Onur Gönül

Effects of Ankaferd Blood Stopper and Celox on the Tissue Factor Activities of Warfarin-Treated Rats

The aim of this study is to evaluate the effect of these new generation hemostatic agents on early-stage soft tissue healing of warfarin-treated rats by measuring the tissue factor (TF) activities. Rats in the warfarin group were treated intraperitonally with 0.1 mg/kg warfarin, and rats in the control group were treated with 1 mL/kg saline. All rats had 3 incisions on dorsal dermal tissue applied Celox, Ankaferd Blood Stopper (ABS), or no hemostatic agent. Six rats from each group were killed on day 4, and the other 6 were killed on day 8. Prothrombin time (PT) and TF activities were evaluated, respectively. Both the hemostatic agents positively affected the hemostasis. Warfarin treatment increased the PT levels as expected. Celox-treated dermal tissues had higher TF activity when compared to ABS-treated ones. The ABS affected the early-stage healing positively in clinical aspect, whereas Celox was more effective on hemostasis by means of increasing TF activities.

A Comparison of the Effects of Midazolam/Fentanyl and Midazolam/Tramadol for Conscious Intravenous Sedation During Third Molar Extraction

PURPOSE This study evaluated the effects of fentanyl and tramadol, used in combination, as sedation for third molar surgical extraction. PATIENTS AND METHODS This prospective, randomized, double-blind, placebo-controlled study included 60 patients undergoing extraction of a horizontal third molar with an Amsterdam Preoperative Anxiety and Information Scale score above 10 points. All of the patients were first given a 0.03-mg/kg bolus of midazolam, and then they were randomized into 3 groups: group A, midazolam only; group B, midazolam and 1-μg/kg fentanyl; and group C, midazolam and 1-mg/kg tramadol. The vital signs were recorded. Patients were assessed for postoperative pain and adverse effects, and patient and surgeon satisfaction was assessed. RESULTS No differences were found in the heart rate among groups (P > .05). The mean blood pressure was also similar until the 40th minute, after which the mean blood pressure in the patients in group A was lower than that in the other 2 groups (P < .01). In the postoperative pain assessment, the visual analog scale scores of the patients in group C were lower than those in the other 2 groups in the first postoperative hour (P < .05). The time at which the first rescue analgesic was taken in groups A, B, and C was 3, 3.5, and 5 hours postoperatively, respectively, and was significantly later in group C (P < .01). No difference was found in patient/surgeon satisfaction among the groups. CONCLUSIONS Tramadol has a better analgesic effect in third molar surgery than fentanyl and placebo.

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.

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.

Management of Midfacial Fractures

The management of midfacial fractures includes the treatment of facial fractures, dentoalveolar trauma, and soft-tissue injuries, as well as associated injuries, mainly of the head and neck [1]. The management of fractures of the maxillofacial complex remains a challenge for the oral maxillofacial surgeon, demanding both skill and expertise [2]. The success of treatment and implementation of preventive measures are more specifically dependent on epidemiologic assessments [3].Midfacial fractures can occur in isolation or in combination with other serious injuries, including mandibular, ophthalmologic, cranial, spinal, thoracic, and abdominal trauma, as well as upper and lower orthopedic injuries [4].The epidemiology of facial fractures varies in type, severity, and cause depending on the population studied. Differences among populations in the causes of maxillofacial fractures may be the result of differences in risk and cultural factors among countries, but are more likely to be influenced by the severity of injury [1,5]. The causes of maxillofacial fractures have changed over the past three decades, and they continue to do so. The main causes worldwide are traffic accidents, assaults, falls, sport-related injuries, and warfare [6-8]. Many articles pertaining to the incidence and causes of maxillofacial injuries have been published [1,4,7-10]. In 2003, Motamedi [7] reported the distribution of facial fractures as 72.9% mandibular, 13.9% maxillary, 13.5% zygomatic, 24.0% zygomatico-orbital, 2.1% cranial, 2.1% nasal, and 1.6% frontal injuries [Figure 1].

Effects of Leukocyte- and Platelet-Rich Fibrin Alone and Combined With Hyaluronic Acid on Pain, Edema, and Trismus After Surgical Extraction of Impacted Mandibular Third Molars

PURPOSE In this prospective, randomized, double-blind controlled study, we evaluated the effects of leukocyte- and platelet-rich fibrin (L-PRF) alone and combined with a hyaluronic acid (HA) sponge on pain, edema, and trismus after mandibular third molar surgery. PATIENTS AND METHODS In total, 60 patients were included in this study. The patients were randomly divided into 3 groups: L-PRF group (L-PRF was applied to the socket), L-PRF-plus-HA group (L-PRF combined with HA was applied to the socket), and control group (nothing was applied). The primary outcome variables were edema (tragus to pogonion, tragus to labial commissure, and angulus mandibulae to lateral canthus), trismus on postoperative days 2 and 7, and postoperative pain scores on a visual analog scale from hour 6 to day 7. RESULTS After extraction, the tragus-to-pogonion values were significantly higher in the control group both on day 2 (higher than L-PRF-plus-HA group) and on day 7 (higher than both groups). The mean increase in tragus-to-labial commissure values on day 2 was significantly higher in the control group than in the L-PRF-plus-HA group. The mean increase in angulus mandibulae-to-lateral canthus values on days 2 and 7 was significantly higher in the control group than in the L-PRF and L-PRF-plus-HA groups. There was no significant difference among groups in trismus and visual analog scale pain scores. Analgesic intake on the day of surgery in the L-PRF-plus-HA group was significantly lower. CONCLUSIONS Our results imply that L-PRF, particularly when combined with HA, can be used to minimize postoperative edema after mandibular third molar surgery. However, further studies with larger samples are required.

Effect of Ankaferd Blood Stopper on Skin Superoxide Dismutase and Catalase Activities in Warfarin-Treated Rats.

Aim: Ankaferd Blood Stopper (ABS) is a new promising local hemostatic agent, and its mechanism on hemostasis has been shown by many studies. However, the effects of ABS on skin superoxide dismutase (SOD) and catalase (CAT) activities have not been investigated before. The aim of this study was to evaluate the effects of this new generation local hemostatic agent on warfarin-treated rats focusing on its the antioxidant potential in short-term soft tissue healing. Methods: Twelve systemically warfarin treated (warfarin group) and 12 none treated Wistar Albino rats (control group) were selected for the trial. Rats in the warfarin group were treated intraperitonally with 0.1 mg/kg warfarin, and rats in the control group were given 1 mL/kg saline 3 days earlier to surgical procedure and continued until killing. All rats had incisions on dorsal dermal tissue, which was applied ABS or no hemostatic agent before suturing. Six of each group were killed on day 4, and the other 6 were killed on day 8. Blood and skin samples were taken. Prothrombin time (PT) in blood samples, CAT, and SOD activities in skin samples were determined. Results: Warfarin treatment dose was found to be convenient and warfarin treatment increased the PT levels as expected. Warfarin treatment decreased CAT activity significantly compared to the control group. The ABS treatment significantly increased SOD activities in the warfarin group at the end of the eighth day. Conclusion: Ankaferd Blood Stopper acted positively in short-term tissue healing by increasing SOD activity in warfarin-treated rats. Therefore, ABS may be suggeted as a promoting factor in tissue healing.

A Rare Case of a Lost Suture Needle during Third Molar Surgery

The authors report a case that is started with a simple upper third molars surgical extraction and a broken 3.0 suture needle tip incident occurred. Broken fragments localization has been detected with 3D cone beam computed tomography (CBCT). Needle tip has been reached with the help of CBCT vision. CBCTs benefits have been discussed on these types of cases and further migration of the needle tip during surgical procedure is reported.

A New and Enhanced Version of Local Anesthetics in Dentistry

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Due to the fear of pain associated with dental injections, some people avoid, cancel, or fail to appear for dental appointments. Pain and anxiety control are among the most important aspects in local anesthetic administration in dental practice. Administration of local anesthetic produces pain and anxiety that may cause subsequent unfavorable behavior (1). As reliable management of pain is an important factor in reducing fear and anxiety in dental treatment, clinicians must have a thorough knowledge of local anesthetic solutions and techniques. When an agent and a technique are chosen, it is important for the clinician to understand the onset, depth, and duration of anesthesia in relation to the operative procedure to be performed (2). This chapter introduces new local anesthetic formulations, techniques, and postinjection complications in dentistry.