A Case Report of Maxillary Aspergillosis with Unusual Clinical and Imaging Presentations.

AIM: The aim of the present study was to present a case of maxillary aspergillosis with unusual clinical presentation and imaging findings. BACKGROUND: The range of lesions and conditions that affect the maxillary sinus is wide and vast. This necessitates a dynamic multidisciplinary approach for proper diagnosis and effective management. CASE DESCRIPTION: We present an unusual case of maxillary aspergillosis that mimicked apical periodontitis and was most consistent with lymphoma from the diagnostic imaging perspective. Histopathology, however, established the correct diagnosis; appropriate management commenced promptly. CONCLUSION: It is imperative that maxillary aspergillosis be diagnosed and managed properly and promptly to improve prognosis. Advanced imaging is required, but it plays an adjunct role to histopathology. Long-term follow-up is also necessary to ensure complete resolution of the infection. CLINICAL SIGNIFICANCE: Correlating clinical and imaging findings is a crucial step and any inconsistencies should be resolved promptly so as not to delay adequate management. Histopathology often serves to dispute any inconsistencies and allows the establishment of a proper diagnosis.

Validity of Cone-beam Computed Tomography in Assessment of Morphological Bony Changes of Temporomandibular Joints.

AIM: The aim of the current study was to correlate the clinical symptoms that are associated with temporomandibular disorder (TMD) to the osseous changes occurring in the affected temporomandibular joint (TMJ), as detected by cone-beam computed tomography (CBCT). MATERIALS AND METHODS: The clinical data of patients that presented with TMJ symptoms was collected and correlated with the CBCT findings for the same patients. Patient recruitment took place over a 1-year period in the Oral and Maxillofacial Surgery and Oral and Maxillofacial Radiology department of the same academic institution. RESULTS: There was a limited mouth opening (MO) (<3 cm). More importantly, there was a statistically significant positive relation between pain and loss of cortication. CONCLUSION: There was no significant correlation between CBCT findings consistent with TMJ degeneration and clinical symptoms. CLINICAL SIGNIFICANCE: Cone-beam computed tomography evaluation of the TMJ is important for providing information about the state and level of TMJ degeneration if any. However, clinical findings should be the most important factor when considering management options for symptomatic TMJ.

A Comparative Study of the Examination Pattern of Panoramic Radiographs Using Eye-tracking Software.

AIM: To analyze the differences between novice and expert orthodontists examining panoramic radiographs with incidental findings of varying difficulty. The null hypothesis states no difference in the examination pattern of panoramic radiographs between novice and expert orthodontists. MATERIALS AND METHODS: Expert and novice orthodontic observers were asked to examine six panoramic radiographs with incidental findings of varying difficulty. The eye-tracking software recorded and analyzed their eye movements during the examination. After examining each radiograph, the observers were asked questions about the radiograph. All these collected data were analyzed to compare the performance of the two sets of observers. RESULTS: The total number of observers was 72 in the novice group and 64 in the expert group. There was only one statistically significant finding between the two groups of observers, which was the end time. Expert orthodontists recorded longer panoramic radiograph examination times. CONCLUSION: There is no significant difference in the abilities of expert and novice orthodontists to examine panoramic radiographs and identify incidental findings. CLINICAL SIGNIFICANCE: Orthodontists might benefit from additional education and continued training in examining and reporting radiographs commonly utilized by this specific group of dental specialists, such as panoramic and cephalometric radiographs.

Meta-analysis of the Incidence of Lingual Nerve Deficits After Mandibular Bilateral Sagittal Split Osteotomy.

INTRODUCTION: Bilateral sagittal split osteotomy is a relatively common maxillofacial surgical procedure. The most commonly reported complication is neurosensory disturbances (NSD). The inferior alveolar nerve is by far the most commonly affected but sporadic reports of NSD of the lingual nerve also exist. The aim of this meta-analysis is to estimate the incidence of lingual nerve NSD following bilateral sagittal split osteotomy. MATERIALS AND METHODS: A systematic search of the English literature was conducted in February 2015 including several databases and using numerous MeSH terms. Article selection was based on preset criteria. Then pertinent data were collected and the incidence of the complications was calculated. RESULTS: Three articles were included in the meta-analysis. Incidence rates ranged between 0.3% and 18% with a pooled incidence of 0.7%. DISCUSSION: Lingual nerve NSD is an infrequent complication of bilateral sagittal split osteotomy. Fortunately, the complication usually resolves within 1 year of the procedure.

Awareness and attitude toward using dental magnification among dental students and residents at King Abdulaziz University, Faculty of Dentistry.

BACKGROUND: The authors conducted a study aimed to assess the awareness and attitude among dental students and residents at King Abdulaziz University, Faculty of Dentistry (KAUFD) toward using dental magnification. METHODS: An e-questionnaire was formulated then sent to dental students and residents (n = 651). The questionnaire included questions that assessed both the awareness and attitude toward using dental magnification. Data were analyzed using IBM SPSS version 22. The chi-square test was used to establish relationships between categorical variables. RESULTS: The response rate was 69.7 % (n = 454). Of those, 78.1 % did not use magnification during dental procedures. However, 81.8 % agreed that dental magnification could enhance the accuracy and quality of their dental work. Thus, 91.6 % thought it would be useful in endodontics and 46.3 % voted for surgery. Of the 21.9 % that used magnification, dental loupes were mostly used, 55.9 %. The majority (59.4 %) of the participants believed that using dental magnification should be introduced by faculty beginning in Year I of dental school. CONCLUSIONS: Among our respondents, most of the undergraduate students did not use dental magnification nor attended courses in the use of dental magnifications. However, most of the students were aware of its significance in improving the accuracy and quality of their work.

Referral pattern to a university-based oral and maxillofacial cone beam CT service.

AIM: Despite the rising popularity of cone-beam computed tomography (CBCT) imaging in the field of dentistry, very few studies have addressed the questions of which dental specialties most frequently request CBCT images and which CBCT indications are most popular. This study attempts to answer both of these questions. METHODS AND MATERIALS: CBCT request forms spanning a 1-year period were analyzed for data. Collected data included the specialty of the referring dentist and the referral reason. RESULTS: A total of 660 referral forms were analyzed. Oral and maxillofacial surgeons were the discipline to most commonly request CBCT examinations. Pretreatment evaluation of potential dental implant sites was the most common indication for requesting CBCT scans. CONCLUSIONS: All dental specialties refer patients for CBCT examinations but at different frequencies and for various reasons that pertain to their respective disciplines. Clinical significance: These findings should be the basis for customizing the availability and scope of imaging services and in developing and modifying educational programmes for dentists and dental specialists.

The Agreement Rate between Radiographic Interpretation and Histopathologic Diagnosis of Jaw Lesions.

BACKGROUND: To determine the agreement rate between histopathologic diagnosis and radiographic interpretation of jaw lesions. METHODS: Cases with jaw pathologies that have diagnostically adequate histopathologic samples and radiographic examinations were reviewed retrospectively. Two board-certified oral and maxillofacial pathologists (OMFP) independently determined the histopathologic diagnosis, while two board-certified oral and maxillofacial radiologists (OMFR) determined the radiographic interpretations independently. Then the histopathologic diagnosis and the radiographic interpretation were compared for agreement. RESULTS: A total of 104 cases (53% females) were included with a mean age of 31 years. The agreement rate between histopathologic diagnosis and radiographic interpretation was 49%. OMFP required OMFR consultations to reach a diagnosis in 16% of cases. The most commonly encountered lesions were by far odontogenic cysts of inflammatory origin and the agreement for this disease category was 49.1%. However, agreement rates were highest for the disease category of tumors (62.5%). CONCLUSION: The agreement rate between OMFP and OMFR was higher for tumors than cysts. Agreement rates between OMFP and OMFR improved with efficient consultation between the two disciplines.

Prevention of infective endocarditis: revised guidelines from the American Heart Association and the implications for dentists.

Infective endocarditis is a rare but life-threatening microbial infection of the heart valves or endocardium, most often related to congenital or acquired cardiac defects. The American Heart Association (AHA) recently updated its recommendations on prophylaxis during dental procedures. The revisions will have a profound impact on both the patient and the dental practitioner. The purpose of this paper is to review the pathogenesis and clinical presentation of infective endocarditis and discuss the 2007 AHA guidelines and their implications for dentists.

Age, gender and parafunctional habits as prognostic factors for temporomandibular joint arthrocentesis.

OBJECTIVE: Arthrocentesis is an effective procedure for management of symptomatic patients with temporomandibular joint (TMJ) anterior disc displacement without reduction (ADDWOR), but its prognostic factors are still under investigation. METHODS: Thirty-six patients with ADDWOR underwent arthrocentesis of the TMJ and hyaluronic acid injection. They were divided into groups based on three prognostic factors: Age, gender, and the presence of parafunctional habits. The procedure outcome (success or failure) was based on pre-set criteria for improvement in pain and maximum mouth opening (MMO) one month preoperatively. RESULTS: Patients with parafunctional habits had a lower success rate than patients without these habits. Interesting trends were noted with age and gender as prognostic factors for arthrocentesis for patients with ADDWOR. CONCLUSION: Arthrocentesis is an effective management method for symptomatic patients with ADDWOR at one-month post treatment, especially in the absence of parafunctional habits.

The effect of varying cone beam computed tomography image resolution and field-of-view centralization on effective radiation dose.

OBJECTIVES: To investigate changes in the effective radiation dose (E) in relation to variations in voxel (VOX) size settings and the field-of-view (FOV) centralization. Methods: This cross-sectional dosimetry study used nanoDot OSLD dosimeters placed at 25 pre-determined sites in the head and neck slices of a RANDO male phantom to measure the absorbed radiation. The imaging scans took place at King Abdulaziz University Dental Hospital, Jeddah, Saudi Arabia between September 2016 and May 2017 using the i-CAT classic cone beam computed tomography (CBCT)  unit. Three VOX size setting were examined: 0.2 mm, 0.3 mm and 0.4 mm. The FOV was alternatively eccentrically centered on the maxillary and mandibular arches while holding all other factors constant. Effective radiation doses were calculated for each VOX size and FOV centralization setting. Results: An inverse and indirect relation was found between E and the VOX size setting with smaller VOX yielding higher E. CBCT scans centered on the mandible resulted in higher E than scans centered on the maxilla. Conclusion: Effective radiation doses are significantly affected by changes in VOX size settings and FOV centralization options. This reflects on the potential radiation risk to patients and highlights the importance of choosing exposure parameters carefully.

Quantitative assessment of mandibular canal compression assessed by cone beam computed tomography.

OBJECTIVE: The aim of this study was to objectively quantify the topographic relation of the mandibular canals, impacted third molars, and cortical plates using cone beam computed tomography (CBCT). STUDY DESIGN: A retrospective chart review was conducted using the database of a university-based imaging service. Two calibrated reviewers examined the CBCT images of 100 cases scheduled for mandibular third molar removal. They characterized the position and condition of the mandibular canal and measured its dimensions at 3 different points relative to the third molars. RESULTS: The mandibular canal is more often located buccal to the third molars but is more likely to be compressed when in a lingual position. The vertical (cephalocaudal) dimensions of the mandibular canal change significantly as the canal progresses toward the ramus. The horizontal (buccolingual) dimensions of the mandibular canal fluctuate very little but significantly narrow in proximity to the third molars. Thinning of the lingual cortical plate is common, whereas grooving of molar roots is uncommon. CONCLUSIONS: Minor variations in the horizontal dimensions of the mandibular canal close to the third molars signify an effect on the canal. This effect may indicate an increased risk of neurovascular injury. The mandibular canal can have a direct or indirect effect on the cortical plates.

Unilateral facial swelling caused by Ramsay Hunt syndrome resembles odontogenic infection.

Facial cellulitis and swellings of the head and neck are worrisome signs of odontogenic infection, which can be life threatening. Most head and neck infections are caused by bacterial pathogens. When treating such infections, dentists must also be aware of possible viral or fungal causes and their associated presentations. This report documents a case of viral infection that initially resembled a bacterial odontogenic infection. It is intended to familiarize dentists with the Ramsay Hunt syndrome and the need for prompt recognition and early definitive treatment.

A survey to assess knowledge, practice, and attitude of dentists in the Western region of Saudi Arabia.

OBJECTIVES: To assess knowledge regarding the management of odontogenic infections by dentists in Jeddah, Kingdom of Saudi Arabia. METHODS: In this cross-sectional study, 150 practitioners responded to a 26-item paper-based questionnaire between August and December 2014. The questionnaire evaluated knowledge and current clinical practices in managing odontogenic infections, as well as the attitude towards antibiotic use and resistance in the community. Basic medical knowledge (BMK) and critical knowledge (CK) scores were calculated from the dentists' response to these questions and were compared according to educational level (bachelor and postgraduate degree holders). RESULTS: The mean BMK score was 1.98 ± 0.4 and CK score was 1.89 ± 0.3. Dentists with bachelor's degrees had higher BMK scores than those with a postgraduate degree (p=0.005), but CK was not significantly different (p=0.400). Most dentists (77%) would prescribe antibiotics after a routine dental extraction, and would undertake definitive surgical treatment (49.2%) only after a localized space infection developed. Although 82.2% agreed that routine prescription of antibiotics increases bacterial resistance in the community, 71% believe that prescribing an antibiotic after routine oral surgical procedures prevents odontogenic infections. CONCLUSION: Dentists in Jeddah require further education through lectures and workshops to stay up to date on current concepts in odontogenic infection management.

Single file reciprocating systems: A systematic review and meta-analysis of the literature: Comparison of reciproc and WaveOne.

The introduction of single-file nickel-titanium (NiTi) reciprocating systems has been a major breakthrough in the field of endodontics. Thus, the aim of this study was to compare the available reciprocating systems, Reciproc and WaveOne, using a meta-analysis with different parameters. A comprehensive electronic literature search for Reciproc and WaveOne using PubMed and Google scholar was initially conducted in September 2014 and updated in September 2016. Inclusion and exclusion criteria were then established. Twenty-six studies were qualified for the systematic review, and only three studies were considered for the meta-analysis using cyclic fatigue resistance as the main parameter. The time to fracture for the Reciproc and WaveOne systems ranged from 119.7 sec to 156.4 sec and 74.8 sec to 99.6 sec, respectively. The pooled difference in mean time to fracture was longer for the Reciproc system by 45.6 sec. This difference was statistically significantly at P value < 0.001. In conclusion, our study supports the finding that Reciproc is more resistant to cyclic fatigue than WaveOne. However, with regard to other parameters, mixed results were obtained. Well-designed randomized clinical trials comparing both systems under the same experimental conditions should be done in future studies.

Sporadic Burkitt's lymphoma of the jaws: the essentials of prompt life-saving referral and management.

Burkitt's lymphoma is an undifferentiated non-Hodgkin's B-cell lymphoma. Three clinical subtypes are recognized: African (endemic), American (sporadic) and HIV associated. Sporadic Burkitt's lymphoma is a rare malignancy among western populations. This report describes a case of sporadic Burkitt's lymphoma of the jaws with an alarmingly rapid spread associated with acute renal failure. This type of rapid progression bespeaks the need for prompt recognition and life-saving referral by the dental practitioner. The clinical features of Burkitt's lymphoma involving the jaws include severely hypermobile, ectopically displaced and supra-erupted teeth. The purpose of this case report and review of the literature is to illustrate the clinical and histopathologic features of Burkitt's lymphoma to help clinicians recognize such cases readily and facilitate prompt and potentially life-saving referral.

A Comparative Study of the Effectiveness of Immediate Versus Delayed Photobiomodulation Therapy in Reducing the Severity of Postoperative Inflammatory Complications.

OBJECTIVE: The aim of this study was to compare the immediate versus the delayed application of photobiomodulation (PBM) therapy following odontectomy of horizontally impacted mandibular third molars, and assess which application method is more effective at reducing postoperative complications. BACKGROUND DATA: Surgical removal of horizontally impacted mandibular third molars is a common surgical procedure, usually associated with postoperative complications such as pain, swelling, and trismus. Several attempts have been made to minimize these complications. One such method is the use of PBM therapy. METHODS: Eighty patients with horizontally impacted mandibular third molars with no inferior alveolar canal approximation were recruited for this study. They were divided into two groups. The immediate group received PBM therapy immediately after surgery and on the 3rd day postoperatively. Subjects in the delayed group received PBM therapy on the 2nd and 4th days postoperatively. All subjects received 2 min of treatment using a 4 W laser beam, during which 171 J were delivered via a 2.8 cm(2) spot size. RESULTS: Clinical and statistical results showed a significant reduction in pain, trismus, and swelling in the immediate PBM therapy group compared with the delayed PBM therapy group. CONCLUSIONS: Immediate PBM therapy is more effective than delayed PBM therapy in minimizing the complications associated with mandibular third molar removal surgery.

A meta-analysis of the efficacy and safety of managing parotid and submandibular sialoliths using sialendoscopy assisted surgery.

OBJECTIVES: To review the available techniques and procedures for management of parotid and submandibular sialoliths with special emphasis on the efficacy and safety of the most commonly used combination of techniques; namely, sialendoscopy with conservative surgical removal of the stone. METHODS: A systematic search of the English literature using MEDLINE, EMBASE, and the Cochrane library databases were conducted at the Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia. Articles between the years 2004 and 2013 were selected on the basis of preset inclusion criteria. Then, they were reviewed against a checklist to assess the evidence of efficacy of therapy or prevention and analyzed for pertinent data. RESULTS: Eleven articles met the inclusion criteria and were reviewed and analyzed. The success rate of sialendoscopy combined with minor surgical removal of parotid and submandibular sialoliths ranges from 69-100%. CONCLUSION: Sialendoscopy combined with a minor surgical extraction of parotid and submandibular sialoliths is safe and efficacious. 

Effect of hyperbaric oxygen on demineralized bone matrix and biphasic calcium phosphate bone substitutes.

OBJECTIVES: The aim of this study was to assess the possible effect of hyperbaric oxygen (HBO) on the healing of critical-sized defects that were grafted with demineralized bone matrix (DBM) combined with Pluronic F127 (F127) to form a gel or putty, or a commercially available biphasic calcium phosphate (BCP), mixed either with blood or F127 to form a putty. STUDY DESIGN: Twenty New Zealand White rabbits were randomly divided into 2 groups of 10 animals each. Bilateral 15-mm calvarial defects were created in the parietal bones of each animal, resulting in 40 critical-sized defects. Group I defects were grafted with either DBM putty or DBM gel. Group II defects were grafted with either BCP or BCP putty. Five animals from each group received HBO treatment (100% oxygen, at 2.4 ATA) for 90 minutes per day 5 days a week for 4 weeks. The other 5 animals in each group served as a normobaric (NBO) controls, breathing only room air. All animals were humanely killed at 6 weeks. The calvariae were removed and analyzed by micro computed tomography (mCT) and histomorphometry. RESULTS: mCT analysis indicated a higher bone mineral content (BMC, P < .05), bone volume fraction (BVF; P < .001), and bone mineral density (BMD; P < .001) of the defects grafted with BCP rather than DBM. Furthermore, the voxels that were counted as bone had a higher tissue mineral density (TMD) in the BCP- than in the DBM-filled defects (P < .001). Histologically complete bony union over the defects was observed in all specimens. Histomorphometric analysis showed that DBM-filled defects had more new bone (P < .007) and marrow (P < .001), and reduced fibrous tissue compared with the BCP defects (P < .001) under NBO conditions. HBO treatment reduced the amount of fibrous tissue in BCP filled defects (P < .05), approaching levels similar to that in matching DBM-filled defects. HBO also resulted in a small but significant increase in new bone in DBM-grafted defects (P < .05). CONCLUSION: Use of DBM or BCP promoted healing in these critical-sized defects. Hyperbaric oxygen therapy resulted in a slight increase in new bone in DBM-grafted defects and much larger reduction in fibrous tissue and matching increases in marrow in BCP-grafted defects, possibly through increased promotion of angiogenesis.