The relation between Schneiderian membrane thickening and radiodiagnostic features of periapical pathology.

This study aimed to assess the relationship between Schneiderian membrane thickening and periapical pathology in a retrospective analysis of Cone Beam Computed Tomography (CBCT) images. For this, 147 CBCT scans containing 258 sinuses and 1,181 teeth were assessed. Discontinuation of the lamina dura, widening of the periodontal ligament space, apical periodontitis (AP), and partly demineralized maxillary sinus floor associated with AP were considered periapical pathology. Maxillary sinus mucosal thickening (MSMT) was classified as odontogenic or non-odontogenic. An irregular band with a focal tooth associated thickening and local thickening related to a root were considered odontogenic types of MSMT. The relation between the imaging features of periapical pathology and the type and thickness of MSMT was determined by logistic regression and linear mixed model, respectively. In addition, linear regression and Mann Whitney test evaluated the relation and demineralization of the AP lesion towards the sinus floor (p≤0.05). The odds of having an odontogenic type of MSMT were significantly higher when a periapical pathology was present in the maxillary sinus. Eighty-two percent of AP partly demineralized towards the sinus floor were associated with an odontogenic MSMT. Both AP lesions partly demineralized towards the sinus floor and, with increased diameter, led to increased MSMT. In conclusion, there is an 82% risk of having an odontogenic type of MSMT with the presence of AP partly demineralized towards the sinus floor. More thickening of the maxillary sinus mucosa is seen with larger AP lesions and partial demineralization of the sinus floor.

Diffuse Sclerosing Osteomyelitis: A Potential Risk Indicator for Peri-implantitis? A Case Series.

PURPOSE: To propose diffuse osteomyelitis as risk indicator for peri-implantitis following the loss of several dental implants in patients that present with highly sclerotic bone areas. MATERIALS AND METHODS: A total of six "nightmare cases"-three of which were treated at the Department of Periodontology of the University Hospitals of the Catholic University Leuven and three of which were referred there for a second opinion-were retrospectively analyzed using radiographs obtained via contact with referring clinicians in order to fully reconstruct the treatment pathway and dental history for each of these patients. RESULTS: All patients suffered from early implant failures and/or severe peri-implantitis with bone loss and crater formation up to the apical level, as well as the loss of all or nearly all implants. Re-examination of their preand postoperative CBCTs, in combination with several bone biopsies, confirmed the diagnosis of a diffuse sclerosing osteomyelitis in the treated area. Osteomyelitis could be linked to a longstanding history of chronic and/or therapyresistant periodontal/endodontic pathology. CONCLUSION: The current retrospective case series seems to suggest that diffuse osteomyelitis should be considered as a risk indicator for severe peri-implantitis. Int J Oral Maxillofac Implants 2023;38:503-515. doi: 10.11607/jomi.9773.

Alveolar bone level at deciduous molars in Flemish children: A retrospective, radiographic study.

AIM: The aim of this retrospective radiographic study in Flemish children was to examine the bone level and bone loss around deciduous molars and factors influencing this. MATERIALS AND METHODS: Two thousand eight hundred ninety six digital intra-oral radiographs of children younger than 18 years old were screened for eligibility. The distance from the cementoenamel junction to the alveolar bone crest was measured, and tooth surfaces were screened for local risk factors that are presumably related to changes in the bone level. A distance >2 mm was defined as bone loss based on previous literature. All measurements were performed by two examiners. RESULTS: One thousand four hundred ninety one radiographs of 796 patients (mean age 6.46 ± 2.38 years) were included. The distance between the cementoenamel junction and the alveolar bone crest ranged from 0.07 to 2.88 mm, and the mean distance was 0.93 ± 0.37 mm. This distance was positively correlated with age (p < .001). In 3.5% of patients, bone loss was diagnosed. Caries, fillings and pulp pathology were associated with bone loss and higher cementoenamel junction-alveolar bone crest distances (p < .05). CONCLUSION: This study found a low prevalence of alveolar bone loss in the primary dentition. Both the bone level and bone loss were strongly correlated with local factors.

Root-end surgery with leucocyte- and platelet-rich fibrin and an occlusive membrane: a randomized controlled clinical trial on patients' quality of life.

OBJECTIVES: The aim of this study was to investigate the impact of the adjunct of leukocyte- and platelet-rich fibrin (LPRF) to root-end surgery (RES) on the patients' quality of life during the first week post RES. MATERIALS AND METHODS: Patients in need of RES were recruited for an open randomized controlled clinical trial (RCT) with a 2 × 2 factorial design. They were randomly allocated to the test (+LPRF) and control (-LPRF) group. Each group was subsequently divided into two strata: with or without an occlusive membrane (Bio-Gide®, Geistlich Biomaterials, Switzerland; BG). After RES, the patients completed daily for 1 week a visual analog pain scale (VAS) and a 5-point Likert-type scale questionnaire concerning activity impairment, occurrence of symptoms, and medication use. RESULTS: Fifty patients were included, equally divided between the test and control group. Only one patient in the "-LPRF+BG-group" had to take additional antibiotics due to a persistent jaw swelling. There was no evidence (p ≤ 0.05) for a difference between the test and control group in VAS, occurrence of pain symptoms, impairment of daily activities, and medication use, over the 7 days and daily during the 7 days post RES. CONCLUSIONS: There was no statistical significant evidence for improvement of patients' quality of life during the first week post RES with LPRF in comparison with RES without LPRF. CLINICAL RELEVANCE: Although LPRF seems to be an inexpensive and autologous agent to reduce pain and swelling post RES, this RCT does not provide a statistical significant evidence for that.

A rare cause of gingival recession: morphea with intra-oral involvement.

Morphea is an inflammatory disorder of the skin and underlying tissues characterized by an overabundance of collagen leading to fibrosis. The prevalence of this disease is estimated at around 0.4-2.7/100,000 people. When the process occurs in the gingival tissues, it induces traction, which can cause gingival recession. A 19-year-old woman was referred to the clinic for a progressive recession on teeth 11 and 12. A pale, atrophic, linear region extending from her nose to her upper lip on the right-hand side of her face was diagnosed as morphea en coup de sabre. Cone beam computed tomography, quantitative polymerase chain reaction and histologic evaluation were used to assess the pathology. Treatment with methotrexate was conducted. After 12 months, no progression of the recession could be observed.