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Öğe Changes in Serological Bone Turnover Markers in Bisphosphonate Induced Osteonecrosis of the Jaws: A Case Control Study(Medical and Dental Consultants’ Association of Nigeria., 2020) Demircan, Sabit; Işler, SCBackground: There are a lot study confirmed the relationship of bone serum markers changes and skeletal irregularities. But there is no sufficient case control studies about the role of these markers on bisphosphonate induced osteonecrosis of jaws (BRONJ). Aims: The aim of this study is to find out if there is any derangement of bone markers in bisphosphonate?treated patients with ONJ. Methods: We obtained serum bone markers and other relevant endocrine assays on 20 patients with osteonecrosis of the jaw (ONJ) and 20 randomized healthy volunteers. All of the ONJ group treated with zoledronic acid and had been withdrawn from bisphosphonate for at least 6 months. Diagnostic criteria for ONJ were those formulated by the American Association of Oral and Maxillofacial Surgeons. Serum levels of several indices of bone remodeling were evaluated using commercial enzyme?linked immunosorbent assays. The biochemical assays were performed on N?Telopeptides of type I collagen (NTX), bone?specific alkaline phosphatase (ALP), calcitonin, osteocalcin, intact parathyroid hormone (PTH), T3, T4, TSH, and Vitamin D 25 hydroxy (Vit?D). Results: In ONJ group, PTH level is statistically higher and TSH, Vit?D, osteocalcin and NTX levels statistically lower compared to control group. Conclusion: We conclude that these changes in PTH, Vit?D, TSH, osteocalcin and NTX levels maybe have a role in the pathophysiology of BRONJ. But the data need to be confirmed by future studies.Öğe Changes in Serological Bone Turnover Markers in Bisphosphonate Induced Osteonecrosis of the Jaws: A Case Control Study(Medical and Dental Consultants’ Association of Nigeria, 2020) Demircan, Sabit; Işler, SCAbstract Background: There are a lot study confirmed the relationship of bone serum markers changes and skeletal irregularities. But there is no sufficient case control studies about the role of these markers on bisphosphonate induced osteonecrosis of jaws (BRONJ). Aims: The aim of this study is to find out if there is any derangement of bone markers in bisphosphonate-treated patients with ONJ. Methods: We obtained serum bone markers and other relevant endocrine assays on 20 patients with osteonecrosis of the jaw (ONJ) and 20 randomized healthy volunteers. All of the ONJ group treated with zoledronic acid and had been withdrawn from bisphosphonate for at least 6 months. Diagnostic criteria for ONJ were those formulated by the American Association of Oral and Maxillofacial Surgeons. Serum levels of several indices of bone remodeling were evaluated using commercial enzyme-linked immunosorbent assays. The biochemical assays were performed on N-Telopeptides of type I collagen (NTX), bone-specific alkaline phosphatase (ALP), calcitonin, osteocalcin, intact parathyroid hormone (PTH), T3, T4, TSH, and Vitamin D 25 hydroxy (Vit-D). Results: In ONJ group, PTH level is statistically higher and TSH, Vit-D, osteocalcin and NTX levels statistically lower compared to control group. Conclusion: We conclude that these changes in PTH, Vit-D, TSH, osteocalcin and NTX levels maybe have a role in the pathophysiology of BRONJ. But the data need to be confirmed by future studies. Keywords: Bisphosphonate; bone markers; bone metabolism; oral pathology; osteonecrosis.Öğe Fixation Methods for Mandibular Advancement and Their Effects on Temporomandibular Joint: A Finite Element Analysis Study(Hindawi, 2020) Demircan, Sabit; Uretürk, Erdoğan Utku; Apaydın, Ayşegül; Şen, SinanObjectives. Bilateral sagittal split osteotomy (BSSO) is a common surgical procedure to correct dentofacial deformities that involve the mandible. Usually bicortical bone fixation screw or miniplates with monocortical bone fixation screw were used to gain stability after BSSO. On the other hand, the use of resorbable screw materials had been reported. In this study, our aim is to determine first stress distribution values at the temporomandibular joint (TMJ) and second displacement amounts of each mandibular bone segment. Methods. A three-dimensional virtual mesh model of the mandible was constructed. Then, BSSO with 9 mm advancement was simulated using the finite element model (FEM). Fixation between each mandibular segment was also virtually performed using seven different combinations of fixation materials, as follows: miniplate only (M), miniplate and a titanium bicortical bone fixation screw (H), miniplate and a resorbable bicortical bone fixation screw (HR), 3 L-shaped titanium bicortical bone fixation screws (L), 3 L-shaped resorbable bicortical bone fixation screws (LR), 3 inverted L-shaped titanium bicortical bone fixation screws (IL), and 3 inverted L-shaped resorbable bicortical bone fixation screws (ILR). Results. At 9 mm advancement, the biggest stress values at the anterior area TMJ was seen at M fixation and LR fixation at posterior TMJ. The minimum stress values on anterior TMJ were seen at L fixation and M fixation at posterior TMJ. Minimum displacement was seen in IL method. It was followed by L, H, HR, M, ILR, and LR, respectively. Conclusion. According to our results, bicortical screw fixation was associated with more stress on the condyle. In terms of total stress value, especially LR and ILR lead to higher amounts.Öğe Histopathological Examination of the Effects of Local and Systemic Bisphosphonate Usage in Bone Graft Applications on Bone Healing(Springer India, 2021) Demircan, Sabit; Isler, S. CemilBackground The effect of bisphosphonates on the resorption process of normal bone tissue has been clearly mentioned in the literature, while their effect on the grafting material is a new research area. Limited former study is not sufficient to determine the strength, reliability and dosage of bisphosphonates. In this study, our aim is to examine the effects of local and systemic use of bisphosphonates in bone graft applications on bone healing, histopathologically. Methods Therefore, 32 Sprague-Dawley rats are separated into four groups. In the first group, only an empty bone defect is made on tibia and the tissue is sutured primarily without any other application. In the second group, bone defect is filled with allograft material and closed without any other application. In the third group (LA), alendronate solution is locally added to the graft material before its application to the site of bone defect. In the fourth group, alendronate is applied systemically after the site of bone defect is grafted and primarily closed. After 6 weeks, all rats are killed and the obtained samples are examined histopathologically. Results Local and systemic application of alendronate increases new bone formation in a statistically significant degree. In LA group, newly formed bone was observed more mature and well developed. Alendronate application does not cause an increase in inflammation, fibrosis and necrosis. There is no increased necrosis with alendronate application. Conclusion Local and systemic application of alendronate in bone grafting increases bone formation without any other complication. But we believe that further research should be made on dosage, usage and possible side effects.Öğe Nitrojen İçeriği, Bifosfonata Bağlı Çene Kemiği Osteonekrozunun Nedeni mi? Fareler Üzerinde Deneysel Çalışma(Türkiye Klinikleri Yayınevi, 2020) Demircan, SabitAmaç: Bifosfonatlar kemik rezorpsiyonu üzerine inhibe edici etkileri nedeni ile iskelet sistemiyle ilgili rahatsızlıklarda sıklıkla kul-lanılmaktadır. Bifosfonatların ciddi bir yan etkisi, bifosfonata bağlı ge-lişen çene kemiği osteonekrozudur. Bu yan etki çoğunlukla nitrojen içeren bisfofonatlar ile görülse de nitrojen içermeyen bifosfonatlarla bildirilen olgular vardır. Çalışmamızda, nitrojen içeren (NBP) ve içer-meyen (non-NBPs) bifosfonat kullanımının sıçan çekim yarası ve yu-muşak doku iyileşmesine etkilerinin histopatolojik olarak incelenmesini amaçladık. Gereç ve Yöntemler: Bu amaçla 48 adet Sprague-Dawley cinsi sıçan 3 gruba ayrılarak çalışma yapılmıştır. Birinci gruba nitrojen içeren bifosfonat (zoledronik asit), ikinci gruba ise nitrojen içermeyen bifosfonat (etidronik asit) 7, 14 ve 21. günlerde subkutan olarak enjekte edilmiştir. Üçüncü grup ise kontrol grubu olarak tayin edilmiştir. Dör-düncü haftanın sonunda tüm sıçanların sağ birinci mandibular molar dişi çekilmiş, palatinal diş etinde 5 mm uzunluğunda, 1 mm derinli-ğinde kesi gerçekleştirilmiştir. Çalışmaya dâhil edilen tüm denekler 6 hafta sonunda sakrifiye edilmiş ve elde edilen örnekler histopatolojik incelemeye tabi tutulmuştur. Bulgular: Sonuçlarımız, NBP kullanımı-nın çekim soketi ve çevresinde mikroorganizma kolonizasyonunu art-tırdığını, osteoklast sayısını ve damarlanmayı baskıladığını, çekim soketi iyileşmesini geciktirdiğini göstermiştir. Çalışmamızda 6 hafta sonunda NBP ile açığa çıkmış nekroze kemik dokusu izlenmiş, ancak non-NBP ile açığa çıkmış kemik veya ülserasyon görülmemiştir. Sonuç: Bu sonuçlar, nitrojen içeren bifosfonatların içermeyenlere kı-yasla daha yüksek oranda osteonekroz ve gecikmiş yara iyileşmesine neden olduklarını göstermektedir.Öğe Orthognathic Surgery after Mandibular Large-Volume Osteoma Treatment(Hindawi, 2020) Demircan, Sabit; İşler, Sabri Cemil; Gümüşdal, Aydın; Genç, BegümOsteoma is a benign asymptomatic osseous tumor. Characterization of osteoma is the proliferation of cancellous or compact bone that increases in size by continuous formation of bone. It can be seen in any craniofacial structures, usually in paranasal sinuses and jaws. In this study, we present a 17-year-old male patient with a giant osteoma in the mandibular condyle. Posttreatment post-op follow-up, post-ortho, and orthognathic surgery after dental implantation are described.Öğe Prosthetically Driven İmmediate İmplant Placement At Lower Molar Area; An Anatomical Study(İstanbul Üniversitesi Yayınları, 2020) Demircan, SabitPurpose To examine the effectiveness and safety of immediate implant placement (IIP), we evaluated the risk of lingual plate perforation (LPP) and mandibular canal perforation (MCP) associated with posterior mandible anatomy using cone beam computed tomography (CBCT) images. Materials and Methods A morphological study of the molar sockets of 135 patients (age: 18–84 y) was done and its relationship to the mandibular canal was investigated. The risk of LPP and MCP was recorded as yes or no. Mandibular cross-sectional morphology was defined as one of three types (U-P-C) using the criteria of Chan et al. Results The risk of LPP was significantly higher for second molars (p = 0.0001), and the risk increased with age (p = 0.039). There was a strong relationship between the risk of LPP and cross-section type U (p = 0.0001). The mean root to alveolar canal (RAC) distance (mm) of males was significantly higher than that of females. The mean RAC value was 5.02 mm for males and 3.49 mm for females. There was no statistically significant relationship between the risk of MCP and sex. There was a significant relationship between the risk of MCP and cross-section type U (p = 0.0001). Although the MCP risk was higher in second molars, there was no statistically meaningful relation between MCP and tooth type. Conclusion The results suggest that IIP in the mandibular molar area carries a high risk of MCP and LPP. Based on the elevated level of risk, a delayed implant protocol should be considered.
