Panoramic Radiographic Relationship of the Mandibular Foramen to the Anterior Border of the Ramus and Occlusal Plane as an Aid in Inferior Alveolar Nerve Block.

The location of the mandibular foramen (MF) on digital panoramic radiographs can be an important guide for clinicians when administering the inferior alveolar nerve block (IANB) for dental anesthesia of the mandible. This study, aimed to assess the location of the MF relative to the anterior border (AB) of the ramus and the occlusal plane (OP) from digital panoramic radiographs. An observational case series study was conducted on digital panoramic radiographs from the oral and maxillofacial radiology department archives of patients at least 18 years of age with a 1:1 scale (100%). The samples had to have at least 2 lower molar teeth on both sides without any blurring, previous fracture of the ramus or other artifacts. The distance of the MF to the OP and the AB of the ramus was measured using a caliper. The role of age and gender were also analyzed statistically using the 2-way analysis of variance test. One hundred ninety-four digital panoramic radiographs were included in the analysis. The findings showed that the vertical distance of the MF to the OP was a maximum of 14.52 mm and a minimum of -3.0 mm (mean 4.32 ± 2.34 mm). The distance of the MF to the AB of the ramus was a maximum of 25.52 and a minimum 9.68 mm (mean 16.48 ± 3.28 mm). Based on these findings, the IANB target site for injection should be approximately 5 mm above the OP and approximately 16.5 mm beyond the AB of the ramus to achieve successful anesthesia of the mandible via standard IANB in an Iranian population.

Bifid mandibular canals: prevalence and implications.

PURPOSE: Bifid mandibular canals (BMCs) are variations of the normal anatomy, with a reported prevalence ranging from 0.08 to 65%. Aberrations of the mandibular canal can have important clinical implications. We therefore sought to assess the prevalence of BMCs and discuss several surgical implications that may be associated with this variation. MATERIALS AND METHODS: A retrospective chart study of available digital panoramic images from our file archives from 2011 to 2013 was performed to search for the prevalence of BMCs; to this end, 5,000 consecutive panoramic radiographs of patients aged 18 to 80 years were studied. Detection of BMCs was based on visualization of 2 radiolucent lines and at least 3 radiopaque borders on the monitor and confirmed by 2 oral and maxillofacial surgeons and 2 dentists. The types of bifidity also were assessed and recorded. Data analysis was performed using the χ(2) test. RESULTS: BMCs were observed in 61, or 1.2%, of 5,000 digital panoramic images. There were no statistically significant correlations found regarding age or gender. The most frequently encountered type of bifid canal was type 2 (82%). CONCLUSIONS: The prevalence of BMCs seen on panoramic images in this study was 1.2% and was not correlated with age or gender.

The plasma-rich in growth factor as a suitable matrix in regenerative endodontics: a case series.

The aim of this report is to describe the positive effect of plasma-rich in growth factor (PRGF) on pulp regeneration and apex formation in cases with necrotic pulps and open apices. After access cavity preparation and cleaning of the canal, triple antibiotic paste was inserted into the canals for the purpose of disinfection. After two weeks, apical bleeding was mechanically created by insertion of a #80 file through the apex. PRGF obtained from the patient was centrifuged and injected into the canals up to the level of the cementoenamel junction; the teeth were restored temporarily. The patients returned for review two weeks later. If there was absence of pain, swelling, fistula or any other complication, the teeth were sealed with MTA and composite. At 22 months follow-up, complete apex closure in two teeth and apical closure and continued increase of dentinal wall thickness in two other cases were evident.

Rate of acquired immunity in dental students after hepatitis B vaccination.

BACKGROUND: Triple-course vaccination against hepatitis B might sometimes fail to increase antibody titers or maintain it at sufficient levels. The aim of this study was to evaluate the rate of seroprotection in dental students after receiving recombinant hepatitis B vaccine. METHODS: Anti-HBs levels of 124 dental students who had received triple-course hepatitis B vaccines (scheduled at months 0, 1, and 6) were examined. Titers ≥ 100 mIU/ml were considered as protective. Associations between age, gender and duration of being vaccinated with the titer of anti-HBs were assessed. RESULTS: The participants' mean age was 24 ± 1.3 years and 93% of them were female. The time passed from receiving the final dose was 3.5 ± 1.4 years. Fifty four percent of the students had protective immune response (95% CI 45.2% to 62.8%), 24.2% had positive but weak immune response (anti-HBs titer was between 10 and 100 mIU/ml), and the rest of the subjects (21.8%) were seronegative after receiving routine HBV vaccination. CONCLUSION: There was a considerable rate of failure in achieving or maintaining acceptable titer levels following routine vaccination against HBV. Hence, determining serum anti-HBs titer after vaccination is recommended.

Use of botulinum toxin A for drug-refractory trigeminal neuralgia: preliminary report.

OBJECTIVE: Botulinum toxin type A (BTX-A) has been used to treat migraine and occipital neuralgia. We report preliminary results of an ongoing study that assesses the efficacy of BTX-A on trigeminal neuralgia (TN) patients refractory to medical treatment. STUDY DESIGN: We treated 15 patients (8 men and 7 women) between 28 and 67 years of age who were suffering from drug-refractory TN from February 2008 to January 2010. Symptoms, including pain duration, provoking factors, affected nerve branch, frequency of TN attacks, and severity of pain just before injections, were evaluated 1 week, 1 month, and 6 months after injection. We injected 50 U reconstituted BTX-A solution at the trigger zones. The overall response to treatment was assessed via a 9-point patient global assessment scale and compared with values at baseline. Statistical analysis was performed by the analysis of variance (ANOVA) test for frequency of TN attacks, the Friedman test for severity of pain, and the Wilcoxon signed-rank test for PGA, and all with the use of SPSS software. RESULTS: Eight men and 7 women aged 28-67 years (mean 48.9 y) suffering from TN from 6 months to 24 years all improved regarding frequency and severity of pain attacks; in 7 patients, pain was completely eradicated and there was no need for further medication. In 5 patients, nonsteroidal antiinflammatory drugs were enough to alleviate pain attacks, and 3 patients again responded to anticonvulsive drugs after injection. All patients developed higher pain thresholds after injections. The ANOVA test showed a significant difference in frequency of attacks before injection and at 1 week, 1 month, and 6 months after injection (P < .001). Friedman test and pair comparison of pain severity scores with Bonferroni correction adjustment showed a significant difference (P < .001) between severity of pain before and after injection. Wilcoxon signed-rank test showed significant improvement in all patients up to 6 months after injection (P < .001). Complications included transient paresis of the buccal branch of the facial nerve in 3 patients. CONCLUSION: This study supports other similar studies and shows that BTX-A is a minimally invasive method that can play a role in treating TN before other more invasive therapies, i.e., radiofrequency and surgery.

Trigeminal neuralgia and radiofrequency.

Trigeminal neuralgia (TN) is a painful neurological disorder often mistaken for pain of dental origin by the patient and dentist. Dentists should be acquainted with TN to differentiate it from orofacial pain and prevent unnecessary tooth extraction. TN pain alleviating modalities are numerous, yet not uniformly effective. Radiofrequency, known for 25 years, is a minimally-invasive outpatient procedure used for TN when drugs are ineffective. The authors evaluate radiofrequency in trigeminal neuralgia patients referred from the dental office.

Outcomes of management of early temporomandibular joint disorders: How effective is nonsurgical therapy in the long-term?

AIM: The first step in the management of Temporomandibular Disorders (TMD) is usually noninvasive, especially if the disorder is in the early stages. Clinically, pain and clicking are early signs and symptoms of TMD. The management of TMD usually includes "splint therapy" and analgesics. In this study, we report our long-term outcomes in the treatment of patients suffering from early TMD. MATERIALS AND METHODS: We assessed the records of 138 patients who were referred for management of TMD. Selection was based on pain and/or clicking of the Temporomandibular Joint (TMJ), no pathologic lesions of the TMJ, no anterior disc displacement without reduction (closed lock), no Degenerative Joint Disease, no history of migraine, trauma, osteoarthritis, metabolic disease, or malocclusion (deep bite, cross bite, jaw deformity, etc). The patients were treated with an acrylic maxillary Interocclusal Splint (IOS) cuspid-rise type and were told to refrain from biting, yawning and chewing hard food. The outcome of the treatment, potential etiologic factors (Bruxism), signs and symptoms and patient demographics (such as age, sex, treatment duration, etc.) were assessed. The data were analyzed using the Chi-square test to correlate significance. RESULTS: One hundred thirty-eight patients (26 males and 112 females) with early signs and symptoms of TMD (pain and/or click of the TMJ) were treated from 2001 to 2010; 81% were females and 19% were males. All the 138 patients used the IOS at night only. The patients were followed-up for 1-9 years. Data analysis showed that 64% of the patients were completely relieved of signs and symptoms; 22% were moderately relieved (decreased severity of signs and symptoms) and 14% had no noticeable post-treatment changes in clicking or pain (P = 0.001). Patients with bruxism and those presenting with both pain and clicking showed a better response to IOS treatment (P = 0.046 and P = 0.001, respectively). The results also showed that age, sex, severity of symptoms and duration of the treatment did not influence treatment results in this group of patients with early TMD. CONCLUSION: In this population, TMD was significantly higher in females. Treatment of early TMD with IOS was effective and moderately effective in long-term in over 80% of the patients during the follow-up period of 1-9 years. Bruxism had a significant etiologic role in TMD; occlusal attrition of the dentition, pain of all the teeth, early morning pain of the masticatory muscles and the TMJ are signs and symptoms to suspect nocturnal bruxism. Use of an IOS is recommended to prevent potential damage to the dentition, periodontium and the TMJ in early TMD.

Trigeminal neuralgia and radiofrequency.

Trigeminal neuralgia is a painful neurological disorder often mistaken for pain of dental origin by the patient and dentist. Dentists should be acquainted with TN to differentiate it from orofacial pain and prevent unnecessary tooth extraction. TN pain-alleviating modalities are numerous, yet not uniformly effective. Radiofrequency, known for 25 years, is a minimally invasive outpatient procedure used for TN when drugs are ineffective. The authors evaluate RF in TN patients referred from the dental office.

Assessment of radiographic factors affecting surgical exposure and orthodontic alignment of impacted canines of the palate: a 15-year retrospective study.

OBJECTIVE: Impacted canines require a combination of both surgical and orthodontic management. In this study, patients treated for bone-impacted canines of the hard palatal were evaluated to assess which radiographic factors influenced the feasibility to move impacted maxillary permanent canines from the hard palate into the alveolar arch. MATERIALS AND METHODS: Eighty patients aged 12 to 24 (average 16 years) were treated surgically and orthodontically to align 146 bone-impacted canines of the hard palate (from 1994 to 2008). Factors such as age, sex, angulation of the canine to the midline (CAM), anomaly of the canine root (RA), overlap of the adjacent lateral incisor root (OALIR), and ratio of root formation (RRF) upon treatment were documented. Radiographic records and demographic data were assessed. The following radiographic measurements of canine position were made from the orthopantomogram (OPG): (1) angulation to the midline, (2) anteroposterior position of the root, (3) overlap of the adjacent incisor. RA or dilaceration was assessed from the OPG, maxillary occlusal (MO), and periapical (PA) radiographs. Whether the impacted canine had responded to surgical exposure and was orthodontically aligned, or surgically removed and discarded was also recorded. The data were analyzed to assess and correlate significance. RESULTS: Eighty patients aged 12 to 24 (19 males and 61 females) with 146 bone-impacted permanent canines of the hard palatal were treated. One hundred and three teeth (70.54%) had responded to surgical exposure and orthodontic alignment within 9 to 12 months. Forty-three impacted canine teeth (29.46%) had to be surgically removed because of ankylosis and no movement after 8 to 9 months using 50 to 60 g of traction force via elastic chains. Data analysis via chi-square and Pearson correlation tests showed that as the CAM increased (> 45 degrees), the canine was more likely to be unresponsive to treatment (P < .001). Increased overlap (> half the root) of the adjacent lateral incisor root (OALIR) via the canine crown influenced the treatment results negatively (P < .001). Additionally, presence of RA was also negatively influential (P < .001). However, the anteroposterior position of the canine did not influence the treatment results significantly, neither did age, sex, nor amount of root formation. CONCLUSION: Bone-impacted canines of the hard palatal are more likely to respond to surgical exposure and orthodontic management if AM is less than 45 degrees on the OPG; there is no RA found on OPG, periapical (PA), and maxillary occlusal (MO) radiographs; and OALIR by the canine crown is nonexistent or less than grade 2 (half the root) on the OPG.

Variable presentations of aneurysmal bone cysts of the jaws: 51 cases treated during a 30-year period.

PURPOSE: Our study aimed to assess the clinicohistopathological features of maxillofacial aneurysmal bone cysts (ABCs) to distinguish parameters significant to diagnosis and treatment, adding to the body of literature on the subject. MATERIALS AND METHODS: Fifty-one patients with maxillofacial ABCs treated during a 30-year period were evaluated. The demographics, histopathological findings, site, age, gender distribution, and types of maxillofacial ABCs were evaluated. The data, therapeutic results, and recurrences were then analyzed. RESULTS: Fifty-one patients diagnosed and treated for ABCs were studied in our series. These included 29 (56.9%) males and 22 (43.1%) females ranging in age from 7 to 58 years, with a mean age of 19.53 +/- 10.79. More than 3/4 of the lesions involved the mandible. ABCs were significantly more common in the mandible and in the first 2 decades of life (P < .05). The site distribution of the location of ABCs within the arch was about equal. Rapidly growing swelling was a significant clinical feature in the majority of the cases (92.2%). ABCs had variable radiographic presentation, but all were radiolucent. All cases were treated by excision and curettage with 84.4% success in the first operation. Eight patients (15.6%) had recurrences after treatment during the follow-up period (2-30 years). CONCLUSION: Maxillofacial ABCs are uncommon lesions with variable clinical and histological presentations that often respond to treatment by surgical curettage. Recurrence may be attributed to incomplete removal of the lesion.

Peripheral and central giant cell granulomas of the jaws: a demographic study.

OBJECTIVE: This study aimed to assess the demographic characteristics of peripheral giant cell granulomas (PGCGs) and central giant cell granulomas (CGCGs) in patients treated at our centers. STUDY DESIGN: This 12-year retrospective study was based on existing data. Files of patients from 1993-2004 with a definite diagnosis of PGCGs and CGCGs from the oral pathology departments of our universities were assessed. Information regarding age distribution, gender, the jaw involved, the presenting area of the lesion, surgical treatment, and recurrence was documented. RESULTS: During the study period, 204 patients with CGCGs were treated. The patients with CGCGs varied in age from 5 to 72 years, and the mean age patients was 23.72 years. Among these, 127 cases (62.87%) occurred in the second and third decades of life. One hundred thirty cases (63.75%) occurred in females and 74 (36.25%) in males. Ninety cases (44.1%) presented in posterior parts of the jaws. One hundred forty-four cases (70.58%) appeared in the mandible. Peripheral GCGs presented in 575 patients, who varied in age from 2 to 85 years with a mean age of 31.02 years. Among these, 297 cases (51.65%) occurred in females and 278 (48.34%) in males. Four hundred sixty-seven cases (81.2%) occurred in the first five decades of life, and 352 cases (61.21%) appeared in the mandible. CONCLUSIONS: Giant cell granulomas comprised 9.29% of oral lesions. Peripheral GCG lesions occurred more than 2 times more frequently than CGCGs. Central GCGs occurred about 2 times more frequently in females, whereas PGCGs had an equal prevalence in both genders (P < .05). The mean age for patients with CGCGs was less than patients with PGCGs (P < .05). Central GCGs involved the mandible approximately 2 times more frequently than the maxilla (P < .05). However, when presenting in the maxilla, CGCGs most frequently presented in the area anterior to the canines (P < .05). Peripheral GCGs involved the mandible approximately 1.5 times more frequently than the maxilla (P < .05). Thorough curettage was the main treatment modality used. There were 9 cases (4.41%) of recurrence of CGCGs and 8 cases (1.39%) of recurrence of PGCGs documented during the follow-up period (ranging from 1-12 years).