns in patients with elongated styloid process.

We investigated the incidence of elongated styloid process (Eagle's syndrome) using panoramic radiographs taken of 860 patients referred to our clinic. Any styloid process identified was classified according to its length, type and the pattern of calcification. Fifty-nine elongated styloid processes were identified in 32 patients (3.7%), most being bilateral; 24 patients were female and eight were male (female/male ratio: 3:1). The mean age of these patients was 43 +/- 14 years (range: 18 - 78 years). Type I (elongated) was the most frequent type on both sides (42/59); and the most frequent patterns of calcification were partially calcified on the left side (18/59) and completely calcified on the right side (16/59). Only two patients were symptomatic. A corrected differential diagnosis is important to distinguish elongated styloid process from other pathologies with partially overlapping symptoms. We would recommend that clinicians consider the possibility of Eagle's syndrome when both the clinical and radiographic evidence support this diagnosis.

Hereditary sensory and autonomic neuropathy: review and a case report with dental implications.

Hereditary sensory and autonomic neuropathy (HSAN) is a rare syndrome which is seen in early childhood. Five different types are described. Absence of pain and self-mutilation are characteristic findings of this syndrome. Teeth in the oral cavity can cause damage to the oral tissues and tongue. When it is diagnosed, there should be co-operation between dentist and neurologist. Using an oral shield prevents the biting and, thus, traumatization of the tissues can be prevented. A case report which is diagnosed as HSAN type 4 is presented and information submitted about its treatment.