The effect of shock waves on mineralization and regeneration of distraction zone in osteoporotic rabbits.

OBJECTIVE: Osteoporotic individuals suffer from various complications such as spontaneous bone fractures due to decreased bone strength and failure in bone healing as a result of decreased bone mineral density and deterioration of bone microstructure. In this study, the effects of Extracorporeal Shock Wave Therapy (ESWT) in a distraction osteogenesis model in osteoporotic rabbits were investigated to prevent these failures and improve bone microstructure. MATERIAL AND METHODS: A total of 28 female New Zealand rabbits underwent mandibular distraction osteogenesis and were divided into four groups: non-ovariectomized control (Cont), ovariectomized control (O-Cont), ovariectomized ESWT1 (O-ESWT1) and ovariectomized ESWT2 (O-ESWT2). ESWT was only applied to the ESWT2 group before the osteotomy, and to both the ESWT1 and ESWT2 groups after the osteotomy. Dual-energy x-ray absorptiometry was used to determine bone mineral density on both the 7th and 28th day of the consolidation. Stereological methods were used to identify new bone formation, connective tissue and neoangiogenesis volume. RESULTS: According to the dual-energy x-ray absorptiometry examination both at the 7th and 28th day of the consolidation, lower bone mineral density was seen in the ESWT groups. However, the stereological examination showed that shock wave therapy significantly increased new bone formation both ESWT1 and ESWT2 compared with O-Cont, significantly increased neoangiogenesis in O-ESWT1 compared with O-Cont. CONCLUSIONS: The application of ESWT in these parameters after osteotomy was beneficial for bone regeneration in mandibular distraction in osteoporotics. However, ESWT has been shown to be ineffective in improving bone mineral density.KEY MESSAGESThe osteoporotic model can be successfully established in rabbits and the subjects can tolerate the distraction procedures.Stereology is a useful analysis method that can determine the volume of the new bone formation and neoangiogenesis.Extracorporeal shock wave therapy has biostimulatory effects on bone tissue.

The assessment of new bone formation induced by unfocused extracorporeal shock wave therapy applied on pre-surgical phase of distraction osteogenesis.

PURPOSE: This study aims to evaluate the effects of extracorporeal shock wave therapy applied before and/or immediately after the osteotomy on the maturation during the consolidation phase. MATERIALS AND METHODS: 21 female New Zealand rabbits were used in the study. Subjects were divided randomly into three groups: Control (Distraction without ESWT), A (Distraction +ESWT After Osteotomy), AB (Distraction+ESWT After and Before Osteotomy). ESWT (500 pulses, 5 Hz, 0.19 mJ/mm2 energy flux density) was applied to group A and group AB after 5, 12 and 19 days after osteotomy and group AB only on days 7,14 and 21 before osteotomy. On the 28th day of the consolidation period, all subjects were sacrificed. Dual-energy x-ray absorptiometry (DEXA) was used to determine bone mineral density (BMD) and bone mineral content (BMC), and stereological methods were used to determine the new bone, connective tissue and neovascularization volumes. RESULTS: As a result of DEXA examinations made on the 1st and 4th week of consolidation, there was no significant difference between groups regarding BMD and BMC values. According to the results of stereological examination, when the connective tissue and new bone tissue were evaluated, higher values were observed in AB when compared to A, and in AB and A compared to the control group, but the differences are not statistically significant. There was no difference between the groups in terms of neovascularization. CONCLUSION: ESWT in these parameters was not positively effective in bone maturation during consolidation when applied before osteotomy or both before and after osteotomy.

Effect of Electrohydraulic Extracorporeal Shockwave Therapy on the Repair of Bone Defects Grafted With Particulate Allografts.

This study determined the effect of electrohydraulic extracorporeal shockwave therapy (ESWT) on the healing of mandible defects repaired using particulate allogenic bone grafts. This study included 20 male Wistar rats aged 12 weeks. In all the animals, a critical-sized defect of 4-mm diameter was created in the mandible and the defect area was filled with particulate allograft. Next, the rats were divided into 2 groups, allograft (G) (n = 10) and allograft + ESWT (GE) (n = 10). On days 3, 5, and 7 after the grafting, rats in the GE group received ESWT involving 200 pulses with an energy flux density of 0.19 mJ/mm. Five rats in each group were sacrificed at the end of week 4 and at the end of week 8. Defect areas were examined radiologically by performing high-resolution computed tomography and stereologically by using the Cavalieri method. Obtained data were compared by performing statistical analysis. Radiological evaluation showed that bone density was higher in rats in the G group than in those in the GE group at week 4. In contrast, bone density was higher in rats in the GE group than in those in the G group at week 8. Stereological examination showed that new bone, connective tissue, and capillary volumes were higher in rats in the GE group than in those in the G group at both weeks 4 and 8. The authors' results indicate that repeated doses of ESWT accelerate the healing of bone defects repaired using allogenic bone grafts.

Therapeutic effects of caffeic acid phenethyl ester on alveolar bone loss in rats with endotoxin-induced periodontitis.

BACKGROUND/PURPOSE: Caffeic acid phenethyl ester (CAPE) is an antioxidant which is decreases the bone resorption and enhances the bone healing. The aim of this study was to investigate the effects of administering systemic CAPE on alveolar bone loss in rats with experimental periodontitis. MATERIALS AND METHODS: Thirty male Sprague Dawley rats were divided into three groups: control, endotoxin-induced periodontitis (EP), and EP treated with CAPE (EP-CAPE). Endotoxin was injected into the gingiva of test rats on days 1, 3, and 5, whereas saline was injected into the control rats. The EP-CAPE group received 10 mmol/kg/day CAPE intraperitoneally for 28 consecutive days. Saline was given in the control and EP groups in the same manner. At the end of the study, intracardiac blood samples were obtained, and the rats were sacrificed. Alveolar bone loss was analyzed with histometric measurements. The oxidative stress index (OSI) was used to evaluate the oxidative stress. The receptor activator of the nuclear factor kappa B ligand (RANKL) level was analyzed stereologically. RESULTS: CAPE administration significantly decreased the serum OSI and interleukin-1ß levels. Alveolar bone loss was statistically higher in the EP group compared with the EP-CAPE group (P < 0.05). Immunohistochemical analyses of the RANKL were significantly lower in the EP-CAPE group than in the EP group (P < 0.05). CONCLUSION: This experimental study revealed that CAPE administration significantly prevented alveolar bone loss and stimulated periodontal tissue healing.

Is it possible to change of the duration of consolidation period in the distraction osteogenesis with the repetition of extracorporeal shock waves?

BACKGROUND: In this study we examined the effects of two different repeated Extracorporeal Shock Waves (ESW) on the consolidation period of the distraction osteogenesis (DO) of the rabbit mandible using stereological, radiological and immunohistochemical methods. MATERIAL AND METHODS: DO was performed unilaterally in the mandible of 18 New Zealand rabbits (six months old, weighing between 2.5-3 kg). In the consolidation period, rabbits were divided into three groups randomly after the distraction period. The distraction zone of the mandible was received no treatment as controls (E0*2). Group 2 (E 500*2) received ESWT (twice 500 impulses at 14 kV and 0.19 mJ/mm2 energy) in the first and fourth days of the consolidation. Group 3 (E1000*2) treated with ESWT (twice 1000 impulses at 14 kV and 0.19 mJ/mm2 energy) in the first and fourth days of the consolidation period. After the sacrification, radiologically bone mineral density, new bone formation, new fibrous tissue and new vessel formation were analyzed by stereological. RESULTS: It was found a statistically significant difference between the study groups and control group in the bone mineral density measurements and the highest value was in the E1000*2 group. In the stereological analysis, new bone formation was highest in the E1000*2 group and there was a significant difference compared to the other groups (E0*2 and E500*2) (p = 0.000). The lowest connective tissue volume was found in the E500*2 and there was a significant difference compared to the other groups (E0*2 and E1000*2) (p = 0.000). The volume of the new vessel was highest in the E500*2 and lowest in the E0*2 group. It was found statistically significant difference between the values of the study and control groups. CONCLUSIONS: Interestingly, we found that repetition of the 1000 impulses ESWT accelerated the consolidation, 500 impulses ESWT extended consolidation period of the DO

Incidence of mandibular fractures in black sea region of Turkey.

BACKGROUND: The aim of this study is to review the incidence of mandibular fractures in the Black Sea Region of Turkey and to present our treatment protocol. MATERIAL AND METHODS: Data were collected regarding age, sex, etiology, time distribution, site of the fracture and the associated injuries and evaluated. These patients were treated at Ondokuz Mayis University Department of Oral and Maxillofacial Surgery between 2003 and 2010. Data were collected from patient files in the archive and were analyzed using SPSS version 20.0 software. RESULTS: A total of 82 patients with 133 mandibular fractures were included in this study. After the follow up period of the patients, the results were achieved from 58 (70.7%) males and 24 (29.3%) females, whose ages ranged from 5 to 72 years and the mean age was 29. Fractures were most seen in 2008 and the busiest month was August. Falls (40.2%) were the major causes of mandibular fractures followed by traffic accidents and violence. The mandibular anatomical sites of higher fracture incidence were: condyle (34.6%), body and symphysis. The number of the fractures and injuries which were seen in other places such as zygomatic arch, alveolar process, tongue, upper and lower lips, orbita, arms was 14. 53 (64.6%) patients were treated by closed reduction, whereas 13 (15.8%) patients were treated by open reduction. CONCLUSIONS: We concluded that our results were widely similar with the studies in developing countries. Socio-economic factors, cultures, geographic conditions and education could affect the etiology of the mandibular fractures and cause different results between the studies conducted in different countries. Key words:Mandibular fractures, etiology, trauma, treatment, complication.

Propolis accelerates the consolidation phase in distraction osteogenesis.

We evaluated the effect of propolis on new bone formation after distraction osteogenesis (DO). This study examined 3 groups: control group, P100, and P200. Rabbits underwent DO of the left mandible after an osteotomy between the first molar and the mental foramen. Bone mineral content and bone mineral density were evaluated using dual-energy x-ray absorption 1 and 4 weeks after the procedure. The volume of connective tissue and new bone and the number of capillaries were measured using stereologic analysis after the subjects were killed. Dual-energy x-ray absorption showed that the bone mineral content and bone mineral density were higher in the groups treated with propolis by week 4, and these parameters were higher in the P200 group. Stereologic analysis showed no significant differences in connective tissue volume and number of capillaries among the groups. New bone volume was lowest in the P200 group. We concluded that propolis accelerates bone formation and may shorten the consolidation phase with DO.