Assessment of neurovascular channels in lateral maxillary sinus wall using cone-beam computed tomography: An imperative clinicians guide for implant placements.

Background: The aim of this study is to evaluate the location and radio morphometric features of the posterior superior alveolar artery (PSAA) in patients undergoing rehabilitation of posterior maxilla and other sinus augmentation surgical procedures by cone-beam computed tomography (CBCT). Materials and Methods: A total of 816 CBCT scans were included. Various radio morphometric measurements were done to assess the PSAA location, diameter, and distances to the sinus floor and alveolar crest. Results: The PSAA was mostly intraosseous in the maximum in the age group 31-51 years (56%), in males (53.4%), and in dentate patients (57.4%). The artery tends to be wider in older patients. Distances to the sinus floor or the alveolar crest tend to be shorter in women. Conclusions: This study suggests that CBCT is a valuable pre-surgical tool and the evaluation of the PSAA on CBCT images could reduce the likelihood of excess bleeding during surgery in the maxillary posterior region.

Human Urinary Metabolomics as Biomarkers in Tobacco Users: A Systematic Review.

Aim: Urine as a biofluid has been rarely used as a diagnostic fluid in oral diseases. The article aims to systematically review the utility of human urinary carcinogen metabolites as an approach for obtaining important information about tobacco and cancer. Materials and Methods: The following article reviews the use of urine and its metabolites as biomarkers in various lesions of the oral cavity including oral squamous cell carcinoma and as a screening method in evaluating tobacco and its components. A bibliographic comprehensive search was carried out in the main databases: PUBMED, SciELO, Google Scholar, VHL, and LILACS for articles that were published from 1985 to 2020. The inclusion criteria were "urinary metabolites," "oral cancer/HNSCC," "body fluids," "tobacco," and "metabolomics." A total of 55 articles were collected which included laboratory studies, systematic reviews, and literature of urinary metabolites in tobacco users. Results: Most of the studies carried out show accurate results with high sensitivity of urinary metabolite biomarkers in individuals with tobacco-based habits and lesions caused by them. Conclusion: The review indicates that urinary metabolite analysis demonstrates its applicability for the diagnosis and prognosis of disease. Urine is a remarkable and useful biofluid for routine testing and provides an excellent resource for the discovery of novel biomarkers, with an advantage over tissue biopsy samples due to the ease and less invasive nature of collection.

Reliability of Grayscale Value for Bone Density Determination in Oral Rehabilitation using Dental Implants.

Introduction: Quality and quantity of jaw bones have been previously classified in literature using different methods. Imaging modalities such as computed tomography (CT), successfully determine bone density of jaws. This study aims to establish the role of cone-beam CT (CBCT) in determining the density of cortical and cancellous bones at different jaw sites. Materials and Methods: Eighty-three possible implant sites in healthy patients were evaluated using NewTomGiano CBCT machine. Cross-sections were obtained and cortical and cancellous bone densities on different aspects of the virtual implant in terms of Hounsfield unit (HU) were determined using New Net Technologies software version 6.1 and were classified according to software from D1 to D4. Data were entered into SPSS software (version 19.0) and were statistically analyzed. Results: The mean HU showed the highest value for cortical and cancellous in the anterior mandible (mean HU 1874.01 and 1131.73, respectively) followed by the posterior mandible (mean HU 1789.20 and 872.95, respectively) and least in posterior maxilla (mean HU 1068.26 and 830.04, respectively). Maximum D1 bone type was found in cortical bone and D2 bone type was noted in cancellous bone area. Males showed very highly significant cortical bone thickness (P < 0.001) whereas females showed more cancellous bone thickness but the results were nonsignificant. Conclusion: A high degree of concordance between different regions of jaw bones with a strong correlation between the four bone types was obtained. Bone density plays a pivotal role in determining the prognosis of the implant. CBCT has proven to be beneficial in bone density analysis.

Evaluation of neurovascular anatomical variation in the anterior mandible in North Indian population: A CBCT assessment.

Introduction: The purpose of this retrospective study was to determine the visibility, location and other morphometric features of lingual foramina on CBCT along with its age wise and gender wise correlation. Material and methods: A total of 250 patients were included in the study. Cross-sectional CBCT images of the mandible in the midline were used to locate and define each detected lingual foramen and canal. Descriptive statistics including tables and graphs were used. Genderwise and Age wise correlations were analyzed using Chi-square tests. Results: The number, direction, length, diameter, distance from alveolar crest and inferior borders of mandible were evaluated. Genderwise Lingual foramen was most frequently located in the mandibular midline, above genial tubercle (81.7%). Agewise it was found to be significant (p = 0.019). Genderwise length of canal was found to be significant (p = 0.022). Genderwise diameter of canal at midpoint was found to be very highly significant (p < 0.001) and at innermost point was found to significant. (p = 0.037) Genderwise and Agewise distance between orifice of canal and alveolar crest was found to be very highly significant. (p < 0.001) Genderwise and Agewise distance between innermost point of canal and alveolar crest was found to be highly significant (p = 0.001) and very highly significant (p < 0.001) respectively. Conclusion: Clinicians may consider CBCT for procedures with a risk of hemorrhagic and neurosensory complications such as dental implant placement in the anterior mandible.

A novel approach in diagnosing multiple dentigerous cysts using CBCT illustration indicative of Mucopolysaccharidosis VI - a case report.

Mucopolysaccharidosis VI is a genetic disorder affecting multiple organs with sundry clinical presentations. The main etiological factor reflects the disturbances in mucopolysaccharide metabolism leading to deposition of acid mucopolysaccharide in various tissues. The pathognomonic features of the disease include a large head, short neck, corneal opacity, open mouth associated with an enlarged tongue, enlargement of the skull, and long anteroposterior dimension with unerupted dentition, dentigerous cyst-like follicles, condylar defects, and gingival hyperplasia. An 18-year-old boy with Maroteaux-Lamy syndrome (mucopolysaccharidosis type VI) is described in this article, emphasizing the oral manifestations and radiographic illustration of lesions in the jaws. It also emphasizes the essential role of cone-beam computed tomography to identify and analyze multicentric pathologies in the jaws.

Significance of Morphometric and Anatomic Variations of Nasopalatine Canal on Cone-Beam Computed Tomography in Anterior Functional Zone - A Retrospective Study.

INTRODUCTION: Oral rehabilitation in maxillary anterior region has increased concerns in the dental fraternity to have detailed morphological examination in treatment planning. The nasopalatine canal (NPC) along with its contents plays an important role in determining the prognosis of implants and their associated surgeries. The present study was performed to evaluate morphometric anatomic variations of the NPC using focused small field of view on cone-beam computed tomography (CBCT). MATERIALS AND METHODS: The study included 250 participants. CBCT examination was conducted using standard exposure and patient positioning protocols. Sagittal, coronal, and axial sections were reviewed to determine NPC morphology and dimensions. RESULTS: Single, round, incisive foramen with mean mesiodistal diameter of 3.23 (±1.00) mm, and mean anteroposterior dimension of 3.03 (±0.96) mm was found. Single Stenson's foramen along with funnel shaped, slanted NPC with mean angulation of 81.97 (±42.19), and mean length of 12.67 (±2.69) mm was found. Mean mesiodistal diameter at nasal fossa of NPC was 3.27 (±1.75) mm, at mid-level was 2.23 (±1.02) mm, at palate was 3.46 (±1.12) mm. At least one additional foramen was found. DISCUSSION: Anatomy of the NPC is highly variable. Age-wise and gender-wise correlations revealed statistically significant results for different parameters. The present study highlighted significance of NPC along with its variations. Therefore, a methodical three-dimensional presurgical assessment is mandatory before any surgical intervention in this region.

Cone-beam computed tomography assessment of bone using grayscale values in patients with diabetes mellitus. A case-control observational study.

BACKGROUND: The density of cortical and cancellous bone is a key reason for implant anchorage which might be severely affected during diabetes. AIM: The aim of the study was to establish the role of cone-beam computed tomography (CBCT) using grayscale values in determining bone density in different jaw sites and in comparing the values in healthy with diabetic patients. MATERIALS AND METHODS: Bone densities in 322 possible implant sites in healthy and diabetic patients were evaluated using NewTomGiano CBCT machine. Cross-sections obtained were assessed for bone densities in terms of Hounsfield Unit on different sites using New Net Technologies software version 6.1. STATISTICAL ANALYSIS: Data were statistically analyzed using SPSS software (version 19.0). RESULTS: Age-wise cortical and cancellous bone densities were compared and no statistical significance was obtained. Gender-wise bone density was compared and significant results were found in males. Jaw-wise bone density was compared and was found to be significantly high in the mandible. The mean cortical bone density in control group was 1608.572 (±380.36), whereas in diabetic group was 1395.368 (±296.97), and the mean cancellous bone density in control was 906.918 (±185.40) and in diabetic was 559.868 (±128.16). Teeth wise in cortical bone significant values were found at premolar region (P = 0.046) and in cancellous bone significant values were found at canine and premolar region (P = 0.012) and highly significant values were found at molar region (P = 0.001). CONCLUSION: CBCT unveils a distinct pattern of cortical and cancellous bone density. A high degree of concordance between different regions of the mouth in cortical and cancellous bones was obtained in different study groups. CBCT could be used for bone density analysis.

Palatal Mucormycosis Masquerading as Bacterial and Fungal Osteomyelitis: A Rare Case Report.

Mucormycosis is an acute, fulminating, fungal disease that frequently involves oral, cranial, and facial structures. It is an opportunistic fatal infection which occurs in debilitating and immunosuppressive states. This report documents a rare case of localized maxillary mucormycosis in a patient with uncontrolled diabetes, with emphasis on early and prompt diagnosis of the same.

Functional role of apoptosis in oral diseases: An update.

Cell death appears to be a basic biological phenomenon which is maintained by the human body. The term apoptosis, also known as programmed cell death, is characterized by several unique morphological and biochemical features. Apoptosis and its different forms are essential for tissue homeostasis. Alteration in molecular mechanisms involved in apoptotic signaling contributes to a vast range of oral diseases. An understanding of the regulation of apoptosis has led to the development of many therapeutic approaches and better management of oral diseases. The review updates us the correlation between apoptosis in normal oral tissues and oral diseases.

Diagnostic efficacy of color Doppler ultrasound in evaluation of cervical lymphadenopathy.

BACKGROUND: To evaluate the efficacy of color Doppler ultrasound (CDUS) in differentiating benign and malignant cervical lymph nodes by detecting differences in blood flow patterns. MATERIALS AND METHODS: In this cross-sectional prospective study, 25 untreated patients with clinical evidence of cervical lymphadenopathy were evaluated. CDUS was performed for 80 cervical lymph nodes. The gray scale parameters of the lymph node and intranodal perfusion sites were the key CDUS features used to differentiate between reactive and metastatic lymph nodes. Histopathological confirmations were obtained and compared with the results of CDUS. RESULTS: Initially, 53 cervical lymph nodes were evaluated by clinical examination. Twenty-seven additional lymph nodes (53 + 27 = 80) were discovered by CDUS evaluation. Gray scale parameters for lymph nodes such as size of lymph node, shape of lymph node, and presence or absence of hilum revealed highly significant results (P < 0.0001). Color Doppler flow signals revealed that central/hilar flow was characteristic for benign nodes whereas peripheral/mixed flow was characteristic for malignant nodes, the findings were highly significant (P < 0.0001). Gray scale and color Doppler features are used to differentiate benign and malignant nodes. CONCLUSION: Within the limitations of this study, CDUS evaluation was found to be highly significant with a high sensitivity and specificity over clinical evaluation CDUS examination provides a prospect to reduce the need for biopsy/fine needle aspiration cytology in reactive nodes.

Computed Tomography in Diagnosis of Admantinoma.

CONTEXT: Admantinoma is second most common benign odontogenic tumor which clinically appears as an aggressive odontogenic tumor, often asymptomatic and slow growing, associated with symptoms such as swelling, dental malocclusion, pain, and paresthesia of the affected area. The radiographic appearance may vary from unilocular to multilocular radiolucencies, imparting a characteristic honey comb, soap bubble appearance or may resemble a caricature of spider. CASE REPORT: This report highlights the importance of conventional and advanced imaging in the diagnosis of large and invasive lesions. Patient reported with complaint of swelling in jaw, which progressively increased; and was found to be bony hard, both intra- and extraorally. Radiographs revealed large multilocular radiolucency on left body and ramus of mandible with soap bubble pattern and knife edged root resorption. Computed tomographic examination evaluated the extent of the lesion, internal structure, and relation to adjacent structures; further a reconstructed image was obtained to evaluate extent of destruction in three dimensions. CONCLUSION: Computed tomography has an important role in the diagnosis and treatment planning is imperative as it is superior in revealing the cortical destruction and extension into the neighboring soft tissues than conventional radiography.

Assessment of anxiety and depression in patients with burning mouth syndrome: A clinical trial.

INTRODUCTION: Burning mouth syndrome is a chronic pain syndrome primarily affecting elderly women with hormonal changes or psychological disorders. It is multifactorial in origin, often idiopathic and its etiopathogenesis, majorly being neuropathic, largely remains enigmatic. AIM: To determine the prevalence of burning mouth symptom, in elderly women and evaluate local and systemic causes responsible for burning sensation. MATERIALS AND METHODS: 100 elderly postmenopausal women were included in the study out of which 56 had a chief complaint of burning sensation. These patients were evaluated for the levels of anxiety and depression by means of questionnaire. The severity of burning and the response to the treatment was assessed with a five point Visual Analog Scale. The results were analyzed using "Chi-square test". RESULTS: There was statistically significant increase in the levels of anxiety and depression in the study group. CONCLUSION: The present study clearly indicates that most of the patients had moderate to severe levels of depression, which suggests that anxiety and depression are constant features in postmenopausal female patients.