Ferda Taşar

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.

The effects of first premolar extractions on third molar angulations.

The purpose of this study was to determine the relationship between the inclinations of second and third molars during a two- to 2.5-year period in patients treated orthodontically both with and without premolar extractions. Records of 37 first premolar extraction patients and 33 nonextraction patients were examined. The pretreatment and posttreatment panoramic radiographs were analyzed. The angles were measured between the long axis of the third molar and the occlusal plane and between the long axis of the third molar and the long axis of the second molar. Changes in third molar angulations from pretreatment to posttreatment for two groups were compared by Mann-Whitney U-test. Statistical analysis revealed that mandibular third molars showed an improvement in angulation relative to the occlusal plane in the first premolar extraction group.

Effects of facemask treatment anchored with miniplates after alternate rapid maxillary expansions and constrictions; a pilot study.

OBJECTIVE To describe the dentoskeletal and soft tissue effects of facemask treatment anchored with miniplates after alternate rapid maxillary expansions and constrictions (Alt-RAMEC) in maxillary retrusion patients. MATERIALS AND METHODS The sample consisted of 15 patients with a mean skeletal age of 11.6 ± 1.59 years undergoing 8 weeks of Alt-RAMEC followed by maxillary protraction. Three hundred fifty to 400 g of force per side was applied to the facemask from the titanium miniplates inserted on the lateral nasal wall of the maxilla. Total treatment time was 9.9 ± 2.63 months. Treatment changes were evaluated cephalometrically and analyzed by means of the dependent t-test and the Wilcoxon signed rank test. RESULTS The miniplates withstood the orthopedic forces exerted during the treatment. Cephalometric findings showed that the maxilla moved forward by 2 mm, with an 0.8° counterclockwise rotation and without maxillary incisor movement. The mandible moved slightly in a downward and backward direction (1.2°). The inclinations of the mandibular incisors decreased significantly (2°). Statistically significant increases were observed in the vertical dimension (1°-1.3°). Soft tissue changes were more marked in the upper lip and soft tissue pogonion than in the lower lip. CONCLUSIONS This treatment approach can offer an advantage for correcting mild/moderate maxillary retrusion in Class III patients.

Comparative Evaluation of Antimicrobial Effects of Er:YAG, Diode, and CO2 Lasers on Titanium Discs: An Experimental Study

PURPOSE This study examined carbon dioxide (CO(2); 10,600 nm), diode (808 nm), and erbium (Er):yttrium-aluminum-garnet (YAG; 2,940 nm) laser applications on Staphylococcus aureus contaminated, sandblasted, large-grit, acid-etched surface titanium discs and performed a comparative evaluation of the obtained bactericidal effects and the applicability of these effects in clinical practice. MATERIALS AND METHODS This study was carried out in 5 main groups: Er:YAG laser in very short pulse (VSP) emission mode, Er:YAG laser in short pulse (SP) emission mode, diode laser with a 320-nm fiber optic diode laser with an R24-B handpiece, and CO(2) laser. After laser irradiation, dilutions were spread on sheep blood agar plates and, after an incubation period of 24 hours, colony-forming units were counted and compared with the control group, and the bactericidal activity was assessed in relation to the colony counts. RESULTS The CO(2) laser eliminated 100% of the bacteria at 6 W, 20 Hz, and a 10-ms exposure time/pulse with a 10-second application period (0.8-mm spot size). The continuous-wave diode laser eliminated 97% of the bacteria at 1 W using a 10-second application with a 320-μm optic fiber, 100% of the bacteria were killed with a 1-W, 10-second continuous-wave application with an R14-B handpiece. The Er:YAG laser eliminated 100% of the bacteria at 90 mJ and 10 Hz using a 10-second application in a superpulse mode (300-ms exposure time/pulse). The Er:YAG laser also eliminated 99% to 100% of the bacteria in VSP mode at 90 mJ and 10 Hz with a 10-second application. CONCLUSIONS The results of this study show that a complete, or near complete, elimination of surface bacteria on titanium surfaces can be accomplished in vitro using a CO(2), diode, or Er:YAG laser as long as appropriate parameters are used.

Effect of low level laser therapy and zoledronate on the viability and ALP activity of Saos-2 cells

A limited number of clinical studies indicate the supportive role of low level laser therapy (LLLT) on medical and/or surgical approaches carried out in treatment modalities for bisphosphonate related necrosis of jaws (BRONJ), the most common side effect of bisphosphonates used to inhibit bone resorption. The purpose of this study was to investigate the effects of LLLT on cell proliferation and alkaline phosphatase (ALP) activity of human osteoblast-like cells (Saos-2) treated with different doses of zoledronate, the most potent bisphosphonate. Saos-2 cells were treated with different concentrations of zoledronate and were irradiated with diode laser (wavelength 808 nm, 10 s, 0.25 or 0.50 W). Cell numbers and ALP activity of the cells were determined. LLLT mildly increased the proliferation rate or ALP activity, while zoledronate reduced both. When applied together, LLLT lessened the detrimental effects of zoledronate and improved cell function and/or proliferation. Based on the results of this study, it was concluded that LLLT has biostimulative effects on Saos-2 cells, even after treatment with zoledronate. LLLT may serve as a useful supportive method for BRONJ treatment through enhancement of healing by osteoblasts.

Effects of maxillary molar intrusion with zygomatic anchorage on the stomatognathic system in anterior open bite patients

The aim of this study was to evaluate the effects of intrusion of the maxillary posterior teeth with zygomatic anchorage on the dentofacial system, on electromyographic (EMG) activity of the masticatory muscles, and on vibration of the temporomandibular joint. The study sample consisted of 19 subjects (13 females, 6 males) with a mean age of 17.7 years. Lateral cephalometric and posteroanterior (PA) radiographs, EMG, and electrovibratographic (EVG) records were obtained before (T0) and after (T1) intrusion. Paired t- and Wilcoxon signed ranks tests were used for statistical evaluation. Maxillary molar intrusion of 3.37 ± 1.21 mm was obtained with a force of 400 g in an average period of 6.84 ± 1.64 months. At T1, all measurements showed that facial growth direction, ANB angle, convexity, and overjet were decreased (P < 0.05). SNB angle, facial depth, and overbite were significantly increased (P < 0.05). Upper lip-E plane distance was increased (P < 0.05). Evaluation of the PA radiographs showed that the right and left molar reference angles were unchanged. EMG and EVG analysis showed that the stomatognathic system at T0 was maintained at T1. Intrusion of the maxillary posterior teeth with zygomatic anchorage is an effective treatment alternative for anterior open bite correction.

Histomorphometrical and radiological comparison of low-level laser therapy effects on distraction osteogenesis: experimental study

Distraction osteogenesis (DO) is the application of traction to the callus formed between bone segments and stimulation of bone formation by creating stress on the callus with this traction. Shorten the duration of DO and increasing the capacity of bone formation is important to prevent the possible complications of DO. For this reason, it was considered that low-level laser therapy (LLLT) may affect positively DO and it can decrease the complication range by shortening the period. Unilateral mandibular distractors were applied on 16 female white New Zealand rabbit to prove this hypothesis with micro CT, plain radiograph and histomorphometric analyses. Eight rabbits were applied LLLT with GaAlAs laser on the distraction area during the distraction period. On the post-distraction 28th day, four rabbits from study group and four rabbits from control groups were sacrificed. The rest of the rabbits were sacrificed on post-distraction 56th day. As a result of this study, significant positive effects of LLLT on post-distraction 28th day were revealed with all analyses. In histomorphometrical analyses, new bone formation was significantly higher in short-term laser applied group comparing to that of short-term control group (p = 0.029). In both microCT and plain radiograph, the highest radioopacity values were observed in short-term laser group when compared with that of the controls (p = 0.043 and p = 0.025, respectively). Even though LLLT increased the healing capacity on short-term, it was not sufficient on long-term (post-distraction 56th day) healing. LLLT application on distraction period, activate healing on bone so it may decrease DO period. The result of this study should be supported with clinical studies and the most effective laser source, dose and application time should be revealed with experimental and clinical studies.

Low-level laser therapy supported teeth extractions of two patients receiving IV zolendronate.

BRONJ (bisphosphonate-related osteonecrosis of jaws) is a frequently encountered disease, particularly in the maxillofacial region, and a consequence of bisphosphonate use. Treatment of BRONJ remains controversial, as efficiency of medical and surgical approaches as well as a combination of these methods with supportive treatments have not been clearly demonstrated in the literature. In recent years, laser usage alone or in combination with the main therapy methods, has become popular for the treatment of bisphosphonate-related osteo-necrosis of jaws. In this article, we present the successful management of two dental patients who had high potentials for BRONJ development as a result of chemo and radiotherapy combined with IV zoledronic acid application. Multiple consecutive teeth extractions followed with primary wound closure and LLLT applications were performed under high doses of antibiotics prophylaxis. Satisfactory wound healing in both the surrounding soft and hard tissues was achieved. LLLT application combined with atraumatic surgical interventions under antibiotics prophylaxis is a preferable approach in patients with a risk of BRONJ development. Adjunctive effect of LLLT in addition to careful infection control on preventing BRONJ was reported and concluded.

YAYGİN ORAL LEUKOPLAKİNİN TEDAVİSİNDE ND-YAG LASER (BİR OLGU RAPORU) TREATMENT OF WIDESPREAD ORAJ LEUKOPLAKIA WITH ND-YAG LASEB (A CASE REPORT)

Ozet Oral leukoplaki, oral mukozada gorulen en yaygin (% 85) prekanseroz lezyondur ve malign transformasyonun % 4-5 oldugu belirtilmektedir, Lezyon oral kavite-nin her yerinde ve siklikla bukkal mukoza ve kommis-surlarda lokalize olmaktadir. Bunu gorulme sikligi sirasiyla; alveoler mukoza, dil, dudak, sert ve yumusak damak, agiz tabani ve gingiva izlemektedir. Oral leukoplaki lezyonlari oldukca farkli boyut, lokalIzasyon ve klinik goruntu vermektedir. Lezyon erkeklerde kadinlardan daha sik ve ozellikle 40 yas uzerinde gorulmektedir. Leukoplakinin etyolojisi cok degiskendir. Lezyonlarin olusmasi sadece (disaridan gelen) lokal faktorlere bagli olmayip ayni zamanda (Iceriden gelen) predispozan faktorlerede bagli olabilir. Tutun, alkol kullanimi, oral sepsis, lokal irritasyon, vitamin eksikligi, hormonal bozukluklar ve galvanik akim gibi faktorler siklikla sorumlu olmaktadir. Lokal faktorlerin elimine edilmesi yeterli olmakta ancak israrli lez-yonlarda konservatif cerrahi eksizyon, elektrokoter ve laser cerrahisi uygulanmaktadir. Sunulan olguda, 46 yasinda erkek hasta maksiller ve mandIbuler kretlcr uzerinde israrli ve yaygin lezyonlardan yakinarak klinigimize basvurdu. Klinik ve histopatolojik inceleme sonrasi lezyonlar basarih bir sekilde laser cerrahisi ile tedavi edildi. Anahtar sozcukler: Leukoplaki, laser tedavisi. Abstract Oral leukoplakia is the most common (% 85) premalig-nant lesion which is seen in oral mucosa and it has been reported that malignant transformation rate is 4-5 percent. Although lesion may be found anywhere in the oral cavity, the buccal mucosa and commissures were most frequently involved, followed in descending order by alveolar mucosa, tongue, lip, hard and soft palates, floor of the mouth and gingiva. The lesions of oral leukoplakia show considerable variation in size, location and clinical appearance. This lesion is more common in men man in women and that it is seen chiefly over the age of 40. The etiology of leukoplakia to be a varied one. Tlie initiation of the condition may depend not only upon exhinsic local factors, but also upon intrinsic predisposing factors. Factors most frequently blamed have been tobacco, alcohol, oralsepsis, local irritation, syphilis, vitamin deficiency, endocrine disturbances and galvanism. Elimination of local factors have been sufficient in the treatment of oral leukoplakia but conservative surgical excision, electro-coagidation and laser surgery have been used in persisted lesions. In our presented case, a 46 year old men referred to our clinic with the complaint of persistent and widespread lesions in his maxillary and mandibulary crest. After the clinical and histopathological examination the lesions were successfully treated with the laser surgery. Key words: Leukoplakia, laser therapy.