Articaine versus Lidocaine in only buccal infiltration anesthesia for the extraction of mandibular anterior teeth. A prospective split-mouth randomized-controlled clinical study.

OBJECTIVE: To investigate the effectiveness of a single labial infiltration of 4% articaine versus 2% lidocaine for the extraction of mandibular anterior teeth without an additional lingual injection. PATIENTS AND METHODS: A prospective, randomized-controlled, split-mouth clinical study was implemented. Healthy adult patients seeking bilateral extraction of mandibular anterior teeth were included in this study. Teeth extractions were randomly assigned to two equal groups, where one mandibular anterior tooth was extracted using a solitary labial infiltration of either 4% articaine (the study group) or 2% lidocaine (the control group). After 14 days, the other mandibular anterior tooth was extracted using the other local anesthetic agent. The selection of the anesthetic agent injected in the first session was done in a randomized fashion. After 5 min of local anesthetic injection, the tooth was extracted, and each patient was asked to record the intensity of the extraction pain using the Visual Analogue Scale (VAS). RESULTS: Thirty-one patients were included in the study. The efficacy of a single labial injection for mandibular anterior teeth extraction was established by the fact that none of the patients in the study or control group required re-administration of local anesthesia. The mean VAS for pain control during tooth extraction was 1.16 ± 0.93 for the articaine group and 1.71 ± 0.90 for the lidocaine group. The pain score showed a statistically significant decrease in the articaine group compared to that in the lidocaine group (P = 0.017). CONCLUSION: Although the anesthetic effects of only buccal infiltration of 4% articaine and 2% lidocaine for extraction of mandibular anterior teeth were comparable, the use of 4% articaine would have more effective and predictable outcomes. CLINICALTRIALS: ORG: (ID: NCT05223075) 3/2/2022.

Accuracy of virtual surgical planning in mandibular reconstruction: application of a standard and reliable postoperative evaluation methodology.

OBJECTIVE: The purpose of this study was to determine the accuracy of virtual surgical planning for mandibular reconstruction, along with the implementation of a postoperative evaluation methodology. MATERIALS AND METHODS: The study is a prospective case series for computer-assisted mandibular reconstruction surgery. Analysis of the degree of agreement between virtual measurements and postoperative actual outcomes was performed. The reliability of the proposed evaluation methodology was assessed and analyzed using the Inter-Class Coefficient (ICC) test. Statistical significance was set at the 5% level. RESULTS: Nine consecutive patients were selected. The analysis of all angular and linear parameters reported a highly statistically significant degree of agreement between the preoperative and postoperative measurements (P < 0.001). Furthermore, an extreme degree of reliability was reported when the evaluation methodology was scrutinized (ICC = 0.9). CONCLUSION: The excellent degree of agreement between the virtual plan and the actual outcome reported in this study validated the surgical accuracy of virtually assisted mandibular reconstruction. This study pointed out the reliability and reproducibility of the standardized evaluation protocol in an attempt to obtain a tolerable value for the acceptable postoperative results regarding the accuracy of computer-assisted surgery.

Bilateral collagenous fibroma of the hard palate: a case report and review of the literature.

BACKGROUND: Collagenous fibroma or desmoplastic fibroblastoma is a rare benign fibrous tissue tumor. It usually presents as a painless, slowly growing mass. Collagenous fibroma arises ordinarily inside the subcutaneous tissues or skeletal muscles. Histopathologically, the tumor consists of scattered stellate and spindle cells in a hypovascular collagenous stroma without atypia or infiltration. The oral cavity is a very uncommon site for desmoplastic fibroblastoma. Only 15 published articles in the literature reported the intraoral location. We present a case of collagenous fibroma with a bilateral distribution on the hard palate. This is the second case of bilateral collagenous fibroma after a previously reported one in literature; however, our case was larger, occupying almost the whole palate. We discuss the management of this rare tumor and how we can reach definite diagnosis. CASE PRESENTATION: A 37-year-old Caucasian female patient had a huge bilateral firm palatal mass that caused breathing problems. There was no history of trauma and the patient had no relevant medical history Total surgical excision under general anesthesia was carried out and histopathological examination suggested a benign mesenchymal tumor. Immunohistochemistry was necessary to confirm the tumor origin and to exclude aggressive fibromatosis. A diagnosis of bilateral collagenous fibroma was reached. Six months after surgery, there was no recurring lesion and the patient's health was good. CONCLUSIONS: Collagenous fibroma is a benign fibrous tissue tumor of unknown cause that is treated with simple excision. The prognosis is good with no recurrence. Reaching an accurate diagnosis is mandatory to avoid aggressive treatment since collagenous fibroma may be misdiagnosed as aggressive fibromatosis in case of massive size. Clinicians and pathologists should be aware of this unusual tumor for conservative management without side effects.

Post-COVID-19 related osteonecrosis of the jaw (PC-RONJ): an alarming morbidity in COVID-19 surviving patients.

PURPOSE: The recent coronavirus disease (COVID-19) pandemic mainly affects the respiratory system; however, several oral and maxillofacial post-COVID-19 complications have also been observed. This series reports the growing number of osteonecrosis cases associated with post-COVID-19 patients. MATERIALS AND METHODS: This is a retrospective, multi-center case series that reports cases with maxillary osteonecrosis after various periods of SARS-CoV-2 infection in the period between January and August 2021 based on the PROCESS guidelines. RESULTS: Twelve cases were reported with post-COVID-19 manifestation of spontaneous osteonecrosis of the maxillary jaw. Five patients were hospitalized during COVID-19 management and all of the twelve cases had at least one systematic Co-morbidity, and undertake corticosteroids prescription based on the COVID-19 disease treatment protocol. The mean onset of osteonecrosis symptoms appearance was 5.5 ± 2.43 weeks calculated from the day of the negative PCR test. The management was successfully done through surgical debridement and pre and post-operative antibiotics. No anti-fungal medications were prescribed as the fungal culture and the histopathological report were negative. CONCLUSION: Post-COVID-related osteonecrosis of the jaw (PC-RONJ) could be now considered as one of the potential post-COVID-19 oral and maxillofacial complications that occurs unprovokedly and mainly in the maxilla.

Pycnodysostosis: a case report and literature review concerning oral and maxillofacial complications and their management.

OBJECTIVE: There is a lack of knowledge regarding pycnodysostosis (PYCD), which is commonly misdiagnosed as other, similar malformations. This study aims to report a patient with PYCD and conjointly present a comprehensive literature review regarding oral complications after oral surgery procedures. STUDY DESIGN: This study aims to report a noteworthy case of a 40-year-old woman with PYCD who suffered from a midface defect after iatrogenic fracture during extraction of the upper right molars. A comprehensive electronic search was carried out in January 2020 for detection and analysis of the most commonly encountered dentoalveolar PYCD-related complications. The study was granted an exemption from the local institutional review board. RESULTS: The electronic search yielded 35 articles reporting 41 PYCD cases with 62 various reported dentoalveolar complications. The survey reported a prevalence of osteomyelitis (n = 39) followed by pathologic fracture (n = 17), iatrogenic fracture (n = 5), and oronasal communication (n = 1). CONCLUSIONS: This study advocates handling patients with PYCD with care through the use of extensive clinical and radiographic examinations, giving priority to any conservative treatment modalities, atraumatic surgical procedures, prophylactic antibiotic prescriptions, and a regular follow-up schedule to tackle any anticipated complications.

Is nasopalatine nerve block still mandated for the extraction of maxillary anterior teeth?

Aim This study was conducted to investigate the effectiveness of a single labial injection of 4% articaine for the extraction of maxillary anterior teeth without the need for nasopalatine supplementary injection.Materials and methods A prospective, controlled, split-mouth clinical study was performed to evaluate the clinical performance of 4% articaine as a single labial infiltration anaesthesia for the extraction of maxillary anterior teeth and to compare it with the routine method of labial injection along with a supplementary nasopalatine injection using 2% lidocaine. Statistical analyses were performed, with the statistical significance being set at 5% level.Results A total of 37 patients met the inclusion criteria, and a statistically significant difference was observed in the reported pain during injection between the single labial articaine injection and the routine labial and palatal lidocaine injections (P <0.001). The extraction of maxillary anterior teeth was possible without the need for an additional nasopalatine injection in all the study patients (n = 37). The difference between both groups was statistically non-significant in terms of the pain encountered during extraction (P = 0.22).Conclusion With the use of 4% articaine as a single labial infiltration anaesthesia, nasopalatine nerve block for the extraction of maxillary anterior teeth may become an outdated modality.

The Use of A Solitary Multi-Planer Herbert Cannulated Bone Screw Osteosynthesis for The Treatment of Mandibular Angle Fracture.

This study aimed to evaluate the clinical and radiographic performance of a single Herbert bone screw in the treatment of mandibular angle fractures. A prospective case series clinical trial enrolling a sample of patients with unilateral isolated mandibular angle fractures was implemented in this study. The primary outcome variable was the fracture healing with postoperative stability. The secondary outcome was the incidence of postoperative complications. All of the recorded data were documented, tabulated, computed, and analyzed. Statistical significance was set at 5% level. Twenty patients were selected. Neither major nor minor clinical complication was reported. Only one case showed slight interfragmentary mobility in the first follow-up period, which improved spontaneously in the sixth postoperative week. A statistically significant gain in the mean bone density across the fracture line was calculated. These favorable clinical and radiographic outcomes may conclude that the utilization of a solitary Herbert cannulated bone screw osteosynthesis provides a successful, economic, minimally invasive and predictable treatment modality for the treatment of mandibular angle fractures.

Evaluation of orbital volume after orbitozygomatic complex fractures fixation: A radiographical study.

BACKGROUND: Orbitozygomatic complex fractures are one of the most commonly encountered injuries of the craniofacial skeleton. The aim of this study was to implement the orbital volume as an objective evaluation modality for the assessment of the accuracy of unilateral Orbitozygomatic complex fracture fixation, by comparing the postoperative values with the contralateral normal side and the pretreated values. MATERIALS AND METHODS: A retrospective radiographic, chart review was performed in order to investigate the primary outcome of the objective quantification of the accuracy of Orbitozygomatic complex fracture reduction utilizing orbital volume analysis. Comparing the postoperative orbital volume values with the preoperative, and the contralateral normal ones was set as the study secondary outcome, along with the percentage of changes in the orbital volume of unilateral Orbitozygomatic complex fracture treated patients. Data reliability was performed using Interclass correlation coefficient and Statistical significance was set at 5% level. RESULTS: Seventeen records met the inclusion criteria. While a statistically significant difference was found between the preoperative orbital volume values of the affected side and that in the normal unaffected side (P < 0.001), a statistically insignificant difference was encountered between the postoperative values and the control side (P = 0.333). An average percentage of decrease of 6.1%. was reported in the postoperative records when compared to the preoperative ones, with a statistically significant difference (P < 0.001). the study reported high inter (ICC = 0.97) and Intra (ICC = 0.97) observer reliability. CONCLUSION: Orbital volume analysis offers a valid modality for the objective evaluation of the efficiency of Orbitozygomatic complex fracture management.

Dentists' practices and patient safety: A cross-sectional study.

PURPOSE: To assess the frequency of dentist-reported practices to ensure patient safety in the dental office and the impact of training and work environment on this frequency using the framework of the International Patient Safety Goals (IPSGs). METHODS: Dentists attending major conferences in Egypt and Saudi Arabia were recruited in a cross-sectional study in 2018. They completed a questionnaire assessing professional background and the frequency of practices for the IPSGs. The relationship between explanatory variables: training (postgraduate degrees and continuing education) and work environment (years in profession, working in public sector and performing surgical procedures) and the outcome variable: frequency of practices for 4 IPSGs was assessed using multivariate general linear model, and univariate general linear model was used to assess their relationship to the overall score of safety practices calculated for all goals. RESULTS: The response rate was 81.1%. Practices related to reducing harm in the office environment were significantly less frequent than practices ensuring medication safety, ensuring safe surgery and controlling infection. The overall frequency of safety practices was significantly higher amongst senior than junior dentists. There were significant differences in safety practices frequency based on postgraduate degrees and receiving safety training. Dentists performing surgical procedures reported less frequent safety practices. CONCLUSION: Practices to reduce harm because of the dental office environment were less frequent than other safety practices. Senior dentists, dentists who had postgraduate degrees and who received safety training reported more safety practices whilst those performing surgical procedures reported fewer safety practices.

Herbert Cannulated Bone Screw Osteosynthesis in Anterior Mandibular Fracture Treatment: A Comparative Study With Lag Screw and Miniplate.

PURPOSE: The Herbert bone screw (HBS) is a successful and minimally invasive method of fracture fixation that is used routinely in orthopedic surgery. The aim of this study was to evaluate the clinical and radiographic performances of the HBS in the treatment of anterior mandibular fractures and compare it with the common and established treatment modalities, the lag screw (LS) and the 2.0-mm miniplate (MP). MATERIALS AND METHODS: This study implemented a randomized clinical trial and enrolled a sample of patients with anterior mandibular fractures. The primary predictor variable was treatment group categorized as HBS, LS, or MP fixation of the fracture. Primary outcome variables were the presence of interfragmentary mobility and radiodensitometric appraisal of fracture healing progression. The secondary outcome was the postoperative clinical evaluation. Other variables collected were grouped into demographic, fracture location, and intraoperative clinical data. All recorded data were documented, tabulated, computed, and analyzed. Statistical significance was set at the 5% level. RESULTS: Twenty-one patients were selected and randomly allocated to 1 of 3 groups based on the fixation modality used. There were no relevant differences in demographic data for the 3 groups. There were no statistically relevant differences in clinical evaluation outcomes. However, there was a statistically significant difference in the gain of mean postoperative bone density between the HBS and MP groups (P = .012) and between the LS and MP groups (P = .045), but not between the HBS and LS groups. CONCLUSION: Cannulated HBS osteosynthesis provides a successful and minimally invasive treatment modality for the management of anterior mandibular fractures.