Doktora Tezleri
Permanent URI for this collection
Browse
Browsing Doktora Tezleri by Issue Date
Now showing 1 - 20 of 57
Results Per Page
Sort Options
Publication Open Access Geleneksel yüzey pürüzlendirme yöntemleri ile dijital olarak kontrol edilebilen er:Yag lazerin mine dokusu üzerindeki mekanik etkilerinin karşılaştırmalı olarak incelenmesi / Comparison of the effects of conventional enamel etching systems and digitally controlled er:Yag laser hand piece on human enamel tissue(Bezmialem Vakıf University, 2015) Karamehmetoğlu, Hilal; Üşümez, SerdarThe aim of this study was to compare the bracket bond strenght, AFM and SEM analysis of etched and debonded enamel surfaces using different enamel etching procedures. In this study intact, extracted 98 human maxillary teeth were used. 80 teeth were divided into four groups: Group 1: Acid (37% phosphoric acid), Group 2: Er:YAG laser (120 mJ, 10 Hz., 40% water, 50% air), Group 3: Er,Cr:YSGG laser (45 mJ, 50 Hz., 30% water, 60% air) and Group 4: Xrunner (100 mJ, 10 Hz., 40% water, 50% air, 2-horizontal+2-vertical scanning). After bonding the braces, samples were stored in distilled water at room temperature for 24 hours, and then thermocycling for a total of 5.000 cycles at 5°C – 55°C with a dwell time of 30 seconds was performed. The shear bond strength was measured by using a universal testing machine with a crosshead speed of 0.5 mm per second. After debonding, the amount of resin remaining on the teeth was determined using the adhesive remnant index. SEM and AFM images were taken from all groups one sample each for etched and debonded enamel surfaces. Er:YAG laser group showed the highest shear bond strenght values followed by acid, Xrunner, and Er,Cr:YSGG laser groups. But the difference was not statistically significant among the groups (p=0.148). There were statistically significant differences among the ARI scores of the groups (p<0.001). Acid group showed significantly higher values than laser groups. Our findings reported that enamel etching with acid, Er:YAG, Er,Cr:YSGG and Xrunner showed mean bracket bond strenght values which are above the range of clinically acceptable values in literature.Publication Open Access Farklı bonding adezivlerinin termal siklus sonrası su absorpsiyon miktarına bağlı olarak lazer uygulamasında yapısal madde kayıplarının incelenmesi / Evaluation of structural loss caused by laser application on different bonding adhesives in relation to the quantity of absorbed water following thermal cyclus procedure(Bezmialem Vakıf University, 2017) Temuçin, Fatih; Yılmaz, BerzaIn today's dentistry, patients who undergo orthodontic treatment prefer ceramic brackets instead of metal brackets, due to their aesthetic appearance. One of the major disadvantages of the ceramic brackets is the difficulty during the debonding procedure. Dental lasers are applied to the bracket surface to make the ceramic onesremoved more easily. The debonding procedure assisted by laser is based on the photoablation effect of the laser on the bonding adhesive, which ensures adhesion of the bracket to the tooth. Photoablation occurs when the laser beam is absorbed by the target tissue and suddenly evaporates with an explosion related to the increasing pressure. Different types of adhesives can be used to bond ceramic brackets to the tooth surface. The structure and the content of the adhesives may differ from each other and this can lead to different responses related to the laser application. In our study, the material loss of different bonding adhesives following Er:YAG laser application was investigated via microcontrolled tomography BT device. Additionally, in order to evaluate the effects of water absorption, some samples were aged with the termal cyclus procedure to simulate the composite materials staying in the mouth conditions. The data obtained from the samples were evaluated statistically with Kruskal Wallis test. The complementary Mann Withney U test was applied. Five different brand of bonding adhesives were used in this thesis study. Material loss was found to vary according to the adhesive bonding brand. Additionally water absorption had been shown to to affect the material loss. Reliance and Opal brand adhesives shown statistically significant higher volume difference and higher crater volume (p = 0.007 and p = 0.043). Key words: Bonding Adhesive, Ceramic Bracket, Laser, Debonding, Micro Computer Tomografi, Thermal CyclusPublication Open Access Farklı adezivlerin kullanıldığı ortodontik bonding sonrası açığa çıkan BİS-GMA'nın in-vivo şartlarda değerlendirilmesi / Evaluation of BİS-GMA following orthodontic bonding with different adhesives: An in vivo study(Bezmialem Vakıf University, 2017) Görükmez, Erhan; Yılmaz, BerzaIn composite adhesives used in orthodontic clinics, ease of use, good adhesion to the enamel surface and resistance to occlusal forces are the main criteria of choice. However, besides these factors, the biocompatibility of the composite adhesives should not be underestimated. The aim of this study is to evaluate the residual Bis-GMA amount related to the use of different orthodontic bracket adhesives cured with light or chemically under in vivo conditions. 48 patients who applied for treatment in Orthodontic Department of Bezmialem Vakif University School of Dentistry were included in the study. Two light curing adhesives (Transbond XT and Opal Seal) and two chemically curing adhesives (Rely-a bond and Unite) were used to bond braces. The patients were asked to shaking with 25 ml drinking water for1 minute. A total of 144 samples were obtained at 3 instances; before bracket bonding, after bracket bonding (firs rinse) and after bracket bonding (second rinse). The samples were placed in amber colored glass bottles and stored at -20 ° C until they would be filtered through a 0.45micron filter and analyzed Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS). In all composite adhesives, BisGMA release was observed following bracket bonding. In the studied groups, the higher amount of release of residual monomer was recorded for the light curing composite adhesives especially in Transbond group(p=0.00). There was statistically no significant difference between groups in T1 and T2 periods after bracket bonding(p>0.05).Publication Open Access Değişik enerji seviyelerinde diyod lazer uygulamasının ekspanse edilmiş midpalatal sutur üzerindeki etkilerinin histomorfometrik olarak incelenmesi / The effect of different doses on the efficiency of LLLT in midpalatal suture using histomorphometry(Bezmialem Vakıf University, 2017) Taş, Gül; Ramoğlu, Sabri İlhanWe aimed to investigate the effect of different doses 940 nm wavelength laser (InGaAsP) applied after midpalatal expansion in rats on sutural activity histomorphometrically at cellular level in rats. In our study, male Wistar rats weighing 180-220 grams were used for 80-12 weeks. The rats were irradiated with Biolase Epic Indium Gallium Arsenide Phosphor (InGaAsP) Diode Laser (wavelength 940 ± 10 nm, power output 0.1 W, continuous mode, frequency 50/60 Hz). The groups were formed as control group, low dose laser group (18 J), medium dose laser group (42 J), high dose laser group (60 J). On day 7, half of the groups in each group were sacrificed and the same laser application procedure as in the remaining rats was continued until the end of day 21. The expansion appliance was applied with a force of 70 grams lateral to the maxillary incisiors of the rats. Histological evaluation revealed that laser low-dose laser group (18 J) after maxillary expansion had a biostimulatory role of laser on bone healing compared to other groups. As a result of statistical evaluation, osteoblast, osteocyte, new bone formation values of low dose laser group were found to increase. According to these results, it might be possible that low-level laser application can shorten the duration of retantion treatment, which is one of the biggest problems in orthodontics.Publication Open Access Farklı pürüzlendirme yöntemlerinin mine renklenmesi üzerine etkisi / Examination of different etching techniques on enamel color(Bezmialem Vakıf University, 2017) Torlak, Betül; Yılmaz, BerzaThe aim of this study is to evaluate the effects of four different enamel etching method and two different composite adhesives on enamel color change. In this study, 120 human premolar teeth extracted for orthodontic purposes were used. Teeth were randomly divided into four etching groups of 37% orthophosphoric acid, Er:YAG laser QSP mode, MSP mode and X-Runner handpiece. Metal brackets are bonded with two different composite adhesives, Transbond XT and Transbond Plus Color Change. After bonding procedure, samples were stored in the staining solution. Color measurements were made by spectrophotometer after bonding and debonding. L, a and b color parameters were recorded according the Cielab and ΔE color differences were calculated using the formula. Statistical analyzes were performed with the SPSS 24.0 software package. The findings of the study show that the coloration related to the orthodontic treatment varies with the different etching methods and the use of different adhesives. However, these values are above the 0.05 p value which makes a statistically significant difference in terms of different etching methods and applications of composite adhesives. In conclusion, this study, which represents the coloring that occurs during orthodontic treatment, did not reveal any significant difference in color in the teeth.Publication Open Access Sağlıklı, hiperplazik ve adenomatöz paratiroit dokularında minör ve majör histokompatibilite antijenlerinin ekspresyon miktarlarının karşılaştırılması / Comparison of the expression patterns of minor and major histocompatibility antigens in healthy, hyperplasic and adenomatous parathyroid tissues(Bezmialem Vakıf University, 2017) Göncü, Beyza Servet; Özten Kandaş, NurAs we learn more about how immune response occurs, it is becoming clear that the characteristics of the tissue can be important as immune cells determines the initiation and progression of an immune response. A formal definition of immunogenicity can be stated as "the ability of a molecule to provoke an immune response or the strength of an immune response". Tissue-specific immunogenicity can be characterized by the determination of Major Histocompatibility Complex and Minor Histocompatibility Antigens as well. The immunogenetic studies of histocompatibility antigens categorized into two groups; major and minor histocompatibility antigens. Human major histocompatibility antigens are known as "human leukocyte antigen" system. The human leukocyte antigen complex is located within the short arm of human chromosome 6 and contains more than 200 genes, has important activities in biology and medicine with the gene regions of diverse function. The major role in medicine is the donor selection in organ and stem cell transplantation. The coordination between innate and adaptive immunity eliminates the survival of organ transplantations as well as parathyroid transplantations. In allorecognition, antigen presenting cells activated by peptide/human leukocyte antigen (HLA) complex and thus changing its course through lymph nodes where T cells reside. Once the recipient antigen presenting cells recognize donor tissue, this leads to activation and migration of T cells where they promote rejection. In solid organ transplantation, cultured tissue cells were presumed as passenger-leukocyte free which ensures prolonged graft survival. With the aim of understanding and characterization of parathyroid gland immunogenicity; the both protein and gene expression patterns of major histocompatibility antigens class I; HLA-A, HLA-B, HLA-C and class II; HLA-DR, HLA-DP, HLA-DQα1, HLA-DQα2 regions were compared in cultured parathyroid cells that derived from healthy, hyperplasic and adenomatous parathyroid tissues. In addition, autosomal restricted minor histocompatibility antigen SP110 protein expression investigated healthy, hyperplasic and adenomatous parathyroid tissues. As a result, HLA-A protein expression remained the same during culture but mRNA expression decreased. HLA-B protein and mRNA expression decreased only in hyperplasia tissues. HLA-C showed weak/no protein expression for both tissues. In addition, cultured parathyroid tissues are still potential targets for class II-restricted allorecognition even during the culture. Therefore, -DQα2 and -DR protein expression was found higher. Besides, parathyroid tissues showed SP110 peptide expression level as follows not detected or moderate in healthy, hyperplasic and adenomatous parathyroid tissues respectively. In conclusion, HLA class I expression patterns was different at every stage. The change in mRNA levels and protein levels was not correlated in different parathyroid tissues and even during culture. Another outcome that the concordance between HLA-DQ and -DR indicates a possible linkage in rejection/poor graft survival of parathyroid tissue transplantation via allorecognition. This mainly due to the regulation control at different levels between gene and its protein as well. The biochemical diversity of proteins means that the individual correlation levels with the associated mRNA varies in parathyroid tissues. Parathyroid tissue should be evaluated in detail with this expression patterns of HLA class I and II for allorecognition prior to transplantation. Current studies showed autosomal restricted minor histocompatibility antigen SP110 peptide was found to recognize HLA-A*03 allele and significantly induces macrophage activation. In future studies, SP110 positivity of parathyroid tissues evaluates for macrophage activation via in vitro cell culture system.Publication Open Access Braket Altında Oluşan Mikrosızıntının Dört Farklı Bonding TekniğindeTermal Siklus ve Çiğneme Similatörü Yöntemleri ile Karşılaştırmalı Olarak Değerlendirilmesi(Bezmialem Vakıf University, 2017) Ok, Ufuk; Yılmaz, BerzaThe microleakage caused by the shrinkage of the adhesive related to the polymerization reaction causes weakening of the connection between the bracket and the tooth surface and leads to the penetration of bacteria. Increased microleakage in the shrinkage zone causes also decalcification, enamel coloring, corrosion and secondary decays. The adhesives used to bond brackets are subjected to the chewing forces and their physical integrty is affected by the thermal changes in the mouth environment. Chewing forces are transmitted directly to the teeth or indirectly through brackets and adhesives or the arch wire. Structural deterioration may occur on the adhesive because of the chewing forces. There are studies showing that these microcracks allow penetration of the oral fluids. In thepresent study, the efficiency on microleakage of asid etch, self etch and two different laser methods was evaluated in comparison. In our study, the enamel surface of 160 extracted teeth was etchedwith acid, self etch adhesives, Er:YAG laser and X-Runner handpiece appliactions. After bondingthe brackets to the specimens, 0.016X0.022 inch nickel titanium arch wire was ligatureted, samples were embedded in autopolymerizing acrylic blocks with imitated periodontal ligament. The specimens were aged with either chewing simulator and thermal cyclingor only thermal cycling procedures. Microleakage amount in milimeters between enamel-adhesive and adhesive-bracket surfaces was recorded for occlusal and gingival sections in each specimen. The median and mean values of microleakage were evaluated with Kruskall Wallis and Mann Withney tests respectively, (p <0.05). Microleakage measured in the gingival part of enamel and adhesive surfaces of the samples aged with chewing simulator was significantly higher. The half of the samples was aged with chewing simulator and thermal cycling procedures while the other half was aged only with thermal cycling. The microleakage values were found to be higher in samples aged with chewing simulator and thermal cycling procedures. The correct simulation of the oral conditions can be crucial to assess and understand the performance of the adhesive materials in laboratory tests.Publication Open Access Farklı lazerlerin ortodontik aparey altındaki antibakteriyel etkilerinin değerlendirilmesi / Evaluation of antibacterial effects of different lasers under orthodontic appliances(Bezmialem Vakıf University, 2017) Ünal Kundakçıoğlu, Gülşah; Yılmaz, BerzaOrthodontic treatment plan may include upper jaw expansion which is often made with appliances containing acrylic. Since the appliances are fixed with bonding procedure, the patients can not remove it and clean the underneath area. This lead to the formation of an anaerobic environment. The aim of our study, is to evaluate the antibacterial / bactericidal effects of the laser technology which may minimize the harm that periodontopathogen and cariogenic bacteria in the anaerobic environment may cause. Porphyromonas gingivalis ATCC33277 and Streptococcus mutans ATCC25175 biofilms were formed on anaerobic conditions on polymethylmethacrylate discs. In order to determine the effect of different wave length lasers on decreasing the number of bacteria, Nd: YAG (1064nm), diode (810 nm) and diode (445 nm) were applied in two different powers(1,5W; 2W) and six study groups were formed. Additionally one control group without laser application was created. Polymethylmethacrylate discs with biofilm were placed in containers providing anaerobic media, and the caps of the containers were replaced with polymethylmethacrylate material. Laser application was made through the modified cap surface. Mitis Salivarius Bacitracin for S. mutans and 0.1 ml of Brucella blood (Vit K + hemin) agar for P. gingivalis were used as proliferation media and the media were incubated in anaerobic medium at 37 ° C for 72 hours. The forming colonies were counted in cfu/ ml. Additionally, Scanning Elektron Microscope (SEM) images of one disc from each study group and the control group was recorded to visualize the bacterial biofilm. In conclusion, our study showed that Nd: YAG (1064 nm), diode (810 nm) and diode (445 nm) lasers have antibacterial / bactericidal effects on S. mutans and P. gingivalis biofilms with cited parameters. It has been determined that the diode laser with the wavelength of 810 nm applied in 2 W 30 sec CW mode has the highest effect on both bacteria.Publication Open Access Farklı yarık tipine sahip dudak damak yarıklı hastalarda üst çene genişletmesinin oluşturduğu stres alanlarının fem analizi ile incelenmesi / Evaluation of the stress distribution during maxillary expansion in patients with different types of cleft lip and palate using the finite element analysis(Bezmialem Vakıf University, 2017) Bölükbaşı, Esra; Yılmaz, BerzaDDY'li hastalarda sıklıkla kollabe maksillaya bağlı çapraz kapanış görülür ve bu sebeple hızlı üst çene genişletme işlemi uygulanmaktadır. Bu çalışmanın amacı, transversal yönde maksiller yetersizlik görülen farklı tipte yarığa sahip DDY'li hastada genişletme işlemi sonucunda oluşan değişikliklerin üç boyutlu sonlu elemanlar yardımı ile değerlendirilmesidir. Çalışmada genç adolesan dönemde, üst çene darlığı olan tek taraflı, çift taraflı komple dudak damak yarığı ve izole damak yarığı olmak üzere 3 farklı tipte yarığa sahip hastanın tomografi görüntülerinden elde edilen üç boyutlu sonlu elemanlar modeli kullanılmıştır. 0,2 mm'lik genişletme sonucu von Mises gerilme dağılımı ve 5 mm'lik genişletme sonucu yer değiştirme dağılımları incelenmiştir. Transversal yöndeki değişiklikler incelendiğinde en fazla ekspansiyonun çift taraflı yarığa sahip modelde gerçekleştiği gözlenmiştir. Benzer miktarda genişleme tek taraflı yarığa sahip modelin yarık içeren tarafında izlenmiştir. Daha az genişleme izole yarığa sahip hasta modelinde ve daha da az miktarda ise tek taraflı yarığa sahip hastanın yarık içermeyen tarafında kaydedilmiştir. Antero-posterior yönde tek taraflı yarığa sahip modelde incelenen yapıların posterior yönde yer değişimi eğilimi gösterdiği gözlenmiştir. İzole damak yarıklı modelde, orta hatta yer alan yapılar anterior yönde yer değiştirme eğilimi gösterirken, lateral bölgedeki yapıların ise posterior yönde yer değiştirme eğilimi gösterdiği gözlemlenmiştir. Çift taraflı komple dudak damak yarıklı modelde ise anterior yönde yer değiştirme eğilimi gözlenmiştir. Vertikal yönde çift taraflı yarığa sahip modelde anatomik yapıların inferior yönde yer değişimi eğilimde olduğu, izole damak yarığına sahip modelde ve tek taraflı yarığa sahip modelde orta hatta yakın yapıların inferior yönde yer değiştirme eğilimi gösterirken, lateral bölgedeki yapıların superior yönde yer değiştirme eğilimi gösterdiği saptanmıştır. İzole damak yarığına sahip hasta modelinde, stres en fazla nazal bölge civarında gözlenirken tek taraflı yarıklı hasta modelinde sutura zigomatikomaksillaris bölgesinde, çift taraflı yarığa sahip hasta modelinde ise sutura zigomatikotemporalis ve sutura zigomatikomaksillaris bölgelerinde biriktiği gözlenmiştir. Anahtar Kelimeler: Tek taraflı dudak damak yarığı; Çift taraflı dudak damak yarığı; İzole damak yarığı; Hızlı üst çene genişletmesi; Sonlu elemanlar analizi.Publication Open Access Adölesan idiopatik skolyoz'lu hastalarda inspiratuar kas eğitiminin solunum kas gücü, solunum fonksiyonları ve fonksiyonel kapasiteye etkisi / The effect of the inspiratory muscle training on respiratory muscle strength, respiratory function and functional capasity in adolescents with idiopatic scoliosis(Bezmialem Vakıf University, 2018) Başbuğ, Gözde; Gürses, Hülya NilgünScoliosis is defined as a lateral flexion of the spine greater than 100 in the anteroposterior radiograph. However, in reality, a 3-dimensional structural deformity involving a curvature in the coronal plane, a change in the curves in the sagittal plane, and a rotation in the transverse plane. Scoliosis deformity is usually progressive and can cause chronic pain, cosmetic problems, decreased quality of life, and activity participation in patients. This three dimensional deformity also causes various respiratory dysfunctions. In this context, scoliosis brings about findings such as decreased respiratory function, inadequate functional capacity and low respiratory muscle strength. The adverse consequences of scoliosis when the angle of the curve exceeds 40 -50 degree usually last for life. Adolescent idiopathic scoliosis (AIS) is defined as "a structural curvature of the spinal cord with lateral flexion and rotation components that occur around the puberty period in healthy children". AIS is the most common type of scoliosis with a 2% incidence in the general population. AIS accounts for 80% of scoliosis cases. Risk of progress of AIS; natural history, skeletal maturity, sex, and curve size. In girls, the curvature is more likely to progress and more likely to need treatment. The size of the curveture increases with the skeletal growth; therefore, a patient who is not yet skeletally immature is at greater risk for progression of the disease. The relationship between scoliosis and altered pulmonary functions has long been known and studied in the literature. Impairment of pulmonary function and functional capacity seen on the AIS are tought depends on spinal curvature, rotation, thoracic kyphosis and lordosis, and chest deformation. Possible disabilities for untreated AIS, such as back pain and pulmonary limitations affect the functional capacity and self-esteem of the person. There are very few studies in this area. From a literary perspective; a significant proportion of the conservative treatment parameter of scoliosis is exercises training for increasing respiratory functions and functional capacity. Assessing respiratory function, determining the risk of restrictive lung disease, identifying respiratory problems of patients with scoliosis, and adding respiratory exercises to their treatment program have great importance for the rehabilitation of patients with scoliosis. In this context, studies are needed to develop the scoliosis specific parameters of respiratory rehabilitation. In our study, we aimed to increase respiratory muscle strength, respiratory functions and functional capacities by providing respiratory training to children with mild to moderate scoliosis. The study included patients who applied to the Faculty of Medicine, Department of Orthopedics and Traumatology of the Bezmialem Vakif University. Patients were directed by the orthopedic surgeon to the Department of Physiotherapy and Rehabilitation of the Faculty of Health Sciences at Bezmialem Vakif University with the diagnosis of AİS. Thirty-four patients were included in the study and randomized into control and training groups. During the first visit of all patients, an evaluation form was filled in which included demographic and clinical features. A 6-min walk distance (6MWD) was calculated for all cases in the training and control groups by applying the 6-min walk test (6MWT). Beside this, pulmonary function test (PFT), respiratory muscle strength (MIP: maximal inspiratory pressure, MEP: maximal expiratory pressure) was assessed and the results is recorded. Angle of trunk rotation (ATR) has evaluated by the same physiotherapist with a scoliometer and were recorded in the patient evaluation form, as well as the demographic information of the patients, as Risser classification, Cobb angle evaluation determined by the orthopedic surgeon. After the initial evaluation, all patients (training and control group) were given a home-based exercise program by the physiotherapist, consisting of deep diaphragmatic respiratory exercises, resistive respiratory exercises to weak zones on the concave sides of the scoliosis, spinal stabilization exercises, strengthening of interscapular muscles and stretching exercises. In the training group, the same home based exercise program as well as inspiratory muscle training (IMT) were given. Inspiratory muscle training was performed with Threshold IMT for 8 weeks, 30% of MIP value, 7 days a week, 15 minutes per set and twice a day. Patients in the training group were taken into control once a week to reevaluate the MIP values and 30% of the measured MIP was identified as the new training workload. In both control and training groups, during weekly controls, home based exercise program has repeated with physiotherapist accompanied by intraoral pressure measurements. At the end of the 8-week training period, the patients were reevaluated. The evaluations at the end of treatment showed statistically significant improvements in respiratory function test parameters including FEV1 (% predictive) and PEF (% predictive) and MIP, MEP values of respiratory muscle strength parameters in both control and training groups (p<0.05). The training group also showed a significant improvement in the value of forced vital capacity (FVC) (% predicted) (p <0.05). We think that home based exercise training, given in both groups with AIS in our study are very useful in terms of development of respiratory muscle power, respiratory functions and functional capacities. In addition to these gains, there was a statistically significant decrease in the ATR of the both patient group after 8 weeks of exercise training (p <0,05). We think that the exercise program we have applied was based on spinal stabilization and 3D breathing exercises, has been very beneficial on trunk rotation. When we look at the results obtained at the end of the 8-week training period, the increases in FVC (% predictive), MIP, MEP and 6MWD were found to be statistically higher than the increases in the control group (p <0,05). In this case, as we have already mentioned in our hypothesis, we can say that IMT has a positive effect especially on FVC, which is a sign of lung volumes, in pulmonary function test parameters. In addition, we think that IMT has a developmental effect on respiratory muscle strength and functional capacity, which is lower in children with AİS than healthy age groups. As a result of our study, the exercise program, consisted of spinal stabilization exercises, interscapular strengthening exercises, stretching exercises and respiratory exercises including diaphragmatic deep breathing exercises and resistive local expansion exercises to the concave regions of the scoliosis were performed throughout the patient group with AIS, is effective by the development of respiratory muscle power, the improvement of respiratory functions, the development of functional capacity and the reduction of trunk rotation caused by scoliosis. In addition to this, according to data of our study, IMT is quite effective at removing the deficits and achieving significant cardiorespiratory gains in mild to moderate AIS cases with inadequate respiratory muscle strength and functional capacities, apart from respiratory dysfunction arising from the likely natural course of the disease. In the light of findings obtained from our study, we would like to inform that a comprehensive exercise program in addition with IMT is a very effective method for cardiopulmonary physiotherapy and rehabilitation of AİS and it is useful for this patient group to disseminate its usage.Publication Open Access Bir senelik retansiyon periyodu sonunda farklı retansiyon protokollerinin oklüzal kontak alanları üzerine etkisi / The effect of different retention protocols on occlusal contact areas in a one-year retention period(Bezmialem Vakıf University, 2018) Kara, Burçak; Yılmaz, BerzaOrthodontic treatment goals can be expressed as achieving ideal tooth alignment, aesthetic, functional occlusion and stability. One of the most important challenges in orthodontics is maintaining the occlusal stability achieved at the end of the active treatment. After orthodontic treatment, the patient is transferred to the retention phase to preserve the new occlusal relationship, and the retention appliances used for this purpose are generally expected to allow settling of the occlusion by the vertically directed movements of posterior teeth, while maintaining the alignment of the teeth and arch dimensions. In our study, the effects of 3 different retention appliances on occlusal contact areas and the changes in OGS scores were investigated at the end of one year retention period. Within the scope of this retrospective study, post-treatment and post-retention records of 90 individuals who received fixed orthodontic treatment in Bezmialem Vakif University, Faculty of Dentistry, Department of Orthodontics were compared. For the selection criteria, an acceptable final occlusion was sought according to the Objective Grading System (OGS) defined by the American Board of Orthodontics (ABO). The individuals were divided into three groups according to the type of retention appliance used. Each group had 30 case: Essix group (1. group), Hawley group (2. group) and fixed retainer group (3. group). All the patients had upper and lower canine-canine bonded lingual retainer, and in addition to this, patients wear Essix for upper arch in group 1, and Hawley plate in group 2, full-time during the first 6 months and half-time (12 hours) during the next 6 months. Dental casts taken after treatment (T1) and at the end of one year retention period (T2) were converted to digital models by scanning with a three-dimensional laser scanner and occlusal contact areas were measured in mm2 using image analysis software (ImageJ). At the end of the retention period, OGS measurements were calculated again on the dental casts and the presence of correlation between OGS scores and contact area change was investigated. As a result of the statistical analysis, it was observed that all the retention types showed significant changes during the retention period. In the Essix group, a statistically significant decrease was found in contact areas for all teeth, except for incisors, and in the Hawley and Fixed retainer groups significant increase was recorded. The increase in the occlusal contact area recorded for the fixed retainer group was found to be higher than that of the Hawley group, but this difference was not statistically significant. On the other hand, at the end of the retention period, OGS scores improved both in the Hawley and Fixed retainer groups, but only the results of the Hawley group was significant. No correlation was found between the occlusal contact area change and OGS score at the end of one year follow-up. In conclusion, Hawley and fixed retainer appliances allow settling during the retention period compared to Essix appliance, moreover they may be more adequate for stability since they didn't cause an increase in OGS scores.Publication Open Access Lingual retainer uygulaması için er:Yag lazer ve konvansiyonel etching metotlarının in vitro olarak karşılaştırılması / In vitro comparison of er: Yag laser and conventional etching methods for lingual retainer application(Bezmialem Vakıf University, 2018) Kurt, Merve; Yılmaz, BerzaThe stability of the teeth alignment following the orthodontic treatment is important in terms of the success of the orthodontist and the patient's satisfaction. Many different retention devices have been designed for this purpose. One of the most commonly used retention tools is the lingual retainer. There are many methods used for roughening the enamel surface for lingual fixed retainer application. It is a challenge to provide the insulation in conventional etching applications. Any failure in the lingual retainer bonding process increases the potential of the relaps. This sensitivity requirement in the conventional etching technique provides the basis for the development of different applications with laser systems. The steps of washing the surface of the enamel are eliminated with lasers, thus it provides the advantage of preventing the saliva contamination during the roughening process. Shrinkage of the adhesive during polymerisation in the bonding of orthodontic attachements may cause microleakage. Another reason for the formation of microfractures is that the attachements bonded to the surface of the teeth are affected by the chewing forces. Structural deterioration occurs in the adhesive due to chewing forces and microfractures are formed. There are various studies showing that these cracks are permit the mouth liquids penetration. Microleakage also causes weakness of the binding and bacterial penetration. Increased bacterial penetration leads to enamel coloring and decalcification. The aim of this study is to evaluate the effects of Erbium: Yttrium-Aluminum-Garnet (Er:YAG) laser and acid etching methods on the bonding strength, fracture type and amount of microleakage. In this doctoral dissertation study, 132 extracted human incisor teeth were used. The enamel surface was roughened using 37% phosphoric acid and Er:YAG laser. Autopolymerized silicone (Anti-Rutsch-Lack; Wenko, Wensselaer, Germany) was applied to the root surface to simulate human periodontal ligament tissue. Using silicone molds, teeth were embedded in the autopolymerizing acrylic as two teeth in each sample. A two-year aging protocol was applied using chewing simulator and thermal cycler devices to mimic the mouth environment. The teeth designated to undergo microleakage evaluation were separated from each other and placed separately in the acrylic blocks to close the apex. Two layers of nail polish have been applied to the teeth to prevent erroneous paintings. In the precision cutting device, sections were taken so that the mesiodistal direction was parallel to the lingual retainer wire. Microleakage between enamel-adhesive and adhesive-retainer wire from mesial and distal sections with stereomicroscope was recorded with millimetric measurements. For evaluation of bonding strength, the lingual retainer was placed in the Universal tester, perpendicular to the tapered piece, and subjected to a tear test. The data at break moment was recorded on the computer in Newton (N). The recorded values were divided by the total surface area of the adhesives on the two teeth and converted to megapascals (MPa). The evaluation of the ARI score was made by examining the same samples. When the bonding strength data were examined, statistically significant difference was found between the groups which were acid-roughened and laser-roughened. Higher force values in the group with the acid etching were recorded. The adhesive remaining on the tooth surface after fracture was examined with stereomicroscope and scored using the Adhesive Remnant Index (ARI). There was statistically significant difference between the groups. Ruptures in the acid-roughened group were more common among between the adhesive and retainer surfaces, while in the laser group , the breakage occurred more often in the enamel-adhesive interface. There was no statistically significant difference in matter of microleakage when the mesial and distal sides were compared between the enamel-adhesive and adhesive-retainer interfaces. When total microleakage was examined by taking the average of these data, the values measured between enamel and adhesive were found to be statistically significantly higher than those measured between adhesive and retainer.Publication Open Access Kistik fibrozisli çocuklarda inspiratuar kas eğitiminin postüral stabilite, denge, solunum fonksiyonları ve fonksiyonel kapasite üzerine etkisi / Effects of inspiratory muscle training on postural stability, balance, pulmonary function and functional capacity in children with cystic fibrosis(Bezmialem Vakıf University, 2018) Zeren, Melih; Gürses, Hülya NilgünCystic fibrosis (CF) is a genetic disorder affecting multiple organs and systems including lungs, pancreas, liver, gastrointestinal system and reproductive system which rely extensively on exocrine secretion. Lung-related problems are the most important cause of morbidity and mortality in these patients. It is stated in the guidelines that physiotherapy approaches for improving airway clearance should be included in the routine treatment of CF patients. Although inspiratory muscle training (IMT) is effectively used in various cardiopulmonary diseases, the literature related to its use in CF patients is conflicted. The number of the studies investigating the involvment of postural stability and balance in chronic lung diseases is rising and it is reported that postural stability may be affected due to respiratory or peripheral muscle weakness, increased work of breathig or hyperinflation. But the literature is limited regarding the involment of postural stability and its related mechanisms in CF patients. Aim of this study was to analyze the factors which may be related to postural stability and balance in CF patients and, to investigate the effects of IMT in addition to a comprehensive chest physiotherapy program on postural stability, balance, pulmonary function and functional capacity. Thirty two children aged between 8-18 who are diagnosed with CF were randomised into experimental or control group. Body composition analysis, pulmonary function test (PFT), respiratory and peripheral muscle strentgth assessments, 6-min walk test (6MWT) and, postural stability, limits of stability and sensory integration of balance tests in Biodex Balance System® were applied to all patients. A comprehensive chest physiotherapy program including thoracic expansion exercises, incentive spirometer, oscillatory positive pressure device, postural drainage, techniques for improving the effectiveness of cough and physical activity counselling was given to the control group to be repeated twice a day, seven days a week for 8 weeks. In addition to the comprehensive chest physiotherapy program, IMT at an intensity of 30% of MIP with Threshold IMT® device was given to the experimental group to be repeated twice a day for 15 minutes. All assessments were repeated at the end of the eighth week. Data was analyzed using SPSS v.20. For analyzing the independent predictors of the balance among the respiratory parameters, linear regression analysis was conducted on thirty-two subjects. Paired Sample T-test or Wilcoxon Test was used for in-group comparisons and Independent Samples T-tes or Mann Whitney U test was used for between-groups comparisons depending on the distribution properties of the data. The results were considered significant with P-values < 0,05. Regression analysis revealed that maximal expiratory pressure (MEP) value was an independent predictor for the overall score of limits of stability test. Subjects with higher MEP value had better overall score of limits of stability test (R=0,514; R2=0,264; p=0,003). After eight weeks of treatment, forced vital capacity, forced expiratory flow in 1 second, peak expiratory flow, MIP, MEP, 6MWT distance, M. Quadriceps strength and overall score of limits of stability test significantly improved in each group (p<0,01). Increase in the MIP value was higher in the experimental group compared to the control group (p<0,001). Improvements in PFT parameters, MEP, functional capacity and overall score of limits of stability test did not differ between groups (p>0,05). In our study, MEP value, which reflects the abdominal muscle strength was found to be an independent predictor for overall score of limits of stability test which evaluates dynamic balance ability, and the improvements in MEP value gained through the treatment reflected positively on the dynamic balance ability of the patients. It is reported in the literature that abdominal muscle strength is closely related to dynamic balance in both healthy subjects and patients with chronic lung diseases. According to our results, it can be assumed that a similar relationship may also exist in children with CF. Considering the previous studies and our results, it is concluded that IMT may be applied selectively to CF patients with significant respiratory muscle weakness but there is insufficient evidence to support its routine implementation in all patients. Beyond the improvement in airway clearance, a comprehensive chest physiotherapy program also improved pulmonary function, respiratory muscle strength and functional capacity in our study; this emphasizes the importance of including chest physiotherapy in the routine treatment of CF patients.Publication Open Access Serebral palsi'li çocuklarda denge ve solunum kas eğitiminin fonksiyonel kapasite, denge, solunum fonksiyonları ve solunum kas kuvvetine etkileri / The effects of balance and respiratory muscle training on functional capacity, balance, respiratory function and respiratory muscle strength in children with cerebral palsy(Bezmialem Vakıf University, 2018) Kepenek Varol, Büşra; Gürses, Hülya NilgünCerebral palsy (CP) is a disorder of the development of movement and posture, causing activity limitations, musculo-skeletal and sensory systems that occurred in the immature brain. The aim of the study was to investigate the effects of balance training and respiratory muscle training on functional capacity, balance, respiratory function and respiratory muscle strength in children with CP. The study included 30 cases with hemiplegic cerebral palsy who are in levels I and II according to Gross Motor Function Classification System, and were randomly assigned to a control (n=15) or a study (n=15) group. All the cases included in the study underwent a physiotherapy program 3 times a week for 8 weeks; 1 exercise session was performed under the supervision of a physiotherapist, other 2 sessions a week were performed at home. While the control group's physiotherapy program included balance exercises based on neurodevelopmental therapy (NGT), the study group's program included inspiratory muscle training (IMT) in addition to balance exercises based on NGT. The IMT which performed on the study group was performed at least 5 days a week. The Six Minute Walking Test (6MWT), pulmonary function test, respiratory muscle strength measurement and postural stability and balance (with Biodex Balance System®) were evaluated in all cases, and after 8 weeks of treatment all the evaluations were repeated. As a result of the study, PEF value, maximum inspiratory and expiratory pressure values, 6MWT distance, and equilibrium functions (except for eyes closed evaluations) (p<0.05) improved in both groups, whereas FVC, FEV1 and FEV1/FVC was not changed before and after treatment (p>0.05). There was no significant differences in the change scores of respiratory function, 6MWT distances, and balance scores between the groups (p> 0.05), whereas the maximum inspiratory and expiratory pressure values further increased in study group compared to control group (p<0.05). In conclusion, respiratory muscle training in children with CP did not have any effect on respiratory function, functional capacity and balance, but significantly increased respiratory muscle strength. There are a limited number of studies regarding respiratory muscle strength and respiratory muscle training in children with CP. Considering the association between respiratory problems and CP, we think that respiratory muscle strength assessment in children with CP and the identification of children who need it, and adding IMT to physiotherapy programs will contribute greatly to the rehabilitative approach of children with CP. Key words: Cerebral palsy, respiratory muscle strength, respiratory muscle training, respiratory function, balance.Publication Metadata only Kronik obstrüktif akciğer hastalığında inspiratuar kas eğitiminin dispne nedeniyle hareket korkusuna etkisinin değerlendirilmesi / Assessment of impact of inspiratory muscle training on fear of movement due to dyspnea in chronic obstructive pulmonary disease(Bezmialem Vakıf University, 2019) Saka, Seda; Gürses, Hülya NilgünChronic obstructive pulmonary disease (COPD) is associated with respiratory muscle weakness, which leads to dyspnea, physical inactivity, decreased exercise capacity, and impaired quality of life. Dyspnea is defined as the difficulty of breathing. Patients with COPD avoid activities that cause dyspnea or compensate by reducing the rate of activity. As a result, fear of movement occurs due to dyspnea. The aim of this study was to evaluate the effect of inspiratory muscle training on fear of movement due to dyspnea in COPD patients. In our study, 40 patients who were referred to Bezmialem University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Pulmonary Rehabilitation Laboratory which was followed-up with the diagnosis of COPD in Bezmialem Medical Faculty, Department of Chest Diseases, were included on a voluntary basis. Demographic assessment form, 6 minutes walking test (6MWT), respiratory muscle strength measurement, Breathlessness Beliefs Questionnaire (BBQ), Hospital Anxiety and Depression Scale (HADS), Saint George's Respiratory Questionnaire (SGRQ), COPD Evaluation Test (CAT) were performed before and after the inspiratory muscle training program. Participants were randomized into two groups. In the training group, inspiratory muscle training was performed in 30 % of the mouth inspiratory pressure (MIP) for eight weeks, at least five days a week, twice a day for 15 minutes. Patients were checked once a week, MIP values were re-measured, and new training intensity was determined in 30 % of the new value. In the control group, 15 % of MIP was given for eight weeks, at least five days a week, and 15 minutes for twice a day. MIP assessment were also performed weekly in control group. The support of Bezmialem Vakif University Scientific Research and Projects (BAP) unit was used for the rubber mouthpieces used in the measurement of respiratory muscle strength and the Threshold-IMT devices used in inspiratory muscle training. Statistical analysis was performed with SPSS package program. The mean ± standard deviation (X ± SS) for the variables indicated by measurement and the percentage (%) for the variables indicated by counting were calculated. The t-test was used to compare the pre- and post-treatment values of the same group. Wilcoxon paired two sample tests were used if the data were not suitable for normal distribution. The t-test was used to compare the measured values of the treatment and control groups. If the data were not suitable for normal distribution, Mann Whitney U test was used. Analysis of the variables determined by counting was performed using chi-square test. The level of significance was determined as p˂0.05. The demographic characteristics and baseline outcome measures of the patients were similar. In training group, there was a statistically significant difference between pre-training and post-training forced expiratory volume in first second (FEV₁), forced vital capacity (FVC), forced expiratory volume in first second to forced vital capacity ratio (FEV₁/FVC), MIP, mouth expiratory pressure (MEP), 6MWT distance, HADS, SGRQ, CAT and BBQ results. In control group, there was statistically significant difference between pre-trainig and post-trainig MIP, MEP, SGRQ (activity), CAT, BBQ results of the patients while there was no significant difference between 6MWT distance, HADS, SGRQ (symptom, effect, total). Also, there was a statistically significant difference in favor of the training group in all outcome measures compared to the difference between the groups pre-training and post-training. As a result of our study; MIP, MEP, 6MWT distance increased, anxiety and depression levels were decreased, SGRQ and CAT quality of life scores improved with inspiratory muscle training. Also, dyspnea related fear of movement was reduced which was the main aim of our study. In conclusion, our study supported the literature related with benefical effects of inspiratory muscle training, as well as determined the benefical effect on fear of movement due to dyspnea in COPD patients. Key words: Fear of movement, dyspnea, inspiratory muscle training, COPDPublication Metadata only Radyoterapi sonrasında kritik boyutlu kemik defektlerinde ksenogreft ile karıştırılan doksisiklin, rifamisin, metronidazol ve klindamisinin deneysel olarak incelenmesi / Experimental investigation of xenograft mixed with doxycycline, rifamycin, metronidazole and clindamycin in critical sized bone defects after radiotherapy(Bezmialem Vakıf University, 2019) Günay, Özgün; Doğanay, ÖzgePatients undergoing cancer treatment and radiotherapy in the head- neck region are at risk for the development of osteoradionecrosis of the jaws. In the ischemic regions, bone healing can be delayed. Infection exacerbates clinical manifestations. Antibiotics are clinically effective on the prevention or treatment of infections and have to be used for long- term. Recently, antibiotics have been thought to have antiinflammatory effects independent of their antibacterial activities and thus contribute to bone healing. We examined the effects of clindamycin, metronidazole, rifamycin and doxycycline mixed with xenograft on bone healing in critical-sized surgical defects in mandible which had been previously exposed to radiation. 50 Wistar albino rats were used. After radiotherapy to every, bicortical bony defects in 5 mm diameter was created in the right mandible of rats, filled with antibiotics and xenograft in the experimental groups, and with only xenograft particles in the control groups. After surgery, sacrifications were performed at fourth week and all specimens were evaluated histologically and histomorphometrically in terms of inflammation, necrosis, fibrosis, new bone formation areas, calcified trabecular bone areas and capillary count. None of the specimens showed symptoms of necrosis, infection or fibrosis. The new bone formation areas were significantly higher in Metronidazole and Clindamycin groups when compared with control group (p <0.01, p <0.01). When the calcified bone trabecular areas were examined, there was a statistically significant difference between the control and Clindamycin group (p <0.01). When Clindamycin was compared with other groups, the difference was also significant (p <0.05). The capillary count was significantly different in the Metronidazole (p <0.05) and Clindamycin groups when compared with the control group (p <0.01). Inflammatory reactions decreased in the groups treated with antibiotics, new bone formation areas and vascularity were increased. Antibiotics might have anti- inflammatory activities independent of their antibacterial properties.Publication Open Access Farklı le fort ı osteotomi yöntemleriyle yapılan maksiller ilerletme yöntemlerinin stabilitelerinin karşılaştırılması / Comparison of the stability of different le fort i osteotomy technics on maxillary advancement methods(Bezmialem Vakıf University, 2019) Alagöz Kabay, Gizem; Kılıç, ErdemÇalışmamızda, ortognatik cerrahide üst çeneyi hareketlendirmek için kullanılan Le Fort I osteotomi tekniğinin bir modifikasyonu olan M şekilli osteotomi tekniğinin, ameliyat sonrası meydana gelebilecek relapsı önleyici etkinliği araştırılmıştır. Bu etkinliğin araştırılmasında, güvenilirliği literatürce destelenen 'Sonlu Eleman Analizi' çalışması kullanılmıştır. İki farklı osteotomi tekniği ile maksillanın relaps açısından en riskli hareketi olan aşağı doğru konumlandırma işlemi sonrası oluşacak maksimum stres alanlarını, fiksasyon sisteminde oluşan stres alanlarını ve bunların sonucunda meydana gelebilecek stabilite ve relaps problemlerini belirlemek amaçlanmıştır. Çalışmamızda bir hastanın bilgisayarlı tomografik görüntüsü 'Sonlu Eleman Analizi' yöntemi kullanılarak işlenmiş, üç boyutlu çalışma modeli üzerinde konvansiyonel Le Fort I osteotomi tekniği ile M şekilli osteotomi tekniğiyle birlikte yapılan maksiller ilerletme ve aşağı konumlandırma işlemi sonrası, kemik ve plak sistemlerinde oluşan maksimum stres alanları stabilite ve relaps açısından değerlendirilmiştir. Çalışmamız 6 gruptan oluşmaktadır. Gruplarda maksiller ilerletme miktarı hepsinde aynı ve 5 mm olup, aşağı konumlandırma miktarı 3 mm ve 5 mm olarak belirlenmiştir. Konvansiyonel Le Fort I osteotomi sonrası segmentler arasına iliak greft konulmuştur. İliak greftin interpozisyonel greft olarak kullanılmasının sebebi literatürce altın standart olarak bildirilmesidir. Kontrol grubunda konvansiyonel Le Fort I osteotomi uygulanmış ancak araya greft konulmamıştır. Osteotomi sonrası L şeklinde 4 delikli plak ve 5 mm'lik vidalarla fiksasyon sağlanmıştır. Çalışmamızın sonucunda, M şekilli osteotomi yönteminin, araya greft konulmuş geleneksel Le Fort I osteotomi yöntemine göre stres parametreleri açısından daha düşük streslerin gözlendiği sonucuna varılmıştır.Publication Open Access Acil Tıp Çalışanlarının (KBRN) Kimyasal, Biyolojik, Radyolojik, Nükleer Kazalara Karşı İlgi, Bilgi ve Tutum Durumu Araştırması / Survey on emergency medicine workers' attention, notion and attitude against (CBRN) chemical, biologic, radiologic and nuclear accidents(2019) Dönmez, Mehmet Akif; Gülen, BediaToplumu etkileyen bütün travmatik olaylarda ilk başvuru noktası olan acil servislerin mevcut kaotik yapısına KBRN (kimyasal, biyolojik, radyolojik, nükleer) kaynaklı bir olayda yeni ve karmaşık yüklerin gelmesi kaçınılmazdır. Tez çalışmamızda; kaza, afet, sabotaj ve terör kaynaklı muhtemel KBRN tehditlerine yönelik acil tıp çalışanlarının (acil tıp uzmanı, acil tıp asistanı, paramedik, acil tıp teknisyeni ve hemşireler) hazırlılık durumlarının ölçülmesi hedeflenmiştir. Acil servis çalışanlarının KBRN tehditleri ve kazalarına yönelik ilgi, bilgi ve tutumlarının yanısıra hastane ve acil servislerin fiziki donanımlarının ve acil servis-hastane, hastane-ilgili kurumlar (AFAD, Sağlık Bakanlığı, UMKE vb.) arası KBRN koordinasyonunun tesbiti; KBRN hazırlığında eksikliklerin giderilmesine ve yol haritasının ortaya konulmasına katkı sağlayacaktır. Üniversite, devlet ve özel hastanelerdeki acil tıp çalışanlarına yüzyüze ve elektronik ortamda ulaşılarak 23 sorudan oluşan bir anket formu uygulanmıştır. Sorulardan üçü demografik bilgilerle ilgili, yirmisi KBRN tehditlerine yönelik farkındalığı, acil servislerin mevcut KBRN hazırlık kapasitesini (dekontaminasyon, kişisel koruyucu ekipman, eğitim ve tatbikat durumu, kurum içi ve kurumlararası koordinasyon) ölçmeye yöneliktir. Çalışmamıza 436 acil tıp çalışanı katılmıştır. Katılımcıların % 42'si (n=183) acil tıp uzmanı , % 17.4'ü (n=76 ) acil tıp asistanı, % 8.3'ü (n=36) acil tıp teknisyeni, % 11.5'i (n=50) paramedik, % 20.9'u (n=91) hemşiredir. Acil tıp çalışanlarının % 46.6'sı (n=203) KBRN vakalarına yaklaşım konusunda kendisini geliştirmek istediğini , % 39'u (n=170) KBRN konusunun şu an öncelikleri arasında olmamakla birlikte konunun öneminin farkında olduklarını ifade etmişlerdir. Karşılaşılan KBRN vakalarında % 39,9 (n=174) oranlı kimyasal maddeleri, % 12,4 (n=54) oranıyla tehlikeli/patlayıcı maddeler izlemektedir. Ankete katılan acil tıp çalışanlarının % 61.8'i (n=268) KBRN konusunda klinisyenlere yönelik KBRN eğitimi almadığını belirtmiştir. Eğitim alanların %88.3'ü (n=145) teorik düzeyde temel tıbbi KBRN eğitimi almıştır. KBRN tatbikatıyla ilgili bilgisi olmayanlar ve yapılan tatbikata katılmayanların toplamı % 87.6 (n=382)'dir. Katılımcıların sadece % 12.4'ü (n=54) hastane içi veya acil servis bünyesinde KBRN tatbikatına iştirak etmiştir. Anketimizi cevaplayanların %13,4'ü (n=60) hastane içi KBRN hazırlığına yönelik koordine birimiyle aktif irtibatlı olduğunu ifade etmiştir. Acil servise gelecek bir KBRN vakasında görev çerçevesi belirlenmemiş kişi sayısı % 81 (n= 353), muhtemel bir KBRN olayında uygulanması gereken prosedürlere yönelik bilgisi bulunmayan çalışan sayısı ise % 77,3'lük (n=337) orana tekabül etmektedir. Şüpheli bir KBRN olayında kişisel koruyucu ekipman giyebilecek durumda olan (mevcudiyetini ve yerini bilen) acil tıp çalışanının % 33,7 (n=147) oranında olduğu görülmüştür. Hastanede/Acil serviste KBRN vakaları için tanı ve teşhis ekipmanlarının mevcut olduğunu ifade edenler % 13,5 (n=59) oranındadır. Kamu tarafından (AFAD, YÖK, Sağlık Bakanlığı) hastaneye/acil servise KBRN hizmet desteği (eğitim, eğitim materyali, tatbikat desteği vb. fon ) sağlandığını beyan eden acil servis klinik şefleri sayısı % 7,1 (n=8)'dir. KBRN Olay Yönetim Sistemi açısından il çapında hastanenin rolünün belirlenmiş olduğu ve ilgili KBRN hizmet yürütücüsü kurumlarla protokolün mevcut olduğunu ifade eden acil servis klinik şeflerinin oranı % 17,2 (n=20)'dir. KBRN kaza ve olayları, hazırlık gerektiren ve ciddiye alınması gereken tehditlerdir. KBRN hazırlığının öneminin bilincindeki acil tıp çalışanları eğitim ve tatbikatla desteklenmeli, acil servislere KBRN kapasitesine yönelik fon sağlanmalı, ekipman ve tesbit cihazlarıyla desteklenmeli, kurum içi ve kurumlararası KBRN koordinasyonun artırılmalıdır.Publication Open Access Farklı Kalınlıktaki Okluzal Splintlerin Temporomandibbular Eklem Üzerine Oluşturduğu Stres Dağılımının Araştırılması / The investigation of the stress distribution of the occlusal splints of different thickness on the temporomandibular joint(Bezmialem Vakıf University, 2019) Erdem, Ahmet; Kütük, NükhetTMJ disorders (TMD) are a common group of patients with chronic pain and reduced quality of life. TMDs can be caused by abnormal stresses from insertion and one of the main methods used in the treatment is occlusal splints. In the published studies, varying thickness splints were used. The aim of this study is to compare the stresses of 3 and 6 mm thick splints on TME with finite element analysis (FEA) and to determine the ideal occlusal splint thickness. TME model was obtained by using computed tomography (CT) data from a patient with skeletal and dental class 1 occlusion. A disc displacement model has been formed by taking the TME disc into the anterior position. Using this model, 3 different models were obtained with occlusal splints with 3 and 6 mm vertical thickness and a model with no occlusal splint. The loading conditions were determined by assigning anatomical muscle strength and vectors on these models in computer environment. In all models, the intensity of stress on the TMJ disc is concentrated on the lateral side between the anterior and middle bands of the disc. In models with occlusal splint, the stress intensity on the disc is spread towards the middle band and the amount is decreased. In all models, the stress density in the condyle head and fossa is concentrated on the surfaces corresponding to the anterior and middle band of the TMJ disc. In the occlusal splint models, the density and amount of stress decreased in the condyle and fossa. Compared to the stress of all components of TMJ, a 6 mm occlusal splint was used, which resulted in less stress intensity than a 3 mm occlusal splint. The use of occlusal splints in the treatment of TMDs reduces stress in TMJ. The use of occlusal splints in increasing vertical thickness may be more useful in reducing stresses occurring in TMJ. Clinical studies to determine the appropriate vertical thickness of occlusal splints to be used in TMD patients based on evidence; should be supported by biomechanics and FEA studies.Publication Open Access Türkiye’de 2015-2018 Yılları Arasında Gerçekleştirilen Bazı Kitlesel Toplanma Etkinliklerindeki Acil Sağlık Hizmetlerinin Değerlendirilmesi / Evaluation of emergency medical services performed in some mass gathering events in Turkey between the years 2015-2018(Bezmialem Vakıf University, 2019) Koçak, Hüseyin; Tuncay, İbrahimDünya Sağlık Örgütü'ne göre kitlesel toplanmalar toplumun acil durum planı ve müdahale kaynaklarının sınırlarının zorlandığı veya aştığı miktarda insanın önceden planlı ya da planlanmamış bir şekilde bir araya gelmesi olarak tanımlanmaktadır. KT'lerde acil sağlık hizmetleri afet tıbbının önemli çalışma alanlarından biridir. Araştırmanın amacı, Türkiye'de 2015-2018 yılları arasında gerçekleştirilen bazı kitlesel toplanmalardaki acil sağlık hizmetlerinde vakalarda görülen travma ön tanıları ile etkinlik türü ve sıcaklık değişkenleri arasındaki ilişkiyi değerlendirmektir. Araştırma tanımlayıcı tipte epidemiyolojik bir çalışmadır. Araştırmanın evrenini 2015-2018 yılları arasında Türkiye'de gerçekleştirilen Çanakkale Kara Savaşlarını Anma Etkinlikleri (ÇKSAE), Zeytinli Rock Festivali (ZRF), İşitme Engelliler Yaz Olimpiyatları (DEAFOLIMPICS) ve Kış Avrupa Gençlik Olimpik Festivali (EYOF) organizasyonlarındaki 112 acil sağlık hizmetleri (ambulans) kayıtları oluşturmaktadır. Veriler Sağlık Bakanlığı Acil Sağlık Otomasyon Sisteminden alınmıştır. Araştırma kapsamında 474 acil sağlık hizmetleri vakası incelenmiştir. Araştırmada vakaların %49,5'i (n=235) DEAFOLIMPICS'de gerçekleşmiştir. Vakaların %57,6'sı (n=273) erkektir. Vakaların yaş ortalaması 30,3±16,5 (Min:0, Max:92)'dır. Yaş gruplarına göre vakaların %57,6'sı 18-34 yaş aralığındadır. Vakaların %22,6'sı (n=107) olimpiyat köyünde (yurtta) gerçekleşmiştir. En çok vaka 12:00-17:59 saat aralığında gerçekleşmiştir (%34,0, n=161). Vakaların %57,4'ü (n=272) medikal nedenle gerçekleşmiştir. Triaj kodlarına göre vakaların %57,7'si (n=153) yeşil kod, %32,3'ü (n=153) kırmızı kod, %15,8'i (n=75) sarı kodtur. Vaka sonuçlarına göre incelendiğinde %54,0'ı (n=256) hastaneye nakil, %20,7'si (n=98) yerinde müdahale, %14,1'i nakil reddi şeklindedir. Hasta ve yaralıların nakledildikleri hastanelerin %66,4'ü (n=176) üniversite veya eğitim araştırma hastanesidir. Vakaların sistolik kan basıncı ortalaması 118 mmhg (min:60, Max:220) diastolik kan basıncı ortalaması 73 mmhg (min:40 , max:120 ), ortalama nabız sayısı 86/dk (min:56, max:140), kan şekeri ölçüm ortalaması 118 mg/dl (min:54 , max:355)'dir. EKG ile görüntüleme işlemi ZRF'deki vakaların %15,0'ında (n=16), DEAFOLIMPICS'de vakaların %13,6'sında (n=32), EYOF'daki vakaların %13,3'ünde (n=8) ve ÇKSAE'deki vakaların %11,1'inde (n=8) gerçekleştirilmiştir. Vakalara konulan ön tanıların %36,3'ü (n=172) travma nedenli vakalar oluşturmaktadır. ÇKSAE'de Hasta Başvuru Hızı (PPR: Patient Presentation Rate) 1.3, Hasta Nakil Hızı (TTHR: Transportation To Hospital Rate) 0.7; DEAFOLIMPICS'de PPR 18.1, TTHR 13.3; EYOF'da PPR 7.5, TTHR 5.1; ZRF'de PPR 0.3, TTHR 0.2 olarak bulunmuştur. KT türüne göre travma vakaları incelendiğinde DEAFOLIMPICS'te meydana gelen travma vakaları ÇKSAE, ZRF ve EYOF'daki travma vakalarına göre istatistiksel açıdan anlamlı olarak fazladır (p<0,05). Sonuç olarak lojistik regresyon modellemesinde travma vakalarını geçirme durumu erkeklerin kadınlara göre 1.6 kat (p<0,05), EYOF etkinliğinde ÇKSAE etkinliğine katılanlara göre 9.5 kat daha fazla bulunmuştur (p<0,05).
- «
- 1 (current)
- 2
- 3
- »