Dental Surgeries Research Articles

Antimicrobial prophylaxis for dental surgery.

Antibiotic prophylaxis for most dental and oral surgical procedures is not needed, especially if the patient is fit...

Determining the Size of the Mental Foramen: A Cone-Beam Computed Tomography Study

Aim: Knowledge of the position of the mental foramen is important to prepare strategy when administering regional anesthesia, performing dental surgical procedures, endodontic treatments. Also, it is critical to analyze diameter of mental foramen in sagittal, coronal, and axial images. The aim of this retrospective study was to determine the diameter of the MF in different planes from CBCT images.
 Methodology: This study was designed at Department of Endodontics, Dicle University, Diyarbakır, Turkey. One hundred twenty three (67 female, 56 male) CBCT scans that met the study criteria were obtained. All images were obtained from i-CAT (Imaging Sciences International, Hatfield, PA). Data were analyzed using Student’s t-tests and Tukey HSD tests.
 Results: For the analysis of age, data were divided into four groups: 12–17, 18–29, 30–49, and ≥50 years. The data were also divided into two groups by gender. Axial and coronal image measurements were also divided into right and left. There was a statistical difference compared with females and males (p<0.05). In the coronal plane, the right region showed significant differences in measurements between the groups (p<0.05). In the axial plane, there was no statistically significant difference between them (p>0.05). The differences between the groups in the left region in the axial plane measurements were significant (p<0.05).
 Conclusions: Using CBCT imaging superimposition of anatomical structures can be eliminated. It is important that determine that the size of the mental foramen. This study is a retrospective study using CBCT from patient and find that the size of the mental foramen.
 How to cite this article: Falakaloglu S, Veis A. Determining the size of the mental foramen: A cone-beam computed tomography study. Int Dent Res 2017;7:20-25.

Regeneration of periapical lesions post-endodontic treatment and periapical surgeries in experimental animals utilizing thermo-responsive nano-β-tricalcium phosphate/chitosan hydrogel: a proof of concept

Using phosphate nanoparticles/polymeric hydrogels presents an interesting approach, especially concerning the reduced particle migration and enhanced biocompatibility. The current work aims to achieve a proof of concept for the development of a thermo-sensitive nano β-tricalcium phosphate (β-TCP)/chitosan (Cs)/glycerophosphate (Gl)/glyoxal (Gly) hydrogel to be applied in periapical surgeries post endodontic treatment. Physicochemical characterization using x-ray powder diffraction, Fourier transform infrared, TEM and SEM was performed. Bone formation efficiency of the achieved β-TCP/Cs/Gl/Gly hydrogel was followed. The composite gels were tested in vivo in dogs in comparison with the commercially available and surgically applied Klipdent-PL® up to three months. Radiographic examinations were performed. Histological evaluations were achieved through histomorphological criteria being apical cementum surface, bone tissue resorption, apical PDL thickness, the intensity of inflammatory reaction and osseous repair. The cytotoxicity results proved the safety of the developed hydrogel. The thermo-sensitive hydrogel possessed comparable enhanced biocompatibility with anti-inflammatory activity. New bone formation was clearly enhanced in the infected teeth. Therefore, it can be directly applied in specific non-invasive dental surgeries.

Quantification of bleeding during dental extraction in patients on dual antiplatelet therapy

In spite of the possibility of triggering thromboembolic events, many professionals indicate the suspension of antiplatelet agents before dental surgical procedures. The aim of this study was to perform a quantitative assessment of intraoperative bleeding in patients on dual antiplatelet therapy. A case–control study was conducted in patients on dual antiplatelet therapy (APT group) and in patients who did not use these medications (control group). The following examinations were requested: complete blood cell count, blood coagulation tests, and platelet aggregation. The quantity of bleeding was measured intraoperatively by collection of aspirated blood. The mean volume of blood lost during the surgical procedure was 6.10ml in the control group and 16.07ml in the APT group (P=0.002). The mean volume of blood lost per minute was 0.60ml/min in the control group and 1ml/min in the APT group (P=0.001), with local haemostatic methods being sufficient to control the bleeding. There was no postoperative bleeding complication in any case. Patients on dual antiplatelet therapy presented a larger volume of bleeding, but this could be controlled by means of local haemostatic measures. Therefore, there is no need to stop either of the two dual antiplatelet therapy medications before dental extractions.

Anticoagulant effects of phytotherapeutic drugs and their importance in surgical dental procedures

ABSTRACT Phytotherapeutic drugs are plant-derived products with medicinal properties. They are used for treating or preventing several diseases. However, patients who use these substances and even health professionals are unaware of their negative effects. One of the most common negative effects of phytotherapeutic drugs reported in the literature is the inhibition of natural coagulation factors in the human body. Therefore, the aim of this study was to perform a brief review of the literature concerning the anticoagulant effects of phytotherapeutic drugs and their importance in surgical dental procedures. Preventive measures, clarification and monitoring of patients taking phytotherapeutic drugs are recommended before performing surgical dental procedures, in order to prevent against complications such as hemorrhage.

Drug-induced osteonecrosis of the jaw: the state of the art.

Osteonecrosis of the jaw (ONJ) is a rare adverse event of antiresorptive drugs such as bisphosphonates (BP) and denosumab (DMAb). The diagnosis of ONJ is considered in cases where exposed bone in the maxillofacial region does not heal within 8 weeks in a patient previously treated with an antiresorptive agent. In patients with osteoporosis, ONJ is reported as a very rare adverse event while in oncologic patients with bone metastases or malignant hypercalcemia the incidence is significantly higher (up to the 1-10% of the patients). The pathophysiology of ONJ is still not completely understood but it is multi-factorial. ONJ is a condition associated with poor oral health, oral surgery, and use of antiresorptive agents. Prevention is of paramount importance especially in cancer patients, in whom the large majority of cases of ONJ (>90%) are reported, but it should also be considered in osteoporotic patients, especially during dental surgical procedure. Some simple prevention procedures are effective in reducing the risk of its appearance. When ONJ unfortunately occurs, the large majority of patients can be managed conservatively. In conclusion, ONJ is a rare condition associated with antiresorptive drugs. Both osteoporotic and oncologic patients should be well informed about its low absolute risk and regarding the fact that the benefits of antiresorptive therapy far outweigh this potential risk of ONJ.

Painful Trigeminal Neuropathy Attributed to a Space-occupying Lesion Presenting as a Toothache: A Report of 4 Cases

Painful trigeminal neuropathy attributed to a space-occupying lesion (code 13.1.2.5 in the International Classification of Headache Disorders, 3rd edition [beta version]) is an orofacial pain condition that has characteristics of classical trigeminal neuralgia but is caused by a space-occupying lesion. We present 4 cases of intracranial lesions mimicking odontogenic pain as follows: case 1, a 61-year-old woman presented with a chief complaint of aching soreness in the right mandibular molar area for 1 year; case 2, a 59-year-old man presented with severe pain in the left maxillary and mandibular molars; case 3, a 72-year-old man presented with a chief complaint of facial shock–like pain on the left side; and case 4, a 75-year-old man presented with a chief complaint of paroxysmal pain and numbness in the buccal gingiva of the right mandibular molar region. Cases 1 and 2 had trigeminal neuralgia, which had previously been incorrectly attributed to osteoma and maxillary sinus retention cyst, respectively, and resulted in inappropriate dental surgical procedures. All patients subsequently underwent magnetic resonance imaging, and the results were consistent with intracranial disease. Magnetic resonance images revealed acoustic neuromas in the cerebellopontine angle in cases 1, 2, and 4 and a small meningioma near the entry to the left Meckel cave in case 3. Cases 1, 3, and 4 had these lesions removed; after which, their pain resolved. Before dental treatment, dental practitioners should focus not only on dental imaging but also on the patient's medical history and pain characteristics.

Mandibular Buccal Bone Thickness In Southeastern Anatolian People: A Cone-Beam Computed Tomography Study

Aim: Buccal bone thickness is an important factor in implant treatment, bone health after tooth extraction, apical surgery, and esthetic outcomes. We evaluated the distance from the mandibular premolar and molar teeth apices to the buccal cortical bone in southeastern Anatolian people using cone-beam computed tomography (CBCT).
 Methodology: This retrospective study was performed in 461 posterior teeth (220 premolars, 241 molars) of 133 patients (62 females, 64 males) at Dicle University, Faculty of Dentistry, Department of Oral and Maxillofacial Radiology. Data were analyzed using Student’s t-tests and Tukey HSD tests.
 Results: The mandibular buccal bone was thicker in men than in women, but the difference was not statistically significant (p>0.05). The thinnest point of the mandibular buccal bone was measured in women as 2.431 mm and in men as 2.491 mm in the first premolar teeth. The thickest point of the mandibular bone was measured in women as 7.940 mm and in men as 7.859 mm in the distal roots of mandibular second molar teeth. For the mandibular first and second premolars, there was no significant difference in buccal bone thickness among the 10–29-, 30–49-, and 50–69-year age groups. The difference between the first and second molar mesial and distal roots of the age groups was significant at the level of buccal root thickness (p<0.05).
 Conclusions: It is important to examine buccal bone thickness (with CBCT) before surgical dental procedures for appropriate implant planning and surgical endodontic treatment. 
 How to cite this article: Aktuna Belgin C, Adiguzel O, Bud M, Colak M, Akkus Z. Mandibular Buccal Bone Thickness In Southeastern Anatolian People: A Cone-Beam Computed Tomography Study. Int Dent Res 2017;7:6-12.
 Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Thalassemia review: features, dental considerations and management.

Thalassemia is a genetic disorder that involves abnormal haemoglobin formation. The two main categories of thalassemia are alpha and beta thalassemia that are then divided into further subcategories. While some mild forms of thalassemia might even go unnoticed and only cause mild anaemia and iron deficiency problems in patients, other more severe forms of thalassemia can even result in death. Individuals with thalassemia can get treatment according to the level of severity of their condition. The main oral manifestations of thalassemia are Class II malocclusion, maxillary protrusion, high caries index, severe gingivitis. Any dental surgical procedure for such patients should be done under antibiotic cover and immediately after transfusion. Caution should be exercised in thalassemia patients due to complications related to compromised immunity and cardiovascular issues. Multidisciplinary approach involving dental surgeon, haematologist and orthodontist is the best advised approach.

Clinically healthy overweight and obese dogs differ from lean controls in select CBC and serum biochemistry values.

Obesity is a global disease, affecting nearly half a billion people. Unfortunately, this trend is mirrored in our canine population. As obesity is a complex inflammatory disease, there is a need to determine whether routine medical screening tests may indicate, or be influenced by, its presence. The objective of the current study was to determine if significant differences exist between CBC and biochemical profile values from control vs overweight/obese, client-owned dogs considered clinically healthy. Dogs presented for routine health examinations, including minor dental or elective surgical procedures, were retrospectively identified from a hospital population. Animals were allocated to 2 categories based on body condition score (BCS), and data were analyzed by Mann-Whitney nonparametric analysis with statistical significance at a P ≤ .05. After exclusions, 116 dogs were assigned to the overweight/obese group (BCS ≥ 7) and 240 dogs to the control group (BCS = 4-6). Overweight/obese dogs had higher total leukocyte counts and higher plasma protein and globulin concentrations. Other differences were attributed to decreased serum water fraction (increased sodium, albumin, calcium, and anion gap) in the overweight/obese group. Interestingly, chloride concentration was decreased (in the face of increased sodium) in the obese group. There is CBC and biochemical evidence to support the concern that obesity influences laboratory values, even in dogs considered clinically healthy. Prospective studies aimed at characterizing these changes are needed to provide insight into the connection between obesity and its comorbidities.

Post-operative Bleeding Risk in Dental Surgery for Patients on Oral Anticoagulant Therapy: A Meta-analysis of Observational Studies.

Background and Objective: Minor dental surgery is invasive and hemorrhagic. Thus, in patients treated with anticoagulants, the bleeding risk related to these invasive procedures is concerning. The aim of this meta-analysis is to evaluate this risk by comparing the post-operative bleeding rates of oral anticoagulation treatment (OAT) patients (without interrupted or altered anticoagulant intake) with non-OAT patients.Methods: PubMed, Embase and the Cochrane Library were searched for eligible studies that compared the post-operative (following minor dental surgery) bleeding rates of OAT patients without interrupted or altered therapy with those of non-OAT patients. Relative risk (RR) and 95% confidence interval (CI) were calculated. Subgroup analyses were used to identify the association between the bleeding rate and different dental surgeries or anticoagulants.Results: Thirty two full text articles were assessed for eligibility and 20 studies were excluded according to the selection criteria. Finally, 12 studies and a total of 2102 OAT patients and 2271 non-OAT patients were included. A pooled analysis indicated that the post-operative bleeding risk in OAT patients is higher than that of non-OAT patients (RR: 2.794, 95% CI: 1.722–4.532, P = 0.000). The pooled RRs in the dental implant surgery and dental extraction subgroups were 2.136 (95% CI: 0.825–5.531, P = 0.118) and 2.003 (95% CI: 0.987–4.063, P = 0.054), respectively. As for the different oral anticoagulants, the pooled RR in the subgroup of new oral anticoagulants (NOACs) was 1.603 (95% CI: 0.430–5.980, P = 0.482), while the pooled RR in the vitamin K antagonists subgroup was 3.067 (95% CI: 1.838–5.118, P = 0.000).Conclusion: Under current evidence, OAT patients were under a higher post-operative bleeding risk than the non-OAT patients following minor dental surgery. For the dental implant surgeries and dental extractions, our study failed to demonstrate a higher risk of bleeding in the OAT patients compared with the non-OAT patients. Besides, The NOACs might be safer than the vitamin K antagonists in dental implant surgery. However, more well-designed studies are required for future research.

The only case of mycotic aneurysm of the PICA: Clinical-radiological remarks and review of literature

We present the first and only case, reported in literature, of a 67-years-old man with a mycotic aneurysm (MA) of the left posterior inferior cerebellar artery (PICA), caused by group B Streptococcus, that we surgically treated, performing neck aneurysm clipping, preserving patency of parent vessel. Moreover the peculiarity of this case is represented by the fact that the MA is originated from a tooth abscess, treated about two years before. To date, there have been only 10 cases of association between MA with either tooth pathologies or dental surgical procedures and our case is the only one originating from PICA. Therefore an extensive literature analysis was performed. Hence if we observe a patient with a fusiform aneurysm in posterior intracranial circulation and clinical history of fever and/or persistent neck swelling after dental pathologies, it is mandatory to consider the possibility of a MA, for a correct differential diagnosis. If the diagnosis is confirmed, it is necessary to research the origin of infection and to set the specific antibiotics therapy.

Prevalence of Osteonecrosis of the Jaw Secondary to Antiresorptive Therapy in Patients Who have Undergone Dental Surgical Procedures: A Retrospective Study

Prevalence of Osteonecrosis of the Jaw Secondary to Antiresorptive Therapy in Patients Who have Undergone Dental Surgical Procedures: A Retrospective Study

Dentistry: should it be in the NHS at all?

When the NHS opened for business in 1948 two of its biggest product lines quickly became the supply of spectacles and dentures. According to the British Dental Association, in the...

The impact of body mass index on craniofacial parameters

The purpose of the study is to analyze BMI and the mean values of craniofacial parameters in the patients measured by directed anthropometry (PDAA) and by 3D scan (P3DAS). The aim of the study is to identify the most frequent localization of facial fat. The study sample was recruited from patients attending dental surgeries in Bratislava. Data were collected from November 2013 to February 2016. In the first subgroup patients were analyzed by directed anthropometry (PDAA) (n=65). In the second subgroup patients were analyzed from 3D scan (P3DAS) (n=35). The differences in mean values of craniofacial parameters between the P3DAS and the PDAA groups had no significant effect on the evaluation of nose breadth, mouth and lower-lip height in the BMI category (18.6–24.9kg/m2). We found an association between BMI values and craniofacial parameters. In two study groups with >25.0kg/m2 higher values were observed in nose breadth, bi-zygomatic breadth, total facial height, mouth breadth and morphologic face height than in the group with 18.6–24.9kg/m2. In the P3DAS the facial fat was most often localized in the bi-gonial breadth and in the PDAA in the bi-zygomatic breadth.

Acoustical estimation of endosseous implant stability: Finite element modeling and experimental validation

Various endosseous implants are widely used in orthopedic and dental surgeries. However, failures are observed, which may have dramatic consequences and are often due to a loss of implant stability. The aim of this presentation is to describe two acoustical methods developed to assess the stability of different implants. First, a quantitative ultrasound method was used to determine the stability of dental implants. A monoelement 10 MHz transducer is screwed into the implant and the signal is processed to obtain an indicator. The method was first validated in implants embedded in biomaterials used as bone substitutes, then in vitro and eventually in vivo by comparison with histology. A 3D FEM was developed to optimize the device conception and carry out sensitivity studies. Second, an impact hammer was used in order to investigate whether the AC implant primary stability can be evaluated using such approach. The method was first validated in vitro and in cadaveric experiments. The results showed that an in...

Greater palatine foramen- morphometry, sexual dimorphism and clinical perspective

Abstract Background and aims: Maxillary nerve block via greater palatine foramen (GPF) is most commonly followed procedure for many dental, oral and maxillofacial surgeries. Many standard textbooks mention location of GPF in a general way. Location of GPF with respect to fixed bony landmarks has been studied by many authors in different population groups. The results of those studies showed lot of variability in location of GPF. The data regarding possible existence of sexual dimorphism are sparse. The present study was aimed at contributing further data regarding morphometry of the GPF. Ao attempt has also been made to look for sexual dimorphism. Material and Methods: One hundred and twenty three adult dry skulls of known sex (male- 55 & female - 68) were studied for GPF with regards to- morphometry, shape, relation to molars, fixed bony landmarks- Median maxillary suture(MMS), Incisive fossa(IF), Posterior border of hard palate(PBHP), Aogle between line joiniog GPF with IF & MMS, direction of opening of GPF into oral cavity. Results: Aotero-posterior diameter on left side (p-0.006), transverse diameter on both sides (p-0.000 on left & right side) distance between GPF to IF on both sides (p- 0.013 right side, p-0.02 left side, GPF-PBHP distance on both sides (p-0.001 left side, p-0.002 on right side) showed statistical significance when compared male with female skulls. In both male and female skulls, Oval shape predominated followed by round and slit variety of GPF. Both on right and left side GPF found to be predominantly related to anterior half of 3rd molar. Direction of opening of GPF into oral cavity was predominantly antero-medial on both sides in male and female skulls. Conclusion: Our study provides a valuable addition to the available literature on location of GPF and also gives an insight to the possible existence of sexual dimorphism.

Osteogenic capacity of alkali-free bioactive glasses. In vitro studies.

The high alkali content bioactive glasses commonly used to regenerate bone in dental, orthopedic, and maxillofacial surgeries induce some cytotoxicity in surrounding tissues. The present study aims the ability of some alkali-free bioactive glasses compositions, recently developed by our research group, to stimulate human mesenchymal stem cells (hMSCs) differentiation into osteoblasts in comparison to 45S5 Bioglass® . The obtained results demonstrated that alkali-free bioactive glasses possess higher stimulating towards differentiation of hMSCs in comparison to the control 45S5 Bioglass® . The von Kossa assay demonstrated that all bioactive glasses studied were able to induce the appearance of calcium deposits even when the cells were cultured in DMEM, proving that these biomaterials per se induce hMSCs cell differentiation. It was also observed that in both cell culture medium used (DMEM, and osteogenesis differentiation medium) alkali-free bioactive glasses clearly induced the appearance of more calcium deposits than the 45S5 Bioglass® , indicating their greater ability to induce cell differentiation. In summary, these results indicate that alkali-free bioactive glasses are a safe and valid alternative to 45S5 Bioglass® . © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2360-2365, 2017.

Optimization of poly-β-hydroxybutyrate production by halotolerant bacterial strains isolated from saline environment

PHB is a biodegradable plastic which is becoming an environmentally friendly substitute to the synthetic plastics that are persistent and accumulate in large amounts and are non-degradable. PHB is a class of Polyhydroxyalkanoate which are similar to commercial plastics like polypropylene but with an added advantage of being biodegradable. To overcome the problem of commercializing PHB production by microorganisms because of the high cost involved, Halotolerant organisms can be used as they are easier to cultivate and do not require strict sterile conditions. In this present study PHB producing halotolerant bacterial strains were isolated from a marine environment and cultivated under saline conditions. The growth conditions of the bacterial strains were optimized for maximum production of PHB. The parameters such as pH, temperature, NaCl concentration, carbon sources, nitrogen sources and carbon and nitrogen ratio were optimized and studied. The growth conditions for each of the parameter were optimized and the PHB production was estimated for the bacterial strains under saline conditions. The optimum pH and temperature range yielded maximum PHB production of about 42 – 45 mg/100ml and 30 – 40 mg/100ml respectively. The perspective application of PHB could be in the medicinal field for manufacturing medical devices as implants for various surgeries such as dental, cranio – maxillofacial and dental surgeries.

Low prevalence of hepatitis B and C among tuberculosis patients in Duhok Province, Kurdistan: Are HBsAg and anti-HCV prerequisite screening parameters in tuberculosis control program?

Objective/background: Viral hepatitis, particularly hepatitis B virus (HBV) and hepatitis C virus (HCV), infections and tuberculosis (TB) are a global public health concern. Co-infection with HBV or HCV among TB patients may potentiate the risk of hepatotoxicity induced by anti-TB drugs. Hence, the aim of this study was to identify the prevalence of HBV and HCV among TB patients included in the Duhok National Tuberculosis Program (NTP). Methods: The Duhok NTP Center is a specialized institution in Duhok City, Iraq, concerned with management and follow-up of TB patients. A cross-sectional study was conducted at the center between June 2015 and May 2016. All documented TB patients were analyzed on the basis of socio-demographic and other characteristics. Thereafter, all patients underwent screening for hepatitis B surface antigen (HBsAg), anti-HCV, and anti-HIV using enzyme-linked immunosorbent assay (ELISA). The results obtained were analyzed by entering the data in binary format into a Microsoft Excel spreadsheet. A p value of <.05 was considered to be statistically significant. Results: Two-hundred fourteen documented TB patients were recruited in this study, with 127 (59.3%) males and 87 (40.7%) females. The mean age of the patients was 40.34years (±20.29). Of the total number of patients, four cases (1.8%) were HBsAg-positive and one case (0.9%) was positive for anti-HCV. The variables significantly associated with HBV were history of surgical dental procedure [odds ratio (OR), 0.04; 95% confidence interval (CI), −0.01 to 0.04; p=.03], and nationality (OR, 13.67; 95% CI, 0.46–210.85; p=.007). Conclusion: The prevalence of HBV and HCV co-infection among TB patients in this study was low. This may be explained by the low rate of blood transfusion among the patients, the very low prevalence of HIV infections in Kurdistan, the negative history of injection drug use, and adherence to universal infection-control measures, including vaccination for HBV. Both history of dental intervention and belonging to a Syrian population were independent risk factors for HBV/TB co-infection.