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Background/purpose: Anatomical features of the lingual undercut region is a potential factor that might increase the risk of displacement of a tooth or fragment. The aim of this study was to report the normal anatomical relationship of impacted lower third molar roots to the lingual cortex and soft tissues of mandible and anatomical variations of lingual balcony in the impacted third molar region. Materials and methods: One hundred impacted third molars (54 males, 46 females) from 65 (31 men, 34 women) patients were evaluated for this study using cone-beam computed tomography. Three measurements [bone thickness, angle (Ang) 1 and Ang 2] were recorded on the coronal section slices of cone-beam computed tomography images; in these images, the impacted third molar root was closest to the lingual soft tissues. Results: The average distance between the tooth root and the lingual outer cortical bone layer (bone thickness) was 1.03 mm. The averages of Ang 1 and Ang 2 were 140.61 degrees and 153.44 degrees. Ang 1 and Ang 2 of female patients were larger than those of male patients. Conclusion: The narrow angulation of the lingual balcony region and the relationship between roots and lingual soft tissues should be noted to avoid undesirable complication of displacement of a tooth or fragment into sublingual, submandibular, and pterygomandibular spaces. There was no relation in the floor of the mouth between the position of the impacted third molar roots and different lingual undercut angulation variations. (C) 2017 Association for Dental Sciences of the Republic of China. Publishing services by Elsevier B.V.

Amac: Dis hekimlerinin intraoral fotograf, alci model ve iki panoramik grafilerin (OPTG) tumunden yararlanip yaptiklari implant planlamalarindaki implant boy, cap ve pozisyon-acili uygulama kararlari ile sadece uc boyutlu dental volumetrik tomografilerde (3BDVT) yaptiklari inceleme sonucu tercih ettikleri implant boy, cap ve pozisyon (acili uygulama) kararlarindaki farkliliklar karsilastirilacaktir. Yontemler: Uc dis hekimligi uzmanlik ogrencisinden hastalarin intraoral fotograflari, alci modelleri ve OPTG’leri verilip bu hastalar icin negatifte basilmis radyolojik goruntuler uzerinde implant sablonu ile; ve sonrasinda hastalarin sadece 3BDVT’leri verilerek dijital ortamda 35 farkli bolgede implant tedavi planlamasi yapmalari istenmistir. Hastalarin yapilan onceki olcumleri ile sonraki olcumleri arasindaki farkliliklar, butunuyle ve calismaya katilimci olarak istirak eden hekimler (katilimcilar) ayri ayri tutularak istatistiksel olarak incelenmistir. Bulgular: OPTG kayitlari, alci modeller ve intraoral fotograflar ile yapilan degerlendirmeler ile 3BDVT kayitlari ile yapilan degerlendirmeler tumden ve katilimcilar arasinda ayri ayri karsilastirildiginda implant uzunluklari (p=0,028), kalinliklari (p=0,001) ve acili pozisyonlandirmalari (p=0,001) arasinda istatistiksel olarak anlamli farklilik gorulmektedir. Sonuc: Mandibula molar bolgedeki implant uygulamalarinda 3BDVT radyografilerinden yararlanilmasi onemlidir.

An ultrasonic resorbable pin (SonicWeld, KLS Martin, Mühlheim, Germany) was compared with hyaluronic acid (Hyaloss Matrix, Anika Therapeutics, Bedford, MA) for their ability to maintain space in non-grafted sinus lifting.A comparative split-mouth study was designed and implemented. Six women and 4 men were included (mean age, 56.7 yr). The primary predictors hyaluronic acid (HA) application and ultrasonic resorbable pin fixation (URPF) were coded as binary variables. The primary outcome variables were height of alveolar bone (HAB) and reduction in sinus volume (RSV). Secondary outcomes were bone density and implant survival.The postoperative mean HAB was significantly higher than the preoperative mean HAB on the 2 sides (P.05). Mean increases in HAB and RSV on the URPF side were significantly greater than those on the HA side (P.05). In total, patients were treated with 40 implants. No type I bone quality was identified; 14 (35%) implants were inserted in type II bone, 22 (50%) in type III bone, and 6 (15%) in type IV bone. There was no statistically meaningful difference between the 2 sides for implant survival or bone quality. At 6 months, all implants were clinically stable and the definitive prostheses were functional, resulting in a survival rate of 100%.There was sufficient bone height to eventually place implants on the 2 sides in all patients. The 2 techniques yielded predictable outcomes in implant survival and bone quality. However, HAB and RSV were considerably greater on the URPF side.

Aims: To present failed rotational palatal flap of a severe rheumatoid arthritis patient with a chronic oroantral fistula and a practical surgical method to deal with the systemic outcomes. Presentation of Case: Bone necrosis at donor site in closure of oroantral fistulas with palatal rotational flap is known to be very rare. We present a 57 years old female, rheumatoid arthritis patient under Methotrexate medication, with a chronic oroantral fistula in the left first molar region. Bone necrosis has been shown at the donor site after full thickness palatal rotational flap procedure. The treatment approach and alternative methods are discussed. Bone necrosis on the donor site has been treated with the re-rotation of the palatal rotational flap tissues, but this time with partial thickness to its original position. Successful healing has been achieved. Discussion and Conclusion: The result of this approach could help practitioners challenging with rheumatoid arthritis caused healing problems and oroantral fistulas. Case Study Aktop et al.; BJMMR, 14(6): 1-5, 2016; Article no.BJMMR.24976 2

Purpose: Maxillary sinus’s inferior pneumatization is a physiological process, which increase with time and accelerates following extraction. The aim of this study was to determine the prevalence of nasal septal deviation (NSD), concha bullosa (CB), and Haller’s cells (HC) and to examine the correlation of maxillary sinus inferior pneumatization (MSIP) with these anatomical variations. Material and Methods : 300 (150 m, 150 f) CBCT scans taken at the Marmara University School of Dentistry from 2011 to 2014 were retrospectively reviewed for the presence of CB, NSD, HC and MSIP. The correlation between pneumatization to the anatomic variants was then compared. Data were analyzed with a Chi-square test. Results : Of the 300 CBCT scans, 44.3% have CB, 37.3% NSD, 19.3% HC and 27.7% MSIP. There was no statistical significancewhen comparing the relationship of patients with CB, NSD, HC and pneumatization. Conclusion : NSD, CB and HC do not have a definite role on sinus’s inferior pneumatization. Further studies should be conducted including potential factors related pneumatization with more sample size for further correlation with NSD, CB,HC.

Background The aim was to evaluate the effectiveness and complications of retromandibular transparotid approach performed for the reduction of dislocated subcondylar fractures. Methods Fourteen patients with subcondylar mandibular fractures were evaluated (8 male, 6 female, age range 19-43 years). The primary predictor variable in the present study was time (preoperative vs postoperative). The primary outcome variables were inflammatory complication, facial nerve deficit (House and Brackmann classification), and presence of parotid fistula. The secondary outcome variables were occlusal disturbances, maximal interincisal opening (MIO), and temporomandibular joint (TMJ) pain (VAS). Results Excellent occlusion and function was observed postoperatively. One salivary fistula occurred after surgery but was healed after 3 weeks. No inflammatory complication was observed. Three patients had grade III and one patient had grade II facial nerve deficit, all recovered in 6 weeks. All patients were free of pain and no malocclusion was observed. MIO was ranging from 34 to 58 mm (mean 44.4 mm) after 6 months. Conclusion The retromandibular transparotid approach is feasible and safe. It facilitates reduction and fixation of subcondylar fractures with functional outcomes and rare complications.

Objective To explore the effects of hyaluronic acid (HA) on bleeding and associated outcomes after third molar extraction. Methods Forty patients who had undergone molar extraction were randomly divided into two groups; 0.8% (w/v) HA was applied to the HA group (n=20) whereas a control group (n=20) was not treated. Salivary and gingival tissue factor (TF) levels, bleeding time, maximum interincisal opening (MIO), pain scored on a visual analog scale (VAS), and the swelling extent were compared between the two groups. Results HA did not significantly affect gingival TF levels. Salivary TF levels increased significantly 1 week after HA application but not in the control group. Neither the VAS pain level nor MIO differed significantly between the two groups. The swelling extent on day 3 and the bleeding time were greater in the HA group than in the control group. Conclusions Local injection of HA at 0.8% prolonged the bleeding time, and increased hemorrhage and swelling in the early postoperative period after third molar extractions.

Although several case reports have described the local and systemic hazards associated with the use of arsenic trioxide, and despite the availability of vital pulp extirpation method, some dentists in certain areas of the world continue to use arsenic trioxide. Aim of this case report was to present the occurrence of osteomyelitis with Arsenic Trioxide use in the jaws of children. Root canal therapy was initiated in an 8-year old girl with the application of arsenic trioxide paste and her tooth to be extracted lately. Alveolar bone surrounding the extraction site and attached gingiva were infected. The sequestrum and the germ of the mandibular right second permanent molar was also extracted during the procedure. At the 6-month follow-up visit, the mandibular right second premolar was decided for extraction due to a poor prognosis. We believe that practitioners who continue to use arsenic trioxide, especially in paediatric patients, should abandon its use.

The aim of this study is to evaluate the effect of these new generation hemostatic agents on early-stage soft tissue healing of warfarin-treated rats by measuring the tissue factor (TF) activities. Rats in the warfarin group were treated intraperitonally with 0.1 mg/kg warfarin, and rats in the control group were treated with 1 mL/kg saline. All rats had 3 incisions on dorsal dermal tissue applied Celox, Ankaferd Blood Stopper (ABS), or no hemostatic agent. Six rats from each group were killed on day 4, and the other 6 were killed on day 8. Prothrombin time (PT) and TF activities were evaluated, respectively. Both the hemostatic agents positively affected the hemostasis. Warfarin treatment increased the PT levels as expected. Celox-treated dermal tissues had higher TF activity when compared to ABS-treated ones. The ABS affected the early-stage healing positively in clinical aspect, whereas Celox was more effective on hemostasis by means of increasing TF activities.

Aim: Ankaferd Blood Stopper (ABS) is a new promising local hemostatic agent, and its mechanism on hemostasis has been shown by many studies. However, the effects of ABS on skin superoxide dismutase (SOD) and catalase (CAT) activities have not been investigated before. The aim of this study was to evaluate the effects of this new generation local hemostatic agent on warfarin-treated rats focusing on its the antioxidant potential in short-term soft tissue healing. Methods: Twelve systemically warfarin treated (warfarin group) and 12 none treated Wistar Albino rats (control group) were selected for the trial. Rats in the warfarin group were treated intraperitonally with 0.1 mg/kg warfarin, and rats in the control group were given 1 mL/kg saline 3 days earlier to surgical procedure and continued until killing. All rats had incisions on dorsal dermal tissue, which was applied ABS or no hemostatic agent before suturing. Six of each group were killed on day 4, and the other 6 were killed on day 8. Blood and skin samples were taken. Prothrombin time (PT) in blood samples, CAT, and SOD activities in skin samples were determined. Results: Warfarin treatment dose was found to be convenient and warfarin treatment increased the PT levels as expected. Warfarin treatment decreased CAT activity significantly compared to the control group. The ABS treatment significantly increased SOD activities in the warfarin group at the end of the eighth day. Conclusion: Ankaferd Blood Stopper acted positively in short-term tissue healing by increasing SOD activity in warfarin-treated rats. Therefore, ABS may be suggeted as a promoting factor in tissue healing.

PURPOSE: To compare bone healing in mandibular vertical body osteotomies (MVBO) after fixation with a resorbable 2.0mm-profile fixation system in the first and third postoperative months in rabbits. METHODS: Twenty hemimandibles of ten rabbits were divided into two groups according to duration of resorbable fixation-one or three months. The MVBOs were performed and one four-hole, resorbable, 2.0mm mini-plate fixation system was used on each side. The computed tomography (CT) scans, scanning electron microscopy (SEM), and histomorphometric outcomes of groups I and II were compared. RESULTS: Significant differences were found between the one- and three- month assessments in terms of newly formed bone ratio values (p

The purpose of this report is to evaluate the effectiveness of a high Le Fort I osteotomy design, including the malar bones, which allows segment sliding over the zygoma and forces the osteotomized segment to move forward with distraction. Two patients (male, 23- and 30-year-old) with malar deficiency underwent high Le Fort I osteotomy and surgically assisted rapid maxillary expansion procedure was followed. Records were taken before and 6 months after surgery for comparison, including intra and extra oral photographs and three-dimensional cone-beam computed tomography (CBCT) images. The bone malar width and bone malar depth changings in malar region were evaluated. Preoperative and postoperative CBCT images and clinical views of the patients showed forward movement of the malar region.Keywords: Cone-beam computed tomography, malar deficiency, malar depth, malarwidth, surgically assisted rapid maxillary expansion

The authors report a case that is started with a simple upper third molar’s surgical extraction and a broken 3.0 suture needle tip incident occurred. Broken fragment’s localization has been detected with 3D cone beam computed tomography (CBCT). Needle tip has been reached with the help of CBCT vision. CBCT’s benefits have been discussed on these types of cases and further migration of the needle tip during surgical procedure is reported.

Objective The goals of this retrospective clinical study were to identify surgically assisted rapid palatal expansion (SARPE) complications and assess their incidence, with the aim of informing surgeons and orthodontists of the risks of this widely used procedure before they recommend it to patients. Study Design Between June 2008 and July 2010, 60 patients (23 women and 37 men) underwent SARPE according to a defined multidisciplinary protocol at the University of Marmara, Istanbul, Turkey. Results Twelve patients (20%) suffered from nasal bleeding. Of these 12, 2 patients suffered late-onset bleeding beginning on postoperative day 8, and in the other 10, nasal bleeding was insignificant. Three patients reported excessive lacrimation postoperatively. Minor problems related to pain and numbness were all temporary. Conclusions SARPE procedures have traditionally been reported to be associated with low morbidity, especially in comparison with other orthognathic surgical procedures. However, many complications have been reported.

The management of midfacial fractures includes the treatment of facial fractures, dentoalveolar trauma, and soft-tissue injuries, as well as associated injuries, mainly of the head and neck [1]. The management of fractures of the maxillofacial complex remains a challenge for the oral maxillofacial surgeon, demanding both skill and expertise [2]. The success of treatment and implementation of preventive measures are more specifically dependent on epidemiologic assessments [3].Midfacial fractures can occur in isolation or in combination with other serious injuries, including mandibular, ophthalmologic, cranial, spinal, thoracic, and abdominal trauma, as well as upper and lower orthopedic injuries [4].The epidemiology of facial fractures varies in type, severity, and cause depending on the population studied. Differences among populations in the causes of maxillofacial fractures may be the result of differences in risk and cultural factors among countries, but are more likely to be influenced by the severity of injury [1,5]. The causes of maxillofacial fractures have changed over the past three decades, and they continue to do so. The main causes worldwide are traffic accidents, assaults, falls, sport-related injuries, and warfare [6-8]. Many articles pertaining to the incidence and causes of maxillofacial injuries have been published [1,4,7-10]. In 2003, Motamedi [7] reported the distribution of facial fractures as 72.9% mandibular, 13.9% maxillary, 13.5% zygomatic, 24.0% zygomatico-orbital, 2.1% cranial, 2.1% nasal, and 1.6% frontal injuries [Figure 1].