Ahmet Altan

Applicability of the Demirjian method for dental assessment of southern Turkish children

Age-related legal problems are especially common in underdeveloped parts of Turkey. In terms of civil and criminal law, the ages from 13 years to 18 years are critical in our country. Estimation of age is a very significant in aspect of accordance with laws. The aims of this study were to evaluate the applicability and accuracy of the Demirjian technique for assessing southern Turkish children; to analyze the sexual dimorphism of dental age in the studied groups; and to define the relationship between the dental age and the degree of mineralization in mandibular permanent tooth in southern Turkish children. This study was performed using panoramic radiographs from 932 healthy southern Turkish children, 444 girls and 488 boys aged between 4 and 18 years. Statistical evaluations were performed using SPSS (Statistical Package for Social Sciences) for Windows 13.0 software. The mean difference between dental and chronological age was calculated for each age and sex group. The paired t-test was used to compare all data. The chi-square test was used for between-group comparisons of categorical variables. Continuous variables were tested for normality using the Kolmogorov-Smirnov test. Relationships between continuous variables were examined using Pearsons correlation coefficient. The same observer re-examined 700 teeth three months after the first examination. The results were evaluated with the intraclass correlation test and both measurements were statistically significantly similar with each other(R = 0.982, p = 0.0001). .Dental age (DA) and chronological age (CA) were consistent for boys in the 16-16.9 age group and for girls in the 9-9.9 and 15-15.9 age groups. From this study, we can conclude that dental age varies across ethnic populations. Additionally, dental maturation varies across different regions of the same country. Because Demirjians standards are not suitable for all age groups of southern Turkish children, a new table is necessary for evaluating this population. Future studies using multi-ethnic population data are needed to establish the international applicability of Demirjians method.

Treatment of displaced mandibular condylar fracture with botulinum toxin A

The aim of this case report is to discuss the effect on condylar reduction of botulinum toxin A treatment used in a child with displaced fracture at condylar neck of mandible. A 3-years old boy was admitted to our clinic for incomplete fracture of mandibular symphysis and displaced condylar fracture at the left side. An asymmetrical occlusal splint with intermaxillary fixation was used instead of open reduction and internal fixation because of incomplete fracture of symphysis and possible complications of condyle surgery. However, it was observed that condylar angulation persisted despite this procedure. Thus, botulinum toxin A was administered to masseter, temporalis and pterygoideus medialis muscles. At the end of first month, it was seen that mandibular condyle was almost completely recovered and that fusion was achieved. In conclusion, Botulinum A toxin injection aiming the suppression of masticatory muscle strength facilitates the reduction in the conservative management of displaced condyle in pediatric patients.

Angioleiomyoma of the gingiva: a report of two cases

Leiomyoma is a type of benign smooth muscle neoplasm that is a common neoplasm of the uterus and gastrointestinal tract but rarely affects the head and neck region and is especially unlikely to affect the oral cavity. The diagnosis of leiomyoma is mainly determined by histopathological studies due to variation in its clinical appearance and symptoms. In the present paper we report two rare cases of gingival angioleiomyoma in the posterior maxilla and mandible. After total excision, hematoxylin-eosin and smooth muscle actin staining confirmed the diagnosis of angioleimyoma.

Management of obstructive sleep apnea in a Treacher Collins syndrome patient using distraction osteogenesis of the mandible

In this study, we present the surgical treatment of obstructive sleep apnea in a child with Treacher Collins syndrome. A 10-year-old girl with a past history of Treacher Collins syndrome presented to our clinic with her parents for respiratory distress and insomnia. The patient was referred to a sleep laboratory where she was diagnosed with obstructive sleep apnea, which was a consequence of her Treacher Collins syndrome. The patient underwent mandibular distraction osteogenesis under general anesthesia. The mandible was expanded by 15 mm using internal bilateral distractors. After distraction osteogenesis, the patient’s respiratory problems resolved, and she was able to sleep comfortably. Distraction osteogenesis was an effective method of advancing the mandible, increasing the upper airway space and ultimately preventing obstructive sleep apnea syndrome in patients with Treacher Collins syndrome.

To what extent does hyaluronic acid affect healing of xenografts? A histomorphometric study in a rabbit model

ABSTRACT Among the many graft materials that have been used for the treatment of bone defects in oral and maxillofacial regions is xenograft. To improve osteoconductive effects of xenografts, they have been combined with various biocompatible materials, such as hyaluronic acid and bone morphogenetic protein. Objective To determine bone-healing capacity of high molecular weight hyaluronic acid (HA) combined with xenograft in rabbit calvarial bone defects. Material and methods Ten adult male New Zealand rabbits (mean weight 3 kg) were included in the study. Three 6-mm-diameter bicortical cranial defects were created on calvarial bone of all rabbits. These defects were filled as follows: a) xenograft; b) HA+xenograft; c) autograft. One month after the first operation, rabbits were sacrificed. Specimens were evaluated histomorphometrically. Results Considering multiple comparisons, differences regarding new bone were statistically significant between all groups (p<0.05). The volume of residual graft was significantly decreased in HA group compared to xenograft group (p=0.035). Marrow space, trabecular thickness (TbTh), trabecular width (TbWi), trabecular separation (TbSp), and number of node: number of terminus (NNd:NTm) in the autograft group were significantly better than xenograft and HA groups (p<0.05). However, regarding marrow space, TbTh, TbWi, TbSp, and NNd:NTm values, xenograft and HA groups showed similar results and the difference were not significant (p>0.05). Conclusion These results support that high molecular weight hyaluronic acid could contribute to the healing of xenograft by improving the percentage of new bone formation and reducing the percentage of residual graft. However, HA did not significantly affect the quality of newly formed bone assessed by microarchitectural parameters.

An Asymptomatic and Overelongated Styloid Process

Elongation of the styloid process is a rare condition. Only 4% of patients have clinical symptoms where elongated styloid process (ESP) occasionally irritates or disrupts adjacent anatomical structures, which is called Eagle syndrome. This present report was aimed at reporting an asymptomatic ESP with unusual width and length.

Rotational autotransplantation of mandibular alveolar ridge.

l r c d f he rehabilitation of edentulous atrophic mandibles with ental implants is often threatened where there has been oss of horizontal alveolar bone. Techniques to augment the one include guided bony regeneration, distraction osteoenesis, ridge splitting osteotomy, onlay grafting with block rafts (autologous or xenograft), or combinations of these.1 he mandibular symphysis, ramus, maxillary tuberosity, iliac rest, tibia, calvaria, and costae are all sources of autologous one. These grafts remain the gold standard,2 but morbidty at the donor site and second operations can be serious isadvantages. We describe a technique in which we used a modied autologous block graft to reconstruct the horizontally esorbed anterior mandible to provide adequate height. After crestal incision, we raised the mucoperiosteal flap at the nterforaminal area, and made a horizontal bicortical cut at east 6 mm apically from the alveolar crest. We chose piezourgery equipment for the osteotomy as it provides good anipulation with its variably-angled handpieces, leaves fine ines with minimal loss of bone, and causes negligible damge to the lingual soft tissues.3 We removed the bone block Fig. 1) and rotated it 180◦ in the coronal plane (the left side f the graft should turn to the right side of the mandible, and he upper border of the graft should turn to the lower borer) (Fig. 2). We used a titanium miniscrew to fix the graft o the buccal surface of the anterior mandible just below the

Effects of Hypericum perforatum on the healing of xenografts: a histomorphometric study in rabbits

The aim of this study was to investigate effects of the Hypericum perforatum (St Johns Wort) on bone healing in rabbit calvarium. Ten male New Zealand rabbits each had three bicortical defects made in the calvarial bones, which were filled with xenograft, xenograft+H perforatum oil extract, and autogenous graft. Four weeks postoperatively all rabbits were killed and the bony defects examined histomorphometrically. Tissue compartments including new bone (p<0.001), marrow space (p<0.001), and residual bone grafts (p=0.014) differed significantly among groups. The volume of residual graft was significantly decreased in the xenograft/H perforatum group compared with those with xenografts alone (p=0.0147). The differences in microarchitectural variables of de novo bone formation were also significant (trabecular thickness (p<0.001), trabecular width (p<0.001), trabecular separation (p=0.001). There were no significant differences in node:terminus ratio between the xenograft/H perforatum group and the other two groups. However, the difference in node:terminus ratio between the autogenous graft and xenograft group was significant (p=0.001) Oil extracts of H perforatum improved bony healing in defects filled with bovine-derived xenografts.

Maksiller Lateral Diş ile Süpernümerer Diş Füzyonu ve Tedavisi: Bir Olgu Sunumu

Fusion is a dental anomaly which causes problems such as aesthetics, periodontal, orthodontic disease. The purpose of this study is to provide aesthetics by extraction of supernumerary fused tooth with lateral tooth that is causing lack of space. It is a sharing case that aestetic and function were ensured by formed lateral tooth. 10 years old boy patient admitted to our clinic with the complaint of his tooth curvature. According to history of the patient, there is no systemic disease of the patient. No problems were observed in the extraoral diagnosis. In the intraoral diagnosis, presence of supernumerary teeth and fused with lateral tooth was observed. In the radiological diagnosis, roots are discrete. Another pathology were not encountered in the mouth. It was planned that the separation of the fused teeth by cut by cutters from junction line and distopalatinal supernumerary tooth was extracted. Perforation was observed on the lateral tooth and treated with CVEK amputation method. Treatment was completed with composite restoration. Controls of patient performed at 12 months. Treatment provided aesthetics by extraction of supernumerary fused tooth with lateral tooth that is causing lack of space so malalignment of teeth has disappeared. Perforation of lateral tooth was treated with amputation method

LARGE DENTIGEROUS CYST IN THE MAXILLARY SINUS LEADING TO DIPLOPIA AND NASAL OBSTRUCTION: CASE REPORT

Dentigerous cysts are the most common developmental odontogenic cyst of the jaws. They are more frequent in males and although most often affected teeth are maxillary canines and mandibular third molars, they may also be related with supernumerary or an ectopically erupted tooth. Our aim was to report the management of ectopic third molar tooth related with a dentigerous cyst in maxillary sinus. 16 years old girl referred to our clinic with a complaint of painful swelling over her right cheek since past six months. All permanent teeth were present except the right upper third molar. External examination showed that the face was gently asymmetrical; levels of eye globes were abnormal. Radiographic examination revealed a cystic lesion related with ectopic third molar which located in the roof of the left maxillary sinus. Under local anesthesia, hard drain was inserted into the hole and the cystic pressure was decreased. After the six month of followup, the operation was performed under general anesthesia. The patient’s symptoms were resolved completely after surgery and remained symptom-free for over a postoperative follow-up period of 3 year. To avoid unwanted effects of a dentigerous cyst, unerupted tooth should be observed with radiographic imaging. Some untreated dentigerous cysts may grow large and have a potential to develop into an odontogenic tumor.