Aesthetic management of a fractured mandibular central incisor with two canals using fibre post.

Mandibular incisors show variations in their root canal anatomy from regular pattern in some cases. Magnification plays a vital role to identify those unusual canal morphologies. A certain modification in access cavity preparation is required to locate those extra canals. Not only the functional restoration but also aesthetic harmony should be restored while treating anterior teeth. In these cases, post space preparation should be done with extra care to prevent vertical root fracture. This case report illustrates the importance of proper radiograph and magnification in the successful identification and management of complex canal systems in mandibular incisors.

Study of cerebrospinal injuries by force transmission secondary to mandibular impacts using a finite element model.

Brain and cervical injuries are often described after major facial impacts but rarely after low-intensity mandibular impacts. Force transmission to the brain and spinal cord from a mandibular impact such as a punch was evaluated by the creation and validation of a complete finite element model of the head and neck. Anteroposterior uppercut impacts on the jaw were associated with considerable extension and strong stresses at the junction of the brainstem and spinal cord. Hook punch impacts transmitted forces directly to the brainstem and the spinal cord without extension of the spinal cord. Deaths after this type of blow with no observed histological lesions may be related to excessive stressing of the brainstem, through which pass the sensory-motor pathways and the vagus nerve and which is the regulatory center of the major vegetative functions. Biological parameters are different in each individual, and by using digital modeling they can be modulated at will (jaw shape, dentition…) for a realistic approach to forensic applications.

Antibiotic Duration and Outcome Complications for Surgical Site Infection Prevention in Traumatic Mandible Fracture.

BACKGROUND: The appropriate duration of antibiotic therapy for surgical site infection (SSI) prevention in traumatic mandibular fracture repair is unknown, and practices vary significantly. The objective of this study was to characterize antibiotic duration and outcomes after surgical repair of traumatic mandibular fracture. METHODS: A single-center, retrospective analysis of all adult patients who underwent surgical fixation of a mandible fracture between January 2014 and December 2016 was performed. Operative service was categorized between otolaryngology (ear, nose, and throat surgery), plastic and reconstructive surgery, and oral and maxillofacial services. Primary outcomes were SSI and operative complications (including osteomyelitis, nonunion, malocclusion, and hardware infections). Differences in antibiotic prescription pattern were analyzed using analysis of variance test and Pearson chi-squared test. RESULTS: A total of 75 patients were included in the study with 33 (44.0%), 26 (34.7%), and 16 (21.3%) managed by plastic and reconstructive surgery, ear, nose, and throat surgery, and oral and maxillofacial services, respectively. Median age was 30.0 y. Median injury severity score was 4.0. There was no significant difference in hospital length of stay (P = 0.44), intensive care unit length of stay (P = 0.53), or postoperative complications (P = 0.15). None of our patients developed an SSI or postantibiotics complications. Although the total inpatient duration of antibiotics was not significantly different among services (P = 0.37), there were significant differences in outpatient duration of antibiotics (P = 0.007) and total duration of antibiotics (P = 0.003). CONCLUSIONS: Duration of antibiotics is not associated with postoperative SSI or antibiotics-related complications. The wide variation in prescribing practices and lack of any clear benefit for prolonged antibiotics provides an opportunity to explore the benefits of a standardized short course of antibiotics. LEVEL OF EVIDENCE: Therapeutic study, III.

Review of Risk Assessment of Major Anatomical Variations in Clinical Dentistry: Accessory Foramina of the Mandible.

Most of the studies of the mandible's anatomical variations have presented the authors' speculations, and only a limited number has provided evidence that demonstrated the actual complications injury to the variant structures caused. To our knowledge, no study has evaluated the risks associated with these variant anatomical structures' injury. We reviewed articles that described clinical cases of the injury to, and anatomical studies of, three anatomical variants of the mandible-the accessory mental, lingual, and retromolar foramina-with which dentists are relatively familiar and that are mentioned often in the context of implant and third molar surgeries, to describe risk assessment methods with which to evaluate potential complications preoperatively. Only a limited number of the clinical reports of injury to the mandible's accessory foramina were available. The potential severe complication of injury of the accessory mental foramen (AMF) is sensory disturbance of the lower lip. Risk of neurosensory disturbance of lower lip can be assessed by AMF/MF ratio and positional relations to the MF. Potential severe complication of injury of the lingual foramen is bleeding and hemorrhage in the oral cavity's floor. Risk of bleeding can be assessed by diameter and positional relation between the mental spine/mylohyoid line. A risk assessment of the retromolar foramen could not be made because of inadequate data. We hope the risk assessments suggested will encourage dentists to predict intraoperative/postoperative complications caused by damaging the mandible's accessory foramina. Clin. Anat. 32:672-677, 2019. © 2019 Wiley Periodicals, Inc.

[Clinical application of vacuum sealing drainage combined with chymotrypsin in the treatment of post-traumatic mandibular osteomyelitis].

This article introduces the combined application of vacuum sealing drainage (VSD) and chymotrypsin in the treatment of post-operative mandibular osteomyelitis. The lesion was washed by chymotrypsin (4000U) and saline (500 ml). VSD is effective in the treatment of traumatic mandibular osteomyelitis. This study investigates the effect of VSD combined with chymotrypsin in the treatment of patients with osteomyelitis after mandibular trauma. It is proved that it has a good effect in ensuring drainage, controlling infection and retaining internal fixation, and can create a good environment for fracture healing.

Management of Bilateral Edentulous Mandible Fractures Through an Intraoral Approach Using CAD/CAM Technology: A Case Report.

The surgical management of edentulous mandible fractures presents unique challenges secondary to poor bone stock and the absence of dentition to assist with fracture reduction. In complex injury patterns, such as bilateral edentulous mandible fractures, an external approach is often necessary to achieve adequate reduction and adaptation of a load-bearing reconstruction plate. We report a case in which computer-assisted design/computer-assisted manufacturing (CAD/CAM) was applied as an adjunct for the acute management of bilateral edentulous mandible fractures in a 58-year-old man. CAD/CAM technology was used to fabricate a patient-specific reconstruction plate and a maxillomandibular splint, which facilitated the successful treatment of this complex injury through an intraoral approach. This case highlights the potential of CAD/CAM technology to improve operative efficiency and clinical outcomes in the acute management of complex edentulous mandible fractures.

Surgical Management of Traumatic Peripheral Osteoma of the Mandible.

Osteomas are benign osteogenic lesions that result from the proliferation of mature bone. Three variants are known: central, peripheral, and extraskeletal. The peripheral variant is the most common and it most frequently affects the paranasal sinuses, rarely occurring in the jaws. This article describes the case of a 33-year-old white male patient who was referred complaining of facial asymmetry. Clinical examination revealed an increase in volume at the base of the right side of the mandible, hard bony consistency and well delimited, painless to the touch, without signs of infection or intraoral alterations. Radiographic examination revealed an oval lobulated, radiopaque sessile lesion adhered to the mandibular base near the insertion of the masseter muscle. The patient reported practicing martial arts many years ago. Owing to the limited access, it was decided to perform the complete lesion removal through an extraoral surgical approach, by using a skin crease in the upper neck region below the lesion. The patient recovered well and the histopathological analysis confirmed the diagnosis of osteoma. The etiopathogenesis of osteoma is not completely elucidated, and 3 theories are more accepted: developmental defect, neoplastic nature, and reactive lesion owing to trauma or local infection. The clinicopathological correlation in the present case supports a traumatic origin. Traumatic peripheral osteoma should be considered in the differential diagnosis of nodular bone-forming lesions affecting the mandible.

Experimental model of osteonecrosis of the jaw in rats treated with zoledronic acid.

We have examined the development of medication-related osteonecrosis of the jaws (MRONJ) in rats with no previous accumulation of zoledronic acid in the mandible. Ten male Wistar rats (weight 350-400g) were anaesthetised with chloral hydrate 450mg/kg intraperitoneally and the first and second mandibular molars on the left side were extracted. The five experimental rats were given six injections of zoledronic acid 0.18mg/kg over the next four weeks (total dose 1.08mg/kg). Two injections were given at once as an intravenous bolus injection (0.36mg/kg). Then rats were given 4 injections (0.18mg/kg) with 1 week interval over the next four weeks, after which they observed for a further four weeks. The five control rats were injected with saline. At the end of the eighth week, the animals were killed by asphyxiation in a carbon dioxide chamber, and their bone structure was visualised using cone-beam computed tomography (CT) and Galaxis software. We then studied the mandibles histopathologically to investigate the incidence of necrosis and infiltration of inflammatory cells. The cone-beam CT images in the experimental group showed deficiencies in the bone structure in the extracted molar area of the lower alveolar ridge. The histological findings in the mandibles of the group given zoledronic acid showed necrosis and infiltration of inflammatory cells, which were not present in the control group. We conclude that the immediate effect of zoledronic acid on the bone tissue during regeneration is an important factor in the development of MRONJ, in addition to the previously reported effects of the duration of treatment with zoledronic acid.

Sustained, localized salicylic acid delivery enhances diabetic bone regeneration via prolonged mitigation of inflammation.

Diabetes is a metabolic disorder caused by insulin resistance and/or deficiency and impairs bone quality and bone healing due to altered gene expression, reduced vascularization, and prolonged inflammation. No effective treatments for diabetic bone healing are currently available, and most existing treatments do not directly address the diabetic complications that impair bone healing. We recently demonstrated that sustained and localized delivery of salicylic acid (SA) via an SA-based polymer provides a low-cost approach to enhance diabetic bone regeneration. Herein, we report mechanistic studies that delve into the biological action and local pharmacokinetics of SA-releasing polymers shown to enhance diabetic bone regeneration. The results suggest that low SA concentrations were locally maintained at the bone defect site for more than 1 month. As a result of the sustained SA release, a significantly reduced inflammation was observed in diabetic animals, which in turn, yielded reduced osteoclast density and activity, as well as increased osteoblastogenesis. Based upon these results, localized and sustained SA delivery from the SA-based polymer effectively improved bone regeneration in diabetic animals by affecting both osteoclasts and osteoblasts, thereby providing a positive basis for clinical treatments. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2595-2603, 2016.

Non-pulsatile traumatic pseudoaneurysm of the internal maxillary artery following trauma to mandible.

Traumatic pseudoaneurysm involving the maxillary artery is rare. Owing to its anatomic location, internal maxillary artery is usually protected by its surrounding structures. Formation of pseudoaneurysm usually takes place after several weeks to months of the initial injury. In this case, we reported a pseudoaneurysm arising from left internal maxillary artery following blunt injuries within 3 hours after a road accident and the treatment with endovascular embolization with titanium coils prior to open reduction and internal fixation of the fractured mandibles.

Flapless cortical bone damage has no effect on medullary bone mesial to teeth being moved.

INTRODUCTION: In this study, we evaluated the effects of bone awl-induced damage to bone surrounding a tooth that was moved. METHODS: A randomized split-mouth design with 7 foxhounds was performed to evaluate protraction of the mandibular third premolars for 56 days with 200 g of orthodontic force. Before initiating tooth movements, a bone awl was used on the experimental side to create 60 buccal and lingual microfracture injuries to the cortical bone without a periosteal flap. Tooth movements were performed on the control and experimental sides. Microcomputed tomography and histology were used to assess bone morphology and modeling. Radiographic and caliper measures were used to assess tooth movements. RESULTS: The awl-induced injuries produced significant damage and microfractures (95 mm(3)). Buccal and lingual cortical bone volume fractions and densities were significantly less and cortical modeling was significantly greater on the experimental sides than on the control sides. Bone volume fractions and densities mesial to the third premolars were the same on the experimental and control sides. Experimental side tooth movements (1.40 ± 0.25 mm) were statistically the same as the control side tooth movements (1.57 ± 0.45 mm). CONCLUSIONS: The effects of flapless, bone awl-induced damage were limited to the cortical bone. Because there was no effect on the medullary bone mesial to the tooth being moved, no differences in tooth movements were produced.

Current concepts in the pathogenesis of traumatic temporomandibular joint ankylosis.

Traumatic temporomandibular joint (TMJ) ankylosis can be classified into fibrous, fibro-osseous and bony ankylosis. It is still a huge challenge for oral and maxillofacial surgeons due to the technical difficulty and high incidence of recurrence. The poor outcome of disease may be partially attributed to the limited understanding of its pathogenesis. The purpose of this article was to comprehensively review the literature and summarise results from both human and animal studies related to the genesis of TMJ ankylosis.

Manejo de la anquilosis temporomandibular postraumática / Management of postraumatic temporomandibular joint ankylosis

La anquilosis de la articulación temporomandibular (ATM) es una patología cada vez menos común y generalmente se presenta como la secuela de un trauma. Es una enfermedad extremadamente invalidante que causa problemas en la masticación, la digestión, el habla, la apariencia y la higiene, que limita la capacidad de atención, especialmente en los pacientes en crecimiento, donde también se asocia a deformidades de la mandíbula y maxila, causando asimetría facial. El enfoque terapéutico de la anquilosis postraumática depende fundamentalmente de la edad del paciente, la localización y la magnitud de la fusión. El tratamiento de estos pacientes es controvertido por el alto índice de recidiva y el inconveniente de predecir el crecimiento de la mandíbula y en consecuenica, del maxilar. El objetivo es marcar la necesidad de protocolizar el tratamiento según la edad del paciente, enfatizando la intervención temprana y un acompañamiento integral del individuo. Se debe prestar especial consideración a los niños para garantizar el seguimiento durante el proceso de crecimiento y desarrollo, con la intención de disminuir las secuelas de la patología en el desarrollo del macizo craneofacial

[Role of oral cavity anaerobic microflora in the pathogenesis of mandible traumatic osteomyelitis].

The role of conditionally pathogenic microflora in the pathogenesis of lower jaw bone traumatic osteomyelites was investigated. The different groups of aerobic and anaerobic microorganisms were detected by real-time PCR. Role of conditionally pathogenic microflora in the pathogenesis of traumatic osteomielytis was shown.

[Stages of bone regeneration and foundation of pharmacоlogical correction of the mandible reparative osteogenesis].

Influents of some medicines on the mandible reparative regeneration in experimental investigations are present in the manuscript. It was discovered that application of parathyroid hormone (PTG) in first 3 days after the mandible fracture decreases of quantity complications on 30% and contributes strong consolidation of bone fragments. Metiluracil in the same period increases complications quantity on 36% and bone fragments consolidation strength was for sure less than after PTG. It was found PTG and vitamin D3 in first resorbtion stage accelerate bone consolidation, retabolil (nandrolone), dexametasone, testosterone and vitamin E slow down bone consolidation. Role of vitamin A, indometazin and calcitonin was doubtful. Practical doctors and experimenters co-ordination efforts are necessary for elaboration of new tactic and strategy of patient treatment with bone trauma.

An excessive coronoid hyperplasia with suspected traumatic etiology resulting in mandibular hypomobility.

There are multiple theories as to the causes of coronoid process hyperplasia of the mandible, including trauma, temporalis muscle hyperactivity, hormonal stimulus, and genetic inheritance. The excess growth of the coronoid process can cause impingement on the zygomatic processes and may result in mandibular hypomobility. A case of an excessive unilateral coronoid hyperplasia with suspected traumatic etiology, which was successfully treated by coronoidectomy and postoperative physiotherapy, is presented. The patient was a 21-year-old man whose maximum mouth opening was 23 mm. The attachments of the temporalis muscle were stripped and the coronoid process was accessed using the Al-Kayat and Bramley approach. The coronoid process was then resected via an intraoral pathway. One week after surgery, physiotherapy was started and the maximum mouth opening had increased to 38 mm. In the case presented, a coronoidectomy with postoperative physiotherapy for treatment of coronoid process hyperplasia produced satisfactory results in the correction of coronoid-malar interference.

Mandibular traumatic peripheral osteoma: a case report.

An osteoma is a slow-growing, benign lesion comprising mature bone tissue. Osteomas rarely occur in maxillary bones, with the exception of the maxillary sinuses. Various possible etiologies have been proposed, including congenital anomalies, chronic inflammation, muscular activity, embryogenetic changes, and trauma. Here we present a case of an osteoma of the buccal plate of the mandible at the site where a sports-related traumatic injury occurred 15 years earlier. Both conventional and 3-dimensional x-ray examinations were used for diagnosis and preoperative evaluation of the possible involvement of the adjacent anatomic structures. The lesion was treated surgically without complications and the patient made a complete recovery. Histologic tests confirmed the preoperative diagnosis. A review of the international literature is also presented.

Distraction osteogenesis of a unilateral hypoplastic mandible.

Distraction osteogenesis (DO) is a surgical process in which two bony segments are gradually separated so new soft tissue and bone will form between them by applying tension through a fixation device. There are three phases to this process: latency phase, distraction phase, and consolidation phase. The technique was originally applied to long bones but in recent years the method has been adapted for use in maxillofacial surgery. Distraction osteogenesis is a new variation of more traditional; orthognathic surgical procedures which can be applied for the correction of dento-facial deformities and syndromes of the jaws, treating upper airway obstruction in paediatric patients with mandibualr retrognathia, due to tongue collapse and physical obstruction in the hypopharangeal region. It is an effective and powerful reconstructive surgical technique, which can be performed safely without the need of bone graft or blood transfusion. We present treatment of a child with severe facial asymmetry after unilateral TMJ ankylosis corrected bydistraction osteogenesis.

Clinical case report: treatment of permanent tooth avulsion following trauma from a dog bite.

This article reviews the treatment of a pediatric patient following head and neck trauma from a dog bite. The patient had an avulsed mandibular incisor, a fractured maxillary lateral incisor, and various facial lacerations. The avulsed tooth was replanted and secured for two weeks by using a physiologic splint. Both traumatized teeth received endodontic therapy and were returned to normal function. Trauma patients require a thorough evaluation and a multidisciplinary approach for the formation of a proper treatment plan.

Odontogenic sinus tract to the chin: a diagnostic dilemma.

Sinus tracts of odontogenic origin most commonly open into the oral cavity but occasionally may drain extraorally. The diagnosis is more difficult when necrosis of the tooth occurs in the absence of dental caries. We report a 23-year-old man with a long-standing chronic wound on the inferior aspect of the chin that was refractory to treatment. This case demonstrates the use of a simple technique to identify a necrotic mandibular incisor tooth as the source of infection.