Yusuf Emes

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.

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.

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.

Effects of bone morphogenetic protein on neonatal rat calvarial osteoblast-like cells: An in vitro study

Bone morphogenetic proteins (BMPs) are factors that promote osteoblastic differentiation and osteogenesis. The aim of this study was to examine the behavior of neonatal rat calvarial osteoblast cells cultured on different concentrations of BMP graft materials. Fifty thousand cells per milliliter were seeded and cultured on graft materials for 24 and 48 h. Different concentrations of BMPs (combination of BMPs numbered from 1 to 14) were supplemented to the medium. To evaluate cellular proliferation and differentiation, specimens were examined for DNA synthesis, alkaline phosphatase (ALP) activity, cell numbers, and viability of the cells. Further, transforming growth factor-beta(1) (TGF-beta(1)) and lactate dehydrogenase (LDH) levels were investigated. Morphological appearance of the specimens at 24 and 48 h of incubation was evaluated using scanning electron microcopy. Evaluations of DNA synthesis, cell count, and cell viability data revealed that a significant difference existed at 24 and 48 h (p < 0.05). The TGF-beta(1) and ALP analysis showed only a significant difference between the groups at the end of 24 h (p < 0.05). Regarding the lactate dehydrogenase activity there was not any significant difference at 24 and 48 h (p > 0.05). No morphological differences were observed in cell morphology on BMP graft material and the control group. These results indicate that BMPs have an inductive effect on osteoblast differentiation and a possible inhibitory effect in the early phases of cell proliferation.

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.

Effects of Hemostatic Agents on Fibroblast Cells

Purpose:Hemostatic agents may be used topically to control hemorrhage, especially in patients with bleeding disorders. The agent used may have a negative effect on the tissue prolonging the healing time. The aim of this study was to compare the effects of 3 different hemostatic agents on fibroblast cells on a rat primary fibroblast cell culture model. Materials and Methods:Ankaferd Blood Stopper (ABD) (Ankaferd Pharmaceuticals Cosmetics Production and Marketing Co.), fibrin glue, and tranexamic acid were the agents to be evaluated for their effects on cell proliferation, cell numbers, cell viability, and cell morphology. Also lactate dehydrogenase, basic fibroblast growth factor, and vascular endothelial growth factor C levels were measured. Results:It was found that all of the agents used in the study have negative effects on fibroblasts, with ABD having the lowest values of cell proliferation, cell number, and cell viability. Conclusion:The results of this study indicate that ABD, fibrin glue, and tranexamic acid may negatively affect tissue healing.

Immediate implant placement without bone grafting: a retrospective study of 110 cases with 5 years of follow-up.

Purpose:Immediate implant placement not only reduces the number of surgeries necessary but also decreases the treatment time and treatment costs. The purpose of the study was to present the clinical results of 110 cases of immediate implant placement without using graft materials at the end of 5 years. Materials and Methods:One hundred and ten implants in 72 patients were included in the study. Inclusion criteria for the patients were presence of at least 2 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. In cases where bone grafting was necessary, the implant was excluded from the study. Results:Healing progressed uneventfully in 105 cases. Four implants were lost as a result of infection in the first 3 months and 1 implant was lost 1 year after the functional loading of the prosthesis. The soft tissue anatomy was clinically acceptable in all patients. The implants that were placed in the extraction sockets of infectious teeth had also acceptable survival rates and clinical success. Conclusion:With proper patient selection, immediate implant placement without bone grafting has predictable survival rates and clinical success.

Management of a mandibular fracture accompanying a gunshot wound.

Gunshot injuries of the mandible can result in high rates of complications, especially in cases of bone loss. A fractured mandible accompanying a gunshot wound almost always has an external wound; the fracture is always compound and comminuted. Sometimes management of these injuries may require multiple surgical interventions. In this clinical report, treatment of a patient, who had a mandibular fracture due to a gunshot wound, is presented.A 52-year-old man with a mandibular fracture in the right mandibular body accompanying a gunshot wound was operated on. Owing to a nonunion, a second surgery was performed using reconstruction plates after hyperbaric oxygen treatment. Healing was uneventful after the second surgical intervention.