Prospective cohort study to evaluate narrow diameter implants for the restoration of a missing maxillary lateral incisor in patients with a cleft palate: Five-year results.

STATEMENT OF PROBLEM: The maxillary lateral incisor is often congenitally missing in patients with a cleft palate. The congenital cleft presents the practitioner with challenges including quantity and quality of bone, a surgically managed cleft correction, and limited clinical space. PURPOSE: The purpose of this investigation was to calculate the 5-year success and survival rate of narrow-diameter implants used to restore a missing lateral incisor in patients with a cleft palate. MATERIAL AND METHODS: Fourteen study participants with a cleft palate and a missing maxillary lateral incisor were enrolled based on established criteria. Seventeen narrow-diameter implants (AstraTech OsseoSpeed 3.0S and OsseoSpeed TX 3.5 mm) were placed using a 2-stage protocol and restored with a custom titanium abutment and a cement-retained crown. Clinical and radiographic examinations were performed annually for 5 years. Four probe depth measurements were measured and evaluated using an analysis of covariance (ANCOVA) with Tukey-Kramer multiple comparisons tests. Radiographic marginal bone loss was measured annually using a digital subtraction technique and evaluated with ANCOVA, and the least square mean was derived. The restoration was evaluated using Pink (PES) and White (WES) Esthetic scores. RESULTS: Regarding probing depth measurements, a significant variance was found between the 4 locations (P<.001), and a linear effect of year was also found (P=.005). The multiple comparisons tests showed the mean buccal probe depth was lower compared with the mean at each of the other 3 locations (P≤.039) from baseline to 5-year follow-up. The least square mean ±standard deviation of the marginal bone loss over the 5-year entire study was 0.55 ±0.088 mm. Regarding prosthesis evaluation, the mean score for PES was 6.15 and 6.63 for the WES with a maximum score of 10. The level for clinical acceptance was set at a total score of 6. To meet the criteria for success over the 5-year period, no more than 2.3 mm of total bone loss was acceptable. The number of implants that met the criteria for success at 5 years was 92%. Regarding survival, the number of implants still in place, functional, and asymptomatic at 5 years was 100%. CONCLUSIONS: Based on the findings, the peri-implant soft tissue probe depths exhibited significant change during the 5-year investigation. Regarding esthetic outcomes, single tooth NDI for replacing a lateral incisor in the cleft patient is a clinically acceptable treatment. Narrow-diameter implants may be a reliable treatment for replacing a missing lateral incisor in patients with a cleft at 5-year follow-up with an implant survival rate of 100% and a success rate of 92%.

Prospective cohort study to evaluate narrow diameter implants for restoration of a missing lateral incisor in patients with a cleft palate: One-year results.

STATEMENT OF PROBLEM: Patients diagnosed with a cleft palate often have a congenitally missing maxillary lateral incisor. The congenital cleft presents the practitioner with challenges including the quantity and quality of bone, a surgically managed cleft correction, and limited clinical space. PURPOSE: The purpose of the present prospective investigation was to report preliminary results at the 1-year follow-up for this planned 5-year investigation of narrow diameter implants used to restore a missing lateral incisor in patients with a cleft palate. MATERIAL AND METHODS: Fourteen study participants with a cleft palate and a missing maxillary lateral incisor were enrolled based on established criteria. Narrow diameter implants (AstraTech OsseoSpeed TX 3.0S and 3.5 mm) were placed by using a 2-stage protocol and restored. All study participants received an Atlantis abutment and a cement-retained crown. Four probing depth measurements and bleeding on probing were measured at baseline and at 1 year. Probing depth measurements were evaluated using a 2-way repeated measures ANOVA with Tukey-Kramer multiple comparisons tests. Radiographic marginal bone loss was measured at 1-year by using a digital subtraction technique and evaluated by using a repeated measures ANOVA. Pretreatment cone beam computed tomography (CBCT) images were used to measure a mean gray level that was proportional to bone mineral density (BMD) in the implant site. One-way mixed ANOVA was used to compare the mean gray level and average implant stability quotient (ISQ) loading. A Pearson correlation was also tested between those parameters (α=.05) for each statistical analysis. RESULTS: The mean marginal bone loss at 1 year was 0.601 ±0.48 mm. Regarding probing depth measurements, a 2-way repeated measures ANOVA found both the location (P=.012) and time (P=.009) were significant. The Tukey-Kramer multiple comparisons test showed a significant difference between the buccal and distal site (P=.006) from baseline to 1-year follow-up. CONCLUSIONS: Narrow diameter implants are a reliable treatment for replacing a missing lateral incisor in patients with a cleft palate at 1 year, with an implant survival rate of 100% and implant success rate of 94% using the established criteria. A negative association was found between the bone mineral density and the implant stability in the alveolar cleft site of a patient with a cleft palate. The peri-implant soft tissue probe depths exhibited significant change during the first year.

Reliability and accuracy of assessing temporary anchorage device-tooth root contact with cone-beam computed tomography.

INTRODUCTION: This study was aimed at investigating the reliability and accuracy of cone-beam computed tomography (CBCT) diagnosis of contact between a temporary anchorage device (TAD) and tooth root and assessing any effect produced by metal brackets, imaging software program, and image segmentation or color enhancement tools. METHODS: Eighteen fresh pig mandibles were used. TADs (Vector, 1.4 × 8 mm) were placed at the buccal intermolar alveolar bone on both sides of the mandibles. With soft tissue kept intact, each mandible underwent CBCT scans (voxel size, 400 µm) before and after placing TADs, and after placing metal brackets on involved molars. Alveolar bone specimens containing the TADs were then exposed to microcomputed tomography (microCT) scans (voxel size, 27 µm) after TAD removal. Two independent raters, blinded of image identity, diagnosed TAD-root contact using ImageJ (National Institutes of Health and the Laboratory for Optical and Computational Instrumentation, University of Wisconsin, Madison, Wis) for microCT; Dolphin (Dolphin Imaging and Management Solutions, Chatsworth, Calif) and Anatomage software programs (Anatomage, Santa Clara, Calif) for CBCT images. Intrarater and interrater reliability and diagnostic accuracy were statistically assessed using Cohen kappa and McNemar tests. RESULTS: Intrarater and interrater reliability of TAD-root contact diagnoses were perfect for microCT diagnoses (κ = 1), generally moderate to good (κ >0.5) for CBCT diagnoses except for the use of color enhancement tools (κ <0.25). For diagnostic accuracy, there was generally a low agreement (κ <0.45) between CBCT and microCT (gold standard). The percent accuracy ranged from 68.1% to 79.2% and was not different among raters, bracket presence/absence, or software choices (chi-square tests, P >0.05). Overall, diagnostic sensitivity was above 80%, whereas specificity was below 55%. CONCLUSIONS: Despite good reliability, diagnoses of TAD-root contact using 400 µm voxel size CBCT imaging tend to be inaccurate, with a likelihood of high false-positive diagnoses.

Sex-related differences in the distance of the mental foramen to the cementoenamel junction in adults: a study using cone beam computed tomography.

Injury to the contents of the mental foramen (MF) can be minimized by using cone beam computed tomography (CBCT) to determine the exact location of the MF prior to surgical procedures. In this retrospective study, variations in the vertical position of the MF between adult men and women older than 18 years were investigated using CBCT. The distance between the superior border of the MF and the most apical aspect of the cementoenamel junction (CEJ) of the mandibular second premolar was measured. Among the randomly accessed CBCT records of 200 patients, 176 MF-CEJ measurements met the inclusion criteria. There was a statistically significant difference (P < 0.001) between the sexes in the location of the MF. The distance in women was shorter by an average of 2.00 mm, irrespective of the side of the mandible. Additionally, a within-sex asymmetry between right and left sides was observed; the asymmetry was significantly greater in men than in women (P < 0.05). Clinicians should be cognizant of the influence of the patient's sex on the vertical position of the MF and the presence of asymmetry in the position of the MF between the right and left sides of the mandible within the sex groups.

A risk prediction model for xerostomia: a retrospective cohort study.

OBJECTIVE: We investigated the prevalence of xerostomia in dental patients and built a xerostomia risk prediction model by incorporating a wide range of risk factors. MATERIALS AND METHODS: Socio-demographic data, past medical history, self-reported dry mouth and related symptoms were collected retrospectively from January 2010 to September 2013 for all new dental patients. A logistic regression framework was used to build a risk prediction model for xerostomia. External validation was performed using an independent data set to test the prediction power. RESULTS: A total of 12 682 patients were included in this analysis (54.3%, females). Xerostomia was reported by 12.2% of patients. The proportion of people reporting xerostomia was higher among those who were taking more medications (OR = 1.11, 95% CI = 1.08-1.13) or recreational drug users (OR = 1.4, 95% CI = 1.1-1.9). Rheumatic diseases (OR = 2.17, 95% CI = 1.88-2.51), psychiatric diseases (OR = 2.34, 95% CI = 2.05-2.68), eating disorders (OR = 2.28, 95% CI = 1.55-3.36) and radiotherapy (OR = 2.00, 95% CI = 1.43-2.80) were good predictors of xerostomia. For the test model performance, the ROC-AUC was 0.816 and in the external validation sample, the ROC-AUC was 0.799. CONCLUSION: The xerostomia risk prediction model had high accuracy and discriminated between high- and low-risk individuals. Clinicians could use this model to identify the classes of medications and systemic diseases associated with xerostomia.

Central giant-cell granuloma in a patient with neurofibromatosis type 1: 7 years of follow-up.

Neurofibromatosis type 1 (NF1) is an autosomally dominant tumor suppressor syndrome and multisystem disease. Central giant-cell granulomas (CGCGs) can be seen in patients with NF1. A 21-year-old female was diagnosed with two CGCGs, one in the mandible and then one in the maxilla, in a 7-year period. Increased incidence of CGCGs in NF1 patients was thought to be caused by an underlying susceptibility to developing CGCG-like lesions in qualitatively abnormal bone, such as fibrous dysplasia. However, germline and somatic truncating second-hit mutations in the NF1 gene have been detected in NF1 patients with CGCGs, validating that they are NF1-associated lesions. Oral manifestations in patients with NF1 are very common. Knowledge of these manifestations and the genetic link between NF1 and CGCGs will enhance early detection and enable optimal patient care.

Trifurcated Mental Foramina: A Cone-Beam Computed Tomography Incidental Finding During the Implant Treatment Planning.

The mental foramen is a known skull anatomical structure located bilaterally on the mandible along the buccal cortical plate. It is located approximately between the roots of premolars in the anteroposterior dimension, and its supero-inferior level on the alveolar height varies in every individual. The position of the mental foramen is very crucial when surgical interventions are planned in the area. An accessory mental foramina can be very well detected in the three-dimensional (3D) imaging modality, especially in 3D volume rendering images. It can still be appreciated in two-dimensional (2D) imaging modalities such as a panoramic; however, at times it can be confused with periapical pathology, especially in cases where caries are present in the teeth. Three-dimensional imaging modality plays a critical role in identifying such anatomical variation, and hence, it is important to evaluate any surgical site in three dimensions prior to surgical intervention.

Maxillary Sinusitis Induced by Medication-Related Osteonecrosis of the Jaw.

The involvement of maxillary sinuses in patients taking bone-related medications has not been comprehensively considered in the literature, mostly dental. Considering the fact that paranasal sinuses are often captured in dental radiographs, it is incumbent upon dental practitioners to recognize abnormal presentations in the paranasal sinuses to ensure the appropriate management of medication-related osteonecrosis of the jaw (MRONJ). We present a case of a giant cell tumor (GCT) with atypical chronic sinusitis manifestation leading to MRONJ.

Patient shielding during dentomaxillofacial radiography: Recommendations from the American Academy of Oral and Maxillofacial Radiology.

BACKGROUND: The American Academy of Oral and Maxillofacial Radiology established an ad hoc committee to draft evidence-based recommendations and clinical guidance for the application of patient contact shielding during dentomaxillofacial imaging. TYPES OF STUDIES REVIEWED: The committee reviewed monographs and reports from radiation protection organizations and studies that reported radiation dose to gonads, breasts, and thyroid gland from dentomaxillofacial imaging. RESULTS: Considering the absence of radiation-induced heritable effects in humans and the negligible dose to the gonads and fetus from dentomaxillofacial imaging, the committee recommends discontinuing shielding of the gonads, pelvic structures, and fetuses during all dentomaxillofacial radiographic imaging procedures. On the basis of radiation doses from contemporaneous maxillofacial imaging, the committee considered that the risks from thyroid cancer are negligible and recommends that thyroid shielding not be used during intraoral, panoramic, cephalometric, and cone-beam computed tomographic imaging. PRACTICAL IMPLICATIONS: This position statement informs and educates the reader on evolving radiation protection practices and provides simple, unequivocal guidance to dental personnel to implement these guidelines. State and local authorities should be contacted to update regulations to reflect these recommendations.

Idiopathic lingual mandibular sequestration and its relationship to medication-related osteonecrosis of the jaws (MRONJ): mini review.

OBJECTIVE: Idiopathic lingual mandibular sequestration is an uncommon condition that affects the lingual aspect of the mandible and may result in a necrosis of the jaw that is clinically indistinguishable from medication-related osteonecrosis of the jaw. This condition, however, is not associated with the intake of antiresorptive medication and may not require the same safeguards for extended periods of time. The etiology of idiopathic lingual mandibular sequestration is still unknown although trauma has been shown to play an important role. METHOD AND MATERIALS: PubMed and the Cochrane Library were used to retrieve papers written in English through the years 1970 to 2021 using the key words "idiopathic osteonecrosis," "lingual sequestration," and "idiopathic jaw sequestration." In addition, clinical presentation of the lesion was included. RESULTS: Idiopathic lingual mandibular sequestration is a benign, mostly self-limiting condition distinct from medication- related osteonecrosis of the jaw. CONCLUSION: The dental clinician should be familiar with this condition and include it in their differential diagnosis when exposed bone is present with no history of radiation to the area or intake of antiresorptive medication. The course of the condition is usually very mild and may be self-limiting and usually does not require surgical intervention.

Imaging of Odontogenic Infections.

Odontogenic infections represent a common clinical problem in patients of all ages. The presence of teeth enables the direct spread of inflammatory products from dental caries, trauma, and/or periodontal disease into the maxilla and mandible. The radiographic changes seen depend on the type and duration of the inflammatory process and host body response. Imaging plays a central role in identifying the source of infection and the extent of the disease spread and in detecting any complications. Many different imaging modalities can be used. The radiographic features associated with acute and chronic inflammatory processes are discussed.

Multidetector Row Computed Tomography in Maxillofacial Imaging.

Multidetector row CT (MDCT) offers superior soft tissue characterization and is useful for diagnosis of odontogenic and nonodontogenic cysts and tumors, fibro-osseous lesions, inflammatory, malignancy, metastatic lesions, developmental abnormalities, and maxillofacial trauma. The rapid advances in MDCT technology, including perfusion CT, dual-energy CT, and texture analysis, will be an integrated anatomic and functional high-resolution scan, which will help in diagnosis of maxillofacial lesions and overall patient care.

Radiologic and pathologic characteristics of benign and malignant lesions of the mandible.

Mandibular lesions develop from both odontogenic and nonodontogenic origins and have varying degrees of destructive potential. Common benign cystic lesions include periapical (radicular) cysts, follicular (dentigerous) cysts, and odontogenic keratocysts. Benign solid tumors represent a broad spectrum of lesions such as ameloblastomas, odontomas, ossifying fibromas, and periapical cemental dysplasia. Malignant tumors that often involve the mandible include squamous cell carcinomas, osteosarcomas, and metastatic tumors. In addition, vascular lesions such as hemangiomas and arteriovenous malformations may develop, further expanding the differential diagnosis. Because mandibular lesions have a wide range of pathologic features but similar imaging appearances, familiarity with embryologic characteristics and secondary findings is crucial. Patient age at manifestation, prevalence, location within the mandible, cystic or solid appearance, border contour, and effect of the lesion on adjacent structures are all considerations in making the diagnosis. Despite this information, however, many lesions are impossible to differentiate without biopsy. In such cases, defining the degree of malignant potential is very helpful. Although imaging will not always provide a specific diagnosis, it should help narrow the differential diagnosis, thereby helping to guide patient treatment.

Benign Jaw Lesions.

There are both odontogenic and nonodontogenic benign lesions in the maxilla and mandible. These lesions may have similar imaging features, and the key radiographic features are presented to help the clinician narrow the differential diagnosis and plan patient treatment. Both intraoral and panoramic radiographs and advanced imaging features are useful in assessing the benign lesions of the jaws. The location, margins, internal contents, and effects of the lesions on adjacent structures are important features in diagnosing the lesions.

Proximity of the Mandibular Canal to Teeth and Cortical Bone.

INTRODUCTION: The proximity of the inferior alveolar canal to the mandibular molar roots may pose a risk of injury during various dental surgeries. The purpose of this study was to evaluate age-related and gender-related changes by using cone-beam computed tomography images between the roots of the second molars, mandibular cortex, and the inferior alveolar canal. METHODS: One hundred fifty-five patients (68 men, 87 women), 20 years and older, who had previous cone-beam computed tomography scans were enrolled in this study. The patients were subcategorized by gender and age (group I, <21 years; group II, 21-40 years; and group III, >40 years). Distance between the mandibular canal (MC) and the second molar distal root apex as well as the 3 mandibular cortical regions (inferior cortex, buccal cortex, and lingual cortex) were measured. RESULTS: In men, the second molar root apex to the MC distance was significantly shorter in group I than in group III (P < .01). In women, the second molar root apex to the MC distance was significantly shorter in group I than in group II and group III (P < .05). In both men and women, the buccal cortex of the mandible to the MC distance was significantly shorter on the right side compared with the left side (P < .01). CONCLUSIONS: Our study shows that age, gender, and region have an influence on the location of the MC in the second molar area.

Oral potentially malignant disorders in a large dental population.

OBJECTIVES: Oral cancer (OC) may be preceded by clinically evident oral potentially malignant disorders (OPMDs). Oral carcinogenesis is a multistep process that begins as epithelial hyperplasia and progresses to oral epithelial dysplasia and finally to fully malignant phenotypes. The aim of our study was to estimate the prevalence of OPMDs in a large population of dental patients. METHODS: Patients were seen in the Oral Diagnosis and Oral Medicine clinics at Boston University Henry M. Goldman School of Dental Medicine between July 2013 and February 2014 and received a comprehensive oral examination to identify any possible mucosal lesions. Patients with a suspected OPMD (submucous fibrosis, oral lichen planus, leukoplakia and erythroplakia) that did not resolve in 2-3 weeks received a biopsy for definitive diagnosis. Logistic regression models were used to explore the relationship between OPMDs and associated risk factors. RESULTS: A total of 3,142 patients received a comprehensive oral examination [median age: 43 (range: 18-97); 54.3% females]. Among these, 4.5% had an oral mucosal lesion with 0.9% being an OPMD (one submucous fibrosis, three epithelial dysplasias, fourteen with hyperkeratosis/epithelial hyperplasia and nine with oral lichen planus). Males and current smokers were associated with higher odds of having OPMD (OR 1.7, 95% CI 0.8-3.8; OR 1.9, 95% CI 0.8-4.1). Increasing age was associated with having OPMDs (p<0.01). CONCLUSION: Optimal oral visual screening for OC remains a simple and essential tool to identify any suspicious lesions and potentially increase survival. Although OPMDs were rare, our results confirm the importance of a thorough chairside screening by dentists and dental students to detect any mucosal changes.