Samet İnal

Intractable Bimaxillary Osteomyelitis in Osteopetrosis: Review of the Literature and Current Therapy

PURPOSE Osteopetrosis (OP), also known as Albers-Schönberg disease, is a rare metabolic bone disease caused by a congenital defect in the development or function of the osteoclasts resulting in generalized increase in skeletal mass. Osteomyelitis is a recognized complication, and prevention of dental infections can be difficult. The locations of osteomyelitis in the jawbones have been either in the mandible or maxilla. In this article, a case of OP complicated with osteomyelitis of the mandible and the maxilla is presented, and types of OP and treatment options are discussed with a literature review. MATERIALS AND METHODS The 18-year-old blind female patient had been diagnosed with OP in the past. She had a purulent discharge at the medial canthus of the left eye, in addition to another discharge of pus in the infraorbital and upper left molar region, and multiple malformed and partially impacted teeth, and there were sequestrum formations in the maxilla and mandible. For the treatment of osteomyelitis, systemic combined antibiotics of sultamicillin 750 mg and ornidazole 500 mg twice daily, were given orally for 5 weeks followed by surgical removal of small sequestra in the jaws. Persistent osteomyelitic bones were removed by saucerization in the mandibular anterior and right premolar region and the left posterior maxilla under the same antibiotic regimen. After wound healing was completely achieved in both jaws, the oroantral opening in the left posterior maxilla was successfully closed with a buccal flap under antibiotic coverage. RESULTS The purulent discharge at the medial canthus of her left eye subsided and she had no recurrent infections during the long-term follow-up of 2 years. CONCLUSION The case reported shows that osteomyelitis is difficult to treat in subjects suffering from OP. Therefore, it is necessary to be very cautious against infections in even minor surgical interventions such as simple dental extractions in patients with OP, regardless of the location of the teeth. When considering removal of impacted teeth in the posterior maxilla, resultant oroantral communication from osteomyelitis of the extraction site should be regarded as a potential complication.

Immunohistochemical comparison of indermil with traditional suture materials in dental surgery.

The aim of this experimental study was to evaluate the effects of indermil on the closure of oral mucosa wounds in comparison with conventional sutures by investigating interleukin 1&bgr; (IL-1&bgr;) and tumor necrosis factor &agr; (TNF-&agr;) markers immunohistochemically in an animal model. The animals were anesthetized by intraperitoneal injection of ketamine (90 mg/kg body weight). Straight incisions were made to the buccal mucosa of the animals. Animals were randomly assigned to 5 groups. Five different materials were used in the study. These were silk, plain catgut, monocryl, vicryl rapide (polyglactin 910), and indermil (N-butyl-2-cyanoacrylate). The wounds were closed primarily. After the region of wounds was examined clinically at the 2nd, 7th, 14th, and 21st days, excisional biopsies were performed, and the tissue samples were examined histopathologically and immunohistochemically. On the 14th day, TNF-&agr; and IL-1&bgr; levels were high in the plain catgut group, moderate in the indermil group, and mild in the monocryl, silk, and vicryl rapide groups. On the 21st day, TNF-&agr; and IL-1&bgr; levels were moderate in the plain catgut group, mild in the indermil and monocryl groups, and nonsignificant in the silk group. After the second day, TNF-&agr; and IL-1&bgr; levels were mild in the monocryl, silk, and vicryl rapide groups. Plain catgut had more negative effects than indermil on wound healing. Indermil should be applied to oral mucosa wounds together with sutures to provide better tissue support.

Fixation of vertically distracted segment with dental implants after breakage of distraction device: case report.

Distraction osteogenesis is an efficient method to augment the mandibular alveolar process for dental implants. Complications of this procedure include fracture of the basal bone, breakage of distractor, wound dehiscenses, undesirable soft tissue changes, and defective movement of the transported segment. We report a case of breakage of the distractor after mandibular alveolar vertical distraction osteogenesis. Mandibular alveolar vertical distraction osteogenesis was applied to 53-year-old woman for prosthetic rehabilitation. Fracture of the distraction device occurred on the 13th day of the activation phase. Radiographic examination revealed the fracture of the distractor rod and lingually displaced alveolar segment. Lingually displaced segment was successfully advanced to the desired position, and fixed to the basal bone using dental implants before the maturation of the distracted bone. We consider that this technique is eligible for the management of these kind of complications.

The effects of haemostatic agents on peripheral nerve function: An experimental study

PURPOSE In the practice of oral and maxillofacial surgery, hemostatic agents are sometimes placed in close proximity to peripheral nerves. In the present study, we evaluated immediate and delayed effects of 4 hemostatic agents (oxidized regenerated cellulose, 5% colloid silver-added gelatine sponge, bovine collagen, bone wax) on peripheral nerve function. MATERIALS AND METHODS A total of 25 rat sciatic nerves were prepared, and the amplitudes were recorded with a physiological data acquisition system. Animals were randomly assigned to 5 groups: control, oxidized regenerated cellulose, gelatine sponge, bone wax, and bovine collagen. The first hour records are defined as immediate effects of these hemostatic agents on nerve function. The animals were then allowed to recover for 4 weeks. At the end of this period, the same surgical and recording procedures were performed. These final records are defined as delayed effects of hemostatic agents on nerve function. According to nerve conduction velocity (NCV) and compound action potential (CAP) values of the experimental groups, early and delayed effects of each hemostatic agent were statistically compared with Bonferroni corrected test (P < .05). RESULTS Statistically, NCV was significantly reduced, and the CAP was significantly increased 1 hour after surgery (P < .05) in the group of oxidized regenerated cellulose. However, there were no significant differences after 4 weeks compared with the first records. In the gelatine sponge group, CAP was significantly increased 4 weeks after the application. In the bovine collagen and bone wax groups, NCV and CAP values (1 hour and 4 weeks after the application) were not statistically significant compared with initial control records. CONCLUSION The present study shows that bovine collagen is the most suitable hemostatic agent applicable for peripheral nerves.