Erdem Kilic

Effect of local simvastatin application on mandibular defects.

Osteoinductive characteristics of bone grafts are important for enhancing osseous healing at grafted defect sites. The cholesterol-lowering drug simvastatin has been shown to stimulate bone formation by increasing the gene expression of bone morphogenetic protein-2 and vascular endothelial growth factor. The purpose of this study was to determine the effect of local simvastatin application on bone defect healing and compare the amount of new bone produced by simvastatin gelatin sponge graft with that produced by a gelatin sponge graft and with natural healing. Twenty-one bone defects at 3 mm diameter were created in the angulus mandible region of Wistar albino rats. In the experimental group, nine defects were grafted with simvastatin dissolved in water mixed with a gelatin sponge. In the control groups, eight defects were grafted with water mixed with a gelatin sponge alone (active control) and six were left empty (passive control). Animals were killed on day 14 and the defects were prepared for radiologic and histologic assessment. Density of the regenerate was evaluated by peripheral quantitative computed tomography. The density of the experimental group was 240% more than the passive control group and 190% more than the active control group (P < 0.01). Histologic examination also showed more new bone formation in the experimental group than control groups. In conclusion, the simvastatin gelatin sponge enhanced bone defect healing in the mandible of rats.

Effects of surgically assisted rapid palatal expansion with and without pterygomaxillary disjunction on dental and skeletal structures: a retrospective review.

OBJECTIVE The aim of this study was to evaluate and compare dental and skeletal changes in surgically assisted rapid palatal expansion (SARPE) patients with (+PP) and without (-PP) pterygomaxillary disjunction. STUDY DESIGN The study casts of 18 maxillary constriction patients indicated for SARPE formed the sample of this retrospective review. The sample was divided into 2 groups. Twenty linear and 2 angular measurements were performed on the study models. RESULTS All transversal measurements increased after expansion in both the +PP and -PP groups. The -PP group showed greater expansion at the midpalatal and gingival levels, while the +PP group exhibited a greater increase of 0.78 mm at the apical base level and 11.25° less tipping in the molar teeth. A greater expansion of nearly 0.7 mm was measured in the premolar region of the +PP group. CONCLUSIONS Both SARPE techniques resulted in significant maxillary expansion.

Effects of Simvastatin on Mandibular Distraction Osteogenesis

PURPOSE The aim of this study was to evaluate the effects of local and systemic simvastatin application on distraction osteogenesis. MATERIALS AND METHODS Eighteen New Zealand white rabbits underwent unilateral mandibular distraction osteogenesis. After 7 days of neutral fixation, 0.4 mm twice per day, distraction was performed for 10 days. Simvastatin was applied locally during the osteotomy phase with a gelatin sponge carrier and systemically during the distraction osteogenesis period by oral gavage. All animals were killed at the end of the consolidation period of 14 days. The distracted mandibles were harvested and evaluated by plain radiography, by peripheral quantitative computed tomography, and with histomorphometry. RESULTS Radiographic evaluation with peripheral quantitative computed tomography showed that the area of the regenerate increased by 9.6% in the local simvastatin group and by 19.3% in the systemic simvastatin group as compared with the control group. In both experimental groups the density of the regenerate increased by 6.7% as compared with the control group. Statistical evaluation of radiographic data showed that all of these changes were not significant. Histomorphometric evaluation determined that there was no statistical difference among groups with regard to the ratios of bone tissue volume to fibrous tissue volume and bone tissue volume to marrow tissue volume. CONCLUSIONS The results of this study suggest that simvastatins effect on enhancing distraction regenerate is limited with the applied doses and methods.

Anterior Mandibular Zone Safe for Implants

AbstractDuring implantology procedures, one of the most serious complications is damage of the inferior alveolar nerve (IAN). The mandibular incisive nerve is described as a terminal branch of the IAN and provides innervation to the lower anterior teeth and canines. The incisive nerve and canal are located in the interforaminal area. Although numerous studies report IAN damage during implant placement, few reports in the literature describes sensory disturbances, such as neuropathic pain, related to mandibular incisive nerve damage.The purpose of this retrospective clinical study was to evaluate the risk of neuropathic pain caused by implant placement in the interforaminal region of the mandible.Panaromic radiographs of patients who were treated with dental implants in the Department of Maxillofacial Surgery, Faculty of Dentistry at Erciyes University, between 2007 and 2012, were examined. Fifty-five patients with suspected relationship between mandibular incisive canal and dental implant were included into this study. Computed tomography scans were obtained from 10 patients who have postoperative neuropathic pain. Relationship between dental implant and mandibular incisive nerve was evaluated using a three-dimensional software program. Mandibular incisive nerve perforation by at least 1 implant was observed in all 10 patients. Descriptive analyses were also provided.Neuropathic pain may occur after implant placement in the interforaminal region due to the perforation of the incisive canal and nerve. According to the results of this retrospective study, the incisive canal and nerve perforation should be considered as a complication of implant surgery in the mandibular anterior area.

Determination of lingual vascular canals in the interforaminal region before implant surgery to prevent life-threatening bleeding complications

OBJECTIVES Profuse hemorrhage and airway obstruction may occur during or after the implant surgery in the interforaminal region. The prevention from this complication requires identifying the location of the mandibular lingual vascular canals (MLVCs). The purpose of this study was to evaluate the anatomical variations of MLVCs and to determine the safety margins for implant placement in interforaminal region. MATERIALS AND METHODS Computer tomography (CT) images of 200 consecutive patients were reexamined retrospectively by a radiologist and a maxillofacial surgeon to evaluate the presence of the MLVCs entering the mandible. The diameter and the number of the canals, the distance between the entrance of the canal and mandibular midline, and the height of the entrances of the canals from the inferior mandibular margin were measured. RESULTS Two hundred and thirty-six median lingual canals (MLCs) and 159 lateral lingual canals (LLCs) were found in 200 patients. Significant differences were found between the number of lingual canals in the midline and canine regions (P < 0.001). CONCLUSION There is a potential risk of complications due to the injuries of the vessels entering the lingual cortical bone through a number of bone canals during implant placement in the interforaminal region.

Alternative method to reposition the dislocated transport segment during vertical alveolar distraction.

g fi f m p e t d u e t oi:10.1016/j.joms.2009.04.026 . Pintol PX, Debnath S: Use of pedicle graft of buccal fat pad to line a nasal defect in releasing pushback palatoplasty. Br J Oral Maxillofac Surg 45:249, 2007 . Clark JM, Saffold SH, Israel JM: Decellularized dermal grafting in cleft palate repair. Arch Facial Plast Surg 5:40, 2003 . Panetta NJ, Gupta DM, Slater BJ, et al: Tissue engineering in cleft palate and other congenital malformations. Pediatr Res 63:545, 2008 . Salyer KE, Sng KW, Sperry EE: Two-flap palatoplasty: 20-year experience and evolution of surgical technique. Plast Reconstr Surg 118:193, 2006 . Tian M, Bing Shi, Xu Huang, et al: Roles of different area of palatine bone denudation on growth and development of maxilla and dental arch: An experimental study in rats. J Craniofac Surg 18:391, 2007 . Choudhary S, Cadier MA, Shinn DL, et al: Effect of Veau-WardillKilner type of cleft palate repair on long-term midfacial growth. Plast Reconstr Surg 111:576, 2003

Accidental benzalkonium chloride (zephiran) injection.

We report a case of an accidental injection of benzalkonium chloride (zephiran) instead of a local anesthetic agent during a tooth extraction. The sudden development of chin and neck swelling led to dyspnea and the patient lost consciousness. She was sent to an emergency clinic by her dentist immediately. After medical treatment for 20 days, the necrotic tissue was debrided and a gingival sulcoplasty was performed. Healing was uneventful.

Maxillary sinus floor augmentation in patients with maxillary sinus pseudocyst: case report

The maxillary sinus floor elevation procedure has gained popularity with predictable results, and is a safe, acceptable technique for bone augmentation, providing a base for dental implant treatment. Faint radiopaque lesions at the base of the maxillary sinus are frequent diagnoses on radiographs and must be identified during dental implant planning. Pseudocysts classically appear hemispheric, homogeneously opaque, and well delineated in panoramic and periapical radiographs. The great majority of these lesions are asymptomatic and do not require surgical treatment. In this case report, we present 4 patients who had a maxillary sinus floor elevation procedure using either crestal or lateral approaches in the presence of antral pseudocysts. No complications were encountered during follow-up periods in these patients and all implants are functioning successfully.

Is it possible to shorten the jaws using contraction osteogenesis

PURPOSE This study investigated whether shortening of osteotomized jaws is possible. MATERIALS AND METHODS Nine sheep were used (2 as controls and 7 as experimental subjects). Distraction devices that had previously been activated to 10 mm were fixed to the mandibles of all animals bilaterally and used in reverse as a contraction device. Control and experimental animals were sacrificed at 1 month and 3 months. Bone in the area of contraction was evaluated using radiodensitometry and microscopy. RESULTS The mandibles were shortened an average of 5.5 mm. Exaggerated bone formation was seen around the osteotomized cortical bone. When histologic slices from experimental animals were examined 1 month after the contraction period, fibrous pseudoarthrosis formation was seen centrally, with hyaline cartilage around it, whereas normal bone formation was seen in the outer part. The hyaline cartilage had turned into normal bone 3 months after the end of contraction. CONCLUSIONS It is possible to shorten bones using contraction osteogenesis.

Evaluation of the effects of guided bone regeneration and periosteum on newly formed bone in a distraction gap.

We determined the causes of bone resorption within a distraction gap and determined whether it could be prevented via guided bone regeneration during distraction. Another goal was to determine the effect of periosteum in bone healing in a distraction gap. Twelve sheep mandibles were bilaterally distracted. One side of the 6 sheep mandibles formed the control group; the other side was the study group, from which the periosteum was excised and distraction was performed. In the other 6 sheep, on the study side, guided bone regeneration was applied with distraction; on the other study side, guided bone regeneration was applied, and the periosteum was excised at the distraction. At the end of a 1-week latent period, all subjects were distracted 10 mm (1 mm/d), and we waited 3 months for consolidation. At the end of this period, all animals were killed, and radiologic evaluations of the newly formed bone within the distraction gap were conducted. The surface area of the regenerating bone in the membrane groups was significantly higher than in the groups without a membrane. However, no additional effect of the periosteum on the bone surface area was observed. No significant difference between the groups in densitometric values was observed. Concomitant use of guided bone regeneration with distraction osteogenesis may be the optimal way to generate a flat bone surface within a distraction gap.