Measurement of the lingual position of the lower third molar roots using cone-beam computed tomography.

PURPOSE: The aim of this study was to evaluate the distance between the roots of the impacted third molars and the floor of the mouth to predict the risk of lingual root displacement during surgery. MATERIALS AND METHODS: Thirty-one patients (5 men and 26 women) were evaluated for this study using cone-beam computed tomography (CBCT). The teeth were grouped according to their position on the orthopantomogram as vertical, mesioangular, horizontal, and distoangular. The distance between 2 points on the roots and lingual soft tissues was measured. RESULTS: The average distance between the apex of the root, which is in the most lingual position, and the lingual cortical plate was 1.03 mm. The average distance between the most lingual point on the apical half of the root, which is in closer proximity, and the lingual cortical plate was 0.65 mm. CONCLUSION: The distance between the apices and the lingual plate is very short, which allows displacement of broken roots or teeth, especially when the lingual plate is perforated.

Immediate implant placement without bone grafting: a retrospective study of 110 cases with 5 years of follow-up.

PURPOSE: Immediate implant placement not only reduces the number of surgeries necessary but also decreases the treatment time and treatment costs. The purpose of the study was to present the clinical results of 110 cases of immediate implant placement without using graft materials at the end of 5 years. MATERIALS AND METHODS: One hundred and ten implants in 72 patients were included in the study. Inclusion criteria for the patients were presence of at least 2 mm of bone beyond the root apex, the absence of acute signs of infection or inflammation in the treatment area, and the absence of systemic pathologies that would contraindicate bone healing around implants. In cases where bone grafting was necessary, the implant was excluded from the study. RESULTS: Healing progressed uneventfully in 105 cases. Four implants were lost as a result of infection in the first 3 months and 1 implant was lost 1 year after the functional loading of the prosthesis. The soft tissue anatomy was clinically acceptable in all patients. The implants that were placed in the extraction sockets of infectious teeth had also acceptable survival rates and clinical success. CONCLUSION: With proper patient selection, immediate implant placement without bone grafting has predictable survival rates and clinical success.

Bisphosphonate-related osteonecrosis: laser-assisted surgical treatment or conventional surgery?

Bisphosphonates (BSPs) are used for the treatment of multiple myeloma, metastatic breast and lung cancer, Paget's disease, osteoporosis, hypercalcemia due to malignancy, and many other skeletal diseases. BSPs reduce osteoclastic functions, which result in bone resorption. Bisphosphonates-related osteonecrosis of jaws (BRONJ) is a newly developed term that is used to describe the significant complication in patients receiving bisphosphonates. BSPs are known to exhibit an anti-angiogenetic effect that initiates tissue necrosis of the hard tissue. There is currently no consensus on the correct approach to this issue. The aim of this retrospective study is to compare the effects of laser surgery with biostimulation to conventional surgery in the treatment of BSP-induced avascular bone necrosis on 20 patients who have been treated in our clinic. BRONJ was evaluated in patients with lung, prostate, and breast cancer under intravenous BSP treatment. Twenty patients in this study developed mandibular or maxillary avascular necrosis after a minor tooth extraction surgery or spontaneously. Bone turnover rates were evaluated by serum terminal C-telopeptide levels (CTX) using the electrochemiluminescence immunoassay technique and patients were treated with laser or conventional surgical treatments and medical therapy. Ten patients were treated with laser surgery and biostimulation. An Er:YAG laser (Fotona Fidelis Plus II® Combine laser equipment, Slovenia) very long pulse (VLP) mode (200 mJ, 20 Hz) using a fiber tip 1.3 mm in diameter and 12 mm in length was used to remove the necrotic and granulation tissues from the area of avascular necrosis. Biostimulation was applied postoperatively using an Nd:YAG laser. Low-level laser therapy (LLLT) was applied to the tissues for 1 min from 4 cm distance using an Nd:YAG laser (Fotona-Slovenia) with a R24 950-µm fiber handpiece long-pulse (LP) mode, 0.25-W, 10 Hz power/cm(2) from the mentioned distance the spot size was 0.4 cm(2), and power output was 2.5 J. Energy density from the mentioned distance was calculated to be 6.25 J/cm(2). The other ten patients were treated with conventional surgery. Treatment outcomes were noted as either complete healing or incomplete healing. There were no statistically significant differences between laser surgery and conventional surgery (p > 0.05). CTX values also did not affect the prognosis of the patients. Treatment outcomes were significantly better in patients with stage II osteonecrosis than in patients with stage I osteonecrosis. Our findings suggest that dental evaluation of the patients prior to medication is an important factor in the prevention of BRONJ. Laser surgery is a beneficial alternative in the treatment of patients with this situation. Further randomized studies with larger patient numbers may also improve our understanding of treatment protocols for this situation.

Surgical treatment of oroantral fistulas: a clinical study of 23 cases.

Oroantral communication can be defined as a pathologic space created between the maxillary sinus and the oral cavity. This communication and subsequent formation of a chronic oroantral fistula is a common complication often encountered by oral and maxillofacial surgeons. Although various techniques have been proposed in published studies, long-term successful closure of oroantral fistulas is still one of the most difficult problems confronting the surgeon working in the oral and maxillofacial region. The decision of which treatment modality to use is influenced by many factors, such as the amount and condition of tissue available for repair, the size and location of the defect, the presence of infection, the time to the diagnosis of the fistula, and, even, the surgeon's past experience. In the present study, 23 patients with a chronic oroantral fistula who underwent surgical correction at Istanbul University Faculty of Dentistry, Department of Oral and Maxillofacial Surgery from 2002 to 2009 were included. The fistulas were treated with a buccal advancement flap in 10 patients and a palatal island flap in 13 patients. The advantages, limitations, and complications of each technique are discussed.

Management of a mandibular fracture accompanying a gunshot wound.

Gunshot injuries of the mandible can result in high rates of complications, especially in cases of bone loss. A fractured mandible accompanying a gunshot wound almost always has an external wound; the fracture is always compound and comminuted. Sometimes management of these injuries may require multiple surgical interventions. In this clinical report, treatment of a patient, who had a mandibular fracture due to a gunshot wound, is presented.A 52-year-old man with a mandibular fracture in the right mandibular body accompanying a gunshot wound was operated on. Owing to a nonunion, a second surgery was performed using reconstruction plates after hyperbaric oxygen treatment. Healing was uneventful after the second surgical intervention.