Gökhan Göçmen

Actinomycosis: report of a case with a persistent extraoral sinus tract

Cervicofacial actinomycosis is a chronic suppurative and granulomatous infection that may reside for years and recur with sudden onset. It is the second most common type of actinomycosis and could be caused by trauma or infection. We report a draining actinomycotic sinus tract with extraordinary thickness that occurred owing to a long-standing chronic periapical infection of an extracted upper left second premolar 3 years before.

The antioxidant and anti-inflammatory efficiency of hyaluronic acid after third molar extraction.

PURPOSE Hyaluronic acid (HA) has a number of clinical applications in current practice. Therefore, correlation of HA with free radicals and inflammatory cells is clinically important. The purpose of this study is to measure the efficacy of high molecular weight HA on the oxidative stress of oral wounds (glutathione (GSH) and lipid peroxidation (LPO) levels), the inflammatory reaction (leucocytes, collagen and angiogenesis content), pain (visual analogue scale (VAS) records) and trismus (maximum interincisal opening (MIO) records) after third molar (M3) extraction. PATIENTS AND METHODS 40 patients were included in this study. 0.2 ml 0.8% HA was applied immediately after surgery within the HA group (n = 20). Nothing was applied to the control group (n = 20). The primary outcome variables were the changes in the inflammatory reaction (leucocyte, angiogenesis and collagen content), oxidative stress (GSH, LPO) and clinical parameters (VAS, MIO). Results were compared immediately after extraction (T0) and 1 week after surgery (T1). Bivariate analyses were used to assess the differences between the HA and control groups for each study variable. RESULTS There was a statistically significant difference of leucocyte infiltration and angiogenesis between the groups at T1. The HA group showed less leucocyte infiltration and more angiogenesis than the control group. There was no statistically significant difference in oxidative stress, VAS or MIO levels between the groups. CONCLUSION Our results confirm the hypothesis that HA has an anti-inflammatory effect following M3 extraction. However, the oxidative stress levels and clinical outcomes were similar after one week. Further studies examining these parameters at different times are necessary.

Treatment of trigeminal neuralgia with bupivacaine HCL using a temporary epidural catheter and pain pump: Preliminary study

OBJECTIVES Trigeminal neuralgia (TN) is a rare form of neuropathic facial pain characterised by severe paroxysmal pain in the face. The treatment for trigeminal neuropathic pain disorder continues to be a major therapeutic challenge, as relief provided by medical therapy generally decreases over time. When medical therapy fails either due to poor or diminishing responses to drugs or to unacceptable side effects, peripheral intervention or surgical management of TN should be considered. STUDY DESIGN Fourteen patients (eight men and six women) who were not responsive to further medical treatment and who were diagnosed with TN previously at other health centres were selected for treatment. For this purpose, the affected nerve was infused with 60 mL (1 mL h(-1)) of 0.5% bupivacaine HCl with a pain pump via an temporary epidural catheter. Patients visual analogue scores (VAS) were recorded on the fifth preoperative day and on postoperative day 5, 2 weeks, 1, 3, 6 and 9 months. RESULTS There was a significant difference between mean preoperative and postoperative VAS value at day 5, 2 weeks, 1, 3, 6 and at the end of 9 months ((68.85 ± 1.43) (13.57 ± 6.68) (11.43 ± 6.70) (14.29 ± 6.52) (20.71 ± 6.41) (20.71 ± 6.41) and (21.43 ± 6.10) respectively; ∗P<0.05). Two of 14 patients did not show any pain relief. CONCLUSIONS Continuous administration of 60 mL of 0.5% bupivacaine HCl at 1 mL h(-1) with a pain pump and epidural catheter can be used as a transition treatment for patients with side effects from high-dose antiepileptic drugs and for patients awaiting neurosurgery or individuals who refuse cranial surgery. It should not be considered as an alternative treatment of neurosurgical approaches, such as MVD, which has a definite long-lasting results.

Effect of Septal Deviation, Concha Bullosa and Haller's Cell on Maxillary Sinus's Inferior Pneumatization; a Retrospective Study.

Purpose: Maxillary sinus’s inferior pneumatization is a physiological process, which increase with time and accelerates following extraction. The aim of this study was to determine the prevalence of nasal septal deviation (NSD), concha bullosa (CB), and Haller’s cells (HC) and to examine the correlation of maxillary sinus inferior pneumatization (MSIP) with these anatomical variations. Material and Methods : 300 (150 m, 150 f) CBCT scans taken at the Marmara University School of Dentistry from 2011 to 2014 were retrospectively reviewed for the presence of CB, NSD, HC and MSIP. The correlation between pneumatization to the anatomic variants was then compared. Data were analyzed with a Chi-square test. Results : Of the 300 CBCT scans, 44.3% have CB, 37.3% NSD, 19.3% HC and 27.7% MSIP. There was no statistical significancewhen comparing the relationship of patients with CB, NSD, HC and pneumatization. Conclusion : NSD, CB and HC do not have a definite role on sinus’s inferior pneumatization. Further studies should be conducted including potential factors related pneumatization with more sample size for further correlation with NSD, CB,HC.

Hyaluronic Acid Versus Ultrasonic Resorbable Pin Fixation for Space Maintenance in Non-Grafted Sinus Lifting

PURPOSE An ultrasonic resorbable pin (SonicWeld, KLS Martin, Mühlheim, Germany) was compared with hyaluronic acid (Hyaloss Matrix, Anika Therapeutics, Bedford, MA) for their ability to maintain space in non-grafted sinus lifting. MATERIALS AND METHODS A comparative split-mouth study was designed and implemented. Six women and 4 men were included (mean age, 56.7 yr). The primary predictors hyaluronic acid (HA) application and ultrasonic resorbable pin fixation (URPF) were coded as binary variables. The primary outcome variables were height of alveolar bone (HAB) and reduction in sinus volume (RSV). Secondary outcomes were bone density and implant survival. RESULTS The postoperative mean HAB was significantly higher than the preoperative mean HAB on the 2 sides (P < .05). Mean increases in HAB and RSV on the URPF side were significantly greater than those on the HA side (P < .05). In total, patients were treated with 40 implants. No type I bone quality was identified; 14 (35%) implants were inserted in type II bone, 22 (50%) in type III bone, and 6 (15%) in type IV bone. There was no statistically meaningful difference between the 2 sides for implant survival or bone quality. At 6 months, all implants were clinically stable and the definitive prostheses were functional, resulting in a survival rate of 100%. CONCLUSIONS There was sufficient bone height to eventually place implants on the 2 sides in all patients. The 2 techniques yielded predictable outcomes in implant survival and bone quality. However, HAB and RSV were considerably greater on the URPF side.

Comparison of ultrasound-guided and conventional arthrocentesis of the temporomandibular joint

Arthrocentesis of the temporomandibular joint (TMJ) can be done either conventionally or under ultrasonographic guidance, and we have compared the effectiveness of the two techniques. Twenty patients who required arthrocentesis of the TMJ were randomly assigned to ultrasonographically guided (US-guided) and conservative arthrocentesis (n=10 in each group). The number of relocations of the first and second punctures, pain experienced during each procedure measured using a visual analogue scale (VAS), and the duration of the procedure were the main outcome variables. The pain score compared with the maximal interincisal mouth opening measured preoperatively, immediately after operation, at 1 week, and 1 and 3 months, were secondary outcome variables. No patient in either group developed a complication, and there was no significant difference between the two groups, except that US-guided arthrocentesis took significantly longer than the conventional technique (p=0.000). US-guided arthrocentesis of the TMJ was no more successful than the conventional technique, and took longer. Further studies with more patients are required to validate these findings.

Evaluation of temporomandibular joint disc-repositioning surgery with Mitek mini anchors.

Purpose: The aim of this study is to evaluate outcome of Mitek mini anchors (DePuy Mitek, Raynham, MA) in TMJ discopexy and assess patient satisfaction based on MRI findings. Patients and Methods: 7 patients suffered from significant pain and dysfunction diagnosed on MRI findings as anterior disc displacement without reduction selected for this study. Anchor stability, assessment of positional changes and roofing were evaluated by postop MRI and OPTGs. Satisfaction was assessed with VAS. Preop and postop maximum interincisal opening measurements were compared. Results: There was significant difference between preop and posto P values of MIO and VAS. All 7 patients noted complete absence of pain at the postop 1-year follow-up. Only 1 patient had postop clicking but showed remarkable improvement of jaw functions (MIO). The articular disk was observed at its normal position in 6 patients except one patient whom MRI confirmed postop partial roofing. OPTGs reveal neither radiologic changes around the mini anchors in the condylar head nor any positional shifts. Conclusion: Disc repositioning with Mitek mini anchors represent improvement in post-op VAS scores and clinical findings (MIO) based on comparison preop and postop MRI scans and panoramic films. However, our study group consists of limited number of patients, further studies with more number of cases are required to evaluate the outcomes

Effects of Ankaferd BloodStopper on dermal healing in diabetic rats

BACKGROUND/AIM Diabetes mellitus inhibits wound-induced angiogenesis, impairs the wound healing process, and leads to the development of chronic wounds. Ankaferd BloodStopper (ABS) is a new and promising local haemostatic agent. Although the mechanism of ABS-mediated haemostasis is well established, little is known about the associated histological and biochemical tissue reactions. The aim of this study was to evaluate the effects of this new-generation local haemostatic agent on short-term soft-tissue healing in streptozotocin (STZ)-treated rats. MATERIALS AND METHODS The 24 Wistar albino rats used in this study were divided into STZ-treated (STZ, n = 12) and nontreated groups (control, n = 12). Four days prior to surgery, rats in the STZ group were subcutaneously administered 60 mg/kg STZ intraperitoneally, while rats in the control group were administered 1 mL saline/kg. An incision was made in the dorsal dermal tissue of all rats, and either ABS or no haemostatic agent (NHAA) was applied to the wound before suturing. All of the rats were euthanised on postoperative day 4. Blood and skin samples were evaluated biochemically and histologically. RESULTS The results showed that STZ treatment impaired soft-tissue healing, assessed by measuring glutathione and lipid peroxidation levels. Moreover, while good histological results were obtained in the control group treated with ABS, there were fewer benefits in the STZ-treated group. CONCLUSION ABSs benefits in the control group seemed to lose their effectiveness under STZ medication.

Maxillary Sinus Augmentation for Dental Implants

Pneumatization of the maxillary sinus secondary to posterior maxillary tooth loss is an extremely common finding. Significant atrophy of the maxilla prevents dental implant placement in this region. Grafting the floor of the maxillary sinus has emerged as the most common surgical modality for correcting this inadequacy. Graft material is introduced into the space created inferior to the sinus membrane. Various grafting materials and techniques might be used in this procedure. The aim of this article is to review the essentials of maxillary sinus augmentation, clarify this procedure for otolaryngologists, explain its function, and describe the augmentation materials, techniques, and complications.

Akılcı ilaç kullanımı ilkeleri doğrultusunda diş hekimliğinde kişisel analjezik listesi oluşturulması

Hekimin hastayla karsilasmadan once hazirlik yaparak, ilgili endikasyona yonelik kendi kisisel ilac listesini olusturmasi ve bu dogrultuda hastalarinin ilacla tedavisini duzenlemesi beklenir. Hekimin bu yaklasimi benimsemesi, akilci ilac kullaniminin (AIK) gerekliliklerinden birisidir. Analjezikler, dis hekimlerinin (DH) en sik receteledigi ilac gruplari arasinda yer alir. Bu yazida, “DH’lerin AIK ilkelerine uygun ilac secimini nasil yapmasi gerektigi” uzerinde durulmaktadir. Bu islemin daha kolay anlasilmasi icin dis hekimliginde “kisisel analjezik listesi” (KAL) secimi ozelinde konunun ayrintilarina yer verilmistir. KAL secimi, analjeziklere ait klinik farmakoloji bilgisinden yararlanarak “etkililik, guvenlilik, uygunluk ve maliyet”ten olusan 4 secim olcutu kullanilarak yapilir. Bu sayede alternatifleri arasindan en iyiler belirlenir. Boylece DH’nin receteleyecegi ilaclara ait bilmesi gereken bilgi yuku ciddi olcude hafifler. Piyasada mevcut cok sayidaki analjezigi ilgilendiren bilgi yukunden kurtulur. Sadece KAL’daki sinirli sayidaki ilaca ait bilgileri iyice ogrenmesi kolaylasir. Bu yontem sayesinde az sayidaki ilaci iyi bilen bir DH, pratikte hem receteye yazacagi ilaci isabetle ve kolaylikla belirler, hem de bu ilacla ilgili hastasina verecegi bilgileri daha kolay aklinda tutar ve bunu daha rahat hayata gecirir. Dolayisiyla, KAL siralamasina sahip olan bir DH, analjezik tedavisini basarili bir seklide duzenleme imkânina kavusur. Analjezik ozelinde kazanilacak bu akilci yaklasimin “transfer etkisi” yoluyla antibiyotik secimi basta olmak uzere dis hekimliginde ihtiyac hissedilen diger ilac/ urun gruplarinin seciminde de benimsenmesi beklenir.