Banu Özveri Koyuncu

Transpalatal Distraction Using Bone-Borne Distractor: Clinical Observations and Dental and Skeletal Changes

PURPOSE The aim of this clinical study was to analyze the outcome, complications, and long-term results of transpalatal distraction for the correction of maxillary transverse deficiency (MTD) and assess skeletal and dental changes in the sagittal, vertical, and transverse planes through cephalograms and dental casts. PATIENTS AND METHODS Ten adult patients with MTD were treated with a Transpalatal Distractor (Surgi-Tec, Bruges, Belgium). Lateral and posteroanterior cephalometric films and dental casts were taken before surgery and at the end of the consolidation period. The statistical analysis of cephalometric film and dental cast measurements was undertaken with paired t tests. RESULTS The intraoperative and postoperative problems encountered were damage to the central incisive teeth as a result of vertical osteotomy, wound dehiscence after the latent period, pain during the distraction period, and loosening of the distractor and buccal displacement of the left alveolar segment during the consolidation period. Model analysis showed that the greatest amount of transverse increase was in the premolar region (7.07 mm for first premolar and 7.10 mm for second premolar). Frontal cephalometric analysis indicated that transverse distances increased more at the alveolar level (7.75 mm) than in the maxillary base (5.25 mm) and nasal region (4.3 mm). The asymmetries between the left and right sides in both dental and skeletal expansions were statistically nonsignificant. The changes in the Sella-nasion-point A, Sella-nasion-point B, Sella-nasion and gonion-gnasion angles were statistically significant. CONCLUSIONS According to the results of this study, transpalatal distraction was found to be a clinically effective technique for palatal expansion in adult patients with MTD. However, treatment planning and regular clinical follow-up visits are necessary for long-term clinical success.

Results and complications of alveolar distraction osteogenesis to enhance vertical bone height

OBJECTIVE The aim of this retrospective study was to analyze the outcome and complications of alveolar distraction osteogenesis for the correction of vertically deficient ridges by using intraosseous and extraosseous distractors. STUDY DESIGN Seven patients with severely atrophic alveolar crests were treated by distraction osteogenesis in 5 alveolar ridge deficiencies by intraosseous distractors and in 2 alveolar ridge deficiencies by extraosseous distractors. The bone deficiencies were secondary to atrophy after periodontal disease, tooth extraction, or trauma. Three months after consolidation of the distracted segments, implants were placed in the distracted areas. The average follow-up period after prosthetic loading was 50 months. RESULTS The mean alveolar height achieved was 7.8 mm (range, 4-9 mm). The intraoperative and postoperative problems encountered were lack of device activation (n = 1), lingual displacement of the distracted segment (n = 1), paresthesia of the lower lip (n = 4), and dehiscence and plate exposure (n = 2). Most of these complications were considered to be minor complications and were solved without any problems. CONCLUSION It was concluded that alveolar distraction osteogenesis seems to be an effective technique to treat vertical alveolar ridge deficiencies, but adequate treatment planning is necessary for success. The complications related to this technique can be solved with simple treatments.

Alveolar distraction osteogenesis in the human mandible: a clinical and histomorphometric study.

Purpose:To identify the quality of newly formed bone in the distraction region and to determine the percentage of mineralized bone formed in the distraction area. Methods:Ten patients with vertically deficient mandibular alveolar ridges were treated by means of distraction osteogenesis. Four months after consolidation of distracted segments, a total of 40 dental implants were inserted in native bone and distracted bone. Bone biopsies were taken at the implant sites with trephine burrs for histological and histometric analyses. Four months after implant placement, abutments were connected, and prosthetic loading of the implants was started. Results:The mean bone gain at the end of distraction was 7.2 ± 0.8 mm. The cumulative success rate of implants 3 years after the onset of prosthetic loading was 100%. The newly formed bone consisted of woven bone reinforced by parallel-fibered bone with bone marrow spaces and the percentage of mineralized bone ranged from 50.56% to 76.88%. Conclusions:Alveolar distraction osteogenesis is able to produce adequate mature bone for the correction of mandibular bone deficits before dental implant insertion.

Effect of tube drainage compared with conventional suturing on postoperative discomfort after extraction of impacted mandibular third molars.

The aim of this prospective randomised study was to assess the effects of tube drainage on postoperative discomfort after the extraction of impacted mandibular third molars. We studied 40 patients (11 men and 29 women) 18 years or older (mean (SD) 21 (3), range 18-29) who required extraction of mandibular third molars. We used a randomised crossover design by which if a drain was inserted on one side, then the other side was managed without a drain on a later occasion. Pain, swelling, and mouth opening were evaluated after 48 h and 7 days postoperatively in both groups. Facial swelling (p=0.001), pain p=0.001), and trismus (p=0.001) were significantly less common in the drained group compared with those not drained. We conclude that the use a tube drain is of benefit in minimising postoperative swelling, pain, and trismus after extraction of mandibular third molars.

Short-term clinical outcomes of two different flap techniques in impacted mandibular third molar surgery

OBJECTIVE The aim of this study was to estimate the influence of flap design on alveolar osteitis (AO) and postoperative side effects following third molar surgery. STUDY DESIGN This study was designed as a randomized single-blind clinical trial. The predictor variable was flap type. Envelope flap and modified triangular flap techniques were used. The primary outcome variable was AO. The secondary outcome variables were pain, swelling, and trismus. Descriptive and bivariate statistics were computed. Statistical significance was set at P ≤ .05. RESULTS Eighty patients with impacted mandibular third molars participated in the study. The envelope flap design was associated with a higher incidence of AO that was not statistically significant. On the second day, postoperative pain and swelling was observed as significantly different with the envelope flap technique. CONCLUSIONS The modified triangular flap had the advantage of less postoperative pain and swelling but had the disadvantage of AO.

GENERAL APPROACH TO THE TREATMENT OF ODONTOGENIC ABSCESSES AND COST ANALYSIS

Purpose: The purpose of this study was to evaluate the relationships between age, gender, symptoms, treatment, length of hospital stay and hospital cost in a group of patients with severe odontogenic infection who has been admitted within the last 6 years. Subjects and Methods: This study was carried out on 30 patients who had been treated in Ege University, Faculty of Medicine, Otolaryngology Department with the diagnosis of odontogenic abscess. Variables such as age, gender, symptoms, systemic disease, imaging techniques, treatment modalities, hospital length of stay and hospital cost were analyzed statistically. Results: There were 12 female and 18 male patients and their mean age was 39 ± 19.78 years. Antibiotics were used in all subjects and their abscesses were mostly drained surgically. The mean hospital length of stay was 8.1 days. There was a statistically significant relationship with the presence of systemic disease and hospital length of stay variables (p=0.017). Conclusion: The cost for treatment of severe odontogenic infections in inpatient units is high in hospitals. Therefore, preventive and routine dental care should be given importance.