The Sustained-released Polylactic Co-glycolic Acid Nanoparticles Loaded with Chlorhexidine as Antibacterial Agents Inside the Dental Implant Fixture.

INTRODUCTION: Titanium-based implants are widely used due to their good biocompatibility and high corrosion resistance. Infections after implant placement are the main reason for the failure of implant treatment. Some recent studies have also shown that microbial contamination can occur at the implant-abutment level in implants with healthy or diseased surrounding tissue. The purpose of this study is to investigate the antibacterial effect of slow-release nanoparticles of polylactic co-glycolic acid (PLGA) loaded with chlorhexidine (CHX) inside the implant fixture. MATERIALS AND METHODS: Thirty-six implants in three groups were examined in the bacterial culture environment. In the first group, PLGA/CHX nanoparticles; in the second group, the negative control group (distilled water) and in the third group, the positive control groups (chlorhexidine) were used. The bacterial suspensions, including Escherichia coli ATCC: 25922, Staphylococcus aureus ATCC: 6538 and Enterococcus faecalis ATCC: 29212 were used to investigate the antimicrobial effect of the prepared nanoparticles. RESULTS: The results showed that the use of PLGA/CHX nanoparticles significantly inhibited the growth of all three bacteria. Nanoparticles loaded with chlorhexidine had a significant decrease in the growth rate of all three bacteria compared to chlorhexidine and water. The lowest bacterial growth rate was observed in the Enterococcus faecalis/PLGA nanoparticles group, and the highest bacterial growth rate was observed in the Staphylococcus aureus/H2O group. CONCLUSION: The current study showed that the use of PLGA/CHX nanoparticles could significantly inhibit the growth of all three bacteria. Of course, the current study was conducted in vitro, and to obtain clinical results, we need to conduct a study on human samples. In addition, the results of this study showed that the chemical antimicrobial materials could be used in low concentrations and in a sustained- released manner in cases of dealing with bacterial infections, which can lead to better and targeted performance as well as reduce possible side effects.

Radiographic texture analysis of the hard tissue changes following socket preservation with allograft and xenograft materials for dental implantation: a randomized clinical trial.

OBJECTIVES: This study aimed to assess the hard tissue changes following socket preservation with allograft and xenograft materials for dental implantation by texture analysis (TA) using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: This prospective clinical trial was conducted on 25 patients who required the extraction of carious mandibular posterior teeth and their subsequent replacement with dental implants. The patients were categorized into three groups: (I) no socket preservation, (II) socket preservation with xenograft material, and (III) socket preservation with allograft material. Four months after tooth extraction, the patients were recalled for preoperative assessment before dental implantation, and CBCT scans were obtained (Kvp:110, mA:1.94, S:3.6). MaZda software was used to compare homogeneity, contrast, and texture complexity on axial CBCT sections among the three groups. RESULTS: Significant differences existed among the three groups in all parameters (P < 0.05) except for the mean correlation parameter (P > 0.05). The results showed no significant difference between the no graft and xenograft groups regarding contrast and differential (dif.) entropy (P > 0.05). Also, no significant difference was found between the xenograft and allograft groups regarding the dif. variance and also between the no graft and allograft groups regarding the inverse difference moment(InvDfMom) and dif. variance parameters (P > 0.05). All other pairwise comparisons revealed significant differences (P < 0.05). CONCLUSION: TA can be used for the quantification of radiographic changes of bone following socket preservation and potentially accelerate the process of decision-making for dental implant treatment.

Efficacy of a New Hemostatic Dental Sponge in Controlling Bleeding, Pain, and Dry Socket Following Mandibular Posterior Teeth Extraction-A Split-Mouth Randomized Double-Blind Clinical Trial.

AIMS: This study aimed to clinically evaluate of a novel gelatin-based biodegradable sponge after mandibular posterior teeth extraction to assess its abilities in controlling bleeding, pain, and dry socket compared a commercial sponge. TRIAL DESIGN: In this study, 26 patients who needed the extraction of two mandibular molar teeth were selected and, in each patient, after tooth extraction, the prepared gelatin sponge was used in the test group and the commercial sponge was used in the control group in the form of a randomized, double-blind, split-mouth clinical trial. The sterile gauzes were used on top of each sponge to absorb the extra blood (unabsorbed blood of sponges) to assess the blood absorption amount. Also, the amount of bleeding was recorded for 1 and 4 h after extraction for two groups. The amount of pain was measured for 12, 24, and 48 h after tooth extraction by Visual Analogue Scale (VAS). All patients also returned for examination four days after extraction to assess the occurrence of dry socket. RESULTS: The results showed that the average weight of absorbed blood by sterile gauze in the control group (6.32 ± 1.06 g) was higher than in test group (3.97 ± 1.1 g), e.g., the bleeding control was better for the test group (p < 0.05). Bleeding was observed to be significantly reduced in the test group within 1 h (p = 0.003), within 1-4 h (p = 0.002), and after 4 h (p = 0.042) post-operatively in comparison to the control group. The average pain decreased significantly over time in both groups and the reduction of the pain was significantly higher for the test group (p < 0.05). Just one dry socket case occurred in the control group. CONCLUSION: The prepared sponge is recommended for use in dental surgeries because of its abilities in bleeding, pain, and dry socket control.

Promising Antimicrobial Action of Sustained Released Curcumin-Loaded Silica Nanoparticles against Clinically Isolated Porphyromonas gingivalis.

BACKGROUND: Porphyromonas gingivalis (P. gingivalis) has always been one of the leading causes of periodontal disease, and antibiotics are commonly used to control it. Numerous side effects of synthetic drugs, as well as the spread of drug resistance, have led to a tendency toward using natural antimicrobials, such as curcumin. The present study aimed to prepare and physicochemically characterize curcumin-loaded silica nanoparticles and to detect their antimicrobial effects on P. gingivalis. METHODS: Curcumin-loaded silica nanoparticles were prepared using the chemical precipitation method and then were characterized using conventional methods (properties such as the particle size, drug loading percentage, and release pattern). P. gingivalis was isolated from one patient with chronic periodontal diseases. The patient's gingival crevice fluid was sampled using sterile filter paper and was transferred to the microbiology laboratory in less than 30 min. The disk diffusion method was used to determine the sensitivity of clinically isolated P. gingivalis to curcumin-loaded silica nanoparticles. SPSS software, version 20, was used to compare the data between groups with a p value of <0.05 as the level of significance. Then, one-way ANOVA testing was utilized to compare the groups. RESULTS: The curcumin-loaded silica nanoparticles showed a nanometric size and a drug loading percentage of 68% for curcumin. The nanoparticles had a mesoporous structure and rod-shaped morphology. They showed a relatively rapid release pattern in the first 5 days. The release of the drug from the nanoparticles continued slowly until the 45th day. The results of in vitro antimicrobial tests showed that P. gingivalis was sensitive to the curcumin-loaded silica nanoparticles at concentrations of 50, 25, 12.5, and 6.25 µg/mL. One-way ANOVA showed that there was a significant difference between the mean growth inhibition zone, and the concentration of 50 µg/mL showed the highest inhibition zone (p ≤ 0.05). CONCLUSION: Based on the obtained results, it can be concluded that the local nanocurcumin application for periodontal disease and implant-related infections can be considered a promising method for the near future in dentistry.

Management of iatrogenic chloroform mucosal burn in the palate: a case report.

Chloroform is used widely in endodontic treatments for solving gutta-percha points, but it can have destructive effects if it comes in to contact with oral mucosa. This article presents a case of necrotic ulcer of palatal and buccal mucosa due to injudicious use of chloroform in endodontic treatment, which has caused severe destruction in maxilla. A conservative treatment method of repeated curettage and irrigation was used and although the lesion healed completely, it had major effects on the patient's quality of life including loss of two teeth. It is important that dentist be aware of the devastating effects of imprudent application of various chemicals used in dentistry. The conservative treatment used for this case can be helpful option for similar cases.

Antibacterial Effects of Curcumin Nanocrystals against Porphyromonas gingivalis Isolated from Patients with Implant Failure.

Background. Despite their benefits, dental implants may sometimes fail for a diversity of causes; the most common reasons of failure are infection and bone loss. Porphyromonas gingivalis (P. gingivalis) bacteria show a major role in peri-implantitis infection and dental implant failure. Methods. In this study, the prevalence of P. gingivalis isolated from the gingival crevicular fluid (GCF) of fifteen Iranian patients with implant failure (more than 1/3 of the implant length), who had average oral and dental hygiene and no antibiotic use for at least one month, was determined. Moreover, the antimicrobial effects of curcumin nanocrystals against isolated P. gingivalis were investigated. The collected samples from patients were transferred to a microbiology laboratory to culture. The presence of P. gingivalis in the culture media was confirmed using a trypsin reagent test. An isolate from a patient with the highest colony count was selected to evaluate the antibacterial effects of curcumin nanoparticles. The inhibition zone diameter, minimum inhibitory concentration (MIC), and minimum bactericidal concentration (MBC) were determined. Results. Out of fifteen patients, eight (53.33%) were positive for the presence of P. gingivalis. The results of the microbial tests showed that curcumin nanoparticles had an MIC of 6.25 µg/mL and an MBC of 12.5 µg/mL. Conclusions. The use of curcumin nanoparticles may control the bacterial infection around the implant.

Effect of Adding Silica Nanoparticles on the Physicochemical Properties, Antimicrobial Action, and the Hardness of Dental Stone Type 4.

This study was conducted to investigate the effect of adding silica nanoparticles on the physicochemical properties, antimicrobial action, and the hardness of dental stone type 4. Dental stone type 4 powder was physically mixed with nanoparticle powder at weight percentages (0, 0.5, 1, and 2 percent). The required amount of powder was added to water according to the manufacturer's instructions. The prepared set materials were subjected to the physicochemical studies; Fourier transmission infrared spectroscopy (FTIR) was taken up to investigate the functional groups and X-ray diffraction (XRD) was used to evaluate the crystallinity. Also, scanning electron microscopy (SEM) was used to examine the morphology of the prepared samples. Agar diffusion test was carried out for the prepared samples against the Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) to test the average growth inhibition zones. Finally, the Vickers surface hardness test was performed for each group using a hardness tester. The adding silica nanoparticles to dental stone type 4 increased the diameter of inhibition zones for the groups in both bacteria significantly (p < 0.05). The results showed that adding silica nanoparticles to dental stone type 4 increased the diameter of inhibition zones for the groups in both bacteria significantly (p < 0.0001). There was a significant difference between all groups and the 0% group in both bacteria (p < 0.0001). Besides, the adding of silica nanoparticles to dental stone type 4 increased the surface hardness significantly (p = 0.0057) without any effect on physicochemical properties. The 0% and the 0.5% groups had significant differences with the 2% group (p = 0.0046 and p = 0.0205 respectively). Then, at least 2% silica nanoparticles are needed for a significant increase. Clinical trials are needed to enlarge for dental stone type 4 containing silica nanoparticles in the future.

A Biodegradable Flexible Micro/Nano-Structured Porous Hemostatic Dental Sponge.

A biodegradable micro/nano-structured porous hemostatic gelatin-based sponge as a dentistry surgery foam was prepared using a freeze-drying method. In vitro function evaluation tests were performed to ensure its hemostatic effect. Biocompatibility tests were also performed to show the compatibility of the sponge on human fetal foreskin fibroblasts (HFFF2) cells and red blood cells (RBCs). Then, 10 patients who required the extraction of two teeth were selected, and after teeth extraction, for dressing, the produced sponge was placed in one of the extracavities while a commercial sponge was placed in the cavity in the other tooth as a control. The total weight of the absorbed blood in each group was compared. The results showed a porous structure with micrometric and nanometric pores, flexibility, a two-week range for degradation, and an ability to absorb blood 35 times its weight in vitro. The prepared sponge showed lower blood clotting times (BCTs) (243.33 ± 2.35 s) and a lower blood clotting index (BCI) (10.67 ± 0.004%) compared to two commercial sponges that displayed its ability for faster coagulation and good hemostatic function. It also had no toxic effects on the HFFF2 cells and RBCs. The clinical assessment showed a better ability of blood absorption for the produced sponge (p-value = 0.0015). The sponge is recommended for use in dental surgeries because of its outstanding abilities.

Antimicrobial effects of nanocurcumin gel on reducing the microbial count of gingival fluids of implant‒abutment interface: A clinical study.

Background. This clinical study aimed to prepare and evaluate the effect of antimicrobial nanocurcumin gel on reducing the microbial counts of gingival fluids of the implant‒abutment interface in patients referred to the Tabriz Faculty of Dentistry for the placement of two dental implants. Methods. Fifteen patients applying for at least two dental implants were included in the study. During the uncovering session, nanocurcumin gel was placed in one implant, and no substance was placed in another (the control group). Then, in three sessions, implantation sessions (10 days after the repair abutment closure session), prosthesis delivery (15 days after the implantation session), and one month after prosthesis delivery, the patients' gingival fluid was sampled and cultured to determine bacterial counts in the gingival fluid by colony-forming units (CFU/mL). T-test was used for statistical analysis of data, and statistical significance was set at P<0.05. Results. This study showed that nanocurcumin gel significantly reduced the CFU/mL of gingival fluid in all three sampling stages compared to the control group. Conclusion. According to the results of this study, the application of antimicrobial nanocurcumin gel inside the implant fixture could reduce the microbial counts of gingival fluids.

Occurrence and severity of spontaneous exposure of cover screw after dental implant placement.

Background: Perforation of the soft tissues overlying the dental implant, resulting in early and spontaneous exposure of cover screws between stages I and II of the two-staged implant placement procedure, is a common problem that can disrupt the primary repair and osseointegration process. The present study aimed to investigate the prevalence of spontaneous exposure of cover screws in dental implants and identify the related risk factors. Methods: The present retrospective, descriptive-analytical study enrolled 40 patients with 182 dental implants in the second stage of the implant placement procedure. Data on patient-related and implant-related classified variables were collected, and all the samples were examined for cover screw exposure based on the classification by Tal. First, the overall prevalence of cover screw exposure was calculated. Then, statistical analysis was performed using SPSS 24 to investigate the effect of different variables on this exposure. The chi-squared test was used at the bivariate level, while the logistic regression was used at the multivariate level. Results: Of 40 participants with 182 implants, 17 implants (9.3%) in 9 patients (22.5%) became exposed to the oral cavity. In terms of severity, Class I exposure was the most common with seven implants. Moreover, Class III was the least common with only one implant. Using the logistic regression analysis, we found significant relationships between the dental implant exposure and the variables of overlying mucosal thickness (OR=24.7, P≤0.001), the duration between tooth extraction and implant placement (OR=9.6, P=0.005), and implant location in the jaw (OR=3.8, P=0.033). Moreover, exposure was more common in the maxillary premolar area (22.5%) than in other locations. Also, there was a significant relationship between implant exposure and lateral augmentation (OR=0.20, P=0.044), indicating the higher risk of exposure in implants with lateral augmentation than those without augmentation. Conclusion: Despite the limitations of this retrospective study, its results showed that three factors, including the overlying mucosal thickness of <2 mm, implant placement in fresh extraction sockets, and maxillary implants, especially at the location of maxillary premolars, were strong predictors of spontaneous implant exposure.

A View on Polymerase Chain Reaction as an Outstanding Molecular Diagnostic Technique in Periodontology.

OBJECTIVES: This study presents a discussion on the fundamentals of polymerase chain reaction (PCR) and its use as a diagnostic tool in periodontology. MATERIALS AND METHODS: A computer-aided as well as hand-made search in PubMed and Scopus indexed journals (relevant to the topic) was done by keywords of molecular technique in periodontology, PCR, applications of PCR, and PCR in periodontics. Only the papers in the English language and outlining PCR and its association with periodontology were collected and utilized to provide a succinct review. There was no limitation for publication time. RESULTS: The results of our search showed that PCR has turned into a standard in diagnosis in the field of periodontology. A variety of researches has demonstrated that its sensitive, and specific characteristics make it a quick and effective technique of recognition, identification, and quantification of microorganisms. Identification of various immunoinflammatory markers at the mRNA expression level as well as ascertaining gene-related polymorphisms can also be performed. CONCLUSIONS: The mechanisms of periodontal disease can further become clarified using PCR. Clinical Relevance. PCR as a diagnostic method can play a main part in the validation of the clinical diagnosis of periodontal disease indicating the reason, pathogenesis, clinical steps, progress, and prognosis of the disease.

Antibacterial effect of nanocurcumin inside the implant fixture: An in vitro study.

OBJECTIVES: Infections after implant placement are the main reasons for the failure of implant treatments. The present study aimed to evaluate the antibacterial effects of nanocurcumin inside the implant fixture against Escherichia coli, Staphylococcus aureus, and Enterococcus faecalis. MATERIALS AND METHODS: Twenty seven implants were classified in three groups for testing the antibacterial effect of nanocurcumin, chlorhexidine (as negative control), and distilled water (as negative control). Each group was then divided into three subgroups to study the effect of the applied torque on the antimicrobial effect of nanocurcumin. All implant abutment assemblies were submerged in bacteria suspension and were incubated at 37°C for 24 hours. The contents of each implant were removed to count the colony of bacteria on the surface of plates containing nutrient agar. RESULTS: Results indicated that the inhibitory rate of bacteria by nanocurcumin was above 99% in all bacteria. Besides, by increasing the amount of applied torque from 10 to 35 N.cm, the CFU of bacteria in exposure to nanocurcumin significantly were decreased (p-value < 0.01). CONCLUSION: The results of this study revealed that nanocurcumin can be used inside the implant fixture in order to use antimicrobial effects and further stabilization and success of the implant.

Nanofibrous asymmetric collagen/curcumin membrane containing aspirin-loaded PLGA nanoparticles for guided bone regeneration.

The goal of the current study was to develop an asymmetric guided bone regeneration (GBR) membrane benefiting from curcumin and aspirin. The membrane was prepared using electrospinning technique and then was physic-chemically characterized by the conventional methods. The release profile of aspirin from the prepared membrane was also measured by ultraviolet spectrophotometry. Also, the antibacterial activities of the membrane was evaluated. We also assessed the in vitro effects of the prepared membrane on the biocompatibility and osteogenic differentiation of dental pulp stem cells (DPSCs), and evaluated in vivo bone regeneration using the prepared membrane in the defects created in both sides of the dog's jaw by histology. The results from the characterization specified that the membrane was successfully prepared with monodispersed nanosized fibers, uniform network shaped morphology, negative surface charge and sustained release platform for aspirin. The membrane also showed antimicrobial effects against all tested bacteria. The presence of curcumin and aspirin in the asymmetric membrane enhanced osteogenic potential at both transcriptional and translational levels. The results of the animal test showed that the test area was completely filled with new bone after just 28 days, while the commercial membrane area remained empty. There was also a soft tissue layer above the new bone area in the test side. We suggested that the prepared membrane in this work could be used as a GBR membrane to keep soft tissue from occupying bone defects in GBR surgeries. Besides, the surgeries can be benefited from antibacterial activities and bone healing effects of this novel GBR membrane while, simultaneously, promoting bone regeneration.

Effect of injection of botulinum toxin on decreasing the symptoms and signs of masticatory muscles in patients with temporomandibular dysfunction.

Background. Temporomandibular joint dysfunction (TMD) is a term that describes problems in the masticatory system, including the temporomandibular joint, the dento-muscular system and the supporting bones. Injection of botulinum toxin, as a noninvasive technique, might be useful in decreasing symptoms such as muscular spasm, dystonia, migraine headaches and TMD. Therefore, the aim of the present study was to evaluate the effect of injection of botulinum toxin on decreasing the symptoms and signs of masticatory muscles in patients with TMD. Methods. A total of 61 patients were consecutively included in the present study in 2016‒2017. All the subjects received a 50-unit injection of Dysport botulinum toxin in the masseter muscles using an extraoral injection technique. The results of the injection were evaluated in terms of pain severity using VAS, clinical evaluations of the joint click through palpation and by determining the inter-incisal distance. The patients underwent follow-up examinations at 1-week, 3-month and 6-month intervals after injection. Data were analyzed with appropriate statistical tests. Results. Comparison of pain severity and articular clicks at different intervals showed decreases in these parameters over time, with significant differences between the time intervals (P<0.05). Comparison of mouth opening at different intervals showed increases in mouth opening over time. Conclusion. The results of the present study showed that injection of botulinum toxin can be used in patients with TMD as a non-invasive treatment modality.

The effect of ameloblastoma and keratocystic odontogenic tumor on the displacement pattern of inferior alveolar canal in CBCT examinations.

Background. The inferior alveolar canal should be examined as a significant anatomical landmark, particularly in the posterior body and ramus of the mandible, for dental and surgical procedures. In the present study, the effects of two pathological lesions, ameloblastoma and keratocystic odontogenic tumor, on canal displacement were investigated. Methods. This study had a single-blinded design. Twenty-six patients with lesions in the mandible referred to Imam Reza Hospital, Tabriz, Iran, were studied in two equal groups (13 patients with a histopathological diagnosis of ameloblastoma and 13 with a histopathological diagnosis of odontogenic keratocyst). After confirming the initial incisional biopsy and pathological report, cone beam computed tomography (CBCT) of lesions larger than 3 cm mesiodistaly and those involving the mandibular posterior body and ramus were included in the study. Two maxillofacial surgeons in association with an oral and maxillofacial radiologist examined three points on CBCT images to determine the mandibular canal position relative to the lesions from the lingual and buccal aspects. Results. The results of statistical analyses showed that in ameloblastoma, the inferior alveolar canal had been displaced more buccally in the ramus area (point A) (84.6%) but in the distal region (point C), the displacement was less buccal (41.6%). The canal was displaced buccally in 53.8% of cases at point A and in 46.2% of cases at point C in KOT lesions. Finally chi-squared test did not show any statistically significant differences between these two lesions. Conclusion. The results of this study showed no relationship between these lesions and the displacement of the mandibular canal.

Effect of Pharyngeal Pack on Postoperative Nausea and Throat Pain in Patients Undergoing Rhinoplasty

Objective: To evaluate the effect of pharyngeal pack on postoperative throat pain and nausea in rhinoplasty patients. Material and Methods: Twenty-eight patients were randomly selected and divided into two groups (n=14). The participants were randomly divided into two groups: G1 - the pharyngeal pack was used (Intervention group) and G2: not used (Control group). Both groups were anesthetized by the same protocol. Throat pain was measured by visual analog scale and nausea by presence / absence. Fischer's exact test, ANOVA, Friedman and Wilcoxon test were used. Results: There was no significant difference in mean pain and presence or absence of nausea between the two groups (p>0.05). But there was a significant difference in mean pain and the presence or absence of postoperative nausea with the intervals (p<0.05). Mean pain had a significant difference 2 hours postoperatively with other times, 6 hours postoperatively with 24 and 72 hours postoperatively, and 24 hours postoperatively with 72 hours (p<0.05). There was no significant difference in the presence or absence of postoperative nausea, between 2 hours and 6 hours postoperatively (p>0.05). The presence or absence of postoperative nausea had a significant difference between 2 hours postoperatively with 24 and 72 hours postoperatively and 6 hours postoperatively with 24 and 72 hours postoperatively (p<0.05). There was no significant difference in nausea between 24 hours and 72 hours postoperatively (p>0.05). Conclusion: None of the two groups were significantly superior in terms of reduction of pain and nausea, but because of the possible effectiveness of the pharyngeal pack in preventing aspiration of objects and tissues during the operation, the use of pharyngeal pack is recommended in patients.

Infratemporal space infection following maxillary third molar extraction in an uncontrolled diabetic patient.

Infratemporal space infection is a rare but serious sequel of odontogenic infection. The diagnosis is difficult due to non spe-cific signs and symptoms. Diabetes mellitus as a definitive risk factor for odontogenic infections needs more consideration during clinical procedures. We report a case of an undiagnosed diabetic patient with isolated infratemporal space infection after tooth extraction with presentation of similar signs and symptoms of temporomandibular joint and muscle problem.

Changes in the gonial angle following bilateral sagittal split osteotomy and vertical ramus osteotomy for mandibular excess.

AIM: The gonial angle plays an important role in ensuring a harmonious facial profile. Changes in this angle after surgery may be an esthetic concern for both the patient and the surgeon. The aim of the present study was to evaluate gonial angle changes after mandibular setback by the bilateral sagittal split osteotomy (BSSO) and vertical ramus osteotomy (VRO) techniques. METHODS: Fifty-eight male patients with mandibular prognathism only were treated from 2004 to 2006 (deformities such as discrepancy of jaws, mandibular setback of more than 10 mm, asymmetry, and vertical discrepancy were excluded). Patients were randomly divided into 2 groups. In the first group, mandibular setback was performed using the Obwegeser technique and wire osteosynthesis with 4 weeks' fixation (IMF), and in the second group, mandibular setback via VRO without wire osteosynthesis and 4 weeks' IMF was carried out. Lateral cephalograms were obtained for all the patients before surgery (T(0)) and 1 year after surgery (T(1)). Gonial angle and occlusal plane-SN in T(0) and T(1) were evaluated. RESULTS: After surgery, the gonial angle had decreased in all patients. Decrease in the gonial angle in the VRO group was greater than the BSSO group. The average decrease in the gonial angle was significantly more (P < 0.05) in the VRO group (7 degrees) than in the BSSO group (2 degrees). CONCLUSION: Gonial angle decrease was observed in the present study following mandibular setback by the VRO and BSSO techniques. This decrease in the VRO group was significantly greater.

Localized osteomyelitis of the mandible secondary to dental treatment: report of a case.

Osteomyelitis of the jaws following dental treatment is a rare condition which usually occurs in immuno-compromised patients both locally and generally. A case is presented with the alveolar bone necrosis resulting from leakage of an arsenical devitalizing paste into the periodontium. The treatment procedures and the outcomes are discussed in this article.