Cihan Bereket

Intractable Bimaxillary Osteomyelitis in Osteopetrosis: Review of the Literature and Current Therapy

PURPOSE Osteopetrosis (OP), also known as Albers-Schönberg disease, is a rare metabolic bone disease caused by a congenital defect in the development or function of the osteoclasts resulting in generalized increase in skeletal mass. Osteomyelitis is a recognized complication, and prevention of dental infections can be difficult. The locations of osteomyelitis in the jawbones have been either in the mandible or maxilla. In this article, a case of OP complicated with osteomyelitis of the mandible and the maxilla is presented, and types of OP and treatment options are discussed with a literature review. MATERIALS AND METHODS The 18-year-old blind female patient had been diagnosed with OP in the past. She had a purulent discharge at the medial canthus of the left eye, in addition to another discharge of pus in the infraorbital and upper left molar region, and multiple malformed and partially impacted teeth, and there were sequestrum formations in the maxilla and mandible. For the treatment of osteomyelitis, systemic combined antibiotics of sultamicillin 750 mg and ornidazole 500 mg twice daily, were given orally for 5 weeks followed by surgical removal of small sequestra in the jaws. Persistent osteomyelitic bones were removed by saucerization in the mandibular anterior and right premolar region and the left posterior maxilla under the same antibiotic regimen. After wound healing was completely achieved in both jaws, the oroantral opening in the left posterior maxilla was successfully closed with a buccal flap under antibiotic coverage. RESULTS The purulent discharge at the medial canthus of her left eye subsided and she had no recurrent infections during the long-term follow-up of 2 years. CONCLUSION The case reported shows that osteomyelitis is difficult to treat in subjects suffering from OP. Therefore, it is necessary to be very cautious against infections in even minor surgical interventions such as simple dental extractions in patients with OP, regardless of the location of the teeth. When considering removal of impacted teeth in the posterior maxilla, resultant oroantral communication from osteomyelitis of the extraction site should be regarded as a potential complication.

Intraosseous carcinoma arising from an odontogenic cyst: a case report

Carcinomas from an odontogenic cyst are not common, yet when they occur, squamous cell carcinomas are the most often seen. Among these cysts, the malignancy of keratocysts or dentigerous cysts are most likely. In contrast, a malignant transformation of a radicular cyst to an intraosseous carcinoma is extremely rare. In this case report, an intraosseous carcinoma arising from an odontogenic cyst in a 26-year-old male patient is presented. This case report clearly demonstrates the importance of the clinicians awareness of the malignant potential of apparently innocuous cystic lesions.

The effects of zoledronic acid on mandibular fracture healing in an osteoporotic model: a stereological study.

AbstractThe aim of this study was to evaluate the effect of zoledronic acid (ZA) in the ovariectomized rat on mandibular fracture. Corpus osteotomies were performed on the mandible of ovariectomized rats. Miniplates were placed on these rats, which were randomly divided into 4 groups. After 7 days, groups 3 and 4 were injected with 0.1 mg/kg ZA. Groups 1 and 2 were control groups, so they were injected 0.1 mg/kg saline solution. Animals in groups 1 and 3 were killed at 4 weeks, whereas groups 2 and 4 were killed 8 weeks after operation. The new bone volume of the fracture gap was examined stereologically. Although the difference was not statistically significant compared with the other groups (groups 1 and 3), more bone formation was found in ZA-treated groups (groups 2 and 4) (P < 0.05).

The predominant bacteria isolated from radicular cysts

PurposeTo detect predominant bacteria associated with radicular cysts and discuss in light of the literature.Material and methodsClinical materials were obtained from 35 radicular cysts by aspiration. Cultures were made from clinical materials by modern laboratory techniques, they underwent microbiologic analysis.ResultsThe following are microorganisms isolated from cultures: Streptococcus milleri Group (SMG) (23.8%) [Streptococcus constellatus (19.1%) and Streptococcus anginosus (4.7%)], Streptococcus sanguis (14.3%), Streptococcus mitis (4.7%), Streptococcus cremoris (4.7%), Peptostreptococcus pevotii (4.7%), Prevotella buccae (4.7%), Prevotella intermedia (4.7%), Actinomyces meyeri (4.7%), Actinomyces viscosus (4.7%), Propionibacterium propionicum (4.7%), Bacteroides capillosus (4.7%), Staphylococcus hominis (4.7%), Rothia denticariosa (4.7%), Gemella haemolysans (4.7%), and Fusobacterium nucleatum (4.7%).ConclusionsResults of this study demonstrated that radicular cysts show a great variety of anaerobic and facultative anaerobic bacterial flora. It was observed that all isolated microorganisms were the types commonly found in oral flora. Although no specific microorganism was found, Streptococcus spp. bacteria (47.5%) – especially SMG (23.8%) – were predominantly found in the microorganisms isolated. Furthermore, radicular cysts might be polymicrobial originated. Although radicular cyst is an inflammatory cyst, some radicular cyst fluids might be sterile.

An evaluation of factors associated with persistent primary teeth

The aim of the present study was to investigate the reasons for the persistence of primary teeth and also use panoramic radiography to determine the characteristics of persistence teeth. Four-hundred and twenty-six panoramic radiographies, which diagnosed one or more retained primary teeth, were selected from 100,577 panoramic radiographic image files from nine clinics and six different cities in Turkey. The selected radiographies were evaluated to determine the reasons for the persistence of primary teeth; furthermore, this study analyzed the characteristics of the retained primary teeth including tooth type, number, location, and root resorption, and whether, or not, the primary teeth showed evidence of pathological conditions, such as periodontal problems, caries, ankylosis, infra-occlusions, or tipping of the adjacent permanent teeth. Six hundred and seventy-seven retained primary teeth were determined in 426 patients (148 males and 278 females). Retained primary teeth were found most frequently in the mandible rather than the maxilla and the left side was more frequently affected than the right side. Level 1 was found as a most frequently encountered root resorption level. Within the limitation of the present study, the most common type of persistent primary teeth seen on the dental arch were mandibular primary second molars, followed by maxillary primary canines. The most frequent reason for the persistence was the congenital absence of successors to the primary teeth, followed by impaction of the successor teeth.

Complex and compound odontomas: Analysis of 69 cases and a rare case of erupted compound odontoma.

OBJECTIVE The purpose of this study was to analyze clinic and radiologic features of the 69 odontoma cases and present a rare case of erupted compound odontoma in the oral cavity. MATERIAL AND METHODS The 69 cases were analyzed with regard to the following parameters: age, gender, location, associated unerupted teeth, missing teeth, radiological and histopathological features and treatment protocols. RESULTS Of the 69 cases, 49 were compound odontoma and 20 were complex odontoma. There was a female predilection for both compound and complex odontomas. Compound odontoma occurred more often in the anterior region of the jaws; complex lesions occurred more often at the posterior mandible. The most common clinical manifestations were the retention of permanent teeth. CONCLUSION Compound odontomas rarely erupt into the mouth. The presented case is the 13 th case of erupted compound odontoma reported in the literature. The treatment of choice is surgical removal of the odontoma. In the case of odontomas associated to impacted teeth, the teeth should be preserved in wait of spontaneous eruption, or alternatively fenestration followed by orthodontic traction is indicated. Regular follow-up period is crucial to evaluate the prognosis of these teeth.

In vitro biomechanical evaluation of modified plating techniques for bilateral sagittal split ramus osteotomy in mandibular advancement.

Abstract The aim of this study was to compare the biomechanical properties of modified plate techniques using a newly designed three-dimensional test model after sagittal split ramus osteotomy. Fifteen synthetic polyurethane mandibular replicas were used and divided into 3 groups. Self-tapping 6-mm titanium screws with an outer diameter of 2.0 mm and private designed plates produced by 316-L stainless steel were used in the study. After the osteotomy, the distal part was advanced by 5 mm. The jaw models were placed to the three-dimensional test model designed by the authors, and the Instron Lloyd LRX device was used to apply a double-sided tensile force from the mandible angulus region of each group. Resistance forces that caused a displacement of 1.5 and 3 mm were recorded with the Instron program. The mean (SD) of the 3 groups were calculated using analysis of variance and the Tukey test. The results were compared statistically, with values of P < 0.05 determined as statistically significant. On the basis of the results of the Tukey comparison within the groups, there was a statistically significant difference between groups 1 and 2 and between groups 1 and 3 at both 1.5- and 3-mm displacement (P < 0.05). No significant difference was observed between groups 2 and 3 (P > 0.05). This test model was able to identify the most appropriate plate type of 3 different modified plate techniques after sagittal split ramus osteotomy.

Beneficial therapeutic effects of sildenafil on bone healing in animals treated with bisphosphonate

Objectives: The purpose of the present study was to evaluate the effects of sildenafil on mandibular fracture healing in animals treated with zoledronic acid by using histologic, histomorphometric, immunohistochemical, and radiodensitometric methods. Materials and Methods: A total of 36 Sprague–Dawley rats (3 months old) were used. All animals were treated intraperitoneally with 0.1 mg/kg zoledronate three times per week, for a total of 8 weeks. Postoperatively, the animals were divided into two groups: zoledronate group (Z), which had no treatment applied (n = 18), and zoledronate + sildenafil (ZS), which were treated daily with 10 mg/kg sildenafil (n = 18). Each group was divided into two subgroups and the animals were sacrificed at the end of week 1 (Z1 and ZS1, n = 9) and week 4 (Z4 and ZS4, n = 9) after the operation. Histologic, histomorphometric, immunohistochemical analysis, and radiodensitometry were performed on the test subjects. Results: Sildenafil-treated groups showed a significant increase in fracture healing scores. This result was supported by the densitometric, histologic, histomorphometric, and immunohistochemical findings. Conclusions: Sildenafil may have positive effects on accelerating and improving fracture healing, and it may be used as a supporting factor in bone healing in patients treated with bisphosphonate (BP) to prevent negative effects of BPs