Postoperative evaluation of Er:YAG laser, piezosurgery, and rotary systems used for osteotomy in mandibular third-molar extractions

OBJECTIVE

This study compared patient postoperative pain, swelling, and trismus after usage of rotary instruments, piezosurgery, and Er:YAG lasers in mandibular third-molar extraction.

MATERIALS AND METHODS

This prospective study was executed with class II and position B vertically impacted mandibular third molars. Patients were divided into three groups according to the osteotomy system used to remove retentive bone: rotary instruments, piezosurgery, and Er:YAG laser. Postoperative pain was evaluated using VAS questionnaires at 12 h, 24 h, 48 h, and 7 days after procedures. Trismus was evaluated by measuring the distance between the maxillary and mandibular incisors at maximum mouth opening, and comparing preoperative measurements with those for postoperative days 2 and 7. Analyses of swelling were carried out via a stereophotogrammetry system. Operation times were measured using a digital stopwatch from the initial incision to the final suture.

RESULTS

There were no statistically significant differences between the groups in terms of pain, trismus, or swelling (p > 0.05). Pain persisted more in the rotary instrument group 24 h later (0 ± 1.3; p = 0.001). The pain scores obtained after 48 h for the piezosurgery (1.81 ± 2.29) and rotary (2.2 ± 2.12) groups were observed at 24 h in the laser group (2.19 ± 1.52). The mean operation time was highest using the laser (19.1 ± 3.85 min; p = 0.001) and lowest using rotary instruments (9.88 ± 2.97 min; p = 0.001).

CONCLUSION

Piezosurgery and Er:YAG laser are good alternatives to rotary instrument systems in third-molar extraction, but both systems are slower than traditional rotary instruments.

Investigation of effects of low level laser therapy in distraction osteogenesis

PURPOSE

The purpose of the study was to investigate the histopathological effects of low level laser therapy (LLLT) application in distraction osteogenesis (DO).

MATERIALS AND METHODS

Twenty adult female New Zealand white rabbits were included in the study. Under general anesthesia unilateral mandibular corpus osteotomy was performed. Custom made external distractors were placed to right mandibles of rabbits. After five days of latency period, distractors were activated once a day for 5 days with 1mm/day frequency. Animals in the study group were exposed to LLLT from six different points transcutanously after each distractor activation. Control group was not exposed to laser irradiation. Animals were sacrificed after 15 and 30 days of consolidation periods and mandibles were processed for histopathological investigation under light microscope. Bone healing was analyzed with a semi-quantitative 4 point scale.

RESULTS

Osteoblastic activity and vascularization were found higher in the study group than control group after 15 days consolidation. Chondroblastic activity of the control group was significantly higher than the study group in both 15 and 30 days of consolidation groups. Osteoblastic activity and trabecular bone formation were found significantly higher in the study group than the control group after 15 days consolidation.

CONCLUSIONS

The use of LLLT in activation period of distraction osteogenesis stimulates bone repair in the early stages of distraction osteogenesis by inducing intramembranous healing and less cartilage tissue formation in the bone callus.

Effects of irrigation temperature on heat control in vitro at different drilling depths

PURPOSE

Thermal injury during implant bed preparation has a major influence on implant osseointegration and survival. This study investigated the effectiveness of the temperature of the saline solution used for heat control during drilling.

MATERIAL AND METHODS

Fresh frozen edentulous segments of bovine mandibles were sectioned into 12 x 6 cm pieces. Thermoresistors were placed 0.5 mm from the drilling cavity walls, at depths of 3, 7, and 12 mm. Signals from the three thermoresistors were analyzed using ORIGIN 5.0 software.

RESULTS

The maximum temperatures during drilling without irrigation were 50.9, 47.4, and 38.1 degrees C at depths of 3, 7, and 12 mm, respectively. With irrigation using saline at 25 and 10 degrees C, the maximum temperatures at a depth of 12 mm were 37.4 and 36.3 degrees C, respectively. All other measurements with both 25 and 10 degrees C saline were below body temperature.

DISCUSSION AND CONCLUSION

This experimental in vitro study showed that more heat was generated in the superficial part of the drilling cavity than at the bottom. Therefore, external irrigation at room temperature can provide sufficient cooling during drilling. Lower temperature saline was more effective in cooling the bone, and irrigation of the site should be continued between the drilling steps.

The impact of omega-3 fatty acids, vitamins E and C supplementation on treatment outcome and side effects in schizophrenia patients treated with haloperidol: an open-label pilot study

Classical antipsychotics like haloperidol are suggested to increase oxidative stress and oxidative cell injury in the brain. Pro-oxidant effect of haloperidol may influence the course and treatment outcomes of schizophrenia. Dietary supplementation of either antioxidants or omega-3 fatty acids was found to improve symptoms of schizophrenia. Thus we decided to assess the impact of combining omega-3 fatty acids, vitamins E and C supplementation on treatment outcome and side effects in schizophrenia patients treated with haloperidol. Ongoing haloperidol treatment of 17 schizophrenia patients was supplemented with 1000 mg capsule of omega-3 fatty acids (180 mg EPA+120 mg DHA) bid, vitamin E 400 IU bid and vitamin C 1000 mg/day. Patients were assessed with Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Negative Symptoms (SANS), Simpson Angus Scale (SAS) and Barnes Akathisia Rating Scale (BARS) over a 4 month period. Gluthatione peroxidase, superoxide dismutase, malondialdehyde, vitamin E and C levels were also evaluated at baseline and at the end of study. BPRS, SANS, SAS and BARS scores obtained at follow-up visits were significantly lower compared to baseline. Superoxide dismutase level was significantly lower at the end of study. No significant differences were detected in other laboratory parameters. Our results support the beneficial effect of the supplementation on positive and negative symptoms of schizophrenia as well as the severity of side effects induced by haloperidol. The effect of supplementation on akathisia is especially noteworthy and it has not been investigated in previous studies.

The influence of alendronate on bone formation after autogenous free bone grafting in rats

OBJECTIVE

This study was undertaken to investigate the influence of alendronate on bone formation after autogenous free bone grafting in rats.

STUDY DESIGN

Fifty-six male Wistar-Albino rats were divided into 3 groups: baseline, saline-treated, and alendronate-treated groups, and followed up at 2, 4, and 12 weeks. In the femur of the rats, autogenous free bone grafts 3 mm in diameter and 2 mm in length were harvested with a standard trephine bur. The bone defects 3 mm in diameter and 2 mm in length were created 5 mm from the donor sites. Each graft was placed in the bone defect and stabilized by perifemoral wiring. The alendronate-treated rats were administered 0.25 mg/kg alendronate subcutaneously daily. The saline-treated rats were given daily saline solution. Serum calcium, phosphate, parathyroid hormone, 1,25-dihydroxyvitamin D, bone alkaline phosphatase (BAP), osteocalcin, and urine calcium were measured. The changes in the number of osteoblasts bordering active bone formation surface and osteoid and lamellar bone formation were evaluated to measure anabolic bone activity.

RESULTS

Alendronate caused significant increase in serum osteocalcin and BAP levels biochemically and the number of osteoblasts histopathologically.

CONCLUSION

Alendronate may be considered among therapeutic options to improve bone formation process in different bone remodeling cases. Further detailed studies should be focused on dosage- and time-dependent effects of alendronate on bone formation.

Pediatric cervicofacial actinomycosis: a case report

Cervicofacial actinomycosis affects many soft tissue and bony structures in the head and neck, and has both granulomatous and suppurative features. Pathogenesis of actinomycosis is still unclear, but trauma provides a portal of entry for the infection. It usually presents as a diffuse swelling with multiple sinus tracts containing macroscopic colonies of the organism known as "sulphur granules." Cervicofacial actinomycosis in children is rare. This article reports a case of actinomycosis in a 10-year-old-boy overlying the left ramus of the mandible.