Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology

Can saliva-based HPV tests establish cancer risk and guide patient management?

Mark W. Lingen — 2010-09-01

Head and neck squamous cell carcinoma (HNSCC) is the 6th most common malignancy in the world today. Despite numerous advances in treatment, the 5-year survival rate has remained modest. This poor outcome is due to several factors, including delayed diagnosis. Therefore, improved early detection and effective prevention strategies are critical components for management of this malignancy. The etiology of classical HNSCC has been attributed to chronic exposure to tobacco and alcohol. In addition, there is now sufficient evidence to support the contention that high-risk forms of the human papillomavirus (HPV) are a major causative factor for HNSCC of the tonsil, base of tongue, and oropharynx. The increasing importance of HPV in oropharyngeal HNSCC has raised considerable concern and uncertainty among healthcare professionals and patients. For example, I am often asked to describe the clinical features of HPV-associated premalignant lesions. Unfortunately, to my knowledge, the clinical spectrum of HPV-associated premalignant disease has not been adequately described. Furthermore, because this subset of HNSCC often develops in hard-to-examine locations, such as tonsillar crypts, it can be exceedingly difficult to even identify the carcinomas. In the absence of such information, how can clinicians identify patients that are at increased risk for harboring an HPV-associated premalignant lesions or HNSCC?

How to optimize the preparation of leukocyte- and platelet-rich fibrin (L-PRF, Choukroun's technique) clots and membranes: Introducing the PRF Box

David M. Dohan Ehrenfest — 2010-09-01

We recently read a very interesting article by Su et al. in OOOOE about the in vitro release of growth factors from a Choukroun's platelet-rich fibrin (PRF) clot after 5, 60, 120, and 300 minutes. The authors concluded that the initial release of the main growth factors was very important during the first minutes and therefore that the PRF membranes should be used as quickly as possible to get the best possible clinical results.

How to optimize the preparation of leukocyte- and platelet-rich fibrin (L-PRF, Choukroun technique) clots and membranes: Introducing the PRF Box

Chen-Yao Su — 2010-08-05

I thank Dr. Dohan Ehrenfest for his comments on our article published in OOOOE, which examined the in vitro release of various growth factors (GFs) from platelet-rich fibrin (PRF). Using our experimental design, we observed some amount of GFs into the PRF releasate (PRFR) and the supernatant serum (SS) soon after the formation of the PRF. We also found a gradual additional release from the PRF over a period of time up to 300 minutes. In an earlier study of the release of GFs from the PRF membrane placed in a culture medium, Dr. Dohan Ehrenfest and colleagues found similar data but noted, nevertheless, a lower initial amount and a somewhat slower rate of release of the GFs.

Prognosis of the implants replaced after removal of failed dental implants

Young-Kyun Kim, Jin-Young Park, Su-Gwan Kim, Hyo-Jung Lee — 2010-05-10

Objectives: Dental implant failures occur occasionally, and clinicians may hesitate to perform a second implantation because of the uncertain prognosis. This study was carried out to evaluate the survival rate and condition of tissue surrounding the replaced implants after removal of failed implants.Study design: Forty-nine patients (60 implants) who underwent placement of a dental implant between June 2003 and December 2006, who experienced implant failure and underwent a second implantation at Seoul National University Bundang Hospital, were included in this study. We investigated surgery techniques in addition to the healing time after the second implantation, the type of second implantation (immediate or delayed replacement), the survival rate of the replaced dental implants, the crestal bone loss around the implant, and condition of the tissue surrounding the implant at the time of final follow-up.Results: The most frequent site of implant failure was the maxillary first molar area. The percentages of cases of immediate and delayed replacement were 48.3% and 51.7%, respectively. The average healing time for patients undergoing delayed replacement was 2.40 ± 3.06 months. No significant difference in the failure rate of the second implant was observed between the immediate and delayed replacement groups (P >.05). The failure rate of the second implant after removal of failed implant was 11.7%, and a third implantation was performed for all of the failed second implantation cases. The second and third implants all survived until the final follow-up, and thus all patients had a successful implant at the time of the final follow-up. The marginal bone loss at the final follow-up (22.00 ± 14.56 months after implantation) was 0.33 ± 0.49 mm, the width of attached gingiva was 1.68 ± 2.11 mm, the plaque index was 0.81 ± 1.05, the gingival index was 0.56 ± 0.63, and the pocket depth was 3.33 ± 1.21 mm.Conclusions: Implant failure occurred most frequently in the maxillary first molar area. We can improve the survival rate of replaced dental implants after removing the initial failed implant using various bone grafting techniques and/or additional implant fixture.

Challenges associated with reentry maxillary sinus augmentation

2010-04-26

Objective: This study was a retrospective assessment of reentry sinus augmentation compared with sinus augmentation performed for the first time.Study design: There were 38 subjects who required sinus augmentation. The study group (17 patients, 21 sinuses) included subjects following failure of a previous sinus augmentation procedure that required reentry augmentation. The control group (21 patients, 21 sinuses) included subjects in which sinus augmentation was performed for the first time. Patients' medical files were reviewed. A preformed questionnaire was used to collect data regarding demographic parameters, medical and dental health history, habits, and intra- and postoperative data.Results: Operative challenges in the study group included adhesions of the buccal flap to the Schneiderian membrane (62%, 13/21, P < .001), bony fenestration of the lateral wall with adhesions (71%, 15/21, P < .001), limited mobility of a clinical fibrotic Schneiderian membrane (71%, 15/21, P < .001), and increased incidence of membrane perforations (47%, 10/21, versus 9.5%, 2/21, P = .03). In the control group the Schneiderian membrane was thin and flexible.Sinus augmentation succeeded in all cases of both groups. Implant failure was significantly higher in the study group (11% versus 0%, P < .001).Conclusions: Clinical success of reentry sinus augmentation is predictable despite its complexity. Clinicians should be aware of anatomical changes caused by previous failure of this procedure. Patients should be informed about the lower success rate of implants when reentry sinus augmentation is required.

Rotational movement of the anterior maxillary segment by hybrid distractor in patients with cleft lip and palate

2010-04-26

Objective: Maxillary anterior segmental distraction osteogenesis (MASDO) is an effective surgical orthodontic treatment for the retruded maxilla in cleft lip and palate because of its benefit of the conservation of velopharyngeal function. Some reports showed MASDO using various devices, but they do not allow the rotational movement of the distracted anterior segment. In this article, we showed MASDO using hybrid distracters (DynaForm System: Stryker Osteosymthesis, Leibinger Micro Implants, Kalamazoo, MI), which allow the advance of the distracted segment with rotational movement.Method: The hybrid distractor with 4 metal arms is secured beyond both alveolar osteotomy lines on each side. These 2 distractors permit rotational movement of the segment by controlling the amount of advancement on each side.Results: For 6 patients with cleft lip and palate, MASDO using hybrid distractors was performed and the anterior segment moved at planned positions without any complications except lip discomfort, which disappeared after removal of the distractor.Conclusion: MASDO, using an institutionally diagnosed hybrid distractor can successfully achieve the necessary rotational movements of the anterior maxillary segment owing to its design, which incorporates some mechanical flexibility.

Finite element analysis of the human mandible at 3 different stages of life

Péter Bujtár, George K.B. Sándor, Attila Bojtos, Attila Szűcs, József Barabás — 2010-05-04

Objective: This study analyzed detailed models of human mandibles at 3 different stages of life with simulation of supra normal chewing forces at static conditions.Methods and materials: Finite element analysis (FEA) was used to generate models from cone-beam computerized tomograms (CBCT) of 3 patients aged 12, 20, and 67 years, using numerically calculated material parameters. Estimated chewing forces were then applied to the simulations.Results: The results reflect higher elasticity in younger models in all regions of the mandible. The experimental models show that physiologic load stress and strain distributional changes of the mandible vary according to age.Conclusion: The CBCT-based model generation used in this study provided high-quality model definition of the 3 individual patients of different ages. FEA has great potential to predict bone responses to paradigms of mechanical activity. Future applications of FEA will include surgical planning, surgical hardware testing, and the design of scaffolds and tissue-engineered constructs.

The Use of Bone Morphogenic Protein for Bone Grafting Alveolar Defects

Joel S. Berger — 2010-09-01

Presentation Summary: Bone grafting of alveolar defects historically used either particulate or block grafts harvested intraorally from the chin, ramus, or extra-orally from the iliac crest, calvarium or tibia. This presentation will describe a technique in which no autogenous bone is used, reducing the morbidity of a donor site as well as the overall time of surgery. Bone morphogenic protein II is a recombinant protein from the family of BMPs. It has been shown to have a very powerful stimulation for the formation of osteoblasts and therefore for the induction of new bone formation. It has recently been introduced and FDA approved for the grafting of alveolar defects. The technique of using bone morphogenic protein to reconstruct defects in combination with bone marrow aspirate will be described, and complications and lessons learned for 150 consecutive cases will be shared with the audience.

The Use of Stereolithic Models for Fabrication of Immediate Load All-On-Five Dental Implants

Joel S. Berger — 2010-09-01

Presentation Summary: Immediate loaded implants in the fully edentulous ridge have been previously described by multiple authors using the Nobel Teeth in an Hour software. This technique depends on a well-healed ridge where no alveoloplasty is done. This paper will discuss the use of stereolithic models in the partially dentate patient where the treatment plan involves removal of all the patient's remaining teeth, and the placement of implants, which are immediately loaded. The technique involves using stereolithic models of the patient that are mounted on an articulator in the patient's acquired occlusion. The teeth are removed on the model, an alveoloplasty performed and the implant analogs inserted. A bone reduction guide, as well as an implant guide, are fabricated on the stereolithic models, as well as the temporary permanent prosthesis. The guides are then used to reproduce the alveoloplasty and implant placement that had been done on the stereolithic models, so that a previously fabricated acrylic prosthesis can be inserted at the time of surgery and function as a temporary permanent prosthesis. Experience with our first group of patients will be shared, outlining complications and failures. 390 implants have been followed for approximately 6 years using this technique.

Computer-Aided Planning of Maxillo-Mandibular Defect Reconstruction Using Fibular-Free Flaps, Cutting Templates and Intra-Operative Navigation

2010-09-01

Statement of Problem: Post-ablative maxillo-mandibular reconstruction using fibular free flaps (FFF) can be challenging. Ideal positioning of jaws relative to each other is essential such that the patient may receive osseointegrated implants and subsequent optimal prosthetic restoration of occlusion. Recently, a computer-aided design/computer aided manufacturing (CAD/CAM) technique was introduced utilizing computed tomography (CT) guided three-dimensional (3D) technology to fabricate intra-operative templates used to create ideal orthogonal jaw relationships during surgical reconstruction. The purpose of this study was to quantitatively and qualitatively evaluate the predictability with which the virtual plan is transferred to in-vivo reconstructions and to describe outcomes in a series of patients undergoing reconstruction of post-ablative maxillomandibular defects.

Computer-Assisted Orthognathic Surgery – Dental and Skeletal Outcomes

2010-09-01

Purpose: Traditional treatment planning in orthognathic surgery incorporates analytical model surgery using plaster casts, which have demonstrated error in final clinical transfer. Recently, computer assisted surgical simulation (CASS) has been advocated as an alternative to analytical model surgery for treatment planning orthognathic surgical cases. However, there are few reports on the effectiveness of CASS for establishing optimal occlusion. The purpose of this study was to evaluate the effectiveness of CASS in: 1) producing class I occlusion, 2) normalizing overjet and 3) transferring the virtual plan into reality.

Distraction Osteogenesis for Primary Reconstructive Treatment of an Avulsive Gun Shot Wound to the Mandible

Marianela Gonzalez, Cesar A. Guerrero, Michael J. Ellis, Michael P. Ding — 2010-09-01

Introduction: Low caliber gunshot wounds (GSW) to the maxillofacial region are often seen in Level I trauma centers. The clinical application of bone transport has been reported since 1995, and since then we have considered its use for extensive mandibular discontinuity defects without the need of external devices.

Idiopathic Condylar Resorption: Analysis of Treatment Outcomes Using Custom-Made TMJ Total Joint Prostheses

Mohammed Nadershahh, Pushkar Mehra — 2010-09-01

Purpose: Idiopathic condylar resorption (ICR) presents a diagnostic and therapeutic challenge to practitioners because of its rarity of occurrence, progressive nature of the deformity, and its simultaneous involvement of skeletal, occlusal and articular structures. Traditionally, costochondral grafts have been used for TMJ replacement in this sub-group of patients, but availability of patientfitted TMJ alloplastic replacement systems offers many benefits over autogenous replacement options.

Mandibular Basal Osteotomy (Wing Genioplasty)

Patricia E. Lopez, Cesar A. Guerrero, Rebeca V. Rodriguez — 2010-09-01

Purpose: This study evaluates the functional and cosmetic results of mandibular inferior border osteotomy, introducing new indications and fixation alternatives. The original genioplasty introduced by Obwegeser, was modified by Sandner and the term “wing” was coined by Triaca.

Improving the Accuracy of Orthognathic Surgery Through the Use of the Tridimensional Orthognathic Gauge™

Michael B. Lee — 2010-09-01

Purpose: Successful orthognathic surgery requires accurate placement of the maxilla and mandible to their ideal predetermined post-surgical position in 3 planes of space. This is necessary to fulfill the surgical goals which routinely include precise alignment of the maxilla to the facial midline, correction of any presurgical canting and esthetic orientation of the jaws in the horizontal and vertical plane. To date, capturing and accurately transferring the third plane of the face—the transverse plane—has been problematic. The Tridimensional Orthognathic Gauge™ is a device that allows for the capture and transfer of this important third plane of the face. Additionally, the tridimensional gauge provides for a check of the accuracy of the centric bite relation which is critical for accurate model surgery and to ensure that the maxillary midline is not deviated. The use of the tridimensional gauge ensures exact placement of the maxillary midline to the predetermined facial midline eliminating this potentially troublesome postoperative aesthetic complication.

Mathematical Model for Osteobstruction in Bone Regeneration Mechanisms: A Headway in Skeletal Tissue Engineering

2010-09-01

Purpose: In this paper, we formulate a mathematical model for the evaluation of parameters responsible for the retardation and eventual acceleration on the contralateral side of the mandible of the experimental animals, following the discovery of a new mechanism of bone regeneration called the osteobstruction mechanism of bone regeneration (a negative mechanism of bone regeneration as opposed to the well established and extensively documented positive mechanisms such as osteogenesis, osteoinduction and osteoconduction).

Open Reduction and Internal Fixation of Mandibular Angle Fractures: A Comparison of Endoscopically-Assisted vs. Non-Endoscopically-Assisted Approaches

Shrinivas Rangarajan, Steven Kaltman, Eustorgio Lopez, Joseph McCain — 2010-09-01

Purpose: Endoscopically assisted surgical procedures have revolutionized the principles of minimally invasive surgery. The use of the endoscope during surgical procedures such as open reduction and fixation of fractures of the orbital floor, mandibular condylar region, frontal sinus and zygomaticomaxillary complex fractures have been well documented. The advantages of endoscopy include less visible scars with smaller incisions, direct visualization with excellent illumination of the field and reduced complications such as facial nerve damage. However, there has not been much discussion in the literature of using the endoscope for the reduction of mandibular angle fractures through a trocar transoral approach. Our study compares the outcomes of open reduction and internal fixation of mandibular angle fractures with and without using the endoscope.

7-Year Retrospective Evaluation of Craniofacial Fractures in Helmeted vs. Non-Helmeted Motorcycle Crashes in Broward County, Florida

J.M. Kaltman, I. Puente, E. Carrillo, S.I. Kaltman — 2010-09-01

Purpose: On July 1, 2000, Florida became the 13th state to amend its mandatory helmet law. Much attention has been focused on death rates and intra-cranial trauma since the amendment. The purpose of this review was to compare the number and types of craniofacial injuries sustained in helmeted vs. non-helmeted motorcyclists involved in crashes.

Anterior Zygoma Implants as an Alternative for the Adult Alveolar Cleft

Cesar A. Guerrero, Patricia Lopez, Marianela Gonzalez, Adriana Sabogal — 2010-09-01

Purpose: This aim of this study is to introduce the use of anterior zygoma implants to anchorage a dental prosthesis in adult cleft patients. Understanding that alveolar grafts and orthodontics is the ideal treatment of the young patient, this new alternative offers an excellent base for dental prosthesis when there is no bone for regular implants, either after failed treatments or confronting a soft tissue closed wide cleft.

Stryker Navigation System Protocol for Craniofacial Reconstruction Planning

Michael Ding, Marianela Gonzalez, Suzanne Verma — 2010-09-01

Purpose: Craniofacial reconstruction can be a challenging situation for both the patient and surgeon. Patients with craniofacial anomalies, post-traumatic injuries and the post-surgical cancer patient with combined soft tissue and osseous defects necessitate a team approach to their rehabilitation. The oral and maxillofacial surgeon can be invaluable to a number of these patients during the reconstructive phase of treatment. With the assistance of the Stryker Navigation System, osteointegrated implants may be utilized in the reconstructive phase of treatment to assist in the retention of facial prosthesis. This is a review of the Stryker Navigation System protocol, with case reports including the pre-operative planning, surgical phase of reconstruction and final prosthetic results fabricated by the anaplastologist.

Surgically-Assisted Rapid Canine Orthodontic Distraction

Pushkar Mehra, Elif Kesar, Mariana Velazquez — 2010-09-01

Purpose: Treatment of dental crowding includes extraction of premolar teeth and retraction of anterior ones including the canines. Time required for canine distalization using traditional orthodontic techniques varies between 6 to 9 months. “Dental distraction” with combined surgical and rapid postoperative orthodontic treatment can possibly shorten the treatment time required for canine distalization.

Treatment of Hemifacial Microsomia with Unilateral Temporomandibular Joint Replacement (TMJ Concepts) in Conjunction with Bimaxillary Surgery

Larry M. Wolford, T. Campbell Bourland, Daniel E. Perez — 2010-09-01

Purpose: Hemifacial microsomia (HFM) or Otomandibular dysostosis is a specific condition that describes the unilateral incomplete or hypoplastic development of the facial soft tissues, ear and skeleton. HFM is the second most common facial birth defect after cleft lip and palate with incidences ranging from 1 in 3,500 live births. Temporomandibular total joint prosthesis may be a viable treatment option for patients with absence of the TMJ in hemifacial microsomia. Traditional methods for reconstructing the absent joint and ramus in HFM include, autogenous bone grafts as well as distraction osteogenesis all with variable and sometimes unpredictable results reported in the literature. The craniofacial condition of hemifacial microsomia presents a unique opportunity for placement of a unilateral TMJ total joint prosthesis which corrects form and function by predictably repositioning the mandible and reconstructing the TMJ in conjunction with bimaxillary orthognathic surgery. We herein report on the treatment outcomes of 5 patients with varying stages of HFM with unilateral total joint replacement in conjunction with contralateral sagital split osteotomy and multiple maxillary osteotomies.

Reconstruction of partial maxillary defect with intraoral distraction osteogenesis assisted by miniscrew implant anchorages

Yimiao Feng, Bing Fang, Guofang Shen, Yunhui Xia, XinTian Lou — 2010-09-01

Objective: The paper reports a custom-made trifocal transport distractor assisted by miniscrew implant anchorages (MIAs) used to reconstruct maxillary defects and evaluates the clinical results of function and esthetics.Study design: Eight patients aged 19-43 years who suffered regional maxillary defects were involved. Each one underwent segmental bone excision of the maxilla and distraction osteogenesis (DO) in the defect region by a custom-made interoral 3-dimensional distractor which was activated by orthodontic elastic force assisted by MIAs at the rate of ≤1 mm/d.Results: New arced bone was found and filled the defect. The average amount of distraction was 13.6 mm (range 10-18 mm). Occlusion relationship was restored via this method, with subsequent placement of oral implants and prosthesis. The regenerated bony segment can be bent to form a curved arch.Conclusion: A combined orthodontics and DO technique can be used to treat partial maxillary defects successfully.

A comparison of bone generation capability in rabbits using tooth ash and plaster of Paris with platelet-rich plasma or fibrin sealant

Bong-Kyun Kim, Su-Gwan Kim, Seo-Yoon Kim, Sung-Chul Lim, Young-Kyun Kim — 2010-06-28

Objectives: Increased attention has been focused on determining the most efficacious materials for generalized bone grafts. This article presents the results of a histomorphometric analysis of bone healing in the calvaria of rabbits. The study compared the use of a tooth ash and plaster of Paris mixture alone, in association with platelet-rich plasma (PRP), and in association with fibrin sealant.Study design: Twelve rabbits were divided into control (group 1) and experimental groups (groups 2, 3, and 4). Group 1 was maintained as an unfilled control, and tooth ash and plaster of Paris were used in group 2, tooth ash and plaster of Paris with PRP were used in group 3, and tooth ash and plaster of Paris with fibrin sealant (Tissucol Duo Quick) were used in group 4. One-half of the animals were killed after 4 weeks, and the rest were killed after 8 weeks. Bone samples were taken from the defect areas, and newly formed bone was analyzed histomorphometrically.Results: The rate of new bone formation in groups 2, 3, and 4 was significantly higher than the rate in the control group. The rate of new bone formation in groups 3 and 4 was higher than the rate in group 2, but the difference was not statistically significant.Conclusion: The concomitant use of PRP or fibrin sealant with tooth ash and plaster of Paris graft materials may have a positive effect on bone healing.

Association of oral lichen planus with thyroid disease in a Finnish population: a retrospective case-control study

Maria Siponen, Lasse Huuskonen, Esa Läärä, Tuula Salo — 2010-07-26

Objective: The objective of this study was to estimate the association between the history of thyroid disease and the prevalence of oral lichen planus (OLP)/oral lichenoid lesions (OLL).Study design: This was a retrospective case-control study using data from the medical records of 222 OLP/OLL patients and 222 age- and sex-matched controls who had visited the Institute of Dentistry, University of Oulu or the Oral and Maxillofacial Department, Oulu University Hospital, from 1992 to 2001. Clinical characteristics of OLP/OLL lesions, other oral mucosal diseases, presence of cutaneous LP, history of allergies, medical history, and the use of regular medications were recorded. The relative odds of OLP, OLL, and OLP/OLL associated with selected patient characteristics were estimated by logistic regression.Results: History of any thyroid gland pathosis was found in 15% (n = 22) of the 152 cases with OLP, in 13% (n = 9) of the 70 cases with OLL, and in 8% (n = 18) of the control subjects; the estimated odds ratios (with 95% confidence intervals) being 2.12 (1.06 to 4.21) for OLP and 1.57 (0.62 to 3.73) for OLL. When confined to hypothyroidism only, this disease was found in 10% (n = 15) of the OLP cases, 9% (n = 6) of the OLL cases, and 5% (n = 11) of the controls; the estimated odds ratios being 2.39 (1.05 to 5.61) for OLP and 1.73 (0.56 to 4.90) for OLL.Conclusion: The association of OLP/OLL and thyroid disease, especially between hypothyroidism and OLP, calls for further investigations in other populations and into the possible mechanisms behind this association.

Adrenal crisis provoked by dental infection: case report and review of the literature

2010-08-05

Primary adrenal insufficiency is an endocrine disorder characterized by cortisol and aldosterone deficiency caused by destruction of the adrenal cortex. Adrenal crisis is a medical emergency with acute symptoms: nausea, vomiting, abdominal pain, fever, hypoglycemia, seizures, hypovolemic shock, and cardiovascular failure. It occurs in patients with chronic adrenal insufficiency who are exposed to additional stress, such as infection, trauma, or surgical procedures. Dental infection is a possible cause of adrenal crisis in patients with chronic adrenal insufficiency, so pediatric endocrinologists and pediatric dentists should be aware of this risk. The purpose of this report was to present a 6-year-old patient in whom Addison disease was diagnosed through adrenal crisis provoked by dental infection. The patient was treated with intravenous rehydration, intravenous hydrocortisone and antibiotics, and extraction of the infected primary tooth. Multidisciplinary approach and collaboration between the pediatric endocrinologist and the pediatric dentist are necessary to enable adequate medical and dental treatment in children with primary adrenal insufficiency.

Changes in saliva interleukin-6 levels in patients with oral squamous cell carcinoma

2010-07-02

Objective: The aim of this study was to elucidate changes in interleukin-6 (IL-6) levels in whole saliva during the treatment of patients with oral squamous cell carcinoma (OSCC).Study design: Twenty-nine consecutive inpatients with OSCC were enrolled. Stimulated saliva was collected just after hospitalization (period 1), just before main treatment (surgery in 26 cases; period 2), and at the time of discharge (period 3). The mean intervals were 11 ± 8 days between periods 1 and 2 and 30 ± 18 days between periods 2 and 3. Nineteen age-matched healthy control subjects were also recruited. Interleukin-6 concentrations were measured by a highly sensitive chemiluminescent enzyme immunoassay.Results: Interleukin-6 was detected in 23 out of 29 samples in the OSCC group in period 1. The concentration of IL-6 was significantly higher in the OSCC group (mean 20.1 ± 36.3 pg/mL) than in the control subjects (0.6 ± 0.8 pg/mL; P = .003). The mean concentration of IL-6 at period 2 was 43.6 ± 95.6 pg/mL, significantly higher than at period 1 (P = .002), and at period 3 was 17.1 ± 27.6 pg/mL (P = .52 [compared with period 2]).Conclusions: Interleukin-6 was up-regulated in saliva in the OSCC patients. The IL-6 level tended to increase before treatment, and it returned to baseline levels after treatment.

Acquired von Willebrand disease secondary to hypothyroidism: a rare cause for postextraction hemorrhage

John M. Hanratty, C.G. Cowan — 2010-07-26

Acquired von Willebrand's Disease (AvWD) is a rare disease with a clinical pattern similar to the congenital disorder that typically presents later in life in patients with no prior history of prolonged bleeding. It has been shown to be related to a number of common medical conditions including lymphoproliferative and myeloproliferative diseases, cardiovascular disease, immunological disorders, neoplasia, drugs, and miscellaneous disorders. We present 2 cases where post- and interoperative hemorrhage were the initial sign of AvWD and a previously undiagnosed hypothyroid condition was the precipitating factor. There are no similar cases reported within the dental literature. We highlight the importance of taking a medical history and bleeding history in all patients about to undergo oral surgery, periodontal surgery, or implant placement. Increased vigilance is suggested when patients, who have been otherwise well, present with abnormal bleeding problems as this may be a manifestation of an underlying undiagnosed disease.

New alternative therapy for orofacial localized scleroderma

Xiao Song Liu, Yan Gao, Li Wu Zheng, Hong Hua — 2010-07-16

Scleroderma is an uncommon disorder characterized by thickening or hardening of the skin and fibrosis of the involved tissues. There are two distinct clinical categories: localized scleroderma and systemic scleroderma. Localized scleroderma refers to scleroderma primarily involving the skin and subcutaneous tissue, with minimal systemic features. Patients with localized scleroderma rarely progress to systemic disease. In systemic scleroderma, the fibrosis may extend to the internal organs, such as the heart, lungs, kidney, and gastrointestinal tract.

Evidence for the changes of antitumor immune response during lymph node metastasis in head and neck squamous cell carcinoma

2010-07-02

Objective: This study aimed to elucidate the differences in antitumor immune responses between primary tumors and metastatic regional lymph nodes in head and neck squamous cell carcinoma (HNSCC).Study design: The clonality of tumor-infiltrating lymphocytes in tissue specimens from 17 HNSCC patients was examined regarding their T-cell receptor (TCR) repertoires and their complementary determining region 3 (CDR3) size spectratyping. Cytokine expression profiles and T-cell phenotypes also were measured by using real-time quantitative polymerase chain reaction.Results: The host immune responses to HNSCC cells, reflected by the TCR repertoire, differed between primary tumors and metastatic lymph nodes. CD8+-T cells and T helper type 1 (TH1)/T cytotoxic 1 (TC1) cell cytokine production in metastatic and nonmetastatic lymph nodes were similar.Conclusions: The antitumor immune response to HNSCC cells changes during lymph node metastasis, and HNSCC cells can escape the cytotoxic immune responses mediated by CD8+-T cells and TH1/TC1 cells. These results suggest that lymph node metastasis might be associated with changes in the nature of the primary tumor antigens.

Gene expression of oncogenes, antimicrobial peptides, and cytokines in the development of oral leukoplakia

2010-09-01

Objective: The aim of this study was to investigate the expression pattern of oncogenes, antimicrobial peptides, and genes involved in inflammation in leukoplakia of the oral cavity compared with healthy gingiva.Study design: Biopsies of healthy gingiva (n = 20) and leukoplakia (n = 20), were obtained during routine surgical procedures. RNA was extracted according to standard protocols. Transcript levels of α-defensin (DEFA) 1/3, DEFA-4, S100-A7, deleted-in-oral-cancer (Doc) 1, interleukin (IL) 1β, IL-6, IL-8, IL-10, tumor necrosis factor (TNF) α, cyclooxygenase (Cox) 2, epidermal growth factor (EGF), keratinocyte growth factor (KGF), transforming growth factor (TGF) β1, TGF-α, collagen-IA1 (Col-1), and tenascin-c were analyzed by real-time reverse-transcription polymerase chain reaction. The proteins encoded by the different genes were visualized by immunostaining.Results: Compared with healthy gingiva (set as 1), there was an increased gene expression of DEFA-4 (179.2-fold), S100-A7 (25.4-fold), EGF (24.8-fold), TGF-β1 (25.2-fold), and tenascin-c (34.3-fold) in oral leukoplakia. The expression of IL-1β and Doc-1 was decreased (0.01-fold and 0.2-fold, respectively).Conclusions: The combination of an increased expression of the antimicrobial peptide DEFA-4, the oncogene S100-A7, EGF, and tenascin-c, and a decreased Doc-1 expression in oral leukoplakia might characterize its potency of malignant transformation. Chronic inflammation seems not to be involved in the development of this lesion.

Peripheral odontogenic fibroma: a clinicopathologic study of 151 cases and review of the literature with special emphasis on recurrence

Priyanshi Ritwik, Robert B. Brannon — 2010-08-05

Objective: The peripheral odontogenic fibroma (POdF) is a rare benign neoplasm of odontogenic origin with limited data on recurrence. The purpose of this study was to define the clinical and histopathologic spectrum of POdF and to investigate its recurrence rate and variables associated with its recurrence.Study design: A total of 151 cases of POdF were accepted for this study, which documented clinical, histopathologic, and follow-up data. Multivariate stepwise logistic regression was used to investigate the association of categorical variables and recurrence.Results: POdF should be considered a mixed odontogenic tumor because it is composed of active odontogenic epithelial and ectomesenchymal components. Of the 58 cases with follow-up, 29 recurred. Budding of the basal cell layer of the surface squamous epithelium was associated with higher recurrence (P = .0186); 27 cases with recurrence which exhibited this feature. The presence of calcification in direct apposition to epithelial rests was associated with lower recurrence (P = .0076); 13 cases that did not recur exhibited this feature.Conclusions: POdF has a 50% recurrence rate. Budding of the surface epithelium and calcification in apposition to odontogenic epithelial rests are histologic predictors of recurrence.

Human papillomavirus in ameloblastoma

Maria Correnti, Marcello Rossi, Maira Avila, Marianella Perrone, Helen Rivera — 2010-09-01

Objective: Ameloblastomas are benign epithelial tumors of odontogenic origin, with a high recurrence rate and local aggressiveness. A few preliminary studies have demonstrated HPV presence mainly in peripheral ameloblastomas. The purpose of this study was to detect HPV-DNA in intraosseous ameloblastomas.Methods: Eighteen cases of intraosseous ameloblastomas of different histological variants were selected. Immunohistochemistry, CISH, nested-PCR, and INNOLiPA HPV Genotyping v2 were used.Results: The predominant age group was between the third and fourth decades of life. Males were more affected with 61% and females represented 39%. Of the 18 cases, 7 were solid multicystic tumors and 11 were unicystic. Of the histological variants, the plexiform represented 3 (17%) of the 18, 2 (11%) were follicular, 2 (11%) were acanthomatous, and 1 (6%) was desmoplastic. All cases were HPV negative by immunohistochemistry and CISH. HPV-DNA was detected in 6 (33%) of the cases by nested-PCR. HPV 6 was the most frequent genotype in 4 (66%) of the 6. Two cases presented a mixture of HPV 16, 33, and HPV 6, 42 respectively. Four of the unicystic ameloblastomas were HPV positive; of these, all presented koilocytic changes and were associated with dentigerous cysts, whereas only 2 positive cases corresponded to solid ameloblastomas. None of the positive cases were related to recurrence rate.Conclusions: We may conclude that HPV low and high risk was detected in our sample of intraosseous ameloblastomas. HPV positivity was observed more in the unicystic cases than solid types.

Thyroid-like papillary adenocarcinoma of the nasopharynx: a case report in a 19-year-old male

Christine N. Sillings, Dwight R. Weathers, John M. Delgaudio — 2010-09-01

Primary thyroid-like papillary adenocarcinomas of the nasopharynx are rare, with only a limited number of cases reported in the literature. However, it is important that pathologists and clinicians alike recognize this entity, as these neoplasms are amenable to surgical resection and carry an excellent prognosis. In this article, we describe the case of a thyroid-like papillary adenocarcinoma of the nasopharynx in a 19-year-old male, with emphasis on clinical findings, histologic and immunohistochemical characteristics, and prognosis. In addition, we include a review of the literature to highlight what we know to date about this rare entity.

Usefulness of MRI and dynamic contrast-enhanced MRI for differential diagnosis of simple bone cysts from true cysts in the jaw

2010-09-01

Introduction: It can be difficult to differentiate simple bone cysts (SBCs) from true cysts in the jaw when these lesions appear unilocular. The present study reports the MR imaging of subjects with SBCs and describes the diagnostic value of the MRI findings.Materials and methods: Ten subjects with SBCs in the jaw were examined using MRI. T1- and T2-weighted images (T1WI, T2WI) were obtained, and contrast-enhanced images and dynamic contrast-enhanced MRI (DCE-MRI) were acquired.Results: In all cases, the contrast-enhanced T1WI acquired approximately 6 minutes after the administration of Gd-DTPA showed marked enhancement of the margin and slight enhancement of the inner part of the cyst cavity. In all cases, the time–signal intensity (SI) curves show a gradual increase in the SI until approximately 15 minutes after the administration of Gd-DTPA. These findings might not be observed on the DCE-MRIs of the other true cysts with epithelial lining that show no enhancement in a cavity.Conclusion: MRI, especially DCE-MRI, can provide useful information for distinguishing SBCs from other cysts.

Integration accuracy of digital dental models and 3-dimensional computerized tomography images by sequential point- and surface-based markerless registration

2010-06-30

Objective: The goal of this study was to evaluate the accuracy of the integration of computerized tomography (CT)–based bone models and laser-scanned dental models by sequential point- and surface-based markerless registration to create a digital maxillofacial-dental model.Study design: The integration accuracy was evaluated in normal skulls (group I) and subjects with maxillofacial deformities (group II) by measuring the distance between the integrated models (for group I and II) and between the final integrated model and the laser-scanned original skull model (for group I).Results: The average error ranged between 0 and 0.2 mm without statistically significant difference in the region of maxilla or mandible and in tooth location.Conclusions: We could confirm that the integration can be made with good accuracy without the aid of fiducial markers for the maxillofacial-dental composite model from the different resolution of CT and dental models.

Comparison of the efficacy of conventional radiography, digital radiography, and ultrasound in diagnosing periapical lesions

2010-09-01

Objectives: The aim of this study was to evaluate the efficacy of conventional radiography, digital radiography and ultrasound imaging in diagnosing periapical lesions.Study design: Twenty-one patients aged between 15 and 45 years with well defined periapical radiolucency associated with anterior maxillary or mandibular teeth requiring endodontic surgery or extraction were selected and consented to the study. Preoperative intraoral periapical radiographs and digital images using charge-coupled device obtained by paralleling technique were assessed by 3 specialist observers who gave their diagnosis of the periapical lesions. Then ultrasound examination was performed and the images were assessed for size, contents, and vascular supply by 3 ultrasonographers. It was followed by curettage of periapical tissues to enable histopathologic investigation, which is the gold standard in diagnosis. The data were statistically analyzed using SPSS, analysis of variance, and κ statistics.Results: The percentage accuracy of diagnosing periapical lesions using conventional radiography was 47.6%, digital radiography 55.6%, and ultrasound 95.2%. Ultrasound had the highest sensitivity and specificity: 0.95 and 1.00, respectively.Conclusion: Conventional and digital radiography enable diagnosis of periapical diseases, but not their nature, whereas ultrasound provides accurate information on the pathologic nature of the lesions, which is of importance in predicting the treatment outcome. Therefore ultrasound can be used as an adjunct to conventional or digital radiography in diagnosing periapical lesions.

Effects of tube current on cone-beam computerized tomography image quality for presurgical implant planning in vitro

Jaideep Sur, Kenji Seki, Hiroshi Koizumi, Koh Nakajima, Tomohiro Okano — 2010-07-02

Objective: The purpose of this study was to evaluate the effect of tube current reduction on the quality of cone-beam computerized tomography (CBCT) images of the maxilla and mandible for presurgical implant planning.Study design: Six cadaver heads were imaged with a CBCT (3D Accuitomo) operated at 80 kVp and variable tube current (8, 4, 2, or 1 mA) in full-scan mode. For the posterior region of maxilla and mandible, half-scans were also performed at similar settings. The images were evaluated independently by 5 oral radiologists for 15 anatomic landmarks regarding presurgical implant planning. The quality of images were compared with their respective reference images at 8 mA and ranked on a 4-point rating scale as excellent, good, fair, or nondiagnostic. The scores of all observers were averaged for each landmark at every exposure condition, and Bonferroni test (P < .05) was performed.Results: The 4 mA images at full-scan mode could visualize each landmark of maxilla and mandible and were evaluated to be the same or almost equivalent in quality as the 8 mA images. Even 2 mA images in full-scan mode and 4 mA in half-scan mode could be used for implant planning. The 1 mA images were unacceptable owing to the substantial degradation in image quality.Conclusion: Significant dose reduction can be achieved by reducing tube current without substantial loss of image quality for presurgical implant planning in CBCT.

Relation between disk/condyle incoordination and joint morphological changes: a retrospective study on 268 TMJs

2010-07-26

Objective: The relation between disk/condyle incoordination and temporomandibular joint (TMJ) morphological changes is incompletely known. To address the research purpose, the investigators designed a cohort study of 268 TMJs. MRIs were evaluated.Study design: A series of morphological parameters were investigated regarding disk, condyle, tuber, interarticular space, and muscles. Pearson chi square was the statistical method used.Results: Disk incoordination is statistically associated with morphological changes of condyle and tuber. No association was detected regarding morphological changes of disk, interarticular space, muscles, and pain. Reported data have shown that disk and condyle incoordination are related to morphological changes of TMJ surfaces (i.e., both condyle and tuber). The functional changes (i.e., pain, interarticular space reduction or enlargement, presence of fat in muscles, and disk derangements) are not associated with disk and condyle incoordination.Conclusion: The reported data do not allow determination of which is the first cause (i.e., the disk/condyle incoordination or morphological changes of TMJ surfaces). Additional studies are needed to address this last question.

Effect of calcium hydroxide dressing on the long-term sealing ability of two different endodontic sealers: An in vitro study

2010-09-01

Objective: The aim of this in vitro study was to evaluate the long-term sealing ability of Real Seal system and Endofill after calcium hydroxide (CH) dressing, by using a fluid filtration model.Study design: Four randomized groups of single-rooted teeth (N = 110) were prepared using a crown-down technique to a size 50 file. Two groups (1 and 2) received CH dressing before filling. Roots were filled with gutta-percha and Endofill (groups 2 and 4) or Resilon and Real Seal (groups 1 and 3). Leakage was measured by using the fluid filtration method after 90 days and determined as μL/min·10 psi.Results: Statistical analysis by Kruskal-Wallis and Mann-Whitney tests indicated that CH dressing groups showed higher leakage values than those where CH was not used (P = .001).Conclusion: It may be concluded that the use of CH as an intracanal dressing material affected the sealing ability of both Real Seal and Endofill sealers.

Assessment of apically extruded debris produced by the single-file ProTaper F2 technique under reciprocating movement

2010-09-01

Objective: This study was designed to quantitatively evaluate the amount of dentin debris extruded from the apical foramen by comparing the conventional sequence of the ProTaper Universal nickel-titanium (NiTi) files with the single-file ProTaper F2 technique.Study design: Thirty mesial roots of lower molars were selected, and the use of different instrumentation techniques resulted in 3 groups (n = 10 each). In G1, a crown-down hand-file technique was used, and in G2 conventional ProTaper Universal technique was used. In G3, ProTaper F2 file was used in a reciprocating motion. The apical finish preparation was equivalent to ISO size 25. An apparatus was used to evaluate the apically extruded debris. Statistical analysis was performed using 1-way analysis of variance and Tukey multiple comparisons.Results: No significant difference was found in the amount of the debris extruded between the conventional sequence of the ProTaper Universal NiTi files and the single-file ProTaper F2 technique (P > .05). In contrast, the hand instrumentation group extruded significantly more debris than both NiTi groups (P < .05).Conclusions: The present results yielded favorable input for the F2 single-file technique in terms of apically extruded debris, inasmuch as it is the most simple and cost-effective instrumentation approach.

Effect of different water flows on root surface temperature during ultrasonic removal of posts

Mariusz Lipski, Michał Dębicki, Agnieszka Droździk — 2010-08-05

Objective: This in vitro study evaluated rises in temperature on the outer root surface of human incisors during ultrasonic post removal with different water flows.Study design: Thirty-six extracted teeth (12 maxillary central incisors, 12 maxillary lateral incisors, and 12 mandibular incisors) were used. After root canal preparation, the teeth were obturated, and prefabricated posts were cemented into the prepared spaces. Posts were ultrasonically instrumented dry and with irrigation at 20 mL/min and 40 mL/min. Temperature changes on the entire mesial outer surfaces of the roots were measured at 10-second intervals using an infrared thermal imaging camera.Results: Increases in root surface temperature were significantly lower when posts were instrumented with 40 mL/min water irrigation compared with dry vibration and 20 mL/min irrigation, which also significantly differed from each other. Statistical analysis among tooth groups showed differences in the mean temperature rise of maxillary central incisors and maxillary lateral incisors compared with mandibular incisors when posts were instrumented dry or with 20 mL/min irrigation. There were no significant differences in mean temperature rises between the studied groups when 40 mL/min irrigation was used.Conclusions: Water cooling during ultrasonic post instrumentation significantly reduced temperature increases on the outer root surface; however, the intensity of the cooling was also important. Our results suggest that copious water irrigation during post removal is an effective method to protect the root's surrounding tissue.

Cyclic fatigue resistance of ProTaper Universal instruments when subjected to static and dynamic tests

2010-09-01

Objective: This study evaluated the number of cycles to fracture of ProTaper Universal S2 instruments when subjected to static and dynamic cyclic fatigue tests.Study design: ProTaper Universal S2 instruments were used until fracture in an artificial curved canal under rotational speed of 300 rpm in either a static or a dynamic test model. Afterward, the length of the fractured segments was measured and fractured surfaces and helical shafts analyzed by scanning electron microscopy (SEM).Results: The number of cycles to fracture was significantly increased when instruments were tested in the dynamic model (P < .001). Instrument separation occurred at the point of maximum flexure within the artificial canals, i.e., the midpoint of the curved canal segment. SEM analysis revealed that fractured surfaces exhibited characteristics of the ductile mode. Plastic deformation was not observed in the helical shaft of fractured instruments.Conclusions: The number of cycles to fracture ProTaper Universal S2 instruments significantly increased with the use of instruments in a dynamic cyclic fatigue test compared with a static model. These findings reinforce the need for performing continuous pecking motions during rotary instrumentation of curved root canals.

Homogeneity of root canal fillings performed by undergraduate students with warm vertical and cold lateral techniques

Christine I. Peters, David Sonntag, Ove A. Peters — 2010-06-24

Objectives: The aim of this study was to determine radiographic and microscopic appearances of root canal fillings performed by undergraduate students using vertical and lateral compaction techniques.Study design: Thirty dental students were instructed how to fill curved simulated canals with gutta-percha and sealer using lateral and vertical compaction. Digital radiographs were taken in buccolingual and mesio-distal projections; radiographs were evaluated for homogeneity and root canal wall contact. Plastic blocks with simulated canals were sectioned and cross sections were assessed under a light microscope for voids. Probabilities were expressed as odds ratios (OR) with 95% confidence intervals (CI).Results: Radiographs showed that the chances of obtaining a homogeneous root canal filling by using a vertical compaction technique were 3 times higher in the coronal canal third (OR 3.2; CI: 1.9, 5.3), the same in the middle third, and 2 times higher in the apical third (CI: 1.1, 2.4) than when using lateral compaction. Microscopic evaluation of the same canals revealed that the chances of obtaining a homogeneous root canal filling by vertical compaction were 3 times higher in the coronal canal third (CI: 1.6, 5.8), almost 3 times higher in the middle canal third (CI: 1.6, 4.7), and about 10 times higher in the apical canal third (OR 9.8; CI: 2.2, 43.4) than by lateral compaction. The chances of transporting filling material beyond the apex were almost 5 times higher (OR 4.6; CI: 2.8, 7.6) when using vertical rather than lateral compaction.Conclusion: Inexperienced students obtained more homogeneous root canal fillings with the vertical compaction method; however, the probability of overextruding filling material with this method was high.

Shaping canals with ProFiles and K3 instruments: does operator experience matter?

M.A. Al-Omari, Tais Aurich, Schyla Wirtti — 2010-06-28

Objective: The aim of this study was to determine the influence of operator experience on the shaping ability of ProFile and K3 nickel-titanium rotary instruments in simulated root canals.Study design: One hundred sixty simulated canals consisting of 4 different shapes in terms of angle and position of curvature were prepared by experienced and inexperienced operators. One experienced operator prepared 80 canals and 2 inexperienced operators prepared 80 canals with a crown-down technique using either ProFile or K3 .06 taper instruments. Images of the canals were taken, using a camera attached to a computer with image analysis software, before surgery and after preparation to sizes 20, 25, and 30 to working length. Postoperative images were combined with the preoperative image to highlight the amount and position of material removed during preparation as well as the shape of the prepared canal.Results: Overall, there was a highly statistically significant difference (P < .001) between the instruments for the time taken to prepare the canals, with K3 instruments taking a mean of 4.9 minutes and ProFile 6.0 minutes. Six instruments fractured (3 in each operator category); 4 were ProFile instruments. Four instruments deformed, all with the inexperienced operators; 3 were K3. No perforations or zips were observed; however, 1 danger zone (created by the experienced operator using K3 instruments) and 1 ledge (created by an inexperienced operator using K3 instruments) were created. Twelve outer widenings were created with a highly significant difference (P < .001) between the operator and instrument used. There was a highly significant difference by instrument (P < .001), and experience (P = .008) regarding absolute transportation at the beginning of the curve and a statistically significant difference (P = .031) for the instrument used regarding absolute transportation half way to the orifice.Conclusion: The experienced operator prepared canals more quickly and safely than the inexperienced operators when using K3 instruments; both used ProFile instruments quickly and safely. Inexperienced operators would be advised to train using less aggressive instruments and when confident could progress to other instrument designs.

2010-09-01

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2010-09-01

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2010-09-01

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2010-09-01

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology

Can saliva-based HPV tests establish cancer risk and guide patient management?

How to optimize the preparation of leukocyte- and platelet-rich fibrin (L-PRF, Choukroun's technique) clots and membranes: Introducing the PRF Box

How to optimize the preparation of leukocyte- and platelet-rich fibrin (L-PRF, Choukroun technique) clots and membranes: Introducing the PRF Box

Prognosis of the implants replaced after removal of failed dental implants

Challenges associated with reentry maxillary sinus augmentation

Rotational movement of the anterior maxillary segment by hybrid distractor in patients with cleft lip and palate

Finite element analysis of the human mandible at 3 different stages of life

The Use of Bone Morphogenic Protein for Bone Grafting Alveolar Defects

The Use of Stereolithic Models for Fabrication of Immediate Load All-On-Five Dental Implants

Computer-Aided Planning of Maxillo-Mandibular Defect Reconstruction Using Fibular-Free Flaps, Cutting Templates and Intra-Operative Navigation

Computer-Assisted Orthognathic Surgery – Dental and Skeletal Outcomes

Distraction Osteogenesis for Primary Reconstructive Treatment of an Avulsive Gun Shot Wound to the Mandible

Idiopathic Condylar Resorption: Analysis of Treatment Outcomes Using Custom-Made TMJ Total Joint Prostheses

Mandibular Basal Osteotomy (Wing Genioplasty)

Improving the Accuracy of Orthognathic Surgery Through the Use of the Tridimensional Orthognathic Gauge™

Mathematical Model for Osteobstruction in Bone Regeneration Mechanisms: A Headway in Skeletal Tissue Engineering

Open Reduction and Internal Fixation of Mandibular Angle Fractures: A Comparison of Endoscopically-Assisted vs. Non-Endoscopically-Assisted Approaches

7-Year Retrospective Evaluation of Craniofacial Fractures in Helmeted vs. Non-Helmeted Motorcycle Crashes in Broward County, Florida

Anterior Zygoma Implants as an Alternative for the Adult Alveolar Cleft

Stryker Navigation System Protocol for Craniofacial Reconstruction Planning

Surgically-Assisted Rapid Canine Orthodontic Distraction

Treatment of Hemifacial Microsomia with Unilateral Temporomandibular Joint Replacement (TMJ Concepts) in Conjunction with Bimaxillary Surgery

Reconstruction of partial maxillary defect with intraoral distraction osteogenesis assisted by miniscrew implant anchorages

A comparison of bone generation capability in rabbits using tooth ash and plaster of Paris with platelet-rich plasma or fibrin sealant

Association of oral lichen planus with thyroid disease in a Finnish population: a retrospective case-control study

Adrenal crisis provoked by dental infection: case report and review of the literature

Changes in saliva interleukin-6 levels in patients with oral squamous cell carcinoma

Acquired von Willebrand disease secondary to hypothyroidism: a rare cause for postextraction hemorrhage

New alternative therapy for orofacial localized scleroderma

Evidence for the changes of antitumor immune response during lymph node metastasis in head and neck squamous cell carcinoma

Gene expression of oncogenes, antimicrobial peptides, and cytokines in the development of oral leukoplakia

Peripheral odontogenic fibroma: a clinicopathologic study of 151 cases and review of the literature with special emphasis on recurrence

Human papillomavirus in ameloblastoma

Thyroid-like papillary adenocarcinoma of the nasopharynx: a case report in a 19-year-old male

Usefulness of MRI and dynamic contrast-enhanced MRI for differential diagnosis of simple bone cysts from true cysts in the jaw

Integration accuracy of digital dental models and 3-dimensional computerized tomography images by sequential point- and surface-based markerless registration

Comparison of the efficacy of conventional radiography, digital radiography, and ultrasound in diagnosing periapical lesions

Effects of tube current on cone-beam computerized tomography image quality for presurgical implant planning in vitro

Relation between disk/condyle incoordination and joint morphological changes: a retrospective study on 268 TMJs

Effect of calcium hydroxide dressing on the long-term sealing ability of two different endodontic sealers: An in vitro study

Assessment of apically extruded debris produced by the single-file ProTaper F2 technique under reciprocating movement

Effect of different water flows on root surface temperature during ultrasonic removal of posts

Cyclic fatigue resistance of ProTaper Universal instruments when subjected to static and dynamic tests

Homogeneity of root canal fillings performed by undergraduate students with warm vertical and cold lateral techniques

Shaping canals with ProFiles and K3 instruments: does operator experience matter?

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