Bilge Gökçen-Röhlig

A comparative analysis of the accuracy of different direct impression techniques for multiple implants

BACKGROUND The aim of this study was to compare the accuracy of different direct implant impression techniques for edentulous arches with multiple implants. METHODS Five experimental groups (n = 5) were assembled. Experimental models were created by a direct splinted technique (EG2 to EG5) and a non-splinted technique (EG1). In EG2 and EG3 synOcta impression copings were splinted with an acrylic resin bar, and in EG4 and EG5 with a light-curing composite resin bar. In EG3 and EG5 the resin bars were sectioned, while the other experimental groups were not. Three-dimensional discrepancies were measured by a computerized coordinate measuring machine. Distortion values among the groups were analysed using one-way repeated measures ANOVA. The post hoc Tukeys test was then performed for multiple comparisons. RESULTS The highest accuracy was obtained in EG2 (mean deviation: 12.70 μm). The acrylic bars demonstrated less deviation (12.70 μm and 22.71 μm) from the master model than the light-curing composite resin groups and the non-splinted group (41.09 μm). The post hoc Tukeys test showed no significant difference among the groups when the effect of splint design on accuracy was investigated. CONCLUSIONS For situations where impressions of multiple implants are to be made, splinting impression copings with acrylic resin demonstrate superior results than the non-splinted technique and splinting with light-curing composite.

Clinical and radiographic outcomes of implants immediately placed in fresh extraction sockets

OBJECTIVE The objective of this study was to examine the clinical and radiographic results of implants placed in fresh extraction sockets for 2 years of function. STUDY DESIGN Ten patients were presented a treatment protocol involving the extraction of their remaining mandibular teeth and immediate placement of 4 implants (2 in fresh extraction sockets; test group (TG, n = 20), 2 in mature bone; control group (CG, n = 20). Descriptive statistics for the differences between baseline and follow-up values were assessed by chi-square test. RESULTS None of the implants lost osseointegration. The MPI Score 0 was 80.3% in SG, 82.7% in CG, and MPI Score 1 was 13.4% in SG and 14.9% in CG at the end of 1 year, and remained stable after 2 years. No significant difference in MPI, MBI, KMW, and PPD were observed between the baseline examination and controls. Chances in MBL in CG were slightly higher in SG. CONCLUSION Placement of implants in fresh extraction sockets is a reliable treatment alternative.

Early results of low-level laser application for masticatory muscle pain: a double-blind randomized clinical study

BackgroundTo evaluate the effect of Low Level Laser (LLL) application at the points of greatest pain in patients with chronic masticatory muscle pain.MethodsA total number of 30 (21 women, 9 men, with a mean age of 39.2) were selected after the diagnosis of MPDS according to the Research Diagnostic Criteria for Temporomandibular Disorder (RDC/TMD). The patients were randomly divided into three groups; laser group I (n = 10); patients received the LLL at the point of greatest pain, laser group II (n = 10); patients received LLL at pre-established points in the effected muscles and placebo group (n = 10). LLL and placebo were applied three times per week, for a total of 12 sessions. Mandibular mobility was examined, masticator muscles tenderness were assessed and PPT values were obtained. Subjective pain levels were evaluated using VAS. The measurements performed before the treatment and after the completion of the therapy. Descriptive statistics (mean, standard deviation, and frequency) Student’s t-test, Mann–Whitney U-test and paired-sample t-tests were used for analysis.ResultsIn both laser groups, there was a statically significant reduction in PPT values of the muscles, number of muscles without any pain on palpation increased significantly, mandibular movements’ ranges were improved. Laser group I demonstrated statistically better results than the Laser group II in all of the measured values. Plasebo group did not show any statistically difference in any of the measured values.ConclusionsLLLT can be accepted as an alternative treatment modality in the management of masticatory muscle pain and direct irradiation seems to effect better.Trial registrationCurrent Controlled Trials ISRCTN31085, Date of registration 28/08/20145.

The role of components of the extracellular matrix and inflammation on oral squamous cell carcinoma metastasis

OBJECTIVES Oral squamous cell carcinoma (OSCC) accounts for about 90% of malignant oral lesions, and is identified as the most frequently occurring malignant tumour of oral structures. We aimed to investigate the genes and pathways related with metastasis on Turkish OSCC patients. MATERIALS AND METHODS We performed whole genome expression profiling array on an Illumina platform. A total of 24 samples with 12 OSCC and 12-paired controls that had no tumour were included in the study. Hierarchic clustering and heat map were used for data visualisation and p-values assessed to identify differentially expressed genes. Kyoto Encyclopedia of Genes and Genomes (KEGG) and Ingenuity Pathway Systems (IPA) analysis were performed to consider biologic meaning of differential expression of the genes between tumour and control groups. RESULTS We identified 790 probe sets, corresponding to 648 genes that were effective in separating invasive and metastatic OSCC. Consequently, we found statistically relevant expression results on extracellular matrix members on MMPs such as MMP3, MMP10, MMP1 and MMP9; on laminin such as LAMC2, LAMA3 and LAMB3; several genes in the collagen family; and also on chemokines from the inflammation process. CONCLUSION Statistically relevant expression changes for MMPs, laminins, collagens, and chemokines, which are components of the extracellular matrix and inflammation process, may be considered as a molecular biomarker for early prediction. Further studies are necessary to determine and understand the molecular mechanisms that underlie OSCC metastasis.

In vivo evaluation of occlusalcontact area and maximum bite force in patients with various types of implant-supported prostheses

Abstract Objective. To determine the effects of various implant retained and/or supported prostheses on number of occlusal contacts (NOC), occlusal contact area (OCA)and maximum bite force (BF). Patients and methods: In total, 56 patients were included in the study; five test groups and two control groups. The patients in the treatment groups received implant-supported/retained prosthesis; over-dentures retained with two individual attachments in occlusion with complete denture, with four individual attachments in occlusion with complete denture, with four individual attachments in occlusion with fixed partial dentures or natural dentition, 6-implant retained fixed bridges in occlusion with natural dentition and 8-implant retained fixed bridges in occlusion with natural dentition. The patients in control group 1 were wearing conventional complete maxillary and mandibular dentures, whereas in control group 2 they had fixed full-arch porcelain-fused to metal restorations prostheses for both arches. Dental Pre-scale was used measure the NOC, BF and OCA. Results. There was no statistically significant difference between the treatment and control groups, among the groups with regards to NOC. OCA demonstrated different results among the removable and fixed reconstruction groups. With regards to BF, removable dentures supported with four implants showed higher bite force values than controls and two implant over-dentures. Also, a fixed reconstruction using eight implants showed higher BF values than a fixed reconstruction using six implants. Conclusion. Use of implants for removable dentures and fixed reconstructions improve occlusal contact area and bite force.

Prosthetic rehabilitation of a patient with a mandibular defect caused by a gunshot wound.

Injuries to the orofacial region may vary from localized injuries to extensive soft and hard tissue loss. In addition to physical and psychologic damages, functional and aesthetic aspects must be restored. This clinical report describes the rehabilitation of a patient with a mandibular defect caused by a gunshot wound. Rehabilitation of this patient, with the use of an overdenture prosthesis, was performed after mandibular surgical hard and soft tissue reconstruction. A maxillary total prosthesis and an implant-supported mandibular overdenture supported by 4 osseointegrated implants were fabricated. Despite limited mouth opening and anatomic deficiencies, the patients aesthetic and functional demands were fulfilled.

Evaluation of orofacial function in temporomandibular disorder patients after low-level laser therapy

Abstract Objective. To evaluate the effect of low-level laser therapy on occlusal contact area, occlusal pressure and bite force in temporomandibular disorder patients. Patients and method. Twenty patients (14 women, six men, mean age 33.1 ± 3.8 years) diagnosed with myofascial pain according to the Research Diagnostic Criteria for Temporomandibular Disorder (RDC/TMD) participated in the study. Twenty healthy individuals, matched in age and gender, served as a control group. Low-level laser was applied to the mastication muscles three times per week, for a total of 10 sessions. The mandibular mobility range was evaluated. The maximum bite force, occlusal contact area and occlusal pressure were measured bilaterally with a dental pre-scale before and after treatment. All variables were analyzed descriptively. Changes in the masticatory muscle tenderness, mandibular movements, maximum bite force, occlusal contact area and occlusal pressure were compared by paired-sample Students t-tests. Results. There was a significant increase in the pressure pain threshold of the examined muscles. Mandibular movements were significantly improved in all patients. There was also a significant decrease in pain by palpation after laser exposure. However, no significant change was found in the maximum bite force, occlusal contact area or occlusal pressure after the treatment and also the values after the treatment were still significantly lower than those of the healthy individuals. Conclusion. This particular type of LLLT is effective at relieving pain but does not provide physical improvement.

Soft Tissue Response and Survival of Extraoral Implants: A Long-Term Follow-up

Maxillofacial defects may be reconstructed by plastic surgery or treated by prosthetic mean rehabilitation. In case of large defects, prosthetic rehabilitation rather than surgical reconstruction is preferred due to the insufficient esthetic results of surgical interventions. However, retention of the craniofacial prosthesis is a great problem despite the satisfactory esthetic results. With the presentation of extraoral implants, the retention of maxillofacial prostheses was improved, and osseointegrated craniofacial implants have become indispensable for retention and stability. However, there are conflicting results regarding the success rates of osseointegrated implants used at the craniofacial region. A total of 24 patients with 64 implants (30 in auricular region of 13 patients, 24 in nasal region of 8 patients, and 10 in orbital region of 3 patients) ranging in age from 16 to 83 years (mean age = 45.45 years) were evaluated. One patient among 13 patients (1/13) has lost his implants in the auricular area, 1 patient among 8 patients (1/8) lost his implants, and 1 patient among 3 patients (1/3) has lost all of her implants. Peri-implant soft tissue response was evaluated for a 60-month period and a total of 654 visits/sites recorded. Grade 0 (no irritation) was present in 72.8% (476/654) of the visits/sites. Grade 1 (slight redness) was observed for 18.8% (123/654). Grade 2 (red and slightly moist tissue) was scored in 6.9% (45/654). Grade 3 (red and slightly moist tissue with granulation) was noted in 1.5% (10/654) and grade 4 (infection) could not be found. Ossseointegrated implants provide reasonable support and show successful results when used with maxillofacial prostheses.

Frequency of temporomandibular disorder signs and symptoms among call center employees

Abstract Objective: The current study aimed to investigate the frequency of signs and symptoms of temporomandibular disorders (TMD) among call center employees. Methods: Workers from four call centers (CC) were invited to participate in this study. The examination was based on the Research Diagnostic Criteria for Temporomandibular Disorder (RDC/TMD). The tenderness of the masticator muscles was assessed on both sides by bilateral palpation. The mobility of the mandible was measured with a plastic millimeter ruler on opening, lateral excursions, and protrusion. Results: In total, 124 call center employees with a mean age of 28.61 ± 4.71 (between 22 and 47 years of age) were enrolled in this study. There was no statistically significant relation between the numbers of calls answered in a day and teeth clenching, teeth grinding, earache, tinnitus, or pain on yawning/chewing. Only protrusive movement pain and joint noise were significantly higher among employees who answered more than 140 calls/day (p < 0.01). An evaluation of the TMD signs and symptoms in relation to job stress level revealed that job stress level significantly affected the incidence of headaches among call center employees (p < 0.01). Conclusion: The present study demonstrated no statistically significant relation between TMD signs and symptoms and call center employees except protrusive movement pain and joint noise. This relation was seen only in the employees who answered more than 140 calls per day. Headache, teeth clenching, and TMJ noise were the signs and symptoms encountered most often in this study. Multicentered studies in different geographic locations should be conducted to eliminate the limitation of this study.