Comparison of psychosocial and aesthetic features of class III malocclusion after orthognathic surgery: Conventional approach versus surgery-first approach.

The aim of this study is to investigate and compare the changes in psychosocial status, self-esteem, and quality of life in patients treated with conventional and SF approaches. 14 patients (mean age 23.04±3.36; 9 male and 5 female) who met the inclusion criteria were included in the SF group; 18 patients with class III malocclusion (mean age 29.27±3.78; 9 male and 9 female) were included in the COS group. In the research protocol, the first questionnaires were carried out 2 weeks before surgery (T0); second survey approximately 4 weeks after surgery (T1); and the third one was done to patients after the treatment was completed (debonding) (T2). In our study, Orthognathic Quality of Life Questionnaire (OQLQ), Pyschosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), Oral Health Impact Profile (OHIP-14), Beck Depression Inventory second edition (BDI-II) and Rosenberg Self-Esteem Scale (RSES), surveys were conducted. No statistically significant difference was observed in all of the PIDAQ parameters and most of the OQLQ parameters within the COS and SF groups (P>0.05). When the BDI-II results were examined, different trends in scores were observed between the two groups, and this difference was found to be statistically significant (P<0.05). In the SF approach, progressive improvement was detected in the patients in terms of psychosocial and quality of life in the early period of treatment. The greater improvement in psychological and social characteristics in the SF approach compared to conventional orthognathic surgery may also be associated with a shorter treatment time.

Does the Cannula Diameter Affect Outcomes of Temporomandibular Joint (TMJ) Arthrocentesis?

PURPOSE: Since its implementation, temporomandibular joint (TMJ) arthrocentesis can be performed with cannulas of different diameters. The aim of this study was to determine the differences in cannula diameter for TMJ arthrocentesis on intraoperative and postoperative parameters. METHODS: A prospective randomized clinical study was conducted using the documentation of Wilkes stage 3 patients with TMJ disorders. Patients were assigned to 2 groups using a system of computer-assisted randomization. Double puncture arthrocentesis (DPA) was performed with 21-gauge cannulas (group 1) and 18-gauge cannulas (group 2). The primary predictor variable was cannula diameter. Pain values assessed using a Likert-type (0 to10) visual analog scale (VAS) were selected as primary outcome variable. Mandibular movements including maximum mouth opening (MMO), lateral excursions (LE) and protrusion (P), were selected as secondary outcomes. Mandibular movements and pain values were recorded before treatment and at 1st day and 3rd months intervals. Descriptive, comparative, and bivariate analyses were conducted. Intraoperative complications were also recorded. RESULTS: DPA was applied to 33 patients (29 females, 4 males). Although group 1 was found to be significantly more advantageous than group 2 in terms of pain levels (P < .05), no statistically significant difference was discovered in terms of total complication numbers and mandibular movements at the follow-up periods (P >.05). CONCLUSIONS: Despite the limited sample size cannula thickness affects postoperative pain level significantly in conventional TMJ arthrocentesis.

Reliability of the Linear Measurement (Contact) Method Compared with Stereophotogrammetry (Optical Scanning) for the Evaluation of Edema after Surgically Assisted Rapid Maxillary Expansion.

Many techniques have been developed to evaluate facial swelling after maxillofacial surgeries. Patients who undergo surgically assisted rapid maxillary expansion (SARME) develop facial edema more often than those who undergo minor oral surgeries. Reliable systems to assess soft tissue dimensions offer many advantages for documentation and treatment planning across surgical fields. (1) Background: The objective assessment of facial swelling is advantageous as it allows the evaluation of the effect of anti-inflammatory drugs. Therefore, this study aimed to compare the reliabilities of linear measurement method and optical scanning for the objective assessment of facial swelling after SARME. (2) Methods: Sixteen (12 women and 4 men) patients were enrolled. Linear measurements between guide points and facial scans were obtained for the left and right sides preoperatively and 1, 2, and 5 days after SARME. Preoperative values were subtracted from each post-operative value and the differences were compared between the two measurement methods. (3) Results: There were no statistically significant differences between the right and left sides at any time point in the measurements with either method. (4) Conclusions: Recently, stereophotogrammetry has been considered the first choice method for evaluating facial swelling. Furthermore, we found a strong correlation between volumetric analysis and linear measurement at all time points and for both sides.

Zoledronic Acid, Bevacizumab and Dexamethasone-Induced Apoptosis, Mitochondrial Oxidative Stress, and Calcium Signaling Are Decreased in Human Osteoblast-Like Cell Line by Selenium Treatment.

Increased intracellular free calcium ion (Ca2+) concentration induces excessive oxidative stress and apoptosis. Medical procedures such as zoledronic acid (Zol), bevacizumab (Bev), and dexamethasone (Dex) are usually used in the treatment of bone diseases (osteoporosis, Paget's disease, etc.) and to prevent metastasis in the bone although the procedures induce osteonecrosis of the jaw through excessive production of reactive oxygen species (ROS). Recently, we observed regulator roles of selenium (Se) on apoptosis and Ca2+ entry through transient receptor potential vanilloid 1 (TRPV1) channels in the cancer cell lines. Therefore, Se may modulate Zol, Bev, and Dex-induced oxidative stress and apoptosis through regulation of TRPV1 channel. In the current study, we investigated the protective effects of Se on apoptosis and oxidative stress through TRPV1 in Zol, Bev, and Dex-induced osteoblast-like cell line. We used human osteoblast-like cell line (Saos-2), and the cells were divided into 12 groups as control, Zol, Bev, Dex, Se, Zol+Se, Bev+Se, Dex+Se, Zol+Dex, Zol+Dex+Se, Zol+Bev, and Zol+Bev+Se which were incubated with drugs (Zol, Bev, Dex, and Se) for 24 h. The cytosolic free Ca2+ concentration was increased by Zol, Bev, Dex, Zol+Bev, and Zol+Dex, although it was reduced by Se treatment. However, Zol, Bev, and Dex-induced increase in apoptosis, caspase 3, caspase 9, poly (ADP-ribose) polymerase 1 expression levels, and intracellular ROS production values in the cells were decreased by Se treatments. In conclusion, we observed that Zol, Bev, and Dex-induced apoptosis, mitochondrial oxidative stress, and calcium signaling are decreased in human osteoblast-like cell line by the Se treatment. Our findings may be relevant to the etiology and treatment of Zol, Bev, and Dex-induced osteonecrosis by Se.

Distribution and pattern of implant therapy in a part of the Turkish population.

OBJECTIVE: To report the distribution and pattern of implant replacement of missing tooth/teeth. METHODS: This retrospective study was conducted at the Suleyman Demirel University, Isparta, Turkey, and used data of patients who had undergone implant replacement of missing teeth/tooth from May 2008 to May 2013. Data analysis included age, gender, number of implants placed, implant location distribution, additional surgery protocol, type of dentures and failure rate. SPSS 12 was used for data analysis. RESULTS: A total of 843 dental implants were performed on 280 patients, 143(51.1%) of whom were men and 137(48.9%) women. Besides, 89(31.8%) of all the participants were aged between 40-49 years. Moreover, 218(77.9%) patients received fixed dentures and 62(22.1%) received overdentures. The posterior region of mandible was the location in 281(33.3%) implants. Bone augmentation was performed in 152(54.3%) patients. Hard tissue grafting with sentetic bone grafts was used in 125(63.8%) patients. Failure was observed in 23(2.7%) implants. CONCLUSIONS: The relationships between denture type and age, and denture type and additional surgery were statistically significant.

Current concepts of oral and maxillofacial rehabilitation and treatment in aviation.

Aerospace medicine is the medical discipline responsible for assessing and conserving the health, safety, and performance of individuals involved in air and space travel. With the upward trend in airline travel, flight-related oral conditions requiring treatment have become a source of concern for aircrew members. Awareness and treatment of any potential physiological problems for these aircrews have always been critical components of aviation safety. In a flight situation, oral and maxillofacial problems may in fact become life-threatening clinical conditions. The unusual nature of aerospace medicine requires practitioners to have unique expertise. Special attention to aerospace medicine will open the way for professionals to develop and apply their skills and capabilities. Both dentists and aviators should be aware of the issues involved in aviation dentistry. This article presents the principles of prevention, treatment guidelines, and dental-related flight restrictions.

Efficacy of immediate postoperative intramasseteric dexamethasone injection on postoperative swelling after mandibular impacted third molar surgery: A preliminary split-mouth study.

OBJECTIVE: To evaluate the efficacy of immediate intramasseteric injection of dexamethasone on postoperative oedema. METHODS: The prospective study was conducted at the Department of Oral and Maxillofacial Surgery, Ankara University, Ankara, Turkey, in July 2012, and comprised patients aged 15-32 years who presented for the removal of bilateral vertical impacted mandibular third molar teeth.The right and left impacted third molars of each patient were randomly allocated into study and control groups. The impacted teeth in the study group were extracted with surgical bone removal, and 2ml of 8mg/2ml dexamethasone was injected into the ipsilateral masseter muscle immediately after suturing.In the control group, dexamethasone was replaced with 2ml of sterile saline solution. Postoperative facial oedema was measured with a tape scale by calculating the distance between several facial landmarks on postoperative day 2. SPSS 15 was used for data analysis. RESULTS: The mean age of 20 patients was 21.35±4.18 years, and there were 9(45%) patients between 15-20 years of age, while 11(55%) were 21-32 years. IN terms of gender, 9(45%) patients were male and 11(55%) were female. Postoperative oedema was significantly reduced in the study group compared to the control group (p<0.05). CONCLUSIONS: Immediate intramasseteric injection of dexamethasone was effective in reducing postoperative oedema after mandibular impacted third molar surgery.

Ankylosed maxillary incisor with severe root resorption treated with a single-tooth dento-osseous osteotomy, vertical alveolar distraction osteogenesis, and mini-implant anchorage.

Dentoalveolar ankylosis interferes with the vertical growth of the alveolar process, which can lead to an open bite, an unesthetic smile, and occlusal disharmony. This case report presents a new treatment protocol for an ankylosed tooth with severe root resorption using a combined surgical orthodontic management protocol involving a single-tooth dento-osseous osteotomy and vertical alveolar distraction osteogenesis with intraoral elastics and mini-implant anchorage. After distraction and active orthodontic treatment, the patient's anterior open bite was corrected. A Class I dental relationship was achieved, overjet was decreased, and a normal incisor relationship was obtained.

Immunohistochemical expression of caspase-3, caspase-5, caspase-7 and apoptotic protease-activating factor-1 (APAF-1) in the liver and kidney of rats exposed to zoledronic acid (ZOL) and basic fibroblast growth factor (bFGF).

BACKGROUND: Bisphosphonates (BPs) like zoledronic acid (ZOL) are widely used for the treatment of different diseases such as osteoporosis, metastatic bone diseases and hypercalcaemia. However, the effects of BPs on apoptosis of the liver and kidney after treatment are unclear. Furthermore, basic fibroblast growth factor (bFGF) is an angiogenic molecule, which plays an important role in angiogenesis and tissue repair. The present study investigated the expression of caspase-3, -5, -7 and apoptotic protease-activating factor-1 (APAF-1) in the liver and kidney of rats treated with ZOL and bFGF. OBJECTIVE: The present study investigated the expression of caspase-3, -5, -7 and apoptotic protease-activating factor-1 (APAF-1) in the liver and kidney of rats treated with ZOL and bFGF. ANIMALS AND METHODS: An animal model with 32 male Sprague Dawley rats was used. The effects of ZOL and bFGF on liver and kidney with the expressions of different apoptosis markers were studied histopathologically and immunohistochemically. Data were analyzed using Cronbach's alpha, Kruskal-Wallis and Bonnferroni-Dunn tests. RESULTS: The main microscopic findings were mononuclear cell infiltrations around the bile ducts, binuclear and markedly enlarged hepatocytes (cytomegaly) and mitotic figures in the liver of rats treated with ZOL only. Immunohistochemically, both APAF-1 and caspase-3, -5 and -7 expressions were found elevated significantly (P < 0.05) in the liver and kidney of these rats. CONCLUSIONS: Our findings showed that ZOL treatment increased while bFGF treatment decreased apoptosis significantly in the liver and kidney of Sprague Dawley rats. CLINICAL IMPORTANCE: The addition of bFGF to ZOL treatment of various diseases might reduce the ZOL effects.

Effects of bisphosphonate on oxidative stress levels in patients with different types of cancer.

We investigated the effects of bisphosphonate (BP) on oxidative stress levels in blood of patients with cancer. In total, 19 patients with cancer and 21 healthy subjects were included in the study. BP was intravenously administrated to the participants for 6 weeks. The patients had higher lipid peroxidation (LP) levels in the plasma and erythrocyte samples but lower glutathione peroxidase (GSH-Px) and plasma vitamin E values. In patients treated with BP, calcium and LP levels decreased, but GSH-Px and vitamin E values improved. In conclusion, we observed that treatment with BP alleviated oxidative stress induced by cancer.

Basic fibroblast growth factor attenuates bisphosphonate-induced oxidative injury but decreases zinc and copper levels in oral epithelium of rat.

Recent studies have reported oxidative damage due to bisphosphonate (BP) in various cancer tissues and neurons, although basic fibroblast growth factor (bFGF) induced antioxidant effects in the cells. The bFGF may modulate the BP-induced oxidative stress in oral epithelium of rats. This study was undertaken to explore possible beneficial antioxidant effects of bFGF on oxidative stress induced by BP in oral epithelium of rats. Twenty-eight rats were equally divided into four groups. The first group was used as control. The second, third and fourth groups intraperitoneally received BP (zoledronic acid), bFGF and BP + bFGF. At the end of 10 weeks, the rats were sacrificed, and oral epithelium samples were taken for analyses. In BP group, the lipid peroxidation levels were increased in the oral epithelium, while the activities of glutathione peroxidase (GSH-Px) and the concentrations of total antioxidant status (TAS) were decreased. In rats treated with bFGF, lipid peroxidation levels decreased, and the activities of GSH-Px and concentrations of TAS improved in the oral epithelium. However, zinc and copper levels were decreased in the oral epithelium by BP and bFGF treatments. Concentrations of vitamin E and reduced glutathione in the samples did not change in the groups. In conclusion, treatment with bFGF modulated the antioxidant redox system and reduced the oral epithelium oxidative stress induced by BP. However, zinc and copper levels were decreased by BP and bFGF treatments.

Detection of epidermal growth factor receptor intensity in asymptomatic fully impacted lower third molar follicles of smoking and nonsmoking patients.

OBJECTIVE: The objective of this study was to determine whether smoking causes pathological changes, comparing intensity of epidermal growth factor receptor (EGFR) expression in smokers' and nonsmokers' pericoronal follicles located around asymptomatic impacted lower third molars. STUDY DESIGN: Eighty-two dental follicles were collected from asymptomatic mandibular third molars of 41 smoker and 41 nonsmoker patients. Specimens were examined immunohistochemically using antibody against EGFR. RESULTS: The expression of EGFR in smokers' pericoronal follicles was higher as compared with nonsmokers (P = 0.036). Also, high EGFR expression was detected in female smokers than in female nonsmokers (P = 0.01). There was a statistically significant correlation between pack-years and EGFR expression intensity in male patients. CONCLUSIONS: The risk of pathological differentiation in pericoronal tissues of smoking patients is higher than in the nonsmoking patients. This factor may be taken into account when deciding whether to remove an asymptomatic impacted lower third molar.

An investigation into the morphometric developments of the maxillary and mandibular arches during the fetal period.

OBJECTIVE: The objective of this study was to determine the developments, morphometric features, and shapes of the maxillary and mandibular arches during the prenatal period in a large series of fetal material. METHODS: The study was carried out on 225 human fetuses aged between 8 and 40 weeks of gestation. General, extraoral, and intraoral parameters were taken from each fetus. The width and depth measurements and the shapes of the maxillary and mandibular arches were achieved using the casts obtained. The arches were categorized according to the shapes of the anterior and posterior regions of the arches. RESULTS: Palatal and mandibular indices did not change during the prenatal period. Maxillary arch measurements were greater than the mandibular measurements. Moreover, width measurements of both arches were greater than the depth measurements during fetal life. We found that the frequencies of triangular maxillary and mandibular arches were highest in the first and second trimesters; whereas, the square model became more frequent in the third trimester and at full term. Classification of the arches according to their posterior regions showed that the tips of the arches shifted medially toward the term. There were significant correlations between width and depth parameters of the arches and extraoral parameters. CONCLUSION: Data obtained in the study would be useful for clinicians by presenting an objective scale related to the prenatal period as well as being helpful in assessing the development of this region, identifying the anomalies and pathologies, and assisting treatment.

Use of Ankaferd Blood Stopper as a hemostatic agent: a clinical experience.

AIM: To determine the efficacy of the topical application of Ankaferd Blood Stopper (ABS) on hemorrhagic diathesis following dental procedures under different conditions. BACKGROUND: Some patients have a tendency to bleed excessively after dental surgery for a variety of reasons, making oral surgical procedures more risky for these patients. Since hemorrhage can cause major morbidity and mortality, the identification of a novel, effective hemostatic agent could improve the management of excessive bleeding that occurs during dental procedures. CASE DESCRIPTIONS: Four patients (3 females, 1 male) aged 28-45 with bleeding tendencies due to different presurgical conditions such as von Willebrand Disease, chronic liver failure, and mitral valve replacement presented for tooth extraction. Hematological consultations were obtained prior to surgical intervention and their international normalized (INR) ratio values were adjusted to less than 1.5; none received clotting factor replacement. All the extractions were performed under local anesthesia with and without epinephrine. In the presence of postsurgical bleeding, the efficacy of the ampule form of topical ABS was observed. Sex, age, anamnesis, von Willebrand Factor, activated partial thromboplastin time, factor VIII, and platelet counts of patients were recorded prior to the extractions. CONCLUSIONS: ABS was found to be effective within 10 to 20 minutes in controlling bleeding in most of the patients after dental surgery. These observations suggest the use of ABS may be a beneficial hemostatic agent for use in patients with hemorrhagic diathesis following tooth extraction. Additional research is needed to clarify the role of this unique medicinal product in the surgical treatment of dental patients with bleeding tendency. CLINICAL SIGNIFICANCE: ABS has demonstrated potential for being an effective hemostatic agent for the treatment of excessive bleeding following dental surgery in four patients with hemorrhagic diathesis.