Immunohistochemical comparison of indermil with traditional suture materials in dental surgery.

The aim of this experimental study was to evaluate the effects of indermil on the closure of oral mucosa wounds in comparison with conventional sutures by investigating interleukin 1ß (IL-1ß) and tumor necrosis factor α (TNF-α) markers immunohistochemically in an animal model.The animals were anesthetized by intraperitoneal injection of ketamine (90 mg/kg body weight). Straight incisions were made to the buccal mucosa of the animals. Animals were randomly assigned to 5 groups. Five different materials were used in the study. These were silk, plain catgut, monocryl, vicryl rapide (polyglactin 910), and indermil (N-butyl-2-cyanoacrylate). The wounds were closed primarily. After the region of wounds was examined clinically at the 2nd, 7th, 14th, and 21st days, excisional biopsies were performed, and the tissue samples were examined histopathologically and immunohistochemically.On the 14th day, TNF-α and IL-1ß levels were high in the plain catgut group, moderate in the indermil group, and mild in the monocryl, silk, and vicryl rapide groups. On the 21st day, TNF-α and IL-1ß levels were moderate in the plain catgut group, mild in the indermil and monocryl groups, and nonsignificant in the silk group. After the second day, TNF-α and IL-1ß levels were mild in the monocryl, silk, and vicryl rapide groups.Plain catgut had more negative effects than indermil on wound healing. Indermil should be applied to oral mucosa wounds together with sutures to provide better tissue support.

Effects of polyglecaprone 25, silk and catgut suture materials on oral mucosa wound healing in diabetic rats: an evaluation of nitric oxide dynamics.

OBJECTIVES: The purpose of this study is to investigate the effects of monocryl (Polyglecaprone 25), silk and catgut suture materials on wound healing in diabetic rats and to evaluate NO (nitric oxide) dynamics. STUDY DESIGN: Fourty-eight male Wistar-Albino rats weighing 220-270 g were used in this study. The rats were categorized into 2 groups, as control group (n=24) and streptozotocin (STZ) induced diabetic group (n=24). For each group, incision wounds were created on the inner cheek mucosa of the animals and wounds were closed primarily with three different types of sutures. These materials were sized 3-0 monocryl (polyglecaprone 25), silk and catgut sutures swaged on. Excisional biopsies were performed at 2nd, 7th, 14th and 21st day (2 rats per day) from the initial surgical procedure. Effects of these suture materials on wound healing and NOS (nitric oxide synthase) activities were compared immunohistochemically in the study. eNOS and iNOS (Endothelial and induced nitric oxide synthase) activities were classified as mild (+), moderate (++) and severe (+++). RESULTS: Mild eNOS activities were seen in both diabetic and control groups at 2nd day specimens. Activities of silk and catgut were similar both in diabetic and control groups at 14th day, this activity in monocryl was mild. 21st day specimens revealed that monocryl has mild eNOS activity than silk and catgut sutures. iNOS activities in diabetic group were greater than control groups and the degrees of the activity in monocryl, silk and catgut sutures were mild, severe and moderate at the 7th day. At the 14th day there was no iNOS activity in diabetic monocryl group. CONCLUSION: All of the materials have the potential capacity to be well tolerated however monocryl seemed to have more beneficial effects on wound healing in diabetic subjects.

Intractable bimaxillary osteomyelitis in osteopetrosis: review of the literature and current therapy.

PURPOSE: Osteopetrosis (OP), also known as Albers-Schönberg disease, is a rare metabolic bone disease caused by a congenital defect in the development or function of the osteoclasts resulting in generalized increase in skeletal mass. Osteomyelitis is a recognized complication, and prevention of dental infections can be difficult. The locations of osteomyelitis in the jawbones have been either in the mandible or maxilla. In this article, a case of OP complicated with osteomyelitis of the mandible and the maxilla is presented, and types of OP and treatment options are discussed with a literature review. MATERIALS AND METHODS: The 18-year-old blind female patient had been diagnosed with OP in the past. She had a purulent discharge at the medial canthus of the left eye, in addition to another discharge of pus in the infraorbital and upper left molar region, and multiple malformed and partially impacted teeth, and there were sequestrum formations in the maxilla and mandible. For the treatment of osteomyelitis, systemic combined antibiotics of sultamicillin 750 mg and ornidazole 500 mg twice daily, were given orally for 5 weeks followed by surgical removal of small sequestra in the jaws. Persistent osteomyelitic bones were removed by saucerization in the mandibular anterior and right premolar region and the left posterior maxilla under the same antibiotic regimen. After wound healing was completely achieved in both jaws, the oroantral opening in the left posterior maxilla was successfully closed with a buccal flap under antibiotic coverage. RESULTS: The purulent discharge at the medial canthus of her left eye subsided and she had no recurrent infections during the long-term follow-up of 2 years. CONCLUSION: The case reported shows that osteomyelitis is difficult to treat in subjects suffering from OP. Therefore, it is necessary to be very cautious against infections in even minor surgical interventions such as simple dental extractions in patients with OP, regardless of the location of the teeth. When considering removal of impacted teeth in the posterior maxilla, resultant oroantral communication from osteomyelitis of the extraction site should be regarded as a potential complication.

Closure of palatal defects following excision of palatal pleomorphic adenomas.

AIM: The purpose of this study is to compare different palatal defect closure techniques following excision of palatal pleomorphic adenomas (PPA) in four cases and to review the associated dental literature. METHODS AND MATERIALS: Excision of all four PPA's was performed under local anesthesia. Three different closure techniques used among the cases included an intact mucosal flap, a pedicled buccal fat pad, or secondary healing. RESULTS: On average the defects healed completely at two months following surgery. While final healing was ideal, partial necrosis of the mucosal flap and minimal postoperative bleeding were seen as complications in two cases. CONCLUSION: Regardless of the size of the palatal defect created by the surgical excision of a PPA it heals ideally by secondary healing. However, the possibility of secondary bleeding and infection during the healing period should be kept in mind.

Fixation of vertically distracted segment with dental implants after breakage of distraction device: case report.

Distraction osteogenesis is an efficient method to augment the mandibular alveolar process for dental implants. Complications of this procedure include fracture of the basal bone, breakage of distractor, wound dehiscenses, undesirable soft tissue changes, and defective movement of the transported segment. We report a case of breakage of the distractor after mandibular alveolar vertical distraction osteogenesis. Mandibular alveolar vertical distraction osteogenesis was applied to 53-year-old woman for prosthetic rehabilitation. Fracture of the distraction device occurred on the 13th day of the activation phase. Radiographic examination revealed the fracture of the distractor rod and lingually displaced alveolar segment. Lingually displaced segment was successfully advanced to the desired position, and fixed to the basal bone using dental implants before the maturation of the distracted bone. We consider that this technique is eligible for the management of these kind of complications.

Use of a Simple Appliance to Prevent Mucosal Irritation by the Distractor Rod during Vertical Distraction: Case Report.

Patient discomfort due to the excessive length of the distractor rod is one of the disadvantages of alveolar distraction osteogenesis. Although this seems to be a minor complication, it can cause severe mucosal irritation on the opposite arch, and uncontrolled forces can lead to the loosening of the screws and the inactivation of the distractor. The purpose of this case report is to introduce an acrylic appliance that is very useful in avoiding the mucosal irritation caused by the long distractor rod. The appliance is simple, effective, and easy to fabricate.

Incomplete mobilization of the maxilla resulting in failed maxillary distraction: a case report.

Maxillary distraction osteogenesis has become an accepted alternative method in the treatment of patients with severe maxillary hypoplasia in craniofacial syndromes and cleft-related deformities. Insufficient distraction, undesirable soft tissue changes, and occurrence of defective distraction vectors are among the potential complications of intraoral maxillary distraction osteogenesis. A 2-stage procedure combining maxillary advancement by distraction technique with genioplasty and mandibular setback surgery was planned to correct jaw deformities in a 22-year-old patient with severe maxillary retrusion, mandibular prognathism, and excessive lower facial height. In the first stage, osteotomies were performed and maxilla was lightly mobilized after down-fracture. Distractors were placed to the maxilla intraorally. During activation period, the maxilla rotated in a clockwise direction, producing a discrepancy between the planned and the actual vectors. Complete distraction was unsatisfactory and the complication was due to surgical technique. This case report presents the failure of maxillary distraction due to incomplete mobilization of the maxilla. Treatment of the case was achieved by the conventional osteotomy techniques at final operation. The maxilla was successfully advanced to the desired position producing good occlusion and an improved facial profile.

Total impaction of deciduous maxillary molars: two case reports.

AIM: The purpose of this report is to present two cases of totally impacted maxillary deciduous molars, considered a rarity in dental practice. BACKGROUND: Primary tooth impaction is quite rare during the development of primary dentition. Various factors contribute to the impaction of a deciduous tooth, including anklyosis, congenitally missing permanent teeth, defects in the periodontal membrane, trauma, injury of the periodontal ligament, precocious eruption of the first permanent molar, defective eruptive force, or a combination of these factors. REPORTS: Case #1: An 18-year-old male presented with a complaint of spontaneous repetitious pain in the maxillary right premolar region. The maxillary right second premolar was clinically absent. Panoramic and periapical radiographs revealed an impacted second premolar close to the inferior wall of the maxillary sinus and an impacted deciduous molar deeply embedded in bone within the maxillary sinus. Case #2: A 14-year-old girl presented with a complaint of crowding of the maxillary teeth. The maxillary right second premolar and the maxillary permanent canines were clinically absent. A panoramic radiograph revealed an impacted maxillary right second premolar and an impacted deciduous molar embedded within bone close to the inferior wall of the maxillary sinus. SUMMARY: The total impactation of deciduous teeth is a rare condition, and few cases have been reported in the literature. The condition generally affects the mandibular second deciduous molar and the maxillary first deciduous least often. In this paper, two cases of totally impacted maxillary deciduous molars are reported.

Biomechanical comparison of different plating techniques in repair of mandibular angle fractures.

OBJECTIVE: The purpose of this study was to evaluate the biomechanical behaviors of different miniplate fixation techniques for treatment of fractures of the mandibular angle. STUDY DESIGN: Twenty sheep hemimandibles were used to evaluate 4 different plating techniques. The groups were fixated with Champy technique, biplanar plate placement, monoplanar plate placement, and 3-dimensional (3D) curved angle strut plate. A custom-made 3-point biomechanical test model was used for the samples. Each group was tested with compression forces by an Instron Lloyd LRX machine. The biomechanical behavior of the groups for the forces (N) that caused displacement of 1.75 mm were compared using the Instron software program and displacement graphics. RESULTS: The variance analyses showed that biplanar plate placement had more favorable biomechanical behavior than Champy technique and monoplanar plate placement (P < .05). In addition, the 3D curved angle strut plate technique had more favorable biomechanical behavior than the Champy technique (P < .05) but was not significantly different from biplanar or monoplanar plate placement techniques (P > .05). CONCLUSION: The study demonstrated that 3D strut plates or dual miniplate techniques had greater resistance to compression loads than the Champy technique. In addition, biplanar plate orientation may provide a more favorable biomechanical behavior than monoplanar plate placement.

The effects of hemostatic agents on peripheral nerve function: an experimental study.

PURPOSE: In the practice of oral and maxillofacial surgery, hemostatic agents are sometimes placed in close proximity to peripheral nerves. In the present study, we evaluated immediate and delayed effects of 4 hemostatic agents (oxidized regenerated cellulose, 5% colloid silver-added gelatine sponge, bovine collagen, bone wax) on peripheral nerve function. MATERIALS AND METHODS: A total of 25 rat sciatic nerves were prepared, and the amplitudes were recorded with a physiological data acquisition system. Animals were randomly assigned to 5 groups: control, oxidized regenerated cellulose, gelatine sponge, bone wax, and bovine collagen. The first hour records are defined as immediate effects of these hemostatic agents on nerve function. The animals were then allowed to recover for 4 weeks. At the end of this period, the same surgical and recording procedures were performed. These final records are defined as delayed effects of hemostatic agents on nerve function. According to nerve conduction velocity (NCV) and compound action potential (CAP) values of the experimental groups, early and delayed effects of each hemostatic agent were statistically compared with Bonferroni corrected test (P < .05). RESULTS: Statistically, NCV was significantly reduced, and the CAP was significantly increased 1 hour after surgery (P < .05) in the group of oxidized regenerated cellulose. However, there were no significant differences after 4 weeks compared with the first records. In the gelatine sponge group, CAP was significantly increased 4 weeks after the application. In the bovine collagen and bone wax groups, NCV and CAP values (1 hour and 4 weeks after the application) were not statistically significant compared with initial control records. CONCLUSION: The present study shows that bovine collagen is the most suitable hemostatic agent applicable for peripheral nerves.

Biochemical and histopathological findings of N-butyl-2-cyanoacrylate in oral surgery: an experimental study.

OBJECTIVES: The increasing use of cyanoacrylates in dentistry, particularly as an adhesive and sealing glue, has raised concerns regarding its potential toxicity in humans. Several different forms of these compounds including methyl- (MCA), ethyl- (ECA), isobutyl-, isohexyl-, and octyl CA have been developed to eliminate tissue toxicity. N-butyl-2-cyanoacrylate is becoming an increasingly popular method for wound closure under low tension. Despite their increasing use, pharmacologic effects of these substances on liver and kidney functions are not widely known. The objective of the present study was to investigate possible immediate and long-term systemic effects of N-butyl-2-cyanoacrylate in oral surgery. STUDY DESIGN: Ten male Wistar rats weighing 220 to 270 g were used in the study. Straight incisions were made to the buccal mucosa of the animals. N-butyl-2-cyanoacrylate adhesive (Indermil) was applied and wounds were closed primarily. Blood specimens were taken periodically from the vena cava of the animals before the surgical procedure and 2, 14, 21, and 65 days after the surgical procedure. The blood specimens of those taken before the application of the adhesive were defined as the control group; blood specimens that were taken 2, 14, 21, and 65 days from the application were defined as study group. The stored plasma samples were analyzed for blood urea nitrogen (BUN), creatinine (CRE), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBI), total protein (TP), albumin (ALB), and amylase (AML). In addition to biochemical parameters, histopathological examination was performed. Blood parameter values of the control and study groups were statistically compared with the Duncan test (P < .05). RESULTS: There were no significant differences in the values of BUN, CRE, ALT, AST, TBI, TP, ALB, and AML between the control and at 2, 14, 21, and 65 days. CONCLUSION: The present study shows that N-butyl-2-cyanoacrylate is a suitable adhesive applicable in oral surgery.

Alveolar distraction osteogenesis of bone graft reconstructed mandible.

This case report describes a patient who had severe mandibular bony deficiency as a result of excision of aggressive central giant cell granuloma. The defect was reconstructed with iliac bone graft. Four years later vertical distraction osteogenesis was performed on the grafted mandible in order to obtain a satisfactory bony height of mandibular ridge. Distraction osteogenesis can be a good alternative for the reconstruction of mandibular deficiencies.