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Dens Invaginatus Anomalisi Gözlenen Maksiller Lateral Dişin Endodontik Tedavisi: Olgu Sunumu
No full textAmaç: Dens invaginatus, mine organının kalsifikasyonundan önce dental papilla içine invajinasyonla oluşan gelişimsel bir dental anomalidir. Etkilenen dişler konik formda, koronal olarak genişlemiş görünümde veya palatal oluğa sahip olabilmektedir. Genellikle daimi dişlerde görülmekle birlikte her iki dentisyonda da gelişebilmektedir. En sık maksiller lateral, santral ve premolar dişlerde gözlenmektedir. Etiyolojisi kesin olmamakla birlikte genetik ve çevresel etkenler rol oynamaktadır. Hipodonti, hiperdonti ve makrodonti ile birlikte görülebilmektedir. Genellikle radyografilerle teşhis edilmekte, KIBT ile detaylandırılmaktadır. Bu olgu sunumunda, sol üst lateral dişte saptanan dens invaginatus anomalisine bağlı gelişen periapikal lezyonun endodontik yönetiminin sunulması amaçlanmaktadır. Olgu Tanımlaması: Sistemik olarak sağlıklı, 14 yaşındaki kız hasta 22 numaralı dişinde ağrı ve mobilite şikayetiyle kliniğimize başvurmuştur. Alınan anamnez ve klinik muayene sonucunda hastanın daimi dişlenme döneminde olduğu belirlenmiştir. Yapılan radyografik değerlendirmede ilgili dişte dens invaginatus gözlenmiştir. Ayrıca, ilgili dişte kronik apikal periodontitis ve bununla ilişkili Miller’a göre sınıf 2 mobilite saptanmıştır. Daha detaylı bir kök kanal sistemi incelemesi için 5x5 fow aralığında KIBT alınmıştır. Yapılan değerlendirmede 22 numaralı dişin tek kanallı olduğu belirlenerek kök kanal tedavisi uygulanmasına karar verilmiştir. Tedavinin ilk seansında uygulanan lokal anestezi ve rubber dam izolasyonu sonrasında giriş kavitesi açılmış, kök kanal boyunun #30 K-file eğe ile 15.5 mm olduğu belirlenmiştir. %5 NaOCl ve SF irrigasyonları ve 0.4 açılı #40 rotary eğe ile dişin kemomekanik preparasyonu tamamlanmıştır. Kalsiyum hidroksit medikamenti yerleştirildikten iki hafta sonra, kanal gütta-perka kon ve AH Plus kök kanal patı kullanılarak doldurulmuş ve kompozit restorasyon yapılmıştır. Bulgular: Dens invaginatus anomalisine sahip dişlerde kök kanal anatomisi varyasyonları görülmektedir. Bu sebeple hastaya tedavi sonrası aralıklı takip randevuları planlanmıştır. Sonuç: Dens invaginatusun, mikroorganizmalar için potansiyel geçiş yolu sağlayarak pulpal ve periodontal hastalık riskini artırdığı düşünülmektedir. Teşhisi dikkatli bir değerlendirme gerektirmekte, tedavisi ise invajinasyonun ve pulpal ve/veya periapikal hastalıkların şiddetine bağlı olarak değişkenlik gösterebilmektedir. Anahtar Kelimeler: Dens invaginatus; dental anomali; kök kanal tedavisiPurpose: Dens invaginatus is a developmental anomaly defined by the invagination of the enamel organ into the dental papilla before calcification. Affected teeth may present conical shape, enlarged crown, or palatal groove. Although it can involve any tooth, it most commonly affects the maxillary lateral incisors, followed by central incisors and premolars, usually in the permanent dentition. Its etiology is unclear, though genetic and environmental factors are suspected. It may coexist with anomalies such as hypodontia, hyperdontia, or macrodontia. Often detected incidentally on radiographs, further evaluation may require CBCT. This report presents the endodontic management of a related periapical lesion. Case Description: A 14-year-old systemically healthy female presented with pain and mobility in tooth 22. Clinical examination and anamnesis confirmed permanent dentition. Radiographs revealed dens invaginatus with chronic apical periodontitis and Class II mobility according to Miller’s classification. A CBCT scan with a 5×5 cm field of view was obtained to assess the root canal anatomy. Evaluation confirmed single canal, and nonsurgical root canal therapy was planned. After local anesthesia and rubber dam isolation, access cavity was prepared, and the working length was measured at 15.5 mm using #30 K-file. The tooth’s chemomechanical preparation was completed using a #40 rotary file 0.4 taper with 5% NaOCl and SF. Following two weeks of calcium hydroxide medication, the canal was obturated with gutta-percha and AH Plus sealer, and the tooth was restored with composite coronal restoration. Follow-up appointments were scheduled. Results: Variations in root canal anatomy are observed in teeth with dens invaginatus anomaly. Therefore, periodic follow-up appointments were scheduled post-treatment. Conclusion: Dens invaginatus is believed to provide a potential pathway for microorganisms, thereby increasing the pulpal and periodontal diseases risks. Its diagnosis requires careful evaluation, and treatment varies depending on the severity of the invagination and any pulpal or periapical involvement. Keywords: Dental anomaly; dens invaginatus; root canal treatment</p
Preclinical Evaluation of a Thebaine Derivative with Analgesic Efficacy and a Favorable Safety Profile Comparable to Morphine
No full textKırık Eğe Yönetiminde Konservatif ve Cerrahi Yaklaşımlar: İki Olgu Sunumu
No full textAmaç: Kök kanal tedavisi sırasında meydana gelen eğe kırığı, tedavi başarısını olumsuzetkileyebilecek önemli bir komplikasyondur. Bu olgu sunumunda, kırık kanal aletlerininyönetiminde konservatif ve cerrahi yaklaşımların klinik sonuçlarının değerlendirilmesiamaçlanmıştır. Olgu Tanımlaması 1: Sistemik olarak sağlıklı 51 yaşındaki erkek hasta, 33numaralı dişe protetik amaçlı endodontik tedavi için kliniğimize yönlendirildi. Klinik veradyografik değerlendirmede herhangi bir patolojiye rastlanmadı. Scope Endo W Gold dönereğe sistemi (Scope Endo, Yozgat, Türkiye) ile şekillendirme sırasında W2 eğesi apikalbölgeden itibaren 18 mm uzunluğunda kırıldı. Kırık aletin çıkartılması amacıyla, ultrasonikuçlarla koronal genişletme yapıldı ve ardından operasyon mikroskobu altında wire loopyöntemi kullanılarak kırık alet kök kanalından çıkarıldı. Kanal, W3 eğesiyle yenidenşekillendirilip %2.5 NaOCl ve %17 EDTA ile yapılan final irrigasyon sonrası, biyoseramikesaslı kanal patı ve güta-perka ile tek kon tekniği kullanılarak dolduruldu. Olgu Tanımlaması2: Sistemik olarak sağlıklı 28 yaşındaki kadın hasta, 15 numaralı dişte ağrı şikâyetiylekliniğimize başvurdu. Anamnezde, ilgili dişe iki yıl önce kök kanal tedavisi uygulandığıöğrenildi. Klinik muayenede dişe perküsyonda pozitif yanıt alındı. Radyografik incelemedeapeks seviyesinde kırık eğe fragmanı ve servikal bölgede metal post tespit edildi. Kırık eğeninkonumu ve zirkonyum restorasyonun varlığı göz önünde bulundurularak cerrahi tedaviplanlandı. Lokal anestezi altında 3 mm’lik apikal rezeksiyon uygulandı ve kırık eğe retrogradyolla çıkarıldı. Hazırlanan retrograd kavite ultrasonik uçlarla şekillendirilerek MTA(mineraltrioksit agregat) ile dolduruldu. Bulgular: Her iki hastanın 3., 6. ve 12. ay takiplerinde, tedaviedilen dişlerin asemptomatik olduğu ve fonksiyonlarını sürdürdüğü gözlemlendi. Sonuç:Endodontik tedavide kırık aletlerin yönetiminde, uygun olgularda wire loop yöntemiylekonservatif çıkarım başarılı olabilirken, konservatif yöntemlerin yetersiz kaldığı durumlardacerrahi yaklaşım etkili ve güvenilir bir tedavi seçeneğidir.Aim: Separated instruments during root canal treatment is a significant complication that maynegatively affect treatment outcomes. This case report aims to evaluate the clinical results ofconservative and surgical approaches in the management of separated instruments. CaseDescription 1: A 51-year-old systemically healthy male patient was referred to our clinic forprosthetic-based endodontic treatment of tooth #33. Clinical and radiographic examinationrevealed no pathological findings. During canal preparation with the Scope Endo W Gold rotaryfile system (Scope Endo, Yozgat, Türkiye), a W2 file fractured 18 mm from the apical region.To retrieve the instrument, coronal enlargement was performed using ultrasonic tips, followedby the wire loop technique under an operating microscope. The fragment was successfullyremoved from the root canal. The canal was then re-shaped using a W3 file, and final irrigationwas performed with 2.5% NaOCl and 17% EDTA. Obturation was completed using the single-cone technique with a bioceramic-based sealer and gutta-percha. Case Description 2: A 28-year-old systemically healthy female patient presented to our clinic with pain in tooth #15.Medical history revealed that root canal treatment had been performed two years earlier. Thetooth was sensitive to percussion. Radiographic evaluation showed a separated file in the apicalregion and a metal post in the cervical third. Considering the fragment’s location and thepresence of a zirconia restoration, surgical approach was planned. Under local anesthesia, 3 mm<p class="p1" style="margin-bottom: 0px; font-width: normal; font-size: 12px; line-height: normal; font-family: "Times New Roman"; font-size
Spatial-Temporal Variations of Inorganic Contaminants and Associated Risks for Sediment of Felent Stream Basin Flowing Along with Silver Mines in the Midwestern Türkiye
No full textThe Kütahya Silver Mine, located in the Felent Stream Basin, stands as Türkiye’s silver production site. Additionally, thermal tourism facilities in the upstream region are also degrading water quality of Felent Stream. This study meticulously examined the levels and spatial-temporal variations of 18 potentially toxic elements (PTEs) in the sediments of the Felent Stream Basin and evaluated their ecotoxicological risks during dry and wet seasons. The average sediments contamination levels of PTEs were ranked as follows: Fe > Al > Zn > Mn > Sr > Pb > Ba > Ni > Cu > As > Cr > Li > V > Cd > Co > Sb > Se > Hg. Remarkably, during the wet season, sediment samples revealed an approximate threefold surge in the average concentrations of PTEs. Ecological risk assessment indicators highlighted that the basin experienced low pollution levels in the dry season, escalating to moderate pollution levels during the wet season. Non-carcinogenic risks for studied PTEs and carcinogenic risks for As remained below the threshold values in both seasons. Statistical analyses pinpointed the Yoncalı District, a prominent thermal tourism area, as the primary contributor to the sediment contamination of the Felent Stream Basin. The Enne Dam Lake, the region’s main stagnant water body, emerged as the least contaminated component, functioning as a natural filter for the basin and significantly mitigating the levels of PTEs in the sediment
Clinical, Radiological, and Histomorphometric Comparison of the Use of Deproteinized Bovine Bone Mineral and Titanium-Prepared Platelet-Rich Fibrin in Maxillary Sinus Augmentation: A Split-Mouth Randomized Controlled Clinical Study
No full textBackground: Maxillary sinus augmentation (MSA) is a standard and predictable procedure to increase bone height in the atrophic posterior maxilla. Many biomaterials are employed in this technique; however, autologous platelet concentrates have been found to reduce clinical recovery time and improve bone gain in MSA. Purpose: This study aimed to compare the radiographic, histomorphometric, and implant stability outcomes of titanium-prepared platelet-rich fibrin (T-PRF) and deproteinized bovine bone mineral (DBBM) in a two-stage MSA technique. Study Design, Setting, Sample: This randomized controlled split-mouth study included patients requiring bilateral two-stage MSA at the Periodontology Department of Kutahya Health Sciences University between March 2022 and April 2023. Patients with systemic comorbidities and residual bone height >5 mm in the bilateral posterior maxilla were excluded. Predictor Variable: The predictor variable was the two-stage MSA technique. Each surgical site was randomly assigned to the T-PRF or DBBM group for two-stage MSA. Main Outcome Variables: The primary outcome was the histomorphometric evaluation of the percentage of new bone between the 2 groups. Secondary outcomes included radiographic evaluation of total bone height (ToBH), bone gain, bone density (BD), and graft volume (GV) on cone-beam computed tomography 6 months post-MSA, clinical assessment of primary implant stability at implant placement and secondary stability 3 months postplacement, and histomorphometric evaluation of the percentage of residual particles, percentage of connective tissue, and percentage of blood vessels from bone biopsy samples collected 6 months after MSA. Covariates: Age, sex, periodontitis susceptibility, and smoking status were treated as covariates. Analyses: The Wilcoxon signed-rank test was used for bivariate comparisons between 2 groups, and the Pearson or Spearman test was used to analyze correlations of variables within groups. A P value ≤ .05 was considered statistically significant. Results: The sample was composed of 10 patients with bilateral maxillary sinuses, 20 MSA regions, 8 (80%) males and 2 (20%) females with a mean age of 51.30 (9.06) year. The percentage of new bone was 19.48 ± 14.60 μm2 in the T-PRF group and 8.31 ± 5.47 μm2 in the DBBM group, and there was no statistically significant difference between the groups (P = .074). Radiographic measurements showed ToBH, GV, and BD values of 10.64 ± 3.96 mm, 989.89 ± 523.07 mm3, and 192.09 ± 127.90 hounsfield unit in the T-PRF group and 14.25 ± 1.65 mm, 1,519.39 ± 432.61 mm3, and 492.77 ± 117.35 hounsfield unit in the DBBM group, respectively. ToBH, GV, and BD values were statistically significant between the groups (P = .01 and P = .00). Primary and secondary implant stability in the T-PRF group were 71.11 ± 12.48 implant stability quotient (ISQ) and 68.03 ± 6.81 ISQ, respectively, compared with 67.94 ± 19.84 ISQ and 72.46 ± 11.21 ISQ in the DBBM group. The difference was not statistically significant between the groups (P = .41 and P = .33). Conclusion and Relevance: Although T-PRF demonstrated inferior radiographic outcomes compared with DBBM during the initial6-month healing phase, both techniques yielded comparable results regarding new bone formation and implant stability. Further research is warranted to explore the efficacy of different T-PRF applications in MSA. This trial is registered at ClinicalTrials.gov (NCT05596084)
The use of magnification in endodontic treatments by endodontists: results of a questionnaire
No full textBackground: The aim of the study to investigate the accessibility and frequency of use of magnification systems in endodontics and to evaluate the economic and logistical factors. Methods: A survey comprising of 34 questions, created in Survey Monkey, was sent to 874 clinicians. The survey consisted of three main sections: demographic information, the use of magnification systems, and financial factors. Descriptive analysis and chi-square tests were performed. Results: Of the participants, 42.3% were endodontists, and 57.7% were postgraduate students in endodontics. Nearly 26.1%, 32.7%, and 41.1% reported using a dental operating microscope (DOM), a loupe, and no magnification system, respectively. When asked how long it would take to recoup the cost of the DOM, considering additional charges or patient preferences, the most common response (40%) was 1–2 years. Conclusion: Although the use of magnification systems has become quite widespread today, it is important to increase their use further. The procurement and use of DOMs have not created a long-term financial burden for clinicians