Clinical outcomes of implants placed with transcrestal maxillary sinus elevation: a systematic review and meta-analysis.

This systematic review and meta-analysis assesses the clinical outcomes of implants inserted during or following transcrestal sinus lifts. The study protocol was prospectively registered on PROSPERO (CRD42024504513). PubMed, Web of Science, Embase, and Scopus databases were searched up to 21 February 2024, and randomised clinical trials utilising transcrestal sinus lifts were included. Qualitative and quantitative syntheses were conducted. A random effects model was used to pool the survival rate of implants placed with transcrestal sinus lifts using hand osteotomes without grafting, along with meta-regression and subgroup analyses. Funnel plots and Egger's linear regression were used to explore possible publication bias. Probabilities of less than 0.05 were considered significant. A total of 1807 records were identified after the initial search. Seventeen studies were included with 10 of them considered for meta-analysis. Studies used hand osteotomes, a combination of piezoelectric and hand osteotomes, drills, and smart lifts for sinus elevation. Only studies that used hand osteotomes reported subsequent vertigo and dizziness in patients. The meta-analysis showed a 100% (95% CI: 99% to 100%) survival rate for both grafted and non-grafted transcrestal sinus lifts using hand osteotomes. Meta-regression showed that follow-up time did not significantly affect the implants' survival. Subgroup analyses showed no significant difference between bone-level and tissue-level implants and one-stage or two-stage implants. On considering the limitations of this study it can be concluded that closed maxillary sinus elevation can be considered a relatively safe technique that is associated with a high survival rate. However, caution should be taken when using hand osteotomes because of a higher rate of sinus lining perforation and reported patient vertigo.

Antral membrane balloon technique versus Densah bur in crestal sinus lift with simultaneous implant placement: a randomized clinical trial.

BACKGROUND: The posterior maxilla presents challenges for implant insertion because of the poor bone quality as well as the loss of vertical bone height. Indirect transcrestal sinus lift techniques are advised when a few millimeters of additional height are needed. This study aimed to evaluate the clinical and radiographic outcomes of antral membrane balloon technique versus Densah burs for transcrestal maxillary sinus lifting with simultaneous implant placement. MATERIALS AND METHODS: This randomized clinical trial was conducted on 22 patients received 32 dental implants for replacement of missed maxillary posterior teeth after crestal maxillary sinus lifting. The patients were randomly divided into two groups. Group 1, patients underwent crestal sinus floor elevation with simultaneous implant placement using antral membrane balloon technique. Group 2, patients underwent crestal sinus floor elevation with simultaneous implant placement using Densah burs. Patients were evaluated clinically and radiographically using cone beam computed tomography (CBCT) at regular time intervals immediately, 6 months and 12 months after surgery. All clinical and radiographic parameters were statistically analyzed. RESULTS: All dental implants were successful for 12 months of follow up. Regarding implant primary stability, there was a statistical significant difference between the study groups in favor of Densah group (P = 0.004), while there was no significant difference after 6 months (P = 0.07). Radiographically, balloon group showed a statistically significant immediate postoperative vertical bone height (P < 0.0001), and significant reduction in vertical bone height after 6 months (P < 0.0001). Densah group showed significant increase in bone density (P ≤ 0.05). CONCLUSION: Both techniques demonstrated successful clinical and radiographic outcomes for crestal sinus lift. The antral membrane balloon group demonstrated better immediate postoperative vertical bone gain, while Densah burs had higher implant primary stability and bone density. TRIAL REGISTRATION: This study was registered in Clinical-Trials.gov PRS ( https://register. CLINICALTRIALS: gov ) under identification number NCT05922592 on 28/06/2023.

Sublabial transmaxillary approach to the inferior aspect of the orbit.

OBJECTIVE: The objective was to demonstrate the surgical steps and outcomes of the sublabial transmaxillary microsurgical approach with endoscopic assistance to treat lesions in the inferior aspect of the orbit, as well as to describe the use of patient-specific 3D models to facilitate surgical preparation and improve experience with the technique. METHODS: The authors' study evaluated data from patients who underwent an endoscope-assisted sublabial transmaxillary approach for inferior orbital lesions. For 2 patients, 3D models were created for preoperative planning and assessment of the approach. Surgical steps comprised osteotomy to access the maxillary sinus, bony resection of the orbital floor, opening of the periorbital fascia, and dissecting and removing the lesion, followed by closure. The neuroendoscope was used to inspect the surgical cavity between each step. RESULTS: The study included 5 patients with varying visual field defects and proptosis who underwent the sublabial transmaxillary microsurgical approach with endoscopic assistance. Complete resection was achieved in all, and all patients reported improvement in visual field defects and proptosis after the procedure. No complications were observed except for transient unilateral maxillary edema noted around the incision site in 3 patients during the early postoperative period, which resolved within a few days. Histopathological examination confirmed the diagnosis of cavernous malformation in all patients. CONCLUSIONS: The sublabial transmaxillary approach is a direct and safe method to resect cavernous malformations at the inferior aspect of the orbit. It reduces the risk of complications associated with lateral, transcranial, and transnasal approaches that may cross critical structures. The microsurgical approach provides the benefit of two-handed dissection for lesions embedded in orbital fat, which can be challenging because of adhesions to surrounding tissues. The use of 3D models can facilitate surgical planning and enhance familiarity with the approach.

Morphological changes in the inferior nasal passage associated with superior repositioning of the maxilla with/without horseshoe osteotomy or turbinectomy.

Superior repositioning of the maxilla during Le Fort I osteotomy (LFI) may narrow the inferior nasal passage. This retrospective study was performed to investigate morphological changes in the inferior nasal passage following LFI with/without additional procedures performed for nasal ventilation (horseshoe osteotomy or inferior turbinate partial resection). Three groups of patients were compared: those undergoing conventional LFI (Conv, 63 patients), LFI with horseshoe osteotomy (Hs, eight patients), and LFI with inferior turbinate partial resection (Turb, 21 patients). Coronal computed tomography images were used to evaluate the degree of stenosis of the inferior nasal passage. The soft tissue and bony tissue volumes in the inferior turbinate were also calculated three-dimensionally. The rate of obstruction of the inferior nasal passage postoperative was 65.9%, 50%, and 11.9% in the Conv, Hs, and Turb groups, respectively (Fisher's exact test, P < 0.001). Patients in the Turb group had significantly less nasal obstruction regardless of the pitch direction of the maxillary movement or volume of the bone in the inferior turbinate (all P < 0.001). In conclusion, for patients with high superior repositioning and well-developed bony tissue in the inferior turbinate, additional procedures are recommended to maintain the ventilation of the nasal passage postoperatively.

Surgical Technique for Compartmental Resection of T4b Gingivobuccal Cancer.

Management of advanced gingivo-buccal complex cancers involving the masticatory space (T4b) is often managed by compartment resection. The oncological safety of the procedure is now clearly established. Based on the origin and epicenter of the tumor there are two classes of compartmental resection. Those tumors arising from the tuberosity of the maxilla and/or upper gingival sulcus region; the resection involves the tumor, posterior maxilla, and the ipsilateral infratemporal fossa. These tumors can be resected by mandibulotomy approach, preserving the mandible. This constitutes class-1 infratemporal fossa resection. The class-2 infratemporal fossa resection is applied for those tumors arising from the retromolar trigone and/or lower gingivo-buccal sulcus region. In this class, the mandible and often the overlying cheek skin needs to be sacrificed, in addition to the contents of the infratemporal fossa and the posterior maxilla. Both the classes of resections are carried out in an orderly fashion following well-defined steps. These sequential steps maximize the exposure of inaccessible structures, enables protection of critical structures as well as minimizes blood loss. This manuscript describes the surgical steps for the two classes of compartmental resection of the infratemporal fossa for advanced gingivo-buccal complex cancers involving the masticatory space.

Maxillary Diffuse Large B-Cell Lymphoma Enshrouded as Osteomyelitis: A Case Report.

Extranodal non-Hodgkin's lymphoma (NHL) afflicting the head and neck region is rare, accounting for only about 5%. Diffuse large B-cell lymphoma (DLBCL) is the most common type of NHL affecting the oral cavity. Due to its variable clinical presentation and non-pathognomic course, it can be easily misdiagnosed with overlapping characteristics to common oral pathologies. In the present case, the authors report an unusual presentation of DLBCL and highlight the significant diagnostic challenge encountered by the clinician. In our case, osteonecrosis of the maxilla with soft tissue swelling misleads the diagnosis of chronic osteomyelitis. However, further, work-up was pursued, and the patient was managed successfully with chemotherapy and is currently disease-free for the past 1 year. An accurate clinico-radiological diagnosis with histopathological confirmation is emphasized to deliver a potentially curative treatment in a timely manner.

Why don't many ENT Surgeons Perform Facial Trauma Surgery.

Introduction: The facial bones are prone to severe injuries due to high exposure and the labile nature of the bones, and they are injured in a significant proportion of trauma patients. Varying from simple, common nasal fractures to communited fractures of the face, management of such injuries can be extremely challenging due to fact that these injuries involve a highly vascular zone with proximity to the airway. In spite of being very well trained in surgeries of face and head neck area, with the exception of nasal bones, not many ENT surgeons in India perform facial bone fracture surgeries. Objective: This questionnaire-based study was planned to explore this key issue to understand as why many ENT surgeons do not perform facial trauma surgeries. Method: A cross-sectional questionnaire-based study was conducted over a period of 2 months Responses were obtained from ENT surgeons across various social groups on a Google Form-based questionnaire. The answers were collected and analysed. Result: A total of 240 valid responses were obtained. Most (56.7%) of the ENT surgeons had more than 15 years of practice. Around half (52%) of surgeons never did facial trauma surgery, and 65% of respondents replied that the main reason for their lack of involvement in facial trauma surgery was that they had no exposure to it during postgraduate training. The majority (65%) also wanted to enter this subspeciality if given a chance. Conclusion: To develop facial trauma management as a subspeciality in ENT, more and more ENT departments in medical colleges should include these surgeries as part of their training programmes. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-024-04604-z.

Evaluation of the Long-Term Success and Patient-Related Outcomes of Zygomatic Implants in Atrophic Maxillary Ridges.

Introduction Zygomatic implants (ZIs) have emerged as a promising option for rehabilitating completely edentulous patients with severe maxillary atrophy. These implants anchor into the zygomatic bone, bypassing the need for extensive grafting procedures. Success rates in dental and craniofacial implant surgeries can be influenced by several surgical factors, including suture techniques, flap design, and treatment planning. The research aimed to present the clinical outcomes and complications in individuals with severely resorbed maxillae who underwent prosthodontic rehabilitation using the Quad Zygoma Protocol (QZP) and the Anatomy-Guided Approach (AGA), focusing on long-term assessment. Material and methods Data for this retrospective study were extracted from the institution's patient database, involving a meticulous review of patient records. This comprehensive examination encompassed demographic data, preoperative assessments, details of surgical procedures, postoperative complications, and subsequent follow-up evaluations. Patients with severe maxillary bone deficiencies resulting in complete edentulism, due to inadequate bone quality and quantity in both anterior and posterior regions, were selected for inclusion. Exclusion criteria were applied to individuals with incomplete records or insufficient follow-up data, as well as those who underwent alternative treatment modalities or presented with comorbidities potentially impacting implant outcomes. The selected patients underwent treatment utilizing the QZP, with each participant subjected to a minimum three-year follow-up period. The implant survival rate, prosthetic success, complications, and Oral Health-Related Quality of Life using the OHIP-14 questionnaire were assessed. Results At the end of the follow-up period involving 12 patients (eight men, four women) with 43 ZIs - 37 from Neodent, four from Nobel Biocare, and two from Norris - with a mean duration of 4.3 years (range: 1.2-5.4), the overall success rate stood at 99.08%, with only 1 out of 42 implants failing. All patients received immediate loading with an acrylic prosthesis, proving effective in 98.2% of cases. The most common issues observed were localized soft tissue inflammation (35.7%) and sinus inflammation (12.5%), occurring after mean follow-up periods of 1.2 and 3.5 years, respectively. In 12 patients, the mean score of the OHIP-14 questionnaire was 1.6 ± 2.6, with a follow-up period of 5 ± 0.6 years. Conclusion The QZP has consistently demonstrated excellent long-term success in restoring severely reduced maxillary structures. An immediate loading approach could aid in stabilizing ZIs through cross-arch support.

Does the anatomy around the pterygomaxillary suture contribute to the risk of bad fractures in Le Fort I osteotomy?

Le Fort I (LF1) osteotomy, a common orthognathic procedure for the maxilla aimed at achieving maxillary mobility by separating the pterygomaxillary suture, poses a risk of bad fracture that may lead to complications and inadequate mobility. Our study analyzed two- and three-dimensional computed tomography images to identify the anatomical factors associated with bad fractures due to an LF1 osteotomy. Point 'a' is where the lateral pterygomaxillary suture on the axial image aligns with the zygomatic alveolar line near the line used for an LF1 osteotomy, with the base line connecting the bilateral 'a' points.Two risk factors were identified on the pterygoid side: (i) when the distance from point 'a' to the intersection of the base line and the medial pterygoid plate was <6.0 mm; and (ii) when the distance from the piriform aperture margin to the base line was <44.78 mm. Six risk factors were identified on the maxillary side, including the distance between the most anterior and most lateral points of the internal surface of the maxillary sinus being <31.9 mm. Our analyses revealed that fractures that occur during pterygomaxillary suture separation in an LF1 osteotomy are influenced by anatomical factors of the maxilla and pterygoid process, which form the pterygomaxillary suture.

A maxillary location of extra-nodal Rosai Dorfman disease: a case report.

Introduction: Rosai-Dorfman disease (RDD) is a rare benign histiocytic proliferation, characterized by a group of clinical symptoms. This report presents a case of extranodal RDD manifesting as a progressively enlarging left maxillary mass in a 42-year-old woman. Surgical exploration and biopsy confirmed the diagnosis of RDD, with characteristic histopathological features including emperipolesis. Treatment involved corticotherapy, resulting in controlled maxillary pain and improvement of the disease after one year. This case underscores the potential for extra-nodal RDD presentations, posing diagnostic challenges and emphasizing the importance of considering RDD in the differential diagnosis of maxillary masses.

Unusual presentation of primary central xanthoma of the maxilla associated with impacted canine: An update on immunohistochemistry in the diagnosis.

A xanthoma is an extremely rare condition that affects the soft tissues and bones and is characterized by a predominance of lipid-rich foamy histiocytes. The onset of xanthomas is frequently accompanied by primary or secondary hyperlipidemia. Primary bone xanthomas are very uncommon benign bone lesions that are not linked to hyperlipidemia. Histopathologically, they are distinguished by histiocytes, an abundance of foam cells or xanthoma cells that contain lipids, and a paucity of multinucleated giant cells. There have only been four reports of primary maxillary xanthoma in the medical literature. We present a rare primary intrabony xanthoma of the anterior maxilla in a 23-year-old normolipidemic female patient with solitary radiolucency. Using CD68, S-100, and CD1a immunohistochemical staining, it is possible to distinguish between macrophage/non-Langerhans histiocytes and Langerhans histiocytes. Therefore, a diagnosis of a central xanthoma of the jaws must be made.

A comparison of preoperative soft tissue contour versus bone accuracy as a predictor of quality of life outcomes in osseous free flap jaw reconstruction using occlusal-based virtual surgical planning.

OBJECTIVES: Occlusal-based virtual surgical planning (VSP) prioritises the placement of endosseous dental implants, over replicating native bone contour. This may compromise facial aesthetics. This study aimed to compare function and health-related quality of life (HRQOL) following maxillomandibular reconstruction according to the ability to replicate preoperative soft-tissue contour and virtual plan. MATERIALS AND METHODS: Patients who underwent occlusal based VSP osseous free flap reconstruction of the maxilla or mandible with high-resolution pre- and post-operative facial computerised tomography imaging and completed the FACE-Q questionnaire were retrospectively identified. Accuracy of reconstruction compared to preoperative soft tissue contour and virtual plan, was measured using 3DSlicer® and CloudCompare® in three dimensions. Random effects modelling determined the associations between bony and soft tissue accuracy and HRQOL/functional domains. RESULTS: Twenty-two patients met the inclusion criteria. For mandibular and maxillary reconstructions, better soft tissue accuracy was associated with improved appearance (p = 0.048) and appearance distress (p = 0.034). For mandibular reconstructions, better soft tissue accuracy was associated with improved smile (p = 0.039) and smile distress (p = 0.031). For maxillary reconstructions, better bony accuracy was associated with improved appearance (p = 0.023) and drooling distress (p = 0.001). Unexpectedly, better bony accuracy was associated with worse eating and drinking (p = 0.015), oral competence (p = 0.005) and eating distress (p = 0.013) in mandibular reconstructions. CONCLUSION: Whilst soft tissue accuracy was associated with better functional and HRQOL outcomes, bone accuracy was associated with worse oral function or distress in mandibular reconstruction. These results require validation but should be considered when performing occlusal-based VSP, which prioritises dental rehabilitation over replicating facial bony contour.

Anatomical Factors of the Anterior and Posterior Maxilla Affecting Immediate Implant Placement Based on Cone Beam Computed Tomography Analysis: A Narrative Review.

BACKGROUND: The aim of this narrative review was to provide insights into the influence of the morphological characteristics of the anatomical structures of the upper jaw based on cone beam computed tomography (CBCT) analysis on the immediate implant placement in this region. MATERIAL AND METHODS: To conduct this research, we used many electronic databases, and the resulting papers were chosen and analyzed. From the clinical point of view, the region of the anterior maxilla is specific and can be difficult for immediate implant placement. FINDINGS: Anatomical structures in the anterior maxilla, such as the nasopalatine canal and accessory canals, may limit and influence the implant therapy outcome. In addition to the aforementioned region, immediate implant placement in the posterior maxilla may be challenging for clinicians, especially in prosthetic-driven immediate implant placement procedures. Data presented within the recently published materials summarize the investigations performed in order to achieve more reliable indicators that may make more accurate decisions for clinicians. CONCLUSION: The possibility for immediate implant placement may be affected by the NPC shape in the anterior maxilla, while the presence of ACs may increase the incidence of immediate implant placement complications. The variations in IRS characteristics may be considered important criteria for choosing the implant properties required for successful immediate implant placement.

Congenital epulis of the newborn; A case report.

INTRODUCTION: Congenital epulis, also known as Neumann's tumor, is an uncommon benign tumor of the oral mucosa that occurs in newborns. It is a rare condition, with fewer than 250 reported cases worldwide. The exact cause or underlying mechanism of this tumor is still not well understood. CASE PRESENTATION: We present a three-day-old male neonate who presented with a swelling on the gingiva that had been present since birth. The infant did not encounter any difficulties with feeding or breathing. The patient had a single, round, pink swelling measuring 2 × 2 × 1 cm on the right maxillary alveolar ridge. The swelling was surgically removed under general anesthesia. Microscopic examination revealed large polygonal cells with abundant granular cytoplasm, centrally located nuclei indicating a diagnosis of congenital epulis. CLINICAL DISCUSSION: Clinical manifestation could vary from no symptoms to feeding difficulty and rarely airway obstruction. It usually tends to grow on anterior alveolar ridge of the newborns, more on the maxilla than on the mandible. Confirmation of the diagnosis is by histopathology, which commonly shows proliferation of polygonal round cells with eosinophilic granular cytoplasm and round central nucleus. Congenital epulis can be approached using different management techniques depending on the size, site of the tumor, and presenting symptoms of the newborns. CONCLUSION: Congenital epulis is rare, but it has to be considered as a differential diagnosis for gingival swelling among neonates.

Radiographic graft changes following maxillary sinus floor augmentation with autogenous bone compared with composite grafts: a one-year single-blind randomized controlled trial.

This study evaluated radiographic graft changes following maxillary sinus floor augmentation with (A) autogenous bone, (B) 1:1 autogenous bone and deproteinized porcine bone mineral, or (C) 1:1 autogenous bone and biphasic bone graft material. Sixty patients were randomly allocated to groups A, B, and C (20 in each). CBCT scans were obtained at enrolment, after surgery (T1), after prosthetic rehabilitation (T2), and 1 year after implant loading (T3). Significant decreases in graft volume (3D) and graft height (2D) from T1 to T3 were observed in all groups (P < 0.05). However, at T2 and T3, graft volume was significantly higher in group B than in groups A and C (P < 0.05), and graft height was significantly higher in group B than in group A (P < 0.05). Bone density increased significantly from T1 to T2 in all groups (P < 0.001). However, bone density was significantly higher in group B than in groups A and C, at T2 and T3 (P < 0.05). No significant correlation between graft volume or height and implant protrusion length or residual bone height was found. In conclusion, 1:1 autogenous bone and porcine bone resulted in significantly higher graft volume, height, and bone density when compared with autogenous bone or a 1:1 ratio of autogenous bone and biphasic bone. However the higher graft volume, height, and bone density did not appear to lead to improved outcomes at 1 year of functional loading when compared to the other groups.

Assessment of variations in the nasopalatine canal on CBCT: considerations from an anatomical point of view.

PURPOSE: The nasopalatine canal (NPC) is one of the most significant anatomical markers in the anterior maxillary region. Its location is quite important, especially for implant placement. Therefore, the purpose of this study was to use cone-beam computed tomography (CBCT) to evaluate the morphology, size, and anatomic variations of the NPC. METHODS: A total of 150 individual CBCT images were assessed in various sections to evaluate the dimensions, morphology, and extent of the NPC. Reformatted sagittal images were chosen to classify the shape and course of the canal. The Student's t-test, the χ² test, and Pearson correlation coefficients were used. RESULTS: The NPC was longer in males than in females, and the mediolateral diameter of the canal was greater in older adults. In sagittal sections, the canal predominantly exhibits a cylindrical shape, while a spindle shape is the least common. In coronal sections, a single shape is most frequently observed, with a Y-shape being the least common. Regarding the orientation of the canal, slanted canals are more prevalent, whereas vertically curved canals are rare. Typically, 2 canal openings are observed, with 4 openings being the least common. CONCLUSION: The current study highlights the challenges associated with identifying the anatomical appearance and variations of the NPC. Consequently, possessing a thorough understanding of this anatomy is essential before undertaking any surgical procedures, such as implant placement. This knowledge helps prevent complications such as nerve injury-related loss of sensation, bleeding due to blood vessel injury, and the development of a nasopalatine duct cyst following trauma to the canal during surgery.

Central Giant Cell Granuloma of the Mandible and Maxilla: A Clinicopathological Study of 21 Cases.

Background Central giant cell granuloma (CGCG) presents as a locally invasive, intraosseous lesion characterized by the accumulation of multinucleated giant cells amidst a matrix of hemorrhage and reactive fibrous tissue that infiltrates bone trabeculae. This idiopathic non-neoplastic proliferative lesion primarily affects the mandible, typically presenting as either unilocular or multilocular radiolucencies on X-rays. Although trauma or intraosseous hemorrhages are potential triggers, the precise histogenesis and etiology remain unclear. CGCG predominantly occurs in children and young adults, with a slight female predilection. Methods and materials A retrospective analysis of 21 cases of CGCG diagnosed at the Oral Pathology/Pathology department of Temple University Hospital between 2015 and 2022 was conducted. Each case was evaluated based on various parameters, including age, gender, presenting symptoms, radiographic findings, clinical differential diagnosis, and histological confirmation. The primary radiographic technique employed for diagnosis was X-ray imaging of the mandible and maxilla. The histological examination involved cutting paraffin-embedded tissue into 5-micrometer-thick sections, which were then stained using routine hematoxylin and eosin (H&E) stain. Notably, no specialized histochemical or immunohistochemical stains were utilized in the evaluation process. Results In our study, we reviewed 21 cases; 9 were male, 11 were female, and one had no available gender data. The age range was 15-76 years, with a mean of 50 years. The mandible was the most commonly affected location (17 cases; 81%) while the maxilla was less commonly involved (4 cases; 19%). Many CGCG lesions were asymptomatic (13 cases; 62%); eight cases (38%) were symptomatic, with pain and fullness of the affected dental region being the main manifestations. In a few cases, conditions such as brown tumor (severe hyperparathyroidism) and odontogenic neoplasms, such as ameloblastoma, were suspected clinically and radiographically. The diagnosis of CGCG with associated acute and chronic inflammation was confirmed in all the cases. Histological evaluation of routinely stained slides was the main diagnostic tool utilized. No special stains or molecular studies were required to establish the final diagnosis. Conclusions Our investigation has determined that CGCG exhibits a non-neoplastic nature, displaying a spectrum of behaviors ranging from non-aggressive to aggressive tendencies. While CGCG is predominantly observed in the mandible, rare instances of involvement in the maxilla have also been documented. Importantly, no confirmed association with neoplastic lesions was identified during our analysis. The clinical course of CGCG tends to be indolent, with some cases presenting in association with impacted teeth. It's noteworthy that CGCG can present features mimicking neoplastic conditions, such as ameloblastoma, or localized lesions linked to systemic disorders such as hyperparathyroidism (brown tumor).

Management of a dentigerous cyst; a ten-year clinicopathological study.

BACKGROUND: Dentigerous cysts, deemed of developmental origin, are benign odontogenic cysts characterized by a gradual growth rate. Their occurrence is twice as prevalent in men compared to women. These cysts are recognized as the most frequent developmental cysts affecting the jaws, with a typical manifestation in individuals aged 20 to 40, while infrequently identified in young children. Notably, dentigerous cysts have the potential to attain significant dimensions, resulting in painless enlargement of the jaw and subsequent deformation. OBJECTIVES: To assess the clinicopathological features and management of ten years of experience with dentigerous cysts. METHODS: A challenging cases were reported from reviewed records of the patients who were treated by the surgical intervention of various dentigerous cysts throughout the period of ten years, 2012-2022 and only histologically confirmed cases were selected, at Ramadi Teaching Hospital in addition to Rashid, Razi, Zuhur Private Hospitals and private clinics in Iraq. RESULTS: 76 patients were included in this clinicopathological research. The highest age group affected was ≤ 18 years (68.4%), 54% were male, the mandible was more affected (63.1%) than the maxilla (36.9%). Marsupialization was applied to 30.3% of the cases, while enucleation was carried out in 69.7%. CONCLUSIONS: The significance of meticulous examination of radiographs and the consequences associated with undetected and untreated ailments is affirmed by this case study. A comprehensive understanding of oral pathology serves as a valuable resource for dentists, facilitating accurate diagnosis, appropriate referrals, and the provision of anticipatory guidance to patients striving to achieve optimal oral health across various age groups.

Morphological evaluation of maxillary arch in unilateral buccally and palatally impacted canines: a cone-beam computed tomography (CBCT)-based study in Northern Iran.

Purpose: This study investigated the association between the maxillary impacted canines' position and the maxilla's morphological features in an Iranian population based on cone-beam computed tomography (CBCT) images. Material and methods: In this cross-sectional descriptive-analytical study, 47 CBCT images of unilateral buccally impacted maxillary canines and 47 CBCT images of unilateral palatally impacted maxillary canines were examined. Several morphological variables were compared between the impacted and non-impacted sides, and between the buccal and palatal impaction types. Results: Gender and age were not significantly associated with the canine impaction type. The alveolar bone height at the impacted side was significantly greater in the buccally impacted group than in the palatally impacted group (p = 0.016). In a comparison of the impacted and non-impacted sides, all variables of alveolar bone thickness at depth of 2 mm, maxillary arch width, and palatal volume had significantly smaller values in the impacted side in both buccally and palatally impacted groups (p < 0.05). The alveolar bone was significantly thicker at the depth of 10 mm in the impacted side of the buccal group (p = 0.024). The maxillary arch perimeter was significantly smaller in the impacted side of the buccal group (p = 0.008). The palatal depth did not significantly differ between the groups. Conclusion: Among the studied variables, the alveolar bone thickness showed contrary results at different depths. The palatal volume and maxillary arch width were significantly smaller on the impacted side in both buccal and palatal groups, and the arch perimeter showed the same results only in the buccal group.