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Surgical Treatment of Oroantral Fistulas: A Clinical Study of 23 Cases

Oroantral communication can be defined as a pathologic space created between the maxillary sinus and the oral cavity. This communication and subsequent formation of a chronic oroantral fistula is a common complication often encountered by oral and maxillofacial surgeons. Although various techniques have been proposed in published studies, long-term successful closure of oroantral fistulas is still one of the most difficult problems confronting the surgeon working in the oral and maxillofacial region. The decision of which treatment modality to use is influenced by many factors, such as the amount and condition of tissue available for repair, the size and location of the defect, the presence of infection, the time to the diagnosis of the fistula, and, even, the surgeons past experience. In the present study, 23 patients with a chronic oroantral fistula who underwent surgical correction at Istanbul University Faculty of Dentistry, Department of Oral and Maxillofacial Surgery from 2002 to 2009 were included. The fistulas were treated with a buccal advancement flap in 10 patients and a palatal island flap in 13 patients. The advantages, limitations, and complications of each technique are discussed.

Bilateral Oroantral Fistulas Following Devitalization Of Teeth By Arsenic Trioxide: A Case Report

Although it is well known that prolonged application or leakage of arsenic trioxide can cause severe damage to the periodontal tissues, the substance is still used by some dentists. This paper describes a case of arsenical necrosis of the jaws affecting the right and the left side of the maxilla. As a result of leakage into the tissues of an arsenical paste from the pulp chamber of endodontically treated teeth, bilateral oroantral fistula (OAF) occurred. It is concluded that there is no justification, whatsoever, for the use of arsenic in modern dental practice. In the following case, buccal advancement flap and submucosal palatal island flap techniques were used for to close the OAF. The submucosal palatal island flap technique resulted in successful closure of the OAF.

Alveolar distraction osteogenesis before placement of dental implants.

Distraction osteogenesis of the edentulous alveolar ridges may be considered an alternative to many other augmentation oriented surgical techniques. It is now being widely used for treating severe forms of alveolar ridge atrophy, especially before the placement of dental implants. Leibinger Endosseous Alveolar Distraction System (LEAD; Stryker Leibinger, Kalamazoo, MI) is an intraosseous distraction device used for edentulous ridges. In this study, the healing was uneventful in all 5 cases that were treated except 1, in which the vitality of the distraction segment could not be maintained. No complications related to the prosthodontic restoration were observed.

A technique for atraumatic extraction of teeth before immediate implant placement using implant drills.

Purpose:The purpose of this article is to present a minimally invasive technique using the implant drills to help extract teeth before the insertion of immediate implants. Materials and Methods:Nine patients (7 women and 2 men) aged 24 to 60 years having root fractures and dental caries were included in this study. Inclusion criteria for the study were presence of at least 4 mm of bone beyond the root apex, the absence of acute signs of infection or inflammation in the treatment area, and the absence of systemic pathologies that would contraindicate bone healing around implants. Heavy smokers were not included in the study. Extraction was done after thinning the root walls by the help of the implant drills. After extraction, implant sites were prepared and implants were inserted. In 2 of the cases, the peri-implant bone defect was filled with autogenous bone graft. Results:Healing progressed uneventfully in all 9 cases. The use of implant drills to thin the root walls provided atraumatic tooth extraction protecting the thin buccal bone. At second stage surgery, all implants were asymptomatic, immobile, and osseointegrated. The soft tissue anatomy was clinically acceptable in all patients. Radiographic examination of all 9 implants showed no peri-implant radiolucency at the end of a year. Conclusion:Successful osseointegration and complete bone healing were observed for all patients. The new extraction technique was found to be effective in immediate implant cases in order not to damage the thin plate of buccal bone.

Accidental displacement of a high-speed handpiece bur during mandibular third molar surgery: a case report

Removal of third molars is one of the most common surgical procedures performed in oral and maxillofacial surgery. This procedure may result in a number of major and minor complications. Accidental displacement of impacted third molars is a complication that occasionally occurs during these operations, but accidental displacement of a high-speed handpiece bur has never been reported in literature before. The aim of this article is to present a rare and previously unreported case of a foreign body in the submandibular space and to review the possible complications seen after third molar surgery.

Ewing's tumor of the mandible

A primary Ewings tumor in the mandible is reported, and the diagnostic imaging features of this lesion are discussed. Modalities used included panoramic and plain films, computed tomography, and 99mTc-MDP scintigraphy.

Intra-articular injection of tenoxicam following temporomandibular joint arthrocentesis: a pilot study.

This study examined the clinical and radiological effects of intra-articular tenoxicam injection following arthrocentesis and compared them with arthrocentesis alone in patients with disc displacement without reduction (DDwoR). 24 temporomandibular joints (TMJs) in 21 patients with DDwoR were studied. Patients were divided randomly into Group A in which only arthrocentesis was performed (14 TMJs in 14 patients) and Group AT which received arthrocentesis plus intra-articular injection of tenoxicam (10 TMJs in 7 patients). Patients were evaluated before the procedure, on postoperative day 7, then 2, 3, 4 weeks, and 2, 3, 4, 5, 6 months postoperatively. Intensity of joint pain was assessed using a visual analog scale. Maximum mouth opening was recorded at each follow-up. TMJ sounds and palpation scores were noted as positive or negative. Magnetic resonance imaging (MRI) was performed before and 6 months after treatment in both groups. Disc form, disc location during neutral position, reduction with movement, joint effusion, structures of the articular surfaces, and bone marrow anomalies were evaluated all in MRIs. Both treatments succesfully increased maximum mouth opening and reduced TMJ pain; there were no complications. Difference between the groups was not statistically significant and a larger controlled study is necessary to clarify this use of tenoxicam.

Measurement of the lingual position of the lower third molar roots using cone-beam computed tomography.

PURPOSE The aim of this study was to evaluate the distance between the roots of the impacted third molars and the floor of the mouth to predict the risk of lingual root displacement during surgery. MATERIALS AND METHODS Thirty-one patients (5 men and 26 women) were evaluated for this study using cone-beam computed tomography (CBCT). The teeth were grouped according to their position on the orthopantomogram as vertical, mesioangular, horizontal, and distoangular. The distance between 2 points on the roots and lingual soft tissues was measured. RESULTS The average distance between the apex of the root, which is in the most lingual position, and the lingual cortical plate was 1.03 mm. The average distance between the most lingual point on the apical half of the root, which is in closer proximity, and the lingual cortical plate was 0.65 mm. CONCLUSION The distance between the apices and the lingual plate is very short, which allows displacement of broken roots or teeth, especially when the lingual plate is perforated.

Prognostic indicators of the outcome of arthrocentesis with and without sodium hyaluronate injection for the treatment of disc displacement without reduction: a magnetic resonance imaging study

This study analysed the prognostic factors for successful arthrocentesis with and without sodium hyaluronate (SH) injection for the treatment of temporomandibular joint (TMJ) disc displacement without reduction (DDwoR) using clinical and radiological results. 29 TMJs in 25 patients with DDwoR were included. Patients were treated with arthrocentesis or arthrocentesis followed by intra-articular (i.a.) injection of SH. Treatment was evaluated for postoperative range of maximum mouth opening and the degree of postoperative pain on a VAS. Prognostic factors analysed were age, sex, duration of locking, trauma history, previous TMJ treatment, depression, bruxism, malocclusion and missing teeth. Degenerative changes were evaluated as probable prognostic factors. After treatment, 24 joints (83%) fulfilled the criteria for success. Duration of locking and present preoperative degenerative changes were the most significant factors for treatment outcome. The results suggest it is sufficient to use only arthrocentesis in patients without preoperative degenerative changes and arthrocentesis with SH in patients with degenerative changes on their preoperative MRIs, but because there were some significant differences between the two groups preventing the authors from comparing them statistically, they cannot come to that conclusion. To clarify the use of SH in such cases, standardized study groups are necessary for future studies.

Effects of bone morphogenetic proteins on osteoblast cells: vascular endothelial growth factor, calcium, inorganic phosphate, and nitric oxide levels.

Purpose:Bone morphogenetic proteins (BMPs) play an important role in the initiation of bone formation by affecting cell growth and differentiation in a variety of cell types including osteoblasts. Vascular endothelial growth factor (VEGF) is an important regulator of angiogenesis and vasculogenesis, and also, VEGF signaling is important for skeletal development. Nitric oxide (NO), calcium (Ca), and inorganic Phosphate (Pi) are important molecules for cell functions. In this study, the effects of BMP on VEGF, Ca, NO, and Pi levels were investigated in an osteoblast cell culture. Materials:Fifty thousand cells per milliliter were seeded and cultured on graft materials for 24 and 48 hours. Different concentrations of BMPs (combination of BMPs numbered from 1 to 14) were supplemented to the medium. Results:BMP was found to increase VEGF (P = 0.00), Ca (P = 0.02), and Pi (P = 0.00) especially in the first 24 hours. The increase in the NO in the experimental groups were found to be statistically insignificant (P = 0.12). Conclusion:Our data state that further investigation should be performed on the effects of BMPs on osteoblast cell membranes and membrane receptors and cell signaling, together with their known effects on early phases of bone and vascular epithelial tissue formation.