Ferhan Yaman

Mandibular fractures: a comparative analysis between young and adult patients in the southeast region of Turkey

Objective The purpose of this study was to review and compare the differences between mandibular fractures in young and adult patients. Material and Methods Patients treated at the Oral and Maxillofacial Department of Dicle University during a five-year period between 2000 and 2005 were retrospectively evaluated with respect to age groups, gender, etiology, localization and type of fractures, treatment methods and complications. Result 532 patients were included in the study, 370 (70%) males and 162 (30%) females, with a total of 744 mandibular fractures. The mean age of young patients was 10, with a male-female ratio of 2:1. The mean age of adult patients was 28, with a male-female ratio of 3:1. The most common causes of injury were falls (65%) in young patients and traffic accidents (38%) in adults. The most common fracture sites were the symphysis (35%) and condyle (36%) in young patients, and the symphysis in adults (36%). Mandibular fractures were generally treated by arch bar and maxillomandibular fixation in both young (67%) and adult (39%) patients, and 43% of the adult patients were treated by open reduction and internal fixation. Conclusion There was a similar gender, monthly and type of treatment distribution in both young and adult patients in the southeast region of Turkey. However, there were differences regarding age, etiology and fracture site. These findings between young and adult patients are broadly similar to those from other studies. Analysis of small differences may be an important factor in assessing educational and socioeconomic environments.

Effect of Intracanal Medication with Calcium Hydroxide and 1% Chlorhexidine in Endodontic Retreatment Cases with Periapical Lesions: An In Vivo Study

BACKGROUND/PURPOSE Calcium hydroxide (Ca(OH)(2)) has been widely used as an intracanal medicament for endodontic retreatment, but very few studies used both Ca(OH)(2) and 1% chlorhexidine (CHX) as intracanal medicaments. The purpose of this study was to assess the in vivo effectiveness of a combination of Ca(OH)(2) and 1% CHX as intracanal medicaments in endodontic retreatment cases with periapical lesions. METHODS Previous cases of endodontically treated teeth with periapical pathosis in 70 patients (36 men and 34 women, age range 18-60 years) were included. Of these teeth, 59 had received root canal treatment and 11 had been subjected to previous apical surgery, indicating endodontic failure. Following the routine procedures, including canal reshaping and irrigation with 2% CHX, a canal medication material containing Ca(OH)(2) powder and a 1% CHX solution was placed into the root canals. Over a 6-week period, the intracanal medication was periodically changed until the teeth became asymptomatic. Patients were recalled at 3-month intervals for radiographic and clinical examination. RESULTS Our clinical and radiographic assessment of retreatment cases showed complete healing in 41 (64%) teeth, incomplete healing in 9 (14%) teeth, and failure in 14 (22%) teeth. For complete healing teeth, the healing time varied from 6 to 36 months. The size of the periapical lesions and previous surgical treatment had no influence on the prognosis. CONCLUSION Our results suggest that a combination of Ca(OH)(2) and 1% CHX can be successfully used as intracanal medicament for disinfection in endodontic retreatment cases with periapical lesions.

Influence of caffeic acid phenethyl ester on bone healing in a rat model

Objective To examine the effects of caffeic acid phenethyl ester (CAPE; a component of honey bee-hive propolis with antioxidant, anti-inflammatory, antiviral and anticancer properties) on bone regeneration and fibrotic healing in a rat model. Methods Male Sprague–Dawley rats (n = 63; mean age 7 weeks; weight 280–490 g) were randomly divided into three groups: A, cranial defect with no bone healing treatment (n = 21); B, cranial defect treated with CAPE (n = 21); C, cranial defect treated with CAPE and β-tricalcium phosphate/hydroxyl apatite (n = 21). Rats were anaesthetized with ketamine (8 mg/100 g) by intraperitoneal injection and a cranial critical size bone defect was created. Following surgery, CAPE (10 µmol/kg) was administered by daily intraperitoneal injection. Seven rats in each group were killed at days 7, 15 and 30 following surgery. Bone regeneration, fibrotic healing and osteoblast activity were evaluated by histopathology. Results Statistically significant differences in healing were found between all groups. There were no statistically significant within-group differences between day 7 and 15. At day 30, bone healing scores were significantly higher in groups B and C compared with group A. Conclusion CAPE significantly improved bone-defect healing in a rat model, suggesting that CAPE has beneficial effects on bone healing.

A Three Dimensional Analysis of Reconstruction Plates used in Different Mandibular Defects

ABSTRACT In this study, the reasons of breaking of the reconstruction plates used in mandibular continuity or mandibular defects were investigated. The study was conducted on 3 cases in which reconstruction plates were used for tumor resection or invasive wound. The objective was to evaluate the mechanical stress in reconstruction plates by means of the finite element method. Three dimensional model of reconstruction plate was exposed to chewing force. A commercial finite element solver (ANSYS) was then applied to this plate to compute the stresses generated in chewing situation. Stress analyses have been carried out by applying Von Mises Yielding Criteria. In the standard reconstruction plate, the results of the finite element analysis revealed that stress resulting from the simulated functional loadings which far exceeded the strengths of the components. The main application of this study was the prediction of fractures as a consequence of known forces. If it was assumed that the patient executes several thousand masticatory movements within a week, a dynamic strain would be present due to the large number of changes in loading, so that there was a danger of a fatigue fracture at the point of the stress concentration (as seen in the analysis), as is also confirmed by clinical practice.

Effects of caffeic acid phenethyl ester on palatal mucosal defects and tooth extraction sockets.

Aim The purpose of this study was to evaluate the effects of caffeic acid phenethyl ester (CAPE) on palatal mucosal defects and tooth extraction sockets in an experimental model. Materials and methods Forty-two male Sprague-Dawley rats with a mean age of 7 weeks and weighing 280–490 g were used in this study. The rats were randomly divided into two groups: group A (the control group, n=21) and group B (the experimental group, n=21). Under anesthesia with ketamine (8 mg/100 g, intraperitoneally), palatal mucosal defects were created and tooth extraction was performed in the rats in groups A and B. Group A received no treatment, whereas group B received CAPE. CAPE was injected daily (10 μmol/kg, intraperitoneally). The rats were killed on days 7, 14, and 30 after the procedures. Palatal mucosa healing and changes in bone tissue and fibrous tissue were evaluated histopathologically. Result Pairwise comparisons showed no statistically significant difference between days 7 and 14 in either group (P>0.05). At day 30, bone healing was significantly better in group B (CAPE) than in group A (control) (P<0.05). Fibrinogen levels at day 30 were significantly higher in group A (control) than in group B (CAPE) (P<0.05). Pairwise comparisons showed no statistically significant difference in palatal mucosa healing levels between days 7 and 14 in both groups (P>0.05). Conclusion In conclusion, the findings of this study suggest that CAPE can significantly improve tooth socket healing.

Dietary arginine silicate inositol complex increased bone healing: histologic and histomorphometric study

Background Arginine silicate inositol complex (ASI; arginine 49.5%, silicon 8.2%, and inositol 25%) is a novel material that is a bioavailable source of silicon and arginine. ASI offers potential benefits for vascular and bone health. Objective The aim of this study was to evaluate the potential effects of ASI complex on bone healing of critical-sized defects in rats. Methods The rats were randomly assigned to two groups of 21 rats each. The control group was fed a standard diet for 12 weeks; after the first 8 weeks, a calvarial critical-sized defect was created, and the rats were sacrificed 7, 14, and 28 days later. The ASI group was fed a diet containing 1.81 g/kg of ASI for 12 weeks; after the first 8 weeks, a calvarial critical-sized defect was created, and the rats were sacrificed 7, 14, and 28 days later. The calvarial bones of all the rats were then harvested for evaluation. Results Osteoblasts and osteoclasts were detected at higher levels in the ASI group compared with the control group at days 7, 14, and 28 of the calvarial defect (P<0.05). New bone formation was detected at higher levels in the ASI group compared with the controls at day 28 (P<0.05). However, new bone formation was not detected at days 7 and 14 in both the groups (P>0.05). Conclusion ASI supplementation significantly improved bone tissue healing in rats with critical-sized defects. This study demonstrated that ASI can enhance bone repair and has potential as a therapeutic regimen in humans.

Displaced lower third molar tooth into the submandibular space: Two case reports.

The aim of this article is to emphasize that the accidental displacement of a lower third molar during extraction is a rare, but potentially serious complication. We present two case reports on a lower third molar tooth dislodged into the submandibular space following its removal from the sockets and the subsequent management of this rare complication. Differences in the direction of displacement, the size of fragment, delay in retrieval, and tissue reactions can all influence this potential serious complication and hence no one technique is uniformly applicable. Though a rare complication, clinicians must be aware of possible lower third molars dislodgement into tissue spaces and the necessity to initiate prompt and appropriate management.

An Experimental Comparison of the Effects of Calcium Sulfate Particles and β-Tricalcium Phosphate/Hydroxyapatite Granules on Osteogenesis in Internal Bone Cavities

ABSTRACT This experimental study was carried out to investigate the effect of medical grade calcium sulphate and β-tricalcium phosphate/hydroxyapatite on new bone formation. Additionally, the study compared these materials for infection, resorption, biocompatibility, immune reaction, fibrotic encapsulation, foreign body reaction and physical attachment. Forty, five-month-old female Wistar Albino rats were used. The 40 rats in the study were divided into 2 groups. Medical grade calcium sulphate particles (SurgiPlasterR Bio-Lok International Company) were applied to the rats in group 1 and β-tricalcium phosphate/hydroxyapatite granules (CamceramR Cam Implants by an osteotech, Inc. Company) to those in group 2. On days 10, 21, 30 and 60 postoperatively the femurs were sacrificed and investigated histopathologically. The Mann-Whitney U test was applied to the data obtained as a result of the histopathological analysis of the specimens. No statistically significant differences were observed between the 2 groups. In conclusion, it was determined that both materials resulted in similar fibrous tissue and inflammation responses, that their biocompatibilities were very good and that they did not cause foreign body reaction. Osteogenesis also was observed in the 2 groups after day 21. The effects of calcium sulphate on bone formation were faster than those of β-tricalcium phosphate/hydroxyapatite. Osteogenesis was not completed to the same extent in the calcium sulphate group as in the β-tricalcium phosphate/hydroxyapatite group.

Comparison of the Effects of Local and Systemic Zoledronic Acid Application on Mandibular Distraction Osteogenesis

Abstract Bisphosphonates are antibone resorptive drugs that are used to prevent bone tissue resorption in several skeletal diseases. The aim of this study was to examine the effects of systemic and local applications of zoledronic acid (ZA) on newly regenerated bone in a model of experimental distraction osteogenesis (DO). To do this mandibular DO was applied to 30 adult female Sprague Dawley rats, which were randomly divided into 3 groups: control, DO only, systemic zoledronic acid (SZA), and local zoledronic acid (LZA). In the LZA group, the gap between the bone fragments was filled with a gelatin sponge soaked in 2 mg of ZA and 0.1 mL of sterile saline. In the SZA group, a single dose of 0.1 mg/kg ZA was administered systemically. After the surgery, there was a 5-day latent waiting period and 10-day distraction phase. Following a 28-day consolidation period, the rats were euthanized and their mandibles were collected. The distracted bone area was seen to be filled with newly regenerated bone tissue in all 3 groups, both histologically and histomorphometrically. In addition, amounts of new bone formation, osteoblast cella, osteoclast (OC) cells, osteopontin, and vascular endothelial growth factor in the SZA and LZA groups were found to be higher when compared with the controls. Furthermore, in the SZA group, new bone formation, osteoblast, OC, osteopontin, and vascular endothelial growth factor were detected in significant amounts compared with the LZA group. Osteoclast numbers did not differ in a statistically significant manner in the SZA group with respect to the LZA group. Based on the results of this study, systemic and local applications of ZA could increase the formation of new bone in patients of DO, and systemic application is a more effective method compared with local application.

Guided bone regeneration with local zoledronic acid and titanium barrier: An experimental study

The aim of this study was to evaluate the effects on new bone formation of autogenous blood alone or in combination with zoledronic acid (ZA), a β-tricalcium phosphate (β-TCP) graft or ZA plus a β-TCP graft placed under titanium barriers. For this purpose, eight adult male New Zealand white rabbits were used in the study, each with four titanium barriers fixed around four sets of nine holes drilled in the calvarial bones. The study included four groups, each containing 2 rabbits. In the autogenous blood (AB group), only autogeneous blood was placed under the titanium barriers. The three experimental groups were the AB+ZA group, with autogenous blood plus ZA, the AB+β-TCP group, with autogeneous blood plus a β-TCP graft, and the AB+β-TCP+ZA group, with autogeneous blood plus a β-TCP graft and ZA mixture under the titanium barriers. The animals were sacrificed after 3 months. The amounts of new bone formation identified histomorphometrically were found to be higher after 3 months than at the time of surgery in all groups. The differences between the groups were examined with histomorphometric analysis, and statistically significant differences were identified at the end of the 3 months. The bone formation rate in the AB+β-TCP+ZA group was determined to be significantly higher than that in the other groups (P<0.05). In the AB+ZA and AB+β-TCP groups, the bone formation rate was determined to be significantly higher than that in the AB group (P<0.05). No statistically significant difference in bone formation rate was observed between the AB+β-TCP and AB+ZA groups. Local ZA used with autogeneous blood and/or graft material appears to be a more effective method than the use of autogeneous blood or graft alone in bone augmentation executed with a titanium barrier.