Beneficial Therapeutic Effects of Sildenafil on Bone Healing in Animals Treated with Bisphosphonate.

OBJECTIVES: The purpose of the present study was to evaluate the effects of sildenafil on mandibular fracture healing in animals treated with zoledronic acid by using histologic, histomorphometric, immunohistochemical, and radiodensitometric methods. MATERIALS AND METHODS: A total of 36 Sprague-Dawley rats (3 months old) were used. All animals were treated intraperitoneally with 0.1 mg/kg zoledronate three times per week, for a total of 8 weeks. Postoperatively, the animals were divided into two groups: zoledronate group (Z), which had no treatment applied (n = 18), and zoledronate + sildenafil (ZS), which were treated daily with 10 mg/kg sildenafil (n = 18). Each group was divided into two subgroups and the animals were sacrificed at the end of week 1 (Z1 and ZS1, n = 9) and week 4 (Z4 and ZS4, n = 9) after the operation. Histologic, histomorphometric, immunohistochemical analysis, and radiodensitometry were performed on the test subjects. RESULTS: Sildenafil-treated groups showed a significant increase in fracture healing scores. This result was supported by the densitometric, histologic, histomorphometric, and immunohistochemical findings. CONCLUSIONS: Sildenafil may have positive effects on accelerating and improving fracture healing, and it may be used as a supporting factor in bone healing in patients treated with bisphosphonate (BP) to prevent negative effects of BP's.

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.

Analyses of 1100 supernumerary teeth in a nonsyndromic Turkish population: A retrospective multicenter study.

PURPOSE: The aim of this study was to analyze the clinical and radiological features of supernumerary teeth (ST), record the related complications, and discuss different forms of treatment. MATERIALS AND METHODS: A total of 111,293 patients were examined over a 3-year period. The patients' ages and genders, in addition to the number, morphology, location, position, shape, developmental stage, and eruption status of ST and associated complications, were recorded. RESULTS: Among the 111,293 patients, there were 851 (0.76%) patients with 1100 ST. Of these patients, 478 (56.2%) were males, and 373 (43.8%) were females, with a mean age of 22.71. Most of the 1100 ST were located in the maxilla, 437 (39.72%) were a conical shape, with 82.81% of these including a fully developed tooth. A mesiodens was the most common type of supernumerary tooth (n=284, 33.37%), followed by distomolars (n=204, 23.97%) and parapremolars (n=146, 17.16%). Among the 1100 ST, 422 (38.36%) were associated with complications. CONCLUSIONS: No previous studies in the literature have examined in detail so many cases with ST. The demographic profile of the patients with ST presented herein provides useful additional epidemiological information.

Complex and compound odontomas: Analysis of 69 cases and a rare case of erupted compound odontoma.

OBJECTIVE: The purpose of this study was to analyze clinic and radiologic features of the 69 odontoma cases and present a rare case of erupted compound odontoma in the oral cavity. MATERIAL AND METHODS: The 69 cases were analyzed with regard to the following parameters: age, gender, location, associated unerupted teeth, missing teeth, radiological and histopathological features and treatment protocols. RESULTS: Of the 69 cases, 49 were compound odontoma and 20 were complex odontoma. There was a female predilection for both compound and complex odontomas. Compound odontoma occurred more often in the anterior region of the jaws; complex lesions occurred more often at the posterior mandible. The most common clinical manifestations were the retention of permanent teeth. CONCLUSION: Compound odontomas rarely erupt into the mouth. The presented case is the 13 th case of erupted compound odontoma reported in the literature. The treatment of choice is surgical removal of the odontoma. In the case of odontomas associated to impacted teeth, the teeth should be preserved in wait of spontaneous eruption, or alternatively fenestration followed by orthodontic traction is indicated. Regular follow-up period is crucial to evaluate the prognosis of these teeth.

The effect of diclofenac on matrix metalloproteinase levels in the rotator cuff.

INTRODUCTION: Matrix metalloproteinases (MMPs) are involved in physiological events such as restructuring of the tissue, morphogenesis, wound healing and normal developmental process. Use of diclofenac sodium following rotator cuff repair can disrupt healing of tendon through acting on MMPs. MATERIALS AND METHODS: Supraspinatus tendons of rats (n = 84) were detached from their insertion on humerus, and repaired to anatomic footprint. Rats were divided into study group (n = 42) and control group (n = 42). Study group received a dose of 1 mg/kg daily diclofenac sodium subcutaneously. The rats were killed at weeks 1, 3 and 6, and seven rats from each groups were included in biomechanical and immunohistological examinations. Immunohistological staining of MMP-2, MMP-3 and MMP13 were used. RESULTS: Maximum load was reduced in the study group at the end of week 1 (8.76 vs. 5.28 N) (p = 0.01). MMP-3 level was statistically significantly lower in the study group at the end of week 1. MMP-13 level and stiffness decreased towards week 6 in the study group while in the control group the level of MMP-2 decreased towards week 6. CONCLUSION: Diclofenac has an impact on the levels of MMP-2, MMP-3 and MMP-13, which are needed for normal healing process, and it can also lead to disruption of tendon healing.

The effect of zoledronic acid on growth plates and high turnover bones.

OBJECTIVES: Bisphosphonates have preventive effect on bone resorption caused by osteoclasts.We aimed to investigate the histopathological effects of zoledronic acid (ZA) on the jaw and long bones and growth plates of rats. METHODS: Thirty-six 12 week-old female Sprague-Dawley rats were divided into the control (C, n=18) and ZA groups (Z, n=18). Z group animals were administered 0.1 mg/kg saline-diluted ZA intraperitoneally three times per week for 8 weeks. C group animals were administered the same amount of saline simultaneously. At the end of 11th week, half the subjects from either the control group (C1) and ZA group (Z1) were sacrificed. At the end of 14th week, the remaining half from both groups were also sacrificed (C2 and Z2). In all animals, no dental procedures were performed; the posterior and anterior mandible and the knee joint including distal femur and proximal tibia were histopathologically investigated. RESULTS: Histological examination revealed that inflammation and necrosis were limited to the posterior mandible of the Z1 and Z2 groups, while the anterior mandible and knee joint including distal femur and proximal tibia remained unaffected however the development of the growth plate of the proximal tibia was found to be arrested in animals of the Z1 and Z2groups. CONCLUSION: Due to it is inhibitory effect over growth plate and inflammatory and necrotic effect over high turnover bones, zoledronic acid should be administered cautiously, especially in pediatric patients who are still in their growth and development stages (Fig. 6, Ref. 34).

Effects of the topical hemostatic agent Ankaferd Blood Stopper on the incidence of alveolar osteitis after surgical removal of an impacted mandibular third molar.

BACKGROUND: Alveolar osteitis (AO) is a commonly seen post-operative complication during the wound-healing period after permanent tooth extraction or surgical removal of impacted third molar teeth. OBJECTIVES: The aim of this clinical study was to evaluate the effects of administration of the topical hemostatic agent Ankaferd Blood Stopper (ABS) into the socket on AO formation after impacted mandibular third molar extraction. PATIENTS AND METHODS: Bilaterally, 100 half-impacted mandibular third molars were extracted in 50 patients. Then, 1.0 mL ABS was administered to achieve hemostasis in one half of the sockets and as a control, the other half was irrigated with 1.0 mL physiological serum after surgery. RESULTS: There was no statistically significant difference in terms of AO formation ( P > 0.05) between the extraction sites. However, the postoperative pain in ABS administration sites was higher than in the other sites for the first 2 days after surgery ( P < 0.05). CONCLUSIONS: The results showed that ABS administration did not increase the incidence of AO formation. Thus, ABS can be used safely for hemostasis after impacted mandibular third molar surgery.

A prospective randomised cross-over study of the effect of local haemostasis after third molar surgery on facial swelling: an exploratory trial.

OBJECTIVE: This study was undertaken in order to evaluate the effects of local haemostasis on the facial swelling induced in patients undergoing surgical removal of impacted mandibular third molar teeth. DESIGN: A prospective randomised cross-over study. SETTING: Department of Oral and Maxillofacial Surgery, Samsun, Turkey, 2002. MATERIALS AND METHODS: Twenty-five healthy patients who were having bilaterally symmetric, impacted third molar extraction were studied. The teeth were removed in two separate operations by two surgeons who had equal academic degrees. The patients were assigned to test and control groups by random selection. One side served as control and on the other local haemostasis was achieved by a haemostatic agent (oxidised regenerated cellulose). This was placed into the socket following gauze packing for 3 minutes (test). The operating time therefore significantly increased in the test group. Data was collected regarding the operating time, mouth opening and facial swelling. RESULTS: There were no statistically significant differences between the test and control groups for the mean values of the facial swelling and mouth opening at day 1 and 3 post-operatively (P > 0.05). Operating time was statistically longer for the test group than the control (P < 0.001). CONCLUSION: This study has shown that establishment of local haemostasis after removal of impacted mandibular third molars is not so effective in preventing facial swelling.