Trigeminal Neuropathy After Mandibular Fractures: Epidemiology and Neurophysiologic Diagnosis.

OBJECTIVES: To study the trigeminal nerve neuropathy prevalence after mandibular fractures and follow nerve recovery and to examine associations with clinical features. SUBJECTS: The files of 304 patients treated for 424 mandibular fractures in Hadassah Medical Center between 2001 and 2008 were analyzed. Twenty-five patients with paresthesia were examined by electro-diagnostic conduction test (quantitative sensory testing). RESULTS: The most common fracture sites were the symphysis (28.5%) and condyle (21.4%). A strong correlation between fracture severity and treatment modality was found. Nerve damage occurred in 13.4% of nondisplaced fractures and in 65.3% of >5 mm displaced fractures. Patients who were treated by open reduction internal fixation demonstrated the biggest difference in quantitative sensory testing values between the affected and nonaffected sides. C nerve fibers were the most damaged and least regenerated. There was correlation between damage perception and objective test results. CONCLUSIONS: There is a correlation between fracture type and displacement severity on neurologic deficit and prognosis. The objective neurosensory damage was manifested by higher nerve excitation threshold on the injured side. Patients should be informed on the prognosis of neurologic deficit according to fracture type.

Deep caries due to Pre-eruptive intracoronal resorption in a newly erupted primary molar.

CASE REPORT: This report describes a rare case of a 19-month-old girl with pre-eruptive intracoronal resorption in the lower left first primary molar which had erupted a few weeks earlier and had deep caries. The treatment is described. CONCLUSION: Dentists who treat children must take into consideration the possibility of pre-eruptive lesions in the primary dentition that may cause involvement of the pulp, either before or shortly post-eruption.

Pro-oxidative synergic bactericidal effect of NO: kinetics and inhibition by nitroxides.

NO plays diverse roles in physiological and pathological processes, occasionally resulting in opposing effects, particularly in cells subjected to oxidative stress. NO mostly protects eukaryotes against oxidative injury, but was demonstrated to kill prokaryotes synergistically with H2O2. This could be a promising therapeutic avenue. However, recent conflicting findings were reported describing dramatic protective activity of NO. The previous studies of NO effects on prokaryotes applied a transient oxidative stress while arbitrarily checking the residual bacterial viability after 30 or 60min and ignoring the process kinetics. If NO-induced synergy and the oxidative stress are time-dependent, the elucidation of the cell killing kinetics is essential, particularly for survival curves exhibiting a "shoulder" sometimes reflecting sublethal damage as in the linear-quadratic survival models. We studied the kinetics of NO synergic effects on H2O2-induced killing of microbial pathogens. A synergic pro-oxidative activity toward gram-negative and gram-positive cells is demonstrated even at sub-µM/min flux of NO. For certain strains, the synergic effect progressively increased with the duration of cell exposure, and the linear-quadratic survival model best fit the observed survival data. In contrast to the failure of SOD to affect the bactericidal process, nitroxide SOD mimics abrogated the pro-oxidative synergy of NO/H2O2. These cell-permeative antioxidants, which hardly react with diamagnetic species and react neither with NO nor with H2O2, can detoxify redox-active transition metals and catalytically remove intracellular superoxide and nitrogen-derived reactive species such as (•)NO2 or peroxynitrite. The possible mechanism underlying the bactericidal NO synergy under oxidative stress and the potential therapeutic gain are discussed.

Enigma of missing teeth in maxillofacial trauma.

PURPOSE: The initial evaluation and treatment of trauma victims should follow a planned approach, as delineated by the Advanced Trauma Life Support protocol, with the main concern securing a patent airway. When trauma has been associated with maxillofacial injury, it can complicate airway management owing to aspirated avulsed teeth or dental prosthetic devices. In such cases, endotracheal intubation can be life-threatening, if the foreign bodies are pushed into the upper respiratory tract. The objective of the present report was to illustrate the diagnostic and management problems related to foreign bodies from the oral cavity lodged in the upper airway after blunt maxillofacial trauma or emergency endotracheal intubation. We also discussed how this could be prevented. PATIENTS AND METHODS: A retrospective study was performed at the Department of Oral and Maxillofacial Surgery, Hadassah Medical Center (Jerusalem, Israel). The records of 1,411 patients admitted for treatment of facial trauma during the past 10 years were reviewed. RESULTS: Of the 1,411 patients, 7 (0.5%) had aspirated foreign bodies that had lodged in the airway because of the trauma or subsequent intubation. CONCLUSIONS: The patient's oral cavity and upper airway must be inspected thoroughly before attempting endotracheal intubation. Any foreign body should be removed from the mouth and throat. This process must be undertaken, despite the stressful and limiting conditions of emergency care.

Immediate placement of dental implants into debrided infected dentoalveolar sockets.

PURPOSE: To describe a protocol for the immediate placement of endosseous implants into debrided infected dentoalveolar sockets. PATIENTS AND METHODS: A total of 30 implants were immediately placed into debrided infected sites in 20 patients. The pathology at the receptacle dentoalveolar sockets varied, and included subacute periodontal infection, perio-endo infection, chronic periodontal infection, chronic periapical lesion, and a periodontal cyst. The immediate placement protocol emphasized the meticulous debridement of the infected tissues in combination with peripheral ostectomy of the alveoli. Guided bone regeneration was accomplished to support bony healing of alveolar defects surrounding the implantation site. Pre- and postsurgical antibiotic therapy was administered. RESULTS: All implants but 1 were osseointegrated and functional when followed up after 12 to 72 months. One implant was mobile after its immediate restoration and was removed. Complications were related to the use of guided bone regeneration. Deficiency of the attached gingiva was noted in 1 case. The treatment approach is illustrated in 2 anterior maxilla cases with 3-year follow-up. CONCLUSIONS: Successful immediate implantation in debrided infected alveoli depends on the complete removal of all contaminated tissue and the controlled regeneration of the alveolar defect. With this proposed clinical approach, experienced clinicians may consider immediate implants as a viable treatment option in patients presenting with dentoalveolar infections.

Patients' perceptions of recovery after exposure of impacted teeth with a closed-eruption technique.

This prospective study evaluated patients' perceptions of recovery after surgical exposure of impacted teeth treated with a closed-eruption surgical-orthodontic technique. Twenty-nine patients (16 female, 13 male; mean age, 16 +/- 2.8 years) were given a health-related quality of life questionnaire to be completed each postoperative day (POD) for 7 days. The questionnaire was designed to assess the patient's perception of recovery: pain, oral function, general activity, and other parameters. The impact of possible predictor variables, such as age, sex, length of surgical procedure, tooth location, height of impaction, and need for bone removal were assessed. Severe pain (27.6%, 13.8%, 3.4%) and consumption of analgesics (76%, 41%, 17%) declined gradually over the first 3 PODs. Improvement in oral function and other symptoms was evident by PODs 3 and 4. Absence from school outweighed interference in daily activity by 3 days (POD 6 vs POD 3). Buccolingual tooth location was the most significant predictor variable, with results showing a delayed recovery for patients with buccally impacted teeth. The most striking difference was reported with regard to swelling (P <.0001), followed by mouth opening (P =.008) and speech (P =.05). When the surgical procedure lasted 30 minutes or longer, there was prolonged recovery from pain (P =.01). This study provides information to patients and clinicians on postoperative recovery after surgical exposure of impacted teeth by the closed-eruption surgical-orthodontic technique.

TMJ lubrication system: its effect on the joint function, dysfunction, and treatment approach.

Normal temporomandibular joint (TMJ) movements primarily depend on free sliding of the disc down the slope of the eminence. Therefore, understanding the lubrication system and how aberrations in this system contribute to TMJ is important. Its effect on dysfunctions, such as disc displacement, anchored disc phenomenon, open lock, and osteoarthritis, are discussed in this article.

Eruption of a severely displaced second permanent molar following surgical removal of an odontoma.

The process of tooth eruption is very complex, and many of its factors remain unknown. Although radiographic features can provide clues into the eruptive potential of a tooth, underlying factors that affect tooth development and eruption are not as well defined, ranging from local disturbances to systemic disease. In addition, it is difficult to predict which teeth will require treatment and when the optimal time is to intervene. The purpose of this report is to illustrate the eruption potential of an impacted molar following the removal of a developing odontoma, despite its unfavorable position in the bone, complete root development, and orthodontic attachment loss.

The use of lasers in dentistry: principles of operation and clinical applications.

This article describes the principles of laser operation and the clinical application of laser technology in the different fields of dentistry. It discusses the use of the Er:YAG laser in restorative dentistry, pediatric dentistry, and periodontics, as well as the introduction of a new side-firing spiral tip for efficient cleaning of the root canal system by means of lateral laser irradiation. Although the Er:YAG laser is used mostly on enamel and dentin, the gingival depigmentation procedure using this laser also is described. Clinical applications of the CO2 and diode lasers on soft tissues, particularly in the fields of oral and maxillofacial surgery and perodontics, are explained. Because teeth whitening for esthetic reasons has gained increasing popularity in dentistry, the application of diode lasers for this purpose is discussed. All the dental laser procedures described in this article are conducted at the Hebrew University-Hadassah School of Dental Medicine and are further investigated in various clinical research projects.

The implications of a broken needle in the pterygomandibular space: clinical guidelines for prevention and retrieval.

The implication of a broken anesthetic injection needle in the posterior part of the oral cavity is described. Needle breakage is preventable if proper preventive measures are used during local anesthesia administration. A broken needle should be removed immediately after a thorough localization and not left in the tissue, as previously believed. Computerized tomography (CT) scan is the proper diagnostic device to locate a broken needle. A careful surgical approach under general anesthesia is recommended to retrieve the needle. Clinical preventive guidelines are described and presented to the pediatric dentist.