The persistently sensitive or painful osseointegrated implant.

OBJECTIVE: To determine why some implants can appear to be well osseointegrated with no signs of infection and yet can remain sensitive to percussion and painful and unable to tolerate the weight of a restoration. STUDY DESIGN: Five patients were identified who between them had 7 implants that met the criteria of being persistently painful and sensitive to percussion while appearing to be well integrated and otherwise disease free. High-definition cone beam computed tomography scans were obtained for all patients. All patients had failed medical treatment. RESULTS: The cone beam computed tomography scans showed radiolucent channels running from the nearest nerve trunk to the vicinity of the sensitive implants. These may represent neurovascular channels that originally supplied the teeth that were present at the site of the implants, and they may have terminal neuromas that neuromas may be irritated by the implant. In all cases removal of the offending implant caused either substantial or complete relief of discomfort. CONCLUSION: The presence of terminal neuromas within the jaws may be responsible for persistent pain and sensitivity in an otherwise well-integrated and disease-free implant. Removal of the offending implant appears to be the only treatment.

Recovery of Sensation Over the Distribution of the Inferior Alveolar Nerve Following Mandibular Resection Without Nerve Reconstruction.

PURPOSE: To assess the long-term recovery of sensation in the lower lip after mandibular resection without reconstruction of the inferior alveolar nerve. MATERIAL AND METHODS: Thirty patients who had mandibular resection carried out without reconstruction of the inferior alveolar nerve were examined after an interval ranging from 6 to 33 years. RESULTS: Only 1 patient, seen 10 years after resection, was totally numb over the distribution of the inferior alveolar nerve. The other 29 patients had some return of sensation and many had a significant return, though it may take several years to reach the final result. Utilizing the MRC scale 70% of patients achieved S3 (return of superficial cutaneous pain and tactile sensibility without over response) CONCLUSION: This study can serve as a baseline for comparison with patients who have had mandibular resection with reconstruction of the inferior alveolar nerve to assess if this procedure improves the outcomes.

Nerve damage in dentistry.

Many forms of dental treatment have the potential to cause injury to the oral branches of the trigeminal nerve, including local anesthetic injections, root canal therapy, implant insertion, bone grafting, and dentoalveolar surgery. Based on the records of a referral center with more than 30 years' experience in managing 3200 of these injuries, this article reviews etiology and prevention; suggests criteria for referral of patients; and discusses treatment for the various types of injury and the results of such treatment.

Nerve Damage From Bone Allografts and Xenografts-A Case Series.

The concept of socket preservation by placing a particulate bone allograft or xenograft into a tooth socket or on the alveolar ridge after tooth removal remains a somewhat controversial topic. The concept is that it will preserve the ridge from resorption and such that subsequent implant insertion will be easier, with fewer complications. However, one particular issue is that these materials, although not directly neurotoxic, appear to be an irritant to the nerves if they come in contact with them. We present a case series demonstrating this complication.

Enucleation with or without adjuvant therapy versus marsupialization with or without secondary enucleation in the treatment of keratocystic odontogenic tumors: A systematic review and meta-analysis.

The purpose of this study was to compare the recurrence rate (RR) of keratocystic odontogenic tumors (KOTs) in patients who underwent enucleation with or without adjuvant therapy, to patients who underwent decompression with or without residual cystectomy. An extensive search of major databases through PubMed, EMBASE, and Cochrane CENTRAL was conducted to identify all relevant articles published without date and language restrictions from inception to December 2015. Relevant articles were selected based on the specific inclusion criteria. A weighted RR and odds ratio (OR) using a Mantel-Haenszel (M-H) test and random effect model with 95% confidence interval (CI) were performed. Meta-regression analysis was conducted to further identify the influence of the duration of follow-up periods on the overall OR. A total of 997 KOTs enrolled in 14 studies were included in this analysis. There was a significant advantage for the enucleation ± adjuvant therapy group in preventing recurrence for patients with KOTs (M-H, OR, 0.514; 95% CI, 0.302-0.875; p = 0.014). The overall pooled weighted RR for enucleation ± adjuvant therapy and decompression ± secondary cystectomy were 18.2% and 27.1%, respectively. The meta-regression analysis showed that duration of follow-up time did not significantly influence the OR of KOT recurrence (Q = 0.506, p = 0.646). In conclusion, initial cystectomy ± adjuvant therapy was associated with fewer recurrences than decompression ± secondary cystectomy.

Does the Excision of Overlying Oral Mucosa Reduce the Recurrence Rate in the Treatment of the Keratocystic Odontogenic Tumor? A Systematic Review and Meta-Analysis.

PURPOSE: The purpose of this study was to identify whether there is scientific evidence to support excision of the overlying mucosa (EOM) in conjunction with cyst enucleation to decrease the recurrence rate (RR) of keratocystic odontogenic tumors (KOTs). MATERIALS AND METHODS: A systematic review with meta-analysis conforming to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was performed. A comprehensive search of 3 major databases through PubMed, EMBASE, and Cochrane CENTRAL was conducted to identify all relevant articles published without date or language restrictions from inception to December 2015. Eligible articles were selected based on the following inclusion criteria: randomized, prospective, or retrospective studies comparing enucleation with EOM to enucleation without EOM for patients with KOTs. The predictor variable was treatment group (enucleation with EOM vs enucleation without EOM). The outcome variables were RR of KOTs, presence of epithelial islands and microcysts in the excised overlying mucosa, and correlation between recurrent cortically perforated KOTs. A weighted RR and odds ratio (OR; using a random- or fixed-effect model) and the Mantel-Haenszel test with 95% confidence interval (CI) were performed using comprehensive meta-analysis software. RESULTS: Eleven studies were included in this review. There was no significant difference between enucleation with and without EOM (random; OR = 3.259; 95%, 0.975-10.901, P = 0.055). The weighted event rates for enucleation with Carnoy's solution plus EOM and enucleation without EOM in cortically perforated lesions were 6.2% (random; 95% CI, 2.6-14) and 9.1% (random; 95% CI, 1.6-38.2), respectively. The weighted event rate for the presence of epithelial islands and microcysts in overlying mucosa of KOTs was 68.8% (random; 95% CI, 27.2-92.9). CONCLUSION: The results of this study suggest that enucleation of KOTs plus the use of Carnoy's solution or liquid nitrogen (when indicated) should be combined with EOM to obtain the lowest RR, specifically for retromandibular trigone, posterior maxillary, and cortically perforated lesions. However, the results from this study do not provide sufficient scientific evidence for EOM in combination with enucleation of KOTs.

Coronectomy: Partial Odontectomy or Intentional Root Retention.

Coronectomy is considered in patients older than 25, where there is an intimate relationship between the roots of a retained lower third molar (occasionally second or first molars) and the inferior alveolar nerve, in noncontraindicated circumstances. It may be used on younger patients with a medium to high risk of inferior alveolar nerve damage. The decision to use this technique is made with the aid of cone-beam computed tomography scans. Short- to medium-term success rate is excellent, but long-term studies are not yet available. The technique is gaining wider acceptance, although there are differences in the indications and actual technique used within and between countries.

Brain abscess potentially secondary to odontogenic infection: case report.

Odontogenic infections are rarely implicated in the causes of brain abscess formation. As such, there are very few reports of brain abscesses secondary to odontogenic infections in the literature. This is due partly to the relative rarity of brain abscesses but also to the difficulty in matching the causative organisms of a brain abscess to an odontogenic source. The authors report a case of a 50-year-old woman whose brain abscess may potentially have been secondary to an odontogenic infection. The patient's early diagnosis, supported by imaging and microbiologic assessment, along with early minicraniotomy and extraction of infected dentition followed by a course of cephalosporins and metronidazole, contributed to a successful outcome.

Comprehensive management of an orthognathic surgery patient with aggressive central giant cell granuloma of the mandible.

This article presents a case involving a 16-year-old boy who came to the Tripler Army Medical Center Oral and Maxillofacial Surgery with a central giant cell granuloma (CGCG) on the anterior mandible. Initial management consisted of surgical curettage and intralesional injection of corticosteroids. Upon completion of steroid therapy, there was clinical and radiographic evidence of remission; however, radiographic evidence of lesion recurrence was seen at a six-month follow-up visit. The CGCG was retreated with curettage and five months of systemic injections of calcitonin, both of which failed. The lesion was most likely an aggressive form of CGCG that progressed despite conservative therapy, with destruction of hard and soft tissues, root resorption, tooth displacement, and paraesthesia in the anterior mandible. The authors present a treatment algorithm with comprehensive management involving surgical resection, reconstruction, orthodontics, and orthognathic surgery with prosthodontic considerations.

What is the effect of timing of removal on the incidence and severity of complications?

PURPOSE: The purpose of this article is to summarize the literature that addresses the following question: "Among patients undergoing third molar removal, do patients who are younger, eg, <25 years, when compared with older patients, have a decreased risk for postoperative complications and more rapid recovery?" MATERIALS AND METHODS: For the purposes of this study, relevant articles were identified through a search of PubMed, Scopus, and the Cochrane Database, using the Medical Subject Headings search terms "third molars" or "wisdom teeth," "complications" and "age," linked to "recovery," "infections," "periodontal conditions," "temporomandibular joint problems," "nerve involvement," "sinus communication," and "mandibular fracture." RESULTS: Relevant studies have been identified and are reported for the following complications and their relationship to the patient's age: 1) time to recovery; 2) incidence of fractures; 3) rates of infection; 4) periodontal complications; 5) nerve involvement; 6) temporomandibular joint complications; 7) nerve injury; and 8) sinus-related complications. CONCLUSIONS: Studies indicate that as one becomes older, third molars (M3s) become more difficult to remove, may take longer to remove, and may result in an increased risk for complications associated with removal. The age of 25 years appears in many studies to be a critical time after which complications increase more rapidly. Conversely, there are no studies indicating a decrease in complications with increasing age. It also appears that recovery from complications is more prolonged and is less predictable and less complete with increasing age. As such, many clinicians recommend removal of M3s in patients as young adults. Advocates of M3 retention need to review carefully with their patients the risks of delaying M3 removal with the same degree of emphasis as the risks associated with operative treatment.

What are the risks of operative intervention?

PURPOSE: The purpose of this article is to conduct a literature review, identify the studies with the highest level of evidence, and summarize the complications associated with operative treatment of impacted third molars (M3s). MATERIALS AND METHODS: To address the research purpose, a search of PubMed, Scopus, and the Cochrane Database was performed, using the Medical Subject Headings search terms "third molars" or "wisdom teeth," "complications," "periodontal complications," "temporomandibular joint," "nerve involvement," "sinus communication," and "mandibular fracture." Individual case reports and anecdotal reports were excluded from review. RESULTS: Relevant studies for the following complications were identified and are reported: 1) periodontal, 2) temporomandibular joint, 3) nerve injury, 4) sinus, and 5) other. CONCLUSIONS: Quality-of-life studies have indicated that around 10% of patients undergoing M3 removal may have a complication. However, most complications are mild and self-limited and undergo complete resolution. Most patients are back at work or school after 2 to 3 days, and long-term complications are rare. Clinicians advocating M3 removal should review in detail the risks of operative intervention in conjunction with the benefits of removal and should be prepared to prevent, anticipate, and manage these complications.

Keratocystic odontogenic tumour (KCOT)--a cyst to a tumour.

PURPOSE: The World Health Organization (WHO) has reclassified 'odontogenic keratocyst' (OKC) to 'keratocystic odontogenic tumour' (KCOT) in 2005. Currently, this tumour is classified as a benign neoplasm of odontogenic origin and not as a cyst. This article reviews and discusses history, classification scheme, aetiology and pathogenesis, molecular and genetic basis, incidence, epidemiology and site, clinical features, imaging, histopathology, immunohistochemistry, treatment options, prognosis, recurrence and malignant transformation of KCOT, with emphasis on understanding the basis of reclassification as 'keratocystic odontogenic tumour'. METHODS: A systematic search and review of the literature was carried out in the online database of the United States National Library of Medicine to identify eligible titles for the study. RESULTS: Current evidence suggests that the scientific community still continues to use the term 'odontogenic keratocyst' more favourably than 'keratocystic odontogenic tumour'. CONCLUSION: The online database search indicates that the scientific community still continues to use the term 'odontogenic keratocyst' more favourably than 'keratocystic odontogenic tumour'. At this juncture, where the terminology has changed from a cyst to a tumour, a thorough review of literature on KCOT is presented.

Permanent nerve damage from inferior alveolar nerve blocks: a current update.

Permanent nerve involvement has been reported following inferior alveolar nerve blocks. This study provides an update on cases reported to one unit in the preceding six years. Lidocaine was associated with 25 percent of cases, articaine with 33 percent of cases, and prilocaine with 34 percent of cases. It does appear that inferior alveolar nerve blocks can cause permanent nerve damage with any local anesthetic, but the incidences may vary.

Long-term outcome of trigeminal nerve injuries related to dental treatment.

PURPOSE: There is little information available on the long-term effects on patients of permanent involvement of the inferior alveolar or lingual nerve because of dental treatment. This study has attempted to document this information from patients who were reviewed between 3 and 9 years after injury. MATERIALS AND METHODS: All patients with an ICD-9 diagnosis of 951.2 (injury to the trigeminal nerve) because of dental treatment, seen in the Oral and Maxillofacial Surgery Clinic at the University of California, San Francisco between January 1, 2001 and December 31, 2006, were contacted in an attempt to complete a telephone survey of long-term effects. RESULTS: Of the 727 patients who were eligible for the study, 145 patients (95 female and 50 male) completed the telephone surveys. Many patients had sought both conventional and alternative treatments after consultation at University of California, San Francisco. A small number of patients had undergone subsequent surgery elsewhere. Many patients reported significant life changes, including adverse effects on employment (13%), relationship changes (14%), depression (37%), problems speaking (38%), and problems eating (43%). In general, however, patients reported improvement over time, often using a number of different coping mechanisms. Males had a greater decrease in symptoms than females, and those older than 40 years reported more pain in the long term than those under 40. Lingual nerve symptoms improved more than inferior alveolar nerve symptoms. CONCLUSIONS: Although most patients continue to have long-term problems that affect the overall quality of life, for most patients there has been improvement in symptoms over time.