Faysal Ugurlu

Oral Pyogenic Granuloma Associated With a Dental Implant Treated With an Er:YAG Laser: A Case Report

A pyogenic granuloma is a tumorlike proliferation that occurs slightly more often in females, frequently involving the gingiva in the maxillary region. Clinically, it presents as a sessile or pedunculated exophytic mass with a smooth or lobulated surface, which tends to bleed easily. Its color can range from pink to dark red. The most common treatment is surgical excision. This case report presents a pyogenic granuloma that formed around an implant 7 years after its insertion. Pyogenic granulomas associated with dental implants are extremely rare; this is the fourth reported case and the first case of pyogenic granuloma to be treated with an Er:YAG laser.

Effects of Midazolam/Low-Dose Ketamine Conscious Intravenous Sedation on Pain, Swelling, and Trismus After Surgical Extraction of Third Molars

PURPOSE To assess the clinical efficacy of midazolam plus low-dose ketamine conscious intravenous sedation on relief from or prevention of postoperative pain, swelling, and trismus after the surgical extraction of third molars. PATIENTS AND METHODS Patients admitted for surgical extraction of mandibular third molars (n = 50) were included. All patients received an initial dose of 0.03 mg/kg intravenous midazolam; then patients in the midazolam-placebo (MP) group received 2 mL of a placebo IV, while patients in the midazolam-ketamine (MK) group received 2 mL of a ketamine + saline combination (0.3 mg/kg ketamine + saline) IV. RESULTS Facial swelling on postoperative days was significantly lower in the MK group than in the MP group (P = .001). Mouth opening on postoperative days was significantly greater in the MK group than in the MP group (P = .001). Pain scores measured on a visual analog scale at 4, 12, and 24 hours after surgery were significantly higher in the MP group than in the MK group (P = .001). CONCLUSIONS Conscious intravenous sedation with midazolam/low-dose ketamine during surgical extraction of third molars can provide the patient with a comfortable procedure and good postoperative analgesia, with less swelling and significantly less trismus. Intravenous low-dose ketamine may be safe and effective in reducing postoperative pain.

Complications related to surgically assisted rapid palatal expansion.

OBJECTIVE The goals of this retrospective clinical study were to identify surgically assisted rapid palatal expansion (SARPE) complications and assess their incidence, with the aim of informing surgeons and orthodontists of the risks of this widely used procedure before they recommend it to patients. STUDY DESIGN Between June 2008 and July 2010, 60 patients (23 women and 37 men) underwent SARPE according to a defined multidisciplinary protocol at the University of Marmara, Istanbul, Turkey. RESULTS Twelve patients (20%) suffered from nasal bleeding. Of these 12, 2 patients suffered late-onset bleeding beginning on postoperative day 8, and in the other 10, nasal bleeding was insignificant. Three patients reported excessive lacrimation postoperatively. Minor problems related to pain and numbness were all temporary. CONCLUSIONS SARPE procedures have traditionally been reported to be associated with low morbidity, especially in comparison with other orthognathic surgical procedures. However, many complications have been reported.

Expansion maxillaire rapide assistée chirurgicalement. Évaluation de différentes techniques chirurgicales et de leur effet sur le complexe dento-squelettique maxillaire par tomographie volumique à faisceau conique (CBCT). Rapport préliminaire

AIM To evaluate and compare the dentoskeletal effects associated with surgically assisted rapid maxillary expansion (SARME) performed with (+) and without (-) pterygomaxillary disjunction (PD), utilizing cone beam computed tomography (CBCT). MATERIALS AND METHODS A retrospective study of 9 patients (1 male, 8 females, mean age 18.9 years) undergoing SARME who were divided into two groups. In group (-PD) the surgical technique followed involved bilateral LeFort I type of osteotomy plus midline osteotomy. In group (+PD) same protocol was followed and pterygoid disjunction was performed additionally. Three-dimensional CBCT scans were obtained preoperatively and 3-6 month postretention. A Hyrax type acrylic bonded expander was used. MIMICS 14.0 (Materialise Europe, Belgium) software was used to evaluate transverse expansion at skeletal, dentoalveolar and dental level. Additionally dental inclinations, alveolar bending and the pattern of expansion sagittally were assessed. Wilcoxons and Mann Whitney U tests were used for comparisons. RESULTS AND DISCUSSION All linear transverse measurements at dental and dentoalveolar level were found to have a statistically significant increase (P < 0.05) in both treatment groups. No statistically significant differences were found between the two groups as well as within groups on skeletal level (except of the anterior expansion of maxilla between piriform rims bilaterally). In -PD group significant buccal tipping of the 1(st) premolar was observed as well as increased buccal bending of the alveolar crest. CONCLUSION This study confirms that SARME is an effective treatment of maxillary transverse deficiency. CBCT is an adequate tool to assess dentoskeletal treatment effects.

Evaluation of Dental Anxiety in Patients Undergoing Dentoalveolar Surgery with Laser Treatment

OBJECTIVE The purpose of this study was to evaluate dental anxiety in patients undergoing apicectomy procedures performed with conventional instruments or an erbium-doped yttrium aluminum garnet (Er:YAG) laser. METHODS Twenty-eight patients undergoing apicectomy were divided into two groups; roots were removed with an Er:YAG laser in group A (n=14) and with conventional instruments in group B (n=14). All patients completed preoperative State-Trait Anxiety Inventories (STAI) and postoperative questionnaires. RESULTS Although state anxiety, trait anxiety, and postoperative questionnaire scores were lower in patients undergoing Er:YAG laser treatment than in those treated with conventional instruments, the differences were not statistically significant. CONCLUSIONS Surgical instruments affect the anxiety levels of dental patients. Even with the STAI scores being lower for patients treated with Er:YAG, use of the Er:YAG laser alone cannot contribute to the resolution of dental anxiety. A patients individual condition is the major factor influencing that patients anxiety level.

Oral lymphangioma of the alveolar ridge – a report of a rare case

Lymphangiomas are benign hamartomatous lesions of the lymphatic vessels, which are commonly seen in the head and neck region. The most frequent locations of oral lymphangiomas are the dorsum of the tongue, followed by the palate, buccal mucosa, gingiva and lips. The various treatment options are surgical excision, radiation therapy, cryotherapy, electrocautery, sclerotherapy, steroid administration, embolization, ligation, laser surgery using neodymium-doped yttrium aluminium garnet, carbon dioxide and radiofrequency tissue ablation. We report a rare case of an oral lymphangioma affecting the posterior alveolar ridge of the maxilla. The 51-year-old male patient was referred to our clinic because of a diffuse, 2×3cm, blue–purple lesion in the right posterior alveolar ridge. The lesion was removed completely, together with adjacent healthy tissue. Histopathological examination confirmed the lesion as a lymphangioma.

Maxillary tuberosity reconstruction with transport distraction osteogenesis.

Severe bone loss due to pathology in the maxillary tuberosity region is a challenging problem both surgically and prosthetically. Large bone grafts have a poor survival rate due to the delicate bony architecture in this area and presence of the maxillary sinus. Our case presentation describes a new technique for reconstructing severe bony defect in the maxillary tuberosity with horizontal distraction osteogenesis in a 45-year-old man. A 4 × 6 × 3 cm cyst was discovered in the left maxillary molar region and enucleated. Three months postoperatively, the area had a severe bone defect extending to the zygomatic buttress superiorly and hamular notch posteriorly. Three months later, a bone segment including the right upper second premolar was osteotomised and distracted horizontally. The bone segment was distracted 15 mm distally. After consolidation, implants were placed when the distractor was removed. A fixed denture was loaded over the implants after 3 months. Complete alveolar bone loss extending to the cranial base can be reconstructed with transport distraction osteogenesis. Distalisation of the alveolar bone segment adjacent to the bony defect is an easy method for reconstructing such severe defects.