Aydin Gulses

Treatment of microstomia with commissuroplasties and semidynamic acrylic splints

Microstomia is defined as an abnormal small oral orifice. Burns and injuries of perioral tissues, perioral surgeries, and genetic disorders can lead to perioral scar formations and restrict mouth opening. Treatment of microstomia requires surgical or conservative approaches. The aim of this report is to assess the effects of surgical commissuroplasty techniques combined with the application of semidynamic mouth splints on 4 microstomia patients with different etiologies. The combination of surgical and conservative techniques proves to be the best method of treating compromised perioral tissues in microstomia patients.

Extraction of a deeply impacted lower third molar by sagittal split osteotomy.

Extraction of deeply impacted wisdom molars from the lower jaw with the bone osteotomy may necessitate removal of extra bone and complicate the procedure with damage to the inferior alveolar nerve and iatrogenic fractures of the mandible. In such cases, the sagittal split osteotomy offers excellent exposure to the operative field and minimizes bone loss at the mandibular ramus. The presented case includes removal of a deeply impacted lower third molar presenting mild infection from the mid-ramus using the sagittal split of the mandible. The sagittal split osteotomy, which appears to be a reliable technique, should be the method of preference when lower molars are deeply positioned between buccal and lingual cortices.

Early Detection of Alterations in the Resonance Frequency Assessment of Oral Implant Stability on Various Bone Types: A Clinical Study

This study was undertaken to evaluate the relation between bone quality and alterations of implant stability quotient values measured during the initial phase of healing. Nineteen patients treated with 106 implants were included in the current study. The mean bone density of the implant recipient area was measured using Simplant 11 software incorporated in the computerized tomography (CT) machine. Mean bone density measurements were recorded in Hounsfield units. The implant recipient sites were subdivided into 5 groups according to bone quality. The numbers of the structures on the recipient site belonging to D1 and D5 types showed no statistical significance and were excluded. Standard 2-stage surgical technique was utilized to prepare the surgical sites. The implant stability quotient (ISQ) value at implant placement was recorded and did not influence the treatment procedure. The ISQ was measured by an Osstell instrument. The ISQ was further registered on the 21st and 60th days. SPSS statistical software was used for the statistical analysis. In comparison with the time of insertion, the mean values of the ISQ were decreasing for the first 21 days. However, on subsequent days, the ISQ values of all bone types have increased and on the 60th day reached the values recorded at the time of insertion. Analysis of the relation between changes in stability and bone type does not reveal statistical significance. With knowledge of the current clinical study, it can be concluded that bone quality in the recipient bone site does not effect changes in implant stability at the early stages of the osseointegration process.

Histomorphometric evaluation of the effect of systemic and topical ozone on alveolar bone healing following tooth extraction in rats

The aim of this study was to investigate the effects of systemic and topical ozone applications on alveolar bone healing following tooth extraction. One hundred and twelve male Wistar rats were divided into eight groups of 14 rats each; seven groups were experimental (A-G) and one formed the control group (K). The experimental groups were further divided into two sub-groups, with seven rats in each - sacrificed on days 14 and 28 (subgroups 1 and 2). The maxillary right central incisors were extracted under general anaesthesia following the administration of local anaesthesia. After sacrifice, semi-serial histological sections were prepared, and mineralized and trabecular bone and osteoid and osteoblast surfaces were measured. Measurements of the trabecular bone showed statistically higher values in the groups treated with systemic ozone (D(2): 50.01 ± 2.12; E(2): 49.03 ± 3.03; F(2): 48.76 ± 2.61; G(2): 50.24 ± 3.37) than in the groups that underwent topical ozone administration (A(2): 46.01 ± 3.07; B(2): 46.79 ± 3.09; C(2): 47.07 ± 2.12; P = 0.030 (G(2)-A(2), G(2)-B(2), G(2)-C(2))). Within the limitations of the current study, it may be concluded that postoperative long-term systemic ozone application can accelerate alveolar bone healing following extraction. However, additional studies are required to clarify the effects of the different ozone applications on new bone formation.

Histological evaluation of the changes in temporomandibular joint capsule and retrodiscal ligaments following autologous blood injection

INTRODUCTION In recent years injection of autologous blood into the temporomandibular joint (TMJ) has been reintroduced as a treatment of chronic recurrent TMJ dislocation. The effects of this treatment on components of the TMJ is not fully understood. The purpose of this article is to evaluate the effects of autologous blood on TMJ capsule and the retrodiscal ligament. MATERIAL AND METHODS A total of 16 healthy adult country bred pig were used in this study. Autologous blood were injected into the upper joint space (4 ml) and around the capsule of TMJ unilaterally (1 ml). This procedure was then repeated on the opposite side only by using 5 ml of 0.9% saline. TMJ capsules and retrodiscal ligaments were examined four weeks following the injections. RESULTS Histological examination of TMJs injected with autologous blood revealed fibrotic changes in 81.25% of the retrodiscal ligaments and 56.25% of the capsular areas. Whilst no changes were seen in the retrodiscal ligaments nor in the capsules of TMJs injected with saline alone. CONCLUSION There is little published clinical data on the use of autologous blood injection and as such the mechanism of action is still unclear. The rate of induction of fibrosis within the retrodiscal ligaments in this study were similar to previously reported studies and case series. However, further studies to evaluate the mechanism of this safe and simple technique are needed.

Clinical and anatomical aspects of possible mylohyoid nerve injury during genioplasties

Damage to the cutaneous branch of the mylohyoid nerve (CBMN) during genioplasties is possible but rare. The aim of this cadaveric study was to demonstrate possible mechanisms of injuring the CBMN during genioplasties. Mandibulotomy access was used to carry out sublingual and lateral cervical dissections on 10 formalinized cadavers with a mean age of 65 years. The length of the mylohyoid nerve was measured at three sections on the mandible. The posterior section of the mylohyoid nerve was 8.7+/-0.5 mm; the middle section was 14.5+/-0.9 mm and the anterior section was 15.6+/-1.2 mm in length. The submental skin island of 7 specimens had unilateral innervation by the CBMN. The bilateral innervation pattern was detected in 3 of the specimens. Damage to the sensory and the motor branches of the mylohyoid nerve can occur during genioplasties by transaction of the soft tissue pedicle attached to the mental spine and inferior border of the symphis. Surgeons should pay attention during dissection and osteotomy of the chin to avoid complications of the mylohyoid nerve and its branches.

The evaluation of the effects of hyperbaric oxygen therapy on new bone formation obtained by distraction osteogenesis in terms of consolidation periods.

ObjectiveThe aim of this study was to evaluate the effect of hyperbaric oxygen therapy on new bone formation obtained by distraction osteogenesis in long- or short-term consolidation periods.Materials and methodsTwenty-four rabbits were used. The animals were divided into two groups of 12 animals each, and vertical mandibular distraction osteogenesis was performed. Hyperbaric oxygen therapy was administered in the first group. Each group was subdivided into two subgroups according to the 30- and 60-day consolidation period. The acquired bone amounts were compared according to their radiographic density and histopathology.ResultsHistopathologically, in the experimental group, callus formation was increased and the new bone was more mineralized. According to the radiographic densitometry analyses, there were no statistically significant differences between the 30-day consolidated subgroups of the experimental group and the 60-day consolidated subgroup of the control group (p = 0.873).ConclusionHyperbaric oxygen therapy can be used to increase the quality and the quantity of bone and to decrease the maturation time which may shorten the consolidation period of vertical distraction osteogenesis.Clinical relevanceThe effect of hyperbaric oxygen therapy on vertical distraction osteogenesis procedure according to consolidation periods has been determined. Hyperbaric oxygen therapy may increase the quality and the quantity of bone and shorten the consolidation period.

Isolation, characterization and investigation of differentiation potential of human periodontal ligament cells and dental follicle progenitor cells and their response to BMP-7 in vitro

AbstractThe aim of this study was to assess the factors, mechanisms and the differences between periodontal ligament (PDL) cells and denta l follicle (DF) progenitor cells towards the osteoblastic/cementoblastic differentiation and to investigate the effects of BMP-7 on developmental (DF) and mature tissue-derived (PDL) cells, respectively. Primary cell culture of PDL cells and DF progenitor cells was performed. Osteogenic differentiation was evaluated using von Kossa, Alizarin Red S and immuno-histo-chemistry staining of osteocalcin. Gene expression pattern was evaluated via real-time PCR. A series of CD surface marks were tested using flow cytometry and fluorescence-activated cell-sorting analysis was performed. Real-time RT-PCR demonstrated similar gene expression pattern of PDL cells and DF progenitor cells: the expression of OPN and OCN significantly was elevated when incubated with osteogenic components, Runx2 was unaffected, and Osteorix was hardly expressed whether in basic medium or induction medium. In addition, BMP-7 induced osteoblast/cementoblast differentiation of PDLSCs and DF progenitor cells in a dose- and time-dependent manner, as reflected by enhanced Runx2 and (OCN) mRNA transcript expression. BMP-7 triggers PDL cells and DF progenitor cells to differentiate towards an osteoblast/cementoblast phenotype.

Fate of a Bovine-Derived Xenograft in Maxillary Sinus Floor Elevation After 14 Years: Histologic and Radiologic Analysis.

This report assesses the results following sinus floor augmentation performed 14 years previously in which bovine bone xenograft material was used without implant insertion. After sinus floor augmentation, using a 20:80 mixture of autogenous bone and inorganic bovine bone material (Bio-Oss), bone biopsy specimens were taken from the grafted site, processed with Donaths sawing and grinding technique, stained with toluidine blue, and mounted on high-sensitivity plates for histology and microradiography. Histologic and microradiographic analysis showed the ingrowth of newly formed bone into the graft with interspersed residual Bio-Oss granules. The percentage of Bio- Oss and newly formed bone was 10.18% and 9.32%, respectively, within a total surface area of 70.61 mm² at the site of the corresponding missing first molar, and the percentage of Bio-Oss and newly formed bone was 11.47% and 14.96%, respectively, within a total surface area of 63.92 mm² at the corresponding missing second molar. The newly formed bone was vital without signs of resorption. This study produced strong evidence that newly formed bone was distributed throughout the bone substitute material around all of its granules and that the grafted site consisted of vital bone even in its central parts. The differences in degradation rate and/or whether the effect of bone graft substitutes alone and/ or in combination with other types, shapes, and sizes of graft materials needs further clinical investigation, especially in regard to long-term changes.

The Efficacy of Mylohyoid Nerve Anesthesia in Dental Implant Placement at the Edentulous Posterior Mandibular Ridge

The aim of this study is to evaluate the anesthetic efficacy of mylohyoid and buccal nerve anesthesia at the posterior edentulous mandible versus regional anesthetic block to the inferior alveolar nerve in dental implant surgery. The study was composed of 2 groups. In the first group (group A), 14 voluntary adults (7 female and 7 male) received local infiltrations of 1 mL articaine HCl 4% with epinephrine 1/200,000 to the ipsilateral mylohyoid and buccal nerves. In the second group (group B, control; 9 female and 5 male adults), the inferior alveolar and the buccal nerve blocks were performed. Visual analog scales were obtained from patients to determine the level of pain during incision, drilling, implant placement, and suturing stages of implant surgery. A combination of buccal and mylohyoid nerve block offered an acceptable level of anesthesia. Two patients from group A stopped the ongoing surgery and had extraregional anesthesia by inferior alveolar nerve block. In group B, patients were operated on successfully. Local anesthetic infiltrations of the mylohyoid and the buccal nerve may be considered alternative methods of providing a convenient anesthetic state of the posterior mandibular ridge.