Guhan Dergin

Effects of irrigation temperature on heat control in vitro at different drilling depths

PURPOSE Thermal injury during implant bed preparation has a major influence on implant osseointegration and survival. This study investigated the effectiveness of the temperature of the saline solution used for heat control during drilling. MATERIAL AND METHODS Fresh frozen edentulous segments of bovine mandibles were sectioned into 12 x 6 cm pieces. Thermoresistors were placed 0.5 mm from the drilling cavity walls, at depths of 3, 7, and 12 mm. Signals from the three thermoresistors were analyzed using ORIGIN 5.0 software. RESULTS The maximum temperatures during drilling without irrigation were 50.9, 47.4, and 38.1 degrees C at depths of 3, 7, and 12 mm, respectively. With irrigation using saline at 25 and 10 degrees C, the maximum temperatures at a depth of 12 mm were 37.4 and 36.3 degrees C, respectively. All other measurements with both 25 and 10 degrees C saline were below body temperature. DISCUSSION AND CONCLUSION This experimental in vitro study showed that more heat was generated in the superficial part of the drilling cavity than at the bottom. Therefore, external irrigation at room temperature can provide sufficient cooling during drilling. Lower temperature saline was more effective in cooling the bone, and irrigation of the site should be continued between the drilling steps.

Evaluating the correlation between the lateral pterygoid muscle attachment type and internal derangement of the temporomandibular joint with an emphasis on MR imaging findings.

OBJECTIVES Disc displacement is accepted as one of major findings in temporomandibular disorders. Correlation between lateral pterygoid muscle (LPM) attachment type to the disc-condyle complex and TMJ dysfunction has rarely been discussed and still not clarified. The purpose of this study was to assess the prevalence LPM attachment type to the disc-condyle complex, and to investigate whether these attachment types are linked to MR imaging findings of ID and TMJ dysfunction in a Turkish population. STUDY DESIGN Ninety-eight TMJs in 49 patients (32 males, 17 females, mean age=36 years) with one of either: TMJ clicking, TMJ locking, restricted movement of the jaw, or pain in the TMJ region, were included. According to the clinical findings and data obtained from MRI examinations, TMJs dysfunctions were classified. LPM attachments to the condyle-disc complex were categorized into three different types. Correlation between TMJ dysfunction and LPM attachments to the condyle-disc complex was evaluated. RESULTS Of 98 TMJs in 49 patients (32 males, 17 females, mean age=36 years), 47 TMJs (%48) were evaluated as normal, 35 (%35.7) had a disc displacement with reduction and 16 (%16.3) TMJ had a disc displacement without reduction. Arthritis was seen in 49 TMJs (%50). LPM attachments to the condyle-disc complex were as follows: Type I (29.6%), Type II (40.8%), and Type III (29.6%). There was no statistically significant difference between the type of muscle attachment and the presence or absence of disc displacement (p=0.481), disc degeneration (p=0.752), articular surface degeneration (p=0.117). CONCLUSIONS There was no statistically significant correlation between the LPM attachment types and TMJ abnormalities.

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.

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.

Direct current electric stimulation in implant osseointegration: an experimental animal study with sheep.

In an effort to obtain a high-quality bone-implant interface, several methods involving alteration of surface morphological, physicochemical, and biochemical properties are being investigated. The aim of our study was to increase the osseointegration rate and quality and decrease the waiting period of dental implants before loading by using a microelectric implant stimulator device. It imitates microelectrical signals, which occur in bone fractures described in terms of piezoelectric theory. A single dental implant (Zimmer Dental), 3.7 mm in diameter, was inserted into the tibia of sheep bilaterally. Twenty-four dental implants were inserted into 12 sheep. Implant on the tibia of each sheep was stimulated with 7.5 μA direct current (DC), while the other side did not receive any stimulation and served as a control. Animals were sacrificed 1, 2, and 3 months after implantation. Bone segments with implants were processed with unclassified method. The determination of new bone formation and osseointegration around the dental implants was investigated by means of undecalcified method, histomorphologically. No statistically significant difference in bone-to-implant contact (BIC) ratio, osteoblastic activity, and new bone formation was found between the stimulation group and the control group at the late phase of healing (4, 8, and 12 weeks). No evidence was found that electric stimulation with implanted 7.5 μA DC is effective at late phase implant osseointegration on a sheep experimental model.

Evaluation of two different rapid maxillary expansion surgical techniques and their effects on the malar complex based on 3d cone-beam computed tomography

We compared and evaluated the effects of two techniques used for surgically assisted rapid maxillary expansion (SARME) using three-dimensional (3D) cone-beam computed tomography, focusing on changes in soft and hard tissue in the malar region. A conventional Le Fort I osteotomy group (10 patients, mean age: 19.3 years) and a high Le Fort I group (12 patients, mean age: 20.4 years) underwent 3D analyses. Changes in hard and soft tissue of the malar region were compared. The average increases in the bone malar width and soft malar width in the high Le Fort I group between the pre- and postoperative periods were 1.43 ± 1.23 and 1.39 ± 1.19 mm, respectively. The average increases in the bone malar depth on the right and left sides in the high Le Fort I group were 1.34 ± 0.81 and 1.60 ± 0.54 mm, respectively. Progress in hard tissues did not reflect significant changes in soft tissue. Context: Effects of high Le Fort I SARME on the malar complex. Aims: To compare and evaluate the effects of two techniques used for SARME, using 3D cone-beam computed tomography, focusing on changes in hard and soft tissues in the malar region. Settings and Design: A conventional Le Fort I osteotomy group (10 patients, mean age: 19.3 years) and a high Le Fort I group (12 patients, mean age: 20.4 years). Methods and Material: Each group underwent 3D analyses, and changes in hard and soft tissues of the malar region were compared. Statistical Analysis Used: The SPSS software (ver. 15.0 for Windows) was used. The Kolmogorov-Smirnov test, Students t test, and paired-samples test were conducted. Results: The average increases in the bone malar width and soft malar width in the high Le Fort I group between the pre- and postoperative periods were 1.43 ± 1.23 and 1.39 ± 1.19 mm, respectively. The average increases in the bone malar depth on the right and left sides in the high Le Fort I group were 1.34 ± 0.81 and 1.60 ± 0.54 mm, respectively. Conclusions: Progress in hard tissues did not reflect significant changes in soft tissue.

Prevalence of nasolacrimal canal obstruction and epiphora following maxillary orthognathic surgery

Acquired injuries of the nasolacrimal apparatus may be the result of craniomaxillofacial surgical procedures, facial trauma, or inflammation. Injury to the nasolacrimal duct system following maxillary orthognathic surgery is rarely reported. This study evaluated the importance of early diagnosis and treatment of epiphora developing after Le Fort I surgery. The records of 83 patients who underwent maxillary orthognathic surgery over a 2-year period were reviewed. The prevalence of postoperative epiphora was 3.6% and it persisted for a mean of 32.7 days. No patient required further surgical treatment of the nasolacrimal duct obstruction. Clinicians should evaluate the lacrimal canal position and schedule close postoperative follow-up of injuries to the nasolacrimal apparatus. These may become permanent, necessitating additional surgery.

Management of the Oroantral Fistula

Communication between the maxillary sinus and oral cavity is a common complica‐ tion in oral surgery. It results mainly from maxillary premolar and molar extractions when the sinus floor is close to the tooth apex. It can also occur after an infection involving the maxillary teeth, invasion of the sinus cavity by a cyst or carcinoma, trauma, the Caldwell-Luc operation, or other dentoalveolar or implant procedures. Openings smaller than 2 mm may heal spontaneously, whereas larger openings require surgical treatment. An oroantral fistula (OAF) may develop as a complication of dental extractions, as a result of infection, or as sequelae of radiation therapy, trauma, and removal of maxillary cysts or tumors. Various techniques have been examined for the closure of oroantral communications. However, the most common question is how to provide better healing of the defect area and the donor site. In this chapter, etiology, clinical features, medical and surgical managements of OAFs, and advantages and disadvantages of different closure methods of closure techniques are discussed in this chapter.

Bone Necrosis in a Rheumatoid Arthritis Patient Secondary to Palatal Rotational Flap: A Practical Surgical Approach

Aims: To present failed rotational palatal flap of a severe rheumatoid arthritis patient with a chronic oroantral fistula and a practical surgical method to deal with the systemic outcomes. Presentation of Case: Bone necrosis at donor site in closure of oroantral fistulas with palatal rotational flap is known to be very rare. We present a 57 years old female, rheumatoid arthritis patient under Methotrexate medication, with a chronic oroantral fistula in the left first molar region. Bone necrosis has been shown at the donor site after full thickness palatal rotational flap procedure. The treatment approach and alternative methods are discussed. Bone necrosis on the donor site has been treated with the re-rotation of the palatal rotational flap tissues, but this time with partial thickness to its original position. Successful healing has been achieved. Discussion and Conclusion: The result of this approach could help practitioners challenging with rheumatoid arthritis caused healing problems and oroantral fistulas. Case Study Aktop et al.; BJMMR, 14(6): 1-5, 2016; Article no.BJMMR.24976 2