A.M. Tüzüner-Öncül

Methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis of the mandible.

Methicillin-resistant Staphylococcus aureus (MRSA) is a type of Staphylococcus that is resistant to certain antibiotics, such as methicillin, oxacillin, penicillin, and amoxicillin. This nosocomial pathogen has become a great threat in hospitals globally. Up to 40% of the normal population carries S. aureus in the anterior nares, and this rate is often higher in hospitalized patients and their attendants. This case report presents a patient with serious MRSA osteomyelitis of the mandible demonstrating purulent discharge. The patient failed to recover despite prolonged postoperative treatment and the administration of several antibiotics. There was a resulting nonunion along with chronic MRSA infection. The treatment protocol involved a multimodal approach with parenteral clindamycin infusion, local rifampicin irrigation, and intermaxillary fixation of the jaws.

Prospective short term comparison of outcomes after single or double puncture arthrocentesis of the temporomandibular joint

Our aim was to compare the single puncture technique for arthrocentesis of the temporomandibular joint (TMJ) with the double puncture technique and to evaluate the short-term effects of a single puncture. Forty patients were randomly divided into two groups: the first was treated by single puncture, and the second with double puncture, arthrocentesis. During the one-month follow-up period the visual analogue and verbal scales for pain, maximal mouth opening, and satisfaction were evaluated within each group and between the two groups. Both groups recorded significant improvements compared with the baseline values in almost all outcome variables. There were no significant differences between the groups. Arthrocentesis of the TMJ was successful with both techniques.

Response of ramus following vertical lengthening with distraction osteogenesis.

Vertical lengthening of the mandibular ramus is considered to be one of the least stable surgical procedures in the management of musculoskeletal maxillofacial deformities. The aim of this study was to evaluate the response of the mandibular ramus following vertical lengthening by means of distraction osteogenesis. This study included eight non-syndromic adult patients with temporomandibular joint ankylosis. The vertical height deficiency of the mandibular ramus and the ramus/condyle unit on the affected side were simultaneously reconstructed by transportation of a bone segment using distraction osteogenesis following gap arthroplasty. Lateral and posteroanterior (PA) cephalograms taken postoperatively before active distraction, at the completion of distraction and 6, 12, 24 months after distraction, were compared to evaluate the changes of the ramus height. In all cases the vertical ramus and ramus/condyle unit height loss were successfully reconstructed by distraction osteogenesis. There was no relapse in the amount of height gained by distraction osteogenesis at the 24 months follow-up review (p>0.05). Acute one stage vertical lengthening of the mandibular ramus is considered to be one of the least stable musculoskeletal procedures with relapse being a significant adverse outcome. In this clinical study gradual vertical lengthening of the ramus through ramus/condyle unit distraction osteogenesis has maintained the initial vertical ramus height gained for 24 months.

Micronucleus assay assessment of possible genotoxic effects in patients treated with titanium alloy endosseous implants or miniplates

The use of titanium and its alloys (Ti-6Al-4V) for oral surgery has increased dramatically in recent years. Ti is a stable biocompatible metal suitable for oral applications and it has been used for endosseous subperiosteal implants and miniplate fixation for more than 25 years. Dental implants are typically made of Ti or Ti alloys. The alloys are potentially toxic due to release of vanadium and aluminum. We tested the possible genotoxicity of Ti alloy endosseous implants and miniplates on the oral mucosal tissues of two groups of patients: 17 patients receiving Ti miniplate and screw fixation, and 37 endosseous dental implant placement patients. Preoperative and postoperative mucogingival cell samples were collected. Genotoxicity was assessed by the micronucleus assay (MN). There were slight but not statistically significant increases in the frequencies of MN (p=0.087 and p=0.047) post-operation in both groups. In summary, neither of the applications showed genotoxicity in the oral epithelial cells of patients.

Combined surgical-orthodontic rehabilitation of cleidocranial dysplasia: 5 years follow-up

Cleidocranial dysplasia (CD) is an autosomal dominant syndrome which is characterized by several skeletal malformations such as non-closed fontanelles, skeletal abnormalities of the maxilla and mandible and absence of clavicles. Mid-facial hypoplasia and mandibular prognathism are mostly seen jaw abnormalities in CD. In this study, the combined orthodontic-surgical treatment of a patient with CD with class III malocclusion and multiple unerupted primary and deciduous teeth is presented.