Gülsün Yildirim

A Preferable Technique for Protecting the Inferior Alveolar Nerve: Coronectomy

PURPOSE The aim of this study was to evaluate the effectiveness of coronectomy for teeth whose root apices are very close to the inferior alveolar canal. PATIENTS AND METHODS The 43 patients of this study needed removal of their lower third molar, whose root apices were very close to the inferior alveolar canal. These patients underwent 47 coronectomies. RESULTS The mean follow-up period was 9.3 months (range, 1 to 48 months). The mean total amount of root movement was 3.4 mm at 6 months, 3.8 mm at 12 months, and 4.0 mm at 24 months. CONCLUSIONS The technique of coronectomy is defined as removing the crown of a tooth but leaving the roots untouched, so that the possibility of nerve damage is reduced. Coronectomy is a preferable technique for patients who run a risk of injury to the inferior alveolar nerve during third molar surgery.

Conservative Treatment Protocol for Keratocystic Odontogenic Tumour: a Follow-up Study of 3 Cases

ABSTRACT Background The keratocystic odontogenic tumour is classified as a developmental cyst derived from the enamel organ or from the dental lamina. The treatment of keratocystic odontogenic tumour of the jaw remains controversial. The aim of this study was to report the outcome of our conservative treatment protocol for keratocystic odontogenic tumour. Methods Three patients with different complaints referred to Oral and Maxillofacial Surgery Clinic, Faculty of Dentistry, Selçuk University. Initial biopsy was carried out in all patients and keratocystic odontogenic tumours was diagnosed subsequent to histopathological examination. The patients with keratocystic odontogenic tumours were treated by enucleation followed by open packing. This conservative treatment protocol was selected because of existing young aged patients. The average follow-up duration of the cases was 2 years. Results Out of 3 cases, 2 lesions were present in mandible and 1 lesion in maxilla. There was no evidence of recurrence during follow-up. All the cases were monitored continuously with panoramic radiographs, computed tomography and clinical evaluations. Conclusions This conservative treatment protocol for keratocystic odontogenic tumours, based on enucleation followed by open packing would be a possible choice with a view of offering low recurrence rate and low morbidity rate particularly in young patients.

The use of autogeneous mandibular bone block grafts for reconstruction of alveolar defects.

Objective: Purpose of this retrospective study was to evaluate outcomes autogenous bone block grafts obtained from mandible for different indications. The healing of the donor and recipient sites in the postoperative period, morbidity and the resorption of the graft were investigated. Patients and Methods: Twenty-nine patients grafted with mandibular bone block graft were participated in the present study. Grafting was applied in these patients for three indications; reconstruction of alveolar cleft, lateral crest augmentation before dental implantation and sinus floor augmentation. All operations were performed under local anesthesia and in some cases sedation was used as well. Results: Minimal exposure of the block graft occurred in three alveolar cleft patients. Secondary epithelization was achieved in all cleft patients with no symptoms of infection. In one patient infection was seen in donor site 1-week after the operation. The region was curetted and antibiotics administrated again. Two patients showed an infection of recipient site, after 4 weeks the grafts were removed. In all the patients, as the screw head became apparent until 1 thread, amount of the resorption were considered <1.5 mm. Conclusion: The usage of mandibular block grafts is a simple and effective treatment modality for reconstruction of different types of alveolar defects and it also reduces cost of treatment.

Comparison of the efficacy of low doses of methylprednisolone, acetaminophen, and dexketoprofen trometamol on the swelling developed after the removal of impacted third molar

Background The aim of the present study was to compare the efficacy of low doses of methylprednisolone, acetaminophen and dexketoprofen trometamol, which are among the drug groups used in our clinic, on postoperative swelling developing after removal of impacted third molar. Material and Methods The three group of patients received either 40 mg methylprednisolone or 300 mg acetaminophen or 12.5 mg dexketoprofen trometamol one hour before the procedure, according to the patient groups. The patients in the methylprednisolone group were injected with methylprednisolone at a dose of 20 mg 24 hour after the procedure and prescribed 300 mg acetaminophen as rescue analgesic. During the postoperative period, the doses that were given before the procedure were continued 3 times a day for 2 days in the acetaminophen and dexketoprofen trometamol groups. Maximal swelling was assessed preoperatively and at the postoperative 48 hours by ultrasound images. Results Swelling was 34% lower in the methylprednisolone than in the other groups; however, no statistically significant difference was found between the groups. The acetaminophen and dexketoprofen trometamol groups exhibited clinical results close to each other. Conclusions Combination of low doses of methylprednisolone and acetaminophen provide a safe and adequate clinical success on swelling. Key words: Methylprednisolone, acetaminophen, dexketoprofen trometamol, third molar extraction, swelling.

Assessment of the Local Effects of Ketamine Requires Exclusion of Systemic Effects

o the Editor:—We read about the interesting study by atilmis et al, which focuses on the local administration of etamine in dental surgery. We find this study important for reasons: 1) there are few clinical trials regarding ketmine’s local effects; and 2) low-dose ketamine effectively educes pain and swelling without any side effects after ocal administration. We would like to comment on local dministration of ketamine and share our experience. Adverse effects after third molar surgical extractions have een reported to show a threefold increase in patients who xperience pain, swelling, and trismus, alone or in combiation, compared with patients who were asymptomatic. o control postoperative inflammation and associated sympoms, it is necessary to provide adequate anti-inflammatory herapy. Ketamine is known to exert anti-inflammatory efects that are not mentioned in the Satilmis et al study. The nti-inflammatory property of ketamine may have further dvantages during third molar extractions. Ketamine is an anesthetic induction drug that has been sed for more than 30 years. It provides strong analgesia fter systemic and intrathecal administration. Ketamine also as a peripheral analgesic action when used for local peipheral application (eg, topical, submucosal). In the Satilis et al study, the analgesic action of submucosal ketmine, which enhances articaine analgesia, could be a result f its central effect, peripheral effect, or both. The systemic nalgesic effects after injection of ketamine make it difficult o assess the local effects. In our similar unpublished data, ssessing ketamine for mandibular impacted third molar xtraction after unilateral local injection of ketamine for ilateral third molar surgery simultaneously, we noted bilatral pain relief. In fact, some of our patients claimed that ain was less on the contralateral site of injection. These esults led us to believe that, beside the local analgesic ffect, the systemic analgesic effects of ketamine may also e important in dental surgery. Further studies may clarify he exact mechanisms of ketamine for local pain relief. Side effects of ketamine may be of concern. In our aboveentioned study, we initially used 0.3 mg · kg 1 ketamine ombined with articaine for the prevention of postoperaive pain. Because of dizziness, unpleasant psychomimetic ide effects, and longer postoperative recovery in patients ith more than 80 kg of body weight, we needed to readust the dose. Submucosal ketamine was decreased to 0.2 g · kg 1 (maximum 18 mg), together with midazolam remedication. This reduced dose led to transient dizziness n some patients. Patients in the study by Satilmis et al weighed ess than 80 kg; therefore they may have encountered fewer ide effects with a similar ketamine dose. Further randomzed studies will highlight the best administration technique nd dose for ketamine in dental surgery.