Assessment of the reliability of radiographic signs on panoramic radiographs to determine the relationship between mandibular third molars and the inferior alveolar canal.

OBJECTIVE: To assess the reliability of radiographic signs of the relationship between impacted mandibular third molars (IMTMs) and the inferior alveolar canal (IAC), and the vertical relationship between IMTM and IAC on panoramic radiographs (PRs) as risk indicators for IAC exposure during extraction. STUDY DESIGN: Seven radiographic signs regarding the appearance of roots and the IAC were assessed as present or absent on PRs. The vertical relationship between IMTM and the IAC was divided into 3 levels. The correlation between radiographic data and IAC exposure during extraction was analyzed by using χ2 statistics and logistic regression analysis. RESULTS: In total, 198 IMTMs were examined. In 46 cases (23.2%), the IAC was exposed during extraction. Four radiographic signs-darkening of the root, narrowing of the root, narrowing of the IAC, and diversion of the IAC-were associated with IAC exposure (P < .05). Concurrence of 2 or more of 7 radiographic signs increased the risk of IAC exposure (P < .001). The vertical relationship between IMTM and the IAC was found to be a risk indicator for IAC exposure (P < .001). No significant correlation was found between IAC exposure and inferior alveolar nerve damage (P = .148). CONCLUSIONS: Panoramic radiography is useful for assessing the risk of IAC exposure during IMTM extraction.

Maxillary sinus aspergilloma of odontogenic origin: Report of 2 cases with cone-beam computed tomographic findings and review of the literature.

Aspergilloma of the maxillary sinus is considered rare in immunocompetent patients, but a considerable increase has recently been seen in the incidence of reported cases. Dental procedures involving the antral region are thought to predispose individuals to this form of aspergillosis. Because aspergilloma shares similar clinical features with other sinus pathologies, its diagnosis may be delayed. Thus, an early diagnosis confirmed by a histopathological examination plays a crucial role in the adequate management of aspergilloma. This article provides a concise review of the reported cases of aspergilloma associated with dental procedures and reports 2 new cases of aspergilloma in middle-aged female patients, with a presentation of their cone-beam computed tomographic findings.

Benign cementoblastoma of the anterior mandible: an unusual case report.

A benign cementoblastoma, which is another name for a true cementoma, is a rare neoplasm that develops from odontogenic ectomesenchyme. It is characterized by a mineralized mass attached to the apex of the root produced by neoplastic cementoblasts. More than 75% of cases arise in the mandible, with 90% of them manifesting in the molar and premolar regions. This neoplasm occurs most commonly in children and young adults, with males being affected slightly more than females. Radiographically, the tumor is observed as a well-defined radiopaque mass that is fused to a tooth root and is surrounded by a radiolucent rim. The treatment of benign cementoblastoma consists of removal of the lesion and extraction of the affected tooth. This report presents an unusual case of benign cementoblastoma in a 31-year-old female, presenting as a densely mineralized mass seen at the apex of the impacted right mandibular canine tooth on radiographs.

Assessment of heat generation during implant insertion.

STATEMENT OF PROBLEM: Many studies have investigated the heat generated during implant preparation, but data are needed to better predict heat generation during implant insertion. PURPOSE: The purpose of this study was to measure the heat generated during insertion of an implant at speeds of 30, 50, and 100 rpm, and with manual insertion. MATERIAL AND METHODS: Sixty-four uniform fresh bovine femoral cortical bone specimens were used. After the cortical bone was drilled, 3 different implant insertion speeds and the manual insertion of the implant were evaluated for 2 different implant diameters. The temperature was measured with 2 Teflon-insulated, type K thermocouples. Data were analyzed by 2-way ANOVA, and the Tukey honestly significant difference test (α=.05). RESULTS: The highest thermal change for 4.1-mm-diameter implants was found at a speed of 100 rpm (9.81°C ±2.29°C), and the lowest thermal change was 3.69°C ±0.85°C at a speed of 30 rpm. A statistically significant difference was found between 100 rpm and the other 3 insertion procedures. The highest thermal change for a 4.8-mm-diameter implant was found at a speed of 100 rpm (8.79°C ±1.53°C), and the lowest thermal change was 4.48°C ±0.85°C at a speed of 30 rpm. No statistical difference was observed with manual, 30 rpm, and 50 rpm; however, a statistically significant difference was found between 100 rpm and the other 3 insertion procedures. CONCLUSIONS: Manual implant insertion and at speeds of 30 rpm and 50 rpm generated lower heat compared with insertion at 100 rpm.

Advancement of the premaxilla with distraction osteogenesis.

OBJECTIVES: The aim of this study was to evaluate the effects of premaxillary advancement with distraction osteogenesis (DO) on the skeletal, dental, and soft tissues. MATERIALS AND METHODS: A total of 21 cases with Angle class I molar relationship and negative overjet or edge-to-edge incisor relationship were included. Due to patient relocation during fixed orthodontic treatment the results of 19 patients (9 females, 10 males) were reported. Their average chronological age was 16.18 ± 3.10 years. An individual tooth-borne distraction appliance was used. Skeletal, dental, and soft tissue changes were evaluated on cephalograms obtained before treatment (T1), at the end of the consolidation period (T2) and fixed orthodontic treatment (T3). Friedman and Wilcoxon tests were applied to determine the significant differences during T1-T2, T2-T3, and T1-T3 periods. RESULTS: At T2 forward movements of ANS, A, and upper incisors were significant. Significant increases of SNA, ANB, and overjet were obtained. The soft tissue points of Pn, Sn, Ss, Ls showed significant anterior movement. Arch length increase of 10.76 mm was significant. At T3 the decreases of SNA and ANB angles, and FH ┴ N-A distance were significant. Pn point showed significant anterior movement. Total treatment time showed significant anterior movement of points ANS, A, and upper incisors. Significant increase of SNA and ANB angles was noted. The soft tissue points followed the movement of the underlying hard tissue. LIMITATION: A class III control group could not be established for ethical reasons. CONCLUSIONS: The facial profile was improved and space was obtained to solve the maxillary anterior crowding with premaxillary advancement through DO.

Temperature variation on root surface with three root-end cavity preparation techniques.

INTRODUCTION: Thermal changes can occur on the external root surface when root-end cavity preparation is performed, which may damage periodontal ligament cells and alveolar bone. OBJECTIVE: The purpose of this study was to evaluate the temperature changes during preparation of the root-end cavities at 1 and 3 mm to the sectioned apical root surfaces when either tungsten carbide round bur, diamond round bur or ultrasonic diamond tip was used. METHODS: Root-end resection was performed at 90 degrees to the long axis of the root, 3 mm from the apex. Specimens were randomly divided into three groups of 12 teeth each for three different root-end cavity preparation techniques to be used, i.e. tungsten carbide bur, diamond bur and ultrasonic diamond retro tip.Thermocouples were used to measure temperature changes at 1 mm (T1) and 3 mm (T2) to the cutting plane during the preparations. RESULTS: For T1, the lowest and the highest mean temperature increases of 3.53 degrees C and 4.34 degrees C were recorded for the carbide and diamond burs, respectively. For T2, the lowest and the highest mean temperature increases of 2.62 degrees C and 4.39 degrees C where recorded for the carbide and diamond burs, respectively. The mean temperatures with the ultrasonic tip were 3.68 and 3.04 degrees C at T1 and T2 region, respectively. For root-end preparation, the ultrasonic preparation technique took the shortest preparation time (10.25 sec) and the diamond bur took the longest time (28.17 sec). CONCLUSION: Ultrasonic retro tips and burs caused temperature to rise from 2.62 degrees to 4.39 degrees C, and these rises were within safety levels.

Autogenous cortical bone and bioactive glass grafting for treatment of intraosseous periodontal defects.

OBJECTIVE: The aim of this 6-month prospective randomized clinical study was to compare the effectiveness of autogenous cortical bone (ACB) and bioactive glass (BG) grafting for the regenerative treatment of intraosseous periodontal defects. METHODS: Via a split-mouth design, 15 chronic periodontitis patients (7 men, 8 women; mean age, 43.47 ± 1.45 years) who had probing pocket depths (PPDs) of ⩾6 mm following initial periodontal therapy were randomly assigned to receive 2 treatments in contralateral areas of the dentition: ACB grafting and BG grafting. The parameters compared in the patients were preoperative and 6-month postoperative PPDs, clinical attachment levels (CALs), and radiographic alveolar bone heights. RESULTS: Both treatment modalities resulted in significant changes in postoperative measurements when compared to preoperative values (p < 0.01). PPDs were decreased, CALs were increased, and radiographic alveolar bone heights were increased by 5.00 ± 0.28, 4.60 ± 0.21, and 5.80 ± 0.43 mm in patients treated with ACB grafting and 5.13 ± 0.32, 4.67 ± 0.27, and 5.33 ± 0.36 mm in patients treated with BG grafting, respectively. Differences between the treatments were not statistically significant (P>.05). CONCLUSIONS: Within the limitations of this study, both ACB and BG grafting led to significant improvements in clinical and radiographic parameters 6 months postoperatively. These results suggest that either an ACB graft, which is completely safe with no associated concerns about disease transmission and immunogenic reactions, or a BG graft, which has an unlimited supply, can be selected for regenerative periodontal treatment.

Alveolar ridge expansion-assisted orthodontic space closure in the mandibular posterior region.

Orthodontic closure of old, edentulous spaces in the mandibular posterior region is a major challenge. In this report, we describe a method of orthodontic closure of edentulous spaces in the mandibular posterior region accelerated by piezoelectric decortication and alveolar ridge expansion. Combined piezosurgical and orthodontic treatments were used to close 14- and 15-mm-wide spaces in the mandibular left and right posterior areas, respectively, of a female patient, aged 18 years and 9 months, diagnosed with skeletal Class III malocclusion, hypodontia, and polydiastemas. After the piezoelectric decortication, segmental and full-arch mechanics were applied in the orthodontic phase. Despite some extent of root resorption and anchorage loss, the edentulous spaces were closed, and adequate function and esthetics were regained without further restorative treatment. Alveolar ridge expansion-assisted orthodontic space closure seems to be an effective and relatively less-invasive treatment alternative for edentulous spaces in the mandibular posterior region.

Resonance frequency analysis of 208 Straumann dental implants during the healing period.

The most important prerequisite for the success of an osseointegrated dental implant is achievement and maintenance of implant stability. The aim of the study was to measure the 208 Straumann dental implant stability quotient (ISQ) values during the osseointegration period and determine the factors that affect implant stability. A total of 164 of the implants inserted were standard surface, and 44 of them were SLActive surface. To determine implant stability as ISQ values, measurements were performed at the stage of implant placement and healing periods by the Osstell mentor. The ISQ value ranges showed a significant increase during the healing period. Except for the initial measurement, the posterior maxilla had the lowest ISQ values, and there was no significant difference among anterior mandible, posterior mandible, and anterior maxilla (P < .05). Implant length did not have a significant influence on ISQ value (P > .05). The second measurement was significantly higher in men compared with women (P < .05). The second measurement was significantly higher than the others at 4.8 mm, and for the final measurement, there were no significant differences between 4.8 and 4.1 mm, which were higher than 3.3 mm (P < .05). When comparing sandblasted, large-grit, acid-etched (SLA) and SLActive surface implants, there were no significant differences for insertion measurements, but for second measurements, SLActive was significantly higher (P = 0), and for the final measurement, there was no significant difference. It appears that repeated ISQ measurements of a specific implant have some diagnostic benefit, and the factors that affect implant stability during the healing period are presented.

Ultrasonography in the evaluation of midpalatal suture in surgically assisted rapid maxillary expansion.

Surgically assisted rapid maxillary expansion (SARME), which combines orthodontics and surgery, is a well-established therapy for transverse maxillary hypoplasia in adults after sutural closure or completion of skeletal maturation. X-rays are usually the preferred monitoring technique for this treatment. Recently, ultrasound scanning has been used successfully in the follow-up of patients undergoing distraction osteogenesis. In this study, ultrasonography (US) was used in the evaluation of bone callus formation in the midpalatal suture in 3 patients undergoing SARME. For each patient, US was performed immediately after active expansion, at 2 and 4 months of the expansion period, at the removal of the expander 6 months later, and at 2 months after expander removal. The results indicated that US might be a useful and accurate method to assess bone fill in the midpalatal suture in patients undergoing SARME. However, further studies are necessary to clarify the US scores in a larger patient group undergoing SARME.

Temperature variation during apicectomy with Er:YAG laser.

OBJECTIVE: The purpose of this in vitro study was to evaluate the generated temperature of the Er:YAG laser, with three different pulse durations for apicectomy, compared with tungsten bur and surgical saw. BACKGROUND DATA: Apicectomy is an endodontic surgery performed to remove the root apex and curette adjacent periapical tissue because of lesions of the apical area that are not healing properly. METHODS: Sixty single-rooted extracted human teeth were resected by three cutting methods: tungsten bur, surgical saw, and Er:YAG laser irradiation with three different pulse durations; pulse duration 50 µs, pulse duration 100 µs, and pulse duration 300 µs. Teflon-insulated, type K thermocouples were used to measure temperature changes during the apicectomy process. Data were analyzed using the general linear models procedure of the SPSS statistical software program. RESULTS: Although there was no statistically significant difference for the mean values of temperature changes at 1 mm away to the cutting site of teeth, there was statistically significant difference among groups for the mean values of temperature changes at 3 mm away to the cutting site of teeth. Additionally, there was statistically significant difference among groups for the total time required for apicectomy. CONCLUSIONS: The laser irradiation with pulse duration 50 µs appears to have the lowest temperature rise and the shortest time required for apicectomy of the three pulse durations. However, Er:YAG laser for apicectomy in all pulse durations could be used safely for resection in endodontics in the presence of sufficient water.

Keratocystic odontogenic tumor: case report with CT and ultrasonography findings.

Keratocystic odontogenic tumor (KCOT) is a benign odontogenic tumor with a potentially aggressive and infiltrative behavior. KCOT is most commonly occurred in mandible and demonstrate a unilocular, round, oval, scalloped radiolucent area, while large lesions may appear multilocular. An important characteristic of KCOT is its propensity to grow in an antero-posterior direction within medullary cavity of bone causing minimal expansion. Definitive diagnosis relies on histological examination. In this report, a KCOT that had an expansion both buccal and lingual cortical bone is described including its features in computed tomography and ultrasonographic exams. The lesion was removed surgically via an intraoral approach under local anesthesia and histologically reported as a KCOT.

Comparison of heat generation during implant drilling using stainless steel and ceramic drills.

PURPOSE: The purpose of this study was to compare the heat generated from implant drilling using stainless steel and ceramic drills. MATERIALS AND METHODS: A total of 40 fresh bovine femoral cortical bone samples were used in this study. A constant drill load of 2.0 kg was applied throughout the drilling procedures via a drilling rig at a speed of 1,500 rpm. Two different implant drill types (stainless steel and ceramic) were evaluated. Heat was measured with type K thermocouple from 3 different depths. Data were subjected to the independent-sample t test and Pearson correlation analysis. The α level was set a priori at 0.05. RESULTS: The mean maximum temperatures at the depths of 3 mm, 6 mm, and 9 mm with the stainless steel drill were 32.15°C, 35.94°C, and 37.05°C, respectively, and those with the ceramic drill were 34.49°C, 36.73°C, and 36.52°C, respectively. A statistically significant difference was found at the depth of 3 mm (P = .014) whereas there was no significant difference at the depths of 6 and 9 mm (P > .05) between stainless steel and ceramic drills. CONCLUSION: Within the limitations of the study, although more heat was generated in the superficial part of the drilling cavity with the ceramic drill, heat modifications seemed not to be correlated with the drill type, whether stainless steel or ceramic, in the deep aspect of the cavity. Further clinical studies are required to determine the effect of drill type on heat generation.

Effect of autogenous cortical bone grafting in conjunction with guided tissue regeneration in the treatment of intraosseous periodontal defects.

OBJECTIVES: The aim of this clinical trial was to evaluate the additional benefit of using guided tissue regeneration (GTR) with autogenous cortical bone (ACB) grafting versus ACB grafting alone for the regenerative treatment of intraosseous periodontal defects. METHODS: Via a split-mouth design, 12 patients with chronic periodontitis (five men, seven women; mean age, 45.3±4.6 years) who had probing pocket depths (PPDs) of ≥6 mm following initial periodontal therapy were randomly assigned to two treatments in contralateral areas of the dentition: a combination of ACB grafting and GTR (with a absorbable membrane of polylactic acid) or ACB grafting alone. The compared parameters were preoperative and 6-month postoperative PPDs, clinical attachment levels (CALs), and radiographic alveolar bone heights. RESULTS: Both treatment modalities resulted in significant changes in the postoperative measurements from the preoperative values (P<.01). The reduction in the PPDs, gain in the CALs, and gain in the radiographic alveolar bone heights were 4.58±1.08, 4.25±1.06, and 5.50±2.24 mm in the patients treated with ACB grafting and GTR and 4.92±1.00, 4.50±0.80, and 5.92±1.83 mm in those treated with ACB grafting alone, respectively. The differences between the treatments were not statistically significant (P>.05). CONCLUSIONS: Within the study limitations, both ACB grafting with GTR and ACB grafting alone lead to significant improvements in clinical and radiographic parameters at 6 months postoperatively. The combined approach does not provide any additional benefit for treating intraosseous periodontal defects.

Nasolabial cyst: case report with CT and MRI findings.

Nasolabial cysts are uncommon primarily unilateral soft tissue lesions located adjacent to the alveolar process above the apices of the maxillary incisors. Clinical features of the nasolabial cysts are smooth fluctuant soft tissue swelling between the upper lip and nasal aperture with obliteration of the nasolabial fold and elevation of the nasal ala. A nasolabial cyst is described including its features on CT and MRI exams.

Effect of surgical drill guide on heat generated from implant drilling.

PURPOSE: The purpose of this study was to evaluate the heat generated in bone by 2 implant drill systems in vitro with and without using surgical drill guides. MATERIALS AND METHODS: Temperature was measured with K type thermocouple in vitro using the bovine femoral cortical bone model. A constant drill load of 2.0 kg was applied throughout the drilling procedures via a drilling rig at a speed of 1,500 rpm. Two different implant drill systems-System A (with external irrigation) and System B (with both external and internal irrigation)-were evaluated. The samples were divided into 4 groups. System A test group 1 (TG1) included the following: 20 samples for drilling with surgical drill guides; control group 1 (CG1): 20 samples for classical implant site preparation. System B test group 2 (TG2) included the following: 20 samples for drilling with surgical drill guides; control group 2 (CG2): 20 samples for classical implant site preparation. Heat was measured at the final drill in the drilling sequence (4.2 and 4.4 mm). Thermocouples were placed at a 1-mm distance from the osteotomy area at depths of 3, 6, and 9 mm. Heat measurements were recorded out to 50 uses by a software program. Data were subjected to the Mann-Whitney U and Kruskal-Wallis tests. The alpha level was set a priori at 0.05. RESULTS: The mean maximum temperatures at the depths of 3, 6, and 9 mm using surgical drill guides were 34.2 degrees , 39.7 degrees , and 39.8 degrees C, respectively, although without using surgical drill guides the values were 28.8 degrees , 30.7 degrees , and 31.1 degrees C. A statistically significant difference was found at the depths of 3, 6, and 9 mm between using surgical drill guides and classical drilling procedure. CONCLUSIONS: From a heat generation standpoint, we conclude that preparing an implant site with using surgical drill guides generates heat more than classical implant site preparation regardless of the irrigation type.

Influence of different suturing techniques on periodontal health of the adjacent second molars after extraction of impacted mandibular third molars.

OBJECTIVE: The objective of this randomized controlled trial was to compare the effects of different suturing techniques (simple loop suture vs. anchor suture) on the periodontal health of the adjacent second molars after impacted mandibular third molar extraction. STUDY DESIGN: Fifteen patients with bilaterally identical impacted mandibular third molars were used. Using split-mouth design, flaps were closed with either anchor suture technique or simple loop suture technique after the extraction of third molars. Postoperative examination included probing pocket depth (PPD) and clinical attachment level (CAL) measured at the distal surface of the second molars before surgery and 6 months after surgery. RESULTS: The PPD and CAL in the distal surfaces of the second molars were significantly higher after 6 months in the simple suture group (P = .001), whereas no differences were found in the anchor suture group (P > .05). Intergroup comparisons showed that the 6-month PPD and CAL values of the distal surfaces were significantly higher in the simple suture group compared with the anchor suture group (P = .015). CONCLUSION: The results suggest that anchor suture might be a better technique to use to maintain healthy periodontium and to prevent periodontal problems after the extraction of impacted third molars.

Advancement of mandibular symphysis with distraction osteogenesis.

This case report demonstrates the effects of mandibular symphysis advancement with distraction osteogenesis (DO) in a 21-year-old man with a Class I molar relationship, protrusive maxillary incisors, crowding in both arches, and increased overjet and overbite. Treatment consisted of maxillary arch leveling, mandibular incisor repositioning through mandibular symphysis advancement with DO, and subsequent mandibular arch leveling. The osteotomy line, between the canine and the first premolar, was extended from the interdental area to the lower border of the mandibular symphysis bilaterally. The distraction device was cemented after mobilization of the mandibular symphysis. The screws were activated (0.8 mm per day) after a latent period of 1 week. The amount of activation per side was 6.4 mm. After an 8-week consolidation period, the distraction appliance was removed. At the end of treatment, increases of SNB angle, effective mandibular length, SN/GoGn, anterior facial height, mandibular incisor inclinations, and labiomental angle were observed. Decreases of ANB angle, overjet, and distance from the lower lip to the esthetic line were noted. Even though this patient's long-term results are not yet available, the results so far are encouraging. Mandibular symphysis advancement with DO seems to be an effective method for correcting mandibular anterior crowding and an increased overjet.

Efficacy of dental practitioners in injection techniques: computerized device and traditional syringe.

OBJECTIVE: To compare the effect of clinicians on the behavioral pain reaction of children who received local anesthesia with a conventional technique and a computerized device (Wand, Milestone Scientific). METHOD AND MATERIALS: One hundred four children aged 6 to 12 years who needed operative dentistry using infiltrative anesthesia in the mandible and maxilla were selected for this study. The patients were divided into 2 groups, each assigned to a different clinician, and received anesthesia either by the Wand or conventional technique. Two experienced pediatric dentists performed all injections. During the injection, the modified behavioral pain scale was used for objective evaluation of the children. RESULTS: Chi-square analysis revealed no statistically significant difference in the behavior of children when receiving the Wand or conventional technique within each dentist and between dentists (P>.05). CONCLUSION: There seemed to be no difference in perceived pain between the Wand and conventional injection performed by experienced clinicians in school-age children

A comparison of injection pain with articaine with adrenaline, prilocaine with phenylpressin and lidocaine with adrenaline.

OBJECTIVE: The objective of the present study was to investigate the pain on injection of articaine with adrenaline, prilocaine with phenylpressin , and lidocaine with adrenaline. STUDY DESIGN: The study sample was comprised of 497 consecutively seen patients received 497 maxillary buccal infiltration injections or inferior alveolar block injections of 4% articaine with 1:200.000 adrenaline, 3% prilocaine with 1.08 mcg phenylpressin, or 2% lidocaine with 1:100.000 adrenaline. Immediately after the injection, patients were asked to rate their injection pain on a six-point scale. RESULTS: There were no significant differences among the anesthetic solutions for injection pain. Patients usually reported mild or no injection pain for all of anesthetic administrations. CONCLUSION: Under the conditions of this study that lidocaine with adrenaline, articaine with adrenaline and prilocaine with phenylpressin seemed to be similar for pain on injection and they could be quite painless.