Mehmet Ali Altay

Management of fractures of the atrophic mandible: a case series

OBJECTIVE This study aims to report the outcome of patients with atrophic mandible fractures. STUDY DESIGN Atrophic mandible fractures in 11 patients (7 females and 4 males) were approached with a transcervical incision, and bone segments were stabilized with 2.7-mm reconstruction titanium plates and locking screws placed at the lateral border of the mandible. In 6 of the 11 cases, autogenous cancellous bone was used to repair a continuity defect or to augment the vertical height of the bone in the region of the fracture(s). RESULTS No major intraoperative or postoperative complications were encountered in any patient. Two patients presented with postoperative infections that resolved with incision-drainage and antibiotics, and removal or replacement of the reconstruction plates or the bone grafts was not required. CONCLUSIONS Treatment of atrophic mandible fractures can be performed safely and effectively with reconstruction plates, with or without bone grafting. The most conservative and predictable treatment in the long term is the definitive reconstructive surgical procedure to restore form and immediate function.

Patient-centered quality of life measures after alloplastic temporomandibular joint replacement surgery

The purpose of this study was to evaluate patient-reported outcome measures of quality of life (QoL) for patients with end-stage temporomandibular joint (TMJ) disease who have undergone TMJ prosthetic replacement. The records of 36 patients who had undergone alloplastic total joint replacement procedures were analyzed. Patients were treated using either TMJ Concepts or Biomet/Lorenz prosthetics. Patients were asked to complete a 12-item TMJ-S-QoL survey, which encompassed questions pertaining to pain, speech, chewing function, and various aspects of social life and mental health. The questions were answered on a 5-point scale. Data were analyzed using the Wilcoxon signed-rank test. Among the 36 patients (six male and 30 female), 18 responded to the survey. Markers of QoL after surgery were compared to the preoperative period. Significant improvements were reported for pain (94.4% of patients), chewing (83.3% of patients), speech (55.6% of patients), anxiety (72.2% of patients), activity (66.7% of patients), recreation (61.1% of patients), and mood (66.7% of patients) (all P<0.05). TMJ prosthetic replacement significantly enhanced QoL among patients suffering from chronic pain, limited range of motion, anxiety, impaired speech, and chewing due to end-stage TMJ disease in this sample of surgical patients.

DOES THE INTAKE OF SELECTIVE SEROTONIN REUPTAKE INHIBITORS NEGATIVELY AFFECT DENTAL IMPLANT OSSEOINTEGRATION? - A RETROSPECTIVE STUDY

The success of osseointegration is influenced by several factors that affect bone metabolism and by certain systemic medications. Selective serotonin reuptake inhibitors (SSRIs) have been previously suggested to be among these medications. This study aims to investigate the association between systemic intake of SSRIs and failure of osseointegration in patients rehabilitated with dental implants. A retrospective cohort study was conducted, including a total of 2055 osseointegrated dental implants in 631 patients (109 implants in 36 SSRI \users and 1946 in 595 nonusers). Predictor and outcome variables were SSRI intake and osseointegration failure, respectively. The data were analyzed with Mann-Whitney test or Fisher exact test accordingly. Both patient-level and implant-level models were implemented to evaluate the effect of SSRI exposure on the success of osseointegration of dental implants. Median duration of follow-up was 21.5 months (range = 4-56 months) for SSRI users and 23 months (range -60 months) for nonusers ( P = .158). Two of 36 SSRI users had 1 failed implant each; thus, the failure rate was 5.6%. Eleven nonusers also had 1 failed implant each; thus, the failure rate was 1.85%. The difference between the 2 groups failed to reach statistical significance at patient and implant levels ( P = .166, P = .149, respectively). The odds of implant failure were 3.123 times greater for SSRI users compared with nonusers. Patients using SSRIs were found to be 3.005 times more likely to experience early implant failure than nonusers. The results of this study suggest that SSRIs may lead to increase in the rate of osseointegration failure, although not reaching statistical significance.

Medication-related osteonecrosis of the jaw: An institution's experience.

ABSTRACT Objectives This study aimed to evaluate and report the outcomes associated with the management of patients who were treated surgically for medication-related osteonecrosis of the jaw (MRONJ).Methods: Demographic and medical profiles of patients with a diagnosis of MRONJ were created. The type of surgical treatment, complications, and treatment outcomes were identified.Results: Twenty-one patients with an average age of 68.42 years (range 40–90 years) were included. Nineteen patients had only mandible involvement, one patient had only maxilla involvement, and one patient had both mandible and maxilla involvement. Thirteen patients underwent marginal resections. Eight patients underwent segmental resection of the mandible with immediate reconstruction. Nineteen patients healed without any complications. Two patients who had undergone segmental resection of the mandible experienced postoperative complications and needed a second surgery to achieve primary closure.Discussion: Advanced MRONJ can effectively be treated with resective surgery in combination with medical treatment.

Does Third Molar Surgery Alter Cardiac Parameters? A Retrospective Study

Objective: To investigate perioperative changes in the cardiac parameters of anxiety, which are blood pressure and heart rate, in patients undergoing surgical extraction of third molars. Material and Methods: Patients who reported anxiety before scheduled procedures were monitored for cardiac parameters before, during and after the surgery. The obtained data were analyzed to determine if there is a certain pattern of change within these values in systemically healthy patients. Alterations in selected parameters with regard to duration and difficulty of operation were also studied. IBM SPSS Statistics was used for data analysis. Repeated-measures of analysis of variance (ANOVA), paired samples t-test and Kruskal-Wallis tests were applied and a significance level of 5% was assessed. Results: Difficulty was categorized as minimally, moderately or very difficult in 9, 28 and 3 patients respectively. Mean operation time was 36.18 minutes with a range of 8 to 91 minutes. Operation time showed no variations with different levels of difficulty (p = 0.268). No statistical differences in any of the parameters listed above could be identified. Conclusion: Despite the common belief that dental procedures initiate anxiety, this study reveals that physiological parameters of anxiety show no significant changes over the course of third molar surgery, likewise difficulty and duration of surgery do not cause noteworthy changes in these parameters.

Is History of Periodontitis a Risk Factor for Peri-implant Disease? A Pilot Study

PURPOSE The aim of this pilot study was to evaluate clinical outcomes of implant treatment in periodontally compromised patients. MATERIALS AND METHODS Partially edentulous patients who were diagnosed and treated for chronic periodontitis and later rehabilitated with implant-supported single crowns or fixed partial dentures were enrolled in this study. At the final follow-up, data on probing pocket depth and bleeding on probing were collected, and changes in peri-implant bone levels were assessed on periapical radiographs. Accordingly, patients were categorized into peri-implant disease-free (PID-free), peri-implant mucositis (PIM), or peri-implantitis (PI) groups. Additionally, information on the history of systemic diseases was obtained and correlated with the findings. RESULTS Seven females and six males with a mean age of 55.2 (standard deviation [SD] ± 8.38) years were included in this study. Fifty-five implants were placed in 13 partially edentulous patients with a history of chronic periodontitis. The mean follow-up in the study was 35.1 (SD ± 2.40) months. No implants were lost in the 13 patients, for a cumulative survival of 100%. PI was confirmed in 3 patients and PIM in 8 patients, while 2 patients were found to be PID-free. Diabetes and hypertension were found to be the predominant systemic factors among patients affected by peri-implant diseases. CONCLUSION Patients with a history of periodontitis are at considerable risk of being affected by peri-implant mucositis, if not by peri-implantitis.

Transconjunctival Lower Blepharoplasty

There is no secret to achieving successful results with lower belpharoplasties; as is the case with any surgical procedure, proper patient evaluation and development of a comprehensive, anatomic-based treatment plan are prerequisites for success. For situations in which a patient has little lid laxity and pseudoherniated periorbital fat, transconjunctival lower blepharoplasty is the treatment of choice. Transconjunctival lower blepharoplasty enables the surgeon to reposition fat, effectively blending the lid-cheek junction and filling the tear trough deformity. In order to better enable clinicians to achieve optimal outcomes, the authors advocate an anatomic-based approach for patient evaluation and treatment planning.