Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology - Articles in Press

Mutational analyses of the BRAF, KRAS, and PIK3CA genes in oral squamous cell carcinoma - Corrected Proof

Karl C. Bruckman, Frank Schönleben, Wanglong Qiu, Victoria L. Woo, Gloria H. Su — 2010-09-02

Objectives: The development of oral squamous cell carcinoma (OSCC) is a complex, multistep process. To date, numerous oncogenes and tumor-suppressor genes have been implicated in oral carcinogenesis. Of particular interest in this regard are genes involved in cell cycling and apoptosis, such BRAF, KRAS, and PIK3CA genes.Study design: Mutations of BRAF, KRAS, and PIK3CA were evaluated by direct genomic sequencing of exons 1 of KRAS, 11 and 15 of BRAF, and 9 and 20 of PIK3CA in OSCC specimens.Results: Both BRAF and KRAS mutations were detected with a mutation frequency of 2% (1/42). PIK3CA mutations were detected at 3% (1/35).Conclusions: This is the first report implicating BRAF mutation in OSCC. Our study supports that mutations in the BRAF, KRAS, and PIK3CA genes make at least a minor contribution to OSCC tumorigenesis, and pathway-specific therapies targeting these 2 pathways should be considered for OSCC in a subset of patients with these mutations.

Influence of chemical irrigants on the tensile bond strength of an adhesive system used to cement glass fiber posts to root dentin - Corrected Proof

2010-09-02

Objective: The aim of this study was to evaluate the influence of endodontic irrigants on the tensile bond strength of an adhesive system used to cement glass fiber posts to dentin.Study design: Fifty bovine roots were divided into 5 groups according to the solution used during instrumentation: G1, 0.9% NaCl (control); G2, 1.0% NaOCl; G3, 2.5% NaOCl; G4, 5.25% NaOCl; G5, 2% chlorhexidine gel + 0.9% NaCl. The root canals were obturated with gutta-percha and AH Plus sealer, and the glass fiber posts were cemented with Clearfil SE Bond/RelyX ARC. The specimens were submitted to tensile strength testing and the results were analyzed by analysis of variance.Results: There were no statistically significant differences regarding the irrigant solution factor (P > .70).Conclusion: It was concluded that the different irrigant solutions did not affect the tensile bond strength of the fixation system used to cement the intraradicular glass fiber posts to dentin.

Oral presentation of malignant mesothelioma - Corrected Proof

2010-09-02

We report a case of metastatic mesothelioma presenting as an oral metastasis in a 46-year-old patient. The patient presented with 2 polypoid lesions that appeared to be benign on the dorsum of the tongue. Excisional biopsy showed the presence of metastatic carcinoma that on further investigation proved to be mesothelioma. The initial presentation of mesothelioma as an oral metastasis is not previously reported. This article highlights the importance of biopsy and histopathological diagnosis in presumed benign lesions and the role of the general dental practitioner in screening for oral neoplasms.

Transcription factor osterix modified bone marrow mesenchymal stem cells enhance callus formation during distraction osteogenesis - Corrected Proof

2010-09-02

This study was designed to investigate the effects of local delivery of bone marrow mesenchymal stem cells (BMMSCs) with or without osterix (OSX) gene transfected on bone regeneration in the distracted zone using a rabbit model of mandibular lengthening. Fifty-four New Zealand white rabbits underwent osteodistraction of the left mandible and were then randomly divided into group A, group B, and group C (n = 18 for each group). At the end of distraction BMMSCs transfected with OSX, autologous BMMSCs and physiological saline were injected into the distraction gaps in groups A, B, and C, respectively. Nine animals from each group were humanely killed at 2 and 6 weeks after completion of distraction. The distracted mandibles were harvested and processed for radiographic, histological, and immunohistochemical examination. Excellent bone formation in the distracted callus was observed in group A and group B; the former showed better bone formation and highest bone mineral density (BMD), thickness of new trabeculae (TNT, mm) and volumes of the newly formed bone area (NBV) in the distraction zones. Group C animals showed poor bone formation in the distracted callus when compared with groups A and B. Positive immunostaining of bone sialoprotein (BSP) was observed in the distracted callus in all groups; however, BSP expression was much stronger in group A than in groups B and C. The results of this study suggest transplantation of BMMSCs can promote bone formation in DO; OSX-mediated ex vivo gene therapy was more effective during bone deposition and callus formation in distraction osteogenesis.

Endodontic flare-ups: a prospective study - Corrected Proof

Vanessa de Oliveira Alves — 2010-09-02

The objective of this prospective clinical study was to evaluate the incidence of flare-ups (pain and/or swelling requiring endodontic interappointment and emergency treatment) and identify the risk factors associated with their occurrence in patients who received endodontic treatment from June 2006 to June 2007 at the endodontics clinic of the São Paulo Dental Association (APCD), Jardim Paulista branch, São Paulo, Brazil. The incidence of flare-ups was 1.71% out of 408 teeth that had received endodontic therapy. Statistical analysis using the chi-squared test (P < .05) indicated a direct correlation between the flare-up rate and the presence of a periradicular radiolucency.

A new topical treatment protocol for oral hairy leukoplakia - Corrected Proof

2010-09-02

Objective: The aim of this study was to present a new topical treatment protocol for oral hairy leukoplakia (OHL), consisting of a 25% podophyllin resin with a 1% penciclovir cream (PP), and to compare this topical treatment protocol's efficacy with that of 2 other topical treatment protocols: a 25% podophyllin resin (P) and a 25% podophyllin resin with a 5% acyclovir cream (PA).Study design: Forty-two human immunodeficiency virus–positive patients with 69 OHL lesions were randomly treated using P, PA, or PP (14 patients in each topical treatment protocol). Clinical healing was determined when the white plaque could no longer be seen in the primary location of the lesion. Topical treatment performance was evaluated by clinical healing within each week of topical treatment protocol as well as by the recurrence of the lesion. Statistical survival analysis was performed using a Cox proportional hazards model.Results: Approximately 55% of the patients presented with clinical healing of OHL within 7-8 weeks of each topical treatment protocol. After the sixth week, the PA treatment protocol presented a faster clinical healing rate of OHL. Recurrence was observed in 3 and 7 OHL lesions treated with P and PP treatment protocols, respectively.Conclusions: The PP treatment protocol proved to be effective; however, the PA treatment protocol was more effective in the clinical healing rate for OHL than P and PP after the sixth week of treatment, and no recurrent OHL was observed in the PA treatment group.

Complications after mandibular distraction osteogenesis: a retrospective study of 131 patients - Corrected Proof

Sven Erik Nørholt, John Jensen, Søren Schou, Thomas Klit Pedersen — 2010-09-02

Objectives: The objectives of this study were to evaluate the occurrence and severity of complications after mandibular distraction osteogenesis (DO) with internal devices.Study design: The study was a retrospective analysis of 131 patients (mean age: 16.2 years) consecutively treated by mandibular DO from 1998 to 2009. Ninety-two patients had unilateral and 39 had bilateral distraction, yielding a total of 170 procedures. The mean follow-up period was 21 months. Severity of complications was ranked in terms of need of intervention and risk of a compromised outcome.Results: Minor, moderate, and severe complications occurred in 58%, 8%, and 3% of the patients, respectively. Most minor complications were related to device activation or temporary hypesthesia. Moderate complications often related to hardware, whereas severe complications occurred in 4 patients with sensory deficit or temporomandibular joint problems.Conclusions: Although minor complications were frequent, they did not compromise treatment outcome, so mandibular DO is considered a safe method for correction of mandibular deformities. Moreover, some of the complications could be prevented by proper precautions.

Donor site morbidity using the Buccinator Myomucosal Island Flap - Corrected Proof

2010-09-02

Objective: The objective of this study was to analyze our experience with donor site morbidity after harvesting a buccinator myomucosal island flap (BUMIF) for reconstructing surgical defects involving the tongue and floor of the mouth after oncological resections in 15 consecutive patients.Study design: Donor site morbidity was evaluated using 5 parameters: mouth opening, oral commissure symmetry, inner vestibule restoration, cheek mucosal lining, and the esthetic result. The clinical evaluation was performed by a blinded panel of 2 clinicians and the patient him- or herself, assessing each parameter with a score ranging from 0 to 3. The 3 scores for each parameter were summed to obtain a score reflecting the overall parameter assessment.Results: The mean mouth opening score was 8.6 out of a maximum of 9 (range, 6-9). The mean commissure symmetry was 8.6 (range, 7-9), the mean inferior vestibule score was 8 (range, 6-9), the mean cheek lining score was 8.2 (range, 7-9), and the mean final esthetic score was 8.5 (range, 6-9).Conclusion: The results of this retrospective evaluation demonstrate that when special care is taken in the management of the BUMIF donor site, its morbidity is extremely low, allowing optimal functional and cosmetic results and confirming the major role of this flap in reconstructing moderate-size defects following tongue and floor of the mouth resections.

CAD/CAM surface templates as an alternative to the intermediate wafer in orthognathic surgery - Corrected Proof

2010-09-02

Objective: A new simple technique using a pair of surface templates fabricated by CAD/CAM technique as an alternative to the use of intermediate surgical wafer is presented.Study design: A patient with transverse maxillary cant and maxillary midline deviation was scanned using computed tomography (CT) to create a 3D model of the maxillofacial bone. Eight virtual cylindrical markers were placed on the selected locations of maxilla. Subsequently, the locations of these cylinders were expressed as drill holes in the preosteotomy templates. The maxillary segment was separated and repositioned in the computer according to preoperative plans. Postosteotomy surface templates were then designed and resin templates were fabricated by a rapid prototyping machine. After investing and casting, metal templates were fabricated. At the beginning of operation, surgical fixation holes on the maxilla were drilled with the preosteotomy templates. Once maxillary osteotomy and segmentation were finished, screws were placed through the holes in the postosteotomy templates into the predrilled holes on the bone correspondingly, and maxillary segments were fixed with the titanium plates.Results: After the postosteotomy templates were positioned and fixed, the maxillary segment was placed to the desired position. Maxillary transverse cant and midline deviation were corrected as the preoperative plan and simulation.Conclusion: The use of the surface templates before and after osteotomy as an alternative to intermediate wafer in orthognathic surgery can minimize labor and errors contained in the traditional way, reducing preoperative work as well as a reduction in operation time.

Oral and maxillofacial radiology as a dental specialty: The first decade - Corrected Proof

William C. Scarfe — 2010-08-23

This year, 2010, marks multiple chronologic milestones for oral and maxillofacial radiology (OMR) in the United States. Most importantly, it is the 10th anniversary of the accreditation of OMR as the 9th recognized dental specialty by the American Dental Association (ADA)—the first such recognition since endodontology in 1963. Although approved by the ADA House of Delegates at their annual autumn meeting in 1999, OMR officially became a specialty effective with the new millennium in 2000. Every 10 years, however, each specialty must undergo a self-study and periodic review, and submit this to the ADA Council on Dental Education and Licensure (ADA-CDEL) for consideration of continuance of specialty status. Therefore, 2010 also provides an administrative marker to evaluate the activities of OMR over the first decade of specialty status, culminating with the submission of a periodic review for OMR to ADA-CDEL this past April. The maturity of OMR is also highlighted this year by 2 other anniversaries: the 61st year of the sponsoring organization of OMR, the American Academy of Oral and Maxillofacial Radiology (AAOMR), initially founded as the American Academy of Dental Roentgenologists, and the 29th year of the formation of the certifying body of OMR, the American Board of Oral and Maxillofacial Radiology.

Simultaneous maxillomandibular distraction osteogenesis in severe progressive hemifacial atrophy with two distractors - Corrected Proof

2010-08-13

Progressive hemifacial atrophy is a rare disorder characterized by an acquired, idiopathic, self-limited, unilateral facial atrophy involving skin, subcutaneous tissue, fat, muscle, and bone. Symmetry and contour restoration are the main treatment challenges. Among many techniques, microvascular reconstruction has been introduced as the gold standard to correct the atrophic deformity. For some patients with severe manifestations, soft tissue reconstruction alone does not obtain the desired outcome. In this series, we used an effective method to restore the severe progressive hemifacial atrophy by simultaneous maxillomandibular distraction osteogenesis with 2 distractors. The results demonstrate an improvement in both the profile and the occlusion plane of the patients with corresponding satisfactory esthetic and functional outcomes. We conclude that the simultaneous maxillomandibular distraction osteogenesis with 2 distractors is an effective method for hemifacial atrophy and bone frame reconstruction, especially ones involved in the discrepancy of the occlusal plane.

Unusual oral complications of herpes zoster infection: Report of a case and review of literature - Corrected Proof

Manoj Kumar Jain, K.S. Manjunath, S.N. Jagadish — 2010-08-09

A case of herpes zoster infection with unusual oral complications involving the mandibular division of the trigeminal nerve is presented. The post-herpetic complications of osteonecrosis, spontaneous exfoliation of teeth, and subsequent pathologic fracture of mandible in the absence of concurrent predisposing factors in a 65-year-old man are demonstrated. Forty-one cases with osteonecrosis and spontaneous exfoliation of teeth previously presented in the literature are reviewed. This is the first report of pathologic fracture after herpes zoster infection.

Case report: endodontic and surgical treatment of an upper central incisor with external root resorption and radicular cyst following a traumatic tooth avulsion - Corrected Proof

Hans-Christian Lux, Falko Goetz, Elmar Hellwig — 2010-08-09

In the age group between 6 and 12 years, trauma to the upper incisors happens frequently. In the case of avulsion, a replantation is the state-of-the-art treatment; however, it may lead to several complications, particularly if suitable posttraumatic management is not carried out. External cervical resorptions as well as apical granuloma and cysts due to microbial contamination of the root canal are common complications. In the presented trauma case, a conservative approach was chosen to treat a large cystic lesion combined with cervical and apical resorptions.After initial placement of Ledermix and calcium hydroxide into the root canal, a marsupialization with the temporary insertion of an obturator was performed. The gradual reduction led to a fast recovery of the bony defect and a root canal filling was placed. The 2-year follow-up showed an improved condition. All adjacent teeth remained vital during the course of the treatment.

Clinical experiences of digital model surgery and the rapid-prototyped wafer for maxillary orthognathic surgery - Corrected Proof

2010-08-09

Objective: The aim of this study was to present our clinical experience regarding the production and accuracy of digitally printed wafers for maxillary movement during the bimaxillary orthognathic surgery.Study design: Fifty-five consecutive patients requiring maxillary orthognathic surgery were included in this study. The plan for digital model surgery (DMS) was dictated by the surgical plans for each clinical case. We carried out digital model mounting, DMS, wafer printing, and confirmation of the accuracy of the procedure.Results: Moving the reference points to the target position in DMS involved a mean error of 0.00-0.09 mm. The mean errors confirmed by the model remounting procedure with the printed wafer by DMS were 0.18-0.40 mm (for successful cases; n = 42) and 0.03-1.04 mm (for poor cases; n = 3).Conclusion: The accuracies of the wafers by DMS were similar to those for wafers produced by manual model surgery, although they were less accurate than those produced by DMS alone. The rapid-prototyped interocclusal wafer produced with the aid of DMS can be an alternative procedure for maxillary orthognathic surgery.

Fixation, registration, and image-guided navigation using a thermoplastic facial mask in electromagnetic navigation–guided radiofrequency thermocoagulation - Corrected Proof

2010-08-09

Objective: For fixation, registration, and image-guided navigation, the aim of this study was to evaluate a thermoplastic facial mask with plastic markers in achieving frameless stereotactic radiofrequency thermocoagulation (RFT).Study design: A thermoplastic facial mask was remolded according to each subject's face. Six markers were placed on the surface and 6 inside. Series of 1.25-mm- and 2.5-mm-slice computerized tomography (CT) scans were made to provide radiologic data. During the phantom study, each plastic sphere inside was selected in turn as the target for frameless stereotaxy. The clinical Hartel puncture of the foramen ovale (FO) was imitated using an electromagnetic navigation system. Navigation-guided RFT was tried in 3 patients.Results: The mean location error was 1.29 mm (SD ±0.39 mm). No significant difference (P > .05) was proven between 1.25-mm and 2.5-mm CT slice acquisition for the image datasets used. The FO punctures in clinical trials were successful and confirmed by CT.Conclusions: Registration and fixation via a fiducial marker–based thermoplastic facial mask is accurate and feasible for use in navigation-guided RFT.

Influence of chlorhexidine application at longitudinal push-out bond strength of fiber posts - Corrected Proof

2010-08-09

Objective: The objective of this study was to evaluate the influence of chlorhexidine application after dentin phosphoric acid etching at immediate and long-term bond strength of a fiber post cemented to root dentin.Study design: Seventy-two single-rooted, human upper teeth were selected. After phosphoric acid etching, each group received a different dentin treatment: no pretreatment or chlorhexidine 0.2% or 2.0%. Three-step etch-and-rinse adhesive and dual-cured resin cement was used to cementation procedure. Half of the teeth were submitted to push-out bond strength test after 24 hours and the other half after 6 months. Data were analyzed by 2-way ANOVA and Tukey.Results: Chlorhexidine application had no influence on bond strength when teeth were stored at the same aging time (P > .05). The storage time significantly decreased the bond strength values of 24 hours to 6 months in all groups (P < .05).Conclusion: After 6 months, chlorhexidine application did not effectively arrest bond strength degradation of fiber posts cemented in human roots.

Fibrous cortical defect (nonossifying fibroma) of the mandibular ramus: report of 2 cases - Corrected Proof

Rafik A. Abdelsayed, Suash Sharma, Henry Ferguson — 2010-08-09

Fibrous cortical defect, also known as metaphyseal fibrous defect and nonossifying fibroma, among other terms, is a benign, non-neoplastic proliferative process that is relatively common in the long bones of skeletally immature adolescents. Although the lesion is thought to be a developmental abnormality or defect, the exact etiopathogenesis is largely unknown. The lesion has a limited growth potential and good treatment outcome. This process is very rare in the gnathic bones, and only a few sporadic case reports are documented. This article presents the clinicopathologic features of 2 additional cases and reviews the relevant literature in attempt to identify key features and facilitate rendering definitive diagnosis for this rare entity.

Minor salivary gland squamous cell carcinoma of the lower lip demonstrating striking perineural invasion - Corrected Proof

2010-08-09

Squamous cell carcinomas (SCC) of minor salivary gland origin are extremely rare. We present an unusual case of a 29-year-old female patient who presented with a well-differentiated SCC of minor salivary gland origin arising in the lower lip. Wedge resections of the lip, including bilateral mental nerve excision, were required to clear the tumor because of striking pathological evidence of perineural invasion distant from the primary tumor site.

Sunitinib may raise the risk of bisphosphonate-related osteonecrosis of the jaw: presentation of three cases - Corrected Proof

Sebastian Hoefert, Harald Eufinger — 2010-08-09

Objective: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a serious side effect of bisphosphonate (BP) medication. Tooth extractions are the most frequent causes for BRONJ. In some cases BRONJ is observed spontaneously, with some anatomic sites carrying a higher risk. Sunitinib, a tyrosine kinase inhibitor, is established in renal cell carcinoma and is known to lead to oral mucositis as a side effect, which in BP patients may additionally raise the risk of BRONJ.Study design: We present 3 patients with renal cell carcinoma under BP medication who developed BRONJ during and after sunitinib medication.Results: In 2 patients, BRONJ was linked to the occurrence of mucositis after sunitinib intake. The third patient showed relapse of completely healed BRONJ lesions shortly after resumption of a sunitinib therapy.Conclusions: Oral mucositis during chemotherapy may raise the risk of BRONJ in cancer patients with BP medication. Especially in renal cell carcinoma patients under sunitinib therapy and intravenous BP medication, oral mucositis should be observed closely because it could be a risk factor for BRONJ.

Scanning electron microscope evaluation of chlorhexidine gel and liquid associated with sodium hypochlorite cleaning on the root canal walls - Corrected Proof

2010-08-09

Objective: The aim of this study was to evaluate, by scanning electronic microscopy (SEM), the cleaning of the root canal walls after instrumentation and irrigation with 2.5% sodium hypochlorite (NaOCl) associated with 2% chlorhexidine (CHX) gel or liquid, combined or not with 17% ethylenediamine tetra-acetic acid (EDTA).Study design: Sixty single-root human teeth were subjected to standardized root canal instrumentation with different irrigants (n = 10): G1) NaOCl + CHX liquid; G2) NaOCl + CHX liquid + EDTA + saline solution; G3) NaOCl + CHX gel; G4) NaOCl + CHX gel + EDTA + saline solution; G5) saline solution; G6) saline solution + EDTA. After instrumentation, the teeth were prepared for SEM analysis (×500 and ×2,000) to evaluate the cleaning of the cervical, middle, and apical thirds. The area analyzed was quantified according to the percentage of open and closed tubules, and data were statistically analyzed by analysis of variance and Tukey tests (P = .05).Results: The number of open tubules was highest in G4 in all root thirds, showing statistically significant difference from G1, G2, and G5 (P < .05). G1 presented higher quantity of closed tubules significant than G2.Conclusion: Irrigation with NaOCl and CHX gel followed by EDTA and saline solution produced greater cleaning of the root canal walls.

Oral focal mucinosis associated with cervical external root resorption: A case report - Corrected Proof

Eran Gabay, Akrish Sharon, Eli E. Machtei — 2010-08-05

Background: Oral focal mucinosis (OFM) and cervical external root resorption are both rare lesions with an unknown etiology. In this article we report on a rare occurrence of OFM associated with cervical external root resorption.Methods: A 44-year-old female patient presented with sharp pain while drinking cold beverages and a firm localized gingival overgrowth adjacent to the buccal aspect of tooth #19. An excisional biopsy of the gingival lesion was taken and a deep cavity was found in the buccal aspect of the root. The cavity was restored with an amalgam filling.Results: The histological findings were of a well-circumscribed lesion composed of myxomatous connective tissue, which contained numerous stellate-shaped fibroblasts. Based on the findings, a diagnosis of OFM was made.Conclusion: A rare case of OFM and cervical external root resorption occurring in the same site was described. A possible link between these 2 phenomena was hypothesized.

The role of surgical therapy in the management of intravenous bisphosphonates-related osteonecrosis of the jaw - Corrected Proof

2010-08-05

Objectives: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) seems resistant to conventional treatment approaches. We report a study with a surgical concept characterized by resection of the necrotic bone followed by sufficient wound closure.Study design: In a clinical study of 24 patients with 33 sites of BRONJ, the surgical basis of the treatment was as follows: (1) conservative treatment with antimicrobiological rinsing, (2) resection of the entire necrotic bone and smoothening of any sharp bone edges, and (3) coverage of the remaining bone by use of a bilayered wound closure.Results: In 88% of cases, BRONJ could be treated with success by use of this surgical therapy. Median follow-up was 60 weeks. There was no statistically significant difference between treatment results irrespective of whether or not bisphosphonate treatment was continued.Conclusion: Because of the high success rate of this surgical technique it seems that patients with BRONJ may benefit from this approach.

Predicting risk for bisphosphonate-related osteonecrosis of the jaws: CTX versus radiographic markers - Corrected Proof

2010-08-05

Background and objective: The most common risk factor for bisphosphonate-related osteonecrosis of the jaws (BRONJ) is dentoalveolar surgery. It has been suggested that reduced serum C-terminal telopeptide (CTX) can determine the degree of osteoclast suppression and may predict the development of BRONJ after dentoalveolar surgery. Although there are many radiographic appearances associated with BRONJ, there are little data that describes changes preceding dentoalveolar surgery. The objective of this retrospective study was: 1) to investigate if reduced serum CTX values (i.e., <150 pg/mL) were associated with BRONJ after dentoalveolar surgery; and 2) to determine if specific radiographic changes are associated with teeth that develop BRONJ after extraction.Study design: A retrospective review of radiographic and/or serum CTX data was performed for 68 patients with a history of bisphosphonate therapy who either underwent dental extraction or were diagnosed with BRONJ in the Department of Oral and Maxillofacial Surgery during the period 2007-2009. Postoperative healing was assessed for 26 patients with reduced serum CTX levels (<150 pg/mL) who either underwent dental extraction or treatment for BRONJ. Preoperative radiographs were evaluated for 55 patients who either healed normally or developed BRONJ after dental extraction.Results: All 26 patients (100%) who had serum CTX levels <150 pg/mL healed successfully after dentoalveolar surgery (20 patients) or after treatment for BRONJ (6 patients). Among the 55 patients who underwent radiographic evaluation, 24 patients (83%) with BRONJ exhibited periodontal ligament (PDL) widening associated with extracted teeth, whereas only 3 patients (11%) who healed normally demonstrated PDL widening.Conclusion: These data suggest that radiographic PDL widening may be a more sensitive indicator than CTX testing in predicting risk of BRONJ. Current guidelines that recommend minimal surgical intervention may need to be revised to include alternative strategies for the elimination or management of this pathology.

Comparison of flap and flapless procedures for the stability of chemically modified SLA titanium implants: an experimental study in a canine model - Corrected Proof

2010-08-05

Background: Flapless implant surgery has been shown to accelerate recovery and increase the vascularity of the peri-implant mucosa after implant placement.Objective: The aim of this study was to compare dental implant stabilization patterns between flap and flapless implant surgeries over the first 8 weeks after implant placement.Study design: In 6 mongrel dogs, bilateral, edentulated, and flat alveolar ridges were created in the mandible. After 3 months of healing, 2 implants (Straumann SLA-active) were placed in each side of the mandible using either a flap or flapless procedure. The implant stability quotient (ISQ) that was obtained from Osstell Mentor was measured at the time of implantation and weekly over the first 8 weeks after implant placement.Results: Implants stabilized more quickly without flap elevation than with flap elevation. For flapless implants, an increase in stability occurred after 2 weeks without a period of decreasing stability. However, for flap implants, a shift in implant stability from decreasing stability to increasing stability occurred after 2 weeks.Conclusion: In the canine model, flapless surgical placement of implants may increase the initial stability of implants compared with implants placed after the reflection of the mucoperiosteal flap.

Orthodontic extrusion of the lower third molar with an orthodontic mini implant - Corrected Proof

Wonse Park, Joon-Soo Park, Yun-Mi Kim, Hyung-Seog Yu, Kee-Deog Kim — 2010-08-05

Neurologic changes owing to damage to the inferior alveolar nerve (IAN) are the most serious complication of lower third molar (M3) extraction because of their close spatial relationship. We adopted the concept of regional orthodontic treatment and extrusion, using skeletal anchorage with an orthodontic mini implant. Two malformed M3s that were closely apposed to the IAN were extruded with the aid of 3 or 4 orthodontic brackets and a mini implant. Both of the M3s were extruded successfully. The patients experienced little discomfort with the orthodontic appliances and there was neither permanent neurologic damage nor fracture of the root fragments following subsequent M3 extraction. Orthodontic treatment using a miniscrew to separate the IAN and M3, or luxation of the M3 may be a good alternative treatment option for extrusion of a vertically impacted lower M3 with fragile roots.

Comparison of ondansetron and metoclopramide antiemetic prophylaxis in maxillofacial surgery patients - Corrected Proof

Koroush Taheri Talesh, Mohammad Hosein Kalantar Motamedi, Shiva Kahnamouii — 2010-08-05

Purpose: The purpose of this study was to compare the efficacy of ondansetron and metoclopramide, administered for the prophylaxis of vomiting in patients undergoing oral and maxillofacial surgery under general anesthesia.Methods: One hundred patients undergoing mandibular osteotomy surgery were studied. Patients were allocated randomly to receive 1 of 2 treatment regimens: 0.15 mg/kg ondansetron or 0.5 mg/kg metoclopramide intravenously 30 minutes before extubation. All were adults and were treated by one surgeon and all operations were the same and lasted 2.5 to 3.0 hours. The patients were assessed at 3 time periods: 0 to 3 hours, 3 to 12 hours, and 12 to 24 hours postoperatively for emesis.Result: The data from this study showed that during the first 24-hour postoperative period, patients receiving ondansetron following general anesthesia had an 11% (11 patients) incidence of emesis compared with 28% (22 patients) in the group that received metoclopramide.Conclusion: In this study, ondansetron (0.1 mg/kg) was twice as effective in preventing postoperative vomiting compared with metoclopramide.

Oral ulcer associated with alendronate: a case report - Corrected Proof

Mohammad Kharazmi, Kerstin Sjöqvist, Milad Rizk, Gunnar Warfvinge — 2010-08-05

Irritation of the mucosa of the aerodigestive tract is a well-known adverse effect of alendronate, whereas oral ulceration has been reported in only 14 articles in both the English and non-English literature. All of these have been associated with misuse of the drug. We here present the first case of severe oral ulceration attributable to use of alendronate without inappropriate therapeutic administration of the medication.

Predisposition of allergy in patients with benign migratory glossitis - Corrected Proof

Mustafa Goregen, Mehmet Melikoglu, Ozkan Miloglu, Teoman Erdem — 2010-08-05

Objective: The purpose of this study was to investigate the presence of allergy in patients with benign migratory glossitis (BMG) using patch and prick tests.Patients and methods: Eighty patients (40 BMG and 40 healthy controls) received patch and prick tests. If at least one test result was positive, patients were considered to be allergic.Results: The prick test was positive in 10 patients (25.0%) of the study group and in 4 patients (10.0%) of the control group. The patch test was positive in 12 patients (30.0%) of the study group and in 6 patients (15.0%) of the control group. When results of both tests were evaluated together, the study group showed a positive rate of 47.5% (n = 19), whereas the control group showed a positive rate of 22.5% (n = 9) (P = .02).Conclusion: Our results revealed that a combination of prick and patch tests can significantly enhance the diagnostic accuracy of predisposition of allergy in patients with BMG.

SAPHO syndrome with affection of the mandible: diagnosis, treatment, and review of literature - Corrected Proof

2010-08-05

The synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare syndrome of unknown etiology. Involvement of the mandible is found in almost 10% of cases. In the literature, conservative treatment is recommended most often, because decortication and partial resection are found to be ineffective and of temporary profit. We report a case of SAPHO syndrome in a 44-year-old women with unilateral hyperostosis of the mandible and massive painful swelling of the surrounding soft tissues. Owing to facial disfiguration and pain, resection of the affected bone followed by immediate reconstruction with a microvascular iliac crest flap were performed. The aim of this paper was to present the necessity of surgical intervention in SAPHO syndrome of the mandible in cases of esthetic and functional limitation.

Implant-supported restoration of congenitally missing teeth using cancellous bone block-allografts - Corrected Proof

2010-08-05

Background and objective: Patients with congenitally missing teeth may present with undeveloped alveolar bone morphology, making implant reconstruction a challenge. The aim of the present study was to evaluate the outcome of dental implants after ridge augmentation with cancellous freeze-dried block bone allografts in patients with congenitally missing teeth.Study design: Twelve patients with a mean age of 21 ± 4 years, were included. Congenitally missing teeth included maxillary lateral incisors, a maxillary canine, and mandibular central and lateral incisors. A bony deficiency of ≥3 mm horizontally and ≤3 mm vertically according to computerized tomography served as inclusion criteria. Twenty-one implants were inserted after a healing period of 6 months. Five out of 21 implants were immediately restored. Bone measurements were taken before bone augmentation, during implant placement, and at second-stage surgery.Results: Nineteen cancellous allogeneic bone-blocks were used. The mean follow-up time was 30 ± 16 months. Bone block and implant survival rates were 100% and 95.2%, respectively. Mean bone gain was statistically significant (P < .001): 5 ± 0.5 mm horizontally and 2 ± 0.5 mm vertically. All of the patients received a fixed implant-supported prosthesis. Soft tissue complications occurred in 4 patients (30%). Complications after cementation of the crowns were seen in 1 implant (4.8%). All implants remained clinically osseointegrated at the end of the follow-up examination. There was no crestal bone loss around the implants beyond the first implant thread.Conclusion: Cancellous bone block-allografts can be used successfully for implant-supported restorations in patients with congenitally missing teeth.

Use of botulinum toxin A for drug-refractory trigeminal neuralgia: preliminary report - Corrected Proof

2010-08-05

Objective: Botulinum toxin type A (BTX-A) has been used to treat migraine and occipital neuralgia. We report preliminary results of an ongoing study that assesses the efficacy of BTX-A on trigeminal neuralgia (TN) patients refractory to medical treatment.Study design: We treated 15 patients (8 men and 7 women) between 28 and 67 years of age who were suffering from drug-refractory TN from February 2008 to January 2010. Symptoms, including pain duration, provoking factors, affected nerve branch, frequency of TN attacks, and severity of pain just before injections, were evaluated 1 week, 1 month, and 6 months after injection. We injected 50 U reconstituted BTX-A solution at the trigger zones. The overall response to treatment was assessed via a 9-point patient global assessment scale and compared with values at baseline. Statistical analysis was performed by the analysis of variance (ANOVA) test for frequency of TN attacks, the Friedman test for severity of pain, and the Wilcoxon signed-rank test for PGA, and all with the use of SPSS software.Results: Eight men and 7 women aged 28-67 years (mean 48.9 y) suffering from TN from 6 months to 24 years all improved regarding frequency and severity of pain attacks; in 7 patients, pain was completely eradicated and there was no need for further medication. In 5 patients, nonsteroidal antiinflammatory drugs were enough to alleviate pain attacks, and 3 patients again responded to anticonvulsive drugs after injection. All patients developed higher pain thresholds after injections. The ANOVA test showed a significant difference in frequency of attacks before injection and at 1 week, 1 month, and 6 months after injection (P < .001). Friedman test and pair comparison of pain severity scores with Bonferroni correction adjustment showed a significant difference (P < .001) between severity of pain before and after injection. Wilcoxon signed-rank test showed significant improvement in all patients up to 6 months after injection (P < .001). Complications included transient paresis of the buccal branch of the facial nerve in 3 patients.Conclusion: This study supports other similar studies and shows that BTX-A is a minimally invasive method that can play a role in treating TN before other more invasive therapies, i.e., radiofrequency and surgery.

Genetic analysis of intraoral KIT-positive gastrointestinal stromal tumor (GIST) - Corrected Proof

M.İsa Kara, Sinan Ay, Fahrettin Goze, Mehri İgci, Sahende Elagoz, Beyhan Cengiz — 2010-08-05

Gastrointestinal stromal tumors (GISTs), mesenchymal neoplasms originating from the cells of Cajal, usually appear in the gastrointestinal tract and abdomen. They often mimic other lesions, including smooth muscle cell tumors and neurogenic tumors. This study presents a case in which a GIST appeared over a 2-month period and was treated by excision and curettage, with no sign of recurrence during the next 42 months. The study also aims to characterize the GIST. Histopathologic analysis and KIT gene amplification and sequencing were performed. On mutation analysis of the GIST material, the novel 69338Tdel mutation was found in exon 11, and the diagnosis of intraoral stromal tumor was made. GISTs in the intraoral region display pathologic properties similar to others developed throughout the gastrointestinal system. Diagnosis is the first step of treatment for a patient. The discovery of oncogenic KIT mutations in GISTs has led to the development of targeted molecular therapy using tyrosine kinase inhibitors. This study investigates the histopathologic and molecular diagnostics of GISTs, and, to the authors' knowledge, it represents the first genetic study of a GIST developing in the intraoral region.

Time to abandon the term angiomyolipoma for non-PEComatous angiomyomatous (or angiomatous) oral tumors with adipocytes - Corrected Proof

2010-08-05

Angiomyolipoma (AML) is the most common benign mesenchymal neoplasm of the kidneys with well-established clinical and morphological features. The oral and maxillofacial pathology literature contains several examples that identify angiomyomatous proliferations of the oral mucosa that contain an adipocytic component as analogous to classic renal AMLs although they differ significantly in their immunohistochemical phenotype. Herein, through review of the pertinent oral pathology literature and the detailed description of 2 lesions, one an oral angiomyoma with an adipocytic component and the other an apparently hamartomatous angioleiomyomatous proliferation with adipocytes, we provide, in our opinion, a solid argument against the use of the term AML for non-PEComatous oral tumors.

The hazards of gutka chewing - Corrected Proof

Ajay G. Nayak, Yogesh Chhaparwal, Keerthilatha M. Pai — 2010-08-05

The review by Javed et al. addresses a very important health problem: gutka chewing, facing the populace of the Indian subcontinent and migrants thereof. It was interesting to read the concepts put forth, especially where the authors have focussed on gutka as a form of smokeless tobacco, thereby giving an impression that areca nut is only a secondary component. However, we would like to point out that gutka is primarily an areca nut–based product with processed additives that also include tobacco. Oral submucous fibrosis (OSF) is mentioned to be more common in gutka chewers than in nontobacco chewers, an erroneous comparison, because it has been conclusively proven that OSF occurs because of areca nut consumption and is not associated with tobacco. If tobacco had been a causative factor for OSF, then other forms of tobacco usage, such as raw tobacco chewing and cigarette/beedi/cigar/pipe smoking should manifest OSF; however, clinically it is never seen in individuals practicing exclusively tobacco abuse. By the same yardstick, the explanation of nicotine causing synergistic damage to fibroblasts does not hold true, as fibroblast damage in exclusive tobacco usage has never been reported. It is well known that fibroblast metabolism is altered owing to activation of procollagen genes, elevation of procollagen proteinase levels, and up-regulation of lysyl oxidase activity brought about by chewing areca nut, leading to increased fibrosis in the oral submucosa. In the discussion, the authors state that cessation of the habit may help to reduce the severity of the condition. Again in the context of OSF, the fibrotic bands once formed do not regress by just cessation of the habit, although the progression may be halted, but the risk of malignant transformation still exists.

Calvarial bone wound healing: a comparison between carbide and diamond drills, Er:YAG and Femtosecond lasers with or without BMP-7 - Corrected Proof

2010-07-26

Objective: This study compared the healing of 2 laser ablation units, erbium YAG and femtosecond lasers versus conventional mechanical cutting with carbide and diamond drills to explore future applications for bone surgery. The effects of laser or mechanical ablation combined with rhBMP-7 were also investigated.Methods and materials: Following defect standardization, a full-thickness circular defect was created on the parietal bones of 160 mice divided into 4 groups: carbide drill, diamond drill, erbium YAG laser, and femtosecond laser. Each of the 4 ablation groups was treated with and without BMP 7. Hard tissue healing was assessed using microcomputerized tomography at 3 and 12 weeks postsurgical time points.Results: The femtosecond laser created wounds that showed slightly delayed bone healing during the observation period when compared with mechanical drilling, although the difference was not statistically significant. The Er:YAG laser showed a healing rate similar to that of the mechanically ablated groups. When BMP 7 was added to the surgical sites, bone wound closure occurred at a similar rate in all test groups.Conclusions: The femtosecond and Er:YAG lasers are 2 laser modalities suitable for bone ablation that are comparable to mechanical instrumentation in terms of bone healing. This study suggested that BMP-7 may be used to enhance bone healing with success regardless of the ablative modality used, whether laser or mechanical drilling.

Complete congenital agenesis of all major salivary glands: A case report and review of the literature - Corrected Proof

N. Pham Dang, M. Picard, J.M. Mondié, I. Barthélémy — 2010-07-26

Congenital agenesis of the salivary glands is uncommon. There are documented cases of partial or unilateral aplasia of the major salivary glands associated with the lacrimal puncta, but very few reports of the absence of all major salivary glands. We report the case of a 10-year-old girl with xerostomia and extensive teeth caries. Physical examination and imaging showed total and bilateral aplasia of the parotid, submandibular, and sublingual glands, with no involvement of the minor salivary glands or the lacrimal puncta. We describe the clinical presentation, important aspects in diagnosing partial forms of the condition, and patient management.

Comparison of clinical outcomes of sinus bone graft with simultaneous implant placement: 4-month and 6-month final prosthetic loading - Corrected Proof

Young-Kyun Kim, Su-Gwan Kim, Jin-Young Park, Yang-Jin Yi, Ji-Hyun Bae — 2010-07-26

Objectives.: The aim of this study was to compare the survival rate and surrounding tissue condition of sinus bone grafts with simultaneous implant placement between 4-month and 6-month occlusal loading after implantation.Study design.: Twenty-seven patients (61 implants) who were treated with sinus bone grafts (sinus lateral approach) and simultaneous Osstem GS II implant placement from July 2007 to June 2008 were included in this study. Of these patients, 14 (31 implants) were in the 4-month loading group, and 13 (30 implants) were in the 6-month loading group. We investigated the implantation type (submerged or nonsubmerged), sinus membrane perforation, type of prosthesis, opposed tooth type, primary and secondary stability of implants, and crestal bone loss around implant and surrounding tissue conditions.Results.: The amounts of crestal bone-loss at the final recall time (12.56 ± 5.95 mo after loading) of the 4-month and 6-month loading groups were 0.19 ± 0.33 mm and 0.39 ± 0.86 mm, respectively. However, the difference between groups was not statistically significant (P = .211). The width of keratinized mucosa, gingival index, plaque index, and pocket depth of the 4-month and 6-month loading groups were 2.50 ± 1.69 mm and 1.73 ± 1.40 mm (P = .081), 0.72 ± 0.83 and 0.59 ± 0.69 (P = .671), 1.11 ± 0.96 and 0.76 ± 0.79 (P = .226), 3.56 ± 0.98 mm and 3.65 ± 1.06 mm (P = .758), respectively. The primary stabilities of implants in the 4-month and 6-month loading groups were 61.96 ± 12.84 and 56.06 ± 15.55 (P = .120), and the secondary stabilities were 71.85 ± 6.80 and 66.51 ± 11.28 (P = .026), respectively. The secondary stability of the 4-month group was significantly higher than that of the 6-month group. There was no statistical difference (P > .05) between the 4-month and 6-month loading groups regarding the implantation type (submerged or nonsubmerged), sinus membrane perforation, type of prosthesis, or opposed tooth type. In the 4-month and 6-month groups, all of the implants survived until the final recall time.Conclusions.: For the cases in which the residual bone was >3 mm and primary implant stability could be obtained, we conclude that loading is possible 4 months after the sinus bone graft and simultaneous implant placement.

Comparison of maxillofacial space infection in diabetic and nondiabetic patients - Corrected Proof

Dipesh D. Rao, Anilkumar Desai, R.D. Kulkarni, K. Gopalkrishnan, C. Bhasker Rao — 2010-07-26

Introduction: Orofacial space infections are common presentations in maxillofacial clinics even in the post-antibiotic era. One of the main factors determining the spread of infection is the host defense mechanism. Diabetes is one of the most common systemic illness suppressing the immunity of an individual and increasing their susceptibility to infections. This study was carried out to compare the spaces involved, the severity of infection, the virulent organism, the efficacy of empirical antibiotics, the length of hospital stay, and the complications encountered in the management of maxillofacial space infection of odontogenic origin in diabetic patients as compared with nondiabetic patients.Methodology: A 4-year prospective study was carried out on patients with maxillofacial space infection of odontogenic origin. The patients were divided into 2 groups on the basis of presence or absence of diabetes.Results: A total of 111 patients were identified out of which 31 were diabetic. The organisms commonly isolated were Streptococcus species with submandibular space being the most common space involved in both the groups. The empirical antibiotic used was amoxicillin plus clavulanic acid combined with metrogyl in 70.27% cases.Conclusion: Streptococcus species is still the most common causative pathogen irrespective of the diabetic status of the patient. The same empirical antibiotic therapy of amoxicillin plus clavulanic acid combined with metrogyl along with hyperglycemia control and surgical drainage of infection yielded satisfactory resolution of infection in the diabetic patients as well.

Endodontic management of maxillary permanent first molar with 6 root canals: 3 case reports - Corrected Proof

2010-07-26

This article discusses the successful endodontic management of 3 permanent maxillary first molars presenting with the anatomical variation of 3 roots and 6 root canals. A literature review pertaining to the variable root canal morphology of the permanent maxillary first molar is also presented. Modifications in the root canal access preparation and methods for examination of the pulpal floor with the aid of magnification for identification of additional canals are emphasized.

Comparative analysis of two different alar base sutures after Le Fort I osteotomy: Randomized double-blind controlled trial - Corrected Proof

2010-07-26

Objective: The aim of this prospective study was to analyze the efficacy of a new alar base cinch suture by comparing it with the commonly used cinch suture described by Schendel and Delaire in Dr. William Bell's book.Study design: Thirty-five patients submitted to maxillary impaction and/or advancements of ≥3 mm were randomly divided into 2 groups. Group 1 received an extra oral alar base cinch suture, and patients from group 2 received the classic intraoral suture. Alar and alar base width were measured before and after surgery in digital photographs, with the patient's head in a submental oblique view. Data were reported as means and standard deviations, and difference between groups were determined using Welch t test. A P value of <.05 was considered to be statistically significant.Results: Mean alar base widening was 1.38 mm in group 1 and 2.5 mm in group 2, and mean alar widening was 1.40 mm in group 1 and 2.31 mm in group 2. The difference was statistically significant (P < .05).Conclusion: Extraoral alar base cinch suture was more effective in maintaining preoperative Alar and alar base width compared with classic intraoral nasal suture.

Secondary cleft rhinoplasty rejuvenates the nose: A suggestion from a panel survey - Corrected Proof

2010-07-20

Background: Cleft-lip nasal deformity (CLND) affects the overall facial appearance and attractiveness. The CLND nose shares some features in part with the aging nose.Objectives: This questionnaire survey examined: 1) the panel perceptions of the role of secondary cleft rhinoplasty in nasal rejuvenation; and 2) the influence of a medical background in cleft care, age and gender of the panel members on the estimated age of the CLND nose.Study design: Using a cross-sectional study design, we enrolled a random sample of adult laypersons and health care providers. The predictor variables were secondary cleft rhinoplasty (before/after) and a medical background in cleft care (yes/no). The outcome variable was the estimated age of nose in photographs derived from 8 German nonsyndromic CLND patients. Other study variables included age, gender, and career of the assessors. Appropriate descriptive and univariate statistics were computed, and a P value of .05).Conclusions: The results of this study suggest that CLND noses lack youthful appearance. Secondary cleft rhinoplasty rejuvenates the nose and makes it come close to the actual age of the patients.

Enhanced initial proliferation and differentiation of MC3T3-E1 cells on HF/HNO3 solution treated nanostructural titanium surface - Corrected Proof

Fuming He, Feng Zhang, Guoli Yang, Xiaoxiang Wang, Shifang Zhao — 2010-07-16

Objective: The aim of this study was to investigate the effects of nano- or submicro topography and fluoride ion on the biology of osteoblasts.Study design: Pure Ti plates were sandblasted, etched with an HCl/H2SO4 solution (control surface) and then etched in a diluted HF/HNO3 solution (test surface). MC3T3-E1 cells attached, spread, and proliferated on both surfaces.Results: The alkaline phosphatase activity was evidently higher for the test surface than for control surface after 4 and 7 days of cell culture. Real-time PCR showed significant increases in type I collagen and osteocalcin gene expression in osteoblast growth on the test surface after 4 days of culture compared with the control surface.Conclusion: With nanotopography and fluoride, hydrogen ions might improve MC3T3-E1 cell proliferation and differentiation during the early stages of cell culture.

Selecting a relevant in vitro cell model for testing and comparing the effects of a Choukroun platelet-rich fibrin (PRF) membrane and a platelet-rich plasma (PRP) gel: Tricks and traps - Corrected Proof

Ling He — 2010-07-09

We have carefully read the letter by David M. Dohan Ehrenfest et al. regarding our article “A comparative study of platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) on the effect of proliferation and differentiation of rat osteoblasts in vitro.”

A 1-year prospective clinical study of soft tissue conditions and marginal bone changes around dental implants after flapless implant surgery - Corrected Proof

2010-07-02

Background: Despite several reports on the clinical outcomes of flapless implant surgery, limited information exists regarding the clinical conditions after flapless implant surgery.Objective: The objective of this study was to evaluate the soft tissue conditions and marginal bone changes around dental implants 1 year after flapless implant surgery.Study design: For the study, 432 implants were placed in 241 patients by using a flapless 1-stage procedure. In these patients, peri-implant soft tissue conditions and radiographic marginal bone changes were evaluated 1 year after surgery.Results: None of the implants were lost during follow-up, giving a success rate of 100%. The mean probing depth was 2.1 mm (SD 0.7), and the average bleeding on probing index was 0.1 (SD 0.3). The average gingival index score was 0.1 (SD 0.3), and the mean marginal bone loss was 0.3 mm (SD 0.4 mm; range 0.0-1.1 mm). Ten implants exhibited bone loss of >1.0 mm, whereas 125 implants experienced no bone loss at all.Conclusion: The results of this study demonstrate that flapless implant surgery is a predictable procedure. In addition, it is advantageous for preserving crestal bone and mucosal health surrounding dental implants.

Comparison of miniplate versus lag-screw osteosynthesis for fractures of the mandibular angle - Corrected Proof

2010-07-02

Objectives.: Treating mandibular angle fractures is common in maxillofacial surgery. The aim of this study was to compare lag screw fixation and miniplates.Study design.: This retrospective investigation compared patients treated with miniplates (n = 24) and with lag screws (n = 21). Inclusion criteria were a solitary angle fracture without comminution or other reasons for load-bearing osteosynthesis. The main parameters for the outcome analysis were fracture gaps at 4 defined measuring points on postoperative radiography. Postsurgical complications were recorded.Results.: Fracture gaps measured in panoramic radiographs differed significantly between the lag-screw (average 0.56 mm) group and the group using 1 miniplate (average 0.85 mm) and 2 miniplates (1.40 mm). Miniplate fixation resulted in a wider fracture gap, especially in the region of the lower margin of the mandible.Conclusion.: Lag-screw fixation demonstrated smaller fracture gaps compared with miniplate fixation.

A comparison of neurosensory alteration and recovery pattern among different types of orthognathic surgeries using the current perception threshold - Corrected Proof

Ji Woon Park, Pill-Hoon Choung, Hong Seop Kho, Young Ku Kim, Jin Woo Chung — 2010-07-02

Objective: The objective of this study was to compare postsurgical neurosensory alteration and recovery patterns among different nerve fiber types and orthognathic surgeries by measuring current perception thresholds (CPT).Study design: CPTs of 186 patients who underwent various orthognathic surgeries (Le Fort I or II, bilateral sagittal split [BSSRO] or intraoral vertico-sagittal [IVSRO] ramus osteotomy with or without genioplasty) were measured at 2000, 250, and 5 Hz, assessing 3 different nerve fiber types before surgery and at 3, 6, and 12 months after surgery.Results: CPTs were highest at 3 months postsurgery and gradually returned to presurgical levels until 12 months postsurgery in most cases. CPT at 2000 Hz showed the largest amount of increase. Le Fort I and IVSRO caused less neurosensory alteration compared with Le Fort II and BSSRO, respectively.Conclusion: Our data provide nerve recovery patterns following various orthognathic surgeries that may be applied to evaluating the patient's severity and recovery of nerve damage.

Maxillary reconstruction using microvascular free flaps - Corrected Proof

2010-06-30

Objective: Loss of all or part of the maxilla as a result of tumor ablation has both functional and aesthetic consequences. Reconstruction of the maxilla remains a challenge despite the availability of several flaps and the skills of the prosthodontist. We have analyzed a series of maxillary resections that underwent flap reconstruction to guide planning of the rehabilitation of patients with such defects.Study design: The authors present 83 patients with various types of maxillary defects that were reconstructed with different microvascular free flaps. All clinical data, including data on the functional and aesthetic outcome, are analyzed.Results: Flap transfer was successful in 80 of 83 patients who underwent maxillary reconstruction. Separation of the oral and nasal cavities was achieved in all cases. Flap compromise occurred in 6 cases, which made revision necessary. Three of these flaps were salvaged and 3 flaps failed. In 10 of 28 patients with transferred bone, osseointegrated implants were inserted and dentally rehabilitated with excellent functional and aesthetic results.Conclusion: Various types of maxillary defects can be reconstructed successfully using different microvascular free flaps. This procedure is challenging because of the anatomical site of reconstruction creating a steep learning curve. If the reconstruction is successful, both facial appearance and oral function can be improved. Microvascular flaps containing bone of the fibula, scapula, or iliac crest facilitate complete dental rehabilitation.

Autotransplantation of teeth: a procedure that gets no respect - Corrected Proof

Joseph Bruce Baviz — 2010-06-28

This month's article “Immediate autotransplantation of mandibular third molars in China” corroborates what many surgeons around the world already know, that autotransplantation is a predictable, albeit underused, procedure. Professors Yan, Li, and Long's success rate of 94% (33 out of 35 followed an average 5.2 years) is on par with many other reports. When the donor tooth they used had an open apex, the success rate was 100%.

Intraosseous ameloblastoma - Corrected Proof

Candice C. Black, Rocco R. Addante, Carrie A. Mohila — 2010-06-28

Ameloblastomas are benign slow-growing aggressive neoplasms with a poorly understood potential for rare metastasis. They are capable of reaching large sizes with extensive local bone erosion and destruction. They are composed of a mixture of ameloblastic epithelium and mesenchyme and arise from rests of outer and inner enamel epithelium and dental lamina. Microscopically, ameloblastomas are recognizable from their recapitulation of embryologic ameloblasts and stellate reticulum. There are 3 subtypes: the conventional or solid-multicystic variant, the unicystic variant, and the desmoplastic variant. Treatment planning for a given tumor includes consideration of location, primary versus recurrent, size, presence of cortical perforation, and age and health of the patient. Complete excision is recommended for conventional and desmoplastic variants. The unicystic variant requires additional subtyping to determine the best treatment approach.

Invasive cervical resorption: report on two cases - Corrected Proof

Miguel Roig, Sergio Morelló, Montse Mercadé, Fernando Durán-Sindreu — 2010-06-28

Invasive cervical resorption is a relatively uncommon form of external root resorption that may lead to tooth loss. This article presents the clinical and radiologic diagnoses and treatment modalities of invasive cervical resorption in 2 patients. In the first case, we did a slow orthodontic forced eruption to make the bone grow coronally. After 6 months, the tooth was extracted and an immediate implant was placed. Eight months later a zirconia crown was cemented. In the second case, we performed root canal treatment followed by a composite reconstruction of the defect. These 2 cases illustrate different approaches based on the extent of the defect.