Rifat Gozneli

Evaluating the correlation between the lateral pterygoid muscle attachment type and internal derangement of the temporomandibular joint with an emphasis on MR imaging findings.

OBJECTIVES Disc displacement is accepted as one of major findings in temporomandibular disorders. Correlation between lateral pterygoid muscle (LPM) attachment type to the disc-condyle complex and TMJ dysfunction has rarely been discussed and still not clarified. The purpose of this study was to assess the prevalence LPM attachment type to the disc-condyle complex, and to investigate whether these attachment types are linked to MR imaging findings of ID and TMJ dysfunction in a Turkish population. STUDY DESIGN Ninety-eight TMJs in 49 patients (32 males, 17 females, mean age=36 years) with one of either: TMJ clicking, TMJ locking, restricted movement of the jaw, or pain in the TMJ region, were included. According to the clinical findings and data obtained from MRI examinations, TMJs dysfunctions were classified. LPM attachments to the condyle-disc complex were categorized into three different types. Correlation between TMJ dysfunction and LPM attachments to the condyle-disc complex was evaluated. RESULTS Of 98 TMJs in 49 patients (32 males, 17 females, mean age=36 years), 47 TMJs (%48) were evaluated as normal, 35 (%35.7) had a disc displacement with reduction and 16 (%16.3) TMJ had a disc displacement without reduction. Arthritis was seen in 49 TMJs (%50). LPM attachments to the condyle-disc complex were as follows: Type I (29.6%), Type II (40.8%), and Type III (29.6%). There was no statistically significant difference between the type of muscle attachment and the presence or absence of disc displacement (p=0.481), disc degeneration (p=0.752), articular surface degeneration (p=0.117). CONCLUSIONS There was no statistically significant correlation between the LPM attachment types and TMJ abnormalities.

A Novel Vector Control Device in Horizontal Bone Transport

Bone grafting is the most frequently used technique for cleft palate repair. The major shortcoming of this method is the difficulty of achieving complete soft tissue coverage in cases with large defects. Buccal or tongue flaps are used most commonly in such cases, but the outcome is not always ideal. Alveolar distraction may be a more promising method for overcoming such problems. 1-4 This article describes a new method developed to treat cases with large defects and presents a case to illustrate the use of this protocol. Materials and Methods Chromium-cobalt crowns with double tubes for the molars and semicircular tubes for other teeth were prepared separately for each segment. Care was taken to orient the tubes in the same horizontal plane. The cast segments were connected by two 1.5-mm stainless steel arch wires. The arches were extended distally from the tubes to accommodate the planned anterior movement of the distraction segments. To avoid mucosal irritation, double tubes were placed as mesially as possible on the molar crowns. The anchoring segments were connected by a transpalatal bar. A custom-designed tooth-borne distractor was positioned occlusally on the arch (Fig 1). Case Report A 16-year-old female patient presented with absence of the premaxilla and bilateral complete cleft lip and palate. The etiology was uncertain. The treatment plan was reconstruction of the premaxilla and correction of the sagittal jaw relationship, using the alveolar distraction protocol to improve the patient’s facial profile and appearance (Fig 2). Treatment started with leveling and alignment of the dental arches, leaving a space of 3 mm between the maxillary second premolar and first molar to avoid root exposure during osteotomy. SURGICAL METHOD First, a cast metal appliance was cemented. The next day, surgery was performed under general anesthesia. The segments were mobilized by making vertical incisions between the maxillary second premolars and first molars, followed by horizontal osteotomies above the roots. During this process, the palatal mucosa was left intact. Arches and distractors were inserted intraoperatively, and the distractors were activated with five full turns (5 mm) to observe the mobility of the discs. The distractors were then closed, the segments were ligated tightly, and the flaps were sutured. After a 5-day latency period, activation was started at a rate of one half turn (0.5 mm) twice a day. The patient was monitored weekly until the 2 segments contacted at the midline. Activation was continued bilaterally until the desired amount of premaxillary augmentation, including 30% overcorrection, was achieved (Fig 3).

Rehabilitation of maxillary anterior esthetics by alveolar distraction osteogenesis with immediate implant placement: a case report.

Esthetic reconstruction of severe soft and hard tissue deficiencies is the utmost challenge in implant dentistry. To prevent postoperative bone resorption and to control the amount of hard and soft tissue volume, distraction osteogenesis followed by immediate implant placement has been proven to be a promising combined technique. The aim of this report is to introduce a treatment strategy to maintain anterior esthetics and to control hard and soft tissue volume in a case, treated with the combined technique of vertical alveolar distraction and immediate implant placement. An osteotomy was performed by the use of an oscillating saw. Cut alveolar segment was mobilized, and a distractor device was inserted in between the segments. During the activation and consolidation periods of distraction, anterior esthetics was provided with removable acrylic provisional crowns placed on the distractors rod. In 2 weeks of distraction period, vertically 10 mm of new bony segment was obtained, and 2 weeks after the removal of distractor, maxillary incisors were extracted. Four dental implants were placed according to the immediate placement protocol. In osseointegration period, provisional restorations were fabricated on abutments to form harmonious gingival contours and to maintain maxillary anterior esthetics until the fabrication of final restorations.

Simultaneous Alveolar Cleft Closure and Dental Midline Correction With Curvilinear Intraoral Distraction

This article describes a new method that enables vector control during alveolar distraction osteogenesis in the treatment of a cleft palate patient. The patient presented with unilateral complete cleft lip and palate, and the alveolar part of the defect was covered by a mobile buccal flap. The distraction was performed by sliding the surgically released tooth segment with the help of an intraoral distractor over 1.5-mm stainless steel archwires held by metal crowns. This vector-controlled method enabled new bone and attached gingiva formation in harmony with the proper alveolar shape.

The effect of temporary hydrostatic splint on occlusion with computerized occlusal analysis system

AIMS The aim of this study was to evaluate the effect of temporary hydrostatic splint on occlusion with computerized occlusal analysis system. MATERIAL AND METHODS Maximal bite force was recorded in intercuspal position by use of computerized occlusal analysis system from 11 female, 9 male, 20 subjects, (average age of 20) with normal intact dentitions. Subjects were instructed to use the hydrostatic splint for 24 h. Occlusal records were repeated three times before and after splint. All recordings were evaluated to determine the repeatability of the computerized occlusal analysis system. RESULTS AND CONCLUSION Hydrostatic splint increased maximum biting force. Relative percentage of left and right bite forces changed in the direction of neurophysiological position of the muscles. Hydrostatic splint can be a viable option for occlusal adjustments.

Effects of Silica Coating by Physical Vapor Deposition and Repeated Firing on the Low‐Temperature Degradation and Flexural Strength of a Zirconia Ceramic

PURPOSE To examine the application of physical vapor deposition (PVD) silica coating as an approach to retard low temperature degradation (LTD) for dental applications. Accelerated aging characteristics of heat- and surface-treated zirconia material were also investigated by exposing specimens to hydrothermal treatment. MATERIALS AND METHODS The specimens (90 disc-shaped specimens [15 mm ×1.2 mm]) were divided into 9 groups (n = 10) according to the test protocol: Ctrl, control (no surface treatment); Ag, autoclave aging; GrAg, grinding + aging; SiAg, silica coating + aging; GrSiAg, grinding + silica coating + aging; 3FAg, 3-time firing + aging; Gr3FAg, grinding + 3-time firing + aging; 5FAg, 5-time firing + aging; Gr5FAg, grinding + 5-time firing + aging. Accelerated aging was performed in a steam autoclave (134°C, 2 bars) for 12 hours. Following each treatment protocol, X-ray diffraction (XRD) analysis was used to estimate the relative amount of monoclinic phase and corresponding transformed zone depth (TZD). Additionally, a biaxial flexure test was used to calculate the flexural strength. Statistical analysis was conducted with one-way ANOVA and Fishers LSD test (p < 0.05). RESULTS The tetragonal-to-monoclinic transformation was retarded by PVD silica coating only on ground surfaces. Ground and heat-treated specimens exhibited the lowest monoclinic content after aging. The biaxial flexural strength value of the GrAg group was significantly higher than the values in all of the other groups except the SiAg group. The flexural strength value of the GrSiAg group was significantly higher than that of the 3FAg group. There was no statistically significant difference between the other groups (p > 0.05). CONCLUSIONS Grinding decreased the susceptibility of zirconia to LTD and increased the flexural strength. PVD silica coating and repeated firing decreased the monoclinic content only in ground specimens during aging.