Haluk Keskin

A comparative analysis of the accuracy of different direct impression techniques for multiple implants

BACKGROUND The aim of this study was to compare the accuracy of different direct implant impression techniques for edentulous arches with multiple implants. METHODS Five experimental groups (n = 5) were assembled. Experimental models were created by a direct splinted technique (EG2 to EG5) and a non-splinted technique (EG1). In EG2 and EG3 synOcta impression copings were splinted with an acrylic resin bar, and in EG4 and EG5 with a light-curing composite resin bar. In EG3 and EG5 the resin bars were sectioned, while the other experimental groups were not. Three-dimensional discrepancies were measured by a computerized coordinate measuring machine. Distortion values among the groups were analysed using one-way repeated measures ANOVA. The post hoc Tukeys test was then performed for multiple comparisons. RESULTS The highest accuracy was obtained in EG2 (mean deviation: 12.70 μm). The acrylic bars demonstrated less deviation (12.70 μm and 22.71 μm) from the master model than the light-curing composite resin groups and the non-splinted group (41.09 μm). The post hoc Tukeys test showed no significant difference among the groups when the effect of splint design on accuracy was investigated. CONCLUSIONS For situations where impressions of multiple implants are to be made, splinting impression copings with acrylic resin demonstrate superior results than the non-splinted technique and splinting with light-curing composite.

Clinical and radiographic outcomes of implants immediately placed in fresh extraction sockets

OBJECTIVE The objective of this study was to examine the clinical and radiographic results of implants placed in fresh extraction sockets for 2 years of function. STUDY DESIGN Ten patients were presented a treatment protocol involving the extraction of their remaining mandibular teeth and immediate placement of 4 implants (2 in fresh extraction sockets; test group (TG, n = 20), 2 in mature bone; control group (CG, n = 20). Descriptive statistics for the differences between baseline and follow-up values were assessed by chi-square test. RESULTS None of the implants lost osseointegration. The MPI Score 0 was 80.3% in SG, 82.7% in CG, and MPI Score 1 was 13.4% in SG and 14.9% in CG at the end of 1 year, and remained stable after 2 years. No significant difference in MPI, MBI, KMW, and PPD were observed between the baseline examination and controls. Chances in MBL in CG were slightly higher in SG. CONCLUSION Placement of implants in fresh extraction sockets is a reliable treatment alternative.

Early results of low-level laser application for masticatory muscle pain: a double-blind randomized clinical study

BackgroundTo evaluate the effect of Low Level Laser (LLL) application at the points of greatest pain in patients with chronic masticatory muscle pain.MethodsA total number of 30 (21 women, 9 men, with a mean age of 39.2) were selected after the diagnosis of MPDS according to the Research Diagnostic Criteria for Temporomandibular Disorder (RDC/TMD). The patients were randomly divided into three groups; laser group I (n = 10); patients received the LLL at the point of greatest pain, laser group II (n = 10); patients received LLL at pre-established points in the effected muscles and placebo group (n = 10). LLL and placebo were applied three times per week, for a total of 12 sessions. Mandibular mobility was examined, masticator muscles tenderness were assessed and PPT values were obtained. Subjective pain levels were evaluated using VAS. The measurements performed before the treatment and after the completion of the therapy. Descriptive statistics (mean, standard deviation, and frequency) Student’s t-test, Mann–Whitney U-test and paired-sample t-tests were used for analysis.ResultsIn both laser groups, there was a statically significant reduction in PPT values of the muscles, number of muscles without any pain on palpation increased significantly, mandibular movements’ ranges were improved. Laser group I demonstrated statistically better results than the Laser group II in all of the measured values. Plasebo group did not show any statistically difference in any of the measured values.ConclusionsLLLT can be accepted as an alternative treatment modality in the management of masticatory muscle pain and direct irradiation seems to effect better.Trial registrationCurrent Controlled Trials ISRCTN31085, Date of registration 28/08/20145.

Estrogen Replacement Therapy Among Post-menopausal Women and Its Effects on Signs and Symptoms of Temporomandibular Disorders

Abstract The prevalence of temporomandibular disorders (TMD) is about two to five times higher in females than in males. Data for the higher prevalence of TMD in women and prevalence rates peak during the reproductive years and decrease after menopause. This indicated that female sex hormones may play a role in the etiology or maintenance of TMD. The aim of this study was to investigate the relationship between postmenopausal hormone use and TMD in Turkish postmenopausal women. One hundred-eighty (180), postmenopausal women, aged 42-72 years, were examined both clinically and by questionnaire with regard to the signs and symptoms of temporomandibular disorders, general health status and use of postmenopausal hormone replacement therapy in the preceding year. Ninety-one (91) postmenopausal women (50.6%) were on hormone replacement therapy (HRT). The remaining 89 (49.4%) postmenopausal women were not on hormone replacement therapy. There was no significant difference found in the signs and symptoms of TMD between postmenopausal women using hormone therapy and those not using postmenopausal hormones. There was no association between the use of postmenopausal hormones and the signs and symptoms of TMD in this study.

Effects of Different Abutment Connection Designs on the Stress Distribution Around Five Different Implants: A 3-Dimensional Finite Element Analysis

The stability of the bone-implant interface is required for the long-term favorable clinical outcome of implant-supported prosthetic rehabilitation. The implant failures that occur after the functional loading are mainly related to biomechanical factors. Micro movements and vibrations due to occlusal forces can lead to mechanical complications such as loosening of the screw and fractures of the abutment or implants. The aim of this study was to investigate the strain distributions in the connection areas of different implant-abutment connection systems under similar loading conditions. Five different implant-abutment connection designs from 5 different manufacturers were evaluated in this study. The investigation was performed with software using the finite element method. The geometrical modeling of the implant systems was done with CATIA virtual design software. The MSC NASTRAN solver and PATRAN postprocessing program were used to perform the linear static solution. According to the analysis, the implant-abutment connection system with external hexagonal connection showed the highest strain values, and the internal hexagonal implant-abutment connection system showed the lowest strain values. Conical + internal hexagonal and screw-in implant abutment connection interface is more successful than other systems in cases with increased vertical dimension, particularly in the posterior region.

Evaluation of orofacial function in temporomandibular disorder patients after low-level laser therapy

Abstract Objective. To evaluate the effect of low-level laser therapy on occlusal contact area, occlusal pressure and bite force in temporomandibular disorder patients. Patients and method. Twenty patients (14 women, six men, mean age 33.1 ± 3.8 years) diagnosed with myofascial pain according to the Research Diagnostic Criteria for Temporomandibular Disorder (RDC/TMD) participated in the study. Twenty healthy individuals, matched in age and gender, served as a control group. Low-level laser was applied to the mastication muscles three times per week, for a total of 10 sessions. The mandibular mobility range was evaluated. The maximum bite force, occlusal contact area and occlusal pressure were measured bilaterally with a dental pre-scale before and after treatment. All variables were analyzed descriptively. Changes in the masticatory muscle tenderness, mandibular movements, maximum bite force, occlusal contact area and occlusal pressure were compared by paired-sample Students t-tests. Results. There was a significant increase in the pressure pain threshold of the examined muscles. Mandibular movements were significantly improved in all patients. There was also a significant decrease in pain by palpation after laser exposure. However, no significant change was found in the maximum bite force, occlusal contact area or occlusal pressure after the treatment and also the values after the treatment were still significantly lower than those of the healthy individuals. Conclusion. This particular type of LLLT is effective at relieving pain but does not provide physical improvement.

Patient responses to vacuum formed splints compared to heat cured acrylic splints: pilot study

ObjectiveVacuum formed and heat cured acrylic splints have been used in the diagnosis and treatment of temporomandibular disorders. The aim of this study was to evaluate patient’s preference to either the vacuum formed or the heat cured acrylic splint.Material and methodsTwenty patients planned to receive splints were chosen from the dental school. Both types of occlusal splints were fabricated for each of them. Each patient used the splints alternatively on a nightly basis for 3 weeks. After 3 weeks, each patient completed a questionnaire regarding the comfort, fit, retention, occlusal contact, taste, gingival and lip irritation, smoothness and smelling. Statistical analysis was conducted by the MacNemar’s Chisquare test.ResultsThere was no statistical difference in patient’s responses to the different splint materials except for the comfort of wearing through the night.ConclusionThe vacuum formed and heat cured acrylic splint may be equally worn in patient preference for treatment of temporomandibular disorders.

SECTIONAL MANDIBULAR COMPLETE DENTURE FOR A TOTAL MAXILLECTOMY PATIENT WITH TRISMUS: A CLINICAL REPORT

This report presents the case of a 60-year-old male patient with trismus induced by radiotherapy and fabrication of a sectional mandibular complete denture to allow the insertion of the denture into the mouth. A mandibular sectional denture was designed in two pieces with a locking mechanism by using mini anchor and ball abutment housing with cap. Patients who have undergone maxillectomy often have constricted mouth openings, as a result of surgical intervention and radiotherapy, and complain of an inability to insert or remove dentures. A new approach is vital for sectional dentures because existing sectional denture fabrication techniques cannot meet the ongoing needs of trismus patients. The mini anchor system with ball abutment housing has better mechanical retention in acrylic resin and can provide favorable stabilization during masticatory function; thus, additional framework is not required for assisting in stabilization and retention.

Oral Rehabilitation of an Osteopetrosis Patient with Osteomyelitis

Osteopetrosis is a congenital disorder characterized by increasing osteoclastic function resulting in osteomyelitis in the jaws. Orofacial findings in osteopetrosis patients are unerupted, malformed, or delayed teeth and many dental caries due to vulnerable enamel and dentin and osteomyelitis. Many reports have described that maxilla is an uncommon site of occurrence for osteomyelitis due to cortical bone morphology and collateral circulation. This report aims to discuss clinical features and prosthodontic management of a patient with clinical features of adult form of osteopetrosis and osteomyelitis in both jaws. The patient has reported better masticatory and speech efficiency with removable dentures in maxillary and mandibular jaw and also self-esteem improvement and family interaction.