Publications by authors named "Sina Uckan"

78 Publications

Comparison of scleral show alterations following Le Fort I osteotomy with either maxillary impaction or lengthening.

J Craniomaxillofac Surg 2021 Feb 10. Epub 2021 Feb 10.

Istanbul Medipol University, School of Dentistry, Department of Oral and Maxillofacial Surgery, Medipol University School of Dentistry, TEM Avrupa Otoyolu Go¨ztepe Çıkışı No: 1 Bağcılar, 34214, İstanbul, Turkey. Electronic address:

This study aimed at evaluating changes in scleral show following Le Fort I osteotomy with either impaction or lengthening of the mid face. Patients who underwent Le Fort I osteotomy were included. The patients were divided according to the direction of the movement: group 1 underwent maxillary advancement and impaction, while group 2 underwent maxillary advancement and lengthening. Standardized preoperative and 6-month postoperative photos were superimposed using Microsoft PowerPoint. The inferior visible scleral area was assessed with landmarks and measured separately using ImageJ software. Marked scleral surface area was determined using pixel count. A total of 36 consecutive patients were included. The mean maxillary advancement in the patients was 4.16 ± 2.14 mm. The mean impaction in group 1 (n= 21) was 1.06 ± 1.49 mm, while the mean vertical lengthening in group 2 (n = 15) was 1.54 ± 1.65 mm. The difference in improvement in the inferior scleral show between the groups was not statistically significant. Preoperative (180 ± 118.2 mm) and postoperative (147.75 ± 92.2 mm) scleral show significantly improved (p = 0.012) in both groups. Scleral show can be overlooked for movements under 6 mm while planning for maxillary orthognathic movement, as it improves regardless of the desired movement.
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http://dx.doi.org/10.1016/j.jcms.2021.01.031DOI Listing
February 2021

Radiographic assessment of the response of teeth following trauma during screw placement for maxillo-mandibular fixation.

Dent Traumatol 2021 Jan 27. Epub 2021 Jan 27.

Department of Oral and Maxillofacial Surgery, Medipol University, İstanbul, Turkey.

Background/aim: Maxillo-mandibular fixation (MMF) screws have gained popularity in recent years for inter-maxillary fixation. MMF screw application involves the risk of dental injury. However, knowledge about the healing responses after root damage in humans is limited, thereby warranting the need to classify the radiographic assessment of healing to enable better prediction of the healing response and effective management of the potential complications. The aim of this study was to assess and classify the radiographic assessment of the responses after root damage to evaluate the long-term outcomes.

Material And Methods: The dental records of patients who underwent orthognathic surgery or trauma management during 2014-2016 at an Oral and Maxillofacial Surgery Department were retrospectively analyzed. The data regarding dental injuries resulting from MMF screw application were evaluated. In total, 16 patients with 34 roots damaged from MMF screw application were enrolled. Post-operative orthopantomographs were analyzed by visual inspection of the affected areas to clarify the extent of root healing. The inter- and intra-rater reliability assessments were subsequently performed.

Results: The results indicated substantial inter- and intra-rater reliability of the responses. Most cases of root damage that were not radiographically related to the pulp (Schulte-Geers Class III defects) had complete or partial healing responses. In addition, 20% of the defects related to the pulp had additional resorption of the bone/dental tissues during the follow-up period.

Conclusions: Three different radiographic responses of root damage following MMF screw trauma were identified. Understanding these different responses is important to guide the management of the potential complications. This proposed radiographic assessment can be used to present root healing data in a more standardized and reliable manner.
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http://dx.doi.org/10.1111/edt.12654DOI Listing
January 2021

The efficiency of propranolol on occurrence and development of 4-nitroquinoline 1-oxide-induced squamous cell carcinoma of the tongue in rats.

J Oral Maxillofac Pathol 2020 May-Aug;24(2):400. Epub 2020 Sep 9.

Animal Research Center, Başkent University, İstanbul, Turkey.

Aims: The aim of this study to investigate the efficiency of propranolol on occurrence and development of 4-nitroquinoline 1-oxide (4NQO)-induced squamous cell carcinogenesis of the tongue in rats.

Subjects And Methods: The sample was composed of 27 male Sprague Dawley rats that received 50 ppm 4NQO for 20 weeks in drinking water. Group 1 ( = 9) was treated with 50 mg/kg/day propranolol for 20 weeks, Group 2 ( = 9), after carcinogenesis inducement for 20 weeks, received propranolol (50 mg/kg/day) for 2 weeks and Group 3 ( = 9) received no treatment. At the end of the experimental stage, the tongue specimens were evaluated under a light microscope and categorized as low- or high-risk lesions according to a binary system.

Statistical Analysis Used: The statistical comparison was performed with a likelihood ratio test.

Results: Histopathological analysis revealed the risk of malignant transformation rates as 33.3% in Group 1, 55.5% in Group 2 and 77.8% in Group 3; however, the difference between the groups was not statistically significant ( > 0.05).

Conclusion: The results of the study suggest that propranolol has a tendency to preventive effect against carcinogenesis.
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http://dx.doi.org/10.4103/jomfp.JOMFP_88_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802876PMC
September 2020

Effect of Horizontal Osteotomy Level on Complication Rates and Neurosensory Deficits After Sagittal Split Ramus Osteotomy.

J Craniofac Surg 2021 Jan 5;Publish Ahead of Print. Epub 2021 Jan 5.

Department of Oral and Maxillofacial Surgery, School of Dentistry, Medipol University, Istanbul, Turkey.

Horizontal osteotomy is one of the most critical step at sagittal split ramus osteotomy (SSRO) and determination of the ideal height of this horizontal osteotomy is essential to avoid nerve and vessel injury.

Purpose: The aim of this study was to evaluate the level of the medial horizontal ramus cut as a risk factor for unfavorable outcomes in the SSRO.

Materials And Methods: Sixty-four patients with dentofacial deformity who applied to Oral & Maxillofacial Surgery Department between August 2018 and August 2019 and undergone orthognathic surgery were evaluated. Out of 64, 49 patients had SSRO with or without maxillary surgery and genioplasty. Twenty-six patient had postoperative computed tomography scan with 6-months follow-up. Finally, 26 patient with 52 SSRO sides were included in this study. Computed tomography scans were evaluated and classification according to osteotomy levels was made. Postoperative neurosensory deficit, bleeding, and intraoperative complications such as bad split, visible damage to inferior alveolar bundle were assessed. Age, gender, neurosensory deficit, bad splits were analyzed and correlated with the level of the osteotomies.

Results: Fifteen osteotomies were above lingula, 24 between apex and base of lingula, and 14 below lingula. One bad split occurred, and no visible damage to the inferior alveolar bundle was seen. There was no significant difference between osteotomy groups in terms of visual analogue scale (VAS) scores (P > 0.05) but in all groups; women's VAS scores are statistically significantly higher than men. (P: 0.036).

Conclusion: There is no correlation between the horizontal osteotomy level and intraoperative or postoperative complications. The low medial horizontal osteotomy can be safely performed in SSRO.
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http://dx.doi.org/10.1097/SCS.0000000000007404DOI Listing
January 2021

Changes of Stress Distributions Around Pterygomaxillary Junction With Different Osteotome Angulations.

J Craniofac Surg 2020 Sep;31(6):1560-1562

Department of Oral and Maxillofacial Surgery, Istanbul Medipol University School of Dentistry, Istanbul.

The aim of this study was to investigate how the alteration of the angulation of osteotome at pterygomaxillary junction affects lateral pterygoid plate, maxillary tuberosity, palatal surface of maxilla, palatine bone and body of sphenoid bone. Following reconstruction of 3D modelling of maxilla, Osteotomes' tip was angulated 45 and 90 to sagittal plane to simulate pterygomaxillary osteotomy. Finite element analyses (FEA) was performed and Von Misses stress distributions were analyzed for two different angulations. Independent sample t test was used to compare differences between 45 and 90 angulations. Von Misses stress values on lateral pterygoid plate were higher in 45 angulation (0.71 ± 0.21 MPa) than 90 angulation (0.54 ± 0.28 MPa). This difference was statistically significant (P < 0.01). Placement of osteotome's tip with 90 angulation had higher stress value than 45 angulation on maxillary tuberosity region. However; difference wasn't significant (P = 0.44). Stress values on body of sphenoid bone were 0.45 ± 0.17MPa for the case of 90 angulation and 0.19 ± 0.09MPa for 45 angulation. Difference between these values were statistically significant (P < 0.01). Possible risk of unfavourable lateral pterygoid plate fracture and complications related with body of sphenoid bone during pterygomaxillary osteotomy was remarkably increased in case of narrow angulation (45). Keeping osteotome at right angle with sagittal plane may avoid these complications.
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http://dx.doi.org/10.1097/SCS.0000000000006397DOI Listing
September 2020

Comparison of Success Rate of Dental Implants Placed in Autogenous Bone Graft Regenerated Areas and Pristine Bone.

J Craniofac Surg 2020 Sep;31(6):1572-1577

Istanbul Medipol University, Department of Oral and Maxillofacial Surgery, Istanbul, Turkey.

Autogenous bone grafting still has been considered as the "gold standard" and wildly used in the case of alveolar bone reconstruction. The aim of the present study is to evaluate the success rate of implants placed in autogenous block augmented ridges and implants placed in pristine bone (PB). This study included 113 patients. Fifty-three patients were treated with autogenous block grafts and particulate bone, after 6 months of healing implant placements were performed in autogenous bone augmented (ABA) areas. In 60 patients implant placement was performed, with no need for grafting and implants were placed into the PB. Follow-up data (pain, mobility, exudation from peri-implant space, success rate, marginal bone resorption) were collected after 5 years of prosthetic loading. The cumulative implant success rate at the 5-year examination was 92.45% for the ABA group and 85% for PB group. There were 3 failed implants in the ABA group and 3 in PB group. Average marginal bone loss was 1.47 mm on ABA group and 1.58 mm on PB group. No statistically significant differences for pain, exudation from peri-implant space, implant mobility, implant success, peri-implant bone loss parameters, and patient satisfaction level were found between groups. The obtained data demonstrated that the success rate of implants placed in regenerated areas are very similar to the success rate of implants those placed in PB.
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http://dx.doi.org/10.1097/SCS.0000000000006401DOI Listing
September 2020

Surgical Protocol for a Safe Lateral Nasal Wall Osteotomy.

J Craniofac Surg 2020 May/Jun;31(3):853-855

Department of Oral and Maxillofacial Surgery, School of Dentistry, Medipol University.

Purpose: The purpose of this study was to define the anatomy and anatomic variations of the lateral nasal wall area to identify safe access points, determine the optimum osteotomy line for Le Fort I osteotomies, and define a surgical protocol.

Materials And Methods: The angulations and widths of 160 lateral nasal walls and the distances of the greater palatine canal were measured on axial images from coronal sections 5 mm over the deepest point of the nasal base.

Results: The average angle between the anterior lateral nasal wall and the medial maxillary sinus wall was 160 degrees in females and 165.67 degrees in males for the right and 155.90 degrees in females and 163.22 degrees in males for the left side. Statistically significant differences were found in the lengths, angulations, and widths of the lateral nasal walls between females and males.

Conclusion: This study described the mean angulations and linear distances between anatomic structures of the lateral nasal wall and it defines the "Medipol protocol" for a safe osteotomy.
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http://dx.doi.org/10.1097/SCS.0000000000006179DOI Listing
August 2020

Orthognathic Surgery Treatment Need in a Turkish Adult Population: A Retrospective Study.

Int J Environ Res Public Health 2019 05 28;16(11). Epub 2019 May 28.

Department of Oral and Maxillofacial Surgery, School of Dentistry, İstanbul Medipol University, İstanbul 34214, Turkey.

Limited information exists on orthognathic procedures and respective dentofacial deformities in Turkey. This retrospective study assessed the orthognathic surgery procedures in two universities, using the Index of Orthognathic Functional Treatment Need (IOFTN), and compared the IOFTN grades according to gender as well as sagittal and vertical skeletal relationships. Records of 200 consecutive patients (120 females, 80 males, mean age = 23.4 (SD: 5.4) years) who received orthognathic treatment (2014-2018) were analyzed. Sagittal (ANB angle) and vertical skeletal type (GoGnSN angle), osteotomies, and IOFTN scores were recorded. Class III, II, and I malocclusions formed 69%, 17.5%, and 13.5% of the samples, respectively. Class III skeletal relationships (69%) and high-angle cases (64%) were the most prevalent ( < 0.05). IOFTN scores were unevenly distributed among genders ( < 0.05) and the prevalent scores were 5.3 (40.5%), 4.3 (15.5%), 5.4 (13%), and 5.2 (7.5%), with 94% scoring 4 or 5 (great and very great functional need). Bimaxillary osteotomies were the most prevalent (55%), followed by LeFort I (32%), and 26% had genioplasty. IOFTN is a reliable tool to identify patients in need of orthognathic surgery. Class III malocclusions and Class III sagittal skeletal relationships were more common in this sample. Comparatively, a higher number of patients had genioplasty as a part of their treatment.
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http://dx.doi.org/10.3390/ijerph16111881DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6603578PMC
May 2019

Sagittal skeletal correction using symphyseal miniplate anchorage systems : Success rates and complications.

J Orofac Orthop 2019 Jan 9;80(1):9-16. Epub 2018 Nov 9.

Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Medipol University, İstanbul, Turkey.

Objectives: Aim of this study is to evaluate success rates and complications related with symphyseal miniplate anchorage systems used for treatment of Class 2 and Class 3 deformities.

Methods: A total of 58 miniplates applied to 29 growing patients were evaluated. The first group comprised 24 symphyseal miniplates applied to 12 patients and Forsus Fatigue Resistant Devices were attached to the head of the miniplates for mandibular advancement. The second group consisted of 34 symphyseal miniplates applied to 17 patients and intermaxillary elastics were applied between acrylic appliances placed on the maxillary dental arch and the symphyseal miniplates for maxillary protraction. Success rate and complications of the symphyseal plate-screw anchorage system were evaluated.

Results: The overall success rate of symphseal miniplates was 87.9%. Six miniplates showed severe mobility and 2 miniplates broke during orthodontic treatment. Infection, miniplate mobility and mucosal hypertrophy were statistically different between the two groups.

Conclusions: Symphyseal miniplates were generally used as successful anchorage units in most patients. Infection, mobility, and mucosal hypertrophy occurred more frequently in Class 2 deformity correction. However, the success rates regarding the two treatment modalities were comparable.
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http://dx.doi.org/10.1007/s00056-018-0160-2DOI Listing
January 2019

Comparison of Tunnel and Crestal Incision Techniques in Reconstruction of Localized Alveolar Defects.

Int J Oral Maxillofac Implants 2017 September/October;32(5):1103–1110. Epub 2017 May 18.

Purpose: The aim of this study was to compare the complication rates of recipient sites prepared using two incision techniques: crestal and tunnel.

Materials And Methods: In this prospective study, patients underwent augmentation procedures (68 patients; 75 sites) by the same surgeon that were performed consecutively using the crestal incision technique (27 horizontal, 10 vertical; crestal group) or the tunnel incision technique (27 horizontal, 11 vertical; tunnel group). Autogenous bone block grafts were harvested with a piezoelectric surgical device, and the grafts were fixed at the recipient sites by two titanium screws in both groups. The authors evaluated minor exposure, transient paresthesia, major exposure, permanent paresthesia, gingival recession at adjacent teeth, surgery time, and visual analog scale pain scores.

Results: Soft tissue dehiscence and graft failure were significantly lower in patients undergoing the tunnel technique.

Conclusion: The tunnel incision technique significantly decreased soft tissue exposure, the most common complication of augmentation procedures with autogenous onlay bone grafts. This technique should be considered an alternative to the crestal incision technique for preparation of the recipient site.
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http://dx.doi.org/10.11607/jomi.5275DOI Listing
May 2017

Unilateral complex syngnathia of the maxilla, mandible, and zygomatic complex in a newborn baby.

Br J Oral Maxillofac Surg 2017 02 30;55(2):211-212. Epub 2016 Jun 30.

Medipol University, TEM Avrupa Otoyolu Goztepe Cikisi No: 1 Bagcilar 34214 Istanbul, Turkey. Electronic address:

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http://dx.doi.org/10.1016/j.bjoms.2016.06.007DOI Listing
February 2017

Lactobacillus rhamnosus could inhibit Porphyromonas gingivalis derived CXCL8 attenuation.

J Appl Oral Sci 2016 Jan-Feb;24(1):67-75

Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Başkent University, Ankara, Turkey.

Unlabelled: An increasing body of evidence suggests that the use of probiotic bacteria is a promising intervention approach for the treatment of inflammatory diseases with a polymicrobial etiology. P. gingivalis has been noted to have a different way of interacting with the innate immune response of the host compared to other pathogenic bacteria, which is a recognized feature that inhibits CXCL8 expression.

Objective: The aim of the study was to determine if P. gingivalis infection modulates the inflammatory response of gingival stromal stem cells (G-MSSCs), including the release of CXCL8, and the expression of TLRs and if immunomodulatory L. rhamnosus ATCC9595 could prevent CXCL8 inhibition in experimental inflammation.

Material And Methods: G-MSSCs were pretreated with L. rhamnosus ATCC9595 and then stimulated with P. gingivalis ATCC33277. CXCL8 and IL-10 levels were investigated with ELISA and the TLR-4 and 2 were determined through flow cytometer analysis.

Results: CXCL8 was suppressed by P. gingivalis and L. rhamnosus ATCC9595, whereas incubation with both strains did not abolish CXCL8. L. rhamnosus ATCC9595 scaled down the expression of TLR4 and induced TLR2 expression when exposed to P. gingivalis stimulation (p<0.01).

Conclusions: These findings provide evidence that L. rhamnosus ATCC9595 can modulate the inflammatory signals and could introduce P. gingivalis to immune systems by inducing CXCL8 secretion.
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http://dx.doi.org/10.1590/1678-775720150145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4775012PMC
November 2016

Stress Distribution on Short Implants at Maxillary Posterior Alveolar Bone Model With Different Bone-to-Implant Contact Ratio: Finite Element Analysis.

J Oral Implantol 2016 Feb;42(1):26-33

2  Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Baskent University, Ankara, Turkey.

The aim of this study was to evaluate the stress distribution of the short dental implants and bone-to-implant contact ratios in the posterior maxilla using 3-dimensional (3D) finite element models. Two different 3D maxillary posterior bone segments were modeled. Group 1 was composed of a bone segment consisting of cortical bone and type IV cancellous bone with 100% bone-to-implant contact. Group 2 was composed of a bone segment consisting of cortical bone and type IV cancellous bone including spherical bone design and homogenous tubular hollow spaced structures with 30% spherical porosities and 70% bone-to-implant contact ratio. Four-millimeter-diameter and 5-mm-height dental implants were assumed to be osseointegrated and placed at the center of the segments. Lateral occlusal bite force (300 N) was applied at a 25° inclination to the implants long axis. The maximum von Mises stresses in cortical and cancellous bones and implant-abutment complex were calculated. The von Mises stress values on the implants and the cancellous bone around the implants of the 70% bone-to-implant contact group were almost 3 times higher compared with the values of the 100% bone-to-implant contact group. For clinical reality, use of the 70% model for finite element analysis simulation of the posterior maxilla region better represents real alveolar bone and the increased stress and strain distributions evaluated on the cortical and cancellous bone around the dental implants.
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http://dx.doi.org/10.1563/aaid-doi-D-14-00003DOI Listing
February 2016

Management of Maxillary Deformity with Segmental Osteotomy followed by Implant Insertion in β-Thalassemia Major Patient.

J Contemp Dent Pract 2015 08 1;16(8):704-7. Epub 2015 Aug 1.

Department of Oral and Maxillofacial Surgery, Medipol University, Istanbul.

Aim: The aim of this report is to present the management of the maxillary deformity and subsequent implant therapy of a case with β-thalassemia major.

Background: β-thalassemia is a hematologic disorder that results from the abnormality of the β-globulin chain synthesis. The best known thalassemia-induced dentofacial problem is the maxillary enlargement, and this undesirable growth of maxilla affects not only the facial esthetics but also dental occlusion, and leads to functional deficiency.

Case Description: A 16-year-old female patient with β-thalasse-mia major was referred with the complaints of severe facial deformity and malocclusion, resulting in psychosocial and functional problems for her. The dentofacial deformity was characterized by an excessive premaxillary growth both in sagittal and vertical planes. Anterior maxillary osteotomy was performed with bilateral canines extraction, and dental implants were inserted to the canine regions, following bone healing. Postoperative course was free of problems with the crown restorations in function. Recurrence has not been occurred at 6 years follow-up.

Conclusion: With maintaining hemoglobin level over 10 gm/dl, correction of maxillary defects is stable for long-term in β-thalassemia major patient. Implant application to these patients may lead to unforeseeable results.

Clinical Significance: Although having some difficulties, such as overbleeding and stability problems, maxillary enlargement can be treated by segmental osteotomies successfully in β-thalassemia major patient. Implant failure frequency may be higher, but many other studies are needed for determining implant survival rate in β-thalassemia major patients.
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http://dx.doi.org/10.5005/jp-journals-10024-1744DOI Listing
August 2015

Combined use of alveolar distraction osteogenesis and segmental osteotomy in anterior vertical ridge augmentation.

Int J Surg Case Rep 2015 28;8C:124-6. Epub 2015 Jan 28.

Baskent University, Departmant Of Oral And Maxillofacial Surgery, Bahçelievler mah. No. 16 Çankaya, Ankara, Turkey. Electronic address:

Introduction: Vertical defects of the anterioral veolar ridge are challenging cases in implant dentistry. Various techniques, such as onlay bone grafting, segmental osteotomy (SO) oral veolar distraction osteogenesis (ADO), have been suggested to manage those situations. ADO has an advantage of being capable of enhancing both hard and soft tissue simultaneously.

Presentation Of Case: One of the possible complications of ADO is rotation ortilting the transport segment (TS). In this report, we present a 30-year old woman who had a severe anterior vertical deficiency. ADO was started to manage the case, but advancement of the TS lagged on the left side and the segment rotated. A SO was planned and the lagged side was corrected. Two years after the surgery, hard and soft tissue gains were found to be preserved.

Discussion: Vertical alveolar bone deficiencies are challenging cases for dental implantology. Alveolar DO promotes soft tissue along with hard tissue, and the bone regeneration process and shows lower infection rates and greater stability over the long term. However, the technique has some disadvantages and can lead to complications, such as breaking of the distraction device, nerve injury or paresthesia, fracture of transport bone, hematoma, wound dehiscence, severe bleeding, and even jaw fractures. Deviation of the TS from the distraction path is another undesired situation. The rigidity of the device, the width of the mucosa, the volume of the transport and anchor segments, and the amount of augmentation can affect vector deviation.

Conclusion: We suggest that SO can be used in similar cases in which TS could not be distracted on a straight vector line.
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http://dx.doi.org/10.1016/j.ijscr.2015.01.038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4353954PMC
March 2015

Comparative evaluation of simultaneous maxillary sinus floor elevation and implant placement with residual bone heights greater or less than 5 mm.

Int J Oral Maxillofac Implants 2015 Jan-Feb;30(1):179-83. Epub 2014 Sep 26.

Purpose: Implants can be inserted simultaneously during sinus floor elevation (SFE), or 6 months later, for posterior maxillary rehabilitation. The residual bone height (RBH) is a major factor that affects the type of surgical procedure that will be performed. The aim of this study was to compare the survival rates of implants inserted during one-stage SFE with two different RBHs (< 5 mm and ≥ 5 mm).

Materials And Methods: This study consisted of implants inserted into an RBH of either < 5 mm or ≥ 5 mm, and the survival of the implants was assessed according to the clinical symptoms of the patients: pain or tenderness during function (or spontaneously), mobility, depth of probing, exudation history, and radiographic bone loss at the final follow-up appointment. The survival rates of the two groups were statistically compared using the Fisher exact test.

Results: Fifty-nine consecutive patients (29 women and 30 men) undergoing a one-stage sinus elevation procedure simultaneously with implant insertion were included in this study. Fifty-one implants were placed in the study group (RBH: 1 to 4.9 mm), and 31 implants were placed in the control group (RBH: 5 to 8 mm). The survival rate of the implants in the study group was 94.2% at the 5.4-year follow-up and 95.8% in the control group at the 7.9-year follow-up. There was no statistically significant difference between the groups in terms of the implant survival rate (P = .785).

Conclusion: The results of this study suggest that SFE with simultaneous implant placement in patients with an RBH < 5 mm can be accomplished, and that the survival rate is similar to that of the one-stage SFE protocol with an RBH of > 5 mm.
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http://dx.doi.org/10.11607/jomi.3614DOI Listing
November 2015

Is the incidence of temporomandibular disorder increased in polycystic ovary syndrome?

Br J Oral Maxillofac Surg 2014 Nov 12;52(9):822-6. Epub 2014 Aug 12.

Endocrinology Department, Mareşal Fevzi ÇakmakCaddesi, 10. Sokak no:45, Ankara, Turkey. Electronic address:

The prevalence of temporomandibular disorders is higher among women than men (ratio 3:1 -9:1). Polycystic ovary syndrome(PCOS) is the most common endocrine disorder in women, which is characterised by chronic low-grade inflammation and excess of androgenic hormones that lead to metabolic aberrations and ovarian dysfunction. Increased activities of various matrix metalloproteinases (particularly MMP-2 and 9) in the serum of these patients has been reported, and it has been hypothesised that high activities of MMP may contribute to loss of matrix and chronic inflammation of the fibrocartilage in temporomandibular disorders. Our aim was to evaluate the incidence of temopormandibular dysfunction in women with PCOS compared with an age-matched, disease-free, control group. We studied 50 patients with previously diagnosed PCOS and 50 volunteers who had normal menstrual cycles. We made a comprehensive clinical examination of the temporomandibular joint (TMJ) and muscles of mastication in both groups and recorded the Visual Analogue Scores (VAS) for pain. There were significant differences (p<0.001) in the incidence of temporomandibular disorders (n=43 (86%) in the PCOS group compared with n=12 24% in the control group), muscle tenderness(n=32 (64%) in the PCOS group compared with n=14 (28%) in the control group) and pain in the TMJ (mean (SD) VAS 2.9 (2.61) compared with 0.3 (1.56). We confirm the higher incidence and severity of disorders of the TMJ in patients with PCOS and suspect that chronic low-grade inflammation may play a part in the aetiology of the disease.
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http://dx.doi.org/10.1016/j.bjoms.2014.07.100DOI Listing
November 2014

An unusual presentation of an intraosseous epidermoid cyst of the anterior maxilla: a case report.

J Med Case Rep 2014 Jul 28;8:262. Epub 2014 Jul 28.

Department of Oral and Maxillofacial Surgery, School of Dentistry, Kırıkkale University, Kırıkkale, Turkey.

Introduction: Intraosseous epidermoid inclusion cysts are rare benign epithelial inclusion cysts in the bone. They are usually found in the cranium and hand phalanges. They are slow growing lesions, and it is difficult to differentiate them from other inflammatory and cystic lesions. Only a few cases of epidermoid inclusion cyst in the jaw have been reported in the literature. This is the fourth case reported as intraosseous epidermoid cyst of the maxilla in the English literature.

Case Presentation: An asymptomatic 59-year-old Caucasian man was referred to our Oral and Maxillofacial Surgery clinic for a unilocular radiolucent area at his anterior maxilla shown on an orthopantomograph. He was scheduled for surgery and underwent cyst extraction surgery. A pathological examination revealed epidermoid cyst. The diagnostic dilemma in this case report in opposition to the presented intraosseous epidermoid cysts in the literature is that there was no trauma history to his upper jaw. Treatment for this cyst is conservative surgical excision and recurrence is uncommon.

Conclusions: This report presents an unusual case of an intraosseous epidermoid cyst that occurred with no trauma history to the upper jaw. Although only three cases of epidermoid inclusion cyst have been reported in the maxilla, epidermoid inclusion cyst should be considered in the differential diagnosis of radiolucent lesions of the jaws.
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http://dx.doi.org/10.1186/1752-1947-8-262DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4131483PMC
July 2014

Radiological and Histological Evaluation of the Effects of Cortical Perforations on Bone Healing in Mandibular Onlay Graft Procedures.

Clin Implant Dent Relat Res 2016 Feb 29;18(1):82-8. Epub 2014 May 29.

Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara, Turkey.

Background: Perforations of the cortical bone may be an advantage for the success of the autogenous bone graft procedure, but whether this perforation has a positive effect on the bone remains controversial.

Purpose: This study evaluates the effects of cortical perforation of the autogenous bone block graft radiologically and histologically.

Materials And Methods: Seven adult pigs were used for this study. On the experimental side, cortical perforation at the host site was prepared, while no perforation was done on the control side. The specimens were evaluated, and the Wilcoxon signed-rank test was used for statistical analysis.

Results: In the radiological evaluation, the Wilcoxon signed-rank test indicated no significant differences in densities among the grafts (p = .23) with a mean of 4.29 ± 0.951 for the unperforated graft side and 3.57 ± 0.976 for the decorticated graft side. In histological evaluation, there was a significant difference in the thickness of the grafts between the groups (experimental group 3.71 ± 1.286, control group: 4.71 ± 0.488; p = .033). However, when the remodeling and osteoblastic activity in the grafts were measured, no significant differences were observed between the groups (p = 1 and p = .133, respectively).

Conclusion: In augmentation with mandibular onlay bone grafts, cortical perforations in the recipient site make no distinct contribution to bone healing within 12 weeks.
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http://dx.doi.org/10.1111/cid.12238DOI Listing
February 2016

Dentofacial effects of skeletal anchored treatment modalities for the correction of maxillary retrognathia.

Am J Orthod Dentofacial Orthop 2014 Jan;145(1):41-54

Professor, Department of Oral-Maxillofacial Surgery, Başkent University, Faculty of Dentistry, Ankara, Turkey.

Introduction: The aim of this clinical study was to investigate the skeletal, dentoalveolar, and soft-tissue effects of 2 skeletal anchorage rationales for Class III treatment compared with an untreated Class III control group.

Methods: Fifty-one subjects who were in the prepubertal or pubertal growth period were included in the study. In group 1 (n = 17), facemasks were applied from miniplates placed in the lateral nasal walls of the maxilla, and intermaxillary Class III elastics were applied from symphyseal miniplates to a bonded appliance on the maxilla in group 2 (n = 17). These skeletal anchored groups were compared with an untreated control group (n = 17). Lateral cephalometric radiographs were obtained at the beginning and the end of the observation periods in all groups and analyzed according to the structural superimposition method. Differences between the groups were assessed with the Wilcoxon signed rank test or the paired-samples t test.

Results: The treatment periods were 7.4 and 7.6 months in groups 1 and 2, respectively, and the untreated control group was observed for 7.5 months. The maxilla moved forward by 3.11 mm in group 1 and by 3.82 mm in group 2. The counterclockwise rotation of the maxilla was significantly less in group 1 compared with group 2 (P <0.01). The mandible showed clockwise rotation and was positioned downward and backward in the treatment groups, and it was significantly greater in group 2 compared with group 1 (P <0.01). Changes in the maxillary incisor measurements were negligible in group 1 compared with group 2. A significant amount of mandibular incisor retroclination was seen in group 1, and a significant proclination was seen in group 2. The maxillomandibular relationships and the soft-tissue profiles were improved remarkably in both treatment groups.

Conclusions: The protocols of miniplates with facemasks and miniplates with Class III elastics offer valid alternatives to conventional methods in severe skeletal Class III patients. However, the 2 maxillary protraction protocols demonstrated significant skeletal and dentoalveolar effects. The miniplate with facemask protocol is preferred for patients with severe maxillary retrusion and a high-angle vertical pattern, whereas in patients with a decreased or normal vertical pattern and retroclined mandibular incisors, miniplates with Class III elastics can be the intraoral treatment option. Therefore, the exact indication of the procedure should be considered carefully.
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http://dx.doi.org/10.1016/j.ajodo.2013.09.009DOI Listing
January 2014

Change in inferior sclera exposure following Le Fort I osteotomy in patients with midfacial retrognathia.

J Oral Maxillofac Surg 2014 Jan;72(1):166.e1-5

Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara, Turkey.

Purpose: For facial esthetic reasons, no sclera should be exposed above or below the irises when the head of a patient who has a normal skeletal pattern is in a neutral position and the eyelids are in a relaxed position. This study evaluated the decrease in sclera exposure after maxillary advancement or impaction in patients with midfacial hypoplasia.

Patients And Methods: Forty-seven consecutive patients (24 male, 23 female) who underwent Le Fort I osteotomy were included. The patients were divided into 2 groups according to type of maxillary movement: group I underwent maxillary advancement (n = 23) and group II underwent maxillary advancement and impaction surgery (n = 24). Standardized preoperative and 6-month postoperative photographs of the frontal view of patients were evaluated using Adobe Photoshop CS5. The proportion of inferior sclera exposure to eye height was determined, and the proportional difference between the preoperative and postoperative orbital views was statistically analyzed.

Results: The proportion of inferior sclera exposure to eye height decreased by a ratio of 0.07 (P = .001) in the right and left eyes of the 47 patients, with an average maxillary advancement of 6.1 mm. The proportion of inferior sclera exposure to eye height of the right and left eyes decreased from 0.1 to 0.02 and from 0.09 to 0.02, respectively, in group I (P = .001). The proportion of inferior sclera exposure to eye height decreased in group II by a ratio of 0.06 in the right and left eyes (P = .001).

Conclusion: Inferior sclera exposure in patients with midfacial hypoplasia and retrognathia decreases significantly in accordance with the change in the lower eyelid position after maxillary advancement or impaction surgeries.
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http://dx.doi.org/10.1016/j.joms.2013.09.025DOI Listing
January 2014

Management of bisphosphonate-related osteonecrosis of the jaw with a platelet-rich fibrin membrane: technical report.

J Oral Maxillofac Surg 2014 Feb 25;72(2):322-6. Epub 2013 Sep 25.

Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara, Turkey.

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a challenging complication resulting from the long-term application of bisphosphonates. In most cases, BRONJ occurs after a surgical procedure involving the jawbone. Currently, the management of BRONJ remains controversial, and there is no definitive treatment other than palliative methods. Platelet-rich fibrin (PRF) represents a relatively new biotechnology for the stimulation and acceleration of tissue healing and bone regeneration. This technical note describes the total closure of moderate bone exposure in persistent BRONJ in 2 weeks with a double-layer PRF membrane. PRF may stimulate gingival healing and act as a barrier membrane between the alveolar bone and the oral cavity. PRF may offer a fast, easy, and effective alternative method for the closure of bone exposure in BRONJ.
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http://dx.doi.org/10.1016/j.joms.2013.07.027DOI Listing
February 2014

The extent of chin ptosis and lower incisor exposure changes following the osseous genioplasties.

J Craniofac Surg 2013 ;24(5):e445-58

From the *Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara; and †Baskent University, Practice and Research Hospital of Adana, Adana, Turkey.

The incision and dissection of the mentalis muscles are inevitable to access the osteotomy line during genial surgery. As the mentalis muscles elevate the central lower lip and support the lip vertically, inadvertent scarring or lengthening of these muscles may lead to lip incompetence and may increase the lower incisor exposure (LIE) that will cause an unaesthetic result. The aim of this study was to evaluate the extent of lip ptosis, LIE, and other soft-tissue changes following different types of osseous genioplasty procedures.Twenty-nine patients (18 females, 11 males) were included in this study. Patients were classified into 3 groups with respect to their genial movement type as genial setback (n = 10), genial advancement (n = 10), and vertical reduction (n = 9). Preoperative and postoperative lateral cephalograms were analyzed to evaluate the horizontal and vertical soft-tissue changes of the lower lip and chin in the 3 genioplasty groups. The statistical evaluations were performed with regression analysis. The mean increase in the LIE was 1.88 mm. Lower incisor exposure and soft-tissue thickness at pogonion were increased significantly in all patients (P < 0.05). Statistically significant differences for lower lip length and vertical position of soft-tissue supramentale values were detected in patients who underwent vertical reduction genioplasty (P < 0.05). Genioplasty procedures requiring the mentalis muscle release cause a 1.88-mm increase in LIE. Vertical positional alterations of the lower lip were especially observed following the vertical reduction genioplasty. Clinician should be aware of this consequence in the course of treatment planning.
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http://dx.doi.org/10.1097/SCS.0b013e31829026afDOI Listing
September 2014

Ultrasound-guided arthrocentesis of the temporomandibular joint.

Br J Oral Maxillofac Surg 2013 Oct 12;51(7):667-8. Epub 2013 Jun 12.

Baskent University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Konya, Turkey. Electronic address:

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http://dx.doi.org/10.1016/j.bjoms.2013.05.144DOI Listing
October 2013

Autogenous cortical bone and bioactive glass grafting for treatment of intraosseous periodontal defects.

Eur J Dent 2013 Jan;7(1):6-14

Department of Oral Surgery, Faculty of Dentistry, Ondokuz Mayis University, Samsun, TURKIYE.

Objective: The aim of this 6-month prospective randomized clinical study was to compare the effectiveness of autogenous cortical bone (ACB) and bioactive glass (BG) grafting for the regenerative treatment of intraosseous periodontal defects.

Methods: Via a split-mouth design, 15 chronic periodontitis patients (7 men, 8 women; mean age, 43.47 ± 1.45 years) who had probing pocket depths (PPDs) of ⩾6 mm following initial periodontal therapy were randomly assigned to receive 2 treatments in contralateral areas of the dentition: ACB grafting and BG grafting. The parameters compared in the patients were preoperative and 6-month postoperative PPDs, clinical attachment levels (CALs), and radiographic alveolar bone heights.

Results: Both treatment modalities resulted in significant changes in postoperative measurements when compared to preoperative values (p < 0.01). PPDs were decreased, CALs were increased, and radiographic alveolar bone heights were increased by 5.00 ± 0.28, 4.60 ± 0.21, and 5.80 ± 0.43 mm in patients treated with ACB grafting and 5.13 ± 0.32, 4.67 ± 0.27, and 5.33 ± 0.36 mm in patients treated with BG grafting, respectively. Differences between the treatments were not statistically significant (P>.05).

Conclusions: Within the limitations of this study, both ACB and BG grafting led to significant improvements in clinical and radiographic parameters 6 months postoperatively. These results suggest that either an ACB graft, which is completely safe with no associated concerns about disease transmission and immunogenic reactions, or a BG graft, which has an unlimited supply, can be selected for regenerative periodontal treatment.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3571503PMC
January 2013

Does the titanium plate fixation of symphyseal fracture affect mandibular growth?

J Craniofac Surg 2012 Nov;23(6):e601-3

Department of Oral and Maxillofacial Surgery, Baskent University, Ankara, Turkey.

The effect of metallic fixation on growth is a major concern in children and is not yet clear. The aim of this study was to evaluate the effect of metallic fixation of mandibular symphyseal fracture on mandibular growth.Eighteen 90-day-old growing white New Zealand rabbits weighing 1.6 to 2.5 kg were included in this study and divided into 2 groups of 9 subjects. In the experimental group, animals underwent mandibular osteotomy, simulating a symphyseal fracture on the midline of mandibular symphysis. The bone segments were fixed with microplates and microscrews (1.6 mm).In the control group, the same surgical incision without performing symphyseal osteotomy was conducted, and 2 screws were inserted on each side of the symphyseal midline.Digital cephalometric and submentovertex radiographs were taken before the operation and at postoperative 6 months for each animal in 2 groups, and cephalometric measurements were performed. The distance between the centers of the head of 2 screws measured at the end of surgery in the control group was compared with measurements at 6 months after surgery. Obtained data were statistically analyzed.There is no statistically significant difference between the 2 groups for growth amount of both sides of the mandible. Difference of ANS-Id (the most anterior points of nasal bone, the most anterior point on the alveolar bone between the lower incisors) and Cd-Id (the uppermost and most distal point of the mandibular condyle, the most anterior point on the alveolar bone between the lower incisors) values of the 2 groups is not statistically significant (P > 0.05).The distance between the 2 screws at the first application significantly increased at the postoperative sixth month (P < 0.05). Metallic fixation of mandibular symphyseal fracture does not affect the vertical and sagittal mandibular growth in growing rabbits.
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http://dx.doi.org/10.1097/SCS.0b013e31826bf424DOI Listing
November 2012

The comparison of angular and curvilinear marginal mandibulectomy on force distribution with three dimensional finite element analysis.

J Craniomaxillofac Surg 2013 Apr 11;41(3):e54-8. Epub 2012 Aug 11.

Department of Oral and Maxillofacial Surgery, School of Dentistry, Baskent University, Ankara, Turkey.

Aim: The purpose of this study was to analyse and compare right angled and curved osteotomy design on stress distribution and to determine an osteotomy design which decreases the risk of pathologic fracture.

Patients And Methods: Solid mathematical model of the mandible was created by three dimensional finite element analysis and two different osteotomy, right angled and curvilinear osteotomy was performed on model. 150 N incisal force vertically and 250 N molar force to the angulus area oblically were applied. The effects of osteotomy types to the stress formation and risk of fracture between models were evaluated.

Results: Right angled osteotomy causes much more stress in the posteroinferior quadrant and mainly localized on the horizontal and vertical osteotomy intersection area. On the other hand, the distribution of the stress on curvilinear formed osteotomy shows posteroinferior localization and stress spreads wider area. Furthermore the amount of stress was less than right-angled one.

Conclusion: In this study, curved osteotomy denominated less stress distribution. The shape of osteotomy might be a factor to decrease the risk of postoperative atrophic mandible fracture.
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http://dx.doi.org/10.1016/j.jcms.2012.07.014DOI Listing
April 2013

Survival rates of implants inserted in the maxillary sinus area by internal or external approach.

Implant Dent 2011 Dec;20(6):476-9

Baskent University School of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey.

Objective: There are 2 surgical techniques to elevate the sinus floor: sinus lift with crestal approach (internal sinus lift [ISL]) and sinus lift with lateral wall approach (external sinus lift [ESL]). The aim of this study was to evaluate and compare the survival rates of implants placed in the posterior maxilla with ESL or ISL.

Patients And Methods: Ninety sinus lifts with lateral wall approach were performed in 82 patients, and 147 implants were inserted in these augmented sinuses in ESL group. Forty-five implants were inserted in maxilla in 33 patients with sinus lift with crestal approach in ISL group. The follow-up time was 33.8 and 15.6 months for ESL and ISL groups, respectively.

Results: One implant failure was observed in ESL group, and there was no implant failure in ISL group. All other implants were functioning well without any significant clinical finding. Implant survival was 99.2% in ESL group and 100% in ISL group.

Conclusion: The sinus lift with lateral wall approach and crestal approach were reliable methods for implant insertion in the posterior maxilla. Survival rates of the ISL were slightly higher than ESL group. However, follow-up time of the ISL was shorter.
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http://dx.doi.org/10.1097/ID.0b013e3182386d34DOI Listing
December 2011

Comparative evaluation of maxillary protraction with or without skeletal anchorage.

Am J Orthod Dentofacial Orthop 2011 May;139(5):636-49

Department of Orthodontics, Faculty of Dentistry, University of Başkent, Ankara, Turkey.

Introduction: The aim of this prospective clinical study was to evaluate the skeletal, dentoalveolar, and soft-tissue effects of maxillary protraction with miniplates compared with conventional facemask therapy and an untreated Class III control group.

Methods: Forty-five subjects who were in prepubertal or pubertal skeletal growth periods were included in the study and divided into 3 groups of 15 patients each. All subjects had skeletal and dental Class III malocclusions with maxillary deficiency, vertically normal growth pattern, anterior crossbite, Angle Class III molar relationship, normal or increased overbite, and retrusive nasomaxillary complex. Before maxillary protraction, rapid maxillary expansion with a bonded appliance was performed in both treatment groups. In the first group (MP+FM), consisting of 5 girls and 10 boys (mean age, 10.91 years), facemasks were applied from 2 titanium miniplates surgically placed laterally to the apertura piriformis regions of the maxilla. The second group (FM) of 7 girls and 8 boys (mean age, 10.31 years) received maxillary protraction therapy with conventional facemasks applied from hooks of the rapid maxillary expansion appliance. The third group of 8 girls and 7 boys (mean age, 10.05 years) was the untreated control group. Lateral cephalometric films were obtained at the beginning and end of treatment or observation in all groups and analyzed according to a structural superimposition method. Measurements were evaulated statistically with Wilcoxon and Kruskal-Wallis tests.

Results: Treatment periods were 6.78 and 9.45 months in the MP+FM and FM groups, respectively, and the observation period in the control group was 7.59 months. The differences were significant between the 3 groups (P <0.05) and the MP+FM and FM groups (P <0.001). The maxilla moved forward for 2.3 mm in the MP+FM group and 1.83 mm in the FM group with maxillary protraction. The difference was significant between 2 groups (P <0.001). The protraction rates were 0.45 mm per month in the MP+FM group and 0.24 mm per month in the FM group (P <0.001). The maxilla showed anterior rotation after facemask therapy in the FM group (P <0.01); there was no significant rotation in the MP+FM group. Posterior rotation of the mandible and increased facial height were more evident in the FM group compared with the MP+FM group (P <0.01). Both the maxilla and the mandible moved forward significantly in the control group. Protrusion and mesialization of the maxillary teeth in the FM group were eliminated in the MP+FM group. The maxillomandibular relationships and the soft-tissue profile were improved remarkably in both treatment groups.

Conclusions: The undesired effects of conventional facemask therapy were reduced or eliminated with miniplate anchorage, and efficient maxillary protraction was achieved in a shorter treatment period.
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http://dx.doi.org/10.1016/j.ajodo.2009.06.039DOI Listing
May 2011

Repositioning a prosthetically unfavorable implant by vertical distraction osteogenesis.

J Oral Maxillofac Surg 2011 Jun 5;69(6):1628-32. Epub 2011 Apr 5.

Department of Periodontology, Baskent University School of Dentistry, Ankara, Turkey.

Prosthetically unfavorable implant positions challenge patients and restorative dentists. Surgical correction of malpositioned implants may be an alternative technique for esthetically and biomechanically acceptable prosthetic restorations. This case report describes an alveolar distraction technique used to coronally reposition a dental implant and the 3-year results in the maintenance phase. To our knowledge, long-term follow-up of this method of correction is unprecedented. The present case report describes the repositioning of an apically positioned and fully osseointegrated implant at the right maxillary canine region using an alveolar distraction technique. Distraction was performed at 1 mm per day and ended when the implant moved 6 mm coronally. After a consolidation phase of 8 weeks, an implant-supported fixed prosthetic restoration was performed. Healing was uneventful after removal of the distractor. During the 3-year follow-up, the implant was fully functional with minimal probing depths, negligible signs of inflammation, and no further bone loss. This intervention illustrates the promise of an alveolar distraction osteogenesis procedure for vertical repositioning of apically positioned implants. This technique also provided soft and hard tissue remodeling to obtain an esthetic and stable restoration.
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http://dx.doi.org/10.1016/j.joms.2010.12.025DOI Listing
June 2011