Alper Sinanoglu

Age estimation by an analysis of spheno-occipital synchondrosis using cone-beam computed tomography.

The spheno-occipital synchondrosis has a relatively late ossification in comparison with other cranial base synchondroses, which makes it a point of interest for forensic age determination studies. The purpose of the present study was to evaluate the reliability of spheno-occipital synchondrosis development in age determination in a Turkish population and to evaluate the reproducibility and reliability of cone beam computed tomography (CBCT) in an evaluation of the fusion stages of spheno-occipital synchondrosis. CBCT mid-sagittal images of 238 (90 males and 148 females) patients between the ages of 7 and 25, with a mean age of 15.45±0.26 and 16.43±0.37, respectively, were examined by three Oral and Maxillofacial Radiologists who evaluated the degree of synchondrosis fusion using a four-stage system. A reevaluation of 50 cases was conducted for intraobserver assessment. Multiple statistical analyses were used to assess the correlation between age and the fusion stage, to compare gender and age according to stages, and to evaluate the inter- and intraobserver agreement. The mean ages for complete fusion (Stage 3) were 18 and 20 for females and males, respectively. The interobserver agreement ranged between substantial and perfect, while the intraobserver agreement was substantial for all three observers. Based on these results, CBCT, when available, might be the method of choice for age estimation using the spheno-occipital synchondrosis fusion stages. Evaluating spheno-occipital synchondrosis has a value for age estimation around the age of 18 years, which affects the legal decisions in Turkey.

Analysis of C-shaped Canals by Panoramic Radiography and Cone-beam Computed Tomography: Root-type Specificity by Longitudinal Distribution

INTRODUCTION The purpose of this study was to document the characteristics of C-shaped canal systems in permanent mandibular second molars using a combination of orthopantomogram (OPT) and cross-sectional cone-beam computed tomographic (CBCT) imaging. METHODS Two hundred participants (94 men and 106 women, mean age = 35 years) who underwent both routine CBCT and OPT examinations were enrolled. One endodontist and 1 oral radiologist examined the images of 339 mandibular second molars and described the radiographic features of C-shaped canals from OPT images as confirmed by CBCT imaging. Root morphology was classified as nonfused (NFRI-II) or fused (FRI-III) based on OPT images. Cross-sectional root canal configurations (C1-C5) were identified from CBCT imaging at 3 different levels (coronal, middle, and apical). Frequency distributions of root morphology and root canal configurations were compared at each level, and interobserver reliability was tested using the Cohen kappa test. RESULTS Of the 339 teeth, 29 (8.6 %) had C-shaped root canal systems. Most of the root canals were NFR type (86%); only 2% had C-shaped root canals (all NFRII). In the FR category, 23 teeth with C-shaped canals were equally distributed between the FRI and FRII subtypes. Interobserver agreement was almost perfect (κ = 0.89 and κ = 0.91; right and left second molars, respectively). Per CBCT imaging, the most common configuration was C3 at all levels; no C5 case was detected. CONCLUSIONS OPT usage can assist in recognizing and diagnosing C-shaped root canal systems. Radicular fusion or proximity is a characteristic feature of C-shaped canal systems. However, nonfused root appearances should also be considered suspicious.

The prominent proteins expressed in healthy gingiva: a pilot exploratory tissue proteomics study

Gingiva is a unique tissue which protects the underlying periodontal tissues from consistent mechanical and bacterial aggressions. Molecular analysis of gingiva is likely to improve our understanding of the underlying biological processes at work. The aim of this preliminary exploratory study is to analyze the proteomic profile of healthy gingiva and to detect prominently expressed proteins. Gingival tissue samples were obtained from periodontally healthy individuals who underwent surgical crown lengthening procedure. After protein isolation, two dimensional gel electrophoresis (2DE) gels were prepared for each sample and only protein spots common to all gels were selected to eliminate the bias caused by the effect of individuals on proteomic profile. Following the 2DE; in-gel tryptic digestion and MALDI-TOF/TOF steps were performed for protein identifications. Forty-seven proteins were successfully identified. The identified proteins were classified based on their classes, molecular functions and involvements in biological processes and metabolic pathways. Among them, 14-3-3 protein sigma, Protein DJ-1, Alpha-enolase, Triosephosphate isomerase, Superoxide dismutase, Peroxiredoxin-1, Protein S100-A9, Galectin-7, Annexin A2/A4, Carbonic anhydrase 1 and chaperone proteins are worthy of attention. The proteomic profile of the gingiva reflected its highly dynamic characteristics. Despite complexity of the gingival tissue proteome, 2DE was an effective approach in studying the common protein expression profile of the gingiva. Considering the significance of gingiva in the formation of periodontal diseases, it is important to generate a detailed proteome map of gingival tissue to set up a bridge between molecular events and the disease formation. This study established an initial proteome map of the gingival tissue from healthy individuals.

Diagnosis of occlusal caries using laser fluorescence versus conventional methods in permanent posterior teeth: a clinical study.

OBJECTIVE The purpose of this in vivo study was to compare three different caries detection methods [laser fluorescence (LFE), visual examination (VE), and radiological examination (RE)] for the detection of occlusal caries in permanent posterior teeth. BACKGROUND DATA Early diagnosis of caries is critical in the management of dental caries. METHODS Two examiners assessed the occlusal surfaces of 217 teeth by visual, radiographic, and laser fluorescence (DIAGNOdent Pen) examination methods. After a 1 week interval, randomly selected patients were recalled. Each measurement was repeated by two examiners before the cases were selected for operative intervention to classify lesion depths. Statistical analysis of the data was performed using SPSS and Stata IC. The intra- and inter-examiner reliabilities and reproducibilities of the VE, RE, and LFE were calculated using Cohens κ statistics. The sensitivities and specificities were plotted in receiver operating characteristic curves. The differences between LFE scores were analyzed using the nonparametric Mann-Whitney U and Wilcoxon tests (α=0.05). RESULTS The VE method exhibited the highest sensitivity, accuracy, and κ values among the diagnostic groups in terms of inter-examiner agreement. With regard to the sensitivity, specificity, and likelihood ratios for the two examiners, significant differences were found between sensitivity and specificity for examiner 1, whereas no statistically significant differences were noted between sensitivity and specificity for examiner 2 for the LFE scores. CONCLUSIONS The DIAGNOdent pen is useful for the detection of dentinal caries of occlusal surfaces in permanent posterior teeth. Combination with other diagnostic conventional methods may enhance the reliability of this tool.

Contrast-to-noise ratio with different settings in a CBCT machine in presence of different root-end filling materials: an in vitro study

OBJECTIVES To compare the contrast-to-noise ratio (CNR) of multiple acquisition settings for four types of retrograde filling materials in CBCT images taken for endodontic surgery follow-up. METHODS 20 maxillary central incisors were endodontically treated and obturated with 4 different root-end filling materials: amalgam, mineral trioxide aggregate, SuperEBA(™) (Harry J Bosworth Company, Skokie, IL) and Biodentine™ (Septodont, Saint-Maur-des-Faussés, France). Teeth were placed in a skull and scanned, one by one, with the Planmeca ProMax(®) 3D Max (Planmeca, Helsinki, Finland); at different voltages: 66, 76, 84 and 96 kVp; with low, normal and high resolution and high definition (HD); with and without metal artefact reduction (MAR). Images were analyzed using ImageJ software (National Institutes of Health, Bethesda, MD) to calculate the CNR. The dose-area product was registered, and the effective dose calculated. RESULTS No statistically significant difference was noted between the four materials. 84 and 96 kVp with low resolution and the use of MAR-generated images that have statistically better CNR than 66 and 76 kVp with HD, normal and high resolutions and without MAR. The use of low resolution also generated the smallest value of effective dose. CONCLUSIONS The best setting for radiographic follow-up in an endodontic surgery with retrograde filling on the Planmeca ProMax is 96 kVp with low resolution and high MAR; this setting produced one of the lowest effective doses.

Correlation between spheno-occipital synchondrosis, dental age, chronological age and cervical vertebrae maturation in Turkish population: is there a link?

Abstract Objective: To assess the correlation between third molar mineralization (TMM), spheno-occipital synchondrosis (SOS) fusion, chronologic age and cervical vertebrae maturation (CVM) for skeletal maturation. Materials and methods: Radiographs for 116 patients between 8 and 28 years were evaluated for age determination using mandibular TMM, SOS fusion and CVM. Spearman Correlation and Kappa test analyses were used to assess the relationship between variables and for intraobserver reliability. Results: Strong correlation was found between chronological age and TMM for males (r = .802) and females (r = .842), very strong correlation was found between age and CVM for males (r = .812) and moderate for females (r = .449), it was strong between age and SOS fusion for males (r = .810) and females (r = .643). Correlation between TMM and SOS was found to be strong for males (r = .759) and moderate for females (r = .534), it was strong between TMM and CVM for males (r = .723) and weak for females (r = .371). Very strong correlation was found between CVM and SOS fusion for males (r = .851) and strong correlation for females (r = .618). Conclusion: Good correlation was found between the degrees of TMM, fusion of SOS and CVM in young Turkish population.

Cyclooxygenase-2 and Ki67 Expression in Oral Leukoplakia: a Clinicopathological Study

ABSTRACT Objectives Oral leukoplakia is a precancerous lesion of the oral mucosa. The upregulation of Ki67 and cyclooxygenase-2 has been reported in both dysplastic and non-dysplastic tissues. The aim of this clinicopathological study was to investigate the prognostic value of Ki67 and cyclooxygenase-2 expression for oral leukoplakia. Material and Methods A total of 50 samples were investigated and the study group consisted of 30 oral leukoplakia samples. Samples of 10 intact oral mucosa and 10 squamous cell carcinoma were included as negative and positive control groups, respectively. Epithelial dysplasia was defined as oral intraepithelial neoplasia (OIN) and classified into subgroups 1 - 3. Tissue samples were assessed immunohistochemically for Ki67 and cyclooxygenase-2 expression. Clinicopathological correlations of oral leukoplakia patients were also investigated. Results All OIN 3 patients were non-smokers (P < 0.05), and homogeneous oral leukoplakia lesions also presented OIN. Both cyclooxygenase-2 and Ki67 expression increased with the severity of lesions, which defined different subgroups (P < 0.05), except there was no significant difference between the hyperkeratosis and OIN groups for Ki67 expression. Conclusions Cyclooxygenase-2 and Ki67 expression may have a prognostic value for the malignant transformation of oral leukoplakia.

Abundant proteins in platelet-rich fibrin and their potential contribution to wound healing: An explorative proteomics study and review of the literature

Background/purpose It is well-known that diverse types of blood proteins contribute to healing process via different mechanisms. Presence and potential involvements of blood-derived abundant proteins in the platelet-rich fibrin (PRF) to its regenerative capacity have not been sufficiently emphasized in the literature. The aim of this paper was to analyze the abundant proteome content of PRF and summarize previously reported effects of identified proteins on wound healing via a literature review. Materials and methods The PRF samples obtained from non-smoking, systemically healthy volunteers were subjected to 2D gel electrophoresis after extracting the proteins from fibrin matrices. All matching spots were excised from the gels and identified by MALDI TOF/TOF MS/MS analysis. A literature review was conducted to reveal possible contributions of identified proteins to wound healing. Results Totally, thirty-five blood proteins were commonly identified among all studied samples. These proteins included serine protease inhibitors, such as alpha-1-antitrypsin, alpha-1-antichymotrypsin, alpha-1-acid glycoprotein, inter-alpha-trypsin-inhibitor, protease C1 inhibitor, and complement proteins. In addition, abundant presence of immunoglobulin G was observed. The abundance of albumin, haptoglobin, ceruloplasmin vitronectin, fetuin-A, ficolin-3 and transthyretin was also detected. Conclusion The results of this study indicated that PRF abundantly contains blood-origin actors which were previously reported for their direct contribution to wound healing. Further studies exploring the protein content of PRF are needed to reveal its undisclosed potential roles in the healing process.

Management of two-rooted maxillary central and lateral incisors: A case report with a multidisciplinary approach involving CAD/CAM and CBCT technology

A thorough knowledge of the root morphology and variations closely relates with the success of endodontic therapy. Although it is rare, additional roots or canals may exist in maxillary incisors, which is an important variation to consider. This paper describes the multidisciplinary management of a maxillary central incisor and a lateral incisor, both of which presented two roots with aberrant crown morphology that was verified by cone beam computed tomography and restored with prosthetic rehabilitation involving full-contour monolithic zirconia crown after root canal treatment.

Use of cone-beam computed tomography and three- dimensional modeling for assessment of anomalous pulp canal configuration: a case report

Three-dimensional (3D) reconstruction of cone-beam computed tomography (CBCT) scans appears to be a valuable method for assessing pulp canal configuration. The aim of this report is to describe endodontic treatment of a mandibular second premolar with aberrant pulp canal morphology detected by CBCT and confirmed by 3D modeling. An accessory canal was suspected during endodontic treatment of the mandibular left second premolar in a 21 year old woman with a chief complaint of pulsating pain. Axial cross-sectional CBCT scans revealed that the pulp canal divided into mesiobuccal, lingual, and buccal canals in the middle third and ended as four separate foramina. 3D modeling confirmed the anomalous configuration of the fused root with a deep lingual groove. Endodontic treatment of the tooth was completed in two appointments. The root canals were obturated using lateral compaction of gutta-percha and root canal sealer. The tooth remained asymptomatic and did not develop periapical pathology until 12 months postoperatively. CBCT and 3D modeling enable preoperative evaluation of aberrant root canal systems and facilitate endodontic treatment.