Postoperative pain and discomfort following tooth extraction are common complications that may negatively affect patients’ quality of life. The potential association between pre-existing sleep disturbances and postoperative discomfort remains insufficiently explored. This study aimed to investigate the association between pre-existing sleep disturbances and postoperative pain intensity, emotional impact, and limitations in daily activities in patients undergoing routine tooth extraction. This retrospective observational cohort study included 111 adult patients (18–65 years) who underwent tooth extraction at Hacettepe University. Preoperative sleep quality was assessed using the Jenkins Sleep Scale (JSS). Participants were classified into two groups: Group A (patients with sleep disturbances; JSS ≥ 12, n = 48) and Group B (patients without sleep disturbances; JSS < 12, n = 63). Postoperative outcomes were evaluated on postoperative day 1 using the American Pain Society Patient Outcomes Questionnaire–Revised (APS-POQ-R). The null hypothesis stated that there would be no difference in postoperative discomfort between the two groups. Statistical analyses included the Mann–Whitney U test and Chi-square test. Patients with pre-existing sleep disturbances (Group A) demonstrated significantly higher pain intensity scores (p < 0.001), greater emotional impact (p = 0.030), and increased limitations in daily activities (p = 0.002) compared with Group B. Satisfaction of pain management was significantly lower in Group A (p = 0.016). No statistically significant differences were observed between groups regarding nausea, numbness, itching, or dizziness (p > 0.05). Pre-existing sleep disturbances were significantly associated with increased postoperative discomfort and reduced satisfaction following tooth extraction. The null hypothesis was rejected. However, given the observational design and the lack of predictive analysis, these results should be interpreted cautiously, and further prospective studies are needed before clinical application can be recommended.

The growth factor sources used in alveolar bone regeneration should be practical and at a level that provides maximum benefit and cost effectiveness. Autologous growth factors are easy and practical to obtain in clinical practice, but their effectiveness in bone regeneration should be assessed in vivo studies. The hypothesis of this study was that the contribution of bone derived growth factors source to bone formation is greater than that of blood-derived growth factor source. Thirty male New Zealand rabbits were utilized in the experiment. Four defects of 8 mm were organized in the calvarium of each rabbit, and four treatment procedures were implemented: (1) empty defect, (2) autograft and xenograft (3) autograft+xenograft functionalized with growth factors released from autograft (4) autograft+ xenograft with injectable platelet rich fibrin (i-PRF). Rabbits were sacrificed at 4, 8 and 12 weeks of healing. Micro-computed tomography and histomorphometrically analyses were performed. The statistical difference was evaluated using two-way repeated measures analysis of variance. The significance level was set as p < 0.05. The autograft+xenograft, autograft+xenograft functionalized with growth factors released from autograft and autograft+ xenograft with i-PRF provided comparable bone formation at 4 and 8 weeks. The autograft+xenograft with i-PRF revealed significantly higher new bone formation at 12 weeks compared to that of autograft+xenograft group. (p = 0.016) There was no difference in the new bone formation between autograft+xenograft with i-PRF and autograft+xenograft functionalized with growth factors groups. (p = 0.75) The residual graft remained comparable among treatment groups at all time points. (p = 0.05) The composite graft contains growth factors obtained from i-PRF showed better new bone formation. Both blood and bone-derived growth factor sources can be utilized to functionalize the osteoconductive graft materials.

This study evaluated patient specific implant (PSI) accuracy at different maxillary locations during LeFort 1 osteotomy. Twelve patients underwent LeFort 1 osteotomy using PSIs and surgical guides. Deviations between the planned and actual positions were calculated for point A, mid-upper-incisal point, canine cusps, and first molar mesiobuccal cusps across the three axes. Spearman's Rho, Friedman, and Wilcoxon Tests with Bonferroni correction were used for analyses. Maxillary movements in LeFort 1 surgery averaged 1,46 ± 0,09 mm mediolaterally, 3,75 ± 0,23 mm anteroposteriorly, and 1,08 ± 0,17 mm superoinferiorly. The average amounts of deviations were 0,41 ± 0,03 mm (mediolateral), 0,60 ± 0,14 mm (anteroposterior), and 0,45 ± 0,15 mm (superoinferior). Negative correlations existed between planned movement and deviation at point A (superoinferior, P = 0.022) and left first molar (mediolateral, P = 0.045). Posterior teeth showed higher deviations (0.62 ± 0.42 mm) than anterior teeth (0.34 ± 0.30 mm) in the superoinferior direction (P = 0.007). The PSI technique ensures excellent transfer of the desired vertical position of the anterior teeth. Small anterior vertical and posterior transverse movements are more prone to deviations than great movements in the same regions and axes.

BackgroundThe present case is a valuable sample revealing a noninvasive mucor fungus ball (FB)'s etiological factors and radiologic characteristics.Case PresentationThe hemifacial pain complaint of the patient was started following the development of type II diabetes. A homogenous and partial radiopacity was radiologically monitored in the left maxillary sinus. An FB in the necrotic background, primarily originating from mucor, was histopathologically diagnosed. A 1-year follow-up was completed uneventfully.ConclusionDiabetes could trigger a symptomatic mucor FB development. Practitioners should be aware of a mucor FB existence if a partial homogenous radiopacification is seen in the maxillary sinuses.

Limiting postoperative edema, pain, trismus, and infection is crucial for smooth healing. This prospective, controlled clinical trial investigated and compared the effectiveness of dexamethasone and hyaluronidase in relieving these complications. In groups Ia and IIa, 8 mg of dexamethasone and 150 IU of hyaluronidase were administered following the removal of impacted teeth, respectively. The contralateral sides (groups Ib and IIb) were determined as control groups. Edema, pain, trismus, and infection were clinically evaluated on the 1st, 2nd, 3rd, and 7th postoperative days. 60 patients were enrolled in the study. Hyaluronidase provided significantly more edema relief than dexamethasone on the 1st, 2nd, 3rd, and 7th postoperative days (P = 0.031, 0.002, 0.000, and 0.009, respectively). No statistical difference was found between dexamethasone and hyaluronidase in VAS and rescue analgesic intake amount values for all time points. Hyaluronidase was more effective in reducing trismus than dexamethasone on the 2nd and 3rd postoperative days (P = 0.029, 0.024, respectively). Neither of the agents significantly increased the postoperative infection rate. Hyaluronidase can be selected when postoperative excessive edema and trismus are anticipated. Dexamethasone may be a cost–effective option if postoperative pain control is merely targeted. This trial was registered in the Clinical Trials Protocol Registration and Results System (ClinicalTrials.gov identifier number: NCT05466604) on 20/07/2022.

This paper examines the relationship between roll rotation of the jaws and changes in alar base or lip line asymmetry in the coronal plane following orthognathic correction. The study involved patients with preoperative frontal alar base and lip line asymmetries greater than 0.5° (because it corresponds to the minimum asymmetry perception threshold) and underwent bimaxillary orthognathic surgery without (Group I) or with (Group II) genioplasty. The alar base angle (ABA), lip line cant angle (LLCA), maxillary cant angle (MxCA), and mandibular cant angle (MnCA) were measured using preoperative and 12 months postoperative cone beam computed tomography (CBCT) images. Thirty-four patients were included in the study. Significant correlations were found between changes in MxCA and ABA besides between changes in MnCA and LCA in Groups I (P=0.016, P˂0.001, respectively) and II (P=0.002, P˂0.001, respectively). The mean of the change in ABA/the change in MxCA and the change in LLCA/the change in MnCA ratios for Group I were 0.59±1.57 and 0.73±0.94, respectively, while those for Group II were 0.46±3.70 and 0.39±2.00, respectively. Angular measurements from jugular and mental foramina points, aligned with the bony midline, offer a convenient tool for predicting alar base and lip symmetry during bimaxillary orthognathic surgery planning.

Objective The purpose of this study is to assess the impact of Sagittal Split Ramus Osteotomy (SSRO) on the alignment of the condyle and orientation of the Ramal segment following surgery in patients operated for the correction of mandibular asymmetry. Methods A total of 27 patients who underwent SSRO were enrolled in this study, and study groups were defined as asymmetric (study group) and symmetric (control group) using linear measurements from the dental midline based on a three-dimensional coordinate system. Differences on preoperative and postoperative values of anterior (AJS), posterior (PJS) and superior joint spaces (SJS), condylar axial angle (CAA), Sagittal Ramal Angle (SRA), and Coronal Ramal Angles (CRA) of study and control groups were measured and compared. The data was analyzed using the “Wilcoxon signed-ranks test” to identify differences between groups. Results Differences between preoperative and postoperative values of CRA and SRA of the contralateral group showed statistically significant results with p-values of 0.007 and 0.005, respectively. A statistically significant change in CAA angle was found in the control and deviation groups ( p = 0.018 and p = 0.010, respectively). Conclusions SSRO has inevitable effects on the condylar and ramal orientation. Individuals with asymmetry require particular attention throughout the planning process and beyond. Conjunctive modalities and modifications should be considered and utilized when necessary. Future studies with larger sample sizes, homogenous follow-up periods, and more comprehensive clinical data are needed to substantiate understanding of the response of the condylar segment. Clinical relevance Orthognathic surgeries inevitably alter the alignment and harmony of temporomandibular structures and may result in change of AJS, PJS, SJS, CAA, SRA, and LRA, which may change the biomechanics of joint and lead to several complications like temporomandibular disorders. Especially in cases with midline asymmetry needs special consideration from planning till the end of the treatment to achieve best results. In severe cases, conjunctive modalities and modifications and other alternatives such as inverted-L osteotomies should be considered.

This study was designed to evaluate the effects of different maxillary movements performed in Le Fort I surgery on the anatomy of the nasal cavity and maxillary sinus, occurrence of rhinosinusitis, and nasal airflow. Patients were divided into three groups: group I underwent pure advancement, group II underwent advancement with yaw rotation, and group III underwent advancement with impaction movements. All evaluations were performed using pre- and postoperative computed tomography images and surveys. Twenty-eight patients were enrolled. The mean pre- and postoperative nasal air volumes in group I were 22.74 ± 6.32 cm3 and 25.17 ± 6.19 cm3, respectively, showing a significant increase (P = 0.041). The mean pre- and postoperative maxillary sinus air volumes were 33.94 ± 13.72 cm3 and 26.28 ± 14.12 cm3 in group II and 35.29 ± 9.58 cm3 and 28.65 ± 8.42 cm3 in group III, respectively, showing significant reductions (P = 0.028 and P = 0.007, respectively). For all movements, the occurrence of septum deviation and nasal airflow impairment was not statistically significant. Pure maxillary advancement movement enhanced nasal cavity air volume. The yaw rotation movement significantly increased quantitative clinical rhinosinusitis symptoms. The risk of airflow impairment following Le Fort I surgery is low.

The purpose of this study was to evaluate, using cone-beam computerized tomography (CBCT), the rate of sinus membrane perforation in osteotome sinus floor elevation (OSFE) performed with and without a graft material. Thirty patients with 52 OSFE sites were included in the study. Patients were divided into the control group (OSFE performed without graft material) and test groups (OSFE performed with autograft or xenograft). The autograft was harvested from the maxillary tuberosity using bone forceps. The xenograft was a commercial product originating from bovine bone. Graft volume was measured using the water displacement method. CBCT was performed at the initial examination and immediately after surgery to measure the residual bone height and to evaluate the endo-sinus bone gain and membrane perforation. The rate of sinus membrane perforation was 15.4%. Of the 52 OSFE procedures, 26.9% were performed without grafting and 34.6% and 38.5% were performed with autografts and xenografts, respectively. Membrane perforation was significantly higher in the autograft group (P = .033). The median volume of graft materials was 0.3 mL. The difference in graft volume between the autograft and xenograft was not statistically significant (P = .768). The mean endo-sinus bone gain was 6.55 mm in patients without membrane perforation and 8.71 mm in patients with membrane perforation; this difference was statistically significant (P = .035). The volume and physical properties of graft materials are important factors in membrane perforation. Further clinical studies with larger and standardized samples are needed to confirm the effect of graft materials on sinus membrane perforation in OSFE.

PURPOSE:The present study evaluated the potential bone regeneration capacity of combining melatonin and simvastatin, with a goal of producing more osteogenic bone substitutes. MATERIALS AND METHODS:A total of 48 male Wistar rats were randomly divided into 4 groups. The following were administered into critical-sized calvarial defects of the rats: Group I-human allograft; Group II-human allograft + 10 mg melatonin; Group III-human allograft + 0.1 mg simvastatin; and Group IV-human allograft + 10 mg melatonin + 0.1 mg simvastatin. Histopathologic, histomorphometric, and microcomputed tomographic evaluations were performed postprocedurally at 4 and 8 weeks. A P value < .05 was considered significant for all evaluations. RESULTS:Groups II and III had significantly superior regeneration compared to Group I at weeks 4 and 8. Group III had significantly superior regeneration compared to Group II, particularly in week 4. Group IV had significantly superior regeneration compared to all groups at week 8. CONCLUSIONS:The local administration of melatonin and simvastatin resulted in increased new bone mass and quality of bone microstructure than was seen in the control group. Simvastatin shortened the defect regeneration time more effectively than melatonin did. The combined use of melatonin and simvastatin provided a synergic effect on bone regeneration, particularly in the late phase of healing.

This study sought to determine the rate of sinus membrane perforation in patients undergoing crestal sinus grafting, as well as the effect of Schneiderian membrane thickness and residual bone height (RBH) on membrane perforation, using cone beam computed tomography. The study included 25 patients undergoing 44 crestal sinus grafting procedures. The sites for crestal sinus grafting were divided into a control group (RBH≥5mm) and a test group (RBH<5mm). All sinus grafting procedures were also categorised based on membrane thickness: group A (<1mm), group B (1–2mm), and group C (≥2mm). The rate of membrane perforation was 18.2%. The median RBH measurement was 5.59mm. No statistically significant difference in membrane perforation rate was found between the test and control groups (P=0.262). The median thickness of the Schneiderian membrane was 1.35mm. There was no statistically significant difference in membrane perforation among the three membrane thickness groups (P=0.431). No significant correlation between RBH and membrane perforation was observed, although clinical observation indicated that there was a tendency for an increased membrane perforation rate in the presence of a RBH<5mm. The perforation rate was found to be at its highest when the membrane was thinner than 1mm.

Integrity of the palatal mucosa may be disrupted due to various pathological and congenital factors. In maxillofacial defects, the buccal fat pad has been used frequently to repair the palatal region and close oro-nasal communications. In this case report, the use of buccal fat pad for the closure of a surgical palatal defect is presented with a 3-year follow-up. A 75-year-old female patient visited our clinic with a complaint of a non-adaptive maxillary denture. During clinical and radiographic examination, a well-demarcated mass on the palatal mucosa extending to the soft palate of the left side was observed. Subsequent to resection of the tumor, a defect occurred on the palatal region extending toward the soft palate. The pedicled buccal fat pad was chosen for closure of the defect. The patient was followed-up at 3, 7, 14, and 30 days after surgery. Epithelization and healing of the surgical wound were uneventful. At the 3-year follow-up, functional closure of the left palatal region was observed with no recurrence. Buccal fat pad is an easily manipulated flap with predictable results for the reconstruction of medium-sized defects of the oral and maxillofacial region with minimal postoperative discomfort for the patient.

Defects of the oral and maxillofacial region may arise from several reasons such as trauma, infection, cyst, tumor, medication related osteonecrosis of the jaw, and misuse of some irritant agents. For reconstruction, autogenous grafts remain the gold standard among the alternatives. In our case, a 42-year-old woman referred to our clinic for implant-supported fixed bridge rehabilitation of her edentulous and defected left 2nd premolar and 1st molar region. In examinations, devitalizing agent-dependent large defect was observed. Anterior iliac crest (AIC) grafting technique was preferred for reconstruction. Consecutively, 16-week bone healing and 3-month implant osseointegration periods were uneventful. After fabrication of the implant-supported fixed bridge, the patient was followed up for 2.5 years with no signs of bone resorption, gingival inflammation, and pain. AIC grafting and implant-borne fixed bridges seem stable and satisfactory methods for large maxillofacial defects.

Bu calismanin amaci, saglik bilincinin, gida kalitesinin, fiyat duyarliginin ve hizmet deneyiminin tuketicilerin ev yemegini satin alirken fazla odeme istekliligi uzerindeki etkileri arastirmaktir. Ev yemegi restoranini daha once tercih eden tuketiciler anketi cevapladilar. Bu arastirmada, kolayda ornekleme yontemiyle secilen 600 kisiye yuz yuze anket uygulanmistir. Elde edilen veriler tanimlayici istatistikler, korelasyon ve regresyon analizi ile degerlendirilmistir. Arastirmanin sonucunda, tuketicilerin ev yemegi restoranlarini tercih etmesinde etkili olan ozelliklerin basinda hijyen ve fiyatin geldigi gorulmustur. Ayrica, saglik bilincinin, gida kalitesinin, fiyat duyarliliginin ve hizmet deneyiminin davranissal niyet uzerinde etkisinin oldugu ortaya cikmistir.

Background Both crestal and lateral techniques in sinus elevation and augmentation are surgical procedures to create adequate bone volume in posterior maxilla. Membrane perforation is a common complication during sinus lifting and it causes the loss of total partial bone graft and acute sinusitis in postoperatively. The lateral approach allows direct vision of the elevated membrane, whereas the crestal technique is a blind procedure so membrane perforation can be occurred without being noticed. Aim/Hypothesis The aim of this study was to reveal the incidence of sinus membrane perforation in crestal sinus lift technique using cone-beam computed tomography (CBCT) scans and determine the morbidity associated with the membrane perforation in follow-up period. Material and Methods Twenty-five patients with a total of 44 crestal sinus lift procedures were included in this study. Each patient were taken CBCT preoperatively, immediate postoperatively and 3 months later postoperatively. The crestal sinus lifting were performed according to Summers technique and modified Summers technique. Dental implants were placed simultaneously crestal sinus lifting or 4 months later based on residual bone height. The membrane thickness, residual bone height and bone width, any sinus pathology were recorded preoperatively. The membrane perforation was determined using immediate postoperative CBCT scans. If a dome-shaped radiologic appearance around the apex of the dental implant or graft material is not observed and an increased radiopacity in the sinus is observed on CBCT scans, the sinus membrane is accepted as perforated. The clinical and radiographical changes were recorded in patients with a membrane perforation. Results The mean residual bone height was 5.59 mm. The mean membrane thickness was 1.35 mm. Membrane perforation rate was 18.2% in 44 crestal sinus lifting. The most perforation rate was found in patients with a membrane thickness below 1 mm (23.5%) but the difference among the groups was not statistically significant (P = 0.431). In all patients with a sinus membrane perforation, the increased radiopacity was detected compared with the preoperative CBCT. 2 patients were suffered from acute sinusitis in follow-up period. Therefore oral antibiotic regimen was prescribed for 14 days in these patients. In 4 sinus lifting, it was determined that graft materials were spreading in the sinus cavity. 3 months later, the radiopacity was decreased in all patients but one. However, this patient had no complaint about clinical signs and symptoms of chronic sinusitis. In 2 patients, the graft resorption around the apex of dental implants was observed after 3 months. Conclusions and Clinical Implications The clinical and radiographical results show that crestal sinus lifting is a safe and predictable surgical procedure. However, the patients with membrane perforation need to be kept in close follow-up to control sinus infection and maintain dental implant survival.

Purpose: Recombinant human hyaluronidase (rHuPH20) is widely used as a spreading factor, which enhances the absorption of subcutaneously injected medicines. The anti-inflammatory and anti-edema effects of the enzyme were demonstrated in previous studies. In the present study, the anti-edema effect of rHuPH20 was compared with that of dexamethasone in a traumatic rat paw edema model. Materials and Methods: Twenty-four Sprague-Dawley rats (weight 200 to 450 g) were divided into 3 groups: control (group 1), rHuPH20 (group 2), and dexamethasone (group 3). Traumatic edema was induced in the right hind paws of the rats using Feeney's weight-drop model. After edema induction, 0.4 mL of rHuPH20 (100 U/kg = 0.88 mg/kg dose) and 0.4 mL of dexamethasone (0.5 mg/kg dose) were injected into the right hind paws of the rats in groups 2 and 3. The paw volumes were measured before edema induction and at 3, 6, 12, 24, 48, and 72 hours after induction using a plethysmometer. The Mann-Whitney U test was used for the statistical analyses. Probabilities < .05 were accepted as statistically significant. Results: The between percentage change in the edema mean values of groups 1 and 3 showed no significant difference at all time points; however, group 2 showed significantly less change in the edema mean values at 3, 6, 12, 24, and 48 hours after edema induction (P<.05) compared with group 1. The change in the edema mean value for group 2 was significantly less than that for group 3 at 3, 6, 12, 24, and 48 hours after edema induction (P<.05). Conclusions: Local rHuPH20 injection more effectively reduced the edema that was induced traumatically in rat paws than did dexamethasone. However, further clinical studies are needed regarding the use of rHuPH20 as a postoperative anti-edema agent in place of dexamethasone. (C) 2018 American Association of Oral and Maxillofacial Surgeons