Potential Circumferential Bone Engagement following Tooth Extraction in the Posterior Mandible: Computed Tomography Assessment.

Background and Objectives: Immediate implant placement (IIP) is a popular surgical procedure with a 94.9-98.4% survival rate and 97.8-100% success rate. In the posterior mandible, it poses a risk of injury to adjacent anatomical structures if the implant engages apical bone. This study sought to assess the implant dimensions that allow for circumferential bone engagement at each position in the posterior mandible without additional apical drilling. Materials and Methods: An observational, cross-sectional study design was used. The pre-extraction cone beam computed tomography scans of 100 candidates for IIP were analyzed. Measurements of each root of the posterior mandibular second premolar, first molar, and second molar were taken from three aspects: buccolingual, mesiodistal, and vertical. Two-sided p values < 0.05 were considered statistically significant. Results: A total of 478 mandibular teeth and 781 roots were assessed. Based on Straumann® BLX/BLT implant-drilling protocols, predicted rates of radiological circumferential engagement (RCE) were 96% for implants 5 mm in diameter in the second premolar root position; 94% for implants 4.0-4.2 mm in diameter in the first molar root position; and 99% for implants 4.5-4.8 mm in diameter in the second molar root position. Corresponding rates of achieving an available implant length (AIL) of 10 mm were 99%, 90%, and 86%. Patients <40 years old were at higher risk of lower RCE and lower AIL (p < 0.005) than older patients for all roots measured. Conclusions: The high primary stability prediction rates based on the calculation of RCE and AIL support the use of IIPs without further apical drilling in the posterior mandible in most cases.

Long-term dental implications of infant oral mutilation: a case series.

Infant oral mutilation (IOM) is a ritual ceremony practised mostly in African cultures, in which the primary tooth bud of the deciduous canine is extracted. Complications and risks of IOM include pain, heavy bleeding and infection that may deteriorate to life-threating conditions. The main long-term consequence of IOM is future dental abnormalities. The scientific literature lacks in-depth analyses of the dental sequelae of this practice among adults who underwent it, and particularly of the aspect of dental treatment. Eight new cases of IOM are presented in this case series, with emphasis on dental diagnosis and treatment modalities. We describe different outcomes of this practice, such as enamel hypoplasia and crown deformations with later necrosis and infection of the root canal system, severe discolouration, immature root apex, impaction of a canine, failure of development and missing lower permanent incisors and canines, an odontoma-like structure, severe periodontal defect and root dilaceration. Familiarity with the practice of IOM is vital in order to identify its manifestations and arrive at the correct diagnosis and optimal course of treatment.

Use of Cone-beam Computed Tomography as a Critical Component in the Diagnosis of an Infected Nasopalatine Duct Cyst Mimicking Chronic Apical Abscess: A Case Report.

Nasopalatine duct cysts (NPDCs) and other nonodontogenic lesions of the oral cavity may mimic odontogenic pathoses. We present a case of a 22-year-old man with a history of dental trauma and a lesion displaying the typical clinical and radiographic signs of a chronic apical abscess- a buccal sinus tract that was traced to a radiolucent area in the periapex of a maxillary central incisor. A comprehensive diagnostic process that included a cone-beam computed tomographic scan and a histopathologic examination of the lesion after complete enucleation led to the final diagnosis of an infected NPDC. The adjacent tooth was vital at the 1-year posttreatment follow-up, and a radiograph demonstrated complete healing of the periradicular structures. This case demonstrates the ability of NPDCs to present clinical and radiographic signs similar to apical inflammatory lesions and the need for a meticulous diagnostic process in order to avoid unnecessary endodontic intervention. The article also discusses the differential diagnoses of nonodontogenic lesions in the premaxillary area.

Demographic and clinical factors associated with referrals and compliance to biopsy of oral and maxillofacial lesions.

BACKGROUND: The gold standard for diagnosing oral disease is tissue biopsy. Data regarding compliance with advised oral and maxillofacial (OMF) biopsy are scarce. PURPOSE: To quantify compliance and evaluate the demographics and clinical factors associated with referrals and compliance with OMF biopsy procedures. METHODS: Medical records of military personnel referred for a biopsy (RB; N = 669) of OMF lesions over a 4-year period were studied retrospectively. These patients were divided into performed the biopsy (PB; N = 386) and not perform biopsy (NPB; N = 283) groups. Demographic and clinical features were analyzed, and demographics were compared to a control group of general military personnel (N > 100,000). RESULTS: The RB group differed from the control group regarding age >21 (OR = 1.681, P < 0.001) and education >12 years of schooling (OR = 1.545, P < 0.001). Differences between the PB and NPB groups related to the clinical features of the lesion but not to demographic parameters. Exophytic and suspected potentially malignant/malignant lesions were positively associated with higher compliance to biopsy (OR = 1.75, P = 0.004 and OR = 2.18, P = 0.017, respectively). CONCLUSION: Referrals to biopsy of OMF lesions are significantly influenced by age and education, whereas compliance is influenced by clinical features or suspected malignancy. Clinicians and health authorities should be aware of non-compliance, enhance awareness to biopsy as the gold standard in the diagnostic workup of OMF lesions, and closely monitor compliance patterns of patients with clinical and demographic risk factors.

Orthodontic elastic separator-induced periodontal abscess: a case report.

Aim. Orthodontic elastic bands were proposed as being the source of gingival abscesses that can rapidly lead to bone loss and teeth exfoliation. We report an adolescent, otherwise, healthy patient whose periodontal status was sound. Shortly after undergoing preparations for orthodontic treatment consisting of orthodontic separators, he presented with a periodontal abscess for which there was no apparent etiology. A non-orthoradial X-ray was inconclusive, but an appropriate one revealed a subgingival orthodontic separator as the cause of the abscess. Removal of the separator and thorough scaling led to complete resolution of the abscess, but there was already residual mild damage to the alveolar bone. Summary. Failure to use appropriate imaging to reveal the cause of gingival abscesses can result in the delay of implementing treatment and halting irreversible alveolar bone loss. An inflammatory process restricted to the gingiva and refractive to conventional therapy should raise the possibility of a foreign body etiology.

A rubber-covered ceramic weapon reduces the incidence of dental trauma in recruits during combat basic training.

The effect of a rubber-covered ceramic weapon was assessed on the incidence of dental trauma during basic training, since soldiers are more at risk of impact from a personal weapon. Dental files of soldiers (n = 4,542), who completed 8 months of training during 2008, were analyzed for incidence and type of dental trauma from a personal weapon. A rubber-covered ceramic weapon (n = 2,972) or a conventional one (n = 1,570, control) was used. Dental trauma was 0.4% per 8 months (0.6% per year) from the ceramic weapon and 1.5% per 8 months (2.3% per year) from the conventional one (p<0.001). The most prevalent type of injury was a simple/noncomplicated crown fracture (82% in study group, 75% in control group). The ceramic weapon significantly reduced dental trauma by diminishing the impact while in direct contact with the teeth or by absorbing and/or distributing the impact force. In conclusion, when possible a rubber-covered ceramic weapon should be preferred for basic combat training.

Incidence of reported dental trauma among soldiers during basic training.

The objective of this study was to assess the incidence, characterizations and etiologies of traumatic dental injuries among Israeli army soldiers during basic combat training. Dental files of soldiers (n=11,053) from several combat military camps, who completed 8 months of basic training during 2006-2007, were analyzed for frequency, type and etiology of dental trauma. The study included 118 files. The incidence of dental trauma was 1.1% per 8 months (1.6% per year). The most frequently traumatized tooth was the right maxillary central incisor (46%), most prevalent type of injury was a noncomplicated crown fracture (45%), and most frequent etiology was the personal weapon (53%), with no statistical correlation toward a right-sided injury. The incidence of dental traumatic injuries during basic combat training was higher than among army personnel as found in other studies. A weapon impact can be a major risk factor for soldiers during basic training.