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Distraction osteogenesis is usually performed in cleft lip and palate patients with severe maxillary sagittal discrepancies, considering the stability of surgical maxillary advancement and the limited complications of velopharyngeal valve insufficiency. Moreover, interdental distraction osteogenesis is a successful treatment protocol for repairing large clefts. Herein, we report a multidisciplinary approach for the treatment of two patients with cleft lip and palate using an archwise distraction appliance (AWDA). AWDA is a tooth-supported, custom-made appliance for closing the alveolar cleft and providing sagittal correction of the maxilla. Using it, the curve of the dental arch is maintained during distraction, and there is no need for a second operation to activate and remove the appliance. Few cases in which archwise distraction was performed have been reported so far. AWDA is a functional and inexpensive appliance used to reduce the alveolar cleft width and produce maxillary advancements in patients with cleft lip and palate.

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Bone grafting is a successful protocol for cleft repair but it is very challenging to close large gaps using local gingival tissue. In the last decade, interdental distraction osteogenesis has been introduced as a successful treatment protocol for repairing such large clefts. In this article a new method for closing the alveolar cleft is introduced and one case is presented. A tooth supported distractor which was specially designed to be inserted on to the main arch wire was used for the distraction. The aim was to distract the tooth segments through the curve of the dental arch and achieve complete closure of the gaps. The distractor introduced had several advantages: it is simple to apply, activate and remove; there is no need for a second operation; it is an outpatient procedure. In the case reported, a very large gap was successfully closed using this protocol whilst maintaining the ideal arch form and generating new bone behind the distracted segments.

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BACKGROUND: Although many studies have compared open and laparoscopic procedures, showing many advantages in favor of the laparoscopic technique during the early postoperative period, only a limited number of reports in the literature compare the two techniques during the later follow-up period with regard to quality of life. This study aimed to compare the effects of these two cholecystectomy techniques on the quality of life and clinical outcome of the patients during long-term follow-up evaluation. METHODS: This study evaluated 200 patients who underwent cholecystectomy operations with either technique between 1993 and 1999 in our department. There were 100 patients in each group. Both groups were similar with respect to age, gender, body mass indexes, American Society of Anesthesiology (ASA) scores, and indications for surgery. The Medical Outcome Study Short Form 36 Health survey (SF-36), which includes 36 items, was used for evaluating the quality-of-life index. In addition to this, a system-specific instrument for gastrointestinal diseases was used to investigate clinical outcome. RESULTS: The mean administration time for the questionnaire was 46.8 +/- 18.7 months in the laparoscopic cholecystectomy (LC) group and 41.5 +/- 16 months in the open cholecystectomy (OC) group. Statistically significant differences were noted in the scores for all eight SF = 36 health status domains in favor of laparospopic surgery. No statistically significant difference was found for abdominal pain, location of the pain, referral to a doctor for the pain, accompanying symptoms, relieving factors for the pain, distention, and dyspeptic complaints, usage of antacid therapy, weight changes, changes in bowel habit, need for a special diet, or sexual functions between the two groups. CONCLUSIONS: The gastrointestinal clinical symptoms were similar in the two groups during the long-term follow-up evaluation, but laparoscopic cholecystectomy was found to be significantly superior to the open technique with respect to the quality of life over the long term.

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Orthodontic extrusion can be time consuming and has a long retention period, making cooperation a critical factor. On the other hand, it has also been shown that surgical techniques may be useful to extrude and save the root. Surgical methods need at least 3 week for root stabilization in new position. This is a case report of a surgical method to treat intruded teeth.

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This study investigates the prevalence of bacteremia after orthodontic banding and debanding, following the application of a 0.2% chlorhexidine gluconate mouthwash. The banding and debanding groups were each composed of 40 young adult patients. In the banding group, patients were asked to rinse their mouth with chlorhexidine gluconate for 60 seconds just prior to fitting of the bands. In the debanding group, they were asked to use the mouthwash immediately before removal of bands and brackets. In both groups pre- and post-treatment blood samples were obtained with a strict aseptic technique. In the banding group, no bacteremia was detected in the pretreatment sample and 2.5% post-treatment bacteremia was detected in the post-treatment sample. In the debanding group, 2.5% bacteremia was found in both the pre- and post-treatment samples. The prevalence of post-treatment bacteremia found in the present study were compared with the findings of 2 preliminary studies in which the prevalence of bacteremia had been investigated after banding and debanding without a prior application of chlorhexidine mouthwash. The application of chlorhexidine mouthwash resulted in a decrease in the prevalence of bacteremia after banding and debanding, but the decrease was not statistically significant.

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PURPOSE: We investigated the effect of laparoscopic v open cholecystectomy on acute-phase reactants. PATIENTS AND METHODS: Fifty patients were randomized to laparoscopic (Group 1) and 50 to open (Group 2) cholecystectomy. Preoperative and postoperative values for acute-phase reactants (ceruloplasmin, fibrinogen, Westergren sedimentation rate, alpha-1-antitrypsin, haptoglobin, and C-reactive protein) in blood samples were compared. RESULTS: Acute-phase reactants and length of hospitalization were significantly lower in patients who underwent a laparoscopic cholecystectomy than in those who underwent an open cholecystectomy. CONCLUSION: Laparoscopic cholecystectomy appears associated with a less intense stress response and less tissue damage than open cholecystectomy.

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The aim of this study was to investigate the prevalence of bacteremia after orthodontic debanding and debonding. The study group comprised 30 patients (10 men, 20 women). All were treated using the Edgewise technique. Patients with acceptable oral hygiene and fixed appliances in both jaws were included in the study group. Blood samples were obtained using a strict aseptic technique before and after removal of bands and brackets. A 6.6% bacteremia prevalence was observed in both preoperative and postoperative blood samples.

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Protraction headgears are commonly used in the treatment of Class III malocclusion characterized by maxillary retrognathism. The upward and forward rotation of the maxilla during protraction is a major unwanted side effect. The aim of this study was to eliminate the upward and forward rotation of maxilla while protracting. Seventeen patients with Class III malocclusion as a result of maxillary retrognathism were treated for 3 months; their average age was 12.81 years. A full coverage acrylic cap splint-type rapid maxillary expansion appliance was cemented and activated twice a day for 5 days. After sutural separation, a maxillary modified protraction headgear was worn and 750 g of force was applied. Wilcoxon signed rank test was carried out to evaluate 42 parameters measured on cephalometric radiographs. The maxilla was displaced anteriorly by downward and backward rotation. The mandible was displaced downward and backward due to anterior elongation of the maxilla. Extrusion and lingual tipping of the upper incisors and intrusion of upper molars and downward and backward rotation of functional occlusal plane were observed. The aim of our study was achieved, which was to avoid upward and forward rotation while protracting the maxilla. In conclusion, maxillary modified protraction headgear (MMPH) can be used effectively in Class III patients with retrognathic maxilla and anterior open bite tendency.

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OBJECTIVE: To test the efficacy of hypertonic saline (20%) and absolute alcohol on the integrity of daughter cysts and the viability of the protoscoleces contained in these cysts. DESIGN: Experimental study. SETTING: Teaching hospital, Turkey. MATERIAL: 80 daughter cysts obtained from two patients with Gharbi type III hydatid cysts of the liver. INTERVENTIONS: The cysts were divided into two groups, in the first of which cysts were placed into hypertonic saline and in the second into absolute alcohol; they were kept there for 5, 15, 30 or 60 minutes. MAIN OUTCOME MEASURES: Integrity of the cyst wall and viability of the contents were evaluated using a vital staining technique with 0.1% eosin. RESULTS: Neither hypertonic saline nor absolute alcohol solution had any effect on the integrity of the daughter cysts or the viability of the protoscoleces. CONCLUSION: Percutaneous drainage of type III hydatid cysts can lead to high recurrence rates.

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The aim of this study was to assess the incidence of bacteremia after orthodontic banding. The study was conducted on 40 healthy orthodontic patients with good oral hygiene. Venous blood samples were obtained with a strict aseptic technique before and after fitting of a molar band in each patient. Microbiologic evaluation of the samples revealed a postoperative bacteremia incidence of 7.5%.

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The aim of this study was to compare the effects on root resorption of continuous and discontinuous force application. The experimental material consisted of 22 first premolars that were to be extracted as part of orthodontic treatment. Prior to extraction, a 100 g tipping force was applied to the experimental teeth by means of elastics. One side was randomly selected to be the continuous force side, and the contralateral side became the discontinuous force side. Elastics were worn 24 hours per day on the continuous force side and 12 hours per day on the discontinuous side. The experimental procedure lasted 9 weeks. Composite electron micrographs of the buccal surface of each specimen were digitized and areas affected by resorption were determined. The degree of root blunting was assessed by visual scoring. Mean percentage of resorption-affected areas was smaller and apical blunting was less severe on the discontinuous force side. The results of this study show that the application of discontinuous force results in less root resorption than does the application of continuous force.

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BACKGROUND: Direct insertion of the trocar is an alternative method to Veress needle insertion for the creation of pneumoperitoneum. The safety of direct disposable shielded trocar insertion for the creation of pneumoperitoneum was assessed by comparing with Veress needle insertion during laparoscopic cholecystectomy (LC). METHODS: One thousand five hundred patients undergoing LC with pneumoperitoneum were included in this study. In 470 patients the Veress needle insertion technique was used, and in 1,030 patients direct trocar insertion technique was used. Patients having indications for open trocar insertion were excluded from the study. RESULTS: Complication rate was significantly higher in the Veress needle group (14% versus 0.9%; P <0.01), and the two major complications, gastric perforation and iliac artery laceration, were also encountered in this group. CONCLUSIONS: Our results suggest that with a lower complication rate, direct insertion of the disposable trocar is a safe alternative to Veress needle insertion technique for the creation of pneumoperitoneum. Such an approach has further advantages such as less cost/instrumentation and rapid creation of pneumoperitoneum.

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Management of intraperitoneally retained gallstones after laparoscopic cholecystectomy (LC) is controversial, as their natural course is not known. This study was undertaken to assess the probable effects of stone morphology and clinically obvious infection on the outcome of retained gallstones in a mouse model. Forty albino mice were divided into four groups. Group I served as the control group (simple laparotomy, n = 10). Groups II, III, and IV (n = 10 in each group) were study groups. "Intact-sterile-cholesterol" (group II), "crushed-sterile-cholesterol" (group III), and "intact" (n = 5) [group IVa] and "crushed" (n = 5) [group IVb] "infected-cholesterol" gallstones aseptically retrieved from three different human patients were implanted to the peritoneal cavity of the animals. Group IV animals were implanted with stones retrieved from an acutely inflamed gallbladder with proven infection. Animals were sacrificed 6 and 12 weeks after the operations. Cultures and tissue samples were obtained. No animal was lost, no microscopic or macroscopic abnormality was observed in groups I and II, and cultures remained negative. In group III, adhesions surrounding the fragmented stones were evident at the 12th week, and no mortality was encountered. The histopathology revealed a fibroblastic reaction, and cultures remained negative in group III. In group IV, three animals from group IVb and one animal from group IVa died because of intra-abdominal sepsis before their sacrifice. All remaining mice showed severe adhesions with localized abscesses at the 12th week. In conclusion, intraperitoneally retained cholesterol gallstones remain inert and do not cause serious peritoneal reaction unless they are crushed into fragments or are from an acutely inflamed gallbladder. It is for this group of patients that laparotomy for total stone clearance is probably not justifiable. Better stone retrieval techniques or even laparotomy may be worthwhile considering in patients with crushed and particularly infected retained stones.

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The aim of this study was to compare two intra-oral molar distalization procedures, involving 15 cases with Class II molar relationships. Magnetic devices were applied to the upper right first molars in each case, while nickel-titanium coil springs were used against the upper left first molars, for a period of 3 months. Measurements were made from lateral cephalograms and from photocopies of models taken before and after the distalization procedure. Although upper molar distalization was achieved with ease in both techniques, nickel-titanium coil springs were found to be the more effective in terms of movement achieved.

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The purpose of this study was to investigate cephalometrically, the effects of a functional appliance-headgear combination, the Elastic Bite-block (EBB). Of 50 Class II division 1 subjects who participated in this study, 30 made up the treatment group and 20 the control group. All of the selected cases exhibited mandibular retrognathism, facial growth pattern either along the Y-axis or in the horizontal direction, and were all at the peak of the prepubertal growth spurt. Whilst the EBB was applied to the treatment group for 1 year, no treatment was performed on the control group. Measurements made on the lateral cephalograms, obtained at the beginning and end of the study were statistically evaluated. The following changes took place as a result of EBB treatment: sagittal growth of the maxilla was inhibited, the upper molars were distalized and intruded, sagittal growth of the mandible was stimulated and the lower molars erupted in a mesio-occlusal direction. As a result of downward and backward rotation of the mandible, the vertical dimension showed incremental changes. The upper and the lower incisors were both uprighted and intruded, and overjet and overbite decreased.

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In our experimental animal model, 50 Winstar-Albino rats were divided into five groups in a randomized manner. After all were anesthesized with ether, laparotomy was performed on each one and the caecum and terminal ileum were scrubbed with a toothbrush until serosal petechial bleedings were seen. In the first group, the abdomen was closed after this procedure. In the second group, the abdomen was closed after application of 0.9% NaCl solution intraperitoneally. In the third group, the abdomen was closed after LMWH (low molecular weight heparin) was given intraperitoneally. In the fourth group, LMWH was given in prophylactic dosage subcutaneously on the day of operation and for the following seven days. In the fifth group, abdomen was closed after heparin was given intraperitoneally. On the fourteenth postoperative day, the rats were sacrificed and intraperitoneal adhesions were scored according to the "Mazuji's Scale". There was a statistically significant difference between group I and group III. No statistically significant difference could be found between group I and group IV (p > 0.05). Between group I and V a statistically significant difference was found (p < 0.005). Again a statistically significant difference was found both between group III and IV (p < 0.05), and between group IV and V (p < 0.001). No such difference was observed between group IV and V (p < 0.05). As a result, in this animal model, LMWH given intraperitoneally to prevent adhesions was found to be more effective than subcutaneous and intraperitoneal heparin application.

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In this study, the clinical effects of two extra-oral orthopaedic appliances were compared cephalometrically. Lateral cephalograms of 60 individuals were used in this investigation. The study group was randomly divided into three parts as a) control, b) mandibular headgear and c) chin-cap groups. The subjects of the study group were selected among Class III, low angle or vertically normally growing individuals. The total observation period was one year. Results showed that both appliances were effective skeletally, but there were some differences between them. The results are as follows; chin-cap therapy led to an inhibition in the development of the upper face and an effective control of the vertical dimension in addition to the posterior positioning of the mandible. Mandibular headgear inhibited general growth and development of the mandible and showed an increase in lower anterior face height and also, a significant lower molar distalization was found.

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The aim of this investigation is to compare Haas and Cast Cap Splint devices from the point of root resorption. The material comprised thirty-eight upper and twelve lower premolar teeth derived from nineteen patients who required RME and subsequent removal of the first premolars as part of their full banded orthodontic treatment. Root resorption and repair areas were observed on the buccal surfaces of premolars. Repair tissue was cellular cementum in both groups. There was no significant difference between these two techniques from the point of root resorption amount.

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The purpose of this investigation was to evaluate the efficiency of the FR-3 appliance on functional Cl III malocclusion cases. A total of 45 functional Cl III cases were chosen from a general clinic intake of which 25 were treated with the FR-3 appliance and 20 were untreated and were taken as a control group. Patients that were treated with FR-3 had the following characteristics: Cl III with maxillary deficiency; functional anterior cross-bite; absence of anterior open-bite; patients in mixed dentition. The mean age in the treatment group was 8.4 years 8.8 years in the control group. The observation period was one year for both groups. The results were as follows: Sagittal forward growth stimulation was not observed in the maxilla. Mandibular growth was redirected in the vertical direction. The SNB angle decreased in that the mandible rotated downward and backward. The ANB angle increased. There was an increase in total and lower anterior facial height and reduction in the overbite. Another skeletal change observed was the increase in the cranial flexure angle. Improved dental results were a significant amount of overjet increase and a decrease in the IMPA. There was also a beneficial effect on the soft tissue profile.

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