Emel Bulut

Cytokine and chemokine levels in radicular and residual cyst fluids.

BACKGROUND Cytokines were thought to play an important role for the expansion of odontogenic cysts. The purpose of this study was to evaluate the cytokine and chemokine levels of radicular and residual cyst fluids. METHODS Cyst fluids were aspirated from 21 patients (11 radicular and 10 residual cysts) and the levels of interleukin-1 alpha (IL-1alpha), tumor necrosis factor-alpha (TNF-alpha), monocyte chemotactic protein-1 (MCP-1), and regulated upon activation normal T cell expressed and secreted (RANTES) were determined by ELISA using commercially available kits. RESULTS Both radicular and residual cyst fluids contained IL-1alpha, TNF-alpha, MCP-1, and RANTES, concentrations of which were significantly higher in the radicular cyst fluids than those in the residual cysts (P < 0.001 for IL-1alpha, TNF-alpha, and RANTES; P < 0.01 for MCP-1). Compared to the other mediators, the concentration of IL-1alpha was found to be highest in both of the cyst fluids. In addition, positive correlations were found between IL-1alpha, TNF-alpha, MCP-1, and RANTES in radicular and residual cyst fluids. CONCLUSION If the radicular cyst is inadvertently left behind following tooth extraction, some degree of inflammation may carry on. Residual cysts, although to a lesser extend than radicular cysts, have the potential to expand.

Large Peripheral Osteoma of the Mandible: A Case Report

Osteomas are benign, slow-growing osteogenic tumors commonly occurring in the craniofacial bones. Osteomas are characterized by the proliferation of compact and/or cancellous bone. It can be of a central, peripheral, or extraskeletal type. The peripheral type arises from the periosteum and is rarely seen in the mandible. The lingual surface and lower border of the body are the most common locations of these lesions. They are usually asymptomatic and can be discovered in routine clinical and radiographic examination. In this paper, we presented a large solitary peripheral osteoma located in the buccal surface of the left posterior mandible and causing facial deformity in a 37-year-old woman. Radiographic examination by computed tomography revealed radiopacity with a well-circumscribed, pedunculated mass approximately 3 cm in size. The osteoma was removed surgically, and no recurrence has been observed.

Use of artificial neural network in differentiation of subgroups of temporomandibular internal derangements: a preliminary study.

PURPOSE Artificial neural networks (ANNs) have been developed in the past few decades for many different applications in medical science and in biomedical research. The use of neural networks in oral and maxillofacial surgery is limited. The aim of this study was to determine the use of ANNs for the prediction of 2 subgroups of temporomandibular joint (TMJ) internal derangements (IDs) and normal joints using characteristic clinical signs and symptoms of the diseases. MATERIALS AND METHODS Clinical symptoms and diagnoses of 161 patients with TMJ ID were considered the gold standard and were employed to train a neural network. After the training process, the symptoms and diagnoses of 58 new patients were used to verify the networks ability to diagnose. The diagnoses obtained from ANNs were compared with diagnoses of a surgeon experienced in temporomandibular disorders. The sensitivity and specificity of ANNs in predicting subtypes of TMJ ID were evaluated using clinical diagnosis as the gold standard. RESULTS Eight cases evaluated as bilaterally normal in clinical examination were evaluated as normal by ANN. In detecting unilateral anterior disc displacement with reduction (ADDwR; clicking), the sensitivity and specificity of ANN were 80% and 95%, respectively. In detecting unilateral anterior disc displacement without reduction (ADDwoR; locking), the sensitivity and specificity of ANN were 69% and 91%, respectively. In detecting bilateral ADDwoR, the sensitivity and specificity of ANN were 37% and 100%, respectively. In detecting bilateral ADDwR, the sensitivity and specificity of ANN were 100% and 89%, respectively. In detecting cases of ADDwR at 1 side and ADDwoR at the other side, the sensitivity and specificity of ANN were 44% and 93%, respectively. CONCLUSION The application of ANNs for diagnosis of subtypes of TMJ IDs may be a useful supportive diagnostic method, especially for dental practitioners. Further research, including advanced network models that use clinical data and radiographic images, is recommended.

Central osteoma associated with root resorption.

Osteomas of the jaws are rare osteogenic lesions considered to be true neoplasms, characterized by the proliferation of compact and/or cancellous bone. It can be central, peripheral, or of an extraskeletal type. The central osteoma arises from the endosteum, the peripheral osteoma from the periosteum, and the extraskeletal soft tissue osteoma usually develops within a muscle. However, in a previous work we have suggested that at least some peripheral osteomas may be reactive rather than neoplasms, probably associated with trauma. Some reported cases did have a clear history of trauma; however, this was not the case in the majority of cases. Whereas peripheral osteomas are fairly easy to diagnose, central osteomas pose a more challenging diagnostic problem and need to be differentiated from other similar lesions of the jaws, such as central ossifying fibroma, condensing osteitis, idiopathic osteosclerosis, osteoblastoma, cementoblastoma, and complex odontoma. With such a low number of case of central osteoma reported, the objectives of the present report are to describe a case of the central osteoma associated with partially root resorption of the mandibular first molar. Our case report participates to literature as a 11th case.

Diffuse large B-cell lymphoma with oral manifestations.

Non-Hodgkin lymphomas (NHLs) are a heterogenic group of lymphoproliferative diseases with their different behavior pattern and response to treatments. As a Hodgkin disease, NHL occurs from lymphoid tissues and can spread to other organs. Prognosis depends on histologic type, grade, and treatment. In the World Health Organization classification, aggressive B-cell lymphomas are diffuse large B-cell lymphoma, Burkitt lymphoma/leukemia, and precursor lymphoblastic leukemia/lymphoma. They may present either nodal or extranodal disease, which may be either localized or disseminated. Diffuse large B-cell lymphoma is the most common type of lymphoma in adults and is clinically, morphologically, and genetically a heterogeneous group of malignant proliferations of mature B cells, too. Diffuse large B-cell lymphoma is the most common type of NHL and accounts for about 30% of the cases. In this clinical report, we evaluated clinically and histopathologically a 64-year-old male patient who had mild pain and edema in his mandibular premolar region, and the excisional biopsy showed diffuse large B-cell lymphoma.

Comparison of the planimetry and point-counting methods for the assessment of the size of the mandible cysts on orthopantomograms

Objective: The purpose of this study is to compare the computer-assisted planimetry and point-counting methods in evaluating the sizes of the mandibular cysts with respect to their agreement and the time required to analyze. Study Design: The surface areas of 46 mandibular cyst lesions on orthopantomograms were estimated using the point-counting and computer-assisted planimetry methods. Three observers evaluated the outlined areas twice, using the point-counting (PC) and computer-assisted planimetry (CAP) methods with an interval of two weeks. In the planimetry technique, digitalized images and ImageJ software were used to measure the surface area of the half mandibles and cysts. The grids were superimposed over the same images and the number of points hitting the interested structures was counted for the point-counting technique. The projection area fraction (PAF) of the cysts within the mandible was estimated using the obtained values by means of the two techniques. Intraclass correlation coefficient was used to assess the level of agreement between the two methods. Inter-rater reliability analysis using the Kappa statistic was performed to determine consistency among raters. Results: CAP and PC techniques showed consistent intra-observer values in all observers. Intraclass correlation between CAP and PC measurements of first, second and third observers were found to be 0.9986, 0.9988 and 0.9994 respectively. The durations of PC technique was 32% higher than the CAP technique. Conclusion: PC and CAP methods were seemed to show sufficient agreement to be used interchangeably. The main disadvantage of the PC analysis is it takes more time than CAP method. Key words:Orthopantomogram, mandible, cyst, point-counting, planimetry.

Horizontal alveolar distraction of the mandibular canine regions for implant placement.

Horizontal alveolar augmentation by distraction osteogenesis is an alternative method for reconstructing atrophic alveolar bone. A 65-year-old woman with atrophy of the alveolar rim in the anterior lower jaw, which had inadequate width for implant placement, was presented. Under general anesthesia, vertical and horizontal osteotomies of the buccolabial cortical bone were performed in the canine regions bilaterally. Modified horizontal distraction devices were stabilized to the mandible. Distraction proceeded from the seventh postoperative day at a rate of 0.450 mm twice a day for 6 days. After 3 months, distraction osteogenesis occurred and increased the alveolar width from 2 to 7 mm. Two implants were placed in the distracted areas. Marginal bone resorbtion around the implants was not observed 12 months after implant placement.

Treatment of Maxillary Glandular Odontogenic Cyst Involving the Same Place of Previously Treated Traumatic Bone Cyst.

Glandular odontogenic cyst is a rare developmental odontogenic cysts of the jaws having an aggressive behavior. The most common site of occurrence is the anterior mandible, and it is widely seen in middle-aged people. It is suggested that trauma could be a precipitating factor for its occurrence. This article presents the diagnosis and treatment of a case of glandular odontogenic cyst at anterior maxilla that occurred at the same localization of a traumatic bone cyst, 5 years after its management.

Rehabilitation of benign pathological condition by dental implants

Dentigerous cysts are benign odontogenic cysts that arise from the dental follicle of an unerupted or developing tooth. They are the second most common odontogenic cysts after radicular cysts and account for approximately 24% of the jaw cysts. Patient may give the history of slowly enlarging swelling. A female patient aged 54 years came to our unit with a diffuse swelling on the left side of her face which was found to be dentigerous cyst on clinical, radiological and histopathological examination. The patient underwent enucleation with extraction of affected teeth leading to partial edentulous state without any pathological fracture of the mandible. Post-operatively after 8 months, adequate bone filling was noted. Implant-supported rehabilitation was done. The present case emphasizes the maintenance of the new bone formation without using any graft materials for the placement of dental implants and also the implant-supported rehabilitation has proven good results in benign pathological lesions.

Delayed Frey syndrome after closed treatment of condylar fracture.

Frey syndrome is also known as auriculotemporal syndrome and gustatory sweating. It is characterized by the occurrence of hyperesthesia, flushing, and warmth or sweating over the distribution of the auriculotemporal nerve and/or greater auricular nerve while eating foods that produce a strong salivary stimulus. It is commonly seen as a complication of parotidectomy and open surgery of temporomandibular joint. It can also be caused by other forms of trauma, including blunt trauma, but rarely does it occur without trauma. The relation between fracture displacement of the condyle and Frey syndrome adds further support to the view of the intimate anatomic relationship of the auriculotemporal nerve with the capsule of the temporomandibular joint. However, despite the proximity of these structures and the high incidence of condylar fracture (25%-36% of mandibular fractures), Frey syndrome is rare after this type of fracture. Symptoms are sometimes delayed and can be very slight; often neither the patient nor the surgeon realizes their presence. The symptoms usually appear 5 weeks to 1 year after nerve damage.In this clinical report, we presented the delayed occurrence of Frey syndrome in a patient in 6 years after closed reduction of condylar fracture. One prospective study and 11 case reports describing the development of Frey syndrome after closed treatment of mandibular condyle fractures were found in the last 4 decades. Our clinical report participates to literature as a 12th case report.