Retrospective study of the bone morphology in the posterior mandibular region. Evaluation of the prevalence and the degree of lingual concavity and their possible complications

BACKGROUND: In order to choose the appropriate implant size and to prevent complications, an oral surgeon must know the size and shape of the mandible. In the posterior mandibular region, a lingual undercut is often found and could represent a difficulty hard to manage if a lingual or buccal perforation occur. A large series of computed tomography (CT) images of the mandibular first molar was evaluated and the bone morphology, the prevalence and the degree of the lingual concavity in the first molar region were studied. MATERIAL AND METHODS: One hundred and fifty-one computed tomography (CT) examinations of patients were retrospectively evaluated to determine anatomical variations in bone morphology in the submandibular fossa region. RESULTS: A total of 151 subjects were included, consisting of 64 males (M) (42.4%) and 87 females (F) (57.6%). The under-cut type ridge was present in 64.2% of the cases. The concavity angle was 66.6 ± 8.9° (M) and 71.6 ± 8.4° (F) and the linear concavity depth 4.5 ± 2.3 mm (M) and 3.1 ± 1.7 mm (F) (p > 0.05). CONCLUSIONS: Mandibles with any lingual concavity present a potential increased risk of lingual cortical perforation during implant placement surgery. CT imaging allows characterizing the anatomy of the submandibular fossa and provides other important information for the preoperative assessment of the posterior mandible for dental implants placement

Salivary gland choristoma in the buccinator muscle: A case report and literature review.

UNLABELLED: Salivary gland choristoma (SGCh) is defined as the presence of normal salivary tissue in an abnormal location. It is a rare entity in oral and maxillofacial region and its ethiology is unknown. The typical presentation of salivary gland heterotopia is an asymptomatic mass that may or may not produce saliva. Some examples of ectopic salivary tissue in the pituitary gland, in the lymph nodes, in the middle ear, in the neck, in the jaw, in the thyroid gland, in the mediastinum and in the rectum have been documented in literature. We report the case of a 61-year-old male presented with a bilateral tumorlike mass in the cheek. The mass was painless, of fibrous consistency and had size change with time. The histological diagnosis was salivary gland choristoma in the buccinator muscle. In this article, we will revise the characteristic of salivary gland heterotopias and we present a report case that has not been described in literature: a bilateral choristoma of salivary gland in the buccinator muscle, which should be included in the differential diagnosis of head and neck masses. KEY WORDS: Choristoma, heterotopias, ectopic tissue, salivary gland, buccinator muscle.

Prevalence of complications after the oral rehabilitation with implant-supported hybrid prostheses

Objectives: Assess the main problems referred by the patients and observed by the professionals after the bucodental rehabilitation with an implant-supported hybrid prothesis. Patients and Methods: A retrospective study was carried out in which there were 43 patients included who were visited in the Department of Oral Surgery and Orofacial Implantology of University of Barcelona Dental School for one year. An oral rehabilitation with an implant-supported hybrid prosthesis was made to those patients. The following variables were registered: age, gender, number of inserted implants, type of implant and principal problems produced by the hybrid prosthesis. Results: The rehabilitation with an implant supported hybrid prosthesis was only performed in 43 of 116 cases treated in one year (January, 2006 to January, 2007). They were 26 men and 17 women of ages between 37 and 74years, being the rate age of 56,5 years. The main complication recorded was the mucositis, associated frequently with a difficulty to carry a correct oral hygiene and to an over extention of the tail of resin of the prosthesis. Other observed problems were the periimplantitis, the break of the acrylic teeth and the loss of some of the prosthetics crews. Conclusions: The most frequent complication after the laying of an implant supported hybrid prosthesis was the mucositis, associated mainly with a prosthetic tail too long and to the consequent difficulty of carrying a correctoral hygiene. In spite of the high prevalence of observed complications, most of them were mild and resolved on subsequent visits (AU)

Prevalence of complications after the oral rehabilitation with implant-supported hybrid prostheses.

OBJECTIVES: Assess the main problems referred by the patients and observed by the professionals after the bucodental rehabilitation with an implant-supported hybrid prothesis. PATIENTS AND METHODS: A retrospective study was carried out in which there were 43 patients included who were visited in the Department of Oral Surgery and Orofacial Implantology of University of Barcelona Dental School for one year. An oral rehabilitation with an implant-supported hybrid prosthesis was made to those patients. The following variables were registered: age, gender, number of inserted implants, type of implant and principal problems produced by the hybrid prosthesis. RESULTS: The rehabilitation with an implant supported hybrid prosthesis was only performed in 43 of 116 cases treated in one year (January, 2006 to January, 2007). They were 26 men and 17 women of ages between 37 and 74 years, being the rate age of 56,5 years. The main complication recorded was the mucositis, associated frequently with a difficulty to carry a correct oral hygiene and to an overextention of the tail of resin of the prosthesis. Other observed problems were the peri-implantitis, the break of the acrylic teeth and the loss of some of the prosthetic screws. CONCLUSIONS: The most frequent complication after the laying of an implant supported hybrid prosthesis was the mucositis, associated mainly with a prosthetic tail too long and to the consequent difficulty of carrying a correct oral hygiene. In spite of the high prevalence of observed complications, most of them were mild and resolved on subsequent visits.

Validation of a computer-assisted system on classifying lower third molars

Objectives: The present study evaluates the reliability of the Radio Memory® software (Radio Memory; Belo Horizonte,Brasil.) on classifying lower third molars, analyzing intra- and interexaminer agreement of the results. Study Design: An observational, descriptive study of 280 lower third molars was made. The corresponding orthopantomographs were analyzed by two examiners using the Radio Memory® software. The exam was repeated 30 days after the first observation by each examiner. Both intra- and interexaminer agreement were determined usingthe SPSS v 12.0 software package for Windows (SPSS; Chicago, USA). Results: Intra- and interexaminer agreement was shown for both the Pell & Gregory and the Winter classifications,p<0.01, with 99% significant correlation between variables in all the cases. Conclusions: The use of Radio Memory® software for the classification of lower third molars is shown to be avalid alternative to the conventional method (direct evaluation on the orthopantomograph), for both clinical andinvestigational applications (AU)

Validation of a computer-assisted system on classifying lower third molars.

OBJECTIVES: The present study evaluates the reliability of the Radio Memory® software (Radio Memory; Belo Horizonte, Brasil.) on classifying lower third molars, analyzing intra- and interexaminer agreement of the results. STUDY DESIGN: An observational, descriptive study of 280 lower third molars was made. The corresponding orthopantomographs were analyzed by two examiners using the Radio Memory® software. The exam was repeated 30 days after the first observation by each examiner. Both intra- and interexaminer agreement were determined using the SPSS v 12.0 software package for Windows (SPSS; Chicago, USA). RESULTS: Intra- and interexaminer agreement was shown for both the Pell & Gregory and the Winter classifications, p<0.01, with 99% significant correlation between variables in all the cases. CONCLUSIONS: The use of Radio Memory® software for the classification of lower third molars is shown to be a valid alternative to the conventional method (direct evaluation on the orthopantomograph), for both clinical and investigational applications.

Effectiveness of substituting cyclosporin A with tacrolimus in reducing gingival overgrowth in renal transplant patients.

OBJECTIVES: This study aims to evaluate the effectiveness of periodontal therapy combined with tacrolimus in the suppression of gingival overgrowth (GO) and the effect on GO of changing from cyclosporin A to tacrolimus. PATIENTS AND METHODS: Sixteen renal transplant patients, averaging 52 years of age, whose kidney function was stable and were receiving treatment with cyclosporin A, were randomly assigned to one of two groups. In the experimental group, patients were instructed in oral hygiene and underwent periodontal treatment, whereas in the control group, only oral hygiene instructions were given. After the first visit and the change of medication from cyclosporine to tacrolimus in both groups, periodic clinical revisions were carried out for 3 months in order to assess the evolution of GO. RESULTS: All patients showed a progressive decrease in GO. There were no statistically significant differences between the two groups (p>0.05). A greater decrease in GO occurred within the first month after changing the medication. CONCLUSIONS: No improved effectiveness in reducing GO was observed for periodontal therapy in combination with tacrolimus. Tacrolimus is an alternative to cyclosporine when attempting to avoid GO in patients with kidney transplants.

Effectiveness of substituting cyclosporin A with tacrolimus in reducing gingivalovergrowth in renal transplant patients

Objectives: This study aims to evaluate the effectiveness of periodontal therapy combined with tacrolimus in thesuppression of gingival overgrowth (GO) and the effect on GO of changing from cyclosporin A to tacrolimus.Patients and Methods: Sixteen renal transplant patients, averaging 52 years of age, whose kidney function wasstable and were receiving treatment with cyclosporin A, were randomly assigned to one of two groups. In theexperimental group, patients were instructed in oral hygiene and underwent periodontal treatment, whereas in thecontrol group, only oral hygiene instructions were given. After the first visit and the change of medication fromcyclosporine to tacrolimus in both groups, periodic clinical revisions were carried out for 3 months in order toassess the evolution of GO.Results: All patients showed a progressive decrease in GO. There were no statistically significant differencesbetween the two groups (p>0.05). A greater decrease in GO occurred within the first month after changing themedication.Conclusions: No improved effectiveness in reducing GO was observed for periodontal therapy in combinationwith tacrolimus. Tacrolimus is an alternative to cyclosporine when attempting to avoid GO in patients with kidneytransplants (AU)

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Minor salivary gland tumors: A clinicopathological study of 18 cases.

INTRODUCTION: Minor salivary gland tumors (MSGTs) are infrequent, representing 10-15% of all salivary neoplasms. Despite this low frequency, MSGTs conform a heterogeneous group of neoplasms characterized by a broad range of histological types. PATIENTS AND METHOD: We identified cases of MSGT in a retrospective study of the biopsies made in the period 1997-2007 in the Service of Oral Surgery (Dental Clinic of the University of Barcelona, Spain). The data collected comprised patient age and sex, the clinical characteristics and location of the tumor, the duration of the lesion, its size, the treatment provided, and the histopathological findings. RESULTS: Of the 18 cases of MSGT studied, 12 corresponded to women (66.7%) and 6 to men (33.3%). The great majority (94.4%) were benign tumors. The preferential location was the posterior third of the hard palate (33.2%), followed by the soft palate (16.7%) and the mucosa of the upper lip (16.7%). The histopathological diagnoses of our MSGTs comprised 10 pleomorphic adenomas (55.3%), 2 cystadenomas (11.1%), 1 myoepithelioma (5.6%), 1 sialadenoma papilliferum (5.6%), 1 basal cell adenoma (5.6%), 1 Warthin's tumor (5.6%), 1 canalicular adenoma (5.6%), and 1 low-grade polymorphic adenocarcinoma (5.6%). DISCUSSION AND CONCLUSIONS: Coinciding with our own results, the literature describes a high recurrence rate for MSGTs (5-30%) when surgical removal is incomplete. Six percent of all benign minor salivary gland tumors are considered to relapse, versus 65% of all malignant lesions. Periodic clinical controls are required, since the possibility of malignant transformation must be taken into account.

Minor salivary gland tumors: A clinicopathological study of 18 cases

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Introduction: Minor salivary gland tumors (MSGTs) are infrequent, representing 10-15% of all salivary neoplasms. Despite this low frequency, MSGTs conform a heterogeneous group of neoplasms characterized by a broad range of histological types.Patients and method: We identified cases of MSGT in a retrospective study of the biopsies made in the period1997-2007 in the Service of Oral Surgery (Dental Clinic of the University of Barcelona, Spain). The data collected comprised patient age and sex, the clinical characteristics and location of the tumor, the duration of the lesion, its size, the treatment provided, and the histopathological findings.Results: Of the 18 cases of MSGT studied, 12 corresponded to women (66.7%) and 6 to men (33.3%). The great majority (94.4%) were benign tumors. The preferential location was the posterior third of the hard palate (33.2%), followed by the soft palate (16.7%) and the mucosa of the upper lip (16.7%). The histopathological diagnoses of our MSGTs comprised 10 pleomorphic adenomas (55.3%), 2 cystadenomas (11.1%), 1 myoepithelioma (5.6%), 1 sialadenoma papilliferum (5.6%), 1 basal cell adenoma (5.6%), 1 Warthin’s tumor (5.6%), 1 canalicular adenoma (5.6%), and 1 low-grade polymorphic adenocarcinoma (5.6%).Discussion and conclusions: Coinciding with our own results, the literature describes a high recurrence rate for MSGTs (5-30%) when surgical removal is incomplete. Six percent of all benign minor salivary gland tumors are considered to relapse, versus 65% of all malignant lesions. Periodic clinical controls are required, since the possibility of malignant transformation must be taken into account (AU)

Nasopalatine duct cyst: report of 22 cases and review of the literature.

OBJECTIVES: Nasopalatine duct cysts (NPDCs) are the most common developmental, epithelial and non-odontogenic cysts of the maxillae. The present study describes the clinicopathological characteristics of 22 NPDCs and discusses their etiology, incidence, treatment and prognosis, with a review of the literature on the subject. STUDY DESIGN: A retrospective observational study was made comprising a period of 36 years (1970-2006), and yielding a series of 22 patients with histopathological confirmation of NPDC. Surgical treatment was carried out under local anesthesia and comprised the dissection and removal of the cyst adopting a usually palatine approach, with the preparation of an enveloping flap from 1.4 to 2.4. RESULTS: No statistically significant correlation was observed between the size of the lesion and patient age, although the size of the cyst differed according to patient gender, with a mean NPDC diameter of 16 mm in males and 12 mm in females. In no case did we observe root resorption or loss of vitality of the upper incisors following surgery. The X-ray image was rounded in 15 cases and heart-shaped in the remaining 7 cases. In the majority of cases panoramic X-rays and periapical and occlusal X-rays sufficed to identify the lesion, though computed tomography was used in cases of doubt. CONCLUSIONS: The etiology of NPDC is unclear. Simple surgical resection is recommended, followed by clinical and radiological control to ensure correct resolution of the case.

Nasopalatine duct cyst: Report of 22 cases and review of the literature

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Objectives: Nasopalatine duct cysts (NPDCs) are the most common developmental, epithelial and non-odontogeniccysts of the maxillae. The present study describes the clinicopathological characteristics of 22 NPDCs and discusses their etiology, incidence, treatment and prognosis, with a review of the literature on the subject.Study design: A retrospective observational study was made comprising a period of 36 years (1970-2006), and yielding a series of 22 patients with histopathological confirmation of NPDC. Surgical treatment was carried out under local anesthesia and comprised the dissection and removal of the cyst adopting a usually palatine approach, with the preparation of an enveloping flap from 1.4 to 2.4.Results: No statistically significant correlation was observed between the size of the lesion and patient age, although the size of the cyst differed according to patient gender, with a mean NPDC diameter of 16 mm in males and 12 mm in females. In no case did we observe root reabsorption or loss of vitality of the upper incisors following surgery. The X-ray image was rounded in 15 cases and heart-shaped in the remaining 7 cases. In the majority of cases panoramic X-rays and periapical and occlusal X-rays sufficed to identify the lesion, though computed tomography was used in cases of doubt.Conclusions: The etiology of NPDC is unclear. Simple surgical resection is recommended, followed by clinical and radiological control to ensure correct resolution of the case

Evaluation of intraexaminer and interexaminer agreement on classifying lower third molars according to the systems of Pell and Gregory and of Winter.

PURPOSE: This study evaluated the intraexaminer and interexaminer reproducibility of 2 systems (Pell and Gregory [P&G] and Winter) for classifying the anatomic position of third molars (M3s) and compared these 2 traditional classification systems with a novel computer-based system (Radio Memory software; Belo Horizonte, Brazil). MATERIALS AND METHODS: Using a descriptive observational study design, we enrolled a sample of 4 surgeons who evaluated M3 position on panoramic radiographs. They classified M3 position (P&G) and inclination (Winter) on 2 different occasions separated by 15 days. M3 position and inclination were also classified using the Radio Memory software. Intraexaminer and interexaminer agreement were computed, as was agreement between the examiners and the Radio Memory software. RESULTS: The radiographic sample comprised 40 M3s. Intraexaminer agreement on classifying the molars according to their inclination was greater than 85% in all cases (mean agreement, 89.37%), whereas reproducibility of classification according to tooth position was observed in only 2 examiners (mean agreement, 66.25%). For the first observations, interexaminer agreement was observed for both classifications, whereas for the second observation, reproducibility among all of the examiners was observed only for the Winter classification. No homogeneity was recorded between the measurements made by the observers and the objective results regarding the position and inclination of the molars determined by the Radio Memory software. CONCLUSIONS: The classification of impacted lower M3s based on their position and following the P&G criteria lacks both intraexaminer and interexaminer reproducibility. However, the levels of intraexaminer and interexaminer agreement are very high when attempting to classify the M3s according to their inclination (Winter classification). These results suggest the advisability of using an objective measurement method to minimize the error introduced by observer interpretation.

Comparison of two needle models in terms of bevel deformation during truncal block of the inferior alveolar nerve.

OBJECTIVES: To evaluate the differences in terms of bevel deformation between two types of needle of the same length and external caliber, but with different internal diameters, during truncal block of the inferior alveolar nerve. STUDY DESIGN: Four operators performed truncal block of the inferior alveolar nerve and infiltrating anesthesia of the buccal nerve for the extraction of a lower third molar in 266 patients. The truncal block was carried out using a standard 27G x 35 mm needle with an internal caliber of 0.215 mm, or a 27G x 35 mm XL Monoprotect needle with an internal caliber of 0.265 mm. The infiltrating anesthesia was made with a Monoprotect or XL Monoprotect needle, both with a caliber of 30G and a length of 25 mm, but with different internal calibers (0.215 and 0.265 mm, respectively). The type of needle used, the anesthetic technique and the number of bone contacts was established during the procedure, the operator working side, the side of the tooth to be removed, the operator in charge of the intervention and the presence of bevel deformation after the anesthetic technique were collected for each patient. RESULTS: A statistically significant association was observed between bevel deformation and the operator performing the truncal block, while a statistically significant association (p use <0.05) was recorded between bevel deformation and the operator performing the infiltrating technique, the internal caliber of the needle and the number of bone contacts. CONCLUSIONS: There are no differences between the Monoprotect needles and the XL Monoprotect needles in terms of bevel deformation. Any such deformation can be attributable to physical -mechanical aspects such as the force with which the operator inserts the needle in the tissues- an aspect that in turn conditions the intensity of needle impact upon bone.

Comparison of two needle models in terms of bevel deformation during truncal block of the inferior alveolar nerve

Objetivos: Evaluar las posibles diferencias existentes en cuanto a la deformación del bisel de dos tipos de aguja de igual longitud y calibre externo, pero de distinto diámetro interno, durante el bloqueo troncal del nervio dentario inferior. Diseño del estudio: Cuatro operadores de similar formación quirúrgica realizaron el bloqueo troncal del nervio dentario inferior y la anestesia infiltrativa del nervio bucal para proceder a la extracción quirúrgica o convencional del tercer molar inferior en 266 pacientes. Para efectuar el bloqueo troncal se utilizó en todos los casos un sistema de jeringa no auto-aspirante (Uniject K(R); Hoechst AG, Frankfurt, Alemania) y dos tipos de aguja: una aguja Monoprotect® de 27G x 35 mm con un calibre interno de 0.215 mm (Sofic SA, Mazamet, Francia) o una aguja XL Monoprotect(R) de 27G x 35 mm con un calibre interno de 0.265 mm (Sofic SA, Mazamet, Francia). Para hacer la anestesia infiltrativa del nervio bucal se utilizó el mismo tipo de jeringa y otros dos tipos de aguja: la Monoprotecto(R) la XL Monoprotect(R), ambas con un calibre de 30G y 25 mm de longitud, diferenciándose en su calibre interno (0.215 y 0.265 mm, respectivamente) (Sofic SA, Mazamet, Francia). En cada paciente fue recopilada de forma sistemática la siguiente información: el tipo de aguja, la técnica anestésica utilizada (troncular directa o indirecta) y el número de veces que se había contactado con el hueso durante ésta, el lado de trabajo del operador, el lado del diente a extraer, el operador que hizo la intervención quirúrgica, así como la presencia o ausencia de deformación del bisel tras la técnica anestésica. Resultados: Para la técnica troncular, sólo se observó una asociación estadísticamente significativa entre la deformación de los biseles de las agujas y el operador que efectuó la técnica anestésica, mientras que para la técnica infiltrativa, se encontró una asociación estadísticamente significativa (p<0,05) entre la deformación de los biseles de las agujas y el operador que efectuó la técnica anestésica, el calibre interno de la aguja y el número de contactos óseos. Conclusiones: No existen diferencias entre las agujas Monoprotect(R) y las agujas XL Monoprotect(R) en cuanto a la deformación de su bisel, sino que la existencia de esta deformación obedece a aspectos físico-mecánicos como la fuerza con la que el operador introduce la aguja en los tejidos, que a su vez condicionará la intensidad del impacto de la aguja sobre el hueso

Objectives: To evaluate the differences in terms of bevel deformation between two types of needle of the same length and external caliber, but with different internal diameters, during truncal block of the inferior alveolar nerve. Study design: Four operators performed truncal block of the inferior alveolar nerve and infiltrating anesthesia of the buccal nerve for the extraction of a lower third molar in 266 patients. The truncal block was carried out using a standard 27G x 35 mm needle with an internal caliber of 0.215 mm, or a 27G x 35 mm XL Monoprotect® needle with an internal caliber of 0.265 mm. The infiltrating anesthesia was made with a Monoprotect® or XL Monoprotect® needle, both with a caliber of 30G and a length of 25 mm, but with different internal calibers (0.215 and 0.265 mm, respectively). The type of needle used, the anesthetic technique and the number of bone contacts was established during the procedure, the operator working side, the side of the tooth to be removed, the operator in charge of the intervention and the presence of bevel deformation after the anesthetic technique were collected for each patient. Results: A statistically significant association was observed between bevel deformation and the operator performing the truncal block, while a statistically significant association (p<0.05) was recorded between bevel deformation and the operator performing the infiltrating technique, the internal caliber of the needle and the number of bone contacts. Conclusions: There are no differences between the Monoprotect® needles and the XL Monoprotect® needles in terms of bevel deformation. Any such deformation can be attributable to physical-mechanical aspects such as the force with which the operator inserts the needle in the tissues – an aspect that in turn conditions the intensity of needle impact upon bone

Influence of lower third molar position on the incidence of preoperative complications.

OBJECTIVE: The present study sought to relate the clinical outcome of mandibular third molar impaction surgery to the orthopanoramic radiographically determined position of the affected teeth based on the classifications of Pell and Gregory, and Winter. STUDY DESIGN: A retrospective study was made of 165 patients undergoing the surgical extraction of lower third molars at School of Dentistry of the University of Barcelona, Barcelona, Spain. The positions of the 259 extracted third molars were documented according to the classifications of Pell and Gregory, and Winter, together with the type of mucosal and bony coverage involved. These tooth position parameters were radiologically assessed using Radio Memory software and were retrospectively correlated to the observed infectious, noninfectious, and neurological postsurgical outcomes. RESULTS: A statistically significant relationship (P < .05) was recorded between the appearance of infectious complications and the position parameters "Pell and Gregory classification," "mucosal coverage," and "bony coverage." A statistically significant relationship (P < .05) was observed between the appearance of noninfectious problems and the parameter "Winter classification." Finally, a significant association (P < .05) was recorded between the position variables and the existence of unwanted neurological changes. CONCLUSIONS: The mandibular position of the impacted third molar may be able to be correlated to the development of complications resulting from impaction removal. Vertical third molars in positions IIA and IIB of the Pell and Gregory classification, with partial mucosal and bony coverage, are the most susceptible to undesired outcomes.