Maxillary Sinus Lift Procedures: An Overview of Current Techniques, Presurgical Evaluation, and Complications.

A maxillary sinus lift procedure is indicated if a dental implant needs to be placed in the posterior maxilla with limited bone available to accommodate a dental implant. Both open and closed sinus lifting procedures are reliable approaches for increasing the bone volume needed to support proper implant positioning. However, these methods can lead to several complications. In addition to the general complications commonly linked to oral surgery, such as swelling or hematoma, the primary complication in open sinus lifting is typically the perforation of the Schneiderian membrane during osteotomy. Detailed and extensive presurgical evaluation is crucial to minimize such complications. The objective of this study was to delineate contemporary trends in sinus lift surgery, with a specific emphasis on different techniques of sinus lift procedure, anatomical and surgical factors, presurgical evaluation, bone grafting, and the practical implications of these factors in implant dentistry cases involving a deficient posterior maxilla. In conclusion, while both osteotome and lateral window techniques can assist clinicians in addressing the complexities of implant placement in a deficient posterior maxilla, bone height before implantation remains a critical factor in determining the success and longevity of implants.

Can Single Buccal Infiltration With 4% Articaine Induce Sufficient Analgesia for the Extraction of Maxillary Teeth? A Systematic Literature Review.

This systematic review evaluates the efficacy of single buccal infiltration of articaine for extracting upper teeth. A search of the PubMed, Ovid SP, Scopus, Embase, and Cochrane databases for English-language studies published between 2000 and 2021 was performed on August 26, 2022, based on the pre-specified question using the MeSH terms [(buccal) and (articaine) and (infiltration) and (dental)]. Of the 16 clinical trials identified involving 1,339 patients, six compared the subjective procedural pain associated with single buccal infiltration of articaine with that of lidocaine, three of which reported reduced pain and the other three greater success in extraction for the articaine group. Four of the 16 studies compared the procedural pain associated with single buccal infiltration of 4% articaine with double (buccal and palatal/lingual) infiltration; two reported insignificant differences between the groups; and the other two reported greater success using buccal and palatal injections. Five of the 16 studies compared the procedural pain associated with single buccal articaine with double buccal and palatal/lingual infiltration of 2% lidocaine and reported insignificant differences. The other of the 16 studies compared the subjective pain associated with single buccal infiltration of 4% articaine 1:100:000 with single buccal infiltration of 4% articaine 1:200:000 and found a statistically significant difference. All of these studies concluded that upper permanent maxillary teeth can be extracted using only a 4% articaine buccal infiltration, but further investigation is necessary to determine whether this approach can replace the gold standard of buccal and palatal infiltration.

Promoter methylation levels of RASSF1 and ATIC genes are associated with lung cancer in Iranian patients.

OBJECTIVES: Epigenetic alterations like methylation of tumor suppressor genes or oncogenes, in respiratory epithelium have been associated with lung cancer. Hypermethylation of genes promoter is an epigenetic event, and is responsible to tumor suppressor genes inactivation as well as oncogenes activation. This study aimed to assess the role of methylation status in promoter of RASSF1 and ATIC genes their potential implication in the pathogenesis of lung tumor in Iranian patients. METHODS: In this study, we collected 100 tissue samples (50 lung cancer tissues and 50 adjacent non-cancerous lung tissues) from Iranian lung cancer patients. The genomic DNA was extracted, and methylation status of both RASSF1 and ATIC genes was investigated by methylation-sensitive high-resolution melting (MS-HRM) assay technique and Real-Time PCR. Cancer Genome Atlas (TCGA) dataset was also analyzed for further validation of the gene's methylation. RESULTS: Methylation of RASSF1 gene promoter was significantly higher in lung tumor tissues. However, promoter methylation levels of ATIC gene was significantly lower in lung tumor tissues. These results were additionally confirmed by TCGA analysis. Promoter methylation of both RASSF1 and ATIC genes was significantly associated with lymph node metastasis, and clinical stage of lung cancer. The receiver operating characteristic (ROC) curve analysis indicated a high accuracy of promoter methylation in these genes as a diagnostic biomarker for lung cancer. CONCLUSIONS: Methylation levels of both RASSF1 and ATIC genes promoters were associated with lung cancer pathogenesis in Iranian population, and may be a suitable biomarker for diagnosis and prognosis of lung cancer in early stage of tumorigenesis.

Management of Mandibular Compound Odontoma With Numbness in the Lower Jaw.

Odontomas are considered to be among the more common odontogenic tumors in the oral cavity. Several authors classify them as hamartomas instead of actual tumors. Odontomes' precise etiology is still unknown. The majority of odontomas are found during routine radiography studies and are asymptomatic. Odontomes typically cause disruptions to the teeth's eruption, most frequently deflection or delayed eruption. Here, the reported study details the surgical management of a mandibular compound odontoma in a patient who presented with a complaint of numbness in his lower jaw.

Autotransplantation of the Lower Posterior Teeth: A Comprehensive Review.

A new era in modern dentistry has emerged where tooth loss is no longer an issue as a result of rapid advancements in implantation and alveolar ridge reconstruction. Despite its wide range of indications, autotransplantation is dependent upon careful patient selection and a suitable technique to ensure successful results both functionally and aesthetically. It is possible to restore physiological occlusion, aesthetics, and masticatory function by varying implant length, diameter, surface, and design, along with autogenous, alogenous, alloplastic, or xenogenous bone substitutes. However, none of the technologies that are used in implant dentistry today can adapt to a child's growing jaw during adolescence. Thus, the young age of the patient restricts implants and creates a challenge for dentists wishing to replace missing teeth. Therefore, tooth autotransplantation can be a good option for treatment. Our objective in this review is to highlight the biological principles required for the successful autotransplantation of teeth. Limits, indications, and prognoses will be analyzed. Hopefully, with increased awareness and acceptance in the dental profession, autotransplantation will become another viable treatment option for those with compromised teeth who still have significant growth potential.

Cone-beam computed tomography evaluation of prevalence and location of mandibular incisive canal in patients attending King Saud University Dental Hospital.

OBJECTIVE: This study aims to facilitate a surgeon's preoperative assessment by detecting the prevalence, location, and course of the mandibular incisive canal (MIC) in our population. METHODOLOGY: A retrospective study was conducted at King Saud University, Riyadh, Saudi Arabia. A total of 93 cone-beam computed tomography (CBCT) scans of patients aged 18-50 years were taken. The images were reformatted from the sagittal sections to para-sagittal sections at premolars, canines, lateral incisors, and central incisors measured to the distance of MIC to the tooth apex, to the inferior border of the mandible, to the buccal cortex, and to the lingual cortex. RESULTS: MIC among the patients was found to be present in 96.8% of the total subjects. Prevalence between genders showed that it was present in 97.9% of the male patients and 95.5% of the female patients. The average distance from the buccal cortex is 4.88, the lingual cortex is 5.54, inferior border is 9.94, and root apices is 7.67. The age-wise and gender-wise comparison of a mean distance of MIC to the different surfaces in the different cross-sections showed that there is no correlation, and there is a significant correlation, respectively. CONCLUSION: The detection of the MIC presence and location using CBCT should be earnestly considered for surgical procedures that are intended to be done in the interforaminal region.

Medication-related Osteonecrosis of the Jaw: A Review.

Medication-related osteonecrosis of the jaw (MRONJ) is a rare, severe debilitating condition from unknown causes. It is characterized by nonhealing exposed bone in a patient with a history of antiresorptive or antiangiogenic agents in the absence of radiation exposure to the head and neck region. The first case of MRONJ was reported in the early 2000s. Diagnostic criteria for MRONJ was developed by the American Association of Oral and Maxillofacial Surgeons (AAOMS) based on pharmacological history as well as clinical and radiographic features. Antiresorptive medications such as bisphosphonate and denosumab are currently considered the treatment of choice in patients with osteoclastic bone disease. These reduce bone turnover and improve bone density, thereby improving bone quality. These agents have also been shown to reduce the risk of osteoporotic fractures due to their potent effect in suppressing osteoclastic activity by slowing the remodeling process and increasing bone density, thereby improving quality of life for most of the patients. Despite the great benefits of bisphosphonates and other antiresorptive medications, osteonecrosis of the jaw (ONJ) due to the effects of these medications in the presence of a local risk factor is a significant drawback. Moreover, antiangiogenic drugs play a major role in developing bone necrosis. They are prescribed in cancer cases to prevent metastasis through the blood and lymph nodes. These drugs interfere with the formation of new blood vessels, resulting in ischemia and eventually ONJ. This risk can be managed by evaluating the route and the duration of administration as such a risk can be considered dose-time dependent. As a preventive measure, dental screening before initiating any type of ONJ-related medications can significantly lower the risk of ONJ. Treatment goals can be achieved through pain and infection control, in addition to the management of bone necrosis and resorption. The aim of this review is to identify all causative agents and summarize the preventive measures, diagnostic criteria, and treatment strategies related to MRONJ.

Maxillary Sinus Pneumatization Following Extractions in Riyadh, Saudi Arabia: A Cross-sectional Study.

Introduction It is generally agreed that tooth extraction may lead to maxillary sinus pneumatization, resulting in a union between the sinus floor and the crest of the remaining bone in extreme cases. Studies that compared pre- and postextraction radiographs suggest that maxillary sinus pneumatization may occur after posterior tooth extractions. This study's aim was to establish the prevalence of maxillary sinus pneumatization following extractions in Riyadh, Saudi Arabia. Material and methodology In this cross-sectional study, 282 panoramic images were randomly selected from the radiology department of the Dental University Hospital in Riyadh, Saudi Arabia, from the years 2015 to 2018. The radiographs included were of patients who had one of the following teeth extracted: the second premolar, the first molar, or the second molar. These radiographs were then evaluated for sinus pneumatization following extractions. The distance between the sinus floor and the inferior border of the alveolar ridge after the extraction was reviewed and assessed for all images. Result The six teeth that were assessed in this study were: 17, 16, 15, 25, 26, and 27. In relation to distribution (unilateral and bilateral), the results showed a statistically significant difference, especially for tooth numbers 16, 15, and 26. The mean values of change in sinus were significantly higher in the unilateral site than the bilateral site. However, the data did not provide any significant difference for the other three teeth (17, 25, and 27). The gender and molar side groups showed no statistical significance. Conclusion The results of the study showed that maxillary sinus pneumatization may occur after posterior tooth extraction.

Blood pressure standards for pre-school children in Saudi Arabia.

The prevalence of hypertension (HTN) in children is increasing. Early detection of HTN in childhood may prevent the occurrence of complications in adult age. Blood pressure (BP) varies between populations according to ethnic and environmental factors. Based on these variations, reference norms developed for one particular population may not be applicable to others. Thus, this study aimed to provide age-, gender-, and height-related BP reference standards using oscillometric techniques for pre-school children in Saudi Arabia. A sub-sample of preschool children aged from 2 to 6 years was selected by multi-stage probability sampling of Saudi population. The samples represented Saudi children from the whole country. Data were collected through a house-to-house survey of all selected households in all 13 regions in the country. Oscillometric devices were used to measure the BP. Data were analyzed to study the distribution pattern of systolic (SBP) and diastolic BP (DBP) and to develop reference values based on age, gender, and height. The values for each age and height percentile were compared with the recent (2017) values of the North American children. A total of 2553 Saudi Arabian children (1299 boys and 1254 girls) aged 2-6 years with complete data on age, gender, height, SBP, and DBP were considered for analysis. Values for SBP and DBP were significantly higher in Saudi children than in the North American children. This study adds evidence to the BP variations between populations with influences such as genetic and environmental factors. The need of every population to define its normal BP standards is essential to avoid unnecessary investigations and anxiety in patients and their parents.

Gorlin-Goltz Syndrome: A Case Report and Literature Review.

Gorlin-Goltz syndrome (GGS) is an infrequent multisystemic disease with an autosomal dominant inherited disorder characterized by the presence of multiple keratocystic odontogenic tumors (KCOT) in the jaws, multiple basal cell nevi carcinomas, and skeletal abnormalities. Early diagnosis of Gorlin-Goltz syndrome is essential as it may progress to aggressive basal cell carcinomas and neoplasias. Gorlin-Goltz syndrome has rarely been reported in Saudi Arabia. This article reports a case of a 13-year-old Saudi female patient with Gorlin-Goltz syndrome and includes an extensive literature review of the syndrome. To the extent of our knowledge, this is the first case reported by dentists in the Kingdom of Saudi Arabia.

The LMS and Z scale growth reference for Saudi school-age children and adolescents.

BACKGROUND/AIM: To establish L, M, and S parameters and z score reference for the assessment of nutrition and growth of Saudi school-age children and adolescents. SUBJECTS AND METHODS: Data from the original cross-sectional study were reanalyzed. The L, M, and S parameters and z scores were calculated for weight, height and body mass index for school-age children and adolescents. RESULTS: A total of 19,299 subjects from 5 to 18 years of age were included. All were Saudi nationals and 9,827 (50.9%) were boys. The L M S parameters and z scores for weight for age, height for age, and BMI for age for boys and girls are presented in detailed tables across the age of commonly used z scores (+3, +2, +1, 0, -1, -2, -3). Graphs corresponding to the same parameters (weight, height, and BMI) showing the main z scores across all ages from 5 to 18 years are illustrated. CONCLUSION: This report provides the first reference for nutritional status and growth of Saudi school-age children and adolescents. This tool is essential for more accurate assessment of growth and nutrition in various clinical conditions and research.

Regional variation in prevalence of overweight and obesity in Saudi children and adolescents.

BACKGROUND/AIMS: There are limited data on regional variation of overweight and obesity in the Kingdom of Saudi Arabia. Therefore, the aim of this report is to explore the magnitude of these variation in order to focus preventive programs to regional needs. SETTING AND DESIGN: Community-based multistage random sample of representative cohort from each region. PATIENTS AND METHODS: the study sample was cross-sectional, representative of healthy children and adolescents from 2 to 17 years of age. Body mass index (BMI) was calculated according to the formula (weight/height²). The 2000 center for disease control reference was used for the calculation of prevalence of overweight and obesity defined as the proportion of children and adolescents whose BMI for age was above 85 th and 95 th percentiles respectively, for Northern, Southwestern and Central regions of the Kingdom. Chi-square test was used to assess the difference in prevalence between regions and a P value of <0.05 was considered significant. RESULTS: The sample size was 3525, 3413 and 4174 from 2-17 years of age in the Central, Southwestern and Northern regions respectively. The overall prevalence of overweight was 21%, 13.4% and 20.1%, that of obesity was 9.3%, 6% and 9.1% in the Central, Southwestern and Northern regions respectively indicating a significantly-lower prevalence in the Southwestern compared to other regions (P<0.0001). CONCLUSIONS: This report revealed significant regional variations important to consider in planning preventive and therapeutic programs tailored to the needs of each region.

The prevalence of neurological disorders in Saudi children: a community-based study.

There are limited data on the pattern and prevalence of pediatric chronic neurologic conditions in the region. Therefore, the objective of this study was to establish the prevalence of these disorders in the Kingdom of Saudi Arabia. A multistage probability sampling design was used to select a random sample of Saudi households representative of the Saudi population. A total of 45 682 Saudi children were screened. Of these children, 313 had a chronic major neurologic disorder indicating a prevalence of 68.5 per 10 000 children, which was the highest among all chronic diseases in children. Mental retardation and cerebral palsy were the most common neurologic disorders among Saudi children with a prevalence rate of 26.3/10 000 and 23.4/10 000, respectively. The finding that major neurologic disorders are the most common pediatric chronic disorders in the Kingdom of Saudi Arabia indicates that priority should be given to research and education as well as health care planning.

Prevalence of malnutrition in Saudi children: a community-based study.

BACKGROUND AND OBJECTIVE: There is no published information on the prevalence of malnutrition in Saudi Arabia. The objective of this study was to establish the prevalence data. METHODS: The prevalence of nutritional indicators in the form of underweight, stunting, and wasting in a national sample of children younger than 5 years of age was calculated using the new WHO standards as reference. Calculations were performed using the corresponding WHO software. The prevalence of moderate and severe underweight, wasting and stunting, was defined as the proportion of children whose weight for age, weight for height, and height for age were below -2 and -3 standard deviation scores, respectively. RESULTS: The number of children younger than 5 years of age was 15 516 and 50.5% were boys. The prevalence of moderate and severe underweight was 6.9% and 1.3%, respectively. The prevalence of moderate and severe wasting was 9.8% and 2.9%, respectively. Finally, the prevalence of moderate and severe stunting was 10.9% and 2.8%, respectively. The prevalence was lower in girls for all indicators. Comparison of the prevalence of nutritional indicators in selected countries demonstrates large disparity with an intermediate position for Saudi Arabia. CONCLUSION: This report establishes the national prevalence of malnutrition among Saudi children. Compared to data from other countries, these prevalence rates are still higher than other countries with less economic resources, indicating that more efforts are needed to improve the nutritional status of children.

Regional disparity in prevalence of malnutrition in Saudi children.

OBJECTIVE: To evaluate the regional difference in the prevalence of malnutrition in Saudi children. METHODS: Data for this study were collected over 2 years (2004 and 2005). A cross-sectional representative sample of the Saudi population of healthy children below 5 years of age was used to calculate the prevalence of malnutrition. The study was carried out in the College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. Body measurements of the weight, length, and height were performed according to standard recommendations. Standard deviation scores were determined using the Lambda, Mu, and Sigma (LMS) statistical methodology. The 1978 NCHS/WHO growth reference was used for the calculation of prevalence of underweight, wasting, and stunting defined as the proportion of children whose weight for age, weight for height, and height for age was below minus standard deviation (-2 SD) for Northern, Southwestern, and Central regions of the Kingdom of Saudi Arabia. Chi-square test was used to assess the difference in prevalence between regions, and a p<0.05 was considered significant. RESULTS: The sample size of children <5 years of age in Central region was 5067, Southwestern 2285, and Northern 2933. The prevalence of underweight was 4%, 19.7% and 5.5%, that of wasting was 6.5%, 16.7% and 6.5% and of stunting was 6.4%, 13.2% and 6.4% in the Central, Southwestern, and Northern regions indicating a significantly-higher prevalence in Southwestern compared to other regions (p<0.001). CONCLUSION: This report revealed a high prevalence of significant nutritional indicators in the Southwestern regions than in other regions. This finding indicates that this region should be given priority for further studies to identify causes, and to design health promotion programs.

Effects of education of the head of the household on the prevalence of malnutrition in children.

OBJECTIVE: To explore the effect of the educational level of the head of household on the prevalence of malnutrition in Saudi children. METHODS: The study was conducted over 2 years in 2004 and 2005 in all regions of the Kingdom of Saudi Arabia (KSA). The design consisted of a stratified multistage probability random sampling of the population of the KSA. The educational level of the heads of the household, and measurements of weight and height of the children were obtained during house visits. Nutritional indicators in the form of weight for age, height for age, and weight for height for children below 5 years of age were determined, and the prevalence of each indicator below -2 standard deviations (SD) was calculated for each level of education. RESULTS: The sample size was 7390 in the weight for age, 7275 height for age, and 7335 for weight for height. The prevalence of underweight (weight for age below -2 SD) increased from 7.4% for the university level to 15.2% in the children of illiterate heads of household. Similar patterns were found for the prevalence of stunting (height for age below -2 SD) and wasting (weight for height below -2 SD). CONCLUSION: This study demonstrates that the higher the education level of the heads of the household, the lower the prevalence of malnutrition in their children, suggesting that completing at least 9-12 years of education (intermediate and secondary school) is needed for better improvement in the nutritional status of the children.

Pattern of sex differences in growth of Saudi children and adolescents.

BACKGROUND: Although variations in growth between boys and girls have been reported, detailed descriptions according to age and growth parameters are not available. OBJECTIVE: The goal of this study was to determine the pattern and magnitude of differences in growth between boys and girls according to age that justify separate growth charts. METHODS: The data set was based on a cross-sectional representative sample of the Saudi population of healthy children and adolescents from birth to 19 years of age. Body measurements (length, height, weight, and head circumference) were performed according to standard recommendations; body mass index was also determined for each subject. The difference in growth between boys and girls was assessed based on z scores and percentiles (5th, 50th, and 95th) of growth parameters using 2 age groups (0-3 years and 2-19 years). The significance of the difference between boys and girls for any growth parameter was tested by ANCOVA. RESULTS: A total of 35,279 children and adolescents from birth to 19 years of age satisfied the criteria for growth measurements. There were 17,880 boys and 17,399 girls; all were Saudi nationals. The Saudi boys were generally taller and heavier than girls up to approximately 7 to 10 years of age. Thereafter, girls generally were taller and heavier than boys from 10 to 14-15 years of age. After that, boys again were taller and heavier. Similar variations were observed for body mass index and head circumference. The difference between boys and girls for each growth parameter was highly significant (P < 0.001). CONCLUSIONS: Based on analysis of these Saudi children and adolescents, the difference in growth between boys and girls was not uniform but depended on age. However, the pattern was remarkably consistent across all growth parameters and appears to reflect the timing of maturation between boys and girls.

Age related reference ranges of heart rate for Saudi children and adolescents.

OBJECTIVE: To evaluate the resting heart rate to define reference values for healthy Saudi children and adolescents. METHODS: To establish representative heart rate (HR) reference values for Saudi Arabian children and adolescents, a sample of children, and adolescents was selected by multi-stage probability sampling of the Saudi population from birth to 20 years of age. The selected sample represents Saudi children from the whole country. Data were collected by a house-to-house survey of all selected households in all the 13 regions in the country. A total of 10,458 Saudi children were included in the study. The HR was measured by oscillometric-automated devices. Upper and lower reference values of the HR in boys and girls were calculated as mean +/= 2 SD. The study is cross-sectional, community based, and conducted over 2 years (2004-2005). Data management and analysis were performed in the College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. RESULTS: Determination of the HR values in a sample representing healthy Saudi children and adolescents from birth to 20 years of age. CONCLUSION: The present study provides age-specific reference values for heart rate (HR) of Saudi children and adolescents based on a large study sample. The use of these standards should aid the identification of children with abnormal HR.

Liver size in Saudi children and adolescents.

BACKGROUND/AIM: To examine the liver size in Saudi children and adolescents. METHODS: A large sample of children was selected from the general population by multistage random probability sampling for the assessment of physical growth. A random subsample of children-newborns to 18 years old-was taken from this larger sample for this study. Liver size below the costal margin and liver span along the midclavicular line were determined by physicians. Data were analyzed using SPSS software and medians and standard deviations were calculated. RESULTS: Between 2004 and 2005, 18 112 healthy children up to 18 years of age were examined. All were term and appropriate for gestational age. There were 9 130 boys and 8 982 girls, yielding a nearly 1:1 male to female ratio. The maximum palpable liver size below the costal margin was 2.4 cm. The median and + 2 SD liver span at birth were 4 and 6.9 cm, respectively. There was no difference in the liver span between boys and girls of up to 60 months of age. Thereafter, a difference could be seen increasing with age, with girls having smaller liver spans than boys. CONCLUSION: This manuscript reports the liver size in Saudi children and adolescents. The data should help physicians in the interpretation of liver size determined by physical examination of children and adolescents.

Blood pressure standards for Saudi children and adolescents.

BACKGROUND AND OBJECTIVES: Blood pressure levels may vary in children because of genetic, ethnic and socioeconomic factors. To date, there have been no large national studies in Saudi Arabia on blood pressure in children.Therefore, we sought to establish representative blood pressure reference centiles for Saudi Arabian children and adolescents. SUBJECTS AND METHODS: We selected a sample of children and adolescents aged from birth to 18 years by multi-stage probability sampling of the Saudi population. The selected sample represented Saudi children from the whole country. Data were collected through a house-to-house survey of all selected households in all 13 regions in the country. Data were analyzed to study the distribution pattern of systolic (SBP) and diastolic blood pressure (DBP) and to develop reference values. The 90th percentile of SBP and DBP values for each age were compared with values from a Turkish and an American study. RESULTS: A total of 16 226 Saudi children and adolescents from birth to 18 years were studied. Blood pressure rose steadily with age in both boys and girls. The average annual increase in SBP was 1.66 mm Hg for boys and 1.44 mm Hg for girls. The average annual increase in DBP was 0.83 mm Hg for boys and 0.77 mm Hg for girls. DBP rose sharply in boys at the age of 18 years. Values for the 90th percentile of both SBP and DBP varied in Saudi children from their Turkish and American counterparts for all age groups. CONCLUSION: Blood pressure values in this study differed from those from other studies in developing countries and in the United States, indicating that comparison across studies is difficult and from that every population should use their own normal standards to define measured blood pressure levels in children.