New method to increase inter-alveolar height with preservation of crestal cortical bone for implant treatment.

The aim of this technique is to provide adequate interocclusal distance (3 mm) allowing preprosthetic management. A bone block was cut with piezosurgery and extracted, leaving the crestal cortical bone intact. The free crestal alveolar bone was fixed to the maxilla with 2 dental implants. After 3 months of follow-up, abutment surgery was performed and osseointegration was evident with adequate interocclusal height (7 mm) allowing prosthetic management.

A c.1244G>A (p.Arg415Gln) mutation in SH3BP2 gene causes cherubism in a Turkish family: report of a family with review of the literature.

OBJECTIVES: The present study was aimed at advancing the understanding of the pathogenesis of cherubism by presenting a case study based on history, physical examination, typical radiological features, molecular and histopathological laboratory tests and a review of the literature. STUDY DESIGN: This study began with a 7-year-old boy who was referred due to mandibular overgrowth. A panoramic radiograph revealed multilocular radiolucent lesions of the upper/lower jaws suggestive of cherubism. Overall, a total of four family members were tested for SH3BP2 mutations, namely two siblings and their parents. Both siblings had been clinically diagnosed with cherubism; however, the parents were clinically normal. Peripheral blood was collected from all participants and genomic DNA sequencing was carried out. RESULTS: A missense mutation was found in the two affected siblings and their asymptomatic mother. The mutation was a 1244 G>A transversion which resulted in an amino acid substitution from arginine to glutamine (p.Arg415Gln) in exon 9. CONCLUSIONS: The present study emphasized the importance of further clinical and molecular investigation even when only a single case of cherubism is identified within a family. Genotype-phenotype association studies in individuals with cherubism are necessary to provide important insights into the molecular mechanisms associated with this disease.

Anterior mandibular zone safe for implants.

During implantology procedures, one of the most serious complications is damage of the inferior alveolar nerve (IAN). The mandibular incisive nerve is described as a terminal branch of the IAN and provides innervation to the lower anterior teeth and canines. The incisive nerve and canal are located in the interforaminal area. Although numerous studies report IAN damage during implant placement, few reports in the literature describes sensory disturbances, such as neuropathic pain, related to mandibular incisive nerve damage. The purpose of this retrospective clinical study was to evaluate the risk of neuropathic pain caused by implant placement in the interforaminal region of the mandible. Panaromic radiographs of patients who were treated with dental implants in the Department of Maxillofacial Surgery, Faculty of Dentistry at Erciyes University, between 2007 and 2012, were examined. Fifty-five patients with suspected relationship between mandibular incisive canal and dental implant were included into this study. Computed tomography scans were obtained from 10 patients who have postoperative neuropathic pain. Relationship between dental implant and mandibular incisive nerve was evaluated using a three-dimensional software program. Mandibular incisive nerve perforation by at least 1 implant was observed in all 10 patients. Descriptive analyses were also provided. Neuropathic pain may occur after implant placement in the interforaminal region due to the perforation of the incisive canal and nerve. According to the results of this retrospective study, the incisive canal and nerve perforation should be considered as a complication of implant surgery in the mandibular anterior area.

Total antioxidant capacity and total oxidant status of synovial fluids in patients with temporomandibular joint pain and dysfunction.

OBJECTIVES: The objective of this study was to investigate whether a relationship exists between total antioxidant capacity (TAC) and total oxidant status (TOS) of synovial fluids (SFs) of temporomandibular joint (TMJ) pain patients with pain and dysfunction. MATERIALS AND METHODS: Forty-two patients with TMJ pain were included in this study. TAC and TOS values of SFs were measured with a novel colorimetric method. Independent t test and correlations were used to analyze the data. RESULTS: TAC of SFs in patients with TMJ pain and limited mouth opening (LMO; n = 21) were significantly lower (P = 0.03) than patients without LMO (n = 21). TOS of SF was negatively correlated with duration of the disease. There was no correlation between TAC, TOS, and VAS scores of the patients as well as age and maximum mouth opening values. CONCLUSIONS: Antioxidant response to oxidative changes (TAC and TOS) in SF decreased as the stage of dysfunction increased. CLINICAL RELEVANCE: Local administration of antioxidant agents might be considered in management of TMJ pain and dysfunction to prevent possible increased oxidative stress.

Is supraperiosteal infiltration anesthesia safe enough to prevent inferior alveolar nerve during posterior mandibular implant surgery?

OBJECTIVES: There is no agreement on using inferior alveolar nerve (IAN) block or supraperiosteal infiltration anesthesia during dental implant surgery in the posterior mandibular region. The aim of this study was to evaluate the effectiveness of supraperiosteal infiltration anesthesia on posterior mandibular region during dental implant surgery. MATERIALS AND METHODS: In this study 52 implants were inserted under supraperiosteal infiltration anesthesia in 29 patients. After the surgery, patients were instructed to note their pain and/or painless dyscomfort on the visual analogue scale (VAS). Their pressure pain threshold (PPT) scores were evaluated by mechanical algometer. The distance between the apical end of the implants and IAN was measured by using calipers on postoperatif panoramic radiographs. RESULTS: 50 implants to 27 patients had been able to place without pain under supraperiosteal infiltration. Implants which were placed at the mandibular second premolar and first molar region had been able to place with free of pain with supraperiosteal infiltration. There was no relationship among the distance between the apical ends of the implants and IAN with intraoperative discomfort of the patients. VAS scores during implant placement at the second premolar region were relatively higher than at the first and second molar region. CONCLUSION: Supraperiosteal infiltration anesthesia is a safe and effective method for posterior mandibular implant surgery. However the length of the implant should be determined carefully to avoid possible damage to IAN during implant placement under supraperiosteal infiltration anesthesia.

Treatment of patient with Papillon-Lefevre syndrome with short dental implants: a case report.

Papillon-Lefevre syndrome (PLS) is an autosomal recessive disorder. Main features of PLS are hyperkeratosis of palms and soles concomitant with premature loss of primary and permanent dentition due to progressive periodontitis. Dental management of patients with PLS is usually challenging because of early excessive loss of alveolar bone support. We describe dental rehabilitation of a 34-year-old patient with PLS with severely atrophic mandible by means of 2 short (6 mm) dental implants between 2 mental foramina supporting an implant retained complete denture. After 1 year of follow-up period, the patient was doing well and there was no sign of bone resorption. In patients with PLS, dental osseointegrated implants (even with shorter lengths) can be safely used for atrophic mandibles instead of invasive preprosthetic applications such as bone augmentation, nerve lateralization, or alveolar distraction to avoid possible complications.

Association of serum total antioxidant capacity and total oxidant status with pain perception in patients with myofacial pain dysfunction.

We aimed to find out the association of total antioxidant capacity (TAC) and total oxidant status (TOS) with generalized pressure pain thresholds (PPT) of patients with myofacial pain dysfunction (MPD). PPT scores of patients with MPD (n = 37) and healthy individuals (n = 43) were measured on the hypothenar region of the hand using a mechanical algometer. Serum samples were collected and TAC and TOS were measured by novel methods. The TAC of patients was significantly lower than that of the control subjects. The difference between the TOS measurements of patients and control subjects was not significant. The PPT scores of the patients were significantly lower than that of control subjects. There may be an association between serum antioxidant capacity and MPD. Low serum TAC might also be related with pain perception.

Isolated lower lip fistulas in Van der Woude syndrome.

Van der Woude syndrome (VWS) is a dominantly inherited disease of orofacial region. Characteristic features of this syndrome are bilateral lower lip sinuses along with cleft lip or palate deformity. However, isolated lower lip pits in VWS without any cleft syndrome is uncommon. Lip pits in VWS are usually asymptomatic; however, patients may complain of watery drainage and/or infection. In this report, asymptomatic isolated lower lip sinuses without any cleft syndrome in a patient and his father are presented.

Evaluation of pain perception in patients with temporomandibular disorders.

PURPOSE: The aim of this study was to assess the pain perception of patients with temporomandibular disorders and to investigate a possible association between pain sensitivity and temporomandibular disorders. PATIENTS AND METHODS: Fifty patients with temporomandibular disorders who were diagnosed according to research diagnostic criteria for temporomandibular disorders and 45 healthy volunteers were conducted. Visual analog scale, designed as 0 being no pain and 100 being worst pain ever experienced, was used to determine subjective pain expression during maximum mouth opening in patients and control subjects. All subjects' pressure pain thresholds were measured 3 times on the hypothenar region of the left hand with a mechanical algometer. Mean value of measured scores was assumed to be the general pressure pain threshold of the individual. RESULTS: Patients with temporomandibular disorder had significantly lower general pressure pain threshold values than pain-free subjects. Women had lower general pressure pain threshold values than men within groups as well. In the patient group, those with limited mouth opening (50 mm). However this result was statistically insignificant. CONCLUSIONS: According to the results of this study temporomandibular disorder patients were significantly different in terms of general pain perception. Systemic pain regulation mechanisms might be involved in temporomandibular disorder development. Some symptoms of temporomandibular disorder patients such as movement limitation and subjective pain expression might be originated from pain perception discrepancies besides severity of disease.

A novel PTCH1 gene mutation in a pediatric patient associated multiple keratocystic odontogenic tumors of the jaws and Gorlin-Goltz syndrome.

Gorlin-Goltz syndrome (GGS) is an uncommon autosomal dominant inherited disorder which comprises the triad of basal cell carcinomas (BCCs), odontogenic keratocysts, and musculoskeletal malformations. Besides this triad, neurological, ophthalmic, endocrine, and genital manifestations are known to be variable. It is occasionally associated with aggressive BCC and internal malignancies. This report documents a case of GGS with a novel mutation in the PTCH1 gene in an 11-year-old child. The clinical, radiographic, histopathologic and molecular findings of this condition, and treatment are described, and a review of GGS was carried out.

Implants in children with hypohidrotic ectodermal dysplasia: an alternative approach to esthetic management: case report and review of the literature.

Ectodermal dysplasia (ED) is a rare congenital disease that affects several ectodermal structures. Children with ED may have various manifestations of the disease that differ in severity. In addition to its other symptoms, ED causes anadontia and hypodontia of the primary or permanent teeth, impacted teeth, malformed and widely spaced peg-shaped teeth, and underdeveloped alveolar ridges. Since the oral rehabilitation of these cases is often difficult, particularly in pediatric patients, treatment should be provided by a multidisciplinary team. Dental implants are the treatment of choice when growth has stabilized, and implants can be used to support, retain, and stabilize the prosthesis. The purpose of this paper was to present a case report of implant placement in a 7-year-old girl with hypohidrotic ectodermal dysplasia and review the current literature to discuss the use of dental implants in such patients.

Treatment of cherubism with salmon calcitonin: a case report.

Cherubism is a familial disease of the jaws which is inherited via autosomal dominant manner. Typical features of cherubism include a painless bilateral, symmetrical enlargement of the jaws, misalignment of teeth, and intra-osseous central giant cell granuloma-like lesions, which are usually evident in early childhood. Treatment of cherubism consists of local curettage of the lesions, jaw contouring, intralesional steroid injections, and systemic calcitonin administration as well. Calcitonin therapy for central giant cell granuloma of the jaws is well documented, and favorable results have been achieved. However, fewer reports have been presented in regard to calcitonin administration for cherubism. In the present report, a 14-year-old boy with cherubism who had intra-osseous cherubic lesions in his mandible was treated with an administration of 200 IU systemic calcitonin every other day via his nasal passage for duration of more than two years. After 30 months of calcitonin therapy, the lesions in the mandible were significantly regressed, and calcitonin application was ceased. Despite some drawbacks, such as unpredictable efficient absorption and patient tolerability, nasal administration is the easiest way to use calcitonin therapy on children. In this report, every-other-day applications of calcitonin increased patient tolerability and might be considered as an effective treatment for mild cherubic lesions.

Marsupialization of unicystic ameloblastoma: a conservative approach for aggressive odontogenic tumors.

Unicystic ameloblastoma (UA) is known as a distinct entity which has a less aggressive behavior when compared with conventional ameloblastoma. In this report, we have presented two cases of UAs, (of which one case showed a more aggressive behavior with mural invasion into the adjacent tissues and granular cell differentiation), both of which were successfully managed with enucleation following marsupialization. We aim to highlight how this method can be used for the successful management of such cases, rather than following more aggressive approaches. In both the cases, marsupialization was done for the UA lesions initially and follow-ups were maintained. When the tumor size had regressed on radiographic follow up, an enucleation procedure with ostectomy of the margins was carried out. Special importance was also given to the endodontic treatment of the teeth involved in the area of the lesion. The patients were free of the condition and did not show any signs of recurrence on radiographic follow-ups even after 30 months of the final procedure. Granular variant of UA is quite rare and had been considered to be more aggressive. Marsupialization of UA is an alternative treatment option of resection even for more aggressive variants, as long as the histological behavior of the lesion was carefully evaluated and strict radiographic follow-up is maintained.

Experimental evaluation of acute molding of the regenerate in mandibular distraction osteogenesis in a rabbit model.

OBJECTIVES: The aim of this study was to investigate the possible effect of acute regenerate molding (ARM) on bone healing in mandibular distraction osteogenesis (DO). STUDY DESIGN: Nine white New Zealand rabbits underwent unilateral mandibular lengthening via DO. Three groups were created: The first underwent 15° ARM, the second group underwent 30° ARM after the distraction period, and the third group served as control without molding. After 1 month of consolidation, all of the animals were killed and histomorphometric evaluation was performed. RESULTS: New bone formation was uneventful in all of the groups. In the ARM groups, the amounts of osteoblasts and newly formed bone areas were higher in compressed areas than in stretched ones (P < .05). The regenerates in the control group and stretched regenerate areas of the ARM groups were similar regarding new bone formation (P > .05). CONCLUSION: Acute regenerate molding could be safely applied immediately after the distraction period to correct postdistraction deformities without compromising bone healing.

The peripheral giant cell granuloma in edentulous patients: report of three unique cases.

The peripheral giant cell granuloma (PGCG) is a rare reactive exophytic lesion taking place on the gingiva and alveolar ridge usually as a result of local irritating factors such as trauma, tooth extraction, badly finished fillings, unstable dental prosthesis, plaque, calculus, chronic infections, and impacted food. This article presents 3 cases of PGCG that presented at the same location of the edentulous mandible of patients that using complete denture for over ten years.