Osman A. Etöz

Resonance frequency analysis of orthodontic miniscrews subjected to light-emitting diode photobiomodulation therapy.

The aim of this prospective experimental study was to evaluate the effect of light-emitting diode (LED) photobiomodulation therapy (LPT) on the stability of immediately loaded miniscrews under different force levels, as assessed by resonance frequency analysis (RFA). Sixty titanium orthodontic miniscrews with a length of 8 mm and a diameter of 1.4 mm were implanted into cortical bone by closed flap technique in each proximal tibia of 15 New Zealand white adult male rabbits (n = 30). The animals were randomly divided into irradiated and control groups under different force levels (0, 150, and 300 cN). OsseoPulse® LED device (Biolux Research Ltd.) 618 nm wavelength and 20 mW/cm(2) output power irradiation (20 minutes/day) was applied to the miniscrews for 10 days. The RFA records were performed at miniscrew insertion session (T1) and 21 days after surgery (T2). Wilcoxon and Mann-Whitney U-tests were used for statistical evaluation at P < 0.005 level. It was found that initial primer stability of all miniscrews was similar in all groups at the start of the experimental procedure. Statistically significant differences were found for changes in implant stability quotient (ISQ) values between LED-photobiomodulated group and the control (0 cN, P = 0.001; 150 cN, P < 0.001; and 300 cN, P < 0.001). Significant increase was found in ISQ values of LPT applied miniscrews under 0 cN (+11.63 ISQ), 150 cN (+10.50 ISQ), and 300 cN (+7.00 ISQ) force during observation period. By the increase of force levels, it was determined that ISQ values decreased in non-irradiated control miniscrews. Within the limits of this in vivo study, the present RFA findings suggest that LPT might have a favourable effect on healing and attachment of titanium orthodontic miniscrews.

A new anatomical landmark to simplify temporomandibular joint arthrocentesis

rthrocentesis of the temporomandibular joint (TMJ) was rst described by Nitzan et al.1 and is an accepted treatment or various disorders of the TMJ. Their technique includes nsertion of two needles along the canthal-tragal line, the first f which is placed into the upper joint compartment of the MJ, and the second anterior to the first to allow effective avage of the joint (Fig. 1). However, in some cases it is diffiult to insert the second needle, which means that lavage fails, he operation takes longer, the patient is uncomfortable, and here may be increased postoperative morbidity and possible amage to the facial nerve.2 For this reason single needle rthrocentesis has been proposed, in which inflow and outow go through the same cannula.2 The joint is lavaged with a ingle needle used for injection and ejection resulting 40 ml f irrigation. However, with a single needle the amount of uid may be inadequate and the pressure too low. Previously, we have used a single cannula with two ports nd two lumens that allow irrigation and lavage of the joint ith the same device and permit sufficient irrigation under the esired pressure.3 Rehman and Hall4 used a similar device alled a Shepard cannula that holds two needles together. evertheless the device that keeps two needles together eems to be relatively thick, which has the potential to damge the nerve. Repetitive use of the device may cause the tips f the needles to blunt, and increase the risk of infection. We propose a new technique, by which the patients are sked to open and close the mouth several times so that the

Anterior Mandibular Zone Safe for Implants

AbstractDuring implantology procedures, one of the most serious complications is damage of the inferior alveolar nerve (IAN). The mandibular incisive nerve is described as a terminal branch of the IAN and provides innervation to the lower anterior teeth and canines. The incisive nerve and canal are located in the interforaminal area. Although numerous studies report IAN damage during implant placement, few reports in the literature describes sensory disturbances, such as neuropathic pain, related to mandibular incisive nerve damage.The purpose of this retrospective clinical study was to evaluate the risk of neuropathic pain caused by implant placement in the interforaminal region of the mandible.Panaromic radiographs of patients who were treated with dental implants in the Department of Maxillofacial Surgery, Faculty of Dentistry at Erciyes University, between 2007 and 2012, were examined. Fifty-five patients with suspected relationship between mandibular incisive canal and dental implant were included into this study. Computed tomography scans were obtained from 10 patients who have postoperative neuropathic pain. Relationship between dental implant and mandibular incisive nerve was evaluated using a three-dimensional software program. Mandibular incisive nerve perforation by at least 1 implant was observed in all 10 patients. Descriptive analyses were also provided.Neuropathic pain may occur after implant placement in the interforaminal region due to the perforation of the incisive canal and nerve. According to the results of this retrospective study, the incisive canal and nerve perforation should be considered as a complication of implant surgery in the mandibular anterior area.

Marsupialization of unicystic ameloblastoma: A conservative approach for aggressive odontogenic tumors

Unicystic ameloblastoma (UA) is known as a distinct entity which has a less aggressive behavior when compared with conventional ameloblastoma. In this report, we have presented two cases of UAs, (of which one case showed a more aggressive behavior with mural invasion into the adjacent tissues and granular cell differentiation), both of which were successfully managed with enucleation following marsupialization. We aim to highlight how this method can be used for the successful management of such cases, rather than following more aggressive approaches. In both the cases, marsupialization was done for the UA lesions initially and follow-ups were maintained. When the tumor size had regressed on radiographic follow up, an enucleation procedure with ostectomy of the margins was carried out. Special importance was also given to the endodontic treatment of the teeth involved in the area of the lesion. The patients were free of the condition and did not show any signs of recurrence on radiographic follow-ups even after 30 months of the final procedure. Granular variant of UA is quite rare and had been considered to be more aggressive. Marsupialization of UA is an alternative treatment option of resection even for more aggressive variants, as long as the histological behavior of the lesion was carefully evaluated and strict radiographic follow-up is maintained.

Osteochondroma of the mandibular coronoid process: a rare cause of limited mouth opening

c e nlargement of the coronoid process of the mandible was rst described by Langenbeck in 1899,1 but Jacob reported he pseudojoint between an enlarged mushroom-shaped andibular coronoid process and the zygoma, now known s Jacob disease.2 The hyperplastic structure of the corooid process in this disease is rare, and the development of n encapsulated osteochondroma and formation of a joint is nique.3 The symptoms of painless restricted mouth openng and an elongated coronoid process of the mandible seen n panoramic radiographs can be confused with those of emporomandibular dysfunction, ankylosis of the temporoandibular joint, and myofascial pain. Three-dimensional omputed tomography (CT) is the gold standard for accurate iagnosis.4

A reactive lesion (pyogenic granuloma) associated with dental implant: a case report.

D ental osseointegrated implants are made of titanium, which is a tissuefriendly and osseointegratable material; the implants have been widely used in preprosthetic surgery. Dental plaque, inadequate oral hygiene, traumatic occlusion, and anatomic drawbacks can cause complications associated with dental implants resulting in peri-implantitis and implant failure. However, gingival reactive lesions like Pyogenic granuloma (PG) or peripheral giant cell granuloma (PGCG) are thought of as common lesions in the natural dentition while such lesions in association with dental implants are uncommon. Pyogenic granuloma is a common, inflammatory hyperplasia of the oral cavity. Although the term ‘‘pyogenic’’ is used, PG is not an infectious lesion. PG usually occurs as a response to different stimulating factors such as local trauma or irritation, iatrogenic and hormonal factors. Because of the female hormone factor it has very high incidence in young females, principally in the second decade of life. Clinically, PG presents as a painless, smooth, or lobulated shape. It is classed as a hemorrhagic lesion because of its vascular structure and its color ranges from pink to dark red. In addition, it bleeds very easily when touched. Sometimes its surface may be covered by a pseudo-membrane due to secondary ulcerations. There are only two case reports in the literature that describe PG associated with dental implants. The aim of this paper is to present the case of a patient with PG in association with dental implant, which had been inserted after bone splitting.

Total antioxidant capacity and total oxidant status of synovial fluids in patients with temporomandibular joint pain and dysfunction

ObjectivesThe objective of this study was to investigate whether a relationship exists between total antioxidant capacity (TAC) and total oxidant status (TOS) of synovial fluids (SFs) of temporomandibular joint (TMJ) pain patients with pain and dysfunction.Materials and methodsForty-two patients with TMJ pain were included in this study. TAC and TOS values of SFs were measured with a novel colorimetric method. Independent t test and correlations were used to analyze the data.ResultsTAC of SFs in patients with TMJ pain and limited mouth opening (LMO; n = 21) were significantly lower (P = 0.03) than patients without LMO (n = 21). TOS of SF was negatively correlated with duration of the disease. There was no correlation between TAC, TOS, and VAS scores of the patients as well as age and maximum mouth opening values.ConclusionsAntioxidant response to oxidative changes (TAC and TOS) in SF decreased as the stage of dysfunction increased.Clinical relevanceLocal administration of antioxidant agents might be considered in management of TMJ pain and dysfunction to prevent possible increased oxidative stress.

Accidental use of alcohol during arthrocentesis of the temporomandibular joint.

A 34-year-old woman was treated by arthrocentesis of he temporomandibular joint (TMJ). The trainee physician ssistant had poured pure alcohol into the sterile container nstead of saline solution, and the surgeon, the nurse, and he other staff were unaware. After local anaesthesia with rticaine hydrochloride (2 ml) and adrenaline (0.005 mg/ml) Maxicaine, VEM, Ankara, Turkey), there was no sign of acial paralysis or asymmetry. A 21 G needle with a 10 ml yringe was inserted 10 mm anterior and 2 mm inferior long the canthal-tragal line until bony contact had been ade at the medial wall of the glenoid fossa.1 The upper oint space was confirmed with pure alcohol (5 ml) instead f saline solution. At this time the patient was free of omplaints. The second needle was inserted almost 3 mm posterior to he first needle until bony contact had been made.2 After a ash-out of the TMJ with alcohol (20 ml), the patient comlained of a burning sensation on the right-hand side of her ace. The surgeon noticed the smell of alcohol and stopped he arthrocentesis immediately. The patient showed signs of aralysis of the facial nerve, and numbness of the lip and ongue on the right-hand side of her face. The temporal, ygomatic, and buccal branches of the facial nerve seemed to e affected. After additional subcutaneous local anaesthesia 1 ml), the surgeon gave effective pressurising arthrocentesis 130 ml/minute, 50 kPa) with physiological saline solution 500 ml) with a dental surgical motor.3 After an hour the umbness in the right lip and tongue recovered, and the burnng sensation subsided by the end of the third hour. Vital ndings were normal but the patient still had paralysis of the ight side of her face. She was given antibiotics, and analesic and anti-inflammatory drugs, and discharged from the linic. Two weeks later her facial paralysis had not improved, nd she was prescribed vitamin B twice a day for 3 months, nd seen monthly for follow-up. The facial paralysis had ompletely resolved by the end of the third month after opertion. She was also free of pain in the TMJ, had no signs of ysfunction, and had no signs of sensory disturbance (Fig. 1).

Maxillary sinus floor augmentation in patients with maxillary sinus pseudocyst: case report

The maxillary sinus floor elevation procedure has gained popularity with predictable results, and is a safe, acceptable technique for bone augmentation, providing a base for dental implant treatment. Faint radiopaque lesions at the base of the maxillary sinus are frequent diagnoses on radiographs and must be identified during dental implant planning. Pseudocysts classically appear hemispheric, homogeneously opaque, and well delineated in panoramic and periapical radiographs. The great majority of these lesions are asymptomatic and do not require surgical treatment. In this case report, we present 4 patients who had a maxillary sinus floor elevation procedure using either crestal or lateral approaches in the presence of antral pseudocysts. No complications were encountered during follow-up periods in these patients and all implants are functioning successfully.

Experimental evaluation of acute molding of the regenerate in mandibular distraction osteogenesis in a rabbit model

OBJECTIVES The aim of this study was to investigate the possible effect of acute regenerate molding (ARM) on bone healing in mandibular distraction osteogenesis (DO). STUDY DESIGN Nine white New Zealand rabbits underwent unilateral mandibular lengthening via DO. Three groups were created: The first underwent 15° ARM, the second group underwent 30° ARM after the distraction period, and the third group served as control without molding. After 1 month of consolidation, all of the animals were killed and histomorphometric evaluation was performed. RESULTS New bone formation was uneventful in all of the groups. In the ARM groups, the amounts of osteoblasts and newly formed bone areas were higher in compressed areas than in stretched ones (P < .05). The regenerates in the control group and stretched regenerate areas of the ARM groups were similar regarding new bone formation (P > .05). CONCLUSION Acute regenerate molding could be safely applied immediately after the distraction period to correct postdistraction deformities without compromising bone healing.