The effect of concha bullosa and nasal septal deviation on palatal dimensions: a cone beam computed tomography study.

INTRODUCTION: Nasal septal deviation (NSD) and concha bullosa (CB) are associated with airway obstruction in mouth breathers. Mouth breathing is associated with alterations in maxillary growth and palatal architecture. The aim of our study was to determine the effect of the presence of CB and NSD on the dimensions of the hard palate using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: A retrospective study was conducted using CBCT scans of 200 study subjects. The study subjects were divided into four groups based on the presence of CB and NSD. Septal deviation angle (SDA), palatal interalveolar length (PIL), palatal depth (PD) and maxillopalatal arch angle (MPAA) were measured in the study groups. RESULTS: The presence of NSD and CB was associated with significant (p < 0.001) differences in the palatal dimensions of the study subjects. The PIL and MPA (p < 0.001) were significantly reduced (p < 0.001), whereas the PD was significantly increased (p < 0.001) in study subjects with NSD and CB. There was no significant change in the palatal dimensions between the unilateral and bilateral types of CB. Among the palatal dimensions, the PIL had the most significant association (R2 = 0.53) with SDA and CB. There was a significant correlation between the palatal dimensions and SDA when CB was present along with NSD. CONCLUSION: Based on the results of this study, it can be concluded that the presence of NSD and CB have a significant effect on the palatal dimensions and, therefore, they may be associated with skeletal malocclusion.

Three-Dimensional Radiological Assessment of Alveolar Bone Volume Preservation Using Bovine Bone Xenograft.

INTRODUCTION: Alveolar bone is critical in supporting natural teeth, dental implants as well as a removable and fixed prosthesis. Alveolar bone volume diminishes when its associated natural tooth is lost. OBJECTIVE: The aim of this study is to evaluate the effectiveness of bovine bone granules on alveolar bone socket augmentation for ridge preservation following atraumatic tooth extraction. MATERIALS AND METHODS: Twenty medically fit patients (12 males and 8 females aged between 18 and 40 years) who needed noncomplicated tooth extraction of 1 mandibular premolar tooth were divided randomly and equally into 2 groups. In control group I, the empty extraction socket was left untreated and allowed to heal in a conventional way. In group II, the empty extraction socket wound was filled with lyophilized bovine bone xenograft granules 0.25 to 1 mm of size, 1 mL/vial. A resorbable pericardium membrane was placed to cover the defect. Clinical and 3-dimensional radiological assessments were performed at day 0, 3 months, and 9 months postoperative. RESULTS: There were no clinical differences in general wound healing between the groups. Comparisons within the groups showed a significant difference of bone resorption of 1.49 mm (95% confidence interval, 0.63-2.35) at 3 months, and further resorption of 1.84 mm (P ≤ 0.05) at 9 months in the control group. No significant changes of bone resorption were observed in group II during the same time interval. Comparison between groups showed a significant difference of bone resorption at 3 and 9 months (2.40 and 2.88 mm, respectively). CONCLUSION: The use of lyophilized demineralized bovine bone granules in socket preservation to fill in the extraction socket seems essential in preserving the alveolar bone dimension as it showed excellent soft and hard tissue healing. This study concludes that the alveolar bone socket exhibited a dynamic process of resorption from the first day of tooth extraction. Evidence shows the possibility of using bovine bone granules routinely in socket volume preservation techniques following tooth extraction.

A study on the association between accessory maxillary ostium and maxillary sinus mucosal thickening using cone beam computed tomography.

BACKGROUND: Accessory maxillary ostium (AMO) has a major role to play in the aetiology of maxillary sinusitis. Mucosal thickening is one of the key radiographic features of chronic maxillary sinusitis. The aim of this study was to identify the location of the AMOs and investigate the association between Mucosal Thickening [MT] and AMO using Cone Beam Computed Tomography [CBCT]. METHODS: CBCT scans of 400 maxillary sinuses from the records of 200 patients who seeked various dental treatments at the Thumbay Dental Hospital, Gulf Medical University, Ajman, United Arab Emirates were evaluated. The incidence, anatomical position and maximal length of accessory maxillary ostia (AMO) in the maxillary antrum were reviewed using CBCT by two examiners. The association between MTs and AMOs were also analysed. RESULTS: Among the 200 CBCT scans, 131 belonged to male patients and 69 scans belonged to female subjects within the age group of 18-65 years (mean age 41.32 years). AMOs were found in 142 maxillary antra (35.5 %). The inter-observer reliability for using CBCT to detect AMO was (k = 0.83). There was no significant difference in the frequency of AMOs when the age (P = 0.19) and gender (P = 0.54) distribution were considered. Sinuses with AMOs, showed significantly greater frequency of MTs (p = 0.001). AMOs with maximal length of less than 1mm were most commonly observed (51.40 %). AMOs with larger greater maximal length were associated with higher degrees of MT. The location of the AMOs, were not affected by the degree of MT. CONCLUSIONS: The study demonstrates a clear association between degree of MT and occurrence of AMO in the maxillary sinus. However, the location of the AMO is independent of the degree of the MT. There is a greater probability of finding an AMO in the maxillary sinus if the MT in the sinus is more than 3 mm.

Biomechanical and radiological assessment of immediate implants for alveolar ridge preservation.

BACKGROUND: The aim of this study was to evaluate the stability of immediate implant placement for alveolar bone augmentation and preservation with bovine bone graft following atraumatic tooth extraction. MATERIALS AND METHODS: This was a prospective interventional study with convenient sampling (n = 10). Thirty patients aged between 18 and 40 years, who needed noncomplicated tooth extraction of mandibular premolar tooth, were sequentially divided equally into three groups. In Group I, simple extraction was done and the empty extraction socket left to heal conventionally. In Group II, extraction sockets were filled with lyophilized bovine granules only. In Group III, immediate implants were placed into extraction sockets, and the buccal gap was also filled with bovine granules. All groups were subjected to cone beam computed tomography scan for radiological evaluation. Assessment of biomechanical stability (radiofrequency analysis [RFA] was performed at 9 months postoperative for Group III to assess the degree of secondary stability of the implants using Osstell. Repeated measure analysis of variance (ANOVA) test was applied when comparing within each group at three different time intervals, whereas one-way ANOVA was applied followed by post hoc-tukey test when comparing between groups. P < 0.05 was considered statistically significant. RESULTS: Radiological assessment reveals a significant difference of bone resorption in alveolar dimension within Group I; 1.49 mm (P = 0.002), and 0.82 mm (P = 0.005), respectively, between day 0 and 3 months. Comparison between Group I and III showed a highly significant difference of bone resorption in ridge width at 3 months 2.56 mm (P = 0.001) and at 9 months interval 3.2 mm (P < 0.001). High RFA values demonstrating an excellent biomechanical stability were observed in Group III at 9 months postoperatively. CONCLUSION: The insertion of immediate implants in extraction sockets with bovine bone augmentation of the buccal gap was able to preserve a greater amount of alveolar ridge volume.