Assessment of dental care during the COVID-19 pandemic in Turkey and future projections / Avaliação dos cuidados dentários durante a pandemia COVID-19 na Turquia e perspectivas

A new coronavirus disease has affected the whole world, starting from Wuhan, China at the end of 2019. The disease, caused by the pathogen of SARS-CoV-2, commonly called COVID-19, has soon passed into the history of epidemics as the most effective pandemic recently. Dentistry has also been significantly affected by the pandemic process, which had a restrictive effect on almost all aspects of social life. Dental treatments are healthcare services that have been applied very carefully in terms of the risk control of cross-infection prior to this pandemic where disinfection and sterilization rules continue to be controlled at the highest level. However, hand instruments used in most dental treatments and generating aerosol has raised concerns, particularly in diseases such as COVID-19, which increase the risk of droplet contamination. This working order is an important risk factor not only for healthcare professionals but also for the contamination of patients and the environment. In addition, the continuing pandemic process and the dynamics of the process require revision of the protocols. For this reason, each country has prepared protocols in order to maintain the dental treatments in the pandemic process in accordance with their own health care conditions and policies. This process caused the dental professionals to reconsider their routine working practices and prospectively, new protocols are recommended for dental applications. This article aims to provide a perspective evaluating the current situation and discuss additional measures to be considered during the pandemic and thereafter.(AU)

Uma nova doença por coronavírus afetou o mundo inteiro, a partir de Wuhan, China, no final de 2019. A doença, causada pelo patógeno da SARS-CoV-2, comumente chamada COVID-19, logo passou para a história das epidemias como a pandemia mais eficaz. A odontologia também foi significativamente afetada pelo processo de pandemia, que teve um efeito restritivo em quase todos os aspectos da vida social. Os tratamentos dentários são serviços de saúde que foram sempre aplicados com muito cuidado em termos de controle de risco de infecção cruzada mesmo antes desta pandemia, onde as regras de desinfecção e esterilização continuam a ser controladas ao mais alto nível. No entanto, as turbinas usadas na maioria dos tratamentos odontológicos que geram aerossóis têm suscitado preocupações, principalmente em doenças como a COVID-19, pelo aumento do risco de contaminação por gotículas. Essa mecânica de trabalho é um importante fator de risco não apenas para os profissionais de saúde, mas também para a contaminação dos pacientes e do ambiente. Além disso, o processo continuado da pandemia e sua dinâmica exigem revisão dos protocolos. Por esse motivo, cada país elaborou protocolos para manter os tratamentos dentários no processo de pandemia, de acordo com suas próprias condições e políticas de saúde. Esse processo levou os profissionais de odontologia a reconsiderar suas práticas de trabalho de rotina e, prospectivamente, novos protocolos são recomendados para aplicações odontológicas. Este artigo tem como objetivo fornecer uma perspectiva para avaliar a situação atual e discutir medidas adicionais a serem consideradas durante e após a pandemia.(AU)

Effects of osteoformin in the rapid distraction osteogenesis of rabbit mandibles.

OBJECTIVE: To evaluate the effects of osteoformin on mineralisation and quality of the new bone formation during rapid distraction osteogenesis. METHODS: This multi-centre study was conducted at the Karadeniz Technical University, Middle East Technical University and Selcuk University. The experimental study was conducted from January 2010 to September 2012 and comprised New-Zealand rabbits that were randomly divided into three groups. In group I distraction rate was 1 mm/day while in groups II and III distraction rates were 2mm/day and 1 mm/day. In groups I and II 100µg/kg osteoformin was injected after the latency period. Distraction region was evaluated by radiological, histomorphometrical and dual energy X-ray absorptiometry analyses. SPSS 17 was used for statistical analysis. RESULTS: There were 18 rabbits with each of three groups having 6(33.3%). Accelerated bone healing was noted in groups I and II compared with group III (p<0.05). No significant differences were indicated between groups I and II (p>0.05). CONCLUSIONS: Local injection of osteoformin was effective in the craniomaxillofacial distraction osteogenesis in rabbits. Further experimental studies are recommended before using osteoformin on humans.

Does an alkaline environment prevent the development of bisphosphonate-related osteonecrosis of the jaw? An experimental study in rats.

OBJECTIVE: To investigate the preventive effect of locally applied sodium bicarbonate on bisphosphonate-related osteonecrosis of the jaw (BRONJ). STUDY DESIGN: Thirty-six Sprague-Dawley rats were divided into 4 groups. Animals in group I received 0.1 mg/kg sterile saline 3 times per week for 8 weeks. Groups II, III, and IV received intraperitoneal zoledronate injection in the same manner with the same frequency and duration. The right first molar tooth was extracted in groups III and IV. One mL 8.4% sodium bicarbonate (SB) was applied to the extraction socket at the time of extraction in group IV. The effect of locally applied SB as an alkalizing agent was evaluated by histomorphometric analysis. RESULTS: BRONJ was observed in none of the animals in the control groups, 67% of the animals in the tooth extraction group, and none of the animals in the local SB application group (P < .01). CONCLUSIONS: Administration of locally applied SB had positive effects on the prevention of BRONJ in animals, but further studies are required to verify the effectiveness of this form of treatment before its use in humans.

Comparative radiologic analyses of newly formed bone after maxillary sinus augmentation with and without bone grafting.

PURPOSE: The present study examined the formation and density of new bone after sinus membrane elevation, with and without bone grafting, and evaluated the bone formation at the apices of the implants with these 2 different maxillary sinus floor elevation techniques. MATERIALS AND METHODS: In a prospective randomized controlled study design, patients requiring reconstruction of their atrophic maxilla were included and divided randomly into grafted and nongrafted groups. Implants were inserted in each group by way of sinus membrane elevation. The formation and density of new bone were evaluated using cone beam computed tomography, performed preoperatively and 1 week, 3 weeks, and 6 months postoperatively. RESULTS: A total of 24 implants were placed in 14 patients, with all implants maintaining stability during 6 months of follow-up. New bone formation was determined in both groups using radiography. No significant differences were found between the 2 groups in terms of new bone density preoperatively nor at 1 week or 3 months postoperatively. However, the density of bone in the nongrafted group was higher than that in the grafted group 6 months after surgery. CONCLUSIONS: These results suggest that the simple elevation of the sinus membrane without bone grafting material can lead to bone formation around implants and that the newly formed bone in the nongrafted group was denser than that in the grafted group.

Short-term results of prolotherapy in the management of temporomandibular joint dislocation.

OBJECTIVE: Prolotherapy, the rehabilitation of ligaments or tendons by induced proliferation of cells by using dextrose, is a noninvasive and effective method for the treatment of temporomandibular joint (TMJ) dislocation. The aim of this study was to evaluate the efficacy of prolotherapy method for the management of acute or chronic dislocation of TMJ. MATERIALS AND METHODS: In this study, 10 patients with TMJ dislocation (2 acute, 8 chronic) were examined retrospectively. All patients consisted of female patients, with a mean age of 28.4, who were treated with prolotherapy procedure. Differences of visual analog scale scores in quality of life, pain on function, and chewing function efficacy between sessions were investigated using the Wilcoxon t test and median values of sessions were evaluated using the Kruskal-Wallis H test. The amount of change at the maximum mouth opening occurring between the preoperative and postoperative values and the frequency of locking episodes were calculated, with results considered statistically significant at P < 0.05. RESULTS: Pain on function scores were significantly decreased in all patients, and TMJ locking were not observed during the follow-up period. Maximum mouth opening exhibited a tendency to decrease, but it was not statistically significant. Also, clicking sound on function presented no significant change (P > 0.05). On the other hand, the visual analog scale scores for quality of life showed significant improvement in all patients (P < 0.05). CONCLUSIONS: The results of this study show that prolotherapy can be used as an efficient, simple, and conservative method to treat TMJ dislocation.

Comparison of the effects of new folkloric hemostatic agent on peripheral nerve function: an electrophysiologic study in rats.

OBJECTIVE: The aim was to evaluate the effects of a new folkloric medicinal plant extract on peripheral nerve function compared with oxidized regenerated cellulose (OC) and bovine collagen (BC). STUDY DESIGN: Under ketamine anesthesia a total of 40 male Sprague-Dawley rat right sciatic nerves were identified. Animals were randomly divided into 5 groups: OC, BC, ankaferd blood stopper (ABS), and negative and positive control groups. The recordings of nerve potentials were carried out using an electrophysiologic data acquisition system. After the application of substances, the nerve conduction velocity (NCV) was recorded for immediate (30 min), early (120 min), and delayed (3 wk) effects on nerve function. RESULTS: Statistically, differences were not found among the hemostatic agents (OC, BC, and ABS) at baseline and all tested periods (early, immediate, and delayed; P > .05). The positive control group exhibited lower NCV values compared with the other solutions at the 30-minute period (P < .05) as well as the other tested time periods (P > .05). OC exhibited NCV values closer to the positive control group at 120 minutes (P > .05). CONCLUSIONS: Folkloric medicinal hemostatic agent could be considered as an acceptable hemostatic material without resulting in any serious peripheral nerve function alterations. The possible desirable effects of bovine collagen and undesirable effects of oxidized cellulose on peripheral nerve function should not be overlooked.

An acoustical analysis of the effects of maxillary sinus augmentation on voice quality.

OBJECTIVE: Increased experience in sinus lifting procedures has led to a number of literature reports, but the potential effects of sinus lifting on voice quality is not clearly addressed in clinical studies. The aim of this study was to objectively investigate the effects of sinus lifting on alterations in voice quality and, in particular, on vocal resonance. STUDY DESIGN: A total of 17 patients who were in need of bilateral sinus augmentation were recruited. Acoustic analyses were performed before and after surgery. Volume changes in the sinuses were recorded before and after surgery using dental volumetric tomography. The Friedman test with Bonferroni correction was used to analyze the data. RESULTS: Changes in the perturbation parameters of acoustic sound analysis were found to be statistically significant. CONCLUSIONS: We recommend that all patients (especially voice professionals) be informed about the possible effects of sinus lifts on speech and voice alterations.

Marginal bone resorption around dental implants placed in grafted sinuses; an up-to-30-month clinical and radiological follow-up.

OBJECTIVE: To determine the relative success of two different bone grafting material - putty and powder forms of De-mineralised Bone Matrix (DBM) - used in sinus lift procedure. METHODS: The retrospective study was conducted at the Department of Oral and Maxillofacial Surgery, Ankara University, Ankara, Turkey, and comprised data related to the patients referred for bilateral maxillary sinus augmentation between 2007 and 2010. During the period, 48 endoosseous implants were placed concurrently with the sinus augmentation in 12 patients. Marginal bone loss around the implants was measured at the time of loading, 12 and 30 months after the treatment. SPSS 11.5 was used for data analysis. RESULTS: Of the 12 patients, 8 (66.6%) were females and 4 (33.3%) were males. All implants osseointegrated in both the putty and powder groups well without any significant clinical finding. The average volume of marginal bone resorption at implants for the putty side was 0.43 +/- 0.22 mm, 0.8 +/- 0.33 mm and 1.12 +/- 0.49 mm at prosthetic loading, 12-month and 30-month follow-up, respectively. For the powder side, the corresponding numbers were 0.48 +/- 0.32 mm, 0.82 +/- 0.46 mm and 1.24 +/- 0.57 mm. No statistically significant difference in bone loss between the two groups was observed (p > 0.05). CONCLUSION: Both putty and powder forms of de-mineralised Bone Matrix showed satisfactory results and there was no significant difference in marginal bone loss around dental implants and survival rates.

Evaluation of sedation in oral and maxillofacial surgery in ambulatory patients: failure and complications.

OBJECTIVES: This study evaluated the failure and complication rates of sedation in ambulatory patients undergoing oral and maxillofacial surgery. MATERIALS AND METHODS: This retrospective cohort study was carried out among 619 patients who had undergone maxillofacial surgical procedures under intravenous sedation with midazolam and fentanyl. Each patient's age, American Society of Anesthesiologists (ASA) classification, systemic condition, surgical procedure, complications, and failures were recorded for evaluation. RESULTS: A total of 400 patients with ASA I, 199 with ASA II, and 20 with ASA III between the ages of 9 months and 84 years were included in the study. The most common systemic disorders in our patients were mental retardation (35%), hypertension (19%), and epilepsy (15%). Evaluation of the cases revealed 9 complications (1.4%) and 9 sedation failures (1.4%). The complications were bradycardia, postoperative agitation and hallucination, drug reaction, vomiting and nausea, desaturation, and hypotension. CONCLUSIONS: Our results in the oral and maxillofacial surgery clinic revealed low complication and failure rates.

A 3-year follow-up of the rehabilitation of Papillon-Lefèvre syndrome by dental implants.

PURPOSE: Papillon-Lefèvre syndrome is a rare autosomal recessive genetic disorder characterized by palmar-plantar hyperkeratosis, with rapidly progressive periodontitis and premature loss of both deciduous and permanent teeth. This article presents the prosthetic rehabilitation of a patient with Papillon-Lefèvre syndrome with dental implants. MATERIALS AND METHODS: Twelve titanium implants were installed in the mandible and maxilla in an 18-year-old male patient with Papillon-Lefèvre syndrome. RESULTS: At 3 years follow-up, all implants were clinically stable and no pain or infection was found. The patient continues to be seen at regular follow-up visits. CONCLUSION: Twelve-implant installation in Papillon-Lefèvre syndrome with 3 years' follow-up has not claimed before. We not only successfully treated our patient functionally and esthetically with dental implant rehabilitation, but also provided psychological benefits to the patient.

Jaw bone changes in rats after treatment with zoledronate and pamidronate.

OBJECTIVE: The aim of this study was to histopathologically evaluate the effects of pamidronate and zoledronate on the mandible in an animal model. STUDY DESIGN: Sixty female Sprague-Dawley rats were used in this study. Animals were divided into 6 groups (10 per group): control-1 (C1), injected with saline solution for 6 weeks; zoledronate-1 (ZA1), injected with zoledronate for 6 weeks; pamidronate-1 (PA1), injected with pamidronate for 6 weeks; control-2 (C2), injected with saline solution for 8 weeks; zoledronate-2 (ZA2), injected with zoledronate for 8 weeks; and pamidronate-2 (PA2), injected with pamidronate for 8 weeks. No dental procedures were performed on the animals. Rats were killed 2 days after the end of drug therapy, and the posterior and anterior mandible and femur of each rat were evaluated histopathologically. RESULTS: Histological examination revealed inflammation limited to the posterior mandible of the ZA2 and PA2 groups; the anterior mandible and femur were not affected. Soft tissue necrosis was evident in one rat in the ZA2 group. CONCLUSION: Specific, bisphosphonate-associated inflammatory bony and soft tissue changes were observed in the mandible, suggesting that these drugs may set the stage for altered healing associated with the development of bisphosphonate-related osteonecrosis of the jaw.

The effects of osteoformin on mineralisation and quality of newly formed bone during mandibular distraction osteogenesis in rabbits.

OBJECTIVE: The aim of this experimental study was to evaluate the effects of osteoformin on mineralization and quality of newly formed bone during distraction osteogenesis in rabbits. STUDY DESIGN: Distraction rate was as 1 mm/day for 5 days. In the experimental group, 100 microg/kg osteoformin in 100 microL/kg phosphate-buffered saline (PBS) was injected into the distraction area at day 1 and day 7 after surgery. In the control group, only 100 microL/kg PBS was injected on the same days. On day 42, the animals were killed. RESULTS: Bone mineral density and bone mineral content values increased significantly in the experimental group (P < .05). Newly formed bone areas, number of vessels and osteoblasts were significantly greater in experimental group (P < .05). The number of fibroblasts were also greater, but it was not significant statistically (P > .05). The number of osteoclasts was significantly lower in experimental group (P < .05). CONCLUSION: The results of this study show that osteoformin improves healing of regenerate in distraction osteogenesis in rabbits.

Evaluation of sedation failure in the outpatient oral and maxillofacial surgery clinic.

PURPOSE: Our goal was to report on the incidence of sedation failures in our outpatient oral surgery clinic. Sedation failure is the inability to complete a procedure under intravenous sedation. There is very little in the oral surgery literature on this subject. MATERIALS AND METHODS: Proper Institutional Review Board approval was obtained from the appropriate governing body for this project. The medical records of 539 intravenous sedation patients treated at the Oral and Maxillofacial Surgery Clinic at our institution were retrospectively evaluated to determine the incidence of failed sedation. Patients sedated with midazolam and fentanyl were placed in group A. There were 323 patients in group A. We placed patients sedated with midazolam, fentanyl and methohexital into group B. There were 216 patients in group B. The gender, medical history, type of procedure being performed, amount of drug given, and the patient's vital signs throughout the procedure were recorded. RESULTS: There were 9 failed sedations with a rate of 1.6% (9/539); 3 in group B (1%) and 6 in group A (2%). Five of our failures were undergoing multiple tooth extractions. Two of the failures were undergoing surgical removal of impacted third molars. Two patients underwent mandibular fracture reduction. Failure was attributed to increased agitation and combativeness, uncontrolled hypertension, tachycardia and desaturation. CONCLUSION: The mandible fracture population and multiple teeth extraction patients had higher rates of failure than other groups. This may be the result of procedure length, type of procedure, or a preoperative anxiety and attitude toward treatment expressed by the patient making sedation unpredictable. Level of training and experience of the practitioner may contribute to sedation failure. These results allow us to develop a prospective study protocol of outpatient sedation and to quantify more detailed information about preoperative anxiety, medical status, and social history than we had available during our chart review. More specific conclusions may help us determine if certain patient populations are at a higher risk for failed sedations.

Infection following treatment of mandible fractures: the role of immunosuppression and polysubstance abuse.

OBJECTIVE: There is little data available on the relationship between immunosuppression and polysubstance abuse and postoperative infection in patients with mandibular fractures. In this study we aimed to assess these parameters. STUDY DESIGN: This study sample consisted of 120 patients who were admitted to the Department of Oral and Maxillofacial Surgery at the Washington Hospital Center between January of 1999 and February of 2002. Patient charts were reviewed and data regarding fracture location, mode of treatment, type of antibiotic therapy, and outcome of treatment including postoperative complications were also recorded. Patient's medical and social histories were also reviewed for a history of diabetes mellitus (DM), human immunodeficiency virus (HIV) status, alcohol abuse, and intravenous drug abuse (IVDA). RESULTS: Of the 120 patients in this study, 17 (14.1%) patients were identified as having a postoperative infection. Among those with postoperative infections, 8 (6.7%) had history of immunosuppression or polysubstance abuse. The strongest association found in this review is the relationship between alcohol (P = 0.50) and IVDA (P = 0.68), and the development of post-operative infections. There was also an increased rate of postoperative infection in HIV-positive patients (P = 0.71) and DM patients (P = 0.77). CONCLUSION: In our study, we observed an increased risk for post-operative infection in HIV-positive individuals and diabetics. This finding lends support to other studies, which have shown a higher incidence of infection in HIV-positive individuals. We also observed an increased risk for postoperative infection among patients with history of alcohol and drug abuse. Therefore, in treatment planning for the correction of mandible fractures in patients with histories of substance abuse, it seems appropriate to make efforts to decrease the postoperative risk.

Treatment of a mandibular fracture with biodegradable plate in an infant: report of a case.

Mandibular fractures in infants are rare. Different methods have been described for treatment of fractures of the mandible in infants. Internal fixation of a mandibular fracture with a biodegradable plate in an 8-month-old baby is described. In addition, choices of treatment modality in such cases are discussed.

Assessment of the sinus lift operation by magnetic resonance imaging.

OBJECTIVES: Vertical bone loss in edentulous maxillary alveolar processes may necessitate a sinus lift before the placement of dental implants. We have measured and assessed maxillary sinuses meticulously before the operation and evaluated the postoperative results of the operation with magnetic resonance imaging (MRI). METHODS: Thirteen edentulous maxillary regions in eight patients were included in the study. The patients were examined 1 week before and 3 months after the sinus lift operations using a 1.5 T superconductive MR imager that gave oblique sagittal T2-weighted images with slices 2 mm thick without a gap. RESULTS: The images that were obtained 3 months after the sinus lift operations confirmed that vertical height had increased. CONCLUSION: We obtained high quality images without any artefacts during a short examination period with a high-resolution scanner. The results showed that it is possible to assess the maxillary sinus before the sinus lift and to evaluate the postoperative results using MRI accurately in three dimensions without the risk of radiation. This makes MRI a suitable alternative to computed tomography (CT).