Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics

Editors

2010-02-01

Disappointment and science: it's mother nature's way of saying “try again”

Craig S. Miller — 2010-02-01

Disappointment comes in many forms and is a common part of science, grant writing, and publishing. Just the other day, I had a colleague tell me he was disappointed with the results he recently obtained. He expected a correlation between 2 variables, and this was not observed. We chatted for a while and came to the conclusion that other correlations may be present, and he set off investigating those possibilities. Sure enough, when a different perspective was taken, new options appeared.

The supraperiosteal route of dexamethasone should be considered for dental surgery

Seza Apiliogullari, Gülsün Yıldırım, Hanife Ataoglu — 2009-11-05

We read the interesting paper by Kim et al. that addresses the use of corticosteroids after third molar surgery. It provides practitioners helpful, quick, and reliable information regarding patients undergoing third molar surgery. Unfortunately, we could not find any data about the supraperiosteal use of dexamethasone that was described previously for dental surgery. Because glucocorticosteroids must be present at the site of inflammation to exert their antiinflammatory effect, infiltration into the buccal vestibule appears to be an effective way of administration for dexamethasone with several advantages. On the basis of this article, there is no consensus on the best way of administration and the most effective dose of dexamethasone. The supraperiosteal route should also be considered when future trials are designed to assess the optimum dose and route of administration of corticosteroids.

The supraperiosteal route of dexamethasone should be considered for dental surgery

King Kim, Eustorgio Lopez — 2010-02-01

We think it is a very interesting thought to inject dexamethasone directly into an intraoral wound in the attempt to create an antiinflammatory effect on the tissues. Three studies that evaluate supraperiosteal injections around a tooth to compare the efficacy of this technique versus placebo injections are presented by the contributor. Although antiinflammatory effects were achieved in all 3 studies compared with placebo, none of the studies demonstrated superiority of this technique over systemic administration of dexamethasone intravenously or intramuscularly.

Short-term high-dose oral prednisone on alternate days is safe and effective for treatment of infantile hemangiomas

Qin Zhou, Xiu Juan Yang, Jia Wei Zheng, Yan An Wang, Zhi Yuan Zhang — 2010-02-01

Hemangioma is the most common benign tumor of infancy, and 60% occur in the head and neck region. It is characterized by proliferation in the first year of life usually followed by spontaneous regression thereafter. Management of hemangiomas remains controversial because at least 60% of lesions will involute without cosmetic sequelae. Consequently, hemangiomas generally do not require treatment unless proliferation interferes with normal function or gives rise to risk of serious disfigurement and complications unlikely to resolve without treatment. Many methods are currently available, including surgery, cryotherapy, laser, and drug therapy. Short-term high-dose oral corticosteroids remain the current mainstay of therapy for infantile hemangiomas, with an efficacy rate of approximately 86%. Between December 2005 and November 2008, we treated 23 children with problematic hemangiomas with short-term high-dose oral prednisone on alternate days at our institution.

Hereditary angioedema: treatment, management, and precautions in patients presenting for dental care

Nicholas J. Van Sickels, Robert B. Hunsaker, Joseph E. Van Sickels — 2010-02-01

Hereditary angioedema (HAE) is a nonhistamine-mediated process causing edema of the tissues of the upper airway, dermis, and subcutaneous tissue. As such it does not respond well to epinephrine, antihistamines, or glucocorticoids. Instead it is treated with attenuated androgenic hormones, episolone aminocaproic acid (EACA), or tranexamic acid, C1 esterase inhibitor, and fresh-frozen plasma. Medical or surgical management of the airway may be necessary in an acute situation. Minor trauma, such as that associated with dental procedures and psychologic stress, may precipitate an attack; however, swelling may not manifest itself for 12-48 hours after a procedure. Symptoms of angioedema may be exacerbated in these patients if they are given an angiotensin-converting enzyme inhibitor. This paper reviews this entity and presents 2 patients who presented for acute care with dental/oral surgical complaints.

Radiation effects on bone healing and reconstruction: interpretation of the literature

Franck Jegoux, Olivier Malard, E. Goyenvalle, E. Aguado, G. Daculsi — 2010-02-01

Objective: Reconstructing irradiated mandibles with biomaterials is still a challenge but little investigated. We collected data that could help us understand studies in the field of regeneration with biomaterials and irradiated bone.Study design: Systematic review of the literature.Results: Delay and duration of radiation delivery and total equivalent dose are the most variable parameters in the various studies, resulting in confusion when interpreting the literature. Most reproducible experiments show that radiation reduces osteogenic cell numbers, alters cytokine capacity, and delays and damages bone remodeling. Interindividual variations and how such changes become irreversible lesions are still uncertain. In the case of regeneration using biomaterials, most studies have addressed the question of reconstruction in previously irradiated bone. The results show that osseointegration is often possible, although the failure rate is higher. The sooner the implantation takes place after the end of the radiation, the higher the likelihood of failure. Few studies have focused on primary reconstruction followed by early irradiation, and most of the currently available engineering models would be altered by radiation. Good outcomes have been obtained with bone morphogenetic protein and with total bone marrow transplanation.Conclusion: This review points out the difficulties in achieving reproducible experiments and interpreting literature in this underinvestigated field.

The levels of vascular endothelial growth factor in the synovial fluid correlated with the severity of arthroscopically observed synovitis and clinical outcome after temporomandibular joint irrigation in patients with chronic closed lock

2009-12-25

Objective: This study aimed to investigate the level of vascular endothelial growth factor (VEGF) in the temporomandibular joint (TMJ) synovial fluid (SF) and the severity of arthroscopically observed synovitis before and after visually guided TMJ irrigation (VGIR) in patients with chronic closed lock (CCL). In addition, the findings were correlated with the clinical outcome.Study design: Twenty-four patients with unilateral CCL, who underwent a second VGIR either as a repeated therapeutic TMJ irrigation or as a follow-up arthroscopy, were enrolled in the study. They were divided into either successful (s-group; n = 11) and unsuccessful (u-group; n = 13) groups. The VEGF level in the aspirated SF and the severity of synovitis were compared between the s- and u-groups. In each group, the same parameters were compared before and after VGIR. The correlation of the VEGF level with the severity of synovitis was also studied.Results: At the first VGIR, the VEGF levels showed no significant differences when comparing s- and u-groups. At the second VGIR, the VEGF level was significantly higher in the u-group. The VEGF level significantly decreased after the first VGIR in the s-group but remained unchanged in the u-group. There was no significant correlation between the VEGF level and the severity of synovitis.Conclusions: The level of VEGF in TMJ SF seems to reflect the clinical status in patients with CCL. Moreover, VEGF may be an important target molecule in future chemotherapy of TMJ CCL.

Effects of surgically assisted rapid maxillary expansion on nasal dimensions using acoustic rhinometry

2009-12-07

Objective: The objective of this study was to evaluate the effects of surgically assisted rapid maxillary expansion (SARME) on nasal dimensions using acoustic rhinometry.Study design: Twenty-seven patients ranging in age from 18 to 53 years were evaluated as having a maxillary transverse deficiency larger than 7 mm, a bilateral cross-bite, and no evidence of nasal obstruction. All patients underwent evaluation of the nasal cavity by acoustic rhinometry both before and 6 months after SARME. The Wilcoxon test was used to evaluate minor cross-sectional areas (MCA) and the nasal volume of the right and left nasal cavities, and these parameters were measured with and without the application of topical nasal decongestant before and after SARME.Results: In comparison with preoperative measurements, minor cross-sectional areas and nasal volumes were significantly larger after SARME. There was a statistically significant difference associated with the use of nasal decongestant; the minor cross-sectional areas and nasal volume of the right and left nasal cavities were smaller when nasal decongestants were not used.Conclusions: Surgically assisted rapid maxillary expansion increases the minor cross-sectional areas and volume of the nasal cavities. Acoustic rhinometry is an objective method for evaluating the geometry of the nasal cavity in patients with transverse maxillary deficiency.

Correction of square jaw with low angles using mandibular “V-line” ostectomy combined with outer cortex ostectomy

Yu-chun Hsu, Jihua Li, Jing Hu, En Luo, Melvin S. Hsu, Songsong Zhu — 2009-12-14

Objective: The objective of this study was to evaluate the feasibility and effectiveness of correction for square jaw with low angle using mandibular “V-line” ostectomy combined with outer cortex ostectomy.Study design: From July 2005 to November 2007, 31 patients who had square faces with low angles were treated with mandibular “V-line” ostectomy combined with mandibular outer cortex ostectomy. All the patients had standard frontal and lateral cephalometric radiographs, panoramic radiographs, and were photographed preoperatively and postoperatively to assess their face contour. The alteration of mandibular angle and width of lower face was observed for 6 to 24 months postoperatively.Results: Postoperative appearance of all 31 cases showed that the width of lower face was reduced expectedly; the gonial angle and the mandibular plane angle were increased effectively. The final aesthetic outcomes were quite satisfactory in all cases for both the surgeons and the patients.Conclusion: A slender oval facial outline as the fashionable aesthetics could be achieved by using mandibular “V-line” ostectomy combined with mandibular outer cortex ostectomy. It might be a feasible and a reasonable surgical procedure for correction of square jaw with low angle.

Autogenous coronoid process pedicled on temporal muscle grafts for reconstruction of the mandible condylar in patients with temporomandibular joint ankylosis

Yiming Liu, Jihua Li, Jing Hu, Songsong Zhu, En Luo, Yuchun Hsu — 2009-12-07

Objective: The aim of this study was to investigate the feasibility of autogenous coronoid process pedicled on temporal muscle grafts (ACPTMG) for reconstruction of the mandible condyle, and to compare the differences in clinical effects with autogenous free coronoid process grafts (AFCPG) in patients with temporomandibular joint (TMJ) ankylosis.Study design: From 2003 to 2005, 48 patients who were diagnosed with uni- or bilateral TMJ ankylosis were randomly divided into 2 groups: group A(24 cases, 28 joints) and group B(24 cases, 30 joints). All patients underwent operations for resection of condyle and surrounding bony masses and simultaneous recreation of the glenoid fossa, which was followed with, for group A, condylar reconstruction using ACPTMG and, for group B, AFCPG, as well as interposition of temporal muscle myofascial flaps or native articular disc. The pre- and postoperative interinsicial opening values and mouth-opening deviation were measured, and decrease in height of mandible ramus was analyzed by panoramic radiographs.Results: All patients showed apparent improved joint function except 1 patient of group B, who showed signs of reankylosis of the joint (<20 mm mouth opening). Radiographic examination and 3-dimensional computerized tomography both showed the grafts to be well attached to the ramus in their original positions and adaptive remodeling in both groups, but relatively more evident bony resorption was noted in group B. The mean measurement of mouth-opening deviation and postoperative decrease in height of mandible ramus in group B were significantly higher than in group A.Conclusions: Satisfactory clinical outcomes show that both ACPTMG and AFCPG seem to be alternative and promising methods in the treatment of TMJ bony ankylosis. Compared with AFCPG, the advantages of ACPTMG include less bony resorption and better long-term clinical outcomes.

Nasopharyngeal teratoma associated with cleft palate in newborn: report of 2 cases

Jie He, Yanan Wang, Hanguang Zhu, Weiliu Qiu, Yue He — 2009-12-07

Teratoma is a true neoplasm that consists of tissues from all 3 embryonic germ layers: ectoderm, mesoderm, and endoderm. Nasopharyngeal teratoma is very rare and accounts for only 2% of all teratomas. We present 2 cases of nasopharyngeal teratomas associated with cleft palate in newborns. The first case was a mushroom-like teratoma arising from the base of the sphenoid bone with cleft soft palate. This case was unique and interesting because no earlier paper has reported a teratoma with such a clinical feature. The second case was a teratoma from the nasal septum of an incomplete cleft palate. The combination of the mass and cleft palate made oral feeding difficult. Complete intraoral resection was performed in both cases. Typical components of true teratoma were identified by microscopic examination after operation. Cleft palate reconstruction was performed before 1 year. Clinical follow-up continues, and no recurrence has been observed to date.

Effect of titanium implant surface nanoroughness and calcium phosphate low impregnation on bone cell activity in vitro

2009-12-25

Background and objective: In the field of bone implant surfaces, the effects of nanoscale modifications have received significant attention. In the present study, bone cell activity on 2 implant surfaces with similar microtopography but distinct chemistry and nanotopography (sandblasted/acid-etched surface as control group, and calcium phosphate (CaP) low impregnated surface (Ossean) as test group, both from Intra-Lock, Boca Raton, FL) were evaluated.Study design: The 2 surfaces were characterized by X-ray photoelectronic spectroscopy (XPS) and scanning electron microscopy (SEM) up to ×200,000 magnification. The micrometer level roughness profiles were evaluated by means of computer software. Cell adhesion, proliferation, and alkaline phosphatase activity were assessed with human SaOS-2 osteoblasts and bone mesenchymal stem cells in nonosteogenic culture conditions.Results: The XPS and SEM results showed that the Ossean surface presented low levels of CaP impregnation within the titanium oxide layer and texturization at the nanometer scale (nanoroughness) compared with the control surface. Moreover Ossean surface induced significantly higher cell differentiation levels than the control (P < .01).Conclusion: This study showed that both homogeneous nanoroughness and CaP low impregnation differently affected in vitro bone cell behavior compared with the control moderately rough surface with less texturing in the nanometer scale. However, the relative importance of nanotopography and surface chemistry in cell reactions is yet to be determined.

Effectable application of vascular endothelial growth factor to critical sized rat calvaria defects

2009-12-25

Objective: An early vascular response for angiogenesis is essential for the normal progression of bone defect healing. Vascular endothelial growth factor (VEGF) is a potent inducer of angiogenesis. The aim of this study was to evaluate the effects of a poly (L,D-lactic-co-glycolic acid) (PLGA) membrane with VEGF encapsulated into PLGA microspheres on bone regeneration at bone defects in rat calvaria.Study Design: Microspheres of PLGA incorporating VEGF165 (VEGF microspheres) were prepared, and critical-size bone defects were created in rat calvaria. The VEGF microspheres, PLGA microspheres, or VEGF microspheres plus PLGA membrane were applied to the defects. Bone regeneration was evaluated using image analysis based on soft radiographic and histologic examination.Results: Mature thick bone regeneration was observed in selected sites at bone defects that had been applied with VEGF microspheres/PLGA membrane compared with those that had been applied with the other treatments.Conclusion: A combination of VEGF microspheres and a PLGA membrane effectively enhances bone regeneration.

Dental implants placed into alveolar clefts reconstructed with tongue flaps and bone grafts

George K.B. Sándor, Robert P. Carmichael, Bozidar M.B. Brkovic — 2009-12-25

Objective: The aim of this study was to describe a case series using surgical and prosthodontic modifications of tongue flaps necessary to adapt them for use in the reconstruction of large cleft deformities refractory to customary measures using dental implants and to study their outcomes in patients with complex cleft lip and palate deformities.Study Design: Five patients were treated with iliac crest bone grafts and covered by anteriorly based tongue flaps divided at either 3 or 4 weeks after surgery. The patients were followed clinically and radiographically for 3-12 years after placement of their dental implants to monitor implant survival and success.Results: One of the 5 patients suffered a partial tongue flap detachment, graft dehiscence, and recurrence of an oronasal fistula, which was successfully treated by shifting the tongue flap tissue from its new location in the palate. A total of 18 dental implants were placed into bone-grafted tissue covered by the tongue flaps. There was 1 implant failure. There were no cases of periimplantitis or bone loss in the 17 surviving implants.Conclusions: Tongue flaps are rarely used clinical entities with a very narrow range of indications. Tongue flaps are useful in the preprosthetic reconstruction of select cases with large residual oronasal fistulae with soft tissue deficits due to scarring from previously failed surgery. Tongue flaps are extremely stressful procedures for patients to endure. Patient selection is of the utmost importance.

Access to the maxillary sinus using a bone flap with sinus mucosal and mucoperiosteal pedicles

Shinya Yura, Takumi Kato, Kazuhuro Ooi, Yuri Izumiyama — 2009-12-25

We describe a procedure for removing lesions in the maxillary sinus using bone flaps with the sinus mucosa and mucoperiosteum. The surgical design is to construct a rectangular trapdoor using 3 consecutive bur-cuts, fracture the upper margin, and lift the bone lid upward. The osteotomy site on the inferior, medial, and lateral sides of the bone lid was exposed subperiosteally, but the mucoperiosteal and sinus mucosal attachments on the superior and central areas of the lid were maintained. Then, following fracture of the upper bone margin, the lid was lifted upward. In this way, the integrity of the mucoperiosteum and sinus mucosa was maintained. Advantages of the bone flap with soft tissue pedicles technique may be quick recovery and restored integrity of the sinus wall, with a low probability of infection because of vascularization of the bone lid. To realize this, a bone flap with both sinus mucosal and mucoperiosteal pedicles is more suitable.

Onlay iliac bone grafting as an ancillary augmentation procedure for paranasal rejuvenation during bimaxillary surgery

Fidan Sabuncuoglu, Altan Varol, Metin Şençimen, Hüseyin Ölmez — 2010-02-01

Objective: The aim of this paper is to present the outcome of iliac bone block grafts used for paranasal augmentation during bimaxillary orthognathic surgery for the patient with deep concavity of canine fosse.Study design: Preoperative evaluation of the patient, done with 3-dimensional (3D) surgical simulation software, revealed deep bony concavity of paranasal area and insufficient soft tissue improvement when Le Fort I level maxillary advancement was accomplished. The deficient sites were grafted and better profile was achieved with 3D simulation. After the leveling phase, Le Fort I advancement and mandibular setback with sagital split osteotomies were performed. Bony deficiency of paranasal regions were corrected simultaneously with autogenous iliac block grafts to obtain maximum improvement in the profile.Results: More satisfactory esthetic results were obtained with paranasal augmentation, and acceptable profile was provided for the patient.Conclusions: Bimaxillary orthognathic surgery combined with augmentation of paranasal area is an efficient method to obtain better aesthetic outcome for patients with severe concave profile. Paranasal augmentation with iliac bone block grafting is a novel technique to ensure favorable soft tissue support and esthetic appearance of the patient.

Use of autologous fat graft for correction of facial asymmetry stemming from Parry-Romberg syndrome

2009-12-07

Facial hemiatrophy is a typical manifestation of Parry-Romberg syndrome, characterized by a slow progressive atrophy that appears in early stages of life, primarily affecting the subcutaneous tissue and subjacent fat on 1 side of the face. We describe the case of a 42-year-old female patient with stabilized moderate facial hemiatrophy on the left side of the face, successfully treated with a 2-stage autologous fat transplant and the use of subcutaneous tunnels among the musculature for the placement of the graft. We also describe the principal forms of correcting facial asymmetry in patients with Parry-Romberg syndrome and demonstrate that an autologous fat graft provides good results in the correction of this deformity, with improved esthetics and patient satisfaction.

Comparison of genioplasty using Medpor and osteotomy

Jung-Yeop Park, Su-Gwan Kim, Sung-Mun Baik, Seo-Yoon Kim — 2010-02-01

Objective: This retrospective study compared genioplasty using Medpor with osteotomy by measuring the amount of anteroposterior change in hard and soft tissue.Study design: Thirty-three patients who underwent mentum augmentation and who were followed-up >6 months were included. Subjects were divided into 2 groups: group A, with 14 patients who underwent genioplasty using osteotomy; and group B, with 19 patients who underwent genioplasty using Medpor. Patients chose one of the treatments themselves.Results: The mean relapse rate of the most prominent or anterior point on the chin in the midsagittal plane of patients who went underwent osteotomy was 18.59%, and the mean relapse rate of patients who went underwent genioplasty with Medpor was 14.56%.Conclusions: It was found that the amount of the movement at the time of surgery when checked after surgery did not change in patients who underwent genioplasty using Medpor compared with patients who underwent genioplasty using osteotomy.

A primary leiomyosarcoma of the lateral border of the tongue

Carlos Alberto S. Pires, Luis Fernando S. Pires, Pérsio A. Faber — 2010-02-01

Soft tissue sarcomas are rare malignant neoplasms (about 1% of all malignances). The leiomyosarcoma of the tongue is a very rare tumor with only 9 cases described in the literature. This article describes a case report of a primary leiomyosarcoma of the lateral border of the tongue treated with local excision that has been free of recurrence for 4 years. Also described in this article is a new technique to stabilize the tongue during surgery.

Effect of Tisseel on bone healing with particulate dentin and plaster of Paris mixture

Wan-Bae Kim, Su-Gwan Kim, Sung-Chul Lim, Young-Kyun Kim, Si-Nae Park — 2009-12-25

Objectives: The purpose of this study was to evaluate the effect of Tisseel on the early healing of bone defects in the skulls of rats.Study design: Forty-eight rats were randomly assigned to 4 groups, and each group was further divided into 3 subgroups which were examined at 4 and 8 weeks after the defects were filled. The 4 different groups were animals containing: no graft (group 1); particulate dentin and plaster of Paris mixture graft (group 2); Tisseel and particulate dentin and plaster of Paris mixture graft (group 3); and Tisseel graft (group 4). After killing the animals at 4 and 8 weeks after surgery, all implant blocks were prepared for histologic sections and histomorphometric analysis.Results: The overall new bone formation was significantly different between the 4-week samples and the 8-week samples. Significant differences between groups 1 and 2, groups 1 and 3, groups 1 and 4, groups 2 and 4, and groups 3 and 4 were observed at 4 weeks after surgery. At 8 weeks after surgery, significant differences between groups 1 and 2, groups 1 and 3, groups 1 and 4, and groups 2 and 4 were observed. As expected, effective bone formation was observed when the defects were filled with either particulate dentin, Tisseel, or particulate dentin–Tisseel combination. It was also observed from this study that particulate dentin is especially effective, followed by the particulate dentin–Tisseel combination and Tisseel.Conclusion: It was concluded that the use of Tisseel may be an alternative therapy for regenerating bone in defects when used in combination with particulate dentin.

Low prevalence of varicella zoster virus and herpes simplex virus type 2 in saliva from human immunodeficiency virus–infected persons in the era of highly active antiretroviral therapy

2010-02-01

Objectives: Human herpesviruses, e.g., herpes simplex virus (HSV) type 1, Epstein-Barr virus, and cytomegalovirus, appear in saliva at greater frequency in persons infected with human immunodeficiency virus (HIV) than in healthy individuals. However, it is not known if varicella zoster virus (VZV) and HSV-2 appear simultaneously during HIV infection at greater frequency in saliva in this era of highly active antiretroviral therapy (HAART). The aim of this study was to investigate the prevalence and amounts of VZV and HSV-2 in the saliva of HIV-infected orally asymptomatic patients.Study design: Quantitative polymerase chain reaction was used to investigate the prevalence, quantity, risk, and correlations of salivary VZV and HSV-2 from 59 HIV-seropositive individuals and 53 healthy control subjects in a case-control cross-sectional study. Seventy-eight percent of the HIV-seropositive patients (46 out of 59) were taking HAART.Results: VZV DNA was detected in the saliva of 5.1% (3 out of 59) of the HIV-positive group and in only 1 healthy control 1.9% (1 out of 53; P = .62). The amount of VZV DNA in the expressors was low, generally <1,100 copies/mL, with no observed difference between the HIV-positive group and the control subjects (P = 1.0). HSV-2 DNA was not detected in either group. In the HIV-infected group, VZV shedding occurred in those on HAART, but was not associated with oral lesions, specific CD4+ or CD8+ T-cell levels, or demographic factors.Conclusions: Varicella zoster virus was detected at low prevalence in the saliva of HIV-infected persons, whereas HSV-2 was not detected in the saliva of this cohort. HAART does not appear to diminish the risk for asymptomatic VZV shedding.

Management of massive osteolysis of the mandible: a case report

Antonio Chi Kit Tong, Tat Ming Leung, Pik To Cheung — 2009-12-25

The management of a previously reported case of massive osteolysis of the mandible with intravenous bisphosphonate, vascularized free bone graft, and dental implants is reported. Restoration of adequate cosmetics and masticatory function was achieved. Despite the use of bisphosphonates, there were no complications with osseointegration. The reconstruction remained stable and functional 6 years afterward.

Commentary: massive osteolysis or Gorham-Stout disease

Cesar A. Migliorati — 2010-02-01

In this issue of the Journal, three interesting case reports, one in the print version and two online, discuss a rare condition characterized by a massive and progressive loss of bone. Although rare, this disease is recognized by several names, including disappearing bone disease (phantom bone), Gorham syndrome, Gorham-Stout syndrome, Idiopathic massive osteolysis, massive Gorham osteolysis, massive osteolysis, Morbus Gorham-Stout disease, progressive massive osteolysis, vanishing bone disease, and essential osteolysis. This bone resorption abnormality can affect different sites of the skeleton and in some instances the head and neck region, as described in these 3 cases. Gorham-Stout disease (GSD) is characterized by massive bone loss, which can affect different skeletal sites, and excessive intraosseous proliferation of small blood or lymphatic vessels, resulting in resorption and destruction of bone. The case reports and literature review update the reader in the various aspects that involve this rare condition, including the fact that the condition is often diagnosed by exclusion and late.

Occurrence and regional distribution of TRAIL and DR5 on temporomandibular joint discs: comparison of disc derangement with and without reduction

Rosalia Leonardi, Luis Eduardo Almeida, Paula C. Trevilatto, Carla Loreto — 2010-02-01

Background: Tumor necrosis factor (TNF)–related apoptosis-inducing ligand (TRAIL) is an apoptosis-inducing member of the TNF gene family which triggers apoptotic signals by interaction with its receptors. It has been suggested to be a major contributing factor to tissue degeneration.Objective: The present study investigated, through immunohistochemistry, the regional expression of TRAIL and in temporomandibular joint (TMJ) disc of anterior disc displacement with reduction (ADDwR) and without reduction (ADDwoR) patients, to help determine the relationship between TMJ disc displacement and apoptosis.Study design: We studied 18 TMJ diseased discs affected by disc displacement without or with reduction and 4 normal TMJ discs. Specimens were processed for immunohistochemistry to evaluate TRAIL and its receptor DR5 expression.Results: Disc tissues from internal derangements (both ADDwR and ADDwoR) exhibited a much higher percentage of TRAIL- and DR5-positive cells as well as stain intensity compared with normal tissue though with regional variation according to the portion of the disc. There was a significantly higher percentage of stained cells in the posterior disc attachment compared with the anterior or intermediate bands of both ADDwR and ADDwoR discs for TRAIL and DR5.Conclusions: TRAIL and DR5 are overexpressed in displaced human TMJ disc, especially in the posterior disc attachment. These results suggest a possible pivotal role of the TRAIL/DR5 system in TMJ disc degeneration.

Oral Candida flora in a group of Jordanian patients with β-thalassemia major

A.M. Hazza'a, Azmi M.G. Darwazeh, Omar S.M. Museedi — 2010-02-01

Objective: Thalassemic patients present with multiple immune abnormalities that may predispose them to oral Candida, however this has not been investigated. The aim of this study was to assess oral candidal colonization in a group of patients with β-thalassemia major both qualitatively and quantitatively.Study design: The oral mycologic flora of 50 β-thalassemia major patients and 50 age- and sex-matched control subjects was assessed using the concentrated oral rinse technique. Candida species were identified using the germ tube test and the Vitek yeast identification system.Results: Oral Candida was isolated from 37 patients (74%) and 28 healthy subjects (56%; P = .04). The mean candidal count was significantly higher in thalassemic patients compared with the healthy group (P < .05) and in patients who had surgical splenectomy compared with nonsplenectomized patients (P = .04).Conclusion: Oral Candida colonization and candidal counts are significantly higher in β-thalseemia major patients than in healthy subjects. Surgical splenectomy may increase the quantity of colonizing oral candidal organisms in thalassemic patients.

Gorham-Stout syndrome: a rare clinical entity and review of literature

Shailesh M. Gondivkar, Amol R. Gadbail — 2009-12-07

Gorham-Stout syndrome is a very rare bone condition of unknown etiology. It is characterized by the spontaneous onset of bone resorption. Bones that previously appeared normal begin to resorb, partially or completely. Sometimes only a thin shell of cortical bone remains, and there is usually a little replacement by fibrous tissue. This process can continue for years but may stop spontaneously. Bone loss can occur in one bone or spread to soft tissue and adjacent bones. Although the disease may strike any of the bones of the body, it is more often recognized earlier when the calvarium and/or the mandible are involved. Because of its rarity, the disorder often goes unrecognized, and lack of agreement on how best to treat Gorham-Stout syndrome can delay the provision of treatment. We report the case of a 58-year-old man whose left body and ramus of mandible had disappeared as a result of massive osteolysis.

Conservative treatment of a pathologic fracture in a patient with Gorham-Stout disease

Fred Pedroletti, Shrinivas Rangarajan, Joseph P. McCain, Ines Velez — 2009-12-25

Gorham-Stout disease, or massive osteolysis, is an extremely rare idiopathic condition characterized by spontaneous, localized relentless resorption of one or several contiguous bones. There is no known successful treatment. Autologous bone graft also resorbs. It is a condition with difficult diagnosis, treatment, and prognosis.We report an extreme case of massive osteolysis of the maxillofacial complex. Unique to this case is that the patient presented with a mandibular fracture, and was taking alendronate (Fosamax), one of the treatment options for patients with Gorham-Stout disease. We discuss our treatment and add to the growing list of patients who have presented with this devastating disease.

Treatment of localized langerhans' cell histiocytosis of the mandible with intralesional steroid injection: report of a case

2010-02-01

Localized Langerhans cell histiocytosis (LLCH), formerly known as eosinophilic granuloma, mainly affects the skull, mandible, vertebrae, and ribs in children and the long bones of adults. Symptoms range from none to pain, swelling, and tenderness over the site of the lesion. General malaise and fever occasionally are present. Radiographically, lesions appear as radiolucent areas with well demarcated borders. LLCH may resolve spontaneously after biopsy in a period of months to years. However, if features include continuous pain, decrease of function, pathologic fractures, migration and resorption of teeth, or rapid progression, then active treatment needs to be considered. Treatment approaches include surgery, radiotherapy, chemotherapy, and intralesional injection of corticosteroids. In children with mandibular LLCH, 1 dose of methyprednisolone succinate injection has proven to be adequate. However, injections have not been performed in cases involving pathologic fracture. We report a new case of LLCH of the mandible that caused a pathologic fracture in an adult patient. Repeated intralesional corticosteroid injections resulted in fracture line disappearance within 14 months and lesion healing by the end of the 36-month follow-up.

Expression of BUBR1 in human oral potentially malignant disorders and squamous cell carcinoma

2009-11-18

Objective: BUBR1 is one of the key components of the spindle assembly checkpoint (SAC) machinery and is activated in response to kinetochore tension. Defects in the SAC contribute to an increased rate of aneuploidization during tumorigenesis. The aim of the present study was to examine the immunohistochemical expression of BUBR1 protein for human oral squamous cell carcinogenesis.Study design: A total of 120 samples of squamous cell carcinoma (SCC, n = 43) and 5 types of potentially malignant disorders (PMDs: oral epithelial dysplasia, n = 11; hyperkeratosis/epithelial hyperplasia, n = 20; lichen planus, n = 16; submucous fibrosis, n = 19; and verrucous hyperplasia, n = 11) of human oral mucosa (1991-2001) from our institution were retrieved and immunohistochemical staining were performed. Normal oral mucosa (n = 9) and fibrous hyperplasia (n = 9) from patients without the aforementioned oral habits were also included in the study.Results: BUBR1 staining was detected at the basal and suprabasal layers in 75 (97.4%) of 77 samples of PMD and 43 (100%) of 43 samples of SCC of oral mucosa but was absent in all samples of normal oral mucosa (n = 9) and fibrous hyperplasia (n = 9). BUBR1 expression of various types of PMD and SCC of oral mucosa was significantly overexpressed as compared respectively with normal mucosa (P < .001) and fibrous hyperplasia (P < .001). Moreover, the expression of oral SCC was significantly higher as compared respectively with the 5 types of oral PMD; on the other hand, BUBR1 expression of verrucous hyperplasia was significantly higher than that of the other 4 types of PMD of oral mucosa (P < .001).Conclusion: Our results may interpret that BUBR1 protein is suggested to be one of the contributing factors involved in the pathogenesis of oral SCC. These also hypothesize that BUBR1 protein is a putative biomarker for human oral squamous cell carcinogenesis.

Papillary synovial metaplasia–like change in oral mucoceles: a rare and previously undescribed histopathologic variant of a common oral lesion

2009-12-07

The development of synovial membrane–like structures has been described previously only in association with breast implants, the bone-cement interface of hip prostheses, tendon implants, testicular implants, and traumatized skin. Previous investigators have theorized that this phenomenon—referred to as “synovial metaplasia”—develops in response to gliding trauma. In some cases, these lesions can exhibit a papillary growth pattern. We report 2 unusual cases of oral mucoceles exhibiting papillary synovial metaplasia–like change: the first arising in the lower lip of an 11-year old African-American boy and the second in the lower lip of a 12-year-old European-American girl. We propose that these cases represent a rare and previously undescribed histopathologic variant of the oral mucocele. These lesions should be distinguished from other oral lesions that may exhibit a papillary cystic growth pattern.

Calcifications in clear cell mucoepidermoid carcinomas

Shaodong Yang, Xinming Chen — 2009-11-02

Information concerning calcifications in clear cell mucoepidermoid carcinoma (MC) of the salivary gland is very scarce, with only 2 earlier reports in the literature. Seven cases of clear cell MC in our institution were reviewed. Unexpectedly, frequent calcifications were confirmed microscopically in 2 cases. This finding suggests that clear cell MC should be considered in the differential diagnosis of salivary gland tumors with calcification.

Multifocal myopericytoma in the maxillofacial region: a case report

Lili Xia, Yu Chen, Ning Geng, Jinyan Jiang, Mingzhong Yang, Weiping Zhang — 2010-02-01

Myopericytoma is a rare mesenchymal neoplasm with perivascular myoid differentiation. Myopericytoma arises most commonly in middle adulthood. The lesion generally involves the distal extremities; however, tumors can also arise at other sites, including the proximal extremities and head and neck. In this case report, a 43-year-old Chinese woman presented with a painless slowly growing nodule in her right cheek. Biopsy revealed a periluminal proliferation of monomorphic oval to spindle-shaped myoid-appearing cells. Immunohistochemistry showed a positive staining for smooth muscle actin. The clinical, pathologic, and immunohistochemical features are discussed. To our knowledge, this is the first case report in the medical literature of multifocal myopericytoma in the maxillofacial region.

Central odontogenic fibroma with features of central granular cell odontogenic tumor

Harinder S. Lotay, John Kalmar, Karel DeLeeuw — 2010-02-01

Much debate exists over the lesions recognized as odontogenic fibromas. In this case report, the authors report 1 lesion that presented with histological features consistent with 2 separate lesions. The findings, histological examination, and recommendations are presented.

Odontogenic tumors in Dakahlia, Egypt: analysis of 82 cases

Mohamed A. Tawfik, Manal M. Zyada — 2009-12-07

Objective: This study was designed to analyze the frequency and distribution of different types of odontogenic tumors in Dakahlia, Egypt, and to compare them with various reports from other parts of the world.Study design: Records of the Oral and Maxillofacial Surgery and Oral Pathology Departments, Faculty of Dentistry, Mansoura University, with histologic diagnosis of odontogenic tumors (based on the World Health Organization classification, 2005), during a 15-year period, were analyzed.Results: A total of 82 cases of odontogenic tumors were reported. Of these, (96.3%) were benign and (3.7%) were malignant. Ameloblastoma (41.5%) was the most frequent type, followed by keratocystic odontogenic tumor (19.5%), odontoma (13.4%), and odontogenic myxoma (8.5%). The mean age of the patients was 29.57 years, with a wide range (4-80 years).Conclusions: Odontogenic tumors show a definite geographic variation. In Dakahlia, Egypt, ameloblastoma and keratocystic odontogenic tumor are the most frequent odontogenic tumors, with distinct anatomic predilections.

Reliability of CBCT and other radiographic methods in preoperative evaluation of lower third molars

2010-02-01

Objectives: The aim of this study was to compare the reliability of cone-beam computerized tomography (CBCT) with that of other radiographic methods in preoperative radiographic determination of the number of roots of lower third molars and their relationship to the inferior alveolar canal (IAC).Study design: Forty-two teeth were clinically studied and imaged using CBCT and other imaging methods—panoramic radiography, multiprojection narrow-beam radiography (MNBR), and cross-sectional tomography. Statistical analysis (kappa values) was used to compare the diagnoses of 2 trained oral radiologists and the radiologic diagnoses with the findings at operation.Results: Cone-beam CT revealed the number of roots of teeth more reliably than panoramic radiographs. CBCT examination was highly reliable in locating the IAC, whereas MNBR was unreliable and cross-sectional tomography fell between the two. With cross-sectional tomography, the IAC was noninterpretable in one-third of the cases.Conclusions: We recommend CBCT examination for preoperative radiographic evaluation of complicated impacted lower third molars.

Comparison of cone-beam CT parameters and sleep questionnaires in sleep apnea patients and control subjects

Reyes Enciso, Manuel Nguyen, Yuko Shigeta, Takumi Ogawa, Glenn T. Clark — 2010-02-01

Objective: The aim of this work was to compare the cone-beam computerized tomography (CBCT) scan measurements between patients with obstructive sleep apnea (OSA) and snorers to develop a prediction model for OSA based on CBCT imaging and the Berlin questionnaire.Study design: Eighty subjects (46 OSA patients with apnea-hypoapnea index [AHI] ≥ 10 and 34 snorers with AHI <10 based on ambulatory somnographic assessment) were recruited through flyers and mail at the University of Southern California School of Dentistry and at a private practice. Each patient answered the Berlin questionnaire, and was imaged with CBCT in supine position. Linear and volumetric measurements of the upper airway were performed by one blinded operator, and multivariate logistic regression analysis was used to identify risk factors for OSA.Results: The OSA patients were predominantly male and older and had a larger neck size and larger body mass index than the snorers. The minimum cross-sectional area of the upper airway and its lateral dimension were significantly smaller in the OSA patients. Airway uniformity defined as the minimum cross-sectional area divided by the average area was significantly smaller in the OSA patients.Conclusions: Age >57 years, male gender, “high risk” on the Berlin questionnaire, and narrow upper airway lateral dimension (<17 mm) were identified as significant risk factors for OSA. The results of this study indicate that 3-dimensional CBCT airway analysis could be used as a tool to assess the presence and severity of OSA. The presence and severity (as measured by the respiratory disturbance index) of OSA is associated with a narrow lateral dimension of the airway, increasing age, male gender, and high-risk Berlin questionnaire.

The prognostic value of panoramic radiography of inferior alveolar nerve damage after mandibular third molar removal: retrospective study of 400 cases

József Szalma, Edina Lempel, Sára Jeges, Gyula Szabó, Lajos Olasz — 2009-10-21

Objective: The aim of the study was to estimate the accuracy of panoramic radiographic signs predicting inferior alveolar nerve (IAN) paresthesia after lower third molar removal.Study design: In a case-control study the sample was composed of 41 cases with postoperative IAN paresthesia and 359 control cases without it. The collected data included “classic” specific signs indicating a close spatial relationship between third molar root and inferior alveolar canal (IAC), root curvatures, and the extent of IAC–root tip overlap. Bivariate and multivariate logistic regression analyses were completed to estimate the association between radiographic findings and IAN paresthesia.Results: The multivariate logistic analysis identified 3 signs significantly associated with IAN paresthesia (P < .001): interruption of the superior cortex of the canal wall, diversion of the canal, and darkening of the root. The sensitivities and specificities ranged from 14.6% to 68.3% and from 85.5% to 96.9%, respectively. The positive predictive values, calculated to factor a 1.1% prevalence of paresthesia, ranged from 3.6% to 10.9%, whereas the negative predictive values >99%.Conclusion: Panoramic radiography is an inadequate screening method for predicting IAN paresthesia after mandibular third molar removal.

Detection of vertical root fracture using cone-beam computerized tomography: an in vitro assessment

2009-12-25

Objectives: This study aimed to compare 2 cone-beam CT units [NewTom 3G (small FOV), Iluma (ultra/low resolution)] and an intraoral CCD sensor in the detection of vertical root fracture (VRF).Study design: The VRFs were created in 30 teeth, and 30 intact teeth served as control samples. All images were evaluated twice by 4 observers. Kappa coefficients were calculated to assess intra- and interobserver agreement, and t tests were used to compare Az values (α = 0.05).Results: Both intra- and interobserver agreement values were higher for the ultra-resolution Iluma and NewTom 3G images compared with the low-resolution Iluma and intraoral CCD images. Az values for the ultra-resolution Iluma and NewTom 3G images were also higher than for the Iluma low-resolution and intraoral CCD images. No significant differences (P > .05) in diagnostic accuracy were found between the Iluma ultra-resolution and NewTom 3G images, with the exception of the second reading of observer 2 (P = .036), and no significant differences (P > .05) were found between the intraoral digital and low-resolution Iluma images.Conclusion: Both ultra-resolution Iluma and NewTom 3G images performed better than low-resolution Iluma and intraoral CCD images in the detection of VRF.

Misleading presentation of an orbital lymphangioma

2009-12-23

We describe a 2-year-old patient with an orbital lymphangioma who presented with massive proptosis. We highlight the importance of magnetic resonance imaging in evaluating such patients, because physical examination can be misleading. We also demonstrate the difficulties of managing recurrent hemorrhages when only subtotal excision is possible, as is frequently the case.

A retrospective analysis of referral patterns for oral radiologic consultation over 3 years in Ontario, Canada

2010-02-01

Objectives: To determine the types of practitioners who most commonly refer and the film type and diagnostic entities that are most frequently submitted for oral radiologic consultation in Ontario, Canada.Study design: A total of 430 referral letters and responses from 2 Ontario oral radiologists from 2003 to 2005 were analyzed. Data collected included the specialty of the referring practitioner, the film type(s) submitted, the radiographic density of the entity of interest, and the interpretation by the radiologist.Results: General practitioners (58.9%) and oral surgeons (21.5%) were the most frequently referring practitioner types, representing 1.2% and 17.1% respectively of each group practicing in Ontario. Also, 18.2% of oral pathologists referred. Panoramic radiographs (79.5%) were included in referrals more often than intraoral radiographs (46.0%). Of the entities, 37.0% were radiopacities, 27.4% were radiolucencies, and 13.5% had mixed radiopaque-radiolucent density. The radiologists interpreted normal features (55.6%) most often.Conclusion: Panoramic radiographs with normal findings were submitted to oral radiologists for consultation most frequently in Ontario.

Nasolabial cyst: case report with CT and MRI findings

A. Pinar Sumer, Peruze Celenk, Mahmut Sumer, N. Tuba Telcioglu, Omer Gunhan — 2009-12-25

Nasolabial cysts are uncommon primarily unilateral soft tissue lesions located adjacent to the alveolar process above the apices of the maxillary incisors. Clinical features of the nasolabial cysts are smooth fluctuant soft tissue swelling between the upper lip and nasal aperture with obliteration of the nasolabial fold and elevation of the nasal ala. A nasolabial cyst is described including its features on CT and MRI exams.

Comparison of cone-beam computerized tomography and intraoral radiographs for determination of the periodontal ligament in a variable phantom

2010-02-01

Objectives: This in vitro study assessed the visualization quality of the periodontal ligament space in cone-beam computerized tomography (CBCT) compared with intraoral radiographs (CR).Study design: A phantom mimicking variable periodontal ligament spaces (0-0.42 mm) was radiographed using CBCT and CR. Fifteen datasets of each modality were randomly mixed and presented twice to 19 experienced examiners and once to 19 inexperienced examiners.Results: Zero-millimeter gaps were recognized in 84.4% of CBCT and in 81.6% of CR images. On CBCT scans, gaps of 0.19 mm were identified with an accuracy of 93%-100% compared with 70.2%-81.7% using CR. Experienced examiners recognized gaps of ≥0.19 mm on CBCT repeatedly with nearly 100% accuracy.Conclusion: Compared with CR, CBCT provides better visualization of simulated periodontal ligament space in this phantom.

High-dose-rate brachytherapy for patients with maxillary gingival carcinoma using a novel customized intraoral mold technique

2010-02-01

Objective: The purpose of this study was to introduce a novel customized intraoral mold treatment for maxillary gingival carcinoma (UGC).Study design: Two patients with UGC were treated as salvage therapy using this technique. The mold was designed to keep normal soft tissues adjacent to the tumor away from the radioactive source as much as possible, and it was shielded by lead. The radiation dose on the buccal mucosa and tongue was measured at the inner and outer surfaces of the intraoral mold before starting high-dose-rate brachytherapy by the remote afterloading system, and was reduced to almost one tenth.Results: The patient had no recurrence and no severe adverse effects on the normal soft tissue adjacent to the tumor until the end of the follow-up period.Conclusion: High-dose-rate brachytherapy using the novel customized intraoral mold might be a treatment option of not only salvage therapy, but definitive therapy of UGC.

Dilated odontome in the mandibular third molar region

2010-02-01

The dilated odontome is the most severe form of the dens invaginatus (dens in dente), which is extremely rare in the mandible, especially in the molar region. A case is reported in a 28-year-old female with an unusual ringlike radiopaque appearance of the mandibular third right molar on panoramic x-ray. CT scan findings were suggestive that the intraosseous circular radiopaque formation was a dilated odontome. The alveotomy of the “tooth” was performed, and histopathological analysis of the inner and surrounding soft tissue revealed a diagnosis consistent with a dilated odontome.

Comparative evaluation of anesthetic efficacy of Gow-Gates mandibular conduction anesthesia, Vazirani-Akinosi technique, buccal-plus-lingual infiltrations, and conventional inferior alveolar nerve anesthesia in patients with irreversible pulpitis

Vivek Aggarwal, Mamta Singla, Debipada Kabi — 2010-02-01

Objective: Conventional inferior alveolar nerve block (IANB) has a poor success rate in inflamed pulps. Three alternative techniques of providing anesthesia to mandibular molars were evaluated and compared with conventional IANB.Study design: Ninety-seven adult volunteer subjects, actively experiencing pain, participated in this prospective, randomized, double-blinded study. Twenty-five patients received Gow-Gates mandibular conduction block anesthesia, 24 patients received “high” Vazirani-Akinosi inferior alveolar nerve block, 26 received only buccal-plus-lingual infiltrations, and 22 patients (control) received conventional IANB anesthesia. Endodontic access preparation was initiated after 15 minutes of anesthesia. Pain during treatment was recorded using a Heft-Parker visual analog scale. Success was recorded for “none” or “mild” pain.Results: Statistical analysis using nonparametric McNemer tests showed that Gow-Gates gave a success rate of 52%, which was statistically higher than control IANB (36%) (P < .05). Vazirani-Akinosi and infiltrations gave 41% and 27% success rates, respectively, with no statistically significant differences from control IANB.Conclusions: Gow-Gates mandibular conduction anesthesia may increase the success rates in patients with irreversible pulpitis compared with conventional IANB. None of the techniques provided acceptable success rates.

Histologic evaluation of the use of membrane, bone graft, and MTA in apical surgery

2010-02-01

The aim of this study was to evaluate the periapical healing after the use of membrane, bone graft, and mineral trioxide aggregate (MTA) in apical surgery of dogs' teeth. Apical lesions were induced in 48 roots of 6 dogs after coronal access and pulpal removal. Apical surgery consisted of osteotomy with trephine bur for the standardization of the critical surgical cavities, followed by apicoectomy, curettage, preparation of the root-end cavities with the aid of the ultrasonic device, and retrofilling with MTA. The surgical sites were divided into: group 1—filled with blood; group 2—filled with blood and recovered with membrane; group 3—filled with bone graft; and group 4—filled with bone graft and recovered with membrane. The results showed that the inflammatory infiltrate, the periapical healing process, and the behavior of MTA was the same in all groups, including the mineralization stimulation. It was concluded that the use of membranes and bone graft materials isolated or associated in apical surgery did not alter the periapical healing process after the root-end filling with MTA.

A decrease in the innate immune response to infection in the presence of root canal sealers

2009-12-07

A healthy root canal system encircles the pulp tissue, which is an organ containing a large number of immune-competent cells. However, the breakdown of this tissue, which occurs frequently upon the occurrence of dental caries or dental trauma, may lead to the colonization of microorganisms in the root canal. The goal of root canal therapy is to prevent or eliminate this infection, followed by the complete obturation of the root canal system, impeding bacterial recolonization of this site. During these procedures, the clinician associates gutta-percha with root canal sealer which enters into contact with the periodontal cells at the root canal's apical foramen. To date, the interference between the contact of immune-competent cells with root canal sealers during the periodontal inflammation or the healing process is a matter of debate.

Iatrogenic pneumomediastinum with extensive subcutaneous emphysema after endodontic treatment: report of 2 cases

Yemi Kim, Myung-Rae Kim, Sun-Jong Kim — 2009-12-07

Pneumomediastinum with subcutaneous emphysema is a relatively rare complication of dental treatment. The most common dental etiology of this complication is the introduction of air via the air-turbine handpiece during surgical extraction of an impacted tooth, but this complication is very rare after nonsurgical endodontic treatment. We report herein 2 cases of massive pneumomediastinum and cervicofacial subcutaneous emphysema that developed after opening an access cavity for endodontic retreatment. We describe its etiologies and guidelines for the prevention of this complication during nonsurgical endodontic treatment.

Biological properties of a neutralized 2.5% sodium hypochlorite solution

2009-12-07

Objectives: The objective of this study was to evaluate the influence of neutralizing a 2.5% NaOCl solution on its cytotoxicity, genotoxicity, and tissue-dissolving potential.Study design: The cytotoxicity and the genotoxicity of Dakin, a 2.5% NaOCl solution, and a neutralized 2.5% NaOCl solution were assessed according to ISO 10993 standards. The weight of palatal mucosa samples placed in neutralized 2.5% NaOCl, 2.5% NaOCl was recorded over time as well as the pH of the solutions.Results: The neutralized 2.5% NaOCl solution was 10-fold more cytotoxic than the 2.5% NaOCl solution. None of the solutions was genotoxic. The 2.5% NaOCl solution had a better tissue-dissolving capacity than the neutralized 2.5% NaOCl solution. The pH of the 2.5% NaOCl solution and neutralized 2.5% NaOCl solution decreased from 12 to 9 and from 7.5 to 5.6, respectively.Conclusion: Neutralizing a 2.5% NaOCl solution increased its cytotoxicity, did not induce any genotoxic effect, and reduced its tissue-dissolving ability.

Management of crown-root fracture tooth by intra-alveolar transplantation with 180-degree rotation and suture fixation

Ming-Pang Chung, Su-Shin Wang, Chih-Ping Chen, Yi-Shing Shieh — 2009-12-07

Teeth with traumatic crown-root fractures extending subgingivally and involving the entire width of the tooth may have problems in endodontic isolation, periodontal maintenance, and restoration. A number of techniques, such as crown lengthening, and orthodontic or surgical extrusion, have been described for treatment of crown-root fractures. However, all of these techniques have limitations in terms of the extended time required for treatment, cost, and esthetic considerations. Intra-alveolar transplantation is an alternative treatment option in the management of complicated crown-root fractures. We describe a case of intra-alveolar transplantation with 180° rotation and suture fixation. At 1-year follow-up, the replanted tooth has normal function and no obvious inflammatory root resorption on radiographic examination.

Comparative analysis of leakage in root canal fillings performed with gutta-percha and Resilon cones with AH Plus and Epiphany sealers

2010-02-01

Objective: The aim of this study was to compare the leakage of root canal fillings of gutta-percha or Resilon cones in association with AH Plus or Epiphany sealer.Study design: Four groups of premolars (n = 64) were instrumented to size 45/.04 ProFile and filled with laterally compacted gutta-percha cones or Resilon cones in association with AH Plus or Epiphany sealer. The specimens were stored for 2 weeks at 37°C and 100% humidity. After that, leakage was measured using the fluid filtration method and determined as μL/min·10 psi.Results: Homogeneity of variance and multiple comparisons tests were performed and indicated that root fillings with the combination of gutta-percha cones and AH Plus sealer showed lower leakage values (P < .05) than the other groups.Conclusion: Considering the experimental conditions and the results obtained, it was concluded that fillings made with gutta-percha cones in combination with AH Plus sealer had the best performance.

Shaping ability of nickel-titanium rotary instruments in simulated S-shaped root canals

2009-12-07

Objective: The aim of this study was to compare the shaping ability of 4 nickel-titanium rotary techniques and 1 hand technique in simulated S-shaped curved root canals.Study design: Seventy-five simulated double-curved resin root canals were divided into 5 groups (n = 15). The canals were compared at 12 different levels and at 3 different times: before preparation and after preparation to master apical 25 and 35. Data were statistically analyzed by performing 2-by-2 comparisons with the Tukey parametric test of variance analysis using a confidence interval of 95%.Results: All of the 75 resin blocks presented transportation of the root canals by transforming the apical curvature into a straight zone and straightening the first curvature. When increasing the diameter from 25 to 35, both curvatures were straightened.Conclusions: Based on the conditions of this study, we can say that the flexibility of the instruments is inversely related with the transportation of the root canals, and that in the double-curved root canals, the apical curvature is always straightened.

Impact of smear layer on sealing property of root canal obturation using 3 different techniques and sealers. Part I

Giorgos N. Tzanetakis, Vasilios D. Kakavetsos, Evangelos G. Kontakiotis — 2009-10-29

Objective: The objective of this study was to determine the influence of smear layer removal on through-and-through fluid movement along root canal fillings obturated using 3 different root canal sealers, namely AH26, Pulp Canal Sealer, and Gutta-Flow, and 3 different obturation techniques.Study design: The fluid transport model was used for detection of through-and-through fluid movement. Root canals of 230 human extracted teeth were mechanically instrumented using the step-back technique. The canals where the smear layer was not removed were irrigated with NaOCl 2.4%, whereas canals where the smear layer was removed were irrigated with EDTA 17% plus NaOCl 2.4%. The teeth were randomly divided into 10 experimental groups (n = 20) and 3 control groups (n = 10) and treated as follows. In group A, where no attempt was made for smear layer removal, the canals were obturated with lateral compaction of gutta-percha and AH26 as a sealer. In group B, the smear layer was removed, and canals were obturated as in group A. In group C (no attempt to remove the smear layer), the canals were obturated with System B plus Obtura II technique and AH26, whereas in group D, the smear layer was removed, and canals were obturated as in group C. The other 4 experimental groups were treated and obturated in the same way as in previous groups, respectively. The sealer that was used in those groups was the Pulp Canal Sealer. Finally, the latter 2 groups were obturated with Gutta-Flow technique. Fluid movement was measured at 24 hours and 30 days and 6 months.Results: In lateral compaction groups (with and without the smear layer), no significant differences were found regarding the ability of the same materials (AH26 and Pulp Canal Sealer) to prevent the fluid movement (P > .05). In warm obturation technique, no significant difference was found between the 2 groups (with and without the smear layer) of AH26 (P > .05). On the contrary, in groups of Pulp Canal sealer, fluid transport values were significantly less when the smear layer was removed (P < .05). Finally, no significant difference was observed between the groups of Gutta-Flow (with and without the smear layer) (P > .05).Conclusions: Under these in vitro conditions, it seems that smear layer removal improves the ability of the filling materials to prevent the fluid movement, at least after the use of warm obturation techniques. On the contrary, smear layer removal does not seem to improve the same ability after the use of cold lateral compaction technique. Further laboratory and also clinical studies are needed in the future to compose a clear view concerning the improvement of sealing ability following smear layer removal.

Attachment of cultured fibroblasts and ultrastructural analysis of simulated cervical resorptions treated with high-power lasers and MTA

2009-12-07

Objective: The present study evaluated the fibroblast attachment and the morphologic changes of simulated cervical root resorptions after irradiation with high-power lasers and the use of mineral trioxide aggregate (MTA).Study design: Standardized cavities were done on the coronal third of 40 single-rooted teeth and assigned into 4 groups according to the treatment applied: (1) untreated control, (2) use of MTA, (3) irradiation with Er:YAG laser (42mJ, 10 Hz, 10 s), and (4) irradiation with high-power diode laser (1 W, 10 s). Fragments were prepared for SEM analysis: 6 samples of each group were plated with human gingival fibroblasts and 4 samples were used for ultrastructural analysis.Results: The cells' attachment was in decreasing order: G3 > G4 > G1> G2, with statistical differences among all groups (P < .05). The samples irradiated with Er:YAG exhibited roughness on the dentinal surface, no smear layer, and open dentinal tubules; those irradiated with diode laser exhibited a smooth surface, more smear layer, and closed dentinal tubules; and the control group showed high amount of smear layer and closed dentin tubules.Conclusions: Irradiation with Er:YAG and diode lasers caused morphologic changes on the dentinal surfaces of simulated resorptions that favored cells' adhesion. MTA showed lower biocompatibility than irradiated groups but allowed cells' adhesion.

Maxillary second molar with 5 roots and 5 canals evaluated using cone beam computerized tomography: a case report

2010-02-01

This case report presents the endodontic management of maxillary right second molar exhibiting 5 roots and 5 root canals. The diagnosis was confirmed with the help of cone beam computerized tomography (CBCT). The article also describes the varied morphology associated with maxillary second molar and the use of a high-end diagnostic imaging modality like CBCT in diagnosing and negotiating these anatomic variations.

ERRATUM to “Case report of extragingival peripheral ameloblastoma in buccal mucosa” [Oral Surg Oral Med Oral Pathol Oral Radiol Endod 108 (2009) 577-9]

2009-12-23

In the abovementioned article the fourth author's name was improperly listed as Tomoaki Yamada. The author's correct name is Chiaki Yamada.

ERRATUM to “Extraction of a deeply impacted lower third molar by sagittal split osteotomy” [Oral Surg Oral Med Oral Pathol Oral Radiol Endod 108 (2009) E36-8]

Metin Sencimen, Altan Varol, Aydin Gülses, Hasan Ayberk Altug — 2010-02-01

In the abovementioned article the last author's name was improperly listed as Ayberk H. Altug. The author's correct name is Hasan Ayberk Altug.

2010-02-01

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2010-02-01

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2010-02-01

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics

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Disappointment and science: it's mother nature's way of saying “try again”

The supraperiosteal route of dexamethasone should be considered for dental surgery

The supraperiosteal route of dexamethasone should be considered for dental surgery

Short-term high-dose oral prednisone on alternate days is safe and effective for treatment of infantile hemangiomas

Hereditary angioedema: treatment, management, and precautions in patients presenting for dental care

Radiation effects on bone healing and reconstruction: interpretation of the literature

The levels of vascular endothelial growth factor in the synovial fluid correlated with the severity of arthroscopically observed synovitis and clinical outcome after temporomandibular joint irrigation in patients with chronic closed lock

Effects of surgically assisted rapid maxillary expansion on nasal dimensions using acoustic rhinometry

Correction of square jaw with low angles using mandibular “V-line” ostectomy combined with outer cortex ostectomy

Autogenous coronoid process pedicled on temporal muscle grafts for reconstruction of the mandible condylar in patients with temporomandibular joint ankylosis

Nasopharyngeal teratoma associated with cleft palate in newborn: report of 2 cases

Effect of titanium implant surface nanoroughness and calcium phosphate low impregnation on bone cell activity in vitro

Effectable application of vascular endothelial growth factor to critical sized rat calvaria defects

Dental implants placed into alveolar clefts reconstructed with tongue flaps and bone grafts

Access to the maxillary sinus using a bone flap with sinus mucosal and mucoperiosteal pedicles

Onlay iliac bone grafting as an ancillary augmentation procedure for paranasal rejuvenation during bimaxillary surgery

Use of autologous fat graft for correction of facial asymmetry stemming from Parry-Romberg syndrome

Comparison of genioplasty using Medpor and osteotomy

A primary leiomyosarcoma of the lateral border of the tongue

Effect of Tisseel on bone healing with particulate dentin and plaster of Paris mixture

Low prevalence of varicella zoster virus and herpes simplex virus type 2 in saliva from human immunodeficiency virus–infected persons in the era of highly active antiretroviral therapy

Management of massive osteolysis of the mandible: a case report

Commentary: massive osteolysis or Gorham-Stout disease

Occurrence and regional distribution of TRAIL and DR5 on temporomandibular joint discs: comparison of disc derangement with and without reduction

Oral Candida flora in a group of Jordanian patients with β-thalassemia major

Gorham-Stout syndrome: a rare clinical entity and review of literature

Conservative treatment of a pathologic fracture in a patient with Gorham-Stout disease

Treatment of localized langerhans' cell histiocytosis of the mandible with intralesional steroid injection: report of a case

Expression of BUBR1 in human oral potentially malignant disorders and squamous cell carcinoma

Papillary synovial metaplasia–like change in oral mucoceles: a rare and previously undescribed histopathologic variant of a common oral lesion

Calcifications in clear cell mucoepidermoid carcinomas

Multifocal myopericytoma in the maxillofacial region: a case report

Central odontogenic fibroma with features of central granular cell odontogenic tumor

Odontogenic tumors in Dakahlia, Egypt: analysis of 82 cases

Reliability of CBCT and other radiographic methods in preoperative evaluation of lower third molars

Comparison of cone-beam CT parameters and sleep questionnaires in sleep apnea patients and control subjects

The prognostic value of panoramic radiography of inferior alveolar nerve damage after mandibular third molar removal: retrospective study of 400 cases

Detection of vertical root fracture using cone-beam computerized tomography: an in vitro assessment

Misleading presentation of an orbital lymphangioma

A retrospective analysis of referral patterns for oral radiologic consultation over 3 years in Ontario, Canada

Nasolabial cyst: case report with CT and MRI findings

Comparison of cone-beam computerized tomography and intraoral radiographs for determination of the periodontal ligament in a variable phantom

High-dose-rate brachytherapy for patients with maxillary gingival carcinoma using a novel customized intraoral mold technique

Dilated odontome in the mandibular third molar region

Comparative evaluation of anesthetic efficacy of Gow-Gates mandibular conduction anesthesia, Vazirani-Akinosi technique, buccal-plus-lingual infiltrations, and conventional inferior alveolar nerve anesthesia in patients with irreversible pulpitis

Histologic evaluation of the use of membrane, bone graft, and MTA in apical surgery

A decrease in the innate immune response to infection in the presence of root canal sealers

Iatrogenic pneumomediastinum with extensive subcutaneous emphysema after endodontic treatment: report of 2 cases

Biological properties of a neutralized 2.5% sodium hypochlorite solution

Management of crown-root fracture tooth by intra-alveolar transplantation with 180-degree rotation and suture fixation

Comparative analysis of leakage in root canal fillings performed with gutta-percha and Resilon cones with AH Plus and Epiphany sealers

Shaping ability of nickel-titanium rotary instruments in simulated S-shaped root canals

Impact of smear layer on sealing property of root canal obturation using 3 different techniques and sealers. Part I

Attachment of cultured fibroblasts and ultrastructural analysis of simulated cervical resorptions treated with high-power lasers and MTA

Maxillary second molar with 5 roots and 5 canals evaluated using cone beam computerized tomography: a case report

ERRATUM to “Case report of extragingival peripheral ameloblastoma in buccal mucosa” [Oral Surg Oral Med Oral Pathol Oral Radiol Endod 108 (2009) 577-9]

ERRATUM to “Extraction of a deeply impacted lower third molar by sagittal split osteotomy” [Oral Surg Oral Med Oral Pathol Oral Radiol Endod 108 (2009) E36-8]

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Information for Readers