Özgür Erdoğan

Comparison of the Effects of Warfarin and Heparin on Bleeding Caused by Dental Extraction: A Clinical Study

PURPOSE Replacement of warfarin with heparin for dental extractions in patients on long-term warfarin therapy is associated with wasted time, consumed labor, and increased treatment expenses. The aim of this study was to evaluate the safety of dental extraction without altering the warfarin regimen in patients with an international normalized ratio from 1 to 4. PATIENTS AND METHODS Forty patients who underwent tooth extraction were divided into 4 groups: continuation of warfarin without interruption (group 1), warfarin bridged with low-molecular-weight heparin (group 2), warfarin bridged with unfractionated heparin (group 3), and a control group of healthy individuals (group 4). Total amount of bleeding (milligrams) was measured for 20 minutes after tooth extraction. International normalized ratio values on the operative day and number of extra gauze swabs used for bleeding control in the first 48 hours were recorded for each patient. Results were statistically analyzed by analysis of variance, Fisher least-significant difference post hoc test, Pearson correlation, χ(2) test, and Student t test. RESULTS Mean amounts of bleeding were 2,486 ± 1,408; 999 ± 425; 1,288 ± 982; and 1,736 ± 876 mg for groups 1, 2, 3, and 4, respectively. There was no severe postoperative bleeding in any patient and the number of used extra gauze swabs did not differ significantly among groups. CONCLUSION With the aid of local hemostatic agents, dental extraction in patients receiving warfarin who have an international normalized ratio from 1 to 4 could be carried out without a significant risk of bleeding and without altering the anticoagulant regimen.

Biological Aspects and Clinical Importance of Ultrasound Therapy in Bone Healing

Objectives. The purpose of this study was to review past and recent literature findings regarding the effects of ultrasound therapy on bone healing and its clinical efficacy in medical and dental interventions. Methods. A literature review was conducted on the effects of ultrasound therapy on bone healing. The studies regarding clinical applications in long bones and maxillofacial bones were evaluated separately from each other. Results. The effects of therapeutic ultrasound on bone healing have been studied for half a century. Numerous clinical and experimental studies have addressed this relationship, and many of them have shown positive correlations. Although several theories have been proposed to explain the mechanism of action, the exact mechanism has not been fully understood. Conclusions. Therapeutic ultrasound therapy in clinical settings is a noninvasive application and has no serious complications or side effects. It may be an acceptable treatment of choice in many types of clinical procedures involving maxillofacial bones.

Effects of smoking on periimplant health status and IL-1β, TNF-α, and PGE2 levels in periimplant crevicular fluid: a cross-sectional study on well-maintained implant recall patients.

Purpose:The aim of this cross-sectional study was to evaluate the effects of smoking on periimplant health status and inflammatory cytokines interleukin-1&bgr;, tumor necrosis factor-&agr;, and prostaglandin E2 levels in periimplant crevicular fluid (PICF) and to determine their correlation with clinical parameters in well-maintained implant recall patients. Material and Methods:A total of 60 dental implants placed in 60 patients (27 patients were smoker and 33 were nonsmoker) were included in the study. Plaque index, gingival index, probing depth, periimplant bone loss, PICF volume, and biochemical cytokine levels in PICF were determined and analyzed statistically. The correlation between PICF cytokine levels and clinical parameters were also analyzed. Results:All clinical parameters with the exception of plaque scores were significantly higher in the smoker group. Significantly increased levels of cytokines were observed in the smoker group. The correlation between the cytokine levels and clinical parameters were more marked in smokers. Conclusions:Although the implants of the smoker patients seem to be clinically healthy, the results demonstrate that the implants are relatively at risk even if in a well-maintained population.

Effects of Zoledronic Acid on Healing of Mandibular Fractures: An Experimental Study in Rabbits

PURPOSE The purpose of the present study was to evaluate the effects of systemically administered zoledronic acid (ZA) on mandibular fracture healing in a rabbit model using radiodensitometric, biomechanical, histologic, and histomorphometric methods. MATERIALS AND METHODS A total of 36 skeletally mature male New Zealand white rabbits were used. The rabbits were randomly divided into 2 groups. A mandibular corpus fracture was created experimentally in all 36 rabbits. The experimental group was administered an intravenous, single dose of 0.1 mg/kg ZA, and the control group was administered only saline infusion during the procedure. All rabbits were sacrificed on the 21st postoperative day. Digital radiodensitometric analysis, a 3-point bending test, and histologic and histomorphometric examinations were performed on the harvested hemimandibles. The data were analyzed statistically. RESULTS Biomechanical testing data showed that ZA treatment resulted in a significant increase in the healed bone strength. This result was supported by the radiologic, histologic, and histomorphometric findings. CONCLUSIONS The results of the present study have revealed that systemic administration of ZA accelerates and improves the bone healing of mandibular fractures.

Outcomes of periradicular surgery of maxillary first molars using a vestibular approach: a prospective, clinical study with one year of follow-up.

PURPOSE The aim of the present prospective, randomized, controlled, clinical study was to compare the outcomes of periradicular surgery of the maxillary first molar tooth using the vestibular approach between 2 preoperative radiologic evaluation methods: cone beam computed tomography (CBCT) and conventional radiography. PATIENTS AND METHODS Periradicular surgery was applied to the maxillary first molar tooth in 40 patients. The patients were divided into 2 groups. The patients in group 1 underwent examination and preoperative planning with CBCT, and the patients in group 2 underwent examination and preoperative planning with conventional radiography. The outcomes of the treatment were evaluated radiographically and clinically, and the data were analyzed statistically. RESULTS The mean operative time was significantly shorter in group 1 than in group 2. According to the radiographic and clinical healing criteria used in the present study, the healing of patients in group 1 was rated as a success in 35%, an improvement in 40%, and a failure in 25%. In the group 2 patients, healing was rated as a success in 42.1%, an improvement in 31.6%, and a failure in 26.3%. Sinus membrane elevation was performed in 92.3% of all patients. Sinus membrane perforation occurred in 20% of the patients in group 1 and 36.8% of the patients in group 2. CONCLUSIONS Periradicular surgery of maxillary first molars using a vestibular approach is a viable treatment method with a low complication rate. Preoperative CBCT examination demonstrated positive contributions to the treatment outcomes.

Comparison of osteoconductive properties of three different β-tricalcium phosphate graft materials: a pilot histomorphometric study in a pig model.

AIMS The aim of this study was to compare the de novo bone formation ability and osteoconductive effects of three different β-tricalcium phosphate (β-TCP) graft materials. The micro-architectural parameters of the newly formed bone tissues were also compared among the different graft materials. MATERIAL AND METHODS Eight male Swiss domestic pigs were used in the study. Five bony defects were made with a trephine bur. Three of the defects were filled with Cerasorb®, Kasios® and Poresorb®. The fourth defect was filled with an autogenous bone graft. The last defect remained empty. All subjects were sacrificed after 8 weeks. RESULTS When compared to a negative control group, significant healing was observed in all the groups except the Cerasorb group. The osteoconductivity of the Poresorb group was better than that of the other groups (p < 0.05). The difference in the osteoconductivity of the Kasios and Cerasorb groups was statistically significant (p < 0.05). Comparison of the micro-architectural properties of newly formed bone tissues retrieved from the defects showed that those filled with Poresorb were the best. CONCLUSION β-TCP materials show different results in terms of the volume and characteristics of new bone formation, although they have a similar chemical structure.

Influence of two different flap designs on the sequelae of mandibular third molar surgery

PurposeThe aim of this study was to compare the influence of triangular and envelope flaps on trismus, pain, and facial swelling after mandibular third molar surgery.MethodsTwenty healthy patients with bilateral, symmetrically impacted mandibular third molars were included in this double-blinded, prospective, cross-over, randomized study. The patients were operated with envelope flap on one side and triangular flap on the other side. Trismus was determined by measuring maximum interincisal opening, and facial swelling was evaluated using a tape measuring method. Pain was determined using visual analog scale (VAS) and recording the number of pain pills taken.ResultsThe facial swelling measurements and VAS scores were lower in the envelope flap group compared to the triangular flap group. There was no significant difference between the two flap designs in operation time, maximum interincisal opening, and the number of analgesics taken.ConclusionEnvelope flap yields to less facial swelling and reduced VAS scores in comparison to triangular flap. There is no clinical difference in trismus between the two flap designs. Despite the higher VAS scores with triangular flap, no additional doses of analgesics were required in triangular flap.

Diagnostic Concordance Characteristics of Oral Cavity Lesions

Purpose. The objective of this study was to evaluate the diagnostic concordance characteristics of oral cavity lesions by comparing the clinical diagnosis of the lesions with the histopathologic diagnosis. Material and Method. A retrospective analysis was conducted on the patients, who were admitted with oral cavity pathology and underwent biopsy procedure between 2007 and 2011. The oral cavity lesions were classified into 6 different groups as odontogenic cysts, nonodontogenic cysts, odontogenic tumors, nonodontogenic tumors, malignant tumors, and precancerous lesions in accordance with the 2005 WHO classification. The diagnoses were also recategorized into 3 groups expressing prognostic implications as benign, precancerous, and malignant. The initial clinical diagnoses were compared with the histopathologic diagnoses. Data were analyzed statistically. Results. A total of 2718 cases were included. Histopathologic diagnosis did not match the clinical diagnosis in 6.7% of the cases. Nonodontogenic tumors and malignant tumors had the highest misdiagnosis rates (11.5% and 9%, resp.), followed by odontogenic tumors (7.7%), precancerous lesions (6.9%), and odontogenic cysts (4.4%). Clinicians were excelled in diagnosis of benign and precancerous lesions in clinical setting. Conclusion. The detailed discordance characteristics for each specific lesion should be considered during oral pathology practice to provide early detection without delay.

Vertical Bone Augmentation Using Bone Marrow-Derived Stem Cells: An In Vivo Study in the Rabbit Calvaria.

Purpose:To evaluate the bone regeneration capacity of bone marrow–derived stem cells (BMSCs) in vertical guided augmentation of bone tissue. Material and Methods:The calvaria of 20 rabbits were vertically augmented with autogenous bone graft (ABG); collagen/beta-tricalcium phosphate (&bgr;-TCP) linked scaffold transplanted with 15 × 104 BMSCs; or scaffold alone (control). The augmentation materials were covered with stainless steel domes. BMSCs were isolated with Ficoll-Paque technique and applied directly without in vitro expansion. The newly formed bone was evaluated using radiodensitometric, histomorphometric, histological, and micro–computed tomographic (micro-CT) analyses after a 12-week healing period. The data excluding micro-CT assessments were compared statistically. Results:Radiodensitometric and bone volume parameters demonstrated increased bone formation in both BMSC group and ABG group compared with control group (P < 0.01), but difference between the BMSC and ABG groups was not significant (P > 0.05). The mean histological scores for the BMSC, ABG, and control groups were 7.44 ± 1.03, 8.44 ± 0.81, and 6.00 ± 1.10, respectively, indicating significant difference among the groups (P < 0.05). Conclusion:BMSCs delivered with a collagen/&bgr;-TCP linked scaffold can provide improved new bone formation that is comparable with autogenous bone block graft through vertical guided bone regeneration technique.