Emin Esen

Comparison of the effects of 2 doses of methylprednisolone on pain, swelling, and trismus after third molar surgery

OBJECTIVE The aim of this study was to compare the effects of intravenous administration of 1.5 mg/kg and 3 mg/kg of methylprednisolone sodium succinate (MP) on pain, swelling, and trismus after third molar surgery. STUDY DESIGN Twenty-six healthy patients with symmetrically impacted mandibular third molars were included in this double-blind, cross-over study. Either 1.5 mg/kg or 3 mg/kg of MP was administered by intravenous route one hour prior to the first operation. At the second operation the other dose was applied. Trismus was determined by measuring maximum interincisal opening and facial swelling was evaluated using a tape measuring method. Pain was determined using visual analogue scale and recording the number of pain pills taken. RESULTS There was no statistically significant difference in trismus, facial swelling, and pain between the two groups. CONCLUSION No clinical benefit of the higher dose of MP was demonstrated.

Determination of the anti-inflammatory effects of methylprednisolone on the sequelae of third molar surgery

PURPOSE The anti-inflammatory effect and adrenal suppressive side effect of methylprednisolone sodium succinate (MP) on the postoperative sequelae of third molar surgery were evaluated using objective methods in a double-blind, crossover study. PATIENTS AND METHODS Twenty patients who were to undergo surgical removal of bilateral, symmetrically placed lower third molars were studied. Each patient was given 125 mg MP intravenously before surgery on one side, and a placebo before surgery on the opposite side on a random basis. Ultrasonographic and computed tomographic examinations were performed to determine the amount of facial edema. Trismus was evaluated by measuring maximal interincisal opening, and pain was evaluated by recording the number of standard analgesic tablets used on the day of surgery and the first postoperative day. Hypothalamic-pituitary-adrenal (HPA) axis function was tested by measuring basal plasma cortisol (hydrocortisone) levels preoperatively and postoperatively. The adrenocorticotropic hormone (ACTH) stimulation test also was performed before and after administration of MP, to evaluate adrenal function. RESULTS Statistical analysis of the data indicated a significant decrease in edema, trismus, and pain in the MP group. Plasma cortisol levels showed a nonsignificant decrease in both the MP- and placebo-treated groups. The ACTH stimulation test indicated normal HPA axis function before and after MP administration. No clinically apparent infection, disturbance of wound healing, or other corticosteroid-related complications were noted. Eighteen patients (90%) indicated a preference for the overall postoperative course when MP was used. CONCLUSION In the absence of contraindications for corticosteroid administration, preoperative use of MP appears to be a safe and effective method of reducing postoperative complications in third molar surgery.

Accidental displacement of an impacted mandibular third molar into the lateral pharyngeal space.

Displacement of impacted teeth is a rarely reported complication) -3 The most common sites of dislodgment are the maxillary sinus and submandibular space. 4 Because there is often dehiscence of the overlying lingual bone, and the mandibular third molar roots may be actually sitting in the submandibular space, root fragments or the entire tooth may be displaced into it during extraction. 5,6 This report describes an unusual case of an impacted mandibular third molar that was displaced into the lateral pharyngeal space.

Effect of zoledronic acid on osseointegration of titanium implants: an experimental study in an ovariectomized rabbit model.

PURPOSE Zoledronic acid (ZA), a new-generation intravenous bisphosphonate, exhibits the greatest affinity for bone mineral with the longest retention, thereby leading to its ability to be dosed at annual intervals in the treatment of osteoporosis. The purpose of this preliminary study was to evaluate the effects of systemic administration of a single dose of ZA on osseointegration and bone healing around titanium dental implants. MATERIALS AND METHODS Thirty-six female New Zealand rabbits (aged 6-12 months) were used in this study. Rabbits were randomly assigned to 1 of 3 groups: sham control group (SH), ovariectomy group (OVX), and OVX and ZA group (OVX + ZA). Animals in the OVX and OVX + ZA groups were subjected to bilateral ovariectomy, whereas animals in the SH group were sham operated. Eight weeks later, 1 implant was placed in each tibia of the animals. ZA was administered in the OVX + ZA group during the implantation, whereas the OVX and SH groups received saline solution infusions. All of the subjects were sacrificed 8 weeks after the implantation, and tibial specimens were harvested. Histomorphometric bone-to-implant contact analysis, resonance frequency analysis, removal torque testing, and digital radiographic absorptiometry were administered, and the data were statistically analyzed. RESULTS Histomorphometric, resonance frequency, and radiodensitometric analyses showed significant improvement in osseointegration of implants in the OVX + ZA group compared with the OVX group. However, the differences in removal torque results between the groups were not statistically significant. CONCLUSIONS The results of this study suggest that systemic ZA administration may improve osseointegration of titanium implants placed in estrogen-deficient states of bone.

Comparison of the Effects of Warfarin and Heparin on Bleeding Caused by Dental Extraction: A Clinical Study

PURPOSE Replacement of warfarin with heparin for dental extractions in patients on long-term warfarin therapy is associated with wasted time, consumed labor, and increased treatment expenses. The aim of this study was to evaluate the safety of dental extraction without altering the warfarin regimen in patients with an international normalized ratio from 1 to 4. PATIENTS AND METHODS Forty patients who underwent tooth extraction were divided into 4 groups: continuation of warfarin without interruption (group 1), warfarin bridged with low-molecular-weight heparin (group 2), warfarin bridged with unfractionated heparin (group 3), and a control group of healthy individuals (group 4). Total amount of bleeding (milligrams) was measured for 20 minutes after tooth extraction. International normalized ratio values on the operative day and number of extra gauze swabs used for bleeding control in the first 48 hours were recorded for each patient. Results were statistically analyzed by analysis of variance, Fisher least-significant difference post hoc test, Pearson correlation, χ(2) test, and Student t test. RESULTS Mean amounts of bleeding were 2,486 ± 1,408; 999 ± 425; 1,288 ± 982; and 1,736 ± 876 mg for groups 1, 2, 3, and 4, respectively. There was no severe postoperative bleeding in any patient and the number of used extra gauze swabs did not differ significantly among groups. CONCLUSION With the aid of local hemostatic agents, dental extraction in patients receiving warfarin who have an international normalized ratio from 1 to 4 could be carried out without a significant risk of bleeding and without altering the anticoagulant regimen.

Biological Aspects and Clinical Importance of Ultrasound Therapy in Bone Healing

Objectives. The purpose of this study was to review past and recent literature findings regarding the effects of ultrasound therapy on bone healing and its clinical efficacy in medical and dental interventions. Methods. A literature review was conducted on the effects of ultrasound therapy on bone healing. The studies regarding clinical applications in long bones and maxillofacial bones were evaluated separately from each other. Results. The effects of therapeutic ultrasound on bone healing have been studied for half a century. Numerous clinical and experimental studies have addressed this relationship, and many of them have shown positive correlations. Although several theories have been proposed to explain the mechanism of action, the exact mechanism has not been fully understood. Conclusions. Therapeutic ultrasound therapy in clinical settings is a noninvasive application and has no serious complications or side effects. It may be an acceptable treatment of choice in many types of clinical procedures involving maxillofacial bones.

Effects of smoking on periimplant health status and IL-1β, TNF-α, and PGE2 levels in periimplant crevicular fluid: a cross-sectional study on well-maintained implant recall patients.

Purpose:The aim of this cross-sectional study was to evaluate the effects of smoking on periimplant health status and inflammatory cytokines interleukin-1&bgr;, tumor necrosis factor-&agr;, and prostaglandin E2 levels in periimplant crevicular fluid (PICF) and to determine their correlation with clinical parameters in well-maintained implant recall patients. Material and Methods:A total of 60 dental implants placed in 60 patients (27 patients were smoker and 33 were nonsmoker) were included in the study. Plaque index, gingival index, probing depth, periimplant bone loss, PICF volume, and biochemical cytokine levels in PICF were determined and analyzed statistically. The correlation between PICF cytokine levels and clinical parameters were also analyzed. Results:All clinical parameters with the exception of plaque scores were significantly higher in the smoker group. Significantly increased levels of cytokines were observed in the smoker group. The correlation between the cytokine levels and clinical parameters were more marked in smokers. Conclusions:Although the implants of the smoker patients seem to be clinically healthy, the results demonstrate that the implants are relatively at risk even if in a well-maintained population.

Effects of glucosamine-chondroitin combination on synovial fluid IL-1β, IL-6, TNF-α and PGE2 levels in internal derangements of temporomandibular joint.

Background The aim of the present study was to evaluate the effects of glucosamine-chondroitin sulphate combination on internal derangements of temporomandibular joint in clinical and biochemical manners. Material and Methods This randomized clinical study included 31 cases reporting joint tenderness, in which disc displacement was detected on MR imaging. In all patients, synovial fluid sampling was performed under local anesthesia. In the study group, the patients were prescribed a combination of 1500 mg glucosamine and 1200 mg chondroitin sulphate, while patients in the control group were only prescribed 50 mg tramadol HCl (twice daily) for pain control. After 8 weeks, synovial fluid sampling was repeated in the same manner. The levels of pain, maximum mouth opening (MMO), synovial fluid IL-1ß, IL-6, TNF-α and PGE2 measured before and after pharmacological intervention were compared. Results The reduction in pain levels was significant in both groups. There was no significant difference between two groups in terms of pain reduction. The improvement in MMO was significant in the study group but it was not in the control group. The MMO improvement was significantly higher in the study group compared to the control group. In the study group, significant decrease was observed in PGE2 level, while the decreases in IL-1β, IL-6 and TNF-α levels were not significant. In the control group, no significant decrease was observed in any of the inflammatory cytokines after 8 weeks, moreover IL-1ß and IL-6 levels were increased. Alterations of IL-1ß and IL-6 levels were significant in study group while TNF-α and PGE2 levels were not, compared to control group. Conclusions In conclusion, these results might suggest that glucosamine-chondroitin combination significantly increases the MMO and decreases the synovial fluid IL1β and IL6 levels in internal derangements of TMJ compared to tramadol. The modifications of synovial fluid TNF-α and PGE2 levels do not reach statistical significance. This combination also provides efficient pain relief in similar level with tramadol, a narcotic analgesic. Key words: Chondroitin sulphate, glucosamine, internal derangement, TMJ, tramadol.